A consensus of current surgical practice favors external skeletal fixation in the patients with open fractures, where it can be difficult to achieve a good position and fixation by the usual methods and ipsilateral multiple fractures where it is desirable to avoid prolonged immobilization of adjacent joints. From March, 1979 to December, 1981, 34 patients with lower limb fractures were treated by the method of external skeletal fixator. 22 patients had open comminuted fractures with extensive soft tissue injuries and 12 patients had multiple fractures which were difficult to reduce and maintain in alignment. In the 30 patients which could be assessed, the final result was excellent or good in 23 patients, acceptable in 5 patients, and poor in 2 patients.
Consensus ; Fracture Fixation ; Fractures, Comminuted ; Fractures, Multiple ; Fractures, Open ; Humans ; Immobilization ; Joints ; Lower Extremity ; Methods ; Soft Tissue Injuries

The exact etiologies and mechanisms of ischemia in avascular necrosis of femoral head are still under investigation. But this condition seems to be increasing during a few decades with increasing use of steroid and alcohol abuse in Korea. The treatment modalities have been based on the stages of the disease by simple radiographic findings that do not describe the accurate pathological extent or localization. Therefore more sophisticated study is needed to treat the AVN of the femoral head well. Magnetic resonance images, simple radiographs, scintigraphs of 13 patients(22 femoral heads), who were admitted and treated at Seoul National University Hospital from April, 1989 to December, 1989 were correlated, to characterize the type of AVN by extent and location regardless of its stage and reveal the relationship between types and stages. It is the result of this study that the type of AVN as well as stage should be considered in determining the treatment modality.
Alcoholism ; Classification ; Head ; Ischemia ; Korea ; Magnetic Resonance Imaging ; Necrosis ; Seoul

No abstract available in English.
Chondrosarcoma, Mesenchymal

OBJECTIVE: The purposes of this study were to observe the radiographic changes of lumbar facet joints by magnetic resonance imaging (MRI) in conservatively and operatively treated groups of patients with herniated intervertebral disc, and to compare the biomechanical effects to lumbar facet joints according to the treatment methods. METHOD: The patients composed of 20 conservatively treated control group and 40 operatively treated group who had disc herniation at lower lumbar spine. Follow-up MRIs were performed in order to assess the radiographic changes of intervertebral disc and lumbar facet joints, such as disc degeneration, lumbar facet joint angle and tropism in either treatment groups individually. RESULTS: There are significant increase in lumbar facet joint angle in operatvely treated group at the level of both L4/5, right L5/S1 compared to that of conservately treated group, but the disc degeneration and facet joint tropism were not changed after treatment in both groups. There's no relationship between treatment period and each parameters. CONCLUSION: The radiographic biomechanical lumbar facet joint changes on MRI seems to be related to degenerative change of lumbar facet joint in operatively treated group with a lumbar disc herniation. Therefore, careful selection of optimal operation time and criteria would be important.
Follow-Up Studies* ; Humans ; Intervertebral Disc Degeneration ; Intervertebral Disc* ; Magnetic Resonance Imaging* ; Spine ; Tropism ; Zygapophyseal Joint*

The purpose of this study is to assess agreement and sensitivity of sacroiliac joint pain provocation tests with fluoroscopically guided, diagnostic sacroiliac joint block. Thirty patients with sacroiliac joint area pain and without other obvious sources of pain were selected. The patients were tested with 11 kinds of sacroiliac pain provocation tests before and after sacroiliac joint block and their pain relief scales were measured before block, after 30 minutes, 1 week, and 2 weeks. According to pain relief scale at 30 minutes after sacroiliac joint block, the patients were divided into 3 groups - response group that was 100-70% pain relief; 9 cases(30%), partial response group that was 69-30% pain relief; 15 cases(50%), and nonresponse group that was 29-0% pain relief; 6 cases(20%). In the response and the partial response group, the sensitivity of pain provocation tests were 88.5% in FABERE, 53.9% in Erichen, 50.5% in Yeoman, 43.3% in Minor, and 38.5% in Gaenslen test. Gamma statistic for agreement in the 5 superior sensitive tests was 0.80 between Minor and Gaenslen test, 0.67 between Yeoman and Minor test, 0.48 between Yeoman and Gaenslen test, and 0.44 between FABERE and Minor test. Pain relief scale 2 weeks later were above 60% in response group and above 50% in partial and nonresponse group. In conclusion, combining the FABERE test and another sensitive test, we enhance diagnostic power for sacroiliac dysfunction.
Humans ; Low Back Pain ; Sacroiliac Joint* ; Weights and Measures

