No abstract available.

Opposition of the thumb is necessary for pinch-one of the three most important functions of the hand. Frequently, opposition is either partially or totally lost in poliomyelitis or median nerve palsy. Several types of operations have been devised for restoration of opposition, and in 1973, Burkhalter et al. announced extensor indicis proprius opponensplasty: the tendon of extensor indicis proprius is brought out in the area of the pisiform and then passed against subcutaneously across the palm to the thumb, being attached to the abductor pollicis brevis and extensor pollicis longus tendon. It is useful in the case of loss of opposition without available finger flexor or wrist motors. Of nine patients who underwent operation-one with Riordan and eight with Burkhalter type of opponensplasty-at National Medical Center, seven had excellent results: one had a fair, and another one had a poor result. Six patients were with low combined median and ulnar nerve injury: one with high combined median and ulnar nerve injury: one with brachial plexus injury: and one with myotmesis of the thenar muscles. From the results, we conclude that Burkhalter type of opponensplasty makes satisfactory result for the hand without opposition movement; it is indicated in high median nerve injury and any combined median and ulnar nerve injury6; early restoration of opposition to the thumb in median nerve injury and in those limbs with multiple tissue trauma adds immeasurably to the over-all early rehabilitative effort.
Brachial Plexus ; Extremities ; Fingers ; Hand ; Humans ; Median Nerve ; Muscles ; Paralysis ; Poliomyelitis ; Tendons ; Thumb ; Ulnar Nerve ; Wrist

Familial hypokalemic periodic paralysis (HOPP) is a rare autosomal-dominant disease characterized by reversible attacks of muscle weakness occurring with episodic hypokalemia. Mutations in the skeletal muscle calcium (CACNA1S) and sodium channel (SCN4A) genes have been reported to be responsible for familial HOPP. Fifty-one HOPP patients from 20 Korean families were studied to determine the relative frequency of the known mutations and to specify the clinical features associated with the identified mutations. DNA analysis identified known mutations in 12 families: 9 (75%) were linked to the CACNA1S gene and 3 (25%) to the SCN4A gene. The Arg528His mutation in the CACNA1S gene was found to be predominant in these 12 families. Additionally, we have detected one novel silent exonic mutation (1950C>T) in the SCN4A gene. As for a SCN4A Arg669His mutation, incomplete penetrance in a woman was observed. Characteristic clinical features were observed both in patients with and without mutations. This study presents comprehensive data on the genotype and phenotype of Korean families with HOPP.
Adolescent ; Adult ; Calcium Channels/*genetics ; Child ; Child, Preschool ; Genotype ; Humans ; Hypokalemic Periodic Paralysis/*genetics ; Infant ; *Mutation ; Phenotype ; Sodium Channels/*genetics

PURPOSE: Many recent studies have been performed to improve adult height in short normal girls with early puberty by arresting rapid pubertal progression. We evaluated the effect of combined therapy with growth hormone (GH) and gonadotropin releasing hormone agonist (GnRHa) on predicted adult height in girls with early puberty, comparing them with a group treated with GnRHa alone. METHODS: Twenty eight girls with early puberty were classified into two groups and treated for an average 18 months. Group I of 18 girls was treated with GnRHa alone (leuprolide acetate; dosage: 30-90 mcg/kg, s.c. every 28 days) and group II of 10 girls was treated in combination with GH (dosage: 0.1 IU/kg, s.c. 5-7 days/week). Two groups were compared in terms of bone age, height, sexual maturity, and predicted adult height at the start and after the treatment. RESULTS: Two groups were not significantly different from each other in chronologic age, bone age, weight, target height, and sexual maturity before and after treatment. After treatment, group I showed predicted adult height (157.1+/-6.2 cm) which was comparable to target height (157.1+/-3.7 cm) and was not significantly higher than predicted adult height before treatment (156.0+/-6.5). On the contrary, group II showed predicted adult height (158.5+/-4.6 cm) which was comparable to target height (156.2+/-3.6 cm), but significantly higher than predicted adult height before treatment (154.2+/-7.4 cm) (P<0.05). CONCLUSIONS: GH and GnRHa combination treatment is more effective than GnRHa treatment alone to improve predicted adult height in girls with early puberty.
Adolescent ; Adult* ; Female* ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Growth Hormone* ; Humans ; Puberty*

