Morphometric Variations in the Volar Aspect of the Distal Radius

BACKGROUND: Significant discrepancy exists between anatomical plate designs and the anatomy of the native distal radius, which may be attributable to considerable morphometric variations in the volar aspect of the distal radius. We aimed to evaluate the degree of variability in the morphometry of the distal radius and identify factors associated with this variability. METHODS: We measured the volar surface angle (VSA) of the intermediate and lateral columns and the volar surface width (VSW) in the distal radius from three-dimensional computed tomography scans acquired from 81 cadaveric forearms. These morphometric parameters were compared between the lateral and intermediate columns, between males and females, and between Koreans and Caucasians. Caucasian morphometric data were obtained and pooled from the previous studies. The coefficient of variation was used to assess the variability of the parameters and Cohen's d to estimate the effect size of the difference between groups. RESULTS: The average VSA of the lateral column was 22°± 6°, and that of the intermediate column was 29°± 8° in Koreans (p < 0.001). The variability was high for both VSAs. The VSA of the intermediate column was significantly larger in males than in females (p < 0.001) and in Caucasians than in Koreans (p < 0.001). The average VSW of distal radius was 30 ± 3 mm at the watershed line, and it became narrower proximally. The VSW was significantly larger in males than in females (p < 0.001) and in Koreans than in Caucasians (p < 0.001). The effect sizes of the difference for the VSA and VSW between sexes, races and columns were medium to large. CONCLUSIONS: Considerable variability exists in the morphometry of the volar distal radius, with sex, race, and column as contributing factors. These results suggest that surgeons should carefully choose an anatomical volar locking plate with appropriate angulation characteristics for each patient to achieve patient-specific alignment of the distal radius.

Revision Anterior Cruciate Ligament Reconstruction

As the number of primary reconstructions of the anterior cruciate ligament (ACL) increase, so do the number of revision ACL reconstructions due to failure. Revision ACL reconstruction has several challenges compared to primary ACL reconstruction. Literature review regarding revision ACL reconstruction was performed to discuss the cause of the failure, results of revision, and to assist the decision-making process and approaches to the patients. Usually good functional stability could be obtained after revision ACL reconstruction, but increased incidence of meniscal and cartilage lesions played a role in patient dissatisfaction. To solve issues such as tunnel widening, malposition, and inserted hardware after primary ACL reconstruction, various surgical technique issues were reviewed.

A Case of Adenoid Cystic Carcinoma of the Nasal Septum Misdiagnosed as Pleomorphic Adenoma / 대한이비인후과학회지

Adenoid cystic carcinoma is one of the most common minor salivary gland malignancies of the paranasal sinuses and nasal cavity and has a propensity for frequent local recurrencesand distant metastasis. It sometimes has variable histopathologic patterns in the same tumor, which makes diagnosis difficult. A very rare case of adenoid cystic carcinoma of the nasal septum, initially thought to be pleomorphic adenoma, is presented along with a review of the literature.

Anatomical Variations and Morphological Diversities of the Pancreatic Ductal System: Clinical and ERCP evaluation / 대한소화기내시경학회지

BACKGROUND/AIMS: The advent of endoscopic retrograde cholangiopancreaticography (ERCP) has made it possible to identify the pancreatic ductal (PD) system. There is no established relationship between the PD system and various pancreaticobiliary diseases. The purpose of this study was to identify the morphological diversities and anatomical variations of PD and to define the relationship between PD types and pancreaticobiliary diseases. METHODS: Five hundred and eighty-two consecutive patients, in whom both PD and common bile duct (CBD) were clearly visualized by ERCP, were included. PD types were categorized according to the relationship between CBD and PD. The anatomical variations were classified into migration, fusion, and duplication anomalies. RESULTS: The PD types were classified into type A 84.4%, type B 9.6%, type C 3.4%, and type D 2.6%. The PD anomalies were noted in 51 patients, which were comprised of 19 (3.3%) fusion anomalies (12 complete pancreas divisum, 7 incomplete pancreas divisum) and 32 (5.5%) duplication anomalies (5 number variations, 27 form variations). No significant relationships between various PD morphologies and pancreaticobiliary diseases were found. Hyperamylasemia was more frequently complicated in type C (41.7%) and D (50%) than in type A and B after ERCP. CONCLUSIONS: Though a close relationship was not found between various PD types and pancreaticobiliary diseases, being familiar with the morphology and anatomical variation is worth it, for more accurate interpretation and for prediction of a complication such as pancreatitis.

A Case of Hypertrophic Gastropathy and Early Gastric Cancer Associated with Pachydermoperiostosis / 대한소화기내시경학회지

Pachydermoperiostosis is a rare hereditary syndrome characterized by finger clubbing, periosteal new bone formation of tubular bones, and hypertrophic skin changes (pachydermia). This syndrome is known to be associated with a variety of diseases such as cranial suture defect, female escuchen, bone marrow failure and autonomic nervous system symptoms such as facial flushing and hyperhidrosis. There are just a few reports documenting gastric ulcer, hypertrophic gastropathy and Crohn's disease as associated diseases. A case is herein reported of pachydermoperiostosis accompanied by hypertrophic gastropathy and early gastric cancer.

