The purposes of this study were to evaluate the diagnostic modalities of the acute rupture of anterior cruciate ligament(ACL) and to know the differences hetween complete and partial ACL rupture preoperatively, analyzing the methods of physical examimation and the clinical features in acutely injured patient. We analyzed the anterior drawer test, Lachman test, KT-2000 arthrometer, MRI findings and associated injuries in the 35 patients who were confirmed to have ACL rupture by arthroscopy of the knee joint, performed within a month after trauma. We divided the patients by arthroscopy into 2 groups: complete rupture group and the partial rupture group. Among the 35 cases of ACL rupture, there were 10 cases of partial rupture and 25 cases of complete rupture. The Lachman s test was the most sensitive method of the physical examinations in detecting acute ACL injuries, with 90% and 92% positive rate in each group retrospectively. KT-2000 arthrometer with more than 3mm side-to-side difference showed all positive findings except one. The findings of ACL rupture in MRI were discontinuity, increased signal intensity, ahnormal course of ACL fibers and so on. The sensitivity of MRI in diagnosing the acute injuries of ACL was 97.2% hut had difficulties in differentiating the complete from partial rupture. Associated injuries of the ACL injured knee were medial and lateral meniscus tear and medial collateral ligament injury. The diagnosis of acute ACL rupture was made possihle hy physical examinations and with use of the KT-2000 arthrometer and MRI was useful in detecting the ACL rupture or associated injuries but not in differentiating complete from partial rupture of the ACL.
Anterior Cruciate Ligament* ; Arthroscopy ; Collateral Ligaments ; Diagnosis* ; Humans ; Knee ; Knee Joint ; Magnetic Resonance Imaging ; Menisci, Tibial ; Physical Examination ; Retrospective Studies ; Rupture

Various anatomical defects have been described in the surviving twin who had a stillborn, macerated monozygotic co-twin with Disseminated Intravascular Coargulation. The etiology is thought to be placental transfer of emboli or thromboplastic material through placental vascular anastomoses. We experienced a case of monozygotic twin with deceased co-twin at 30 weeks of gestation and confirmed to have antenatal periventricular germinal matrix and intraventricular hemorrhage, multicystic periventricular leukomalacia and diffuse encephalomalacia by neurosonography on first day of life despite of no clinical evidence of brain damage. The pathologic findings of placenta revealed infarct with massive fibrin deposition. A brief review of related literature is presented.
Brain* ; Encephalomalacia ; Fibrin ; Hemorrhage ; Humans ; Infant, Newborn ; Leukomalacia, Periventricular ; Placenta ; Pregnancy ; Twins ; Twins, Monozygotic*

PURPOSE: To describe the magnetic resonance (MR) findings of intracranial dural arteriovenous fistulae (DAVF) and associated venous hypertensive diseases, and to determine their diagnostic value. MATERIALS AND METHODS: MR Imagings of twelve cases of angiographically-proven intracranial DAVF were analyzed. The presence of signal voids, dilatation of involved dural sinus, the dilatation of the extra/intradural venous system, high signal intensity on T2 weighted image, cerebral edema, intracranial hemorrhage, and hydrocephalus were retrospectively analyzed. MR findings and angiographic classification were compared. RESULTS: In 11 of 12 patients (92%), MR revealed the location of DAVF. In five cases, these were cavernous, and in six, they were extracavernous; the locations of the latter were as follows: superior sagittal sinus (SSS), 4: torcula, 1; lateral sinus & SSS, 1. Except for the lateral sinus lesion, all the DAVF seen in thses 11 patients showed the presence of signal voids and dilatation of the involved dural sinus. Findings of associated venous hypertensive disease, namely dilatation of the superior ophthalmic vein and cortical venous system, cerebral edema, and high signal intensity on T2-weighted images were observed in three cavernous lesions (50%), but all extracavernous DAVF (100%) showed associated venous hypertensive disease. When the grade of angiographic classification was high and reflux of sinus blood to the cortical vein was seen on angiography, the MR findings of intracranial venous hypertension showed good correlation. CONCLUSION: The MR findings of DAVF include dilatation of the dural sinus and signal voids of feeding arteries and draining vein. Other findings which suggest intracranial venohypertensive disease are dilatation of the cortical and medullary vein, hydrocephallus, cerebral edema and intracranial hamorrhage. These and the angiographic findings correlate well and suggest that in the diagnosis of DAVF and the detection of intracanial venohypertension, MR is a non-invasivse technique which can be use be usefully employed before final diagnosis by angiography.
Angiography ; Arteries ; Arteriovenous Fistula ; Brain Edema ; Central Nervous System Vascular Malformations* ; Classification ; Diagnosis ; Dilatation ; Humans ; Hydrocephalus ; Hypertension ; Intracranial Hemorrhages ; Magnetic Resonance Imaging* ; Retrospective Studies ; Superior Sagittal Sinus ; Transverse Sinuses ; Veins

