An anatomical reduction and maintainance of articular fracture is on of the basic principles In Orthopedic Surgery if good function is to ensue, especially in a major welght bearing joint such as hip knee ankle. In displaced articular fractures, excellent results can be achieved mainly by an open anatomical reduction and firm internal fixation. We performed an open reduction and internal flxation with plates and screws in a patient with the severely comminuted acetabular fracture, and a satisfactory result is obtained.
Acetabulum ; Ankle ; Hip ; Humans ; Joints ; Knee ; Orthopedics

This clinical report is a review of the medical records of the 161 cases of postoperative adhesive intestinal obstruction treated at the Department of Surgery, Chung-Goo Sungsim General Hospital during 5 years from January 1991 to December 1995. The results of the study are as follows; 1) The most frequent age group was the 4th decade and the most prevalent age groups in the strangulated intestinal obstruction were below 10 years and above 60 years. 2) There was no difference among the types of previous abdominal operations in terms of the possibility of the strangulation. 3) The incidence of postoperative complication in the strangulated intestinal obstruction(58.3%) was higher than that in the non-strangulated intestinal obstruction(7.7%). 4) The overall mortality rate was 2.5%. The mortality rate in the strangulated intestinal obstruction was 8.3%, and was higher than that in the non-strangulated intestinal obstruction. 5) It is ideal to operate just before progression to strangulation, but it is not easy to decide when it happens. An operation should be considered in the following cases. (1) The presence of two or more symptoms; abdominal pain, obstipation, vomiting and abdominal distension. (2) The presence of two or more signs; leukocytosis, fever, tachycardia, localized abdominal tenderness, rebound tenderness and continuous abdominal pain. (3) Clinical signs of deterioration after 72 hours of conservative treatment.
Abdominal Pain ; Adhesives* ; Fever ; Hospitals, General ; Humans ; Incidence ; Intestinal Obstruction ; Leukocytosis ; Medical Records ; Mortality ; Postoperative Complications ; Tachycardia ; Vomiting

On the contrary to congenital anomalies of intestinal rotation in pediatric patients, those in adults are generally nonsymptomatic and of little consequence. Occasionally, however, an adult may have midgut nonrotation and complain of chronic or recurrent abdominal pain. Intestinal nonrotation can be divided into complete or partial failure of rotation and into abnormalities affecting the proximal segment, the distal segment or both. We report herein a 43-year old female patient with symptomatic partial, cecocolic nonrotation.
Abdominal Pain ; Adult* ; Female ; Humans

Since 1949, lithium has been widely used for treatment of manic depressive disorder. It has also been used for agranulocytosis after anticaneer chemotherapy and partially for hyperthyroidism. But it is well known that the long term administration of this drug is associated wih various antithyroid effects such as hypothyroidism, simple goiter, nodules and even thyrotoxicosis. Although the exact mechanism for leading hypothyroidism or goiter is still unknown, the incidence of lithium-induced hypothyroidism is 1-37% during lithium atment. We had an experience of newly developing goiter with or without hypothyroidism during lithium treatment in 4 MDP patients. Among our patients, the duration of lithium administration was from 0.7 months to 11 years, and the development of thyroid abnormality was impossible to predict. They were treated with thyroxine while lithium was discontinued causing favorable outcome. We suggest that routine thyroid function test include thyroid autoimmune antibody screening in patients planning to undergo lithium treatment.
Agranulocytosis ; Antithyroid Agents ; Depressive Disorder ; Drug Therapy ; Goiter* ; Humans ; Hyperthyroidism ; Hypothyroidism ; Incidence ; Lithium Carbonate* ; Lithium* ; Mass Screening ; Thyroid Function Tests ; Thyroid Gland ; Thyrotoxicosis ; Thyroxine

Down syndrome is perhaps the most common genetic condition associated with mental retardation. In cytogenetic examination, trisomy 21 is in 95% of Down syndrome, and the others are mosaicism, translocation or deletion. There are many associated diseases with Down syndrome such as, thyroid function abnormality, congenital heart disease, intestinal blockage, and so on. Hypothyroidism appeared in 15% before adolescent in Down syndrome patients. In Korea, there were several reports of Down syndrome with hypothyroidism in childhood but not in adulthood. And we had three cases of hypothyroidism with Down syndrome in adulthood. Cytogenetic examination revealed trisomy 21 in the 2 cases and 1 case of mosaicism. Antithyroid antibody was positive in one case. None of these cases was admitted due to symptoms of hypothyroidism. It is very difficult to make the diagnosis of hypothyroidism in Down syndrome because of similarity in symptoms between Down syndrome and hypothyroidism. Thus, periodic thyroid function test should be made in Down syndrome, and this could be a part of improving quality of life in Down syndrome.
Adolescent ; Adult* ; Congenital Abnormalities ; Cytogenetics ; Diagnosis ; Down Syndrome* ; Heart Diseases ; Humans ; Hypothyroidism* ; Intellectual Disability ; Korea ; Mosaicism ; Quality of Life ; Thyroid Function Tests ; Thyroid Gland

