To analyse the clinical characteristics of children with atrial flutter(AF1), we reviewed(the medical records of the children who had been admitted and diagnosed as AF1 or 12 leads surface ECG during the period between February, 1986 and Octobe, 1990. The onset age of 25 children was evenly distributed between gestational period and upto 14 years of age. The sex ratio between boys and girls was 11:14. The cardiac abnormalities were detected in 21 children(dilated cardiomyopathy in 3, congenital heart defect in 18). In 4 children, AF1 occured in apparently normal heart. In 9 children, AF1 developed without relation to cardiac surgery(4 in normal heart, 3 in dilated cardiomyopathy, 2 in preoperative CHD). AF1 developed in 9 children within 30 days postoperatively(group A) and in 7, after 30 days postoperatively(group B). In group A, various types of operation were done. In 2 of them, AF1 persisted beyond the immediate postoperative period and 1 died of cardiac decompensation 3 months postoperatively. In group B, operative procedures before AF1 were Senning operation in 2, Fontan operation in 2, operation for tetralogy of Fallot, ventricular septal defect with severe tricuspid regurgitation, endocardial cushion defect in 1 each. Five children in group B( except 1 Senning operation and 1 Fontan operation) had significant residual atrioventricular regurgitation. The associated rhythm disturbance besides AF1 could be determined in 23 children. The sinus node dysfunction was associated in 8 ; the supraventricular dysrhythmia in 10; the ventricular dysrhythmia in 6; the atrioventricular conduction disturbance in 3, and no other associated rhythm disturbance in 6. The efficacy of various methods in conversion of AF1 to sinus rhythm were 57.1%(4/7) with DC cardioversion, 38.5%(5/13) with digoxin and other antiarrhythmic drug(amiodarone, beta blocker, quinidine, verapamil, flecainide), 25%(5/20) with pacing in esophagus or endocardium. The follow-up evaluation was possible in 24 children. Eight children were dead : 5 due to chronic decompensation, 2 due to sudden cardiac arrest, and 1 due to sepsis. Of the 16 alive children, 14 had recovered the normal sinus rhythm and the other 2 had persistent AF1. Twelve children without AF1 and 1 with persistent AF1 were on medication, Although there were none cardiac death in children without persistent AF1, 7 out of 9 children with persistent AF1 were dead. Of the 7 children with significant atrioventricular regurgitation, corrective procedures were done in 4. There were no death in these 4 children, despite of 2 cardiac death out of 3 children on whom corrective procedure were not done. In conclusion, the atrioventricular regurgitation was a significant factor in relation to the occurrence and persistence of AF1 and the prognosis was bad in children with persistent AF1. It is recommended to trat the children with AF1 associated with atrioventricular regurgitation promptly and more aggressively.
Age of Onset ; Atrial Flutter* ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Child* ; Death ; Death, Sudden, Cardiac ; Digoxin ; Electric Countershock ; Electrocardiography ; Endocardial Cushion Defects ; Endocardium ; Esophagus ; Female ; Follow-Up Studies ; Fontan Procedure ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Humans ; Medical Records ; Postoperative Period ; Prognosis ; Quinidine ; Sepsis ; Sex Ratio ; Sick Sinus Syndrome ; Surgical Procedures, Operative ; Tetralogy of Fallot ; Tricuspid Valve Insufficiency ; Verapamil

Two cases of Klippel-Trenaunay-Weber Syndrome were presented and its literatures were reviewed. The patients were 25 year old male farmer and 38 year old housewife. Both had hypertrophy, port-wine nevus, and varicosities in case 1, on left lower extremity since birth. The length and cirumference of the affected leg were longer than the other side, and X-ray showed osteohypertrophy of tibia of the involved leg,
Adult ; Humans ; Hypertrophy ; Klippel-Trenaunay-Weber Syndrome* ; Leg ; Lower Extremity ; Male ; Nevus ; Parturition ; Tibia

Two cases of Klippel-Trenaunay-Weber Syndrome were presented and its literatures were reviewed. The patients were 25 year old male farmer and 38 year old housewife. Both had hypertrophy, port-wine nevus, and varicosities in case 1, on left lower extremity since birth. The length and cirumference of the affected leg were longer than the other side, and X-ray showed osteohypertrophy of tibia of the involved leg,
Adult ; Humans ; Hypertrophy ; Klippel-Trenaunay-Weber Syndrome* ; Leg ; Lower Extremity ; Male ; Nevus ; Parturition ; Tibia

PURPOSE: To evaluate surface configuration of intervertebral disc on three dimensional CT. MATERIALS AND METHODS: Three dimensional surface images reconstructed from CTscans(1 mm thick) of 20discs in 14 healthy adults were reviewed. Disc surface was classified into peripheral and central zones in contact with consecutive peripheral ring and central endplate. Local irregularity incidence, pattern in radial, concentric, or mixed form, size, location, and extension were observed. Incidence and severity ranges in 4 grades of general irregularity, and peripheral width relative to central radius were evaluated. RESULTS: Normal disc mostly showed smooth surface with few display of small local irregularity(6/20) which was mainly radial in pattern(4/5), posterolaterally located(4/6), and confined within peripheral zone(5/6). General irregularity displayed(5/20) was all grade I and peripheral width was 0.82 of central radius. CONCLUSION: Normal disc shows smooth surface but few may display small local irregularity maybe due to very early degenerative change.
Adult ; Humans ; Incidence ; Intervertebral Disc* ; Radius

