BACKGROUND: Anatomic anterior cruciate ligament (ACL) reconstruction has been presented as a means to more accurately restore the native anatomy of this ligament. This article describes a new method that uses a double bundle to perform ACL reconstruction and to evaluate the clinical outcome. METHODS: Grafts are tibialis anterior tendon allograft for anteromedial bundle (AMB) and hamstring tendon autograft without detachment of the tibial insertion for posterolateral bundle (PLB). This technique creates 2 tunnels in both the femur and tibia. Femoral fixation was done by hybrid fixation using Endobutton and Rigidfix for AMB and by biointerference screw for PLB. Tibial fixations are done by Retroscrew for AMB and by native insertion of hamstring tendon for PLB. Both bundles are independently and differently tensioned. We performed ACL reconstruction in 63 patients using our new technique. Among them, 47 participated in this study. The patients were followed up with clinical examination, Lysholm scales and International Knee Documentation Committee (IKDC) scoring system and radiological examination with a minimum 12 month follow-up duration. RESULTS: Significant improvement was seen on Lachman test and pivot-shift test between preoperative and last follow-up. Only one of participants had flexion contracture about 5 degrees at last follow-up. In anterior drawer test by KT-1000, authors found improvement from average 8.3 mm (range, 4 to 18 mm) preoperatively to average 1.4 mm (range, 0 to 6 mm) at last follow-up. Average Lysholm score of all patients was 72.7 +/- 8.8 (range, 54 to 79) preoperatively and significant improvement was seen, score was 92.2 +/- 5.3 (range, 74 to 97; p < 0.05) at last follow-up. Also IKDC score was normal in 35 cases, near normal in 11 cases, abnormal in 1 case at last follow-up. CONCLUSIONS: Our new double bundle ACL reconstruction technique used hybrid fixation and Retroscrew had favorable outcomes.
Adult ; Anterior Cruciate Ligament/*surgery ; Bone Screws ; Female ; Femur ; Humans ; Male ; Orthopedic Procedures/*methods ; Prospective Studies ; Tendons/transplantation ; Treatment Outcome ; Young Adult

OBJECTIVE: In Moyamoya disease, the primary goal of treatment is to improve collateral circulation through angiogenesis. In the present study, we obtained and sub-cultured bone marrow stromal cells (BMSCs) from rats without a cell-mediated immune response. Then, we injected the labeled BMSCs directly into adjacent temporal muscle during encephalomyosynangiosis (EMS). Three weeks after BMSC transplantation, we examined the survival of the cells and the extent of neovascularization. METHODS: We divided 20 rats into a BMSC transplantation group (n=12) and a control group (n=8). Seven days after the induction of chronic cerebral ischemia, an EMS operation was performed, and labeled BMSCs (1x106(6)/100 microliter) were injected in the temporal muscle for the transplantation group, while an equivalent amount of culture solution was injected for the control group. Three weeks after the transplantation, temporal muscle and brain tissue were collected for histological examination and western blot analysis. RESULTS: The capillary/muscle ratio in the temporal muscle was increased in the BMSC transplantation group compared to the control group, showing a greater increase of angiogenesis (p<0.05). In the brain tissue, angiogenesis was not significantly different between the two groups. The injected BMSCs in the temporal muscle were vascular endothelial growth factor (VEGF)-positive by immunofluorescence staining. In both temporal muscle and brain tissue, the expression of VEGF by western blot analysis was not much different between the two groups. CONCLUSION: During EMS in a chronic cerebral ischemia rat model, the injection of BMSCs resulted in accelerated angiogenesis in the temporal muscle compared to the control group.
Animals ; Blotting, Western ; Bone Marrow ; Brain ; Brain Ischemia ; Collateral Circulation ; Fluorescent Antibody Technique ; Mesenchymal Stromal Cells ; Moyamoya Disease ; Rats ; Temporal Muscle ; Transplants ; Vascular Endothelial Growth Factor A

