No abstract available.
Fracture Fixation, Intramedullary*

INTRODUCTION: The reconstructions of posterior cruciate ligament (PCL) has been increasing because of increased incidence of insufficiency of the PCL and improved surgical skill Arthroscopic operation is known better than open in cruciate ligamet reconstruction in many respects. Arthroscopic PCL reconstruction, especially using hanstring tendon has some benefits. This study is retrospective study analyzing 20 patients treated by arthroscopically assisted PCL reconstruction using hamstring tendon. ALATERIAL AND METHODS: From November 1993 to June 1996, 20 patients with PCL insufficiency had heen treated by arthroscopically assisted PCL reconstruction using double-looped hamstring (semitendinosus and gracilis) tendon by first author. The isometric point was located slightly posterosuperior than anatomic attachment in femur and 0.8-1.0cm below articular margin in tibia. They were confirmed by intraoperative fluoroscopy. The remnants of intact PCL bundle and meniscofemoral ligaments were preserved and added to the graft. They were nineteen men and one women, with a mean age 31.8 years (range, 15-56 years). RESULTS: The results were as follows; 1. The patients were followed from 13 months to 44 months after operation (average 2years and 2months ). 2. Post operative neurovascular irjuries were not found. 3. No revision case was observed and second operations were made in two cases with posterolateral rotatory instability after primary reconstruction. 4. All patient has no symptom of instability after operation. S. At last follow up, Lyshohn knee scores improved from 62 preoperatively to 89 postoperati.vely on average. CONCLUSION: Arthroscopically assisted PCL reconstruction using double-looped hamstring (semitendinosus and gracilis) tendon is easier and less damage than using bone-patellar tendon-bone graft. It preserves intact meniscofemoral ligament, some intact fibers of PCL bundle and quadriceps mechanism. We think it is a effective treatment for PCL insufficiency patients."
Bone-Patellar Tendon-Bone Grafts ; Female ; Femur ; Fluoroscopy ; Follow-Up Studies ; Humans ; Incidence ; Knee ; Ligaments ; Male ; Posterior Cruciate Ligament* ; Retrospective Studies ; Tendons* ; Tibia ; Transplants

OBJECTIVE: Locking of the knee is usually attributed to a tear of meoiscus, or to a loose body that rnechanically obstructs the motion of joint. A less frequently recognized cause of a locked knee is a partial tear of the ACL. The purpose of this study is to report that the partial tear of,the ACL at the femoral attachment site of posterolateral bundle provided a mechanical obstruction in the knW, and it is convicted the injury mechanism of isolated ACL. MATEIRALS AND METHODS: The author presents 16 cases in which the torn ACL was observed knee locking under arthroscopy fram February 1993 to June 1996. Patients ages ranged from 22 to 54 years. The mechanism of injuries were 6 sports activity (Ski 4, Soccer 1, Badminton 1), 4 slip down, 3 pedestrian car accidents and 3 unknown causes with especially low velocity injuries. Although the chief complain in each case was knee pain, all had locking knee that, on physical examination, locked from 5 to 20 of full extension, and 4 locked full flexion. The positive Lachman test was obtained 3 of the 16 paiients. Associated intraarticular injuries were 2 tears of the medial meniscus, 1 lateral meniscus. RESULTS: The average time to arthroscopy was 3 nonths with a range of 1 month to 10 rnonths. An arthroscopic diagnosis and treatment were performed and meniscal tears were ruled out as the cause of locking in all patients. The injury mechanism of isolated ACL was the hyperextensioo of the knee with leg I/R and especially low velocity injuries. The ACL was found to have a partial tear at the site of femoral attachment of an estimated P-L bundle. The torn segment of the ACL to become interposed between the lateral femoral condyle and the latera1 tibial condyle and to act as mechanical block was demcinstrated. CONCLUSION: In all cases, the torn portion of the ACL was excised under arthroscopy and knee locking was resolved.
Arthroscopy ; Diagnosis ; Humans ; Joints ; Knee* ; Leg ; Menisci, Tibial ; Physical Examination ; Racquet Sports ; Soccer ; Sports

