Camptodactyly is a non-traumatic flexion deformity of the PIP joint of the digit (except thumb) and one of rare congenital anomalies of the hand. It may be a clinical manifestation of some other syndrome and may not be a disease of its own right. It is very difficult for this particular problem to get satisfactory results. We analysed 36 digits of 19 patients, whom we treated and followed up for an average of 1.7 years from 1982 to 1988 at the Department of Orthopedic Surgery, Seoul National University Hospital. The following results were obtained. 1. Male to Female ratio is 8: 11 and age ranged from 14 months to 32 years old. 2. Unilateral and single digit involvement is twice more commonly found than bilateral and multiple digit involvement respectively. 3. Third digit is the most frequently involved one in our series. 4. Besides soft tissue contractures on the volar aspects of the PIP joints, other pathologic findings are thick reddish glistening palmar skin in 6 patients, tendon problems in 4 patients and bone-joint hypoplasia in 1 patient. 5. We have done 3 types of operation, that is, skin graft, flexor tenotomy with skin Z-plasty, extensor reconstruction with flexor tenotomy and skin Z-plasty. The results of operations ranged from good to poor, however most cases showed above fair results at the final follow-up. 6. Camptodactyly seems to be a disease of various etiologies and pathologies. And it is strongly suggested that the treatment of this syndrome should be individualized according to their pathologies found at surgery.
Congenital Abnormalities ; Contracture ; Female ; Follow-Up Studies ; Hand ; Humans ; Joints ; Male ; Orthopedics ; Pathology ; Seoul ; Skin ; Tendons ; Tenotomy ; Transplants

Degenerative arthritis of the lumbar spine is one of the main causes of the low back pain over the fifth decade of life. Nowadays, it seems that the number of obese person increases gradually and the role of Obesity in the development of articular degeneration remains controversial. The authors studied 100 cases of the primary degenerative arthritis of the lumbar spine clinically and statistically and compared 50 cases among these with 2 control groups, with and without low back pain, from Mar. 1982 to Sep. 1982. The results were as follows: 1. Among the patients with the degenerative arthritis of the lumbar spine, the ratio of male to female was 1:4, and the age group with the highest frequency was the 6th decade (47%) 2. 44% was obese in the arthritis group and 26% in the control group with low back pain and 12% in the control group without low back pain. 3. The relative risk of the hypothesis that the arthritic patient is obeser than the patient with low back pain but without degenerative changes on X-ray was 2.3, but the hyposthesis was proved to be statistically insignificant. The relative risk of the hypothesis that the arthriticpatient was obeser than the patient without low back pain and degenerative changes on X-ray was 6.3 and proved to be statistically significant.
Arthritis ; Female ; Humans ; Low Back Pain ; Male ; Obesity ; Osteoarthritis ; Spine

Treatment of femoral shaft fractures in children is varying according to age. Satisfactory results have been obtained with longitudinal skin traction, split Russell traction, ordinary Russell traction, 90-90 skeletal traction, and immediate application of a spica cast(2,4,6,11,15). Most authors use one or more techinques routinely. It is safe and convenient to use single treatment protocol to treat all fractures of same type, Distal femoral skeletal traction with the knee and hip flexed 90 degrees and with the thigh hanging free, using the trunk as counter traction, has been used routinely for femoral shaft fractures in children(age 4-12). We reviewed 30 cases of femoral shaft fractures in children treated with 90-90 skeletal traction. 1. The average age of the patients was 6.8 years(range, 4-12 years), and almost all were caused by pedestrian injury. 2. The average time of traction was 48 days(range, 28-75), and 12 cases(40%) were treated without spica cast application. 3. Four among 30 cases developed angular deformity exceeding acceptable range(15° in AP view, 20° in lateral view), and three of them were proximal third fractures. 4. The older the patient, the longer the duration of limited activity and the more tendency of angular deformity. 5. 90-90 skeletal traction is easy, safe and convenient to treat all femoral shaft fractures of the children between four and ten years old.
Child ; Clinical Protocols ; Congenital Abnormalities ; Hip ; Humans ; Knee ; Skin ; Thigh ; Traction

No abstract available.
Thanatophoric Dysplasia*

Hypertensive encephalopathy is an acute clinical syndrome that shows central nerve dysfunction with sudden and marked elevation in blood pressure. But its pathophysiologic mechanisms, clinical courses and prognosis are still not clear. In order to study clinical manifestations and response to treatment in patients with hypertensive encephalopathy, we reviewed 45 patients with hypertensive encephalopathy who were admitted in Dept. of Internal Medicine, National Medical Center, from January 1975 to December 1984. The following results were obtained: 1) The ratio of male to female was 1.1:1. The peak age of incidence was in the 6th and 7th decade with mean age of 57.5 years. 2) Among 45 patients, only 29 had known history of hypertension and the average duration of hypertension was 8.1+/-3.6 years. 3) The most common sympotm was severe headache (68.9%). And altered consciousness, nausea and/or vomiting, focal neurologic signs and visual disturbance were also common symptoms in decreasing order of frequency. 4) Funduscopic examination showed hypertensive retinopathy in 20 of 24 (91.7%) patients and lumbar puncture revealed increased CSF pressure in 12 of 20 (60%) patients. 5) In most patients, the mean interval to symptomatic improvement was 2.1 days after administration of anti hypertensive agents, but in 6 patients with initial mean arterial blood pressure above 170mmHg, 4 patients showed delayed response and 2 patients were expired.
Antihypertensive Agents ; Arterial Pressure ; Blood Pressure ; Consciousness ; Female ; Headache ; Humans ; Hypertension ; Hypertensive Encephalopathy* ; Hypertensive Retinopathy ; Incidence ; Internal Medicine ; Male ; Nausea ; Neurologic Manifestations ; Prognosis ; Spinal Puncture ; Vomiting

