The central venous catheter(Quinton) was replaced in the right atrium for chemotherapy and blood sampling to a eight-year old girl with acute lymphoblastic leukemia. The catheter was flushed with heparin two times daily and the chemotherapeutic drug regimens by CCSG-105 protocol were vincristine, prednisone, L-asparaginase, daunomycin, methotrexate, cyclophosphamide, cytosine arabinoside, 6-mercaptopurine and adriamycin. On day 31 of catheterization, the lumen for blood sampling was blocked. From day 60 of catheterization, anorexia, nausea, vomiting, abdominal distension and tachypnea were developed. Echocardiogram, lung scan, pulmonary function test(PFT), arterial blood gas analysis (ABGA) were done. Two cemtimeters in diameter of thrombosis was found in the right atrium on echocardiogram. The lung scan showed slight decrease in uptake of Tc-99m on the whole lung fields. Restrictive ventratory impairment on PFT and decreased PaO2(48 mmHg) on ABGA were found. To lysis of thromboembolism, urokinase(4,400 IU/kg for initial 10 minutes and the 4,400 IU/kg for 12 hours) was injected intravenously and aspirin(30 mg/kg/d, po) was given. The thrombosis was disappeared from the atrium on echocardiogram and PaO2 was increased up to 97 mmHg temporary. The catheter was removed but total haziness on the right middle and lower lobes were developed after 5 days. The same dose of urokinase was injected just infront of the embolism through Pitfall catheter for 8 days intermittently as results of pulmonary angiography. Symptoms and PaO2 were alleviated and the lung was expanded with mild atelectasis on day 55 of the first fibrinolytic enzyme therapy. Although the frequent complications of central venous catheter are catheter occlusion and infection, we have to check the development of thromboembolism with echocardiogram periodically or in case of unexplained respiratory symptoms.
6-Mercaptopurine ; Angiography ; Anorexia ; Blood Gas Analysis ; Catheterization ; Catheters ; Central Venous Catheters* ; Cyclophosphamide ; Cytarabine ; Daunorubicin ; Doxorubicin ; Drug Therapy ; Embolism ; Enzyme Therapy ; Female ; Heart Atria ; Heparin ; Humans ; Lung ; Methotrexate ; Nausea ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prednisone ; Pulmonary Atelectasis ; Tachypnea ; Thromboembolism* ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Vincristine ; Vomiting

From May, 1971 to June, 1984, we performed extensive saucerization on the chronic osteomyelitis of long bones eradicating all pathologic foci; not only sequestra but sclerotic involocurum and necrotic original cortex embeded by new bone, which was different from the conventional methods such as sequestrectomy or guttering in its extensiveness. Clinical analysis on the base of radiologic evaluation after saucerization was done on the 16 patients; for average 5 years of follow-up. The results obtained were as follows; 1. The angulatory deformity of the long bones after pathologic fracture complicated by the chronic osteomyelitis was not corrected satisfactorily due to the bony sclerosis or hyperostosis at the fracture site, especially in cases of posterior or medial angulation. 2. The recurrence was closely related to the persisting non-sequestered original cortical lesion after incomplete saucerization, which was embeded by the new bone. So to prevent the recurrence the non-sequestered original cortical lesion must be removed completely. 3. The cortical defect after saucerization was restored completely in patients under the age of 14, but which was not the way in patients over the age of 16.
Congenital Abnormalities ; Follow-Up Studies ; Fractures, Spontaneous ; Humans ; Hyperostosis ; Osteomyelitis ; Recurrence ; Sclerosis

The first metacarpal base fracture is classified as extra-articular fracture, intra-articular fracture and epiphyseal injury. Intra-articular fracture was firstly described in 1882 by Bennett and Rolando described about Y shape comminuted fracture in the first metacarpal base in 1910. In 1938, Robert wrote about oblique fracture injured by first metacarpal base fracture. First metacarpal base fracture can be adjusted easily by C/R, but it is difficult to maintain the good axis. In case of fail of reduction, malunion, joint stiffness and traumatic arthritis can be shown as complications and finally some problems in grasping and pinching are resulted. Therefore, firstly the most accurate reduction, secondarily effective method to maintain the condition and thirdly the protection of limitation of motion are goal of treatment. Authors reviewed 17 cases treated by 0/R & C/R for the past 5 years from 1975 to 1980 at National Medical Center, especially reviewed the cases of which observation more than 1 year was possible. The results were as followings: 1. The incidence of first metacarpal base fracture was 1.0% of all fractures & dislocations. 2. Out of 17 cases, there were 14 male and right side 9 cases and left side was 8 cases. 3. The most common case of fracture was injury at work and traffic accident, sports injury, slipping down and falling down. 4. The method of treatment were C/R & percutaneous pinning in 10 cases and 0/R & K-wire fixation were 7 cases. 5. The result of treatment showed 8 excellent, 1 good, 1 fair, out of 10 cases of C/R and percutaneous pinning. In 0/R and K-wire fixation, 4 excellent, 2 good, and 1 fair showed out of 7 cases. 6. Soft tissue infection was appeared from 1 case of open fracture which accompanied second metacarpal fracture as complication and it caused adduction contracture in first web space.
Accidental Falls ; Accidents, Traffic ; Arthritis ; Athletic Injuries ; Clinical Study ; Contracture ; Dislocations ; Fractures, Comminuted ; Fractures, Open ; Hand Strength ; Humans ; Incidence ; Intra-Articular Fractures ; Joints ; Male ; Metacarpal Bones ; Methods ; Soft Tissue Infections

