No abstract available.

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

To evaluate the effect of intertrochanteric femoral derotational osteotomy(IFDO) on the sagittal plane kinematics and kinetics of the hip and pelvis in spastic cerebral palsy, we compared the preoperative and post-operative results of 3 dimensional gait analysis. Intertrochanteric femoral derotational osteotomy alone without psoas procedure was performed in 34 hips of cerebral palsy patients with increased femoral anterversion regardless of preoperative dynamic or static hip flexion contracture. Those who had other concomitant hip procedures were excluded. There were 24 diplegics and 10 hemiplegics. Mean age of the patients at the time of operation was 9.1 years (range, 4.9 to 22). They were divided into three subgroups according to the degree of dynamic hip flexion contracture; 13 patients with normal hip extension in terminal stance (group I), 13 patients with maximum hip extension in terminal stance between 0 and 15 degrees (group II), and 8 patients with maximum hip extension in terminal stance of more than 15 degrees (group III). The gait analysis included clinical assessment, video-taping, 3D-kinematics and kinetics, and dynamic EMG. Linear parameters of gait, kinematic parameters, sagittal plane hip moment parameters, and total hip energy parameters were compared. Postoperatively, cadence and double support time decreased, whereas walking velocity and stride length increased in all groups. Maximum and minimum pelvic tilt were improved in all groups. The range of pelvic tilt improved in all groups except group I. Hip flexion-extension curve shifted into extension in all groups. Marked improvement in maximum hip extension in stance and the range of hip motion were observed in all groups. The sum of extensor moment decreased, whereas that of flexor moment increased significantly in all groups. The conversion timing from extensor to flexor moment significantly improved in group I and II. The decrease of power generations of Hl and the increase of power absorptions of H2 were significant in all groups. However, there were no significant changes in power generation of H3 in all groups. The changes of peak power generation timing of H3 was not consistent among the groups. Femoral derotational osteotomy at the intertrochanteric level brings the lesser trochanter forward resulting in iliopsoas lengthening effect. We found significant improvement of the sagittal plane kinematics and kinetics of the hip and pelvis when IFDO alone was performed without psoas tenotomy. The psoas lengthening procedure may be considered secondarily at the time of hardware removal after full evaluation of the psoas lengthening effect.
Absorption ; Biomechanical Phenomena ; Cerebral Palsy* ; Contracture ; Family Characteristics ; Femur ; Gait ; Hip* ; Humans ; Kinetics ; Muscle Spasticity* ; Osteotomy* ; Pelvis* ; Tenotomy ; Walking

Increased splenic uptake of radiocolloid is a helpful sign in the scintigraphic diagnosis of diffuse hepatocellular diseases, but any attempt has been made to quantify this phsiologic phenomenon. The purpose of thestudy is to evaluate a simple computer quantitation of S/L ratio and to determine normal range and S/L ratios forvarious hepatic diseases. Authors analized S/L ratios of 194 cases of liver scintigraphy from July 1984 to May1985. The results are as follows; 1. The age distribution of normal and various heptic disases was most frequentin 30 to 40 decade. 2. The classification of studied groups were normal subjects (80 cases), hepatitis(30 cases),liver cirrhosis (59 cases), hepatoma(8 cases), metastasis(10 cases), and miscellaneous diseases(7 cases). 3. Thesimple computer quantitation method exhibits small interobserver variation.(r=0.92, p<0.001) 4. The mean S/L ratioin normal group was determined 0.34 (S.D=0.12) with a its range from 0.10 to 0.58 (0.34±2 S.D). The mean S/Lratios in various hepatic diseases were as follows; 0.52 (S.D=0.18) in hepatitis, 1.10 (S.D=0.43) in cirhhosis,0.77 (S.D=0.38) in hepatoma, 0.47 (S.D=0.21) in metastasis, and 0.43(S.D=0.17) in miscellaneous diseases. 5. Theelevated S/L ratios rather than normal values were found in hepatitis (30%), cirrhosis(51%), hepatoma(63%), and metastasis(20%). 6. The sensitivity of single scintigraphic diagnosis of liver cirrhosis was 63%, but thesensitivity was improved to 90% when combined with S/L ratio. 7. The simple computer quantitation of the S/L ratiois a valid and useful method in the interpreation of liver scintigraphy and also may increase the sensitivity inthe diagnosis of liver cirrhosis and hepatoma combined with cirrhosis.
Age Distribution ; Carcinoma, Hepatocellular ; Classification ; Diagnosis ; Fibrosis ; Hepatitis ; Liver Cirrhosis ; Liver ; Methods ; Neoplasm Metastasis ; Radionuclide Imaging ; Reference Values

