The aim of this study was to follow patients in whom preoperative MRI demonstrated grade-3 lesions in the medial meniscus but no visible tears at arthroscopic ACL reconstruction, and to ascertain whether these meniscal lesions would progress to definite tears after reconstruction. The Study population consisted of 19 patients with a mean age of 23.2 years. Intraoperative arthroscopy showed normal appearance in 16 of 19 menisci and mild degree superficial legions in 3 menisci. None of the patients had any special treatment for the menisci at surgery. As controls, 39 patients who showed no tears on MRI and arthroscopy were studied. All MR studies were performed on a 0.5 T MR unit with field echo pulse sequences. A slice thickness of 1.5 mm was used with no interslice gap. Grade-3 legions progressed to definite tears in 8 of the 19 studied patients (42.1%) 12 to 33 months after ACL reconstruction. The Remaining 11 patients showed only symptoms or signs suggesting meniscal tears during a mean follow-up of 26.1 months. In the controls, medial meniscal tears occurred in 2 of the 39 patients (5.1%) 15 to 18 months after reconstruction. The studied patients were divided into a tear group (n=8) and a no-tear group (n=11). When the number of slices with grade-3 lesions was compared between the 2 groups, the mean slice number in the tear group (5.8 slices) was significantly greater than that in the no-tear group (3.1 slices) (P<0.05). These results suggest that even if no visible tear is found at surgery, patients in whom grade-3 lesions are identified in many slices have a high risk of developing definite tears after ACL reconstruction.

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In this study, we evaluated the relationship between beat-to-beat changes in high frequency components of the QRS complex and ventricular arrhythmias by using a newly developed event-related (ER) signal averaging technique. The study involved 82 patients with premature ventricular contractions (PVC), 56 of whom, including 16 with ventricular tachycardia (VT), were enrolled in Analysis I. In Analysis I, averaged sinus beats were classified into three patterns: 1) the sinus beat immediately before PVC (BEF) ; 2) that immediately after PVC (AFT) ; and 3) all sinus beats (ALL). Analysis II covered the remaining 26 patients, and involved five modes of event-related signal averaging, using: 1) the second beat preceding PVC (2-B) ; 2) the beat immediately preceding PVC (1-B) ; 3) the beat immediately after PVC (1-A) ; 4) the second beat after PVC (2-A) ; and 5) the beat isolated (ISO) from PVC. The filtered QRS duration (F-QRS) and the integral voltage of the terminal 40 msec (RMS 40-I) were measured using these averaging patterns. F-QRS in the VT group was longer than that in the non-VT group, but RMS 40-I was shorter. The F-QRS of BEF (1-B) was significantly longer than that of AFT (1-A). The transient difference in the F-QRS was observed in both VT and non-VT groups. This difference was almost eliminated at AFT (1-A) in the non-VT group, but was stable at AFT (1-A) in the VT group. Simultaneousely, RMS 40-I in BEF was significantly shorter than that in AFT. This transient decrease of RMS 40-I was observed in both VT and non-VT groups. Although RMS 40-I after this decrease showed a return almost to the control level at AFT in the non-VT group, it tended to remain even at AFT in the VT group.
The sudden prolongation of F-QRS that occurred with the RMS 40-I decrease in BEF was related to the appearance of PVCs.
We attributed the fact that these changes in F-QRS and RMS 40-I were observed even at AFT in the VT group to electrophysiologically preferable conditions for reentry.

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To evaluate the relationship among the extracellular matrix (ECM) and mitogen-activated protein kinase (MAPK) family for the vascular damages in hyperglycemia, we injected Mongolian gerbils intravenously with 150 mg/kg streptozotocin (STZ) and observed over the next one year the resulting aortic changes by immunohistochemical techniques.
After STZ treatment, hyperglycemia was confirmed. At 4 weeks after STZ administration morphological observation revealed increased stromal components among the vascular smooth muscle cells (SMCs). Immunohistochemically, extracellular matrices such as fibronectin and laminin were localized in the aorta at 4 weeks and one year after STZ administration. The reaction products of MAPK in vascular SMCs were more increased at one year than at 4 weeks after STZ administration.
After STZ administration, the increase of ECM and MAPK was observed in the aorta, which suggests these factors play important roles in the pathogenesis of macrovasculopathy in diabetes mellitus.

