PURPOSE: We evaluated the distribution of hypoperfusion in patients with traumatic brain injury (TBI) and the relationship of thalamic hypoperfusion to severity of cognitive and behavioral sequelae. MATERIALS AND METHODS: Tc-99m ECD SPECT and MRI were performed in 103 patients (M/F=81/22, mean age 34.7+/-15.4 yrs) from 0.5 to 55 months (mean 10.3 months) after TBI. The patients were divided into three groups showing no abnormalities (G1), focal (G2) and diffuse injury (G3) on MRI. Psychometric tests assessed 11 cognitive or behavioral items. In all patients, we evaluated the distribution of hypoperfused areas in SPECT, and in 57/103 patients, neuropsychological (NP) abnormalities in patients with thalamic hypoperfusion were compared with those of patients without thalamic hypoperfusion. RESULTS: The perfusion deficits were most frequently located in the frontal lobe (G1, 42.3%: G2 34.5%: G3 33.3%), temporal lobe (24~26%) thalami (21~22.4%), parietal and occipital lobe (< or =10%). Numbers of NP abnormalities in the cases of cortical hypoperfusion with or without concomitant thalamic hypoperfusion were following: the former 4.7+/-1.5 and the latter 3.2+/-1.4 in G1, 5.0+/-1.1 and 4.8+/-1.2 in G2, 6.8+/-1.8 and 6.3+/-1.1 in G3, respectively. This difference according to thalamic hypoperfusion was significant in G1 (p=0.002), but was not significant in G2 or G3. CONCLUSION: SPECT in patients with TBI had demonstrated hypoperfusion mostly involving the frontal, temporal and thalami. In normal group on MRI, frontal hypoperfusion was more prominent than that of any other group, Furthermore in this group, SPECT could predict severity of NP outcome by concomitant thalamic hypoperfusion with cerebral cortical abnormalities.
Brain Injuries* ; Brain* ; Equidae* ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Occipital Lobe ; Perfusion ; Psychometrics ; Rabeprazole ; Temporal Lobe ; Tomography, Emission-Computed, Single-Photon*

Closed intramedullary nailing for trochanteric fractures of femur has many advantages such as minimal operative trauma, low incidence of infection, good stability of fracture, low incidence of delayed or nounion and early ambulation. Complications have been frequently experienced especially in elderly, osteoporotic patients, but these could be avoided by meticulous surgical procedure. The authors hsve treated 99 cases of intertrochanteric fracture and 23 cases of subtrochanteric fracture from March 1982 to December 1987 with this method and the results are summerized as follows : 1. The aversge age was 61.4 yrs. 2. In classification of intertrochanteric fracture, stable fractures(Kyle type I & II) were 53 cases(43.3%) and unstable fractures(Kyle type III & IV) were 46 cases(37.6%). And in subtrochanteric fracture, stable transverse fractures were 12 cases(9.8%) and unstable long oblique or spiral fractures were 11 cases(9.0%). 3. Intraoperative complications were experienced in 23 cases(18.8%). The entry hole breakage was most common and occurred in 16 cases. 4. Of the 94 patients with more than 6 months follow-up, 21 patients(22.3%) showed more than one complication, e.g, knee joint pain in 15 cases, external rotation deformity in 8 and nail migration in 11 including 3 cases of fixation loss and one case of nonunion with nail breakage, etc. 5. Complications occurred more frequently in unstable fractures(31.8%) and in old ages (29.1%) than in stable fractures and in young ages respectively. And it was felt that complications could be minimized by packing of the medullary canal with nails. 6. It is thought that flexible intramedullary nailing is a good method for trochanteric fractures of femur not only in elderly debilitated patients but also in young patients. However, experience and caution are required to prevent complications.
Aged ; Classification ; Congenital Abnormalities ; Early Ambulation ; Femur ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Hip Fractures ; Humans ; Incidence ; Intraoperative Complications ; Knee Joint ; Methods

Dislocation involving talus is a rare injury comprising less than 1% of all dislocations of the joint. One case of lateral subtalar di location of the talus treated at the Department of Orthopedic Surgery, Kang Nam General Hospital in Decernber 1985. The patient was followed for 6 months and satisfactory healing was obtained.
Dislocations ; Hospitals, General ; Humans ; Joints ; Orthopedics ; Talus

In Korea, slipped capital femoral epiphysis is a rare disease. In which the capital femoral epiphysis migrate posteriorly and inferiorly against the neck portion. Sometimes it should be differentiated from other conditions that separate the femoral capital epiphysis. We have experienced a rare case of separation of capital femoral epiphysis due to an osteosarcoma in the proximal femoral metaphysis in the 15 years of old girl.
Epiphyses ; Female ; Humans ; Korea ; Neck ; Osteosarcoma ; Rare Diseases ; Slipped Capital Femoral Epiphyses

