Forty-nine children between the ages of 2 and 10 years, treated conservatively for fomoral shaft fracture, were studied clinically and radiographically to access the complications and related factors. They had an average follow-up of 48.8months(range, 12 to 77months). 35 percent of the patients had significant associated injuries. Leg length discrepancies of 10mm to 20mm are observed in 5 cases(10%) of the patients. The average overlap of bone ends at union was 6.5mm. The average growth acceleration was 8.8mm regardless of sex, age, upper limb dominance, fracture site or shape, but was promoted by overriding of the fracture ends at union, There were 16 cases(32%) of excessive angular deformity of 10° to 25° after union. However all deformities were remodelled enough to give normal alignment of the joint surface. The growth plate played on important role in the remodelling process.
Acceleration ; Child ; Congenital Abnormalities ; Follow-Up Studies ; Growth Plate ; Humans ; Joints ; Leg ; Upper Extremity

No abstract available.
Blood Donors* ; Communicable Diseases* ; Humans

There are many hypotheses of spinal instability after trauma and the concept had been recently changed from 2-column concept by Holdsworth to 3-column concept by Francis Denis & McAfee and also there are controversies about the operative management of the unstable thoracolumbar spine fractures and fracture-dislocations. So we tried to find some relationship between the spinal instability and the effect of the stabilization operation for the fractures and fracture-dislocations in the thoracolumbar spine in this study. Totally 53 cases that stabilization operation had been performed for the unstable fractures and fracture-dislocations of the thoracolumbar spine at Yonsei University Hospital, including Yongdong hospital, from March, 1973 to October, 1984 and followed up over 6 months, were reviewed. 1. Majority of the patients (84.9%) was in an active age group (20–49 years of his age) and more common in males. 2. The first lumbar vertebra was most commonly involved segment (43.3%) and falling from a height was the most common cause of injuries (50.9%). 3. Injuries to the anterior, middle and posterior column of the spine (58.5%) was the most common mechanism of injury according to the classification by Francis Denis and McAfee. 4. The wedged deformity of the involved segment over 50% was usual (71.7%) and mean wedged deformity was 57% of the height of the vertebral body and most commonly associated fractures besides the body itself was laminae fractures (46.5%). 5. Seventy eight percent of the angular deformity was corrected after Luque rod instrumentation and 76%, after Harrington rod instrumentation, 68%, after posterior wiring, 58%, after anterior decompression and anterior interbody fusion. 6. Forty twa point seven percent of the displacement in anteroposterior plain X-ray film and 58.8% in the lateral film were corrected by Luque rod instrumentation and 39.5% in anteroposterior film and 44.3% in the lateral film were corrected by Harrington rod instrumentation. 7. No significant differences in the recovery of the neurologic signs were found according to the method of surgical treatments. 8. So Luque rod or Harrington rod instrumentation is now recommended for obtaining the spinal stability as a method of surgical treatment in the unstable thoracolumbar spine fractures and fracture-dislocations.
Accidental Falls ; Classification ; Congenital Abnormalities ; Decompression ; Humans ; Male ; Methods ; Neurologic Manifestations ; Spine ; X-Ray Film

Suppurative arthritis of the knee is a well known complication following intra-articular injection of steroids on the other hand, tuberculous arthritis following such injection is rare. From January, 1981 to April, 1986, 46 patients of tuberculous arthritis of the knee were admitted to Severance Hospital and Yong-Dong Severance Hospital of Yonsei University College of Medicine. Among them 22 patient (48%) had a history of intra-articular injection of steroids and we analyzed them. The results were as follows: 1. The average age was 48.6 years (3–71 years). And sex ratio was in 1:2.7 as female predominant. 2. Initial diagnosis before the steroid injection were osteoarthritis (13 patients), rheumatoid arthritis (6 patients), and traumatic arthritis (3 patients). The fifty percent of the patients were injected by the local practitioner and fourty five percent had a history of accupuncture and moxa cautery. The preoperative diagnosis (diagnosis on admission) were tuberculous arthritis (12 patients), pyogenic arthritis (5 patients), rheumatoid arthritis (3 patients) and osteoarthritis(2 patients). 3. The number of intra-articular injection ranged from 2 to 100 times (average 12.8) during periods ranging from 1 month to 4 years (average 19.2 months). And interval between last injection and confirmation of tuberculous arthritis ranged from 1 week to 2 years (average 7.0 months). 4. Eight patients (36%) had a active or inactive pulmonary tuberculosis. 5. The positive cultures of typical Mycobacteria tuberculosis were obtained from 11 patients 59%). 6. The modalities of treatment were synovectomy or curettage in 16 patients and arthrodesis in 6 patients. And all patients were treated by antibuberculous chemotherapy. In conclusion, we observed that tuberculous arthritis developed not infrequently after intra-articular injection of steroids. And we considered the causes of tuberculous arthritis following intra-articular injection of steroids were; 1) reactivation of dormant injection or hematogenous, spreed due to interferance of host defence mechanisms, 2) contamination by the instrument and equipment, 3) aggravation of preexisting tuberculous lesions. Whenever one try to inject the steroid into joint, bacterial culture foi the pyogenic organism including tuberculosis and fluid analysis from the joint fluid should be done before the injection. We recommend that other method for the confirmation for the tuberculosis is needle biopsy of the synovium. If the symptoms are not improved after injection or the joint shows inflammatory reaction, one must discontinue the injection and reexamine the joint fluid analysis and culture for the confirmation of the infection.
Arthritis ; Arthritis, Infectious ; Arthritis, Rheumatoid ; Arthrodesis ; Biopsy, Needle ; Cautery ; Curettage ; Diagnosis ; Drug Therapy ; Female ; Hand ; Humans ; Injections, Intra-Articular ; Joints ; Knee Joint ; Knee ; Methods ; Osteoarthritis ; Sex Ratio ; Steroids ; Synovial Membrane ; Tuberculosis ; Tuberculosis, Pulmonary

