No abstract available.
Hydronephrosis*

For treatment of the pressure sore, varieties of methods have been developed such as skin graftings, local flap, myocutaneous or fasciocutaneous flap, etc.. Except mild cases, myocutaneous flaps have been used commonly for the best coverage and padding of the wound. But the gluteus maximus muscle is not an expendable muscle, so the myocutaneous flaps using gluteus maximus muscle result in significant functional loss in ambulatory patients. Various methods as fasciocutaneous flap to reserve a function of the gluteus maximus muscle have been developed. We especially designed a bilateral fasciocutaneous flap in the fashion of interdigitating extended V-Y advancement in sacral sore when the defect is fusiform transversely in shape. With this design, we obtained reduced tension in the midline suture with less dissection in medial portion of the fasciocutaneous flap and made the flap more rleliable by including more parasacral perforators within the flap. We have experienced the eight cases of gluteal fasciocutaneous V-Y advancement flap and obtained the excellent results without flap necrosis. We conclude that a bilateral fasciocutaneous flap in the fashion of interdigitating extended V-Y advancement is useful in sacral sore when the defect is fusiform transversely in shape.
Humans ; Myocutaneous Flap ; Necrosis ; Pressure Ulcer ; Skin Transplantation ; Sutures ; Wounds and Injuries

Congenital muscular torticollis is a distinct entity, in which the primary pathologic picture is limited to the sternocleidomastoid muscle. Associated deformities of the face, head and cervical spine are secondary in character, resulting from an abnormal position of the head both prior and subsequent to birth. The etiology of congenital muscular torticollis is not clear yet. There are various opinions about adequate age and methods for treatment. From January 1970 to December 1984, 53 cases of congenital muscular torticollis were treated surgically at the Department of Orthopedic Surgery, Severance Hospital. From January 1980 to December 1984, 10S cases of congenita muscular torticollis were treated conservatively at the same hospital. Totally, 161 cases were studied and analyzed retrospectively and the results are summerized as follows: 1. Among the 161 cases, thers were 88 males and 73 females. The lesion was on the left side in 89 cases. 2. There were 85 cases of normal spontaneous vaginal delivery and 58 cases of complicated labor including 34 cases of breech delivery. 3. There were 6 cases associated with other congenital anomalies; one of them was combined with congenital subluxation of the hip joint. 4. Results of conservative physiotherapy were good under 1 year of age and results of surgical correction were good under 6 years of age. 5. The failure of conservative physiotherapy did not influence the results of surgical correction performed later. 6. The results of reoperation, when the initial surgical correction failed, were not as good. 7. Facial asymmetry correction results were especially good under 6 years of age when much growth potential remained. 8. There were no differences in results according to the various kinds of cervical braces although the results were good when the cervical brace was worn over 3 months. 9. On pathologic examination, there was no hemorrhagic reaction. The muscle was atrophied and was replaced by fibrous bands. Therefore, congemtal muscular torticollis is thought to be caused by abnormal intrauterine position rather than by birth trauma, and it is expected to get a good result by treating congenital muscular torticollis as early as possible.
Braces ; Clinical Study ; Congenital Abnormalities ; Facial Asymmetry ; Female ; Head ; Hip Joint ; Humans ; Male ; Orthopedics ; Parturition ; Reoperation ; Retrospective Studies ; Spine ; Torticollis

Calcaneal fractures involving subtalar joint can be associated with prolonged and severe disability. Many different methods have been tried for the treatment in order to search for better results. From March 1983 to December 1985, 8 cases of calcaneal fractures involving subtalar joint were treated by open rcduction and internal fixation. and the results were as follows: 1. Satisfactory results were obtained from 7 cases out of 8. 2. Anatomic reduction was obtained by open reduction and internal fixation. 3. When medial approach failed, combined lateral and medial approaches gave better visualization of articular fecets and ensured anatomic reduction.
Subtalar Joint

No abstract available.
Peripheral Nerves*

A web arising in the bile duct is a rare disease. Most cases are found at operation or autopsy becasue of the rare incidence and absence of specific clinical manifestations. However, early diagnosis has been feasible with the development of radiologic studies. We report a case of choledochal web with a review of the literature.
Autopsy ; Bile Ducts ; Early Diagnosis ; Incidence ; Rare Diseases

