Limb salvage operation in primary malignant bone tumors is increasing recently, according to the improvement of diagnostic methods, surgical technique and adjuvant chemotherapy. The purpose of this study is to obtain the interim results of survival rate and the functional grade of the limb in primary malignant bone tumors treated by limb salvage operation. Between 1985 to 1993, 63 primary malignant bone tumors treated by limb salvage operations. Tumor prosthesis arthroplasty was performed in 49 patients, resection arthrodesis in 9 patients, and IM nailing with cement molding in 5 patients. Autoclave autograft was combined in 2 patients. Adjuvant chemotherapy and postoperative radiotherapy were performed in selected patients. The average follow-up period was 50 months(ranged 12 months to 116 months). In the cases of osteosarcoma, estimated survival rate was 61.9% based on Kaplan-Meier survival plot. In the parosteal sarcoma, the survival rate was 87.5% and 80% in chondrosarcoma patients. According to functional grading by Enneking, 66% was excellent, 20% was good, 11% was fair and one patients was poor. Complications occurred in 16 patients:wound infection was developed in 6 patients, local recurrence in 4, peroneal nerve palsy in 2 patients and femoral stem loosening in 2 patients. Fracture in resection arthrodesis and pulmonary metastasis were also occurred. Reoperation was performed in 10 patients at average 31 months after initial operation. Revision tumor persthesis arthroplasty was performed in one patient due to local recurrence and in 2 patients due to femoral stem loosening. Three amputations were done due to recurrence of tumor. IM nailing with cement molding was performed in one patient due to deep infection and repeated arthrodesis was done in a fracture patients. Scheduled custom-made tumor prosthesis arthroplasty was performed within a year in 2 patients treated with IM nailing with cement molding. In conclusion, with the careful preoperative assessment, adjuvant chemotherapy and skillful surgical technique, limb salvage operation would provide the primary malignant bone tumor patients for longer survival and better quality of life.
Amputation ; Arthrodesis ; Arthroplasty ; Autografts ; Chemotherapy, Adjuvant ; Chondrosarcoma ; Extremities ; Follow-Up Studies ; Fungi ; Humans ; Limb Salvage ; Neoplasm Metastasis ; Osteosarcoma ; Paralysis ; Peroneal Nerve ; Prostheses and Implants ; Quality of Life ; Radiotherapy ; Recurrence ; Reoperation ; Sarcoma ; Survival Rate

When the non-union gap in a long bone is more than half of the diameter of the bone at that level, it presents a significant challenge to traditional bone grafting technique. Even if there are several good ways for this problem, such as shortening, traditional various bone grafting, electrical stimulation and free vascularized bone graft, most of these techniques have some difficulties to maintain the stability of fracture post-operatively, and we have to keep their extremities into a cast or external fixator so long. So we have attempted to treat the large osseus gap non-union in long bone with fixation of heavy duty or condylar plate on one side of fracture for fracture stability, a long tibial corticocancellous strut graft on the other side of fracture for fracture stability and rapid bony union, and extensive cancellous chip bone graft between the plate and tibial graft to enhance the bony union. We have experienced 9 cases of large osseus gap non-union in long bone with this technique from March 1981 to September 1986 at the department of orthopaedic surgery, St. Mary's hospital, Catholic University Medical College. 1. Their, 7 males and 2 females, average age was 38 years old, with a range of 24 to 53 years old. The distribution of the involved bone was 6 femur, 2 humerus, 1 radius and ulna with 1.4 years of average duration of non-union, ranged from 7 months to 2.4 years. The average gap from normal bone to normal bone was 4.8cm, with a range of 2.7cm to 7.4cm. The average number of previous surgical procedures was 4, with a range of 2 to 7. Four of the nine patients had quiescent osteomyelitis. 2. Post-operative immobilization with splint or cast was applied for 6 weeks for upper extremity and 8 weeks for lower extremity followed by active R.O.M. exercise and non-weight bearing crutch walking. 3. Five of the nine cases(55.6%) had completely bony union. This occured on an average 8 months post-operatively and was faster in the forearm bones and femur than in the humerus. An additional cancellous bone graft was done in two. But other two of the patients had subsequent amputation because of recurrent and uneontrollable osteomyelitis stirred up by the surgery. 4. This procedures was proved to be one of valuable adjuvant method in treatmqnt of large osseous gap non-union of long bones.
Amputation ; Bone Transplantation ; Electric Stimulation ; External Fixators ; Extremities ; Female ; Femur ; Forearm ; Humans ; Humerus ; Immobilization ; Lower Extremity ; Male ; Methods ; Osteomyelitis ; Radius ; Splints ; Transplants ; Ulna ; Upper Extremity ; Walking

