Histomorphometry of Osteogenesis Imperfecta I / 대한내분비학회지

Osteoporosis imperfecta (OI) is a genetic disorder characterized by fragility of bone, deafness, blue sclerae; and laxity of joints. Four types of OI are distinguished by clinical findings. Although mutations affecting collagen I are responsible for the disease in the most patients, the mechanism by which the genetic defects cause abnormal bone development has not been well established. Therefore we evaluated static and dynamic bone histomorphometry of type I OI in the case study of a 15 year old boy with OI who had blue sclerae, a history of frequent fracture and a familial history of blue sclerae. Biopsy of the ilium showed loss of connection between the cortical bone and trabecular bones. The Harversian system in the cortical bone was poorly developed. In the trabecular bones, the lamellar pattern was poorly developed. Mineral apposition rate of the cortical bone was 1.0 m/day and of the trabecular bone was 0.79 m/day. Thus OI might be regard as a disease whereby abnormal collagen synthesis interferes with bone strength by multiple mechanisms.

Graves' disease detected by myalgia / 대한내과학회지

Graves' disease is commonly associated with a variety of muscle abnormalities from muscle weakness, paralysis to exophthalmopathy. There are several reports of Graves disease associated with polymyositis and myasthenia gravis. It is generally uncommon that muscle enzyme is increased in patients with hyperthyroidsm without polymyositis. We report thyrotoxic myopathy presented as myalgia without muscle weakness but with increased muscle enzyme, which was improved by anti-thyroid drug. A 33 year-old man developed severe proximal myalgia and headache. The creatinine kinase level was elevated. But there was no specific finding in electromyography. Muscle biopsy showed increased number of mitochondria and decreased glycogen content. There was no inflammatory cell infiltration. Diagnosis of hyperthyroidism due to Graves' disease was made, followed by the treatment with prothiouracil 300 mg per day. Five day after the treatment, myalgia improved, and serum CPK was decreased. He never complain myalgia after thyroid function was normalized.

A Case of Pancytopenia Caused by Sheehan's Syndorme Improved with Hormone Replacement Therapy / 대한내분비학회지

Postpartum ischemic necrosis of the pituitary gland, known as Sheehan's syndrome, is well- established clinical entity. In anterior pituitary insufficiency, there is very often a normochromic or hypochromic anemia but pancytopenia secondary to the hypopituitarism is less common. We report a case of pancytopenia due to complete aplasia of the bone marrow associated with Sheehan's syndrome, in which hormone replacement therapy alone produced full hematological recovery.

2 Cases of Transcatheter Embolization Therapy of Massive Lower Gastrointestinal Bleeding due to Typhoid Fever / 대한내과학회지

Typhoid fever is still endemic in developing countries and the cause of much morbidity and mortality. Complications such as intestinal hemorrhage, intestinal perforation, hepatitis, pyelonephritis, cholecystitis, osteomyelitis are known to occur. The classical approach to management of intestinal hemorrhage due to typhoid ulceration has been conservative. In, however, the event of massive, persistent and life-threatening hemorrhage not responding to conservative measures, early surgical intervention is life-saving. But surgical intervention is difficult due to multiple bleeding sites and friable distal ileum and colon. These two cases are reported in order to draw attention to the usefulness of mesenteric arteriography and the effectiveness of transcatheter embolization therapy in massive intestinal hemorrhage due to typhoid fever.

Subcutaneous Implantation Metastasis of a Cholangiocarcinoma of the Bile Duct after Percutaneous Transhepatic Biliary Drainage (PTBD) / 대한소화기내시경학회지

Percutaneous transhepatic biliary catheterization (PTC) has not only been increasingly used in the localization of benign and malignant lesions, but it is also considered rapid, safe and effective method to establish internal and external drainage for decompression of biliary obstructions. Infections and granulomas at the catheter entry site can occasionally develop, but are easily managed. However, such technique, when used both for obtaining malignant cells for diagnosis and for percutaneous decompression of the biliary tract can exposure the patient at risk for dissemination of the tumor along the catheter tract. This rare complication has been observed in a patient who underwent percutaneous transhepatic biliary drainage (PTBD) for malignant biliary tract obstruction. Although tumor cell seeding along the catheter tract is a very rare complication, we think that PTBD should be avoided when curative resection is planned.

A Case of Delayed Puberty due to Hypoplasia of Anterior Pituitary Gland with Pituitary Stalk Agenesis and Ectopic Neurohypophysis / 대한내분비학회지

Hypopituitarism is not a common cause of delayed puberty, however it should always be considered, especially if there are such signs as severe dwarfism, dollish face, truncal obesity, small hands and feet, and microgenitalia. Either congenital or acquired, hypopituitarism can be resulted from hypothalamic and hypophyseal lesions. The clinical feature can be diverse depending on age of the patients, rate of progression, degree of hormone deficiency and characteristics of the lesion. The recent high interest in delayed puberty and the improved detection of hypothalamic hypophyseal lesions using combined pituitary fuction stimulation test, brain CT and MRJ, has made the differential diagnosis of hypopituitarism possible as the cause of delayed puberty. MRI has shown hypophyeal hypoplasia accompanied by anterior pituitary hypoplasia and ectopic neurohypophysis in some of the patients with hypopituitasm, and although the anatomical abnormality around the hypophysis in these patients is considered the reason for hypopituitarism, the pathogensis of which has not yet to be known. We, here, report a case of delayed puberty by hypopituitarism due to hypoplasia of anterior pituitary gland, pituitary stalk agenesis and ectopic neurohypophysis with brief review of the litereature.

