In the treatment of dislocations and subluxations of the hip in the older children, whether congenital or paralytic, orthopedic surgeons are blessed with a wide variety of commonly used surgical procedures; namely, Salters innominate osteotomy, acetabtloplasties, Pembertons pericapsular osteotomy, shelf operations, Chiaris pelvic displacement osteotomy. and Colonnas capsular arthroplasty. However, with increasing age and soft tissue contractures,these procedures become ineffective, leaving a wide range of age between older children and young adults subject to uncertain or unfavarable prognosis. Steels triple osteotomy (1973) is aimed at coverig this age group, when displacement or in nominate osteotomy is either technically infeasible or likely to fail. It consists of an open reduction with or without soft tissue release and skeletal traction, redirection of the acetabulum to cover the femoral head by osteotonmies of the pelvis that has lost its young cartilagenous resiliency, and preservation and physiological remodelling of the articular cartilage of the acetabulum. We performed Steels osteotomy on a 21-years-old female with a severe paralytic subluxation of the hip associated with pelvic obliquity and paralytized both lower extremities. One and a half year follow-up result was satisfactory with a stable and congruous joint despite paralysis and with the patient walking for the first time in her life.
Acetabulum ; Adult ; Arthroplasty ; Cartilage, Articular ; Child ; Dislocations ; Female ; Follow-Up Studies ; Head ; Hip ; Humans ; Joints ; Lower Extremity ; Orthopedics ; Osteotomy ; Paralysis ; Pelvic Bones ; Pelvis ; Prognosis ; Steel ; Surgeons ; Traction ; Walking ; Young Adult

Acute mobile thrombus of the abdominal aorta after chemotherapy is a very unusual finding, which can be a potential source of arterial embolism. We report here on a case of an acute mobile aortic thrombus with renal infarction. We successfully treated the patient with hybrid operation-open surgical and endovascular approach. Our case shows that hybrid treatment using wire-directed balloon catheter thrombectomy is a feasible, minimally-invasive treatment for a mobile aortic thrombus.
Angioplasty ; Aorta ; Aorta, Abdominal ; Catheters ; Chimera ; Embolism ; Humans ; Infarction ; Thrombectomy ; Thrombosis

No abstract available.
Animals ; Liver* ; Rats* ; Selenium*

We experienced a case of unilasteral vocal cord paralysis following cuffed endotracheal intubation for abdominal surgery. The patient had have no laryngotracheal symptoms prior to the operation and anesthesia was uneventful. He complained of hoarseness post-operatively but no visible evidence of trauma secondary to the intubation was mainfested on the indirect laryngoscopic examination, except left vocal cord paralysis. There were no obvious causes for the vocal cord paralysis and possible etiologic factors. Therefore, no specific treatment was done except for the bed rest, humidification and gurgling. Vocal cord function returned nearly normal after six months.

To provide optimal obstetric anesthetic care, it is essential for the anesthetist to know well the maternal physiological alterations produced by pregnancy, labor and paturition, physiology and pharmacology of the fetal placental complex and how these are altered by analgesics and anesthetics (Bonica, 1972). Recently, the tendency to cesarean section has increased; the cesarean section rate was 8.1. (Lee et al., 1974) and 15% (Dripps et al., 1977). Choice of regional or general anesthesia for cesarean section depends on many factors. As, the paturient is considered to have a full stomach, regional anesthesia is advantageous. However, if the indication is fetal distress or maternal hemorrhage, the necessity for rapid delivery overrides all other considerations. For elective cesarean section the choice of anesthesia largely relates to patients condition and physicans preference, although the somewhat. longer time required for delivery in a repeated cesarean section may indicates regional rather than general anesthesia (Dripps et al., 1977; James et al., 1977). The problem of anesthetic management of cesarean section was fetal depression due to sedatives, analgesics and anesthetics during delivery. In emergency cesarean section, the major problem in general anesthesia is aspiration of gastric contents and in regional anesthesia it is hypotension. Regarding fetal and neonatal depression associated with anesthesia, the effects of general or regional anesthesia or. the neonatal neurobehavioral status have been reported by many authors (Standley et al., 1974; Tronick et al., 1976; Hollmen et al., 1978). Thus we have made a clinical analysis of anesthesia for 300 cases by random sampling among 1725 cesarean sections. including emergency and elective operations, performed from July 1973 to June 1978 in Severance Hospital at Yonsei University College of Medicine. Clinical analysis was made of frequency of cesarean section, age distribution, parity, indication of cesarean section, physical status (A.S.A. classification), premedication, anesthetic method, relationship between Apgar score and the type of anesthesia, relationship between induction to delivery time and one minute Apgar score, time to initial blood pressure drop after spinal anesthesia, blood loss, the methods of cardiopulmonary resuscitation of the newborn, perinatal mortality and neonatal neurobehavioral states. The result are as follows: 1) The incidence of cesarean action was 18.4 percent of total deliveries and the tendency is increasing. 2) One minute Apgar score in spinal anesthesia is better than in general anesthesia (0. 01 < p < 0.025). 3) Blood loss in spinal anesthesia (566+/-146 ml) is less than in general anesthesia(796+/-388ml). 4) Blood pressure showed a drop within ten minutes in 83 percent of cases after induction of spinal anesthesia. 5) Perinatal mortality of general anesthesia (3.9%) is more than spinal anesthesia (1.9%). Even though clinical results of spinal anesthesia seem to be more favorable than those of general anesthesia, from the above observation it may be concluded that choice of anesthesia for cesarean section depends on each maternal condition and only one anesthetic method should not be exclusively used.
Age Distribution ; Analgesics ; Anesthesia* ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal ; Anesthetics ; Apgar Score ; Blood Pressure ; Cardiopulmonary Resuscitation ; Cesarean Section* ; Depression ; Emergencies ; Female ; Fetal Distress ; Hemorrhage ; Humans ; Hypnotics and Sedatives ; Hypotension ; Incidence ; Infant, Newborn ; Parity ; Perinatal Mortality ; Pharmacology ; Physiology ; Pregnancy ; Premedication ; Stomach

