The discovery and synthesis of vitamin D and the elucidation of the role of sunlight in the activation of the vitamin D precursors changed the syndromes of rickets from a therapeutic enigma to a socioeconomic and public health problem. Since Albright in 1937 first described vitamin D resistsnt rickets, which did not respond to treatment with the usual dose of vitamin D, it has progressively become a common form of rickets in practice. In addition, as the result of increasing understanding of renal physiology and careful investigation, a spectrum of renal tubular abnormalities have been identified which cause clinical rickets and which in many cases are insensitive to even large doses of vitamin D. We have reported a case of an unusual form of vitamin D resistant rickets which did not easily respond to treatment with high doses of vitamin D and was associated with hypocalcemia in multiple pathologic fractures in the lower extremities of the patient.
Familial Hypophosphatemic Rickets ; Fractures, Spontaneous ; Humans ; Hypocalcemia ; Lower Extremity ; Physiology ; Public Health ; Rickets ; Sunlight ; Vitamin D ; Vitamins

No abstract available.
Free Tissue Flaps* ; Lower Extremity*

No abstract available.
Humans ; Infant*

Acute generalized exanthematous pustulosis(AGEP) is a disease entity caused mostly by drugs or viral infections. Clinically it manifests as generalized erythema, erythema multiforme and amicrobial pustules with fever. Histologically, AGEP is composed of neutrophilic subcorneal and spongiform pustules. A 70-year-old female, with no personal or family history of psoriasis, was given medication including diltiazem for hypertension. Fourteen days after taking the medications, pustular eruptions appeared on the face and rapidly spread to the trunk and limbs. A Laboratory examination revealed neutrophilic leukocytosis and an elevated erythrocyte sedimentation rate. The skin biopsy showed subcorneal and spongiform pustules. We report here a case of AGEP probably due to diltiazem.
Acute Generalized Exanthematous Pustulosis* ; Aged ; Biopsy ; Blood Sedimentation ; Diltiazem ; Erythema ; Erythema Multiforme ; Extremities ; Female ; Fever ; Humans ; Hypertension ; Leukocytosis ; Neutrophils ; Psoriasis ; Skin

The purpose of this paper is to define the bacterial sources of wound infection after surgery including debridement for open fractures. Total number of patients were 123 during surgery July 1975 to Oct. 1976 at Hangang Sacred Heart Hospital. Out of 123 cases 17 were infected postoperatively. Serial bacterial cultures were performed for specimens taken from the contaminated wound in emergency room and by exposing the Petri-dishes in the operating room. Additional cultures were carried out for 17 specimens taken from the infected wounds postoperatively. Positive bacterial cultures from the initial wounds were obtained in 71 cases (57.7%) out of 123 contaminated wounds in emergency room. Setting monitoring of air contamination in conventional operating room, 51 colonies of bacterial growth per 1 hour exposure were noted and common organisms were colliform bacilli, streptococci and staphylococci in order. Postoperative wound infection rate was 13. 8%. Common pathogens were staphylococcus aureus, coliform bacilli and pseudomonas and kanamycin was most effective antibiotics. The retrospective bacteriological studies for 17 infected cases elucidated following results: 1) Organisms of same species; from initial wound and infected wound postoperatively 7 cases 2) Organisms of same species; from air contamination in the operating room and infectected wound postoperatiyely 5 cases 3) Organism of same species; from air contamination in the operating room, initial wound and infected wound postoperatively 1 case 4) Others (contagious or endogenous origin) 4 cases The results reveal that the initial contaminated open fracture and air contamination during surgery are the main sources of postoperative infection. Four cases which the infectious sources were not determined included in contagious origin dogmaticaIly.
Anti-Bacterial Agents ; Debridement ; Emergency Service, Hospital ; Enterobacteriaceae ; Fractures, Open ; Heart ; Humans ; Kanamycin ; Operating Rooms ; Pseudomonas ; Retrospective Studies ; Staphylococcus aureus ; Surgical Wound Infection ; Wound Infection ; Wounds and Injuries

A fracture of the femoral neck in a young adult differs from the same fracture in an older patient in the following respects; 1. A relatively uncommon injury. 2. A significant difference in the severity of trauma. 3. A less satisfactory result. At the point of view, we studied the femoral neck fcartures in 15, 20- to 50-year-old patients. The aims were to analyze why these fractures occur in young adults, and what results can be expected after internal fixation. The results were as follows; 1. Common in men (3:1). 2. 80% (12/15 cases) of the fractures were caused by severe trauma. 3. The 3 cases (20%) were associated with the other fractures. 4. The factors infuencing the clinical results and complications in our study; a. Severity of trauma. b. Degree of displacement. c. Existence of posterior comminution. d. Time interval between accident and operation. 5. The multiple pinning got the more rigid fixation and diminished the rate of fixation failure. 6. All cases were achieved good to acceptable reduction. 7. Satisfactory functional results were achieved in 93.3%. 8. The rate of avascular necrosis was 15.4% (2/13 cases). It is concluded that the most of femoral neck fractures in younger patients occur because of the significant trauma. In our study, the incidence of avascular necrosis was not greater than in order patients. Therefore, to get as good a result as possible it seems important to perform the anatomical tion and rigid internal fixation with or without bone graft.
Femoral Neck Fractures ; Femur Neck ; Humans ; Incidence ; Male ; Middle Aged ; Necrosis ; Transplants ; Young Adult

