A 56-year-old man received subtotal gastrectomy for an early gastric carcinoma type IIa+IIc with submucosal invasion. The tumor was made up of mixed papillo-tubular adenocarcinoma and solid carcinomatous portion, the latter comprising approximately four-fifths of the total tumor mass. The solid portion was confined within the submucosa and revealed a mixture of trabecular, compact and pelioid patterns of large polyhedra cells, resembling hepatocellular carcinoma of the liver(Edmondson-Steiner grade 2). Sinusoid-like vascular stroma of classical trabecular hepatocellular carcinoma intervened the tumor cell nests but was not associated with endothelial-cell lining. Immunohistochemical stainings with alpha-fetoprotein and alpha1-antitrypsin gave a strong reactivity in those areas of hepatoid differentiation and in the adjacent minute portion of adenocarcinoma. The findings suggest that a portion of gastric carcinoma may transdifferentiate into cells with hepatoid features along the line of endodermal lineage.
Male ; Humans ; Adenocarcinoma ; Carcinoma, Hepatocellular

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

We examined 59 intermittent strabismic patients who were not alternate fixaters. Fixing eyes of these patients were found to be more myopic that the fellow eyes in 80% of the cases, and it was statistically significant(p<0.01). When both eyes were myopic and corrected with glasses, the more myopic of the two eyes was still used to fixate at distant objects(87%). Although neither the duration of strabismus nor the degree of anisometropia was found to be significantly related(r=0.336), we do suspect that myopia of the fixating eyes is causatively related to greaterer use rather than clearer image of certain distant objects without accommodation.
Anisometropia ; Eyeglasses ; Glass ; Humans ; Myopia ; Refractive Errors* ; Strabismus

BACKGROUND: Trauma is the third leading cause of death, irrespective of age, and the leading cause of death in persons under 40 years of age. Computed tomography (CT) is an effective technique in the initial emergent evaluation of the abdomen and head following blunt trauma. Most chest indies are not seen on conventional chest radiography, or may be underestimated. But routine use of CT in the initial emergent evaluation of chest trauma is controversial. CT, however, has been shown to be useful in the diagnosis of unsuspected chest injuries and in directing therapeutic interventions. This review discusses the efficacy of emergent CT in patients with blunt trauma on the chest. METHODS: To evaluate the efficacy of CT of the thorax, a retrospective study comparing early thoracic CT scanning with initial chest roentgenogram(CXR) was carried out on 121 patients with blunt trauma on the chest. The interval between CXR and CT was less than 1 hour. RESULTS: Among 121 patients, 42 patients had normal initial chest roentgenogram in whom 19 patients showed normal CT findings. Sensitivities of diagnosing pneumothorax and pleural effusion by CXR were low (49.3%and 45.1%respectively), whereas 65.7% (44/67) of patients had thoracostomy only by CXR. CONCLUSIONS : Although sometimes abused in patients with chest trauma, CT of the thorax is an effective method of detecting thoracic injuries and provides accurate information regarding their pattern and extent in the initial emergent diagnosis.
Abdomen ; Cause of Death ; Diagnosis ; Emergencies* ; Head ; Humans ; Pleural Effusion ; Pneumothorax ; Radiography ; Retrospective Studies ; Thoracic Injuries ; Thoracostomy ; Thorax* ; Tomography, X-Ray Computed

In addition to general charceteristics of tibial fracture, segmental tibial fracture is commonly combined with extensive soft tissue injury, comminution and displacement with poor blood supply in its middle segment. According to recent reports, intramedullary nailing was regarded as the excellent method in the management of this kind of fracture. Twenty-one cases were treated at the department of Orthopaedic Surgery, National Medical Center from January 1980 to December 1987 and following results were obtained; 1. Most common type of fracture was Type I (38.1%). Almost all the fractures were accompanied by open wounds(85.7%) and GIIIB open wounds were 12 cases(57.1%). 2. A verage union time was 31.8 weeks(union rate, 76.2%) and showed marked difference between closed fracture(20.2 weeks) and GIIIB open one(38.6 weeks). 3. Better results were seen in 8 cases of intramedullary nailing(average union time, 24.2 weeks), while all the plating method showed non-union in 3 cases of open wound.
Fracture Fixation, Intramedullary ; Methods ; Soft Tissue Injuries ; Tibia ; Tibial Fractures ; Wounds and Injuries

