The approach toward paralytic hips in children with subluxation or dislocation has been essentially conservative and palliative, frequently.accepting the subluxation or dislocation. Buster Brown belt, ischial seat brace, or crutches with non-weight bearing is frequently prescribed. For obvious reasons, both the patient and the surgeon are reluctant to resort to hip fusion, and muscle or tendon transfer about the hip cannot be expected to function in the presence of subluxation or dislocation. On the other hand, deformities about the hip are corrected successfully by standard procedures, such as adductor tenotomy, Soutters fasciotomy, and Campbells iliac crest transfer. In severe, fixed deformities in older children, the overall balance may be restored by varus or valgus osteotomy of Irwin, leaving the deformities uncorrected. Jones varus osteotomy is aimed at reduction of the hip, but it ignores the factor of remodeling and is of temporary benefit. More recently, Salters and Pembertons osteotomies have been suggested in the treatment of paralytic subluxation or dislocation, but the lack of remodeling remains unchallenged. During the period of 14 years, from October 1963 to May 1976, we operated on 132 hips in 108 cases of paralytic hips, mostly in children, at Seoul National University Hospital. Of the total cases, 104 cases were residual poliomyelitis, 3 cases cerebral palsy, and one case meningomyelocele, Operative procedures carried out on these hips were as follows: Soutters abductor fasciotomy; 35 Campbells iliac crest transfer; 22 Lumbodorsal fasciotomy; 20 Ober-Barrs erector spinae and tensor fasciae latae transfer; 29 Thomas-Thompson-Straubs external oblique transfer; 15 Sharrards iliopsoas transfer; 6 Mustards iliopsoas transfer; 20 Legg-Dicksons tensor fasciae latae transfer; 8 Blecks iliopsoas recession; 1 Hip fusion; 2 Pembertons pericapsular osteotomy; 28 Salters innominate osteomy; 26 Steels triple osteotomy; 1 Chiari's osteomy; 1 Soft tissue release operations were carried out whenever necessary, either prior to or at the time of reconstructive surgery. In 39 hips, osteotomies were either combined at the same time or were followed by muscle or tendon transfers, while in the earlier 4 hips osteotomy alone resulted in recurrence of subluxation or dislocation and required repeat osteotomy combined with muscle transfer, and in another hip, recently, osteotomy was complicated by infection and muscle transfer has been postponed to date. In our experience with paralytic hips, when subluxation or dislocation is present, either muscle or tendon transfer alone or osteotomy or arthroplasty alone will likely fail or, at best, will be ineffective. Most satisfactory and' permanent results were obtained when these hips were aggressively treated by maximum correction of deformities followed by combined mechanical(osteotomy or arthroplasty) and functional (muscle or tendon transfer) stabilizations. This often permits elimination of the brace and hip fusion is seldom necessary, thus resulting in functional salvage of a flail hip. Also, any surgery on the knee and the foot of the same limb is greatly enhanced by reconstruction of the hip.
Arthroplasty ; Braces ; Cerebral Palsy ; Child ; Congenital Abnormalities ; Crutches ; Dislocations ; Extremities ; Fascia ; Foot ; Hand ; Health Resorts ; Hip ; Humans ; Knee ; Meningomyelocele ; Mustard Plant ; Osteotomy ; Poliomyelitis ; Recurrence ; Seoul ; Steel ; Surgical Procedures, Operative ; Tendon Transfer ; Tendons ; Tenotomy

