Eighty three rickets could be diagnosed at our department during eight years from August of 1969 to July of 1977. Among them fourteen children, whose radiographs and clinical description were precise with well-documented follow-up study of more than one year, were subjected to this analysis. Evaluation of the healing and correction of the lower leg deformity in these rachitic children obtained the following results. 1. Among fourteen rachitic children, thirteen patients (26 legs) showed varus and one patient (2 legs) showed valgus deformity. 2. Mean mechanical tibio-femoral angle showed shift from the initial 16.1°±5.3° to 5.5°+4.0° at final visit, which indicated the gradual correction of the deformity with the advance of the ages of children. The follow-up study after three years in this series showed that the correction became almost complete. 3. At the epiphyseo-metaphyseal region of the distal femur, the initial angle showed two distinct trends of change. The initial varus angle more than 7 or 8 showed the decrease at the later follow-up study, while the initial angle less than 7 or 8 showed the increase. 4. The epiphyseo-metaphyseal region of the proximal tibia showed the minimum change of angle. Mean angle of deviation from the vertical line was 3.7°±2.9° at first visit and 2.6°± 2.4°at final visit. The least degree of varus and the trend toward valgus observed in this region may refiect its compensatory activity against the varus deformity of the leg as a whole. 5. The epiphyseo-metaphyseal region of the distal tibia showed the maximum degree of varus at both initial and final check although the greatest degree of correction was attained. The initial mean varus angle of 23.9°±9.2° became 12.9°±7.1° at final visit. 6. The results of this study have shown that the correct evaluation of the rcchitic leg deformity is possible with measurement of the mechanical tibio-femoral angle and that the deviation angle of each epipyseo-metaphyseal region is preferable.
Child ; Congenital Abnormalities ; Femur ; Follow-Up Studies ; Genu Varum ; Humans ; Leg ; Rickets ; Tibia

The authors report the experience of twenty patients of transpedicular Zielke instrumentation after anatomical reduction of the spondylolisthesis. Anstomical reduction was done with the aid of temporary application of Harrington distraction rod, and the reduced segment was fixed with transpedicular Zielke instrumentation. And, anterior interbody fusion was supplemented in a single stage operation. Follow up period was between 13 to 25 months after operation with the average of 19 months. 1. The age of the patients was 38 years in average ranging from 11 to 61 years. 2. Types of the spondylolisthesis were spondylolytic type in 11 cases, degenerative type in 6 cases, dysplastic type in 1 case and pathologic type in 2 cases. 3. The level of the lesion were L5-Sl in 12 cases, L4-5 in 7 cases and L3-4 in 1 case. 4. Pre-operative clinical feature included low back pain in 95%, radiating pain in 65%, and neurological claudication in 45%. 5. The average percentage of slippage was changed from 24% preoperatively to 6% postoperatively and to 8% at the final follow up. The initial correction rate was 75% and the amount of correction loss during the follow up period was 11% in average. 6. Slip angle was changed from 3°preoperatively to −3°poetoperatively and to 0°at the end of follow up. In the 12 cases with local kyphosis, average slip angle of 14°preoperatively was improved to 2°postoperatively, and to 7°at the end of follow up. 7. Bony fusion was obtained in 19 cases within 4 to 6 months. 8. There were 2 cases of metal failure with considerable loss of reduction ; one patient with pathologic spondylolisthesie due to active tuberculous spondylitis required re-operation and another patient showed fusion eventually in the redisplaced position. Other complication included 1 transient dysuria, 1 ileus and 2 meralgia paresthetics. 9. Clinical symptoms were improved in 95%. Follow up result of the operation according to Gill's criteria were excellent 65%, good 25%, fair 5%, and poor 5%.
Dysuria ; Follow-Up Studies ; Humans ; Ileus ; Kyphosis ; Low Back Pain ; Spondylitis ; Spondylolisthesis

