The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. Indication: anatomic or pathophysiologic indication includes venous diameter within 2-20 mm, reflux time > or =0.5 seconds and distance from the skin > or =5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis > or =class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles' ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks.
Baths ; Catheter Ablation* ; Catheters ; Consensus* ; Heparin ; Knee Joint ; Lidocaine ; Saphenous Vein ; Sclerotherapy ; Skin ; Stockings, Compression ; Swimming ; Thrombosis ; Varicose Veins* ; Walking

No abstract available.
Nocardia Infections*

A 69-year-old male patient presented with a 2 week history of left leg swelling. The past medical history was unremarkable. On physical examination, his left leg was swollen up to the thigh and Homan's sign was positive. Duplex ultrasound revealed a solid and cystic lesion localized only at the iliac vein. Surgical exploration was performed under the suspicion of adventitial cystic disease (ACD). The final pathologic diagnosis was ACD. Although ACD has usually been reported in arterial segments, venous involvement has been reported. In the majority of these reported patients, the common femoral vein is associated with venous ACD. According to a Medline search, there have been nine reports related with venous ACD. Only two cases of external iliac vein (EIV) involvement of ACD have been previously reported, including one Korean report. We report here on a case of recently experienced EIV ACD.
Aged ; Edema ; Femoral Vein ; Humans ; Iliac Vein ; Leg ; Male ; Physical Examination ; Thigh

PURPOSE: To evaluate the antiproliferative and antifibrotic effects of alpha-tocotrienols in primary cultured orbital fibroblasts from thyroid-associated ophthalmopathy (TAO) patients. METHODS: Orbital fibroblasts were cultured (5 eyes from TAO patients, 5 eyes from normal patients) and classified into a control group, alpha-tocotrienol group and alpha-tocopherol group. The cell viability was measured using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. The proliferation of orbital fibroblasts was measured using the Click-iT(TM) assay. The collagen production of the control and alpha-tocotrienol groups was measured using a hydroxyproline assay. RESULTS: The alpha-tocotrienol and alpha-tocopherol groups showed no cytotoxicity up to 150 microm in orbital fibroblasts from TAO and normal patients. The proliferation of orbital fibroblasts from TAO and normal patients was significantly inhibited with alpha-tocotrienol at 80 microm and 120 microm. The collagen production of orbital fibroblasts from TAO patients was significantly inhibited with alpha-tocotrienol at 120 microm. CONCLUSIONS: The results from the present study indicate that non-toxic concentrations of alpha-tocotrienol have significant antiproliferative and antifibrotic effects on orbital fibroblasts from TAO patients.
alpha-Tocopherol ; Cell Survival ; Collagen ; Eye ; Fibroblasts ; Fibrosis ; Graves Ophthalmopathy ; Humans ; Hydroxyproline ; Orbit ; Tetrazolium Salts ; Thiazoles ; Troleandomycin ; Vitamin E

A case of child fasciola liver abscess was reported. This case was a. A 5-years-old boy who had a history of fever and abdominal pain for 2 days. There was eosinophilia (15%) and an abdominal ultrasound demonstrated heterogenous hypoechoic mass in the liver. He was diagnosed with bacterial liver abscess and was treated with Unasyn, Amikin, Cefotaxime, and metronidazole. But, the fever did not subside completely and blood eosinophil count was increased to 50%. New hypoechoic lesion in the liver was revealed on the follow-up abdominal ultrasound. Liver biopsy was done and it revealed eosinophil infiltration. Also, there was eosinophil infiltration (20%) in his bone marrow. The serologic test for parasite-specific IgG antibody by micro-ELISA confirmed the diagnosis of Fasciola hepatica infection. He was successfully treated for two days with oral Triclabendazole, 15 mg/kg, daily. Blood eosinophil count was down to 10% and there was no abnormal lesion in the liver on abdominal ultrasound finding.
Abdominal Pain ; Amikacin ; Biopsy ; Bone Marrow ; Cefotaxime ; Child* ; Diagnosis ; Eosinophilia* ; Eosinophils ; Fasciola ; Fasciola hepatica ; Fascioliasis ; Fever ; Follow-Up Studies ; Humans ; Immunoglobulin G ; Liver Abscess* ; Liver* ; Male ; Metronidazole ; Serologic Tests ; Ultrasonography