T The Flexor tendon injury caused by trauma of hand and forearm is commonly reported and earlier treatment for trauma is recommendable. But in many cases, earlier treatment is often not possible due to degree of injured tissues and infection. Specially in cases of severe trauma and damage of tendon sheath and pulley, the solution of limitation of motion is still remained as a difficult problem up to present due to scar tissue adhesion to surrounding tissues even after the primary treatment. The Department of orthopaedic surgery of National Medical Center during four years from 1981 to 1985 have treated 22 patients (27 fingers) of old flexor tendon injuries with tendon reconstruction and followed up more than for 6 months for clinieal study arrd the results ase as follows: 1. The old flexor tendon injuries are composed of 18 patients of the first decade and the second decade, especially in male. 2. The main causes of injury were deep lacerations by sharp objects (12 patients, 55.6%) and crushing injuries (9 patients, 40.8%). 3. Tendon injuries were mostly occurred in the index and ring finger. The incidence rate was equal between the 2 fingers, 25.7% representatively. Most of the injuries (21 cases, 77.8%) occurred in the zone II (Kleinert classification). 4. According to Boyes' classification, Grade 2 was 16 patients (19 cases): Grade 4, 3 patients (4 cases): Grade 3, 2 patients (3 cases): and Grade 5, 1 patient. 5. The operation method in zone II was free tendon graft in 10 cases and staged tendon graft in 7 cases. 6. The timing of operation depends on whether the open wounds were completely healed or not as well as subsidence of swelling. In case of swelling. In case of stiff fingers normal range of motions should be restored by vigorous exercise before operation. 7. According to the assessment based on strickland and Glovac, 20 cases out of 22 cases (13 cases of free tendon graft and 9 cases of staged tendon graft were satisfactory result.
Cicatrix ; Classification ; Clinical Study ; Fingers ; Forearm ; Hand ; Humans ; Incidence ; Lacerations ; Male ; Methods ; Reference Values ; Tendon Injuries ; Tendons ; Tissue Adhesions ; Transplants ; Wounds and Injuries

Fourteen total cystectomy specimens with primary carcinoma of urinary bladder were investigated to illustrate the overall prevalence and nature of mucosal changes adjacent to the overt carcinoma and to clarify the distribution pattern and extent of carcinoma in situ in regard with multiplicity, histological type and depth of invasion of the macroscopically visible tumor mass. Of 14 cases subjected to this study were 12 cases of transitional cell carcinoma of varying degree of differentiation and invasion, one adenocarcinoma, and the another one with no grossly detectable tumor but history of previous cystoscopic removal of papillary transitional cell carcinoma. Each specimen was processed by a histotopographic technique developed by authors, an easy access to reconstruct the mucosal changes using reconstruction paper. For the histological grading and staging of the overt carcinomas, Ash's and Collins' classifications were applied, respectively. Carcinoma in situ (CIS) was found in 10 out of 11 cases with overt urothelial carcinoma of urinary bladder and one case with no grossly visible neoplasm, in which cystoscopic removal of papillary carcinoma was carried out previously. Distribution pattern of CIS was mostly circular (group I) or arborizing (group II) , located around the overt carcinoma within 0.5 to 2.0cm., but not beyond 3.0cm. from its margin. Correlation between multiplicity of overt carcinomas and presence of CIS was evident together with irregularity of its distribution, but no significance was found with gross appearance, histological grading or with staging.
Adenocarcinoma ; Carcinoma in Situ* ; Carcinoma, Papillary ; Carcinoma, Transitional Cell ; Classification ; Cystectomy ; Mucous Membrane* ; Prevalence ; Urinary Bladder*

