Pulmonary atresia with major aorto-pulmonart collateral arteries(abbreviated as MAPCA in the following)as a route for pulmonary blood flow presents many problem in diagnosis and management and recently new approach to surgical management (unifocalization)was suggested and few reported it's application. Nineteen cases who had pulmonary with MAPCA, diagnosed at Seoul National University Children's Hospital from October 1987 to May 1989, were studied to lool at the relationship between MAPCA, central pulmonary artery and segmental pulmonary arteries. Also was observed the clinical course and operative management. The average number of MACPA in each patient was 4, two toward right lung and the other two toward left lung. MACPA arose most frequently from descending aorta and innominate artery contralateral to the side of aortic arch. Central pulmonary artery was identified in 86.7%. The number of bronchopulmonary segment connected to central pulmonary artery directly or indrectly was very variable so was the number of bronchopulmonary segment connected to MAPCA only. Three had a total correction and 14 had a various kinds of palliative operation once or twice. Seven had a called "unifocalization"(connection of MAPCA to central pulmonary artery) to correct arborization abnormality but the result was not satisfactory for technical reason.
Aorta, Thoracic ; Arteries* ; Brachiocephalic Trunk ; Diagnosis* ; Humans ; Lung ; Pulmonary Artery ; Pulmonary Atresia* ; Seoul

No abstract available.
Fractures, Spontaneous* ; Humerus* ; Replantation* ; Sarcoma, Ewing*

BACKGROUND AND OBJECTIVES: Idiopathic restrictive cardiomyopathy is a very rare and poorly recognized disease in children. This study is performed to describe the clinical course and to define potential predictors of outcome. MATERIAL AND METHOD: We reviewed the medical records and diagnostic studies of 11 consecutive patients during the period from Jan.1991 to Aug. 2000. RESULTS: The age at diagnosis was 1.2-13 years (median 7 years) and the duration of follow up was 3-90 months (median 3.6 years). All except one were symptomatic (dyspnea in ten, chest pain in four). The chest pain was associated with significant ST depression on both resting and exercise ECG, suggesting myocardial ischemia. Two had complete heart block as either initial or terminal event. Cardiac catheterization was done in nine ( mean pulmonary arterial wedge pressure 23+/-6mmHg, systolic pulmonary arterial pressure 47+/-14mmHg, mean right atrial pressure 11+/-9mmHg). Echocardiographic dimensional ratio of left atrium and aorta (LA/Ao) was 2.41+/-0.58. Mitral E/A inflow ratio was 2.72+/-1.42, E wave deceleration time was 93.6+/-44.2ms. During follow up, six died. The 2 year and 5 year cumulative survival rates were 54.5% and 18.8% respectively. The predictor for nonsurvivor were pulmonary venous congestion and LA/Ao >2.5(p<0.05). Verapamil was tried in 6 cases without favorable effect in all. CONCLUSION: Considerable numbers of restrictive cardiomyopathy have myocardial ischemia associated with ST depression and chest pain. The patients with pulmonary venous congestion and severe left atrial enlargement (LA/Ao>2.5) were at risk for death, requiring prompt definitive treatment such as cardiac transplantation.
Aorta ; Arterial Pressure ; Atrial Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathy, Restrictive* ; Chest Pain ; Child* ; Deceleration ; Depression ; Diagnosis ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Heart Atria ; Heart Block ; Heart Transplantation ; Humans ; Hyperemia ; Medical Records ; Myocardial Ischemia ; Pulmonary Wedge Pressure ; Survival Rate ; Verapamil

No abstract available.
Posterior Cruciate Ligament*

STUDY DESIGN: This study analyzed the efficacy of the reduction and its maintenance using the posterior pedicular screw system in adult patients undergoing surgical treatment for symptomatic, isthmic spondylolisthesis. OBJECTIVE: To evaluate the effect of the reduction for lumbar isthmic spondylolisthesis in adult. SUMMARY OF LITERATURE REVIEW: If the increase of the shear force is approved as a main biomechanical feature of spondylolisthesis, reduction of the shear forces to the physiologic level must be regarded as the goal of surgical treatment. MATERIALS AND METHODS: 11 cases were treated with posterior monosegmental two point f;cation and posterolateral fusion (Group 1), 8 cases with a combined surgery of posterior monosegmental two point fixation, posterolateral fusion and anterior interbody fusion (Group 2), and 20 cases with posterior two segmental three point fixation and posterolateral fusion (Group 3). We assessed the clinical results and the radiologic objective parameters. RESULTS: The patients were followed up for more than 2 years (mean : 64 months). The satisfactory clinical results were 9 cases (81.8%) in Group 1 ,7 cases (87.5%) in Group 2 and 17 cases (85%) in Group 3. Radiologically, the efficacy of reduction and its maintenance were satisfactory results in Group 2, and the changes of the slip angle and the disc height showed that the loss of correction was greater than postoperative correction, although there were no statistical significant differences in the three groups. CONCLUSION: According to the our results, there was no significant relationship between the clinical result and the rdiological one. However, we think that the correcton of the deformity using the posterior pedicular screw system have some biomechanical advantages and seem to be recommendable for the treatment of isthmic spondylolisthesis in adults.
Adult* ; Congenital Abnormalities ; Humans ; Spondylolisthesis*

