PURPOSE: The purpose of this study is to evaluate the effectiveness of low-dose gabapentin for interdigital neuroma. MATERIALS AND METHODS: Between April 2000 and June 2003, 32 patients (39 feet) with interdigital neuroma were treated with using low-dose gabapentin. Two of the 32 patients were male, and thirty were female, and the average age was 47.4 years. The follow-up was 6 to 44months (mean 15.1 months). All cases were diagnosed by physical examination and ultrasonography or MRI. Low-dose gabapentin (300-600 mg) was prescribed and shoe modification was recommended. The patients were evaluated through questionnaire. RESULTS: Neuroma was found in twenty one cases at the third intermetatarsal space, and thirteen at the second intermetatarsal space. The sensitivity of ultrasonography was 96% and that of MRI was 79%. Overall satisfaction was rated as excellent or good by 18 cases (57%). Average pain relief ratio was 50.3%, and in 14 cases, more than 80% of pain relief was noted. Nine (28%) of 32 patients showed they had no activity restrictions, such as daily activities or work, whereas 8 (25%) had mild restrictions and 15 (47%) had major restrictions. Twelve of 15 patient with major restrictions had been treated operatively (neurectomy; 10 cases, decompression; 2 cases). One case had gastrointestinal problem. CONCLUSION: Low-dose gabapentin for interdigital neuroma was one of the effective conservative treatments. The operation may be preserved for patient with the persist symptoms, nevertheless the conservative treatments and use of low-dose gabapentin.
Decompression ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Neuroma* ; Physical Examination ; Shoes ; Ultrasonography

PURPOSE: The result of cementless total knee arthroplasty with posterior cruciate ligament retention in rheumatoid arthritis patients was evaluated. MATERIALS AND METHODS: Thirty patients (fifty knees) followed up after cementless total knee arthroplasty with posterior cruciate ligament retention was evaluated clinically and radiologically. Average follow up was 9.2 years(5.1~14.3). RESULTS: The mean HSS knee score improved from 47.4 preoperatively to 81.8 postoperatively, and the mean range of motion of 89.7 degrees preoperatively to 101.2 degrees postoperatively. The mean tibiofemoral angle was 4.9 degrees valgus. Posterior instability was observed in 1 case(2%) at the most recent follow up. Radiolucent line was observed in 41 cases(82%), and osteolysis was observed around tibial component in 13 cases(26%), and around femoral component in 4 cases(8%). Eight cases(16%) of revision was due to 1 case of aseptic loosening and osteolysis each, and the other due to polyethylene wear of patellar or tibial component. CONCLUSION: Although there are osteopenia in rheumatoid arthritis compared to osteoarthritis, cementless total knee replacement with posterior cruciate retention showed stable fixation. However, the new method for initial fixation of tibial component is needed because osteolysis around tibial component tended to start around cancellous screws.
Arthritis, Rheumatoid* ; Arthroplasty* ; Arthroplasty, Replacement, Knee ; Bone Diseases, Metabolic ; Follow-Up Studies ; Humans ; Knee* ; Osteoarthritis ; Osteolysis ; Polyethylene ; Posterior Cruciate Ligament ; Range of Motion, Articular

Kienböck’s disease is an avascular necrosis of the lunate that can be accompanied by a lunate fracture. Although numerous studies on Kienböck’s disease have been conducted, its natural history is incompletely understood and there is no consensus for treatment. Various wrist arthroscopic surgeries have been attempted owing to the increasing interest in wrist minimal-invasive surgery. Traditionally, the Lichtman classification, based on the osseous status, is used widely to assess Kienböck’s disease. On the other hand, age, vascular condition, and cartilage status are also important when making a treatment plan for Kienböck’s disease. This article introduces a new classification and treatment algorithm combining osseous, vascular and cartilage classifications. Moreover, the roles and limitations of arthroscopy in this new algorithm are reviewed, and the author’s preferred treatment protocol based on staging is introduced.

