As trochanteric fractures frequently occur in the elderly patients and complications such as pneumonia, thrombo-embolic disease, decubitus ulcer, and urinary tract infection are common, early mobilization after open reduction and internal fixation with hip nail are the standard treatment. Since 1931 when Smith-Peterson first introduced a tri-flanged nail, further more, since 1941 when Jewett pioneered the one-piece nail by adding a solid plate to a Smith-Peterson nail, numorous implants including threaded pins, screws, nails, and plates have been modified and desiged for fractured hips till now to achieve early ambulation and to maintain stable reduction. In 1955 Pugh and Ken introduced a sliding nail-plate and Schumpelick described the use of sliding screw-plate, which was modified further by Callender and Holt pioneered the concept of heavy nail in 1963. Recently compression sliding screw-plate is popular. Also many surgeons such as Evans, Dimon and Hughston, Sarmiento, and Boyd and Anderson have attempted to provide stable fixation of fracture by altering the position of fracture fragments to improve the mechanical resistances of bone to disruptive forces of weight-bearing. The surgical procedures of open reduction and internal fixation were carried out and followed for more than 6 months on 45 intertrochanteric fractures at Department of Orthopedic Surgery, Seoul National University Hospital, from Jan. 1968 to June. 1975 and the results were observed as follows. 1. Of 45 cases of inter-trochanteric fractures 28 cases occurred in man, 17 cases in woman and each mean age was 54 years in man, 74 years in woman. 2. Of fixation devices, Smith-Peterson nail-plates were used in 19 cases, Jewett nails in 15 cases, compression sliding screw-plates in 9 cases, Smith-Peterson nail in 1 case, and Ken sliding nail-plate in 1 case. 3. Stable fractures occurred in 10 cases were fixed internaly after anatomical reduction. 4. Dimon-Hughston reductions and Jewett Nailing were achieved in 11 cases of 12 unstabIe fractures and had disadvantages such as some limitation of R.O.M. of the affected hip, shortening, and valgus deformity. 5. Of 9 unstable fractures treated by compression sliding screw-plate 7 cases were reduced as anatomicaly as possible and 2 cases were reduced non-anatomicaly because of impossible anatomical reduction but good results were obtained except one failed nailing. 6. Of 7 failures, 6 cases resuIted from failures of nailing during operation and only 1 failure resulted in varus defermity after Dimen-Hughston reduction with Jewett nail.
Aged ; Congenital Abnormalities ; Early Ambulation ; Female ; Hip ; Hip Fractures ; Humans ; Orthopedics ; Pneumonia ; Pressure Ulcer ; Seoul ; Surgeons ; Urinary Tract Infections ; Weight-Bearing

Clinical observation of thirty-eight cases of pyogenic osteomyelitis of the spine for the period of eleven years, from 1965, at Seoul National University Hospital was carried out with the following results. 1. The incidence of pyogenic osteomyelitis of the spine among total cases of the pyogenic osteomyelitis was 6.9% and the ratio between the spine tuberculosis and the pyogenic osteomyelitis of the spine was 1:0.067. 2. The sex ratio between male and female wss 3.8: 1 The incidence was higher ia the second and third decade and the average prevalent age was 30.8 years of age. 3. The site of infection was in the lumbar vertebrae in 25 cases(66%), thoracic in seven(19%), lumbosacral in three, sacral in two and cervical in one. In the region of a vertebra, the vertebral body was affected in 33 cases (87%) and the neural arch and processes in other 5 cases (13%) 4. The causative micro-organism was isolated in 27 cases from the diseased focus; coagulase positive staphylococcus in 18 cases (67%), streptococcus in one, salmonella in one and the mixed infection in two. 5. Frequent clinical symptoms and signs were back pain, tenderness, muscle spasm, fever and chillness, and limited motion of the spine. 6. The roetgenographic findings were in order of disc space narrowing, destruction of the vertebral body, kyphosis or loss of lordosis, erosion, bony bridging or spur formation, sclerosis and paravertebral abscess. 7. The conservative treatment was performed in 14 cases. Among 7 cases in which the follow-up was possible, only 3 cases obtained the satisfactory result, four cases were readmitted for the recurrence and two cases among them needed the operative treatment later. The operative treatment was peformed in 26 cases; The focal curettage with anterior interbody fusion through anterior approach was carried out in 13 cases with the satisfactory result in almost all cases. 8. The advantages of the operative treatment were that the isolation of the offending organism was efficient and the definite diagnosis was feasible, and especially in cases of anterior spinal fusion the healing and union of the infected spine was better clinically and roetgenographically in comparision with those of conservative treatment, in which the expected spontaneous fusion was not found in any case and the recurrence was also frequent.
Abscess ; Animals ; Back Pain ; Coagulase ; Coinfection ; Curettage ; Diagnosis ; Female ; Fever ; Follow-Up Studies ; Humans ; Incidence ; Kyphosis ; Lordosis ; Lumbar Vertebrae ; Male ; Myalgia ; Osteomyelitis ; Recurrence ; Salmonella ; Sclerosis ; Seoul ; Sex Ratio ; Spasm ; Spinal Fusion ; Spine ; Staphylococcus ; Streptococcus ; Tuberculosis

