A Malignant Schwannoma is a relatively rare primary nerve sheath tumor arises from Sehwann cells of the peripheral nerves. This tumor is frequently associated with von Recklinghausens disease. A high percentage of patients experience local recurrence even after radical surgical excision, and eventual pulmonary metastases via the intraneural and hematogenous routes. The treatment of choice is radical excision or amputation. Results of treatment with radiation and chemotherapy have been disappointing. The authors have experienced two cases of Malignant Schwannoma, one of which was located in the median nerve of the palm, the other in the ulnar nerve of the arm, but neither were associated with von Recklinghausens disease.
Amputation ; Arm ; Drug Therapy ; Humans ; Median Nerve ; Neoplasm Metastasis ; Neurilemmoma ; Neurofibromatosis 1 ; Peripheral Nerves ; Recurrence ; Ulnar Nerve

When chemical agents penetrate the placenta, it is potentially hazardous to the embryo because the embryonic stage is known to be extremely sensitive to various toxic agents. It has been reported that exposure to some chemical agents during pregnancy resulted in the induction of malformation or cancer in the offspring of experimental animals (Larsen, 1947; Klein, 1952; DiPaolo, 1964; Druckrey et al. 1966; Mohr et al, 1966; DiPaolo and Elis, 1967; Spatz and Laqueus, 1967; Alexandrov, 1968; Fujii and Nishimura, 1969; Rice, 1969; Bulay and Wattenberg, 1970; Currie, 1970; Vesselinovitch et al, 1971; Swenberg et al, 1972; Nomura et al, 1973). Fraser and Fainstat (1954) and Kalter (1954) found that administration of cortisone to pregnant female mice induced the appearance of cleft palates in the offspring. The frequency with which this deformity appears was observed to depend on: I) the genotype of the treated animal (strain differences), 2) the dose of the chemical administered, 3) the time during the gestation period when the animal was treated. A single intraperitoneal injection of 5-fluorouracil at 10, 11, 12 or 13 days after copulation in mice also produced abnormalities to the feet, deft palate and deformities of the tail in a large proportion of fetuses (Dagg, 1960). Urethan has been considered to be a highly teratogenic and carcinogenic agent in experimental animals (Nishimura and Kuginuki, 1958: Nomura and Okamoto, 1972). However, they stated that accurate timing of urethan toxicity and accurate calculation of urethan dosage actually reaching the embryo make it possible to analyze the sensitivity of the developing mouse embryo to mortality, growth inhibition, malformation and neoplasm. Nomura and Okamoto (1972) reported that when pregnant mice were exposed to urethan on various days of gestation (day 5 to 19) by a single injection malformations and neoplasms were induced in their offspring. It is frequently implied that an abnormal phenotype is due to the aberration in the genotype, but it is not possible to prove the specitic causal relation. Though, the frequent association between a variety of chromosomal abnormalities solves the problem of how the genotypic and phenotypic are interreiated (Schultz, 1965). 5-bromodeoxyuridine (BUdR) and dimethylnitrosamine (DMN) induce chromosome aberrations in Chinese hamster cells cultured human lymphocytes and mouse cells in vivo (Somers and Hus, 1962; Kato, 1968; Matsuoka et al, 1979; Hahn and Kim, 1979). BUdR is a thymidine analog incorporated into only the DNA of proliferating cells and its mutagenic action is well understood (Freese, 1963). DMN is a potent carcinogen which induces tumors of the liver, lung, and kidney in rats (Magee and Bames, 1959). This agent has no teratogenic effect in rats when given in doses of different concentrations for different periods of time and by several routes of administeration during all stages of embryogeny (Alexandrov, 1967). The experiments reported in this study were undertaken to investigate the possibility that treatment of ICR inbred pregnant mice with BUdR and DMN might shows deformities or abnormalities in their offspring and also to determine whether chemical exposure during fetus will effect at 32 weeks after birth with second exposure to DMN by cytogenetical means. In this study, estrus ICR females were mated and 32 mice which had been diagnosed as pregnant were used. BUdR at the rate of 70, 100 and 150mg/kg of body weight was injected intraperitoneally at 6, 7, 8 days and 9, 11, 13 days of gestation, and DMN at the rate of 10, 20 and 30 mg/kg of body weight was injected at 8, 10, 12 days and 14, 15, 16 days of gestation, The offspring were examined macroscopicaily at time of birth for malformations. All animals were killed at 32 weeks of age and examined for liver abnormalities. The liver were cultured and treated with 1, 5 and 10 ug/ml of DMN for 18 hours. The frequencies of chromosome aberrations and sister chromatid exchanges (SCE) were analyzed. The results are summarized as follows: 1. The litter size was reduced on treated animals. 2. Among the 279 progeny from 36 BUdR treated mothers, malformations were seen in a total of 10 progeny and the group treated at the 9 to 13 gestation days stage had the most. 3. Of the 155 progeny from 24 mothers injected with DMN, none had any visible deformity. However. 37.5% of the group were found to have liver nodules after 32 weeks treated at the 8 to 12 gestation day stage. 4. Repetitive treatment with DMN of the liver culture of the previously BUdR and DMN treated progeny, showed increased chromosome aberrations and SCE frequencies. In conclusion since the exposure of the mother of BUdR and DMN during pregnancy leads to increased chromosomal abnormalities of the cultured liver cells of progeny when treated with DMN a second time, it is necessary to keep in mind that genetic damage may be occure to the progeny by exposing the mother during pregnancy.
Animals ; Body Weight ; Bromodeoxyuridine ; Chromosome Aberrations ; Cleft Palate ; Congenital Abnormalities ; Copulation ; Cortisone ; Cricetinae ; Cricetulus ; Cytogenetics ; Dimethylnitrosamine ; DNA ; Embryonic Structures ; Estrus ; Female ; Fetus ; Fluorouracil ; Foot ; Genotype ; Humans ; Injections, Intraperitoneal ; Kidney ; Litter Size ; Liver ; Lung ; Lymphocytes ; Mice ; Mortality ; Mothers ; Mutagens ; Palate ; Parturition ; Phenotype ; Placenta ; Pregnancy ; Rats ; Sister Chromatid Exchange ; Tail ; Thymidine ; Urethane

