Polydactyly is one of the most common congenital anomalies of the limb, however its surgical treatment varies from simple excision to reconstruction. The purpose of this study is to present out classification of polydactyly in which the type of surgery was concerned primarily. Two hundred and thirty five digits(134 fingers and 101 toes) in 188 patients were operated from 1980 to 1992. We divided the polydactyly into two types-the simple type, in which the extradigit arises from only one digit, and the complex type in which the extradigit connects more than two adjacent main digits. The simple type was subdivided into joint type(type I), in that the extradigit has its own joint in its origine; epiphyseal type(type II), the extradigit share common epiphysis with main digit; and hypoplastic type(type III), the extradigit is connected only by soft tissue to the main digit. The epiphyseal type(type II) was further divided into subtype A(type IIA), in that the origin seems to be directly derived from the epiphysis; and subtype B(type IIB), which resemble an osteochondroma. Type III and type IIB can be treated by simple excision, however the type I and type IIB can be treated by arthroplasty with or without osteotomy as well as excision of extradigit. Result of surgical treatment in 1 digit of the simple form, which siginifies the extradigit arising from only one digit, are good in 193 digits(91%), fair 14(6.6%), and poor 5(2.4%) after an average follow-up period of 20 months. Our principles in the surgical treatment of polydactyly was treatment according to the type, and early treatment.
Arthroplasty ; Classification ; Epiphyses ; Extremities ; Fingers ; Follow-Up Studies ; Humans ; Joints ; Osteochondroma ; Osteotomy ; Polydactyly

No abstract available.
Intra-Articular Fractures* ; Tibia*

We observed 44 eyes of 43 patients who were diagnosed as macular edema in branch retinal vein occlusion(BRVO) by fluorescein angiogram, which had been followed up over 6 months after argon-green laser photocoagulation. In our cases, sixth decade of age was most commonly affected and there were no significant difference in sexual prevalence and laterality. Eighty six percent was 0.5 or less in initial visual acuity and 59.1% was 0.5 or more in final visual acuity. Increased visual acuity of 2 lines or more was 61.4% and decrease was only 9.1%. After laser treatment, visual improvements of each comparing group were as follow: 60.7% in superotemporal and 62.5% in inferotemporal, 56.5% in hypertensive patients and 66.7% in normotensive patients, 61.5% in below 6 months from onset of symptom until entry into laser photocoagulation and 61.1% in over 7 months, and there were no significant statistical difference.
Fluorescein ; Humans ; Light Coagulation* ; Macular Edema* ; Prevalence ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Visual Acuity

A patient with extraskeletal cervical epidural Ewing's sarcoma who presented with cervical radiculopathy is reported. A 58-year-old woman presented with right posterolateral neck pain and upper extremity radiculopathy. The computed tomography myelography showed epidural and paravertebral masses on right side, with widening of the ipsilateral neural foramina at the C2-C3 level. On magnetic resonance images, the mass was isointense to soft tissue on T1-weighted images, hyperintense on T2-weighted images, and showed diffuse enhancement on GdTA enhanced T1-weighted images. The staged, combined posterior and anterior approach were done and the tumor mass was subtotally removed. During postoperative adjuvant chemotherapy with Cytoxane, Adriamycin, Vincristine, Prednisolone regimen, the patient died of severe compression of upper cervical cord by recurrent, extended tumor mass in the spinal canal.
Chemotherapy, Adjuvant ; Cyclophosphamide ; Doxorubicin ; Drug Therapy ; Female ; Humans ; Middle Aged ; Myelography ; Neck Pain ; Prednisolone ; Radiculopathy ; Sarcoma, Ewing* ; Spinal Canal ; Upper Extremity ; Vincristine

We have applied the intraoperative use of Perfluorophenanthrene (C14F24) liquid in 19 eyes of complicated retinal detachment surgery in 19 patients since November 1990 to October 1991. The vast majority of case of retinal detachment was trauma (9 eyes) and uveitis including pars planitis (6 eyes) remainders were juvenile retinoschisis, cataract surgery, myopIa, diabetes one eye each. The grade-D of proliferative change was found in 9 eyes (D1 3 eyes, D2 3 eyes, D3 3 eyes) and 8 eyes belong to over grade-C2 (C2 4 eyes, C3 4 eyes). Multiple anterior retinal tears were found in two. Giant retinal tear was noticed in 5 eyes and the other one was made on therapeutic purpose. Intraoperative reattachment was obtained in all eyes. The follow-up periods were 6 or more (mean 9.1) months. At last follow-up, the retina was attached in 12 eyes (63%), partially attached in 2 (10%) and redetached in 5 (26%). Visual acuity was improved or same in 12 eyes (63%), became worse in 7(37%). Visual acuity of 0.02 or better was obtained in 12(63%) eyes and 3(16%) saw 0.1 or better. Perfluorophenanthrene liquid was thought as non-toxic, heavy biomaterial and effective to treat the complicated retinal detachments.
Cataract ; Follow-Up Studies ; Humans ; Myopia ; Pars Planitis ; Retina ; Retinal Detachment* ; Retinal Perforations ; Retinaldehyde* ; Retinoschisis ; Uveitis ; Visual Acuity ; Vitrectomy

