No abstract available.
Immunoglobulins* ; Tuberculosis, Pulmonary*

The treatment of extensive soft tissue injury of the lower extremities is known to be one difficulty in the field of orthopedic surgery. At present, reconstructive surgery with large cutaneous flaps is being employed, and the authors present 2 cases of a combination of flaps for extensive soft tissue injury of the lower extremity at the Department of Orthopedic Surgery of Severance Hospital during a 5 months period from June, 1983 to November, 1983. The results of the study are as follows: 1. A one-stage reconstruction of extensive soft tissue injury was done with a combination of a scapular and a latissimus dorsi flap. 2. There was no limitation of motion of the shoulder in spite of the excision of the scapular and the latissimus dorsi flaps around the axillary area. 3. The primary closure of the donor flap sites was feasible. 4. The reconstructive surgery of the extensive soft tissue injury using the above combination of the scapular and latissimus dorsi flaps can be used without restriction as to the age of the patient.
Humans ; Lower Extremity ; Orthopedics ; Shoulder ; Soft Tissue Injuries ; Superficial Back Muscles ; Tissue Donors

Buerger's disease was first identified in 1908 by Leo Buerger as a distinct clinicopathological entity, which causes severe pain and necrosis on distal parts of the extremities and occurs especially in young male adults. In spite of many treatment modalities, it is not completely cured but results in amputation in the long run. So, we studied a total of 120 cases of Buerger's disease, who were admitted at Yonsei University, Severance Hospital from Jan., 1975 to June, 1985 and we obtained the following results. 1. All the patients were male and majority of them were under 40 years of age (69.2%). 2. 118 cases were smokers and 2 cases were non-smokers. 3. The initial symptoms were resting pain, necrosis, and color change in descending order of frequency. 4. Diagnoses were made mainly by angiogram(75.8%) and most common site of obstruction was popliteal artery (49.4%). 5. After sympathectomy and angioplasty, there was temporary relief of symptoms, but none showed good results after long term follow up. As a result, amputations were performed after sympathectomy in 47 cases(39.2%), of which 36 cases(76.6%) received that surgery within 2 yeas after sympathectomy. 6. The pressure index not only helps diagnose the disease but also is a very useful method to objectively assess the severity of the initial symptoms and postoperative results.
Adult ; Amputation ; Angioplasty ; Clinical Study ; Diagnosis ; Extremities ; Follow-Up Studies ; Humans ; Male ; Methods ; Necrosis ; Popliteal Artery ; Sympathectomy ; Thromboangiitis Obliterans

Tuberculosis of the bones and joints is not an uncommon condition in Korea, but extraosseous tuberculosis of the soft tissue is relatively rare. A few reports of extraosseous tuberculosis, tuberculous tenosynovitis and bursitis, hsve been published in the literature, but there have been no reports concerning soft tissue tuberculosis in other than the tendon, synovium and bursa. We reviewed 7 cases of soft tissue tuberculosis of the lower back at the Department of Orthopedic Surgery, Yonsei University College of Medicine from Jan. 1984 to Sept. 1986. Five cases had received steroid injection to the lumbosscral region, and two had undergone acupuncture, thus all seven cases had experienced injections to the lumbosacral region. We think that a possible route of infection is the hematogenous one, at an area of decreased local resistance after steroid injection, And that direct inoculation of the tuberculous bacilli was result of artificial injection and acupuncture. But, further studies are needed to support the proposal that the hematogenous route following steroid injection and direct inoculation by artifical puncture is the source of soft tissue tuberculosis. These results indicate that steroid injections into the soft tissue should be performed limitedly under sterile conditions.
Abscess ; Acupuncture ; Bursitis ; Joints ; Korea ; Lumbosacral Region ; Orthopedics ; Punctures ; Synovial Membrane ; Tendons ; Tenosynovitis ; Tuberculosis