A Study on Usage of Classroom Desks and Chairs by Teenagers

OBJECTIVES: To evaluate the compatability of high school students' desks and chairs to the fittness of their physique, to examine the factors related the posture and pain while they use the classroom desks and chairs, and to analyze the curvature of spine in sitting position. METHOD: Measurements of the dimensions of desks and chairs and a written survey to question students' habits regarding to the usage of classroom desks and chairs along with the physical examinations of spine including the analysis of spine curvature in sitting position with an electrogoniometer. RESULTS: Seven hundred forty nine among 831 male students, and 1,017 among 1,074 female students, complained of discomforts associated with the usage of classroom desks and chiairs. An examination of spine in sitting position using an electrogoniometer showed that both male and female subjects displayed the spine curvatures in the order of thoracic kyphosis, lumbar lordosis, and scoliosis. All subjects displayed pain in the order of low back(38.8%), posterior neck(23.9%), shoulder and elbow joints(15.8%), and buttock(15.7%). CONCLUSION: The study revealed an urgent need for the adaptation of classroom desks and chairs according to the growing physique of the adolescents. A majority of the teenaged subjects experienced the discomfort from the use of improper funiture and a poor posture. Authors highly recommend a formal education to the students regarding the importance of proper posture and the usage of adjustable desks and chairs.

A Case of Partial Hypopituitarism after Recovery from Korean Hemorrhagic Fever / 대한내분비학회지

Heorrhage and infarct-like necrosis of anterior lobe of the pituitary gland is one of the characteristic pathologic findings of the autopsied cases of Korean Hemorrhagic Fever (KHF) patients, but there has been rare reports of hypopituitarism in patients with KHF. Recently we have experienced a patient with hyponatremia who had recovered from KHF. He was admitted to our hospital due to nausea, vomiting, and epigastric discornfort. To determine the function of the anterior pituitary gland, hormonal levels of target galnds and pituitary gland were measured, and combined pituitary stimulation test was performed. ACTH, GH, and prolactin deficiency were confirmed by combined pituitary stimulation test in this patient. There was no evidence of hypothalamic or other pituitary diseases by brain MRI. Our experience shows that KHF can be a cause of hypopituitarism and these findings should alert physicians the possibility of hypopituitarisrn in patients who had recovered from KHF.

EXPLOSIVE INJURY OF THE HAND

No abstract available.

Posterior Fusion of Unstable Cervical Spine Fracuture Using Bone Cement / 대한정형외과학회잡지

The authors have reviewed 16 cases of the fracture of the femoral neck in children which were treated at Pusan Gospel Hospital during the period of 5 years from March 1975 to January 1980. 12 of the 16 fractures of femoral neck had sustained the injury by automobile accidents. The ratio between boy and girl was 1.6:1. There were five Type-II (Transcervical), nine Type-III (Cervicotrochanteric) and two Type-IV (In-tertrochanteric) femoral fractures by Delbets classiflcation. 2. cases of undisplaced and displaced Type-IV were treated with abduction plaster spics cast. 14 cases, which were displced and had associated injury, were reduced by closed reduction and internal fixation with hagie pin, cortical screw and cancellous screw under general anesthesia. 11 of 16 cases were followed for 7 months to 29 months, average 14 months. The results were rated according to criterias of the Ratliff. Satisfactory results were obtained in 9 cases and those of 5 cases were treated by closed reduction and internal fixation wlth cancellous screw. Pain was developed in a Type-II and Type-II due to loosening of metal devices for internal fixation.

Study of Congenital Scoliosis / 대한정형외과학회잡지

Congenital scoliosis is defined as a lateral curvature of the spine caused by congenital anomalies of the vertebral development. In this study seventeen congenital scoliosis patients seen and treated by either Milwaukee brace or surgical intervention at Department of Orthopedic Surgery, Seoul National University Hospital from December 1972 to April 1978 were evaluated according to frequency of the curve pattern, character of the deformity, method of treatment and its correctability. The following results were obtained in this study. 1. Age distribution was from 2 to 39 years and mean age was 13.4 years. 2. The most common deformity pattern was hemivertebra in 8 cases (47.1%), unilateral unsegmented bar in 4 (23.6%) and mixed type in 3 (17.6%). 3. The most common curve level was thoracic in 6 cases (35.3%), followed by thoracolumbar in 4 (23.5%) and lumbar in 4 (23.5%). 4. The best corrected type by Milwaukee brace was trapezoid vertebra (29.4%) and then mixed type(26.1%), followed by block type (20%) and hemivertebra(2.3%). 5. The operative treatment was performed in the cases of unilateral bar and progressive type with Milwaukee brace. In terms of the correctability of the curvature, the surgical intervention was better than the conservative treatment, with the result of its average correction of 33.5% that is compared with 15.9% of Milwaukee brace. 6. Halofemoral traction was effectively applied in the cases of rigid and severe curve; the initial curve 76.3 degress with 21.3% of flexibility. 7. Loss of correction in operative treatment was 2.3 degrees (6.5%).

Osteoblastoma: A Case Report / 대한정형외과학회잡지

Osteoblastoma is a benign lesion somewhat similar to ostoid osteoma histologically but different from it clinically, roentgenologically and grossly. The autors have experienced a case of benign osteoblastoma of the neural arch of the Iumbar spine, and treated the case by total laminectomy and conflrmed with biopsy.