Case Reports : Calcinosis Cutis at the Tarsus of the Upper Eyelid

( Ik Hyun Jun ),( Sung Eun Kim ),( Sang Yeul Lee ),( Gi Jeong Kim ),( Jin Sook Yoon ) 대한안과학회 2011 Korean Journal of Ophthalmology Vol.25 No.6

Calcinosis cutis involves the inappropriate deposition of calcium within the dermis layer of the skin, and is often associated with rheumatoid disease. A 42-year-old woman presented for evaluation of a hard palpable mass on the left upper eyelid. After everting the eyelid, a large papillomatous mass with a broad base was identified on the superior area of the tarsus. The lesion was partially excised posteriorly under local anesthesia, and pathologists identified the mass as calcinosis cutis. The patient had no systemic or trauma history, and the serum levels of calcium and phosphorous were normal. Idiopathic calcinosis cutis should be included in the differential diagnosis for a protruding papillomatous mass of the tarsal plate, and surgical debulking could be a viable option for large protruding lesions, although more follow-up is necessary to monitor regrowth.

마이봄샘의 눈꺼풀판내 각질낭종 1예

최경준,권미정,이민정,Kyung Jun Choi,MD,Mi Jung Kwon,MD,Min Joung Lee,MD 대한안과학회 2015 대한안과학회지 Vol.56 No.1

Purpose: To report a patient presenting with an intratarsal keratinous cyst of the Meibomian gland in the upper eyelid and a review of the relevant literature.Case summary: A 65-year-old male presented with a right upper eyelid mass which started 5 months prior. The patient reported that the mass recurred several weeks prior even after incision and curettage procedure. The mass was 9 x 5 mm in size and located in the center of the right upper eyelid at the level of lid crease, fixed to the tarsus and a whitish elevated focus was observed at the palpebral conjunctival surface. The mass was excised under local anesthesia and originated from the tarsus. The histopathological examinations revealed an intratarsal keratinous cyst composed of stratified squamous epithelium without keratohyalin granules and filled with keratin. The immunohistochemical studies showed positive staining results for cytokeratin 5/6, epithelial membrane antigen, and carcinoembryonic antigen. Conclusions: Intratarsal keratinous cyst of the Meibomian gland should be considered as a differential diagnosis of a recurrent tarsal mass. J Korean Ophthalmol Soc 2015;56(1):109-113

Magnetic Resonance Imaging and Ultrasonographic Evaluation of Canine Tarsus

윤정희 한국임상수의학회 2024 한국임상수의학회지 Vol.41 No.2

The tarsus in dogs has a complex structure that makes its evaluation relatively challenging. Because an accurate diagnosis of the tarsus is difficult through basic examinations alone, imaging tests are essential. Previous studies have explored the anatomical and radiological features of the canine tarsus using several imaging modalities. However, the imaging utility of the tarsus across different modalities has not been thoroughly evaluated. This study aimed to visualize the tarsal structures using magnetic resonance imaging (MRI) and ultrasonography, compare their utility, and propose suitable imaging modalities and conditions for evaluating specific tarsal structures. Magnetic resonance imaging and ultrasound scans of the tarsus of four healthy dogs were performed, and two observers rated the utility of each image on a five-point scale. Although MRI is more beneficial for assessing the tarsal structures than ultrasound, ultrasound also appears clinically useful for evaluating the cranial tibialis muscle, deep digital flexor tendon, subcutaneous fat, joint space, and superficial digital flexor tendon. In addition, each structure of interest can be evaluated for optimal visibility using specific ultrasound sections, MRI sequences, and planes. In veterinary clinical practice, an initial assessment using ultrasound imaging with optimal visibility is required and if further evaluation is necessary, MRI examinations with optimal MRI sequences and planes can be performed.

