Evaluation and management of the anterior cruciate ligament (ACL) deficient knee pose several problems. For acute injuries, the essential factors are diagnosis of the ACL rupture and associated injuries, and selection of the appropriate method of the management. Until recently, the frequency of complete disruption of the ACL was though to be less than that of the medial collateral ligament. However, there is little doubt that the ACL is the most frequently torn ligament in the knee. Diagnosis may be made with a combination of tests: Anterior drawer, valgus or varus stress test, Lachman, and pivot shift. If the patients is unable to relax because of pain or fear, examination under the anesthesia should be performed. Treatment can be surgical or nonsurgical. Since the ACL is vital to normal knee function, surgical intervention is advisable in the majority of cases of acute disruption. Authors analyzed the records of 58 cases of acute knee ligament injuried patients treated at the department of Orthopaedic Surgery, Kang-Nam St. Marys Hospital, Catholic Medical College and Center, from November 1982 to January 1984, with follow-up range from 6 to 20 months. 1. Among 58 cases, 41(71%) had anterior cruciate ligament injury and 39(67%) had medial collateral ligament injury. 2. The causes of injury were mostly traffic accident (77%) and majority of the patients was in their twenties and thirties of age. 3. Among 41 cases of ACL Injury, 5 had isolated anterior cruciate injury, 27 cases (66%) had associated medial collateral injury, 9 (22%) had associated lateral collateral injury, and 7 (17%) had associated posterior cruciate ligament injury. 4. Meniscal injury was found only in 6 cases (15%); 4 medial and 2 lateral menisci. 5. Majority of anterior cruciate injured patients (71%) had more than 5mm joint openning than normal side in valgus or varus stress radiogram with the knee in extension. 6. In all cases of anterior cruciate ligament injured patients, the Lachman test was positive under the general anesthesia, hut anterior drawer test was positive in 80%. 7. In about 90% of the cases, the anterolateral rotatory instability (ALRI) test was positive and this finding was accentuated when the lateral collateral ligament was torn. 8. Among 41 cases, 16 (39%) had failure at the insertion site, 7 (17%) had tibial spine avulsion, and 9 patients each (22%) had tear at the ligament substance level and had grade II sprain. 9. In twenty-three, primary repair was done, in 9, primary intra-articular recopstruction was performed and 9 were treated conservatively. The result was from fair to excellent almost in all cases.
Accidents, Traffic ; Anesthesia ; Anesthesia, General ; Anterior Cruciate Ligament ; Clinical Study ; Collateral Ligaments ; Diagnosis ; Exercise Test ; Follow-Up Studies ; Humans ; Joints ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Menisci, Tibial ; Methods ; Posterior Cruciate Ligament ; Rupture ; Spine ; Sprains and Strains ; Tears

