The hand is an organ of both motion and sensibility. Motion is necessary for the highly adaptive functions of pinch, grasp, and hook. When a major muscle is paralyzed, the balance of the hand is disrupted. The objective of reconstructive procedure is to achieve a limited but balanced functional performance by means of redistributing assets rather than creating new motor and sensory units. Among the variable methods of treatment, the tendon transfer is a useful method in restoring the lost functions of the paralyzed hand. Authors reviewed 3 cases of paralyzed hands: the first one had an impairment of the opposition and flexion of the thumb caused by brachial plexus injury; the second one had an adducted thumb and a flexion contracture of the index and middle fingers due to a severe compression injury to forearm; the third one was a quadriplegics due to the C5-6 fracture-dislocation, but fortunately had a function of active flexion in ring and little fingers. They were treated by Omer's technique plus other reconstructive procedures for the paralysis at the Department of Orthopaedics, Catholic Medical Center from 1978 to 1981. By this procedure gratifying results such as restoration of pinching and grasping function were obtained.
Brachial Plexus ; Contracture ; Fingers ; Forearm ; Hand Strength ; Hand ; Methods ; Muscles ; Paralysis ; Tendon Transfer ; Thumb

Despite the technical improvements in Internal flxation of neck fracture were made in recent years, complications, such as non-union of the fracture and avascular necrosis of the femoral head, are not infrequent. Various operative techniques have been proposed to secure the reduced fracture fragment till union, and to restore or improve the circulation in the femoral head. One of them is muscle-pedicle bone graft to the fracture site of neck. It is very important if one can predict the vascularity of the femoral head prior to treatment and also the healing process of the neck fracture during treatment. In the past, there have been considerable investigations to achieve these goal, but no method universally has been accepted as reliable and practical. Among them, Intra-osseous venography (I.O.V.) and sclntimetry utilizing the isotope trace techniques were widely used in recent. Authors adopted a cephalic and trochanteric I.O.V. to observe the fracture healing and to predict viabillty of the femoral head, and also tried a new technique (Indirect cepallc I.O.V.) to perform both techniques of I.O.V. at the same time. With the ald of image Intensifler, a bone marrow needle Is inserted 1 inch below the greater trochanter of femur, and when the tip of the needle is reached 0.5 to 1.0 cm near to fracture line in the marrow cavity, about 25 cc of 75% Urograffin is Injected by speed of 1 cc per second with sereial X-rays taken at 1,3,5 and 15 minutes (trochanteric I.O.V.). Then already inserted puncture needle for trochanteric I.O.V. are more advanced through the fracture line of the neck into the femoral head. About 10 cc of 75% Urograffin Is Injected by speed of 1 cc per second with serial X-rays taken (Indirect cephallc I.O.V.). The merits of this indirect cophalic l.O.V. via trochanteric route is that it is also simple and Practical and there is no significant complication: such as septic arthritis of hlp & thrombophlebitis. Difficulties of inserting the needle through the trochanter and the neck into the head and occasional unwanted hip-arthrogram are listed as the main demerits of this technique. But these demerits can be minimized by the accurate image intensifier control. A positive trochanteric venography is one in which venous drainage is established across the fracture site with opaque contrast medium being spread out diffusely into the head, and eventually draining out into the surrounding soft tissue via draining velns. While positive cephalic venography via trochanteric route is one in which contrast medium is spread out diffusely in the head and trochanteric region via crossing veins. Hereby, we performed internal fixation and an autogenous muscle-bone pedicle graft composed of the quadratus femoris muscle in 4 cases of femoral neck fracture which are confirmed that there are head viability by using of the cephalic I.O.V.. Since then, we checked the both I.O.V. every 6 wks post-operatively. The results seemed to be good in regard to bony union in all 4 cases, and we have also found that cephalic and trochanteric I.O.V. are a useful diagnostic tool in hip fracture.
Arthritis, Infectious ; Bone Marrow ; Drainage ; Femoral Neck Fractures ; Femur Neck ; Femur ; Fracture Healing ; Head ; Hip ; Methods ; Neck ; Necrosis ; Needles ; Phlebography ; Punctures ; Thrombophlebitis ; Transplants ; Veins