소아 유연성 편평족에서 Kalix® 족근동 기구를 이용한 거골하 관절 제동술

황석민,엄준상,이동오,이종수,김성욱,원태구,정홍근 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.6

Purpose: The purpose of this study was to evaluate the radiographic and clinical outcomes of subtalar arthroereisis as a method of treatment for pediatric flexible flatfoot. Materials and Methods: We retrospectively investigated 14 feet among 10 patients with flexible flatfoot, who were treated with a subtalar arthroereisis using a sinus tarsi implant between March 2007 and June 2012. Radiographically, the talo-1st metatarsal angle, talar declination, and calcaneal pitch angle have all been measured on lateral radiographs. The talo-navicular coverage angle and talo-1st metatarsal angle was measured on anteroposterior (AP) radiographs and tibio-calcaneal angle was assessed by hindfoot alignment view. Visual analogue scale (VAS) pain scores and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used for clinical evaluation. Results: The mean follow-up was 48.7 months (16–98 months), and the mean age was 11.6 years (6–19 years). Radiographically, the mean pre-operative and postoperative values measured by the lateral foot radiograph were -25.1° and -7.5° for talo-1st metatarsal angle, 37.4° and 23.2° for talar declination, and 8.3° and 15.0° for calcaneal pitch angle, respectively. The mean preoperative and postoperative values measured by foot AP radiograph were 23.0° and 11.9° for talo-navicular coverage angle and 17.2° and 9.0° for talo-1st metatarsal angle, respectively. Moreover, tibio-calcaneal angle improved from valgus 17.4° on average to 4.5° on average. Clinically, the VAS score and AOFAS score was improved from 5.8 to 1.5 and from 61.8 to 90.4, respectively. Complication was sinus tarsi pain that occurred in 5 cases (35.7%). Conclusion: We achieved a satisfactory correction of pediatric flexible flatfoot deformities via subtalar arthroereisis, using a sinus tarsi implant with favorable radiographic and clinical measures. However, high potential complication rate of postoperative sinus tarsi pain on weight-bearing should carefully be considered. 목적: 소아의 유연성 편평족에 대한 거골하 관절 제동술의 방사선적 및 임상적 결과를 평가하고자 하였다. 대상 및 방법: 2007년 3월부터 2012년 6월까지 건국대학교병원에서 편평족으로 진단 후 거골하 관절 제동술을 시행받은 10명, 14예의 환자를 대상으로 하였다. 방사선적으로는 측면 방사선 사진을 통하여 거골-제1 중족골 간 각, 거골 수평면각 및 종골 경사각을 측정하였다. 전후면 방사선 사진을 통하여 거주상골 피복각 및 거골-제1 중족골 간 각을 측정하였고, 후족부 정렬 사진을 통하여 경골-종골각을 측정하였다. 임상적 평가로는 수술 전후의 visual analogue scale (VAS) 통증 지수와 미국 정형외과 족부족관절학회(American Orthopaedic Foot and Ankle Society, AOFAS) 기능 점수를 조사하였다. 결과: 평균 추시 기간은 48.7개월(16-98개월)이었으며, 평균 연령은 11.6세(6-19세)였다. 방사선적 측면 족부 방사선 사진상에서 거골-제1 중족골 간 각은 술 전 평균 -25.1도에서 술 후 평균 -7.5도, 거골 수평면각은 술 전 평균 37.4도에서 술 후 평균 23.2도 및 종골 경사각은 술 전 평균 8.3도에서 술 후 평균 15.0도로 각각 향상 측정되었다. 전후면 방사선 사진에서 측정한 거주상골 피복각은 술 전 평균 23.0도에서 술 후 평균 11.9도로, 거골-제1 중족골 간 각은 술 전 평균 17.2에서 술 후 평균 9.0도로 감소하였다. 또한 후족부 정렬상 경골-종골 각은 술 전 평균 외반 17.4도에서 술 후 평균 외반 4.5도로 호전되었다. 임상적으로는 VAS 통증 점수는 술 전 5.8점에서 술 후 1.5점으로, AOFAS 점수는 술 전 61.8점에서 술 후 90.4점으로 향상되었다. 합병증으로는 족근동 통증이 5예(35.7%)에서 발생하였다. 결론: 소아의 유연성 편평족 환자에서 족근동 삽입물을 이용한 거골하 관절 제동술을 시행하여 방사선적 및 임상적으로 우수한 결과를 얻었고, 편평족 변형에 대해 만족스러운 교정을 얻을 수 있었다. 하지만 수술 후 체중 부하 시 족근동 통증의 높은 발생 가능성에 대해서는 유념하여야 할 것이다.