Malignant laryngeal tumors include a variety of histologic types with different biologic features, each calling for a different therapeutic approach and giving rise to a different prognosis. We experienced a case of laryngeal adenosquamous carcinoma which is an extremely rare neoplasm in larynx. The lesion is histologically distinctive because of the presence of mixed areas of unequivocal adenocarcinoma and squamous cell carcinoma. Differential diagnosis include adenoid squamous cell carcinoma and mucoepidermoid carcinoma. It is found that combined surgery and additional radiation therapy is necessary because the biologic behavior and prognosis of this neoplasm are considered as more aggressive and worse than that of conventional squameus cell carcinoma.
Adenocarcinoma ; Adenoids ; Carcinoma, Adenosquamous* ; Carcinoma, Mucoepidermoid ; Carcinoma, Squamous Cell ; Diagnosis, Differential ; Larynx* ; Prognosis

PURPOSE: To evaluate the effectiveness of new management policies on the incidence of invasive Candida infections METHODS: This observational study involved a retrospective analysis of the patients' medical records. In total, 99 very low birth weight infants, who were admitted to the neonatal intensive care unit at Ajou University Hospital from January 2010 to December 2011, were enrolled for the study. Period I, defined as the period before the revision of management policies, comprised 57 infants; whereas, period II, defined as the period after the implementation of new management policies, comprised 42 infants. The new management policies entailed a reduction in antibiotic and histamine type 2 receptor blocker (H2 blocker) use, duration of central venous catheterization, and duration of endotracheal intubation. RESULTS: There was a significant overall decrease in the use of antibiotics including 3rd generation cephalosporin and H2 blockers (P<0.05), and a significantly lower incidence of invasive Candida infections in period II as compared to period I (0/42 vs. 6/57, respectively; P=0.037). Comparison between infants with invasive Candida infections (n=6) and those without (n=93) showed that gestational age (odds ratio [OR], 0.909; 95% confidence interval [CI], 0.829 to 0.996; P=0.042) and the duration of 3rd generation cephalosporin use (OR, 1.093; 95% CI, 1.009 to 1.183; P=0.029) were statistically significant risk factors. CONCLUSION: The new management policies effectively decreased overall use of antibiotics, especially 3rd generation cephalosporin, and H2 blockers, which led to a significantly lower incidence of invasive Candida infections.
Anti-Bacterial Agents ; Candida ; Candidiasis, Invasive ; Catheterization, Central Venous ; Central Venous Catheters ; Cross Infection ; Gestational Age ; Histamine ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Medical Records ; Retrospective Studies ; Sepsis

PURPOSE: We reviewed the results of cross finger flaps after surgical release and vigorous postoperative exercises for long-standing, severe flexion contractures of the Proximal Interphalangeal (PIP) joints of fingers. MATERIALS AND METHODS: In 9 patients, all contracted tissue was sequentially released and the resultant skin defect was covered with a cross-finger flap. The cause of the contracture was contact burn in 4, skin graft in 3, and a previous operation in 2. The mean follow-up period was 41.2 months. RESULTS: The mean flexion contracture/further flexion in the joints were improved from 73.4/87.8degrees to 8.4/95.4degrees at the last follow-up. A mean of 19.5degrees of extension was achieved with vigorous extension exercise after the operation. The mean gain in range of motion (ROM) was 79.4degrees. Near full ROM was achieved in 3 cases. There were no major complications. CONCLUSIONS: In severe flexion contractures with scarring of the PIP joints of fingers, cross finger flaps after sufficient release and vigorous postoperative exercise seems to be a reasonable option to obtain satisfactory ROM of the joints.

PURPOSE: There have been few reports about the endoscopic carpal tunnel release (ECTR) in elderly patients and its efficacy and safety are not well-known. We evaluated the clinical outcomes of ECTR using Agee technique in patients older than 65 years. MATERIALS AND METHODS: From October 2000 to January 2007, thirty-five patients (42 hands) who underwent ECTR using Agee technique were enrolled. The average age of the patients was 67.2 years (range, 65-71 years). The duration of symptoms averaged 10 months (range, 6-33 months). For evaluation of the clinical outcomes, physical examination and subjective assessment of the hand function using the Boston carpal tunnel questionnaire were performed at postoperative 1-year follow-up and compared with those obtained at preoperative evaluation. The mean follow-up period was 18 months (range, 12-24 months). RESULTS: There were no neurovascular injury and scar tenderness. At postoperative 1-year follow-up, paresthesia, numbness, Phalen's sign, tinel sign, two point discrimation, and grip power were significantly improved compared with those obtained at preoperation. According to the Boston questionnaire, symptom severity score improved from 3.43 preoperatively to 1.89 postoperatively, and functional status score improved from 3.18 preoperatively to 2.21 postoperatively (p<0.05). Thenar atrophy still remained in 32 hands (76.2%). CONCLUSION: Although thenar atrophy did not improve in many cases, symptom severity and functional status scores improved in most patients treated with ECTR. The single portal ECTR is a safe and efficacious treatment option in elderly patients with carpal tunnel syndrome.
Aged ; Atrophy ; Boston ; Carpal Tunnel Syndrome ; Cicatrix ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Hypesthesia ; Paresthesia ; Physical Examination ; Surveys and Questionnaires

