A consensus of current surgical practice favors external skeletal fixation in the patients with open fractures, where it can be difficult to achieve a good position and fixation by the usual methods and ipsilateral multiple fractures where it is desirable to avoid prolonged immobilization of adjacent joints. From March, 1979 to December, 1981, 34 patients with lower limb fractures were treated by the method of external skeletal fixator. 22 patients had open comminuted fractures with extensive soft tissue injuries and 12 patients had multiple fractures which were difficult to reduce and maintain in alignment. In the 30 patients which could be assessed, the final result was excellent or good in 23 patients, acceptable in 5 patients, and poor in 2 patients.
Consensus ; Fracture Fixation ; Fractures, Comminuted ; Fractures, Multiple ; Fractures, Open ; Humans ; Immobilization ; Joints ; Lower Extremity ; Methods ; Soft Tissue Injuries

PURPOSE:Cardiovascular morbidity has recently been demonstrated to potentially reduce life expectancy in growth hormone deficiency(GHD). The aim of this study was to evaluate cardiovascular abnormalities and atherosclerotic changes in adults with childhood-onset GHD in whom GH treatment had been stopped at the achievement of final height. METHODS:Nine patients with childhood-onset GHD(7 idiopathic and 2 organic), with an age of 24.0+/-.0 year, were studied. Clinical characteristics of subjects were determined and blood pressure, body mass index(BMI), and serum concentrations of lipids were measured. Structural and functional evaluation of cardiovascular system was performed by M-mode echocardiography and linear phase array imaging transducer. RESULTS:BMI of patients was 27.3+/-.7 mg/m2, and four patients(44%) were overweight(BMI 25-30 mg/m2), but none was obese(BMI >30 mg/m2). The percentage of patients who had total cholesterol > or = 200 mg/dL, triglyceride > or = 150 mg/dL, LDL cholesterol > or = 140 mg/dL, and HDL cholesterol < or = 40 mg/dL were 56%, 44%, 33 %, and 44%, respectively. Interventricular septum thickness(IVST), left ventricular posterior wall thickness(LVPWT), left ventricular end-diastolic internal diameter (LVID), left ventricular mass index(LVMI) of patients were 6.4+/-2.1 mm(SDS -1.5+/-1.1), 6.3+/-1.2 mm(SDS -2.1+/-0.8), 44.9+/-4.3 mm(SDS -1.0+/-0.9), and 85.4+/-94.8 g/m2 (SDS -0.5+/-6.8), respectively. The number of patients whose IVST, LVPWT, LVID, and LVMI were decreased(<-2SD) were 4(44%), 5(56%), 1(11%), and 6(67%), respectively. Carotid artery intima-media thickness(IMT) was 0.86+/-0.22 mm, and it was increased(>2SD) in 3 patients(33%). Three out of four patients with IVST lower than -2SD had increased carotid artery IMT, whereas none of five patients with IVST higher than -2SD had increased carotid artery IMT. There were no differences in echocardiographic findings between groups according to sex, age, duration of disease, duration after GH discontinuation, BMI, and severity of dyslipidemia. CONCLUSION: Decreases in IVST, LVPWT, and LVMI, and an increase in carotid artery IMT were observed in a significant number of patients with childhood-onset GHD. These findings support the need of GH replacement after completion of growth and careful evaluation of cardiovascular changes in patients with childhood-onset GHD.
Adult* ; Blood Pressure ; Cardiovascular Abnormalities* ; Cardiovascular System ; Carotid Arteries ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Dyslipidemias ; Echocardiography ; Growth Hormone* ; Humans ; Life Expectancy ; Transducers ; Triglycerides

