Injuries in the industries has been steadily increasing in this country in recent years. Injuries in the industries intricate in accoriance with the industrial environment, mechanism of injuries and the other factors of employees. In 6 years 201 patients with industrial injuries underwent treatment in the Department of Orthopaedic Surgery of the National Medical Center, and the result of treatment is reported in this paper. 1. 70 cases out of 201 cases were in the age group between 21 to 30 year. 186 cases were male and 15 were female. The incidence is remarkably higher in male. 2. In 80 cases the injuries were caused by machinery with pressor parts. The patients were chiefly manual workers in factories. 3. Of 280 injuries, 148 (62.8%) were upper extremities, 105 (37.5%) were lower extremities and 27 (96%) were trunks. The most common site of injuries was hand. 4 Of 146 injuries with fractures, 94 were treated by manual reduction and cast, and 52 were treated by open reduction. 5. Treatment for open wounds was debridement followed by delayed primary closure and/or skin graft. The primarily closed open wounds by local clinics were observed and treated according to wound condition. 6, 17 cases out of 22 phalangeal bone fractures were treated by manual reduction and splint. 5 cases were treated by K-wire internal fixation, among them 3 cases had to be treated by amputation. 7. Incidence of early camplication was considerably high with 137 sites out of 280 sites and the late complication was 79 sites after treatment of the early complications.
Amputation ; Debridement ; Female ; Fractures, Bone ; Hand ; Humans ; Incidence ; Lower Extremity ; Male ; Skin ; Splints ; Transplants ; Upper Extremity ; Wounds and Injuries

IVRO is one of the most common procedures to setback prognathic mandible. Since 1993 we have set-up our own protocol for functional physiotherapy(Park's protocol) after IVRO. This is a study on openbite and relapse tendency after IVRO followed by our protocol. We obtained lateral cephalograms of twenty-seven patients which were taken immediately after surgery, 3 months, 6 months and 1 year postoperatively. Changes in positions of each point were analyzed. The results were as follows: 1. No remarkable openbite occured during the first year after IVRO. Upper teeth, lower teeth and anterior mandible moved upward, it seems to show that post-op orthodontic treatment did not contribute to reduce openbite tendency during post-op period. Rater, the lower teeth and mandible moved with the upper teeth as the compensation mechanism. 2. Lower Incisal Edge moved anteriorly up to 6 months, so overjet decreased from 3.3mm to 2.9mm during the first six months. Skeletal changes in anterior mandible showed slight anterior movement, therefore showing slight relapse tendency, but it represented no statistical significance. 3. The physiotherapy according to our protocol was used for only a month after operation, but there was no openbite tendency, and the occlusion was stable over one year.
Compensation and Redress ; Humans ; Mandible ; Open Bite* ; Prognathism* ; Recurrence* ; Tooth

A case of fibrocalcifying pseudotumor occuring at a very unusual site, the intraosseous region of axis, is presented. Previous reports of similar lesions in skull base, intracranial parenchyme, soft tissue around spine, mediastinum, and pleura have been described under the designation 'fibro-osseouslesions' and 'calcifying pseudoneoplasm' The etiology, pathogenesis and natural course of the lesion are still unknown. Bvt the lesion is probably benign nature and reactive lesion rather than neo-plastic. Authors performed resection of lamina, spinous process, and a portion of pedicles and occipitocervical fusion to prevent spinal cord compression due to cortical expansion or fracture. Microscopically, amorphous, basophilic, hyaline, and chondroid calcifying masses were rimmed by palisading histiocytes and foreign body-type giant cells. No evidence of malignancy was found.
Axis, Cervical Vertebra* ; Basophils ; Giant Cells, Foreign-Body ; Histiocytes ; Hyalin ; Mediastinum ; Pleura ; Skull Base ; Spinal Cord Compression ; Spine

