A variety of substitutes and numerous operative procedures have been described to stabilize the anterior cruciate ligament(ACL) deficient knee. OBJECTIVES: The purpose of this study has been to evaluated the remodelling process of bone-patef- lar tendon-bone(B-PTB) allograft(Tutoplast(r)) for ACL reconstruction by means of light microscopic(LM) and electron microscopic(EM) examinations from the biopsy specimens obtained at the time of second-look arthroscopy. The authors also have been grossly observed the width, vascularity, elasticity and stability of B-PTB allograft. MATERIALS AND METHODS: ACL reconstruction using B-PTB allograft was performed on 22 consecutive patients. Among them, 12 patients were reviewed and the average age at time of operation was 22.5 years ranging from 21 to 40 years. The second look arthroscopy was performed at 6 months, 12 months, 24 months in each of the 4 cases. The gross findings of allograft were observed, and biopsy was done by the method of Millonig. Results; The arthroscopic findings of the reconstructed ACL were partially covered with synovium and narrowed in diameter at 6 months follow up. At 12 months follow up after reconstruction, that grafted ligaments were covered with more synovial membrane, and observed the more thickness with normal strength similar to normal anterior cruciate ligament configuration. At 24 months, grafted ligaments were grossly similar to normal ACL. The LM findings demonstrated many fibroblasts with spindle shape nuclei and and hypercellularity at 6 months. At the 12 months, crimp pattern of collagen bundles and decreased hypercellularity observed. At 24 months, grafted ligament were similar to nomal ACL. The EM findings that fibroblasts were showed abundant cytoplasm which contained marked dilated rough endoplasmic reticulum(r-ER) and aggregates of microfilaments at 6 months. At 12 months, fibroblasts with folded nuclei and abundant cytoplasm were observed. At 24 months, demonstrated the fibroblasts with abundant cytoplasm and densely packed collagen fibrils. Collagen fibrils displayed parallel arrangement and characteristic cross striation with a periodicity. Scanning EM findings showed uniformly small diameter of collagen in the transeverse section. CONCLUSIONS: Gross & LM findings of B-PTB allograft were similar to that of normal ACL at 6 months, and at 12 months, postoperatively. But EM findings of B-PTB allograft were compared with the biopsy samples of normal ACLs, the allograft was still undergoing maturation 24 months postoperati vely.
Actin Cytoskeleton ; Allografts* ; Anterior Cruciate Ligament* ; Arthroscopy ; Biopsy ; Collagen ; Cytoplasm ; Elasticity ; Fibroblasts ; Follow-Up Studies ; Humans ; Knee ; Ligaments ; Patella* ; Patellar Ligament* ; Periodicity ; Prospective Studies* ; Surgical Procedures, Operative ; Synovial Membrane ; Transplants

Poland's syndrome is congenital anomaly which was described first by Alfred Poland in 1841. The clinical features are variable but always include congenital aplasia of fingers and syndactyly. We have experienced a case of Poland's syndrome. This case was male children and revealed thoracic anomaly of right side (absence of pectoral muscles and anterior axillary fold), atrophy of forearm muscles, ipsilateral syndactyly with aplasia of thumb and middle phalanges of 2, 3, 4, 5,th fingers, and ipsilateral congenital radio-ulnar synostosis.
Atrophy ; Child ; Fingers ; Forearm ; Humans ; Male ; Muscles ; Poland ; Syndactyly ; Synostosis ; Thumb

The Ehlers-Danlos syndrome is a familial disorder of connective tissue, and seven distinct clinical forms are reported. Author experienced two cases of the type 3 Ehlers-Danlos syndrome which present hypermobility of the joints, asymmetry of the thorax, anomalies of the thoracic spine, and flatfoot. So, we report these patients with references.
Connective Tissue ; Ehlers-Danlos Syndrome ; Flatfoot ; Humans ; Joints ; Spine ; Thorax

