The suprapatellar plica is a remnant of the embryonic septum separating the suprapatellar pouch from the knee joint. Complete type of suprapatellar plica is rarely reported and its clinlical significance is controversial. The purpose of this study is to verify the complete type of suprapatellar plica as an important cause of anterior knee pain and to evaluate the clinical results after arthroscopic excisien of it. From September 1991 to April 1997, we studied prospectively 54 patients, 90 knees which were diagnosed as cornplete type of suprapatellar plica preoperatively. The mean age was 32 years (15-57 years) and sex distribution was 14 males and 40 females. For the preoperative diagnosis, we checked clinical symptom, past history, physical finding and plain X-ray routinely and performed bone scan, double contrast arthrogram and MRI, if necessary. All patients complained vague anterior knee pain at standing, sitting, stair climbing and exercise for long times. All 90 knees were examined arthroscopically. Among them, 80 knees had complete type of suprapatellar plica and remaining 10 knees had other findings. After all, positive predictive value of preoperative diagnosis for complete type of suprapatellar plica was 89%. Among 36 patients diagnosed as bilateral preoperatively, 33 patients(92%) were confirmed as bilateral in arthroscopic examination. After arthroscopic excision of plica, clinical results were total relief of pain in 19 knees(24%), improvement in 55 knees(69%), no change in 6 knees(7%) and none of worsening. In conclusion, complete type of suprapatellar plica should be considered as an important cause of anterior knee pain especially which is vague, intermittent and bilateral.
Diagnosis ; Female ; Humans ; Knee ; Knee Joint ; Magnetic Resonance Imaging ; Male ; Prospective Studies ; Sex Distribution

Ligament injuries of the knee joint are very common among competitive athletes. Acrurate assessment ot the nature of these injuries is a prerequisite for appropriate therapy. The purpose of this study is to evaluate the significance of MRI findings in assesing the status of ACL tear and associated injuries. 31 cases of ACL injuries were examined and reconstructed arthroscopically from Jan. 1997 to Sep. 1997 at Kyung Hee University Hospital. 1n all cases, we reviewed preoperative physical and MRI findings and performed postoperative radiologic assessments. Results were as follows; 1. Lachman test and Pivot shift test were positive in all 31 cases but anterior drawer test was positive in 29 case,s. 2. In MRI findings, 24 cases were interpretated as complete ACL tear and / cases as inccomplete ACL tear. But these 7 cases were confirmed as complete tear in mthroscopic exanunation with careful probing of ACL fiher. 3. MRI showed associated meniscal injuries in 19 cases(61%)-14 cases(74%) at medial meniscus, 5 cases(26%) at lateral meniscus. All cases were confirmed arthroscopically. In conc1usion, physical findings are more reliable than MRI findings in diagnosing the complete ACL tear and deciding the ACL reconstruction. But MRI findings are very helpful to assess the associated injuries and plan the treatments.
Anterior Cruciate Ligament ; Athletes ; Equidae ; Humans ; Knee Injuries ; Knee Joint ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial

Fat embolism is the presence of fat globules in the peripheral circulation and in the lung, brain, kidney, heart, and so on -not in the fine emulsion of a metabolic lipemia but in globules large enough to obstruct arterioles and capillaries. The fat droplets can derive from fractures of long bone due to disruption of the fatty marrow, from extensive bruising of the soft tissue, and from fat tissue in burns. Fat embolism has also been reported in patients suffering from various diseases including alcoholism, fatty liver, diabetes mellitus and pancreatitis. We investigated 19 autopsies with fatty liver of varying degrees to establish a correlation between fatty change of liver and pulmonary fat embolism. Among 19 cases, 3 cases with moderate to severe fatty change of liver, and 1 case with submassive hepatic necrosis and mild fatty change showed Grade II pulmonary fat embolism. In histologic section with Sudan III stain, the arteries and capillaries of lung were occupied and distended by round, oval, or staghorn fat globules. The alveoli may contain edema fluid and blood. Although the pulmonary fat embolism occuring in the presented cases didn't cause death on its own, one should be aware that a life-threatening mobilization of fat into the lungs and even into the systemic circulation is possible in fatty liver and submassive hepatic necrosis.
Alcoholism ; Arteries ; Arterioles ; Autopsy ; Bone Marrow ; Brain ; Burns ; Capillaries ; Diabetes Mellitus ; Edema ; Embolism, Fat* ; Fatty Liver* ; Heart ; Humans ; Hyperlipidemias ; Kidney ; Liver ; Lung ; Necrosis ; Pancreatitis ; Sudan

