No abstract available.

No abstract available.

Residual adduction of the forefoot is recognized as common sequelae of treated clubfoot. The causes of residual forefoot adduction may be metatarsus varus, talonavicular subluxation and subluxation of the calcaneocuboid joint. But, less attention has been given to subluxation of the calcaneocuboid joint. The purpose of this study was to assess the correlation between subluxation of calcaneocuboid joint and residual forefoot adduction, and to suggest the guideline of treatment for subluxation of the calcaneocuboid joint. A retrospective analysis was done by the medical records and radiographs of 48 clubfeet (thirty-four patients) that had been treated with an operation (thirty-three feet) or conservative methods (fifteen feet) at the Kang-Nam St. Mary's Hospital, between 1990 and 1995. The severity of adduction of the forefoot was determined by the angle of talo-first metatarsal. Subluxation of the calcaneocuboid joint was measured by using a grading system. And then, the forefoot adduction was categorized to mild, moderate, and severe degree according to the talo-first metatarsal angle. The average length of follow-up was eighteen months. Of the 48 feet, seventeen had no subluxation of the calcaneocuboid joint (35.4%), twenty-seven Grade I subluxation (56.3%), and four Grade 3 subluxation (8.3%) on initial radiograph. On the final radiograph, twenty-five feet had a residual adduction of the forefoot. In reviewing the distribution of the residual forefoot adduction according to the initial grade of the calcaneocuboid joint subluxation, Grade 0 subluxation had 6 forefoot adduction (35.3%), Grade I subluxation had 15 forefoot adduction (55.6%), and Grade 3 subluxation had 4 forefoot adduction (100%). Grade II calcaneocuboid joint subluxation had two severe residual forefoot adduction deformities (2 out of 4 cases) and Grade I calcaneocuboid joint subluxation had one severe residual forefoot adduction deformity (1 out of 15 cases). But, there was no severe forefoot adduction deformity in Grade 0 calcaneocuboid joint subluxation. The average angle of talo-first metatarsal was decreased in Grade 0 and Grade I subluxation, whereas it was increased in Grade II subluxation. Conclusively, we believe that there is significant correlation between the severity of subluxation of calcaneocuboid joint and residual forefoot adduction, and that the patients who have a Grade II subluxation of calcaneocuboid joint need operative correction of the subluxation of the calcaneocuboid joint.
Clubfoot* ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Humans ; Joints* ; Medical Records ; Metatarsal Bones ; Metatarsus ; Retrospective Studies

BACKGROUND: Percutaneous transluminal coronary angioplasty(PTCA) is one of the most widely used therapeutic procedures in the treatment of patients with coronary artery disease. However, acute closure and late restenosis remain a major limitation of PTCA despite extensive efforts to prevent. Coronary artery stents have been proposed as a treatment modality for acute closure and restenosis. We evaluated the initial success rate, complications, the restenosis rate, and the clinical outcomes after coronary artery stenting. METHODS: We implanted 56 stents(Palmaz-Schatz(PS) stent : 38 ; #3.0-14, #3.5-7, #4.0-17, Gianturco-Roubin(GR) stent : 18 ; #2.5-4, #3.0-10, #3.5-1, #4.0-3) in 51 patients(male : 40, mean age : 58+/-1 year). The clinical characteristics of the subjects were unstable angina in 26(51%), stable angina in 2, and myocardial infarction in 23(45%) patients(acute : 18). Follow-up angiography was done at a mean duration of 5.4 month(1-12) after coronary stenting for 34 lesions(61%) of 30 patients. RESULTS: 1) The indications of stenting(n=56) were De novo in 33(59%), bailout procedure in 15(27%), suboptimal result after PTCA in 6, and restenosis after PTCA in 2 stents. The location of lesions were LAD in 24, RCA in 27, and circumflex artery in 5 lesions. Angiographic morphologic characteristics were type B in 38(BI : 3, B2 : 35) and type C in 18 lesions. 2) The angiographic and clinical success rate was 96%(54/56) and 94%(52/56). There were no significant difference in stent modality, lesion site and morphology, and indication of stent. 3) Procedural complications were 1 acute closure which was recanalized by emergency coronary artery bypass graft(CABG), 1 death with subacute closure, 2 dissection, and 5 hemorrhages requiring transfusion. 4) The overall restenosis rate was 26%(9/34). The restenosis rate was reduced significantly in PS stent[PS : 9%(2/22) vs GR : 58%(7/12), P < 0.05], > or =3.5mm of stent size[> or =3.5mm : 6%(1/18) vs 3.5mm : 50%(8/16), p < 0305], and high pressure ballooning group(poststenting adjunct balloon dilation pressure > 12atm) [High pressure(+) : 7%(1/14) vs High pressure(-) : 40%(8/20), p<0.05]. 5) The restenosis sites were managed with re-PTCA in 4, elective CABG in 1, and medical follow-up in 4 patients. CONCLUSION: Coronary stenting is an effective and safe procedure for the management of coronary artery disease. The PS stent and GR stent are considered as a safe means for bail-out, and the PS stent can reduces the restenosis rate especially.
Angina, Stable ; Angina, Unstable ; Angiography ; Arteries ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels* ; Emergencies ; Follow-Up Studies* ; Hemorrhage ; Humans ; Myocardial Infarction ; Stents*

