In 5 cases of congenital coxa vara, 7 cases of acquired coxa vara and 4 hips in 3 cases of acquired coxa valga, we performed subtrochanteric osteotomies at Department of Orthopedic Surgery, SeoulNational University Hospital, from December 1980 to February 1984. At a relatively short interim follow-up, following observations were made on the correction of the femoral neck-shaft angle deformities. l. In the congenital coxa vara group, at an average follow-up of 1 year and 3 months, 97.9% of the correction obtained by osteotomy was maintained, based on the roentgenographic measurements of femoral neck-shaft angle. In the acquired coxa vara group, at an average follow-up of 1 year and 2 months, 93.3 % of the correction obtained by osteotomy was maintained. In the acquired coxa valga group, at an average follow-up of 1 year and 5 months, 92.9% of the correction obtained by osteotomy was maintained. 2. At final follow-up, leg length gain averaged 1.26cm in the congenital coxa vara group and 2.23cm in the acquired coxa vara group. An average 0.70cm decrease in leg length was noted in the acquired coxa valga group. 3. Trendelenburg sign, which was positive in all the cases of the congenital and acquired coxa vara group, reverted to negative in all. 4. Slight overcorrection in cases of the acquired coxa vara and undercorrection in cases of the acquired coxa valga, is recommended for later loss of surgically corrected femoral neck-shaft angle. In the congenital coxa vara, it appeared that loss of correction was relatively minor.
Congenital Abnormalities ; Coxa Valga ; Coxa Vara ; Follow-Up Studies ; Hip ; Leg ; Orthopedics ; Osteotomy

In 1973, Steel described triple innominate osteotomy in which the ischium, the superior pubic ramus and ilium superior to the acetabulum are divided and the acetabulum is repositioned anterolaterally and is stabilized by a bone graft and metal pins. Its goal is to establish a stable hip for dislocation or subluxation of the hips in older children and adults on whom it is impossible to correct effectively the instability by any one of the more conventional osteotomies, i.e. Salter's, Pemberton's or Chiari's, or by the capsular arthroplasty of Colonna. During the eleven years and eight months, from December 1973 to August 1985, at the Department of Orthopedic Surgery, Seoul National University Hospital, we performed Steel's triple innominate osteotomy on 41 cases, of which 37 were residual poliomyelitis and 4 septic hip residua. 4 cases of residual poliomyelitis were lost during follow up. The remaining 37 cases were reviewed for the efficacy and limitations of triple innominate osteotomy. We observed following conclusions: 1. Aside from congenital dislocation and dysplasia of the hip, paralytic conditions, such as residual poliomyelitis, are good indications of Steel's triple innominate osteotomy in older children, adolescents and young adults. Acetabular acclivity is adequately reduced and stability is improved. 2. Septic hip residua, including healed tuberculosis, is another indication of triple innominate osteotomy, particularly when total hip arthroplasty is contemplated. 3. When abductors are partially paralyzed, triple innominate osteotomy alone results in appreciable increase in abductor power, by providing a better muscle tension. 4. Substantial gain in leg length is an added advantage of triple innominate osteotomy. An average of 1.74 cm was gained at osteotomy site in our series. In adults, when limb shortening is relatively m i nor, triple innominate osteotomy alone can be a more convenient alternative to conventional, more formidable method of leg length equalization, such as femoral lengthening. This is particularly true when there is some instability or when abductors are weak. 5. Following improvement in mechanical stability by triple innominate osteotomy, weak abductors and extensors may be augmented by appropriate muscle transfer, resulting in more stable hip functionally. 6. In a hypermobile paralytic hip, iliopsoas tenotomy is neither necessary nor desirable at the time of osteotomy. When the hip is dislocated, or when the hip has marked flexion deformity, iliopsoas tenotomy fascillitates adequate correction, but this greatly increases the risk of neurological complication.
Acetabulum ; Adolescent ; Adult ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Child ; Congenital Abnormalities ; Dislocations ; Extremities ; Follow-Up Studies ; Hip ; Humans ; Ilium ; Ischium ; Leg ; Methods ; Muscle Tonus ; Orthopedics ; Osteotomy ; Poliomyelitis ; Seoul ; Steel ; Tenotomy ; Transplants ; Tuberculosis ; Young Adult

