High tibial osteotomy is a useful procedure in the treatment of early stage osteoarthritis of the knee which is confined to the medial compartment. But long term follow-up study of high tibial osteotomy has not been provided yet and its prerequisite for a successful result still remains unrevealed. Since the osteoarthritis can progress after the osteotomy, it may result in the loss of correction and recurrence of pain and require conversion to total knee replacement arthroplasty. We studied clinically and radiologically the long term result of high tibial osteotomy in 11 patients(16 knees) who had been treated at the Department of Orthopaedic surgery of Seoul Paik Hospital during the period from January, 1978 to May, 1989, and follow-up for longer than 4 years. Preoperative mean varus angle was 6.4 degrees and immediate postoperative mean valgus angle was 8.6 degrees and final mean valgus angle was 4.7 degrees. The average loss of correction angle was 3.9 degrees. At 2-year follow-up, the results of 16 knees were as follows; excellent in six knees, good in seven knees. The final results at average 7.2-year follow-up were excellent in four knees, good in six knees and one knee was converted to total knee replacement arthroplasty. The results showed deterioration of clinical results and loss of correction with time after osteotomy. However, in more than half of the cases the results were good or excellent at the final follow-up, We, therefore, conclude that high tibial osteotomy is still a useful procedure in osteoarthritis of the knee if performed with a precise surgical technique and an adequate overcorrection more than 10 degrees.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Knee ; Osteoarthritis ; Osteotomy ; Recurrence ; Seoul

PURPOSE: To evaluate changes in the degree of pseudomyopia and prognosis in patients with convergence spasm and acquired pseudomyopia. METHODS: The medical records of patients with convergence spasm and acquired pseudomyopia at the Korea University Medical Center from 2011 to 2014 were identified. We reviewed the patients' gender, age, onset time, visual acuity, refractive error, angle of strabismic deviation and the selected management (cycloplegics, patching, cycloplegics + patching, prism glasses). RESULTS: At the first medical examination, the mean age was 20.08 years. The mean spherical equivalent was -3.75 diopter (D) in the right eye and -4.03 D in the left eye based on manifest refraction and -2.59 D in right eye and -2.85 D in left eye using cycloplegic refraction. Eleven of 12 patients had esodeviation with a mean esodeviation of 10.42 D. The pupil size was 3.63 mm in the right eye and 3.63 mm in the left eye. No patient experienced severe miosis (pupil size <2 mm). Observation (5), patching (3), cycloplegics (2), patching + cycloplegics (1) and prism (1) management were performed in 12 patients. Outcomes included completely cured (3), improvement (7) and no change or recurrence (2). CONCLUSIONS: Active management is necessary for patients with convergence spasm and acquired pseudomyopia.
Academic Medical Centers ; Esotropia ; Humans ; Korea ; Medical Records ; Methods* ; Miosis ; Mydriatics ; Prognosis ; Pupil ; Recurrence ; Refractive Errors ; Spasm* ; Visual Acuity

Living-Related-Liver-Transplantation(LRLT) has been established as a reliable method of treatment for patients with end-stage liver disease when the scarcity of cadaveric organ donor was considered. But the hepatic artery is high at risk in thrombosis(HAT) following LRLT. So microsurgical technique was introduced in anastomosis of hepatic artery. This study was aimed at using microsurgical technique in LRLT and presenting some technical details of the procedures. From December 1994 to November 1997, a sereis of 41 LRLTs on patients with end-stage liver disease was performed with follow-up period of 5 to 40 months(mean,15.6 months). Organs were donated by living-related donors(n=36) and living-nonrelated ones(n=5). Hepatic artery was reconstructed with microsurgical technique by plastic surgeon. All hepatic arteries were patent intraoperatively and postoperatively except one case, which had leakage at anastomosed site on the postoperative fourth day.Hepatic artery is high at risk in thrombosis(HAT) following LRLT due to the caliber discrepancy and technical difficulties. To overcome these risks, microsurgical technique was introduced. The technique has greatly reduced arterial complication. However, there are some difficulties in microsurgery of LRLT, which are somewhat different from those in other microsurgery fields: the first difficulty is to obtain a good operative field and a sufficient view through the microscope. The second one is to overcome arterial caliber discrepancy. And the last is to achieve a stable posture in narrow and deep operating field against the respiratory movement and heartbeat.With the persistent team approach of plastic and general surgeons in the field of LRLT, we could have reduced the HAT and have had better outcome after LRLT.
Arteries ; Cadaver ; Follow-Up Studies ; Hepatic Artery ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Microsurgery ; Posture ; Tissue Donors*

