No abstract available.
Carcinoma, Papillary* ; Thyroid Gland* ; Tretinoin*

PURPOSE: We compared the first postoperative diagnostic and post-therapy scans of patients who received therapeutic doses of I-131, to investigate the difference in clinical outcomes between patients with concordant findings of diagnostic and post-therapy scans and patients with discrepant (more lesions in post-therapy scan) findings. MATERIALS AND METHODS: The first postoperative diagnostic and post-therapy radioiodine scans of one hundred forty three patients with well differentiated thyroid carcinoma were reviewed. Diagnostic scans were obtained following ingestion of 185 MBq of I-131 and post-therapy scans were obtained after therapeutic dose of 3.7~9.3 GBq of I-131. Successful ablation was defined as no radioiodine uptake on diagnostic radioiodine scan and normal range of serum thyroglobulin level (<10 ng/ml) during serum TSH elevation. RESULTS: Discrepant scan findings were noted in 25 (17.5%) patients. Twenty-two patients (15.4%) showed more lesions in post-therapy scan and 3 patients (2.1%) showed stunning effect. Nine (64.3%) of 14 patients with distant metastasis revealed metastatic lesion(s) only on post-therapy scan. Stunning effect was considered as sublethal damage in 1 patient and treatment by a diagnostic dose in 2 patients. Ablation was achieved in 52.4% (75/143) of all patients. Ablation rate and mean cumulative radioiodine dose were not different statistically between concordant and discrepant groups. CONCLUSION: There were 17.5% difference between diagnostic and post-therapy scan findings when using 185 MBq of I-131 as a diagnostic dose. However, 64.3% of distant metastases were revealed only on post-therapy scan. Ablation rate and mean cumulative radioiodine dose were not different statistically between concordant and discrepant groups. The stunning effect was considered as not only sublethal damage but also treatment by a small diagnostic dose of radioiodine.
Eating ; Humans ; Neoplasm Metastasis ; Reference Values ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms*

No abstract available.
Classification* ; Tibia*

In cross sectional fashion we recoreded the cone response in 98 adult diabetics and 20 normal controls according to the recommendation by the International Society for Clinical Electrophysiology of Vision. The photopic oscillatory potentials were extracted from the cone response by highpass filtering. The clear media and attached retina were criteria for inclusion in this study. The data were statistically analyzed expecting that this procedure may provide a feature that could have some clinical significance. The analysis of variance demonstrated that the summed amplitude of the oscillatory potentials, and second oscillatory potential amplitude were the most sensitive parameters to the diabetic retina. A timing delay in the first oscillatory potential wavelet, and a reduction in the second oscillatory potential amplitude and the summed amplitude of oscillatory potentials were the commonest abnormalities. Hence, the second oscillatory potential amplitude and the summed amplitude of oscillatory potentials may be the most valuable indicator among the photopic electroretinogram parameters representing a quantitative measure of overall retinal dysfunction.
Adult* ; Electrophysiology ; Humans ; Retina ; Retinaldehyde

In acute tears of the lateral complex of the knee, it is extremely important to make a complete diagnosis not to overlook the other injured structures in the knee since tears are rarely limited to just the lateral collateral ligament. Among the primary individual structures of the lateral ligament complex that may be involved are the lateral collateral ligament, lateral capsule, popliteus muscle, arcuate ligament complex, iliotibial band, biceps femories, intermuscular septum, and of course, the lateral meniscus as well. Further, it is important to repair lateral tears as soon as possible after injury even though the lateral instability of the knee is less frequent but because it is more easily overlooked and more disabling than the other instability of the knee. Therefore, to evaluate the result of surgically treated patients having the lateral instability, we analyzed the 33 cases with minimum 1 year follow-up period who were treated at the Orthopaedic Department, Kangnam St. Mary's Hospital, from February, 1982 to June, 1985. Among 145 knee ligament injury cases, 39(26.9%) had lateral instability but six were lost to follow-up. Among these remaining 33 cases, 5(15.2%) had isolated lateral collateral ligament injury, 18(54.5%) had associated anterior cruciate ligament injury, 4(11.8%) had associated posterior cruciate ligament injury and 26(78.9%) had injury of other lateral structures including lateral collateral ligament. In all cases having associated anterior cruciate ligament injury there was severe anterolateral rotatory instability under the general anesthesia. The severity of the anterolateral rotatory instability was very much correlated with the severity of the lateral structural injuries. Eighteen out of 19 cases having associated injuries of anterior or posterior cruciate ligament, had 5 mm or more joint opening at the 0 varus stress radiogram. Thirteen(92.8%) out of fourteen isolated ligament complex injuries, and 8(53.3%) out of 15 cases having associated anterior cruciate ligament injury had good-excellent or fair(+) result. None of the patients who had associated anterior and posterior cruciate ligament injuries had good-excellet result. Therefore, the patients who had the lateral ligament complex injury associating with anterior cruciate ligament tend to have residual anterolateral rotatory instability even though the repair or reconstruction was carefully done in comparision with the patients of isolated lateral ligament complex or anterior cruciate ligament injury. Because anterior cruciate ligament injury associated with lateral ligament complex increases the anterolateral rotatory instability significantly.
Anesthesia, General ; Anterior Cruciate Ligament ; Collateral Ligaments ; Diagnosis ; Follow-Up Studies ; Humans ; Joints ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Lost to Follow-Up ; Menisci, Tibial ; Posterior Cruciate Ligament ; Tears

