The PCL is the strongest ligament in the knee joint. And it gives the posterior stability to the knee joint and act on rotation of knee joint. The many authors reported the surgical approaches for PCL. But none of them was satisfactory for exposure for PCL. Authors report the approach for repair and reconstruction on PCL injury The purpose of this report is to get the more satisfactory exposure of operation field for anatomical repair of injuried PCL. 1. PCL injury combined with MCL injury. a) MCL injury at its femoral attachment area. Detach the injuried MCL from femoral attachment completely, continue with anteromedial incision, and can observe both femoral and tibial attachment of PCL and ACL. b) MCL injury at its tibial attachment area. Retract the injuried MCL, medial meniscus, joint capsule superiorly, and through between medial meniscus and tibial proximal protion, also can observe the tivial attachment of PCL. 2. Isolated PCL injury. a) at tibial attachment(avulsion fracture) Through posterior approach or straight anteromedial approach, incised the posteromedial joint capsule, and can observed the tibial attachment of PCL. b) at substance level. Detach the MCL from its femoral attachment with bone-block and apply the knee valgus force. And can observe the entire length of PCL. Also reinforce the repaired site of PCL by reconstruction using a semitendinosus tendon.
Joint Capsule ; Knee Joint ; Knee ; Ligaments ; Menisci, Tibial ; Posterior Cruciate Ligament ; Tendons

No abstract available.
Female ; Humans ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy*

The purpose of this study was to investigate whether a radiometric analysis of radicular cysts and periapical granulomas is useful in the differential diagnosis. In this experiment, twenty-nine periapical radiographs of the radicular cyst and those periapical granuloma were used. The periapical radiography was taken by intraoral paralleling device. The X-ray film was digitized and digitally filtered to reduce film-grain noise. We estimated density difference of the inner/outer area, roundness or circularity, bone profile or scan line of the margin and cumulative percentage frequency curve of radicular cyst & periapical granuloma. The obtained results were as follows ; 1. The differences in density between ROIs of inner and outer area of radicular cysts were smaller than those of periapical granulomas. 2. The equivalent circular diameter was over 6.3mm, there was significant difference between periapical cyst and periapical granuloma. 3. In differential diagnosis of radicular cyst and periapical granuloma using bone profile, sensitivity, spicificity and accuracy were considerably high(0.83, 0.86, 0.86) respectively. 4. Cumulative percentage frequency curve of the radicular cyst was closer to the pseudo-pixel value of 50 than average curve, whereas periapical granuloma was closer to that of 0. Hence we conclude that digital radiometric features might be useful in the differential diagnosis between radicular cyst and periapical granuloma.
Diagnosis, Differential ; Noise ; Periapical Granuloma* ; Radicular Cyst* ; Radiography ; X-Ray Film

This study was performed to demonstrate the effect of linear or nonlinear contrast enhancement on subtraction images. Three different textures were radiograped on dental film. The first radiograph was taken without the presence of an object. the second, which showed trabucular bone, was taken of the molar area of a human. the third radiograph was taken of the coronal part of molars. Each film was digitized into a 1312 X 1024 pixel X 8 bit depth matrix by means of a Nikon 35 mm film scanner(LS-3510AF, Japan) with fixed gain and internal dark current correction to maintain constant illumination. The scanner was interfaced to a Macintosh LC III computer(Apple Computer, Charlotte, N.C.). This resulted in three pairs of images, including different textures-plain, bone and enamel. Digital regular, linearly and nonlinearly enhanced subtraction was performed. Computer software was used to simulate lesions in the shape of a 2D-Gaussian curve on each of a pair of images. The each subtraction images were presented in a random sequence to two groups of 10 observers(students and dentists). ROC analysis was used to compare observer performance. The following results were obtained; 1. All of LCE subtraction, equalized subtraction and regular subtraction images of plain texture were diagnosed the best by far. 2. The data revealed a siginificant LCE effect in both the student group and the expert group. 3. Clinical expertise was a helphul factor for the observers in this study.
Dental Enamel ; Humans ; Lighting ; Molar ; ROC Curve

