In the past several years, total hip replacement arthroplasty has become an established procedure in the management of painful arthritic hips in older adults. It is still gaining an increasing popularity as experience has accumulated and indications broadened. The authors reviewed the first 47 total hip replacement arthroplasties in 41 patients performed at the Department of Orthopedic Surgery, Seoul National Univerity Hospital, during the period of 4 years and 8 months, from April 1972 to November 1976. The longest follow-up was 4 years and 8 months and the shortest 1 month, the average being 2 years and 1 month. The youngest age was 17 years and the oldest 71 years, the average being 41 years. There were 26 males and 15 females. The underlying etiology was as follows: primary osteoarthritis 4 hips, avascular necrosis 12 hips, septic hip residua 18 hips (pyogenic 11 hips, tuberculosis 7 hips), rheumatoid arthritis 3 hips, failed previous operation 3 hips (failed endoprosthesis 2 hips, failed total hip replacement 1 hip), secondary osteoarthritis 5 hips (congenital dislocation 4 hips, Legg-Perthes disease 1 hip), and nonunion of femoral neck 2 hips. Following types of prosthesis were used; Sbarbaro 3, Charnley 8 (including custom-made extralong, narrow stem and extra-small stem prostheses), Muller 22, and Trapezoidal-28 14. The results were evaluated by the methods of Harris and d'Aubigne, both preoperatively and postoperatively, In the average, Harris' score improved from 57 to 92 (gains of 35) and the d'Aubigne rating from 10.4 to 16.8 (gains of 6.2) following operations.
Adult ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Dislocations ; Female ; Femur Neck ; Follow-Up Studies ; Hip ; Humans ; Legg-Calve-Perthes Disease ; Male ; Necrosis ; Orthopedics ; Osteoarthritis ; Prostheses and Implants ; Seoul ; Tuberculosis

Our experience with recurrent dislocation of the patella on ten knees in eight patients seen at Seoul National University Hospital during the last 2 years and eight months is reported. Five were female and three male. The age ranged from seven to 27 years. In four of the patients the onset was attributable to a definite history of trauma, while in one patient the dislocation was considered due to developmental anomalies and in another it was clearly congenital Still another patient had a progressively short limb due to premature closure of the distal femoral epiphysis with accompanying flexion-valgus deformity of the knee, presumably caused by an unrecognized infection during early childhood One adolescent girl had bilateral knock knees. The knock knees were treated successfully by supracondylar osteotomy and one post-traumatic knee by classical Roux-Goldthwait procedure with equally excellent result, The rest were treated by Greens vastus medialis transfer with division of the iliotibial band or reefing of the medial joint capsule when necessary. In one knee dislocation recurred, probably due to avulsion of the transferred vastus, and two knees had residual subluxation and limitation of flexion. The results on the remaining seven knees were excellent.
Adolescent ; Congenital Abnormalities ; Dislocations ; Epiphyses ; Extremities ; Female ; Genu Valgum ; Humans ; Joint Capsule ; Knee Dislocation ; Knee ; Male ; Osteotomy ; Patella ; Quadriceps Muscle ; Seoul

A rare case of mesothelial/monocytic incidental cardiac excrescences (cardiac MICE) is described in the aspect of pathological interest. This cardiac lesion is pathologically characterized by exuberant proliferation of mixed mesothelia and monocytes and might be misdiagnosed as metastatic carcinoma, rhabdomyosarcoma, and histiocytoid hemangioma, if the disease is not in the minds of pathologists. The reactive nodular hyperplasia due to irritation to mesothelia by various causes is a most prevailing pathogenetic mechanism. About 20 cases have been reported in the worldwide literature. A 67-year-old female patient presented with cough and dyspnea for 2 months, without any history of previous cardiac operation. 2D echocardiography of the heart revealed moderate amount of pericardial effusion with posterior wall thickening. Under the impression of metastatic malignancy, pericardiostomy was performed. Grossly, the tissue was dark hemorrhagic and friable and the histologic sections revealed the solid tumor-like proliferation of round to polygonal histiocytic cells admixed with small cuboidal mesothelial cells which formed strips and tubular arrays. They were found within the fibrinous network and there were scattered empty vacuolar spaces. Immunohistochemical staining confirmed their biphasic nature with the CD68 positivity of the histiocytes and the cytokeratin positivity of the cuboidal cells. Factor VIII positivity was not detected in any cell components. The lesion was considered the monocytic and mesothelial proliferation of reactive nature, so-called cardiac MICE in the pericardial cavity. We report a typical case of so-called MICE first in the Korean literature.
Aged ; Animals ; Cellular Structures ; Cough ; Dyspnea ; Echocardiography ; Factor VIII ; Female ; Fibrin ; Heart ; Hemangioma ; Histiocytes ; Humans ; Hyperplasia ; Keratins ; Mice ; Monocytes ; Pericardial Effusion ; Pericardial Window Techniques ; Rhabdomyosarcoma

No abstract available.
Progeria*

No abstract available.
Child* ; Humans ; Thyroid Gland* ; Thyroid Neoplasms*

No abstract available.
Tricuspid Atresia*

No abstract available.
Animals ; Immunohistochemistry* ; Neurons* ; Rats* ; Substantia Nigra*

