A 14-year old girl presented with urinary incontinence along with normally secured voluntary voiding. Careful physical examination revealed leakage of urine through a small opening near the vestibule, ventral to the urethral meatus. Cystoscopically, the right ureteral orifice was absent but otherwise normal. Nonfunctioning right kidney was found on excretory urography. A #4 ureteral catheter was inserted into the ectopic opening as high as 10cm, and the retrograde pyelogram showed dilated right ureter ending blindly at the level of lumber vertebra II with stricture at the level of the tip of the catheter. After the right nephroureterectomy, she became dry and was discharged on the 12th postoperative day. The removed kidney weighed only 8 Gm. and pathological diagnosis was congenital hypoplasia of the right kidney with ectopic ureteral opening.
Adolescent ; Catheters ; Constriction, Pathologic ; Diagnosis ; Female ; Humans ; Kidney* ; Physical Examination ; Spine ; Ureter* ; Urinary Catheters ; Urinary Incontinence ; Urography

Tuberculous spine has high incidence in children. Many cases of the tuberculous spine are complicated by deformities of the spine and disability such as paraplegia, cardio-plumonary dysfunction, and also early death. There are now several reports on the pulmonary dysfunction due to spinal deformities such as scoliosis and kyphoscoliosis, but there are few papers on the pulmonary function of patients with the tuberculous spine and kyphosis in children. This article is a report on the study of chest excursion in 70 kyphotic children and of the pulmonary function in 10 cases of severe kyphotic patients with collapsing tuberculous spine. The following results are obtained through the study: 1) Chest excursion was evidently diminished in the cases of moderate and severe thoracic, and severe lumbar involvement. The remainders were nearly within normal limits. 2) The study revealed that the chest excursion and the radiological kyphosis has a very gradually sloped negative correlation in thoracic involvement. 3) Pulmonary function in the severe kyphotics who had the curve over 50 degree were revealed as follows; a) Over 50 percent of the cases had diminished vital capacity. That is, over-all average was 67.7 percent of normal capacity. Especially inspiratory reserve volume was diminished, it was 63.7 percent of normal. Maximum breathing capacity was 68.8 percent of normal. b) Tidal volume, timed vital capacity, minute ventilation rate and O2 consumption were within normal limits or nearly normal.
Child ; Congenital Abnormalities ; Forced Expiratory Volume ; Humans ; Incidence ; Inspiratory Reserve Volume ; Kyphosis ; Paraplegia ; Respiration ; Scoliosis ; Spine ; Thorax ; Tidal Volume ; Ventilation ; Vital Capacity

Tuberculosis of the spine still remains as an important problem and also have high incidence in children in Korea. Many cases of the tuberculous spine are complicated by deformities of the spine and disability such as paraplegia, incordination of the cardio-pulmonary function and also result in early death. For the treatment of the tuberculous spondylitis following measure should be considered. First, eradication of the tuberculous lesion by conservative treatment or combined surgery, secondly, prevention of the deformity of the spine. Lastly, care for physical and psycological or emotional changes, and care for cardio-pulmonary dysfunction which develops after establishment of spinal deformity. Authors also attempted to analyse the kyphotic changes of the tuberculous spine of 70 children who were ambulating treatment at Pusan University Hospital and Pusan Charity Hospital, and obtained the result as follows; 1. Lower thoracic and upper lumbar were mostly involved. Nearly all cases of the new involvement of adjacent vertebra within 18 months. Only 4 cases now involvement occured after 18 months. 3. Kyphosis aggrevated grossly in 61.3% of cases. Most of them were apparent within 18 months but the changes developed after 18 months in 4.23% of cases. 4. In measuring the radiological kyphosis, Salters angle usually more simpler one than the internal gibbus angle. 5. Salters angle was larger involved than the internal gibbus angle except in mild and severe cases of the lumbar and lumbosacral involvement. Increase of kyphosis was 13.6 degree by internal gibbus angle and 16.3% by Salters angle. Kyphosis increased after 18 months were 3.1 degree by internal gibbus angle and 5.0 degree by Salters angle. 6. Radiological kyphosis changed in all stages and at least we should consider the changes of the kyphosis could be measured. 7. By the Kawakamis spinometer, the compensatory curvature, the posture of the patient and state of the kyphosis could be measured. 8. The compensatory curvature measured by Kawakamis spinometer were as follows: a) compensatory curvature in decrement in mild or morderate degree of cases, changed lumbar only or both cervical and lumbar curvature. b) compensatory curvature in increment in severe thoracic involvement changed both cervical and lumbar curvature, or cervical one only, the value in the cervical one was larger than that in the lumbar curvature.
Busan ; Charities ; Child ; Congenital Abnormalities ; Humans ; Incidence ; Korea ; Kyphosis ; Paraplegia ; Posture ; Spine ; Spondylitis ; Tuberculosis

It has been well known that the incidence of delayed or nonunion of tibial shaft fracture is high and in order to improve methods of treatment and to get satisfactory final results in these fractures, it is important to find out as early as possible whether the fracture is healing normally or not. The fracture healing is closely related to the circulatory conditions at the fracture site, however, in contrast to animal experiments it is impossible to visualize directly the circulatory conditions at the fracture site. There have been many efforts to visualize indirectly these vascular re-establishments through angiography. Kaski(1974) reported a paper concerning osteomedullography of tibial fracture with phlebocompression and noticed 5 types of veins related to the process of healing. We performed 54 cases of osteomedullography in 41 tibial fracture at 3 months after treatment and the following results were obtained: 1. The sinusoidal vein in the proximal fragment was observed most frequently and the next were intra-osseous crossing vein, periosteal callus vein, ascending branch of main efferent vein, and periosteal veins of proximal fragment in decreasig frequency. 2. The rate of positive finding in osteomedullography at 3 months after treatment was lower, and periosteal callus veins were observed more frequently in the group treated with only cast immobilization than in the group treated with plate and screws. 3. In the group treated with compression plate and screws, osteomedullographs were positive in all 3 cases within 3 months after operation and sinusoidal veins in the proximal fragment were visualized in all cases, however periosteal callus vein was not visualized at all. 4. After bone graft, the differentiation of periosteal callus from grafted bone was not easy in plain X-ray film, but osteomedullography was very useful in these cases. Positive findings were noticed in 2~3 months in all cases following bone graft. 5. The authors found that the ideal time of performing osteomedullography was 3 months following treatment. If found to be negative after 4 months following treatment, bone graft was necessary.
Angiography ; Animal Experimentation ; Bony Callus ; Fracture Healing ; Immobilization ; Incidence ; Tibial Fractures ; Transplants ; Veins ; X-Ray Film

