The anterior cruciate ligament has been considered one of the basic stabilizers in the knee as a very complex in its function. A large number of treatment regimens and philosophies showed controversies in its treatment. And we have experienced recurrence of the instability after operation of the injured ligament. So, the authors devised a new operative technique for the loose anterior cruciate ligament, that is, distal davancement of the loose anterior cruciate ligament with a bone-block as a biomechanical fixation. We have performed 11 cases of the anterior cruciate ligament using distal advancement method. The results were as follows; 1. Eleven cases (92%) showed good results by the rating system of Cincinnati sports-medicine and Orthopaedic Center. 2. The distal advancement of the anterior cruciate ligament is technically simple and biomechanically reasonable, but further investigation is necessary to answer the question regarding the long term results.
Anterior Cruciate Ligament ; Knee ; Ligaments ; Methods ; Philosophy ; Recurrence

No abstract available.
Allografts*

Purpose: A video-urodynamic study is known as the most accurate test to differentiate between benign prostatic hyperplasia (BPH) with overactive bladder and detrusor instability but requires expensive equipment and an expert technique, so is not commonly available. We performed a video- urodynamic study and ice-water test which is easily performed for the diagnosis of a neurogenic bladder in the patients with symptomatic BPH associated with overactive bladder and compared the results. Materials and Methods: The video-urodynamic study using a 10-Fr triple lumen urodynamic catheter was performed in 36 patients with symptomatic BPH associated with overactive bladder that had frequency, weak stream, nocturia, urgency, urge incontinence, dysuria and no clinical neurogenic defect. After the video-urodynamic study, the ice-water test was performed by instilling 4degreesC sterilized water through a catheter at 200ml/ min in the supine position. The volume instilled was about 30% of the bladder capacity. The ice-water test was positive if there was an efflux of water around the catheter during or after water instillation. Results: Thirty two of the 36 symptomatic BPH patients with an overactive bladder were negative on the ice-water test. All 32 patients who had a negative ice-water test were BPH with overactive bladder on the video- urodynamic study. Four of the 36 symptomatic BPH patients with an overactive bladder were positive on the ice-water test. Two of the 4 patients who had a positive ice-water test were BPH with overactive bladder and the other two were detrusor instability on the video-urodynamic study. Conclusions: Therefore, in case of a positive ice water test, a video-urodynamic study is needed to differentiate between BPH with overactive bladder and detrusor instability in patients with symptomatic BPH associated with overactive bladder.
Catheters ; Diagnosis ; Dysuria ; Humans ; Ice ; Nocturia ; Prostatic Hyperplasia* ; Rivers ; Supine Position ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Bladder, Overactive* ; Urinary Incontinence, Urge ; Urodynamics ; Water

PURPOSE: To compare surgical results of two patient groups with punctal obstruction. One group underwent punctoplasty while the other group underwent silicone tube intubation. METHODS: We compared postoperatively 48 eyes of 37 patients with punctal obstruction within and after one year of the procedure. 24 eyes of 17 patients had punctoplasty and 24 eyes of 20 patients had silicone tube intubation by the same surgeon. RESULTS: Upon follow-up within one year after the punctoplasty, 13 eyes (54%) showed no epiphora, nine eyes (38%) showed intermittent epiphora, and two eyes (8%) showed persistent epiphora. However, after silicone tube intubation, 20 eyes (83%) showed no epiphora, three eyes (13%) showed intermittent epiphora, and one eye (4%) showed persistent epiphora. Over one year after the punctoplasty, one eye (4%) showed no epiphora, 19 eyes (78%) showed intermittent epiphora, and four eyes (17%) showed persistent epiphora. However, after the silicone tube intubation, 17 eyes (71%) showed no epiphora, six eyes (25%) showed intermittent epiphora, and one eye (4%) showed persistent epiphora. CONCLUSIONS: Silicone tube intubation is more effective than punctoplasty in the long term treatment of punctal obstruction.
Eye ; Follow-Up Studies ; Humans ; Intubation ; Lacrimal Apparatus Diseases ; Silicones

