The PCL is the strongest ligament in the knee joint. And it gives the posterior stability to the knee joint and act on rotation of knee joint. The many authors reported the surgical approaches for PCL. But none of them was satisfactory for exposure for PCL. Authors report the approach for repair and reconstruction on PCL injury The purpose of this report is to get the more satisfactory exposure of operation field for anatomical repair of injuried PCL. 1. PCL injury combined with MCL injury. a) MCL injury at its femoral attachment area. Detach the injuried MCL from femoral attachment completely, continue with anteromedial incision, and can observe both femoral and tibial attachment of PCL and ACL. b) MCL injury at its tibial attachment area. Retract the injuried MCL, medial meniscus, joint capsule superiorly, and through between medial meniscus and tibial proximal protion, also can observe the tivial attachment of PCL. 2. Isolated PCL injury. a) at tibial attachment(avulsion fracture) Through posterior approach or straight anteromedial approach, incised the posteromedial joint capsule, and can observed the tibial attachment of PCL. b) at substance level. Detach the MCL from its femoral attachment with bone-block and apply the knee valgus force. And can observe the entire length of PCL. Also reinforce the repaired site of PCL by reconstruction using a semitendinosus tendon.
Joint Capsule ; Knee Joint ; Knee ; Ligaments ; Menisci, Tibial ; Posterior Cruciate Ligament ; Tendons

The shoulder fusion is one of the good method to relieve pain, improve the function and stabilize the flail shoulder joint. But recent advance of arthroplasty, the procedure is less popular. Authors studied and analized 23 patients who received shoulder arthrodesis from Aug. 1978 to Aug. 1986 and reported functional outcome after shoulder arthrodesis. Among twenty three patients, brachial plexus palsy were eighteen, upper extremity residual poliomyelitis in three and shoulder joint turberculosis in two respectively. Postoperative follow up was 12 months to 9 years and 6 months, average being 2 years and 6 months. It took 14.4 weeks in average for shoulder arthrodesis. The postoperative abduction fusion angle was 33.8 degrees in average(20 degrees to 50 degrees). The active abduction after shoulder fusion was mean 51.8 degrees(20 degrees to 85 degrees). The abduction fusion angle between 20 degrees and 40 degrees was presented satisfactory results in the point of pain relief, functional assessment and patients satisfaction. High abduction fusion angle(more than 40 degrees) revealed pain around the fused shoulder area. The combined extra and intraarticular arthrodesis revealed better results. The Saber-cut approach was more valuable for secondary elbow reconstruction than Henry approach.
Arthrodesis ; Arthroplasty ; Brachial Plexus ; Elbow ; Follow-Up Studies ; Humans ; Methods ; Paralysis ; Poliomyelitis ; Shoulder Joint ; Shoulder ; Upper Extremity

BACKGROUND: Liver transplantation (LT) has become the treatment of choice for advanced liver disease. However, renal dysfunction often complicates the course of liver transplant recipients. The preoperative serum creatinine level have been shown to be an important predictor of a short-term graft and patient survival rates and the need for perioperative dialysis. This study examined the impact of the pretransplant renal function on the anesthetic characteristics and renal function after LT. METHODS: Patients undergoing LT were divided two groups according to the creatinine (Cr) level at time of LT. The following information was collected for each patient: age, etiology, weight and height, serum Cr, Cr clearance, patient survival, and cause of death. The laboratory data was collected at preoperative day, operation day and postoperative 1, 7, 30 days and 6 months. The hemodynamic profile was collected during LT. RESULTS: There were 27 patients in the renal dysfunction (RD) group. Ascites, total blood transfusion and fluid administration was significantly higher in the RD group. The hemodynamic parameters were similar in both groups. The BUN and Cr levels were significantly higher in the RD group in the perioperative period. At the preoperative period, the AST, ALT, bilirubin and prothrombin time was significantly higher in the RD group. The postoperative ICU stay and mortality rate was higher in the RD group. CONCLUSIONS: A pretransplant renal dysfunction is the result of deterioration in the liver function in the preoperative period, and indicates a greater requirement of blood and fluid during surgery.
Ascites ; Bilirubin ; Blood Transfusion ; Cause of Death ; Creatinine ; Dialysis ; Hemodynamics ; Humans ; Liver Diseases ; Liver Transplantation ; Liver* ; Mortality ; Perioperative Period ; Preoperative Period ; Prothrombin Time ; Survival Rate ; Transplantation ; Transplants