A 62-year-old male with a smoking history of 30 pack-years presented with a 1-year history of a periumbilical pulsating mass. He had been treated for hypertension for 2 years. Physical examination revealed a huge pulsating mass in the periumbilical abdomen. Femoral and popliteal arterial pulses were palpable. Computed tomography showed arterial dissection in the proximal segment of the superior mesenteric artery, a huge aneurysm (52×50 mm) with mural thrombus and two smaller aneurysms (20×20 mm) in the right ileocolic and ileal branches, along with atherosclerotic changes. Interposition using the great saphenous vein was performed after aneurysmal isolation and ligation of jejunal branches in the sac. Distal flow was reestablished by end-to-end and end-to-side anastomoses of the right ileocolic and ileal branches, respectively. No complications were observed at 1-year follow-up.
Abdomen ; Aneurysm* ; Aortic Aneurysm, Abdominal* ; Follow-Up Studies ; Humans ; Hypertension ; Ligation ; Male ; Mesenteric Artery, Superior* ; Middle Aged ; Physical Examination ; Saphenous Vein ; Smoke ; Smoking ; Thrombosis

PURPOSE: To investigate MR imaging characteristics of the fracture healing process. MATERIALS AND METHODS: We performed MR-pathologic correlation of fractures experimentally produced by the three-point beding system inthe proximal tibias of 24 New Zealand white rabbits. Axial spin echo T1-weighted image(T1WI), T2-weighted image(T2WI) and T1WI after gadopentetate dimeglumine injection were obtained 1-28 days after fracture MR imaging was followed by freezing, sectioning along the MR imaging planes and histopathologic examinations. Changes in MR signal around the fractures were correlated with histopathologic findings. RESULTS: Hematomas and inflammatory tissue around the fractures, noted one day after fracture, showed slightly increased homogeneous signal intensityon T1WI, heterogeneous hyperintensity on T2WI and heterogeneous contrast enhancement. Granulation tissue,cartilage, and immature osteoid, noted 1-4 weeks after fracture, showed iso- or slight hyperintensity on T1WI, hyperintensity on T2WI and contrast enhancement. Hard callus containing ossified osteoid showed hypointensity onboth T1WI and T2WI without contrast enhancement. CONCLUSION: The characteristics of MR signal intensity and contrast enhancing pattern can explain the histopathology of the fracture healing process.
Bony Callus ; Fracture Healing ; Freezing ; Gadolinium DTPA ; Hematoma ; Magnetic Resonance Imaging* ; Rabbits ; Tibia*

PURPOSE: Authors investigated the associated findings and their value in the diagnosis of anterior cruciate ligament(ACL) injury in MR image. MATERIAL AND METHODS: The knee MR images of 47 patients with ACL injury(complete; 24, partial; 23) and 61 patients with normal ACL confirmed by the knee arthroscopy or operation were reviewed retrospectively. The degree of anterior translocation of tibia and the degree of posterior cruciate ligament(PCL) buckling were evaluated. The prevalence and pattern of associated adjacent bone, ligament and meniscus injuries were studied. RESULTS: The means( +/- 2standard errors) of anterior translocation were different significantly in statistical analysis(p<0.001, student t-test) between injury group(7.51 +/- 1.16mm) and normal group(-0.56 +/- 0.92mm). In the level of 5mm of anterior translocation for the criteria of ACL injury, the sensitivity, specificity, accuracy were 78.7%, 89.5%, 84.3% for each. The means of PCL buckling ratio were also different statistically b. etween injury group(0.23 +/- 0.02) and normal group(0.17 +/- 0.01)(p<0.001). In the level of 0.20 for diagnostic criteria of ACL injury, the sensitivity, specificity, accuracy were 71.4%, 83.6%, 78.4% for each. Thirty one medial meniscus tear(66%), thirteen lateral meniscus tear(28%), ten medial collateral ligament injury(28%), one PCL injury (2%) were associated with ACL injury. The twenty nine bone marrow changes were found in twenty patients {43%) which included acutely injured seven patients. In acute cases, the bone marrow changes were depicted as diffuse or focal high signal intensity lesions in lateral femoral or tibial condyles in contrast to the changes in chronic cases depicted as focal low signal intensity lesions in variable location. Lateral femoral condylar notch depression were found in nine patients(19%) and avulsion fractures of anterior tibial spine in four patients(9%). CONCLUSION: The associated findings with ACL injury (anterior translocation, buckling of PCL, associated bone, ligament and meniscus injuries) are considered to be helpful in the diagnosis of ACL injury on Knee MR images, when the findings of anterior cruciate ligament itself are not confirmative.
Anterior Cruciate Ligament* ; Arthroscopy ; Bone Marrow ; Collateral Ligaments ; Depression ; Diagnosis ; Humans ; Knee ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Prevalence ; Retrospective Studies ; Sensitivity and Specificity ; Spine ; Tibia

