Although causes of restriction of knee extension in osteoarthritis are thought to be contractures involving the posterior capsule and the hamstring muscles, intercondylar notch stenosis, osteophyte, loose body, and displacement of ruptured meniscus, few studies have investigated incidence and treatment. The purpose of this study is to consider intercondylar notch stenosis and anterior impingement as major causes of flexion contracture in osteoarthritic knee and to assess their relationship through arthroscopic notchplasty. We performed arthroscopic notchplasty and debridement in sixty patients (sixty-eight cases) with more than Sflexion contracture for early osteoarthritic knee and compared flexion contracture before and after operation. The average flexion contracture was 13degrees (5degrees-35degrees) before operation and 4degrees (0degrees- 25degrees) immediately after. An average of 9degrees improvement was shown, with 29 cases ( 48% ) showing improvement of over 5degrees. Our study indicates that flexion contracture in the 29 cases (48%) improved by arthroscopic notchplasty was caused by intercondylar notch stenosis and anterior impingement. Arthroscopic notchplasty may beneficially affect those with flexion contracture in early osteoarthritic knee when conservative management of this disease has failed. This is a preliminary study on the immediate postoperative outcome, therefore, long-term follow-up and recurrence rate should be investigated in future studies.
Constriction, Pathologic ; Contracture ; Debridement ; Follow-Up Studies ; Humans ; Incidence ; Knee* ; Muscles ; Osteoarthritis ; Osteophyte ; Recurrence

No abstract available.
Posterior Cruciate Ligament* ; Tendons*

PURPOSE: Despite the well-known public health benefits of vaccination, increasing public concern about the safety of childhood vaccinations has led some parents to refuse or hesitate having their children immunized. The purpose of this study was to identify the subjectivity of parents toward refusal of childhood vaccination. METHODS: Q-methodology, in which subjective viewpoints are explored and analyzed using a combination of quantitative and qualitative techniques, was used. Thirty-five participants were asked to rank 42 statements on diverse issues of childhood vaccination according to a continuous 9-point scale ranging from -4 for strongly disagree to +4 for strongly agree. Collected data was analyzed using the PC-QUANAL program. RESULTS: The results revealed three discrete groups of parents in the refusal of children's immunization: type I, distrust; type II, concern about side effects, and type III, belief that vaccinations are unnecessary. CONCLUSION: Special nurse counselors who can provide correct information about vaccination based on the three types should be part of the government policy. Customized education programs to shift viewpoints should be also redeveloped according to the results in this study.
Child ; Counseling ; Disulfiram ; Humans ; Parents ; Public Health ; Rejection (Psychology) ; Vaccination

We experienced a case of lumbar epidural lipomatosis patient who had been treated with several epidural steroid injection for the management of lower back pain. This 67-years-old man, complained of lower back pain and radiating paresthetic pain to the dorsum of left foot. Epidural lipomatosis is a rare condition of focal or multiple deposition of excessive adipose tissue in epidural space. Since excessive deposited adipose tissue compresses the spinal cord or spinal root, patients complaint the atypical low back pain and low extremity radiculopathy which mimics the symptoms of spinal stenosis or herniated nucleus pulposus. In managing of lower back pain patient, especially who had been treated with steroid previously, we should consider that epidural lipomatois would be one of the cause.
Adipose Tissue ; Epidural Space ; Extremities ; Foot ; Humans ; Lipomatosis* ; Low Back Pain* ; Radiculopathy ; Spinal Cord ; Spinal Nerve Roots ; Spinal Stenosis

Cutaneous metastasis into the umbilicus, known as a Sister Mary Joseph nodule, is quite rare. Gastric adenocarcinoma is the most common primary origin overall, whereas gynecologic tumors such as ovarian cancer are the leading cause in women. In most cases, the nodule manifests after the primary tumor had been diagnosed. In rare cases, however, it serves as the first sign of the underlying malignancy. Here, we report the case of a 59-year-old woman who presented with a nodule on the umbilicus and was diagnosed with metastatic adenocarcinoma originating in the gallbladder.
Adenocarcinoma ; Female ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Middle Aged ; Neoplasm Metastasis* ; Ovarian Neoplasms ; Siblings* ; Umbilicus

