Dislocation of the elbow joint is so frequent an injury, and its treatment so standardized, that most of the recent orthopaedic study devoted to the subject has focused on neurovascular complication or recurrent dislocation. Some authors reported minimal period of disability and better range of extension after three to five days short-term immobilization in simple acute dislocation. We, authors, had analyzed clinically 17 cases of acute dislocation of elbow joint who were treated at orthopaedic department of Catholic Medical College from Jan., 1978 to Dec., 1981. The results obtained were as follows: 1. The most prevalent age were second and third decades (76.5%). Males predominated by a ratio of 13:4. 2. The major mode of injury was slip down accident (58.8%). All cases were acute simple dislocation without open wound. 3. Posterolateral, dislocations were 13 cases (76.5%) and posterior dislocations were 3 cases (17.6%). These two type of dislocation were 94.1% of all cases. No anterior dislocation was noted. 4. Four fractures of radial head and one fracture of lateral epicondyle of humerus were seen. Associated fractures were noted in 29.4% of all cases. 5. Severe complication was none except one recurrent habituai dislocation and limitation of elbow extension, averaging 10.5 degrees, 6. In 9 cases which were immobilized for 3 to 5 days had an average loss of extension of 6 degrees and an average of 7 weeks of disability. In 7 cases which were immobilized for 3 weeks had an average loss of extension of 18 degrees and an average of 18.3 weeks of disability. Therefore, immediate reduction and 3 to 5 dhys of immobililization is excellent treatment for uncomplicated dislocations.
Clinical Study ; Dislocations ; Elbow Joint ; Elbow ; Head ; Humans ; Humerus ; Immobilization ; Male ; Wounds and Injuries

PURPOSE: The vaginal wall sling was introduced by Raz as a simpler and lessmorbid alternative to fascial or synthetic slings for the treatment of female stress urinary incontinence. The purpose of this study was to determine the efficacy and safety of anterior vaginal wall sling in the management of women with anatomical incontinence(Al) and intrinsic sphincteric deficiency(ISD). MATERIALS AND METHODS: We performed vaginal wall sling on 46 consecutive women with stress incontinence. Preoperative evaluation included voiding cystourethrogaphy, urodynamic study, cystocsopy and incontinence staging with SEAPI classification. Postoperative subjective SEAPI outcome measures and assessment of complications were checked on a 3-month basis. RESULTS: Of the patients 19(49%) had Al and 27(59%) had ISD. Median follow-up was 8 months (range 6 to 10). Mean operation time was 65 minutes. At follow-up all of the patients reported no stress incontinence and 15% reported urge incontinence. De novo urge incontinence did not occur. Complications included prolonged voiding difficulty(8,7%), suprapubic pain(8.7%), and pain on leg abduction(4.3%). Four patients had a prolonged time to gain complete bladder emptying, which required more than 3 weeks to resolve. Permanent urinary retention has not occurred in any patient. CONCLUSIONS: Vaginal wall sling is a safe, simple and effective procedure for the treatment of stress urinary incontinence due to Al and ISD.
Classification ; Female* ; Follow-Up Studies ; Humans ; Leg ; Outcome Assessment (Health Care) ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Urge ; Urinary Retention ; Urodynamics

