We treated three cases of bone tumors-giant cell tumor, chondroblastoma and malignant fibrous histiocytoma-with a custom-made prosthetic replacement. The patients were followed from 10 months to 18 months, postoperatively. The results of these study are as follows: 1. Satisfactory anatomic restoration 2. Early ambulation 3. Good function 4. Biomechanically sound reconstruction
Chondroblastoma ; Early Ambulation ; Humans

To observe the change in the status of stresses according to three different postural angulation of an intervertebral disc with or without nucleus pulposus, 6 specimens of a 3-dimensional photoelastic model of the spine were made of epoxy. The nucleus pulposus portion was replaced with silicon in three models, and the three were made without silicon. Through axial application of a vertical compressive load of 8 kg, the peculiar patterns of the isochromatic fringes were observed. Stresses on the intervertebral disc were analyzed according to three different postural angulations of the intervertebral disc with the nucleus pulposus and without the nucleus pulposus. The results of these study are as follow: 1. In an erect neutral posture with the nucleus pulposus, the stress concentration was much increased at the posterior portion rather than at the anterior portion. Also, the high stress was concentrated at the medial and central portion. In an erect neutral posture without the nucleus pulposus, the stress concentration was much increased at the anterior portion rather than at the posterior portion and the stress distribution seemed to be locally concentrated. 2. In a maximal flexed posture, the stress concentration was much increased at the posterior portion rather than at the anterior portion. Comparing the presence of the nucleus pulposus with the absence of the nucleus pulposus, the stress concentration was lower at the anterior portion in the presence of the nucleus pulposus than in the absence of the nucleus pulposus. However, the stress distribution at the posterior portion was nearly same in the two groups. According to the analysis of the stress distribution diagram, as a whole, the stress pattern around the disc was evenly distributed. 3. In a maximal extended posture, the higher concentration of the stress distribution at the anterior and medial portion rather than in the posterior and lateral portion was observed. The stress concentration was higher in the presence of the nucleus pulposus than in the absence of the nucleus pulposus. 4. Comparing the maximal flexed posture with the erect neutral posture, the stress concentration in the flexed posture was much decreased in the posterior portion rather than in the erect neutral posture, and an even distribution of the stress pattern in the flexed posture was observed. 5. In the presence of the nucleus pulposus, at the anterior and posterior portion, the stress concentration in the flexed posture was much decreased compared with the extended posture. In the absence of the nucleus pulposus, at the anterior and posterior portion, the stress concentration in the extended posture was much decreased compared with the flexed posture.
Intervertebral Disc* ; Posture ; Silicon ; Spine

No abstract available.
Intervertebral Disc*

Aneurysm of the sinus of Valsalva on mostly congenital disease that develops more frequently in Orientals, is very low in incidence. In most cases, aneurysm of the sinus of Valsalva extends to intracardiac and results in ruptures into the right ventricle or atrium. The likelihood of extracardiac aneurysm of the sinus of Valsalva is very low. Cases of extracardiac aneurysm are usually accompanied by aortic regurgitation and can cause right ventricle outflow tract obstruction, myocardial ischemia, and myocardial infarction due to compression by aneurysm. Since the aneurysm can rupture in the intrapericardium and cause cardiogenic shock or sudden death, definite diagnosis and management are important. If confirmed, it is preferable operform a surgical correction. We report here, with a literature review, a case where myocardial ischemia and aortic egurgitation caused by aneurysm developed in the left coronary and noncoronary sinus, and were surgically corrected with satisfactory esults.
Aneurysm* ; Aortic Valve Insufficiency ; Death, Sudden ; Diagnosis ; Heart Ventricles ; Incidence ; Myocardial Infarction ; Myocardial Ischemia ; Rupture ; Shock, Cardiogenic ; Sinus of Valsalva*

