Since 1856, Mayer13) coined the term “osteotomy” for a tibial resection for an angular deformity, various shapes and designs of osteotomies in long bone or pelvis have been popularized to treat the malunion, osteoarthritis of hip and knee, bow leg, L.C.P., or C.D.H. etc. The purpose of corrective osteotomy for tibia is so different from that of upper extremity because it must be restored the weight bearing alignment, and equalize or minimize the leg length discrepancy. We respectively reviewed 14 cases with various angular deformities on tibia who were treated at Dept. of Orthopaedic Surgery, Catholic Medical College from Jan. 1976 to Dec. 1984. The results obtained were as follows: 1. Causes of angular or rotational deformities of tibia were malunion in 11, bow leg in 2 and partial closure of distal tibial epiphysis in l. 2. Ten cases of tibial deformities exceeded over the 10° of medial or lateral angulation and 15° of anterior or posterior bowing were corrected for normal weight-bearing alignment in lower leg. And a rotational deformity may be so disabling to walk as to require surgery. So four cases of tibial angular deformities combined with more than 20° of external rotation and 5° of internal rotation were corrected for normal good looking walks. 3. The maximum length that can be gained by an opening wedge osteotomy was near the point of maximum angluation, but it could be changed by the cause of deformity and patient's age. We've done 4 cases of opening and 10 cases of closing wedge osteotomy. 4. Angular deformity in one plane due to fracture in children under 10 years of age may be corrected spontaneously by growth, but deformities due to bow leg or epiphyseal injury cann't be expected any spontaneous correction of deformity by growth. So three cases of tibial deformities due to bow leg or epiphyseal injury in children were corrected in earlier after recognition of that deformities because of possible damage to articular cartilage and the combined rotational deformities. 5. A slight deformity if the angulation involves near a joint, knee or ankle could be seriously disabling and so must be correctcd earlier. 6. Functional results of the corrective wedge osteotomy in angular and rotational deformities of tibia were excellent, good, fair in 4, 7 and 3, respectively.
Ankle ; Cartilage, Articular ; Child ; Congenital Abnormalities ; Epiphyses ; Genu Varum ; Humans ; Knee ; Knee Joint ; Leg ; Numismatics ; Osteoarthritis, Hip ; Osteotomy ; Pelvis ; Tibia ; Upper Extremity ; Weight-Bearing

No abstract available.
Humans ; Mothers*

Autologous Transfusion, storage of one's own blood for subsequent infusion if needed, is safe and effective in a variety of scheduled operative procedures. Obstetric involvement in such programs in very limited, however, because of concern over the possibility of inducing premature labor or causing fetal distress by blood volume change or vasovagal reactions. We describe our experience with pregnant women in this program. The incidence of vagovagal reactions of autologous donation was 9.5% (2.21). After entry into this program, 17pastients received a total 37pints, which consist of 19 Autologous and 18 Homologous. Homologous transfusion was avoided in 30% of patients receiving blood. The values of the mean hematocrits before and after hpebotomy were 34.1% and 31.8% respectively. It was stastically significant (p<0.01). We recommended that autologous blood donation by pregnant women in third trimester is safe for mothers or infants and it should be strongly encouraged for patient with placenta previa and repeated cesarean section.
Blood Donors ; Blood Volume ; Cesarean Section ; Female ; Fetal Distress ; Hematocrit ; Hemorrhage* ; Humans ; Incidence ; Infant ; Mothers ; Obstetric Labor, Premature ; Placenta Previa ; Pregnancy ; Pregnancy Trimester, Third ; Pregnant Women* ; Surgical Procedures, Operative

