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This is an analysis of 1282 cases of poliomyelitis from patient records gathered over a 20 year period from the year of 1964. The results are as follows : 1. The most visits recorded in any one year were 301(23%) in 1965. The most visits recorded in a 5 year period were 961(67%) in the years of 1965–1969. 2 Of a total of 1158 cases whose year of onset was recorded, the earliest onset was in 1900: only one case. Since 1981 no new onsets have been recorded. However, the majority of cases : 1014(87%) showed an onset between 1955–1974. 3. Of a total of 1282 cases whose place of residence at primary examination was recorced, 891(70%) resided in Seoul and 391(30%) in the rural areas. 4. Of a total of 1282 cases whose sex was recorded, males comprised 777(61%) and females 505(39%). 5. Of a total of 883 cases whose season of onset were recorded: 526(60%) onsets occured in the warm, 272(31%) in the cool, and 85(9%) in the cold season of yesr. 6. Of a total of 1155 cases whose age at onset was recorded, the youngest was 4 months and the oldest 28 years of age. The largest group comprising 915 cases(79%) were two years of age or younger. 7. Of a total of 1146 cases whose period between onset and primary visit was recorded: 182(16%) were in acute, 414(36%) were within convalescent, and 732(64%) were in residual stage. 8. Of a total of 1268 cases whose age at initial examination was recorded, 233(18%) were two years or younger, 1021(81%) were 14 years or younger. 9. Of a total of 445 cases whose vaccination history was recorded, 234(53%) had been vaccinated prior to onset. Of those only 112(48%) had completed the required course of vaccincation. 10. Of the total of 1282 cases, deformities resulting from muscular paralysis were recorded in 1099(86%) cases. The number of deformities occuring in these cases totalled 3141: 189 deformities(6%) were in the trunk, 64(2%) were in upper extremity, and 2888(92%) were in lower extremity. Among the lower extremity, 1270(40%) were in the foot. The most frequent single deformity was knee flexion with the total of 464(15%). 11. Of a total of 798 cases whose leg length was verified, 394 were measured by scanogram and 404 cases by measurement of actual leg length. The greatest leg length discrepancy was 12cm in a 17 year-old male, and the most average discrepancy in those bone growth completing, age of 17–20 years, was 3.2cm. 12. Of a total of 1282 cases, 503(39%) cases had prescriptions for supportive devices, but only 316(25%) cases actually had made and wore them. Among those prescriptions, the most common type prescribed was the long-leg brace, which totalled 351. 13. Of the total of 1282 cases, 449(35%) received 1297 surgical procedures, an average of 2.9 per patient. The operations on soft tissue comprised 734(57%) procedures : 348 tendon transplantations with the most(170 procedures) on peroneals, 147 tendon lengthenings with the most(146 procedures) on Achilles tendon, and 234 fasciotomies with the most (117 procedures) on iliotibial band. The operations on bone and joint comprised 563(43%) procedures : 274 leg length equalizations with the most(172 procedures) of growth stimulation, 186 arthrodeses with the most(115 procedures) of triple arthrodesis of the foot, and 92 osteotomies with the most(41 procedures) on tibis. 14. Since problems remaining in the residual stage of poliomyelitis are almost always permanent, observation of these cases over a long period of time has generated invaluable experience from which we have gained considerable knowledge. 15. It has been a revelation to see the considerable degree of compensation in growing children such as a decrease in leg length discrepancy as the end of growth approached. Cases of so called hand-knee gait showing hypertrophy of fingers have lost this in a few years, following corrective measures. 16. We feel that all cases of leg length discrepancy do not need to be treated uniformly, considering the power of the ability of growing children to compensate without any inter vention. 17. Prediction of type of motion or deformities using physical examination of muscular paralysis is very difficult because the compounding factors of not only the paralysis of various muscles but the individual characteristics. The age, sex, lifestyle, motivation etc. have been shown to have an over-riding influence. 18. Decisions to brace or operate should not be made hastily but only after careful and thorough examination. We saw many quite severely disabled cases walk remarkably well without braces or surgery by their own means of compensation or device. 19. Cases with almost no lower extremity muscle power except for 20–30% hip rotators could walk surprisingly well using the sartorius muscle as a main controlling force. So we dubbed their manner of walking the sartorius gait. 20. Bracing can be very burdersome, and decisions to brace should not be made on the textbook alone. Some cases happily choose surgery over bracing. 21. For one time surgical procedure, it is better to choose bone over soft tissue for a better result. When the surgery is two stage, soft tissue surgery done after bone and joint surgery has healed will produce better results. 22. We must all realize that not only poliomyelitis, but also all chronic diseases need mental treatment as well as physical. Because, in rehablitation mental disablity is more harmful than physical in the final analysis.
Achilles Tendon ; Age of Onset ; Arthrodesis ; Bone Development ; Braces ; Child ; Chronic Disease ; Compensation and Redress ; Congenital Abnormalities ; Female ; Fingers ; Foot ; Gait ; Hip ; Humans ; Hypertrophy ; Joints ; Knee ; Leg ; Life Style ; Lower Extremity ; Male ; Motivation ; Muscles ; Osteotomy ; Paralysis ; Physical Examination ; Poliomyelitis ; Prescriptions ; Seasons ; Seoul ; Tendons ; Tenotomy ; Upper Extremity ; Vaccination ; Walking