A case of extraluminal leiomyosarcoma of IVC / 대한내과학회지

We report a case of extraluminal leiomyosarcoma of inferior vena cave(IVC) in a 56 year old woman. She was admitted to our hospital because of right lower quadrant discomfort for a month. Radiologic finding including ultrasonography, computerized tomography, magnetic resonance imaging showed heterogenous solid mass adhering to IVC and the confirmative diagnosis was made by ultrasonography guided percutaneous needle biopsy. She underwent radical resection surgery. No adjuvant treatment was performed and she has been in the follow up without recurrence of the disease.

Factors Affecting the Response to Oral Calcitriol Therapy in CAPD Patients with Secondary Hyperparathyroidism / 대한신장학회잡지

Calcitriol therapy is an important treatment for the prevention and control of secondary hyperparathyroidism in continuous ambulatory peritoneal dialysis (CAPD) patients. However, this often has been limited by the associated hypercalcemia and hyperphosphatemia due to increase in intestinal calcium and phosphorus absorption. Many studies reported that these limitations could be avoided by changing routes, frequency and dose of calcitriol treatment. But, there are still controversy about each methods and the results on the PTH response to conventional calcitriol treatment in CAPD patients. This study was performed to evaluate the factors affecting the response to oral calcitriol in CAPD patients. A retrospective study was done in 92 CAPD patients with secondary hyperparathyroidism(intact PTH level >200pg/ml) on oral calcitriol treatment. After baseline study of serum calcium, phosphorus, alkaline phosphatase, BUN, creatinine and intact PTH, calcitriol therapy was begun via oral rou- te, daily. Serum calcium, phosphorus, alkaline phosphatase, BUN, creatinine, intact FI'H and other bio- chemical markers were checked at 3 month, 6 month after treatment. Parathyroid gland ultrasonography was performed to detect parathyroid hypertrophy and nodule and to measure the diameter of parathymid gland. All the patients were divided into two groups according to percent reduetion of i-PTH(initial PTH PTH after 3, 6 months)X100/initial PTH(%),deltaPTH during oral calcitriol therapy for 3 and 6 months(group I ; delta PTH >30%, group II ; delta PTH <30%). RESULT: 1) All 92 patients(mean age 46.5 11.3yr, M: F 45: 47, mean CAPD duration 51.3 39.4 months) were administered oral calcitriol, daily. Mean calcitriol dose during 3 month was 0.43 0.22Mg and during 6month 0.43 0.24Mg. 2) After 3-month treament, there were significant differences in initial i-PTH, the diameter of parathyroid gland, initial phosphorus, intial total alkaline phosphatase and duration of CAPD between group I and II(406.7+/-196.5 vs. 871.0+/-478Apglml, 6.2+/-2.6 vs. 13.1+/-5.2mm, 5.0+/-1.3 vs. 5.7+/-1.3mg/dl, 93.7+/-4L1 vs. 171.9+/-137.6IU/L, 40.1+/-34.9 vs. 73.5+/-37.8months, p< 0.05, respectively). 4) After 6-month treament, there were significant differences in initial i-PTH, the diameter of parathyroid gland, intial total alkaline phosphatase and duration of CAPD between group I and II(474.1+/-266.6 vs. 889.7+/-485.4pg/ml, 6.4+/-2.7 vs. 14.5+/-5.1mm, 107.9+/-80.1 vs. 180.7+/-121.5IU/L, 40.5+/- 32.9 vs. 81.8+/-35.3months, p<0.05, respectively). 5) The significant negative correlation was shown between deltaPTH and the duration of peritoneal dialysis, the diameter of parathyroid gland, initial PTH level and PTH response during 3-month and 6-month oral calcitriol treatment. The response to oral calcitriol was poor when i-PTH level more than 500pg/ml(kappa 0.429, p value <0.01), the diameter of parathyroid gland more than 10.0mm(kappa 0.641, p value<0.01), the duration of CAPD more than 55months(kappa 0.524, p value< 0.01). These data suggested that initial i-PTH level, the diameter of parathyroid gland size and the duration of CAPD were independent risk factors of the poor response to oral calcitriol therapy in CAPD patients with secondary hyperparathyroidism.

Diversion Colitis: Diversion Colitis A case report

Pseudomyxoma peritonei may result from implantation of benign or malignant tumor in peritoneal cavity and is filled with gelatinous material (termed "Jelly Belly") in abdominal cavity. Its origin is usually an appendiceal or ovarian mucinous adenoma or cystadenocarcinoma, but other primary origin such as uterus, intestine, pancreas and stomach umor have been reported. Generally, pseudomyxoma peritonei is slowly progressive and has low grade malignant potential. This report presents a unusual long term survival after evacuation of 15,000 cc of gelatinous material from abdominal cavity which was the low grade mucinous adenocarcinoma and a review of the current literature, management and new its concept. The origin of pseudomyxoma peritonei of this case was most likely from appendiceal mvcinous adenocarcinoma.