BACKGROUND: Cleaning and disinfection of fiberoptic bronchoscope requires careful attention, especially to mycobacterium species because the contamination of mycobacteria could raise confusion on diagnosis. Recently, we detected contamination of Wydex(R) solution used in bronchoscope washer with Mycobacterium chelonae. In this study, we evaluated the mycobactericidal effect of 12 kinds of disinfectants for M. chelonae. METHOD: To evaluate the bactericidal effect of Wydex(R) 2%, Cidex(R) 2.25%, Cidex(R) 3%, Bacteriokiller (BK) disinfectant, Perasafe(R), HICLO-S(R), Lamicine(R), ethanol, Instrusept(R), Virkon(R), Betadine(R), and Vipon(R) against M. chelonae, culture was performed after exposure of two M. chelonae strains (ATCC 35749, the type strain and the strain isolated from contaminated Wydex(R) solution) to each disinfectant solution. The growth of organism was examined for up to 8 weeks. RESULTS: Growth of M. chelonae (reference strain of ATCC 35749 and isolated strain) was observed after a week incubation for Wydex(R) 2%, Cidex(R) (2.25%, 3%) and control. For BK disinfectant and Perasafe(R), they grew after 2-3 weeks, and 3-4 weeks, respectively. For HICLO-S(R) and Lamicine(R), only the contaminated strain grew after two and three weeks, respectively. For ethanol, Virkon(R), Betadine(R), Vipon(R), and Instrusept(R) , growth was not observed from either strain. CONCLUSIONS: On the basis of these results, Instrusept(R), virkon(R), ethanol, Betadine(R), and Vipon(R) were effective for the disinfection of M. chelonae. Especially, Instrusept(R) was thought to be useful as a disinfectant for bronchoscopes because it has advantages including non-corrosiveness, chemical stability, and non-irritativeness. And additional washing with ethanol might be effective. The finding that strain isolated from contaminated bronchoscopes was more resistant to disinfectants than reference strain suggested that the more resistant strains are selected throughout the improper disinfection.
Bronchoscopes ; Diagnosis ; Disinfectants* ; Disinfection ; Ethanol ; Mycobacterium chelonae* ; Mycobacterium*

A case of gallbladder empyema caused by Pediococcus pentosaceus is discussed. This appears to be the first reported case of gallbladder empyema caused by this organism. The laboratory method to identify this vancomycin-resistant gram-positive cocci and antimicrobial susceptibility of this organism are described.
Cholecystitis* ; Gallbladder* ; Gram-Positive Cocci ; Pediococcus*

BACKGROUND: Treatment of adult patent ductus arteriosus(PDA) has many difficulty such as pulmonary hypertension, arterial wall calcification, aneurysmal chage of ductus. We tried to evaluate the effect of surgical interruption of PDA on postopeative change of heart size. MATERIAL AND METHOD: From 1987 to 1997 we experienced 30 cases of the ligation of patent ductus arteriosus in adult at the department of cardiovacular surgery in Masan Samsung General Hospital. RESULT: There were 9 males and 21 females and their ages ranged from 16 to 44 years, with a mean age of 26.1 years. 15 patients had pulmonary hypertension and 9 patients complained of dyspnea with a degree of functional NYHA class III. Operation method was double or triple ligation using Teflon felt. Postoperative complications were wound dehiscence in 3 patients and transient hoarseness in 1 patient. The mean preoperative cardiothoracic ratio was 54.7%, and mean postoperative cardiothoracic ratio was 51.9%. The change of cardiothoracic ratio was more typical in the cases who had congestive heart failure. Their mean preoperative cardiothoracic ratio was 64.8% and the mean postoperative cardiothoracic ratio was 58.5% there was no postoperative deaths. CONCLUSION: We canclude that the improvement in cardiothoracic ratio may result from surgical intervention of PDA.
Adult* ; Aneurysm ; Ductus Arteriosus, Patent* ; Dyspnea ; Female ; Heart ; Heart Failure ; Hoarseness ; Hospitals, General ; Humans ; Hypertension, Pulmonary ; Ligation* ; Male ; Polytetrafluoroethylene ; Postoperative Complications ; Wounds and Injuries

