During the period from january, 1972, to march, 1979, Twenty-four patients underwent mitral valve replacement at the seoul national University Hospital. Their ages ranged from 8 years to 20 years, with 11 patients being 16 years of age or younger at the time of operation. There were 12 males and 12 females and their weight ranged from 25 to 53 Kilograms. Seventeen patients had advanced stages of heart disease as evidenced by the functional classification: 14 cases were in functional class III and 3 cases in functional class IV (New York heart Association). A history suggestive of rheumatic fever was elicited in 75 per cent of our patients. Radiographic evaluation demonstrated marked cardiomegaly in the majority of the patients. The cardiothoracic ratio was over 70 per cent in 5 patients and between 60 and 70 per cent in 17 patients. Cardiac catheterization was carried out in all patients before operation. There were 3 patients with evidence of severe pulmonary hypertension. In 2 patients the pulmonary artery pressures were normal. On physical and hemodynamic examinations, 3 patients had associated with aortic regurgitation, 2 patients had tricuspid regurgitation, 1 patient had tricuspid and aortic regurgitations and 3 patients had atrial septal defect or ventricular septal defect or transposition of great arteries. The pathologic findings of the mitral valve indicated rheumatic valvulitis in 16 patients, while in the remaining 7 the etiology was undetermined. In only one patient the cause was congenital cardiac anomaly. Seventeen patients had predominant mitral regurgitation and 7 patients predominant mitral stenosis. Twenty-nine cardiac prosthetic and bioprosthetic valves were replaced in 24 patients in the past 8 years. This series included 24 mitral, 4 aortic and 1 tricuspid valve replacement. Including in this group were patients who had concomitant aortic valve replacement(3 patients), tricuspid valve replacement(1 patient), tricuspide annuloplasty and closure of ventricular septal defect(1 patient), and closure of atrial septal defect and ventricular septal defec(3 patients). There were five deaths in the postoperative period, resulting in an operative mortality rate of 20.8 per cent. high postoperative mortality was seen in the patients with associated aortic valvular disease and congenital cardiac anomaly.
Adolescent* ; Aortic Valve ; Aortic Valve Insufficiency ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Child* ; Classification ; Female ; Heart ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Male ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Mortality ; Postoperative Period ; Pulmonary Artery ; Rheumatic Fever ; Seoul ; Transposition of Great Vessels ; Tricuspid Valve ; Tricuspid Valve Insufficiency

During the period from january, 1972, to march, 1979, Twenty-four patients underwent mitral valve replacement at the seoul national University Hospital. Their ages ranged from 8 years to 20 years, with 11 patients being 16 years of age or younger at the time of operation. There were 12 males and 12 females and their weight ranged from 25 to 53 Kilograms. Seventeen patients had advanced stages of heart disease as evidenced by the functional classification: 14 cases were in functional class III and 3 cases in functional class IV (New York heart Association). A history suggestive of rheumatic fever was elicited in 75 per cent of our patients. Radiographic evaluation demonstrated marked cardiomegaly in the majority of the patients. The cardiothoracic ratio was over 70 per cent in 5 patients and between 60 and 70 per cent in 17 patients. Cardiac catheterization was carried out in all patients before operation. There were 3 patients with evidence of severe pulmonary hypertension. In 2 patients the pulmonary artery pressures were normal. On physical and hemodynamic examinations, 3 patients had associated with aortic regurgitation, 2 patients had tricuspid regurgitation, 1 patient had tricuspid and aortic regurgitations and 3 patients had atrial septal defect or ventricular septal defect or transposition of great arteries. The pathologic findings of the mitral valve indicated rheumatic valvulitis in 16 patients, while in the remaining 7 the etiology was undetermined. In only one patient the cause was congenital cardiac anomaly. Seventeen patients had predominant mitral regurgitation and 7 patients predominant mitral stenosis. Twenty-nine cardiac prosthetic and bioprosthetic valves were replaced in 24 patients in the past 8 years. This series included 24 mitral, 4 aortic and 1 tricuspid valve replacement. Including in this group were patients who had concomitant aortic valve replacement(3 patients), tricuspid valve replacement(1 patient), tricuspide annuloplasty and closure of ventricular septal defect(1 patient), and closure of atrial septal defect and ventricular septal defec(3 patients). There were five deaths in the postoperative period, resulting in an operative mortality rate of 20.8 per cent. high postoperative mortality was seen in the patients with associated aortic valvular disease and congenital cardiac anomaly.
Adolescent* ; Aortic Valve ; Aortic Valve Insufficiency ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Child* ; Classification ; Female ; Heart ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Male ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Mortality ; Postoperative Period ; Pulmonary Artery ; Rheumatic Fever ; Seoul ; Transposition of Great Vessels ; Tricuspid Valve ; Tricuspid Valve Insufficiency

