The purposes of this clinical study are to observe the clinical findings of the high lumbar disc herniation, to analyze the of the posterior approach and to define the surgical indications of the high lumbar disc herniation. We analyzed the 13 cases which were treated at the Deparment of the Orthopaedic Surgery, National Medical Center from March 1988 to December 1992(Mean follow up rate : 17. 2 months). 1. We operated 10 cases by posterior approach and 1 case by anterior approach due to marked degenerative osteophyte. 2. We evaluated the post-operative results by modified Macnab criteria, the 2 cases showed no symptomatic improvement because of respectively associated high lumbar osteophyte and lower lumbar spinal stenosis. 3. On conclusion, suspicion is important in cases of incompatible clinical symptoms and signs of the intervertebral disc herniation. MRI is the most recommended diagnostic tool, because it can provide the high lumbar levels with saggital section image and differentiate herniation from degenerative osteophyte. As for the surgical indications of high lumbar disc herniations, we suggest marked dural compression by disc or sequestered disc materials in MRI, definite neurological complications such as ankle clonus, increased DTR, weakness of quadriceps and hip flexor muscle and severe radiating pain on the anterior thigh. We recommended the posterior approach for the surgical intervention of high lumbar disc herniation except cases marked degenerative osteophytes.
Ankle ; Clinical Study ; Follow-Up Studies ; Hip ; Intervertebral Disc ; Magnetic Resonance Imaging ; Osteophyte ; Spinal Stenosis ; Thigh

Creutzfeldt-Jakob disease(CJD) is characterized clinically by rapidly progressive dementia with pyramidal, extrapyramidal, and cerebellar symptoms and signs, and histologically by spongiform change, neuronal loss and reactive gliosis. We have experienced 2 cases of CJD. Case 1 was a 36-year-old male who had suffered from myoclonus and cerebellar symptoms including sluggish speech, gait and balance disturbance. Case 2 was a 70-year-old female who had showed cognitive dysfunction, ataxic gait and disturbance of extraocular movement. Both patients, underwent brain biopsy. Case 1 revealed marked cortical atrophy, 2mm in thickness, with neuronal loss and astrocytic proliferation extending into white matter. The spongiform change, made up of many small, usually rounded or oval, vacuoles was noted mainly in the neuropil. Case 2 revealed remarkable spongiform change throughout the cortex and cytoplasmic vacuoles compressing the nuclei of neuronal cells were numerous. Neuronal loss and gliosis were also found without considerable change in the white matter. On double immunostaining against GFAP and PrP(Prion Protein), there was a weak positive reaction for PrP in the perinuclear cytoplasm in case 1, and a strongly positive reaction in case 2. The electron microscopic examination showed numerous membrane-bound vacuoles in neuropil and perikarya of neurons. The majority of the vacuoles were multiseptated by thin membranous structures. They demonstrated curled, or disrupted membrane, that had foldings and protrusions into the vacuolar clear spaces. There were neither identifiable virus-like particles nor amyloid deposition.
Female ; Male ; Humans

The transpedicular screw fixation is known to be capable of providing more secure correctional, force and rigid fixation to the spine. But it is often accompanied by various complications, including stress shield effects, loosening in osteoporotic spine, pseudoarthrosis, hardware problems and long-term change in motion behaviors at the adjacent motion segment and etc. The purpose of this study is to compare the flexible and rigid rods system in terms of complications and problems for various degenerative lumbar diseases. From September 1991 to November 1994, 41 patients were operated with the flexible rods system (group A) and 39 patients with the rigid rods system (group B). They were followed up for more than 4 years. The flexible rods system was composed of 41 cases of Wiltse system and the rigid rods system was composed of 29 cases of Diapason, 8 cases of TSRH and 2 cases of CD instrument. The resuits of the study were as follows: 1. By standard Cobb lateral measurement, 7 cases in group A and 10 cases in group B showed significant loss of sagittal angle (>4), post-operatively. 2. Hardware failure was noted in 7 cases in group A and 10 cases in group B. In group A, rod bending was seen in 4 cases, rod breakage in 2 and screw loosening in one. In group B, screw loosening was observed in 5 and screw-rod locking mechanism failure in 5 cases. 3. In spondylolisthesis patients, 10 cases in group A and 14 in group B, there was no statistically significant differences between the two groups in the reduction rate immediately after surgery and loss of reduction at the last follow up. 4. Clinical results were good to excellent in 85.4% of patients in group A and 82.1% of group B. No statistically significant differences between the two groups were found, 5. No statistically significant differences between the two groups were found with respect to degenerative changes at the adjacent motion segment to the fused level and pseudoarthrosis.
Follow-Up Studies ; Humans ; Pseudarthrosis ; Spine* ; Spondylolisthesis

