PURPOSE: The authors report a case of Rubinstein-Taybi syndrome with optic disc coloboma and chorioretinal coloboma. CASE SUMMARY: A 17-month-old female infant was brought to our clinic presenting exodeviation in the right eye. On cycloplegic refraction, her refractive power was -5.50 D sph -2.50 D cyl axis 180degrees in the right eye and +0.50 D sph in the left eye. On ophthalmologic examination, exotropia of 60 prism diopters with no limitation of ocular movement was observed. Fundus examination showed optic disc coloboma and chorioretinal coloboma in the right eye. The patient's physical characteristics were downward slanted palpebral fissures, long eyelashes, low set ears, and the thumb and the big toe were disproportionately broad. The patient also demonstrated delayed gait abilities. The clinical diagnosis of Rubinstein-Taybi syndrome was given. CONCLUSIONS: The authors report a child with Rubinstein-Taybi syndrome with optic disc coloboma and chorioretinal coloboma, the first to be reported in Korea.
Axis, Cervical Vertebra ; Child ; Coloboma ; Ear ; Exotropia ; Eye ; Eyelashes ; Female ; Gait ; Humans ; Infant ; Korea ; Rubinstein-Taybi Syndrome ; Thumb ; Toes

Calcaneal fractures involving subtalar joint can be associated with prolonged and severe disability. Many different methods have been tried for the treatment in order to search for better results. From March 1983 to December 1985, 8 cases of calcaneal fractures involving subtalar joint were treated by open rcduction and internal fixation. and the results were as follows: 1. Satisfactory results were obtained from 7 cases out of 8. 2. Anatomic reduction was obtained by open reduction and internal fixation. 3. When medial approach failed, combined lateral and medial approaches gave better visualization of articular fecets and ensured anatomic reduction.
Subtalar Joint

The back pain is increasingly becoming a major problem in the elderly people. The cause of back pain in the elderly patient is quite different from in the young subject. And relationship of the occurrence of osteoporosis with the incidence of fractures in general is currently regarded as a major factor. The authors performed clinical observation on 194 elderly patients who were treated for back pain during 5 years period from April, 1983 to April, 1988 at the Department of Orthopaedic Surgery, Severance Hospital and relationship between osteoporosis and compression fracture of spine was reviewed. The results were as follows : l. Among the 194 cases of back pain(28.3% of total admission cases), whose age were over 50: 142 cases were female and 52 cases were male, being more common in female. 2. Most common cause of back pain was the compression fracture of spine : 86 cases(44.3 %). Osteoporosis was associated with 66 cases(76.7%) out of 86 cases. 3. The number of compression fracture in same patient was more frequent in osteoporotic patient and thoracolumber junction (T12, Ll) was the major site of fracture (45.6%). Compression fracture of spine caused by osteoporosis occured at multiple level in 60.6%. 4. Twenty three cases(34.8%) of compression fracture of spine with osteoporosis were found to have previous history of fractures of spine and/or extremities by radiological examination. Regarding this results, compression fractures of spine was not infrequent cause of back pain in the elderly. It was thought that re-fracture of spine should be prevented by vigorous approach against osteoporosis along with the treatment of presenting fracture in these patients.
Aged ; Back Pain ; Clinical Study ; Extremities ; Female ; Fractures, Compression ; Humans ; Incidence ; Male ; Osteoporosis ; Spine

Since 1952, Ilizarov external fixator has been developed and used for more than 30 years in Russia and world-wide interest on it has been prevalent during last 2-3 years. The fixation of the tension applied thin wires to the metal frame resist flexional and translational deformity just like other extenal fixators. But, it allows cyclic axial micro-motion at the fracture site without loss of reduction so that it can provide good environment for the fracture healing biologically and biomechanically. Another advantage of Ilizarov external fixator is that it permits mobilization of the adjacent joints and weight bearing of the fractured limb during the application of it and shortens the duration of administration. Since 1988, We applied the Ilizarov external fixator for the treatment of diffcult tibial fractures (open comminuted, segmented and comminuted fractures, nonunion, maunion) and obtained good results in 7 cases. So we report our results even if we had limited cases and experiences.
Congenital Abnormalities ; External Fixators ; Extremities ; Fracture Healing ; Fractures, Comminuted ; Joints ; Russia ; Tibia ; Tibial Fractures ; Weight-Bearing

Piriformis syndrome, a term applied to an abnormal condition of the piriformis muscle, is characterized by symptoms and signs due to sciatic nerve entrapment at the greater sciatic notch. Recently we reviewed a case of unusual low back pain, radiating to the left lower extremity with tenderness particular in the left buttock. The patient was successfully treated by sectioning the piriformis tendon. We described the clinical features of a case of piriformis syndrome and reviewed the foreign literature.
Human ; Male ; Middle Aged ; Muscular Diseases/*etiology ; Nerve Compression Syndromes/*etiology ; *Sciatic Nerve

PURPOSE: We wanted to evaluate the efficacy of MIPO (minimal invasive plate osteosynthesis) technique by LCP (locking compression plate) for treating proximal tibia fractures. MATERIALS AND METHODS: Twenty-three patients, who had operation due to proximal tibia fracture and available for follow up for more than 1 year were included in this study. Cause of injury and accompanied injuries were checked. Operation time, period to bone union, range of joint motion and alignment were evaluated with complications. RESULTS: Mean bone union time was 13.7 weeks (10~20). Twenty-one cases of the patients showed angulation of less than 5 degrees and 17 cases had normal range of motion. Five cases showed skin irritation by the plate and 2 cases had superficial infection. CONCLUSION: LCP by MIPO technique for treating proximal tibia fracture showed excellent results. Delicate technique is required for the proper adjustment of LCP and the alignment of the lower leg.
Follow-Up Studies ; Humans ; Joints ; Leg ; Reference Values ; Skin ; Tibia

