Spontaneous rupture of flexor pollicis longus tendon by tendolipomatosis in proximal phalanx : A case report

Lee, Young-Keun,Lee, Malrey Wolters Kluwer Health 2018 Medicine Vol.97 No.37

<P><B>Abstract</B></P><P><B>Rationale:</B></P><P>Spontaneous flexor pollicis longus (FPL) tendon rupture is rarely reported. Although there are several studies investigating spontaneous FPL tendon rupture, the exact etiology of spontaneous rupture is unclear. Here, we present a case of unusual spontaneous FPL tendon rupture due to tendolipomatosis.</P><P><B>Patient concerns:</B></P><P>A 64-year-old right-handed retired male teacher was referred to our clinic with an inability to flex the interphalangeal joint of his left thumb.</P><P><B>Diagnosis:</B></P><P>Magnetic resonance imaging (MRI) revealed complete FPL tendon rupture at the level of the distal one-third of the proximal phalanx.</P><P><B>Interventions:</B></P><P>With the patient under general anesthesia, the FPL tendon was explored through a volar zig-zag incision. During the operation, the FPL tendon was found to be ruptured completely. Gross examination revealed a slightly yellowish denaturated tissue at the distal end of the ruptured tendon. We excised the denaturated tissue from the distal end of the ruptured tendon and sent it for histological examination. FPL tendon was repaired primarily via modified Becker method. Histopathological examination revealed normal vasculature in the tendon tissue and degenerative changes associated with lipid deposits in the tendon tissue.</P><P><B>Outcomes:</B></P><P>At 12-month follow-up, the patient was completely asymptomatic and had excellent IP joint range of motion (0° to 40°) in his left thumb. The wrist grip strength was 30 kg (28 kg in the Rt.) and the thumb pinch strength was 5.7 kg (4.7 kg in the Rt.). The Quick DASH score was 0.</P><P><B>Lessons:</B></P><P>Spontaneous rupture of the FPL tendon, attributed to degenerative changes caused by tendolipomatosis, is the first report of its kind, in the authors’ opinion. Hence we recommend to perform the histopathological examination of the debrided tissue from the ends of the ruptured tendon, if the physicians couldn’t know the exact cause of the spontaneous intratendinous rupture of the FPL. And early diagnosis followed by debridement and primary tendon repair provides an effective outcome.</P>

Optimization of fuzzy fules : Integrated approach for Classification Problems

MalRey Lee,Jae-Deuk Lee 보안공학연구지원센터 2005 보안공학연구논문지 Vol.2 No.1

A Study of Construct Fuzzy Inference Network using Neural Logic Network

Lee, Jae-Deuk,Jeong, Hye-Jin,Kim, Hee-Suk,Lee, Malrey Korean Institute of Intelligent Systems 2005 INTERNATIONAL JOURNAL of FUZZY LOGIC and INTELLIGE Vol.5 No.1

This paper deals with the fuzzy modeling for the complex and uncertain nonlinear systems, in which conventional and mathematical models may fail to give satisfactory results. Finally, we provide numerical examples to evaluate the feasibility and generality of the proposed method in this paper. The expert system which introduces fuzzy logic in order to process uncertainties is called fuzzy expert system. The fuzzy expert system, however, has a potential problem which may lead to inappropriate results due to the ignorance of some information by applying fuzzy logic in reasoning process in addition to the knowledge acquisition problem. In order to overcome these problems, We construct fuzzy inference network by extending the concept of reasoning network in this paper. In the fuzzy inference network, the propositions which form fuzzy rules are represented by nodes. And these nodes have the truth values representing the belief values of each proposition. The logical operators between propositions of rules are represented by links. And the traditional propagation rule is modified.

