No abstract available.
Diagnosis*

The Graf system has supposed advantages with its flexible nature, as compared with rigid fixation. But there have been no reports about effects in the adjacent motion segment after soft stabilization. The purpose of this study was to evaluate the radiologic changes occuring in the adjacent segments of the Graf system and to assess its ability stabilizing the lumbar spine. A retrospective review of radiographs and medical records was undertaken in 32 cases who had been treated with the Graf system in degenerative lumbar spinal disorders. The average age at operation was 52.5 years and the average follow up period was 49.6 months. The results of this study were as follows: clinical assesments based on the Kirkaldy-Willis criteria revealed excellent in 13 cases (40.6%), good in 16 cases (50%), fair in 2 cases (6.3%) and poor in 1 case (3.1%). Radiologically we analysed the adjacent segments in 25 cases except the cases which did not have the correspondence between the clinical findings and the radiological findings, and the fixated segments in 32 cases. The acceleration of degenerative changes were found in the above adjacent segments in 11 cases (44%) and in the below adjacent segments in 5 cases (27.7%). Also, those changes were found in the fixated segments with discectomy in 19 cases (50%) and in the fixated segments without discectomy in 9 cases (37.5%). In conclusion, we think that the Graf system in a lumbar region may biomechanically influence the adjacent segments. The mechanical effects of the device could be changed by the polyester bands which were followed for a longer period of time in the fixated segments. Therefore, randomized prospective studies comparing the Graf system to other treatement methods could provide clear indications for lumbar spinal disorders.
Acceleration ; Diskectomy ; Equidae ; Follow-Up Studies ; Lumbosacral Region ; Medical Records ; Polyesters ; Retrospective Studies ; Spine

Glossopharyngeal neuralgia, first discribed by Labat in 1928, is a very rare disease of unknown cause. This neuralgia is associated with a characteristic sharp pain of the posterior pharynx, tonsils and larynx, and especially triggered by swallowing action. It is said that this pain is more severe than that of trigerminal neuralgia and the pain may last several up to 30 minutes and the attack repeats intermittently. Diagnosis of glosspharyngeal neuralgia is made by the symptoms and by the elongation of the right side of the styloid process in this case. The glossopharyngeal nerve block by the deposition of local anesthetic solution is useful in the accurate diagnosis of the douleureux or neuralgia in which this nerve is involved and in providing anesthesia for operative intervention upon the posterior third of the tongue. This is a report of a case of glossopharyngeal neuralgia, which did not respond to Tegretol and other analgesic drugs and treated by glossopharyngeal nerve block with 0.5% bupivacaine l.5-2.0 ml. The block was performed every day for 15 days and the neuralgia disappeared without complication.
Analgesics ; Anesthesia ; Bupivacaine ; Carbamazepine ; Deglutition ; Diagnosis ; Glossopharyngeal Nerve ; Glossopharyngeal Nerve Diseases* ; Larynx ; Neuralgia ; Palatine Tonsil ; Pharynx ; Rare Diseases ; Tongue

Acute pulmonary edema associated with direct current shock is a rare complication. Pulmonary edema with an increase in heart size following direct current shock have been previously reported and confirmed. The cause of this complication is unknown. This is not due to a sudden increase in the cardiac output with the establishment of sinus rhythm. It has been most commonly noted in the presence of mitral or aortic valvular diseases or ventricular dysfunction. It is likely that acute alteration or disparities in atrial or ventricular mechanical function consequent to electrical discharge precipitate pulmonary congestion. This is a case report of acute pulmonary edema following cardioversion with direct current shock which caused ventricullar fibrillation during tonsillectomy. He was treated with oxygen, iuretics, digitalis, steroid, dopamine and PEEP (positive end expiratory pressure). The patient recovered uneventful ventilation.

