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

PURPOSE: To identify the four layers based on intranodular vascular nature visible in multiphase incremental bolus dynamic CT and to determine any differential points according to various factors of liver abscess with this vascular nature or not. MATERIALS AND METHODS: We categonized 29 cases of confirmed liver abscess into three different groups according to presence of four layers visible in early phase(arterial phase) of CT. Three groups were compared in regard to the results of antiamebic antibody test and bacteriologic study and presense of cholangitic abscess and internal septation. RESULTS: We could separate four layers, innermost hypodense central cavitary lesion, hyperdense granular tissue, hypodense abscess wall and outermost hyperdense compensatory hypervascular zone in 18 cases(62%), only two layers, cavity and wall in six cases(21%), and characteristically we could find three layers without innermost cavitary lesion in five cases(17%). But we couldn't find significant correlations between various clinical factors of liver abscess and our vascular groups. CONCLUSION: Our method of CT could represent four layers based on vascularity in 62% of cases. And also could find the unusual inflammatory mass containing three layer which must be differentiated from other malignant solid mass. But we couldn't find differential point between various clinical factor of liver abscess and imaging diagnosis. We think that with the improvement of hardware such as spiral CT, identification of four layers will be earier and will be very helpful in early detection and proper treatment planning of liver abscess.
Abscess* ; Diagnosis ; Liver Abscess* ; Liver* ; Tomography, Spiral Computed

Rheumatoid arthritis is a chronic inflammatory systemic disease of young or middle aged adults, characterized by destructive and proliferative changes in the synovial membrane, periarticular structures, skeletal muscle and perineural sheath. Eventually joints are destroyed, ankylosed and deformed. Therefore the aim of treatment is to keep the inflammatory process at a minimum, thereby preserving joint motion, maintaining health of muscles supplying motor power about the joint, and preventing secondary joint stiffness and deformity. Much of the increasing enthusiasm for surgical treatment of rheumatoid arthritis revolves around preventing the destruction of cartilage and tendon simply by excising as much as possible of the tissue that produces the destruction, namely the inflamed synovial membrane. Synovectomy probably is the earlient and most rewarding procedure that can be done in the treatment of rheumatoid arthritis. For the period of 11 yesrs from March 1966 to December 1977, 16 cases of rheumatoid knees were treated by synovectomy and the results of clinical observation was as follows. 1. Synovectomy was performed in 16 knees of 13 patients and 11 patients were followed up. 2. Of 13 patients, 10 patients were female and 3 patients were male. 3. Peak age incidence was in the third decade (38.4%) and the postoperative results were more satisfactory in younger patients than in older patients. 4. Post operative range of motion was not specifically correlated to the duration of symptom. 5. Postoperative results were not specifically correlated to the laboratory findings. 6. Postoperative range of motion was satisfactory in 6 cases and was unsatisfactory in 5 cases.
Adult ; Arthritis, Rheumatoid ; Cartilage ; Congenital Abnormalities ; Female ; Humans ; Incidence ; Joints ; Knee ; Male ; Middle Aged ; Muscle, Skeletal ; Muscles ; Range of Motion, Articular ; Reward ; Synovial Membrane ; Tendons

Revascularizations of 14 occlusive arterial diseases in the lower extremities with the Transluminal Endarterectomy Catheter was done successfully. The causes of occlusions were atherosclerosis in 9 cases and cardiogenic thromboembolism in 5 cases. The site of lesions were at the common femoral artery in 1 case, the superficial femoral artery in 6 cases and the popliteal artery in 7 cases. The length of the lesion were below 5cm(n=3), 5-10cm(n=2), 11-20cm(n=6) and 21-30cm(n=3). Complications were distal embolism(n=1) and hematoma at the puncture site(n=1). No symptoms recurred in any cases during 2 months -15 months followup. Endarterectomy with Transluminal Endarterectomy Catheter was found to be an effective method for revasculizations of occlusive arterial disease in the lower extremity, especially in long segmental occlusion.
Atherosclerosis ; Catheters ; Endarterectomy* ; Femoral Artery ; Follow-Up Studies ; Hematoma ; Lower Extremity* ; Methods ; Popliteal Artery ; Punctures ; Thromboembolism

No abstract available.
Female ; Ovulation* ; Pregnancy*

In treatment of infected ununited fractures of the tibia, We have solved this disastrous problems by posterior bone graft through posterolateral approach. By this posterior bone graft, We can achieve both bone union and infection contral simultaneously. The results were as follows: 1. Total cases of the infected ununited fractures were 17 cases, among them 16 cases were open fracture initially. 2. They occured more commonly in young adult, 7 cases(41%) were in 4th decade, and all cases were male. 3. Tibial union was achieved in 16 cases and one patient can not walk without brace due to ain on fracture site. 4. Infection was cleared in 16 cases, but one case had intermittent drainage of pus. 5. The most common complication was stiffness of the ankle and tarsal joint. 6. There was no infection in grafted bone.
Ankle ; Braces ; Drainage ; Fractures, Open ; Fractures, Ununited ; Humans ; Male ; Suppuration ; Tarsal Joints ; Tibia ; Transplants ; Young Adult