STUDY DESIGN: The indications of the lumbosacral spinal fusion has been very controversial. The posterior lumbar interbody fusion has the popularity of the spinal fusion: coaption of large surface areas of cancellous bone without shear forces, anatomic restoration and maintenance of more normal dimensions of the joint space, total discectomy as preparation for the fusion, and the accomplishment of better neural decompression without creating instability of the spine. OBJECTIVES: To evaluate the long-term results of the surgical management of degenerative lumbar disease by the modified transdiscal posterior lumbar interbody fusion technique using cancellous chip graft were analyzed. SUMMARY OF LITERATURE REVIEW: The disadvantages of classical posterior lumbar interbody fusion has a injury of nerve root by extensive retraction with the insertion of peg grafts into the disc space, compression of root by graft retropulsion, inadeguate removal of annulus fibrosus and end plates from excessive bleeding from venous plexus of spinal canal and from vertebral cancellous bone. MATERIALS & METHOD: Author's 43 cases who had transpedicular instrumentation and modified transdiscal PLIF using cancellous chip graft since 1989 in the Department of Orthopedic Surgery, Korea University Hospital were analyzed, retrospectively. After preparation of the interspace has been complete by total discectomy, removal of the cartilaginous end plates and perforation of the cortical plates using the ring curette, cancellous chip grafts are inserted into the interspace with the Funnel technique. The structural success of each fusion was documented by sequencial radiographs. The criteria for fusion included: homogenous amalgamation of the fusion mass and vertebral bodies, trabeculation, mass configuration, and no motion demonstrable by hyperflexion studies. The results obtained were as follows: 1. Stable fusion was obtained in 39 patients(91%) at post-operative 6 months. 2. Clinically no patient developed neurologic deficit after fusion and 41 patients (95.3%) had good results by Gill's criteria. 3. No significant complications influencing operative result were observed except minor complications such as paralytic ileus, transient dysuria and superficial infection. 4. In conclusion, modified transdiscal PLIF procedure using cancellous chip graft showed excellent clinical and radiological results to achieve spinal fusion and the procedure is technically feasible and should be considered more widely employed.
Decompression ; Diskectomy ; Dysuria ; Hemorrhage ; Humans ; Intestinal Pseudo-Obstruction ; Joints ; Korea ; Neurologic Manifestations ; Orthopedics ; Retrospective Studies ; Spinal Canal ; Spinal Fusion ; Spine ; Transplants*

The goal of fracture treatment is to restore the patient to pre-injury function level. But the outcome assessment after orthopedic interventions has usually focused on physician-defined parameters of technical success, such as fracture union, alignment and range of motion rather than patient function and quality of life. However, the correlation among improvements in these parameters and functional status, psychosocial well being is inconsistent and weak in the elderly. Therefore authors assessed the functional status after surgical intervention of hip fractures in the elderly with functional recovery score(FRS). Independence in basic activities of daily living, in instrumental activities of daily living, in mobility, freedom from pain and intact memory were assessed in 133 hip fractures in the elderly. The hip fractures in the elderly resulted in 24.8% loss of function after the first year. The older the age, the more the loss of function after surgery of hip fractures. The more functional loss was observed in female patients and in patients with poor postoperative radiological results, but statistically insignificant (P>0.05). The more functional loss was observed in patients with underlying medical disease preoperatively and it was statistically significant (P<0.05). We recommend the evaluation of functional status in the elderly after hip fractures.
Activities of Daily Living ; Aged* ; Female ; Freedom ; Hip Fractures* ; Hip* ; Humans ; Memory ; Orthopedics ; Quality of Life ; Range of Motion, Articular

BACKGROUND: This study compared the clinical and radiological outcomes of the single calcar screw plate and Polarus nail techniques for the treatment of the proximal humerus fractures. METHODS: Seventy-two patients diagnosed with displaced proximal humerus fracture were enrolled for the study. Of these, 50 patients underwent the locking plate surgery with a single calcar screw (plate group), whereas 22 patients underwent the Polarus nail surgery (nail group). The plate group was further divided into plate 1 group (with medial support), and plate 2 group (without medial support). The radiological and functional results of both groups were compared to the nail group. RESULTS: The α angle 1 year after surgery was significantly different between plate 1 and plate 2, and plate 2 and nail groups (p=0.041, p=0.043, respectively). The ratio that does not satisfy the reference value of γ angle was 2.8% in plate 1, 7.1% in plate 2 and 22.7% in nail group (p=0.007); there was a significant difference between plate 1 and nail group, and plate 2 and nail group (p=0.014, p=0.033, respectively). CONCLUSIONS: No significant differences were observed in the clinical results between locking plate and Polarus nail. However, in the plate 2 group and nail group, the rate of failure to maintain reduction during the 1-year period after surgery was statistically and significantly higher than the plate 1 group (level of evidence: level IV, case series, treatment study).
Humans ; Humeral Fractures ; Humerus* ; Reference Values

