Because clinical course of the Legg-Calve'-Perthes disease (LCPD) is varied and unpredictable, it is important that pediatric orthopedists have to know prognostic factors of LCPD in order to choose proper method of treatment. The most universally accepted prognostic factor is the patient's age at the onset of the disease, and most patient's who are less than 5 years old have been treated non-operatively. However, we believe that the extent of involvement of the femoral head is more important in this age group and that operative treatment can get good results in cases of servere head involvement. The purpose of this study is to evaluate the efficacy of femoral varus osteotomy in patients before the age of 5 years with severe involvement. We reviewed 18 patients (23 hips) who were less than 5 years old with Catterall group III (5 patients, 7 hips) or IV (13 patients, 16 hips) involvement from June 1984 to June 1994. Femoral varus osteotomies were performed in all cases. We followed up more than 2 years (range, from 24 to 130 months) and analysed clinical and radiological results. The results were as follows: 1. The mean duration from onset of the disease to the stage of repair was 16 months (range, from 8 to 27 months). 2. 2 hips (28.6%) in group III and 12 hips (75%) in group IV showed radiographic head at-risk signs. 3. Clinically all hips in group III showed good result. However, among the 16 hips in group IV, 13 hips were rated good and 3 hips were fair. Overall, 20 hips (86.9%) showed good result. 4. Radiologically all hips in group III showed good result, whereas in group IV, 10 hips were rated good and 6 hips were fair. Overall, 17 hips (78.9%) showed good result. We concluded that femoral varus osteotomy in patients less than 5 years old with severe involvement might shorten the course of disease and might be effective method.
Child* ; Child, Preschool* ; Fibrinogen ; Head ; Hip ; Humans ; Legg-Calve-Perthes Disease* ; Osteotomy*

No abstract available.
Ankle Fractures* ; Ankle*

No abstract available.

Surgical stabilization using instrumentation for thoracolumbar injuries offers several advantages such as nearly anatomic reduction of fractures, protection of neurologic structures and most importantly early ambulation of the patient. The treatment of fracture-dislocation of the thoracolumbar spine has been progressively improved over the past decades and recently a lot of new device have been introduced to improve fixability of the involved vertebrae three dimensionally and short segmental fixation as possible. The authors have treated 17 cases of unstable thoracolumbar fracture using Cotrel-Dubousset instrumentation in the Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital from Jan. 1988 to Jan. 1989 with the following results: 1. Bursting fractures are the most common type(52.9%) of mechanism of injury. 2. Excellent anatomic reductions were obtained and compression, wedging and local kyphotic deformities were nicely corrected. 3. Short segmental fixation can preserve the maximal spinal mobility. 4. No significant loss of reduction or loosening of implant was found. 5. Remarkable neurologic recoveries were observed in cases of incomplete cord lesion. 6. Significant neurologic recovery was found in patients treated with laminectomy and Cotrel-Dubousset instrumentation.
Congenital Abnormalities ; Early Ambulation ; Heart ; Humans ; Laminectomy ; Orthopedics ; Spine

Fractures of the tibial condyles, involving as they do weight-bearing articular surfaces and frequently accompanied by soft tissue injuries such as collateral ligaments, cruciate ligaments, and menisci present a variety of problems in treatment and prognosis. Slee, Apley, and others maintained the opinion that most fractures of the tibial condyles could be managed conservatively. On the other hand, Rombold, Schatzker, and others seemed to consider closed treatment to be virtually s form of therapeutic nihilism and adviced open reduction. But recently most authors agree that the method of treatment has to be selected in each individual case, and recommand anatomical reduction of the fracture as possible and early knee motion. The authors have treated 17 cases of tibial condylar fractures with arthroscopic management and extraarticular distal approach in the Department of Orthopedic surpery, Kang Dong Sacred Heart Hospital from Oct. 1986 to Jul. 1989. Of the above cases, 11 cases could be followed for a period of anywhere from 1 year to 31/2 years and analysed according to the cause, classification, treatment, and result. The following results were obtained from the analysis of 11 tibial condylar fractures. l. Of the 11 cases, 7 (63.6%) were male and 4 (36.4%) were female. 2. Of the 11 cases, 7 (63.6%) were due to traffic accident (5 pedestrians, 2 occupants) and 3 (27.3%) were due to fall from height. 3. Among 11 cases, 7 (63.6%) were associated with other injuries. 4. Bone graft was needed in 5 cases. 5. All were treated by arthroscopic management with anatomically and functionally good results. 6. By arthroscopic mangement, it was easy to find and treat the accompanying intraarticular lesion. 7. With early active and C.P.M. exercise, almost full range of motion was obtained in all cases.
Accidents, Traffic ; Classification ; Collateral Ligaments ; Female ; Hand ; Heart ; Humans ; Knee ; Ligaments ; Male ; Methods ; Orthopedics ; Pedestrians ; Prognosis ; Range of Motion, Articular ; Soft Tissue Injuries ; Tibia ; Transplants ; Weight-Bearing