Local or distant flap surgery has been applied in the soft tissue defect area where bone and tendon are exposed, but there are many pitfalls in these surgeries including limitation of donor site selection, as well as functional and aesthetic dissatisfaction of the donor and recipient site. So these problems have facilitated the development and study of skin substitute (artificial dermis). The history of artificial skin began in the 1980s with the invention of Stage I membrane by Yannas and Burke. Since then it has been developed and applied to chinical cases of extensive burn injury and soft tissue defect. In 1989, and artificial dermis (Terudermis) composed of fibrillar collagen and heat denaturated atelocollagen was developed by Konish. It has the advantage of allowing early-incorporation of cellular and vascular components into its collagen sponge, as well as dehydrothermal cross-linking, which is very weak. This study included 18 consecutive cases which underwent application of artificial dermis on bone and tendon from January 1997 to November 1998. The exposed areas were the result of trauma in 10 cases, postoperative complications in 2 cases, and other causes in 6 cases. The follow-up period ranged from 3 months to 18 months, averaging 11 months. A week after wound debridement and Terudermis application, neovascularization had begun and granulation tissue appeared aften 2-3 weeks. Then the split or full -thickness skin graft was secondarily applied resulting in the production of sufficient skin. In conclusion, Terudermis application to an area of exposed bone and tendon is a very useful method, especially when primary local or distant flap surgery cannot be used. This method is very simple, convenient and reliable.
Burns ; Collagen ; Debridement ; Dermis ; Fibrillar Collagens ; Follow-Up Studies ; Granulation Tissue ; Hot Temperature ; Humans ; Inventions ; Membranes ; Porifera ; Postoperative Complications ; Skin ; Skin, Artificial ; Tendons* ; Tissue Donors ; Transplants ; Wounds and Injuries

Bromidrosis is a disorder characterized by rancid body odor which influences a patient's social life and mental health. The therapeutic modalities and the mechanism of bromidrosis have been carefully studied, however, there have been few reports about the genetic inheritance of bromidrosis. We investigated the family history of 42 patients who were operated on for bromidrosis and followed up to the third generation in 10 cases. The results were as follows: Results of investigation which were followed up the second generation. The fathers of five patients and the mothers of 11 patients had bromidrosis in 18 male patients. The fathers of six patients and the mothers of 12 patients had bromidrosis in 24 female patients. Thirty-four patient (81.0%) among a total of 42 have a single parent with bromidrosis. Result of investigation which were followed up to the third generation Bromidrosis was occurred in 17 of 42 patients (40.5%) in the second generation, and 18 of 27 patients (66.7%) in the third generation. In one case, a father transmitted bromidrosis to his three sons, and as a result, X-linked inheritance could be ruled out Bromidrosis was not skipped in every generation of all families. We on conclude that bromidrosis is an autosomal dominant inherited disorder.
Fathers ; Female ; Genes, X-Linked ; Humans ; Male ; Mental Health ; Mothers ; Odors ; Single Parent ; Wills*

No abstract available.
Intervertebral Disc* ; Retrospective Studies*

Nevoid basal cell carcinoma syndrome (NBCC syndrome) is a very rare autosomal dominant dermatopathy characterized by a primary triad with variable secondary anomalies. The chief features include nevoid basal cell carcinomas, one or more skeletal anomalies, and multiple odontogenic keratocysts of the jaw. We report a case of NBCC syndrome in a 43-year old male who had multiple nevoid basal cell carcinomas on the retroauricular area, face, chest wall, and back, which have been present since childhood. Skull x-rays revealed relatively well-circumscribed cystic, radiolucent lesions on bilateral rami of both upper and lower jaws, calcification of the falx cerebri, agenesis of the right coronoid process, and a bifid chin. The cystic lesions were histologically confirmed as keratocysts.
Child ; Male ; Female ; Humans

