In management of foot deformity, the operative procedures such as tendon transplantation and bone stabilization are of the relatively recent origin. The first tendon transfer was performed by Nicoladoni in 1881. Since that original report, a voluminous literature was appeared on the subject of tendon trasplantation. During the period, from Jan. 1960 to May. 1992, we have done clinical studies of the 189 feet on 167 patients who had been undergone tendon transfer. The results are as followes, 1. Residual poliomyelitis, leprosy, cerebral palsy and club foot are common etiology. Among them, residual poliomyelitis was the most common, especially in 1960 to 1969. Recently trauma and aged leprosy were increased. 2. Among 189 feet, the equinovaurs deformities were 90 cases. 3. Posterior tibial tendon, peroneus tendons, anterior tibial tendon, Achilles tendon and extensor hallucis tendon were transferred. 4. Posterior tibial tendon was mostly used. 5. The evaluation for surgery, for Good to Excellent was 114 feet 60. 3% 6. The poor results were noticed in the cases of the calcaneal deformity and showed in the age below 5 years old.
Achilles Tendon ; Cerebral Palsy ; Congenital Abnormalities ; Foot Deformities ; Foot ; Humans ; Leprosy ; Poliomyelitis ; Surgical Procedures, Operative ; Tendon Transfer ; Tendons

Opposition of the thumb is necessary for pinch-one of the three most important functions of the hand. Frequently, opposition is either partially or totally lost in poliomyelitis or median nerve palsy. Several types of operations have been devised for restoration of opposition, and in 1973, Burkhalter et al. announced extensor indicis proprius opponensplasty: the tendon of extensor indicis proprius is brought out in the area of the pisiform and then passed against subcutaneously across the palm to the thumb, being attached to the abductor pollicis brevis and extensor pollicis longus tendon. It is useful in the case of loss of opposition without available finger flexor or wrist motors. Of nine patients who underwent operation-one with Riordan and eight with Burkhalter type of opponensplasty-at National Medical Center, seven had excellent results: one had a fair, and another one had a poor result. Six patients were with low combined median and ulnar nerve injury: one with high combined median and ulnar nerve injury: one with brachial plexus injury: and one with myotmesis of the thenar muscles. From the results, we conclude that Burkhalter type of opponensplasty makes satisfactory result for the hand without opposition movement; it is indicated in high median nerve injury and any combined median and ulnar nerve injury6; early restoration of opposition to the thumb in median nerve injury and in those limbs with multiple tissue trauma adds immeasurably to the over-all early rehabilitative effort.
Brachial Plexus ; Extremities ; Fingers ; Hand ; Humans ; Median Nerve ; Muscles ; Paralysis ; Poliomyelitis ; Tendons ; Thumb ; Ulnar Nerve ; Wrist

Ganglia are the most common soft tissue tumors of the hand. Ganglia found on the dorsum of the wrist usually arise from the scapholunate ligament and are usually located between the extensor digitorum communis tendon of the index finger and extensor pollicis longus tendon. Intratendinous ganglion is a very rare lesion of unknown etiology and natural history that originates within the tendon. A patient is described who presented with a painful mass on the dorsolateral aspect of the wrist due to an intratendinous ganglion of the extensor pollicis longus tendon. Treatment consisted of excision of the extensor pollicis longus tendon with ganglion followed by mini free tendon graft using palmaris longus tendon.
Fingers ; Ganglia ; Ganglion Cysts ; Hand ; Humans ; Ligaments ; Natural History ; Tendons ; Transplants ; Wrist

