Limb lengthening with any kind of lengthening apparatus is accepted as a standard method to correct leg length discrepancy. And furthermore, the deformity accompanying shortening is corrected by multifocal lengthener. twenty two patients have undergone lower limb reconstruction by the technique of unilateral bone transport for diaphyseal bone defect, nonunion or deformity in the presence of shortening from May 1990 to August 1993 in Wilson Leprosy Center & Rehabilitation Hospital. All Patients had bifocal procedure using bifocal monofixator(Orthofix) and bone defects were graduaily filled by bone transport. Average healing index(days/cm)was 61. Average bone defect was 7,4cm, and average transported length was 5.4cm. In conclusion, the unilateral bone transport system using bifocal monofixator has satisfactory outcome, and salvaged limbs where amputation has been previously the only option.
Amputation ; Congenital Abnormalities ; Extremities ; Humans ; Leg ; Leprosy ; Lower Extremity ; Methods ; Rehabilitation

The hip joint subluxation and dislocation due to poliomyelitis worsen the limping and caused the painful hip. Shelf procedure has been described as a safe, conservative and reliable approach to the of a dysplastic acetabulum. We performed shelf procedure for the dysplastic hip in poliomyelitis in thirteen patients since May, 1990. The age at operation was 21 to 38 years old and three of them were male and ten were female. All the patients were followed up for average 2.5 years(1-4. 5yrs). The hip joints showed better stability after shel'f procedure and less limping. There was no complication except one redislocation.
Acetabulum ; Dislocations ; Female ; Hip Joint ; Hip ; Humans ; Male ; Poliomyelitis

The purpose of this study is to estimate cesarean section rate in Korea and analyze the socioeconomic variables and health resources which affect regional variation in the rate. Samples were drawn from the record of vaginal and cesarean section deliveries based upon insurance claim bills which have been submitted to the National Federation of Medical Insurance for the first three months, January through March, 1991. The results are obtained as follows: It was found that, cesarean section rate was increasing rapidly up to 23.1% in 1991. Cesarean section per 10 thousand insured people was 4.8 and the number of cesarean section per 10 thousand insured eligible(15-49 years old) female was 7.6. The fee for normal delivery was 109,489 won and that for cesarean section was 390,024 won. The average days of hospitalization in normal delivery was 2.3 days, and those in cesarean section was 7.6 days. On the average cesarean section has a longer of stay as much as by 4.3 days and cost 3.6 times more than normal deliveries. Cesarean section rates vary among medical facilities: 19.8% at clinics 37.6% in small-scale hospitals, and 29.1% in general hospitals. The regional variation of cesarean section rates was also fairly prominent. The South Cheju Gun has the highest rate of cesarean section, 56.2%. Meanwhile no cesarean section cases has been reported in Sunchang Gun during the period of this study. The variation is noted among provinces. The rate for Cheju province has been 3.4 times higher than that for Chunnam. The number of cesarean section per 10 thousand insured people vary greatly among regions, too. This study has found that there exists significant regional variations among various geographic units in terms of average length of stay, average cost, number of obsretricians and number of beds. Multiple regression analysis was done to identify factors explaining the regional variance of various cesarean section rates: In the urban areas, no significant explaining variables were noted except the number of beds for the dependent variable of cesarean section cases per 10 thousand insured eligible females. The smaller the number of bed, the more cases of cesarean section was noted for an urban area. The is mostly because the rate of cesarean section is higher in medium-size hospitals than in large general hospitals. In the rural areas, the factor of education has been found significant for all three dependent variables. The higher the educational level, the rate of cesarean section is most likely to rise. An income variable measured by the amount of monthly insurance contribution has been identified a powerful predictor in explaining the variance of cesarean section rates. The same has been noted for the number of obstetricians. Similar findings are observed for the country as a whole. The income level has been found as the most powerful explaining factor in the regional variance of cesarean section rates. In general the rate is higher in the urban areas, and lower in the area with more small hospitals. As this is the initial attempt to identify the factors relevant to the regional difference in the rates of cesarean section, more elaborated study is urgently required.
Cesarean Section* ; Education ; Fees and Charges ; Female ; Health Resources ; Hospitalization ; Hospitals, General ; Humans ; Insurance ; Jeju-do ; Korea* ; Length of Stay ; Pregnancy

