The purpose of this study was to investigate the arthro-sonographic appearance of the chronic anterior talofibular ligament (ATFL) injury. Twenty-nine patient, who were identified to have partial or complete ATFL tears by conventional ultrasonography were included. Intraarticular injection of 5 mL of fluid (2.5 cc lidocaine+2.5 saline) was performed under ultrasound-guidance, which was followed by arthrosonography. Among 23 patients with partial tear which was detected by the conventional ultrasonography, 11 patients were identified to have complete tear by the arthrosonography. Among 6 patients with complete tear was detected by conventional ultrasonography, all of them identified to have complete tear by the arthrosonography. Arthrosonography is helpful in evaluation the configuration of ATFL complete tear and detecting complete tear by making them appear larger and apparent after instillation of fluid.
Humans ; Injections, Intra-Articular ; Ligaments

OBJECTIVE: The objectives of this study were to clarify the short-term effects of transforaminal epidural steroid injection (TFESI) for degenerative lumbar scoliosis combined with spinal stenosis (DLSS), and to extrapolate factors relating to the prognosis of treatment. METHOD: Thirty-six patients with lumbar radicular pain from DLSS were enrolled. Subjects were randomly assigned to one of two groups (steroid or lidocaine group). We compared the effect of pain suppression at 2, 4 and 12 weeks after the procedure between the two groups. Radiographic analysis included measurement of the Cobb's angle, the upper endplate obliquities of L3 and L4, and maximal lateral olisthy between two adjacent lumbar vertebrae. Sagittal plane measurement included lumbar lordosis, and thoracolumbar kyphosis. Statistical analysis of both radiographic and clinical parameters along with treatment outcome was performed to determine any significant correlations between the two. RESULTS: There were no significant differences in the demographic data, initial visual analogue scale (VAS) or Oswestry disability index (ODI) between the steroid group (n=17) and the lidocaine group (n=19). Two, 4, and 12 weeks after injection VAS, ODI showed a significantly greater improvement in the steroid group compared to the lidocaine group (p<0.05). The radiographic and clinical parameters were not significantly correlated with treatment outcome. CONCLUSION: Our findings suggest that fluoroscopic transforaminal epidural steroid injections appear to be an effective non-surgical treatment option for patients with degenerative lumbar scoliosis combined with spinal stenosis (DLSS) and radicular pain.
Animals ; Constriction, Pathologic ; Humans ; Kyphosis ; Lidocaine ; Lordosis ; Lumbar Vertebrae ; Prognosis ; Scoliosis ; Spinal Stenosis ; Treatment Outcome

Bilateral trans-scaphoid perilunate fracture dislocations are uncommon and have been rarely reported in the literature. Furthermore, it is more difficult to manage in the case of Fenton's syndrome (scaphocapitate fracture syndrome, trans-scaphoid trans-capitate fracture dislocation). These injuries occur after a high-energy trauma caused by fall from height or vehicular accidents. These fracture dislocation patterns have very few reported cases in the literature and little information as to the diagnosis, management, and surgical approach for treatment. We present a case of scaphocapitate fracture syndrome on the right hand and trans-scaphoid trans-triquetral perilunate injury on the left hand at the same time.
Diagnosis ; Dislocations* ; Hand