It is well-known that early diagnosis and treatment is still the most important aspect of congenital dislocation of the hip. However, the orthopaedist can not see the cbildren with dislocated hip before they begin to Walk, especially in the developing countries. When the children with dislocated hips are discovered lately,it is impossible to reduce the hip by simple manipulation, and also is very difficult to maintain the reduction successfully. Our method of treatment was based on the concept that the various components of the abnormal joint will develop satisfactorily into a normal hip provided acccurate congrucus and concentric reduction is obtained as early as possible to take advantage of the maximum growth potential, and is maintained throughout growth, In this study 16 children with 18 dislocated hips among the 75 children with congenitally dislocated hips were primarily treated by open reduction,followed by 3 weeks of temporary fixation of reduced hip by Kirschner wire and 6 weeks of cast immobilization from November 1973 to April 1979. They were clinically and roentgenologically analized. The end results of treatment were assessed by 3 roent- genological determinants; the medial joint space, the acetabular angle and the centeredge angle. The results obtained were as follows: 1. The pathologically widened medial joint space of hip or hips decreased rapidly during first 6 months after reduction, irrespective of the age at reduction, and satisfactory results were obtained in 83 per cent indicated by joint space distance less than 10 mm. 2. Postoperative Kirschner wire fixation of reduced hip to maintain the reduced position did not impair the physeal growth or bring the joint stiffness. 3. The acetabular angle improved rapidly during the first year after reduction in all age groups of patients and thereafter the rate of acetabular development decreased, but the acetabular angle continued to improve throughout the period of observation and satisfactorily (less than 25 degrees) developed in 83 per cent of children. 4. The center-edge angle increased rapidly during first three months after reduction and was satisfactory (more than 20 degrees) in 78 per cent. Overall success rate of treatment was 81.3 per cent. 5. Assessment of end results by medial joint space has more advantages in evaluating the result of treatment because of the aimplicity of it's measurement and leas error regardless of the change of patients position on roentgenagrams. 6. There were only few complications (11.1%) after surgical treatment; coxa magna in a case and resubluxation in another case were complicated. 7. Parameters utilized for assessing the results were faund to be the very helpful criteria to evaluate the hip development indicated by cephalocotyloid relation when used together. 8. Simultaneous open reduction followed by temporary internal fixation with K-wire was found to be recommendable method of treatment ae a first choice of treatment even in children under age of 3 if once nonsurgical reduction fails; because by this type of treatment more easily and accurately concentric reductions were obtained, and also reduction was more easily maintained without subsequeat redislocation.
Acetabulum ; Child ; Developing Countries ; Dislocations ; Early Diagnosis ; Hip ; Humans ; Immobilization ; Joints ; Methods

BACKGROUND: A newly-found mitochondrial toxin, 3-nitropropionic acid (3-NP), has been proved to induce apoptosis in the striatum. Although striatal lesions produced by 3-NP could develop through an excitotoxic mechanism, the exact relationship between apoptosis induction and excitotoxicity after 3-NP treatment is still not clear. We investigated the role of excitotoxicity and oxidative stress on apoptosis induction within the striatum following intra-peritoneal injection of 3-NP. METHODS: 3-NP was injected for 5 days intra-peritoneally in three month-old mice. One day after the last injection, animals were decapitated. To confirm the presence of apoptosis, we performed in-situ detection of DNA fragmentation by using TUNEL technique and agarose gel elctrophoresis after DNA extraction from striatum. To examine the effect of frontal cortex removal on 3-NP-indeced apoptosis, we removed left frontal cortex by aspiration. For excitotoxicity, NMDA-receptor antagonist-MK 801, non-NMDA antagonist-NBQX, and saline were injected intraperitoneally before 3-NP treatment To detect superoxide, we administered hydroethidium (HEt: 200 ul; 1mg/ml) into the jugular vein 2 days after 3-NP, and the density of oxidized HEt in samples were examined under flouscent microscope. We performed caspase staining to test immunoreactivity of caspase 3 in samples. RESULTS: The TUNEL positive cells were not observed in the striatum ipsilateral to the frontal cortex-removed side, but found in the contralateral striatum. Superoxide radicals measured by using HEt and caspase immunoreactivity were also significantly weaker in the striatum ipsilateral to the frontal cortex-removed side than the contralateral striatum. TUNEL staining revealed less apoptotic changes in the striatum of MK801-treated group than NBQX-or saline-treated groups. DNA laddering on agarose gel electrophoresis was observed in the striatum of NBQX- or saline-treated mice, but not found in MK 801-treated group. CONCLUSION: We demonstrated that removal of the corticostriatal glutamate pathway reduced superoxide production as well as apoptosis induced by 3-NP and NMDA receptor antogonist, but not non-NMDA antagonist, prevented 3-NP-induced apoptosis in the striatum. These results suggest that NMDA-mediated glutamatergic excitotokicity plays an important role in 3-NP related striatal damage.
Animals ; Apoptosis ; Caspase 3 ; DNA ; DNA Fragmentation ; Electrophoresis, Agar Gel ; Glutamic Acid ; In Situ Nick-End Labeling ; Injections, Intraperitoneal* ; Jugular Veins ; Mice* ; Mitochondria ; N-Methylaspartate ; Oxidative Stress ; Sepharose ; Superoxides

