The tibial plateau fracture which involving articular surface of the proximsl tibia is very common in pedestrian injury of the traffic accident and sometimes results in significant disability in knee joint function. The authors analized 40 cases of the tibial plateau fracture treated in our depsrtment during the year 1980 through 1985. The results obtained are as follows : l. 15 cases were treated by conservative methods. 2. 25 cases were treted by operative methods. 3. 33 cases(82.5%) were “Acceptable” group according to Roberts criteria.
Accidents, Traffic ; Knee Joint ; Tibia

No abstract available.
Bronchogenic Cyst*

Previous observations have demonstrated that fibronectia (FN) is deposited high abundance in basal cell carcinoma (BCC) stroma. Since FN is a glycoprotein which promotes interaction between cells and extracellular matrix, it may been important component of slowly expansile carcinoma such as BCC. Furthermore, BCCs aggressiveness varies with it's histologic appearance. The authors investigated distribution of plasma FN (pFN) in 8 BCC cases with various histologic types (3 nodulocystic type, 2 infiltrative type, 2 keracotic type, 1 adenoid type) and 4 squamous cell carcinomas (SCC), which have a more aggrcisive biologic behavior than BCC using immunohistochemical staining. In normal skin, pFN was strongly positive at the clenzoepidermal junction and perivascular area with a linear pattern, and in the papillary dermis with a reticular pattern, and was weakly positive in the reticular dermis. In BCC, pFN was strongly positive in nodulocystic BCC, with the highest concentration along the periphery of the tumor island in a filamentous pattern, .hereas, it was moderately positive in adenoid, keratotic, infiltrative BCC stroma. In SCC, pFN was weakly positive around tumor the margins with a thin, coarse deposition These results show that with epidermal tumors, the degree of the pFN expression in stroma is propotional to their aggressiveness.
Adenoids ; Carcinoma, Basal Cell* ; Carcinoma, Squamous Cell ; Dermis ; Extracellular Matrix ; Fibronectins* ; Glycoproteins ; Plasma* ; Skin

In the treatment of posterior cruciate ligament injury, posterior displacerrient of tibia might be occured because of the direction of gravity due to weight of lower leg. To prevent this problem several methods have been introduced, but not settled yet. Therfore the author tried to solve this problem by applying Quengel brace that was firstly described by Mommsen in 1922 and perfected by Jordan using the correction of flexion contracture of the knee in hemophiliacs. But owing to the development of some problems in original hinge for prevention of posterior displacement of tibia after posterior cruciate ligament injury, we modified the design of the hinge that more effective anterior traction force should be operated on tibia. The authors applied Quengel brace including original and modified hinge to 21 cases of posterior cruciate ligament injury between June 1983 and May 1986. The followings were obtained. 1. By modification of the hinge, more effective anterior traction force operated on tibia without pressure sore or joint narrowing. 2. On clinical application of modified Quengel brace, posterior displacement of tibia were prevented effectively.
Braces ; Contracture ; Gravitation ; Joints ; Jordan ; Knee ; Leg ; Posterior Cruciate Ligament ; Pressure Ulcer ; Tibia ; Traction

It would be naive to assume that any operative procedure is the solution to the problem of sacral pressure sore in the field of the orthopaedic surgery. The procedures outlined here involve the creation of compound myocutaneous flaps of the gluteus maximus muscle, skin, and the subcutaneous tissue. The myocutaneous flap us- ing the gluteus maximus muscle is a vascular flap instead of a random flap, with better blood supply for healing and advantage of an increased amount of cushion effect. We present an alternative method which will provide satisfactory and substantial soft tissue coverage in sscral pressure sores.
Methods ; Myocutaneous Flap ; Pressure Ulcer ; Skin ; Subcutaneous Tissue ; Surgical Procedures, Operative