Injuries in the industries has been steadily increasing in this country in recent years. Injuries in the industries intricate in accoriance with the industrial environment, mechanism of injuries and the other factors of employees. In 6 years 201 patients with industrial injuries underwent treatment in the Department of Orthopaedic Surgery of the National Medical Center, and the result of treatment is reported in this paper. 1. 70 cases out of 201 cases were in the age group between 21 to 30 year. 186 cases were male and 15 were female. The incidence is remarkably higher in male. 2. In 80 cases the injuries were caused by machinery with pressor parts. The patients were chiefly manual workers in factories. 3. Of 280 injuries, 148 (62.8%) were upper extremities, 105 (37.5%) were lower extremities and 27 (96%) were trunks. The most common site of injuries was hand. 4 Of 146 injuries with fractures, 94 were treated by manual reduction and cast, and 52 were treated by open reduction. 5. Treatment for open wounds was debridement followed by delayed primary closure and/or skin graft. The primarily closed open wounds by local clinics were observed and treated according to wound condition. 6, 17 cases out of 22 phalangeal bone fractures were treated by manual reduction and splint. 5 cases were treated by K-wire internal fixation, among them 3 cases had to be treated by amputation. 7. Incidence of early camplication was considerably high with 137 sites out of 280 sites and the late complication was 79 sites after treatment of the early complications.
Amputation ; Debridement ; Female ; Fractures, Bone ; Hand ; Humans ; Incidence ; Lower Extremity ; Male ; Skin ; Splints ; Transplants ; Upper Extremity ; Wounds and Injuries

Potentially, some donor site complications are associated with the harvesting of autogenous tricortical iliac bone grafts for anterior spinal fusion. The purpose of this study was to evaluate the reliability of the anterior iliac crest reconstruction after harvesting autogenous iliac grafts for anterior spinal fusion. We devided into two groups : the study group were the anterior iliac crest reconstruction in 57 patients with minimal twelve months follow up period, the control group were not the anterior iliac crest reconstruction in 21 patients who could not obtain the rib from retroperitoneal approach. The average follow up was obtained at 43.3 months(12 to 72 months) in study group, at 41.6 months(12 to 60 months) in control group. The study group had a tendency to improve the donor site pain after incorporation of the rib graft and the control group tend to remain the donor site pain till late especially in the thinner group and combined disease group. In residual deformity of the donor site, the study group was superior to the control group. Residual deformity of the study group was associated with the complications such as displacement and resorption of the grafts. Cosmetic residual deformity tends to be higher in the thinner group. Radiographically all rib gragts incorporated in situ in 51 patients despite of some cases of migration(Average 11 weeks and 4 days) and clinical results did not affect by biological behavior of rib grafts on the follow up radiogram. The authors attempted anterior iliac crest reconstruction using the implants (Mennen plate in 3 patients, threaded pin in 3 patients) after large harvesting of autogenous tricortical graft in 6 patients who could not obtain the rib from retroperitoneal approach or could not fit the rib too the defect. In those cases the results were satisfactory clinically. These results suggest anterior iliac crest reconstruction can minimize painful deformity after the harvesting of autogenous tricortical iliac grafts for anterior spinal fusion.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Ribs ; Spinal Fusion ; Tissue Donors ; Transplants