No abstract available.

Frequency of fracture of the acetabulum is becoming increasingly with the increase of automobile accident. If fractures are not accurately evaluated, classified and reduced anatomically, major sequelae and complications such as traumatic arthritis, joint instability and avascular necrosis of the femoral head were highly developed. The principles of treatment are to restore the fractured acetabulum to its normal anatomy, to maintain and/or restore function, and accordingly early joint motion to promote healing and to prevent joint adhesion. However, the treatment of displaced fracture of the acetabulum has been controversial: that is, should these fractures be treated by closed or open method? Judet et al(1964), Pennal(1980) and Matta et al(1986) advocated open reduction and internal fixation for displaced fractures of the acetabulum. Especially, Matta et al reported that displaced fracture must be reduced to a displacement of 3mm or less, in addition to congruent reduction of the femoral head with weight-bearing dome of the acetabulum, to achieve a satisfactory clinical result. However, some authors reported that, if closed reduction such as traction was used, good result could be obtained. We analysed 42 cases of acetabular fractures to compare the results of closed treatment with that of open treatment as well as its complication after each treatment. All were treated at Kang-Nam St. Marys Hospital from June 1981 to June l86. The complications were' developed in 7(29.2%) out of 24 cases of conservatively treated group, and 5 (27. 8 %) of 18 cases of surgically treated group. However, 7 (70%) of 10 conservatively treated cases of displaced fracture developed complication. In all conservatively treated cases, traumatic arthritis was developed. Five of 18 surgically treated patients developed complications, such as deep wound infection in two cases, traumatic arthritis in two cases, and avascular necrosis in one case. The causes of complication in 5 surgically treated cases were wrong surgical approach by wrong classification in three cases, failure of internal fixation in a case and inevitable avascular necrosis in a case, respectively. Thus, anatomical restoration of the joint surface offered the best chance for a symptom free hip and reduced the complication such as traumatic arthritis. Even though traumatic arthritis and avascular necrosis may develop later by other causes, total hip replacement surgery will be much eased, if the nor mal joint anatomy is restored at initial treatment. Proper selection of the best suited surgical approach analysing the type fracture to minimize the sequelae is mandatorily stressed when surgical treatment is indicated.
Acetabulum ; Arthritis ; Arthroplasty, Replacement, Hip ; Automobiles ; Classification ; Head ; Hip ; Humans ; Joint Instability ; Joints ; Methods ; Necrosis ; Traction ; Weight-Bearing ; Wound Infection

The management of fractures of the intercondylar eminence of the tibia is uncomplicated when the fracture has minimal displacement(type I) or when only anterior one-third or half of the eminence is elevated(type II)(Meyers and Mckeever 1959, 1970). The treatment of complete separation(type III) has been controversial. Many authors however recommended conservative treatment even for the completely separated fracture if the fracture fragment is not rotated. Two cases of non-union of the tibial spine fracture we experienced were; one in type IIl, and the other type II. They were treated conservatively by cast immobilization. One patient had severe anterolateral rotatory.instability and had lateral meniscal tear, and the other had transverse ligament impingement at the fracture gap which interfered the reduction of the fragment and also bony union. Through the clinical experience and the two listed non-union cases, we drafted a therapeutic plan for the avulsed tibial spine fractures. The authors recommend open reduction and internal fixation of the avulsion fracture of the tibial spine in following circumstance; 1) all of the type K complete separation injuries 2) tibial spine fracture with positive Lachman test and soft end point 3) fracture with associated ligament injury. We applied the above surgical indications for 13 cases. The authors reviewed 25 cases of the anterior tibial spine fracture patients treated at the Department of Orthopaedic Surgery, Catholic Unviersity Medical College during the period from October 1982 to August 1986 and the following results were obtained. 1. The cases were classified into 3 different categories according to the Meyers and Mckeever classification; Type I(7 cases, 29%), Type II(10 cases, 40%), Type III(8 cases, 31%). 2. Associated ligament injuries on the same knee were rupture of LCL for 7 cases(28%) and MCL for 6 cases(24%). 3. Twelve out of thirteen open reduction and internal fixation cases had excellentresult in minimum 6 months follow-up period.
Classification ; Follow-Up Studies ; Humans ; Immobilization ; Knee ; Ligaments ; Rupture ; Spine ; Tears ; Tibia

