PURPOSE: Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle is frequently found in association with a tear of the anterior cruciate liagment (ACL). The purpose of this study was to determine which ligamentous and meniscal tears are associated with kissing contusion. MATERIALS AND METHODS: We retrospectively reviewed the findings depicted by 323 consecutive MR images of the knee and confirmed at arthroscopy. For the diagnosis of disruption, ligaments, medial menisci (MM) and lateral menisci (LM) were evaluated using accepted criteria. We compared the prevalence and location of meniscal and ligamentous tears between group I (44 knees with kissing contusion) and group II (279 knees without kissing contusion). For statistical analysis the chi-square test was used. RESULTS: ACLs were torn in all 44 knees (100%) with kissing contusion, and 78 (28%) of 279 without kissing contusion. There were ten medial collateral ligament (MCL) tears (23%) in group I, and 17 MCL tears (6%), five lateral collateral ligament (LCL) tears (2%) and ten posterior cruciate ligament (PCL) tears (4%) in group II. In group I, meniscal tears were found in 22 MM (50%) and in 19 LM (43%), while in group II, they occurred in 128 MM (46%) and 128 LM (46%). In group I, 17 (77%) of 22 MM tears and 13 (68%) of 19 LM tears were located in the posterior horn, while in group II, the corresponding figures were 97/128 (76%) and 60 of 128 (47%). The differing prevalence of ACL and MCL tears between the groups was statistically significant (p<0.05), but differences in the prevalence and location of meniscal tears were not (p>0.05). CONCLUSION: Although kissing contusion was a highly specific sign of ACL tears, its presence was also significant among MCL tears. There was no signifficant difference in meniscal tears with or without kissing contusion.
Animals ; Arthroscopy ; Collateral Ligaments ; Contusions* ; Diagnosis ; Horns ; Knee ; Lateral Ligament, Ankle ; Ligaments* ; Menisci, Tibial ; Posterior Cruciate Ligament ; Prevalence ; Retrospective Studies

Extraskeletal bone-forming lesions are myositis ossificans, fibrodysplasia(myositis) ossificans progressiva, and extraskeletal osteosarcoma. It is of paramount importance to clearly distinguish these lesion from extraskeketal osteosarcoma. Myositis ossificans, by far the most common among these lesions, is a benign, ossifying process that is generally solitary and well circumscribed. It is found most commonly in the musculature, but it may also occur in other tissue, especially in tendons and subcutaneous fat. It occur as the result of various kinds of soft tissue injury(surgical scars, burns, dislocation of joints etc.) and also observed in patients with tetanus, in paraplegics secondary to traumatic spinal injury. Although there is general agreement that myositis ossificans is a nonprogressive benign process without nerplastic potential, its pathogenesis is still poorly understood.We experienced a myositis ossificans associated with chronic, extensive pressure sore in patient with paraplegia secondary to spinal injury.
Burns ; Cicatrix ; Dislocations ; Humans ; Joints ; Myositis Ossificans* ; Myositis* ; Osteosarcoma ; Paraplegia ; Pressure Ulcer* ; Spinal Injuries ; Subcutaneous Fat ; Tendons ; Tetanus

Primary malignant melanornn of the vagina is rare, with only about 130 reported cases worldwide. They presumably arise from melanocytes that are present in the vagina in 3% of normal wornen. Vaginal melanoma accounts for less than 1% of melanomas and less than 3% of primary malignant tumors of the vagina. Most of patients complain vaginal bleeding, vaginal discharge, foreign body sensation in order. The best treatment of vaginal melanoma rernains eni.gmatic, Many authors indicate that radical surgery may be the pcferred approach and the number of reported cases treated with radical surgery is increasing. But other author comment that no significant change in survival is apparent with radical surgery. Overall prognosis is poor as most patients have deeply penetrating lesions at the time of diagnosis. Recently, not only the effort to increase the survival rate but the quality of life including sexual function after treatment is becoming an important issue about treatment ot cancer patients. We experienced a case of primary malignant melanoma of the vagina treated with radical surgery and restored the sexual function by vulvovaginal reconstruction using gracilis myocutaneous flap. So we report this case with brief literature review.
Diagnosis ; Foreign Bodies ; Humans ; Melanocytes ; Melanoma* ; Myocutaneous Flap ; Prognosis ; Quality of Life ; Sensation ; Survival Rate ; Uterine Hemorrhage ; Vagina* ; Vaginal Discharge

