Preperative radiologic indices, such as cortical index of Engh, morphological cortical index of Sportono and Romagnoli, canal flare index of Noble, and their relationship to the postoperative canal filling, femoral stem fitness, stability and clinical result at last follow up were analyzed in 111 hips of 96 patients treated with bipolar or total hip arthroplasty at the Department of Chthopedic Surgery, Korea University Hospital, between January 1985 and May 1993. The results obtained were as follows: 1. The cortical index had no correlations with age, metaphyseal filling and clinical result but isthmic filling was proportional to the cortical index. In femoral stem fitness and stability, most cases of press fit and optimal stability were obtained in group 3 and 4 that have thick cortex. 2. The morphological cortical index had no correlation with age, canal filling and clinical results. But it was proportional to the postoperative femoral stem fitness and stability. 3. The canal flare index had no correlation with age. The metaphyseal filling was increased in the stove piped canal group(less than 3.0 canal flare index), but isthmic filling was increased in normal canal group(3.0-4.7 canal flare index). The most cases of press fit and optimal stability were obtained in normal canal group. More satisfactory clinical results were obtained in nomal canal group. Above results suggest that straight type of cementless femoral component could get better press fit fixation, postoperative stability and more satisfactory clinical results in the cases of cortical index larger than 2.0, mophological cortical index larger than 2.7 and canal flare index larger than 4.0 but metaphyseal filling is unsatisfactor.
Arthroplasty ; Arthroplasty, Replacement, Hip ; Follow-Up Studies ; Hip ; Humans ; Korea

No abstract available.
Tuberculosis, Pulmonary*

Segmentalization of spinal fixation enhances correction of the coronal plane deformity and allows preservation of normal sagittal contour offering rigid fixation. Purpose of this paper was to evaluate the efficacy and safety of segmental pedicle screw fixation in the treatment of idiopathic thoracic scoliosis. From 1987 to 1991, 78 idiopathic thoracic scoliosis patients were treated with CD instrumentation. Thirty-one were treated with hooks, 23 with pedicle screws inserted in hook pattern and 24 with segmental pedicle screws. In segmental screw group, the screws were inserted for every other on the convex side. After follow up of minimum 2 years(range:24 to 52 months), the results of coronal, sagittal and rotational correction were compared. Major curve correction was 55% with hooks, 66% with hook pattern screws and 72% with segmental screws, with loss of correction of 6%, 2% and 1% respectively. Compensatory curve correction was 57% with hooks, 67% with hook pattern screws and 70% with segmental screws. In patients with hypokyphosis, all groups showed significant improvement, with best restoration in segmental screws. Rotational correction of the apical vertebra was 19% with hooks, 26% with hook pattern screws and 59% with segmental screws. Thirteen(3%) screws were malpositioned but they did not cause neurologic impairment nor adversely affect the results of treatment. This study implies that the segmental pedicle screw fixation is safe and effective method of correcting the triplanar deformity of the thoracic idiopathic scoliolis.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Methods ; Pedicle Screws ; Scoliosis ; Spine

A reduced retroversion angle of humeral head may predispose to recurrent anterior shoulder dislocation and may also be a factor in persistent instability after soft tissue procedures. Rotation osteotomy of proximal humerus is one of many surgical modalities proposed for recurrent anterior shoulder dislocation. To support such an operation, fundamental knowledge of shoulder anatomy is essential. The semi-axial view by Soderlund have been regarded as simple and reliable method for measuring humeral head retroversion angle. The purpose of this study was to evaluate validity of the semi-axial view and to assess reference values for humeral head retroversion angle in Korean. Humeral head retroversion angle was determined from 80 healthy subjects, 48 men and 32 women. Radiographs which shown less than 10degrees between humeral shaft axis and epicondylar axis were defined as acceptable radiographs by Soderlund. Acceptable radiographs were selected and two orthopedic surgeons measured retroversion angle, separately. Acceptable radiographs were obtained in only 70 shoulders (43.8%). The mean angle was 35.2+/-8.24degrees for dominant hand and 32+/-6.27degrees for nondominant in Korean. The mean angle was 35.3+/- 7.78degrees for right side and 31.9+/-6.8degrees for left. The interobserver difference was 2.9degrees. The semi-axial view by Soderlund was not reproducible solely. But if correct arm position is considered, the method presented is easy to use daily.
Arm ; Axis, Cervical Vertebra ; Female ; Hand ; Humans ; Humeral Head* ; Humerus ; Male ; Orthopedics ; Osteotomy ; Reference Values ; Shoulder ; Shoulder Dislocation