OBJECT: Pre-ALL is a very rare preteukemic state, which percedes acute lymphocytic leukemia, while MDS(pre-ANLL), usually the well-known type of preleukemic state, precedes acute non-lymphocytic leukemia. Initially it shows transient pancytopenia without any evidence of leukemia in bone marrow findings, followed by acute lymphocytic leukemia after recovery from pancytopenia of a short period within weeks or months. We report a case with pre-ALL in childhood. CASE: A 15-month-old male baby was admitted with the complaints of fever and cough for 5 days and pallor for 2 weeks prior to admission. On admission, CBC showed pancytopenia without any evidence of leukemia, which was recovered spontaneously in a short period, and then was followed by acute lymphocytic leukemia of CALLA negative, early pre-B cell type. During antileukemic chemotherapy, he had suffered from severe bacterial infections and was finally died of sepsis 8 months after first admission. CONCLUSION: We report a case of pre-ALL in childhood, which was preceded by CALLA negative, early pre-B cell ALL, with a review of the literatures, briefly.
Bacterial Infections ; Bone Marrow ; Cough ; Drug Therapy ; Fever ; Humans ; Infant ; Leukemia ; Male ; Pallor ; Pancytopenia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Precursor Cells, B-Lymphoid ; Sepsis

Unlike the United States, cases of firearm suicides in Korea are rare and are usually limited to military soldiers and policemen. In addition, there is no case report of a suicide by a homemade handgun in Korea. The present victim was a 24-year-old soldier with a fascination for firearms. He had a history of depression and social phobia during his military service. He constructed a homemade handgun from a plastic model gun, also known as a BB gun. During the vacations, he committed suicide with the homemade gun, which caused a penetrating gunshot wound to his chest. The structure and ammunition of the homemade handgun is demonstrated in this report. We have also discussed a few details of the forensic investigation and evaluation of the homemade handgun fatality.
Depression ; Firearms ; Humans ; Korea ; Military Personnel ; Plastics ; Phobic Disorders ; Suicide ; Thorax ; United States ; Wounds, Gunshot ; Young Adult

No abstract available.
Calcinosis*

The purpose of this study is to confirm the effectiveness of stay-suture which is commonly used in the procedure of end to end anastomosis, to find out general biomechanical properties of peripheral nerve with gradual stretching and to evaluate the histological difference after breakage of the nerve. The sciatic nerves of adult rabbits were excised and they were grouped by I and II. Group I was composed of 14 normal sciatic nerves and group II, 14 sciatic nerves sutured with 5-0 nylon after transection. They were stretched on the "Instron" universal testing machine at a constant rate of 200mm/min until breakage took place and the results were compared. The mean maximal tensile strength was 13.6N in group I and 2.1N in group II, representing about one seventh value. The mean ultimate tensile strength was 4.2MPa in group I and 0.9MPa in group II, representing about one fifth value. In load-elongation curve of group I, viscoelastic property was noted as all other biological tissues have. The mean modulus of elasticity was 19 in normal sciatic nerves, which is somewhat lower value than other tissues, indicating superior elastic property of peripheral nerves. Transverse histologic examination showed that epineurium lost its continuity earlier than perineurium, implying perineurium is a more resistant structure than epineurium. However, to confirm this, it is thought to be necessary to examine the nerves serially during distraction at each different status. In conclusion, stay-suture provided about one fifth of ultimate tensile stress, implying its usefullness of resisting excessive tension in end to end anastomosis of peripheral nerves. Normal sciatic nerves showed viscoelastic property with mean modulus of elasticity of 19.
Adult ; Elastic Modulus ; Humans ; Nylons ; Peripheral Nerves ; Rabbits ; Sciatic Nerve ; Tensile Strength

