We have experienced 11 cases of large bony defect that were treated using microsurgery since 1981. Free vascularized bone transplantation was performed in 8 of them, vascularized bone transposition in 2 cases, and free vascularized joint transplantation in the remaining 1 case. The causes of the large bony defect were primary bone tumor (4 cases), congenital pseudoarthrosis (3 cases), open comminuted fracture (2 cases), sequela of osteomyelitis (1 case), and post-traumatic ankylosis of PIP joint of second finger (1 case). As a donor, fibula was used in 8 cases, iliac crest in 1 case, rib in 1 case and in the remaining 1 case, the second M-P joint of foot was transplanted. In 9 of 11 cases, successful result was obtained and 2 cases were failed because of vascular damage following tibial lengthening in one case and infection on the grafted area in the other one. From the above data and review of articles, following conclusions were obtained. 1. Fibula is thought to be the most appropriate donor for the large bony defect in the extremity, especially in lower extremity, but the donor site must be determined according to the anatomical and physilogical condition of the patient. 2. After mechanical lengthening of the extremity, it is recommened to perform the microvascular surgery after sufficient time for the recovery of vascular damage. But further studies are required for the identification of the change in the vascular tissue following stretching and its recovery time. 3. Progression of the ossification in the epiphysis of transplanted iliac crest was observed and this finding proposed us the idea that the epiphyseal plate injury or leg length discrepancy will be able to be treated with free vascularized epiphyseal plate transplantation and the reconstruction of the destroyed joint of growing children will be possible using free vascularized joint transplantation. 4. As the technique become more popular, the free vascularized bone transplantation is being used for the reconstruction of the extremity more frequently, but it seems to be wise to restrict its indication to cases which are impossible to be treated with more simple methods such as vascularized bone transposition or pedicled bone graft.
Ankylosis ; Bone Transplantation ; Child ; Epiphyses ; Extremities ; Fibula ; Fingers ; Foot ; Fractures, Comminuted ; Growth Plate ; Humans ; Joints ; Leg ; Lower Extremity ; Microsurgery ; Osteomyelitis ; Pseudarthrosis ; Ribs ; Tissue Donors ; Transplants

In patients disabled by severe rheumatoid and degenerative arthritis of both knees, bilateral total knee arthroplasty(TKA) afforded much functional improvement in pain relief and function. Postoperative results of bilateral TKA was described as being similiar to those observed among patients with single joint replacement. The purpose of this study is to evaluate the etiology and postoperative result of bilateral TKA performed on 32 knees in 16 patients at Department of Orthopedic Surgery, Seoul National University Hospital from Mar. 1985 to Oct. 1988. In our series, there were 15 females and only 1 male, their mean age was 53 years. Duration of follow up was ranged from 1 to 4 years and 5 months being average 1 year and 6 months. The results were as follow. 1. Cheif complaints were pain in 18 cases(100%) and difficulty in walking in 15 cases(82%). 2. Preoperative etiology was rheumatoid arthritis in 11 cases and degenerative arthritis in 7 cases. 3. Knee joint function by HSS(Hospital for Special Surgery) knee rating score was increased from 44.6 points preoperatively to 81.2 points postoperatively. 4. The tibiofemoral angle was changed from 1.4 degree varus to 4 degree valgus. 5. The prothesis type used were PFG(Press Fit Condylar) in 22 knees, Miller-Galante in 8 knees, AMK in 3 knees, PCA in 2 knees and unicompartmental type in 1 knee. 6. Complication were 1 case of knee fusion due to concomittant tuberculous arthritis and mild joint effusion in 6 knees. 7. Bilateral one-stage arthroplasty may be considered as an alternative procedure.
Arthritis ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Female ; Follow-Up Studies ; Humans ; Joints ; Knee ; Knee Joint ; Male ; Orthopedics ; Osteoarthritis ; Passive Cutaneous Anaphylaxis ; Seoul ; Walking

