Transpedicular Screw fixation and Harrington distraction rod are effective means of managing unstable thoracolumbar fracture and fracture dislocation. The authors analysed the 52patients who were treated with above 2methods from March 1986 to February 1993. The results were as follows: 1. Most of patients were in 5th decade compare to younger group and most common cause of injury was fall down, but traffic accident is increasing. 2. The most commonly involved sites were T12and L1 vertebrae and most common type of injury is bursting fracture. 3. Postoperative anterior and posterior column of vertebrae body correction rate were 35.0%/34.4% in ISF group and 29.3%/27.9% in Harrington group. Postoperative correction loss rate were 0.13/0.04 in ISF group and 0.06/0.04 in Harrington group. 4. Postoperative correction of kyphosis angle were average 18 in ISF goup and average 15° in Harrington group. Loss of correction angle was average 23° in ISF group and average 4.4° in Harrington group. 5. Range of spinal fixation was average 3.1 segments in ISF group and average 6.2 segments in Harrington group. 6. There was no significant difference in neurologic recovery between ISF group and Harrington group. The patients who had been recovered neurologically more than 1 grade were 28.6% in Harrington group and 29.2% in ISF group. 7. ISF has some benefit in spnal vertebral body height correction and in maintenance of correction compare to Harrington group. Nevertheless disadvantages of ISF group such as long operative time and possibility of cord compression by pedicular screw, ISF has advantages of almost anatomical reduction and the least spinal fusion.
Accidents, Traffic ; Body Height ; Dislocations ; Humans ; Kyphosis ; Operative Time ; Spinal Fusion ; Spine

Atropine is the classic antimuscarinic anticholinergic drug that bas been used to block cholinergic neurotransmission in basic research and received recent interest clinically in the intracavernous pharmacotherapy of erectile dysfunction. It has been suggested that at low dose(0.00000001M), atropine blocks muscarinic receptors, thereby reducing both cholinergic of the adrenergic and cholinergic excitation of the NANC neuroeffector systems, on the other hand, at large pharmacological dose(0.001M),induces the release of EDRF which recently has been identified as nitric oxide(NO) or NO like substance. Therefore, we tried to confirm the action of atropine in the cavernosal tissue and define its mechanism. Strip of rabbit corpus cavernosum were isolated and mounted in 10 ml organ chambers to measure isometric tension. Muscle strips submaximally precontracted with phenylephrine(5x0.000001M) and treated with increasing concentrations of atropine(0.00000000001M to 0.00lM) showed tension increase upto 0.00000001M of atropine, and thereafter, relaxed concentration dependently(0.0000001M: 43.7%, 0. 000001M: 63.0%,0.00001M:86.2%,0.0001M:93.6%,0.001M:100%). Relaxations to atropine(5x0.000001M) were not inhibited even partially by endothelial disruption or by pretreatment with methylene blue or pyrogallol. Pretreatment of muscle strips with atropine(5x0.00000lM) caused concentration- related inhibition of a phenylephrine induced contraction, and in calcium-free high potassium depolarizing solution, decreased basal tension as well as inhibited contraction induced by CaC12. However, atropine did not produce reduction of responses to depolarizing medium(20, 40, 80mM KCl). With these results we can confirm the relaxation effect of atropine at a larger dose(>0.0000001M)on the cavernosal smooth muscle and suggest that its action is mediated by increasing intracellular calcium sequestration,not by hyperpolarization or EDRF.
Atropine* ; Calcium ; Drug Therapy ; Erectile Dysfunction ; Hand ; Male ; Methylene Blue ; Muscle, Smooth ; Phenylephrine ; Potassium ; Pyrogallol ; Receptors, Muscarinic ; Relaxation* ; Synaptic Transmission

Particulate wear debris(polyethylene, polymethylmethacrylate and metal particles, or combination of these) can initiate aseptic loosening. To eliminate polyethylene debris and reduce the total amount of wear, metal on metal bearings(Metasul) which were made of a wrought Co-28Cr-6Mo-0.2C alloy, were introduced. From May 1994 total hip replacements using a Metasul metal on metal articulation were performed by the authors. 34 patients with 40 hips with minimum follow-ups during 24 months were analysed in this study. The mean follow up period was 31 months(ranging from 24 to 47 months). We used Armor cups and standard cups as acetabular comporients and SL stems, CLS stems and cone stems as femoral components. Preoperative average Harris hip score of 48 points became postoperatively 93(from minimum 81 to maximum 100). And there were slight and occasional thigh pains in 2 cases(5%). There were no revisions for the early aseptic loosening of femoral stems or stem failures. Radiologic evaluation which revealed mild calcar atrophy was developed in 33 cases(82.5%), revealing cortical hypertrophy in 10 cases(25%). Osteolysis was not noted around the prosthetic stem nor around the cup. Radiolucent lines were found in 9 cases of femoral components(22.5%) and in 1 case of acetabular component(2.5%) and subsidence of more than 3mm in 1 case of femoral components(2.5%) were also found. There was 1 case of definitive loosening of acetabular component(2.5%). These also showed that endosteal bone formation adjacent to femoral prosthesis was developed in 22 cases(55%) but no distal pedestal and stem shift occurred. The short-term but satisfactory results of the contemporary metal on metal articulation investigated in this study were encouraging and warrant continued study.
Acetabulum ; Alloys ; Arthroplasty* ; Arthroplasty, Replacement, Hip* ; Atrophy ; Follow-Up Studies ; Hip ; Humans ; Hypertrophy ; Osteogenesis ; Osteolysis ; Polyethylene ; Polymethyl Methacrylate ; Prostheses and Implants ; Thigh

No abstract available.

