Oncogenous or tumor-induced rickets is recognized as Vitamin D-resistant hypophosphatemic rickets that heals after excision of a coexisting tumor in either bone or soft tissue. Its pathogenesis is not clarified, but it has been suggested that the tumor elaborates a homoral substance inhibiting tubular reabsorption of phosphate or that the tumor inhibits the synthetic process of 1, 25-dihydroxcholecalciferol. We present two cases of vitamin D-resistant rickets, one associated with intrasseous well-differentiated osteosarcoma in the pelvis and the other associated with fibrosarcoma of distal femur. The case with low grade osteosarcoma showed immediate improvement of rickets after excision of the tumor, but the case with fibrosarcoma showed no improvement after amputation and was fatally terminated 5 months later due to lung metastasis.
Amputation ; Femur ; Fibrosarcoma ; Lung ; Neoplasm Metastasis ; Osteosarcoma ; Pelvis ; Rickets ; Rickets, Hypophosphatemic ; Vitamins

Demand for high quality medical care has recently been increasing in step with high level of income and education. Patients prefer the use of large general hospitals to small community hospitals. Large hospitals, usually located at urban area, expand their capacities to cope with the increasing demand, therefore, they easily secure revenue necessary for growth and development of hospitals. However, small community hospitals are facing with serious financial difficulties caused from the reduction of patients in one hand and the inflation of cost in another. If small rural hospitals were closed, the closure would have negative impacts on local economies in addition to the decrease in access to medical care. Community leaders should have an insight on the contribution of community hospitals to local economies. They could make a rational decision on the hospital closure only with the understanding of hospital's contribution to the community. This study is designed to develop an economic model to estimate the contribution of rural hospital to local economies, and also to apply this model with a specific hospital. The contribution of a hospital to local economies consists of two elements, direct effect and multiplier effects. The direct impacts include hospital's local purchasing power, employee's local purchasing power, and the consumption of patients coming from outside the community. The direct impact induces multiplication effect in the local economy. The seed money invested to other industries grows through economic activities in the economy. The seed money invested to other industries grows through economic activities in the region. This study estimated the direct effect with the data of expenditure of the case hospital. The total effect was calculated by multiplied the direct effect with a multiplier. The multiplier was drown from the ratio of marginal propensity of income and expenditure. Beside the estimation of the total impacts, the economic effect from the external resources was also analyzed by the use of the ratio of patients coming outside the region. The results are as follows. 1. The direct economic contribution of the hospital to the local economy is 1,104 million won. 2. The value of multiplier in the region is 2.976. 3. The total economic effect is 3,286 million won, and the multiplication effect is 2,182 million won. 4. The economic contribution from the external resources is 245 million won which is 7.5% of the total economic effect.
Education ; Growth and Development ; Hand ; Health Expenditures ; Health Facility Closure ; Hospitals, Community ; Hospitals, General ; Hospitals, Rural* ; Humans ; Inflation, Economic ; Models, Economic

The congenital ball-and-socket ankle joint is a rare condition and is associated with congenital shortening of the lower extrimity and various skeletal abnormalities of the foot. This disease entity was reported in the German literature by Politzer in 1931 and in the English literature by Lamb in 1958. Several series have been reported since, suggesting that the condition may not be as rare as generally thought. This case is, to our knowledge, the first reported in this country.
Ankle Joint ; Ankle ; Foot

One hundred eighty-eight patients with avascular necrosis of the femoral head in adults, who were admitted and treated in Department of Orthopedic Surgery, Seoul National University Hospital between January of 1965 and May of 1985 are investigated in terms of the history, clinical data and laboratory examinations. And, the following results were obtained. 1. The incidence was higher in the 5th decade and the sex ratio between male and female was 3.3:l. 2. 106 cases (56%) had the bilateral hip involvement. 3. The most frequent etiological factor was alcohol (72 cases, 38%), followed by trauma (35 cases, 19 %), and steroid (32 cases, 17%). 4. Underlying diseases in steroid-induced avascular necrosis of the femoral head were dermopathy (9 cases), nephropathy (4 cases), pain over other joints (5 cases), systemic lupus erythematosus (2 cases), etc. 5. The time intervals between etiological events and appearances of clinical symptoms were 2 years and 3 months in the steroid induced cases, 1 year and 1 month in trauma induced ones, 2 years and 1 month in femur neck fracture cases, 2 years and 2 months in Caissons disease, and 3 years in post-irradiation 6. Bone scan was valuable in the early diagnosis of avascular necrosis of the femoral head. 7. Selective femoral head angiography show narrowing of lateral femoral circumflex artery, narrowing or obstruction of medical femoral circumflex artery, and obstruction of superior retinacular artery. 8. It is suggested that minor trauma and osteoporosis could make micro-fracture, resulting avascular necrosis of the femoral head, and the vascular change is secondary to the avascular necrosis.
Adult ; Angiography ; Arteries ; Early Diagnosis ; Female ; Femoral Neck Fractures ; Femur ; Head ; Hip ; Humans ; Incidence ; Joints ; Lupus Erythematosus, Systemic ; Male ; Necrosis ; Orthopedics ; Osteoporosis ; Seoul ; Sex Ratio