PURPOSE: Calcific lesion of the hand is infrequently recognized, presenting with severe pain and swelling of the affected joint. The purpose of this study is to describe clinical features associated with this condition by reviewing surgically treated patients. MATERIALS AND METHODS: A retrospective study was carried out in 11 patients who had operation clinical and radiographic data were collected by medical records. RESULTS: Eight patients were females and three were males with age ranging between 27-75 years (mean: 48 years). By location, five cases of interphalangeal joint, three cases of metacarpophalangeal joint of thumb, two cases of carpal tunnel and one case of distal ulna area were noted. Interval between symptom presentation and operation was 9.4 month (range: 6-18 month). During 10 month follow-up (range: 6-12 month), recurrence had not occurred. CONCLUSION: Although the prevalence of calcific lesion of hand and wrist is low, it may cause severe pain and swelling. If conservative treatment fails or any nerve compression symptom develops, surgical removal of the calcific lesion is recommended.
Female ; Follow-Up Studies ; Hand ; Humans ; Joints ; Male ; Metacarpophalangeal Joint ; Prevalence ; Recurrence ; Retrospective Studies ; Thumb ; Ulna ; Wrist

PURPOSE: This study was designed to measure time-dependent changes in muscle excursion and collagen content after tenotomy, and to analyze the correlation between muscle excursion and collagen content in a rabbit model. MATERIALS AND METHODS: Twenty-four rabbits underwent tenotomy of the second extensor digitorum longus (EDL) muscles on the right legs and were randomly assigned to three groups based on the period of time after tenotomy (2, 4, and 6 weeks). The second EDL muscles on left legs were used as controls. At each time after tenotomy, passive muscle excursion and collagen content, determined by hydroxyproline content, were measured bilaterally, and the ratio of each value to the normal one was used. RESULTS: The mean ratio of muscle excursion after tenotomy to the value of the control decreased in a time-dependent fashion: 92.5% at 2 weeks, 78.6% at 4 weeks, and 55.1% at 6 weeks. The mean ratio of hydroxyproline content in muscle to the value of the control increased in a time-dependent fashion: 119.5% at 2 weeks, 157.3% at 4 weeks, and 166.6% at 6 weeks. There was a significant negative correlation between the ratio of hydroxyproline content in muscle after tenotomy to the control values and the ratio of muscle excursion after tenotomy to the control values (r=-0.602, p=0.002). CONCLUSION: The decrease in muscle excursion seems to correlate with the increase in collagen content in the muscle in a time-dependent fashion following tenotomy.
Animals ; Collagen/*metabolism ; Hydroxyproline/metabolism ; Muscle, Skeletal/*metabolism ; Rabbits ; Tendon Injuries/*metabolism ; Tendons ; Tenotomy ; Time Factors

This report describes a 6 year-old boy who was treated with one-bone forearm procedure for acquired pseudoarthrosis of the ulna combined with radial head dislocation after radical ulna debridement for osteomyelitis. At more than 20 years of follow-up, the patient had a nearly full range of elbow movements with a few additional surgical procedures. Pronation and supination was restricted by 45degrees, but the patient had near-normal elbow and hand functions without the restriction of any daily living activity. This case shows that one-bone forearm formation is a reasonable option for forearm stability in longstanding pseudoarthrosis of the ulna with radial head dislocation in a child.
Child ; Forearm/*pathology/*surgery ; Humans ; Male ; Pseudarthrosis/*pathology/*surgery ; Ulna/*pathology/*surgery