Authors analyzed the findings of nineteen cases of arthroscopic second-look operations after posterior cruciate ligament (PCL) reconstruction with autogenous bone-patellar tendon-bone (BPTB) and Trevira augmentation by two tunnel technique during the period from Nov, 1993 to Jan. l997 in fifty-one cases, along with the results of reconstruction in terms of clinica1 knee scoring, radiographichl and arthroscopic findings. The results were as follows; Age ranged fmm 20 to 53 years, the average being 32.3 years. Thirteen cases (68%) had associated knee injuries; five medial collateral ligament (MCL) injuries, four lateral collateral ligament (LCL) injuries, two associated injuries of MCL and medial meniscus, one both menisci and one associated injury of anterior cruciate ligament and MCL. The average period fmm PCL injury to reconstruction was 7 weeks (range, 1 to 52 wecks) and the mean period from PCL reconstruction to second-look operation was 20.3 months (range, 10 to 46 months). The average Miiller s knee score at the last follow-up was 86 paints. The radiographical results: The distance of posterior translation of the PCL reconstrueted knee compared with the normal sidc knee in posterior stress roentgenography was average 3.8mm (range, 0 to 1 1 mm). The position of the fernoral bone block on the plane of extended Blumansaats line, from the anterior end of the line, was average 32%. The level of proximal end of the tibial bone block according to the tibial tunnel orifice into the joint was mean negative 2.6 degrees position. The findings of arthroscopic second-look examination; In 9 cases (47%), the reconstructed ligamcnts were well covered with synovial tissue and looked like almost normal PCL. There were five cases (26%) of severe fragmentation, three cases (16%) of partial torn fibers of the grafted tendon. And one case showed the thinning of thc grafted tendon compared with the initial diameter at the time of reconstruction and one case showed overgrawth of the synovial membrane which suitounding the grafted tendon. All the Trevira which were augmented at the time of PCL reconstruction were ruptured. Twelve cases (63%) were stable, three cases (16%) were slightly lax and 4 cases (21%) showed laxity of the grafted tendon by the posterior drawer test and probing under arthroscopy, The isometricity which was checked at the time of PCL reconstruction was average 3.4mm. From the ahove results, PCL reconstruction with autogenous BPTB by the two tunnel technique seemed to be a valuable procedure, but there were some cases of unfavorable results. Authors think that a new graft fixation method is needed for resolving the problem mentioned above.
Anterior Cruciate Ligament ; Arthroscopy ; Collateral Ligaments ; Dronabinol ; Follow-Up Studies ; Joints ; Knee ; Knee Injuries ; Lateral Ligament, Ankle ; Menisci, Tibial ; Paint ; Posterior Cruciate Ligament* ; Radiography ; Synovial Membrane ; Tendons ; Transplants

Impetigo herpetiformis is a form of pustular psoriasis that occurs during pregnancy and may be life-threatening. The pathogenesis and etiology of impetigo herpetiformis is not clear, but several reports have associated onset of this disorder with hypocalcemia, hypoparathyroidism, and the use of oral contraceptives. The typical lesions are erythematous patches that are studded with tiny superficial pustules particularly coalescing at their margins causing pain, and a burning sensation. Laboratory findings include an elevated erythrocyte sedimentation rate, increased peripheral blood leukocyte counts, hypoalbuminemia, and in severe cases, hypocalcemia. The histopathology is the same as that of pustula psoriasis. Our patient, a 31 year-old female (Intra Uterine Pregnancy 28 weeks), was admitted to our hospital due to generalized skin eruption and severe constitutional symptoms. Her clinical features, laboratory and histopathologic findings were compatible with that of impetigo herpetiformis. In spite of our all efforts, intrauterine fetal death was noted at her 33rd week of pregnancy. We report a case of impetigo herpetiformis terminating in fetal death with the review of literature.
Adult ; Blood Sedimentation ; Burns ; Contraceptives, Oral ; Female ; Fetal Death* ; Humans ; Hypoalbuminemia ; Hypocalcemia ; Hypoparathyroidism ; Impetigo* ; Leukocyte Count ; Pregnancy ; Psoriasis ; Sensation ; Skin

The arthroscopic procedure has been one of the useful treatment modalitis in osteoarthritis of the knee, which does not respond to conservative treatment. Authors reviewed the resuJts of 61cases of 61 patients(18 males and 43 females) that had been treated with arthroscopic procedures including arthroscopic simple )avage, partial menisectomy, removal of the loose bodies, synovectomy and chondroplasty. The purpose of this study is to evaluate indication and effectiveness of arthroscopic surgery for osteoarthritic knee. 1. Seventy-one percent of sixty-one patients had relief of pain and other clinical symptoms after arthroscopic procedures. 2. Sixty-one pereent were still good at last follow-up more, than one year. 3. The favorable results were obtained after removal of loose bodies or partial menisectomy in association with osteoarthritic knee cornpared with the other procedures. And the poor results were obtained in patients with severe degenerative changes and severe cartilage defects of both femoral condyles. 4. The normal-alignment knees had much better results after arthroscopic surgery compared with valgus or varus knees. Our results suggest that arthroscopic surgery can be one of the good alternative treatment methods for osteoarthritic knee and a time-saving procedure before arthroplastic surgery.
Arthroscopy ; Cartilage ; Follow-Up Studies ; Humans ; Knee* ; Male ; Osteoarthritis

Lichenoid keratosis (LK), a lichen planus-like keratosis, is a rather frequent skin disorder that has some histological features similar to lichen planus. However, the classification system for LK has not been settled. We report two cases of LK and propose a new classification for LK correlating with clinicohistopathological findings.
Actins* ; Classification ; Keratosis* ; Lichen Planus ; Lichens ; Skin

