We have reviewed seven cases of fracture-separation of the distal humeral epiphysis, one of which was initially misdiagnosed as a fracture of the lateral condyle. There were difficulties in making the diagnosis. The injury must be distinguished from an elbow dislocation and a fracture of the lateral humeral condyle. All seven patients revealed posteromedial displacement of the distal humeral epiphysis on initial x-rays. Three patients were treated by closed reduction and cast immobilization, and four patients by open reduction and internal fixation. All three patients with conservative treatment had slight cubitus varus (under 5 degrees). Two patients with operative treatment had significant deformities of the elbow, one 25 degrees of valgus and one 20 degrees of varus. In treatment of these injuries, accurate evaluation of the state of reduction is most important. We got acceptable results with a conservative treatment.
Child* ; Congenital Abnormalities ; Diagnosis ; Dislocations ; Elbow ; Epiphyses* ; Humans ; Immobilization

No abstract available.
Antibody Formation* ; Heat-Shock Proteins* ; Hot Temperature* ; Mucocutaneous Lymph Node Syndrome*

A total 48 cases of myelography using Metrizamide were performed between August 1981 and July 1983 at the department of Orthopedic Surgery, Kwangju Christian Hospital. Of these cases, H.N.P was 26, tuberculous spondylitis 16, spondylolisthesis 4, and multiple sclero-sis 2 cases. The advantages of this study were as folows: 1. Complications were minimal in most of the cases except a slight headache. 2. Large amount of infusion was possible. 3. Rootlet was clearly seen. 4. Removal of dye was not necessary. 5. It gave a good contrast for the radiologic study.
Gwangju ; Headache ; Metrizamide ; Myelography ; Orthopedics ; Spondylitis ; Spondylolisthesis ; Water

PURPOSE: We applied lateral lithotomy position to the severe ureteral stricture cases supposed to fail with only retrograde approach. MATERIAL AND METHODS: From October 1997 to April 1999, 13 patients with severe ureteral stricture (lenghth>2cm or complete obstruction) supposed to fail with only retrograde approach and one patient with study. The causes of ureteral strictures were pelvic malignancy in 5, tuberculosis in 4, trauma in 2 and others in 2. The patient's ipsilateral shoulder was rotated and fixed like lateral position. And ipsilateral pelvis was elevated with sandbag or pad and rotated about 45 degrees, too. The retrograde approach was tried at first, if fail, antegrade approach was combined. RESULTS: We could insert ureteral stent via retrograde approach only in 3 patients and we needed aid of antegrade approach for passage through ureteral stricture in the other 11 patients (79%). Percutaneous antegrade approaches were combined in those 11 patients and we could pass the guide wire and indwell the stent in 10 of 11 patients (91%) using this position. CONCLUSIONS: The lateral lithotomy position was very helpful to the simultaneous retrograde and antegrade approach in severe fibrotic or malignant ureteral strictures.
Constriction, Pathologic ; Humans ; Pelvis ; Shoulder ; Stents ; Tuberculosis ; Ureter*

Various susceptibility tests have been used to determine minimal inhibition concentration (MIC) of dermatophytes. They have limitations to apply practically because they need long time to determine MiC. Authors examined MIC of T. rubrum to ketoconazole and itraconazole using 96- well microplate and 24-well macroplate by method of Granade and Artis and tried to check the possibility of this method on clinical application. Nine strains of T. rubrum from patients with dermatophytosis were used. Evaluations of the factors affecting MIC were also tried. The results as follows. 1. Effect of inoculation density on determination time and MIC: Determination of MIC were possible in 4th days after inoculation at higher inoculation density (aborbance 2.0, 1.0) compared to 6th days at lower inoculation density (absorbance 0.5, 0.25). 2. Effect of incubation temperature on MIC: When incubating at 37℃, MIC were below 0.006-0.04µg/ml to ketoconazole and below 0.006-0.04µg/ml to itraconazole while at 25℃ 0.08-5.68µ8/ml to ketoconazole and 0.006-0.71µg/ml to itraconazole. Significant reduction of MIC was observed at 37℃ compared to 25℃. 3. Effect of container size on determination time and MIC: When incubating in 96–well microplate and 24-well macroplate, determination of MIC was possible in 4th to 6th days after inoculation in broth-containig 96-well microplate compared to 8th to 12th days in broth-containing 24-well macroplate. But no difference in MIC was observed between different container size. 4. Effect of media on MIC: When using broth as media, MIC were below 0.006-5.68µg/ml to ketoconazole, below 0.006-0.36µg/ml to itraconazole in broth-containg 24-well macroplate. When using agar as media, MIC were below 0.006-5.68 µg/ml to ketoconazole, below 0.006-5.68 µg/ ml to itraconazole in agar-containing 24-well macroplate. 5. These findings confirm that determination of MIC of dermatophtes by method of Granade and Artis is fast and simple technique for antifungal susceptibility test.
Agar ; Arthrodermataceae ; Humans ; Itraconazole ; Ketoconazole ; Methods* ; Tinea ; Trichophyton*

