Acetabular bone deficiencies encountered during the revision hip arthroplasties should be recon- structed to provide the implant stability and to restore the normal center of rotation of hip and the leg length. We revised the loosened acetabular cup by grafting fresh-frozen bulk femoral head and inserting uncemented cup in 17 hips of 15 patients. The average follow-up period was 2 years and 3 months. The acetabular bone deficiencies were type 2A in 6 hips, type 2B in 8, type 3A in 1 and type 3B in 2 by Paprosky's classification. Three blocks of femoral head were grafted in 3 type 3 deficiencies, but only one in type 2 deficiencies. The cup-host bone contact was 41% on the average. However, the cup-host bone contact in the zone I was present only in 12 out of 17 hips and its average was 14%. Incorporation of the allograft into the host bone occurred between 5 months and 1 year and 7 months (average, 8,6 months) after revision surgery. Significant radiographic loosening sign was noted only in 2 hips which had not only type 3B bone deficiencies reconstructed with 3 blocks of femoral head allograft but also no cup-host bone contact in zone I . The bulk allograft of fresh-frozen femoral head demonstrated acceptable results in type 2 acetabular bone deficiencies, although the follow-up period was relatively short. Reconstruction of type 3B acetabular bone deficiencies by using multiple blocks of femoral head allograft had been failed. We presumed that the lack of the graft stability and the intimate contact between the grafts and host bone was the cause of failure.
Acetabulum* ; Allografts* ; Arthroplasty ; Classification ; Follow-Up Studies ; Head* ; Hip ; Humans ; Leg ; Transplants

Fractures of the metacarpal and phalanx of the hand are common occurances and bony union usually occurs without difficulties. If complication of the metacarpal and phalangeal fracture of the hand occurred, it causes significant functional deficit. The authors have reviewed 92 patients, 121 cases of metacarpal and palangeal fracture of the crushed hand which were treated with internal fixation with/without open reduction in the deparment of orthopaedic surgery in Holy Family Hospital from Jan. 1985 to Dec. 1989. The authors obtained the following results ; 1. The incidence of nonunion and delayed union was 12.4% (15/121 cases). 2. The criteriae of nonunion and delayed union are progressive angulation at fracture site after removal of implant, lack of bony union evidence in the radiography more than 12 weeks after injury, tenderness and pain on motion at fracture site and gross pseudomotion. 3. Nonunion and delayed union occurred more commonly in phalangeal fractures, shaft fractures, severely traumatized fractures (open fractures, marked displaced fractures, comminuted fractures and fractures had associated injuries in the same hand) and under-reduced fractures after internal fixation. 4. Mean TAM (total active motion) range at last follow up was 94.5°in thumb and 186.6°in finger and that of nonunion and delayed union cases was 89°in thumb and 153.5°in finger.
Fingers ; Follow-Up Studies ; Fractures, Comminuted ; Hand ; Humans ; Incidence ; Radiography ; Thumb

The purpose of this study was to evaluate the effect of fibrin tissue adhesive and porous resorbable calcium carbonate on the periodontal regeneration of the class II furcation defect in dogs. Class II furcation defect was surgically created on the second, third, and fourth premolars bilaterally in the mandibles of six mongrel dogs. The experimental sites were divided into four groups according to the treatment modalities: Control-surgical debridement only; Group I-calcium carbonate grafting; Group II-application of fibrin adhesive only; Group III-application of fibrin adhesive after calcium carbonate grafting. The animals were sacrificed at the 2, 4, and 12 weeks after periodontal surgery and the decalcified specimens were prepared for histological and histometrical examination. The results are as follows : Clinically, there were no inflammatory response in all groups after 2, 4, 12 weeks. In the Control group, junctional epithelium was grown downward to the reference notch. In Group I, graft materials were exfoliated from the defect throughout the experimenta periods andnew bone was seen in the notch area at 4 and 12 week specimens. In Group II, fibrin adhesive was absorbed at 2 week specimens, and connective tissue attachment increased than that of control group. New cementum and new bone were seen above the notch area. In Group III, the graft material was maintained in the defect throughout the experimental period and inducing the amount of periodontal tissue regeneration was higher than other groups. These results suggest that the use of fibrin tissue adhesive in conjunction with porous resorbable calcium carbonate would improves the stability of graft material and inhibit the epithelial down growth and make it be a feasible method for periodontal regeneration.
Animals ; Bicuspid ; Calcium Carbonate* ; Calcium* ; Carbon ; Connective Tissue ; Debridement ; Dental Cementum ; Dogs* ; Epithelial Attachment ; Fibrin Tissue Adhesive* ; Fibrin* ; Furcation Defects* ; Mandible ; Regeneration* ; Transplants

