No abstract available.
Jaundice*

No abstract available.
Diagnosis* ; Osteoma, Osteoid*

Sleep disordered breathing is highly prevalent in the elderly and affects older men and women similarly. Nocturia, cardiovascular diseases, cognitive impairment, traffic accidents and repeated falls are common manifestations of sleep apnea in the elderly and sleep study may be indicated in these patients. When a sleep study is planned, reliable markers of respiratory efforts and a tibial EMG should be included because central sleep apneas and periodic leg movements are common in the elderly patients. Although cardiovascular morbidity and mortality seem to be lower in the elderly than in middle-aged adults, these may not be as low as commonly believed. Excessive daytime sleepiness, cognitive dysfunction and nocturia can be improved by effective treatment with continuous positive airway pressure and a therapeutic trial should be recommended to all symptomatic patients. It is still unclear whether sleep apnea in older adults is a specific entity or the same disease as in younger adults. Further clinical research is warranted.
Accidents, Traffic ; Adult* ; Aged ; Cardiovascular Diseases ; Continuous Positive Airway Pressure ; Female ; Humans ; Leg ; Male ; Mortality ; Nocturia ; Sleep Apnea Syndromes* ; Sleep Apnea, Central

It has been well known that the incidence of delayed or nonunion of tibial shaft fracture is high and in order to improve methods of treatment and to get satisfactory final results in these fractures, it is important to find out as early as possible whether the fracture is healing normally or not. The fracture healing is closely related to the circulatory conditions at the fracture site, however, in contrast to animal experiments it is impossible to visualize directly the circulatory conditions at the fracture site. There have been many efforts to visualize indirectly these vascular re-establishments through angiography. Kaski(1974) reported a paper concerning osteomedullography of tibial fracture with phlebocompression and noticed 5 types of veins related to the process of healing. We performed 54 cases of osteomedullography in 41 tibial fracture at 3 months after treatment and the following results were obtained: 1. The sinusoidal vein in the proximal fragment was observed most frequently and the next were intra-osseous crossing vein, periosteal callus vein, ascending branch of main efferent vein, and periosteal veins of proximal fragment in decreasig frequency. 2. The rate of positive finding in osteomedullography at 3 months after treatment was lower, and periosteal callus veins were observed more frequently in the group treated with only cast immobilization than in the group treated with plate and screws. 3. In the group treated with compression plate and screws, osteomedullographs were positive in all 3 cases within 3 months after operation and sinusoidal veins in the proximal fragment were visualized in all cases, however periosteal callus vein was not visualized at all. 4. After bone graft, the differentiation of periosteal callus from grafted bone was not easy in plain X-ray film, but osteomedullography was very useful in these cases. Positive findings were noticed in 2~3 months in all cases following bone graft. 5. The authors found that the ideal time of performing osteomedullography was 3 months following treatment. If found to be negative after 4 months following treatment, bone graft was necessary.
Angiography ; Animal Experimentation ; Bony Callus ; Fracture Healing ; Immobilization ; Incidence ; Tibial Fractures ; Transplants ; Veins ; X-Ray Film

The authors reviewed 17 patients with radial nerve palsy complicating fracture of humerus who were treated at the Department of Orthopedlc Surgery, St. Mary's Hospital Catholic Medical College, for past 3 years from Jan. 1974 to Dec. 1976, and the following results were obtalned. 1. The ratio of male to female in 17 cases with radial nerve palsy was 4 to 1, and In patients within the first decade the ratio was same (1:1). But those in the 3rd and 4th decade showed high incidence of palsy. 2. Among 113 humerus shaft fractures, 17 cases (15.0%) complicated the radial nerve palsy; among 17 cases the middle shaft fractures were 15, lower 2, none in the upper third. 3. The radial nerve was the most vulnerable to injury at the middle third of the humerus, especially when there was comminution of fracture. 4. The incidence of radial nerve palsy in closed fracture (102 cases) was 13.7% (14 cases), and 27.2% (3cases) in open fracture (11 cases). 5. By early surgical exploration the practlcal cause of radial nerve palsy in 9 cases were found; 2 cases by bruise, 2 by interposition, 2 severance of nerve, one stretching, one impaled, and one unknown. 6. There were no signiflcant correlation between the type of nerve damage and the degree of its recovery, and between duration of paralysis since onset and its prognosis. 7. Of the 17 cases with palsy, complete recoveries were obtained 11 cases, 5 incomplete, and no recovery in one.
Contusions ; Female ; Fractures, Closed ; Fractures, Open ; Humans ; Humerus ; Incidence ; Male ; Paralysis ; Prognosis ; Radial Nerve

