Free vascularized fibula is often used in orthopaedic reconstructive surgery because the fibula is a straight cortical bone, long enough, and has a long vascular pedicle. But morbidity is occurred at the donor site which may cause problems at the ankle in children. We reviewed 10 causes who had free vascularized fibula transfer at the Department of Orthopaedic Surgery, Yonsei University College of Medicine from January 1984 to June 1989. This study is attempted to evaluat the effects of fibular defect on the ankle in children and the results of treatment. Free vascularized fibula transfer was done in 5 cases due to ossifying fibroma, 3 cases due to nonunion of fracture and 2 cases due to congenital pseudoarthrosis. The average valgus deformity was 3 degrees in 2 cases in which distal tibiofibular fixation was done with one screw and 6 degrees in 8 cases in in which distal tibiofibular fixation was not done. Three cases had severe valgus deformity and secondary operation was done. The attended type of operation was distal tibiofibular fusion in 3 cases. The valgus deformity was changed after distal tibiofibular fusion from 4 degrees to 3 degrees in 3 cases. The size of fibular defect did not effect on the degree of valgus deformity of the ankle. In conclusion, fibular defect can cause valgus deformity of the ankle in children and early distal tibiofibular fusion is recommended to prevent valgus deformity of the ankle in growing child who as defect on fibular.
Ankle ; Child ; Congenital Abnormalities ; Fibroma, Ossifying ; Fibula ; Humans ; Pseudarthrosis ; Tissue Donors

BACKGROUND AND OBJECTIVES: As previously reported, unstable angina is usually related to characteristic coronary artery lesion's morphology analyzed by coronary angiogram. This takes the form of an eccentrically placed convex stenosis with a narrow neck due to one or more overhanging edges or irregular, scalloped borders, or both. Although most studies were done for lesions with high degree stenosis(>50%), recent studies emphasized the role of vulnerability of plaque in acute coronary syndrome and even mild degree stenotic lesions may progress rapidly to evoke acute coronary syndrome. Therefore in this study, we analyzed the morphological characteristics of coronary artery lesions with mild degree stenosis as well as severe stenosis. MATERIALS AND METHODS: We conducted a retrospective study of 96 patients with angina pectoris (42 of stable patients and 54 of unstable patients) who underwent coronary angiography. Each lesions with 25% or greater diameter stenosis were categorized into simple and complex lesion(convex intraluminal obstruction with a narrow neck or irregular borders, diffuse irregularities, ulceration, thrombus). Calcification of coronary artery, extents of lesions were analyzed and stenosis grade and location were categorized by AHA classification. RESULTS: There were no significant differences between the stable angina and unstable angina in risk factors and vessel involvement, numbers of lesions, calcification and total obstruction. In morphologic analysis, complex lesions were more frequent in unstable angina than stable angina (49% vs 33%, p<0.05). The mean of percent diameter stenosis was not signigicantly different between two groups, but severe stenotic lesions with 90% or more stenosis were more frequent in unstable angina (34% vs 22%, p<0.05). Locations of involved vessels were similar between the angina groups. Complex lesions were distributed more frequent in RCA and simple lesions were more in LAD and LCX (p<0.05). CONCLUSIONS: The lesions with both complex morphology and severe degree stenosis are closely implicated in unstable angina.
Acute Coronary Syndrome ; Angina Pectoris ; Angina, Stable ; Angina, Unstable* ; Classification ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels* ; Humans ; Neck ; Pectinidae ; Retrospective Studies ; Risk Factors ; Ulcer

ObjectiveTo explore the relative factors of the compliance in schizophrenic out-patients.Methods118 schizophrenic out-patients chosen randomly were investigate with the compliance and assessed with Clinical Global Impression-Severity of Illness (CGI-SI), Social Disability Screening Schedule (SDSS), Brief Psychiatric Rating Scale (BPRS) and Treatment Emergent Symptom Scale (TESS) by telephone. Logistic regression analysis was used to confirm the relative factors of the compliance.Results56.8% of all patients were of full compliance. The risk factors of compliance in schizophrenic out-patients were the frequency of medicine taken, the scores of CGI-SI and the insight of the illness. ConclusionIt is important to choose effective and convenient antipsychotic drugs and improve the insight of the illness to enhance the compliance of the schizophrenic out-patients.