Indeterminate cell proliferations are rarely described in dermatology literature. Indeterminate cells are characterized by positivity for S-100 protein and CD-la, but are distinguished from Langerhans cells by the absence of Birbeck granules. We present a case of congenital indeterminate cell histiocytoma in a 6-day-old male infant. A Skin examination revealed a solitary, erythematous, 6*6cm, superficially crusted, dome shaped papule on his forehead. A Histopathologic examination showed a dense cellular infiltrate in the dermis, below the atrophic epidermis. Frequently, the nucleus demonstrated a single cleft or crease like the shape of a kidney. These cells showed positivity for S-100 protein. Birbeck granules were not found on electron microscopic examination.
Dermatology ; Dermis ; Epidermis ; Forehead ; Histiocytoma* ; Humans ; Infant ; Kidney ; Langerhans Cells ; Male ; S100 Proteins ; Skin

Winkelmann granuloma is a very rare disorder characterized by histologic findings of perhaps[ic] infiltration, collagen degeneration, and granulomatous inflammation, which usually show palisading features. A number of diseases, especially systemic immunoreactive diseases, are associated with this disorder. We describe a focal neutrophilic necrosis : type of Winkelmann granuloma associated with hypothy- roidism and rheumatoid arthritis.
Arthritis, Rheumatoid* ; Collagen ; Granuloma* ; Hypothyroidism* ; Inflammation ; Necrosis ; Neutrophils

Primary pulmonary hypertension is a rar, incurable, and progressive clinical entity. When associated with pregnancy, the prognosis of primary pulmonary hypertension is worsened with maternal mortality rates of at least 50%. The patient was a 29-year-old mother in her 2nd pregnancy, with previous uncomplicated gestation, 5 years ago. She had been well until the 28th week of present gestation when she was admitted because of increasing dyspnea on exertion. She was a housewife with no remarkable family and past histories. We have experienced a patient with primary pulmonary hypertension in pregnancy. She was treated with an oral calcium-channel blocker and low-molecular-weight heparin and was delivered vaginally with good maternal and fetal outcome. So we report a case of primary pulmonary hypertension associated with pregnancy and review literature.
Adult ; Dyspnea ; Heparin, Low-Molecular-Weight ; Humans ; Hypertension, Pulmonary* ; Maternal Mortality ; Mothers ; Pregnancy* ; Prognosis

PURPOSE: Patients with Kawasaki disease (KD) who remain febrile after first dose of intravenous immunoglobulin (IVIG) are usually treated with a second dose of IVIG. However, the optimal dosage of IVIG in the retreatment of KD is still controversial. We evaluated the impact of IVIG dose difference on the coronary artery lesion (CAL) in the retreatment of KD. METHODS: We performed a prospective study on 24 patients with KD requiring IVIG retreatment from January 2000 to December 2004. The patients were assigned to receive IVIG in the retreatment of KD either as a single infusion of 2 g/kg (A group, 12 patients) or 1 g/kg (B group, 24 patients). We compared the CAL of B group to that of A group for comparable risk of both groups. RESULTS: The incidence of CAL was significantly higher in the 5 of 24 (20.9%) patients with IVIG retreatment vs the 18 of 315 (5.8%) afebrile patients after first course of IVIG treatment (P=0.016). There were no significant differences in age, sex, and other clinical and laboratory findings known as risk factors of CAL between the two groups. Among 24 patients with IVIG retreatment, there were no significant difference in the incidence of CAL between the two groups(Group A, 3/12=25%, vs Group B, 2/12=16.7%) (P>0.05). CONCLUSION: Single 1 g/kg IVIG therapy is comparable outcome to single 2 g/kg IVIG therapy in the retreatment of KD, although the efficacy of this practice requires assessment with a randomized controlled prospective trial in more patients.
Coronary Vessels ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Incidence ; Mucocutaneous Lymph Node Syndrome* ; Prospective Studies ; Retreatment* ; Risk Factors

Relapsing polychondritis is a rare systemic disorder characterized by recurrent inflammation of cartilaginous structures, the eye, the audiovestibular and cardiovascular systems. Skin lesions, found in 17% to 38% of cases, include leukocytoclastic vasculitis, livedo reticularis, erythema nodosum, erythema multiforme, keratoderma blenorrhagicum, psoriasis, polyarteritis nodosa, thrombophlebitis and other various conditions. We report a 65-year old man with relapsing polychondritis and associated thrombophlebitis. The patient was treated with oral dapsone and systemic steroid with complete resolution of symptoms. However, the patient died of severe intractable pneumonia.
Aged ; Cardiovascular System ; Dapsone ; Erythema Multiforme ; Erythema Nodosum ; Humans ; Inflammation ; Livedo Reticularis ; Pneumonia ; Polyarteritis Nodosa ; Polychondritis, Relapsing* ; Psoriasis ; Skin ; Thrombophlebitis* ; Vasculitis

Functional paraganglioma of the mediastinum is an uncommon tumor of the paraganglion system that causes symptoms and signs of episodic catecholamine release. It has not been reported in Korea. We experienced a case of a 17 years old man with a history of diaphoresis and paroxysmal hypertension refractory to therapy since 14 years old. Urinary execretion of catecholamine and its metabolites were elevated. Computed tomography(CT) scan revealed high density mass located on the posterior mediastinum in the area of the right fifth intercostal space. At thoracotomy, a 3X3X4cm sized lesion was resected and confirmed as a paraganglioma.
Adolescent ; Humans ; Hypertension* ; Korea ; Mediastinum* ; Paraganglioma* ; Pheochromocytoma ; Thoracotomy