PURPOSE: To investigate the results of surgical treatment of the symptomatic accessory navicular in adolescent. MATERIALS AND METHODS: 11 patients who were 11~16 years old with symptomatic accessory navicular were identified between 2001 and 2009. Six cases were diagnosed after trauma and 8 cases were diagnosed by accident with painful bony protrusion on medial aspect of foot. In cases after at least 3 months of ineffective conservative treatment, patients were treated by resection of accessory navicular and reattachment of tibialis posterior tendon to the apex of the medial longitudinal arch using periosteum and ligamentous soft tissue without transposition of its course. And then short leg cast was applied for correction of the flat foot (if it is combined) which was molded into the longitudinal arch with the talonavicular joint released and foot inverted during about 6 weeks. RESULTS: All were type II accessory navicular without tibialis posterior tendon lesions. In most cases pain was improved, results were excellent in seven and good in four. Calcaneal pitch angle and talus-first metatarsal angle was improved about 4.64degrees and 5.79degrees in average. CONCLUSION: Symptomatic accessory navicular in adolescent might not be associated with the tibialis posterior tendon lesions. The surgical treatment composed of excision of the accessory navicular with simple replication of the tibialis posterior tendon without altering its course led to good results in most cases. The procedure has a low rate of complications. And it is easy to be performed with a good satisfaction.
Adolescent ; Flatfoot ; Foot ; Fungi ; Humans ; Joints ; Leg ; Ligaments ; Metatarsal Bones ; Periosteum ; Tendons

PURPOSE: To investigate the results of surgical treatment of the symptomatic accessory navicular in adolescent. MATERIALS AND METHODS: 11 patients who were 11~16 years old with symptomatic accessory navicular were identified between 2001 and 2009. Six cases were diagnosed after trauma and 8 cases were diagnosed by accident with painful bony protrusion on medial aspect of foot. In cases after at least 3 months of ineffective conservative treatment, patients were treated by resection of accessory navicular and reattachment of tibialis posterior tendon to the apex of the medial longitudinal arch using periosteum and ligamentous soft tissue without transposition of its course. And then short leg cast was applied for correction of the flat foot (if it is combined) which was molded into the longitudinal arch with the talonavicular joint released and foot inverted during about 6 weeks. RESULTS: All were type II accessory navicular without tibialis posterior tendon lesions. In most cases pain was improved, results were excellent in seven and good in four. Calcaneal pitch angle and talus-first metatarsal angle was improved about 4.64degrees and 5.79degrees in average. CONCLUSION: Symptomatic accessory navicular in adolescent might not be associated with the tibialis posterior tendon lesions. The surgical treatment composed of excision of the accessory navicular with simple replication of the tibialis posterior tendon without altering its course led to good results in most cases. The procedure has a low rate of complications. And it is easy to be performed with a good satisfaction.
Adolescent ; Flatfoot ; Foot ; Fungi ; Humans ; Joints ; Leg ; Ligaments ; Metatarsal Bones ; Periosteum ; Tendons

Hemodialysis (HD) patients continually exposed to heparin are at risk of developing heparin-induced thrombocytopenia (HIT). However, HIT is very rare in chronic HD patients with end-stage renal disease (ESRD). The authors report the case of a chronic HD patient with ESRD who developed HIT complicated by recurrent thrombocytopenia and significant bleeding episodes. A 67-year-old man with diabetic ESRD on chronic HD suddenly developed recurrent acute bleeding episodes and severe thrombocytopenia (platelet count <1.0x10(3)/uL) 2 months prior to presentation. These bleeding episodes and the thrombocytopenia always occurred 1 week after initiating HD with heparin, and improved within 1 week of discontinuing heparin. HIT was confirmed by ELISA for anti-heparin/platelet factor 4 antibody. HD was conducted successfully and thrombocytopenia did not occur after switching argatroban for heparin. This case report suggests that clinicians must consider HIT in the differential diagnosis of thrombocytopenia during maintenance HD.
Aged ; Diagnosis, Differential ; Enzyme-Linked Immunosorbent Assay ; Hemorrhage ; Heparin ; Humans ; Kidney Failure, Chronic ; Pipecolic Acids ; Renal Dialysis ; Thrombocytopenia

