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 simplified method of the cardiac conduction system (CCS) is evaluated by the study of 73 forensic cases. The sinoatrial node were observed in all cases (100.0%), atrioventricular node in 70 cases (95.9%) and penetrating bundle (His bundle) in 70 cases (95.9%). We divided the cases into three groups as the group of cardiac death (25 cases), non-cardiac death (24cases) and sudden unexpected death but undeterminable cause of death (24 cases) diagnosed after routine autopsy including routine cardiac examination and toxicological analysis and compared the type and incidence of CCS lesions in each groups. Narrowing of the sinoatrial (SA) or atrioventricular (AV) artery by fibromuscular hyperplasia (FMH) and fatty infiltration in SA or AV node were identified in all groups, lymphocytic infiltration in SA or AN node in cardiac and non-cardiac death group, hemorrhage and fibrosis of SA or AV node were identified in cardiac death group. FMH of the artery of SA or AN node occured more commonly in undeterminable cause of death group (45.1%) than in cardiac (16.0%) and non-cardiac group (20.8%) and severe narrowing (> or =75%) of the artery of SA or AV node was only present in undeterminable cause of death group (29.2%). The results led to the conclusion that this simple technique is very useful in detection of major abnor-malities of CCS with minimal effort and examination of the CCS in death which the routine autopsy and drug screen fail to provide a cause of death can yield a cause of death in a significant percentage of cases.
Arteries ; Atrioventricular Node ; Autopsy ; Cause of Death ; Death ; Death, Sudden* ; Fibrosis ; Hemorrhage ; Hyperplasia ; Incidence ; Sinoatrial Node

We reviewed forensic autopsies and scene examinations performed at Central District of National Institute of Scientific Investigation, requested by every kinds of law enforcement agencies in Chung-cheong area of Korea during the year of 2003, 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 investigation on the spot was performed in 220 cases ; Among these cases, 161 cases (73.2%) were unnatural deaths and the most common cause of death was trauma (61 cases). Autopy was per-formed in 93 cases (42.3%). 2. The total number of forensic autopsy were 685 cases (452 males and 233 females). The number of the forties (215 cases) and the thirties (124 cases) occupied almost half (49.5%) of all cases of autopsy. 3. Unnatural deaths were 434 cases (63.3%), natural 204 cases (29.8%), and the unknown 47 cases (6.9%). In 434 cases of unnatural deaths, suicide was 84 cases (19.3%), homicide 115 cases (26.5%), acci-dent 186 cases (42.9%), and the undetermined 49 cases (11.3%). Homicide occupied 43.7% of trauma, 77.1% of blunt force injury excluding traffic and fall down injury, and 97.7% of sharp force injury. The homicide rate in asphyxia was 35.0%. It showed only 1 cases (1.9%) of homicide in poisoning. 4. In 434 cases of unnatural deaths, traumatic deaths were 229 cases (52.8%). Blunt trauma was 70 cases (30.6%) and the leading cause of death in traumatic death. Of remaining 205 cases of unnatural deaths, there were 52 cases (12.0%) of poisonings, 51 cases (11.8%) of thermal injuries, 41 cases (9.4%) of drowning, 40 cases (9.2%) of asphyxia, 19 cases (4.4%) of medical procedures, and 2 cases (0.5%) of electrocution. 5. Among 204 natural deaths, cardiovascular diseases were 106 cases (52.0%) and the leading cause of death in natural deaths. 36 cases (17.6%) of diseases involving vascular system were followed. 6. Child deaths under the age of 10 were 32 cases. Among these cases, unnatural deaths were 14 cases (43.8%) and most of them were accident.
Asphyxia ; Autopsy* ; Cardiovascular Diseases ; Cause of Death ; Child ; Drowning ; Homicide ; Humans ; Korea* ; Law Enforcement ; Male ; Poisoning ; Suicide

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

The authors present a case of intracranial aneurysm with Takayasu's arteritis. A 10-year-old boy was admitted with complaints of sudden bursting headache and vomiting. Computed tomographic(CT) scan showed subarachnoid hemorrhage and measure blood pressures between in each side did differ significantly. Aortoangiogram showed narrowing of the abdominal aorta and stenosis at their origins of the renal arteries. An angiogram of the right carotid artery revealed a saccular aneurysm located at the proximal portion of the middle cerebral artery. Intracranial aneurysm with Takayasu's arteritis is a rare entity, even more in children.
Aneurysm ; Aorta, Abdominal ; Carotid Arteries ; Child* ; Constriction, Pathologic ; Headache ; Humans ; Intracranial Aneurysm* ; Male ; Middle Cerebral Artery ; Renal Artery ; Subarachnoid Hemorrhage ; Takayasu Arteritis* ; Vomiting