To evaluate the risk and factors associated with seizure recurrence in children with epilepsy while receiving the adequate anticonvulsant treament, we studied 58 patients with newly diagnosed epilepsy who were followed prospectively for a median of 26 months (range 7 to 54). The results were as follows: 1) Forty-four of the 58 patients (75.9%) had recurrence of seizure. 2) The rate of recurrence according to type of seizure was observed to be 22 patients (68.8%) in generalized tonic-clonic seizure, 6 patients (85.7%) in simple partial seizure, 5 patients (83.3%) in complex partial seizure, 3 patients (100%) in mixed seizure, 2 patients (100%) in absence, 3 patients (100%) in infantile spasm, 1 patient (100%) in atonic seizure, 2 patients (50%) in secondary generalized seizure. There was no significant difference in the risk of recurrence observed among these seizure types. 3) The risk of recurrence varied according to the history of seizure, seizure recurrence was observed in 100% of the cases with history of neonatal seizure, 72.7% of the cases with febrile convulsion, and 73.3% of the cases with non-specific history. No significant difference was observed among these past history of seizure. 4) The rate of seizure recurrence according to electroencephalographic abnormalities did not differ significantly. Seizure recurrence was noted in 13 of the 18 patients with mildly disordered tracings (72.2%), 15 of the 20 patients with moderate abnormality (75.0%), and 12 of the 16 patients with severe abnormality (75.0%). 5) Recurrence rate according to cause of seizure was more significantly frequent in those with symptomatic epilepsy than in those with idiopathic type (100% vs 70.2%, p<0.05). 6) The frequency percentage of seizure recurrence by age groups of below 1 year, 1 to 3 years, 4 to 6 years, and above 6 years at onset of seizure were 100, 66.7, 57.1, and 72.7, respectively. The rate of seizure recurrence was significantly highest in patients aged below 1 year at onset of seizure. 7) There was significant difference in seizure recurrence between those with and without abnormalities as shown by neurologic examination (100% vs 70.8%, p<0.05). 8) There was no consistent difference in valproic acid serum levels between those who had a recurrence and those who did not. The patients receiving phenobarbital had significantly high serum levels of the phenobarbital in recurrent groups than those who had no recurrence. In conclusion, factors associated with an increased risk of seizure recurrence were early age at onset of epilepsy, symptomatic epilepsy, and neurologic abnormalities. We found no associations between risks of recurrence and types of epilepsy, or electroencephalographic abnormalities.
Anticonvulsants* ; Child ; Epilepsy ; Humans ; Infant ; Infant, Newborn ; Neurologic Examination ; Phenobarbital ; Prospective Studies ; Recurrence* ; Risk Factors ; Seizures* ; Seizures, Febrile ; Spasms, Infantile ; Valproic Acid

Endobronchial leiomyoma is extremely rare and accounts for less than 2% of benign tumors of the lower respiratory tract. Leiomyomas are predominantly found in the young and the middle aged : of the average age being 35 years for bronchial and lung parenchymal lesions and 40.6 years for tracheal lesions. The symptom depends on the location of the tumor, its size, and changes in the lung distal to the lesion. A 37-year-old woman was admitted to our hospital complaining of coughing. Bronchoscopy revealed complete obstruction of the right main bonchus at the carina by an oval-shaped, nonulcerative, smooth, and pinkish-tan tumor with a broad margin and extended to the left main bronchus. A biopsy was performed and showed a benign spindle cell tumor. A right pneumonectomy was performed because of chronic infection, and the lung could not expanded during aeration. The histological diagnosis of the resected specimen was leiomyoma. The postoperative course was uneventful.
Adult ; Biopsy ; Bronchi ; Bronchoscopy ; Cough ; Diagnosis ; Female ; Humans ; Leiomyoma* ; Lung ; Mediastinitis ; Middle Aged ; Pneumonectomy ; Respiratory System

