Damages to the sensory, autonomic and motor nerves in leprosy patients are followed by anesthesia, dryness of the skin and muscular paralysis. Most plantar ulcers in leprosy patients are caused by repetitive moderate stress. Minor injuries such as bruising sustained as a result of the misuse of anesthetic limbs may lead to ulceration, scar formation and secondary infection. Cellulitis develops and destroys subcutaneous tissue, resulting in an infection which can reach the bone. As a result of osteomyelitis, bone is absorbed, sequestra are extruded and the architecture of the foot is destructed. The most common sites of the plantar ulceration are over the metatarsal heads, the base of the fifth metatarsal, the base of the proximal phalanx, and the calcaneus. During the past 9 years, we treated 85 patients with ulcers located on the sole and the dorsum of the foot, and lower third of the leg. To prevent osteomyelitis and amputation of the lower leg, we performed various treatment modalities such as free and pedicle flaps, skin grafts, and mechanical stretching devices of the skin (e.g., Sure Closure, Proxiderm, etc), as well as consistent vacuum-assisted closure. We obtained satisfactory results in most cases. We report detailed results and related references.
Amputation ; Anesthesia ; Calcaneus ; Cellulitis ; Cicatrix ; Coinfection ; Extremities ; Foot Ulcer* ; Foot* ; Head ; Humans ; Leg ; Leprosy* ; Metatarsal Bones ; Negative-Pressure Wound Therapy ; Osteomyelitis ; Paralysis ; Skin ; Subcutaneous Tissue ; Transplants ; Ulcer

No abstract available.
Quality of Life* ; Surveys and Questionnaires*

Fractures of the tibial shaft are the most common among the long bone fractures, and have much difficulty in treatment due to their numerous complications. Thirty patients with fractures of the tibial shaft were treated with Ender nails under the image intensifier at the Department of Orthopedic Surgery, Yeungnam University Hospital from December 1986 to November 1991. The following results were observed. 1. The average age was 37.3 years and the number of male was three times of the female. The most common cause was traffic accident. 2. Twenty cases out of thirty one were closed fracture and the remaining 11 were open. The comminuted and segmental fractures were 18 (57.7%) in number and the most common fracture site was the middle one third (53%). 3. Average interval from injury to operation was 7.6 days and 19 cases showed associated injuries. 4. The mean duration of the bone union was 18.9 weeks and 2 cases showed the delayed union. 5. Twelve complications were noted such as shortening, varus deformity, delayed union, ankle motion limitation, nail irritation, and soft tissue infection.
Accidents, Traffic ; Ankle ; Congenital Abnormalities ; Female ; Fractures, Bone ; Fractures, Closed ; Humans ; Male ; Orthopedics ; Soft Tissue Infections ; Tibia*

Steroid cell tumor of ovary, first described as lipid cell tumor, is rare lesions composed entirely of cells resembling typical steroid hormone - secreting cells, that is lutein cells, Leydig cells, and adrenal cortical cells. Steroid cell tumors oftcn secret androgen and manifest themselves with symptoms of virilization. Other presentations include abdominal swelling or pain, menstrual dysfunction, postmenopausal bleeding, or rarely ascites. We experienced a case of right ovarian steroid cell tumor, not otherwise specified(NOS), manifested hirsuitism and amenorrhea in 49 - year - old patient. The tumor was about 5 cm in size, and associated with huge ascites (l3,000 ml), both pleural effusion, and elevated serum CA 125. We present a case of Meigs syndrome associated with benign ovarian steroid cell tumor with a brief review of the literature.
Amenorrhea ; Ascites* ; Dysmenorrhea ; Female ; Hemorrhage ; Humans ; Leydig Cells ; Luteal Cells ; Male ; Meigs Syndrome ; Ovary ; Pleural Effusion ; Virilism

Computerized tomography(CT) has proven to be far superior to other diagnostic studies in the detection of intracranial lesions after head injuries. The procedure is especially appropriate for early and accurate diagnosis because it can be done quickly with no discomfort and minimal risk. CT was utilized as a screening diagnostic procedures in 100 consecutive patients of head injuries who were alert and neurologically no deficits in a 8 months period. 11 abnormal CT Scans found at 10 patients:six epidural hematomas, two intracerebral hematomas, one sudural hygroma and one temporal contusion. The cases presented are discussed in light of pertinent literature.
Contusions ; Craniocerebral Trauma* ; Diagnosis ; Head* ; Hematoma ; Humans ; Lymphangioma, Cystic ; Mass Screening ; Tomography, X-Ray Computed

