The most commonly used graft source for anterior cruciate ligament reconstruction is the autogenous bone- patellar tendon-bone graft unit. Despite a good success record, intraoperative technical errors and postoperative complications have been known. Author analyzed intraoperative technical errors and postoperative complications, in 44 patients who were treated at the department of orthopaedic surgery, chosun university hospital from Jan. 1994 to Jun. 1996. The most common intraoperative technical errors was screw graft divergency in 5 cases. Other intraoperative technical errors were too anteriorly location of femoral tunnel in 1 case, too anteriorly location of tibial k femora) tunne.l both in 1 case, graft tunnel mismatching in 1 case, graft pullout in 1 case and partial destruction of posterior cortex of femoral tunnel in 1 case, fracture of the bone plug in 1 case. The most common postoperative complication was patellar tendinitis in 20 cases (45.5%). Other postoperative complications were anterior knee pain in 14 case. (31.8%), patellar crepitation in 12 cases (27.3%), quadriceps atrophy in 9 cases (20.5%), arthrofibrosis in 3 cases and graft failure in 2 cases. Author concluded the causes of intraoperative complications were technical errors, and anteriorly location of graft tunnel is most influenced factor to final fuctional results. To eliminate the postoperative complications, intraoperative technical errors should be avoided and also accelerated rehabilitation should be done.
Anterior Cruciate Ligament Reconstruction ; Atrophy ; Humans ; Intraoperative Complications ; Knee ; Patellar Ligament* ; Postoperative Complications* ; Rehabilitation ; Tendinopathy ; Transplants

No abstract available.

No abstract available.
Intra-Articular Fractures* ; Tibia*

In the fractures and dislocations of the carpus, prompt and accurate diagnosis is the prime prerequisite for restoring function to this most complicated joint in the body. And then, early precise reduction and continuous maintenance of the reduced position until ligamentous and bone healing is complete provide the best chance of achieving a satisfactory restoration of function. We analysed forty five cases of fractures and dislocations of the carpus which were treated for 5 years from Jan. 1984 to Dec. 1988 at the Department of Orthopedic Surgery, College of Medicine, Hallym University. The following results were obtained; l. Of the total 45 injuries, scaphoid fractures were seen in 32(71.1%), other carpal bone fractures except scaphoid in 13 patients(28.9%), and carpal bone dislocation and fracture- dislocations in 11 patients(24.4%). 2. Carpal scaphoid fracture 1) 19 of the 32 patients(59.4%) had an associated ipsilateral upper extremity injury. 2) This fracture was common in the young male. 3) A union rate(95.6%) was achieved using a usual conservative treatment for undisplaced racture(14), operative treatment for displaced(18). 4) The mean time to radiological union for all fractures was 11.1 weeks. Old fracture by SotoHall classification took the longest time to union(18.2 weeks), subacute fracture 13 weeks, and acute fracture 9 weeks. 5) 10 cases were treated for nonunion, 5 of 10 nonunions were classified as type (50%). 2 cases showed ultimately nonunion in spite of various sorts of treatment, which belonged to waist fracture. 3. Other carpal bone fractures except scaphoid were seen in 13(15 bones) of 45 injuries, and pisiform(4) and triquetrum(4) fractures were common. 4. Carpal dislocation and fracture-dislocations were seen in 11 of the 45 injuries and dorsal transscaphoid perilunate dislocations(4) were common. These were treated by C.R. and cast immobilization or O.R. and K-wire fixation relatively good results were obtained.
Carpal Bones ; Classification ; Clinical Study ; Diagnosis ; Dislocations ; Humans ; Immobilization ; Joints ; Ligaments ; Male ; Orthopedics ; Upper Extremity

The distal tibial physes begins its closure about 18 months prior to complete cessation of the tibial growth, closing first in its midportion, then medially, and finally, laterally. So the patterns of the ankle fracture during this period would be different from those of the adult or the children before this period. During the six year period from 1983 to 1988 at the department of orthopedic surgery, college of medi-cine, Hallym University, we found and analysed 54 adolescent patients with the ankle fracture which developed before the closure of the distal tibial growth plate, which were followed up more than 1 year. The results were as follows 1. During the 6 year period of this study, the adolescent ankle fracture comprise 4.4% (54 cases) of all the ankle fractures(1158 cases). Injury occurred more often in male than in female(44 versus 10). The mean age was 13.7 years. 2. The most common cause of injury was traffic accident being in 26 cases(48.1%), the next was slip down accident in 11 cases, and the third was sports activity in 10 cases. 3. The incidence of the adoescent ankle fractures using the Salter-Harris classification revealed 20 (37%) type II, 7 (13%) type III, 5 (9.3%) type IV, and 4 (7.4%) type I and that using the Dias and Tachdjian classification revealed 14 (25.9%) Supination-Inversion, 10 (18.5%) Supination-External rotation, 7 (12.7%) Pronation-Eversion-External rotation, and 1 (1.9%) no adjustable fracture. There were 9 (16.7%) Tillaux and 9 (16.7%) triplane fractures, which were belonged to both classifications 4. The treatments performed were closed reduction and cast immobilization for 28 cases (51.9 %), open reduction and internal fixation for 20 cases (37%), and closed reduction and percutaneous pinning for 6 cases. 5. There were complications experienced in 9 cases, which were 3 premature epiphyseal closure, 3 joint surface incongruity, 2 angular deformity, and 1 leg shortening. 6. For the prevention of the complication, the treatment of the adolecsent ankle fracture should be treated like as adult fracture.
Accidents, Traffic ; Adolescent ; Adult ; Ankle Fractures ; Ankle ; Child ; Classification ; Clinical Study ; Congenital Abnormalities ; Growth Plate ; Humans ; Immobilization ; Incidence ; Joints ; Leg ; Male ; Orthopedics ; Sports

No abstract available.