Fuzzy logic decision making for multi-robot security systems

Lee, Malrey,Tarokh, Mahmoud,Cross, Matthew Springer-Verlag 2010 The Artificial intelligence review Vol.34 No.2

Trigger finger secondary to a neglected flexor tendon rupture

Lee, Malrey,Jung, Young-Ran,Lee, Young-Keun Wolters Kluwer Health 2019 Medicine Vol.98 No.1

<P><B>Abstract</B></P><P>Secondary trigger finger caused by trauma to the hand, especially associated with partial flexor tendon rupture, is not a common condition. Thus, the clinical manifestations of these patients are not well-known. The aim of this study is to present secondary trigger finger caused by a neglected partial flexor tendon rupture including discussion of the mechanism and treatment.</P><P>We retrospectively reviewed the records of 6 patients with trigger finger caused by a neglected partial flexor tendon rupture who had been treated with exploration, debridement, and repairing of the ruptured tendon from August 2010 to May 2015. The average patient age was 41 years (range, 23–59). The time from injury to treatment averaged 4.7 months. The average follow-up period was 9 months (range, 4–18). Functional outcome was evaluated from a comparison between the Quick-disabilities of the arm, shoulder, and hand (DASH) score and the visual analogue scale (VAS) for pain, which were measured at the time of preoperation and final follow up.</P><P>Four patients showed partial rupture of the flexor digitorum profundus (FDP) tendon and 3 showed partial rupture of the flexor digitorun superficialis (FDS) tendon. Both the FDP and FDS tendons were partially ruptured in 2 patients, and the remaining patient had a partial rupture of the flexor pollicis longus tendon. All patients regained full range of motion, and there has been no recurrence of triggering. The average VAS score decreased from 3.6 (range, 3–5) preoperatively to 0.3 (range, 0–1) at the final follow up. The average Quick-DASH score decreased from 33.6 preoperatively to 5.3 at the final follow up.</P><P>When we encounter patients with puncture or laceration wounds in flexor zone 2, even when the injury appears to be simple, partial flexor tendon laceration must be taken into consideration and early exploration is recommended.</P>

Arthroscopic Resection of a Tenosynovial Giant Cell Tumor in the Wrist : A Case Report

Lee, Young-Keun,Han, Youngshin,Lee, Malrey Williams & Wilkins Co 2015 Medicine Vol.94 No.42

<P><B>Abstract</B></P><P>The treatment for giant cell tumors of the tendon sheath is surgical therapy, but surgical recurrence rates were reported to be as high as 50% in some cases. Therefore, complete radical excision of the lesion is the treatment of choice. If the tumor originates from the joint, it is important to perform capsulotomy. Here, the authors report the first case of successful treatment of a localized intra-articular giant cell tumor in the wrist by arthroscopic resection.</P><P>A 28-year-old right-handed woman visited the clinic because of left wrist ulnar-side pain, which had been aggravated during the previous 15 days. Vague ulnar-side wrist pain had begun 2 years ago. When the authors examined the patient, the wrist showed mild swelling on the volo-ulnar aspect and the distal radioulnar joint, as well as volar joint line tenderness. She showed a positive result on the ulnocarpal stress test and displayed limited range of motion. Magnetic resonance imaging revealed an intra-articular mass with synovitis in the ulnocarpal joint. Wrist arthroscopy was performed using standard portals under regional anesthesia. The arthroscopic findings revealed a large, well-encapsulated, yellow lobulated soft-tissue mass that was attached to the volar side of the ulnocarpal ligament and connected to the extra-articular side. The mass was completely excised piece by piece with a grasping forceps. Histopathologic examination revealed that the lesion was an intra-articular localized form of a tenosynovial giant cell tumor.</P><P>At 24-month follow-up, the patient was completely asymptomatic and had full range of motion in her left wrist, and no recurrence was found in magnetic resonance imaging follow-up evaluations.</P><P>The authors suggest that the arthroscopic excision of intra-articular giant cell tumors, as in this case, may be an alternative method to open excisions, with many advantages.</P>

Termite tunneling feature extraction using genetic algorithm

Lee, Malrey,Kang, Eun-Kwan Springer-Verlag 2012 SOFT COMPUTING Vol.16 No.3

Small Finger Snapping due to Retinacular Ligament Injury at the Level of Proximal Interphalangeal Joint : A Case Report

Lee, Young-Keun,Lee, Jun-Mo,Lee, Malrey Williams & Wilkins Co 2015 Medicine Vol.94 No.24