Symphyseal injury is increasing in number together with today's speed of development of car industry in Korea. However, this injury is not common in practice. Some authors reported that symphyseal injury is only 4 to 6% of all pelvic fractures. Symphysis pubis has characteristicsl anatomy to maintain mechanical integrity of the pe1vis with circumferential ligament. The pelvis is a ring structure with strong ligaments. This support include the symphysis pubis, the anterior and posterior sacroiliac ligaments, and the strong sacrotuberous ligaments. According to Peltier(1964), when symphysis is separated more than 1.0cm, pubic instability will be developed. However, Wild(1982) reported that pelvic instability develops when separation of the symphysis exceeds more than 2.5cm. Tile(1984) reported that anterior pubic rami acts as a strut to prevent anterior collapse of the pelvic ring during weight bearing. However, in the presence of intact posterior structures, it gives little effect on pelvic stability. In addition to trauma, pelvic instability develops congenitally or by pregnancy. During pregnancy, pregnancy-related hormones relsx the ligameritous stuctures of the pelvic girdle. In most instances, the major pelvic ring returns to normal when the effect of the relaxin hormones disappear. However, in rare instances, a major symphysis disruption may continuously persist. To evaluste the trauma-induced separation of the symphysis pubis, we analyzed the 19 cases with 15 months follow-up on an average, who were treated at the Orthopaedic Department, Kang-Nam St. Marys Hospital, from June 1981 to June 1986. The results were as follows 1. Among 19 cases, 9 cases(47.4%) were male, 10 cases(52.6%) were female. And average age of the patients was 30.2 years. 2. The main cause of the fracture was traffic accident in 18 out of 19 cases. 3. In cases of symphyseal separation more than 3.4cm, fracture-separation of both sacroiliac joint was certainly occured. However, in cases with separation more than 2.2cm, unilalateral fracture-dislocation of sacroiliac joint occurred. 4. Open reduction and interal fixatiopn including external fixation was performed in 9 og cases. As an indication of surgery, separation of the symphysis, which exceeds more than 2.2cm and which associated (1) with sacroiliac fracture-dislocation, (2) failed conservative treatment, and (3) when simultaneously emergency urological operation is indicated.
Accidents, Traffic ; Emergencies ; Female ; Follow-Up Studies ; Humans ; Korea ; Ligaments ; Male ; Pelvis ; Pregnancy ; Pubic Bone ; Relaxin ; Sacroiliac Joint ; Weight-Bearing

In the orthopaedic literatures of the past thirty years, many methods of treating fractures of the tibial shaft have been reported, and there have been many analyses of the end results of such treatments. Recently, closed flexible intramedullary nailing have been widely used to treat fractures, and results were also presented. These nails were inserted using a relatively simple procedure without reaming. The fracture site was disrupted minimally, thereby lessening the risk of infection. Dynamic controlled motion at the fracture site led to early callus formation. However, there were only few reports of comparative study of the results of intramedullary nailing such as Rush and Ender nsilings. Authors csrried out retrospective study of the 51 tibial shaft fractures that were internally fixed with Rush or Ender nails, who were trested at the Orthopaedic Depsrtment, Kang-Nam St. Mary's Hospital, from May 1981 to May 1987. The results were as follows :1. The radiological union was obtained at 12.8 weeks in Ender nailing group, and 13.7 weeks in Rush nailing group. The median healing time was shorter in the Ender nailing group than the Rush nailing group. 2. Ratio of the external callus formation did not show the difference between Ender and Rush nailing groups. 3. Rush nailing group had more complications than Ender nailing group. Especially, among 4 cases not associated with fibular fracture in Ender nailing group, 2 cases had varus malunion of the fractured tibia. 4. Even in the distal 1/3 tibial fracture, Ender and Rush nailings were well indicated.
Bony Callus ; Fracture Fixation, Intramedullary ; Retrospective Studies ; Tibia ; Tibial Fractures