With the advent of improyed external fixation device, femoral lengthening has gained renewed popularity in recent years in the treatment of unequal leg length. Wagner(1971) and De Bastiani et al(1987), among others, have made epochal contribution in this field. During the period from May 1984 to May 1987, 25 patients with leg length discrepancy underwent femoral lengthening using Wagner's or De Bastianis distractable external fixators at the Department of Orthopedic Surgery, Seoul National University Hospital. There were 6 patients below 16 years of age admitted to the Children's Hospital, and 19 patients were 16 years or older. The mean age was 18.2 years, ranging from 3 years to 36 years. The underlying etiology included residual poliomyelitis in 20 patients, epiphyseal injury in 2 patients, congenital short femur in 1 patient, septic hip residua in 1 patient, and cerebral palsy in 1 patient. The mean leg length discrepancy was 4.5cm, ranging from 1.3cm to 7.4cm. The mean length gained was 4.1cm, ranging from 1.8cm to 6.4cm. All except two patients had two stage procedures with iliac crest strut bone graft. The mean time required for radiological consolidation of bone graft was 4.8 months. The plate and screws used for osteosynthesis was removed after the medullary canal has been re-established. Six patients had removal of the plate and screws between 8 months and 25 months after the second stage osteosynthesis. Technical errors included 1 case of incomplete osteotomy which required manual clasis, and another case of faulty insertion of Schanz screws that required reinsertion. Five cases (33.3%) had the minor pin tract infection. Schanz screw breakage occurred in a case of one stage femoral lengthening. Loosening of plate and screws was seen in three cases. One case had delayed union requiring augmentation bone graft. Stiff knee with less than 90°of flexion was encountered in one case. One case sustained fracture of patella during physiotherapy. Despite of a long list of complication, the ultimate goal of leg length equalization was successfully achieved in all the cases.
Cerebral Palsy ; External Fixators ; Femur ; Hip ; Humans ; Knee ; Leg ; Orthopedics ; Osteotomy ; Patella ; Poliomyelitis ; Seoul ; Transplants

Cervical spine injury, because of its increasing frequency and catastrophic neurological complication, has attracted many attention of every orthopedic surgeons. Moreover, the indications of surgical treatment and the indications of anterior or posterior fusion have been argued till now. Forty-one patients with cervical spine injury had been treated operatively at Department of Orthopedic Surgery, Seoul National University Hospital from January, 1980 to April, 1987. The surgically treated patients were followed up from 1 year to 7 years with average duration of 2.5years. We performed this study to define the advantages of the surgical treatment, the indications of the anterior and posterior fusion, the postoperative neurological changes, the importance of early reduction, and the result of surgical treatment in late instability cases and obtained the following results. 1. Flexion-rotation injury, in twenty three patients(56.0%), was the most frequent mechanism of injury. 2. Anterior decompression and fusion was performed in 8 patients(19.5%) when there were neural compression by fractured bone fragment or ruptured intervertebral disc material and rupture of anterior longitudinal ligament with hyperextension injury, without poterior ligament complex injury, and posterior fusion and wiring in 33 patients(80.5%) when there were upper cervical spine(C1, C2) injuries and posterior ligament complex injury. 3. Neurological involvements were observed in 35 patients(85.4%) on arrival, and partial and complete neurological recoveries were obtained in 20 patients(57.1%) out of 35 patients postoperatively. 4. Neurological recovery was obtained in 80% when the closed reduction was performed within 12 hours after the injury and only 40% after 12 hours. 5. Neck pain and/or neurology was improved in all 9 patients with late instability postoperatively. 6. Postoperative complication rate was totally 43.9%, but direct surgical complications were 2 cases(4.9%) out of 18 cases.
Decompression ; Humans ; Intervertebral Disc ; Ligaments ; Longitudinal Ligaments ; Neck Pain ; Neurology ; Orthopedics ; Postoperative Complications ; Rupture ; Seoul ; Spine ; Surgeons

No abstract available.
Cell Line* ; Genes, Tumor Suppressor* ; Humans* ; Lung Neoplasms* ; Lung*

