Many injuries of the hand have been occurred in these days because of frequent industrial hazards and frequent handling of tools in modern civilizing life. A voluminous amount of literature has been recently concerned with many problems and questions posed by tendon surgery. Many investigations have been devoted to discussion of suture materials, tendon suturing, grafting, healing, rate of healing, nutrition and related clinical and laboratory endeavors. Whatever the material, the aim of tendon suture is not only restoration of a strong mechanical union but also sliding function of the tendon. Thus the question has always been after what delay active mobilization can be allowed or encouraged. If immobilization allows fibroblasts to invade the tendon extremities and form a scar mass, its prolong leads to adhesion and loss of normal sliding. On the other hand, one can admit that early passive or active mobilization, even if only over a short distance may distend the adherences and transform them into a kind of mesotenon assuring a better sliding function. Before permiting early motion, several factors must be considered such as tensile strength of the suture material, holding power of the suture for the tnedon, bulkiness of the repair and stress that must be withstood. Thus it is the purpose of this study to analysis and comparing of tensile strength and morphological changes in the healing process of tendon tissues by different suturing methods. For this study deep flexor tendon on third toe of adult chicken with an initial weight of about 2Kg was used. The animals were divided into 4 sutured groups which including different suturing methods. Suturing methods used were interrupted suture, Bunnels lace suture, Kessler suture and end-weave anastomosis, which have been applied frequently in tendon surgery. All suture material used were the same size 4-0 Ethilon which has least tissue reaction but high strength. In the animals, after the sharp dissection of the distal portion of the deep flexor tendon on third toe, the tendon stumps were approximated and sutured by 4 different methods. Then a long leg cast in the position of flexion of the foot and ankle joint was applied. On operation day and fifth, tenth, fourteenth and twenty-first postoperative day; the animals were sacrified and the specimens were gained. The measurement of the tensile strength of the sutured tendon was performed through the use of force transducer with the recording of polygraph for permitting continous monitoring of a progressively increasing load until the failure of tendon repair. Specimens stained with hematoxylin-eosin and Massontrichrome stain were observed during 42 days after operation. The findings are as follows. 1. The tensile strength of sutured tendon groups using interrupted suture, Kessler suture, and end-weave anastomosis were reduced maximally on fifth postoperative fay and the tensile strength of Bunnel's lace suture group was reduced maximally on tenth postoperative day. Thereafter the strength was increased progressively on entire experimental groups. 2. The tensile strength of end-weave anastomosis group was the strongest among all experimental groups during experimental period. 3. Just after the repairs of injured tendon, the order of strength was Bunnel. Kessler and inerrupted suture but the strength was nearly approximated on 21st day. 4. The morphological healing process of interrupted and Kessler suture were better than that of Nunnel and end-weave suture. From these morphological and physical results, it is suggested that Kessler suture is better suturing method in tendon repair.
Adult ; Animals ; Ankle Joint ; Chickens ; Cicatrix ; Extremities ; Fibroblasts ; Foot ; Hand ; Humans ; Immobilization ; Leg ; Methods ; Nylons ; Sutures ; Tendons ; Tensile Strength ; Toes ; Transducers ; Transplants

