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.
Child* ; Heart Arrest, Induced* ; Humans ; Oxygen*

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*

OBJECTIVE: It is generally accepted that ectopic pregnancy (EP) may adversely affected on the female fertility. However, it is not fully understood how it influences on the future fertility after treatment of an EP, so we intended to evaluate its effects, METHODS: This study was undertaken on 473 patients with clinically and pathologically proven diagnosis of ectopic pregnancies at the Department of Obstetrics and Gynecology, Anam Hospital, Kroea University Medical College hom Jan. 1, 1989 to Aug. 31, 1996. RESULTS: The incidence of ectopic pregnancy was 1 in 19.6 deliveries (5.1%). The overall spontaneous conception rate after treatment of ectopic pregnancy was 67.4%, and among them, the rate of intrauterine pregnancy (IUP) and repeat ectopic pregnancy (rEP) was 56.3% and 11.1% respectively. The occurrance rate of infertiity after treatment of EP was 32.6%. The mean time to IUP after treatment of EP was 16.5 months, and 79.0% of all IUP were conceived within 2 years after treatment. The mean time to repeat ectopic pregnancy was 15.9 months. With increasing maternal age, IUP rate was decreased and rEP rate was increased but they were statistically not signiTicant. Repeat EP rate was also increased in multiparous women but it was also statistically not significant. Overall PR (IUP and rEP) was decreased in women who have organic lesions (adhesions, endometriosis, PID etc.) in pelvic cavity(p=0.003). Patients who were treated with conservative surgery achieved a lower conception rate without statistical significance and it may be due to low cases. CONCLUSION: Future fertility rate was not significantly altered by EP itself, but rather affected by patient's age, organic lesions and previous history of pelvic surgery. Recently, the advent of assisted reproductive technology and its associated techniques improved the female fertility in women with such a problem.
Birth Rate ; Diagnosis ; Endometriosis ; Female ; Fertility* ; Fertilization ; Gynecology ; Humans ; Incidence ; Maternal Age ; Obstetrics ; Pregnancy ; Pregnancy, Ectopic* ; Reproductive Techniques, Assisted

OBJECTIVE: The prevalence of multifetal pregnancies has increased up to 30% as a result of the introduction of ovulation inducing agents for assisted reproductive teclmology(ART). An exttemely poor pognosis could be expected for viable pregnancies in multifetal gestation. So, to decrease the consequence of multiple pregnancies and prevent complications, especially premature baby irreversibly damaged, selective fetal reduction to the smaller number of fetuses should be considered in an early gestational period. METHODS: From May 1994 to Apr 1998, transvaginal selective fetal reduction in 13 pati including 9 triplet, 3 quadruplet and 1 quintuplet. Of the 13 patients, 4 were obtained by controlled ovarian hyperstimulation with intrauterine insemination (COH with IUI), 6 were by IVF-ET, 2 wae by controlled ovarian hyperstimulation with natural contact and 1 was by natural conception. Selective fetal reduction using intracardiac KC1 injection and aspiration of amniotic fluid carried out in 8-11 weeks of gestation. RESULTS: After procedures, 8 patients were remained as twin pregnancies, 5 patients as singleton pregnancies and 1 of the remaining twin embryos vanished after procedure. There have been 7 sets of twin delivery including 1 stillbirth and 3 singleton delivery. 1 cases are ongoing state. All of the singleton delivery were completed after 37 weeks of gestation. Of the twin delivery, 2 cases were delivered after 37 weeks of gestation, 2 cases in 35-37 weeks, and 3 cases before 35 weeks of gestation. Unfortunately, 1 stillbirth occurred in 20 weeks of gestation and 2 cases of singleton were aborted. As 3 losses(2 singleton, 1 twin) occurred, the delayed fetal loss rate in this selective fetal reduction was 25.0%(3/12). There was no fetal anomaly related to the procedure. CONCLUSION: Selective fetal reduction in multifetal pregnancies is a rather safe procedure and it may improve the outcome of multiple pregnancies.
Amniotic Fluid ; Embryonic Structures ; Female ; Fertilization ; Fetus ; Humans ; Insemination ; Ovulation ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Pregnancy, Multiple ; Pregnancy, Twin ; Prevalence ; Quadruplets ; Quintuplets ; Reproductive Techniques, Assisted* ; Stillbirth ; Triplets

