No abstract available.
Orthopedics*

Forty children underwent three crossed K-wires fixation after reduction of the totally displaced supracondylar fracture(type IE ) of the humerus from October 1994 to March 1997, were reviewed. The patients age ranged from 3 years and 2 months to 12 years and 7 months, averaging 6 years and 6 months. Preoperatively, five patients(12.5%) had concomitant nerve injury. Three patients(7.5%) revealed ischemic sign on distal part of the fracture. All the fractures were treated within 24 hours after arrival at the emergency room. After general anesthesia, all but one fractures reduced by closed means. Each reduced fracture was fixed by two parallel K-wires in lateral side followed by one crossed medial K-wire under fluoroscopic control. The preoperative distal ischemia of the three patient restored blood supply within 24 hours after reduction. The K-wires were removed after averaging 3.3 weeks after operation in out patient clinic. Five patients revealed neurologic deficit preoperatively recovered completely within 4 months after reduction of the fractures. The followup period ranged from 12 months to 32 months, averaging 17 months. By Flynns functional and cosmetic criteria, 39 patients(97.5%) among forty patients resulted in satisfactory criteria. The one unsatisfactory patient revealed cubitus varus treated by corrective osteotomy. In conclusion, three crossed K-wires fixation is considered as effective and safe method for the totally displaced supracondylar fracture of the humerus in children.
Anesthesia, General ; Child* ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Humerus* ; Ischemia ; Neurologic Manifestations ; Osteotomy

Although the incidence of tuberculous arthritis of the hip is being decreased with improvement of hygiene, preventive measures and chemotherapy, it remains as important disease in orthopedic surgery. In the tuberculous arthritis of the hip, eradication of the disease with improvement of joint function is ideal treatment. But classical treatment of anti-tuberculous chemotherapy, synovectomy, and especially hip fusion which was done in most cases in adults, have their own limitation in functional results. Recently the methods of total hip replacement arthroplasty done in tuberculous arthritis with treatment of infection by antituberculous chemotherapy reported good results. During the period from January 1970 to December 1984, total hip replacement arthroplasty were done in 55 patients of tuberculous arthritis of the hip in Seoul National University Hospital. The average follow-up period was 3 years and 1 months. And, the following results were obtained. l. of the 55 cases, 50 cases(90.9%) were resulted in success without reactivation of tuberculosis, and 5 cases(9.1%) were resulted in failure. In those cases, the follow-up period were more than 1 year. 2 . The average period of immediate preoperative anti-tuberculous chemotherapy was higher in the success cases with 10.0 weeks than in the failure cases with 4.5 weeks. 3 . The average preoperative ESR was lower in the success case with 12.4mm/ hr than in the failure cases with 28mm/hr. 4 . Failure cases were restricted to active cold abscess in operative finding. 5. The positive bacteriology was fewer in the success cases with 4% than in the failure cases with 60%. 6. Follow-up functional results of the success cases were superior to any other methods of treatment. It is our conclusion that preoperative anti-tuberculous chemotherapy is important to reduce inflammatous reaction, and although granulation or caseation necrosis is found in operation field, total hip replacement can be successful if there is no active cold abscess.
Abscess ; Adult ; Arthritis ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Bacteriology ; Drug Therapy ; Follow-Up Studies ; Hip ; Humans ; Hygiene ; Incidence ; Joints ; Necrosis ; Orthopedics ; Seoul ; Tuberculosis

BACKGROUND: Standard treatments may provide adequate containment in mild to moderate Legg-Calve-Perthes disease (LCPD), but they can be problematic in more severe cases. The purpose of this study was to report the results of combined shelf acetabuloplasty with femoral varus osteotomy in severe LCPD. METHODS: We reviewed 12 patients who had undergone combined shelf acetabuloplasty with femoral varus osteotomy. The indications for this type of operation were: (1) above 8 years of age at clinical onset; (2) massive femoral epiphysis involvement (Catterall group 4, lateral pillar C); (3) femoral head lateral subluxation on the anteroposterior radiograph; and (4) impending hinged abduction on preoperative magnetic resonance imaging or arthrography. The mean age was 9.3 years (range, 8 to 10.8 years). The patients were clinically evaluated with Iowa hip score and leg length discrepancy at the final follow-up. Radiographic outcome was assessed using the Stulberg classification to evaluate femoral head sphericity. The presence of osteoarthritis was evaluated by the Tonnis classification. Correlation analysis was conducted to analyze the preoperative factors that were strongly associated with patients' outcomes. RESULTS: The mean follow-up period was 10.1 years (range, 7.1 to 13.2 years). Functional grade was excellent in all patients at last follow-up (mean, 92; range, 82 to 99). The mean leg length discrepancy after skeletal maturity was 0.9 cm (range, 0 to 1.7 cm). There were no significant complications or need for additional surgery. Radiographically, 92% of patients reached satisfactory outcomes: Stulberg grade I, 0 cases; Stulberg grade II, 4 cases (34%); Stulberg III, 7 cases (58%), Stulberg IV, 1 case (8%); and Stulberg V, 0 cases. There was no osteoarthritis by Tonnis classification. CONCLUSIONS: The surgical outcomes for combined shelf acetabuloplasty with femoral varus osteotomy in severe LCPD patients over 8 years old are comparable with other advanced surgical methods. In the cases of severe disease that match our inclusion criteria, our containment method could be another treatment option.
Acetabuloplasty/adverse effects/*methods ; Child ; Female ; Humans ; Leg Length Inequality ; Legg-Calve-Perthes Disease/radiography/*surgery ; Male ; Osteotomy/adverse effects/*methods ; Pain ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome

