The fabella, a sesamoid bone that occasionally is found in humans on the gliding surface of the lateral head of the gastrocnemius, is a sign of an atavistjc pattern. The authors examined radiograph of knees of 817 patients for the presence of fabella and determined the incidence of fabella in traumatic patients as compared with non-traumatic patients with primary osteoarthrosis or vague pain in that knees. The results were as followes: l. 31.0% of 626 adult patients had at least a unilateral fabella. 2. There was no difference in the incidence of fabella according to sex (p<0.01). 3. The youngest boy showing the fabella was aged 12 years & 8 months, the youngest girl 15 years & 2 months. 4. 87.1% of the patients who had a fabella had one bilaterally. 5. Fabellae were more common in the patients with primary osteoarthrosis or vague pain in that knees. 6. It is our opinion that the presence of fabella is more important in the clinical aspect in Korea.
Adult ; Female ; Head ; Humans ; Incidence ; Knee ; Korea ; Male ; Osteoarthritis ; Sesamoid Bones

Reduction of displaced diaphyseal fractures of the radius and ulna in adult must be nearly anatomical for restoration of mormal function. Most of the fractures require operative management, and various methods of open reduction and internal fixation have been recommended. Because we believe that anatomical reduction followed by rigid internal fixation provides the most satisfactory results for these injuries, dynamic compression plating method is frequently used in our hos pi tal. We studied 52 diaphyseal fractures of the forearm bone in 33 patients treated at the S.R.C.H. from May 1980 to December 1985. Of the 33 patients, 20 had fractures of the radius and ulna; 6, fractures of the radius only; and 7, fractures of the ulna only. The fractures of both bones were treated with plate and screws in 19 patients. In another one, the ulna was treated with plate and screws and the radius was treated by screw fixation only. The results were as follows: l. Of the 52 fractures, 51(98.1%) were united after the initial operation within 23 weeks. 2. The average time for radiological union of the fracture, excluding those complicated by infection or non-union, was 11.1 weeks for 24 radii and 10.9 weeks for 25 ulnae. 3. Only one patient(3.0%) was complicated by infection and only one(1.9%) non-union of radius occurred. 4. The functional results were excellent or satisfactory in 25 patients(83.3%). 5. We have found that in adults the auto compression plating is a successful method for the diaphyseal fractures of the forearm.
Adult ; Diaphyses ; Forearm ; Humans ; Methods ; Radius ; Retrospective Studies ; Ulna

Subtrochanteric fractures of the femur are difficult to manage successfully. Two factors, involvement of cortical bone tissue and concentration of stress, frequently have been mentioned as reasons for the high incidence of failure in the treatment of these fractures. We studied 37 patients with 38 subtrochanteric fractures treated at the Seoul Red Cross Hospital from Feb. 1978 to Nov. 1983. The results were obtained as follows: 1. Of the 37 patients studied, 29 were male and 8 female. The majority of male patients (representing 62.1%) were between 21 and 50 years of age, while 7 of 8 female patients were after 50years of age. 2. In 27 (73.0%) of our patients, the fracture resulted from high-energy trauma, traffic accident or fall from height. 3. Many fractures in the present series could not be classified in the manners described by Fielding, Zickel or Seinsheimer. So, we could not find any correlation between fracture type and used fixation device or its prognosis. 4. The associated injuries, which were relatively common in lower limb (10 cases) and pelvis (8 cases), made the fractures more difficult to treat. 5. Of the 38 fractures, 35 (92.1%) were treated by operative means. The Jewett nail was the device most commonly used, with a total of 11(31.4%) fractures being so treated. 6. The average time from operation to partial weight bearing was 12.9 weeks. 7. The average time untill clinical union was about 14 weeks and radiographic union about 24 weeks. 8. From these series, it was considered that, although early weight bearing is frequently impossihle, Jewett nail, plate and screw, compression hip screw, Judet plate or blade plate can be applied successfully to the treatment of subtrochanteric fractures of the femur if the most proper one which can stabilize the lesion effectively is selected and weight bearing is delayed for a sufficient period.
Accidents, Traffic ; Bone and Bones ; Clinical Study ; Female ; Femur ; Hip ; Hip Fractures ; Humans ; Incidence ; Lower Extremity ; Male ; Pelvis ; Prognosis ; Red Cross ; Seoul ; Weight-Bearing