Lowe et al. have described a disease characterized by organic aciduria, decreased renal ammonia production, hydrophthalmos, and mental retardation, this disease is now called as Lowe's syndrome or oculo-cerebro-renal syndrome which manifests growth plates, metabolic acidosis, and characteristic eye changes, including bilateral cataract, glaucoma and nystagmus. It is a congenital hereditary affectation. Most of the patients with this syndrome are male sex. We report a new case of Lowe's syndrome in a 5-year old girl.
Acidosis ; Ammonia ; Cataract ; Child ; Female ; Glaucoma ; Growth Plate ; Humans ; Hydrophthalmos ; Intellectual Disability ; Male

There has been much interest in the involvement of wind-up in the hyperalgesia and allodynia of chronic pain syndrome. For investigating the hehaviorml parallels of this wind-up phenomenon, it was limed to evaluate the changes of neurotransmitters(aspartate. lutamate, and taurine) in central sensitization after formalin-induced peripheral nerve injurv in the rats. The experiment was divided into two subexperiments; One was the formalin test.;and the other was microdialysis for evaluation of neurotransmitters. In formalin test (n=7), 50 microliter of 5% formalin was injected suhcutaneously in the foot dorsum of the right hind limb with a 30 G neeclle. To cluantify the formilin response. the number of spontaneous t1inches was counted at 1-2 minutes and 5-6 minutes and at 5 minutes intervals during the period 10- 60 minutes after formalin injeclion. In microdialysis study. the experimental animals were divided randomly into two groups. In experimentl group (n=10). the microdialysis catheter was perfused with artificial cerehrospinal fluid by 3 microliter/min for one hour. Then. the two beseline dialysis samples were collected and 50 microliter of 5% formalin was injected .iuhcutaneously in thc plantar surface of the right hind paw with a 30 G needle. Three 10 minutes dialysate samples were collected after formalin injection. In control group(n=10), the normal saline instead of formalin was used. The results were as followed: In formalin test, there was a biphasic pattern of flinchine after formalin injection. The peak in phase I was shown at 2 minutes after formalin injection. The second peak was shown at 35 minutes alter formalin injection during phase II. In microdialysis study, thcre were statistically significant increascs of aspartate and lutamate concentrations, excitatory neuro transmitters, during the first 10 minutes after formalin injection. After lhen, all values of these neurotransmitters were rcturned to baseline values. The concentrations of taurine, an inhihitory neurotransmitter, was shown a tendency of an increase after formalin injection but, it was not statistically significant. From these results, it secms that the excitatory amino acid ncurotransmitter may partly play a role to triqer the central sensitization after peripheral nerve injury.
Animals ; Aspartic Acid ; Catheters ; Central Nervous System Sensitization* ; Chronic Pain ; Dialysis ; Dronabinol ; Excitatory Amino Acids ; Extremities ; Foot ; Formaldehyde ; Hyperalgesia ; Microdialysis ; Needles ; Neurotransmitter Agents* ; Pain Measurement ; Peripheral Nerve Injuries* ; Peripheral Nerves* ; Rats* ; Taurine

