Surgical Treatment of Macrodystrophia Lipomatosa Involving Superficial Peroneal Nerve in the Foot and Ankle / 대한정형외과학회잡지

Macrodystrophia lipomatosa is a congenital disease characterized by gradual proliferation in the mesenchymal cell, such as fibroadipose tissue. Pathologically, fatty tissue is deposited in the nerve sheath, periosteum, bone marrow, and subcutaneous tissue, contributing to the macrodactyly of the foot. To date, there has not been any report on macrodystrophia lipomatosa of the superficial peroneal nerve in the Korean orthopedic literature. Conservative approach, such as decompression or debulking surgery, is recommended due to neurogenic dysfunction. However, we report a 43-year-old male with macrodystrophia lipomatosa involving the superficial peroneal nerve of the right foot and ankle, who underwent a second toe ray amputation as well as soft tissue and nerve resection.

Triangular Fixation Technique for Bicolumn Restoration in Treatment of Distal Humerus Intercondylar Fracture

BACKGROUND: Distal humerus intercondylar fractures are intra-articular and comminuted fractures involving soft tissue injury. As distal humerus is triangle-shaped, parallel plating coupled with articular fixation would be suitable for bicolumn restoration in treatment of distal humerus intercondylar fracture. METHODS: This study included 38 patients (15 males and 23 females) who underwent olecranon osteotomy, open reduction and internal fixation with the triangle-shaped cannulated screw and parallel locking plates (triangular fixation technique). Functional results were assessed with the visual analog scale (VAS) scores, Mayo elbow performance (MEP) scores and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires. Anteroposterior and lateral elbow radiographs were assessed for reduction, alignment, fracture union, posttraumatic arthrosis, and heterotopic ossification, and computed tomography (CT) scans were used to obtain more accurate measurements of articular discrepancy. RESULTS: All fractures healed primarily with no loss of reduction. The mean VAS, MEP, and DASH scores of the affected elbow were not significantly different from those of the unaffected elbow (p = 0.140, p = 0.090, and p = 0.262, respectively). The mean degree of flexion was significantly lower in the affected elbow than in the unaffected elbow, but was still considered as functional (p = 0.001, > 100degrees in 33 of 38 patients). Two cases of articular step-offs (> 2 mm) were seen on follow-up CT scans, but not significantly higher in the affected elbow than in the unaffected elbow (p = 0.657). Binary logistic regression analysis revealed that only Association for Osteosynthesis (AO) type C3 fractures correlated with good/excellent functional outcome (p = 0.012). Complications occurred in 12 of the 38 patients, and the overall reoperation rate for complications was 10.5% (4 of 38 patients). CONCLUSIONS: Triangular fixation technique for bicolumn restoration was an effective and reliable method in treatment of distal humerus intercondylar fracture. This technique maintained articular congruency and restored both medial and lateral columns, resulting in good elbow function.

Acute Shortening and Delayed Lengthening in Management of Lower Leg Amputation: A Case Report

Acute bone shortening and delayed lengthening by Ilizarov surgery have been used to treat a wide range of soft tissue injuries including open fracture, osteomyelitis of the tibia and lower leg amputation. It has advantages such as bone lengthening as well as minimizing the loss of damaged tissues via tissue expansion. Here, we report a case of 52-year-old male with satisfactory results through acute bone shortening, replantation, and gradual bone lengthening after complete amputation of the ankle with related literature reviews.

Venous Thromboembolism and Superficial Femoral Artery Obstruction after Femur Intertrochanteric Fracture: A Case Report / 대한고관절학회지

As the elderly population increases, occurrence of hip fractures has shown a rapid increase, and posttraumatic and postoperative venous thromboembolism can lead to fatal complications. Current prophylactic management includes mechanical and chemical prophylaxis. A 76-year-oldfemale, who was lost to follow-up after diagnosis of pulmonary thromboembolism four years ago, was admitted to our emergency room for a right intertrochanteric fracture. Before the operation, the thromboembolism recurred and was treated with anticoagulation medication. Bipolar hemiarthroplasty and fixation of the greater trochanter with a hook plate were performed 18 days after the trauma. Superficial femoral artery obstruction and venous thromboembolism occurred on the first day after the operation.