PURPOSE:The project of the neonatal mass screening test for inborn errors of metabolism are just at the beginning in Korea and there was a few reports about the overall incidence and subtypes of congenital hypothyroidism. METHODS:In this study, we analysed the 97 cases of newborns with hyperthyrotropinemia who were detected by neonatal screening test to identify the incidence and early clinical manifestations of each subtypes of congenital hypothyroidism. Thyroid function were measured by thyrotropin(TSH) level, T4, T3, Free T4, Free T3, thyroglobulin, T3 resin uptake, TBII, TBG in serum, thyroid ultrasonography and 99mTc thyroid scan. We reanalysed the thyroid functions 1 week after discontinuance of L-thyroxine treatment for 1 year. RESULTS: 1) The time of neonatal screening test were between 3 and 7 days after birth in 46 cases(47.4%) and 8 and 14 days after birth in 35 cases(36.1%). Two cases (2.1%) were done neonatal screening test at the age of 2 days old. 2) The major cause of thyroid disorders were primary hypothyroidism in 45 cases of the total due to thyroid aplasia(7 cases), thyroid hypoplasia(17 cases), ectopic thyroid gland(12 cases) and dyshormonogenesis(9 cases). Other causes of thyroid disorders were TBG deficiency(11 cases), TBG dysfuction(1 case), transient hyperthyrotropinemia(28 cases) and transient hypothyroidism(12 cases). 3) Serum level of thyrotropin(TSH) at diagnosis were 223.5+/-229.6microU/ml in thyroid aplasia, 41.6+/-42.9microU/ml in thyroid hypoplasia, 52.4+/-55.6microU/ml in ectopic thyroid gland. TSH levels were significantly high in thyroid aplasia. T4 levels in thyroid aplasia are 1.7+/-2.0microg/dl and this is significantly lower than other types of thyroid disorders. T3 levels were within normal range except in thyroid aplasia and TBG deficiency. 4) Prolongation of physiologic jaundice was the most common clinical manifestation(33.3%) in patients with primary hypothyroidism and macroglossia, hypothermia, umbilical hernia and cold skin were the next commom clinical manifestations in order to present. 5) Osseous development was normal in 57 cases(82.6%) out of 69 cases who accomplished roentgenographic examination of knees. Only 12 cases(17.4%) showed retardation of osseous development, but there was no significant differences between types of thyroid disorders. 6) Most of the newborn(93.3%) with primary hypothyroidism started to treatment within 8 weeks of age. 7) Initial dosage of L-thyroxine was 10microg/kg/day and decreased 6 to 12 months after treatment. 8) There was significantly decreased thyroid uptake of 99mTc after 1 year follow-up in 5 cases of dyshormonogenesis. 9) The serum TSH levels returned to normal ranges within 6 month after treatment in transient hypothyroidism and transient hyperthyrotropinemia. CONCLUSIONS:Special attention should be paid to transient hyperthyrotropinemia and transient hypothyroidism because many of the congenital thyroid disorders showed transient type and it is necessary to establish the diagnostic guideline to early detect these transient types of congenital thyroid disorders.
Congenital Hypothyroidism ; Diagnosis ; Follow-Up Studies ; Hernia, Umbilical ; Humans ; Hypothermia ; Hypothyroidism ; Incidence ; Infant, Newborn ; Jaundice ; Knee ; Korea ; Macroglossia ; Mass Screening ; Metabolism, Inborn Errors ; Neonatal Screening* ; Parturition ; Reference Values ; Skin ; Thyroglobulin ; Thyroid Dysgenesis ; Thyroid Gland* ; Thyroxine ; Ultrasonography

OBJECTIVES: Alzheimer's disease(AD) and mild cognitive impairment(MCI) affect several nervous structures involved with the autonomic nervous system. Association between neuropsychiatric deficits and heart rate variability has been observed. But cardiac autonomic function in AD has been scarcely studied and the results reported are conflicting. We investigated autonomic function in normal control, MCI, AD using heart rate variabil-ity(HRV) technique. METHODS: Time and frequency-domain variability of 5-min R-R interval series was comparatively evaluated in 26 normal control subjects, 22 MCI subjects and 34 AD subjects. Analysis of variance(ANOVA) was used to compare the differences across groups. Correlations between MMSE-KC and HRV components were performed using Pearson's correlation coefficient. RESULTS: No significant difference was observed among the groups in time, frequency-domain analysis of HRV (p>0.05). HRV were not found to be significantly correlated with the degree of cognitive impairment. CONCLUSIONS: There were no differences in HRV with MCI, AD subjects when compared with normal controls. Further investigation is required to use HRV technique as noninvasive parameters of MCI and AD.
Alzheimer Disease ; Autonomic Nervous System ; Heart ; Heart Rate ; Mild Cognitive Impairment

