The anterior horn of the medial meniscus is the site of most variations, but anomalies of the medial meniscus are extremely rare. From July 1990 through December 1994, the authors performed arthroscopy on 1068 symptomatic knee joints and incidentally found anomalous insertion of the anterior horn of the medial meniscus into the anterior cruciate ligament in eleven knees. They had another lesion(7 discoid lateral meniscus with or without tear, medial collateral ligament tear, Posterior cruciate ligament avulsion fracture). All but one discoid lateral menisci were reshaped, one had to be treated by total lateral meniscectomy, discoid medial meniscus also by reshaping, torn medial meniscus by partial meniscectomy, torn medial collateral ligament by repair and avulsion fracture of posterior cruciate ligament by arthroscopic pinmonths(average, 21.7 months) after surgery. The results were satisfactory except for 2 patients. One damaged his knee in a traffic accident and the other was treated by total meniscectomy of discoid lateral meniscus. It was concluded that this anomaly was not related to the patient's symptoms and mainly associated with discoid lateral meniscus.
Accidents, Traffic ; Animals ; Anterior Cruciate Ligament ; Arthroscopy ; Collateral Ligaments ; Horns ; Humans ; Knee ; Knee Joint ; Menisci, Tibial ; Posterior Cruciate Ligament ; Tears

PURPOSE:Craniopharyngioma is one of the most important intracranial tumors in pediatric age which causes multiple pituitary hormone deficiencies. We have studied clinical characteristics in patients with craniopharyngioma, focusing on changes of endocrine function, change of growth pattern, and change of body mass index before and after surgery. In addition, we wanted to know the effect of growth hormone therapy on growth velocity and body mass index, and to identify contributing factors for spontaneous growth in spite of growth hormone deficiency. METHODS:A total number of 17 patients who were diagnosed as having craniopharyngioma at the Department of Pediatrics, Asan Medical Center during the period of January, 1991 to December, 1997 were included in this study. Retrospectively, we reviwed medical records as to their endocrine function tests and auxoloogical data before, after surgery. RESULTS: 1)The number of patients of male and female were 9 and 8 respectively. Mean age was 7.3+/-4.3 years. 2)Preoperatively, 3 patients were thyroid hormone deficient, 3 patients were corticosteroid deficient, and 3 patients suffered from diabetes inspidus. 3)Postoperatively, GH and TSH deficiency were found in 100%, ACTH in 88.2%, ADH in 82.3%, and LH/FSH in 60%, 53% respectively. 4) Mean growth velocity in 14 GH deficient patients without growth hormone treatment for 2 years were 3.5+/-2.4cm/year during the 1st year and 3.1+/-1.7cm/year during the 2nd year. Although height standard deviation score(Ht. SDS) was decreasing trend as -0.24+/-2.19 at diagnosis, -0.94+/-1.73 at 1 year later, and -0.76+/-1.76 at 2 years later, it was not statistically significant. To our suprise, 4 out of 14 patients achieved greater growth velocity than nomal in spite of growth hormone deficiency during the 1st year after operation. 5) Although the mean body mass index of 14 GH deficient patients without GH treatment was increasing trend as 17.9+/-3.5 at diagnosis, 19.0+/-4.5 at 1 year later, and 19.9+/-4.8 at 2 year later, it was not statistically significant. 6) The mean Ht. SDS increased significantly in 7 patients treated with growth hormone(P<0.05) for 2 years, but change of body mass index was not significant. 7) Comparision of postoperative serum prolactin levels and changes of body mass index between spontaneous growth and stunted growth group did not reveal significant difference. CONCLUSION: Since most patients with craniopharyngioma become multiple pituitary hormone deficient after operation, it is important to predict and detect pituitary dysfunction to manage it effectively. Although patients with postoperative GH deficiency responded well to GH treatment, further study is needed to clarify what are the main contributing or prognostic factors for spontaneous growth without growth hormone treatment.
Adrenocorticotropic Hormone ; Body Mass Index ; Chungcheongnam-do ; Craniopharyngioma* ; Diagnosis ; Female ; Growth Hormone ; Humans ; Male ; Medical Records ; Obesity ; Pediatrics ; Prolactin ; Retrospective Studies ; Thyroid Gland