One of the commonest and most serious problems of the injured hand is flexion contractures of the fingers. Such deformities not only functionally impair the digit, but also reduce or restrict the functional capability of the entire hand. We reviewed 150 digits of 73 patients with flexion contractures of the fingers which had been treated at National Medical Center from Jan. 1976 to Dec. 1985. The results were as follows: 1. The duration of flexion contractures which were scattered from 4 months to 17 years and average duration of contracture was 20.6 months. 2. The methods of treatment were Z-plasty, adhesiolysis, capsulotomy, excision of both collateral ligaments, stripping of extensor mechanism and volar plate and release of flexor tendon sheath according to injury mechanism and duration of contracture. 3. The postoperative results showed up 32 (21.3%) excellent, 78 (52%) good, 24 (16%) fair and 16 (10.7%) poor. 4. The postoperative results of burned injury which showed up-8 excellent, 11 good out of 20 cases they are supposed to have satisfactory results. 5. Crushing injury which had intraarticular fracture or comminution show up unsatisfactory results. 6. It seems obvious that the early active motion of interphalangeal joint is important to improve joint function. 7. The arc of motion was retained in a more functional position postoperatively than preoperatively.
Burns ; Clinical Study ; Collateral Ligaments ; Congenital Abnormalities ; Contracture ; Fingers ; Hand ; Humans ; Intra-Articular Fractures ; Joints ; Tendons

In the treatment of elderly hip fracture, early mobilization as a means of reducing early postoperative morbiyt and morbidity is mandatory. Even though Ender nailing have many advantages, most serious problems with use of Ender nailing method are distal migration of nails, subsequent loss of fixation and limited knee joint motion. To prevent these difficult problems, we have used distal wiring technique with Ender nailing since 1988. In operation, we performed Ender nailing as usual manner under image intensifier and for the prevention of the nail migration, we performed circumferential wiring through the each Ender nail eye and above the adducter tubercle of the distal femur. Forty six cases were available with minimum follow-up of six months which were healed radiologically and clinically (Mean follow up: 21 months). The mean age was 74 years (Range: 52 years-88 years)and showed 26 cases of famale and 20 cases of male. The radiological morphometry using Singh index showed poor bone quality: 36 cases were below Grade III and the fracture type was classified by Tronzo criteria. In results, patients who had Ender nailing with distal wiring showed no distal migration, however one case of proximal migration was observed at the beginning stage of this technique. So, in elderly trochanteric fracture, to reduce the complication of the Ender nailing, especially nail migration, the authors recommend the Ender Nailing with distal wiring technique.
Aged ; Early Ambulation ; Femoral Fractures ; Femur ; Follow-Up Studies ; Hip ; Humans ; Knee Joint ; Male ; Methods

Nine species of genus Ganoderma collected in Korea and abroad including Ganoderma lucidum complex and G. lucidum were compared by investigating growth characteristics. In the bottle culture, the mycelial growth periods of G. lucidum from Taiwan and North America was 26 to 30 days compared to that of Korean G. lucidum, which was 30 to 32 days. Cultivation period of Taiwan and North American isolates was 30 to 32 days which were 11 to 17 days shorter than those of Korean isolates. Biological efficiency of Taiwan and North American isolates were ranged from 3.3 to 5.5%, which were apparently lower than that of Korean isolates which ranged from 6.2 to 9.4%. Korean isolates had longer stipes(15~40 mm) and more number of pileus(4~6/bottle) than those of Taiwan and North American isolates. The G. lucidum isolates collected from Korea will be regarded as the independent species from the G. lucidum collected from Taiwan and North America since, the G. lucidum from Korea showed much different growth characteristics in various aspects compared to the G. lucidum from Taiwan and North America.
Fruiting Bodies, Fungal ; Ganoderma* ; Korea ; North America ; Reishi* ; Taiwan

