STUDY DESIGN: Retrospective study of 72 patients treated for the acute lower cervical spinal injury with or without spinal cord injury. OBJECTIVES: We designed this study to evaluate the determining factors in the prognosis of the acute cervical spinal cord injury. We hypothesized as the prognosis is dependent on the severity of injury, not by time-related for the initiation of the treatment. SUMMARY OF BACKGROUND DATA: There is still controversies in the management of the acute cervical spinal cord injury. And the prognosis is generally considered to depend on the severity of trauma to the spinal cord. METHODS: We divided neurologic status into 4 groups; complete, incomplete, root injury and no neurologic deficit group. And there were complete cord injury in 12, incomplete cord injury in 34, single root injury in 14 and no neurologic deficit in 12 patients. The time to operation since injury was 24 hours in 7, 7 days in 32, 3 weeks in 15, 6 weeks in 8, and more than 6 weeks in 5 cases. The operation was indicated mainly for the patients with irreducible fracture-dislocation or for the patients with bony fragments, and disc materials impinging on the spinal cord. Surgical treatment were done in 67 cases with anterior cervical discectomy and fusion(ACDF), ACDF with anterior stabilizaiton, posterior wiring, and circumferential fusion. We statistically analyzed the relationship hetween the time to surgery after injury and the degree of neurologic recovery after surgical treatment by chi square test. RESULTS: There were no neurologic recovery in complete cord injury. There were incomplete cord injury in 34 patients, 8 anterior cord syndrome had no neurologic recovery, among 24 patients with central cord syndrome(CCS) 18(22/24 operated) had neurologic recovery in various degrees and 2 of Brown-Sequard syndrome showed significant neurologic recovery. In nerve root injury, all except l (1/12) patient had complete neurologic recovery. There were neurologic recovery in 2/2 CCS when operated within 24 hours, 8/10 CCS when operated between 2-7 days and 4/5 CCS when operated between 2-3 weeks. There were neurologic recovery in 3/3 CCS when operated between 4-6 weeks and 1/2 CCS when operated more than 7 weeks after injury. There was no significant difference in the relationship between the time to surgery after injury and the degree of neurologic recovery after operation(X2=2.48, df=4, P=0.65). CONCLUSION: Spinai cord injury is directly related with the magnitude of injury at the time of trauma, and the prognosis is determined entirely at the time of injury, And the prognosis is not altered hy time of the treatment.
Brown-Sequard Syndrome ; Diskectomy ; Humans ; Neurologic Manifestations ; Prognosis* ; Retrospective Studies ; Spinal Cord Injuries* ; Spinal Cord* ; Spinal Injuries

No abstract available.

This is a retrospective review of 11patients of type II SLAP lesion which were found during arthroscopic treatment of 26 patients diagnosed SLAP lesion, clinically and radiologically, hetween March l989 and June 1996. Follow-up time was averaged 26 months (range, l2 months to 72 months) and average age was 30 years old. All patients were treated arthroscopically for SLAP lesion. In type II 2 cases were repaired hy biodegradable tacks (Suretac(R)), 9 cases were repaired by transglenoid and transscapular tcchnique that included dehridement of the frayed lahrum and ahrasion of the superior glenoid neck, followed hy the placement of multiple suture on the torn capsular-labrum complex and lahrum-biccps tendon complex using suture hook, heath pin and # 0 PDS (Rhee's method). Among 9 cases with transglenoid and transscapular suture technique in type II SLAP lesion, the result were quantitated with Rowe ratin scale, 4 cases were exellent, 3 cases were good and 2 cases were fair. Our modification technique, using transglenoidal two bone hole technique and tying on scapular spine can ohtain as compatible fixation as other techniques which include metal staple, bioderadahle tacks (Suretac(R)) and anterior anchoring system such as mini-Revo. Our technique also has reasonable recurrence rate with few complication. The advantage of our modified technique is able to do superior capsular advancement, capsular plication and capsular shift which procedures are very difficult in other techniques. We propose arthroscopic transglenoid and transscapular suture technique (Rhee's method) for type II SLAP lesion as one of new method of suture for type II SLAP lesion.
Adult ; Follow-Up Studies ; Humans ; Neck ; Recurrence ; Retrospective Studies ; Spine ; Suture Techniques ; Sutures ; Tendons