The results of arthroscopic synovectomy of the knee joints were reviewd in 23 joints of 21 patients hetween May 1992 and June 1996. The results were as follows: 1. Pain, tenderness, swelling, ROM of synovitis syrnpknns were much nsiproved postoperatively. 2. The degrees of articular cartilage damage were closely related to posto-perative functional recovery. 3. Preoperative and postoperative ESR changes were not ditferent signihcantly, 4. Recurrence rate was 17%, 4 cases. Of them, 2 cases were rheumatoid arthritis, 1 case was pigmented villonodular synovitis, I case was nonspecipic synovitis 5. Complicatior of arthrosc:opic synovectomy was nol found. We concluded that arthroscopic synovectoiny was very useful method of early diagnosis and treatment of synovial memhrane diseases.
Arthritis, Rheumatoid ; Arthroscopy ; Cartilage, Articular ; Early Diagnosis ; Humans ; Joints ; Knee Joint* ; Knee* ; Recurrence ; Synovitis ; Synovitis, Pigmented Villonodular

Fifty-nine knees with a specific diagnosis of mediopatella plica syndrom; under arthroscopy were treated by arthroscopic resection. The patients were se1ected for arthroscopy only if the symptoms had continued after a course of physical therapy and medication for at least three weeks. Seven patients were lost in follow up period. Fifty-two knees were reviewed after mean period of 21.5 monl;hs (range 12 to 37). The results were graded as excelient (61.5%), good (25%), poor (9.6%) and failure (3.9%). Majority of the patients ratect their result as excellent or good. We concluded that with the meticulous resection of the pathologic plica with arthroscopy, good result can he expected with resumption of athletic activities and no or mild pain in knee joint.
Arthroscopy ; Diagnosis ; Follow-Up Studies ; Humans ; Knee Joint* ; Knee* ; Sports

No abstract available.

Treatments of tibia shaft fracture are closed reduction followed by cast immobilization, external fixation, intramedullary nailing and internal fixation with plate and screws. Among these, intramedullary nailing is commonly used method today. The tibia nailing has high rate of union, but malunion, infection, the joint stiffness and anterior knee pain develops frequently. We reviewed the clinical and radiological result of anterior knee pain retrospectively after tibia nailing. The result were as follows: l. Age distribution of tibia shaft fracture was 17 to 76, and mean age was 40 male patients were 35 and female 13. 2. The open fractures were 17 and the closed fractures were 34. 3. The causes of' tibia shaft fracture were traffic accidents(30cases), fall down injuries(6 cases), slip down injuries(1 1 cases) and other injuries(4 cases) Among the these, 19 cases were cornbined with other fractures or neuri.isurgical injuries. 4. The incision methods were recorded as follows: parapatella tendon incision were 9 cases, patella splitting incision were 25 cases and unrecorded were 17cases. 5. According to the radiological analysis, the average nail plateau distance was 10.3mm and the extent of nail protrusion beyond the anterior cortex was -1.73mm. Among these, protrusion of proximal targeting screws were 8 cases. 6. Insertion of nail through the patella tendon was associated with a hipher incidence of knee pain compared to paratendon site of insertion. The extent of nail protrusion were related to anterior knee pain after tibia intramedullary nailing.
Age Distribution ; Female ; Fracture Fixation, Intramedullary* ; Fractures, Closed ; Fractures, Open ; Humans ; Immobilization ; Incidence ; Joints ; Knee* ; Male ; Patella ; Patellar Ligament ; Retrospective Studies ; Tendons ; Tibia*