BACKGROUND AND OBJECTIVES: The majority of laryngeal tumors are known to be SCC (squamous cell carcinoma). Non-SCC (non-squamous cell cancers) of the larynx represent a diverse spectrum of diseases with different prognosis and ratio-nales of management from SCC. Therapeutic options to these tumors depend on their histopathological characteristics and clinical behaviors. The purpose of this study was to assess the unique aspects of the non-SCC and to draw diagnosis and provide management options and prognostic variables. MATERIALS AND METHOD: Eleven non-SCC of the larynx from the 212 patients who were diagnosed with larynx cancer during their 3-year visits from 1997 to 2000 were reviewed retrospectively. RESULTS: The incidence of non-SCC was 5.2%. Pathology of non-SCC revealed 3 cases of malignant lymphoma, 2 cases of verrucous cell carcinoma and neuroendocrine carcinoma one case each of basaloid squamous cell carninoma, salivary duct carcinoma, adenocarcinoma, and spindle cell carcinoma. The most common site of origin was supraglottis (6 case, 56.5%), followed by glottis (4 cases, 36.4%) and subglottis (2 cases, 17.2%). Non-Hodgkin's lymphomas and basaloid squamous cell carninoma were treated by chemotherapy. The remaining cases were treated with surgery followed by postoperative radio-therapy or postoperative chemotherapy. The mean follow-up period was 26.8 months (12-43 months). CONCLUSION: Non-SCC accounts for approximately 5.2% of all malignancies of the larynx. Tissue biopsy is the most important diagnostic tool for the non-SCC of the larynx and the tissue sample must be obtained from the deep portion of the submucosal layer. Except for malignant lymphomas, the combined therapy that includes surgery would be the best method of treatment for non-SCC.
Adenocarcinoma ; Biopsy ; Carcinoma, Neuroendocrine ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Glottis ; Humans ; Incidence ; Laryngeal Neoplasms ; Larynx* ; Lymphoma ; Lymphoma, Non-Hodgkin ; Pathology ; Prognosis ; Retrospective Studies ; Salivary Ducts

Sjogren syndrome is a chronic autoimmune disease characterized by lymphocytic infiltration of exocrine glands resulting in dry mouth and eyes. Approximately one-third of patients present with systemic manifestations, but respiratory muscle involvements have been rarely reported. We report a case of acute respiratory failure complicated by primary Sjogren syndrome. Muscle biopsy revealed perivascular lymphocytic infiltrations. Corticosteroid therapy improved respiratory muscle weakness. Sjogren syndrome should be considered as one of the underlying diseases causing acute respiratory failure.
Autoimmune Diseases ; Biopsy ; Exocrine Glands ; Humans ; Mouth ; Muscular Diseases ; Respiratory Insufficiency ; Respiratory Muscles* ; Respiratory Paralysis ; Sjogren's Syndrome*

Surgical revascularization is very effective for the relief of chest pain, improvement of exercise tolerance and ventricular performance in certain ischemic heart diseases. Bypass graft angiography and native coronary angiography after coronary artery bypass graft(CABG) were required for the evaluation of graft patency, progression of the native coronary artery disease and to predict the prognosis of the patients after CABG. The cases included in this study involved 15 patients who underwent selective bypass graft angiography among 102 CABG cases. Thirty eight sites were bypassed by saphenous vein and two sites by internal mammary artery. The results were as follows: 1) The overall patency rate of the saphenous vein bypass graft was 76.3% and the two sites of the internal mammary artery bypass graft were both patent. 2) The patency rate of direct anastomosis was 86.2% and of sequential anastomosis, 44.4%. 3) In eight patients who underwent native coronary angiography, five patients showed progression of grafted coronary artery disease. Among them, two patients had accompanying progression of coronary artery disease in non-grafted vessels. 4) Follow up treadmill test performed in six patients showed improvement of exercise tolerance in all patients. 5) There was some increase in the ejection fraction of the left ventricle after CABG in six patients who received follow up left ventriculography.
Angiography* ; Chest Pain ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Exercise Test ; Exercise Tolerance ; Follow-Up Studies ; Heart Ventricles ; Humans ; Mammary Arteries ; Myocardial Ischemia ; Prognosis ; Saphenous Vein ; Transplants*

