Chemonucleolysis is a significant innovation in the treatment of herniated lumbar disc disease. The prodedure is relatively safe and the results are highly acceptable, but in most studies, the failure rate is 20-25%. Computed tomography was performed from January, 1986 to June, 1987 at the Department of Orthopedic Surgery, Yonsei University on six patients with herniated lumbar discs who did not improve with chemonucleolysis. The results of this study are as follows : 1. The herniated lumbar disc remained unchanged in 4 cases and was reduced in 2 cases. 2. In 2 cases of hernia reduced, the development of a diffuse annular bulging was noted and compression of the dural sac unchanged. 3. Chemonucleolysis was carried out at two levels in 2 cases and the herniated lumbar disc was not changed in these cases. 4. Thickening of the ligament flavum was noted in 1 cases. 5. Computed tomography findings after chemonucleolysis were good correlation with the clinical results in failed cases. In the cases not relieved the symptoms over 3–6 months after chemonucleolysis, it is necessary follow up computed tomography to decide the further treatment.
Follow-Up Studies ; Hernia ; Humans ; Intervertebral Disc Chemolysis ; Ligaments ; Orthopedics

Three main types of operative teehnique are in general use today in the treatment of spondylolysis or spondylolisthesis: namely, total laminectomy alone, total laminectomy and posterior fusion, and anterior interbody fusion. According to Hoover(1968), above operations have yielded satisfactory results in approximately 70% of the cases. In recent years, Watkins, Adkins and Rombold have independently reported their cxperience with posterolateral intertransverse fusion, which they claim is based on a more sound mechanical basis and has yielded better results. The author performed anterior interbody fusion in 4 cases and posterolateral intertransverse fusion in 3 cascs at Seoul Naval Hospital during the 2 year period from May 1968 through May 1970 The postoperative follow-up period was maximum one year and minimum six months. Only one casc of anterior interbody fusion has shown sound fusion, while all ihe three posterolateral intertransverse fusions with posterior H-graft have yielded sound fusion with satisfactory clinical improvement by six months after operation.
Follow-Up Studies ; Laminectomy ; Seoul ; Spondylolisthesis ; Spondylolysis

Muscle transplanation surgery is presently widely accepted as a good precedure not only for cosmetic, but also for functional results, a concept to which Marina's observations on the absence of fixed and predetermined functions in the nuclei and associated tracts of the oculomotor system give great support; however, not everyone is in agreement with this concept. This paper report one case in which the total transplantation of the vertical rectus muscles midway between their insertions and the insertion of the lateral rectus muscle were carried out, in addition recession of the medial rectus muscle and resection of the paralyzed lateral rectus muscle. Our case have been followed up during 8 months to rule out late complications, aspecially ocular movement and diplopia. No late complications, however, have been found up to remaining underaction of the right superior and inferior oblique muscles and also medial rectus muscle. The eyes were straight with abduction of the right eye up to 40 prism diopters. Binocular vision was present and there was no diplopia. The cosmetic result was excellent.
Diplopia ; Muscles ; Paralysis* ; Vision, Binocular

No abstract available.
Shoulder Fractures*

Myocarditis is defined as the myocardial inflammation caused by various infectious agents (such as virus, rickettsia , bacteria, protozoa, fungus and parasites). The clinical manifestations of myocarditis ranges from the asymptomatic state due to focal inflammation to fulminant fatal congestive heart failure secondary to diffuse myocardial involvement. Clinically, in some cases, it may simulate an acute myocardial infarction. We experienced a case of acute fulminant myocarditis that presented as acute myocardial infarction initially, and then progressed into and recovered from congestive heart failure and multiorgan failure.
Asymptomatic Diseases ; Bacteria ; Estrogens, Conjugated (USP)* ; Fungi ; Heart Failure* ; Inflammation ; Myocardial Infarction ; Myocarditis* ; Rickettsia