A total of 172 cases of MVR using the St. Jude Medical valve was conducted in the period from August 1986 to May 1996. The hospital mortality rate was 3.5% (n=6) and the late mortality rate was 3.3% (n=5). According to the follow-up of 161 surviving patients, the average length of survival was 50.23+/-0.27 months. Three cases of prosthetic valve related complication deaths were identified. Two cases could be ascribed to left atrial thrombi and resulting cerebral infarction, and one case was prosthetic valve endocarditis. Two cases were caused by hemorrhagic complications that we presume to have been accompanied by anti-coagulation therapy. The actuarial survival rate of all cases at 10 years was 92.3%. We conclude that good clinical results and a low complication rate could be achieved through mitral valve replacement with the St. Jude Medical valve. We also conclude that mid-term and long-term follow-ups were instrumental and necessary.
Cerebral Infarction ; Endocarditis ; Follow-Up Studies ; Heart Valve Prosthesis ; Hospital Mortality ; Humans ; Mitral Valve* ; Mortality ; Survival Rate

BACKGROUND: Although the efficacy of morphine in a neuropathic pain state is somewhat controversial, spinally administered morphine reversed the tactile allodynia in a previous animal study. Using a behaviorial test, we examined the involvement of serotonergic and adenosine receptors in the mechanism of the antiallodynic action of the intrathecal morphine by injection of serotonergic and adenosine antagonist in a rat model of neuropathic pain induced by a spinal nerve ligation. METHODS: Male Sprague-Dawley rats were prepared with a tight ligation of the left lumbar 5th and 6th spinal nerve and a chronic lumbar intrathecal catheter implantation. Morphine 1 microgram was administered intrathecally to attenuate the tactile allodynia. Methysergide 10 microgram and 30 microgram, theophylline 20 microgram was administered intrathecally before and after the injection of morphine in order to investigate the reversal of an increased allodynic threshold by morphine. The allodynic thresholds for the left hindpaw withdrawl to von Frey hairs were assessed and converted to %MPE. RESULTS: The tactile allodynic threshold was significantly increased by 1 microgram of intrathecal morphine (P < 0.05). Methysergide 10 microgram and 30 microgram, but not theophylline 20 microgram, reversed significantly the antiallodynic effect of intrathecal morphine in pre- and post-treatment (P < 0.05). CONCLUSIONS: The results suggested that the mechanism of tactile antiallodynia induced by intrathecal morphine appears to be mediated by serotonin receptor system at the spinal level in the rat model of spinal nerve ligation.
Adenosine ; Animals ; Catheters ; Hair ; Humans ; Hyperalgesia ; Ligation* ; Male ; Methysergide* ; Models, Animal ; Morphine* ; Neuralgia* ; Rats, Sprague-Dawley ; Receptors, Purinergic P1 ; Serotonin ; Spinal Nerves* ; Theophylline*

PURPOSE: Intravenous immunoglobulin (IVIG) is effective for the treatment of idiopathic thrombocytopenic purpura (ITP) in children. Recently, several reports have been published that show its impact on the absolute neutrophil count. The present study was performed to confirm these findings. METHODS: Data on 26 ITP patients were analyzed. Patients with febrile illness or increased C-reactive protein levels at presentation, which would influence the neutrophil counts, were excluded to determine the sole impact of IVIG. In addition, patients who received steroid treatment were also excluded. RESULTS: Sixteen boys and ten girls were analyzed. For patients who received an IVIG dose of 0.4 g/kg/day (n=17), the absolute neutrophil count (ANC) measured next day was significantly decreased. For patients who received an IVIG dose of 1 g/kg/day (n=9), the ANC measured the next day was also significantly decreased. However, the decrease was more profound in the high-dose group compared to the low-dose group. Among six cases with profoundly decreased ANC greater than 1,000/ mm3, four patients (67%) received IVIG at a dose of 1 g/kg/day. All four cases with increased ANC were treated with IVIG dose of 0.4 g/kg/day, and three cases (75%) among them had a febrile reaction during IVIG administration. None of the cases with decreased ANC had a febrile reaction. No cases had infectious complications reported. CONCLUSION: IVIG treatment for ITP patients appears to suppress the ANC. This decrease of ANC was more pronounced when a higher dose of IVIG was used. Some cases with increased ANC counts after IVIG use were found only in low-dose IVIG group, and was associated with febrile reactions during IVIG use.
C-Reactive Protein ; Child* ; Female ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Neutrophils* ; Purpura, Thrombocytopenic, Idiopathic*