This is an analysis of 137 feet of triple arthrodesis over a period of 23 years.1964–1987. The average period of follow-up was 4 years and 2 months. The results are as follows. 1. The ratio of male to female was 64 to 68 cases, and right to left was 75 to 62 feet. 97 feet(70. 8%) were operated on between late 1960 and early 1970. 89 cases(67.4%) came for their initial examination when they were aged between 9–20 years. Age at the surgery was between 55/12–50 years, and among them 134 feet(97.8%) were operated after age of 8 years. 2. 128(93.4%) out of 132 cases were residual poliomyelitis, and 97(70.8%) out of 137 feet were equinovarus. 3. 100 out of 132 cases receiving triple arthrodesis also received a total of 179 additional procedures simultaneously to achieve better correction. The major additional procedure was. Achilles tendon lengthening in 81 cases followed by plantar fasciotomy in 49 cases. 4. Surgical approach was by Ollier's method, and arthrodesis by Lambrinudi's method. 5. 134 out of 137 feet required triple arthrodesis in order to correct the deformity. On this operative procedure it was utmost important to dissect the tarsal bones and surrounding soft tissues thoroughly to loosen and rearrange the joints. In this way even severe deformity was corrected satisfactorily. 6. At the time of Achilles tendon lengthening by Z-plasty deviding it longitudinally, on the tibial side the tendon was cut at the calcaneal attatchment, and on the fibular side at the proximal end. We think that this produced more efficient and satisfactory results especially in the correction of equinovarus. 7. Internal fixation was done by one staple on 110 feet and two staples on 7 feet. On one staple use, it was inserted connecting the talus and the cuboid. More firm contact between two bones as it progressing into bone was achieved by placing with slightly spread legged staple. 8. We could not find any pseudoarthrosis or delayed union. It is assumed the reason for this was good dissection of bone and joint, firm internal and external immobilization, and good postoperative management. 9. Talar and navicular necrosis occurred in 6 feet(4.4%), but did not affect the final fusion of the arthrodesis. In relatively severe necrosis, we found flattening of the talus and complaint of considerable pain but nevertheless, no special additional procedure was done. 10. We found some cases of postoperative degenerative hypertrophic osteoarthritis in tibio-talar and navicular-cuneiform joint. We feel this phenomenon is due to compensatory stress emanating from the fusion of three joint, and new contact of articular surfaces with changed biomechanical force. 11. When doing triple arthrodesis, the optimal age for surgery is 10-12 years, i.e., before the completion of bone growth, the reason is during the remaining period of bone growth, there is opportunity for the bone and other tissues to adjust to the newly formed stresses of weightbearing and joint motion. 12. Of a total of 137 feet receiving triple arthrodesis, excellent results were seen in 31(23%), good in 82(60%), fair 20(14%) and failed in 4(3%).
Achilles Tendon ; Arthrodesis ; Bone Development ; Clubfoot ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Foot ; Humans ; Immobilization ; Joints ; Leg ; Male ; Methods ; Necrosis ; Osteoarthritis ; Poliomyelitis ; Pseudarthrosis ; Surgical Procedures, Operative ; Talus ; Tarsal Bones ; Tendons ; Weight-Bearing

