The head patient with musculoskeletal trauma is a challenge to the orthopedic surgeon and its incidence is increasing markedly with the development of modern culture and a high velocity motor vehicle. So, for the purpose of studying the difference between lower extremity fracture concomitant with head injury and only lower extremity fractured patients, we studied the radiologic bone union time, serologic test and heterotopic ossification. For the control group we analysed each 10 patients of only femur and tibia fractures. The following clinical results were obtained by analysis of 46 patients of lower extremity fracture concomitant with head injury, experienced in the Department of Orthopedic Surgery, Yonsei University College of Medicine in past 5 years from Jan. 1980 to Dec. 1984. 1. The mean age was 24.5 yrs old (2~6 yrs old) and the prevalent age was 1st and 3rd decade, and the sex ratio between males and females was 2.8: l. 2. The most common mode of injury was auto-pedestrian injury (84.8%) and the other was falling down injury(15.2%) . 3. The common brain injuries were cetebral contusion with skull fracture (37.0%) and cerebral contusion only(34.8%) . Among 26 patients whos mental states were not alert, 23 patients recovered mental states completely. 4. Serum Calcium, Phosphate, and Alkaline Phosphatase level were no difference between the head injury with lower extremity fractured patients and only lower extremity fractured patients. 5. There were no evidence of early bony union in the patients with head injury. 6. The formation of callus were abundant in the patients of lower extremity fracture with head injury rather than the only lower extremity fractured patients. 7. The incidence of heterotopic ossification was 10.9% and all patients with heterotopic ossification were treated with physiotherapy and all patients recovered fully. 8. The incidence of complication was 17.3% and there was no fat embolic patients. In conclusion, there was no evidence of early bony union, but the callus formation was abundant in the patients of lower extremity fracture concomitant with head injury.
Accidental Falls ; Alkaline Phosphatase ; Bony Callus ; Brain Injuries ; Calcium ; Clinical Study ; Contusions ; Craniocerebral Trauma ; Female ; Femur ; Head ; Humans ; Incidence ; Lower Extremity ; Male ; Motor Vehicles ; Orthopedics ; Ossification, Heterotopic ; Serologic Tests ; Sex Ratio ; Skull Fractures ; Tibia

We performed 75 cases of daryocystorhinostomy from Jan. 1988 to Dec. 1990. A routine dacryocystography was performed prior to operation in all cases. A modified T oti's method was applied as a surgical technique "H" shaped incision was done. Both anterior and posterior flaps were sutured adequately and vaseline guaze was used as a plugging agent for 7 to 10 days Success was achieved in 72(96.0%) of 75 cases. The causes of 3-failures were organized granulation tissue and trauma.

No abstract available.
Anterior Cruciate Ligament* ; Patellar Ligament*

The increased incidence of the trochanteric fracture of the femur was accompanied by the development of the vehicle and the prolongation of the average life-span. Recently it has been also increased in an active person from thirties to forties. 87 cases of the trochanteric fracture of the femur in 86 patients who have been admitted and treated at the Department of Orthopedic Surgery of Hanyang University Hospital during 8 years and 10 months, from May, 1972 to February, 1981, were reviewed. The results of this study were as follows: 1. The trochanteric fracture of the femur was more common in male and was frequent in a person who was from thirties to forties and who had vigorous social activity. 2. An injury from traffic accident was the most common cause of the fracture from thirties to forties and an injury from slip down was most common in seventies. 3. The unstable fracture which was classified by Evans' classification, Boyd and Griffin Type II Fx. and Tronzo Type III Fx. were most common in the intertrochanteric fracture and the Fielding Type II Fx. was most common in the subtrochanteric fracture of the femur. 4. Other injuries were accompanied by the trochanteric fracture of the femur in 38 patients (44.2%) and the pelvic bone fracture was the most common associated injury in these patients. 5. The weight bearing was allowed earlier in the patient who had been given the surgical Tx. than in the patient who had been given the conservative Tx. 6. In adults, there was no significant differences in the duration to achieve the bony union between the conservative treatment and surgical treatment performed. 7. We considered that the diminution of the probable complications by early weight bearing after accurate open reduction in accordance with the Type of the Fx. followed by secure internal fixation with devices is an ideal method of the Tx.
Accidents, Traffic ; Adult ; Classification ; Clinical Study ; Femur ; Hip Fractures ; Humans ; Incidence ; Male ; Methods ; Orthopedics ; Pelvic Bones ; Weight-Bearing

