Tibial tunnel placement during endoscopic anterior cruciate ligament (ACL) reconstruction has received increased emphasis in the recent literature. Tibial tunnel length is a factor that affect graft fixation, potential impingement, and graft abrasion. Appropriate tunnel length is a critical tecpnical consideration. A tunnel that is too long may make distal fixation and femoral tunnel placement difficult... A tunnel that is too short results in graft extrusion, necessitating supplemental fixation techniques. This grafl-tunnel mismatch can be avoided if fhe sum of the tibial tunnel length plus the intraarticular distance of ACL is equal to or greater than the graft tendon length plus 20mm (the minimum interference fixation possible when using the smallest available 20 mm long interference screw). Authors published an article to determine the reiationship between the length of patellar tendon and that of anterior cruciate ligament, to calculate the tibial tunnel length through the dissection of 19 cadaveric knees (ACL length (mm)=0.73 X Patellar tendon length-2.69 (p Anterior Cruciate Ligament ; Cadaver ; Humans ; Knee ; Patellar Ligament ; Tendons ; Transplants

The angiopathy and neuropathy is the basic mechanism causing diabetic gangrene, but the exact mechanism is still unknown. The foot is especially susceptible to diabetic complication of angiopathy and neuropathy. In such a vulnerable foot, trivial trauma may quickly lead the foot to ulceration, infection, gangrene, and to the cataclysmic amputation. Twenty nine patients with diabetic gangrene were studied, the conclution were as follow. 1. Overall incidence is 1.8%, most common age over 50 years of age, and the most common disease durstion is from 10 to 14 years. 2. The most common site is toe (56% of cases). 3. The most common predisposing factor was local pressure (41% of cases), the radiographic bone change was seen in 14% of cases. 4. The FBS level is from 200 to 300 in 35% of cases. 5. Bacterial infection was seen in 80%, and staphylococcal aureus was most common. 6. The surgical or conservative treatment were effective in 80% of cases and mortality was 14%. 7. Diabetic retinopathy was most common associated complication (47% of cases).
Amputation ; Bacterial Infections ; Causality ; Diabetes Complications ; Diabetes Mellitus ; Diabetic Retinopathy ; Foot ; Gangrene ; Humans ; Incidence ; Mortality ; Toes ; Ulcer

No abstract available.
Dexamethasone* ; Psychotic Disorders*

BACKGROUND: Total intravenous anesthesia with propofol can cause respiratory depression and apnea especially during induction of anesthesia. To study the possibility of reversal of respiratory depression during anesthesia with propofol, pretreated with nabuphine or not, the respiratory effects of doxapram to spontaneously ventilating patients were investigated. METHODS: Patients were divided into 4 groups - saline-propofol-saline group (SPS), saline-propofol- doxapram group (SPD), nalbuphine-propofol-saline group (NPS), and nalbuphine-propofol-doxapram group (NPD). After saline or nalbuphine pretreatment, anesthesia was induced with propofol and then doxapram or saline was intravenously injected. Apneic time interval, blood pressure, heart rate, respiratory rate, minute ventilation, end tidal CO2 partial pressure and oxygen saturation were measured in every minutes during induction of anesthesia. Percent changes of each values were compared. RESULTS: There is no differences in apneic time intervals in each groups. The percent change of first minute ventilation in SPD group after doxapram injection unchanged significantly compared with those depressions of SPS, NPS and NPD group (p<0.05). Respiratory rates increased in SPD and SPS groups after laryngeal mask insertion. There is no differences in minute ventilation, respiratory rate and end-tidal CO2 concentration between nalbuphine pretreated groups regardless of doxapram injection. CONCLUSIONS: Doxapram has effect in increasing minute ventilation after propofol induction within first few minutes, but it cannot reverse respiratory depression during propofol induction pretreated with nalbuphine.
Anesthesia ; Anesthesia, Intravenous* ; Apnea ; Blood Pressure ; Depression ; Doxapram* ; Heart Rate ; Humans ; Laryngeal Masks ; Nalbuphine* ; Oxygen ; Partial Pressure ; Propofol* ; Respiratory Insufficiency ; Respiratory Rate ; Ventilation

