To evaluate the effect of a new topical anesthetic cream (EMLA : Eutectic mixture of local anesthetics) on reducing pain associated with DPT vaccination, we conducted a clinical observation on eighty infants who were brought to well baby clinic of Yeungnam University Hospital for DPT vaccination. 80 Infants, who were between 2 months and 8 months in age, were divided into two groups. EMLA treated group and control group. Male to femle sex ratio was 1.4 to 1. EMLA cream was applied 60 minutes before DPT vaccination, the effect of reducing pain was assessed by using McGrath's face scale, Oucher pain scale and modified behavioral pain scale (MBPS) and also evaluated by measuring the duration and time of crying (the time of the first crying after iniection, duration of the first crying, total duration of crying). The scores of those scales were lower in EMLA treated group than in control group significantly (P<0.01 in McGrath's face scale. MBPS and p<0.05 in Oucher pain scale). There was no difference in the time of the first crying after vaccination in both groups. The duration of the first crying was shorter in EMLA treated group than control group of crying was also shorter in EMLA treated group (EMLA treated group 9.0±12.5 sec, p<0.05). Transient skin erythema was noted in 5 infants after EMLA application, but no other adverse effects were observed. We conclude that the application of EMLA cream before vaccination seems to be an effective and safe way to reduce the pain from vaccination, but it takes usually 60 minutes to get the anesthetic effect of EMLA and it is expensive, so EMLA cream can not be recommended in routine vaccination in infants now.
Anesthetics ; Crying ; Erythema ; Humans ; Infant ; Male ; Sex Ratio ; Skin ; Vaccination* ; Weights and Measures

Autograft using suction hlistered epidermis is one of the surgical therapeutic mod- alities of vitiligo, and has been successfully used by several authors. The maintenance of grafting pigment is belieued to be more important than repigmentation itself. To examine the maintenance of pigment, 22 vitiligo patients were treated by autograft using suction blistered epidermis and followed for 16.8 months. Repigmentation developed in 20 patients, Two patients were lost to follow up. Out of 20 patients, grafting pigment was maintained in 17 patients(85% ) and disappeared in three patients(15% ). By clinical subtype, the rates of maintenance were 100% in segmental type, 80% in localized type and 66% in generalized type. The best results were observed in a head and neck location and the worst rates and maintenance were in the hand. However, these differences were not statistically significant. likewise, age and sex were not factors in maintenance and repigrnentation. Based on this study, autograft using suction blistered epidermis appears to be a good therapeutic modality for stable vitiligo, particularly segmental vitiligo.
Autografts* ; Blister* ; Epidermis* ; Follow-Up Studies* ; Hand ; Head ; Humans ; Lost to Follow-Up ; Neck ; Suction* ; Transplants ; Vitiligo

Arthroscopic anterior cruciate ligament reconstruction with bone-patella tendon-bone has been commonly using for ACL insufficient patients. Bone-patellar tendon-bone graft is a strong intra-articular substitute, which allows, by means of its bony end, a rigid fixation with early bone to hone healing. As a counterpart, potentially serious cornplications & donor site morbidity has been reported, such as patella fracture & patella tendon avulsion, anterior knee pain, patella tendinitis, dcmor site pain and bone defect. We suppose tightly packing the donor site bony defect with hetrograft (Lubboc) may be also useful. So, we analyzed the morphological change in bony defect and donor site morbidity between the group of non-replaced bony defect and the group of replaced bony defect using by heterograft (Lubboc). We replaceJ hetrograft into the patellar side bony defect in 15 knees and left alone in l5 knees. The average follow up period was 17 months. The results werc as follows: 1. Nearly norma1 appearance on the bony defect showed at the long tenn follow up roentgenogram in the group of replaced hetrograft, but scalloping on the pateltar bomp defect was seen in non-replaced group. 2. Donor site morbidity (pain or patellai tendinitis) was developed 8 knees in the replaced group, and 7 knees in the non-rep)aced group. 3. We conclude that the filled in the bony defect hy hone graft (heterografl:) can not decrease the donor site morbidi ty.
Anterior Cruciate Ligament Reconstruction ; Bone-Patellar Tendon-Bone Grafts ; Follow-Up Studies ; Heterografts* ; Humans ; Knee ; Patella ; Patellar Ligament* ; Pectinidae ; Tendinopathy ; Tissue Donors* ; Transplants

Isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament has been thought very rare. We also had experienced only nine cases of above injury in our center during 5.5 years from January, 1976 to June, 1981. Eight cases of them were followed for an average of the thirteen months, but one of them was eliminated from the study because follow-up study was impossible for the case. The purposes of this paper are to present eight cases of isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament and to discuss the causes and mechanisms of the injury and the method of screw fixation for the avulsed fracture fragment. Seven were injured by traffic accident and one by fall on the knee. All cases seemed to be injured by the force directed against the flexed knee which violently stroke the anterior surface of the proximal end of the tibia or inferior portion of the knee and drove it backwards. We found the tear of posterior capsule only in one patient who was seeming injured by extensive force. All cases were treated operatively by means of screw fixation, and excellent results were obtained in five cases, good in two, and fair in one case.
Accidents, Traffic ; Follow-Up Studies ; Humans ; Knee ; Methods ; Posterior Cruciate Ligament ; Stroke ; Tears ; Tibia

