Limb lengthening with any kind of lengthening apparatus is accepted as a standard method to correct leg length discrepancy. And furthermore, the deformity accompanying shortening is corrected by multifocal lengthener. twenty two patients have undergone lower limb reconstruction by the technique of unilateral bone transport for diaphyseal bone defect, nonunion or deformity in the presence of shortening from May 1990 to August 1993 in Wilson Leprosy Center & Rehabilitation Hospital. All Patients had bifocal procedure using bifocal monofixator(Orthofix) and bone defects were graduaily filled by bone transport. Average healing index(days/cm)was 61. Average bone defect was 7,4cm, and average transported length was 5.4cm. In conclusion, the unilateral bone transport system using bifocal monofixator has satisfactory outcome, and salvaged limbs where amputation has been previously the only option.
Amputation ; Congenital Abnormalities ; Extremities ; Humans ; Leg ; Leprosy ; Lower Extremity ; Methods ; Rehabilitation

The hip joint subluxation and dislocation due to poliomyelitis worsen the limping and caused the painful hip. Shelf procedure has been described as a safe, conservative and reliable approach to the of a dysplastic acetabulum. We performed shelf procedure for the dysplastic hip in poliomyelitis in thirteen patients since May, 1990. The age at operation was 21 to 38 years old and three of them were male and ten were female. All the patients were followed up for average 2.5 years(1-4. 5yrs). The hip joints showed better stability after shel'f procedure and less limping. There was no complication except one redislocation.
Acetabulum ; Dislocations ; Female ; Hip Joint ; Hip ; Humans ; Male ; Poliomyelitis

Deep infection following total hip replacement arthroplasties remains one of the most serious complications in orthopaedic surgery. Between Jan. 1986 to Dec. 1991, 1130 cementless total hip arthroplasties were performed at Wilson rehabilitation hospital. Among them, fourteen patients (incidence :1.2%) developed deep wound infection, and they were retrospectively reviewed including clinical features, laboratory datas and their managements. The infection was noted in ten patients within three months, in one patient between three to twelve months and in three patients after twelve months from cementless total hip replacement arthroplasties. All of them were suffered from hip pain, six patients were manifested with generalized fever, and twelve patients with draining fistulas. Thirteen patients showed elevated ESR. Major infecting organism was Staphylococcus in ten patients. They were initially treated with meticulous debridement, ingress and eress tube irrigation, and antibiotics, but four patients had to be operated Girdlestone arthroplasties due to recurrence of infection and loosening of the prosthesis. Eight patients got quiescency from infection for at least five months from the last drainage operation. But two patients still have draining fistulas inspite of bony ingrowth achieved to the prosthesis.
Anti-Bacterial Agents ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Clinical Study ; Debridement ; Drainage ; Fever ; Fistula ; Hip ; Humans ; Prostheses and Implants ; Recurrence ; Rehabilitation ; Retrospective Studies ; Staphylococcus ; Wound Infection

Articular cartilage is a highly differentiated tissue, lacking a vascular supply and having only limited regenerative capability. Cut or other mechanical damage restricted to the cartilage does not repair. Experimentally and clinically, cartilage defect that penetrate the subchondral bone undergoes repair through the formation of tissue usually characterized as fibrous, fibrocartilaginous or hyaline-like cartilaginous tissue. There is little definitive informations about local or systemic factors that control the differentiation of mesenchymal cells to osteoblast, chondroblast or fibroblast. Our study was designed to evaluate the effect of transforming growth factor-beta (TGF-pl) and autogenous periosteal graft on the healing of osteochondral defect of distal femur of rabbit and also the possibility of these method to be clinically applicable to human. The experimental model used in the present study for including cartilage in rabbit was based mainly on the model used by Frukawa et al14). in rabbit. A full thickness osteochondral defect of 80 rabbit were made with 2mm diameter of drill-bit and electrically driven drill. Experimental animals were divided into four group: 1) group I, osteochondral defect only, 2) group II, osteochondral defect with infiltration of phosphate buffer solution, 3) group III, osteochondral defect with infiltration of TGF-Bl, 4) group IV, osteochondral defect with autogenous periosteal graft. The healing of the defect was assessed at 1 week, 3 weeks, 5 weeks, 12 weeks after operation by gross and histochemical examination. At 1 week, fibrinoid material in edge to edge arcade arrangement was present in group I,II,III,IV. At 3 weeks, spindle shaped undifferentiated mesenchymal cell present in the periphery of fibrinous network, but there is no appearance of mesenchymal cell in group I,II. At 5 weeks, essentially complete repopulation of the defect with progressive differentiation of cells to chondroblast, chondrocyte, osteoblast and synthesis of cartilage and matrix in their appropriate location in group III and IV were found. At 12weeks, hyaline like cartilage formation was observed in group III and IV. but early trace of degeneration of the cartilage were seen in many defect with the prevalence and intensity of the degeneration increasing at group I and 3 . Our study demonstrated in detail the repair of full-thickness defect in rabbit articular cartilage extending into cancellous bone of the marrow cavity under influence of local growth factor (TGF-pl) and autogenous periosteal graft. Excellent reconstruction of articular cartilage was observed in TGF- Bl infiltration group and autogenous periosteal graft group as early as 5 weeks after the creation of defect. Although the further study should be carried out for their clinical application, we conclude that TGF-Bl regulates the overall mechanism of matrix constituent in connective tissue and autogenous periosteal graft have a chondrogenic potential to repair major osteochondral defect. these suggest that TGF-Bl and autogenous periosteal graft may be a important pathophysiological regulator of chondro- genesis.
Animals ; Bone Marrow ; Cartilage ; Cartilage, Articular ; Chondrocytes ; Connective Tissue ; Femur ; Fibrin ; Fibroblasts ; Humans ; Hyalin ; Models, Theoretical ; Osteoblasts ; Prevalence ; Transplants*

