A survey of the literature on the treatment of ruptures of deltoid ligament associated with fracture of distal part of fibula is controversial. Some authors advocated surgical repair of the ruptured deltoid ligament based on the theoretical consideration, while others advocated non-operative treatment based on the clinical consideration. We studied the results in forty-five patients who were treated for disruption of the deltoid ligament and a distal fibular fracture. The length of follow-up in our series was twelve to twenty-four months, with an average of fifteen months. When the fibular fracture was adequately reduced and medial clear space was returned to its normal width, the 91 percents both of patients of being treated with repair of deltoid ligament and patients of being treated without repair had a good or excellent results.
Clinical Study ; Fibula ; Follow-Up Studies ; Humans ; Ligaments ; Rupture

PURPOSE: The prognostic factors in acute lymphoblastic leukemia was patient's age at diagnosis, sex, hepatosplenomegaly, initial WBC & platelet count. Recently immunophenotype has being studied as guidance for several treatment protocol. We performed a retrospective study to evaluate the significance of immunophenotype on clinical course & long-term survival in children with acute lymphoblastic leukemia. METHODS: One hundred two children with acute lymphoblastic leukemia were admitted to the Department of Pediatrics, Yonsei University College of Medicine from Jan.1991 to Dec. 1995, and bone marrow aspiration biopsies and immunophenotyping were performed. The prognostic significance of immunophenotype was evaluated base on the median event free survival and probability of survival at the end of follow-up. RESULTS: 1) In 102 children comprised 14 cases under 2 years old, 71 cases from 2 to 10 years of age and 17 cases above 10 year old. The ratio of male to female was 6 : 4. 2) By CCG risk grouping, standard risk in 21 cases, intermediate risk in 35 cases, high risk in 46 cases. 3) By cytologic classification of FAB, Ll in 65 cases, L2 in 31 cases, L3 in 2 cases 4) Remission induction rate in early pre-B ALL was 100% (39/39), among those recurrence rate 20% (8/39). 5) Remission induction rate in pre-B ALL was 90% (26/29), among those recurrence rate 54% (14/26). 6) Remission induction rate in B-cell ALL was 33%(113), and all cases was expired during follow-up. 7) Remission induction rate in T-cell ALL was 100% (12/12)), among those recurrence rate 41% (5/12). 8) Remission induction rate in T-B mixed ALL was 71%(517), among those recurrence rate 0% (0/5), but non-remission cases was expired during follow-up. 9) Remission induction rate in Myeloid Ag(+) ALL was 83%(516), among those recurrence rate 80% (415). CONCLUSIONS: These results suggest that better result on long-term survival was observed in early pre-B ALL than in T-cell, 7-B mixed, or Myeloid antigen positive ALL and immunophenotype have prognostic impact in acute Iymphoblastic leukemia.
B-Lymphocytes ; Biopsy, Needle ; Bone Marrow ; Child* ; Child, Preschool ; Classification ; Clinical Protocols ; Diagnosis ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Immunophenotyping ; Leukemia ; Male ; Pediatrics ; Platelet Count ; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Prognosis ; Recurrence ; Remission Induction ; Retrospective Studies ; T-Lymphocytes

PURPOSE: The purpose of this report is to evaluate the measured values of normal Korean calcaneus by conduct of a cadaveric study. MATERIALS AND METHODS: A total of 42 calcanei were obtained from Korean cadavers. A digital goniometer was used for measurement of Bohler's angle, Gissane angle, posterior facet articular inclination angle, and Fowler-Philip angle of calcaneus. A vernier caliper was used for measurement of the maximal antero-posterior length, maximal transverse width, and maximal height of calcaneus. RESULTS: The average Bohler's angle, Gissane angle, posterior facet articular inclination angle, and Fowler-Philip angle was 32.3degrees+/-5.0degrees, 114.4degrees+/-8.2degrees, 61.2degrees+/-4.4degrees, and 60.3degrees+/-7.6degrees. The average maximal antero-posterior length, maximal transverse width, and maximal height of calcaneus was 74.2+/-3.0 mm, 43.0+/-4.0 mm, and 42.5+/-3.0 mm. CONCLUSION: The measured values of normal Korean calcaneus were lower than the values reported in the international literature. Therefore, development of appropriate instruments reflecting the anatomical characteristics of Koreans will be needed.
Cadaver* ; Calcaneus*