A 19 yar-old male patient was admitted to the department of neurology in Severance hospital beause of slowly progressive spastic paraparesis. On examination, dark brown skin color, sparse hair, spastic weakness and hypesthesia of lower extremities were noted. The laboratory studies showed high serum ACTH level with lowest normal limit of serum cortisol level. Brain MRI scan revealed high signal intensities in bilateral corticospinal tracts on T, Weighted images with gadolinium enhancement and T2eighted images. The results of three modal evoked potential studies(SEP. BAEP. VEP) were abnormal bilaterally. Nerve conduction studies and sural nerve biopsy suggested the presence of peripheral neuropathy.
Adrenocorticotropic Hormone ; Adrenoleukodystrophy* ; Biopsy ; Brain ; Evoked Potentials ; Gadolinium ; Hair ; Humans ; Hydrocortisone ; Hypesthesia ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Muscle Spasticity ; Neural Conduction ; Neurology ; Paraparesis, Spastic ; Peripheral Nervous System Diseases ; Pyramidal Tracts ; Skin ; Sural Nerve

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

Deveolopmental coax vara represents coax vara not present at birth but rather developing in early childhood, showing a progressive deterioration in the proximal femoral neck-shaft angle during growth. In order to determine the factors that could affect the results of corrective osteotomy, we evaluated the results of 15 developmental coax vara in 12 patients who had been treated with the femoral osteotomy at the Department of Pediatric Orthopedic Surgery, Seoul National University Children's Hospital, from February 1983 to March 1993. Of the 12 patients, there were 6 boys and 6 girls. Three patients had bilateral operations, 5 patients on the right, and the remaining 4 patients on the left. Average at the onset of symptoms was 4 years plus 5 months(range; from 1 year to 7 years plus 2 months), and average age at the tome of operation was 6 years plus 3 months(range; from 2 years plus 4 months to 10 years). We could obtain the following results: 1. Average post-operative loss of neck-shaft angle was 5% in the cases in which post-operative neck-shaft angle was converted more than 130 degrees, and was 8% in the cases in which post-operative neck-shaft angle was converted less than 130 degrees. 2. Loss of neck-shaft angle was higher during the first post-operative period, and was higher in cases in which the triangular osseous defect was persistent post-operatively. There was no correlation between the post-operative neck-shaft angle and disappearance of triangular osseous defect. 3. The femoral anteversion was converted 8.7 degrees to 27.2 postoperatively. 4. The premature arrest of the capital femoral physis was higher in cases in which the neck-shaft angle was less than 130 degrees postoperatively. 5. Leg length discrepancy, which was 2.1 cm preoperatively, did not change in cases in which the neck-shaft angle was more than 130 degrees postoperatively. However, it was converted to 3.3 cm in cases in which the neck-shaft angle was less than 130 postoperatively. 6. we could observe the femoral head deformity in 6 out of 7 cases in which the operation was performed after 7 years of age. We could draw the following conclusion based on our results: 1. We must correct the neck-shaft angle more than 130 degrees. 2. We could not equalize the leg length discrepancy by corrective osteotomy alone. 3. It may be reasonable to perform the corrective osteotomy before 7 years of age.
Congenital Abnormalities ; Coxa Vara ; Female ; Head ; Humans ; Leg ; Orthopedics ; Osteotomy ; Parturition ; Seoul

