This study has been examined different morphologic measurements in the evaluation of patients with lumbar spinal stenosis. Preoperative CT-Myelography from 30 patients who underwent surgery for central lumbar stenosis were analyzed. Based on this, we concluded as follows : 1) Bony measurement alone did not reliably identify patients with spinal stenosis. 2) Measurement of the transverse area of the dural sac on CT-Myelography was the most accurate method for identifying stenosis. 3) Lumbar myelography was still considered to have an important role in the valuation of a patient with stenosis because of correlation between the cross-sectional area of the dural sac and the anteroposterior diameter of the dural sac was excellent. 4) We identified soft-tissue problems as the main cause of stenosis. 5) The most common level of maximum stenosis was L4-5.
Constriction, Pathologic ; Humans ; Myelography* ; Spinal Stenosis*

Arthroscopic synovectomy has some limitations for adequate posterior visualization, and it is difficult to establish the posterior portal because of potential damage to neurovascular structures. The purpose of this study is to introduce a newly designed arthroscopic technique passing through posterior septum and to review the arthroscopic synovectomy using transposterior septal portal in the knee. Routine arthroscopic examination of the knee joint is performed using standard anterolateral and anteromedial portals. Posterior arthroscopic technique is divided into four steps. The first step is to make a posteromedial portal. The second step is to make a posterolateral portal. The third step is to make a hole at the posterior septum and to examine the posterolateral compartment. The fourth step is to examine the posteromedial compartment by switching the arthroscope to the posterolateral portal in the same manner. This technique provides complete visualization of the posterior compartment of the knee joint including the posterior aspect of the medial and lateral femoral condyles, posterior horn of both menisci, the posterior cruciate ligament(PCL), the meniscofemoral ligament, posterior aspect of the popliteal tendon, and the posterior capsule. We reviewed 47 cases(of 43 patients) of arthroscopic synovectomy using anterolateral, anteromedial and transposterior septal portal. The results were assessed with follow up of at least 1 year using the criteria of pain, synovitis, effusion, and range of motion. In 15 case rheumatoid arthritis, we had good result in 14 cases, but 1 case of recurrence was noted at 2 months after surgery. Non specific synovitis, 11 cases, had the similar result of rheumatoid arthritis. In 9 cases with hemophilic arthritis, pain and effusion were improved, but range of motion was improved minimally. In 2 cases with gouty arthritis, 2 cases with tuberculous arthritis, and I case with pigmented villonodular synovitis(PVNS), range of motion was rather reduced. It is considered that arthroscopic technique using transposterior septal portal is safe procedure without damaging the PCL, posterior capsule, neurovascular structures, and very efficient method in removing hypertrophied synovium or debris of persistent synovitis or arthritis of the knee joint and helpful in removing encapsulated loose bodies located behind the PCL.
Animals ; Arthritis ; Arthritis, Gouty ; Arthritis, Rheumatoid ; Arthroscopes ; Arthroscopy ; Follow-Up Studies ; Horns ; Knee ; Knee Joint ; Ligaments ; Range of Motion, Articular ; Recurrence ; Synovial Membrane ; Synovitis ; Tendons

The fibrovascular tissues surrounding a glaucoma implant have been found to play a major role for the orbital absorption of aqueous humor following a glaucoma implant surgery. An ultrasonographic study was performed to investigate the ultrasonographic, characteristics of the tissues and its relationship with the postoperative intraocular pressure(IOP) control. Twenty-three eyes of 23 patients had undergone the e-PTFE membrane-silicone tube implantation and had been followed up for at least 6-month(mean +/- SD, 17 +/- 8.8 months). An ultrasonographic study for these eyes included such paramneters as presence of an aqueous reservoir surrounding the implant, size(height) of the aqueous reservoir and echoreHectivity from the reservoir wall tissues. The aqueous reservoir was identified in 22(96%) of 23 eyes and had a height varying from 1.0 mm to 5.5 mm. In eyes with an aqueons reservoir. 3 mm high or more, the IOPs were all 21 mmHg or less without further glaucoma medications(p=0.040, chi-square). In one eye with an obliterated reservoir on ultrasonography, the opening of the silicone tube was found to be occluded toward the extrascleral portion of the implant when reoperation was performed. The echo reflections from reservoir wall tissues were denser and higher comparing with those from the sclera of the respective eye in 7 eyes with a complete failure of postoperative lOP control(>or=30 mmHg on maximum medical theraph). These eyes also had and irregular echoreflections within the aqueous reservoir, which reflect an invasion of proliferating tissues into the reservoir.
Absorption ; Aqueous Humor ; Glaucoma* ; Humans ; Orbit ; Reoperation ; Sclera ; Silicones ; Ultrasonography

