The superior volume maintenance of membranous over endochondral bone grafts, which was shown in several studies has provided the basis for its preferred clinical use as an onlay grafting material on the craniofacial skeleton. The scientific rationale for this seeming embryological advantage, however, has never been proven, Since the cortical component of membranous bone is proportionally greater than that of endochondral bone, it follows that membranous grafts would show greater volume maintenance over time. Our hypothesis is that the pattern of onlay bone graft resorption is primarily determined by a graft's micro-architecture (relative cortical and cancellous composition) rather than its embryololgical origin(membranous versus endochondral). Fourty adult New Zealand white rabbits were used for this study. There were 8 animals in each of 4 groups. The rabbits of each group were sacrificed at 3, 8, and 16 weeks. Four types of grafts were placed subperosteally, onto each rabbit's cranium: a hydroxyapatite, a cortical bone graft of membranous origin, a cortical bone graft of endochondral origin and a cancellous bone graft of endochondral origin. Membranous bone grafts were obtained from the lateral mandible and endochondral bone grafts were obtained from the ileum. In order to determine post-sacrifice volume and density of the bone grafts, a caliper technique and bone densitometry(bone densitometer: LUNAR, DPX-L, U.S.A.) were performed on all of the bone grafts. Bone graft specimens were histologically examined at 3, 8, and 16 weeks.The measurement of volume and density show that there is a statistically greater resumption in the cancellous endochondral bone grafts for all parameter, compared to either the endochondral or membranous cortical bone grafts or hydroxyapatite at all time points(p< 0.05). In addition, there is no significant difference in the resorption rates between the endochondral and membranous cortical bone grafts for all parameters at all time points. By placing cortical bone grafts and cancellous bone grafts on the recipient sites separately, we have shown that the former grafts maintain their volumes, widths and projections significantly better than the latter grafts. Futhermore, we found no statistical difference in resorption rates between the two cortical bone grafts of different embryologic origins, a finding which has never been previously shown. Bone volume fraction, measured with bone densitometry, was shown to be higher in cortical bone than in cancellous bone at all time points, further illustrating the differences between cortical and cancellous bone.From our results, we believe cortical bone to be a superior onlay-graftiong material, independent of its embryololgic origin.
Adult ; Animals ; Biological Factors* ; Densitometry ; Durapatite ; Humans ; Ileum ; Inlays* ; Mandible ; Rabbits ; Skeleton* ; Skull ; Transplants*

PURPOSE: To recanalize the occlusive lesion of superficial femoral artery at origin site by retrograde approach via popliteal artery. MATERIALS AND METHODS: 15 patients, who were poor surgical candidates due to coronary artery disease and who had severe occlusive lesion of superficial femoral artery close to its origin with good distal runoffs to popliteal artery, were selected. Patients were all~men and range of age were from 53 years to 66 years (mean age:63 years). Range of lesion length were from 15cm to 30cm (mean length:22.4cm). Localization of popliteal artery was done with Doppler stethoscope or "road-map" DSA. The method of recanalization were transluminal endarterectomy catheter (TEC), TEC and angioplasty, thrombolysoangioplasty (TLA). RESULT: Retrograde puncture of popliteal artery were done in 15 patients successfully. TEC & PTA was performed in 9 patients, TEC only in 2 patients, and TLA & PTA in 2 patients. During the follow-up period of 5 months to 2 years reocclusion did not occurr in 10 patients except for 1 patient with poor cardiac output in whom it occured 1 day later. Remained 4 patients were lost in follow up. Any neurologic or vascular complication did not occur. CONCLUSION: Retrograde approach of superficial fernoral artery via popliteal artery in patients with difficult vascular intervention by common method provides a useful, alternative recanalization method.
Angioplasty ; Arteries ; Cardiac Output ; Catheters ; Coronary Artery Disease ; Endarterectomy ; Femoral Artery* ; Follow-Up Studies ; Humans ; Popliteal Artery* ; Punctures ; Stethoscopes

PURPOSE: To investigate the levels of radiation exposure of an operator which may be influenced by the wearing an apron, type of procedure, duration of fluoroscopy and operator's skill during various interventional procedures MATERIALS AND METHODS: Radiation doses were measured both inside and outside the apron(0.5mm lead equivalent) of the operator by a film badge monitoring method and the duration of fluoroscopy was measured in 96 procedures prospectively. The procedures were 30 transcatheter arterial embolizations (TAE), 25 percutaneous transhepatic biliary drainages (PTBD), 16 stone removals (SR), 15 percutaneous needle aspirations (PCNA) and 10 percutaneous nephrostomies(PCN). To assess the difference of exposure by the operator's skill, the procedures of TAE and PTBD were done separately by groups of staffs and residents. RESULTS: Average protective effect of the apron was 72.8%. Average radiation exposure(unit:micro Sv/procedure) was 23.3 in PTBD by residents, 10.0 in PTBD by staffs, 10.0 in SR, 8.7 in TAE by residents, 7.3 in TAE by staffs, 9.0 in PCN and 6.0 in PCNA. Average radiation exposure of residents were 1.9 times greater than those of staffs. CONCLUSION: Radiation exposure was not proportionally related to the duration of fiuoroscopy, but influenced by wearing an apron, various types o[procedure and operator's skills.
Aspirations (Psychology) ; Film Dosimetry ; Fluoroscopy ; Needles ; Pregnenolone Carbonitrile ; Proliferating Cell Nuclear Antigen ; Prospective Studies

