The purposes of this study were to document the dimensions of the intercandylar notch in the normal knee; to compare normal knee notches stenosis and femoral intercondylar roof angle to those knees with ACL tears; to compare sexual difference in normal knee to determine if there is a relationship between femoral intercondylar roof angle and notch stenosis and ACL tears. We analyzed 128 MRI of knees taken using the Signa 1.5T MR machine between the ages of 18 and 46 from Feb. 1995 to Feb. 1996. The Group 1 was ninty-one normal knees. The Group 1-F was the normal twenty-two knees of female. The Group 1-M was the normal sixty-nine knees of male. The Group 2 was thirty-seven knees with MRI and arthroscopically confirmed ACL tears within 2 months after injury. We measured the femoral intercondylar roof angle, open notch angle, ratio of notch width at two-thirds of the notch height to condylar width, and ratio of maximum notch width to condylar width from sigittal, transverse cut of MRI. The measurements of the two groups were compared for statistical significance using the student's t-test. Statistically significant differences were found between normal (Group 1) and ACL injured knees (Group 2) in regard to ratio of notch width at two-thirds of the notch height to condylar width, and ratio of maximum notch width to condylar width, but no significant differences were found in the femoral intercondylar roof angle, and open notch angle, suggesting a significant association between anterior outlet stenosis and ACL tears. And statistically significant difference was found only in the ratio of maximum notch width to condylar width between normal male (Group 1-M) and female (Group 1-F), suggesting more stenotic in male group. Although a stenotic femoral intercondylar notch may contribute to a torn ACL, the intercondylar roof angle and open notch angle does not correlate with an ACL tears.
Constriction, Pathologic ; Female ; Femur* ; Humans ; Knee ; Magnetic Resonance Imaging* ; Male

Ganglion cysts on the anterior cruciate ligament should he suspected in any patient having pain and clicking sensation during terminal knee extension. Previous investigators have reported incidental findings of ganglion cysts on the anterior cruciate ligament. We report a symptomatic case of a ganglion cyst on the anterior cruciate ligment that was treated successfully with arthroscopic debridement.
Anterior Cruciate Ligament* ; Debridement ; Ganglion Cysts* ; Humans ; Incidental Findings ; Knee ; Research Personnel ; Sensation

Staging of carcinoma of the urinary bladder is important for the choice of therapy and also has prognostic implications. Hitherto the staging has been based upon cystoscopy with bio psy, transurethral resection , and palpation with complementary radiographic examlnations such as cystography, urography, lymphangiography, ultrasound and angiography. However, with all these methods, the staging of bladder carcinomas still uncertain and inferior to CT. Authors analyzed CT staging of bladder cancers and compared with pathologic staging of laparotomy results. The results are as follows: 1. Overall accuracy of CT staging in bladder carcinoma was 72 percent. 2. Overstaging was 20 percent (5/25) and understaging was 8 percent (2/25). 3. All of CT stage B cancers were proven to be stage B, pathologlcally. 4. In 6 cases of CT stagec cancers,only one was correct,3 were overstaged and 2 were understaged. 5. In 7 cases of CT stage D cancers, 5 were correct and 2 were overstaged. 6. CT detected only 2 cases of pelvic Iymph node involvement in 4 of pathologically proven Iymphadenopathy.
Angiography ; Cystoscopy ; Laparotomy ; Lymphography ; Palpation ; Ultrasonography ; Urinary Bladder Neoplasms ; Urinary Bladder ; Urography

Achilles tendon is the most powerful and the biggest tendon of the body and its rupture is frequently sports-related. Many authors reported the effects of mobilization, electricity, ultrasound and various drugs as factors influencing the injured tendon. We studied the effects of early passive mobilization after firm suture using plantaris tendon as tension suture material and reinforcing membrane on the repair of a ruptured Achilles tendon. From March 1992 to December 1995, twenty-two operations on the Achilles tendon were carried out in our hospital. 1. Fourteen patients were male and eight patients were female. The mean patient age was 38 years, ranging from 13 to 68 years. Average follow-up periods was 2 years and 7 months, ranging from 12 months to 3 years and 8 months. 2. The rupture site was 4.7cm proximal to the tendon insertion into the calcaneus on average. 3. We performed the operations with end to end suture technique. After approximation of the ruptured ends of the tendon with a No. 5 Ethibond tension suture using a modified Kessler stitch, placed plantaris tendon in a fascial needle and pass it circumferentially and distal plantaris tendon is fanned out and tacked over the repair. 4. Postoperative treatment was done as following protocol Short leg cast was done with equinus position for initial 3 weeks, and then cast was removed, hydrotherapy and passive exercises was employed. About 6 weeks after operation when the foot can be brought to right angle, a reverse 90degrees ankle stop short leg brace was applied for additional 6 weeks and partial weight bearing was aUowed. 5. Follow-up results were classified according to the Arner-Lindholm scale. We had 16 excellent results and 6 satisfactory results. After rigid suture it may be possible to introduce a regimen of progressive isometric stimulation and protected loading and streching combined with removable orthosis. Such early exercises are likely to improve the rate of rehabilitation over plaster immobilization.
Achilles Tendon* ; Ankle ; Braces ; Calcaneus ; Electricity ; Exercise ; Female ; Follow-Up Studies ; Foot ; Humans ; Hydrotherapy ; Immobilization ; Leg ; Male ; Membranes ; Needles ; Orthotic Devices ; Rehabilitation ; Rupture* ; Suture Techniques ; Sutures ; Tendons ; Ultrasonography ; Weight-Bearing

