MR Imaging of Tibial Plateau Fractures: Evaluation of Fracture Types and Associated Soft Tissue Injuries

PURPOSE: To evaluate the usefulness of magnetic resonance imaging (MRI) for assessing fracture types and soft tissue injuries associated with tibial plateau fractures. MATERIALS AND METHODS: MRI was performed in 38 patients with tibial plateau fractures, each of which was classified according to the Schatzker system. We evaluated MR images and assessed the prevalence of each fracture type and accompanying soft tissue injuries. We also assessed whether ligamentous injury correlated with the extent of articular depression, splitting, and comminution. In 24 patients, diagnosis was based on MRI and operative or arthroscopic findings, and in 14 patients, on MRI alone. RESULTS: The totals of fracture types I, II, III, IV, V and VI were 4 (11 %), 15 (39 %), 6 (16 %), 4 (11 %), 4 (11%), and 5 cases (13 %), respectively. In 30 cases (79 %), there were associated ligamentous or meniscal injuries. Medial collateral ligaments and lateral menisci were injured in 17 (45 %) and 14 cases (37 %), respectively. Type II and IV fracture patterns were associated with soft tissue injuries in 14 of 15 cases (93 %) and 4 of 4 cases(100 %), respectively. As the extent of articular depression increased and the extent of bony comminution decreased, there was an increased prevalence of accompanying ligamentous injuries. CONCLUSION: In tibial plateau fractures, MR imaging is a useful diagnostic modality for the evaluation of both fracture type and accompanying ligamentous or meniscal injuries.

Radiologic Findings of Primary Epiploic Appendagitis: Focused on the Ultrasonographic Findings

PURPOSE: The purpose of this study was to analyze the radiologic findings of primary epiploic appendagitis, with particular attention to the correlation of ultrasonographic, clinical, CT, MR and surgical findings. MATERIALS AND METHODS: Among 14 patients with primary epiploic appendagitis who presented with the rapid onset of a very localized pain and tenderness, we performed ultrasonography in all, CT in eight, and MRI in four of these eight. Surgery was performed in two patients. Follow-up examinations were performed using US, CT and MRI (n=2), US and CT (n=2), US alone (n=2), and with regard to clinical features (n=12). RESULTS: US performed in 14 patients revealed the presence in all of small, well-defined, ovoid, noncompressible hyperechoic (n=12) or isoechoic (n=2) solid masses attached to the colonic wall, without bowel wall change and without communication with bowel lumen. CT performed in 8 patients showed varying hyperattenuating fatty lesions in the same location in the abdomen, without other inflammatory process. MRI findings of four patients were helpful for further evaluation of internal architecture. CONCLUSION: In primary epiploic appendagitis, US findings were sufficiently characteristic to allow accurate diagnosis and valuable for the differential diagnosis of other acute conditions of the abdomen.

Abnormal Uterine Bleeding Due to Vascular Abnormality Caused by D&E : Doppler Sonography for Diagnosis and Transcatheter Arterial Embolization for Treatment

PURPOSE: We attempted to evaluate the usefulness of Doppler sonography in the diagnosis of uterine vascular abnormality caused by previous D&E, and to report that transarterial embolization is an exceelent treatment modality. MATERIALS & METHODS: We analyzed gray-scale US, color/duplex Doppler US and angiographic findings inseven patients with radiologically proven uterine vascular abnormality. Two of the seven cases were pseudoaneurysms and five of the seven cases were AVMs. In one of the AVMs, two small pseudoaneurysms were combined. In all cases, transarterial embolizations using 3mm coil or/and gelfoam particles were performed. Follow-up US studies, including color Doppler US, were performed. RESULTS: On color/duplex Doppler sonography, two cases of pseudoaneurysm showed blood pools with turbulent arterial flow, and five cases of AVM showed asymmetrically increased vascularity, with variable high velocities composed of the pulsatie arterial flow, with ahigh diastoic component. On angiography, the former showed pseudoaneurysmal sacs, and the latter densely opacified vascular tangles. No more abnormal uterine bleeding was shown, following transarterial embolization in all cases. CONCLUSION: Color/duplex Doppler sonography was valuable in the diagnosis or treatment of abnormal uterine bleeding caused by uterine vascular abnormality such as acquired AVM or pseudoaneurysm.

A Case of Primary Mediastinal Germ Cell Tumor Associated with Klinefelter's Syndrome / 결핵

Klinefelter's syndrome is characterized by small testes, azoospermia, gynecomastia, and elevated levels of plasma gonadotropins in men with two or more X chromosomes. Previous investigators reported that patients with Klinefelter's syndrome are predisposed to the development of a non-seminomatous germ cell tumor in the mediastinum. It is suggested that this linkage may be due to the hormonal imbalance in Klinefelter's syndrome and consequently, the formation of dysgenetic germ cell and/or abnomal migration of germ cell. We report here a case of Klinefelter's syndrome in a 24-years-old man who was presented with anterior mediastinal mass. The clinical and laborarotory findings were compatible with Klinefelter's syndrome and he was found to have 47 XXY karyotype. Pathological findings for mediastinal mass revealed mixed germ cell tumor composed of mature cystic teratoma and endodermal sinus tumor. He was treated with cis-platin containing chemotherapy and followed up in partial remission.