The peripheral blood eosinophil and serum IgE level in 53 patients with atopic dermatitis (AD) were measured. The patients were divided into 2 groups by severity(mild and severe grous) and into 3 groups by the associated respiratory atopic deseases and/or their family history : respiratory group(patient, with both AD and respiratory atopy), family history group (patient with both AD and family history of respiratory atopy), and atopic group(patient with neither respiratory atopy nor family history of respiratorv atopy). We designed to study which factors are important in the elevation of serum IgE and peripheral blood eosinophil level in AD, and to know possible relationships between the serum eosinophil and IgE level and the several groups of AD. The results are as follows : 1. Peripheral eosinophil counts were higher in severe group(224.8/mm) than in mild group (180.0/mm)(p<0.05). 2. Peripheral eosinophil counts were 220.0/mm in atopic group, l65.0/mm in family history group, and 332.4/mm in respiratory group, but there was no stitistically significant difference among 3 groups. This suggests that concomitant respiatitiry atopy or a family history of respiratory atopy is not an important factor in the elvation of peripheral blood eosinophil counts in AD. 3. Serum IgE was higher in severe group(443.2IU/ml) than in mild group(231.5IU/ml)(p<0.05). 4. Serum IgE level in respiratory group(754.6IU/ml) were signifiiantlly higher than in atopic (286.6IU/ml) or family history group(342.0IU/ml)(p<0,01). But there was no significant. difference between family and atopic group. This result suggests that concomittent respiratory atopy is a potential factor in elevation of serurn Igi in AD. 5. Slightly high correlation between peripheral blood and IgE level appeared in all 53 patients (r=0.434) and severe group(r=0.480). But, respiratory group(r=0.060), family history group(r=0.111) and atopic group(r=0.202) showed poor relationships.
Dermatitis, Atopic* ; Eosinophils* ; Humans ; Immunoglobulin E*

An immunohistochemistry for S-100 protein by biotin avidin system technique was done to evaluate the existence and distribution pattern of S-100 protein positive cells in various obtained were as follows. 1) Positive immunostaining for S-100 protein was observed in myoepithelial cell, serous acinar cell and nervous bundle in normal salivary gland. 2) Strong immunoreactivity for S-100 protein was shown in plemorphic adenoma, which was localized not only in myoepithelial cord or sheets of epithelial portion but also in chondrocytes, stellate cells of myxoid stroma and in squamous keratin pearl of mesenchymal metaplastic foci. 3) The S-100 protein was demonstrated in the tumor cells of tubular adenoma, acinic cell tumors and in epidermoid area of mucoepidermoid tumors. 4) Immunoreactivity for S-100 protein, however, was not found in the tumor cells of adenoid cystic carcinoma and adenolymphoma except for stroma reticulum cells. 5) Intensity of positive reaction for S-100 protein varied from cell to cell: Some had intense immunoreactivity, whreas others were only weakly positive or completely negative, even in myoepithelial cell nest of the same pleomorphic adenoma.

We report an unusual case of sebaceous hyperplasia in an 18-year-old male manifestated clinically as yellowish, grouped papules with a linear distribution, present on the right side of forehead since birth. Histopathologically, a large sebaceous gland composed of numerous lobules grouped around a centrally dilated duct was seen. The sebaceous lobules distributed in the upper dermis showed direct connection to the skin surface, which suggested a transepidermal elimination of sebaceous lobules.
Adolescent ; Dermis ; Forehead ; Humans ; Hyperplasia* ; Male ; Parturition ; Sebaceous Glands ; Skin