No abstract available.
Laryngeal Muscles*

BACKGROUND: Serologic markers are used to screen and diagnose the hepatitis B virus infection. In endemic area of hepatitis B, the coexistence of HBsAg and anti-HBs was frequently observed. This finding is unusual and difficult to interpret. In this study, we performed three molecular biologic assays-polymerase chain reaction (PCR), chemiluminescent molecular hybridization assay (CMHA), branched DNA (bDNA) nucleic acid hybridization assay- to detect HBV-DNA in the sera which showed both HBsAg and anti-HBs positivity. To define the patients` exact clinical conditions, we analysed the characteristics of the patients according to their diagnoses, other serologic markers and clinical findings. METHODS: HBsAg and anti-HBs were detected by EIA (Enzygnost, Behringwerke, Germany) from clinical specimens of Yonsei University College of Medicine Severance Hospital collected In the period between January 1996 and December 1996. Eighty three specimens from Severance Hospital and twenty two specimens from Health Care Center were randomly selected and were subjected to HBV PCR, HBV CMHA and HBV bDNA assay for the presence of HBV-DNA. RESULTS: The patients were arbitrarily divided into 4 groups on the basis of the optical density values of enzyme immunoassay results. Group I (high HBsAg and high antral-HBs) consisted of 6 cases; group II (high HBsAg and low anti-HBs) consisted of 70 cases, group III (low HBsAg and high anti-HBs) consisted of 1 case; group IV (low HBsAg and low antral-HBs) consisted of 6 cases. Among 83 cases, the positive rate was 51.8% (43 cases) using PCR method, 53.0% (44 cases) using CMHA, 60.2% (50 cases) using bDNA assay. HBeAg and anti-HBc IgM were helpful to predict the presence of HBV-DNA in the sera. CONCLUSIONS: More than half of the patients who showed both HBsAg and anti-HBs positivity were positive for HBV-DNA by molecular biologic methods. In contrast, no one whose serologic markers with only anti-HBc positivity with out HBsAg and anti-HBs positivity showed HBV-DNA positive in the sera from Health Care Center. Taken together, the management and follow-up of the patients of both HBsAg and anti-HBs positivity could be greatly aided by combined adoption of any one molecular biologic assay of HBY-DNA with other serologic markers such as HBeAg and anti-HBc IgM.
Biological Assay ; Branched DNA Signal Amplification Assay ; Delivery of Health Care ; Diagnosis ; DNA ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens* ; Hepatitis B virus ; Hepatitis B* ; Hepatitis* ; Humans ; Immunoenzyme Techniques ; Immunoglobulin M ; Nucleic Acid Hybridization ; Polymerase Chain Reaction

PURPOSE: To investigate the changes in postural balance before and after total hip arthroplasty (THA) using computerized dynamic posturography MATERIALS AND METHODS: This was a prospective study of 18 patients undergoing total hip arthroplasty. We evaluated each patient's postural balance prior to, and at least 12 months after, total hip arthroplasty by using computerized dynamic posturography. We compared the preoperative equilibrium scores with the postoperative equilibrium scores. Clinical results were assessed for all patients preoperatively and postoperatively using the Harris hip scoring system. We investigated whether postural balance improves, and what factors were related to this parameter. RESULTS: Patients showed significant improvement in postural balance by means of proprioception after total hip arthroplasty (p<0.05). We found, during intercepting visual compensation, that an increase in the Harris hip score was correlated with an improvement in balance (p<0.01, r = 0.649). CONCLUSION: Patients with Total hip arthroplasty showed improvement in dynamic postural balance through proprioceptive recovery, and balance improved as the Harris hip score increased. This resulted in decreased pain, recovery of articular function, enhancement of physical activity, and ultimately improvement in postural balance by means of total hip arthroplasty.
Arthroplasty ; Compensation and Redress ; Hip ; Humans ; Motor Activity ; Postural Balance ; Proprioception ; Prospective Studies

