Double-contrast arthrography of the knee, that is roentgenographic examination of the supporting structures of the knee joint with the aid of the radiopaque dyes, has been utilized infrequently until recent years in our country. A growing appreciation of the advantages of arthrography, increased experience with the technique, and an increasing ability to interprete the arthrogram have led to more frequent use of this diagnostic aid. Double-contrast arthrography of the knee is of particular value in the examination of the patient with an atypical history of in jury and unusual physical findings, or in the individual with an acute injury who cannot tolerate a manipulative physical examination. Its use has led to greater diagnostic acumen prior to operative intervention and in many cases has aided the orthopedic surgeon in determing whether or not surgery indicated and in surgical exploration. And its accuracy of the diagnosis of the meniscus tear has been very high, greater than 90% in many series. The followings are summary of result; 1) Double-contrast arthrography of the knee is a valuable diagnostic procedure. 2) Prolonged observation and procrastination in the treatment of patients with symptomatic knees could be avoided. 3) There were no complications of arthrography and all patients returned to work immediately after the procedure. 4) In this series, 2 cases out of the 6 cases of the torn lateral meniscus were not demonstrated correctly by arthrography. From this result, it is suggested that the interpretation of arthrographic findings is somewhat difficult at present time. In future, further experience and study for arthrography is demanded for more accurate interpretation of the conditions of the structures of the knee joint and also is desired to compare with the arthroscopic findings.
Arthrography ; Coloring Agents ; Diagnosis ; Humans ; Knee ; Knee Joint ; Menisci, Tibial ; Orthopedics ; Physical Examination ; Tears

Flexor tendon injuries of the “no man's land”(Zone2) in the hand have long been considered one of the problem areas for hand surgeons because of the frequently unsatisfactory result of treatment. Two-stage tendon reconstruction using the silicone rod prosthesis is one of the recent valuable procedures for management of severely damaged hand. From Aug. 1977 to Jun. 1978, the authors performed this procedure using “Hunter Silicone Rod” on 4 cases of flexor tendon injuries accompanied by deep cicatrix of soft tissue and stiffness of finger joints. The follow-up results were excellent in 3 cases out of the 4, and poor in the remaing case which had marked wound infection and stiffness of finger joints.
Cicatrix ; Finger Joint ; Follow-Up Studies ; Hand ; Prostheses and Implants ; Silicon ; Silicones ; Surgeons ; Tendon Injuries ; Tendons ; Wound Infection

Deep vein thrombosis(DVT) after joint arthroplasty in tbe lower extmmity has been one of the major causes of death in postoperative complications. But, there is little information on incidence and clinical risk factors of DVT in Korea. Fifty-eight patients (sixty-two cases) who underwent TKR were included in this study for evaluation of the incidence of DVT and correlation with clinical risk factors after total knee replacement(TKR) in Korea. Venography were performed preoperatively and postoperatively, and clinical risk factors were examined. The preoperative venography was performed within seven days before the surgery, and postoperative venography seven to 14days after the surgery. There was no evidence of thrombosis in any patient preoperatively, but thrombi were observed in seven cases (11%) postoperatively. Six cases showed thrombi in the calf vein and one case showed thrombi in the femoral vein. There was no statistically significant difference in incidence rate of DVT according to clinical risk factors such as age, toumiquet time, BMI(body mass index), diastolic blood pressure, operation time and coagulation assay(platelet, PT, aPTT, Anti-thrombin III, fibrinogen).
Arthroplasty ; Arthroplasty, Replacement, Knee* ; Blood Pressure ; Cause of Death ; Femoral Vein ; Humans ; Incidence* ; Joints ; Knee ; Korea ; Phlebography ; Postoperative Complications ; Risk Factors* ; Thrombosis ; Veins ; Venous Thrombosis*

