Patients with rickets frequently are seen by orthopaedic surgeon with complaints of growth disturbance, limb deformity, weakness, and multiple fracture. Among them, bow leg deformity is the most common and difficult orthopaedic problem. In growing child, however, if effective tretment is given sufficiently in early age and early disease process, the deformities usually correct spontaneously and there is little need for orthopaedic treatment other than careful observation. The orthopaedic treatment may be required to correct deformities that cannot be expected to improve with growth. A clinical study was done for 11 cses of rachitic bow leg deformity who were treated at the department of orthopaedic surgery, Catholic medical College and Center from Jan. 1978 to Dec. 1981. Results obtained were as follows: 1. The most common patients age group was in 1 to 2 years of age and there was no sexual difference. 2. Associated deformities with rachitic bow leg were rachitic rosary (5 cases), double wrist (3 cases), coxa vara (1 case), and Harrison's groove (1 case). 3. Low Ca * P solubility product, below the level of 30 (mg/dl)2 suggested active form of rickets in all cases. 4. Laboratory values such as Ca * P solubility product and alkaline phosphatase improved at 3 weeks after administration of vitamin D in 7 cases, 3 at 6 weeks, and no improvement in one case even at 6 months after treatment. 5. Six months after treatment, the average amount correction of tibiofemoral angle was 9° (43.7% of initial angle) in group 1, 13.3° (47.0%) in group II, 4.9° (29.6%) in group III, and 3.3°(25.6%) in group IV. 6. Through this study it is suggested that the more growth correction of the rachitic bow leg deformity in a younger child below the age of 2 is obtained with growth by treatment, whereas a little or no growth correction can be expected after the age of 3 or 4 years.
Alkaline Phosphatase ; Child ; Clinical Study ; Congenital Abnormalities ; Coxa Vara ; Extremities ; Fractures, Multiple ; Genu Varum ; Humans ; Rickets ; Solubility ; Vitamin D ; Wrist

We report a case of acute intermittent porphyria presenting with variable symptoms and signs such as hypertension, polyneuropathy, syndrome of inappropriate secretion of antidiuretic hormone and cerebral infarction. A 47 year-old female patient entered hospital with abdominal pain followed by generalized seizure. She was diagnosed to have acute intermittent porphyria in consequence of Watson-Schwartz test and δ-ALA in 24 hours urine. She was managed with conservative treatment but died of respiratory failure.
Abdominal Pain ; Cerebral Infarction ; Female ; Humans ; Hypertension ; Polyneuropathies ; Porphyria, Acute Intermittent* ; Respiratory Insufficiency ; Seizures

No abstract available.
Heart* ; Thoracic Surgery*

No abstract available.
Emergencies* ; Emergency Service, Hospital* ; Epilepsy* ; Humans ; Seizures*

BACKGROUND: Peripheral blood stem cell transplantation in children has some difficulties compared with adult cases. Despite the children's total blood volume is small, they have a relatively higher volume of blood per weight than adults. Also, it is hard for the children to maintain 2 central vein during leukapheresis to shorten the time consumed. We compared the artery-harvest and central vein-harvested group for possible risk and stem cell yield in pediatric patients with malignancies. METHODS: From August, 1995 to January, 1997, 21 leukapheresis was performed by 7 patients. The patients who could have 2 central veins for leukapheresis were included in vein-harvested group and the patients who could have only 1 central vein were included in artery-harvested group. The peripheral vein was not used for leukapheresis. COBE Spectra(COBEBCT, Lakewood, CO) was used and priming was done by packed RBCs in patients weighing less than 20kg. Stem cell yield was assessed by MNC, CD34+, CFU-GM, respectively. During leukapheresis, the patients were closely monitored for change in vital sign, evidence for thrombosis, bleeding, hypocalcemia, etc. RESULTS: There was no serious complication in each group of patients. After the leukapheresis, WBC and platelet count decreased but Hb level was increased due to reinfusion of primed packed RBCs. Average flow rate was higher in vein-harvested group but there was no difference in time consumed and results in stem cell assay. CONCLUSION: Peripheral stem cell harvest in children by radial artery can be performed safely and easily without an increased risk or complication. In younger children, it is possible to achieve even more higher stem cell yield. If the patient is unable to maintain 2 central vein for leukapheresis, transient radial arterial catheterization is a safe and convenient method.
Adult ; Blood Volume ; Catheterization* ; Catheters* ; Child ; Colony-Forming Units Assay ; Granulocyte-Macrophage Progenitor Cells ; Hemorrhage ; Humans ; Hypocalcemia ; Leukapheresis ; Peripheral Blood Stem Cell Transplantation ; Platelet Count ; Radial Artery ; Stem Cells* ; Thrombosis ; Veins ; Vital Signs

