Arthroscopic synovectomy has some limitations for adequate posterior visualization, and it is difficult to establish the posterior portal because of potential damage to neurovascular structures. The purpose of this study is to introduce a newly designed arthroscopic technique passing through posterior septum and to review the arthroscopic synovectomy using transposterior septal portal in the knee. Routine arthroscopic examination of the knee joint is performed using standard anterolateral and anteromedial portals. Posterior arthroscopic technique is divided into four steps. The first step is to make a posteromedial portal. The second step is to make a posterolateral portal. The third step is to make a hole at the posterior septum and to examine the posterolateral compartment. The fourth step is to examine the posteromedial compartment by switching the arthroscope to the posterolateral portal in the same manner. This technique provides complete visualization of the posterior compartment of the knee joint including the posterior aspect of the medial and lateral femoral condyles, posterior horn of both menisci, the posterior cruciate ligament(PCL), the meniscofemoral ligament, posterior aspect of the popliteal tendon, and the posterior capsule. We reviewed 47 cases(of 43 patients) of arthroscopic synovectomy using anterolateral, anteromedial and transposterior septal portal. The results were assessed with follow up of at least 1 year using the criteria of pain, synovitis, effusion, and range of motion. In 15 case rheumatoid arthritis, we had good result in 14 cases, but 1 case of recurrence was noted at 2 months after surgery. Non specific synovitis, 11 cases, had the similar result of rheumatoid arthritis. In 9 cases with hemophilic arthritis, pain and effusion were improved, but range of motion was improved minimally. In 2 cases with gouty arthritis, 2 cases with tuberculous arthritis, and I case with pigmented villonodular synovitis(PVNS), range of motion was rather reduced. It is considered that arthroscopic technique using transposterior septal portal is safe procedure without damaging the PCL, posterior capsule, neurovascular structures, and very efficient method in removing hypertrophied synovium or debris of persistent synovitis or arthritis of the knee joint and helpful in removing encapsulated loose bodies located behind the PCL.
Animals ; Arthritis ; Arthritis, Gouty ; Arthritis, Rheumatoid ; Arthroscopes ; Arthroscopy ; Follow-Up Studies ; Horns ; Knee ; Knee Joint ; Ligaments ; Range of Motion, Articular ; Recurrence ; Synovial Membrane ; Synovitis ; Tendons

Thromboembolism is the most common serious complication following total hip arthroplasty and most common cause of death after total hip arthroplasty. A prospective randomized study in 170 cases of elective cementless total hip arthroplasty was carried out to examine the incidence of deep vein thrombosis and pulmonary embolism after cementless total hip arthroplasty from Aug. 1993 to May 1995. Laboratory study, clinical symptoms and signs, chest roentgenograph and precipitating factors were analysed. Venography and lung perfusion scan using radionuclide scan were used for this study. The weight, height, sex, habitus of alcohol and smoking, hypertension, diabetes mellitus, previous operation history of ipsilateral lower extremity, etiology of hip joint disease, and transfusion of blood were not precipitating factors, but the age over 40 and previous history of pulmonary embolism had a significant effect on the incidence of deep vein thrombosis. There was no significant relationship between the incidence of deep vein thrombosis and the laboratory assay, clinical symptoms and signs. Deep vein thrombosis was detected in 29 cases(17.0%), pulmonary embolism in 22 cases(12.9%), and fatal pulmonary embolism in 1 case(0.6%). The most common location of deep vein thrombosis was the popliteal area.
Arthroplasty, Replacement, Hip* ; Cause of Death ; Diabetes Mellitus ; Hip Joint ; Hypertension ; Incidence ; Lower Extremity ; Lung ; Perfusion ; Phlebography ; Precipitating Factors ; Prospective Studies ; Pulmonary Embolism* ; Smoke ; Smoking ; Thorax ; Thromboembolism ; Venous Thrombosis*

