In 1814, Giovanni Battista Monteggia first described two cased of fracture of proximal third of ulna with a dislocation of radial head, and this combined injury is now known as the Monteggia fracture. Despite its rarity, the importance of early recognition of dislocated radial head and correct treatment has been emphasized. Eight cases of Monteggia fracture were studied from March, 1984 to June, 1987. The results are as follows 1. Male patients were six and female were two. 2. The frequent cause of injury was fall down in four cases. 3. Bado type I accounted for 50%, type II for 12.5% and type III for 37.5%. 4. The level of ulna fracture was above upper one third of ulna in seven. 5. The common direction of dislocated radial head was anterior. 6. Two children and two adults were managed by closed reduction. 7. The results (by Bruce et al. criteria) were 3 excellent, 2 good, 1 fair and 2 poor. Four ulna fractures in adult were treated by open reduction and internal fixation using a semitubular plate.
Adult ; Child ; Clinical Study* ; Dislocations ; Female ; Head ; Humans ; Male ; Monteggia's Fracture* ; Ulna ; Ulna Fractures

No abstract available.
Extremities*

Osteogenesis imperfecta has been categorized as a heritable disorder of connective tissue affecting both bone and soft tissues and is characterized by fragility of bone, blue sclera, and deafness, less frequently by dentinogenesis imperfect and laxity of ligament. The goals of orthopedic management with osteogenesis imperfecta are the treatment of acute factures and long term rehabilitation in an effort to maintain ambulation. We report a case of osteogenesis imperfecta with anterior bowing of tibia which was successfully corrected by multiple osteotomies and intramedullary fixation by Sofield method and reviewed literatures.
Connective Tissue ; Deafness ; Dentinogenesis ; Ligaments ; Methods ; Orthopedics ; Osteogenesis Imperfecta* ; Osteogenesis* ; Osteotomy ; Rehabilitation ; Sclera ; Tibia ; Walking

Femur neck fracture is well known as one of the major death cause after trauma in elderly patients, and unsolved fracture due to its frequent association with complications such as avascular necrosis and nonunion. Through meticulous evaluation of the patient, hip and surgeon's experiences, reduction of mortality and morbidity as well as rapid recovery of the patient to the preinjury social and ambulatory status without local complications and revision after treatment is urgently needed. Many factors about this fracture in itself were noted, but we have analyzed 18 femur neck fracture of the patients older than 50 years preliminarily according to age, fracture pattern, osteoporosis, etiology and method of treatment with its delay in association with major complications especially avascular necrosis and nonunion. The results are as follows; 1. Of these 18 fractures, 11 were in females, 8 were caused by minor trauma such as slipdown accident and 4 were associated with definite osteoporosis according to the Sing's classification. 2. Fracture pattern of these 18 are undisplaced in 4, displaced subcapital in 11, displaced transcervical in 3. 11 fractures in the patients older than 60 year are composed of 3 undisplaced or impacted fractures and 8 displaced subcapital fractures. 3. These 18 fractures were treated by closed reduction and internal fixation with multiple pins in 13, and hemiarthroplasty in 4, but one was not treated to die after discharge from hospital. 4. Undisplaced or impacted fractures and 3 displaced transcervical fractures were not associated with any complications such as avascular necrosis or nonunion. But 4 of 6 displaced subcapital fractures were complicated by avascular necrosis, 3 of which were reduced in the varus position within 1 week, and the other was reduced in the good position on 1 week after trauma. There was no complication in 2 displaced subcapital fractures reduced in valgus position within 3 days after trauma. According to the above results, the prognosis of the femur neck fracture is dependent upon the fracture pattern and delay in its treatment. So it is inevitable to reduce the fracture in anatomical or valgus position as early as possible. But the arthroplasty may be needed in displaced subcapital fractures delayed for several days, with its reluction in extreme varus position or impossible and with preexisting disease in the same hip joint (total hip replacement).
Aged* ; Arthroplasty ; Cause of Death ; Classification ; Female ; Femoral Neck Fractures* ; Femur Neck* ; Femur* ; Hemiarthroplasty ; Hip ; Hip Joint ; Humans ; Methods ; Mortality ; Necrosis ; Osteoporosis ; Preexisting Condition Coverage ; Prognosis

No abstract available.
Elbow*

Herpes simplex esophagitis can occur in those with normal immune function, but is more often seen in those who are immunocompromised. In one series, 5 percent of post-kidney transplant recipients had herpes esophagitis. We experienced a case of herpes simplex esophagitis, following renal transplantation in a 9 year old male. He complained of epigastric pain, nausea and blood-tinged vomiting. Endoscopic examination showed volcano ulcer, mucosal friability and multiple confluent ulcers covered by whitish exudates on elevated margin in the middle and lower esophagus. Microscopic findings revealed multinucleated giant cells, margination of chromatin, intense nonspecific inflammation and strong positive for herpes simplex virus immunohistochemical staining. Esophageal lesions and symptoms improved after acyclovir therapy.
Acyclovir ; Child* ; Chromatin ; Esophagitis ; Esophagus ; Exudates and Transudates ; Giant Cells ; Herpes Simplex* ; Humans ; Inflammation ; Kidney Transplantation ; Male ; Nausea ; Simplexvirus* ; Transplantation ; Ulcer ; Vomiting

