No abstract available.

No abstract available.
Peripheral Vascular Diseases*

No abstract available.
Gastrointestinal Diseases*

No abstract available.
Kyphosis* ; Spine* ; Tuberculosis*

Thirty-six femoral heads with non-traumatic osteonecrosis(ON) at precollapse stage in 32 patients were studied with repeated magnetic resonance(MR) imagings at three-month intervals to reveal the occurrence of marrow edema of the proximal femur in early stage ON. Eighteen hips were randomly selected for the core decompression and the remaining 18 hips were treated conservatively. The criteria of marrow edema in this study were signal abnormalities of low signal intensity in T1-weighted image, and isointensity or hyperintensity in T2-weighted image which involved the femoral head beyond the necrotic zone, extending to the neck and trochanteric area. Eight femoral heads demonstrated marrow edema at the initial MR imaging and seven out of eight were associated with pain for one to six weeks before the first MR study. Core decompression was performed on four out of those seven symptomatic femoral heads with marrow edema after the first MR imaging. The symptom was relieved promptly in three out of four core decompressed hips. The remaining one core decompressed case showed reccurrent marow edema on follow-up MR imagings. Out of 28 hips free of marrow edema at the initial MR study, 14 hips underwent core decompression after the first evaluation and the remaining 14 hips were treated conservatively. One out of 14 core-decompressed hips and three out of 14 nonoperated hips showed marrow edema in follow-up MR studies. Two cases experienced hip pain while two cases remained symptomless at the presence of marrow edema. Four femoral heads under-went core biopsy and three cases received total hip arthroplasty at the presence of marrow edema. In those four hips which underwent core decompression during the presence of marrow edema, intraosseous pressure(IOP) ranged from 36 to 60 (mean; 49) mmHg. In the remaining 14 core decompressed hips, the IOP ranged from 16 to 52 (mean; 37) mmHg. The histology of those four core biopsies and three resected femoral heads showed a collection of eosinophilic plasma-like fluid in the marrow space around the necrotic zone, a finding compatible with marrow edema. This study suggests that marrow edema of the proximal femur may occur during the progression of the ON of the femoral head and is frequently associated with increased intraosseous pressure and pain. Core decompression can relieve marrow edema and associated pain promptly. But the effect is temporary, and core decompression does not prevent marrow edema permanently.
Arthroplasty, Replacement, Hip ; Biopsy ; Bone Marrow ; Decompression ; Edema ; Eosinophils ; Femur ; Follow-Up Studies ; Head ; Hip ; Humans ; Magnetic Resonance Imaging ; Neck ; Osteonecrosis ; Prospective Studies

Twenty-eight patients with 20 tibia fractures and 8 femur fractures were treated with external fixation. The average age at fracture was 10 years 10 months ranging from 5 years to 17 years 6 months. Of 28 fractures, 6 were closed fractures and 22 were open fractures. The average follow-up of these children was 23 months. Monofixators were used in 12 fractures and Ilizarov fixators in 16 fractures. The average time to healing of the fractures was 14.6 weeks(range, 6 to 44 weeks). Seven segmental bone defects(range, 2 to 17cm) were treated with the Ilizarov method of internal bone transport using the transport ring and bone grafting at the docking site. The average healing index for callus distraction was 25 days per centimeter. Seven patients had 10 major complications that necessitated additional operative procedures. There were 4 nonunions. Three patients had an infected nonunion, which was treated with the Ilizarov fixator and polymethyl-methacrylate antibiotic beads. One patient had a hypertrophic nonunion which was treated with plate fixation. Three patients who had an epiphyseal injury had shortening with angular deformity, which was treated by callus distraction. Three patients had a joint contracture, which was treated by the percutaneous tenotomy and Ilizarov fixator. The selection of the type of external fixator depends on the fracture pattern and the Ilizarov fixator is recommended for complicated fracture with severe comminution or segmental bone loss.
Bone Transplantation ; Bony Callus ; Child ; Congenital Abnormalities ; Contracture ; External Fixators ; Femur ; Follow-Up Studies ; Fractures, Bone ; Fractures, Closed ; Fractures, Open ; Humans ; Ilizarov Technique ; Joints ; Surgical Procedures, Operative ; Tenotomy ; Tibia

Interlocking and Ender nail fixations have been widely used for the surgical treatment of diaphyseal fractures of femur. Interlocking nail could give advantage of high stability to unstable, cominuted fractures. It requires, however, advanced technique and exposure to radiation harzard, often complicated by further comminution, displacement, breakage of drill bit or loosening of locking screws. Ender nail, on the contrary, is easier in procedure without reaming, thereby maintaining endosteum and requiring short operation time. It, however, cannot avoid complications of shortening, rotational deformity, migration of nails, etc. This study aimed at comparative evaluation of the clinical results of two different nailings(23 Interlocking and 19 Ender nails) performed from March 1987 to March 1993. The study materials were 42 femoral fractures out of 41 adult patients with the followed-up between one and seven years(average 3.5 years). The results are summarized as below: 1. Fracture occurred mostly in the mid-diaphysis(81%) and the Type III comminution(63%) was most common according to the Winquist-Hansen classifiaction. 2. The operative time averaged ninty five minutes in Interlocking nailing, while sixty minutes in Ender nailing. The blood loss was negligible in both techniques. 3. Fluoroscopic assessment after insertion of the nails revealed that Interlocking gave superior stability to Ender nail, while Ender nail produced earlier callus formation(7.5 weeks in average) than Interlocking nail(9.0 weeks in average, p < 0.05). It took both nails average eighteen weeks to obtain clinical union(p>0.05). 4. Interlocking nail was complicated by loosening of locking screws in two, angulation in one, breakage of drill bit in one cases. Ender nail showed protrusion in two, limb shortening in three, rotational deformity in three cases respectively. There was neither operative infection nor nonunion.
Adult ; Bony Callus ; Congenital Abnormalities ; Extremities ; Femoral Fractures ; Femur ; Humans ; Operative Time

Objective: To retrospectively review the characteristics of preschool children with speech and language disorders to determine their clinical features and compares the average degrees of language delay based on hospital visit purposes, language developmental delay causes, and maternal language. Methods: One thousand one hundred two children (832 males, 270 females) with the chief complaint of language or speech problems who underwent language assessment for the first time were included. Their medical records, including demographic data, language environments, and family history of language problems and other developmental problems, were collected. Furthermore, the results of language and developmental assessments and hearing tests were collected. Results: Among the children enrolled in this study, 24% had parental problems and 9% were nurtured by their grandparents. The average degree of language delay did not differ regarding purposes of hospital visits. The average degree of language delay was greatest in children with autism spectrum disorders and least in children with mixed receptive–expressive language disorders. In children with mothers who do not speak Korean as their native language, social quotients in the social maturity scale were less than 70. Conclusion Language environment is an essential factor that may cause speech and language disorders. Moreover, maternal language seems to affect the social quotient of the social maturity scale.