Isometric positioning of the ACL graft is an important consideration in successful reconstruction of the ACL-deficient knee. The purpose of this study is to get a certain guideline in the endoscopic one-tunnel technique of anterior cruciate ligament reconstruction by measuring the skin angle and determine the degree of minimum flexion of the knee joint during femoral tunneling and interference screw fixations. To get the guide lines, first we get the tibial tunnel angle parallel to the Blumensaat's line from fully extended lateral knee joint radiography. Secondly measure the differences between angles of the femur-tibia shaft and anterior thigh-leg skin. Then measure the minimum femur-tibia flexion angle does not perforated the posterior cortex of the distal femur during femoral tunneling. Intraoperative measuring the angle between interference screw guide pin and tibial tunnel to get the parallelism of the femoral tunnel and interference screw. The results were as follows; The average femur-tibia shaft angle with 30degrees anterior thigh-leg skin angle was 30.2+/-1.75degrees, with 45degrees was 45.2+/-1.23degrees, with 60degrees was 61.9+/-4.23degrees, with 75degrees was 78.6+/-2.62degrees, with 90degrees was 97.8+/-3.96degrees. Predetermined sagittal tibial tunnel vector on the 0degrees extension knee joint lateral radiographs were applied to the several knee joint dynamograms. The mean minimum flexion angle of the femur-tibia shaft that doesn't perforate the posterior cortex of the femur was 45+/-1.58degrees (male), 44.5+/-4.97degrees (female). The average angle between interference screw guide pin and tibial tunnel was 23.0+/-2.23degrees. The findings of the present study suggest that anterior thigh-leg skin angle can be used instead of the true femur-tibia shaft angle. Less knee flexion angle makes good arthroscopic view during the tibio-femoral tunneling and interference screw fixation.
Anterior Cruciate Ligament Reconstruction ; Femur ; Knee Joint* ; Knee* ; Radiography ; Skin ; Transplants

Myelopathy or dysfunction of the spinal cord, can be caused by degenerative processes of the cervical vertebrae. Cervical spondylotic myelopathy can be divided into five distinct syndromes on the basis of clinical presentation by Ferguson. Absolute indication for surgery is the progression of neurologic deficit. Decompression may be achieved using an anterior, posterior, or a combined approach, but each patient has unique clinical conditions that require individualized treatment. The purpose of the study was to evaluate the operative results by the clinical manifestation. In evaluating the results, the evaluation system established by the Japanese Orthopedic Association was employed. The average preoperative score in the 14 patient was 8.7 points and the average postoperative score was 12.7 points. The better results have been obtained for those who were managed with decompression within 1 year after onset of symptoms and those who had lateral type. In conclusion, the prognosis for the recovery of the spinal cord function is related with the onset of clinical symptoms and degree of neurological deterioration, so early detection and operative decompression for cervical spondylotic myelopathy may be the best method for the prevention of those unwanted and potentially devastating neurological deteriorations.
Asian Continental Ancestry Group ; Cervical Vertebrae ; Decompression ; Female ; Humans ; Neurologic Manifestations ; Orthopedics ; Prognosis ; Spinal Cord ; Spinal Cord Diseases*

A major cause of less than ideal results following intraarticular anterior cruciate ligament (ACL) reconstruction has been imprecise nonanatomic tunnel position for graft placement either in the femur, the tibia, or both. Lack of defined constant reference landmarks for reproducible tunnel placement has contributed to this problem on both sides of the joint. The purpose of this study was to define constant anatomic intraarticular and extraarticular landmarks that can be used as definitive reference points to reproducibly create a tibial tunnel for ACL reconstruction that (1) results in an impingement-free graft in full extension; (2) positions the tibial tunnel such that the sagittal tunnel-plateau angle is parallel with the sagittal intercondylar roof-plateau angle in full extension to minimize shear seen by the graft at the tibial tunnel inlet. Preoperative full extension and 90degrees flexion lateral radiographs were obtained. Preoperative measurements of the tibial tunnel-tibial shaft angle and distance from inferior pole of patella to entry point of tibial tunnel were useful tool for impingement free, Blumensaats line paralleling ACL reconstruction with autogenous bone patella tendon bone graft. The average tibial tunnel-tibial shaft angle was 34+/-4.59degrees (male), 33.5+/-3.37degrees (female). The mean distance between patella inferior pole and tibial tunnel entry point was 6.62+/-0.61cm (male), 6.21+/-0.89cm (female). This study sought to define constant anatomic landmarks extraarticularly as well as intraarticularly that can be used to reliably create an ideal tibial tunnel for ACL reconstruction.
Anatomic Landmarks ; Anterior Cruciate Ligament ; Bays ; Femur ; Joints ; Patella ; Patellar Ligament ; Tibia ; Transplants

SUMMARY: Benign fibrous histiocytoma of the knee is a very rare entity. We report on one case of benign fibrous histiocytoma that involved the patellar fat pad, an areas of involvement not previously reported. Diagnostic arthroscopy was performed to show retrobulging of infrapatellar fat pad without specific synovial changes. The lesion was completely resected. At short-term follow-up, all symptoms were resolved. Arthroscopy can be used as an diagnostic tool for identification of intraarticular lesions of the knee, but appears not to be a good tool for clean removal of mass within patellar fat pad.
Adipose Tissue* ; Arthroscopy ; Follow-Up Studies ; Histiocytoma, Benign Fibrous* ; Knee

