No abstract available.
Colon* ; Diverticulitis* ; Laparoscopy*

During the period from 1979 to 1987, bone bridge connecting epiphysis to metaphysis was removed and replaced with a free fat transplant for partial epiphyseal plate closure in 7 patients. Bone bridge resection and free fat interposition was repeated in one patient. Average age of the patients was 9.2 years and sites of epiphyseal plate closure were distal femur in 6 patients and proximal tibia in one patient. The causes of closure were physeal fracture(4), infection(2) and a complication of intramedullary nailing(1). The mean follow-up period was 3 years 9months. Tomograms specifically determine the location and the extent of bone bridge. Successful results which mean spontaneous correction of angular deformity or decreased limb length discrepancy, were obtained in 3 patients. Although deformity recurred or limb length discrepancy was increased somehow, some benefits were obtained in another 2 patients. Benefits from the procedure was negligible or questionable in 2 patients. The poor results were seemingly related to physeal closure following infection and larga size of bone bridge. Bone bridge resection and free fat interposition was considered to be effective method for the treatment of the partial epiphyseal plate closure in the selected cases.
Congenital Abnormalities ; Epiphyses ; Extremities ; Femur ; Follow-Up Studies ; Growth Plate ; Humans ; Methods ; Tibia

The purpose of this study is to investigate the effect of lengthening in long bones on the articular carilage by observing the changes in articular cartilage, Fifty-seven rabbits of growing period were divided into four lengthening groups; 5%, 10%, 20%, and 30%. Lengthening by callotasis that was done on the left tibiae and right tibiae were used as control. After lengthening histopathological, histochemical and autoradiographic studies were done on the proximal and distal tibial articular cartilages. That following observations were made. 1. As compared with controls, statistically significant degenerative changes were noted in proximal and distal articular cartilages when the tibiae were lengthened 10% or more. 2. In the proximal joints, the changes were significant between 10% and 20% lenghtening groups, but not between the 20% and 30% lengthening groups. 3. In the distal joints, the changes were significant. Not only were there between 10% and 20% lengtening groups but also there were between 20% and 30% lengtening groups. 4.Degenerative changes were frequently found in the intermediate zone between the periphery and the center, where most of the weight is borne.5. Decrease in matrix content of degenerated articular cartilage was noted by histochemical studies using safranin-0 and Alcian-blue.6. Autoradiography with S04 was done to quantitate matrix content of articular cartilage, and the mean uptake ratio of the articular cartilage was slightly higher than others in the 30% lengthening group. This esuggest decreased matrix synthesis, but no statistical significance was found. Following conclusion were drawn from above observations. 1. In rabbits, tibial lengthening tended to cause microscopic degenerative changes, and the changes begun to appear when the tibiae were lengthened 10% or more. 2. When lengthened over 20%, the changes became more pronounced in the distal joint than in the proximal joint.
Autoradiography ; Bone Lengthening ; Cartilage, Articular ; Joints ; Leg ; Osteogenesis, Distraction ; Rabbits ; Tibia

BACKGROUND: This study was performed to evaluate our experience on laparoscopic appendectomy. METHODS: Retrospective analysis was performed on 2,856 patients who had been operated by laparoscopic appendectomy under diagnosis of acute appendicitis at the Sung-Ae Hospital and Kwang-Myoung Sung-Ae Hospital from October 1991 to July 1998. RESULTS: Among 2,856 patients who had undergone laparoscopic appendectomy,2,379 patients (83.3%) were operated due to simple acute appendicitis, 275 patients (9.6%) due to perforated appendicitis. Operation time was 44.6 minutes for simple acute appendicitis and 60.3 minutes for perforated appendicitis. In perforated appendicitis, intra-peritoneal irrigation and drain insertion was performed. The length of hospital stay in patient with simple acute appendicitis was 3.7 days (5.82 days in conventional appendectomy) and patients with perfotrated appendicitis was 6.1 days (9.91 days in conventional appen-dectomy). Complications such as wound infection, intra-abdomen abscess, trocar site bleeding, subcutaneous emphysema developed in 43 (1.5%) patients (79/1,947, 4.5% in conventional appendectomy). In 202 (7.1%) patients, appendix was normal, but another diseases were detected, including acute pelvic inflammation, ovarian cyst, mesenteric lymphadenitis, enteritis, diverticulitis in order. CONCLUSION: Overall complication rate was lower in laparoscopic appendectomy compared with conventional appendectomy and the length of hospitalization of laparoscopic appendectomy was shorter. When the acute appendicitis is suspected, especially in the reproductive women, the laparoscopic approach would be better diagnostic and therapeutic value than conventional method. Therefore laparoscopic appendectomy would be replaced with conventional appendectomy.
Abscess ; Appendectomy* ; Appendicitis ; Appendix ; Diagnosis ; Diverticulitis ; Enteritis ; Female ; Hemorrhage ; Hospitalization ; Humans ; Inflammation ; Length of Stay ; Mesenteric Lymphadenitis ; Ovarian Cysts ; Retrospective Studies ; Subcutaneous Emphysema ; Surgical Instruments ; Wound Infection

