Fifty four consecutive total knee arthroplasties were reviewed to compare the accuracy of extramedullary versus intramedullary tibial resection guides. An extramedullary guide ( Group I ) was used in 25 cases and an intramedullary guide ( Group 2 ) was used in 29 cases. Group 1 system included the LCS knee system and Group 2 system included the Whiteside Ortholoc Advantim total condylar knee system. Preoperatively, the two groups were similar, with no statistical significant differences observed in diagnosis, alignment, and patient age. Postoperative tibial component alignment angles were similar in both group (Group 1, 0.8degrees varus; Group 2, 1.1degrees varus ). In group 1, 84% of tibial components were aligned within 2degrees of the 90degrees goal and in group 2, 83% of tibial components were aligned within the same range ( p > 0.05 ). In all cases, an intramedullary guide was used to prepare the distal femur. In femorotibial angles, with group 1 averaging 4.2degrees valgus versus 4.7degrees valgus in group 2 (p > 0.05). If the optimal femorotibial angle was defined by the range from 5+/-2, it was achieved in 76% in Group 1 and 72% in Group 2 ( p > 0.05 ). This study demonstrates no significant differences between the extramedullary and intramedullary group not only in optimal tibial component alignment angle but also in optimal femorotibial angle. This means that each system is satisfactory for the tibial side, but it is more important for the surgeon to appreciate that the indications, potential limitations and sources of errors are unique to each system and to decide which system to use according to the particular case in question.
Arthroplasty* ; Diagnosis ; Femur ; Humans ; Knee*

The cutaneous metastaaes from carcinoma of breast produce four definite clinical types: inflammatory carcinoma, telangiectatic carcinoma, nodular carcinoma, and carcinoma en cuirasse. We present a case of 51-year-old woman who had purpuric, hard, sclerotic plaque with ulceration, crust and. several pea-sized hemorrhagic papulovesicular eruptions on the right chest wall for one year. Histopathological findings show metastatic ductal carcinoma but, the primary focus was not determined.
Breast ; Carcinoma, Ductal ; Female ; Humans ; Middle Aged ; Thoracic Wall ; Ulcer

No abstract available.
Meningitis, Cryptococcal*

PURPOSE: To evaluate the clinical characteristics, treatments and outcome of patients with hemorrhagic shock and encephalopathy(HSE) syndrome. METHODS: We performed a clinical study on 14 patients who were diagnosed as hemorrhagic shock and having encephalopathy syndrome in the Department of Pediatrics, from 1984 to 1998. Age, sex, clinical symptoms and physical findings at admission, the most deranged laboratory findings, radiologic findings, treatments and outcome were analyzed. RESULTS: The age of onset was 1.0+/-0.9 years and the male to female ratio was 1: 1.8. At admission, clinical findings included dehydration in 85.7%, shock in 85.7%, fever in 71.4%, vomiting in 71.4%, diarrhea in 64.3%, GI bleeding in 50%, convulsion in 42.9%, and edema in 35.7%. Altered mental state was found in 100%, hepatomegaly in 64.3%, and splenomegaly in 21.4%. Laboratory findings revealed D-dimer positive in 92.9%, the mean hemoglobin level 8.2+/-2.1g/dL, BUN 35.7+/-24.0mg/dL, creatinine 1.9+/-1.5mg/dL, AST 561.0+/-1,412.1IU/L, ALT 858.9+/-1,649.8IU/L, blood glucose 229.5+/-197.4mg/dL, ammonia 195.4+/-129.7pg/dL, and total bilirubin 4.9+/-8.2mg/dL. On serologic tests, rotavirus and Epstein-Barr virus was found in 1 patient(7.1%), respectively. The mortality rate was 78.6%. CONCLUSION: We found that shock and disseminated intravascular coagulation(DIC) played important roles in the pathogensis of HSE syndrome, and encephalopathy, hepatic and renal insufficiency, and respiratory failure were secondary complications resulting from shock and DIC. Despite vigorous treatment, the prognosis was very poor. We feel more efforts should be focused on investigating the etiology and pathophysiology of HSE to prevent as well as develop a specific therapy. (J Korean Pediatr Soc 2000;43:814-819)
Age of Onset ; Ammonia ; Bilirubin ; Blood Glucose ; Creatinine ; Dacarbazine ; Death, Sudden* ; Dehydration ; Diarrhea ; Edema ; Female ; Fever ; Hemorrhage ; Hepatic Encephalopathy ; Hepatomegaly ; Herpesvirus 4, Human ; Humans ; Infant* ; Male ; Mortality ; Pediatrics ; Prognosis ; Renal Insufficiency ; Respiratory Insufficiency ; Rotavirus ; Seizures ; Serologic Tests ; Shock ; Shock, Hemorrhagic* ; Splenomegaly ; Vomiting