No abstract available.
Stomach Neoplasms*

No abstract available.
Hernia, Umbilical* ; Ultrasonography*

BACKGROUND/AIMS: Intestinal lymphangiectasia is a disease characterized by dilated lymphatics of the intestinal mucosa and excessive enteric loss of plasma proteins. Instead of multiple blind peroral jejunal biopsy, duodenal endoscopy and endoscopic small bowel biopsy were performed. We evaluated the significance of endoscopic small bowel biopsy and the usefulness of the other diagnostic methods in the diagnosis of intestinal lymphangiectasia in children. METHODS: Fourteen children seen between August 1989 and August 1997 with clinically suggestive intestinal lymphangiectasia were analysed. The median age at onset of symptoms was 4 years. Primary intestinal lymphangiectasia occurred in 10 children and secondary intestinal lymphangiectasia occurred in 4 children, of whom two had Fontan operation, one had constrictive pericarditis, and one had Crohn's disease. Low fat, high protein diet with medium chain triglycerides was the mainstay of treatment. RESULTS: 1) Diarrhea was present in 14 patients, and edema in 11 patients. Hypocalcemic tetany occurred in 6 children and vomiting in 5 children. Dight children had ascites and three of these had chylous ascites. Growth retardation was present in four patients, chylothorax in one, and lymphedema in one. The initial serum albumin concentration was 1.8 g/dl, the serum calcium level 6.7 mg/dl, and the total lymphocyte count 623 /mm(3). 2) Dilated lymphatics in the small bowel mucosa was confirmed by endoscopic biopsy in 14 children(100%). The sensitivity of alpha1-antitrypsin clearance was 100%. Duodenal endoscopy showed scattered white spots covering mucosa in 11 children(79%). Small bowel series revealed thickened mucosal folds in 10 children(77%). Four(31%) had positive finding of 99mTc-antimony lymphoscintigraphy. 3) Responses to treatment in children with primary intestinal lymphangiectasia were graded as good if the symptoms resolved, and poor if there was no lasting resolution of symptoms and repeated albumin administration. Response to therapy was good in four and poor in six patients. The mean age at onset of symptoms was 8 years in good resonse group, and 2 years in poor response group (p<0.05). CONCLUSION: The diagnosis of intestinal lymphangiectasia is confirmed by duodenoscopy and endoscopic small bowel biopsy in a child with diarrhea, edema, hypoalbuminemia, and lymphocytopenia. As compared with other diagnostic methods such as small bowel series and lymphoscintigraphy, duodenoscopy and endoscopic small bowel biopsy are very sensitive and should be performed early.
Ascites ; Biopsy* ; Blood Proteins ; Calcium ; Child* ; Chylothorax ; Chylous Ascites ; Crohn Disease ; Dental Caries ; Diagnosis* ; Diarrhea ; Diet ; Duodenoscopy ; Edema ; Endoscopy ; Fontan Procedure ; Humans ; Hypoalbuminemia ; Intestinal Mucosa ; Lymphedema ; Lymphocyte Count ; Lymphopenia ; Lymphoscintigraphy ; Mucous Membrane ; Pericarditis, Constrictive ; Serum Albumin ; Tetany ; Triglycerides ; Vomiting

PURPOSE: The purpose of this study is to evaluate the diagnostic availability of the morphology of mitochondria to identify the nature or the origin of neoplasms. MATRIALS AND METHODS: We analysed two cases of ovarian malignancy- a case of malignant steroid cell tumor, unclassified and a case of metastatic carcinosarcoma from the adrenal cortex- which were difficult to identify the origin and the nature of the tumor for special staining, immunohistochemical and ultrastructural methods. RESULTS: To evaluate the nature or the origin of neoplasms, we performed immuno histochemistry for various antigens and special stains, however the specific diagnostic clues were not provided by these modalities. The ultrastructural characteristics of mitochondria of neoplastic cells showing tubular or tubulo-vesicular inner mitochondrial membranes provided diagnostic clues as a marker for steroidogenic potential. The morphology of mitochondria is related to the enzyme activity and steroid-biosynthetic capacity of cells. Especially, the inner mitochondrial membrane structure is believed to be related to the steroid biosynthetic activity. In hypofunctional state of corticosteroid productian, a reduced number of inner mitochondrial membranes showing tubular patterns is noted. In cantrast, the stimulation of steroidogenesis result in a progressive increase of mitochondrial membrane showing densely packed rounded vesicular patterns via tubulo-vesicular patterns according to the activity of steroidogenesis. CONCLUSION: The tubular, the vesicular and the tubulo-vesicular mitochondria will be valuable to identify the uncertainty of nature and origin of tumor as a stemidogenic.
Carcinosarcoma ; Coloring Agents ; Diagnosis* ; Mitochondria ; Mitochondrial Membranes ; Uncertainty