The enhancing potential of anatoxin a (AFB1) and D-galactosamine (DGA) on development of preneoplastic glutathione S-transferase placental form positive (GST-P+) hepatic foci was examined using an in vivo mid-term assay system based on two-stage concept of hepatocarci-nogenesis. Rats were initially given a single dose (200 mg/kg) of diethylnitrosamine (DEN) intraperi-toneally, and thereafter. with an interval of 2 weeks, AFBl at a graded concentration (0.06, 0.012, 0.0024, 0.00048, and 0.000096 mg/kg i.g.) and DGA (100 mg/kg i.p.) were administered for 6 weeks and then sacrificed. All rats were subjected to a two-thirds partial hepatectomy to induce a potent growth stimulus to DEN-altered hepatocytes at the week 3. The modifying potential was scored by comparing the number and the area (mm2) per cm2 of GST-P+ foci in the liver with those of the corresponding control group given DEN alone. AFBl (at a graded concentration between 96 ng/kg and 60 microgram/kg) exerted a strong promoting effect oil induction of GST-P+ foci with both the number and the area. The logarithmic dose of AFBl and the potency to promote hepatocarcinogenesis were in dose-dependent relationship. DGA, a known necrogenic chemical to cause periportal necrosis and stimulate hepatocellular proliferation. also revealed the increase in the area of GST-P+ foci. although its enhancing potentia1 was 1ess profound than that of AFBl. The results suggest that DGA is also a useful proliferative stimulus m improve the medium-termdetection of unknown carcinogens.
Rats ; Animals

The etiologic impacts in primary hepatocellular carcinoma among Koreans seem different from those in other countries with its high incidence and close association of hepatitis B virus infection and liver cirrhosis. A series of 35 lobectomy specimens of hepatocellular carcinoma (HCC) was examined by means of electron microscopy to elucidate the general ultrastructural characteristics and to understand the morphogenesis of various histological growth patterns and cytologic features of HCC. 1) General cytological details of HCC were similar to those of non-neoplastic hepatocytes, but characterized by scantiness of subcellular organelles. Degree of cellular differentiation was not correlated with ultrastructural features of HCC. 2) Acinar pattern of HCC seemed to develop by either dilatation of central bile canaliculus or central cystic degeneration of microtrabecular growth, and clear cell group of HCC was expressed in abundance of glycogen particles and lipid droplets. 3) Intranuclear inclusions of HCC proved to be cytoplasmic herniations of tumor cells, and intracytoplasmic tubular arrays appeared to originate from the endoplasmic reticulum. 4) Hyaline globules seen in HCC corresponded to clumps of microfilamentous structures similar or identical to Mallory's hyalin.
Humans ; Incidence ; Carcinoma, Hepatocellular

OBJECTIVE: This study was performed to evaluate the usefulness of New cervicography by comparing cervicographic finding with Papanicolaou smear and result of colposcopically directed biopsy. METHODS: This study group consisted of 189 patients who visited the Department of Obstetrics and Gynecology, Chung-Ang University Pildong Hospital from September 1998 to August 1999. All women simultaneously underwent Papanicolaou smear and New cervicography. If either method was positive, the patient was referred for colposcopically directed biopsy. RESULTS: The New cervicography was significantly more sensitive than the Papanicolaou smear(92.2% vs 60.8%, p<0.01), whereas the Papanicolaou smear was significantly more specific than the New cervicography(99.3% vs 75.0%, p<0.05). The false positive rate of New cervicography was 75%, significantly higher than 0.7% of Papanicolaou smear. There was no significant difference between the negative predictive value of cervicography and Papanicolaou smear. When New cervicography and Papanicolaou smear were used together, the sensitivity was significantly higher than Papanicolaou smear used alone(98.1% vs 60.8%, p<0.01) and false negative rate was significantly lower than Papanicolaou smear(1.9% vs 39.2%, p<0.01). However the specificity, positive predictive value of the combined test were lower than Papanicolaou smear. CONCLUSION: Cervicography is one of the Papanicolaou smear adjunctive tests and a useful method to detect cervical cancer. Our study confirms the previously suspected low sensitivity of Papanicolaou smear and demonstrate that cervicography is more sensitive than Papanicolaou smear and less specific. From the above results, when New cervicography and Papanicolaou smear were used together, the detection rate of cervical cancer will be increased more easily since the cases missed by one method may be picked up by another.
Biopsy ; Female ; Gynecology ; Humans ; Mass Screening* ; Obstetrics ; Papanicolaou Test ; Sensitivity and Specificity ; Uterine Cervical Neoplasms*