No abstract available.
Hyperthyroidism*

BACKGROUND: It is well known that intracoronary thrombolysis during the early period of acute myocardial infarction leads to the limitation of myocardial necrosis, preserves left ventricular function, and improves survivals. The recanalization rate of intracoronary rrokinase infusion into infarct-related coronary artery was known as 62-94 percents in previos studies. The various factors influence the outcome of intracoronary thrombolysis, including total dose of urokinase, time from onsrt of chest pain to thrombolysis. The purpose of this study was to evaluate whether the occlusion site morphology influences recanalization rates of intracoronary thrombolysis. METHODS: We evaluated infarct-related coronary artery morphology of 56 acute mycardial infarction patients who performed intracoronary thrombolytic therapy within 6-12 hours after the onset of acute myocardial infarction. Intracoronary urokinase infusion was performed at a rate of 25000 IU/minute. The presence of calcification, collaterals, side branches and the stump site morphologies(thrombus type, pencil type, cutting type) were identified on magnified 35mm cine frames. RESULTS: Reperfusion was successed in 34 patients and failed in 22 patients. There were no statistically significant difference in the pressure of calcification, collaterals, and side branches between success and failure groups. Intracoronary thrombus was identified in 21 percent of success group, but not in failure group. The reperfusion rates according to stump site morphology were 76% in thrombus type, 58% in cutting type, and 42% in pencil type(p<0.05). CONCLUSION: Our study indicates the presence of intracoronary thrombus and the morphology of thrombus type is more effective in intracoronary thrombolysis in acute myocardial infarction. The identification of types of the coronary obstruction will be helpful for the selection of intracoronary thrombolysis in acute myocardial infarction patients. And the results suggest that the difference of stump composition show different stump morphologies.
Chest Pain ; Coronary Vessels* ; Humans ; Infarction ; Myocardial Infarction* ; Necrosis ; Reperfusion ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Ventricular Function, Left

PURPOSE: This study is aimed to investigate perceptions of caregivers and medical staff toward do not resuscitate (DNR) and advance directives (AD). METHODS: Participants were 141 caregivers and 272 medical staff members from five general hospitals. A questionnaire used for the study consisted of 20 items: 14 about DNR perceptions, three about AD, one each for age, gender and employment. RESULTS: Both medical staff and caregivers strongly recognized the need for DNR and AD, and the level of recognition was higher with medical staff than caregivers (DNR chi2=44.56, P=0.001; AD chi2=16.23, P=0.001). The main reason for the recognition was to alleviate sufferings of patients in the terminal phase. In most cases, DNR and AD were filled out when patients with terminal conditions were admitted, and patients made the decisions by consulting with their guardians. Medical staff better recognized the need and for growing demand for guidelines for the DNR and AD decision making process than caregivers (chi2=7.41, P=0.0025). CONCLUSION: This study showed that patients highly rely on their caregivers when making decisions for DNR and AD. Thus, it is important that patients and caregivers are provided with objective information about the decisions. Since participants' strong support for DNR and AD was mainly aimed at alleviating patients' suffering, further study is needed in the association with hospice care. Medical staff also needs to understand the different views held by caregivers and fully consider the disparity when informing patients/caregivers to make the DNR and AD decisions.
Advance Directive Adherence ; Advance Directives ; Caregivers* ; Decision Making ; Employment ; Hospice Care ; Hospitals, General ; Humans ; Medical Staff* ; Personnel, Hospital ; Resuscitation Orders ; Surveys and Questionnaires

We experienced one case of severe pituitary dwarfism in a 10 years old female girl. Magnetic resonance image (MRI) revealed transection of the pituitary stalk stalk with the formation of high intensity ectopic posterior lobe located at the median eminence and agenesis of an anterior lobe of pituitary gland. The serum growth Hormone (GH) response to clonidine and L-dopa revealed severe GH deficiency. The patient had responses to TRH, normal TSH and partial prolactin response, respectively. There was not response LH and FSH to GnRH. The morning cortisol concentration and serum T4 concentration were decreased below the normal range. These findings and no hyperprolactinemia suggested the presence of a vascular connection between the pituitary gland and hypothalamus, which is not visible on MRI. Sofar, the primary cause of idiopathic pituitary dwarfism in many patients is injury to hypothalamus by perinatal insults. In this patient, there was no history of perinatal insults and postnatal head trauma but transection of the pituitary stalk. We report a case of severe pituitary dwarfism due to agenesis with brief review of related litereature.
Child ; Clonidine ; Craniocerebral Trauma ; Dwarfism, Pituitary* ; Female ; Gonadotropin-Releasing Hormone ; Growth Hormone ; Humans ; Hydrocortisone ; Hyperprolactinemia ; Hypothalamus ; Levodopa ; Magnetic Resonance Imaging ; Median Eminence ; Pituitary Gland* ; Pituitary Gland, Anterior* ; Prolactin ; Reference Values