1. Fifty one cases of fractures of the shaft of the femur in children, treated at Seoul National University Hospital during the seven years, from August 1962 to July 1969, were analyzed. 2. In thirty eight of the cases fracture involved the middle third of the shaft, in eleven the upper third, and in two the lower third. 3. Bryant traction was employed in fifteen of the cases ranging from four months to six years of age. One case, five years old, was complicated by Volkmanns ischemic contracture on both legs. 4. Russell traction was employed in eleven of the cases ranging from six to fourteen years of age. Angulation and distraction must be watched especially in the younger age group, although we encountered no serious complications which required subsequent treatment. 5. Hoke traction was employed in twelve of the cases ranging from six to eleven years of age. Although this form of treatment is not particularly popular, we are of the opinion that it is the treatment of choice over two years of age and,under six years of age and that between six and twelve years of age it may be optionally employed along with Russell traction. We found it. particularly useful and convenient in selected cases in which Russell traction could not be effectively employed. 6. In some of the complicated cases, open reduction and internal fixation, closed reduction with pin and plaster immobilization, or skeletal traction was employed.
Child ; Femur ; Humans ; Immobilization ; Ischemic Contracture ; Leg ; Seoul ; Traction

OBJECTIVES: Anticardiolipin antibody (ACA) and lupus anticoagulant (LA) are acquired antiphospholipid antibodies (APAs), which are regarded as important risk factors far vascular thrombosis and recurrent fetal loss. Although the clinical relevance of APAs in dialysis patients is uncertain, recent studies have suggested that APAs are involved in bioincompatibility and thrombogenic complications in hemadialysis (HD) patients. METHOD: We performed a cross sectional study of ACA and LA in 50 stable HD patients and their 68 vascular accesses (52 native arteriovenous fistulae and 16 synthetic arterovenous grafts), with the analysis of factors associated with the presence of APAs and the retrospective evaluation of vascular access occlusion (VAO). LA was assessed by platelet neutralization method whereas IgG-ACA was measured by a solid phase ELISA. Values higher than 23GPLU/ml (IgG phospholipid units) were considered to be positive for IgG-ACA and positive values for LA was more than 8 seconds in prolongation of the clotting time with human platelet lysate. Vascular access survival was assessed by Kaplan- Meier method, RESULTS: The mean age of the subject (M:F 21:29) was 46 years and the mean duration of hemodialysis was 49 months. The frequency of VAO in entire subjects was 0.45+/-0.98 episodes/patient year. The median value of IgG-ACA was 16.0 GPLU/ml with a distribution from 2.7 to 46.1GPLU/ ml. The median titer of I.A was 4.5 (3.1-45.6) seconds. Fourteen patients (28%) were found to have at least one episode of VAO. In spite of comparable clinical and biochemical data according to the presence of VAO, the titers of IgG-ACA (13.6+/-7.7 vs, 20.3+/-8.7GPLIJ/ml, P<0.05) and LA (4.5+/-2.9 vs. 11.7 +/-12.6sec, P<0.05) were significantly higher in VAO group. Six out of 50 patients(12%) had an increased titer of IgG-ACA and LA was found in 11 patients(22%). No patients were positive for ACA and LA simultaneously. There was no significant difference in sex, etiology of ESRD, diabetic status, the dosage of heparin during HD or the amount of erythropoietin administered according to the presence of APAs. We could not find any significant correlation between the titer of APAs and age, duration of dialysis, blood pressure, platelet count and biochemical parameters. In the patients with positive ACA, the frequency of VAO was 1.05+/-0.12 episodes/patient year, which was significantly higher than patients without ACA (0.33+/-0.17 episodes/ patient year, P<0.05). In the patients with the presence of LA(1.06+/-0.43 vs. 0.12+/-0.06 episodes/ patients year, P<0.01). The median vascular access survival time in IgG-ACA positive patients (32.7 months) was significantly decreased compared to 66.8 months in IgG-ACA negative group. CONCLUSION: Our data suggest that the presence of APAs (ACA and/or LA) affects the event-free vascular access survival in HD patients. Therefore the evaluation of APAs status have to be included in the diagnostic strategies for the patients with recurrent VAO. Further studies are necessary to explore the pharmacologic intervention method to decrease APAs and prevent VAO in HD patients.
Antibodies, Anticardiolipin* ; Antibodies, Antiphospholipid ; Arteriovenous Fistula ; Blood Platelets ; Blood Pressure ; Dialysis ; Enzyme-Linked Immunosorbent Assay ; Erythropoietin ; Heparin ; Humans ; Kidney Failure, Chronic ; Lupus Coagulation Inhibitor* ; Platelet Count ; Renal Dialysis* ; Retrospective Studies ; Risk Factors ; Thrombosis