Total 9 cases of extraintestinal amoebiasis, amebic liver abscess and amebic lung abscess, were treated with metronidazole. The diagnosis and progress check were done by (1) stool examination, (2) size and pain of liver, (3) hematological examination, (4) urinanalysis, (5) X-ray or liver scanning (6) examination of aspirated pus from liver and (7) immobilization test of E. histolytica. Results are summarized as follows: Amebic hepatitis: Metronidazole was given to 3 cases with daily dose of 0.9-1.2 gm for 3-7 days. Clinical symptoms were completely restored by the treatment. Amebic lung abscess: One case was treated with metronidazole for 3 days with the daily dose 1.2 gm. X-ray findings showed remarkable improvement by the treatment. An additional administration of the drug for 6 days resulted complete resolution of the pneumonic changes. Amebic liver abscess: Four cases were treated with metronidazole. The daily doses were 0.4-2.4 gm and continued for 2-10 days. Aspiration of the abscess for 1-10 times or continuous drainage of pus were performed during the course supplementarily. All cases were recovered to normal by the combining treatment. No remarkable side effect was noticed by the drug administration, and no relapse was experienced up to date.
parasitology-protozoa-Entamoeba histolytica ; chemotherapy ; metronidazole ; liver ; lung ; amoebiasis

Sixteen patients who underwent 18 modified Colonna capsular arthroplasty for old unreduced DDH1 between 1984 and 1992 were recalled and critically reviewed. The average age at operation was 11.5 years (range, 8.1 to 14.5 years). The average follow-up period was 7 years and 1 month (range, 5 to 13 years). All of the patients had pain or discomfort of the hip and limp. Femoral shortening was combined in all patients, and 13 hips required concurrent pelvic osteotomy (Chiari osteotomy in 5 hips Salter innominate osteotomy in 1 hips and Steel s osteotomy in 2 hips) or slotted shelf augmentation (5 hips) due to small and shallow acetabulum relative to the femoral head. In the remaining 5 hips which had thick medial acetabular wall acetabular reaming alone was performed. At the latest followup, 9 hips showed excellent 5, good; and 4, fair results according to the modified Harris hip score and IOWA hip score. In addition, all patients except one were satisfied with the outcome in terms of regaining hip stability and decrease in pain or discomfort and limp. Radiological evaluation revealed progressive, significant increase in size of the femoral head and sphericity improvement in 12 hips. The sphericity of the femoral head did not improve in other 2 hips. In the remaining 4 hips, in which preoperative femoral head shape was relatively aspherical, the sphericity worsened after affection of ischemic necrosis or osteoarthrosis. Complications included undisplaced femoral neck fracture during physiotherapy in 2, ischemic necrosis in 2, heterotropic ossification in 2, acetabular protrusio due to too much reaming in 3 hips, and residual subluxation requiring additional pelvic surgery in 2 hips, In conclusion, we believe that modified Colonna capsular arthroplasty with femoral shortening is valid, if properly done, in the reconsruction of painful hip with old unreduced DDH in late childhood and adolesence.
Acetabulum ; Adolescent* ; Arthroplasty* ; Femoral Neck Fractures ; Follow-Up Studies* ; Head ; Hip ; Humans ; Iowa ; Necrosis ; Osteoarthritis ; Osteotomy ; Steel

