Tuberous sclerosis is an autosomal dominant disorder of cellular differentiation that affect the brain, skin, heart, kidney and other organs. We experienced three cases of tuberous sclerosis that affect multiple organs in mother and two daughters. We report these cases with brief review and related literatures.
Brain ; Heart ; Humans ; Kidney ; Mothers* ; Nuclear Family* ; Skin ; Tuberous Sclerosis*

There are 3 basic methods for surgical treatment of axillary osmidrosis; 1) method that removes only subcutaneous cellular tissue without removing skin 2) method that removes skin and subcutaneous cellular tissue en bloc, and 3) method that partially removes skin and subcutaneous cellular en bloc as well as removing the subcutaneous cellular tissue of the adjacent region. We studied the results of partial removal of the skin and subcutaneous cellular tissue en bloc, as well as the removal of subcutaneous cellular tissue of the adjacent region to compare the results of the bipedicled flap with the graft conversion method. There was no difference between two methods in results and complication rates. There are 3 advantage to this procedure. First, about 70-80% of apocrine glands were centrally distributed among the axillary hairbearing region therefore, resection of the central portion of axillary hair distribution area is important for good result. Second, the preservation of the subdermal plexus with careful excision of adjacent underlying subcutaneous tissue under the aid of the magnifying surgical loupe, is important for good wound healing. Third, the central excision of the axillary hair distribution area provides good exploration for undermining and defatting of the undersurface of the adjacent area, therefore it tooks a shorter operation time.
Apocrine Glands ; Hair ; Skin ; Subcutaneous Tissue ; Transplants ; Wound Healing

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is hardly controllable organism among the pathogen of nosocomial infection, because it is resistant to most antibiotics except vancomycin and local treatment with most antiseptics are not effective to eradicate MRSA from the infected wounds. There is increasing fear that MRSA infection can be spread widely in the hospitals. The effectiveness of Gentian Violet against MRSA was reported by Saji et al in 1992 for the first time. We tried Gentian Violet dressing on MRSA infected wounds to evaluate whether at not the Gentian Violet is effective to eradicate 11RSA which existed in the open wound. METHODS: 24 patients were treated by wet dressing with 0.1%Gentian Violet soaked gauze twice daily. They included 10 cases of sacral and trochanteric pressure sore, 6 cases of postoperative wound infectious, 3 cases of posttraumatic skin defects, 2 cases of DM foot, 1 case of post infectious skin defect and 2 cases of electrical burn, The wound culture was evaluated for elimination of MRSA infection twice weekly. RESULTS: The clinical results revealed that MRSA was not detected in all cases within 34days (average 13.5 days) after topical administration 0.1% Gentian Violet. CONCLUSION: There is no evidence of tissue irritation with Gentian Violet dressing on open wound or wound margin. After negative conversion of MRSA with Gentian Violet dressing, gram (-) organism was isolated in a half of the cases. 0.1% Gentian Violet topical administration is a useful treatment method of wound infection with MRSA.
Administration, Topical ; Anti-Bacterial Agents ; Anti-Infective Agents, Local ; Bandages* ; Burns ; Cross Infection ; Femur ; Foot ; Gentian Violet* ; Gentiana* ; Humans ; Methicillin-Resistant Staphylococcus aureus* ; Pressure Ulcer ; Skin ; Vancomycin ; Viola ; Wound Infection* ; Wounds and Injuries*

STUDY DESIGN: A retrospective analysis was performed on 40 patients who had had previous lux bar spine surgeries. OBJECTIVE: To determine what factors most influenced surgical outcome and to analyze results in a series of revision lumbar surgeries. SUMMARY OF BACKGROUND DATA: Satisfactory surgical outcome of the revision lumbar surgery range from 28% to 82% and are rarely comparable to primary surgery. Many factors predicting outcome from repeat lumbar surgery haute been listed. METHODS: Forty patients were analyzed who had had previous lumbar surgeries. The patients were classified into 5 groups according to diagnosis: 3 Infection,5 instability,8 nonunion, 14 HNP and 10 spinal stenosis. of 40 patients,33 patients(82.5%) underwent fusion with instrumentation for repeat surgery. Their clinical course was followed for a minimum of 1 year. The number of surgery on each mpatient was 1.3 times on an average. RESULTS: Overall, 80% of patients had a satisfactory result. Obviously extruded or sequestrated HNP in MRI findings, complete block of contrast with severe radiculopathy and/or myelopathy in spinal stenosis, complete decompression, neurolysi s and fusion with instrumentation, and longer than 6 month pain relief after precious surgery were correlated with satisfactory outcome. However, the number of precious operation, age, repair of pseudarthrosis , no abnormality at surgery and combined multiple degenerative joint disease were significantly correlated with poor surgical outcome. The most common complication during repeat surgery was dural tear in 5 cases(12.5%). CONCLUSIONS: Success rate of revision surgery was low as compared to primary operation. Therefore, erroneous diagnosis and faulty surgical technique understandably lead to failure, and precise attention to preoperative and intraoperative detail can minimize these sources of error.
Decompression ; Diagnosis ; Humans ; Joint Diseases ; Magnetic Resonance Imaging ; Pseudarthrosis ; Radiculopathy ; Reoperation ; Retrospective Studies ; Spinal Cord Diseases ; Spinal Stenosis ; Spine* ; Tears

