No abstract available.
Low Back Pain

Of great interest in modern medicine is the subject of transplantation in the living body, concerned fundamentally with a shift from any damaged tissue or organ to a new one which will continue to live and function in a healthy manner. Much work and constant effort is in progress in this field and many accounts have been reported concerning attempts to solve this problem. Bone grafting, for example, has been highly successful, and now is widely used in orthopedic procedures, with good results. However, the transplantation of articular cartilage has not yet been improved to the point to warrant full-scale clinical application, although reports have appeared occasionally since the partial success achieved in man by Lexer (1908) and in animals by Judet (1908), and concerted efforts are at present being made to diecover a successful technique. Medawar (1948) reported that the failure of tissue homografte to “take” is known to be attributable to the active immune response called forth in the host by incompatibility antigens present in the cells of the grafted tissue. Bacsich and Wyburn (1947) concluded that the special behavior of these grafts is usually ascribed to the avascular nature of cartilage, the cells of which are separated from those of the host by a matrix which acts as a physical barrier and which may, in addition, have a specific protective capacity.(Continued....)
Allografts ; Animals ; Architectural Accessibility ; Bone Transplantation ; Cartilage ; Cartilage, Articular ; History, Modern 1601- ; Immunity, Active ; Orthopedic Procedures ; Transplants

Alveolar soft-part sarcoma has been originally described as a unique pathological entitiy by Christopherson, Foote, and Stewart in 1952, who have chosen its name because of their uncertainty in determining from which cells the tumor arose. The tumor is generally considered to be malignant and originates in soft tissue, the most commonly in the deep tissues of the extremities. The case, reporting here, illustrated several of the recognized characteristics of alveolar soft-part. sarcoma, both clinically and pathologically and is described in view of its rarity of its kind and difficulty of accurate diagnosis. The patient was a 29 year old male who has complained of a adult. fist-sized mass on posterolateral aspect of left arm for one year. Roentgenographic findings showed multiple metastatic lesions on both lung fields, left humerus, skull and cervical spine. The mass on the same site recurred after excision and hemoptysis probably due to aggravation of the metastatic lesions of the both lungs developed 4 months later. He died 8 months after surgery.
Adult ; Arm ; Diagnosis ; Extremities ; Foot ; Hemoptysis ; Humans ; Humerus ; Lung ; Male ; Sarcoma ; Sarcoma, Alveolar Soft Part ; Skull ; Spine ; Uncertainty

The incidence of low back pain as shown in the literature indicates that approximately 65~80% of the population at one time or another have had significant trouble. Low back pain causes one to lose time from work or other activity if an attack is significant, and it is also an universal problem in all economic and social brackets. The vast majority of etiological causes of low back trouble comes from discogenic origin, such as degenerative change of the intervertebral lumbar disc. Disc degeneration should be interpreted as a more or less physiological process which begins at about the age of 20 and continues throughout life. As disc degeneration proceeds, the normal physiologic biomechanics of low back can be transformed to pathomechanics of the spine as a causes of disability. Clinically plain radiography has been routinely used to substantiate the diagnosis of disc degeneration. The typical radiological abnormalities of degeneration are those of marginal spur, narrowing of disc space, Schmorls nodule and sclerosis of the opposing surfaces of the vertebral bodies, etc. However, these changes generally appear somewhat later when degeneration has eventually progressed and in the early stage are generally considered to be negative. Attention is directed to detection of pathomechanical abnormalities of disc degeneation with radiograms being taken in the standing dynamic position rather than in the supine non-dynamic position. The purpose of the study was to investigate some sigificant evidence of dynamograms to evaluate the changes in motion of the lumbar intervertebral joints, and to obtain comparison of the mobility of the joint involved with that of adjacent joints in the same spine. The case material consisted of one hundred and nine patients with discogenic low back pain. In clinical classification, the cases were separated into groups of lumbar insufficiency, intervertebral disc herniation and degenerative spondylosis for the purpose of analysis. Although this was an investigation of the significance in pathologic spines, ten normal subjects with no symptoms, between the ages of twenty and twenty five years, were included in the study as a control to interpret the findings. Non-dynamograms in the non-weight bearing supine position and dynamograms in the weight bearing standing position were made in each case. Non-dynamograms were taken with antero-posterior and lateral projections of the cases. Dynamograms were taken with antero-postericr and lateral projections, and additional lateral views in flexion and extension of spine. The focal film distance was eighty centimeters with the central ray at the third lumbar vertebra. Roentgenograms were analysed by comparison of non-dynamograms and dynamograms, and of groups of patients classified. The results of the study are as follows. 1. Early degenerative change such as abnormal mobility or primary instability was observed by dynamograms. 2. Dynamograms were helpful to detect the level of disc degeneration involved. 3. By dynamograms it has been found possible to deduce severity of disc degeneration. 4. Flexion-extension radiograms have appeared worthwhile to predict the level at which disc protrusion has occurred. In conclusion it is to be expected that there will be a valuable for dynamoradiological assessment in clinical application not only for diagnostic purposes in which it is possible to detect confirmatory evidence of early degeneration, and to predict the level and severity of disc degeneration, but also in the therapeutic aspect where one has to decide how to manage the lesion when it has occurred.
Classification ; Diagnosis ; Humans ; Incidence ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Joints ; Low Back Pain ; Physiological Processes ; Posture ; Radiography ; Sclerosis ; Spine ; Spondylosis ; Supine Position ; Weight-Bearing

