Management of subtrochanteric fractures of the femur is difficult because of the high mechanical stresses in this region; furthermore, the bone here is mainly cortical and comminution is frequent. These two factors, involvement of cortical bone tissue and concentration of stress, have been mentioned as reasons for the high incidence of complication in the treatment of these fractures, such as Relayed union, mechanical failure and rnalunion. Thirty cases of subtrochanteric fractures in twenty-nine patients were reviewed, which have been managed at the Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine from Jan. 1980 to Dec. 1984 and the following results were obtained: l. Of the 29 patients reviewed, 22 were male and 7 were female. Mean age was 45.7 years in male and 67.3 years in female. 2. Traffic accidents were the most common cause of injury(44.8%) 3. Pelvic bone fractures(7 cases) and rib fractures(7 cases) were the most common associated injuries. 4. Fielding's type II (13 cases) fracture and Seinsheimer's type IV (10 cases) fracture were most common. 5. Of the 30 cases, 26(86.7%) were treated by open reduction and internal fixation. Of fixation devices, a Jewett nail was most commonly used in 13 cases (50.0%). 6. The mean duration of bony union was 20.4 weeks. There was no significant difference in union rate between fractures which were treated by operative means and fractures by conservative means. And more longer period was needed in union as fracture goes distally. 7. Weight bearing was allowed earlier in patients treated by operative means (average 10.5 weeks) than in patients by conservative means (average 18.0 weeks.). 8. Of the 30 cases, 8 complications (26.7%) occured, that is: delayed union(4 cases), mechanical failure (3 cases) and angular deformity(1 case). All of them occured in Fielding's type II and III fractures except 1 case. Loss of medial buttress and unstable reduction were considered to be causing factors. 9. Satisfactory result was obtained by stable anatomical reduction and internally fixed by Jewett nail and compression hip screw. In case of intramedullary nail, good result was expected when used in non-comminuted fracture of distal portion. Also, additional supplementary screw fixation, circlage wire and bone graft were recommended, when necessary.
Accidents, Traffic ; Bone and Bones ; Clinical Study ; Female ; Femur ; Hip ; Hip Fractures ; Humans ; Incidence ; Male ; Orthopedics ; Pelvic Bones ; Ribs ; Stress, Mechanical ; Transplants ; Weight-Bearing

PURPOSE: This study aimed to evaluate the effect of anticonvulsants on serum carnitine levels as well as normal serum carnitine levels. METHODS: We measured the serum carnitine levels in 53 healthy children(34 males, 19 females) and 115 epileptic children(55 males, 60 females) receiving a various antiepileptic drugs. We assessed the effects of antiepileptic drugs on serum carnitine level together with a correlation between serum carnitine level and duration of treatment, and blood level of anticonvulsant. RESULTS: 1.Carnitine levels in healthy children 1)There was a positive correlation between total and free carnitine serum levels and the age of the children. 2)The serum total carnitine levels were increased in age group over 5 years of age and serum free carnitine levels were increased in age group over 1 year of age as compared with those of between 1 month and 12 months age group. 2.Carnitine levels in epileptic children receiving anticonvulsants 1)The serum levels of total and free carnitine were significantly reduced in the patients with valproate monotherapy group, valproate polytherapy group, and polytherapy group without valproate as compared with the control group. 2)The reduction was more significant in the patients of valproate polytherapy group than in those of valproate monotherapy group. 3.There was a significant inverse correlation between the serum carnitine levels and the duration of the valproate treatment but not between serum carnitine levels and the blood level of valproate. 4.Carnitine deficiency was corrected in all cases after oral administration of L-carnitine(50mg/kg/day). CONCLUSIONS: Carnitine deficiency may be suspected in patients taking valproate therapy and regular measurement of carnitine levels appears warranted in these patients. If carnitine deficiency is documented, the patient can be treated by oral carnitine supplementation.
Administration, Oral ; Anticonvulsants* ; Carnitine* ; Child ; Humans ; Male ; Valproic Acid

PURPOSE: This study was performed to determine the sensitivity of neonatal electroencephalography (EEG) in detecting underlying brain disease, to compare the sensitivity and specificity of EEG with those of brain ultrasonography and to determine the prognostic value of EEG for neonatal neurologic diseases. METHODS: Eighty-seven newborn babies were subjected to a electroencephalographic examination for the evaluation of underlying neurological diseases and EEGs were recorded at least before three days of life. The findings of early ultrasonography performed within three days after birth were compared with those of magnetic resonance imaging(MRI) or ultrasonography after seven days of life. RESULTS: The EEG results were more sensitive and specific than ultrasonography for the detection of neonatal brain damage. The EEG results showed 91.7% sensitivity for mild grade neurological sequelae and 100.0% sensitivity for moderate and severe-grade neurological sequelae in predicting the neurological outcome. However, early ultrasonography results showed 20.8% and 18.8% of sensitivity and specificity, respectively. CONCLUSION: EEG is a highly sensitive diagnostic tool for detecting neonatal brain disease and is valuable for predicting the long-term outcome of neurologic sequelae.
Brain ; Brain Diseases ; Electroencephalography* ; Humans ; Infant, Newborn ; Parturition ; Sensitivity and Specificity ; Ultrasonography

