The goals of treatment of the slipped capital femoral eiphysis(SCFE) are to stabilize the slipped epiphysis, prevent further slipping and induce early closure of the epiphyseal plate. Mutiple pinning was used for the treatment but in recent years, percutaneous in-situ fixation technique with 1 or 2 cannulated screws is preferred due to the advantages of low rate of complication such as pin penetration. We report the results of experimental study and the functional results after percutaneous pinning. The purpose of the experimental study was the investigation for changes of the screw length and the site of screw entry point according to the degree of slipping by bony model. The entry point of the screw was changed toward anterior and proximal portion of femoral neck and the length of inserting screw was changed to be shorter according to the degree of slip. We have treated 10 patients(13 hips) with slipped capital femoral epiphysis(SCFE) at our department since Jan. 1989. Among them, 6 patients(7 hips) could be followed for more than 2 years. There were 5 boys and 1 girl. One case was affected on the both hip. The average age at operation was 11.8 year old. All cases were obese. Degree of slipping was showed 6 cases in mild and 1 case in moderate. The slipping of acute onset was 3 cases, acute-on chronic 3 cases and chronic 1 case. In radiographic results, 6 cases were showing in Grade 0, 1 case was in Grade II. In functional results, 3 cases were excellent, 3 cases in good and 1 case in poor. One poor functional result was a case complicated by chondrolysis.
Epiphyses ; Female ; Femur ; Femur Neck ; Growth Plate ; Hip ; Humans ; Slipped Capital Femoral Epiphyses

Squamous cell carcinoma(SCC) is a recognized late complication of chronic discoid lupus erythematosus(CDLE). There are many case reports of SCC in white patients with chronic DLE. However, it is uncommon in blacks and Asians. The etiology of squamous cell carcinoma is multifactorial. The predisposing factors for the development of SCC in these patients include actinic keratosis, Bowen's disease, burn scars, arsenic keratosis, and chronic discoid lupus erythematosus. Of these causes, SCC developing in the lesions of CDLE is very rare. We report a patient who has been evaluated for ten years with a diagnosis of discoid lupus erythematosus and has squamous cell carcinoma.
African Continental Ancestry Group ; Arsenic ; Asian Continental Ancestry Group ; Bowen's Disease ; Burns ; Carcinoma, Squamous Cell* ; Causality ; Cicatrix ; Diagnosis ; Humans ; Keratosis ; Keratosis, Actinic ; Lupus Erythematosus, Discoid*

OBJECTIVES: The purpose of this study was to determine the clinical significance of residual amniotic fluid volume, as measured by the amniotic fluid index(AFI), on the prediction of latency period and perinatal outcomes in patients with preterm premature rupture of the membranes(PPROM). METHODS: Study population consisted of 103 singleton pregnancies with PPROM between 24 and 34 weeks' gestation. Amniotic fluid index was determined using transabdominal ultrasound at admission. Latency period was defined as time interval in hours between admission and delivery. All medical records of mothers and neonates were reviewed. Spearman's rho rank correlation, receiver-operator characteristic(ROC) curve analysis, survival analysis and Cox's proportional hazard model were used for statistical analysis. RESULTS: There was a statistically significant correlation between latency period and AFI at admission. ROC curve analysis showed that AFI at admission had a significant predictive value in the prediction of latency period < 48 hours. Survival analysis demonstrated that AFI < 5.0 was strongly associated with the likelihood of shorter latency period, Cox's proportional hazard model indicated that AFI < 5.0 was a significant independent predictor for the occurrence of latency period < 48 hours even after adjustment of other independent variables. The patients with AFI <5.0 had a higher rate of cesarean section due to fetal distress than those with AFI > 5.0 but the incidence of chorioamnionitis was not significantly different between two groups. Comparing the perinatal mortality and neonatal morbidity including infectious morbidity between the neonates born to mothers with AFI <5.0 and those with AFI > 5.0, there was no significance after adjustment of gestational age at birth. CONCLUSION: AFI at admission has a significant correlation with latency period and predictive value in prediction of latency period in the patients with PPROM. AFI <5.0 is a independent predictor for the shorter latency period.
Amniotic Fluid* ; Cesarean Section ; Chorioamnionitis ; Female ; Fetal Distress ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Latency Period (Psychology)* ; Medical Records ; Membranes* ; Mothers ; Parturition ; Perinatal Mortality ; Pregnancy ; Proportional Hazards Models ; ROC Curve ; Rupture* ; Ultrasonography