M-mode echocardiograms were recorded in 268 apparently healthy young male adults and the mitral valve motion during systole was analyzed. In 149 cases( 55.6%) out of 268 the predominant echo of mitral valve closure(CD line) was recorded as smooth line moving slowly anteriorly, in 48 cases(17.9%) the CD line showed an abrupt transient posterior motion during early systole, in 24 cases(9.0%) there were multiple additional echoes posterior to the CD line, 17 cases(6.3%) the mitral valve closure was recorded as pansystolic anteriorly concave echo deviating less than 2 mm from a drawn CD line, and 10 cases(3.7%) as curvilinear and anteriorly convex echo deviating from a drawn CD line. In the remaining 20 cases(7.5%), the mitral valve closure was recorded as pansystolic anteriorly concave echo deviating more than 2 mm from a drawn CD line, which was categorized to have mitral valve prolapse in the current study. However, there were no significant differneces in various echocardiographic dimensions of the heart and the aorta between those with and without mitral valve prolapse.
Adult ; Aorta ; Echocardiography* ; Heart ; Humans ; Male* ; Mitral Valve Prolapse* ; Mitral Valve* ; Systole

Cardiovascular disease is the most important cause of unexpected sudden death. Although ischemic heart disease by coronary atherosclerosis is the most common cause of sudden cardiac death, other diseases such as cardiomyopathy, congenital heart disease, valvular heart disease and rarely myocarditis can produce sudden cardiac death. Myocarditis is an inflammatory process of the myocardium characterized by an interstitial inflammatory infiltrate and an injury to myocytes adjacent to the inflammatory cells. The clinical expression of myocarditis ranges from the asymptomatic state to fulminant fatal congestive heart failure. Because myocardial involvement is subclinical in most acute infectious disease, the majority of patients have no specific complaints referable to the cardiovascular system. It is possible that it causes a medicolegal problems in case of sudden death. Therefore, author reviewed the clinical and pathological findings of 18 myocarditis autopsy cases. The victims 'age was varied 4-month-59-year olds. 5 (28%) were male and 13 (72%) were female. 15 cases received medical treatment due to clinical symptoms(URI symptoms: 2 cases, tonsillitis and tonsillar abcess: 3 cases, GI symptoms: 5 cases, URI & GI symptoms: 3 cases, pneumonia: 1 case, operation due to ovarian tumor: 1 case) and were associated with medicolegal problem. By the results of this study, important gross findings were pericardial effusions, characteristic cardiomegaly, and pulmonary edema.
Asymptomatic Diseases ; Autopsy ; Cardiomegaly ; Cardiomyopathies ; Cardiovascular Diseases ; Cardiovascular System ; Communicable Diseases ; Coronary Artery Disease ; Death, Sudden ; Death, Sudden, Cardiac ; Female ; Heart Defects, Congenital ; Heart Failure ; Heart Valve Diseases ; Humans ; Male ; Muscle Cells ; Myocardial Ischemia ; Myocarditis* ; Myocardium ; Palatine Tonsil ; Pericardial Effusion ; Pneumonia ; Pulmonary Edema ; Tonsillitis

A retrospective analysis of 36 cases of petrous pyramid fractures was studied clinically and radiographically during last 5 years. Of 503 patients with skull fractures admitted to the Inha University hospital, of which 7.1% involved the petrous pyramid. The most common mode of injury was a motor vehicle accident and the most common age group was the first decade. The anatomic location of fractures in the petrous pyramid were evaluated by high resolution computed tomography and it disclosed 20 longitudinal and 16 transverse fractures. The principal symptoms and signs, occurring alone or in combination, were a otologic problem, facial paralysis and CSF liquorrhea. The otologic problems were noted in almost every case. The facial palsy and CSF liquorrhea were present in 16 cases(36%) and 9 cases(25%), respectively. The anatomic type of fractures well corresponded to the principal symptoms and signs and the prognosis, the development rate of principal symptoms and signs of the transverse fracture was more higher and the prognosis of that was worse than the longitudinal fracture.
Facial Paralysis ; Humans ; Motor Vehicles ; Petrous Bone* ; Prognosis ; Retrospective Studies ; Skull Fractures