Bone defect of the long bone continues to challenge orthopedic surgeons. It is usually very difficult to obtain union. Ilizarov ext. fixation has recently gained popularity as a multifactorial approach to the management of tibial bone defect because nonunion, bone defects, limb shortening, and deformity can all be addressed simultaneously with the Ilizarov apparatus. From February 1992 to May 1993 at the department of orthopedic surgery, Inje University Pusan Paik Hospital, 9 patients aged from 8 to 37 years were treated for tibial bone defect. The causes were open comminuted fractures with initial bone loss and bone defect after removal of infected necrotic bone. Bony defect size was ranged from 2cm to 14cm, averaging 7.2cm. Bony defects were gradually closed by the Ilizarov's internal bone transport technique, and final equalization of leg length discrepancy was achieved by means of external lengthening technique. Soft tissue defects were treated with secondary closure, split thickness skin graft, and muscle flap. The average healing index was 42.8 days/cm. According to Paley's classification the complications were developed as follows; The problem included pin tract infection(9), knee flexion contracture(4), and intractable pain(1), the obstacles included delayed union(3) and premature consolidation(1), the complication included nonunion(9) and equinus ankle(1). At an average 1 years follow up, according to Paley and Catagnl's classification, body and functional results were either excellent or good in 7 cases. So, we recommend that Ilizarov technique is very useful treatment for open fracture with bone loss, bone defect after removal of infected necrotic bone and limb shortening.
Busan ; Classification ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Fractures, Comminuted ; Fractures, Open ; Humans ; Ilizarov Technique ; Knee ; Leg ; Orthopedics ; Skin ; Surgeons ; Tibia ; Transplants

Supracondylar fracfture of the humerus is the most common fracture about the elbow joint in children. Early accurate reduction is very important to obtain good results. The authors reviewed 44 cases of supracondylar fractures treated at Inje Universsity Pusan Paik Hospital from January 1986 to December 1990. Average follow-up time was 1 year 6 months. The results were as follows; 1. Thirty cases were treated with closed reduction and percutaneous pinning, ten with manipulation and cast immobilization, three with skeletal traction and the rest one with open reduction and internal fixation. 2. If there was a difference of the angle within 10-degree in post-reduction X-ray, deformity did not follow at the last follow-up. 3. The common formula was that a change of 5-degree in Baumann's angle corresponded to a 2- degree change in the clinical carrying angle. 4. Baumann's angle did not change between that of initially accepted and that of the final follow up X-ray. So, the authors recommend post-reduction measurements of the Baumann's angle as the adequancy of reduction of supracondylar fractures in children.
Busan ; Child ; Congenital Abnormalities ; Elbow Joint ; Follow-Up Studies ; Humans ; Humerus ; Immobilization ; Traction

OBJECTIVE: Helicopter ambulance transport (HAT) is a highly resource-intensive facility that is a well-established part of the trauma transport system in many developed countries. Here, we review the benefit of HAT for neurosurgical patients in Korea. METHODS: This retrospective study followed neurotrauma patients who were transferred by HAT to a single emergency trauma center over a period of 2 years. The clinical benefits of HAT were measured according to the necessity of emergency surgical intervention and the differences in the time taken to transport patients by ground ambulance transport (GAT) and HAT. RESULTS: Ninety-nine patients were transferred to a single university hospital using HAT, of whom 32 were taken to the neurosurgery department. Of these 32 patients, 10 (31.3%) needed neurosurgical intervention, 14 (43.8%) needed non-neurosurgical intervention, 3 (9.4%) required both, and 11 (34.4%) did not require any intervention. The transfer time was faster using HAT than the estimated time needed for GAT, although for a relatively close distance (<50 km) without ground obstacles (mountain or sea) HAT did not improve transfer time. The cost comparison showed that HAT was more expensive than GAT (3,292,000 vs. 84,000 KRW, p<0.001). CONCLUSION: In this Korean-based study, we found that HAT has a clinical benefit for neurotrauma cases involving a transfer from a distant site or an isolated area. A more precise triage for using HAT should be considered to prevent overuse of this expensive transport method.
Air Ambulances* ; Ambulances ; Developed Countries ; Emergencies ; Humans ; Korea ; Neurosurgery ; Retrospective Studies ; Trauma Centers ; Triage

Polyorchidism is a rare anomaly. It may result from transverse division of the urogenital ridge, a hypothesis that best explains the anatomical features of the supernumerary testicle. Until recently, histology provided the only proof of polyorchidism but new imaging techniques, such as sonography and magnetic resonance imaging(MRI), allows a highly accurate diagnosis of supernumerary testes rendering biopsy unnecessary. We report a case of polyorchidism in a 24 month-old-boy in whom the scrotal sonogram and magnetic resonance imaging confirmed the presence of 2 testicles without any evidence of tumor within his right hemiscrotum and who was treated conservatively and followed up 2 years.
Biopsy ; Diagnosis ; Magnetic Resonance Imaging ; Testis ; Ultrasonography

