In the past several years, total hip replacement arthroplasty has become an established procedure in the management of painful arthritic hips in older adults. It is still gaining an increasing popularity as experience has accumulated and indications broadened. The authors reviewed the first 47 total hip replacement arthroplasties in 41 patients performed at the Department of Orthopedic Surgery, Seoul National Univerity Hospital, during the period of 4 years and 8 months, from April 1972 to November 1976. The longest follow-up was 4 years and 8 months and the shortest 1 month, the average being 2 years and 1 month. The youngest age was 17 years and the oldest 71 years, the average being 41 years. There were 26 males and 15 females. The underlying etiology was as follows: primary osteoarthritis 4 hips, avascular necrosis 12 hips, septic hip residua 18 hips (pyogenic 11 hips, tuberculosis 7 hips), rheumatoid arthritis 3 hips, failed previous operation 3 hips (failed endoprosthesis 2 hips, failed total hip replacement 1 hip), secondary osteoarthritis 5 hips (congenital dislocation 4 hips, Legg-Perthes disease 1 hip), and nonunion of femoral neck 2 hips. Following types of prosthesis were used; Sbarbaro 3, Charnley 8 (including custom-made extralong, narrow stem and extra-small stem prostheses), Muller 22, and Trapezoidal-28 14. The results were evaluated by the methods of Harris and d'Aubigne, both preoperatively and postoperatively, In the average, Harris' score improved from 57 to 92 (gains of 35) and the d'Aubigne rating from 10.4 to 16.8 (gains of 6.2) following operations.
Adult ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Dislocations ; Female ; Femur Neck ; Follow-Up Studies ; Hip ; Humans ; Legg-Calve-Perthes Disease ; Male ; Necrosis ; Orthopedics ; Osteoarthritis ; Prostheses and Implants ; Seoul ; Tuberculosis

Xeroderma pigmentosum, a rare, genetically determined dermatosis, is often cornplicated by malignant chagnes of various types-most commonly, basal-cell epithelioma, squamous cell epithelioma, less frequently malignant meIanoma, keratoacanthoma, fibrosarcoma, and endothelioma have been reported. In Korea, no case has ever been reported in literature except four cases at a symposium for dermatology, two of them complicated by basal-cell epithelioma, and the others by squamous cell epithelioma. This case reported was complicated by squamous cell epithelioma. As one of the anticancer treatments, especially for skin cancer, Bleomycin is, now, drawing the attention for its high therapeutic index with only few side effects. For this case, we injected Rleomycin 15mg at once, twice a week, for 8 weeks, So total injection was 16 times and 240mg of Bleomycin was given in total. While this amount given for this case was not enough for the complete treatment of squamous cell epithelioma, we got the following results: 1. Clinically, the ulcerated lesion of the cancer on the right ala nasi had shrunken in size with reepithelialization at the margin showing clear surface, and 2. microscopically, the atypical cancer cell masses and individual cell keratinizations had been decreased in size and in number, and less remarkable comparing to those in untreated stage at his first visit to the hospital.
Bleomycin* ; Carcinoma* ; Dermatology ; Fibrosarcoma ; Keratoacanthoma ; Korea ; Skin Diseases ; Skin Neoplasms ; Ulcer ; Xeroderma Pigmentosum

Initial success with total hip arthroplasty on those severely crippled, painful hips in elderly people has prompted its application to a broad variety of conditions; namely, primary and secondary osteoarthritis, rheumatoid arthritis, avascular necrosis of the femoral head, and failed arthroplasties. Some have attempted it on previously arthrodesed hips, while others have successfully treated failed Girdlestone by total hip arthroplasty. To date, however, total hip arthroplasty remains essentially a procedure for older people. It has been greatly emphasized that total hip arthroplasty on 29 cases of residual hips secondary to pyogenic or tuberculous infection occurred during childhood. All were young adults ranging from 17 to 56 years of age, with a mean age of 32. 1 years. None of the hips had active infection at time of operation, although in 2 cases biopsy, at the arthroplasty, revealed chronic granulomatous inflammation. The hips had bony or fibrous ankylosis,or pseudarthrosis with dislocation, and presented marked flexion deformity, bony hypoplasia, limb shortening, and muscle atrophy. In 6 cases, arthroplasty was preceded by preliminary anterior soft tissue release and osteotomy of the ankylosis, followed by skeletal traction. In one case, anterior release through a separate incision was carried out on the same setting prior to arthroplasty. Lateral approach with trochanteric osteotomy was routinely employed, except in two in which the hip was approached posteriorly without trochanteric osteotomy. Trapezoidal-28 prosthesis was used in 17 cases, 5 of which were of short neck, thin stem sized, 7 of which were of medium neck small stem sized. Muller prosthesis was used in 8 cases, 7 of which were of standard neck standard stem sized. One small straight stem Charnley prosthesis failed and was later replaced by a custom-made Charnley stem prosthesis. Two offset bore ovoid cup and Charnley extra-small stem were used. In addition to routine preoperative, intraoperative, and postoperative antibiotics, Kanamycin was mixed to cement routinely. There was no postoperative wound infection. In two cases with presumably healed tuberculosis, infection recurred after arthroplasty. In all the remaning hips, painless serviceable function was restored, especially in view of diverse range of motion in orientals. In the oriental life style, the importance of a mobile hip cannot be overstressed.
Aged ; Ankylosis ; Anti-Bacterial Agents ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Biopsy ; Congenital Abnormalities ; Dislocations ; Extremities ; Femur ; Head ; Hip ; Humans ; Inflammation ; Kanamycin ; Life Style ; Muscular Atrophy ; Neck ; Necrosis ; Osteoarthritis ; Osteotomy ; Prostheses and Implants ; Pseudarthrosis ; Range of Motion, Articular ; Surgical Wound Infection ; Traction ; Tuberculosis ; Young Adult