Great strides has been made in the past 20 years in the treatment of scoliosis. Treatment before scoliosis becomes severe eliminates the need for extensive surgery. Early detection of scoliosis by school screening has proven to be valuable for early diagnosis and prevention of severe deformities. Authors screened 5,256 middle and high school students in Seoul, who were chosen arbitrarily, to determine the incidence rates of scoliosis, and following results were obtained. 1. Scoliosis was diagnosed on a combination of at least one positive physical sign and a lateral curvature more than 5 degrees on an antero-posterior standing X-ray. 2. The overall incidence of scoliosis was 4.68% (Male 0.74%, Female 6.43%). 3. Idiopathic scoliosis was found in 238 students, congenital scoliosis in 5, and paralytic scoliosis in 3. 4. The most common pattern of curvature was thoracic curve. 5. In the single curve right to left ratio was 2.1, but 8.4 in the upper curve of double curve. 6. Close observations were required for all the 246 students and treatment was required in 14 students who had more than 20 degrees, 9 students for Milwaukee brace, and 5 students for surgical correction.
Braces ; Congenital Abnormalities ; Early Diagnosis ; Female ; Humans ; Incidence ; Korea ; Mass Screening ; Scoliosis ; Seoul

No abstract available.
Heart Septal Defects, Atrial* ; Hemodynamics*

Fractures of the tibial shaft are the most common among the long bone fractures, and have much difficulty in treatment due to their numerous complications. Thirty patients with fractures of the tibial shaft were treated with Ender nails under the image intensifier at the Department of Orthopedic Surgery, Yeungnam University Hospital from December 1986 to November 1991. The following results were observed. 1. The average age was 37.3 years and the number of male was three times of the female. The most common cause was traffic accident. 2. Twenty cases out of thirty one were closed fracture and the remaining 11 were open. The comminuted and segmental fractures were 18 (57.7%) in number and the most common fracture site was the middle one third (53%). 3. Average interval from injury to operation was 7.6 days and 19 cases showed associated injuries. 4. The mean duration of the bone union was 18.9 weeks and 2 cases showed the delayed union. 5. Twelve complications were noted such as shortening, varus deformity, delayed union, ankle motion limitation, nail irritation, and soft tissue infection.
Accidents, Traffic ; Ankle ; Congenital Abnormalities ; Female ; Fractures, Bone ; Fractures, Closed ; Humans ; Male ; Orthopedics ; Soft Tissue Infections ; Tibia*

