In the endoscopic one-incision anterior cruciate ligament(ACL) reconstruction, placing the graft's tendon-bone interface flush with the intraarticular femoral tunnel results in frequent distal graft protrusion. On the contrary, we occasionally found that the intraarticular posterior cruciate ligament(PCL) length was longer than patellar tendon length and had a great difficulty in performing the endoscopic one-incision technique of PCL reconstruction. The purpose of this study is to get a certain guideline in the endoscopic one-incision technique of cruciate ligament reconstruction by measuring intraarticular distance of ACL, PCL and patellar tendon and by measuring distance between the insertion of pes anserinus and medial tibial plateau in 19 cadaveric knees. The results were as follows; 1. The average patellar tendon length was 36.2±4.7mm(range 24.7-45.0). 2. The average ACL length was 23.7±3.9mm(range 16.5-30.3). 3. The average PCL length was 32.7±3.8mm(range 25.4-41.0). 4. The average distance between the insertion of pes anserinus and medial tibial plateau was 38.3±5.4mm(range 27.2-53.6). Clinical Relevance: Since Korean patellar tendon is shorter than Caucasian's and intraarticular distance of ACL is same as Caucasian's, graft-tunnel mismatch doesn't seem to be a major problem with the accurate technique of the endoscopic one-incision ACL reconstruction in Korean patients. It is possible to interfere with the pes anserinus if the length of the tibial tunnel is needed more than 44.8 mm, It is very difficult to perform an endoscopic one-incision PCL reconstruction if the length of patellar tendon is less than 35mm because intraarticular distance of PCL is sometimes longer than patellar tendon in such cases.
Adult ; Cadaver ; Humans ; Knee ; Ligaments ; Patellar Ligament ; Transplants

Although procedures to reproduce the lost thumb through osteoplastic reconstruction and adjacent finger transfer operations appeared reasonably successful in providing for better prehension, nonetheless the methods lacked predictabiiity and too often the results were unacceptable esthetically. In recent years the development of microsurgery and surgical experiences has made it possible to free one stage transplantation of toe to replace missing thumb. Based on our past experiences with limb replantation since 1975, we accomplished the first toe to thumb transplantation done in Korea on October 28, 1978. Therafter we succeeded in one stage toe-to-thumb transplanatation in five cases. The shortest follow up period was thirteen months, and the longest, twenty-three months. One cases was excluded in this report due to short follow up period. Excellent results were achieved in all cases. There were no limping or pain while walking after removal of great toes or second toe. Great toe transplantation is more favorable donor area than second toe in toe-to-thumb transplantation. Free toe-to-thumb transplantation on making a thumb in missing thumb is the most excellent method of thumb reconstruction, but skillful technique and specialized microsurgical training is mandatory.
Extremities ; Fingers ; Follow-Up Studies ; Humans ; Korea ; Methods ; Microsurgery ; Replantation ; Thumb ; Tissue Donors ; Toes ; Transplantation ; Walking

No abstract available.
Emergencies ; Humans

Gastric stump cancer is defined as cancers that develop in the gastric remnant after the gastric resection of nonmalignant lesions or malignant lesions. The interval between gastrectomy and the detection of gastric stump cancer must be over 5 years in nonmaligant lesions and 10 years in malignant lesions. Symptoms of gastric stump cancer are not specific, so, diagnosis is often delayed. Early detection and curative operation is very important in gasric stump cancer and follow-up endoscopic examination is the most importaint diagnostic tool to detect gastric stump cancer. Recently we experienced a case of early gastric stump cancer. We report review of the literature to remind the important of gastric stump cancer and the important of follow-up endoscopic examination.
Diagnosis ; Esophagus* ; Follow-Up Studies ; Gastrectomy* ; Gastric Stump* ; Intestines* ; Stomach*

STUDY DESIGN: Retrospective study. PURPOSE: This study aims to investigate the clinical and radiological results of contralateral indirect decompression through minimally invasive unilateral transforaminal lumbar interbody fusion (MI-TLIF). OVERVIEW OF LITERATURE: Several studies have proposed that blood loss and operation time could be reduced through a unilateral approach, although many surgeons have forecast that satisfactory foraminal decompression is difficult to achieve through a unilateral approach. METHODS: The study included 30 subjects who had undergone single-level MI-TLIF. Visual analogue scale (VAS) and Oswestry disability index (ODI) were analyzed for clinical assessment. Disc height, segmental lordosis, and lumbar lordosis angle were examined for radiological assessment. The degree of contralateral indirect decompression was evaluated through a comparative analysis, with a magnetic resonance imaging (MRI) performed preoperatively and at one year postoperatively. RESULTS: Intraoperative blood loss volume was 308.75 mL in the unilateral approach group (UAP), and 575.00 mL in the bilateral approach group (BAP), showing a statistically significant difference. Operation time was 139.50 minutes in the UAP group, and 189.00 minutes in the BAP group, exhibiting a statistically significant difference (p<0.05). On the other hand, no significant difference was found in VAS, ODI, disc height, lordosis angles and the degree of nerve decompression in the vertebral foramen, using MRI, between the two groups (p>0.05). CONCLUSIONS: Satisfactory results were acquired with MI-TLIF conducted through the unilateral approach of contralateral indirect decompression, in alignment with the bilateral approach. Therefore, contralateral indirect decompression is thought to be a useful procedure in reducing the operation time and volume of blood loss.
Animals ; Decompression* ; Hand ; Lordosis ; Magnetic Resonance Imaging ; Retrospective Studies ; Spinal Fusion ; Surgical Procedures, Minimally Invasive

