No abstract available.
Rectal Fistula*

The authors reviewed 50 patients of congenital dislocation of the hip who had surgical treatment at the Department of Orthopedic Surgery, Seoul National University Children's Hospital from October, 1985 to August, 1993. We investigated the contributing factors to coxa magna after surgical treatment and it's relationship to the avascular necrosis of femoral head, and observed the influnce of coxa magna on the development of the hip joint. Coxa magna was defined as a femoral head with the greatest diameter 15% greater than the opposite side. To assess the development of the acetabulum in the hips with coxa magna, radiographical horizontal and vertical parameters were measured preoperatively, and at postoperative 1 year, 2 year, and 3 year or more. Twenty-one of fifty hips had coxa manga. The incidence of coxa magna increased in patients who had open reduction at younger age(average 30 months), compared to older age(average 44 months). Neither femoral osteotomy nor pelvic osteotomy increased statistically the incidence of coxa magna. Avascular necrosis of femoral head did not necessarily resulted in coxa magna. There were not statistically significant differences in the coverage ratios of femoral head by the acetabulum between coxa magna positive and negative groups, because lateral acetabular growth accompanied in accordance with enlargement of femoral head in the majority of cases with coxa magna. Open reduction alone caused concomitant vertical overgrowth of ipsilateral hemi-pelvis with resultant pelvic tilt and leg length inequality(IHD>5mm, upto 2cm) in 6 of 10 cases. The patients, who had coxa magna with good radiological results by Severin's classification, underwent open reduction at younger age and had lesser enlargement of the femoral head, compared to those with fair or poor results.
Acetabulum ; Classification ; Dislocations ; Head ; Hip Joint ; Hip ; Humans ; Incidence ; Leg ; Necrosis ; Orthopedics ; Osteotomy ; Seoul

BACKGROUNDS:Bile reflux gastritis can occur when pylorus ablation is associated with bile stasis in the stomach. It can also occur with a gastrojejunostomy when bile is continuously poured into the gastric remnant after a vagotomy and an antrectomy. The diagnosis of bile reflux gastritis can be made only when the patient has bile gastritis documented on biopsy; the simple observation of a bile-stained mucosa in a gastric remnant is not sufficient to make the diagnosis of bile reflux gastritis. METHODS: Technetium-99m diisopropyl iminodiacetic acid (Tc-99m DISIDA) scintigraphy was used to study bile reflux into the gastric remnant in 31 patients with gastric operations. All patients had gastrofibroscopic biopsies in order to identify the bile reflux gastritis. RESULTS: Tc-99m DISIDA Scintigraphy identified bile reflux in 15 (83.2%) of 18 patients after a subtotal gastrectomy and a Billroth II gastrojejunostomy. Hewever, no bile reflux occured in either the 10 patients with a hemigastrectomy plus Billroth I gastoduodenostomy or the 3 patients with a truncal vagotomy plus pyloroplasty. Also, gastrofibroscopic biopsies identified bile reflux gastritis in only 3 patients (9.7%) with a subtotal gastrectomy plus Billroth II reconstruction. CONCLUSIONS: The patients who underwent a subtotal gastrectomy and Billroth II reconstruction showed higher bile reflux rates than did the patients who underwent a hemigastrectomy plus Billroth I reconstruction and a truncal vagotomy plus pyloroplasty (p<0.05). Also, only 9.7% of the postgastrectomy patients developed bile reflux gastritis.
Bile Reflux ; Bile* ; Biopsy ; Diagnosis ; Gastrectomy ; Gastric Bypass ; Gastric Stump ; Gastritis ; Gastroenterostomy ; Humans ; Mucous Membrane ; Pylorus ; Radionuclide Imaging* ; Reflex* ; Stomach ; Vagotomy ; Vagotomy, Truncal

