PURPOSE: Residual head tilt has been reported in patients with superior oblique muscle palsy (SOP) after surgery to weaken the inferior oblique (IO) muscle. The treatments for these patients have not received appropriate attention. In this study, we evaluated the superior rectus (SR) muscle recession as a surgical treatment. METHODS: The medical records of 12 patients with SOP were retrospectively reviewed. Each of these patients had unilateral SR muscle recession for residual head tilt after IO muscle weakening due to SOP. The residual torticollis was classified into three groups on the basis of severity: mild, moderate, or severe. Both IO muscle overaction and vertical deviation, features of SOP, were evaluated in all patients. The severity of the preoperative and postoperative torticollis and vertical deviation were compared using a paired t-test and Fisher's exact test. RESULTS: The torticollis improved in nine of 12 (75%) patients after SR muscle recession. The difference between the preoperative and postoperative severity of torticollis was statistically significant (p = 0.0008). After surgery, the mean vertical deviation was significantly reduced from 12.4 prism diopters to 1.3 prism diopters (p = 0.0003). CONCLUSIONS: Unilateral SR muscle recession is an effective method to correct residual head tilt after IO muscle weakening in patients with SOP. This surgical procedure is believed to decrease head tilt by reducing the vertical deviation and thereby the compensatory head tilt.
Adolescent ; Adult ; Child ; Child, Preschool ; Diplopia/*surgery ; Female ; Head Movements ; Humans ; Infant ; Male ; Oculomotor Muscles/*surgery ; Retrospective Studies ; Strabismus/*surgery ; Torticollis/*surgery ; Treatment Outcome ; Trochlear Nerve Diseases/*surgery

Fractures in the subtrochanteric region of the femur present more formidable problems in treatment than do other trochanteric fractures, because such severe stresses exit at the fracture site. Therefore, as a rule we prefer to treat subtrochanteric fractures by operative means if possible. Many internal fixation devices have been recommanded for use in subtrochanteric fractures and each of these devices have advantages in certain types of subtrochanteric fractures, and their selection should be based on the individual fracture anatomy. A total of 20 patients with fracture of the subtrochanteric region of the femur, who were treated by internal fixation with Judet plate between January 1982 and December 1988 have been reviewed. Our conclusions were as follows; 1. Average age was 38 years old and most common cause of injury was traffic accident. 2. Cast immobilization was done after Judet plate fixation. Partial weight bearing ambulation was enabled from POD 10 weeks and full weight bearing ambulation was enabled from POD 16 weeks. 3. 18 in 20 cases, primary bony union was happened and the mean duration of radiological bony union was 24 weeks. 4. 3 cases of complications, metal failure with refracture (2 cases) and screw loosening (1 case), were occured due to early weight bearing in the post operative course. 5. Judet plate fixation was gave satisfactory result in uncomminuted subtrochanteric fracture, especially Seinsheimer's type I, II-A,B,C or Fieldings type I, II. 6. From a consideration of these series, Judet plate showed easy to use, perfect adaptation and rigid fixation. We thought Judet plate is one of a good implants for rigid fixation of subtrochanteric fracture without severe medial cortical disruption.
Accidents, Traffic ; Clinical Study ; Femur ; Hip Fractures ; Humans ; Immobilization ; Internal Fixators ; Walking ; Weight-Bearing

Miller-Dieter syndrome consists of severe type I lissencephaly, abnormal facial appearance, and sometimes other birth defects. Lissencephaly is a brain malformation manifested by a smooth cerebral surface, thickened cortical mantle, and microscopic evidence of incomplete neuronal migration. It comprises the agyria-pachygyria spectrum of malformation, thus excluding polymicrogyria and other cortical dysplasia. Type I lissencephaly results from abnormal migration between about 10 and 14 weeks gestaion. The brain is often small, and the ventricle is enlarged posteriorly The corpus callosum may be small or absent. The structural pattern of the cerebral hemispheres and ventricles is distintly immature, reminiscent of fetal brain. The superficial cellular layer resembles an immature cortex, with some separation into zones similar to layers III, V, and VI of normal cortex, although the cell population is decreased. In 1963 Miller described a malformation syndrome in a brother and sister with postnatal growth deficiency, craniofacial defects, and serious abnormalities of neurologic function. Autopsy at 3 and 4month of age, respectively, revealed lissencephaly. Subsequently, Dieker reported four additional patients with this disorder and referred to it as the 'lissencephaly syndrome'. We have experienced a case with this syndrome. Then we report this rare case with brief review of literature.
Autopsy ; Brain ; Cerebrum ; Congenital Abnormalities ; Corpus Callosum ; Humans ; Lissencephaly ; Malformations of Cortical Development ; Neurons ; Siblings

