We report a case of pigmented spindle cell nevus occurred in a 4-year-old girl. The lesion was well-demarcated, 2.5 x 3mm sized black macule on the left thenar area. The histopathologic findings of excisional biopsy specimen revealed the prociferation of uniform spindle-shaped pigmented melanocytes at the dermoepidermal junction and sharply definded lateral margins.
Biopsy ; Child, Preschool ; Female ; Humans ; Melanocytes ; Nevus, Spindle Cell*

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

Squamous cell carcinoma is a primary malignant tumor of the skin arising from the epidermis with etiology unknown, and chronie irritations are considered as predisposing factors such as prolonged exposure to sunlight, chronic ulceration of the scar, persistent draining sinus of the chronic osteomyelitis. Habitual pipe smoking and exposure to heavy metal or chemical agents are also thought to be contributing factors to produce this tumor. Orthopaedic surgeons are occasionally concerned in case of patients with squamous cell carcinoma developed in the extremities particularly arising from the persistent draining sinus of the chronic osteomyelitis. We reviewed 12 patients with squamous cell carcinoma in the extremities treated at National Medical Center between 1963 and 1975. All cases were definitely diagnosed clinically and histopathologically. 1) Male to female ratio was 11:1. Average sge of the patients was 52. 2) Farmer is predominant in incidence as 10 out of 12. 3) Sites of invoIvement were buttock and lower extremities in all cases. 4) Predisposing factors of the tumor were chronic skin ulceration in 7 cases, persistent draining sinus of chronic osteomyelitis in two and unknown in three cases. 5) Duration of the skin ulceration or draining sinus before producing tumor was considerably long between 10 and 30 years in majority of the cases. 6) Duration of newgrowth before operation was less than one year in 5, between one and two years in three, and more than two years in four cases. 7) Pre-operative chest X-ray was normal in all cases. However X-ray of the bones of affected limbs showed no bony change in two cases, and various bony changes in 10 cases such as periosteal reaction, cortical erosion, findings of pre-existing chronic osteomyelitis etc. In detail, two cases revealed direct infiltration and active bony destruction into the cortex and medulla by tumor mass. 8) We performed amputation or disarticulation at various levels in 5 cases, radical excision in 3 and biopsy in one case. 9) Within 6 months postoperatively, four cases showed local recurrence of newgrowth as well as metastasis to the lung concomitantly. Three of them were the cases of radical resection. One of them developed distant metastasis to the clavicle.
Amputation ; Biopsy ; Buttocks ; Carcinoma, Squamous Cell ; Causality ; Cicatrix ; Clavicle ; Disarticulation ; Epidermis ; Epithelial Cells ; Extremities ; Farmers ; Female ; Humans ; Incidence ; Lower Extremity ; Lung ; Male ; Neoplasm Metastasis ; Osteomyelitis ; Recurrence ; Skin ; Skin Ulcer ; Smoking ; Sunlight ; Surgeons ; Thorax ; Ulcer

Benign chondroblastoma of bone is a relatively rare primary bone tumor which develops in the 2nd to 3rd decade involving the epiphysis of the long bone. The over-all reported cases of the world have been lesser than 400 after determining the entity as benign chondroblastoma in 1942 by Jaffe and Lichtenstein. A case of the benign chondroblastoma with involvement of the greater trochanter of the femur of a 19 years old boy is presented. The conclusive diagaosis was led by histological examination. Considerable new bone formation and bony spicules which might be derived from previous multiple puncture made us to confuse with osteogenic sarcoma. The specimen was composed of reddish brown hemorrhagic and fragile tissue with scattered either yellowish gritty calcified material or bluish translucent ones. The postoperative course has been smooth and there has been no evidence of recurrence for postoperative 15 months.
Chondroblastoma ; Epiphyses ; Femur ; Humans ; Male ; Osteogenesis ; Osteosarcoma ; Punctures ; Recurrence