PURPOSE: Treatment efficacy for children with speech and language delay has been the subject of considerable debate in recent years. We evaluated the clinical features of children with delayed speech and language and their prognoses according to their etiologies after 6 months of speech and language therapy. METHODS: From January, 2000 to March, 2004, we retrospectively reviewed 56 children with speech and language delay who were administered speech and language therapy for 6 months in Uijongbu St. Mary's Hospital. RESULTS: Of 56 cases, the proportion of developmental language disorder was 66.1 percent, structural malformation 19.6 percent, mental retardation 12.5 percent, hearing defect 1.8 percent. The ratio of male to female was 4.6: 1 and the most frequent age group was over 47 months. The mean age of first spontaneous words with useful meaning was 15.9 months. The mean gestational age of the subjects was 39.8 weeks. The proportion of full-term infants was 96.4 percent and of premature infants was 3.6 percent. As for the birth order, the proportion of the first baby was 51.8 percent, the one of second babies it was 42.9 percent, and percent of third babies it was 7.1 percent. After 6 months of language intervention, 32.4 percent of patients with developmental language disorder showed normal linguistic development. All the patients with mental retardation showed sustained language and speech delay. As for the patients with structural malformations, five out of 11 patients showed normal linguistic development. CONCLUSION: The relatively advanced old age of majority of participants in this study suggests the necessity of screening test for language delay in this local community.
Birth Order ; Child* ; Female ; Gestational Age ; Hearing ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intellectual Disability ; Language Development Disorders* ; Language Therapy* ; Linguistics ; Male ; Mass Screening ; Prognosis ; Retrospective Studies ; Treatment Outcome

A 17-year-old-boy with a bilateral incomplete cervical rib, upon abduction of his left arm at 45 degrees, had immediately begun to show symptoms of severe tingling, claudication, pallor, and weakness of his left upper extremity. These symptoms were aggravated at 90 degrees, leaving him debilitated from his work in the printing office. Transfemoral positional subclavian arteriography revealed total occlusion of the subclavian artery immediately distal to a cervical rib during 90 degrees abduction. Resection of the anterior scalene and medial aspect of the middle scalene muscles, cervical and first ribs, and arteriolysis were performed via a combined supraclavicular and infraclavi cular approach. He has returned to work as a printer with marked relief of symptoms and has remained asymptomatic over follow-up periods of 10 months.
Angiography ; Arm ; Cervical Rib ; Follow-Up Studies ; Muscles ; Pallor ; Ribs ; Subclavian Artery ; Thoracic Outlet Syndrome* ; Upper Extremity

In 1964, Abbott and Colleagues published the world's first heterotopic heart transplantation technique in the rat. Their method established circulation by end-to-end anastomoses of the graft's aorta and pulmonary artery to the recipient's abdominal aorta and Inferior Vena Cava (IVC), respectively. In 1966, Tomita et al altered Abbott's technique by employing end-to-side rather than end-to-end anastomoses, thus eliminating the hind leg paralysis that sometimes resulted from Abbott's technique. In order to prevent postsuture hemorrhage (since 7-0 silk suture was the finest available at that time), Tomita's aortic anastomosis was done with double up-and-down continuous suture technique. A single layer continuous anstomosis effected the pulmonary artery-IVC anastomosis. The availability of Nylon monofilament suture made it possible for Ono and Lindsey to use a single layer suture technique for the aortic end-to-side anastomosis in their modified rat heart transplantation. We observed survival time between control group and Immunosuppression (Cyclosporine administration, 10mg/Kgx4 times postoperatively) group after heterotopic heart transplantation in the rat model. The cyclosporine adminstration group survived longer than the control group, thus we concluded that cyclosporine was based on Immunosuppressive drugs.
Allografts ; Animals ; Aorta ; Aorta, Abdominal ; Cyclosporine ; Heart Transplantation* ; Heart* ; Hemorrhage ; Immunosuppression ; Leg ; Models, Animal* ; Nylons ; Paralysis ; Pulmonary Artery ; Rats* ; Silk ; Suture Techniques ; Sutures ; Vena Cava, Inferior

