Congenital vertical talus associating tarsal coalition, which is a very anomalous condition and causes severe rigid flat foot, is presented with literary reviews. This case was treated with soft tissue release and triple arthrodesis.
Arthrodesis ; Flatfoot ; Talus

Percutaneous nephrostomy for relief of obstruction and functional preservation of the kidney was effectivelyperformed 19 times in 14 patients for recent 1 year since July 1982 at Departement of Radiology in Seoul NationalUniversity Hospital. The etiologies of the total 14 obstructive uropathies were metastatic cervix cancer in 6-cases, metastatic rectal cancer in 2 cases, and metastatic bladder cancer, malignant mixed mesodermal tumor operimetrium, pyonephrosis, bilateral staghorn stone, UVJ obstruction of undertermined cause, congenital UPJobstruction in 1 case respectively. Percutaneous nephrostomy was done bilaterally in 1 case of congenital UPJobstruction and unilaterally in 13 cases. We used ultrasound as puncture guide in 13 cases and CT in 1 case. Majorcomplication was absent, but minor complications occured in 4 patients; gross hematuria persisting 24 hours (1case), catheter dislodgment after several seeks (2 cases ) and luminal narrowing after 3 months(1 case).Satisfactory outcomes were made in 13 patients except 1 patient who succumbed one day after the procedure due topreexisting severe sepsis. The procedure proved to be safe and effective alternative to operative nephrostomy insome patients with urinary obstruction.
Catheters ; Hematuria ; Humans ; Kidney ; Mesoderm ; Nephrostomy, Percutaneous ; Phenobarbital ; Punctures ; Pyonephrosis ; Rectal Neoplasms ; Seoul ; Sepsis ; Ultrasonography ; Urinary Bladder Neoplasms ; Uterine Cervical Neoplasms

While effectiveness of ultrasound in diagnosis of stone in gallbladder and common bile duct has been wellestablished, role of ultrasound in detection of intrahepatic bile duct stone has rarely been described. However,in ultrasonographic diagnosis of common bile duct and gall bladder stone, evaluation of intrahepatic bile duct isessential to decrease the incidence of residual stone because about 5-8% of common bile duct and/or gall bladderstone also have stone in intrahepatic bile duct. We studied 27 cases of intrahepatic bile duct stone diagnosedwith ultrasound for recent 14 months from Sep. 1983 to Nov.1984 at Department of Radiology, Seoul NationalUniversity, and analysed ultrasonographic findings of the stones. The results were as follows: 1. In 27 cases outof total 35 cases(77.1%), intrahepatic duct stones were confirmed by operation, postoperative T-tubecholangiography, ERCP. PTC, and CT; in 4 cases(11.4%), there were no stone in hepatic duct; and in 4 cases (11.4%)intrahepatic ducts were not completely evaluated because of incomplete studies. 2. 17 cases of 27cases with provenintrahepatic duct stones had also common bie duct and/or gall bladder stones(63%). 3. Ultrasound showed echogenicmaterial (from due to mass) in 27 cases(100%), posterior shadowing in 26 cases(96%), and ductal dilatation in 23cases(85%). 4.Intrahepatic stones tend to be apeared as mass-like echogenecity, with the increase in size, numberand degree of agregation of stones.
Bile Ducts, Intrahepatic ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Diagnosis ; Dilatation ; Gallbladder ; Hepatic Duct, Common ; Incidence ; Seoul ; Shadowing (Histology) ; Ultrasonography ; Urinary Bladder ; Urinary Bladder Calculi

