A case of congenital dislocation of the both knees in a newborn infant which is a very rare condition and difficult to treat, is reported together with the reviews of the literature and the discussion of the future therapeutic programme of the condition.
Dislocations ; Humans ; Infant, Newborn ; Knee

We have many unsolved problems about the femoral neck fracture, especially non-union of the fracture and avascular necrosis of the femoral head. It seems clear that underlying these are two basic problems; first, the mechanical difficulties in maintaining secure fixation; and second, biological factors interfering with union, paramount of which is damage to the blood supply of the femoral head. Intra-capsular fracture of the femoral neck heals in the same way as other intra-articular fractures-only by endosteal and not by periosteal repair. If the femoral head has an intact blood supply, repair appears early on both sides of the fracture. But if the femoral head is not viable, this repair appears only on the neck side of the fracture. It can migrate into the head and heal the fracture only if there is close apposition and rigid fixation of well reduced fracture fragments. Clearly the femoral neck fracture heals not by periosteal callus but by callus arising from the marrow supporting structure. Yet there is still no reliable clinical method of determining early the union of the femoral neck fracture and the viability of the femoral head. The femoral head intra-osseous venography, first described by Hulth (1953), to predict viability of the femoral head after fracture of the femoral neck has been carried by various previous authors (Hulth1953 1956 1958, Dahlgren 1959, Harrison 1962, Hulth and Johansson 1962, Nagai 1962). However, they did not mention healing process of fractures of the femoral neck in these studies. To observe the fracture healing and to predict the viability of the femoral head, authors adopted a femoral trochanteric intra-osseous venographic technique. The precedure was carried out under the control of a T-V image intensifier. Venous drainage of the femoral head parallels the arterial supply. There are several venous drainage routes in the hip region; the medial and lateral circumflex vein, gluteal vein, nutrient vein, femoral vein, vein of the ligamentum teres and obturator vein. With the aid of a T-V image intensifier, a bone marrow needle is driven 1 inch below the femoral greater trochanter. When the tip of the needle is in the marrow cavity, about 30cc, of 75% Urograffin is injected. Next X-rays are taken at intervals of 2 seconds, the last film at 5 minutes. A positive venography is one in which venous drainage is seen, and opaque fluid is seen in mottled distribution throughout neck region and part of the head. A negative venography is one in which no venous drainage is seen, on the contrary, opaque fluid pools within the trochanteric region are evident and remain for at least 5 minutes. A positive venography indicates that the head has an intact circulation, thus it may be predicted that the fracture can unite and the head is alive. Negative venography suggests that fracture union is not and will not take place and that the head may be dead. This study provided information about fracture heaIing processes and vascularities of the femoral head and its surrounding tissues during and after fractures healing. We have found that trochanteric intra-osseous venography is a useful diagnostic tool in hip injuries.
Biological Factors ; Bone Marrow ; Bony Callus ; Drainage ; Femoral Neck Fractures ; Femoral Vein ; Femur ; Femur Neck ; Fracture Healing ; Head ; Hip Injuries ; Hip ; Methods ; Neck ; Necrosis ; Needles ; Phlebography ; Round Ligaments ; Veins

