Thirty years ago a major arterial laceration was devasting injury, threatening survival of the limb in almost every case. Increased awareness of vascular injuries and of feasibility of immediate and more advanced arterial repair techmique reduced the amputation rate. The authors reviewed 163 patients of vascular injuries in extremities, who were admitted to Severence Hospital of the Yonsei University College of Medicine from January, 1979 to December, 1986. The results were follows : 1. Among the 163 patients, 146 patients were male patients. 2. Most of the victims were in their twenties. 3. The most common cause in the upper extremity was glass injury. The most common cause in the lower extremity was being struck by moving vehicles. 4. More complications in vascular injuries were associated with severe soft tissue crushing and comminuted fracture of the bone. 5. More favorable results can be gained through the use of microvascular techniques than through conventional techniques in vascular reconstruction.
Amputation ; Clinical Study ; Extremities ; Fractures, Comminuted ; Glass ; Humans ; Lacerations ; Lower Extremity ; Male ; Upper Extremity ; Vascular System Injuries

BACKGROUND: Allergen-specific immunotherapy ( IT ) can be an important adjunctive therapy in the treatment of allergic disorders. Although a number of studies have shown that cytokine production by T cells may be modified by IT, IT-induced chsnges at the single cell level in allergen -specific Th ( T helper ) and Tc ( cytotoxic T ) responses have not been reported. Objective : The objectives of the present study were ( 1 ) to demonstrate differences in the house dust mite(HDM)-induced cytokine production patterns of Th and Tc cells between untreated and treated HDM allergic patients and ( 2 ) to determine whether there are differences between child and adult patients in Th and Tc cell responses to HDM. METHOD: This study included twenty Dermatophagoides farinae (Df)-sensitive asthmatics ( ten children and ten adults ), of which five children and five adults received immunotherapy to Df over a 1.5- to 3-year period. Peripheral blood mononuclear cells ( PBMC ) were isolated from peripheral blood of each patient and cultured in the presence of IL-2 ( 10ng/ml ) and Df extract (100ug/ml) for 6 days. After harvesting cultured cells, Th and Tc cell frequencies were determined by a multiparameter cytokine flow cytometric assay that allows simultaneous determination of intracellular IFN-r and IL-4 in CD4+ or CD8+ cells. RESULTS: Predominant Th2 responses to Df were observed in all untreated child patients, three untreated adult patients, and two treated adult patients. On the other hand, predominant Thl responses to Df were observed in all treated child patients, two of untreated adult patients, and three of treated adult patients. Predominant Tcl responses to Df were observed in all groups of patients. However, Tcl responses were more prominent in adults than in children and in treated adult patients than in untreated adult patients. In children, there were no differences in predominant Tcl responses except in one treated child, in whom more prominent Tcl response was observed.
Adult ; Cells, Cultured ; Child ; Dermatophagoides farinae ; Dust ; Hand ; Humans ; Immunotherapy* ; Interleukin-2 ; Interleukin-4 ; T-Lymphocytes

No abstract available.
Dexamethasone* ; Psychotic Disorders*

Leg length discrepancy or short stature is a significant problem to patient psychosocially, cosmetically, and there has been many efforts for limb lengthening. There are many report about lower limb lengthening since the first description of femoral lengthening by Codivilla in 1905. Although limb lengthening using external fixator was popularized by Anderson, the result was poor because of many difficulties in techniques and complications. Recently, a great progress in lower limb lengthening was made by distraction osteogenesis by llizarov and callotasis by De Bastiani. But as such exter- nal fixator has some problem in technique, cosmesis or complications. Therefore gradual elongation intrameduilary nailing(Albizzia) developed by Guichet in 1986 has gained attention for more stability and relatively less discomfort. We reviewed 18 cases in 11 patients(5 males and 6 females) who visited the department of Orthopedic Surgery of Severance Hospital at Yonsei University with limb leg length discrepancy due to sequeale of poliomyelitis, familial short stature and Turner syndrome. They all underwent lower limb lengthening using Albizzia technique between December 1995 and January l997. The average age at the time of the operation was 22.7 year. Famiiial short stature was in 12 cases(67%), Turner syndrome in 2 cases(11%), and leg length discrepancy due to the sequelae of poliomyelitis in 4 cases(22%). The site of lengthening were 5 cases of femur(28%) and l3 cases of tibia(72%). The latency period was average of 7 days. During the distraction period, 15 ratchetings per day(1 mm/day) were performed. In case of bilaterai femoral lengthenings, average length of gain(LG) was 6.0cm and percentage of increase(PI) l6.8%(16.2-17.4), lengthening index(LI) 1.2 month/cm(0.75-2.2). In case of unilateral femoral lengthening, LG was 3.8cm, Pl 7.8 %, Ll 1.3 month/ cm. In case of bilateral tibial lengthening, average LG was 5.5cm(3.5-6.0~) and Pl 18.8%(12.0-22.9), LI 1.3month/cm(0.67-2.3). In case of unilateral tibial lengthening, LG was 2.9cm(2.3-3.5), P1 9.4 %(7.7-11.7), LI 2.8 month/cm(2.2-3.1). Lengthening index in poliomyelitis by llizarov was 3.l month/cm, but it was 1.3 in femur and 2.8 in tibia hy Albizzia method. There are some advantages and disadvantages or contraindications and indications of the Albizzia technique. We suggest that the Albizzia technique is more stahle, more comfortable and no longer lengthening time compared to external fixator such as Ilizarov.
Albizzia ; External Fixators ; Extremities* ; Femur ; Humans ; Latency Period (Psychology) ; Leg ; Lower Extremity ; Male ; Orthopedics ; Osteogenesis, Distraction ; Poliomyelitis ; Tibia ; Turner Syndrome

