From August, 1981 to November, 19S5, the Hoffmann and Monofixateur apparatus were employed in the treatment of thirty five open tibial fractures that we considered to have a poor prognosis with more conventional forms of treatment. The results were obtained as follows; l. Application of Monofixateur was minimum iatrogenic soft tissue injuries and easier, simpler than Hoffmann and two external fixators were favorable device with rigidity in wound management. 2. Two external fixators could obtained sufficient stability when 3 or more pins were applied at each fragment of fracture in Hoffmann and 2 or more pins in Monofixateur. Monofixateur could obtained high stability with small number of fixation components and more stronger against anterior-posterior bending and in Hoffmann more stronger against lateral bending. 3. External components of Monofixteur was located in anterior surface, therefore dynamization converted tensile force of anterior surface of tibia to compression force and then bone union was activated. 4. After operation, in Hoffmann correction of compression, distraction and angular, rotational deformity were possible and in Monofixateur correction of compression distraction, and anterior or posterior angulation was possible. 5. Because of rigid stability of two external Bxators, these allowed early movement, avoiding joint stiffness and duration ambulation unilateral assembly of device in position biomechanically favorable. 6. The lateral view of fracture site could not be confirmed accurately due to overlapping of Hoffmann's adjustable connecting rod and bony shadow. In Monofixateur A-P and lateral view of Fx. site could be confirmed. 7. Accurate reduction and compression played a important role in bone union. 8. The time to fixation for all of the fractures averaged 20 weeks in Hoffmann and 16 weeks in Monofixateur. The time to union averaged 24 weeks in Hoffmann and 20 weeks in Monofixateur.
Clinical Study ; Congenital Abnormalities ; External Fixators ; Joints ; Prognosis ; Soft Tissue Injuries ; Tibia ; Tibial Fractures ; Walking ; Wounds and Injuries

OBJECTIVE: In June 28, 2012, a 'Hospitalization guideline for car accident patients' was announced to mediate the clash of opinions about the hospitalization of minor head trauma patients among doctors, patients and insurance companies. The guideline was issued to describe the patients' symptoms and emotions in detail after the injury. In this paper, evaluation for the guideline and suggestions for modifications was done. METHODS: Thirty-two doctors, 96 patients and 60 employees were each given surveys about the hospitalization guidelines, related personnels' attitude and evaluation of patients' emotional problems. The frequency, ratio and chi-square test were performed. RESULTS: Sixty-eight point eight percent of doctors, 79.8% patients and 91.6% insurance company employees agreed to the need for a guideline. Among the 68.8% doctors that supported the need for a guideline, 18.8% knew that the guideline actually existed. Sixty-nine point two percent of doctors said that they would apply the guideline once they were introduced to it. Among the announced guideline provisions, 'Glasgow coma score less than 15' and 'socially not suitable for discharge' required reevaluation since 40.6% all surveyors consented that these two criteria were not suitable. The consensus supporting the need for emotional evaluation came out to be 78.1%, 58.5%, 50.9% in doctors, patients and insurance employees respectively. CONCLUSION: Although a guideline for hospitalization of minor head injury patients is necessary, some part of it seems to be reevaluated and improved, especially for clauses related to the patient's emotional problems. These changes and revisions to the guideline require further speculation and research.
Coma ; Consensus ; Craniocerebral Trauma* ; Hospitalization* ; Humans ; Insurance ; Patient Admission

No abstract available.
Angioplasty* ; Constriction, Pathologic*

Congenital lipoid adrenal hyperplasia (CLAH) is the most severe form of congenital adrenal hyperplasia which is caused by mutations in the steroidogenic acute regulatory protein (StAR). The mutations in StAR gene resulted in failure of the transport cholesterol into mitochondria for steroidogenesis in the adrenal gland. Twin sisters (A, B) with normal 46, XX were born at 36+2 gestational week, premature to nonrelated parents. They had symptoms as hyperpigmentation, slightly elevated potassium level and low level of sodium. Laboratory finding revealed normal 17-hydroxyprogesterone level, elevated adrenocorticotropin hormone (A, 4,379.2 pg/mL; B, 11,616.1 pg/mL), and high plasma renin activity (A, 49.02 ng/mL/hr; B, 52.7 ng mL/hr). However, the level of plasma cortisol before treatment was low (1.5 microg/dL) in patient B but normal (8.71 microg/dL) in patient A. Among them, only patient A was presented with adrenal insufficiency symptoms which was suggestive of CLAH and prompted us to order a gene analysis in both twin. The results of gene analysis of StAR in twin revealed same heterozygous conditions for c.544C>T (Arg182Cys) in exon 5 and c.722C>T (Gln258*) in exon 7. We report the first case on the mutation of p.R182C in exon 5 of the StAR gene in Korea.
17-alpha-Hydroxyprogesterone ; 46, XY Disorders of Sex Development ; Adrenal Glands ; Adrenal Hyperplasia, Congenital ; Adrenal Insufficiency ; Adrenocorticotropic Hormone ; Cholesterol ; Exons ; Genes, vif ; Humans ; Hydrocortisone ; Hyperpigmentation ; Hyperplasia ; Korea ; Mitochondria ; Parents ; Phosphoproteins ; Plasma ; Potassium ; Renin ; Siblings ; Sodium ; Twins

