For prevention of limitation of range of motion due to arthrofibrosis of the knee joint after anterior cruciate ligament reconstruction, it is accepted in general that the operation should be delayed for about three weeks after injury. We studied the duration form operation to time of full range of motion, and analized the results in forty-eight patients who had undergone arthroscopic anterior cruciate ligament recostruction using the autologous bone-patella tendon-bone graft and early CPM, range of motion exercise during Feb. 1991 and June 1994. The results were as follows: 1. The average interval from injury to operation were 1.3 weeks in acute injury group, 6 weeks in subacute injury group and 20.7 months in chronic group. The average interval from operation to full range of motion were 7.1 weeks in acute injury group, 5.7 weeks in subacute injury group and 3.0 weeks in chronic group. 2. In acute injury group, 14(93.3%) of 15 cases showed full extesion and only 1 case(6.7%) showed the limitation of extension less than 5 degrees. In subacute injury group, 6(85.7%) of 7 cases showed full extension but1 case(14.3%) showed the limitation of extension less than 5 degrees. On the other hand in the chronic injury group, all the 26 cases(100%) of the patients showed full extension. 3. In acute injury group, 14(93.3%) of 15 cases showed full flexion and only 1 cases(6.7%) showed the limitatin of flexion less than 5 degrees. In subacute injury group, 6(85.7%) of 7 cases showed full flexion but 1 case(14.3%) showed the limitation of flexion less than 5 degrees. On the other hand in the chronic injury group, 23(88.5%) of 26 cases could flex to full range of flexion, and 3 cases(11.5%) revealed limitation of flexion less than 5 degrees. 4. The limitation of ROM mainly due to arthrofibrosis can be prevented by early range of motion execise and active rehabilitation in the acute or chronic anterior cruciate ligament reconstruction using the autograft bone-patella-bone graft. Although in acute patients the interval from operation to full ROM can be prolonged, the full ROM can be achieved after all.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Autografts ; Hand ; Humans ; Knee Joint ; Patella ; Patellar Ligament ; Range of Motion, Articular ; Rehabilitation ; Transplants

Magnetic resonance imaging(MRI) is accepted as a useful tool for the diagnosis of injury of the knee recently. The anterior cruciate ligament tear is accompanied by the damage of the osseous and soft tissue of the knee. The occult osseous lesion is found on magnetic resonance imaging as bone density change that is not found on the simple radiograph. From Jan. 1992 to Apr. 1994, magnetic resonance imaging was performed on 44 patients with acute anterior cruciate ligament tears. MRI was done within 6 weeks of the index anterior cruciate ligament injury. The criteria of decreased signal intensity on the Tl weighted image and increased signal intensity on the T2 weighted image was applied for the incidence assessment of the occult osseous lesion. After arthroscopy with or without ACL reconstruction, follow-up simple radiograph was checked every 3 months. Occult osseous lesions were documented in 32(73%) of the 44 patients. Of the 32 patients with bony lesion, 81% had lesions of the lateral compartment. Lateral femoral condyle was involved in 15 cases(46.9%), and lateral tibial plateau in 22 cases (68.8%). Follow-up X-ray revealed no joint deperession in all of the 32 patients with the occult osseous lesion. This result suggests that there is a high correlation between the occult osseous lesion of lateral compartment of the knee on magnetic resonance imaging and anterior cruciate ligament tear. The presence of the occult osseous lesion in the patient with acute anterior cruciate ligament tear did not affect rehabilitation and weight bearing.
Anterior Cruciate Ligament ; Arthroscopy ; Bone Density ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Joints ; Knee ; Magnetic Resonance Imaging ; Rehabilitation ; Tears ; Weight-Bearing

Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management.
Adult ; Arteries ; Cardiopulmonary Bypass ; Catheterization ; Causality ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels ; Emergencies ; Extracorporeal Membrane Oxygenation ; Heart Failure ; Hemodynamics ; Humans ; Lower Extremity ; Male ; Oxygenators, Membrane ; Spasm* ; Stents ; Transplants*

