A retrospective quality assurance study of intraoperative consultation (frozen section) was carried out to assess the accuracy and to determine the reasons of discordance. Of 14,977 surgical pathology cases accessioned over a 6-month period in Asan Medical Center, frozen sections were done on 1,270 (8.5%) patients and 2,392 frozen sections (1.88 frozen sections/case) were performed. Discordance was noted in 106 cases (4.4%) and diagnosis was deferred in 26 cases (1.1%). All deferred cases were reviewed with the result of 53.8% justified and 46.2% unjustified. The discordant cases were divided into three categories as to their clinical significances: category A (no affect on patient care) 61.3%, B (minimal affect) 9.4%, and C (major affect) 29.2%. Of 31 category C cases, 7 cases were false positive and 24 cases were false negative. Misinterpretation (70.8%) was the leading cause of discordance, followed by sampling error (15.1%), failure to identify lesion (8.5%), and technical problem (5.7%). More than one-third (35.8%) of all discordances were of central nervous system cases. Total central nervous system cases were 403 (16.8%) with a significantly higher disordance rate (9.8%) and deferral rate (2.5%) in comparison to the other cases with 3.4% discordance rate and 0.8% deferral rate. There were 43 colorectal cancer cases of intraoperative consultation for adequacy of resectional margins. The surgical margins were between 0.4 cm and 28 cm (mean: 6.7 cm) away from the tumor and there was no tumor-positive case. The study indicates surgical pathology should 1) promote interpretative skills in cases involving minute fragments of neurosurgical cases, 2) defer the diagnosis and ask for more tissue on inadequate or inappropriate specimens and 3) give only gross opinions without unnecessary frozen section procedures in the event of simple, clear-cut cases.
Abscess ; Anti-Bacterial Agents ; Biopsy ; Central Nervous System ; Chungcheongnam-do ; Colitis, Ulcerative ; Colorectal Neoplasms ; Diagnosis ; Diagnosis, Differential ; Endoscopy ; Enterocolitis, Pseudomembranous* ; Frozen Sections* ; Humans ; Mucous Membrane ; Necrosis ; Pathology ; Pathology, Surgical ; Retrospective Studies ; Selection Bias

Divergent placement of the femoral interference screw has been described as a major pitfall in single incision endoscopic reconstruction of the anterior cruciate ligament. This study reviews the radiographic results in 30 consecutive endoscopic single-incision ACL reconstructions using interference screw fixation to find a method to reduce the divergent femoral screw fixation. We measured the angles which were determined by a line through axis of femoral bone block and axis of interference screw in anteroposterior and lateral view of knee(APD/LD),through axis of femoral tunnel and axis of tibial tunnel in the full extension-anteroposterior view(AFT),through the longitudinal axis of distal femoral shaft and axis of femoral tunnel in the anteroposterior and lateral view(APFT/LFT). Average LD(4.96+/-62degrees) was significantly larger than average APD(1.303+/-13degrees) (P=0.008). Significant correlation was present between APD and APFT(g=-0.3882, P=0.034), between LD and LFT(gamma=0.6933, P=0.000) and other variables had no significant correlation. The femoral divergence in the anteroposterior plane occurred in the case with small angle between longitudinal axis of femoral shaft and that of femoral tunnel, and vice versa in lateral plane. During drilling of femoral tunnel, more than 90 flexion causes LFT to increase and the risk of femoral divergence increases. Therefore, in the anteroposterior plane, angle between femoral tunnel and longitudinal axis of femoral shaft shoud be made as large as possible and flexion of knee should not be more than 90 during drilling of femoral tunnel.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Axis, Cervical Vertebra ; Knee ; Patellar Ligament*

