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

No abstract available.
Fractures, Open*

PURPOSE: A study was designed to assess the effect of intraperitoneal instillation of ropivacaine in larparoscopic cholecystectomy patients using computerized patient controlled anesthesia (PCA). METHODS: From January 2009 to June 2009, 40 patients with uncomplicated, symptomatic cholecystitis with cholelithiasis who were referred to Chung-Ang University Medical Center for laparoscopic cholecystectomy were included in the study. Patients in group C (control group) received normal saline 100 ml and those in group I (instillation group) received intraperitoneal instillation of 2 mg/kg of ropivacaine diluted in 100 ml saline at the initiation of pneumoperitoneum. Patients were assessed for pain by blinded investigators at 6 time intervals after surgery; 2 hr, 4 hr, 8 hr, 12 hr, 24 hr, and 48 hr. The frequency at which patients pushed the button of the PCA on bolus requirement (FPB) was assessed by a patient-controlled module on the PCA machine. RESULTS: The mean total fentanyl consumption was lower in group I (367.39+/-85.88) than in group C (535+/-100.29) during the 48 hours (P<0.001). Fentanyl velocity and FPB showed significant difference between the groups (P<0.005). Visual analogue scale (VAS) measured pain scores were significantly lower in group I than in group C at 4 hr (P=0.027), 8 hr (P=0.010), 12 hr (P=0.011). CONCLUSION: Intraperitoneal instillation of ropivacaine at the beginning of laparoscopic cholecystectomy (LC) combined with normal saline infusion is an effective method for reducing pain after LC.
Academic Medical Centers ; Amides ; Anesthesia ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholelithiasis ; Fentanyl ; Humans ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Pneumoperitoneum ; Research Personnel

No abstract available.
Erythropoietin* ; Humans* ; Kidney Failure, Chronic*

BACKGROUND: Carotid endarterectomy (CEA) is an effective treatment for the prevention of stroke in patients with high grade carotid stenosis. Electroencephalographic (EEG) monitoring and measurement of stump pressure are the most widely used methods for assessing the risk of cerebral ischemia during CEA. We designed this study to assess the usefulness of EEG and stump pressure for shunt insertion during CEA. METHODS: Nineteen patients were enrolled from January, 1996 to April, 1999. We calculated the percent of carotid stenosis in the patients by the NASCET (North American Symptomatic Carotid Endarterectomy Trial) criteria. The inclusion criteria of the CEA were high grade stenosis (>70%), or moderate stenosis (>50%) with ulcerated plaque. Intra-operative monitoring by using stump pres-sure, and an EEG was performed in 19 operations. RESULTS: The number of patients with asymptomatic and sympto-matic carotid stenosis were 6 and 13 respectively. Shunt during the operations was used in 12 patients; nine had both significant EEG changes and low stump pressures, two had only low stump pressure, one patient had only a significant EEG change. The peri-operative complications of mortality and stroke were found in one case. In the other patients, there no stroke recurrences during the mean follow-up period of 24 months. CONCLUSIONS: EEG and stump pressure may be useful in deciding shunt insertion during CEA for detecting ischemic changes.
Brain Ischemia ; Carotid Stenosis ; Constriction, Pathologic ; Electroencephalography* ; Endarterectomy, Carotid* ; Follow-Up Studies ; Humans ; Mortality ; Recurrence ; Stroke ; Ulcer