Because of the extremely limited potential of damaged articular cartilage for either repair or regeneration, and the fact that prosthetic joint replacement is contraindicated for children and young adults due to wear, loosening and mechanical failure of the artificial joint, there is a need for biologieal resurfacing of large, full-thickness defects in diseased or damaged joints by transplantation of a tissue with significant chondrogenic potential. The purpose of this study was to investigate the chondrogenic potential of free intra-articular autografts of the perichondrium or periosteum under the influence of joint motion, to characterize the newly formed cartilage, and to determine which is the more effective method to repair the articular defect. In a rabbit model, rib perichondrium and rib periosteum were used to repair full-thickness defects in the femoral condyle. The newly formed tissue was then evaluated grossly, histologically and histochemically at four, eight and twelve weeks after grafting. Successful grafts of the perichondrium or periosteum proliferate to fill the full-thickness articular cartilage defect with neocartilage which produces glycosaminoglycans in the matrix, as demonstrated by the uptake of saframin O. This production of a large amount of glycosaminoglycans in the reparative tissue is similar to that of hyaline cartilage. Unacceptable results were obtained in 38% of the perichondrial grafts, and in 32% of the periosteal grafts. These failures were due to femoral condyle fractures, and detachment of the grafts or failure of proliferation of the grafts. There was no statistically significant difference between the final results of the perichondrial and periosteal grous(p>0.1). The technique of grafting must be improved to increase the rate of successful grafts in which neocartilage resembling hyaline cartilage fills the articular cartilage defect. The positive results of the present experimental investigation prove that biological resurfacing of full-thickness defects in osteoarthritis, especially of small joints, may be clinically possible through the use of free autogenous perichondrial or periosteal grafts. Such biological resurfacing would be a valuable alternative to prosthetic joint replacement, especially in the treatment of children and young adults.
Autografts ; Cartilage ; Cartilage, Articular ; Child ; Glycosaminoglycans ; Humans ; Hyaline Cartilage ; Joints ; Methods ; Osteoarthritis ; Periosteum ; Regeneration ; Ribs ; Transplants ; Young Adult

Multi-drug resistant tuberculosis is an emerging threat to humans. Despite steady efforts of the national tuberculosis control program, current prevalence of multi-drug resistant tuberculosis rate is increasing in Korea. In Korea, it is effective to both improve the medical transfer system on tuberculosis, and also to make a new tuberculosis patient control system with integrated public-private sector. Improvement focused on the new medical transfer system is a suitable model considering current situation of the Korean medical system. This model can be achieved by replacing the traditional drug susceptibility test method, which requires a long turnaround time, with rapid molecular biological method, and improving the overall process of specimen transport system, report system, and guidelines for tuberculosis, as well. Using such model, doctors can discover multi-drug resistant tuberculosis patients at an earlier stage, prescribe appropriate drugs at the right time, and effectively support directly observed treatment short course strategy. Therefore, this new model for improvement of multi-drug resistant tuberculosis control program, medical transfer system-focused public-private integrated system, can present an effective tool for enhancing and modifying functions of the current national tuberculosis programme in Korea.
Humans ; Korea ; Prevalence ; Tuberculosis ; Tuberculosis, Multidrug-Resistant

Chondroblastoma is a rare primary neoplasm of bone which involves the epiphysis of the long bone and develops mostly in the 2nd decade of life. We reviewed the cases of twenty patients with chondroblastoma who were treated at the Department of Orthopaedic Surgery, Yonsei University College of Medicine between 1969 and 1989. All patients were followed for 1 year or longer. The results were as follows. 1. The proximal end of the humerus(25%) and the proximal end of the femur(25%) were the most common sites. 2. 85% of patients were between 11 to 20 years old and male to female ratio was 3:2. 3. The most common symptom was pain and in 30% of patients it was appeared after minor trauma. 4. The average diameter of lesion is 4.2cm in its long axis and the more longer the duration, the more larger the size of lesion. 5. Involvement of the epiphyseal plate was twice as common in the patients with a closing plate as in those with an open one. 6. The most common microscopic finding was the presence of chondroblast and chondroid matrix. 7. Two patients(10%) had a local recurrence. 8. The final functional results were considered to be good in sixteen(80%) patients. 9. Accurste localization of the lesion during biopsy is very important especially in the case of deep seated lesion.
Biopsy ; Chondroblastoma ; Chondrocytes ; Epiphyses ; Female ; Growth Plate ; Humans ; Male ; Recurrence