Systemic arteriovenous (AV) fistulas are a rare but well-recognized cause of hyperkinetic circulation that, if undetected, may lead to congestive heart failure. We experienced a very rare case of acquired arteriovenous fistula. A 61-year-old female patient presented with congestive heart failure symptoms after percutaneous pinning for right sternoclavicular joint dislocation. We surgically obliterated the fistula between aorta and innominate vein and performed tricuspid annuloplasty for severe tricupid insufficiency simultaneously. She was discharged with complete relief of her symptoms and has been well during 2 years and 6 months follow up.
Aorta ; Arteriovenous Fistula* ; Brachiocephalic Veins ; Dislocations ; Female ; Fistula ; Follow-Up Studies ; Heart Failure ; Humans ; Joints* ; Middle Aged ; Sternoclavicular Joint ; Tricuspid Valve

The purpose of this study is to determine whether magnetic resonance imaging(MRI) can assist in deci- sion-making in the treatment of acute posterolateral complex injuries. We reviewed retrospectively seven patients with acute posterolateral complex injury, among the 79 cases that had taken cruciate ligament recon- struction. MRI findings were then correlated with the results of examination under anesthesia or operi lateral reconstruction. Based on surgical and clinical findings, there were six complete and four partial posterolateral complex injuries. MRI was able to accurately describe the extent of injury in each case. All ten patients had concomitant anterior cruciate ligament tears, and seven were three posterior cruciate ligament injuries. The iliotibial band was avulsed from Gerdys tubercle in seven patients. In knees with complete tears, separation of the coronary ligament of the lateral meniscus was noted on MRI. A characteristic bone contusion on the anteromedial femoral condyle was present in nine patients. Popliteal tendon tearing was observed in eight cases, and biceps femoris was torn in six patients. In knee with complete tears, tears of the lateral collateral ligament complex was noted both on MRI and intraoperatively. A high-quality MRI in patients sustaining these injuries will assist the surgeon in directly applying surgical techniques in a timely fashion.
Anesthesia ; Anterior Cruciate Ligament ; Contusions ; Humans ; Knee* ; Lateral Ligament, Ankle ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Posterior Cruciate Ligament ; Retrospective Studies ; Tendons

One hundred and ninety-four consecutive patients with two hundred and one diaphyseal femur fractures were retrospectively reviewed to evaluate the frequencies, types and the results of treatments for the associated ipsilateral knee ligaments and menisci injuries from Oct. 1990 to Feb. 1997 at Eulji Medical Center. Fifteen patients had associated ipsilateral knee ligament injuries. There were eleven(73.3%) males and four(26.7%) females with an average age of 35.7(17-68) years. Thirteen(86.7%) patients were injured by traffic accident. Ten patients were followed for average of 38 months(12-73 months). There were five(33.4%) partial and two(13.3%) complete tears of anterior cruciate ligaments, three(20.0%) partial and four(26.7%) complete tears of posterior cruciate ligaments, one(6.7%) partial and four(26.7%) complete tears of medial collateral ligaments, one(6.7%) complete and three(20.0%) partial tears of lateral collateral ligaments, five(33.3%) tears of medial menisci and four(26.7%) tears of lateral menisci. There was no relationship between specific ligament damage and the cause of the injury or level of fracture. Better range of knee motion and HSS knee score was obtained when both the femur and ligament injuries were surgically managed. The invention of the MRI and the development of arthroscopic techniques have made it easy to diagnose and take care for ligament injuries. Early diagnosis and proper treatment on ruptured ligaments and tom meniscus combined with diaphyseal femur fractures seem to be important for good prognosis.
Accidents, Traffic ; Anterior Cruciate Ligament ; Collateral Ligaments ; Early Diagnosis ; Female ; Femoral Fractures* ; Femur ; Humans ; Inventions ; Knee* ; Lateral Ligament, Ankle ; Ligaments* ; Magnetic Resonance Imaging ; Male ; Menisci, Tibial ; Posterior Cruciate Ligament ; Prognosis ; Retrospective Studies

No abstract available.
Dislocations* ; Elbow*

The cauda equina syndrome is a relatively uncommon, but serious complication. And it can have grave long-term consequences for the patient. The purpose of the study is to analyse the causes, clinical courses and to find the methods of prevention of cauda equina syndrome following lumbar spine surgery. We reviewed 6 cases among 287 patients wbo had been operated on and followed for minimum 12 months at Seoul Adventist Hospital from March 1991 to March 1996. The obtained results were as follows. 1. All six cases was noted only in patients who had operative procedures for spinal stenosis and possible causes were 3 cases of epidural hamatoma, 1 case of unrecognized and recurred disc herniation, 1 case of retained ligament flavum and 1 case of pseudomeningocele formation due to unrecognized dura tear. 2. Progressive neurologic deficits, decreased perianal sensation and loss of anal wink were present in all cases and were diagnostic. 3. Only three cases which were occurred within 24 hours and early treated within 12 hours, had no specific residual neurologic deficits. In conclusion, it is recommended that operators should be very cautious during the spine surgery. And also early recognition and surgical decompression is very important. During early postoperative periods, only repeated and regular neurologic examinations will enable early diagnosis and treatment to reduce permanent neurological damage.
Cauda Equina* ; Decompression, Surgical ; Early Diagnosis ; Humans ; Ligaments ; Neurologic Examination ; Neurologic Manifestations ; Polyradiculopathy* ; Postoperative Period ; Sensation ; Seoul ; Spinal Stenosis ; Spine* ; Surgical Procedures, Operative

No abstract available.
Paraplegia* ; Pseudarthrosis* ; Spondylitis, Ankylosing*