No abstract available.
Cyclic GMP* ; Cytomegalovirus* ; Gene Expression* ; Humans*

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 diagnosis of insulinoma is made primarily by the detection of an inappropriately elevated serum insulin level in the presence of a low blood glucose level. The successful resection of insulin-secreting islet cell turnors is greatly facilitated by accurate preoperative localization. But, the modalities of ultrasonography, computer tomography, magnetic resonance imaging and selective arteriography often fail to detect insulinoma smaller than 1.5 cm in diameter. In this report, we describe a patient with an insulinoma successfully localized by percutaneous transhepatic portal vein sampling but not by abdominal ultrasonography, computer tomography and selective arteriography. Percutaneous transhepatic portal vein catheterization with insulin sampling showed sudden step-up of insulin concentrations near 6 cm from distal splenic vein. During operation, a 1×1.3cm sized tumor was found at the junction of body and tail of pancreas, so distal pancreatectomy was performed, We propose that preoperative percutaneous transhepatic portal vein catheterization with measurement of radioimmunoactive insulin concentration is a safe and reliable method and plays an important role to localize insulinoma that are considered occult after conventional diagnostic studies have been negative.
Angiography ; Blood Glucose ; Catheterization ; Catheters ; Diagnosis ; Humans ; Insulin ; Insulinoma ; Islets of Langerhans ; Magnetic Resonance Imaging ; Methods ; Pancreas ; Pancreatectomy ; Portal Vein ; Splenic Vein ; Tail ; Ultrasonography

High tibial osteotomy is a useful procedure in the treatment of early stage osteoarthritis of the knee which is confined to the medial compartment. But long term follow-up study of high tibial osteotomy has not been provided yet and its prerequisite for a successful result still remains unrevealed. Since the osteoarthritis can progress after the osteotomy, it may result in the loss of correction and recurrence of pain and require conversion to total knee replacement arthroplasty. We studied clinically and radiologically the long term result of high tibial osteotomy in 11 patients(16 knees) who had been treated at the Department of Orthopaedic surgery of Seoul Paik Hospital during the period from January, 1978 to May, 1989, and follow-up for longer than 4 years. Preoperative mean varus angle was 6.4 degrees and immediate postoperative mean valgus angle was 8.6 degrees and final mean valgus angle was 4.7 degrees. The average loss of correction angle was 3.9 degrees. At 2-year follow-up, the results of 16 knees were as follows; excellent in six knees, good in seven knees. The final results at average 7.2-year follow-up were excellent in four knees, good in six knees and one knee was converted to total knee replacement arthroplasty. The results showed deterioration of clinical results and loss of correction with time after osteotomy. However, in more than half of the cases the results were good or excellent at the final follow-up, We, therefore, conclude that high tibial osteotomy is still a useful procedure in osteoarthritis of the knee if performed with a precise surgical technique and an adequate overcorrection more than 10 degrees.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Knee ; Osteoarthritis ; Osteotomy ; Recurrence ; Seoul

OBJECTIVE: Excessive external rotation of the hemiplegic foot is a common problem of hemiplegic gait. There has been a few report on etiological investigation and corrective measurement of an excessive external rotation of hemiplegic foot. Thus we present a newly designed Torque heel to correct the external rotation of hemiplegic foot. METHOD: Ten hemiparetic patients with an excessive external rotation of affected foot participated in this study. All of the participants were able to walk at least 10 meters with metal a ankle foot orthosis (AFO) using a single cane. Each of these patients was placed on four tries of walk: (1) on a bare foot; (2) with an AFO; (3) with an AFO and a quarter inch of lateral wedge; and (4) with an AFO and the Torque heel . Gait patterns were analysed by the Vicon 370, three dimensional motion analyser. RESULTS: The speed and stride length increased in all tries except for the bare foot walk. Those who walked with the assistive devices showed no difference in the speed and stride length. All the participants showed an increased in external rotation of pelvis and ankle. Those who walked with an AFO and Torque heel presented a decrease in the external rotation of foot and pelvis. The hip and ankle motions of the hemiplegic limbs were not affected with the AFO and Torque heel . A significant degree of correction in pelvic rotation with an AFO and Torque heel was noted. CONCLUSIONS: This study indicates that an AFO with Torque heel is beneficial to the correction of external rotation of a hemiplegic foot. And the excessive external rotation of hemiplegic foot may be due possibly to the external rotation of pelvis.
Ankle ; Canes ; Extremities ; Foot Orthoses ; Foot* ; Gait Disorders, Neurologic ; Gait* ; Heel* ; Hip ; Humans ; Pelvis ; Self-Help Devices ; Torque*

The purposes of this study were to identify lumbar lordosis in low back pain patients and to investigate differences in lumbar lordosis in low back pain patients according to etiologies. On the basis of the findings of spinal roentgenogram, MRI, and SPECT imagies, the patients were divided into four groups; 1) facet syndrome with facet joint inflammation or degenerative change, 2) disc herniation including disc bulging or extrusion, 3) combined low back pain accompaning facet joint lesion with disc herniation, 4) simple low back pain with no abnormal imaging findings. There were statistically significant decrease in low back pain patients compared with normal controls in terms of lumbosacral curvature. No sex and age differences were observed within low back pain patients and normal controls in terms of lumbosacral curvature. The review disclosed a significant decrease of the lumbosacral angle in order of simple low back pain, disc herniation, combined low back pain compared with normal controls. But facet syndrome patients showed no change of lumbosacral angle. Patients with disc bulging showed no significant decrease of lumbosacral angle compared with normal controls but patients with disc extrusion showed significant decrease. It is believed that the decrease of lumbosacral angle in low back patients results from a pathokinesiological effort to keep facet joint from pressure stemed from facet overlying and to minimize the shearing force over lumbosacral joint. The facet joint stiffness due to inflammation may play a major role in no change of lumbosacral angle in facet syndrome patients. In conclusion, different causes of low back pain should be taken into consideration for the assessment of lumbosacral angle.
Animals ; Humans ; Inflammation ; Intervertebral Disc Displacement ; Joints ; Lordosis* ; Low Back Pain* ; Magnetic Resonance Imaging ; Tomography, Emission-Computed, Single-Photon ; Zygapophyseal Joint