INTRODUCTION: The fixation strength of transpedicular screw system in the vertebral hody relied on bone quality and anatomical characteristics of vertebral pedicle, designs of screw and types of connection(rod or plate) with screw. The purpose of this study is to verify the biomechanical nature of the transpedicular fixation in spine under various conditions with porcine vertebrae. MATERIAL AND METHOD: Fresh porcine vertebrae and the custom-made screws were used in this experiment. To reduce the errors caused by vertebral bodies of different size and quality, vertebral bodies having regular range of pedicular width(10.0 to 11.5mm) and hone density(more than 1.0 gm/cm2) were used. The pedicle screws were inserted in the same procedure and axial pull out test was performed with using the Material Testing System(lntron8511, Canton, USA). The experiments were performed in four types to assess the difference of strength accroding to designs of the screw hy using two group of screws. The first group of screw was designed according to the outer and inner diameter and the second group was designed according to the shape, pitch, and thread profile of screw. Experiment I was perfomed to evaluate the effect of screw diameters on the biomechanical pull-out strength hy using the first group of custom-made pedicle screw which fixed all other factors except the diameter of screw. Experiment I was to verify the effect of screw shape, experiment III to verify the effect of pitch and experiment IV to verify the effect of thread profile. RESULTS: The results of experiments were summarized as follows: Experiment I showed that the screw of larger outer diameter had greater holding strength. Experiment II showed that the holding strength of cylindrical shaped screw is superior to that of conical shaped screw. Experiment III showed that there is no statistical significance between different modes of pitch. Experiment IV showed that the holding strength of buttress shape of thread profile is superior to that of V-shape. CONCLUSION: It seemed that the fixation strength of the screw was more powerful with 1 mm increment of outer diameter in 4-7mm of outer diameter, 3mm of pitch and buttress shape of thread of the screw with the same operation technique.
Spine

No abstract available.
Dexamethasone*

Diabetes Mellitus (DM) is a syndrome accompanied with the abnormal secretion or function of insulin, a hormone that plays a vital role in controlling the blood glucose level (BGL). Type 1and 2 DM are most common form and the prevalence of the latter is recently increasing. The aim of this article was to assess whether Type 2 DM could act as a predisposing risk factor on the pulpo-periapical pathogenesis. Previous literature on the pathologic changes of blood vessels in DM was thoroughly reviewed. Furthermore, a histopathologic analysis of artificially-induced periapical specimens obtained from Type 2 diabetic and DM-resistant rats was compared. Histopathologic results demonstrate that the size of periapical bone destruction was larger and the degree of pulpal inflammation was more severe in diabetic rats, indicating that Type 2 DM itself can be a predisposing risk factor that makes the host more susceptible to pulpal infection. The possible reasons may be that in diabetic state the lumen of pulpal blood vessels are thickened by atheromatous deposits, and microcirculation is hindered. The function of polymorphonuclear leukocyte is also impaired and the migration of immune cells is blocked, leading to increased chance of pulpal infection. Also, lack of collateral circulation of pulpal blood vessels makes the pulp more susceptible to infection. These decrease the regeneration capacity of pulpal cells or tissues, delaying the healing process. Therefore, when restorative treatment is needed in Type 2 DM patients, dentists should minimize irritation to the pulpal tissue un der control of BGL.
Animals ; Blood Glucose ; Blood Vessels ; Collateral Circulation ; Dentists ; Diabetes Mellitus ; Humans ; Inflammation ; Insulin ; Microcirculation ; Neutrophils ; Prevalence ; Rats ; Regeneration ; Risk Factors ; United Nations

Hemobilia is a disease caused by injury or conditions that cause the abnormal communication between intrahepatic blood vessels and biliary tract, resulting in leakage of blood into the biliary tract. In the past, trauma had been the most common cause of hemobilia. However, with the increasing invasive procedures in the hepatobiliary tract, iatrogenic origin has become the major cause of hemobilia. Also, non-traumatic etiologies of hemobilia include vascular malformation such as aneurysm, gallstone, inflammation, biliary tumor, hepatocellular carcinoma and coagulopathy. Among these non-traumatic etiologies, choledocholithiasis is a rare cause of hemobilia. The authors have experienced two cases of hemobilia caused by choledocholithiasis, which was diagnosed by abdominal ultrasonography, abdominal CT and duodenoscopy. Both patients were treated by the endoscopic sphincterotomy and stone removal with basket.
Aneurysm ; Biliary Tract ; Blood Vessels ; Carcinoma, Hepatocellular ; Choledocholithiasis ; Common Bile Duct* ; Duodenoscopy ; Gallstones ; Hemobilia* ; Humans ; Inflammation ; Sphincterotomy, Endoscopic ; Tomography, X-Ray Computed ; Ultrasonography ; Vascular Malformations