When the non-union gap in a long bone is more than half of the diameter of the bone at that level, it presents a significant challenge to traditional bone grafting technique. Even if there are several good ways for this problem, such as shortening, traditional various bone grafting, electrical stimulation and free vascularized bone graft, most of these techniques have some difficulties to maintain the stability of fracture post-operatively, and we have to keep their extremities into a cast or external fixator so long. So we have attempted to treat the large osseus gap non-union in long bone with fixation of heavy duty or condylar plate on one side of fracture for fracture stability, a long tibial corticocancellous strut graft on the other side of fracture for fracture stability and rapid bony union, and extensive cancellous chip bone graft between the plate and tibial graft to enhance the bony union. We have experienced 9 cases of large osseus gap non-union in long bone with this technique from March 1981 to September 1986 at the department of orthopaedic surgery, St. Mary's hospital, Catholic University Medical College. 1. Their, 7 males and 2 females, average age was 38 years old, with a range of 24 to 53 years old. The distribution of the involved bone was 6 femur, 2 humerus, 1 radius and ulna with 1.4 years of average duration of non-union, ranged from 7 months to 2.4 years. The average gap from normal bone to normal bone was 4.8cm, with a range of 2.7cm to 7.4cm. The average number of previous surgical procedures was 4, with a range of 2 to 7. Four of the nine patients had quiescent osteomyelitis. 2. Post-operative immobilization with splint or cast was applied for 6 weeks for upper extremity and 8 weeks for lower extremity followed by active R.O.M. exercise and non-weight bearing crutch walking. 3. Five of the nine cases(55.6%) had completely bony union. This occured on an average 8 months post-operatively and was faster in the forearm bones and femur than in the humerus. An additional cancellous bone graft was done in two. But other two of the patients had subsequent amputation because of recurrent and uneontrollable osteomyelitis stirred up by the surgery. 4. This procedures was proved to be one of valuable adjuvant method in treatmqnt of large osseous gap non-union of long bones.
Amputation ; Bone Transplantation ; Electric Stimulation ; External Fixators ; Extremities ; Female ; Femur ; Forearm ; Humans ; Humerus ; Immobilization ; Lower Extremity ; Male ; Methods ; Osteomyelitis ; Radius ; Splints ; Transplants ; Ulna ; Upper Extremity ; Walking

No abstract available.
Transplants*

No abstract available.
Transplants*

The development of immuohistochemistry and the application of electron microscopy have revolutionized our understanding of the pathopysiology of pituitart adenoma. The clinical value of functional characterization of pituitary adenoma has been realized. Immunohistochemical stains using polyclonal antibodies to six pituitary hormones (GH, PRL, ACTH, TSH, FSH & LH) were performed to classify the pituitary adenoma and to investigate the relationship between the results of the immunohistochemical study and pared to the serum hormone level. The results are summarized as follows: The Most common clinical type of pituitary adenoma was prolactinoma and the second was nonfunctioning adenoma. However, the most common immunohistological type of pituitary adenoma was null cell adenoma, the second one, lactotrope adenoma and the third one, mixed sommatotrope & lactotrope adenoma. In the clinically nonfunctioning adenoma cases, null cell adenoma were present in 75%; gonadotrope adenoma and corticotrope adenoma were present in 25%, while the serum prolactin level was increased in ten of the twenty cases(50%) of the null cell adenoma. When the serum prolactin level was increased above the 150ng/ml, the tumor cells gave positive reactions in 95.2% of cases immunohistochemically. But in the cases of GH, FSH & LH, the tumor cells gave positive reactions in 100%, 75%, and 66.7%, respectively. In the case of increased serum prolactin level, more than 50% and 30% proportion of tumor cells showed positive reactions in the micro- and macroadenoma, respectively.
Adenoma

No abstract available.
Brain Death* ; Brain*

No abstract available.
Forehead*

No abstract available.
Forehead*

No abstract available.
Child* ; Heart Arrest, Induced* ; Humans ; Oxygen*

This report deals with three cases of accessory hepatic nodules incidentally noted during operation. Two of them were found on the serosal surface of the gallbladder with no connection to the main body of the liver. The other case was in the greater omentum. All three cases were small oval shaped, measuring less than 1 cm in maximum dimension and were composed of histologically normal hepatic tissue and seemed to receive blood supply from the adjacent tissue through the capsular blood vessels. Presence of the fairly well retained intralobular mesenchymal component may reflect that accessory hepatic nodules develop after conjugation of hepatic diverticulum and septum transversum.