Perifolliculitis capitis abscedens et suffodiens is a rare chronic recalcitrant follicular disorder which clinically presents itself as pulstules, nodules, intercommunicating abscess and sinuses that leave atrophic, hypertrophic or keloidal scars. Although the etiology of this of condition is unknown, its association with acne conglobata and hidradenitis suppurativa, collectively termed the follicular occlusion triad, suggest a cammon basic pathogenic mechanism of follicular retention. The therapeutic problem is reflected in the variety of therapies that have been tried with varying degrees of success. We report a case of a 34-year-old man who showed a patch of alopecia on the vertex of his scalp. Clinically, the scalp showed multiple soft fluctuant elevated nodules with nonscarring alopecic patches. We performed a treatment with isotretinoin(13-cis-retinoic acid) during 6 months. The patients clinical appearance was much improved and local recurrence and hair loss have not been observed to date.
Abscess ; Acne Vulgaris ; Adult ; Alopecia ; Cicatrix ; Hair ; Hidradenitis Suppurativa ; Humans ; Isotretinoin* ; Keloid ; Recurrence ; Scalp

Clinical experience using different anesthetic methods for intravenous regional anesthesia in extremities was compared, To group 1 (22 cases, 20 for upper extremity and 2 for lower extremity surgery, with 5 min. limb elevation) 1.5mg/kg Lidocaine hydrochloride was administered and a single pneumatic tourniquet applied. For both group 2 (15 patients, 10 for upper limb and 5 for lower limb operations with limb elevation) and group 3 (11 cases, all for upper extremity operations, but Esmarch bandages instead of pre tourniquet elevation) 3. 0 mg/kg Lidocaine hydroehloride was used and a second tourniquet placed distal to the first. In all groups the anesthetic concentration was 0. 5 and 0. 25 per cent for the upper and lower extremities respectfully. Pneumatic tourniquet pressure applied was 250 mmHg for the upper limb and 500mmHg for the lower. Excellent anesthesia resulted in 68. 2 per cent in group 1, 73.3 per cent in group 2, and 100 per cent in group 3. No serious complications were encountered. Incidence of incomplete anesthesia and/or tourniquet pain could be decreased by increasing the anesthetic concentration, using a secondary tourniquet, and by selecting the region to be anesthetized (upper extremities in favor of the lower). It is concluded that intravenous regional anesthesia is simple, effective and safe and is recommended for ambulatory patients, emergency operations and for patients for whom general anesthesia is deferred.
Anesthesia ; Anesthesia, Conduction* ; Anesthesia, General ; Bandages ; Emergencies ; Extremities ; Humans ; Incidence ; Lidocaine ; Lower Extremity ; Tourniquets ; Upper Extremity