Abdominal Ultrasonographic Findings of Salmonellosis

PURPOSE: We evaluated the abdominal uttrasonographic findings of Salmonellosis. MATERIALS AND METHODS: This study included 64 patients who were confirmed as salmonellosis by blood culture. We retrospectively analyzed the abdominal ultrasonographic findings with particular attention to enlarged mesenteric lymph nodes(mesenteric lymphadenitis), thickening of bowel wall, especially terminal ileum and cecum(ileocecitis), hepatosplenomegaly, ascites, gallbladder wall thickening, and enlarged lymph nodes in porta hepatis. RESULTS: The 64 cases were observed as mesenteric lymph node enlargement(44 cases), wall thickening of the terminal ileum and cecum(36 cases), hepatomegaly and/or splenomegaly(42 cases), minimal ascites(8 cases), gallbladder wall thickening(6 cases), and enlarged lymph nodes in porta hepatis(4 cases). No abnormal finding was seen in 10 patients. CONCLUSION: The mesenteric lymph node enlargement, wall thickening of the terminal ileum and cecum, hepatomegaly and/or splenomegaly, minimal ascites, gallbladder wall thickening, and enlarged lymph nodes in porta hepatis are suggestive findings of salmonellosis on abdominal ultrasonography in patients with fever and acute abdomen.

Clinical Observation of Interscalene Brachial Plexus Block / 대한마취과학회지

We performed the interscalene technic of brachial plexus block for an operation of the upper extremity in 94 patients. We used 1%, 1.5% or 2% lidocaine solution with or without 1:200,000 epinephrine. There were paresthesias in all cases of needle puncture with the interscalene approach. The resutls were as follows: 1) Onset of anesthesia was observed in 3~10 minutes(average: 5 min.) 2) Complete anesthesia was observed in 10~30 minutes(average: 18 min.) 3) The mean interval of anesthesia to operation was 22 minutes. 4) We observed satisfactory blocks in 81 cases, unsatisfactory block in 8 cases and failure in 5 cases. 5) There were not any complications such as pneumothorax, dyspnea, convulsions, subarachnoid or epidural injection, etc.

Clinical Study of Hydroxyzine as a Premedicant / 대한마취과학회지

Sedative and antiemetic effect of hydroxyzine as a premedicant were studied and results were compared with a placebo and Talwin. Two hundred and fourty patients were evaluated. These patients were divided into 6 groups. There were fourty patients in each group. Group 1: Hydroxyzine 50mg. Group 2: Hydroxyzine 100mg. Group 3: Placebo. Group 4: Talwin 20mg. Group 5: Hydroxyzine 5pmg plus Talwie 20mg. Group 6: Hydroxyzine 100mg plus Talwin 20mg. The results were as follows; 1) Satisfactory sedation was ovtained in 75% with group I, in 92.5% with group 2, in 30% with group 3, in 40% with group 4, in 82. 5% With group 5, and in 97. 5% with group 6. Better results were obtained with hydroxyzine plus Talwin group than hydroxyzine anly. 2) The incidence of postoperative nausea and vomiting in recovery room, 7. 5% wlth group 7. 5 % with group 3, 20% with group 4, 5%. with group 5. There was no case of nausea and vomiting in group 2 and group 6. We obtained a significant difference in antiemetic effect between Talwin only and the Talwin plus hydroxyzine group. 3) There was no adverse change on vital signs in all cases.

A Clinical Analysis of Anesthesia for the Repair of Cleft Lip and Cleft Palato / 대한마취과학회지

We experienced 450 cases of anesthesia for the operation of cleft lip and cleft palate. The observed results were as follows. 1) Anesthetics for the operation of cleft lip were 200 cases(44.4%), cleft palate were 248 cases(55.1%), naso-ocular fistula correction and oro-ocular correction was 1 case each. 2) Sex distribution was 298 males(66.2%) and 152 females(33.8%). 3) 292 cases(66%) were under 20kg of body weight. 4) The techniques of anesthesia were NRB with Jackson-Rees' modification in 297 cases (66%) and the semiclosed circle absorption system in 153 eases(34%). 5) The main anesthetics were halothane in 431 cases(95.8%) and Valium-Dmerol in 19 cases (0. 42%) 6) The mean blood loss in palatoplasty was 6.4 ml per kg of body weight but it was 10. 7 ml per kg in the 5~10 kg of body weight group, 9. 6 ml per kg in the 10-20 kg of body weight group, and 8. 5 ml per kg in the 20~30 kg of body weight group. 66 cases (14.7%) received blood transfusion. 7) Familial incidence was found in 4.7% (21 cases). 8) Incidence of cleft lip combined with cleft palate was 42.7%(192 cases among 450 cases), and 154 cases(51.7%) were males and 88 cases(25%) were females. 9) The most common type of cleft lip was incomplete left cleft lip(30%), and of cleft palate was complete median cleft palate(52%). 10) lntraoperative anesthetic complication occurred in 8 cases(1.8%).