We presented a case of Ehlers-Danlos syndrome(ED syndrome) in s 21-year- old male, who had hyperextensibility of skin, skin fragility, and cigarette paperlike atrophic scars with no joint problems since infancy. There was a family history which was suggestive of autosomal dominant trait. Microscopic examination of the skin biopsy specimen from the normal appearing skin on the right forearm showed no abnormal appearance. In this case the manifestations of skin including marked hyperextensibility might be in accord with type I (gravis) ED syndrome, but the joint manifestation did not correspond to this type. It might be hard to classify this case according to the eleven types of ED syndrome. Wed rather consider this case as a. mixed form of type I and type Il ED syndrome.
Biopsy ; Cicatrix ; Ehlers-Danlos Syndrome ; Forearm ; Humans ; Joints ; Male ; Skin ; Tobacco Products

No abstract available.
Takayasu Arteritis*

Femoral shaft fractures are usually accompanied with extensive soft tissue injury due to high energy force and are difficult to manage for functional stress with weight bearing. According to Boyd(1965), femoral shaft is the first of non-union among the long bone shafts. And because of inadequate internal fixation, poor immobilization and infection, non-union of femoral shaft is still of interest to all the orthopaedic surgeons. During past 10 years, 19 cases of non-union of the femoral shaft were treated at dept. of Orthopaedic Surgery, Ewha Womans University hospital and following results were obtained. l. Of 19 cases, male between 20-40th age group was predominent. Prevalent type and site was mid. 1/3 comminuted fractures(p > 0.05). 2. Initial treatment was 10 cases of intramedullary nailing; 8 of plate fixation; 1 of screw fixation. Bone graft was added to 10 cases. 3. The probable causes of non-union were complex; 11 of inadequate interal fixation, 4 of poor external immobilization and 4 of infection. 4. 4 cases of infection were managed with control of infection and fixation. And 11 cases were fixed with plate and the other 4, with intramedullary nailing. All were supplemented with autogenous bone graft. 5. Postoperative immobilization was done with 15 cases of hip spica cast and 4 of long leg cast for average 9.3 weeks. 6. All were united at average 8.9 months. Limitation of motion of knee was remained in 3 cases in spite of physiotherapy. Severe osteoporosis was noted in 3 cases and leg length shortening with limping was found in 1 case.
Adult ; Clinical Study ; Female ; Femur ; Fracture Fixation, Intramedullary ; Hip ; Humans ; Immobilization ; Knee ; Leg ; Male ; Osteoporosis ; Soft Tissue Injuries ; Surgeons ; Transplants ; Weight-Bearing

No abstract available.

No abstract available.
Biopsy* ; Child* ; Humans

BACKGROUND: The P50 which is the oxygen tension corresponding to 50% saturation at pH 7.40, PCO2 40 mmHg and temperature 37oC is an accepted and useful reference to characterize the oxygen affinity for hemoglobin. This study evaluated the accuracy of P50 calculated from a single measurement of pH, PO2 and SO2 compared with linear regression and sigmoid Emax model in patients undergoing general anesthesia. This study also compared P50 of just after anesthetic induction to P50 of 90 min later. METHODS: This study was conducted in 10 patients undergoing total abdominal hysterectomy. Just after induction of anesthesia, 20G catheter was indwelled at cephalic vein of forearm and venous return was occluded with a tourniquet. After 4 min, 6 blood samples were obtained every one minute. After 90 min, 6 blood samples were obtained with same method. All blood samples were analyzed with blood gas analyzer within 30 min after withdrawal. P50 was calculated from three methods of calculation, linear regression and sigmoid Emax model. The difference between the actural P50 and calculated P50 was evaluated. RESULTS: P50's calculated from three methods were 25.8+/-1.1, 26.1+/-1.1, 26.0+/-1.2 mmHg respectively. P50's 90min after anesthetic induction (26.1+/-1.3, 26.3+/-1.2, 26.2+/-1.2 mmHg) were significantly greater than P50's just after anesthetic induction (25.5+/-0.8, 25.8+/-1.0, 25.9+/-1.1 mmHg)(P<0.05). Difference between calculated P50 and actual P50 of 120 blood samples from 10 patients according to SO2 were -5.7+/-4.5 (SO2<20%), 0.0+/-1.9 (20%90%). Sigmoidicity of oxygen dissociation curves from 10 patients with sigmoid Emax model was 2.78+/-0.13 (mean SD). CONCLUSIONS: The method calculating P50 from a single measurement of pH, PO2, SO2 was relatively reliable to estimate the change of oxygen dissociation curve of a patient. The affinity of hemoglobin to O2 was reduced during general anesthesia.
Anesthesia ; Anesthesia, General* ; Catheters ; Colon, Sigmoid ; Forearm ; Humans ; Hydrogen-Ion Concentration* ; Hysterectomy ; Linear Models ; Oxygen ; Tourniquets ; Veins

