Lumbar spinal stenosis is a common category of spinal disease in which a decrease in the volume of the spinal canal results in compression of the neural elements. Its pressure symptoms are characterized by vague back-pain and chronic sciatica. The goals of surgical treatment in lumbar spinal stenosis are the relief of pain and the preservation or restoration of neurologic function. Extensive laminectomy in lumbar spinal stenosis results in postoperative instability and postoperative vertebral subluxation with pain, restricted movement, and further neural compression occurs after decompressive laminectomy. Therefore internal fixation devices have been used in these circumstances to prevent postoperative instability while the fusion being consolidated. From February 1988 to October 1988, 36 patients of lumbar spinal stenosis had undergone operations with decompressive laminectomy and segmental spinal instrumentation with transpedicular screws at the department of Orthopaedic Surgery, Yonsei University College of Medicine. In 18 patients degenerative changes in lumbar spine were the principal aetiologic factor:7 patients had spondylolisthetic spinal stenosis:ll patients had combined spinal stenosis. All patients were followed up for periods varying between twelve and ninteen months. According to Kim's criteria, the postoperative results were as follows;excellent in 17 cases(47.2% ), good in 15 cases(41.7% ) and fair in 4 cases(11.1% ). The study revealed that segmental spinal instrumentation with transpedicular screws provided a rigid fixation, early ambulation, minimal fusion and reducing of recovery period were possible. In conclusion, segmental spinal instrumentation with transpedicular screws is a good and reliable method of stabilization after extensive decompressive laminectomy.
Early Ambulation ; Humans ; Internal Fixators ; Laminectomy ; Methods ; Sciatica ; Spinal Canal ; Spinal Diseases ; Spinal Fusion ; Spinal Stenosis ; Spine

No abstract available.
Bone Morphogenetic Proteins*

STUDY DESIGN: This study is a retrospective evaluation of the high lumbar disc herniations. OBJECTIVE: The purposes of this study is to observe the clinical and radiological findings and out-comes of the high lumbar disc herniations, thus providing a guideline for making diagnosis and for proper treatment modality. SUMMARY OF LITERATURE REVIEW: High lumbar disc herniations at the L1 -2, L2-3 and L3-4 levels represent less than 5% of all disc herniations. The location of pain was highly complected. The represented symptoms and signs such as motor, sensory and reflex changes were variable and potentially misleading in suggesting a level of the disc herniation. MATERIAL AND METHODS: Thirty-one patients with high lumbar disc herniations were retrospectively evaluated. Seventeen patients were treated conservatively and fourteen patients underwent surgery. Review of results was undertaken by an independent observer using a proven outcome assessment measure. RESULTS: The incidence of high lumbar disc herniation is 4.7%(L1-2: 13%, L2-3: 29%, L3-4: 58%) with declining frequency as the level ascends. The peak age incidence is 6th decade in male and 5th decade in female. The positive rate of femoral nerve stretching test(74%) is higher than that of straight leg raising test(51%). In fourteen operative cases, the positive rate of straight leg raising test is 86%. The accuracy of MRI findings in predicting the type of herniated disc is 93%. In results of operation thirteen cases showed more than fair grade(93%). CONCLUSION: The age incidence of the high lumbar disc herniation is older than that of the lower lumbar disc herniation. The femoral nerve stretching test is more useful than straight leg raising test in making diagnosis of high lumbar disc herniations. The prognosis after treatment is comparable with high lumbar disc herniations.
Diagnosis ; Female ; Femoral Nerve ; Humans ; Incidence ; Intervertebral Disc Displacement ; Leg ; Magnetic Resonance Imaging ; Male ; Prognosis ; Reflex ; Retrospective Studies

We have analysed 13 patients with malignant obstructive jaundice due to metastasis who were treated with local radiation therapy to the area of porta hepatis at the Radiation Therapy Department of Paik hospital attached to the Inje University between 1984 and 1988. A good response was observed in 6 out of 7 evaluable paitens receiving a total radiation dose ranging from 2600 to 5480 cgy in 2.6 to 6 weeks. A complete response was noted in 5 patients, a partial response in 1 patient, and no response in 1 patient. The overall median survival for 13 patients was 3 months. But two patients lived more than a year without recurrence of jaundice. Moderate dose, localized field radiation therapy appears to the beneficial in relieving obstructive jaundice and gives a good symptomatic relief.
Humans ; Jaundice ; Jaundice, Obstructive* ; Neoplasm Metastasis ; Recurrence