Hypochondroplasia is a form of short
Achondroplasia ; Christianity ; Dwarfism ; Extremities ; Hand

Arthrodesis of the knes has lost its nopularity since the development of modern knee replscement arthroplasties, however it still has its place as a salvage procedure when replacement arthroplasties are contraindicated. Various techniques have been in the use including the time-tested Charnleys compressiori arthrodesis. Instead of using Charnley's and other similar compression devices, the authors applied single or double compression plates in 8 knees with severe destruction and deformities, and the results are summerized ss follows: l. Included in this series are 5 cases of tuberculous arthritis, 1 case of septic arthritis, 1 case of resistant scar contracture, and 1 case of Charcots knee. 2. Successful fusion was obtained within 18th week, aversge 13th week. No case of pseudarthrosis was experienced. 3. 3 cases of postop. wound drainage and 1 case of peroneal nerve palsy were experienced, but these did not compromise the final results. 4. It may be concluded that Arthrodesis of the knee using compression plate is rigid enough to permit early mobilization of patients and get the certainty of union.
Arthritis ; Arthritis, Infectious ; Arthrodesis ; Arthroplasty ; Arthroplasty, Replacement ; Cicatrix ; Congenital Abnormalities ; Contracture ; Drainage ; Early Ambulation ; Humans ; Knee ; Paralysis ; Peroneal Nerve ; Pseudarthrosis ; Wounds and Injuries

A 63-year-old male who had subtotal gastrectomy for early gastric cancer three months ago underwent Tc-99m bone scintigraphy for the evaluation of skeletal metastases. He had no symptoms such as fever, tenderness, or wound discharge. On physical examination, the surgical scar along the midline of the upper abdomen had keloid formation and there was no radiographic evidence of calcification. Bone scintigraphy (Fig. 1A & 1B) demonstrated an unusual linear increased uptake along the midline of the upper abdomen that corresponded to the skin incision for subtotal gastrectomy. Usually, an incisional scar will not be visualized in Tc-99m methylene diphosphate (MDP) scintigraphy beyond two weeks after surgery.1) Upon reviewing the literature, there were only a few reports where localization of Tc-99m MDP in surgical scars were found two months after surgery.2) It was also reported that a few cases with Tc-99m MDP uptake in the keloid scar developed after surgery. Although there are several potential mechanisms that may explain the uptake of Tc-99m MDP in scar tissue, the primary mechanism in older scars is suggested to be a result of pathological calcification.2) Siddiqui et al3) suggested it could be due to microscopic calcification in small resolving hematomas. However, the primary mechanism in keloid scar is not well-known. We should obtain oblique or lateral views to differentiate the uptake in healing surgical scars from the artifactual uptake.
Abdomen ; Cicatrix ; Fever ; Gastrectomy* ; Hematoma ; Humans ; Keloid* ; Male ; Middle Aged ; Neoplasm Metastasis ; Physical Examination ; Radionuclide Imaging ; Skin ; Stomach Neoplasms ; Technetium Tc 99m Medronate* ; Wounds and Injuries

A 60-year-old male with carcinoma of the prostate and cerebral infarction underwent a Tc-99m MDP bone scintigraphy for the evaluation of skeletal metastases. Bone scintigraphy (Fig. 1) showed multiple areas of increased uptake of Tc-99m MDP in the skull, spine, and ribs representing skeletal metastases. Two different patterns of uptake occurred in the skull region (Fig. 1A-C); one represents bony metastasis and the other represents cerebral infarction. The shape, size, location, intensity, and border of the increased uptake differed between the two lesions. An oval-shaped pattern with smaller size, greater intensity and more sharply defined border in the frontal region was consistent with bony metastasis. A rectangular-shaped pattern with larger size, lesser intensity and relatively indistinct border in the temporo-parieto-occipital region was consistent with cerebral infarction. Increased uptake of bone-seeking radiotracers in cerebral infarction has been reported previously.1-4) A suggested mechanism by which bone-seeking radiotracers accumulate in the necrotizing cerebral tissue is an alteration of the blood-brain barrier induced during cerebral infarction, which results in entry of the radiotracers into the extracellular space of the brain.4) Brain CT (Fig. 2) performed 7 days before and one month after the bone scintigraphy revealed lesions on the right temporo-parieto-occipital region consistent with acute hemorrhagic and chronic cerebral infarction, respectively.
Blood-Brain Barrier ; Brain ; Cerebral Infarction* ; Extracellular Space ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis* ; Prostate ; Radionuclide Imaging* ; Ribs ; Skull ; Spine ; Technetium Tc 99m Medronate*

No abstract available.
Ampulla of Vater* ; Duodenum ; Tuberculosis*

No abstract available.