The approach toward paralytic hips in children with subluxation or dislocation has been essentially conservative and palliative, frequently.accepting the subluxation or dislocation. Buster Brown belt, ischial seat brace, or crutches with non-weight bearing is frequently prescribed. For obvious reasons, both the patient and the surgeon are reluctant to resort to hip fusion, and muscle or tendon transfer about the hip cannot be expected to function in the presence of subluxation or dislocation. On the other hand, deformities about the hip are corrected successfully by standard procedures, such as adductor tenotomy, Soutters fasciotomy, and Campbells iliac crest transfer. In severe, fixed deformities in older children, the overall balance may be restored by varus or valgus osteotomy of Irwin, leaving the deformities uncorrected. Jones varus osteotomy is aimed at reduction of the hip, but it ignores the factor of remodeling and is of temporary benefit. More recently, Salters and Pembertons osteotomies have been suggested in the treatment of paralytic subluxation or dislocation, but the lack of remodeling remains unchallenged. During the period of 14 years, from October 1963 to May 1976, we operated on 132 hips in 108 cases of paralytic hips, mostly in children, at Seoul National University Hospital. Of the total cases, 104 cases were residual poliomyelitis, 3 cases cerebral palsy, and one case meningomyelocele, Operative procedures carried out on these hips were as follows: Soutters abductor fasciotomy; 35 Campbells iliac crest transfer; 22 Lumbodorsal fasciotomy; 20 Ober-Barrs erector spinae and tensor fasciae latae transfer; 29 Thomas-Thompson-Straubs external oblique transfer; 15 Sharrards iliopsoas transfer; 6 Mustards iliopsoas transfer; 20 Legg-Dicksons tensor fasciae latae transfer; 8 Blecks iliopsoas recession; 1 Hip fusion; 2 Pembertons pericapsular osteotomy; 28 Salters innominate osteomy; 26 Steels triple osteotomy; 1 Chiari's osteomy; 1 Soft tissue release operations were carried out whenever necessary, either prior to or at the time of reconstructive surgery. In 39 hips, osteotomies were either combined at the same time or were followed by muscle or tendon transfers, while in the earlier 4 hips osteotomy alone resulted in recurrence of subluxation or dislocation and required repeat osteotomy combined with muscle transfer, and in another hip, recently, osteotomy was complicated by infection and muscle transfer has been postponed to date. In our experience with paralytic hips, when subluxation or dislocation is present, either muscle or tendon transfer alone or osteotomy or arthroplasty alone will likely fail or, at best, will be ineffective. Most satisfactory and' permanent results were obtained when these hips were aggressively treated by maximum correction of deformities followed by combined mechanical(osteotomy or arthroplasty) and functional (muscle or tendon transfer) stabilizations. This often permits elimination of the brace and hip fusion is seldom necessary, thus resulting in functional salvage of a flail hip. Also, any surgery on the knee and the foot of the same limb is greatly enhanced by reconstruction of the hip.
Arthroplasty ; Braces ; Cerebral Palsy ; Child ; Congenital Abnormalities ; Crutches ; Dislocations ; Extremities ; Fascia ; Foot ; Hand ; Health Resorts ; Hip ; Humans ; Knee ; Meningomyelocele ; Mustard Plant ; Osteotomy ; Poliomyelitis ; Recurrence ; Seoul ; Steel ; Surgical Procedures, Operative ; Tendon Transfer ; Tendons ; Tenotomy

Illuminating type poster looks very impressive and one may feel as if it were on the view box in his readingroom. Some difficulties and nuisances really exist in making them and a few of demerits can also be encounteredthat of contrast enhancement and of rough graininess. Contact print renders the best quality, though, KodakTechnical-Pan film with HC-110 (Dil. F) developer, llford xp 1–400 with Kodak C-41 color developer and KodakPlus-X with Microdol-X developer combinations also work in minimizing the deterioration of resolution and grainisswhich can almost always occur in enlargement prints.