Purpose: To evaluate the risk factors for the development of osteonecrosis in civilian professional divers by an epidemiologic study and to determine the correlation between osteonecrosis in divers and coagulopathy by analysis of serologic markers that are related to thrombophilia and hypofibrinolysis. Materials and Methods: Forty-two divers, who collected pen shells (Atrina pinnata), and among whom 10 had osteonecrosis (group 1), were compared with 32 divers without osteonecrosis (group 2). Both groups were evaluated based on the number of years of diving experience, number of dives per year, mean number of dives per day, mean diving time and depth, and diving methods. We determined any statistically significant differences among these variables. We measured the levels of serologic markers that were related to hyperlipidemia, thrombophilia, and hypofibrinolysis from the divers and a control group of 20 physicians (group 3). The levels of the serologic markers were compared between groups 1 and 2 and between the divers and the control group, in order to determine the relationship between the serologic markers and the development of dysbaric osteonecrosis. Results: None of the variables demonstrated any statistically significant differences, except for the mean diving time, in which group 1 had a mean diving time of 124 minutes and group 2 had a mean diving time of 62.1 minutes (P<0.05). In the analysis of the serologic markers, there were no statistically significant differences between groups 1 and 2; however, in comparison with the group 3, the divers demonstrated significantly decreased activity levels of proteins C and S (Protein C: P<0.05; Protein S: P<0.05), and an increase in the levels of plasminogen activator inhibitor-1 (PAI-1) (P<0.05). Conclusion: The divers with osteonecrosis had a longer mean diving time than did those divers without osteonecrosis. In the serologic marker analysis, the divers with osteonecrosis demonstrated significantly decreased activity levels of Proteins C, S and a significant increase in the levels of PAI-1, compared with the control group.
Biomarkers* ; Diving ; Epidemiologic Studies* ; Epidemiology ; Hyperlipidemias ; Osteonecrosis* ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Protein S ; Risk Factors ; Thrombophilia

The developement of squamous cell carcinoma from the draining sinus of chronic osteomyelitis has long been recognized as a rare and late complication. The mode of developement of carcinoma at the site of chronic osteomyelitis is not well understood. This, however, is chiefly a disease of middle aged men, and tibia is the most common site. There are two types in this carcinoma; superficial and deep types. In the superficial type obvious presence of fungaiing growth makes diagnosis simple and easily confirmed by biopsy. In the deep type the diagnosis is difficult clinically, but the features most frequently described are an increase in pain and discharge with swelling and hemorrhage. Amputation at the adequate level is the treatment of choice. Three cases of the disease involving one left femur, and two left tibiae are reported with review of literature.
Amputation ; Biopsy ; Carcinoma, Squamous Cell ; Diagnosis ; Epithelial Cells ; Femur ; Hemorrhage ; Humans ; Male ; Middle Aged ; Osteomyelitis ; Tibia