Total hip arthroplasty was performed on a 32 year old man with hemophilia A. A series of complications were encountered; namely, femoral shaft fracture during arthroplasty, hemolytic anemia, Factor VII inhibition, pseudotumor formation and wound dehiscence and sepsis as a result of shortage of cryoprecipitate supply, and general debilitation and septicemia from fhe use of immunosuppressive agents, finally leading to death 67 days after operation. Initially, 399 bottles of cryoprecipitate (each containing approximately 100 units of Factor VII) were anticipated. In practice, however, a total of 660 bottles and packs had been consumed on the patient when the supply was exhausted. Total hip arthroplasty can be carried out on hemophilia patients, provided that the planning be impeccable and the supply of antihemophilic factor virtually unlimited.
Anemia, Hemolytic ; Arthritis ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Factor VII ; Hemophilia A ; Humans ; Immunosuppressive Agents ; Sepsis ; Wounds and Injuries

Our experience with recurrent dislocation of the patella on ten knees in eight patients seen at Seoul National University Hospital during the last 2 years and eight months is reported. Five were female and three male. The age ranged from seven to 27 years. In four of the patients the onset was attributable to a definite history of trauma, while in one patient the dislocation was considered due to developmental anomalies and in another it was clearly congenital Still another patient had a progressively short limb due to premature closure of the distal femoral epiphysis with accompanying flexion-valgus deformity of the knee, presumably caused by an unrecognized infection during early childhood One adolescent girl had bilateral knock knees. The knock knees were treated successfully by supracondylar osteotomy and one post-traumatic knee by classical Roux-Goldthwait procedure with equally excellent result, The rest were treated by Greens vastus medialis transfer with division of the iliotibial band or reefing of the medial joint capsule when necessary. In one knee dislocation recurred, probably due to avulsion of the transferred vastus, and two knees had residual subluxation and limitation of flexion. The results on the remaining seven knees were excellent.
Adolescent ; Congenital Abnormalities ; Dislocations ; Epiphyses ; Extremities ; Female ; Genu Valgum ; Humans ; Joint Capsule ; Knee Dislocation ; Knee ; Male ; Osteotomy ; Patella ; Quadriceps Muscle ; Seoul

Two cases of old unreduced dislocation of shoulder are reported. One was the posterior dislocation for six months with malunited fracture of humeral shaft in thirty degree lateral angulation. Her shoulder and arm aches with limitation of motion remaining only ten degrees in every direction but abduction in thirty degrees, The malunion of humeral shaft and shoulder were reduced surgically in result of eighty degrees abduction, seventy degrees flexion, sixty degrees extension and twenty degrees of external rotation with free of pain. Another case was an anterior dislocation for one year. Her range of shoulder motions are almost normal degree but brachial plaxus compression symptoms. Open reduction in practically Putti-Platt procedure was performed. She became completely free of brachial plexus symptom and ranges of shoulder motion are normal except about fifteen degrees less external rotation than preoperative condition. The surgical indication and the result of treatment were discussed for the the neglected cases of old unreduced dislocation of the shoulder.
Arm ; Brachial Plexus ; Dislocations ; Fractures, Malunited ; Shoulder

No abstract available.
Hypopituitarism* ; Magnetic Resonance Imaging ; Pituitary Gland*

