PURPOSE: The globe luxation is a rare phenomenon in which there is a forward displacement of the eye ball so that the eye lids spasmodically close behind it. In Korea, no case has been reported. The authors experienced a case of globe luxation by laceration of the conjunctiva with trauma. METHODS: The authors experienced a case of globe luxation in 64-year-old male who had crushed with infantile marry-go-round handle and complained proptosis and ocular pain. Ocular examination revealed best corrected visual acuity of right eye 0.1, IOP 44mmHg, conjunctival hyperemia and laceration, extraocular muscle limitation in all direction. Exophthalmometer shows right eye 23mm, left eye 19mm. Orbital CT yielded proptosis and globe luxation without avulsion of internal and external rectus muscle and optic nerve. RESULTS: After the lateral canthotomy, we successfully treated with the corticosteroid therapy without visual impairment or eyeball movement disorder. we report a case of globe luxation with the review of literature.
Conjunctiva ; Exophthalmos ; Humans ; Hyperemia ; Korea ; Lacerations ; Male ; Middle Aged ; Movement Disorders ; Optic Nerve ; Orbit ; Vision Disorders ; Visual Acuity

39 patients with tibial shaft fracture had treated by open reduction and internal fixation with AO DCP and screws applying on the medial surface of the tibia, at the Department of Orthopedic Surgery, Ulsan Dongkang Hospital, from January, 1983 to December, 1985. A clinical study was done on all the 39 cases with the follow-up check over 1 year. In general, because the lateral surface of the tibia is well covered by rich soft tissue, it is popularized to apply the plate on the lateral aspect of the tibia. In our department, we applied the plate on the medial aspect of the tibia, which resulted in mimi-zing soft tissue injuries and, by inserting the screws perpendicular to the surface of the bone, increased stability of the fixation; and therefore resulted in relatively short operation time, relatively low incidences of infection and non-union; but there had been some drawbacks such as focal skin necrosis, hematoma, adhesion after fixatives removal, and cosmetic disfiguring. But there were no problems during the follow up periods. So, this is a recommandable procedure of internal fixation with the plate for the tibial shaft fractures.
Clinical Study ; Fixatives ; Follow-Up Studies ; Hematoma ; Humans ; Incidence ; Necrosis ; Orthopedics ; Skin ; Soft Tissue Injuries ; Tibia ; Ulsan

Fourty one cases of open fractures of tibial shaft complicated with varying degrees of soft tissue injuries were trested by one-plane unilateral external fixation with AO fixator. In seventeen csses among them, interfragmental lag screw fixation was applied in addition, for more rigidity and stability of the fixation. All of thern were followed up at least for one year and we obtained the following results. 1. Rigid stable external fixation provided by additional minimum internal fixation may not increase the rate of infection but rather enhance prompt primary bone healing. 2. One-plane unilatersl external fixation may facilitate good access to the wound for subsepuent reconstructive procedures, and enhance pain-free early full range of joint motion, thus promote early bone union. 3. Comparing with bilsteral fixation, there wss almost no difference in the union time of the fracture even with one-plsne unilatersl fixation.
Clinical Study ; External Fixators ; Fractures, Open ; Joints ; Soft Tissue Injuries ; Tibia ; Wounds and Injuries