BACKGROUND: The circadian rhythm of circulating melatonin is regulated by the endogenous oscillators, the suprachi-asmatic nuclei, and entrained by the light-dark cycle of the environment, but it seems that the rhythm can be affected by variable lesions outside the retina-pineal pathway. We intended to know how acute cerebral infarction affects on the cir-cadian rhythm of plasma melatonin secretion. METHODS: Plasma melatonin level was measured from 64 patients with acute cerebral infarction. On admission, blood samples were collected by venipuncture at 2AM, 4AM, 10AM, and 2PM and melatonin level was measured by radioimmunoassay. The state of consciousness of each patient was assessed clini-cally and the infarction site and size were evaluated clinically and radiographically. RESULTS: Among 64 patients with acute cerebral infarction, dramatic blunting or obliteration of nocturnal melatonin surge in the blood was found in 29 patients. The circadian rhythm of melatonin secretion was absent in 12 of 35 alert patients, in 10 of 20 drowsy patients, and in 5 of 7 stuporous patients. Melatonin secretion into plasma was markedly decreased in all 2 comatose patients. Of 14 patients with brainstem lesions, 8 patients showed decreased melatonin levels with the absence of a nocturnal rise, although most of them were alert. CONCLUSIONS: This study suggests that brainstem and the initial mental state might contribute to the regulation of the circadian rhythm of plasma melatonin even though the lesion does not involve the retina-pineal pathway, but further extensive study is required to elucidate it. (J Korean Neurol Assoc 19(4):359~363, 2001)
Biological Clocks ; Brain Stem ; Cerebral Infarction* ; Circadian Rhythm* ; Coma ; Consciousness ; Humans ; Infarction ; Melatonin* ; Phlebotomy ; Photoperiod ; Pineal Gland ; Plasma ; Radioimmunoassay ; Stupor

No abstract available.
Fractures, Open*

With improvement of anterior fixation devices, anterior instrumentation-fusion in treatment of thoracolumbar fracture becomes as effective as posterior interbody fusion which has mainly been used up to now. Also, computerized tomography enables us to diagnose the spinal fracture accurately including retropulsive bony fragment and degree of narrowing of spinal canal. We analyzed 18 cases which were treated with anterior interbody fixation in thoracolumbar fracture from Mar. 1977 to Oct. 1986 in Orthopaedic dept. of National Medical Center. The results were as follows ; 1. The mechanism of injury involved falling down in 7 cases, traffic accident 5 cases, and miner injury in 4 cases. 2. The clsssification of fracture by Denis method was compression fracture in 4 cases, bursting fracture in 11 cases, Seat-belt injury in 1 case, Fx-dislocation in 2 cases. 3. The methods of internal fixation were iliac bone graft only in 8 cases, anterior Harrington rod in 2 cases, Webb implant in 6 cases, and Zielke rod in 2 cases. 4. The average preoperative kyphotic angulation was 19.5(range 10 to 22) and immediate postoperative angulation was 10.1(range 2–16). The correction rate was 48%, and the loss of correction was 2.8(range 2–13). The final correction rate was 38.1% with implants, 29.1% without implants. 5. Early operation can get better neurologic recovery. 6. Firm and stsble fixation device is needed.
Accidental Falls ; Accidents, Traffic ; Fractures, Compression ; Methods ; Miners ; Spinal Canal ; Spinal Fractures ; Transplants

Fractures of the distal end of the femur are difficult to manage because of the a wide range of potential complications. In the past, there has been a reluctance toward treatment of fractures of the distal end of femur with internal fixation. Recently, however, a trend toward internal fixation has become evident and good results have been reported by several authors. We analyzed 30 cases of distal femur fracture involving knee joint in the Department of Orthopaedic Surgery in National Medical Center from Jan. 1982 to Dec. 1986. 1. There were 30 cases in 29 patients. And were devided in 23 closed and 7 open fractures. 2. Clinical union were taken from 3 to 5 months in conservative and 2 to 3.5 months in operative treatment. 3. Satisfactory results were 5 cases(64%) in conservstive and 16 cases(73%) in operative treatment. 4. Significant complication were stiffness and infection.
Clinical Study ; Femur ; Fractures, Open ; Humans ; Knee Joint ; Knee