Fat embolism is the presence of fat globules in the peripheral circulation and in the lung, brain, kidney, heart, and so on -not in the fine emulsion of a metabolic lipemia but in globules large enough to obstruct arterioles and capillaries. The fat droplets can derive from fractures of long bone due to disruption of the fatty marrow, from extensive bruising of the soft tissue, and from fat tissue in burns. Fat embolism has also been reported in patients suffering from various diseases including alcoholism, fatty liver, diabetes mellitus and pancreatitis. We investigated 19 autopsies with fatty liver of varying degrees to establish a correlation between fatty change of liver and pulmonary fat embolism. Among 19 cases, 3 cases with moderate to severe fatty change of liver, and 1 case with submassive hepatic necrosis and mild fatty change showed Grade II pulmonary fat embolism. In histologic section with Sudan III stain, the arteries and capillaries of lung were occupied and distended by round, oval, or staghorn fat globules. The alveoli may contain edema fluid and blood. Although the pulmonary fat embolism occuring in the presented cases didn't cause death on its own, one should be aware that a life-threatening mobilization of fat into the lungs and even into the systemic circulation is possible in fatty liver and submassive hepatic necrosis.
Alcoholism ; Arteries ; Arterioles ; Autopsy ; Bone Marrow ; Brain ; Burns ; Capillaries ; Diabetes Mellitus ; Edema ; Embolism, Fat* ; Fatty Liver* ; Heart ; Humans ; Hyperlipidemias ; Kidney ; Liver ; Lung ; Necrosis ; Pancreatitis ; Sudan

Congenital lipoid adrenal hyperplasia, the most severe form of congenital adrenal hyperplasia, is caused by mutations in the steroidogenic acute regulatory protien (StAR). It is characterized by failure of synthesis of all three classes of adrenal steroids and massive accumulation of lipids and cholesterol in the adrenal cortex. The computed tomography (CT) unequivocally delineated massively enlarged adrenal glands of fat-tissue attenuation, enabling early diagnosis and replacement therapy. We report a case of congenital lipoid adrenal hyperplasia, in which CT established that lipoid deposition at the adrenal cortex disappeared after the adrenal hormone replacement therapy.
Adrenal Cortex ; Adrenal Glands ; Adrenal Hyperplasia, Congenital ; Cholesterol ; Early Diagnosis* ; Hormone Replacement Therapy ; Hyperplasia* ; Steroids

OBJECTIVE: To elucidate the correlation of nitric oxide (NO) concentrations in follicular fluid (FF) with the ovarian response as well as the age in women undergoing controlled ovarian hyperstimulation (COH). METHODS: This study was performed in 72 cycles of whom underwent COH for in vitro fertilization at infertility clinic of Changwon Hanmaeum Hospital and Pusan National University Hospital from Aug., 2003 to Dec., 2003. Each FF was collected at the oocyte retrieval and NO concentrations in FF were assessed. We analyzed the correlation of NO concentrations in FF with the ovarian response as well as the age in women undergoing COH. RESULTS: Among 72 cycles, the clinical pregnancy rate was 37.5% (27cycles). There were no significant differences in patient's age, ampules of gonadotropins used, estradiol level on the day of hCG administration, the number of oocytes retrieved, and fertilization rate between pregnant and nonpregnant groups. However, negative correlation was found between the follicular size and NO concentrations in FF. No significant correlation was found between age and NO concentrations in FF. Comparing NO concentrations in FF between pregnant and nonpregnant women by age, NO concentrations in FF were higher at nonpregnant women, significantly those of them more than 40 years old. CONCLUSION: These results suggest that NO concentrations in FF cannot be a marker for the ovarian response, and have no correlation with all parameters of COH including patients' age with exception for the follicular size.
Adult ; Busan ; Estradiol ; Female ; Fertilization ; Fertilization in Vitro ; Follicular Fluid* ; Gonadotropins ; Gyeongsangnam-do ; Humans ; Infertility ; Nitric Oxide* ; Oocyte Retrieval ; Oocytes ; Pregnancy Rate