As tuberculous otitis media is nowadays not common, young physicians are not good at the disease. Accordingly, the correct diagnosis can be delayed causing complications, for instances, irreversible hearing loss, facial nerve paralysis, and so on. It is, moreover, so hard to make clear diagnosis when aural cholesteatoma is combined with tuberculosis of the middle ear. Recently, we experienced a case of tuberculous otitis media combined with cholesteatoma. The patient had a history of chronic otorrhea and was operated on with a presumptive diagnosis of chronic otitis media with cholesteatoma. Postoperatively the diagnosis of tuberculosis with cholesteatoma was established by histologic examination. We believe that any patient with a long history of discharging ears needs histologic examination, as tuberculosis might be the cause of infection. We report our findings in this patient and discuss the relationship between the tuberculosis and chronic otitis media with cholesteatoma with review of literatures.
Cholesteatoma* ; Cholesteatoma, Middle Ear ; Diagnosis ; Ear ; Ear, Middle ; Facial Nerve ; Hearing Loss ; Humans ; Otitis Media* ; Otitis* ; Paralysis ; Tuberculosis

No abstract available.
Brain* ; Hydrocephalus*

BACKGROUND: Remifentanil and sevoflurane are characterized by rapid emergence from anesthesia. Therefore, propofol-remifentanil anesthesia (PR) and sevoflurane-nitrous oxide anesthesia (SN) were compared with regard to the recovery characteristics in children. METHODS: Sixty children scheduled for tonsillectomy were randomly assigned to receive PR (n = 30) or SN (n = 30). The PR group was induced by remifentanil, propofol and vecuronium, maintained with infusion of remifentanil and propofol. The SN group was induced by sevoflurane, nitrous oxide, vecuronium maintained with sevoflurane in 50% nitrous oxide. At the end of operation, all anesthetics were discontinued and 100% oxygen was inspirated in both groups. The times to spontaneous breathing, extubation, eye opening, PACU discharge were assessed and postoperative nausea/vomiting, agitation were noted. RESULTS: Spontaneous breathing occurred after 9.29 +/- 1.02 minutes (PR) versus 6.85 +/- 0.60 minutes (SN) (P < 0.05), extubation after 9.19 +/- 0.91 minutes versus 8.87 +/- 0.67 minutes, eye opening after 9.47 +/- 1.01 minutes versus 14.85 +/- 0.80 minutes (P < 0.05) and PACU discharge after 21.32 +/- 2.01 minutes versus 27.55 +/- 1.72 minutes (P < 0.05). The occurrence of postoperative nausea/vomiting was 7% (PR) versus 13% (SN), and the incidence of agitation was 60% (PR) versus 83% (SN). CONCLUSIONS: It was observed that the recovery of propofol-remifentanil anesthesia was faster than that of sevoflurane-nitrous oxide anesthesia, except spontaneous breathing. The incidences of postoperative nausea/vomiting were low in both groups, and the incidences of agitation were higher in SN group than in PR group.
Anesthesia Recovery Period ; Anesthesia* ; Anesthesia, General ; Anesthetics ; Child* ; Dihydroergotamine ; Humans ; Incidence ; Nitrous Oxide ; Oxygen ; Propofol ; Respiration ; Tonsillectomy ; Vecuronium Bromide