The longevity of the peritoneum has been an object of interests and speculation since the inception of CAPD. Peritoneal mesothelial cells(MC) are the most important intraperitoneal cell quantitatively and have the capability to secret different types of substances including lubricant and various cytokines. It may therefore be essential to have information on the MC mass during peritoneal dialysis. However, there were no specific tools to evaluate the exact status of peritoneal membrane. CA125 is a 22kDa glycoprotein which is a clinically useful tumor marker of non-mucinous epithelial ovarian carcinoma. Recently, other cells including pleural and peritoneal MC have been proved to express CA125. This study was undertaken to determine whether CA125 can be used as a bulk marker of MC mass in clinically stable 23 CAPD patients. We also analyzed whether the observed intraperitoneal production of CA125 can be attributed to MC using the cultured human peritoneal MC from omentum. The CA125 production by MC in vitro was estimated with cultured MC of various number(10,000-5,000,000/well) for different period of time. The median concentration of CA125 was significantly higher in 24-hour spent dialysate than in serum(5.5 vs. 17.3U/ml, P<0.05). There was signifcant negative correlation between the dialysate CA125 level and the incidence of peritonitis. In-vitro experiment using cultured MC cell showed an exponential increase of CA125 level during confluence(6th day of culture), and persistently increased till 15 days of culture, reaching a plateau. A linear relation between the number of MC and the amount of CA125 in supernatant was also observed. In conclusion, CA125 is locally produced in the peritoneal cavity and can be an useful marker of MC mass in stable CAPD patients. Since the clinical significance of the inverse correlation between the CA125 level and peritonitis incidence is uncertain(low CA125 as a second result of repeated peritonitis or the importance of MC mass to regulate the antibacterial defense mechanism?), a prospective follow-up study is necessary to confirm the relation between dialysate CA125 and the incidence of peritonitis.
Cytokines ; Glycoproteins ; Humans ; Incidence ; Longevity ; Membranes ; Omentum ; Peritoneal Cavity ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritoneum ; Peritonitis

Hereditary sensory motor neuropathy type V (HAMN V) is very rare disease entity. The authors experienced a patient who had the findings of peroneal muscular atrophy and pyramidal tract feature. A 20 year-old man was admitted to our hospital due to gait disturbance. Scissoring gait and peroneal muscular atrophy were observed. The findings of electrophysiologic studies were compatible with axonal type peripheral neuropathy. The results of other evaluations were compatible with HAMN V. To our knowledge, it is the first report in Korea.
Axons ; Charcot-Marie-Tooth Disease ; Gait ; Humans ; Korea ; Peripheral Nervous System Diseases ; Pyramidal Tracts ; Rare Diseases

