PURPOSE: To evaluate clinical and radiological results and to analyse the parapatellar complications after endoscopic anterior cruciate ligament reconstruction using central one-third bone-patellar tendon-bone autografts. MATERIALS AND METHODS: 66 cases among 158 consecutive cases from Feb 1990 to May 1996 were reviewed and evaluated with regard to patellofemoral pain, crepitus, quadriceps atrophy, graft donor site complication, Lysholm knee scoring system and radiological assessment. The average period of follow up was 23 months (range, 12-57 months) and the average age at operation was 31 years old (range, 18-58 years). RESULTS: The average Lysholmn knee score improved from 57.5 points preoperatively to 91.3 points at follow up. The instrumented anterior laxity test showed that excellent anterior stability was regained in most patients. There were many cases of parapatellar complications, 7 cases (10.6%) of anterior knee pain, 21 cases (32.8%) of crepitus, 43 cases (65.1%) of quadriceps weakness, 29 cases (45.3%) of graft donor site paresthesia and 15 cases (23.4%) of pain on kneeling. CONCLUSIONS: Although endoscopic ACL reconstruction using central one-third bone-patellar tendon-bone autografts had good clinical results, many parapatellar complications were noted. In order to prevent these complications, different reconstruction techniques and graft materials should be considered
Adult ; Anterior Cruciate Ligament Reconstruction ; Atrophy ; Autografts* ; Follow-Up Studies ; Humans ; Knee ; Paresthesia ; Tissue Donors ; Transplants

No abstract available.
Intubation* ; Laryngeal Masks*

Complications after surgical treatment of trochanteric fracture such as varus deformity or delayed union are frequent and there are many difficulties to maintain the stability of fragments because of the cortical deficit or comminution on medial aspect of the neck and posterior trochanteric fragment. Evans, Dimon, Sarmiento and others suggested several methods of internal fixation, furthermore it is attempted recently to reduce the fragments anatomically with sliding compression hip screw and plate. 31 cases of interal fixation on trochanteric fracture were carried out from March, 1972 to February 1979 at the Orthopaedic Department of Seoul Adventist Hospital and their comparable results were as follows. 1. Acceptable placement of metals was noted 2 cases of 6 cases in Smith-Petersen nail with Thornton plate fixation, 2 cases out of 8 cases in Smith-Petersen nail with McLaughlin plate fixation and 9 cases out of 14 cases in sliding compression hip screw and plate fixation. 2. Complications after internal fixation such as varus deformity and delayed union were noted 1 case out of 3 cases in multiple pinning, 3 cases out of 6 cases in Smith-Petersen nail with Thornton plate fixation, 4 cases out of 8 cases in Smith-Petersen nail with McLaughlin plate fixation, 4 cases out of 14 cases in sliding compression hip screw and plate fixation. 3. Required weeks in union were 18 weeks in Multiple pinning, 20 weeks in Smith-Petersen nail with Thornton plate fixation, 25 weeks in Smith-Petersen nail with McLaughlin plate fixation and 16 weeks in sliding compression hip screw and plate fixation. 4. There are few complications in treatment of trochanteric fracture with surgical procedure using Sliding compression hip screw and plate.
Adult ; Clinical Study ; Congenital Abnormalities ; Femur ; Hip ; Humans ; Metals ; Neck ; Seoul

OBJECTIVE: Moyamoya disease (MMD) is an uncommon cerebrovascular disorder, characterized by progressive occlusion at the terminal portion of the internal carotid artery. Incidence of the disease is high in East Asia and familial MMD accounts for about 15% of the disease. Although the pathogenesis is unknown, association of HLA class I or II alleles with MMD has been reported with conflicting results. We investigated whether there is a difference in HLA class II association between familial and non-familial forms of the disease. METHODS: A total of 70 Korean children with MMD, including 16 familial cases (10 probands), and 207 healthy controls were studied. Among familial cases, only 10 probands were used for the HLA frequency analysis. High resolution HLA-DRB1 and DQB1 genotyping was performed using polymerase chain reaction (PCR)-sequence specific oligonucleotide hybridization and PCR-single strand conformation polymorphism methods. RESULTS: The phenotype frequencies of HLA-DRB1*1302 (70.0%) and DQB1*0609 (40.0%) were significantly increased in familial MMD compared to both controls [vs. 15.5%, corrected p (pc) = 0.008, odds ratio (OR) = 12.76; vs. 4.3%, pc = 0.02, OR = 14.67] and non-familial MMD patients (vs. 14.8%, pc = 0.02, OR = 13.42; vs. 1.9%, pc = 0.02, OR = 35.33). The frequencies of DRB1 and DQB1 alleles in non-familial MMD patients were not significantly different from those in controls. CONCLUSION: Our findings suggest that the genetic polymorphism of HLA class II genes or other closely linked disease relevant gene(s) could be a genetic predisposing factor for familial MMD.
Alleles ; Carotid Artery, Internal ; Cerebrovascular Disorders ; Child ; Chimera ; Far East ; Genes, MHC Class II ; HLA-DQ Antigens ; HLA-DR Antigens ; HLA-DRB1 Chains ; Humans ; Incidence ; Moyamoya Disease ; Odds Ratio ; Phenotype ; Polymerase Chain Reaction ; Polymorphism, Genetic

Takayasu's arteritis(TA) is a nonspecific areritis of unknown etiology affecting segmentally the aorta and its main branches, which result in stenosis, occlusion or aneurysm of involved arteries. The clinical manifestations present with a variety of symptoms such as headache, dyspnea on exertion, pain and weakness of extremities, pulse deficit, and hypertension according to involves arteries. Usually it can be managed by medical or surgical treatment, and recently by percutaneous transluminal balloon angioplasty. The type III classified by Lupi-Herrena and associates is the most frequent variety of TA. However the case of type III involving both subclavin arteries and both renal arteries has rarely been reported. We experienced a case of TA involving both subcalvian arteries, and both renal arteries presented with paroxysmal hypertension and right flank pain, in which the stenosis of both subclavian arteries were managed by percutaneous transluminal balloon angioplasty and the stenosis and occlusion of both renal arteries were successfully managed by aorto-renal bypass surgery with autogenous right iliac artery and synthetic vessel(Gortex). The patient was discharged uneventfully.
Aneurysm ; Angioplasty, Balloon ; Aorta ; Arteries* ; Constriction, Pathologic* ; Dyspnea ; Extremities ; Flank Pain ; Headache ; Humans ; Hypertension ; Iliac Artery ; Renal Artery* ; Subclavian Artery ; Takayasu Arteritis*

No abstract available.

