Various methods of spinal instrumentation have been used for treatment of unstable fracture & fracture-dislocation of thoraco-lumbar spine. Recently, newly designed short segment fixation devices using pedicle screw were designed and there was a trend to use this posterior short segment instrumentation using pedicle screw. We have used AO internal fixator as posterior instrumentation for unstable spine fracture of thoracolumbar spine since November, 1987. Previously we used Harrington instrumentation and Luque rod wiring for treatment of unstable fracture of thoracolumbar spine and we reported the results of clinical analysis of those systems on Feb, 1987. We analyzed the clinical results of 93 cases those who underwent operative treatment using each posterior instrumentation system for unstable fracture and fracture-dislocation of thoraco-lumabr spine at our hospital from Dec. 1983 to Oct. 1989. Among that 93 cases, the Harrington instrumentation were 35 cases, Luque rod instrumentation were 36 cases and AO internal fixator were 22 cases. The results were as follows:1. The most commonly injured level was Ll (44 case) and followed by T12(33 cases, 86%). 2. By Francis Denis classification, Burst type fracture was most common(42 cases, 45%). 3. Change of kyphotic angle were checked on lateral X-ray view. There no significant differences between those groups using H-rod(58.64%), Luque-rod(54.8%), and AO internal fixator(60.1%) on immediate post-op X-ray. But there noticed least loss of correction of kyphotic angle when using AO internal fixator comparing with other groups. 4. The correction rates of height of anterior and middle column were checked by Denis-Edward method, there noticed best correction rate in AO internal fixator group. 5. The ROM of trunk were checked, there were no significant differences in H-rod, L-rod, and AO internal fixator group in long term follow up.
Classification ; Dislocations ; Follow-Up Studies ; Internal Fixators ; Methods ; Pedicle Screws ; Spine

The ankle is a modified complex hinge joint consisting of the distal tibio-fibula joint (Syndesmosis), and the ankle joint proper(hinge joint), and is important in weight bearing, standing and walking. So, the goals of treatment of ankle fracture are anatomical positioning of talus in the mortise and regaining a smooth articular suface. Unless these requisites are achieved by treatment, post-traumatic arthritis is likely to occur. We analyzed 120 cases of ankle fracture, most of which were treated surgically by A-0 method, in Department of Orthopaedic Surgery, Hyundai Haesung Hospital from January, 1982 to December 1985. The results are as follows; 1. The most common victim was 3rd–4th decades man, and the cause was direct blow. 2. The most common type was pronation-external rotation type of Lauge-Hansen classification, and Type A of Danis-Weber type. 3. The more favorable result was noted in Danis-Weber type A than type B and type C,and noted worst result in pilon fracture. 4. Favorable results can be gained by semi-tubular plate in fibular fracture than any other fixation material. 5. On application of semi-tubular plate, there were no significant differences in results between that placed posteriorly and that placed laterally. 6. We did not transfix the distal tibio-fibular joint in stable Danis-Weber type C injury without any specific sequellae. 7. We obtained better result by removal of transfixing screw 6 weeks after operation. 8. We obtained good results with only 3 weeks immobilization after operation.
Ankle Fractures ; Ankle Joint ; Ankle ; Arthritis ; Classification ; Immobilization ; Joints ; Methods ; Talus ; Walking ; Weight-Bearing

