No abstract available.
Arthrodesis* ; Femur* ; Giant Cell Tumors* ; Giant Cells* ; Transplants*

Fifty percents of patient with achondroplasia present neurological disturbances of varying degree. Congenital narrowing of the spinal canal in achondroplastics seems to be the main cause of the cord disturbance, and there are several other causes such as prolapse of intervertebral discs, spondyloarthitic degenerative manifestations and wedging of vertebral body. Surgical treatment of the cord disturbance consist of anterior decompression with fusion and posterior decompression. We experienced L1-2 disc herniation in achondroplasia with rapid progression of neurologic symptoms and treated with posterior decompression. Two years after operation, the patient had good result.
Achondroplasia ; Decompression ; Humans ; Intervertebral Disc ; Neurologic Manifestations ; Prolapse ; Spinal Canal

Operations on the inner aspect of the pelvis are often necessary for irreducible fracture of the ilium, irreducible fracture of superior and medial portion of the acetabulum, tumors and infections involving iliac fossa, and fracture-dislocation and infection of the sacro-iliac joint. Until now Letournel and Judet's ilioinguinal and iliofemoral approaches provided access to anterior column of the pelvis by elevating muscle layer on inner aspect of the pelvis. We used modified iliofemoral approach using ASIS(anterior superior iliac spine) osteotomy to gain better access to anterior column, the pelvlc brim, and in some occasions as far as anterior sacroiliac joint while avoiding injury to the structures in the inguinal ligament and lateral femoral cutaneous nerve and reported six cases treated with this approach. In conclusion, a modified iliofemoral approach using ASIS osteotomy is a useful approach which can obtain an excellent exposure in the inner pelvis.
Acetabulum ; Ilium ; Joints ; Ligaments ; Osteotomy ; Pelvis ; Sacroiliac Joint

There are several considerations in performing free vascularized fibular graft for the treatment of the large bone defect, e.g., bone fixation, additional bone graft, and management of complication. Authors have analyzed 25 cases treated with free vascularized fibular graft at Holy Family Hospital between Jun. 1985 and Dec. 1994. The mean follow up was 27.4 months The results were as follows: 1. The causes of the defect were traumatic defect with infection of 16 cases, bone tumor of 4 cases, congenital pseudoarthrosis of tibia of 3 cases and osteomyelitis of 2 cases. 2. Hypertrophy of the graft was more common in the lower extremity and in the patient under the age of 15. 3. Nonunion of graft occurred in 4 cases(16%). These cases were fixed with screws and/or pin ini tially and subsequently treated with rigid internal fixation. 4. Stress fracture of graft occurred in 3 cases(12%). Two cases of them were treated with internal fixation. 5. Additional bone graft were performed in 6 cases(24%), among 17 cases who had bone defect of lower extremity in adult. In conclusion, authors emphasize that rigid internal fixation and additional bone graft in performing free vascularized fibular graft are recommended for obtaining early solid bony union and achieving early rehabilitation.
Adult ; Follow-Up Studies ; Fractures, Stress ; Humans ; Hypertrophy ; Lower Extremity ; Osteomyelitis ; Pseudarthrosis ; Rehabilitation ; Tibia ; Transplants

Incidence of non-contiguous multiple spine fracture was increased from 3.2%~4.5% at 1960th and 70th to 5.7% ~23.8% at 80th and 90th. But there is no reports in Korea which has high incidence of traffic and industrial accidents. In 345 consecutive patients with acute spine fracture, we found that 43 patients (12.5%) had multiple non-contiguous spine fractures. At the 43 patients studies 37 (87.4%) sustained fractures at 2 levels while 6 had more than 3 levels of injury, 26 were injured by fall from heights, 27 (62.8%) had 2.33 associated injuries on an average, and 12 (27.9%) had a neurologic deficit. There are five patterns account for 26 (50%) of the total number of patients. In 19 patients (44.2%), there was a mean 29.3 days delay (from 3 to 233 days) in diagnosis of the minor lesions. In 19 delay diagnosed minor lesions, it confirmed by bone scan in 12 patinets(63.6%). Two patients died within 24 hours after accident, and 41 patients (41 major and 50 minor fractures) were treated in our hospital. Among them, 21 (51.2%) needed modification of treatment by the presence of non-con- tiguous multiple spine fractures. According to above findings, the physician must be aware of the possible noncontiguous multiple spine fractures when examine and treat the patients with spine fracture.
Accidents, Occupational ; Diagnosis ; Humans ; Incidence ; Korea ; Neurologic Manifestations ; Spine