Reiter's syndrome is a clinical triad of urethritis, conjunctivitis, and arthritis, but the characteristic mucocutaneous lesion occurs very frequently. Therefore, Reiters syndrome in fact might better be considered a tetrad, consisting in its complete form of urethritis, arthritis, conjunctivitis, and mucocutaneous lesions. In initial stage of the disease, the arthritis usually appear after the urethritis and conjunctivitis have been made. The arthritis is usually of subacute onset, reaching its full intensity within a few weeks in most cases. Additionally a man with Reiters syndrome who developed aortic insufficiency with no evidence of syphilis or rheumatic heart disease has been reported. Two cases of Reiters syndrome are presented with the review of the literature: the first case was a 60 years old male who had non-gonococcal urethritis with mucous purulent discharge, conjunctivitis, polyarthritis, and aortic insufficiency; the second case was a young man aged 21 years who had the characteristic conjunctivitis and a past history of urethritis, and he also has had obvious keratodermia blenorrhagica and polyarthritic symptoms and signs.
Arthritis ; Conjunctivitis ; Humans ; Male ; Rheumatic Heart Disease ; Syphilis ; Urethritis

No abstract available in English.
Neurilemmoma

OBJECTIVE: Using [123I]IPT-SPECT, we compared between the dopamine transporter (DAT) density of the basal ganglia in first-episode, patients with schizophrenia and DAT density in normal control subjects. We investigated the change between DAT density before and after taking olanzapine during 4weeks in patients with schizophrenia. We studied correlations between the clinical symptoms of schizophrenia and DAT density. METHODS: Ten patients with schizophrenia and ten healthy control subjects were included in this study. Brief Psychiatric Rating Scale (BPRS) and Montgomery-Asberg Depression Rating Scale (MADRS) were obtained before and after 4-week treatment with olanzapine in schizophrenic group. Nuclear imaging using [123I]IPT-SPECT was obtained in normal control subjects and schizophrenic group before taking olanzapine. After 4-week treatment with olanzapine, Nuclear imaging was obtained in schizophrenic group. RESULTS: There is significant negative correlation between BPRS total score, withdrawal subscale score after treatment and DAT density before treatment. There is significant positive correlation between the age of onset and DAT density after treatment and there is significant negative correlation between the duration of illness and DAT density after treatment. CONCLUSION: The data of this study suggest that DAT density in basal ganglia in patients with schizophrenia would be a predicting factor in treatment response.
Age of Onset ; Basal Ganglia ; Brief Psychiatric Rating Scale ; Depression ; Dopamine Plasma Membrane Transport Proteins* ; Dopamine* ; Humans ; Psychopathology* ; Schizophrenia*