PURPOSE: The purpose of this study is to evaluate the relationship between the angle formed between the proximal most screw through the locking compression plate-proximal lateral tibia (LCP PLT) and the joint line, and to evaluate if this angle can be used intraoperatively as an assessment tool to determine normal alignment of the tibia in the coronal plane. MATERIALS AND METHODS: There are two parts to this study: in the first part, LCP PLT was applied to 30 cadaveric adult tibia. The angle between the joint line and the proximal most screw was measured and termed as the 'joint screw angle' (JSA). In the second part, 56 proximal tibial fractures treated with LCP PLT were retrospectively studied. Two angles were measured on the radiographs, the medial proximal tibial angle (MPTA) and the JSA. Their relationship was analyzed statistically. RESULTS: The average JSA was 1.16 degrees in the anatomical study. Statistical analysis of the clinical study showed that the normal MPTA had a direct correlation with an acceptable JSA. CONCLUSION: We therefore conclude that the JSA can be used intraoperatively to assess the achievement of a normal coronal axis.
Adult ; Aged ; Aged, 80 and over ; *Bone Screws ; Female ; Humans ; Male ; Middle Aged ; Orthopedic Procedures/*methods ; Retrospective Studies ; Tibial Fractures/radiography/*surgery

This study was performed to investigate the expression of two porcine endogenous retrovirus (PERV) elements, PERV gag and full-length conserved PERV, in blood cells collected periodically from organ-recipient monkeys that underwent pig to non-human primate xenotransplantation. The heart and kidney-respectively acquired from alpha-1,3-galactosyltransferase knockout (GT-KO) pigs that survived for24 and 25 days-were xenografted into cynomolgus monkeys. The two PERV elements expressed in the xenografted GT-KO pig organs were not present in the blood cells of the recipient monkeys. In the present study, we deduced that PERVs are not transmitted during GT-KO pig to monkey xenotransplantation.
Blood Cells ; Endogenous Retroviruses* ; Haplorhini* ; Heart ; Heterografts ; Macaca fascicularis ; Primates ; Swine ; Transplantation, Heterologous*

Eosinophilic gastroenteritis is a rare disorder of the stomach, small intestine and colon, characterized by variable eosinophilic infiltration of the bowel wall and peripheral blood eosinophilia, abnormal gastrointestinal symptoms and signs. The pathogenesis of this disease still remains unknown, but several studies support allergic or immunologic etiology. Considerable variability in clinical presentation depends on the site of the gastrointestinal tract and the depth of bowel wall involvement. Herein we experienced a case of eosinophilic gastroenteritis confined to small intestine presenting progressive weight loss, abdominal pain and diarrhea. Enteroscopic findings showed diffuse multiple nodularity of mucosal folds in small bowel, especially duodenum and proximal jejunum. Jejunal and duodenal biopsy specimen demonstrated marked eosinophilic infiltration. These symptoms and signs were improved within 3 weeks after short course of prednisone therapy.
Abdominal Pain ; Biopsy ; Colon ; Diarrhea ; Duodenum ; Enteritis* ; Eosinophilia ; Eosinophils* ; Gastroenteritis ; Gastrointestinal Tract ; Intestine, Small ; Jejunum ; Prednisone ; Stomach ; Weight Loss

The overexpression of X-linked inhibitor of apoptosis protein (XIAP), a member of IAP family protein, is intuitively expected to be associated with unfavorable clinical features in malignancies; however, there have been only a very limited number of studies reporting the clinical relevance of XIAP expression. This study was performed to investigate the prognostic relevance of XIAP expression in childhood acute myeloid leukemia (AML). In 53 children with de novo AML, the level of XIAP expression was determined by using quantitative reverse transcriptase-polymerase chain reaction and was analyzed with respect to the clinical characteristics at diagnosis and treatment outcomes. As a result, the XIAP expression was found to be higher in patients with extramedullary disease than in those without (P=0.014). In addition, XIAP overexpression (> or =median expression) was associated with an unfavorable day 7 response to induction chemotherapy and also associated with a worse 3-yr relapsefree survival rate (52.7+/-20.9% vs. 85.9+/-14.8%, P=0.014). Multivariate analyses revealed that XIAP overexpression was an independent unfavorable prognostic factor for relapse-free survival (hazard ratio, 6.16; 95% confidence interval, 1.48-25.74; P=0.013). Collectively, XIAP overexpression may be used as an unfavorable prognostic marker in childhood AML.
Adolescent ; Child ; Child, Preschool ; Female ; Gene Expression Regulation, Leukemic ; Humans ; Infant ; Leukemia, Myeloid, Acute/*diagnosis/drug therapy/mortality ; Male ; Prognosis ; Reverse Transcriptase Polymerase Chain Reaction ; Survival Rate ; X-Linked Inhibitor of Apoptosis Protein/*metabolism