PURPOSE: The purpose of this study was to analyze the clinical effectiveness of open reduction in the treatment of distal humeral fracture using a newly designed combined approach of anterolateral and lateral approaches to protect the radial nerve. MATERIALS AND METHODS: We investigated 24 consecutive cases of distal humeral fracture who received open reduction and internal fixation with a plate and screws with a minimum follow-up period of 1 year. We analyzed the patients' age, sex, fracture pattern, timing of the union, range of motion of the elbow joint, and complications. The Mayo elbow performance index (MEPI) was employed for the assessment of elbow joint function. RESULTS: Clinical union was observed at 10.8 weeks (6~20 weeks) on average. Pre-operatively, there were 3 cases of incomplete radial nerve palsy. All of the cases recovered, and there was no additional radial nerve palsy due to surgery. According to the MEPI, 13 cases were "excellent" and 10 cases were "good" or better, comprising 95.83% of the cases. The range of motion at the elbow was 5.5 degrees (0~15 degrees) of extension, and 131.5 degrees (120~145 degrees) of flexion, suggesting no functional disability. The duration of return to work was 11.2 weeks (5~32 weeks) on average. There were no nonunion, malunion, or infection complications. CONCLUSION: The combined anterolateral and lateral approach we designed is a clinically effective approach due to facilitation of protection of the radial nerve and attainment of adequate fixation space.
Elbow ; Elbow Joint ; Follow-Up Studies ; Humeral Fractures ; Humerus ; Paralysis ; Radial Nerve ; Range of Motion, Articular ; Return to Work

PURPOSE: To evaluate position of the mandibular condyle within articular fossa in an asymptomatic population radiographically by a cone beam computed tomography. MATERIALS AND METHODS: Cone beam computed tomography of 60 temporomandibular joints was performed on 15 males and 15 females with no history of any temporomandibular disorders, or any other orthodontic or prosthodontic treatments. Position of mandibular condyle within articular fossa at centric occlusion was evaluated. A statistical evaluation was done using a SPSS. RESULTS: In the sagittal views, mandibular condyle within articular fossa was posteriorly located at medial and central sections. In the coronal views, mandibular condyle within articular fossa was laterally located at central section. Mandibular condyles in the right and left sides were showed asymmetric positional relationship at medial,central, and lateral sections. CONCLUSION: Mandibular condyle within articular fossa in an asymptomatic population was observed nonconcentric position in the sagittal and coronal views.
Cone-Beam Computed Tomography* ; Female ; Humans ; Male ; Mandibular Condyle* ; Prosthodontics ; Temporomandibular Joint ; Temporomandibular Joint Disorders

No abstract available.
Tendinopathy

BACKGROUND: Due to the anatomical nature of the radial nerve, dissection and attainment of an adequate operative field in mid to distal humerus fracture is dangerous and limited. We devised a combined anterolateral and lateral approach that ensures protection of the radial nerve. This is achieved by performing bimodal dissection of the proximal humerus anteriorly and the distal humerus laterally. METHODS: Thirty-five consecutive patients were treated using a combined anterolateral and lateral approach for a minimum follow-up period of 24 months. We analyzed time to bony union, time to return to daily work, range of motion, elbow joint function as assessed by the Mayo elbow performance index and complications. RESULTS: Radiologic bony union was observed at 11.2 weeks (range, 8 to 20 weeks) on average. Four cases of incomplete radial nerve palsy before surgery all recovered. Time to return to work was 10.2 weeks (range, 2 to 32 weeks) on average. The average range of motion of the elbow was 3.3degrees (range, 0degrees to 10degrees) of extension and 135.9degrees (range, 125degrees to 145degrees) of flexion. There were 21 cases of excellent and 13 cases of good or better recovery, comprising over 97.1% on the Mayo elbow performance index. There were no complications of radial nerve palsy, non-union, mal-union, or infection. CONCLUSIONS: Our a modified combined anterolateral and lateral approach is a clinically effective surgical method of achieving protection of the radial nerve and securing easy and firm internal fixation.
Adolescent ; Adult ; Aged ; Female ; Humans ; Humeral Fractures/radiography/*surgery ; Male ; Middle Aged ; Orthopedic Fixation Devices ; Orthopedic Procedures/adverse effects/instrumentation/*methods ; Pain, Postoperative ; Prospective Studies ; Range of Motion, Articular ; Return to Work ; Treatment Outcome