PURPOSE: This study examined the influence of meteorological phenomena on the development of spontaneous pneumothorax (SP). METHODS: We conducted this study from January to November 2004. We obtained the daily SP incidence from data requested by the National Health Insurance office from general hospital in Daejon, and we got the meteorological data from the Daejon Regional Meteorologic office. The difference in meteorological phenomena between cluster days (3 or more SP) and no SP days was analyzed using a generalized additive model (GAM) that used a specialized form of the non-parametric, non-linear regression test. RESULTS: Five hundred sixty-six SP patients were included. There were 369 male patients and 74 female patients. SP patients were associated with significantly lower atmospheric pressure and with broad swings of daily atmospheric pressure for 4-7 days prior to the hospital visits. More clouds had gathered for several days before cluster days than had gathered on days with no SP. CONCLUSION: Development of SP is related with meteorological phenomena. SP occurs when lower atmospheric pressure, broad swings of atmospheric pressure, and cloudy weather are collectively exprienced for several days before the hospital visit.
Atmospheric Pressure ; Daejeon ; Female ; Hospitals, General ; Humans ; Incidence ; Male ; Meteorological Concepts ; National Health Programs ; Pneumothorax* ; Weather

Moyamoya disease is characterized by a bilateral progressive narrowing of the distal internal carotid and proximal portions of the anterior and middle cerebral arteries. The cerebral vessels of the 11 to 14 mm embryonic period are extremely similar to these moyamoya vessels. The vertebral arteries unite with a contralateral homologue to form the basilar artery during embryonic development and rarely, the failure of complete fusion results in duplication of these arteries. It is well known that moyamoya disease sometimes is accompanied by persistent primitive arteries, cerebral aneurysm, or rarely arteriovenous malformation. However, no case of the moyamoya disease with complete duplication of basilar artery has been previously reported. These two types of vascular abnormality are probably associated in certain developmental period, and moyamoya disease causes hemodynamic load in the basilar artery system as a collateral pathway and these effects are also involved in duplication of basilar artery. The relationship between these two varieties of vascular abnormality and possible pathogenesis of the moyamoya disease are discussed.
Aneurysm ; Arteries ; Arteriovenous Malformations ; Basilar Artery* ; Cerebral Arteries ; Embryonic Development ; Female ; Hemodynamics ; Middle Cerebral Artery ; Moyamoya Disease* ; Pregnancy ; Vertebral Artery

It is well known that circulating antibodies are produced by plasma cells derived from B lymphocytes, and T lyphocytes are endowded with the capacity to regulate the type and intensity of virtually all immune responses. Therefore, the measurement of relative and absolute number of lymphocytes in the peripheral blood of myasthenia gravis patients could be of value. We have studied the distribution pattern of lymphocytes and helper/suppressor ratio in the peripheral blood of 28 myasthenic patients in comparison with 10 patients of other neurologic diseases as control by using immunobead method. There was no significant differences between 17 myasthenic patients who had taken only anticholinesterase and control. But in 17 patients who had taken steroid, Helper T lymphocyte was decreased significantly compared to control. Both T lymphocyte and B lymphocyte were also decreased significantly compared to 17 myasthenic patients who had taken only anticholinesterase without steroid therapy. In 3 patients who had undergone thymectomy, there was significant decreases of suppressor T lymphocyte. Plasma exhange as a treatment for myasthenia gravis is currently the subject of clinical interest and research. Clinical response and muscle power measured by using sphygmomanometer were followed in 2 patients in myasthenic crisis and in 4 patients with severe disease refractory to all other treatment modalities, received 4-6 cycles of plasma exchange with Hemonetics 30-S. 2 patients had a recurrence 1.5 and 6 months after first course of plasma exchange respectively, Therefore, they had to take a second course of plasma exchange. The satisfactory increment of muscle power was noticed in 5 out of 6 cases after fourth plasma exchange.
Antibodies ; B-Lymphocytes ; Humans ; Lymphocytes* ; Myasthenia Gravis* ; Plasma Cells ; Plasma Exchange* ; Plasma* ; Recurrence ; Sphygmomanometers ; Thymectomy