PURPOSE: To avoid prolonged recovery time and scar tenderness in open carpal tunnel release and possible nerve or tendon injuries by bulky instruments in endoscopic techniques, we tried to percutaneously release the transverse carpal ligament using simple, thin instruments. MATERIALS AND METHODS: We performed carpal tunnel release percutaneously through a single small incision on the wrist with curved mosquito and meniscectomy hook knife under general or regional anesthesia in 41 wrists of 27 patients during the last 5 years and followed up for at least one year. Before and after release, endoscopic examinations were done to rule out space occupying lesions or other anormalies and to confirm complete release. RESULTS: According to the Cseuz's criteria, 38 cases (93%) showed excellent or good results, which was compatible to open or endoscopic technique with special instruments and there was no major neurovascular injury except one superficial palmar arch laceration associated with the second palmar incision in complicated case. CONCLUSIONS: From earlier experience, we learned that this simple technique may be used successfully with low cost without any fear of complication.
Anesthesia, Conduction ; Cicatrix ; Culicidae ; Humans ; Lacerations ; Ligaments ; Tendon Injuries ; Wrist

Polyethylene wear is one of the major problems following total knee arthroplasty. Many factors affect the degree and the pattern of polyethylene wear. We experienced three cases of early catastrophic poly- ethylene wears. All cases showed flexion contracture with severe genu varum deformity and total knee arthroplasty was performed with Advantim total knee prostheses in all cases. Postoperatively, bony align- ment and ligament balancing were good in all cases. However, in 12 to 22 months later, lateral subluxa- tion and valgus instability were developed with early catastrophic polyethylene wear especially in the medial compartments. Flat surface geornetry of polyethylene might be responsible for the development of lateral subluxation and early catastrophic wears. From these experience, we concluded that the mediolat- eral as well as anteroposterior dishing is essential for the stability of the artificial joint and prevention of early rapid wear of polyethylene articular inserts following total knee arthroplasty.
Arthroplasty ; Congenital Abnormalities ; Contracture ; Genu Varum ; Joints ; Knee ; Knee Prosthesis ; Ligaments ; Polyethylene*

NO abstract available.
Glomerulonephritis, IGA* ; Humans ; Immunoglobulin A* ; Lymphocytes* ; RNA, Messenger* ; Transforming Growth Factor beta

Schwannomas are benign, slow-growing peripheral nerve sheath tumors commonly occurring in the head, neck, and flexor regions of the extremities. Although most schwannomas are easily diagnosable, their variable morphology can occasionally create difficulty in diagnosis. Reporting pathologists should be aware that schwannomas can exhibit a broad spectrum of morphological patterns. Clinical and radiological examinations can show correlation and should be performed, in conjunction with ancillary tests, when appropriate. Furthermore, deferring a definitive diagnosis until excision may be necessary for small biopsy specimens and frozen sections. This report underscores these challenges through examination of two unique schwannoma cases, one predominantly cellular and the other myxoid, both of which posed significant challenges in histological interpretation.

Aneurysms of the superior mesenteric artery are rare, accounting for 8% of visceral artery aneurysms. About 60% of all superior mesenteric artery aneurysms have a mycotic origin. The only helpful clinical manifestations are episodes of previous abdominal pain and a history of valvular heart disease. In this case, a 66-year-old female patient with mitral regurgitation and aortic regurgitation presented with pain in the upper abdominal area. A superior mesenteric artery aneurysm was diagnosed at the time of impending rupture. Since excellent collateral circulation was present, an aneurysmectomy without revascularization was performed, and no ischemic symptom occurred. The patient presented no major complications during the postoperative course.
Abdominal Pain ; Aged ; Aneurysm ; Aneurysm, Infected* ; Aortic Valve Insufficiency ; Arteries ; Collateral Circulation ; Endocarditis* ; Female ; Heart Valve Diseases ; Humans ; Mesenteric Artery, Superior* ; Mitral Valve Insufficiency ; Rupture

PURPOSE: The diagnosis of hypertrophic pyloric stenosis(HPS) can be made by clinical manifestations and upper gastrointestinal(UGI) series in most cases. Recently, the ultrasonogram(US) is a more accurate and reliable method for the diagnosis of HPS in early stage. METHODS: We retrospectively studied 27 HPS patients confirmed surgically from January 1999 to March 2000. We reviewed clinical histories and physical and laboratory findings. Among these patients, ultrasonograms were carried out in 23 cases preoperatively. Therefore, we analyzed pyloric muscle thickness(PT), pyloric diameters(PD), and pyloric canal lengths(PL), and calculated pyloric volume(PV) by the equation of 'PV=pie(1/2PV)2xPL'. RESULTS: The mean age on admission was 39.0+/-20.4 days and 70.4% of the patients were under 6 weeks of age. The mean age at onset was 26.9+/-20.4 days and the duration of symptoms was 12.7+/-11.6 days. On physical examination, the pyloric tumors were palpated in 14 cases(51.9%) and the gastric peristalses were noted in 8 cases(29.6%). UGI series were carried out in 21 cases, and all of them had the characteristic findings of HPS. The mean PT was 5.23+/-1.05mm, the mean PD wase 13.56+/-2.25mm, the mean PL was 21.42+/-3.85mm, and the calculated PV was 3.23+/-1.35 mL. According to the criteria by Stunden, et al., PT(>=4mm), PD(>=12mm) and PL(>=15mm) were satisfied in 91.3, 73.9 and 91.3% respectively. The PV(>=1.4mL) was satisfied in 95.7% according to the criterion by Westra, et al. CONCLUSION: The US in the diagnosis of HPS is safe and useful. With measurements of PV parameter, the diagnosis by US will be more reliable and more accurate.
Diagnosis ; Humans ; Peristalsis ; Physical Examination ; Pyloric Stenosis, Hypertrophic* ; Retrospective Studies ; Ultrasonography

