It is likely that the peroneus longus tendon acts as a structure resisting the varus force upon the first column of the foot. Our study was designed to examine the possibility that absence of the peroneus longus insertion into the first metatarsal and first cuneiform will destabilize the first metatarsal. The fresh frozen cadaveric specimens of the lower leg were obtained. There were six right feet. The specimens appeared normal visually and roentgenographically. The tibial remnant was rodded by an intramedullary rod and the sprcimen was positioned in a specially designed rig so that standing position of the foot was simulated. The tibia was then loaded with twenty pounds. To obtain reproducible radiographic landmarks radioopaque beads were implanted underneath the level of the cortex through small drill holes in the following location : First metatarsal (one bead in the head, another bead in the base). The second metatarsal (again one bead in the head, on e bean in the base). To simulate the contraction of the peroneus longus muscle a suture was placed into the proximal end of the tendon, brought through two pulleys and loaded with a five pound weight. To create a varus force on the first metatarsal a stab incision was made over the base of the first metatarsal at its medial aspect and a suture was passed through the base of the first metatarsal. The suture was guided over a pulley and loaded with ten pounds. The second metatarsal head was fixed to the bottom of the rig with a smooth Steinmann pin. At this point an AP roentgenogram was taken of the footto assure proper positioning of the foot. Thereafter, the soft tissue between the first and second toe were cut sequentially : (1) Transection of the skin of the first web space both dorsally and plantarly. (2) Transection of the adductor hallucis tendon and the intermetatarsal ligament. (3) Transection of the peroneus longus tendon at its insertion. Each step in the transaction of the soft tissues was followed by another X-ray examination. In each roentgenogram the proximal and distal beads in the first and second metatarsal were connected by a line and the angles between those lines were measured. The results were statistically analyzed with the Friedman Chi square test between each step of the ten feet. Following the first and second step angular changes are not significant. Following the final step, adding release of the tendon insertion of the peroneus longus, the angle changes from 15.95 to 20.55 degrees (difference 4.60 degrees) and this is significant (p < 0.05).
Cadaver ; Foot ; Head ; Leg ; Ligaments ; Metatarsal Bones ; Metatarsus ; Posture ; Skin ; Sutures ; Tendons ; Tibia ; Toes

One of the common cause of the acquired adult flat foot is posterior tibial tendon insufficiency whose etiology and development is different from that of congenital flat foot, and various methods, such as synovectomy, tendon transfer, calcaneal osteotomy and arthrodesis, can be used to treat the symptoms. The sliding calcaneal osteotomy has been recently introduced by Mark Myerson. The basic concept beneath this treatment is that by displacing distal part medially after a calcaneal osteotomy, the valgus strain in hindfoot can be relieved to place the joint back to the normal position. In order to find out the effect of the sliding calcaneal soteotomy on the flat foot, we measured the changes in the strain in the upper medial spring ligament complex underneath the talonavicular joint after the operation. Four right hand four left fresh frozen cadaver foot specimens, which included the distal half of the tibia were utilized. The spring ligament was isolated with its origin at the sustentaculum tali and insertion on the navicular. At the medial calcaneus the soft tissues were periostially dissected and a small incision was made over the lateral calcaneus for the purpose of visualization. For each specimen a calibrated open liquid metal strain gauge was secured at the origin and insertion of the ligament with superglue and the gauge was sutured along the length of the superomedial portion of the spring ligament complex allowing for the gauge to slide freely. A tibial rod was driven into the intramedullary canal and the foot was always placed in the neutral plantigrade position in the test fig such that the rod was vertical at all times. A initial strain measurement was obtained with only the weight of the platform (19.6N) on the tibia. Weights were added in 7 increments to a total 472 Newton and strains were recorded. Three trials were conducted. The specimens were then removed from the rig and an oblique osteotomy were conducted. A repeated measures analysis of variance showed a significant (p < 0.001) reduction in strain following the osteotomy. To conclude, the direct measurements support the concept that a calcaneal osteotomy provides an alteration which is favorable to unloading the medial arch.
Adult ; Arthrodesis ; Cadaver ; Calcaneus ; Flatfoot ; Foot ; Hand ; Humans ; Joints ; Ligaments ; Osteotomy ; Posterior Tibial Tendon Dysfunction ; Tendon Transfer ; Tibia ; Weights and Measures

