Polyethylene wear is one of the major problems following total knee arthroplasty. Many factors affect the degree and the pattern of polyethylene wear. We experienced three cases of early catastrophic poly- ethylene wears. All cases showed flexion contracture with severe genu varum deformity and total knee arthroplasty was performed with Advantim total knee prostheses in all cases. Postoperatively, bony align- ment and ligament balancing were good in all cases. However, in 12 to 22 months later, lateral subluxa- tion and valgus instability were developed with early catastrophic polyethylene wear especially in the medial compartments. Flat surface geornetry of polyethylene might be responsible for the development of lateral subluxation and early catastrophic wears. From these experience, we concluded that the mediolat- eral as well as anteroposterior dishing is essential for the stability of the artificial joint and prevention of early rapid wear of polyethylene articular inserts following total knee arthroplasty.
Arthroplasty ; Congenital Abnormalities ; Contracture ; Genu Varum ; Joints ; Knee ; Knee Prosthesis ; Ligaments ; Polyethylene*

No abstract available.
Dermatitis, Exfoliative ; Phototherapy ; Psoriasis

PURPOSE: We evaluated oncologic outcomes of chondrosarcomas and analyzed the disease-free survival rate of chondrosarcomas according to the various factors. MATERIALS AND METHODS: We performed a retrospective study for the disease-free survival rate of 48 chondrosarcomas, 44 of which underwent surgical treatment and followed up more than 18 months since 1993, and in the remaining 4 cases, the patients died before 18 months after surgery. The vsariables were location, tumor volume, histologic grade, stage, age at presentation and treatment performed. The mean follow up period was 43.8 months (1-196 months). RESULTS: The overall disease-free survival rate was 77.1% at mean 43.8 month follow up. The 5 year- and 10 year disease-free survival rates were 64% and 58% respectively. The histologic grade, stage, age at presentation revealed statistical significance on disease-free survival. All 9 patients treated with extended curettage for grade 1 central chondrosarcomas revealed disease-free survival with excellent functional outcome. CONCLUSION: The disease-free survival rate of chondrosarcomas mainly depended on histologic grade, stage and age at presentation. Local recurrence and distant metastasis also revealed statistically significant differences of disease-free survival rate. Comparing to wide resection, extended curettage for low-grade central chondrosarcomas in extremities were efficient methods with similar survival rate and less functional losses and complications.
Chondrosarcoma ; Curettage ; Disease-Free Survival ; Extremities ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Survival Rate ; Tumor Burden

High tibial osteotomy is a useful procedure in the treatment of early stage osteoarthritis of the knee which is confined to the medial compartment. But long term follow-up study of high tibial osteotomy has not been provided yet and its prerequisite for a successful result still remains unrevealed. Since the osteoarthritis can progress after the osteotomy, it may result in the loss of correction and recurrence of pain and require conversion to total knee replacement arthroplasty. We studied clinically and radiologically the long term result of high tibial osteotomy in 11 patients(16 knees) who had been treated at the Department of Orthopaedic surgery of Seoul Paik Hospital during the period from January, 1978 to May, 1989, and follow-up for longer than 4 years. Preoperative mean varus angle was 6.4 degrees and immediate postoperative mean valgus angle was 8.6 degrees and final mean valgus angle was 4.7 degrees. The average loss of correction angle was 3.9 degrees. At 2-year follow-up, the results of 16 knees were as follows; excellent in six knees, good in seven knees. The final results at average 7.2-year follow-up were excellent in four knees, good in six knees and one knee was converted to total knee replacement arthroplasty. The results showed deterioration of clinical results and loss of correction with time after osteotomy. However, in more than half of the cases the results were good or excellent at the final follow-up, We, therefore, conclude that high tibial osteotomy is still a useful procedure in osteoarthritis of the knee if performed with a precise surgical technique and an adequate overcorrection more than 10 degrees.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Knee ; Osteoarthritis ; Osteotomy ; Recurrence ; Seoul

