Arthroscopy has now become a valuable method for the diagnosis and treatment of the internal derangement of the knee. Based on the experiences gained during the past three years, in which 93 knees with posttraumatic disorders were observed arthroscopically, several uncommon and interesting findings were encountered. Such illustrative findings have been summarized here. I. Injury at the parameniscal portion is readily overlooked and especially the middle and posterior one-thirds are inaccessible. A wavy undulation of the concave margin of the meniscus, when abnormally exaggera;ed by tibial rotation, possibly suggests the presence of this type of injury. 2. The discoid cartilage and the bucket-handle tear of meniscus occasionally show similar pattern arthroscopically. 3. The plica of the knee can sometimes be a cause of knee disorders. Any internal derangement, which tends to be localized around the patella, warrants close scrutiny for its presence. 4. A large foreign body within a knee joint could easily be removed by virtue of direct arthroscopic visualization.
Arthroscopy ; Cartilage ; Diagnosis ; Foreign Bodies ; Knee Joint ; Knee ; Methods ; Patella ; Tears ; Virtues

Reconstruction of soft tissue defect with exposure of the tendons and bone in the lower third of the leg and the heel represents a challenge to plastic surgeons. The sural artery flap is a fasciocutaneous flap supplied by the sural artery that accompanies the sural nerve and connects with a septocutaneous perforator of the peroneal artery via a suprafascial network of vessels. For the coverage of soft tissue defects, we operated on 10 patients using a distally-based sural artery flap. The sites of the soft tissue defect were the lower third of the leg in 7 cases and the heel in 3 cases. The size of flap varied from 3.5x4cm to 12x18cm. Nine of 10 flaps survived completely. One flap in which the sural nerve was preserved showed partial necrosis but healed spontaneously. Two flaps showed slightly venous congestion which disappeared after a few days. The advantages of the sural flap are a reliable blood supply, easy and quick elevation of the flap, preservation of the major artery and minimal donor site morbidity. The disadvantage of the flap is hypoesthesia at the lateral part of the foot. In conclusion, the distally-based sural artery flap can be used safely for soft tissues coverage in the lower third of the leg and the heel.
Arteries* ; Foot ; Heel ; Humans ; Hyperemia ; Hypesthesia ; Leg ; Necrosis ; Sural Nerve ; Tendons ; Tissue Donors

No abstract available.
Uterus*

Rheumatoid arthritis can result in progressive deformity of the forefoot, which leads to marked limitation in shoe wear, significant pain, and substantial diminution in standing and walking ability. Twenty feet of seventeen patients with severe forefoot deformities underwent surgical correction hy means of first metatarso-phalangeal arthrodesis and resection arthroplasties of the lesser M-P joints from May, I 994 to March, l996. The results were as follows; l. Suhjective improvement in pain, standing and walking ability, and shoe wear was excellent in fifteen (7~5%) feet, good in three (l5%), fair in one (5%), and poor in one (5%) foot. 2. The average hallux valgus angle (HVA), 1st intermetatarsal angle (IMA) were improved from 46.7 and 13.7 to 11. 1 and 8.2 degree individuaIly. 3. The average angle of dorsiflexion after the first metatarsophalangeal (MP) joint arthrodesis was 12.9 degree. 4. Complications of the procedures were minimal; three delayed wound healing, one non-displaced fracture of fusion site due to trauma, one malunion of the 1st MTP joint, one recurrence of the fibular deviation of the lesser toes.
Arthritis, Rheumatoid ; Arthrodesis ; Arthroplasty ; Congenital Abnormalities* ; Foot ; Hallux Valgus ; Humans ; Joints ; Recurrence ; Shoes ; Toes ; Walking ; Wound Healing

No abstract available.
Transplants

Bone graft is an important procedure in craniomaxillofacial reconstruction and the success of reconstruction depends on the survival of the grafted bone. In this study, the survival of the membranous inlay bone graft on the mandibles of dogs was investigated with bone scan and histologic examination. The inlay bone graft, 1x2cm critical-sized bone, was completely separated from the lower border of the mandible of dogs and then refixed to the original site. Bone scan and histologic examination were done at 1,2,3 and 4 weeks postoperatively. The bone scan after 1 week showed radioisotope uptake on the margin of the grafted bone and the isotope count was 21% compared to the uptake of the normal bone. After 2 weeks, the radioisotope uptake in the grafted bone increased to 52% of normal bone uptake. After 3 and 4 weeks, the degree of isotope uptake was 111% and 124% respectively. Histological findings after 1 week showed the absence of osteoblastic activity and 6 viable blood vessels in one 200X magnified field, which was 25% compared to the vessels of the normal bone. After 2 weeks, osteoblastic activities were noted and the number of viable blood vessels totalled 15, which was 63% of the vessels of the normal bone. After 3 weeks, osteoblastic activities increased and the number of viable blood vessels totalled 21, which was 88% of the vessels of the normal bone. After 4 weeks, there were markedly increased osteoblastic activities with a total number of 23 vessels, which was 96% of the normal bone. In summary, the revascularization of the membranous inlay bone graft began from the first week after bone graft, and then it gradually increased. After 3 weeks, the revascularization had returned to a nearly normal value compared with the value of the near-by normal mandibular bone.
Animals ; Blood Vessels ; Dogs ; Inlays* ; Mandible* ; Osteoblasts ; Reference Values ; Transplants*