Arthroscopically assisted anterior cruciate ligament(ACL) reconsturction provide a technique with less morbidity, less pin, less sacr, lower ris k of sepsis. The magnification offered by arthroscopic visualization also provide a clearer view, more precise location of anatomical landmarks, and the ability to place the graft in the exact anatomic sites. However, in order to accomplish all these goals, the surgeon must possess a high level of psychomotor skills, which take time and practice to develop. Wile this learning curve is being completed, there are occasion when complications will occur, and, realistically these may be difficult to avoid. The purpose of this study is to evaluate author's cases in which complication occurred during the endoscopic one-incision ACL reconstruction using the patellar tendon and to offer some tips on how to avoid them and how to salvage the situation if they do occur. We reviewed 22 complications (11 patients) out of 40 ACL reconstructions performed between May 1994 and December 1995. The complications were divergence(6), graft-tunnel mismatch(5), too anterior tibial tunnel(3), too anterior femoral tunnel(2), too posterior femoral tunnel(2), rotation of screw around the graft(2), guide pin breakage(1), bone plug retraction into the joint(1). It is suggested that arthroscopist should constantly try to avoid the intraoperative complications of arthroscopically assisted ACL reconstruction and follow the precautions and preventive measures recommended.
Intraoperative Complications ; Knee ; Learning Curve ; Patellar Ligament ; Sepsis ; Transplants

PURPOSE: The purposes of this study were to analyze the MR findings of medulloblastoma, and to evaluate the subarachnoid dissemination and the significance of contrast enhanced MR of brain and spine for tumor.. MATERIALS AND METHODS: The preoperative brain MR studies of 18 patients (9 males, 9 females;mean age, 9.4 years) with surgically proved medulloblastomas were retrospectively reviewed to characterize these neoplasms with regard to their location, size, MR signal intensity, appearance after contrast enhancement, presence of cyst and necrosis, subarachnoid dissemination, and other associated findings. In 14 patients postoperative spine MR studies were evaluated for staging and therapeutic planning. RESULTS: The most frequent location of medulloblastoma was the inferior vermis and the mean tumor size was 4.1 x 3.6 x 3.9 cm. On Tl-weighted image, medulloblastomas generally had low to intermediate signal, predominantly hypointense relative to white matter. On T2-weighted image, medulloblastomas showed modetately high signal, hyperintense relative to white matter. Inhomogeneous contrast enhancement was demonstrated in 13 patients(72.2%) after injection of gadopentetate dimeglumine(Gadolinium). Cyst and necrosis within the tumor were visualized in 15 patients(83.3%). Subarachnoid disseminations of medulloblastomas were noted in 11 patients(61.1%), of which 6 demonstrated intracranial and 2 intraspinal dissemination. Three had both intracranial and intraspinal dissemination. In nine cases with intracranial lesions, there were intraparenchymal mass formation(7), subarachnoid nodules(5), infundibular lesions(2) and diffuse gyral enhancement(I). In five cases with intraspinal lesions, there were extramedullary intradural small nodules(3), central canal nodules(2), intradural masses(I)and fine nodular and sheet-like leptomeningeal enhancement(1). Other associated findings included intratumoral hemorrhage(11.1%), per/tumoral edema(44.4%), tonsillar herniation(44.4%), hydrocephalus(88.9%) and calcification(44.4%). CONCLUSION: Medulloblastomas revealed low to intermediate signal intensity on Tl-weighted image and intermediate to moderately high signal intensity on T2-weighted image, relative to cerebellar white matter. Medulloblastomas were solid tumors with cystic necrosis, which showed inhomogeneous enhancement and subarachnoid disseminations to the intracranial and intraspinal spaces after Gd-DTPA enhancement. Gd-enhanced MR of brain and spine was an useful diagnostic modality in preoperative diagnosis and in staging of postoperative cases of medulloblastomas, which was superior to postcontrast CT or precontrast MR.
Brain* ; Diagnosis ; Gadolinium DTPA ; Humans ; Male ; Medulloblastoma ; Necrosis ; Retrospective Studies ; Spine*

