The diagnosis and treatment of avascular necrosis of femoral head advanced, after Freud issued examples of bilateral avascular necrosis of femoral head (AVN) in 1926. But still not fixed in treatment and diagnosis. Recently early diagnosis and treatment produced good result. Whole body bone scan, intraosseous pressure mornitoring, intramedullary venography, C-T, or MRI, Selective femoral angiography also used in early diagnosis. Selective femoral angiography was performed for 56 patients, who has suspected as AVN by sumple X-ray and WBBS in order to estimate. How the femoral angiographic finding exist in AVN. In the control group femoral angiography performed to 5 person with normal stage of clinical and radiologic finding. So the result are as following l. All cases in the control group were not observed terminal branch of superior and inferior capslar branch. 2. In AVN the alteration of vasculature appeared 22 patients among 56 patient. 3. The altered vasculature presented 87.5% in traumatic group and 31.5% in nontraumatic group. 4. Collateral circulation was 22.2% in the cases of patients under 6 moths of the time interual between etiological events and clinical symptoms, 89.5% over 6 months. 5. Collateral circulation received 86.8% from inferior gluteal artery two cases from superior gluteal artery, and three cases form obturator artery. 6. Clinical tolerance was supposed to in well developed collateral circulation. According to the above results, Vascular alteraion were noted very much in traumatic group and development of collateral circulation were related promote clinical tolerance. Selective femoral angiography was not effective to assist early diagnosis and treatment of AVN for it could not detect terminal branch of superior and inferior capsular artery that reflected intraossous vasculsture. We need the new nethod of angoigraphy in order to early diagnosis.
Angiography ; Arteries ; Collateral Circulation ; Diagnosis ; Early Diagnosis ; Head ; Hip ; Humans ; Magnetic Resonance Imaging ; Moths ; Necrosis ; Phlebography

Differential diagnosis between physiologic bow legs and nonphysiologic bow legs is difficult and still not fixed in diagnosis, especially under 5 years old age. Recently the problem exist in differential diagnosis and treatment method of rickets because of non-specific laberatory finding in rickets. Metaphyseal-Diaphyseal angle in distal femur, Diaphyseal-Diaphyseal angle between femur and tibia, and Metaphyseal-Diaphyseal angle in proximal and distal tibia, and Metaphyseal-Metaphyseal angle in tibia are measured and compared for 30 bow legs children. And divided into rickets group and physiologic bow legs group by clinical and laboratory findings. The results are as following 1. Mean age was 1.91 years old at initail examination, 2.08 years old in rickets group, 1.73 years old in phisiologic bow legs group. 2. Diaphyseal-Disphyseal angle between femur and tibia was 18.12 ±6.80 in rickets group. And 10.17±5.36 in phisiologic bow legs group. Metaphyseal-Diaphyseal angle in distal femur was 10.88±3.62 in rickets group. And 8.42±4.42 in physiologic bow group. 3. Metaphyseal-Diaphyseal angle in proximal tibia was 11.50±2.56 in rickets group. And 7.17±2.01 in phisiologic bow legs group. It's angle in distal tibia was 10.50±3.86 in the former and 9.50 ±3.09 in the later group. Metaphyseal-Metaphyseal angle in tibia was 20.68±3.91 in rickets group and 16.78±4.11 in phisiologic bow legs group. According to the above mentioned results. Metaphyseal-Metaphyseal angle and Metaphyseal- Diaphyseal angle in tibia are comparable to gross appearance of bow legs deformed children rater than Diaphyseal-Diaphysealangle between femur and tibia, and Metaphyseal-Diaphyseal angle in distal femur. All values are high in rchekts, statistically. Therfore measurement of above mentioned angle in simple X-ray is valuable in differential diagnosis between phisiologic bow legs and Rickets.
Child ; Diagnosis ; Diagnosis, Differential ; Femur ; Genu Varum ; Humans ; Methods ; Rickets ; Tibia

We had treated 24 patients who had nonunions of the carpal scaphoid from June 1987 to September 1995. 17 of 24 nonunions of carpal scaphoid were treated by K-wires fixation and autogenous iliac bone grafts. Another 7 cases were treated by Herbert screw fixation and autogenous iliac bone graft. 24 patients were followed up average 42.6 months and obtained following results; l. Among 24 cases, 23 cases were men and 19 cases were the third and fourth decade. Most common injury was the falling accidents (11 cases: 45.8%). 2. Most common pattern of fractures was waist type (20cases: 83.3%) in anatomical site and transverse type (15 cases: 75.0%) in pattern of fracture line. 3. Preoperative scapholunate angles (mean 52.9degrees: K-wires, 69.1degrees: Herbert screw) has been improved after open reduction and internal fixation by K-wires or Herbert screw (mean 46.2degrees: K-wires, 51.1degrees: Herbert screw). 6 cases had DISI deformity preoperatively with scapholunate angles over 70degrees (mean 80.0degrees: K-wires, 84.0degrees: Herbert screw) has been corrected after ORIF (mean 48.0: K-wires, 58.0: Herbert screw). 4. Bony unions were obtained in average 13.2 weeks in K-wires group and 9.8 weeks in Herbert screw group. 5. 13 cases (76.5%) in K-wires group and 6 cases (85.7%) in Herbert screw group were excellent and good result by Maudsley method. 6. The complications and sequalaes were present 4 cases in K-wires group with degenerative arthritis on radioscaphoidal and scapholunate joint and collapse of proximal pole and 1 case in Herbert screw group with screw malposition. So, We were thought that ORIF with K-wires and Herbert screw was effective treatment for nonunions of carpal scaphoid, especially Herbert screw fixation and autogenous iliac bone graft. In comparison of bony union and results of treatment, Herbert screw group was more effective than K- wires group.
Congenital Abnormalities ; Humans ; Joints ; Male ; Osteoarthritis ; Transplants