The function of the knee joint is determined by the anatomical integrity of ligamentous structures, however the ligaments and soft tissues which support by the knee joint are too weak to tolerate forceful stresses. The knee joint is one of the most susceptible joints to ligamentous injury. Recently, the incidence of ligamentous injuries of the knee increased because of rise in traffic accidents and participation in sports. For good results, it is very important to make an early diagnosis and to give prompt management. The authors reviewed 67 cases of ligamentous injuries in patients who were admitted and managed at the Department of Orthopaedic Surgery of Presbyterian Medical Center from March of 1976 to December of 1982. The results of the clinical study are as follows: 1. The prevalent age group is the 3rd through 5th decades, and more frequent in males (8. 6 times). 2. The traffic accident is the most common cause of injury (80. 6%) and many ligamentous injuries were associated with fracture (53. 2%). 3. The most common ruptured individual ligament was the medial collateral ligament. The isolated ligamentous rupture of anterior and posterior cruciate ligament was 3 cases each, but most of the cruciate ligaments were combined with other ligament injury. 4. The rupture sites of the individual ligaments were found to be the following: (a) The medial collateral ligament was ruptured most frequently in the mid-substance (45. 2%), with the deep layer ruptured at the femoral attachment and the superficial layer in the mid-substance; (b) The lateral collateral ligament torn at the fibular attachment (62. 5%); (c) The anterior cruciate ligament torn at the femoral and tibial (47. 6%, respectively); (d) The posterior cruciate ligament torn at the femoral attachment (40. 0%). 5. It is significant if the difference between the normal knee and the injured knee on the stress film is more than 10 or 10mm. 6. Excellent and good results were obtained in 95.2% by non-surgical management and in 93.0% by surgical management. 7. Early surgical repairs, made within 2 weeks after injury, gave much better results than late repairs.
Accidents, Traffic ; Anterior Cruciate Ligament ; Clinical Study ; Collateral Ligaments ; Early Diagnosis ; Humans ; Incidence ; Joints ; Knee Joint ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Male ; Posterior Cruciate Ligament ; Protestantism ; Rupture ; Sports

Beurgers disease is a specific, recurrent, segmental, inflammatory, obliterative vascular disease involving principally the medium sized arteries and veins of the extremities. The disease was originally described by Leo Beurger in 1908. The results in treatment were not satisfactory in spite of many interaction and experiencies in treatment. So the present study is clinical analysis of 136 cases of Beurgers disease, who were treated at the Department of Orthopaedic Surgery and General Surgery, Presbyterian Medical Center, for the past 12 years, from 1971 to 1982. The results obtained are as follows: Sex distribution was predominent in male(97.1%) and peak incidence in the fourth decade. One hundred twenty eight cases had smoked over 10 years and sixty percent had more than one operation previously because of the same disease. The most common symptom was pain in the extrimities, necrosis, skin color change and coldness were in that order of frequency. The lower extremities were more commonly involved. The most common site of obstruction at the arteriogram was the popliteal artery. Among the surgery cases, 20 of the sympathetomized patients had followed-up, and the long term result showed improvement in 17 cases and all the results of the vascular surgery were poor.
Arteries ; Clinical Study ; Extremities ; Humans ; Incidence ; Lower Extremity ; Necrosis ; Popliteal Artery ; Protestantism ; Sex Distribution ; Skin Pigmentation ; Smoke ; Thromboangiitis Obliterans ; Vascular Diseases ; Veins