Nail Lengthening using the Eponychial Flap / 대한정형외과학회잡지

PURPOSE: We wanted to introduce a nail lengthening technique with an eponychial flap for treating finger tip amputation, and we review the relevant literature. MATERIALS AND METHODS: Twenty-five patients who received eponychial flap surgery between November 2001 and April 2006 were enrolled in this study. Retrospectively, the patients were asked, by using a questionnaire, about their satisfaction with their nail shape and length. The preoperative findings and the findings at the last follow up and the contralateral finger nail lengths were measured with a ruler and those were all compared according to the percentage of change. RESULTS: The average operation time was fourteen minutes (range: 10 to 19 minutes). All the flaps survived and there was no infection, congestion of the flap, or additional deformity of nail. The average follow up period was five months. The nails were lengthened an average of 0.35 cm. The last follow up questionnaire showed that the patients were satisfied with their nail's appearance with an average score of 95.5 points. CONCLUSION: Nail lengthening using an eponychial flap is a convenient, safe and aestheticall pleasing procedure.

Expression of the Growth Factors Correlates with Metastasis of Chondrosarcoma and Its Malignancy / 대한정형외과학회잡지

PURPOSE: We expected that benign and malignant cartilagenous tumors may be distinguished, and that the growth factors may be correlated with oncologic outcomes according to their expression of growth factors. MATERIALS AND METHODS: Immunohistochemical study of some growth factors (bFGF, IGF, TGF-beta1, TGF-beta3) were performed upon paraffin-embedded tissues of 11 enchondroma and 25 chondrosarcoma patients who were treated surgically in our hospital. The Envision+system was used to performed the immunohistochemistry. RESULTS: bFGF was more highly expressed in the enchondroma group (p=0.04), and IGF-I was expressed more so in grade 3 chondrosarcoma than the other grades (p=0.012). The co-expressions of IGF-I and TGF-beta3 were remarkable in the chondrosarcoma group (p<0.001). Four metastases developed among the eleven patients of the TGF-beta3 expression group, and TGF-beta3 expression was found to correlate with distant metastasis in chondrosarcoma (p=0.026). Differences in recurrences or metastases according to the surgical margin between factor-expression group and factor-non-expression group were not significant in all growth factors. CONCLUSION: In chondrosarcoma, TGF-beta3 is closely related to metastasis. In addition, bFGF and IGF-I may be a guideline for the differentiation of benign and malignant cartilagenous tumors and of help when deciding the treatment plan.

Surgical Treatment of the Metastatic Tumors of the Femur / 대한정형외과학회잡지

Metastasis to bone with destruction of the skeletal system is a common problem in old patients with malignancy. Destruction of the musculoskeletal system poses major problems for the patients, including uncontrollable pain, forced immmobilization, pathologic fracture and hypercalcemia. The purpose of this study is to evaluate the effectiveness of surgical treatment and to suggest treatment guidelines for impending or established pathologic fractures due to metastasis of the femur. Between 1985 and 1995, thirty six patients who had pathologic or impending fractures in the femur underwent surgical treatment. The indications of surgery for pathologic fractures are 1) the possibility of survival time more than three months, 2) more benefits of sungical treatment than those of conservative treatment, 3) the possibility of rigid internal fixation, 4) patient s general condition allowing surgery, and those in impending fractures are 1) cortical destruction more than 50% or lytic lesion more than 2.5cm. The method of surgery was excision of the tumor and rigid internal fixation to allow early ambulation with or without bone cement augmentation. The results were analyzed by three criteria, the performance status, pain relief and survival time. Pain relief more than Lots was achieved in 80.6% of patients according to the Kaiko's criteria. The performance status improved more than one grade in all patients except one who died of acute respiratory failure and the mean improvement was 1.8 grade by the Functional Classification of the New York Heart Association. Postoperatively, most of the patients had only slight to moderate limitation of physical activities and felt comfortable at rest and ordinary activities. The survival time was 20.9 months in patients with single metastasis and 10.2 months in patients with multiple metastases. But there was no statistical significance due to large deviation of survival time in each case. In summary, surgical stabilization of the pathologic lesion involving the femur provided definite improvement of quality of life including pain relief and early ambulation. In selected patients with single metastasis, low grade malignancy, or good performance status, postoperative survival time may be expected to be prolonged. More aggressive treatment for the metastatic lesion of the femur is suggested.