Syringoid eccrine carcinoma is a rare adnexal tumor of eccrine origin, and has metastatic potential and high recurrence rate following conventional surgical excision. Mohs micrographic surgery has been commonly used for various malignant skin cancers to minimize the defect after surgery, and to decrease the recurrence rate. We present a case of syringoid eccrine carcinoma successfully treated by Mohs micrographic surgery.
Mohs Surgery* ; Recurrence ; Skin Neoplasms

PURPOSE: Thumb hypoplasia gives rise to various derangement of hand functions, leading to various degrees of malformation. The treatment of choice for grade IV or V congenital hypoplasia of the thumb, classified by Buck-Gramcko's criteria, is the pollicization of the index finger. The purpose of this article is to review the clinical usefulness of pollicization for more than grade IV hypoplasia. MATERIALS AND METHODS: Three grade IV and 3 grade V hypoplastic thumbs in 6 patients, one with radial club hand, were reviewed retrospectively. They underwent pollicization between 1987 and 1997. The index metacarpi were osteotomized for shortening and readjusted by pronation. To evaluate postoperative function, authors used the criteria of Sundararaj and Mani. RESULTS: Except for the exclusion of one patient, four had excellent and one had good functional statuses. CONCLUSION: Pollicization was considered to be worthwhile for functional improvement of the hands in more than grade IV congenital hypoplasia of the thumb.
Fingers ; Hand ; Humans ; Pronation ; Retrospective Studies ; Thumb*

BACKGROUND: The several forms of treatment of Graves disease-thyroidectomy, antithyroid drugs and radioiodide therapy-are in wide use now. But which therapy is best is a matter of debate. Some authors reported that in patients who underwent thyroidectomy, higher titers of serum antimicrosomal antibody were associated with 1) higher formation rates of germinal centers, 2) more lymphocyte infiltration in the thyroid tissue, 3) higher incidence of hypothyroidism, and 4) lower incidence of recurrence. We were interested in the relationship of thyroid autoantibody titers, ADCC(antibody-dependent cell-mediated cytotoxicity) activity and the clinical response to antithyroid medication. METHODS: We measured ADCC activities from patients in Graves disease(n-48), Hashimoto thyroiditis(n=17) and normal control(n=9). The patients of Graves disease were followed up for more than 1 year, and they were grouped into A(n=17, well responsed group to antithyroid medication) and B(n=31, poorly responsed group). We examined ADCC activities of patients' sera by chromium release assay. RESULTS: 1) Mean age of patients with Graves disease was 34.4210.4 years and 15 patients were male(31%). 2) Results of thyroid function tests of the Graves' patients were T 585.9 +/- 255.3 ng/dL, T4 21.3 +/- 12.2 mg/dL, TSH 0.11 +/- 0.06mIU/mL. Concentrations of antimicrosomal antibody, antithyroglobulin antibody and thyrotropin binding inhibitory immunoglobulin were 1279.1 +/- 1486.7 IU/mL, 488.1 +/- 751.1 IU/mL, and 38.5 +/- 33.4U/L respectively. 3) There was no significant difference between levels of thyroid hormones or concentrations of thyroid autoantibodies and ADCC activities in graves patients. 4) The ADCC activity of the Graves patient group(24.49%) was significantly higher than that of the normal control group(3.76%), and significantly lower than that of the Hashimotos thyroiditis group(36.34%). 5) There was no significant difference in ADCC activity between group A(18.24 +/- 13.44%) and B(27.91 +20.02%). CONCLUSION: From this results, we suggested that ADCC activity seems to be no value as a prognostic factor in predicting the response to antithyroid drugs in Graves disease patients. But, further studies, larger number of patients and long-term follow up, are needed.
Antibody-Dependent Cell Cytotoxicity ; Antithyroid Agents ; Autoantibodies ; Chromium ; Follow-Up Studies ; Germinal Center ; Graves Disease* ; Humans ; Hypothyroidism ; Immunoglobulins ; Incidence ; Lymphocytes ; Recurrence ; Thyroid Function Tests ; Thyroid Gland ; Thyroid Hormones ; Thyroidectomy ; Thyroiditis ; Thyrotropin