In complication of infective endocaditis splenomegaly and splenic infarction are not uncommon but splenic rupture is very rare. We report a case of splenic rupture complicated by infective endocarditis in 1 71-yr-old man who had been suffered from rheumatic heart disease (aortic regurgitation and stenosis and mitral regurgitation). The patient was admitted to mild fever and generalized weakness for 20 days. Diagnosis of infective endocarditis due to Staphylococcus epidermidis was made by clinical manifestaions and blood culture study.On 34th day of admissionthe patient suddenly displayed the symptoms and signs of massive intraperitoneal hemorrhage. Splenic rupture was revealed by paracentesis and radiologic studies. Rupture of spleen is an uncommon and usually fatal complication of infective endocarditis. Therefore early diagnosis and prompt treatment must be performed.
Constriction, Pathologic ; Diagnosis ; Early Diagnosis ; Endocarditis* ; Fever ; Hemorrhage ; Humans ; Paracentesis ; Rheumatic Heart Disease ; Rupture ; Spleen ; Splenic Infarction ; Splenic Rupture* ; Splenomegaly ; Staphylococcus epidermidis

BACKGROUND: The dipyridamole and dobutamine stress echocardiography have been studied as a non-invasive diagnostic test in coronary artery disease. Recently, some authors have extended the usefulness of these tests to predicting the prognosis of myocardial infarction patients. But as far as we know, there was no literature which tried boh tests to the same infarcted patients group. So, we performed both tests in the 23 infarcted patients to compare and evaluate both tests as predicting the prognosis in myocardial infarction. METHODS: Patients underwent (1) two-dimensional echocardiography under basal condition and after dipyridamole infusion for 4 minites at the dose of 0.14mg/kg/min, (2) another two dimensional echocardiography under basal and during dobutamine infusion at each dose of 5 to a maximum of 20microg/kg/min at 1 or 2 days after dipyridamole stress echocardiography, and (3) coronary and left ventricular angiography. Preinfusion and peak infusion images were analyzed independently by two different observers using Nova Micro Sonic soft were(DataVueII and ColorVue II analysis system). The segmental wall motions were scored as follows ; hyperkinetic : 1, normal : 2, hypokinetic : 3, akinetic : 4. THe test response was considered positive if abnormal wall motion and reduced myocardial thickening were observed during drug infusion at the vascular distributions except the akinetic infarcted segment identified during basal condition. The coronary angiography was analyzed by measuring the maximal luminal diameter stenosis with caliper and 50% or greater diameter narrowing was considered significant. The sensitivity and specificity were calculated by comparing echocardiographic prediction and angiographic findings. RESULTS: 1) Among 22 patients with sufficient image in dipyridamole stress echocardiography, 13 patients have myltivessel coronary disease without resting akinesia of non-infarcted segments. Only 5 patients showed positive findings in dipyridamole stress echocardiography(sensitivity, 38.4%). Among 9 patients who has single or minimal disease, 9 patients were negative finding(specificity, 100%). 2) Among 21 patients with sufficient image in dobutamine stress echocardiography, 12 patients have multivessel coronary disease without resting akinesia of non-infarcted segments. 7 patients showed positive finding in dobutamine stress echocardiography(sensitivity, 58.3%). Among 9 patients who has single or minimal disease, 8 patients showed negative finding(specificity, 88.8%). 3) In hemodynamic changes, dipyridamole stress echocardiography showed significant changes in heart rates and double products and dobutamine stress echocardiography showed significant changes in heart rates, systolic blood pressure and double products. 4) There was no significant side effect during both stress tests inacute and old myocardial infarction patients. CONCLUSION: 1) The dobutamine and dipyridamole stress echocardiography are safe and easy test for myocardial infarction patients. 2) The dobutamine stress echocardiography has higher sensitivity than dipyrdamole stress echocardiography for identifying multivessel coronary disease in myocardial infarction patients but the dose of both drugs were relatively small to get the adequate results. So the high dose of drugs must be tried in feature study.
Angiography ; Blood Pressure ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Diagnostic Tests, Routine ; Dipyridamole* ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Exercise Test ; Heart Rate ; Hemodynamics ; Humans ; Myocardial Infarction* ; Phenobarbital ; Prognosis ; Sensitivity and Specificity

