We studied the technical problems of step-cut osteotomy and a method to improve the problem. When a bony fragment is removed from distal humerus in step cut osteotomy, we obtain a bony defect of the shape of a right triangle. The distal part of this defect is right angled(90 degrees) but the proximal part inserted in it is less 2than 90 degrees, they do not correspond to each other. There is, however, no explanation on this in the original article. By personal communication with DeRosa, he said he would remove a part of the small bony spike of the lateral side after osteotomy. However, it is technically difficult to remove a part of the distal bony spike because it is tiny and it can cause a fracture on the bony spike. Even in a successful 1case, there arises a problem of fixing with a cortical screw. To solve this problem, we instead removed a part of the lateral cortex of proximal part so that we made possible the contact of medullary canal at the osteotomy site without removing the lateral spike of distal bony spike. This way, a more stable fixation and a faster bony union were made possible. This modified method was performed on 17 cases, in which the average age of the patients was 13 years old(9 to 18). For 4-6 weeks after the operation, they were immobilized the upper extremity in a cast, and after that, then were allowed to do exercises. We obtained the complete bony union between the 10th and 16th week after the operation. In the follow-up cases of minimum 1 year, 12 cases were proven excellent, 3 cases were good, and 2 cases were poor by Oppenheim's criteria. There was one case of radial nerve transient paresis and one case of metal failure. There was no nonunion on osteotomy site. By using the modified method, we made possible the mechanically stable and technically easier fixation to obtain satisfactory results.
Exercise ; Follow-Up Studies ; Humans ; Humerus ; Methods ; Osteotomy ; Paresis ; Radial Nerve ; Upper Extremity

In order to compare mechanical stability of the Ilizarov external fixation methods for treatment of pilon fracture of the tibia, six human amputed tibiae were utilized to simulate Ruedi type I, II, and III fractures anatomically and non-anatomically reduced. Six fracture models which were either anatomically(3) or non-anatomically(3) reduced were first stailized by the Ilizarov construct composed of two tibial rings and foot assembly with connecting rods and ankle hinges and underwent axial load compression test using Instron. And then same tests were repeated on the models in which ankle hinges between the tibial rings and foot assembly were removed to examine biomechanical effect of the ankle hinges on the fracture stability. When the fracture model was fixed by the construct without ankle hinges, 720 N-780 N were required to disrupt fracture stability. When the fracture was non-anatomically reduced and was fixed by the construct without ankle hinges, 420 N-520 N were required to disrupt the fracture stability. The current study suggests that Ilizarov fixation system should have the construct composed of two tibial rings and foot assembly with connection rods and ankle hinges to prevent fracture destabilization during early ankle motion and weight-bearing in the tibial pilon fracture.
Ankle ; Foot ; Humans ; Methods ; Tibia ; Weight-Bearing

No abstract available.
Vascular System Injuries*

In the whole arm type of brachial plexus injury, the nerve grafting method give the best result. As it is impossible, however to operate the preganglionic whole arm type by interfascicular nerve graft, the treatment of this type of injury is difficult. In this lesion, neurotization may be the only useful method. To evaluate it's efficacy, 38 cases of multiple neurotization have been reviewed. The follow up period was on average 45 months(24 months to 76 months). The results are as follows: 1. Motor or sensory improvement of good or better results was observed in 27 nerves(29%) and that of better-than-fair results in 54 nerves(57%). 2. The best results were obtained in patients less than thirty year old and in the patients where the operation was performed within the first six months after injury(19 cases, 42%). 3. The use of spinal accessory, phrenic, intercostal and supraclavicular nerves, as a source of neurotization produced similar results. Phrenic nerve neurotization was performed without any significant respiratory difficulty. 4. The results of neurotization were analysed by Kim's method. Functional recovery of the upper extremity showed relatively poor results. 5. Out of the 25 patients who had developed a painful syndrome before neurotization, 19 cases(60%) showed improvement of the symptom. Multiple neurotization in preganglionic whole arm type of brachial plexus injury is of a little value in improving upper extremity function. Nerve neurotization can not always make a paralysed upper limb useful, because it is impossible to control the digits and intrinsic muscles in the hand and to restorate fine sensation by it. Nevertheless, functional recovery of the paralyzed upper limb, compared with no previous muscle contraction, encourages patients who have suffered serious brachial plexus injuries to start an active their life again.
Arm ; Brachial Plexus ; Follow-Up Studies ; Hand ; Humans ; Methods ; Muscle Contraction ; Muscles ; Nerve Transfer ; Phrenic Nerve ; Sensation ; Transplants ; Upper Extremity

