We experienced one case of severe pituitary dwarfism in a 16 years old male boy that magnetic resonance image(MRI) revealed transection of the pituitary stalk with the ectopic location of posterior pituitary gland and hypoplastic anterior pituitary gland. The serum growth horrnone(GH) response to clonidine and L-dopa revealed severe GH deficiency. The patient revealed normal response in TSH, prolactin and LH, FSH to TRH and LHRH respectively. So far, the primary cause of idiopathic pituitary dwarfism in many patients was due to hypoxic injury to hypothalmus by perinatal insults. In this patients, there was no history of perinatal insults and postnatal head trauma. We report a case of severe dwarfism due to hypogenesis of anterior pituitary gland.
Clonidine ; Craniocerebral Trauma ; Dwarfism ; Dwarfism, Pituitary ; Gonadotropin-Releasing Hormone ; Humans ; Levodopa ; Male ; Pituitary Gland ; Pituitary Gland, Anterior ; Pituitary Gland, Posterior ; Prolactin

Although there are various methods of operative treatment for hony mallet finger, the operative technique is not so easy and complications such as joint stiffness, sott tissue prohlems, infection, change of nail shape and arthrosis are common. The authors performed operations for 26 cases of hony mallet fingers, fixing the hony frapment by Kirschner wire, pull-out wire suture and miniscrew respectively, from Jan. l988 to Jun. l996. The results were as follows. l. According to Niechajev's classification. there were 3 cases of type B, 7 cases of type C, l4 cases of type D, and 2 cases of type E. And 11 cases were accompanied hy crushing injury. 2. Involved fingers were third finger in 11cases, fit'th finger in 7 cases, fourth finger in 5 cases, second finger in 2 cases. and thumb in I case. 3. The hony mallet finger was caused hy occupational injury in l6 cases, direct blow in 7 cases and sports injury in 3 cases. 4. The fractured fragment was fixed hy Kirschner wire in 9 cases, by pull-out suture in 9 cases and by miniscrew in 8 cases. 5. The results were evaluated hy Kanies scale. Sixteen cases had satisfactory results. Seven cases (87.5%) were satisfactory in miniscrew fixations. 5 cascs (55.6%) in pull-out wire suture methocls and 2 cases (22.2%) in Kirschner wire tixations. 6. The complications were joint incongruity in 4 cases, dorsal prominece in 6 cases, painful limitation of motion in 2 cases which were treated by arthrodesis, pin site infection in 2 cases and hreakage of wire suture in 1 case. 7. The miniscrew fixation offered relatively firm fixation, low complication rate, and good results. so it can be considered as one of the good methods of treatment for hony mallet finger.
Arthrodesis ; Athletic Injuries ; Classification ; Fingers* ; Joints ; Occupational Injuries ; Sutures ; Thumb

No abstract available.
Amniotic Fluid* ; Arteries* ; Female ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Rheology*

The elbow joint is the most commonly dislocated-joint in the body except for the shoulder, and in children less then 10 years old, it is the most frequently dislocated articulation. The injury and the treatment are well described in most standard textbooks, but the characteristic findings and follow-up evaluations are not generally recognized. Authors have clinically analyzed 45 cases of traumatic fracture and dislocation of the elbow joint which are treated between January, 1975 and June, 1985 at the Department of Orthopedic Surgery, Wonju Medical College of Yonsei University. The results were as follows; 1. The age incidences were in even distribution except in the old ages where the incidence was low and the male to female ratio was 7: 3. 2. The major cause of the injury of the elbow was fall down (60%). 3. Posterior and posterolateral dislocations were about 60% of all cases. 4. Associated fractures were 35.6% of all the elbow dislocations, of which medial epicondyle fracture had the highest incidence. 5. Complications including ulnar nerve injury (3 cases), median nerve injury(1 case), radial nerve mjury(1 case), rupture of brachial artery(2 cases), recurrent dislocation(1 case) and calcification of ligament(2 cases) were observed. 6. Pure elbow dislocation occurred in 13 cases (28.9%). 7. The average immobilization period for patient with non-operative treatment (45%) and operative treatment(55%) were 7 days and 3 weeks, respectively, and much better results were seen in patients with non-operative treatment than in operative treatment and in shortened immobilization period.
Child ; Clinical Study ; Dislocations ; Elbow Joint ; Elbow ; Female ; Follow-Up Studies ; Gangwon-do ; Humans ; Immobilization ; Incidence ; Male ; Median Nerve ; Orthopedics ; Radial Nerve ; Rupture ; Shoulder ; Ulnar Nerve

