The approach toward paralytic hips in children with subluxation or dislocation has been essentially conservative and palliative, frequently.accepting the subluxation or dislocation. Buster Brown belt, ischial seat brace, or crutches with non-weight bearing is frequently prescribed. For obvious reasons, both the patient and the surgeon are reluctant to resort to hip fusion, and muscle or tendon transfer about the hip cannot be expected to function in the presence of subluxation or dislocation. On the other hand, deformities about the hip are corrected successfully by standard procedures, such as adductor tenotomy, Soutters fasciotomy, and Campbells iliac crest transfer. In severe, fixed deformities in older children, the overall balance may be restored by varus or valgus osteotomy of Irwin, leaving the deformities uncorrected. Jones varus osteotomy is aimed at reduction of the hip, but it ignores the factor of remodeling and is of temporary benefit. More recently, Salters and Pembertons osteotomies have been suggested in the treatment of paralytic subluxation or dislocation, but the lack of remodeling remains unchallenged. During the period of 14 years, from October 1963 to May 1976, we operated on 132 hips in 108 cases of paralytic hips, mostly in children, at Seoul National University Hospital. Of the total cases, 104 cases were residual poliomyelitis, 3 cases cerebral palsy, and one case meningomyelocele, Operative procedures carried out on these hips were as follows: Soutters abductor fasciotomy; 35 Campbells iliac crest transfer; 22 Lumbodorsal fasciotomy; 20 Ober-Barrs erector spinae and tensor fasciae latae transfer; 29 Thomas-Thompson-Straubs external oblique transfer; 15 Sharrards iliopsoas transfer; 6 Mustards iliopsoas transfer; 20 Legg-Dicksons tensor fasciae latae transfer; 8 Blecks iliopsoas recession; 1 Hip fusion; 2 Pembertons pericapsular osteotomy; 28 Salters innominate osteomy; 26 Steels triple osteotomy; 1 Chiari's osteomy; 1 Soft tissue release operations were carried out whenever necessary, either prior to or at the time of reconstructive surgery. In 39 hips, osteotomies were either combined at the same time or were followed by muscle or tendon transfers, while in the earlier 4 hips osteotomy alone resulted in recurrence of subluxation or dislocation and required repeat osteotomy combined with muscle transfer, and in another hip, recently, osteotomy was complicated by infection and muscle transfer has been postponed to date. In our experience with paralytic hips, when subluxation or dislocation is present, either muscle or tendon transfer alone or osteotomy or arthroplasty alone will likely fail or, at best, will be ineffective. Most satisfactory and' permanent results were obtained when these hips were aggressively treated by maximum correction of deformities followed by combined mechanical(osteotomy or arthroplasty) and functional (muscle or tendon transfer) stabilizations. This often permits elimination of the brace and hip fusion is seldom necessary, thus resulting in functional salvage of a flail hip. Also, any surgery on the knee and the foot of the same limb is greatly enhanced by reconstruction of the hip.
Arthroplasty ; Braces ; Cerebral Palsy ; Child ; Congenital Abnormalities ; Crutches ; Dislocations ; Extremities ; Fascia ; Foot ; Hand ; Health Resorts ; Hip ; Humans ; Knee ; Meningomyelocele ; Mustard Plant ; Osteotomy ; Poliomyelitis ; Recurrence ; Seoul ; Steel ; Surgical Procedures, Operative ; Tendon Transfer ; Tendons ; Tenotomy

Intestinal capillariasis is caused by a small trichurid nematode, Capillaria philippinensis, which infects freshwater fish as intermediate hosts and subsequently fish eating birds as definitive hosts. It has occurred in areas such as the Philippines and Thailand where people eat raw fish. We report an imported case of intestinal capillariasis in a 31-year-old Korean man who lived in Saipan for ten years. He suffered from diarrhea with weight loss, abdominal distension, and pitting edema in the lower extremities for two years. He ate raw freshwater fish in the Saipan 2 years ago. The diagnosis was confirmed by jejunal biopsy. Flat mucosal surface without villi contained sections of numerous round worms with stichosome, larvae, and eggs which were identified as Capillaria philippinensis. The patient was successfully treated with albendazole.
Adult ; Albendazole ; Biopsy ; Birds ; Capillaria ; Diagnosis ; Diarrhea ; Eating ; Edema ; Eggs ; Fresh Water ; Humans ; Larva ; Lower Extremity ; Ovum ; Philippines ; Protein-Losing Enteropathies* ; Thailand ; Weight Loss