Eighteen cases of osteonecrosis of the femoral head associated with macromolecular polyvinylpyrrolidone (PVP) deposition were analysed on the basis of clinical, radiologic and pathologic features. The cases were observed during 8 years period from January, 1974 to December, 1981. The pathogenesis of the osteonecrosis of the femoral head due to PVP storage in reticuloendothelial system were discussed in detail. Parenteral administration of high-molecular PVP in repeated, long duration led to osteonecrosis of the femoral head. Storage of PVP in the histiocytes of the bone marrow resulted in osteonecrosis of the femoral head followed by microciculation disturbance. PVP-induced osteonecrosis were manifested as multiple foci of necrosis involving not only the femoral head, other long bones around joints, but also the visceral reticuloendo-thelial system characterized by infiltrates of histiocytes laden with PVP. The patients with PVP induced osteonecrosis complianed multiple joint pain in their early course of the disease. On roentgenogram, osteonecrosis were often noted in the hip, shoulder, knee, and ankle in order or frequency. Foamy histiocytes laden with PVP were characteristic on hematoxylin-eosin stain diagnostic on Weigert's elastica, phosphotungstic acid hematoxylin, and Congo red stains. As far as rationale of the treatment concerning a number of staging systems for Osteonecrosis, the choice of surgical procedures were similar to those given by W.F. Enneking et al. In the series, we have performed two hips in total surface replacement, 26 hips in total hip replacement mostly for 3rd generation-configuration of Charnley prosthesis. In addition, one case for free vascularized fibula graft and trans-trochanteric rotational osteotomy after Sugioka were also included for this study. The result of treatment was rather optimistic. However, complications have occured in 4 hips of 3 patients which required removal of whole prosthetic components. Therefore, we underwent revisional surgery in three out of four hips subsequently during the short post-poerative follow-up. These will be published in the future.
Ankle ; Arthralgia ; Arthroplasty, Replacement, Hip ; Bone Marrow ; Coloring Agents ; Congo Red ; Fibula ; Follow-Up Studies ; Head ; Hematoxylin ; Hip ; Histiocytes ; Humans ; Joints ; Knee ; Mononuclear Phagocyte System ; Necrosis ; Osteonecrosis ; Osteotomy ; Phosphotungstic Acid ; Povidone ; Prostheses and Implants ; Rubber ; Shoulder ; Transplants

PURPOSE: To analyse the macular thickness in normal and diabetic patient using OCT mapping protocol. METHODS: OCT using macular thickness map protocol was performed in 46 eyes of 25 healthy volunteers and 121 eyes of 85 diabetic patients with clinical diagnosis of no diabetic retinopathy (25 eyes), nonproliferative diabetic retinopathy (NPDR) without clinically significant macular edema (CSME; 35 eyes), proliferative diabetic retinopathy (PDR) without CSME (27 eyes), and diabetic retinopathy with CSME (34 eyes). RESULTS: The mean +/- standard deviation foveal thickness was 146 +/- 21 micrometer in normal eyes, 147 +/- 20 micrometer in diabetic eyes without retinopathy, 173 +/- 24 micrometer in NPDR without CSME, 174 +/- 27 micrometer in PDR without CSME, and 322 +/- 146 micrometer in diabetic retinopathy with CSME. There was significant difference in foveal and outer temporal retinal thickness between the normal eyes and the diabetic retinopathy without CSME group (p<0.01). Diabetic eyes with CSME had a statistically significant greater thickness in each of the areas compared with the other group and showed perifoveal focal macular edema in 5 eyes. CONCLUSIONS: OCT mapping protocol provide intuitive and objective information on focal diabetic macular edema.
Diabetic Retinopathy ; Diagnosis ; Healthy Volunteers ; Humans ; Macular Edema ; Retinaldehyde ; Tomography, Optical Coherence

Perfluorodecalin, which is one of the perfluorocarbon liquids, is not established safety in use of long-acting intraocular tamponade. Therefore, to determine its safety we injected it alone and combined with silicone oil into the vitreous of vitrectomized eyes. We evaluated the changes of the fundus, electroretinogram, histopathology as light and electron microgragh after lensectomy and vitrectomy in pigmented rabbits periodically. In rabbits replaced with perfluorodecalin alone, fundus showed mild proliferative vitreoretinopathy and micrographs showed the destruction of the inner and outer segments of the photoreceptors. In rabbits replaced with perfluorodecalin and silicone oil, fundus showed more severe proliferative vitreoretinopathy than perfluorodecalin alone and micrographs showed the destruction of the entire retina. In electroretinogram, the amplitude was decreased markedly. So, it is considered that perfluorodecalin was not tolerant in case of longacting intraocular tamponade and also perfluorodecalin combined with silicone oil developed severe proliferative vitreoretinopathy.
Rabbits ; Retina ; Silicone Oils* ; Vitrectomy ; Vitreoretinopathy, Proliferative