This is a case report of a 5-month-old male who was brought in to hospital for evaluation of jaundice from birth. The baby had a history of ileal atresia operated 2 days after birth. At the age of one month, Tc-99m DISIDA hepatobiliary scintigraphy was performed at other hospital and reported to show good hepatic uptake of the tracer but no uptake in the billiary tree, gall bladder, or intestine for 24 hours post injection. He was judged to have biliary atresia. However, subsequent exploratory laparotomy revealed that the hepatobiliary tree appeared intact and that there was a gall bladder. Additionally, the patient had central aorto-pulmonary shunt for the right ventricular septal defect with pulmonary stenosis of a peripheral type at the age of 4 months. The second hepatobiliary scintigraphy was performed on admission at the age of 5 months, showing a gall bladder but no intestinal uptake up to 24 hours. Retrospectively, the histological specimen of the liver obtained at the exploratory laparotomy was re-evaluated, and by the histological findings coupled with clinical data, arteriohepatic dysplasia (Alagille's syndrome) was diagnosed. In this report, we emphasize the diagnostic limitation of hepatobiliary scintigraphy and the importance of overall clinical and histologic evaluation in a case of Alagille's syndrome. (Korean J Nucl Med 2000;34:154-158)
Alagille Syndrome* ; Biliary Atresia ; Heart Septal Defects, Ventricular ; Humans ; Infant ; Intestines ; Jaundice ; Laparotomy ; Liver ; Male ; Parturition ; Pulmonary Valve Stenosis ; Radionuclide Imaging ; Retrospective Studies ; Urinary Bladder

OBJECTIVE: The heart diseases are known as a major cause of sudden death, as well as a cause of poor life-quality of school-age children. But there have been few mass screening of heart diseases in these children in Korea. This study was done to estimate the prevalence of heart diseases of these population. METHODS: We screened all elementary students(grade 1) in 12 cities and 16 counties(Gun) in Kyonggi province from 1992 to 1995. The first screening was done by auscultation of doctors and simultaneously by checking using 'auto-interpreter of EKG-cardiac sound'(Fukuda Densi ECP 50A). We conducted futher examinations to whom classified as being abnormal condition in first screening, by using EKG, chest x-ray, doppler echocardiograpy(if needed). RESULTS: The total number of examined students was 161,308(92% of the population), the male were 83,238 and female were 78,070. The congenital heart diseases(CHD) patients were 290(18 per 10,000) - male 155(18.6 per 10,000) and female 135(17.3 per 10,000). The most frequent disease was ventricula septal defect(VSD, 45.5%), Atrial septal defect(ASD, 14.8%), Tetralogy of Follot(TOF, 11.7%), and Patent Dutus Arteriosis(PDA, 7.6%) in order. In female, the order was VSD(48.1%), ASD(13.3%), TOF(11.1%), and PDA(10.4%). The total number of EKG abnormality were 433(62.7 per 10,000) among 69,056 screened children in 1995. The complete right bundle branch block(CRBBB) and paroxymal ventricular contraction(PVC) were frequent(26.6%, 26.3% in each), and incomplete right bunddle branch block(IRBBB,14.6%), paroxymal atrial contraction(PAC, 6.7%), abnormal Q(5.8%), Wolf-Pakinson-White syndrom (5.5%) in order. In female, the most frequent abnormality was PVC(29.8%), and CRBBB(19.9%) in order. CONCLUSION: We could present the stable prevalence of the rare heart disease. The prevalence of congenital heart diseases was 18.0 per 10,000 and of EKG abnormality was 62.7 per 10,000 among school children.
Auscultation ; Child* ; Death, Sudden ; Electrocardiography ; Female ; Gyeonggi-do* ; Heart Diseases* ; Heart* ; Humans ; Korea ; Male ; Mass Screening ; Prevalence* ; Thorax