OBJECTIVE: Using [123I]IPT-SPECT, we compared between the dopamine transporter (DAT) density of the basal ganglia in first-episode, patients with schizophrenia and DAT density in normal control subjects. We investigated the change between DAT density before and after taking olanzapine during 4weeks in patients with schizophrenia. We studied correlations between the clinical symptoms of schizophrenia and DAT density. METHODS: Ten patients with schizophrenia and ten healthy control subjects were included in this study. Brief Psychiatric Rating Scale (BPRS) and Montgomery-Asberg Depression Rating Scale (MADRS) were obtained before and after 4-week treatment with olanzapine in schizophrenic group. Nuclear imaging using [123I]IPT-SPECT was obtained in normal control subjects and schizophrenic group before taking olanzapine. After 4-week treatment with olanzapine, Nuclear imaging was obtained in schizophrenic group. RESULTS: There is significant negative correlation between BPRS total score, withdrawal subscale score after treatment and DAT density before treatment. There is significant positive correlation between the age of onset and DAT density after treatment and there is significant negative correlation between the duration of illness and DAT density after treatment. CONCLUSION: The data of this study suggest that DAT density in basal ganglia in patients with schizophrenia would be a predicting factor in treatment response.
Age of Onset ; Basal Ganglia ; Brief Psychiatric Rating Scale ; Depression ; Dopamine Plasma Membrane Transport Proteins* ; Dopamine* ; Humans ; Psychopathology* ; Schizophrenia*

BACKGROUND: Little has been known about the incidence, the relationship with H. pylori infection and the prognosis of the multiple gastric polyposis. Recently, it was suggested that the eradication of H. pylori infection led the disappearance of the gastric polyps associated with H. pylori. We carried out a prospective study to determine the effect of H. pylori eradication on multiple gastric polyposis associated with H. pylori. METHODS: From July 1997 through August 2000, 13 patients who had multiple gastric polyposis on upper gastrointestinal endoscopy were recruited for this study. After eradication of H. pylori, we performed follow-up endoscopy at 2-3 months and 5-6 months later. RESULTS: The topographical distributions of gastric polyps were as following : antrum only in 7 cases, antrum and lower body in 4 cases, antrum and fundus area in 1 case, and entire stomach in 1 cases, respectively. The histopathological findings were as following : 13 cases showed chronic active gastritis, 2 cases with hyperplastic polyps, and 1 case with adenomatous polyps. After eradication of H. pylori infection, regression of multiple gastric polyps occurred in 7 cases (53.8%). In 7 cases with regression, regression was observed in 5 cases with chronic active gastritis alone, 1 case with hyperplastic polyps, and 1 case with adenomatous polyps. The re-biopsy specimens in 7 cases with regression revealed that the grade of inflammation decreased from 2.2 to 1.5 by the histological index of the updated Sydney system. CONCLUSION: With these results, we may conclude that the development of multiple gastric polyposis might be closely related with chronic H. pylori infection, and the eradication of H. pylori could lead to the regression of polyposis.
Adenomatous Polyps ; Drug Therapy ; Endoscopy ; Endoscopy, Gastrointestinal ; Follow-Up Studies ; Gastritis ; Humans ; Incidence ; Inflammation ; Polyps ; Prognosis ; Prospective Studies ; Stomach

OBJECTIVE: We investigated the usefulness of the scintigraphic swallowing study in selecting the patients with low risk of aspiration pneumonia among those who showed small amount of laryngeal aspiration in videofluoroscopy. METHOD: Scintigraphic swallowing study was performed in 22 patients with brain injury who showed small amount of laryngeal aspiration in videofluoroscopy. Oral feeding was tried in the patients who showed airway clearing function or no aspiration in scintigraphic swallowing study, and they were followed up for possible aspiration pneumonia. RESULTS: Total of sixteen patients showed no aspiration in scintigraphic swallowing study. Five patients showed laryngeal aspiration, but preserved airway clearing function. One patient showed impairment of airway clearing function. Oral feeding was tried in 21 patients. Oral feeding was successful in 18 of 21 patients but not in 3 patients because of dysphagia or cough. Only 1 patient developed pneumonia after 246 days of follow up. CONCLUSION: Scintigraphic swallowing study is useful to select the patients with low risk of aspiration pneumonia among the patients who showed small amount of laryngeal aspiration in videofluoroscopy.
Brain Injuries* ; Brain* ; Cough ; Deglutition Disorders ; Deglutition* ; Follow-Up Studies ; Humans ; Pneumonia ; Pneumonia, Aspiration ; Radionuclide Imaging