The most frequent complication of the open arthrotomy for the cruciate reconstruction are quadriceps weakness and flexion contracture of the knee. Besides complications such as chondromalacia, patellar maltracking, saphenous neuralgia and patellar crepitus are not infrequent in wide open arthrotomy. We adopted an open method with smaller incision like arthroscopic maneuver to reduce these complications. The pre-requisite of this mini-incision are arranging a proper instrument and graft material. We advocate Achilles autograft which is longer and more flexible than other autografts and by taking advantage of these characteristics, we could performed reconstruction with relatively small incision. The advantages of mini-incision technique are early recovery of quadriceps function and little complication. We applied this method in ACL, PCL and simultaneous ACL & PCL reconstruction, with the result of early recovery of qudriceps function.
Autografts ; Cartilage Diseases ; Contracture ; Knee ; Methods ; Neuralgia ; Transplants

Involvement of the vena cava by direct vascular extension of renal cell carcinoma occurs in approximately 5% of patients undergoing nephrectomy for this neoplasm. While successful, removal of caval neoplastic thrombi has been reported occasionally, it has been general impression that renal cell carcinoma extending into the vena cava carried an extremely poor prognosis. A 45 years-old male patient was admitted with painless gross hematuria and palpable mass on fight upper quadrant. Surgical exploration was done through 10th thoracoabdominal incision. A right nephrectomy and retroperitoneal lymph node dissection were done for renal cell carcinoma. It was evident on palpation that the tumor was in the It was evident on palpation that the tumor was in the inferior vena cava Partial resection of the inferior vena cava and removal of intra vena cava thrombus were performed. This patient has led a normal life for 18 months following surgery without clinical evidence of tumor. And so, we were presented with review of the literature.
Carcinoma, Renal Cell* ; Hematuria ; Humans ; Lymph Node Excision ; Male ; Middle Aged ; Nephrectomy ; Palpation ; Prognosis ; Thrombosis ; Vena Cava, Inferior*

PURPOSE: Management of the soft tissue defect in the lower extremity caused by trauma has always been difficult. Coverage with local and free muscle flaps after complete surgical excision of necrotic soft tissue and bone is a major strategy for treatment. There is no doubt that muscle provides a good blood supply, thus improving bone healing and increasing resistance to bacterial inoculation. However, accompanying problems are seen in cases with shallow dead space. This research was conducted to assess the efficacy of raising anterolateral thigh flaps and transferring them to the defect after complete debridement of non-viable, infected, and scar tissue as an alternative way to use local or free muscle flaps. METHODS: From March 2005 to October 2007, 18 cases of soft tissue defect on lower extremities were re-surfaced with an anterolateral thigh perforator free flap. RESULTS: The follow-up period ranged from 1 to 31 months with a mean of 15.9 months. All flaps survived completely. Satisfactory aesthetic and functional results were achieved. Under a two-point discrimination test, 13 patients had sensory recovery from 11 mm to 20 mm after 6 months postoperatively. CONCLUSION: Reconstruction of the lower extremity with anterolateral thigh perforator free flaps after appropriate debridement is a good alternative way to use local or free muscle flaps.
Cicatrix ; Debridement ; Discrimination (Psychology) ; Follow-Up Studies ; Free Tissue Flaps* ; Humans ; Lower Extremity* ; Thigh*

BACKGROUND: For Neer type IIB fracture of distal clavicle with coracoclavicular ligament injury, various surgical treatments have been used in literatures. However, there was no consensus on the optimal treatment. The aim of this study is to report the clinical and radiological results of open reduction and internal fixation of unstable distal clavicle fracture and suture augmentation of disrupted coracoclavicular ligament. METHODS: A prospective study was performed in 23 patients with Neer type IIB distal clavicle fracture in Seoul Medical Center, Eulji Hospital, and National Medical Center. Firstly, suture anchors are inserted in the base of coracoid process and preliminary reduction was achieved by tie-off of three suture limbs around the clavicle. Then, the final fixation was completed with anatomical locking plate. Bony union and the distance between coracoclavicular ligaments were evaluated. Clinical results and complications including stiffness and secondary procedures were evaluated. RESULTS: Bony union was achieved in all cases except one (22 of 23). At mean 14.9 months, no significant difference in the mean coracoclavicular distance was observed compared to uninjured shoulder (8.2 +/- 7.9 mm versus 7.3 +/- 3.4 mm, p=0.14). Pain visual analogue scale, American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were 0.5, 83.4, 78.5, and 6.2, respectively. Revision surgery was performed in one case of nonunion. Four patients who complained of skin irritation underwent implant removal. CONCLUSIONS: In cases of an unstable distal clavicle fracture with coracoclavicular ligament disruption, satisfactory clinical results were obtained by locking plate fixation and coracoclavicular ligament suture augmentation concurrently.
Arm ; Clavicle* ; Consensus ; Elbow ; Extremities ; Hand ; Humans ; Ligaments* ; Prospective Studies ; Seoul ; Shoulder ; Shoulder Fractures ; Skin ; Suture Anchors ; Sutures*

