Camptodactyly is a non-traumatic flexion deformity of the PIP joint of the digit (except thumb) and one of rare congenital anomalies of the hand. It may be a clinical manifestation of some other syndrome and may not be a disease of its own right. It is very difficult for this particular problem to get satisfactory results. We analysed 36 digits of 19 patients, whom we treated and followed up for an average of 1.7 years from 1982 to 1988 at the Department of Orthopedic Surgery, Seoul National University Hospital. The following results were obtained. 1. Male to Female ratio is 8: 11 and age ranged from 14 months to 32 years old. 2. Unilateral and single digit involvement is twice more commonly found than bilateral and multiple digit involvement respectively. 3. Third digit is the most frequently involved one in our series. 4. Besides soft tissue contractures on the volar aspects of the PIP joints, other pathologic findings are thick reddish glistening palmar skin in 6 patients, tendon problems in 4 patients and bone-joint hypoplasia in 1 patient. 5. We have done 3 types of operation, that is, skin graft, flexor tenotomy with skin Z-plasty, extensor reconstruction with flexor tenotomy and skin Z-plasty. The results of operations ranged from good to poor, however most cases showed above fair results at the final follow-up. 6. Camptodactyly seems to be a disease of various etiologies and pathologies. And it is strongly suggested that the treatment of this syndrome should be individualized according to their pathologies found at surgery.
Congenital Abnormalities ; Contracture ; Female ; Follow-Up Studies ; Hand ; Humans ; Joints ; Male ; Orthopedics ; Pathology ; Seoul ; Skin ; Tendons ; Tenotomy ; Transplants

It is essential to define the accurate location and extent of bony bridge in relation to the epiphyseal plate for operation of partial epiphyseal plate closure by bony bridge resection. Since magnetic resonance imaging(MRI) provides excellent tissue contrast and multiplaner image, it could be applied to the diagnosis and mapping of bony bridge of epiphyseal plate. A thirteen year old female with post-traumatic epiphyseal injury of ankle was diagnosed by MRI. We could assess the bony bridge accurately by direct sagittal and coronal images and excellent tissue contrast of MRI.
Ankle ; Diagnosis ; Female ; Growth Plate ; Humans ; Magnetic Resonance Imaging

Treatment of femoral shaft fractures in children is varying according to age. Satisfactory results have been obtained with longitudinal skin traction, split Russell traction, ordinary Russell traction, 90-90 skeletal traction, and immediate application of a spica cast(2,4,6,11,15). Most authors use one or more techinques routinely. It is safe and convenient to use single treatment protocol to treat all fractures of same type, Distal femoral skeletal traction with the knee and hip flexed 90 degrees and with the thigh hanging free, using the trunk as counter traction, has been used routinely for femoral shaft fractures in children(age 4-12). We reviewed 30 cases of femoral shaft fractures in children treated with 90-90 skeletal traction. 1. The average age of the patients was 6.8 years(range, 4-12 years), and almost all were caused by pedestrian injury. 2. The average time of traction was 48 days(range, 28-75), and 12 cases(40%) were treated without spica cast application. 3. Four among 30 cases developed angular deformity exceeding acceptable range(15° in AP view, 20° in lateral view), and three of them were proximal third fractures. 4. The older the patient, the longer the duration of limited activity and the more tendency of angular deformity. 5. 90-90 skeletal traction is easy, safe and convenient to treat all femoral shaft fractures of the children between four and ten years old.
Child ; Clinical Protocols ; Congenital Abnormalities ; Hip ; Humans ; Knee ; Skin ; Thigh ; Traction

It is essential to define the mechanical and morphological characteristics of bone in undrestanding the mechanism and treatment of fractrues of bone. We already reported the results of bending study in 1983 and tension study in 1987 to assess the mechanical and morphological changes of bone according to the growth. Following these studies, we performed torsion study on growing long bone to have better understanding of the characteristics of bone. In order to assess the mechanical and morphological properties of fracture of growing bone by torsion, we divided 100 Newzealand white rabbits(40 1-month-old rabbits, 20 3-months old rabbits and 40 5-months-old rabbits) into 6 experimental groups according to their maturity and side : Group 1(right femur of 1 month old), Group 2( left femur of 1 month old), Group 3(right femur of 3 months old), Group 4(left femur of 3 months old), Group 5(right femur of 5 months old), Group 6(left femur of 5 months old). Each group of femora were loaded in torsion with varing distance and the following results were obtained: 1. Fracture shapes were composed of the spiral component and the vertical component which connected the two ends of the spiral component. 2. Younger bones revealed greater deformation angle and apex angle but less obliquity than older bones. 3. When the gap between the grips were lengthened three times, there was a very signi ficant increase of deformation angle and obliquity but apex angle was decreased and the fracture angle showed little change. 4. It was necessary to measure the apex angle and obliquity in the morphological description of fractures by torsion. 5. We observed when a certain degree of angular deformity was applied on a bone at a certain age, the fracture was occured through the tension failure regardless of types of loading forces.
Congenital Abnormalities ; Femur ; Hand Strength ; Humans ; Infant, Newborn ; Rabbits

