1. Fifty one cases of fractures of the shaft of the femur in children, treated at Seoul National University Hospital during the seven years, from August 1962 to July 1969, were analyzed. 2. In thirty eight of the cases fracture involved the middle third of the shaft, in eleven the upper third, and in two the lower third. 3. Bryant traction was employed in fifteen of the cases ranging from four months to six years of age. One case, five years old, was complicated by Volkmanns ischemic contracture on both legs. 4. Russell traction was employed in eleven of the cases ranging from six to fourteen years of age. Angulation and distraction must be watched especially in the younger age group, although we encountered no serious complications which required subsequent treatment. 5. Hoke traction was employed in twelve of the cases ranging from six to eleven years of age. Although this form of treatment is not particularly popular, we are of the opinion that it is the treatment of choice over two years of age and,under six years of age and that between six and twelve years of age it may be optionally employed along with Russell traction. We found it. particularly useful and convenient in selected cases in which Russell traction could not be effectively employed. 6. In some of the complicated cases, open reduction and internal fixation, closed reduction with pin and plaster immobilization, or skeletal traction was employed.
Child ; Femur ; Humans ; Immobilization ; Ischemic Contracture ; Leg ; Seoul ; Traction

Since Palmer's introduction of the torn medial collateral ligament, many clinical and anatomical studies were performed. But any reconstructive procedure of the medial collateral ligament of the knee known to us, has not solved the problem completely yet. The purpose of present study is to describe a technique of reconstruction, socalled Tatsuzawa's tenodesis surgery of transposed semitendinosus tendon, and is to report the clinical results of 45 cases treated by his procedure between April 1976 and June 1981. In addition, significance of the procerdure was compared with the result of primary closure group of the torn ligament. Tatsuzawa's procedure consists of reinforcement surgery of the repaired or unrepaired torn medial collateral ligament with forwardly transposed semitendinosus. The semitendinosus tendon was brought forward to lie adjacent to deep layer of the medial collateral ligament. The transposed part of the tendon was sutured throughout its length to the medial collateral ligament and to the medial aspect of the tibia and femoral condyle. Because the direction of transposed tendon as similar to the direction of fibers of medial collateral ligament, the procedure was very simple and anatomical one, and had some functional advantages. In this series some old cases are treated only with tendon reinforcement operation without repairing the laxed torn ligament. The results of the surgery were evaluated by the Asais modification of the Feltons evaluation criteria. Results obtained were as follows: 1. In semitendinosus tenodesis with or without primary repair of the torn ligament, satisfactory results were obtained (excellent and good) in 33 cases (73.3%). But in 20 cases of the primary repair group, the satisfactory results were obtained in 11 cases (55%). More satisfactory results were obtained with the semitendinosus tendon reinforcement operation of the torn ligament than only with primary repair. 2. In 29 cases with fresh injury of the medial collateral ligament in which the primary repair together with the tendon reinforcement procedure was performed, satisfactory (excellent and good) results were obtained in 72.4% (21 cases), and in 16 untreated old cases in which only the tendon reinforcement procedure were done, satisfactory results were obtained in 75%. 3. In 5 cases having medial collateral and anterior cruciate ligaments tear, excellent results were obtained in 3. This explains that semitendinosus tendon reinforcement procedure is the key one of the reconstructive operative procedures. It is thought that the procedure is also effective for the anterior cruciate tear to provide the anterior instability.
Anterior Cruciate Ligament ; Clinical Study ; Collateral Ligaments ; Knee ; Ligaments ; Surgical Procedures, Operative ; Tears ; Tendons ; Tenodesis ; Tibia

Five cases of the spinal tuberculosis with severe kyphosis and paraplegia were treated with radical surgery at the Department of Orthopedic Surgery, Seoul National University Hospital. All the cases were involved at the thoracic spine and kyphosis were ranged 100 through 150 degrees. Severe fixed chest deformity and impaired pulmonary function were observed. By thoracotomy, aorta was seen to be adherent to the surrounding tissue and this was separated from the verterbral lesion with meticulous procedure. The focus was curetted radically exposing spinal cord which was decompressed with anterior transposition. Then the spine was stabilized with anterior interbody fusion. Postoperative intensive pulmonary care and antituberculous therapy are imperative for the good result. Spinal tuberculosi with severe kyphosis and paraplegia could be benefited with the radical surgery by the experienced surgeon.
Aorta ; Congenital Abnormalities ; Kyphosis ; Orthopedics ; Paraplegia ; Seoul ; Spinal Cord ; Spine ; Thoracotomy ; Thorax ; Tuberculosis, Spinal

