Out of 3288 patients admitted National Leprosy Center in Sorok-do, could be selected 120 patients confirmed to have one or more plantar ulcers, whose frequency and localization form the basis of this clinical observation. 1. Of 120 patients, 32 had ulcers bilaterally, so that total 196 ulcers in 152 feet were subjected to study. 2. Male patients were approximately three times more frequent than female. Age range showed that 76(63.3%) of 120 patients were in their six and seven decade, and only three cases were under the third Decade. 3. The base of first metatarsal was the site with highest incidence of ulcer (28.6%), and the bases of all metarsals occupied 57.7% of all ulcers. The medial plantar and the heel were low in incidence. 4, Transverse division of the plantar surface revealed that ulcers were located predominantly in the forefoot part (64.8%), showing gradual decrease in the midfoot (27%) and the hindfoot region (8.2%) 5. Longitudinal section of the plantar surface into three compartments showed almost even distribution of ulcers, though the central ray showed slightly lower incidence than those of the medial and lateral ray. 6. Dynamic pressure triangle was found to be the site of preference, in which 100 ulcers(59%) of all was observed. 7. Non-lepromatous patients showed the higher rate of occurrence, in that they occupied 21.3% of all the patients, while 30.8% of 120 ulcer-patients were non-lepromatous type. 8. Of total 196 ulcers, those with history of more than ten years were 117(59.7%), and 18 of them had the history of more than 30 years.
Female ; Foot ; Foot Ulcer ; Heel ; Humans ; Incidence ; Leprosy ; Male ; Metatarsal Bones ; Ulcer

The femoral neck fracture having concomitant fracture of the femoral shaft occurs predaminantly in young man and have known to associate the serious complications. One of such factures is sometimes overlooked and is possibly due to a more obvious nature of the shaft fracture than that of the ipsilateral neck. Six cases of this type of combined fractures in ipsilateral femur are reported with the review of 1 iteratures. In six cases of the femoral neck fractures, three which were unrecognized at initial examiaation in early phase, resulting in serious residue as much as deformity and avascular necrosis of the femoral head, and other three were recognized in early at initial examination healed in good anatomic position and in due time. Through this observation it is stressed that early discovery and adaquate treatment of the fracture is the only solution to minimize the sequelae.
Congenital Abnormalities ; Femoral Neck Fractures ; Femur ; Femur Neck ; Head ; Neck ; Necrosis

Acute hematogenous osteomyelitis adjacent to hip, though uncommon, should be included in the differential diagnosis of the patients presenting symptoms suggestive of septic arthritis of hip. When it occurs in children, it is particularly serious, because the diagnosis at first may be very difficult to be made. Our observations on seven cases reported here suggest the following findings to be helpful for early differential diagnosis of osteomyelitis of innominate bones from septic hip. 1. Among 7 cases, 4 had lesions in ischium, and 3 in os ilii. 2. The initial diagnosis on admission in 3 cases out of 7 was wrongly made to be septic arthritis of hip. 3. Early accurate diagnosis is essential to initiate early treatment, and there by shortens the convalescent time and minimize sequelae. 4. The diagnosis could be made in the cases by clinical and roentgenographic findings, such as fever, pain nature, antalgic posture of hip together with range of hip motion, tender point around hip and positive soft tissue and bony X-ray findings, but K-ray taken on early stage of infection could not provide any clue until bone lesion appears. 5. Gentle passive motion of hip is more easily permitted without eliciting severe pain and restriction of motion in the infection of innominate bone than in the septic hip. This also can be another clue to differentiate the acute osteomyelitis of innominate bone from septic arthritis of the hip.
Arthritis, Infectious ; Child ; Diagnosis ; Diagnosis, Differential ; Fever ; Hip ; Humans ; Ischium ; Osteomyelitis ; Pelvic Bones ; Posture