PURPOSE: The purpose of this study was to evaluate the long term results of performing femoral varus osteotomy (FVO) for the treatment of Legg-Calve-Perthes disease (LCPD). MATERIALS AND METHODS: We selected 35 LCPD patients who received FVO and they were followed up to the time their skeletons' matured. The inclusion criteria were patients in a fragmentation stage, the patients were in Catterall group III or IV, and the patients underwent a teleoroentgenographic examination at the time of full skeletal maturity. RESULTS: The radiological outcome at the time of skeletal maturity was assessed using Stulberg's classification. The final results were 4 hips in class I, 17 hips in class II, 13 hips in class III, one hip in class IV and none in class V. The satisfactory results (good+fair hips) were 34 hips (97%). Significant shortening (>10 mm) was observed in 12 hips (34%). In 35 patients, 5 (14%) had same leg length (less than 2 mm difference), 27 (77%) had shortening of 2 mm or more, and 3 had lengthening of 2 mm or more in the operated limb. Of these 12 patients with significant shortening, only 3 patients (9%) showed shortening of 21 mm or more. CONCLUSION: FVO is a reliable method for managing LCPD in patients who are in Catterall group III or IV and who are in the fragmentation stage of disease.
Extremities ; Hip ; Humans ; Leg ; Legg-Calve-Perthes Disease ; Osteotomy

PURPOSE: The aim of this study was to evaluate the effectiveness and indication of radiofrequency ablation(RFA) using renal VX2 tumors by implantation of VX2 tumor cells under the renal capsule in rabbits. MATERIALS AND METHODS: Ten rabbits were injected with 30-40microliter VX2 tumor cells(1.2x10(7) viable cells/ml) under the renal capsule of the right kidney by right subcostal incision. On the 14th day after the tumor cells were implanted, we checked for the development of renal tumors, and the sizes and shapes(exophytic or central) of the tumors by the use of computed tomography. We performed RFA in the renal VX2 tumors with a 17G StarBurst electrode through kidney exposure. After the first and third day following RFA, renal function was checked. On the third day, we performed CT and harvested the kidneys for gross and microscopic evaluation. RESULTS: We confirmed the development of renal VX2 tumors in nine cases. Tumor shapes were exophytic in seven cases and central in two cases; the mean size of the tumors was 2.1 cm(range, 1.1-3.8cm). In all tumors, RFA was performed. From the use of enhanced CT after RFA on the third day, all of the lesions treated with RFA showed no enhancement. From the pathological findings, coagulative necroses were seen on all of the lesions treated with RFA. The necrotized tumor size after RFA was not different statistically as measured by CT and a pathological examination (p=0.833) CONCLUSIONS:: In centrally located renal tumors, we experienced thermal injury in pelvocalyceal systems. RFA is an effective method for nephron sparing surgery as the tumor cells completely disappear and there is preserved renal function and the procedure is easy to apply. We suggest that the RFA method for exophytic renal tumors is more effective than other procedures.
Rabbits ; Animals

Fungal endocarditis is a rare disease in infants, but it has been reported with increasing frequency among premature infants requiring neonatal intensive care. Congenital heart disease, pro- longed intravenous catheterization, the use of intravenous alimentation, broad-spectrum antibiotics administration and narcotic addiction are risk factors. Candida endocarditis is an unusual but severe complication of systemic candidiasis. Its occurrence has been related to the placement of a central venous catheter with its tip close to or within the right atrium and persistent candidemia. Embolization to major blood vessels is a common complication of Candida endocarditis and repeated pulmonary emboli are suspected to be cause of the repeated episodes of circulatory shock which finally leads to death. Thus, early diagnosis of Candida invasion and prevention of Candida endocarditis are essential for survival. We report a case of Candida endocarditis which was successfully managed with surgical removal and antifungal therapy. (J Korean Pediatr Soc 2000;43:832 836)
Anti-Bacterial Agents ; Blood Vessels ; Candida* ; Candidemia ; Candidiasis ; Catheterization ; Catheters ; Central Venous Catheters ; Early Diagnosis ; Endocarditis* ; Heart Atria ; Heart Defects, Congenital ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Opioid-Related Disorders ; Rare Diseases ; Risk Factors ; Shock ; Tricuspid Valve*