After developement of antimicrobial chemotherapy, morbidity and mortality from pyogenic arthritis has been reduced dramatically, but still this disease has remained as a serious and lifethreatening infectious disease of childhood or late sequelae in surviving patients. For the period of 7 years from January 1973 to December 1979, fifty nine children who were treated as septic arthritis at Severance Hospital were studied retrospectively and the results are summerized as follows. 1. Among the 59 cases, 32 cases (54.25%) were male and 27 cases (45.8%) were female. The most prevalent age was 4 to 10 years (40%). 2. Lag period to treatment in most cases was 5 days, and the most prevalent signs on admission was pain around the involved joint. 3. The most commonly affected joint was the hip joint (42.4%). The other affected sites in order of frequency were the knee, ankle and shoulder joint. 4. The underlying causes were composed of infectious focus in 18 cases, minor trauma in 6 cases, iatrogenic reason in 4 cases and unknown in 31 cases. 5. In laboratory findings, the numbers of W.B.C. and E.S.R. were increased in 66.1%, and roentgenologic studies revealed normal in 67.7%, soft tissue swelling in 21% and joint space widening in 9.7%. 6. Causative micro-organism was isolated in 41 cases: Staphylococcus aureus in 34 cases. B-hemolytic streptococcus in 3, Pseudomonas aeroginosa in 2, Enterobacter species in 2. 7. Staphylococcus aureus was highly sensitive to Cephalothin (88.2%) and Methycillin (85.3%), but was highly resistant to Penicillin (88.2%). 8, Four cases were treated non-surgically and 55 cases surgically with arthrotomy-drainage and arthrotomy-continuous irrigation. The results were satisfactory in 83% and unsatisfactory in 17%. 9. The complications were found in 14 cases: recurrence in 4, joint stiffness in 3, dislocation in 2 and sepsis in 1 case. In conclusion, a better result was obtained in cases with early diagnosis and surgical treatment with proper antibiotics.
Ankle ; Anti-Bacterial Agents ; Arthritis ; Arthritis, Infectious ; Cephalothin ; Child ; Clinical Study ; Communicable Diseases ; Dislocations ; Drug Therapy ; Early Diagnosis ; Enterobacter ; Female ; Hip Joint ; Humans ; Joints ; Knee ; Male ; Mortality ; Penicillins ; Pseudomonas ; Recurrence ; Retrospective Studies ; Sepsis ; Shoulder Joint ; Staphylococcus aureus ; Streptococcus

Congenital coxa vara is an uncommon dysplasia, not evident at brith, which first noticed when the child begins walking. Radiographs of the proximal femur include a decreased neck shaft angle, a wide and vertically aligned physis, an irregular metaphyseal ossification, a shortened femoral neck, a triangular osseous fragment adjacent to the inferior margin of the physis, a normal but osteoporotic femoral head, and secondary degenerative changes of the hip joint in neglected case. Prompt diagnosis and early management can reduce severe deformity and degenerative changes of the hip. Authors had been treated two cases of congenital coxa vara with valgus osteotomy followed by good results.
Child ; Congenital Abnormalities ; Coxa Vara ; Diagnosis ; Femur ; Femur Neck ; Head ; Hip ; Hip Joint ; Humans ; Neck ; Osteotomy ; Walking