PURPOSE:Although Hashimoto's thyroiditis is the most common cause of goiter in children and adolescents, it is not clear what proportion of patients become hypothyroid and which tests are the best predictors of this state. To determine whether these kinds of variations occur in the course of Hashimoto's thyroiditis and whether the size of the thyroid gland or immunologic markers correlate with the course or outcome of Hashimoto's thyroiditis are main objects of our study. METHODS:A total number of 48 patients who were diagnosed as having Hashimoto's thyroiditis at the Department of Pediatrics, Asan Medical Center during the period of January, 1992 to December, 1997 were included in this study. Retrospectively, we reviewed medical records as to their clinical and labaratory data. RESULTS:Thyroid function status at initial diagnosis of Hashimoto's thyroiditis were euthyroidism(33.3%), compensatory hypothyroidism(33.3%), overt hypothyroidism (27.1%), hyperthyroidism(8.3%) in order. Positivity of antithyroglobulin antibodies and antimicrosomal antibodies were 77.1% and 66.7% respectively. In 33 patients, 12(36.4 %) were on remission status after 3 years from initial diagnosis. Antithyroglobulin antibody titer was significantly decreased after 2-year follow up in remission group. Initial antithyroglobulin antibody titer and thyroid function status were not related to remission status after 3-year from diagnosis. CONCLUSION: About 36% of patients with Hashimoto's thyroiditis can be in remission after 3-year from diagnosis. Decrease of antithyroglobulin antibody titer is related to remission status. Further study is necessary to know what can be the predicting factors for early remission, for example, initial thyroid function status, initial antithyroid antibody titier, circulating immune complex, age, sex and size of thyroid.
Adolescent ; Antibodies ; Antigen-Antibody Complex ; Biomarkers ; Child ; Chungcheongnam-do ; Diagnosis ; Follow-Up Studies ; Goiter ; Humans ; Hypothyroidism ; Medical Records ; Pediatrics ; Retrospective Studies ; Thyroid Gland* ; Thyroiditis*

To investigate the properties and mechanism of PAF and TNF on the synthesis of prostaglandin E2 in human amnion, primary monolayer culture method was used for human amnion cell incubation. Amnion cells were incubated with various concentrations of PAF or TNF in Ca++ containing medium for various duration. Then PG E2 concentrations were measured by RIA and analyzed for the effect of PAF and TNF on PG E2 production according to their doses and incubation time. To test the role of Ca++ in E2 production, Ca++ free medium, Ca++ -channel antagonist and cyclo-oxygenase inhibitor were substituted or added in incubation medium. Following results were obtained. The synthesis of PG E2 was significantly enhanced by PAF of 10(-6) mol/L. The TNF also stimulated PG E2 synthesis at concentration of 10(-6)g/ml. The maximal level in PAF(10-6mol/L)-stimulated release of PG E2 was observed after 16 hours in incubation. The TNF(10(-6)g/ml)-induced PG E2 release was maximal after 24 hours of incubation. Combined application of PAF and TNF produced positive effect in PG E2 production. PAF or TNF stimulated-PG E2 production in Ca++ -free media was much lower than that of Ca++ -containing media. The PAF-stimulated PG E2 release was significantly inhibited by Ca++ -channel antagonist but TNF-stimulated PG E2 release was not effected by Ca++ -channel antagonist or cyclo-oxygenase inhibitor. It is strongly suggested us that both PAF and TNF enhance PG E2 release by amnion cell, although Ca++ -channel opening is essential only for PAF stimulation.
Amnion* ; Blood Platelets* ; Dinoprostone* ; Humans* ; Platelet Activating Factor* ; Prostaglandin-Endoperoxide Synthases ; Tumor Necrosis Factor-alpha*