Ossifying fibroma is a benign tumor which arises typically within the jaw bone and rarely affect the long bone. The usual affected site in the long bone is tibia and fibula. Ossifying fibroma has a moderate tendency to progress during childhood and ceases to progress after puberty. So, surgery should be delayed as long as possible. But if the lesion is wide, which may cause pathologic fracture or severe deformity, it would be necessary to resect the lesion and restore the alignment. We have experienced 10 cases of ossifying fibroma which were treated at Department of Orthopaedic Surgery, Yonsei University College of Medicine, from Jan. 1984 to Nov. 1992. Results were.as follows: l. Among 10 cases, female was 5 cases and male was 5 cases. Age at operation was 9 years 1 month in average ranging from 1 year 7 months to 18 years 6 months. 2. The lesion site was 9 cases in the tibia, 1 case in the fibula. 3. Attended type of treatment was 3 cases of bone biopsy and observation, 1 case of curettage and bone graft, 1 case of curettage, external fixation with Ilizarov apparatus and internal transportation, 1 case of resection with curettage and free vascularized fibular graft, and 4 cases of wide resection and free vascularized fibula graft. 4. Second operation was needed in 2 cases due to recurrence which were performed incomplete wide resection. In conclusion, continuous observation is needed until puberty when the lesion ceases to progress in ossifying fibroma but radical surgery like wide resection and free vascularized fibula transfer is needed if there is a risk of pathologic fracture or severe bowing deformity due to its large size.
Adolescent ; Biopsy ; Congenital Abnormalities ; Curettage ; Female ; Fibroma, Ossifying ; Fibula ; Fractures, Spontaneous ; Humans ; Jaw ; Male ; Puberty ; Recurrence ; Tibia ; Transplants ; Transportation

Various methods have been described for surgical treatment of recurrent shoulder dislocation. Arthroscopic techniques for stabilizing the shoulder have the theoretical advantage of reduced complication, decreased discomfort, and improved motion. The arthroscopic Bankart procedure was performed in 23 cases at Department of Orthopaedic Surgery, Yonsei University College of Medicine, from January, 1991 to December, 1993. This study is an attempt to evaluate results of arthroscopic Bankart procedure by Caspari's technique. Results of this study were as follows: l. According to the clinical evaluation of Rowe, results were excellent in 18 cases, good in 2 cases, fair in 1 cases and poor in 2 case. The prognosis was related to the size of Hill-Sachs lesion. 2. Complication after treatment included 5 cases of knot problem, 1 case of subluxation, and 2 cases of redislocation. Redislocation was developed in one patient who played ice hockey at 2 months after operation and in one patient who played soccer at 8 months after operation. Subluxation was developed in one patient who had psychologic problem. Among 5 patients who had knot prob- lem, two patients had a operation of removal. In conclusion, Caspari's suture technique in arthroscopic Bankart procedure needs some modification on the insertion point of the guide pin and suturing technique. And arthroscopic Bankart procedure by Caspari's technique offers good cosmetic results, low perioperative morbidity, low complications except knot irritation, and excellent results by the Rowe's criteria for patients with anterior shoulder instability.
Arthroscopy ; Hockey ; Humans ; Prognosis ; Shoulder ; Shoulder Dislocation ; Soccer ; Suture Techniques

OBJECTIVETo study the efficacy of Xiaoyao Powder (XYP) combined with interferon alpha (IFN-alpha) in treating HBeAg positive chronic hepatitis B (CHB) patients and the effect on their quality of life (QOL).

METHODSTotally 193 patients with HBeAg-positive CHB confirmed by liver biopsy were randomly assigned to 2 groups, Group A (94 cases) and Group B (99 cases). IFN-alpha1b was subcutaneously injected to patients in Group A at the dose of 50 microg, thrice per week. Those in Group B additionally took XYP. The therapeutic course for all was 24 weeks. Clinical efficacy was observed by assessing ALT restoration rate, HBeAg negative rate, HBeAg conversion rate, HBV DNA negative rate, complete response rate, partial response rate, and symptoms integral. The evaluation of QOL was performed by using chronic liver disease questionnaire (CLDQ) score. Adverse reaction occurrence rate was observed in the two groups.

RESULTSBetter effects were obtained in Group A on ALT restoration rate, HBeAg negative rate, HBV DNA negative rate, complete response rate, partial response rate, TCM symptoms integral, the total effective rate of TCM sysmptoms, CLDQ score, and adverse reaction rates, showing statistical difference when compared with Group B (P < 0.05, P < 0.01).