Sanders 2형 종골 골절에 대한 두 가지 외측도달법의 비교연구

문정석 ( Jeong Seok Moon ),이우천 ( Woo Chun Lee ) 대한골절학회 2009 대한골절학회지 Vol.22 No.1

목적: Sanders 2형 종골 골절에 대한 외측 도달법 중 광범위 도달법과 최소 도달법의 임상결과를 비교하고자 하였다. 대상 및 방법: 2002년 6월부터 2007년 2월까지 본원에서 Sanders 2형 종골 골절로 광범위 또는 최소 외측도달법으로 개방적 정복술을 시행받고 1년 이상 관찰한 32명 33예를 대상으로 하였다. 광범위 도달법은 20예, 최소 도달법은 13예였고, 이들 평균 연령은 각각 43.3세, 46.3세였다. 양 군의 임상적 평가 및 방사선학적 평가, 술 후 합병증을 비교하였다. 결과: 양 군 간 평균연령, 체질량 지수, 수술시간의 차이가 없었다. AOFAS 점수는 광범위 도달법이 73.7±24.0점, 최소 도달법이 80.8±11.4점으로 차이가 없었다 (p=0.716). 통증점수는 광범위 도달법이 3.8±2.6점, 최소 도달법이 3.2±1.5점으로 차이가 없었다 (p=0.774). 술 전-술 후 Bohler각도 및 Gissane각도는 양 군 간 차이가 없었다. 술 후 합병증은 광범위 도달법의 경우 비복신경증상 2예, 부정유합 1예, 심부감염 1예가 발생하였고 최소 도달법에서는 없었다. 결론: Sanders 2형 종골 골절에 선택적으로 사용한다면 최소 도달법은 술 후 합병증이 적은 좋은 방법 중의 하나로 생각한다. Purpose: To compare the clinical results between the extensile lateral approach and sinus tarsi approach in the open reduction of the Sanders type II calcaneal fracture. Materials and Methods: From July 2002 to Februry 2007, thirty two patients having thirty three calcaneal fractures of Sanders type II were managed with open reduction and internal fixation using the extensile lateral approach or sinus tarsi approach. The mean age of 19 patients using extensile lateral approach was 43.3 years. The mean age of 13 patients using sinus tarsi approach was 46.3 years. Clinical outcome, radiographic parameters, and postoperative complications were compared between both groups. Results: There was no difference between two groups associated with patients demographs. The mean AOFAS score and VAS between both groups were not different (p=0.716, p=0.774). The mean Bohler`s angle and Gissane`s angle between both groups were not different (p=0.343, p=0.357). Two cases of sural nerve injury, one malunion, and one deep infection were occurred in the group of extensile lateral approach. However, patients using sinus tarsi approach had no postoperative complications. Conclusion: The clinical results of sinus tarsi approach may be comparable with those of extensile lateral approach, with the advantages of reduced risk of postoperative complications.

소아 유연성 편평족에서 Kalix<SUP>®</SUP> 족근동 기구를 이용한 거골하 관절 제동술

황석민(Seok-Min Hwang),엄준상(Joon-Sang Eom),이동오(Dong-Oh Lee),이종수(Jong-Soo Lee),김성욱(Sung-Wook Kim),원태구(Tae-Gu Won),정홍근(Hong-Geun Jung) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.6

