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

BACKGRUOND: Although treatment with etretinate or modified Ingram method is effective for psoriasis, both regimens have limitations beeause of the risk of long-term toxicity. OBJECTIVE: We performed retinoid-modified Ingram combination therapy expecting greater therapeutic efficacy and less side effect. METHODS: Thirty three plaque-form psoriasis patients were included. Pretreatment with etretinate for 1 to 2 weeks was followed by modified Ingram therapy in combination with etretinate. RESULTS: l. Among 33 patients, clearing was shown in 26 patients(78.8%), 4 patients(12.1%) was improved, and 3 patients(9.1%) showed failure. The number of cleared patient was 13/15 (86.7% ) in moderate group, and 13/18 (72.2%) in severe group. 2. In cleared patients, the mean numbers, duration, and total dose of UVB therapy reaching grade 4 were 11.9, 24.5 days, 1348.5 mJ/cm in trunk, and 13.5, 29.1 days, 1733.3 mJ/cm in extremities. Their differences between trunk and extremities were not statistically significant (p>0.05). 3. In cleared patients, the mean numbers, duration, total dose of phototherapy, and total close of etretinate reaching grade 4 in severe group were not significantly higher than them in moderate group (p>0.05). 4. There were some side effects of etretinate such as cheilitis, dry mouth, and side effects of modified Ingram therapy such as erythema, pruritus. But there was no discontinuation of therapy due to side effect. 5. In 22 patients who were followed up at least,one year, the mean remission time was 149 months in moderate group and 6.9 months in severe group. CONCLUSION: Our study suggests that retinoid-modified Ingram regimen is effective and tolerable in the treatment of psoriasis, especially in severe group.
Acitretin ; Cheilitis ; Erythema ; Etretinate ; Extremities ; Humans ; Mouth ; Phototherapy ; Pruritus ; Psoriasis* ; Retinoids

BACKGRUOND: Although treatment with etretinate or modified Ingram method is effective for psoriasis, both regimens have limitations beeause of the risk of long-term toxicity. OBJECTIVE: We performed retinoid-modified Ingram combination therapy expecting greater therapeutic efficacy and less side effect. METHODS: Thirty three plaque-form psoriasis patients were included. Pretreatment with etretinate for 1 to 2 weeks was followed by modified Ingram therapy in combination with etretinate. RESULTS: l. Among 33 patients, clearing was shown in 26 patients(78.8%), 4 patients(12.1%) was improved, and 3 patients(9.1%) showed failure. The number of cleared patient was 13/15 (86.7% ) in moderate group, and 13/18 (72.2%) in severe group. 2. In cleared patients, the mean numbers, duration, and total dose of UVB therapy reaching grade 4 were 11.9, 24.5 days, 1348.5 mJ/cm in trunk, and 13.5, 29.1 days, 1733.3 mJ/cm in extremities. Their differences between trunk and extremities were not statistically significant (p>0.05). 3. In cleared patients, the mean numbers, duration, total dose of phototherapy, and total close of etretinate reaching grade 4 in severe group were not significantly higher than them in moderate group (p>0.05). 4. There were some side effects of etretinate such as cheilitis, dry mouth, and side effects of modified Ingram therapy such as erythema, pruritus. But there was no discontinuation of therapy due to side effect. 5. In 22 patients who were followed up at least,one year, the mean remission time was 149 months in moderate group and 6.9 months in severe group. CONCLUSION: Our study suggests that retinoid-modified Ingram regimen is effective and tolerable in the treatment of psoriasis, especially in severe group.
Acitretin ; Cheilitis ; Erythema ; Etretinate ; Extremities ; Humans ; Mouth ; Phototherapy ; Pruritus ; Psoriasis* ; Retinoids

