Being a rare disease entity, there have been few references about the cleft hand in Korea. We evaluated the postoperative cosmetic results of 17 cleft hands in 14 patients, who were treated surgically at the Department of Orthopedic Surgery of Seoul National University Hospital, from 1982 to 1993. Among 14 patients, 8 were males. Bilateral cleft hands were in five patients and unilateral in 9. Three of five patients who had bilateral cleft hands, were treated surgically on both hands. Remaining two patients had an operation on one hand which affected more severely. Average age at the time of operation was 2 years and 5 months(5 months-10years). Average duration of follow-up was 34 months(1 year 1 month-7years 5 months). By Lange's classification, typical patterns were 16 hands and atypical pattern one. By Flatt's classification, there were 8 hands of I b, 7 I c, 1 I a, 1 II. One patient had family history whose father had both cleft hands and feet. Congenital anomalies other than cleft hand were associated in 10 of 14 patients. Two patients had 3 associated anomalies, 4 patients 2, and 4 patients one. Syndactyly was the most common associated anomaly of affected cleft hand. Central cleft was closed by Snow-Littler technique in 4 hands(24%), Barsky method in 12(71%) and others in 1(6%). Metacarpal bone was treated by intermetacarpal ligament reconstruction in 1 hand(6%), excision only 7(41%), transfer of 2(rd) metacarpal to 3(rd) metacarpal base after excision 5(29%), and 2(rd) metacarpal corrective osteotomy 3(18%). Complications were in 2 hands; one wound dehiesence of cleft, and one partial necrosis of skin. The cosmetic results of surgical treatment were graded into good, fair or poor by the parents-Good ; when parents were satisfied with the result, Fair; improved cosmesis but not satisfied, and Poor; no improvement after surgery. Good was in 16 hands and fair in one.
Classification ; Fathers ; Follow-Up Studies ; Foot ; Hand ; Humans ; Korea ; Ligaments ; Male ; Methods ; Necrosis ; Orthopedics ; Osteotomy ; Parents ; Rare Diseases ; Seoul ; Skin ; Syndactyly ; Wounds and Injuries

Neurilemoma is benign never-sheath tumor which has been described as painless mass and is usually discovered incidentally. It is the most common tumor of peripheral nerve origin and may arise in any nerve where Schwann cells occur. There are few domestic reports which were clinically evaluated in tens of cases of neurilemoma so far. We evaluated on the 56 cases of neurilemoma confined to the trunk and extremities, in the aspect of clinical characteristics, radiology, pathology, EMG, surgical treatment and postoperative results, who were surgically treated at the Department of Orthopedic Surgery of Seoul National University from 1984 to 1994. Among 56 patients, male were 29 and female were 27, and there was no sexual difference. The average age at surgical intervention was 46.4 years (16–83yrs) and 46.4% of patients were in the age of fourties and fifties. The anatomical locations of the tumors were as followed: upper extremities in 22(39%) cases, neck and supraclavicular area in 15(27%) cases, sacrum and lower extremities in 14(25%) cases and trunk in 5(9%) cases. Symptoms were palpable mass in 55 cases, local tenderness in 14, radiating pain in 11, pain in 10, paresthesia in 11, motor weakness in 2 cases. The average follow up period was 19.1 months(13–56 month). Median nerve was involved most frequently(14%), then ulnar nerve(11%). There was no cases which occurred in multiplicity or associated with neurofibromatosis. Marginal excision was done in 51 cases(91%), incisional biopsy only in 4 cases(7%), wide excision in 1 case. The size of the tumors in the longest axis was smaller than 2cm in 9 cases, between 2 and 4cm in 31 cases, between 4 and 6cm in 13 cases and more than 6cm in 3 cases. Malignant change or recurrence was not found in all cases.
Biopsy ; Extremities ; Female ; Follow-Up Studies ; Humans ; Lower Extremity ; Male ; Median Nerve ; Neck ; Neurilemmoma ; Neurofibromatoses ; Orthopedics ; Paresthesia ; Pathology ; Peripheral Nerves ; Recurrence ; Sacrum ; Schwann Cells ; Seoul ; Transcutaneous Electric Nerve Stimulation ; Upper Extremity

PURPOSE: To evaluate risk factors associated with the development of strabismus in children with organic ocular diseases. METHODS: The authors reviewed the medical records of 143 patients diagnosed with organic ocular disease between the ages of six months and 19 years from March 2000 through September 2009. The distributions of etiology, age, visual acuity and visual acuity difference between both eyes at onset of visual loss, spherical equivalent difference between both eyes, duration of visual loss, and nystagmus were analyzed to determine relationships with the development of strabismus. RESULTS: Of 143 patients, strabismus developed in 41 children (28.7%). The causative diseases were congenital cataract (73.2%), developmental cataract (7.3%), uncorrected aphakia (7.3%), retinal detachment (4.9%), lens subluxation (2.4%), optic nerve disorder (2.4%), and corneal opacity (2.4%). The incidence of strabismus increased significantly in the cases of congenital disease, those < or = five years of the age at onset of visual loss, those with < or = 20/200 visual acuity, and those with large interocular spherical equivalent difference. There was no relationship between incidence of strabismus and visual acuity difference between both eyes. However, the incidence of strabismus increased significantly when the visual acuity difference was more than three Snellen lines in congenital ocular disease. CONCLUSIONS: When ocular disease is congenital, an increased risk of onset of strabismus should be considered when the age at onset of visual loss is less than five years, when visual acuity is below 20/200, and when there is a large spherical equivalent difference between both eyes.
Adolescent ; Aphakia ; Cataract ; Child ; Corneal Opacity ; Eye ; Humans ; Incidence ; Lens Subluxation ; Medical Records ; Optic Nerve ; Retinal Detachment ; Risk Factors ; Strabismus ; Visual Acuity

