The hand is an organ of both motion and sensibility. Motion is necessary for the highly adaptive functions of pinch, grasp, and hook. When a major muscle is paralyzed, the balance of the hand is disrupted. The objective of reconstructive procedure is to achieve a limited but balanced functional performance by means of redistributing assets rather than creating new motor and sensory units. Among the variable methods of treatment, the tendon transfer is a useful method in restoring the lost functions of the paralyzed hand. Authors reviewed 3 cases of paralyzed hands: the first one had an impairment of the opposition and flexion of the thumb caused by brachial plexus injury; the second one had an adducted thumb and a flexion contracture of the index and middle fingers due to a severe compression injury to forearm; the third one was a quadriplegics due to the C5-6 fracture-dislocation, but fortunately had a function of active flexion in ring and little fingers. They were treated by Omer's technique plus other reconstructive procedures for the paralysis at the Department of Orthopaedics, Catholic Medical Center from 1978 to 1981. By this procedure gratifying results such as restoration of pinching and grasping function were obtained.
Brachial Plexus ; Contracture ; Fingers ; Forearm ; Hand Strength ; Hand ; Methods ; Muscles ; Paralysis ; Tendon Transfer ; Thumb

Despite the technical improvements in Internal flxation of neck fracture were made in recent years, complications, such as non-union of the fracture and avascular necrosis of the femoral head, are not infrequent. Various operative techniques have been proposed to secure the reduced fracture fragment till union, and to restore or improve the circulation in the femoral head. One of them is muscle-pedicle bone graft to the fracture site of neck. It is very important if one can predict the vascularity of the femoral head prior to treatment and also the healing process of the neck fracture during treatment. In the past, there have been considerable investigations to achieve these goal, but no method universally has been accepted as reliable and practical. Among them, Intra-osseous venography (I.O.V.) and sclntimetry utilizing the isotope trace techniques were widely used in recent. Authors adopted a cephalic and trochanteric I.O.V. to observe the fracture healing and to predict viabillty of the femoral head, and also tried a new technique (Indirect cepallc I.O.V.) to perform both techniques of I.O.V. at the same time. With the ald of image Intensifler, a bone marrow needle Is inserted 1 inch below the greater trochanter of femur, and when the tip of the needle is reached 0.5 to 1.0 cm near to fracture line in the marrow cavity, about 25 cc of 75% Urograffin is Injected by speed of 1 cc per second with sereial X-rays taken at 1,3,5 and 15 minutes (trochanteric I.O.V.). Then already inserted puncture needle for trochanteric I.O.V. are more advanced through the fracture line of the neck into the femoral head. About 10 cc of 75% Urograffin Is Injected by speed of 1 cc per second with serial X-rays taken (Indirect cephallc I.O.V.). The merits of this indirect cophalic l.O.V. via trochanteric route is that it is also simple and Practical and there is no significant complication: such as septic arthritis of hlp & thrombophlebitis. Difficulties of inserting the needle through the trochanter and the neck into the head and occasional unwanted hip-arthrogram are listed as the main demerits of this technique. But these demerits can be minimized by the accurate image intensifier control. A positive trochanteric venography is one in which venous drainage is established across the fracture site with opaque contrast medium being spread out diffusely into the head, and eventually draining out into the surrounding soft tissue via draining velns. While positive cephalic venography via trochanteric route is one in which contrast medium is spread out diffusely in the head and trochanteric region via crossing veins. Hereby, we performed internal fixation and an autogenous muscle-bone pedicle graft composed of the quadratus femoris muscle in 4 cases of femoral neck fracture which are confirmed that there are head viability by using of the cephalic I.O.V.. Since then, we checked the both I.O.V. every 6 wks post-operatively. The results seemed to be good in regard to bony union in all 4 cases, and we have also found that cephalic and trochanteric I.O.V. are a useful diagnostic tool in hip fracture.
Arthritis, Infectious ; Bone Marrow ; Drainage ; Femoral Neck Fractures ; Femur Neck ; Femur ; Fracture Healing ; Head ; Hip ; Methods ; Neck ; Necrosis ; Needles ; Phlebography ; Punctures ; Thrombophlebitis ; Transplants ; Veins