목적: 소아의 유연성 편평족에 대한 거골하 관절 제동술의 방사선적 및 임상적 결과를 평가하고자 하였다. 대상 및 방법: 2007년 3월부터 2012년 6월까지 건국대학교병원에서 편평족으로 진단 후 거골하 관절 제동술을 시행받은 10명, 14예의 환자를 대상으로 하였다. 방사선적으로는 측면 방사선 사진을 통하여 거골-제1 중족골 간 각, 거골 수평면각 및 종골 경사각을 측정하였다. 전후면 방사선 사진을 통하여 거주상골 피복각 및 거골-제1 중족골 간 각을 측정하였고, 후족부 정렬 사진을 통하여 경골-종골각을 측정하였다. 임상적 평가로는 수술 전후의 visual analogue scale (VAS) 통증 지수와 미국 정형외과 족부족관절학회(American Orthopaedic Foot and Ankle Society, AOFAS) 기능 점수를 조사하였다. 결과: 평균 추시 기간은 48.7개월(16-98개월)이었으며, 평균 연령은 11.6세(6-19세)였다. 방사선적 측면 족부 방사선 사진상에서 거골-제1 중족골 간 각은 술 전 평균 -25.1도에서 술 후 평균 -7.5도, 거골 수평면각은 술 전 평균 37.4도에서 술 후 평균 23.2도 및 종골 경사각은 술 전 평균 8.3도에서 술 후 평균 15.0도로 각각 향상 측정되었다. 전후면 방사선 사진에서 측정한 거주상골 피복각은 술 전 평균 23.0도에서 술 후 평균 11.9도로, 거골-제1 중족골 간 각은 술 전 평균 17.2에서 술 후 평균 9.0도로 감소하였다. 또한 후족부 정렬상 경골-종골 각은 술 전 평균 외반 17.4도에서 술 후 평균 외반 4.5도로 호전되었다. 임상적으로는 VAS 통증 점수는 술 전 5.8점에서 술 후 1.5점으로, AOFAS 점수는 술 전 61.8점에서 술 후 90.4점으로 향상되었다. 합병증으로는 족근동 통증이 5예(35.7%)에서 발생하였다. 결론: 소아의 유연성 편평족 환자에서 족근동 삽입물을 이용한 거골하 관절 제동술을 시행하여 방사선적 및 임상적으로 우수한 결과를 얻었고, 편평족 변형에 대해 만족스러운 교정을 얻을 수 있었다. 하지만 수술 후 체중 부하 시 족근동 통증의 높은 발생 가능성에 대해서는 유념하여야 할 것이다. Purpose: The purpose of this study was to evaluate the radiographic and clinical outcomes of subtalar arthroereisis as a method of treatment for pediatric flexible flatfoot. Materials and Methods: We retrospectively investigated 14 feet among 10 patients with flexible flatfoot, who were treated with a subtalar arthroereisis using a sinus tarsi implant between March 2007 and June 2012. Radiographically, the talo-1st metatarsal angle, talar declination, and calcaneal pitch angle have all been measured on lateral radiographs. The talo-navicular coverage angle and talo-1st metatarsal angle was measured on anteroposterior (AP) radiographs and tibio-calcaneal angle was assessed by hindfoot alignment view. Visual analogue scale (VAS) pain scores and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used for clinical evaluation. Results: The mean follow-up was 48.7 months (16–98 months), and the mean age was 11.6 years (6–19 years). Radiographically, the mean pre-operative and postoperative values measured by the lateral foot radiograph were -25.1° and -7.5° for talo-1st metatarsal angle, 37.4° and 23.2° for talar declination, and 8.3° and 15.0° for calcaneal pitch angle, respectively. The mean preoperative and postoperative values measured by foot AP radiograph were 23.0° and 11.9° for talo-navicular coverage angle and 17.2° and 9.0° for talo-1st metatarsal angle, respectively. Moreover, tibio-calcaneal angle improved from valgus 17.4° on average to 4.5° on average. Clinically, the VAS score and AOFAS score was improved from 5.8 to 1.5 and from 61.8 to 90.4, respectively. Complication was sinus tarsi pain that occurred in 5 cases (35.7%). Conclusion: We achieved a satisfactory correction of pediatric flexible flatfoot deformities via subtalar arthroereisis, using a sinus tarsi implant with favorable radiographic and clinical measures. However, high potential complication rate of postoperative sinus tarsi pain on weight-bearing should carefully be considered.