Dupuytren's contracture is a idiopathic hypertrophy of palmar aponeurosis and consequent flexion deformity of distal palms and fingers. This patient is a 58-year-old man who has been suffering from diabetes mllitus since last 20 years. Skin lesion developed from one year ago. Skin lesion is a well defined, yellowish brown, nontender, firm, pea-sized nodule at distal palmar crease proximal to ring finger on both hands. On physical examination, he is within normal limit except skin lesion and flexion deformity on both hands. Skin biopsy on nodule revealed non-specific fibrosis. Literature was briefly reviewed.
Biopsy ; Congenital Abnormalities ; Dupuytren Contracture* ; Fibrosis ; Fingers ; Hand ; Humans ; Hypertrophy ; Middle Aged ; Physical Examination ; Skin

No abstract available.

BACKGROUND: To get the information about the clinical characteristics of the paroxysmal junctional tachycardia in children and to get the general principle in managing these children. METHOD: Analysis of the medical records of the 43 patients(male 30, female 13) with paroxysmal junctional tachycardia(JT) who had been followed-up in this hospital for a mean of 4.6 years(range 1 month up to 12 years) was done. RESULT: In 19 patients, JT started before 1 years of age : in 2, during gestational period, in 15, within 4 months of age, in 2, after 4 months of age. The next peak was 7 in the age of 5 years. The associated cardiac abnormalities were complex congenital defects in 2, tumor in 1, dilated and hypertrophic cardiomyopathy in 1 each. The significant hemodynamic disturbances during JT were noticed in 25. Among those whose surface electrocardiogram during JT were available, mean heart rate during JT was 232rpm(range 160-310) ; narrow QRS complex in 33 and wide in 1 ; P` wave in ST segment or T wave in 22. The delta waves were noticed after stopping JT and during followe up in 20. The types of delta waves were A in 7, B in 9, and indeterminate in 4. The different forms of delta waves unrelated to the degree of fusion were noticed in 6 ; disappearance or intermittent form of delta wave in 4. The efficacy of stopping JT was as follows : ATP 84.4%(38/45), diving reflex 50%(7/14), other vagal stimulation 71.4%(5/7), digoxin 72.7%(8/11), verapamil 54.5%(12/22), D/C cardioversion 62.5%(5/8), neosynephrine 100%(2/2). There were 2 deaths due to associated cardiac defects and 2 elective catheter ablations during the followe up period. The preventive medication with digoxin, beta blocker, and/or verapamil was succesful in 14, partially succesful in 11, failed in 14. The 7 persistent JT were treated with amiodarone in 3, with amiodarone and beta blocker in 1, with flecainide and digoxin in 1. In 1, surgical ablation of accessory pathway was done due to persistent JT. At present, JT do not recur or occur transiently without drugs in 29 ; with drugs, JT become controlled without recurrence in 4, with transient episodes in 4 and with intermittent episodes in 1. CONCLUSION: Althouh the JT in children is benign in most cases spite of the severity during the early period, JT is persistent in cases and needs potent drugs to control JT. Ablation of the foci may be necessary in these cases. Even in patients whose long-term results are benign, it is necessary to choose the optimal drugs to terminate and prevent the JT during the intervening period.
Adenosine Triphosphate ; Amiodarone ; Cardiomyopathy, Hypertrophic ; Catheters ; Child* ; Congenital Abnormalities ; Digoxin ; Diving ; Electric Countershock ; Electrocardiography ; Female ; Flecainide ; Heart Rate ; Hemodynamics ; Humans ; Medical Records ; Phenylephrine ; Recurrence ; Reflex ; Tachycardia* ; Verapamil

No abstract available.
Histiocytosis*

PURPOSE: To avoid prolonged recovery time and scar tenderness in open carpal tunnel release and possible nerve or tendon injuries by bulky instruments in endoscopic techniques, we tried to percutaneously release the transverse carpal ligament using simple, thin instruments. MATERIALS AND METHODS: We performed carpal tunnel release percutaneously through a single small incision on the wrist with curved mosquito and meniscectomy hook knife under general or regional anesthesia in 41 wrists of 27 patients during the last 5 years and followed up for at least one year. Before and after release, endoscopic examinations were done to rule out space occupying lesions or other anormalies and to confirm complete release. RESULTS: According to the Cseuz's criteria, 38 cases (93%) showed excellent or good results, which was compatible to open or endoscopic technique with special instruments and there was no major neurovascular injury except one superficial palmar arch laceration associated with the second palmar incision in complicated case. CONCLUSIONS: From earlier experience, we learned that this simple technique may be used successfully with low cost without any fear of complication.
Anesthesia, Conduction ; Cicatrix ; Culicidae ; Humans ; Lacerations ; Ligaments ; Tendon Injuries ; Wrist

An anatomical reduction and maintainance of articular fracture is on of the basic principles In Orthopedic Surgery if good function is to ensue, especially in a major welght bearing joint such as hip knee ankle. In displaced articular fractures, excellent results can be achieved mainly by an open anatomical reduction and firm internal fixation. We performed an open reduction and internal flxation with plates and screws in a patient with the severely comminuted acetabular fracture, and a satisfactory result is obtained.
Acetabulum ; Ankle ; Hip ; Humans ; Joints ; Knee ; Orthopedics