Depiction of the Periosteum Using Ultrashort Echo Time Pulse Sequence with Three-Dimensional Cone Trajectory and Histologic Correlation in a Porcine Model

Objective@#To evaluate the signal intensity of the periosteum using ultrashort echo time pulse sequence with threedimensional cone trajectory (3D UTE) with or without fat suppression (FS) to distinguish from artifacts in porcine tibias. @*Materials and Methods@#The periosteum and overlying soft tissue of three porcine lower legs were partially peeled away from the tibial cortex. Another porcine tibia was prepared as three segments: with an intact periosteum outer and inner layer, with an intact periosteum inner layer, and without periosteum. Axial T1 weighted sequence (T1 WI) and 3D UTE (FS) were performed. Another porcine tibia without periosteum was prepared and subjected to 3D UTE (FS) and T1 WI twice, with positional changes. Two radiologists analyzed images to reach a consensus. @*Results@#The three periosteal tissues that were partially peeled away from the cortex showed a high signal in 3D UTE (FS) and low signal on T1 WI. 3D UTE (FS) showed a high signal around the cortical surface with an intact outer and inner periosteum, and subtle high signals, mainly around the upper cortical surfaces with the inner layer of the periosteum and without periosteum. T1 WI showed no signal around the cortical surfaces, regardless of the periosteum state. The porcine tibia without periosteum showed changes in the high signal area around the cortical surface as the position changed in 3D UTE (FS). No signal was detected around the cortical surface in T1 WI, regardless of the position change. @*Conclusion@#The periosteum showed a high signal in 3D UTE and 3D UTE FS that overlapped with artifacts around the cortical bone.

Depiction of the Periosteum Using Ultrashort Echo Time Pulse Sequence with Three-Dimensional Cone Trajectory and Histologic Correlation in a Porcine Model

Objective@#To evaluate the signal intensity of the periosteum using ultrashort echo time pulse sequence with threedimensional cone trajectory (3D UTE) with or without fat suppression (FS) to distinguish from artifacts in porcine tibias. @*Materials and Methods@#The periosteum and overlying soft tissue of three porcine lower legs were partially peeled away from the tibial cortex. Another porcine tibia was prepared as three segments: with an intact periosteum outer and inner layer, with an intact periosteum inner layer, and without periosteum. Axial T1 weighted sequence (T1 WI) and 3D UTE (FS) were performed. Another porcine tibia without periosteum was prepared and subjected to 3D UTE (FS) and T1 WI twice, with positional changes. Two radiologists analyzed images to reach a consensus. @*Results@#The three periosteal tissues that were partially peeled away from the cortex showed a high signal in 3D UTE (FS) and low signal on T1 WI. 3D UTE (FS) showed a high signal around the cortical surface with an intact outer and inner periosteum, and subtle high signals, mainly around the upper cortical surfaces with the inner layer of the periosteum and without periosteum. T1 WI showed no signal around the cortical surfaces, regardless of the periosteum state. The porcine tibia without periosteum showed changes in the high signal area around the cortical surface as the position changed in 3D UTE (FS). No signal was detected around the cortical surface in T1 WI, regardless of the position change. @*Conclusion@#The periosteum showed a high signal in 3D UTE and 3D UTE FS that overlapped with artifacts around the cortical bone.

Rapidly Growing Anaplastic Ganglioglioma Mimicking Brain Metastasis in a Middle-Aged Woman: A Case Report

Anaplastic gangliogliomas (AGGs), the malignant counterpart of gangliogliomas, are classified as grade III tumors by the World Health Organization. Although, the clinical course and optimal treatment of AGGs are not well understood, they often result in worse local control rate and shorter survival. The authors describe the magnetic resonance imaging findings of a middle-aged woman with supratentorial AGG, that manifested as a rapidly growing cystic mass which mimicked metastasis. The authors suggest that AGG may be considered as a possible diagnosis for a rapidly growing peripheral enhancing mass in the brain, especially when it is superficially located.

