Twelve neglected congenital dislocations of the hip in ten patients over the age of eight years were treated by open reduction and chiari osteotomy. Reduction was aided by preoperative traction only in two hips, by femoral shortening with preoperative traction in three and by femoral shortening only in seven. The average follow up period in our series is 3 years, ranging from 1 year and 2 moths to 4 years and 5 months. The overall results were good but one case of avascular necrcsis and one case of redislocation were seen. By our experience it is thought that all old and congenitally dislocated hip in the growing age can be reduced by femoral shortening with soft tissue release, and preoperative traction for its reduction is not undispensable. The most problem in the treatment of the old congenital dislocation of the hip is the postoperative partial ankylosis in the affected hip and this problem would be overcome by delicate operative technique and meticulous hemostasis.
Ankylosis ; Dislocations ; Follow-Up Studies ; Hemostasis ; Hip ; Humans ; Moths ; Osteotomy ; Traction

Granuloma gluteale infantum may be considered a complication oi the primary irritant type of diaper dermatitis and a modern disease due to the change in tae are of the napkin area. Most patients were infants who had worn plastic diapers and were treated with fluorinated topical corticasteroid cream for their diaper dermatitis. The lesions comorise one or several, soft and reddish brown or livid purple nodules on the napkin area. We report a typical case of granuloma gluteale infantum in a 13-month old female who had been treated with topical cortieosteroid crearn for her diaper derniat;lis. The granuloma regressed spontaneously after withdrawl of the topical corticosteroid and restricted use of the occlusive plastic diaper.
Dermatitis ; Female ; Granuloma* ; Humans ; Infant ; Plastics

No abstract available.
Blepharoptosis*

No abstract available.
Animals ; Cats* ; Laminectomy* ; Spine*

The mechanism of cytolysis by complement attack of nucleated cells(NC) is of special interest in comparison to that of red blood cells. It is known that NC death by membrane attack comples, C5b-9, is caused by many factors, i.e., efficiency of complex assembly, activation of intrinsic metabolic pathway by signal transduction, cytotoxic effect of the channel itself and natural repair ability. These factors suggest that colloid osmotic lysis, known in red blood cells, does not fully explain the complement-mediated cell death of NC. In this study, the authors investigated correlation between biochemical and morphological changes to prove "Ca2+-mediated metabolic death"8~13) representing a mechanism of NC death caused by C5b-9 attack. The L1210 cells, mouse leukemic cell line carrying small complement channel(TAC5b-91) were used in the experiments. The amounts of intracellular adenine nucleotides to extracellular Ca2+, ouabain, KC1 and dextran were analyzed by bioluminescence method using luminometer. Cell viability was checked by 0.4% trypan blue dye and LDH release. Morphological observation of TAC5b-91 was done by immunocytochemical staining and electron microscope. The results were as follows: 1) The release of ATP, ADP and AMP followed by cell death was rapid and progressive along the incubation time at 37 degrees C and it was accelerated in 1.5 mM of [Ca2+]0. 2) There was no evidence of ATP repairment in the TAC5b-91. 3) Extracellular KC1(150 mM), dextran(0.66 mM) and ATP supplement(0.2 microM) could not effectively inhibit ATP depletion and cell death. Ouabain(27 and 100 microM) enhanced cell death and could not completely prevent ATP loss. 4) Most of the mitochondria showed swelling, loss of cristae and Ca2+ deposit in matrix in the electron microscopic observation. Rapid, sustained and irreversible depletion of adenine nucleotides was due to Ca2+ deposit with destruction of mitochondria and also the leakage through transmembrane channels. Moreover this energy depletion was accelerated by high extracellular Ca2+ concentration. These results indicate that Ca2+-mediated, energy exhaustion is one of the mechanisms of the metabolic cell death by C5b-9 attack of NC.
Mice ; Animals

