The purpose of this study is to evaluate the results of bone graft or cement fill for tibial bone defect in total knee arthroplasty. 51 knee in 45 patients which had bone graft or cement fill for tibial bone defect of more than 1cm3 in total knee arthroplasty, between March, 1990 and July, 1994 at the department of Orthopedic Surgery in Hanyang University Hospital were followed for average 30 months. Bone grafts were performed in 33 knees and cement fills in 18 knees. The size of tibial defect was measured after removal of sclerotic and dense bone in the tibial plateau. The average size of tibial defect treated by bone graft was 4.9 cm3 in volume, 11 mm in height and the average size of tibial defects treated by cement fills was 1.5cm3 in volume, 6.8 mm in height. The results were as follows ; 1. In true A-P and lateral x-ray checked by fluoroscopic guide, trabecular union was seen in all 33 knees of bone grafts without collapse, loosening and bone resorption. In one of 18 knees of cement fill, radiolucent line was detected 2 mm in width between cement mantle and the adjacent tibial bone. In other 17 knees, radiolucent was seen 1 mm or less in width. 2. According to the system of Knee Society Score, average knee rating score was improved from 23.2 points preoperatively to 90 points postoperatively in bone graft cases, from 23.4 points preoperatively to 93.2 points postoperatively in cement fill cases. Average functional score was improved from 14.8 points preoperatively to 81.5 points postoperatively in bone graft cases, from 13.3 points preoperatively to 81.4 points postoperatively in cement fill cases. 3. Finally, we obtained the good results by cement fill during cement fixation of tibial component or bone graft without cement fixation of tibial component for small tibial bone defect and by bone graft for large tibial bone defect.
Arthroplasty, Replacement, Knee ; Bone Resorption ; Humans ; Knee ; Orthopedics ; Transplants

PURPOSE: This study compared the accuracy of an abutment-framework (A-F) taken with open tray impression technique combining cementon crown abutments, a metal framework and resin cement to closed tray and resin-splinted open tray impression techniques for the 3-implant definitive casts. The effect of angulation on the accuracy of these 3 techniques was also evaluated. MATERIAL AND METHODS: Three definitive casts, each with 3 linearly positioned implant analogs at relative angulations 0, 30, and 40 degrees, were fabricated with passively fitted corresponding reference frameworks. Ten impressions were made and poured, using each of the 3 techniques on each of the 3 definitive casts. To record the vertical gap between reference frameworks and analogs in duplicate casts, a light microscope with image processing was used. Data were analyzed by two-way analysis of variance and the Tukey test. RESULTS: The open tray techniques showed significantly smaller vertical gaps compare to closed tray technique (P < .05). The closed tray and the resin-splinted open tray technique showed significantly different vertical gaps according to the angulation of implant (P < .05), but the A-F impression technique did not (P > .05). CONCLUSION: The accuracy of the A-F impression technique was superior to that of conventional techniques, and was not affected by the angulation of the implants.
Crowns ; Light ; Resin Cements

It is notoriously difficult to obtain a sound bony union of congenital paeudarthrosis of tbe tibia with conventional methods. This paper is the results of using the free vascularized fibular graft for congenital pseudarthorsis of the tibia in 7 patients since 1978 in this hospital, which is the first attempt in Korea. During the follow-up periods from 9 months to 32 months, 5/7 patients(71%) had good or excellent bony union, 2 patients had bone resorption at tbe distal site of grafted bone and required a second supplementary cancellous bone graft with electrode insertion. So it is thought that the free vascularized fibular graft is one of good methods of treatment for congenital pseudarthrosis of the tibia.
Bone Resorption ; Electrodes ; Follow-Up Studies ; Humans ; Korea ; Pseudarthrosis ; Tibia ; Transplants