OBJECTIVE: To determine of the regulation of cyclooxygenase-2 (COX-2) expression by Interleukin-1beta in WISH cells. METHODS: Amnion WISH cells were incubated in media containing increasing concentrations of IL-1beta or with various inhibitors. Increased COX-2 expression was determined by Western blot analysis with anti-COX-2 antibody. Concomitant measurements of culture media PGE2 were made by an enzyme immunoassay. RESULTS: The COX-2 and prostaglandin E2 production induced by IL-1beta increased in a dose- and time-dependent manner. One of the regulating factors that induced COX-2 by IL-1beta was protein kinase C (PKC). PKC inhibitor, Ro 31-8220 was pretreated and continued treating by IL-1beta. Then, PKC inhibitor completely blocked COX-2 protein induction by IL-1beta. In contrast, COX-2 induction by IL-1beta after pretreating PKC stimulator, phobol 12-myristate 13-acetate was potentiated with synergism. Another factor in controlling COX-2 protein induction was identified as phosphatidylinositol 3-kinase (PI 3K). COX-2 protein induction by IL-1beta after pretreating PI 3K inhibitors, wortmannin and LY294002 strongly increased. This kind of result reflected that PI 3K act as negative regulator. COX-2 induction by IL-1beta was known to be regulated in not only transcription step, but also translation step after performing experiment of actinomycin and cycloheximide treatment. CONCLUSION: COX-2 protein and prostaglandin E2 production induced by IL-1beta were controlled by many factors in amnion cell. Among those factors, PKC and PI 3K have an important role, but their control mechanism act as positive and negative, respectively.
Amnion ; Blotting, Western ; Culture Media ; Cycloheximide ; Cyclooxygenase 2* ; Dactinomycin ; Dinoprostone ; Immunoenzyme Techniques ; Interleukin-1beta* ; Phosphatidylinositol 3-Kinase ; Protein Kinase C

Cutaneous involvement of patient with systemic cryptococcosis occur in 10% to 15% of the case reported in literature. We report a case of cutaneous cryptococcosis clinically mimiking keratoacanthoma in a 70-year-old male. The lesions showed multiple erythematous papules and elevated central crusted nodules with peripheral telangiectasia on the face, and he had been treated with chemotherapy for peripheral T-cell lymphoma. The skin biopsy specimen showed granulomatous reaction with lympohistiocytic infiltration and many round spores. The fungus culture from skin lesion showed mucoid creamy colored colonies and revealed microscopically thick encapsulated spores in India ink preparation. The culture on Christensen urea agar at 25degrees C for 1 week was positive. The patient was treated with intravenous administration of fluconazole 200 mg/day for a week with partial improvement. But he refused further treatment, and died after a month of discharge.
Administration, Intravenous ; Agar ; Aged ; Biopsy ; Cryptococcosis* ; Drug Therapy ; Fluconazole ; Fungi ; Humans ; India ; Ink ; Keratoacanthoma ; Lymphoma, T-Cell, Peripheral ; Male ; Skin ; Spores ; Telangiectasis ; Urea

Pigmented spindle cell nevus (PSCN) was first described by Reed et al. in 1975 as a distinctive form of nevocellular nevus. Although some authors consider PSCN to be a pigmented variant of Spitz nevus, most classify it as a separate disease. We encountered a two year old boy with deeply pigmented macule on the left foot dorsum. It's histologic features were sharply demarcated lateral margin, confinement above reticular dermis and entirely composed of heavily pigmented spindle cells. There were no atypical mitotic fugures or nuclear pleomorphism, and cell size was uniform. The pathologic features were consistent with PSCN.
Cell Size ; Dermis ; Foot ; Humans ; Infant* ; Male ; Nevus ; Nevus, Epithelioid and Spindle Cell ; Nevus, Spindle Cell*