PURPOSE: This study describes the CT and MR findings of mucoceles occurred in the post-operative maxillary sinuses. MATERIALS AND METHODS: CT and/or MR of 19 maxillary mucoceles in 16 patients who had been operated by CaldwelI-Luc procedure were reviewed. CT scans were performed after contrast enhancement in axial and coronal planes with 5mm thickness. Three cases were studied with a 2.0 T or 0.5 T MRI, which demonstrated multi-compartment lesions. RESULTS: The lesions were bilateral in 3 cases. Compartmentalization of the antral cavity was seen in 7 out of 19 involved sinuses. Surgical bone defect of the anterior wall was the most frequent route of extension (11 cases) and extension into the infratemporal fossa with erosion of posterolateral wall was seen in 7 lesions. In 6 cases, the lesions involved orbit. The expansile and erosive bone changes were localized in every case. In one case with multi-compartment lesion, both T1- and T2-weighted MR images showed different signal intensities in each compartment which represented different protein concentration. CONCLUSION: Post-operative maxillary mucocele showed CT findings of localized erosion and bulging most frequently at the anterior wall in which the bone windows were made during the previous surgery. Post-operative compartmentalization of maxillary antrum may cause eccentric expansion of mucocete and each compartment may show different signal intensities on MR.
Humans ; Magnetic Resonance Imaging ; Maxillary Sinus* ; Mucocele* ; Orbit ; Tomography, X-Ray Computed

The changes in the surface of articular cartilage of femoral condyle from rabbits were evaluated after degenerative changes were made by the technique advocated by Hulth. The medial collateral and both cruciate ligaments were excised, and a medial menisectomy was done. Then the right knee joint was injected with 1 ml of Na-hyaluronate gel every two weeks. The animals were sacrificed at two, four, six, eight, or sixteen weeks postoperatively. After sacrifice, the medial femoral condyle was excised and prepared for the light microscopic and scanning electron microscopic study. At eight to sixteen weeks, there were chondrocyte clones with clefts to the radial zone and increased loss of the height of articular cartilage on the control side; but, on theexperimental side there was a significant delay and lessening of the arthriticresponse. The biocompatibility and the protective effect of joint degeneration of this device make this material a valuable adjuvant in the treatment ofosteoarthritis and the traumatized joints.
Animals ; Cartilage, Articular/drug effects/ultrastructure ; Disease Models, Animal ; Gels ; Hyaluronic Acid/*therapeutic use ; Knee Joint/drug effects/ultrastructure ; Microscopy, Electron, Scanning ; Osteoarthritis/*prevention & control ; Rabbits ; Support, Non-U.S. Gov't

No abstract available.
Spinal Stenosis*

No abstract available.

Since the nose is the most prominent part in the face, the plastic surgeons are interested in the continued effort for rhinoplasty. Nasal tip projection is essential to optimal nasal for the patient's face. But, the nasal tips of Orientals are characterized by bulbous appearance due to thick and tense skin, flaring of nostril. and restriction of nasal tip projection due to underdevelopment of medial crus of alar cartilage and short columella. Most orientals want to correct their nasal tip as well as shape of nose. We present clinical cases of various nasal tip deformities which were corrected with various operative methods through either alar rim incision of open rhinoplasty incision depending upon the severity of tip deformity in order to achieve more natural tips and good nasal tip projection. And the clinical cases were categorized into causes of nasal tip deformity and methods of nasal tip augmentation. We are reporting these reporting these cases with review of literatures.
Cartilage ; Congenital Abnormalities ; Nose ; Rhinoplasty ; Skin ; Transcutaneous Electric Nerve Stimulation

BACKGROUND: Epidermolytic palmoplantar keratoderma (EPPK) is an autosomal dominant disease of cornification which presents as severe thickening of the palms and soles with prominent epidermolytic hyperkeratosis pathologically. Recent studies have shown that EPPK is caused by mutations in the keratin 9 (K9) gene which is expressed essentially only in the palms and soles. Previously, We have reported that patients in one large pedigree of EPPK have an R162W substitution in the K9 protein. In this pedigree, two women whose husbands are both EPPK patients had become pregnant. OBJECTIVE: Since both women were concerned about this genetic disorder, we have performed prenatal diagnosis by biopsy analysis of chorionic villi tissue. METHODS: Chorionic villi biopsies were performed at 12 weeks gestation. Since the skin lesions are strictly confined to the palms and soles of the babies, the prenatal diagnosis of EPPK by ultrastructural analysis of fetal skin biopsy or amniotic fluid cells is highly problematic. Polymerase chain reaction amplification of specific allele (PASA) assay and direct DNA sequencing analyses were performed whether the fetuses carried mutant allele of K9 gene. RESULTS: PASA assay and direct DNA sequencing analyses showed that one fetus was normal, but the other fetus carried the abnormal allele. Subsequently, the mother of the unaffected fetus delivered a normal child, but the mother of the affected fetus terminated the pregnancy. CONCLUSION: We describe the analysis of the K9 mutation in the two fetuses at risk for EPPK. We believe that this is the first report of prenatal diagnosis for EPPK. But, we have to think about the ethical problems before we decide to perform the prenatal diagnosis of any kind of skin diseases.
Alleles ; Amniotic Fluid ; Biopsy ; Child ; Chorionic Villi ; Chorionic Villi Sampling ; Female ; Fetus ; Humans ; Hyperkeratosis, Epidermolytic ; Keratin-9 ; Keratoderma, Palmoplantar, Epidermolytic* ; Mothers ; Pedigree* ; Polymerase Chain Reaction ; Pregnancy* ; Prenatal Diagnosis* ; Sequence Analysis, DNA ; Skin ; Skin Diseases ; Spouses