PURPOSE:Improved adult final height(FH) is a major goal in the treatment of children with short stature due to growth hormone deficiency(GHD). The purpose of this study was to evaluate final height in idiopathic and organic GHD children after long-term growth hormone(GH) treatment. METHODS:Twenty five(16 males and 9 females) patients with GHD(14 idiopathic and 11 organic GHD) were included. GHD was diagnosed by two or more GH provocation tests(peak GH level <10 ng/mL). All subjects had multiple pituitary hormone deficiencies, and aged 10.7+/-.5(5.5-14) years at the start of GH treatment. The patients were treated with GH 0.45-0.7 IU/kg/week in 3-7 divided doses for 6.9+/-.8(5.2-10) years. Treatment was ended when growth velocity reached lower than 2 cm/year and/or bone age reached 16 years. Standard auxologic measurements were performed at the start of GH treatment and at every 6 month after initial GH treatment. RESULTS:FH was 166.9+/-.8 cm, which was not significantly lower than target height(167.1+/-.9 cm) and predicted adult height(169.1+/-5 cm). FH SDS was significantly improved to -0.8+/-.5 compared with -3.4+/-.0 of height SDS at the start of GH treatment. The largest height increment was observed in the first year of GH treatment, with a gradual decrease in the following years. There was no difference in FH and FH SDS between idiopathic and organic GHD. Unwanted serious adverse events were not observed in all patients during GH therapy. CONCLUSION: Early diagnosis and continuous treatment with optimal doses of GH to near adult height improve the outcome in children with short stature due to idiopathic and organic GHD.
Adult ; Child* ; Early Diagnosis ; Growth Hormone* ; Humans ; Male

All clinical studies reported in the literature have indicated that non-operative treatment is the treatment of choice for the diaphyseal fractures of the clavicle. It has also been suggested by some that open reduction may contribute the development of nonunion. From 1985 to 1989, 23 of 133 diaphyseal fractures of the clavicle were treated by open reduction and internal fixation with the intramedullary pinning with or without cerclage wiring, or prebent plate and screw fixation with supplementary iliac bone graft in each instance. All fractures healed without any complication such as the infection, pin migration, other fixation failure, neurovascular accident, and pseudarthrosis. Based on our experience and review of the literature, we concluded that the indications for open reduction and internal fixation should be: 1. The patient's inability to tolerate prolonged immobilization or recumbency in multiple injury. 2. Widely distracted or displaced fractures in adults. 3. Comminution with one or more large butterfly fragments. 4. Neuro-vascular compromise due to displacement and impingement of the bone fragment. 5. Symptomatic delayed union or nonunion. 6. Refracture. And early operative treatment is safe, reliable and provide excellent results comparable to the conservative treatments.
Adult ; Butterflies ; Clavicle ; Humans ; Immobilization ; Multiple Trauma ; Pseudarthrosis ; Transplants

This study was undertaken to investigate the effect of anesthesia(balanced anesthesia) and surgery on plasma thyroxine and triiodothyronine levels in ten surgical patients by means of the radioimmunoassay method which provides a quantitative measure of thyroid function. The sex ratio between male and female patients was 1:1, mean age was 30.1+/-12.26 and the average body weight was 57.38+/-15.81kg. The plasma triiodothyronine level before anesthesia and surgery was 138.1+/-32.64(ug/dl) but at 90 minutes and 120 minutes after anesthesia and surgery they were 100+/-19.64(ug/dl) and 92.4+/-7.49(ug/dl) respectively. The plasma thyroxine level remained unchanged during anesthesia and surgery. Consequently there was a statistically significant decreased level in plasma triiodothyronine but there was no change in plasma thyroxine level during anesthesia and surgery.
Anesthesia* ; Balanced Anesthesia* ; Body Weight ; Female ; Humans ; Male ; Plasma* ; Radioimmunoassay ; Sex Ratio ; Thyroid Gland ; Thyroxine* ; Triiodothyronine*

