PURPOSE: To compare the results of posterior cruciate ligament reconstructions by tibial inlay and tibial tunnel techniques. MATERIALS AND METHODS: Despite of conservative treatment, all patients (31 cases) had pain and grade 2 or more posterior instability. Posterior drawer test and posterior drawer stress radiography were performed. Clinically, Lysholm knee score and Tegner activity score were evaluated. RESULTS: In the tibial tunnel group, posterior drawer test demonstrated grade 1 instability in 7 cases, grade 2 in 4 cases, and grade 3 in 1 case at the last follow-up. In the tibial inlay group, there was grade 1 instability in 14 cases and grade 2 in 5 cases. On posterior drawer stress radiography, the mean side-to-side difference in measurement of the tibial tunnel group improved from 12.4 mm preoperatively to 4.0 mm at follow-up, and that of the tibial inlay group improved from 11.8 mm to 2.9 mm. Lysholm knee score and Tegner activity score improved to 86.8 points and 5.83 points, respectively, in the tibial tunnel group, and to 88.2 points and 5.84 points, in the tibial inlay group. CONCLUSION: PCL reconstruction with the tibial inlay technique tends to maintain better posterior stability, but there is no statistically significant difference between the two techniques. Further study may be required.
Follow-Up Studies ; Humans ; Inlays* ; Knee ; Posterior Cruciate Ligament* ; Radiography

Cryptotia is a relatively common congenital anomaly in orientals. It is charaterized by obliteration of auriculocephalic sulcus and buried ear cartilage of upper pole beneath the scalp skin. In addition, there is often a posterior displacement of the superior crus of antihelix. The goals of surgical correction are the coverage of skin deficit, deepening of the auriculocephalic sulcus and the correction of deformed cartilage. Some authors stressed a tendency for the superior portion of the auricle to spring back to the original portion after surgery. We have devised a surgical method to prevent recurrence of the cartilagenous deformity using combined method of Fukuda and Onizuka. From March in 2001 to Jan, 2004, We have repaired 6 cryptotic deformities in 5 patients including one bilateral cryptotia. Between them We used combined method of Fukuda and Onizuka in 4 severely deformed cryptotic superior ear cartilage correction with satisfactory results. Single Fukuda's method was used in 2 mildly deformed cryptotias. The combined method composed of Z-plasty incision for skin releasing, and incision along the crus and then flattened the crus by mattress suture, multiple incisions in the back of the superior crus and then grafting the piece of conchal cartilage producing a splinting to hold the crus out in a smooth, curved configuration for the correction of the superior portion of the deformed ear. The results were remarkable improvement of profile in severely deformed cryptotia. And so this combined method is useful method for the correction of severely deformed cartilage in cryptotia.
Cartilage ; Congenital Abnormalities ; Ear ; Ear Cartilage ; Humans ; Nose ; Recurrence ; Scalp ; Skin ; Splints ; Sutures ; Transplants

BACKGROUND AND OBJECTIVES: Aortic stiffness is an independent predictor of cardiovascular mortality and of all other causes in hypertensive patients. The object of this study was to investigate whether aortic stiffness, measured by pulse wave velocity (PWV), could be used as an independent predictor for detecting coronary artery atherosclerosis. SUBJECTS AND METHODS: PWV was measured by an invasive method. All patients (n=187, M/F= 77/110) were suspected as having the coronary artery disease (CAD) and underwent coronary angiography. CAD was classified as that with or without calcification and stenosis and was classified by the calcification segments and stenotic vessel numbers. RESULTS: Coronary artery calcification was significantly associated with diabetes mellitus (p<0.001), the waist/hip circumference ratio (p=0.012), hypertension (p=0.002), age (p<0.001) and PWV (p<0.001). Multiple logistic regression analysis revealed that coronary artery calcification was highly associated with age (OR=1.052, p=0.023) and PWV (OR=1.213, p<0.001). Significant coronary artery stenosis was associated with hypertension (p=0.002), diabetes mellitus (p=0.015), age (p=0.004), waist/hip circumference ratio (p=0.019), systolic blood pressure (p=0.007), pulse pressure (p=0.016), low density lipoprotein levels (p=0.004) and PWV (p<0.001). Multivariate analysis showed that PWV (OR=1.370, p<0.001) and low density lipoprotein levels (OR=1.022, p=0.006) were the best predictors of coronary artery stenosis. Patients with severe coronary atheosclerosis exhibited a greater increased aortic PWV. CONCLUSION: A high aortic PWV is an independent marker for coronary artery stenosis and calcification in suspected CAD patients. The aortic PWV could be used as an independent predictor for ischemic heart disease in patients with suspected CAD.
Atherosclerosis ; Blood Pressure ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diabetes Mellitus ; Humans ; Hypertension ; Lipoproteins ; Logistic Models ; Mortality ; Multivariate Analysis ; Myocardial Ischemia ; Pulse Wave Analysis* ; Vascular Stiffness*

