BACKGROUND: Anatomic footprint restoration of anterior cruciate ligament (ACL) is recommended during reconstruction surgery. The purpose of this study was to compare and analyze the femoral and tibial tunnel positions of transtibial single bundle (SB) and transportal double bundle (DB) ACL reconstruction using three-dimensional computed tomography (3D-CT). METHODS: In this study, 26 patients who underwent transtibial SB ACL reconstruction and 27 patients with transportal DB ACL reconstruction using hamstring autograft. 3D-CTs were taken within 1 week after the operation. The obtained digital images were then imported into the commercial package Geomagic Studio v10.0. The femoral tunnel positions were evaluated using the quadrant method. The mean, standard deviation, standard error, minimum, maximum, and 95% confidence interval values were determined for each measurement. RESULTS: The femoral tunnel for the SB technique was located 35.07% +/- 5.33% in depth and 16.62% +/- 4.99% in height. The anteromedial (AM) and posterolateral (PL) tunnel of DB technique was located 30.48% +/- 5.02% in depth, 17.12% +/- 5.84% in height and 34.76% +/- 5.87% in depth, 45.55% +/- 6.88% in height, respectively. The tibial tunnel with the SB technique was located 45.43% +/- 4.81% from the anterior margin and 47.62% +/- 2.51% from the medial tibial articular margin. The AM and PL tunnel of the DB technique was located 33.76% +/- 7.83% from the anterior margin, 45.56% +/- 2.71% from the medial tibial articular margin and 53.19% +/- 3.74% from the anterior margin, 46.00% +/- 2.48% from the medial tibial articular margin, respectively. The tibial tunnel position with the transtibial SB technique was located between the AM and PL tunnel positions formed with the transportal DB technique. CONCLUSIONS: Using the 3D-CT measuring method, the location of the tibia tunnel was between the AM and PL footprints, but the center of the femoral tunnel was at more shallow position from the AM bundle footprint when ACL reconstruction was performed by the transtibial SB technique.
Adult ; Anterior Cruciate Ligament Reconstruction/*methods ; *Femur/radiography/surgery ; Humans ; Imaging, Three-Dimensional/*methods ; Knee Joint/physiology ; Male ; Prospective Studies ; Surgery, Computer-Assisted/*methods ; *Tibia/radiography/surgery ; Tomography, X-Ray Computed

Purpose: The aim of this study was to report seven cases of metallic radial head prosthesis and present the limit of use in Korea. Materials and Methods: Metallic radial head arthroplasty was performed on 7 patients between April 2006 and December 2006, who had complex elbow injury including comminuted radial head fracture. Indication, operative findings and outcome were assessed. Availability and payment of implant were investigated. Results: All of the patients had more than one associated injury including coronoid fracture, olecranoan fracture, and ligament ruptures. According to Mason classification, there were three type III and four type IV fractures. All radial head fractures were too comminuted to reconstruct. There were two excellent results, four good, and one poor, as graded by Mayo score. There were no patient with instability and implant related complications. Insufficient supply of implant did not enable to do scheduled surgery in 2 cases. Current medical insurance did not cover charge for radial prosthesis, five patients could not help paying for that by themselves. Conclusion: Metallic radial head implants are useful when the radial head cannot be repaired reliably. Preoperative preparing and coverage by medical insurance based on appropriate indication are helpful for decision for a treatment option.
Arthroplasty ; Classification ; Elbow ; Head* ; Humans ; Insurance ; Korea* ; Ligaments ; Prostheses and Implants* ; Radius ; Rupture

We report two cases of cutaneous Mycobacterium(M.) marinum infections in a 43-year-old man and a 31-year-old woman who had multiple subcutaneous nodules on the left upper extremity and an erythematous ulcer on the right elbow, respectively. Skin biopsy specimens revealed chronic granulamatous inflammation and AFB positive bacilli in the dermis. The culture from tissue specimens on Lowenstein-Jensen media at 30'C for 10 days, yielded cream-colored colonies, which became yellow when exposed to light. The organism was identified as M. marinum by selected biochemical reactions. The patients were treated with surgical excision followed by administration of minocycline and administration of minocycline, respectively.
Adult ; Biopsy ; Dermis ; Elbow ; Female ; Humans ; Inflammation ; Minocycline ; Mycobacterium marinum* ; Mycobacterium* ; Skin ; Ulcer ; Upper Extremity