It is well-known that early diagnosis and treatment is still the most important aspect of congenital dislocation of the hip. However, the orthopaedist can not see the cbildren with dislocated hip before they begin to Walk, especially in the developing countries. When the children with dislocated hips are discovered lately,it is impossible to reduce the hip by simple manipulation, and also is very difficult to maintain the reduction successfully. Our method of treatment was based on the concept that the various components of the abnormal joint will develop satisfactorily into a normal hip provided acccurate congrucus and concentric reduction is obtained as early as possible to take advantage of the maximum growth potential, and is maintained throughout growth, In this study 16 children with 18 dislocated hips among the 75 children with congenitally dislocated hips were primarily treated by open reduction,followed by 3 weeks of temporary fixation of reduced hip by Kirschner wire and 6 weeks of cast immobilization from November 1973 to April 1979. They were clinically and roentgenologically analized. The end results of treatment were assessed by 3 roent- genological determinants; the medial joint space, the acetabular angle and the centeredge angle. The results obtained were as follows: 1. The pathologically widened medial joint space of hip or hips decreased rapidly during first 6 months after reduction, irrespective of the age at reduction, and satisfactory results were obtained in 83 per cent indicated by joint space distance less than 10 mm. 2. Postoperative Kirschner wire fixation of reduced hip to maintain the reduced position did not impair the physeal growth or bring the joint stiffness. 3. The acetabular angle improved rapidly during the first year after reduction in all age groups of patients and thereafter the rate of acetabular development decreased, but the acetabular angle continued to improve throughout the period of observation and satisfactorily (less than 25 degrees) developed in 83 per cent of children. 4. The center-edge angle increased rapidly during first three months after reduction and was satisfactory (more than 20 degrees) in 78 per cent. Overall success rate of treatment was 81.3 per cent. 5. Assessment of end results by medial joint space has more advantages in evaluating the result of treatment because of the aimplicity of it's measurement and leas error regardless of the change of patients position on roentgenagrams. 6. There were only few complications (11.1%) after surgical treatment; coxa magna in a case and resubluxation in another case were complicated. 7. Parameters utilized for assessing the results were faund to be the very helpful criteria to evaluate the hip development indicated by cephalocotyloid relation when used together. 8. Simultaneous open reduction followed by temporary internal fixation with K-wire was found to be recommendable method of treatment ae a first choice of treatment even in children under age of 3 if once nonsurgical reduction fails; because by this type of treatment more easily and accurately concentric reductions were obtained, and also reduction was more easily maintained without subsequeat redislocation.
Acetabulum ; Child ; Developing Countries ; Dislocations ; Early Diagnosis ; Hip ; Humans ; Immobilization ; Joints ; Methods

Reiter's syndrome is a clinical triad of urethritis, conjunctivitis, and arthritis, but the characteristic mucocutaneous lesion occurs very frequently. Therefore, Reiters syndrome in fact might better be considered a tetrad, consisting in its complete form of urethritis, arthritis, conjunctivitis, and mucocutaneous lesions. In initial stage of the disease, the arthritis usually appear after the urethritis and conjunctivitis have been made. The arthritis is usually of subacute onset, reaching its full intensity within a few weeks in most cases. Additionally a man with Reiters syndrome who developed aortic insufficiency with no evidence of syphilis or rheumatic heart disease has been reported. Two cases of Reiters syndrome are presented with the review of the literature: the first case was a 60 years old male who had non-gonococcal urethritis with mucous purulent discharge, conjunctivitis, polyarthritis, and aortic insufficiency; the second case was a young man aged 21 years who had the characteristic conjunctivitis and a past history of urethritis, and he also has had obvious keratodermia blenorrhagica and polyarthritic symptoms and signs.
Arthritis ; Conjunctivitis ; Humans ; Male ; Rheumatic Heart Disease ; Syphilis ; Urethritis

No abstract available in English.
Neurilemmoma

The authors compared the basic characteristics of rural woman in relation to family planning for June 1967 and June 1969 in Kyung San Country Kyungpook Province, Korea. The statistics showed that these characteristics are gradually changing. The marriage age was slightly higher than the past year and the formal education of women increased. The ideal children number, and tile gravidity and mortality rates decreased. At the same time the number of induced abortions, the knowledge of family planning, and the acceptance rate of contraception increased. These phenomena seem to follow the present worldwide trend.
Abortion, Induced ; Child ; Contraception ; Education ; Family Planning Services* ; Female ; Gravidity ; Gyeongsangbuk-do ; Humans ; Korea ; Marriage ; Mortality

