Authors analyzed the findings of nineteen cases of arthroscopic second-look operations after posterior cruciate ligament (PCL) reconstruction with autogenous bone-patellar tendon-bone (BPTB) and Trevira augmentation by two tunnel technique during the period from Nov, 1993 to Jan. l997 in fifty-one cases, along with the results of reconstruction in terms of clinica1 knee scoring, radiographichl and arthroscopic findings. The results were as follows; Age ranged fmm 20 to 53 years, the average being 32.3 years. Thirteen cases (68%) had associated knee injuries; five medial collateral ligament (MCL) injuries, four lateral collateral ligament (LCL) injuries, two associated injuries of MCL and medial meniscus, one both menisci and one associated injury of anterior cruciate ligament and MCL. The average period fmm PCL injury to reconstruction was 7 weeks (range, 1 to 52 wecks) and the mean period from PCL reconstruction to second-look operation was 20.3 months (range, 10 to 46 months). The average Miiller s knee score at the last follow-up was 86 paints. The radiographical results: The distance of posterior translation of the PCL reconstrueted knee compared with the normal sidc knee in posterior stress roentgenography was average 3.8mm (range, 0 to 1 1 mm). The position of the fernoral bone block on the plane of extended Blumansaats line, from the anterior end of the line, was average 32%. The level of proximal end of the tibial bone block according to the tibial tunnel orifice into the joint was mean negative 2.6 degrees position. The findings of arthroscopic second-look examination; In 9 cases (47%), the reconstructed ligamcnts were well covered with synovial tissue and looked like almost normal PCL. There were five cases (26%) of severe fragmentation, three cases (16%) of partial torn fibers of the grafted tendon. And one case showed the thinning of thc grafted tendon compared with the initial diameter at the time of reconstruction and one case showed overgrawth of the synovial membrane which suitounding the grafted tendon. All the Trevira which were augmented at the time of PCL reconstruction were ruptured. Twelve cases (63%) were stable, three cases (16%) were slightly lax and 4 cases (21%) showed laxity of the grafted tendon by the posterior drawer test and probing under arthroscopy, The isometricity which was checked at the time of PCL reconstruction was average 3.4mm. From the ahove results, PCL reconstruction with autogenous BPTB by the two tunnel technique seemed to be a valuable procedure, but there were some cases of unfavorable results. Authors think that a new graft fixation method is needed for resolving the problem mentioned above.
Anterior Cruciate Ligament ; Arthroscopy ; Collateral Ligaments ; Dronabinol ; Follow-Up Studies ; Joints ; Knee ; Knee Injuries ; Lateral Ligament, Ankle ; Menisci, Tibial ; Paint ; Posterior Cruciate Ligament* ; Radiography ; Synovial Membrane ; Tendons ; Transplants

BACKGROUND: Primary stenting as a direct reperfusion procedure after acute myocardial infarction might reduce recurrent myocardial infarction and target vessel revascularization. However, result of long or multiple stenting in the long or tandem lesions were not known. METHOD: From Jan. 1996 to Dec. 1998, patients with acute myocardial infarction including cardiogenic shock were undergone primary stenting using long or multiple stent. The clinical end points were death, recurrent infarction, subsequent bypass surgery, or repeat angioplasty of the infarct-related vessel. The results were compared with age, sex, lesion, and risk matched standard stenting group. RESULT: Baseline characteristics were similar for the 20 patients who underwent standard length stenting and the 13 patients who underwent long or multiple stenting. Stent diameter was similar in two group (3.4+/-0.3 mm vs. 3.5+/-0.4 mm, p=0.65), but total stent length was longer in long or multiple stenting group (15.5+/-1.8 mm vs. 40.18.4 mm, p=0.01). Average numbers of stent using in multiple stenting were 1.5+/-0.7. Stenting in the infarct-related artery was successful in all patients randomized to stent treatment. At 6 months, the incidence of the primary end point was 25% (5/20) in the standard stent group and 31%(4/13) in the long or multiple stent group (p=0.5). CONCLUSION: Outcomes of long or multiple stenting including mortality, recurrent myocardial infarction and target vessel revascularization was similar to standard stenting. Long or multiple stenting after acute myocardial infarction may possible procedure in some selective cases having long or tandem lesion.
Angioplasty* ; Arteries ; Humans ; Incidence ; Infarction ; Mortality ; Myocardial Infarction ; Reperfusion ; Shock, Cardiogenic ; Stents*