No abstract available.
Kinetics* ; Wrist*

Subclavian vein catheterization is a well estab1ished technique in adults for central venous pressure monitoring and the infusion of irritant solutions. Its use in small children is less common, preaumably because of technical difficulties in inserting the catheter and the disk of major complications. During cardiac surgery heparinization potentially adds to the risk of hematoma forma-tion. But it is often preferred becauae of the greater stability of the catheter on the anterior chest wall and allows a greater freedom of the neck and upper limb movement. We have experienced 62 open heart surgeries for congenital heart disease between April 14th and Oecember 31th 1986. In 47 children ranging in age from 11 months to 15 years, there was a high succes rate and no morbidity. It is concluded that infraclavicular subclavian vein catheterization is a useful means of measuring central venous presaure and establishing a central infusion line in children undergoing open heart surgery.
Adult ; Catheterization ; Catheters ; Central Venous Pressure ; Child* ; Freedom ; Heart ; Heart Defects, Congenital ; Hematoma ; Heparin ; Humans ; Neck ; Subclavian Vein* ; Thoracic Surgery* ; Thoracic Wall ; Upper Extremity

We have experienced early extubation after 20 consecutive open heart surgeries for congenital heart disease between May 19 th and May 30 th this year. Eighteen of those 20 had the tracheal tube removed in the operating room immediately after operation. The reanlts were good and satisfactory. Two required postoperative ventilatory support for several hours at RICU. Sufentanil (Sufenta) 10-15 ug/kg was used intravenously as a major narcotic anesthetic for 18 podiatric patients and Fentanyl 50 ug/kg used for 2 adult Patients. The advantages of early extubation are as follows ; It is more physiologic, more comfortable, psychologically leas anxiety provoking for the patients and has less chance of pulmonary infection and less chance of ventilator mishaps arid it also shortens RICU stay and hospitalization. It is concluded that early extubation after open heart surgery for congenital heart disease has minimal risk and definite advantages in carefully selected patients.
Adult ; Anxiety ; Fentanyl ; Heart Defects, Congenital ; Heart Diseases* ; Heart* ; Hospitalization ; Humans ; Operating Rooms ; Sufentanil ; Thoracic Surgery* ; Ventilators, Mechanical

The authors presented a family whose 4 siblings had been suffered from oculopharyngeal muscular dystrophy of autoscmal recessive trend, with symptoms of progressive ptosis, external ophthalmoplegia, dysarthria, dysphagia and facial muscle atrophy, and we performed HLA study on these 9 family members which showed no interrelationship between oculopharyngeal muscular dystrophy and HLA Haplotypes.
Atrophy ; Deglutition Disorders ; Dysarthria ; Facial Muscles ; Haplotypes ; Histocompatibility Testing* ; Humans ; Muscular Dystrophy, Oculopharyngeal* ; Ophthalmoplegia ; Siblings

A clinical study was done on 29 cases of spontaneous pontine hemorrhage which were confirmed by brain CT scan at Keimyung university Dongsan hospital from Jan. 1981 to Feb. 1986. The results are summarized as follows. 1. The incidence of pontine hemorrhage was 7.4% of all spontaneous intracranial parenchymal hemorrhage. 2. The most prevalent age group were 40th and 50th decades and male to female ratio was 2.2:1. 3. The most common precipitating factor was hypertension and most of pontine hemorrhage occurred during daily routine or increased activities. 4. Symptoms on onset were headache, altered consciousness, vomiting, dizziness, motor weakness, dysarthria, sensory disturbance and generalized convulsion, in order of frequency. 5. Cardinal neurologic signs on admission were loss of consciousness, ocular signs e.g. Pinpoint or miotic pupil absent horizontal doll's eye movement ocular bobbing skew deviation MLF syndrome, motor weakness e.g. quadriparesis hemiparesis decerebrate rigidity, positive Babinski sign. 6. Mean size of hematoma on CT was 6.8cc and 44% was under 5cc. Hematoma of 4th ventricle was seen in 36% of pontine hemorrhage. 7. 25 cases of pontine hemorrhage were divided into 3 groups according to the location of hematoma on CT-basilar (2 cases), tegmental (15 cases), diffuse (8 cases). 8. All 29 cases of pontine hemorrhage were treated medically, 21% were improved, and 79% hopeless discharge or death. 9. Mild disturbance of consciousness on admission, small size (under 5cc) of hematoma and absence of hematoma in the 4th ventricle seem to be good prognostic indicators.
Brain ; Consciousness ; Decerebrate State ; Dizziness ; Dysarthria ; Eye Movements ; Female ; Headache ; Hematoma ; Hemorrhage* ; Humans ; Hypertension ; Incidence ; Male ; Neurologic Manifestations ; Ocular Motility Disorders ; Paresis ; Precipitating Factors ; Pupil ; Quadriplegia ; Reflex, Babinski ; Seizures ; Tomography, X-Ray Computed ; Unconsciousness ; Vomiting