OBJECTIVE: Bone marrow stromal cells (MSCs) are stem cells that can differentiate into chondrogenic, osteogenic, myogenic, adipogenic, and neurogenic cells according to the surrounding environment. Moreover, transplanted stem cells can migrate from the graft site in the recipient brain. The survival and migration patterns of the transplanted MSCs are investigated histologically. METHODS: Bone MSCs were harvested from adult Fisher rats and cultured for several passages. To identify cells derived from MSCs, 5microM bromodeoxyuridine (BrdU) was added to the medium 72 hours before transplantation. Bone MSCs were transplanted into the striatum of the recipient rat stereotactically. Test groups consisted of intracerebral transplantation of MSCs (n=6) and control-cultured medium alone (n=4). BrdU, hematoxylin and eosin staining were performed fourteen days after transplantation. RESULTS: More than 80% of the cultured MSCs showed reactivity to BrdU in vitro. Transplanted MSCs were found mainly around the injection route and migrated from the injection site about 1mm along the white matter. The corpus callosum clearly showed migration of MSCs. CONCLUSION: The results suggest that stem cells can be easily obtained from the adult bone MSCs and the transplanted MSCs can migrate from the grafted site. In such cases, the migration pattern of the grafted MSCs may be determined according to the recipient environment.
Adult ; Animals ; Bone Marrow* ; Brain ; Bromodeoxyuridine ; Corpus Callosum ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Mesenchymal Stromal Cells* ; Rats* ; Stem Cells ; Transplants

BACKGROUND: Coronary artery spasm plays an important role in the pathogenesis of variant angina. However the precise mechanism (s) and the clinical characteristics of variant angina remain to be elucidated. We investigated the clinical characteristics and diagnostic features of variant angina. METHODS: The clinical characteristics and coronary angiographic findings were analyzed in 178 patients with angiographically documented coronary artery spasm, which developed spontaneously or was provoked by the admistration of intravenous ergonovine maleate. All patients were followed for at least 1 year or more or until their death. RESULTS: One hundred and eleven patients complained of chest pain which developed especially at night and in the early morning. One hundred and thirty three patients (74.7%) were smokers. The electrocardiographic findings at the time of admission showed no changes in 147 cases (82.6%), testes showed ST segment elevation in 22 cases (12.4%), ST segment depression in 2 cases (1.1%), T wave inversion in 7cases (3.9%). The treadmill test was performed in 135 cases, ST segment elevation was noted in 6 patients (4.4%) and ST segment depression in 18 patients (13.3%). All of the other results were within normal range. The ergonovine provovative tests for coronary spasms were safe and effective. The right coronary artery was the most prevalent site of coronary artery spasm. Drug treatment was applied initially to all patients, but only 115 patients (64.5%) received the follow-up. Of these three died from cardiac arrest. The rate of cardiac death was low (1.7%) in patient, which made it difficult to know the risk factors for the cardiac deaths. Two (1.1%) had cardiac arrest. They didn`t take any medication. Patients with variant angina usually responded well to nitrates and calcium antagonists. Thus nitrates and calcium antagonists are useful in preventing attacks and abolished attacks of variant angina. CONCLUSION: In this study, 13.2% of coronary artery disease was variant angina. The effectiveness of drug therapy and the prognosis of the patients was quite good in the group. But when chest pain happens, the adequate use of nitrate agents is needed because of cardia arrest or cardiac death in 2.8% of the patients.
Calcium ; Cardia ; Chest Pain ; Coronary Artery Disease ; Coronary Vessels ; Death ; Depression ; Drug Therapy ; Electrocardiography ; Ergonovine ; Exercise Test ; Follow-Up Studies ; Heart Arrest ; Humans ; Nitrates ; Prognosis ; Reference Values ; Risk Factors ; Spasm ; Testis

Ionizing radiation has long been used in medicine since the discovery of X-rays. Diagnostic imaging using synchrotron radiation has been under investigation since Rubenstein et al. reported dual-energy iodine-K-edge subtraction coronary angiography. Recently, computed tomography (CT) and magnetic resonance imaging (MRI) have provided better quality results than conventional radiology, providing important information on human internal structures. However, such techniques are unable to detect fine micron sized structures for the early diagnosis of tumors, vascular diseases and other medical objectives. Third generation synchrotron X-rays are well known for their superiority in coherence and energy tunability with respect to conventional X-rays. Consequently, new contrast mechanisms with a superior spatial resolution are becoming available. Here we present the extremely fine details of live animal internal structures using unmonochromatized synchrotron X-rays (white beam) and a simple detector system. Natural movements of the internal organs are also shown. The results indicate that this imaging technique can be applied to investigating microstructures and evaluating the function of the internal organs. Furthermore, this imaging system may be applied to humans as the next tool beyond CT and MRI.
Animal ; *Diagnostic Imaging ; Male ; Mice ; Mice, Inbred HRS ; *Synchrotrons