Suicidal strangulation by ligature (so-called self-strangulation) is distinctly uncommon. It is distinct from self-suspension in cases of hanging, the latter being a far more common form of suicide. Suicidal strangulation by ligature must be separated from homicidal strangulation by ligature. But clear distinction between the homicidal and suicidal strangulation by ligature is often impossible on the basis of the anatomical findings alone, although fractures of the larynx in suicidal strangulations are distinctly unusual. An accurate evaluation of circumstances, a thorough post-mortem examination, and inspection of the scene are extremely important in such cases. It is equally important to examine the type of noose and knot as well as the number of turns around the neck. We reports three cases of suicidal strangulation by ligature with brief review of literature.
Asphyxia ; Autopsy ; Larynx ; Ligation* ; Neck ; Suicide

One case of the iatrogenic injury of carotid artery is reported. The deceased person was a 54-yearold woman. She visited a local clinic because she had the severe pain on back and neck and the radiating pain of left lower extremity. Under the diagnosis of the herniated cervical disc, the operation was performed. After five hours from starting the operation, respiratory difficulty, facial cyanosis and syncope were found, suddenly. Cardiopulmonary resuscitation was performed, however eventually she died. The autopsy was performed. In the neck, large hematoma at the posterior portion of neck organ and perforation of right carotid artery were noted.
Autopsy* ; Cardiopulmonary Resuscitation ; Carotid Arteries* ; Cyanosis ; Diagnosis ; Female ; Hematoma ; Humans ; Lower Extremity ; Neck ; Syncope

We reviewed forensic autopsies and scene examinations performed at Central District of National Institute of Scientific Investigation, requested by every kinds of law enforecement agencies in Chungcheong area of Korea during the year of 2004, and analysed the data of forensic autopsies and scene examinations according to the cause of death and the manner of death. The results are as follows ; 1. Scene examination on the spot was performed in 49 cases ; Among these cases, 36 cases(73.5%) were unnatural deaths and the most common cause of death was trauma(20 cases). Autopy was performed in 23 cases(46.9%). 2. The total number of forensic autopsy were 643 cases(437 males and 206 females). The number of the forties(156 cases) and the thirties(114 cases) occupied almost half(42.0%) of all cases of autopsy. 3. Unnatural deaths were 448 cases(69.7%), natural 169 cases(26.3%), and the unknown 26 cases(4.0%). In 448 cases of unnatural deaths, suicide was 133 cases(29.7%), homicide 180 cases(40.2%), accident 86 cases(19.2%), and the undetermined 49 cases(10.9%). Homicide occupied 70.2% of trauma, 65.2% of blunt force injury excluding traffic and fall-down injury, and 83.6% of sharp force injury. The homicide rate in asphyxia was 35.8%. It showed no case of homicide in poisoning. 4. In 448 cases of unnatural deaths, traumatic deaths were 198 cases(44.2%). Blunt trauma was 61 cases(30.8%) and the leading cause of death in traumatic death. Of remaining 250 cases of unnatural deaths, there were 67 cases(14.2%) of asphyxia, 63 cases(14.1%) of thermal injuries, 59 cases(13.2%) of drowning, 49 cases(10.9%) of poisoning, and 10 cases(2.2%) of medical procedures. 5. Among 169 natural deaths, cardiac diseases were 98 cases(56.0%) and the leading cause of death in natural deaths. 29 cases(17.2%) of diseases involving digestive system and 26 cases(15.4%) of disease involving vascular system were followed. 6. Child deaths under the age of 10 were 35 cases. Among these cases, unnatural deaths were 21 cases(60.0%) and most of them were homicide and accident.
Asphyxia ; Autopsy* ; Cause of Death ; Child ; Digestive System ; Drowning ; Heart Diseases ; Homicide ; Humans ; Jurisprudence ; Korea* ; Male ; Poisoning ; Suicide