PURPOSE: Headache is a frequent symptom in pediatric practice, but the prevalence of chronic recurrent headache was estimated in several studies with wide variations, because of inadequate expression and differences in case definition in children. Headache classification of International Headache Society is usually used in adults, but the application of it to children is uncommon, so we tried to diagnosis children with headache by using International Headache Society Classification. METHODS: We analyzed the clinical pictures, physical examinations including neurologic examination, PNS series, EEG and CT or MRI in 53 children with nonprogressing recurrent headache over than one month, who visited to pediatric department of Dong-A University hospital from January, 1995 to Feburary, 1996 and diagnosed them by using International Headache Society Classification. RESULTS: 1) The sex ratio between male and female was 1:1.2. 2) Diagnosed groups consisted of children with migraines in 22 cases(41.5%), tension-type headache in 19 cases(35.9%), coexisting migraine and tension-type headaches in 5 cases(9.4%), miscellaneous headaches not associated with structual lesion in 1 case(1.9%), headache associated with vascular disorders in 2 cases(3.8%), headache associated with nonvascular intracranial disorder in 1 case(1.9%), headache due to facial pain in 3 cases(5.6%). 3) Of 22 migraine cases, 13 cases(59.1%) had migraine with aura, 8 cases(40.9%) have migraine without aura and of 19 tension-type headache cases, 8 cases(42.1%) have episodic type, 11(57.9%) cases have chronic type. 4) Of 53 cases with recurrent headache, 3 cases(6%) had abnormal findings in CT or MRI. 5) Of 53 cases with recurrent headache, 9 cases(17%) had abnormal findings in EEG. CONCLUSIONS: International Headache Society Classifications are useful, but the diagnostic criteria are too strict for children, especially in migraine and tension type headache.
Adult ; Child* ; Classification* ; Diagnosis ; Electroencephalography ; Facial Pain ; Female ; Headache* ; Humans ; Magnetic Resonance Imaging ; Male ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Neurologic Examination ; Physical Examination ; Prevalence ; Sex Ratio ; Tension-Type Headache

To study the basic pathological changes of small intestine in metagonimiasis, light- and electron microscopic studies were made, using a total of 21 cats which were experimentally infected with metacercariae of Metagonimus yokogawai. The metacercariae were obtained from naturally infected sweetfish (Plecoglossus altivelis) by digestion technique. The cats were divided in control, light-infection(10,000 metacercariae infected) and heavy-infection(50,000 metacercariae infected) groups. Cats were killed at the 5th, 10th, 15th day, and 4th, 8th and 10th week after the infection. And the small intestine was prepared for the study. Pathological studies comprised gross examination, worm distribution pattern, light microscopic examination and both transmission and scanning electron microscopic examinations. The results obtained were summarized as follows. Gross morphologic changes were the most marked during the first 2 weeks after infection. The gross abnormalities were severer in the heavily infected animals. The changes were dryness and listlessness of serosal surface due to dehydration, mushy and/or watery intestinal content, effacement of transverse nodes and enlargement of mesenteric lymph folds and Peyer's patches. After 4 weeks of infection, these changes became less marked showing a tendency to return to normal. The sectioned flukes were distributed from duodenum to proximal ileum. However, individual variation was marked in distribution. In the heavy-infection group, the locality of parasitism tended to extend more distally. The locality of M. yokogawai in the intervillous space was mostly in the lower-most portion of intervillous space, where they compressed and eroded epithelial cells probably due to mechanical damage to the structure. Very rarely the worms were found in lumen of Lierberkuehn's crypt, and reaching, in two occasions, into proprial lymphoid tissue. Light-microscopically the lesion was restricted in mucosa: Early mucosal changes were shortening, blunting, fusion, and thickening of the villi, crypt hypertrophy with consequent decrease of villus/crypt ratio, as well as stromal changes of edema, capilliary ectasia and marked inflammatory cell infiltration of lymphocytes and plasma cells. Goblet cells were markedly reduced in number as with depletion of its cytoplasmic content. In the later stages of infection, mucosa restored its normal configuration in spite of persistent parasitism of the worms. At the infection stage of 5-15 days, there was significant shortening of the microvillous height with varible destruction of glycocalyx in electron microscopic examination. With lapse of infection time, microvilli became to restore the normal pattern. With these morphological changes, it appears that diarrhea in experimental metagonimiasis would be related to the decrease of absorptive surface of the small intestine particularly in the early phase of infection. The significant changes seen in villi and microvilli might be due to massive intrusion or invasion of Metagonimus worms into the crypts, causing direct mechanical and possible host-immune response to the small bowel mucosa.
parasitology-helminth-trematoda ; metagonimiasis ; Metagonimus yokogawai ; pathology ; cat-intestine ; edema ; lymphocytes ; plasma cells ; goblet cell