BACKGROUND: Idiopathic thromboycytopenic purpura(ITP) is one of the most common acquired bleeding disorders in childhood. The entity of chronic ITP is defined as the persistence of thrombocytopenia for more than 6 months from initial presentation. There are the controversies regarding the diagnosis and management of this disease. The aim of this study is to compare the responses to managements and clinical symptoms of children with chronic ITP. METHODS: We retrospectively analyzed patients with chronic ITP diagnosed and managed between Jan., 1992 and June, 1997. Data from 33 cases were collected. The length of follow-up ranged from 6 months to 5 years. Statistical analysis was done using Jandel Sigmastat software(version 2.0). RESULTS: 1) Mean age is 5.4+/-4.3 years. The ratio of female to male is 0.65. 2) Most common clinical symptoms at presentation were petechiae(81.8%) and mucosal bleeding(42.4%). The patients who presented only petechiae and purpurae were 18 cases(54.5%), both petechiae and mucosal bleeding were 9 cases(27.3%). 3) The platelet count was 43,015+/-39,912/mm3. Bone marrow examinations showed normal or increased megakaryocyte, no abnormal cells and normal cellularity. 4) The prolonged complete response lasting more than 6 months without maintenance therapy was attained in 15.2% of the patients. A continuous complete response was observed in 6.1% to prednisone and IV-gamma-globulin. A prolonged complete response to dexamethasone was in 23.8% and continuous complete response was in 14.3%. The splenectomy was underwent in 3 patients. All of them had a prolonged complete response. One of six patients who were treated with combination chemotherapy had a prolonged complete response. CONCLUSION: This analysis of chronic ITP patients suggests that splenectomy remains the most effective treatment and the next one is high dose dexamethasone therapy. But the number of patients was not enough, more attention should be given to the management of chronic idiopathic thrombocytopenic pupura(ITP).
Bone Marrow Examination ; Child ; Dexamethasone ; Diagnosis ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Male ; Megakaryocytes ; Platelet Count ; Prednisone ; Purpura ; Purpura, Thrombocytopenic, Idiopathic* ; Retrospective Studies ; Splenectomy ; Thrombocytopenia

Well differentiated fetal adenocarcinoma of the lung is a subtype of pulmonary blastoma. In this report, CT-guided fine needle aspiration smears were performed at the right upper lobe of the lung in a 45 year-old male patient who had the smoking history of one pack per day for 25 years. The smears disclosed round, papillary, and tubular patterns of cell clusters. The individual cells had relatively uniform, small to medium sized nuclei without nucleoli, and showed vesicular or eosinophilic cytoplasm with indistinct cell border. The morules were seen in the central area of papillary clusters. They were composed of two cell types, outer single layered cuboidal cellular lining and central three-dimensional cluster of cells simulating fetal lung. These cytologic features need to be differentiated from usual pulmonary adenocarcinoma, carcinoid, and pulmonary blastoma. On histologic findings, the tumor arised in the bronchial epithelium. And the tumor cells had abundant intracytoplasmic glycogen with neuroendocrine feature on histochemical study. In addition, the multiplicity of this tumor is the unique point comparable to the previous reports.
Adenocarcinoma* ; Biopsy, Fine-Needle ; Carcinoid Tumor ; Cytoplasm ; Eosinophils ; Epithelium ; Glycogen ; Humans ; Lung* ; Male ; Middle Aged ; Pulmonary Blastoma ; Smoke ; Smoking

Seven patients with large aneurysm of the inferior wall of the internal carotid artery were treated during a recent six-year period; this report presents the findings. In this type of aneurysm, the neck arises from the ventral surface of the internal carotid artery at the level of the segment of the posterior communicating artery(PComA). As is the case with the ventral paracliniod type, the treatment of the this aneurysms presents the surgeon with technical problems involving safe exposure and clipping. The incidence of female patients was high, and aneurysms were large; in all cases, the clinical presentation was subarachnoid hemorrhage. In three cases, clipping was incomplete. During surgery, the neck of the aneurysms was hidden by the segment of PComA, and the dome adhered to the PComA and to the anterior choroidal artery. The outcome was considered good in five patients; one, however, was moderately disabled, and one died. We classified these aneurysms as separate from those of the internal carotid artery-PComA junction, and described their surgical treatment and related problems.
Aneurysm* ; Arteries* ; Carotid Artery, Internal ; Choroid ; Female ; Humans ; Incidence ; Neck ; Subarachnoid Hemorrhage

