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

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

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

BACKGROUND: This study was conducted to investigate the roles of the spinal and peripheral gamma-aminobutyric acid (GABA)-ergic systems for the mechanical hypersensitivity produced by chronic compression of the dorsal root ganglion (CCD). METHODS: CCD was performed at the left 5th lumbar dorsal root ganglion. The paw withdrawal threshold (PWT) to von Frey stimuli was measured. The mechanical responsiveness of the lumbar dorsal horn neurons was examined. GABAergic drugs were delivered with intrathecal (i.t.) or intraplantar (i.pl.) injection or by topical application onto the spinal cord. RESULTS: CCD produced mechanical hypersensitivity, which was evidenced by the decrease of the PWT, and it lasting for 10 weeks. For the rats showing mechanical hypersensitivity, the mechanical responsiveness of the lumbar dorsal horn neurons was enhanced. A similar increase was observed with the normal lumbar dorsal horn neurons when the GABA-A receptor antagonist bicuculline was topically applied. An i.t. injection of GABA-A or GABA-B receptor agonist, muscimol or baclofen, alleviated the CCD-induced hypersensitivity. Topical application of same drugs attenuated the CCD-induced enhanced mechanical responsiveness of the lumbar dorsal horn neurons. CCD-induced hypersensitivity was also improved by low-dose muscimol applied (i.pl.) into the affected hind paw, whereas no effects could be observed with high-dose muscimol or baclofen. CONCLUSIONS: The results suggest that the neuropathic pain associated with compression of the dorsal root ganglion is caused by hyperexcitability of the dorsal horn neurons due to a loss of spinal GABAergic inhibition. Peripheral application of low-dose GABA-A receptor agonist can be useful to treat this pain.
Animals ; Back Pain ; Baclofen ; Bicuculline ; GABA-A Receptor Agonists ; GABA-A Receptor Antagonists ; GABA-B Receptor Agonists ; gamma-Aminobutyric Acid ; Ganglia, Spinal ; Hyperalgesia ; Hypersensitivity* ; Muscimol ; Neuralgia ; Posterior Horn Cells ; Rats* ; Receptors, GABA ; Spinal Cord

Silver-Russel syndrome (SRS) is a disorder present at birth that involves poor growth, low birth weight, differences in the size of the two sides of the body, and genital anomalies. The diagnosis is based on distinct prenatal growth restriction and the presence of typical dysmorphic features, including short stature and limb asymmetry. We report a case of bilateral cryptorchidism with no other genital anomalies in SRS. This report provides an overview of the genital anomalies of SRS and describes, for the first time, a laparoscopic orchiopexy in SRS.
Cryptorchidism ; Dwarfism ; Extremities ; Fetal Growth Retardation ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Laparoscopy ; Male ; Orchiopexy ; Parturition

Two autopsy cases of asphyxia due to oxygen deficiency are reported. The first case is that a 38-year-old man died in a storehouse. Many pears were stored in a storehouse and the its atmosphere was strictly controlled. The second case is that a 42-year-old man died in the boiler room of a fishing ship. Much amount of Freon gas escaped due to a defect of the refrigerator in the boiler room. The victim entered the boiler room because he repaired the refrigerator. But, the victim died when he entered the boiler room immediately. In this article, the autopsy findings and the contents of the investigation of scene of two cases are described.
Adult ; Anoxia* ; Asphyxia* ; Atmosphere ; Autopsy* ; Chlorofluorocarbons ; Humans ; Oxygen* ; Pyrus ; Ships ; United Nations

Postmortem body inspection at scene and examination of the scene of death are very important in determination of the suspected cause of death, manner of death and interpretation of events leading death, nature of injuries, time of death etc. Actually these works must be performed by well-experienced forensic pathologists. And forensic pathologists should visit the scene of death before the body is removed. In Korea, attendance at scene of death by forensic pathologists is not performed effectively due to low faculty of forensic pathologists and the problem of medicolegal investigation system. But we try to overcome these problems and begin to the work of postmortem body inspection at scene and examination of the scene of body in area of Daejeon Metropolitan city since March, 2003. In this report we recommend the guideline for postmortem body inspection at scene on forensic aspects. We believe that sharing the experience and knowledge about scene investigation including postmortem body inspection at scene and examination of the scene of death is very important to improve and change the environment of medicolegal investigation system in the future.
Cause of Death ; Korea

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