Paralytic hand is the ultimate result of permsnent damage of the central nervous system, failure of the functional repair of peripheral nerve injuries and extensive muscular or tendinous defect resulting in the impairment of hand function. There are a lot of controversies in the side of treatment methods in the paralytic hand, and it is very difficult to formulate the most adequate surgical reconstruction for a given pstient. At Depsrtment of Orthopedic Surgery, Seoul National University Hospital, 66 cases oi paralytic hands in 62 patients have been treated surgically with tendon transfers for 7 years from Jan, 1980 to Dec, 1986. 49 case in 46 patients were followed up for more than one year, and surgical method and its results were anslysed. They consist of CNS lesion (17), peripheral nerve lesion(23) and musulotenidinous defect(9). The methods of surgical reconstruction were opponenesplasty(12), standard set extensor reconstruction(9), Green and Bsnks FCU transfer(11), intrinsic reconstruction(7), pronator rerouting(7), adductorplasty (5) and so on. The mean follow-up was 2.2 years, and in 38 cases good or excellent results were obtained.
Central Nervous System ; Follow-Up Studies ; Hand ; Humans ; Methods ; Orthopedics ; Peripheral Nerve Injuries ; Peripheral Nerves ; Seoul ; Tendon Transfer

Numerous operations have been described to treat the recurrent anterior dislocation of the shoulder, but no one procedure was accepted as the choice of operation. We perforemed 6 Bristow procedures and 5 combined Bankart and Putti-Platt procedures and examined six shoulders by arthroscope from sep. 1989 to Sep. 1992, and we analysed the pathologic feature and the results of them. The average follow-up period was 2.2 years. 1. There were 8 males and 3 females and their average age was 33.7 years. The mean age in initial dislocation was 28 years. 2. The number of recurrent dislocation before operation was 17.9 times and the average duration of the disease was 5.7 years. 3. The pathologic lesions observed in intraoperative field were Hill-Sachs lesion (72.7%), Bankart lesion (90.9%), and the erosion of the glenoid rim (54.5%). On arthroscopic examination of 6 cases, Hill-Sachs lesion was found in 4 cases, Bankart lesion was seen in all of 6 cases, and the erosion of the glenoid rim was observed in 4 cases. 4. The average range of the limitation of external rotation was 17.3 and its significant difference was not observed between 2 operative groups. 5. By Rowes rating sheet, 4 cases of 5 combined Bankart and Putti-Platt operations were excellent and 1 case was good. 6. In conclusion, combined Bankart and Putt-Platt operation was considered as a good surgical procedure in the treatment of recurrent anterior dislocation of the shoulder.
Arthroscopes ; Dislocations ; Female ; Follow-Up Studies ; Humans ; Male ; Shoulder

The author analyzed detailed pattern of pelvic bone fracture in 52 cases of posterior urethral injuryassociated with pelvic bone fracture in male. The relationship between fracture and urethral injury was reviewed n38 cases who received retrograde urethrography at the time of injury. The pattern of urethral injury due to pelvicbone fracture was newly classified. The results were as follows; 1. In age distribution, the most common was 5thdecade(26.9%). 2. The most freqent type of pelvic rami fracture was two rami fracture(52%). 3. There was no casewith only the superior ramus fracture, and all cases were associated with inferior ramus fracture with or withoutsuperior ramus fracture. 4. In inferior ramus fracture, the ratio of ischial ramus fracture to pubic ramusfracture was 46.1:17.4. 5. In cases with only the ischial ramus or pubic ramus fracture, unilateral fractureexceeded bilateral fracture(44.2:19.3). 6. The bladder rupture was found in 10 among the total 52 cases, 9 ofwhich were associated with superior ramus fracture, and 8 were extraperitoneal type. 7. The most common type ofurethral injury was Type III(73.7%), and followed by Type II(10.5%), Type I(7.9%), and Type IV(7.9%). 8. Theseresults strongly suggested that the superior ramus frature was related to bladder rupture, and inferior ramusfracture to urethral injury.
Age Distribution ; Humans ; Male ; Pelvic Bones ; Rupture ; Urinary Bladder