OBJECTIVE: To evaluate whether the basal serum luteinizing hormone (LH) levels in the presence of normal serum follicle stimulating hormone (FSH) are useful as a prognostic indicator of ovarian response to controlled ovarian hyperstimulation (COH). METHODS: From January 1997 to January 1999, 91 infertile women with tubal factor who had undergone in vitro fertilization and embryo transfer (IVF-ET) were enrolled in the present study. COH was performed using long protocol of gonadotropin-releasing hormone (GnRH) agonist. All patients included in this study had blood samples drawn on cycle day 2 or 3 prior to COH for measurement of basal FSH and LH. Women who had other infertility factors or high basal FSH levels (> or = 8.5 mIU/ml) were excluded from this study. The results of COH and IVF-ET were compared between two groups according to the level of basal LH (low LH group [< 3mIU/ml] vs. control group [> or = 3mIU/ml]). RESULTS: Patient's characteristics were comparable in both groups except basal LH level. The number of ampules and duration of exogenous gonadotropins required were significantly higher in the low LH group than those in the control group (p<0.001; p<0.005, respectively). The number of follicles > or = 14mm diameter on the day of human chorionic gonadotropin (hCG) injection was significantly less in the low LH group than that in the control group (p<0.001). The serum estradiol level on the day of hCG injection was also significantly lower in the low LH group, with 1115.5 +/- 380.9 pg/ml compared with 1340.6 +/- 403.0 pg/ml in the control group (p<0.005). There were significantly lower numbers in oocytes retrieved, oocytes fertilized and embryos frozen in the low LH group than those in the control group (< 0.001; < 0.001; <0.005, respectively). However, there was no difference in the fertilization rate between the two groups. The clinical pregnancy rate per cycle seemed to be lower in the low LH group, but the difference did not achieve significance (26.2% vs 39.7%). There were no differences in the miscarriage rate and multiple pregnancy rate between the two groups. CONCLUSION: This study demonstrates that the low basal LH levels ( < 3 mIU/ml) could be predictive of low ovarian response to COH and poor IVF results.
Abortion, Spontaneous ; Chorionic Gonadotropin ; Embryo Transfer ; Embryonic Structures ; Estradiol ; Female ; Fertilization ; Fertilization in Vitro ; Follicle Stimulating Hormone ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Humans ; Infertility ; Lutein* ; Luteinizing Hormone* ; Oocytes ; Pregnancy ; Pregnancy Rate ; Pregnancy, Multiple

PURPOSE: In caring patients with urinary tract infection(UTI), it is prominent to know causative agents and their antimicrobial susceptibilities, of which domestic data appear somewhat different from those reported in the literature. The study was done to learn the distribution of pathogens causing UTI and their antimicrobial susceptibilities in Korean children. METHODS: One hundred forty two inpatients diagnosed with symptomatic UTI in the Department of Pediatrics, Hanyang University Hospital from 1997 to 2002 were retrospectively enrolled to analyze relevant information obtained from medical records, including causative agents of UTI and their antimicrobial susceptibilities. RESULTS: The average age of the study patients was 1.9 years with the peak in infants younger than 1 year of age(105 patients), of which 84 patients were younger than 6 months of age. The male to female ratio was 4:1 in <1 year of age and 1:2.1 in > or =1 year of age. Isolated organisms in urine cultures included Escherichia coli 83.1%, Klebsiella pneumoniae 6.3%, Proteus mirabilis 2.1%, and their distributions were not different, whether suprapubic specimen(100 patients) or non-suprapubic specimen(42 patients) was cultured. Antimicrobial susceptibility of E. coli was above 90% against ceftriaxone, ceftazidime, amikacin, 40-65% against trimethoprim-sulfamethoxasole, tobramycin, gentamicin, and 16.9% against ampicillin. CONCLUSION: E. coli was isolated in 83.1% of children with UTI, which is comparable to the data in the literature. The fact that susceptibility of E. coli was low to ampicillin, gentamicin, and trimethoprim-sulfamethoxasole indicates that the empiric and prophylactic choices of antimicrobials for UTI in Korean children should be investigated further.
Amikacin ; Ampicillin ; Ceftazidime ; Ceftriaxone ; Child* ; Escherichia coli ; Female ; Gentamicins ; Humans ; Infant ; Inpatients ; Klebsiella pneumoniae ; Male ; Medical Records ; Pediatrics ; Proteus mirabilis ; Retrospective Studies ; Tobramycin ; Urinary Tract Infections* ; Urinary Tract*