PURPOSE: In patients with traumatic hyphema, we investigated the changes of corneal endothelium and the associated ocular complications that might attribute to endothelial damage. MATERIALS & METHODS: We reviewed the medical records of 67 patients(67 eyes) who had been admitted and treated for blunt ocular trauma with hyphema between February 1997 and June 2000. One month after injury, endothelial photographs of both eyes of each patient were taken with specular microscope to compare the endothelium of the injured eyes with that of the normal fellow eyes. The endothelial parameters were studied in relationship to various complications to see the relationship between the complications and the endothelial damage. RESULTS: Compared with the fellow uninjured eyes, the injured eyes had a mean decrease in endothelial cell density (ECD) of 5.6% (P=0.015). Nine patients had significant corneal edema with epithelial defect on initial admission, which was defined as corneal impact lesion. In the group with the corneal impact lesion, the mean ECD decrease was 23.1% (P=0.016) and the mean coefficient of variation (COV) increase was 24.8% (P=0.01). With other variables such as the amount of hyphema and the degree of angle recession, statistically significant results could not be obtained. In 20 patients on long-term follow-up examination (mean 36.7 months after the injury), the injured eyes had a mean increase in ECD of 2.5% compared to the result on initial examination. This change was minimal and statistically not significant. CONCLUSION: In patients with traumatic hyphema, this study showed reduced endothelial cell densities in the injured eyes compared to the normal fellow eyes. In particular, statistically significant decrease in ECD was noted to be associated with corneal impact lesion.
Corneal Edema ; Endothelial Cells ; Endothelium ; Endothelium, Corneal ; Follow-Up Studies ; Humans ; Hyphema* ; Medical Records

No abstract available.
Child* ; Humans ; Infant*

There was a development of the diagnostic aids such as electromyography, discography, epidural venography, myelography, and CT in lumbar disc herniation. In 1984, Edgardo et al. described that the diagnosis of unusual extreme lateral disc herniation might be suggested by CT, but the diagnosis was made more certain with CT done after discography. Also, in 1986, Michael et al. reported,that the addition of CT to lumbar discography could help the clinician to obtain an anatomically valid diagnosis in people who, in spite of prior negative diagnosis evaluation, continue with significant clinical symptoms of low back pain and sciatica. The authors have studied 25 cases of CT after discography from July 1984 to June 1987. The results were as follows;1) CT after discography, which was a diagnostic method of direct visualization of nucleus pulposus herniation, shown same finding as previous CT in 16 cases and more accurate finding of herniated site snd size in 2 cases. 2) In one csse, the diagnosis of extreme lateral disc herniation, which was suggested by previous CT, made more certain with CT after discography. 3) There was false negative in 6 cases.
Diagnosis ; Electromyography ; Low Back Pain ; Methods ; Myelography ; Phlebography ; Sciatica

BACKGROUND: Transforming growth factor (TGF)- has a large variety of biological functions, including the modulation of inflammation and the immune system, and is presumed to play important roles in repairing wounds and reducing scarring. The objective of this study is to examine the effects of TGF-1 on healing wounds and reducing scarring. We have also analysed the ability of the hemagglutinating virus of Japan (HVJ) liposome mediated antisense oligodeoxynucleotides (ODNs) to specifically inhibit wound-induced expressions of TGF-1 proteins and mRNA in the rat skin. METHODS: Skin wounds were created on the backs of 80 anesthetized rats. The first group of wounds, as the controls, was unmanipulated. The second group of wounds, as positive controls or an excessive scarring model, was injected with TGF-1 subcutaneously. The third group of wounds was injected with anti-TGF-1 antibody subcutaneously. The fourth group of wounds was injected with HVJ liposome mediated antisense ODNs for TGF-1 subcutaneously. The wounds of all groups were bisected and analysed histologically 5, 10, 15, 30, and 50 days after the wounds were made. RESULTS: All control wounds (TGF-1 or no injection) healed with scarring, whereas the wounds treated with the antibody or antisense ODNs healed with less scar formation compared to the control group. The wounds treated with the antibody or antisense ODNs had fewer macrophages, less collagen and fibronectin contents than the other wounds. Northern blotting and in situ hybridization analysis showed that wound sites treated with HVJ liposome mediated antisense ODNs for TGF-1 exhibited decreased levels of TGF-1 mRNA after injury. CONCLUSIONS: These findings suggest an important new approach to controlling scarring in normal wound healing, complementing the practice of adding exogenous growth factors to chronic wounds in the attempt to inhibit collagen deposition.
Animals ; Blotting, Northern ; Cicatrix* ; Collagen ; Complement System Proteins ; Fibronectins ; Genetic Therapy* ; Immune System ; In Situ Hybridization ; Inflammation ; Intercellular Signaling Peptides and Proteins ; Liposomes ; Macrophages ; Oligodeoxyribonucleotides ; Oligoribonucleotides ; Rats ; RNA, Messenger ; Sendai virus ; Skin ; Transforming Growth Factor beta ; Transforming Growth Factors ; Wound Healing ; Wounds and Injuries