After dual plating with a locking compression plate for comminuted intraarticular fractures of the distal humerus, the incidence of ulnar nerve injury after surgery has been reported to be up to 38%. This can be reduced by an anterior transposition of the ulnar nerve but some surgeons believe that extensive handling of the nerve with transposition can increase the risk of an ulnar nerve dysfunction. This paper reports ulnar nerve injuries caused by the incomplete insertion of a screw head in dual plating without an anterior ulnar nerve transposition for AO/OTA type C2 distal humerus fractures. When an anatomical locking plate is applied to a distal humeral fracture, locking screws around the ulnar nerve should be inserted fully without protrusion of the screw because an incompletely inserted screw can cause irritation or injury to the ulnar nerve because the screw head in the locking system usually has a slightly sharp edge because screw head has threads. If the change in insertion angle and resulting protruded head of the screw are unavoidable for firm fixation of fracture, the anterior transposition of the ulnar nerve is recommended over a soft tissue shield.
Head* ; Humeral Fractures ; Humerus* ; Incidence ; Intra-Articular Fractures ; Surgeons ; Ulnar Nerve*

No abstract available.
Bone Substitutes* ; Polyethylene*

Pseudohypoparathyroidism is a medical disorder characterized by a complex disorder of renal resistance to parathyroid hormone and the mechanism underlying the disease is still unclear. The authors described two cases of pseudohypoparathyroidism in sibling,who had metabolic anomalies(hypocalcemia and hyperphosphatemia, high circulatin immunoreactive PTH)and basal ganglia calcification. Bilateral basal ganglia calcifications, which was not visible on plain skull film, was detected by CT scan of brain MRI. We report these cases with a review of related literatures.
Basal Ganglia ; Brain ; Humans ; Hyperphosphatemia ; Magnetic Resonance Imaging ; Parathyroid Hormone ; Pseudohypoparathyroidism* ; Siblings* ; Skull ; Tomography, X-Ray Computed

Scrotal leiomyosarcoma arising from dartos layer not involving the testis, epididymis or spermatic cord is very rare tumor. We report a case of scrotal leiomyosarcoma in 29 year old man who present with right scrotal painless growing mass. The lesion had been for 3 months but there was no related symptom such as pain or tenderness. The excised lesion was 3 x 3cm sized ovoid mass with smooth surface and it had no relationship with the testis, epididymis and spermatic cord. Its pathologic finding was compatible with leiomyosarcoma. So additional radical orchiectomy was done.
Adult ; Epididymis ; Humans ; Leiomyosarcoma* ; Male ; Orchiectomy ; Scrotum* ; Spermatic Cord ; Testis

PURPOSE: To determine the upper limit of peripheral nerve lengthening without loss of function, the recovery time of peripheral nerve palsy due to nerve lengthening and their histological changes. MATERIALS AND METHODS: Twelve adult New Zealand rabbits weighing about 2.5 kg were assigned to the following groups. Group 1 (n=6) was subjected to slow tissue expansion with 30% of nerve lengthening while group 2 (n=6) was rapid expansion with 40% lengthening of nerve. The expanders were refilled every 2 times during the 2nd and 4th weeks making a total four times of expansion. The rabbits were assessed in terms of affected leg paralysis, neural length gain, EMG with nerve conduction velocity and histological changes. RESULTS: In group 1 (n=6), paralysis on affected leg was found in one rabbit and was recovered spontaneously on the 4th weeks after expander removal. In Group 2 (n=6), paralysis was found in four rabbits, and three of them were recovered on 4, 5 and 9 weeks after removal of the expander. EMG study showed increase in distal latency of 2.50+/- 0.20 m/sec, and decrease in nerve conduction velocity of 62.49+/- 5.30 m/sec compared to normal side with 1.89+/- 0.14 m/sec and 75.39+/- 7.82 m/sec. The mean neural length gain was 6 mm (30% of 20 mm of initial pre-experimental nerve length) in group 1 and 8 mm (40% of 20 mm) in group 2. Light microscopic examination revealed the loss of segmental myelination, decrease of myelination, and vacuolation. Electron microscopic examination showed that the normal ring shaped contour of axon was changed to convoluted shape.
Adult ; Axons ; Humans ; Leg ; Myelin Sheath ; Nerve Expansion ; Neural Conduction ; Paralysis ; Peripheral Nerves ; Rabbits ; Sciatic Nerve* ; Tissue Expansion*

BACKGROUND: Medical interviewing skills are now recognized as the most important skill to be acquired for the purpose of accurate diagnosis and treatment. Among the several evaluation methods of interviewing skills, audiovisual method has the merit of allowing the fellow residents to have discussion about the interview and of receiving feedback from the teaching faculty by replaying the real interview. In addition, it allows the resident to evaluate his or her interviewing skills, The purpose of this study is to evaluate the reliability and the validity of family residents' self-interviewing skill evaluation protocol. METHODS: A modified arizona interview rating scale which is an interviewing skill evaluating protocol has been used after Korean version became available. Six interviews with outpatients were recorded and evaluated respectively by 10 residents. The results were compared with that of Golden Standard to assess its validity. Finally, 10 residents were divided into two groups and the results among the groups were compared to evaluate the reliability of the scale. RESULTS: The evaluation of interviewing skills conducted by the residents showed significant rate of correspondence with the Golden Standard(kappa=.22), and in the comparison of 17 evaluation items, there appeared significant correspondence in 7 items. The analysis of the rate of correspondence between the two group of residents revealed significant rate of correspondence (kappa=0.43). Lastly, the comparisons between the items showed significant rate of correspondence in ll items CONCLUSIONS: The residents' self interviewing skill evaluation protocol showed significant validity and reliability from which it may be concluded that the protocol can be used as an effective evaluating method.
Arizona ; Diagnosis ; Diagnostic Self Evaluation ; Humans ; Outpatients ; Reproducibility of Results*