We investigated fifteen men and twenty one women, who were diagnosed to have asteroid hyalosis between June, 1997 and November, 1997 at Seoul National University Hospital. After obtaining their medical history a complete eye examination was performed. Specimen was examined by light microscope in one case. Funduscopic examination revealed bilateral involvement in 5 cases. Twenty six patients were diabetic and 12 were hypertensive. There was a significant association with diabetes. Light microscopic exam showed variable sized spherical structures with brown rim. Further decrease in visual acuity due to asteroid hyalosis was not observed in 35 cases in which follow-up exams were possible. In conclusion, asteroid hyalosis rarely caused visual loss and were likely to be monocular and to occur in old age.
Female ; Follow-Up Studies ; Humans ; Male ; Seoul ; Visual Acuity

Patellofemoral instability, by definition, is a condition where the patella bone pathologically disarticulates out from the patellofemoral joint, either through subluxation or complete dislocation. The overall incidence of patellofemoral instability ranges between 5.8 and 29 per 100,000. Over time, patients with patellar instability can have debilitating pain, limitations in basic function, and long-term arthritis.Current Concepts: Risk factors for patellofemoral instability include trochlear dysplasia, patella alta, increased tibial tubercle-to-trochlear groove distance, abnormal patella lateral tilt, and coronal and torsional malalignment. The proper treatment is often debatable. Conservative treatment is suitable for acute dislocation but has a high failure rate for chronic instability, which usually necessitates surgical treatment. Today’s common surgical treatments focus on fixing anatomical defects, relieving symptoms of instability, and allowing patients to return to a suitable level of activity.Discussion and Conclusion: In this review, we summarize the relevant pathophysiology, categorization, clinical features, physical examination, imaging, and treatment options for patellofemoral instability.

No abstract available.
Osteotomy*

It has been thought the histological features of rheumatoid arthritis do not reliably indicate the degree of activity or prognosis of the disease and that they are not specific for that condition (Hemerman, 1963). Recently, however, Muirden and Mills (1971) found in rheumatoid joints submitted for synovectomy a direct correlation between the degree of lymphocytic infiltration and joind damage. Lymphocytes might play a helpful role in protection of the rheumatoid joint. Muirden (1970) has also reported a significant relationship between histological estimates of the extent of the iron deposits nd the grades of roentgenographic changes in biopsied joints. The present study directed to confirm and analyze the changes in the clinical and pathological aspects, with the cases synovectomized at Korea and Severance Hospital, Seoul, Korea. Resuits: Clinical and histological studies were made on 21 cases of “classical” and “definite” rheumatoid arthritis submitted to the Department of Orthopaedic, Korea General Horsital and the Department of Pathology, Yonsei University College of Medicine, during the period from 1966 to 1975, and results were as follows. 1 In age distribution, 16 cases (76.2%) were in the interval between 21 and 51 years old: the mean age was 33.5 years old. The sex distribution showed approximately a three fold female predominance with 16 females (76.2%) to 5 male cases (23.8%). 2. The most common chief complaint recorded were morning stiffness and multiple joint pain. Other symptoms, in descending order of occurrence were tenderness, synovial swelling, flexion deformity, joint swelling and subcutaneous nodules. The interval from initial complaint to admission varied from 7 months to 15 years, with a mean interval of 5.9 years. 3. Serological studies for rheumatoid factor were done on 15 cases and eight (53.3%) were found to be positive while seven cases (46.7%) were negative. The positive cases had longer histories and were in older age groups than the negatives. 4. Histologic findings were characterized by proliferation of suface lining cells of synovium, infiltration of lymphocytes, proliferation and thickeness of the vessels, and synovial villi, deposition of fibrins and hemosiderins and infiltration of acute inflammtory celIs. Each of the characteristics studied was ratect on a scaled score ranging from 0 to 3 from 1 to 3. For each patient the scaled scores were totaled and the totals ranged between 6 and 18 with a mean score of 10.5 5. Roentgenographic findings were characterized by swelling of the soft tissues swelling of the joints,. narrowed space of the joint cavity, and destruction of bone. Each of the characteristics studied was rated. on a scaled score ranging from 0 to 3 or from 1 to 3. For each patient the scaled scores were totaled and the totals ranged between 3 and 11 with a mean score of 7.1. 6. There was no significant correlation between histologic findings such as synovial hyperplasia or infiltration of lymphocytes, and clinical findings such as age, duration of histories, presence of rheumatoid factor, roentgenographic findings or surgicaI findings.
Age Distribution ; Arthralgia ; Arthritis, Rheumatoid ; Congenital Abnormalities ; Female ; Fibrin ; Hemosiderin ; Humans ; Hyperplasia ; Iron ; Joints ; Korea ; Lymphocytes ; Male ; Pathology ; Prognosis ; Rheumatoid Factor ; Seoul ; Sex Distribution ; Synovial Membrane