We report a rare case of intrathoracic lymphangiomatosis associated with chylothorax in a 3-year-old boy. The patient had been healthy until he had chickenpox followed by continued dyspnea. The biopsy specimen showed proliferating lymphatic channels & spindle cells in the lung tissue. The boy died of respiratory failure despite conservative treatment and surgical treatment with pleurodesis. An autopsy was performed. Pleura and pericardium showed severe adhesion to the right lung parenchyma. The cut surface of lung showed thickened interlobular septum with honeycomb-appearance. Histologically, extensive intercommunicating and anastomosing endothelial-lined lymphatic channels were noted along the visceral and parietal pleura, pericardium, around the great vessels, and in the anterior mediastinum over the thymus. These lymphatic channels infiltrated into the pulmonary parenchyme along the bronchovascular bundles. There were scattered areas of spindle cell proliferation with extravasation of RBCs mimicking Kaposi's sarcoma. Histologic diagnosis and differential diagnosis on biopsy materials can be difficult to establish but awareness of the intrathoracic lymphangiomatosis and its various clinical presentation may be helpful for diagnosis.
Autopsy* ; Biopsy ; Cell Proliferation ; Chickenpox ; Child, Preschool ; Chylothorax ; Diagnosis ; Diagnosis, Differential ; Dyspnea ; Humans ; Lung ; Male ; Mediastinum ; Pericardium ; Pleura ; Pleurodesis ; Respiratory Insufficiency ; Sarcoma, Kaposi ; Thymus Gland

In autopsy, the evaluation of the size and weight of th internal organs is very important for the understanding of the pathologic conditions. The normal data of the internal organs must have regard to size, weight, sex, age and body weight. There are many reports on the normal value of human organs in Japan and other Western countries. But there are some variations in normal value according to race, geographics and living standard. In Korea, Lee & Roh had reported on weights of various organs of Korean and their proportional weights to body weights in 1957, based upon autopsy records from 1929 to 1941. But, there has been many improvement in socioeconomic status during past half-century in this country. And the Korean body conditions have much improved. Upon the base of above consideration, normal data fit for present Korean is mandatory. We have analysed records of 45 cases of Korean young adults's autopsy cases which were performed from Jan. 1984 to Dec. 1985, and obtained following data. The results obtained are as follows: Heart : left ventricle thickness; 1.76+/-0.3 cm right ventricle thickness; 0.5+/-0.1 cm Aorta circumference; 6.1+/-0.5 cm Pulmonary a. circumference; 7.0+/-0.7 cm Weight : 338+/-54 gm Lung : size: left; length 23.3+/-2.78 cm, width 12.3+/-2.28 cm, thickness 6.4+/-1.55 cm right; length 24.1+/-2.65 cm, width 14.7+/-2.95 cm, thickness 6.6+/-1.31 cm Weight : left; 541+/-117 gm, right; 634+/-118 gm Liver : size: greatest transverse measurement; 28.5+/-2.7 cm vertical measurement; 16.6+/-1.74 cm great anterior-posterior diameter; 8.8+/-1.51 cm weight: 1,559+/-267 gm Spleen : length: 12.7+/-2.1 cm, breadth: 8.4+/-1.5 cm, thickness: 3.4+/-1.1 cm, weight: 155+/- 69.3 gm Pancreas : length; 16.7+/-2.8 cm, weight: 111+/-34.5 gm Kidney : size: left; length; 11.2+/-0.7 cm, width; 5.9+/-0.7 cm, thickness; 3.8+/-0.8 cm, thickness; 3.6+/-0.7 cm weight: left; 150+/-25 gm, right; 138+/-29 gm Brain : weight: 1,498+/-132 gm
Adult ; Male ; Female ; Humans

No abstract available.
Amino Acids* ; Animals ; gamma-Aminobutyric Acid* ; Horns* ; Neurons* ; Rats* ; Receptors, GABA*