OBJECTIVES: The goal of this study is to observe the anatomy around the maxillary sinus ostium and gain an understanding that will help prevent serious complications during middle meatal antrostomies. MATERIALS AND METHODS: Dissection of the maxillary sinuses was carried out in 64 embalmed frozen cadavers, 105 maxillary sinuses. Using a digital ruler, forceps and a malleable probe, we measured the important anatomical relationships around the maxillary sinus ostium and uncinate process, the accessory ostium, and the nasolacrimal duct. RESULTS: 1) The mean width of the uncinate process was 4.9 mm in the mid portion ; 2) A natural ostium of the canal type was observed in 76% of cases ; 3) An accessory ostium was found in 18% of cases and the mean size was 3.17x2.41 mm ; and 4) The mean shortest distance between the nasolacrimal duct and the natural ostium was 4.8 mm. CONCLUSION: Surgeons must keep surgical anatomy in mind to prevent complications when performing endoscopic sinus surgery.
Cadaver* ; Maxillary Sinus* ; Nasolacrimal Duct ; Surgical Instruments

BACKGROUND: Heat shock proteins (HSPs), or stress proteins, are immunodominant antigens of many microorganisms. In this study, we have detected the anti-HSP 70 antibody and tried to explain the role of the antibody with respect to the pathogenesis of SLE. Furthermore, we have attempted to find out the possibility to link the presence of the autoantibody with the monitoring and diagnosis of systemic lupus erythematosus (SLE). METHODS: A total of 80 samples from 55 SLE patients were screened for the presence of anti-HSP 70 antibodies. Simultaneously 59 healthy people were tested as a control group. The anti-HSP 70 antibodies were measured by enzyme-linked immunosorbent assay (ELISA) and confirmed by western blot in anti-HSP 70 antibody ELISA positive samples. The activity of disease state was confirmed by the patients' medical record and systemic lupus activity measure (SLAM). RESULTS: The mean optical density (O.D.450) of ELISA in healthy controls and SLE patients were 0.15+/-0.18 (mean+/-S.D.) and 0.13+/-0.14. The correlation of SLAM Score and ELISA O.D. was r2=0.19, P=0.014. And, the mean O.D. value of ELISA was 0.18+/-0.02 and 0.11+/-0.01 before and after treatment (P <0.05). We compared samples with SLAM Score. The O.D. of anti-HSP 70 ELISA in these patients were 0.20+/-0.02 and 0.08+/-0.002 before and after treatment respectively (n=10, mean+/-S.D., P <0.01). CONCLUSIONS: Anti-HSP 70 antibody was not a clinically useful diagnostic marker in SLE patients. However, the titer of anti-HSP 70 antibody can be used for the monitoring of the therapeutic effectiveness in these patients.
Antibodies ; Blotting, Western ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Heat-Shock Proteins ; Humans ; Immunodominant Epitopes ; Lupus Erythematosus, Systemic* ; Medical Records

In dermatomyositis, involvement of the skeletal muscles of upper esophagus has been reported in many literatures. However, a number of published reports have suggested that motility disturbances of distal esophagus may also be a cause of dysphagia in dermatomyositis and dysphagia in these cases are mainly caused by crico-pharyngeal obstruction or hypomotility of esophagus. The nutcracker esophagus is the one of common esophageal hypermotility disorders causing dysphagia which is characterized manometrically by high pressure in distal esophagus. Recently, we experienced a patient with dermatomyositis who had complained of dysphagia and was diagnosed as having nutcracker esophagus by mannometry. The association of nutcracker esophagus and dermatomyositis has not been reported in the literature. Moreover, the mechanism of nutcracker esophagus differs with that of esophageal involvement in dermatomyositis. Thereby, we report a patient with dermatomyositis who had nutcracker esophagus in the course of her disease.
Deglutition Disorders ; Dermatomyositis* ; Esophageal Motility Disorders* ; Esophagus ; Glycogen Storage Disease Type VI ; Humans ; Manometry ; Muscle, Skeletal