PURPOSE: We intended to evaluate the results of arthroscopic anterior cruciate ligament(ACL) reconstruction using Bone-achilles tendon-bone composite allograft by analyzing the results clinically and radiologically. MATERIALS AND METHODS: From May 1996 to June 1999, we followed 23 patients who had arthroscopic ACL reconstruction using bone-achilles tendon-bone composite allograft for minimum 24 months, and measured laxity using KT-2000 arthrometer, Lysholm score and enlargement of tibial tunnel width on plain radiograph. RESULTS: In KT-2000 arthrometer test, there was only side-to-side differences of 1.67 +/-0.7 mm between the involved and contralateral limb. Lysholm score was 61.7 +/-10.2 preoperatively and 89.3 +/-5.1 at the last follow up. And there was no tibial tunnel enlargement more than 5 mm at the last follow up. CONCLUSION: Arthroscopic ACL reconstruction using bone-achilles tendon-bone composite allograft has advantage of preservation of anatomic structure and secure bone-to-bone fixation like the bone-patel-lar tendon-bone graft that bone-achilles tendon-bone composite allograft is a reasonable choice in ACL reconstruction.
Allografts* ; Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Extremities ; Follow-Up Studies ; Humans ; Transplants

No abstract available.

Methods: In this study, 30 patients with DS with checked standing dynamic radiographs of the lumbar spine in Gwangmyeong Sungae Orthopedic Clinic were recruited. Standing lateral radiographs were evaluated in extension, 45° of flexion (mid-range) and 90° of flexion (terminal-range) of the lumbar spine. Instability was defined as sagittal translation greater than 3 mm from the extension position. Patients were divided into three groups: a control group, an MI group, and a terminal-range instability (TI) group. Radiographic outcome (stenosis grade) and clinical outcome were compared between the three groups. Results: The average sagittal translation of the lumbar spine was 5.2 mm in extension, 6.6 mm in mid-range, and 7.2 mm in endrange. MI was observed in eight patients (26.2%) and TI was seen in 12 patients (40%). Of eight patients with MI, three patients did not have instability at terminal-range (occult patients) and five patients had instability at terminal-range (typical patients). Body weight and body mass index (BMI) was significantly higher in the MI group as compared to the control group. BMI was positively correlated with slippage to mid-range. There was no significant difference in stenosis grade, Visual Analog Scale, and Oswestry Disability Index. In the TI group, there was no significant difference in radiographic clinical parameters as compared to the control group. Conclusions MI was demonstrated in 25% of DS patients. Mid-range motion was increased with BMI. Mid-range lateral radiography can reveal occult instability in patients with DS, particularly in obese patients.

BACKGROUND/AIMS: Colonoscopy training programs and the minimal experience with colonoscopy required to be considered technically competent are not well established. The aim of this study was to determine the colonoscopy learning curves and factors associated with this difficult procedure at a single center. METHODS: A total of 3,243 colonoscopies were performed by 12 first-year gastroenterology fellows, and various clinical factors were assessed prospectively for 22 months. Acquisition of competence (success rate) was evaluated based on two objective criteria: (i) the adjusted completion rate (>90%) and (ii) cecal intubation time (<20 minutes). RESULTS: The overall success rate in reaching the cecum in less than 20 minutes was 72.8%. The cecal intubation time was 9.34+/-4.13 minutes (mean+/-SD). Trainees' skill at performing cecal intubation in <20 minutes reached the requisite standard of competence after 200 procedures. Cecal intubation time decreased significantly from 11.3 to 9.4 minutes after 100 procedures and improved continuously thereafter. Female patients and advanced patient age (over 60 years) were associated with prolonged cecal intubation time (>20 minutes). Surgery of the uterus and ovaries was significantly correlated with delayed cecal intubation time, but not after sufficient colonoscopy experience. CONCLUSIONS: The minimum number of procedures to reach technical competence was 200. The cecal intubation time was longer in female and older patients.
Cecum ; Colonoscopy ; Female ; Gastroenterology ; Humans ; Intubation ; Learning ; Learning Curve ; Mental Competency ; Ovary ; Prospective Studies ; Uterus

The most common initial rhythm in a sudden cardiac arrest is ventricular fibrillation or pulseless ventricular tachycardia. This is potentially treatable with defibrillation, especially if provided early. However, any delay in defibrillation will result in a decline in survival. Defibrillation requires coordination with the cardiopulmonary resuscitation component for effective resuscitation. These two components, which form the key links in the chain of survival, have to be brought to the cardiac victim in a timely fashion. An effective chain of survival is needed in both the institution and community settings.