PURPOSE: In this study, we evaluated the thickness of each retinal layer using spectral-domain optical coherence tomography (OCT) and investigated the correlation between the thickness of each retinal layer and postoperative visual acuity in eyes with idiopathic epiretinal membrane (ERM). METHODS: This retrospective study included 46 eyes from 46 patients with idiopathic ERM who underwent pars plana vitrectomy. Each retinal layer thickness was measured by spectral-domain OCT before operation and at 1, 3, and 6 months after operation. The thickness of each retinal layer was evaluated in the control group before the operation. We performed an analysis of the changes in thickness of each retinal layer at 6 months after operation and then investigated the correlation between the retinal layer thickness and visual improvement. RESULTS: Preoperatively, the thickness of the retinal nerve fiber layer (RNFL) in the ERM group showed more increased compared with that in the control group, and the thickness of photoreceptors and retinal pigment epithelium were decreased compared to those in the control group. At 6 months after the operation, thickness changes were reduced at the RNFL, ganglion cell layer (GCL), inner plexiform layer (IPL), GCL-IPL complex, and outer plexiform layer, while the photoreceptor layer increased compared with the values preoperatively. Differences in the preoperative thickness of GCL between the two groups had a significant correlation with postoperative visual acuity (r = 0.477, p = 0.008). CONCLUSIONS: Differences in preoperative thickness of the GCL between the two groups had a significant correlation with postoperative visual acuity. The greater was the thickness of the GCL, the worse was the visual outcome.
Epiretinal Membrane* ; Ganglion Cysts ; Humans ; Nerve Fibers ; Retinal Pigment Epithelium ; Retinaldehyde* ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity* ; Vitrectomy*

OBJECTIVE: Results from various methodological modalities indicate laterality of brain function and information processing abnormalities in patients with schizophrenia. In neurophysiological field, there is particular interest in the P300 component of event related potentials, being recorded during discriminative information processing. A wide literatures documented reduction of P300 amplitudes in schizophrenic patients. The present study was designed to investigate the topographic pattern of amplitudes of P300 in the patients with schizophrenia. METHOD: The subjects were composed of patients (N=20) with schizophrenia by DSM-VI and normal controls (N=20). The Auditory event related potential P300 were measured by "oddball paradigm", which known as a standard method. P300 latency was determined by Global Field Power and amplitudes measured on 5 electrodes (Fz, Cz, Pz, T3, T4) were compared between controls and patients. RESULTS: There were reduction of P300 amplitudes on all 5 cortical areas in patients with schizophrenia compared with normal controls. There is no anterior to posterior effect but also left to right effect in the both groups. CONCLUSION: P300 amplitudes reduction without localization were founded in patients with schizophrenia.
Automatic Data Processing ; Brain ; Electrodes ; Event-Related Potentials, P300 ; Evoked Potentials* ; Humans ; Schizophrenia*

PURPOSE: Previous lumbar spinal surgery (PLSS) is not currently considered as a contraindication for regional anesthesia. However, there are still problems that make spinal anesthesia more difficult with a possibility of worsening the patient's back pain. Spinal anesthesia using combined spinal-epidural anesthesia (CSEA) in elderly patients with or without PLSS was investigated and the anesthetic characteristics, success rates, and possible complications were evaluated. MATERIALS AND METHODS: Fifty patients without PLSS (Control group) and 45 patients with PLSS (PLSS group) who were scheduled for total knee arthroplasty were studied prospectively. A CSEA was performed with patients in the left lateral position, and 10 mg of 0.5% isobaric tetracaine was injected through a 27 G spinal needle. An epidural catheter was then inserted for patient controlled analgesia. Successful spinal anesthesia was defined as adequate sensory block level more than T12. The number of skin punctures and the onset time were recorded, and maximal sensory block level (MSBL), time to 2-segment regression, success rate and complications were observed. RESULTS: The success rate of CSEA in Control group and PLSS group was 98.0%, and 93.3%, respectively. The median MSBL in PLSS group was higher than Control group [T4 (T2-L1) vs. T6 (T3-T12)] (p < 0.001). There was a significant difference in the number of patients who required ephedrine for the treatment of hypotension in PLSS group (p = 0.028). CONCLUSION: The success rate of CSEA in patients with PLSS was 93.3%, and patients experienced no significant neurological complications. The MSBL can be higher in PLSS group than Control group.
Aged ; Anesthesia, Spinal/*methods ; Female ; Humans ; Lumbar Vertebrae/*surgery ; Male ; Middle Aged ; Prospective Studies ; Tetracaine/*administration & dosage