In South Korea at the end of 2006, the total number of patients that had undergone renal replacement therapy was 46,730 (hemodialysis: 62.1%, peritoneal dialysis: 17.1%, functioning kidney transplantation: 20.8%). There were 9,197 new renal replacement therapy patients in 2006 and the incidence rate per million 185.3. In South Korea, the most common primary cause of end stage renal disease was diabetic nephropathy (42.3%), hypertensive nephrosclerosis (16.9%), and chronic glomerulonephritis (13.0%). The National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) has recommended placement of autogenous arteriovenous fistulas over alternatives including the use of arteriovenous grafts and central venous catheters to improve the overall outcome of patients undergoing hemodialysis. However, autogenous arteriovenous fistulas, like polytetrafluoroethylene grafts, are also subject to dysfunction and eventual failure. Since first described in 1982, percutaneous transluminal balloon angioplasty has become the mainstay of treatment for accesses failing because of underlying central or peripheral venous stenoses. When angioplasty alone fails, alternative treatment modalities, including stent placement and atherectomy, allow immediate salvage in most cases. Consequently, interventional treatment should be attempted first for dysfunctional and thrombosed autogenous vascular access and should be initiated in all dialysis centers so long as the local radiologists are trained and enthusiastic.
Angioplasty ; Angioplasty, Balloon ; Arteriovenous Fistula ; Atherectomy ; Central Venous Catheters ; Constriction, Pathologic ; Diabetic Nephropathies ; Dialysis ; Glomerulonephritis ; Humans ; Incidence ; Kidney ; Kidney Failure, Chronic ; Nephrosclerosis ; Polytetrafluoroethylene ; Renal Dialysis ; Renal Replacement Therapy ; Republic of Korea ; Stents ; Thrombosis ; Transplants

To assess the clinical & nutritional status of long-term survivors of biliary atresia, history taking, medical record review, physical examination (height, weight, midarm circumference, triceps skin fold thickness), blood tests (LFT, prothrombin time, platelet count, prealbumin, calcium) and liver needle biopsy were performed in 12 patients in whom Kasai procedure had been performed up to 10 years before at Department of Pediatric Surgery in Seoul National University Hospital. In the height and weight, there was no patient below 5 percentile. Triceps skin fold thickness (TSF) was above 75 percentile in all patients and showed good fat nutritional status. Midarm circumference (MAC) was above 5 percentile in all patients, therefore there was no skeletal muscle protein malnutrition. Serum prealbumin level was abnormal in 2 patients with abnormal liver function and revealed visceral protein malnutrition. Serum calcium level was decreased below normal range in 4 patients with abnormal liver function. One patient had mild ascites. Five patients had abnormal liver function and 7 patients showed clinical manifestation of portal hypertension. Liver needle biopsy was performed in 5 patients and no cirrhotic change was observed. Some patients showed visceral protein malnutrition and vitamin D malabsorption but growth, development and nutritional status were generally satisfactory. Five patients (42%) showed normal liver function and no portal hypertension. In conclusion, Kasai procedure is satisfactory as a primary treatment in biliary atresia but significant portion (7/12) of long-term survivors had abnormal liver function or portal hypertension. Continuous and careful follow-up is needed not to miss the proper time of liver transplantation.
Ascites ; Biliary Atresia* ; Biopsy, Needle ; Calcium ; Follow-Up Studies ; Hematologic Tests ; Humans ; Hypertension, Portal ; Liver ; Liver Transplantation ; Malnutrition ; Medical History Taking ; Muscle, Skeletal ; Nutrition Assessment* ; Nutritional Status ; Physical Examination ; Platelet Count ; Prealbumin ; Prothrombin Time ; Reference Values ; Seoul ; Skin ; Survivors* ; Vitamin D

Three cases of giant pituitray adenoma are reported. Two cases were operated by transsphenoidal approach and a case by transcranial approach. Transsphenoidal approach showed satisfactory results despite of marked suprasellar extension of tumors. We report rare giant pituitary adenomas with review of relevant literatures.
Adenoma ; Pituitary Neoplasms*