BACKGROUND: Acromioclavicular (AC) stability is maintained through a complex combination of soft-tissue restraints that include coracoclavicular (CC), AC ligament and overlying muscles. Among these structures, the role of the CC ligament has continued to be studied because of its importance on shoulder kinematics, especially after AC injury. This study was designed to determine the geometric change of conoid and trapezoid ligaments and resulting stresses on these ligaments according to various scapular motions. METHODS: The scapuloclavicular (SC) complex was isolated from a fresh-frozen cadaver by removing all soft tissues except the AC and CC ligaments. The anatomically aligned SC complex was then scanned with a high-resolution computed tomography scanner into 0.6-mm slices. The Finite element model of the SC complex was obtained and used for calculating the stress on different parts of the CC ligaments with simulated movements of the scapula. RESULTS: Average stress on the conoid ligament during anterior tilt, internal rotation, and scapular protraction was higher, whereas the stress on the trapezoid ligament was more prominent during posterior tilt, external rotation, and retraction. CONCLUSIONS: We conclude that CC ligament plays an integral role in regulating horizontal SC motion as well as complex motions indicated by increased stress over the ligament with an incremental scapular position change. The conoid ligament is the key structure restraining scapular protraction that might occur in high-grade AC dislocation. Hence in CC ligament reconstructions involving only single bundle, every attempt must be made to reconstruct conoid part of CC ligament as anatomically as possible.
Biomechanical Phenomena ; Cadaver* ; Dislocations ; Ligaments* ; Muscles ; Scapula ; Shoulder

Purpose: To report our experience with nine cases of pathologic synovial plica on radiohumeral joint which symptom of painful snapping elbow was improved by arthroscopic resection. Materials and Methods: Between 1999 and 2004, 43 cases of elbow arthroscopy were performed by one surgeon. Eight patients with nine cases showed pathologic synovial plica in conjunction with snapping or posterolateral elbow pain. The mean age of eight patients (man: 7, woman: 1) was 29 years (range 16~56 years). All patients had a trial of conservative treatment at least six months (range 6~16 months). The diagnosis was confirmed before surgery in six cases and at the time of surgery in three cases. Pain, snapping, and subjective results were evaluated at least 12 months in the average (range 12~24). Results: All patients showed a hypertropic lateral synovial plica with local synovitis. Seven of them had an associated lesion of chondromalacia on radial head. One of them was associated with radiocapitellar arthritis and had a wrapping over the radial head. Six patients experienced improved posterolateral pain at the end of study (VAS<1). However, the other two patients had occasional pain with activity. One of them persisted with mechanical symptoms, which was treated with additional arthroscopic procedure. Conclusion: Synovial plica in elbow should be considered as an important entity of common elbow disease, especially when pain in the lateral aspect of the elbow with a snapping sensation during motion is featured in patients. The arthroscopic resection seems to be safe and efficient in the short and long term treatment of plica in the elbow joint.
Arthritis ; Arthroscopy ; Cartilage Diseases ; Diagnosis ; Elbow Joint ; Elbow* ; Female ; Head ; Humans ; Joints ; Sensation ; Synovitis

BACKGROUND: The purpose of our study was to evaluate the accuracy of reduction based on postoperative computed tomography (CT) images after arthroscopic stabilization using tightrope system for unstable distal clavicle fracture. METHODS: Twelve patients with distal clavicle fracture combined with coracoclavicular (CC) ligament injury (type II, V) who received arthroscopically assisted fixation using a flip button device were evaluated for accuracy of reduction using 3-dimensional postoperative CT scan by measuring the degree of distal clavicular angulation and clavicular shortening. RESULTS: Immediate postoperative plain radiograph confirmed restoration of the CC distance (CCD) in 10 patients. At final follow-up, the CCD remained reduced anatomically on plain radiographs in these patients. All patients showed excessive posterior angulation and shortening compared to the opposite side. The average Constant score recovered to 94.8 at final follow-up. CONCLUSIONS: Indirect reduction and arthroscopic subacromial approach with flip button fixation of unstable distal clavicle fractures demonstrated favorable clinical results despite unavoidable posterior angulation of distal clavicle and shortening the total length of clavicle.
Arthroscopy ; Clavicle ; Follow-Up Studies ; Humans ; Ligaments ; Tomography, X-Ray Computed

