No abstract available.
Cadaver* ; Fascia Lata* ; Fascia*

We present our technique for reconstruction of the posterior cruciate ligament (PCL) using the quadrupled hamstring tendons with EndoButton(Acufex Microsurgical, Mansfield, MA). This paper describes the surgical technique of the procedures and reports the preliminary results in 10 patients with a more than 12 months follow-up. There were 8 males and 2 females ranging in age from 17 to 37 years (average 25 years). The average time from injury to operation was 3 weeks (range; 2 weeks to 4 weeks). Of ten patients, 6 were classified as an isolated tear, 2 were associated with lateral collateral ligament tears. A torn meniscus was present in 2 cases. We used one-incision technique. The results of these PCL reconstructions with a minimum follow-up of 12 months are as follows. Patients were evaluated preand postoperatively using the Lysholm, and Hospital for Special Surgery Knee ligament rating scales. Average knee ligament evaluation scores were Lysholm preoperative 48, postoperative 87.6; and Hospital for Special Surgery preoperatively 33.5, postoperative 88.8. We chose the semitendinosus and gracilis tendons with EndoButton fixation for PCL reconstruction for specific reasons: (1) No injury to the extensor mechanism and (2) Easy passage of the graft through the tibial tunnel. (3) The problem about the screw and patellar bone-tendon-bone can be resolved. (4) It preserves intact meniscofemoral ligament, some intact fibers of PCL bundle. (5) When rupture of the PCL is associated with ACL tear, each ligament should be reconstructed. In such a case, we preserve patellar tendon for reconstruction of the ACL, The technique presented here is not applicable to all individuals requiring PCL reconstruction but does provide significant advantages to those patients for whom it is utilized. Although the clinical results are very promising at this length of follow up, long-term study is required to evaluate our PCL reconstruction procedure more precisely.
Female ; Follow-Up Studies ; Humans ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Male ; Patellar Ligament ; Posterior Cruciate Ligament* ; Rupture ; Tendons ; Transplants* ; Weights and Measures

Detection and evaluation of early soft tissue changes are important in rheumatoid arthritis or other jointdiseases. The most important factors for radiologic demonstration of soft tissue changes are resolving power andthe optimization of contrast differences between structures representing skin and subcutaneous tissue densities.Phantom study was done by using combination of immersion technique and mammography to get the most reliable methodfor improvement of soft tissue contrast without deterioration of resolution. Clinical application was also done in5 normal volunteers and 5 rheumatoid patients. The results indicate that soft tissue contrast, especially betwenskin and subcutaneous tissues can be significantly imporved with combination of immersion technique andmammography with 50% ethanol in both phantom and clinical study.
Arthritis, Rheumatoid ; Clinical Study ; Ethanol ; Healthy Volunteers ; Humans ; Immersion ; Mammography ; Radiography ; Skin ; Subcutaneous Tissue

PURPOSE: To describe the MR characteristics of giant cell tumor of bone. MATERIALS AND METHODS: MR iraagings of 15 cases of pathologically proved giant cell tumor were retrospectively analyzed. Signal intensity and homogeneity, involvement of articular surface, low signal intensity rim around the tumor, cortical disruption and soft tissue involvement were evaluated. RESULTS:Tumor showed low signal intensity on T1 weighted images(93%), inhomogenous high signal on T2 or T2* weighted images(93%) and inhomogeneous enhancing pattern(88%). In 11 cases of giant cell tumor of long bones, all cases showed involvement of articular margin and 10 cases(90%) showed rim of low signal intensity between tumor and normal marrow. Disruption of cortical bone(25%) and soft tissue involevement(7%) were also demonstrated. CONCLUSION: We concluded that giant cell tumor showed characteristic MR findings could be helpful in making correct diagnosis.
Bone Marrow ; Diagnosis ; Giant Cell Tumor of Bone ; Giant Cell Tumors* ; Giant Cells* ; Retrospective Studies