The diverse effects of antidepressants on sleep are mediated by their agonistic or antagonistic properties on specific neurotransmitters: the catecholamine, serotonergic, cholinergic, and histaminergic neurotransmitter systems, which also regulate the timing and cycling of sleep. Therefore, antidepressants can have both class- and compound-specific effects on sleep/wake dynamics, sleep stages, and on motor control during sleep. For these reasons, the sedating or wake-promoting effects of these medications are important factors influencing specific drug selection. As these sleep-related effects may in turn influence both medication compliance as well as the course of the disease state itself, it is important for clinicians to understand and predict the possible effects of antidepressants on sleep. Some antidepressants, such as amitriptyline, doxepine, trazodone, and mirtazapine, possess sedating properties and improve sleep continuity via alpha-1 adrenoceptors and histamine H1 receptor blockade, combined with 5HT(2A/2C) receptor blockade. Other antidepressants, such as SSRI, SNRI and MAOIs, worsen sleep and may cause insomnia, an effect which may be linked to facilitation of 5HT(2A/2C) receptors. The majority of antidepressants are REM (rapid eye movement) suppressants, though some, such as nefazodone, bupropion, and mirtazapine, lack REM-suppressing effects. On the other hand, the effects of antidepressants on slow wave sleep (SWS) are much less consistent than their effects on REM sleep. Available data suggest that antidepressants, including some TCAs, and trazodone, increase SWS, possibly as a function of their 5-HT(2A/2C) receptor antagonism. In contrast, antidepressants lacking 5-HT(2A/2C) receptor antagonist effects, including SSRIs, SNRIs and MAOIs, may produce no change or even decrease in SWS. Knowledge of the effects of antidepressants on sleep will be helpful in estimating the sleep disturbance caused by these compounds, and can thus help in the selection of appropriate compound for individual patients.
Amitriptyline ; Antidepressive Agents* ; Bupropion ; Doxepin ; Hand ; Humans ; Medication Adherence ; Neurotransmitter Agents ; Receptors, Adrenergic ; Receptors, Histamine H1 ; Sleep Initiation and Maintenance Disorders ; Sleep Stages ; Sleep, REM ; Trazodone

No abstract available.
Gene Expression* ; Microscopy, Electron, Scanning* ; Virulence*

Vascular ingrowth is essential for the survial of the graft tissue. The purposes of this study were to evaluate any changes in signal intensity of cqropreserved meniscal allograft with time in the magnetic resonance images(MRI) and to demonstrate the viability of the grafts. Eight patients underwent meniscal transplantation with cryopreserved allcgrafts using the bone block technique. MRIs of the knee were taken at 3 days, 3 weeks, 6 weeks, 3 month, 6 months. And I year after the implantation. A second-look arthroscopy and a small meniscal biopsy(sized 2mm x 2mm1 at the peripheral and central part of the meniscus were conducted at 3 months and 1 year. Three days after the operation, the signal intensity of the implanted meniscus revealed a homogenrous low signaJ intensity that could not be differentiated from that of' a contralateral normal meniscus. At 3 weeks, a high signal intensity appeared at the periphery of the meniscus. This signal, which did not communicate into the joint space, fuither intensified at 6 weeks. The high signal intensity of the meniscus, though still higher than that of the normal meniscus, decrexsed slightly at 3 months and continued to decrease progressively even a year after the implantation. The second-look arthroscopy revealed that the grafts were viable and that there was no tearing or shrinking of the meniscus. Cellular proliferation was also found at the central edge oi' the meniscus at 3 months. This cellular pattern differentiated from that of a nonmal meniscus in that the d stribution of cells was not in an even, but in a clonal pattem. The cellularity after a year, however, was sirnilar to that of normal meniscus except some area with deficiency of cells. It can be concluded that increased signal intensity of' the implanted meniscus with time indicates hypervascularity caused by vascular ingrowth, similar to the high signal intensity ot>tained from normal meniscus in young children. Increasecl signal intensity in the chronological postoperative MRls demonstrates the viability of the implanted cryopreserved meniscal allograft.
Allografts* ; Arthroscopy ; Cell Proliferation ; Child ; Humans* ; Joints ; Knee ; Magnetic Resonance Imaging* ; Transplants

PURPOSE: To identify the changes of bony landmarks with rotation and to compare the reliability and accuracy of Perdriolle's method before and after training on the exact bony landmarks. MATERIALS AND METHODS: Simple A-P radiographs were taken with rotation from 5 degree to 50 degree at 5 degree interval using 10 dry human vertebrae (2 sets of T3, T6, T9 8 L3) with no bony abnormality. Axial rotation was measured before and after training on the exact bony landmarks by three observers, twice for each radiographs. Repeated measures of ANOVA were used for inter- < intraobserver variance and regression analysis for root mean square error and deviation of differences. RESULTS: Mamillary process, inner margin of lamina, proximal and distal costovertebral joints, upper margin of concave pedicle and tip of the transverse process on the convex side confused the exact outline of the pedicle, while neural foraminal margin was helpful in identifying the location of the indistinct convex pedicle and concave vertebral border. Of the 660 measurements before and after training 372 and 397 errors were made, respectively, of which 88.9% and 88.5% were within +/-5 degree(P > 0.05). Incidence of error greater than 5 degree was high at upper thoracic vertebra and 20 degree-40 degree of rotation regardless of training. The effects of training, however, was greatest at T3 and 20 degree-40 degree of rotation. Inter- < intraobserver variance was diminished at T3 and at the rotation between 20 degree-40 degree after training. CONCLUSIONS: We could conclude that training on the exact bony landmarks did not reduce the overall error incidence. Accuracy and reliability, however, was increased at T3 after training and the efficacy of training was more evident in moderate vertebral rotation than in small or large vertebral rotation.
Humans ; Incidence ; Joints ; Spine