족근동 증후군으로 오인된Accessory Anterolateral Talar Facet에 의한 거종관절 충돌

박재우,박철현 대한족부족관절학회 2018 대한족부족관절학회지 Vol.22 No.1

Purpose: To evaluate the clinical and radiographic results of surgical treatment for patients with sinus tarsi pain due to accessory talar facet impingement. Materials and Methods: Between July 2013 and July 2015, nine patients who underwent surgery for the accessory talar facet impinge- ment were reviewed. The mean follow-up period was 18.6 months (12 ∼ 36 months), and the mean age was 33.1 years (19 ∼ 60 years). Previous trauma history, duration of symptom, and types of surgery were analyzed. The clinical results were evaluated using the Ameri- can Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS). Radiographic results were as- sessed using Meary’s angle, calcaneal pitch angle, heel alignment angle, and heel alignment ratio. Results: All patients had evident trauma history prior to the initial symptom. The mean duration of symptoms was 25.6 months (6 ∼ 120 months). Four patients received only accessory anterolateral talar facet (AALTF) excision, and four patients received medial sliding calcaneal osteotomy (MSCO). One patient underwent both AALTF excision and MSCO. The AOFAS ankle-hindfoot score was signifi- cantly improved from 73 (62 ∼ 77) preoperatively to 93 (67 ∼ 100) postoperatively. The VAS score was decreased from 6 (5 ∼ 7) preopera- tively to 1 (0 ∼ 5) postoperatively. The Meary’s angle and calcaneal pitch angle showed no significant difference after surgery. The heel alignment angle and ratio increased from –3.6° (–10° ∼ 5°) and 0.22 (–0.15 ∼ 0.6) preoperatively to 2.8° (1° ∼ 5°) and 0.42 (0.3 ∼ 0.6) post- operatively, respectively. Conclusion: If there is persistent sinus tarsi pain in patients with hindfoot valgus, accessory talar facet impingement caused by AALTF could be considered as a cause of chronic sinus tarsi pain.

전위성 관절내 종골 골절에서 최소 침습적 족근동 도달법 및 압박나사 내고정술을 이용한 수술적 치료

김용민,조병기,손현철,박지강,정호승,Kim, Yong-Min,Cho, Byung-Ki,Shon, Hyun-Chul,Park, Ji-Kang,Jeong, Ho-Seung 대한족부족관절학회 2012 대한족부족관절학회지 Vol.16 No.4

Purpose: This study was performed to evaluate the clinical outcomes of operative treatment using mini-open sinus tarsi approach for displaced intraarticular calcaneal fractures. Materials and Methods: We studied 18 cases (16 patients) of intraarticular calcaneal fractures who were treated with sinus tarsi approach by same surgeon. The mean age of patients was 44.8 years, and mean follow-up period was 17.2 months. The measurement of B$\ddot{o}$hler angle, Gissane angle, the degree of articular surface depression, and the period to union were performed through preoperative and postoperative radiographs. The clinical evaluation was performed according to hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and scale of the Creighton-Nebraska health foundation (CNHF). Results: B$\ddot{o}$hler angle and Gissane angle had improved significantly from preoperative average $9.8^{\circ}$, $117.6^{\circ}$to average $22.4^{\circ}$, $113.4^{\circ}$ immediate postoperatively, and had maintained to average $21.8^{\circ}$and $114.2^{\circ}$ at the last follow-up. The degree of articular surface depression had improved significantly from preoperative average 5.2 mm to 1.2 mm at the last follow-up. All cases achieved bone union, and the period to union was average 10.5 weeks. AOFAS score was average 86.2 points at the last follow-up. There were 7 excellent, 9 good, and 2 fair results according to the CNHF scale. Therefore, 16 cases (88.8%) achieved satisfactory results. Conclusion: The minimally invasive sinus tarsi approach using headless compression screw seems to be an effective surgical method for displaced intraarticular calcaneal fractures, because of the possibility of accurate restoration of articular surface and the low risk of postoperative soft tissue complications.