We observed the gastric varices in l89 variceal patients with liver cirrhosis and in 129 patients with UGI bleeding by endoscopy. Gastric varices was found in 27 cases(14.2%) amoag 189 variceal cases. There was variceal bleeding in 74 cases(57.4%) beieg the toy cause of UGI: bleeding among l29 cases with UGI bleeding and 6(4.7%) had endoscopically proved gastric Variceal bleeding. Cardiac and fundic varices were observed in l8 and 12 cases, respectively end 12 cases of cardiac varices were mainly observed on the lesser curvature side. The incidence of isolated gastric varices being 30 % amoag gastric varices was far less than that of esophagogastric varices. There was no significant relations between the severity of liver cirrhosis and the kinds of varices These results suggest that gastric varices are not infrequent cause of UGI bleeding cases. Therefore all must have attention in gastric intestinal fiberscopic examination in portal hypertensive patients.
Endoscopy ; Esophageal and Gastric Varices* ; Hemorrhage ; Humans ; Incidence ; Liver Cirrhosis ; Play and Playthings ; Varicose Veins

Toxic epidermal necrolysis (T~EN) is a severe mucocutaneous disease characterized by epidermal necrosis possibly extended to the entire body surface and involving multiple internal organs. Digestive tract may be involved too, but there is few report about gastrointestinal lesion in patient with TEN. Recently we experienced a case of TEN with gastrointestinal bleeding in previously healthy 32-year-old woman. The condition developed three days after the initiation of treatment with NSAID and progressed caudally, involving 60 percent of the skin surfaces. During a period of admission gastrointestinal bleeding was noticed. The gastrofiberscopy showed diffuse superficial mucosal lesion with oozing from swollen friable and erythematous mucosa. The skin lesion was progressed inspite of withdrawal of causative agents. The patient was expired due to combined septic shock 10 days later. We report this case with gastrofiberscopic findings and a brief review of literature.
Adult ; Female ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Mucous Membrane ; Necrosis ; Shock, Septic ; Skin ; Stevens-Johnson Syndrome*

OBJECTIVE: To compare the multiplex-PCR and hybrid capture methods for detection of Human papillomavirus (HPV) in uterine cervical swab samples. METHODS: This study determined the HPV infection and its risk group (subtype) in uterine cervical swab samples of 91 Korean women by HPV hybrid capture I and multiplex-PCR method. RESULTS: The prevalence of HPV infection determined by muliplex-PCR was more higher than by hybrid capture method I. Of 65 women with nonspecific uterine cervical lesions, the frequence of HPV-positivity was 14/65 (12 low-risk and 2 high-risk HPV) by hybrid capture method I and was 37/65 (34 low-risk and 3 high- risk HPV) by multiplex-PCR method, respectively. The frequence of high-risk HPV was 2/6 in LSIL, 7/14 in HSIL, 4/6 in uterine cervical cancer by hybrid capture method I, and was 2/6 in LSIL, 8/14 in HSIL, 4/6 in uterine cervical cancer by multiplex-PCR method. CONCLUSION: These results suggest that multiplex-PCR is more sensitive, simple and cost-effective technique than Hybrid-capture I in the detection of HPV infection in the uterine cervix.
Cervix Uteri* ; Female ; Humans* ; Multiplex Polymerase Chain Reaction* ; Prevalence ; Uterine Cervical Neoplasms