OBJECTIVE: The purposes of this study were to evaluate the relation of the lumbar plexus with the psoas compartment, to measure the distance from skin to psoas compartment, and to determine the efficacy of psoas compartment block for the unilateral leg pain and/or low back pain. METHOD: Six cadavers were dissected and the computed tomography of the lumbar region were performed in 22 subjects. The psoas compartment block of 10 ml of 0.5 percent lidocaine were performed in 31 patients with unilateral leg pain and/or low back pain. Visual Analog Scale (VAS) and sensory, motor functions were assessed before the block and 5, 30 minutes, and 1, 2, 3 hours and 1 week after the block. The distance from skin to psoas compartment were measured during the procedure. The questionnaires on the procedure were completed after 1 week. RESULTS: Cadaver dissections demonstrated that the 3 main nerves of lumbar plexus were within the psoas compartment between the level of L4 and L5. Computed tomography provided that the average distances of anterior and posterior borders of psoas major from the low back skin were 10.8 & 6.3 cm and that of medial & lateral borders from the median sagital plane were 2.9 & 7.1 cm respectively. There were statistically significant correlations between distance from skin to psoas compartment and body weight, abdominal circumference as well as body mass index (p<0.0001). The VAS was 7.7 before the block and 5.4 1 week after the block (p<0.05) and satisfactory outcomes were shown in 71 percent of the subjects. CONCLUSION: Psoas compartment block was effective for the patients with unilateral leg pain and/or low back pain without major side effects and complications.
Body Mass Index ; Body Weight ; Cadaver ; Humans ; Leg ; Lidocaine ; Low Back Pain ; Lumbosacral Plexus ; Lumbosacral Region ; Surveys and Questionnaires ; Skin ; Visual Analog Scale

This study aimed to investigate the frequency of dental visits after coronavirus disease 2019 (COVID-19) in children and adolescents in comparison to that of adults. The data on the number of dental visits on the basis of different classification and treatment codes for all the age groups were provided by the Health Insurance Review and Assessment Service from January 2017 to December 2020. To reduce the impact of the population change, dental visits per 1000 people was used. After the start of the pandemic, dental visits per 1000 people decreased in all age groups when analyzed for the diseases of pulp and periapical tissues classification code and dental visits per 1000 people decreased over 5 years age groups when analyzed for the pulp treatment code. Regarding the restorative treatment code, visits in the 0 - 19 years age group decreased after the pandemic. Based on the comparison of the number of confirmed COVID-19 cases to that of monthly dental visits by treatment codes, the change rate of pulp and restorative treatments gradually decreased after the waves of the pandemic in February and August 2020 in Korea. Furthermore, dental visits per 1000 people for gingivitis and periodontal disease classification code increased after the pandemic in all age groups. The rate of decrease in dental visits per 1000 people for restorative treatments in children and adolescents was higher than that in adults. The rate of decrease in the number of dental visits for multi-visit pulp treatments showed a rapid decrease as compared to that of 1-visit pulp treatments after the pandemic. This study identified changes in the number of dental visits of children and adolescents after COVID-19 transmission in comparison to that observed in adults.