MPL 9000 lithotriptor may be characterized by ultrasonic localization, automatic target system, water cushion and under water spark gap generation of shock wave. In an effort to evaluate clinical efficiency of this machine, we analyzed therapeutic results of 250 cases of urinary calculi treated by extracorporeal shock wave lithotripsy (ESWL) using MPL 9000 lithotriptor. Technically it was difficult to visualize the upper ureter stones with ultrasonic scanning, so all of them were pushed up before treatment. For staghorn stones or large stones, percutaneous nephrolithotomy (PCNL) or ureteral stenting were performed before treatment selectively. The overall stone free rate. at 4 weeks after last session, was 89.2% while that of stones larger than 3cm was 50%. The complications such as gross hematuria, flank pain, steinstrasse and fever were controlled successfully by conservative treatment. In conclusion, ESWL with MPL 9000 might be successful in most patients with urolithiasis but in cases of large renal stone or upper ureteral stone auxiliary procedures will be required.
Fever ; Flank Pain ; Hematuria ; Humans ; Lithotripsy ; Nephrostomy, Percutaneous ; Shock* ; Stents ; Ultrasonics ; Ureter ; Urinary Calculi* ; Urolithiasis

No abstract available.
Funnel Chest*

No abstract available.

Turner's syndrome results from complete or partial monosomy of the X chromosome and is characterized by hypogonadism or related other congenital anomalies in phenotypic females. In these patients, there are failure to develop normal secondary sex characteristics, amenorrhea, or short stature at puberty and the ovaries are reduced to atrophic fibrous strands devoid of ova and follicles(streak gonads). Individuals with this condition are particularly prone to the development of gonadoblastoma. For this reason, the gonads should be early removed and supplemental estrogen therapy given. We experienced a case of Turner's syndrome, 45, XO/46, XY karyotype in a 20-year-old phenotypic female complained an amenorrhea. On the exploratory laparotomy, the right gonadal mass is sevearly adhered to the adjacent organs and measures 8 x 5 x 5 cm in dimension and 75gm in weight and shows multiple foci of hemorrhage with necrosis. The left streak gonad measures 3.5 x 2 x 1.5 cm in dimension and shows multiple foci of calcification. Microscopically, the right gonadal mass reveals malignant mixed germ cell tumor, composed of endodermal sinus tumor, composed of endodermal sinus tumor with dysgerminoma and gonadoblastoma. The left streak gonad consists of mainly dense fibrous connective tissue and shows some foci of calcification associated with gonadoblastoma. On immunohistochemical and special stainings, the cytoplasm and hyalin droplets of the endodermal sinus tumor component reveal strong positivity to the a-fetoprotein and PAS. After removal of both gonads, the serum level of the a-fetoprotein is markedly down from 1742ng/ml to 2.6 ng/ml.
Female ; Humans

In treatment of infected ununited fractures of the tibia, We have solved this disastrous problems by posterior bone graft through posterolateral approach. By this posterior bone graft, We can achieve both bone union and infection contral simultaneously. The results were as follows: 1. Total cases of the infected ununited fractures were 17 cases, among them 16 cases were open fracture initially. 2. They occured more commonly in young adult, 7 cases(41%) were in 4th decade, and all cases were male. 3. Tibial union was achieved in 16 cases and one patient can not walk without brace due to ain on fracture site. 4. Infection was cleared in 16 cases, but one case had intermittent drainage of pus. 5. The most common complication was stiffness of the ankle and tarsal joint. 6. There was no infection in grafted bone.
Ankle ; Braces ; Drainage ; Fractures, Open ; Fractures, Ununited ; Humans ; Male ; Suppuration ; Tarsal Joints ; Tibia ; Transplants ; Young Adult

Squamous cell carcinoma is a malignant tumor arising from the epidermis or its appendages, Squamous cell carcinoma of extremity comprises approximately 1 to 2 percent of all squamous celi carcinoma and of these 0.2 to 1.7 percents are secondary to chronic osteomyelitis and 2 percents are secondary to the burn scar. We experienced 4 cases of squamous cell carcinoma invading bone directly, of these 2 cases are secondary to chronic osteomyelitis and 2 cases are secondary to the burn scar. With prompt and aggressive surgical treatment the prognosis is good. Routine regional lymphadenectomy is unnecessary because in most instances enlarged nodes are inflammatory and subside after amputation.
Amputation ; Burns ; Carcinoma, Squamous Cell ; Cicatrix ; Epidermis ; Epithelial Cells ; Extremities ; Lymph Node Excision ; Osteomyelitis ; Prognosis

Fibromatosis in childhood is a rare tumor and also prone to aggressive behavior. This tumor may spread to involve contiguous soft parts and osseous structures, but does not metastasize. We experienced a case of fibromatosis in an 12-year-old giri who complained of palpable masses in the region of the right buttock and right foot. The case has been followed for 6-years since February 1973. Bony change has occured even after several attempts of surgical excision but a distant metastasis has not occured.
Buttocks ; Child ; Fibroma ; Foot ; Humans ; Neoplasm Metastasis