Gangweon-do is known to be highly endemic area of sparganosis more than other provinces in Korea. A seroepidmiologic examination for the detection of anti-Spirometra erinacei plerocercoid IgG in serum was carried out in normal inhabitants in Hongcheon-gun, Gangweon-do. Sere were tested by enzyme-linked immunosrobent assay (ELISA) for the anti-sparganum antibodies. Positive rate for anti-sparganum antibody in 719 adults was 3.3%. Data of the questionnaire for 24 ELISA positive inhabitants revealed that 20 had a history of eating raw meat of snakes, 24 had a history of eating frogs, and 24 had a history of drinking stream water. Two positive cases had a past history of sparganosis. Two positive cases showed current symptoms of sparganosis. The data revealed that ELISA would be useful to find infected cases among normal inhabitants at sparganosis-endemic areas.
Adult ; Aged ; Aged, 80 and over ; Animals ; Antibodies, Helminth/*blood ; Enzyme-Linked Immunosorbent Assay ; Female ; Human ; Immunoglobulin G/*blood ; Korea/epidemiology ; Male ; Middle Aged ; Seroepidemiologic Studies ; Sparganosis/*epidemiology ; Spirometra/*immunology

Moderate to severe unilateral ptosis has previously been treated with levator resection or frontalis sling and cosmetic double fold in the opposite eyelid. This method often resulted in undesirable asymmetrical lid lag phenomenon in down gaze. From December 1991 to December 1994, we treated 65 cases of unilateral ptosis with frontalis sling or levator resection, and simultaneously cosmetic frontalis sling have been performed in the unaffected normal eyes of 41 patients and cosmetic double fold have been performed in the unaffected normal eyes of 11 patients. After 6 months of operation, authors survey the patients content. The number of cases of content were 4(36.36%) in 11 cosmetic double fold group and 31(75.6%) in 41 cosmetic frontalis sling group. The content after cosmetic frontalis sling was higher than cosmetic double fold. Asymmetrical lid lag phenomenon on downward gaze which is inevitable complication postoperatively was reduced by means of cosmetic frontalis sling of unafeected normal eye in unilatral ptosis. The authors expect that the patient will be more satisfied with the result of symmetrical lid lag in down gaze after cosmetic frontalis sling of unaffected normal eye in aesthetic aspect.
Eyelids ; Humans

No abstract available.
Cryptococcosis* ; Tuberculosis, Pulmonary*

Evaluations of residual renal function and the therapeutic effectiveness in renal tuberculosis have largely been dependent on intravenous pyelogram or Contrast-CT scan, even though, exact renal function are not evaluated with there methads. 99mTc-DMSA is a radiopharmaceutical that is trapped in the functioning tubular cells of the kidney and therefore, quantitative renal function could be evaluoted by ineasuring the counts of renal radioactivity and concomittant evaluation of renal morphology could be passible with the analog imapes of the radioactivity. The authors retrospectively analyzed 99mTc-DMSA scans of 75 kidndys of 67 patients with confirmed renal tuberculosis. We classified the morphologies of tuberculous kidneys as 6 types. We classified the morphologies of tuberculous kidneys as 6 types such as the type with small cortical defect, with parenchymal ulcerocavernous lesions, ulcerocavernous fistula to pelvis, mass-like defects, contracted kidney with ureter visualization, and the type with nonvisualization of kidney, corresponding to the characters of renal tuberculous pathogenesis with abscess formation, ulcerocavernous fistula, and fibrosis, and correspondings to the renal anatomy with parenchyma, and pelvocalyceal collecting system. Their mean residual renal functions measured with 99mTc-DMSA uptake rates were 19.0%, 18.4%, 7.9%, 12%, 4.1%, 3.4% respectively.
Abscess ; Fibrosis ; Fistula ; Fluspirilene ; Humans ; Kidney ; Pelvis ; Radioactivity ; Retrospective Studies ; Succimer* ; Technetium Tc 99m Dimercaptosuccinic Acid ; Tuberculosis, Renal* ; Ureter

Decentralization to local governments and amending of Health center Law are to promote the efforts of health planning at the level of local agencies. In the health facility planning, it is important to take into account that what to be built, where to be located, how far should be service area and so forth, because health facilities are immovable, and require capital as well as personnel and consumable supplies. The aim of our study, answering to the question of 'where to be located?`, is to determine the best location of urban health sub-center. At the local level, planning is the matter of finding the best location of specific facility, in relation to population needs. We confine the accessibility, which is basic to location planning, to geographic one. Location-Allocation Model is used to solve the problem where the location is to maximize geographic accessibility. To minimize the weighted travel distance, objective function, Rk= aijwidij is used. Distances are measured indirectly by map measure-meter with l:25,000 Suwon map, and each potential sites, 10 administrative Dongs in Kwonson Gu, Suwon, are weighted by each number of households, total population, maternal age group, child age group, old age group, Relief for the livelihood, and population/primary health clinics. we find that Kuwoon-Dong, Seodun-Dong, Seryu3-Dong, according the descending orders, are best sites which can minimize the weighted distance, and conclude that it is reasonable to determine the location of urban health sub-center among those sites.
Child ; Equipment and Supplies ; Family Characteristics ; Gyeonggi-do ; Health Facilities ; Health Facility Planning ; Health Planning ; Humans ; Jurisprudence ; Maternal Age ; Politics ; Urban Health*