The congenital cystic adenomatoid malformation of the lung is an unusual pulmonary entity, and usuallysymptomatic in infancy with sign of resiratory distress. This abnormality consists of enlarged, multicystic lobewith smooth-walled cysts of variable sized, which can communicate with major bronchi through malformed air passagethat usually lacks in cartilage. Roentgenographic findings are three types. First type is multicystic patternshowing various sized of cysts and causing mediastinal shift with pulmonary herniation. Second type is dominantcystic pattern underlying multicystic lesion, Third type is solid homogenous mass. Prompt surgical resection ischoice of treatment. We recently experienced a case of congenital cystic adenomatoid malformation of the lung of27 day female in fant and report with reviwe of literatures.
Bronchi ; Cartilage ; Cystic Adenomatoid Malformation of Lung, Congenital ; Female ; Humans ; Lung

N,N-Diethylnitrosamine (DEN) has been proved to have carcinogenic potential in the initiation or promotion stage and the transformed cells proliferate to form preneoplastic nodules which are positive for placental form of glutathione S-transferase (GST-P). E-Cadherin, a member of the cadherin family, is expressed in epithelial cells. To evaluate the role of adhesion molecules (E-Cadherin, alpha-catenin, and beta-catenin), which have not been well understood in carcinogenesis, we investigated the changes of E-cadherin, alpha-Catenin and beta-Catenins by immunohistochemistry and immunoblotting in DEN-induced hepatocarcinogenesis of rat liver. In addition, the sequential analysis of histopathology and the expression of GST-P were also examined. Immunoreactive areas for GST-P were gradually increased from early period of carcinogenesis and strong GST-P positive foci were noted in various lesions, especially in the clear cell and eosinophilic cell nodules. Immunohistochemically, the E-Cadherin expression was increased in DEN-treated preneoplastic nodules in 4 and 10 weeks and hepatocellular carcinomas displayed relatively reduced expression compared with the hyperplastic nodules. But alpha- and beta-catenin expression was increased in hyperplastic nodules and hepatocellular carcinomas. Immunoblotting studies revealed that the level of alpha-catenin (cytosol and membranous fraction) was overexpressed in hyperplastic nodules as well as hepatocellular carcinomas, which showed markedly increased expression. The membranous fraction of beta-catenin was markedly increased in 10 weeks of DEN treatment and slightly reduced in hepatocellular carcinomas. These findings suggest that during DEN-induced hepatocarcinogenesis, the clear cell and eosinophilic cell nodules expressing GST-P in their cytoplasm are early transformed cell nodules. The altered expression of E-Cadherin and catenins is closely related with tumor propagation. Loss or reduced expression of E-cadherin may play a role in the progression of late hyperplastic nodule to hepatocellular carcinoma in DEN-induced rat hepato carcinogenesis.
alpha Catenin ; Animals ; beta Catenin ; Cadherins* ; Carcinogenesis ; Carcinoma, Hepatocellular ; Catenins* ; Cytoplasm ; Eosinophils ; Epithelial Cells ; Glutathione Transferase* ; Glutathione* ; Humans ; Immunoblotting ; Immunohistochemistry ; Liver* ; Rats*