The authors reviewed 85 knees in 59 patients(9 males, 50 females) who had preoperative flexion contracture(FC) greater than 20° and taken total knee arthroplasty(TKA) at the Seoul National University Hospital from Jan.1987 to Dec.1992. We reviewed the surgical methods according to preoperative FC, changes of postoperative FC and range of motion, and clinical and radiologic findings. In our series, 48 knees were degenerative arthritis(average FC: 26°), 34 knees, rheumatoid arthritis(average FC: 40°)and 3 knees, others(average FC:28°). The average follow-up period was 2 years(range, 1 to 4(+8) years). Seventy three knees with FC less than 45 (Group I)had been treated with TKA accompanied with adequete soft tissue release, removal of osteophyte and appropriate bone resection. Eleven knees with FC greater than 50° (Group II) had been treated with skin traction followed by TKA. One knee with 65° of FC(Group III)was treated with posterolateral and posteromedial release including tendon lengthening at first, and then TKA in second stage. Preoperative FC was significantly greater in RA group than in DA group. Flexion contracture improved until postoperative 3 years in DA group and improved until postoperative 2 years and slightly deteriorated after then in RA group, but statistically insignificant(p>0.05). There was no difference of FC at postoperative 2 weeks and final follow-up between Group I and II. Range of motion improved until postoperative 2 years in DA group significantly(p < 0.05). In RA group, range of motion improved until postoperative 2 years(p>0.05) and deteriorated after then(p < 0.05). With TKA, range of motion increased significantly in both Group I and II and there was no difference of range of motion between Group I and II at final follow-up. Postoperative HSS score and pain score improved in DA and RA groups significantly, and final HSS score with greater in DA group than RA group(p < 0.05). Preoperative HSS score and pain score of Group I were significantly higher than those of Group II, but final follow-up, there was no difference between two groups. There was no correlation between final FC and HSS score. There was no difference in score of radiolucency between two groups in which final FC was greater and lesser than 10°. We thought that in knees with fixed flexion contracture, successful correction of moderate to severe flexion contracture and satisfactory result of total knee arthroplasty can be achieved by adequate soft tissue release, appropriate bone resection, and/or preoperative management.
Arthroplasty, Replacement, Knee ; Contracture ; Follow-Up Studies ; Humans ; Knee ; Male ; Osteophyte ; Range of Motion, Articular ; Seoul ; Skin ; Tenotomy ; Traction

Tennis elbow is common, and offen disabling problem even in daily living;conservative treatments commonly make satisfactory results, but recurrence is frequent and discouraging. So, surgical treatments are considered in certain cases. The authors report the retrospective analysis of 15 patients treated by nirschl and pettrone procedure. Patients were evaluated with Nirschl and Pettrone assessment method at an average 10.3 months(range, 5 to 32 months0 after surgery. thirteen of 15(87%) patients had more than fair postoperative rating. Two patients had postoperative complications;one with infection and the other with transient mild limitation of elbow motion. No postoperative deterioration of the clinical state was seen. And biopsy specimens of all case showed degenerative changes. Resection of the degenerated site of tendon origin of the humeral epcondyle(The Nirschl and Pettrone procedure) yield satisfactory results in properly selected patients.
Biopsy ; Elbow ; Humans ; Methods ; Recurrence ; Retrospective Studies ; Tendons ; Tennis Elbow ; Tennis

Initial success with total hip arthroplasty on those severely crippled, painful hips in elderly people has prompted its application to a broad variety of conditions; namely, primary and secondary osteoarthritis, rheumatoid arthritis, avascular necrosis of the femoral head, and failed arthroplasties. Some have attempted it on previously arthrodesed hips, while others have successfully treated failed Girdlestone by total hip arthroplasty. To date, however, total hip arthroplasty remains essentially a procedure for older people. It has been greatly emphasized that total hip arthroplasty on 29 cases of residual hips secondary to pyogenic or tuberculous infection occurred during childhood. All were young adults ranging from 17 to 56 years of age, with a mean age of 32. 1 years. None of the hips had active infection at time of operation, although in 2 cases biopsy, at the arthroplasty, revealed chronic granulomatous inflammation. The hips had bony or fibrous ankylosis,or pseudarthrosis with dislocation, and presented marked flexion deformity, bony hypoplasia, limb shortening, and muscle atrophy. In 6 cases, arthroplasty was preceded by preliminary anterior soft tissue release and osteotomy of the ankylosis, followed by skeletal traction. In one case, anterior release through a separate incision was carried out on the same setting prior to arthroplasty. Lateral approach with trochanteric osteotomy was routinely employed, except in two in which the hip was approached posteriorly without trochanteric osteotomy. Trapezoidal-28 prosthesis was used in 17 cases, 5 of which were of short neck, thin stem sized, 7 of which were of medium neck small stem sized. Muller prosthesis was used in 8 cases, 7 of which were of standard neck standard stem sized. One small straight stem Charnley prosthesis failed and was later replaced by a custom-made Charnley stem prosthesis. Two offset bore ovoid cup and Charnley extra-small stem were used. In addition to routine preoperative, intraoperative, and postoperative antibiotics, Kanamycin was mixed to cement routinely. There was no postoperative wound infection. In two cases with presumably healed tuberculosis, infection recurred after arthroplasty. In all the remaning hips, painless serviceable function was restored, especially in view of diverse range of motion in orientals. In the oriental life style, the importance of a mobile hip cannot be overstressed.
Aged ; Ankylosis ; Anti-Bacterial Agents ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Biopsy ; Congenital Abnormalities ; Dislocations ; Extremities ; Femur ; Head ; Hip ; Humans ; Inflammation ; Kanamycin ; Life Style ; Muscular Atrophy ; Neck ; Necrosis ; Osteoarthritis ; Osteotomy ; Prostheses and Implants ; Pseudarthrosis ; Range of Motion, Articular ; Surgical Wound Infection ; Traction ; Tuberculosis ; Young Adult