Essential thrombocythemia, a subcategory of chronic myeloproliferative disorder, is characterized by absolute thrombocytosis due to excessive clonal proliferation of platelets, hyperaggregability of platelets and increased incidence of thrombosis and hemorrhage. Essential thrombocythemia may cause frequent vascular thrombosis, but it can be a rare cause of acute ischemic heart diseases such as acute myocardial infarction without atherosclerosis, unstable angina and angina pectoris. We report a case of essential thrombocythemia complicated by acute myocardial infarction. A patient with a previous history of vascular thrombotic complications (such as transient ischemic attack and deep vein thrombosis) was managed with 2.8 million units of intravenous urokinase, antiplatelet agent, ACEI, antianginal medications and hydroxyurea. There were clinically remarkable improvements and no further episodes of thrombotic ischemic vascular complications, including acute myocardial infarction.
Angina Pectoris ; Angina, Unstable ; Atherosclerosis ; Hemorrhage ; Humans ; Hydroxyurea ; Incidence ; Ischemic Attack, Transient ; Myeloproliferative Disorders ; Myocardial Infarction* ; Myocardial Ischemia ; Thrombocythemia, Essential* ; Thrombocytosis ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Veins

BACKGROUND: Post-ischemic myocardial dysfunction (myocardial stunning) is known to be associated with low reflow phenomenon or the reduction of coronary vasodilatory reserve. However, it remains controversial whether a relationship between myocardial stunning and post-ischemic impairment of coronary flow reserve exists. With increased influx of calcium into myocardial cells precipitated by ischemia and reperfusion known to be involved not only in the progression of myocardial tissue damage but also in the pathogenesis of post-ischemic myocardial dysfunction and impaired coronary vasodilatory reserve, it has been hypothesized that calcium channel blockers exert protective effects on post-ischemic myocardial dysfunction and microvascular dysfunction. PURPOSE: To investigate the effects of diltiazem, a calcium channel blocker, on post-ischemic myocardial dysfunction and coronary vasodilatory reserve, vehicle or diltiazem was administered before brief coronary artery occlusion in open chest dogs. Peak coronary flow and myocardial contractile function were measured after intracoronary infusion of endothelium-dependent vasodilator acetylcholine and endothelium-independent vasodilator adenosine. The parameters measured before and after reperfusion in control dogs and diltiazem-treated dogs were compared. METHOD: Open chest dogs (n-17) underwent 20 minutes occlusion of left circumflex artery followed by reperfusion for 60 minutes:the subjects were divided into two groups (n-10 in control group and n-7 in diltiazem group). Diltiazem dogs received diltiazem (0.2 mg/kg) intravenuously 15 minutes before coronary occlusion. Control dogs received vehicle-a saline solution. Coronary blood flow was measured with electromagnetic flow probe. Coronary flow reserve was determined by peak coronary flow after intracoronary infusion of acetylcholine (ACH, 0.01ug/kg) and adenosine (ADE, 1.5 mg/kg):it was also determined by reactive hyperemia (RH) measured after coronary occlusion for 20 seconds at baseline and 30 and 60 minutes after reperfusion. Segmental left ventricular function was assessed by 2-D echocardiography at the level of mid-papillary muscle, and changes of left ventricular function was expressed as % change of myocardial thickening and % change of endocardial thickening. RESULTS: Peak coronary flow and minimal coronary vascular resistance with ACH, ADE and RH were maintained at 30 and 60 minutes after reperfusion in the diltiazem group, but those in the control group were significantly impaired. There was no