The surgical technique for removal of ruptured lumbar intervertebral disc has changed very little since it was introduced by Mixter and Barr in 1934. The technique of the interlaminar operation used by most neurosurgeons was used successfully in early cases to relieve the sciatica, but many patients were unable to return to heavy work because of low back pain. Cloward described a different surgical technique for removal of a ruptured lumbar intervertebral disc. The operation utilizes a transverse skin incision and a wide bilateral stlipping and retraction of fascia and muscles. The ligamentum flavum is not removed but detached and reflected medially in a flap. Only the bone margins of the adjacent facets are removed. A complete laminectomy is never done except for spondylolisthesis when the separate neural arch is disarticulated and removed. Using a "Vertebral Spreader", and interlaminar exposure is developed two to three times larger than that obtained y the "standard" technique. The advantages are obvious: 1. Both operations were done through a single transverse incision. A wider lateral exposure for the skin wound, being made parallel to the lumbar operation was possible and the normal skin lines, heals better with less scar. 2. The entire ligament is preserved, by separating its attachments from the lamina and reflecting in a flap, a larger opening into the spinal canal is obtained and the replaced flap protects the dura and prevents scarring. 3. Cloward recommends the use of a narrow, sharp chisel and hammer, but we used the spinal rongeurs including the Kerrison punch to remove part of the laminal edge. We leave the articular facets of the lumbar disc surgery because the articular facets are considered important major elements in the articulation of the vertebral joints, and as an essential bony surface to be used in posterior spinal fusion operation. 4. The routine use of intrathecal cortisone after lumbar disc operation has not been used in our cases because of increased pressure of the cerebrospinal fluid in modified prone position of the patient.
Cerebrospinal Fluid ; Cicatrix ; Cortisone ; Fascia ; Humans ; Intervertebral Disc ; Joints ; Laminectomy ; Ligaments ; Ligamentum Flavum ; Low Back Pain ; Muscles ; Prone Position ; Sciatica ; Skin ; Spinal Canal ; Spinal Fusion ; Spondylolisthesis ; Wounds and Injuries

This study was to evaluate the clinical usefulness of 99m Tc-MDP bone scintigraphy for assessing vascular ingrowth into the ocular implants after enucleation and evisceration. Twenty four patients(M:F=7:17, mean age:36), with a coralline hydroxyapatite after uncomplicated enucleation or evisceration surgery were studied. Uptake ratio was also calculated by measuring the implants activity(H)and contralateral orbit activity(N). Grading score and uptake ratio were compared with clinical outcome of vascularization. Additionally, we also analyzed the vascularization status as time lapse between primary surgery and scintigraphic study and surgical methods. The degree of grade and uptake ratio were inversely correlated with vascular ingrowth. Higher than grade 2 or greater than 1.56 in H/N ratio seemed to be an indicator for better prognosis. 99m Tc-MDP bone scintigraphy can be a useful method to evaluate the vascularized status of implants. Adequate time for 99m Tc-MDP bone scintigraphy after enucleation and evisceration was 11~20 weeks.
Durapatite ; Orbit ; Prognosis ; Radionuclide Imaging*

