This paper introduces a safe arthroscopic technique passing through the posterior septum from the posteromedial cotnpartment to the posterolateral compartment, or vice versa, without damage to the PCL, capsule, and/or neurovascular structures. The posterior septum is triangular, bounded by the PCL anteriorly, the posterior portion of the femoral I.ntercondylar notch superiorly, the posterior capsule posteriorly, and devicles the posterior compartment of the knee joint into the posteromedial and posterolateral compartments. The middle genicular vessel pierces the posterior capsule and runs along the superior border of the posteriorseptum. There are no dangerous important structures at the central portion of the triangle of the posterior septum. This arthroscopic posterior portal technique is devided 4 steps. The first step is to make a posteromedial portal under direct arthroscopic visualization. The second step is to make a posterolateral portal. The third step is to make a hole at the posterior septum and to examine throposterolatera] compartment. The fourth step is to examine the posteromedial compartment through the posterior septum. This technique provides complete visualization of the posterior compartment of the knee joint, including the posterior aspect of the both femoral condyles, the posterior hom of both menisci, the PCL, the meniscofemoral ligament (Wrisberg s ligament), the posterior aspect of the pop liteal tendon, the femoral attachment of the ACL, the posterior septum and the posterior capsule. We have used this technique from October, 1994 to June, 1996 in 58 knees; arthroscopic total synovectomy in 43, removal of the loose bodies located behind the PCL in 8, PCL re!construction in 4, meniscal repair with all inside suture technique in 3. In conclusion, this procedure is very helpful in performing arthroscopic total synovectomy in chronic, acute, hemophilic, and crystal induced synovitis, in removing encapsulated loose bodies located behind the PCL, and in suturing peripheral tears of the posterior hom of the medial rneniscus with an all inside suture technique.
Knee Joint* ; Knee* ; Ligaments ; Suture Techniques ; Synovitis ; Tendons

The purposes of this study were to evaluate the diagnostic modalities of the acute rupture of anterior cruciate ligament(ACL) and to know the differences hetween complete and partial ACL rupture preoperatively, analyzing the methods of physical examimation and the clinical features in acutely injured patient. We analyzed the anterior drawer test, Lachman test, KT-2000 arthrometer, MRI findings and associated injuries in the 35 patients who were confirmed to have ACL rupture by arthroscopy of the knee joint, performed within a month after trauma. We divided the patients by arthroscopy into 2 groups: complete rupture group and the partial rupture group. Among the 35 cases of ACL rupture, there were 10 cases of partial rupture and 25 cases of complete rupture. The Lachman s test was the most sensitive method of the physical examinations in detecting acute ACL injuries, with 90% and 92% positive rate in each group retrospectively. KT-2000 arthrometer with more than 3mm side-to-side difference showed all positive findings except one. The findings of ACL rupture in MRI were discontinuity, increased signal intensity, ahnormal course of ACL fibers and so on. The sensitivity of MRI in diagnosing the acute injuries of ACL was 97.2% hut had difficulties in differentiating the complete from partial rupture. Associated injuries of the ACL injured knee were medial and lateral meniscus tear and medial collateral ligament injury. The diagnosis of acute ACL rupture was made possihle hy physical examinations and with use of the KT-2000 arthrometer and MRI was useful in detecting the ACL rupture or associated injuries but not in differentiating complete from partial rupture of the ACL.
Anterior Cruciate Ligament* ; Arthroscopy ; Collateral Ligaments ; Diagnosis* ; Humans ; Knee ; Knee Joint ; Magnetic Resonance Imaging ; Menisci, Tibial ; Physical Examination ; Retrospective Studies ; Rupture

Neuroleptic malignant syndrome is a rare, but potentially life-threatening adverse event associated with the use of neuroleptic agents. We describe the case of a 47-year-old schizophrenic woman who was treated with clozapine for years. The patient developed acute renal failure with pulmonary edema, and underwent mechanical ventilation and hemodialysis.
Acute Kidney Injury ; Antipsychotic Agents ; Clozapine* ; Female ; Humans ; Middle Aged ; Neuroleptic Malignant Syndrome* ; Pulmonary Edema ; Renal Dialysis ; Respiration, Artificial ; Rhabdomyolysis