We reviewed 35 patients who received an operation for the Spondylolisthesis from July 1980 to July 1985. The follow-up period between operation and evaluation was at least 14 months and average 32 months. we obtained the following results. 1. The age distribution was from 23 years of age to 70 years of age and the prevalent decade was at the 5th. 2. Sex difference showed male 9 cases and female 26 cases, that is, female preponderance about 3 times. 3. 24 cases were isthmic type and 11 cases were degenerative type. The ratio between isthmic type and degenerative type was about 2: l. 4. Isthmic type was found at the 4th and 5th decades frequently and degenerative type was at 5th and 6th decade frequently. 5. The displacement between L4 and L5 was 21 cases and the displacement between L5 and sacrum was 14 cases. 6. In isthmic type, the displacement between L4 and L5 was 11 cases and the displacement between L5 and sacrum was 13 cases. In degenerative type, the displacement between L4 and L5 was 10 cases and the displacement between L5 and sacrum was 1 case. So the isthmic defect occurred at 2 levels almost equally and degonerative type occurred at L4-5 predominantly. 7. Overall results are excellent 2 cases(6%), good 29 cases(82%), fair 2 cases(6%), and poor 2 cases (6%).
Age Distribution ; Clinical Study ; Female ; Follow-Up Studies ; Humans ; Male ; Sacrum ; Sex Characteristics ; Spondylolisthesis

For the measurement of the bone quantity, various methods have been used. Recently, the methods such as a microdensiometry, single photon absorptiometry, quantitative computed tomography were introduced. However, these methods are expensive modalities to be used in daily clinical practice. For the evaluation of the osteoporosis, author's observed Saville's grades, spine contral score and spine fracture on the simple spine roentgenograms of 346 patients over 40 years of age who were exsmined due to their backache at the Department of Orthopedadic Surgery, Kang Nam St. Mary's Hospital, Seoul, and following results were obtained: 1. The percentile incidence of osteoporosis with regard to age and sex : (1) The percentile incidence of osteoporosis over Saville's Grade I was 59.2%(205 of 346 persons); in males 47.4%(55 of 116 persons) and in females 65.2%(150 of 230 persons). (2) The percentile incidence of osteoporosis over Grade 1 in 5th decade was 27.2%(17.1% in males and 33.9% in females), 55.8% in 6th decade(46.6% in males, and 60.4% in females), 78.1% in 7th decade(64.7% in males, and 82.9% in females), 93.7% in 8th decade(87.5% in males and 97% in females), and 100% in both sexes of 9th decade. (3) The percentile incidence of Grade 1 osteoporosis in 5th decade was 23.9%, and in 6th decade it was 46.7%. Thus, Grade I osteoporosis was most common in these age groups. In 7th and 8th decades, Grade I osteoporosis was more common in males, while in the females ot these age groups Grade II was more common. There was no sex difference in the incidence of osteoporosis after the age of 80. Grade IV osteoporosis was found only in a woman who had hysterectomy 7 years ago, and has suffered from Parkinsonism for 3 years. (4) The overall incidence of Grade I osteoporosis was 34.6%, and Grade II was 21.3 %. The incidence of osteoporosis over Grade III was 1.7% in males, and 6.5% in females. 2. Incidence of osteoporosis assessed by Barnett's central score and its correlation with Saville's assessment: (1) The central score obtained at the 3rd lumbar spine ranged from 71.4 to 106.4. The number of cases were 16 in the score range of 70 to 80, 93 in the score range of 101 to 110, and 5 in the score range of 111 to 120. In consequence the most high incidence was in the score range of 91 to 100. (2) Grade O Oxteoporosis corresponded with the central score of 96.4 on an average (range : 86.8 to 106.4), Grade I corresponded with 91.6 (range : 85.7–103.1), Grade II corrosponded with 86.4 (range : 78.3–96.9), Grade III corresponded with 79.4 (range : 71.4–91), and Grade IV corresponeded with 75.8. (3) Barnett defined the spine is osteoporotic, when the central score is below 80. However, in this study only 16 patients(4.6%) had the score below 80. No bodies having Grade 0 and I osteoporosis had the score below 80; of those 16 patients having the score below 81, 5 were Grade II, 10 Grade III, and one Grade IV. Through this study, it is clesr that there is no correlation in these two assessing methods. The central score below 80 was found in severely porotic patients such as Grade III and IV, but was not found in most cases of Grade I and II osteoporotic patients. (4) The vertebral defromity was found only in 38 cases (10.9%), and it was found only in 18.9% of osteoporosis patients. The percentile incidence of deformity was 5.3% of Grade I, 31% of Grade II and 52.9% of Grade Ill. (5) Of these deformities, wedge-shaped one was found in 6 cases of Grade I porosis, 20 of Grade II, and 3 of Grade III. Cod-fish vertebrae (biconcave) were found in 2 of Grade II and 4 of Grade III. The flattened body was found in 1 of Grade II and 2 of Grade III. Thus, biconcave and flattened vertebrae were found only in the porotics over Grade II severity. (6) In 24 cases, one body was deformed, and in 14 cases multilevel vertebral deformities were found. In these 20 cases had deformity in the Ll, 10 cases each in T12 and L2, 7 cases in L3, 6 cases in L4, and 4 cases in Tll. In summary, the most deformities were in the dorsolumbar region. (7) Fracture was induced by trauma in the 11 cases(29%), among which 10 were wedgeshaped, and the rest was flattened. The biconcave vertebra was found not to be related with injury.
Absorptiometry, Photon ; Back Pain ; Congenital Abnormalities ; Female ; Humans ; Hysterectomy ; Incidence ; Male ; Osteoporosis ; Parkinsonian Disorders ; Seoul ; Sex Characteristics ; Spine