Nineteen patients with twenty six fingers were admitted to the Department of Orthopedic Surgery, Yonsei University College of Medicine with Zone II flexor tendon injury of the fingers during a period of 9 years from January 1980 to December 1988. 17 cases received free tendon graft and 9 cases received staged tendon graft. The result of long term follow-up of these patients are as follows. 1. The interval from tendon injury to tendon graft did not influence the operational result. 2. The main factor influencing operational result was flexion deformity whieh was in turn deeply related to preoperational passive range of motion. 3. Due to the relative anatomic simplicity, the thumb had better results after treatment than the other fingers. 4. Satisfactory results were obtained with free tendon graft in most of the Pre-operational Grade I group, good soft tissue without scarring or joint contracture, whereas in the Grade II group and above, complicated with scarring, joint damage or nerve injury, free tendon graft resulted only in 33 % success. 5. In Grade II group and above, free tendon graft resulted only in 33% success whereas 71% of staged tendon graft resulted in good or excellent results. This suggested that staged tendon graft had better operational results than free tendon graft in cases of severe tendon injury.
Cicatrix ; Clinical Study ; Congenital Abnormalities ; Contracture ; Fingers ; Follow-Up Studies ; Humans ; Joints ; Orthopedics ; Range of Motion, Articular ; Tendon Injuries ; Tendons ; Thumb ; Transplants

The wrist consists of a complex structure, including 8 tiny carpal bones and their adjoining soft tissue. Recently the number of injuries of carpal joint is on the increase by accident in leisure or by industrial accident. Carpal bone fracture or dislocation is often mistakably identified as a sprain, which is liable to lead its opportune time to care. So, we analyzed 39 cases to which long-term follow-up was available, among 44 cases which were treated at the department of orthopedic surgery, Yonsei University medical college. The results were as follows; l. Of all 44 cases, 42 were males, and males in 30, 40 decades numbered 32 cases, forming 73 % of all. 2. Of 29 scaphoid fractures, 22 cases were mid 1/3 fractures, and of 15 perilunate dislocation, 10 cases were dorsal transscaphoid perilunate dislocations. 3. Among 39 cases which long-term follow-up was available in the classification by Soto-Hall, 18 cases were acute, in 21 cases treatment was started beyond 2 weeks later after injury. 4. The more delayed diagnosis, the longer period needed bone union for scaphoid fracture. 5. All scaphoid fractures including transscaphoid perilunate dislocation, showed a union rate of 94.3%, and were complicated by 2 non-unions, 3 avascular necrosis, 1 osteoarthritis and one case accompanied an incomplete median nerve injury. So, initial careful evaluation is needed to good prognosis of scaphoid fracture.
Accidents, Occupational ; Carpal Bones ; Carpal Joints ; Classification ; Clinical Study ; Delayed Diagnosis ; Dislocations ; Follow-Up Studies ; Humans ; Leisure Activities ; Male ; Median Nerve ; Necrosis ; Orthopedics ; Osteoarthritis ; Prognosis ; Sprains and Strains ; Wrist

We analysed the thirty three cases of the free vascularized bone graft performed in the Department of Orthopaedic Surgery, Yonsei University College of Medicine from February 1982 to December 1989 and would like to report the results as follows. 1. There were 27 cases in men and 6 cases in women and the mean age was 27.3 years. 2. We have performed the procedure for the reconstruction of the large bony defects developed after massive trauma in 13 cases, core decompression of the avascular necrosis of the femoral head in 8 cases, tumoral resection in 6 cases, treatment of congenital pseudoarthrosis in 3 cases, and bone infection in 3 cases. 3. The most common recipient site was tibial shaft (18 cases, 54%) and the most common donor site was fibular shaft (23 cases, 69%). 4. The average length of bone defect (or grafted bone) in 23 cases of vascularized fibular graft was 9.8 cm and in 9 cases of vascularized osteocutaneous iliac bone graft, it was 5.8 cm. 5. The follow-up period was ranged from 13 months to 5 years 8 months (mean, 2 years 2 months). 6. All patients were evaluated clinically and roentgenographycally on the basis of fuctional recovery and bony union. Of the 33 cases, 31 cases (93%) showed satisfactory functional recovery with sound bony union. 7. It is highly expected that the vascularized bone graft is a one of the better alternatives for the reconstruction of the large bone defect and prevention of the early state of the avascular necrosis of the femoral head from progession.
Decompression ; Extremities ; Female ; Follow-Up Studies ; Head ; Humans ; Male ; Necrosis ; Pseudarthrosis ; Spine ; Tissue Donors ; Transplants