Staging of carcinoma of the urinary bladder is important for the choice of therapy and also has prognostic implications. Hitherto the staging has been based upon cystoscopy with bio psy, transurethral resection , and palpation with complementary radiographic examlnations such as cystography, urography, lymphangiography, ultrasound and angiography. However, with all these methods, the staging of bladder carcinomas still uncertain and inferior to CT. Authors analyzed CT staging of bladder cancers and compared with pathologic staging of laparotomy results. The results are as follows: 1. Overall accuracy of CT staging in bladder carcinoma was 72 percent. 2. Overstaging was 20 percent (5/25) and understaging was 8 percent (2/25). 3. All of CT stage B cancers were proven to be stage B, pathologlcally. 4. In 6 cases of CT stagec cancers,only one was correct,3 were overstaged and 2 were understaged. 5. In 7 cases of CT stage D cancers, 5 were correct and 2 were overstaged. 6. CT detected only 2 cases of pelvic Iymph node involvement in 4 of pathologically proven Iymphadenopathy.
Angiography ; Cystoscopy ; Laparotomy ; Lymphography ; Palpation ; Ultrasonography ; Urinary Bladder Neoplasms ; Urinary Bladder ; Urography

Primary malignant parovarian epithelial tumors are extremely rare, with only 56 cases previously reported in the world literature. Most parovarian epithelial tumors are of paramesonephric (Mullerian) origin. In this article, we report the first case in the Korean literature of papillary serous cystadenoma of borderline malignancy from paramesonephric parovarian cyst. This case presented here is of particular interest since this neoplasm is rare. A 48-year-old female underwent a hysterectomy with bilateral adnexectomy and pelvic lymph node dissection for a cystic tumor of the right parovarian area. The tumor, measuring 13 cm in diameter, was apart from the ovaries, fallopian tubes and uterus. The cyst wall had well-developed smooth muscle layers. The cyst was lined with mildly atypical ciliated and non-ciliated low columnar cells compatible with those of paramesonephric origin. From the inner surface of the cyst several cauliflower-like structures projected into the lumen. They were of a predominantly papillary architecture covered by atypical epithelial cells with piling-up and occasional glandular growth. No destructive stromal invasion was identified.
Cystadenoma, Serous* ; Epithelial Cells ; Fallopian Tubes ; Female ; Humans ; Hysterectomy ; Lymph Node Excision ; Middle Aged ; Muscle, Smooth ; Ovary ; Parovarian Cyst* ; Uterus

No abstract available.
Endoderm* ; Endodermal Sinus Tumor*

No abstract available.
Paralysis* ; Tourniquets*

No abstract available.
Occupational Diseases*

Vestibular rehabilitation therapy (VRT) is an exercise-based treatment program designed to promote vestibular adaptation and substitution. The goals of VRT are 1) to enhance gaze stability, 2) to enhance postural stability, 3) to improve vertigo, and 4) to improve activities of daily living. VRT facilitates vestibular recovery mechanisms: vestibular adaptation, substitution by the other eye-movement systems, substitution by vision, somatosensory cues, other postural strategies, and habituation. The key exercises for VRT are head-eye movements with various body postures and activities, and maintaining balance with a reduced support base with various orientations of the head and trunk, while performing various upper-extremity tasks, repeating the movements provoking vertigo, and exposing patients gradually to various sensory and motor environments. VRT is indicated for any stable but poorly compensated vestibular lesion, regardless of the patient's age, the cause, and symptom duration and intensity. Vestibular suppressants, visual and somatosensory deprivation, immobilization, old age, concurrent central lesions, and long recovery from symptoms, but there is no difference in the final outcome. As long as exercises are performed several times every day, even brief periods of exercise are sufficient to facilitate vestibular recovery. Here the authors review the mechanisms and the key exercises for each of the VRT goals.
Activities of Daily Living ; Cues ; Exercise ; Head ; Humans ; Immobilization ; Orientation ; Posture ; Vertigo ; Vision, Ocular

Four children with medically refractory multiform seizures were submitted for section of the corpus callosum for last 3 years. These patients had medically intractable generalized seizures diagnosed preoperatively as the Lennox-Gastaut syndrome characterized by a combination of seizure patterns, most frequently drop attack with generalized tonic-clonic, generalized tonic and atonic seizure. Guided by pre- and intra-operative electroencephalographic monitoring, the section was carried out in the anterior 2/3 or 4/5 part of callosum. Five to 28 months' postoperative follow-up suggests good results:Three patient showed no more drop attack except intermittent focal myoclonic seizures in 1 case and one patient had generalized seizures less in frequency than preoperative state. Corpus callosotomy seems to be an effective surgical approach for the intractable epilepsy with drop attack of multifocal origin, but longer follow-up is needed.
Child* ; Corpus Callosum ; Electroencephalography ; Epilepsy* ; Follow-Up Studies ; Humans ; Seizures ; Syncope