Objective To investigate the feasibility,safety and effect of gasless laparoscopic surgery used in patients at the second trimester.MethodsFrom Aug.2006 to Aug.2008,the data of 10 cases at gestational 15 - 24 weeks complicated by ovary benign tumors ( the diameters more than 5 cm) undergoing gasless laparoscopic surgery were studied retrospectively.Operation time,bleeding loss,period of hospitalization,the status of fetus and newborn babies,and peri-operative or postoperative complications were observed.ResultsAll 10 cases were treated by gasless laparoscopic surgery,including 4 cases with mature teratoma,5 cases with epithelial tumors and 1 case with ovarian endometrioma.The mean time of surgery was (30 ± 5) minutes,the mean bleeding in the surgery was (30 ± 8) ml,the mean period of in hospitalization was ( 6 ± 2 ) days.The blood gas ( pH:7.42 ± 0.11,7.41 ± 0.18,7.42 ± 0.12 ),blood pressure [ mean arterial pressure (MAP):(90.4 ± 3.1 ),(90.6 ± 0.7 ),( 89.7 ± 0.8) mm Hg( 1 mm Hg =0.133 kPa) ] and heart rates [ ( 84.0 ± 1.6),( 84.3 ± 1.7 ),( 82.7 ± 1.1 ) bpm ] in all cases at pre,peri and postoperative time did not show statistical difference ( P all ＞ 0.05 ).The fetal hearts were all in the normal range preoperative,intraoperative and postoperative time (P ＞ 0.05 ).No perioperative and postoperative complications were observed.All the cases underwent term delivery.Fetal weight and Apgar score did not show abnormality.ConclusionGasless laparoscopic surgery at the second trimester is feasible and safe to mother and fetus.

Objective To explore the effect of multi-detector computed tomography (MDCT)scan parameters and imaging post-processing methods on metallic artifacts,so as to achieve the perfection in reduction of artifacts caused by metallic implants.Methods Water phantom with titanium alloy steel plate was scanned under MDCT with alternating scan parameters including tube voltage, tube current,pitch and focal spot.The areas of image artifacts were measured and correlated with the scan parameters.Another 1 5 postoperative patients with vertebral implantation scaned with the conventional scan parameters were also included in the study.Ima-ging post-processing including multi-planar reconstruction (MPR),window width and level adjustment,and volume rendering tech-nique (VRT)was performed by using optimized and conventional methods,respectively,and then the image quality was evaluated. Results The areas of image artifacts under the differnt tube voltage,pitch,and focal spot were statistically different.With the in-crease of the tube voltage or the decrease of the pitch,the area of image artifacts decreased gradually.The area of image artifacts scanned with the small focal spot was smaller than the large one.There was no significant difference for the area of image artifacts scanned with the different tube currents.The metallic artifacts decreased by using the soft tissue algorithm (Kernel B40f)in the bone window reconstruction,wide windows (2 000 HU window width,600 HU window level)in observing,and VRT.Conclusion Selection of appropriate MDCT scan parameters and imaging post-processing methods can reduce the metal artifacts,improve the image quality and diagnosis.

We have treated three cases of bone abscesses, two in proximal tibia and one in os calcis, by radical excision and filling the remaining bone cavity with autogenous iliac bone graft. We have observed them postoperatively for one to six years. They have not shown any sign of recurrence and they are carrying out their normal daily activity without any restriction. Eventhough it is against the basic fundamental of surgery to lay bone grafts in an infected area, our treatment was successful. We believe that this was resulted from the administration of the broad spectrum antibiotics, complete excision of the diseased tissue, gentle handling of the tissue at the surgery, and relatively perfect postoperative care. When the remaining bone cavity after the surgery of the osteomyeIitis can not filled by the usual method such as muscle pedicle graft, especially in the proximal metaphyseo-epiphyseaI region of the tibia, fresh cancellous bone graft immediately after the radical excision, and primary closure of the operative wound may be tried. It seems that this method brings rapid and permanent heaIing of the chronic osteomyelitis. Thus the patient can leave hospital earlier, pays Iess expense, and returns to his work earlier.
Abscess ; Anti-Bacterial Agents ; Humans ; Methods ; Osteomyelitis ; Postoperative Care ; Recurrence ; Tibia ; Transplants ; Wounds and Injuries

Objective To analyze the influence of different types of seizures and nonepileptic events on peripheral white blood cell (WBC)counts. Methods We prospectively collected blood samples from all patients and detered WBC count to evaluate the relation of each type of seizure,duration,frequencies,and ttme lapse between a seizure and collection of blood sample to peripheral WBC count. Results Peripheral WBC count was elevated in about 50% cases after a generalized seizure. The length of a seizures was positively associated, whereas its frequencies and the lapse time was negatively correlated with the increase in WBC counts. Conclusion Peripheral WBC counts increase significantly after a generalized seizure.