We investigate the serial change of the bone density of the lengthening sites in distraction osteogenesis in long bone lengthening of the lower extremity by measuring the pixel value of the PACS(Picture Archiving Communication System). The purpose of this study was to find the clinical implication of the pixel value in PACS in the distraction osteogenesis. The number of the distraction sites were 22 in tibia and 16 in femur. The average distraction length was 4.5cm ranged between 2.1cm and 7.0cm in femur, 4.1cm ranged hetween 1.9cm and 6.8cm in tibia. When the image were sent to the PACS workstations, they were directly interfaced to the workstation without any processing. The absolute and the relati ve pixel values of cortical bones of the original and the lengthening sites repr sented in workstation of PACS were obtained by average value measuring 3 times by 3 different persons. The average absoiute pixel value of the original cortical bone near distraction site was not significantly changed, maintaining 575+/-6 in femur, and 570+/-7 in tibia. The absolute pixel vaIues in AP and lateral view were not significantly changed until 6 week/cm, but rapidly increased after 7 week/cm hoth in the tibia and the femur. The relative pixel value of the lengthening sites were more than 95% in three of the four cortices at the time of the removal of the external fixators. in conclusion, the pixel value of the PACS can be a rapid, simple and easy method for detection of the change of the bone density in distraction osteogenesis.
Bone Density* ; Bone Lengthening* ; External Fixators ; Femur ; Humans ; Lower Extremity* ; Osteogenesis, Distraction* ; Tibia

Open carpal tunnel release has been the standard method of sumical treatment of carpal tunnel syndrome. Recently endoscopic carpal tunnel release has been introduced and is heing used by many authors. The advantages of this new technique are less postoperative pain, rapid restoration of power and rapid return-to-work. However many considerate authors, in spite of these advantages. insist that the inevitahle risk of neurovascular injury during the endoscopic procedure should not he underestimated. The purpose of our study is to compare the clinical results of endoscopic carpal tunnel release with those of open release. 20 open carpal tunnel releases in 16 patients and 15 endoscopic carpal tunnel reieases (single-portal technique) in 11 patients were performed hy the first author. Preoperative conditions of both groups are not different. Authors compared the clinical results between the two groups with some parameters. The overall clinical results were not different significantly hetween two groups. Rapid return-to-work(36 days in endoscopic group versus 60 days in open group) and less postoperative scar and pillar pain in endoscopic group were demonstrated. However, the major complication of one median nerve injury in endoscopic group seemed to overweigh these some benefits. We suggest that the standard operative technique for carpal tunnel syndrome should be open carpal tunnel release and more considerations should be takcn in choosing endoscopic method because of its inherent risk.
Carpal Tunnel Syndrome ; Cicatrix ; Humans ; Median Nerve ; Pain, Postoperative ; Return to Work

The Di(a+b-) phenotype is extremely rare among Caucaclans and mostly confined to mongoloids. The incidences of Di antigen among Koreans were reported to be 6.1 to 14.5%, with an average of 9.6%; it can be calculated that the frequency of Di(a+b-) is 0.25% on the average. Authors report the first case of hemolytic disease of the newborn due to anti-Dib in Korea. The Diego phenotypes of the mother, baby and father were Di(a+b-), Di(a+b+) and Di (a-b+), respectively. The mother's serum and eluate from infant's erythrocytes contained anti-DP antibody active in the antiglobulin phase. After transfusions of Di-negative red cells from the mother and mother's relative, the patient was recovered from anemia and jaundice.
Anemia ; Erythrocytes ; Fathers ; Humans ; Incidence ; Infant, Newborn* ; Jaundice ; Korea ; Mothers ; Phenotype

To assess the role of multiple factors in influencing occurrence of ventricular premature complexes after acute myocardial infarction twenty-four hour Holter electrocardiographic tape recording were made in 40 survivors of an acute myocardial infarction 10 to 20days after attack. Ventricular premature complexes in the early post infarction period were not correlated with left ventricular function, age, sex, smoking, diabetes mellitus, previous angina, and previous myocardial infarction. The occurrence of ventricular premature complexes showed a positive correlation with the occurrence of ST-T change. The occurrence of ventricular premature complexes during sleep hours was compared to the awake state. In 22 patients, the incidence of ventricular premature complexes are excluded from analysis, the 22 of patients, or in 76 percent, sleep was associated with a lowered occurrence of ventricular extrasystoles.
Diabetes Mellitus ; Electrocardiography ; Humans ; Incidence ; Infarction ; Myocardial Infarction ; Smoke ; Smoking ; Survivors ; Tape Recording ; Ventricular Function, Left ; Ventricular Premature Complexes*

The hemostatic effect of endoscopic microwave coagulation method for upper gastrointestinal bleeding was evaluated clinically. Hemostasis over 72 hours was achieved in 18 of 20 cases (90%) with upper gastrointestinal bleeding by the endoscopic microwave coagulation method. It is noteworthy that this method was effective in all 4 cases of pulsatile bleeding from exposed vessels. We conclude that this method is useful for emergency endoscopic hemostasis on upper gastrointestinal bleeding, especially bleeding from exposed vessels.
Emergencies ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Microwaves*

No abstract available.
Ear*