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*

No abstract available.
Child* ; Hip* ; Humans ; Osteoma, Osteoid*

No abstract available.

Although joint infection with severe destruction remains a serious problem and severe bone loss is relative contraindication of arthrodesis, knee arthrodesis is most commonly a salvage procedure. Its goals are to relieve pain and restore the patient to functional level of activity. The purpose of this study is to evaluate the results and complications of Ilizarov method for knee arthrodesis in the presence of infection. We retrospectively reviewed the records of twelve patients who had managed with knee arthrodesis with Ilizarov method. Indications for the operation included a infected skeletal defect secondary severe open trauma in four patients, an infection at the site of an arthroplasty in three (with failure of previous arthrodesis with monofixator in one), an infected charcot joint in four and one pyogenic arthritis spreading from osteomyelitis of proximal tibia. The average age of the patients at the time of operation was fifty-three years (range twenty-two to eighty years). Follow-up averaged 17 months. The minimum follow up periods was 9 months. Average duration of Ilizarov fixator application was 7.2 months. In 3 cases we performed corticotomy and internal bone transport to treat large bone defect (17cm, 8cm, 6.5cm). Autoiliac bone graft was done in fusion site in two cases, and in three cases we performed bone graft at the docking site. Solid osseous union occured in each patient. There was no reinfection and nonunion. Average shortening was 3.4 cm. Complications were related to pin tract. When last seen, all patients were free of pain and could walk without cruthes or cane. Despite its pin tract problems, bulky cumbersome and expensive apparatus, the Ilizarov method is one of effective method for knee arthrodesis in the presence of infection and large bone loss especially.
Arthritis ; Arthrodesis* ; Arthropathy, Neurogenic ; Arthroplasty ; Canes ; Follow-Up Studies ; Humans ; Ilizarov Technique* ; Joints ; Knee Joint* ; Knee* ; Osteomyelitis ; Retrospective Studies ; Tibia ; Transplants

Exposure with the tibial tubercle osteotomy was done for ten revisions and one primary total knee replacements out of 200 total knee arthroplasties performed from 1985 to 1996. The cases were analyzed with regard to complications and technical considerations. The preoperative diagnoses were infected total knee arthroplasty in seven, aseptic loosening in three and one ankylosed knee. Eixtensive exposure was achieved enough for debridement and reimplantation. The tubercle was fixed with two or three 3.5mm screws. The average duration of follow up was 30 months. Post operative knee flexion averaged 87 degrees. There were two complications, one avulsion of the fragment and one tibial fracture. The advantage of this procedure included wide exposure for difficult knee surgeries and more proximal fixation for improved flexion.
Arthroplasty* ; Arthroplasty, Replacement, Knee ; Debridement ; Diagnosis ; Follow-Up Studies ; Knee* ; Osteotomy* ; Replantation ; Tibial Fractures

No abstract available.
Fractures, Spontaneous* ; Prostheses and Implants*

STUDY DESIGN: This case report presents a 50-year-old patient with tabetic Charcoal spinal arthropathy combined with spinal stenosis, and its management. OBJECTIVES: To present the case report and follow-up results of Charcoal arthropathy with spinal stenosis of the lumbosacral spine, which was treated by circumferential fusion with instrumentation and decompressive laminectomy. LITERATURE REVIEW: Most reports of Charcot spine mention the etiology, clinical characteristics, pathology, and management of the condition. Surgical management of Chariot spines with spinal stenosis are rare. There is no report of the two-stage procedure of circumferential fusion and decom-pression for Charcot spine with spinal stenosis. MATERIALS AND METHODS: The patient complained of back pain, radiating pain to both lower legs, and 100m neurologic claudication. Serologic testing was positive in VDRL and FTA-ABS tests. Surgical treat-nent consisted of anterior resection of the L5 body with an autogenous iliad bone graft. It was followed by a posterior wide laminectomy of L5 for spinal stenosis, and CD instrumentation with transpedicular screws was applied to L3-S1 with lateral bone graft. RESULTS: At 27 months follow-up, clinical symptoms of back pain and radiating pain were disappeared. The patient walked without claudication, and satisfied with her condition. Firm bony fusions from L3 to S1 were obtained. There was no evidence of further destruction or neural compromise in the 27 months following surgery. CONCLUSION: A case of Charcoal arthropathy of the lumbosacral spine with spinal stenosis of L3-5 and L5-S1 has been reported, and the pathology, clinical features, and management of this condition were discussed. Circumferential fusion for Charcot spine and wide decompressive laminectomy for spinal stenosis are advisable.
Back Pain ; Charcoal ; Fluorescent Treponemal Antibody-Absorption Test ; Follow-Up Studies ; Humans ; Laminectomy ; Leg ; Middle Aged ; Pathology ; Pathology, Clinical ; Serologic Tests ; Spinal Stenosis* ; Spine* ; Transplants