In dealing with lateral condylar injuries of humerus, the chance of pitfalls and having a poor functional result with poor management is much greater because it is a physeal injury involving intraarticular surface. Lateral condylar physeal injuries of distal humerus have been regarded as Salter-Harris Type IV injury. But indeed, true Salter-Harris type IV injury of lateral condyle of distal humerus are rare. It should be regarded as Salter-Harris type II injury. Previously Milch classified the lateral condyle fracture of distal humerus as type I and type II after Stimson's description. It seems to be most useful to plan therapeutic modalities by classification of lateral condyle fracture on the basis of stage of displacement proposed by Jakob et al and Milch's type. Authors performed clinical analysis about lateral condyle fracture of distal humerus in children. Among 79 cases, who were treated at department of orthopaedic surgery, Hyundai haesung hospital from Mar. 1982 to Mar. 1988, it was possible to follow up in 30 cases. The result were as follows ; 1. The age incidence was confined from age of 3 to age of 12. Peak age was around 6. 2. Most of fractures were Milch's type II (75 cases) in contrast to Milch's type I (4 cases). 3. Precise differentiation of stage I and II displacement was needed for evaluation of stability of fracture and planning treatment modalities. 4. In case of stage II displacement, cast immobilization alone was insufficient. K-wire fixation was needed for prevention of displacement and better result. 5. In all of cases(30 cases) overgrowth of lateral condyle and spur formation were noticed but it has no clinical disabilities. 6. There were no significant differences of outcome between different fracture types and different stage of displacement. But significant differences of outcome were noticed how treatment performed. Accurate anatomical reduction and stable fixation was needed. 7. 2 cases of severe cubitus varus(20') were occured. In 21 cases, carrying angle were changed, valgus change were more common than varus change. It was thought to be relative undergrowth of lateral condyle of humerus and malunion as its causes. 8. In all cases, there were no loss of R.O.M.
Child ; Classification ; Clinical Study ; Follow-Up Studies ; Humans ; Humerus ; Immobilization ; Incidence

The genome of Hantaan virus, the prototype of the hantavirus genus, is composed of three segmented, single stranded negative sense RNA genome. The 5' and 3' termini of the Hantaan virus RNA genome contain noncoding regions (NCRs) that are highly conserved and complementary to form panhandle stuctures. There are some reports that these NCRs seems to control gene expression and viral replication in influenza virus and vesicular stomatitis virus. In this study, we examined whether NCRs in Hantaan virus play a role in expression of the viral nucleocapsid protein (Np) and foreign (luciferase) gene. The 5' and/or 3' NCR-deleted mutants were constructed and analysed. The Np expression of 5' NCR-deleted clone, it showed 40% reduction. To investigate the role of NCR in foreign gene expression, the clones which are replaced ORF of Hantaan viral Np gene with that of luciferase gene were constructed. The results were similar to those of the experiments using Np gene. These results suggest that 3' NCR is more important than 5' NCR in protein expression. To find out a critical region of 3' NCR in more important than 5' NCR in protein expression. To find out a critical region of 3' NCR in protein expression, several clones with a deleted part of 3' NCR were constructed and analyzed. The deletion of the conserved region in 3' NCR showed 20~30% decrease in Np expression. However there were no change in luciferase activities between clones with or without non-conserved region of 3' NCR. These results suggest that the 3' NCR of Hantaan virus S genome, especially conserved region in 3' NCR, plays and important role in the expression of Hantaan viral Np and foreign genes.
Animals ; Clone Cells ; Ecthyma, Contagious ; Gene Expression ; Genome* ; Hantaan virus ; Hantavirus ; Luciferases ; Nucleocapsid Proteins* ; Nucleocapsid* ; Orthomyxoviridae ; RNA ; Vesicular Stomatitis

No abstract available.
Ethics, Medical ; Health Communication/ethics ; Humans ; Mass Media/*ethics ; Physicians/*ethics ; Republic of Korea ; Social Support ; Societies, Medical/ethics