Management of patients with unstable fracture or fracture-dislocation of thoraco-lumbar spine continues to be controversial. One area of disagreement involves spinal fusion with internal fixation for prevention of later spinal instability. Intemal fixation of the spine without fusion has been advocated in the treatment of the unstable thoraco-lumbar fracture or dislocation. During the period of January 1981 to March 1984, thirty-two patients underwent fixation by Harrington distraction rod without fusion for the treatment of thoraco-lumbar fractures. Eight cases among them had second operation for the removal of the Harrington rods in 13.4months after Harrington rod fixation and were followed up clinically and radiolagically for 1 year at the Department of Orthopaedic Surgery, St. Mary's Hospital, Catholic Medical College and Center. The rationales for this procedure were to minimize the number of permanently stabilized segments and to provide more spinal mobility. We have expected that spontaneous fusion of vertebral body occur by the prolonged immobilization with Hamngton distraction rods. After the Harrington rods, the average conection rate of kyphotic angle was 41.8% and average correction rate of height of collapsed vertebral body or displacement of vertebral body was 42.3% at one year follow up. Instrumentations in eight patient were removed at 13.4 months after the initial surgery and the patients were followed up for one year. At the time of removal of instrumentation, unilateral partial facetectomy was done for histologic examination of the facet joint which is above the lower Harrington hook in four patients. The average correction rate of kyphotic angle was 37.5% and the average correction rate of height of collapsed or displaced vertebral body was 40.6% at one year after the removal of H-rods. The range of spine motions were incresed gradually. But histologic findings of the immobilized facet joint revealed fibrillation, fissures, thinning of the normal cartilagenous surface, decreased cartilagenous cellularity, and vascular tidemark invasion which are characteristics of osteoarthritis. Through this study, we obtained following conclusions: 1. Immediate Harrington distraction rodding was effective for the anatomic reduction of the collapsed vertebral body. And it provided immediate spinal stability, and spontaneous fusion of vertebral body. 2. Prolonged immobilization of the spine by Harrington rods is believed to have deleterious effect on articular cartilage of the immobilized facet joint as the degenerative changes of the cartilage of the facet joint was consistently found in this study. And it was regarded as a predisposing factors in the development of symptomatic arthritis of the spine. 3. If a fractured and collapsed vertebral body can be reduced by Harrington distraction rods, a spontaneous fusion of vertebral body occur. Harrington rodding without fusion could be one of the useful surgeries for management of the fractures and fracture-dislocation of the spine.
Arthritis ; Cartilage ; Cartilage, Articular ; Causality ; Dislocations ; Follow-Up Studies ; Humans ; Immobilization ; Osteoarthritis ; Spinal Fusion ; Spine ; Zygapophyseal Joint

PURPOSE: We designed this study to identify and suggest the reasonable timing of adjuvant radiotherapy in the treatment of uterine carcinosarcoma according to the surgical intent and patterns of progression. MATERIALS AND METHODS: We retrospectively analyzed a total of 50 carcinosarcoma patients diagnosed between 1995 and 2010. Among these 50 patients, 32 underwent curative surgery and 13 underwent maximal tumor debulking surgery. The remaining five patients underwent biopsy only. Twenty-six patients received chemotherapy, and 15 patients received adjuvant radiotherapy. RESULTS: The median follow-up period was 17.3 months. Curative resection (p < 0.001) and stage (p < 0.001) were statistically significant factors affecting survival. During follow-up, 30 patients showed progression. Among these, eight patients (16.0%) had loco-regional progression only. The patients who had received adjuvant radiotherapy did not show loco-regional progression, and radiotherapy was a significant negative risk factor for loco-regional progression (p = 0.01). The time to loco-regional progression was much earlier for non-curative than curative resection (range, 0.7 to 7.6 months vs. 7.5 to 39.0 months). CONCLUSION: Adjuvant radiotherapy in the treatment of carcinosarcoma might be related to a low loco-regional progression rate. Radiotherapy should be considered in non-curatively resected patients as soon as possible.
Biopsy ; Carcinosarcoma ; Follow-Up Studies ; Humans ; Radiotherapy, Adjuvant ; Retrospective Studies ; Risk Factors

No abstract available.
Smoke* ; Smoking Cessation* ; Smoking*

OBJECTIVE: To assess the results of the sacrospinous ligament suspension using Miya hook for the treatment of uterovaginal prolapse or vault prolapse following hysterectomy. METHODS: Between October 1997 and December 2000, in Kyung Hee Medical Center, 50 pelvic organ prolapse patients underwent vaginal hysterectomy and sacrospinous ligament suspension or sacrospinous ligament suspension only. We evaluated age, parity, operation time, recovery time, duration of hospitalization, change of Hemoglobin level, number of vaginal delivery, type of prolapse, and complications. RESULTS: Forty-four patients (88%) had uterine prolapse and six patients (12%) had vaginal vault prolapse. All patients underwent sacrospinous suspension and anterior-posterior colporraphy in which forty-one patients (82%) underwent concomitant vaginal hysterectomy. There has been one failure case. And then repeat sacrospinous ligament suspension with anterior and posterior vaginal repair was performed successfully. Recurrent prolapse hasn't been developed yet. Most common problems were transient voiding difficulty and vague buttock pain. CONCLUSION: The sacrospinous ligament suspension is considered to be effective and safe in the treatment of vault and uterine prolapse. It avoids major abdominal surgery and allows the surgeon to correct coexistent cystocele and rectocele.
Buttocks ; Cystocele ; Female ; Hospitalization ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Ligaments* ; Parity ; Pelvic Organ Prolapse* ; Prolapse ; Rectocele ; Uterine Prolapse