No abstract available.
Burns*

Congenital dificiency of the fibula has a clinical spectrum ranging from partial deficiency to complete absence. The major clinical problems are the severe leg-length discrepancy and the deformities of the foot and ankle. The traditional method of compensation for severe leg-length discrepancy has been ablation of the forepart of the foot by the Symeor Boyd method and subsequent fitting of a prosthesis. The development of newer techniques of limb-lengthening with Ilizarov apparatus in recent years has changed the concept of treatment. The authors have treated 5 patients with congenital deficiency of the fibula by the Ilizarov lengthening method at the Department of orthopedic Surgery, Seoul National University Hospital between Feb, 1989 and Dec. 1992. Five patients had leg length shortening rainging from 6.0cm to 9.3cm(average, 7.6cm) and had surgery at an average age of 9.1 years. The leg length discrepancy was projected to average 10.7cm(range, 8.8cm-13.3cm). Leg length equalization was achieved by one stage lengthening in 4 of 5 patients with an average 8.3cm(range, 6.0cm-12.4cm) lenthening. In one patient, there was 3.5cm residual shortening even after 8.1cm of lengthening. Complications were encountered in 4 patients: recurrent foot deformities in 3 cases, temporary knee flexion contracture in 3 cases, and stress fracture at the regenerated site in 1 case. In all 3 Acterman and Kalamchi's Type II cases, the width of distal tibial physis apparantly narrowed down after lengthening of average 9.3cm(average 51.8% lengthening, 33.4-73%). We found that in congenital deficiency of the fibula the Ilizarov method was effective to achieve lengthening and to correct deformities, unless there were severe shortening of the leg and complex three-plane deformity of the foot and ankle. However, excessive lengthening in one stage should be avoided to prevent recurrence of valgus deformity and growth plate damage of the tibia.
Ankle ; Compensation and Redress ; Congenital Abnormalities ; Contracture ; Fibula ; Foot ; Foot Deformities ; Fractures, Stress ; Growth Plate ; Humans ; Ilizarov Technique ; Knee ; Leg ; Methods ; Orthopedics ; Prostheses and Implants ; Recurrence ; Seoul ; Tibia

Acute renal cortical necrosis in which there is destruction of the renal cortex and sparing of the renalmedulla, is a relatively rare cause of acute renal failure. A definitive diagnosis of acute renal corticalnecrosis is based on renal biopsy, but on CT(computed tomography) the rather specific contrast-enhanced appearance of acute renal cortical necrosis has been described. As renal biopsy is not available, contrast-enhanced CT is auseful, noninvasive investigate modality for the early diagnosis of acute renal cortical necrosis. We report the characteristic CT findings of acute renal cortical necrosis in a patient with acute renal failure following anoperation for abdominal trauma.
Acute Kidney Injury ; Biopsy ; Diagnosis ; Early Diagnosis ; Humans ; Kidney Cortex Necrosis* ; Tomography, X-Ray Computed*

In order to investigate the validity of the Steel's gluteus medius and minimus advancement, we reviewed 21 hips in 14 spastic cerebral palsy patients, who had advancement of the gluteus medius and minimus insertion for the correction of in-toeing gait between November 1985 and February 1992. The procedure was limited to those patients who had moderate to severe in-toeing gait with positive Steel's stretch reflex. There were eight boys and six girls. The average age at the time of surgery was 6.7 years(2.9 years-11.9 years). The procedure was performed on both hips in seven patients. Of the 14 patients, nine had diplegia, three hemiplegia, and two paraplegia. The average follow-up time was 4.3 years(1 year-8.5 years). In-toeing gait was converted to neutral or physiologic out-toeing gait in 17 hips(81%), excessive out-toeing in 2 cases(9.5%), and mild residual in-toeing in 2 cases(9.5%), Steel's stretch reflex, which was present in all cases preoperatively, disappered in 19 hips(90.5%) postoperatively, Abductor power, however, decreased from 4+ to 4− in average postoperatively, Among the 16 hips, which had no Trendelenburg sign or gait preoperatively, 8 hips(50%) showed positive Trendelenburg sign and gait postoperatively. In conclusion, Steel's gluteus medius and minimus advancement appears to be effective in the correction of in-toeing gait, but there is high risk of weakening the abductor power.
Cerebral Palsy ; Female ; Follow-Up Studies ; Gait ; Hemiplegia ; Hip ; Humans ; Muscle Spasticity ; Paraplegia ; Reflex, Stretch

