Clubfoot or talipes equinovarus is the most common congenital anomaly of the foot observed in children as well as in adults. This deformity should be treated immediately after birth, and so the cases of old neglected clubfeet are quite rare now. Moreover, in the cases of old neglected clubfoot, it is very difficult to get satisfactory results because there will be secondary adaptive changes in the tarsal bones and surrounding soft tissues. Therefore, clubfeet are considered to be one of many things requiring on or more of the many different types of treatment. The authors have experienced to treat nine cases of old neglected clubfoot from May, 1978 to April, 1988 at the Department of Orthopedic Surgery, St. Mary's Hospital, and reported herewith. 1. Their average age was 14.8 years old (3 to 25 yesrs old). There were one bilateral clubfeet, left foot in 5 cases and right foot in 4 cases. 2. According to the age of the patients and severity of deformities, two patients from three to ten years old were treated with soft-tissue release and serial casting, and seven patients after ten years old were treated by soft-tissue release, various osteotomies and triple arthrodesis. Postoperative management consisted of long leg cast for first four weeks and short leg walking cast for another four to eight weeks. 3. The results were estimated by the talo-calcaneal index according to Beatson et al(3)radiologically and their external appearance of corrected foot subjectively. The talo-calcaneal index was improved from 17.8° to 37° after operation and all of patients satisfied with the results of their operation.
Adult ; Arthrodesis ; Child ; Clubfoot ; Congenital Abnormalities ; Foot ; Humans ; Leg ; Orthopedics ; Osteotomy ; Parturition ; Tarsal Bones ; Walking

No abstract available.
Common Variable Immunodeficiency* ; Humans

No abstract available.
Snake Bites* ; Snakes*

Increase of AST and ALT is a common biochemical finding in patients with multiple trauma. So it is difficult to make a decision for appropriate operation timing and to predict prognosis with consideration of parenchymal liver disease. We studied patients with multiple trauma who admitted to orthopedic department with increased AST & ALT and patients who had hepatitis from Jan. 1993 to Dec. 1993. The patients were checked AST & ALT on admission day and followed by the 3rd, 5th, 9th day, second and third week. We checked the relation of changed level of these enzymes and severity of injury, combined abdominal trauma, head trauma and the presence of HBs Ag/Ab. We concluded as followed: 1) Traumatized patients had high AST than ALT during first 3 days but hepatitis patients had higher ALT than AST during throughout admission days. High ALT in hepatitis patients had statistically significance compare to traumatized patients. 2) Traumatized patients with high AST were decreased more rapidly than ALT and showed normalized enzymatic level by 3rd week. 3) The AST level was higher in severely injured patients and it was statistically significant within first 3 days. But ALT was not correlated with the severity of injury. 4) In patients with abdominal injury, AST was higher than ALT and AST had significance but ALT had none. 5) There is no specific correlation between these enzyme level in neurosurgical problem and the presence of HBsAg/Ab.
Abdominal Injuries ; Craniocerebral Trauma ; Hepatitis ; Humans ; Liver Diseases ; Multiple Trauma ; Orthopedics ; Prognosis

OBJECTIVE: To compare the outcomes of a method of assigning patients to a vaginal or laparoscopically assisted vaginal approach to hysterectomy. METHOD: Hysterectomy is the most common gynecologic operation. A clinical evaluation was attempted to analyze 100 cases of LAVH which was performed at St. Paul hospital from May 1997 to March 2000, and to compare them with 100 cases of vaginal hysterectomy at the same hospital. we used simple electrosurgical technique without using the disposable staples and other instruments. RESULTS: The mean age of the patients for LAVH was 46.18 years and that of VTH was 50.23 years. The most common indication for LAVH and VTH was Myoma uteri. The mean Hb change in LAVH was 2.15 and the Hb change of VTH was 2.17. The mean operative time of LAVH was 142.96 minutes and that of VTH was 77.06 minutes. The mean weight of uterus for LAVH was 221g and the mean weight of VTH was 182 g. The total percentage of urinary tract injury for LAVH was 3 % and that for VTH was 2 %. CONCLUSION: VTH, if possible, must be considered as a primary choice since it is were efficient than LAVH in cost, cosmetic aspects and complications. Further LAVH may be replaced with a laparotomy for hysterectomy in case of an insufficient operational experience, a previous abdominal operation hystory and the incapability of being indicated for VTH.
Female ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Laparotomy ; Myoma ; Operative Time ; Urinary Tract ; Uterus

We had experienced a case of congenital lobar emphysema in a 3 months old male infant. Chief symptoms included tachypenea, respiratory difficulty, cyanosis, Chest X-ray or chest CT scan revealed extensive emphysematous changes of the right upper and middle lobes, compression of the right lower lobe and shifted of mediastinum to the left side. This condition was appeared in the absence of infection and foreign body in the bronchus and its failure to respond to conservative treatment. This patient was treated by the right upper and right middle lobes pneumonectomy. A brief review of literature was made.
Bronchi ; Cyanosis ; Emphysema* ; Foreign Bodies ; Humans ; Infant ; Male ; Mediastinum ; Pneumonectomy ; Thorax ; Tomography, X-Ray Computed

