Now that ankylosing spondylitis is known to be relatively common, it is important that mild cases should be diagnosed earlier to avoid inappropriate investigation and unhelpful non-specific therapy and to improve social rehabilitation. However, difficulties in the diagnosis of ankylosing spondylitis are often encountered. To establish the clinical values of SPECT in ankylosing spondylitis, a study of radiologic evaluation, quantitative bone scan and SPECT have been carried out in 34 patients who were firmly suspected as having ankylosing spondylitis by other tests. This study showed that SPECT could improve the applicability of the imaging modality in the diagnosis and the assessment of disease activity and the capacity of early diagnosis in patients with ankylosing spondylitis. We believe that improved three dimensional localization in and around the sacroiliac joints by SPECT might overcome several diagnostic difficulties. Especially when radiographic abnormalities are not present in the early period, the diagnostic values of SPECT may be more potential.
Diagnosis ; Early Diagnosis ; Evaluation Studies as Topic ; Humans ; Rehabilitation ; Sacroiliac Joint ; Spondylitis, Ankylosing* ; Tomography, Emission-Computed, Single-Photon*

Failure of fixation of intertrochanteric fractures that have been treated with a fixed-angle sliding hip-screw device is frequently related to the position of the lag screw in the femoral head. The purpose of this study is to introduce the concept of the tip-apex distance and to demonstrate its clinical usefulness as a predictor of cutout of the screw used for fixation of the intertrochanteric fractures of the hip. The tip-apex distance is the sum of the distance from the tip of the lag screw to the apex of femoral head on an anteroposterior radiograph and this distance on a lateral radiograph after controlling for magnification. To determine the value of tip-apex distance in the prediction of cutout of the lag screw, 67 intertrochanteric fractures that have been treated with a fixed-angle sliding hip screw device were studied. The minimum duration of follow-up was three months during which period all of the fractures either healed or had failure of the fixation. The average tip-apex distance was 21mm (range,22.8-65.8mm) for the successfully treated fractures compared with 35mm (range,8.4-65.8mm) for those in which the screw cutout. There was strong statistical relationship between an increasing tip-apex distance and the rate of cutout. An unstable fracture, a poor reduction were also associated with a significantly increased risk of failure due to cutout.
Femur ; Follow-Up Studies ; Head ; Hip Fractures* ; Hip*

PURPOSE: To show the results of treatment of ipsilateral unstable femoral fracture during postoperative period of total hip arthroplasty. MATERIAL AND METHOD: We analyzed eight cases of ipsilateral unstable femoral fractures during the postoperative period of total hip arthroplasty, which were treated operatively from November 1992 to November 1995. The follow-up period ranged from 2 years to 3 years and 8 months (average, 2 years 8 months). There were seven cases of type B2 fractures and one case of type B3 fracture according to the Duncan's8) classification. All showed femoral stem loosening. One case was treated with revision of new femoral stem and internal fixation using wire. Six cases were treated with revision of long femoral stem and internal fixation using wire or Parham band. One case was treated with revision of long femoral stem and internal fixation using plate and wire. All cases had bone graft performed at the fracture site of femur. RESULTS: The results of treatment of periprosthetic fractures showed that seven cases were satisfactory and one case was unsatisfactory. The complications were as follows: nonunion in one, heterotopic ossification in two, and one case of limb shortening. CONCLUSION: The treatment of ipsilateral femoral fractures during postoperative period of total hip arthroplasty can be complex and difficult but revision arthroplasty with a new femoral stem prosthesis, combined with internal fixation and bone graft, may be satisfactory, if the femoral stem is displaced or loosened.
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Classification ; Extremities ; Femoral Fractures* ; Femur ; Follow-Up Studies ; Ossification, Heterotopic ; Periprosthetic Fractures ; Postoperative Period ; Prostheses and Implants ; Transplants