difference in reduction of % change of peak flow with ACH in both groups (p-0.44), but the reduction of % change of peak flow with ADE was attenuated in the diltiazem group when compared with the control group (p-0.03) 60 minutes after reperfusion. Total myocardial thickening and endocardial wall motion at 30 and 60 minutes after reperfusion were significantly reduced than those assessed before coronary occlusion in both groups, but the endocardial wall motion was less depressed in the diltiazem group than that in the control group. There was no correlation between % change of peak flow in response to ACH and to ADE and % change of myocardial thickening:there was also no correlation between % change of endocardial wall motion in the control group and % change of myocardial thickening in the diltiazem group. There was however good correlation between % change of peak flow and % change of endocardial wall motion in the diltiazem group. CONCLUSION: The findings that changes in peak coronary flow and minimal coronary vascular resistance do not correlate with the change in myocardial contractile function in the dog model with reperfusion after 20 minutes coronary occlusion suggest that microvascular and myocardial stunning develop independent of each other. The protective effect of diltiazem on impaired coronary flow reserve and contractile dysfunction following reperfusion after brief ischemia also suggests that calcium overloading plays a role in the pathogenesis of microvascular stunning as well as myocardial stunning.
Acetylcholine ; Adenosine ; Animals ; Arteries ; Calcium ; Calcium Channel Blockers ; Calcium Channels ; Coronary Occlusion ; Coronary Vessels ; Diltiazem* ; Dogs* ; Echocardiography ; Hyperemia ; Ischemia ; Magnets ; Myocardial Stunning ; Reperfusion ; Sodium Chloride ; Thorax* ; Vascular Resistance ; Ventricular Function, Left

BACKGROUND: The patients with atopic dermatitis (AD) show a defective barrier function of the skin and symptoms such as xerosis, pruritus and erythematous lesions with increased transepidermal water loss (TEWL). The choice of topical moisturizer is very significant for AD patients because these symptoms could be relieved by a local moisturizing agent that strengthens the epidermal barrier function. OBJECTIVE: This study was performed to evaluate the effects of the moisturizer APDDR-0801, which contains physiologic lipid granules (DermaON(R)), for relieving the symptoms associated with AD. METHODS: 128 patients (17.8+/-12.1 years) who were suffering from mild to moderate AD topically applied the test moisturizer twice daily for up to 4 weeks. The treatment efficacy was evaluated by the investigator global assessment (IGA) score, the eczema area and severity index (EASI) score, the transepidermal water loss (TEWL), the visual analogue scale (VAS) for pruritus and sleep disturbance, and the level of inflammatory cytokines in the horny layer of the flexural areas. RESULTS: The test moisturizer was well-tolerated and 58.6% of the patients achieved clinical improvements (over moderate) after the application of the test moisturizer for 4 weeks. The significant relief of AD symptoms was observed from 2 week to 4 week in a time-dependent manner. Significant improvements in the signs and symptoms of AD were observed at 4 week, such as the EASI score (37.8% improvement), the TEWL (20.3% improvement in the antecubital fossa lesion), the VAS score for pruritus (26.2% improvement), and VAS score for insomnia (39.7% improvement). CONCLUSION: The moisturizer APDDR-0801 (Atobarrier Cream(R), which contains physiologic lipid granules, effectively relieved the symptoms associated with AD.
Cytokines ; Dermatitis, Atopic ; Eczema ; Humans ; Pruritus ; Research Personnel ; Skin ; Sleep Initiation and Maintenance Disorders ; Stress, Psychological ; Treatment Outcome