A new fluorinated benzodiazepine compound Ro 5-4200 was used for induction in 58 surgical patients to evaluate the possibility of an intravenous anesthetic induction agent (Table 2 and 3). The hypnotic properties as well as respiratory, cardiovascular, muscle relaxant and local effects were observed. 1. Ro 5-4200 in doses of 2mg was slowly injected intravenously to adult patients (body weight ; 54.2+/-10.3 kg) and 1 mg to a child (body weight; 22 kg, 5 yr.) (Table 2). The tim between the start of injection and the loss of consciousness was 110.3"+/-68.6", taken from the beginning of the injection until the patient was asleep and eyelash and corneal reflexes abolished. Sleep did not occur in 2 patients (Table 4). 2. But the time to sleep after the injection varied remarkebly according to the dilution of the drug. When the dose of 2 mg of the drug was injected, undiluted directly to the small vein, the time to sleep was 83.2"+/-31.4" and 69.1"+/-31.4"; in the former case the patients complained of pain along the injected vein and the latter did not. 3. The hypnotic time with the diluted solution of the drug was 144.5" +/-4.6" and 117.3"+/-77.8", in which the former complained of pain during injection, and the latter did not. 4. Blood pressure, pulse rate and respiratory rate were measured immediately prior to induction and again 2 and 5 minutes after induction. A slight but insignificant rise in blood pressure with a mean of 3.4% in systolic and 6.7% in diastolic pressure above control value was observed in 2 minutes after injection. And at 5 minutes there was a significant fall in blood pressure, 11.3% and 4.3% respectively (p<0.05) (Table 5). 5. Pulse rate increased significantly by 12.7 beats (14.2%) a minute in 2 minutes after injection and 15.7 beat (17.5%) a minute in 5 minutes after injection from a control level of 89.6 (p<0.01) ,(Table 6). 6 Respiration became shallower and the rate decreased as the patients fell asleep. Apnea occurred in 4 patients (6.9%). In the apnea cases, respiration was controlled by mask and positive pressure ventilation. It needed that the facilities for positive pressure ventilation be available in case apnea develops. 7. During induction, tremors, abnormal muscle movements, and laryngospasm were not observed. Hiccough was observed in 4 cases (6.9%). Hiccugh had the tendency to recur during intra-abdominal procedure. 32 patients (55.0%) had an antegrade amnesia, that is shortly before the injection of the drug. They did not remember being moved to the operating table or the insertion of the injection needle. 8. Ro 5-4200 caused pain on injection when given undiluted directly into a small vein on the dorsum of the hand, and the pain was also complained of even when the drug was diluted to 5 times with normal saline or intravenous drip infusion. A localized thrombophlebitis was not seen. 9. Laryngeal reflexes were retained on induction but endotracheal intubation was tried successfully without muscle relaxant in three cases. In this procedure the patients tended to be awake and showed some resistance. The help of muscle relaxants in intubation is recommended. As to degree of everity and nature of muscle fasciculation after succinylcholine, there was somewhat delayed appearance but degree was not altered by Ro 5-4200 10. Recovery from anesthesia and reversal of muscle relaxation was unaltered. The induction was satisfactory, but slow, and characterized by minimal change in blood pressure, pulse rate and respiration. Because of this delayed induction time and the varied degree of depth of sleep, the agent seemed to be improper as an intravenous induction agent. Acknowledgements: Samples of Ro 5-4200 have been kindly supplied by Hoffmann La Roche, Hong Kong. The authors wish to thank Dr. S.S.Lo and Dr. P.A. Bulhr of Roche Products Ltd., for their assistance and advice.
Adult ; Amnesia ; Anesthesia ; Apnea ; Benzodiazepines* ; Blinking ; Blood Pressure ; Child ; Fasciculation ; Flunitrazepam* ; Hand ; Heart Rate ; Hiccup ; Hong Kong ; Humans ; Infusions, Intravenous ; Intubation ; Intubation, Intratracheal ; Laryngismus ; Masks ; Muscle Relaxation ; Needles ; Operating Tables ; Positive-Pressure Respiration ; Reflex ; Respiration ; Respiratory Rate ; Succinylcholine ; Thrombophlebitis ; Tremor ; Unconsciousness ; Veins