Intramedullary myelitis due to bacterial meningitis associated with cervical epidural abscess is very rare. Its cause and clinical features are non-specific, therefore exact diagnosis is often missed or mistaken for other disease and immediate treatment may be delayed. We report a case of intramedullary myelitis due to epidural abscess presented with prominent symptoms of meningitis and manifestations of acute cerebrovacular accident. A 69 -year-old man was admitted due to right hemicranial headache with pain on right posterior neck and febrile sensation. At first, the patient's headache was improved by conservative therapy. Three weeks later, the patient showed abrupt right hemiparesis (MRC grade 2/5) with drowsy mentality. The CSF findings of the patient were compatible with acute bacterial meningitis. Cervical spine MRI showed cervical epidural abscess and extensive intramedullary myelitis from cervical to lumbar spinal cord. After antibiotic therapy, mentality of the patient became to be alert and right hemiparesis was improved to MRC grade 4/5. Follow up cervical spine MRI after several weeks represented that the lesions of cervical epidural abscess and intramedullary myelitis were significantly diminished.
Diagnosis ; Epidural Abscess* ; Follow-Up Studies ; Headache ; Humans ; Magnetic Resonance Imaging ; Meningitis ; Meningitis, Bacterial* ; Myelitis* ; Neck ; Paresis ; Sensation ; Spinal Cord ; Spine

The purpose of this study is to estimate the minimum optimal scale(MOS) of the self-employed health insurance associations. Considering the high proportion of operating expenses, the author have selected 254 regional health insurance associations from the 1990 Finance Report of the self-employed health insurance programs. both a quadratic function and a hyperbolic function were chosen for the analysis. The dependent variables are the average maintenance cost per insured person and per household, and the independent variables are the number of insured members and of household. The minimum optimal scale was obtained from the differentiation of the quadratic function. Major findings are summarized as follows: 1. The M.O.S. was calculated as 166,174 members (27,442 households) for the rural self-employed health insurance associations and 258,462 members (75,446 households) for the urban. Providing that both the rural and urban health insurance associations would e integrated, the M.O.S. be found to become 231,687 members (68,101 households) 2. Compared with the optimal minimum scale, the magnitude of the current health insurance association found to be much smaller, less than half of the optimal scale. 3. In order to reduce the operating cost, it is necessary to enlarge the operational scale of self-employed health insurance associations.
Family Characteristics ; Humans ; Insurance ; Insurance, Health* ; Korea* ; Urban Health

Bacille Calmette-Guerin (BCG) lymphadenitis is the most common complication of BCG vaccination. It commonly occurs in infants aged <6 months involving ipsilateral axillary lymph nodes. We described BCG lymphadenitis in a 22-month-old boy presenting swelling of left supraclavicular lymph node that was confirmed by real-time polymerase chain reaction (PCR) and the multiplex PCR targeting the region of difference (RD).
Humans ; Infant ; Lymph Nodes ; Lymphadenitis* ; Male ; Multiplex Polymerase Chain Reaction ; Mycobacterium bovis* ; Real-Time Polymerase Chain Reaction ; Vaccination*

PURPOSE: To determine the characteristic CT findings of infectious sacroiliitis and ankylosing spondylitis. MATERIAL AND METHOD: We retrospectively reviewd CT findings in 10 patients with infectious sacroiliitis confirmed by culture and clinical follow ups and in 5 patients with ankylosing spondylitis by HLA-B27 typing. Mean ages were 30 years in ankylosing spondylitis and 29 years in infectious sacroiliits. CT scans were obtained with GE 9800 or Toshiba 900-S scanner. We analyzed CT findings in regard to the morphology and the degree of bone erosion, and the adjacent soft tissue change. RESULT: All cases of ankylosing spondylitis had bilateral and asymmetic bone erosion, predominantly in ilium, showing subchondral sclerosis on ilium. Infectious sacroiliitis showed unilateral involvement and soft tissue swelling in 10 cases and abscess in 5 cases. CONCLUSION: We concluded that CT was useful in the differentiation between infectious sacroiliitis and ankylosing spondylitis.
Abscess ; Follow-Up Studies ; HLA-B27 Antigen ; Humans ; Ilium ; Retrospective Studies ; Sacroiliitis* ; Sclerosis ; Spondylitis, Ankylosing* ; Tomography, X-Ray Computed