PURPOSE: The replacement of functional genes into cells that lack genes or mutant genes is the basis of gene therapy. In cancer, where cells often have multiple genetic defects, the replacement of critical genes may suffice to suppress cell growth or induce cell death. In malignant brain tumors, p53 mutation are among the most frequently observed genetic findings and inactivation p53 suggests that p53 plays a critical role in carcinogenesis and tumor progression. Therefore, we study the successful transfer of the wild-type p53 gene using a replicative deficient adenovirus vector into human glioma and medulloblastoma c~ell lines. Meterials and Methods: The human glioma cell line T-98G, U-87MG, U-373MG were used. To determine the efficiency of the adenovirus vector, cell lines were transfected with the Ad-p gal and analysed with X-Gal staining. Cell viability was determined by trypan blue exclusion every day after infection and Westem blot analysis was used to conform the expression of the exogenous p53 protein. RESULTS: Cell growth of the Ad-CMV-p53 infected U-373MG, and U-87MG was significantly suppressed. It appeared that exogenous p53 protein expression had an earlier ad more profound suppressive effect on U-373MG having a mutated p53 gene than on U-87MG having a wild-type p53. The expression of the exogenous p53 was more than 10 times higher than the expression of the endogenous p53. To examine the decreased viability, U-373MG was stained with Hochest 33258 and detected nuclear condensation and apoptic body. Staining results suggest that cells undergo apoptosis. CONCLUSION: The replicative deficient adenoviral vector can transfer and express p53 in human glioma cell lines in vitro, restoring wild-type p53 tumor suppressor functions. The restoration of normal p53-encoded protein in the mutant ceil lines induced cell death. The high expression of the newly transduced protein had different effects on the growth rate of the infected cell lines depending on the p53 status of the cells.
Adenoviridae* ; Apoptosis ; Brain Neoplasms ; Carcinogenesis ; Cell Death ; Cell Line* ; Cell Survival ; Genes, p53 ; Genetic Therapy ; Glioma* ; Humans ; Medulloblastoma ; Trypan Blue

Authors reviewed about scoliosis the chest films of 325 congenitalheart diseasepatients who visited Seoul National University Hospital during the period of Jan. 1986 to Dec. 1987 to find out the incidence of scoliosis in congenital heart disease patients and to define the nature of scoliosis associated with congenital heart disease and came to following conclusions. 1. When curvatures of 10 degrees or more on chest P-A was classified as scoliosis, the incidence of scoliosis was 14.4%. It was more than 6 times the prevalence of scoliosis of 2. 3% in general population in Korea. 2. There was no difference in the incidence of scoliosis between the cyanotic and acyanotic heart diseases (P < 0.05). 3. There was no difference in the incidence of scoliosis between individual heart diseases (P < 0.05). 4. The scoliosis associated with congenital heart diseases showed a relative male preponderance. The male to female ratio of scoliosis was 1: 2.1 in patients with congenital heart disease while male to female ratio of idiopathic scoliosis in in general populationwas 1: 8.7 in Korea. 5. The curve pattern of scoliosis associated with congenital heart disease was predominantly right sided, comprising 74.5%. There was no difference of curve pattern between the scoliosis associated with congenital heart disease and the scoliosis in the general population. 6. The curve pattern of scoliosis was influenced neither by the side of the aortic arch nor the thoracotomy incision.
Aorta, Thoracic ; Female ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Incidence ; Korea ; Male ; Prevalence ; Scoliosis ; Seoul ; Thoracotomy ; Thorax

Descending necrotizing mediastinitis (DNM) is one of the most lethal form of mediastinitis originating from an oropharyngeal infection. It requires an early and aggressive sugical treatment, but the operative approach and optimal form of mediastinal drainage remains controversial. We report a case of DNM in a 45-year-old male who underwent right cervicomediastinotomy to drain the deep neck space, upper mediastinum and anterior mediastinal drainage was accomplished through a subxiphoid approach. After this procedure, he steadily improved and was dischrged on hospital day 36. We report this case with a brief review of the literature.
Drainage ; Humans ; Male ; Mediastinitis* ; Mediastinum ; Middle Aged ; Neck