In the study of craniofacial deformity, it is very important that identifying the factor which can affect the morphology and which is closely related to the morphology, because it can not only improve the comprehension of growth and developmental process but also be applied in growth prediction and treatment modality. Several investigators have already mentioned the characterstics of head posture and airway space in relations to morphologic difference. But it is very meaningful work in clarifying the correlation between morphology, head posture and airway space that observing the change of head posture after morplologic change caused by operation and the change of airway space after same procedure. To investigate above correlation, I selected normal group which is consisted of 43 adults and mandibular prognathism group which is consisted of 47 adults who had been operated by sagittal split ramus osteotomy and were followed up more than 1 year. With their lateral skull radiograghs, reference lines which can evaluate each measuring points and areas without effect of postural change were first determined. And using above reference lines, change of airway space, positional change of tongue and hyoid, change of cranial and cervical angulations were measured. The results obtained from the study were as follows 1. In the change of head posture, the position of tongue and hyoid neighboring to pharynx is more closely related to the reference line of cervical column than to reference line of cranium. 2. After mandibular setback operation, the airway dimension was decreased to 81.6% of preoperative state at 1 month postoperatively and was slightly increased to 89.7% at 1 year postoperatively. 3. Posterior movement of tongue plays important role in decrease of airway dimension and inferior movement of hyoid was closely correlated with posterior movement of tongue. 4. Postoperative anterior movement of mandible, namely, morphologic relapse had correlation with relapse phenomenon of airway dimension. 5. Craniocervical angulation increased postoperatively. Especially in the postoperative early state, there was increased foreward inclination of cervical angulation rather than increase of cranial angulation. But at postoperative 1 year it was observed that cervical inclination was returned to preoperative state and cranial angulation was increased gradually. 6. Increase rate of airway dimension was correlated with the increase of cranial angulation from postoperative 1 month to 1 year. In conclusion, relapse tendency of airway dimension following increase of cranial angulation was found after mandibular setback operation and it is considered that increase of cranial angulation is one of compensatory mechanism in airway maintenance.
Adult ; Comprehension ; Congenital Abnormalities ; Growth and Development ; Head ; Humans ; Mandible ; Osteotomy, Sagittal Split Ramus ; Pharynx ; Posture ; Prognathism ; Recurrence ; Research Personnel ; Skull ; Tongue

OBJECTIVES: The purpose of this study is to analyse sleep habits and sleep disorders in the elderly population ased 65-84 years. METHODS: Epidemiological survey was performed at home by means of semistructured interviews in the city of Pusan, Korea. Subjects were randomly selected. The questionnaire consisted of 128 items including demographic findings, sleep habits, sleep disorders, somatic illnesses, and psychological distresses. RESULTS: (1) The mean retiring time was 10.28 h (SD1.30 h) and the mean wake-up time was 5.24 h (SD 1.33 h). The mean duration of sleep was 5.63 h (SD 1.80 h ). The subjects reported they woke up an average of 2.05 (SD 1.59) times per night. All of the above results were not related to age or gender. However, the mean frequency of difficulty in initiating/maintaining sleep was 2.2 times for men and 3.2 times for women (p<0.05). (2) The prevalence of insomnia was 57.7% and was not related to age or gender. Difficulty in initiating sleep was the most commonly reported insomnia complaint(52.4%). Early morning awakening was reported by 50.0% of patients and difficulty in maintaining sleep was reported by 45.1% of them. Worrying in bed and physical pain were strong contributing factor to insomnia. CONCLUSIONS: The results of our study showed several characteristics of sleep habits in the elderly. Sleep disorder in old age is not inevitable or trivial. Since sleep disturbance in older adults is common and distressing, it has implications for general health and well-being. Active concern and therapeutic intervention for the sleep habits and sleep disorders in the elderly are needed.
Adult ; Aged* ; Busan* ; Female ; Humans ; Korea ; Male ; Prevalence ; Surveys and Questionnaires ; Sleep Wake Disorders* ; Sleep Initiation and Maintenance Disorders

