An electron microscopic study was conducted in order to investigate the healing and maturation process of central one third of donor site patellar tendon which was used for endoscopic anterior cruciate ligament reconstruction. 17 patients among 118 consecutive series, which underwent ACL reconstruction from January 1990 to March 1995, were involved in this study according to various followup periods. At 6 months follow-up, hypercullular and randomly arranged fibrohlasts had abundant cytoplasm with marked irregular cytoplasmic borders and short cytoplasmic extensions. Thc, nuclei of fibroblasts had prominent nuclear indentation with chromatin condensation along the nuclear mernbrane and prominent nucleolus. The cytoplasm contained irregularly dilated rough endoplasmic reticulum, Golgi complex, and pinocytic vesicles. Intercellular space were occupied by newly-formed, immature col)agen fibrills without distinct parallel arrangement, and the diameter of collagen fibrils was unifoimly small. At 12 months, fibroblast and collagen fibrils showed a little matured findings except the small diameter of collagen fibrils. At 24 months, irregular-shaped fibroblasts were still present, which contained folded nuclei, ahundant cytoplasm with large amount of rough endoplasmic reticulum and Golgi complex. Collagen fihril showed also a unimodal distribution pattern with small diameter, however had a tendency to have a regular parallel arrangement. These finding suggest that the donor site of a patellar tendon was still quite different from normal patellar tendon in electron microscopic morphology even at 24 months postoperative follow-up regardless of considerable maturation of regular parallel arrangement pattern of collagen fibril.
Anterior Cruciate Ligament Reconstruction ; Chromatin ; Collagen ; Cytoplasm ; Dronabinol ; Endoplasmic Reticulum, Rough ; Extracellular Space ; Fibroblasts ; Follow-Up Studies ; Golgi Apparatus ; Humans ; Patellar Ligament* ; Tissue Donors*

Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome due to compression of the median nerve at the wrist. Division of the transverse carpal ligament for median nerve compression in patients with carpal tunnel syndrome is a common and successful procedure. A variety procedures exist to release the transverse carpal ligament the classic open release, limmited open or percutaneous release, and endoscopic release. From February 1994 to January 1996, 39 carpal tunnel releases were performed by percutaneous method in 30 patients (3 males and 27 females) at the Chonnam University Hospital. The patients age ranged from 42 to 67 years (average 54.8 years). The duration of the symptoms ranged from 3 months to 10 years. According to Brown's outcome analysis, results were as follows. 1. Persistent pain and paresthesia were noted in only 3 cases (7.7%) at 24 week postoperatively. 2. Two-Point discrimination on the index finger was improved significantly at 12 week postoperatively (p<0.05). In electromyographic study, conduction delay of motor and sensory fibers was diminished significantly at 4 week postoperatively (p<0.05). 3. Functional outcomes (grip strength, pinch strength, scar tenderness and return to work) were showed good and excellent result. We concluded that percutaneous decompression is one of the less morbid method for decompressing the carpal canal and relief of symptoms for the patient.
Carpal Tunnel Syndrome* ; Cicatrix ; Decompression* ; Discrimination (Psychology) ; Fingers ; Humans ; Jeollanam-do ; Ligaments ; Male ; Median Nerve ; Paresthesia ; Peripheral Nerves ; Pinch Strength ; Wrist

