Limb salvage operation in primary malignant bone tumors is increasing recently, according to the improvement of diagnostic methods, surgical technique and adjuvant chemotherapy. The purpose of this study is to obtain the interim results of survival rate and the functional grade of the limb in primary malignant bone tumors treated by limb salvage operation. Between 1985 to 1993, 63 primary malignant bone tumors treated by limb salvage operations. Tumor prosthesis arthroplasty was performed in 49 patients, resection arthrodesis in 9 patients, and IM nailing with cement molding in 5 patients. Autoclave autograft was combined in 2 patients. Adjuvant chemotherapy and postoperative radiotherapy were performed in selected patients. The average follow-up period was 50 months(ranged 12 months to 116 months). In the cases of osteosarcoma, estimated survival rate was 61.9% based on Kaplan-Meier survival plot. In the parosteal sarcoma, the survival rate was 87.5% and 80% in chondrosarcoma patients. According to functional grading by Enneking, 66% was excellent, 20% was good, 11% was fair and one patients was poor. Complications occurred in 16 patients:wound infection was developed in 6 patients, local recurrence in 4, peroneal nerve palsy in 2 patients and femoral stem loosening in 2 patients. Fracture in resection arthrodesis and pulmonary metastasis were also occurred. Reoperation was performed in 10 patients at average 31 months after initial operation. Revision tumor persthesis arthroplasty was performed in one patient due to local recurrence and in 2 patients due to femoral stem loosening. Three amputations were done due to recurrence of tumor. IM nailing with cement molding was performed in one patient due to deep infection and repeated arthrodesis was done in a fracture patients. Scheduled custom-made tumor prosthesis arthroplasty was performed within a year in 2 patients treated with IM nailing with cement molding. In conclusion, with the careful preoperative assessment, adjuvant chemotherapy and skillful surgical technique, limb salvage operation would provide the primary malignant bone tumor patients for longer survival and better quality of life.
Amputation ; Arthrodesis ; Arthroplasty ; Autografts ; Chemotherapy, Adjuvant ; Chondrosarcoma ; Extremities ; Follow-Up Studies ; Fungi ; Humans ; Limb Salvage ; Neoplasm Metastasis ; Osteosarcoma ; Paralysis ; Peroneal Nerve ; Prostheses and Implants ; Quality of Life ; Radiotherapy ; Recurrence ; Reoperation ; Sarcoma ; Survival Rate

It is known that CD28, a positive costimulatory receptor, plays a very important role in inducing the optimal stimulation of T lymphocytes. CTLA-4 (CD152), however, acts as a negative regulator in T lymphocyte activation. The effect of an feline immunodeficiency virus (FIV) infection on the expression of feline CD28 and CTLA-4 was studied with FIV-infected and uninfected peripheral blood mononuclear cells (PBMC) using a competitive PCR assay. The nature of CD28 and CTLA-4 expression was also examined with fresh and antigen-stimulated PBMC. FIV infection induced a lower expression of CD28, but a higher expression of CTLA-4 in the infected PBMC than in the uninfected PBMC. Relatively high levels of CD28 expression were demonstrated in both the fresh and the antigen-stimulated PBMC. The expression level of CTLA-4 in the freshly isolated PBMC was rather low, however, FIV antigen stimulation induced a relatively high expression of CTLA-4 in feline PBMC.
Animals ; Antigens, CD ; Antigens, CD28/*biosynthesis ; Antigens, Differentiation/*biosynthesis ; Antigens, Viral/*immunology ; Cats ; Cell Survival ; Cells, Cultured ; Gene Expression ; Immunodeficiency Virus, Feline/immunology/*physiology ; Leukocytes, Mononuclear/immunology/*virology ; Polymerase Chain Reaction/veterinary

Pulmonary agenesis is a very rare anomaly. It is defined as total absence of the pulmonary parenchyma, vascular structures, and bronchi beyond the carina. We experienced a case of right pulmonary agenesis in association with other congenital defects who died at 1 day of age. The other defects included: esophageal atresia, tracheoesophageal fistula, cardiac malformation, anal atresia and a malformed left thumb. The cardiac malformations were a type of Pentalogy of Fallot, composed of right ventricular hypertrophy, ventricular septal defect, an overiding of aorta, pulmonary atresia, and an atrial septal defect. Hand roentgenograms of the malformed left thumb showed an unarticulated metacarpopharyngeal joint. This unique combination of anomalies is extremely rare.

Central nervous system impairment is common in diabetic patients, even in the early stages of the disease, and could be associated with peripheral neuropathy. The aims of this study were to prospectively investigate central nerve conduction in young adults with type 1 diabetes using pattern-reversal visual evoked potentials (PRVEP) and to determine how those results were related to clinical risk factors and the parameters of the peripheral nerve conduction study (NCS). A total of 36 type 1 diabetic patients (15 males) 5-24 years of age (mean 14.5 ± 4.7) underwent PRVEP and NCS annually for five years. For comparison, 39 healthy age and sex matched individuals (mean 14.8 ± 5.0) were evaluated as the control group. The P100 latencies of the PRVEP were prolonged at the study entry in the patients compared with the controls (p< 0.001). Significant correlations were not found between any of the parameters of PRVEP and the glycosylated hemoglobin levels; however, the changes in the parameters of the peripheral NCS were well correlated with metabolic control. The latencies and amplitudes of the P100 were not related to the majority of the parameters of the NCS. A prolonged PRVEP latency may be a sign of optic pathway dysfunction, which begins before apparent diabetic retinopathy. Poor glycemic control proved to be an important risk factor over the 5 years in terms of its relation to the development of peripheral neural pathway abnormalities. However, once central conduction was delayed, its changes were poorly related to diabetic control and the attributes of the peripheral nerve conduction study over the 5-year follow-up.
Diabetes Mellitus