PURPOSE: To evaluate the usefulness of dynamic CT during the hepatic arterial phase with rapid IV injection ofcontrast material in distinguishing hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (ICAC) asthe cause of biliary obstruction. MATERIALS AND METHODS: We retrospectively reviewed two-phase dynamic incrementalCT or helical CT findings in 22 patients with intrahepatic duct obstruction secondary to pathologically provenHCCs (n=12) or ICACs (n=10). Two-phase CT scans were obtained 20-45 seconds (hepatic arterial phase) or 2 minutes(equilibrium phase) after the initiation of a bolus injection of contrast material (5 mL/sec, 150 mL). Theenhancement patterns of tumors, as seen on two-phase images, were classified as hypo-, iso-, or hyperattenuated,relative to surrounding liver parenchyma. Two-phase images were compared and correlated with pathologic findings. RESULTS: During the hepatic arterial phase, diffuse high-enhancement was seen in nine HCCs (75%) and partialenhancement in three (25%); five (50%) of the ten ICACs were hypodense and five (50%) were hypodense withperipheral enhancement. During the equilibrium phase, however, all HCCs were hypodense and capsular enhancementwas seen in four cases (33.3%). All ICACs were hypodense with mild peripheral or central heterogeneousenhancement. Contrast enhancement patterns of HCCs during the hepatic arterial phase were significantly different(P<.0001) from those of ICACs. CONCLUSION: Our results suggest that dynamic CT during the hepatic arterial phase,with rapid IV injection of contrast material, is useful for the differentiation of HCC from ICAC as the cause ofbiliary obstruction.
Carcinoma, Hepatocellular* ; Cholangiocarcinoma* ; Humans ; Liver ; Retrospective Studies ; Tomography, Spiral Computed ; Tomography, X-Ray Computed

The AO internal fixation system(the Fixateur Interne) is effective in reducing and stablizing a variety of unstable thoracolumbar fracture patterns. It is relatively effective in decompressing the canal of retropulsed bony fragments associated with burst fracture. Sixty-Two patients with unstable thoracolumbar spine fractures were treated with the AO internal fixator. They were followed for an average of 21 months(range 15-29 months). A compartive radiographic analysis of kyphosis and vertebral height was made using pre-operative, post-operative and follow-up radiogram. Changes in neural canal compromise were measured in 18 cases of burst fractures. Failure of instrumentation occured in 9 cases which were carefully analyzed. Recently, we've constructed the system of which the Schanz screws would be directed divergently in sagittal plane in the hope that the load to the screws might be reduced, thus the failure rate.
Follow-Up Studies ; Hope ; Humans ; Internal Fixators ; Kyphosis ; Neural Tube ; Spine

PURPOSE: We wanted to identify the difference of the measured values between a navigation system and radiographs when performing open and closed wedge high tibial osteotomy (HTO) under the control of a navigation system. MATERIALS AND METHODS: Thirty-two open wedge HTOs and 51 closed wedge HTOs were performed using a navigation system. The postoperative mechanical axis percent, which was planned on the navigation system, was 62%. The mechanical axis (MA) was measured before osteotomy and after fixation on the navigation system, and these were compared with the measured values from the radiographs. The difference of the postoperative MA between the navigation system and the radiographs was compared according to the type of HTO. The alteration of the tibial posterior slope angle was also compared. RESULTS: For the open wedge HTO, the mean MA after fixation was valgus 2.7degrees on the navigation system and the postoperative MA was valgus 4.0degrees on the radiograph. For the closed wedge HTO, the mean MA after fixation was valgus 3.5degrees on the navigation system and the postoperative MA was valgus 1.6degrees on the radiograph (p=0.000). The mean tibial posterior slope angle was increased by 5.3degrees after the open wedge HTO and it was decreased by 1.8degrees after closed wedge HTO (p=0.000). CONCLUSION: Performing HTO with a navigation system could increase the surgical accuracy because the navigation system checked the intraoperative correction angle in real time. Weight bearing makes a difference for the postoperative MA between the navigation system and radiographs. This should be taken into account, according to the type of HTO.
Axis, Cervical Vertebra ; Knee ; Osteoarthritis ; Osteotomy ; Surgery, Computer-Assisted ; Weight-Bearing

The original valve-sparing procedures for aortic root aneurysms were remodeling and reimplantation of the aortic root. The remodeling technique provides more physiologic movement of the cusps within 3 reconstructed neo-sinuses, thus preserving root expansibility through the interleaflet triangles. However, the durability of remodeling has been a matter of concern due to the high rate of aortic insufficiency when annular dilation is not addressed. Therefore, a modified approach was developed, combining a physiologic remodeling of the root with a subvalvular annuloplasty. This case report highlights the first case of successful aortic root remodeling with external subvalvular ring annuloplasty in Korea.
Aneurysm ; Aortic Aneurysm ; Cardiac Valve Annuloplasty ; Korea ; Replantation