STUDY DESIGN: The authors reviewed 14 patients with neurologic deficits caused by ossification of ligamentum flavum(OLF) of thoracic and thoracolumbar spine. OBJECTIVE: To evaluate the clinical and roentgenographic characteristics and suggest the treatment method of the OLF in the thoracic and thoracolumbar spine. SUMMARY OF LITERATURE REVIEW: The reported OLF mainly developed at the thoracolumbar area. It compressed the spinal cord and resulted to the symptoms of thoracic myelopathy. The methods of treatment were posterior decompression including laminectomy or laminoplasty, and sometimes anterior and posterior decompression, with or without fusion. The OLF was not common disease yet and many surgeons have met a problem in making the decision of the extent of posterior decompression multiple or selective. METHODS: The authors reviewed 14 patients with the OLF using clinical reports and roentgenographic studies. We checked the plain roentgenograms, computed tomograms, and magnetic resonance imagings. We performed the posterior decompression using total laminectomy without fusion. We divided three groups according to the operative methods. Group I included the patients with one or two levels of OLF treated with posterior extensive laminectomy. Group II included the patients with OLF in three or more levels, or combined other cord-compressing diseases. They had been treated with multiple posterior or anterior decompression for the entire cord-compressing levels. Group III included the patients with same conditions as group II but they had been treated with selective decompression for the mainly symptomatic levels of OLF. RESULTS: We found the OLF at 54 segments of 14 patients. The involvement of OLF was 29 segments(53.7%) in thoracolumbar and 25 segments(46.3%) in thoracic area. The most commonly involved segment was T10-11(16.7%) and the second was T11-12(14.8%). Clinically the most common neurologic deficit was motor weakness and sensory deficit. The most symptomatic level of OLF was T10-11 and T12-Ll segment(28.6% at each) and the next was T11-12 segment(21.4%). We got the favorable results in group I and group III. But the final results of group II were not good. CONCLUSION: The OLF was most common at the thoracolumbar area and the symptoms and signs were revealed same as those of the thoracic myelopathy. We obtained favorable clinical results after posterior laminectomy without fusion in cases with the OLF in 1-2 segments. In the cases with multiple OLF in three or more segments, or the cases with other cord-compressing diseases, we could get more favorable results in the patients with the selective decompression than the patients with multiple decompression for the entire cord-compressing diseases.
Decompression ; Humans ; Laminectomy ; Ligamentum Flavum* ; Neurologic Manifestations ; Spinal Cord ; Spinal Cord Diseases ; Spine*

Mucocele of the appendix is uncomrnon and rarely diagnosed preoperatively. The malignant rountpart-i.e. mucinous cystadenocarcinoma--has the same grross appearance and many micro scopic features in cornmon wilhe the benign form. It rnay be associated with ovarian mucinous cystadenoma of strikingly similar microscopic appearence. A serious complication is a rupture of the mucoeele resulting in pseudomyxoma peritonei. Each case of benign and malignant mucocelr of the appendix falsely diagnosecl as an oovarian tumor before laparotxumy are presented wilh a brief rieview of the literatures.
Appendix* ; Cystadenoma, Mucinous ; Mucins ; Mucocele* ; Pseudomyxoma Peritonei ; Rupture

PURPOSE: The goal of intermittent androgen deprivation (IAD) therapy in prostate cancer patients is to delay the disease progression and improve the survival rate. Therefore, the duration of off-treatment is very important for the effective treatment outcome of IAD. We analyzed factors that influence the duration of off-treatment in IAD. MATERIALS AND METHODS: We reviewed the medical records of 45 patients with prostate cancer who had completed at least 1 cycle of IAD. Uni- and multi-variate tests were used to determine the factors, which are predictive to the duration of off-treatment. These factors included: the patient's age, biopsy Gleasons score, initial PSA, presence of bone metastasis, PSA levels at 3 months following on-treatment and at 3 months following off-treatment, and the duration of on-treatment. RESULTS: The average follow up duration was 34 months (15-71 months). The average off-treatment duration of each cycle was 11.1 (4-40), 7.5 (4-14), and 5.6 (3-10) months for the 1st, 2nd and 3rd cycles, respectively. Independent factors associated with the extension of duration of off-treatment, by univariate tests, included: initial PSA value, PSA values at 3 months following on-treatment, PSA at 3 months following off- treatment, and duration of on-treatment. The duration of off-treatment was inversely related to the serum PSA level at the start, 3 months following on-treatment, and 3 months following off-treatment, while it was directly related to the duration of on- treatment by multivariate tests. CONCLUSIONS: The pretreatment serum PSA level and the serum PSA level at 3 months following on-treatment and off-treatment were valuable predictors for the duration of off-treatment in IAD.
Biopsy ; Disease Progression ; Follow-Up Studies ; Humans ; Medical Records ; Neoplasm Metastasis ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Survival Rate ; Treatment Outcome

No abstract available.
Gestational Sac* ; Ultrasonography*