Rheumatoid arthritis is a chronic inflammatory systemic disease of young or middle aged adults, characterized by destructive and proliferative changes in the synovial membrane, periarticular structures, skeletal muscle and perineural sheath. Eventually joints are destroyed, ankylosed and deformed. Therefore the aim of treatment is to keep the inflammatory process at a minimum, thereby preserving joint motion, maintaining health of muscles supplying motor power about the joint, and preventing secondary joint stiffness and deformity. Much of the increasing enthusiasm for surgical treatment of rheumatoid arthritis revolves around preventing the destruction of cartilage and tendon simply by excising as much as possible of the tissue that produces the destruction, namely the inflamed synovial membrane. Synovectomy probably is the earlient and most rewarding procedure that can be done in the treatment of rheumatoid arthritis. For the period of 11 yesrs from March 1966 to December 1977, 16 cases of rheumatoid knees were treated by synovectomy and the results of clinical observation was as follows. 1. Synovectomy was performed in 16 knees of 13 patients and 11 patients were followed up. 2. Of 13 patients, 10 patients were female and 3 patients were male. 3. Peak age incidence was in the third decade (38.4%) and the postoperative results were more satisfactory in younger patients than in older patients. 4. Post operative range of motion was not specifically correlated to the duration of symptom. 5. Postoperative results were not specifically correlated to the laboratory findings. 6. Postoperative range of motion was satisfactory in 6 cases and was unsatisfactory in 5 cases.
Adult ; Arthritis, Rheumatoid ; Cartilage ; Congenital Abnormalities ; Female ; Humans ; Incidence ; Joints ; Knee ; Male ; Middle Aged ; Muscle, Skeletal ; Muscles ; Range of Motion, Articular ; Reward ; Synovial Membrane ; Tendons

Supracondylar fractures of the humerus is the most common elbow fractures in children. Many papers has been published about the treatment of the supracondylar fractures of the humerus in children and prevention of both Volkmann's ischemic contractures and nerve injuries associated with these fractures, however, unfortunately it is still one of the most difficult fractures to manage. After successful reduction, the late complications of loss of elbow motion, the change in carrying angle, myositis ossificans, and progressive ulnar nerve palsy still lie ahead. For the period of 5 years from January 1975 to December 1979, 110 patients who had been treated for supracondylar fractures of the humerus at Severance Hospital, Yonsei University Coilege of Medicine were studied and analyzed retrospectively and the results are summerized as follows: 1. The age of the patients varied from 1 to 26 years, the majority (80.0%) being between 4 to 11 years and the fractures were on the left side in 71.8% and males comprized 75.5%. 2. The extension type comprized 94.5%. 3. Most common complications were cubitus varus deformities. 4. Percutaneous pinning and open reduction and internal fixation elicited rare cubitus varus diformities. 5. Limitation of motion was most frequent camplication after open reduction and internal fixation. 6. All cases which showed cubitus varus deformities were initially medially displaced fractures. 7. Four median nerve injuries were associated with posterolateral displacement and one radial nerve injury was associated with posteromedial displacement. 8. Finally, with prompt and adequate treatment, there were no Volkmanns ischemic contractures seen in this study.
Child ; Congenital Abnormalities ; Elbow ; Humans ; Humerus ; Ischemic Contracture ; Male ; Median Nerve ; Myositis Ossificans ; Radial Nerve ; Retrospective Studies ; Ulnar Neuropathies

The obliteration of a fat plane between the gastric carcinoma and the pancreas is a major criterion on CT scan for pancreatic invasion of gastric carcinoma. However, this sign is not always a reliable indicator of invasion, as the patients with gastric carcinoma are often emaciated. Producing a false positive CT findings. The purpose of our study is to improve the diagnostic accuracy of pancreatic invasion of gastric carcinoma in cases which the fat plane between the gastric carcinoma and the pancreas is obliterated in conventional CT scan. The authors performed lateral decubitus as well as supine CT scans and upper gastrointestinal series(UGIS) in 49 pathologically proven cases in which the fat plane was obliterated between the gastric carcinoma and the pancreas on conventional supine CT scan. Pancreatic invasion was suggested when the fat plane was obliterated persistently in the lateral decubitus view as well as the supine CT images and the involved gastric wall and adjacent pancreas maintained constant approximation despite postural change(CT+), and when the gastric tumor moved downward on the erect view of the UGIS no more than 1.5 time the height of the first lumbar vertevral body(UGIS+). Among 49 cases in which the fat plane between the gastric carcinoma and the pancreas was obliterated on supine CT scan, pancreatic invasion was confirmed pathologically in 11 cases(22.4%). Eight of 11 cases proven as pancreatic invasion were correctly diagnosed as pancreatic invasion by this combined analysis (CT+/UGIS+, 72.7%). Twenty seven of 38 cases proven as no pancreatic invasion were correctly diagnosed as no pancreatic invasion(CT-/UGIS-, 71.1%). Twelve cases showed CT +/UGIS-or CT-/UGIS+, so it was inconclusive whether there was invasion or not. The overall diagnostic accuracy was 71.4%. In conclusion, combined analysis with supine and lateral decubitus CT and UGIS is useful for improving diagnostic accuracy for pancreatic invasion by gastric carcinoma in patients of which the fat plane between the gastric carcinoma and the pancreas is obliterated on conventional supine CT.
Humans ; Pancreas ; Tomography, X-Ray Computed