PURPOSE: Although growth hormone treatment is now widely used to treat some group of children with short stature, it is still expensive and many parents are seeking alternative therapies. We report the current status of alternative therapies for children visiting the 'growth clinic' in a single tertiary center. METHODS: Questionnaire about the usage of alternative therapy was used. Parents were asked whether they used alternative therapies and where they achieved the information. Also, they were asked whether the treatment was effective, and whether they would continue to use the alternative therapy. RESULTS: Two hundred and twenty nine children (127 boys, 102 girls) visiting the growth clinic in Dongsan Medical Center from February 2005 to January 2006 were analyzed. Their ages were between 6.1 years to 15.4 years (mean 10.4 years). Height Standard Deviation Score (SDS) were between -3.2 to 1.0 (mean -1.1). Twelve boys (9.4%) and 7 girls (6.9%) were more than zero in height SDS value. Among 145 children (63.3%) who used the alternative therapy, supplemental foods and oriental herbs were most widely used (43.3% each) followed by over-the-counter drugs. They attained the information most frequently from their neighbors followed by television, newspaper, and internet. More than half (57.9%) of the parents answered that the alternative therapies were not effective. However, 46.9% of the parents answered they would continuously use the therapy though it is ineffective. CONCLUSION: Many patients visiting the 'growth clinic' for short stature had experiences on the alternative therapies. Although these therapies seemed not quite effective, many parents answered that they would continue alternative therapy.
Child ; Complementary Therapies ; Growth Hormone ; Humans ; Internet ; Periodicals ; Nonprescription Drugs ; Parents ; Surveys and Questionnaires ; Television

OBJECTIVE: The purpose of this retrospective study was to evaluate the incidence of deep vein thrombosis (DVT) in spinal cord injury (SCI). METHOD: We analyzed the incidence of DVT and factors that alter its risk in 263 SCI patients. The injury status of each SCI subject was categorized as either motor complete or motor incomplete and either quadriplegic or paraplegic. The cause of injury was categorized as either traumatic or nontraumatic. Duplex ultrasound was performed in the clinically DVT suspected patients. No patient had been started on anticoagulant prophylaxis prior to diagnosis of DVT. RESULTS: Fifteen patients (5.7%) had a diagnosed DVT and one patient (0.4%) had a diagnosed pulmonary embolism. Motor complete lesion and quadriplegic status were better predictors of DVT than motor incomplete lesion and paraplegic status. Cause of injury and existence of spasticity were not statistically correlated with the incidence of DVT. Accuracy of clinical diagnosis was 45.4%. All cases of the diagnosed DVT was located proximal veins (iliac and femoral veins). Ten of 15 DVTs (66.6%) were detected earlier than 2 months after SCI. CONCLUSION: Incidence of DVT in SCI patients were 5.7%. Motor complete lesion and quadriplegic status were suggested as significant predictors of DVT in SCI patients.
Diagnosis ; Humans ; Incidence* ; Muscle Spasticity ; Pulmonary Embolism ; Retrospective Studies ; Spinal Cord Injuries* ; Spinal Cord* ; Ultrasonography ; Veins ; Venous Thrombosis*

OBJECTIVE: To investigate the rates and mean duration of symptom recurrence after repeated radiofrequency thermocoagulations of the lumbar medial branch nerves for facet joint syndrome. METHOD: Medical records of 284 patients who had consecutive radiofrequency thermocoagulations for facet joint syndrome were reviewed. Responses of repeated radiofrequency thermocoagulations were compared with the initial radiofrequency thermocoagulation for mean duration of symptom recurrence and visual analogue scale (VAS). RESULTS: Forty-one (14.4%) among the patients who had radiofrequency thermocoagulation for facet joint syndrome were treated with additional radiofrequency thermocoagulation because of symptom recurrence. Thirty-seven patients were treated twice and four patients were treated three times. The mean duration of symptom recurrence of these patients was 7.3 months (2.3~12.3 months). Reduction of the VAS pain scores were significantly lower after repeated radiofrequency thermocoagulations compared with initial radiofrequency thermocoagulation (p<0.05). CONCLUSION: With well-defined diagnostic criteria for facet joint syndrome and a meticulous technique of radiofrequency thermocoagulation, radiofrequency thermocoagulation would be a useful treatment modality for patients with facet joint syndrome.
Electrocoagulation ; Humans ; Medical Records ; Recurrence ; Zygapophyseal Joint