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the effectiveness of microdiscectomy under local anesthesia in comparison with general anesthesia. SUMMARY OF LITERATURE REVIEW: No co RESULTS: Between both groups there is no significant operation time difference. However, the average hospital stay duration in the general anesthesia group was 7.3 days, while it was 4.7 days in the local anesthesia group (P<0.05). The VAS and ODI scores were improved in both groups. Thirty-two cases (84.2%) of the general anesthesia group and 40 cases (80%) of the local anesthesia group showed satismparative studies regarding the outcomes of microdiscectomy under local and general anesthesia could be found in the literature. MATERIALS AND METHODS: Between May 2000 and June 2004, 88 patients who underwent microdiscectomy under local anesthesia (n=50, local anesthesia group) or under general anesthesia (n=38, general anesthesia group) were selected and included in this study with a follow up period more than 3 years. The operation time and duration of hospital stay were documented. The Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) were used to evaluate the degree of symptom relief. The patient satisfaction was evaluated using the MacNab's criteria and postoperative complications.fied results by the MacNab's criteria with no statistically significant difference (P>0.05). Three patients in the general anesthesia group and 7 patients in the local anesthesia group needed a reoperation. CONCLUSIONS: A microdiscectomy under local anesthesia shows faster recovery period. But it shows also a relative high revision rate. In patients with old age and underlying disease, local anesthesia can be used for the microdiscectomy selectively and careful exploration of the herniated disc is required.
Anesthesia, General* ; Anesthesia, Local ; Diskectomy* ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Length of Stay ; Patient Satisfaction ; Reoperation ; Retrospective Studies

Tumoral calcinosis is an uncommon disease, characterized by deposits of large, calcified soft tissue masses around major joints in children and young adults. The causes of the lesion have not yet been established, but are presumed an inborn error of metabolism of phosphorus. It has been recommanded medical treatment or surgical excision, but recurrence of the lesion is frequent. We report a case of young female patient who presented with tumoral calcinosis at the age of 10 years.
Calcinosis* ; Child ; Female ; Humans ; Joints ; Knee Joint* ; Knee* ; Metabolism ; Phosphorus ; Recurrence ; Young Adult

STUDY DESIGN: This is a retrospective study analyzing the results of posterior lumbar interbody fusion(PLIF) with TPM cages in spondylolisthesis OBJECTIVES: The purpose of this study was to evaluate the clinical, radiologic results & affecting factors of PLIF with TPM cages in spondylolisthesis. SUMMARY OF LITERATURE REVIEW: The ordinary PLIF has 86-98% of radiologic union rate and clinical satisfactory rate. The problems of ordinary PLIF were graft breakage, donor site morbidity, limited bone resources, high failure rate using only transpedicular screw fixation. MATERIALS AND METHODS: From October 1995 to January 1999, 108 consecutive patients with spondylolisthesis were treated by PLIF with TPM cages, in which morcellized bone chips salvaged from posterior neural arch applied, and pedicle screw fixation. RESULTS: Preoperative Low Back Pain score(total 100 points) was improved from 47.4 points to 88.7 points at last follow-up. 10 point visual analogue scale was reduced to 1.5 point at last follow-up. In the end results, Ninty-two percent of patients rated as excellent or good. The preoperative value of slippage, 18.6% was achieved to 5.5% at last follow-up. The anterior intervertebral disc space height was increased from 10.0 to 16.2mm postoperatively. Fusion occurred in all patients except one. Groups below 60-year-old patient at the time of surgery showed better clinical results than those above 60 (p<0.05). No clear correlations were noted between sex, the types of spondylolisthesis, bone mineral density, smoking habits and obesity in clinical, radiologic results. CONCLUSION: PLIF with TPM cages is appeared to be a recommended procedure of choice to treat lumbar spondylolisthesis and this operation should be performed with a caution in aged patients.
Bone Density ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Low Back Pain ; Middle Aged ; Obesity ; Retrospective Studies ; Smoke ; Smoking ; Spondylolisthesis* ; Tissue Donors ; Transplants

STUDY DESIGN: A retrospective study OBJECTIVES: To examine the influence of cervical spondylosis on an acute cervical spinal cord injury. SUMMARY OF LITERATURE REVIEW: There are no reports on the relationship between cervical spondylosis and acute cervical spinal cord injuries. MATERIALS AND METHODS: Twenty six patients who underwent operative treatment for acute cervical injuries with spinal cord injury were evaluated. The mean age and follow-up period was 58 years and 2.2 years, respectively. The evaluation was performed by examining the causes of the injuries, and the classification of fractures according to the presence of cervical spondylosis. This study compared the degrees of postoperative neurological recovery with motor index score in the groups with and without cervical spondylosis. RESULTS: Cervical cord injuries were more prevalent in the group 60 years and older; 17 cases vs. 9 cases in the group under 60 years. Eleven (65%) and 6 (35%) cases in the group 60 years and older had sustained a high and low energy injury, respectively. In contrast, mostly high energy injuries (8 in 9 cases) were encountered in the group under 60 years of age. A low energy injury could cause a acute cervical cord injury in the group 60 years and older, who also had cervical spondylosis. In those cases, previous cervical spondylosis might be one of the etiologic factors. CONCLUSIONS: The cases with cervical spondylosis in the group 60 years and older tended to show incomplete cord injury and good postoperative neurological recovery when they had sustained cervical cord injuries.
Follow-Up Studies ; Humans ; Retrospective Studies ; Spinal Cord ; Spinal Cord Injuries ; Spondylosis

