Giant cell tumor is an uncommon neoplasm, arising from the mesenchymal cells of bone marrow. The lesion was first described by Sir Astley Cooper in 1818. Levert in 1845 gave a detailed delineation of this tumorous condition. Paget in 1853 provided an excellent description of what remains a guiding treatise. In 1940, Jaffe, Lichtenstein, and Portis identified it as an entity with distinctive roentgenographic, hiatological, and clinical characteristics. Since then, frequent detailed reports analyzing the treatment and prognosis were published by many authors. The classic grading system is that of Jaffe, Lichtenstein, and Portis. Grade I,II, and III correspond respectively to insignificant, moderate, and marked atypism of the nuclei of the stromal cells. Tumors of Grade III are considered to be frankly malignant. While Dahlin and associates and Goldenberg and his co-workers found the grading of no prognostic value, Lichtenstein, in 1972, still claimed that in his experience the grading of giant cell tumor is of practical value. Twenty seven cases of giant cell tumor were seen and treated at Severance Hoepital during the 18 years from July 1960 to June 1978. The tumors were mostly diatributed 55% in the 21 to 40 years group and mostly located around the knee (52%). According to the pathologlcal grading, these casosbelonged to Grade I and Grade III in 19% each and to Grade Il in 62%. The treatment consisted of curettage and bone graft in 14 cases, amputation in 4 cases, en bloc excision in 3 cases, partial resection and fusion, curettage and bone graft with radiotherapy in 2 cases each, curettage and bone cement, and en bloc excision and endoprosthsis in one case each. On following up the end results, the over all recurrence rate was 18.5% (5 cases) and the malignant change rate was 3.7% (1 case). In this study one case was changed into malignant degeneration in Grade II and a pulmonary metastasis was found. Among our cases, 5 were of recurrences, primarily treated by curettage and bone graft in to cases, partial excision with fusion in one case, and curettage, and bone graft with radiotherapy in one case. The recurrence rate seems not to be correlated with the grade. In the treatment of this tumor, surgical treatment if pcssible is recommended. The definitive procedures for removal of the tumors in this series were curettage-and bone graft, excision or resection with or without bone graft, and amputation. Resection and prosthesis replacement was employed in our cases for one lesion in the proximal end of humerus. A new alternative in the choice of surgery has been tried in many authors. This alternative is a thorough curettage of the tumor and filling with bone or acylic bone cement. In our series bone cement filled up the lesion of the distal end of tibia. Tumors located around the knee and distal radius showed higher recurrence than other sites. The results obtained from this study led us to conclude that: 1) The highest incidence was in the age group from 21 to 40 years in 15 cases (55%) and sex distribution was almost equal 2) The most frequent sites of this tumor are the lower end of the femur, upper end of tibia, and lower end of the radius (18 cases, 67%). 3) The pathological grading in this series showed 5 cases in Grade I, 17 cases in Grade II, and 5 cases in Grade III. 4) Recurrence rate was 18.5% and all cases recurred within 2 years after first surgery. 5) A case who is in Grade II in pathological finding was changed into malignant degeneration and pulmonary metastasis. 6) Tumors located around the knee and distal radius were higher in recurrence than at other sites.
Amputation ; Bone Marrow ; Curettage ; Femur ; Giant Cell Tumors ; Giant Cells ; Humans ; Humerus ; Incidence ; Knee ; Neoplasm Metastasis ; Prognosis ; Prostheses and Implants ; Radiotherapy ; Radius ; Recurrence ; Sex Distribution ; Stromal Cells ; Tibia ; Transplants

The increase of health care expenditures is an important problem in the almost countries. Also, suppression of the health care expenditures is an important problem in the health field of Korea since the national health insurance for total people in 1989. Thus, it is very important to grasp the change of the health care expenditures of family and proportions of the health care expenditures to total expenditures of family, because they are the basis of national health care expenditures in Korea. While the health care expenditures of urban family were increased during 1980-1993 by 12.8% annually, the total expenditures of urban family were increased by 14.8% annually. consequently, the proportions of health care expenditures to total expenditures were decreased from 5.98% to 4.76%. The proportions of health care expenditure for 3 years to come were predicted to 4.75% in 1994, 4.67% in 1995, and 4.63% in 1996 by the time-series ana]ysis. That is, it was predicted that they would be decreasing slowly. The product elasticity of health care expenditure was less than 1 in the multiple regression analysis, so the health care is normal good rather than superior good. Therefore, it seems that the household economy is able to bear the expense pursuing the improvement of quality of health care by actualizing the medical insurance fee.
Delivery of Health Care* ; Elasticity ; Family Characteristics ; Fees and Charges ; Hand Strength ; Health Expenditures* ; Humans ; Insurance ; Korea ; National Health Programs ; Quality of Health Care