No abstract available.
Humans ; Hypophosphatemia*

To clarify the exact role of endomyocardial biopsy in the diagnosis and monitoring of adriamycin-induced cardiotoxicity and to observe the actual relationship between pathologic changes and cardiac dysfunction, a cross-sectional clinical study was conducted. Echocardiography was used to evaluate cardiac dysfunction in 18 patients who had received chemotherapy including adriamycin(mean dose : 410mg/m2 of B.S.A.) without clinical evidence of congestive heart failure, and in 19 normal controls. Six patients receiving adriamycin underwent 7 transfemoral endomyocardial biopsy procedures, and the specimens were evaluated by light and electron microscopy for evidence of drug-related cardiotoxicity. Indexes of cardiac systolic function obtained by M-mode echocardiography(left ventricular dimension, excursion of interventricular septum and left ventricular posterior wall, shortening fraction and ejection fracton) did not show any statistically significant difference between patients who received adriamycin and normal controls. In transmitral flow-velocity curves recorded by Doppler echocardiography with a 2.25MHz probe, the patients showed less E peak velocity and decreased E/A ratio compared with normal controls, which suggests left ventricular diastolic dysfunction in the patients who received adriamycin. All the specimens of the endomyocardial biopsy showed significant pathologic changes of adriamycin indnced cardiotoxicity which was characterized by myofibrillar loss and vacuolization of the cytoplasm. In 2 specimens, pathologic grade was II, while 5 specimens showed pathologic changes of grade III and further chemotherapy with adriamycine was not done in thse 5 cases. From these results it is suggested that pathologic changes precede the clinical onset of congestive cardiomyopathy in the patients receiving adriamycin and left ventricular diastolic dysfunction occurrs before ejection fraction falls to subnormal levels. We conclude that sequential endomyocardial biopsy is absolutely indicated for exact diagnosis and monitoring of adrinamycin-induced cardiotoxicity to prevent the development of irreversible and often fatal cardiomyopathy.
Biopsy ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cytoplasm ; Diagnosis ; Doxorubicin* ; Drug Therapy ; Echocardiography ; Echocardiography, Doppler ; Heart Failure ; Humans ; Microscopy, Electron

PURPOSE: The incidence of childhood cancer in the Korea was studied to compare incidence rates between countries and between different regions in Korea. MATERIALS AND METHODS: A tatal of 2,891 cases, registered in the Natinal Cancer Registy from 1993 to 1995, were analysied. Death Certificate Only(DCO) cases were not included. DCO % was estimated about 22%. We calculated the incidence rates according to the International Classification of Childhood Cancer. The age-standardized rates by diagnostic group was compared with those of other countries. The total incidence of childhood cancer were compared among 34 cities in Korea with the rates in the rest of the nation. RESULTS: The crude incidence of all childhood cancer was 94.1 per million. The cumulative incidence to age 15 was 0.137% and the age-standardized rate, calculated using the world standard population, was 96.1 per million. In the incidence rates by diagnostic group, we observed many similarities with other countries in East Asia. The age-standardized rates of E, F and AL cities were significantly higher(p<0.05). In the 0-4 age group, F, AL and BB cities showed higher rates(p<0.05). In 5~9 years and 10~14 years, F city only had higher rates(p<0.05). CONCLUSION: Further study will be needed in order to investigate possible environmental factors which may account for the regional variations.
Classification ; Death Certificates ; Far East ; Humans ; Incidence* ; Korea

The Cornelia de Lange syndrome is characterized by severe growth and mental retardation; typical facies; low-pitched, weak, growling cry, and various bone abnormalities, as was first described by Cornelia de Lange in 1933. On the other hand, Legg-Perthes disease is the condition, in which avascular necrosis of the femoral head develops, as was first described by Legg, Calve and Perthes in 1910. Review of the worlds literature disclosed only one case of Legg-Perthes disease associated with Cornelia de Lange syndrome. We experienced a case of Legg-Perthes disease associated with Cornelia de Lange syndrome in a 8 years old boy, which was treated surgically for Legg-Perthes disease. A brief review of literature was made.
De Lange Syndrome ; Facies ; Hand ; Head ; Humans ; Intellectual Disability ; Legg-Calve-Perthes Disease ; Male ; Necrosis