The significance of the posterior cruciate ligament (PCL) in the stability of the knee and the necessity for surgical repair of its tears are still controversial. The purpose of this study is to present the short term results of surgical repair and Kennedy LAD augmentation for 15 cases with PCL injury. In 14 patients (15 knees), the torn PCL was repaired with pullout suture technique and Kennedy LAD augmentation was done from june 1993 to june 1994. The follow-up period ranged from 12 months to 25 months (average, 18months). The main causes of injuries were traffic accidents in 12. Thirteen of the patients were men and one was a woman, ranging in age from 17 to 52 years(average, 35 years). 10 knees were acute injury and repaired at average 9 days after injury. There were 11 cases that had combined injuries(4 ACL injuries, 4 meniscus injuries, 3 MCL injuries etc). In eight knees, the tear was in mid substance area and in five it was near femoral attach site and in two it was near tibial attach site. Postoperative results were evaluated by roentgenographic evaluation of posterior sagging and Lysholm knee score. 11 knee were stable but 4 knees were unstable posteriorly during postoperative follow-up period. 3 chronic injuried knees were included in 4 posteriorly unstable knees. There are 7 combined knee injuries in 11 stable knees and no combined injuries in unstable knees and average Lysholm knee score was 89.7 in stable knees and 90 in unstable knees and there was no significant difference between two groups. On the based of this study, surgical repair with pollout suture technique and augmentation with Kennedy LAD in acute PCL injury is a one of the good method for preventing posterior sagging but more longer follow-up period and more cases must be needed to accept this method.
Accidents, Traffic ; Female ; Follow-Up Studies ; Humans ; Knee ; Knee Injuries ; Lysholm Knee Score ; Male ; Methods ; Posterior Cruciate Ligament ; Suture Techniques ; Tears

Purpose: To report the surgical skills needed, and the clinical results of, minimally invasive hip surgery with dynamic hip screws and the comparison with the classical technique in stable pertrochanteric fractures of the femur. Materials and Methods: Thirty-two patients with pertrochanteric fractures of the femur who were treated with dynamic compression hip screws between April 1999 and March 2004, and were evaluated retrospectively, and were followed up for more than 12 months. 16 cases were treated with a classical dynamic hip screw technique and 16 cases with a minimally invasive technique in random order. The mean age was 73.2 years, and there were 11 males and 21 females. The operative times, total hemovac bleeding loss, functional scores, and average hemoglobin decrease ratios were evaluated. The clinical assessments were performed with the Harris Hip Score (HSS) and bony union was evaluated with serial follow-up plain radiographs. Results: The average operative time was 63.9 minutes with the classical technique and 42.5 minutes with the minimally invasive technique. The total average hemovac blood loss was 640 cc with the classical technique and 143 cc with the minimally invasive technique. Clinically, the HHS was an average of 85.9 and 89.2 in groups 1 and 2, respectively, by the last follow-up and there were no statistically significant differences between the two groups (P <0.05) The hemoglobin decrease ratio was the same in both groups and there was no nonunion. Conclusion: Minimally invasive dynamic hip screw insertion was useful in stable pertrochanteric fractures, because it decreased blood loss and operative times; and there were no changes in fracture healing and functional outcomes.
Female ; Femur ; Follow-Up Studies ; Fracture Healing ; Hemorrhage ; Hip* ; Humans ; Male ; Operative Time ; Retrospective Studies ; Surgical Procedures, Minimally Invasive

Teratomas of the fallopian tube are extremely rare, and only about 50 cases have reported in the world literature. Most cases of mature cystic tubal teratoma are asymptomatic and are discovered as an incidental finding on physical or radiologic examination, or at the time of laparatomy. We report a case of mature cystic teratoma of the right fallopian tube which was discovered during pelvic ultrasonogram for antenatal care in a 28 year old woman. Right salpingectomy was performed during cesarean section for cephalo-pelvic distortion at IUP 39 weeks. Gross examination of the right fallopian tube reveals a distended fallopian tube, measuring 8cm in length and 2cm in diameter. On section, it is filled with several small pedunculated nodules and cysts containing sebaceous materials. Microscopically the tumor was seen in continuity with the lining epithelium of mucosal folds. The majority of the tumor was composed of well differentiated mature elements of three germ layers with skin and skin appendages, mature brain tissue, bone, breast tissue, intestinal mucosa and bronchial epithelium.
Female ; Humans ; Cysts