PURPOSE: Colonic diverticulitis was rare in Korea in the past. However, it is progressively increasing probably because of a prolonged life span and a westernized diet pattern. Especially, right-sided colonic diverticulitis is difficult to differentiated from acute appendicitis. The purpose of this study was to verify the usefulness of laparoscopic-assisted surgery for the diagnosis and treatment of colonic diverticulitis. METHODS: We retrospectively reviewed 65 patients with colonic diverticulitis who underwent surgery from January 1998 to December 2002. RESULTS: The mean age of the patients was 36.3 years. Males were more prevalent than females (1.6:1). Abdominal ultrasonography (USG) was used as a diagnostic tool in 40 cases (61.5%), abdominal USG with colon enema in 8 cases (12.3%), and abdominal USG with abdominal CT in 4 cases (6.2%). The preoperative diagnosis was acute appendicitis in 52 patients (80.0%), perforated diverticulitis in 10 patients (15.4%), peritonitis in 2 patients (3.5%), and peptic ulcer perforation in 1 patient (1.5%). The postoperative diagnosis was simple diverticulitis in 47 cases (72.3%). The cecum was the most commonly involved area (55 cases, 84.6%). The types of open surgery were an appendectomy in 17 cases (26.1%), a right hemicolectomy in 17 cases (26.1%), a cecectomy in 6 cases (9.2%). The types of laparoscopic- assisted surgery were an appendectomy in 17 cases (26.1%), a laparoscopic-assisted right hemicolectomy in 4 cases (6.2%), and an anterior resection in 1 case (1.5%). The postoperative complication rate was 11.9% (5 cases). All of these occurred with the open technique, but no statistically significant difference existed between the complication rates for the two operative procedures (P=0.158). The mortality rate was zero for both operative procedures. The length of hospital stay (4.72+/-4.3 vs 10.1+/-6.2)(P=0.001) was significantly shorter in the laparoscopic-assisted group than in the open group. CONCLUSIONS: Preoperative diagnosis is sometimes difficult in patients with colonic diverticulitis. We consider laparoscopic-assisted surgery to be a useful diagnostic and therapeutic modality in such cases. The laparoscopic technique offers particular advantages to diverticulitis patients because of the short hospital stay and the low morbidity and mortality rates.
Appendectomy ; Appendicitis ; Cecum ; Colon* ; Diagnosis ; Diet ; Diverticulitis ; Diverticulitis, Colonic* ; Enema ; Female ; Humans ; Korea ; Length of Stay ; Male ; Mortality ; Peptic Ulcer Perforation ; Peritonitis ; Postoperative Complications ; Retrospective Studies ; Surgical Procedures, Operative ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: This study was performed in order to compare unenhanced CT with diffusion-weighted, T2-weight-ed,and fast FLAIR MR imaging in the detection of hyperacute cerebral ischema induced in a dog and to deter-mine whichmodality first detected cerebral ischemia. MATERIALS AND METHODS: Experimental cerebral infarction was induced bythe occlusion of intracerebral arter-ies using embolic materials (polyvinyl-alcohol, 300 -6 00 micro) introducedthrough a microcatheter into the internal carotid artery of five dogs weighing 12 -20 kg. Serial CT and MR imageswere obtained at one hour intervals from one to five hours after occlusion, and were analyzed independently by tworadiologists. We assessed changes in attenuation, as seen on unenhanced CT and the signal intensity of the lesionon each MR image, and measured the contrast-to-noise ratio (CNR) of the lesions. RESULTS: Ischemic lesions weredetected on unenhanced CT 1 -3 hours after occlusion of cerebral arteries. In all dogs, the lesions were detectedearliest on diffusion-weighted images obtained at 1 hour. They were detect-ed on T2-weighted images at 3 -5 hoursand on fast FLAIR images of 2 -5 hours. The CNR of ischemic lesions increased gradually during the 5-hour period.It was highest on diffusion-weighted images, while on unen-hanced CT, T2-weighted, and fast FLAIR images it wassimilar. CONCLUSION: Hyperacute ischemic lesions were detected earliest on diffusion-weighted images, and earlieron unenhanced CT than on fast FLAIR or T2-weighted MR image.
Animals ; Brain Ischemia ; Carotid Artery, Internal ; Cerebral Arteries ; Cerebral Infarction* ; Dogs* ; Magnetic Resonance Imaging*