There are several rnethods to correct the tibial bony defect including resection, cement filling, autograft or allograft and metal augmentation. The purpose of this study is to find the adequate treatment method of tibia bony defect through analysis of the result with above methods. From Sep. 1993 to Dec. 1997, the authors analyzed 93 cases of tibial medial bony defect corrected by overresection of lateral condyle, allograft and metal wedge or block among 358 cases of primary total knee arthroplasty(TKA) operated at Asan Medical Center. All cases were devided into four groups according to the treatment method; group A(31 cases) with overresection of lateral condyle, group B(37 cases) with metal wedge, group C(21 cases) with metal block and group D(4 cases) with allograft. The mean follow up period was 23.6 months(12 56 months). The results were as follows, 1. There were no definite statistical difference between group A, B, C and D in HSS knee score, ROM, correction of deformity. But in group D, there is one case of loss of the correction. 2. Loosening of the implant was not noted, but 17 cases of mild bony resorption was found just beneath the implant. It was particularly prominent in group B(9 cases) than group A(5 cases) and C(3 cases). 3. Among 4 cases of allograft, one has developed collapse of allograft. 4. 3 cases of deep infection developed only in group C, which were followed by revision TKA. Although further follow up study should be carried out, we concluded that resection of lateral tibial condyle, allograft, metal augmentation is a good substitute to the correction of the tibial bony defect in primary TKA.
Allografts ; Autografts ; Chungcheongnam-do ; Congenital Abnormalities ; Follow-Up Studies ; Knee ; Tibia

Although variation is the rule with pancreatic duct morphology, certain variants occur as a result of altered embroological development. These ductal configurations, most striking deviations from the normal configuration, may be classfied according to alterations of embryological development. These congenital variants of pancreatic duct may be important for several reasons. First, the pseudomass effect of ductal anomalies can be mistaken for carcinoma by the inexperienced radiologists. Second, whether or not the anomaly is important, it is present in many patients with recurrent pacreatitis. Original descriptions were based on small sampling of postmortem studies and surgical specimen, but more recently the advent of endoscopic retrograde cholangiopancreatography(ERCP) has confirmed of the work of early anastomists and increased awareness of these variants. To evalute of frequency, characteristics of associated disease and clinical significance of pancreatic anomalies, we have reviewed of 5330 case of ERCP filmes which were undertaken between July, 1973 and August, 1993. Having reviewed of ERCP filmes, we found out 9 case of pancreatic duct variants. Among them, 7 cases were classified as ductal duplication anomalies, 4 cases of number variation, most, bifuricaiton and 3 cases of form variation, which were composed of loop, spiral and terminal N. Three cases of fusion anomalies were also noted, which were 2 cases of panceratic divisum and 1 case of incomplete pancreatic divisum. The associated diseases were 6 cases of bile duct and galbladder stones and 3 cases of pancreatic cancer. We could not find out the case of congenital anomalies as cause of obstructive pain and pseudomass effect.
Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde* ; Humans ; Pancreatic Ducts* ; Pancreatic Neoplasms ; Pancrelipase ; Strikes, Employee

A technique for Thallium-201 imaging after two separate injections of the tracer, which took less than I hour, was performed to evaluate if this technique could be used clinically as a noninvasive screening test of angina pectoris. 29 patients who complained of chest pain were included in this study: 18 patients were proven to have coronary artery disease by coronary angiography and 11 patients had normal coronary arteries. With the patient supine at rest, 1.0 mCi of Thallium was injected intravenously and imaging was performed in the anterior and 50degrees left anterior oblique projections for a preset time according to Okada's protocol. Immediately after acquisition of the rest images, without moving the camera head, an infusion of dipyridamole was done at the rate of 0.14 mg/Kg/min for 4 minutes. Two minutes after stopping the infusion, 1.0 mCi of Thallium was injected intravenously and 50degrees left anterior oblique and anterior projection images were acquired. Images of the same projection were realigned using computer image registration approach (PDP-11/34 computer of DEC company). The rest image was then subtracted from the realigned dipyridamole image to produce an image representing perfusion during dipyridamole induced hyperemia (subtraction image). The results were as follows; 1) All of the subtraction images were of adequate quality for interpretation. 2) 16 cases in 18 patients of angina pectoris and 1 case in 11 normal control showed perfusion defects, so the over all sensitivity and specificity of the subtraction versus rest Thallium image technique for diagnosis of angina pectoris were 89% and 91%, respectively. 3) All patients (8 cases) whose left ventriculography revealed abnormality of regional wall motion showed perfusion defects in corresponding segments. But qualitative analysis of Thallium image could not predict if the patient whose Thallium image revealed perfusion defect has abnormality of regional wall motion. 4) segmental analysis was performed to know the association between the site of coronary artery stenosis and the perfusion defects in Thallium scan, which revealed the sensitivities for detecting stenosis of LCX, LAD & RCA were 50-60% in range and the range of specificities were 89-92%. 5) Adverse effects of dipyridamole were headache (2 cases) and chest pain (4 cases) but aminophylline was not needed in any case. In conclusion, split dose Thallium dipyridamole scan can be used as a noninvasive screening test of angina pectoris reducing the total duration of imaging to less than one hour. Futher applications of this technique may include the assessment of myocardial perfusion before and immediately after coronary angioplasty and coronary artery bypass graft and the evaluation of the impact of pharmacotheraphy on regional myocardial perfusion.
Aminophylline ; Angina Pectoris* ; Angioplasty ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Diagnosis* ; Dipyridamole* ; Head ; Headache ; Humans ; Hyperemia ; Mass Screening ; Perfusion ; Sensitivity and Specificity ; Thallium ; Transplants