PURPOSE: To assess how accurately computed tomography (CY) can demonstrate the abnormal findings which are believed to cause the clinical signs and symptoms of hearing loss (HL), vertigo and facial paralysis (FP) in patients with temporal bone trauma. MATERIALS AND METHODS: The authors studied CT scans of 39 ears in 35 patients with temporal bone trauma. CT scans were performed with 1-115 mm slice thickness and table incrementation. Both axial and coronal scans were obtained in 32 patients and in three patients only axial scans were obtained. We analyzed CT with special reference to the structural abnormalities of the external auditory canal, middle ear cavity, bony labyrinth, and facial nerve canal, and correlated these findings with the actual clinical signs and symptoms. As to hearing loss, we evaluated 32 ears in which pure tone audiometry or brainstem evoked response audiometry had been performed. RESULTS: With respect to the specific types of HL, CT accurately showed the abnormalities in 84% (16/19) in conductive HL, 100% (2/2) in sensorineural HL, and 25% (2/8) for mixed HL. When we categorized HL simply as conductive and sensorineural, assuming that mixed be the result of combined conductive and sensorineural HL, CT demonstrated the abnormalities in 89% (24/27) for conductive HL and 50% (5/10) for sensorineural HL. Concerning vertigo and FP, CT demonstrated abonormalities in 67%(4/6), and 29% (4/14), respectively. CONCLUSION: Except for conductive HL, CT seems to have a variable degree of limitation for the demonstration of the structural abnormalities resulting sensorineural HL, vertigo or facial paralysis. It is imperative to correlate the CT findings with the signs and symptoms in those clinical settings.
Audiometry ; Audiometry, Evoked Response ; Brain Stem ; Ear ; Ear Canal ; Ear, Inner ; Ear, Middle ; Facial Nerve ; Facial Paralysis ; Hearing Loss ; Humans ; Temporal Bone* ; Tomography, X-Ray Computed ; Vertigo

Subfalcial herniation secondary to a unilateral supratentorial space occupying lesion is frequently seen on the brain CT scan, however, the development of distal anterior cerebral artery infarction following compression of the terminal branches of the pericallosal artery against the falx during the period of subfalcial herniation is uncommon. For the last three years, we have experienced three cases of distal anterior cerebral artery infarction caused by subfalcial herniation on the brain CT scan. All patitnts had acute subdural hematomas resulting in subfalcial herniation on the first CT scan and subsequently developed focal infarctions in the ipsilateral paracentral lobule. The patients did not improve clinically and died several days after operation. The development of such infarction may reflect severe cerebral injury and portend a poor clinical outcome.
Anterior Cerebral Artery* ; Arteries ; Brain ; Hematoma, Subdural, Acute ; Humans ; Infarction* ; Infarction, Anterior Cerebral Artery ; Tomography, X-Ray Computed

The superficial sural artery flap is supplied by the superficial sural artery that accompanies the sural nerve. The superficial sural artery connects distally with a peroneal artery septocutaneous perforator via a suprafascial network of vessels that permits the flap to be raised on its distal pedicle. We treated 10 patients who showed soft tissue defect of the lower third of the leg, around the ankle and the hindfoot with this flap. The causes of the soft tissue defect were trauma in 6 cases, pressure sore in 2 cases, squamous cell carcinoma in 1 case and osteomyelitis in 1 case. The sites of the soft tissue defect were the lower third of the leg in 5 cases, around the ankle in 2 cases and the hindfoot in 3 cases. The size of the soft tissue defect was from 5x6 cm to 8xl2 cm. All 10 flaps survived. Two flaps showed slight venous congestion which cleared in a few days. The time for flap dissection was 15 minutes in average. The results of our cases show that the distally based superficial sural artery flap is useful for the soft tissue coverage of the lower third of the leg, around the ankle and the hindfoot. The advantages of the flap are that the blood supply is reliable, elevation is easy and quick, the major arteries are not sacrificed and the donor site morbidity is negligible.
Ankle ; Arteries* ; Carcinoma, Squamous Cell ; Humans ; Hyperemia ; Leg ; Lower Extremity ; Osteomyelitis ; Pressure Ulcer ; Sural Nerve ; Tissue Donors

Holoprosencephaly is a rare and complex malformation affecting the cleavage of the developing forebrain and is usually associated with defects of the mid Face. We have experienced a case of holoprosencephaly, diagnosed prenatally by ultrasound examination at 31 weeks of pregnancy in a 31-year-old primigravida woman. This case is characterized by holoprosencephaly, cleft palate, cleft lip, left renal aplasia and right renal hypertrophy. The chromosomal study showed a deletion of the long arm of chromosome 7, 46, XX, del(7)(q32), We report with a terminal deletion of chromosome 7q associated with atypical clinical picture and holoprosencephaly.
Adult ; Arm ; Chromosome Aberrations* ; Chromosomes, Human, Pair 7 ; Cleft Lip ; Cleft Palate ; Female ; Holoprosencephaly ; Humans ; Hypertrophy ; Multicystic Dysplastic Kidney* ; Pregnancy ; Prosencephalon ; Ultrasonography

