BACKGROUND: In patients after acute myocardial infarction, signal-averaged electrocardiography is used as the one of the non-invasive methods for the prediction for ventricular arrhythmia, one of the causes ofn death in acute myocardial infarction. Signal-averaged electrocardiography has allowed the identification of low-amplitude, high-frequency signals(late potentials)in the terminal portion of the QRS complex. They are thougt to be occured in the portion of electrophysiologically unstable myocardium. The presence of late potentials identifies regions of delayed conducton in the elctrophysiologically unstable border zone of an acute infarction. These electrophysiologic change of myocardium is influenced by the patency of infarct-related artery. A patent artery is associated with electrical stability of myocardium, decreased in cidence of late potentials and improved survival. METHODS: 58 patients of acute myocardial infarction underwent signal-averaged electrocardiography, coronary angiography within 10 days after AMI, 20 of healthy persons underwent signal-averaged electrocardiography. RESULTS: In patent group, late potentials were recorded in 7 of 38 patients(18%) as compared with 13 of 20 patients(65%) of non-patent group. The statistically significant parameters of signal-averaged electrocardiography beteen patent and non-patent group were filtered total QRS duration(TQRS, 106.7+/-20.9msec), high frequency low amplitude signal (HLAS, 30.8+/-7.5 vs 41.3+/-16.5 msec)with HLAS being the most powerful varialble in the model. CONCLUSION: These results suggest that the patency of infarct-related artery is associated with electrophysiologic stability of myocardium and signal-averaged electrocardiography is one of the useful non-invasive method in risk stratification of acute myocrdial infarction.
Arrhythmias, Cardiac ; Arteries* ; Coronary Angiography ; Electrocardiography* ; Humans ; Infarction ; Myocardial Infarction* ; Myocardium

STUDY DESIGN: A retrospective study. OBJECTIVES: To assess the relationship between surgical outcomes and preoperative MRI findings, a retrospective review was conducted on the surgical outcomes depending on the preoperative MRI findings including type of herniation and Modic changes. SUMMARY OF LITERATURE REVIEW: In most reports, the patients that have large disc herniation were expected to have improved surgical outcomes. However, there have been controversies regarding the outcomes and Modic changes. MATERIALS AND METHODS: The retrospective review was conducted in 82 patients who underwent a discectomy for single level lumbar disc herniation. The average follow-up period was 34.2 months. Among their preoperative baseline MRI measurements, the stage of disc herniation, degree of nerve root compression, degree of dural sac compression, and Modic change of vertebral endplate were evaluated for the subsequent comparison between the preoperative and postoperative changes and ODI score. RESULTS: Patients with extrusion or sequestration type showed significant improvements compared to the patients with protrusion type disc herniation. By degree of nerve root compression, patients with root compression showed significant improvements compared to the patients who had contact type. The degree of dural sac compression revealed no correlation with changes in the ODI score. 23 of the 82 patients, the preoperative MRI showed a Modic change. Compared to the group who did not show such a Modic change, they turned out to be unrelated to the preoperative and postoperative changes in the ODI score. CONCLUSIONS: Patients who had extrusion or sequestration type disc herniation showed a better clinical improvement than protrusion type. Patients with compression type root lesion showed better clinical improvement than contact type root lesion. No correlation was noted regarding the outcomes of the surgical treatment and degree of dural sac compression or Modic changes.
Diskectomy ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Radiculopathy ; Retrospective Studies