PURPOSE: To perform and compare differential diagnosis of patients with thyroid-associated myopathy, idiopathic orbital myositis and normal controls based on orbital computed tomography. Orbital fat and extraocular muscle densities were quantified using Hounsfield Unit (HU) and their characteristics were compared and analyzed. METHODS: From February 2005 to January 2013, orbital computed tomography was performed on 90 eyes of 47 thyroid-associated myopathy patients, 18 eyes of 14 idiopathic orbital myositis patients and 280 eyes of 140 normal subjects. The average values of orbital fat and extraocular muscle densities were measured and compared using HU. The density differences between the patients with thyroid-associated myopathy and the normal group were analyzed by age, clinical activity score, ocular protrusion and disease duration. RESULTS: In the thyroid-associated myopathy group, orbital fat and extraocular muscle densities were -87.8 +/- 12.5 HU and 48.7 +/- 7.1 HU, respectively. In the idiopathic orbital myositis group, the orbital fat and extraocular muscle densities were 79.9 +/- 9.9 HU and 49.2 +/- 9.1 HU, respectively. There was a statistically significant lower result of orbital fat in the thyroid-associated myopathy group (p = 0.002), however, the extraocular muscle density did not show a statistically significant difference (p = 0.775). The orbital fat and extraocular muscle densities of the normal group were -79.0 +/- 11.2 HU and 54.3 +/- 6.3 HU, respectively. There were significantly lower results in both orbital fat and extraocular muscle densities in the thyroid-associated myopathy group than normal group (p = 0.000). In active cases and those accompanied by ocular protrusion, there was no significant difference in orbital fat density (p = 0.345 and p = 0.952, respectively), while extraocular muscle density significantly decreased (p = 0.007 and p = 0.003, respectively). CONCLUSIONS: A difference between the orbital fat and extraocular muscle densities in thyroid-associated myopathy and idiopathic orbital myositis could be quantitatively found using HU and orbital computed tomography.
Diagnosis, Differential ; Humans ; Muscles* ; Muscular Diseases* ; Orbit* ; Orbital Myositis*

PURPOSE: Obesity has been known to be a cause of insulin resistance and dyslipidemia, and along with coronary artery disease and diabetes, is associated with metabolic syndrome(MS). This study aimed to ascertain the cause and prevalence of MS in obese children and adolescents. METHODS: Two hundred and seventy-seven school children, who showed more than a 95th percentile of body mass index(BMI) for age and sex, underwent oral glucose tolerance tests; fasting plasma lipid profiles, leptin, and CRP were measured; and ultrasonography was done. RESULTS: Out of 277 obese children, the prevalence of MS was 37.5%, with 38.7% occurring in males and 35.2% in females. The prevalence was 20.8% in primary school children and 50.3% in middle school children. MS was present in 25.2% of mildly obese children, 43.9% of moderate and 71.4% of highly obese children, showing increased occurrence among the severer degrees of obese groups. Increased prevalence was observed in males with high blood pressure, and females with high triglyceride levels. The ratio of children satisfying more than one, more than two, more than three, more than four and all of the five criteria for diagnosis of MS were 90.6%, 63.5%, 37.5%, 8.3%, and 0.4%, respectively. Aside from diagnostic criteria for MS, a statistically significant difference was present between obese patients with or without the syndrome in such items as weight, BMI, degree of obesity, visceral fat thickness, ratio of body fat, leptin, and adiponectin, fasting and 2 hour post prandial insulin concentration. CONCLUSION: The prevalence of MS is currently on the rise among children, due to the rapidly increasing rate of obesity, westernized diet, higher calorie intake and reduced exercise. The prevalence of MS in obese children was 37.5% - higher than US results - after implementation of modified pediatric criteria established by ATP III Asia-Pacific standard in 2003. It would therefore be necessary to establish an acceptable universal standard for the diagnosis of MS, and extend the study to the general pediatric population in order to acquire more accurate data on the prevalence of the disease.
Adenosine Triphosphate ; Adiponectin ; Adipose Tissue ; Adolescent ; Child* ; Coronary Artery Disease ; Diagnosis ; Diet ; Dyslipidemias ; Fasting ; Female ; Glucose Tolerance Test ; Humans ; Hypertension ; Insulin ; Insulin Resistance ; Leptin ; Male ; Obesity ; Obesity, Abdominal ; Plasma ; Prevalence* ; Triglycerides ; Ultrasonography