Fracture of the tibial shaft is one of the most common fractures of the long bones and frequently followed by malunion, delayed union and nonunion. We experienced the cases of further increase in the angulation after clinical union of the tibial shaft fractures treated by conservative method. So we analyzed 39 cases of tibial shaft fractures which were followed up from 12 weeks to 37 weeks after clinical union in adults. The results were as follows; l. 7 of the 39 cases(18%) showed the increase in the angulation, and all of them were male. 2. Increase in the angulation occurred more frequenlty in the comminuted fractures than simple fractures. 3. The increment of angulation was more marked in group of patients with higher angulation at the time of clinical union. 4. Increase in the angulation occurred more commonly in the cases not associated with fibula fracture than in the cases associated with fibula fracture. 5. Further increase in the angulation was less common in the cases in whom early weight bearing with PTB cast was started.
Adult ; Fibula ; Fractures, Comminuted ; Humans ; Male ; Methods ; Tibia ; Weight-Bearing

The courses of the progression in the fibrous dysplasia are characterized by asymptomatic progression or spontaneous regression in some cases after the growth has ceased and the aims of treatment for a fibrous dysplasia are prevention of the pathologic fractures and correction of the deformities. The osteogenic potentiality of the cambium layer in the periosteum and the beneficial effect on the osteogenesis of the impregnating bone graft with autologous red marrow are well documented. We experienced an extensive fibrous dysplasia with cortical thinning and pathologic fracture and it was managed with subperiosteal combined xenograft of Kiel bone with autologous red marrow for the induction of cortical thickening and prevention of the pathologic fractures because of the inoperability of curettage due to extensive lesion over the entire femur, limitations in obtaining large amount of autogenous cancellous bone for the graft and lack of the facilities of the bone bank. This subperiosteal composite xenograft with autologous red marrow for a fibrous dysplasia gave an excellent result of a remarkable cortical thickening and we think this can be a type of management for a entensive fibrous dysplasia. So we are reporting this case with bibliographic reviews.
Bone Banks ; Bone Marrow ; Cambium ; Congenital Abnormalities ; Curettage ; Femur ; Fractures, Spontaneous ; Heterografts ; Osteogenesis ; Periosteum ; Transplants

The treatment of supracondylar fracture of the femur remains a difficult problem because of the wide range of portential complications. In the past, authors thought conservative treatment was superior to operative treatment of supracondylar fracture of the femur. In addition, the advent of the Cast-Brace introduced the change in concept of the conservative treatment. Recently, however, the advances in the techniques and in the devices used in intemal fixation have encouraged the operative treatment. Tibiofemoral angle, gap or stepping of the articular surface of the distal femur, range of motion of the knee, and pains in the knee were used to evaluate the following results investigated by statistical study(T-test). These clinical results were shown by analyzing 49 cases of supracondylar fracture of the femur trea ted in the Department of Orthopedic Surgery, Hallym College of Medicine, from Jan. 1980 to Dec. 1983 1. We end result of each patient was evaluated by scaled score value calculated from above mentioned criteria. 2. The mean value of the operative treatment(35 cases) was 31.03±5.52, while that of the conservative treatment(14 cases) was 27.71±4.56. 3. The mean value of the group which began the exercise of the knee joint within 2 weeks (33 cases) was 32.24±4.43. The mean value of the other group which began the exercise of the knee joint after 2 weeks(16 cases) was 25.78±4.56. This difference of means between two groups was statistically significant. Beginning the knee joint exercise within 2 weeks has large effect on the result of the treatment. 4.The results of treatment in patient over age of 50 were graded as fair irrespective of methods of treatment. 5. Various devices were used in intemal fixation but there was no difference in the results. 6. We mean value of the Tibiofemoral angle(difference from normal angle) in the operative treatment was 2.37±6.25 and that of the conservative treatment was 8.04±4.62. Both of the above method of treatment showed a varus trend, especially in the conservative treatment. In statistical study, through, there was no significance in two methods.
Adult ; Femur ; Humans ; Knee ; Knee Joint ; Methods ; Orthopedics ; Range of Motion, Articular ; Statistics as Topic

Deep vein thrombosis is a frequently lethal complication following musculoskeletal surgery and skeletal trauma. For this study on incidence of deep vein thrombosis, we examined the data on 40 patients with contrast venography. Thrombosis limited to the veins in the calf of the leg was shown in 10 patients by venography. None of these patients had clinical symptoms of deep vein thrombosis or indicating embolism. We therefore concluded that the incidence of deep vein thrombosis of the lower extremity after injury or operation in Korea is not so rare as was considered before.
Embolism ; Humans ; Incidence ; Korea ; Leg ; Lower Extremity ; Phlebography ; Thrombosis ; Veins ; Venous Thrombosis