Patients with severe acetabular bony deficiency in total hip revision arthroplasties need the use of autogenous or allogenic bone grafts. The Authors performed 28 cases of total hip revision arthroplasties between June 1991 and January 1995 with femoral head allograft for acetabular bony deficiencies and evaluated the clinical and radiological results according to AAOS classification. The clinical result was evaluated by D'Aubigne and Postel score. The mean score was improved from 3.9 points to 5.1 points at follow-up. In radiological evaluation, osseous union of graft was achieved within 12 month and rerevision were performed in two cases (92.8% survival rates) but radiological radiolucent line in at least one zone was seen in five hips in two year follow up. In conclusion, the results of hemispherical microporocoat cup with allogenic bone in segmental or cavitary defect using with acetabular reinforcement ring in combined deficiency were encouraging to date. Success rate of allograft reconsruction of the acetabulum results from a variety of acetabular defect. In our studies, only 40% showed stable bony fixation over short period.
Acetabulum* ; Allografts ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Classification ; Follow-Up Studies ; Head ; Hip ; Humans ; Transplants*

Harrington Instrumentation and Spinal Fusion to treat the unstable fracture and fracture-dislocation of the thoraco-Iumbar spine is a very effective method. This method not only decompresses the spinal cord and nerve roots by anatomical reduction and preserves spinal stability, but also makes possible early rehabilitation and prevention of complications. A clinical study was made of twelve patients who were hospitalized and treated at the Department of Orthopaedic Surgery, Chung-Nam National University Hospital from Oct. 1978 to J une 1980. The following results were obtained: 1. Of twelve patients, five(42%) had a flexion-compression fracture, four(33.3%) had a shear fracture-dislocation, two(16.7%) had a flexion-rotational fracture, and one(8.3%) had a bursting fracture. 2. Seven(58%) had a complete neural deficit and five (42%) had an Incomplete neural deficit. Two (28%) of the seven patients with complete neural deficit showed slight neurological recovery, but two patients(40%) with incomplete neural deficit gained complete recovery. 3. Correction of the kyphotic deformity was 16 degrees on the average, and the displacement was completely corrected in five of the six patients. 4. During the follow-up period, there was a final loss of about five degrees (range 3-16 degree) of kyphotic correction In our patients and there was no difference in loas of correction between laminectomy group and control group. 5. After an average of 18 postoperative days, ambulation was started, and acute hospital days were 77 days on the average. 6. There was no difference in spinal fusion rate between brace-wearing group (4 cases) and cast Immobilized group (8 cases). 7. Two cases (16.6%) of the twelve cases showed spontaneous interbody fusion.
Clinical Study ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Laminectomy ; Loa ; Methods ; Rehabilitation ; Spinal Cord ; Spinal Fusion ; Spine ; United Nations ; Walking

Intertrochanteric fractures frequently occur in elderly patients. Early mobilization after rigid internal fixation of unstable intertrochanteric fractures has recently reduced the mortality and morbidity. Between March, 1976 and February, 1980, eighteen patients over 60 years old with unstable intertrochanteric fractures were treated by Jewett nailing after Dimon & Hughstons reduction at the department of Orthopaedic Surgery, Chung Nam University. Among the eighteen patients, twelve patients could be followed, ranging from 6 months to 2.1 years, with an average follow-up of 11 months. The results were obtained as follows: 1. The main causes of fractures were falling down and slip down. 2. In treatment of unstable intertrochanteric fractures by medial displacement and valgus nailing with Jewett nail, early ambulation and early weight bearing were possible with satisfactory results. 3. The average time for fracture union in twelve cases who were followed up were 17.1 weeks, but two cases with severe comminution of posterior and medial fragment of the trochanter revealed delayed union. 4. The medial displacement of distal fragment and valgus nailing in unstable intertrochanteric fracture shortened the operation time and reduced complications by early ambulation, but had disadvantages such as some limitation of motion of affected hip joints, shortening of affected extremities and delayed union.
Accidental Falls ; Aged ; Early Ambulation ; Extremities ; Femur ; Follow-Up Studies ; Hip Fractures ; Hip Joint ; Humans ; Mortality ; Weight-Bearing

