Rheumatoid arthritis (RA) is a systemic disease with medication as the treatment of choice. However, surgical treatment is recommended when no improvement is noted despite aggressive conservative treatment. Synovectomy provides desirable outcomes for RA patients in the early stage with a glenohumeral joint of Larsen grade II or less; conversely, arthroplasty is recommended for patients with a glenohumeral joint of grade III or higher. RA patients often have attenuation and dysfunction of the rotator cuff, and reverse shoulder arthroplasty has been proven to provide favorable outcomes in some patients. RA is often complicated with osteoporosis and bony deformity; therefore, close attention is necessary to prevent fractures during shoulder arthroplasty.
Arthritis, Rheumatoid ; Arthroplasty ; Congenital Abnormalities ; Humans ; Osteoporosis ; Rotator Cuff ; Shoulder Joint* ; Shoulder*

No abstract available in English.

Periprosthetic fracture after total elbow replacement surgery is a difficult complication to manage, especially when it comes together with implant loosening. If stem revision and internal fixation of the periprosthetic fracture are performed simultaneously, this would be a very challenging procedure. Most of total elbow replacement implants are cemented type. Cement usage at periprosthetic fracture site may interfere healing of fractured site. Authors underwent internal fixation with use of locking plate and cerclage wire for periprosthetic fracture, allogenous fibular strut bone inserted into the humerus intramedullary canal allowing the fractured site to be more stable without cement usage. At 10-month follow-up, the complete union and good clinical outcome was achieved. We present a novel technique for treating periprosthetic fracture with implant loosening after total elbow replacement surgery, using intramedullary allogenous fibula strut bone graft.

Under the general anesthesia the effect of topical anesthesia on the incidence of oculocardiac reflex was investigated by preoperative instillation of 0.5% tetracaine into the 48 eyes during horizontal strabismus muscle surgery. In all cases, recession was done first. The results were as followings: 1. The incidences of oculocardiac reflex in treated and control group were 33% and 71% respectively and the difference was statistically significant(p<0.025). 2. The reduction in the incidence of oculocardiac reflex was noted both in recession and resection. But there was no statistically significant difference between treated group and control group in resection. 3. The incidence of oculocardiac reflex was not related with age, sex, type of strabismus, kind of muscles and type of surgery.
Anesthesia* ; Anesthesia, General ; Incidence ; Muscles ; Reflex, Oculocardiac* ; Strabismus ; Tetracaine

PURPOSE: This study reported the clinical results of partial fasciectomy on Dupuytren's contracture and evaluated the factors associated with progression. MATERIALS AND METHODS: A retrospective analysis was performed on 32 hands in 28 patients who had subtotal fasciectomy for Dupuytren's contracture from 1992 to 2007. We evaluated complications and clinical results by Honner's classification. Through telephone interviews, we checked the progression of contracture including recurrence and extension in twenty three patients with a mean postoperative period of 5.9 years. The relationship between progression and several factors were analyzed using statistical analyses. RESULTS: Clinical results were excellent in 13 cases, good in 12, fair in 4, and poor in 3. Progression rate was 48% (11patients). It occurred at operated fingers in 3 cases, non-operated fingers in 7 cases and both in 1 case. Progression was correlated with smoking and was more common in patients with bilateral disease, but not with alcohol, age or severity. Complications occurred in 4 patients (1 complex regional pain syndrome, 1 nerve injury and 2 delayed wound healing). CONCLUSIONS: Partial fasciectomy is a suitable method for Dupuytren's contracture. Complication rate is not high if careful operation is performed. However, progression is common in patients with bilateral disease or smoking habitus.
Contracture ; Dupuytren Contracture ; Fingers ; Hand ; Humans ; Interviews as Topic ; Postoperative Period ; Recurrence ; Retrospective Studies ; Smoke ; Smoking

No abstract available.
Anemia, Aplastic* ; Bone Marrow Transplantation* ; Bone Marrow* ; Immunomodulation*