BACKGROUND: It is understood that amylase is poor and lipase is a little better than amylase in specificity for the diagnosis of acute pancreatitis. But we recognized that the general knowledge was resulted from the study of inappropriate design of some researchers. So, we tried to find out the true diagnostic value of amylase and lipase by the study of appropriate design, and with the above result, evaluated the usefulness of lipase as a diagnostic test for acute pancreatitis. METHODS: We reviewed the serum levels of the amylase and lipase in 33 patients complaining acute abdominal pain diagnosed as acute pancreatitis by image study (computed tomography, ultrasonography) , and in the 134 patients of control group who, with abdominal pain, were diagnosed finally as non-pancreatic disease at discharge after admission and treatment. Serum amylase and lipase activity were measured by aca IVTM (Chiron Inc.). RESULTS: The sensitivity of amylase and lipase for the diagnosis of acute pan creatitis was 81.8% and 87.8%, respectively. The specificity of amylase and lipase for the diagnosis of acute pancreatitis was 92.5% and 86.5%, respectively. The sensitivity and specificity was 84.6% and 96.3% respectively, when two enzymes were combined by 'and' strategy. The lipase activity remained elevated longer than the amylase in acute pancreatitis. CONCLUSIONS: On the contrary of the general knowledge, sensitivities and specificities of the amylase and lipase were fairy high and didn't show big dirt ferences between two enzymes. Though only one of the two enzymes could be selected for the diagnosis of acute Pancreatitis, using both of the enzymes increased the specificity, and lipase was useful to detect the patient who came to hospital a few days later after the onset of symptom.
Abdominal Pain ; Amylases ; Diagnosis* ; Diagnostic Tests, Routine ; Humans ; Lipase* ; Pancreatitis* ; Sensitivity and Specificity

Lovastatin(Mevacor) belongs to a new generation of potent drugs for the treatment of hypercho- lesterolemia. It acts by competitive inhibition of 3-hydroxyl-3-methylglutaryl coenzyme A(HMG-CoA) reductase, diminishing in that way the cholesterol synthesis in the liver. HMG-CoA reductase inhibitors also affect cutaneous lipid content. This can induce cutaneous side effects such as eczernatous rashes or xerotic, ichthyosiform lesions due to abnormality in the barrier function in some patients. We report a 54-year-old male patient who developed ichthyosiform skin lesions under treatment with lovastatin(Mevacor) for hypercholesterolemia.
Cholesterol ; Exanthema ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypercholesterolemia ; Liver ; Lovastatin ; Male ; Middle Aged ; Oxidoreductases ; Skin*

Vulva syringomas are rare in reviewing literature. In our case, a 29-year-old had multiple papular lesions involving both sides of the vulva. Microscopically the lesion showed dilated cystic sweat ducts some of which have small comma like tails resembling tadpoles. It is the purpose of this report to present a rare case of syringoma which was limited to the vulva without involvement of other sites.
Adult ; Humans ; Larva ; Sweat ; Syringoma* ; Vulva*

BACKGROUND: Exercise-induced coronary spasm is occasionally recognized in patients with variant angina, but the patterns of exercise-induced coronary spasm and its relation to clinical features are still not clear. METHODS: Eight consecutive patients with variant angina without significant stenosis of the coronary artery performed serial treadmill exercise tests during early morning, late morning, and in the afternoon. The subjects repeated the tests after administration of atropine and doxazosin or phentolamine. RESULTS: (Upon drug administration), anginal episodes with ST-segment changes (elevation 5, depression 1) Occurred repeatedly in 6 of the 8 patients during early morning; the episodes occurred in only 2 patients during the afternoon exercise test. Four patients showed exercise-induced angina and ST-segment changes during early morning but not in the afternoon, and 2 of them showed mild episodes of exercise-induced angina and ST-segment changes during late morning. Three of the four patients had the characteristic clinical history of angina in early morning during usual activities but not during daytime activities despite the activities being more strenuous. Another 2 patients showed both exercise-induced ST-segment elevation and angina in early morning and afternoon, and they had the characteristic history of more episodes at night and in early morning but only occasionally in the daytime with or without relation to activity. One of the two patients showed intermittent ST-segment elevation during the exercise test. The other two patients had exercise-induced episodes neither in the early morning nor in the afternoon; they had a characteristic history of episodes only at night during sleep but never in the early morning nor in the daytime. Atropine did not suppress the exercise-induced angina in 4 of 5 patients studied. Doxazosin or phentolamine suppressed the exercise-induced episodes in 3 of 5 patients studied but aggravated spontaneous episodes in 3 patients. CONCLUSION: These data suggest that there's possibility of presence of different patterns of exercise-induced coronary spasm, which may be induced by different mechanisms from those in spontaneous episodes in patients with variant angina.
Atropine ; Constriction, Pathologic ; Coronary Vessels ; Depression ; Doxazosin ; Exercise Test ; Humans ; Phentolamine ; Spasm*