Chronic osteomyelitis is refractory because of the characteristics of bone. The soft tissues of bone are surrounded by hard walls, and inflammation of the contained tissues causes circulatory disturbances which can readily read to necrosis of various parts of the bone. Since it is impractical to deliver antibiotics to the target tissue at a sufficiently high concentration by the intravenous route, local administration is considered to be essential. There are many materials for drug delivery system. Antibiotic-containing cement beads qualify as a drug delivery system. The distance to which the effective concentration of an antibiotic extends from the carrier material is of clinical importance in evaluating a drug delivery system. We evaluated the concentration of gentamicin released from gentamicin mixed bone cement in bone marrow and bactericidal activity of released gentamicin according to time. Female albino rats weighing approximately 350 grams were used. Beads were made to gentamicin mixed Palacos PMMA bone cement. Three rats in each group were killed on 1st, 3rd day and 1st, 2nd, 3rd, 4th, 5th and 6th week. Extracted bone marrow was homogenized with 5ml of phosphate buffer saline (PBS) and removed beads with 5ml of PBS were incubated for 24 hours in 37degrees C. Gentamicin concentration from bone marrow and elution fluid from removed bead was measured using TDX machine and bactericidal activity of released gentamicin was measured by bactericidal broth dilution method using Bacillus subtilis ATCC 21008. Gentamicin sulfate gave a maximum concentration within the 1st week, which gradually decreased but was still effective at 6th week. Gentamicin concentration from removed bead gave a maximum concentration at 1st day, which gradually decreased to 6th week.
Animals ; Anti-Bacterial Agents ; Bacillus subtilis ; Bone Marrow ; Drug Delivery Systems ; Female ; Gentamicins* ; Humans ; Inflammation ; Necrosis ; Osteomyelitis ; Polymethyl Methacrylate* ; Rats

Between 1989 and 1995, 14 patients with Kienbock's disease were treated with radial shortening or a radial wedge osteotomy. Clinical and radiological changes were classified according to Lichtman's stages and ulnar variance. Seven patients were male and seven were female. The mean age was 45 years, ranging from 29 to 64. The average follow-up period was 29 months, ranging from 12 to 61. Of the ten patients with negative ulnar variance who were treated by radial shortening, two cases were in Lichtman's stage II, six cases were stage III-a and two cases were stage III-b. Of the four patients with zero or positive ulnar variance who were treated by a radial wedge osteotomy, one case was stage 11 and three cases were stage III-a. The results were evaluated in terms of diminished wrist pain, increased grip strength, increased range of wrist motion and radiologic changes of the lunate. Wrist pain had diminished in all patients and grip strength had increased on average from 54% to 70% in the unaffected side. The range of arc of the wrist had increased on average from 59degrees preoperatively to 93 postoperatively. Sclerosis of the lunate improved in 43% of cases, cystic changes of the lunate improved in 57%, fragmentation of the lunate improved in 36% and the carpal height ratio increased in 50%. Of the 14 patients, 13 patients (93%) showed satisfactory results. One patient had an unsatisfactory result, according to Lichtman's criteria. These results suggest that radial shortening or a radial wedge osteotomy is recommended in patients with stage ll, III-a or III-b Kienb ck's disease, according to the ulnar variance. Early wrist pain reduction, increased range of motion and grip strength and improved avascularity of the lunate are all positive outcomes attainable with these treatment methods.
Female ; Follow-Up Studies ; Hand Strength ; Humans ; Male ; Osteonecrosis* ; Osteotomy* ; Range of Motion, Articular ; Sclerosis ; Wrist