The endoscopic single-incision technique using interference fit screws to secure patellar tendon-bone plugs in the femoral and tibial tunnels has been very popular method for ACL reconstruction. However, several potential complications has been reported such as violation of the posterior wall of the femoal tunnel, laceration of graft during femoral screw insertion, protrusion of the tibial bone block distally due to a lengthy graft and more frequently divergence of the femoral interference screw. We performed 56 consecutive endoscopic ACL reconstruction. In Groi.p I, femoral tunnel drilling were performed at 70-80 degrees of knee flexion. In Group 11, they were done at $5 degrees of knee flexion. Postoperative radiographic analysis of bone-interference screw divergence angle shows 5.9 degrees in AP view, 6.21 degrees in Lateral view in Group I and 3.14 degrees, 3.35 degre.s in Group II respectevely. In conclusion, Bone-interference screw divergence can be decreased with less knee flexion about 45 degree during preparing femoral tunnel.
Knee* ; Lacerations ; Transplants

No abstract available.
Paramyxoviridae Infections* ; Polymerase Chain Reaction* ; Reverse Transcription*

We report a case of tension pneumothorax after an endoscopic sphincterotomy. A 78-yr-old woman presented with progressing dyspnea. She had undergone an endoscopic retrograde cholangiopancreatogram three days before due to acute cholecystitis. She underwent endoscopic sphincterotomy for stone extraction, but the procedure failed. On arrival to our hospital, she complained about severe dyspnea and she had subcutaneous emphysema. A computed tomogram scan revealed severe subcutaneous emphysema, right-side tension pneumothorax, and pneumoretroperitoneum. Contrast media injected through a transnasal biliary drainage catheter spilled from the second portion of the duodenum. A second abdominal computed tomogram showed multiple air densities in the retroperitoneum and peritoneal cavity, which were consistent with panperitonitis. We recommended an emergent laparotomic exploration, but the patient's guardians refused. She died eventually due to septic shock. Endoscopic retrograde cholangiopancreatogram is a popular procedure for biliary and pancreatic diseases, but it can cause severe complications such as intestinal perforation. Besides perforations, air can spread through the abdominal cavity, retroperitoneum, mediastinum, and the neck soft tissue, eventually causing pneumothorax. Early recognition and appropriate management is crucial to an optimal output of gastrointestinal perforation and pneumothorax.
Acute Disease ; Aged ; Cholangiopancreatography, Endoscopic Retrograde/*adverse effects ; Cholecystitis/diagnosis ; Female ; Humans ; Intestinal Perforation/etiology ; Pneumothorax/*diagnosis/etiology ; Retropneumoperitoneum/*diagnosis/etiology ; Sphincterotomy, Endoscopic ; Tomography, X-Ray Computed

Bleeding from anastomotic site in operation for aorta has been troublesome, because it has influence on postoperative morbidity and mortality. Therefore, hemostasis is very important. We describe a simple and effective method for achieving hemostasis of the anastomotic site in aortic surgery. By wrapping around anastomotic site with remnant artificial vascular graft, we have acquired good results.
Aorta ; Hemorrhage ; Hemostasis* ; Mortality ; Transplants*

We describe a case of 43-year-old man who had a pseudoaneurysm of the medial superior genicular artery after arthroscopic partial meniscectomy with standard anterolateral and anteromedial portals. Pseudoaneurysm of the medial superior genicular artery has been reported at the previous superomedial portal site after arthroscopy. Described herein is a unique case that involved the medial superior genicular artery at the previous anteromedial portal site after arthroscopy. The pseudoaneurysm was successfully treated with transcatheter embolization.
Adult ; Aneurysm, False/*etiology ; Arteries ; Arthroscopy/*adverse effects/methods ; Humans ; Knee/*blood supply ; Male ; Menisci, Tibial/*surgery

PURPOSE: This study examined the yield of mammographically detected calcifications following a stereotactic vacuum-assisted biopsy (SVAB) using an upright add-on type stereotactic device. MATERIALS AND METHODS: Ninety-two women underwent a SVAB between April 2002 and December 2005, and 90 calcifications obtained by the SVAB were evaluated retrospectively. The calcification retrieval rate was examined. The false negative and underestimation rates were determined by comparing the biopsy results with the results from surgery and follow-up mammography. RESULTS: The calcification retrieval rate was 97.8% (90/92). The histopathology of the 90 lesions was benign for 66 (73.3%), borderline for 3 (3.3%) and malignant for 21 (23.3%). A total of 22 malignancies were confirmed surgically. SVAB had a false negative rate of 4.5 % (1/22). The underestimation rate of a surgically excised atypical ductal hyperplasia (ADH) and of ductal carcinoma in situ (DCIS) was 50% (1/2) and 10% (2/20), respectively. CONCLUSION: The use of SVAB with an upright add-on type stereotactic device is an efficient biopsy method for mammographically detected microcalcifications, with low false negative and high calcification retrieval rates.
Biopsy* ; Biopsy, Needle ; Breast Neoplasms ; Calcification, Physiologic ; Carcinoma, Intraductal, Noninfiltrating ; Female ; Follow-Up Studies ; Humans ; Hyperplasia ; Mammography* ; Retrospective Studies ; Stereotaxic Techniques