Arthrography is an invaluable procedure in critically verifyging the concentricity of closed reduction and the optimum position of stability. And it is known to be the most accurate and certain way of demonstrating lesser degrees of incongruity. It can visualize the intrinsic obstructive fractors, such as capsular attachment, the labrum, the psoas tendon and its relationship to the joint, the pulvinar, ligamentum teres, the inferior transverse ligament, and the shape of the femoral head and acetabulum. We analyzed 20 cases of congenital dislocation of the hip in 17 patients, which had been evaluated by arthrography. The results are as follows: 1. We found the inferior approach very efficient among many kinds of arthrographic techniques. 2. Among 20 cases, 12 cases could be treated with closed reduction and 8 cases were treated by open reduction such as capsuloplasty, partial limbusectomy, and removal of space occupying lesion in acetabulum, including 2 cases of Salter's innominate osteotomy and 1 case of derotational osteotomy. 3. Among the intracapsular obstructive factors which played major role in hindering closed reduction, capsular constriction was shown in 8 case, inverted or hypertrophic limbus in 5 cases, and other space occupying lesions in 2 cases. 4. We performed combined operation including bone and soft tissue for severe extra- and intracapsular lesions and closed reduction for mild to moderate extra- and intracapsular lesions. 5. Arthrography of the hip joint was indispensable in evaluating the intracapsular osstructive lesions as well as detecting the subtle incongruent reduction.
Acetabulum ; Arthrography ; Constriction ; Dislocations ; Head ; Hip Joint ; Hip ; Humans ; Joints ; Ligaments ; Osteotomy ; Pulvinar ; Round Ligaments ; Tendons

In 1974, bipolar endoprosthesis was first introduced by Bateman & Giliberty. It has theoretical advantages including minimizing acetabular wear, possible reduction of incidence of stem loosening, lessening of dislocation and easy revision procedure. Various methods for the treatment of fracture of the femur neck have been developed & performed, but it is still called “the unsolved fracture” in certain situation. But the role of it as primary treatment of fracture of the femur neck continues to be controversial. Current clinical results encourage its continued use and expansion of indication. Authors reviewed and analysed 21 cases of bicentric endoprosthesis and 1 case of Giliberty endoprosthesis those have been operated at the Department of Orthopaedic Surgery, National Medical Center from 1981 to 1983. Following results were obtained, l. According to disorder distribution, 14 cases were neglected fracture of femur neck, 2 old fracture, 1 idiopathic femoral head necrosis and 2 avascular necrosis & 1 non-union complicated by femoral neck fracture. 2. Among 20 cases, 8 cases were operated within 1/2 1 month after injury and 6 cases within 1 3months 3. Harris lateral appmach was used in 16 cases (80%) and Modified Gibson approach in 4 cases (20%). There were no significant differences in morbidity during operation and postoperative complication. 4. We used femoral stems those head diameter was 22 and 32mm(Charnley & Miiller type) and head pieces those diameter was 48-51 mm in male and 44–48 mm in Ifemale. 5. 3 cases were stiff in inner bearing without acetabular erosion. 6. In 6 cases more than 2 years followup 1 degree CE angle of Wiberg was increased in 2 cases of youngage respectively without associated hip joint pain. 7. Although inclination of head piece was vertical in 8 cases, fracture and dislocation were not found. 8. The circumference of head piece and opposite femoral head was measured and compared. There were 12 cases (mean 12.6 mm) that of head piece larger than opposite femoral head and 3 cases smaller than opposite femoral head. 9. There was 4 cases of complication (3 patients) and still no reoperation and revision converted to T.H.R. 10. With regard to average 18 months of follow-up, 7 cases of 81–90 Harris hip-rating score, 6 of 91–100, 4 of 71–80 and 3 of 61–70.
Acetabulum ; Dislocations ; Femoral Neck Fractures ; Femur ; Femur Neck ; Follow-Up Studies ; Head ; Hip Joint ; Humans ; Incidence ; Male ; Neck ; Necrosis ; Postoperative Complications ; Reoperation