The Relative Incidence of Congenital anomalies of the Hand / 대한정형외과학회잡지

There has been a few articles dealing with the incidence of congenital anomalies of the hand in Korea. In this paper, we have analyzed patients who have visited the hand clinic of Seoul National University Children s Hospital from March 1993 to February 1995 to study the relative incidence of congenital anomalies of the hand. We regarded more than two visits of the same patients as one. They were categorized into two groups by our classification system. First group consisted of the patients who showed hand anomaly only. The other group consisted of the patients who had anomalies in the other sites as well as in the hand. The first group was divided into two subgroups; the patients who had single entity of hand anomaly, and those who had more than two entities of hand anomalies. From the clinical analysis based on above criteria, following results were obtained. There were 626 anomalies in 547 patients, 319 (58.3%) males and 228 (41.7%) females (1.4: 1). Unilateral involvements of hand anomaly were noted in 385 (70.3%) patients (229 in right, 156 in left) and bilateral in 162 (29.7%). As a whole, the most common anomaly was trigger thumb (16.5%) and the second was polydactyly (16.1%). Other anomalies, in order of frequency, were syndactyly, camptodactyly, hypoplasia, brachydactyly, cleft hand and so on. In the first group who had hand anomaly only, there were 407 patients who had single entity of hand anomaly. Among these, trigger thumb were 25.3%, and polydactyly 16.2%. There were 68 patients who had multiple entities of anomalies. Among these, the syndactyly was the most common anomaly (23.9%) and the polydactyly was the next (16.2%). Fifty eight (10.6%) patients had anomalies in the hand as well as in the other site. Among these, camptodactyly was the most commonly found (36.5%) and polydactyly was the next common variety (19.0%) in the hand. In the anomalies which occurred in other than hand, arthrogryposis multiplex congenita was the most common (30.0%). Syndactyly of the foot (22.9%) and polydactyly of the foot (18.6%) were the next common anomalies.

Effects of Three Dimensional Corrective Osteotomy in Cubitus Varus of Adults / 대한정형외과학회잡지

Cubitus varus is a complex three-dimentsional deformity. In addition to deformity on varus-valgus plane, internal torsion of distal humerus is frequently combined. Also limitation of flexion-extension could be associated in some patients. Surgical correction of the cubitus varus after skeletal maturity, could have some different clinical course from those of growing children. However there have been few papers dealing with the surgical treatment of cubitus varus in adults. From May 1988 to December 1993, 23 patients who were older than 17 years of age, had correc- tive osteotomy for cubitus varus considering its three planes of the deformity at Seoul National University Hospital. To prevent serpentine deformity medial displacement of distal fragment was also combined during operation. The avereage age was 26 years(17-47), and the average follow-up after the operation was 1 year and 6 months(6 months-3 years). The presumed diagnosis of initial injury deduced from history and preoperative radiograms, was supracondylar fracture in 19 cases(86.4%). Others were lateral condylar fracture of humerus in two, and fractures associated with elbow dislocation in two. The average age at the time of initial injury was 8 years(2-14), and average delay from occurrence of deformity to the operation, were 13 years. Tardy ulnar nerve palsy was associated in 3 cases(13.6%). The preoperative average angle of cubitus varus was 26 degrees(16-45), flexion contracture 11 degrees(-5

A Clinical Study on the Fellow Eyes in Unilateral Retinal Detahment

The vitreous and fundus changes in the fellow eyes of 121 patients with unilateral retinal detachment were evaluated ophthalmoscopically. Fourteen cases with traumatic retinald etachment were included in this study. We studied the relationship between the posterior vitreous detachment, lattice degeneration, retinal holes, myopia and retinal detachment to be of any help in prevention of progression of retinal detachment. Retinal breaks were found in 11.6% and lattice degeneration in 21.5% of fellow eyes. The frequency of retinal breaks and lattice degeneration in fellow eyes were greater than that of retinal breaks and lattice degeneration in normal eyes. Retinal breaks and lattice degeneration were found most frequently in the superior temporal quadrant followed by the inferior temporal quadrant. Posterior vitreous detachment(PVD) was found in 33.9% of fellow eyes. Of the 41 eyes with PVD, 22 eyes had retinal breaks and lattice degeneration and 19 eyes had no retinal breaks and lattice degeneration. The proportion of myopia was 54.5% and that of high myopia over -8.0D was 16.5%. The proportion of myopia and high myopia were higher in the fellow eye of patients with unilateral retinal detachment than in general population. In myopic eyes, the incidence of retinal holes, lattice degeneration, and PVD were greater than that of retinal tear.