We carried out animal experiment in order to determine the effect of resection of nerves, muscles and tendons on the induction of osteoporosis. One hundred and forty rats, weighing approximately 250 gm, were divided into seven groups. In Group I, as a control group, the three skin incisions, one on the anterior aspect of the knee, one on the anteromedial aspect of proximal thigh, and one on the posterior aspect of proximal thigh were made and wounds were sutured. In Group II, the patellar tendon and the extensor digitorum longus tendon were divided to disable knee extension. In Group III, all the knee flexors were divided. In Group IV, all the knee extensors and flexors were divided. In Group V, the femoral nerve was divided to disable knee extension. In Group VI, the sciatic and obturator nerves were divided to diable knee flexion. In Group VII, the sciatic, and obtrator nerves were all divided. Before the procedures, bone density was measured by photon absorptiometry and postoperatively, the measurement was repeated every two weeks until the eighth week. At the time of each measurement, two rats were sacrificed out of each group and were submitted to microphotographic measurement of the tibial cortices. The results were as follows. l. In the muscle and tendon resection groups (Group II, Group III, Group IV), the bone density significantly decreased two weeks after operation and then, gradually increased four, six and eight weeks. 2. In the nerve resection groups (Group V, Group VI, and Group VII), the bone density decreased significantly two and four weeks after operation and then gradually increased six, and eight weeks after operation. 3. In both motor resection and denervation, the paralysis of both flexors and extensors of the knee, caused more decrease in bone density than the paralysis of either flexor or extensor. 4. In the muscle and tendon resection groups, the bone density was significantly more decrease two weeks after operation when the flexors were resected, but thereafter there was no significant difference between the flexors and extensors resection. In the nerve resection group, the paralysis of knee flexors caused more decrease in bone density than the paralysis of knee extensors throughout the entire experimental period. 5. The nerve resection groups demonstrated significantly more severe loss of bone density than muscle and tendon resection groups throughout the entire experimental period. 6. The values of bone density measured by photon absorptiometry correlated well with the cortical thickness indices. Bssed upon these observations, we came to the following conclusions. 1. The osteoporosis following injuries of the nerve, muscle, and tendon is most significant at two weeks after injury. 2. Denervation causes more severe osteoporosis than muscle and tendon injuries. 3. It is suggested that the photon absorptiometry is a reliable means in the evaluation of the osteoporosis.
Absorptiometry, Photon ; Animal Experimentation ; Animals ; Bone Density ; Denervation ; Femoral Nerve ; Knee ; Muscles ; Obturator Nerve ; Osteoporosis ; Paralysis ; Patellar Ligament ; Rats ; Skin ; Tendon Injuries ; Tendons ; Thigh ; Tibia ; Wounds and Injuries

Ilizarov device is a circular external skeletal fixator with crossed transfixation wires and connecting rods. Its stability depends on the tension in the wire and the spatial orientation of the fixator frame. It provides extreme versatility for correction of three dimensional complex deformities including angulation, rotation, shortening and translation. In an attempt to identify the various factors that contributed to the outcome and the complications of lengthening, we reviewed the first 19 cases of leg lengthening by the Ilizarov technique in 17 patients with leg length inequality or dwarfism. Simultaneous correction of the three dimensional deformities was also aimed at in 13 patients, and osteosynthesis of congenital pseudarthrosis of the tibia in 2 patients. Follow-up periods averaged 1.6 years, ranging from 1 year to 2.8 years. The results were summarized as follows : 1. The amount of lengthening averaged 5.2cm, ranging from 2.0cm to 9.8cm. 2. The percentage increase was 27%, ranging from 9% to 58%. 3. The average healing index (month/cm) was 1.3months/cm and it was higher in the groups that had premature consolidation, complete osteotomy, single level corticotomy and neurologic compromise as compared with the groups that had adequate corticotomy, double level corticotomy and no neurologic complication. 4. The desired lengthening was obtained in 14 cases. Simultaneous correction of the deformities and osteosynthesis for nonunion were also achieved satisfactorily during lengthening. 5. There were sixteen cases of problems (84%), which were pin tract inflammation (7 cases), Transient senrory change (3 cases), knee joint flexion contracture (2 cases), nut breakage (2 cases). There were thirteen cases of obstacles (68%), which were equinus deformity(5 cases), premature consolidation (3 cases), pathologic fracture (3 cases), and delayed consolidation (2 cases). There was only one ture complication case. In conclusion, the Ilizarov technique was very effective for leg lengthening in children, particularly when three dimensional deformities were combined with leg length shortening. But a thorough knowledge of the Ilizarov technique and meticulous care during lengthening are mandatory to prevent the pitfalls and complications.
Child ; Congenital Abnormalities ; Contracture ; Dwarfism ; Follow-Up Studies ; Fractures, Spontaneous ; Humans ; Ilizarov Technique ; Inflammation ; Knee Joint ; Leg Length Inequality ; Leg ; Nuts ; Osteotomy ; Pseudarthrosis ; Tibia