Discoid meniscus is a congenital morphological variable anomaly of meniscus which is often asymptomatic. Arthroscopic surgeries on 91 symptomatic lateral discoid menisci of 84 patients were performed at the Department of Orthopedic Surgery, Seoul National University Hospital during the period of Jan. 1987 to Jan. 1994, which equals 19.2% of arthroscopic meniscectomies performed. Follow up was done from minimum of 1 year to maximum of 8 years, with an average period of 3 years and 10 months. Retrospective study was done with the review of clinical records, roentgenograms, MRI, and arthroscopic findings on recorded videotapes to evaluate the clinical and radiological features, results of arthroscopic treatment and possible prognostic factors. The followings are the results: 1. The lateral discoid meniscus encompassed 19.2% of arthroscopic meniscectomies performed at the same period, which was relatively high incidence. Arthroscopic partial and subtotal menis- cectomy resulted in satisfactory results. 2. Since 8 (11%) knees were not diagnosed preoperatively as discoid meniscus due to type being incomplete or torn meniscus displacement, these points should be considered with clinical findings at diagnosis of discoid meniscus. 3. 34.9% of 83 menisci with tear had previous trauma history which showed high vulnerability to tear. Discoid menisci without tears but with grade II intrasubstance increased signal and symptoms were treated with arthroscopic meniscectomy and showed good results. Therefore discoid menisci without tears should be considered of arthroscopic meniscectomy in the presence of clinical symptoms and MRI findings. 4. Lysholm total and pain scores were significantly improved at postop. 1 year and at the final follow up with p<0.05. Factors such as degenerative changes, sex, age, duration of preoperative symptoms, presence of tears and types of meniscectomy gave no significant influence on the results and the prognosis.
Arthroscopy ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Knee* ; Magnetic Resonance Imaging ; Orthopedics ; Prognosis ; Retrospective Studies ; Seoul ; Videotape Recording

No abstract available.
Eosinophil Cationic Protein* ; Eosinophils* ; Rhinitis*

Trauma, such as ankle fractures, has been the major etiology of ankle arthritis. It has been reported that 70-80% of ankle arthritis cases are due to lateral ankle instability and post-traumatic ankle arthritis. Ankle arthrodesis is the gold standard for end-stage ankle arthritis treatment, but it restricts ankle motion and leads to adjacent joint arthritis in the long term. Low tibial osteotomy is indicated for unicompartmental ankle osteoarthritis (OA) with varus/valgus deformity to realign the malalignment and redistribute the localized tibial plafond and malleolar pressure upon the talus and relieve ankle pain. Ankle distraction arthroplasty is another option for young patients with early ankle OA to widen the ankle joint space and decrease pain. Total ankle arthroplasty (TAA) is a viable surgical alternative for end-stage ankle OA to relieve ankle pain while preserving ankle motion. Recently, a 3-component total ankle system has been predominant, and the outcomes and survival of TAA have improved somewhat. Prospective comparative studies on ankle arthrodesis and TAA should be performed in the future, especially with critical evaluation of complications. Ankle arthrodesis and TAA are 2 major surgical options for end-stage ankle arthritis, but research on other possible alternatives for early stage OA should be performed in the future.
Animals ; Ankle ; Ankle Joint ; Arthritis ; Arthrodesis ; Arthroplasty ; Congenital Abnormalities ; Humans ; Joints ; Osteoarthritis ; Osteotomy ; Talus

Fistula between the right renal artery and the infereior vena cava is a rare disorder, of which only 7 cases were reported in so far as the authors have reviewed. A 34-year-old man, who had got a stab wound on the abdomen and undergone an abdominal surgery 12 years ago during his military service, visited the hospital because of occipital headache and known hypertension for 5 years. On examination, his blood pressure was 200/140mmhg, and a thrill and loud continuous vascular bruits over the paraumbilical and right loin region were noted. his blood pressure was refractory to usual antihypertensive regimens. The chest X-ray film showed cardiac enlargement and pulmonary congestion. With the aids of abdominal ultrasonogram, static and dynamic renal scanning with (99m)T-DTPA, excretory urogram, aortogram and selective right renal angiogram, he was diagnosed as right renal artery inferior vena cava fistula. After fistulectomy and repair of walls of both vessels, his blood pressure was successfully controlled with drugs.
Abdomen ; Adult ; Arteriovenous Fistula* ; Blood Pressure ; Estrogens, Conjugated (USP) ; Fistula ; Headache ; Humans ; Hypertension ; Hypertension, Renovascular ; Military Personnel ; Renal Artery* ; Thorax ; Ultrasonography ; Vena Cava, Inferior* ; Wounds, Stab ; X-Ray Film

No abstract available.