PURPOSE: To describe the magnetic resonance (MR) findings of pigmented villonodular synovitis(PVNS) of the knee, and to evaluate the clinical value of MR in the diagnosis of PVNS. MATERIALS AND METHODS:MR imagings of seven patients with PVNS were studied. The type of lesion, presence of bony erosion, the signal intensity, and the relationship between contrast enhancement and signal intensity on T2-weighted images were analyzed, retrospectively. RESULTS: The lesion was mainly villous in three patients and nodular in four, and bony erosion was seen in one patient. On T2-weighted image, the signal intensity of the villous form was mixed iso- and hypointense in two, hypointense in one, and that of the nodular form was heterogeneous with hypo-, iso-, and hyperintensities. The hypointense portion on T2-weighted image showed poor contrast enhancement, which may suggest hemosiderin deposition or advanced fibrosis. The iso- or hyperintense portion on T2-weighted image showed strong enhancement, which suggest active cellular proliferation. CONCLUSION:MR imaging could be a very useful modality in the diagnosis as well as prediction of histological findings of the PVNS.
Cell Proliferation ; Diagnosis ; Fibrosis ; Hemosiderin ; Humans ; Knee* ; Magnetic Resonance Imaging* ; Retrospective Studies ; Synovitis, Pigmented Villonodular*

In adenomatous polyposis coli there are many colonic and extracolonic manifestations, and various combinations of these induce different clinical presentations and syndromes. We experienced a unique case of adenomatous polyposis of the large intestine and stomach in a 39-year-old man. In the colon, small cell neuroendocrine carcinoma rather than adenocarcinoma had developed, which did not contain adenomatous or carcinomatous foci. The adenomatous polyps in the colon were all small and sessile with no cancerous or precancerous change two years after the resection of the symptomatic gastric adenomas, even though the gastric adenomas were larger and showed dysplastic change. We think this case is another variant of adenomatous polyposis syndrome.
Adenocarcinoma ; Adenoma

A new benzodiazepine derivative, Rohypnol (Ro 5-4200), was used for management of general anesthesia with nitrous oxide, narcotics and muscle relaxants to evaluate the effect on the cardiovascular and respiratory system in 35 surgical patients. In each patient, we observed the blood pressure, pulse rate, minute volume and arterial blood gas analysis and also local effects, postoperative recovery state and amnesia. The results are as follows; 1) Induction dosage of Rohypnol was not constant as other benzodiazepines. 2) Rohypnol showed a little effect an the cardiovascular system. 3) The effects of Rohypnol on the respiratory system were negligible but slight depression was seen. 4) If respiration became shallower or apnea occured during induction with Rohypnol, it was preferred to use assisted or controlled ventilation with 100% oxygen. 5) It was thought better to give oxygen through a nasal catheter for prevention of decreased PaO2 in recovery room. 6) When we used the non-depolarizing muscular relaxants instead of S.C.C. for intubation, we observed that a significantly decreased amount of relaxant was needed for maintenance of general anesthesia.
Amnesia ; Anesthesia, General ; Apnea ; Balanced Anesthesia* ; Benzodiazepines ; Blood Gas Analysis ; Blood Pressure ; Cardiovascular System ; Catheters ; Depression ; Flunitrazepam* ; Heart Rate ; Humans ; Intubation ; Narcotics ; Nitrous Oxide ; Oxygen ; Recovery Room ; Respiration ; Respiratory System ; Ventilation

Particulate wear debris(polyethylene, polymethylmethacrylate and metal particles, or combination of these) can initiate aseptic loosening. To eliminate polyethylene debris and reduce the total amount of wear, metal on metal bearings(Metasul) which were made of a wrought Co-28Cr-6Mo-0.2C alloy, were introduced. From May 1994 total hip replacements using a Metasul metal on metal articulation were performed by the authors. 34 patients with 40 hips with minimum follow-ups during 24 months were analysed in this study. The mean follow up period was 31 months(ranging from 24 to 47 months). We used Armor cups and standard cups as acetabular comporients and SL stems, CLS stems and cone stems as femoral components. Preoperative average Harris hip score of 48 points became postoperatively 93(from minimum 81 to maximum 100). And there were slight and occasional thigh pains in 2 cases(5%). There were no revisions for the early aseptic loosening of femoral stems or stem failures. Radiologic evaluation which revealed mild calcar atrophy was developed in 33 cases(82.5%), revealing cortical hypertrophy in 10 cases(25%). Osteolysis was not noted around the prosthetic stem nor around the cup. Radiolucent lines were found in 9 cases of femoral components(22.5%) and in 1 case of acetabular component(2.5%) and subsidence of more than 3mm in 1 case of femoral components(2.5%) were also found. There was 1 case of definitive loosening of acetabular component(2.5%). These also showed that endosteal bone formation adjacent to femoral prosthesis was developed in 22 cases(55%) but no distal pedestal and stem shift occurred. The short-term but satisfactory results of the contemporary metal on metal articulation investigated in this study were encouraging and warrant continued study.
Acetabulum ; Alloys ; Arthroplasty* ; Arthroplasty, Replacement, Hip* ; Atrophy ; Follow-Up Studies ; Hip ; Humans ; Hypertrophy ; Osteogenesis ; Osteolysis ; Polyethylene ; Polymethyl Methacrylate ; Prostheses and Implants ; Thigh