The intraosseous ganglion is a rare cystic lesion of bone most frequently located in the subchondral epiphysis of long bones with or without direct communication with a joint cavity. This case is reported to call attention to this lesion which deserves consideration in the differential diagnosis of solitary cystic lesions of bone. We were reported a 59-aged woman without direct communication with the knee joint and osteoarthritis which was treated with the curettage and chip-bone graft.
Bone Cysts ; Curettage ; Diagnosis, Differential ; Epiphyses ; Female ; Humans ; Joints ; Knee Joint ; Osteoarthritis ; Tibia ; Transplants

Three cases of severe spinal kyphotic deformities were treated with Halo-pelvic Apparatus. Among these three cases, two were tuberculous kyphotic deformities involving the thoracolumbar vertebrae with paraplegia. And the other one was cervical kyphotic deformity due to neurofibromatosis with neurologic involvement. The following results and considering problems were obtained. 1. Two cases of tuberculous kyphosis, 130° and 115°, were corrected to 120° and 100° respectively. And one case of neurofibromatic kyphosis, 90° was corrected to 53°. 2. Among two cases of tuberculosis in which the one was revealed full neurologic recovery, and the other resulted in permanent paraplegia. And a case of neurofibromatosis was fully recovered neurologically. 3. Total period of immobilization with Halo-pelvic Apparatus was 16, 18, 18 weeks in three cases respectively, but there was no avascular necrosis of odontoid process. 4. One case of neurofibromatosis with anterior spinal fusion revealed no loss of correction of kyphosis. But two cases of tuberculosis without anterior spinal fusion showed loss of correction of kyphosis, 20° respectively. 5. Removal of internal kyphosis was not easy, because it is likely to injury the blood supply to spinal cord. 6. During distraction, severe pain was noticed in the rib cage, which prevented further distraction. 7. After 9 weeks, ambulation with Halo-pelvic Apparatus was hindered with pain due to pelvic pin loosening. 8. In order to prevent loss of correction of kyphosis, it was considered that anterior spinal fusion should be followed by posterior spinal fusion.
Congenital Abnormalities ; Immobilization ; Kyphosis ; Necrosis ; Neurofibromatoses ; Odontoid Process ; Paraplegia ; Ribs ; Spinal Cord ; Spinal Fusion ; Spine ; Tuberculosis ; Walking

Myasthenia gravis is a disease characterized by muscle weakness upon exertion of an involved muscle group and partial return of function eithe with rest or the administration of anticholinesterase. It is generally thought that myasthenia gravis is caused by an autoimmune response associated with the thymus gland and thymectomy is considered to be the treatment of choice for countering this autoimmune process. It is a well known fact that perioerative nticholinesterase therapy, muscle relaxant administration during operation and postoperative respiratory management are in dispute. We described a case of a 42 year old male myasthenic patient with mild symptoms who needed 4 days of artificial ventilatory support following thymectomy.
Adult ; Autoimmunity ; Dissent and Disputes ; Humans ; Male ; Muscle Weakness ; Myasthenia Gravis* ; Thymectomy ; Thymus Gland

OBJECTIVE: The purpose of this study was to determine neonatal outcomes according to laboratory and clinical features in preeclampsia before 35 weeks gestation. METHODS: The medical records of all patients delivered at the hospital from January 1, 1996 through March 31, 2002 were reviewed for the occurrence of preeclampsia before 35 weeks gestation. We compared their maternal medical and obstetric courses and neonatal outcomes with those in a group of non preeclamptic patients who delivered at similar gestational ages. RESULTS: The preeclampsia group had lower mean birth weight, 1-minute Apgar score and umbilical arterial pH. But there were no difference in the incidence of neonatal death, respiratory distress syndrome, grade 3 and 4 intraventricular hemorrhage, and culture-proven sepsis. Results were similar when analysis was limited to infants born before 32 weeks. CONCLUSION: Maternal preeclampsia does not improve neonatal outcome of infants born before 35 weeks gestation.
Apgar Score ; Birth Weight ; Gestational Age ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature* ; Medical Records ; Pre-Eclampsia* ; Pregnancy* ; Sepsis