Blue Rubber Bleb Nevus syndrome, or Bean's syndrome is a very rare disease characterized by an association of 1) hemangioma cutis in which the nevi feel like rubber blebs; 2) hemangiomas of the digestive organs; 3) iron-deficiency anemia due to hemorrhage from the digestive tract. Sometimes, the bleeding is so severe and massive that the patient needs blood transfusions and/or emergency operations. We present a 29-year-old man with Blue Rubber Bleb Nevus syndrome. This patient was admitted to out hospital due to recently aggrevated dizziness and intermittent rectal bleeding. Multiple bluish tumors were noted on the palm, sole and glans penis. Laboratory examination revealed severe iron-deficiency anemia. Barium studies revealed multiple polypoid masses in the stomach, small bowel and colorectum. On esophagogastroduodenoscopy and colonoscopy, three or four dozens of hemangiomas with variable size and shape were noted in the stomach, duodenum at or around the ampulla of Vater and colorectum. This patient was of particular interest because rectal bleeding occurred from rectal lesion which protruded out of anus and caused bleeding during defecation, and which showed as a 2.0 cm Yamada type III polypoid lesion. Endoscopic ultrasonography confirmed us that this lesion was confined to the mucosa and submucosa without extension into muscle layer. Endoscopic polypectomy of this lesion was performed because which considered as the main focus of current rectal bleeding. He was discharged without any complication and 4 months later, he was well without rectal bleeding and his hemoglobin level increased upto 13.5 g/dl. To our knowledge, this is the first case of Blue Rubber Bleb Nevus syndrome in Korea.
Adult ; Ampulla of Vater ; Anal Canal ; Anemia, Iron-Deficiency ; Barium ; Blister* ; Blood Transfusion ; Colonoscopy ; Defecation ; Dizziness ; Duodenum ; Emergencies ; Endoscopy, Digestive System ; Endosonography ; Gastrointestinal Tract ; Hemangioma ; Hemorrhage ; Humans ; Korea ; Male ; Mucous Membrane ; Nevus* ; Penis ; Rare Diseases ; Rubber* ; Stomach

No abstract available.
Arthrogryposis*

Parathyroid hormone (PTH) has not been studied as extensively as therapeutic agents of osteoporosis, but the anabolic effect of parathyroid hormone on the skeleton has been demonstrated in several studies. The current study was undertaken to assess the effect of parathyroid hormone on bone mass and its biomechanical competence using ovariectomized rat model. Fifty female Sprague Dawley rats of 3 months old were randomized into five groups, 10 in number for each groups. Group I: sham-operation, Group II: ovariectomy (OVX) plus saline injection, Group III: OVX plus PTH 20ug/kg, Group IV: OVX plus PTH 40ug/kg, Group V: OVX plus PTH 80ug/kg. Treatment regimens were initiated 8 weeks after ovariectomy and continued for 4 weeks thereafter. Bone mineral density was measured in proximal one-third level of tibia by dual energy X-ray absorptiometry (QDR-2000, Hologic, U.S.A). Biomechanical competence was assessed in lumbar vertebral body by universal testing machine (Instron-4467, U.S.A). The average of bone mineral density in sham operated group was 0.088+/-0.0084g/cm (2), and in control group (OVX +/- saline)was 0.065+/-0.0095g/cm (2). Bone mineral density decreased in control group significantly. The average of bone mineral densities in Group III, IV, V (OVX + PTH) were 0.071+/- 0.0089, 0.081+/-0.0086 and 0.084+/-0.0093g/cm (2), respectively. This showed that parathyroid hormone injected groups had significantly higher bone mass than control group (p<0.0#5), and the increment was in proportion to the amount of parathyroid hormone in the range (p<0.05). The average of biomechanical competence of lumbar vertebral body in sham operated group was 30.036.24 MPa and was 25.11+/-5.69 MPa in control group. In Group III, IV,V they were 25.74+/-6.77, 27.96+/-5.17 and 29.83+/-5.79 MPa, respectively. Above results seem supportive of the phenomenon that parathyroid hormone exert anabolic effect on osteoporotic bones in certain experimental condition.
Absorptiometry, Photon ; Anabolic Agents ; Animals ; Bone Density* ; Female ; Humans ; Infant ; Mental Competency ; Models, Animal ; Osteoporosis ; Ovariectomy ; Parathyroid Hormone* ; Rats* ; Rats, Sprague-Dawley ; Skeleton ; Spine* ; Tibia*

Spondylometaphyseal dysplasia (SMD) is an extremely rare, which affects the spine and metaphy-ses of the tubular bones on terms of enchondrogenesis. Children who had Kozlowski dwarfism, type of SMD are not recognized until they reach school age since they have normal clinical feature, weight and size in early childhood. Authors experienced a typical case of Kozlowski type of SMD in a 10 years old male who had i) generalized platyspondyly with anterior tapering of vertebrae ii) generalized metaphyseal dysplasia iii) minimal changes in the carpal and tarsal bones. This case is to be reported with review of references.
Child ; Dwarfism ; Humans ; Male ; Spine ; Tarsal Bones

No abstract available.
Aged* ; Child* ; Dislocations* ; Hip* ; Humans