Purpose : As the recombinant human growth hormone has been widely available, a lots of parents having short statured children are interested in promoting growth of them whatever the etiologies of short stature they have. However, the growth hormone therapy for growth-promoting effect is only justified in well-established indications such as growth hormone deficiency, fumer syndrome, and chronic renal insufficiency. This study was undertaken to classify the children with chief complaint of short stature by its cause and giving the basic epidemiologic data for it so that the size of population in which growth hormone is indicated can be estimated. Methods : According to Ranke's etiologic classification, we categorized the 579 children who visited our pediatric endocrinology clinic with chief complaint of short stature during the period of March 1994 to August 1996. In this prospective study, history regarding growth was taken, physical examination and laboratory tests including bone age, thyroid function, blood chemistry were carried out. The auxological data were analyzed. Additional chromosomal study or growth hormone provocative tests were performed when needed. Results : Out of 579 patients, 360(62.2%) were classified as normal and 127(21.9%) were classified as normal variants which consist of familial [74(12.8%)], constitutional [48(8.5%)], and mixed familial & constitutional short stature[5(0.9%)]. Pathologic short stature was found in only 80(13.8%). Those are growth hormone deficiency(28), Tumer syndrome(16), intrauterine growth retardation(14) in order. Other etiologies list varieties of dysmorphism, skeletal dysplasia, chromosomal disorders. Conclusions : This results suggest the vast majority of children with chief complaint of short stature are normal or normal variants. Only 7.8% of children who visited our clinic were indicated for growth hormone therapy.
Chemistry ; Child* ; Chromosome Disorders ; Classification* ; Endocrinology ; Growth Hormone ; Human Growth Hormone ; Humans ; Parents ; Physical Examination ; Prospective Studies ; Renal Insufficiency, Chronic ; Thyroid Gland

Since the invasiveness and metastatic potential of the carcinoma and the proliferation of the tumor cells are the decisional factors in determining the prognosis of carcinoma, it has been a principal area of study to foresee these factors in early stage of the disease process. The purpose of the study was to propose a method to precisely determine the prognosis of tumor. The investigation was performed, using laminin, type IV collagen, and Ki-67 antibody, to reveal the invasiveness and proliferation of the squamous cell carcinoma which is the most prevalent cancer in the area of oral and maxillofacial complex. Frozen tissue sections, 6-8mum in thickness, were prepared from the surgical excision of fresh squamous cell carcinoma for the experimental group. The control group was composed of sections from the normal oral mucosa of the contralateral side. Following incubation in an appropriate primary antibody including laminin, type IV collagen and Ki-67, LSAB method was employed and the tissue sections were treated with DAB for light microscopic immurlohistochemistry. Semiquantitative analysis of the basement membrane was composed of five different positivity of laminin and type IV collagen according to the intensity of the staining. Mean number of Ki-67 positive cells per 2000 total cells in one slide were calculated along with the standard deviation. The obtained results were as follows : 1. In the basement membrane of normal oral mucosa, antibodies against laminin and type IV collagen showed regular thickened, continuous line. Positive reaction was also detected in the vascular walls. Ki-67 labelling index was 4.10+/- 0.80%, and the positive cells were distributed mainly in the basal and parabasal cell layers. 2. In basement membrane of the proliferating tumor adjacent to carcinoma, antibodies against laminin and type IV collagen showed irregular thin, discontinuous line. Ki-67 labelling index was 18.95+/-4.67%, and the parabasal cell layer exhibited increased number of positive cells. 3. In the basement membrane of the main proliferating tumor, antibodies against laminin and type IV collagen showed almost indistinct interrupted line and/or almost indistinct line. Ki-67 labelling index was 31.56+/-5.51%, and the parabasal and spinous cell layer indicated increased cell positivity. 4. Invasive islands showed almost negative reaction to the antibody against type IV collagen, and almost indistinct line of the laminin antibody was observed. Based upon these findings, the loss of laminin and type IV collagen and the Ki-67 labelling index were the highest in the basement membrane of invasive islands. Therefore, it is thought that invasive islands were more deeply involved, than main proliferating tumor, in the invasiveness and proliferation of tumor, and the more the invasiveness of the tumor, the more the cell proliferative activity.
Antibodies ; Basement Membrane ; Carcinoma, Squamous Cell* ; Collagen Type IV* ; Islands ; Laminin* ; Mouth Mucosa ; Prognosis