Objective To establish a UPLC-Q-TOF-MSE fingerprint of Yiqi Fumai Injection (YQFM) for providing reference for visual, easy and overall control of its quality. Methods The chromatographic separation was performed on a Waters Acquity UPLC HSS T3 (100 mm × 2.1 mm, 1.8 μm) column with the mobile phase consisting of acetonitrile and 0.1% formic acid for gradient elution. The flow rate was 0.3 mL/min, and the column temperature was 30 ℃. The capillary voltage was set at 2.5 kV. The nebulization gas was set to 800 L/h at 400 ℃, and the source temperature was 100 ℃. The BPC obtained with negative ion ESI mass spectra were selected for the fingerprint analysis. Similarity evaluation was used to evaluate the quality of YQFM from different batches. Based on the intensities of the ions for common peaks, HCA and PCA were performed using SPSS 19.0 and Simca-P software. Results The UPLC-Q-TOF-MSE fingerprint of YQFM was established by using 28 batches of sample and 18 common peaks were found, of which 15 mutual peaks from Ginseng Radix et Rhizoma rubra, three mutual peaks from Ophiopogonis Radix. Compared with the reference substances and references, 16 of the common peaks were identified and the similarity of 28 batches samples were over 0.970. 28 batches of YQFM could be divided into four grades when the sum of squared Euclidean distance is 5-10 in the result of HCA; PCA got seven principal components through dimension reduction and accumulative contribution rate reached 84.989%. By fitting the load factor model of the first principal component, ten markers greatly impacting on the quality were found. The comprehensive evaluation function of YQFM in different batches was constructed according to the principal component score. Among 28 batches of YQFM, the comprehensive score of S28 was the best, closely followed by S22, S11 and S9, while S14 and S13 was the worst. Conclusion The utilization of UPLC-Q-TOF-MSE fingerprint coupled with chemical pattern recognition could objectively and effectively assess the quality of YQFM, can provide a more comprehensive reference for the quality control of YQFM.

Objective To establish a quantitative analysis of multi-components with a single-marker (QAMS) method for the determination of nine components in Yiqi Fumai Injection (YFI). Methods Ginsenoside Rb1 was used as internal reference substance. The relative correlation factors (f) of ginsenosides Rg1, Re, Rf, Rc, Ro, Rb2, Rd, and schisandrin were calculated and established by HPLC. The separation was performed on a Diamonsil® C18 column (2) (250 mm × 4.6 mm, 5 μm), with the mobile phase consisting of acetonitrile and 0.05% phosphoric acid water for gradient elution. The column temperature was 30 ℃, and the detection wavelength was set at 203 nm, flow rate was 1 mL/min. The results were compared with those obtained by the external standard method in 25 batches of YFI. Results Ginsenosides Rg1, Re, Rf, Rb1, Rc, Ro, Rb2, Rd, and schisandrin had good relations within the ranges of 0.929-4.644, 0.818-4.089, 0.732-3.660, 1.461-7.305, 0.636-3.181, 0.618-3.092, 0.788-3.941, 0.758-3.789, and 0.178-0.889 μg, respectively. The recovery rates were 97.08%-100.94%. The f values of ginsenosides Rg1, Re, Rf, Rc, Ro, Rb2, Rd, and schisandrin to ginsenoside Rb1 were 1.970, 0.929, 1.196, 0.870, 0.830, 0.786, 0.906, and 12.082. The two methods did not show the significant difference in assay results. Conclusion The QAMS method is feasible and credible, and could be used to determine the multiple components in YFI.

Administration, Rectal ; Adolescent ; Adult ; Aged ; Chronic Disease ; Drugs, Chinese Herbal ; administration & dosage ; Humans ; Male ; Middle Aged ; Phytotherapy ; Prostatitis ; drug therapy ; Suppositories