Topographical measurement of the attachments of the central band of the interosseous membrane on interosseous crests of the radius and ulna

To suggest a reasonable isometric point based on the anatomical consistency of interosseous membrane (IOM) attachment in association with topographic characteristics of the interosseous crests, the footprints of the central band (CB) of the IOM on the radial and ulnar interosseous crests (RIC and UIC) were measured. Methods: We measured the distance from the CB footprints from each apex of both interosseous crests in 14 cadavers and the angles between the forearm axis of rotation (AOR) and the distal slopes of the RIC and UIC in 33 volunteers. Results: The CB footprints lay on the downslope of both interosseous crests with its upper margin on average 3-mm proximal from the RIC’s apex consistently in the radial length, showing normality (p>0.05), and on average 16-mm distal from the UIC’s apex on the ulna without satisfying normality (p0.05), and there was no side-to-side difference in both forearms (p<0.05). Conclusions: The CB attached to the downslope just distal to the RIC’s apex constrains the radius to the UIC that coincides with the AOR of the forearm circumduction, maintaining itself both isometrically and isotonically.

Clinical Relevance of the Femoral Intercondylar Notch Width and the Posterior Tibial Slope for ACL Rupture

PURPOSE: The purpose of this study was to evaluate the relationship between the femoral intercondylar notch width (ICW), the posterior tibial slope angle (PTS), rupture of the anterior cruciate ligament (ACL) and the ruptured site. MATERIALS AND METHODS: We retrospectively reviewed 105 cases of ruptured ACL (105 patients), and 91 cases of intact ACL (91 patients). The ICW and PTS were measured from the plain knee radiographs. The ratio of the ICW and the femoral intercondylar notch height (ICH) was also measured. As for the site of ACL rupture, the patients with a ruptured ACL were divided into 3 groups (group 1: femoral attach site, 2: mid-substance, 3: tibial attach site), and the correlations between the ICW and the PTS of each group were analyzed. RESULTS: The mean ICW of the ACL ruptured group was 15.51+/-4.30 mm (95% confidence interval: 15.48~15.53), that of the ACL intact group was 24.49+/-3.86 mm (24.47~24.52), and the mean PTS of the ruptured ACL group was 7.68+/-3.78degrees (7.65~7.70) and that of the intact ACL group was 6.12+/-3.85degrees (6.10~6.13). A narrow ICW was a significant risk factors for ACL rupture (odds ratio=0.661 [0.602~0.720], p<0.01). But we did not get any statistically significant results for the increase PTS (odds ratio=1.073 [1.062~1.134], p=0.197). According to the ruptured site, the analysis of variance of the ICW and PTS had no significant correlation. CONCLUSION: A narrow ICW is a significant risk factor for ACL rupture.

Short-Term Revisits to Emergency Medical Center

PURPOSE: More than a few patients revisit Emergency Departments (EDs) with the same complaint. It is generally assumed that a revisit within a short period happens due to an inadequate evaluation during the previous visit, which creates a quality problem in emergency care. The purpose of this study is to analyze patient's revisiting the ED within 48 hours after being discharged and to use this information as a tool for quality assurance in the ED. METHODS: We carried out a chart review of patients who have revisited the ED within 48 hours between March 1, 2000 and February 28, 2002. We divided the patients into three groups according to their age. Disease variables were analyzed according to the age groups and admission rates. RESULTS: A total of 78,182 patients visited the ED during the period. Of these, 66,974 patients were discharged from the ED and the others were admitted. Of these discharged, 1,012 patients revisited the ED with the same complaints within 48 hours. The common disease or complaint of the short-term revisiting patients in order were acute abdomen, acute pharyngotonsilitis, ureter stones, respiratory problems, etc. Admissions of revisiting patients were due to acute abdomen, acute gastroenteritis, acute appendicitis, intussucception, panperitonitis, ileus, etc. There were significantly different admission rates according to initial symptoms, diseases and the age group of the revisiting patient. CONCLUSION: For quality improvement of emergency care, we need to standardize a management protocol, and the guidance for patient care provided in this paper might be recommended. A short -stay unit in the ED may be useful in some cases.

Partial Liver Resection in Hepatolithiasis

Patients with hepatolithiasis have complicated clinical features. Many patients have bilobar involvement and biliary strictures at multiple levels are frequently observed. Treatment of hepatolithiasis should be individualized according to the underlying condition. We reviewed the therapeutic results for hepatolithiasis in 81 patients. Forty-three patients (53.1%) underwent partial resection of the liver, and 38 received non-resectional treatment. Abdominal pain in the right upper quadrant was the most common symptom and history of cholangitis was confirmed in 24 patients (29.6%). Intrahepatic stones were located in the left side of the liver in 40 patients, and 31 patients had stones in both sides of the liver. Left lateral segmentectomy was the most commonly used operation (n=31); other types of hepatic resection were segmentectomy of the right lobe (n=8), left lobectomy (n=3), and right lobectomy (n=1). For the drainage of the biliary outflow, we carried out hepaticojejunostomy with subcutaneous jejunostomy in 14 patients and choledochoduodenostomy in 8 patients. All patients underwent cholangiography and percutaneous choledochoscopic examination post-operatively to confirm the absence of residual stones. Residual stones were detected in 8 patients (6 with biliary drainage alone, 2 with hepatic resection). There was no operation-related mortality. The mean value of the operative time was longer in the patients receiving hepatic resection (216 min. versus 187 min.). There were no significant differences in terms of post-operative complications (6 with biliary drainage alone, 8 with hepatic resection) or hospital stay between the patients who received hepatic resection and those who received non-resectional treatment. In conclusion, partial resection of a diseased liver is an effective treatment for hepatolithiasis in selected patients and does not increase peri-operative morbidities.

Clinical Features and Prognosis of Leptomeningeal Carcinomatosis

This study was done in 8 cases of leptomeningeal carcinomatosis which were confirmed by positive C.S.F. cytology at Yonsei University Medical Center from August 1987 to September 1989. We found following results through investigating the clinical features and prognosis of leptomeningeal carcinomatosis. 1. Primary site was stomach in 4 patients, lung in 3 patients, rectum in 1 patient 2. Positive Cytology was 6 patients at initial CSF study, and 2 patients at second CSF study. 3. Median diagnostic interval from diagnosis of primary tumor was 76 days. 4. Frequent neurologic symptoms were headache, nausia and vomiting, and frequent neurologic signs were nuchal rigidity and weakness of lower extremities at this study. 5. Median survival interval from diagnosis of leptomeningeal carcinomatosis was 7 days without treatment, 31 days (15 days-45 days) with radiation therapy, and over 115 days (80 days-over 156 days) with radiation therapy and intrathecal MTX. Two patients were living when this study was completed.