Total release of the hamstrings of the knee from their origin was performed In nine cerebral plasied children. Eighteen procedures were performed in nine patients whose age ranged from three to sixteen years with an average of ten years. The average follow-up period was twenty one months from ten to thirty-six months. The spastic knee flexion was correction adequately; in mest instances the crouch posture was corrected, gait was improved, and a long stride was possible. The power of the hamstrings was assessed in the fourteen limbs of the children who could walk or cooperate in musicle testing. The power was graded as good in six knees and as normal in one. Seven showed improvement in gait; six patients who had never walked were able to do so after hamstring release; and one patient was able to stand up for the first time in his life after the operation. Eight out of nine cases are now able to stand up with or without support of a brace, and to walk with a brace in five cases and without support in two. However, increased lumbar lordosis and genu recurvatum has occurred in two cases each.
Animals ; Braces ; Cerebral Palsy ; Child ; Extremities ; Follow-Up Studies ; Gait ; Humans ; Knee ; Lordosis ; Muscle Spasticity ; Posture

To investigate the factors influencing workers' perception and attitude toward special periodic health screening test for workers, a survey with self-administered questionnaires was performed on 279 workers who had special periodic health screening test from september 1 to October 15, 1994. A study model was developed by modifying the health belief model. The end and intermediate response variables of the model were the voluntary participation and necessity perception on the special screening for workers, and The result of analysis was consistent with the study model. Rates for the necessity perception and voluntary participation on the special1 screening for workers were 77.2%, 79.2%, respectively. Factors influencing on the voluntary participation were necessity perception, benefit of special screening for workers, and cue to action. And on the necessity perception were susceptibility and severity to occupational disease, knowledge to special screening for workers, and support of company. General and occupational characteristics influencing on the susceptibility and severity to occupational disease were sex, age, educational level, work duration, and health education. On the knowledge to special screening for workers were age, educational level, work duration, and locus-of-control. On the benefit of special screening for workers were age, locus-of-control, pride on health, and health education. Therefore, to increase the voluntary participation and necessity perception on the special periodic health screening for workers, l) if a worker is judged as occupational disease, the judgment should be widely known in his workplace, 2) the screening result forms should be directly sent to the workers themselves, 3) for the positivity of employers, the campaign and education program subjected to them should be planned, 4) health education should give the first consideration to the younger, lower educational level, and newly employed women, and its frequency should be increased and it should be more frequently dealt with occupation-related subjects, and 5) the employers should have a careful concern in not being disadvantageous to workers due to result of screening.
Cues ; Education ; Female ; Health Education ; Humans ; Judgment ; Mass Screening* ; Occupational Diseases ; Surveys and Questionnaires

In recent years the rate of the spine Injury tends to be on the increase year by year as the rate of traffic and industrial accidents are increased. During industrial, sports and automobile accidents are occurred, the various forces were exerted by the mechanism, “flexion, extension, flexlon-rotation, vertlcal compression and shearing.” These exercise their effects on the vertebral bodies, the neural arches and intervertebral disc and the contents of the spinal cord, depending on direction and intensity of the trauma, and the posture and muscular attitude existent at the movement. Once the neurological Iesion has been diagnosised and the type of vertebral injury has been established and particularly after a decision has been made as to whether the spinal injury is stable or unstable, a rational method of treatment can be decised upon: Our treatment consists of providing the best condition for recovery from the spine injury, preventlng further neurologlcal damage in the unstable area, achieving stable bone and llgament heallng ln satisfactory position, preventing metabolic compllcations from being fatal, mobllizing the patient early, and rehabilitating to provide maximum fuctlonal independence with the remaining-muscle power avallablc to the cord injury patient. One hundred and fifty seven spine fracture and dislocation patients were clinically observed and evaluated from Jan. 1972 to Dec. 1978 in our study. The result of this study may be summerized as follows: 1. Out of the patients, there were 135 male and 22 female cases. The ratio between male and female was 6.1:1. The majority (84.7%) of the spine injuries was found in the age of 20 to 50 years. Fifty-two percent of the cases was caused by industrial accidents. 2. The most common site of the lesion occurred between T-11 and L-2 vertebrae (71.8%). 3. In cervical injury, fracture dislocation type was most common (50%), and especially, pure dislocation by extension mechanism was 12.5% but in thoracolumbar iniury, simple anterior wedge compression fracture was most common (66.6%) and there were no pure dislocations just like cervical spine injury cases. 4. Fifty seven cases of the total were complicated by paraplegia, of which 62.5% in cervical region and 31.6% in thoracolumbar region were noticed. The most frequent type of the injury in which paraplegia developed was the fracture dislocation (73.8%) and the most common site of the lesion was between the T-12 and the L-2 vertebrae. 5. Open reduction was performed in 9 cases out of 24 cervical spine injury patients and in 41 cases out of 133 thoracolumbar injury patients. 6. Prognosis of neurologic recovery in initially complete lesion was poor, regardness of treatment. In the cervical lesion cases there were no patients who were recovered. But in the other sites about 10.5% of initially complete lesion showed partial neural recovery comparing to 62.5% of initially incomplete lesions. 7. Progressive deformity is often noted as a complication of spine fracture or dislocation when solid fusion fails to develop. The increment of kyphosis after treatment is as follows: Simple wedge fracture
Accidents, Occupational ; Automobiles ; Catheterization ; Catheters ; Clinical Study ; Congenital Abnormalities ; Diagnosis ; Dislocations ; Female ; Fractures, Compression ; Humans ; Intervertebral Disc ; Kyphosis ; Laminectomy ; Male ; Methods ; Paraplegia ; Posture ; Prognosis ; Spinal Cord ; Spinal Injuries ; Spine ; Sports ; Urinary Bladder