Endoscopic injection sclerotherapy(EIS) has been widely used in treating and eradicating acutely bleeding esophageal varies, but may be associated with some undesirable local and systemic complications. Endoscopic variceal ligation(EVL), which consists of mechanicai ligation and thrombosis of varices using elastic o-band, has been recently developed as a non operative alternative to EIS. We performed EVL in 65 patients who had bled from esophageal varices between November 1991 and September 1993. Total 274 sessions were performed and 774 o-bands were used. Six patients were actively bleeding and all of them were successfully controlled by emergency EVL. During the follow-up period, five patients who had combined hepatoma died. Varices were eradicated or reduced grade I in 43(71.6%) of the 60 survivals by 8-36 ligations(mean 15.6 ligation) in 2-13 EVL sessions(mean 5.6 sessions). During follow up period, five patients had recurred from grade 0 to grade 2 or 3 in 106-260 days(mean 182.6 days), and then eradicated by repeated EVL. During or after EVL, there were no complications, except mild substernal distress and mild dysphagia in 17 and 7 patients respectively. These results showed that EVL is a safe and effective method for eradication of bleeding esophageal varices.
Carcinoma, Hepatocellular ; Deglutition Disorders ; Emergencies ; Esophageal and Gastric Varices* ; Follow-Up Studies ; Hemorrhage ; Humans ; Ligation* ; Thrombosis ; Varicose Veins

There was an error in article.

At the end of the operation, residual neuromusular blookade may be antagonized by anticholines-terase (edrophonium, neostigmine and pyridostigmine). Neostigmine is probably commonly used antagonist of nondepolarizing neuromuscular blocking agents. But, because of an apparent longer duration of action and lesser muscarinic effects, pyridos- tigmine has been suggested as possibly superior to neostigmine as an antagonist of nondepolarizing neuromuscular blockade. Accordingly, present study observed the heart rate, systolic and diastolic blood pressure changes following equipotent doses of pyridostigmine and neostigmine given with glycopyrrolate in inhalation anesthesia (halothane and enflurane). Eighty patients were randomly divided in four groups as follows: Group I: halothane, glycopyrrolate + neostigmine Group II: halothane, glycopyrrolate + pyridostigmine Group IIl: enflurane, glycopyrrolate + neostigmine Group IV: enflurane, glycopyrrolate +pyridostigmine The results were as follows: 1) In halothane and enflurane anesthesia, the changes in heart rate were significant in each group after 4 minutes and especially, the group I, III showed more decrease than the group II, IV. 2) Tachycardia were observd until 6 minutes after administration of anticholinesterase in each group. Bradycardia were appeared at 6 minutes in the group I, IIl and at 14 minutes in the group II, IV and, each group showed bradycardia which continued over 20 mintes. 3) Even though the decrease of systolic and diastolic blood pressure showed transiently with time, there were no significant difference in the changes in ach group. 4) When the same anticholinesterase was administered, the cardiovascular responses were no significant difference between the halothane and enfurane anesthesia. In conclusion, pyridostigmine with glycopyrrolate seems to produce minimal changes in the cadiovascular responses in halothane and enflurane anesthesia.
Anesthesia ; Anesthesia, Inhalation* ; Blood Pressure ; Bradycardia ; Cholinergic Agents ; Enflurane ; Glycopyrrolate ; Halothane ; Heart Rate ; Humans ; Inhalation* ; Mentha ; Neostigmine* ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Pyridostigmine Bromide* ; Tachycardia

Prostate specific antigen (PSA) has become established as the most useful serological marker for monitoring patients with prostate cancer. However, the benefits of serum PSA values are controversial in screening procedures for prostate cancer due to the rather low specificity of PSA test. To determine if different assays yield comparable results, we compared the IMx PSA enzyme immunoassay and the ELSA PSA monoclonal immunoradiometric assay. We analyzed 72 serum specimens from 68 patients with prostatic disease (12 patients with cancer, 47 benign hyperplasia and 9 prostatitis) and 13 from normal controls by both assays. Results from the assays revealed close linear correlation but the ELSA PSA assay yielded values 1.5 times those of the IMx PSA assay In 13 patients with histologically diagnosed benign prostatic hyperplasia, number of patient with PSA value over l0 ng/ml measured by IMx and ELSA assay were 2(15% ) and 4(31%), respectively. We conclude that the proportional bias between assays demonstrates a need for improved standardization of PSA assays.
Bias (Epidemiology) ; Humans ; Hyperplasia ; Immunoenzyme Techniques* ; Immunoradiometric Assay* ; Mass Screening ; Prostate-Specific Antigen ; Prostatic Diseases ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Sensitivity and Specificity