In order to investigate the validity of the Steel's gluteus medius and minimus advancement, we reviewed 21 hips in 14 spastic cerebral palsy patients, who had advancement of the gluteus medius and minimus insertion for the correction of in-toeing gait between November 1985 and February 1992. The procedure was limited to those patients who had moderate to severe in-toeing gait with positive Steel's stretch reflex. There were eight boys and six girls. The average age at the time of surgery was 6.7 years(2.9 years-11.9 years). The procedure was performed on both hips in seven patients. Of the 14 patients, nine had diplegia, three hemiplegia, and two paraplegia. The average follow-up time was 4.3 years(1 year-8.5 years). In-toeing gait was converted to neutral or physiologic out-toeing gait in 17 hips(81%), excessive out-toeing in 2 cases(9.5%), and mild residual in-toeing in 2 cases(9.5%), Steel's stretch reflex, which was present in all cases preoperatively, disappered in 19 hips(90.5%) postoperatively, Abductor power, however, decreased from 4+ to 4− in average postoperatively, Among the 16 hips, which had no Trendelenburg sign or gait preoperatively, 8 hips(50%) showed positive Trendelenburg sign and gait postoperatively. In conclusion, Steel's gluteus medius and minimus advancement appears to be effective in the correction of in-toeing gait, but there is high risk of weakening the abductor power.
Cerebral Palsy ; Female ; Follow-Up Studies ; Gait ; Hemiplegia ; Hip ; Humans ; Muscle Spasticity ; Paraplegia ; Reflex, Stretch

The definition of volvulus is an axial twist of a portion of the gastrointestinal tract along its mesentery. The involved bowel is obstructed partially or completely with a variable degree of arterial and venous occlusion. The colon is the most common site for volvulus. The splenic flexure is the least common site of colonic volvulus. We experienced a case of the volvulus of the splenic flexure. It will be the 30th case of the volvulus involving the splenic flexure in the English literature, to our knowledge. A 30-year-old woman was admitted due to abdominal pain and distention with vomiting. An emergency barium study revealed characteristic "bird beak" sign. Surgery was performed resecting the involved colon of splenic flexure. The result was excellent.
Adult ; Barium Sulfate/diagnostic use ; Case Report ; Colonic Diseases/*radiography ; Female ; Human ; Intestinal Obstruction/*radiography

Spontaneous rupture of the rectosigmoid colon and herniation of the small intestine through the rupture site and eventual evisceration through the anus is a very rare event. In the literature, only 42 cases have been reported. The majority of them occurred in patients with rectal prolapse and one case was reported in association with a third-degree uterine prolapse. We experienced an 81-year-old female patient with rectal prolapse and second-degree uterine prolapse complicated by spontaneous perforation of the rectosigmoid colon and anal evisceration of the small intestine. Segmental resection of the nonviable small intestine, primary repair of the ruptured rectosigmoid colon, and sigmoid loop colostomy were performed, and the patient recovered well. In our patient, both rectal and uterine prolapses cooperatively damaged the anterior wall of the rectosigmoid colon and resulted in perforation. So, rectal and uterine prolapses should be treated before the complication develops. In this patient, uterine prolapse should be treated because of the recurrence of this rare episode.
Aged ; Aged, 80 and over ; Case Report ; Colonic Diseases/etiology* ; Female ; Human ; Rectal Prolapse/complications* ; Rupture, Spontaneous ; Uterine Prolapse/complications*

Exogenous lipoid pneumonia (ELP) is a chronic inflammatory reaction of the lungs resulting from the aspiration of vegetable, animal or mineral oils. Squalene, is a derivative of shark liver oil that is taken as a traditional remedy in some Asian countries, and is used widely also in cosmetics. Similar to the symptoms in most cases of oil aspiration, the symptoms of squalene-induced lipoid pneumonia are either absent or nonspecific. Hence, the disease is generally detected incidentally. Although many cases with predisposing factors have been reported, ELP with achalasia is quite rare. We report a 47-year old woman with achalasia who developed ELP after ingesting squalene. The patient was treated successfully by supportive care and surgical treatment of the achalasia.
Animals ; Asian Continental Ancestry Group ; Cosmetics ; Eating ; Esophageal Achalasia ; Female ; Humans ; Liver ; Lung ; Mineral Oil ; Pneumonia ; Sharks ; Squalene ; Vegetables