<P><B>Abstract</B></P><P>Pathological snapping secondary to posttraumatic subluxation of the extensor tendon at proximal interphalangeal joint (PIPJ) of the finger is rare. Here, we want to describe a patient with snapping of the left small finger at PIPJ due to retinacular ligament injury.</P><P>A 24-year-old man was admitted because of a 5-year history of a snapping sound in the left small finger. On examination, the radial side lateral band of the small finger was dislocated volarly at the level PIPJ with flexion of >50°, which was clearly felt over the skin. There was an obvious snapping sound at the time of dislocation. There was no specific radiographic abnormality. With the patient under regional anesthesia, exploration through a zigzag skin incision over the dorsum of the PIPJ revealed that the retinacular ligament complex was injured. We also found a partial tear in PIPJ capsule, through the incision of the injured retinacular ligament complex. We repaired the joint capsule and retinacular ligament complex with prolene 4–0. Postoperatively the small finger was immobilized in a below-elbow plaster splint with full extension of the fingers for 1 week, then dynamic splinting was advised for another 5 weeks and unrestricted full active motion was allowed at the 6th week.</P><P>At the 6-month follow-up, the patient had regained full range of motion with no discomfort, and there was no sign of recurrence.</P><P>We stress that when there is snapping over the dorsum of the PIPJ of the finger, the clinician should suspect rupture of the retinacular ligaments, especially in minor trauma patients. Primary repair of retinacular ligaments and dynamic splinting provided satisfactory results without recurrence in our patient.</P>

Flexor Tendon Entrapment at the Malunited Base Fracture of the Proximal Phalanx of the Finger in Child : A Case Report

Lee, Young-Keun,Park, Soojin,Lee, Malrey Wolters Kluwer Health 2015 Medicine Vol.94 No.35

<P><B>Abstract</B></P><P>The proximal phalangeal base is the most commonly fractured hand bone in children. Such fractures are rarely reported as irreducible due to flexor tendon entrapment. Here, we describe a patient who sustained a malunited fracture on the right fifth finger proximal phalanx with flexor tendon entrapment after treatment with closed reduction with K-wires fixation.</P><P>A 13-year-old patient came to the clinic following a bicycle accident 6 weeks ago. He presented with flexion limitation in his small finger on the right hand. During physical examination, the patient felt no pain, and the neurovascular structures were intact. However range of motion (ROM) in his small finger was not normal. Plain radiographs displayed a Salter–Harris type II fracture of the small finger proximal phalanx base and volar angulation with callus formation. During the operation, it was established that the flexor digitorum superficialis (FDS) around the fracture had a severe adhesion, whereas the flexor digitorum profundus (FDP) was entrapped between the volarly displaced metaphyses and the epiphyses and united with the bone. We removed the volarly displaced metaphyses and freed FDP and repaired the A2 pulley. The bone was anatomically fixed with K-wires. In the treatment after the operation, on the 2nd day, the patient was permitted the DIP joint motion by wearing a dynamic splint.</P><P>At the 12-months follow-up, the patient had regained full ROM with no discomfort and the proximal phalanx growth plate of the small finger closed naturally with normal alignment.</P><P>When treating a proximal phalangeal base fracture in children, the possibility of flexor tendon entrapment should be considered and should be carefully dealt with in its treatment.</P>

Why is the number of primary tunnels of the formosan subterranean termite, Coptotermes formosanus Shiraki (Isoptera: Rhinotermidae), restricted during foraging?

Lee, Sang-Hee,Su, Nan-Yao,Lee, Malrey 한국응용곤충학회 2009 Journal of Asia-Pacific Entomology Vol. No.

Subterranean termites forage by digging a network of tunnels to come into contact with food sources. When 1000 termites (Coptotermes formosanus Shiraki) were placed in a laboratory arena, 6.7 primary tunnels were constructed. The aim of this study was to explain the empirical observation in which termites restrict the number of primary tunnels. To this end, we constructed a model to simulate termite tunnel patterns based on empirical data and to calculate food transportation efficiency, <TEX>${\gamma}$</TEX>, for the tunnel patterns. The efficiency was defined as the ratio of the number of encountered food particles to the sum of the shortest length from the location of encountered food particles to the initial position of growth of the tunnel. The <TEX>${\gamma}$</TEX> was maximized when the number of primary tunnels was 5 or 6, which was fairly consistent with the empirical number of primary tunnels. This result indicated that termites may restrict the number of their primary tunnels to improve the transportation efficiency, which is directly related to their survival.