PURPOSE: To assess the value of contrast-enhanced color Doppler ultrasonography(US) in the detection of ves-sels related to hepatocellular carcinoma(HCC). MATERIALS AND METHODS: Between July 1997 and April 2000, 76 HCCs in 70 patients (50 men and 20 women; mean age, 57.8 years) were confirmed histologically or clinically. Tumor site and size at gray scale US, and afferent, intratumoral and efferent color signals at precontrast and postcontrast color Doppler US were deter-mined. Afferent signals were classified as basket or penetrating type, and intratumoral signals as spotty, linear or mixed. Efferent signals were categorized as signal to portal vein or signal to hepatic vein, and postcontrast color signal changes as focal, general or marginal spotty type. We also measured the color percentage of intra-tumoral signals as seen during precontrast and postcontrast study. RESULTS: The detection rate changed from 41(53.9%) to 60(78.9%) in cases with afferent signals, from 50(65.8%) to 64(84.2%) in those with intratumoral signals, and from 6(7.9%) to 9(11.8%) in those with efferent signals. Overall, 74(97.4%) cases showed positive findings at postcontrast color Doppler US. The most common enhancing pattern was general, occurring in 33(43.4%) cases. The color percentage of intratumoral signals increased from an average of 8.2% to 34.9%. The detection rate of intratumoral signals from tumors less than 3 cm in diameter increased from 56.8% to 100%, and that of deeply-located tumor-related signals (17 cas-es) increased from 47.1% to 94.1%. CONCLUSION: The use of contrast enhanced color Doppler US increased the detection rate of afferent, intratumoral, and efferent signals, especially that of intratumoral signals from tumors less than 3 cm in diameter and signals from deeply located tumors. In addition, the modality can aid the diagnosis of HCC by evaluating tumor dynamics.
Diagnosis ; Female ; Hepatic Veins ; Humans ; Liver Neoplasms ; Male ; Portal Vein ; Ultrasonography, Doppler, Color*

PURPOSE: The purpose of this article is to study whether the Doppler ultrasound differentiate obstructive hydronephrosis from nonobstructive hydronephrosis in sonographically diagnosed hydronephrosis. MATERIALS AND METHODS: We studied 35 kidneys of 27 patients with hydronephrosis which were diagnosed with sonography. Resistive indices were calculated from Doppler waveforms at the level of interlobar or arcuate arteries. We divided the materials into two groups with obstructive and nonobstructive hydronephrosis according to the findings of intravenous pyelography, retrograde pyelography, and anterograde pyelography. These were compared with normal control group(20 kidneys in 10 persons). We also grouped patients regarding to the duration after onset of clinical symptom, and graded the hydronephrosis into three group according to sonographic findings. We analyzed the correlations of the above sonography and clinical findings with resistive index. Hydronephrosis was obstructive in 20 kidneys(in 17 patients) and nonobstructive in 15 kidneys(in 10 patients). RESULTS: There was statistically significant difference between the mean resistive indices in obstructive hydronephrosis(0.74 +/- 0.02) and that in nonobstructive hydronephrosis (0.60 +/- 0.02)(p<0.05). Also there was no difference between the mean resistive indeces in nonobstructive hydronephrosis and that in normal control group(0.59 +/- 0.07)(P > or = 0.05). CONCLUSION: The use of Doppler sonography can be helpful in detecting the presence or absence of true obstruction in patients with hydronephrosis.
Arteries ; Humans ; Hydronephrosis* ; Kidney* ; Ultrasonography ; Urography