Nesidioblastosis is characterized by a diffuse proliferation of islet cells arising from pancreatic ducts and is the most common cause of hyperinsulinemic hypoglycemia in newborns and infantile. It is exceedingly rare in adults and no concensus regarding its diagnosis and management is available. We herein describe an elderly man with fasting hypoglycemia, inappropriate insulin hypersecretion. And pathologic examination of his pancreas revealed the characteristic finding of nesidioblastosis confirmed by immunohistochemical stain.
Adult ; Aged* ; Diagnosis ; Humans ; Hypoglycemia* ; Infant, Newborn ; Insulin ; Islets of Langerhans ; Nesidioblastosis* ; Pancreas ; Pancreatic Ducts

PURPOSE: We evaluated oncologic outcomes of chondrosarcomas and analyzed the disease-free survival rate of chondrosarcomas according to the various factors. MATERIALS AND METHODS: We performed a retrospective study for the disease-free survival rate of 48 chondrosarcomas, 44 of which underwent surgical treatment and followed up more than 18 months since 1993, and in the remaining 4 cases, the patients died before 18 months after surgery. The vsariables were location, tumor volume, histologic grade, stage, age at presentation and treatment performed. The mean follow up period was 43.8 months (1-196 months). RESULTS: The overall disease-free survival rate was 77.1% at mean 43.8 month follow up. The 5 year- and 10 year disease-free survival rates were 64% and 58% respectively. The histologic grade, stage, age at presentation revealed statistical significance on disease-free survival. All 9 patients treated with extended curettage for grade 1 central chondrosarcomas revealed disease-free survival with excellent functional outcome. CONCLUSION: The disease-free survival rate of chondrosarcomas mainly depended on histologic grade, stage and age at presentation. Local recurrence and distant metastasis also revealed statistically significant differences of disease-free survival rate. Comparing to wide resection, extended curettage for low-grade central chondrosarcomas in extremities were efficient methods with similar survival rate and less functional losses and complications.
Chondrosarcoma ; Curettage ; Disease-Free Survival ; Extremities ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Survival Rate ; Tumor Burden

PURPOSE: To investigate prognostic factors influencing on local recurrence, distant metastasis and event-free survival of liposarcomas. MATERIALS AND METHODS: Fifty-two patients managed for liposarcomas since 1993 were analyzed respectively in the view of prognostic influence of patient age, tumor size, location, histologic type, histologic grade, resection type, surgical margin, chemotherapy and radiation therapy on local recurrence, distant metastasis and event-free survival. The mean follow up period was 39 months. The univariate and multivariate regression analysis were performed for statistical evaluation. RESULTS: The local recurrences occurred in 11 patients (21.2%) and distant metastasis in 4 patients (8%), Event-free survival rate at 4 year follow up was 67%. In univariate analysis, histologic grade, surgical margin, chemotherapy and radiation therapy were significant prognostic factors on local recurrence (p<0.05). However, histologic grade lost its significance in muitivariate analysis. Trunk location revealed higher rate of distant metastasis than extremity location. In univariate analysis on event-free survival. histologic grade and chemotherapy were significant factors (p<0.05). No factor remained significant in multivariate analysis. CONCLUSION: Considering selection bias, positive surgical margin was negative prognostic factor on local recurrence. Liposarcomas arisen in trunk revealed higher rate of distant metastasis. There was no independent prognostic factor on event-free survival of patients with liposarcomas.
Disease-Free Survival ; Extremities ; Follow-Up Studies ; Humans ; Liposarcoma ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Selection Bias

OBJECTIVE: Reactive oxygen metabolites and polymorphonuclear leukocytes have been implicated in the pathophysiology of reperfusion injury. The mechanisms involved in superoxide-mediated leukocyte adherence remain unclear, however, nitric oxide(NO) may contribute to this response. The present study is undertaken to elucidate mechamisms controlling NO based mechanisms that regulated leukocyte-endothelial interactions in the cerebral vasculature after global cerebral ischemia and reperfusion. METHODS: Pial venular leukocyte adherence of anesthetized newborn piglets was quantified by in situ fluorescence videomicroscopy through closed cranial windows during basal conditions and during 2hours of reperfusion after global ischemia induced by 9minutes of asphyxia. Nitric oxide synthase(NOS) was inhibited by local window superfusion of L-nitroarginine(NA); superfusion of sodium nitroprusside(SNP) was used to donate NO. RESULTS: The mean number of adherent leukocytes to cerebral venules in the 9minutes asphyxia and 2hours reperfusion group were 161+/-19 compared with 13+/-4 in the nonasphyxial group. Superfusion of L-NA through the cranial window for 2hours resulted in leukocyte adherence similar to that observed during the initial 2hours of reperfusion after asphyxia. Leukocyte adherence was not additionally increased in asphyxic animal treated with L-NA. SNP inhibited asphyxia induced leukocyte adherence back to control levels. CONCLUSIONS: Nitric oxide inhibits leukocyte adherence to cerebral venules during the initial hours of reperfusion after asphyxia, and that NO supplementation inhibit asphyxia induced leukocyte adherence back to control levels. These results indicate that NO is an important factor in ischemia-reperfusion induced leukocyte adherence.
Animals ; Arginine ; Asphyxia ; Brain Ischemia ; Fluorescence ; Humans ; Infant, Newborn ; Ischemia* ; Leukocytes ; Microscopy, Video ; Neutrophils ; Nitric Oxide* ; Nitroprusside ; Oxygen ; Reperfusion Injury ; Reperfusion* ; Sodium ; Venules*