OBJECTIVE: To evaluate whether co-culture of oocytes on vero cell monolayers from Day 0 (Day 0 group) after egg retrieval results in an increase in developmental capacity such as fertilization rate, embryo quality, blastulation and clinical pregnancy rate compared with co-culture of oocytes from Day 1 (Day 1 group). METHODS: Sperms were treated with Hams F-10 supplemented with 10% human follicular fluid (hFF). Vero cells for co-culture were prepared in TCM-199 with 10% FBS. Oocytes were co-cultured from Day 0 and fertilized oocytes were co-cultured from Day 1 on vero cell monolayers in DMEM with 10% and 20% hFF, respectively after egg retrieval. On day 1, 2 and 5, fertilization rate and grade of embryos and blastocysts were evaluated. Results (fertilization rate, cleavage rate, grade of embryos and blastocysts and pregnancy rate) were considered statistically significant when p value was less than 0.05 using t-test and ci2. RESULTS: In sibling oocytes of same cycles, no differences were found in fertilization rate (94.6 vs. 91.4%), cleavage rates (94.6 vs. 91.4%), embryo grade (on day 2 and 3) and blastulation (65.6 vs. 57.0%) and their grade. In different oocytes of different cycles (patients), no differences were found in fertilization (79.8 vs. 78.3%), cleavage rates (77.7 vs. 76.4%) and blastulation (56.0 vs. 45.3%), but pregnancy rate was higher in the Day 0 group than in the Day 1 group (60.0 vs. 42.9%). CONCLUSIONS: This study revealed that the embryonic development capacities were not affected by the different co-culture time in the sibling oocytes of same cycles. Although no statistical significance, because of small size of study, there was a trend for higher pregnancy rates in Day 0 group compared to Day 1 group in different oocytes of different cycles.
Blastocyst ; Coculture Techniques* ; Embryonic Development* ; Embryonic Structures ; Female ; Fertilization ; Follicular Fluid ; Humans ; Oocytes* ; Ovum ; Pregnancy ; Pregnancy Rate ; Siblings ; Spermatozoa ; Vero Cells

BACKGROUND/AIMS: It has been reported that the difference in the hepatitis C virus (HCV) genotype due to genetic heterogeneity of HCV influence the clinical features, prognosis of HCV associated liver disease and response to interferon therapy. Prevalence of different genotypes of HCV may also vary between geographic areas. The aim of this study was to examine the relationship between the response to interferon alpha (IFN-a) therapy and HCV genotypes in patients with chronic HCV infection in Taegu and its environs. METHODS: One hundred seventy six patients known to be HCV antibody and HCV-NA positive were evaluated for HCV genotypes by restriction fragment length polymorphism. Among patients who had elevated ALT levels, 67 patients have been investigated for the role of the HCV genotype on disease outcome and the response of IFN-a therapy. RESULTS: Genotype 1b were found in 59.0% of patients (103/176), genotype 2a in 37.5% (66/176). The mode of transmission of HCV infection was guessed as transfusion in genotype 1b, but as parenteral infection in genotype 2a. According to their response to IFN-a therapy, 73 patients were divided into three groups, complete response, 18 (60%) of 30 patients with genotype 2a and 21 (48.8%) of 43 patients with genotype 1b: partial response, 5 (16.7%) of 30 patients with genotype 2a and 7 (16.2%) of 43 patients with genotype 1b: no response, 7 (23.3%) of 30 patients with genotype 2a and 15 (34.9%) of 43 patients with genotype 1b. Good response to IFN-a therapy was observed among patients group showing normal platelet count in patients with genotype 1b and normal GGT in patients with genotype 2a. CONCLUSIONS: The most frequently identified genotype was genotype 1b in Taegu and its environs, followed by genotype 2a. The HCV genotype was not a reliable predictor of response to IFN-a therapy. When a standardized regimen of IFN-a was administered, pretreatment serum platelet counts and GGT level seem to be useful predictor of IFN-a therapy in HCV infection. Further investigations are required in order to establish a correlation between viral factors and therapeutic responses.
Daegu* ; Genetic Heterogeneity ; Genotype* ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Humans ; Interferon-alpha ; Interferons ; Liver Diseases ; Platelet Count ; Polymorphism, Restriction Fragment Length ; Prevalence ; Prognosis

Between january 1, 1981 and December 31, 1986, 1,310 Cesarean sections (26.7%) were performed among 4,898 paturient women at St. Mary's pospital, Catholic Medical College. The perioperative condition of the newborns along with morbidity and mortality after Cesarean section wha analyzed. The incidencea of Cesarean sections between 1981 and 1986 were 25.0% 27 .6%, 23.4%, 29.5%, 31.2% and 27.1%, respectively. The anesthetic methods employed were inhalation anesthesia with thiopental sodium for induction and nitrous oxide-oxygen-halothane for maintenance of anesthesia. This study did net include the 76 cases of lumbar epidural or spinal technique performed during this Period. Based on one minute Apgar scores, 82 infants (6.26%) were assessed as moderately (score 4-6) depressed, and 44 infants (3.36%) were rated as severely (score 0~3) depressed. Twenty (45.5%) of the severely depressed newborns were promptly resuscitated and given ade- quate treatement, but 11 infants (25.0%) did not survive. The incidence of idiopathic respiratory distress syndrome (IRDS) in this study was 9 cases (0.79%) Ammong 7he total 1,310 cases; this induded 7 cases of premature birth or low birth weight and 2 cases of aspiration pneumonia. The mortality of the IRDS group was 4 of 9 cases (44.4%). Among the severely depressed group, the time from induction to delivery was five minutes in 8 case? (18.2%) , six to ten minutes in 22 cases (57.777) and more than 11 minutes in 14 cases (31.8%) . The pro7n7stic status of newborn babies was evaluated with respect to the anesthetic procedure and the outcome of deliveries by Cesarean sections performed between 1981 and 1986 at St. Mar's Hospital, Catholic Medical College, Seoul, Korea.
Anesthesia ; Anesthesia, Inhalation ; Cesarean Section* ; Female ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn* ; Korea ; Mortality ; Pneumonia, Aspiration ; Pregnancy ; Premature Birth ; Seoul ; Thiopental