A total of 72 cases of internal biliary drainage procedure has been done percutaneously at Departement ofRadilogy, Seoul Natinal Universtiy Hospital for recent 4 and half years since August 1981. Five different types ofinternal drainage including endoprosthesis were applied to various conditions with different obstruction levels.The different method of procedure in each type of internal drainage was described and the results were analysed.1. Among the clinical diagnosis in 72 cases, carcinoma of bile duct was in 37 cases as the most frequent one. Thenext was pancreas head carcinoma in 16 cases, followed by metastatic carcinoma and other disease. 2. Type Iinternal drainage, classical internal and external type with distal end in duodenum, was applied in 43 cases asthe most comon one. Type II, modification of type I with distal end in CBD, was applied in 17 cases. Type III,endoprosthesis distal end into duodenum, was applied in 7 cases. Type IV, endoprosthesis just across theobstruction in bile duct, was applied in 2 cases, Type V, combined type of any internal drainage with externaldrainage, was applied in 3 cases. 3. According to various obstruction level, prefered type could be selected. Forproximal obstruction type II and IV were preferred and for distal obstruction type III was chosen. However, type Icould be applied in any situation. 4. Early complication occurred in 9 cases(12.5%). Clinical imporvement withdecrease in bilirubin level was observed 17 of 21 cases in which follow-up data was available over 2 months. 5.Though the experience with those 72 cases it is recommended that appropriate type of internal biliary drainageshould be selected according to prognosis, obstruction level and clinical findings of each patient.
Bile Ducts ; Bilirubin ; Diagnosis ; Drainage ; Duodenum ; Follow-Up Studies ; Head ; Humans ; Methods ; Pancreas ; Prognosis ; Seoul

PURPOSE: To evaluate the differences of functional imaging patterns between conventional spoiled gradient echo(SPGR) and echo planar imaging(EPI) methods in cerebral motor cortex activation. MATERIALS AND METHODS: Functional MR imaging of cerebral motor cortex activation was examined on a 1.5T MR unit with SPGR (TR/TE/flip angle=50ms/40ms/30degree, FOV=300mm, matrix size=256x256, slice thickness=5mm) and an interleaved single shot gradient echo EPI (TR/TE/flip angle=3000ms/40ms/90 degree, FOV=300mm, matrix size=128x128, slice thickness=5mm) techniques in five male healthy volunteers. A total of 160 imaging in one slice and 960 images in 6 slices were obtained with SPGR and EPI, respectively. A right finger movement was accomplished with a paradigm of an 8 activation/ 8 rest periods. The cross-correlation was used for a statistical mapping algorithm. We evaluated any differences of the time series and the signal intensity changes between the rest and activation periods obtained with two techniques. Also, the locations and areas of the activation sites were compared between two techniques. RESULTS: The acivation sites in the motor cortex were accurately localized with both methods. In the signal intensity changes between the rest and activation periods at the activation regions, no significant differences were found between EPI and SPGR. Signal to noise ratio (SNR) of the time series data was higher in EPI than in SPGR by two folds. Also, larger pixels distributed over small p-values at the activation sites in EPI. CONCLUSIONS: Good quality functional MR imaging of the cerebral motor cortex activation could be obtained with both SPGR and EPI. However, EPI os preferable because it provides more precise information on hemodynamics related to neural activities than SPGR due to high sensitivity.
Fingers ; Healthy Volunteers ; Hemodynamics ; Humans ; Magnetic Resonance Imaging* ; Male ; Motor Cortex* ; Signal-To-Noise Ratio

