Proximal femoral focal deficiency (PFFD) in early infancy is characteristic by quite shortening of the tight segment, flexed, abducted and externally rotated position In assciation with a stable hip which Is freely mobile. Authors experienced a case with the congenital deficiency of the femoral head. The case showed the normal femoral segment and no any other bony anomalies which cannot be Included in Aitkens or Amstutz's classification.
Classification ; Head ; Hip

Intraspinal tumors in children are of especially interest to orthopaedic surgeons for two reasons; First, musculoskeletal abnormalities, are often treated for long periods before the correct diagnosls is suspected; Second, important orthopaedic problems are encountered in almost everychild treated for intraspinal tumor, not only during the immediate postoperative management but all through subsequent growth. We report a case presentation of the intraspinai tumor, dermoid cyst, successfully treated with operation.
Child ; Dermoid Cyst ; Humans ; Musculoskeletal Abnormalities ; Surgeons

The methods of reconstruction for chronic Iigamentous instability of the knee have changed much since the concept of rotary instability was introduced by Slocum and Larson in 1968. The first step to successful management of these probrams is the accurate dlagnosis of the type or types of the instability that exist. Appropriate operative procedures should then be selected according to the type and degree of the instability as well as the age, general conditlon and the function demand of the patient. The stability can be restored passively by a near anatomical. repair of the injured ligaments, and can be reinforced actively by a proper muscle or tendon transplantation, such as the five-one procedure for anteromedial rotary instability. Nineteen knees of active, well motivated patients were operated on for chronic knee instabilities according to these new concepts. Although the follow-up period was relatively short, the results of the procedures was generally satisfactory.
Follow-Up Studies ; Humans ; Knee ; Ligaments ; Surgical Procedures, Operative ; Tendons

During a 12-month period high-resolution, real-time ultrasonography (US) with graded compression was performed on 268 consecutive patients with clinically suspected acute appendicitis and its complication. US visualization of a fluid-filled, non-compressed appendix or a decompressed, thick-walled appendix was the primary criterion for a diagnosis of acute appendicitis. The sonographic findings were correlated with surgical-pathologic outcome in 92 cases and with the findings of clinical follow-up in the remainder. US was found to be accurate in the diagnosis of acute appendicitis and its complication with a sensitivity of 93.3%, a specificity of 98.9%, and an accuracy of 97%. The predictive value of a positive test was 97.7%; that of a negative test was 96.7%. There were two false-positive examination in patients with a thick-walled appendix or periapperdiceal abscess, which were surgically confirmed as appendiceal adenocarcinoma and perforated cecal diverticulitis respectively. There were six false-negative examination in patients with a sonographically no-visible appendix, which were confirmed surgically as acute appendicitis(n=5) and perforated appendicitis(n=1). Our results show that high-resolution, real-time US is an accureate imaging modality in the diagnosis of acute appendicitis and the evaluation of its complication.
Abscess ; Adenocarcinoma ; Appendicitis* ; Appendix ; Diagnosis* ; Diverticulitis ; Follow-Up Studies ; Humans ; Sensitivity and Specificity ; Ultrasonography*

No abstract available.
Dislocations* ; Knee*

Klippel-Feil syndrome is characterized by congenital fusion of cervical vertebrae with a wide range of associated anomaly. The authors present a 50-year-old Klippel-Feil syndrome patient with a minor trauma followed progressive quadriparesis. He had typical radiologic findings of type II Klippel-Feil syndrome and presented progressive myelopathy due to cord compression at foramen magnum level with cervical instability. The patient underwent craniocervical decompression and fusion. The authors reviewed the pertinent literatures and discussed this rare syndrome.
Cervical Vertebrae ; Decompression ; Female ; Foramen Magnum ; Humans ; Klippel-Feil Syndrome* ; Middle Aged ; Quadriplegia* ; Spinal Cord Diseases

BACKGROUND AND OBJECTIVES: The efficiency of second harmonic generation at 532 nm is high when a pulsed Nd : YAG laseris used as a pump source of fundamental waves. The pulse durations of 532 nm-irradiation can be varied from 10 ns to 1000 ns by changing the pumping method. The purpose of this study was to compare the macroscopic and micropscopic changes in the muscle and skin after irradiation by 532 nm Flash lamp pumped solid state (FPSS) laser and Diode pumped solid state (DPSS) laser, whose pulse durations are 600 ns and 100 ns, respectively. MATERIALS AND METHOD: Two experiments were conducted on the muscle and skin of guinea pig. First, the guinea pig muscle and skin were irradiated by the 532 nm FPSS and DPSS lasers with various intensities and time duration. Macroscopic examinations were performed on the muscle lesions and immediate histopathologic examinations on the skin were carried out. RESULTS: The volume of vaporization and necrosis of the guinea pig muscle by the FPSS laser was larger than that by the DPSS laser. The vaporization and necrosis reaction of skin by the FPSS was significantly stronger than that by the DPSS laser. CONCLUSION: It appears that the DPSS laser system would be superior over the FPSS laser system in providing more accurate and precise surgery with less intense injury on the surrounding tissue.
Animals ; Guinea Pigs* ; Guinea* ; Necrosis ; Skin* ; Volatilization