Human sperm are not only pleomorphic but also tend to show large numbers of obvious abnormalities that may be associated with infertility. It is known that the greater the numbers of abnormalities present in each sperm (teratozoospermic index) relates closely to abnormalities in sperm function and the presence of infertility. The variation in morphology that may be seen among human sperm involve the head, midpiece and tail. An oval head is deemed to be normal but many shape and size variations can be seen in an ejaculate, and these include large, small or tapering heads. Amorphous heads are now known to be associated with chromosomal anomalies and a sperm may even show the presence of a double head. Another anomaly of sperm morphology that is occasionally seen is the abnormality known as globozoospermia. In this condition, the sperm head lacks an acrosome and, as a consequence, the head of each spermatozoon becomes rounded. We have experienced a case of globozoospermia which was conceived by intracytoplasmic sperm injection. So we report this case with a brief review of literatures.
Acrosome ; Head ; Humans ; Infertility ; Male ; Sperm Head ; Sperm Injections, Intracytoplasmic* ; Spermatozoa

BACKGROUND: Adaptive remodeling of the wall of diseased arterial segments occurs to compensate for the accumulation of atherosclerotic plaque. Histopathologic studies and intraoperative high-frequency epicardial coronary ultrasound imaging as well as intracoronary ultrasound imaging have shown that human coronary arteries enlarge in parallel with the formation of atherosclerotic plaque. Therefore, the lumen area is preserved until the progressive accumulation of plaque exceeds the compensatory mechanisms of the vessel. In 1995, however, Pastercamp et al. reported that arterial wall constriction (shrinkage) or inadequate enlargement may be a different mechanism associated with the development of severe arterial lumen narrowing in addition to plaque proliferation. The aim of this study is to examine what extent of de novo native coronary arterial stenosis is accompanied by compensatory enlargement and to find the predictors of inadequate remodeling with intravascualr ultrasound. METHODS: Fifty eight patients were enrolled from February 1997 through October 1997. Patients who had the lesion of more than 50% stenosis of minimal luminal diameter in coronary angiography were indicated. The lesion which was located in the ostium or was very tortuous or angulated was excluded. The lesion which had the history of balloon angioplasty or stent insertion was also excluded. We used 20 MHz endosonic intravascular ultrasound catheter. We measured EEM area (External Elastic Membrane area), lumen area and plaque plus media area and analysed plaque characteristics. RESULTS: 1) Fifty-eight consecutive patients (43 men, 15 women; mean age 55.4 years, range 33 to 78) who had not undergone previous catheter intervention were studied with a single intravascular ultrasound system. 2) Among 58 patients, 20 patients (35%) had acute myocardial infarction, 30 patients (52%) unstable angina, 6 patients (10%) stable angina and 2 patients (3%) old myocardial infarction. Lesions were located at the left anterior descending arteries in 29 patients (50%), right coronary arteries in 21 patients (36%) and left circumflex coronary artery in 8 patients (14%). 3) Compensatory enlargement was observed in 19 (32%) of 58 lesions and inadequate compensatory enlargement in 39 (68%). 4) EEM and plaque areas at lesion site of compensatory enlargement group were significantly larger than those of inadequate enlargement group (p<0.05). 5) Risk factors for coronary arterial disease including diabetes mellitus, hypertension, hypercholesterolemia (serum cholesterol<0A65B>240 mg/dl), smokings and plaque characteristics were not statistically related with inadequate enlargement. Although there was no statistical significance, there was a tendency of inadequate enlargement in patients with diabetes mellitus and calcified plaque. 6) The only predictor of inadequate remodeling was the postmenopausal female (p<0.05). CONCLUSION: Adaptive compensatory coronary arterial remodeling was occured less frequently in patients with acute coronary syndromes than in patients with stable angina. The only statistically significant predictor of adaptive compensatory coronary arterial remodeling was postmenopausal women. Inadequate compensatory coronary arterial remodeling was occured more frequently in patients with diabetes mellitus or calcified plaque but without statistical significance.
Acute Coronary Syndrome ; Angina, Stable ; Angina, Unstable ; Angioplasty, Balloon ; Arteries ; Catheters ; Constriction ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Diabetes Mellitus ; Female ; Humans ; Hypercholesterolemia ; Hypertension ; Male ; Membranes ; Myocardial Infarction ; Phenobarbital ; Plaque, Atherosclerotic ; Risk Factors ; Smoke ; Stents ; Ultrasonics* ; Ultrasonography