Thelper (Th) cells play a pivotal role in the regulation of immune responses. Since Th epitopes in adenovirus have not yet been defined, in this study, it was attempted to search for Th epitopes of adenovirus antigens that are restricted by MHC class II (H-2E). Among candidate viral proteins to be screened for Th epitopes, structural protein was selected, since they induced strong IL-2 release from adenovirus immune lyrnph node (LN) cells and the presence of E1 protein, which contains immunodominant cytotoxic T lymphocyte epitopes, did not potentiate the T cell responses. To confirm the presence of Th epitopes in the structural protein, virions were trypsinized and the resulting polypeptides whose molecular weights were lower than 5,000 were fractionated by HPLC. Some of the HPLC fraction turned out to induce LN cell proliferation. Ten synthetic peptides were designed as candidate Th epitopes from the primary amino acid sequences of adenovirus hexon and penton protein which are major constituents of the virion. The selected sequences share the common features of other known H-2E' binding ligands. Among these ten synthetic peptides, peptide of hexon protein amino acid residue 709-721 induced noticeable proliferation of LN cells from preimmune mice, and also able to induce IL-2 secretion from adenovirus-specific T hybridomas, suggesting that the peptide was the most immunodominant Th epitope. Hexon protein 221-233 and hexon protein 676-688 are considered as epitopes also. This study revealed three epitope sequences from adenovirus structural protein that are presented by class II MHC, H-2E.
Adenoviridae* ; Amino Acid Sequence ; Animals ; Cell Proliferation ; Chromatography, High Pressure Liquid ; Epitopes ; Epitopes, T-Lymphocyte* ; Hybridomas ; Interleukin-2 ; Ligands ; Mice ; Molecular Weight ; Peptides ; Trypsin ; Viral Proteins ; Virion

Polyamines are closely related to cell growth and differentiation and increased levels of urine polyamines (UPs) has been reported in various human cancers. However, there were few reports on changes of UPs in patients with cervical carcinoma. We investigated the clinical utility of UPs as well as serum squamous cell carcinoma (SCC) antigen in cervical carcinoma. The association of pretreatment SCC antigen and UPs with clinicopathologic parameters was assessed in 478 patients with cervical carcinoma. SCC antigen was measured by radioimmunoassay and UPs by enzymatic assay method. The prognostic significance of pretreatment SCC antigen and UPs, and the relationship between pretreatment and posttreatment SCC antigen and UPs according to treatment modalities were analyzed. There was a trend of increased level of UPs with cancer progression, whereas significant difference of SCC antigen value was found with cancer progression. Among various clinicopathologic parameters, tumor size and macroscopic lymph node metastasis were associated with pretreatment SCC antigen and UPs level as well. Increased pretreatment SCC antigen level (>2.0ng/ml) and UPs level (>45 micromol/g creatinine) had significant impact on survival. Multivariate analysis revealed that pretreatment SCC antigen, lymph node metastasis and tumor size were independent prognostic factors on survival in the same stage patients. SCC antigen levels decreased after radiotherapy and neoadjuvant chemotherapy. In patients treated by radiation, response status was associated with postradiation SCC antigen, which showed a good correlation with survivals. UPs positivity and SCC antigen positivity in 42 recurrent cervical cancers were 64.7% and 57.9%, respectively. Pretreatment SCC antigen, combination of SCC antigen and UPs, tumor size, macroscopic lymph node metastasis and invasion depth were correlated with recurrent or residual cervical carcinoma. In conclusion, UPs together with SCC antigen may be used to assess the extent of disease status and to define the prognosis in cervical carcinoma.
Carcinoma, Squamous Cell* ; Drug Therapy ; Enzyme Assays ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Polyamines* ; Prognosis ; Radioimmunoassay ; Radiotherapy

A 42-year old man was admitted for treatment of a fracture of the medial condyle of the left femur. After 10 days of cast immbilization of the above mentioned extremity, erythematous papulo-vesicular eruption was noted under the external splintage. We concluded that this was an unusual allergic contact dermatitis which is caused by CaSO4.1/2H20, and proved it by patch test in our clinic.
Calcium Sulfate ; Dermatitis, Allergic Contact ; Extremities ; Femur ; Patch Tests

Core tissue for histologic study is believed by many pathologists to be more diagnostic than material from needle aspiration. Recently introduced automated biopsy gun simplifies core biopsies with increased quantity and quality of samples. Authors performed 38 percutaneous biopsies from 38 patients with 18G automated biopsy guns under US guide. Diagnostic target tissues were obtained in 33 biopsies(87%), inadequate tissues in 4 (11%), and adequate but not of target tissue in 1(3%). There was no major complication requiring treatment, but pain needing analgesics and pain with nausea/vomiting were experienced in 2 and 1 biopsies respectively. Average number of needle passes was 1.5(1-5) We concluded that US-guided gun biopsy was a easy and safe way to obtained tissue samples of good quantity and quality, especially useful in hospitals without constant availability of specialists in cytopathology.
Analgesics ; Biopsy* ; Firearms ; Humans ; Needles ; Specialization