Limbic bone or persistant epiphysis seen roentgenographically on the anterosuperior aspects of the vertebral bodies represents another form of discal extrusion, seperating a small fragment of bone from the body of the involved vertebra. Lindblom, in 1951, demonstrated the pathophysiology with discography. Anterior herniation of the nucleus pulposus was also revealed by discography by Cloword and Buzaid in 1952. The authors reviewed 3 cases of limbic bone of the vertebrae.
Epiphyses ; Spine

No abstract available.

There are strong evidences suggesting that Thl and Th2 lymphocytes develop from the same Thlymphocyte precursor under the influence of environmental or genetic factors acting at the level of antigen presentation, but it remains to be answered whether it is possible to change the cytokine profile of established or ongoing Th1 and Th2 response. The purpose of this study is to reveal whether it is possible to reverse the cytokine profile of human Th lymphocytes by the modulation of antigen presentation. Using a multiparameter flow cytometric assay that allows simultaneous determination of surface CD4 and intracellular IFN-r or IL-4, we have studied the emergence of Th1 or Th2 lymphocytes in response to tetanus toxoid exposure and the patterns of cytokine synthesis in established T lymphocyte clones. Th2 populations arising after 4 wk of stimulation in IL-2, PHA, tetanus toxoid and irradiated autogeneic peripheral blood mononuclear cells as antigen presenting cells (APC) could give rise to IFN-r-producing Th1 lymphocytes when stimulated in IL-2 plus PHA in the absence of antigen and APC. These IFN-r-producing Th1 lymphocytes nearly disappeared and IL-4-producing Th2 lymphocytes predominated again when cultured again in the presence of antigen and APC. In contrast, prolonged culture in the absence of antigen and APC induced relative predominance of IFN-r-producing The lymphocytes. The cytokine profile of long-term Th2 population arising originally from the repeated stimulation in the presence of antigen and APC appeared more homogeneous and less reversible, although they could convert to Th1 lymphocytes when cultured without antigen and APC. These findings may explain that the polarized Th response is reversible depending on the presence of antigen presentation.
Antigen Presentation* ; Antigen-Presenting Cells ; Clone Cells ; Humans ; Interleukin-2 ; Interleukin-4 ; Lymphocytes ; T-Lymphocytes, Helper-Inducer* ; Tetanus Toxoid

The Marjolin's ulcer is the malignant lesion developed in a burn scar or chronic fistula. Due to the low prevlalence of this lesion, there has been disagreement in its clinical features, methods of treatment, and prognosis. We evaluated 19 cases of patients who had been admitted to Severence Hospital from Jan. 1970 to Dec. 1958. The results were as follows : 1. The previous lesion was burn scar in 52% of the cases and fistula of chronic osteomyel-itis in 32%. 2. The mean latent period was 31.5 years. 3. The initial symptoms were increased pain(74%), discharge with foul odor(68%) and bleeding(58%). 4. Upon histological examination, all of the cases were squamous cell carcinoma. 5. The rate of recurrence of metastasis at time of diagnosis was 32%. 6. Of the 16 patients treated by surgery, local recurrence was noted in 4 cases. Three of these cases were patients who had been treated by excision and split thickness skin graft. 7. The time interval for local recurrence ranged from 6 months to 11 months(average 8. 8 months). In conclusion, the squauious cell carcinoma of the Marjolin's ulcer seems to have a worse prognosis than other squamous cell carcinoma and it requres aggressive treatment. The burn scar or chronic fistula that occured in elderly patients especially required more adequste treatment and close observation.
Aged ; Burns ; Carcinoma, Squamous Cell ; Cicatrix ; Clinical Study ; Diagnosis ; Fistula ; Humans ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Skin ; Transplants ; Ulcer

In 1973, Daniel and Taylor reported the first successful microsurgical transplantation of the groin flap as a one-stage reconstrutive procedure. The free vascularized groin flap has several advantages, such as its potenitally large size, comfortable position of the patient during operation, minimal donor site morbidity, possible coverage of the donor site scar with a bikini, its multiple arterial and venous system, and the potential for incorporating bone with the overlying skin. The authors perfomed free groin flaps in 36 patients at Severance Hospital, Yonsei University College of Medicine from January 1985 to August 1988. The results were as follows : 1. Good results were obtained in 26 of 36 cases with a 72.2% success rate. The results were better in the upper extremity than the lower extremity. 2. The anatomical classification of the superficial circumflex iliac artery was as follows : a common origin of the superficial circumflex iliac artery and the superficial inferior epigastric artery in 39.5% of cases, an absent superficial inferior epigastric artery with a large compensatory superficial circumflex iliac artery in 36.8%, separate origins of the two vessels in 7.9%, and an origin from a profunda femoral artery in 15.8%. This result was similar to that of Daniel and Taylor. 3. The average diameter of the artery was 1.0mm and the average length of the vascular pedicle was 9.0mm. 4. The results were better in the end to side anastomosis than the end to end anastomosis, but there was no statistical significance. 5. In the 10 failed cases, free scapular flaps were performed in 4 cases, skin grafts in 5 cases, and the cross leg flap in one case. 6. The donor sites healed well by primary closure without functional disturbance except in one cases in which secondary closure was done. In conclusion, the free vascularized groin flap can be used without restriction as a onestage reconstruction of an extensive soft tissue injury of the extremity.
Arteries ; Cicatrix ; Classification ; Epigastric Arteries ; Extremities ; Femoral Artery ; Groin ; Humans ; Iliac Artery ; Leg ; Lower Extremity ; Skin ; Soft Tissue Injuries ; Tissue Donors ; Transplants ; Upper Extremity