PURPOSE: Deep vein thrombosis (DVT) after joint arthroplasty in the lower extremity has been a major cause of death postoperatively. However, there is few reports on incidence and risk factors of DVT in Korea. We evaluated the incidence of DVT, correlation between the DVT, and risk factors and effectiveness of color doppler ultrasonography for diagnosis of DVT after joint arthroplasty in the lower extremity. MATERIALS AND METHODS: One hundred and six cases (99 patients) of total hip or knee arthroplasties from March 1996 to August 1997 were included in this study. There were forty-four total hip arthroplasties and sixty-two total knee arthroplasties. No patients received prophylactic agents for DVT. Venogram and color doppler ultrasonogram were obtained within 7 days preoperatively and in 7 to 14 days postoperatively. Only venography was performed in 45 cases and both venography and color doppler ultrasonography were performed in 61 cases. RESULT: On venogram, there were no evidence of thrombi in all cases preoperatively but thrombi were observed in 9 cases (8.5%) postoperatively. Among these positive cases, eight cases showed thrombi in the calf vein and one case in the femoral vein. Color doppler ultrasonography could not detect any thrombi among 3 cases which had positive findings with venogram. In contrast to other reports, we did not identify a correlation between DVT and so-called risk factors such as age, tourniquet time, BMI (body mass index), diastolic blood pressure, operation time and coagulation assay (platelet, PT, aPTl, Anti-thrombin III, fibrinogen) CONCLUSIONS: We concluded that color doppler ultrasonography may not be an effective method in the diagnose is of DVT of calf vein in asymptomatic patients and that so-called risk factors had no relation to DVT.
Arthroplasty* ; Blood Pressure ; Cause of Death ; Diagnosis ; Femoral Vein ; Hip ; Humans ; Incidence ; Joints* ; Knee ; Korea ; Lower Extremity* ; Phlebography* ; Risk Factors ; Tourniquets ; Ultrasonography ; Ultrasonography, Doppler, Color* ; Veins ; Venous Thrombosis*

Anterior mediastinal teratoma was removed from the right hemithorax of a 15-year-old male patient presenting initially with right chest discomfort and hemoptysis. He was died following precipitous clinical deterioration, 2 months after open thoracotomy. The true malignant nature of this tumor, that there are endodermal sinus tumor and squamous cell carcinoma, was apparent on resection specimen. The former had metastasized to right supraclavicular lymph node. A similar case has not been reported previously on the review of the pertinent literature on malignant mediastinal teratoma.
Male ; Humans

Lipid cell tumors of the ovary are among the rarest of the functional ovarian neoplasms. Recently, authors experienced a case of lipid cell tumor of the left ovary in a 19 year old female, who presented with amenorrhea and hirsutism for 4 years. Grossly, the ovary was well encapsulated, and measured 6.5x6x4.5 cm. Cut surface show homogenous yellowish bulging neoplastic tissue and peritheral displaced normal ovarian tissue. Microscopically, neoplastic cells were composed of rounded and polyhedral cells, arranged in nests seperated by rich vascular networks. On the basis of the author's findings and the evidence available in the literature, we determined this case as ovarian lipid cell tumor.
Female ; Humans

A 55 year old male complain right shoulder pain and right upper quadrant pain about three months. He was a heavy alcoholism. Highly selective angiography, CT scan and operation findings suggest primary malignant neoplasm of the liver. Right hepatic lobectomy and partial diaphragmectomy was done under impression of heaptocellular carcinoma. The specimen measured 15x11x9 cm and disclose relatively hard and nodular mass devoid of cirrhotic changes. Cut surface show unilobar large mass measuring 11x8x6 cm and bearing brightly yellow discoloration and multifocal hemorrhagic necrosis. Histological characteristics were diffuse proliferation of large neoplastic cells with ample cytoplasm, containing granular materials, erythrophagocytosis, neutrophagocytosis and hemosiderin pigments. Atypical and bizarre mitosis and multinucleated giant cells bearing abundant erythro and neutrophagocytosis were frequently seen. The large or vesicular nuclei were irregular, with occasional deep indentations and revealed sharply defined nuclear membrane, coarse chromatin and conspicious nucleoli. Ultrastructurally the cytoplasm of neoplasltic cells had lysosomal granule, phagolysosome, phagocytized material and residual bodies. Immunohistochemical stains for alpha 1-antitrypsin, alpha 1-antichymotrypsin, vimentin and lysozyme showed positive reactions, but, alpha fetoprotein, cytokeratin, S-100 protein, factor VIII, complement 3 receptor and carcinoembryonic antigen were negative. Alpha-naphtyl acetate esterase activity in paraffin embedded tissue ribbon showed negative reaction. These findings show compatible with primary malignant lymphoma, true histiocytic type, (histiocytic sarcoma, Kupffer cell carcinoma) of the liver.
Male ; Humans