Verapamil overdose results in cardiac arrhythmia including the complete A-V block, and hypotension due to decreased peripheral resistance and decreased myocardial contractility. However, sustained-release verapamil overdose frequently has atypical presentations, such as delayed and prolonged course of toxic signs and symptoms. Although several cases of sustained-release verapamil overdose have been reported worldwidely, the specific treatment modalities and prognostic indicators for verapamil overdose have not been well-defined. Recently, we experienced a case of sustained-release verapamil overdose in 30-year-old female. 10 hours after verapamil ingestion she presented in severe bradycardia and hypotensive shock state. Initial EKG showed the complete AV block and her systolic blood pressure was below 60 mmHg. Temporary cardiac pacemaker was performed and she was treated with activated charcoal, glucagon, amrinone, and several sympathomimetics, and 48 hours after admission, she was fully recovered.
Adult ; Amrinone ; Arrhythmias, Cardiac ; Atrioventricular Block ; Blood Pressure ; Bradycardia ; Charcoal ; Eating ; Electrocardiography ; Female ; Glucagon ; Humans ; Hypotension ; Shock ; Sympathomimetics ; Vascular Resistance ; Verapamil*

Chyloperitoneum, also called chylous ascites, is a rarely reported complication of abdominal surgery. In most cases, the diagnosis and treatment is not difficult. The characteristic milky colored odorless fluid is easily detected by drainage or aspiration. With the help of diagnostic radiology and laboratory tests, it has become easier to detect the chyloperitoneum. Chyloperitoneum subsides spontaneously or responds well to medical treatment. Death from chyloperitoneum is extremely rare. However, 3 cases of medically intractable chyloperitoneum were encountered at our hospital after curative surgery for gastrointestinal malignancies (two colorectal cancers and one gastric cancer). Herein, the authors report these case and discuss their treatments.
Chylous Ascites* ; Colorectal Neoplasms ; Diagnosis ; Drainage

OBJECTIVES: The aim of this study is to estimate the relative risk for breast cancer using the Gail model and to observe the relationship between mammographic density and the 5-year risk of breast cancer. METHODS: A total of 600 women who visited the Department of Obstetrics and Gynecology in Chung-Ang University Yongsan Hospital were screened using the Gail model to estimate their relative risk for breast cancer. The correlation between the 5-year risk of breast cancer and the mammographic density of 462 women who had performed mammography within 1 year of the study was analyzed. RESULTS: The mean age of the study subjects was 56.7 +/- 8.2 years. The estimated mean values for the 5-year risk and lifetime risk for breast cancer were 1.23 +/- 0.46% and 7.90 +/- 2.76% respectively in all study subjects. The estimated mean value of the 5-year risk for breast cancer increased with age. Otherwise, the estimated lifetime risk for breast cancer decreased with age. Ninety-two women (15.3%) were classified as high-risk because their estimated 5-year risk was over 1.67% or their lifetime risk was over 20%. High risk percentages according to age were 10.5% in the thirties, 0.84% in the forties, 7.2% in the fifties, 32.7% in the sixties, and 35.7% in the seventies. Among the high risk postmenopausal women, 52.2% were taking hormone therapy. Mammographic density was not significantly correlated with the estimated 5-year risk for breast cancer. CONCLUSION: About fifteen percent of study subjects were at high risk for breast cancer according to the estimated 5-year risk or lifetime risk for breast cancer using Gail model. Mammographic density was not correlated with the 5-year risk for breast cancer.
Breast ; Breast Neoplasms ; Female ; Gynecology ; Humans ; Mammary Glands, Human ; Mammography ; Obstetrics ; Risk Assessment