The result of clinical survey of seventy-five children with supracondylar fractures of the humerus is presented. Sixty-eight fractures had gross displacement, and seven were undisplaced ones. Seven children with undisplaced fractures were treated with simple splinting. Twenty-one fractures with gross displacement were closedly reduced and immobilized by cast. Twenty cases treated with over-head skin traction or skeletal traction, and followed by cast immobilization, and twenty-seven were operatively reduced and were fixed with 2 K-wires. The results obtained were as follows: 1. The average age of children was 6.8 years, and the male and female ratio was 2.1:l. 2. 97.1% (66 cases) was the extension type and 2.9% (2 cases) was the flexion type. 3. Good end results were obtained in the well-reduced groups, such as undisplaced fractures and surgically reduced fractures. Of 27 operated cases, 19 who had early operation without manipulative trial or traction, had excellent results, while 8 who had surgery in delay developed limitation of flexion and/or extension motion of the elbow. Of these 19, two cases developed mild extension limitation as sequella. 4. As complications, incomplete ulnar nerve palsy developed in one case, but it spontaneously recovered in 3 weeks after open reduction. During treatment utilizing the olecranon pin traction, pin tract infection developed in 2 cases, but the infection was controlled by the antibiotic administration and wound dressing. Severe cubitus varus deformity developed in 4 cases among the conservatively treated group (manipulatively reduced group and skeletal traction group). These 4 children had corrective osteotomy. Mild deformity was the inevitable one when it is treated conservatively. Limitation of elbow motion developed in 23 cases (32%) as a sequella. 5. Fracture healed mostly in three weeks after reduction and immobilization. Average hospital stay for conservatively treated patients was 17.2 days, whereas that for surgically treated patients was 5.8 days in average. 6. Early anatomical reduction by any means whether it is surgical or nonsurgical, proved to be only the methods which bring the satisfactory results, and minimize the sequellae.
Bandages ; Child ; Congenital Abnormalities ; Elbow ; Female ; Humans ; Humerus ; Immobilization ; Length of Stay ; Male ; Olecranon Process ; Osteotomy ; Skin ; Splints ; Traction ; Ulnar Neuropathies ; Wounds and Injuries

Most cases of spondylolisthesis are asymptomatic and successfully managed with conservative treatment. Operation was performed in 20% of symptomatic cases having severe back pain, neurological symptoms and or progressive slipping. Although surgical treatments are divided into decompression and fusion, various methods were tried frorn simple Gill's resection to posterior and/or anterior fusion with instrumentation in case of severe slipping. The authors reviewed 49 cases of symptomatic spondylolisthesis, who were surgically treated, and well followed up at Kang-Nam St. Mary's Hospital during past 6 years from January, 1981, to June, 1987. l. Among 49 cases, 23 were isthmic type and 26 were degenerative in nature, and 40 were females. 24 patients(92.3%) of degenerative type were female over 4th decade. Mean age was 47.9 years. 2. The most common site of involvement was L4–5 intervertebral space(25 cases,; 51.0%). 17 cases(73.9%) of isthmic thpe were involved in L5-Sl intervertebral space, and 21 cases (80.8%) of degenerative type were involved L4–L5 intervertebral space. 3. The symptoms were low back pain, intermittent claudication and sciatica in order of incidence. 4. The average slipping measured by Taillard method was 19.5%, and Meyerding's grade I slipping(69.3%) was the highest in the percentile incidence. The average degree of slipping in isthmic type(23.6%) was greater than that of degenerative type(16.4%). 5. Myelogram mainly showed complete or near complete block in degenerative type and ventral indentation in isthmic type. C–T myelogram showed mainly central stenosis in degenerative type, and nerve root compression in isthmic type. 6. In 9 cases,anterior fusions were done ; 5 degenerative and 4 isthmic. In 37 cases, decompression and posteriolateral fusions were done with or without instrumentation ; instrumented in 11 cases. 7. Clinically, the results were judged as excellent in 16 cases(32.7%), good in 26 cases(53.1 %), fair in 6 cases(12.2%), poor in 1 case(2.1%). Thus, 42 cases(85.8%) were considered satisfactory. The satisfactory results were obtained in 77.8% of anterior interbody fusion cases, 88 5% of posterolateral fusion cases, 90.7% of decompression and posterolateral fusion with instrumentation cases. There was no appreciable difference in clinical results between isthmic and degenerative types. 8. There were no changes in slipping in 35 cases(71.5%), Partial reduction were possible in 13 cases(28.5%), and further splipping developed in a patient who had decompression surgery alone. Among 46 cases of vertebral fusion, complete fusion was obtained in 43 cases(93.5%) within one year. 9. Solid anterior spondylodesis was obtained in all the cases of degenerative type, while in 2 cases(50%) of the isthmic type, graft crumbled with redisplacement and delayed fusion. Through the results, it is concluded that posterior instrumentation may not be essential for the successful spondylodesis in cases of posterolateral fusion, since there was no statistical significance in the results between the instrumented and non-instrumented, and isthmic type and degenerative type, and that anterior interbody fusion is best indicated for the treatrment of the degenerative type and not for the isthmic type. Therefore, if anterior interbody fusion is chosen for the successful treatment of isthmic type, a certain type of internal fixator should be combined.
Back Pain ; Clinical Study ; Constriction, Pathologic ; Decompression ; Female ; Humans ; Incidence ; Intermittent Claudication ; Internal Fixators ; Low Back Pain ; Methods ; Radiculopathy ; Sciatica ; Spinal Fusion ; Spondylolisthesis ; Transplants