Forty six cases of Legg-Calve-Perthes disease were reviewed clinically and roentgenographically in order to determine a satisfactory method of assessing the prognosis and to correlate the clinical and roentgenographical results. 1. The patients were children 3 to 12 years of age, with the peak at 6 years. The average age of visit (or diagnosis) was 6.7 years and that of onset was 6.4 years. 2. The total number of hips involved were 49, three cases being bilateral (6. 5%). Boys predominated girls by a ratio of 4.7:1 3. End results in children below 6 years of age were better than those in children above 6 years. The end results of treatment with the containment method were better than those with the noncontainment method. 4. The hips with excellent result had an average of 2.5mm. of uncovering of the femoral head at the time of diagnosis. The degree of uncovering increased as the roentgenographical result deteriorated, in the poor hips the average uncovering being 9mm. The average for the normal side was 2mm. The uncovering at onset is an accurate guide to the likely end result. 5. The Catterall assessment was of reliable prognostic value. In the excellent group, the majority of the hips belonged to Groups 1 and 2, In the poor group, there were no hips in Group 1 and increasing number of hips belonged to Groups 2,3 and 4. 6. The head at risk judged by Gage's sign, calcification of lateral epiphysis, lateral subluxation of the femoral head, and presence of a horizontal epiphyseal line indicated poor prognosis. 7. There was a close correlation between the severity of clinical features and the severity of residual roentgenographic findings.
Child ; Clinical Study ; Containment of Biohazards ; Diagnosis ; Epiphyses ; Female ; Head ; Hip ; Humans ; Legg-Calve-Perthes Disease ; Methods ; Prognosis

Although the method to obtain a good results of treatment is still controversial in ankle fracture, most authors agree with open reduction and internal fixation for unstable ankle fracture. They also emphasize the importance of accurate reduction and rigid fixation of fractured lateral malleolus. Recently, the good results of early weight bearing and joint motion has been recognized. Therefore the cast immobilization for long duration is eliminated after surgery by many authorities. In addition to positive role of early ankle motion and weight bearing, we could expect the advantage of subsidence of stiffness, osteoporosis, and early returning to social activity. The seventy-eight unstable ankle fractures treated at Severance Hospital, Yonsei University College of medicine with open reduction and internal fixation were analyzed in clinical and radiological aspects. The following results were obtained. 1. In unstable ankle fracture, the good functional results were obtained with early joint motion and weight bearing after accurate reduction and rigid fixation. 2. The accurate reduction and rigid fixation for lateral malleolar fracture was the most significant factor in contributing to good results. 3. Syndesmotic ligament should be examined on each exploration of fractured fibular. In spite of the immediate weight bearing, the transfixion screw has remained in place without loosening or breakage. 4. The reduction of medial malleolar fracture was relatively easy and seems not to affect the results.
Ankle Fractures ; Ankle ; Clinical Study ; Immobilization ; Joints ; Ligaments ; Methods ; Osteoporosis ; Weight-Bearing

The spine is the most common site of metastatic cancer in the skeletal system. Managment of the lesion site due to the relation of the spinal cord or nerve root and post-operative treatment present coplicated and difficult problems. One hundred and ninety-three cases of metastatic cancer of the spine were seen and treated during the 5 year period from January 1981 to December 1985 in the Department of Orthopedic Surgery, Severance Hospital Yonsei University, College of Medicine in Seoul, Korea. This study was based on the clinical symtoms, radiological studies, laboratory studies, and tissue pathology of selected cases. Most of cases were treated by chemotherapy, radiation therapy, and hormonal therapy in selected terminal cases. In cases of intractable pain and neurological deficit, surgical intervention is advocated for relief of pain and to improve nursing care and daily activity. Unfortunately in Korea most patients and families refuse surgical intervention, the main reason being that surgery can not cure the disease itself. The results of the study lead us to conclude that; The incidende of spinal metastasis was 31.8% of the metastatic lesions of all skeletal systems, and was almost equally distributed in males and females l. 14: l. The primary site of the tumor was in decreasing order lung (25.9%), breast(9.8%), cervix of the uterus(6.7%), stomach(5.7%), liver(5.3%), kidney(3.7%), thyroid(3.7%), prostate(2.6%), bladder(2.6%), rectum(2.0%), ovary(1.0%), pancreas(1.0%), skin(1.0%), colon(0.5%), larynx(0.5%), and unknown origins (27.5 %). The peak age of the patient was the 7th decade in males and the 6th decade in females. The prominent clinical symtom was diffuse back pain (79.0%) which was characteristically worse in a resting position especially at night. The most significant laboratory finding was an elevated serum alkaline phosphatase in 28% of the cases. The predilection site of metastasis was the thoraco-lumbar junction. Diagnostically a whole body bone scan was more sensitive than a plain film.
Alkaline Phosphatase ; Back Pain ; Cervix Uteri ; Drug Therapy ; Female ; Humans ; Korea ; Lung ; Male ; Neoplasm Metastasis ; Nursing Care ; Orthopedics ; Pain, Intractable ; Pathology ; Seoul ; Spinal Cord ; Spine