PURPOSE: To report the results of acetabular revisions performed with the cementless, hemi-spherical porous coated component supported by viable host bone and minimal allobone graft for acetabular deficiencies. MATERIALS AND METHODS: A retrospective study was completed for 22-revision acetabular components, using the cementless hemispherical porous coated prosthesis and minimal femoral head allograft. There was an average follow up of 48 months, with a range of 24 to 84 months. Radiographic measurements were performed in several aspects; cup-allograft contact, inclination, vertical and horizontal migration of acetabular cup, and acetabular zone by modified zone of DeLee and Charnley, in which location, size and progression or non-progression of radiolucent zone were recorded. The acetabular deficiencies were classified by the American Academy of Orthopaedic Surgeons Committee and were type I in 2 hips (9%), type II in 12 hips (55%), and type III in 8 hips (36%). Twenty acetabular cup cases of Harris-Galante II were used in this study, 1 case of Harris- Galante I, and 1 case of Duraloc. The average size of the cup was 57(44-66) mm. RESULTS: The average cup-allograft contact was 72.5% in 19 cases and we could not differentiate the margin between the host bone and the allograft in 3 cases. There was no significant vertical or horizontal migration of acetabular cup. Radiolucent zones in follow-up radiographs were 8 cases in zone IA, 4 cases in zone IB, 4 cases in zone IIB, 9 cases in zone IIC, 8 cases in zone IIIA, and 7 cases in zone IIIB. One case showed 2 mm radiolucent area in zone IIC and another case showed 3 mm radiolucent area in zone IIB, but the radiolucencies were not progressive. The remaining cases showed less than 0.5 mm radiolucent area or no radiolucent zone. The average period of bony incorporation was 13.1 months. CONCLUSIONS: We suppose that acetabular revision with the cementless hemispherical porous coated cup supported by viable host bone and minimal bone graft produces good results.
Acetabulum* ; Allografts ; Follow-Up Studies ; Head ; Hip ; Prostheses and Implants* ; Retrospective Studies ; Transplants

Giant cell tumor is an uncommon primary bone tumor of young adults with the highest incidence in patients 20 to 40 years of age. These tumors are most frequently found in the metaphyseal-epiphyseal region of the long bones, especially around the knee joint and the distal end of the radius. So the normal life expectancy and an active life style of the patient necessitate a reliable and durable surgical remedy for eradicating the tumor and preserving joint function. Furthermore, these have an unpredictable clinical behavior. Although almost always benign, these tumors are locally agressive and tend to have a high rate of rerurrence, and malignant transfomation is well known to be 6 15%. Thus the lesions produce a practically difficult therapeutic problem for the orthopaedic surgeon, and a satisfactory method of treatment has not yet been found. Clinical observations were carried out on 33 cases of giant cell tumor of bone in the Department of Orthopaedic Surgery, Yonsei University College of Medicine from May 1975 through May 1985, and the following results were obtained. 1. The highest incidence, 23 cases (70%), accurred in the 21 40 year old age group, and the sex distribution was 18 males and 15 females. 2. The most frequent locations were the distal feuiur, proximal tibia and distal radius. Twenty four cases(73%) occurred around the knee joint. 3. The pathologic grading according to Jaffes criteria showed 10 cases(30.3%) in grade I, 20 cases (60.6%) in grade II and 3 cases(9.1%) in grade III. 4. As the primary treatment modality, currettage and bone graft were performed in 9 cases, currettage and bone cementing in 9 cases, amputation or disarticulation in 7 cases, enbloc excision with or without other procedures in 6 cases and currettage and radiotherpy in 2 cases. 5. Eight cases(24.2%) recurred after primary treatment and 6 cases of the 8 recurrences appeared within 2 years after primary treatment. 6. Four of the 9 tumors treated by currettage and bone graft recurred, as did two of the 9 tumors treated by currettage and bone cementing. No recurrence occurred in the 7 tumors treated by amputation or disarticulation. 7. As the secondary treatment modality for 8 recurrences, amputation or disarticulation was performed in 5 cases.
Amputation ; Disarticulation ; Female ; Giant Cell Tumor of Bone ; Giant Cell Tumors ; Giant Cells ; Humans ; Incidence ; Joints ; Knee Joint ; Life Expectancy ; Life Style ; Male ; Methods ; Radius ; Recurrence ; Sex Distribution ; Tibia ; Transplants ; Young Adult