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common problem after general anesthesia. Compared with inhalational anesthetics, propofol has an antiemetic effect. We investigated the incidence of PONV after propofol and sevoflurane anesthesia for strabismus surgery in pediatric patients, and evaluated the effectiveness of ondansetron prophylaxis after sevoflurane anesthesia. METHODS: A healthy pediatric patients (n = 150) were divided into three groups. Group P (n = 50) received intravenous anesthesia with propofol; Group S (n = 50), inhalational anesthesia with sevoflurane; and Group S-O (n = 50), inhalational anesthesia with sevoflurane and 0.06 mg/kg (up to 4 mg) of ondansetron. The occurrence and intensity of PONV were recorded. RESULTS: The incidence of PONV after sevoflurane-ondansetron anesthesia did not differ from that after propofol anesthesia, but was significantly attenuated. The recurrence of PONV after sevoflurane-ondansetron was lower than after propofol and sevoflurane anesthesia. CONCLUSIONS: Sevoflurane anesthesia with ondansetron prophylaxis may be a good alternative to propofol in terms of avoiding PONV.
Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics ; Antiemetics ; Humans ; Incidence ; Ondansetron ; Pediatrics* ; Postoperative Nausea and Vomiting* ; Propofol* ; Recurrence ; Strabismus*

PURPOSE: The purpose of this study was to evaluate the anatomical similarity of three-dimensional (3D) morphometric parameters between right and left knees. MATERIALS AND METHODS: Ten fresh-frozen paired cadaveric knees were tested. Following dissection, footprint areas of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were measured. Surface scanning was performed using a 3D scanner. Scanned data were reproduced and morphometric parameters were measured on specialized software. After making mirror models, we compared footprint center positions of the ACL and PCL of both sides and calculated the average deviation of 3D alignment between the right- and left-side models. RESULTS: No significant side-to-side differences were found in any morphometric parameters. Bony shapes displayed a side-to-side difference of < 1 mm. Distal femoral and proximal tibial volumes did not present side-to-side differences, either; the average 3D deviations of alignment between the right and left sides were 0.8±0.4/1.1±0.6 mm (distal femur/proximal tibia). Center-to-center distances between the right and left ACL footprints were 2.6/2.7 mm (femur/tibia) for the anteromedial bundle and 2.4/2.8 mm for the posterolateral bundle. They were 1.9/1.5 mm for the anterolateral bundle and 2.2/1.8 mm for the posteromedial bundle of the PCL. CONCLUSIONS: There was a remarkable 3D morphometric similarity between right and left knees. Our results might support the concept of obtaining morphologic reference data from the uninvolved contralateral knee.
Anatomy, Comparative ; Anterior Cruciate Ligament ; Cadaver ; Imaging, Three-Dimensional ; Knee Joint ; Knee ; Posterior Cruciate Ligament

Sleeve fractures of the patella are cartilaginous avulsion fractures from the lower pole of the patella. They occur mainly due to sports injuries in adolescents. They may be missed in diagnosis due to rare incidence and small bony fragment on simple radiographs. In this report, an unusual bilateral simultaneous sleeve fracture in a healthy child is described.
Adolescent ; Athletic Injuries ; Child ; Diagnosis ; Humans ; Incidence ; Patella*

Female ; Follow-Up Studies ; Fractures, Open ; Head ; Humans ; Jaw Fixation Techniques ; Male ; Mandibular Condyle ; Prognosis ; Vertical Dimension