Ten opening-wedge callotasis through the proximal tibia just below the tuberosity were performed using the Ilizarov apparatus in ten patients who had premature asymmetrical closure of the proximal tibial physis and subsequent genu recurvatum. In 4 knees, the genu recurvatum was due entirely to osseous deformity. In the remaining 6 knees, it was due to a combination of ossseous and soft-tissue (ligament and capsule) deformity. In the 6 knees that had combined deformity, the osseous deformity was predominant in all knees. The average age of the patients at surgery was 16.3 years (range, 11.0-20.5 years). Before operation, the average angle of recurvatum was 19.6 degree (range, 15-26 degree) with an average of 76.6 degrees of abnormal tilt of the tibial plateau. The average shortening of the ipsilateral limb in ten patients was 2.7 cm (range, 0.5-8.7 cm). The average duration of correction was 49 days (23-85 days), and the average fixation time was 150 days for management of genu recurvatum and associated limb-length discrepancy. In 3 patients, there were complications including patella infera, pin track infection and transient peroneal nerve palsy. After a mean follow-up of 4.2 years (range, 1.1-5.9 years), most patients had an excellent or good radiographic and functional results without any recurrence. We have found the Ilizarov method to be valid in the management of genu recurvatum with or without concomitant shortening, with relatively few complications, but full understanding of the basic principles and strict adherence to the details of the method must be carefully followed.
Congenital Abnormalities* ; Extremities ; Follow-Up Studies ; Humans ; Ilizarov Technique* ; Knee ; Osteogenesis, Distraction ; Paralysis ; Patella ; Peroneal Nerve ; Recurrence ; Tibia

Laryngeal schwannoma is extremely rare. We report the CT and MRI findings of a case occurring in a 65-year-oldwoman, and describe the pathologic correlation. Pre-contrast CT scanning revealed a right supraglot-tic mass witha slightly hyperdense central part and a hypodense peripheral part. Post-contrast CT scanning re-vealed anenhanced hyperdense central part and a rim-like hypodense peripheral part. The density of the pe-ripheral part waslower than that of muscle. The mass showed homogeneous low signal intensity on T1-weighted MR images, homogeneoushigh signal intensity on T2-weighted MR images, and an enhanced high signal intensity central part and a lowsignal intensity peripheral part on gadolinium enhanced T1-weighted images. The enhanced central part correlatedwith Antoni A areas and the peripheral part, showing low attenuation, correlated with Antoni B areas.
Gadolinium ; Magnetic Resonance Imaging ; Neurilemmoma* ; Tomography, X-Ray Computed

Acute eosinophilic pneumonia(AEP) was first described in 1989 and represents a clinical entity distinct from chronic eosinophilic pneumonia. AEP is characterized by acute respiratory insufficiency, hypoxemia, fever, diffuse radiographic infiltrates, and eosinophilia in bronchoalveolar lavage fluid or lung biopsies in the absence of infection, atopy, or asthma. Rapid response to corticosteroids is characteristic. We experienced a 47-year-old metal driller presenting typical clinical and radiological characteristics of AEP. We confirmed eosinophilic pneumonia with brochoalveolar lavage analysis and transbronchial lung biopsy. We report a case of AEP diagnosed by clinical, radiographic, and histologic findings with a brief review of the literature.
Adrenal Cortex Hormones ; Anoxia ; Asthma ; Biopsy ; Bronchoalveolar Lavage Fluid ; Eosinophilia ; Eosinophils* ; Fever ; Humans ; Lung ; Middle Aged ; Pulmonary Eosinophilia* ; Respiratory Insufficiency ; Therapeutic Irrigation