Twenty-five patients with unstable fracture or fracture-dislocation of the thoracolumbar and lumbar spines were treated with Cotrel-Dubousset instrumentation. Internal fixation was done in two ways; long rodding in seventeen patients and short rodding in eight. Short segment posterolateral or posterior autogenous iliac bone graft was done in all cases. The amount of correction of the collapsed anterior vertebral body height and the local kyphotic angle at the immediate post-operation were similar between the two groups, but loss of correction at last follow-up was more severe in the short rodding group. Instrument failure was also more common in the short rodding group. In conclusion, it was found that short segment stabilization of spine fractures with Cotrel-Dubousset instrument can effectively reduce fracture but can not maintain reduction until fusion. Therefore, long rodding was reconfirmed to be the better method of stabilization of the thoracolumbar and lumbar spines fractures.
Body Height ; Follow-Up Studies ; Humans ; Methods ; Spine ; Transplants

BACKGROUND: We assessed the effectiveness of arthroscopic capsular release for the treatment of adhesive capsulitis. Further, we tried to ascertain the clinical benefits, if any, of pancapsular release over selective capsular release, where the two differ by performing or not performing a posterior capsular release, respectively. METHODS: Thirty-five consecutive patients with either primary or secondary adhesive capsulitis who failed conservative treatment for more than 6 months were enrolled in the study. A total of 16 patients allocated in group 1 received a pancapsular release that comprises the release of the rotator interval, anteroinferior capsular, and the posterior capsular release, whereas 19 patients in group 2 received a selective capsular release that comprises only the release of the rotator interval release and anteroinferior capsular release. The clinical outcomes, visual analogue scale (VAS) score, Constant score, and range of motion, were assessed preoperative and postoperatively. RESULTS: In both groups, the preoperative VAS score, Constant score, and ROM showed a significant improvement by the 6-month follow-up. We found that the immediate postoperative internal rotation was significantly higher in group 1 than group 2. Despite significant differences seen between the two groups at the initial postoperative period, there were no significant differences in Constant score, VAS score, and the ROM at all the subsequent follow-ups between the two groups. CONCLUSIONS: Arthroscopic capsular release for the treatment of adhesive capsulitis is very effective. However, pancapsular release did not show any advantage over selective capsular release in terms of overall clinical outcome.
Bursitis* ; Follow-Up Studies ; Humans ; Joint Capsule Release* ; Postoperative Period ; Range of Motion, Articular

No abstract available.
Humans ; Korea* ; Multiple Birth Offspring*

Etretinate, an effective retinoid in the treatment of pustular, erythrodermic and chronic plaque type psoriasis, has the disadvantage of a long terminal elimination half-life. On the other hand, acitretin, the active metabolite of etretinate, has much shorter terminal elimination half-life and is being reported as an agent with good antipsoriatic activity by several authors. To evaluate the clinical efficacy of acitret.in in comparison with etretinate, we treated 10 patients wit,h acitretin at a dose of 30mg per day and 11 patients with etretinate at a same dose for 12 weeks. The PASI score at 12 week was significantly reduced in each group as compared with baseline PASI score. In the acitretin treated group the initial PASI score of 14.5 reduced to 3.9, while the etretinate group PASI score reduced from 12.0 to 3.1. The PASI score differ ences between the acitretin and etretinate groups at each time during therapy and the end of therapy were not statistically significant. The severity of adverse reactions with acitretin was similar to those with etretinate but their incidence was higher. The change in laboratory parameters in the acitretin group was simlar to that of the etretinate group. In view of these results and the known pharmacokinetic advantage of acitretin, that is the short terminal elimination half-life, it is conceivable that acitretin may be a useful alternative to etretinate in the treatment of psoriasis.
Acitretin* ; Etretinate* ; Half-Life ; Hand ; Humans ; Incidence ; Psoriasis*