PURPOSE: Authors investigated the associated findings and their value in the diagnosis of anterior cruciate ligament(ACL) injury in MR image. MATERIAL AND METHODS: The knee MR images of 47 patients with ACL injury(complete; 24, partial; 23) and 61 patients with normal ACL confirmed by the knee arthroscopy or operation were reviewed retrospectively. The degree of anterior translocation of tibia and the degree of posterior cruciate ligament(PCL) buckling were evaluated. The prevalence and pattern of associated adjacent bone, ligament and meniscus injuries were studied. RESULTS: The means( +/- 2standard errors) of anterior translocation were different significantly in statistical analysis(p<0.001, student t-test) between injury group(7.51 +/- 1.16mm) and normal group(-0.56 +/- 0.92mm). In the level of 5mm of anterior translocation for the criteria of ACL injury, the sensitivity, specificity, accuracy were 78.7%, 89.5%, 84.3% for each. The means of PCL buckling ratio were also different statistically b. etween injury group(0.23 +/- 0.02) and normal group(0.17 +/- 0.01)(p<0.001). In the level of 0.20 for diagnostic criteria of ACL injury, the sensitivity, specificity, accuracy were 71.4%, 83.6%, 78.4% for each. Thirty one medial meniscus tear(66%), thirteen lateral meniscus tear(28%), ten medial collateral ligament injury(28%), one PCL injury (2%) were associated with ACL injury. The twenty nine bone marrow changes were found in twenty patients {43%) which included acutely injured seven patients. In acute cases, the bone marrow changes were depicted as diffuse or focal high signal intensity lesions in lateral femoral or tibial condyles in contrast to the changes in chronic cases depicted as focal low signal intensity lesions in variable location. Lateral femoral condylar notch depression were found in nine patients(19%) and avulsion fractures of anterior tibial spine in four patients(9%). CONCLUSION: The associated findings with ACL injury (anterior translocation, buckling of PCL, associated bone, ligament and meniscus injuries) are considered to be helpful in the diagnosis of ACL injury on Knee MR images, when the findings of anterior cruciate ligament itself are not confirmative.
Anterior Cruciate Ligament* ; Arthroscopy ; Bone Marrow ; Collateral Ligaments ; Depression ; Diagnosis ; Humans ; Knee ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Prevalence ; Retrospective Studies ; Sensitivity and Specificity ; Spine ; Tibia

This paper reviews the indications and surgical technique of supramalleolar osteotomy as one of the treatments for moderate degenerative ankle osteoarthritis. Although it is technically demanding and requires extensive preoperative planning, supramalleolar osteotomy will be a good treatment option for moderate degenerative ankle osteoarthritis. The osteotomy is designed to shift the weightbearing axis to the lateral side of the ankle joint and unload the medial side of the joint. In our experience, a supramalleolar osteotomy is effective to the treatment of moderate ankle osteoarthritis with a small amount of preoperative talar tilt and varus or normal heel alignment.
Ankle Joint ; Ankle* ; Heel ; Joints ; Osteoarthritis* ; Osteotomy* ; Weight-Bearing