In order to determine the beneficial or detrimental effects of motion on fracture healing, rabbits femora were fractured surgically and each fracture was immobilized with a apecially designed external skeletal flxation device, which permitted a controlled spontaneous angulatory motion. in the first control group no motion was permitted; in the second group 5 degrees, and in the third group 10 degrees of angulatory motion was permitted. At 7th post-operative week, the bony union rates were 79%, 93%, and 54% In the first, second and third groups, respectively. Radiographically, the fractures were united most sufficiently in the second group. The ultimate bending load was signlficantly greater In the second group than the control but no significant differences were observed between the other groups. The ultimate bending stress and the modulus of elasticity were significantly greater ln the second group than the control and the third group, but no signlficant dlfferences were observed between the control and the third group. Fracture healing was significantly enhanced in the second group as compared to the control and the third group. It is suggested that a certain amount of motion at the fracture site enhances fracture healing, while excessive motion hinders it. Such enhancement seems to be related with the motion itself, and not wlth the muscle or jolnt function, since the rabbits Included in this study permitted the spontaneous full weight bearing which also permitted near normal muscle and joint function.
Elastic Modulus ; Fracture Healing ; Joints ; Rabbits ; Weight-Bearing

Patients with rickets frequently are seen by orthopaedic surgeon with complaints of growth disturbance, limb deformity, weakness, and multiple fracture. Among them, bow leg deformity is the most common and difficult orthopaedic problem. In growing child, however, if effective tretment is given sufficiently in early age and early disease process, the deformities usually correct spontaneously and there is little need for orthopaedic treatment other than careful observation. The orthopaedic treatment may be required to correct deformities that cannot be expected to improve with growth. A clinical study was done for 11 cses of rachitic bow leg deformity who were treated at the department of orthopaedic surgery, Catholic medical College and Center from Jan. 1978 to Dec. 1981. Results obtained were as follows: 1. The most common patients age group was in 1 to 2 years of age and there was no sexual difference. 2. Associated deformities with rachitic bow leg were rachitic rosary (5 cases), double wrist (3 cases), coxa vara (1 case), and Harrison's groove (1 case). 3. Low Ca * P solubility product, below the level of 30 (mg/dl)2 suggested active form of rickets in all cases. 4. Laboratory values such as Ca * P solubility product and alkaline phosphatase improved at 3 weeks after administration of vitamin D in 7 cases, 3 at 6 weeks, and no improvement in one case even at 6 months after treatment. 5. Six months after treatment, the average amount correction of tibiofemoral angle was 9° (43.7% of initial angle) in group 1, 13.3° (47.0%) in group II, 4.9° (29.6%) in group III, and 3.3°(25.6%) in group IV. 6. Through this study it is suggested that the more growth correction of the rachitic bow leg deformity in a younger child below the age of 2 is obtained with growth by treatment, whereas a little or no growth correction can be expected after the age of 3 or 4 years.
Alkaline Phosphatase ; Child ; Clinical Study ; Congenital Abnormalities ; Coxa Vara ; Extremities ; Fractures, Multiple ; Genu Varum ; Humans ; Rickets ; Solubility ; Vitamin D ; Wrist

There have been many methods of manual reduction of shoulder dislocation. But each method has its unique complications such as fracture of'humeral neck or shaft as well as vascular and nerve injuries around the shoulder due to excessive pulling and rotation during the maneuver. The present authors devised a method in which the backrest of a chair is used as a fulcrum during manupulative reduction. The dislocated shoulder can be abducted by the backrest rim, when the armpit is placed over the top of the backrest. In this abducted position of the shoulder, minimal adduction force on distal humerus and gentle backward pressure on humeral head are very effective in reducing the anterioly disocated shoulder.
Axilla ; Humeral Head ; Humerus ; Methods ; Neck ; Shoulder Dislocation ; Shoulder

Twenty nine patients who had fracture of tibial shaft were treated with closed Rush nailing and early weight bearing. 1. The average age was 37.8 years (range from 20 to 65), and 21 were men and 8 women. Eighteen cases were open fractures and 11 closed. 2. The time for clinical union was averaging 15.4 weeks. In some cases callus appeared as early as 3 weeks after nailing and in most cases appeared at 8 weeks. 3. Mild angular and rotational deformity of the fractured shaft were developed as complication but did not present any clinical problems. No deep wound infection and pulmonary embolism were encountered. 4. The nails allowed a certain dynamic controlled motion at the fracture site which was probably beneficial to early callus formation. 5. This type of closed nailing method required no medullary reaming, further periosteal stripping and muscle detachment. The allowance of early knee and ankle movements and early weight bearing after surgery could be listed as the advantage.
Ankle ; Bony Callus ; Congenital Abnormalities ; Female ; Fractures, Open ; Humans ; Knee ; Male ; Methods ; Pulmonary Embolism ; Tibia ; Weight-Bearing ; Wound Infection

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