Articular cartilage is a highly differentiated tissue, lacking a vascular supply and having only limited regenerative capability. Cut or other mechanical damage restricted to the cartilage does not repair. Experimentally and clinically, cartilage defect that penetrate the subchondral bone undergoes repair through the formation of tissue usually characterized as fibrous, fibrocartilaginous or hyaline-like cartilaginous tissue. There is little definitive informations about local or systemic factors that control the differentiation of mesenchymal cells to osteoblast, chondroblast or fibroblast. Our study was designed to evaluate the effect of transforming growth factor-beta (TGF-pl) and autogenous periosteal graft on the healing of osteochondral defect of distal femur of rabbit and also the possibility of these method to be clinically applicable to human. The experimental model used in the present study for including cartilage in rabbit was based mainly on the model used by Frukawa et al14). in rabbit. A full thickness osteochondral defect of 80 rabbit were made with 2mm diameter of drill-bit and electrically driven drill. Experimental animals were divided into four group: 1) group I, osteochondral defect only, 2) group II, osteochondral defect with infiltration of phosphate buffer solution, 3) group III, osteochondral defect with infiltration of TGF-Bl, 4) group IV, osteochondral defect with autogenous periosteal graft. The healing of the defect was assessed at 1 week, 3 weeks, 5 weeks, 12 weeks after operation by gross and histochemical examination. At 1 week, fibrinoid material in edge to edge arcade arrangement was present in group I,II,III,IV. At 3 weeks, spindle shaped undifferentiated mesenchymal cell present in the periphery of fibrinous network, but there is no appearance of mesenchymal cell in group I,II. At 5 weeks, essentially complete repopulation of the defect with progressive differentiation of cells to chondroblast, chondrocyte, osteoblast and synthesis of cartilage and matrix in their appropriate location in group III and IV were found. At 12weeks, hyaline like cartilage formation was observed in group III and IV. but early trace of degeneration of the cartilage were seen in many defect with the prevalence and intensity of the degeneration increasing at group I and 3 . Our study demonstrated in detail the repair of full-thickness defect in rabbit articular cartilage extending into cancellous bone of the marrow cavity under influence of local growth factor (TGF-pl) and autogenous periosteal graft. Excellent reconstruction of articular cartilage was observed in TGF- Bl infiltration group and autogenous periosteal graft group as early as 5 weeks after the creation of defect. Although the further study should be carried out for their clinical application, we conclude that TGF-Bl regulates the overall mechanism of matrix constituent in connective tissue and autogenous periosteal graft have a chondrogenic potential to repair major osteochondral defect. these suggest that TGF-Bl and autogenous periosteal graft may be a important pathophysiological regulator of chondro- genesis.
Animals ; Bone Marrow ; Cartilage ; Cartilage, Articular ; Chondrocytes ; Connective Tissue ; Femur ; Fibrin ; Fibroblasts ; Humans ; Hyalin ; Models, Theoretical ; Osteoblasts ; Prevalence ; Transplants*

No abstract available.
Humans ; Intensive Care Units* ; Critical Care* ; Poisoning*

No abstract available.
APACHE* ; Intensive Care Units* ; Critical Care*

Sixteen patients who had radial head fractures were treated with open reduction and internal fixation using Herbert screws (10 patients), and with silastic prosthetic replacement (6 patients) from March, 1992 to December, 1994 in Chungnam National University hospital. The average duration of follow up was 19.5 months. The purpose of this study is to examine the role of Herbert screw fixation and silicone replacement arthroplasty and to asscess the clinical results of two groups functionally, radiologically in raidial head fractures. By functional rating index (modified After B.F. Morrey et al), the results were classified as excellent (9 patients), good (6 patients), fair (No patient) and poor (1 patient). Nine of the ten patients treated by open reduction and internal fixation using Herbert screws had resulted in excellent or good. All patients were inserted silastic implants were showed excellent or good results. Especially, in Mason Type III radial head fractures, three of four patients treated by Herbert screws and all 5 patients treated by silastic prosthesis were considered to excellent or good results. We concluded that Herbert screw fixation or silastic prosthetic replacement had satisfactorily appeared to be the alternative treatment option for Mason Type III radial head fractures.
Arthroplasty, Replacement ; Chungcheongnam-do ; Follow-Up Studies ; Head* ; Humans ; Prostheses and Implants ; Silicones