No Abstract Available.
Blepharoplasty*

Simultaneous quantification of multiple marker compounds in herbal medicine by high performance liquid chromatography (HPLC) analysis is still a challenge due to the complexity in various parameters to be considered and co-existing multi-components. As a case study, a reliable HPLC method for simultaneous quantification of paeoniflorin from Paeoniae Radix and decursin from Angelicae Gigantis Radix in various commercial herbal medicine was developed based on analytical quality by design (AQbD) strategy. As a first step, risk assessment was performed to select the critical method parameters (CMPs) which were decided as organic mobile phase ratio and column oven temperature. In order to evaluate the effect of the CMPs on critical method attributes (CMAs) of peak resolution and tailing, central composite design (CCD) was employed. The final chromatographic conditions were optimized as follows: column- C 18 , 4.6 × 250 mm, 5 μm particle size; mobile phase- A: acetonitrile, B: 0.1% acetic acid water; detection wavelength- 235 nm for paeoniflorin, 325 nm for decursin; column oven temperature- 25 o C; flow rate- 1.0 mL/min; gradient mobile phase system as Time (min) : % A, 0:14, 25:14, 30:50, 60:50, 61:100, 65:100, 66:14, 75:14. The method was successfully validated according to the International Conference on Harmonization (ICH) guidelines and piloted for ten commercial herbal medicines.

There remains many difficult problems for plastic surgeons when they try to reconstruct soft tissue defect, especially defect on lower extremity with poor vascularity. We experienced two kinds of artificial dermis, Alloderm (LifeCell Corporation, USA) and Terudermis(Terumo, Japan). We applied them for 12 patients from October 1998 to May 1999. Their wounds had various causes. The authors debrided the necrotic tissue and got the artificial dermis soaked enough in saline. After fixing the artificial dermis with suture fixation, thin STSG was harvested. Applying the thin STSG on artificial dermis and Tie-over dressing were done to prevent mobilization. From our experience we had several suggestions to keep in mind. Preoperatively, you have to decrease the discharge with frequent dressing change. Intraoperativeiy, in order to avoid the mobilizaion between the artificial dermis and STSG, you have to fix them well with suture fixation. Postoperatively, the larger is the exposed bone or tendon, the longer the splint applying time is required. Nine patients out of 12 patients(75%) had no problem. Three patients underwent partial loss. Two patients suffered from infection or rough dressing. One patient failed due to careless mobilization before the artificial dermis is completely settled. The authors recommend to appky the artificial dermis rather than more aggressive procedures when the wound size is smaller than 2 x 4 cm with bone or tendon exposure. The authors think that the artificial dermis is also very useful to prevent postoperative scar contracture.
Bandages ; Cicatrix ; Contracture ; Dermis* ; Humans ; Lower Extremity ; Splints ; Sutures ; Tendons ; Wounds and Injuries

BACKGROUND: An association between diabetes and tuberculosis has long ken implied. The severity of diabetes appears to correlate with the degree of tuberculous activity. METHODS: A retrospective chart review of 82 patients with active pulmonary tuberculosis in diabetics(DMTB) and 83 patients with active pulmonary tuberculosis in nondiabetios (Non-DMTB) admitted to the Kyung Hee Medical Center between January 1995 and December 1996 was undertaken. RESULTS: The sex ratio of DMTB was 58 : 24, and that of Non-DMTB was 62 : 21. Male patients predominated in both groups. The highest incidence of DMIB was 6th and 7th decades and that of Non-DMTB was 3rd and 4th decades. In case which the tuberculosis developed after diagnosis of diabetes, the prevalence of pulmonary tuberculosis was the highest in diabetes for 5 -10 years. On chest X-ray findings, the moderate advanced tuberculosis cases were the most common (60.9% in DMTB and 50.6% in Non-DMTB). There was no relation between the degree of tuberculosis activity on chest x-ray(minimal, moderata awl far advanced tuberculosis) and presence of diabetes. The incidence of lower lung field tuberculosis in DMTB was significantly higher than Non-DMTB(p<0.05). The multiple lobe involvement was the predominant chest roentgenograpflc finding in both groups. There was no significant difference of treatment response between DMTB and Non-DMTB. There was no relationship between initial HbA1c and the stverity of pulmonary tuberculosis on chest X-ray. During treatmenu of pulmonary tuberculosis in excellently and well controlled diabetes, the cure rate of pulmonary tuberculosis was sigrificantly higher than the pcorly controlled diabetes and the rate of treatment failure was significantly lower than poorly controlled diabetes. (p<0.05). CONCLUISON: Poor control of blood glucose is related with increased rate of treatment failure in pulmonary tuberculosis with diabetes mellitus. Further investigation will be needed to study the mechanisms of treatment failure in poorly controlled diabetics with pulmonaiy tuberculosis.
Blood Glucose ; Diabetes Mellitus ; Diagnosis ; Humans ; Incidence ; Lung ; Male ; Prevalence ; Retrospective Studies ; Sex Ratio ; Thorax ; Treatment Failure ; Tuberculosis ; Tuberculosis, Pulmonary*

