The Waltons method-a method of dynamic reconstruction of old ligament injuries of the knee and a combination procedure of O'Donoghue, Bosworth, and Slocum-was introduced with one case experience. This method seemed to be better than other reconstructive procedures, especially in the aspect of rotatory and valgus instability of the knee.
Knee ; Ligaments ; Methods

No abstract available.

Six cases of a rare variant of endocervieal adenocarcinoma (Adenoma maligum, AM) were collected for clinicopethologic analysis. The everage age of six patients was 49.3 years, and their chief com plaints were persis(ent mucid or watery discharge and intermittent vaginal spotting, The clinical im presaion was carcioma of The uterine cervix in faur out, of six cases. All except one were pathologically confirmed by initia1 biupey. two cases by colposcopic biopsies, two by cone biopsies, one by cone biopsy after suggested AM in calposcopic hiopsy. One case was incidentally found from hysterectnmised speeimen, which waas suspected as adennmyosis. On gross examination, the cervix usualty appeared either firm or indurated with thickening af the wall excepl one which was presented es a fungnting mass. The characteristic histologic feetures were ext,ensive arborizing endeervical glands with marked variation in size and shape, and the glands lined by mucin conyaining columnar epithelial cells with basal bland looking nuclei but with occasional cytologic atypia and rare mitose. The nenplasi.ic glands were characterized by deep stronml invasion be yond normal enddcervical glands, assosiated with loose edematous periglandular desmaplastic stromal reaction in moat cases. Immunohistochemical stainnings for carcinoembryonie antigen (CEA) revealed ey- toplasmic positivity in five cases. The clinical stage for all exeept one incidental case were : four Ib and one II b. In three cases, the radical hysterectomy with unilateral salpingooophorectomy plus dissection of bilateral pelvic and paraaortic lymph nodes was performed, and in one case radiotherapy was done prior to radical hysterectomy with bilateral salpingoophorectomy plus the dissection of left pelvic lymph nodes followed by chemotherapy. Total abdominal hysterectomy with bilateral salpingooophorectomy plus Burch's operation followed by radiation therapy was performed in on case. The remaining one case was treated with radiation therapy. Metastasis to the left obturator lymph node was discovered in one case with state IIb, and the patient expired 29 months after the radiotherapy. The remaining five cases are being carefully followed up. From our experience, we conclude that the early diagnosis of AM can be made based on comprehensive analysis concerning the clinical features, histopathological and immunohistochemical findings. The early diagnosis and proper therapy can lead to the better prognosis.
Adenocarcinoma ; Adenoma* ; Biopsy ; Cervix Uteri* ; Drug Therapy ; Early Diagnosis ; Epithelial Cells ; Female ; Humans ; Hysterectomy ; Lymph Nodes ; Metrorrhagia ; Mucins ; Neoplasm Metastasis ; Prognosis ; Radiotherapy

To evaluate the possibility of the newly developed highly porous glass ceramics as a space-filler in the cavitary bone defect, we made the opening sized 1 × 0.5 cm on the medial aspect of the right proximal tibia of nine rabbits. We impacted the highly porous glass ceramics firmly to the medullary cavity of rabbit tibia through the opening. Each three were sacrificed at 4th, 8th, and 12th week and analyze in vivo reaction of the glass ceramics in rabbit tibia with radiological and histological methods. On radiological examination, radiolucent line was seen around impacted glass ceramics at 4th week, but this radiolucent line was obliterated gradually to 12th week. On histological examination, new bone formation with osteoblast was appeared at 4th week without foreign body reactions. At 8th week, newly formed bone infiltrated into the porous space between glass ceramics particles was noticed, and the surface of glass ceramics was tightly bound by newly formed bone with osteoblastic rim and mature bone, At 12th week, the amount of newly formed mature bone increased, though there was on evidence of resorption of glass ceramics particle. So, we suggest that the highly porous glass ceramics is one of the possible artificial bone graft substitutes, especially as a space-filler.
Ceramics ; Foreign Bodies ; Glass ; Osteoblasts ; Osteogenesis ; Rabbits ; Tibia ; Transplants