No abstract available.
Child* ; Humans ; Humerus*

No abstract available.
Patellar Dislocation*

Paralytic hand is the ultimate result of permsnent damage of the central nervous system, failure of the functional repair of peripheral nerve injuries and extensive muscular or tendinous defect resulting in the impairment of hand function. There are a lot of controversies in the side of treatment methods in the paralytic hand, and it is very difficult to formulate the most adequate surgical reconstruction for a given pstient. At Depsrtment of Orthopedic Surgery, Seoul National University Hospital, 66 cases oi paralytic hands in 62 patients have been treated surgically with tendon transfers for 7 years from Jan, 1980 to Dec, 1986. 49 case in 46 patients were followed up for more than one year, and surgical method and its results were anslysed. They consist of CNS lesion (17), peripheral nerve lesion(23) and musulotenidinous defect(9). The methods of surgical reconstruction were opponenesplasty(12), standard set extensor reconstruction(9), Green and Bsnks FCU transfer(11), intrinsic reconstruction(7), pronator rerouting(7), adductorplasty (5) and so on. The mean follow-up was 2.2 years, and in 38 cases good or excellent results were obtained.
Central Nervous System ; Follow-Up Studies ; Hand ; Humans ; Methods ; Orthopedics ; Peripheral Nerve Injuries ; Peripheral Nerves ; Seoul ; Tendon Transfer

Posteroanterior radiographs of normal wrist were taken in seventeen volunteers, and analysed to determine the dynamic relationships between the radiocarpal and midcarpal joint during radioulnar deviation. The total arc of radioulnar deviation was 59 degrees, and the motion was 44% radiocarpal and 56% midcarpal. During radioulnar deviation, the motion at the midcarpal joint was more than that at the radiocarpal joint. It is suggested thst dorsoradial and palmar-ulnar flexion as it occurs at the midcarpal joint can be correlated in radio-ulnar deviation of the wrist more than the coronal sliding motions as it occurs mainly at the radiocarpal joint.
Joints ; Volunteers ; Wrist

Interlocking nailing technique has many advantages in the fracture treatment. Such as the prevention of infection and devitalization by closed technique, stable intramedullary osteosynthesis, bone grafting effect of reaming debris, and early restoration of loading and function, comparing to the conventional intramedullary nailing. However, we met many problems during the operative procedure due to deficient concept and technique. We have checked the possible problems during and after the procedure of interlocking nailing for the tibia or femur fractures in 69 cases. 1. Sixty nine cases were consisted by 26 cases of femur fractures and 43 cases of tibia fractures. 2. The inadequate implant length was the most common error in the implant selection (4 cases in femur, 6 cases in tibia). 3. A new fragment was made in 12 patients(17%) during surgery, more commonly in the femur (9 cases), especially medial side and distal to the fracture line. 4. Bone shortening, angulation deformity or rotational deformity, caused by incomplete reduction, were developed more commonly in the tibia than in the femur. 5. Post-operative deep infection were developed in 2 cases(3%). 6. Delayed or non-union were developed in 18 cases(28%), who were followed for more than 3 months. 7. Circumferential wiring or bone grafting using semiclosed technique is thought to be useful to prevent delayed or nonunion when there is a wide gap between fractured fragments pre-operatively.
Bone Transplantation ; Congenital Abnormalities ; Femur ; Fracture Fixation, Intramedullary ; Fractures, Bone ; Surgical Procedures, Operative ; Tibia

Partial knee ankylosis is a recognized complication of following open operative procedure, trauma and disease processes about the knee. Intraarticular trauma or surgical procedures such as TKR, synovectomy or patellar fracture were main source of intraarticular or extraarticular soft tissue adhesion and contracture were resulted from distal femoral and proximal tibial fractures. The purpose of this study is to report the value of arthroscopic adhesiolysis of partial knee ankylosis and to evaluate the clinical results of its application in various conditions. From October 1982 to December 1992, 56 cases in 54 patients who had severe limitation of motion in the knee joint following open operative procedure or trauma about the knee were treated by fibroarthrolysis under the arthroscopic control. For release of thick fibrous tissue, we used our designed blunt metal bar. The following results were obtained. There were 30 males and 24 females and the age at the time of release ranged from 20 to 69 years old(average 38.7 years old). The interval between last open operative procedure or trauma and arthroscopic adhesiolysis ranged from 3 months to 6 years(average 16 months). The interval between arthroscopic adhesionlyssis and the last follow up evaluation ranged from 1 year to 9 years(average 49 months), The average preoperative range of knee motion was 42.2 and the postoperative range of motion under the anesthesia was 115.5 and the average final knee range of motion at follow up was 101.3. So the average loss of motion between postoperative and final motion was 14.2. Complications were one case of patellar and tibial condylar fracture respectively. In the author's experience, arthroscopic adhesiolysis seems to be applied to the various condition of the partial knee ankylosis and the results are better than the other surgical procedures when it was performed early enough16).
Anesthesia ; Ankylosis ; Contracture ; Female ; Follow-Up Studies ; Humans ; Knee Joint ; Knee ; Male ; Range of Motion, Articular ; Surgical Procedures, Operative ; Tibial Fractures ; Tissue Adhesions