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

Recently, the treatment principles of congenital dislocation of the hip has been altered markedly. The importance of concentric reduction and its maintenance during growth period in CDH has been stressed by many authors. Acetabular remodelling capacity has been argued between many authors, because it was critical criteria about the determination of operating period and methods. Authors selected 25 cases of congenital dislocation of the hip, which was treated by closed reduction, open reduction and femoral osteotomy to obtain concentric reduction of the hip. And we analyzed the change of acetabular angle and femoral anteversion in two group: Group 1-below 2 years and Group 2-from 2 years to 4 years old. The results were as follows: 1. The change of acetabular angle was improved markedly: average 15° in the Group I and average 13° in the Group 2 in 2 years. 2. The change of femoral anteversion in the Group I was markedly improved: average 15°, but, the in the Group 2 was not significant: average 6°. 3. It was thought that the perfomance of femoral osteotomy without innominate osteotomy in the Group 2, could achieve the satisfactory acetabular remodelling.
Acetabulum ; Dislocations ; Hip ; Osteotomy

The lateral syndesmosis malleolar complex is a factor of importance for congruence and stability of the ankle joint. The failures of function due to excessive talar motion or instability and incongruity, predisposes the osteoarthritis of ankle joint. The authors analysed 46 cases of lateral malleolar fracture with diastasis in our department during the years 1976 through 1986. The results obtained are as follows. 1. The most common cause of injury was slipping down and the other causes were falling down and traffic accident in order. 2. The types by Weber classification showed 21 cases of type BS(+) and 25 cases of type C. The most common type by Lauge-Hansen classification was supination-external rotation type(21 cases, 45.7%). 3. Partial diastasis was noted in 25 cases(54.3%) and total diastssis in 21 cases(45.7%). 4. Open reduction was performed in 43 cases. For the treatment of diastasis, 20 cases were treated with transfixation screws, 9 cases with repair of anterior inferior tibiofibulsr ligament and 11 cases with both method. 5. According to colton's criteria, the result was good in 24 cases(65%), fair in 10 cases (27%) and poor in 3 cases(8%). 6. The incidence of traumatic arthritis was 29.7%(11 cases).
Accidental Falls ; Accidents, Traffic ; Ankle Joint ; Arthritis ; Classification ; Clinical Study ; Incidence ; Ligaments ; Methods ; Osteoarthritis

Recently, the incidence of hematogenous osteomyelitis tends to increase dse to abuse of the antibiotics and resistent organisms to antibiotics. The three main causes of complication to be chronic stage in hematogenous osteomyelitis were failure of early diagnosis, inadequate choice of antibiotics with insufficient duration and insufficient surgical intervention. Furthermore, hematogenous osteomyelitis of fibula in children has low incidence, so the possibility of chronicity is able to be increased because of delayed diagnosis and inadequate treatment. During the period of 10 yesrs extending from 1977 to 1986, we have treated 12 cases of hematogenous fibular osteomyelitis in children and clinical analysis was made about comparison with prevalent hematogenous osteomyelitis of distal femur or proximal tibia. The following results were obtained; 1. The incidence in males was 1.4 times grester than females. 2. The incidence of involved sites was 2 times dominant in Rt, and all cases were observed in proximal and distal metaphyseal area of fibula. 3. Clinical symptomes and signs were pain, local heat, redness and local tenderness in all of acute cases and 70% of chronic cases with sinus formation and pathologic Fx. 4. ESR was elevated to average 42 mm/hr in all acute cases highestly, but highest leucocytosis was observed in subacute case. 5. Definite bone changes in radiologic findings was observed in only subacute and chronic cases, and uptake of radioisotope in bone scan was observed in 2 acute cases, which were all performed. 6. Causative organism was only staphylococcus aureus, and high sensitive antibiotics to taphylococcus aureus were Cephalosprin, Cloxacillin, Amikin and observed resistance to penicillin(82.5%) and tetracycline(82.5%). 7. Early diagnosis, adequate antibiotic choice with sufficient duration and early surgical decompression and drainage were considered to be essential part of management of hematogenous fibular osteomyelitis and preventing its chronicity.
Amikacin ; Anti-Bacterial Agents ; Child ; Cloxacillin ; Decompression, Surgical ; Delayed Diagnosis ; Drainage ; Early Diagnosis ; Female ; Femur ; Fibula ; Hot Temperature ; Humans ; Incidence ; Male ; Osteomyelitis ; Staphylococcus aureus ; Tibia