BACKGROUND: Regarding reconstruction surgery of the anterior cruciate ligament (ACL), there is still a debate whether to perform a single bundle (SB) or double bundle (DB) reconstruction. The purpose of this study was to analyze and compare the volume and surface area of femoral and tibial tunnels during transtibial SB versus transportal DB ACL reconstruction. METHODS: A consecutive series of 26 patients who underwent trantibial SB ACL reconstruction and 27 patients with transportal DB ACL reconstruction using hamstring autograft from January 2010 to October 2010 were included in this study. Three-dimensional computed tomography (3D-CT) was taken within one week after operation. The CT bone images were segmented with use of Mimics software v14.0. The obtained digital images were then imported in the commercial package Geomagic Studio v10.0 and SketchUp Pro v8.0 for processing. The femoral and tibial tunnel lengths, diameters, volumes and surface areas were evaluated. A comparison between the two groups was performed using the independent-samples t-test. A p-value less than the significance value of 5% (p < 0.05) was considered statistically significant. RESULTS: Regarding femur tunnels, a significant difference was not found between the tunnel volume for SB technique (1,496.51 +/- 396.72 mm3) and the total tunnel volume for DB technique (1,593.81 +/- 469.42 mm3; p = 0.366). However, the total surface area for femoral tunnels was larger in DB technique (919.65 +/- 201.79 mm2) compared to SB technique (810.02 +/- 117.98 mm2; p = 0.004). For tibia tunnels, there was a significant difference between tunnel volume for the SB technique (2,070.43 +/- 565.07 mm3) and the total tunnel volume for the DB technique (2,681.93 +/- 668.09 mm3; p < or = 0.001). The tibial tunnel surface area for the SB technique (958.84 +/- 147.50 mm2) was smaller than the total tunnel surface area for the DB technique (1,493.31 +/- 220.79 mm2; p < or = 0.001). CONCLUSIONS: Although the total femoral tunnel volume was similar between two techniques, the total surface area was larger in the DB technique. For the tibia, both total tunnel volume and the surface area were larger in DB technique.
Adult ; Anterior Cruciate Ligament/injuries/surgery ; Anterior Cruciate Ligament Reconstruction/*methods ; Autografts ; Femur/*radiography/surgery ; Humans ; Imaging, Three-Dimensional ; Male ; Tendon Injuries/*radiography/rehabilitation/surgery ; Tendons/transplantation ; Tibia/*radiography/surgery

BACKGROUND: Among the various methods for correcting nasal deformity, the composite graft is suitable for the inner and outer reconstruction of the nose in a single stage. In this article, we present our technique for reconstructing the ala and columella using the auricular chondrocutaneous composite graft. METHODS: From 2004 to 2011, 15 cases of alar and 2 cases of columellar reconstruction employing the chondrocutaneous composite graft were studied, all followed up for 3 to 24 months (average, 13.5 months). All of the patients were reviewed retrospectively for the demographics, graft size, selection of the donor site and outcomes including morbidity and complications. RESULTS: The reasons for the deformity were burn scar (n=7), traumatic scar (n=4), smallpox scar (n=4), basal cell carcinoma defect (n=1), and scar contracture (n=1) from implant induced infection. In 5 cases of nostril stricture and 6 cases of alar defect and notching, composite grafts from the helix were used (8.9x12.5 mm). In 4 cases of retracted ala, grafts from the posterior surface of the concha were matched (5x15 mm). For the reconstruction of the columella, we harvested the graft from the posterior scapha (9x13.5 mm). Except one case with partial necrosis and delayed healing due to smoking, the grafts were successful in all of the cases and there was no deformity of the donor site. CONCLUSIONS: An alar and columellar defect can be reconstructed successfully with a relatively large composite graft without donor site morbidity. The selection of the donor site should be individualized according to the 3-dimensional configuration of the defect.
Burns ; Carcinoma, Basal Cell ; Cicatrix ; Congenital Abnormalities ; Constriction, Pathologic ; Contracture ; Demography ; Ear ; Humans ; Necrosis ; Nose ; Retrospective Studies ; Smallpox ; Smoke ; Smoking ; Succinates ; Tissue Donors ; Transplants

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

BACKGROUND: Recent guidelines recommend that all cirrhotics undergo screening upper endoscopy to identifly risk patients for bleeding from varices. The aim of this study was to determine whether clinical and laboratory variables were predictive of the occurrence and progression of esophageal varices. METHODS: This is a retrospective analysis of cirrhotics who had a screening upper endoscopy during 10 years after liver biopsy. Fifty-eight patients were recruited. Univariate/multivariate analysis was used to evaluate associations between the development and progression of esophageal varices and patients characteristics including platelet count, liver chemistry value, prothrombin time, shunt index(heart to liver uptake ratio) through transrectal TI-201 liver scan, probability(P)-value (Y=3.3431-0.8160 x ALT/AST ratio-0.0343 x prothrombin time+2.6963 x shunt index, P=e(y)/(e(y)+1)), ascites, splenomegaly, hepatic encephalopathy. RESULTS: There were 36 patients without esophageal varices or with stable varices during 10 years and 22 patients with new developed esophageal varices or progressive varices during 10 years as determined by upper endoscopy. On multivariate analysis, patients with a probability(P)-value of > or = 0.647 and a platelet count of < or = 100,500/mm3 had a risk of the development and progression of esophageal varices. CONCLUSIONS: Non-endoscopic predictors (probability(P)-value and platelet count) could be used to stratify patients with cirrhosis for the risk of the development and progression of esophageal varices and such stratification could be used to improve the effectiveness of screening upper endoscopy for esophageal varices.
Ascites ; Biopsy ; Blood Platelets ; Chemistry ; Endoscopy ; Esophageal and Gastric Varices* ; Fibrosis ; Hemorrhage ; Hepatic Encephalopathy ; Humans ; Liver Cirrhosis* ; Liver* ; Mass Screening ; Multivariate Analysis ; Platelet Count ; Prothrombin ; Prothrombin Time ; Retrospective Studies ; Splenomegaly ; Varicose Veins