We examined the expressions of CD44 splice variants (v4/5, v6), alpha-smooth muscle actin, nm23 to evaluate their roles as prognostic factors in 70 cases of uterine cervical carcinoma (stage IB to IIB) who were surgically treated from January 1989 to June 1990 with a clinical follow-up of a minimum of 5 years. The expression was examined by an immunohistochemical method using archival formalin fixed paraffin embedded tissue. In the 70 cases, 61 cases were squamous cell carcinoma and 9 cases were adenocarcinoma. CD44v4/5, CD44v6, alpha-smooth muscle actin, and nm23 were detected in 41.4%, 70%, 100%, and 74.3% of tumor samples, respectively. CD44 splice variants and nm23 showed membrane and cytoplasmic staining of tumor cells, respectively. The expression of alpha-smooth muscle actin showed cytoplasmic staining confined to stromal cells and was classified into three grades by the extent in stromal cells: with less than 10% of stromal cells; 32.9%, 10-50% of stromal cells; 40.0%, more than 50%; 27.1%. These expressions were not correlated with histologic types, lymph node involvement, recurrence, and grades of tumor infiltrating lymphocyte (TIL). But CD44v4/5 had significantly inverse correlation with TIL (p=0.049). The expression of CD44v4/5 was significantly correlated with that of CD44v6 (p=0.05), and that of alpha-smooth muscle actin was inversely correlated with that of nm23 (p=0.049). In conclusion, in FIGO IB-IIB uterine cervical carcinoma CD44 variants, nm23, and SMA show high prevalence, however, with little prognostic significance assessed by recurrence and lymph node metastasis.
Actins* ; Adenocarcinoma ; Carcinoma, Squamous Cell ; Cytoplasm ; Follow-Up Studies ; Formaldehyde ; Lymph Nodes ; Lymphocytes ; Membranes ; Neoplasm Metastasis ; Paraffin ; Prevalence ; Recurrence ; Stromal Cells ; Uterine Cervical Neoplasms*

Because screening gastrointestinal endoscopies have been widely performed recently, diagnosis rates of early stage cancer have been increasing rapidly. This trend has also led to advances in therapeutic endoscopy, which is less invasive than surgery. The state-of-the-art technique, endoscopic submucosal dissection (ESD), allows more favorable outcomes than conventional endoscopic mucosal resection (EMR) regarding en-bloc resection of the lesion, irrespective of the size of the lesion. ESD has already been established as the standard therapeutic option for neoplastic lesions in the upper gastrointestinal tract. However, the use of ESD for colorectal lesions is not yet established because of the unique pathological, organ specific characteristics of colonic lesions. Moreover, endoscopists are required to have higher qualifications to perform ESD and tend to cause complications more frequently. Nevertheless, it is obvious that ESD has a therapeutic advantage for certain colonic lesions and enables endoscopists to achieve a higher en-bloc resection rate, resulting in enhanced curability and more accurate histopathological assessment. Recent development of a special colonoscope for ESD and refinement of devices such as surgical knives and traction systems are expected to overcome some limitations of ESD and a standard protocol will be available in the near future. In this review, we will discuss the current status and future prospects of colorectal ESD.
Colon ; Colonoscopes ; Colorectal Neoplasms ; Endoscopy ; Endoscopy, Gastrointestinal ; Imidazoles ; Mass Screening ; Nitro Compounds ; Traction ; Upper Gastrointestinal Tract

BACKGROUND: Aspiration of gastric contents is one of the most feared complications during anesthesia. But the routine preoperative order "NPO after midnight" produces thirst, hunger, irritability and other unpleasant experiences in elective inpatients. So, we evaluated the effect of preoperative clear fluid (orange juice) intake, with and without ranitidine, on gastric volume and pH. METHODS: Sixty unpremedicated adult patients, ASA class I or II, scheduled for elective operation were randomly divided into three groups. Group I (n = 20) fasted after midnight. Group II (n = 20) ingested orange juice 150 ml, 2 3 hours before anesthesia. Group III (n = 20) ingested orange juice 150 ml with ranitidine 150 mg, 2 3 hours before anesthesia. As soon as the patients were intubated and stabilized after induction, gastric contents were collected via 16 18 French Salem Sump tube. Gastric volume and pH were measured. RESULTS: Statistically significant differences were found between groups I and II on the hand and group III on the other, in both of gastric volume and pH. But there were no significant differences between groups I and II. CONCLUSIONS: These results suggest that preoperative clear fluid intake does not affect gastric volume and pH. Moreover, concomitant administration of ranitidine decreases gastric volume and increases pH.
Adult ; Anesthesia ; Citrus sinensis ; Hand ; Humans ; Hunger ; Hydrogen-Ion Concentration* ; Inpatients ; Ranitidine* ; Thirst