P450 CYP2D6 enzyme(debrisoquine hydroxylase) is known to metabolize many neuroleptics and some genetic polymorphisms in the CYP2D6 gene were reported to be associated with tardive dyskinesia(TD). We investigeted the association of two genetic polymorphisms in the CYP2D6 gene, CYP2D6*4 and CYP2D6*10, with TD in Korean schizophrenic subjects. Subjects consisted of 71 Korean schizophrenics and TD was evaluated using the Abnormal Involuntary Movement Scale(AIMS). There were no statistically significant differences in the demographic variables of age, male to female percentage and the current antipsychotic(CPZ equivalent) dose between the grup with TD and the group without TD. But the duration of antipsychotic drug exposure was siginificantly higher in the group without TD(p=0.000, by independent t-test). The mean AIMS score in the group with TD was 11.2+/-6.6(S.D.). Genotypings ofr the presence of CYP2D6*4 and CYP2D6*10 wee done using PCR amplifications and endonuclease digestions. There were no statistically significant genotypic and alleleic associations between TD and CYP2D6*4(by chi-square tests), and between TD and CYP2D6*10(by chi-square tests). These results indicate that the CYP2D6*4 and CYP2D6*10 polymorphisms have no significant roles in the causation of TD.
Antipsychotic Agents ; Asian Continental Ancestry Group ; Cytochrome P-450 CYP2D6 ; Dyskinesias ; Female ; Humans ; Male ; Movement Disorders* ; Polymerase Chain Reaction ; Polymorphism, Genetic

PURPOSE: Mucopolysaccharidosis type II (MPS II or Hunter syndrome) is a rare lysosomal storage disorder caused by iduronate-2-sulfatase (IDS) deficiency. MPS II causes a wide phenotypic spectrum of symptoms ranging from mild to severe. IDS activity, which is measured in leukocyte pellets or fibroblasts, was reported to be related to clinical phenotype by Sukegawa-Hayasaka et al. Measurement of residual plasma IDS activity using a fluorometric assay is simpler than conventional measurements using skin fibroblasts or peripheral blood mononuclear cells. This is the first study to describe the relationship between plasma IDS activity and clinical phenotype of MPS II. METHODS: We hypothesized that residual plasma IDS activity is related to clinical phenotype. We classified 43 Hunter syndrome patients as having attenuated or severe disease types based on clinical characteristics, especially intellectual and cognitive status. There were 27 patients with the severe type and 16 with the attenuated type. Plasma IDS activity was measured by a fluorometric enzyme assay using 4-methylumbelliferyl-alpha-iduronate 2-sulphate. RESULTS: Plasma IDS activity in patients with the severe type was significantly lower than that in patients with the attenuated type (P=0.006). The optimal cut-off value of plasma IDS activity for distinguishing the severe type from the attenuated type was 0.63 nmol.4 hr-1.mL-1. This value had 88.2% sensitivity, 65.4% specificity, and an area under receiver-operator characteristics (ROC) curve of 0.768 (ROC curve analysis; P=0.003). CONCLUSION: These results show that the mild phenotype may be related to residual lysosomal enzyme activity.
Enzyme Assays ; Fibroblasts ; Humans ; Iduronate Sulfatase ; Leukocytes ; Mucopolysaccharidoses ; Mucopolysaccharidosis II ; Phenotype ; Plasma ; Sensitivity and Specificity ; Skin

PURPOSE: Mucopolysaccharidosis type II (MPS II or Hunter syndrome) is a rare lysosomal storage disorder caused by iduronate-2-sulfatase (IDS) deficiency. MPS II causes a wide phenotypic spectrum of symptoms ranging from mild to severe. IDS activity, which is measured in leukocyte pellets or fibroblasts, was reported to be related to clinical phenotype by Sukegawa-Hayasaka et al. Measurement of residual plasma IDS activity using a fluorometric assay is simpler than conventional measurements using skin fibroblasts or peripheral blood mononuclear cells. This is the first study to describe the relationship between plasma IDS activity and clinical phenotype of MPS II. METHODS: We hypothesized that residual plasma IDS activity is related to clinical phenotype. We classified 43 Hunter syndrome patients as having attenuated or severe disease types based on clinical characteristics, especially intellectual and cognitive status. There were 27 patients with the severe type and 16 with the attenuated type. Plasma IDS activity was measured by a fluorometric enzyme assay using 4-methylumbelliferyl-alpha-iduronate 2-sulphate. RESULTS: Plasma IDS activity in patients with the severe type was significantly lower than that in patients with the attenuated type (P=0.006). The optimal cut-off value of plasma IDS activity for distinguishing the severe type from the attenuated type was 0.63 nmol.4 hr-1.mL-1. This value had 88.2% sensitivity, 65.4% specificity, and an area under receiver-operator characteristics (ROC) curve of 0.768 (ROC curve analysis; P=0.003). CONCLUSION: These results show that the mild phenotype may be related to residual lysosomal enzyme activity.
Enzyme Assays ; Fibroblasts ; Humans ; Iduronate Sulfatase ; Leukocytes ; Mucopolysaccharidoses ; Mucopolysaccharidosis II ; Phenotype ; Plasma ; Sensitivity and Specificity ; Skin