No abstract available.
Neoplasm Metastasis* ; Neuroblastoma*

BACKGROUND: The clinical significance of mean platelet volume (MPV), platelet distribution width (PDW) and megathrombocyte index (MTI) is not clear. METHODS: We examined platelet indices in 900 cases of patients with hematologic disorders and compared them with those of the control to predict thrombopoiesis in the bone marrow. MPV and PDW were measured by Coulter Counter STKS (U.S.A). We calculated megathrombocyte index (MTI, the percentage of megathrombocytes) in the peripheral blood film using ocular micrometer, and examined megakaryocyte number in the bone marrow aspirates. RESULTS: In patients with acute leukemia, and aplastic anemia, MPV and MTI were lower than the control but PDW was higher. In myeloproliferative disorders, all platelet indices were higher, and in ITP (idiopathic thrombocytopenic purpura), MPV and MTI were higher but PDW was not significantly different. MTI was higher in complete remission than initial acute leukemia. All platelet indices were not significantly different between pre- and post-BMT in AML. But in aplastic anemia, MPV and MTI were higher in post-BMT than pre-BMT. MTI was a better index to screen than MPV in the decreased megakaryocyte group, but in increased megakaryocyte group, there was no difference in screening ability between MPV and MTI. CONCLUSIONS: The platelet indices in peripheral blood may be good markers for predicting thrombopoiesis in hematologic disorders and in post chemotherapy of acute leukemia. In addition, after BMT of aplastic anemia, these indices could be used as valuable markers of engraftment.
Anemia, Aplastic ; Blood Platelets* ; Bone Marrow ; Drug Therapy ; Humans ; Leukemia ; Mass Screening ; Mean Platelet Volume ; Megakaryocytes ; Myeloproliferative Disorders ; Thrombopoiesis

PURPOSE: The role of MRI in the detection of cholangiocarcinoma of the common hepatic duct has rarely been described. This study was attempted to ascertain characteristic MR features of cholangiocarcinoma. MATERIALS AND METHODS: The T1(500/30, TRs/TEs) and T2 weighted(200/80, TRs/TEs) MR images were obtained from nine patients with cholangiocarcinoma of the common hepatic duct. The common hepatic lesions were detected in seven cases. MR features of cholangiocarcinoma were analysed according to the signal intensity and associated findings. RESULTS: The seven cases showed lower signal intensity than the surrounding normal liver parenchyma on T1 weighted image. On T2 weighted image, the tumor showed isosignal intensity and hyperintensity in four and three patients, respectively. T2 image also revealed diffusely increased signal intensity in some hepatic lobe or segment in four cases, and Intrahepatic periductal high signal intensity in one case. Other associated MR findings were intrahepatic metastasis, and intratumoral hemorrhage, each noted in a different case. CONCLUSION: T2 weighted Image appears to be effective in the detection of cholangiocarcinoma of the common hepatic duct and evaluation of its associated intrahepatic lesions.
Cholangiocarcinoma* ; Hemorrhage ; Hepatic Duct, Common* ; Humans ; Liver ; Magnetic Resonance Imaging ; Neoplasm Metastasis

Between June 1985 and March 1990, 25 patients with primary malignant bone tumors, including 15 cases of osteogenic sarcoma, two cases of periosteal osteogenic sarcoma, six cases of chondrosarcoma, and two cases of malignant fibrous histiocytoma, were treated with limb-salvage procedures. Fourteen patients underwent limb salvage operations with tumor prosthesis arthroplasty, 6 with resection-arthrodesis, 4 with wide resection, and 1 with autoclaved autograft. Pre- and/or post-operative chemotherapy with or without radiotherapy was combined with these limb salvage operations. The average follow-up period was 25.2 months (6 to 52 months) since diagnosis. The estimated 3.5-year survival rate of the total 25 patients was 39.5% based on the Kaplan-Meier survival plot. In the 15 cases of osteogenic sarcoma, the estimated Kaplan-Meier 34-month survival rate was 46.2%. Seventeen patients who were followed up for more than 1 year were grouped by functional grading: 11 (65%) were excellent; 3 (18%) good; 2 fair (12%); and 1 poor. Complications occurred in 4 patients, 1 had a local recurrence, 2 had superficial wound infections, and 1 a loosening of the femoral stem. Metastases were shown in 15 case, and the most common location was the lung.
Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Arthroplasty ; Bone Neoplasms/drug therapy/radiotherapy/*surgery ; Chondrosarcoma/drug therapy/radiotherapy/*surgery ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Histiocytoma, Benign Fibrous/drug therapy/radiotherapy/*surgery ; Humans ; Lung Neoplasms/secondary ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Osteosarcoma/drug therapy/radiotherapy/*surgery ; Survival Analysis