We describe here the case a patient with advanced cervix carcinoma and who developed idiopathic thrombocytopenic purpura (ITP). A 63-year-old woman with stage IV squamous cell carcinoma of the uterine cervix and that was complicated by hydronephrosis was treated palliatively with 45Gy of external beam radiation to the pelvis. About 3 years later, she developed hematochezia and severe thrombocytopenia. The laboratory examinations showed no evidence of thrombotic thrombocytopenic purpura or disseminated intravascular coagulopathy, and she was positive for serum anti-platelet antibodies. On the bone marrow examination, there was a normal number and morphology of megakaryocytes with no evidence of malignant cell infiltration. We made the clinical diagnosis of ITP, and the intravenous immunoglobulin and steroid therapy was successful. This case suggests the possibility that ITP can occur in association with advanced cervix carcinoma.
Antibodies ; Bone Marrow Examination ; Carcinoma, Squamous Cell ; Cervix Uteri ; Female ; Gastrointestinal Hemorrhage ; Humans ; Hydronephrosis ; Immunoglobulins ; Megakaryocytes ; Middle Aged ; Pelvis ; Purpura, Thrombocytopenic, Idiopathic ; Purpura, Thrombotic Thrombocytopenic ; Thrombocytopenia

The objective of this study was to investigate the effects of various occlusal loads on the stress distribution of the buccal cervical region of a normal maxillary second premolar, using a three dimensional finite element analysis (3D FEA). After 3D FE modeling of maxillary second premolar, a static load of 500N of three load cases was applied. Stress analysis was performed using ANSYS (Swanson Analysis Systems, Inc., Houston, USA). The maximum principal stresses and minimum principal stresses were sampled at thirteen nodal points in the buccal cervical enamel for each four horizontal planes, 1.0 mm above CEJ, 0.5 mm above CEJ, CEJ, 0.5 mm under CEJ. The results were as follows 1. The peak stress was seen at the cervical enamel surface of the mesiobuccal line angle area, asymmetrically. 2. The values of compressive stresses were within the range of the failure stress of enamel. But the values of tensile stresses exceeded the range of the failure stress of enamel. 3. The tensile stresses from the perpendicular load at the buccal incline of palatal cusp may be shown to be the primary etiological factors of the NCCLs.
Bicuspid ; Dental Enamel ; Finite Element Analysis ; Tooth Cervix

Tracheobronchial rupture is considered to be a life-threatening condition and most commonly occurs after blunt trauma to the neck or chest. However, single- and double-lumen endotracheal tubes can cause serious airway injury. The recognition of this complication and a knowledge of the possible contributory factors is critical, because failure to do so could result in lethal events. We report the case of a 63-year-old male patient who developed pneumomediastinum three days after routine orotracheal intubation.
Humans ; Intubation ; Intubation, Intratracheal* ; Male ; Mediastinal Emphysema* ; Middle Aged ; Neck ; Rupture ; Subcutaneous Emphysema ; Thorax

Multiple endocrine neoplasia type 1(MEN 1) is an autosomal dominantly inherited syndrome, characterized by the combined occurrence of tumors of the parathyroid glands, endocrine pancreas, and anterior pituitary gland. The MENIN gene, which is a kind of tumor suppressor gene, is located at the chromosomal locus 11q13. It consists of one untranslated exon and nine exons encoding the menin protein. We report a case of a 22-yearss-old woman with MEN type 1, who was proven to have a mutation in the MENIN gene. The patient was admitted because of repeated hypoglycemia. The fasting plasma glucose level was 32mg/dL. Seventy two hours fasting test showed an the insulin/glucose ratio as 0.33. Endoscopic ultrasonography detected multiple masses on the pancreas. The arterial -stimulated venous sampling(ASVS) with calcium showed sudden step up of insulin at the head and tail portions of the pancreas. The sellar MRI showed a pituitary mass that produced prolactin. Instead of a pathologic diagnosis from operational specimen, the genetic analysis revealed a mutation in the MENIN 1 gene(exon 2, 200~201insAGCCC).
Blood Glucose ; Calcium ; Diagnosis ; Endosonography ; Exons ; Fasting ; Female ; Genes, Tumor Suppressor ; Head ; Humans ; Hyperparathyroidism ; Hypoglycemia ; Insulin ; Insulinoma ; Islets of Langerhans ; Magnetic Resonance Imaging ; Male ; Multiple Endocrine Neoplasia Type 1* ; Multiple Endocrine Neoplasia* ; Pancreas ; Parathyroid Glands ; Pituitary Gland, Anterior ; Prolactin ; Prolactinoma