To assess the effectiveness of Magnetic Resonance Imaging (MRI) with endorectal surface coil in the ataging of carcinoma of the uterine cervix with emphasis on parametrial involvement. Thirty women with clinically and radiographically proven carcinoma of the uterine cervix were initially included for this study, but thirteen patients were excluded since the stages of tumors wore beyond stage IIa. CT and MR findings of the remaining seventeen patients were performed at Cheil General Hospital and compared a1ong with clinical findings with the special emphasis on the parametrial involvement by the tumor. Staging was assessed by CT and MRI, and the results were compared with the pathologic staging. Radiea1 abdominal hysterectomy with the pelvic and paraaortic lymphnode dissection was done to all sewenteen patients. The staging made primarily by CT and MRI was either stsge 1 or Ila, but MR images with endorectal surface coil was superior to CT in the visualization of depth of tumor infiltration, especially parametrial involvement. The determination of the depth of the tumor made by MR images showed statistically significant correlation with histologic evaluation(R =0.768, p<0.01). The accuracy rate for the evaluation of the parametrial invo1vement was 82.3% far CT and 94.1% for MRI with endorectal surface coil. The overall accuracy rate for tumor staging was 70.5% for clinical, 58.8% for CT and 82.3% for MR evaluation. The accurecy rate in evaluation of the pelvic and paraaortic lymphnode was 88.2% for CT, but the evaluation done by MRl was not adequate due to small FOV(field of view). In assessment of The steging of careinoma of the uterine cervlx, MR images with endorectal surface coil was superior to CT, especially in the evaluation of the parametrial involvement.
Cervix Uteri* ; Female ; Hospitals, General ; Humans ; Hysterectomy ; Magnetic Resonance Imaging* ; Neoplasm Staging

PURPOSE: To evaluate the efficacy of combined treatment of metallic biliary stent placement and radiotherapy in malignant biliary obstruction. MATERIALS AND METHODS: Between January 1992 and February 1994, 22 patients with malignant biliary obstruction were treated with metallic biliary stent placement and radiotherapy. The causes of the obstruction included cholangiocarcinoma(n=14), gallbladder carcinoma(n=4), colon cancer(n=2), pancreatic head cancer (n=1), and stomach cancer(n=1). According to the sites of obstruction level, patient were divided into 2 groups; hilar obstruction(n=18) and common bile duct obstruction(n=4). The patients received dose of 45 Gray/18 fraction by external radiotherapy and 20Gy/8f by high dose rate brachytherapy with iridium--192 source through percutaneous transhepatic biliary drainage(PTBD) catheter. The duration of stent patency after placement, survival period and survival rate by Kaplan Meier method were calculated in dead and alive patients, respectively. RESULTS: In all 22 patients, the duration of stent patency was 5.5(1.3--18.5)months. Survival periods after stent placement and PTBD were 5.3(2.0--8.5 )months and 7.9(4.0--14.7)months respectively in 9 dead patients and 7.7(1.3--21.0)months and 9.5(2.3--23.0)months in 13 alive patients. In all 22 patients, the survival rates in 6, 12 and 18 months were 78.9%, 47.5 % and 35.6 %, respectively. CONCLUSIONS: The results with combined metallic biliary stent placement and radiotherapy for the palliative treatment of malignant biliary obstruction in this study was more favorable, as compared with those of the other authors with only metallic biliary stent placement.
Brachytherapy ; Catheters ; Colon ; Common Bile Duct ; Gallbladder ; Head and Neck Neoplasms ; Humans ; Palliative Care ; Radiotherapy* ; Stents* ; Stomach ; Survival Rate

Ten emhalmed cadaveric adult bony hemipelvis specimens were ohtained to evaluate the configuration of the posterior column of acetabulum and to find a safe path for screw placement into it as well as to report on the morphological data of the ischial tuherosity and to determine the most optimaI technique for ischial tuberosity screw placement for open reduction and internal fixation of posterior acetabular fracture. Cadaveric studies were performed analyzing icm cross-sections through the acetabulum for the purpose of studying the anatomical configuration of the danger zone. The plane of the cross-section was perpendicular to the posterior column. Each cross-section had the medial boundary ot the acetabulum projected onto the posterior column. By analysing the projections on the posterior column, the exact configuration of the danger zone was determined. In this study, the average width of the posterior column at the mid-acetabular Ievel was 3.9cm. Computed tomography scan of the acetabulum yielded valuable int'ormation regarding screw placement in the posterior column. The average width, height and depth of the ischial tuberosity were 25.7 mm, 33. 1 mm and 31.7mm, respectively. The average angles hetween the posterior and medial aspects and hetween the posterior and lateral aspects of the ischial tuherosities were 79.5degreesand 111.5degrees, respectively. The entry point of the screw should be Smm or 10mm medial to the lateral margin of the ischial tuherosity and the screws should be directed 35-40degrees, 45-50degrees and 50-55degrees caudally at the level of the inferior acetahular margin and lcm and 2cm below it, respectively. to obtain the most favorable bony purchase.
Acetabulum* ; Adult ; Cadaver ; Humans