Cerebral air embolism is a rare but fatal complication of central venous catheterization. Here, we report a case of paradoxical cerebral air embolism associated with central venous catheterization. An 85-yr-old man underwent right internal jugular vein catheterization, and became obtunded. Brain MR imaging and CT revealed acute infarction with multiple air bubbles on the side of catheter insertion. The possibility of cerebral air embolism should be considered in patients developing neurological impairment after central venous catheterization, and efforts should be made to limit cerebral damage.
Aged, 80 and over ; Brain/pathology ; Catheterization, Central Venous/*adverse effects ; Echocardiography, Transesophageal ; Embolism, Air/*etiology/ultrasonography ; Embolism, Paradoxical/*etiology/ultrasonography ; Humans ; Intracranial Embolism/*etiology/ultrasonography ; Magnetic Resonance Imaging ; Male ; Tomography, X-Ray Computed

OBJECTIVES: In our studies, we have made efforts to compare illness representation among the pathological gamblers, social gamblers, the family members of gambler, the gambling industry employees, and general adults and to investigate what kinds of illness representation make an estimate of therapy intention. METHODS: 222 gambling users, 125 family members of gambler, 95 employees in gambling industry, and 1383 general adults were included in this study. Symptom representation, negative characteristic representation, negative consequence representation, internal and external attribution representation, spontaneous recovery representation, recovery representation through therapeutic help of speciality, time lapse representation were constructed and included for illness representation of pathological gambling. RESULTS: 1) Pathological gamblers had lower symptoms, negative characteristics, negative consequences and therapeutic help seeking representation than other groups, on the other hand higher external attribution representation and spontaneous recovery representation. 2) Families of problem gambler have inconsistent characteristics higher external attribution and negative consequences and lower therapeutic help seeking representation. 3) It was founded that negative consequences representation and external representation were low in gambling industry employees. 4) The more symptom representation increased and external attribution decreased, the more therapeutic intention increased in case of problem gamblers and their families. CONCLUSION: Pathological gamblers have the lowest awareness and acceptance on mental problem caused by excessive gambling. However, suggested that family members of gambler and gambling industry employees also have partially self defensive and contradicted representations. It was suggested that awareness on severity of symptom and internal attribution representation needs to be increased in order to participate therapeutic place.
Adult ; Gambling* ; Hand ; Humans ; Intention

Neurothekeoma is a relatively uncommon tumor of nerve sheath origin. Most of these tumors are benign and malignant transformation was not reported. Usually, these tumors arise during childhood or early adulthood life with female preponderance. They have a predilection for the head, neck and shoulder region but any part of the body may be affected. Their usual size is between 0.5-3.0 cm. Rapid growth and ulceration are rare, and local recurrence tends to occur after incomplete excision. We report a case of neurothekeoma developed in the scalp of a 21-year-old woman. It was first noticed about 1year ago. This mass had been increasing in size slowly. On physical examination, 2 x 1.5 cm sized papule with localized alopecia was identified on the frontal scalp area. It was excised in 5.5 x 3.6 cm. The histologic finding of the lesion showed that lobules, fascicles or rests of spindle shaped or epitheloid cells in a myxoid of mucosubstance. The tumor cells were positive for S-100 and vimentin but showed negative for EMA, cytokeratin, desmin, actin and HMB45. After surgical excision of tumor, split-thickness skin graft was done. Three months after the operation, rectangular shape tissue expander (180 cc Sebbin(R)) was inserted on both sides of the previous wound. After removal of tissue expander, the wound closed with local flap. The patient did not have any evidence of recurrence for 6 months.
Actins ; Alopecia ; Desmin ; Female ; Head ; Humans ; Keratins ; Neck ; Neurothekeoma* ; Physical Examination ; Recurrence ; Scalp* ; Shoulder ; Skin ; Tissue Expansion Devices ; Transplants ; Ulcer ; Vimentin ; Wounds and Injuries ; Young Adult