Tibial tunnel placement during endoscopic anterior cruciate ligament (ACL) reconstruction has received increased emphasis in the recent literature. Tibial tunnel length is a factor that affect graft fixation, potential impingement, and graft abrasion. Appropriate tunnel length is a critical tecpnical consideration. A tunnel that is too long may make distal fixation and femoral tunnel placement difficult... A tunnel that is too short results in graft extrusion, necessitating supplemental fixation techniques. This grafl-tunnel mismatch can be avoided if fhe sum of the tibial tunnel length plus the intraarticular distance of ACL is equal to or greater than the graft tendon length plus 20mm (the minimum interference fixation possible when using the smallest available 20 mm long interference screw). Authors published an article to determine the reiationship between the length of patellar tendon and that of anterior cruciate ligament, to calculate the tibial tunnel length through the dissection of 19 cadaveric knees (ACL length (mm)=0.73 X Patellar tendon length-2.69 (p Anterior Cruciate Ligament ; Cadaver ; Humans ; Knee ; Patellar Ligament ; Tendons ; Transplants

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

Many types of meniscal anomalies were reported. Authors found a double-layered lateral meniscus, with one meniscus overlying another. The 39-year old male patient had torn medial and lateral menisci. We performed partial medial and lateral meniscectomy, and incidentally found that lateral meniscus was double-layered. It was characteristic that the upper small accessory meniscus was firmly connected from the posterior horn to middle segments of the lower main meniscus along its peripheral edge. We left it alone. The symptoms were gone, So, it was thought that this anomaly was not related to the patient's symptoms.
Animals ; Horns ; Humans ; Male ; Menisci, Tibial

No abstract available.
Humans ; Peptic Ulcer*

PURPOSE: To investigate the levels of radiation exposure of an operator which may be influenced by the wearing an apron, type of procedure, duration of fluoroscopy and operator's skill during various interventional procedures MATERIALS AND METHODS: Radiation doses were measured both inside and outside the apron(0.5mm lead equivalent) of the operator by a film badge monitoring method and the duration of fluoroscopy was measured in 96 procedures prospectively. The procedures were 30 transcatheter arterial embolizations (TAE), 25 percutaneous transhepatic biliary drainages (PTBD), 16 stone removals (SR), 15 percutaneous needle aspirations (PCNA) and 10 percutaneous nephrostomies(PCN). To assess the difference of exposure by the operator's skill, the procedures of TAE and PTBD were done separately by groups of staffs and residents. RESULTS: Average protective effect of the apron was 72.8%. Average radiation exposure(unit:micro Sv/procedure) was 23.3 in PTBD by residents, 10.0 in PTBD by staffs, 10.0 in SR, 8.7 in TAE by residents, 7.3 in TAE by staffs, 9.0 in PCN and 6.0 in PCNA. Average radiation exposure of residents were 1.9 times greater than those of staffs. CONCLUSION: Radiation exposure was not proportionally related to the duration of fiuoroscopy, but influenced by wearing an apron, various types o[procedure and operator's skills.
Aspirations (Psychology) ; Film Dosimetry ; Fluoroscopy ; Needles ; Pregnenolone Carbonitrile ; Proliferating Cell Nuclear Antigen ; Prospective Studies

Unlike medical students, doctors-in-training (residents) are physicians who can legally provide medical treatment with a medical doctor's license obtained from Korea the Ministry of Health and Welfare, and thus they are liable for the care they provide. Therefore, residents need to be aware of the legal and risks they facing in medical practice and ensure that they have the ability to deal with such risks. Legal responsibilities of residents can be examined from three perspectives: the relationships between patients and doctors, the relationships between doctors and medical officials, and the Korean health and welfare system. With regard to the relationships between patients and doctors, the legal responsibilities of doctors-in-training span a diverse range of liability for explanation (informed consent), malpractice, medical records, prohibition on revealing medical secrets, emergency medical treatment, treatment for the opposite sex, and other basic responsibilities. They will be liable for any damage caused under Article 268 of the Criminal Code, which addresses the crime of professional negligence resulting in injury or in death, and Article 750 of the Civil Code, which addresses torts liability, and above and beyond them of legal liability in general. With regard to the relationships between doctors and medical officials, the legal responsibilities can be classified into two types of relationships. One is between a doctor and a senior doctor, and the other is between a doctor and a doctor from a different medical specialization. it there is miscommunication between two or more doctors, it could lead to poor outcomes for patients. Regarding the health and welfare system, the issuance of medical licenses and the duty of notification are the most important legal responsibilities. The system's treatment of residents require special caution as issuance of falsified medical licenses has caused serious social problems. Laws that state the various notification duties allow no exceptions even for the residents. Residints should therefore understand the basic notification duties involved in cases of accidental death, child abuse, and etc. and prepare for contingencies.
Child ; Child Abuse ; Crime ; Criminals ; Dietary Sucrose ; Dissent and Disputes ; Emergencies ; Humans ; Jurisprudence ; Korea ; Liability, Legal ; Licensure ; Malpractice ; Medical Records ; Social Problems ; Students, Medical

A wide variety of cancers metastasize to the ovaries. In a majority of instances the primary site is the gastrointestinal tract, breast, or other gynecologic organs. The best known tumor of this type is signet-ring cell adenocarcinoma. The gallbladder and bile duct are rare sources of these metastases. The authors have had an experience of a case that was presented of Krukenberg tumor metastatic from the gallbladder and report the case with brief review of literature.
Adenocarcinoma ; Bile Ducts ; Breast ; Female ; Gallbladder* ; Gastrointestinal Tract ; Krukenberg Tumor* ; Neoplasm Metastasis* ; Ovary

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

From retrospective review of 111 tibial fractures treated by interlocking intramedullary nailing, 38 operative errors in 28 cases(25%) were included in this study. The errors were classified into two categories. The first category included eighteen errors that related to fracture reduction; nine angular malalignments, four failures in closed nailing to open the fracture site, two peroneal nerve palsies, two shortenings of tibial length(more than 1cm), and one rotational malalignment. The second category comprised twenty errors that related to the nailing itself; eight protrusions of proximal nail tip, five overdistractions of fracture gap (more than 3mm), four additional fragmentations, two mistakes in interlocking screw insertion, and one ankle joint injury by the distal nail tip. Functional results of those 28 cases at the last follow-up(average, 17.5 months; range, 9 to 29 months) were excellent or good in only 60.8 per cent, while the control group treated by adequate operative technique showed excellent or good results in 92.8 per cent.
Ankle Joint ; Fracture Fixation, Intramedullary ; Paralysis ; Peroneal Nerve ; Retrospective Studies ; Tibial Fractures