Between 1989 and 1995, 14 patients with Kienbock's disease were treated with radial shortening or a radial wedge osteotomy. Clinical and radiological changes were classified according to Lichtman's stages and ulnar variance. Seven patients were male and seven were female. The mean age was 45 years, ranging from 29 to 64. The average follow-up period was 29 months, ranging from 12 to 61. Of the ten patients with negative ulnar variance who were treated by radial shortening, two cases were in Lichtman's stage II, six cases were stage III-a and two cases were stage III-b. Of the four patients with zero or positive ulnar variance who were treated by a radial wedge osteotomy, one case was stage 11 and three cases were stage III-a. The results were evaluated in terms of diminished wrist pain, increased grip strength, increased range of wrist motion and radiologic changes of the lunate. Wrist pain had diminished in all patients and grip strength had increased on average from 54% to 70% in the unaffected side. The range of arc of the wrist had increased on average from 59degrees preoperatively to 93 postoperatively. Sclerosis of the lunate improved in 43% of cases, cystic changes of the lunate improved in 57%, fragmentation of the lunate improved in 36% and the carpal height ratio increased in 50%. Of the 14 patients, 13 patients (93%) showed satisfactory results. One patient had an unsatisfactory result, according to Lichtman's criteria. These results suggest that radial shortening or a radial wedge osteotomy is recommended in patients with stage ll, III-a or III-b Kienb ck's disease, according to the ulnar variance. Early wrist pain reduction, increased range of motion and grip strength and improved avascularity of the lunate are all positive outcomes attainable with these treatment methods.
Female ; Follow-Up Studies ; Hand Strength ; Humans ; Male ; Osteonecrosis* ; Osteotomy* ; Range of Motion, Articular ; Sclerosis ; Wrist

Bone defect occurs due to various causes, such as neoplasms, cysts, trauma, infection, congenital disease and surgical intervention. Autograft is generally considered to be the gold standard in bone graft surgery. But, allograft, xenograft and bone substitutes have been used because of complication and limited quantity of autograft. Calcium sulfate is one of the bone substitutes. We reviewed and analyzed 18 cases with bone defects that were treated with calcium sulfate from January 1997 to April 1997. We used the Osteoset' pellets that contained calcium sulfate 98%, produced by Wright Medical Technology Inc. in U.S.A., to fill defects in all cases. Except in 2 cases, autogenous cancellous bone from patients own iliac crest was mixed with calcium sulfate from 30% to 50%. Follow-up time averaged 13.7 months(range, from 12 to 15 months). The degree of absorption of calcium sulfate and new bone growth at conventional roentgenography was represented by percentage at each follow-up. The results were as follows. First, 8 weeks after operation, 93% of calcium sulfate was absorbed. Second, 6 months after operation, nearly 90% of new bone growth was observed. Third, until last follow-up, there was no noticeable complication, such as infection or foreign body reaction. We concluded that calcium sulfate might be on effective material for bone defects because of rapid absorption rate and easy recognition of new bone growth.
Absorption ; Allografts ; Autografts ; Bone Development ; Bone Substitutes* ; Calcium Sulfate* ; Calcium* ; Follow-Up Studies ; Foreign-Body Reaction ; Heterografts ; Humans ; Radiography ; Transplants

Thumb opposition is essential for all precision handling, in daily activity. Thenar muscle wasting is common in long-standing severe carpal tunnel compression. Unfortunately, muscle wasting rarely recovers after decompression of the nerve. A single-stage procedure, combining carpal tunnel release and opponensplasty, is therefore a logical proposal. Between July of 1993 and May of 1996, 15 patients of carpal tunnel syndrome with thenar muscle atrophy were operated upon Camitz-Littler opponensplasty at Kyungpook University Hospital; combination of palmaris longus transfer and median nerve decompression as a simultaneous procedure. Postoperative thumb opposition was assessed by means of three separate indices-maximal palmar abduction, spatial rotation, thumb-to-finger apposition. Results for an average post-operative follow-up of 12.0 months were achieved 'good' by 86.7%. We concluded that palmaris longus transfer as an opponensplasty carried out in combination with carpal tunnel release is a simple and effective procedure for restoration of opposition in case of severe carpal tunnel syndrome.
Carpal Tunnel Syndrome ; Decompression ; Follow-Up Studies ; Gyeongsangbuk-do ; Humans ; Logic ; Median Nerve ; Muscular Atrophy ; Thumb