PURPOSE: The aim of this study was to determine whether liver resection treated by using laparoscopy is equally safe for patients who have benign liver mass, hepatolithiasis, hepatocellular carcinoma (HCC), or metastatic liver cancer. METHODS: We performed our study in 32 patients with the following conditions: 17 patients with IHD stones, 7 with HCC, 1 with cholangiocarcinoma, and 7 patients who had colon cancer with liver metastasis. On a retrospective bases, these patients were investigated for clinical history, type of operation, time for the operation, hospital stay, and post operative complications. RESULTS: The target age range was from 37 to 80 years and the mean age was 61.2 years old. The percentage of patients over 60 years old was 68.7%. According to their past history, 8 patients had experienced an upper abdominal operation. In our study there were 9 cases of left hepatectomy (28.1%), 9 cases of left lateral segmentectomy (28.1%), 2 cases of sectionectomy, and 12 cases of wedgeresection. The average operation time was 364+/-148 mins, the average bleeding amount was 417 cc, and the average hospital stay was 13.2 days. There were 8 cases (25%) of postoperative complications developed (2 bile leak, 1 intrabdominal abscess, 1 acute renal failure, 2 wound infection). All cases were improved with conservative management. And there was one case of remnant IHD stone, which had surgical treat and one patient had peritoneal carcinomatosis, who had laparoscopic liver resection for HCC. CONCLUSION: Our study showed that laparoscopic liver resection has advantages; it is less painful, causes a small operative scar, a the short period of hospital stay and has cosmetic benefits. In the future, laparoscopic liver resection could be an important option for the treatment of hepatolithiasis and HCC through improved surgical instrument and skill of operation.
Abscess ; Acute Kidney Injury ; Bile ; Carcinoma ; Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Cicatrix ; Colonic Neoplasms ; Cosmetics ; Hemorrhage ; Hepatectomy ; Humans ; Laparoscopy ; Length of Stay ; Liver ; Mastectomy, Segmental ; Neoplasm Metastasis ; Postoperative Complications ; Retrospective Studies ; Surgical Instruments

Purpose: This study was conducted to assess the antidepressant effects of capsaicin in chronic depressive rats and elucidate the mechanism underlying its effects. Methods: Male Wistar rats (280~320 g, 8 weeks of age) were subjected to depression induced by chronic unpredictable mild stresses. The rats were exposed to 8 kinds of stresses for 8 weeks. In the last 2 weeks, fluoxetine or capsaicin was injected subcutaneously. The dose of fluoxetine was 10 mg/kg (body weight), while the doses of capsaicin consisted of low (1 mg/kg), middle (5 mg/kg), and high (10 mg/kg). The forced swim test (FST) was conducted to evaluate the immobility time of rats. The immobility time indicates despair, one of symptoms of depression. The change of tryptophan hydroxylase (TPH) in the dorsal raphe was investigated using immunohistochemistry. In the hippocampus cornu ammonis (CA) 1 and 3, glucocorticoid receptor (GR) expression was measured. Results: The immobility time in the FST was significantly lower (p < .05) in the low-dose (M = 32.40 ± 13.41 seconds) and middle-dose (M = 28.48 ± 19.57 seconds) groups than in the non-treated depressive rats (M = 90.19 ± 45.34 seconds). The amount of TPH in the dorsal raphe was significantly higher (p < .05) in the middle-dose (M = 249.17 ± 35.02) and high-dose (M = 251.0 ± 56.85) groups than in the non-treated depressive rats (M = 159.78 ± 41.16). However, GR expression in the hippocampus CA1 and CA3 did not show significant differences between the non-treated depressive rats and the capsaicin-injected rats. Conclusion This study suggests that capsaicin produces an antidepressant-like effect on chronic unpredictable mild stress-induced depression in rats via the serotonin biosynthesis pathway.