No abstract available.
Scoliosis*

An association of low total cholesterol in blood with psychiatric diseases and suicidal behavior has been suggested. As part of an attempt to further explore this relationship, we examine first, whether serum cholesterol levels in psychiatric patients with suicidal attempt would be lower than in non-suicidal psychiatric inpatients or normal controls, second, whether such significant difference of cholesterol levels would be present when the diagnostic groups are analyzed separately, third whether low cholesterol level would be associated with a history of serious suicidal attempts, and finally, whether low cholesterol level in suicide attempters is as state or a trait marker. We determined the serum cholesterol levels in 231 patients admitted to an emergency room following an suicidal attempt, in the same numbers of age-, sex- and diagnosis-matched non-suicidal psychiatric controls, and in the same numbers of age-, sex matched normal controls. The seriousness of an attempt was divided into 5 grades according to the degree of the resulting medical injury. Total cholesterol levels in suicide attempters were significantly lower compared with both psychiatric and normal controls, when sex, age, and nutritional status(i.e., body mass index) were controlled for. This significant relationship was observed in major depressive disorders and personality disorders, but not in schizophrenia and bipolar type I disorders. The severity of suicide by a lowering of blood cholesterol was related to the magnitude of the cholesterol reduction. After treatment of their psychiatric ailments, the cholesterol levels in suicide attempters were significantly increased. This result suggests that low cholesterol level in psychiatric patients might be a potential biological marker of suicide risk. It is hypothesized that low cholesterol levels is associated with the suicide by modifying the serotonin metabolism, the production of interleukin-2 and melatonin metabolism in psychiatric patients.
Biomarkers ; Cholesterol* ; Depression ; Depressive Disorder, Major ; Emergency Service, Hospital ; Humans ; Inpatients ; Interleukin-2 ; Melatonin ; Metabolism ; Personality Disorders ; Schizophrenia ; Serotonin ; Suicide*

The use of lower extremity tourniquets for procedures of the lower leg is considered routine in orthopedic surgery, but, lower extremity tourniquets do harm occasionally. While the tourniquet is inflated, metabolic changes such as increased PaCO2 , lactic acid, and serum potassium and decreased level of PaO2 and pH occur in the ischemic limb. Deflation of tourniquet results in release of anaerobic metabolic products during ischemia into systemic circulation. In this ischemia/reperfusion situation, oxygen free radicals could potentially be produced during the reperfusion period by several mechanisms. One of these mechanisms is release of intracellular superoxide or hydrogen peroxide by activated neutrophils in the area. These reactive oxygen species(ROS) could be a causative factor for the postreperfusion no-flow, lung injury, induction of tourniquet shock, etc. The purpose of this clinical study was to investigate the effect of tourniquet deflation on the hemodynamic changes, changes of blood gas analysis, and hydrogen peroxide production using flow cytometric analysis of fluorescent DCF(Dichlorofluorescein). Quantitative analysis of fluorescent DCF was performed in resting and fMLP(N-formyl-methyonyl-leucyl-phenylalanine) or PMA(phorbol myristate acetate) stimulated neutrophils. Also differences of these factors between two groups of tourniquet time, one is less than one hour and the other more than one to two hours, were analysed. The hemodynamics(blood pressure, pulse rate), arterial PO2, bicarbonate, base excess, and hydrogen peroxide production showed no significant change before and after tourniquet release(p>0.05). Arterial pH and PaCO2 decreased significantly until 10 and 5 minutes after tourniquet release, respectively(p>0.05). Tourniquet time didn’t reveal any significances differences. These results indicate that tourniquet application with400mmHg pressure and less than 2 hours does not release significant hydrogen peroxide into systemic circulation during reperfusion period after tourniquet release.
Blood Gas Analysis ; Blood Pressure ; Clinical Study ; Extremities ; Flow Cytometry ; Free Radicals ; Hemodynamics ; Hydrogen Peroxide ; Hydrogen ; Hydrogen-Ion Concentration ; Ischemia ; Lactic Acid ; Leg ; Lower Extremity ; Lung Injury ; Myristic Acid ; Neutrophils ; Orthopedics ; Oxygen ; Potassium ; Reperfusion ; Shock ; Superoxides ; Tourniquets

No abstract available.
Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Korea*

Traumatic Brain Injury (TBI) is as common in elderly people as it is in young adults. Compared to TBI among young adults, TBI among the elderly differs in mechanism of injury, clinical presentation, comorbidities, and prognosis. This article begins with an overview of the literature on epidemiology, unique characteristics and pathophysiology of geriatric head injuries. Neurological sequelae and indices of general outcome following TBI will be disussed. We will discuss the proposed relationship between TBI and Alzheimer's disease, which lead to a greater understanding of the pathogenesis of both TBI and Alzheimer's disease. The literature about the assessment and management of TBI will be reviewed.
Aged* ; Alzheimer Disease ; Brain Injuries* ; Comorbidity ; Craniocerebral Trauma ; Epidemiology ; Humans ; Prognosis ; Young Adult