Mitral stenosis is characterized by chronic pulmonary arterial hypertension. Although it is well recognized that right ventricle can be affected by pressure-overload in patients with mitral stenosis, the study for effects on right ventricular function after relief of pressure overload was difficult after open heart surgery due to paradoxical septal motion and scarring change of pericardium. Recently, percutaneous mitral valvuloplasty(PMV) has been used in patients with mitral stenosis as an alternative to surgical mitral commissurotomy. The present study was designed to demonstrate the difference of right ventricle between normal subjects and patients with mitral stenosis, as well as to investigate the changes of right ventricle before and after PMV with Doppler- echocardiography and isovolumic indices. The results were summarized as follows : 1) Right ventricular emptying fraction which was assumed to be proportional to right ventricular ejection fraction was depressed significantly in patients with mitral stenosis than those of normal subjects. However, there were no sighificant differences in Vpm between the two groups. 2) Right atrial and ventricular areas of patients with mitral stenosis were enlarged significantly than those of normal subjects. Right ventricular diastolic function measured by transtricuspid pulsed Doppler showed relaxation abnormality pattern in patients with mitral stenosis. 3) Enlarged right atrium and ventricular area were decreased significantly after PMV. Depressed right ventricular sytolic and diastolic function were recovered after relief of pressure-overload by PMV. However, there were no significant changes in Vpm after PMV. 4) Right ventricular emptying fraction was inversely correlated with mean pulmonary artery pressure and right ventricular end-diastolic area. Discriminant factor between group with right ventricular diastolic dysfunction and group without diastolic dysfunction was pulmonary vascular resistance. In conclusion, there were right ventricular systolic and diastolic dysfunction without abnormal right ventricular contractility in patients with mitral stenosis, moderate pulmonary hypertension and normal sinus rhythm, and these functional abnormalities were largery reversible after relief of pressure-overload on the right ventricle by PMV.
Cicatrix ; Echocardiography ; Heart Atria ; Heart Ventricles ; Humans ; Hypertension ; Hypertension, Pulmonary ; Mitral Valve Stenosis* ; Pericardium ; Pulmonary Artery ; Relaxation ; Stroke Volume ; Thoracic Surgery ; Vascular Resistance ; Ventricular Function, Right*

Idiopathic hypertrophic pachymeningitis (IHP) is a rare, chronic nonspecific and granulomatous inflammatory disorder of the dura with unknown etiology. The diagnosis can be established by open biopsy and exclusion of all other specific granulomatous and infectious diseases. We report a typical case of spinal IHP occurring in a long segment of cervical and thoracic dura from C6 to T8. The patient was 56-yr-old female, who had been suffered from pain on her upper back and both arms for 3 months and recent onset motor weakness of both legs. During the 9 months of follow-up period, she experienced the improvement of her neurologic symptoms with combined therapy of partial excision and corticosteroid medication. Since early surgical intervention and subsequent pulse ste-roid therapy are mandatory for this disease to avoid irreversible damage of nervous system, the identification of this unique disease entity is essential on frozen diagnosis. A few cases have been reported in Korean literature.
Case Report ; Female ; Follow-Up Studies ; Human ; Magnetic Resonance Imaging ; Meningitis/diagnosis/*pathology/therapy ; Middle Age ; Spinal Diseases/diagnosis/*pathology/therapy

Pachyonychia congenita (PC) is a rare autosomal-dominant ectodermal dysplasia, which is characterized by hypertrophic nail dystrophy, diffuse or focal symmetrical hyperkeratosis of the palms and soles, oral leukokeratosis, follicular keratosis on the extensor surfaces of the extremities, and other ectodermal defects. However, the variable degree of gene mutation may result in nail abnormalities alone. The nail changes presented in our patient are the only clinical manifestation. Hypertrophic nail dystrophy and yellowish discoloration, without involving any other organs, were shown in both mother and baby since birth. To the best of our knowledge, the case of PC affecting only the nails has never been reported in Korea before. Herein, we report monosymptomatic form of PC, which is notable for its rareness and unique pattern, distinct from previously reported cases.
Ectoderm ; Ectodermal Dysplasia ; Extremities ; Humans ; Keratosis ; Korea ; Leukoplakia, Oral ; Mothers ; Nails ; Nails, Malformed ; Pachyonychia Congenita ; Parturition

Two cases of renal infarctions were presented with review of literature.
Infarction*

Owing to the rapid development of intervention techniques and devices, endovascular coil embolization of cerebral arteries has become standardized. It is particularly preferred when a patient presents with an unruptured intracranial aneurysm of the posterior communicating artery (PcomA). However, the risk of thrombogenic complications of the coil migration may also result in a large cerebral infarction. When coil migration occurs during embolization, a procedure for removal of the embolic coil should be performed immediately. We experienced a clinically rare case of migration of a framing coil to the distal middle cerebral artery aneurysm during endovascular embolization of an unruptured PcomA aneurysm. The migrated coil was barely retrieved using snare techniques.
Aneurysm ; Arteries ; Cerebral Arteries ; Cerebral Infarction ; Embolization, Therapeutic ; Humans ; Intracranial Aneurysm ; SNARE Proteins