Urinary tract obstruction is one of the most common abnormalities of the excretory system in children. It is well known that renal function is progressively deteriorated by urinary tract obstruction and partially recovered by relief of the obstruction. But the reports about the changes of the renal function in contralateral healthy kidney after relief of unilateral obstruction are rare. Thus, we investigated pre- and post-operative changes of renal function not only on the obstructed kidneys but also on the contralateral normal kidneys in twenty-two children(12 were younger than 2 years old) with unilateral hydronephrosis due to ureteropelvic junction obstruction, using 99m-Tc-DMSA renal uptake rate. A marked increase in 99m-Tc-DMSA renal uptake rate was observed in twelve cases(54.5 % ) after pyeloplasty on the obstructed kidney. Among them eight children were younger than 2 years old. In 7 children younger than 2 years old, a preoperative 99m-Tc-DMSA renal uptake rate in contralateral normal kidney was markedly decreased. Among them, marked increase in postoperative 99m-Tc-DMSA renal uptake rate was observed in 5 cases(71.4%). In other words, in 5 children younger than 2 years old, a remarkable increase of 99m-Tc-DMSA renal uptake rate after reconstructive operation was recognized not only on obstructed kidney but also on the contralateral normal kidney. These tendency could not be observed in those older than 3 years old. These results suggest that, in the young children, the obstructed kidney inhibits the contralateral normal and compensatory renal growth, and that the relief of obstruction eliminates this inhibition and causes the renal growth spur in a normal kidney. In summary, we proposed that it is essential to correct unilateral ureteropelvic junction obstruction before two years of age if an improvement of renal function not only on the obstructed kidney but also on the normal kidney is to be expected.
Child* ; Child, Preschool ; Humans ; Hydronephrosis ; Kidney ; Urinary Tract

Root conditioning has been introduced to dissolve the smear layer, and to aid in detoxification following root planing. It produces surface demineralization, resulting to exposure of dentin collagen fibrils and opening of dentinal tubules. The purpose of the present study was to examine the possibility of obtaining root conditioning effect by using ethylenediamine tetraacetic acid(EDTA) solution instead of low pH etchants such as citric acid and tetracycline hydrochloride(Tc-HCl). Total 48 root specimens(4x5x2mm) were prepared from the mesial and distal root of 24 periodontitisaffected human mandibular molars after scaling and root planing. The specimens were treated with EDTA(17%, neutral pH, Pulpdent?, Pulpdent Co., USA) for 1 min., 2 min., and 3 min., and tetracycline hydrochloride(100mg/ml) for 5 min. using the rubbing technique and the placement technique without rubbing. The dentinal tubules of the specimens were examined under a scanning electron microscopy(JEOL, JSM- 840A, Japan). On the microphotographs taken at x3,000 magnification, the number of identifiable dentinal tubules, opened dentinal tubules, and fully opened dentinal tubules(over 0.9micrometer in diameter) per the unit area(1,067?m2) were counted. And the rate of opened dentinal tubule and the rate of fully opened dentinal tubule were calculated. The difference of those rates among all groups was statistically analyzed by ANOVA and Dunkan test. The results were as follows; 1. In the specimens applied with EDTA, the rate of opened dentinal tubule was not significantly different between each group regardless of application technique and application time(p>0.1). 2. In the specimens applied with EDTA, the rate of fully opened dentinal tubule had tendency to be increased in proportion to application time regardless of application technique. 3. In the specimens applied with EDTA within 2 min., the rate of fully opened dentinal tubule failed to show significant difference between the two techniques(p>0.1). But, in the specimens applied for 3 min., the rate of fully opened dentinal tubule was significantly higher in the specimens applied by the rubbing technique than those by the placement technique(p<0.001). 4. In the specimens applied with Tc-HCl for 5 min., both the rate of opened dentinal tubule(p<0.01) and the rate of fully opened dentinal tubule (p<0.001) were induced significantly higher by the rubbing technique than the placement technique. 5. The rate of fully opened dentinal tubule was significantly higher in both the specimens rubbed for 3 min. with EDTA and the specimens rubbed for 5 min. with Tc-HCl than other groups(p<0.001). But there was no significant difference between the two(p>0.1). The results demonstrate that 17% EDTA solution can replace low pH etchants for root conditioning, and the rubbing technique for at least 3 min. is recommendable.
Humans

Congenital urethral stricture are uncommon in boys and occurs at the junction of the endodermal primary urethra and ectodermal secondary urethra. This structure is thought to be related embryonically to failure of complete dissolution of urogenital membrane at the junction of the urogenital sinus and genital fold. Endoscopically, this lesion is recognized as a ring-form stenosis just distal to the external urethral sphincter. Congenital urethral stricture is an important cause of recurrent urinary tract infections, enuresis, failure in thrive or hematuria in pediatric urological practice. The most effective treatment of this lesion is optic internal urethrotomy under direct vision. We report two cases of 6 and 12-year-old boys hospitalized with complaints of high fever, dysuria, urgency and frequency. Six-year-old boy has grade III VUR and 12-year-old boy has grade IV VUR with Hutch diverticulum. We managed with visual internal urethrotomy only in 6-year-old boy but visual internal urethrotomy and bilateral ureteroneocystostomy in 12-year-old boy.
Child ; Constriction, Pathologic ; Diverticulum ; Dysuria ; Ectoderm ; Endoderm ; Enuresis ; Fever ; Hematuria ; Humans ; Male ; Membranes ; Urethra ; Urethral Stricture* ; Urinary Tract Infections* ; Urinary Tract*