BACKGROUND: Atracurium is a benzylisoquinolium nondepolarizing neuromuscular blocking drug. It releases histamine upon the rapid administration of more than 2 x ED95. Cisatracurium is about three to four times more potent than atracurium, less likely to release histamine, and has weaker cardiovascular or autonomic effects. Mivacurium releases histamine to about the same degree as atracurium at the same dose. This study was undertaken to reevaluate the experimental model for the evaluation of effects on the autonomic nervous system, and to determine the neuromuscular blocking profiles and the vagolytic effects of atracurium, cisatracurium and mivacurium in cats. METHODS: Cats, either sex, anesthetized with pentobarbital, were used. Neuromuscular blocking effects were assessed using the effects on the anterior tibialis muscle twitch evoked with supramaximal stimuli (0.2 ms-duration, 0.1 Hz). Inhibition of the parasympathetic nervous system was assessed in response to bradycardia to vagal nerve stimulation with ten-second trains of square-waves (0.5 ms-duration, 20 Hz). The dose-response curves for both neuromuscular blocking and vagolytic actions were determined for each animal. The dose-response curves were constructed in cumulative fashion. The response for vagal stimuli was measured two minute after each dosing. Vagal ID50 (The doses that produced 50% inhibition of the response to vagus nerve stimulation) were determined. RESULTS: NMB ED95 and NMB ED50, respectively, were 102.0 +/- 28.3 and 143.7 +/- 40.5 microgram/kg for atracurium, 81.4 +/- 13.3 and 110.7 +/- 18.8 microgram/kg for cisatracurium, and 56.8 +/- 17.4 and 74.2 +/- 25.0 microgram/kg for mivacurium. Vagal ID50 was 2,654 +/- 1,651 microgram/kg for atracurium, 655 +/- 389 microgram/kg for cisatracurium, and 606 +/- 182 microgram/kg for mivacurium. The vagal ID50/NMB ED95 and vagal ID50/NMB ED50 were 18.5 and 26.0 for atracurium, 5.9 and 8.1 for cisatracurium, and 8.2 and 10.7 for mivacurium. CONCLUSIONS: Atracurium has a wider margin of safety only for vagal stimulation as compared with cisatracurium and mivacurium. However, we couldn't exclude that either sympathetic stimulation or histamine release might contribute to heart rate.
Animals ; Atracurium* ; Autonomic Agents ; Autonomic Nervous System ; Bradycardia ; Cats* ; Heart Rate ; Histamine ; Histamine Release ; Models, Theoretical ; Neuromuscular Blockade* ; Parasympathetic Nervous System ; Pentobarbital ; Vagus Nerve ; Vagus Nerve Stimulation

Benign tumors of the mendible are uncommon lesions. That were classifed into odontogenic tumors and nonodontogenic tumors. Author reviewed the radiological evaluation and pathological microscopic finding from 33 benign tumors of the mandible that were comfirmed by the biopsy during last 10 years in Dental Clinics, Ewha Womans University Hospital and Seoul Natinal University Dental Hospital. Following results were obainend; 1.Benign tumors of the mandible were classified into odontogenic (66.7%) and non-odontogenic tumors (33%). 2. The range of the age distribution was between 6 years and 67 years old. The commonest age group was the second decade(39.4%). 3. There was no difference to sex distribution. 4. The most frequent locatio was the body of the mandible (42.4%). 5. Radiographic findings were relatively characteristic in odontogenic tumors rather thannon-odontogenic tumors. 1) Radiolucent cystic lesions-ameloblastoma, odontogneic myxoma, odontogneic fibroma,aneurysmal bone cyst and neurofibroma. 2) Radiopaque mass lesions-odontoma, cementoma and osteoma. 3) Mixed patterns-ossifying fibroma, cementifying fibroma, calcifying odontogenic epithelial tumor and hemangioma. It was concluded that the radiographic examination was of value to diagnose the benign tumos of tee mandible in symptomless patients.
Age Distribution ; Biopsy ; Bone Cysts ; Cementoma ; Dental Clinics ; Female ; Fibroma ; Hemangioma ; Humans ; Mandible ; Myxoma ; Neurofibroma ; Odontogenic Tumors ; Osteoma ; Seoul ; Sex Distribution