PURPOSE: The purpose of this study was to examine the effects of a cognitive behavioral stress management program on diabetic self-care and glycemic control with type 2 diabetic patients. METHODS: Thirty three diabetic patients who were older than 40 were recruited from a public health center and conveniently assigned into both experimental(n=16) and control groups(n=17). Participants in the experimental group had attended the weekly cognitive behavioral program for 8 weeks. Data were collected from June 2005 to August 2006 and analyzed by independent t-test using the SPSS WIN program. RESULTS: After an 8 week intervention, participants in the experimental group reported on increasement of diabetic self-care behaviors and an increasement of blood glucose levels, which were significantly different from those in the control group. CONCLUSION: On the basis of those findings, we concluded that the cognitive behavioral stress management program has positive effects on diabetic self-care and glycemic control for the patients with DM. Further research is needed to identify the long-term effects of the cognitive behavioral program.
Blood Glucose ; Diabetes Mellitus* ; Glucose ; Humans ; Public Health ; Self Care*

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to determine the effectiveness of performing transpedicular screw fixation in idiopathic scoliosis surgery by evaluating the radiological results. LITERATURE REVIEW SUMMARY: Deformity correction using pedicle screw fixation in scoliosis surgery is one of the most effective methods of treatment. However, the extent of correction and the complication rate are quite variable. MATERIALS AND METHODS: We evaluated the radiological results of performing posterior correction with using transpedicular screws in sixty patients who were suffering with idiopathic scoliosis. The follow-up duration was 39 months (range: 12 to 91 months). The changes of the coronal and sagittal geometry in the major and compensatory curves were measured according to the Cobb method with using the anteroposterior and lateral radiographs in the standing and lateral bending positions before the surgery and at the final follow-up. RESULTS: In the coronal plane, the average correction rate of the major curve was 77% and that of the compensatory curve was 72% on the immediate postoperative radiographs. In the sagittal plane, the Cobb angle in those patients who had a hypokyphosis under 15 degrees was improved from 9.0 degrees to 21.2 degrees. The angle between the lowest instrumented vertebra and T10, and also the lumbar lordosis did not change significantly. The correction rate of the rotational deformity of the apical vertebra was 55%, and that of the translation degree was 68%. The correction rate of the translation of the lowest instrumented vertebra was 54% and that of the tilting angle was 77%. No patients had a significant loss of correction in the coronal or sagittal plane at the latest follow-up. CONCLUSIONS: Posterior correction using transpedicular screws was an effective method for treating idiopathic scoliosis, and it resulted in a high correction rate at the major curve and the compensatory curve even with short segment fixation, and it reduced the loss of the correction angle.
Animals ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Lordosis ; Retrospective Studies ; Scoliosis* ; Spine