Objective: The purpose of the present study was to screen the prevalence of aneurysms in migraineurs; to differentiate presenting features in migraineurs with and without aneurysm; and also to correlate the locations of aneurysm to the clinical features of migraine. Methods: A total of 4,416 subjects were interviewed and completed self-reported questionnaires on headache. Of these, 1,773 subjects diagnosed to have migraines based on the International Classification of Headache Disorders II (ICHD-II) criteria were screened for aneurysm by magnetic resonance angiography (MRA). When aneurysm was suspected, further investigation with trans femoral cerebral angiography (TFCA) or three dimensional computerized tomography (CT) angiography was performed. Based upon MRA findings, subjects were grouped into unruptured aneurysm migraine patients (UAMP) and no aneurysm migraine patients (NAMP). Results: The prevalence of aneurysm was 3.6% (63 of 1,773) with the mean age of 56.0 years, which were not different from those of general population. There was no difference in migraine subtypes between UAMP and NAMP. Aggravation of headache by estrogen replacement therapy during menopause (p=.039), history of migraine in young age (p= .021), diplopia (p=.026), and retroauricular pain (p=.025) were significantly associated with presence of aneurysm. Although aneurysms were detected more in anterior circulation, there was no correlation between aneurysm site and headache location. The average size of aneurysm was 3.5 ± 2.1 mm and none were ruptured. Interventional therapy of aneurysm did not alter the feature of migraine. Conclusions: The incidence of aneurysm was not different in migraine patients as compared to the general population. Some features which significantly differentiate whether migrainuers have aneurysm or not warrant further study to have a predictive and localizing value.

No abstract available.
Humans

OBJECTIVE: This study was designed to evaluate whether maternal serum human chorionic gonadotropin(hCG) level measured during second trimester could be used as a predictor of pregnancy-induced hypertension. METHODS: Between March 1996 and November l997, 505 pregnant women undergoing second trimester(14-22 weeks of amenorrhea) triple marker screening for neural tube defect and Down syndrome who delivered at our institution were reviewed. All samples were assayed in the same laboratory and medical records were reviewed about medical and obstetrical history. RESULTS: Maternal serum human chorionic gonadotropin level(multiples of the median, MoM) was significantly higher in the pregnancy-induced hypertension group than in the control group. With the use of 2. l multiples of the median as a cutoff value, the sensitivity of human chorionic gonadotropin as a screening marker for development of pregnancy-induced hypertension was 38.7%, the specificity was 95.9%, positive predictive value was 38.7% and negative predictive value was 95.9%. Conlusion: We suggest that second trimester maternal serum human chorionic gonadotropin levels can be used clinically as an early predictive marker for pregnancy-induced hypertension.
Chorion ; Chorionic Gonadotropin* ; Down Syndrome ; Female ; Humans ; Humans* ; Hypertension* ; Hypertension, Pregnancy-Induced ; Mass Screening ; Medical Records ; Neural Tube Defects ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy* ; Pregnant Women ; Sensitivity and Specificity

No abstract available.
Humans

No abstract available.

Letterer-Siwe disease, Hand-Schuller-Christian disease and eosinophilic granuloma of the bone are merely different clinical expressions of one disease. Lichtenstein grouped these three clinical syndromes and proposed that this disease be termed histiocytosis X. This grouping was based on the histologic similarities and the possibility of transformation of one syndrome into another. The cause of histiocytosis X remains unknown. Histiocytosis X is a condition that presents single or multiple lesions, distributed in the soft tissue, lymph nodes, various organ and bones, especially in the areas of marked reticuloendothelial activity. The authors reviewed the clinical findings, radiographs and the treatment of the twenty-six patients with histiocytosis X diagnosed on the base of pathologic findings at Severance Hospital, between January, 1971 and December, 1980. Among the twenty-six patients, twenty-one patients could be followed, ranging from one month to six years, with an average follow-up of 1.6 years. The results obtained were as follows: 1. There was a slight male predominance (61.6%). The age ranged from 2 months to 42 years (average 8.2 years). Sixty-five percents of patients were the child under 4 years of age. 2. Hand-Schuller-Christian disease (50%) was the most common form of this disease. Letterer-Siwe disease developed in the youngest (average 1.2 years) and eosinophilic granuloma in the eldest (average 20.4 years). 3. The common manifestations were hepatomegaly, skin rashes and anemia in Letterer-Siwe disease; palpable mass, pain and exophthalmos in Hand-Schuller-Christian disease; pain and mass in eosinophilic granuloma. 4. The common sites of the skeletal lesions were skull, spine and femur, etc. 5. The patients with single skeletal lesion improved regardless of the methods of treatment. 6. Vinblastine, methotrexate and/or prednisone were valuable agents for the multiply involved patients. 7. Prognosis was poor for the patients who were young at onest, or who had multiple systemic involvements, but in case only with skeletal involvement the prognosis was good. Eosinophilic granuloma is the most benign variant, while Letterer-Siwe disease is the most malignant type.
Anemia ; Child ; Clinical Study ; Eosinophilic Granuloma ; Exanthema ; Exophthalmos ; Femur ; Follow-Up Studies ; Hepatomegaly ; Histiocytosis ; Histiocytosis, Langerhans-Cell ; Humans ; Lymph Nodes ; Male ; Methotrexate ; Prednisone ; Prognosis ; Skull ; Spine ; Vinblastine