Myocardial bridging is defined as segmental engulfment of a major epicardial coronary artery by myocardial fibers, causing a systolic narrowing or milking effect of the coronary arterial segment. During systole, the intramuscular part of coronary artery is compressed by contraction of overbridging ventricular muscle, therefore blood flow distal to the lesion is impaired and angina pectoris or acute myocardial infarction may occur. We experienced a case of Non-Q myocardial infarction in a 42 years-old female patient with myocardial bridge at the proximal and middle part of left anterior descending coronary artery.
Adult ; Angina Pectoris ; Coronary Vessels ; Female ; Humans ; Milk ; Myocardial Bridging* ; Myocardial Infarction ; Systole

With the recent development in microsurgery, the use of a perforator flap has been widely implemented. If the length of the ALT flap pedicle is insufficient despite adequate preoperative planning, pedicle length extension is necessary. We planned for a reverse ALT free flap using the distal vessel of the descending branch for pedicle length extension in the case of ALT perforator branch originating from the proximal portion of the descending branch. For the management of venous congestion, the distal venae comitantes were anastomosed to the proximal venous stump in an antegrade manner, successfully resolving the venous congestion. Modified reverse-flow ALT free flap, wherein the venae comitantes are anastomosed to the proximal vein stump, is a good option that allows for relatively simple pedicle extension within the same operative field when securing an adequate pedicle length is difficult because of the origin of the perforator from the proximal descending branch, unlike the initial surgical plan.
Free Tissue Flaps ; Hyperemia ; Lower Extremity ; Microsurgery ; Perforator Flap ; Surgical Flaps ; Thigh ; Veins

Purpose: To evaluate and compare the degree of visualization of the vitreous and internal limiting membrane (ILM) during pars plana vitrectomy (PPV) using preservative-free triamcinolone acetonide (PF-TA) or triamcinolone acetonide suspension (TAS). Methods: We retrospectively analyzed the medical records of 61 eyes of 61 patients who underwent 25-gauge PPV and ILM peeling for various macular diseases. We assigned the patients to PF-TA and TAS groups, i.e., according to the type of triamcinolone acetonide used. The degree of visualization of the vitreous and ILM was classified into four different categories. The number of dye injections during PPV, need for indocyanine green (ICG), time elapsed before ILM peeling, and intraocular pressure (IOP) before surgery, 1 day and 1 month after surgery were determined. Results: The degree of visualization of the vitreous and ILM was significantly better in the PF-TA group compared with the TAS group. Although the number of dye injections during PPV was not different between the PF-TA and TAS groups (2.56 ± 0.07 and 2.37 ± 1.08, respectively, p = 0.06), the need for ICG was significantly different (6 and 22 eyes, respectively, p < 0.01). The time elapsed before ILM peeling was 185.68 ± 130.02 s in the PF-TA group and 411.15 ± 267.38 s in the TAS group (p < 0.01). The IOP was not different before or 1 day after surgery between the PF-TA and TAS groups, but was significantly different 1 month after surgery (12.88 ± 3.10 and 14.41 ± 2.91 mmHg, respectively, p = 0.03). Conclusions Visualization of the vitreous and ILM was better when using PF-TA compared to TAS. PF-TA-assisted PPV could reduce the usage of ICG and was associated with a reduced latency to ILM peeling. Because this was in turn associated with a lower IOP at postoperative 1 month, PF-TA was safer and more effective than TAS.

A statistical observation was made on 525 in-patients in the Department of Urology Catholic Medical College, during the period from the January 1. 1978 to December 31, 1979.
Urolithiasis ; Urology

PURPOSE: We evaluated the efficacy of leukotriene receptor antagonist and second generation anti-histamine in children with moderate to severe persistent allergic rhinitis. METHODS: Twenty eight patients who were treated with second generation anti-histamine for 4 weeks (Zyrtec syrup(R), Group A) and 58 patients who were treated with leukotriene receptor antagonist for 4 weeks (Singulair(R), Group B) were enrolled in this study. Control group (n=22) was received only first generation anti-histamine (Hydroxyzine) intermittently. Efficacy were evaluated by nasal scores in nasal congestion, rhinorrhea, nasal itching, sneezing and total nasal symptom score (a sum of patient ratings of nasal congestion, rhinorrhea, nasal itching, sneezing) before treatment and at 2 and 4 weeks after treatment. RESULTS: There were no difference in the total IgE and total eosinophil count of 3 groups. There were also no significant difference in the initial symptom scores. For nasal congestion, group A and B showed significant improvement at 2 and 4 weeks after treatment compared with controls (each P=0.006, P=0.000, P=0.023, P=0.001). For sneezing, group A and B showed significant improvement at 2 weeks after treatment compared with controls (each P=0.048, P=0.011) and group B also showed significant improvement at 4 weeks after treatment compared with controls (P=0.041). In total nasal symptom score (TNSS), group A and B showed significant improvement at 2 and 4 weeks after treatment compared with controls (each P=0.014, P=0.005, P=0.008, P=0.005). CONCLUSION: In the moderate to severe persistent allergic rhinitis, leukotriene receptor antagonist or second generation anti-histamine is effective in nasal congestion and sneezing.
Child ; Eosinophils ; Estrogens, Conjugated (USP) ; Humans ; Immunoglobulin E ; Pruritus ; Receptors, Leukotriene ; Rhinitis ; Rhinitis, Allergic, Perennial ; Sneezing