In our series with old electrical burn around the the wrist, there are several characteristics: for example, bad scarring in palm and volar aspect of wrist and distal forearm, large multiple defects of the flexor tendons, low median and ulnar nerve palsy, and occasionally insufficient blood supply. Between 1992 and 1995, we treated 8 cases of 7 patients with staged reconstruction. 4 patients with bilateral involvements had below-elbow amputee of contralateral upper extremity. The common approachs in each were soft tissue coverage, staged tendon reconstructiuon, and opponensplasty. The length of time between the injury and tendon reconstruction was 9 months on an average. Soft tissue coverage consisted of: 1. free tissue transfer (n=3), 2. abdominal (n=3) or groin (n=2). Total numbers of flexor tendon reconstruction were 26. Among them, staged reconstruction using silicone prosthesis were done in 18 tendons and primary tendon graft following tenolysis were done in 8 tendons. The time between first and second stage tendon reconstruction was 4.13 months. In all cases, opponen-splasty using extensor indicis proprius (n=4), extensor pollicis longus (n=2), and extensor digiti mini- mi (n=l), were performed. Good functional improvement of the hand were obtained in all cases. Patient s satisfaction were much better than the degree of functional improvement of the hand.
Amputees ; Burns* ; Cicatrix ; Forearm ; Groin ; Hand ; Humans ; Prostheses and Implants ; Silicones ; Tendons ; Transplants ; Ulnar Neuropathies ; Upper Extremity ; Wrist*

PURPOSE: Early detection of appendicitis has increased due to development of computed tomography and ultrasonography, yet we are frequently meeting complicated appendicitis, including perforation, abscess and a gangrenous appendicitis due to delayed diagnosis. For that reason, we want to evaluate predictive factors for the complicated appendicitis. METHODS: A total of 128 patients with appendicitis, after 13 patients with a duration of under 12 hours and 15 patients with pathological non-appendicitis were excluded from 156 patients, who visited Kwangju Christian Hospital from November 2008 to November 2010 were retrospectively reviewed. RESULTS: There were 62 patients (48.3%) with simple appendicitis and 66 patients (51.7%) with complicated appendicitis. In univariate analysis, age (P < 0.001), C-reactive protein (P < 0.001) and the diameter of the appendix (P = 0.006), were found to be significant. Multivariate analysis demonstrated that C-reactive protein was an independent predictor for complicated appendicitis (odds ratio, 1.371; 95% confidence interval, 1.155 to 1.628; P < 0.001). The cut-off value of C-reactive protein was set at 7.05 mg/dL by using receiver operating characteristic curve (0.805; sensitivity, 57.6%; specificity, 98.3%). CONCLUSION: This study suggests that if C-reactive protein is above 7.05 mg/dL, immediate and proper management should be performed due to a high probability of complicated appendicitis, especially in young children or elderly patients who frequently present with vague symptoms.
Abscess ; Aged ; Appendicitis ; Appendix ; C-Reactive Protein ; Child ; Delayed Diagnosis ; Humans ; Multivariate Analysis ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity

Twenty-five patients with unstable fracture or fracture-dislocation of the thoracolumbar and lumbar spines were treated with Cotrel-Dubousset instrumentation. Internal fixation was done in two ways; long rodding in seventeen patients and short rodding in eight. Short segment posterolateral or posterior autogenous iliac bone graft was done in all cases. The amount of correction of the collapsed anterior vertebral body height and the local kyphotic angle at the immediate post-operation were similar between the two groups, but loss of correction at last follow-up was more severe in the short rodding group. Instrument failure was also more common in the short rodding group. In conclusion, it was found that short segment stabilization of spine fractures with Cotrel-Dubousset instrument can effectively reduce fracture but can not maintain reduction until fusion. Therefore, long rodding was reconfirmed to be the better method of stabilization of the thoracolumbar and lumbar spines fractures.
Body Height ; Follow-Up Studies ; Humans ; Methods ; Spine ; Transplants