Shortening and angular deformities in children are one of important orthopedic management problem. Conceptually, lengthening of the short side in treatment of limb length inequality is, in most instance, the most attractive approach to this problem. Throughout the evolution of lengthening procedures, the method that has remained most consistently acceptable is osteotomy followed by gradual distraction. However, the idea of increasing the length of or modifying the axis of s bone during growth by means of distraction of the grwoth plate is relatively new. Recently, Monticelli and Spinelli have had experience with a new and novel method of lower limb lengthening by physeal distraction. We have studied the results of effect of distraction epiphysiolysis and the use of nonsteroidal anti-inflammatory agents to impede bone bridge as well as premature epiphyseal closure. There are some reports in which indomethacin could prevent reformation of a bone bridge between the epiphysis and metaphysis without inhibiting normal growth and bone remodeling. For this study, a total of 30 rabbits with an initial weight of about 600 gram was used. At operation two K-wires(l.lmm in diameter) were drilled percutaneously on parallel trscks through the epipaysis and diaphysis of proximal tibia. Epiphyseal distraction of Turnbuckle type designed at our school was applied on each side of K-wire insertion at the tibia. The correct position of pin was confirmed by radiography and the rate of distraction is 0.5–1mm per day. Distrsction was continued for 3–6 weeks and radiographs was taken every 2 weeks. Some rabbits was sacrified sfter removal of distractor. Through these examination, following results were obtained. 1. Seperation of the epiphysis from the metaphysis occurred after average 3 days, and it always occurred in the zone of provisional calcification. 2. Short term results of growth plate distraction looked promising and longer limbs were seen, but long term results were unsstisfactory with premature epiphyseal closure and bone bridge formation occuring in many cases. 3. The role of indomethacine to impede bone bridge formation across the seperated growth plate could be observed, and was found that shortening could be possibly decreased. 4. Distraction epiphysiolysis would be one of valuable leg lengthening procedure at an age when the subjects bone growth is nearly complete, and also the administration of indomethacin with growth plate distraction might be effective to diminish the significant Change of shortening or angulation in high-risk juvenile fractures.
Anti-Inflammatory Agents, Non-Steroidal ; Bone Development ; Bone Remodeling ; Child ; Congenital Abnormalities ; Diaphyses ; Epiphyses ; Epiphyses, Slipped ; Extremities ; Growth Plate ; Humans ; Indomethacin ; Leg ; Lower Extremity ; Methods ; Orthopedics ; Osteotomy ; Rabbits ; Radiography ; Socioeconomic Factors ; Tibia

The degenerative arthritis following total menisectomy has led to consideration of the need for meniscal transplantation, this study evaluates the morphologic and histologic changes fol lowing fresh meniscal autograft and allograft in therabbits. Transplantation of the medial meniscus was carried out in two groups of 32 rabbits(autograft group=16 rabbits, allograft group=16 rabbits). The morphological and histological changes of the transplanted auto-and allografted menisci and the articular cartilage of the medial femoral and tibial condyle were observed at 2,4,6,8,10,12,22,28 weeks postoperatively. There were no significant differences between auto and allograft groups in gross appearance. Histologically, the fibrous adhesion was noted between grafted meniscus and joint capsule 2 weeks after operation, but complete healing was seen at the suture sites without rejection phenomenon at 6 weeks in both groups. There were prominent inflammatory reactions such as lymphocytes and inflammatory cells infiltration during early postoperative stages(2,4 weeks) only in the allograft group, and more prominent fibrotic reactions in the allograft group than auto-graft group. The results of this study suggest that meniscal allografts are able to adapt to the host tissues, survive within the joint environment, and provide a functional replacement for the removed meniscus, but further studies for graft-host immune response and a method to take the maintenance and deposits of graft must be needed to perform the meniscal allograft in human.
Allografts ; Autografts ; Cartilage, Articular ; Humans ; Joint Capsule ; Joints ; Knee Joint ; Knee ; Lymphocytes ; Menisci, Tibial ; Methods ; Osteoarthritis ; Rabbits ; Sutures ; Transplants