Stress fractures have been well documented in the lower extremity. Stress fractures of the upper extremities are uncommon. We report a case of an ulna stress fracture in a 32 year old female non-professional golfer.
Female ; Fractures, Stress ; Humans ; Lower Extremity ; Ulna ; Upper Extremity

Unfused olecranon epiphysis has been reported rarely. We found an unfused olecranon tip within joint and a few small spurs on the apposing olecranon fossa and removed it successfully through the arthroscope. We think that it is a part of secondary ossification center of the olecranon and tbat it was separated through the epiphyseal plate by repetitive impaction of the tip of the olecranon into the olecranon fossa during pitching. In conclusion, fusion of the intra-articular part(articular center) of the olecranon epiphysis can not occur by nature. Repetitive extension overload during pitching may cause symptoms, and could be treated with arthroscopic control.
Adult ; Arthroscopes ; Baseball ; Epiphyses ; Growth Plate ; Humans ; Joints ; Olecranon Process

After reconstruction of anterior cruciate ligament, increased idameter of femoral or tibia1 bone tunnel has been obsened on plain radiogram. The etiology of radiographic tunnel enlargement is not well understood and the significance of this tunnel enlargement is unknown. This retrospective study reviewed tibial tunnel diameter in 34 cases of anterior cruciate ligament reconstructions. And we evaluated the correlation between the tibial tunnel enlargement and the position of screw fixation, instability, choice of graft, and clinical results at 1 year postoperatively. AII operation was per formed using a single incision technique. After 3 or 4 months and one year after operation, the diameter of tibial tunnel was measured with digital caliper on the plain radiogram. Tibial tunnel sclerotic margins were measured in the level Of medial tibial plateau on the lateral view of knee. Average tunnel enlargement of 3 allografts was 1.62mm and that of 15 autografts was 2.03mm. No significant difference was seen in KT-10000 arthrometer measurements between enlarged group (amount of enlage-ent >+1 S.D) and not-enlarged group (less than +1 S.D). No coelation was present between the increased tunnel diameter and Lysholm score. Cases with 10mm or more vertical distance between the most proximal point of tihial interference screw and the level of m4eial tibial plateau had average 1.15mm tibial tunnel enlargement and cases with less than 10mm vertical distance ha & I average 2.52mm tibial tunne] enlargement;the difference was not significant (P>0.05). The tibial tunnel enlargement was not correlated with position of screw, clinical results, stability of knee. The tibial tunnel enlargement was not caused hy only mechanical factor such as motion of intra-tunnel portion of graft-tendon.
Allografts ; Anterior Cruciate Ligament* ; Autografts ; Knee ; Retrospective Studies ; Transplants

The original technique for endoscopic anterior cruciate ligament reconstruction has several potential complications because of constraints imposed by working through the tibial tunnel: improper femoral tunnel placement, violation of the femoral tunnel posterior wall, femoral interferenc screw divergence, graft laceration during screw insertion, and distal tibial bone block prr>trusion. We performed 25 endoscopic anterior cruciate ligament reconstructions with bone-tendon-bone graft using a mo3ified technique that minimizes each of these problems, through the use of a anteromedial portal more centrally and distally placed than the original that portal. Postoperative radiographic review showed femoral screw divergence in 20% of cases (2 in the anteroposterior plane, 2 in the lateral plane and 1 in both planes), but the average angles (AP: 0.52+- 1.85, Lateral: 1.48+-3.30) were insignificant. There was no graft damage during screw insertion or grafttunnel mismatch. We concluded that this modified technique allows simplified, reproducible tunnel and interference screw placement.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Knee ; Lacerations ; Transplants