Injuries to the acromioclavicular joint are usually the result of force applied downward to the acromoion. Surgery treatment modalities for grade IU complete acromioclavicular dislocation are extremely varied and usually successful. 13 cases of complete acromioclavicular dislocation were operated by techniuqe of Kirschner wire with tension-band wiring at Wonju Christian Hospital from June 1984 to Oct. 1985. And they had been followed for average 17.8 months and following results were obtained. l. Of the 13 cases, male was 8 cases(61%) and female was 5 cases(39%) . 2. The most common cause of injury was traffic accident. Nexts were fall down, slip down and direct blow. 3. Results were evaluated by using Weaver and Dunn criteria, 12 cases(92.3%) were good and 1 case was fair but this technique involved a more extensive implant removal that required general anesthesia. Therefore, AO tension-band wiring is thought useful operative method in the treatment of acromioclavicular dislocation.
Accidents, Traffic ; Acromioclavicular Joint ; Anesthesia, General ; Dislocations ; Female ; Gangwon-do ; Humans ; Male ; Methods

The anterior approach to arthrodesis of the cervical spine has become a widely accepted. However, anterior interbody fusion in the presence of the posterior instability may be complicated by the bone graft dislodgement, kyphotic deformity or nonunion. As an attempt to prevent this complications, anterior cervical plate after graft placement was introduced. Although, anterior cervical plates provide excellent fixation for the anterior column, potential risk for injury to the spinal cord, soft tissues or screw loosening leading to dysphagia has been reported. Morscher, of Switzerland, has developed an anterior cervical spine locking plate(CLSP) system that attempts to prevent the migration and looseing of screw by using a cross-split screw head that can be locked into the plate. The secondary advantage of this system is the limination of the required posterior cortex purchase. The authors reviewed 42 patients in whom the CLSP system was applied for the treatment of degenerative disease or trauma. With a mean followup of 18 months, all 42 patients went on to fusion. One patient had screws placed in the discal space, hardware failure occurred in two patients. There was no iatrogenic injury to the spinal cord or esophagus. In conclusion, the CLSP system provides a reliable fusion with minimal complications. It should be considered in multilevel anterior cervical arthrosis and cervical fractures.
Arthrodesis ; Congenital Abnormalities ; Deglutition Disorders ; Esophagus ; Follow-Up Studies ; Head ; Humans ; Spinal Cord ; Spine ; Switzerland ; Transplants

STUDY DESIGN: In a prospective study of 38 patients undergoing lumbar pedicle screw instrumentation 200 pedicle hole were tested intraoperatively using electrical stimulation. OBJECTIVES: To evaluate the searching stimulus intensity at pedicle in Korean and to identify the most vulnerable root in transpedicular screw fixation of lumbosacral spine. MATERIALS AND METHOD: Electromyelogram(EMG) was monitored from eight lower extremity muscles bilaterally. Constant current stimulation pulses(0.2msec duration) were delivered through a ball-tipped nasopharyngeal probe used to evaluate each pedicle hole, and evaluated for searching stimulus intensity, the current necessary to evoked EMG RESULTS: The searching stimulus intensity above 5 mA were 194 cases(97.0%), above 7mA 151cases(75.5%), above 10 mA 107 cases(53.5%) and below 5 mA were 6 cases(3.0%). The vastus medialis muscle is most sensitive in L2(100%), L3(83.3%), tibialis anterior is in L4(68.4%), peroneus longus is in L5(44.2%) and gastrocnemious is in S1(64.5%). CONCLUSIONS: Stimulus-evoked EMG monitoring is a valuable and efficacious adjunct to lumbar pedicle screw instrumentation. A stimulation threshold greater than 5 mA reliably indicates adequate screw position and the root located at infero-medial side of pedicle is most vulnerab18 in transpedicular screw fixation.
Electric Stimulation ; Humans ; Lower Extremity ; Muscles ; Prospective Studies ; Quadriceps Muscle ; Spine

Usually the condition of ipsilateral fracture of femur and tibia is called floating knee, it is termed applied to the flail knee joint segment. The key point of the treatment is focused to the early restoration of the knee function. We experienced 86 consecutive cases during the period from March 1978 to February 1991 in Yonsei University Wonju College of Medicine. Among them, 51 cases(above 16 years old) were analysed with the mean follow up period of 2.1 years(1.2-5.6 years). The results obtained were as follows: 1. Main cause of these fractures is traffic accident. Among them, the pedestrian accident is more than in-car accident. 2. The cases of open fracture were 13 cases (25.5%) in femur and 31 (60.8%) in tibia. The degree of open fracture was more severe in tibia. 3. There were 2 cases (3.9%) of fat embolism syndrome preoperatively. 4. At an average 25 months follow up after injury, the good and excellent result of the group 1 and 3 was 85.2%, and the group 2 and 4 was 71.4% by Karlström and Olerud criteria. 5. At the last follow up examination, the mean loss of range of motion of the knee was 5.6° in group 1 and 3, 10.9° in group 2 and 4(P < 0.05). 6. The operative treatment of the both side is better than case of one side operation and other side conservative treatment.
Accidents, Traffic ; Clinical Study ; Embolism, Fat ; Femur ; Follow-Up Studies ; Fractures, Open ; Gangwon-do ; Knee ; Knee Joint ; Range of Motion, Articular ; Tibia