In the past several years, total hip replacement arthroplasty has become an established procedure in the management of painful arthritic hips in older adults. It is still gaining an increasing popularity as experience has accumulated and indications broadened. The authors reviewed the first 47 total hip replacement arthroplasties in 41 patients performed at the Department of Orthopedic Surgery, Seoul National Univerity Hospital, during the period of 4 years and 8 months, from April 1972 to November 1976. The longest follow-up was 4 years and 8 months and the shortest 1 month, the average being 2 years and 1 month. The youngest age was 17 years and the oldest 71 years, the average being 41 years. There were 26 males and 15 females. The underlying etiology was as follows: primary osteoarthritis 4 hips, avascular necrosis 12 hips, septic hip residua 18 hips (pyogenic 11 hips, tuberculosis 7 hips), rheumatoid arthritis 3 hips, failed previous operation 3 hips (failed endoprosthesis 2 hips, failed total hip replacement 1 hip), secondary osteoarthritis 5 hips (congenital dislocation 4 hips, Legg-Perthes disease 1 hip), and nonunion of femoral neck 2 hips. Following types of prosthesis were used; Sbarbaro 3, Charnley 8 (including custom-made extralong, narrow stem and extra-small stem prostheses), Muller 22, and Trapezoidal-28 14. The results were evaluated by the methods of Harris and d'Aubigne, both preoperatively and postoperatively, In the average, Harris' score improved from 57 to 92 (gains of 35) and the d'Aubigne rating from 10.4 to 16.8 (gains of 6.2) following operations.
Adult ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Dislocations ; Female ; Femur Neck ; Follow-Up Studies ; Hip ; Humans ; Legg-Calve-Perthes Disease ; Male ; Necrosis ; Orthopedics ; Osteoarthritis ; Prostheses and Implants ; Seoul ; Tuberculosis

Pecutaneous transhepatic portogram with selective catheterizatio of the portal vein and its tributaries notonly provide information about the status of portal circulation and but can also be used in the treatment ofbleeding esophageal varices by selective embolization with various embolic materials. The authors describe easierand safer modified method of conventional percutaneous transhepatic portogram. We wish to describe our experiencewith the technical aspects and portosystemic collateral patterns in 26 patients with variceal bleeding, from July1985 to July 1986 at Kyungpook National University Hospital. 1. To overcome the difficulties of catheter passageand superselection of variceal supplying vein, we used 7F sheath directly introduced over the ,018″ guide wire.We used coaxial system using 25cm 18G needle within 7F vessel dilator to make the tip of dilator more rigid. 2.Variceal obliteration attempted in 23 patients who showed variceal supplying veins on the protogram, Successfulobilteration was obtained in 20 patients. We used absolute ethanol, stainless steel coil, and Gelfoam cubes withsclerosing and embolica agent of variceal vein. 3. Portosystemic collaterals of 24 patients; Coronary vein;21cases, Inferior mesenteric vein:9 cases, Short gastric vein:7 cases, Umbilical & paraumbilical vein; 6 cases,Gastrorenal: 3 cases, Splenorenal: 2 cases, Splenoretoperitoneal: 1 case. 4. The number of coronay vein were 18cases of single and 4 cases of two. The locations of coronary vein: Splenic vein: 13 cases, Main portal vein: 7cases, Junctional area: 6 cases. 5. Transhepatic obliteration of the gastroesophageal veins is a relatively simpleand usually successful form of palliative treatment for actively bleeding and stable gastroesophageal varices.
Catheters ; Coronary Vessels ; Esophageal and Gastric Varices ; Ethanol ; Gelatin Sponge, Absorbable ; Gyeongsangbuk-do ; Hemorrhage ; Humans ; Methods ; Needles ; Palliative Care ; Portal Vein ; Splenic Vein ; Stainless Steel ; Varicose Veins ; Veins