No abstract available.
Axilla* ; Paget Disease, Extramammary*

PURPOSE: We report a distinctive lesion in the articular cartilage of the talar dome in anterior bony impingement syndrome of the joint. MATERIALS AND METHODS: Arthroscopic debridement was done in 68 ankles under the diagnosis of anterior impingement syndrome of the ankle joint between October 1994 and June 1996. There were 6 tram track lesions of talar dome of the 68 ankles. We evaluated arthroscopic findings of tramtrack lesion, injury mechanism, and treatment results according to the criteria of Ogilvie-Harris DJ et al. RESULTS: All six male patients were professional or collegiate soccer players. Average age was 29 years (26 to 34). All 6 cases were dorminant ankles. Trauma history was not definite in all 6 cases. All 6 patients were anterior impingement syndrome of the ankle and treated by arthroscopic removal of osteophytes. The cartilage lesions were full thickness defects, located in the anterior half of the medial aspect of the talar dome and were longitudinal with variable widths resembling a tram track, thus named ""tram track lesion"". Tram track lesion and osteophytes were contacted by ankle dorsiflexion. Overall, good and excellent results were achieved in five patients at a mean follow up of twenty-seven months. Two cases had recurrences of osteophytes. CONCLUSIONS: Tram track lesion of talar dome occurred by repeated scratching of the osteophyte of distal tibia and treated effectively by arthroscopic removal of osteophyte and debridement.
Ankle ; Ankle Joint ; Arthroscopy ; Cartilage ; Cartilage, Articular ; Debridement ; Diagnosis ; Diphenhydramine ; Follow-Up Studies ; Humans ; Joints ; Male ; Osteophyte ; Recurrence ; Soccer ; Tibia

Early MRI and arthroscopic findings were compared to evaluate the efficacy of the former for patients, who upon physical examination, were diagnosed with possihle acute ACL tears. MRI, taken between 1-21 days after injury, had to reveal complete ACL tears and arthroscopic surgery should have taken place 3-12 weeks after the injury for patients of this prospective study. Fifty such cases were initially catagorized according to five MRI patterns. Types I to V were separated by the following ACL tear characteristics: Enlarged and diffusely increased in signal, horizontally oriented, non-visualized, discontinuous and vertically oriented. The cases were then divided into two groups of arthroscopic findings; Group A included cases of complete ACL tearing and group B included those with intact or minimally torn ACLs. Of MRI types I through V, there were 31, 9, 5, 4, and I cases of each respectively. 37 cases resulted in complete ACL tears (21 type I, 6 type II, 5 type III, 4 type IV and 1 type V) and 13 cases were catagorized into group B, 10 of which had pattern type I and 3 of which had pattern type II. As result, types III, IV and V had a 100% Positive Predictive Value (PPV) whereas types I and II together had a 67% PPV vaiue. Division of the cases into the five pattern types in early MRI proved valuble for possible cases of acute ACL tears. MRI pattern types III, IV and V were correlated with definite complete ACL tears. However, caution must be taken for types I and II, the majority of the cases, for which there exists a significant possibility for misdiagnosis and consequently unnecessary arthroscopic surgery.
Arthroscopy ; Diagnostic Errors ; Humans ; Knee ; Magnetic Resonance Imaging* ; Physical Examination ; Prospective Studies

Vascular ingrowth is essential for the survial of the graft tissue. The purposes of this study were to evaluate any changes in signal intensity of cqropreserved meniscal allograft with time in the magnetic resonance images(MRI) and to demonstrate the viability of the grafts. Eight patients underwent meniscal transplantation with cryopreserved allcgrafts using the bone block technique. MRIs of the knee were taken at 3 days, 3 weeks, 6 weeks, 3 month, 6 months. And I year after the implantation. A second-look arthroscopy and a small meniscal biopsy(sized 2mm x 2mm1 at the peripheral and central part of the meniscus were conducted at 3 months and 1 year. Three days after the operation, the signal intensity of the implanted meniscus revealed a homogenrous low signaJ intensity that could not be differentiated from that of' a contralateral normal meniscus. At 3 weeks, a high signal intensity appeared at the periphery of the meniscus. This signal, which did not communicate into the joint space, fuither intensified at 6 weeks. The high signal intensity of the meniscus, though still higher than that of the normal meniscus, decrexsed slightly at 3 months and continued to decrease progressively even a year after the implantation. The second-look arthroscopy revealed that the grafts were viable and that there was no tearing or shrinking of the meniscus. Cellular proliferation was also found at the central edge oi' the meniscus at 3 months. This cellular pattern differentiated from that of a nonmal meniscus in that the d stribution of cells was not in an even, but in a clonal pattem. The cellularity after a year, however, was sirnilar to that of normal meniscus except some area with deficiency of cells. It can be concluded that increased signal intensity of' the implanted meniscus with time indicates hypervascularity caused by vascular ingrowth, similar to the high signal intensity ot>tained from normal meniscus in young children. Increasecl signal intensity in the chronological postoperative MRls demonstrates the viability of the implanted cryopreserved meniscal allograft.
Allografts* ; Arthroscopy ; Cell Proliferation ; Child ; Humans* ; Joints ; Knee ; Magnetic Resonance Imaging* ; Transplants