Treatment of unstable cervical spine fracture by skull traction is time consuming procedure, and treatment by Halo appratus has many advantages but it is very expensive. Bone cement has been applied occasionally as an adjunct to metallic internal fixation in treating patient with malignancy, i.e. limited life expectancy. Internal fixation with bone cement in addition to routine posterior fusion with bone graft is tried eliminate the need of application of complicated external immobilization in treating unstable cervical spine fracture of young patient. We experienced two cases of posterior cervical fusion using bone cement with satisfactory results. The advantages of this method are: 1. Rapid and solid fixation 2. Early ambulation 3. Reduce complicated external support 4. Reduce the date of hospitalization.
Early Ambulation ; Hospitalization ; Humans ; Immobilization ; Life Expectancy ; Methods ; Osteotomy ; Skull ; Spine ; Traction ; Transplants

Bone substitutes are being used increasingly in bony surgery as more than two million bone grafts are performed worldwide per year. Autobone grafts represent the gold standard for bone grafting, but morbidity and limited availability are the main problems. Allobone grafts are osteoconductive, but there are still concerns regarding the infection risks, costs, and donor availability issues. As an alternative, widely used ceramic-based synthetic bone substitutes are based alternatively on calcium (hydroxyapatite, tricalcium phosphate, calcium sulfate, calcium phosphate). Ceramic-based bone substitutes are osteoconductive, but they are weaker than cortical bone and are not osteoinductive. Bone morphogenic protein, demineralized bone matrix, and platelet-rich plasma are used to obtain an osteoinductivefunction. Recently, cell-based and gen-based bone substitutes were developed and studied. This paper reviews the basic information and the latest concepts on bone grafts and bone substitutes.

In the present study, the effect of primary infection to reinfection with Ascaris suum larvae was experimented in mouse model. Mice were challenged with l,000 infective stage eggs of Ascaris suum. The embryonated eggs were directly introduced into stomach of mice. Reinfection was performed at 50 days after the primary infection with same method as primary infection. Mice were sacrificed 3, 5, 7, 10, 15 and 20 days after infection in both groups respectively. Larvae collected from livers and lungs with Baermann's apparatus were enumerated and measured after sacrifice. Sera of mice were also collected at same time. The results of the experiment were as follows: With antigen prepared from coelomic fluid of adult Ascaris suum and sera collected from mice before reinfection, the production of antibody in experimental mice was confirmed by the gel-diffusion technique. In the livers of reinfected mice, the larvae were recovered up to 10 days after challenge, otherwhile in the primary infected mice, the larvae were observed up to 7 days. The maximum number of larvae were observed in the lungs of primary infected mice on 10 days after inoculation. In the lungs of reinfected mice, maximum number of larvae were recovered on 7 days after, only few larvae were recovered on 10 days after reinfection. As regards the growth of the larvae, the third stage larvae, over 500 micrometer in length, appeared in livers at 5 days after reinfection, but it couldn't be found on 7 days and 10 days after challenge. The third stage larvae continuously developed were observed in lungs of mice from 5 days after reinfection. In conclusion, it was found that development of larvae in livers of immune mice were probably repressed by the immune mechanisms being rised in livers and defence mechanism is also acting by interfering with the process of larval penetration into the lung from the liver.
parasitology-helminth-nematoda ; immunology ; Ascaris lumbricoides ; mouse