The purpose of this retrospective study was to evaluate the morphology of the intercondylar notch of the knee in 72 anterior cruciate ligament (ACL) intact group and 30 acute and chronic ACL tear group by plain radiographs and MRI, and to find the predisposing factors of ACL tear. The ACL tear group was divided into acute and chronic ACL tear group. In plain lateral radio-graphs, beta angle, angle between extension line from anterior cortical line of distal femur and from Blumensaat s line, was measured. In magnetic resonance imaging, the width of intercondylar notch (NB), the widest width of both femoral condyle (NW), intercondylar notch width from lower one third point of notch basal line (NB1), intercondylar notch width from upper one third point of notch basal line (NB2), depth of intercondylar notch from notch basal line (ND), and intercondylar angle which made from both end point of notch basal line and apex of intercondylar notch (alpha) were measured. Three groups were compared with each other by statistical analysis. Stastistically, the acute ACL tear group had narrow upper portion of intercondylar notch than chronic ACL tear group and more acute angle of roof of the intercondylar notch than intact ACL group. So in notchplasty, the upper one-third of intercondylar notch should be carefully widened. And after fixation of femoral interference screw, arthroscopic observation should be done whether reconstruced graft touchs the roof of the intercondylar notch during the extension of the knee.
Anterior Cruciate Ligament ; Causality ; Femur ; Knee ; Magnetic Resonance Imaging* ; Retrospective Studies ; Transplants

No abstract available.
Bone Cysts* ; Fractures, Spontaneous*

Osteoid osteoma is a relatively common benign skeletal tumor that usually affects the cortex of the long bone. Despite its common incidence, the diagnosis is often delayed and confused with other entities such as stress fracture, tuberculosis, osteomyelitis and intracortical abscess. Moreover, the diagnosis becomes more difficult when the osteoid osteoma develops in the intra-articular region. Several factors contribute to the difficulty of the diagnosis: First, osteoid osteoma is relatively rare compared to other causes of articular pain. Second, it presents non-specific clinical manifestation in the hip joint much like other intraarticular disorders. Third, plain radiographs sometimes do not represent the characteristic findings. Fourth, MR imaging reveals inconsistent signal intensities, especially in the early stage. Bone scan also lacks specificity for diagnosis. Recently, we experienced four cases of intra-articular osteoid osteoma of the hip joint and presented them with a review of the literatures.
Abscess ; Diagnosis ; Fractures, Stress ; Hip Joint ; Hip* ; Incidence ; Magnetic Resonance Imaging ; Osteoma, Osteoid* ; Osteomyelitis ; Sensitivity and Specificity ; Tuberculosis

BACKGROUND: The cause of autoimmune thyroid diseases (AITD), including Graves disease and Hashimotos thyroiditis, is largely unknown. To identify the genes responsible, most attention has been focussed on the HLA regions in the early studies. However, these studies have repeatedly shown a weak association between AITD and the HLA-DR3 in Caucasians. To understand and find out the mechanisms underlying the development of AITD, a search for non-HLA linked susceptibility genes is important. A recent study from American population have indicated an association between a polymorphism of CILA-4 gene and Graves disease. To clarify the relationship of the CTLA-4 polymorphism and AITD, the allele frequency of CTLA-4 gene from the patients with Graves disease and with Hashimotos thyroiditis in Korean papulation were analysed. METHODS: The CTLA-4 exon 1 polymorphism (49, A/G) was analysed by PCR-based, RFLP (Restriction Fragment Length Polymorphism) from 92 women and 37 men with Graves disease and 50 women and 9 men with Hashimotos thyroiditis diagnosed. Also, 287 healthy controls including 155 women and 132 men with no clinical evidence or family history of thyroid disease were enrolled. RESULTS: 1) In the group of Graves disease, there was significantly more patients with alanine homozygote (GG) than in control group (P<0.0005, RR=1.40). However, there was not significant with threonine homozygote (AA) between two groups (P=0.052). In the group of Hashimotos thyroiditis, no significant differences were found between all homozygotes and heterozygote. 2) In the group of Graves disease, there were significantly more patients with alanine homozygote (GG) (P<0.0001, RR=1.85) and significantly fewer patients with threonine homozygote (AA) than in the group of Hashimoto's thyroiditis (P<0.005, RR 0.25). CONCLUSION: Regardless of sex difference, alanine homozygote (GG) at exon 1 (codon 17) of CTLA-4 is associated with Graves disease in Korean population, which suggests genetic susceptibility is some role in the pathogenesis of Graves disease.
Alanine ; Exons ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Graves Disease ; Heterozygote ; HLA-DR3 Antigen ; Homozygote ; Humans ; Lymphocytes* ; Male ; Polymorphism, Restriction Fragment Length ; Sex Characteristics ; Threonine ; Thyroid Diseases* ; Thyroid Gland* ; Thyroiditis