BACKGROUND: The survival rate of children with neuroblastoma has been improved over 20 years, excluding the metastatic disease, in which it does not exceed 20% so far. New treatment modalities have been developed to improve the outcome in metastatic disease. Preoperative chemotherapy reduce the size, the vascularity and the adhesiveness, so increase the resectability of the primary tumor. This retrospective clinical study was designed to review the survival rate in neuroblastoma and to analyze the effect of preoperative chemotherapy in the view point of neoadjuvant therapy on long-term survival in advanced disease. METHODS: One hundred and thirty-four cases were reviewed from 135 patients with neuroblastoma registered at the Department of Pediatrics in Seoul National University Children's Hospital from January, 1985 till December, 1995. The survival rate was reviewed according to the stage. The age, sex of the patients, the stage, anatomical site of the tumor, the level of serum ferritin and neuron-specific enolase were analyzed for the risk factors on survival. RESULTS: Ranges of age at diagnosis were from 1 month to 166 months with the median of 39 months. Five year survival rates and five year disease-free survival rates were 100%, 100% in stage 1(n=5), 90.9%, 90.9% in stage 2(n=13), 43.4%, 40.6% in stage 3(n=19), 27.1%, 19.8% in stage 4(n=95) and 100%, 100% in stage 4S(n=2), respectively. In stage 3, five year survival rate was 52.5% in group receiving neoadjuvant chemotherapy, 28.6% in control group(P=0.02). Five year disease-free survival rate was also noted as 48.6%, 28.6% in each group(P=0.02). In stage 4, five year and ten year survival rates were 27.6%, 23.6% in group receiving neoadjuvant chemotherapy, 26.9%, 0% in control group(P=0.02). Five year and ten year disease-free survival rates were 14.3%, 14.3% in group receiving neoadjuvant chemotherapy, 20%, 0% in control group (P=0.11). In univariate analysis, the age, the stage, and the site of primary tumor appeared to affect the long-term survival. CONCLUSION: Neoadjuvant chemotherapy and delayed primary surgery contribute for advance in survival in advanced neuroblastoma via increasing the resectability of the primary tumor.
Adhesiveness ; Child ; Diagnosis ; Disease-Free Survival ; Drug Therapy* ; Ferritins ; Humans ; Neoadjuvant Therapy ; Neuroblastoma ; Pediatrics ; Phosphopyruvate Hydratase ; Retrospective Studies ; Risk Factors ; Seoul ; Survival Rate

PURPOSE: We performed the retrospective analysis to find the outcome of external beam radiotherapy alone in advanced esophageal cancer patients. METHODS AND MATERIALS: One hundred and six patients treated with external beam radiotherapy alone between July 1990 and December 1996 were analyzed retrospectively. We limited the site of the lesions to the thoracic esophagus and cell type to the squamous cell carcinoma. Follow-up was completed in 100 patients (9 4%) and ranged from 1 month to 92 months (median; 6 months). RESULTS: The median age was 62 years old and male to female ratio was 104:2. Fifty-three percent was the middle thorax lesion and curative radiotherapy was performed in 83%. Mean tumor dose delivered with curative aim was 58.6 Gy (55-70.8 Gy) and median duration o f the radiation therapy was 53 days. The median survival of all patients was 6 months and 1-year and 2-year overall survival rte was 27% and 12%, respectively. Improvement of dysphagia was obtained in most patients except fo 7 patients who underwent feeding gastrostomy. The complete response rate immediately after radiation therapy was 32% (34/106). The median survival and 2-year survival rate of the complete responder was 14 months and 30% respectively, while those of the nonresponder was 4 months and 0% respectively (p=0.000). The median survival and 2-year survival rate of the patients who could tolerate regular diet was 9 rnonths and 16% while those of the patients who could not tolerate regular diet was 3 months and 0%, respectively (p=0.004). The survival difference between the patients with 5 cm or less turnor length and those with more than 5 cm tumor length was rnarginally statistically significant (p=0.06). However, the survival difference according to the periesophageal invasion or mediastinal lymphadenopathy in the chest CT imaging study was not statistically significant in this study. In a multivariate analysis, the statistically significant covariates to the survival were complete response to radiotherapy, tumor length, and initial degree of dysphagia in a decreasing order. The complication was observed in 10 patients (9%). CONCLUSION: The survival outcome for advanced esophageal cancer patients treated by external be am radiotherapy alone was very poor, In the treatment of these patients, the brachytherapy and chemotherapy should be added to improve the treatment outcome.
Brachytherapy ; Carcinoma, Squamous Cell ; Deglutition Disorders ; Diet ; Drug Therapy ; Esophageal Neoplasms* ; Esophagus ; Female ; Follow-Up Studies ; Gastrostomy ; Humans ; Lymphatic Diseases ; Male ; Middle Aged ; Multivariate Analysis ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Thorax ; Tomography, X-Ray Computed ; Treatment Outcome