This is to present the clinical analysis of 197 (165 Patients) open fractures of long bones which were treated at Han Gang Sacred Heart Hospital from December 1971 June 1975. The results obtained as follows: 1. The causes of injury were traffic accident 91, industrial accident 63, home acident 8 and other 3. 2. In this study, there were 139 males and 26 females. The main age incidence ranged 11–40 years. 3. Among the 197 cases, Tibia and fibula were affected mostly(54.8%) 4. Associated injuries included closed fracture of long bone 35, cerebral contusion 15, skull fracture 10, maxillofascial inury 9, joint dislocation 6 and other 21. 5. The method of treatment was chiefly debridement and primary closure of open wound with 16 internal fixation, followed by cast immobilization 161, skeletal traction 15 and pin & plaster. 5. 6. Consequent incidence of infection was 10.7% (deep 5.1%, superficial 5.6%) 7. The causative strains were coliform bacillus 28, pseudomonas 16, staphylococcus 6, streptococcus 1, and bacillus subtilis 1, 8. Death occured in 3 cases: the causes were sepsis due to pseudomonas 2 and anuria due to renal shut down 1.
Accidents, Occupational ; Accidents, Traffic ; Anuria ; Bacillus ; Bacillus subtilis ; Contusions ; Debridement ; Dislocations ; Female ; Fibula ; Fractures, Closed ; Fractures, Open ; Heart ; Humans ; Immobilization ; Incidence ; Joints ; Male ; Methods ; Pseudomonas ; Sepsis ; Skull Fractures ; Staphylococcus ; Streptococcus ; Tibia ; Traction ; Wounds and Injuries

BACKGROUND: In vitro study, normal cardiac prosthetic valve has functional regurgitation due to structural characteristics of prosthetic valve. To evaluate functional regurgitant characteristics of prosthetic valves, we examined patients who had clinically normal mitral prosthesis. METHODS: Transesophageal two-dimensional and color doppler echocardiography were performed to 25 patients who had the clinically normal mitral prosthesis. RESULTS: Seven patients had the mitral bioprosthesis and 18 patients had the mitral mechanical prosthesis. Regurgitation was found in 4 patients(57%) with bioprosthetic valve, and the pattern of regurgitation was central in three patients and unilateral in one patient. But regurgitation was detected in 17 patients(94%) with mechanical prosthesis, and the pattern of regurgitation was bilateral in twelve patients, unilateral in four patients and central in one patient(p=0.0035). The length of regurgitant jets were 22.00+/-6.73(mm) in bioprosthetic valve and 28.65+/-7.33(mm) in mechanical valve. The regurgitant jets were detected in systolic period in most of patients. But in 4 patients who had tachycardia during TEE, regurgitation was detected in systolic and early diastolic period. CONCLUSION: Regurgitation was found in clinically normal cardiac prosthetic valves by TEE. These findings may be useful to differentiate between normal and abnormal cardiac prosthesis.
Bioprosthesis ; Echocardiography, Doppler, Color ; Echocardiography, Transesophageal* ; Humans ; Prostheses and Implants* ; Tachycardia

BACKGROUND: To evaluate the efficacy of transesophageal echocardiography(TEE) to detect left atrial thrombi(LAT) and to investigate the clinical and echocardiography parameters which related with LAT. METHOD: We performed TEE and TTE simultaneously to 98 consecutive patients who had native mital valve disease or mital prosthesis as usual method. We examined the presence and location of LAT and spontaneous contrast(SC) in TEE and measured left atrial dimension(LAD), ejection fraction(EF), mital valve area(MVA) in TTE. Cardiac rhythm, history of anticoagulation and systemic embolization were also reviewed. We compared such parameters in LAT positive/negative groups and SC positive/negative groups. RESULTS: 1) In TEE, we detected 26 cases of LAT, among them seventeen cases : left atrial appendage(LAA) thrombi, 3 cases : combined LA and LAA thrombi, 6 cases : LA thrombi. In TTE, six cases showed LAT but we couldn't detect LAA thrombi. The difference between two methods was statistically significant(p<0.05). 2) LAT positive group showed larger LAD, lower EF, and higher prevalence of AF, systemic embolization, and LAT than negative groups(p<0.01). 3) SC positive group showed larger LAD, lower EF, higher prevalence of AF, systemic embolization LAT than SC negative groups(p<0.05). 4) In multiple discriminant analysis, the history of systemic embolization was most important factor which can suspect LAT(Wilk's Lambda:0.77152. p<0.0001). SC, EF, presence of AF, LAD, anticoagulation therapy. MVR were also statistically valuable factors in order. The hit ratio of this analysis was 86.84%. CONCLUSION: We can suggest that TEE is very useful method to detect LAT than TTE, and the spontaneous contrast was very important factor which can suggest LAT and systemic embolization in mitral valve disease.
Echocardiography ; Echocardiography, Transesophageal* ; Humans ; Mitral Valve ; Prevalence ; Prostheses and Implants