BACKGROUND: Rheumatoid arthritis(RA) is a systemic disease not infrequently involing the heart. It has been known that pericardial effusion, most commonly observed cardiac abnormality in patients with RA, and other cardiac manifestations such as conduction disturbances, valve thickenings, and enlargement of left atrium or aorta are associated with RA. We have determined the nature and extent of cardiac manifestations of RA in comparison with those of control group by echocardiographic examination. METHOD: 27 patients with RA(4 males and 23 females, mean age=47 +/-13 years) and 22 control subjects(3 males and 19 females, mean age+43 +/- 11 years) were randomly selected. Standard two-dimensional, M-mode and doppler echocardiographic examination were done on each group of subjects. RESULTS: 1) Pericardial effusions were more commonly detectd in patients with RA than control group(55.6% vs 22.7%, p<0.01). There were no significant differences in the amount of pericardial effusion according to the duration and the stage of RA. 2) Thickness of each cardiac valve was thicker in patients with RA than control group. But, there were no statistical significance between them. 3) The left ventricular mass index(LVMI) and the diameter of aorta showed a trend to increase in patients with RA(109.5 +/-28.0 g/m(2) vs 94.2 +/-24.6 g/m(2), p=0.054). 4) The diameter of left atrium was more lager in patients with RA(35.1 +/- 4.0mm vs 31.6 +/- 4.5mm, p=o.005). 5) The E/A ratio of mitral valve was statistically significantly lower in patients with RA(RA:control=1.2 +/- 0.5 : 1.7 +/- 0.4, p=0.01). CONCLUSION: The asymptomatic patients with RA more frequently show cardiac abnormalities such as pericardial effusion, valve thickening, decrease of E/A ratio than control group. So two-dimensional echocardiography is necessary for early, noninvasive and accurate evaluation of asymptomatic cardiac abnormalities in patients with RA.
Aorta ; Arthritis, Rheumatoid ; Echocardiography ; Female ; Heart ; Heart Atria ; Heart Valves ; Humans ; Male ; Mitral Valve ; Pericardial Effusion

BACKGROUND: The aim of this study is to evaluate the clinical outcomes between anti-thymocyte globulin (ATG) and basiliximab induction in deceased donor kidney transplantation (DDKT). METHODS: Between May 2006 and February 2015, 40 patients underwent DDKT at our institution. Three cases (7.5%) of them were lost during the following-up schedule. In this study, ATG induction criteria were donor age >50 years old or donor creatinine level >1.3 mg/dL except hepatitis B virus positive and hepatitis C virus positive recipients. Recipients were divided into two groups: the ATG group (n=20) and the basiliximab group (n=17). RESULTS: The 1-year patient survival in the ATG group was 89.4% compared to 93.8% in the basiliximab group (P=0.989). Graft survival for a 1 year in the ATG and the basiliximab group was 89.1% and 93.8%, respectively (P=0.967). Incidences of acute rejection episodes were more prevalent in the basiliximab group (15.0% vs. 29.4%, P=0.428). The glomerular filtration rate level by period of recipients was not different in both group (12th month, 64.60+/-16.17 mg/dL vs. 68.51+/-18.60 mg/dL, P=0.544). The overall complications during the follow-up were not significantly different in both groups (90.0% vs. 76.5%, P=0.383). CONCLUSIONS: The results showed that there was no difference in the patient survival and graft survival between induction of ATG and basiliximab of the DDKT were not different. Therefore, use of both induction agents led to a good patient and graft survival and ATG might be a safe and preferable agent for relatively poor renal function of donor in kidney transplantation.
Antilymphocyte Serum* ; Appointments and Schedules ; Creatinine ; Follow-Up Studies ; Glomerular Filtration Rate ; Graft Survival ; Hepacivirus ; Hepatitis B virus ; Humans ; Incidence ; Kidney Transplantation* ; Tissue Donors*