STUDY DESIGN: A retrospective analysis of the results of various methodologies for the surgical treatment of an unstable burst fracture with posterior column injuries. OBJECTIVES: To compare the radiological and clinical results in unstable burst fractures, treated with various surgical methodologies (anterior, posterior and combined fusion), and to confirm their efficacy. LITERATURE REVIEW SUMMARY: Many authors recommended various surgical methods for the treatment of an unstable burst fracture, and of these, combined fusion is recommended for the preservation of stability. MATERIALS AND METHODS: A retrospective review of results was carried out on 22 patients, confirmed with an unstable burst fracture associated with a posterior column injury, between Nov. 1996 and Mar. 2003. The preoperative plane x-ray, CT and MRI, and the last postoperative follow up plane X-ray and CT, in 22 unstable burst fracture patients, were reviewed. The authors looked for laminar fracture, facet injury and inter-spinous widening in the plane x-ray, canal compromise on the CT, and a posterior ligament injury and dural tear on the MRI. The neurological injury was evaluated using the Bardford and McBride criteria and the clinical result with the Denis' pain and work scale. RESULTS: In the anterior fusion group, the radiological findings showed 3 laminar fractures, 2 facet injuries, 7 inter-spinous widening and 8 posterior ligament injuries. In the posterior fusion group, they showed 5 laminar fractures, 4 facet injuries, 5 inter-spinous widening and 5 posterior ligament injuries. In the combined fusion group, they showed 5 laminar fractures, 4 facet injuries, 4 inter-spinous widening and 5 posterior ligament injuries. The average canal compromise was 54.3% in cases of anterior fusion, 20.9% of posterior fusion and 74% of the combined fusion groups. A dural tear was found in 1 each of the anterior and posterior and 4 of the combined group. From the clinical results, improvements of the neurology in the anterior, posterior and combined groups were 2.0, 1.7 and 1.3 degrees, respectively. From the Denis' pain & work scale better than good degrees were shown in 3 of the anterior, 4 of the posterior and 2 of the combined groups. CONCLUSIONS: In conclusion, there were no differences in the improvements of the neurology and clinical results according to the surgical methodology employed. However, the use of combined fusion is recommended for the preservation of stability in an unstable burst fracture with combined posterior ligament and bony injuries as well as with severe canal compromise.
Follow-Up Studies ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Neurology ; Retrospective Studies ; Tears

STUDY DESIGN: A retrospective analysis of the results of various methodologies for the surgical treatment of an unstable burst fracture with posterior column injuries. OBJECTIVES: To compare the radiological and clinical results in unstable burst fractures, treated with various surgical methodologies (anterior, posterior and combined fusion), and to confirm their efficacy. LITERATURE REVIEW SUMMARY: Many authors recommended various surgical methods for the treatment of an unstable burst fracture, and of these, combined fusion is recommended for the preservation of stability. MATERIALS AND METHODS: A retrospective review of results was carried out on 22 patients, confirmed with an unstable burst fracture associated with a posterior column injury, between Nov. 1996 and Mar. 2003. The preoperative plane x-ray, CT and MRI, and the last postoperative follow up plane X-ray and CT, in 22 unstable burst fracture patients, were reviewed. The authors looked for laminar fracture, facet injury and inter-spinous widening in the plane x-ray, canal compromise on the CT, and a posterior ligament injury and dural tear on the MRI. The neurological injury was evaluated using the Bardford and McBride criteria and the clinical result with the Denis' pain and work scale. RESULTS: In the anterior fusion group, the radiological findings showed 3 laminar fractures, 2 facet injuries, 7 inter-spinous widening and 8 posterior ligament injuries. In the posterior fusion group, they showed 5 laminar fractures, 4 facet injuries, 5 inter-spinous widening and 5 posterior ligament injuries. In the combined fusion group, they showed 5 laminar fractures, 4 facet injuries, 4 inter-spinous widening and 5 posterior ligament injuries. The average canal compromise was 54.3% in cases of anterior fusion, 20.9% of posterior fusion and 74% of the combined fusion groups. A dural tear was found in 1 each of the anterior and posterior and 4 of the combined group. From the clinical results, improvements of the neurology in the anterior, posterior and combined groups were 2.0, 1.7 and 1.3 degrees, respectively. From the Denis' pain & work scale better than good degrees were shown in 3 of the anterior, 4 of the posterior and 2 of the combined groups. CONCLUSIONS: In conclusion, there were no differences in the improvements of the neurology and clinical results according to the surgical methodology employed. However, the use of combined fusion is recommended for the preservation of stability in an unstable burst fracture with combined posterior ligament and bony injuries as well as with severe canal compromise.
Follow-Up Studies ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Neurology ; Retrospective Studies ; Tears