It is well known the early diagnosis and early treatment is very important for the patient with congenital dislocation of the hip(CDH) to provide a favorable function in the whole life. However, despite screening programmes for the detection of CDH, children with dislocated hip continue to present late. While there has been general agreement as to the need for treatment of persistent acetabular dysplasia secondary to CDH, the appropriate treatment has been a matter of controversy for many years, and the surgical treatment of CDH in old children presents a more formidable technicalchallenge than in younger child. The author studied 26 cases in 23 patients of CHD aged between 6 years and 13 years at the Department of Orthopedic Surgery of Yonsei University during a 6 year period from January, 1979 to December, 1984. The aim of this study was to find out available surgical treatment for the old childhood with CDH and to assess the comparative results of age, degree of acetabular dysplasia and the station of femoral head displacement. The results of this study are are as follows; l. Among the 23 patients, female was 20 patients, male was 3 patients and 3 female patients show bilateral involvement. And among 26 cases, left hip involvement was 21 cases and right hip involvement was 5 cases. 2. Age at initial operation was 8 years and 10 months in average ranging from 6 years and 2 months to 13 years and 4 months, and average follow-up time was 3 years and 11 months ranging from 1 year 6 months to 5 years 2 months. 3. Attended type of surgery of the CDH in old childhood were 4 cases of Salter's innominate osteotomy, 5 cases of Sutherland's double innominate osteotomy, 5 cases of Salter's innominate osteotomy with femoral shortening and 12 cases of Klisic procedure. 4. Age of the patient as well as degree of acetabular dysplasia and station of femoral head displacement may influence on determination of type of the surgical procedure. 5. The older the age at initial operation and the more the displacement of femoral head, the results was less favorable. 6. As in young childhood, the clinical results of treatment are invariably better than the radiological results. 7. Overall final results of leg length discrepancy was 1.0cm in length and range of leg length discrepancy differs from type to type of surgical procedure. 8. Complications developed after treatment were avascular necrosis of femoral head in one case, fracture of the ipsilateral femure in 3 cases and wound infection in 1 case.
Acetabulum ; Child ; Dislocations ; Early Diagnosis ; Female ; Femur ; Follow-Up Studies ; Head ; Hip ; Humans ; Leg ; Male ; Mass Screening ; Necrosis ; Orthopedics ; Osteotomy ; Wound Infection

Cauda equina syndrome has been described as a complex of low back psin, bilateral sciatica, saddle anesthessia and motor weakness in the lower extremity that progress to paraplegia with bladder and bowel incontinence. The syndrome is uncommon, accouting spproximately 1–16% of reported cases of lumbar disc herniation, but needs urgent diagnosis and surgical treatment. Clinical observations were carried out on 8 cases of cauda equina syndrome in the Department of Orthopaedic Surgery, Yonsei University College of Medicine from June 1980 through June 1986 and the following results were obtained. 1. The highest incidence, 5 cases(63%), occured in 40 49 year old age group and the sex distribution was 5 males and 3 females. 2. Eight cases fell into two clinical groups. group 1(3 cases) presented with a sudden onset without any previous history of low back pain and group 2(5 cases) presented with a incidious onset with history of recurrent low back pain. 3. Preoperative myelogram revealed a totsl block to the flow of the contrsst medium in all cases. 4. Wide laminectomy and discectomy were performed in all cases within 2 weeks after the onset of bladder symptom and 3 cases with two levels of disc prolapse were found. 5. Among total 11 levels of disc prolapse, there was 5 levels of L5-S1, 4 levels of L4-5 and 2 levels of L3-4. 6. The duration of the preoperative bladder symptom was 3.3 days in group 1 and 6.4 days in group 2. 7. With a minimum of 6 months follow up, motor power wss fully recovered in 5 cases, sensory in 6 cases and bladder function in 4 cases.
Cauda Equina ; Diagnosis ; Diskectomy ; Female ; Follow-Up Studies ; Humans ; Incidence ; Laminectomy ; Low Back Pain ; Lower Extremity ; Male ; Paraplegia ; Polyradiculopathy ; Prolapse ; Sciatica ; Sex Distribution ; Urinary Bladder

