A Case of Ruptured Penile Epidermal Cyst

Epidermal cyst, a benign tumor, can occur after trauma and surgical interventions such as implanting epidermal keratinized squamous epithelial cells and sebaceous glands into the dermis and subcutaneous tissues. It can occur anywhere in the body. However, penile epidermal cysts are very rare. We present a case of a symptomatic penile mass of a 34-year-old male patient with a ruptured epidermal cyst.

A Case of Ruptured Penile Epidermal Cyst

Epidermal cyst, a benign tumor, can occur after trauma and surgical interventions such as implanting epidermal keratinized squamous epithelial cells and sebaceous glands into the dermis and subcutaneous tissues. It can occur anywhere in the body. However, penile epidermal cysts are very rare. We present a case of a symptomatic penile mass of a 34-year-old male patient with a ruptured epidermal cyst.

Hemospermia due to Multiple Stones in the Enlarged Prostatic Utricle

Cystic enlargement of prostatic utricle, a vestigial remnant of mullerian duct, is a rare condition in males. The prostatic utricle distends with urine during voiding and then passively drains. Poor emptying leads to urine retention and stasis. Stone formation may result from obstruction. Patients present clinically with chronic urinary tract infection, hematuria, urethral discharge, epididymitis, and voiding dysfunction. We present a case of multiple stones in the enlarged prostatic utricle associated with hemospermia.

Suprapubic Cystostomy: Risk Analysis of Possible Bowel Interposition Through the Percutaneous Tract by Computed Tomography

PURPOSE: The most serious complication of suprapubic cystostomy is bowel injury. By computed tomography (CT), we investigated the risk factors of possible bowel interposition through the percutaneous suprapubic cystostomy tract. MATERIALS AND METHODS: From September to October 2009, we consecutively reviewed 795 abdominopelvic CT scans of adult patients performed for various reasons in our hospital. From these scans, we selected the films wherein the urinary bladder was distended more than 6 cm above the symphysis pubis. We then determined whether the bowel was interposed between the bladder and the skin at the routine puncture site of suprapubic cystostomy (the midline of the abdomen 3 cm above the upper margin of the symphysis pubis). We analyzed which factors influenced the possibility of the bowel being interposed between the bladder and the skin at the suprapubic puncture site. RESULTS: A total of 226 CT (148 males, 78 females) scans were selected. The mean patient age was 63 years (range, 26-84 years). The mean distance between the upper margin of the symphysis pubis and the umbilicus was 14.4 cm (range, 7.2-21.0 cm). In the multivariate analysis, obesity, a positive history of radical pelvic surgery, and a short distance (< or =11 cm) between the symphysis pubis and the umbilicus had significant correlations with bowel interposition in the assumed tract. CONCLUSIONS: When performing a suprapubic cystostomy, extreme caution is needed to avoid possible bowel injury in patients who are obese, had a previous radical pelvic operation, or have a short distance between the upper margin of the symphysis pubis and the umbilicus.

Ovarian Cystadenoma Mistaken as Postvoid Residual Urine by Portable Ultrasound Scanning

Residual urine can be erroneously estimated due to cystic pelvic pathology by portable ultrasound scanning. We report a case involving a false-positive elevated postvoid residual urine result using a bladder ultrasound caused by an ovarian cystadenoma unrelated to the urinary tract.

Xanthogranulomatous Pyelonephritis with Spontaneous Nephrocutaneous Fistula / 대한비뇨기과학회지

Fistula formation between the upper urinary tract and cutaneous tissue is an uncommon complication in urogenital disease. Xanthogranulomatous pyelonephritis(XGP) is a severe, chronic infection of the renal parenchyma that is often associated with calculi and obstruction. We present a rare case of XGP with a nephrocutaneous fistula.

Effect of Glucosamine for Knee Osteoarthritis

PURPOSE: To assess the efficacy of glucosamine sulfate in the treatment of patients with knee osteoarthritis. MATERIALS AND METHODS: Using a double blind, randomized controlled trial design, patients with clinical and radiographic evidence of knee osteoarthritis were recruited into 3 groups, The glucosamine group of 43 patients was treated with glucosamine 550mg capsule and the placebo group of 27 patients with rice powder 250mg and lactose 250mg capsule, three times daily for 12 weeks. The NSAID group of 26 patients was treated with etodolac(lodine(R) 200mg capsule three times daily for 6 weeks. Clinical and radiographic change was evaluated by assessing the Lysholm knee score, pain score, passive range of knee motion, deformity of the knees, Kellgren-Lawrence radiographic scale and width of the tibio- femoral joint space in weight bearing radiography. RESULTS: In the glucosamine group, significant improvement was found in Lysholm knee score since 6 weeks of treatment and in pain score since 9 weeks compared with the placebo group, but not in radiographic indices. In the NSAID group, both Lysholm knee score and pain score were significantly improved than other groups since 3 weeks of treatment. In both glucosamine and NSAID groups, significant improvement was not found in passive range of motion and deformity of the knees. CONCLUSION: The effect of glucosamine was lower and slower than NSAlD in the treatment of the patients with knee osteoarthritis and improvement of Lysholm knee score was expected with long-term use of glucosamine over 6 weeks and pain-relief over 9 weeks.

