No abstract available.
Upper Extremity Deep Vein Thrombosis

There are many procedures for treatment of injuries of acromioclavicular separation, but still controversies concerning the best management of these injuries. From March 1981 to August 1984 at Masan Korea Hospital, twelve cases were treated by technique of modified Phemister method, two cases by Dewar and Barrington method, two cases by Stewart method, one case by Neviaser method, three cases by skillful neglect method and two cases by shoulder harness immobilization. The following results were obtained. 1. These injuries were more prevalent in male and more in right side. 2. The most common cause of injuries was traffic accident and followed by falling from the height. 3. Three cases were grade 2 and nineteen cases grade 3 by Allman's classification. 4. We treated these injuries by operative method in seventeen cases and non-operative method in five cases. 5. There were good functional results of treatment in operative method. 6. There were two cases of superficial wound infection, two cases of migration of K-wire and one case of recurrence of deformity in operative method, and two cases of shoulder stiffness and 2 cases of recurrence of deformity in non-operative method.
Accidental Falls ; Accidents, Traffic ; Acromioclavicular Joint ; Classification ; Congenital Abnormalities ; Humans ; Immobilization ; Korea ; Male ; Methods ; Recurrence ; Shoulder ; Wound Infection

No abstract available.
Wilms Tumor*

PURPOSE: LASEK is a newly developed refractive surgery technique that can make up for the complications from PRK and LASIK. The most unique procedures in LASEK is covering of the cornea with epithelial flap after keratectomy. We examined the effect of corneal epithelial flap on the wound healing of canine cornea. METHODS: Operation was performed in eyes from 12 dogs, and the 12 eyes were recovered with epithelial flap and the remaining 12 eyes were recovered without epithelial flap. Wound healing process was compared using fluorescein staining, light and transmission electron microscopic examination. RESULTS: Fluorescein stained area of the cornea was reduced with time in both groups, and from 9 hours after the operation, it was significantly reduced in the group with epithelial flap compared with those of the group without epithelial flap (p< 0.05). On light microscopic examination of the group with epithelial flap, and normal epithelial structure was found at 24 and 48 hours, respectively. However, in the group without epithelial flap, no complete reepithelialization had occurred on center at 48 hours after the operation. On transmission electron microscopic examination, eyes of the group with epithelial flap showed hemidesmosomes in the area where epithelial flap was closely contacted with the stroma at 24 hours, and they were completely developed at 48 hours. On the other hand, in the group without epithelial flap, hemidesmosomes developed only in the proximal portion but not at the leading edge even at 48 hours. CONCLUSIONS: These results suggest that corneal epithelial flap accelerate the wound healing process of the cornea and the wound healing process depend on the vitality of the epithelial flap.
Animals ; Cornea ; Dogs ; Fluorescein ; Hand ; Hemidesmosomes ; Keratectomy, Subepithelial, Laser-Assisted ; Keratomileusis, Laser In Situ ; Refractive Surgical Procedures ; Wound Healing* ; Wounds and Injuries*

PURPOSE: In order to evaluate microstructural changes after shock wave exposure, gross, light microscopic and transmission electron microscopic findings were analyzed with rabbit gallgladders. MATERIALS AND METHODS: A preliminary study(2 rabbits) was performed to determine the dosage intensity of shock waves needed to inflict damage, using a EDAP LT 01 piezoelectric extracorporeal shock wave Iothotriptor. The gallbladders of three different groups of rabbits were given shock waves of various intensity. A storage value of 100, 50, 25 at rate of 20/sec under 80% power were given to group I (4 rabbits), group II( 4 rabbits), and group III(3 tabits), respectively. The rabbits were sacrified 6--12 hours later. RESULTS: The observed pathologic changes in the transmission electron microscopy were vaculization of cytoplasm and swelling of epithelial cells with dilatation and structural alteration of intracellular organelles, especially endoplasmic reticulum. Cell membrane rupture and necrosis were observed at the markedly affected area. The structural changes of intracellular organelles were minimally found at a storage value of 25. However, above pathologeic changes with dilatation and structural alterations of endoplasmic reticulums were more profund at value of 100. CONCLUSION: Early histologic changes induced by shock waves are dose dependent and the findings of cellular damage caused by ESWL might be explained as above.
Cell Membrane ; Cytoplasm ; Dilatation ; Endoplasmic Reticulum ; Epithelial Cells ; Gallbladder* ; Microscopy, Electron, Transmission ; Necrosis ; Organelles ; Rabbits ; Rupture ; Shock*