BACKGROUND: The purpose of this study was to investigate whether brain AT1 receptor stimulation contributes as a hypertensive mechanism to deoxycorticosterone acetate (DOCA)-salt hypertension. METHODS: 1) Acute injection:Losartan (1 mg/4 uL) or artificial cerebrospinal fluid (aCSF) was injected into the lateral cerebral ventricle (icv) of conscious control uninephrectomized Wistar rats or rats with DOCA-salt at 2 or 4 weeks, and mean arterial pressure (MAP) and heart rates (HR) were recorded. 2) Chronic injection:Using osmotic minipump, losartan (1 mg/kg/d) or aCSF was injected to a sham group or three DOCA-salt rat groups [icv-aCSF, icv-losartan, sc-losartan (subcutaneous) groups] for 4 weeks, after which the MAP and HR were recorded in addition to the weights of the left (LV) and right ventricles (RV) and kidneys. RESULTS: 1) Acute injection: In rats treated with DOCA-salt, resting MAP significantly increased compared to the control group [144+/-6 mmHg (2 weeks), 170+/-5 mmHg (4 weeks) vs 115-120 mmHg (controls)]. MAP decreased significantly (2 weeks, 4 weeks) at 4, 8, 24 hours after icv injection of losartan to the level of the control group. 2) Chronic injection: The general trend showed that MAP decreased more in the icv-losartan group than in the icv-aCSF group (127+/-15.2 mmHg vs 141.1+/-5.5 mmHg, p=0.0578). In all DOCA-salt groups, no differences in RV weight were found. In the icv-aCSF and sclosartan groups, the kidney weight increased compared to the control group, but there was no difference in LV and kidney weight between the icv-losartan group and the control group. CONCLUSION: Normalization of MAP after acute or chronic icv administration of the AT1 receptor antagonist suggests that the stimulation of the brain AT1 receptor plays a significant role in the development and maintenance of hypertension in the DOCA-salt hypertensive rat model. Losartan icv injection appeared to have a protective effect on the heart and kidney.
Angiotensin II ; Animals ; Arterial Pressure ; Brain ; Cerebral Ventricles ; Cerebrospinal Fluid ; Desoxycorticosterone ; Heart ; Heart Rate ; Heart Ventricles ; Hypertension* ; Kidney ; Losartan* ; Models, Animal ; Rats* ; Rats, Wistar ; Receptor, Angiotensin, Type 1 ; Weights and Measures

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is a difficult procedure to perform on patients who have undergone a Billroth II gastrectomy, Whipple's operation or Roux-en-Y gastrobypass surgery. Our study was designed to evaluate the clinical usefulness of cap-assisted ERCP for beginner endoscopists in cases of surgically altered anatomy. METHODS: From April 2008 to March 2010, 16 patients with biliary diseases and who had previously undergone abdominal surgery such as Billroth II gastrectomy or Roux-en-Y operation were analyzed. A single endoscopist performed all the procedures using a cap-assisted gastroscope, after ERCP training. RESULTS: Cap-assisted ERCP was attempted in 24 sessions of 16 patients. Afferent loop intubation and selective bile duct cannulation was successfully achieved in 19 sessions (79.1%). Among the patients who had undergone a Billroth II gastrectomy, 19 out of 20 sessions were successfully conducted. Only 4 patients who had undergone a previous Roux-en-Y operation failed afferent loop intubation. Duodenal free wall perforation developed in one case. There were no cases of mortality. CONCLUSIONS: Therapeutic cap-assisted ERCP was useful in patients who had previously undergone a Billroth II gastrectomy and this may be helpful for inexperienced endoscopists.
Anastomosis, Roux-en-Y ; Bile Ducts ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Gastrectomy ; Gastroenterostomy ; Gastroscopes ; Humans ; Intubation

PURPOSE: We sought to determine whether bone marrow-derived mesenchymal stem cells (BMMSC) could attenuate the inhibition of alveolarization induced by hyperoxia. METHODS: Human BMMSC (SNU-hMSC) were infused into the peritoneal cavity (IP) or trachea (IT) of neonatal rats exposed to hyperoxia (90% O2 from D1) on D5. The rats were then exposed to the same degree of hyperoxia for another 9d and sacrificed on D21. Morphometric analysis of the lungs and immunofluorescent staining in order to determine cell fates of infused SNU-hMSC were performed. RESULTS: The airspace of the hyperoxia control group (90% O2 for 14d) was significantly larger and more simple (mean linear intercept [Lm] : 68+/-16 micrometer vs 33+/-3 micrometer) and the alveolar surface area [SA] was significantly smaller (646+/-72 cm2 vs 1,042+/-477 cm2) than those of the normoxia control group. The Lm of the BMMSC- infused groups was significantly shorter irrespective of infusion route (52+/-2 micrometer [IP], 50+/-8 micrometer [IT] vs 68+/-16 micrometer) and the SA of the BMMSC IP infusion group was significantly larger (646+/-172 cm2 vs 346+/-142 cm2) than those of the hyperoxia control group. The IT-, but not IP-, infused BMMSC groups were observed in lung tissue and assumed to be type I and type II alveolar epithelial cell phenotypes. CONCLUSION: BMMSC, when infused into neonatal rats exposed to hyperoxia, significantly attenuated the inhibition of alveolarization irrespective of the infusion route. It seems that BMMSC, when infused IT, engrafts into lung tissue and differentiates into alveolar epithelial cells. These results indicate that BMMSC could be considered as a potential candidate therapy for bronchopulmonary dysplasia.
Animals ; Bronchopulmonary Dysplasia ; Epithelial Cells ; Humans ; Hyperoxia* ; Infant, Newborn ; Lung ; Mesenchymal Stromal Cells* ; Peritoneal Cavity ; Phenotype ; Rats* ; Trachea