BACKGROUND: The aim of this study was to examine the association between the common polymorphisms of the adiponectin gene(ACDC) and the intima-media thickness(IMT) of the common carotid arteries in type 2 diabetic patients. METHODS: The B mode ultrasound examination of carotid artery was performed on 133 type 2 diabetic patients. The carotid IMT was calculated using the Intimascope computer program. The SNP45 and SNP276 of the ACDC were examined. RESULTS: There was no significant difference in the carotid IMT among the SNP45 genotypes(0.66+/-0.18mm for TT, 0.71+/-0.12mm for TG and 0.64+/-0.15mm for GG, P=NS). Subjects carrying the SNP276 GG genotype had a markedly lower serum adiponectin concentration than those carrying the TT genotype(3.35+/-2.00microgram/mL vs. 4.98+/-2.24microgram/mL, P=0.029) The carotid IMT was significantly higher in patients with the SNP276 GG genotype than those with the TT genotype (0.70+/-0.17mm vs. 0.59+/-0.13mm, P=0.032). Patients with the +45GG/+276GG genotype combination showed significantly higher mean carotid IMT than the other genotype combinations(0.78+/-0.09mm vs. 0.71+/-0.15mm, P=0.013) CONCLUSIONS: These results suggest that the adiponectin gene, SNP276 is associated with the carotid IMT in type 2 diabetic patients. Further studies are will be needed to confirm these genotypephenotype associations.
Adiponectin* ; Carotid Arteries* ; Carotid Artery, Common ; Genotype ; Humans ; Ultrasonography

The resistance to recombinant human erythropoietin (r-HuEPO) in patients with chronic renal failure can develop in conditions such as iron deficiency, chronic bleeding, or chronic inflammatory disease. Recently, there have been several case reports of pure red cell aplasia due to antibody production to r-HuEPO in chronic hemodialysis patients. A 59-year old female undergoing chronic hemodialysis responded well to r-HuEPO for 6 years. But, a rapidly progressive anemia was then noted which was unresponsive to maximal doses of r-HuEPO and the patient became transfusion-dependent. Bone marrow examination showed absence of red cell precursors. A detailed search for the cause of this pure red cell aplasia was unrevealing. We conclude that although very rare, pure red cell aplasia should be considered in evaluating chronic hemodialysis patients with erythropoietin-resistant anemia.
Anemia* ; Antibody Formation ; Bone Marrow Examination ; Erythropoietin ; Female ; Hemorrhage ; Humans ; Iron ; Kidney Failure, Chronic ; Middle Aged ; Red-Cell Aplasia, Pure* ; Renal Dialysis*

BACKGROUND/AIMS: Endoscopic biliary sphincterotomy (EST) has a very important role in the treatment of pancreatico-biliary diseases, but it has complications. We retrospectively investigated whether the types of electrosurgical currents affect occurence of complications. MEHTODS: In pancreatico-biliary diseases, consecutive 150 patients undergoing EST with pure cutting current (cutting group) and then consecutive 150 patient with blend current (blended group) were studied in respect to post-EST complications and the presence of periampullary diverticulum and papillitis in major papilla. Major bleeding was defined as a decrease in hemoglobin of at least 2 g/dL. Clinical pancreatitis was defined as abdominal pain with elevated serum amylase above three times about the upper normal limit after 48 hour. RESULTS: Major bleeding has not occurred. Minor bleeding occurred in 25/300 patients (8.3%), but was not different in cutting group (n=150) and blended group (n=150). Except 54 patients with elevated amylase before procedure, pancreatitis occurred in 13/246 patients (5.3%), but was not different in cutting group (n=122) and blended group (n=124). Two cases in blended group had moderate pancreatitis. There was no differences of bleeding, pancreatitis, in patients with diverticulum (n=112) and without diverticulum (n=188). Minor bleeding was more common in patients with papillitis (n=24) than without papillitis (n=276) (p=0.000), but the incidence of post EST pancreatitis was similar. In 235 patients with choledocholithiasis, there was no difference in terms of bleeding, pancreatitis in cutting group (n=120) and blended group (n=115). CONCLUSIONS: Post- EST bleeding and pancreatitis were not affected by the types of electrosurgical current used. When EST was performed in patient with papillitis, minor bleeding was observed commonly.
Abdominal Pain ; Amylases ; Choledocholithiasis ; Diverticulum ; Hemorrhage ; Humans ; Incidence ; Pancreatitis ; Papilledema ; Retrospective Studies ; Sphincterotomy, Endoscopic*