Median nerve somatosensory evoked potentials (SSEPs) were studied in 98 cases of cerebrovascular disease(CVD), and compared with the SSEPs of 100 healthy subjects. According to the clinical and radiological (brain CT and/or MRI) findings, the patients were divided into four groups; 21 cases with brainstem lesion, 33 with thalamic lesion, 32 with subcortical lesion, and 12 with cortical lesion. Comparing with the results of SSEPs obtained from 100 cases of normal subjects, abnorrnal SSEPs were found 7 of 21 patients in brainstem lesion, 17 of 33 in thalamic lesion, 15 of 32 in subcortical lesion, and 9 of 12 in cortical lesion. There are no statistical significance betueen the lesion site and rate of abnormal SSEPs findings. The 48 patients of CVD exihibited abnormal findings with the patterns of(1) absence ol conical responses in 32 cases(32.7%), (2)decreasing the ratio of amplitude between non-affected and affected cortex in 21 cases (21.4%), (3) prolonged inter-peak latency (IPL) between P/Nl3-N19 in 10 cases(10.2%), (4)distorted shapes in 8 cases(8.7%), and (5) low amplitudes of affected cortical potentials in 6 cases (61%). There were 9 cases who revealed abnormally high amplitude of cortical potentials over the non-affected hemisphere. These findings are suggesting that alteration of amplitude are more prominent than prolonged IPL between P/Nl3-Nl9 in SSEPs of CVD. The changes of SSEPs look more related to the deficit position and vibration sense rather than the pin-prick.
Brain Stem ; Evoked Potentials, Somatosensory* ; Humans ; Median Nerve ; Vibration

Female ; Pregnancy ; Pregnancy, Ectopic*

Thoracic outlet syndrome (TOS) is an uncommon condition which is caused by compression of subclavian artery, vein or brachial plexus in the region of thoracic outlet area, which is composed by the first rib, clavicle, anterior and middle scalene muscles and other connective tissue. In arterial TOS, chronic arterial compression causes arterial stenosis, poststenotic dilatation, aneurysm formation, intramural thrombus and peripheral arterial embolism. We present herein a case of arterial TOS patient with multiple distal embolization. The patient was 43-year old male with crutch ambulation because of sequelae of polioviral infection in his youth. His chief complaint was discoloration and gangrenous change of five right digits for 1 month. A rudimentary first right rib was found in simple chest X-ray. Angiographic findings were stenosis and poststenotic dilatation of right subclavian artery, multiple peripheral arterial embolic obstructions and numerous collateral vessel formation. Right thoracoscopic sympathectomy (T2), resection of the abnormal first rib and the abnormal axillary arterial segment was performed through the supraclavicular and transaxillary incision, then interpositional graft with saphenous vein was done for arterial reconstruction. A minor lymphatic fluid collection around the area of operation occurred, but it was easily controlled by percutaneous drainage. The gangrenous wounds of digits were improved after restoration of blood circulation.
Adolescent ; Adult ; Aneurysm ; Blood Circulation ; Brachial Plexus ; Clavicle ; Connective Tissue ; Constriction, Pathologic ; Dilatation ; Drainage ; Embolism ; Humans ; Male ; Muscles ; Ribs ; Saphenous Vein ; Subclavian Artery ; Sympathectomy ; Thoracic Outlet Syndrome* ; Thorax ; Thrombosis ; Transplants ; Veins ; Walking ; Wounds and Injuries

BACKGROUND: This study was conducted to find out the relationship between autonomous function and fatigue rating. The subjects were patients with complaints of fatigue who visited the department of family medicine in a general hospital. METHODS: We conducted this study from April to December 2002 in patients complaining of fatigue. The subjects were categorized into low, intermediate, and high fatigue groups. Heart rate variability was measured for five minutes at rest, followed by a five minute mental arithmetic test. We analyzed the relationship between fatigue ratings and autonomous function with SPSS 10.0. RESULTS: There was a statistically significant increase in the mean heart rate variability in the all three groups at rest and with stress. There was a statistically significant increase in LF norm increase in the low and high fatigue groups. HF norm showed a statistically significant decrease in the intermediate and high fatigue group. The variation in LF norms was highest in the low fatigue group and lowest. With the mental arithmetic test, the low fatigue group showed decreased rMSSD, HF and HF norm values compared to the intermediate group. The above values showed decrease in the high fatigue group compared to the low group. CONCLUSIONS: Overactivity of the sympathetic nervous system was observed as fatigue ratings increased. The cadiovascular autonomic response tended to decrease as fatigue ratings increased.
Autonomic Nervous System ; Fatigue* ; Heart Rate ; Hospitals, General ; Humans ; Sympathetic Nervous System