For more than 20 years, many cytologic techniques have been developed for endometrial sampling such as Gravlee jet aspirator, Isaacs cell sampler, Vabra aspirator, Pipelle, etc. But none of the techniques received general acceptanee as a replacement for dilatation and curettage. Hence dilatation and curettage is still used to evaluate women at high risk for endometrial cancer and infertility, to manage abnormal uterine bleeding and to follow womeh on hormone replacement therapy, But biopsy methods produce enough pain to lower patients acceptance, Z-sarnpler is a new simple plastic endornetrial suction curette that provides a histologic diagnosis like Pippelle, This study compared the clinical usability of the Z-sampler to that of endometrial biopsy by dilatation and eurettage. The Z-sampler obtained sufficient tissues for histologic diagnosis in 45 cases(45/50, 90.0%), it was lower than that of end.ometrial biopsy(49/50, 98,0%), But the accuracy of tissue diagnosis was almost equal to that of endometrial biopsy. In addition. Z-sempler cau less pain(94.1%) and the duration of this procdure was shorter than that of endometrial biopsy by dilatation and curettage. These results suggest that the Z-sampler may be efficieot technique in endometrial tissue diagnosi, like dilatation and curettage and it has greater patient acceptability due to less pain, less bleeding and shorter duration of procedure.
Biopsy ; Diagnosis ; Dilatation and Curettage* ; Dilatation* ; Endometrial Neoplasms ; Female ; Hemorrhage ; Hormone Replacement Therapy ; Humans ; Infertility ; Plastics ; Suction ; Uterine Hemorrhage

Although diabetes mellitus (DM) is treatable, it is still not curable. Its chronicity is associated with a high prevalence of psychiatric disorders, especially depression in type 2 DM and learned helplessness in type 1 DM. In turn, this depression and helplessness may affect a patient's adherence to medical appointments, compliance to treatment, and effective doctor-patient relationships, which are vital to promising outcomes. This study reviews the existing literature regarding the interactional relationships between depression, DM and the doctor/patient relationship, and also suggests certain aspects of the doctor/patient relationship which can contribute to more successful treatment outcomes.
Appointments and Schedules ; Compliance ; Depression ; Diabetes Mellitus ; Helplessness, Learned ; Object Attachment ; Physician-Patient Relations ; Prevalence

No abstract available.
Chondroma*

Successful regeneration of a cartilage framework using perichondrium has been reported by several authors but there are some arguments surrounding mucosal regeneration. Some authors report that regeneration of mucosa is completed by ingrowth from neighboring tissue but others insist that it occurs via metaplasia from the squamous epithelium. This study was designed to investigate the differences in regeneration between nonvascularized and vascularized flaps. A 5 X 15mm sized vascularized composite flap composed of vascularized perichondrium pedicled on the central auricular artery and free buccal mucosa which was harvested from the oral cavity and sutured on the vascularized perichondrium was fabricated in a rabbit ear. It was transferred to a pre-created 4 X 12mm tracheal defect. A morphologic study was carried out to determine the outcome of the grafted mucosa at regular intervals under light microscopy after H and E staining. A nonvascularized perichondrial-mucosal composite flap with the same dimension was transferred in the control group. The results are as follows;1) The control group showed necrosis of the grafted mucosa and defective area was covered by ingrowth of the neighboring normal mucosa. The periphery of the defective area regenerated earlier than the central area and immature epithelia were still found 6 weeks after the graft. Regeneration of cilia was rather inconsistently observed 8 weeks after the transfer. 2) In the experimental group, the grafted mucosa survived on the vascularized perichondrium which was thought to act as a vascularizing bed. Two weeks after reconstruction, the covering epithelium appeared almost as normal as the tracheal columnar epithelium. At 4 weeks, the regenerated mucosa could hardly be distinguished from the normal mucosa. Regeneration of cilia was consistent at 6 weeks in the experimental group. Mucosal regeneration in the experimental group was superior to the control group in terms of degree and quality. Mucosal coverage of the control group occurred by ingrowth from the neighboring mucosa. In the experimental group, survival of the grafted mucosa relied upon revascularization through the vascular pedicle. It can be conceived that metaplasia of the grafted mucosa occurs in a vascularized composite flap transferred group. In conclusion, maintenance of vascularization is essential to successful regeneration of grafted mucosa with good quality.
Arteries ; Cartilage ; Cilia ; Ear ; Epithelium ; Metaplasia ; Microscopy ; Mouth ; Mouth Mucosa ; Mucous Membrane ; Necrosis ; Regeneration ; Transplants