Our present knowledge of impetigo contagiosa extends from its first description as a separate clinical entity by Fox in I864, and the proof of its bacterial etiology by Radcliffe-Crocker in 1881. Both staphylococci and streptococci have been discovered from the lesions, but the relative preponderance of each varies greatly, and reports are contradictory. Seventy-eight patients with impetigo contagiosa were studied bacteriologically in order to ascertain the primary etiologic agent. Also, a susceptibility test (Bauer- Kirby method) was done on the isolated organisms with 7 antibiotics which are used frequently in the clinical field. Specimens obtained from the skin lesions were cultured and organisms were isolated. They were identified by various biochemical and serological tests. A DN ase test, a carbohydrate fermentation test, and a coagulase test were done for the isolated staphylococci. A bacitracin disc method and a precipitin test(Lancefield method) were done for the isolated B-hemolytic streptococci. The results were as follows: Fifty-six cases(71.8%) were infected by staphylococcus only. Twenty cases(25.6%) were infected by a mixture of staphylococcus and p-hemo- lytic streptococcus. Only 2 cases(2.6%) were infected by B-hemolytic streptococcus alone. All 76 strains of staphylococci were identified as coagulase positive staphylococci. Among the 22 strains of B-hemolytic streptococci, 15 strains were identified as group A and remaining 7 strains were identified as group B. Coagulnse negative sta,phylococcus was not found. In the susceptibility test to 7 antibiotics, staphylococci showed susceptibility to lincomycin, erythromycin, cloxacillin, and chloramphenicol, and resistance to tetra-cycline, penicillin, and ampicillin. Streptococci showed susc.ptibility to all of the above antibiotics except tetracycline. From the results of this experiment, it was concluded that the primary etiologic agent of impetigo contagiosa was coagulase positive staphylococcus and streptococcus for the most part can be considered as a secondarily infecting agent. Coagulase negative staphylococcus apparently is not implicated as an etiologic agent of impetigo contagiosa. The results of the antibiotic susceptibility tests would seem to indicate that the use of such antibiotics as tetracycline, penicillin, and ampicillin is not indicated in the treatment of impetigo contagiosa.
Ampicillin ; Anti-Bacterial Agents ; Bacitracin ; Chloramphenicol ; Cloxacillin ; Coagulase ; Erythromycin ; Fermentation ; Humans ; Impetigo ; Lincomycin ; Penicillins ; Serologic Tests ; Skin ; Staphylococcus ; Streptococcus ; Tetracycline

To 48 adult patients general and spinal anethesia was administered for elective orthopedic (intra-thoracic and extremity) and abdominal(general and gynecological) operations. Radial artery was cannulated and postoperative change of PaO2 was observed for 7days. The results are as follows: 1) General anesthesia administered for operations on the legs results in a reduction of PaO₂ which is maximal immediately after discontinuation of anesthesia, gradually returns toward normal in a 3-hour period, and becomes normal on the first postoperative day. 2) General anesthesia administered for thoracomy and laparotomy is followed by the same early changes, which do not return toward normal in the first 3 hours. Reduciton of PaO₂ persists, and PaO₂ continue to deteriorate for several days, not completely returning to normal even 7days post-operatively. 3) When spinal anesthesia is administered for laparotomy, PaO₂ does not begin to fall untill several hours after the end of operation. The subsequent course follows as that in 2, above. 4) When spinal anesthesia is administered for operation on the legs, PaO₂ does not change significantly throughout the postoperative period. 5) Thus, it is concluded that late forms of postoperative hypoxemia is influenced primarily not by the method of anesthesia, but by site of operation.
Adult ; Anesthesia ; Anesthesia, General ; Anesthesia, Spinal ; Anoxia ; Humans ; Laparotomy ; Leg ; Methods ; Orthopedics ; Oxygen ; Postoperative Period ; Radial Artery

The deformed and rigid spine presenting moderate to severe kyphosis and scoliosis results in a restriction of function of the lung best characterized spirographically by a reduction in vital capacity. When the lesion involves the thoracic spine, restriction of function is more marked. Spinal deformities such as kyphosis and scoliosis develop from various causes. Tuberculous spondylitis, a main cause of kyphosis and scoliosis, is increasingly found in Korea. Cardiorespiratory dysfunction caused by spinal deformity poses another problem besides the spinal deformity perse. To perform therapeutic measures such as Harrington instrumentation, with or without preoperative localizer cast and halofemoral traction, as well as anterior interbody fusion, evaluation of pulmonary function and arterial gas analysis preoperatively is helpful to prevent and reduce postoperative cardiorespiratory failure or complications. The authors have reviewed the results of arterial gas analyses and pulmonary function tests on 35 cases of scoliosis and 60 cases of kyphosis done at the Department of Orthopedic Surgery, Seoul National University Hospital, from January 1975 to February 1978. The results were as follows: 1. Average degree of scoliosis in 35 cases was 89; vital capacity 60% of normal, and maximum breathing capacity 72%. Average degree of dorsal spine kyphosis in 38 cases was 93.5; vital capacity 38%, and maximum breathing capacity 73% Average degree of lumbar spine kyphosis of 22 cases was 79; vital capacity 77%, and maximum breathing capacity 84%. 2. Static values for pulmonary function such as vital capacity and dynamic values such as maximum breathing capacity hed a significant negative correlation with the severity of scoliosis and kyphosis. 3. Decrease in vital capacity due to scoliosis and kyphosis correlated positively with decrease in maximum breathing capacity. 4. Arterial oxygen saturation had a significant negative correlation with the severity of scoliosis and kyphosis.
Congenital Abnormalities ; Korea ; Kyphosis ; Lung ; Orthopedics ; Oxygen ; Respiration ; Respiratory Function Tests ; Scoliosis ; Seoul ; Spine ; Spondylitis ; Traction ; Vital Capacity