Most proximal humeral fractures respond satisfactorily to conservative treatment. It is only the occasional displaced fracture or fracture-dislocation that demaads special treatment. The purpose of this study is to analysis the results of closed and open reduction of displaced proximal humeral fractures according to Neers classification. Fifty-two cases of these fractures, followed up more than five months, are presented. 1. The average age of patients was 40. I years. 2. The fractures were classified according to Neers method. Nearly half (48.1%) of the cases were one-part fractures. Next, two-part fractures rated 42.3%, while three-part fractures, only one (l.9%). 3. Among the total 52 patients, 42 cases(80.8%) were treated conservatively and 10 were operated. We performed surgical operations in seven cases among 22 two-part fractures, aix were reduced with Kirschner wires and one treated with Kirschner wire and staple. The average age of these seven cases was 26. 6 years and the resulta were good except one. 4. The results of these patients were evaluated by the Neers criteria. Of 52 caaes, 40 had good results, five, fair, and the remaining seven poor results. Twenty-three cases (92%) in 25(100%) one-part fractures were good and 17 cases (77.3%) in 22 (100%) two-part fractures were also good. In three-part and four-part fractures the results were all poor.
Bone Wires ; Classification ; Humans ; Methods ; Shoulder Fractures

A clinical analysis was done on 129 patients (131 cases) of the ankle fractures that were admitted and treated in Orthopedic Department, Inchon Christian Hospital from January 1973 to December 1980. The following results were obtained: l. Of the 129 patients, male was 104 patients and female 25 patients, the average age of the patients was 37. 2. The main cause of the injuries was traffic accident (38.2%), and the remain causes were industrial accident (28.2%), fall down (18.3%), slip down (11.5%), and sports injury (3.8%) in order. 3. The most common type by Lauge-Hansen classification was supination-external rotation type (37.4%). 4. In method of treatment, operative treatment was done in 72 cases and nonoperative in 59 cases. 5 The average duration of the cast immobilization in nonoperative treatment was 8 weeks and operative 7 weeks. 6. The better result was obtained by operative treatment than nonoperative one. 7. The most poor result was noticed in pronation-external rotation type according to Lauge-Hansen classification. 8. We agree that the accurate reduction of the lateral malleolus make the talus in good anatomic position in ankle joint. 9. We agree that Lauge-Hansen classification is useful in diagnosis and treatment of ankle fracture.
Accidents, Occupational ; Accidents, Traffic ; Ankle Fractures ; Ankle Joint ; Ankle ; Athletic Injuries ; Classification ; Clinical Study ; Diagnosis ; Female ; Humans ; Immobilization ; Incheon ; Male ; Methods ; Orthopedics ; Talus

Humans ; Malocclusion ; Mandibular Condyle ; Mouth ; Prognosis ; Retrospective Studies ; Temporomandibular Joint ; Temporomandibular Joint Disorders

Direct pressure monitoring by means of an intra-arterial cannula has been considered benefit for assesment of the critically ill patients, safe conduct of controlled hypotension and obtaining arterial samples for blood gas analysis. Cannulation of the radial artery is commonly used, but in neurosurgical operation the upper part of the body is usually nut easily accessible to the anesthetist and this may lead to increase the frequency of dorsalis pedis arterial cannulation. Recently we have experienced the undesirable episode of toe amputation resulting from gangrene following dorsalis pedis cannulation in 62 year old female neurosurgical patient. Femoral angiography performed on the post-operative 27th day showed that neraly complete obstruction of the posterior tibial artery at the level of ankle joint, and progressive tapering of the peroneal artery blanches below the ankle joint. We suppose that dorsalis pedis arterial thrombosis and posterior tibial arterial occulusion would seem to be a contributing factor of foot gangrene.
Amputation ; Angiography ; Ankle Joint ; Arteries* ; Blood Gas Analysis ; Catheterization* ; Catheters ; Critical Illness ; Equidae ; Female ; Foot* ; Gangrene* ; Humans ; Hypotension, Controlled ; Middle Aged ; Nuts ; Radial Artery ; Thrombosis ; Tibial Arteries ; Toes