Cryptococcosis is a disease caused by the Cryptococcus neoformans, occcuring most frequently in immunocompromised hosts. Cutaneous involvement is seen in 10-15 % of disseminated cases and its manifestation is variable. A 52 year old man presented with a subcutaneous neck mass and severe headache which had lasted for 2 months and 1 month respectively. Initially cutaneous involvement was monomorphic and localized and a CSF study failed to reveal any organisms. After several weeks of herb medication, however, multiple skin lesions occurred with varied morphology and a CSF study confirmed cryptococcosis by culture. The Urine cortisol was markedly elevated, suggesting an exogenous intake of steroid.
Cryptococcosis* ; Cryptococcus neoformans ; Headache ; Humans ; Hydrocortisone ; Immunocompromised Host ; Middle Aged ; Neck ; Skin

Malignant esophago-bronchial fistula is an incurable and distressing condition. The passage of swallowed saliva and solid or liquid food into the bronchial tree causes coqghing and frequent pulmonary infection and collapse. Most patients are unfit for major surgery, but intubation offers a quick, simple and effective treatment with improved length and quality of life. However, intubation with simple esophageal tubes are liable to result in failure to occlude the fistela, migration of the tube, erosion, and in the case of latex tubes, disintegration. To overcome these problems, the fistula is intubated perorally with a prosthesis surrounded by a foam rubber cuff contained ia silicone sheath, in which vacuum can be created. This cuffed prosthesis is the most satisfactory design for the treatment of malignant esophago-bronchial fistula with effiective and gentle occlusion of the fistula without risk of pressure necrosis. We experienced a case of the endoscopic treatment with a cuffed prosthesis for malignant esophago-bronchial fistula. So we report this case with brief review of the previous literatures.
Bronchial Fistula* ; Esophageal Neoplasms ; Fistula ; Humans ; Intubation ; Latex ; Necrosis ; Prostheses and Implants* ; Quality of Life ; Rubber ; Saliva ; Silicones ; Vacuum

No abstract available.
Neurofibroma* ; Scalp*

This study was designed to evaluate the therapeutic effect between single(A group) and five-day(B group) administration of IV gammaglobulin in the patients with Kawasaki disease from June 1987 to September 1993, who were admitted to the Department of Pediatrcs, Hanyang University College of Medicine. The clinical and echocardiographic results were as follows. 1) Of 90 cases, 40 cases belong to A group, and 50 cases to B group. The ratio of male to female was 2.60 : 1, and 85% of A group and 76% of B group was under the age of 3 years. 2) In 90% of A group and 88% of B group, peak level of platelet count was above 400,000.mm3, and as a whole peak level of platelet in 88.9% above 400,000/mm3. 3) Complications in S group were hepatitis(22.5%), coronary arterial involvement(12.5%), and gall bladder hydrops(7.5%), and in B group hepatitis(26%), gall bladder hydrops(18%), coronary arterial involvement(12%), pericardial effusion(4%), and meningitis(2%). 4) All 5 cases with mild coronary arterial dilatation in a group had improved in follow up echocardiography after 6 months. And in B group, 5 of 6 cases with coronary arterial involvement had improved, but coronary pathology in one case with large coronary aneurysm sustained after 2 years. In conclusion, we could not find the significant difference in reduction of the duration of illness or the coronary arterial disease between two groups, but we recommend single intravenous infusion of gammaglobulin as soon as possible to prevent severe coronary arterial disease.
Blood Platelets ; Coronary Aneurysm ; Dilatation ; Echocardiography ; Female ; Follow-Up Studies ; Humans ; Infusions, Intravenous ; Male ; Mucocutaneous Lymph Node Syndrome* ; Pathology ; Platelet Count ; Urinary Bladder

In carpal injury, a good functional end result seems to correlate with final anatomic alignment of carpus after treatment. Some cases are often misdiagnosed and result in inadequate treatment. Forty six cases of carpal injuries were analysed which were treated for 9 years from 1975 to 1984 at the Department of Orthopedic Surgery, Seoul National University Hospital. The observations can be summarized as follows. 1. The male to female ratio was 3.5: 1 and 82% of total cases were in the third and fourth decades. 2. The most frequent cause of injury was fall from height with outstretched hand. 3. Trans-scaphoid perilunar dislocation and its variant were the most common diagnosis in this analysis. 4. All of the scapho-lunate dissociation showed volar flexion intercalated segmental instability with scapho-lunate gap more than 2 mm in our series. 5. In 11 cases of trans-scaphoid perilunar dislocation and its variant, carpal collapse was found in 10 cases. In 5 cases dorsiflexion intercalated segmental instability pattern and in one case volar flexion intercalated segmental instability pattern were found to be present. 6, There was an increase in scapho-lunate angle in all cases of dorsiflexion intercalated segmental instability, but a decrease in scapho-lunate angle is not a consistent finding in volar flexion intercalated segmental instability. 7. In 24 cases more than 6 months follow-up, excellent and good results were obtained in 20 cases. 8. As a result of above findings, authors conclude that scapho-lunate gap more than 2mm has diagnostic value in scapho-lunate dissociation but that dorsiflexion intercalated segmental instability or volar flexion intercalated segmental instability only means the changes in the relationship between carpal bones and does not have definite or specific diagnostic value for a specific carpal injury.
Carpal Bones ; Diagnosis ; Dislocations ; Female ; Follow-Up Studies ; Hand ; Humans ; Male ; Orthopedics ; Seoul ; Wrist