To assess the adequacy of medical manpower and medical fee for the newborn nursery care, the author visited 20 out of 24 hospitals with the pediatric training program in Youngnam area between July 29 and August 14, 1991. Total number of newborn, both normal and sick, admission and discharge in 1--30 June 1991 was obtained from the logbook of nursery. Head nurse and staff pediatrician of the nursery were interviewed to get the current staffing for the nursery and their subjective opinion on the adequacy of nursery manpower and the difficulties in recruiting manpower. Average medical fee charged for the maternity and normal newborn nursery care was obtained from the division of self-audit of medical insurance claim of each hospital. Average minimum requirement of nursing care time for one normal newborn per day was 179.5 (+/-58.6) minutes; 2023(+/-50.7) minutes for the university hospitals and 164.2(+/-60.5) minutes for the general hospitals. The ratio of minimum requirement of nursing care time and available nursing time was 1.42 on the average. Taking the additional requirement of nursing care for the sick newborns into consideration, the ratio was 2.06. The numbers of R. N. and A. N. in the nurserys of study hospitals were 31%, and 17%, respectively, of the nursing manpower for the nursery recommended by the American Academy of Pediatrics. These findings indicate that the nursing manpower in newborn nursery is in severe shortage. Ninety percent of the head nurses and 85% of the staff pediatrician stated that the newborn nursery is short of R.N. and 75% of them said that the nurse's aide is also short. Major reason for not recruiting R.N. was the financial constraint of hospital. For the recruitment of nurse's aide, short supply was the second most important reason next to the financial constraint. However, limit of quarter in T.O. was the major reason for the national university hospitals. Average total medical fee for the maternity and newborn nursery cares of a normal vaginal delivery who stayed two nights and three days at hospital was 219,430Won. Out of the total medical fee, 20,323Won(9.3%) was for the newborn nursery care. In case of C-section delivery six nights and seven days, who stayed otal medical fee was 732,578Won and out of the total fee 76,937Won (12.0%) was for the newborn care. Cost for a newborn care per day by cost accounting was 16,141Won for the tertiary care hospitals and 14,576Won for the all other hopitals. The ratio of cost and the fee schedule of the medical insurance for a newborn care per day was 5.0 for the tertiary care hospitals and 4.9 for the all other hospitals. Considering the current wage level of the medical personnel, capital investment for the hospital facilities and equipments, and the cost for hospital maintenance, it is hard to expect adequate quality care in the newborn nursery under the current medical insurance fee schedule.
Education ; Fee Schedules ; Fees and Charges ; Fees, Medical* ; Hospitals, General ; Hospitals, University ; Humans ; Infant, Newborn* ; Insurance ; Investments ; Maintenance and Engineering, Hospital ; Nurseries* ; Nursing ; Nursing Care ; Nursing, Supervisory ; Pediatrics ; Salaries and Fringe Benefits ; Tertiary Healthcare

We report a case of cutaneous T-cell lymphoma in a 40-year-old man. He has suffered from generalized pruritus for 10 years. Seven months ago, multiple nodules developed over the scalp, face, and thigh. The physical examination showed thickened dystrophic twenty nails with brownish discoloration and lichenified, eczematoid lesions over the trunk and extremities. The skin biopsy revealed diffuse, extensive infiltrates of atypical lymphoid cells in the dermis, which appeared as T lymphocytes by immuno-histochemistry; approximately 90% of the tumor cells were CD3-positive, 80% were CD4-positive, and 60% CD45RO-positive. Laboratory analyses in the peripheral bload showed 18% atypical lymphocytes (Sezary cell), an elevated LDH(746 U/liter), and abnormal lymphocyte subset proportions(ratio of Th/Ts is 4.08). A bone marrow puncture revealed the infiltrations of lymphoid cells and computed tamo-graphy showed no evidence of other organ involvement except the swelling of bilateral inguinal lymph nodes. Spontaneous partial regression of the tumors ensued on the way of oral antihistamines and topical corticosteroids for the relief of the pruritus. The tumorous skin lesions and onychodystrophy disappeared completely with 6 cycles of systemic chemotherapy of CHOP(cyclophosphamide, doxoru-bicin, vincristine, and prednisone).
Adrenal Cortex Hormones ; Adult ; Biopsy ; Bone Marrow ; Dermis ; Drug Therapy ; Extremities ; Histamine Antagonists ; Humans ; Lymph Nodes ; Lymphocyte Subsets ; Lymphocytes ; Lymphoma, T-Cell, Cutaneous* ; Physical Examination ; Pruritus ; Punctures ; Scalp ; Skin ; T-Lymphocytes ; Thigh ; Vincristine

No abstract available.
Angiography* ; Heart Septal Defects, Ventricular* ; Pulmonary Artery* ; Pulmonary Atresia*