A Case of Pilomatricoma of the Upper Eyelid

The pilomatricoma is rare benign tumor of the hair follicle. It occurs as a solitary tumor usually on the face and upper extremities of children and young adults. It involves the periorbital region, the upper eyelids and the brow are involved most frequently. It appears as a firm, deep-seated subcutaneous nodule that is covered by normal or pink skin. It is not hereditary, there are a few instances of familial occurrence. The authors experienced a case of pilomatricoma of the right upper eyelid in a 20-year-old male and present with the review of literature.

A Case of Pilomatricoma of the Upper Eyelid

The pilomatricoma is rare benign tumor of the hair follicle. It occurs as a solitary tumor usually on the face and upper extremities of children and young adults. It involves the periorbital region, the upper eyelids and the brow are involved most frequently. It appears as a firm, deep-seated subcutaneous nodule that is covered by normal or pink skin. It is not hereditary, there are a few instances of familial occurrence. The authors experienced a case of pilomatricoma of the right upper eyelid in a 20-year-old male and present with the review of literature.

Two Cases of Congenital Fibrosis of the Extraocular Muleles

Congenital fibrosis of the extraocular muscle is characterized by the replacement of normal contractile muscles by fibrous tissue in varying degrees. Therefore, the clinical manifestation is dependent upon the degree of fibrous involvement. Brown reported 3 cases of the severe form of congenital fibrosis under the title of "General fibrosis syndrome". It has been known that the inferior rectus muscles are usually most prone to maximal involvement, which causes the eye to assume a hypotropic position with a chin elevation. We experienced two cases of congenital fibrosis of the extraocular muscles; one was a mild form with monocular involvement, and the other was a severe form with absence of all extraocular movement in the both eyes. In the latter, the histopathological examination of the excised tissue by light microscopy revealed that the inferior rectus muscle had a partly degeneration of some muscle fibers, as well as connective tissue proliferation. The lateral rectus muscle was replaced by fibrous tissue and fat cell. We discussed the clinical and histopathological features in the congenital fibrosis of the extraocular muscles.

Two Cases of Tuberous Sclerosis

Retinal hamartomas are usually found in more than half of patients with ocular involvement of tuberous sclerosis. Morphologically, the retinal hamartomas have been divided into three types: type 1, the relatively flat, soft-appearing, and semitransparent lesions; type 2, elevated, nodular, and solid-appearing masses; and type 3, a combination of the two. In some instances, fundus contains a number of midpripheral depigmented lesions that appeared to be punched-out. The authors experienced two cases of tuberous sclerosis which consist of retinal hamartomas, skin lesions, and seizure. The first case was a 22-year-old man with all 3 types of retinal hamartomas and one punched-out lesion. The second case was a 19-year-old female with type 1 retinal hamartomas in both eyes. Retinal hamartomas showed varying degrees of diffuse fluorescein leakage according to the types from the capillaries within the tumors.

Two Cases of Tuberous Sclerosis

Retinal hamartomas are usually found in more than half of patients with ocular involvement of tuberous sclerosis. Morphologically, the retinal hamartomas have been divided into three types: type 1, the relatively flat, soft-appearing, and semitransparent lesions; type 2, elevated, nodular, and solid-appearing masses; and type 3, a combination of the two. In some instances, fundus contains a number of midpripheral depigmented lesions that appeared to be punched-out. The authors experienced two cases of tuberous sclerosis which consist of retinal hamartomas, skin lesions, and seizure. The first case was a 22-year-old man with all 3 types of retinal hamartomas and one punched-out lesion. The second case was a 19-year-old female with type 1 retinal hamartomas in both eyes. Retinal hamartomas showed varying degrees of diffuse fluorescein leakage according to the types from the capillaries within the tumors.