Subepidermal calcified nodule(SCN) is a form of calcinosis cutis which is usually present as a single small, raised, hard nodule with verrucous surface. A 13-year-old girl presented with a 10-month history of a ricegrain-sized, hard, yellowish white papule on both upper eyelids. The lesions were asymptomatic and had increased slowly in size. An excisional biopsy specimen of the left upper eyelid showed acanthosis and narrow pointed rete ridges of the epidermis, and closely aggregated deposition of basophilic material in the uppermost dermis. The material in the dermis did not stain with von Kossa. It was confirmed as calcium deposition by staining with alizarin red S which is far more specific for calcium than the von Kossa stain.
Adolescent ; Basophils ; Biopsy ; Calcinosis ; Calcium ; Dermis ; Epidermis ; Eyelids ; Female ; Humans

Nocturnal enuresis is by any standard the most benign voiding dysfunction in children, with a spontaneous cure rate of up to 15% per year. On the other hand it is one of the most sociopsychologically disturbing diseases in children because of its association with taboos and rites, and for families with bedwetters it is also a significant economic burden. Many investigators have reported upon the effectiveness of drugs in alleviating nocturnal enuresis in children and adults. We evaluated the results of drug therapy in 60 children with nocturnal enuresis: 42 boys and 18 girls. mean age 8.7 years(range 5-15). All children were evaluated after treatment with imipramine, and the response rate of imipramine was 76.7%. For the remaining 14 non-responders, desmopressin was given intranasally at bedtime. And the response rate of desmopressin was 64.3%. So, the overall response rate of imipramine and desmopressin was 9l.7%. No serious side effects were observed. These data show that the combined therapy with imipramine and desmopressin is very effective in treating enuresis.
Adult ; Child ; Deamino Arginine Vasopressin* ; Drug Therapy ; Enuresis* ; Female ; Hand ; Humans ; Imipramine* ; Nocturnal Enuresis ; Research Personnel ; Taboo

Since the recognition that certain conditions such as allergic rhinitis, asthma and urticaria are due to the substances which are innocuous to the individuals, it has been a common practice to establish a diagnosis by reexposure of the individual to the suspected subsutance. Their pathogenesis was classified into immunologic and nonimmunologic mechanism. The immunologic mechanism in such conditions is mainly due to interaction between antigen and IgE skin-sensitizing antibody bound to tissue mast cells. There are two approaching methods in evaluating allergic disease. One is in vitro test which includes R.A.S.T. and leukocukocyte histamine release test and the other method is in vivo test which includes provocation test and skin tests. Prick test, a kind of skin test, is most frequently used in clinical procedure because of its simplicity and safety of appliation and better correlation with clinical history as well as specificity and highly reproducibility. It is well accepted that the therapeutic principle in allergic disease is to find out the causative allergens and get rid of them from patient's environment. If the causative allergens are inavoidable, the patient should be treated by means of specific hyposensitization. In evaluating allergic disease, the patient's clinical history is most important. (countinued..)
Allergens ; Asthma* ; Diagnosis ; Histamine Release ; Humans ; Immunoglobulin E ; Mast Cells ; Rhinitis* ; Sensitivity and Specificity ; Skin Tests ; Urticaria

BACKGROUND: In recent years the treatment of primary nocturnal enuresis (PNE) with desmopressin (DDAVP) has been promising. The route of administration until now had been intranasal, but because the tablets were introduced for the treatment of diabetes insipidus they have also become available for the treatment of PNE. PURPOSES: To find the efficacy and safety of the treatment with desmopressin tablets in a group of children with monosymptomatic nocturnal enuresis. Materials and METHODS: The efficacy and safety of at least 3 months of treatment with oral desmopressin (1-deamino-8-D-arginine-vasopressin) (DDAVP tablets, Minirin) at doses of 200 to 600 ug. at bedtime were investigated in 50 children (ages 5 to 15 years) with monosymptomatic nocturnal enuresis. The efficacy of the drug was measured in reductions of the number of wet nights per week. RESULTS: The number of wet nights per week decreased from a mean of 6.1 to 2.0 (p<0.01). During the treatment period, 22 (44%) patients could be classified as good responders (0 to 1 wet night per week) and 15 (30%) as responders (over 50% reduction of wet night) and 13 (26%) as nonresponders (less than 50% reduction of wet night). No side effects we.e observed. CONCLUSION: Oral desmopressin has a clinically significant effect on patients with monosymptomatic nocturnal enuresis, and therapy is safe when administered as long-term treatment.
Child ; Deamino Arginine Vasopressin* ; Diabetes Insipidus ; Enuresis ; Humans ; Nocturnal Enuresis* ; Tablets*

No abstract available.
Shoulder Fractures*

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