The fine structure of cells in the trigeminal mesencephalic (Me5) nucleus in the rat was studied by transmission electron microscopy. This nucleus located in the mid-brain and the rostral portion of the pons, most neurons in the caudal part of Me5 nucleus were sufficiently large (40~50micrometer) and appeared as round-shaped unipolar cells. The Me5 neurons had a large, round, centrally located nucleus, and their cytoplasm contained numerous mitochondria, dense granular endoplasmic reticulum, abundant Golgi apparatus, groups of free ribosomes, some heterogeneous particles and neurofilaments. Cell surfaces were studded irregularly with small spinouts processes, and they contained a few fine irregularly arranged neurofilaments and some granular endoplasmic reticulum. Boutons contacting the soma of Me5 neurons were defined as axosomatic synapses and bostons contacting dendrites located between the Me5 neurons were defined as axodendritic synapses. Based on differences in bouton and vesicle morphology, the four synaptic bouton types were identified. 1. Asymmetrical as well as symmetrical synapses with small round vesicles. 2. Asymmetrical synapses with pleomorphic admixture contained predominantlyspherical vesicles. 3. Symmetrical synapses with pleomorphic vesicles of flattened, spherical and dense-core vesicles. 4. Asymmetrical as well as symmetrical synapses with heterogeneous and large dense-core vesicles. Synaptic boutons containing round vesicles and large dense-core vesicles were most frequently observed.
Animals ; Carisoprodol ; Cytoplasm ; Dendrites ; Endoplasmic Reticulum, Rough ; Golgi Apparatus ; Microscopy, Electron, Transmission ; Mitochondria ; Neurons ; Pons ; Presynaptic Terminals ; Rats* ; Ribosomes ; Synapses

This survey comparing the primary causes of eye disease and visual impairment between rural and urban areas was conducted from the beginning of February through May of 1989. The outcome of that research on 686 residents (1372 eyes) of Buan-Kun, Chunbuk, and 997 residents (1994 eyes) of Dobong-Ku, Seoul, is as follows: 1. Of the basic ocular affections, pterygium was the most prevalent in Baun-Kun with 178 eyes (13.0%), while allergic and chronic conjunctivitis were in the majority in Dobong-Ku with 170 eyes (8.5%). 2. In causes of visual impairment, refractive error showed to be the main one in both Buan-Kun with 135 eyes (9.8%) and Dobong-Ku with 132 eyes (6.6%). 3. In rate of blindness, Buan-Kun had 7.0% monocular blindness and 3.2% of binocular blindness, while 4.1% of monocular blindness and 1.7% of binocular blindness were found in Dobong-Ku. 4. In causes of blindness, cataract (51.1%) was followed by macular degeneration (17.4%), corneal opacity (13.0%), and vascular retinopathy (9.8%) in Buan-Kun, while cataract (56.0%), macular degeneration (6.7%), corneal opacity (6.7%), and phthisis (6.7%) were recorded in that order in Dobong-Ku.
Adolescent ; Adult ; Aged ; Blindness/epidemiology ; Child ; Child, Preschool ; Eye Diseases/*epidemiology ; Female ; Humans ; Infant ; Infant, Newborn ; Korea/epidemiology ; Male ; Middle Aged ; Random Allocation ; Vision Disorders/*epidemiology

OBJECTIVE: After a rigorous management of increased intracranial pressure by decompressive craniectomy (DC), cranioplasty (CP) is usually carried out for functional and cosmetic purposes. However, the optimal timing of CP remains controversial. Our study aims to analyze the relationship between the optimal timing of CP and the post-operative complications. METHODS: From January 2013 to December 2015, ninety patients who underwent CP in a single institution were analyzed. We set the independent variables as follows: 1) patient characteristics; 2) the time interval between the DC and CP; 3) operation time; 4) anesthesia time; and 5) pre-operative computed tomography (CT) findings such as a degree of sunken brain by ratio of A (the median length from scalp to midline) to B (the length from midline to inner table of skull at this level). The dependent variables of this study are the event of post-operative complications. RESULTS: The overall complication rate was 33.3%. There was no statistical significance in the time interval between the DC and CP in the groups with and without complications of CP (p=0.632). However, there was a significant statistical difference in the degree of sunken brain by ratio (A/B) between the two groups (p<0.001). CONCLUSION: From this study, we conclude that it is better to determine the optimal timing of CP by the pre-operative CT finding than by the time interval between the DC and CP. Hereby, we suggest a potentially useful determinant of optimal timing of CP.
Anesthesia ; Brain* ; Decompressive Craniectomy ; Humans ; Intracranial Pressure ; Scalp ; Skull