BACKGROUND: Suspension ligamentoplasty using abductor pollicis longus (APL) tendon without bone tunneling, was introduced as one of the techniques for treatment of advanced first carpometacarpal (CMC) arthritis. The purpose of this study was to evaluate the radiologic and clinical results of APL suspension ligamentoplasty. METHODS: The medical records of 19 patients who underwent APL suspension ligamentoplasty for advanced first CMC arthritis between January 2008 and May 2012 were reviewed retrospectively. The study included 13 female and 6 male patients, whose mean age was 62 years (range, 43 to 82 years). For clinical evaluation, we assessed the grip and pinch power, radial and volar abduction angle, thumb adduction (modified Kapandji index), including visual analogue scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Radiologic evaluation was performed using simple radiographs. RESULTS: The mean follow-up was 36 months (range, 19 to 73.7 months). Mean power improved from 18.3 to 27 kg for grip power, from 2.8 to 3.5 kg for tip pinch, and from 4.3 to 5.4 kg for power pinch. All patients showed decreased VAS from 7.2 to 1.7. Radial abduction improved from 71degrees preoperatively to 82degrees postoperatively. The modified Kapandji index showed improvement from 6 to 7.3, and mean DASH was improved from 41 to 17.8. The height of the space decreased from 10.8 to 7.1 mm. Only one case had a complication involving temporary sensory loss of the first dorsal web space, which resolved spontaneously. CONCLUSIONS: The APL suspension ligamentoplasty for treatment of advanced first CMC arthritis yielded satisfactory functional results.
Adult ; Aged ; Aged, 80 and over ; Carpometacarpal Joints/*surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Osteoarthritis/*surgery ; Postoperative Complications ; Retrospective Studies ; Tendons/*surgery ; Thumb/*surgery

Pontine hematoma would be diagnosed and made its follow-up readily as the extent of hematoma could be clearly defined since the CT scan was available, especially with MRI in recent. Authors attemped to analyse 20 cases of pontine hematoma clinically, considering factors of influence their prognosis, admitted in Inha hospital from March 1989 to February 1992. Classification of pontine hematoma was made out according to the findings of brain CT scan taken on admission:2 cases of Type T1 to the hematoma localized in the tegmentum unilaterally, 1 case of Type T to those in the tegmentum bilaterally with some extent into the 4th ventricle, 12 in Type T to those in the tegmentum, midbrain and mostly the 4th ventricle, and 5 in Type B to those in the basis pontis mainly with tegmentum and midbrain. Of 219 spontaneous intracerebral hematoma, pontine hematoma was 9.1%. 17 hypertension and 11 previous CVA episodes including 7 cerebral infarction and 4 ICH were endountered. Age distribution was 50% in 6th decade and male to female ratio was 3:2. On admission 14 cases were under 6 in Glasgow coma scale, 6 small reactive pupils and 11 ocular bobbing. Particularly, nuclear facial paralysis was 14 in initial bilateral type, of which 7 dead within 10 days, 5 fixed in left facial paralysis and 1 case into right paralysis later. Four surgical interventions were 1 simple EVD, 1 Urokinase irrigation through EVD, 1 steretactic aspiration and 1 direct hematoma removal. Prognosis was related to various factos:GCS on entry, volume and classification of hematoma, in addition to laterality of nuclear facial paralysis. Clinical course was better in cases over 10 GCS on entry, volume and classification of hematoma, in addition to laterality of nuclear facial paralysis. Clinical course was better in cases over 10 GCS, Type T1 and T2, and unilateral facial paralysis in which the ratio of left to right was 2:1, while it was very poor in patients who were GCS below 6, Type B and bilateral facial paralysis. On the contrary, 7 of 20 cases were dead within 10 days, 13 patients alive for more 3 months after the hemorrhage were observed with fixed facial paralysis in nuclear type, 1 ilateral, 4 right, and 8 left side. It is suggested and requested for further careful follow-up that the hemorrhage may occur from the border zone between paramedian, short and long circumferential arteries supplying transection area of the pons unilaterally, near on around the facial nucleus, more frequent in left side.
Age Distribution ; Arteries ; Brain ; Cerebral Infarction ; Classification ; Facial Paralysis ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Hematoma* ; Hemorrhage ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Male ; Mesencephalon ; Paralysis ; Pons ; Prognosis* ; Pupil ; Tomography, X-Ray Computed ; Urokinase-Type Plasminogen Activator