Equinus deformity of ankle, adduction and flexion deformity of hip and flexion contracture of knee are most common deformities in spastic cerebral palsy. There were many surgical treatment methods according to its causes. Authors has analysed 115 patients(224 operation) who had been operated with three procedure (Modified Egger's op, Proximal hamstring elongation, Distal hamstring elongation) and compared the results of these procedure at Sam Yook Rehabilitation Center from Jan. 1980 to Dec. 1987. The following results are obtained: 1. The results of Modified Egger's operation were unsatisfied because of complicaLion and little angle correction ability of flexion contracture of knee joint. 2. Even though there was no differences in angle correction ability of flexion contracture of knee joint between two procedures, the results of proximal hamstring elongation were superior to them of distal elongtion because early walking ability is more easily improved.
Ankle ; Cerebral Palsy ; Congenital Abnormalities ; Contracture ; Equinus Deformity ; Hip ; Knee Joint ; Knee ; Muscle Spasticity ; Rehabilitation Centers ; Walking

Fractures of the femoral neck in children are rare and usually severe violence to occur, which accounts for the high frequency of associated injuries. Since the femoral neck in children has many anatomic and physiologic differences, not only are there many difficulties during the treatment period, but complications such as post-traumatic coxa vara, avascular necrosis of the femoral head, and premature epiphyseal closure may occur, sixty-two cases in sixty patients of fractures of the femoral neck in children which were treated at Severance Hospital, Yonsei University College of Medicine from Jan. 1971 to Dec. 1987 and at Young-Dong severance Hospital, Yonsei University college of Medicine from May. 1983 to Dec. 1987 were analyzed both clinically and radiologically. The following results were obtained: l. Of the 62 cases, the ratio of boys to girls was approximately 2:1 and the highest incidence was between 4 to 6 years old. 2. The main cause of fracture was traffic accidents, which occurred in 33 cases(53.2%). 3. According to the classification of Delbet and Colonna, the cervicotrochanteric fracture was the most common type(41.9% of the cases) and 29 cases(46.8%) were displaced fractures. 4. Thirty two cases(51.6%) were treated by conservative treatment and twenty eight cases (45.2%) by closed reduction and internal fixation. 5. Common associated injuries were genito-urinary tract injury, soft tissue injury, long bone fracture and pevic bone fractures. 6. All cases were followed for from 14 months to 15 years, average 8 years. 7. The results were analyzed according to Ratliff's assessment and 41 cases(66.1%) showed good results. 8. The total number of cases with complications was 33(53.2%). The most common complication being coxa vara and premature epiphyseal closure(32.2%). 9. Secondary treatment was done in 7 cases and correction osteotomy was done in 4 cases which had showed a good results. The authors found that for the treatment of type IV fractures, closed reduction followed by plaster of Paris immobilization was adeguate but for type I, II, III after early closed reduction, internal fixation was performed as soon as possible using threaded pins as the internal fixation device. The results were poor in type I and type II, fractures with severe displacement, and in cases in which the treatment was delayed due to associated injury.
Accidents, Traffic ; Calcium Sulfate ; Child ; Classification ; Coxa Vara ; Female ; Femur Neck ; Fractures, Bone ; Fractures, Closed ; Head ; Humans ; Immobilization ; Incidence ; Internal Fixators ; Necrosis ; Osteotomy ; Soft Tissue Injuries ; Violence

We experienced one case of severe pituitary dwarfism in a 10 years old female girl. Magnetic resonance image (MRI) revealed transection of the pituitary stalk stalk with the formation of high intensity ectopic posterior lobe located at the median eminence and agenesis of an anterior lobe of pituitary gland. The serum growth Hormone (GH) response to clonidine and L-dopa revealed severe GH deficiency. The patient had responses to TRH, normal TSH and partial prolactin response, respectively. There was not response LH and FSH to GnRH. The morning cortisol concentration and serum T4 concentration were decreased below the normal range. These findings and no hyperprolactinemia suggested the presence of a vascular connection between the pituitary gland and hypothalamus, which is not visible on MRI. Sofar, the primary cause of idiopathic pituitary dwarfism in many patients is injury to hypothalamus by perinatal insults. In this patient, there was no history of perinatal insults and postnatal head trauma but transection of the pituitary stalk. We report a case of severe pituitary dwarfism due to agenesis with brief review of related litereature.
Child ; Clonidine ; Craniocerebral Trauma ; Dwarfism, Pituitary* ; Female ; Gonadotropin-Releasing Hormone ; Growth Hormone ; Humans ; Hydrocortisone ; Hyperprolactinemia ; Hypothalamus ; Levodopa ; Magnetic Resonance Imaging ; Median Eminence ; Pituitary Gland* ; Pituitary Gland, Anterior* ; Prolactin ; Reference Values