PURPOSE: All procedures for the removal of retained intrahepatic stones were performed on inpatient basis. We evaluated the advantage of the procedures performed on inpatient basis compared with outpatient basis in terms of the success rate, causes of failure and the complication. MATERIALS AND METHODS: Percutaneous removal of retained intrahepatic stones was performed in 58 patients through a T-tube tract on inpatient basis from April 1990 to December 4992. Stones were exclusively intrahepatic in 28 patients, whereas 30 patients had combined stones in common bile duct. Preshaped catheters, baskets, and balloon catheters were used to remove the stones and dilate the strictures of the ducts. Extracorporeal shock wave lithotripsy and choledochoscopy with electrohydraulic lithotripsy were used to crush the impacted stones. RESULTS: The stones were completely removed in 34 (58.6%) of 58 patients and most of the stones were removed in 17 patients (29.3%). The overall success rate was 87.9%. The complications (cholangitis in 13% and pancreatitis in 0.8% per session) were found and successfully managed by appropriate care. CONCLUSION: Better success rate could be achieved by more aggressive appraoch on inpatient basis when compared with previous reports on outpatient basis. We suggest that the procedures should be performed on inpatient basis especially in a case with severe strictures or impacted stones.
Catheters ; Common Bile Duct ; Constriction, Pathologic ; Humans ; Inpatients ; Lithotripsy ; Outpatients ; Pancreatitis ; Shock

OBJECTIVE: This retrospective study of 13 patients who underwent surgical treatment for symptomatic lumbar synovial cyst was performed to evaluate the clinical findings and pathogenesis of lumbar synovial cyst. METHODS: The clinical characteristics of the patients were investigated by reviewing the hospital records, preoperative radiological images, and operation records. By observing preoperative CT scans Facet degeneration grade at the lesion and opposite side of pathologic level and adjacent levels were assessed and compared. RESULTS: There were 5 males and 8 females (average 65.8 year-old). Six patients presented with low back pain and leg pain, and 7 patients presented only leg pain. Most common pathologic level was L4-5. All patients underwent the cyst resection with/without decompressive laminectomy or discectomy. The additional instrumentation was not performed in all patients. No complications or recurrence was observed during average 34.5 months follow-up. There was no significant difference of facet degeneration grade between the lesion side of pathologic level and opposite side of same level or lower adjacent level. CONCLUSION: In the present study, all patients showed clinical improvement by the simple surgery without any instrumentation. No significant correlation between the occurrence of synovial cyst and the degeneration grade of facet joint was revealed.
Diskectomy ; Female ; Follow-Up Studies ; Hospital Records ; Humans ; Laminectomy ; Leg ; Low Back Pain ; Male ; Recurrence ; Retrospective Studies ; Synovial Cyst ; Zygapophyseal Joint