BACKGOUND: Recently it has been reported that several cytokine gene polymorphisms regulate cytokine production and play an important role in immune and inflammatory response. We evaluated IL-1beta IL-1Ra, and TNF-alpha gene polymorphism in patients with primary glomerulonephritis to determine the association between cytokine polymorphism and disease susceptibility. METHODS: In this study, we enrolled 118 patients with primary glomerulonephritis and healthy 300 persons who had visited the health screening center. We analyzed -511C/T polymorphism of IL-1beta tandem repeats polymorphism in intron 2 of IL-1Ra and -308G/A polymorphism of TNF-alpha We classified primary glomerulonephritis according to pathologic finding and clinical diagnosis. RESULTS: There were no differences with IL-1betaand TNF-alpha gene polymorphism between patient and control group. The carriage of IL1RN*2 was significantly associated with an increased risk of primary glomerulonephritis (patients:control=12.75:5.4%, p<0.01). IL1RN*2 was significantly frequent in patients with membranous GN or minimal change disease (p<0.05). When we classified glomerulonephritis according to clinical diagnosis, IL1RN*2 carriage rate was higher in patients with nephrotic syndrome and RPGN or acute nephritic syndrome than patients with asymptomatic urinary abnormalities (p<0.05). IL-1beta(TT) genotype was more prevalent in acute glomerulonephritis (68.4%) than asymptomatic urinary abnormalities or other glomerulonephritis. TNF2 carriage rate showed a lower tendency in patients with asymptomatic urinary abnormalities. CONCLUSION: IL1RN*2 is significantly associated with an increased risk of development of primary glomerulonephritis. We suggest cytokine gene polymorphism is also related to clinical manifestations of glumerulonephritis.
Diagnosis ; Disease Susceptibility ; Genotype ; Glomerulonephritis* ; Humans ; Interleukin 1 Receptor Antagonist Protein* ; Introns ; Mass Screening ; Nephrosis, Lipoid ; Nephrotic Syndrome ; Tandem Repeat Sequences ; Tumor Necrosis Factor-alpha*

A 24-year-old male visited our hospital because of pain in both flanks. His biochemistry profile showed an elevated serum creatinine level and low serum uric acid level. History taking revealed that he had undertaken exercise prior to the acute kidney injury (AKI) event, and he stated that family members had a history of urolithiasis. His renal profile improved after hydration and supportive care during hospitalization. Although the patient was subsequently admitted again due to AKI, his status recovered with similar treatment. Since the diagnosis of the patient was familial renal hypouricemia with exercise-induced AKI, we performed genotyping of SLC22A12, which encodes human urate transporter 1. The diagnosis was confirmed by the detection of a homozygous mutation of W258X. We herein, report a case of familial renal hypouricemia confirmed by genotyping of SLC22A12, and review the relevant literature.
Acute Kidney Injury ; Biochemistry ; Creatinine ; Diagnosis ; Hospitalization ; Humans ; Male ; Uric Acid ; Urolithiasis ; Young Adult

BACKGROUND: Transforming growth factor-beta (TGF-beta) is a multifunctional cytokine involved in immune disorders, cancer, asthma, lung fibrosis, and chronic kidney disease, and its signal pathways are considered crucial mediators of a variety of cellular processes. In addition, several recent studies have reported that TGF-beta receptor (TGF-betaR) gene polymorphism is associated with chronic kidney disease. However, the association between end-stage renal disease (ESRD) and the TGF-beta gene polymorphism has not been sufficiently investigated. In this study, we hypothesized that polymorphisms of the TGF-beta ligands or their receptors may be related to ESRD. METHODS: We assessed the relationship between four single-nucleotide polymorphisms (SNPs) in the TGF-betaR2 and TGF-beta2 genes and ESRD, in 312 patients with ESRD and 258 controls. RESULTS: Compared with the control participants, the frequencies of the TGF-betaR2 (rs764522*C) and TGF-betaR2 (rs3087465*G) alleles were significantly higher in the patients with ESRD. Genotyping analysis demonstrated that two SNPs in TGF-betaR2 of the four SNPs included in the study were significantly associated with ESRD in the codominant 1 [rs764522, odds ratio (OR)=1.65; rs3087465, OR=1.63], dominant (rs764522, OR=1.63; rs3087465, OR=1.57), and log-additive (rs764522, OR=1.54; rs3087465, OR=1.39) models after adjusting for age and sex. CONCLUSION: We suggest that TGF-betaR2 polymorphisms (rs764522 and rs3087465) increase the risk of development of ESRD.
Alleles ; Asthma ; Fibrosis ; Humans ; Immune System Diseases ; Kidney Failure, Chronic* ; Ligands ; Lung ; Odds Ratio ; Polymorphism, Single Nucleotide ; Receptors, Transforming Growth Factor beta ; Renal Insufficiency, Chronic ; Signal Transduction ; Transforming Growth Factor beta ; Transforming Growth Factor beta2