BACKGROUND: We studied the interaction between Succinylcholine (SCh) and mivacurium when mivacurium was administered during early and late recovery from SCh block was investigated. METHODS: Eighty patients undergoing elective surgery under general anesthesia were studied. General anesthesia was induced and maintained with propofol under TCI control. Neuromuscular function was measured in response to TOF stimulation of the ulnar nerve using an electromyographic method. The patients were allocated randomly to the following four groups; group 1 (n = 20): a bolus intravenous injection of 0.08 mg/kg mivacurium; group 2 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 2 minutes of 1 mg/kg SCh injection; group 3 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 25% recovery of initial twitch height from twitch height depression induced by 1 mg/kg SCh; group 4 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 75% recovery of initial twitch height from twitch height depression induced by 1 mg/kg SCh. The onset and duration of neuromuscular blockade, recovery rate and TOF ratio at T75% were measured. RESULTS: The onset of block in groups 3 and 4 were slower than in group 1 (5.2 +/- 0.7 and 2.3 +/- 0.6 vs 2.5 +/- 0.4 min P < 0.05). The clinical duration in groups 2 and 3 were longer than in groups 1 and 4 (12.5 +/- 2.1 min and 11.3 +/- 1.7 min vs 17.0 +/- 3.0 min and 18.5 +/- 2.6 min, p < 0.05). There was no difference in recovery index all groups. The TOF ratio of groups 2, 3 and 4 were smaller than for group 1 (38.2 +/- 5.3, 32.3 +/- 5.6 and 31.5 +/- 4.2 vs 56.0 +/- 7.3, P < 0.05). CONCLUSIONS: The Previous 1 mg/kg SCh injection was affected the time course of action of mivacurium 0.08 mg/kg-induced neuromuscular block.
Anesthesia, General ; Depression ; Humans ; Injections, Intravenous ; Neuromuscular Blockade* ; Propofol ; Succinylcholine* ; Ulnar Nerve

One hundred and eighty nine cases of ventricular septal defect, which was confirmed by cardiac catheterization at Severance Hospital, were observed on clinical, hemodynamic, electrocardiogr sphic findings and their correlation, during the period from January, 1964 to December, 1979. The six hundred and forty one cases of congenital heart disease under fiften years old received cardiac catheterization during this period. The incidence of ventricular septal defect was 35.1% in our hospital. Sixty nine cases had corrective surgery at the Department of Chest Surgery, Yonsei University. The results were as follows; 1) One hundred and eight nine cases of ventricular septal defect included. One hundred and ten male patients and Seventy five. Female patients. 2) The age distribution of the one hundred and eight five cases of ventricular septal defect were 59 cases(31.9%) between 7 and 12 years of age, 56 cases(30.3%) between 3 and 6, 40 cases(22.2%) under 2 years, and 29 cases(15.6%) over 13 years of age. 3) The common symptoms of 117 cases of isolated ventricular septal defect showed frequent upper respiratory tract illness 86 cases(73.5%), exertional dyspnea 75 cases(64.1%), growth retardation 23 cases(19.6%), and palpitation 12 cases(10.2%). 4) The common physical findings included systolic murmur in all cases on the third and forth intercostal space on auscultation, systolic thrill in 69 cases(58.9%), hepatomegaly in 41 cases(35.0%), protrusion of anterior chest wall in 31cases(26.4%) and cyanosis in 6cases(5.2%). 5) The electrocardiographic findings showed LVH 45 cases(34.8%), RH 19cases(16.2%) and no ventricular hypertrophy 15 cases(12.8%). The correlation to electrocardiographic findings and right ventricular systolic pressure showed mean pressure of 28.2 mmHg in normal EKG patterns, 45.9mmHg in LVH, 59.6mmHg in BVH, and 77.6mmHg in RVH. 6) On cardiac catheterization of 117 cases of isolated ventricular septal defect, the ratio of systolic prressure of main pulmonary artery(Pp/Ps) was in 76 cases(64.9%) below 45%, 20 cases(17.1%) between 45 and 75%, and 21 cases(18.0%) over 75%. Pulmonary artery systolic pressure was under 30mmHg in many cases in older children; 15 cases between 3 and 6 years of age, 20 cases between 7 and 12, 8 cases over 13 years old. 7) The cardiac disease associated with ventricular septal defect were 65 cases in all; 31cases of pulmonary stenosis, 10 cases of aortic insufficiency, 6 cases of atrial septal defect and 2 cases of persistent left superior vena cava.
Adolescent ; Age Distribution ; Auscultation ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Child ; Cyanosis ; Dyspnea ; Electrocardiography ; Female ; Heart Defects, Congenital ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular* ; Hemodynamics ; Hepatomegaly ; Humans ; Hypertrophy ; Incidence ; Male ; Pulmonary Artery ; Pulmonary Valve Stenosis ; Respiratory System ; Systolic Murmurs ; Thoracic Wall ; Thorax ; Vena Cava, Superior