PURPOSE: A number of drugs are capable of changing body weight as a side effect. A number of neurotransmitter systems acting in several hypothalamic nuclei are pivotal to the storage regulation of body fat. Leptin is a protein encoded by the ob gene that is expressed in adipocyte. It regulates eating behavior by activating the action to the satiety center in the hypothalmus. The purpose of this study is to investigate the changes of serum leptin in children with epilepsy. METHODS: Serum leptin levels were measured in 43 epileptic patients (30 males, 13 females) receiving valproate or carbamazepine by radioimmunoassay. Thirty patients (19 males, 11 females, 10.0+/-5.0 years of age) were treated with valproate (VPA group) and 13 patients (11 males, 2 females, 9.1+/-4.0 years of age) were treated with carbamazepine (CBZ group). Obesity index and body mass index were calculated before and during anticonvulsant medications. RESULTS: 1) Body mass indices were significantly increased after VPA or CBZ medication; from 17.24+/-2.74 to 18.47+/-2.60 in VPA group, from 16.77+/-1.69 to 17.43+/-3.01 in CBZ group. 2) Obesity indices were increased without statistical significance after medication in both group. 3) Serum leptin levels were significantly higher in VPA group (4.54+/-4.77ng/ml) than CBZ group (2.47+/-2.26ng/ml). CONCLUSION: Body weight gain after VPA medication in susceptible individual might be related to a certain mechanism that elevates serum leptin level.
Adipocytes ; Adipose Tissue ; Body Mass Index ; Body Weight ; Carbamazepine ; Child* ; Epilepsy ; Feeding Behavior ; Female ; Humans ; Leptin* ; Male ; Neurotransmitter Agents ; Obesity ; Radioimmunoassay ; Valproic Acid ; Weight Gain

We evaluated the prophylactic efficacy of intravesical irrigation with distilled water immediately after transurethral resection(IUR) of superficial bladder tumor patients. Control group(n=30), with normal saline irrigation immediately after TUR(=15 min.) and continuous intravesical instillation of adriamycin 150mg with 3000ml normal saline for 2 days postoperatively. Distilled water group(n=28), with the same modality as control group, except for distilled water as the irrigation solution. The overall recurrence rates were 35.7% in distilled water group, which were more effective than 60.0% in control group. The 2 yeas tumor free rates by Kaplan-Meier method was higher in distilled water group ( 71.4% ) than control group (46.4% ), respectively with statistical significance. But, the mean time to recurrence were 13.3 months in control group and 14.1 months in distilled water group, without significant differences between two groups. These results support that the reasonable benefits of distilled water for prophylaxis of recurrence in superficial bladder tumor.
Administration, Intravesical ; Doxorubicin ; Humans ; Recurrence ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Water*

Epiblepharon is frequently encountered n oriental eyelid, especially in children. It is characterized by a horizontal fold of redundant skin and abundant orbicularis muscle near lid margin, which the lashes vertically, or posteriorly towards the eye. Surgical therapy of epiblepharon in correcting the trichiasis includes lid bracing sutures, burried sutures, skin resection, a Hotz procedure or its modification, and a Jones procedure. In our opinion, these procedures are not sufficient, because these procedures will not correct the epicanthal folds. Epicanthal folds have been a one of the characteristics of Asian over 50 percents of population in Japan and South Korea, and it either reduce the aesthetic result of the double-eyelid procedure or make the correction of the entropion and epiblepharon difficult. Although many surgical procedures are available to eliminate epicanthal folds, scarring on the medial canthus is in still and obstacle for surgeons to overcome. From January of 1998 to October of 1998, we used half z-plasty procedures in 5 cases to correct epicanthal folds in epiblepharon. There were few complications in our series. We believe that half z-plasty can get a good result in the correction of epibolepharon and oriental epicanthal folds.
Asian Continental Ancestry Group ; Braces ; Child ; Cicatrix ; Entropion ; Eyelids ; Humans ; Japan ; Korea ; Skin ; Sutures ; Trichiasis

Pigmented villonodular synovitis and synovial chondromatosis are known as a poup of interrelated tumorous disorders that involve the lining of the joints, hursa and tendon sheath. Pigmented villonodular synovitis consists of proliferatin synovia1 tissue containing histiocytes, librohlasts, multinucleated giant cells, and capillaries that can destroy dense fihrous tissue, form soft tissue masses, and invade bone. Synovial chondromatosis consists of hyaline cartilage nodules within the synovium and synovial joint cavities, develop multiple loose fragments of cartilage within the joint. They may represent a reactive inflammatory process or henign neoplasm and usually occur in latge synovial joints, including the knee, hip and ankle. There are some reports stating that pigmented villonodular synovitis has coexisted with synovial chondromatosis. but none have reported that they occurred simultaneously in a large single joint. This is a report on a diagnosed and arthroscopicully treated pigmented villonodular synovitis and synovial chondromatosis that occurred simultaneously in the same ankle joint.
Ankle Joint* ; Ankle* ; Capillaries ; Cartilage ; Chondromatosis, Synovial* ; Giant Cells ; Hip ; Histiocytes ; Hyaline Cartilage ; Joints ; Knee ; Synovial Membrane ; Synovitis, Pigmented Villonodular* ; Tendons