A Consideration of Breast Imagery in Art as Depicted through Western Painting

The aim of this study is to consider breast imagery in art as depicted through western painting. Twenty western art paintings were collated. Most of the sample paintings were created from the mid-nineteenth century to the late twentieth century and some are from the Renaissance period. Ten anthropometric items were used to measure 15 distances between two landmarks and 3 angles between three points. The distance from the nipple to the sternal notch and to the midclavicular point was the same and they were 0.46 of the distance from the sternal notch to the umbilicus. The shape of the projection of the breast was almost an isosceles triangle and the altitude of the triangle was at a proportion of 0.45 of the bottom length and 0.16 of the distance from the sternal notch to the umbilicus. The distance between the lateral ends of the breasts was 2.14 times the facial width and the distance between nipples was 1.36 times the facial width. Proportions from works of art are more ideal and attractive than clinically measured proportions. The desirable ratios measured from historical paintings might be useful in planning breast surgeries.

Lumbar Lordosis Restoration with an Eight Degree Cage in Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to determine how much lumbar lordosis is restored with an eight degree cage in posterior lumbar interbody fusion (PLIF) for degenerative lumbar spinal disease. MATERIALS AND METHODS: A total of 61 patients who underwent PLIF using a metal cage with an eight degree lordotic angle were evaluated. Cases with complications such as subsidence of the cage or instrument failure were excluded from this study. Lumbar lordosis, segmental lordosis, disc height, and bony union were analyzed on the patients' radiographs. RESULTS: Cages were inserted at L3-4 in 17 patients, L4-5 in 54 patients, and L5-S1 in 20 patients. The number of fused level was 1 segment in 32 patients, 2 segments in 27 patients, and 3 segments in 2 patients. The lumbar lordosis was 33.6degrees before surgery, improved to 37.6degrees after surgery, and then was changed to 37.0degrees at the final follow-up. Segmental lordosis at which the cage was inserted was restored after surgery at L4-5 and L5-S1. Disc height was improved with surgery as well. Satisfactory bony fusion was achieved in 95% of the patients. CONCLUSION: PLIF using an eight degree lordotic cage for degenerative spinal disease resulted in restoration of lumbar lordosis and segmental lordosis, although these angles showed some loss of correction after surgery.

Functional Outcome of Bioabsorbable Suture Anchor and Metal Screw Fixation on Tibial Side for Anterior Cruciate Ligament Reconstruction / 대한스포츠의학회지

The aim of this study was to evaluate the postoperative outcomes of anterior cruciate ligament (ACL) reconstructionuction using 2 additional fixation technique on tibial side. Between October 2008 and February 2012, sixty consecutive patients who underwent ACL reconstruction with allograft for ACL injuries were retrospectively enrolled. All patients were reconstructed with fresh frozen achilles tendon or posterior tibialis tendon allograft. Fixation on tibial side with bioabsorbable suture anchor (BSA) was in 30 patients (group A) and metal screw fixation was in 30 patients (group B). The data was collected at preoperatively and at least 1 years postoperatively, which included KT-2000 arthrometer objectively, and Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) scores subjectively. At the final follow up, the KT-2000 arthrometer improved significantly with an average of 3.28 mm anterior translation in the group A, 3.56 mm in group B. The preoperative mean Lysholm, Tegner and IKDC score was 46.14, 4.86, 63.17 in the group A, and 45.30, 4.40, 54.07 in the group B. The postoperative mean Lysholm, Tegner and IKDC score was 83.80, 8.14, 75.57 in the group A, and 88.75, 7.62, 65.10 in the group B. All functional outcomes were improved significantly (p=0.004) in both groups, but no differences were noted between the 2 groups (p>0.05). Both additional fixation techniques using BSA or metal screw fixation on tibial side in ACL reconstruction improved functional outcomes significantly. BSA technique seems to provide adequate strength suitable for early rehabilitation after ACL reconstruction.

Comparison of Bioabsorbable Suture Anchor Fixation on the Tibial Side for Anterior Cruciate Ligament Reconstruction Using Free Soft Tissue Graft: Experimental Laboratory Study on Porcine Bone