Divergent placement of the femoral interference screw has been described as a major pitfall in single incision endoscopic reconstruction of the anterior cruciate ligament. This study reviews the radiographic results in 30 consecutive endoscopic single-incision ACL reconstructions using interference screw fixation to find a method to reduce the divergent femoral screw fixation. We measured the angles which were determined by a line through axis of femoral bone block and axis of interference screw in anteroposterior and lateral view of knee(APD/LD),through axis of femoral tunnel and axis of tibial tunnel in the full extension-anteroposterior view(AFT),through the longitudinal axis of distal femoral shaft and axis of femoral tunnel in the anteroposterior and lateral view(APFT/LFT). Average LD(4.96+/-62degrees) was significantly larger than average APD(1.303+/-13degrees) (P=0.008). Significant correlation was present between APD and APFT(g=-0.3882, P=0.034), between LD and LFT(gamma=0.6933, P=0.000) and other variables had no significant correlation. The femoral divergence in the anteroposterior plane occurred in the case with small angle between longitudinal axis of femoral shaft and that of femoral tunnel, and vice versa in lateral plane. During drilling of femoral tunnel, more than 90 flexion causes LFT to increase and the risk of femoral divergence increases. Therefore, in the anteroposterior plane, angle between femoral tunnel and longitudinal axis of femoral shaft shoud be made as large as possible and flexion of knee should not be more than 90 during drilling of femoral tunnel.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Axis, Cervical Vertebra ; Knee ; Patellar Ligament*

The wrist consists of a complex structure, including 8 tiny carpal bones and their adjoining soft tissue. Recently the number of injuries of carpal joint is on the increase by accident in leisure or by industrial accident. Carpal bone fracture or dislocation is often mistakably identified as a sprain, which is liable to lead its opportune time to care. So, we analyzed 39 cases to which long-term follow-up was available, among 44 cases which were treated at the department of orthopedic surgery, Yonsei University medical college. The results were as follows; l. Of all 44 cases, 42 were males, and males in 30, 40 decades numbered 32 cases, forming 73 % of all. 2. Of 29 scaphoid fractures, 22 cases were mid 1/3 fractures, and of 15 perilunate dislocation, 10 cases were dorsal transscaphoid perilunate dislocations. 3. Among 39 cases which long-term follow-up was available in the classification by Soto-Hall, 18 cases were acute, in 21 cases treatment was started beyond 2 weeks later after injury. 4. The more delayed diagnosis, the longer period needed bone union for scaphoid fracture. 5. All scaphoid fractures including transscaphoid perilunate dislocation, showed a union rate of 94.3%, and were complicated by 2 non-unions, 3 avascular necrosis, 1 osteoarthritis and one case accompanied an incomplete median nerve injury. So, initial careful evaluation is needed to good prognosis of scaphoid fracture.
Accidents, Occupational ; Carpal Bones ; Carpal Joints ; Classification ; Clinical Study ; Delayed Diagnosis ; Dislocations ; Follow-Up Studies ; Humans ; Leisure Activities ; Male ; Median Nerve ; Necrosis ; Orthopedics ; Osteoarthritis ; Prognosis ; Sprains and Strains ; Wrist

Arthroscopically assisted anterior cruciate ligament(ACL) reconsturction provide a technique with less morbidity, less pin, less sacr, lower ris k of sepsis. The magnification offered by arthroscopic visualization also provide a clearer view, more precise location of anatomical landmarks, and the ability to place the graft in the exact anatomic sites. However, in order to accomplish all these goals, the surgeon must possess a high level of psychomotor skills, which take time and practice to develop. Wile this learning curve is being completed, there are occasion when complications will occur, and, realistically these may be difficult to avoid. The purpose of this study is to evaluate author's cases in which complication occurred during the endoscopic one-incision ACL reconstruction using the patellar tendon and to offer some tips on how to avoid them and how to salvage the situation if they do occur. We reviewed 22 complications (11 patients) out of 40 ACL reconstructions performed between May 1994 and December 1995. The complications were divergence(6), graft-tunnel mismatch(5), too anterior tibial tunnel(3), too anterior femoral tunnel(2), too posterior femoral tunnel(2), rotation of screw around the graft(2), guide pin breakage(1), bone plug retraction into the joint(1). It is suggested that arthroscopist should constantly try to avoid the intraoperative complications of arthroscopically assisted ACL reconstruction and follow the precautions and preventive measures recommended.
Intraoperative Complications ; Knee ; Learning Curve ; Patellar Ligament ; Sepsis ; Transplants