Although wound healing is a natural biologic process by which the homeostasis is preserved, the resultant hypertrophic scar or scar contracture may produce undesirable morphologic and functional sequelae. To overcome these problems, a number of attempts to produce skin substitute have been made in recent years, but none have proved to be entirely satisfactory. We compared the wound healing of full-thickness dorsal skin defects between ADM(acelluar dermal matrix)-applied wound and ADM non-applied wound group in 20 adult female Sprague-Dawley rats. The wound area was serially evaluated at 1,2,3 weeks and the difference in the mean area ratios between the two groups was then statistically analyzed using Wilcoxon rank sums test. We also performed histological evaluation of the wounds at 1,2,3 weeks. Results were as follows: 1. Experimentally produced ADM was easy to handle. Histologic findings showed no epithelium, no appendages, no cells dermal and subcutaneous layer and pure bundles of collagen. 2. The wound area ratio of ADM applied wound group was statistically larger than that of ADM non-applied(control) wound group. That is, ADM was able to inhibit the wound contraction compared with the ADM non-applied wound group. 3. In the ADM-applied group, we observed low grade exudates, no infection, fine take-up of ADM on full-thickness skin defect, gross and histologic findings of neovascularization, and progressive epithelization on ADM. These findings of biologic attachment implies the function of the ADM as a dermal substitute. These can be basis of the study on the development of artificial skin.
Acellular Dermis* ; Adult ; Animals ; Cicatrix ; Cicatrix, Hypertrophic ; Collagen ; Contracture ; Epithelium ; Exudates and Transudates ; Female ; Homeostasis ; Humans ; Rats* ; Rats, Sprague-Dawley ; Skin* ; Skin, Artificial ; Wound Healing ; Wounds and Injuries*

To establish predictors of prognosis and recurrence of hepatocellular carcinoma (HCC) after curative resection, retrospective analyses of clinical and pathologic factors were done in 85 hepatectomized patients of HCC. The median follow-up duration was 30.5(range: 3-134) months. Two postoperative mortalities and five palliative resections were excluded from analysis of recurrence. The overall 1, 3, 5 year survival rates in 85 patients were 78.6%, 63.6%, 45.6%. The 1, 3, 5 year survival rates in 78 curative resections were 81.8%, 70.2%, 50.3%. The 1, 2, 3 year survival rates of the palliative resections(5 cases) were 60%, 20%, 0%. The 1, 3, 5 year recurrence-free survival rates in the curative resections were 64.4%, 43.2%, 27.5%. Included prognostic variables were age, gender, viral hepatitis, cirrhosis, serum alpha-FP level, ICG-R15, diabetes, preoperativeTACE, tumor size, tumor capsulation, number of tumors, vascular invasion, tumor histologic grading, stage of the chronic hepatitis, and anatomic resection. The significant factors affecting recurrence were number of tumors and vascular invasion.
Carcinoma, Hepatocellular* ; Fibrosis ; Follow-Up Studies ; Hepatectomy ; Hepatitis ; Hepatitis, Chronic ; Humans ; Mortality ; Prognosis ; Recurrence* ; Retrospective Studies ; Survival Rate

No abstract available.
Graves Disease* ; Insulin*

Teratocarcinoma is a form of mixed germ cell tumor composed of a mixture of teratoma and embryonal carcinoma. It is rarely found in the brain, but when present it is most commonly found in the pineal region. We investigated a case of primary teratocarcinoma in the pineal region. The patient was a 10 year old boy who had suffered from a bitemporal headache for one month. Brain CT and MRI revealed a rather well defined ovoid heterogenous mass in the pineal gland region, measuring 4.3 x 3.8 x 3.0 cm in size. Microscopically the tumor contained areas of immature teratoma and embryonal carcinoma. Immunohistochemical staining revealed positive reactions for cytokeratin, epithelial membrane antigen, carcinoembryonic antigen, and alpha-fetoprotein in the embryonal carcinoma component.

Free tissue transfer has revolutionized tissue reconstruction. Microvascular operation techniques using free tissue transfer make it possible to precisely restore various defects and deformities. There are various surgical flaps available for this surgery, such as muscle flaps, musculocutaneous flaps, or fasciocutaneous flaps. The development of perforator flaps enables multi-component reconstruction with reduced donor site morbidity. Successful reconstruction must be approached with the goals of not only providing stable coverage, but most importantly, of restoring function. Therefore, the selection of flaps is dependent on the recipient site characteristics and the functional and aesthetic results at both the recipient and donor sites. With the high success rate of free flaps and the popularization of the perforator flap, microvascular surgery has played a major role in various reconstructive fields.
Congenital Abnormalities ; Free Tissue Flaps ; Humans ; Microsurgery* ; Myocutaneous Flap ; Perforator Flap* ; Surgical Flaps ; Tissue Donors