OBJECTIVE: To investigate the activities of upper trapezius and deltoid muscles in shoulder abduction in full can and empty can position in rotator cuff tear patients. METHOD: Twelve subjects with right rotator cuff tear patients participated in this study. Each subject performed scapular plane abduction with humeral external rotation (full can position) and with humeral internal rotation (empty can position). Electromyography (EMG) was recorded with surface electrodes at the both upper trapezius, anterior, lateral, and posterior deltoid muscles during shoulder abduction. The EMG activity of each muscle was normalized according to the highest EMG activity during a maximum manual muscle test for the corresponding muscle. RESULTS: Muscle activities of the lesion side's upper trapezius and lateral deltoid were significantly greater than those of the normal side in full can position. In empty can position, the activities of upper trapezius, anterior, and lateral deltoid increased in lesion side. In comparison between full can and empty can exercises, over 30degrees abduction arcs, empty can exercise showed increased muscle activities of upper trapezius and all deltoid muscle in lesion side. In contrast, anterior and lateral deltoid only showed increased in the muscle activities under empty can exercise in sound side. CONCLUSION: Rotator cuff tear is involved in changed the activities of upper trapezius and deltoid muscles. And these results suggested that in rotator cuff tear patients, the changed pattern of muscle contraction should be considered in shoulder exercise.
Anesthetics, Local ; Deltoid Muscle ; Electrodes ; Electromyography ; Exercise ; Humans ; Lidocaine ; Muscle Contraction ; Muscles ; Rotator Cuff ; Shoulder ; Tears

BACKGROUND: To determine the natural progression of conservatively treated rotator cuff tears, we evaluated changes in radiologic and clinical parameters in patients whose recalcitrant tears were neglected after conservative treatment. METHODS: A total of 73 patients with recalcitrant rotator cuff tears in spite of conservative treatment were included in this study. We measured changes in tear size and in the extent of fatty infiltration of the rotator cuff by comparing the initial and final follow-up magnetic resonance imagings (MRIs). To determine factors influencing the change in tear size, we collected the medical history of patients taken at the time of initial admission. RESULTS: The average follow-up period was 20.1 months, and the average increase in tear size across this period was 6.2 mm. In terms of steroid injection, we found that the increases in tear size of the steroid injection group (p=0.049) and of the sub-group that had received more than three steroid injections (p=0.010) were significantly greater than that of the non-steroid injection group. CONCLUSIONS: We found that the increase in cuff tear size was on average 6.2 mm across the follow-up period, indicating that neglecting cuff tears may cause them to progress into more severe tears. We also observed that a history of steroid injection might be a possible risk factor for a worse prognosis of cuff tears. Therefore, we suggest that patients with rotator cuff tears and a history of steroid injection are recommended aggressive modes of treatment such as surgery.
Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Prognosis ; Retrospective Studies* ; Risk Factors ; Rotator Cuff* ; Tears*

PURPOSE: To evaluate the clinical feature and the results of the treatment of Lisfranc joint fracture/dislocation with limited open reduction, pin fixation and Ilizarov external fixation. MATERIALS AND METHODS: From June 2001 to May 2003, six patients with Lisfranc fracture/dislocation were treated. The average periods of follow-up was 23 months. After limited open reduction on the second tarso-metatarsal joint, we performed pin fixation of the above joint. On the other Lisfranc joint fracture/dislocation, closed reduction and the application of Ilizarov external fixator was done. This rigid system produced the early partial weight bearing and joint motion of the injured foot and ankle joint. The parameters used were radiographic evaluation, patient's clinical assesment and the AOFAS midfoot score. RESULTS: We used the Myerson's criterier to evaluate the radiographic result. All cases could be achieved more than nearly anatomical reduction. Three cases of excellent and 3 cases of good result could be obtained in the evaluation of the patient's clinical assesment. The average AOFAS midfoot score was 87.2 (76~95) points. CONCLUSION: The treatment using Ilizarov external fixation on Lisfranc joint fracture/dislocation can be another useful method.
Ankle Joint ; Dislocations* ; Equidae ; External Fixators ; Follow-Up Studies ; Foot ; Humans ; Joints* ; Weight-Bearing