PURPOSE: To report a case of noninfectious endophthalmitis after intravitreal injection of aflibercept. CASE SUMMARY: A 67-year-old male patient presented with sudden vision loss 2 days after intravitreal aflibercept injection for neovascular age-related macular degeneration. Mild conjunctival injection and moderate inflammation in the anterior chamber were noted, but he had no ocular pain or hypopyon. The patient was diagnosed with noninfectious endophthalmitis and successfully treated with topical antibiotics and topical steroid eye drops. The infection was apparently cleared at 3 days. At 10 days after the initial presentation, his vision loss resolved completely. CONCLUSIONS: Noninfectious endophthalmitis after intravitreal injection of aflibercept can be treated with topical steroids.
Aged ; Anterior Chamber ; Anti-Bacterial Agents ; Endophthalmitis* ; Humans ; Inflammation ; Intravitreal Injections* ; Macular Degeneration ; Male ; Ophthalmic Solutions ; Steroids

The hypothesis that primary branchiogenic carcinoma originates from a branchial cleft cyst is controversial since the entity was first described in 1882. In 1950, stringent criteria were established for the diagnosis of primary branchiogenic carcinoma, the most important criterion being histologic proof of carcinoma arising from a normal cyst epithelium. Only a limited number of cases have successfully fulfilled these criteria. In this article, we describe a case of squamous cell carcinoma arising in the second branchial cleft cyst and also discuss the diagnosis, histopathologic features, and therapeutic options.
Branchial Region* ; Branchioma* ; Carcinoma, Squamous Cell ; Diagnosis ; Epithelium

This study was performed in order to evaluate the usefulness of the crush cytologic features and differential diagnosis between meningiomas and schwannomas in the central nervous system. Deeply seated and unusually located meningiomas and schwannomas with equivocal or erroneous frozen section diagnosis can be correctly diagnosed cytologically in crush preparations. Twenty-four meningiomas and nine schwannomas were studied by frozen section and crush preparation technique. These tumors displayed distinctive cytologic features. In meningiomas, the tumor tissue fragments were easy to crush, and the tumor cells were arranged in small clusters, flat sheets, papilla-like, whorling pattern or singly. Individual tumor cells displayed round or oval nuclei with finely granular chromatin pattern and inconspicuous small nucleoli. Occasionally psammoma bodies, nuclear pseudoinclusion or nuclear grooves were found. In schwannomas, tissue fragments were hard in consistency and difficult to crush. The crushed tissue presented as thick, irregular fragments with sharp borders. The cells showed ill-defined cytoplasm and round, oval, cigar-shaped or curved nuclei. It is important to emphasize that the smear pattern under low-power view and cytologic features are helpful in discriminating between these two tumors.
Central Nervous System* ; Chromatin ; Cytoplasm ; Diagnosis ; Diagnosis, Differential* ; Frozen Sections ; Meningioma* ; Neurilemmoma*

Amyloidosis is characterized by a deposition of insoluble fibrils in various organs and tissues. Amyloid deposition, in the gastrointestinal track, provokes a dysfunction of the organ, due to an accumulation of fibrils, and causes a variety of clinical symptoms and endoscopic findings. Primary amyloidosis in the gastrointestinal tract is rarely reported in Korea. We experienced a case of recurrent intestinal bleeding, in a 59-year-old female patient with primary amyloidosis. A colonoscopy revealed the presence of multiple large circular ulcers. In the entire colon, diffuse nodular lesions with edema and bleeding were found. A colonoscopic biopsy established the diagnosis of amyloidosis, to the exclusion of other disease components. We concluded that the patient had localized amyloidosis. Though a definitive therapeutic strategy has not been established for localized gastrointestinal amyloidosis, the patient has been successfully treated with a high-dose of steroids and azathioprine.
6-Mercaptopurine/analogs & derivatives/therapeutic use ; Amyloidosis/*diagnosis/drug therapy/pathology ; Antimetabolites/therapeutic use ; Colon/pathology ; Colonoscopy ; Female ; Gastrointestinal Hemorrhage ; Humans ; Middle Aged ; Steroids/therapeutic use ; Tomography, X-Ray Computed