No abstract available.
Blood Flow Velocity* ; Pregnancy* ; Umbilical Arteries*

The transarterial embolization has been widely used to control bleeding. It has a variety of clinical utility; to reduce bleeding on the surgical field, to reduce the size of malignant tumor as a preopearative treatment, to treat arteriovenous malformation or arterial aneurysm as a curative method and to promote life qua' ity of patient with diffuse or multiple hepatocellular carcinoma as a palliative treatment, etc. With the advance of modem technology, various embolic materials have been also developed. IIowever, it has not- been -fully investigated of histopathologic changes of the embolized organs according to the embolic materials used. This study was undertaken to investigate the histopathologic changes of embolized renal artery in rabbit by various embolic materials, according to each embolic material and to time passed by after embolization. Of the 5 arteries embolized by ethylene vinyl alcohol copolymer(EVAL), one showed abscess formation in embolized kidney. The other 4 allowed to perform further pathologic study: within a week after embolization there was no any specific change in vessels, however, r,unimal endothelial hypertrophy was observed following 2 weeks of embolization. Of the 8 renal arteries embolized by N-buthyl-2-cyanoacrylate(Histoacryl), 4 showed total occlusion of the main renal arteries as well as renal infarction, which reflects the strong adhesiveness of Histoacryl to vascular wall. The other 4 showed fibrinoid degeneration in vascular wall within a week. However, further change was not observed thereafter. In all the 5 renal arteries embolized by polyvinyl
Abscess ; Adhesiveness ; Aneurysm ; Arteries ; Arteriovenous Malformations ; Carcinoma, Hepatocellular ; Enbucrilate ; Hemorrhage ; Humans ; Hypertrophy ; Infarction ; Kidney ; Modems ; Palliative Care ; Polyvinyls ; Renal Artery*

The types of the synovial plicae were classified according to the classification of Kim and Choe(1997). The purpose of this study was to evaluate the diagnostic ability of MRI for synovial plicae. We retrospectively reviewed the MR findings of the knee in 95 cases of 91 patients. In all 95 cases, findings of arthroscopy and MR images were available. MRI was performed with a 1.5 Tesla Magnetom(Siemens) using a round surface coil. Pulse sequence were Tl weighted image(TR 650ms /TE 20ms) and T2 weighted image(TR 2000ms/TE 70ms). MR images could not show the infrapatella plicae and lateral plicae clearly, but some suprapatellar plicae were shown in T2 weighted MR images (37.5% of hole type, 80% of complete type, 26% of medial type). In 20(22%) of the 90 cases with medial patella plicae proved by arthroscopy, a low intensity band was shown above the medial condyle of the femur on T2 weighted MR images. These 20 cases included 3 of fenestra type, 9 of wide shelf type and 8 of medial shelf type. The low intensity band seen on T2-weighted MR images and its anatomical relation to the medial femoral condyle are helpful in diagnosing the presence of medial shelf type and wide shelf type of medial plicae.
Arthroscopy* ; Classification ; Femur ; Humans ; Knee* ; Magnetic Resonance Imaging* ; Patella ; Retrospective Studies