BACKGROUND: Sleep-related breathing disorders(SRBD) and periodic leg movements disorder(PLMD) are both common, and are considered as separate sleep disorders. However, both disorders show high comorbidity. SRBD and PLMD can result in excessive daytime sleepiness and insomnia due to frequent sleep fragmentation So, it is very important to consider the presence of PLMD, when we are dealing with the diagnosis and management of SRBD. The objectives of this study were to determine the incidence of PLMD in patients with SRBD, and 13 describe any differences between patients with and without PLMD. METHOD: The authors reviewed the sleep recordings of 106 Patients with a final diagnosis of SRBD(obstruclive sleep apnea or upper airway resistance syndrome), who underwent full nocturnal polysomnography, including the monitoring of the anterior tibialis electromyogram. All sleep records were recorded and scored using the standard criteria. The data was analyzed by the student t-test. RESULTS: 106 patients(M=76, F=30) were included in the analysis. Data revealed a mean age of 49.5 +/- 13.6 years, a respiratory disturbance index(RDI) of 22.3 +/- 25.4/hour sleep, a lowest oxygen saturation of 84.9 +/- 11.3%, a mammal esophageal pressure of -41.0 +/- 19.1cm H2O, and PLM index(PLMI) index(PLMI) 13.1 +/- 22.4 movements/ hour sleep. Forty four percent(47 of 106 patients) had a PLMI of greater than 5 on this study. The mean age of the patients with PLMD was significantly higher than that of the patients without PLMD(p < 0.005). Fe-male patients with SRBD accompanied more PLMD(p < 0.05). The apnea index of the patients with PLMD was significantly lower than that of the patients without PLMD(p < 0.01). The percentage of stage 1 sleep in the patients with PLMD was significantly lower than that of the patients without PLMD(p < 0.05). CONCLUSION: The prevalence of PLMD in the patients with SRBD was high at 44.3%. The patients with PLMD were older and had more high RDI in comparison to the patients without PLMD, which was consistent with previous findings. The authors recommend that more careful consideration of PLMD is required when diagnosing and treating SRBD.
Airway Resistance ; Apnea ; Comorbidity* ; Diagnosis ; Extremities* ; Humans ; Incidence ; Leg ; Mammals ; Oxygen ; Polysomnography ; Prevalence ; Respiration* ; Sleep Apnea Syndromes ; Sleep Deprivation ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders

Intravesical instillation of Tice Chicago strain BCG(120mg) was given to 21 patients with biopsy proved superficial transitional cell carcinoma. A short course therapy group consisting of 6 or 8 weekly instillation was followed by monthly cystoscopic examination and cytology in 13 patients. Maintenance therapy consisting of twice dose of BCG and monthly 4 courses booster instillation were given to 15 patients considering of high risk group. We evaluated PPD skin test & Multi-test responsiveness in both cancer group and 22 control group. Of 21 cancer patients whose preinstillation PPD negativeness was 75% and convert rate from negative to positive was 75% and in control group their PPD negative ratio is also 70%(9 cases). Side effects were minor and self limiting in the majority of patients without using antituberculors regimen. Although our limited experience, BCG immunotherapy may be also the current treatment of choice for patients with superficial bladder cancer and will require further investigation especially in our Korea.
Administration, Intravesical ; Bacillus* ; Biopsy ; Carcinoma, Transitional Cell ; Humans ; Immunotherapy ; Korea ; Mycobacterium bovis ; Skin Tests ; Urinary Bladder Neoplasms ; Urinary Bladder*

Intravesical instillation of Tice Chicago strain BCG(120mg) was given to 21 patients with biopsy proved superficial transitional cell carcinoma. A short course therapy group consisting of 6 or 8 weekly instillation was followed by monthly cystoscopic examination and cytology in 13 patients. Maintenance therapy consisting of twice dose of BCG and monthly 4 courses booster instillation were given to 15 patients considering of high risk group. We evaluated PPD skin test & Multi-test responsiveness in both cancer group and 22 control group. Of 21 cancer patients whose preinstillation PPD negativeness was 75% and convert rate from negative to positive was 75% and in control group their PPD negative ratio is also 70%(9 cases). Side effects were minor and self limiting in the majority of patients without using antituberculors regimen. Although our limited experience, BCG immunotherapy may be also the current treatment of choice for patients with superficial bladder cancer and will require further investigation especially in our Korea.
Administration, Intravesical ; Bacillus* ; Biopsy ; Carcinoma, Transitional Cell ; Humans ; Immunotherapy ; Korea ; Mycobacterium bovis ; Skin Tests ; Urinary Bladder Neoplasms ; Urinary Bladder*