PURPOSE: The effects of gonadotropin-releasing hormone agonist (GnRHa) treatment on the energy metabolism in girls with central precocious puberty (CPP) are controversial. We focused the changes and related factors of serum levels of leptin and adiponectin in girls with CPP before and during GnRHa treatment. METHODS: Thirty girls with idiopathic CPP were enrolled in the study. Their auxological data and fasting blood were collected at the baseline and after six months of GnRHa treatment. RESULTS: After treatment, height (P<0.001), weight (P<0.001), and serum leptin levels (P=0.033) were significantly increased, whereas body mass index (BMI), homeostasis model of assessment-insulin resistance, serum adiponectin levels, and adiponectin/leptin ratio exhibited no significant changes. A Pearson correlation analysis showed that height, weight, BMI, and their standard deviation scores (SDSs), but not basal LH, FSH, and estradiol, were significantly correlated with serum leptin levels before and after GnRHa treatment. After a multiple linear regression analysis, only BMI was associated with serum leptin levels. Moreover, leptin SDSs adjusted for BMI were not significantly different before and after GnRHa. The Δ leptin levels (r2=0.207, P=0.012), but not with Δ leptin SDS (r2=0.019, P=0.556), during GnRHa treatment were positively correlated with Δ BMI. CONCLUSION: These results suggest that GnRHa treatment in girls with CPP does not affect serum levels of leptin and adiponectin and insulin resistance. Serum leptin levels were depend on the changes in BMI during GnRHa treatment.

PURPOSE: The effects of gonadotropin-releasing hormone agonist (GnRHa) treatment on the energy metabolism in girls with central precocious puberty (CPP) are controversial. We focused the changes and related factors of serum levels of leptin and adiponectin in girls with CPP before and during GnRHa treatment. METHODS: Thirty girls with idiopathic CPP were enrolled in the study. Their auxological data and fasting blood were collected at the baseline and after six months of GnRHa treatment. RESULTS: After treatment, height (P<0.001), weight (P<0.001), and serum leptin levels (P=0.033) were significantly increased, whereas body mass index (BMI), homeostasis model of assessment-insulin resistance, serum adiponectin levels, and adiponectin/leptin ratio exhibited no significant changes. A Pearson correlation analysis showed that height, weight, BMI, and their standard deviation scores (SDSs), but not basal LH, FSH, and estradiol, were significantly correlated with serum leptin levels before and after GnRHa treatment. After a multiple linear regression analysis, only BMI was associated with serum leptin levels. Moreover, leptin SDSs adjusted for BMI were not significantly different before and after GnRHa. The Δ leptin levels (r2=0.207, P=0.012), but not with Δ leptin SDS (r2=0.019, P=0.556), during GnRHa treatment were positively correlated with Δ BMI. CONCLUSION: These results suggest that GnRHa treatment in girls with CPP does not affect serum levels of leptin and adiponectin and insulin resistance. Serum leptin levels were depend on the changes in BMI during GnRHa treatment.

Achalasia is very uncommon in children, and cases accompanied with alacrima and adrenal insufficiency is even more uncommon. When these three disorders are seen altogether, it is called triple A syndrome. It is inherited in an autosomal recessive manner and has potentially life-threatening sequelae. So, pediatricians should always consider the possibility of triple A syndrome when seeing children with achalasia. Neurological abnormalities such as autonomic neuropathy, peripheral neuropathy, sensory impairment and mental retardation occasionally accompany. We report a 2-year-old girl who presented with repeated vomiting, short stature and alacrima. Diagnosis of achalasia was made after perfoming esophagogram and endoscopy and was confirmed with esophageal manometry. After pneumatic dilatation, she became asymptomatic.
Adrenal Insufficiency ; Child ; Child, Preschool ; Diagnosis ; Dilatation ; Endoscopy ; Esophageal Achalasia ; Female ; Humans ; Intellectual Disability ; Manometry ; Peripheral Nervous System Diseases ; Vomiting

Background: The purpose of this study is to explain the factors influencing the incurrence of catastrophic health expenditure of national health insurance households using panel data observed over a long period. Methods: The study targeted 3,652 households who had no censoring during the 11-year survey period (2007–2017) and householders whose insurance type was consistently maintained as national health insurance. Generalized estimating equations were adopted to identify factors affecting the occurrence of catastrophic health expenditure at 20%, 30%, and 40% threshold levels. A subgroup analysis was conducted by categorizing groups depending on the existence of the elderly in the household. Results: For the last 11 years, the incidence of catastrophic health expenditure in the households without the elderly decreased slightly at all threshold levels, but the households with the elderly seemed to be increased. At baseline, household type showed a statistically significant relationship with all other variables. The results of generalized estimating equations analyses show that household income was not significant at all threshold levels in the households without elderly. On the other hand, in the households with the elderly, the 2nd (odds ratio [OR], 1.33–2.05) and 3rd quintile groups (OR, 1.25–2.55) were more likely to have catastrophic health expenditure compared to the 1st quintile of household income group. Conclusion As the amount of health expenditures relative to the ability to pay is increasing in households with the elderly, the application of an intervention followed by consistent monitoring is needed. This study found that there were differences in influencing factors according to the presence of the elderly in the households. In particular, in households with the elderly, interesting results have been drawn regarding the occurrence of catastrophic health expenditure in the near-poor, so additional research is required.

No abstract available.
Cisplatin*