BACKGROUND: It is well known that collateral circulation has important roles in ischemic heart diseases. The method most commonly used at present to evaluate collateral flow is coronary angiography. However, there are debates about the functional significance of angiographically visible collaterals because angiography visualizes only vessels that are larger than 100um in diameter. Recent studies suggest that myocardial contrast echocardiography (MCE) is a useful method in assessing collateral flow because it uses small microvascular tracers (4-12um) as a contrast agent. By using MCE, this study evaluates the role of angiographically visible collaterals in patients with acute myocardial infarction (AMI) and chronic ischemic heart disease. METHOD: Forty-one patients who underwent coronary angiography and MCE were included in this study (22 patients with acute myocardial infarction and 19 patients with chronic ischemic heart disease). Antegrade coronary flow was less than TIMI 3 flow in all patients. Myocardial perfusion through collaterals with MCE was evaluated by injecting sonicated Hexabrix into nonobstructing coronary arteries. Angiographically visualized collateral vessels were analysed as four grades and compared with the degree of myocardial opacification by MCE through collateral vessels. RESULT: Angiographic collaterals were frequently observed in patients with AMI and chronic ischemic heart disease with< or = TIMI 2 flow . There was poor correlation between TIMI grade and the grade of collaterals by angiography in AMI (r--0.29, p-0.20) and chronic ischemic heart disease (r--0.31, p-0.19). There was no correlation between collateral grades and myocardial opacification by MCE through collateral vessels in AMI (r-0.07, p-NS) and chronic ischemic heart disease (r-0.10, p-NS). In patients with relatively well developed collaterals (Grade II or III), the ischemic zone was perfused better through collateral flow in the chronic ischemic heart disease group than in the AMI group (Mean Retrograde Opacification Index 0.84+/-0.23 vs 0.32+/-0.22, p<0A65A>0.05). CONCLUSION: The study suggests that the role of angiographically visible collaterals is different in chronic ischemic heart disease and acute myocardial infarction. The grade of angiographically visible collaterals does not imply the extent of perfusion to myocardum at risk through collateral vessels.
Angiography ; Collateral Circulation ; Coronary Angiography ; Coronary Vessels ; Echocardiography ; Heart ; Humans ; Ioxaglic Acid ; Myocardial Infarction ; Myocardial Ischemia* ; Perfusion*

BACKGROUND: It has been demonstrated that within 2 weeks following acute myocardial infarction (AMI), exercise-induced ST-segment depression (STD) indicates subendocardial ischemia in the viable myocardium within infarcted or remote area from the infarction. Exercise-induced ST-segment elevation (STE) in leads with abnormal Q wave is associated with left ventricular dysfunction or aneurysm rather than transmural ischemia. We studied whether each pattern of ST-segment shift on exercise ECG during recovery phase following AMI is correlated with the perfusion status of infarcted myocardium evaluated by myocardial contrast echocardiog-raphy (MCE), regardless of findings of coronary angiography (CAG). METHOD: Study population was consisted of 25 patients with AMI (anteior wall: 11 patients, inferior wall: 14 patients, mean age=57.3+/-8.9years). Patients underwent exercise ECG and coronary angiography at 10 days post-AMI. After CAG, sonicated Hexabrix was injected into both coronory arteries alternatively and 2-D echocardiography was taken in parasternal short axis, apical 4, and 2 chamber views. To analyze the echocardiographic image semiquantitively, left ventricle was divided into 20 segments and perfusion status was graded as good, partial, and no opacification. RESULT: All patients with exercise-induced STE (n=8) in Q-leads had patent infarcted-related artery and poor collaterals on CAG, which was associated with poor or no opacification of infarcted myocardium on MCE. Patients with exercise-induced STD (n=9) frequently had closed infarct-related artery (67%), but good opacification of infarcted myocardium was shown by retrograde perfusion via collaterals, which was commonly seen in patients with multivessel disease. CONCLUSION: In early recovery phase of acute myocardial infarction, exercise-induced ST elevation in Q leads was associated with poor perfusional status in infarcted myocardium, even with patent infarct-related artery on CAG, while exercise-induced ST depression was frequently seen in the good perfusional status despite of closed infarted-related artery, which was commonly observed in patients with multivessel disease.
Aneurysm ; Arteries ; Axis, Cervical Vertebra ; Coronary Angiography ; Depression ; Echocardiography ; Electrocardiography ; Heart Ventricles ; Humans ; Infarction ; Ioxaglic Acid ; Ischemia ; Myocardial Infarction* ; Myocardium* ; Perfusion* ; Ventricular Dysfunction, Left