Leg length discrepancy or short stature is a significant problem to patient psychosocially, cosmetically, and there has been many efforts for limb lengthening. There are many report about lower limb lengthening since the first description of femoral lengthening by Codivilla in 1905. Although limb lengthening using external fixator was popularized by Anderson, the result was poor because of many difficulties in techniques and complications. Recently, a great progress in lower limb lengthening was made by distraction osteogenesis by llizarov and callotasis by De Bastiani. But as such exter- nal fixator has some problem in technique, cosmesis or complications. Therefore gradual elongation intrameduilary nailing(Albizzia) developed by Guichet in 1986 has gained attention for more stability and relatively less discomfort. We reviewed 18 cases in 11 patients(5 males and 6 females) who visited the department of Orthopedic Surgery of Severance Hospital at Yonsei University with limb leg length discrepancy due to sequeale of poliomyelitis, familial short stature and Turner syndrome. They all underwent lower limb lengthening using Albizzia technique between December 1995 and January l997. The average age at the time of the operation was 22.7 year. Famiiial short stature was in 12 cases(67%), Turner syndrome in 2 cases(11%), and leg length discrepancy due to the sequelae of poliomyelitis in 4 cases(22%). The site of lengthening were 5 cases of femur(28%) and l3 cases of tibia(72%). The latency period was average of 7 days. During the distraction period, 15 ratchetings per day(1 mm/day) were performed. In case of bilaterai femoral lengthenings, average length of gain(LG) was 6.0cm and percentage of increase(PI) l6.8%(16.2-17.4), lengthening index(LI) 1.2 month/cm(0.75-2.2). In case of unilateral femoral lengthening, LG was 3.8cm, Pl 7.8 %, Ll 1.3 month/ cm. In case of bilateral tibial lengthening, average LG was 5.5cm(3.5-6.0~) and Pl 18.8%(12.0-22.9), LI 1.3month/cm(0.67-2.3). In case of unilateral tibial lengthening, LG was 2.9cm(2.3-3.5), P1 9.4 %(7.7-11.7), LI 2.8 month/cm(2.2-3.1). Lengthening index in poliomyelitis by llizarov was 3.l month/cm, but it was 1.3 in femur and 2.8 in tibia hy Albizzia method. There are some advantages and disadvantages or contraindications and indications of the Albizzia technique. We suggest that the Albizzia technique is more stahle, more comfortable and no longer lengthening time compared to external fixator such as Ilizarov.
Albizzia ; External Fixators ; Extremities* ; Femur ; Humans ; Latency Period (Psychology) ; Leg ; Lower Extremity ; Male ; Orthopedics ; Osteogenesis, Distraction ; Poliomyelitis ; Tibia ; Turner Syndrome

BACKGROUND: The loss of ganglion cells observed in Alzheimer's disease (AD) patients might be attributable to a neurodegenerative process involving the neuroretinal structure. The objective of this study was to determine the retinal thickness in patients with AD using optical coherence tomography (OCT). METHODS: Neuro-ophthalmologic examinations were performed in eight AD patients and eight age-matched control subjects. The average thicknesses of the retinal nerve fiber layer (RNFL) and the ganglion cell-inner plexiform layer (GCIPL) were measured using spectral-domain OCT in both subject groups, and the results were compared. RESULTS: The RNFL was thinner in AD patients than in the age-matched controls (p<0.05), especially at the nasal and inferior retina, and the GCIPL was also significantly thinner (p<0.05). CONCLUSIONS: The decreased retinal thickness observed in AD patients suggests that OCT can be used as a biological marker of AD. The findings of this preliminary study suggest that the extent of the reduction in GCIPL and RNFL thicknesses should be investigated further.
Alzheimer Disease ; Biomarkers ; Ganglion Cysts ; Humans ; Nerve Fibers ; Retina ; Retinaldehyde ; Tomography, Optical Coherence