BACKGROUND: Opioids are known to increase the incidence of postoperative nausea and vomiting (PONV). Remifentanil is an ultrashort-acting opioid with a potent analgesic effect and is useful for rapid emergence. This study compared the effect of remifentanil on the incidence and severity of PONV and postoperative pain with that of fentanyl in patients undergoing laparoscopic surgery, which is normally associated with a high incidence of PONV. METHODS: Forty-four adult female patients, who were scheduled for laparoscopic ovarian cyst enucleation, were randomly assigned to either the remifentanil or fentanyl group. Anesthesia was induced with propofol after injecting fentanyl 2 microgram/kg or remifentnail 1 microgram/kg and was maintained with sevoflurane. Remifentanil and fentanyl was infused continuously in the range of 0.2-0.5 microgram/kg/min and 0.03-0.05 microgram/kg/min, respectively. Ketorolac 0.5 mg/kg was injected 30 min before the end of surgery. The incidence and severity of PONV and pain were recorded upon arrival at the recovery room and 2, 6, 12 and 24 hours thereafter. RESULTS: The incidence and severity of PONV and pain were significantly higher in the remifentanil group upon arrival at the recovery room than in the fentanyl group. The incidence and severity of PONV and pain at the other measurement times were similar. CONCLUSIONS: Despite the ultrashort action duration of the remifentanil, the incidence and severity of PONV and postoperative pain immediately after awakening was higher in the remifentanil group undergoing laparoscopic ovarian cyst enucleation than in the fentanyl group. However, there were no significant differences after two hours in the recovery phase.
Adult ; Analgesics, Opioid ; Anesthesia ; Balanced Anesthesia* ; Female ; Fentanyl* ; Humans ; Incidence ; Ketorolac ; Laparoscopy ; Ovarian Cysts* ; Pain, Postoperative ; Postoperative Nausea and Vomiting* ; Propofol ; Recovery Room

OBJECTIVE: To investigate whether an audible cracking sound during shoulder manipulation following distention arthrography is clinically significant in patients with adhesive capsulitis of the shoulder. METHODS: A total of 48 patients (31 women, 17 men) with primary adhesive capsulitis of the shoulder completed the study. All participants underwent C-arm-guided arthrographic distention of the glenohumeral joint with injections of a corticosteroid and normal saline. After distention, we performed flexion and abduction manipulation of the shoulder. The patients were grouped into sound and non-sound groups based on the presence or absence, respectively, of an audible cracking sound during manipulation. We assessed shoulder pain and disability based on a Numeric Rating Scale (NRS), the Shoulder Pain and Disability Index (SPADI), and passive range of motion (ROM) measurements (flexion, abduction, internal and external rotation) before the procedure and again at 3 weeks and at 6 weeks after the intervention. RESULTS: The patients were divided into two groups: 21 were included in the sound group and 27 in the non-sound group. In both groups, the results of the NRS, SPADI, and ROM assessments showed statistically significant improvements at both 3 and 6 weeks after the procedure. However, there were no significant differences between the two groups except with respect to external rotation at 6 weeks, at which time the sound group showed a significant improvement in external rotation when compared with the non-sound group (p<0.05). CONCLUSION: These findings showed that manipulation following distention arthrography was effective in decreasing pain and increasing shoulder range of motion. In addition, the presence of an audible cracking sound during manipulation, especially on external rotation, was associated with better shoulder range of motion.
Adhesives* ; Arthrography* ; Bursitis* ; Female ; Humans ; Range of Motion, Articular ; Shoulder Joint ; Shoulder Pain ; Shoulder*