Since 1983, the transtrochanteric rotational osteotomy has been performed in 38 hips of 36 patients for the nontraumatic avascular necrosis of the femoral head at the department of orthopaedic surgery of Seoul National University Hospital. Out of them, 26 hips(18 cases of Sugioka grade I and 8 cases of Sugioka grade II ) were followed up for more than 1 year. The average period of follow-up was 3 years and 5 months(range, 1 year and 2 months to 7 years). These cases include 3 cases of failure before 2 years after operation. Overall, the result was satisfactory in 20 cases(77%)out of a total of 26 cases(success in 18 cases(69%)and good in 2 cases(8%)). The results of the grade I lesions(14 cases of success and 1 case of good result out of 18 cases) were better than those of the grade I lesions(4 cases of success and 1 case of good result out of 8 cases). Complications occurred in 5 cases. These include an ectopic ossification, a stress fracture of the neck, a nonunion of the osteotomy site, a nonunion of the greater trochanter and a delayed union of the greater trochanter. There were 6 cases of failure. For the 4 cases of them, hip replacement arthroplasy was performed. The MRI images axial to the longitudinal axis of the femoral neck gave excellent information for the operation.
Femur ; Femur Neck ; Follow-Up Studies ; Fractures, Stress ; Head ; Hip ; Humans ; Magnetic Resonance Imaging ; Neck ; Necrosis ; Ossification, Heterotopic ; Osteotomy ; Seoul

The effect of temperature on the pH-dependence of actomyosin superprecipitation was studied, using actomyosin extracted from the rabbit and frog skeletal muscle tissues. The pH optima of superprecipitation was rather broad in both the rabbit and frog actomyosin. In the frog, superprecipitation measured at 16-42 degrees C was relatively independent of pH variations between 6.7 to 8.5, but it was significantly inhibited at pHs outside of this range, showing a sharp inflection of the curve. The pH at the inflection point was inversely proportional to the incubation temperature, but the (OH-)/(H+) ratio at the inflection point was not changed with temperature. The log (OH-)/(H+) was approximately -0.6 on the acidic side and 3.16 on the alkaline side. Similarly, superprecipitation of the frog actomyosin was virtually independent of the medium pH of the intermediate range (approximately 6.0-8.5); but it was drastically inhibited at pHs below or above this range, thus revealing a sharp inflection of the curve. Again, the pH at the inflection point changed inversely with temperature, preserving a constant (OH-)/(H+) ratio. The log (OH-)/(H+) ratio at the inflection point was approximately -2 on the acidic side and 3.5 on the alkaline side. The above pH effects were not associated with irreversible protein damage or with the changes in buffer species. These results strongly suggest that suppression of the superprecipitation of rabbit and frog actomyosin gels, at a low and high pH, be due to alterations in the fractional dissociation of histidine-imidazole and cysteine-SH groups, respectively.
Actomyosin* ; Animal ; Calcium/physiology ; Hydrogen-Ion Concentration ; Muscle Contraction ; Precipitation ; Rabbits ; Temperature*

No abstract available.
Bone Density*

A case of contact dermatitis due to herb onintment is described in a 24 year-old female patient. After topical application of herb ointment, she developed erythematous papules and plaques on the face and neck. Patch test revealed positive reactions to ammoniated mercury, thimerosal, and the herb ointment. Energy-dispersive X-ray microanalysis of the herb ointment showed a striking peak for mercury.
Dermatitis, Contact* ; Electron Probe Microanalysis ; Female ; Humans ; Neck ; Patch Tests ; Strikes, Employee ; Thimerosal ; Young Adult

PURPOSE: To evaluate the findings and the role of contrast enhanced magnetic resonance imaging in avascular necrosis of femoral head. MATERIALS AND METHODS: Sixteen patients with avascular necrosis of femoral head were examined with MRI. Tl-weighted and T2-weighted images and contrast-enhanced Tl-weighted images were obtained. Enhancing characteristics of the necrotic area and synovium were determined. Also a change of the disease extent after enhancement was assessed. RESULTS: Twenty seven avascular necrosis of the femoral head including 11 cases of bilateral lesion were detected. Fifteen cases revealed collapse of the femoral head. The portions of the lesion with low signal intensity on Tl-weighted images and high signal intensity on T2-weighted images showed contrast enhancement in 15 cases. However, the portions with low signal intensities both on T1 and T2-weighted images showed enhancement in one case. There was no significant change of the disease extent after enhancement. Synovium showed enhancement in 18 cases, and joint effusion was detected in 23 cases. CONCLUSION: Contrast enhanced MR images may be helpful in predicting histopathologic findings of avascular necrosis of the femoral head, but not useful for evaluating the extent of disease.
Head* ; Humans ; Joints ; Magnetic Resonance Imaging* ; Necrosis* ; Synovial Membrane

No abstract available.
Colorectal Neoplasms* ; Follow-Up Studies*