The Clufoot is still controversial in the etiology, the pathology, and the method of the treatment. Turco issued one stage posteromedial soft tissue release in 1971, which is still widely used. But the Turco's procedure is not satisfactory results in forefoot adduction and ankle motion. McKay and Simon were performed one stage complete subtalar soft tissue release and reported better results compared with those who had posteromedial release. So we performed Turco's posteromedial release with lateral release by Cincinnati incision in 12 patients (20 feet) and analysis the results from Oct. 1987 to Jul. 1989 at the department of orthopaedic surgery of CNUH. The results were as followings ; 1. The mean age of the patient at first examination was 1 year 9 months (range from at birth to 5 year 10 months) and the mean age at operation was 2 year 1 month (range from 4 months to 5 year 10 months). 2. The clinical results were excellent in 2 feet, good in 14 feet, fair in 3 feet and unsatisfactory in 1 foot. 3. The radiological results were satisfactory in 18 feet and unsatisfactory in 2 feet. 4. Forefoot adduction was corrected in 14 feet (70%) as normal range, 3 feet as acceptable, and 3 feet as unacceptable 10' over the normal range. 5. Two feet of hind foot overcorrection result was operation as McKay's method. 6. The Clincinnati incision was favorable to visulization and release of the posteromedial, anteromedial and posterolateral structure of the foot.
Ankle ; Clubfoot ; Foot ; Humans ; Methods ; Parturition ; Pathology ; Reference Values

Epidural morphine injection was done in nineteen patients who had been admitted from March to August 1990 to the Intensive Care Unit, Severance Hospital, Yonsei Medical Center for respiratory care including ventilator care. Morphine suplphate, 2.67 +/- 0.27 mg was injected one to three times to four patients after chest trauma, and to fifteen patients after thoracotomy. Tidal volume and vital capacity were increased from 4.45 +/- 0.48 and 8.31 +/- 0.50 to 6.91 +/- 0.41 and 12.81 +/- 0.73 mg/kg. However, respiratory rates decreased from 26.07 +/- 1.41 to 20.07 +/- 1.16/min. Inspiratory force increased from -13.40 +/- 1.31 to -26.53 +/- 1.82 cmH2O. Pain score decreased from 9.22 +/- 0.57 to 3.56 +/- 0.83 during this period. PaCO2 did not differ significantly (39.33 +/- 1.13 and 39.48 +/- 1.42 mmHg). Side effects such as pruritis and urinary retention were treated with naloxone 7 approximately 10 ng/kg/min. Mean arterial pressure and pulse rates stayed stable during the study periods. Ventilator hours and ICU stays differed from the control group. However, the duration was not statistically significant. The control group consisted of patients who were admitted during the six months from September 1989 to February 1990 to the ICU for respiratory care, without epidural morphine injection.
Adult ; Female ; Hemodynamics/drug effects ; Human ; Injections, Epidural ; Intensive Care Units ; Male ; Middle Age ; Morphine/*administration & dosage ; Pain/drug therapy ; Prospective Studies ; Respiration/*drug effects/physiology ; Thoracic Injuries/*physiopathology ; Thoracotomy ; *Ventilators, Mechanical

Seventy-nine fiberoptic bronchoscopies were performed in 46 Patients during 2 years in the Intensive Care Unit of Severance Hospital, Yonsei Medical Center. Bronchoscopies were done more than twice in 13 patients. Forty-three bronchoscopies were done through the orotracheal tube in 27 patients, and narcotics and sedatives such as morphine sulfate, diazepam and lorazepam were added with pancuronium bromide during 52 bronchoscopy procedures in 21 patients. Ventilatory support was accomplished by control mode ventilation for 63 bronchoscopies in 37 patients. Twenty-four patients were from the surgical department, and 37 bronchoscopies were performed in 18 patients in a post-thoracotomy state. Twenty-two patients were nonsurgical patients. We performed 48 bronchoscopies in 26 patients to treat lung haziness, 14 bronchoscopies in 3 patients to confirm the operative anastomosis after pneumonectomy or tracheoplasty, and 11 bronchoscopies to confirm the airway patency and vocal cord movement. We obtained good results from 41 bronchoscopies performed for therapeutic purposes and 28 bronchoscopies done for diagnostic purposes. But in 4 patients with pleural effusion and pneumonia, we could not get any improvement in chest X-ray taken after bronchoscopy. We suggested other procedures in 6 patients for diagnosis or treatment, such as suspension laryngoscopy, thoracentesis, ultrasonogram and laser surgery.
Airway Obstruction/diagnosis ; *Bronchoscopes ; Critical Care ; Evaluation Studies ; Female ; *Fiber Optics ; Human ; Male ; Respiratory Insufficiency/*diagnosis/therapy