OBJECTIVE: This study was performed to investigate whether 1) progestogens induce changes of vascular tone in endothelium-denuded smooth muscles of human uterine artery, 2) endothelium-independent vascular reactivity is mediated by intracelluar calcium ion modulation through 2 types of calcium channel, both voltage- and receptor-dependent and 3) 3 kinds of progestogen such as a progesterone, C19 nortestosterone(norethindrone acetate ; NETA) and C21 progestogen(medroxyprogesterone acetate ; MPA), have a different vasoreactivity. METHODS: The uterine arteries were obtained at the time of hysterectomy from 24 women who had no cardiovascular disease risk factors and the endothelium was denuded. Vascular reactivity was monitored by using isometric force transducer and recorded by physiograph. Endothelial integrity was assessed by adding 10micrometer acetylcholine(endothelium-dependent vasorelaxant) to the specimens, which were pretreated with 1micrometer norepinephrine(alpha-adrenergic stimulant). The integrity of smooth muscle was assessed by adding 10micrometer sodium nitroprusside(endotelium -independent vasorelaxant) and 10micrometer tamsulosin(alpha-adrenergic blocker) to the specimens, pretreated with 1micrometer norepinephrine. The uterine smooth muscles were pretreated with 35mM and 70mM potassium chloride and 10-7M and 10-6M norepinephrine. Three kinds of progestogen - progesterone, NETA and MPA - each at 5 different concentrations(10-9g/ml, 10-8g/ml, 10-7g/ml, 10-6g/ml and 10-5g/ml) were used. RESULTS: The loss of endothelial function and adequacy of smooth muscle function were confirmed. Three kinds of progestogen had concentration-dependent inhibitory effects on vascular smooth muscle contr action induced by high potassium solution and norepinephrine, respcetively. There were no siginificant differences noted among the inhibitory effects of three progestogens in 35mM concentration of potassium solution and 10-6M norepinephrine induced muscular contraction. In 70mM potassium solution, there were significant differences among the three progestogens-induced inhibitory effects. Progesterone showed the most potent inhibitory effect, NETA was intermediate, and MPA had the mildest effect. In 10-7M norepinephrine, progesterone had more potent inhibitory effect than NETA or MPA. The difference between progesterone and NETA/MPA was statistically siginificant, with no significance between NETA and MPA. CONCLUSION: The results of this study revealed that progestogens have a concentration-dependent vaso-relaxant effect on endothelium-denuded vasular smooth muscles via a calcium antagonistic mechanism of direct inhibitory effects on receptor- and voltage-dependent calcium ion channels. This vaso-relaxant effect of progestogens differed among a variety of progestogens. In conclusion, the progestogens combined with estrogens have not antagonistic effect on vaso-relaxation at least and maybe have synergistic effect with estrogens, in vivo.
Calcium ; Calcium Channels ; Cardiovascular Diseases ; Endothelium ; Estrogens ; Female ; Humans* ; Hysterectomy ; Muscle Contraction ; Muscle, Smooth ; Muscle, Smooth, Vascular* ; Norepinephrine ; Potassium ; Potassium Chloride ; Progesterone ; Progestins* ; Risk Factors ; Sodium ; Transducers ; Uterine Artery

Vascularized fibular graft is one of the treatment option for avascular necrosis of femoral head (ANFH) and has been known as providing a strut mechanical support and new vascular bed. It is very important to evaluate a healing process in femoral head after vascularization procedure. But a plain radiographic finding has a problem to assess pathological changes of ANFH treated with vascularized fibular graft. Authors analyzed chronogical changes of Tc-99m-HDP bone scan in 31 cases of ANFH treated with vascularized fibular graft from April, 1991 to May, 1994 and following results were obtained. l. Until 2 months after surgery, no change in size of cold defect area and no significant change in extent of RI uptake in reactive zone were noted. 2. During 2 months and 6 months after surgery, slight decrease in size of cold defect area and minimal changes in extent of RI uptake in reactive zone were observed. 3. During 6 months and 12 months after surgery, size of cold defect area decreased to 1/2 and changes in extent and degree of RI uptake in reactive zone were observed. 4. During 1 year and 2 years after surgery, size of cold defect area were minimal and sometimes faded away. RI uptake with decreased density in reactive zone broadened and moved to subchondral area. 5. After 2 years after surgery, cold area faded away and small increased RI uptake were observed in same site. In conclusion, Tc-99m-HDP bone scan which is economic and easily applicable in a patient is very useful for follow up study in ANFH treated with vascularized fibular graft.
Follow-Up Studies ; Head* ; Hip ; Humans ; Necrosis* ; Transplants*