A Radiological and Histological Study of Carbonate Apatite Collagen composite and Hydroxyapatite Implanted in Bone Defects of the Rabbit Tibiae / 대한정형외과학회잡지

Autograft is frequently used to restore anatomic morphology and functional properties in bone defects. Disadvantages of the autograft are related to donor site morbidity and include the risk of wound infection, increased blood loss, and additional postoperative discomfort. Allograft and xenograft, which are currently employed as the most common alternative to autografts, encounter the complications. such as fracture, resorption, and nonunion secondary to immunologic rejection. Hydroxyapatite(HAp), a calcium phosphate ceramic, is a well known biocompatible artificial bone substitute without induction of systemic toxic and foreign body reactions. Bone conduction is usually occurred by the implanted HAp. Biodegradation of HAp is poor and the bone formation around HAp is slow and about more than 70% of the natural apatite in bone is composed of carbonate apatite that has carbonic radical(CO3) instead of hydroxyl radical(OH-) or Phosphate radical(PO4 ) of HAp. Carbonate apatite ahs been known as that the physicochemical properties are similar of the natural bony apatite. In vivo experiment, carbonate apatite demonstrates non-toxic reactions. In this study, the compostite consisted of carbonate apatite and type I collagen, which is the bony structural protein, was implanted in rabbit tibiae to evaluate possibility as an artificial bone substitute. Biodegradation rate of the composite, the rate and qiantity of the regenerative cortical and cancellous bone formation were investigated radiologically and histopathologically. HAp and the carbonate apatite coilagen composite(Ap-C) were applied in the dissected rabbit tibiae(7-8mm), and fixed by external fixators. Postoperative roentgenograms were taken 2, 4, 6, and 8 weeks after implantations. For histological ohservations, the rabbits were sacrificed and the specimens were obtained 2, 4, 6, and 8 weeks after operation. Radiological Lane scores of Ap-C were 1.16±0.92, 2.16±0.98, 3.33± 0.82, and 3.67±0.51 in 2. 4, 6 and weeks after operation, while the Lane score of HAp were 0.53±0.84, 0.83±0.75, 1.67±0.81, and 2.83±0.98 respectively. Ap-C demonstrated the faster degradation and more bone formation then HAp. Though physicochemical properties of carbonate apatite is similar to those of HAp, the carbonate apatite and type I collagen composite(Ap-C) revealed rather faster degradation and bone formation than HAp in both radiological and histological investigations.

Experimental Study on the Effects of Suture and Limited Active Motion on Achilles Tendon Healing / 대한정형외과학회잡지

The injured tendon is thought to be healed by, extrinsic healing from tendon sheath and adjacent connective tissue, and intrinsic healing from epitenon and endotenon. About the factors influencing the healing of injured tendon, many authors reported the effects of mobilization, electricity, ultrasound and various druge. Especially, active or passive mobilization had been known to promote the healing process and to reduce adhesion. To investigate the influences of active limited mobilization, intrinsic and extrinsic healing process, right Achilles tendons of 30 New Zealand white rabbits were grouped according to the types of treatments (Group I; tenotomy of Achilles tendon only, Group II; Tenotomy and long leg cast, Group III; surgical repair after tenotomy and long leg cast). The tendon sheath was repaired in all the groups, and the left Achilles tendons were used as control. At six weeks after operation, the tendons were removed and analysed biomechanically using Instron 1000, and histologically. The following results were obtained: 1. There were significant decreased of break strength, in order of Group III, Group I and Group II(p < 0.05). But, no difference was found between control group and Group III. 2. Extension length to the rupture, was decreased significantly in the experimental groups than control group. But there was no difference among the experimental groups. 3. Histologically, dense proliferation of fibroblasts and hypertrophy of tendon was observed in Group I; and matured fibricytic tendon tissues in Group II and III. In Group II, the amount of matured tendon tissues and degree of maturity were less than in Group III. In summary, suture and active limited motion were considered as promoting factors on the tendon healing.

Tenolysis in the hand and wrist / 대한정형외과학회잡지

Adhesion around tendons of the hand and wrist and subsequent limitation of motion, is one of the major complications after tendon surgery. In addition to the tendon surgery such as tendon repair or graft, infection, open reduction of fracutres, and burn scar contracture could be the casuses of tendon adhesion. Tenolysis and adequate postoperative rehabilitation program, has been proved to be effective in preventing of adhesion, whatever the cause may be, if its continuity is maintained. In order to evaluate the efficiency and problems of tenolysis, we reviewed 37 fingers of 31 patients who had been treated by tenolysis at Seoul National University Hospital from 1981 to 1991. There were 20 men and 11 women, and the average age was 28.2 years(9-45 years). The causes of adhesion were various; 24 fingers(64%) after tendon repair or tendon graft, 3 fingers(8%) after infection, 4 fingers(10%) after treatment of fracture, 4 fingers(10%) after burn scar contracture, and the other 2 fingers(5%) after curettage of enchondroma. Involved tendon were flexor tendon in 28 fingers and extensor in 9. The average duration of follow-up was 17 months(13 months to 4 years). Active motion of involved finger was started within 2 days after operation. The Total Active Motion(TAM) after operation was average 213°(100°-260°), compared to 123°(40°-180°) before operation. According to Strickland formula which was modified by us, the postoperative results were excellent in 17 fingers, good in 9 fingers, fair in 6 fingers and poor in 5 fingers. In 24 cases who had tenolysis after repair or graft, 19 case(79%) were rated as excellent or good. But in 7 cases whose causes of adhesion were infection or burn scar contracture, only 3 cases(42%) were rated as excellent or good. Compairing the results between younger(less than 30 years of age) and older(more than 30 years of age) group, the younger group showed excellent and good in 8496 and the older group in 41%, The complications were tendon rupture in 3 fingers and minor infection in 2 fingers, respectively. In summary, tenolysis was considered as a useful procedure to improve function of tendon bound down in scar tissue. And the results were better in younger age group(p < 0.05) and in previous tendon repair or graft(p < 0.05) group.

Metatarsal lengthening by callotasis in brachymetatarsia / 대한정형외과학회잡지

No abstract available.