PURPOSE: The use of graft tissue fixation using bioabsorbable interference screws (BISs) in anterior cruciate ligament (ACL) reconstruction offers various advantages, but limited pullout strength. Therefore, additional tibial fixation is essential for aggressive rehabilitation. We hypothesized that additional graft tissue fixation using bioabsorbable suture anchors (BSA) would provide sufficient pull-out strength. MATERIALS AND METHODS: Twenty four fresh frozen porcine distal femur and patellar tendon preparations were used. All specimens were divided into three groups based on additional fixation methods: A, isolated BIS; B, BIS and BSA; and C, BIS and post cortical screw. Tensile testing was carried out under an axial load. Ultimate failure load and ultimate failure load after cyclic loading were recorded. RESULTS: The ultimate failure loads after load to failure testing were 166.8 N in group A, 536.4 N in group B, and 438 N in group C; meanwhile, the ultimate failure loads after load to failure testing with cyclic loading were 140 N in group A, 466.5 N in group B, and 400 N in group C. Stiffness after load to failure testing was 16.5 N/mm in group A, 33.5 N/mm in group B, and 40 N/mm in group C. An additional BSA fixation resulted in a significantly higher ultimate failure load and stiffness than isolated BIS fixation, similar to post screw fixation. CONCLUSION: Additional fixation using a BSA provided sufficient pullout strength for ACL reconstruction. The ultimate failure load of the BSA technique was similar to that of post cortical screws.

A Retrospective Comparative Study of Internal Fixation with Reconstruction Plate Versus Anatomical Locking Compression Plate in Displaced Intercondylar Fractures of Humerus

PURPOSE: To analyze the clinical result of a conventional reconstruction plate (CRP) fixation and locking compressive plate (LCP) fixation on the surgical treatment of an adult's displaced intercondylar fracture of humerus. MATERIALS AND METHODS: A total of 40 patients enrolled in the study were treated between August 2002 and May 2012. Fixation with a CRP was performed in 20 patients (group A) and anatomical locking compression plate fixation was performed in 20 patients (group B). The clinical and functional evaluation was performed according to the Mayo elbow performance score and Cassebaum classification of elbow range of motion (ROM), disabilities of the arm, shoulder and hand score. RESULTS: The Mayo elbow functional evaluation scores, eight cases were excellent, 10 cases were good, and two cases were fair in group A, and 12 cases were excellent, seven cases good, and one case fair in group B; both groups showed satisfactory results. The durations of attaining 90 to 120 degrees of the ROM of joints postoperatively were 8.3 days on average (6 to 15 days) in group A and 5.5 days on average (5 to 9 days) in group B, demonstrating a significant difference between the two groups (p=0.04). Although the correlations of clinical results according to the difference of bone mineral densities (BMDs) were not statistically significant between the two groups (p=0.35), loss of fixation occurred due to loosening of screws in two patients with low BMDs in whose operations reconstruction plates were used. CONCLUSION: The use of locking compressive plate on the surgical treatment of an diaplaced intercondylar fracture of humerus have a good clinical results because that permits early rehabilitation through good fixation and reduces the complications such as loosening of screws.

Tarsal Tunnel Syndrome associated with Os Sustentaculi (A Case Report) / 대한족부족관절학회지

Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve or one of its branches within the tarsal tunnel, and is often caused by ganglia, lipoma, accessory muscles, varicosities, neural tumours, trauma and systemic diseases. We have successfully treated a patient with tarsal tunnel syndrome which was associated with os sustentaculi.

Telomerase Expression in Colorectal Tubular Adenoma Determined by Immunohistochemical Staining / 대한소화기학회지

BACKGROUND/AIMS: Telomeres are simple repeat elements located at each chromosome end of eukaryotic cells. The main function of telomeres is to cap the chromosome end and protect it from enzymatic attack. Telomerase that facilitates the synthesis of telomere has been detected in not only cancer but also precancerous lesion. In this study, we compared the telomerase expression between low grade and high grade colorectal tubular adenoma. METHODS: Among thissues from forty eight patients with colorectal tubular adenoma (23 low grade and 25 high grade colorectal dysplasia), telomerase expressions were evaluated by immunohistochemical staining. RESULTS: We classified 48 patients into two groups by the extent of nuclei staining pattern. High telomerase expression was a group which showed staining nucleus pattern above 50% in tubular adenoma. Low telomerase expression was a group which showed staining pattern nucleus below 50%. Twelve in 25 high grade colorectal dysplasia showed high telomerase expression (48%). Only one in 23 low grade colorectal dysplasia showed high telomerase expression (4%). Telomerase expression was much higher in the tissues from the patients with high grade than in those with low grade colorectal dysplasia (p<0.05). CONCLUSIONS: Activation of telomerase may be related to the malignant potential in colorectal epithelial cells. Further studies are needed to define the role of telomerase in colorectal tumorigenesis.