Mondor's disease is an uncommon superficial thrombophlebitis of the anterolateral thoraco-ab dominal wall. It's cause is unknown, but it is often associated with recent local trauma, muscular strain, and strenuous exercise. It has clinical features of a palpable, tender, linear cutaneous nodule and is always almost unilateral, and solitary, but rarely multiple. A 39-year-old man presented multiple cord-like tender subcutaneous linear lesions on the left ventrolateral thoracoabdominal wall for 3 weeks. He had done strenuous exercise and stretching for 2 months prior to his visit. Histologic finding revealed thrombophlebitis. The lesion did not involute with systemic and intralesional steroids, but three months later, it disappeared.
Adult ; Humans ; Steroids ; Thrombophlebitis

Loss of bone mass is usually detected after bone marrow transplantation (BMT) during the early post-transplant period. However, little is known about the long-term effects of BMT on bone metabolism. We have prospectively investigated 11 patients undergoing BMT. Bone mineral density (BMD) was measured before BMT, and 1, 2, and 3 yr after BMT. Serum markers of bone turnover were serially measured before BMT and 1, 2, 3, 4, and 12 weeks, 6 months, and 1 yr after BMT. The mean change in the lumbar spine (L2-4) BMD, calculated as the percent change from the baseline to the level at 1, 2, and 3 yr was -4.7% (NS), -1.1% (NS), and +6.4% (p<0.05), respectively. The mean change in the total proximal femur BMD from the baseline to the level at 1, 2, and 3 yr was -8.5% (p<0.01), -8.7% (p<0.05) and -5.6% (p<0.05), respectively. In summary, there was little decline in lumbar BMD at 1 yr following BMT and gradual recovery until 3 yr. In contrast, femoral BMD decreased much more than the lumbar area at 1 yr and did not recover until 3 yr. The mechanism of skeletal site-selective differences in the changes of BMD needs to be elucidated.
Adult ; Age Factors ; Anemia, Aplastic/therapy ; *Bone Density ; Bone Marrow Transplantation ; Bone and Bones/drug effects/*metabolism/radiation effects ; Collagen/blood ; Collagen Type I ; Cyclophosphamide/therapeutic use ; Estradiol/blood ; Follicle Stimulating Hormone/blood ; Humans ; Leukemia/therapy ; Luteinizing Hormone/blood ; Middle Aged ; Myelodysplastic Syndromes/therapy ; Peptides/blood ; Prospective Studies ; Time Factors

Cases of coexistent lichen sclerosus et artrophicus and morphea have been reported. It is controversial that both diseases are single disease-spectrum or entirely separated. We encounterd a forty five year old female with a hypopigmented firm plaque on the left neck. Its histologic feature showed compact orthokeratosis, follicular plugging, atrophy of the stratum malpighii with vacuolar alteration of basal layer, and homogenization of the collagen in the upper dermis (lichen sclerosus et atrophicus). Increased thick collagen bundles were seen in the lower dermis (morphea).
Atrophy ; Collagen ; Dermis ; Female ; Humans ; Lichen Sclerosus et Atrophicus* ; Lichens* ; Neck ; Scleroderma, Localized*

The Objective of this research was to construct the multimedia database system that was necessary for the education of the practitioners and the students. To establish this system, there were technical problems as follows: 1) The processing of the images, 2) The rapid processing of the information with the computer network, 3) The development of diagnosis tools, 4) The technique to establish the database system, 5)The link between the database system and the internet, and 6) The method to educate through many cases. The analysis for diagnosis and treatment planning were provided as two parts : model analysis and cephalometric analysis. As a model analysis, arch length discrepancy and Bolton tooth ratio were provided for the part of patient information. Cephalometric analyses were provided in the part of initial diagnosis. The Cephalometric analysis ver 2.0 and the PowerCeph pro 3.3.5 were used to show Tweed, Steiner and Jarabak analysis. In the main part, Kim's analysis and some measurements were added. In the post-treatment or retention part, we show the superimposition of the cephalometrics with which you can find the effectiveness of the various orthodontic treatment. The address of this home page is "http://damis.snu.ac.kr/orthodontics"
Diagnosis ; Education ; Education, Continuing* ; Humans ; Internet ; Multimedia* ; Tooth