PURPOSE: Duchenne/Becker muscular dystrophy(DMD/BMD) is an X-linked recessive disorder caused by mutations of dystrophin genes. The purpose of the present study is to determine the frequency and the patterns of dystrophin gene deletions and to investigate the correlation of genotypes and phenotypes. METHODS: There were included a total of 89 children(88 boys and 1 girl) diagnosed as DMD/BMD by immunohistochemistry and/or genetic analysis from 1999 to 2003 at Seoul National University Children's Hospital. We analyzed the genomic DNA by multiplex PCR using a 26 dystrophin exon primer set. Direct sequencing was performed on 23 exons(in which point mutations were detected in other previous reports) in 22 patients without deletions. Phenotype and genotype relationship analysis was performed on the basis of retrospective clinical reviews. RESULTS: The frequency of dysmorphin gene deletions was 54%(32/59), which is lower than that of European and American data. Exon deletions were detected in 59 cases and the deletion "hot spots" were exon 44-54 constituting 80% of all deletions. In 6 cases without detectable deletions, 6 point mutaions(3 nonsense mutations and 3 nucleotide variants) were detected. The patients whose deletions were in the central parts or the patients with multiple exon deletions tended to show earlier symptom onsets and more rapid progressions of weakness but there were no statistical significances. CONCLUSION: Since deletions in dystrophin genes were detected in about 50% of the patients, studies on dystrophin protein expressions using muscle biopsy samples must be done for correct diagnosis.
Biopsy ; Codon, Nonsense ; Diagnosis ; DNA ; Dystrophin* ; Exons ; Gene Deletion ; Genotype ; Humans ; Immunohistochemistry ; Molecular Biology* ; Multiplex Polymerase Chain Reaction ; Muscular Dystrophies* ; Phenotype ; Point Mutation ; Retrospective Studies ; Seoul

PURPOSE: Duchenne/Becker muscular dystrophy(DMD/BMD) is an X-linked recessive disorder caused by mutations of dystrophin genes. The purpose of the present study is to determine the frequency and the patterns of dystrophin gene deletions and to investigate the correlation of genotypes and phenotypes. METHODS: There were included a total of 89 children(88 boys and 1 girl) diagnosed as DMD/BMD by immunohistochemistry and/or genetic analysis from 1999 to 2003 at Seoul National University Children's Hospital. We analyzed the genomic DNA by multiplex PCR using a 26 dystrophin exon primer set. Direct sequencing was performed on 23 exons(in which point mutations were detected in other previous reports) in 22 patients without deletions. Phenotype and genotype relationship analysis was performed on the basis of retrospective clinical reviews. RESULTS: The frequency of dysmorphin gene deletions was 54%(32/59), which is lower than that of European and American data. Exon deletions were detected in 59 cases and the deletion "hot spots" were exon 44-54 constituting 80% of all deletions. In 6 cases without detectable deletions, 6 point mutaions(3 nonsense mutations and 3 nucleotide variants) were detected. The patients whose deletions were in the central parts or the patients with multiple exon deletions tended to show earlier symptom onsets and more rapid progressions of weakness but there were no statistical significances. CONCLUSION: Since deletions in dystrophin genes were detected in about 50% of the patients, studies on dystrophin protein expressions using muscle biopsy samples must be done for correct diagnosis.
Biopsy ; Codon, Nonsense ; Diagnosis ; DNA ; Dystrophin* ; Exons ; Gene Deletion ; Genotype ; Humans ; Immunohistochemistry ; Molecular Biology* ; Multiplex Polymerase Chain Reaction ; Muscular Dystrophies* ; Phenotype ; Point Mutation ; Retrospective Studies ; Seoul