The aim of percutaneous transhepatic biliary drainage(PTBD) is to decrease serum bilirubin level and promoteliver function in patient with biliary tract disease, especially obstruction by malignant disese. But somepatients showed persistent high serum bilirubin level or higher than pre-PTBD level. Percutaneous transhepaticbiliary drainage was performed in 341 patients of obstructive jaundice for 5 years from July, 1981 to July, 1986at departement of radiology, Seoul Natinal University Hospital. Follow up check of the serum bilibrubin level waspossible in 188 patients. Among them the authors analysed 32 patients who showed persistent high serum bilirubinlevel after PTBD. The results were as follows: 1. The male to female ratio was 3.4:1 and the age ranged from 33 to 75. 2. The causes of obstructive jaundice included 30 malignant diseases and 2 benign diseases. Malignant diseasewere 16 cases of bile duct carcinoma, 7 cases of pancreatic cancer and 7 cases of matastasis from stomach, colonand uterine cervix. Benign disease were 1 cases of common hepatic duct stone and 1 case of intrahepatic ductstones. 3. The msot common level of obstruction was trifurcation in 17 cases. 4. The most common indication ofPTBD was palliative drainage of obstruciton secondary to malignant tumor in 28 cases. 5. Change of serujmbilirubin level ratio(post-PTBD level) was 1.28, 1.22, 1.38, 1.51 in serial period of 1–3 days, 4–6 days, 1–2 week 2–3 week after PTBD. 6. Causes of persistent high serum bilirubin level after PTBD were 12 cases of partialdrainage of intrahepatic bile, 13 cases of hepatic dysfunction including 9 cases of metastatic nodule, 2 cases ofbiliary cirrhosis, 2 cases of multiple liver abscess, and 7 cases of poor function of cather including 4 cases ofhemobilia, 1 case of multiple intrahepatic stones, pyobilia and intraheptic Clonorchis sinensis.
Bile ; Bile Ducts ; Biliary Tract Diseases ; Bilirubin ; Cervix Uteri ; Clonorchis sinensis ; Drainage ; Female ; Fibrosis ; Follow-Up Studies ; Hepatic Duct, Common ; Humans ; Jaundice, Obstructive ; Liver Abscess ; Male ; Pancreatic Neoplasms ; Seoul ; Stomach

Purpose: To analyze the causes and to prevent dislocations of the hip joint that occur in patients who underwent revisions of total hip arthroplasties by changing only the polyethylene liners and femoral heads, subsequent to primary total hip arthroplasties. Materials and Methods: We evaluated 28 patients who underwent acetabular component revisions of total hip arthroplasties subsequent to primary total hip arthroplasties. The average age of the patients was 55 years old and all 28 patients had operations through the posterolateral approach. In 17 of the cases, the acetabular cups, polyethylene liners, and femoral heads were changed; in 10 cases, just the polyethylene liners and femoral heads were changed; and in 1 case, only the polyethylene liner was changed. Results: We observed 7 cases of hip dislocations that occurred among a total of 28 cases after revisions of total hip arthroplasties. In all 7 cases, the polyethylene liners and femoral heads were changed, but not the acetabular cups. In additional, in all 7 cases of dislocation, the patients were non-compliant and started weight-bearing prematurely after revisions of the total hip arthroplasties Conclusion: We observed new dislocations in the 7 cases in which the polyethylene liners and femoral heads were changed. The main reasons were inadequate soft tissue tension and hip joint laxity. Therefore, it is necessary to increase the neck length, use elevated rim polyethylene liners, readjust the acetabular cups to their optimal positions, and apply hip abduction braces to patients early after revision of total hip arthroplasties in order to lessen the danger of dislocations.
Acetabulum* ; Arthroplasty ; Braces ; Dislocations* ; Head ; Hip ; Hip Dislocation ; Hip Joint ; Humans ; Neck ; Polyethylene ; Risk Factors* ; Weight-Bearing

Among 334 thoracolumbar spinal injury patients who were admitted to this hospital from June 1972 to June, 1982, 66 patients with fracture and fracture dislocation of thoraco-lumbar spine which were defined as unstable clinically and radiologically were treated with surgical measures. The ratio between male and female was 7.3:1, the majority was found in third and fourth decade (46 cases, 69%), and the most common cause of injury was falling from a height (38 cases, 58%). The most common site of the injury was lumbar spine (29 cases, 44%) and the most common mechanism of injury was flexion-rotation (29 cases, 44%). Our surgical measures were Harrington rod instrumentation with either anterior or posterior fusion (25 cases, 38%), posterior wiring and fusion (14 cases, 21%), anterior decompression and anterior fusion (14 cases, 21%), posterior fusion (4 cases, 6%), anterior fusion and posterior fusion (3 cases, 5%) and etc. The average correction of displacement was 65% and the average correction of kyphotic deformity was 50%. The most remarkable correction was found at the cases of Harrington rod instrumentation (71%, 74%). Neurological deficit had already developed in 43 cases(65%) prior to operation, and the recovery was observed in 18 cases(42%). Most excellent recovery of neural deficit was found also at the cases of Harrington rod instrumentation (11 cases, 52%). We have analysed the results of these treatment and obtained following conclusions. 1. For the unstable fracture and fracture-dislocation of thoraco-lumbar spine with or without neural involvement, immediate surgical treatments were valuable to expect restoration of anatomical reduction and promotion of every possible recovery of neural function with spinal stability and fewest complication. 2. Fixation with Harrington rod instrumentation appears to provide better reduction and stability with neural improvement than other methods, and therefore early undertaking of rehabilitation activities is possible. 3. For the patients who are seriously compromised or require anterior decompression, immediate posterior reduction and fixation with Harrington rod instrumentation followed anterior decompression and anterior fusion of the involved segments at the eariest feasible time, we feel, is the treatment of choice.
Accidental Falls ; Clinical Study ; Congenital Abnormalities ; Decompression ; Dislocations ; Female ; Humans ; Male ; Mortuary Practice ; Rehabilitation ; Spinal Injuries ; Spine