Osteoporosis is a skeletal condition that is characterized by reduction in bone volume and an increased vulnerability to fracture, practically of the proximal femur and vertebrae. Unfortunately, osteoporosis does not usually become obvious until a patient presents with a fracture. For this reason, it has been referred to as the silent epidemic. While radiological examination remains the mainstay of diagnosis, there are certain disadvantages associated with this technique. Almost one third of the skeletal mass must be lost before osteoporosis becomes apparent on a plain radiograph and radiological artifacts are not uncommon. Many methods have been developed for quantitative assessment. of the skeleton. So osteoporosis can be detected early and its progression and response to therapy can be carefully monitored. Recently, quantitative computed tomography(QCT) has been investigated as a means for non-invasive quantitative determination of bone mineral density of the spine. Highly signifcant correlation have been found between vertebral trabecular mineral amount and quantity determined by QCT. Furthermore vertebral strength and failure load have been found to correlate well with trabecular density determined by QCT. Authors has analysed bone mineral density(BMD) of 213 patients who visited Severance Hospital, Yonsei University College of Medicine from Jan. 1988 to Sept. 1989. The aims of this study is to compare BMD of osteoporosis group with that of mormal group, to investigate correlation between BMD and age distribution, and to estimate fracture threshold in osteoporosis group. Following results were obtained:l. After 20 years of age, men lose an average of 0.83 per cent of bone per year, and women lose an average of 0.96 per cent per year. Such lost in women seems to be accelerated during and after menopause. 2. The bone mineral densities for the osteoporosis group are lower than those for the normal group by 28.4% for male and 29.7% for female. There was little difference between sex. 3. It is suggested that 90mg/cm3 of BMD is the fracture threshold for the osteoporosis group. 4. The compression fracture rate among post-menopausal women is 38.8%.
Age Distribution ; Artifacts ; Bone Density ; Diagnosis ; Female ; Femur ; Fractures, Compression ; Humans ; Male ; Menopause ; Miners ; Osteoporosis ; Skeleton ; Spine

BACKGROUND/AIMS: The study proposed to evaluate the efficacy of anticancer drugs of intraarterial chemoinfusion and investigate prognostic factors influencing survival. METHODS: A total of 127 patients diagnosed as having advanced hepatocellular carcinoma(HCC) of same stage (TNM stage IVa) from 1996 to 1998 were examined. Two intraarterial infusion chemotherapeutic regimens were employed: Adriamycin(Group I) and Cisplatin(Group II). RESULTS: Overall survival was significantly diffrent(10.0 vs 5.7months) and favored Group I. By the univariate analysis, significant prognostic factors included: age, portal vein thrombosis(PVT), size(>5cm) and type of tumor, response rate (size & -fetoprotein) at 3 months after therapy, level of albumin, alkaline phosphatase, and total bilirubin. After repeated therapy, Group I showed better survival (14.0 vs 7.9 months), but there was no statistical difference in survival rate between two groups in the case of large size, PVT, and diffuse type. CONCLUSION: Group I showed better survival than Group II in advanced HCC of TNM stage IVa. But, considering prognostic factors, there was no significant difference in survival rate between two groups except small size or nodular type of HCC. TNM classification of stage IVa should be reconsidered to include prognostic factors influencing survival rate such as PVT, size and type of HCC.
Alkaline Phosphatase ; Bilirubin ; Carcinoma, Hepatocellular* ; Classification ; Humans ; Infusions, Intra-Arterial ; Neoplasm Staging ; Portal Vein ; Psychotherapy, Group ; Survival Rate ; Treatment Outcome*