We have retrospectively analyzed the clinical and radiological outcome in 22 cervical spondylotic myeloradiculopathy patients who underwent combined front anterior decompression and fusion) and back (open door laminoplasty) surgery between Mar. 1991 and Jan. 1995. Clinical symptoms were evaluated by Japanese Orthopaedic Association(JOA) score and the recovery rate. Plain radiogram and MIR were taken before and after surgery, and then the cervical curvature, change of body to canal ratio and the A-P compression ratio of the cord were measured and compared to the clinical symptoms. Results : The mean JOA score increased from 10.1±3.3 preoperatively to 14.7±1.4 at the final follow-up with a mean recovery rate of 64.4%. No patients deteriorated as a result of the combined procedure. Post-op. radiograms showed an increasement of body to ratios (average 0.69±0.09 pre-op. to 1.0±0.13 post-op.) and maintenance or recovery of cervical Lordosis. On MRI, the A-P compression ratios of the cord were increased with recovery of subarachnoid space after the operation in most cases (average 38.4±7.6 pre-op. to 55.7±7.2 post-op.). Conclusion : This combined procedure safely and effectively resulted in decompression of the spinal cord and good functional recovery in patients with 1) anterior and posterior pathology, 2) narrow spinal canal and large spondylotic bar or herniated disc encroaching the spinal canal more than 5mm, 3) narrow spinal canal and kyphotic deformity, 4) narrow spinal canal and segmental instability, 5) multisegmental cord compression and severe radiculopathy.
Animals ; Asian Continental Ancestry Group ; Congenital Abnormalities ; Decompression ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Lordosis ; Magnetic Resonance Imaging ; Pathology ; Radiculopathy ; Retrospective Studies ; Spinal Canal ; Spinal Cord ; Subarachnoid Space

OBJECTIVES: The authors have intended to know the drug interaction of fluoxetine and haloperidol when coadministering two drugs to the chronic schizophrenics by assessing the changes of positive, negative symptoms and extrapyramidal symptoms. METHOD: We selected 38 patients, the chronic schizophrenics with no physical problems. they are randomly assigned to placebo group and drug group. And then, placebo or fluoxetine 20mg were administered to the subjects of each group during 8 week period. We have assessed their psychopathology and extrapyramidal symptoms using positive and Negative Syndrome Scale(PANSS), Clinical Global Impression(CGI), Simpson-Angus Scale at o, 2, 4, 6, 8 week during the period. RESULTS: 38 patients have completed the study during 8 week. 1) PANSS, CGI : no significant difference between groups and no significant change according to the times. 2) Simpson-Angus Scale : no significant changes. CONCLUSION: When co-administering fluoxetine and haloperidol, there were no significant changes of psychopathology and extrapyramidal symptoms. There results suggest that it is safe to coadminister fluoxetine to schizophrenic with haloperidol treatment.
Drug Interactions ; Fluoxetine* ; Haloperidol* ; Humans ; Psychopathology*

It is well studied about the composition of tear and it`s function, but not about the proportion of tear proteins in the dry eye, in which tear volume is reduced and tear film is unstable. Therefore, we performed this study to determine the proportion of tear proteins. This study involved 150 subjects, 50 volunteers and 100 outpatients who visited Ophthalmologic department from January to December in 1997. Dry eye was classified into mild and severe dry eyes. Four fractions of tear protein were demonstrated by electrophoresis. The proportion of tear proteins in fraction 1 to 4 were 31.0+/-5.9%(mean+/-standard deviation), 2.9+/-1.3%, 40.8+/-5.5%, 25.2+/-5.2%, in control group, 33.4+/-7.1%, 3.4+/-3.0%, 41.6+/-7.7%, 21.5+/-4.8% in mild dry eye group, 37.5+/-11.4%, 3.2+/-2.2%, 40.3+/-9.1%, 19.5+/-5.3% in severe dry eye group respectively. With severty of the dry eye, the proportion of fraction 1 was increased and the proportion of fraction 4 was decreased, both of which were statistically significant difference(P<0.01). In proportion to the severity of dry eye, the proportion of tear proteins became unstable. For the diagnosis and management of the dry eye,we consider the supplement of the decreased portion of tear proteins.
Diagnosis ; Electrophoresis ; Humans ; Outpatients ; Tears* ; Volunteers

Papineau's technique represents an excellent method of dealing with serious bone infections with significant bone and soft tissue loss. The procedure is carried out in three stages: the 1st stage is the excision of infected bone and soft tissue, stabilization of the fracture site, the 2nd stage is the cancellous bone grafting, and the 3rd stage is the skin coverage. During the period from June 1980 to September 1982, our limited experience with 14 cases has been extremely satisfactory; 1. This method is applicable to traumatic osteomyelitis and some cases in which the infection has been blood borne. 2. Successful bone grafting in the presence of infection depends upon; a. complete sequestrectomy and removal of all infected tissue b. an adequate vascular bed for the graft c. no dead space d. sufficient immobilization.
Bone Transplantation ; Immobilization ; Methods ; Osteomyelitis ; Skin ; Transplants