BACKGROUND: Propofol and alfentanil are frequently combined for general anesthesia. The purpose of this study was to characterize the appropriate effect-site concentration of alfentanil combined with an effect-site concentration of propofol of 4 microgram /ml during endotracheal intubation. METHODS: One hundred and thirty patients, aged 40-70 years and scheduled for abdominal surgery were randomly allocated to four groups according to the target effect-site concentrations of alfentanil: 0 ng/ml in the placebo group, 50 ng/ml in the P50 group, 75 ng/ml in the P75 group, and 100 ng/ml in the P100 group. All patients received a computer controlled infusion of propofol with an effect-site concentration of 4microgram/ml. After equilibration between plasma and effect-site was achieved, and the trachea of the patient was intubated. The assessments of hemodynamic changes were usually confined to the measurement of changes in systolic/diastolic blood pressure (SBP/DBP), mean arterial pressure (MAP), and heart rate (HR). Also, we checked the dose requirements of ephedrine and atropine used to correct hypotension and bradycardia. RESULTS: The use of alfentanil (especially 50 or 75 ng/ml) was effective at blunting the SBP increase during the few minutes after intubation. However, the dose requirements of ephedrine and atropine in the P100 group were significantly higher than those in other groups. CONCLUSIONS: The appropriate effect-site concentration of alfentanil combined with an effect-site concentration of propofol of 4microgram/ml during endotracheal intubation lies between 50 and 75 ng/ml.
Alfentanil* ; Anesthesia, General ; Arterial Pressure ; Atropine ; Blood Pressure* ; Bradycardia ; Ephedrine ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hypotension ; Intubation ; Intubation, Intratracheal* ; Plasma ; Propofol* ; Trachea

BACKGROUND: The aim of this study was to examine the safety and efficacy of patient-controlled sedation (PCS) according to the lock-out time (LOT, 1 or 2 min) with a demand bolus of propofol and alfentanil fixed during a colonofiberscopy. METHODS: Fifty ASA physical status 1 or 2 patients who underwent a colonofiberscopy were enrolled in this study. They were provided with a PCS pump (Perfusor(R) fm, B Braun Germany, nominal infusion rate, NIR = 1,000 ml/h) containing propofol (9.1 mg/ml) and alfentanil (45.5microgram/ml) in order to self-administer a 2 ml bolus whenever they felt uncomfortable. The lock-out time (LOT) was set to 1 (n = 20, group 1) or 2 (n = 30, group 2) minutes. The Observer's Alertness/Sedation (OAA/S) score, D/A (delivery/attempt, %), blood pressure, heart rate, respiratory rate, SpO2, end tidal CO2 and bispectral index (BIS) were assessed and measured during and/or after the procedures. The verbal descriptive pain scores, as well as the patient's and endoscopist's satisfaction scale were assessed after the procedures. RESULTS: Intraoperative and postoperative pain scores, D/A, the patient's and endoscopist's satisfaction were similar in both groups. However, the lowest BIS values in group 1 was lower than in group 2 (70.3 +/- 12.2 and 77.6 +/- 6.8, respectively, P = 0.010). There were fewer patients whose lowest OAA/S score was <3 in group 2 (4/30) than in group 1 (11/20)(P = 0.002). CONCLUSIONS: With a demand bolus of propofol (18.2 mg) and alfentanil (91.0microgram) fixed, the incidence of over-sedation was higher at LOT 1 min than at LOT 2 min while the efficacy was similar in the PCS with a high NIR during the colonofiberscopy.
Alfentanil* ; Blood Pressure ; Germany ; Heart Rate ; Humans ; Incidence ; Pain, Postoperative ; Propofol* ; Respiratory Rate

PURPOSE: Hepatoprotective effect of prostaglandin E1 (PGE1) has been verified in numerous animal experiments but not so apparent in clinical trials. Although the reason for this discrepancy in clinical results is still unknown, one possible explanation is the instability of PGE1. In this study, the hepatoprotective effect of lipo-PGE1, which is known to be stable during pulmonary circulation and have more targeting effect, was investigated in canine partial liver allotansplantation. In order to reckon in the possible injury during harvest of partial liver, lipo-PGE1 was infused from the start of living graft harvest procedure. METHODS: Mongrel dogs weighing about 25 kg were divided into control (n=6) and lipo-PGE1 (n=6) group. Partial liver allotransplantation was performed. In lipo-PGE1 group, lipo-PGE1 was slowly infused through splenic venous cannulation during the donor liver harvesting procedure (50 mg) and continuously infused (60 mg/day) for 48 hrs after reperfusion. The aspartate aminotransferase (AST), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) were monitored. RESULTS: The AST and ALP levels of the lipo-PGE1 group were significantly lower than that of the control group at both 1 hour and 48 hours after reperfusion. The LDH level in lipo-PGE1 group was lower at 1 hour and 48 hours after reperfusion, but no significant differences were shown between two groups. CONCLUSION: This study demonstrated the hepatoprotective effect of the lipo-PGE1 against ischemia-reperfusion injury in canine partial liver allotransplantation.
Alkaline Phosphatase ; Allografts* ; Alprostadil* ; Animal Experimentation ; Animals ; Aspartate Aminotransferases ; Catheterization ; Dogs ; Humans ; L-Lactate Dehydrogenase ; Liver Transplantation ; Liver* ; Pulmonary Circulation ; Reperfusion ; Reperfusion Injury ; Tissue Donors ; Transplants