OBJECTIVE: The epidural fluid collection (EFC) as a complication of cranioplasty is not well-described in the literature. This study aimed to identify the predictive factors for the development of EFC as a complication of cranioplasty, and its outcomes. METHODS: From January 2004 to December 2012, 117 cranioplasty were performed in our institution. One-hundred-and-six of these patients were classified as either having EFC, or not having EFC. The two groups were compared to identify risk factors for EFC. Statistical significance was tested using the t-test and chi-square test, and a logistic regression analysis. RESULTS: Of the 117 patients undergoing cranioplasty, 59 (50.4%) suffered complications, and EFC occurred in 48 of the patients (41.0%). In the t-test and chi-test, risk factors for EFC were size of the skull defect (p=0.003) and postoperative air bubbles in the epidural space (p<0.001). In a logistic regression, the only statistically significant factor associated with development of EFC was the presence of postoperative air bubbles. The EFC disappeared or regressed over time in 30 of the 48 patients (62.5%), as shown by follow-up brain computed tomographic scan, but 17 patients (35.4%) required reoperation. CONCLUSION: EFC after cranioplasty is predicted by postoperative air bubbles in the epidural space. Most EFC can be treated conservatively. However, reoperation is necessary to resolve about a third of the cases. During cranioplasty, special attention is required when the skull defect is large, since EFC is then more likely.
Brain ; Epidural Space ; Follow-Up Studies ; Humans ; Logistic Models ; Reoperation ; Risk Factors ; Skull

OBJECTIVE: The aims of current study are to compare complications following cranioplasty (CP) using either sterilized autologous bone or polymethyl methacrylate (PMMA), and to identify the risk factors for two of the most common complications: bone flap resorption (BFR) and surgical site infection (SSI). METHODS: Between January 2004 and December 2013, 127 patients underwent CP and were followed at least 12 months. Variables, including sex, age, initial diagnosis, time interval between decompressive craniectomy (DC) and CP, operation time, size of bone flap, and presence of ventriculo-peritoneal shunt, were analyzed to identify the risk factors for BFR and SSI. RESULTS: A total of 97 (76.4%) patients underwent CP using PMMA (Group I) and 30 (23.6%) underwent CP using autologous bone (Group II). SSI occurred in 8 (8.2%) patients in Group I, and in 2 (6.7%) in Group II; there was no statistically significant difference between the groups (p=1.00). No statistically significant risk factors for SSI were found in either group. In Group I, there was no reported case of BFR. In Group II patients, BFR developed in 18 (60.0%) patients at the time of CP (Type 1 BFR), and at 12-month follow up (Type 2 BFR) in 4 (13.3%) patients. No statistically significant risk factors for BFR were found in Group II. CONCLUSION: CP using sterilized autologous bone result in a significant rate of BFR. PMMA, however, is a safe alloplastic material for CP, as it has low complication rate.
Bone Resorption ; Craniotomy ; Decompressive Craniectomy ; Diagnosis ; Follow-Up Studies ; Humans ; Polymethyl Methacrylate* ; Risk Factors ; Surgical Wound Infection ; Ventriculoperitoneal Shunt

PURPOSE: It is known that insulin resistance is important because it may precede the development of Diabetes Mellitus. We evaluated the gender difference of insulin resistance in obese children & adolescents. METHODS: 92 obese children and 187 adolescents (age:5-16 y, >95th percentile of the body mass index [BMI] for age and sex) were included in this study. The abdominal fat, abdominal circumference, and intraabdominal fat depth (IAFD), plasma fasting insulin, leptin, adiponectin, lipid profiles and high sensitive-C reactive protein (hs-CRP) were measured, and a two-hour oral glucose tolerance test with insulin measurement were performed. RESULTS: The plasma total cholesterol, leptin, fasting insulin & HOMA-IR levels of obese females were higher than those of obese males. The sex, waist circumference, IAFD & adiponectin levels were strongly correlated with HOMA-IR by multiple linear regression analysis (P<0.05). CONCLUSION: Adolescent females may have specific fat distribution and were expressed to have higher leptin and relatively lower adiponectin concentration compared to adolescent males, developing higher insulin resistance, even though having lesser abdominal fat and waist size. Further investigation is required to verify the gender difference of insulin resistance in obese children and adolescents.
Abdominal Fat ; Adiponectin ; Adolescent* ; Body Mass Index ; Child* ; Cholesterol ; Diabetes Mellitus ; Fasting ; Female ; Glucose Tolerance Test ; Humans ; Insulin Resistance* ; Insulin* ; Leptin ; Linear Models ; Male ; Obesity ; Plasma ; Waist Circumference