PURPOSE: We investigated the technical feasibility and clinical results of percutaneous bladder neck suspension(PBNS) using bone anchors(Vesica) which represents a minimally invasive surgical procedure for the treatment of stress urinary incontinence caused by hypermobility of the proximal urethra and bladder neck. MATERIALS AND METHODS: Among women who underwent PBNS using bone anchors for type I or type II stress urinary incontinence, 22 women were followed for at least postoperative 9 months. A miniature bone anchor was used. On each side the suture was attached to the pubocervical fascia and the vaginal wall via a broad ?Z-stitch?. Postoperative voiding status was evaluated during office follow-up visits and telephone surveys. RESULTS: Mean operation time was 32 minutes. Mean hospital stay was 0.9 days. Mean follow-up was 13 months(9 to 18 months). In the 22 patients, the procedure was successful in 18 cases(82%), with 11(50%) of the patients completely dry and 7(32%) significantly improved. Preoperative urgency was present in 10 patients(45%). Postoperative resolution rate of urgency was 60%(6 of 10 patients). In 4 cases(18%), de novo urgency was documented. Removal of the bone anchor and suture was necessary in only one patient, because of persistent vaginal infection. Other complications were transient urinary retention in 3 patients(14%), prolonged suprapubic discomfort in 1 patient(4.5%) and incidental bladder perforation in 1 patient(4.5%). Major complications such as chronic urinary retention, osteitis pubis were not noted. CONCLUSIONS: The use of this bone anchoring technique and preservation of the endopelvic fascia appears to enhance the success rate without increasing the risk to the patient and, as minimally invasive procedures, reduce the surgery time and the length of hospitalization. However, the suspension sutures of PBNS may pull through the paraurethral tissue because there is no paravesical scar formation as in open procedures. Therefore we conclude that modifications of the suspension technique should be required for the improvement of long-term results.
Cicatrix ; Fascia ; Female ; Follow-Up Studies ; Hospitalization ; Humans ; Length of Stay ; Neck* ; Osteitis ; Suture Anchors* ; Sutures ; Telephone ; Urethra ; Urinary Bladder* ; Urinary Incontinence* ; Urinary Retention

To evaluate the radiographic characteristics of osteochondritis dissecans (OCD) and useful parameter for predicting mechanical stability, we retrospectively analysed 26 plain radiographic examinations and seven MR imagings in 28 cases of OCD in 24 patients. Typical radiologic findings were osteochondral defect with sclerotic rim of variable thickeness and osteochondral fragment. Sites of osteochondral defect were medial (35.9%) or lateral (32%) femoral chondyle and medial (7.1%) or lateral (25%) side of talar dome. Sclerotic rim was seen in 24 cases (85%) and osteochondral fragments including nine loose bodies were seen in 21 cases (75%). The size of osteochondral defect with unstable fragment (average 2.05cm) and loose body (2.04cm) in the knee joint were similar to, but statistically larger than that with stable fragment (1.35cm). All osteochondral defects were well visualized on MR images. Abnormalities of articular cartilage and effusion in the interface between the parent bone and fragment were seem in five cases of which there were confirmed three unstable cases arthroscopically. We conclude that size of defect may be a good parameter for predicting mechanical stability and MRI may be useful in the diagnosis of OCD and determining the methods of treatment.
Cartilage, Articular ; Diagnosis ; Humans ; Knee Joint ; Magnetic Resonance Imaging ; Osteochondritis Dissecans* ; Osteochondritis* ; Parents ; Retrospective Studies