There was increasing tendency to stabilize unstable cervical spine injuries surgically with the benefit of good stability of the spine, easy nursing care, early mobilization and therefore early rehabilitation. A clinical study was performed on 47 patients with fractures and dislocations of the cervical spine treated at the department of orthopedic surgery, Inje Medical College, Paik Hospital from Jan. 1975 to Dec. 1981. Following is the summery of the our findings. 1. The prevalent age distribution was between 3rd and 6th decade and the ratio between males and females was 10:1. The most common cause of injuries was automobile accident (70%). 2. The most common site of the injuries was C5-6 (34%) and the most frequent mechanism of injury was flexion-rotation type (47%). 3. In overall patients, neurologic damage was found at first examination in 73% and among these, complete paralysis below the injured level in 26%, incomplete paralysis in 11% and nerve root injury in 35%. 4. Among 47 patients, conervative treatment was performed on 9 patients, anterior spinal fusion on 8 patients, anterior spinal fusion with Halo application on 4 patients, posterior wiring with posterior spinal fusion on 16 patients and posterior wiring with anterior spinal fusion on 8 patients. 5. In the several methods of treatment, the posterior wiring with anterior spinal fusion revealed the best results, the correction rate of displacement was 92%, the correction rate of angular deformity 98% and neural recovery rate 72%. 6. The posterior wiring with posterior spinal fusion revealed good results in correction of displacement and angular deformity but required rigid external support for a long time. The anterior spinal fusion revealed poor results in correction of displacement(67%) and angular deformity(38%) and required rigid external support for a long time and had increasing tendency of kyphotic angle after operation. 7. In the treatment of unstable cervical spine injury, we thoughy that early posterior reduction with posterior wiring and followed anterior spinal fusion was ideal for accurate reduction, rigid stability and early mobilization with simple external support.
Age Distribution ; Automobiles ; Clinical Study ; Congenital Abnormalities ; Dislocations ; Early Ambulation ; Female ; Humans ; Male ; Nursing Care ; Orthopedics ; Paralysis ; Rehabilitation ; Spinal Fusion ; Spine

Pellegrini-Stieda's disease is a post-traumatic disorder of the knee. It is characterized by a crescentric-like bony formation in the region of the medial condyle of the femur, which usually makes its appearance upon roentgenographic examination three or more weeks after injury to the knee. During the three and a half years from January 1979 to July 1982, eleven patients were treated by conservative method and only one patient was treated by operation. The results were as follows; l. All give a history of trauma. 2. The major findings in this disease were pain in motion, local tenderness, and limitation of motion. 3. In roentgenographic findings of these cases, we noted the followings: 1) The most common site of the calcification was the proximal area of the tibial collateral ligament. 2) In seven cases (58%), the evidence of calcification was noted in 4 weeks to 12 weeks following original trauma. 3) Eight cases (67%) showed a radiolucent area from 0.5 to 3mm in thickness between the bony shadow and the femur. 4) Eight cases (67%) showed a crescentric shape of calcified area. 5) In seven cases (58%), the size of calcified mass was 1.5 to 3.5cm in length and 1 to 3mm in width. The mean size of calcified mass about 3cm in length and about 2.5mm in width. 4. Eleven cases were treated conservatively and one case was treated operatively. The results were satisfactory, and all patients were able to return to their works.
Clinical Study ; Femur ; Humans ; Knee ; Medial Collateral Ligament, Knee ; Methods