Sebaceous carcinoma (SC) is a rare tumor, accounting for approximately 0.7% of skin cancers. SC can be classified as ocular SC (OSC) or extraocular SC (EOSC) depending on its location. Because EOSC accompanied by metastases is rare, there is a paucity of data about EOSC accompanied by metastasis. This study presents a case of an aggressive EOSC of the scalp with lymph node metastases. The patient underwent wide local excision of the primary tumor with a 1 cm safety margin and bilateral radical lymph node dissection. However, recurrence was observed 1 month after surgery. Radiation therapy and resection were performed for the recurrent tumor. However, distant metastases to both lungs eventually occurred. Here, we describe a rare recurrent case of EOSC of the scalp with distant organ metastasis with a review of the literature.

Granular cell tumor is one of the rare tumorous condition. At present there are estimated 600 reported examples of the tumor in the medical literature. Malignant granular cell tumor is a well established but extremely rare entity that is found in appr- oximately 2 % of all granular cell tumor. Diagnosis should be restricted to neoplasms that are similar in their histological appearance to benign granular cell tumors but can be seperated on the basis of cellular pleomorphism, mitotic activity, and, most importantly, their capacity to produce metastases. The authors had experienced that a 55 years old male patient had two large malignant granular cell tumors at the left thigh and left inguinal area with metastatic lesion.
Diagnosis ; Granular Cell Tumor ; Humans ; Male ; Neoplasm Metastasis ; Thigh

BACKGROUND: Two successive surveys were conducted in the same rural areas. The first survey was intended to obtain an initial estimate of public familiarity with, understanding of, and attitudes toward epilepsy. The second survey was performed to assess trends in public attitudes toward epilepsy and the putative effect of campaigns on such a trend. METHODS: Cross-sectional studies were conducted by means of a door-to-door interview using the same questionnaire, in which all residents over 19 years of age, living in the survey area, were targeted. Vehicles for the educational campaign took the form of lectures and small group discussions. RESULTS: Of 820 respondents in the first survey, 93% of respondents were familiar with epilepsy. Nevertheless, only 8.5% answered they had an epileptic person among their family or relatives. The understanding of epilepsy among respondents appeared to be not only based more on supernatural or superstitious thinking, but was also less comparable to that of other studies. The attitudes toward epilepsy also were far more negative in Korean rural areas than in other countries. The false belief that epilepsy cannot be treated was the factor that contributed most to negative attitudes in Korean rural areas. Even though it was not remarkable, and was not attributed to the campaigns entirely, a positive trend was obvious not only in understanding the cause of epilepsy but also in attitudes toward epilepsy. CONCLUSIONS: It is important to recognize the fact that the majority of respondents still remain unchanged in their misunderstanding of and negative attitudes toward epilepsy, regardless of the new positive trend. In order to ameliorate prejudices against epilepsy and allow epileptic persons to interact with and adapt to their surroundings properly, not only continuous and repetitive educational efforts but also the sympathy of professional and lay societies regarding epilepsy would be needed.
Cross-Sectional Studies ; Surveys and Questionnaires ; Education ; Epilepsy* ; Humans ; Jeollanam-do* ; Lectures ; Prejudice ; Recognition (Psychology) ; Thinking

BACKGROUND: Excitotoxicity and epileptogenesis have often been associated with glutamate receptor activation. Some evidence indicates that selective down regulation of AMPA receptor may be the mechanism of delayed neuronal cell death in the hippocampus. METHODS: We used in situ hybridization to examine the hybridization density (HD) of NMDA and AMPA receptors on excitotoxicity and epileptogenesis in the hippocampus of the kainic acid (KA)-induced rat seizure model. Some Sprague-Dawley rats were injected with KA, and others with MK-801 prior to KA injection. The rats were killed at 8 hours or 4 weeks after KA or MK-801/KA injection. HD of [3H]MK-801 and [3H]AMPA bind-ing in subfields of the hippocampus was measured by an image analyzer. RESULTS: After 8 hours of KA injection, [3H]MK-801 binding was increased in CA1 and CA3, and decreased in dentate gyrus, and [3H]AMPA binding was decreased in all of CA1, CA3 and fascia dentata, and pretreatment of MK-801 did not affect [3H]AMPA binding in all of CA1, CA3 and dentate gyrus. After 4 weeks, both [3H]MK-801 and [3H]AMPA binding were prominently increased in inner molecular layer of dentate gyrus. CONCLUSIONS: Glutamate receptors, especially NMDA receptor, were associ-ated with excitotoxicity in the hippocampus but the selective down regulation of GluR2 subunit of AMPA receptor without NMDA receptor activation may not be sufficient to cause excitotoxic neuronal cell death in CA1 and CA3. In addition, the synaptic reorganization in inner molecular layer of dentate gyrus was proved to be chronically hyperex-citable in function and may contribute epileptogenesis.
Animals ; Autoradiography* ; Cell Death ; Dentate Gyrus ; Dizocilpine Maleate* ; Down-Regulation ; Glutamic Acid* ; Hippocampus ; In Situ Hybridization ; Kainic Acid ; N-Methylaspartate ; Neurons ; Rats ; Rats, Sprague-Dawley ; Receptors, AMPA ; Receptors, Glutamate* ; Receptors, Ionotropic Glutamate* ; Seizures*