STUDY DESIGN: Experimental investigation in vitro. OBJECTIVES: To evaluate the relationship between the degeneration of intervertebral disc cells, and low back pain induced by degeneration of intervertebral disc cells and increases in use of proinflammatory mediators via nicotine stimulation. SUMMARY OF LITERATURE REVIEW: Smoking is a leading cause of degeneration of intervertebral disc cells and low back pain. According to the existing literature, nicotine, one of the main ingredients in cigarettes, causes the degeneration of intervertebral disk cells including decrease of glycoprotein through generation of carboxy-hemoglobin, vasoconstriction, and disability of fibrinolysis and changes of metabolism of nucleus pulposus cells. MATERIALS AND METHODS: Annulus fibrosus of intervertebral disc and knee joint cartilage were collected from pigs; these cells were acquired by gradual enzyme decomposition. Using Trypan blue, concentration and survival rate of cells were examined; cells were inserted on alginate beads for tertiary cultivation. Nicotine was then applied at 0, 50, 100, 200 and 300 nM, respectively, and the samples were cultivated for three, six and nine days, respectively. After collecting culture fluid, it was measured for interleukin(IL)-1beta, IL-6 and IL-8 with the ELISA Test. DNA of cells used for cultivation was quantitated and the amount of the resulting proinflammatory mediator was normalized. The results were then compared with the result of same study on cartilage of porcine knee joints. RESULTS: For changes of the inflammatory mediator based on the concentration of nicotine, in nicotine stimulation with low concentration of 50 nM and the control group, there was no significant change, while transient increases of inflammatory mediator showed in nicotine stimulation with concentrations of 100, 200 nM, respectively. There was not a significant increase of IL-1beta observed in all nicotine stimulation groups; these were the same results in porcine cartilage study. The level of IL-6 in 200, 300 nM nicotine concentration showed significant increases, respectively. The level of IL-8 in high dose nicotine stimulation groups also showed significant increases of DNA on the sixth day. And in porcine cartilage study group, significant changes were observed in 200, 300 nM, but the absolute value was lower than that of annulus fibrous cells group. CONCLUSION: Inflammatory mediators such as IL-6 and IL-8 increased as the result of tertiary cultivation of annulus fibrosus cells of porcine intervertebral disk and nicotine stimulation. It is believed that the cells of the disc annulus are more sensitive than articular chondrocytes to nicotine stimulation. This may be the focus of future long-term studies effects of nicotine other inflammatory cytokines.
Cartilage ; Chondrocytes ; Cytokines ; DNA ; Enzyme-Linked Immunosorbent Assay ; Fibrinolysis ; Glycoproteins ; Interleukin-6 ; Interleukin-8 ; Intervertebral Disc* ; Knee Joint ; Low Back Pain ; Metabolism ; Nicotine* ; Smoke ; Smoking ; Survival Rate ; Swine ; Tobacco Products ; Trypan Blue ; Vasoconstriction

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the efficacy of cervical expansive laminoplasty for patients with quadriplegia due to traumatic cervical spinal cord injury (SCI) without skeletal injury. SUMMARY OF LITERATURE REVIEW: There are a few studies on the surgical results for acute cervical SCI without bony injury. MATERIALS AND METHODS: From 2003 to 2010, among the patients who visited emergency room with post-traumatic quadriplegia, 12 patients who had underwent cervical expansive laminoplasty for acute cervical SCI without body injury and cord compression on MR images were included in this study. We evaluate the pre-operative swelling on MRI, the change of neurologic symptoms at pre-, post operative state, respiration state, complication and survival period. RESULTS: The average of motor index scores at the time of admission to the emergency room was 23 (4–30), and the average was changed to 29(4–43) during the follow-up period. No significant neurological improvement was observed in 11 cases except 1 case. The average time for operation after the injury was 26 hours(9–72). 4 patients showed paradoxical respiration when they first visited emergency room and the symptom continued after the operation and during follow-up periods. Another 4 patients showed paradoxical respiration after the operation. In all 8 cases who showed paradoxical respiration, tracheostomy and occasional ventilation were needed. In the follow-up period, 6 patients died due to respiratory failure within 1 year after the surgery. All these patients presented severe spinal cord edema on preoperative MRI with paradoxical respiration. CONCLUSIONS: Efficacy of expansive laminoplasty for quadriplegic patients due to acute cervical SCI without bony injury may be limited. In many patients, no significant neurological recovery was observed but it was clearly identified that prognosis was related to the grades of spinal cord edema and paradoxical respiration.
Cervical Cord ; Edema ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Laminoplasty* ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Prognosis ; Quadriplegia ; Respiration ; Respiratory Insufficiency ; Retrospective Studies ; Spinal Cord ; Tracheostomy ; Ventilation