Acute Lymphedema after Coronary Angiography: A Case Report

Lymphedema may develop after surgery, radiation, trauma, infections, malignant tumors, immobility and chronic venous insufficiencies. These triggering factors produce additional stress to the already impaired lymphatic system, resulting in mechanical insufficiency. However, we usually do not consider hematoma after coronary angiography as a cause of lymphedema. We report a case of a patient with lymphedema, especially on the lower extremities, after coronary angiography.

The prevalence and risk factors of lower limb lymphedema in the patients with gynecologic neoplasms / 대한산부인과학회지

OBJECTIVE: To identify the prevalence and risk factors for lower limb lymphedema in the patients after gynecologic neoplasms treatment in Korea. METHODS: We retrospectively reviewed the medical records and interviewed 242 gynecologic neoplasms patients who have managed surgically and medically over a 4 year period between January 2003 and December 2006. We identified the patients with lower limb lymphedema as described by the medical records or reported by the interviews. We obtained demographic characteristics, other medical history, cancer type, stage of cancer, lymph node dissection, chemotherapy, radiotherapy, hormone therapy and laboratory findings. Multiple logistic regression analysis was done to evaluate the risk factors for lower limb lymphedema. RESULTS: Forty eight (19.8%) patients out of two hundred forty two had lower limb lymphedema. Those patients with lower limb lymphedema had a higher body mass index, radiotherapy history, chemotherapy history and lymph node dissection history, radical hysterectomy. Multivariate analysis revealed that body mass index, radiotherapy and lymph node dissection were independently risk factors for lower limb lymphedema after gynecologic neoplasms treatment. CONCLUSION: The patients who had radiotherapy, body mass index greater than 25 or lymph node dissection must be considered as potential candidates to have lower limb lymphedema in the patients after gynecologic neoplasms treatment. Therefore, these patients should be informed during the follow-up period about this morbidity, the preventive measures, and the treatments.

Magnetic Resonance Arthrographic Findings of the Painful Hemiplegic Shoulder

OBJECTIVE: To identify the etiology of hemiplegic shoulder pain by magnetic resonance (MR) arthrography. METHOD: The study included seventy-four hemiplegic patients with shoulder pain. After several physical examinations, all patients had fluoroscopically guided injection by a physiatrist with a maximum of 12~15 ml of contrast agent. Then T1-weighted, T2-weighted and fat-suppressed T1-weighted images were taken at the oblique coronal plane. In addition, fat-suppressed T1-weighted images were obtained at the oblique sagittal and oblique coronal plane. RESULTS: Except for the 9 patients who did not finish the study, the mean age of the participants was 61.5+/-8.9 years and mean duration of the cerebrovascular accident (CVA) was 15.7+/-9.7 weeks. The findings were as follows: 40% supraspinatus tendinitis, 30.8% superior labrum anterior to posterior (SLAP) lesion, 29.2% adhesive capsulitis, 24.6% supraspinatus partial tear, 23.1% biceps tendinitis, 13.8% supraspinatus full thickness tear, 7.7% infraspinatus partial tear. The SLAP lesion had significant statistic relationship with biceps tendinitis (p<0.05) but not with rotator cuff lesion. CONCLUSION: We found that causes of hemiplegic shoulder pain were various. The prevalence of the SLAP lesion was high (30.8%). We recommend the MR arthrography when the hemiplegic shoulder pain does not improve by conventional therapy or the cause of the pain is uncertain.

Two Cases of Linear Scleroderma 'En Coup de Sabre' Treated with Polymethylmethacrylate Microspheres (PMMA-NewPlastic(R)) / 대한피부과학회지

Localized scleroderma is a disease of unknown origin and is characterized by circumscribed sclerotic skin changes. When occurring in a linear pattern, it is called linear scleroderma. 'En coup de sabre' is a subtype of linear scleroderma which is characterized by band-like, ivory-colored depressions on the frontoparietal scalp region. Several treatment modalities have been used. However, they have not been effective or safe. We report our experience of two patients with 'en coup de sabre' on the forehead, who were treated successfully with polymethylmethacrylate microspheres (PMMA-NewPlastic(R)).