There have long been a lot of controversies on the treatment of unstable thoracolumbar spine fracture, and the role of decompression is also controversial. Compression of the neural elements by retropulsed bone fragments can be relieved indirectly by the reduction with posterior instrumentation or directly by the exploration of the spinal canal through a posterolateral or anterior approach. There is no universal agreement about the indications for each of these method. Authors analyzed the result of 24 cases of thoracolumbar spine fracture which had been operated by anterior decompression and Kaneda instrumentation from the February 1990 to May 1993 at Inha general hospital. The results were as follows: 1. The most common cause of injury was falling from a height, 20 cases (83.3%). And the 12 cases were in the 4th decade, with an average age of 37.7 years. 2. According to McAfee classification, there were 7 stable(29.2%) and 15 unstable bursting fractures(62.5%). And the most common level of injury was L1(11 cases, 45.8%). 3. Neurologic status was improved one or more grade(Frankel grade) in 21 cases except one case of complete paraplegia. 4. The average correctional angle of kyphotic deformity was 13.1° immediate postoperatively, and the loss of correction(average, 6.7°) was observed during the follow-up period. 5. The segmental instability was found at the level below the fusion in three cases during the follow-up period. 6. There was neither failure of instrument, dislodgement of graft bone nor lateral wedging during the follow-up period.
Accidental Falls ; Classification ; Congenital Abnormalities ; Decompression ; Follow-Up Studies ; Hospitals, General ; Methods ; Paraplegia ; Spinal Canal ; Spine ; Transplants

PURPOSE: The purpose of this study was to evaluate early outcomes of ALTA (aluminum potassium sulfate and tannic acid, Ziohn(R)) injection compared with those of a submucosal hemorrhoidectomy for the treatment of internal hemorrhoids. METHODS: From September 2008 to April 2009, a total of 50 patients who had internal hemorrhoids (Golliger grade II to IV) were treated by using either ALTA injection (n=25) or a submucosal hemorrhoidectomy (n=25). Outcomes with respect to pain scores, analgesics use, and satisfaction levels of the patients, and complications were compared. RESULTS: The mean number of hemorrhoidal piles was 3.52 in the ALTA injection group and 3.56 in the operation group. The average amount of ALTA injection was 27.34 cc. Pain scores measured at one day and 7 days after the treatment, and the number of analgesics used in the injection group were significantly lower than those in the operation group (P<0.001). However, there was no significant difference in the satisfaction level between two groups. One case of treatment failure was found in the ALTA injection group. There was no difference in complications between the injection group (n=4) and the operation group (n=5) (P=0.725). CONCLUSION: When compared with a submucosal hemorrhoidectomy, ALTA injection showed less post-treatment pain and less analgesics use. Overall complication rates were not different between the two groups. We found the early outcomes of ALTA injection for the treatment of internal hemorrhoids to be comparable to those of surgery. Thus, large-scale and long-term follow-up studies are needed to clarify the proper indications for ALTA injection.
Analgesics ; Follow-Up Studies ; Hemorrhoidectomy ; Hemorrhoids ; Humans ; Potassium ; Sclerotherapy ; Sulfates ; Tannins ; Treatment Failure

OBJECTIVE: To determine the life expectancy and causes of death of the children with Down syndrome(DS), longitudinal follow-up study was done for 29 cases of DS who were born at CHA hospital located in Seoul During the period from July 1991 to Dec. 1994. METHODS: 29 cases were divided into groups according to the presence of congenital heart disease (CHD) and leukemia. CHD group was subdivided into DS with complete AVSD(atrioventricular septal defect) and DS without complete AVSD. Survival curves were calculated by kaplan-Meier product limit method. Each group were compared by log rank test. The factors affecting mortality rate were analyzed by Cox's proportional hazard regressional model. RESULTS: There were no statistical differences in mortality rate between groups with CHD(35.3%) and without CHD(33.3%)(p=0.7373). Statistical difference was not observed between CHD subgroups with AVSD and with CHD other than AVSD. There were significant statistical difference in mortality rate between groups with leukemia and without leukemia(p=0.0001). CONCLUSION: The factor affecting mortality rate of DS was the presence of leukemia regardless of presence of CHD in our study cases with DS.
Cause of Death ; Child* ; Down Syndrome* ; Follow-Up Studies ; Heart Defects, Congenital ; Humans ; Kaplan-Meier Estimate ; Leukemia ; Life Expectancy ; Mortality ; Seoul ; Survival Analysis*

Fibrolipoma is a rare histological variant of lipoma characterized by proliferation of mature fat and fibrous tissue. Most of the benign lipomatous tumors in the palm reported in the literature developed in the nervous tissue, especially the median nerve sheath. We report an unusual form of fibrolipoma on the palm which arose from the subcutaneous tissue or superficial palmar fascia in the palm, not the nerve or tendon sheath. There was no recurrence 3 years after surgical removal was performed.
Fascia ; Lipoma ; Median Nerve ; Recurrence ; Subcutaneous Tissue ; Tendons

