An Unusual Form of Progressive Massive Fibrosis In Pneumoconiosis / 결핵

Pneumoconiosis, very popular to coal miners who are exposed to coal dusts dominantly, was introduced in the 19th century to describe lung diseases consequent to the inhalation of mineral dusts. Coal workers' pneumoconiosis(CWP) colloquially called "black lung" in the United States, is a distinct pathologic entity resulting from the tissue reaction to deposits of dust include the coal macule, which associated with focal emphysema constitutes the characteristic lesion of simple CWP and complicated CWP or progressive massive fibrosis(PMF). Coal mining are also associated with chronic bronchitis, chronic airflow limitation, and/or generalized emphysema. Progressive massive fibrosis lesions may imprint on and obliterate airways and vessels, and cavitation is not uncommon, being the consequence of ischemic necrosis or mycobacterial infections. We report a case which is unusual form of progressive massive fibrosis to be differentiated from lung carcinoma. It is a rapid growing PMF with ischemic necrosis. By the studies which are about risk of having progressive massive fibrosis, it is predicted to be 1.4%. And the other study shows that simple pneumoconiosis clearly predisposed to PMF, with five year attack rates of 13.9%, 12.5%, 4.4% and 0.2% among men with categories 3, 2, 1, and 0 respectively at the start of the risk periods.

Brittain Ischiofemoral Arthrodesis / 대한정형외과학회잡지

The indication of hip arthrodesis has tendency to decrease since the total hip replacement proved to be very effective, but the arthrodesis is inevitable for the infectious arthritis especially in young individuals to obtain painless stable joint. Authors reviewed 11 cases of Brittain ischiofemoral arthrodesis performed for the advanced hip tuberculosis during the years between 1972 to 1978 at Fatima hospital. These cases were 6 males and 5 females having ages from 5 to 31 with an average of 16 years old. The immobilization after surgery was rest having hip spica cast for the periods from 12 weeks to 17 weekes averaging 14 weeks and the crutch walking with gradual weight bearing as tolerated was recommended after discarding the cast for the cases who have united osteotomy, well maintained graft, and no evidence of the disease progession, even though the joint is not fused. Eventuaily good bony ankylosis as well as union of the osteotomy was found in 7 cases including a case who had fracture of the osteotomy after a minor trauma during the early days of walking without crutches which became united after having an another hip spica cast for 3 months. Three cases revealed the fibrous ankylosis with good union of the osteotomy but they had painless stable joints. In one of these fibrous ankylosis the tibial graft failed to be fixed in ischium and in the rest two cases bony ankylosis was expected later on because the last examinations were at 6 months and 7 months after surgery. The most unsatisfactory result was the case who discarded the cast at home and a non-union of the osteotomy was found at the first visit on five and a half years after surgery, when she refused further treatment of the non-union because there had been surprisingly little pain with usual daily activities. Brittain arthrodesis considered to be an effective procedure for the advanced unilateral hip tuberculosis to obtain the painless stable joint permitting early ambuiation.

Effects of Posterior Spine Fusion on Vertebral Growth in Children / 대한정형외과학회잡지

There is debatable opinions as to the nature and clinical significance of the changes that may occur in the spine after posterior spine fusion performed in growing children. Clinical survey is known to be difficult because X-ray films in children are not easy to interpret and measure in the presence of disease and accuracy is uncertain due to magnification on X-ray films. Authors selected 8 cases of tuberculous spondylitis which were managed with posterior spine fusion under the criterias that cases had surgery under 10 years old, no evidence of pseudoarthrosis clinically and roentgenologically on serial examinations at least once 1 year, follow-up more than 2 years since 3 months after surgery, enough spines are included on lateral X-ray films, and accurate measurement and correction of magnification are possible. The cases were surveyed for changes occured in fused spines after posterior spine fusion and the results were as follows: 1. There was actual lengthening of grafted bone mass after solid fusion in all cases although the amounts were minimal. 2. The fused spines grew 46% on an average less than adjacent normal unfused spines. 3. The vertebral bodies of fused spines grew nearly same as the adjacent normal vertebral bodies. 4, The intervertebral disc spaces of the fused spines were narrowed in all cases. 5. The intervertebral angles had tendency to increase and kyphosis angles to decrease.

Compression Arthrodesis of the Knee / 대한정형외과학회잡지

Twelve cases of compression arthrodesis of the knee, which was performed during the period 1973 to 1978, were reviewed. All of the cases had tuberculous arthritis of the knee and included 3 children. Post-operative management was carried out with compression in a long leg cast with crutch walking for an average of 6 weeks and successive cylinder casts without compression and permitting full weight bearing were applied on an average of every 7 weeks. All cases eventually revealed bony fusion and the tuberculosis subsided without signiflcant complications even in the children.