The incidence of ectopic pregnancy is increased since IVF-ET has started. The risk factors for ectopic pregnancy after assisted reproductive techniques are tubal abnormality, previous myomectomy, the number of transfered embryo, the technical aspects of embryo transfer, the amount of transfered medium and uterine reverse contraction after embryo transfer. Because of the possibility of combined pregnancy after IVF-ET, bilateral adnexal area should be examined by transvaginal ultrasonography at searching intrauterine gestational sac and also serial beta-hCG levels should be checked. We report a case of simultaneous left tubal and right ovarian pregnancies after IVF-ET with a brief review of literature.
Embryo Transfer ; Embryonic Structures ; Female ; Gestational Sac ; Incidence ; Pregnancy ; Pregnancy, Ectopic* ; Reproductive Techniques, Assisted ; Risk Factors ; Ultrasonography

BACKGROUND: The clacification of the wall and narrowing of the lumen of the coronary artery is closely related to the process of atherosclerosis and its severity. Thus, the present study of calcified coronary artery lesions by analysis of cineangiography is attempt to define the incidence and factors to affect the coronary artery calcification. METHODS: Our report concerns a consecutive series of 513 patients who underwent coronary angiography between January 1, 1991 and September 30, 1993. We determined the relationship between the coronary artery calcification and sex, age, risk factors, serum calcium, BUN, creatinine, lesional lumen stenosis and severity of coronary artery disease. RESULTS: Among patients with significant coronary artery disease, 22%(62/282 cases) had the coronary artery calcification by cineangiography. Patients with calcification were older(62+/-8 years) than those without calcification(56+/-10 years)(p=0.0001). The distribution of calcified coronary artery was 35 lesions in LAD, 17 in LCX, 16 in RCA and 4 in LM. The calcification rate was 38%(40/104 cases) for patients with multi-vessel disease, compared to 12%(22/178 case) for those with single vessel disease(p=0.0001). Patients with calcification significantly had the long lesion(22.4+/-13.4mm), compared to those without calcification(18.0+/-11.3mm)(=0.012). Coronary artery calcification was correlated with smoking habits. CONCLUSION: Coronary artery calcification was seen in 22 percent and strongly correlated with age, smoking habits, the severity of disease and length of lesion.
Atherosclerosis ; Calcium ; Cineangiography* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Creatinine ; Humans ; Incidence* ; Risk Factors ; Smoke ; Smoking

Objective: : Although full-endoscopic lumbar interbody fusion (Endo-LIF) has been tried as the latest alternative technique to minimally invasive transforaminal lumbar interobody fusion (MIS-TLIF) since mid-2010, the evidence is still lacking. We compared the clinical outcome and safety of Endo-LIF to MIS-TLIF for lumbar degenerative disease. Methods: : We systematically searched electronic databases, including PubMed, EMBASE, and Cochrane Library to find literature comparing Endo-LIF to MIS-TLIF. The results retrieved were last updated on December 11, 2020. The perioperative outcome included the operation time, blood loss, complication, and hospital stay. The clinical outcomes included Visual analog scale (VAS) of low back pain and leg pain and Oswestry disability index (ODI), and the radiological outcome included pseudoarthosis rate with 12-month minimum follow-up. Results: : Four retrospective observational studies and one prospective observational study comprising 423 patients (183 Endo-LIF and 241 MIS-TLIF) were included, and the pooled data analysis revealed low heterogeneity between studies in our review. Baseline characteristics including age and sex were not different between the two groups. Operation time was significantly longer in Endo- LIF (mean difference [MD], 23.220 minutes; 95% confidence interval [CI], 10.669–35.771; p=0.001). However, Endo-LIF resulted in less perioperative blood loss (MD, -144.710 mL; 95% CI, 247.941–41.478; p=0.023). Although VAS back pain at final (MD, -0.120; p=0.586), leg pain within 2 weeks (MD, 0.005; p=0.293), VAS leg pain at final (MD, 0.099; p=0.099), ODI at final (MD, 0.141; p=0.093) were not different, VAS back pain within 2 weeks was more favorable in the Endo-LIF (MD, -1.538; 95% CI, -2.044 to -1.032; p<0.001). On the other hand, no statistically significant group difference in complication rate (relative risk [RR], 0.709; p=0.774), hospital stay (MD, -2.399; p=0.151), and pseudoarthrosis rate (RR, 1.284; p=0.736) were found. Conclusion : Relative to MIS-TLIF, immediate outcomes were favorable in Endo-LIF in terms of blood loss and immediate VAS back pain, although complication rate, mid-term clinical outcomes, and fusion rate were not different. However, the challenges for Endo-LIF include longer operation time which means a difficult learning curve and limited surgical indication which means patient selection bias. Larger-scale, well-designed study with long-term follow-up and randomized controlled trials are needed to confirm and update the results of this systematic review.