PURPOSE: This study examined the results of treatment according to the stage and size of a spontaneous osteonecrosis lesion of the knee (SONK) in the patients over 60 years of age. MATERIALS AND METHODS: Twenty-two knees from 19 patients over 60 years of age were treated for spontaneous osteonecrosis of the knee at our institution between January, 2000, and June, 2004. The mean follow time was 20.7 months. The condylar ratios, proportion of the lesion size to the condyle were measured. The size was obtained by multiplying the values from the anteroposterior and lateral radiographs. The stages were classified radiographically, and the treatment results were analyzed according to the size and stage. Conservative treatment was performed if the ratio and size were <40% and 5.0 cm2, respectively. Arthroplasty was performed if the ratio or size was >40% or 5.0 cm2. A paired T-test, Spearman correlation test and Wilcoxon test were used for the statistical evaluation. RESULTS: There was a higher prevalence in females (15 patients, 79%), and the mean age was 65 years (46-77 years). Bilateral involvement was observed in 3 patients. The lesions involved mainly the medial femoral condyle (21 cases, 95%). Seven cases (31%) had a condylar ratio <40% and 15 cases (69%) had a condylar ratio >40%. Conservative treatments were performed in 5 cases staged radiographically as I or II and there were no significant changes in the knee scores (p=0.931). Of the 17 cases staged III and IV radiographically, conservative treatment and arthroplasty were performed in 7 and 10 cases, respectively. Seven cases, in whom conservative treatments had been performed, showed a decreased in the knee scores compared with the increased knee scores in 10 patients treated with arthroplasty (p=0.943). CONCLUSION: An accurate diagnosis and measurement of the size and staging of spontaneous osteonecrosis of knee in patients over 60 years of age is important for proper treatment. Clinically, no further progression of symptoms is visible on grade I and II spontaneous osteonecrosis of the knee after conservative treatment. However, arthroplasty improves the clinical results in patients with radiological grade III and IV osteonecrosis compared with conservative treatment.
Aged* ; Arthroplasty ; Diagnosis ; Female ; Humans ; Knee* ; Middle Aged* ; Osteonecrosis* ; Prevalence

No abstract available.
Herpes Simplex ; Herpes Zoster ; Humans ; Methylmethacrylates ; Polystyrenes

Currently, Korea is a low endemicity country for HAV, especially in children. However, recent reports of hepatitis A outbreaks show that there has been a shift of disease incidence to adolescents and young adults, with 2 cases of acute liver failure in one reported outbreak. We need to study the immune status for HAV in order to provide information for the establishment of preventive measures and possible consequences of HAV in Korea. A total of 334 infants, children and adolescents less than 20 years of age living in rural areas of Kyonggi Province, Korea were evaluated for anti-HAV immune status in 1996. Five hundred and eighty-four primary school children living in the same area were separately evaluated for the natural seroconversion rate between 1993 and follow-up samples taken in 1996. Anti-HAV IgG antibody was measured by enzyme immunoassay (HAVAB EIA kit, Abbott Laboratories, Chicago, Illinois, USA). In comparison with previous reports of seroprevalence rates, our data confirmed a dramatic drop in seroprevalence rates among children and adolescents under 20 years of age living in rural areas, from over 63.8% two decades ago to 4.6% in 1996. Natural acquisition of HAV antibody in primary school children rarely occurs, registering only 0.5% during three years. Several outbreaks in young adults during 1996-1998 suggested that immunity against HAV in this population is so low that massive outbreaks are unavoidable. Teenagers and young adults, especially soldiers, who are likely to be exposed to contaminated food or water, would also have a greater risk of hepatitis A. Immunizing children with HAV vaccine as a routine schedule should also be considered in Korea in the future, particularly if the disease burden could be estimated and the cost-effectiveness of the vaccine could be proved.
Adolescence ; Adult ; Age Distribution ; Child ; Child, Preschool ; Female ; Hepatitis A/prevention & control* ; Hepatitis A/epidemiology* ; Hepatitis A Vaccines ; Human ; Immunization* ; Infant ; Korea ; Male ; Prevalence ; Sex Distribution ; Viral Hepatitis Vaccines/therapeutic use*