There is increasing need for network connecting personal computers(PC) together. Thus Local Area Network(LAN) emerged, which was designed to allow multiple computers to access and share multiple files and programs and expensive peripheral devices and to communicate with each user. We built PC-LAN in our department that consisted of 1) hardware-9 sets of personal computers(IBM compatible 80386 DX, 1 set:80286 AT, 8sets) and cables and network interface cards (Ethernet compatible, 16bits) that connected PC and peripheral devices 2) software - network operating system and database management system. We managed this network for 6 months. The benefits of PC-LAN were 1) multiuser (share multiple files and programs, peripheral devices) 2) real time data processing 3) excellent expandibility and flexibility, compatibility, easy connectivity 4) single cable for networking ) rapid data transmission 6) simple and easy installation and management 7) using conventional PC's software running under DOS(Disk Operating System) without transformation 8) low networking cost. In conclusion, PC-LAN provides an easier and more effective way to manage multiuser database system needed at hospital departments instead of more expensive and complex network of minicomputer or mainframe.
Database Management Systems ; Hospital Departments ; Humans ; Microcomputers* ; Minicomputers ; Pliability ; Running

Recently, tibial shaft fractures become more severe because of high speed traffic accidents. The open tibial fracture is a difficult one to treat because of its common complications such as infection, soft tissue defect, delayed union and non-union. We studied 37 cases of open tibial fractures which were treated with external fixation. The results are as follows: 1. The average patient age was 29.3 years and male predominated by a ratio of 4.3: l. 2. The traffic accidents were the most common cause of injury. 3. Most cases(67.6%) were type III fracture(by classification of Gustilo and Anderson). 4. Hoffmann external fixator gave rigid fixation and good wound access. 5. There were 28 cases(75.7%) which needed secondary soft tissue reconstruction. 6. The infection rate was 21.5%(8 cases). These all healed with conservative management. There were 5 cases of pin tract infection which healed without developing osteitis. 7. The average union time was 28.7 weeks. In type III fracture there was marked delay in union (average 32.1 weeks). 8. The rate of development of delayed or non-union was 35.1%. In these cases, bony union was obtained with cancellous bone graft.
Accidents, Traffic ; Classification ; External Fixators ; Humans ; Male ; Osteitis ; Soft Tissue Infections ; Tibia ; Tibial Fractures ; Transplants ; Wounds and Injuries

The incidence of diabetes mellitus is in increasing tendency because of expension of medical care, economic development and increasing of the population of the aged person recently. The diabetic foot is one of serious complication of diabetes. With the advancement of the method of treatment of diabetes the other acute metabolic complications are decreased, but the development of diabetic gangrene encounteres at any age of adult life with increasing of incidence according to the duration of diabetes. The most of them requires operation, and its treatment is difficult frequently because of high incidence of wound problem in healing. So it is important to educate and prevent for lowering its incidence. From January 1978 to December 1984, 38 patients with diabetic foot were treated and analysed at Department of Orthopaedic Surgery of Presbyterian Medical Center. The results obtained are as follow. 1. The average of annual incidence of diabetic gangrene was 2.85%. There was increasing tendency of incidence to 1981, thereafter decreasing tendency. 2. 71% of patients with gangrene were in over-50 year age group. 3.72% of patients were in duration of diabetes more than 5 years. 4.79% of patiens were in inadequate treatment before admisson. 5. There was no relationship between fasting blood sugar level and development of gangrence. 6. The most common site of the lesion was big toe. 7. The most common predisposing fector was local pressure (39%), then minor trauma, and burn injury. 8. The primary wound healing rate was 53% after operation. 9. There was no relationship between the lowest palpable artery and primary wound healing. 10. The most common combined complication of diabetes was retinopathy (47%), then neuropathy and hypertension. 11. The rate of bacterial infection was 66%, and the most common organism was staphylococcus aureus (36%).
Adult ; Arteries ; Bacterial Infections ; Blood Glucose ; Burns ; Clinical Study ; Diabetes Mellitus ; Diabetic Foot ; Economic Development ; Fasting ; Gangrene ; Hallux ; Humans ; Hypertension ; Incidence ; Methods ; Protestantism ; Staphylococcus aureus ; Wound Healing ; Wounds and Injuries