From mechanocardiography and echocardiography, the systolic time intervals and the ejection phase indices were measured with determination of serum digoxin concentration(SDC) to elucidate the value of oral maintenance digoxin therapy on patients with heart failure in sinus rhythm. The drug interactions of digoxin with quinidine in heart failure, with verapamil in atrial fibrillation, and with aluminium hydroxide gel in healthy volunteers were observed with concomitant changes of SDCs. The results obtained are as follows. 1. After 10 days of treatment with digoxin 0.25 mg/day in 21 patients with heart failure there was a significant decrease in electromechanical systole(QS2), pre-ejection period(PEP) and PEP/left ventricular ejection time(LVET) ratio. There was also and equivocal decrease in LVET and an equivocal increase in mean velociy of circumferential fiber shortening(Vcf). However there was no significant change in ejection fraction(EF) and heart rate. The steadystate SDC was 1.20+/-0.12(S.E.M.)ng/ml. 2. Excellent correlation of the systolic time interval sand ejection phase indices measured from mechanocardiography and those determined from echocardiography was demonstrated. 3. SDCs were measured before and following quinidine therapy in 20 patients receiving maintenance digoxin for heart failure and who require quinidine for suppression of ventricular premature beats. Steady-state SDC following quinidine(Y) could be estimated form steady-state SDC before quinidine(X) as expressed by regression equation, Y=-0.394+2.309 X with correlation coeffcient, r=0.927(p<0.01). 4. In 12 patients with atrial fibrillation receving maintenance digoxin 0.25 mg/day, SDC before and following coadministration fo first 160 mg/day and later 240 mg/day of verapamil for 7days on each occasion was 0.85+/-0.07(S.E.M.) ng/ml, 1.00+/-0.09(S.E.M.)ng/ml and 1.33+/-0.13(S.E.M.)ng/ml, respectively. The difference of SDC between at control and under 240mg/day of verapamil was significant statistically(p<0.05). 5. Digoxin 0.75mg single-dose studies of bioavailability in 11 healthy volunteers showed a statistically significant difference(p<0.05) of the area under the 8-hour SDC curve between the digoxin only group and the digoxin plus aluminium hydroxide gel group. The area under the curve was 680+/-25(S.E.M.) min*ng/ml and 509+/-29(S.E.M.) min*ng/ml, respectively.
Atrial Fibrillation ; Biological Availability ; Cardiac Complexes, Premature ; Digoxin* ; Drug Interactions ; Echocardiography ; Healthy Volunteers ; Heart Failure ; Heart Rate ; Humans ; Quinidine ; Silicon Dioxide ; Systole ; Verapamil