Objective: : Although several commercialized bone cements are used during percutaneous vertebroplasty (PVP) for patients with osteoporotic vertebral compression fracture (OVCF), there are no reports using domestic products from South Korea. In this study, we investigated the safety and efficacy of Spinofill® (Injecta Inc., Gunpo, Korea), a new polymethyl methacrylate product. Methods: : A prospective, single-center, and single-arm clinical trial of 30 participants who underwent PVP using Spinofill® for painful thoracolumbar OVCF was performed with 6-months follow-up. Clinical and surgical outcomes included the Visual analog scale (VAS), Korean-Oswestry disability index (K-ODI), and Odom’s criteria, complication rate, and recurrence rate. Radiological outcomes were evaluated by measuring the findings of postoperative computed tomography and simple radiograph. Results: : The pain of VAS (from 8.95±1.05 to 4.65±2.06, p<0.001) and the life quality based on K-ODI (from 33.95±5.84 to 25.65±4.79, p<0.001) improved significantly, and successful patient satisfaction were achieved in 20 patients (66.7%) 1 day after surgery. These immediate improvements were maintained or more improved during the follow-up. There was no surgery- or product-related complications, but OVCF recurred in two patients (6.7%). Favorable cement interdigitation was reported in 24 patients (80.0%), and extra-vertebral cement leakage was reported in 13 patients (43.0%). The mean vertebral height ratio (from 60.49%±21.97% to 80.07%±13.16%, p<0.001) and segmental kyphotic angle (from 11.46°±8.50° to 7.79°±6.08°, p=0.002) improved one day after surgery. However, these short-term radiological findings somewhat regressed at the end. Conclusion : The overall outcomes of PVP using Spinofill® were as favorable as those of other conventionally used products.

Lesch-Nyhan syndrome is an X-linked recessive disorder characterized by hyperuricemia, choreoathetosis, spasticity, mental retardation, and compulsive, self-injurious behavior. This disorder results from a complete deficiency of the purine salvage enzyme, hypoxanthine-guanine phosphoribosyl transferase(HPRT). We report here on a case of Lesch-Nyhan syndrome in a 1-year, 7-month-old male who presented with frequent vomiting, failure to thrive, and developmental delay. The diagnostic work-up revealed hyperuricemia, hyperuricosuria, and medullary nephrolithiasis. The HPRT activity in the erythrocytes was undetectable with a biochemical assay. We also identified de novo mutation which was a deletion of the 649th base, adenosine, in HPRT gene(649delA) by analysis of cDNA using RT-PCR technique coupled with direct sequencing.
Adenosine ; DNA, Complementary ; Erythrocytes ; Failure to Thrive ; Humans ; Hyperuricemia ; Hypoxanthine Phosphoribosyltransferase ; Infant ; Intellectual Disability ; Lesch-Nyhan Syndrome* ; Male ; Muscle Spasticity ; Nephrolithiasis ; Self-Injurious Behavior ; Vomiting

Allan-Herndon-Dudley syndrome (AHDS) is an X-linked intellectual disability caused by monocarboxylate transporter 8 (MCT8) deficiency. AHDS manifests in global developmental delay, axial hypotonia, quadriplegia, movement disorders in male patients, and most of them show the delayed or hypomyelination on brain magnetic resonance images. Typically, Triiodothyronine (T3) levels are markedly elevated, thyroid stimulating hormone (TSH) levels are normal or elevated, and free thyroxine (T4) levels are normal or decreased. In AHDS patients, early neurological manifestations are easily mistaken as cerebral palsy with unknown origin. Here, we present a novel c.826G>A mutation in a boy with severe axial hypotonia, limb dystonia and developmental delay. Thyroid function test including TSH, T3, and free T4 levels was the important clue for the diagnosis of AHDS of the patient.
Brain ; Cerebral Palsy ; Diagnosis ; Dystonia ; Humans ; Intellectual Disability ; Male* ; Movement Disorders ; Muscle Hypotonia ; Neurologic Manifestations ; Quadriplegia ; Thyroid Function Tests* ; Thyroid Gland* ; Thyrotropin ; Thyroxine ; Triiodothyronine