From retrospective review of 111 tibial fractures treated by interlocking intramedullary nailing, 38 operative errors in 28 cases(25%) were included in this study. The errors were classified into two categories. The first category included eighteen errors that related to fracture reduction; nine angular malalignments, four failures in closed nailing to open the fracture site, two peroneal nerve palsies, two shortenings of tibial length(more than 1cm), and one rotational malalignment. The second category comprised twenty errors that related to the nailing itself; eight protrusions of proximal nail tip, five overdistractions of fracture gap (more than 3mm), four additional fragmentations, two mistakes in interlocking screw insertion, and one ankle joint injury by the distal nail tip. Functional results of those 28 cases at the last follow-up(average, 17.5 months; range, 9 to 29 months) were excellent or good in only 60.8 per cent, while the control group treated by adequate operative technique showed excellent or good results in 92.8 per cent.
Ankle Joint ; Fracture Fixation, Intramedullary ; Paralysis ; Peroneal Nerve ; Retrospective Studies ; Tibial Fractures

The direct antiglobulin test (DAT) is used in investigating autoimmune hemolytic anemia, drug-induced antibodies, hemolytic diseases of newborn and alloimmune reactions to recently transfused red cells. We performed 3,033 DATs in our blood bank from 1985 to 1992. When using a polyspecific antihuman globulin reagent, the DAT was positive in 7.2% of all cases tested. In further studies using monospecific anti-IgG and anti-C3d reagents, three patterns of reactivity were founded: in 37% of cases, red cells are coated with IgG alone; in 18% of cases, the red cells are coated with both IgG and complement; and in 45% of cases only with complement. We evaluated clinical significance of DAT positive results with the 227 patients' medical records which can be available for reviewing among the positive DAT patients. The male to female ratio of DAT positive patient was 1:2 and 41% of cases were belong to the 20-30 years old age group. The most common underlying disorders were systemic lupus erythematosus (29.5%), idiopathic (10.1%), hematologic malignancy (8.8%), and liver disease (6.2%). Patients with warm reactive autoantibodies account for 60.4% of all DAT positive cases. Cold reactive autoantibodies were demonstrated in 11%, and the mixed-types were 2.6%. Drug-induced DAT positive findings were observed in 15.4% and the DAT positve caused with transfusion associated alloantibodies were 7.5%. IgG warm-reactive autoagglutinins were more commonly detected in patients with autoimmune hemolytic anemia and drug induced hemolysis. Definite hemolysis was present in 37% of all DAT positive patients and especially in all patients with mixed type autoagglutinin. Drugs caused a positive DAT were cephalosporin, penicillin, isoniazid, and rifampicin.
Anemia, Hemolytic, Autoimmune ; Antibodies ; Autoantibodies ; Blood Banks ; Complement System Proteins ; Coombs Test* ; Female ; Hematologic Neoplasms ; Hemolysis ; Humans ; Immunoglobulin G ; Indicators and Reagents ; Infant, Newborn ; Isoantibodies ; Isoniazid ; Liver Diseases ; Lupus Erythematosus, Systemic ; Male ; Medical Records ; Penicillins ; Rifampin