PURPOSE: To investigate which spectral domain optical coherence tomography (SD-OCT) findings predict visual outcome after anti-vascular endothelial growth factor (VEGF) treatment in neovascular age-related macular degeneration (NV-AMD). METHODS: We reviewed the medical records of patients with treatment-naive NV-AMD who underwent three or more consecutive anti-VEGF injections. The patients were divided into three groups according to their changes of visual acuity (VA); improved (group I), static (group S), or worsened (group W). We assessed the incidences and values of all available SD-OCT findings of these groups, compared these findings between the three groups and compared the initial values with the post-treatment values. RESULTS: Better initial VA and longer external limiting membrane (ELM) length were associated with less change in VA after anti-VEGF treatment. The initial VA was mildly correlated with initial photoreceptor inner and outer segment junction (IS/OS) length and initial ELM length. The final VA was also mildly correlated with the final IS/OS length and the final ELM length. VA was significantly changed after anti-VEGF treatment in groups W and I. With regard to incidence, disruption of the IS/OS (IS/OS-D), disruption of the ELM (ELM-D) and ELM length differed significantly between the three groups, particularly ELM-D. The incidences of IS/OS-D and ELM-D in group I were significantly lower than those in groups S and W, and those in group S were also lower than those in group W. The ELM length in group I was significantly longer than it was in groups S and W, and the ELM length in group S was longer than that for group W. However, these three findings did not change after the anti-VEGF treatment. CONCLUSIONS: Initial IS/OS-D, ELM length and particularly ELM-D can be useful predictors of the visual outcome after anti-VEGF treatment in NV-AMD patients.
Aged ; Aged, 80 and over ; Angiogenesis Inhibitors/*therapeutic use ; Choroidal Neovascularization/*drug therapy/physiopathology ; Female ; Humans ; Intravitreal Injections ; Male ; Middle Aged ; Ranibizumab/*therapeutic use ; Retinal Photoreceptor Cell Inner Segment/pathology ; Retinal Photoreceptor Cell Outer Segment/pathology ; Tomography, Optical Coherence ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Visual Acuity/*physiology ; Wet Macular Degeneration/*drug therapy/physiopathology

No abstract available.

The abdominal manifestations of tuberous sclerosis are most frequently related to hamartomas of the kidneys which are readily detectable on CT scans because of their fat content. However, lipomas or angiomyolipomas of the liver are quite rare. Two patients with angiomyolipomas of the kidney had typical kin lesions of tuberous sclerosis. Orie had been on long-term dialysis for chronienal failure due to an angiomyolipomatous lesions and the other had undergone nephrectomy because of nonfunction kidney. Hepatic hamartomas were also seen in both atients. We should anticipate that such masses are not infrequent with uberous sclerosis.
Angiomyolipoma* ; Dialysis ; Hamartoma ; Humans ; Kidney ; Lipoma ; Liver ; Nephrectomy ; Renal Insufficiency* ; Sclerosis ; Tomography, X-Ray Computed ; Tuberous Sclerosis*

Epidermal cysts may develop on any part of the body. Most of them are thought to occur following inflammation of the epithelium of the hair follicle. These found on the palm and sole where the hair follicle is absent have been considered to developmant of following a traumatic inclusion of the epidermis into the Dermis. Because only a few cases w re known to be related to preceding trauma, the latter assumption has been questioned. Reerly, the HPV-like virions and papillomavirus genus-speciric antigen were detected in the epicrml cyst of the sole in some reports. 1 our cases of plantar epidermal cyst were studied for the presence of human papillomavirus using conventional histologic and immunohistochemical examinator Histologic examination showed three characteristic findings, that is, intracytoplasmic eosinophil odies in the cyst wall, parakeratosis within the cyst caviti, and vacuolar structures disperse the wall and cavity. In all of the cases, immunohistochernical staining was positive for papule evirus antigen. These findings suggest an etiologic as.iation between the papillomavirus infection and plantar epidermal cyst.
Dermis ; Eosinophils ; Epidermal Cyst* ; Epidermis ; Epithelium ; Hair Follicle ; Humans* ; Inflammation ; Papilloma* ; Papillomavirus Infections ; Parakeratosis ; Virion