Fifty four consecutive total knee arthroplasties were reviewed to compare the accuracy of extramedullary versus intramedullary tibial resection guides. An extramedullary guide ( Group I ) was used in 25 cases and an intramedullary guide ( Group 2 ) was used in 29 cases. Group 1 system included the LCS knee system and Group 2 system included the Whiteside Ortholoc Advantim total condylar knee system. Preoperatively, the two groups were similar, with no statistical significant differences observed in diagnosis, alignment, and patient age. Postoperative tibial component alignment angles were similar in both group (Group 1, 0.8degrees varus; Group 2, 1.1degrees varus ). In group 1, 84% of tibial components were aligned within 2degrees of the 90degrees goal and in group 2, 83% of tibial components were aligned within the same range ( p > 0.05 ). In all cases, an intramedullary guide was used to prepare the distal femur. In femorotibial angles, with group 1 averaging 4.2degrees valgus versus 4.7degrees valgus in group 2 (p > 0.05). If the optimal femorotibial angle was defined by the range from 5+/-2, it was achieved in 76% in Group 1 and 72% in Group 2 ( p > 0.05 ). This study demonstrates no significant differences between the extramedullary and intramedullary group not only in optimal tibial component alignment angle but also in optimal femorotibial angle. This means that each system is satisfactory for the tibial side, but it is more important for the surgeon to appreciate that the indications, potential limitations and sources of errors are unique to each system and to decide which system to use according to the particular case in question.
Arthroplasty* ; Diagnosis ; Femur ; Humans ; Knee*

There are many difficult problems and various methods in the treatment of difficult fractures of the femur. Form May 1991 to August 1994, 9 cases of difficult fractures of the femur were treated with Ilizarov external fixator. We obtained good result for all cases as follow : 1. There were 1 case of severely segmental and comminuted fracture with bone loss, 3 cases of infected nonunion after internal fixation(2 cases combined with bone loss), 2 cases of non-union after internal fixation and 3 cases of severely segmental and comminuted fractures. The traffic accident injury was in 6 cases and the falling down injury was in 3 cases. 2. The bone union was obtained in all cases and the duration of Ilizarov external fixator application was minimum 7.7 months up to 19 months with an average of 1.3 months and full weight bearing was possible in all cases after removal of the Ilizarov external fixator. 3. We experienced 9 complication; there were 6 cases of pin tract infection which were controlled by antibiotic injection at that site and there were three cases of limitation of motion of knee. So we conclude that the Ilizarov external fixation technique is one of the effective methods for the treatment of difficult fracture of the femur(ex. segmental, comminuted fracture, bone defect, osteomyelitis and nonunion) in spite of having experienced only few cases.
Accidental Falls ; Accidents, Traffic ; External Fixators ; Femur ; Fractures, Comminuted ; Knee ; Osteomyelitis ; Weight-Bearing

BACKGROUND AND OBJECTIVES: Perfluorocarbon exposed sonicated dextrose albumin (PESDA) microbubbles has been suggested to facilitate thrombus disruption under the transcutaneous ultrasound (US). Thus, we investigated whether such a noninvasive approach could augment thrombolytic effect of fibrinolytic agent in an experimental thrombotic model. MATERIALS AND METHODS: Thrombus formation was induced with electrical injury in the rabbit iliofemoral arteries (n=20): Thrombus occlusion was documented by angiography in all arteries. In the control group, only tissue plasminogen activator (t-PA, 3 mg/kg) was administered intrav-enously in five rabbits. In the Group 1 (n=9), injured arteries were exposed to transcutaneous US (20 kHz, 30 W/cm2, continuous mode) with t-PA (3 mg/kg). In the Group 2 (n=6), the same treatment was given while administering PESDA continuously (10 ml/min, intravenous). Angiographic results were evaluated at 10 minute interval for 1 hour respectively. RESULTS: In the control group, two of five iliofemoral arteries (40.0%) were recanalized and one of nine iliofemoral arteries (11.1%) was recanalized in Group 1. In contrast, four of six iliofemoral arteries (66.7%) were recanalized angiographically in Group 2 (p=0.392 vs. control group: p=0.047 vs. Group 1). However, late reocclusion occurred in all iliofemoral arteries of Group 2. CONCLUSION: Although PESDA with transcutaneous US significantly enhanced initial angiographic patency rate of t-PA, it was associated with high rate of reocclusion. Further studies will be necessary for clinical application of this noninvasive method in acute arterial occlusion.
Angiography ; Arteries ; Glucose* ; Microbubbles ; Rabbits ; Thrombolytic Therapy* ; Thrombosis ; Tissue Plasminogen Activator ; Ultrasonography*

No abstract available.
Lymphomatoid Papulosis* ; Mycobacterium* ; Tuberculosis*

No abstract available.
Lymphomatoid Papulosis* ; Mycobacterium* ; Tuberculosis*

Double-orifice mitral valve is a relatively rare congenital abnormality, usually discovered at autopsy or surgery. In most cases, the double-orifice mitral valve causes no hemodynamic effects, sometimes it is regurgitant, and rarely is stenotic. Appreciation of this echocardiographic abnormality is important because double orifice mitral valve is often associated with other congenital anomalies and this echocardiographic findings may be confused with other cardiac abnormalities. The authors report a case of isolated congenital double-orifice mitral valve in a 42-year-old woman. Data from the literature are reviewed and the echocardiographic images of the malformation are described.
Adult ; Autopsy ; Congenital Abnormalities ; Echocardiography ; Female ; Hemodynamics ; Humans ; Mitral Valve*