No abstract available.
Asian Continental Ancestry Group* ; Female ; Humans

PURPOSE: We analyzed the clinical data of T3 colorectal cancer patients to assess whether T3 subdivision correlates with node (N) or metastasis (M) staging and stage-independent factors. METHODS: Five hundred fifty-five patients who underwent surgery for primary colorectal cancer from January 2003 to December 2009 were analyzed for T3 subdivision. T3 subdivision was determined by the depth of invasion beyond the outer border of the proper muscle (T3a, <1 mm; T3b, 1 to 5 mm; T3c, >5 to 15 mm; T3d, >15 mm). We investigated the correlation between T3 subdivision and N, M staging and stage-independent prognostic factors including angiolymphatic invasion (ALI), venous invasion (VI) and perineural invasion (PNI). RESULTS: The tumors of the 555 patients were subclassified as T3a in 86 patients (15.5%), T3b in 209 patients (37.7%), T3c in 210 patients (37.8%) and T3d in 50 patients (9.0%). The nodal metastasis rates were 39.5% for T3a, 56.5% for T3b, 75.7% for T3c and 74.0% for T3d. The distant metastasis rates were 7.0% for T3a 9.1% for T3b, 27.1% for T3c and 40.0% for T3d. Both N and M staging correlated with T3 subdivision (Spearman's rho = 0.288, 0.276, respectively; P < 0.001). Other stage-independent prognostic factors correlated well with T3 subdivision (Spearman's rho = 0.250, P < 0.001 for ALI; rho = 0.146, P < 0.001 for VI; rho = 0.271, P < 0.001 for PNI). CONCLUSION: Subdivision of T3 colorectal cancer correlates with nodal and metastasis staging. Moreover, it correlates with other prognostic factors for colorectal cancer.
Colorectal Neoplasms ; Humans ; Muscles ; Neoplasm Metastasis ; Neoplasm Staging

PURPOSE: We aimed to evaluate the early (<30 days) results and to analyze risk factors for the development of stroke and new brain infarction (NBI) after carotid endarterectomy (CEA). METHODS: From September 2003 to August 2008, 233 CEAs were performed on 222 patients with critical internal carotid artery (ICA) stenosis in a single center. Patient characteristics, history of neurological symptoms, procedural details, and postoperative complications were examined based on the medical records. The incidence and risk factors for early postoperative stroke were evaluated. After excluding CEAs without performing diffusion-weighted brain MRI, 128 CEAs were investigated for frequency and the risk factors of NBI were analyzed. Chi-square test, Fisher's exact test, Student T-test, and logistic regression model were used for statistical analysis. RESULTS: Of a total of 233 CEAs, any and ipsilateral stroke rates were 1.3% and 0.4%, respectively. There was no early postoperative mortality. Early postoperative complications included 4.3% in transient cranial nerve injury, 1.7% in myocardial infarction, and 3.4% in hematoma. In univariate analysis, the significant risk factor for stroke was plaque ulceration (P=0.04). The frequency of NBI and ipsilateral NBI were 8.4% and 3.1%, respectively. The ulceration on ipsilateral ICA revealed statistically significant risk factors for the development of NBI (RR, 5.29; 95% CI, 1.024~27.325; P=0.04). CONCLUSION: Our study showed a lower incidence of stroke and NBI after carotid endarterectomy and that it is safe procedure for the treatment of patients with severe (>70%) carotid stenosis. We also found that plaque with ulceration was a significant risk factor for the development of postoperative NBI.
Brain ; Brain Infarction ; Carotid Arteries ; Carotid Artery, Internal ; Carotid Stenosis ; Constriction, Pathologic ; Cranial Nerve Injuries ; Endarterectomy ; Endarterectomy, Carotid ; Hematoma ; Humans ; Incidence ; Logistic Models ; Medical Records ; Myocardial Infarction ; Postoperative Complications ; Risk Factors ; Stroke ; Ulcer

No abstract available.
Female ; Neurilemmoma* ; Ovary*

PURPOSE: This study investigated the potential of dual differentiation of stem cells into osteo- and chodrogenesis depending on scaffold type even in the same environment. MATERIALS AND METHODS: For the part of the cartilage tissue section, MSCs were suspended in alginate solution and bead droplets were made using 23G syringe. For the bone tissue section, PCL/HA scaffolds were made using the bio-plotting system followed by seeding mesenchymal stem cells (MSCs) onto the scaffolds. Scaffolds with MSCs were cultured in cocktail media containing osteogenic and chondrogenic growth factors for up to 21 days. To provide mechanical environments which articular cartilage experiences in-vivo, intermittent hydrostatic pressure (IHP) was engaged. Various cellular responses were assessed: the quantitative analysis of DNA contents, GAG contents, ALP activities and immunofluorescence. RESULTS: We found that IHP promoted MSCs differentiation into the targeted cell types. That is, MSCs in alginate scaffolds were able to be differentiated into chondrocytes, while those onto PCL/HA scaffolds were able to be differentiated into osteoblasts. CONCLUSION: Depending on the scaffold characteristics MSCs can be differentiated into bone cells or chondrocytes. This technique can provide a cue for the treatment of osteochondral defects utilizing tissue engineering.
Bone and Bones ; Cartilage ; Cartilage, Articular ; Chondrocytes ; Cues ; DNA ; Fluorescent Antibody Technique ; Hydrostatic Pressure* ; Intercellular Signaling Peptides and Proteins ; Mesenchymal Stromal Cells* ; Osteoblasts ; Stem Cells ; Syringes ; Tissue Engineering