Purpose: We report a rare case of allergic contact dermatitis after the use of a non-preservative 0.5% moxifloxacin ophthalmic solution.Case summary: A 60-year-old male presented with bacterial corneal ulceration of the right eye. He was treated with 50 mg/mL of fortified cefazolin and 14 mg/mL of tobramycin that were tapered as the corneal lesion improved after 1 month, and 0.5% moxifloxacin application was started. After 2 weeks of moxifloxacin treatment, the patient developed conjunctival injection, lid swelling, redness, and itching in the right eye. An allergic reaction was suspected and moxifloxacin administration was immediately stopped. The symptoms improved after the administration of oral antihistamines, 0.5% loteprednol eye drops, and steroid combination ointment. Conclusions Patients treated with 0.5% topical moxifloxacin should be monitored for allergic contact dermatitis, even if preservative-free eye drops are used.

Non-typhoidal salmonella is rarely the cause of pacemaker infection. A 68-year-old man was referred to our hospital with tenderness and swelling at his cardiac resynchronization therapy defibrillator (CRT-D) implantation site. He had undergone CRT-D implantation because of sustained ventricular tachycardia and heart failure 7 years earlier, and the generator had been changed 2 months earlier. Twenty-four years earlier, he had undergone aortic valve replacement and mitral valve repair. We removed the generator and all of the CRT-D leads. After lead extraction, non-typhoidal salmonella serogroup B was cultured at the pocket and lead tip. The patient was managed successfully with lead extraction and antibiotic therapy.
Aortic Valve ; Cardiac Resynchronization Therapy ; Defibrillators ; Heart Failure ; Humans ; Mitral Valve ; Salmonella ; Salmonella Infections ; Tachycardia, Ventricular

BACKGROUND: Hospitals provide programs for routine screening health examination to meet the needs of people who take keen interest in the prevention of cancer and chronic diseases. But current programs do not reflect individual characteristics such as age, sex, occupation, and risk factors. Expensive diagnostic tests not based on evidence raise a continued issue of controversy. We evaluated on the scientific evidence of screening tests in these programs. METHODS: Internet home pages were searched for screening test provided by 6 major hospitals and by National Health Insurance Corporation. Screening tests were arranged by target diseases which were chosen by the authors. We reviewed the guidelines of several organizations and compared the scientific evidence of each test by the recommended guidelines. RESULTS: Excessive investigation, such as tumor markers, abdominal ultrasonography, anti-HCV Ab, and VDRL were routinely administered against recommended guidelines. Screening tests lacking sufficient evidence for recommendation were included. Furthermore, selection of the screening tests options and time interval was based on the clients' economic state and non-expert preference. CONCLUSION: Screening tests were uniformly administered in excess with insufficient evidence. Tailored screening program should be administered considering individual characteristics and risk factors.
Chronic Disease ; Diagnostic Tests, Routine ; Internet ; Korea ; Mass Screening* ; National Health Programs ; Occupations ; Risk Factors ; Biomarkers, Tumor ; Ultrasonography

OBJECTIVES: The objective of this study was to examine the effects of osmotic-controlled release oral delivery system methylphenidate on changes in regional cerebral blood flow (rCBF) in children with attention-deficit hyperactivity disorder (ADHD) using single photon emission computed tomography (SPECT). METHODS: A total of 26 children with ADHD (21 boys, mean age: 9.2±2.05 years old) were recruited. Each ADHD participant was examined for changes in rCBF using technetium-99m-hexamethylpropylene amine oxime brain SPECT before and after 8 weeks methylphenidate medication. Brain SPECT images of pediatric normal controls were selected retrospectively. SPECT images of ADHD children taken before medication were compared with those of pediatric normal controls and those taken after medication using statistical parametric mapping analysis on a voxel-wise basis. RESULTS: Before methylphenidate medication, significantly decreased rCBF in the cerebellum and increased rCBF in the right precuneus, left anterior cingulate, right postcentral gyrus, right inferior parietal lobule and right precentral gyrus were observed in ADHD children compared to pediatric normal controls (p-value<.0005, uncorrected). After medication, we observed significant hypoperfusion in the left thalamus and left cerebellum compared to pediatric normal controls (p-value<.0005, uncorrected). In the comparison between before medication and after medication, there was significant hyperperfusion in the superior frontal gyrus and middle frontal gyrus and significant hypoperfusion in the right insula, right caudate, right middle frontal gyrus, left subcallosal gyrus, left claustrum, and left superior temporal gyrus after methylphenidate medication (p-value<.0005, uncorrected). CONCLUSION: This study supports dysfunctions of fronto-striatal structures and cerebellum in ADHD. We suggest that methylphenidate may have some effects on the frontal lobe, parietal lobe, and cerebellum in children with ADHD.
Basal Ganglia ; Brain ; Cerebellum ; Child* ; Frontal Lobe ; Humans ; Methylphenidate* ; Parietal Lobe ; Rabeprazole ; Retrospective Studies ; Thalamus ; Tomography, Emission-Computed, Single-Photon