BACKGROUND: Influenza is a serious illness that causes significant morbidity and mortality, especially in high risk patients. The purpose of this study was to investigate influenza vaccination coverage rate and perceptions of people with chronic disease on vaccination in Korea. MATERIALS AND METHODS: Patients with diabetes, chronic kidney disease undergoing hemodialysis, and asthma were surveyed. Individual interviews were performed to patients with diabetes visiting the endocrinology department in a university hospital and patients undergoing maintenance hemodialysis in 4 local clinics and 2 university hospitals. Questionnaires were mailed to patients who were registered to have asthma in a university hospital and were asked to mail back. Demographic data, history of vaccination in season 2005-2006, and perceptions on vaccination were asked. RESULTS: Five hundred and five diabetes patients, 260 hemodialysis patients and 123 asthma patients were analyzed. Influenza vaccination coverage rate was 37.4% in diabetes patients and statistically significant factors associated with vaccination were as follows: lower education level, provider recommendation, previous vaccination, belief in efficacy of vaccination. Forteen and two tenth of patients were recommended to receive influenza vaccine, and the most frequent recommenders were doctors (43.6%). Influenza vaccination coverage rate was 81.9% in patients undergoing hemodialysis and statistically significant factors associated with vaccination were as follows: provider recommendation, previous vaccination, belief in efficacy of vaccination. Sixty six and five tenth of patients were recommended to get influenza vaccination, and the most frequent recommenders were doctors (45.3%) closely followed by nurses (43.6%). Seventy and seven tenth of patients with asthma received influenza vaccination. Previous vaccination was the only statistically significant factor associated with vaccination. Sixty six and nine tenth were recommended to get a vaccination and the most frequent recommenders were doctors (39.8%). CONCLUSIONS: Influenza vaccination coverage was considerably different among different chronic illnesses. The rate was relatively high in patients with chronic kidney disease undergoing hemodialysis and asthma while it was low in patients with diabetes. The rate of vaccine recommendation was low in all patients and active recommendations by health-care workers should be made.
Asthma ; Chronic Disease ; Endocrinology ; Hospitals, University ; Humans ; Influenza Vaccines ; Influenza, Human ; Postal Service ; Renal Dialysis ; Renal Insufficiency, Chronic ; Seasons ; Vaccination ; Surveys and Questionnaires

Segmental zoster paresis is characterized by focal, asymmetric motor weakness in the myotome corresponding to the dermatome of the rash. A 73-year-old man, who presented with severe right shoulder pain and shoulder girdle muscle weakness, was diagnosed with segmental zoster paresis involvement of the C5 C6 motor roots as a complication of herpes zoster. Girdle muscles (supraspinatus, deltoid and infraspinatus) atrophy had developed in his right shoulder. An MRI showed rotator cuff tearing in his right shoulder; therefore, an arthroscopic rotator cuff repair was performed. Herein, this case is presented to emphasize the importance of considering post-herpetic segmental motor paresis in the differential diagnosis of acute painful motor weakness of the upper extremities.
Acute Pain ; Aged ; Atrophy ; Diagnosis, Differential ; Exanthema ; Herpes Zoster* ; Humans ; Magnetic Resonance Imaging ; Muscle Weakness ; Muscles ; Muscular Atrophy ; Paresis* ; Rotator Cuff* ; Shoulder ; Shoulder Pain ; Upper Extremity