Ulnar lengthening, one of the operative treatment methods for Kienbock's disease, is based on the theory that ulnar minus variance is a significant causative factor of Kienbock's disease. It is considered that this method can promote the revascularization of the devascularizied lunate by reducing the forces concentrated at the wrist joint and that over-all carpal collapse is halted or reversed when the ulnar part of the carpus is supported better. 4 patients with Kienbock's disease treated by ulnar lengthening with iliac bone graft were reviewed after follow-up ranging from12 months to 30months. In all of 4 patients, relief of pain was satisfactory and there was no remarkable complication.
Follow-Up Studies ; Humans ; Methods ; Osteonecrosis ; Transplants ; Wrist Joint

Flowcytometry is a very important technique for the analysis of cell properties, with the advantages of simultaneous multiparameter analysis of large cell population in a short time. Recent advances in computer science and techniques in cell preparation and staining make it more valuable for the study of cell biology and its clinical application. This study was performed to establish the techniques of flowcytometry analysis of osteosarcoma cells, to evaluate the results of the characteristics of the DNA and specific cell cycle phase of osteosarcoma cells obtained by preparation of paraffin-embedded tissue blocks, and to analyze any possible difference between cell populations lacated apart from each other in the tumor mass for making a base for further clinical application. Paraffin-embedded tissue blocks were obtained from 10 cases of primary osteosarcoma, which had undergone amputation without chemotherapy or radiotherapy. Tissue blocks obtained from the most superficial and the deepest portions of the tumor mass from the skin surface were selected respectively in each cases. To evaluate the technique and results obtained, analysis of the whole sample were performed twice in a separate setting. Satisfactory DNA histogram was obtained from 14 of 20 tissue blocks, with the values of distribution in the specific cell cycle phases. DNA aneuploidy was found in 2 cases with a DNA index of 1.6 and 1.3, and no difference in DNA ploidy by the location in tumor mass. The S-phase and G2+M phase fraction were 13.2±8.5 and 6.2±3.1 respectively, reflecting the increased cell proliferation compared with normal cell population. There was no statistically significant difference of these values between superficial and deep portions, but the difference was 9.0±9.7 with a maximum of 26.6, much greater than the difference 3.3±3.6, between the first and second set of analysis. Flowcytometry is a very useful technique in the analysis of the DNA and cell cycle phase properties, and the characteristics of DNA and cell proliferation status of osteosarcoma cells were successfully evaluated by this technique. Unsatisfactory DNA histograms were thought to be the result of inappropriate samples. To adequately evaluate the changes in the tumor mass, standardization in obtaining tumor tissue about the location in the tumor mass is suggested for future studies with flowcytometry about the properties of tumor cells.
Amputation ; Aneuploidy ; Cell Cycle ; Cell Proliferation ; DNA ; Drug Therapy ; Osteosarcoma ; Ploidies ; Radiotherapy ; Skin

We report our series of the Ilizarov surgery for lengthening and deformity correction in upper extremity at the Severance Hospital and the Yong-Dong Severance Hospital between February 1992 and October 1994. We performed the Ilizarov surgery in 12 limb segments, there were 3 humerus, 5 radius, 3 ulna and 1 metacarpal bone. The etiologies of the limb length discrepancies were 7 posttraumatic physeal injuires, 2 congenital deformities, 1 posttraumatic bone loss, 1 posttraumatic amputation and 1 postinfectious physeal injury. The goals of treatment were bone lengthening alone in 8 cases, bone lengthening and deformity correction including angular correction in 4 cases. The bone was lengthened between 1.0 cm and 9.2 cm (mean 3.7 cm) representing a 8.1% to 63.0% (mean 24.5%) increase in length. The healing index varies from 1.0 mos/cm to 10.5 mos/cm (mean 3.4 mos/cm) except three cases which need additional fixation with plate and screws add to wedge osteotomy. By radiologic appearance of the distraction callus, the straight type were 6 cases, the attenuated type were 4 cases and the pillar type were 2 cases. The healing indices of each type were 1/5 mos/cm, 7.7 mos/cm and 12.4 mos/cm, respectively. In conclusion, lengthening and deformity correction of the upper extremity can be successfully achieved by gradual mechanical distraction using the Ilizarov method. In case of pillar type, healing index was high and therefore control of the rate and the rhythm should be tried. If this control is of no use, early interventional procedure would be beneficial. The healing index of the straight type was much lower than that of the attenuated or the pillar type.
Amputation ; Bone Lengthening ; Bony Callus ; Congenital Abnormalities ; Extremities ; Humerus ; Ilizarov Technique ; Osteotomy ; Radius ; Ulna ; Upper Extremity

The authors report two cases of successful reconstruction in infected nonunion of the femur involving marked shortening by compression and gradual distraction at the nonunion site using Ilizarov external fixator. At first, infection was controlled by radical excision & the administration of systemic antibiotics for four weeks and we also started compression at the nonunion site 3 days after operation. Autogenous iliac bone graft was added to strengthen the site of new bone formation lastly. In this report, the role of the compression seems to provide a good environment for distraction osteogenesis by focal necrosis and triggering inflammation. Compression and gradual distraction may be one of the treatment mordalities for nonunion of a long bone with massive bone loss or shortening, even infected.
Anti-Bacterial Agents ; External Fixators ; Femur* ; Inflammation ; Necrosis ; Osteogenesis ; Osteogenesis, Distraction ; Transplants