BACKGROUND: There are some variables including chamber size in irritant patch test responses. Several non-invasive bidengineering methods for quantifying and obtaining information have been developed in recent decades. OBJECTIVE: Our study was done to compare the effect of chamber size and the volume effect on the irritation potential of 1% SLS solution. METHODS: Patches with 1% sodium lauryl sulfate(SLS) solution were applied to the volar forearm of 14 healthy volunteers for 24 h. Finn chambers with 8mm(20ul), 12mm(60pl), 18mm(80ul, 200ul) inner diameters were used. Visual score and transepidermal water loss (TEWL) were measured at 30 min after removal of the patches, and every 24 h up to 4 days. RESULTS: The results are summarized as follows. 1. Visual scores were 0.18+0.32(8mm), 0.75+0.33(12mm) and 0.64+0.41(18mm) at 24 h after removal of 1% SLS and were 0.11+0.29, 0.50+0.34 and 0.25+0.26 on 4 days after removal. They were inereased 30 min and 24 h after removal and decreased towards normal 4 days after removal. By chamber size, the skin response with the large Finn chamber(12mm) increased more significantly than with the small Finn chamber(8mm). However, there were no significant differences in skin response between large and extralarge Finn chambers(18mm). 2. TEWL values were 11.86+4.09, 23.05+6.1l and 22.24+7.54g/m/h at 30 min after removal and were 9.37+2.30, 1..49+3.08 and 14.56+5.00g/m/h on 4 days after removal. They were increased 30 min after removal and decreased towards normal 4 days after removal. By chamber size, their results were the same as visual scores. 3. By visual score and TEWL, the skin response with 200pl of 1% SLS increased more significantly than 80pl in the extralarge Finn chamber. CONCLUSION: The small Finn chamber may be too small to elicit sufficient cutaneous irritation for evaluation. The large Finn chamber having larger test areas may be suitable to yield positive reactions to certain irritants. Also, the quantity of test solution per mm skin may be of importance for the skin response.
Forearm ; Healthy Volunteers ; Irritants ; Patch Tests ; Skin ; Sodium

No abstract available.
Mycobacterium tuberculosis* ; Mycobacterium* ; Polymerase Chain Reaction*

BACKGROUND: Alpha hydroxy acids (AHAs) are known to diminish corneocyte cohesion at the innermost levels of the stratum corneum and have been used in the treatment of various disorders of keratinization. However, their effect on skin barrier function and their irritant potential is not fully understood. OBJECTIVE: Our study was done to evaluate the skin irritancy of AHAs in normal human skin. METHODS: Patches with 1%, 5% and 10% solutions of lactic acid (LA) and glycolic acid (GA) were applied to the volar forearm of 20 healthy volunteers for 24 hours using large Finn chambers with filter paper. Visual scores, erythema (E-) index and transepidermal water loss (TEWL) were measured at 30 min, 24 h and 48 h after removal of the patches. RESULTS: The results are summarized as follows. 1. Visual scores were 0.1+/-0.3 (1%), 0.5+/-0.6 (5%) and 1.1+/-0.8 (10%) at 24 h after removal of LA, and were 0.2+/-0.4 (1%), 0.6+/-0.6 (5%) and 1.0+/-0.7 (10%) at 24 h after removal of GA. They were increased in proportion to the concentrations and there were significant differences in skin responses between the control and each concentration of the solutions. 2. E-indices were 9.1+/-2.1 (control), 8.8+/-1.8 (1%), 9.0+/-2.6 (5%) and 10.5+/-3.9 (10%) at 24 h after removal of LA, and were 9.4+/-1.8 (control), 9.3+/-2.3 (1%), 10.0+/-3.0 (5%) and 11.1+/-3.5 (10%) at 24 h after removal of GA. They were not increased in the patch areas of 1% and 5% solutions in both the LA and GA group, but were significantly increased in the patch areas of 10% solutions in both the LA and GA group. 3. TEWL values were 7.3+/-2.3 (control), 8.3+/-4.0 (1%), 9.8+/-4.5 (5%) and 16.7+/-9.1 (10%) at 24 h after removal of LA, and were 8.1+/-3.2 (control), 7.8+/-3.8 (1%), 8.6+/-3.0 (5%) and 10.9+/-4.1 (10%) at 24 h after removal of GA. They were not increased in the patch areas of 1% LA, 1% GA and 5% LA, but there were high significant differences between the controls and 10% solutions of both LA and GA. CONCLUSION: Visual scores were increased in all concentrations of AHAs tested, but the increase in E-index and TEWL values were not significant or minimal in 1% and 5% solutions of AHAs. These findings suggest that AHAs could be classified as non-corrosive irritants.
Erythema ; Forearm ; Healthy Volunteers ; Humans* ; Hydroxy Acids* ; Irritants ; Lactic Acid ; Skin*

No abstract available.