BACKGROUND: Many institutes are interested in lung metastatectomy than before because of the improved long term survival, low mortality, and low morbidity after lung metastatectomy. However, prognostic factors affecting long term survival are controversial. We attempt to analyze the prognostic factors affecting retrospectively by comparing the results of lung metastasectomy. MATERIAL AND METHOD: Between Jan. 1990 and Dec. 1997, 74 operations were taken in 63 patients with pulmonary metastases in various primary sites. We analyzed the postoperative long term survival according to sex, cell type, laterality, disease free interval(DFI), operation, the number of metastases, and the size of the largest metastasis. RESULT: There were 27 male and 36 female patients. Sex did not appeared to affect survival time(p=0.849). The primary tumor was carcinoma in 32, sarcoma in 28, and others in 3. Cell type, considering carcinoma and sarcoma, did not relate to survival time(p=0.071). DFI had no influence on the outcome(p=0.902). The type of operative procedure had no influence on the outcome(p=0.556). The laterality of metastases, 47 unilateral(74.6%) and 16 bilateral(25.4%), had no influence on the outcome(p=0.843). The number of metastases excised(one, two or three, four or more) did not appear to affect survival(p=0.263). The size of largest metastasis(<=10mm, 11mm-30mm, and >30mm) did not appear to affect survival(p=0.751). Previous factors were evaluated in both the carcinoma and sarcoma patients respectively. DFI was the only significant prognostic factor in metastatic lung sarcoma(p=0.0026). CONCLUSION: Survival was not related to sex, cell type, laterality, DFI, operative procedure, number of metastases, nor the size of the largest metastasis. DFI was related to the survival time in sarcoma group but further study is needed.
Academies and Institutes ; Female ; Humans ; Lung Neoplasms* ; Lung* ; Male ; Metastasectomy ; Mortality ; Neoplasm Metastasis ; Retrospective Studies ; Sarcoma ; Surgical Procedures, Operative

OBJECTIVE: Symptom provocation paradigms using event-related functional magnetic resonance imaging(fMRI) can be an important tool to visualize neuroanatomic correlates of PTSD symptoms. The purpose of this study is to measure regional changes of brain upon exposure to fear stimulus and elucidate the probable relation between signal changes and fear response in PTSD. METHOD: Event-related fMRI was performed during a task where traffic accident-related photos and checkerboards were presented in 9 women with PTSD and 9 woman normal controls in unpredictable order. MRI data were acquired on a 1.5 T GE vision system with a head volume coil. Stimuli were presented on a mirror mounted on the head coil. A total of 200 functional images were taken during a 10-minute scanning session. TR was 3 seconds and inter-stimulus time was varing 4.5 to 11.5 seconds. Data was analyzed using SPM99. RESULTS: In PTSD group, the fear conditions versus the neutral conditions showed activations in both occipital cortex, both fusiform gyrus, left parietal lobule, both insula, right cerebellar tonsil, right putamen, right claustrum, but deactivations in both prefrontal gyrus(p<0.001). In normal control group, activation were found for the fear conditions as compared with the neutral conditions in left fusiform gyrus, both occipital cortex, left parietal lobule, right frontal lobule(p<0.001). CONCLUSIONS: Emotion provocation paradigm using event-related functional magnetic resonance imaging can be applied to illustrate fear response mechanism in PTSD. The result suggests that insula, limbic lobe, cerebellum may play a role in mediating fear response in PTSD.
Basal Ganglia ; Brain ; Cerebellum ; Female ; Head ; Humans ; Magnetic Resonance Imaging* ; Negotiating ; Palatine Tonsil ; Putamen ; Rabeprazole ; Stress Disorders, Post-Traumatic*