PURPOSE: This study aimed to characterize the autonomic and chaotic control of heart rate and circadian rhythm in asymptomatic patients with postoperative tetralogy of Fallot (pTOF). METHODS: Twenty-four-hour electrocardiogram recordings were obtained in 30 asymptomatic pTOF patients and in 30 age-and sex-matched controls, aged between 6 and 11 years. The data was digitized and partitioned into sections of 30- minute'durations. For each section, time-domain and frequency-domain measures (low- and high- frequency component) of heart rate variability and three measures based on chaotic dynamics- approximate entropy, correlation dimension and Lyapunov exponent-were calculated. RESULTS: In pTOF patients, 24-hour mean values of the time domain measures, high-frequency component, and all chaotic measures were significantly lower, while 24-hour mean value and all 6-hour mean values of the low-frequency component were significantly higher; all 6- hour mean values of high-frequency component, except from 6am to midday, were significantly lower. In pTOF patients, all 6-hour mean values of all three chaotic measures were significantly lower. In pTOF patients, the day- night circadian variation seen in controls was diminished (time- domain measures) or absent (low- and high- frequency component). CONCLUSION: Even in asymptomatic patients with pTOF, who are thought to be at minimal risk of fatal arrhythmia, a sustained increase in sympathetic activity and decrease in vagal activity, abnormal circadian rhythm of the autonomic activity, and decreased cardiac chaos were found. When other arrhythminogenic risk factors are superimposed, these abnormalities may contribute to the development of fatal arrhythmia and sudden death.
Arrhythmias, Cardiac ; Child* ; Circadian Rhythm* ; Death, Sudden ; Electrocardiography ; Entropy ; Heart Rate ; Humans ; Risk Factors ; Tetralogy of Fallot*

BACKGROUND: Recently, in our ageing society, the change in dietary pattern and increase in obesity have caused the metabolic syndrome to increase in Korea. Because of the association of the risk of cardiovascular diseases, the metabolic syndrome must be prevented and well managed. We examined the association between the metabolic syndrome and the serum testosterone and DHEA-S concentration. METHODS: The subject of this study included 231 men aged more than 40 years old who visited the health promotion center of a university hospital from March 2004 to March 2006. We excluded the subjects who were currently on medications except for antihypertensive and hypoglycemic agents. We defined the metabolic syndrome according to the ATP III with Asia-Pacific waist circumference. To examine the association between the metabolic syndrome and the serum testosterone concentration, we used the method of multiple logistic regression analysis. RESULTS: The prevalence of the metabolic syndrome in our subjects was 32.9%. Decreased serum testosterone concentration was significantly associated with large waist circumference and high fasting blood sugar. Men with testosterone values in the upper tertile had a significantly lower risk of metabolic syndrome (OR=0.34, P=0.018). CONCLUSION: After statistical adjustment for age, smoking, income, exercise, alcohol intake, and body mass index, the serum testosterone concentration was negatively associated with the metabolic syndrome.
Adenosine Triphosphate ; Adult ; Blood Glucose ; Body Mass Index ; Cardiovascular Diseases ; Fasting ; Health Promotion ; Humans ; Hypoglycemic Agents ; Korea ; Logistic Models ; Male ; Obesity ; Prevalence ; Smoke ; Smoking ; Testosterone* ; Waist Circumference