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract, but also occurs at a lower frequency in extra-gastrointestinal regions such as omentum, mesentery, retroperitoneum and undefined abdominal sites. This tumor is called extragastrointestinal stromal tumor (EGIST). EGIST is mostly diagnosed as a cystic mass, but rarely occurs as a disseminated abdominal tumor. We experienced a 70-year-old man with primary EGIST presenting as peritoneal dissemination. Abdominal CT showed diffuse peritoneal thickening with a large amount of ascites, but no definite mass lesion. Laparoscopic biopsy was performed and histologic findings showed tumor composed of epithelioid cells. In the results of immunohistochemical stains, the tumor showed positive reactivity with CD117 (c-kit), CD34, vimentin and actin, but negative reactivity with desmin and S-100 protein. On account of unresectability and histologic parameters of malignant behavior, he was started on imatinib.
Actins/metabolism ; Aged ; Antigens, CD34/metabolism ; Gastrointestinal Stromal Tumors/*diagnosis/pathology ; Humans ; Laparoscopy ; Male ; Peritoneal Neoplasms/*diagnosis/secondary ; Positron-Emission Tomography ; Proto-Oncogene Proteins c-kit/metabolism ; Tomography, X-Ray Computed ; Vimentin/metabolism

Protective effect of human cerebrospinal fluid antioxidants against enzyme inactivation caused by metal-catalyzed oxidation systems were investigated. When purified glutamine synthetase(GS) was incubated with human cerebrospinal fluid(CSF), the enzyme was progressively inactivated. Catalase and EDTA could inhibit the enzyme inactivation by 50-80%. Small-molecular(Mr<-10,000) fraction of CSF inactivated the exogenous GS, but large-molecular(Mr>-10,000) fraction did not. The GS inactivation by the small-molecular fraction was also markedly inhibited by catalase and EDTA. These results suggested that metal-catalyzed oxidation is involved in the GS inactivation by the small-molecular fraction of CSF. Dithiothreitol(DTT)was shown to inhibit almost completely the oxidative inactivation of GS by CSF. However, DTT inhibited only partially the oxidative inactivation of GS caused by small-molecular fraction of CSF. When large-molecular fraction of CSF was separated by anion-exchange HPLC chromatography, there was a peak of antioxidant activity inhibiting the small-molecular fraction-induced GS inactivation in the presence of DTT. The antioxidant activity was neutralized by monoclonal antibodies to transthyretin. Purified transthyretin was found to efficiently inhibit ascorbate/Cu2+-induced GS inactivation in the presence of DTT. Uric acid and glucose did not shoe any protective effect on the GS inactivation in the same condition. The above results suggest that metal-catalyzed oxidation occurs normally in human CSF, and the transthyretin may play an important role as a CSF antioxidant in protecting proteins from metal-catalyzed oxidation.
Antibodies, Monoclonal ; Antioxidants ; Catalase ; Cerebrospinal Fluid* ; Chromatography ; Chromatography, High Pressure Liquid ; Edetic Acid ; Glucose ; Glutamine ; Humans* ; Prealbumin* ; Shoes ; Uric Acid

The purpose of this study was to evaluate and compare the effect of inhibition of postsurgical adhesion formation in the rat model by meclofenamate, tolmetin, TC-7, Hyskon, and heparin. Laparotomies were performed on grossly healthy, mature nonpregnant female rats, and proximal 1 cm of each uterine horn was traumatized with unipolar electrocautery. Each rat was randomly assigned to one of six different groups(control, meclofenamate, tolmetin, heparin, TC-7, and Hyskon group), and different solutions or an adhesion barrier were placed into traumatized uterine horn before closure. One week later adhesion formation was scored according to percent involvement of each traumatized uterine horn(0 to 4), and adhesion density(0 to 2), and compared using one-way analysis of variance and Fishers exact test. Compared with the control group, postsurgical adhesion formation was significantly decreased in the TC-7 group(average adhesion score, 1.72), the meclofenamate group(2.19), the Hyskon group(2.53), and the tolmetin group(2.93). The TC-7 group was also significantly decreased in adhesion formation compared with the Hyskon, tolmetin, heparin groups, and meclofenamate group was significantly decreased in adhesion formation compared with tolmetin and heparin groups. There were no significant differences between groups in adhesion density. So we suggest that meclofenamate is a cost-effective agent in inhibition of postsurgical adhesion formation.
Animals ; Dextrans* ; Electrocoagulation ; Female ; Heparin* ; Horns ; Humans ; Laparotomy ; Meclofenamic Acid ; Models, Animal* ; Rats* ; Tolmetin