Numerous operations have been described to treat the recurrent anterior dislocation of the shoulder, but no one procedure was accepted as the choice of operation. We perforemed 6 Bristow procedures and 5 combined Bankart and Putti-Platt procedures and examined six shoulders by arthroscope from sep. 1989 to Sep. 1992, and we analysed the pathologic feature and the results of them. The average follow-up period was 2.2 years. 1. There were 8 males and 3 females and their average age was 33.7 years. The mean age in initial dislocation was 28 years. 2. The number of recurrent dislocation before operation was 17.9 times and the average duration of the disease was 5.7 years. 3. The pathologic lesions observed in intraoperative field were Hill-Sachs lesion (72.7%), Bankart lesion (90.9%), and the erosion of the glenoid rim (54.5%). On arthroscopic examination of 6 cases, Hill-Sachs lesion was found in 4 cases, Bankart lesion was seen in all of 6 cases, and the erosion of the glenoid rim was observed in 4 cases. 4. The average range of the limitation of external rotation was 17.3 and its significant difference was not observed between 2 operative groups. 5. By Rowes rating sheet, 4 cases of 5 combined Bankart and Putti-Platt operations were excellent and 1 case was good. 6. In conclusion, combined Bankart and Putt-Platt operation was considered as a good surgical procedure in the treatment of recurrent anterior dislocation of the shoulder.
Arthroscopes ; Dislocations ; Female ; Follow-Up Studies ; Humans ; Male ; Shoulder

No abstract available.
Arthroplasty, Replacement, Hip*

Total hip replacement for adults with severe acetabular dysplasia presents a difficult problem because deficient bone stock and soft tissue contractures usually prevent sitting at the normal anatomic level. The rationales of high hip center are due to high failure rate of bulk structural weight bearing graft, good short-term result of hemispherical cementless acetabular component in revision surgery, high hip center but not lateral which does not adversely affect the biomechanics of the hip, and intimate apposition with viable host bone. We represented the short-term results of 21 total hip replacements with proximal placement of the acetabular cup than the anatomical position that is normally used. The mean duration of follow up was 18 months(range, 12-58 months) and the mean age of the patient was fifty-one years(range, thirty to sixty-seven years). Most of these hips had a major deficiency or defect of the acetabular bone stock. They had an aver- age Harris hip score of 47 points preoperatively and 90 points postoperatively. Roentgenographic measurements showed that the mean change in the height of the center of the hip postoperatively was only +6.6 millimeters and the mean change of horizontal location of them was 10 millimeters medial to the preoperative position. Postoperative complications included calcar fracture(1 case), trochanteric bursitis(1 case), postop- erative dislocation(1 case) and one case of radiological loosening of the acetabular component. The center of the hip in THR is not a crucial parameter with regard to the long-term stability of acetabular component, so our recommendation is to place the acetabular component at a more proximal but not lateral position if strong bone stock is available. But future studies of high hip center need to address femoral component longevity.
Acetabulum ; Adult ; Arthroplasty, Replacement, Hip ; Contracture ; Femur ; Follow-Up Studies ; Hip Joint ; Hip ; Humans ; Longevity ; Osteoarthritis ; Postoperative Complications ; Transplants ; Weight-Bearing

BACKGROUND: In anesthesia for tonsillectomy in children, deep general anesthesia, rapid recovery to consciousness and the return of protective airway reflexes are desirable. This study was designed to estimate the efficacy of TIVA with propofol and fentanyl compared with isoflurane-N2O. METHODS: Forty pediatric patients in ASA class I for tonsillectomy were allocated randomly to either TIVA with propofol and fentanyl (n=20, T) or isoflurane-N2O (n=20, I) group. Anesthesia was induced with propofol 1 mg/kg, fentanyl 3 microgram/kg IV and was maintained by continuous infusion of propofol 6~10 mg/kg/hr, fentanyl 6~10 microgram/kg/hr in T group and was induced with thiopental 5 mg/kg IV and maintained by inhalation of 1.2~2.5 vol% isoflurane in I group. The changes of hemodynamics, recovery time and complications were evaluated. RESULTS: Systolic and diastolic pressure were increased in I group than T group at 1 min after intubation (p<0.05). Heart rate was increased in I group than T group at 1 min after intubation, 1 min and 5 min after incision, changing tube, end of operation and 5 min after end of operation (p<0.05). The recovery time was shorter in T group than I group (p<0.05). Pain on injection was more frequent in T group than I group (p<0.05), and excitatory effect during emergence was more frequent in I group than T group (p<0.05). CONCLUSIONS: TIVA with fentanyl and propofol is better than isoflurane-N2O for anesthesia of tonsillectomy in children in view of small hemodynamic change, early and gentle recovery pattern and side effects.
Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous* ; Blood Pressure ; Child* ; Consciousness ; Fentanyl ; Heart Rate ; Hemodynamics* ; Humans ; Inhalation ; Intubation ; Isoflurane* ; Propofol ; Reflex ; Thiopental ; Tonsillectomy*

No abstract available.