The intrauterine fetal death(IUFD) is the death of the fetus prior to complete expulsion or extraction from its mother when the fetus is over 20 weeks gestation or weights more than 500 gm. This is a clinical study of 262 cases of IUFD and 262 control cases among 18542 deli-veries at Chung Goo Sung Sim Hospital during 10 years from 1987 to 1996. The results obtain-ed were as follows: 1. The incidence of IUFD was 1.41%. 2. The risk of IUFD was high in women older. 3. The risk of IUFD was high in women with parity of three or more, there was a previous history of IUFD in 11.2% of the IUFD cases and in 6.3% of the control cases, but there was no difference between the two groups of women in history of spontaneous abortion. 4. The sex ratio of male versus female was 1.24:1 in the IUFD cases, 1.11:1 in the control cases. 5. The low birth weight and preterm infants were much more frequent in the IUFD cases. 6. The mode of delivery IUFD was induced labor(77.5%), laparotomy(12.2%), spontaneo- us delivery(10.3%). The indications for laparotomy were placental abruption, placenta previa, transverse lie, previous cesarean section status, cephalopelvic disproportion and uterine rupture. 7. The most common cause of IUFD was unexplained causes(45.1%). 8. There were 67 cases(25.6%) of maternal complication, and the most common complica- tion was fever(35.8%). 9. In the incidence of abnormal coagulation test, the low platelet count(<100,000/mm3) was 8.0%, the prolonged prothrombin time(>14 seconds) was 7.2%, the prolonged partial thr- omboplastin time was 1.0%, the hypofibrinogenemia(<150mg/dl) was 7.2% and the elevated fibrinogen degradation products(>40 ug/ml) was 8.4%. 10. The risk of IUFD was lowered as the number of antenatal care was increased.
Abortion, Spontaneous ; Abruptio Placentae ; Blood Platelets ; Cephalopelvic Disproportion ; Cesarean Section ; Female ; Fetal Death* ; Fetus ; Fibrinogen ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Laparotomy ; Male ; Mothers ; Parity ; Placenta Previa ; Pregnancy ; Prothrombin ; Sex Ratio ; Uterine Rupture ; Weights and Measures

OBJECTIVE: 1) To compare prolactin responses to (and related clinical manifestations of) haloperidol, risperidone, and other atypical antipsychotics (clozapine, olanzapine, quetiapine, zotepine) with data from previous reports. 2) To investigate the association between changes in serum prolactin levels after the administration of antipsychotics and 44-bp insertion/deletion polymorphism in 5-HT transporter-linked polymorphic region (5-HTTLPR) in Korean schizophrenics. METHODS: The subjects were 136 patients diagnosed schizophrenic according to the DSM-IV criteria for schizophrenia who had taken antipsychotics for at least 3 months. The 136 patients consisted of the following 82 taking haloperidol (48 males and 34 females), 25 taking risperidone (14 males and 11 females), and 29 taking other atypical antipsychotics (18 males and 11 females). We measured serum prolactin concentrations by radioimmunoassay and investigated the clinical manifestations. We examined the genotype distribution and allele frequency of the 5-HTTLPR in all subjects by polymerase chain reaction of genomic DNA with primers flanking the promoter regions of the 5-HTT gene. Chi-square test, ANOVA and tukey test were used for statistical analysis with SAS 8.1 and p values of 0.05 or less were regarded as significant difference. RESULTS: Serum prolactin levels of patients taking haloperidol and risperidone were significantly higher than those taking other atypical antipsychotics (p<0.05). Females showed significantly higher prolactin levels than males (p<0.05). There was no significant difference in the genotype distribution and allele frequency of 5-HTTLPR among groups taking haloperidol, risperidone, and other atypicals. There was also no significant difference in genotype distribution and allele frequency of 5-HTTLPR between male and female schizophrenic patients. CONCLUSIONS: These results suggest that there was no association between serum prolactin levels after the administration of antipsychotics and 5-HTTLPR polymorphism in Korean schizophrenics.
Antipsychotic Agents* ; Diagnostic and Statistical Manual of Mental Disorders ; DNA ; Female ; Gene Frequency ; Genotype ; Haloperidol ; Humans ; Male ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Prolactin* ; Promoter Regions, Genetic ; Radioimmunoassay ; Risperidone ; Schizophrenia ; Serotonin Plasma Membrane Transport Proteins ; Serotonin*