Finite Element Analysis ; Humans ; Mandible ; Stress, Mechanical

Objectives: . Prognosticating idiopathic sudden sensorineural hearing loss (ISSNHL) is an important challenge. In our study, a dataset was split into training and test sets and cross-validation was implemented on the training set, thereby determining the hyperparameters for machine learning models with high test accuracy and low bias. The effectiveness of the following five machine learning models for predicting the hearing prognosis in patients with ISSNHL after 1 month of treatment was assessed: adaptive boosting, K-nearest neighbor, multilayer perceptron, random forest (RF), and support vector machine (SVM). Methods: . The medical records of 523 patients with ISSNHL admitted to Korea University Ansan Hospital between January 2010 and October 2017 were retrospectively reviewed. In this study, we analyzed data from 227 patients (recovery, 106; no recovery, 121) after excluding those with missing data. To determine risk factors, statistical hypothesis tests (e.g., the two-sample t-test for continuous variables and the chi-square test for categorical variables) were conducted to compare patients who did or did not recover. Variables were selected using an RF model depending on two criteria (mean decreases in the Gini index and accuracy). Results: . The SVM model using selected predictors achieved both the highest accuracy (75.36%) and the highest F-score (0.74) on the test set. The RF model with selected variables demonstrated the second-highest accuracy (73.91%) and F-score (0.74). The RF model with the original variables showed the same accuracy (73.91%) as that of the RF model with selected variables, but a lower F-score (0.73). All the tested models, except RF, demonstrated better performance after variable selection based on RF. Conclusion . The SVM model with selected predictors was the best-performing of the tested prediction models. The RF model with selected predictors was the second-best model. Therefore, machine learning models can be used to predict hearing recovery in patients with ISSNHL.

BACKGROUND: The neuromuscular blocking effects of a nondepolarizing neuromuscular blocker (NDNM) during a nitroglycerin (NTG) infusion were significantly potentiated and prolonged. NTG reduced the requirement of a NDNM in surgical patients. We investigated the influence of a NTG single bolus injection on a mivacurium nuromuscular blockade. METHODS: We studied 36 adult surgical patients, ASA physical status I or II, between 15 and 53 years old. Neuromuscular monitoring was measured by TOF-GUARD (Biometer Co., Denmark). Anesthesia was induced by thiopental sodium 3-5 mg/kg and fentanyl 3 microgram/kg, and maintained with 3 L/min N2O, 2 L/min O2 and 1 vol.% isoflurane. Patients were randomly assigned to 3 groups: 1) Control group (mivacurium 0.16 mg/kg), 2) N100 group (mivacurium 0.16 mg/kg, NTG 100 microgram), 3) N200 group (mivacurium 0.16 mg/kg, NTG 200 microgram). We measured the train-of-four (TOF) response from the beginning of recovery to the complete regaining of muscle twitch. RESULTS: NTG produced a prolongation of the neuromuscular blocking effect by mivacurium. T1 (contro group: 12.1 +/- 0.5, N100 group: 15.8 +/- 0.4 and N200 group: 11.6 +/- 0.4 min), T25 (16.4 +/- 0.4, 20.5 +/- 0.5 and 14.9 +/- 1.0 min), T75 (22.5 +/- 0.9, 29.4 +/- 0.7 and 20.1 +/- 1.0 min), T95 (27.3 +/- 0.6, 39.6 +/- 0.7 and 24.6 +/- 1.5 min) and the recovery index (6.1 +/- 0.6, 9.0 +/- 0.4 and 5.3 +/- 0.7 min) were significantly prolonged in the N100 and N200 groups (P < 0.05). CONCLUSION: These results suggest that a NTG bolus injection prolonged the neuromuscular blocking effect of mivacurium, dose relatively.
Adult ; Anesthesia ; Fentanyl ; Humans ; Isoflurane ; Middle Aged ; Neuromuscular Blockade ; Neuromuscular Monitoring ; Nitroglycerin* ; Thiopental