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

In recent study, exercise hypertension is associated with a lower adjusted mortality rate and is likely to a good prognostic sign, although its clinical significance is uncertain. The purpose of this investigation was to study exercise hypertensive reaction and to search its related factors. From June. 1st to Aug. 31st 1996, 108 males, mean age 41.5years(range, 20~70) attended the exercise stress test as volunteers during checking-up of health & disease at Health Service Center of Kwang-ju Christian hospital. The exercise stress test using stationary leg bicycle was done until the examiner were exhausted, at which we measured peak exercise systolic blood pressure & Pulse rate. The results are shown as follows. Exercise hypertension was present in 22 subjects(20.0% ). Including age, body mass index, RPE scales at 70% maximal heart rate, rate of level of elevation of heart rate during exercise, no significant related factors associated with exercise hypertension was present by the discriminant analysis. Multivariate regression analysis demonstrated that exercise-induced increase in systolic blood pressure was positively correlated with only resting systolic pressure(r=0.101, p less than 0.01). RPE(Rating of Perceived Exertion) scales was 18.05+/-1.31 when pulse rate of the examiner was reached to 70% of rnaximal heart rate(220-age (years) ). In conclusion, no significant related factor associated with exercise hypertension was presents, but exercise-induced increase of systolic blood pressure was positively correlated with only resting systolic pressure.
Blood Pressure ; Body Mass Index ; Exercise Test ; Gwangju ; Health Services ; Heart ; Heart Rate ; Humans ; Hypertension* ; Leg ; Male ; Mortality ; Volunteers ; Weights and Measures

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*

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

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

Some cases of renal malignancy associated with adult (autosomal dominant) polycystic kidney disease have been reported. Most of these malignancies were diagnosed as renal cell carcinoma. But the case of transitional cell carcinoma has not been reported. We report a case of renal pelvic and urethral transitional cell carcinoma associated with adult polycystic kidney.
Adult* ; Carcinoma, Renal Cell ; Carcinoma, Transitional Cell* ; Humans ; Kidney ; Polycystic Kidney Diseases ; Polycystic Kidney, Autosomal Dominant*

BACKGROUND AND AIMS: Abdominal distension from the insufflation of air can create more troublesome discomfort after colonoscopy (CFS) than after upper endoscopy. Many patients report difficulty in expelling insufflated air after CFS. One previous study demonstrated that insertion of rectal tube at the conclusion of CFS significantly improves patient satisfaction with the procedure. The aim of this study was to compare the effectiveness of rectal tube placement for abdominal decompression after CFS in an effort to limit patient discomfort by carefully applying air suction during CFS. METHODS: We conducted a prospective trial in 103 consecutive patients undergoing elective CFS. Patients were randomized to receive rectal tube placement at the end of the procedure or simple air suction during the procedure. Patients were evaluated by clinical symptoms and signs 10 minutes after completion of CFS. RESULTS: All 103 patients had a complete examination of the colon to the cecum. No specific complications occurred during and a day after examination. The two groups were well matched with respect to age, sex, height, weight, chief complaints. There were no significant differences between the two groups for bowel preparation, duration of examination, abdominal pain during procedure, abdominal disten-sion 10 minutes after CFS, and abdominal pain 10 minutes after CFS (p >0.05). CONCLUSIONS: Meticulous air suction during CFS reduces abdominal discomfort and distension after CFS and is as effectively as the placement of a rectal tube at the con-clusion of CFS.
Abdominal Pain ; Cecum ; Colon ; Colonoscopy* ; Endoscopy ; Humans ; Insufflation ; Lower Body Negative Pressure ; Patient Satisfaction ; Prospective Studies ; Suction

BACKGROUND: We evaluated the usefulness of a newly developed molecular typing method of infrequent restriction site polymerase chain reaction (IRS-PCR) as an epidemiological DNA fingerprinting tool for Candida tropicalis. METHODS: Thirty-two strains of C. tropicalis comprising eight sporadic strains and 24 clonal strains belonging to six clones, of which clonal type were previously confirmed by pulsed-field gel electrophoresis (PFGE), were tested by IRS-PCR to evaluate the usefulness of this technique. Twenty strains of Candida species, including C. glabrata, C. krusei, C. albicans, and C. parapsilosis, were also tested to assess the ability of IRS-PCR to discriminate among species of Candida. RESULTS: Using the IRS-PCR assay, sporadic strains of C. tropicalis could not be differentiated from clonal strains. Most strains belonging to the same clones were classified as different IRS-PCR types or clusters, and some different sporadic strains were classified as the same IRS-PCR types. When pattern variation was examined for different strains of C. tropicalis using IRS-PCR, pairwise similarity measured by the Dice coefficient was 75.4~100%. In contrast, pairwise similarity among isolates of five different species of Candida was 25~69.2%. Therefore, five different species of Candida were easily differentiated. CONCLUSION: The IRS-PCR typing assay appears to be an inadequate tool for the epidemiological typing of C. tropicalis, because the typing result of IRSPCR is not comparable to that of PFGE. To our knowledge, this is the first evaluation study for IRSPCR as an epidemiological typing tool for C. tropicalis.
Candida tropicalis* ; Candida* ; Clone Cells ; DNA Fingerprinting ; Electrophoresis, Gel, Pulsed-Field ; Epidemiologic Studies ; Molecular Typing ; Polymerase Chain Reaction* ; Technology Assessment, Biomedical

The aim of this study is to identify the species characteristics of the dog mastication compared to the human by analyzing 8 landmarks on the heads from seven beagle dogs. The masticatory unit of the dog was relatively located posterior than the human. The predominance of horizontally-oriented fibers of the temporalis of the dog was shown in spite of vertical mandibular movement. The biomechanics of the coronoid process and the temporalis of the dog revealed but not superiorly-elevating like the human backward rotating the coronoid process. The masseter was also obliquely -oriented and the temporalis was observed in distinct two-layers. In the dogs, the higher coronoid process compared to the condyle was observed; the vertical difference of them was larger than human. The temporalis performs stronger action than masseter and related with marked horizontal action of the temporalis. These morphologies indicated that the mastication of the dog needs strengthened horizontal stability and it was taken by the cervical muscles attached backwardly to the skull. Thickened temporalis is adapted in feeding. The dentition of dog was longer and farther from the condyle and the pterygoid muscles were not well-developed than human, indicated unfavourable lateral movement. These findings were consistent with evolutionary tendency, feeding without hands and narrow skull.
Animals ; Biomechanics ; Dentition ; Dogs ; Hand ; Head ; Humans ; Mastication ; Muscles ; Pterygoid Muscles ; Skull ; Stomatognathic System