BACKGROUND: In the midthoracic region, a fluroscope guided epidural block has been proposed by using a pedicle as a landmark to show the height of the interlaminar space (Nagaro's method). However, clinical implication of this method was not fully evaluated. We studied the clinical usefulness of a fluoroscope guided thoracic epidural block in the midthoracic region. METHODS: Twenty four patients were scheduled to receive an epidural block at the T6-7 intervertebral space. The patients were placed in the prone position. The needle entry point was located at the junction between midline of the pedicle paralleled to the midline of the T7 vertebral body (VB) and the lower border of T7 VB on anteroposterior view of the fluoroscope. The needle touched and walked up the lamina, and the interlaminar space (ILS) was sought near the midline of the VB at the height of the pedicle. RESULTS: The authors could not insert an epidural needle at T6-7 ILS in two patients and it was instead inserted at T5-6 ILS. However, other patients showed easy insertion at T6-7 ILS. The mean inward and upward angulations were 25degrees and 55degrees respectively. The mean actual depth and calculated depth from skin to thoracic epidural space were 5.1 cm and 6.1 cm respectively. Significant correlation between actual needle depth and body weight, podendal index (kg/m) or calculated needle depth was noted. CONCLUSIONS: The fluorposcope guided epidural block by Nagaro's method was useful in the midthoracic region. However, further study for the caudal shift of needle entry point may be needed.
Analgesia ; Body Weight ; Epidural Space ; Fluoroscopy ; Humans ; Needles ; Prone Position ; Skin ; Thoracic Vertebrae

PURPOSE: Important advances in the treatment of acute myelogenous leukemia have been made with the introduction of cytosine arabinoside (ara-C) and anthracyclines (daunorubicin) over the past 20 years. Currently, 60 to 80% of patients with acute myelogenous leukemia achieve complete remission with induction chemotherapy consisting of ara-C and daunorubicin (adriamycin) AD ("7+3"). The one-fourth of complete responders will have extended long-term survival and may be cured. Therefore wetreated patients with acute myelogenous leukemia admitted to our hospital with AD ("7+3") regimen. METHODS: Induction therapy; Thirty four patients with previously untreated acute myelogenous leukemia received AD ("7+3") regimen (ara-C, 200 mg/m2/d by continuous infusion for seven days, and daunorubicin, 45 mg/m2/d for 3 days). The second course of therapy was AD ("5+2"), if the patients failed to enter remission. Consolidation therapy; three cycles of consolidation chemotherapy were administered with at least 4 week interval following remission. Course 1; ara-C at 100 mg/m2 by subcutaneous injection every 12 hour for seven days, 6-thioguanine at every 12 hour 100 mg/m2 orally every 12 hour for 7 days). Course 2; ara-C (same as course 1) at 100 mg/m2 by subcutaneous injection every 12 hour for seven days, vincristine at 1.5 mg/m2 (maximum 2 mg) by bolus injection for 1 day, prednisolone at 40 mg/m2 (maximum 60 mg) orally for 7 days. Course 3; ara-C (same as course 1) daunorubicin at 45 mg/m2 by 1 hour infusion for 3 dyas. RESULTS: Sixty-eight percent of the 34 patients entered complete remission. The remission duration for all patients in complete remission ranged from 4 weeks to 3122+ weeks, with the median of 50 weeks. The median duration of survival in complete responder group was 62 weeks. Twenty-Six percent of patients with complete remission are alive at 5 years. Cases with extramedullary leukemic involvement were found in four patients; M2 with orbital mass, M3 and M4 with CNS leukemia, M5a with subcutaneous nodules. Among the potential prognostic variables including age, initial WBC count, percent of blast in peripheral blood,none was statistically related to prognosis. CONCLUSION: Combination chemotherapy with cytosine arabinoside and daunorubicin is a effective regimen for acute myelogenous leukemia as much as other regimen. Futher clinical trials for effective treatment regimen and method are necessary to raise the complete remission rate.
Anthracyclines ; Consolidation Chemotherapy ; Cytarabine* ; Cytosine* ; Daunorubicin* ; Drug Therapy ; Drug Therapy, Combination* ; Humans ; Induction Chemotherapy ; Injections, Subcutaneous ; Leukemia ; Leukemia, Myeloid, Acute* ; Orbit ; Prednisolone ; Prognosis ; Thioguanine ; Vincristine