The tibial condylar fractures involving the articular surface can produce some disability of the knee joint because it is frequently accompanied by soft tissue injury to the ligaments and menisci. Accurate anatomical reduction and rigid internal fixation with early motion is known to decrease the complications. During a period of 10 years, from January 1978 to December 1987, we treated 105 tibial condylar fractures at Severance Hospital. Of the above, 77 cases have been analyzed according to the classification, cause of injury, method of treatment, final result and complication. The 77 cases were classified as follows ; total condylar depression 17(22%), undisplaced 16 (21 %), split compression 16(21 %), comminuted 14 (18%), local compression 5 (7%), split 1 (1%) and others 8(10%). Among these, 59 cases revealed the result of “ACCEPTABLE” according to Porter's criteria. Of the conservative group, 86% obtained the rating of “ACCEPTABLE” and 67% of the operative group did as well. Possible complications include traumatic arthritis (9), limited motion (9), wound infection (6), instability (3), angular deformity (2), intraarticular loose body (2), nonunion (1) and myositis ossificans.
Arthritis ; Classification ; Clinical Study ; Congenital Abnormalities ; Depression ; Knee Joint ; Ligaments ; Methods ; Myositis Ossificans ; Soft Tissue Injuries ; Wound Infection

Systolic time interval measurements were made sequentially during second, third trimesters and postpartum period. Recordings were made in the supine position after bed rest for at least five minutes in order to obtain a steady state. In second trimester, pre-ejection period index (PEPI) was significantly shortened and left ventricular ejection period index(LVETI) remained normal while PEP/LVET decreased. Four possible mechanisms may be involved to account for the alterations in hemodynamic changes during this period(late stage of second trimester) : (1) increased metabolic demands of pregnancy: (2) hemodynamic effects of hypervolemia: (3) circulatory adjustments secondary to an arteriovenous shunt-like effect of the placental circulation: (4) cardiovascular effect of steroid hormone. The third trimester was characterized-by a markedly shortened LVETI, a prolonged PEPI and PEP/LVET. This findings are consistent with impaired left ventricular performance and are probably due to decreased left ventricular preload resulting from diminished venous return secondary to inferior vena caval obstruction by the large gravid uterus. In the postpartum period, the PEPI and PEP/LVET remained elevated and the LVETI shortened in the supine position. It is concluded that alterations in systolic time intervals occur normally during the course of uncomplicated pregnancy and persist into the postpartum period.
Bed Rest ; Female ; Hemodynamics ; Humans ; Placental Circulation ; Postpartum Period* ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third* ; Supine Position ; Systole* ; Uterus

Schizencephaly, first described by Yakovlev and Wadsworth in 1946, is a rare congenital anomaly characterized by gray matter-lined clefts that extend through the entire cerebral hemisphere, from the ependymal lining of the lateral ventricle to the subarachnoid space. Clinically, patients with schizencephaly present motor dysfunction such as hemiparesis, seizures, and variable developmental delay. Absence of septum pellucidum, gray matter heterotopia, polymicrogyria, and hypoplasia of optic nerves were also frequently found to be associated with schizencephaly. We experienced a case of open-lip schizencephaly in a one-day-old male infant with wide, tense fontanel, which was confirmed by MRI.
Cerebrum ; Humans ; Infant ; Lateral Ventricles ; Lip* ; Magnetic Resonance Imaging ; Male ; Malformations of Cortical Development* ; Optic Nerve ; Paresis ; Seizures ; Septum Pellucidum ; Subarachnoid Space ; Transcutaneous Electric Nerve Stimulation

Primary pulmonary hypertension is a rar, incurable, and progressive clinical entity. When associated with pregnancy, the prognosis of primary pulmonary hypertension is worsened with maternal mortality rates of at least 50%. The patient was a 29-year-old mother in her 2nd pregnancy, with previous uncomplicated gestation, 5 years ago. She had been well until the 28th week of present gestation when she was admitted because of increasing dyspnea on exertion. She was a housewife with no remarkable family and past histories. We have experienced a patient with primary pulmonary hypertension in pregnancy. She was treated with an oral calcium-channel blocker and low-molecular-weight heparin and was delivered vaginally with good maternal and fetal outcome. So we report a case of primary pulmonary hypertension associated with pregnancy and review literature.
Adult ; Dyspnea ; Heparin, Low-Molecular-Weight ; Humans ; Hypertension, Pulmonary* ; Maternal Mortality ; Mothers ; Pregnancy* ; Prognosis