Background: and Purpose Premanifest mutation carriers with spinocerebellar ataxia (SCA) can exhibit subtle abnormalities before developing ataxia. We summarized the preataxic manifestations of SCA1, -2, -3, and -6, and their associations with ataxia onset. Methods: We included studies of the premanifest carriers of SCA published between January 1998 and December 2019 identified in Scopus and PubMed by searching for terms including ‘spinocerebellar ataxia’ and several synonyms of ‘preataxic manifestation’. We systematically reviewed the results obtained in studies categorized based on clinical, imaging, and laboratory markers. Results: We finally performed a qualitative analysis of 48 papers. Common preataxic manifestations appearing in multiple SCA subtypes were muscle cramps, abnormal muscle reflexes, instability in gait and posture, lower Composite Cerebellar Functional Severity scores, abnormalities in video-oculography and transcranial magnetic stimulation, and gray-matter loss and volume reduction in the brainstem and cerebellar structures. Also, decreased sensory amplitudes in nerve conduction studies were observed in SCA2. Eotaxin and neurofilament lightchain levels were revealed as sensitive blood biomarkers in SCA3. Concerning potential predictive markers, hyporeflexia and abnormalities of somatosensory evoked potentials showed correlations with the time to ataxia onset in SCA2 carriers. However, no longitudinal data were found for the other SCA gene carriers. Conclusions Our results suggest that preataxic manifestations vary among SCA1, -2, -3, and -6, with some subtypes sharing specific features. Combining various markers into a standardized index for premanifest carriers may be useful for early screening and assessing the risk of disease progression in SCA carriers.

Background: and Purpose Premanifest mutation carriers with spinocerebellar ataxia (SCA) can exhibit subtle abnormalities before developing ataxia. We summarized the preataxic manifestations of SCA1, -2, -3, and -6, and their associations with ataxia onset. Methods: We included studies of the premanifest carriers of SCA published between January 1998 and December 2019 identified in Scopus and PubMed by searching for terms including ‘spinocerebellar ataxia’ and several synonyms of ‘preataxic manifestation’. We systematically reviewed the results obtained in studies categorized based on clinical, imaging, and laboratory markers. Results: We finally performed a qualitative analysis of 48 papers. Common preataxic manifestations appearing in multiple SCA subtypes were muscle cramps, abnormal muscle reflexes, instability in gait and posture, lower Composite Cerebellar Functional Severity scores, abnormalities in video-oculography and transcranial magnetic stimulation, and gray-matter loss and volume reduction in the brainstem and cerebellar structures. Also, decreased sensory amplitudes in nerve conduction studies were observed in SCA2. Eotaxin and neurofilament lightchain levels were revealed as sensitive blood biomarkers in SCA3. Concerning potential predictive markers, hyporeflexia and abnormalities of somatosensory evoked potentials showed correlations with the time to ataxia onset in SCA2 carriers. However, no longitudinal data were found for the other SCA gene carriers. Conclusions Our results suggest that preataxic manifestations vary among SCA1, -2, -3, and -6, with some subtypes sharing specific features. Combining various markers into a standardized index for premanifest carriers may be useful for early screening and assessing the risk of disease progression in SCA carriers.

The coexistence of pheochromocytoma and renal artery stenosis has been recognized since 1958, but it is rare. We have experienced an anesthetic management of 43-year-old female patient of renovascular hypertension associated with right adrenal pheochromocytoma. Proper preoperative preparation, sufficient sedation, smooth induction, complete analgesia and good muscle relaxation were very important. Relative cardiovascular stability was achieved with sodium nitroglycerine, sodium nitroprusside and verapamil during tumor manipulation. After the tumor was removed, we could control the hypotension with dopamine, dobutamine, crystalloid and colloid. On the operative field there was no definite anatomic stenosis of renal artery and it was suggested that leakage of catecholamines from pheochromocytoma causes functional, reversible spasm of renal artery and thus renovascular hypertension.
Adult ; Analgesia ; Catecholamines ; Colloids ; Constriction, Pathologic ; Dobutamine ; Dopamine ; Female ; Humans ; Hypertension, Renovascular* ; Hypotension ; Muscle Relaxation ; Nitroglycerin ; Nitroprusside ; Pheochromocytoma* ; Renal Artery ; Renal Artery Obstruction ; Sodium ; Spasm ; Verapamil