Lupus erythematosus panniculitis is a rare variant of lupus erythematosus primarily involving a panniculus with or without discoid lupus erythematosus in the overlying skin. A 34-year-old woman showed multiple, variable-sized, indurated subcutaneous nodules on both her upper arms and axillae. A Histopathological examination revealed lobular panniculitis with infiltration of several hyperchromatic atypical large lymphocytes. The infiltrated cells were positively stained with LCA, UCHL-1, CD4, CD8, but not with CD20 and CD68. A T cell receptor -chain gene and immunoglobulin heavy chain gene rearrangement study showed no monoclonality. The result of an ANA test was positive at 1: 40 in a homogeneous pattern. Skin lesions were improved by combined therapy with daily hydroxychloroquine 400mg and prednisolone 10mg in a week and after 6weeks, resolved with atrophic depressed scars. After 4 months, she complained of symptoms of the Raynaud phenomenon and was managed by nifedipine. There has been no recurrence during follow-up for 7 months.
Adult ; Arm ; Axilla ; Cicatrix ; Female ; Follow-Up Studies ; Gene Rearrangement ; Humans ; Hydroxychloroquine ; Immunoglobulin Heavy Chains ; Lupus Erythematosus, Discoid ; Lymphocytes* ; Nifedipine ; Panniculitis ; Panniculitis, Lupus Erythematosus* ; Prednisolone ; Raynaud Disease ; Receptors, Antigen, T-Cell ; Recurrence ; Skin

We herein present a case of a 2-year-old girl with non-Hodgkin's lymphoma(NHL) of the lymphoblastic type involving cutaneous sites at the time of diagnosis. The histological finding was typical of lymphoblastic lymphoma. However, immunophenotypically, this lymphoma was not of the T-cell or B-cell type, although the vast majority of lymphoblastic lymphomas involving the skin are usually of the pre-B cell or T-ce11 type. Until now, there have been few reports of non-T, non-B primary cutaneous lymphoblastic lymphoma expressing surface CD10 and CD56 antigens as in this case.
Antigens, CD56 ; B-Lymphocytes ; Child, Preschool ; Diagnosis ; Female ; Humans ; Lymphoma ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Precursor Cells, B-Lymphoid ; Skin ; T-Lymphocytes

We herein report a case of secondary cutaneous diffuse large B-cell lymphoma(DLBCL) occurring in a 66-year-old woman. The skin lesions were erythematous infiltrative nodules on the right inguinal area. Histologically, the skin lesion disclosed DLBCL mainly composed of immunoblasts. Concurrently, she showed lymph node involvement. Initially, however, we could not define the conclusive temporal sequences between nodal lesions and skin lesions. Finally, additional further studies revealed this case as secondary cutaneous 8-cell lymphoma, and she was managed with systemic chemotherapy.
Aged ; B-Lymphocytes* ; Drug Therapy ; Female ; Humans ; Lymph Nodes ; Lymphoma ; Lymphoma, B-Cell* ; Skin

Peripheral T-cel1 lymphoma(PTCL) encompasses histopathologically and clinically various spectra of cutaneous T-cell lymphoma(CTCL). In this report, we describe two cases of PTCL showing diRerent clinical courses according to EBV(Epstein-Barr virus) positivity. The chnical course of case 1 with EBV-associated PTCL was rapidby fatal and refractory to intensive chcmotherapy. However, in case 2, EBV genomes were not found in her lesional tissues and she showed an indolent clinical course withoaat systemic symptoms. Accordingly, serological and immunohistochemical investigations for EBV might be mandatory in cutaneous PTCL to evaluate clinical prognosis.
Genome ; Herpesvirus 4, Human* ; Immunoblastic Lymphadenopathy* ; Lymphoma* ; Lymphoma, T-Cell, Peripheral ; Prognosis ; T-Lymphocytes

We herein report a case of nasal type T/natural killer(NK)-cell lymphoma(TNKCL). This lymphoma is characterized by the expression of CD2, CD43 and NCAM(CD56) antigen, an aggressive clinical course, frequent extranodal spreading, a strong association with Epstein-Barr virus(EBV), and the absence of T-cell receptor(TCR) gene rearrangement. NCAM antigen is known to be a possible determinant of extranodal dissemination of peripheral T-cell lymphoma(PTCL). The patient is a 70-year-old male with skin lesion on his forearm. Histopathological and immunohistochemical studies were diagnostic of EBV-associated TNKCL. Untill now, he has failed to respond to anticancer therapy.
Aged ; Forearm ; Gene Rearrangement ; Herpesvirus 4, Human ; Humans ; Lymphoma* ; Male ; Neural Cell Adhesion Molecules ; Skin ; T-Lymphocytes