Matrix metalloproteinases have long been viewed as ideal candidates for proteinases that enables tumor cells to permeated basement membrane defenses and invade surrounding tissue. There is growing evidence that the MMPs have an expanded role, as they are important for the creation and maintenance of a microenvironment that facilitates growth and angiogenesis of tumors at primary and metastatic sites. MT-MMPs are not secreted but instead remaining attached to cell surfaces. Although not all of the MT-MMPs are fully characterized, MT-MMPs have important role in localizing and activating secreted MMPs. The MMP genes are transcriptionally responsive to a wide variety of oncogene, growth factors, cytokine, and hormones. Currently, a number of MMP inhibitors are being developed and some have reached clinical trials as anti-metastatic or anti-cancer therapies. MT1-MMP is involved in the activation of proMMP-2. MT1-MMP is significant not only as a tumor marker but as a new target for chemotherapy against cancer. The purpose of this study was to evaluate the effects of protein kinase C inhibitor(genistein) on the proliferation of HT1080 and expression of MT1-MMP mRNA. Human fibrosarcoma cell line HT1080 was cultured and divided 2 groups. The experimental group was treated with 100 microM genistein and incubated 12h, 24h for [3H]-thymidine uptake assay and northern hybridization individually. And the control group was treated with same amount of PBS for the above procedures. [3H]-thymidine incorporation was measured with beta ray detector. And RT-PCR and northern blotting for MT1-MMP mRNA was performed. The results were as follows 1. [3H]-thymidine uptake was reduced in experimental group with statistical significance. 2. MT1-MMP mRNA expression was significantly reduced in experimental group. These results showed that protein kinase C inhibitor (genistein) inhibited proliferation of HT1080 and almost completely blocked transcription of MT1-MMP mRNA. So, it is possible to use the protein kinase inhibitor (genistein) as anti-metastatic and anti-proliferative agent.
Basement Membrane ; Beta Particles ; Blotting, Northern ; Cell Line ; Drug Therapy ; Fibrosarcoma ; Genistein* ; Humans ; Intercellular Signaling Peptides and Proteins ; Matrix Metalloproteinase 14 ; Matrix Metalloproteinase Inhibitors ; Matrix Metalloproteinases ; Membranes* ; Neoplasm Metastasis ; Oncogenes ; Peptide Hydrolases ; Protein Kinase C ; Protein Kinases ; RNA, Messenger*

OBJECTIVE: This study was conducted to elucidate the associations of HLA with systemic sclerosis (SSc) in Koreans. METHODS: HLA associations with SSc according to SSc-specific autoantibody status and clinical subsets (diffuse and limited) were investigated. HLA-A, B, and C antigens were typed by the serological method using microlymphocytotoxicity test, and HLA-DR by DNA typing method using PCR-reverse hybridization and PCR-SSCP in 56 Korean patients with SSc and 226 healthy controls. For SSc patients, anti-Scl-70 and anicentromere antibodies were tested by double immunodiffusion and indirect immunofluorescence, respectively. RESULTS: The results of HLA class I antigen typing showed that the frequencies of HLA-A24, B52 and B62 were increased, whereas those of A33, B44 and B58 were decreased in SSc patients compared to healthy controls. The frequency of HLA-DR2 was significantly increased, whereas that of HLA-DR13 was decreased in patients with SSc compared to controls. Among HLA-DR2 alleles, both HLA-DRB1*1501 and *1502 were increased in SSc patients compared to controls. According to clinical status, HLA-DRB1*1501 was increased in limited SSc patients and that of DRB1*1502 was increased both in diffuse and limited SSc patients compared to controls. According to autoantibody status, HLA- DRB1 1502 was significantly increased in anti-Scl-70-positive SSc patients and that of DRB1 1501 was increased in anti-Scl-70-negative SSc patients compared to controls. The association of HLA-DR2 alleles with SSc according to clinical subsets and anti-Scl-70 antibody status revealed that the frequency of HLA- DRB1 *1501 was significantly increased in anti-Scl-70-negative limited SSc patients compared to controls. CONCLUSIONS: These results suggest that different HLA-DR2 alleles are associated with different types of SSc in Koreans. HLA-DRB1 1502 shows strong association with anti-Scl-70-positive SSc, and DRB1 1501 with anti-Scl-70-negative limited SSc. It is concluded that the pathogenesis of SSc in Koreans is in part, based on the same genetic background.
Alleles ; Antibodies ; Asian Continental Ancestry Group ; DNA Fingerprinting ; Fluorescent Antibody Technique, Indirect ; HLA-A Antigens ; HLA-A24 Antigen ; HLA-DR Antigens ; HLA-DR2 Antigen ; HLA-DRB1 Chains ; Humans ; Immunodiffusion ; Scleroderma, Systemic*