Recent studies in western countries have reported that the mechanism pf pain are concorded with gate control opiage receptor binding sites and the release of intrinsic morphine like substances, sodium glutamate and also with bradykinin, seroconin, histamine and prostaglandin E. Otherwise the mechanism of the stimulstion producing analgesia has been reported to involve a neurophysiologic and neurohumoral inhibitory effect at the level of spinal cord, brain stem, thalamus and cortex. This has been clarified but further study should improve the chance of understanding the mechanism of pain. From the standpoint of pain management, medications used to manage pain have some unfortunate side effects. nerve blocks cause anesthesia toxicity, major neurosurgical procedures have many complications. Subarachnoidal and epidural analgesics have unknown irritation pneumonia and drug toxicity, and plexus or pituitary gland block with phenol or alcohol has uneventful complication. From January 1980 to December 1982, electrical acupuncture stimulation has been used on 210 cases at HANYANG university hospital in the pain clinic. I found it useful in relieving pain which has not responded to various conventional methods which included medications, nerve blocks, neurosurgical intervantion and neuropolytics. The results are as follows: 1) There are two kinds of treated patients: One is consultation case-12 from internal medicine, 16 from orthopedic surgery, 10 from neurosurgical and 2 from psychiatry. Another 170 cases were patients who directly to the clinic. And the age distribution shows the highset number of patients in the 3rd decade(21%) and in the 4th decade(24.8%). 2) The region of pain was 21% lumbar, 13.8% shoulder, 10% lower leg and head or face with 9.5%. 3) The duration of the pain showed 10 days 25.7%, 1~2 month 18.6%, one year 11.4% and the longest up to 20 years. 4) Patients who were able to walk into the clinic were 19.5%, moderate cases who to be accompanied were 58.6% and bedridden cases were 21.9%. 5) Treatment was conducted mainly on low frequency stimulation with various waves that included the general dynamic activity point plus reactive electro permeable point (REPP) 81.9% and REER plus head in situ needle 18.1%. 6) In 16.7% only one treatment was administered, in 46.1% 2~5 treatments were given, in 28.6% 6~10 treatments were given and in 3 cases more than 100 treatments were administered. 7) Of the 210 cases, 43.3% showed marked improvement, 41.4% were improved, 13.8% showed translent improvement and there were 3 cases of no improvement. The total confidence was 84.7%. 8) There are no serious complications except hypertensive shock case, submucosal hemorrhagic petechia 7 cases and generalized fatigue 18 cases. In conclusion, electrical acupuncture stimulation of the peripheral nervous system can be used to relieve pain replacing such conventional means as medications, nerve blocks, major neurosurgical procedures, neuroytics and physiopsychic therapy which are generally less effective.
Acupuncture ; Age Distribution ; Analgesia ; Analgesics ; Anesthesia ; Binding Sites ; Bradykinin ; Brain Stem ; Drug-Related Side Effects and Adverse Reactions ; Electric Stimulation* ; Fatigue ; Head ; Histamine ; Humans ; Internal Medicine ; Leg ; Morphine ; Needles ; Nerve Block ; Neurosurgical Procedures ; Orthopedics ; Pain Clinics ; Pain Management ; Peripheral Nerves* ; Peripheral Nervous System ; Phenol ; Pituitary Gland ; Pneumonia ; Shock ; Shoulder ; Sodium Glutamate ; Spinal Cord ; Thalamus

