PURPOSE: The purpose of this study was to identify changes in knee muscle strength after reconstruction of the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). METHODS: Thirteen subjects (males) with anterior ligament injury and ten subjects (males) with posterior ligament injury voluntarily participated in this study. Both groups were evaluated at the pre-and post-reconstruction stages using an isokinetic dynamometer. Peak torque, total work, and the hamstrings to quadriceps (H/Q) peak torque ratio were calculated at angular velocities of 60°/sec and 180°/sec. Statistical analysis was conducted on SPSS 18.0 for Windows using t-tests to compare mean differences. RESULTS: At an angular velocity of 60°/sec, both the ACL and PCL groups showed a significant increase in muscle strength in the flexors and extensors. Muscle strength in the extensors was significantly increased in the PCL group compared to the ACL group. At an angular velocity of 180°/sec, the ACL group showed a significant increase in muscle endurance in the flexors and extensors, and the PCL group showed a significant increase in muscle endurance in the flexors. At angular velocities of 60°/sec and 180°/sec, the H/Q peak torque ratio increased in the ACL group but decreased in the PCL group. Consequently, the H/Q peak torque ratio was significantly different for the two groups. CONCLUSION The results suggest that the patients with ACL injury should focus on strengthening the knee extensors and that the patients with PCL injury need to strengthen the knee flexors.

PURPOSE: Computed tomography (CT) has become popular in the diagnosis of acute pyelonephritis (APN) and its related complications in adults. The aim of this study was to investigate the relationship between uncommon CT findings and clinical and laboratory data in patients with APN. MATERIALS AND METHODS: From July 2009 to July 2012, CT findings and clinical data were collected from 125 female patients with APN. The six uncommon CT findings (excluding a wedge-shaped area of hypoperfusion in the renal parenchyma) studied were perirenal fat infiltration, ureteral wall edema, renal abscess formation, pelvic ascites, periportal edema, and renal scarring. The clinical parameters analyzed were the age and body mass index of the patients as well as the degree and duration of fever. Laboratory parameters related to inflammation and infection included white blood cell count, C-reactive protein (CRP) level, erythrocyte sedimentation rate, pyuria, and bacteriuria. RESULTS: The most common CT finding was perirenal fat infiltration (69 cases, 55%). A longer duration of fever, higher CRP level, and grade of pyuria were related with perirenal fat infiltration (p=0.010, p=0.003, and p=0.049, respectively). The CRP level was significantly higher in patients with renal abscess and ureteral wall edema (p=0.005 and p=0.015, respectively). CONCLUSIONS: The uncommon CT findings that were related to aggravated clinical and laboratory parameters of APN patients were perirenal fat infiltration, ureteral wall edema, and renal abscess formation. The inflammatory reaction and tissue destruction may be more aggressive in patients with these CT findings.
Abscess/etiology/radiography ; Acute Disease ; Adipose Tissue/pathology/radiography ; Adult ; Edema/etiology/radiography ; Female ; Humans ; Kidney Diseases/radiography ; Middle Aged ; Pyelonephritis/complications/pathology/*radiography ; Retrospective Studies ; Tomography, X-Ray Computed/methods ; Ureteral Diseases/etiology/radiography

We report a case of combined off-pump coronary artery bypass grafting (OPCAB) and living-donor liver transplantation (LDLT). Patient was admitted to undergo liver transplantation due to Child C cirrhosis secondary to hepatitis B infection, and incidentally, his preoperative cardiac evaluation revealed silent ischemia due to the two-vessel coronary artery disease (CAD). Patient underwent OPCAB followed by LDLT. There was no perioperative cardiovascular event during the days of hospitalization. From the successful anesthetic experience of a combined OPCAB and LDLT, we cautiously suggest that a combined OPCAB and LDLT could be a surgical treatment for the patients with end-stage liver disease (ESLD) and advanced CAD.
Child ; Coronary Artery Bypass, Off-Pump ; Coronary Artery Disease ; Fibrosis ; Hepatitis B ; Hospitalization ; Humans ; Ischemia ; Liver ; Liver Diseases ; Liver Transplantation ; Living Donors ; Transplants