Objectives: The purpose of study is to evaluate serial MR imaging of myocardial infarction using non-surgical model of myocardial infarction after percutaneous transcatheter coronary arterial embolization in dogs. MATERIALS AND METHODS: We evaluated serial pre- and post-contrast MR images with Gd-DTPA (gadolinium-diethylenetriamine-pentaacetic acid) of heart of the eleven mongrel dogs (immediate group (n=3), one week group (n=3), three weeks group (n=5)) after making non-surgically induced myocardial infarction. We confirmed the infarct with TTC staining and microscopically. The location and extents of the myocardial infarction were correlated. RESULTS: A total of 24 MR images were archived; 11 images of the immediate post-embolic period, 8 images of one-week follow-up, and five of 3-week follow-up images. Comparing with the signal intensity of normal myocardium, immediate post-embolic MR images showed low or iso signal intensities (SI) of the infarct area on T1-weighted images (T1WI) and high SI on T2-weighted images (T2WI). No contrast enhancement with Gd-DTPA was made in all cases of the immediate post-embolic MRI. One-week and 3-week follow-up MR images showed low or iso SI on T1WI and slight high or iso SI on T2WI. Contrast enhancement images in both one-week and 3-week follow-up MRI showed denser enhancement of infarct area in one-week follow-up. The myocardial wall thinning was seen in 5 of eight dogs after one week and in 3 of five after 3 weeks. CONCLUSION: In non-surgical animal models of myocardial infarction, MR images showed low or iso SI on T1WI, and high SI on T2WI in various stages, and contrast enhancement was maximum after one week and gradual decrease to 3 weeks. The myocardial wall thinning was seen in one-to 3-week follow-up MR images.
Animals* ; Dogs ; Follow-Up Studies ; Gadolinium DTPA ; Heart ; Magnetic Resonance Imaging* ; Models, Animal* ; Myocardial Infarction* ; Myocardium

PURPOSE: To analyze angiearchitecture of arteriovenous malformations(AV malformation) in order to clarify the angiegraphic risk factors for intracerebral hemorrhage and other nonhemorrhagic symptoms. MATERIALS AND METHODS: Eighty-five patients with angiegraphically-proved brain arteriovenous malformation were included in this study. Retrospective review of clinical history and angiography was done. Topographic analysis and evaluation of 17 angiearchitectural characteristics were conducted. RESULTS: Deep-seated and cortico-callosal type, small nidus size, intranidal pouch, one draining vein, deep venous drainage only venous stenosis and venous aneurysm were the most discriminating or predictive characteristics of hemorrhage in brain arteriovenous malformation. And those with large nidus size, dural supply and venous hypertension were correlated with nonhemorrhagic symptoms such as seizure, headache and neurologic deficit. CONCLUSION: Detailed analysis of the angiearchitecture of brain arteriovenous malformations is needed to identify the features that are correlated with prognostic implications for the treatment of patients with ^V malformations.
Aneurysm ; Angiography ; Arteriovenous Malformations* ; Brain* ; Cerebral Hemorrhage ; Constriction, Pathologic ; Drainage ; Headache ; Hemorrhage ; Humans ; Hypertension ; Neurologic Manifestations ; Retrospective Studies ; Risk Factors ; Seizures ; Veins

To evaluate the normal development of the paranasal sinuses in children with CT, authors prospectively studied with brain CT scans of 260 children without known sinus diseases, ranging in age from 7 days to 16 years. Maximal anteroposterior and transverse diameters(mm) and maximal cross-sectional area(mm2) of both sides of the maxillary sinus were measured with the aid of computer device. As to the ethmoidal and sphenoidal sinuses, we simply documented the presence of the aplastic ethmoidal sinus and calculated the age-incidence of the sphenoidal sinus pneumatization, respectively. There noted three phases in the development of the maxillary sinus. The anteroposterior and transverse diameters of the maxillay sinus increased nearly in parallel. The former was always greater than the latter. In no cases was the ethmoidal sinus aplastic and almost all sinuses were pneumatized even in infants as early as 7 days old. CT identified the conchal pattern of sphenoidal sinus pneumatization in infants as early as 11 days old. Sphenoidal sinus pueumatization was seen in 38% of the children under the age of 1 year, 82% of the children between the age of 1 and 2 years, and almost all children older than 2 years. The anteroposterior and transverse diameters of the maxillary sinus seem to reach the adult size by 8 years of age, and the conchal pattern of sphenoidal sinus pneumatization can be recognized earlier with CT than on the plain radiographs.
Adult ; Brain ; Child* ; Humans ; Infant ; Maxillary Sinus ; Paranasal Sinuses* ; Prospective Studies ; Tomography, X-Ray Computed