Since 1957, multiple possible mechanisms have been suggested to explain the production of the osteonecrosis of the femoral head and it is now accepted that steroid medication is one of the etiologic factors producing osteonecrosis of the femoral head. Among the surgical procedures in ischemic osteonercrosis of the femoral head are bone grafting, core decom-pression, rotational osteotomy, angulation osteotomy, hemiarthroplasty and total hip replacement. The choice of surgical procedures in the management of idiopathic osteonecrosis of the femoral head is dependent on several factors. Most important are the etiology and stage of the lesion. Other considerations are the patients age, lifestyle, and demands on his hip, and the surgeons preference and expertise. We reviewed 32 total hip replacements in 22 patients, which had been performed to treat steroid-induced osteonecrosis of the femoral head at Department of Orthopaedic Surgery, National Medical Center from Jan. 1975 to Dec. 1981. The longest follow-up was 7 years and 6 months and the shortest, 1 year, the average being 2 years and 6 months. The results were as follows: 1. There were 13 males and 9 females and more than half were in 5th decade. 2. Principal causes to use oral corticosteroids were rheumatoid arthritis, arthralgia, and low back pain in the order of frequency. 3. Duration of corticosteroid medication was between 2 months and 12 years and 18 patients took more than 12 months. 4. Of 18 patients who had the bilateral involvement, the two also had osteonecrosis of the humeral head. 5. Roentgenographically, 30 hips were in stage IV and 2, in stage III according to the classification of Arlet and Ficat. 6. Types of the implants used were Charnely (28 cases), MQller (2 cases) and Trapezoidal-28 (3 cases). 7. The function of the each hip was evaluated preoperatively and postoperatively by the method of Wilson and Salvati and all improved from average poor to average good.
Adrenal Cortex Hormones ; Arthralgia ; Arthritis, Rheumatoid ; Arthroplasty, Replacement, Hip ; Bone Transplantation ; Classification ; Female ; Follow-Up Studies ; Head ; Hemiarthroplasty ; Hip ; Humans ; Humeral Head ; Life Style ; Low Back Pain ; Male ; Methods ; Osteonecrosis ; Osteotomy ; Surgeons

BACKGROUNDS: Though K-ADL was developed and validated, weighting each item of K-ADL is needed to evaluate the severity of functional disability as a whole. METHODS: Nominal group technique was used to weight individual items of K-ADL. Relevant experts were recruited; one specialist in geriatrics, one expert in elderly health service, one doctor expert in questionnarie, one nurse and two social welfare workers and one caregiver who work in nursing home for elderly, one nurse working at dementia care center. At the first round, each expert assigned the weights of each item. At the second round, those experts met, discussed, and re-evaluated each weighting. Using the newly developed weighted score, we measured its validity compared to brain-disability grade and three experts' decision of severe dysfunction. RESULTS: For inability to perform task, 7 points were given to 'dressing'and 'washing face', 6 points to 'bathing', 9 points to 'feeding', 8 points to 'transfer and toileting'. If any assistance is needed, 7 points were scored to 'dressing', 4 points were scored to 'washing face', 'feeding', 'transfer' and 'toileting', 2 points were scored to 'dressing'. Correlation coefficient between weighted K-ADL sum and brain-disability grade was -0.665(p=0.000). CONCLUSIONS: We assigned differential weighting to each of K-ADL and found that summing weighted K-ADL was excellent in some validity test.
Aged ; Caregivers ; Dementia ; Geriatrics ; Health Services ; Humans ; Nursing Homes ; Social Welfare ; Specialization ; Weights and Measures

The incidence of pancreatic trauma is increasing and still remains a major source of morbidity and mortality. We have graded the pancreatic trauma on CT according to its pattern into four grades. We also determine the accuracy of CT in the evaluation of pancreatic trauma and the role of CT for delineation of pancretic ductal injury which is critical factor in outcome of pancreatic trauma. CT correctly diagnosed the pancreatic trauma and its traumatic pattern and severity in 22 of 25 cases. Pancreatic enlargement was the most common findings observed in 19 cases. Other findings were 15 cases of intrapancreatic low density hematoma, 12 cases of parenchymal fracture which were predilected in pancreatic neck area. CT grade III and IV could predict the pancreatic ductal injury, and was well correlated with severity of posttraumatic pancreatitis, duration of admission days and incidence of complications. So we concluded that CT can play a definite role for diagnosing and determining the prognosis of pancreatic trauma.
Diagnosis* ; Hematoma ; Incidence ; Mortality ; Neck ; Pancreatic Ducts ; Pancreatitis ; Prognosis

No abstract available.
Methemoglobinemia*

No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

Mullerian agenesis or dysgenesis, rare developmental anomaly presenting as primary amenorrhea, is characterized by absence of vagina and absence or rudimentary development of the uterus. Anatomic anomalies of the axial skeleton and kindney often accompany this psychologically devatating condition. There are various methods of surgical treatment for congenital absence of the vagina. The six cases reviewed in this paper were all treated with McIndoe technique. All of 6 women experienced satisfactory sexual activity and were satisfied with vaginal depth following vaginal creation using a split thickness skin graft technique. Despite the existence of several alternative methods, the McIndoe technique is a relatively simple and highly successful procedure and hence is still prefered by many surgeons.
Amenorrhea ; Female ; Humans ; Sexual Behavior ; Skeleton ; Skin ; Transplants ; Uterus ; Vagina*