The instability of the degenerative spondylolisthetic lumbar spine was clinically evaluated by patients symptoms and serial radiograms. With X-ray films of patients lumbar spine, the lumbosacral angle, the sacral angle, the vertebral height difference between anterior and posterior surface of the 5th lumbar vertebra and the level of intercristal line were analysed. And the results of treatment were analysed too. The Results were as follows: 1) In degenerative spondylolisthetic L3 and L4 spines, facets were arranged in sagittal plane and sacrum was vertically arranged, but in L5 facets were coronally arranged and sacrum and in horizontal plane. 2) The lumbosacral angle was 149.9 and the average difference between anterior and posterior height of L5 vertebral body was 3mm. These results revealed that sacrum was more vertical and the 5th vertebral body was more rectangular, so lumbar lordosis was decreased as a whole. 3) The intercristal line was passed at IA or L4–5 interspace in 72.1% of cases(normal:95.8%), so L4 vertebra was placed in higher level. 4) In group A posterolateral fusion was done in 2 cases. Among group B and C, operation was done in 9 cases;4 cases with laminectomy and 5 cases with laminectomy and posterolateral fusion. Two years after surgery, slipping and instability were far advanced in 2 laminectomized cases for whom posterolateral fusion was followed later. 5) Unstable group of degenerative spondylolisthesis with severe neurological symptoms and claudication must be treated by decompressive laminectomy and posterolateral fusion, especially in patients under 60 years of age. 6) Young woman having flattened lumbar curve without slipping, narrowed disc space of L4–5, high-seated L4 and vertical sacrum is thought to be in prespondylolisthetic stage of degenerative origin; therefore, intensive back muscle exercise to prevent the slipping should be performed and periodic X-ray examinations should be followed up to detect the progress of the disease.
Animals ; Back Muscles ; Female ; Humans ; Laminectomy ; Lordosis ; Sacrum ; Spine ; Spondylolisthesis ; X-Ray Film

PURPOSE: To evaluate the correlation between onset of brain infarction and Gd-DTPA enhancing patterns on MRI. MATERIALS AND METHODS: We reviewed MRI of 58 lesions in 45 patients with clinically documented brain infarction retrospectively. Axial, coronal and sagittal T1WI (TR/TE 450-520/20), T2WI (TR/TE 2190/90) and Gd-DTPA enhanced T1WI were performed with a 0.5T superconductive MR system. We analyzed Gd-enhancing patterns lhat were divided into intravascular, meningeal, and parenchymal enhancement. Parenchymal pattern was subdivided into mottled, partial ring like and dense enhancement. RESULTS: lntravascular enhancement was seen at 1-10 days in 30(53%) of 58 infarctions. Meningeal enhancement (13%) was noted at 1--6 days. Parenchymal enhancement (50%) was seen at 2--28 days and subdividing patterns are as follows:The mottled enhancement pattern was seen earlier at 2-8 days and partial ring like or dense enhancement patterns at 5-28 days. CONCLUSION: After reviewing Gd-enhanced MRI of infarction, the intravascular and meningeal enhancement patterns were earlier than parenchymal enhancement. Among parenchymal patterns, the mottled pattern was seen earlier than partial ring like or dense patterns. In conclusion, Gd-enhancing patterns of brain infarction are useful in estimating the age of infarction including acute infarction.
Brain Infarction* ; Brain* ; Gadolinium DTPA* ; Humans ; Infarction* ; Magnetic Resonance Imaging* ; Retrospective Studies

Gougerost-Blum syndrome is a rare disease and characterized by lichenoid papules in association with purpuric lesions. So far as we know there has been no report of, in literatures, Gougerot-Blum syndrome with leukemia. We experienced a case of typical Gougerrot_Blum syndrome with acute myeloblastic leukemia in a 30 year-old female patient. This patient complained of rashes on whole body for 2 months, and frequent epistaxis and gum bleeding for 20 days. The skin revealed miliary to rice sized rusty colored lichenoid papules on whole body especially on legs and arms. Histopathologically the skin showed the picture of Gougerot-Blum syndrome. On peripheral blood examination and bone marrow aspiration myeloblastic leukemia was confirmed. The patient was treated with 6-mercaptopurine, cytoxan and prednisolone with slight improvement of skin lesions, but no improvement of leukumia itselt.
6-Mercaptopurine ; Adult ; Arm ; Bone Marrow ; Cyclophosphamide ; Epistaxis ; Exanthema ; Female ; Gingiva ; Granulocyte Precursor Cells ; Hemorrhage ; Humans ; Leg ; Leukemia* ; Leukemia, Myeloid, Acute ; Prednisolone ; Rare Diseases ; Skin

No abstract available.
Lymphoma*

No abstract available
Constriction, Pathologic* ; Stents*