We developed Extor pins for Extor external fixator, it made of stainless steel and applied it clinically to manage open fractures and chronic osteomyelitis from December, 1993 to January, 1995. The main aim of present study is to compare the mechanical strength and biocompatibillity between Extor pins and AO Schanz pins, and to determine the safety and possibility of clinical use. We performed the biomechanical test for bending, tension, and shearing of pin itself using universal testing machine (LR5OK) and pullout test in cadeveric cortical femur to determine the bone holding power. There was no significant difference between Extor and AO Schanz pin (p>0.05). Clinically, the incidence of pin site infection, pin lossening, radiological rarefaction, and pathological change were not different significantly (p>0.05). Although Extor pins are somewhat different from AO Shanz pins in material and design characteristics, we can find the safety and possibility of clinical use of Extor pins made in Korea.
External Fixators* ; Femur ; Fractures, Open ; Incidence ; Korea ; Osteomyelitis ; Stainless Steel

The elbow is the most frequent area of complaint in children and adolescent baseball players. The physical stresses associated with repetitive throwing create extra-ordinary forces, which may affect the normal osteochondral and soft tissue developmental process and are the important factors causing the decrease of competitive power and shortening of life as a baseball player in adolescents. We surveyed the 114 baseball players of middle & high school in Taegu in order to evaluate the prevalance of symptoms and radiologic findings of the elbow and correlation of these findings to career & position of the baseball game. The results were as follows. 1. Of 114 players, 83 were non-pitchers and 31 were pitchers. The mean career was 3.8 years (7 months to 6 years). 2. The 77 players (67.7%) had the pain on their elbow during or after daily exercise. Other clinical symptoms were locking (30.7%), limitation of motion (18.4%), swelling (16.6%) and clicks on motion (10.5%). 3. On the radiogram of the elbow, hypertrophy or separation of medial epicondyle were seen in 34% of players, loose bodies in 17%, hypertrophy of the humerus in 12% and cystic change of the capitellum in 11%. 4. The mean career of symptomatic players was 4.4 years but non-symptomatics was 2.7 years. The mean career of players who had abnormal radiologic findings was 5.1 years but 3.1 years in players who had no abnormal radiologic fingings. 5. Symptoms and pathologic changes were more common in the elbow of pitcher' s group due to throwing frequency & pitching style. 6. Among the 77 players who had any kinds of problem of the elbow, 49 players of them had no experience of visiting hospital. 7. To prevent these injuries of the elbow, the following recommendations were made. First, restrict the number of innings pitched per game. Second, avoid throwing the curve ball in this age group. Third, ensue an adequate warm up period before exercise or rest after games. Fourth, inform parents and coaches of possible harmful nature of excessive throwing.
Adolescent* ; Baseball* ; Child ; Daegu ; Elbow* ; Humans ; Humerus ; Hypertrophy ; Parents

The use of a central one-third patellar tendon as an autograft for surgical reconstruction of a c4maged cruciate ligament is common. However, recent clinical studies indicate that decreased quadriceps strength, decreased range of motion, decreased thigh circumference and patello-femoral problems can be associated with this procedure. Some of these complications may result from alterations in the structural properties of the remaining patellar tendon. The objective of this study was to examine tructural change of the remaining patellar tendon using MRI after removal of its central one-third. We evi.luated 10 patients received ACL reconstruction using autogenous central third bone-patellar tendon-bone. The mean age of the. Patient was 24 years old. The mean follow-up period was 30 months. The surgicd techn:ique was arthroscopically assisted ACL reconstruction using single incision. Only paratenon was repaired, reniaining patellar tendon defect. We checked the thickness, width, length and cross-sectional area of patellar te.ndon defect from axial MR scan. We also checked preoperative MR image of the same patient and compare, Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Autografts ; Follow-Up Studies ; Humans* ; Ligaments ; Magnetic Resonance Imaging ; Patellar Ligament* ; Range of Motion, Articular ; Tendons ; Thigh ; Young Adult

Nephrogenic diabetes insipidus (NDI) can cause nonobstructive hydronephrosis. Congenital NDI (CNDI) is caused by a genetic mutation. This case report presents a 12-year-old girl who was incidentally diagnosed with nonobstructive hydronephrosis due to NDI caused by AQP2 gene mutation after being evaluated for microscopic hematuria found on routine health examination at school. The patient's medical and family history was unremarkable, and she complained of nocturia only at the time of the clinic visit. Bilateral hydronephrosis on abdominal ultrasonography prompted a water deprivation test, leading to diagnosis of NDI. Genetic study confirmed p.Asn (AAC)123Ser (AGC) in exon 2 of the AQP2 gene. Polyuria and hydronephrosis improved following arginine-vasopressin therapy. CNDI responsive to treatment should be considered as a possible cause of nonobstructive hydroureter.
Ambulatory Care ; Child ; Diabetes Insipidus, Nephrogenic* ; Diagnosis ; Exons ; Female ; Hematuria ; Humans ; Hydronephrosis* ; Nocturia ; Polyuria ; Ultrasonography ; Water Deprivation