Some of the techniques for bone grafting for delayed union or nonunion of the long bone are used currently. In 1991, at arthroscopy workshop in Phoenix, Arizona, Lanny L. Johnson, M.D. reported a case of endoscopic bone grafting for the delayed union on the humerus. He suggested the possibilities of endoscopic bone grafting such as minimal incision, magnified visualization, accurate debridement, accurate graft placement, vascular preservation, outpatient surgery and reduced cost. The author performed endoscopic bone grafting and extra-articular adhesionlysis on the delayed union of femur with extra-articular ankylosis. The patient was a 28 year old housewife with blood type Rh(-). The duration after initial operation was more than 9 months. The result of the graft was satisfactory. In the future endoscopic bone grafting could be performed for nonunion, delayed union and congenital bone defect.
Ambulatory Surgical Procedures ; Ankylosis ; Arizona ; Arthroscopy ; Bone Transplantation ; Debridement ; Education ; Femur ; Humans ; Humerus ; Transplants

No abstract available.
Observer Variation*

No abstract available.

With the development of spinal fusion and internal fixation, rehabilitation mediclne, urinary control and antibiotics, the outlook for patients with cervical spine injuries has brightened considerably, as compared with half a century ago. However, splnal cord injury still remains as one of the most devastating accidents that man can Incur and still survive. There is increasing tendency to stabllize unstable cervical spine injuries surglcally for the benefit of early mobilization,.early rehabilitation, easy nursing care, and rigid stability of the spine. A clinical study was performed on 72 patients with 76 fractures and fracture-dislocatlons of the cervical spine, who were hospitalized and treated at Severance Hospital during the period between January 1970 and December 1978 and the following results were obtained. 1. The prevalent age distribution was between 30 and 50 years of age (59.7%), and the ratio between males and females was 5:1. The most common cause of injury was falling from a height (51.4%). 2. In overall patients, neurologic damage was found at first examination in 69.4%, and among these, complete paralysis below the injured level In 41.7%, incomplete paralysis in 25%, and nerve root injury in 2.7%. 3. The mechanisms of injury included flexion-rotation (50%), extension-distraction (18%), flexion-compression (12.5%), pure flexion (5.5%), axial compression (5.5%), and unclassified (8.3%). 4. Among 72 patients, emergency decompressive laminectomy was performed on 10 patients, anterior interbody fusion on 15 patients, posterior fusion with wiring on 3 patients and the rest of patients were treated conservatively. 5. There was no significant difference in the recovery of neurologic loss between conservatively and surgically treated patients, but it was thought better to stabilize the unstable fracture-dislocations surgically for early mobilization and rehabllitatlon.
Accidental Falls ; Age Distribution ; Anti-Bacterial Agents ; Clinical Study ; Early Ambulation ; Emergencies ; Female ; Humans ; Laminectomy ; Male ; Nursing Care ; Paralysis ; Rehabilitation ; Spinal Fusion ; Spine

PURPOSE: The purpose of this study was to examine the significance of increased bone density according to whether bone grafts were applied using demographic data with Cone Beam Computed Tomography (CBCT) and to compare the bone densities between before and after implant prosthesis using the Hounsfield index. MATERIALS AND METHODS: Thirty-six randomly selected computed tomography (CT) scans were used for the analysis. The same sites were evaluated digitally using the Hounsfield scale with V-Implant 2.0(TM), and the results were compared with maxillary posterior bone graft. Statistical data analysis was carried out to determine the correlation between the recorded Hounsfield unit (HU) of the bone graft and implant prosthesis using a Mann-Whitney U test and Wilcoxon Matched-pairs test. RESULTS: The bone grafted maxillary posterior teeth showed an increase in the mean values from-157 HU to 387 HU, whereas non-grafted maxillary posterior teeth showed an increase from 62 HU to 342 HU. After implantation, the grafted and non-grafted groups showed significantly higher bone density than before implantation. However, the grafted group showed significantly more changes than the non-grafted group. CONCLUSION: Bone density measurements using CBCT might provide an objective assessment of the bone quality as well as the correlation between bone density (Hounsfield scale) and bone grafts in the maxillary molar area.
Bone Density ; Cone-Beam Computed Tomography ; Data Interpretation, Statistical ; Dental Implants ; Molar ; Prostheses and Implants ; Tooth ; Transplants