BACKGROUND: In acute myocardial infarction, left ventricular remodeling, which was influenced by infarct size, location, and patency of infarct related artery(IRA), is a important prognostic factor for chronic heart failure and survival. Recently, several reports suggested that patent IRA does not always mean true myocardial reperfusion, and myocardial contrast echocardiography(MCE) may be a useful tool for assessing infarct size and viability of infarcted myocardium. So, we investigated the association between the degree of myocardial reperfusion assessed by MCE and long term change of left ventricular volume in acute anterior wall myocardial infarction patients who had patent IRA. METHODS: The study population was consisted of 17 patients with first acute anterior wall myocardial infarction patients who had patent left anterior descending artery by thrombolytic therapy or rescue PTCA. MCE was done immediately after coronary angiography within two weeks of myocardial infarction onset and analyzed by semiquantitative method to get opacification index. For analysis of left ventricular ejection fraction, wall motion abnormality and left ventricular volume, echocardiogram was taken within 2 weeks of myocardial infarction oneset and 9 months later in each case. Wall motion abnormality was quantified as wall motion index. According to serial changes of left ventricular volume, patients were divided into two groups ; group 1(less than 10% increase of LV volume at follow-up compared to intial echocardiographic exam) and group 2(more than 10% increase of left ventricular volume). We compared the opacification index of infarcted myocardium, wall motion abnormality, and ejection fraction between the two groups. RESULTS: Initial left ventricular volume and ejection fraction were not different between group 1 and group 2, but the opacification index was lower and initial wall motion index higher in group 2 than group 1. Opacification index, wall motion index, ejection fraction and left ventricular volume were closely correlated in the whole cases. By multivariate ananlysis, opacification index was the only significant factor predicting left ventricular volume increment. CONCLUSION: Myocardial reperfusion, which is closely correlated with ejection fraction and wall motion abnormality, acts as a independent predictor of left ventricular dilatation after acute anterior wall myocardial infarction. This result suggests that assessment of microvascular integrity with myocardial contrast echocardiography may be a valuable indicator to predict long-term change of left ventricular volume, although this is suggestive result in a limited number of patients.
Anterior Wall Myocardial Infarction* ; Arteries ; Coronary Angiography ; Dilatation ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction ; Myocardial Reperfusion* ; Myocardium ; Stroke Volume ; Thrombolytic Therapy ; Ventricular Remodeling

BACKGROUND: Trichloroacetic acid (TCA) is an agent widely applied in dermatology for skin regeneration. To test whether TCA can offer an advantage for the regeneration of oral soft tissue defects, the cellular events following TCA application were explored in vitro and its influence on the oral soft tissue wound healing was evaluated in a canine palate model.METHODS: The cytotoxicity and growth factor gene expression in human gingival fibroblasts were tested in vitro following the application of TCA at four concentrations (0.005%, 0.05%, 0.5% and 1%) with different time intervals (0, 3, 9 and 21 h). One concentration of TCA was selected to screen the genes differentially expressed using DNA microarray and the associated pathways were explored. TCA was injected in open wound defects of the palatal mucosa from beagle dogs (n = 3) to monitor their healing and regeneration up to day 16-post-administration.RESULTS: While the 0.5–1% concentration induced the cytoxicity, a significantly higher expression of growth factor genes was observed after 3 and 9 h following the 0.5% TCA application in comparison to other groups. DNA microarray analysis in 0.5% TCA group showed 417 genes with a significant 1.5-fold differential expression, involving pathways of cell cycle, FoxO signaling, p53 signaling, ubiquitin mediated proteolysis and cAMP signaling. In vivo results showed a faster reepithelialization of TCA-treated wounds as compared to spontaneous healingCONCLUSION: TCA promoted the healing and regeneration of oral soft tissue wound defects by up-regulating the cell cycle progression, cell growth, and cell viability, particularly at a concentration of 0.5%.
Animals ; Cell Cycle ; Cell Survival ; Dermatology ; Dogs ; Fibroblasts ; Gene Expression ; Humans ; In Vitro Techniques ; Mouth Mucosa ; Mucous Membrane ; Oligonucleotide Array Sequence Analysis ; Palate ; Proteolysis ; Regeneration ; Skin ; Trichloroacetic Acid ; Ubiquitin ; Up-Regulation ; Wound Healing ; Wounds and Injuries