No abstract available in English.
Antigen-Antibody Complex ; Arthritis ; Rabbits ; Synovial Membrane

Cysticercosis is due to a larva of Taenia Solium. It is frequently reported in developing countries. It usually affects subcutaneous tissue, muscles and brain. But, spinal cysticercosis is rare and is usually diagnosed at surgery. Authors experienced a case of spinal cysticercosis accompanied with spondylolistheses at the same level. Space occupying lesion and arachnoiditis, confirmed by MMCT and MRI, were noted at the same level of spondylolistheses. So, it was very hard to make dicision whether we should open up the dura or not.
Arachnoid ; Arachnoiditis ; Brain ; Cysticercosis ; Developing Countries ; Larva ; Magnetic Resonance Imaging ; Muscles ; Spondylolisthesis ; Subcutaneous Tissue ; Taenia solium

We Studied 48 patients(62 hips) who were performed hip arthroplasties at the Department of Orthopaedic Surgery, Soonchunhyang University hospital from February 1990 to August 1992. The purpose of the present study was to compare canal filling ratio and clinical results of cases treated by cementless femoral stem with 19 Harris Galante(straight stem), 23 Anatomic(curved stem) and 20 Multilock (straight stem). The follow-up periods ranged from 12 months to 36 months. We assessed canal filling at metaphysis, mid-stem and distal canal, and clinical results according to canal filling. The results were as follows ; 1. The average filling ratio of the medullary canal by each type of stem in the coronal plane were as follows. Harris Galante ; 80. 5%, Anatomic ; 79. 4%, Multilock; 79. 8% in metaphysis. Harris Galante ; 88. 7%, Anatomic ; 88. 3%, Multilock ; 87. 3% in mid-stem. Harris Galante ; 95. 1%, Anatomic 90. 2%, Multilock ; 94. 5% in distal canal. At distal canal, the average canal filling of Harris Galante and Multilock were more excellent than Anatomic in coronal plane. 2. The average filling ratio of the medullary canal by each type of stem in the saggital plane were as follows. Harris Galante ; 64. 0%, Anatomic 69. 6%, Multilock ; 68. 6% in metaphysis. Harris Galante ; 79. 6%, Anatomic; 84. 5%, Multilock; 80. 2 in mid-stem. Harris Galante ; 78. 3%, Anatomic ; 82. 6%, Multilock ; 84. 5% in distal canal. At mid-stem, the average canal filling of Anatomic was more excellent than Multilock and Harris Galante. At metaphysis and distal canal, the average canal filling of Anatomic and Multilock were more excellent than Harris Galante in saggital plane. 3. The average Harris's hip scores of each type of stem at the final follow-up was 89. 9 in Harris Galante, 90. 3 in Anatomic and 91. 9 points in Multilock. There was no significance statistically(p>0.05). 4. The correlation between the average canal filling and thigh pain was not statistically significant (p>0. 05).
Arthroplasty ; Follow-Up Studies ; Hip ; Thigh