We performed 15 cases of modified Bristow procedures for recurrent anterior instability of shoulder from january, 1987 to december, 1992 and the following results were obtained. 1. The patient's age at initial dislocation varied from 15 years to 29 years of age. 2. The most common cause of the recurrent anterior instability of shoulder was sport injury(6 cases) and next were traffic accident, hanging with one hand. 3. The average loss of external rotation of shoulder after operation were 10 degrees and internal rotation were 7 degrees. 4. The post-operative complication and recurrence were not observed. 5. End results were excellent in 7 and good in 5 by Rowe's grading system. 6. Strict attention to bone block placement was mandatory and decreased the risk of screw malpo-sition.
Accidents, Traffic ; Dislocations ; Hand ; Recurrence ; Shoulder ; Sports

The purpose of this study was to investigate the ability of cultured chondrocytes to prevent formation of bony bridge and possibly to repair of the damaged growth plate. Growth cartilage cells were obrained from the new born canine epiphyseal plates and was culture-expanded in high density. It took 14 days until formation of micro mass of cartilage cells which was easily removable from the culture flask. Twenty dogs were divided into two groups: group I (10), the medial side of growth plate of right proximal tibia was destroyed and cultured chondrocytes were homografted into the defect: and group II (10), the medial side of growth plate of right proximal tibia was destroyed and was left as it was. Left leg was served as a control. Serial radiological and histological observation were made until 16 weeks after homografting to determine the growth parrern. Following results were obtained. 1. In group I, 8 of 10 dogs had near normal growth with little angular deformity of the tibia, averaging 8° at post-op 16 weeks. Two dogs had 20° angulation at 16 weeks post-surgery. In contrast in group II, angular deformity was obvious at 4 weeks post-surgery, reaching 31° at 16 weeks post-surgery. 2. In group II, bony bridge was consistently formed on the medial side of the proximal tibia. In group I, the cultured chondrocytes initially appeared to be an amorphous cartiagenous mass, which, however, remained to contribute to matrix formation as time went on. 3. This study showed the ability of cultrued chondrocytes to prevent formation of bony bridge and possibly to repair the damaged growth plate. To prove the effectiveness of homografting of the growth cartilage cells for reconstruction of the growth plat, further studies should be followed.
Allografts ; Animals ; Cartilage ; Chondrocytes ; Congenital Abnormalities ; Dogs ; Growth Plate ; Leg ; Tibia ; Transplantation, Homologous

BACKGROUND: The etiologies of ischemic cerebrovascular diseases are various-thrombosis or artery to artery embolism, cardiogenic embolism and lipohyalinosis. In the past embolic cerebral infarct was thought to occur uncommonly. But these days substantial portion of patients have been found to have potential embolic sources by transesophageal echo cardiography and carotid duplex doppler. As transesophageal echocardiography has a high yield for identification of potential sources of cardiac embolism in patients with ischemic cerbrovascular diseases, its use has been increasing. In Korea an increasing number of patients with ischemic cerebrovascular diseases have been examined by transesophageal echocardiography since 1990. But in all the previous studies transesophageal echocardiographic evaluation has been confined to the patients with high probability of embolic cerebral infarct. All kinds of ischemic cerebrovascular diseases patients have never been examined by transesophageal echocardiography and carotid duplex doppler and the prevalence of potential embolic sources in Korean ischemic cerebrovascular disease patients is not known. The aim of this study was to evaluate the prevalence of potential cardiovascular embolic sources by transesophageal echocardiography and carotid duplex doppler in unselected patients with ischemic cerebrovascular diseases. METHODS: We evaluated all kinds of ischemic cerebrovascular diseases patients admitted from 1994. 9. 1. until 1995 9. 31. to the Departments of Neurology and Internal Medicine of Kangnam General Hospital. We evaluated them by transesophageal echocardiography, carotid doppler, brain CT(or brain MRI). A significant carotid stenosis was defined as a duplex scandetected lesion producing at least 50% vessel narrowing. The following echocardiographic findings were defined prospectively as potential cardiac sources of embolism : atrial appendage or left atrial cavity thrombus, spontaneous echocardiographic contrast, atrial septal aneurysm, interatrial shunt, ventricular aneurysm, ventricular thrombus, myxomatous mitral valve and protruding atherosclerotic plaque in the ascending aorta or transverse aortic arch. RESULTS: Of 64 patients admitted during the study period, 30 were excluded(Three patients were critically ill, and twenty seven patients refused diagnostic work-up.). Thorough diagnostic work-up was performed in 34 patients. Transesophageal echocardiographic positive findings were present in six patients(17.6%). Of them four(4/34, 11.7%) had spontaneous echo contrast, two(2/34, 5.8%) had left atrial thrombi, one(1/34, 2.9%) had ascending aorta atheroma. Eleven patients(11/34, 32.3%) had abnormalities in carotid doppler study. Five patients(5/34, 14.7%) had abnormalities both in transesophageal echocardiography and carotid doppler study. CONCLUSIONS: The results suggest that among ischemic cerebrovascular diseases patients substantial portion of patients have potential embolic sources. The prevalence of potential embolic sources in Korea may be higher than previously expected. Because the relative small number of the patients studied make it difficult to generalize the results, further studies with a large number of patients are needed.
Aneurysm ; Aorta ; Aorta, Thoracic ; Arteries ; Atrial Appendage ; Brain ; Carotid Stenosis ; Critical Illness ; Echocardiography ; Echocardiography, Transesophageal ; Embolism ; Hospitals, General ; Humans ; Internal Medicine ; Korea ; Mitral Valve ; Neurology ; Plaque, Atherosclerotic ; Prevalence ; Prospective Studies ; Thrombosis