Chronic neutrophilic leukemia(CNL) is a rare disorder characterized by persistent neutrophilia of mature cell type without evidence of infection, hepatosplenomegaly, elevated neutrophil alkaline phosphatase score and the absence of Philadelphia chromosome We report a typical case of CNL with multiple myeloma(IgG-lambda type) in 68 years old female. Many neutrophils had toxic granule and vacuole. The peripheral blood smear showed neutrophlic leukocytosis(50,940/microliter, neutrophil 94%) with rare immature form. The cytogenetic study showed normal karyotype without Philadelphia chromosome. She was diagnosed as multiple myeloma with paraproteinemia, lytic bone lesion of skull, and immature plasma cells in bone marrow.
Aged ; Alkaline Phosphatase ; Bone Marrow ; Cytogenetics ; Female ; Humans ; Karyotype ; Leukemia, Neutrophilic, Chronic* ; Multiple Myeloma* ; Neutrophils ; Paraproteinemias ; Philadelphia Chromosome ; Plasma Cells ; Skull ; Vacuoles

We performed 15 cases of modified Bristow procedures for recurrent anterior instability of shoulder from january, 1987 to december, 1992 and the following results were obtained. 1. The patient's age at initial dislocation varied from 15 years to 29 years of age. 2. The most common cause of the recurrent anterior instability of shoulder was sport injury(6 cases) and next were traffic accident, hanging with one hand. 3. The average loss of external rotation of shoulder after operation were 10 degrees and internal rotation were 7 degrees. 4. The post-operative complication and recurrence were not observed. 5. End results were excellent in 7 and good in 5 by Rowe's grading system. 6. Strict attention to bone block placement was mandatory and decreased the risk of screw malpo-sition.
Accidents, Traffic ; Dislocations ; Hand ; Recurrence ; Shoulder ; Sports

Usually the condition of ipsilateral fracture of femur and tibia is called floating knee, it is termed applied to the flail knee joint segment. The key point of the treatment is focused to the early restoration of the knee function. We experienced 86 consecutive cases during the period from March 1978 to February 1991 in Yonsei University Wonju College of Medicine. Among them, 51 cases(above 16 years old) were analysed with the mean follow up period of 2.1 years(1.2-5.6 years). The results obtained were as follows: 1. Main cause of these fractures is traffic accident. Among them, the pedestrian accident is more than in-car accident. 2. The cases of open fracture were 13 cases (25.5%) in femur and 31 (60.8%) in tibia. The degree of open fracture was more severe in tibia. 3. There were 2 cases (3.9%) of fat embolism syndrome preoperatively. 4. At an average 25 months follow up after injury, the good and excellent result of the group 1 and 3 was 85.2%, and the group 2 and 4 was 71.4% by Karlström and Olerud criteria. 5. At the last follow up examination, the mean loss of range of motion of the knee was 5.6° in group 1 and 3, 10.9° in group 2 and 4(P < 0.05). 6. The operative treatment of the both side is better than case of one side operation and other side conservative treatment.
Accidents, Traffic ; Clinical Study ; Embolism, Fat ; Femur ; Follow-Up Studies ; Fractures, Open ; Gangwon-do ; Knee ; Knee Joint ; Range of Motion, Articular ; Tibia

The purpose of this study was to investigate the ability of cultured chondrocytes to prevent formation of bony bridge and possibly to repair of the damaged growth plate. Growth cartilage cells were obrained from the new born canine epiphyseal plates and was culture-expanded in high density. It took 14 days until formation of micro mass of cartilage cells which was easily removable from the culture flask. Twenty dogs were divided into two groups: group I (10), the medial side of growth plate of right proximal tibia was destroyed and cultured chondrocytes were homografted into the defect: and group II (10), the medial side of growth plate of right proximal tibia was destroyed and was left as it was. Left leg was served as a control. Serial radiological and histological observation were made until 16 weeks after homografting to determine the growth parrern. Following results were obtained. 1. In group I, 8 of 10 dogs had near normal growth with little angular deformity of the tibia, averaging 8° at post-op 16 weeks. Two dogs had 20° angulation at 16 weeks post-surgery. In contrast in group II, angular deformity was obvious at 4 weeks post-surgery, reaching 31° at 16 weeks post-surgery. 2. In group II, bony bridge was consistently formed on the medial side of the proximal tibia. In group I, the cultured chondrocytes initially appeared to be an amorphous cartiagenous mass, which, however, remained to contribute to matrix formation as time went on. 3. This study showed the ability of cultrued chondrocytes to prevent formation of bony bridge and possibly to repair the damaged growth plate. To prove the effectiveness of homografting of the growth cartilage cells for reconstruction of the growth plat, further studies should be followed.
Allografts ; Animals ; Cartilage ; Chondrocytes ; Congenital Abnormalities ; Dogs ; Growth Plate ; Leg ; Tibia ; Transplantation, Homologous

No abstract available.
Amenorrhea* ; Cytogenetics* ; Female