The object of treatment of Legg-Calve-Perthes disease (L.C.P.D.) is to shorten the clinical course and minimize, or prevent residual deformity, This is accomplished by placing the femoral head deeply within the acetabulum, so that its articular surface is completely contained and maintaining a full range of motion, thereby preventing lateral extrusion of head, concentrated vertical loads and collapse. The purpose of this study was to determine the predicting value of prognosis and correlation of three different evaluating methods, when examining an identical series of radiographs to assess the effect of treatments, and to determine whether the result obtained by femoral osteotomy gave better result than those by non-surgical means. During the past ten years prior to writing, 89 patients with L.C.P.D. were treated by authors. Seventy eight (87.6%) patients were boys and 11 (12.4%) girls. Their ages at the time of initial visit ranged from 2 to 13 years. Twelve (13.5%) patients had bilateral and 77 had unilateral involvement for a total of 101 hips. They were analysed according to Catteralls classification, and also comparative study was done for 32 patients who were followed up over 15 months. The longest follow-up was 5 years and 2 months. They were divided into 2 groups: clildren in group A were treated by rest and abduction brace,. followed over 3 years and 3 months in average, and children in group B were treated, by intertro-chanteric osteotomy, followed over 2 years and 6 months in average. End results for 32 cases were evaluated at each follow-up time by Length/Width Index (L/W.I.) of femoral neck (Robichon, 1974), Migration Index (M.I.) and Spherical quotient (S.Q.) of capital femoral epiphysis (Edsberg et al, 1979). L/W.I.,M.I, S.Q. were used not only as the method of evaluation, but also were used as a predicting the prospective clinical course during the treatment by regular measurement whether it takes the good course or not. Results obtained were as follows: 1. 21(20.8%) were classified as group I, 30(29.7%) as group Il. 31(30.7%) as group III and 19 (18.8%) as group IV. 43 children (42.6%) on their initial visit were found to have this diasbling hip condition at stage II (necrosis and early fragmentation stage). 2. Regardless of the type of treatment, good results were obtained in younger children under age of 7 years, and in mild form as in group I, and lI. Also good, results were obtained in the cases who had treatment at early stage of the disease. No difference was found in the end results between girls and boys when they had same degree of head involvement. 3. In 14 surgically-treated patients, the good results were obtained in 9(64.3%) when assessed by L/W I. 10(75.4%) by M.I., and 7(50%) by S.Q., while in 18 conservatively treated patients good results were obtained in 8(44.4%) when assessed by L/W I. in 6(33.3%) by M.I., and 7(38.7%) by S.Q.. This fact means that S.Q. under-estimates the results of well-treated cases, while M.I. seemingly over-estimates them. 4. when X-rays of the hips were taken in different position's, different L/W Indices were unexpectedly obtained; these deviations in assessment may be listed as a drawback. Migration Index can prognosticate the healing process of the disease during treatment, if the index together with medial joint space is measured repeatedly with certain intervals. Also it is difficult to obtain accurately the S. Q. by measurements because of difficulty locating the center of fragmentary head, but it is considered the best method assessing the end-result at the healed stage. S.Q. expresses the head spherocity, while the M. I. expresses the degree of head coverage and the neck L/W.I. expresses the indirectly amount of neck deformity. 5. When the clinical course is assessed by three evaluating methods, occasionally these three results contradict to each other and do not show similar prognostic tendency or trend. The reason is that neck L/W Index and Spherical quotient indicate directly the progress of the disease while Migration Inex receases only the state of femoral head containment and there by indirectly indicates ensuing prospective course when containment is good, and do not indicate the state of severity of the involved head. 6. In this study, the result of surgically treated patients were superior to those of conservatively treated patients.
Acetabulum ; Braces ; Child ; Classification ; Congenital Abnormalities ; Containment of Biohazards ; Epiphyses ; Female ; Femur Neck ; Follow-Up Studies ; Head ; Hip ; Humans ; Joints ; Legg-Calve-Perthes Disease ; Methods ; Neck ; Osteotomy ; Prognosis ; Prospective Studies ; Range of Motion, Articular ; Writing

Isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament has been thought very rare. We also had experienced only nine cases of above injury in our center during 5.5 years from January, 1976 to June, 1981. Eight cases of them were followed for an average of the thirteen months, but one of them was eliminated from the study because follow-up study was impossible for the case. The purposes of this paper are to present eight cases of isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament and to discuss the causes and mechanisms of the injury and the method of screw fixation for the avulsed fracture fragment. Seven were injured by traffic accident and one by fall on the knee. All cases seemed to be injured by the force directed against the flexed knee which violently stroke the anterior surface of the proximal end of the tibia or inferior portion of the knee and drove it backwards. We found the tear of posterior capsule only in one patient who was seeming injured by extensive force. All cases were treated operatively by means of screw fixation, and excellent results were obtained in five cases, good in two, and fair in one case.
Accidents, Traffic ; Follow-Up Studies ; Humans ; Knee ; Methods ; Posterior Cruciate Ligament ; Stroke ; Tears ; Tibia