No abstract available.
Pregnancy*

To characterize the immunopathologic phenotype of the cells in the lesional ti.:sue and to further examine the mechanism of the development of the annular lesions in leprosy, we have studied immune cells (T lymphocyte and its subsets, Langerhans cells, and HLA-DR antigen expressing cells) at different anatomical sites inside, active border, and outside normal skin in the annular lesions of leprosy. We took biopsy specimens from 4 patients of BT type, then processed the specimens by the staining methods eif indirect immunoperoxidase with monoclonal antibodies. In the active border the number of T cell was over 50g of the total cells infiltrated in the dermis. Helper T cells were dominant in number, and about three fourths of the cells were positive for HLA-DR staining. In two patients they had expression of DR antigen on the surfaces of the keratinocytes in the epidermis, in contrast to that of the inside, even the intensities were not. strong. At the inside of the annular lesions T cells were about 40% and the ratio of helper/suppressor T cell was approxiinately 1: 1, However, HLA-DR positive immune cells were not more than 10g among the total infiltrates. Langerha,ns cells were increased in number and in size either in the border or at the inside of the annular lesions. With these results we presume that the T cell mediated imrnune responses against Mycobacterium leprae may play an important role in the formation and extension of the annular lesions in leprosy.
Antibodies, Monoclonal ; Biopsy ; Dermis ; Epidermis ; HLA-DR Antigens ; Humans ; Keratinocytes ; Langerhans Cells ; Leprosy* ; Lymphocytes ; Mycobacterium leprae ; Phenotype ; Skin ; T-Lymphocytes ; T-Lymphocytes, Helper-Inducer

No abstract available.

The tibial pilon fracture has been described as difficult fracture to manage. We have reviewed 23 cases of tibial pilon fractures from Mar. 1987 to Feb. 1993 at our hospital. 1. The fractures were classified into five types according to the system of Ovadia and Beals and the methods of treatment were divided into two groups; 9 cases were treated with Ilizarov device(Group I). 6 cases out of Group I were type 3, 4 and 5. Other methods were performed in 14 cases(Group II). 8 cases out of Group II were type 3, 4, and 5. 2. In type 3, 4 and 5 fractures, there were 86 per cent good and fair radiographic results in Group I and 63 per cent good and fair results in Group II. 3. Satisfactory results were obtained by the treatment of Ilizarov method especially in type 3, 4 and 5 fractures. The advantages of Ilizarov device were its primary reduction with ligamentotaxis, easy open reduction due to proximal and distal stabilization, minimal soft tissue injury and minimal internal fixation.
Ilizarov Technique ; Soft Tissue Injuries

The authors have reviewed 11 cases of prosthetic replacement for severe proximal humeral fractures which were treated from March 1989 to December 1993, paying particular attention to the range of motion attained after surgery and the factors which influence the limitation of shoulder motion. The results of this study were as follows: l. Among the 11 cases, 10 cases showed sttisfactory pain relief. 2. Active motion of the shoulder averaged 91° of forward flexion, 72.8° of abduction and 35° of external rotation. 3. The humeral offset averaged 30.9mm in normal shoulder and 18.9mm in affected shoulder. 4. In 6 cases which the humeral offset measured over 20mm, active motion averaged 104° of forward flexion and 83° of abduction and 5 cases showed satisfactory results. 5. In 5 cases which the humeral offset measured under 20mm, active motion averaged 104° of forward flexion and 83 of abduction and 5 cases showed unsatisfactory results. 6. Prosthetic replacements were performed within 1 week after injury in 7 cases and among these 5 cases showed satisfactory results. The range of motion after prosthetic replacement for severe proximal humeral fracture was disappointing. We concluded that limited range of motion is mainly due to reduced humeral offset and restoration of humeral offset by appropriate reattachment of greater tuberosity will allow better clinical result.
Range of Motion, Articular ; Shoulder ; Shoulder Fractures