Our experience with recurrent dislocation of the patella on ten knees in eight patients seen at Seoul National University Hospital during the last 2 years and eight months is reported. Five were female and three male. The age ranged from seven to 27 years. In four of the patients the onset was attributable to a definite history of trauma, while in one patient the dislocation was considered due to developmental anomalies and in another it was clearly congenital Still another patient had a progressively short limb due to premature closure of the distal femoral epiphysis with accompanying flexion-valgus deformity of the knee, presumably caused by an unrecognized infection during early childhood One adolescent girl had bilateral knock knees. The knock knees were treated successfully by supracondylar osteotomy and one post-traumatic knee by classical Roux-Goldthwait procedure with equally excellent result, The rest were treated by Greens vastus medialis transfer with division of the iliotibial band or reefing of the medial joint capsule when necessary. In one knee dislocation recurred, probably due to avulsion of the transferred vastus, and two knees had residual subluxation and limitation of flexion. The results on the remaining seven knees were excellent.
Adolescent ; Congenital Abnormalities ; Dislocations ; Epiphyses ; Extremities ; Female ; Genu Valgum ; Humans ; Joint Capsule ; Knee Dislocation ; Knee ; Male ; Osteotomy ; Patella ; Quadriceps Muscle ; Seoul

Fixed pelvic obliquity refers to a composite deformity induced by contractures both above and below the pelvis and the elements of this deformity are frequently interrelated during the period of growth. From the functional standpoint, leg length discrepancy is caused by deformities of the pelvis and lower extremities, such as pelvic obliquity and acetabular dysplasia, as well as by inequality of true limb bone length, and these deformities either aggravate or compensate functional discrepancy. During fhe fourteen years period, from August 1968 to August 1982, at the Department of Orthopaedic Surgery, Seoul National University Hospital, we treated 35 cases of fixed pelvic obliquity and acetabular dysplasia associated with true or functional limb length discrepancy by means of lumbodorsal fasciotomy or pelvic osteotomies such as Salters innominate osteotomy or Steels triple osteotomy, combined, if necessary, with contralateral abductor fasciotomy to gain functional limb length as well as to improve posture and balance. In many cases of residual poliomyelitis, epiphysiodesis was also performed when indicated. These cases were reviewed and following observations were made: 1. Of the 35 cases, residual poliomyelitis with 29 cases (83%) was by far the main cause of leg length discrepancy. Cerebral palsy (2cases), Legg-Perthes disease (2 cases), and fibrous ankylosis secondary to septic hip (2 cases) comprised the remainder. 2. The male-to-female ratio was about equal, being 17 to 18. 3. The average age at the time of operation was 17.9 years, the youngest being 7 years and the oldest being 30 years. The average age at the time of current follow-up was 18.8 years. 67% of those followed was skeletally mature. 4. An average of 1.35cm of bone length was gained radiographically by pelvic osteotomies. Steels triple osteotomy was more effective in gain than Salters innominate osteotomy. 5. An average of 2.43cm of functional length when standing was gained radiographically by lumbodorsal fasciotomy alone. 6. An average of 2.61cm of functional length when standing was gained radiographically by lumbodorsal fasciotomy and combined contralateral Soutters or Campbells fasciotomy. 7. An average of 3.57cm of functional length when standing was gained radiographically by lumbodorsal fasciotomy and combined ipsilateral Steel's triple osteotomy. 8. An average of 1.73cm of functional lengthening when standing was corrected radiographically by ipsilateral Soutter's fasciotomy. 9. When lumbodorsal fasciotomy and Steel's triple osteotomy were combined with contralateral Soutter's or Campbell's fasciotomy, the average radiographic gain in standing length was 3.77cm. 10. Leg length discrepancy in terms of true bone length is conventionally corrected either by epiphysiodesis or bone shortening on the longer limb, or by bone lengthening on the shorter limb. We believe that when leg length discrepancy is associated with fixed pelvic obliquity, frequently aggravating the disability functionally, lumbodorsal fasciotomy and/or pelvic osteotomies on the shorter side and, combined if necessary, Soutters or Campbells fasciotomy on the longer side, can, in many instances, successfully correct or reduce functional limb discrepancy and improve balance, posture and function. Any residual discrepancy, true or functional, may then be corrected by conventional methods.
Acetabulum ; Ankylosis ; Bone Lengthening ; Cerebral Palsy ; Congenital Abnormalities ; Contracture ; Extremities ; Follow-Up Studies ; Hip ; Leg ; Legg-Calve-Perthes Disease ; Lower Extremity ; Osteotomy ; Pelvis ; Poliomyelitis ; Posture ; Seoul ; Socioeconomic Factors ; Steel