No abstract available.
Hypothermia* ; Liver Transplantation* ; Liver*

Cervical plexus blocks (CPBs) have been used in various head and neck surgeries to provide adequate anesthesia and/or analgesia; however, the block is performed in a narrow space in the region of the neck that contains many sensitive structures, multiple fascial layers, and complicated innervation. Since the intermediate CPB was introduced in addition to superficial and deep CPBs in 2004, there has been some confusion regarding the nomenclature and definition of CPBs, particularly the intermediate CPB. Additionally, as the role of ultrasound in the head and neck region has expanded, CPBs can be performed more safely and accurately under ultrasound guidance. In this review, the authors will describe the methods, including ultrasound-guided techniques, and clinical applications of conventional deep and superficial CPBs; in addition, the authors will discuss the controversial issues regarding intermediate CPBs, including nomenclature and associated potential adverse effects that may often be neglected, focusing on the anatomy of the cervical fascial layers and cervical plexus. Finally, the authors will attempt to refine the classification of CPB methods based on the target compartments, which can be easily identified under ultrasound guidance, with consideration of the effects of each method of CPB.
Airway Obstruction ; Analgesia ; Anesthesia ; Cervical Plexus Block* ; Cervical Plexus* ; Classification ; Head ; Methods ; Neck ; Ultrasonography

Tumor localization in patients receiving neoadjuvant chemotherapy (NACT) is challenging because substantial therapeutic remission of the original tumor after NACT is often noted.Currently, there is no guidance device that allows for an accurate estimation of the resection range in breast-conserving surgery after NACT. To increase the accuracy of tumor resection, we used a 3-dimensional-printed breast surgical guide based on magnetic resonance imaging (MRI) in the supine position for a breast cancer patient who underwent breast-conserving surgery after NACT. Using this device, the breast tumor with apparent therapeutic changes after NACT on imaging was successfully removed with clear resection margins by identifying the original tumor site in the affected breast. Irrespective of whether the residual tumor area after NACT is well defined, it is possible to confirm and target the tumor area on pre-NACT MRI using this device.

Tumor localization in patients receiving neoadjuvant chemotherapy (NACT) is challenging because substantial therapeutic remission of the original tumor after NACT is often noted.Currently, there is no guidance device that allows for an accurate estimation of the resection range in breast-conserving surgery after NACT. To increase the accuracy of tumor resection, we used a 3-dimensional-printed breast surgical guide based on magnetic resonance imaging (MRI) in the supine position for a breast cancer patient who underwent breast-conserving surgery after NACT. Using this device, the breast tumor with apparent therapeutic changes after NACT on imaging was successfully removed with clear resection margins by identifying the original tumor site in the affected breast. Irrespective of whether the residual tumor area after NACT is well defined, it is possible to confirm and target the tumor area on pre-NACT MRI using this device.

The purpose of this study was to measure curvature contour skin dose using radiochromic film and TLD for a conventional open field. We also attempted to quantify the degradation of skin sparing associated with use of immobilization devices for high energy photon beams and to calculate the skin dose with a help of Monte Carlo (MC) simulation. To simulate head-and-neck and shoulder treatment, a cylindrical solid water phantom 11 cm in diameter was irradiated with 6 MV x-rays using 40x40 cm2 field at 100 cm source axis distance (SAD) to the center of the phantom. Aquaplastic mesh mask was placed on the surface of the cylindrical phantom that mimicked relevant clinical situations. The skin dose profile was obtained by taking measurements from 0degrees to 360degrees around the circumference of the cylindrical phantom. The skin doses obtained from radiochromic film were found to be 47% of the maximum dose of D(max) at the 0degrees beam entry position and 61% at the 90degrees oblique beam position without the mask. Using the mask (1.5 mm), the skin dose received was 59% at 0degrees incidence and 78% at 80degrees incidence. Skin dose results were also gathered using thin thermoluminescent dosimeters (TLD). With the mask, the skin dose was 66% at 0degrees incidence and 80% at 80degrees incidence. This method with the mask revealed the similar pattern as film measurement. For the treatments of the head-and-neck and shoulder regions in which immobilization mask was used, skin doses at around tangential angle were nearly the same as the prescription dose. When a sloping skin contour is encountered, skin doses may be abated using thinner and more perforated immoblization devices which should still maintain immoblization.
Axis, Cervical Vertebra ; Carboxymethylcellulose Sodium ; Immobilization ; Incidence ; Masks ; Prescriptions ; Shoulder ; Skin ; Water