A 40-year-old woman had a pruritic, vesiculobullous eruption of her face for 6 weeks with no evidence of systemic disease. A biopsy showed subepidermal blisters and dermal infiltrates of neutrophilic inflammatory cells. Direct immunofluorescence demonstrated thick linear deposits of IgG and C3 along the basement membrane zone. The cleavage plane was identified to be just beneath the lamina densa. Using Western immunoblots, the patient's IgG autoantibodies were found to recognize type VII proeollagen. Moderate starting doses of systemic prednisolone gave a good response for this patient with an early inflammatory form of epidermolysis bullosa acquisita.
Adult ; Autoantibodies ; Basement Membrane ; Biopsy ; Blister ; Blotting, Western ; Epidermolysis Bullosa Acquisita* ; Epidermolysis Bullosa* ; Female ; Fluorescent Antibody Technique, Direct ; Humans ; Immunoglobulin G ; Neutrophils ; Prednisolone

BACKGROUND: Polyarteritis nodosa(PAN) is a disease of necrotzing vasculitis which has a clinical spectrum encompassing those cases of multisystem involveme it and skin-limited variant. The clinical course of cutaneous PAN has been considered to be a benign one, however there is sorne controversy regarding its nosological entity. OBJECTIVE: To characten the clinical course of the patients with cutaneous PAN and determine whether or not it is a benign disease or something more sever. METHODS: Clinical and laboratory findings in 8 patients with Logy-proven cutaneous PAN but without any detectable visceral involvement were observed periochelly during a follow-up period over 18 months. Meticulous physical and pertinent laboratory earinations were performed each time during their visits. RESULTS: Livedo reticulari, on the lower legs was the mostorenon cutaneous findings with these patients. During the follow-up periods there were no suspected abnormal physical and laboratory findings to have other organ involvement in all 8 patients Serologic examinations for antineutrophil cytoplasmic antibody and hepatitis-B surface antigen revealed negative in all patients tested. CONCLUSION: The follow-up periods of 2 years or so does not seem to be long enough in characterizing the clinical features of PAN. However, the cutaneous: on of PAN can be regarded as a benign cutaneous variant of the disease having no visceral lesion of arteritis, even though mild degrees of constitutional symptoms and a few laboratory abnormlites could be seen.
Antibodies, Antineutrophil Cytoplasmic ; Antigens, Surface ; Arteritis ; Follow-Up Studies ; Humans ; Leg ; Polyarteritis Nodosa* ; Vasculitis

No abstract available.
Hemosiderosis* ; Humans ; Kidney Failure, Chronic* ; Seizures*

Hospitals have been very susceptable to changes in external environment. Accordingly, they have been experiencing great financial difficulty due to low insurance rates and increasing competition. As a remedy, hospitals have attempted to use computer in a strategic manner. Such system is called strategic information system (SIS) , and order communication system (OCS) is an example of SIS in hospital setting. While OCS has known to be effective in reducing waiting time for outpatients, many hospitals are reluctant to introduce this system mainly because there are no real data or methods for justifying the cost of the system. Cost-benefit analysis has been traditionally used for such purpose, but this method deals with limited portion of benefits and therefore not very useful for analyzing the economic feasibility of SIS. In this paper, information economics tools which expand cost with value was used to analyze the economic feasibility of OCS. To assist the analysis, financial simulation model was developed using simulation package, called IFPS (Interactive Financial Planning System).
Cost-Benefit Analysis ; Humans ; Information Systems ; Insurance ; Outpatients

Fracture of the metal base of tihial components of total knee arthroplasty has heen occasionally reportecl. The most common cause of the failure of the metal hase plate was known to be a fatigue fracture around the screw hole where the strength of the metal hase plate was the weakest. We experienced a case of the fracture of the metal hase plate secondary to the t'racture of the posteromedial corner of the metal tihial condyle which was weakened due to the shoil peg hole for the base plate of MG II implant. Since the proximal portion of the posterior tihial condyle was normally thin, cutting the hone for the base plate made it thinner and wcaker than normal. Therefore stress fracture of the bone occurred and the overlying metal plate was subsequently hroken. From this experience. we concluded that the posterior peg hole may cause unwanted failure of the posteromedial corner of the tibial base plate.
Arthroplasty* ; Fractures, Stress ; Knee*