The methods available for arthroscopic debridement vary widely in cost and efficiency. The use of laser treatment is growing rapidly with advantages of production of smooth surface and avoidance of direct contact. Nevertheless, growing attention is directed to the negative side effects of laser-controlled cartilage ablation, especially to the depth effects of the various lasers on which various scientific studies have focused. The purpose of this study is to evaluate the thermal side effects of Ho: YAG laser and Excimer laser on human articular cartilage hy histological analysis. Sixteen human articular cartilages were obtained during total knee arthroplasty for patients with advanced degenerative arthritis. Three craters, 1cm in diameter, were created on each articular cartilage by shaver, Holmium: YAG laser and Excimer laser in the saline medium. These total 48 craters were prepared to tissue specimen by paraffin blocks and stained with Hematoxylin-Eosin(HE) and Massons trichrome. Under the light microscope, we analysed extents of thermal necrosis and thermal change in craters. Also some specimens were fixed by 2.5% glutaraldehyde and ohserved in changes of three different methods under scanning electron microscope. We report the results as follow: 1. The average times to making one crater were 25 seconds in shaver, 33 seconds in Holmium: YAG laser, and 65 seconds in Excimer laser respecti vely. 2. In gross inspection, the most smoothing surface of crater was seen on the specimens of Excimer laser. 3. In histological findings, thermal necrosis on hematoxylin and eosin sections was not noted after shaver use, whereas seen average of 243.8+/-159.6micrometer in Molmium: YAC laser and 36.6+/-17.1micrometer in Excimer laser(p=0.000). Thermal change on trichrome-stained sections was not noted after shaver use, hut showed average of 372.1 +/-203.1micrometer in Holmium: YAG laser and 76.0+/-47. Imicrometer in Excimer laser(p=0.000). 4. In scanning electron micrograph, coagulation of collagen fiher in the matrix was ohserved, with less extents in Excimer than Holmium: YAG laser. In conclusion, Excimer laser was superior to Holmium: YAG laser in terms of thermal necrosis and precision, whereas Holmium: YAG laser was more effective due to rapid time for procedure. To minimize the thermal necrosis during laser chondroplasty, we suggest it is desirable to less energy and reduce exposure time to laser beam on the articular surface.
Arthroplasty ; Cartilage ; Cartilage, Articular* ; Collagen ; Debridement ; Eosine Yellowish-(YS) ; Glutaral ; Hematoxylin ; Holmium* ; Humans* ; Knee ; Lasers, Excimer* ; Lasers, Solid-State* ; Necrosis ; Osteoarthritis ; Paraffin

We presented a 64-year-old man who complained sudden onset of ulnar sided wrist pain, paresthesia in ulnar aspect of left hand after swinging a golf club. The intermittent pain was not relieved by physical therapy, local injection and medication on local clinics. Physical examination revealed tenderness on the area of the hook of hamate and weakness on flexion of 5th finger in the left side. Plane X-ray and electrodiagnostic study did not show abnormal findings. Bone scan revealed increased uptake localized on left ulnar site of wrist joint. For proper diagnosis, MRI and carpal tunnel view of left wrist were performed and fracture of the hook of hamate was found. We reported a case of non-union of golf related fracture of the hook of hamate by delayed diagnosis with the review of literatures.
Delayed Diagnosis ; Diagnosis ; Fingers ; Golf* ; Hand ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Paresthesia ; Physical Examination ; Wrist ; Wrist Joint

Dural arteriovenous fistula (DAVF) of anterior cranial fossa is a rare entity. The authors report a 57 year-old man presented with retro-orbital headache caused by a large hematoma in the right frontal lobe. Angiography demonstrated a DAVF of anterior cranial fossa fed by branches of middle meningeal and anterior ethmoidal artery. Endovascular therapy using N-butyl cyanoacrylate was tried, however, was failed to occlude the fistula. After than, the lesion was successfully obliterated by surgical means. The therapeutic roles and pitfalls of endovascular treatment and surgical treatment for the anterior fossa DAVF are discussed.
Angiography ; Arteries ; Central Nervous System Vascular Malformations* ; Cranial Fossa, Anterior* ; Cyanoacrylates ; Fistula ; Frontal Lobe ; Headache ; Hematoma ; Humans ; Middle Aged

No abstract available.
Electroencephalography* ; Neuronal Ceroid-Lipofuscinoses ; Neurons*