BACKGROUND: The orthostatic hypotension in response to the assumption of an upright posture is regulated by activation of sympathetic nerves. Role of the vestibular system and neural pathway on orthostatic hypotension were investigated. METHODS: Changes of arterial blood pressure produced by head-up tilting, rotatory stimulation of the vestibular system, or electrical stimulation to the vestibular nerve, vestibular nuclei, and rostral ventrolateral medulla (RVLM) were measured in Sprague-Dawley rats. Also, field potentials were recorded in the vestibular nuclei and RVLM and c-Fos expression was evaluated in the brain stem in order to investigate the vestibulosympathetic pathways. RESULTS: The three phasic blood pressure responses were elicited by head-up tilting: initial fall, early recovery, and late sustained pressure at near control levels, the magnitude of the pressure fall was parallel with the degree of head-up tilting in normal rats. Return position from head-up tilting recovered control level of blood pressure after a brief rapid elevation. However, bilateral labyrinthectomy resulted in exaggerated initial falling and devoid of early recovery phase during postural change. Sinusoidal rotation about off-vertical axis of the vestibular system elicited more elevation of blood pressure than rotation about earth vertical axis. Electrical stimulation of the vestibular nerve, vestibular nucleus, and RVLM produced elevation of blood pressure, which was the most prominent by stimulation of RVLM. Field potentials composed of P, N1, N2 waves in the vestibular nuclei were recorded by stimulation of the vestibular nerve, while weak potentials in RVLM were recorded by stimulation of the vestibular nuclei. An electrical stimulation of the vestibular nuclei expressed c-Fos immunoreactive cells in RVLM. CONCLUSION: These results suggest that the otolith organ of the vestibular system plays a major role in control of orthostatic hypotension, and the pathway of vestibulosympathetic reflex in control of blood pressure involves the vestibular nuclei, RVLM, intermed-iolateral nuclei of the thoracic spinal cord.
Animals ; Arterial Pressure ; Axis, Cervical Vertebra ; Blood Pressure ; Brain Stem ; Electric Stimulation ; Hypotension, Orthostatic* ; Neural Pathways ; Otolithic Membrane ; Posture ; Rats* ; Rats, Sprague-Dawley ; Reflex* ; Spinal Cord ; Vestibular Nerve ; Vestibular Nuclei

Objectives: The purposes of this study were to compare the degree of sodium reduction practice and estimate sodium intake by salty food preference. Methods: Sodium reduction practices, salty food preferences and estimated sodium intake were surveyed for restaurant owners (n = 80), employees (n = 82) and customers (n = 727) at the restaurants participating in the sodium reduction project in Daegu, Korea. Estimated sodium intake was performed by examining sex, age, body mass index (BMI), salty eating habit and dietary behaviors. Results: The degree of sodium reduction practice was significantly higher in salinity meter use (P < 0.001), low salt seasonings (P < 0.001) and efforts to make the foods as bland as possible overall (P < 0.001) in the restaurants participating in sodium reduction project than in homes (P < 0.001). The degree of sodium reduction practice appeared lower in the high salty food preference group than in the low-preference group in such items as efforts to make the foods as bland as possible overall (P < 0.05) and washing the salty taste and then cooking (P < 0.05). The high-preference group showed high-salt dietary behavior, including eating all the soup until nothing was left (P < 0.05) more than the low-preference group, but low-salt dietary behavior included checking the sodium content in processed foods (P < 0 .0 5) less than the low-preference group. The high-preference group was higher in the soup and stew intake frequency than the low-preference group (P < 0.05) and much lower in nuts (P < 0.05) and fruits (P < 0.05) intake frequency. The high-preference group had a higher salty eating habit (P < 0.05), salty taste assessment (P < 0.05) and estimated sodium intake (P < 0.05) than the low-preference group. Conclusions The present study showed that the salty food preference was strongly associated with lower sodium reduction practice and higher estimated sodium intake.

BACKGROUND: Recent studies suggest the hypothesis that blockade of nociceptive input with local anesthetics before surgery can decrease pain beyond the immediate postoperative period. The purpose of this study was to determine if the preincisional infiltration with local anesthetics affected postoperative pain relief. METHOD: Among 30 patients having tonsillectomy, 15 patients(group 1) given peritonsillar infiltration using lidocaine with epinephrine(1 : 200,000) were compared with 15 patients(group 2)given peritonsillar infiltration using saline with epinephrine(1 : 200,000). Following general anesthesia with a mixture of O2-N2O(50%) and enflurane(1-2vol.%), peritonsillar infiltration were performed 5 minutes before surgery. Constant incisional pain and pain on swallowing were assessed using a visual analogue scale at 4 hour, 1, 2, 3 and 4 days postoperatively. The time to emergence and behaviour of patient at 0.5, 1 and 4 hour were recorded postoperatively. RESULT: Preincisional infiltration with lidocaine resulted in a significant decrease in postoperative pain during 4 days after surgery and smoother emergence. CONCLUSION: There were significant difference in pain scores between lidocaine group and saline group during 4 days after surgery. Preincisional lidocaine infiltration seemed to have analgesic activity beyond the residual anesthetic period. The results of this study support the theory of pre-emptive analgesia.
Analgesia ; Anesthesia, General ; Anesthetics ; Anesthetics, Local ; Child* ; Deglutition ; Humans ; Lidocaine* ; Pain, Postoperative ; Postoperative Period ; Tonsillectomy