BACKGROUND: The transplantation of organs between phylogenetically disparate or harmonious species has invariably failed due to the occurrence of hyperacute rejection or accerelated acute rejection. But concordant cardiac xenograft offer us an opportunity to study xenotransplantation in the absence of hyperacute rejection. Current therapeutics for the prolongation of survival of rodent concordant xenotransplantation are not ideal with many regimens having a high mortality rate. Cyclosporine A & Mycophenolate Mofetil are new immunosuppresive agent which has been shown to be effective at prolonging survival of allograft, as purine synthesis inhibitor. MATERIAL AND METHOD: We used white mongrel rats as recipient and mice as donor, divided 4 groups(n=6), control group(Group 1) has no medication or pretreatment, Group 2 has splenectomy as pretreatment 7~10 days before transplantation, Group 3 has Cyclosporine A treatment group, Group 4 has combined treatment of Cyclosporine A & Mycophenolate Mofetil(RS 61443). We compared survival time. RESULT: We can't find significant difference of survival time between each groups. CONCLUSION: We concluded that rejection of cardiac xenograft was different from rejection of allograft, and new immunossuppresive Agent(Mycophenolate Mofetil, Cyclosporine A) was not effective for prolongation of survival time after cardiac xenograft.
Allografts ; Animals ; Cyclosporine ; Heart* ; Heterografts* ; Humans ; Immunosuppression ; Mice* ; Models, Theoretical* ; Mortality ; Rats* ; Rodentia ; Splenectomy ; Tissue Donors ; Transplantation ; Transplantation, Heterologous

BACKGROUND: Esophageal perforation is an extremely lethal injury that requires careful management for survival. MATERIAL AND METHOD: We performed a retrospective clinical review of 14 patients treated for esophageal perforation at the Department of Thoracic and Cardiovascular Surgery hanyang University Hospital between July 1986 and August 1998. Cardiovascular Surgery Hanyang University Hospital between July 1986 and August 1998. RESULT: The ration between male and female patients was 12:2 and their ages ranged from 9 to 68 years( average: 446 years). Iatrogenic perforations were found in 6 patients(42.9%) spontaneous perforations in 3 patients(21.4%) traumatic perforations in 2 patients(14.3%) and caustic perforations foreign body origin and esophagel cancer in 1 patient (7.1%) each. Four of the patients(28.6%) had esophageal ruptures located cancer in 1 patient (7.1%) each. Four of the patients (28.6%) had esophageal ruptures located in the cervical esophagus and 10 patients (71.4%) in the thoracic esophagus, The most frequent location was in the mid third portion of the esophagus (35.7%) there were also 2 patients(14.3%) in the upper third portion and 3 patients(21.4%) in the lower third portion. Complications encountered included mediastinitis empyema or pleural effusion mediastinal or lung abscess sepsis and aspiration pneumonia. The most frequent complication that occurred was mediastinitis in 9 cases (57%) Three patients underwent conservative treatment. Among the patients who underwent surgical treatment 5 patients underwent primary closure 6 patients underwent open drainage and 2 patients underwent reconstrumction (1 patients had an initial primary closure and 1 patient had an initial open drainage procedure). The mortality rates for those with conservative and surgical treatment were 66.7% (2cases) and 9.1% (1 cases) respectively. CONCLUSIONS: Perforation of the esophagus although very rare has a high mortality rate and thus aggressive operative therapy is necessary.
Drainage ; Empyema ; Esophageal Perforation* ; Esophagus ; Female ; Foreign Bodies ; Humans ; Lung Abscess ; Male ; Mediastinitis ; Mortality ; Pleural Effusion ; Pneumonia, Aspiration ; Retrospective Studies ; Rupture ; Sepsis

OBJECTIVE: This study sought to investigate independent predictive factors for subclinical atherosclerosis in Korean patients with rheumatoid arthritis (RA). METHODS: We used high-resolution B-mode ultrasonography to measure the carotid artery intima-media thickness (IMT) and carotid plaque in 367 patients with RA. Detailed information on the demographic characteristics, cardiovascular (CV) risk factors, and RA disease characteristics were collected on all subjects. The relationship of the carotid artery IMT and carotid plaque to relevant clinical and laboratory variables were examined. RESULTS: Old age and male sex had the most significant association with increased IMT and presence of plaque than other factors. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and mKHAQ (Korean version of modified health assessment questionnaire) were significantly associated with both increased IMT and presence of plaque after univariate analysis adjusting for age and sex. A multivariable logistic regression analysis revealed that ESR and TJC68 were independent factors associated with the presence of plaque (p<0.001 and p=0.019, respectively). There was a significant linear correlation between the number of plaques and ESR (p<0.001 and R2=0.07). CONCLUSION: Our results indicated that markers of systemic inflammation contributed significantly to subclinical atherosclerosis in patients with RA. We emphasize the need for aggressive control of RA disease activity in patients who persistently demonstrate highly elevated ESR levels.
Arthritis, Rheumatoid ; Atherosclerosis ; Blood Sedimentation ; C-Reactive Protein ; Cardiovascular Diseases ; Carotid Arteries ; Cohort Studies ; Humans ; Inflammation ; Logistic Models ; Male ; Risk Factors