Triple arthrodesis was performed on 167 feet in 153 patients at the Department of Orthopaedic Surgery, Seoul National University Hospital, during the 19 years from July 1957 to March 1976. Review of statistics, technical problems, and complications has led to following conclusions. 1) Of the total of 167 feet, residual poliomyelitis was the most common etiology with 127 feet (76%). 2) The youngest age was 5 years and the oldest 54 years, the 12–17 year group with 84 feet occupying half of the cases. 3) 79 feet (46.7%) had equinovarus deformity and 27 feet had equinocavovarus. 13 feet had no deformities. 4) Hoke's lazy S incision was utilized in 110 feet and Olliers incision in 57 feet. Hokes technique was employed in 118 feet and Lambrinudi's technique or its modification in 44 feet, while in the 5 feet without deformity exeresis alone was performed. Steinmann pins were used in 121 feet for temporary internal fixation and staples were used in 39 feet. 7 feet had no internal fixation. The senior author (D.Y.L.) routinely employs Hoke's incision, Hoke triple arthrodesis and Steinmann pin fixation, while when there is no deformity simple exeresis may be performed. 5) In our opinion, Hoke triple arthrodesis can correct any deformity and is particularly suitable in severely deformed rigid feet, since excision and replacement of the head of the talus affords better exposure and mobilization as well as easier set-up of the foot. 6) Whenever necessary, triple arthrodesis was combined with tendo Achilles lengthening, percutaneous plantar fasciotomy, posterior capsulotomy, medial or posteromedial release, subtalar and midtarsal wedge osteotomy, tibiotalar arthrodesis, supramalleloar osteotomy, and transmetatarsal osteotomy, followed by cast wedging or tendon transfers if indicated. 7) There was no nonunion in our cases. Clinically significant skin necrosis and wound sloughing occurred in 8 feet, gross postoperative infection in 2 feet, secondary osteoarthritis of the ankle in 2 feet, significant residual equinus deformity in 8 fret(in seven tendo Achilles lengthening was not done and in the one with tendo Achilles lengthening the deformity had been extreme and rigid), residual varus deformity in 3 feet, and residual valgus in 1 foot. These major complications occurred mostly in older children and adults, in whom deformities were severe and rigid and extensive surgery was necessary in order to achieve adequate correction. In such feet, correction is extremely difficult and greater risks of a variety of complications demand meticulous attention to technical details and postoperative care.
Adult ; Ankle ; Arthrodesis ; Child ; Clubfoot ; Congenital Abnormalities ; Equinus Deformity ; Foot ; Head ; Humans ; Necrosis ; Osteoarthritis ; Osteotomy ; Poliomyelitis ; Posterior Capsulotomy ; Postoperative Care ; Seoul ; Skin ; Talus ; Tendon Transfer ; Wounds and Injuries

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

Oculoinotor nerve is a very important nerve in the ophthalornology, innervating the medial rectus, inferior rectus, inferior oblique, superior rectus, levator palpebrae superioris, and the presynaptic parasyrnpathetic outflow to the internal muscles of eye (the ciliary muscle and the sphincter muscle of the iris) . To examine the fine structure of neurons and synapses in the oculomotor nucleus projecting the rnedial rectus Hiuscle, 50% horseradish peroxidase (HRP) solution was injected into the rnedial rectus rnuscle of the cat, and serial sections of midbrain were studied with electron microscopes. Large motor neuron, small motor neuron and spindleshape motor neuron were examined. Cell body contained rich organells that. were nucleus, rough endoplasmic reticulum, HRP containing lysosorne, mitochondria and ribosome etc. Three kinds of synapses that are axosomatic synapse, axo-dendritic synapse and axo-axonic synapse were examed. Moreover, the nerve terminals had spherical-shaped synaptic vesicles. These results suggest that the function of inotorneurons related to the medial rectus muscle is not. defined by the shape and distribution of nerve terrninals but. depends on the shape of synaptic vesicles.
Animals ; Cats* ; Endoplasmic Reticulum, Rough ; Horseradish Peroxidase ; Mesencephalon ; Mitochondria ; Motor Neurons ; Muscles ; Neurons ; Ribosomes ; Synapses ; Synaptic Vesicles

PURPOSE: This study was performed to investigate the effect of shift work on diurnal blood pressure (BP) pattern in nurses. Method: We studied 20 healthy nurses engaged in 3 shift work. 24-hour ambulatory BP monitoring was performed to each nurse two times during the day and night shift. Five nurses were excluded because of inadequate BP measurement. RESULTS: All subjects were female. The mean age was 27.4 years (range: 23?33 years) and mean body mass index was 19.7 Kg/m2 (range: 18.0-21.2 Kg/m2). The changes of systolic BP (17.8+/-9.1 vs. 13.2+/- 4.7%, p=0.031), diastolic BP (22.3+/-8.7 vs. 17.3+/-9.0%, p=0.061), and heart rate (25.2+/- 5.2 vs. 12.5+/-8.7%, p=0.001) during the sleeping period were decreased after a night shift compared with day shift. The non-dipper group significantly increased from 20% to 40% after a night shift (p=0.018). CONCLUSION: Working night shift is significantly associated with non-dipper status in nurses.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Body Mass Index ; Circadian Rhythm ; Female ; Heart Rate ; Humans