Acute suppurative thyroiditis is uncommon in children. The relative rarity of thyroid infection is thought to reflect its complete fibrous encapsulation, generous vascular and lymphatic supply and high local iodine level. The bacterial involvement include the normal oropharyngeal microflora, and broad spectrum antibiotic therapy including anaerobic coverage should be utilized initially. We have experienced three cases of acute suppurative throiditis. All of them had painfull swelling on anterior cervical area and diagnosed by clinical and radiological features. Since two of them occured repeatedly, we report with brief review of literatures.
Child* ; Humans ; Iodine ; Thyroid Gland ; Thyroiditis, Suppurative*

sodium hyaluronate in beagle dogs. METHODS:In group 1, hGH(Eutropin, r-hGH) 0.29mg/kg was injected subcutaneously to 6 beagle dogs everyday for 7 days. In group 2, 1mg/kg in sustained- release formulation using sodium hyaluronate(SR-hGH), was injected subcutaneously to 6 beagle dogs. In group 3, 2mg/kg of the same formulation(SR-hGH) was injected subcutaneously to 6 beagle dogs. Blood samplings were done for the measurement of GH and IGF-1 concentrations with ELISA kit(Diagnostic Systems laboratories, Inc., USA) RESULTS:GH concentration in group 1 was below 0.5ng/ml before injection and elevated to 98.1+/-15.7 at 1 hr, 124.2+/-15 at 2 hr, 57.8+/-18.1 at 4 hr, 23.8+/-4.8 at 6hr, 10.8+/-3.7 at 8 hr, 2.8+/-1.6 at 10 hr, 1.0+/-0.7 at 12 hr, and 0.5+/-0.1ng/ml at 24hr after injection. Peak GH concentration was observed in 2 hr and thereafter decreased progressively and returned to basal level at 10 hr after injection. From the 2nd day GH concentration was measured only at 6 hr after daily GH injection, indicating the values of 20.9+/-8.7, 16.2+/-14.9, 23.1+/-8.5, 34.3+/-9.9, 16.1+/-7.0, and 21.8+/-13.0ng/ml at 2nd, 3rd, 4th, 5th 6th, and 7th day, respectively. GH concentrations in group 2(SR- hGH 1mg/kg) were 136.7+/-22.8 at 1hr, 149.3+/-29.9 at 2hr, 110.6+/-17.8 at 4hr, 103.7+/-18.2 at 6hr, 108.3+/-21.0 at 8hr, 91.4+/-21.4 at 10hr, 79.6+/-15.9 at 12hr, 23.7+/-8.3 at 24hr, 5.5+/-1.5 at 30hr, 0.7+/-0.2 at 48hr, 1.4+/-1.4 at 54hr, and 0.5+/-0.1ng/ml at 72hr after injection. GH concentration was elevated above the basal level for 72hr with the peak at 2hr after injection of SR-hGH of 1mg/kg. GH concentrations in group 3(SR-hGH 2.0mg/kg) were 196.7+/-45.2 at 1hr, 219.4+/-39.8 at 2hr, 198.1+/-38.0 at 4hr, 196.0+/-31.4 at 6hr, 179.2+/-28.3 at 8hr, 151.8+/-19.5 at 10hr, 141.3+/-23.1 at 12hr, 72.9+/-14.7 at 24hr, 43.7+/-14.2 at 30hr, 3.8+/-1.6 at 48hr, 1.6+/-0.5 at 54hr, 0.8+/-0.5 at 72hr, 0.5+/-0.1 at 78hr, and 0.5+/-0.2ng/ml at 120hr. Peak GH concentration occurred at 2hr after injection and remained high concentration till 72hr and returned to basal level thereafter. IGF-1 concentrations in group 1 changed from 190.5+/-68.1ng/ml before injection, to 326.4+/-96.2, 346.4+/-79, 391.4+/-86.9, 417.0+/-96.1, 422.1+/-92.0, 429.9+/-86.4, and 478.0+/-90.2ng/ml at 12hr, 30hr, 54hr, 78hr, 102hr, 126hr, and 150hr, respectively. IGF-1 concentrations in group 2 were 128.5+/-37.0 ng/ml before and 268.0+/-64.2, 307.6+/-63.1, 374.8+/-55.3, 335.5+/-39.4, 301.9+/-44.8, 288.5+/-42.5, 272.8+/-51.8, 273.9+/-46.0, 251.1+/-40.9, and 239.2+/-45.0ng/ml at 24hr, 30hr, 48hr, 54hr, 72hr, 78hr, 96hr, 102hr, 126hr, and 150hr, respectively after injection. Peak IGF-1 concentration was measured at 48hr and remained in high concentration till 150hr after injection. IGF-1 concentrations in group 3 were 116.0+/-68.9ng/ml before and 365.5+/-118.6, 400.0+/-135.1, 463.6+/-138, 450.2+/-140.0, 337.2+/-122.4, 301.4+/-113.4, 236.3+/-89.1, 226.3+/-75.5, 148.9+/-55.2, and 129.8 48.4ng/ml at 24hr, 30hr, 48hr, 54hr, 72hr, 78hr, 96hr, 102hr, 126hr, and 150hr, respectively after injection. Peak IGF-1 concentration was at 48hr and remained in high concentration till 150 hr after injection. There was no significant difference in IGF-I conc between group I and group 3. CONCLUSION: Sustained-release form(1mg or 2mg/kg) of hGH with sodium hyaluronate released GH for 72 hours with the peak level at 2 hours and higher concentration of IGF-I above baseline maintained for 150 hour after injection with peak level at 48 hour. There was no difference in IGF-1 concentration between SR-hGH 1mg/kg and 2mg/kg injection. So sustained release form 1mg/kg will be more effective for GH therapy as weekly injection mode. More extensive study is needed to permit for new therapeutic application.
Animals ; Dogs* ; Drug Delivery Systems ; Enzyme-Linked Immunosorbent Assay ; Growth Hormone* ; Hyaluronic Acid ; Insulin-Like Growth Factor I ; Sodium