No abstract available.
Hemorrhage*

No abstract available.
Hydronephrosis*

Urea reduction ratio (URR) and Kt/Vurea are objective parameters of dialysis delivery in hemodialysis patients and correlate with nutritional status and patient outcome. URR and Kt/Vurea depend on postdialysis blood urea nitrogen (BUN). In patients with severe postdialysis urea rebound (PDUR), these parameters do not accurately reflect dialysis adequacy. We measured PDUR 30 minutes after dialysis in 26 chronic stable hemodialysis patients. The impact of PDUR on dialysis delivery assessed by URR and Kt/Vurea and the independent factors affecting on PDUR were evaluated. All patients had been dialyzed for 4 hours thrice a week using hemophan membrane. 1) The mean age of patients was 48.6+/-14.8 years and sex ratio was 1:2.3. The mean duration of hemodialysis was 42.7+/-45.0 months. Primary renal diseases were chronic glomerulonephritis 11 (42.3%), diabetic nephropathy 7 (26.9%), and hypertension 4 (15.4%). 2) The mean blood flow was 209.2+/-17.4ml/min. URR, Kt/Vurea, and nPCR using immediate postdialysis BUN were 60+/-7%, 1.13+/-0.21, 1.09+/-0.28g/kg/ day, respectively. The mean recirculation rate was 4.4+/-2.3%. 3)The mean PDUR was 12.2+/-4.6% (range:6-22 %). URR, Kt/Vurea, and nPCR using BUN 30 minutes after dialysis were 55+/-7%, 0.99+/-0.18, and 1.02+/-0.25 g/kg/day, respectively and were significantly lower than those using immediate postdialysis BUN (P<0.05). 4) When the patients were divided according to the degree of PDUR (low PDUR group:<12%, high PDUR group: > or = 12%), high PDUR group was significantly higher than low PDUR group in hematocrit (27.0+/-2.6 vs. 23.5+/-3.6%, P=0.008), URR (64.3+/-5.4 vs. 55.8+/-6.8%, P=0.002), Kt/Vurea (1.26+/-0.17 vs. 1.03+/-0.18, P=0.002), and total recirculation rate (5.6+/-2.7 vs. 3.6+/-1.7%, P=0.05). There were no differences in age, sex, postdialysis body weight, ultrafiltration rate, blood flow, serum albumin, predialysis BUN, creatinine, and nPCR. 5) In multiple regression analysis, the independent factors affecting on PDUR were Kt/Vurea (beta=0.546, P<0.001), recirculation rate (beta=0.422, P<0.001), and hematocrit (beta=0.366, P=0.0017). In conclusion, we think that PDUR should be considered in hemodialysis patients when estimating dialysis delivery, especially if they had high Kt/ Vurea, recirculation rate, and hematocrit.
Blood Urea Nitrogen ; Body Weight ; Creatinine ; Diabetic Nephropathies ; Dialysis* ; Glomerulonephritis ; Hematocrit ; Humans ; Hypertension ; Membranes ; Nutritional Status ; Renal Dialysis* ; Serum Albumin ; Sex Ratio ; Ultrafiltration ; Urea*

No abstract available.
Abscess* ; Reoperation*

As a decompression means, the fasciotomy has been of good evaluation in many diseases such as impending V.I.C., ischemic myositis due to CO poisoning, snake bite, burn, anterior tibial compartment syndrome, carpal tunnel syndrome and gas gangrene, etc. From 1966 to 1973, 7 cases of snake bites and 5 cases of the ischemic myositis due to CO poisoning were treated at the Orthopedic Department of Seoul National University Hospital and the results were as follows; 1. All cases of the snake bites had got good results without any complication after the fasciotomy, while the fasciotomy performed in the ischemic myositis due to CO poisoning were not effective. 2. The time elapsed from the snake bite to the fasciotomy had a close relation to the prognosis. 3. In the 4 of 5 cases of the ischemic myositis due to CO poisoning, infections were superimposed on the fasciotomy sites. 4. The inappropriately continuous use of the tourniquet for hours after the snake bites caused worse prognosis.
Burns ; Carpal Tunnel Syndrome ; Compartment Syndromes ; Decompression ; Extremities ; Gas Gangrene ; Myositis ; Orthopedics ; Poisoning ; Prognosis ; Seoul ; Snake Bites ; Tourniquets

A new fibrinogen system, consisting of highly concentrated fibrinogen and thrombin, is going to be applied in many clinical fields. Especially in injuries of the cartilagenous joint surface as chondral or osteochondral fractures, replantation of the fragments must be considered mandarory in order to preserve joint congruence and to prevent further destruction of the articular cartilage. The authors have an encouraging results by using this fibrin adhesive system (F.A.S.) in the experimental works.
Cartilage, Articular ; Fibrin Tissue Adhesive ; Fibrinogen ; Joints ; Replantation ; Thrombin