It is well known that early diagnosis and early treatment is very important for the patient with congenital dislocation of the hip joint to provide a favorable function in the whole life. The goal of treatment, which is either conservative or operative, is to replace the dislocated hip into the socketand restore its anatomical position. If the head is reduced lately, it may subluxate or redislocate. As a result, secondary osteoarthritis will be complicated in such hips at a laterdate The most cases of congenital dislocation of hip have a increased anteversion and vaglus deformity. It is known that these deformity are cause of redislocation or subluxation, and should be corrected by varus or derotational varus osteotomy to restore for normal cephalocotyloid relationship. We analized 18 residual subluxation of hips which had been treated by derotational varus osteotomy. The results obtained are as follows. 1. Regardless of the age at the time of osteotomy and the amount of varization, the neck-shaft angle corrected to nearly normal in all cases within 3 years after the osteotomy. 2. Acetabular development, indicated by acetabular index, was satisfactory when the osteotomy was done before 4 years, but unsatisfactory in the cases after 4 years of age. 3. Coxa valga epiphysialis of the subluxated head corrected spontaenously after osteotomy in all cases. 4. Subluxated head, indicated by C-E angle and migration percentage, reduced in the cases who had by the derotational varus osteotomy in patients below age of 4 years, but it persisted without further luxation in the cases over 4 years of age.
Acetabulum ; Congenital Abnormalities ; Coxa Valga ; Dislocations ; Early Diagnosis ; Head ; Hip Joint ; Hip ; Humans ; Osteoarthritis ; Osteotomy

No abstract available.
Sinusitis*

The villous adenoma of the duodenum is a rare disease and a considerable portion of the cases are known to be associated with malignancy. Although the diagnosis can be made with duodenoscopy, some cases showed false negative rate for malignancy detection with endoscopic biopsy only. So Whipple's operation is preferred than local excision. We experienced a case of tubulovillous adenoma involving ampulla of Vater, which recurred after local excision. So we report a case of tubulovillous adenoma involving ampulla of Vater with relevant literature.
Adenoma* ; Adenoma, Villous ; Ampulla of Vater* ; Biopsy ; Diagnosis ; Duodenoscopy ; Duodenum ; Rare Diseases

BACKGROUND AND OBJECTIVES: Dizziness is the most common symptom of vertebrobasilar insufficiency (VBI), occurring in at least two-thirds of patients. The aim of our study is to document the clinical features and the treatment outcomes in the dizzy patients with VBI. SUBJECTS AND METHOD: A retrospective review of 36 patients suffering dizziness associated with VBI was performed at a tertiary referral center. RESULTS: The most frequent type and duration of dizziness were rotational (52.8%) and minute (55.6%). Sixteen patients (44.4%) reported that their episodes of dizziness occurred several times per a month. Half of the patients had at least one isolated episode of dizziness and in 25% VBI began with an isolated episode of vertigo. Twenty-three patients (63.9%) had risk factors for cerebrovascular diseases. Benign paroxysmal positional vertigo occurred in 27.8%, and 38.9% had a significantly decreased or absent response to caloric stimulation. On the dynamic posturography, visual dysfunction (33.4%) and vestibular dysfunction (19.4%) were observed. Thirty-two patients (88.9%) had abnormal finding on the pure tone audiometry. Nineteen (61.3%) of 31 patients experienced resolution or significant reduction of their episodes of dizziness with treatment. But one patient progressed to acute infarction. CONCLUSION: VBI-associated dizziness cause various clinical manifestations and there should be relevant differential diagnosis for episodic vertigo that last only minutes. We should pay special attention to the VBI in patients with isolated, transient dizziness and the risk factor of the cerebrovascular disease.
Audiometry ; Diagnosis, Differential ; Dizziness ; Humans ; Infarction ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers ; Vertebrobasilar Insufficiency* ; Vertigo

No abstract available.
Humans ; Radiography* ; Spine*

No abstract available.
Hemangiosarcoma* ; Nasal Cavity*

No abstract available.
Adenoidectomy* ; Child* ; Humans ; Snoring* ; Tonsillectomy*

After extensive studies of the regenerated meniscus, most of authors believe that newly replaced meniscus completely consisted of fibrous connective tissue Instead of forming fibrocartilaginous tissue. This experiment was planned to investigate the chronological effect on the normal menisci and replaced one which formed after meniscectomy In rabbits knees. Total meniscectomy was performed on the medial menlsci of both knee joints of the 40 young rabbits (5 weeks old), weighting from 300 to 400 gm and 40 adult rabbits weighting from 1800 to 2200gm. In both groups, meniscal specimens were obtained from medial area of both knee joints 3,5, 12,24 and 48 weeks following meniscectomy respectively. Medlcal meniscl of normal 5,12,24 and 48 weeks old rabbits were used as control. Each specimen was examined grossly and histologically. Serial histological sections were cut at 6um and stained with hematoxylin and eosin for the histological examination and Safranln-0 fast green Iron hematoxylin for the histochemical examination. The result obtained were as follows: 1. Macroscopically all regenerated meniscl were less shlny and smaller than normal. Its margin was blunt shaped and completely connected with synovial membrane. 2. The meniscus, at 5 weeks after birth was composed with flbroblast and flbrocyte without cartilage cells. At 12 weeks after birth, In 2 out of 4 menisci flbrocytes were transformed with round oval shaped cells with lacunae and they looked Immature cartilage cells and Iightly stained with Safranin-O. 3. In young experimental rabbits, cartilage cells were found in one out of 14 regenerated meniscl at 12 weeks after meniscectomy while in mature rabbits cartilage cells were found in 2 out of 13 regenerated meniscl at 24 weeks after meniscectomy and newly formed 3 menlsci were strongly stained with Safranin-0. Mean rate of cartilage transformation of regenerated meniscl was 10.6% in young rabbits and 8.1% In adult rabbits without much difference in Incidence of transformation rate. Cartilagenous transformation in the small area of regenerated menlscus was found In 10% of cases. It ls summarized from the result that regenerated meniscl firstiy composed with fibrous tissue, but later on regenerated meniscus partiy transforms Into cartllage cells but not entirely. It is speculated that this cartllaginous transformation is due to adaptive metaplasia.
Adult ; Cartilage ; Connective Tissue ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Incidence ; Iron ; Knee ; Knee Joint ; Metaplasia ; Parturition ; Rabbits ; Synovial Membrane