Syndrome of 4q deletion is characterized by an abnormal shape of the skull, craniofacial dysmorphism, cardiovascular malformations, genitourinary defects, limb and digital anomalies, and developmental delay. We experienced a case of 4q interstitial deletion in a 2 day-old female neonate who showed short extremities, partial agenesis of corpus callosum and congenital heart defects. We report the case with a brief review of the literature.
Agenesis of Corpus Callosum* ; Chromosomes, Human, Pair 4 ; Extremities ; Female ; Heart Defects, Congenital ; Humans ; Infant, Newborn ; Skull

OBJECT: The nonstress test(NST) and complete biophysical profile(BPP) were compared with the rapid biophysical profile(BPP) in order to evaluate the efficacy of the rapid BPP, namely, the combination of amniotic fluid index(AFI) and sound-provoked fetal movement(SPFM) detected by ultrasound, in predicting intrapartum fetal distress in high-risk pregnancies. STUDY DESIGN: From JAN 9th 2000, through JAN 5th 2001, the prospective study of diagnostic tests was conducted on a total of 91 high-risk singleton pregnancies, undergoing antepartum assessment both the standard NST and the new rapid BPP(including other indices of complete BPP). The diagnostic indices of the NST, rapid BPP and complete BPP were calculated in term of predicting intrapartum fetal distress. RESULT: The sensitivity, specificity, negative predictive value, and positive predictive value of NST were 50.00, 94.81, 96.05, and 42.86% respectively, and those of rapid BPP were 75.00, 98.53, 98.53, and 75.00%, and those of complete BPP were 83.33, 98.72, 98.72, and 83.33%, as well. In addition, the efficiency of NST, rapid BPP, and complete BPP were 91.57%, 97.22% and 97.62% respectively. CONCLUSIONS: The rapid BPP is an effective and reliable predictor of intrapartum fetal distress with high-risk pregnancies. Moreover, it may be inexpensive and less time-consuming method.
Amniotic Fluid ; Diagnostic Tests, Routine ; Female ; Fetal Distress ; Pregnancy ; Pregnancy, High-Risk ; Prospective Studies ; Sensitivity and Specificity ; Ultrasonography

BACKGROUND: Psoriatic arthritis (PsA) is one of the inflammatory arthritis associated with psoriasis. Several studies have described the clinical difference between psoriatic patients with PsA and those without PsA. OBJECTIVE: The purpose of this study was to examine the difference in clinical features and prevalence of comorbidities between psoriatic patients with and without PsA in Korea. METHODS: We retrospectively evaluated 173 patients diagnosed with psoriasis. Patients were subdivided based on the presence or absence of PsA. We analyzed clinical manifestations including comorbidities and laboratory tests such as total cholesterol, triglyceride, C-reactive protein, erythrocyte sedimentation rate (ESR), and fasting glucose. RESULTS: Among 173 patients with psoriasis, 29 patients (16.8%) were diagnosed with PsA. The mean age of psoriasis onset for patients with PsA was 7.6 years earlier (p=0.017) than for those without PsA. The duration of psoriasis was 4.6 years longer (p<0.001) in patients with PsA than in patients without PsA. Nail involvement was more common in patients with PsA (p<0.001). There were statistically significant differences between the two groups regarding ESR levels (p=0.003) and the prevalence of diabetes mellitus (p=0.032). CONCLUSION: We found several differences in the prevalence of comorbidities, levels of inflammatory markers, and epidemiologic characteristics between psoriatic patients with and without PsA. This study may help improve strategies for the clinical approach for treating psoriasis in dermatology.
Arthritis ; Arthritis, Psoriatic* ; Blood Sedimentation ; C-Reactive Protein ; Cholesterol ; Comorbidity* ; Dermatology ; Diabetes Mellitus ; Fasting ; Glucose ; Humans ; Korea ; Prevalence ; Psoriasis* ; Retrospective Studies* ; Triglycerides