Haglunds deformity is a prominence at posterosuperior portion of the calcaneus. Extrinsic irritation on this prominence can give rise to retrocalcaneal bursitis or Achilles tendinitis. Partial resection of the posterosuperior aspect of the calcaneus was performed on 7 heels with Haglunds disease. All patients were reviewed both by radiographic examination and by questionnaire after an average 14.5 months. All but one patient showed an excellent result in a view point of pain relief. The average passive dorsiflexion angle of the ankle was improved from 5 to 25 degree, postoperatively. There was no complication such as recurrence, wound problem or paresthesia.
Ankle ; Bursitis ; Calcaneus ; Congenital Abnormalities ; Heel ; Humans ; Paresthesia ; Surveys and Questionnaires ; Recurrence ; Tendinopathy ; Wounds and Injuries

BACKGROUND: Sodium lauryl sulfate(SLS) is the most widely utilized model for studying acute and cumulative irritation. Sodium lauroyl glutamate(SLG) has exhibited a low irritation potential and an anti-irritating effect on other anionic surfactants. OBJECTIVE: Our study was done to compare the skin irritancy of SLS and SLG using non-in- vasive techniques. METHODS: Patches with 1% SLS and SLG solution were applied to the volar forearm of 20 healthy volunteers for 24 h. Finn chambers with 8mm(20pl) and 12mm(60pl) inner diameters were used. Visual scores, transepidermal water loss(TEWL) and an erythema(E)-index were measured at 30 min after removal of the patches, and every 24hours(h) up to 4 days. RESULTS: The results are summarized as follows. 1. Visual scores were 0.20+0.30(8mm) and 0.73+0.34(12mm) at 24 h after removal of 1% SLS and were 0.15+0.29(8mm) and 0.30+0.41(12mm) at 24 h after removal of 1% SLG. They were increased at 30 min and 24 h after removal and decreased towards normal at 4 days after removal. By chamber size, the skin response with large Firin chamber(12mm) increased more significantly than with the small Finn chamber(8mm). In the small Finn chamber, there were no significant differences in the skin response between 1% SLS and 1% SLG. In the large Finn chamber, the skin response with 1% SLS increased more significantly than with 1% SLG. 2. TEWL values were 11.14+4.77(8mm) and 20.48+10.61(12mm) at 24 h after removal of 1 % SLS and were 10.38+3.99 and 14.87+7.46 at 24 h after removal of 1% SLG. They were increased at 30 min after removal and decreased towards normal 4 days after removal. By chamber size, their results were the same as the visual scores. Also, on comparison between 1% SLS and 1% SLG, their results were the same as the visual scores. 3. E-index was 10.05+2.70(8mm) and 11.15+2.56(12mm) at 24 h after removal of 1% SLS and was 10.15+2.16 and 10.60+2.26 at 24 h after removal of 1% SLG. They were increased at 30 min after removal and decreased towards normal 4 days after removal. By chamber size, their results were the same as the visual scores. In the small and large Finn chamber, there were no significant differences in the skin response between 1% SLS and 1% SLG. CONCLUSION: SLS is more irritating than SLG. The large Finn chamber may be more suitable to yield positive irritant reactions than the small Finn chamber. Also, TEWL measurements may be a more accurate and sensitive method than the E-index.
Forearm ; Glutamic Acid* ; Healthy Volunteers ; Skin ; Sodium Dodecyl Sulfate* ; Sodium* ; Surface-Active Agents

Cirsoid aneurysm of the calp is a congenital arteriovenous malformation which is the result of abnormal connections betwe:.n the external carotid artery and scalp veins with a subsequent dilatation of vascular channels nd formation of aneurysm. We report a case of cirsoid aneurysm of the scalp on the left parieto-occipital area of 14-year-old female who had had 8 x 5 x 0.8 cm sized pulsating soft mass for 2 years. 4 vessel angiog raphy revealed a arteriovenous malformation that emerge mainly from a superficial temporal artery and occipital artery of the left external carotid artery and partially from the right superficial temporal artery and drined into the left scalp vein. The mass was removed by excision with ligation of the feeding arter es and followed up for 2 years without recurrence.
Adolescent ; Aneurysm* ; Arteries ; Arteriovenous Malformations ; Carotid Artery, External ; Dilatation ; Female ; Humans ; Ligation ; Recurrence ; Scalp* ; Temporal Arteries ; Veins

Poor R-Wave Progression(PRWP) of precordial leads is frequently encountered electrocardiographic findings of uncertain significance and has simply been deemed as suggestion of anterior myocardial infarction without concrete ground. 217 cases with poor R-Wave Progression have been analyzed on clinical records and results are as follows. 1) PRWP was most frequently found in fifties and sixities, comprising 63.9% of the subjects. 2) Co-existent disease entities with PRWP were classified into three categories, cardiovascular diseases, chronic lung diseases and normal variants. 3) The cardiovascular diseases related with PRWP were mainly hypertensive diseases, comprising 59.8% of cardiovascular diseases, followed by ischemic heart disease, valvular heart disease and cardiomyopathies. 4) PRWP may be an early sign of acute myocardial infarction in a certain part of cases, which was endorsed by typical clinical symptoms and enzyme studies. 5) As the criterion of PRWP, V3R equal to or less than 3 mm was thought more adequate for higher specificity rather than 4 mm.
Cardiomyopathies ; Cardiovascular Diseases ; Electrocardiography ; Heart Valve Diseases ; Lung Diseases ; Myocardial Infarction ; Myocardial Ischemia ; Sensitivity and Specificity