PURPOSE: To help in the early diagnosis of postoperative infections in lumbar stenosis, attempts were made to evaluate a large number of patients having levels of ESR, CSR and CRP at fixed intervals, following an uncomplicated instrumented posterolateral fusion with wide decompression. MATERIALS AND METHODS: 101 lumbar stenosis patients were included in this study. The levels of ESR, CSR and CRP were checked on the 2nd, 3rd, 4th, 7th, 10th and 14th postoperative days. These data were plotted in relation to time in order to follow their changes. The relationships between these and the perioperative factors (operation time, fusion levels, estimated bleeding amount and transfusion amount) were evaluated statistically. RESULTS: The ESR and CSR had peak levels by the 3rd postoperative day, which then became highly variable until 14 days. The CRP level was highest on the 2nd postoperative day, which decreased rapidly, was and reached nearly normalized levels by 14th day. The ESR and CSR values on the 7th postoperative day showed a tendency to correlate with the perioperative factors, but the CRP value showed no significant correlations. CONCLUSIONS: Our study revealed the effectiveness of CRP, and ineffectiveness of ESR and CSR, in the early detection of deep infections following surgery for wide lumbar stenosis.
Constriction, Pathologic* ; Decompression* ; Early Diagnosis ; Hemorrhage ; Humans

Primary tumors of the heart are rare, three quarter of the tumors are benign, and nearly half of the benign heart tumors are myxomas. Cardiac myxoma usually originate in the left atrium about 75 percent, however, only 3 to 4 percent of myxoma are detected in the left ventricle. We report on a 32 years old woman with left ventricular myxoma who presented with shortness of breath, chest tightness, and general weakness. Acute pulmonary embolism and left ventricular myxoma were found on a perfusion lung scan and echocadiogram. A mass located on septal wall of left ventricle was excised en bloc. The patient recovered uneventfully and careful follow up has be performed periodically.
Adult ; Dyspnea ; Female ; Follow-Up Studies ; Heart ; Heart Atria ; Heart Neoplasms ; Heart Ventricles ; Humans ; Lung ; Myxoma* ; Perfusion ; Pulmonary Embolism* ; Thorax

It is very important to select the appropriate operative method in cancer surgery. For proximal gastric cancer, a total gastrectomy (TG) has usually had less morbidity and mortality than an extended total gastrectomy (ETG). To compare and evaluate the results of a TG with those of an ETG, the authors analyzed 50 cases treated by a TG and 50 cases treated by an ETG during the last 12 years. The results were as follows: The post operative complication rates were 34% for a TG and 54% for an ETG, the average operation time was 3 hours 53 minutes for a TG and 3 hours 42 minutes for an ETG, the postoperative fasting period was 7.1 days for a TG and 6.5 days for an ETG, and the mean length of hospital stay was 21.4 days for a TG and 22.6 days for an ETG. the ETG had a higher complication rate than the TG, but there was no statistical difference between the operation times, the postoperative fasting periods, and the length of stay in the hospital. from our experience, it is suggested that the ETG is easier, or almost the same, to carry out than the TG procedure. Therefore, we recommend an ETG for proximal gastric cancer to achieve better curative results.
Fasting ; Gastrectomy* ; Length of Stay ; Mortality ; Stomach Neoplasms*