The fractures of the cervical spine are relatively uncommon, but they may cause serious neurologic deficits temporarily or permanently. So, it is very important to treat the patients early by way of exact evaluation for the sites and the mechanisms of the injuries. The authors reviewed retrospectively 188 cervical spinal fractures in 100 patients from Sep. 1984 to Aug. 1990. Commonly involed levels were C5 and C6 in lower cervical level and C2 in upper cervical level and the sites in each spine were body; lamina and odontoid process. The hyperflexion injury was the most common type of the cervical spinal fractures occupying 53% of all cervical fractures and cause more multipe fractures(2.26 fractures/patient) than in hyperextension (1. 68 fractures/patient). In hyperflexion injuries, body, transverse and spinous process were commonly involved but lamina fracture was relatively common in hyperextension injury. The dislocations associated with fractures were developed most commonly in hyperflexion injury and 70% of these were anterior dislocation and the most commonly involved levels were C5-6 and C6-7. In conclusion, hyperflexion injury needs more close examination for the entire spinal levels than injuries of other mechanisms because it results in more severe fractures with or without dislocation and relatively frequent multiple fractures in different levels.
Dislocations ; Humans ; Incidence* ; Neurologic Manifestations ; Odontoid Process ; Retrospective Studies ; Spinal Fractures* ; Spine

No abstract available.
Diabetes Mellitus* ; Hearing* ; Humans

OBJECTIVE: Our purpose was to investigate the relation between types of early diastolic notch and placental location and to evaluate the differences in perinatal outcomes. METHODS: We evaluated the Doppler waveform of the uterine artery in 149 pregnant women having an early diastolic notch after 26 weeks gestation, however we were unable to follow the obstetric outcomes in 20 women. Placental location was determined by transverse view of ultrasonography and classified as central and lateral placenta. The unilateral diastolic notches were divided into 3 groups depending on the placental location (ipsilateral: same side of the placenta, contralateral: opposite side of the placenta, and median: central placenta) RESULTS: In the bilateral notch group, the S/D ratio of the contralateral uterine artery was higher than the ipsilateral one(n=60, mean=3.22 Vs 2.80, p=0.0067). Of the 89 unilateral notches observed, the S/D ratio of the uterine artery in patients having early diastolic notch was higher compared to those without early diastolic notch.(t-test, mean=2.74,1.92, p=0.0001) Patients with bilateral notches were associated with poor perinatal outcomes significantly more than the patients with unilateral notches(p=0.003). Among the unilateral groups (ipsilateral: n=10, median: n=21, contralateral: n=58), there was no significant difference in perinatal outcomes. CONCLUSION: The early diastolic notch can be observed on both or either sides of the uterine artery independent on placental location. More bilateral notches were associated with poor pregnancy outcomes than unilateral notches. The pregnancy outcomes tended to be similar in unilateral notch irrespective of placental location, but showed worse outcomes than the control group. Careful analysis of the uterine artery in nonplacental side is necessary because of the frequent appearance of early diastolic notch and higher vascular resistance.
Female ; Humans ; Placenta ; Pregnancy ; Pregnancy Outcome ; Pregnant Women ; Rheology* ; Ultrasonography ; Uterine Artery* ; Vascular Resistance

No abstract available.
Cardiac Tamponade*