PURPOSE: The management of local recurrence after curative surgery of the rectal cancer remains difficult clinical problems to surgeons. This study was performed to analyze the outcomes of patients with local pelvic recurrence according to its recurrence type. METHODS: A total 109 patients with local recurrence were evaluated. Among the 109 patients 62 were local recurrence alone and 47 were both local and systemic recurrence. The recurrence type was classified as Central, Anterior, Posterior, Lateral and Perineal recurrence according to the relation of the tumor location and either intra pelvic organ and/or fixed pelvic structure. RESULTS: Only 26 (23.9%) of the 109 patients had curative resection and the remaining 83 (76.1%) patients had palliative exploration or nonsurgical procedure. The resectability according to the recurrence type showed that the Central and Anterior type was higher than other type of recurrences (P=0.001). When the primary operation was Abdominoperineal Resection (APR) the resectability was poorer than Low Anterior Resection (LAR) (P=0.0001). When comparing the patients with local recurrence alone, the 5 year survival rate was significantly higher patients treated by curative resection than palliative or non-resection group (P=0.002). Mean follow up period was 44.2+/-30.0 months and mean recurrence time between primary operation and recurrence was 26.0+/-22.7 months. CONCLUSIONS: Resection for central type of the recurrent is potentially curative, however treatment failure was common when the recurrence invaded fixed pelvic structure. Our data suggest that local pelvic recurrence should be treated with radical resection as can as possible.
Classification* ; Follow-Up Studies ; Humans ; Prognosis* ; Rectal Neoplasms* ; Recurrence* ; Survival Rate ; Treatment Failure

PURPOSE: As the oncologic safety of coloanal anastomosis (CAA) has been proven by many other authors, the incidence of CAA following a ultra-low anterior resection has increased. The purpose of this study is to evaluate the functional outcomes and complications for patients who underwent an ultra-low anterior resection and CAA for distal rectal cancer. METHODS: 57 patients underwent CAA following an ultra-low anterior resection between July 1997 and November 2003. 44 patients, who were followed up for more than 6 month after diverting ileostomy repair were evaluated for recurrence pattern, complications, and functional outcomes. RESULTS: The median follow-up period was 32.0+/-22.8 (8~83) months. The mean age of the patients was 54.3+/-10.4 (23~74) years. The types of anastomosis were straight CAA (n=20) and J pouch CAA (n=37). The mean tumor size was 4.1+/-1.9 (2~8) cm, the mean distal resection margin was 1.3+/-0.9 (0.2~4) cm. Six months later, the anastomosis distance following diverting ileostomy repair was measured at 3.24+/-0.6 (2~4) cm from the anal verge. The complications were multiple fistulas (n=3), fistula with anal stenosis (n=1), local recurrence with anal stenosis (n=1), anal stenosis (n=7). Anal incontinence (Kirwan grade III) was noted in 14 patients, and bowel movements more than 6 times per day were observed in 16 patients. Overall recurrence occurred in 6 patients (13.6%). The 5-years survival rate was 84.4%, and the 5-year disease-free survival was 68.9%. CONCLUSIONS: Although CAA in patients with rectal cancer provides excellent long-term survival, a low risk of recurrence, in tolerable function, complications, and poor functional outcomes have been observed with CAA; therefore, the choice of this method should be considered carefully.
Colonic Pouches ; Constriction, Pathologic ; Disease-Free Survival ; Fistula ; Follow-Up Studies ; Hand* ; Humans ; Ileostomy ; Incidence ; Rectal Neoplasms* ; Recurrence ; Survival Rate

Retrorectal cystic harmatoma; Tailgut cyst, is a rare congenital disease typically presented as presacral mass, and malignant change of this disease is extremely rare. Frequently, This disease is misdiagnosed or confused at initial time. So, we have a case of tailgut cyst and report the clinical symptom and the result. A 40-year-old woman has admitted at Severance hospital for the anal pain. About 6cm sized irregular cystic and solid mass in the retrorectal area involving coccygeal bone and right gluteal muscle tendon were detected in magnetic resonance image. Under the impression of malignant tailgut cyst, the patient underwent Hartmann's operation (abdomino-sacral approach) under the sacral resection (S4, 5). The pathology was adenocarcinoma (poorly differentiated) arising from a tailgut cyst involving rectal adventitia, gluteus muscle and sacral bone. For the following 4 months after the operation, The patient is doing well with no evidence of recurrence.
Adenocarcinoma* ; Adult ; Adventitia ; Female ; Humans ; Pathology ; Recurrence ; Tendons