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To evaluate the efficacy of MRI in assessing anterior cruciate ligament (ACL) reconstruction graft integrity, we compared MRI findings with arthroscopic findings in 52 patients who had undergone arthroscopically assisted ACL reconstruction using semitendinosus and gracilis tendons augmented by woven polyester. MRI and arthroscopy were carried out 12 months after the operation. The MR appearance of ACL grafts was categorized into 3 types by signal intensity and continuity of the ligament according to Rak's method: 1. well-defined type: the graft was visualized as a smoothly continuous band with low signal over the entire course; 2. intermediate type: signal intensity increased and a low-signal band was visualized only in part of the graft; 3. indiscernible type: the graft was not identified through the joint cavity due to markedly increased signal intensity. When the MR appearance of intermediate or indiscernible types was defined as torn, the grafts were presumed to be torn in 9 patients whose arthroscopic findings were 7 intact and 2 torn grafts. All cases with intact MRI findings were intact on arthroscopic examination. Thus, the sensitivity, specificity and accuracy of MRI as an evaluative tool for ACL graft tears were 100%, 86% and 86.5%, respectively.

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We investigated the surgical results of lumbar disc herniation in the elderly. Ten elderly patients underwent surgical treatment between 1990 and 1999. There were 7 males and 3 females with a mean age of 68.2 years (range: 60∼85 years). Thirteen patients in their 20s and 30s were used as a control. Preoperatively, severe leg pain and gait disturbance, and higher rates of negative straight leg-raising were shown in the elderly group. Higher levels of herniation and higher graded disc degeneration were shown compared with the young. The mean total of the Japanese Orthopedic Association score in the elderly group improved from 5.1 points to 13.1 points postoperatively, and that in the young group improved from 6.9 points to 14.5 points. The recovery rate was 82.6% in the elderly group and 94.3% in the young group. Postoperatively, the recovery of gait disturbance in the elderly group tended to be poor compared with the young group. The elderly patients would not tolerate bed rest and would often do poorly if kept recumbent and in pain for long periods of time. Satisfactory results are being sought with regard to the operative management of lumbar disc herniation in the elderly.

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We present here a case of massive subchorionic hematoma complicated by intrauterine growth retardation and oligohydramnios diagnosed at 22 weeks' gestation. The patient was managed with the following medications: (1) tocolysis with ritodrine infusion, (2) 10%maltose infusion therapy (1500mL/day), (3) antibiotic infusion (cefotaxim sodium, 2 g/day×7) and (4) kampo therapy with Sairei-to until delivery. At 33 weeks and 0 days' gestation, a female baby weighing 1,342 g was delivered without complication by caesarean section. During surgery, an escape of about 500∼600 g of dark brown blood with no clots was noted from the subchorionic space of the placenta. Examination of the placenta showed a large fibrosis with well-defined margins on the fetal surface.

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The spontaneous disappearance of a hepatic cyst is described. A 62-year-old woman presented with symptoms of general fatigue in August 1992. Her past medical history was significant for chronic hepatitis, which was diagnosed in 1990 but not treated. Initial laboratory tests revealed mild liver dysfunction with a positive serologic test for hepatitis C. In August 1992, ultrasonography and computed tomography disclosed a cystic lesion along the middle hepatic vein in the right anterior segment of the liver, which was 40 mm in diameter. Repeat radiologic studies in June 1994 demonstrated that the size of the cyst was unchanged. In May 1995, the cyst was only 25 mm in diameter, and it continued to decrease in size thereafter, to 10 mm in September 1995 and 7 mm in September 1996. No hepatic cyst was visualized in December 1996, though the region in which the cyst existed was hyperechoic. Laboratory data were essentially unchanged from August 1992 to December 1996. Clinically the patient remained asymptomatic.

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A 69-year-old type 2 diabetic man was admitted due to diabetic gangrane. He had a history of subtotal gastrectomy. During hospitalization, he was treated with regular insulin and 300 mg/day of acarbose. He developed a low grade fever, cough and nasal discharge, and was given a compound "cold" remedy with anticholenergic properties. The next day, he suffered from a paralytic ileus. Oral intake and acarbose were withheld and the ileus spontaneously resolved after 2 days. These finding indicate the possibility that the ileus was triggered by drugs with anticholinergic properties in this elderly diabetic patient treated with α-glucosidase inhibitors.

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