Proliferating cell nuclear antigen (PCNA, PC10), an auxillary protein of DNA polymerase, plays a main role in the early stage of DNA Synthesis and is synthesized from Gl phase to s phase of the cell cycle. Nucleolar organizer region (NORs) are DNA loops encoding RNA proteins(AgNORs). To evaluate correlation with PCNA labelling index (LI)and AgNORs according to histological grades and clinical stages of transitional cell carcinoma of the urinary bladder, the authors analysed 54 transitional cell carcinoma using immunohistochemical stain for PCNA and silver stain for AgNORs in paraffin sections. The comparison of PCNA (PC10) LI and clinical stage showed a significant correlation (p<0.05), where as PCNA (PC10) LI according to histologic grade showed no significant correlation. High grade tumors showed increase PCNA LI. Superficial tumors (Ta-Tl) showed significantly lower PCNA LI than muscle invasive tumors (T2-T4)(p<0.05). There was no significant correlation between AgNORs and clinical stage, bur higher stage and higher grade tumors showed increased noubers of AgNORs. These results suggest that PCNA LI has a significant correlation with clinical stages of transitional cell carcinoma of the urinary bladder.

Congenital esophageal stenosis due to tracheobronchial remnants is one of main forms of congenital esophageal stenosis, and it was first described by Frey and Duschel in l936. An 18-month-old male presented with underdevelopment and dehydration state due to persistent vomiting several times per day since 3 months after his birth. Esophagogram revealed an elongated and diiated esophagus with marked stenosis at distal portion. Partial distal esophagectomy was performed. Histologically, the thickened esophageal wall is composed of tracheobronchial remnants including hyaline cartilages, mucous glands, and ductal structures lined by ciliated respiratory epithelium under stratified squamous mucosa.
Male ; Humans

Congenital esophageal stenosis due to tracheobronchial remnants is one of main forms of congenital esophageal stenosis, and it was first described by Frey and Duschel in l936. An 18-month-old male presented with underdevelopment and dehydration state due to persistent vomiting several times per day since 3 months after his birth. Esophagogram revealed an elongated and diiated esophagus with marked stenosis at distal portion. Partial distal esophagectomy was performed. Histologically, the thickened esophageal wall is composed of tracheobronchial remnants including hyaline cartilages, mucous glands, and ductal structures lined by ciliated respiratory epithelium under stratified squamous mucosa.
Male ; Humans

Injuries of the cervical spine from C3 down to C7 are complex and potentially devastating injuries. The treatment of this condition is complicated and controversial. However, there is an increasing tendency to stabilize unstsble cervical spine injuries surgically with the benefit of good stability of the spine, easy nursing care, early mobilization and rehabilotation. We analysed clinically the 26 patients with unstable lower cervical spine injuries st the department of orthopaedics, National Medical Center from Jan. 1979 to Dec. 1988. The results obtained were as follows:1. The prevalent age distribution was between 20 and 50 years of age(71%), and the ratio between male and female was 6: l. 2. The most common cause of the injury was traffic accident(42%), and the most frequent mechanism of injury was distractive-flexion type(42%). 3. In the overall clinical evaluation, 73% of the patients were judged to have had excellent and good results, and the range of the motion was more limited in the patient who underwent posterior fusion due to wide level of fusion. 4. The patients with distractive-flexion injuries with minimal neurologic deficit were at risk of late instability following conservative treatment, and therefore open reduction and posterior fusion may be advisable. 5. The patients who were given posterior fusion were noted to have a few significant late changes, but the patient with anterior fusion carried a high incidence of progressive kyphotic deformity and persisting, pain. 6. When anterior fusion is used in the patient with posterior instability for the purpose of cord decompression, anterior cervical plate is valuable than the fusion with graft only in view of preventing progressive kyphotic deformity.
Age Distribution ; Congenital Abnormalities ; Decompression ; Early Ambulation ; Female ; Humans ; Incidence ; Male ; Neurologic Manifestations ; Nursing Care ; Spine ; Transplants