This article introduces a new method of thumb reconstruction with the use of an iliac bone graft and a free neurovascular wrap-around flap from the big toe, previously reported by Morrison et al. in 1980. Using this method it is possible to reconstruct a thumb similar to the missing part without total sacrifice of the toe. There is no mobile portion in the reconstructed thumb and motion is provided only by intact joint of traumatized thumb. In thumb reconstruction, it is possible to preserve the nail and its pulp, thus preventing swivelling of the nail and loss of pulp sensation as well as ensuring continued nail growth. This is achieved by free tissue transfer from the 1st web space of the foot, innervated by the deep peroneal nerve and supplied by the dorsalis pedis artery with relatively large diameter. Three cases of thumb reconstruction were performed with this method. Follow up was done for an average of 11.3 months; the rate of viability was 100% with excellent appearance; the 2-point discrimination averaged 8.3 mm.
Arteries ; Discrimination (Psychology) ; Follow-Up Studies ; Foot ; Hallux ; Joints ; Methods ; Peroneal Nerve ; Sensation ; Thumb ; Toes ; Transplants

The simple cutaneous flap and myocutaneous flap are presently being employed in skin defects since Daniel and Taylor first tried the free flap in 1973. But the simple cutaneous flap which is being employed at present has problem in the flap size, the variation and complexity of the anatomical structure and postoperative complication of the donor site. On the other hand, the myocutaneous flap has partially solved the problem of a simple cutaneous flap, but the myocutaneous flap remains inadequate when thin flap reconstruction only is required. The scapular flap was first suggested by Saijo in 1978 and Santos described the anatomical aspects of the scapular flap in 1980. Since Gilbert first clinically utilized the scapular flap, it was seen to be much more suitable for relatively thin cutaneous flaps, The authors present 10 cases of free scapular flap performed at the Department of Orthopedic Surgery of Severance Hospital during the period of one year and 2 months from April, 1983 until June, 1984. The results of the study are as follows: 1. The scapular flap was of medium size in 9 cases and large in one case. 2. The pedicles of the scapular flaps were constant in length and diameter. 3. The flap was uniform and relatively thin in thickness. 4. The reconstruction of a large soft tissue defect was possible with a combination of scapular flap and latissimus dorsi myocutaneous flap done in one stage. 5. The donor site of a scapular flap can be primarily closed. 6. The free scapular flap is an excellent choice when intermediate-sized or large-sized uninnervated flap coverage is necessary for soft tissue damage.
Clothing ; Free Tissue Flaps ; Hand ; Humans ; Myocutaneous Flap ; Orthopedics ; Postoperative Complications ; Skin ; Superficial Back Muscles ; Tissue Donors

No abstract available.
Vascular System Injuries*

Degloving injuries of the fingers result in avulsion of skin and subcutaneous tissue from the underlying deep fascia, the arterial supply is embarrassed and necrosis may result. Theoretically primary microvascular replantation may be a complete solution, however, the prognosis in terms of both immediate and long term function following avulsed digits is poor. The ideal reconstruction aims at retension of mobility and restoration of a skin cover that is adherent, has a sensibility approaching the norm, and is free from pain. A method of finger reconstruction for an avulsion injury using a free neurovascular wrap-around flap from the big toe may be a choice of treatment for both esthetic and functional aspects.
Fascia ; Fingers ; Hallux ; Methods ; Necrosis ; Prognosis ; Replantation ; Skin ; Subcutaneous Tissue

The treatment of extensive soft tissue injury is a chsllenge to Orthopedidic Surgeon especially in young children and at present reconstructive surgery with free flap is being employed under microscopy actively. The author present 27 cases of free flaps in young children below 6 years old, which were performed from March 1983 to December 1986. The results are as followes ; 1. The mean age was 4.9 years old. 2. The mechanism of injuries were all pedestrian injury. 3. We performed 27 cases of free flaps, among them 24 cases of flap were survived(88.9 %) with good functional and cosmetic result. 4. The vessels were larger in these young children than we expected. It is apparent that in a healthy child even though below 6 years old, the careful application of microsurgical principle is an excellent method for salvaging devascularized parts that are vital for function or appearance.
Child ; Clinical Study ; Free Tissue Flaps ; Humans ; Methods ; Microscopy ; Soft Tissue Injuries