OBJECTIVES: Aim of this study is to investigate the clinical efficacy of the vestibular function tests (VFTs) and the predictability of lesion side of vestibular asymmetry parameters in acute unilateral peripheral vestibulopathy. METHODS: Medical records and results of VFTs (caloric, rotatory chair, and head impulse tests) of 57 patients with acute unilateral vestibulopathy were reviewed retrospectively. The VFTs were examined within 7 days after the clinical onset. RESULTS: For the caloric test, 74% showed significant canal paresis and the predictability of lesion side was 88%. For the sinusoidal harmonic acceleration test, 91% had low gain in at least 1 Hz, phase lead showed 70%, 89% showed phase asymmetry and the predictability of lesion side was 90%. For velocity step test, 67% had abnormal Tc asymmetry and the predictability of lesion side was 95%. In bedside head impulse test (HIT), abnormal catch up saccades were observed in 89% and the predictability of lesion side was 100%. For the video HIT, cover or overt catch-up saccades were observed in 95% and the predictability of lesion side was 100%. One hundred percent (100%) had low gain on the video HIT, but the lesion sides were uncertain because of bilateral involvements or artifacts. CONCLUSIONS: The most important things in the diagnosis of acute unilateral vestibulopathy are typical clinical symptoms and spontaneous nystagmus. A combination of rotatory, caloric, and HITs will result in a more complete examination of the vestibular system. Among them, HIT is recommended as the best tool in acute unilateral vestibulopathy.
Acceleration ; Artifacts ; Caloric Tests ; Diagnosis ; Exercise Test ; Head ; Head Impulse Test ; Humans ; Medical Records ; Paresis ; Retrospective Studies ; Saccades ; Treatment Outcome ; Vestibular Function Tests

The tibial pilon fracture has been described as difficult fracture to manage. We have reviewed 23 cases of tibial pilon fractures from Mar. 1987 to Feb. 1993 at our hospital. 1. The fractures were classified into five types according to the system of Ovadia and Beals and the methods of treatment were divided into two groups; 9 cases were treated with Ilizarov device(Group I). 6 cases out of Group I were type 3, 4 and 5. Other methods were performed in 14 cases(Group II). 8 cases out of Group II were type 3, 4, and 5. 2. In type 3, 4 and 5 fractures, there were 86 per cent good and fair radiographic results in Group I and 63 per cent good and fair results in Group II. 3. Satisfactory results were obtained by the treatment of Ilizarov method especially in type 3, 4 and 5 fractures. The advantages of Ilizarov device were its primary reduction with ligamentotaxis, easy open reduction due to proximal and distal stabilization, minimal soft tissue injury and minimal internal fixation.
Ilizarov Technique ; Methods ; Soft Tissue Injuries

A 32-year-old man was transferred to an intensive care unit due to respiratory difficulties with a 4-day history of progressive areflexic quadriparesis following acute hepatitis A. A nerve-conduction study revealed inexcitability of most nerves. The cerebrospinal fluid showed albuminocytologic dissociation, suggesting Guillain-Barre syndrome (GBS). The patient appeared brain dead on day 4, showing absent brainstem reflexes, respiratory failure, and fully dilated and fixed pupils. This case is an example of how GBS can evolve and simulate a brain-dead state from fulminant deafferentation following acute hepatitis A.
Adult ; Brain Death ; Brain Stem ; Cerebrospinal Fluid ; Guillain-Barre Syndrome* ; Hepatitis A* ; Hepatitis* ; Humans ; Intensive Care Units ; Pupil Disorders ; Quadriplegia ; Reflex ; Respiratory Insufficiency

BACKGROUND: Opsoclonus-myoclonus syndrome (OMS) is a rare neurological disorder that is characterized by involuntary eye movements and myoclonus. OMS exhibits various etiologies, including paraneoplastic, parainfectious, toxic-metabolic, and idiopathic causes. The exact immunopathogenesis and pathophysiology of OMS are uncertain. CASE REPORT: We report the case of a 19-year-old male who developed opsoclonus and myoclonus several days after a flu-like illness. Serological tests revealed acute mumps infection. The findings of cerebrospinal fluid examinations and brain magnetic resonance imaging were normal. During the early phase of the illness, he suffered from opsoclonus and myoclonus that was so severe as to cause acute renal failure due to rhabdomyolysis. After therapies including intravenous immunoglobulin, the patient gradually improved and had fully recovered 2 months later. CONCLUSIONS: This is the first report of OMS associated with mumps infection in Korea. Mumps infection should be considered in patients with OMS.
Acute Kidney Injury ; Brain ; Cerebrospinal Fluid ; Eye Movements ; Humans ; Immunoglobulins ; Korea ; Magnetic Resonance Imaging ; Male ; Mumps ; Mumps virus* ; Myoclonus ; Nervous System Diseases ; Ocular Motility Disorders ; Opsoclonus-Myoclonus Syndrome* ; Rhabdomyolysis ; Serologic Tests ; Young Adult