Eccrine angiomatous hamartoma is a distinct developmental anomaly showing, histologically, hyperplasia of eccrine sweat apparatus and of vascular elementa in the same lesion, and clinically, the angiomatous lesions with occasional tenderness and profuse local sweating. Recently, we examined an 18-year-old, otherwise healthy girl having, on the anterior aspect of the right leg, an extensive, irregularly marginated and somewhat bluish, tender, firm subcutaneous mass. The mass was studded with several overlying macular, verrucous or nodular angiomatous patches which showed conspicuous hyperhidrosie. Histological examination revealed marked hyperplasia, hypertrophy and cystic dilatations of eccrine sweat apparatus accompanied by proliferation of the capillary hemangiomatous component and ectopic, thick smooth muscle bundles in the deep dermis and subcutaneous tissue.
Adolescent ; Capillaries ; Dermis ; Dilatation ; Female ; Hamartoma* ; Humans ; Hyperplasia ; Hypertrophy ; Leg ; Muscle, Smooth ; Subcutaneous Tissue ; Sweat ; Sweating

PURPOSE: In patient with blunt trauma of chest, supine AP x-ray cannot differenciate the lung contusion, laceration, atelectasis, and hemothorax definitely. Therefore, computed tomographic evaluation is needed for accurate evaluation of the injuries. In our knowledge, there are few reports about CT findings of blunt chest trauma, in our country, therefore we tried to fiud the characteristic CT findings in patients with blunt trauma. MATERIALS AND METHODS: We analyzed the plain x-ray and CT image of 4 patient with blunt chest trauma. Location and morphology of lung parenchymal contusion and laceration, hemopneumothorax, chest wall injuries and location of chest tube. RESULTS: Lung parenchymal contusion was noted in 53 segments. of 16 patiants'infiltration(n=27 segment), and multiple nodular pattern was noted in 15 segment, pattern of consolidation along the lung periphery was seen in 11 segment. Laceration was noted in 18 lesion and most commonly located in paravertebral area(b=8). CONCLUSION: CT scan of chest in patient with blunt chest trauma, provides accurate informations of the pattern of injuries, and localization, therefore, should be performed as po9ssible.
Chest Tubes ; Contusions ; Hemopneumothorax ; Hemothorax ; Humans ; Lacerations ; Lung ; Pulmonary Atelectasis ; Thoracic Wall ; Thorax* ; Tomography, X-Ray Computed

The introduction of perforator flaps represented a significant advance in microsurgical reconstruction. However, confusion has developed due to the erroneous belief that perforator flaps are different from conventional flaps. The concept of the perforator is not new, but is an idea that evolved from the conventional flap. In fact, some of the flaps used by microsurgeons were perforator flaps. The only difference is the anatomical level of the blood vessels involved; the perforator concept is focused on the distal circulation, so-called 'perforator'. Therefore, thinner sections of tissue can be taken from the conventional donor sites of myocutaneous flaps. With the use of perforators, there are no longer "flap of choice" for specific reconstructions, because conventional donor sites have become universal donor sites, enabling the harvesting of a variety of flaps. Moreover, depending on the surgeon's ability, any flap can be utilized as a perforator-based island flap whose source vessel has been completely preserved. Therefore, tissues can be efficiently customized and tailored into any configuration required for reconstruction. The application of perforator flap technique enables more precise dissection, and allows more selective harvesting of thinner flaps, which will expand options in reconstructive surgery. No doubt the technique will continue to evolve.
Humans ; Perforator Flap/*blood supply/classification/trends ; Reconstructive Surgical Procedures/*methods ; Skin Transplantation/*methods ; Surgical Flaps/*blood supply ; Tissue and Organ Harvesting/*methods