Radial nerve paralysis associated with humeral shaft fracture is the most common peripheral nerve lesion complicating fractures. The mechanism of injury, treatment, and prognosis of radial nerve paralysis associated with fracture of the humerus vary considerably, depending on when the nerve injury occured with respect to the humeral fracture and its subsequent treatment. A clinical study was performed on 243 patients with fractures of the humeral shaft. Especially fourty two cases of radial nerve paralysis associated with fracture of the humerus were analyzed at Department of Orthopedic Surgery, Yonsei University College of Medicine from January 1965 to December 1982. The results were summarized as follows: l. Among 243 humerus shaft fractures, the ratio of male to female was 2: 1. The common cause of radial nerve paralysis associated with humerus fracture were due to traffic accident and industrial machine injury. The closed fracture was 205 cases(84.4%) and the most common type of fracture was comminuted fracture(52.6%) 2. Among 243 humerus shaft fractures, 42 cases(17.3%) complicated the radial nerve paralysis. The radial nerve paralysis was the most vulnerable to injury at the distal third of the humerus, especially when there was open or comminuted fracture. The incidence of primary radial nerve paralysis was 8%(34 cases), and 19#g(8 cases) in secondary radial nerve paralysis. 3. Among 42 radial nerve paralysis associatd with humerus fractures, 15 cases were treated by conservative method. And 27 cases were treated by surgical exploration. By surgical exploration the practical cause of radial nerve paralysis were found: 13 cases negative, 5 cases contusion, 3 cases stretching. The recovery sign of radial nerve paralysis was noted from 2 weeks after treatment. Spontaneous neurological recovery was not noted beyond 6 months after treatment. Thirty two patients were available for follow up study. The overall recovery rate of radial nerve paralysis was 81.3. The practical causes of patient with no recovery of nerve function were cross section of nerve, severe stretching or entrapment of radial nerve between the sites of fracture. From a consideration of these series, it was concluded that satisfactory result was obtained from conservative management in humerus shaft fracture associated with radial nerve paralysis. Indication of early surgical exploration of radial nerve paralysis associated with humeral fractures are open fractures requiring debridement, spiral or oblique fractures with marked displacement, and progressive nerve paralysis.
Accidents, Traffic ; Clinical Study ; Contusions ; Debridement ; Female ; Follow-Up Studies ; Fractures, Closed ; Fractures, Comminuted ; Fractures, Open ; Humans ; Humeral Fractures ; Humerus ; Incidence ; Male ; Methods ; Orthopedics ; Paralysis ; Peripheral Nerves ; Prognosis ; Radial Nerve

The transfer of a sensory island of skin to an anesthetic area on the hand has been the most important development in hand surgery in the past decade. A neurovascular island flap transfer has proved useful for the treatment of finger injuries in primary cases and in secondary cases. The purpose of this paper is to describe the use of local composite tissue, isolated and transferred on a neurovascular pedicle graft for the secondary reconstruction procedures of finger injuries. Thirty two fingers had been operated on for "neurovascular island flap" coverage operation at the Department of Orthopedic Surgery, Yonsei University, Severance Hospital and Inchon Severance Hospital during the period from 1983 to 1992. The follow up study was carried out on twenty hands over a year period after an operation. The results obtained were as follows. 1. Among twenty hands the cases of thumb are ten. The index are eight, other fingers are two. 2. The ratio between male and female was about 4: 1 The most common procedures of primary treatment were abdominal distant flap (14cases). 3. All had better touch, pain and temperature sensibility in the flap than the surrounding recipient area. Thirteen patients reffered a pinprick in the flap to the donor finger, All had decreased two point discrimination corresponding to the pulp about 6 months after operation. 4. The use of neurovascular pedicle graft as a method of tissue transfer which permits a wide range of motion and comfortable appearance without jeopardizing either circulation or sensation.
Clinical Study ; Discrimination (Psychology) ; Female ; Finger Injuries ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Incheon ; Male ; Methods ; Orthopedics ; Range of Motion, Articular ; Sensation ; Skin ; Thumb ; Tissue Donors ; Transplants

No abstract available.
Hand*