Herpes simplex encephalitis (HSE) is the most common form of encephalitis, with predilection for the temporal lobes and insular cortex. The presence of RBCs is a characteristic finding of CSF analysis and hemorrhagic transformation of the lesions on CT or MRI is not a rare, because the hemorrhagic necrosis is an important pathologic finding of HSE. However, intracerebral hematoma is rarely reported. We report a case of PCR proven HSE with hemotomas in both the medial temporal lobes, which has not been reported.
Encephalitis ; Encephalitis, Herpes Simplex ; Hematoma ; Herpesvirus 1, Human ; Methylmethacrylates ; Necrosis ; Polymerase Chain Reaction ; Polystyrenes ; Temporal Lobe

BACKGROUND AND PURPOSE: Although traditionally regarded as spared, a range of oculomotor dysfunction has been recognized in amyotrophic lateral sclerosis (ALS) patients. ALS is nowadays considered as a neurodegenerative disorder of a third compartment comprising widespread areas of extra-motor brain including cerebellum. Our objective was to perform an observational study to examine for ocular motor dysfunction in patients with ALS and for any differences between bulbar-onset and spinal-onset patients. METHODS: Thirty two ALS patients (bulbar onset: 10, spinal onset: 22) underwent the standardized systemic evaluations using video-oculography. RESULTS: Oculomotor dysfunctions such as square wave jerks, saccadic dysmetria, abnormal cogwheeling smooth pursuits and head shaking and positional nystagmus of central origin have been observed in the ALS patients at a relatively early stage. Abnormal smooth pursuits and saccadic dysmetria were increased in the bulbar-onset compared to the spinal-onset (p < 0.05). CONCLUSIONS: These oculomotor abnormalities may be a marker of neuro-degeneration beyond motor neurons in ALS, especially in bulbar-onset disease. Future longitudinal studies of eye movement abnormalities have provided insights into the distribution and nature of the disease process.
Amyotrophic Lateral Sclerosis* ; Brain ; Cerebellar Ataxia ; Cerebellum ; Eye Movements ; Head ; Humans ; Longitudinal Studies ; Motor Neurons ; Neurodegenerative Diseases ; Nystagmus, Physiologic ; Observational Study ; Pursuit, Smooth

BACKGROUND: Overexpression of heat shock protein 70 (HSP70) has been observed in many types of cancer including gastric adenocarcinomas, although the exact role of HSP70 in carcinogenesis remains unclear. METHODS: The study analyzed a total of 458 radical gastrectomy specimens which were immunohistochemically stained with HSP70, p53, and Ki-67 antibodies. RESULTS: The study determined that the expression of HSP70 was significantly increased in early gastric cancer (EGC) compared to advanced gastric cancer (p<0.001). The HSP70 expression was correlated with well-differentiated tumor type, intestinal type of Lauren classification and the lower pT and pN stage. Negative expression of Ki-67 and p53 expression was associated with poor prognosis. The study did not find any correlation between HSP70 and p53 expression. The study determined that HSP70 expression in the EGC subgroup was associated with a poor prognosis (p=0.009), as well as negative Ki-67 expression (p=0.006), but was not associated with p53. Based on multivariate analysis, HSP70 expression (p=0.024), negative expression of Ki-67, invasion depth and lymph node metastasis were determined to be independent prognostic markers. CONCLUSIONS: HSP70 is expressed in the early stages of gastric adenocarcinoma. In EGC, HSP70 is a poor independent prognostic marker and is correlated with a low proliferation index.
Adenocarcinoma ; Gastrectomy ; Heat-Shock Proteins ; Hot Temperature ; HSP70 Heat-Shock Proteins ; Ki-67 Antigen ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms

Purpose: Colonoscopy is an effective method of screening for colorectal cancer (CRC), and it can prevent CRC by detection and removal of precancerous lesions. The most important considerations when performing colonoscopy screening are the safety and satisfaction of the patient and the diagnostic accuracy. Accordingly, the Korean Society of Coloproctology (KSCP) herein proposes an optimal level of standard performance to be used in endoscopy units and by individual colonoscopists for screening colonoscopy. These guidelines establish specific criteria for assessment of safety and quality in screening colonoscopy. Methods: The Colonoscopy Committee of the KSCP commissioned this Position Statement. Expert gastrointestinal surgeons representing the KSCP reviewed the published evidence to identify acceptable quality indicators and indicators that lacked sufficient evidence. Results: The KSCP recommends an optimal standard list for quality control of screening colonoscopy in the following 6 categories: training and competency of the colonoscopist, procedural quality, facilities and equipment, performance indicators and auditable outcomes, disinfection of equipment, and sedation and recovery of the patient. Conclusion The KSCP recommends that endoscopy units performing CRC screening evaluate 6 key performance measures during daily practice.