BACKGROUND AND SIGNIFICANCE: Neck manipulation or trauma uncommonly be associated with serious and even fatal vascular complications. We presented the clinical and radiologic findings in 3 patients of brainstem and/or cerebellar infarct with basilar artery occlusion and extracranial vertebral artery stenosis or occlusion,. Cases : In the patient 1, the infarction of pons and lsft cerebellar hemisphere outbroke just after being seized by the collar. The angiographic findings were complete occlusion of basilar artery and left vertebral artery on C1 level and vertebrobasilar junctional occlusion of right vertebral artery. In the patient 2, extensive infarction of pons and left cerebellar hemisphere developed just after chiropractic manipulation of the neck. The angiographic findings were occlusions of left vertebral artery and distal portion of the basilar artery. In the patient 3, right cerebellar and medullary infarction of posteroinferior cerebellar artery territory occurred just after autobicycle accident. The angiographic finding was complete occlusion of left vertebral artery on C1 lever. They had not another risk factor of the stroke. CONCLUSIONS: We experienced and presented 3 cases of posterior circulation infarctio with vertebrobasilar stenoocclusion just following cervical manipulation or neck trauma.
Arteries ; Basilar Artery ; Brain Stem ; Humans ; Infarction* ; Manipulation, Chiropractic ; Manipulation, Spinal* ; Neck ; Pons ; Risk Factors ; Stroke ; Vertebral Artery ; Vertebrobasilar Insufficiency

BACKGROUND: Angiogenesis is an essential process for the growth and metastatic ability of solid tumors. One of the key factors known to be capable of stimulating tumor angiogenesis is the vascular endothelial growth factor (VEGF). The serum VEGF concentration has been shown to be a the malignant pleural effusion showing a correlation with the biochemical parameters. The VEGF has been shown to play a role in the inflammatory diseases, but rarely in the tuberculosis (TB). The serum and pleural fluid VEGF levels were measured in patients with lung cancer and TB. Their relationship with the clinical and laboratory parameters and repeated measurement 3 months after various anticancer treatments were evaluated to assess the utility of the VEGF as a tumor marker. METHODS: Using a sandwich enzyme-linked immunosorbent assay, the VEGF concentration was measured in both sera and pleural effusions collected from a total of 85 patients with lung cancer, 13 patients with TB and 20 healthy individuals. RESULTS: The serum VEGF levels in patients with lung cancer (619.9±722.8ph/ml) were significantly higher than those of healthy controls (215.9±191.1pg/ml), However, there was no significant difference between the VEGF levels in the lung cancer and TB patients. The serum VEGF levels were higher in large cell and undifferentiated carcinoma than in squamous cell carcinoma and adenocarcinoma. The serum VEGF levels of lung cancer patients revealed no significant relationship with the various clinical parameters. The VEGF concentrations in the malignant effusion (2,228.1±2,103.0pg/ml) were significantly higher than those in the TB effusion (897.6±978.8pg/ml). In the malignant pleural effusion, the VEGF levels revealed significant correlation with the number of red blood cells (r=0.75), the lactate dehydrogenase (LDH)(r=0.70), and glucose concentration (r=-0.55) in the pleural fluid. CONCLUSION: The serum VEGF levels were higher in the lung cancer patients. The VEGF levels were more elevated in the malignant pleural effusion than in the tuberculous effusion. In addition, the VEGF levels in the pleural fluid were several times higher than the matched serum values suggesting a local activation and possible etiologic role of VEGF in the formation of malignant effusions. The pleural VEGF levels showed a significant correlation with the numbers of red blood cells, LDH and glucose concentrations in the pleural fluid, which may represent the tumor burden.
Adenocarcinoma ; Carcinoma ; Carcinoma, Squamous Cell ; Enzyme-Linked Immunosorbent Assay ; Erythrocytes ; Glucose ; Humans ; L-Lactate Dehydrogenase ; Lung Neoplasms* ; Lung* ; Pleural Effusion ; Pleural Effusion, Malignant ; Tuberculosis ; Tuberculosis, Pleural* ; Tumor Burden ; Vascular Endothelial Growth Factor A*