Total vascular occlusion (TVO) of the liver was used during parenchyma resection in two patients with large hepatoma located near hepatic vein or inferior vena cava. This technique was achieved by clamping the porta hepatis as well as suprahepatic and infrahepatic IVC. Durations of TVO were 15 and 25 minutes respectively. Three and four units of packed RBC were transfused for each patient. Postoperative hepatic or renal failure did not occur. The technique of TVO is easy and safe for resection of large and critically located tumors that would otherwise present operative risk.
Carcinoma, Hepatocellular* ; Constriction ; Hepatic Veins* ; Humans ; Liver* ; Renal Insufficiency ; Vena Cava, Inferior*

The authors reviewed charts of 50 consecutive cases which were operated for blowout fracture on preoperative symptoms and signs, intraoperative findings, and surgical prognosis according to timing of surgery, location of fracture and size of fracture, from May 1, 1985, to April 30, 1991, respectively. Most of them had persistent diplopia, positive forced duction test and conspicuous blemish enophthalmos preoperatively. In addtion, the most common site of fracture in the orbital floor was anterior 1/3 with a size of one to two em in vertical diameter. Good prognosis may be expected in patient with anterior fracture of orbital floor, operated within 4 weeks after receiving trauma. Chemosis and lower lid retraction were encountered as an early and late postoperative complications, respectively.
Diplopia ; Enophthalmos ; Humans ; Orbit ; Postoperative Complications ; Prognosis

We report a very rare case of congenital adrenal agenesis presented with adrenal insufficiency in a 4-day-old female newborn. She was admitted with darkish skin color and seizure. Her external genitalia was normal. Elevated serum level of adrenocorticotropic hormone and increased plasma renin activity were observed. Plasma cortisol level and aldosterone level were decreased. Pelvic ultrasonography revealed bilateral agenesis of adrenal glands. Six exons of the steroidogenic factor-1 (SF-1, NR5A1) gene and their intronic flanking sequences were normal. Now, she is continuously receiving replacement doses of glucocorticoids and mineralocorticoids under adrenal insufficiency. Her growth and development are completely normal. We propose that when a patient presents with 46, XY disorder of sex development or normal female genitalia with adrenal insufficiency, SF-1 gene mutation study should be included in the differential diagnosis.
Adrenal Glands ; Adrenal Insufficiency ; Adrenocorticotropic Hormone ; Aldosterone ; Diagnosis, Differential ; Exons ; Female ; Genitalia ; Genitalia, Female ; Glucocorticoids ; Growth and Development ; Humans ; Hydrocortisone ; Infant, Newborn ; Introns ; Mineralocorticoids ; Plasma ; Renin ; Seizures ; Sexual Development ; Skin

PURPOSE: There is ample evidence suggesting an important role for cyclooxygenase-2 (COX-2) and microsomal prostaglandin E2 synthase-1 (mPGES-1) in tumorigenesis. This study aimed at evaluating the clinical significance of the expressions of COX-2 and mPGES-1 in the development and progression of human renal cell carcinomas (RCC). MATERIALS AND METHODS: Tumor samples were obtained from 27 RCC patients who had undergone a radical nephrectomy. The expressions of COX-2 and mPGES-1 were evaluated using immunohistochemistry and Western blot analyses. RESULTS: COX-2 and mPGES-1 were expressed in 16 (59.3%) and in 11 (40.7%) of the 27 RCC patients. The expressions of COX-2 and mPGES-1 were correlated with the tumor grade, but not with the pathological stage. Western blot analysis confirmed a higher COX-2 expression in the RCC than non-tumorous tissues, but that of mPGES-1 was similar between the tumorous and non-tumorous portions. CONCLUSIONS: Our results suggest that the expression of COX-2 in RCC patients may be associated with carcinogenesis and; therefore, a useful biomarker in RCC.
Blotting, Western ; Carcinogenesis ; Carcinoma, Renal Cell* ; Cyclooxygenase 2* ; Dinoprostone* ; Humans* ; Immunohistochemistry ; Nephrectomy