OBJECTIVE: The purposes of this study were to identify the incidence of subcortical aphasia and to investigate the different linguistic characteristics and prognosis. METHOD: Twenty-nine stroke patients(18 men and 11 women) with aphasia were investigated in the study. On the basis of the findings of brain CT and MRI images, the patients were divided into either cortical aphasia group or subcortical aphasia group. Fifteen cortical aphasia patients and 14 subcortical aphasia patients underwent an aphasia screening test. Fluency, comprehension, speech, naming, repetition, reading, and writing abilities were evaluated as the modalities of language. All patients received the speech therapy and were reevaluated at three months after the initial evaluation. RESULTS: The incidence of subcortical aphasia was 48.3% of all aphasia patients from the stroke. Subcortical aphasia patients showed more variable types of aphasia and less linguistic damage than the cortical aphasia patients. The prognosis of subcortical aphasia patients was better than the cortical aphasia patients. Especially the cases of global aphasia from the subcortical lesions showed a rapid recovery and good prognosis. CONCLUSION: Early recognition of the subcortical aphasia and a comprehensive speech therapy would be beneficial for the improvement of linguistic function in the subcortical aphasia patients.
Aphasia* ; Brain ; Comprehension ; Humans ; Incidence ; Linguistics ; Magnetic Resonance Imaging ; Male ; Mass Screening ; Prognosis ; Speech Therapy ; Stroke* ; Writing

BACKGROUND: Only two pharmacokinetic models of propofol are commercially available in the category of target controlled infusion (TCI) pumps: the modified Marsh and Schnider models. Both models were developed using propofol-LCT (long chain triglyceride). Depending on the excipient, the pharmacokinetic properties of fast-acting drugs, such as propofol, vary. Hence, it is necessary to evaluate the predictive performances of both models using propofol-MCT (medium chain triglyceride)/LCT, which is frequently used in clinical practice. METHODS: This was a computer simulation study, using data collected in the previous clinical analysis used to evaluate the predictive performance of a pharmacokinetic model of propofol-MCT/LCT. The infusion profiles for each patient were applied as inputs to both models. Simulations were performed using TCI software, and the simulated plasma concentrations of both models were calculated. RESULTS: In total, 217 plasma samples, obtained from 35 patients, were used to determine the predictive performance. The pooled median (95% CI) biases and inaccuracies were 9.6 (−1.7 to 15.4) and 32.1 (22.6–38.2) respectively, for the modified Marsh model, and −5.9 (−8.9 to −0.7) and 26.3 (21.7–27.8) respectively, for the Schnider model. CONCLUSIONS: Although the pooled bias and inaccuracy of the Schnider models were clinically acceptable (< 10–20% and approximately 20–30%, respectively), the Schnider model consistently produced negatively biased predictions. Conversely, even though the pooled inaccuracy of the modified Marsh model failed to meet this criterion, the value did not deviate significantly from the standard. Therefore, it is reasonable to conclude that both TCI models can be used for propofol-MCT/LCT.
Bias (Epidemiology) ; Computer Simulation ; Humans ; Pharmacokinetics ; Plasma ; Propofol ; Wetlands*

PURPOSE: The purpose of this study was to analyze the clinical effectiveness of open reduction in the treatment of distal humeral fracture using a newly designed combined approach of anterolateral and lateral approaches to protect the radial nerve. MATERIALS AND METHODS: We investigated 24 consecutive cases of distal humeral fracture who received open reduction and internal fixation with a plate and screws with a minimum follow-up period of 1 year. We analyzed the patients' age, sex, fracture pattern, timing of the union, range of motion of the elbow joint, and complications. The Mayo elbow performance index (MEPI) was employed for the assessment of elbow joint function. RESULTS: Clinical union was observed at 10.8 weeks (6~20 weeks) on average. Pre-operatively, there were 3 cases of incomplete radial nerve palsy. All of the cases recovered, and there was no additional radial nerve palsy due to surgery. According to the MEPI, 13 cases were "excellent" and 10 cases were "good" or better, comprising 95.83% of the cases. The range of motion at the elbow was 5.5 degrees (0~15 degrees) of extension, and 131.5 degrees (120~145 degrees) of flexion, suggesting no functional disability. The duration of return to work was 11.2 weeks (5~32 weeks) on average. There were no nonunion, malunion, or infection complications. CONCLUSION: The combined anterolateral and lateral approach we designed is a clinically effective approach due to facilitation of protection of the radial nerve and attainment of adequate fixation space.
Elbow ; Elbow Joint ; Follow-Up Studies ; Humeral Fractures ; Humerus ; Paralysis ; Radial Nerve ; Range of Motion, Articular ; Return to Work

Bilateral traumatic abducens nerve palsy is a rare condition. We report a case associated with Hangman's fracture without skull fracture. Seventeen cases of bilateral traumatic nerve palsy were found in the literature and only four cases had bilateral traumatic abducens nerve palsy associated with cervical spine fracture without skull fracture. In case of head and neck injury, the abducens nerve may be damaged at the point of fixation to the dura mater. The pathogenesis, the clinical conditions and the radiological findings are presented.
Abducens Nerve Diseases* ; Abducens Nerve* ; Dura Mater ; Head ; Neck Injuries ; Paralysis ; Skull Fractures ; Spine