Amblyopia and strabismus are common in eyes of prematurity and the need for early detection of amblyopia and amblyogenic factors is widely recognized. So, we performed refraction in premature infants at the 6 months of age to evaluate the incidence and degree of myopia and the changes of refractive errors according to the development, disease course and photocoagulation therapy of retinopathy of prematurity[ROP]. It is the purpose of this study to evaluate the effectiveness of MTI[medical Technology, Inc]photoscreener by comparing the sensitivity and specificity between refractive errors determined by manifest photorefraction and cycloplegic photorefraction in 6-month-old premature infants in Sung-Ae General Hospital. Pass or fail screening data from photograph of 32 non-dilated and dilated premature infant were calculated by two masked observers, compared with the results of cycloplegic retinoscopy, and the statical analysis was carried out. In the cases of cycloplegic photorefraction, Ten eyes of myopia, 4 eyes of emetropia, and 50 eyes of hyperopia were found, and 21 eyes of astigmatism above 1.5D were also detected. Overall statistical analysis of sensitivity and specificity rate were 71.7% and 69.5%in manifest photorefraction, 87.5% and of 75%in cycloplegic photorefraction, respectively. In non-cycloplegic photorefraction, sensitivity of myopia and hyperopia were 92.8%, 65%, but in cycloplegic photorefraction, sensitivity of myopia and hyperopia were 75%, 100%, respectively. The outcomes of our study suggest that MTI photoscreener in cycloplegic photorefraction was more reliable than non-cycloplegic photorefraction. Myopia under 1D turned to hyperopia in cycloplegic photorefraction, so the sensitivity of that was not to be reliable, but the sensitivity of hyperopia was high. Thus, the authors can readily recommand this cycloplegic photorefraction in uncooperable infants to evalute the refractive error conveniently.
Amblyopia ; Astigmatism ; Hospitals, General ; Humans ; Hyperopia ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Light Coagulation ; Masks ; Mass Screening ; Myopia ; Refractive Errors ; Retinoscopy ; Sensitivity and Specificity ; Strabismus

OBJECTIVE: Endovascular treatment as well as surgical treatment has become a treatment method for the management of the intracerebral aneurysms. The authors present the results of surgical and endovascular treatment of middle cerebral artery (MCA) bifurcation aneurysms. METHODS: From 1999 to 2005, 54 MCA bifurcation aneurysms were treated with surgical or endovascular methods at our hospital. Forty two patients had ruptured aneurysms and 12 had unruptured aneurysms. Of 54 aneurysms, 33 were treated with surgical clipping, 20 with Guglielmi detachable coil (GDC) embolization and 1 with cross over treatment. The medical, radiological and operation records were reviewed retrospectively. RESULTS: Of the 54 patients, 37 (68.5%) were female and 17 (31.5%) were male. In the surgically treated group, 22 (66.7%) experienced excellent or good outcomes (GOS 5 or 4), 8 (24.2%) had fair or poor outcomes (GOS 2 to 3), and 3 (9.1%) died (GOS 1). In the endovascularly treated group, 15 (75%) had excellent or good outcomes, 1 (5.0%) had fair outcomes (GOS 3), and 4 (20%) died. Symptomatic vasospasm revealed 9 (25.7%) in the surgically treated group, and 6 (30%) in the endovascularly treated group. Seven (20.5%) complications occurred from the surgical group, 3 (15%) from the endovascular group. On logistic regression analysis, there were no significant differences in GOS and vasospasm between surgically treated group and endovascularly treated group (p=0.788, 0.643, respectively). CONCLUSION: Endovascular treatment of MCA bifurcation aneurysms results in clinical outcome equal to the outcome of surgical treatment of MCA bifurcation aneurysms and it can be a good alternative method for MCA bifurcation aneurysms treatment.
Aneurysm* ; Aneurysm, Ruptured ; Female ; Humans ; Intracranial Aneurysm ; Logistic Models ; Male ; Middle Cerebral Artery* ; Retrospective Studies ; Surgical Instruments

Zonisamide was administered to 20 patients with refractory epileptic seizures. The mean duration of the administration was 6 months, and the mean dosage was 7.2 mg/kg/day. The efficacy of zonisamide was rated remarkable in 15% of the cases, improvement in 40%, and no change in 45%. The response rates of zonisamide were 62.5% for myoclonic seizures, 50% for tonic-clonic seizures, 80% for atonic seizures and 33.3% for atypical absence seizures. There was no correlation between the clinical response and dose or serum concentration of the drug. The adverse effects were observed in 35% of the cases which were drowsiness, dizziness, ataxia, nausea, and vomiting. In all cases, however, the administration of zonisamide could be continued.
Ataxia ; Child* ; Dizziness ; Epilepsy* ; Epilepsy, Absence ; Humans ; Nausea ; Seizures ; Sleep Stages ; Vomiting