This experimental studies was to investigate the location of CNS labeled neurons following injection of pseudorabies virus (PRV), Bartha strain, into the rat thymus. After survival times of 96~120 hours following injection of PRV, the rats were perfused, and their spinal cord and brain were frozen sectioned(30micrometer). These sections were stained by PRV immunohistochemical staining method, and observed with light microscope The results were as follows: 1. The PRV labeled spinal cord segments projecting to the rat thymus were founded in cervical and thoracic segments. Densely labeled areas of each spinal cord segment were founded in lamina V, VII, X, intermediolateral nucleus and dorsal nucleus. 2. In the rhombencephalon, PRV labeled neurons projecting to the thymus were founded in the A1 noradrenalin cells/C1 adrenalin cells/caudoventrolateral reticular nucleus, rostroventro-lateral reticular nucleus, medullary reticular nucleus, area postrema, nucleus solitary tract, nucleus raphe obscurus, nucleus raphe pallidus, nucleus raphe magnus, gigantocellular reticular nucleus, lateral paragigantocellular nucleus and spinal trigeminal nucleus. 3. In the mesencephalon, PRV labeled neurons were founded in parabrachial nucleus, Kolliker-Fuse nucleus, central gray matter, substantia nigra, nucleus dorsal raphe, A8 dopamin cells of retrorubral field, Edinger-Westphal nucleus, locus coeruleus, subcoeruleus nucleus and A5 noradrenalin cells. 4. In the prosencephalon, PRV labeled neurons were founded in reuniens thalamic nucleus, paraventricular thalamic nucleus, precommissural nucleus, paraventricular hypothalamic nucleus, anterior hypothalamic nucleus, lateral hypothalamic nucleus, preoptic hypothalamic nucleus, retrochiasmatic area, arcuate nucleus, dorsomedial hypothalamic nucleus and ventromedial hypothalamic nucleus. These results suggest that PRV labeled neurons of the spinal cord projecting to the rat thymus might be the neurons related to the viscero-somatic sensory and sympathetic preganglionic neurons, and PRV labeled neurons of the brain may be the neurons response to the movement of smooth muscle in blood vessels. These PRV labeled neurons may be central autonomic center related to the integration and modulation of reflex control linked to the sensory system monitoring the internal environment. These observations provide evidence for previously unknown projections from spinal cord and brain to the thymus which may be play an important role in the regulation of thymic function.
Animals ; Anterior Hypothalamic Nucleus ; Arcuate Nucleus ; Area Postrema ; Blood Vessels ; Brain ; Dorsomedial Hypothalamic Nucleus ; Herpesvirus 1, Suid* ; Hypothalamic Area, Lateral ; Immunohistochemistry ; Locus Coeruleus ; Mesencephalon ; Midline Thalamic Nuclei ; Muscle, Smooth ; Neurons* ; Paraventricular Hypothalamic Nucleus ; Prosencephalon ; Pseudorabies* ; Rats* ; Reflex ; Rhombencephalon ; Spinal Cord ; Substantia Nigra ; Thymus Gland* ; Trigeminal Nucleus, Spinal ; Ventromedial Hypothalamic Nucleus

The interlocking nail is used as a valuable method in treating humerus shaft fracture because of the merit, including relatively simple procedure, one of the most stable fixation methods, and allowing early ROM excericise and low complication. Fourteen pateints with humerus shaft fractures were treated using interlocking nail at the Department of Orthopaedic Surgery Paik Hospital from Jan.1993 to Oct.1994. l. Among the 14 pateints, average age was 34.8 years and 9 cases were male and the most common cause of injury was traffic accident. 2. Associated injury including 3 cases of ipsilateral scapular fracture, I case of ipsilateral clavicle fracture, and 1 case of brachial plexus injury, and 1 case of radial nerve injury. 3. The mean duration of the radiologic bone union was 8.6 weeks. 4. There was no serious post operative complication such as non-union, infection, bending or rotational deformity at fracture site, impingement syndrome, metal failure of the nail or interlocking screws. 5. To prevent the impingement syndrom and rotator cuff injury, we countersinked the proximal end of the nail into the humeral head and minimized skin incision.
Accidents, Traffic ; Brachial Plexus ; Clavicle ; Congenital Abnormalities ; Humans ; Humeral Head ; Humerus ; Male ; Methods ; Radial Nerve ; Rotator Cuff ; Skin ; Tibia