A Case of Bowen's Disease with Modified Phenol Peel (Exoderm(R)) / 대한피부과학회지

We report a case of Bowen's disease in a 63-year-old male patient who presented with a 15x10cm-sized, large erythematous, scaly plaque on his back. Histopathologic examination revealed Bowen's disease. The skin lesion was improved after treatment with modified phenol peeling. Modified phenol peeling of Bowen's disease can be an alternative method of therapy for those lesions which are too large for excision and primary closure.

A Case of Darier's Disease Complicated by Eczema Herpeticum / 대한피부과학회지

Eczema herpeticum is a herpes simplex virus (HSV) infection with disseminated skin involvement superimposed on a pre-existing dermatosis such as atopic dermatitis, neurodermatitis, pemphigus vulgaris and Darier's disease. We report a case of eczema herpeticum by HSV-1 infection confirmed by polymerase chain reaction in a 20-year-old man associated with Darier's disease.

A Clinical Study of Androgenetic Alopecia / 대한피부과학회지

BACKGROUND: Androgenetic alopecia (AGA) is one of the most common type of alopecia among all men and women after puberty. The number of patients with AGA appears to be gradually increasing. OBJECTIVES: The purpose of this study was to investigate the clinical status such as age, family history, and type of patients with AGA and to review recent Korean literature. METHODS: 1500 patients with AGA who had visited the Department of Dermatology, Busan Paik Hospital, Inje University School of Medicine during the last 7 years (from May 1997 through December 2003) were examined through the clinical records. RESULTS: 1) There were 1162 male and 338 female patients being most prevalent in the third decade in both sexes. 2) In males AGA, Norwood-Hamilton's type II was the most common. 3) In females AGA, Ludwig's type I was the most common. 4) There was a family history of baldness in 62.9% of relatives in male patients and 48.8% in female patients. 5) The largest number of patients with AGA first visited our department when they had had 1-5 year's history of AGA in both sexes. 6) In the management of male AGA, oral finasteride only or with topical medications was the most common (72.4%) treatment modality. 7) In the management of female AGA, topical minoxidil solution only or with other topical medications was the most common (78.7%) treatment modality. CONCLUSIONS: The proportion of young patients with mild types appears to be high among AGA patients. It might be largely due to psychological stress in social situations.

A Case of Apocrine Type of Cutaneous Mixed Tumor with Follicular Differentiation / 대한피부과학회지

Mixed tumor of the skin or chondroid syringoma is a benign neoplasm characterized by histological features of a mixture of epithelial and mesenchymal components. Mixed tumor could be divided into two distinct types, eccrine and apocrine. We report a 59-year-old man with a 2X1 cm sized nodule on the right upper eyebrow. Histologically, it showed typical features of mixed tumor with tubules exhibiting branching and cystic dilatation in the myxoid and chondroid stroma. We observed apocrine type of cutaneous mixed tumor with follicular differentiation.

Concurrent Appearance of Alopecia Areata in Four Siblings / 대한피부과학회지

Familial occurrence of alopecia areata is not uncommon. A positive family history ranging among 10% to 40% has been reported from different surveys. A prevalence of 3% has been observed among siblings. The simultaneous onset of the disease in four siblings is, however, rare. We report the concurrent appearance of alopecia areata in four siblings and suggest emotional and genetic factors as possible causes.

A case of Hairy Elbows Syndrome / 대한피부과학회지

Hypertrichosis cubiti, also named hairy elbows syndrome, circumscribed hypertrichosis in which a remarkable amount of long vellus hair is localized on the extensor surfaces of the upper extremities. We report a case of hairy elbows syndrome in a 12-year-old female patient, who was treated for short stature in pediatrics. She was referred to our department because of hypertrichosis of both elbows. Her height is 131cm, it is below 3 percentile of that of age. We could not find any physical abnormalities and other developmental disorders except short stature. But, Her intelligence is somewhat delayed comparative to that of age. She denied her family history about that. The literature on this subject is reviewed, and some clinical and etiopathogenic aspects are discussed.

The measurements of ventricular size of brain CT in mood disorder / 신경정신의학

No abstract available.