BACKGROUND/AIMS: To compare treatment outcome of hepatocellular carcinoma(HCC) under the size of 5 cm in relation to underlying liver function and treatment modalities, analysis of data from 145 patients was performed. METHODS: In this study, the records of 145 patients with small HCC (< 5 cm in diameter determined by hepatic angiography) were reviewed. Clinical parameters were analyzed and survival rate, recurrence rate were calculated. RESULTS: There were 107(73.8%) men and 38 women. Mean age at diagnosis was 55.1(range .' 25 83 year-old). HBsAg was detected in 97(66.9%) patients. Seventy two(50.0%) patients showed markedly elevated(>40 ng/mL) serum alpha-fetoprotein(AFP) level. Liver cirrhosis was associated in 109(75.2%) patients. Sixty five(44.8%) patients underwent surge, 63(43.5%) underwent transarterial therapy(TAT), 8(5.5%) underwent other modalities of therapy and the remaining 9(6.2% ) patients did not receive any specific treatment for HCC. In relation to the underlying liver function, 119(82.1% ) patients belonged to the non-cirrhotic or Child-Pugh class A, 20(13.8%) to class B and 6(4.1%) to class C. The median follow-up duration was 21 months. When analyzed with respect to treatment modalities alone, median survival was 43 months for all patients, 60 months for surgery, 29 months for TAT, 20 months for other treatment and 18 months for patients who received no specific treatment. Without considering liver function, cumulative 3 year survival rate was 68.6% for surgery, 43.9% for TAT, 29.2% for other treatment and 0% for no treatment. The survival rate for the patients who underwent surgery was significantly higher than for any other treatment modalities without considering the underlying liver function or in the non-cirrhotic/Child-Pugh class A(p<0.001). In patients whose tumor size was equal to or less than 3 cm, there was no difference in survival rate in relation to the treatment modalities when not considering the underlying liver function of each patient(p>0.05). But in patients classified as the non-cirrhotic/Child-Pugh class A, better survival was observed in the surgep group than the TAT group(p<0.05). The only factor influencing survival was the pre-treatment serum AFP level(p<0.05). The overall recurrence rate was 30.3%. For the entire patients, the factor significantly influencing the recurrence rate was the presence of underlying cirrhosis. When considering only the patients in the surgery group, the different types of surgical procedures significantly influenced the recurrence rate. CONCLUSION: Surgery is the treatment of choice for patients with HCC equal to or smaller than 5 cm. But for those patients whose tumor size is less than 3 cm, TAT may be a reasonable alternative to surgep when the liver function is not adequate for hepatic resection. Because overall recurrence rate exceeded 30% and median time of recurrence was only 9.5 months after definitive treatment, careful follow-up is required for all patients who undergo treatment for small HCC.
Carcinoma, Hepatocellular* ; Diagnosis ; Female ; Fibrosis ; Follow-Up Studies ; Hepatitis B Surface Antigens ; Humans ; Liver Cirrhosis ; Liver* ; Male ; Recurrence ; Survival Rate ; Treatment Outcome*

PURPOSE: For an isolated tear of the subscapularis tendon, the presented technique using a subclavian portal provides both a good angle for anchor placement and sufficient space for managing the upper portion of a subscapularis tendon tear. MATERIALS AND METHODS: The conventional method needs 2 additional portals for traction, debriding the footprint and anchor fixation for repair. The presented technique requires only an anterior portal for suture management and a subclavian portal without cannula for suture anchoring and placement of suture hooks. RESULTS: The two suture limbs of the anchor can be placed on the subscapularis tendon by the switching technique and these limbs are repaired sequentially. CONCLUSION: This technique is simple and reproducible and it can be applied to partial tears and minimally retracted subscapularis tears.
Catheters ; Extremities ; Suture Anchors ; Sutures ; Tendons ; Traction

OBJECTIVE: This retrospective study of 57 patients was performed to evaluate the therapeutic effectiveness of percutaneous endoscopic surgery by using interlaminar approach (ILA) in symptomatic lumbar disc herniation (LDH) at L5-S1. METHODS: Visual analogue pain score (VAS) and Oswestry disability index (ODI) were used to assess the clinical outcome. All assessment was done on 1 day before the operation, 3 days, 3months and 12months after the operation. RESULTS: The mean preoperative back and leg VAS was decreased from 5.6+/-1.4, 8.5+/-1.7 to 1.8+/-1.2, 1.5+/-1.3 at 3 days, 1.2+/-1.1, 1.8+/-1.7 at 3 months, and 1.4+/-1.7, 1.6+/-1.3 at 12 months after the operation. Mean preoperative ODI score was improved from 46.8+/-22.4% to 17.7+/-11.6% at 3 days, 15.3+/-10.1% at 3 months, and 16.2+/-9.3% at 12 months after the operation. There were 2 cases of surgical failure due to dural tearing and calcified disc. One patient presented with transient paresthesia postoperatively. Two patients showed the recurrent disc herniation at the same level and same side, and underwent second open surgery. CONCLUSION: The present study revealed that percutaneous endoscopic surgery by using ILA is an effective surgical modality for the selective cases of LDH at L5-S1.
Diskectomy ; Humans ; Leg ; Paresthesia ; Retrospective Studies