BACKGROUND: Procaine binds to DNA and reduces cisplatin nephrotoxicity, but the mechanism is poorly understood. We explored whether procaine amelioration of cisplatin nephrotoxicity was related to down-and/or up-regulation of inflammatory response gene tumor necrosis factor-alpha (TNF-alpha), oxidative stress indicator gene heme oxygenase-1 (HO-1) or cell cycle inhibitor gene p21. METHODS: Cisplatin and procaine were intraperitoneally injected to mice at a single dosage of 16 and 80 mg/kg, respectively. Renal evaluation was performed 72 hours after cisplatin administration. The expression of transcripts and proteins was analyzed using real time RT-PCR and Western blot, respectively. RESULTS: Procaine treatment moderately attenuated necrotic changes of renal proximal tubules and increases in BUN and creatinine concentration by cisplatin administration. Kidney platinum level between the cisplatin (cis) group and the cisplatin + procaine (CisPro) group was not different. Although the level of TNF-alpha mRNA increased 4-fold higher in the Cis group than in the control, this increase was not attenuated by procaine treatment. Gene expression of p21 and HO-1 was elevated 175 and 4-times higher in the Cis group than in the control, respectively. But their expression was no further elevated, rather significantly reduced in the CisPro group compared to the Cis group. Protein abundance of p21 and HO-1 was paralleled by their respective mRNA expression. CONCLUSIONS: Procaine amelioration of cisplatin nephrotoxicity is likely to be achieved through processes other than the regulation of TNF-alpha, HO-1 or p21 gene expression.
Animals ; Blotting, Western ; Cell Cycle ; Cisplatin* ; Creatinine ; DNA ; Gene Expression ; Heme Oxygenase-1 ; Kidney ; Mice* ; Oxidative Stress ; Platinum ; Procaine* ; RNA, Messenger ; Tumor Necrosis Factor-alpha ; Up-Regulation

Animal experiment was carried out to measure the physiologic changes of thoracic or thoracolumbar spine that occurred as a result of electrical stimulation, and to evaluate the usefulness of electrical stimulation as a possible treatment for scoliosis. Unilateral electrical stimulations were applied to the back muscle of immature rabbits.They were subgrouped into medial, intermediate, and lateral muscle stimulated groups in order to observe the effects of various electrode placements. The radiograms were taken every other week to observe the changes of the spinal curvatures for the period of 12 weeks. The histological studies of the muscles, which were obtained from the stimulated(right) and the nonstimulated(left) sides at the same level, also were carried out to determine the response of the muscles to the electrical stimulation. The results were as follows. l. A significant scoliotic curvature was observed two weeks after electrical stimulation, and those curvatures did not change more for the next six weeks in spite of prolonged stimulation. 2. Scoliotic curvature induced by electrical stimulation for eight weeks remained unchanged for another four weeks after stopping stimulation. 3. There were no statistical differences in the induced scoliotic curvature among the three groups stimulated at different sites of the medial, intermediate, and lateral regions respectively. 4. A prolonged unilateral electrical stimulation could induce the scoliosis, and may be used as a method for treatment of scoliosis.
Animal Experimentation ; Back Muscles ; Electric Stimulation ; Electrodes ; Methods ; Muscles ; Scoliosis ; Spinal Curvatures ; Spine

No abstract available.
Adult* ; Femur* ; Humans

Intramuscular Stimulation (IMS) is a refined technique of traditional oriental acupuncture, and IMS has proved effective for relieving chronic pain of a neuropathic origin. IMS is currently seen to be quite a safe procedure with minimal complications having been reported to date. Various complications have been documented for acupuncture, but few complications or adverse effects have been reported in relation to the relatively new technique of IMS. We report here on a case of cervical spinal epidural hematoma that manifested as a cause of delayed hemiparesis. The safety of this procedure in unpracticed hands seems to be questionable.
Acupuncture ; Chronic Pain ; Hand ; Hematoma ; Hematoma, Epidural, Spinal ; Paresis

The authors report a case of an unusual spinal Langerhans cell histiocytosis (LCH) in an adult presenting with neurological deficits. A 36-year-old woman presented with LCH involving the cervical spine and presenting with neurological deficit. Despite aggressive surgical intervention followed by chemotherapy and radiation therapy, recurrence at the other site occurred repeatedly and the patient eventually succumbed to acute respiratory distress syndrome. LCH is a benign disease that resolves spontaneously, but in cases with neurological deficits, aggressive surgical treatment followed by chemotherapy and radiation therapy should be considered.
Adult ; Female ; Histiocytosis, Langerhans-Cell ; Humans ; Recurrence ; Respiratory Distress Syndrome, Adult ; Spine