Recently developed cDNA microarray or DNA chip technology allows expression monitoring of expression of hundreds and thousands of genes simultaneously and provides a format for identifying genes as well as changes in their activity. In order to search for changes in gene expression after X irradiation in HL60 cells, cDNA microarray technique was done. In this study, expression of 588 human genes (including oncogenes, tumor suppressor genes, cell cycle regulator genes, intracellular signal transduction modulator genes, apoptosis related genes, transcription factor genes, growth factors and receptor genes, cytokine genes, etc) were analyzed. For cDNA microarray analysis mRNAs were extracted from control and 8 Gy-irradiated HL60 cells. As a result the changes in expression of several genes were observed. This alteration of gene expression was confirmed by reverse transcription-polymerase chain reaction. The expression of heat shock 60 KD protein, c-jun, erythroid differentiation factor, CPP32, myeloid cell nuclear differentiation antigen, MAP kinase-activated protein kinase, interleukin-8, monocyte chemotactic peptide 1 and RANTES genes was increased, but the expression of p55CDC gene was decreased after X irradiation.
Apoptosis ; Cell Cycle ; Chemokine CCL5 ; DNA, Complementary* ; Gene Expression ; Genes, Regulator ; Genes, Tumor Suppressor ; HL-60 Cells* ; Hot Temperature ; Humans ; Intercellular Signaling Peptides and Proteins ; Interleukin-8 ; Monocytes ; Myeloid Cells ; Oligonucleotide Array Sequence Analysis* ; Oncogenes ; Protein Kinases ; RNA, Messenger ; Shock ; Signal Transduction ; Transcription Factors

The efficacy of tandem high-dose chemotherapy and autologous stem cell rescue (HDCT/ASCR) was investigated in patients with high-risk neuroblastoma. Patients over 1 yr of age who were newly diagnosed with stage 4 neuroblastoma from January 2000 to December 2005 were enrolled in The Korean Society of Pediatric Hematology-Oncology registry. All patients who were assigned to receive HDCT/ASCR at diagnosis were retrospectively analyzed to investigate the efficacy of single or tandem HDCT/ASCR. Seventy and 71 patients were assigned to receive single or tandem HDCT/ASCR at diagnosis. Fifty-seven and 59 patients in the single or tandem HDCT group underwent single or tandem HDCT/ASCR as scheduled. Twenty-four and 38 patients in the single or tandem HDCT group remained event free with a median follow-up of 56 (24-88) months. When the survival rate was analyzed according to intent-to-treat at diagnosis, the probability of the 5-yr event-free survival+/-95% confidence intervals was higher in the tandem HDCT group than in the single HDCT group (51.2+/-12.4% vs. 31.3+/-11.5%, P=0.030). The results of the present study demonstrate that the tandem HDCT/ASCR strategy is significantly better than the single HDCT/ASCR strategy for improved survival in the treatment of high-risk neuroblastoma patients.
Adolescent ; Child ; Child, Preschool ; Combined Modality Therapy/mortality ; Drug Therapy/*mortality ; Female ; Humans ; Infant ; Korea/epidemiology ; Longitudinal Studies ; Male ; Neuroblastoma/*mortality/*therapy ; Prevalence ; Risk Assessment/methods ; Risk Factors ; Stem Cell Transplantation/*mortality ; Survival Analysis ; Survival Rate ; Treatment Outcome

PURPOSE: The risk of invasive fungal infection is greater for allogeneic hematopoietic stem cell transplantation (HSCT) than for autologous transplantation. Therefore, many transplantation centers use antifungal prophylaxis for allogeneic HSCT, however, there exists no standard guidelines or consensus regarding autologous HSCT. MATERIALS AND METHODS: A prospective double-blind randomized study was conducted in autologous HSCT recipients who were divided into prophylaxis and empirical treatment groups, and we investigated the efficacy of itraconazole prophylaxis in pediatric autologous HSCT. RESULTS: Total 87 autologous HSCT episodes in 55 children with high-risk solid tumors were studied. No invasive fungal infections occurred in either group. However, patients in the prophylaxis group had a significantly shorter duration of fever (p < 0.05) and received antibacterial treatment of shorter duration (p < 0.05) with fewer numbers of antibiotics (p < 0.05 for the use of second line antibiotics) than those in the empirical group. No significant additional adverse events were found with itraconazole prophylaxis. CONCLUSION: Although beneficial effects such as a shorter duration of fever and reduced need for antibiotic use were observed in the prophylaxis group, the results were not sufficient to draw a definite recommendation about the routine use of antifungal prophylaxis in pediatric autologous HSCT recipients with high-risk solid tumors (Trial registration: NCT00336531).
Anti-Bacterial Agents/therapeutic use ; Antifungal Agents/*therapeutic use ; Child, Preschool ; Cost-Benefit Analysis ; Double-Blind Method ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Humans ; Itraconazole/*therapeutic use ; Mycoses/*prevention & control ; Neoplasms/*surgery ; Prospective Studies ; Risk Factors ; Transplantation, Autologous ; Treatment Outcome