No abstract available.
Pneumonia*

Patients undergoing thoracotomy experience severe postoperative pain and marked respiratory impairment. Analgesics(narcotics or loeal anesthetics) administered via epidural catheter in epidural space have been shown to provide postoperative analgesia and improve respiratory mechanics after thoracotomy. Several different methods have been utilized in an attempt to reduce pain and pulmonary mechanics after thoracotomy. These include epidural blocks using local anesthetics, epidural narcotics, ketamine, steroid, and clonidine. These methods have been shown to provide pain relief with relative preservation of lung volumes in the postoperative period, but have disadvantages. Especially epidural local anesthetics may cause hypotension and motor blockade of lower extremities, and epidural narcotics may cause pruritus, nausea and vomiting, urinary retension and respiratory depression. In an attempt to provide excellent analgesia and improve pulmonary mechanics after thoracotomy and to decrease the side effects associated with the intermittent bolus administration of epidural narcotics or local anesthetics, we performed a study of continuously administered epidural infusion of small concentration of fentanyl combined with low concentration of bupivacaine. Twenty eight patients undergoing thoracotomy were randomized into groups based upon a postoperative pain regimen as indicated: Group I: intermittent intramuscualr injection of nalbuphine 0.2 mg/kg(n=13), Group II: continuous epidural injection of mixtures of 0.2/ bupivacaine and fentanyl 3 ug/ml(n= 15). Two, 8, 24 and 48 hours postoperative, the following indices were measured: visual analogue pain scale, vital capacity, tidal volume, arterial blood gas analysis(pH, PaCo2, PaO2), side effects, and 24 hour urine 17-ketosteroids. The results were as follows: 1) Pain score was evaluated by visual analogue pain scale postoperatively and the pain scores significantly decresed in group II as compaired with those in group L 2) Vital capacity and tidal volume in group II were more improved than group I. 3) There was no difference in arterial blood gas analysis except for decreased PaO2 at 2 hour and 24 hour compared with preoperative value in group L 4) Major complications in group II were two cases of nausea and vomiting, one case of urinary retension, whereas only I patient in group I complained of nausea and vomiting. 5) No significant difference occurred in 24 hour urine l7-ketosteroid at 24 hour and 48 hour postoperatively in group I and group II, which were within normal limits.
17-Ketosteroids ; Analgesia* ; Anesthetics, Local ; Blood Gas Analysis ; Bupivacaine* ; Catheters ; Clonidine ; Epidural Space ; Fentanyl* ; Humans ; Hypotension ; Injections, Epidural ; Ketamine ; Lower Extremity ; Lung ; Mechanics ; Nalbuphine ; Narcotics ; Nausea ; Pain Measurement ; Pain, Postoperative ; Postoperative Period ; Pruritus ; Respiratory Insufficiency ; Respiratory Mechanics ; Thoracotomy* ; Tidal Volume ; Vital Capacity ; Vomiting

No abstract available.
Humans ; Langerhans Cells* ; Prognosis*

BACKGROUND AND OBJECTIVES: Flow-mediated brachial artery vasoactivity has been proposed as a noninvasive means for assessing endothelial function. The present study is designed to assess the influence of aging on endothelial function and when vasoactivity developed initially, peaked. MATERIALS AND METHOD: We measured brachial artery diameter for 60 seconds continuously using 7.5 MHz ultrasound following 5 minutes of lower arm occlusion in 22 normal volun-teers (young group: 10 volunteers, 26.5+/-1.9 years; old group: 12 volunteers, 55.9+/-3.3 years). After sublingual administration of 0.6 mg nitroglycerine, 240 seconds continuously. And then we measure vasoactivity every 3 seconds. RESULTS: Flow-mediated vasodilation (FMD) was started earlier in young group (24.3+/-2.8 sec; old group 28.8+/-3.6 sec, p=0.017). After release of occlusion, peak vasoacitivity time was at 35.5+/-4.7 seconds and peak vasoactivity was 8.4+/-1.7% in young group (old group 6.9+/-1.5%, p=0.099). Endothelial independent vasodilation (EID) was started at 80.7+/-13.3 seconds after sublingual nitroglycerine in young group (vs 80.0+/-19.0 sec), peaked at 177.5+/-16.9 seconds (vs 171.3+/-13.8 sec). Peak vasoactivity was higher in young group (19.1+/-3.1%; old group 15.9+/-2.5%, p=0.033). CONCLUSION: We conclude that 1) Aging has influence on endothelial function about initiating time of vasoactivity as well as peak vaso- activity. 2) FMD can be measured around 50 seconds after release of brachial artery occlusion and EID at 180 seconds after application of sublingual nitroglycerine. 3) The initiating time of vasoactivity (under 30 seconds) can be used for evaluation of endothelial function.
Administration, Sublingual ; Aging* ; Arm ; Brachial Artery ; Nitroglycerin ; Ultrasonography* ; Vasodilation ; Volunteers