No abstract available.
Child* ; Fagopyrum* ; Humans ; Hypersensitivity*

BACKGROUND: Intussuseception is one of the most common diseases requiring abdominal emergency care in early childhood. The delay in diagnosis increases morbidity and, in particular, reduces the success rate of the non-surgical method of reduction. In this report, the authors determined the clinical characteristics of pediatric patients with intussusception, and the factors involved in delayed diagnosis and the efficacy of doppler ultrasonography in diagnosis. METHODS: The authors performed a retrospective study of 44 cases in 42 patients with intussusception who had visited the emergency room of SamSung medical center from January 1st to December 31, 1996. RESULTS: The sex ratio was equal and 64.3% of the patients were under 1 year of age. The prevalent complaints were vomiting(36.4%) and abdominal pain(33.8%). Ultrasonography was used in 11 cases, 3 of them were performed because of obscure symptoms and the rest were due to diagnostic delay. The average time past from visit to diagnosis was 4 hours and 20 minutes, and there were 4 diagnostic delays. Air enema reductions were unsucessful in 11 cases(25%) and that was related to hospital-visit delays and long time past from symptom onset to diagnosis. There were no motalities. CONCLUSION: To reduce delays in diagnosis and unnecessary operations, the use of doppler ultrasonography is recommanded in suspicious cases. And to reduce the hospital-visit delays, related to the failure on non-surgical reduction, the education about this disease is necessary.
Delayed Diagnosis ; Diagnosis ; Education ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Enema ; Humans ; Intussusception* ; Retrospective Studies ; Sex Ratio ; Ultrasonography ; Ultrasonography, Doppler

No abstract available.
Anencephaly* ; Autopsy*

No abstract available.
Pancreas*

PURPOSE: This study focused on in vitro cell differentiation and surface characteristics in a magnesium coated titanium surface implanted on using a plasma ion source. MATERIALS AND METHODS: 40 commercially made pure titanium discs were prepared to produce Ti oxide machined surface (M) and Mg-incorporated Ti oxide machined surface (MM). Surface properties were analyzed using a scanning electron microscopy (SEM). On each surface, alkaline phosphatase (ALP) activity, alizarin red S staining for mineralization of MC3T3-E1 cells, and quantitative analysis of osteoblastic gene expression, were evaluated. Actin ring formation assay and gene expression analysis of TRAP and GAPDH performing RT-PCR were performed to characterize osteoclast differentiation on mouse bone marrow-derived macrophages (BMMs). RESULTS: MM showed similar surface morphology and surface roughness with M, but was slightly smoother after ion implantation at the micron scale. M was more hydrophobic than MM. No significant difference between surfaces on ALP activity at 7 and 14 days were observed. Real-time PCR analyses showed similar levels of mRNA expression of the osteoblast phenotype genes; osteopontin (OPN), osteocalcin (OCN), bone sialoprotein (BSP), and collagen 1 (Col 1) in cell grown on MM at 7, 14 and 21 days. Alizarin red S staining at 21 days showed no significant difference. BMMs differentiation increased in M and MM. Actin ring formation assay and gene expression analysis of TRAP showed osteoclast differentiation to be more active on MM. CONCLUSION: Both M and MM have a good effect on osteoblastic cell differentiation, but MM may speed the bone remodeling process by activating on osteoclast differentiation.
Actins ; Alkaline Phosphatase ; Animals ; Bone Remodeling ; Cell Differentiation ; Collagen ; Gene Expression ; Integrin-Binding Sialoprotein ; Macrophages ; Magnesium* ; Mice ; Microscopy, Electron, Scanning ; Osteoblasts* ; Osteocalcin ; Osteoclasts* ; Osteopontin ; Phenotype ; Plasma ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Surface Properties ; Titanium*