PURPOSE: To evaluate the effectiveness of radioiodine treatment for metastatic thyroid carcinoma, we reviewed results of radioactive iodine treatment in patients with functional lung or bone metastases. MATERIALS ANF METHODS: Of 760 patients who were treated for differentiated thyroid cancer between 1984 and 1998, we detected pulmonary metastases and bone metastases in 76 patients (10.0%) and 20 patients (2.6%), respectively. Among them, we could evaluate the effectiveness of I-131 therapy in 53 patients with lung metastases and 15 patients with bone metastases. RESULTS:Of 53 patients who received I-131 therapy with a mean cumulative dose of 26.2 GBq (1.1-84.4 GBq) for pulmonary metastases, metastatic lung lesions completely resolved in 19 patients (35.8%) and improved in 22 patients (41.5%). In 13 of 19 patients with complete remission of pulmonary metastases, the total accumulated dose of I-131 was less than 18.5 GBq. We found 43 sites of metastatic bone lesions in 15 patients with bone metastases. Of 29 lesions which received I-131 therapy, metastatic lesions improved in 14 sites (48.3%), but did not change or progress in 15 sites (51.7%) despite the I-131 therapy. Three lesions were completely cured with a combination treatment of surgery(+/- external radiotherapy) and I-131 therapy, and the other 11 lesions improved. CONCLUSION: Radioactive iodine treatment gives favorable results for pulmonary metastases. However, for bone metastases, there might be a need to use combination therapy including I-131 and surgery or external irradiation.
Atrial Natriuretic Factor ; Humans ; Iodine ; Lung ; Neoplasm Metastasis* ; Thyroid Gland* ; Thyroid Neoplasms*

A case of nonfunctioning pancreatic islet cell tumor is described. A 34 years old female patient had intermittent epigastric pain and nausea for 6 months and she had nothing suggestive of neuroendocrine symtoms. Physcial examination showed an epigastric mass which wae deepseated, nontender, and well-demarcated. The routine upper endoscopic evatuation was negative. Abdominal ultrasonography and computed tomography showed a well-defined round solid mass with multifocal necrosis but did not revealed the origin of the lesion. Endoscopic retrograde pancreatography showed upward and rightward displacement of the proximal body portion of main pancreatic duct with nonvisualization of the secondary branches of pancreatic duct, suggesting that the mass originated from the pancreas. Resection of the mass with partial pancreatectomy and Roux-en-Y pancreaticojejunostomy was perfomed and the pathology was coafirmed as nonfunctioning pancreatic islet cell tumor containing somatostatin by immunohistochemical technique.
Adenoma, Islet Cell ; Adult ; Female ; Humans ; Immunohistochemistry ; Islets of Langerhans* ; Nausea ; Necrosis ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreaticojejunostomy ; Pathology ; Somatostatin ; Ultrasonography