The maxillary alveolar ridge separates the palate from the lip and clefts of the primary palate have a cleft of the alveolus as well. In the most common clefts of the primary palate, the alveolar portion of the cleft is located between the lateral incisor, if present, and the canine. The cleft may also pass between the central incisor and the lateral incisor, rarer forms of clefts may pass between the central incisor or more distally on the maxillary arch. There are still considerable differences of opinion as to the optimal time for closure of alveolar defects, with or without concomitant bone grafting. But the preferred time for the operation with bone graft is between age 9 and 11 before the canine teeth have fully erupted. As an alternative to primary bone grafting, Skoog developed the periosteoplasty, or "boneless bone graft" technique, in which periosteal continuity was established between maxillary segments by the transfer of local periosteal flaps from the anterior maxillary wall. this procedure, which takes advantage of the propensity of periosteum to form bone in young children, leads to the formation of new bone within the alveolar cleft in spite of the fact that no bone graft is used.This study attempts to defin the effectiveness of early alveolar cleft repair with gingivo-vestibular-mucoperiosteal flap.The results in 6 unilateral alveolar clefts and 1 bilateral alveolar cleft, which is corrected early by gingivo-vestibular-mucoperiosteal flap, have been satisfactory alveolar arch continuity and alveolar bone formation with tooth eruption.
Alveolar Process ; Bone Transplantation ; Child ; Cuspid ; Humans ; Incisor ; Lip ; Osteogenesis ; Palate ; Periosteum ; Tooth Eruption ; Transplants

No abstract available.
Bandages* ; Gentian Violet* ; Gentiana* ; Methicillin-Resistant Staphylococcus aureus* ; Wounds and Injuries*

Twenty five patients (twenty seven hips) who had Chiari osteotomy at Kang Nam St. Marys Hospital between 1980 and 1995 were reviewed to evaluate the factors in the operative technique that contribute to successful outcome and assess the clinical results in various conditions. The length of follow-up ranged from one to fourteen years and the age of at operation ranged from four to twentythree years. Eighteen patients had developmental dysplasia of the hip: four, septic hip: three had another disorders, Prior to the Chiari osteotomy, fourteen hips had an femoral osteotomy and four, trochanteric arthroplasty. We used to the standard osteotomy as described by Chiari with certain modification. A pneumatic saw and osteotome are used instead of Gigli saw. This technique is simple procedure to make the correct level and angle. Bone graft was not performed in all cases even the osteotomy was displaced more than 50 percent of the iliac width. The overall results were 12 excellent, eight good, five fair, and two poor. In eleven patients, the osteotomy had to be displaced more than 50 percent to provide good coverage of the femoral head. Their results were good or excellent. A good result will be obtained if enough attention is paid to displacing the osteotomy. The osteotomy using the pneumatic saw provides accurate level and direction of osteotomy and it is an simple procedure also.
Adolescent* ; Arthroplasty ; Child* ; Femur ; Follow-Up Studies ; Head ; Hip ; Humans ; Osteotomy* ; Transplants

OBJECTIVE: To find out the changes of the plantar pressure distribution of foot and the pathway of center of pressure (COP) in normal preschool children with age. METHOD: Thirty-eight normal children aged 1 to 6 were participated in this study. We divided into three groups according to the age. Foot contact area, pressure of the foot and pathway of COP were measured using F-scan in-shoe measuring system (Tekscan Inc.) during the gait. RESULTS: The ratio of midfoot contact width to forefoot contact width was decreased with age (p<0.05). And the relative pressure of the medial midfoot was decreased with age (p<0.05). In the analysis of COP, the ratio of anteroposterior length of COP to total contact length was significantly increased (p<0.05), and the ratio of mediolateral width of COP to forefoot contact width was tend to decrease. CONCLUSION: We can identify the characteristics and changes of the foot pressure distribution and the pathway of COP in preschool children with normal foot using F-scan system. These quantitative data of foot scan are useful for evaluating the foot pathology in preschool children during the gait.
Child ; Child, Preschool* ; Foot* ; Gait* ; Humans ; Pathology

Transurethral resection of Prostate(TURP) is the current optimal therapy for benign prostatic hypertrophy. But in some cases of BPH patients, TURP cannot be performed because the patients have medical disorders not to be operated. Thus several alternatives have been used in the management of BPH patients, especially who had anesthetic contraindications to an operation. We experienced 12 cases of BPH patients applied with Intraurethral Cath(IUC) from April 1991 to September 1995. Eleven patients became able to void after IUC insertion. The maximal flow rates were 5.1 to 15.7 ml/sec and average value was 11.8 ml/sec. Almost all patients showed irritative voiding symptoms such as urgency, urge incontinence, frequency, and dysuria at first. In 7 patients, these symptoms disappeared spontaneously within 2 to 5 days and oxybutynin chloride was used orally in 2 patients. Suprapubic cystostomy was done in three patients because two patients had severe irritative voiding symptoms and one patient had persistent urinary retention. The stent was changed every 3 to 6 months. Stone formation around the device was noted in 2 patients and migration of device into the bladder was found in 2 patients. In 4 patients, TURP was performed when the patient's condition improved enough to be operated under epidural anesthesia. In conclusion, the use of IUC is thought to be a valid, cost effective and safe alternative to TURP in the treatment of highly operative risk patients with benign prostatic hypertrophy.
Anesthesia, Epidural ; Cystostomy ; Dysuria ; Humans ; Prostatic Hyperplasia* ; Stents* ; Transurethral Resection of Prostate ; Urinary Bladder ; Urinary Incontinence, Urge ; Urinary Retention

No abstract available.