Here, we report a case of artificial prosthesis of the knee joint combining with homogenous bone transplantation for the treatment of giant cell tumor of the right distal femur. At one year follow up, the patient complains almost no pain nor tenderness at operative site and ambulates with partial weight bearing with crutches. The X-ray finding shows satisfactory bony union with progressive bony remodelling.
Bone Transplantation ; Crutches ; Femur ; Follow-Up Studies ; Giant Cell Tumors ; Humans ; Knee Joint ; Knee ; Prostheses and Implants ; Weight-Bearing

No abstract available.
Posterior Cruciate Ligament*

In this study, we are to produce the single chain variable fragment (scFv) antibodies against surface protein of hepatitis B virus (HBV) using antibody phage display technique. Balb/c mice were immunized with preS1 and cDNAs of heavy and light chains of splenic B cells from immunized mice were prepared using RT-PCR. Two cDNAs were linked with (64S) linker DNA under recombination PCR to produce single chain Fv DNA. After digestion of scFv DNA with Sp 1 and Not 1, the digested DNA was ligated into pCANTAB 5E and electroporated into E. coli XL1-Blue to prepare scFv-library. The size of library was 1 * 10' pfu/ml. Phage antibodies (phabs) against preS1 were rescued with M13K07 helper phages, and preS1-binders were selected through 3 times of panning using 96 well microtitre plates. Phage antibody clones were assayed directly for the ability to bind preS1 by ELISA. And then 7 phage antibody clones had high ELISA signals against preS1. Phabs from preS1-specific pMsc-17 had the strongest ELISA signal to preS1. Phabs from pMsc-17 were used for Western blot to preS1 and the results revealed that it was specific to preS1. To prepare the soluble scFv antibody, phabs from pMsc-17 were transfected into non-suppressor E. coli HB2151, and grown under 1 mM IPTG. Soluble scFv antibody was mainly accumulated in the periplasmic space, but small amount of antibody was secreted into culture media.
Animals ; Antibodies ; B-Lymphocytes ; Bacteriophages* ; Blotting, Western ; Cell Surface Display Techniques ; Clone Cells ; Culture Media ; Digestion ; DNA ; DNA, Complementary ; Enzyme-Linked Immunosorbent Assay ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Isopropyl Thiogalactoside ; Mice* ; Periplasm ; Polymerase Chain Reaction ; Recombination, Genetic ; Single-Chain Antibodies*

Heterotopic pregnancy is the coexistency of intrauterine and extrauterine pregnancy. The incidence of heterotopic pregnancy is about 1 to 30,000 pregnancy in a natural cycle. However, the frequency of heterotopic pregnancy has steadily increased because of rising incidence of pelvic inflammatory disease, pelvic surgery and the development of ovulation induction and assisted reproduction. Because heterotopic pregnancy is difficult to diagnose and it has high morbidity and mortality rate, one should always take this into consideration and should conduct careful and thorough gynecologic evaluation. We have experienced a case of heterotopic pregnancy in a 29-year old woman who presented with acute abdominal pain in a natural cycle and report this case with a brief review of literature.
Abdominal Pain ; Adult ; Female ; Humans ; Incidence ; Mortality ; Ovulation Induction ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Heterotopic* ; Reproduction

No abstract available.
Carcinoma, Papillary*

Human monoclonal antibodies have considerable potential in the prophylaxis and treatment of viral disease. By cloning human Ig gene segments from the B cells of volunteer into pComb3 phagemid vector, antibody library was created of filamentous phage particles displaying Fab fragments on their surface after being rescued with M13KO7 helper phages. The size of library was 7x10' pfu. Phage antibodies (phabs) were panned against biotinylated preS1 using streptavidine coated Dynabead. The soluble Fab antibodies were prepared from phagemid colonies and assayed directly for the ability to bind preS1 by ELISA. And then 3DW and SGW specific to preS1 which have both heavy and light chain to form Fab fragment, were selected. The soluble Fab antibody from 3DW was expressed highly at the concentration of 0.1 - 1.0 mM of IPTG, and 5 hours postinduction. The soluble antibodies from 3DW and SGW showed their relative affinities of 2x10' M ', and Sx10 M ', respectively, and the specificities to preS1 on ELISA. Our results suggest that antibody phage display library is very useful method to generate the human monoclonal antibody and that the human Fab monoclonal antibodies specific to preS1 selected in this study open the way to treat hepatitis B as a component of passive irnmunotherapeutics.
Antibodies ; Antibodies, Monoclonal ; B-Lymphocytes ; Bacteriophages* ; Clone Cells ; Cloning, Organism ; Enzyme-Linked Immunosorbent Assay ; Genes, Immunoglobulin ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans* ; Immunoglobulin Fab Fragments ; Isopropyl Thiogalactoside ; Streptavidin ; Virus Diseases ; Volunteers