The investigation of systolic time intervals and hemodynamics was performed in 42 patients with liver cirrhosis by noninvascive methods. The patients were divided into four groups according to the presence or absence of anemia and/or ascites: i.e. group I; cirrhosis without anemia and ascites, group II; cirrhosis with ascites only, group III; cirrhosis with anemia only, and group IV; cirrhosis with ascites and anemia. In the resting state of the patients, the systolic time intervals and hemodynamic data were measured by the high speed simultaneous recordings of electrocardiogram, phonocardiogram, carotid and femoral arterial pulse tracings, and compared with those obtained from 155 normal adult subjects. 1. The pulse were increased considerably in group IV, and diastolic blood pressure was elevated in group II with significance. 2. The stroke volume and cardiac output were increased significantly in group III. 3. The peripheral resistance was reduced particularly in group III, and the volume elasticit coefficient was decreased in group IV. 4. The QS1 interval was prolonged significantly in group II and IV, but QS1 interval corrected by multiple regression equation proposed by our laboratory (illustrated in the text) did not show significant difference compared with that of normal subjects. 5. The left ventricular ejection time(LVET) and total electromechanical systole(QS 2) appeared to be shortened in group II and IV, but the corrected LVET and QS 2 were not different significantly from those of the normal subjects
Adult ; Anemia ; Ascites ; Blood Pressure ; Cardiac Output ; Electrocardiography ; Fibrosis ; Hemodynamics* ; Humans ; Liver Cirrhosis* ; Liver* ; Stroke Volume ; Systole ; Vascular Resistance

The investigation of systolic time intervals and hemodynamics was performed in 42 patients with liver cirrhosis by noninvascive methods. The patients were divided into four groups according to the presence or absence of anemia and/or ascites: i.e. group I; cirrhosis without anemia and ascites, group II; cirrhosis with ascites only, group III; cirrhosis with anemia only, and group IV; cirrhosis with ascites and anemia. In the resting state of the patients, the systolic time intervals and hemodynamic data were measured by the high speed simultaneous recordings of electrocardiogram, phonocardiogram, carotid and femoral arterial pulse tracings, and compared with those obtained from 155 normal adult subjects. 1. The pulse were increased considerably in group IV, and diastolic blood pressure was elevated in group II with significance. 2. The stroke volume and cardiac output were increased significantly in group III. 3. The peripheral resistance was reduced particularly in group III, and the volume elasticit coefficient was decreased in group IV. 4. The QS1 interval was prolonged significantly in group II and IV, but QS1 interval corrected by multiple regression equation proposed by our laboratory (illustrated in the text) did not show significant difference compared with that of normal subjects. 5. The left ventricular ejection time(LVET) and total electromechanical systole(QS 2) appeared to be shortened in group II and IV, but the corrected LVET and QS 2 were not different significantly from those of the normal subjects
Adult ; Anemia ; Ascites ; Blood Pressure ; Cardiac Output ; Electrocardiography ; Fibrosis ; Hemodynamics* ; Humans ; Liver Cirrhosis* ; Liver* ; Stroke Volume ; Systole ; Vascular Resistance

Currently, three different automated objective refractors are available commercially and are being used throughout the world. The most recently developed objective refractor. Dioptron, is an electro-optical instrument for measuring the refractive state of the eyes. The computer in this instrument takes the measurements and calculates automatically his objective refraction in term of sphere, cylinder and axis corrected for 12mm vertex distance. The motivation for this investigation was the need for a quantitative evaluation of Dioptron to determine how it may be utilized most effectively in clinical practice. The results in this study are based on comparisions of differences between Dioptron and streak retinoscopy which were examined the random samples of 800 eyes. In this analysis, authors found that the Dioptron proved to be more accurate in the cylinder and axis and equivalent in sphere findings when compared to streak retinoscopy although Dioptron could not replace physician's judgement.
Axis, Cervical Vertebra ; Evaluation Studies as Topic ; Motivation ; Retinoscopy*