Authors reviewed 459 cases which had been followed up over 3 months after surgery to evaluate the incidence of consecutive esotropia and its associated factors. For every case, we investigated the age at the surgery, the methods of surgery, stereopsis, cycloplegic refractive power, the deviation difference between far and near fixation, the deviation before surgery and the results at the postoperative 1 day, 1 week, 1 month, 4 months, 6 months, 1 year and 3 years. The incidence of consecutive esotropia tended to decrease as time passed, and occurred in 21 cases[4.6%] at the last follow-up[averaging 13.1 months]. When the deviation difference between at the distance and the near fixation was above 10 delta and the results at the postoperative 1 day was overcorrection above 10 delta, with significantly higher[p<0.05] incidence of consecutive esotropia. Other factors were not statistically significant. In conclusion, the preoperative factor was the far and near deviation difference above 10 delta and the postoperative factor was the first day postoperative overcorrection above 10 delta. It is considered that the nonsurgical treatment can be desirable for the former cases, and overcorrection above 10 delta should be avoided for the latter.
Depth Perception ; Esotropia* ; Exotropia* ; Incidence

Arthroscopic surgery of the knee is now a widely performed orthopedic technique. Of this, arthrosoopic surgery of discoid meniscus is one of the most technically demanding procedures of this field. In our experience, discoid meniscus was appeared to be frequently accompanied with villous hypertrophied synovium, which obstructed the arthroscopic view. The purpose of this study is to prove the presence of synovial hypertrophy in discoid meniscus and to develop an adequate portal of entry for successful arthroscopic surgery of discoid meniscus. 155 cases of arthroscopy of the knee were performed at the Department of Orthopedic Surgery, College of Medicine, Seoul National University between January 1987 and March 1988. Of these, 25 cases were discoid menisci and they were all lateral. Operative findings were observed through arthroscopy and they were also reviewed by recorded video tapes in 25 cases of arthroscopic surgery of discoid meniscus and 57 cases of non-discoid meniscal lesions for the presence of synovial hypertrophy. Synovial biopsy was performed in selected cases with synovial hypertrophy for observation of histological findings. Hypertrophied synovium in discoid meniscus was mainly localized in anterior compartment and intercondylar area of tibia. Therefore, when conventional anterolateral or anteromedial portals were used, much difficulty was confronted because hypertrophied synovium obstructed the visual field and crowding with surgical instruments was occurred in restricted space of discoid meniscus. Much more clear visual field was obtained when the medial midpatellar portal was used instead of conventional portals. The conclusions of this study are as follows : 1. The incidence of discoid meniscus was 16.1%. 2. Synovial hypertrophy was present in all 25 cases of discoid meniscus and 21 cases among 57 non-discoid meniscal lesions(35%) on operative findings 3. Synovial biopsy of hypertrophied synovium showed irritative nonspecific inflammatory lesions but there was no histologicsl differences between discoid and non-discoid meniscus. 4. Medial midpatellar portal is considered to be better approach than conventional portals for clear visual field and less crowding with instruments in arthroscopic surgery of lateral discoid meniscus.
Arthroscopy ; Biopsy ; Crowding ; Hypertrophy ; Incidence ; Knee ; Orthopedics ; Seoul ; Surgical Instruments ; Synovial Membrane ; Tibia ; Visual Fields

PURPOSE: The aim of the study was to evaluate the clinical outcome and complications of tension free vaginal tape (TVT) procedure for the surgical treatment of female stress urinary incontinence. MATERIALS AND METHODS: Between April 1999 and May 2000, 41 women with stress urinary incontinence underwent TVT procedure. Preoperative evaluation included questionnaires study, physical examination, one hour pad test and urodynamic study. Postoperative clinical outcome, patient's satisfaction and complications were checked after 3-months. RESULTS: The mean age of patients was 51.6 years (range 40-76) and mean hospital stay 2.1 days (range 1-10). The mean follow-up period was 9.9 months (range 3-15). Thirty six patients (87.8%) were cured, 2 patients (4.9%) were improved. Two of 3 patients with failed operation who developed postoperative urge incontinence had grade III cystocele. Five bladder perforations and 1 obturator nerve injury occurred. The abdominal leak point pressure (LPP) increased from 50.6cmH20 to 110.8cmH2O, detrusor pressure of maximal flow rate (Pdet.Qmax) increased from 15.8cmH2O to 28.6cmH2O and maximal flow rate (Qmax) decreased from 32.8ml/s to 22.5ml/s after operation. CONCLUSIONS: The TVT procedure is an effective and feasible surgical treatment for female stress urinary incontinence. However, in patients with grade III cystocele, postoperative urge incontinence may develop after the procedure. Since TVT procedure involves securing the mid-urethra, urinary obstruction may also occur, necessitating the need for continued follow-up as well as a careful comparison with other sling procedure.
Cystocele ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Obturator Nerve ; Physical Examination ; Surveys and Questionnaires ; Suburethral Slings* ; Urinary Bladder ; Urinary Incontinence ; Urinary Incontinence, Urge ; Urodynamics