PURPOSE: We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. MATERIALS AND METHODS: 118 patients (M: F=66:52, 62.7+/-10.5 years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest T1-201/stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heart failure and unstable angina) were surveyed through perioperative periods (14.6+/-5.6 days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. RESULTS: Peri-operative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease. Multivariate analysis sorted` out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. CONCLUSION:: We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery.
Death ; Electrocardiography ; Heart Failure ; Humans ; Multivariate Analysis ; Myocardial Infarction ; Myocardial Ischemia ; Perfusion ; Perioperative Period ; Retrospective Studies ; Risk Factors ; Tomography, Emission-Computed, Single-Photon*

No abstract available.
Child* ; Humans ; Meningitis* ; Plasma*

BACKGROUND AND OBJECTIVES: Dual isotope myocardial SPECT, rest thallium-201/dipyridamole stress Tc-99m sestamibi is used to diagnose coronary artery disease. We examined predictive value of myocardial SPECT for the prognosis of patients having or suspected coronary artery disease. MATERIALS AND METHOD: We examined 692 patients referred for dipyridamole stress myocardial perfusion SPECT. Cardiac events (hard and soft events) were followed up with medical record review and telephone interview. Survival analysis and multivariate Cox proportional hazard model were used to find significant predictors and the incremental predictive value of myocardial SPECT. Patients with coronary angiography (n=246) were analyzed in separate group. RESULTS: There were 4 hard events and 3 soft events in 341 normal SPECT group (1.20%/yr). There were 5 hard events and 21 soft events in 351 abnormal SPECT group (4.69%/yr). Survival curve was separated between normal SPECT group and abnormal SPECT group (p<0.01). In univariate analysis, smoking, history of myocardial infarction, typical chest pain and SPECT findings were important variables. In multivariate analysis, SPECT result was the single most independent predictor. Large reversible perfusion abnormality predicted worse prognosis. In patients with coronary angiography, SPECT did not add statistically significant predictive value to the coronary angiography. CONCLUSION: Dipyridamole stress Tl-201/ MIBI dual isotope myocardial perfusion SPECT provided excellent prognostic information. Extent of reversible perfusion decrease was the independent predictor of future cardiac events.
Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Dipyridamole ; Humans ; Interviews as Topic ; Medical Records ; Multivariate Analysis ; Myocardial Infarction ; Perfusion ; Prognosis ; Proportional Hazards Models ; Smoke ; Smoking ; Tomography, Emission-Computed, Single-Photon*

Retinal toxicity secondary to intravitreal injection of gentamicin for the purpose of prophylaxis or treatment of endophthalmitis was reported infrequently and it was thought to be caused by an error in the intravitreal injection technique or by faulty dilution of gentamicin. After vitrecotomy, we experienced two cases of ischemic retinopathy secondary to intravitreal injection of gentamicin for prevention of endopthalmitist.
Endophthalmitis ; Gentamicins* ; Intravitreal Injections ; Retinaldehyde ; Vitrectomy*

PURPOSE: To access geriatric patients' satisfaction with care in emergency center and identify factors associated with global satisfaction METHODS: Between January 1, 2002 and June 30, 2002, we performed prospective study of 1446 patients over 65 years old age. global satisfaction survey asked patients on Likert sacle(1=excellent, 5=poor). each factor dichotomized into yes versus others, except, Time parameter, and care decisions. In time parameter, dichotomized into "too long" versus others and care decisions dichotomized "no" versus others. RESULT: Totally patients number of over 65 years were 2,123 and received 1,446 cases of complete survey. Only 2% of patients answered "excellent" and 604 cases of "very good". Patients answered that they were significantly well heared by doctors(82.0%, p =0.020) and by nurses(98.1%, p=0.001).1,425 cases(98.5%) answered waiting time were too long. CONCLUSION: To improve satisfaction in geriatric patient, physicians should be more attentive to geriatrics' concerns and questions. especially reduced long waiting time.
Aged ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Prospective Studies