BACKGROUND: Blood pressures rneasured by a nurse at reception room as a part of routine physical examination are oft,en used as a indicator of medical care. Blood pressure at reception room and consultation room are, however, often different to each other and these differences are caused by various factors including difference of white coat effect by nurse and doctor. Thus, this study was performed in order to know whether blood pressure difference really exit, and its associated factors. METHODS: Two hundred ninety one patients who visited to one university hospital farnily practice were enrolled in this study. Blood pressure and pulse rate at reception room and consultation room, waiting t,ime, time interval between reception and consultation, smoking status, and intake of coffee and food were collected. Nine patients were excluded, because blood pressure either at reception room or at consulation room was not recorded. This study was performed by one nurse and two doctors. They defined the guideline for method of blood pressure measurement before the study, and used the same kind of indirect cuff sphygmomanometer. RESULTS: Two hundred eighty two patients were analyzed. The number of men was one hundred twenty five. Systolic blood pressure at consultation room was higher than that at reception room by 1.6+/-11.9mmHg (P<0.05). Sixty five cases(65%) in systolic blood pressure and 111 cases(40%) in diastolic blood pressure showed blood pressure differences more than 5mmHg. The group with systolic blood pressure difference between reception room and consultation room(SBP) in more than 5mmHg is more likely to be hypertensive than the group with SBP in less than 5mmHg(P<0.01). More female patients(66%) and hypertensive patients(59%) were belong to the group whose systolic blood pressure at consultation room were 5mmHg higher than at reception room(P<0.01). Twenty four patients(30%) of the group whose systolic blood pressure at reception room were 5mmHg higher than at consultation room had cigarette smoking within 1 hour, and this ratio was significantly higher than the other groups whose systolic blood pressure difference was less than 5rnmHg or systolic blood pressure at consultation room were 5mmHg higher than at reception room(P<0.01). There was relatively good concordance in classifying hypertension and normal blood pressure according to measurement site(Overall kappa, 0.747, P<0.01). CONCLUSIONS: Many patients showed blood pressure differences more than 5mmHg between reception room and consultation room. Systolic blood pressure at consultation room was higher than that at reception room, and there was relatively good concordance in classifying hypertension and normal blood pressure according to measurement site, but the adverse effect by misclassification should not be neglected. The importance as well as the limitation of blood pressure measurement at reception room should be considered in screening and treating hypertensive patient. Every time when blood pressure is taken, physicians should keep in mind to consider patients factors which may influence blood pressure level.
Blood Pressure* ; Coffee ; Female ; Heart Rate ; Humans ; Hypertension ; Male ; Mass Screening ; Outpatients* ; Physical Examination ; Smoke ; Smoking ; Sphygmomanometers

BACKGROUND: Hypertension is one of the frequent problems for which family physicians are well encountered to manage. Nonpharmacologic measures which include stress relaxation, low salt diet, weight reduction, moderation of alcohol intake, physical activity, tobacco avoidance are used as definitive or adjuvant therapy for hypertension. Family physicians should vigorously encourage their patients to adopt these life style modifications. This study was conducted to know how many nonpharmacologic treat,ment modalities are adopted by hypertensives and to find predicting factors. METHODS: A total of 100 of the hypertensive patients who are followed up via the department of family medicine, Hanyang University Hospital, from September 1995 through November 1995 are included in this study. A trained nurse interviewed patients according to the previously designed structured questionnaire. The overall response rate was 90% and the fill-up rate of the questionnaire was 100%. RESULTS: Sixty three patients were women. The mean age was 57.4 years(range, 20 to 84). Sixty one percent accompanied one or more other diseases, of which diabetes mellitus was the most common disorder. The mean systolic pressure was 143.9 mmHg and the mean diastolic blood pressure was 89.3mmHg. Ninty-three percent of patients received antihypertensives with compliance of 81 to 100%. Twenty four percent of patients adhered to regular exercise, 36 percent weight reduction, 48 percent low salt diet, 79 percent moderate drinking, 81 percent stress relaxation, and 87 percent no smoking. Of those six non-pharmacological treatments, 3.6 behaviors were adhered. Male patients were more attended with the low salt diet. Eleven patients of 2S alcoholics(44.0%) reduced their amount of alcohol intake and 8 of 17 smokers quitted smoking (47.1%) after they were diagnosed as hypertension. The mean BEPSI score was 1.5. Fifty one percent of patients had stress within the last three months, 32 percent had cumulative fatigue. The occupational stress was the most common one. All exercise which patients reported were isotonic. Seventeen percent of the patients took certain herb medicine or folk medicine. CONCLUSIONS: Of those 100 hypertensives who were treated at the department of family medicine, Hanyang University hospital, 24% adhered to regular exercise, 36 per cent weight reduction, 48 percent low salt diet, 79 percent moderate drinking, 81 percent stress relaxation, and 87 percent quit smoking in order. Of those six non-pharmacological treatments, 3.6 behaviors were adhered on the average. Nonpharmacologic treatment should be promoted by family physician as an important strategy for treatment of hypertension.
Antihypertensive Agents ; Blood Pressure ; Compliance ; Diabetes Mellitus ; Diet ; Diet, Reducing ; Drinking ; Fatigue ; Female ; Humans ; Hypertension ; Life Style ; Male ; Medicine, Traditional ; Motor Activity ; Physicians, Family ; Relaxation ; Smoke ; Smoking ; Tobacco ; Weight Loss ; Surveys and Questionnaires

No abstract available.