This study is verifying the hypothesis that distraction followed by recompression may promote fracture healing of the osteoporotic bone on the assumption that distraction induces increased callus formation at the distracted gap and recompression results in fusiform callus, having biomechanically stronger fracture stiffness. Sixty-six Sprague-Dawley rats, in which osteoporosis were induced 6-8 weeks after oophorectomy, were separated into two groups. Group I was control group that had fracture healing by simple external fixation. Group II was experimental group that had fracture healing by monofocal distraction-compression. Radiomorphometric study revealed that there was significantly increased amount of callus and ensuing bone formation, which becehe obvious from 20 days after osteotomy in group II compared with group I. Biomechanical study also showed that tensile break strength was significantly higher in group II compared with group I with time. It is concluded that monofocal distraction-compression method may be one of the useful method to promote fracture healing of the estrogen deficient osteoporotic bone.
Animals ; Bony Callus ; Estrogens ; Female ; Fracture Healing* ; Osteogenesis ; Osteoporosis* ; Osteotomy ; Ovariectomy ; Rats* ; Rats, Sprague-Dawley

Castleman's disease, or giant Iymph node hyperplasia, is a Iymphoproliferative disorder which is characterized by Iymphoid hyperplasia with capillary proliferation, and divide histologically into two 0varieties, hyaline vascular and plasmal cell form. Some system manifestations are occasionally accompanied with the diseases, but peripheral neuropathy is a rarely reported manifestatlon of them and not in Korea. The present report describes a 40 year old female patient who had been admitted to Yonsei university medicai center because of progressive quadriparesis. On examination, she revealed various other manifestations such as hyperpigmentation, Iymphadenopathy, pitting edema, and bilateral papilledema. The electrophysiologic studies and sural nerve biopsy showed severe sensori-motor peripheral neuropathy showing features of mixed demyelinatlon and axonal degeneration. The Iymph node biopsy showed features compatible with Castleman's disease of hyaline vascular type. The recovery was poor over four month period despite of treatment with corticosterold.
Adult ; Axons ; Biopsy ; Capillaries ; Edema ; Female ; Giant Lymph Node Hyperplasia ; Humans ; Hyalin ; Hyperpigmentation ; Hyperplasia ; Korea ; Papilledema ; Peripheral Nervous System Diseases* ; Quadriplegia ; Sural Nerve

PURPOSE: A lateral neck node metastasis is common in patients with papillary thyroid carcinoma. If a preoperative diagnosis is not made or is uncertain, an intraoperative biopsy for a frozen examination should be considered. The aims of this study were to evaluate the factors predicting a lateral neck node metastasis and to suggest guidelines for an intraoperative neck node biopsy. METHODS: From March 2003 to January 2006, 79 patients (7 males, 72 females) with 89 intraoperatively biopsied lateral neck nodes were enrolled in this study. The median age was 45 years. Among these patients, two or more lateral neck nodes were biopsied intraoperatively in 9 patients and one node was biopsied in the others. The clinicopathological features and radiological findings were reviewed. RESULTS: Among the 79 patients with 89 lateral neck nodes, 25 patients with 26 lateral neck nodes (29%) showed a metastasis. Univariate analysis revealed the computed tomography (CT) findings of lateral neck nodes such as a longitudinal size >1 cm (P=0.001), postcontrast Hounsefield Unit (HU) >110 (P<0.001), presence of necrosis (P<0.001), absence of hilum (P<0.001), and irregular margin (P<0.001) were found to be significant predicting factors. The pathologic findings of tumors such as multifocality (P= 0.006), bilaterality (P=0.001), tumor size >2 cm (P=0.008), extracapsular invasion (P=0.005) had significant impact on a lateral neck node metastasis. Multivariate analysis revealed a longitudinal size >1 cm (P=0.039), postcontrast HU >110 (P<0.001), and bilaterality of the tumor (P= 0.001) with a suspiciously enlarged lateral neck node in CT to have a significant impact on node metastasis. However, bilateral tumor with lymph nodes >110 HU were the most important factors. CONCLUSION: The most significant factors influencing lateral neck node metastasis were multifocal, bilateral, large size (2 cm < or = ), extracapsular invasion of the primary tumor, and the CT findings of lymph nodes such as a large longitudinal size (1 cm < or =), necrosis, the absence of hilum, irregular margin and increased postcontrast HU (110 < or =).
Biopsy ; Carcinoma, Papillary ; Diagnosis ; Humans ; Lymph Nodes ; Male ; Multivariate Analysis ; Neck* ; Necrosis ; Neoplasm Metastasis* ; Thyroid Gland* ; Thyroid Neoplasms*