Tuberculosis is a systemic disease with a world-wide distribution, and its occurance in the oral cavity is well documented in the literature. Disease of oral cavity and jaw caused by Mycobacterium tuberculosis is very rare, so it is often difficult to diagnose tuberculosis in the oral cavity. When granulomatous and ulcerative lesion persists in the oral cavity for a long time, it may be considered a tuberculosis. When differential diagnosis is needed, the most reliable indicators of mycobacterial infection are careful clinical evaluation, skin test, acid-fast staining, biopsy and culture. We report a case of tuberculous osteomyelitis which simultaneously occurred on the maxilla and mandible in a 85 years old man that proved diagnosis difficult, but which responded very well to surgical treatment and chemotherapy.
Aged, 80 and over ; Biopsy ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Humans ; Jaw ; Mandible* ; Maxilla* ; Mouth ; Mycobacterium tuberculosis ; Osteomyelitis* ; Skin Tests ; Tuberculosis ; Ulcer

PURPOSE: To compare the findings of MR cholangiography with those of ultrasound and biochemistry in patients with suspected choledocholithiasis, and to evaluate the clinical utility and role of MR cholangiography prior to laparoscopic cholecystectomy. MATERIALS AND METHODS: We retrospectively reviewed the radiologic findings and clinical records of 103 consecutive patients in whom choledocholithiasis was suspected and who underwent both ultrasound and MR cholangiography. For MR imaging, a 1.5T unit was used, and axial T1-FLASH, True FISP, and oblique coronal HASTE and RARE images were obtained. Initial biochemical values (AST, ALT, total bilirubin) were correlated with the findings of MR cholangiography. RESULTS: Choledocholithiasis was present in 36 of 103 patients: overall, there were 34 true-positive, 63 truenegative, four false-positive, and two false-negative results. In the detection of choledocholithiasis, MR cholangiography showed the following characteristics: sensitivity, 94%; specificity, 94%; positive predictive value, 89%; negative predictive value, 96%; accuracy, 95%. Calculi in the common bile duct were detected in 3 of 33 patients (9%) in whom ultrasound showed that the caliber of the common bile duct was normal and whose laboratory findings were normal, and in 12 of 43 (28%) of those whose common bile duct was dilatated or whose laboratory values were abnormal. Calculi were present in the common bile duct of 21 of 27 patients (78%) with abnormal laboratory values and abnormal ultrasound findings. CONCLUSION: Choledocholithiasis was detected in 25% of patients without clinical suspicion and was not present in 25% of patients with strong clinical suspicion. In patients with this condition, MR cholangiography is noninvasive and accurate, and we suggest that in patients with suspected choledocholithiasis, it should be a routine diagnostic procedure prior to laparoscopic cholecystectomy.
Biochemistry ; Calculi ; Cholangiography* ; Cholecystectomy, Laparoscopic* ; Choledocholithiasis* ; Common Bile Duct ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography

Barrett's esophagus is a metaplasia of the esophageal epithelium of any length, such that normal squamous epithelium is replaced by specialized columnar epithelium with goblet cells. It is important to diagnose and survey Barrett's esophagus because it is believed to be the major risk factor for development of esophageal adenocarcinoma. However, the prevalence of Barrett's esophagus in Korea is low. Mixed connective tissue disease (MCTD) is a systemic disorder in which patients have combinations of the clinical features of systemic lupus erythematosus, systemic sclerosis, and polymyositis. Although gastroesophageal reflux disease is common in esophageal involvement in MCTD, long-segment Barrett's esophagus in MCTD has not been reported in Korea. We report here a 15 cm-long segment of Barrett's esophagus extending to the proximal esophagus in a female patient who has had MCTD for 2 years, and we review the literature.
Adenocarcinoma ; Barrett Esophagus ; Epithelium ; Esophagus ; Female ; Gastroesophageal Reflux ; Goblet Cells ; Humans ; Korea ; Lupus Erythematosus, Systemic ; Metaplasia ; Mixed Connective Tissue Disease ; Polymyositis ; Prevalence ; Risk Factors ; Scleroderma, Systemic