Sanders 4형 종골 관절내 골절에 대한 최소 침습적 내고정술의 임상 결과

이준영,장현웅,김영욱 대한골절학회 2019 대한골절학회지 Vol.32 No.4

Purpose: This study evaluated the radiologic and clinical results in patients who underwent minimal invasive surgery using sinus tarsi approach in Sanders type IV calcaneal fracture. Materials and Methods: This retrospective study evaluated 13 cases of Sanders type IV calcaneus fractures that were treated by minimal invasive surgery using the sinus tarsi approach from July 2012 to April 2017. Further, these cases could be followed up for more than 12 months. Bone union, radiologic parameters such as Böhler’s angle, Gissane’s angle, calcaneal height, length, and width, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the postoperative complications were evaluated. Results: Bony union was achieved in all the cases at the final follow up, and the mean union time was 5.5 months. One patient underwent reoperation for a surgical site infection, six patients had post traumatic arthritis, and two of them underwent subtalar joint fusion. The mean AOFAS ankle-hindfoot score was 81.2. At the final follow-up, the mean values of Böhler’s angle and Gissane’s angle were 20° and 119.8°, respectively, and the mean values of the calcaneus height, length, and width were 46.8 mm, 81.8 mm, and 45.6 mm, respectively. Conclusion: Minimal invasive surgery using the sinus tarsi approach for Sanders type IV calcaneal fracture resulted in satisfactory anatomic reduction and stable fixation, and satisfactory clinical and radiologic results were obtained in most of the patients. Minimal invasive surgery is thought to reduce the soft tissue-related complications as compared to surgery using the extensile lateral approach. 목적: Sanders 4형의 종골 골절에서 족근동 접근법을 이용하여 최소 침습적 내고정술을 시행한 환자에서 수술 후 방사선학적 및 임상적 결과를 알아보고자 하였다. 대상 및 방법: 2012년 7월부터 2017년 4월까지 Sanders 4형의종골 골절로 본원에서 수술 치료를 시행한 환자 중 12개월이상 추시가 가능했던 13예를 대상으로 후향적 분석을 시행하였다. 수술 방법은 족근동 접근법을 이용하여 최소 침습적내고정술을 시행하였다. 방사선학적 평가로 골유합과 Böhler 각, Gissane각, 종골의 높이, 길이 및 폭 5가지 항목을 평가하였고, 임상적 평가로 미국 족부족관절 정형외과학회(American Orthopaedic Foot and Ankle Society [AOFAS]) 족부- 후족부 점수(ankle-hindfoot score)를 이용하여 분석하였고수술 후 합병증에 대해 평가하였다. 결과: 최종 추시에서 모든 예에서 골유합을 얻었고, 평균 골유합 기간은 5.5개월이었다. 1예에서 수술 부위 감염으로 재수술을 시행하였고, 6예에서 후외상성 관절염이 관찰되었으며 그 중 2예에서 거골하 관절 유합술을 시행하였다. AOFAS 족부-후족부 점수는 평균 81.2점이었다. 최종 추시에서Böhler각과 Gissane각의 평균값은 각각 20°, 119.8°였고, 종골의 높이, 길이 및 폭의 평균값은 각각 46.8 mm, 81.8 mm, 45.6 mm였다. 결론: Sanders 4형의 종골 골절에서 족근동 접근법을 통한 최소 침습적 내고정술을 시행했을 경우 만족할 만한 해부학적정복 및 안정적인 고정을 얻을 수 있었고, 대부분의 환자에서만족할 만한 임상적 및 방사선학적 결과를 얻을 수 있었다. 최소 침습을 통한 수술을 시행함으로써 광범위 외측 접근법을 통한 수술에 비해 연부조직 관련한 합병증을 줄일 수 있을 것으로 생각된다.

물위에서 걷는 거미의 다리 형태와 특징

김주필(Joo-Pil Kim),김대희(Dae-Hee Kim) 한국거미연구소 2016 한국거미 Vol.32 No.2

2014년 3월부터 8월18일 까지 닷거미과, 늑대거미과, 무당거미과, 왕거미과, 갈거미과를 수면 위에서 걷도록 하여 관찰 조사 연구한 결과를 이에 보고하는 바이다. From March to August 18 2014, after comparing and analyzing the tarsus structure of Pisauridae, Lycosidae, Nephilidae, Araneidae, Tetragnathidae, authors report the results of investigations. In observation of Arachnids tarsus structure with a scanning electron microscope, authors have found that wandering spiders inhabiting at the water’s edge have countless hairs on metatarsus and the hairs are covered with fine hairs. On the other hand, settling spiders have much less hairs on tarsus and the fine hairs on their hair were not observed.