BACKGROUND: The endothelium is an important regulator of vascular tone via release of relaxing and constricting substances. The regulatory effect of the endothelium has been shown to be impaired in atherosclerotic arteries in human and animal models of hypertension. But there are some debates on extent and developing time of endothelium dysfunction in patients with hypertension, and the determining factors for endothelium dysfunction also were not defined. The objects of this study are to determine whether endothelial function is impaired in coronary and peripheral arteries, and to investigate the predicting factors for endothelial dysfunction in patients with essential hypertension. METHODS: The study patients comprised 14 patients with essential hypertension(M : 7, Mean age : 50+/-2 year) and 6 normal control (M :2, Mean age : 45+/-4 year). We assessed the vasomotor response to acetylcholine and nitroglycerin by change of arterial diameter during the infusion of acetylcholine, from 10(-9M) to 10(-6M) in coronary artery and 7.5, 15, and 25ug/min in left superficial femoral artery, and on intracoronary injection of 200ug nitroglycerin after acetylcholine infusion. RESULTS: 1) There were no significant differences in sex, age, body mass index and ventricular mass index, except systolic(174+/-5 vs 118+/-7mmHg, p<0.001) and distolic blood pressure(106+/-5 vs 75+/-5mmHg,p<0.001) between patients with hypertension and normal control. 2) There were no significant differences in laboratory date of total cholesterol, HDL-cho-lesterol, lipoprotein(a), microaluminuria and von-Willebrand Factor but Fibrinogen level was raised significantly in patients with hypertension than normal control(299+/-26 vs 192+/-23ng/dl, p=0.04). 3) The vasoconstrictor response to acetylcholine, 10-8 to 10-6 M concentration, at proximal, mid, and distal left anterior descending coronary artery were increased significantly in hypertensive patients than normal control(p<0.05). At rest superficial femoral artery, the vasodilator response to acetylcholine, only 25ug/min, was decreased in patients with hypertension(p<0.05). There was no signficant difference in the vasodilator response to nitroglycerin at coronary artery between two groups but in superficial femoral artery, the vasodilator response to nitroglycerin was decreased significantly in hypertensive patients(p<0.05). CONCLUSIONS: The results of this study suggest that endothelium dependent vascular relaxation is impaired in both coronary and superificial femoral artery and it remained to be investigated the predicting factors for endothelial dysfunction in patients with essential hypertension.
Acetylcholine ; Arteries ; Body Mass Index ; Cholesterol ; Coronary Vessels ; Endothelium ; Femoral Artery ; Fibrinogen ; Humans ; Hypertension* ; Lipoprotein(a) ; Models, Animal ; Nitroglycerin ; Relaxation

No abstract available.
Hyperostosis, Cortical, Congenital*

Bony defect is one of the most common problems in craniomaxillofacial surgery. Although aurogenous bone graft is the best choice for the treatment of bone defect, it provides many problems such as donor site morbidity, irregular absorption, and limited amount of harvest. To overcome the shortcomings of autogenous bone graft many bone substitutes have been introduced. The ideal bone substitution is to have characteristics such as cheap, easy to obtain, rapid fusion to recipient bone, hard structure, long maintenance of shape and volume, low infection rate, and low exposure rate. Among those bone substitutes which have been widely used we chose lyophilized cartilage allograft because of low antigenecity, low resorption rate, easiness of carving and ling term preservation. From August 1993 to August 1997, 66 patients had been performed craniomaxillofacial reconstruction with lyophilized cartilage allograft. Orbital wall reconstruction and correction of enophthalmos were 24, correction of cleft lip and nose deformity were 19, temporal augmentations were 7, and others 16. Complications such as infection, exposure were not common. And partially removed cartilage was proved some calcification. Radiologic follow-up presented well positioned lyophilized cartilage allograft. Two radiologic works revealed haziness of bone density at the site of cartilage allograft. This suggests the ossification of lyophilized cartilage allograft. Together with liw infection rate, low exposure rate, and good framework for osteoconduction, lyophilized cartilage allograft are regarded as one of the good bone substitutes.
Absorption ; Allografts* ; Bone Density ; Bone Regeneration ; Bone Substitutes ; Cartilage* ; Cleft Lip ; Congenital Abnormalities ; Enophthalmos ; Follow-Up Studies ; Humans ; Nose ; Orbit ; Tissue Donors ; Transplants

Spinal cord tumors usually present themselves with severe pain without neurologic deficits during early stages. Cervical or thoracic spinal tumors can evoke anterior neck pain or chest pain without neurologic symptoms. As a result, when chest pain or anterior neck pain occurs initially, many physicians think its origin is a cardiac disorder such as angina. Eventually, during cardiac evaluation and treatment, myelopathy or radiculopathy develops to reveal spinal cord tumor. Even though it is rare, when anterior neck or chest pain is the presenting complaint, the possibility of spinal cord tumors should be considered. We report a case of spinal cord tumor with initial presentations of anginal chest pain and electrocardiographic myocardial ischemic changes (ST segment depression and T-wave inversion) in a 45 year old male patient who had no history of hypertension. It was later discovered that the cause was due to an A-V malformation.
Chest Pain* ; Depression ; Electrocardiography ; Humans ; Hypertension ; Male ; Neck ; Neck Pain ; Neurologic Manifestations ; Radiculopathy ; Spinal Cord Diseases ; Spinal Cord Neoplasms*

No abstract available.
Shoulder*

No abstract available.
Achilles Tendon*