PURPOSE: It is the purpose of this study to investigate the distribution of the refractive error between amblyopic and nonamblyopic eye in the strabismic or anisometropic amblyopia and also evaluate the relationship among refractive error, axial length and the depth of amblyopia. METHODS: We prospectively reviewed the corrected best visual acuity, amount of deviation, cycloplegic refractive error and axial length in a total of 65 patients who are 29 strabismic and 36 anisometropic amblyopic patients from February 1999 to June 2001. RESULTS: Hyperopia was detected in as many as 20 of 29 strabismic (69%) and 22 of 36 anisometropic amblyopia (61%). In strabismic amblyopia the depth of amblyopia is correlated with the degree of hyperopia (r=0.535, p=0.022), not with axial length. In anisometropic amblyopia, the depth of amblyopia is correlated with the degree of hyperopia (r=0.689, p=0.000) and the degree of myopia (r=-0.691, p=0.013), and in especially hyperopic anisometropia, it is correlated with axial length (r=0.513, p=0.017). CONCLUSIONS: Hyperopia was the major refractive error in strabismic and anisometropic amblyopia and the depth of amblyopia is correlated with degree of hyperopia. In hyperopic anisometropic amblyopia, the greater the depth of amblyopia, the shorter the axial length.
Amblyopia* ; Anisometropia ; Humans ; Hyperopia ; Myopia ; Prospective Studies ; Refractive Errors* ; Visual Acuity

A murime monoclonal antibody (mAb) specific for the envelope glycoprotein gp120 of human immunodeficiency virus type-I (HIV-1) was chemically coupled to pokeweed antiviral protein (PAP) from Phytolacca americana. The immunotoxin was purified by FPLC using 5200 colum. The purified immunotoxin efficiently bound to HIV-infected T cells as evidenced by fluorescence-activated cell sorter analysis. The immunotoxin selectively killed human T lymphoid lines infected with HIV-lIIIB at less than 250 pM of the immunotoxin cells, while PAP or mAb alone did not have any significant effect on infected cells. The uninfected control T cell lines were not affected. Human cells infected with HIV-2 or other HIV-1 strains were not killed, suggesting that the killing depends completely on the antibody used for coupling. These in vitro results suggest that the PAP-mAb conjugate may be used to selectively remove cells expressing viral antigens from individuals infected with HIV.
Antigens, Viral ; Cell Line ; Glycoproteins ; HIV ; HIV-1 ; HIV-2 ; Homicide ; Humans* ; Immunotoxins ; Phytolacca americana* ; T-Lymphocytes*

PURPOSE: Authors investigated the associated findings and their value in the diagnosis of anterior cruciate ligament(ACL) injury in MR image. MATERIAL AND METHODS: The knee MR images of 47 patients with ACL injury(complete; 24, partial; 23) and 61 patients with normal ACL confirmed by the knee arthroscopy or operation were reviewed retrospectively. The degree of anterior translocation of tibia and the degree of posterior cruciate ligament(PCL) buckling were evaluated. The prevalence and pattern of associated adjacent bone, ligament and meniscus injuries were studied. RESULTS: The means( +/- 2standard errors) of anterior translocation were different significantly in statistical analysis(p<0.001, student t-test) between injury group(7.51 +/- 1.16mm) and normal group(-0.56 +/- 0.92mm). In the level of 5mm of anterior translocation for the criteria of ACL injury, the sensitivity, specificity, accuracy were 78.7%, 89.5%, 84.3% for each. The means of PCL buckling ratio were also different statistically b. etween injury group(0.23 +/- 0.02) and normal group(0.17 +/- 0.01)(p<0.001). In the level of 0.20 for diagnostic criteria of ACL injury, the sensitivity, specificity, accuracy were 71.4%, 83.6%, 78.4% for each. Thirty one medial meniscus tear(66%), thirteen lateral meniscus tear(28%), ten medial collateral ligament injury(28%), one PCL injury (2%) were associated with ACL injury. The twenty nine bone marrow changes were found in twenty patients {43%) which included acutely injured seven patients. In acute cases, the bone marrow changes were depicted as diffuse or focal high signal intensity lesions in lateral femoral or tibial condyles in contrast to the changes in chronic cases depicted as focal low signal intensity lesions in variable location. Lateral femoral condylar notch depression were found in nine patients(19%) and avulsion fractures of anterior tibial spine in four patients(9%). CONCLUSION: The associated findings with ACL injury (anterior translocation, buckling of PCL, associated bone, ligament and meniscus injuries) are considered to be helpful in the diagnosis of ACL injury on Knee MR images, when the findings of anterior cruciate ligament itself are not confirmative.
Anterior Cruciate Ligament* ; Arthroscopy ; Bone Marrow ; Collateral Ligaments ; Depression ; Diagnosis ; Humans ; Knee ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Prevalence ; Retrospective Studies ; Sensitivity and Specificity ; Spine ; Tibia