Grice extra-articular subtalar arthrodesis has been performed as either a temporizing or a definite procedure in young children to correct the dynamic hindfoot valgus deformity without affecting subsequent growth of the foot. Fifty eight extra-articular subtalar arthrodesis in thirty patients, performed at Seoul National University Children's Hospital from setpember 1985 to June 1989, were retrospectively reviewed to evaluate the clinical and radiographic results. There were 52 valgus feet in 26 patients and 6 varus feet in 4 patients secondary to cerebral palsy, meningomyelocele, congenital snomalies, and other neuromuscular diseases. In many instances, additional tendon surgeries were also required to correct deformities or achieve the muscle balance. The review consisted of personal interview, physical examination, and radiological assessment. On physical examination, preoperative hindfoot valgus deformty(mean: 14.3°clinically) was well corrected, postoperative hindfoot valgus ranging from neutral to valgus 5°clinically in 35 of 52 cases(67.3%). Correction of the lateral talocalcaneal angle on standing lateral radiographic view averaged 8.5 degrees(from 57.3 degrees preoperatively to 37.6 degrees postoperatively). In valgus feet, there were 3 cases with mild pain around the ankle joint. There were 5 cases of graft resorption and 2 cases of nonunion. Graft failure was more frequent when the proximal end of the graft was directed anterior to the weight bearing axis. With original Grice subtalar arthrodesis, satisfactory results were obtained in 34 of 52(65.4%) hindfoot valgus feet. In 6 varus feet, there were 1 undercorrection and 2 recurrence of varus deformity. We re-emphasize the importance of strict operative technique to obtain satisfactory results. We also believe that Grice procedure may be used for the correction of subtalar instability in selected cases of varus foot before muscle baancing procedures.
Ankle Joint ; Arthrodesis ; Cerebral Palsy ; Child ; Congenital Abnormalities ; Foot ; Humans ; Meningomyelocele ; Neuromuscular Diseases ; Physical Examination ; Recurrence ; Retrospective Studies ; Seoul ; Tendons ; Transplants ; Weight-Bearing

We investigated the effect of tibial lengthening by means of callotasis on enchondral growth of the tibia, Ninety-nine 5-week-old immature rabbits were separated into five groups according to the percentage of lengthening : GroupI(10% lengthening), Group II (20% lengthening), Group III (30% lengthening), Group IV (40% lengthening), Group V (sham operation without lengthening). Osteotomy of the tibia and fibula was made at the proximal metaphysiodiaphyseal junction. Distraction was started at the rate of 0.25mm twice a day from the third postoperative day to simulate the currently accepted callotasis. In Group I, II, and V, there two were no statistically significant differences in the growth rates between the left operated and the right normal tibiae. In contrast, the ratios of left over right tibial length decreased significantly in Group III (4.8%), and Group IV (8.6%) at the completion of lengthening(p < 0.0001), and remained decreased until near skeletal maturity. Histomorphometric study revealed that, in Group III and IV, there were statistically significant decreases in the ratios of the thickness of left over night tibiae at both proximal and distal growth plate(p < 0.0001). Immunohistochemical study also revealed that, in Group III and Group IV, the ratios of left over right bromodeoxyuridine(BrdUrd) labeling percentage decreased significantly (p < 0.0001). In summary, when the tiba was lengthened 30% or more, retardation of enchondral growth was evident, which persisted from the time of completion of lengthening to near skeletal maturity. It is postulated that unphysiologically increased pressure on the growth plate due to excessive bone lengthening may be closely related with the inhibition of enchondral growth.
Bone Lengthening ; Fibula ; Growth Plate ; Osteogenesis, Distraction ; Osteotomy ; Rabbits ; Tibia