PURPOSE: This study was performed to investigate the effect of shift work on diurnal blood pressure (BP) pattern in nurses. Method: We studied 20 healthy nurses engaged in 3 shift work. 24-hour ambulatory BP monitoring was performed to each nurse two times during the day and night shift. Five nurses were excluded because of inadequate BP measurement. RESULTS: All subjects were female. The mean age was 27.4 years (range: 23?33 years) and mean body mass index was 19.7 Kg/m2 (range: 18.0-21.2 Kg/m2). The changes of systolic BP (17.8+/-9.1 vs. 13.2+/- 4.7%, p=0.031), diastolic BP (22.3+/-8.7 vs. 17.3+/-9.0%, p=0.061), and heart rate (25.2+/- 5.2 vs. 12.5+/-8.7%, p=0.001) during the sleeping period were decreased after a night shift compared with day shift. The non-dipper group significantly increased from 20% to 40% after a night shift (p=0.018). CONCLUSION: Working night shift is significantly associated with non-dipper status in nurses.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Body Mass Index ; Circadian Rhythm ; Female ; Heart Rate ; Humans

Superior oblique myokymia is an unusual disorder of ocular motility characterized by rapid, small ampulitude and rotary oscillations limited to one eye. Symptoms of monocular oscillopsia and torsional diplopia are experienced by the patient, and the cause remains obscure. We experienced a case of superior oblique myokymia that developed in a 53-year-old male. We report this unusual case with literature review.
Carbamazepine ; Diplopia ; Humans ; Male ; Middle Aged ; Trochlear Nerve Diseases*

Acquired tumors of the nonpigmented ciliary epithelium are rare diseases. They are difficult to diagnose and present as pseudoadenomatous hyperplasia, adenoma or adenocarcinoma. They exhibit slowly progressive enlargement leading to a subluxated lens, cataract, and secondary glaucoma. And some of the more malignant tumors may extend extrasclerally. We report a case of adenoma of nonpigmented ciliary epithelium which produced a cataract.
Adenocarcinoma ; Adenoma* ; Cataract ; Epithelium* ; Glaucoma ; Hyperplasia ; Rare Diseases

To examine the clinical characteristics of ocular emergency in Sungnam, we analyzed 3784 of the eye patients who visited emergency medical center of Inha university hospital during 3 years from January 1, 1995 to December 31, 1997 The ambulation rate of eye patients was 3.97% of total patients visiting emergency medical center and the admission rate was 8.30%. Male was more common than female about 2-fold and the patients in the age of 3rd decade(30.8%) and 4th decade(23.7%) were common Regarding the eye in trouble, there was no significant difference between right eye and left eye. September and autumn were most common month and season and visit rate of Sunday(27.7%) was highest in a week. According to the arrival time at emergency medical center, largest group was between 9 PM and 12 AM and within 1 hour from the onset of disease most patients visit emergency medical center. Most frequent cause of visit was beating by fist and common ocular diseases were conjunctivitis(20.4%), orbital contusion(17.9%) and eyelid laceration(13.9%).
Emergencies* ; Eyelids ; Female ; Gyeonggi-do* ; Humans ; Male ; Orbit ; Seasons ; Walking

Meningeal irritation signs sometimes develop after myelography due to bacterial infection by contamination during the procedure or chemical irritiation by contrast media itself. CSF profiles of chemical meningitis often mimick those of bacterial meningitis, sometimes causing difficulty in differentiation, but in that case clinical course soon reverse in short time without any complication. Postmyelography chemical meningitis by metrizamide (AmipaqueR) has been well described but iohexol (OmnipaqueR) has rarely been reported to cause chemical meningitis. We experienced a patient of chemical meningitis by iohexol and here descibe the case.
Bacterial Infections ; Contrast Media ; Humans ; Iohexol ; Meningitis* ; Meningitis, Bacterial ; Metrizamide ; Myelography*

OBJECTIVES: The aim of the study was to determine the characteristics of patients who did not match the audiometric criteria of idiopathic sudden sensorineural hearing loss (SSNHL) but complained of acute hearing loss. METHODS: By thorough medical chart reviews, historical cohort study was performed with consecutive data of 589 patients complaining of acute unilateral sensorineural hearing loss without identifiable causes between 2005 and 2013. Those patients demonstrating a hearing loss of at least 30 dB at three consecutive frequencies based on pure tone audiometry were classified as group I; the others were classified as group II. Patients' characteristics, final hearing, and hearing improvement rate (HIR) between the two groups were compared. RESULTS: Group II exhibited distinctive characteristics, including an early age of onset of the hearing loss (P<0.01), an absence of accompanying diabetes (P<0.01) and hypertension (P<0.01), and better unaffected hearing and final hearing compared with group I (P<0.001). However, the HIR of the patients in the two groups was not significantly different (P>0.05). CONCLUSION: Patients who did not meet the audiological criteria of SSNHL exhibited distinctive characteristics compared to SSNHL patients.
Age of Onset ; Audiometry ; Cohort Studies ; Hearing Loss* ; Hearing Loss, Sensorineural* ; Hearing Loss, Sudden ; Hearing* ; Humans ; Hypertension ; Prognosis