Ultrasonography is suited for screening patients with a mass in the soft tissue because of its safety, low cost, apparent sensitivity and non-invasiveness. But the application in orthopaedic surgery is insufficient. Authors examined 102 patients who had a palpable soft tissue mass of extremities and trunk with ultrasonography. Location, internal echogenicity, margin, and extent of soft tissue involvement, especially neurovascular bundle by tumor were evaluated. The diagnosis of mass was confirmed by histopathology after excision or biopsy of the mass. The ultrasonography correctly identified and differentiated the cystic lesions of 34 cases. The sonograms of all 16 malignant lesions showed ill-defined margin and heterogenous internal echo. The extent of soft tissue involvement, especially neurovascular bundle was confirmed exactly with ultrasonography. Therefore, in malignant tumor, after confirmation of no neurovascular involvemment with ultrasonography, limb-salvage operation could be considered and planned. In one case of abscess, percutaneous biopsy was done under guidance of ultrasonography. Therefore, ultrasonography can be used as a guide for percutaneous biopsy without exposure to radiation.
Abscess ; Biopsy ; Diagnosis ; Extremities ; Humans ; Mass Screening ; Ultrasonography

Brodie's abscess is a primary subacute pyogenic osteomyelitis that has a thin wall of fibrous tissue and sclerotic bone. The authors have encountered a case of a Brodie's abscess that was developed in the same place of both tibia at the same time and treated the case with surgery and continuous closed irrigation.
Abscess ; Osteomyelitis ; Tibia

BACKGROUND: Korea is, known to be an endemic area of viral hepatitis B, and 5-6% of population are carriers. Immunization can reduce the spread of hepatitis B infection. Hower, not all people respond to hepatitis B immunsation. 5-15% of primary vaccinees fail to be immunized. After revaccination, only 37.5 44% of the primary failures elicit antibody response. Recent studies have reported that it is effective to inject a double dose vaccination in immunocompromsed patients. In some country, they recommend that neonate whode mother is HBV carrier shoud receive double dose vaccination. This study documented the results of double dose vaccintion only once to nonrsponders toward the HBV immunzation. METHODS: Healthy nonresponders to Hepatitis B immunization were recuited from Sep. 1995 to Aug. 1996. Subjects with their AST/ALT level over 40, or over 65 years old were excluded. They were received 2ml of plasma-derived vaccine(Hepavax-B) intramuscularly in the deltoid muscle. Anti-HBs antibody testing were performed at 1 to 3 months after vaccintion. RESULTS: 17 healthy nanreponders to Hepatitis B immunization(male 10, female 7) were included. Their mean ages were 47(32 to64), AST/ALT level 20/19(16 to 28/11 to 35), smoking 4.3pys(1 to 7). Seroconversion occured in 13 of them(76.5%). CONCLUSIONS: Nonresponders to Hepatitis B vaccintion respond well to double dose vaccination once.
Aged ; Antibody Formation ; Deltoid Muscle ; Female ; Hepatitis B* ; Hepatitis* ; Humans ; Immunization ; Immunization, Secondary ; Infant, Newborn ; Korea ; Mothers ; Smoke ; Smoking ; Vaccination*

The estimated incidence of duodenal Crohn,s disease ranges from 0.5-4% of the patients with Crohn,s disease. However, isolated involvement of Crohn,s disease in the duodenum is very rare, and most duodenal Crohn's disease is accompanied with it elsewhere in the gastrointestinal tract. As clinical, radiographic, and endoscopic features may overlap with those of peptic ulcer disease, patients presenting with isolated duodenal involvement may be perplexing diagnostically. The initial treatment for duodenal Crohn,s diease is medical, but if complications such as gastric outlet obstrution, intractable pain during medical therapy, or hemorrhage occur, surgical intervention is necessary. We experienced one case of isolated duodenal Crohn,s disease showing gastric outlet obstruction without any lesion elsewhere in the gastrointestinal tract and report the case with a review of the literature.
Crohn Disease* ; Duodenum ; Gastric Outlet Obstruction ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Incidence ; Pain, Intractable ; Peptic Ulcer

Kleine-Levin syndrome (KLS) is a rare disorder and is diagnosed by recurrent episodes of hypersomnia, hyperphagia, and neurobehavioral dysfunctions. We present a case of a male 19 year-old with seven episodes of the above symptoms. All episodes occurred after a respiratory infectious illness and spontaneously resolved after a few days or a few weeks. A polysomnography showed prolonged sleep latency and decreased REM sleep (14.6%). A multiple sleep latency test revealed a slightly short mean sleep latency (8min 7sec) and three sleep-onset REM episodes in a series of four sleep latency tests across a one day period. The electrophysiological features of previously reported were reviewed.
Disorders of Excessive Somnolence ; Humans ; Hyperphagia ; Kleine-Levin Syndrome* ; Male ; Polysomnography ; Sleep, REM ; Young Adult