After dual plating with a locking compression plate for comminuted intraarticular fractures of the distal humerus, the incidence of ulnar nerve injury after surgery has been reported to be up to 38%. This can be reduced by an anterior transposition of the ulnar nerve but some surgeons believe that extensive handling of the nerve with transposition can increase the risk of an ulnar nerve dysfunction. This paper reports ulnar nerve injuries caused by the incomplete insertion of a screw head in dual plating without an anterior ulnar nerve transposition for AO/OTA type C2 distal humerus fractures. When an anatomical locking plate is applied to a distal humeral fracture, locking screws around the ulnar nerve should be inserted fully without protrusion of the screw because an incompletely inserted screw can cause irritation or injury to the ulnar nerve because the screw head in the locking system usually has a slightly sharp edge because screw head has threads. If the change in insertion angle and resulting protruded head of the screw are unavoidable for firm fixation of fracture, the anterior transposition of the ulnar nerve is recommended over a soft tissue shield.
Head ; Humeral Fractures ; Humerus ; Incidence ; Intra-Articular Fractures ; Surgeons ; Ulnar Nerve

We report here on an uncommon case of peliosis hepatis with hemorrhagic necrosis that was complicated by massive intrahepatic bleeding and rupture, and treated by emergent right lobectomy. We demonstrate the imaging findings, with emphasis on the triphasic, contrast-enhanced multidetector CT findings, as well as reporting the clinical outcome in a case of peliosis hepatis with fatal hemorrhage.
Tomography, X-Ray Computed/*methods ; Rupture ; Peliosis Hepatis/complications/*radiography/surgery ; Necrosis ; Humans ; Hemorrhage/etiology/*radiography/surgery ; Female ; Adult

Brown adipose tissue is specialized to burn lipids for thermogenesis and energy expenditure. Second-generation antipsychotics (SGA) are the most commonly used drugs for schizophrenia with several advantages over first-line drugs, however, it can cause clinically-significant weight gain. To reveal the involvement of brown adipocytes in SGA-induced weight gain, we compared the effect of clozapine, quetiapine, and ziprasidone, SGA with different propensities to induce weight gain, on the differentiation and the expression of brown fat-specific markers, lipogenic genes and adipokines in a mouse brown preadipocyte cell line. On Oil Red-O staining, the differentiation was inhibited almost completely by clozapine (40 microM) and partially by quetiapine (30 microM). Clozapine significantly down-regulated the brown adipogenesis markers PRDM16, C/EBPbeta, PPARgamma2, UCP-1, PGC-1alpha, and Cidea in dose- and time-dependent manners, whereas quetiapine suppressed PRDM16, PPARgamma2, and UCP-1 much weakly than clozapine. Clozapine also significantly inhibited the mRNA expressions of lipogenic genes ACC, SCD1, GLUT4, aP2, and CD36 as well as adipokines such as resistin, leptin, and adiponectin. In contrast, quetiapine suppressed only resistin and leptin but not those of lipogenic genes and adiponectin. Ziprasidone (10 microM) did not alter the differentiation as well as the gene expression patterns. Our results suggest for the first time that the inhibition of brown adipogenesis may be a possible mechanism to explain weight gain induced by clozapine and quetiapine.
Adipocytes, Brown/drug effects ; Adipogenesis/drug effects ; Adipokines/metabolism ; Animals ; *Antipsychotic Agents/administration & dosage/adverse effects ; Cell Differentiation/drug effects ; Cell Line ; Cell Survival/drug effects ; *Clozapine/administration & dosage/adverse effects ; *Dibenzothiazepines/administration & dosage/adverse effects ; Gene Expression Regulation/drug effects ; Humans ; Mice ; *Piperazines/administration & dosage/adverse effects ; Schizophrenia/drug therapy ; *Thiazoles/administration & dosage/adverse effects ; Weight Gain/*drug effects

The callotasis is widely used in lengthening of bones without bone graft. We thought that the accompanying vessels is critical in the viability of distal tissue to the lengthened area and has an important effect on the bone-lenthening itself. So we made an assumption that the accompanying vessels is adapted to the lengthening via neogenesis more than simple physical stretching. At this, we placed a pair of small external fixator in the left tibiae of ten Spraugue-Dawley rats and made an osteotomies. At two weeks after 25% lengthening, vessels of both lengthened and unlengthened side was harvested and five sections from each vessels were stained with BrdU immunohistochemical staining. We investigated the DNA synthesis counting the number of BrdU labeled cells. The number of BrdU labeled cells is significantly increased in the lenthened side arteries(p<0.0001). The synthesis of DNA was significantly increased in the center rather than the ends (p<0.0001). And there was no difference between the number of the BrdU labeled cells of proximal part and that of distal parts(p=0.316). It means that the accompanying vessles in the distraction-lengthening are adapted to the lengthening not only by just physical stretching but also by neogenesis of vascular cells.
Animals ; Bromodeoxyuridine* ; DNA ; External Fixators ; Immunohistochemistry* ; Osteogenesis, Distraction* ; Osteotomy ; Rats ; Rats, Sprague-Dawley* ; Tibia* ; Transplants