PURPOSE:Present evidences suggest that Ureaplasma urealyticum is a cause of pneumonia, septicemia, and bronchopulmonary dysplasia (BPD) in newborn infants, particularly those born prematurely. The purpose of this work was to examine the relationship between Ureaplasma urealyticum in the tracheal aspirates and adverse outcomes, such as BPD and early onset neonatal sepsis in premature infants. METHODS:A polymerase chain reaction (PCR) was performed on tracheal aspirates collected within 24 hour after birth in 176 premature infants less than 35 weeks of gestation and admitted to the neonatal intensive care unit of Bundang CHA Hospital. RESULTS:U. urealyticum was detected in 37 of 176 preterm infants (21.0%). Gestational age (29+5+/-2+5 wk vs. 30+6+/-2+5 wk, P=0.013) and birth weight (1.39+/-0.44 kg vs. 1.59+/-0.55 kg, P=0.037) were lower in the U. urealyticum-positive group compared to the control group. The incidence of early onset neonatal sepsis (16.2% vs. 6.5%, P=0.045) and BPD (45.9% vs. 29.5%, P=0.047) was higher in the U. urealyticum-positive group compared to the control group, but the severity of BPD was not different between two groups. However, multiple logistic regression analysis revealed that the presence of U. urealyticum was not independently related to the development of early onset neonatal sepsis and BPD. CONCLUSION:The results suggest that colonization of the lower respiratory tract by U. urealyticum might not be related to the development of neonatal sepsis and BPD directly in preterm infants.
Birth Weight ; Bronchopulmonary Dysplasia ; Colon ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Logistic Models ; Parturition ; Pneumonia ; Polymerase Chain Reaction ; Pregnancy ; Respiratory System ; Sepsis ; Ureaplasma ; Ureaplasma urealyticum

Five cases of coronary arteriovenous fistula(CAVF) were diagnosed with coronary arteriography during recent 3 years in Seoul National University Hospital. In one patients, the CAVF was from right coronary artery to left ventricle at posterior aspect. In another, the CAVF was from left circumflex to left atrium. In the remaining three, it was from conal branch of left anterior descending to pulmonary artery. The correct diagnosis for the appropriate treatment of CAVF is important since the incicence of the ischemic coronary heart disease is increasing recently.
Adult* ; Angiography ; Arteriovenous Fistula* ; Coronary Disease ; Coronary Vessels ; Diagnosis ; Heart Atria ; Heart Ventricles ; Humans ; Pulmonary Artery ; Seoul

Pulmonary aspergilloma is potentially a life threatening disease resulting from the colonization of lung cavities by Aspergillus fumigatus. A case is reported: a 43-year-old man with symtomatic cavitary aspergilloma presenting with severe productive coughing, hemoptysis, occasional fever, and chilling. On preoperative plain chest radiograph and CT scan, we could find a rounded irregular opacity in a large pulmonary cavity. He received 2 separate operations for therapeutic need. At the first opertion, we performed cavernostomy and thoracoplasty because of severe pleural adhesions, tearing of cavity wall, and high risk of respiratory insufficiency. At the second operation, we performed myoplasty and omentoplasty for closure of remaining air space and complete wrapping of the BPF site. All symptoms of dyspnea and hemoptysis have since resolved. We believed that in the high risk patients who have severe respiratory symptoms, such as in aspergilloma and open cavity with a risk of respiratory insufficiency, cavernostomy followed by myoplasty or omentoplasty should be recommended.
Adult ; Aspergillus fumigatus ; Colon ; Cough ; Dyspnea ; Fever ; Hemoptysis ; Humans ; Lung ; Pulmonary Aspergillosis ; Radiography, Thoracic ; Respiratory Insufficiency ; Surgical Flaps ; Thoracoplasty ; Tomography, X-Ray Computed