As the development of CT scan enabled rapid and precise diagnoses of epidural hematoma, recent efforts have been sought to reduce its mortality rate. This study is a retrospective clinical analysis of one hundred eighty-one consecutive cases of epidural hematoma treated at the Department of Neurosurgery in Dong-guk University Hospital between Jan. 1991 and Dec. 1994. The rate of unsatisfactory outcome is 10.5%, While the mortality rate is 4.9%. Delayed epidural hematoma was founded tobe 12%. The authors have attempted to identify the factors influencing the prognosis of epidural hematoma. Based on the results of the above study we concluded that age, initial Glasgow coma scale, pupillary reflex and its size, IICP findings on brain CT, hematoma amount, associated intracranial lesions, rate of development of symptoms and timing of operation after injury are all relevant prognostic factors.
Brain ; Diagnosis ; Glasgow Coma Scale ; Hematoma* ; Mortality ; Neurosurgery ; Prognosis ; Reflex, Pupillary ; Retrospective Studies ; Tomography, X-Ray Computed

Posttraumatic cerebral infarction is a recognized complication of craniocerebral trauma, but, its frequency, cause, and influence on mortality are not well defined. During a two year period, 706 patients with head trauma were examined in our hospital with cranial CT studies. The CT findings which strongly suggested the herniation were seen in 46 patients. The posttraumatic cerebral infarction was diagnosed retrospectively in 18 of these patients. Detailed information, including CT findings were recorded from 1 to 10 days after admission. Posttraumatic cerebral infarctions were seen in the vascular territories of the middle cerebral artery(PCA) in 9 patients, posterior cerebral artery(PCA) in 4 patients, anterior cerebral artery(ACA) in 3 patients, and multiple in 2 patients. Outcomes of these 18 patients were severely disabled in 8 patients, moderate disabled in 6 patients, and death in 3 patients. Only one remaining patient was demonstrated a good recovery. These results suggest that cerebral infarction with severe head trauma might be associated with significantly bad influence on outcome of these patients when compared with those without cerebral infarction.
Cerebral Infarction ; Craniocerebral Trauma ; Humans ; Mortality ; Retrospective Studies

PURPOSE: To assess the efficacy of superselective intra-arterial chemotherapy (SSIAC) via the bilateral uterine arteries in cases of cervical carcinoma. MATERIALS AND METHODS: Eighteen patients with stage IIa (n=10), IIb (n=7), or IIIa (n=1) cervical carcinoma underwent one (n=2) or two (n=16) courses of preoperative SSIAC with Vincristine, Cisplatin, and Mitomycin C. We estimated the extent of reduction of tumor volume and improvement of stage, comparing pre-SSIAC MRI to postoperative results. Tumor vascularity, as seen on uterine arteriography, and procedural complications, were also evaluated. RESULTS: A marked reduction in tumor volume was observed in all patients, an average reduction volume of 94.7%. Improvement of stage was noted in 16 patients, and in six of these, no residual viable tumor or microinvasive residual tumor was seen. On angiography, tumor hypervascularity was demonstrated in seven patients, but its degree was not substantially related to therapeutic response. In no case did significant systemic complications of result from chemotherapy; in one patient, however, we experienced a serious complication of necrotizing cystitis due to malpositioning of a catheter in the superior vesical artery. CONCLUSION: SSIAC via the bilateral uterine arteries is an effective complementary modality for the treatment of various stages of cervical carcinoma.
Angiography ; Arteries ; Catheters ; Cisplatin ; Cystitis ; Drug Therapy* ; Humans ; Magnetic Resonance Imaging ; Mitomycin ; Neoplasm, Residual ; Tumor Burden ; Uterine Artery* ; Vincristine