Beyond the usual age of walking, the dysplasia of dislocated hip has become severe and its reversivility limited so that the reduced hip cannot maintained in stable position. The innominate osteotomy redirect cartilage of the hip and provide stability in the functional position of walking. The author have experienced 45 cases out of 42 patients with congenital dislocation of the hip who were treated by innominate osteotomy at Department of Orthopedic Surgery College of Medicine Yonsei University from Jan. 1979 to Dec. 1986. The analysis of result of operation has been Jan. 1979 at least 18 months follw-up study. 1. The mean age was 4.2 years ranging fron 18 months to 14 years.2. The mean value of parameters in preoperative evaluation, acetabular index was 37°, neck shaft angle 146°, CE angle −64° and leg length discrepency 1.5cm. After operation, actabular index was 20°, neck shaft angle 137° and CE angle 39° in average. And operated limb was longer as 0.5cm in average. 3. By anatomical assessment of NcKay, 17 cases were graded excellent, 19 cases good, 7 cases fair and 2 cases poor. Especially among the patients above 6 years old, only 6 cases were graded excellent or good. 4. As to the post-operative complication, limitation of motion was noted in 4 cases, redislocation in 2 cases, subluxation in 1 cases, avascular necrosis of femoral head in 1 case and infection in 1 case.
Acetabulum ; Cartilage ; Dislocations ; Extremities ; Head ; Hip ; Humans ; Leg ; Neck ; Necrosis ; Orthopedics ; Osteotomy ; Walking

Although many different attempts have been made to reduce adhesions after tendon surgery, this complicated problem continues to be foremost among factors compromising tendon surgery and repair. The results of the finest tendon surgery and repair are frequently compromised by adhesions that restrict motion, decrease function and often lead to permanent deformation. Many substances and materials have been introduced into the area around primary flexor tendon repairs in an effort to prevent or diminish the adhesion formation. Various biochemical agents including antihistamines, anaboilic agents, lathyrogenic drug, betaamino-propionitrile and steroids, have been investigated and material such as nylon, cellophane, polyethylene film and silastic have been used to form pseudosheath. However the results with all of these method have been disappointing. Recently, interest has grown in a mucopolysaccharide found in synovial fluid hyaluronic acid. Synovial fluid normally contains a concentration of 2-3 mg/ml of hyaluronic acid. Preliminary investigations suggest that hyaluronic acid placed between the tendon and its sheath promote tendon healing and decrease adhesion formation. With this in mind, the present study was designed to examine the effect of hyaluronic acid on injured chicken flexor tendon healing and to determine the quantity and quality for adhesions in hyaluronic acid treated chicken compared to control. The stereomicroangiographic technique has enabled us to study the vascular process inside the tendon and surrounding tissues after injury of the tendon. For the study, the deep flexor tendon of the third toe of adult chicken with initial weight of about 2kg was used. Animals were divided into three groups and treated with different levels of hyaluronic acid. After 1,3,7,21,35 and 42 days postoperation, the animals were sacrificed and specimen were prepared. Obtained specimen were examined macroscopically and microscopically. At 1,3,5, and 7 weeks postoperation, microangiographic study were done and examind specimen by stereomicroscope. The results were as follows: 1. Though both the treated and control groups showed adhesion, hyaluronic acid treated tendon showed less adhesion tissue and better sliding properties as compared to the controls. 2. During the first week after operation, microangiographic studies showed failure of filling of all the vessels within the injured tendon. At 3 weeks highly vascular adhesions which extended throughout the injured site were observed. After then, the amount of vascularity decreased. 3. There were no difference microscopically between hyaluronic acid treated and control group at first week. After one week hyaluronic acid treated group showed less granulation tissue and less formation of collagen fibers. 4. There were no difference of healing process between hyaluronic acid treated and control group. From this results, it is suggested that hyaluronic acid is effective in reducing the adhesions after the tendon surgery.
Adult ; Animals ; Cellophane ; Chickens ; Collagen ; Granulation Tissue ; Histamine Antagonists ; Humans ; Hyaluronic Acid ; Methods ; Nylons ; Polyethylene ; Steroids ; Synovial Fluid ; Tendons ; Toes