STATEMENT OF PROBLEM: A new implant impression technique which use abutments as impression coping, and use resin cement as a splinting material was described. Accuracy of this technique was compared with conventional closed tray and resin splinted open tray technique for a 15degrees angled 3-implant model MATERIAL AND METHODS: A dental stone master model with 3 linearly positioned implant analogue and a reference framework which was passively fitted to it were fabricated. The center analogue was perpendicular to the plane of model and the outer analogues had a 15degrees angulation forward or backward. 10 closed tray impressions, 10 resin splinted open tray impressions, 10 abutment-resin framework cementation impressions and 10 abutment-metal framework cementation impressions were made with additional silicone material and poured with dental stone. A light microscope with image processing was used to record the vertical gap dimension between reference framework and analogue of duplicated cast made with each 4 impression techniques. Statistical analysis used one-way ANOVA with post-hoc tests Tukey test of .05 level of significance RESULTS: Significant difference in the vertical gap dimension was found between closed tray technique; 74.3 (+/-33.4)micrometer and resin splinted open tray technique, and two other new technique. (P>.05) Abutment-metal framework cementation technique;42.5 (+/-11.9)micrometer was significantly different from resin splinted open tray technique. (P<.05) Abutmentresin framework cementation technique;51.0 (+/-14.1)micrometer did not differ significantly from resin splinted open tray technique;50.3 (+/-16.9)micrometer. (P>.05) CONCLUSION: Within limitations of this study, the accuracy of implant level impressions of resin splinted open tray technique was superior to that of closed tray technique. A new technique using abutment and metal framework cementation was more accurate than resin splinted open tray technique.
Cementation ; Light ; Resin Cements ; Silicones ; Splints

BACKGROUND: Although a magnetic resonance imaging (MRI) is highly sensitive for changes associated with ischemic stroke, the detection of an acute ischemic lesion is usually impossible within 6 hours of the stroke onset on a conventional MRI. The perfusion MRI is a new imaging technique for diagnosing acute ischemic stroke. We evaluate the clinical usefulness of the perfusion MRI in predicting the final infarct extent in 18 patients with acute middle cerebral artery (MCA) territory ischemic stroke. METHOD: The perfusion MRI was performed within 6 hours after the stroke onset in all patients with a single-section dynamic contrast-enhanced T2*-weighted imaging in conjunction with a conventional routine MRI and MR angiography. Time-concentration curves and cerebral blood volume (CBV) maps were calculated from the dynamic MR imaging data by using numerical integration techniques. We compared findings of CBV maps with infarction on a follow-up CT or MRI. RESULTS: In 14 of 18 patients, the CBV in the occluded MCA territory were decreased. In the remaining 4 patients with a reversible ischemic neurologic deficit (RIND) or transient ischemic attack (TIA), the CBV were increased in 3 and normal in 1. Out of 14 patients with a decreased CBV, two had focal regions of increased CBV within the affected territory, indicating reperfusion hyperemia. The regions of increased or decreased CBV were eventually converted to infarction on follow-up images in all 14 patients. Out of 4 patients with RIND or TIA, one showed focal infarction in centrum semiovale on a follow-up image. CONCLUSIONS: The perfusion MRI was useful for the assessment of hemodynamic change about cerebral perfusion and may predict the extent of final infarction in acute MCA territory ischemic stroke. These results suggest that the perfusion MRI may play an important role in the diagnosis and management of acute ischemic stroke.
Angiography ; Blood Volume ; Diagnosis ; Follow-Up Studies ; Hemodynamics ; Humans ; Hyperemia ; Infarction ; Ischemic Attack, Transient ; Magnetic Resonance Imaging* ; Middle Cerebral Artery* ; Neurologic Manifestations ; Perfusion* ; Reperfusion ; Stroke*

No abstract available.
Cerebral Infarction