BACKGROUND: Target point mutation of DNA topoisomerase, which is the typical mode of quinolone resistance, cannot explain high level resistance to quinolones. Therefore, many authors looked into over expression of efflux pump as the possibility. After quantificating the arcA mRNA, which controls AcrAB- TolC, the authors tried to find out the difference in the expression of arcA mRNA according to MIC of ciprofloxacin. The authors also tried to determine the usefulness of real time PCR, which is more reproducible and takes less time than preexisting immunoblot assay, through quantification of acrA. MATERIAL AND METHODS: Mutations in topoisomerase (GyrA, ParC) of 20 quinolone resistant E. coli isolates were identified by PCR and direct DNA sequencing. AcrA level was measured by real time PCR. GAPDH of E.coli was used as endogenous control. The expression of acrA was confirmed through northern hybridization method, the results obtained by real time PCR were compared. RESULTS: 1) Topoisomerase mutations were found in all quinolone resistant E. coli strains. 2) AcrA expression in fluoroquinolone-resistant E. coli was quantified by using real time PCR. There was no relationship between the ratio of acrA expression to GAPDH and MIC of ciprofloxacin. 3) With Northern hybridization, we compared the band of acrA to that of GAPDH in compactness and area. No difference in the expression according to MIC could be found. 4) The results of AcrA/GAPDH were significantly correlated between the real-time PCR and northern blot (P<0.05, correlation coefficiency 0.98). CONCLUSION: In this study, no relationship between overexpression of AcrA gene and high level fluoroquinolone resistance. Therefore, we assume that mechanism other than AcrAB efflux pump is involved in and contribute to high-level fluoroquinolone resistance. However, the degree of efflux pump expression could be confirmed with real time PCR using acrA mRNA. Therefore, real time PCR could be used in the molecular biologic study on the mechanism of resistance to antibiotics.
Anti-Bacterial Agents ; Blotting, Northern ; Ciprofloxacin ; DNA Topoisomerases, Type I ; Escherichia* ; Fluoroquinolones* ; Point Mutation ; Polymerase Chain Reaction ; Quinolones ; Real-Time Polymerase Chain Reaction* ; RNA, Messenger ; Sequence Analysis, DNA

BACKGROUND: Target point mutation of DNA topoisomerase, which is the typical mode of quinolone resistance, cannot explain high level resistance to quinolones. Therefore, many authors looked into over expression of efflux pump as the possibility. After quantificating the arcA mRNA, which controls AcrAB- TolC, the authors tried to find out the difference in the expression of arcA mRNA according to MIC of ciprofloxacin. The authors also tried to determine the usefulness of real time PCR, which is more reproducible and takes less time than preexisting immunoblot assay, through quantification of acrA. MATERIAL AND METHODS: Mutations in topoisomerase (GyrA, ParC) of 20 quinolone resistant E. coli isolates were identified by PCR and direct DNA sequencing. AcrA level was measured by real time PCR. GAPDH of E.coli was used as endogenous control. The expression of acrA was confirmed through northern hybridization method, the results obtained by real time PCR were compared. RESULTS: 1) Topoisomerase mutations were found in all quinolone resistant E. coli strains. 2) AcrA expression in fluoroquinolone-resistant E. coli was quantified by using real time PCR. There was no relationship between the ratio of acrA expression to GAPDH and MIC of ciprofloxacin. 3) With Northern hybridization, we compared the band of acrA to that of GAPDH in compactness and area. No difference in the expression according to MIC could be found. 4) The results of AcrA/GAPDH were significantly correlated between the real-time PCR and northern blot (P<0.05, correlation coefficiency 0.98). CONCLUSION: In this study, no relationship between overexpression of AcrA gene and high level fluoroquinolone resistance. Therefore, we assume that mechanism other than AcrAB efflux pump is involved in and contribute to high-level fluoroquinolone resistance. However, the degree of efflux pump expression could be confirmed with real time PCR using acrA mRNA. Therefore, real time PCR could be used in the molecular biologic study on the mechanism of resistance to antibiotics.
Anti-Bacterial Agents ; Blotting, Northern ; Ciprofloxacin ; DNA Topoisomerases, Type I ; Escherichia* ; Fluoroquinolones* ; Point Mutation ; Polymerase Chain Reaction ; Quinolones ; Real-Time Polymerase Chain Reaction* ; RNA, Messenger ; Sequence Analysis, DNA