CONCLUSIONXYP could elevate the efficacy of TCM symptoms of HBeAg-positive CHB patients and anti-viral effect, improve their QOL, and reduce adverse reaction of IFN-alpha.

Adult ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Hepatitis B e Antigens ; Hepatitis B, Chronic ; drug therapy ; Humans ; Interferon-alpha ; therapeutic use ; Male ; Quality of Life ; Treatment Outcome

No abstract available.
Esophageal Achalasia*

OBJECTIVETo investigate the effectiveness of anterior debridement,bone graft, and posterior pedicle screw-rod internal fixation in the treatment of lumbosacral tuberculosis.

METHODSFrom January 2005 to June 2012,18 patients with lumbosacral tuberculosis undergoing the surgical treatment by anterior debridement, bone graft, and posterior pedicle screw-rod internal fixation were reviewed retrospectively. There were 12 males and 6 females with an average age of 44 years old ranging from 35 to 67. Among them, 2 cases were simple low back pain,3 cases were low back pain combined with radiating pain of lower extremity and 13 cases were muscle strength hypesthesia. According to Fankle grading,the nerve function was grade C in 3 cases,grade D in 10 cases,grade E in 5 cases. Of these cases,L4.5 was involved in 8 cases,L5 in 4 cases and L5S1 in 6 cases. The lumbosacral angle was 150 to 270 and the erythrocyte sedimentation rate (ESR) was 45 to 93 mm/h before treatment. The clinical indexes including the lumbosacral incidence, Frankel grade and ESR were reviewed at follow-up.

RESULTSAll 18 cases were followed up for 14 to 22 months. The mean operation time was 180 min. The amount of bleeding was 400 to 800 ml. Except 1 case with iliac vein injuried and 4 cases with abdominal distension,no spinal injuries and severe relative complication occurred, and neurologic function improved in various degrees. Pain in lumbosacral area and radicular pain in lower extremities disappeared. The X-ray and CT films demonstrated that bony fusion was obtained in all patients during 9 to 13 months postoperatively. The lumbosacral angle and ESR were improved significantly.

CONCLUSIONAnterior debridement, bone graft, and posterior pedicle screw-rod internal fixation is an effective method in dealing with lumbosacral spine tuberculosis.

Adult ; Aged ; Blood Loss, Surgical ; Bone Transplantation ; Debridement ; Female ; Fracture Fixation, Internal ; instrumentation ; Humans ; Lumbosacral Region ; injuries ; surgery ; Male ; Middle Aged ; Pedicle Screws ; Retrospective Studies ; Tuberculosis, Spinal ; surgery

A 17 year old girl underwent a surgery of spine fusion for a tuberculous cervical spine (C(4~5) ) under halothane-02 anesthesia. On the 1st postoperative day, sudden high fever(39.7 degrees C) with chillness and leukocytosis with eosinophilia were noted. On the following day, generalized jaundice, right hypochondralgia and slight hepatomegaly with marked impairment of liver function tests were noted. HB antigens were negative and there was no transfusion history of blood or blood products. About 2 months after operation, she was discharged with symptomatic improvement and almost normal laboratory data.
Anesthesia* ; Drug-Induced Liver Injury* ; Eosinophilia ; Female ; Halothane* ; Hepatomegaly ; Humans ; Jaundice ; Leukocytosis ; Liver Function Tests ; Spine

Succinylcholine has been reported to cause elevation of intraocular pressure(IOP.) IOP measurements, following single and mixed intravenous administration of succinylcholine and pancuronium, given immediately after thiopental, were made in 40 surgical patients, to assess the effect of pacuronium on the succinylcholine induced increase in IOP. The major findings of this study were as follows; 1) Tbiopental showed significant lowering effect on IOP. 2) A single intravenous injection of succinylcholine(1mg/kg) caused a slight rise of lOP. 3) A single intravenous injection of pancuronium(4mg) caused a slight decrease of IOP. 4) A mixed intravenous injection of succinylcholine and pancuronium increased the IOP more significantly than succinylcholine alone, This also means that pancuronium do not inhibit succinylcholine induced increase In IOP. 5) Tracheal intubation caused a rise of IOP significantly.
Administration, Intravenous* ; Humans ; Injections, Intravenous ; Intraocular Pressure* ; Intubation ; Pancuronium* ; Succinylcholine* ; Thiopental