Hemochromatosis is an inherited genetic disorder of iron metabolism which can also occur as a secondary result of iron-overload. It leads to organ damage such as cardiomyopathy, liver cirrhosis, hypogonadism, and diabetes. This paper discusses a case of secondary hemochromatosis associated with repeated transfusions, presenting as asymptomatic hypoparathyroidism and subclinical hypothyroidism with multiple organ involvement. The 29-year-old female, who had severe aplastic anemia, received multiple transfusions totaling approximately 1,400 units of red blood cells over 15 years. During her routine laboratory examination, hypocalcemia was detected with decreased intact parathyroid hormone and increased thyroid stimulating hormone. Serum ferritin, iron, and total iron binding capacity had increased to 27,583.03 ng/mL, 291 microg/dL, and 389 microg/dL, respectively. She had unusually bronze skin and computed tomography revealed iron deposition in the thyroid, liver, and heart. Multiorgan involvement as seen in this case is rare in hemochromatosis associated with secondary transfusions. To the best of the author's knowledge, this is the first case report in Korea of hypoparathyroidism and subclinical hypothyroidism due to iron deposition in the parathyroid and thyroid gland.
Adult ; Anemia, Aplastic ; Cardiomyopathies ; Erythrocytes ; Female ; Ferritins ; Heart ; Hemochromatosis* ; Humans ; Hypocalcemia ; Hypogonadism ; Hypoparathyroidism* ; Hypothyroidism* ; Iron ; Korea ; Liver ; Liver Cirrhosis ; Metabolism ; Parathyroid Hormone ; Skin ; Thyroid Gland ; Thyrotropin

It is a well known fact that the best method of determinign need ofr transfusion is the accurate measurement of blood loss related to the patient's status and surgical maneuvers during operation. There are many complications of blood transfusion and their pathophysiologic mechanism, and theprevention and management has been discussed. Among the complications of blood transfusion, urticaria is the most common symptom. The pathophysiologic mechanism of urticaria is understood in some degree at the present time but there are many different opinions as to its prevention and management. Furthermore antihistamine has been widely used for the prevention of urticaria but there are many debatable events about the use of antihistamine. This study was undertaken to investigate the recent reports concerning the use of antihistamine for the prevent in and management of urticaria. Two hundred eighty eight transfused patients among the total of six thousand four hundred forty eight surgical cases done at the Hanyang University hospital from January 1st to December 31th 1983. were reviewed. The result are as follows: 1) The incidence of urticaria was 28 cases (9.72%) among the 288 transfused cases and there was no sex difference. 2) The age distribution was 10 cases (12%) in the 2nd decade and 9 cases(11.3%) in the 4th decade. 3) The lowest incidence of urticaria was 5 cases (5.3%) with A blood type and high of incidence with B, O and AB blood type. 4) The physical status of class 3 was seem in 10 cases(43.5%) as the most common occurrence of urticaria. 5) The highest incidence of urticaria was observed in 9(45%) of 20 obstetric cases. 6) There was no significant differnece of urticaria incidence between the groups which did and did not use antihistamine. Also in the group which received histamine 10 minutes before treansfusion there was a significant decreases 6 cases (3.41%) among the 178 transfused cases. 7) There was no significant statistical difference between blood loss and transfused blood volumes. 8) There was no significant statistical change in the mean values of hemoglobin and hematocrit which were measured preoperatively, in recovery room and 24 hours after operation. 9) In the patient's who were tranfused with more than 10 oints of whole blood, urticaria developed in 9 cases (50%) among 18. From the results of this study, I consider the most effective method for the prevention of urticaria to be the administration of histamine 10 minutes before transfusion. Further investigation of this method will be carried out.
Age Distribution ; Blood Transfusion* ; Blood Volume ; Hematocrit ; Histamine ; Humans ; Incidence ; Recovery Room ; Sex Characteristics ; Urticaria