BACKGROUND/AIMS: We studied to evaluate the virological and biochemical responses to lamivudine and to detect YMDD mutants in patients who received long-erm lamivudine therapy. METHODS: We conducted a one-ear trial of lamivudine in 45 Korean patients with chronic liver disease due to hepatitis B virus. The patients were treated with a single oral average dose of 100 mg of lamivudine every day for 12 months. RESULTS: The suppression of serum HBV DNA was sustained in 77.8% of the patients and the normalization of serum ALT in 80%. The proportions of patients with HBeAg seroconversion were 25%. YMDD mutants were detected in 4 of 8 patients who showed sustained HBV DNA and serum ALT response (n=31) and in 3 of 8 patients who showed HBV DNA or serum ALT breakthrough (n=9). The response to lamivudine therapy in HBeAg-egative patients was excellent. CONCLUSION: Lamivudine therapy resulted in a significant virological and biochemical improvements and were well tolerated. But, YMDD mutants were detected during lamivudine therapy.
DNA ; Hepatitis B e Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Lamivudine* ; Liver Diseases* ; Liver*

To evaluate the coronary vasomotor tone in vasospasic angina, we compared the diameters of non-spastic segments of vasospastic group with those of control group. The internal diameters of each segment of three major coronary arteries were measured on the basal coronary angiogram, and nitroglycerin administration after provocation with ergonovine or acetylcholine. The vasospastic angina group consisted of 26 patients(20 males, 6 females, mean age of 54 years) and control group consisted of 25 patients (7 males, 18 females, mean age of 55 years). The basal coronary arterial diameters in vasospastic angina group were smaller than those in control group(p<0.05) except the distal segment of right coronary artery. The percent dilation ratio in vasospastic angina group was greater than that in control group(p<0.05). In vasospastic angina group there was no significant difference in the degree of constriction after provocation with ergonovine or acetylcholine between proximal and distal segment. These observations suggest that in vasospastic angina, basal coronary arterial tone is increased in the entire coronary arterial tree and the localized spasm may reflect local hyperrespon siveness.
Acetylcholine ; Constriction ; Coronary Vessels ; Ergonovine ; Female ; Humans ; Male ; Nitroglycerin ; Spasm

Myelodysplastic syndromes (MDS) are a group of refractory anemias resulting from a clonal stem cell disorder often associated with cytogenetic abnormalities. There is increasing recognition of immunological abnormalities in patients with MDS, including defective B- and T-cell function, hyper- or hypogammaglobulinemia and monoclonal gammopathy. MDS have been associated with Sjogren's syndrome, polymyalgia rheumatica, relapsing polychondritis and systemic lupus erythematosus. Although there may be various rheumatologic features, including acute arthritis in MDS, chronic inflammatory arthritis is uncommonly combined. There have been a few reports that described cases of rheumatoid arthritis (RA) concurrent with MDS, but advanced rheumatoid arthritis with typical joint deformities has rarely been reported. We report a case of rheumatoid arthritis with atlantoaxial subluxation combined with refractory anemia in a 31-year-old woman.
Adult ; Arthritis, Rheumatoid/radiography ; Arthritis, Rheumatoid/pathology ; Arthritis, Rheumatoid/complications* ; Arthritis, Rheumatoid/blood ; Case Report ; Female ; Follow-Up Studies ; Human ; Myelodysplastic Syndromes/pathology ; Myelodysplastic Syndromes/complications* ; Myelodysplastic Syndromes/blood