PURPOSE: To assess the value of the bolus-tagging method for improving the image quality of contrast-enhanced MR abdominal angiography, and to evaluate the relationship between peak arterial enhancement time and patients' age, weight and heart rate. MATERIALS AND METHODS: Contrast-enhanced 3D FISP abdominal MR angiography was performed in 81 patients during a four-month period. The bolus-tagging method was used in a study group comprising 33 patients, and to this end, 1 ml of Gd-DTPA (gadolinium-diethylenetriamine penta-acetic acid) was administered. thirty sequential images (1 image/sec) were then obtained using turbo-FLASH sequencing. After determining peak arterial enhancement time from the time-to-signal intensity curve, optimal scan delay time can be calculated according to the formula used in our patient series. The 48 patients in whom the bolus-tagging method was not used comprised the control group ; in the study group scanning commenced at the optimal scan delay time (and at 10 seconds in the control group) after the administration of 0.2 mM/kg Gd-DTPA using an automatic power injector. Using a three-point scale we evaluated and compared between the two groups the success with which arterial images were obtained. In addition, vascular visibility -an indication of the quality of arteries and veins-was determined using a four-point scale. In the study group, the relationship between peak arterial enhancement time and patients' age, weight heart rate was also assessed. RESULTS: Pure arterial images were successfully obtained in 32 patients (97%) in the study group and in 40 (83%) in the control group. This difference was not statistically significant (p>.05). With regard to vascular visibility, diagnostic arterial images were seen in 30 patients (91%) in the study group and in 33 patients (69%) in the control group; arterial visibility was significantly better in the study group (p=.0197). On the other hand, the diagnostic venous images were seen in 31 patients (94%) in the study group and in 36 (75%) in the control group; there was no significant difference between the two groups (p=.2367). Peak arterial enhancement time increased significantly with age (r=.443, p=.0098); no correlation,however was seen between peak arterial enhancement time and weight (p>.05) or heart rate (p>.05). CONCLUSION: Used with contrast-enhanced 3-D FISP MR abdominal angiography, the bolus-tagging method provides better arterial visibility. Peak arterial enhancement time increased significantly with age.
Angiography* ; Arteries ; Gadolinium ; Gadolinium DTPA ; Hand ; Heart Rate ; Humans

PURPOSE: To assess the value of the bolus-tagging method for improving the image quality of contrast-enhanced MR abdominal angiography, and to evaluate the relationship between peak arterial enhancement time and patients' age, weight and heart rate. MATERIALS AND METHODS: Contrast-enhanced 3D FISP abdominal MR angiography was performed in 81 patients during a four-month period. The bolus-tagging method was used in a study group comprising 33 patients, and to this end, 1 ml of Gd-DTPA (gadolinium-diethylenetriamine penta-acetic acid) was administered. thirty sequential images (1 image/sec) were then obtained using turbo-FLASH sequencing. After determining peak arterial enhancement time from the time-to-signal intensity curve, optimal scan delay time can be calculated according to the formula used in our patient series. The 48 patients in whom the bolus-tagging method was not used comprised the control group ; in the study group scanning commenced at the optimal scan delay time (and at 10 seconds in the control group) after the administration of 0.2 mM/kg Gd-DTPA using an automatic power injector. Using a three-point scale we evaluated and compared between the two groups the success with which arterial images were obtained. In addition, vascular visibility -an indication of the quality of arteries and veins-was determined using a four-point scale. In the study group, the relationship between peak arterial enhancement time and patients' age, weight heart rate was also assessed. RESULTS: Pure arterial images were successfully obtained in 32 patients (97%) in the study group and in 40 (83%) in the control group. This difference was not statistically significant (p>.05). With regard to vascular visibility, diagnostic arterial images were seen in 30 patients (91%) in the study group and in 33 patients (69%) in the control group; arterial visibility was significantly better in the study group (p=.0197). On the other hand, the diagnostic venous images were seen in 31 patients (94%) in the study group and in 36 (75%) in the control group; there was no significant difference between the two groups (p=.2367). Peak arterial enhancement time increased significantly with age (r=.443, p=.0098); no correlation,however was seen between peak arterial enhancement time and weight (p>.05) or heart rate (p>.05). CONCLUSION: Used with contrast-enhanced 3-D FISP MR abdominal angiography, the bolus-tagging method provides better arterial visibility. Peak arterial enhancement time increased significantly with age.
Angiography* ; Arteries ; Gadolinium ; Gadolinium DTPA ; Hand ; Heart Rate ; Humans