Reversible posterior leukonecephalopathy syndrome RPLS), a neurologie disorder associated with evidence of posterior cerebral edema on neuroimaging studies, has been described in both adults and children. Conditions predisposing to RPLS include malignant hypertension, renal dysfunction, toxemia of pregnancy, interferon therapy, and the use of immunosuppressive agents. When associated with acute hypertension, RPLS typically occurs concurrently with the fulminant clinical syndrome of hypertensive encephalopathy We describe occipital lobe seizures, in the setting of only moderate elevations of blood pressure, as the major clinical manifestation of RPLS.
Adult ; Blood Pressure ; Brain Edema ; Child ; Humans ; Hypertension ; Hypertension, Malignant ; Hypertensive Encephalopathy ; Immunosuppressive Agents ; Interferons ; Neuroimaging ; Occipital Lobe ; Posterior Leukoencephalopathy Syndrome* ; Pre-Eclampsia ; Seizures

A rare case of a metastatic lesion of breast carcinoma in the talus of the left foot, approximately 14 months after simple mastectomy including resection of axillary lymph node is reported. The operation was undertaken 14 months prior to this admission and gradual onset of pain, swelling and redness were noticed about the left ankle. X-ray showed irregular osteolytic changes on the superolateral aspect of the body and the superior aspect of the neck of the left talus without periosteal reaction, Metastasis was confirmed by biopsy and pathological findings were also submitted.
Ankle ; Biopsy ; Breast Neoplasms ; Breast ; Foot ; Lymph Nodes ; Mastectomy, Simple ; Neck ; Neoplasm Metastasis ; Talus

A Paralytic hip with subluxation or dislocation may be treated by any of the ischial seat brace, hip fusion, muscle or tendon transfer, and more recently Pembertons or Salters osteotomy. 61 hips on 45 cases have been reconstructed, by one or combination of various procedures at Seoul National University Hospital during the 7 year period from October 1963 to October 1970. Follow-up results of these hips were evaluated by the reporters' according to the criteria of both functional and mechanical stability. Of the 43 cases with known results 9 rated Undetermined, 2 Fair, 5 Good, and 27 Excellent. Analysis of the 27 Excellent cases suggests that the most satisfactoy results can be obtained when the hips are attacked by concomitant functional(muscle or tendon transfer) and mechanical (Pembertons or Salters osteomy) stabilizations. In our experience, a combination of muscle or tendon transfer and an arthroplasty of Pemberton or Salter type can be carried out at the same setting, and at the same time results in better and more permanent rehabilitation of the hip than either muscle or tendon transfer or arthroplaty alone and often eliminates braces and the need for hip fusion, and thus a flail hip can be functionally salvaged. Our approach has become more aggressive in recent years, and we sometimes do not hesitate radical operations in children below 5 years of age or in convalescent stage of poliomyelitis in order to prevent further progression of hip deformities. More recently, Sharrards posterior transplantation of the iliopsoas tendon, originally described for reconstruction of paralytic hips in meningomyelocele, was carried out in 4 cases of residual poliomyelitis and we are satisfied with the initial results.
Arthroplasty ; Braces ; Child ; Congenital Abnormalities ; Dislocations ; Follow-Up Studies ; Hip ; Humans ; Meningomyelocele ; Osteotomy ; Poliomyelitis ; Rehabilitation ; Seoul ; Tendon Transfer ; Tendons

Benign chondroblastoma of bone is a relatively rare primary bone tumor which develops in the 2nd to 3rd decade involving the epiphysis of the long bone. The over-all reported cases of the world have been lesser than 400 after determining the entity as benign chondroblastoma in 1942 by Jaffe and Lichtenstein. A case of the benign chondroblastoma with involvement of the greater trochanter of the femur of a 19 years old boy is presented. The conclusive diagaosis was led by histological examination. Considerable new bone formation and bony spicules which might be derived from previous multiple puncture made us to confuse with osteogenic sarcoma. The specimen was composed of reddish brown hemorrhagic and fragile tissue with scattered either yellowish gritty calcified material or bluish translucent ones. The postoperative course has been smooth and there has been no evidence of recurrence for postoperative 15 months.
Chondroblastoma ; Epiphyses ; Femur ; Humans ; Male ; Osteogenesis ; Osteosarcoma ; Punctures ; Recurrence