BACKGROUND: Acute hypoxia tolerance has been evaluated by the time of useful consciousness, subjective symptoms, cardiovascular changes, visual deterioration, psychological performance, and so forth. But these methods are either subjective, lacking strict objectivity, or too demanding to collect sufficient data. Pulse oximeter monitoring has come to be used not only in hospitals but in the aviation environment. This noninvasive oxygen monitoring apparatus warrants a highly objective analysis to investigate acute hypoxia tolerance. METHODS: Eight healthy male volunteers (20-25 years old) were exposed three times to a simulated altitude of 25,000 ft (7,620 m) at intervals of 7 days. We monitored arterial oxygen saturation (SaO2) and pulse rate by a pulse oximeter. The duration from taking the mask off to the time of 60% SaO2 was regarded as acute hypoxia tolerance. The venous hemoglobin concentration was measured a day before exposure to hypoxia. A questionnaire on the 14 subjective hypoxic symptoms was obtained after hypobaric chamber training. RESULTS: There were neither differences of acute hypoxia tolerance, hemoglobin concentration, nor pulse rate according to the repeated exposure of hypoxia. Four symptoms of sleepiness, fatigue, flushing and thinking impairment were sustained regardless of repeated exposures to hypoxia. But the incidence of symptoms of ear pain, anxiety, abdominal pain were reduced according to the repeated hypoxia. CONCLUSION: With pulse oximeter monitoring there was no difference between the values of time of 60% SaO2 in repeated exposures to hypoxia. The incidence of some subjective symptoms was reduced according to the repeated exposures to hypoxia.
Abdominal Pain ; Altitude ; Anoxia* ; Anxiety ; Aviation ; Consciousness ; Ear ; Fatigue ; Flushing ; Heart Rate ; Humans ; Incidence ; Male ; Masks ; Oxygen ; Thinking ; Volunteers ; Surveys and Questionnaires

The management of thyroid nodules, about which widely differing views have been expressed for many years, is still a controversial subject. The primary reason for concern about thyroid nodules is that they might be malignant.The incidence of carcinoma in patients with multinodular goiters has reported to be considerably lower than in patients with a single nodule. In this retrospective study of 510 cases of thyroidectomies over a 14-year period, 151 patients with factors predisposing them to neoplasia, such as Grave's disease and thyroiditis, were eliminated. The remaining 93 patients with clinically evident multinodular goiters were compared with remaining the 226 patients with a solitary cold nodule. The incidence of carcinoma in the 266 patients with a solitary cold nodule was 15.4%. In the 93 patients with clinically evident multinodular goiters, the incidence of carcinoma was 18.3%. The difference is not significant. It is of interest that male patients with multinodular goiters had the highest incidence of carcinoma at 25.0%, whereas, males with a solitary cold nodule had an incidence of only 17.9%. In conclusion, once known factors that predispose patients to neoplasia are eliminated, there does not seem to be a significant difference in the incidence of thyroid carcinoma between patients with operatively and histopathologically proved solitary cold nodules and those with multinodular goiter.
Goiter* ; Humans ; Incidence* ; Male ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Thyroidectomy ; Thyroiditis

No abstract available.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Carcinogens, Environmental/adverse effects ; Combined Modality Therapy ; Helicobacter Infections/epidemiology/microbiology ; Helicobacter pylori ; Human ; Incidence ; Korea/ethnology ; *Precancerous Conditions ; Prognosis ; *Stomach Neoplasms/epidemiology/etiology/therapy ; *Transients and Migrants ; United States/epidemiology

C-reactive protein(CRP), a normal constituent of the serum in healthy individuals, increases in response to various bacterial infections and cellular necrosis. To find out if the C-reactive protein concentration is of any value in the diagnosis of acute appendicitis, ninety consecutive patients suspected to have acute appendicitis were studied prospectively. Of these, 54 patients(group A) had acute appendicitis and 6 patients(group B) underwent surgery with a diagnosis of acute appendicitis; however, histopathology disclosed a normal appendix. Seventeen patients(group C) had no identifiable cause for their illness and 13 patients(group D) had an identifiable cause for their illness, though not appendicitis. The mean serum CRP value was 49.00mg/L in group A, 18.92mg/L in group B, 20.31mg/L in group C, and 63.22mg/L in group D. Within group A, the mean CRP value in the 36 patients with the inflammed appendix was 33.56mg/L. The mean value in the 7 patients with the gangrenous appendix was 73.16mg/L, and 97.61mg/L in 11 patients with the perforative appendix. Serum CRP levels were normal in two patients with acute appendicitis. Besides these 2 patients, all patients with normal CRP had a normal appendix found at the time of operation or their symptoms resolved spontaneously. It is concluded that an increase in CRP levels to more than 5 mg/L is not a definitive indicator of acute appendicitis. However, when there is doubt about the diagnosis of acute appendicitis, a normal serum CRP level should be used as a basis for the decision to defer surgery.
Appendicitis* ; Appendix ; Bacterial Infections ; C-Reactive Protein* ; Diagnosis ; Humans ; Necrosis ; Prospective Studies

No abstract available.
Epilepsies, Myoclonic* ; Neuroblastoma*