BACKGROUND: Owing to increase in elderly population, the importance of geriatric health is accentuated strongly. We surveyed cancer patients aged 60 years or more to investigate the common cancers, time trend to compare with whole cancer patients. METHODS: We analyzed the data of cancer patients aged 60 years or more who were admitted cancer patients, diagnosed by pathologic biopsy, received radiotherapy, registered as cancer patients on death certification and diagnosed by the other methods in a university hospital from January, 1987 to December, 1995. RESULTS: We analyzed at intervals of three year, from 1987 to 1989. The order of common cancer sites were stomach(30.1% ), lung(19.9% ), liver and intrahepatic(11.4% ), bladder (6.2% ), colon(5.5% ), gallbladder and extrahepatic(4.9%), rectosigmoid(4.2% ), pancreas (3.2%), cervix(2.9%), esophagus(2.8%) and the number of patients was 1025. From 1990 to 1992, the order of common cancer sites were stomach(23.5%), lung(19.3% ), liver and intrahepatic(10.3% ), gallbladder and extrahepatic(4.4% ), rectosigmoid(4.2% ), pancreas (3.9%), cervix(3.7%), colon(3.5% ), esophagus(2.7%) and the number of patients was 1470. From 1993 to 1995, the order of common cancer sites were stomach(19.5%), lung(17.2%), liver and intrahepatic(11% ), rectosigmoid(5.1% ), colon(4.5% ), gallbladder and extrahepatic(4.5% ), bladder(4.1% ), cervix (3.8% ), pancreas(3.7% ), esophagus(2.0% ) and the number of patients was 1519. CONCLUSIONS: Stomach, lung, and hepatic cancers were decreasing and rectosigmoid and pancreatic cancers were increasing in triannual frequency of cancer patients aged 60 years or more, The proportion of elderly patients in all age cancer patients was increasing except gallbladder and extrahepatic cancer. According to the prolongation of life span, cancer frequency increased in old age.
Aged ; Biopsy ; Certification ; Cervix Uteri ; Female ; Gallbladder ; Humans ; Life Support Care ; Liver ; Liver Neoplasms ; Lung ; Pancreas ; Pancreatic Neoplasms ; Radiotherapy ; Stomach ; Urinary Bladder

BACKGROUND: Usually fever subsides within one week in over 90% of pulmonary tuberculosis (TBp) patients after the start of short-course anti-tuberculosis therapy, but occasionally it persists over two weeks after treatment. When the fever persists, drug resistance, combined infection, or drug fever, and so on, are considered as an etiology and, in some cases, drugs are changed. But inadvertent discontinuation of a short-course regimen inevitably will extend the duration of treatment, and the treatment completion may be delayed. This study was performed to investigate the causes of prolonged fever (PF) and to identify the predictors of PF in drug-susceptible TBp patients in Korea. METHOD: five hundred-ninety-eight patients, who were admitted to Asan Medical Center from January 1996 to March 1999, diagnosed with TBp and prescribed short-course, anti-tuberculosis treatment, were reviewed. PF was difined as having fever over two weeks despite treatment. The causes of PF were ansalyzed. Drug-susceptible TBp patients who presented no caussp es for PF, except turberculosis itself, were selected(n=22), and they were compared with those who had no fever at diagnosis(n=22) and those who had fever at diagnosis, which had subsided within two weeks after treatment(n=22). Clinical, laboratory, and radiological parameters were compared among the three groups. RESULTS: Twenty-eight(4.8%) of 598 patients showed PF over two weeks despite short-course treatment. the causes of PF were drug fever (n=2), multi-drug resistant tuberculosis (n=3), disseminated Mycobacterium Kansasii infection (n=1), and drug-susceptible tuberculosis itself (n=22). The patients with PF had more risk factors for tuberculosis, long duration of symptoms before treatment, night sweats, weight loss, numerous acid fast bacilli on sputum smear, anemia, hyponatremia, hypoalbuminemia, over three lung cavity numbers and extensive infiltratoion, indicating that they had prolonged and extensive lung diseases. CONCLUSION: The main cause of PF in TBp despite short-course regimen seems to be drug-susceptible but extensive disease in Korea. Any changes to the drug regiment provided for TBp patients with prolonged fever despite treatment should be carefully considered.
Anemia ; Chungcheongnam-do ; Diagnosis ; Drug Resistance ; Fever* ; Humans ; Hypoalbuminemia ; Hyponatremia ; Korea ; Lung ; Lung Diseases ; Mycobacterium kansasii ; Risk Factors ; Sputum ; Sweat ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary* ; Weight Loss