No abstract available.
Liver*

The concept of surface replacement arthroplasty of the hip is to replace the diseased joint surface with artificial plastic and metal cup in the acetabular and femoral head respectively, and to restore the normal anatomy and gain biomechanical function. Ten cases of Wagner type's surface replacement arthroplasty performed in Department of Orthopedic Surgery, Seoul National University Hospital since July 1979 are reviewed, and their minimum follow up is two months. In terms of the Pain control and improvement of range of motion in the hip, surface replacement arthroplasty showed about the same result compared with conventional total hip. In our cases there was no one complicatian, even though it is too short to evaluate the result of this operation. Wagner recommends surface replacement arthroplasty to perform through anterior approach, but 2 cases of our ten patients that have relatively good range of motion of the hip could be operated on this surgery by anterolateral approach (oblique skin incision) without trochanteric osteotomy, because of high incedence of myositis ossification with anterior approach. It is our conclusion that surface replacement arthroplasty of the hip may be used as an interim procedure to gain time in young patient who needs conventional total hip replacement which reveals increasing complication with the lapse of time.
Acetabulum ; Arthroplasty, Replacement ; Arthroplasty, Replacement, Hip ; Femur ; Follow-Up Studies ; Head ; Hip ; Humans ; Joints ; Myositis ; Orthopedics ; Osteotomy ; Plastics ; Range of Motion, Articular ; Seoul ; Skin

No abstract available in English.
Arthroplasty ; Arthroplasty, Replacement, Hip ; Follow-Up Studies

The purpose of this study is to compare the biologic properties of tendon to hone healing and hone to hone healing in knee ligament reconstruction. The lateral 4mm of patellar tendon which was detached from its tihial insertion site either subperiostcally(group I) or with a bone block(group II) was implanted and fixed using pullout method to the proximal tihia. Ten rabbits were killed at each of four time periods (two, four, eight and twelve weeks after the implantation), and the histological and biomechanical characteristics of thc graft healing sites were evaluated. Serial histological analysis of tendon to hone healing group revealed organization of the healing site similar to normal tendon to hone attachment by twelve weeks, while hone to bone healing group demonstrated direct hony union by eight weeks. The tension failure test for the patellapatellar tendon graft - tihia complex revealed that group II had significantly higher values than group I at four and eight weeks. The findings ot this study demonstrated that bone to hone healing has more rapid process than tendon to hone healing, although no significant difference was noted once the healing has matured. We can suggest lhat the duration and extent of postoperative protection of the knee for pntients who had a reconstruction of a ligament using hone - lendon autograft should be longer and higher than lor patients who had a reconstruction using hone - tendon hone autogralf.
Autografts* ; Dronabinol ; Humans ; Knee ; Ligaments ; Patellar Ligament* ; Rabbits* ; Tendons* ; Transplants

Nineteen patients (twenty knees) with degenerative arthritis of knee treated by arthroscopic curettage were reviewed. Of the nineteen patients, there were eighteen females and one male ranging in age from 49 to 68 years (mean, 57 years). The mean follow up period was 18.2 months (range, 12 months to 21 months). Simple standing roentgenorgram and 99m-Tc bone scintigraphy were used to select the patients with medial compartment involvement only, less than 5 degree of varus deformity and sparing of patello-femoral joint. Knee scoring by Hospital for Special Surgery Formula showed improvement from the preoperative average 68 points to postoperative average 89.6 points (21.6 points increase) and 84.1 points (16.1 points increase) at 6 months and one year respectively. Arthroscopic curettage of knee, if done early in degenerative arthritis, not only can shorten hospital days and immobilization period but also can defer other major surgical treatments by promoting natural healing process and symptomatic relief.
Congenital Abnormalities ; Curettage ; Female ; Follow-Up Studies ; Humans ; Immobilization ; Joints ; Knee ; Male ; Osteoarthritis ; Radionuclide Imaging

No abstract available.
Knee* ; Synovitis*

Total hip replacement arthroplasties(THRA) have been done in 19 patients(31 hips), who were diagnosed ad ankylosing spondylitis from January, 1984 till July, 1993 at Seoul National University Hospital. All patients were male; 12 patients were affected bilaterally. Modified New York criteria was used as diagnostic criteria. HLA B27 antigen was positive in 18 cases(95%). The thoracolumbar spine and sacroiliac joint were affected in all cases and cervical spine was affected in five patients, among them, fiberoptic laryngoscopic intubation was needed in four cases. The trastrochanteric approach was used in 19 cases, which have severe limitation of motion and deformity of the acetabulum. For the prevention of postoperative heterotopic ossification, low dose radiation therapies were done in 10 cases of the risk group. The average follow-up period was three year and eleven months(two year-seven year and 10 months). Harris hip score and radiographs were obtained at each follow-up. The mean preoperative Harris hip score was 50(19–90), and finally, the mean Harris hip score was 87(68–96). Loosening of endoprothesis was noted in 3 cases and heterotopic ossification in 5 hips. Ischial enthesopathy was observed in 13 cases. Among the hips which had heterotopic ossification, four were class Ι by Brooker's classification and only one was class Ⅲ. No nonunion was observed in the cases which had trochanteric osteotomy expect breakage of wire in 4 cases. In THRA of ankylosing spendylitis, we obtained good result clinically and radiologically. In severely affected cases, we had used transtrochanteric approach and obtained good result due to better operative field. The incidence of heterotopic ossification was not significant and the prophylactic low dose radiation therapy seems to be effective in risk group.
Acetabulum ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Classification ; Congenital Abnormalities ; Femur ; Follow-Up Studies ; Hip ; HLA-B27 Antigen ; Humans ; Incidence ; Intubation ; Male ; Ossification, Heterotopic ; Osteotomy ; Rheumatic Diseases ; Sacroiliac Joint ; Seoul ; Spine ; Spondylitis, Ankylosing