PURPOSE: To assess the utility of magnetic resonance(MR) cerebral blood volume (CBV) map in the evaluation of brain tumors. MATERIALS AND METHODS: We performed perfusion MR imaging preoperatively in the consecutive 15 patients with intracranial masses (3 meningiomas, 2 glioblastoma multiformes, 3 low grade gliomas, 1 lymphoma, 1 germinoma, 1 neurcyotma, 1 metastasis, 2 abscesses, 1 radionecrosis ). The averages age of the patients was 42 years (22yr-68yr), composed of 10 males and 5 females. All MR images were obtained at 1.5T imager(Signa, GE Medical systems, Milwaukee, Wisconsin). The regional CBV map was obtained on the theoretical basis of susceptibility difference induced by first pass circulation of contrast media.(contrast media: 15cc of gadopentate dimeglumine, about 2ml/sec by hand, staring at 10 second after first baseline scan). For each patient, a total of 480 images (6 slices, 80 images/slice in 160 sec) were obtained by using gradient echo(GE) single shot echo-planar image(EPI) sequence (TR 2000ms, TE 50ms, flip angle 90degree, FOV 240x240, matrix 128x128, slice-thick/gap 5/2.5). After data collection, the raw data were transferred to GE workstation and rCBV maps were generated from the numerical integration of deltaR2* on a voxel by voxel basis, with home made software(deltaR2*=-ln(S/S0/TE). For easy visual interpretation, relative RGB color coding with reference to the normal white matter was applied and color rCBV maps were obtained. The findings of perfusion MR image were retrospectively correlated with Gd-enhanced images with focus on the degree and extent of perfusin and contrast enhancement. RESULTS: Two cases of glioblastoma multiforme with rim enhancement on Gd-enhanced T1 weighed image showed increased perfusion in the peripheral rim and decreased perfusion in the central necrosis portion. The low grade gliomas appeared as a low perfusion area with poorly defined margin, In 2 cases of brain abscess, the degree of perfusion was similar to that of the normal white matter in the peripheral enhancing rim and was low in the central portion. All meningiomas showed diffuse homogeneous increased perfusion moderate or high degree. One each of lymphoma and germinoma showed homogenously decreased perfusion with well defined margin. The central neurocytoma showed multifocal increased perfusion areas of moderate or high degree. A few nodules of the multiple metastasis showed increased perfusion of moderate degree. One radionecrosis revealed multiple foci of increased perfusion within the area of decreased perfusion. CONCLUSION: The rCBV map appears to correlate well with the perfusion state of brain tumor, and may be helpful in discrimination between low grade and high grade glioma. The further study is needed to clarify the role of perfusion MR image in the evaluation of brain tumor.
Abscess ; Blood Volume ; Brain Abscess ; Brain Neoplasms* ; Brain* ; Clinical Coding ; Data Collection ; Discrimination (Psychology) ; Female ; Germinoma ; Glioblastoma ; Glioma ; Hand ; Humans ; Lymphoma ; Magnetic Resonance Imaging* ; Male ; Meningioma ; Necrosis ; Neoplasm Metastasis ; Neurocytoma ; Perfusion* ; Retrospective Studies

In clinical practice a serious sciatic nerve injury may result from an errornous injection of commonly used antibiotics and other therapeutic or prophylactic agents into the gluteal region which can occur at any age, especially common in infants, children and small debilitated patients. Although many isolated cases and several large series of injuries have been reported, the pathogenesis, pathology and its physiology of injection injury of the peripheral nerves in man have been poorly studied. This experimental study was conducted in order to observe the changes and degree of the functional disability of the sciatic nerve following injection of various drugs such as Rheumapyrine, Chloromycetin, Penicillin and physiological normal saline solution. Fourty-three normal adult rabbits were divided into four groups depending on injected materials and also divided into two groups of acute and chronic stages. The drugs were injected into the right sciatic nerve intraneurally and around the left sciatic nerve perineurally. For the functional study in the nerve, contractability of the calf muscle was recorded on a physiograph at intervals of 1, 3, 5, 15 and 30 minutes after the injection of the drugs. Rheobase, chronaxie and strength-duration curve of both extensor and flexor muscles of fet were recorded and measured on a chronaxie meter at intervals of 1, 2, 3 and 4 weeks after the injection. The physiogram showed the greatest reduction in contractability of the muscles in Rheumapyrine, moderate reduction in Penicillin and the least reduction in Chloromycetin group. In the measurements of rheobase and chronaxie there were marked increase of values in group of Rheumapyrine injection. There was no significant differences in values among the group of Penicillin, Chloromycetin and saline injections in comparison with those in the control group. In the analysis of strength-duration curve, it showed a pattern of complete denervation in 3 cases and a pattern of partial denervation in 3 out of 8 cases with Rheumapyrine injection, and a pattern of partial denervation in 3 out of 6 cases with Penicillin and 2 out of 8 cases with Chloromycetin injection. There was no significant differences in values of rheobase, chronaxie and strength-duration curve as time elapsed following the injury. It was postulated the functional and physiological disabilities were developed after the injection when there was a severe degree of nerve damages on the basis of histopathological study.
Adult ; Anti-Bacterial Agents ; Buttocks ; Child ; Chloramphenicol ; Chronaxy ; Denervation ; Humans ; Infant ; Muscles ; Pathology ; Penicillins ; Peripheral Nerves ; Physiology ; Rabbits ; Sciatic Nerve* ; Sodium Chloride