No abstract available.
Knee ; Ligaments* ; Magnetic Resonance Imaging

Fractures involving both tibial plataeus result form high energy trauma such as a traffic accidents or falls, and it is frequently accompanied by soft tissue injuries. Thus it is very difficult to treat these fractures satisfactorily and severe complications can be caused. The purpose of study is to analyze the clinical results, complication and factors influencing the results after open reduction and internal fixation of tibial bicondylar fractures. Twenty cases(19 patients) of tibial bicondylar fractures which had been treated by open reduction and internal fixation from January 1989 to December 1994 were analyzed after 1 to 5 years follow-up. The results were as follows. 1. By AO classification, the most common type was C3(13 cases). 2. According to Blokker's criteria, 5 cases was unsatisfactory and all of these cases were C3. 3. Unsatisfactory results were 3 cases of reduction loss(angular deformity), one case of deep infection and one case of unresolved peroneal nerve palsy. 4. Tibial tubercle osteotomy, bone graft and medial buttress plate were important for anatomical reduction and maintenance.
Accidental Falls ; Accidents, Traffic ; Classification ; Follow-Up Studies ; Osteotomy ; Paralysis ; Peroneal Nerve ; Soft Tissue Injuries ; Tibia ; Transplants

Carcinoma, Squamous Cell ; Gingiva ; Head ; Humans ; Hyperbaric Oxygenation ; Neck ; Osteoradionecrosis ; Prostheses and Implants ; Radiotherapy

BACKGROUND: Clinical trials have shown that b-adrenergic blocking drugs are effective and well tolerated in patients with mild to moderate congestive heart failure. Carvedilol is a mild b1-selective adrenergic blocking agent with vasodilating properties due to a blocker and antioxidant and anti-proliferative properties. This study assessed the efficacy and safety of carvedilol in patients with moderate to severe congestive heart failure caused by idiopathic dilated cardiomyopathy. METHODS: We enrolled 27 patients with moderate to severe congestive heart failure with a left ventricular ejection fraction of 35% by MUGA scan. Each patient was randomly assigned to either control (n-9) or carvedilol (n-18, target dose 25 mg bid) for 6 months while background therapy with digoxin, diuretics, and ACE inhibitor remained constant. RESULTS: Compared to the control group, patients in the carvedilol group showed significant increase of left ventricular ejection fraction (p<0.05). In addition, patients in the carvedilol group had a tendency to show a decrease in left ventricular end-diastolic dimension and heart rate. Also, the carvedilol group had a greater frequency of symptomatic improvement than the control group. There was neither serious side effects nor hospitalization. CONCLUSION: These finding indicate that carvedilol produces important clinical benefits in patients with moderate to severe heart failure treated with digoxin, diuretics, and ACE inhibitor without serious side effects.
Cardiomyopathy, Dilated ; Digoxin ; Diuretics ; Heart Failure* ; Heart Rate ; Hospitalization ; Humans ; Stroke Volume

Positron emission tomography(PET) is a diagnostic method that creates high resolution, 3-Dimentional tomographic images of the distribution of positron emitting radionuclides in human body. Computed tomography(CT) and magnetic resonance imaging(MRI) are routinely used to delineate the presence and extent of primary and metastatic oral and maxillofacial malignancy. Because the CT and MRI criteria for malignancy depend upon morphology, these imaging techniques have limitations in their ability to identify malignant tissue when fascial planes are distorted or destroyed. PET has the advantage of imaging metabolic changes that appear to be linked to malignancy. Recently, PET has shown promise in the early detection of primary and metastatic oral and maxillofacial canter and has been used to evaluate the tumor response to chemotherapy and radiotherapy. We report cases of diagnosis of oral and maxillofacial cancers and review the literatures to determine whether PET is effective in identifying oral and maxillofacial tumors.
Diagnosis ; Drug Therapy ; Electrons* ; Human Body ; Magnetic Resonance Imaging ; Positron-Emission Tomography* ; Radioisotopes ; Radiotherapy

The use and safety of the esophageal electrocardiogram for detection and diagnosis of using lead ll in major burn patient, especially burn of chest and face Compared with lead ll , 100% of cardiac rhythm was properly detected with the esopha-geal electrcardiogram. Large distinct P waves, resulting from the proximity of the esophageal lead to the left atrium, clearly established the temporal relationship between atrial and ventricular depo- larization Ne complications were encountered during the atudy. The esophageal lead is safe, simple to use, and provides valuable information fur dele- ction or diagnosis of cardiac rhythm during major burn anesthesia.
Anesthesia ; Burns* ; Diagnosis ; Electrocardiography* ; Heart Atria ; Humans ; Thorax

Gastric volvulus can either present as an acute or chronic symptoms according to the degree of gastric rotation and subsequent obstruction. The diagnosis of gastric volvulus is often difficult and is mainly based on imaging studies. We describe a case of mesenteroaxial gastric volvulus associated with paraesophageal hernia, well demonstrated on upper gastrointestinal (UGI) series and coronal reconstructed CT image.
Diagnosis ; Hernia, Hiatal* ; Intestinal Volvulus* ; Stomach Volvulus ; Stomach*