PURPOSE:Growth hormone(GH) therapy is very effective for the treatment of short stature, but it is unconvenient that GH should be injected daily because of short half-life. Sustained-release forms of GH preparation is needed for better compliance. This study aimed to measure peak pattern and duration of release of hGH from solid microparticles using sodium hyaluronate. METHODS:In group 1, hGH(EutropinTM) 285microg/kg was injected subcutaneously to 2 Jindo dogs everyday for 7 days. In group 2, hGH solution(EutropinTM) was continuously infused subcutaneously for 12 hours a day for the first 2 days via mini pump(minimed co.) and then for 24 hours a day thereafter until 7th day with the rate of 11.9microg/kg/hr. In group 3, dose of 2mg/kg hGH in sustained-release formulation using sodium hyaluronate, was injected subcutaneously to 3 Jindo dogs. In group 4, two dose levels of 1mg/kg and 2mg/kg hGH in sustained-release formulation using sodium hyaluronate, were injected subcutaneously to each group of 4 Beagle dogs. To evaluate side reactions from continuous injection of sodium hyaluronate, sustained release form of hGH 2mg/kg was injected to 4 Beagle dogs once a week for 4 weeks and compared to 4 control Beagle dogs. Blood samples were withdrawn half- hourly for 6 hour and 2-4 times a day thereafter in Jindo dogs and at 6hr, 12hr, 22hr in the first day and twice a day(at 9:00, 16:00 O'clock) for the following 6 days. RESULTS:In group 1, peak GH conc. of 122+/-27ng/ml was observed at 1 hour after hGH(EutropinTM) 285microg/kg injection and 1/2 of peak GH conc. at 4 hour. and decreased to 2ng/ml at 24 hour. GH AUC(Area under curve) was 670(ng/ml.hr). In group 2, initial steady state GH conc. of 25ng/ml occurred after 6 hour, however, GH conc. decreased gradually to 16ng/ml at the 7th day. GH AUC based on th initial steady state GH conc. was 600(ng/ml.hr). In group 3(Jindo dogs), GH conc. was peaked at 12 hour and 1/2 of peak GH conc at 30-46 hour and decreased to baseline at 70 hour. GH AUC was 2173(ng/ml.hr). In group 4(Beagle dog), peak GH concentrations of 56+/-7ng/ml and 108+/-12ng/ml were observed at 12 hour for the doses of 1mg/ kg and 2mg/kg, respectively and 1/2 of peak GH conc at 48 hour and decreased to baseline at 80 hour. GH AUC was 3560(ng/ml.h) for 2mg/kg treated dogs. Serum IGF-1 was increased to peak levels of 520ng/ml, and 580ng/ml for the doses of 1mg/kg 2mg/kg, respectively, and persisted above the baseline till 120 hour. There was no specific side reaction during experimental period. CONCLUSION: Sustained-release form of hGH with sodium hyaluronate released GH for 70-80 hour with the peak level lower than that resulted from the conventional aqueous formulation of the equivalent dose, and higher concentration IGF-I maintained for 120 hour after injection above baseline. More extensive study is needed to permit for new therapeutic application.
Animals* ; Area Under Curve ; Compliance ; Dogs ; Growth Hormone* ; Half-Life ; Hyaluronic Acid ; Insulin-Like Growth Factor I ; Polymers