OBJECTIVE: This study was designed to evaluate the long term effect of the epidural injections with steroid and local anesthetics in the low back pain patients by assessments of Visual Analog Scale (VAS) scores and several relating factors that influence good results. METHOD: Seventy two low back pain patients with or without sciatica were treated with epidural injections of weekly steroid (methylprednisolone acetate) and daily local anesthetics (lidocaine and bupivacaine) for 2 weeks via an epidural catheter. The efficacy of the epidural injections was assessed with Visual Analog Scale (VAS) score at the day of admission (VAS1), discharge (VAS2) and during the long term follow up period (VAS3)(mean : 14 months, 8~24 months). RESULTS: VAS1, VAS2 and VAS3 were 6.22+/-2.03, 3.36+/-1.49, and 3.39+/-1.45 respectively. VAS2 and VAS3 were significantly different with VAS1 (p<0.05). CONCLUSION: Epidural injections of steroid and local anesthetics are effective not only in the short term period, but also in the long term peroid for patients with low back pain with or without sciatica.
Anesthetics, Local* ; Catheters ; Follow-Up Studies ; Humans ; Injections, Epidural* ; Low Back Pain* ; Sciatica ; Visual Analog Scale

PURPOSE: An osseous defect in the glenoid and humeral head is closely associated with recurrence of anterior shoulder instability. The purpose of this article is to describe the open surgical techniques and introduce our experiences with anterior instability with a significant osseous defect. MATERIALS AND METHODS: We reviewed the articles that have focused on and/or mentioned the affect of osseous defects on anterior shoulder instability. The open surgical techniques and its related pearls are summarized in this review. RESULTS: Accurate evaluation for the size and location of the osseous defect is critical for preventing recurrence after restoration of the anterior capsulolabral structure. The glenoid bone restoration techniques include the coracoids transfer (the Bristow procedure and the Latarjet procedure) and a structural iliac bone graft. Rotational humeral osteotomy and an osteoarticular allograft could be used for repairing a significant posterosuperior humeral defect (Hill-Sachs lesion). Shoulder arthroplasty may be tried for treating a humeral bone defect, but more study on this is needed. CONCLUSION: Open surgical restoration decreases the risk of recurrence anterior shoulder instability that is combined with a significant osseous defect. Arthroscopic surgery currently has limitations for treating an osseous defect, but it will become useful in proportion to the development of arthroscopic instruments and techniques in the future.
Arthroplasty ; Arthroscopy ; Humeral Head ; Osteotomy ; Recurrence ; Shoulder ; Transplantation, Homologous ; Transplants

PURPOSE: To report three cases of severe endothelial cell density loss after iris claw phakic intraocular lens (Artisan® lens) implantation. CASE SUMMARY: A 32-year-old woman underwent iris claw intraocular lens implantation in both eyes. Preoperative corneal endothelial cell count was 2,556 cells/mm² in the right eye and 2,674 cells/mm² in the left eye. After 4 years, the corneal endothelial cell count was 1,968 cells/mm² in the right eye and 1,997 cells/mm² in the left eye. A 27-year-old woman underwent iris claw intraocular lens implantation in both eyes. Preoperative corneal endothelial cell count was 3,222 cells/mm² in the right eye and 3,122 cells/mm² in the left eye. After 4 years 8 months, the corneal endothelial cell count was 2,729 cells/mm² in the right eye and 2,488 cells/mm² in the left eye. A 39-year-old woman underwent phakic intraocular lens implantation in other clinic, and the lens of left eye was removed the same day because of elevated intraocular pressure. She underwent iris claw intraocular lens implantation in the left eye. Preoperative corneal endothelial cell count was 2,500 cells/mm² in the left eye, which decreased to 1,873 cells/mm² after 8 years. Six months after intraocular lens removal and cataract surgery, her cornea endothelial cell count was 1,412 cells/mm². CONCLUSIONS: Although iris-fixed intraocular lens implantation is safe and effective for correcting myopia, at least 4 years of long-term observation for evaluating corneal endothelial cell density maybe necessary.
Adult ; Animals ; Cataract ; Cornea ; Endothelial Cells* ; Female ; Hoof and Claw ; Humans ; Intraocular Pressure ; Iris ; Lens Implantation, Intraocular ; Lenses, Intraocular ; Myopia ; Phakic Intraocular Lenses*