BACKGROUND AND OBJECTIVES: The tympanosclerosis is an abnormal deposits of collagen materials on the lamina propria of the tympanic membrane or the middle ear mucosa. It usually appears as a whitish plaque on the tympanic membrane through otoscopic examination. The etiology of tympanosclerosis is not known, but there are some theories that attempt to explain the pathogenesis. The aim of this study is to understand the pathogenesis of tympanosclerosis and to find out the methods to minimize the occurrence of tympanosclerosis after ventilation tube insertion. MATERIALS AND METHODS: Otoscopic examination, impedance and pure tone audiometry were performed on 190 patients (306 ears) with serous otitis media, and on those who have undertaken ventilaton tube insertion from 1990 to 1998 at the otolaryngology department in Hanyang University Hospital. Then, the patients' medical and operative records were reviewed and analyzed in view of location and pathogenesis of tympanosclerosis. RESULTS: Incidence rate of tympanosclerosis was 42.5% in non-cleft patients and 61.9% in congenital cleft and palate patients. The rate increased when larger and heavier tube was used and the middle ear fluid was highly viscous. Most common sites for the development of tympanosclerosis were in the posteroinferior and anteroinferior portions of the tympanic membrane. Tympanosclerosis had little effect on hearing but in severe cases, it caused mild degree of hearing loss. CONCLUSION: We consider that tympanosclerosis is an inevitable result of ventilation tube insertion and its pathogenesis is multifactorial. We found that we can minimize the occurrence of tympanosclerosis by using small and light ventilation tubes, and avoid intraoperative bleeding and minimal mechanical trauma on the tympanic membrane by aspiring the middle ear fluid.
Audiometry ; Collagen ; Ear, Middle ; Electric Impedance ; Hearing ; Hearing Loss ; Hemorrhage ; Humans ; Incidence ; Mucous Membrane ; Myringosclerosis* ; Otitis Media with Effusion ; Otolaryngology ; Palate ; Tympanic Membrane ; Ventilation*

STUDY DESIGN: Retrospective study. PURPOSE: To evaluate the incidence and risk factors of complications following posterior vertebral resection (PVR) for spinal deformity. METHODS: A review of 233 patients treated with PVR at one institution over a nine-year period (1997 to 2005) was performed. The average age was 33.5 years. Complications were assessed in terms of surgical techniques (posterior vertebral column resection [PVCR] and decancellation osteotomy) and etiologies of deformity. RESULTS: Local kyphosis was corrected from 51.4degrees to 2.7degrees, thoracic scoliosis 63.9degrees to 24.5degrees (62.6% correction), and thoracolumbar or lumbar scoliosis 50.1degrees to 17.1degrees (67.6%). The overall incidence of complications was 40.3%. There was no significant difference between PVCR and decancellation osteotomy in the incidence of complications. There were more complications in the older patients (>35 years) than the younger (p < 0.05). Hig her than 3,000 ml of blood loss and 200 minutes of operation time increased the incidence of complications, with significant difference (p < 0.05). More than 5 levels of fusion significantly increased the total number of complications and postoperative neurologic deficit (p < 0.05). Most of the postoperative paraplegia cases had preoperative neurologic deficit. Preoperative kyphosis, especially in tuberculous sequela, had hig her incidences of complications and postoperative neurologic deficit (p < 0.05). More than 40degrees of kyphosis correction had the tendency to increase complications and postoperative neurologic deficit without statistical significance (p > 0.05). There was 1 mortality case by heart failure. Revision surgery was performed in 15 patients for metal failure or progressing curve. CONCLUSIONS: The overall incidence of complications of PVR was 40.3%. Older age, abundant blood loss, preoperative kyphosis, and long fusion were risk factors for complications.
Congenital Abnormalities ; Heart Failure ; Humans ; Incidence ; Kyphosis ; Neurologic Manifestations ; Osteotomy ; Paraplegia ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Scoliosis ; Spine