The posterior cruciate ligament, because of its location and axial role in knee function, was assumed to be a fundamental stabilizer for the knee joint. Reconstruction of the posterior cruciate ligament has been a demanding operation due to difficulties of appropriate graft material. Posterior cruciate substituing material should be biocompatible, durable, stress-strain capable and ease to be used. Achilles tendon autografts were thought to meet these criteria. Recently, we have advocated partial Achilles tendon autograft in reconstructive operation of posterior cruciate ligament with promising result. Posterior cruciate ligament reconstructions were done in 8 knees, with follow-ups ranging from 7 to 23 months, averaging 13 months. The results were as followings: l. Average preoperstive knee score was 46 and it was improved up to 88 after operation. 2. Among the 8 knees, 3 belonged to the excellent, 4 to good, and 1 to fair groups respectvely. 3. Achilles tendon autograft turned out to be a good substitute for the posterior cruciate deficient knee. The results were promising. Achilles tendon autograft regarded to be suitable for the posterior cruciate liagament reconstruction and desirable features of this autogenous graft included distinguished biocompatability, mechanical stability in fixation strength as well as stress-strain capability, and consistency in reproducible operative technique.
Achilles Tendon ; Autografts ; Follow-Up Studies ; Knee ; Knee Joint ; Posterior Cruciate Ligament ; Transplants

No abstract available.
Mass Screening* ; Prospective Studies*

Double contrast arthrography has been widely accepted as a method to diagnose the internal derangement of the knee. It is a safe and technically simple procedure permitting accurate diagnosis of lesions of the menisci. In 20 cases operated upon, with the diagnosis of internal derangement of the knee, we performed double contrast arthrography before surgery. We analysed the cases concerning the diagnostic accuracy of arthrography, its clinical significance and discrepancies between arthrographic findings and postoperative lesions. The results were as follows: 1. The cases consisted of 16 cases of meniscal lesion, 4 cases of ligamentous lesion and 3 cases of loose body. 2. In the meniscal lesions, 14 of the 16 cases (87.5%) were diagnosed accurately by arthrography, Therefore arthrography was more useful in diagnosing meniscal lesions as compared with clincal symptoms (69%). 3. In cases of ligamentous lesions arthrography was not significant-ly helfpful, in contrast clinical signs afforded important clues. 4. We encountered 1 case of false positive and 1 case of false negative.
Arthrography ; Diagnosis ; Knee ; Ligaments ; Methods

After discovery of Penicillin by Fleming in 1939, a great improvement in the treatment of osteomyelitis has been made and the mortality rate in acute stage was markedly decreased. But due to misplacement of antibiotics, and the improper treatment of the osteomyelitis, the tendency to chronicity and various sequellae of the osteomyelitis are still persist. So, it will be of importance to reconsider the management of various sequellae of pyogenic osteomyelilis. We reviewed 3 cases of sepsis, 10 cases of pathologic fracture, 6 cases of sepsis, 6 cases of malignant turnor developed in an old draining sinus, 2 cases of bone defect, 3 cases of joint contracture and 4 cases of deformity and growth disturbance 604 cases of osteomyelitis treated at National Medical Center between 1972 to 1983. The results were as follows: 1. Established sepsis was noted in 3 cases, and one of these patient dead. We treat these patients with high dose of the antibiotics accompanied by decompression of the lesion. 2. Pathologic fracture developed in 10 cases, which was treated with either conservative or operative treatment. All cases obtained good union except one. 3. Spuamous cell carcinoma developed in 6 cases around the old draining sinus. All cases were treated with amputation. Theres no recurrence except one. 4. Bone defect developed in 2 cases. A case of bone defect in humeral shaft was treated with vascularized fibular graft and obtained firm union and good function. 5. Joint contracture was treated with soft tissue release and even joint fusion in severe case. The results were not gratifying. 6. Deformity and growth disturbance of limbs were treated with soft tissue release, osteotomy and stapling. Most of the cases obtained good results, but limb length discrepancy was not recovered satisfactorily.
Amputation ; Anti-Bacterial Agents ; Congenital Abnormalities ; Contracture ; Decompression ; Extremities ; Fractures, Spontaneous ; Humans ; Joints ; Mortality ; Osteomyelitis ; Osteotomy ; Penicillins ; Recurrence ; Sepsis ; Transplants