BACKGROUND: The optimal screening tools for hepat ocellular carcinoma are regular tests of alpha fetoprotein (aFP)and liver ultrasonography every 6 months in high risk group. To implement successful long-term project for reducing cancer-mortality,it is essential to know the reasons f or non-compliance among the high risk group. METHODS: A telephone survey was done a mong the hepatitis B surface antigen positive patient group who had not receiveda follow-up test of aFP and liver ultrasonography. This group was selected among the patients who had received health examinations from January,2002 to December,2002 at a university hospital center for health promotion, and the reasons for non-compliance were inquired. RESULTS: There were no stati stical di fferences i n educational level,economic status,age,and sex between the patient group who had taken appropriate follow-up tests and the group who had not. But there were statistically significant differences in the admission history and t ransf usi on hi st ory bet ween t he t wo groups. The reasons for non-compliance were as follows:1. ignorance to the significance of follow-up examination (41.7%),2.lack of time (27.8%),3.no specific signs of cancer (22.2%),4.high costs (5.6%),and 5.fear of discovering serious disease. CONCLUSION: It is important to have patients educated on the significance of screening and early diagnosis of hepatocellular carcinoma.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Compliance ; Early Diagnosis ; Follow-Up Studies ; Health Promotion ; Hepatitis B Surface Antigens* ; Hepatitis B* ; Hepatitis* ; Humans ; Liver ; Mass Screening* ; Telephone ; Ultrasonography

Hazardous chemicals, such as polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs) and heavy metals, are known as being harmful to human health were included in oils released by the Herbei Spirit Oil Spill accident in December 2007. To investigate changes of eating habits by the exposure to harmful substances, we conducted 5 focus group interviews for residents at Taean coast areas, who had experienced the oil spill accident. Participants included 46 women (mean age: 57.2 +/- 10.9) who were mainly responsible for preparing family meals. Focus group discussions were audio-taped, transcribed and categorized by themes. Participants expressed more frequent illness symptoms such as dizziness, vomiting, visual loss, and skin diseases after the accident. They mentioned that their worries about economic hardship and worsened health status since the accident induced mental problems, such as depression about their children. Regarding eating habits, participants reported less intakes of fishes and meats and relatively more intakes of vegetables and kimchi due to the lack of household incomes after the accident. Although the participants had been used to collecting or catching fish or shellfish for their consumption previously, they mainly purchased these foods from local markets after the accident. Changes of eating habits induced by the accident included drinking boiled water and having steamed or fried seafood rather than raw seafood. Changes of food intakes occurred less frequently in older adults due to their long-term fixed eating habits, although they felt uncomfortable for having raw fish. The findings of this study clearly present that the exposure of hazardous substances by the oil spill accident had a significant impact on changes in eating habits besides economic, physical, and mental problems among the residents in Taean. Continuous health and nutrition monitoring and support are needed.
Adult ; Child ; Depression ; Dizziness ; Drinking ; Eating ; Family Characteristics ; Female ; Fishes ; Focus Groups ; Hazardous Substances ; Humans ; Korea ; Meals ; Meat ; Metals, Heavy ; Oils ; Petroleum Pollution ; Polycyclic Hydrocarbons, Aromatic ; Seafood ; Shellfish ; Skin Diseases ; Steam ; Vegetables ; Volatile Organic Compounds ; Vomiting ; Water

The pathogenesis and origin of vulvar cyst lined by a ciliated columnar epithelium is unknown. But it is suggested that origins of the epithelium of cyst are Mullerian or Wolffian duct or urogenital sinus, while heterotopia (sequestration and migration of tissue) or dysontogenesis (defective embryonic development) or prosoplasia (abnormal development resulting in a "higher state" of organization) or metaplasia have also been suggested. We experienced one case of Mullerian cyst of vulva. So we report above the case with a brief review of literature.
Epithelium ; Metaplasia ; Vulva* ; Wolffian Ducts