Tuberous sclerosis is a neurocutaneous syndrome with autosomal dominant inheritance with variable penetrances and the incidence is approximately one in 10,000 live births. It is described as a clinical triad of mental retardation, seizures and adenoma sebaceum. Tuberous sclerosis is characterized by the development of hamartomas and benign neoplasms involving the brain and other organs. Typical lesions include cortical tubers and subependymal hamartomas in the brain, rhabdomyomas in the heart, angiofibromas and periungual fibromas of the skin and angiomyolipomas in the kidney. A splenic hamartoma is a rare benign lesion. Only about 100 cases have been reported since its first description by Rokitansky in 1861. We report a case of child with a splenic hamartoma associated with tuberous sclerosis.
Angiofibroma ; Angiomyolipoma ; Brain ; Child ; Fibroma ; Hamartoma* ; Heart ; Humans ; Incidence ; Intellectual Disability ; Kidney ; Live Birth ; Neurocutaneous Syndromes ; Rhabdomyoma ; Seizures ; Skin ; Tuberous Sclerosis* ; Wills

BACKGORUND: infusion of propofol by a target-controlled infusion (TCi) system is effective in achieving conscious sedation for anxious patients presenting for dental surgery. However, there is no report of conscious sedation for mandibular fracture patients using propofol TCi. The objective of this study was to evaluate the appropriation of a conscious sedation using propofol for mandibular fracture patients. METHODS: Twenty patients with a mandibular fracture undergoing an open reduction and miniplate insertion operation were analyzed. We anesthetized patients using a propofol infusion by a TCi system (Diprifusor :Master TCi:Pilot Anesthesia is, France) with local anesthesia using lidocaine. The BiS score was evaluated continually during surgery using a microcomputer (A-2000 BiS monitor , Aspect Medical System, USA). We set the infusion machine at a target concentration 2mug/ml, and adjusted the propofol concentration for a BiS score range of 80-85. infusion rate, total dosage, duration of induction, recall of operative procedure and cooperation scores were checked. BiS, heart rate, noninvasive arterial blood pressure, and SpO2 were recorded during the operation. RESULTS: The mean BiS score was 82.95, the mean target concentration of propofol was 2.645mug/ml, the mean infusion rate was 136.3mug/kg/min, and the mean cooperation score was 2.5, the patients were cooperative. The score of amnesia was 0.2, almost patients did not recall the intraoperative event. The mean duration of stay in the recovery room was 22.2 minutes, and the most frequent side effect was pain on injecion of propofol. CONCLUSiONS: Conscious sedation with propofol TCi is an effective anesthesia method substitute for general anesthesia with quick emergence, few side effects, and safety for mandibular fracture patients.
Amnesia ; Anesthesia ; Anesthesia, General ; Anesthesia, Local ; Arterial Pressure ; Conscious Sedation* ; Heart Rate ; Humans ; Lidocaine ; Mandibular Fractures* ; Microcomputers ; Propofol* ; Recovery Room ; Surgical Procedures, Operative

Chronic postirradiation changes of skin reflect the injury of dermal structures particularly the vasculature and connective tissue. The clinical signs include atrophy, partial or complete destruc tion of cutaneous appendatges, telangiectasis, sclerosis of underlying tissue, pigrnentary changes, and in rare instances, ulceration with or without var ious premalignant and malignant neoplasms. The patient, was a 65-year-old man, who had been exposed to a large amount. of X-ray irradi- ation on his hands incidentally or accidentally for a long time. The skin changes of his hand were thickening and hardening of all digits loss or focal consttict,ion of digits, and keratotic papules. Epidermal hyperplasia and fibrous thickening of collagen bundles were found on skin biopsy. Gradual narrowingal of the bony caliber with eventual resorption was noticed on radiologic examination. It has been rarely reported in the literature that chronic radiation dermatitis develops severe and unusal manifestions such as acrosclerosis and loss of digit due to osteoradionecrosis.
Aged ; Atrophy ; Biopsy ; Collagen ; Connective Tissue ; Dermatitis* ; Hand ; Humans ; Hyperplasia ; Osteoradionecrosis* ; Sclerosis ; Skin ; Telangiectasis ; Ulcer