The authors reviewed 85 knees in 59 patients(9 males, 50 females) who had preoperative flexion contracture(FC) greater than 20° and taken total knee arthroplasty(TKA) at the Seoul National University Hospital from Jan.1987 to Dec.1992. We reviewed the surgical methods according to preoperative FC, changes of postoperative FC and range of motion, and clinical and radiologic findings. In our series, 48 knees were degenerative arthritis(average FC: 26°), 34 knees, rheumatoid arthritis(average FC: 40°)and 3 knees, others(average FC:28°). The average follow-up period was 2 years(range, 1 to 4(+8) years). Seventy three knees with FC less than 45 (Group I)had been treated with TKA accompanied with adequete soft tissue release, removal of osteophyte and appropriate bone resection. Eleven knees with FC greater than 50° (Group II) had been treated with skin traction followed by TKA. One knee with 65° of FC(Group III)was treated with posterolateral and posteromedial release including tendon lengthening at first, and then TKA in second stage. Preoperative FC was significantly greater in RA group than in DA group. Flexion contracture improved until postoperative 3 years in DA group and improved until postoperative 2 years and slightly deteriorated after then in RA group, but statistically insignificant(p>0.05). There was no difference of FC at postoperative 2 weeks and final follow-up between Group I and II. Range of motion improved until postoperative 2 years in DA group significantly(p < 0.05). In RA group, range of motion improved until postoperative 2 years(p>0.05) and deteriorated after then(p < 0.05). With TKA, range of motion increased significantly in both Group I and II and there was no difference of range of motion between Group I and II at final follow-up. Postoperative HSS score and pain score improved in DA and RA groups significantly, and final HSS score with greater in DA group than RA group(p < 0.05). Preoperative HSS score and pain score of Group I were significantly higher than those of Group II, but final follow-up, there was no difference between two groups. There was no correlation between final FC and HSS score. There was no difference in score of radiolucency between two groups in which final FC was greater and lesser than 10°. We thought that in knees with fixed flexion contracture, successful correction of moderate to severe flexion contracture and satisfactory result of total knee arthroplasty can be achieved by adequate soft tissue release, appropriate bone resection, and/or preoperative management.
Arthroplasty, Replacement, Knee ; Contracture ; Follow-Up Studies ; Humans ; Knee ; Male ; Osteophyte ; Range of Motion, Articular ; Seoul ; Skin ; Tenotomy ; Traction

The most common cause of small bowel obstruction is postoperative adhesion, and besides a hernia, metastatic or primary cancer and small bowel tumors are possible causes. Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction and is associated with debilitating conditions with marked weight loss. SMA syndrome results from the compression of the third part of the duodenum due to the narrowing of the aortomesenteric angle. We report a 28-year-old woman with SMA syndrome after acute gastroenteritis. Her stomach was severely dilated due to the duodenal obstruction and computed tomography showed the compression of the third portion of the duodenum by SMA. She was conservatively cared for and thus favorably improved.
Adult ; Duodenal Obstruction ; Duodenum ; Female ; Gastroenteritis ; Hernia ; Humans ; Mesenteric Artery, Superior ; Stomach ; Superior Mesenteric Artery Syndrome ; Weight Loss

BACKGROUND: Diuretic agents are widely used in the treatment of variable diseases. Although some diuretics may cause photosensitive reactions, this has been a relatively neglwted area of investigation. OBJECTIVE: The study was undertaken to examine whether or not the diuretic agents could cause phototoxicity with the photohemolysis test and with the Candida albica as test. METHOD: Photohemolysis test: Fresh human red blood cells (RHC) were washed and diluted to 200 fold of original volume with TCM buffer. Test compound suspension, were added to the diluted blood at the final concentration of 10 M. Each sample was irradiated with 50 J/cm of UVA, and control samples were incubated in water bath with light shielding. After additional incubation in a dark water bath for 30 minutes the sarnples were centrifuged. After adding Drabkins reagent, measurement of absorbance of the supernatents by speetrophotometer at 420, 540, 550nm were performed. The degree of photohemolysis was determined by comparing the results wiith the control solution. Candide elbicens test wenty microliter of each solution of arious diuretics were applied to Sabourauds dextrose agar plate in which Candida albicanp had been diffusely applied previously. Four hours after the application, 80 J/cm of UVA was irradiated. The irraicated plates and nonirradiated controls were incubated in a darlI room for 48 hours, and were examined clearzones arround the drugs as the mean of positive results fcir the phototoxic potential of the drugs. RESULTS: The photohemolyeii; vaIues of azosemide, spironolaetonet, iamterene, and xipamide at 420, 540, and 550nm were 70.57%/28.36%/31.61%/83.65%/16.40%/15.21%/75.66%/25.40%/28.17%, and 14.02%/9.11%/8.99% respectively, which exceeds the mear,injful positive value of above 5 , With the Candida olbicans test all teat solution at concentration of 1% and 5% showed negstive results. CONCLUSION: A phototoxic reaction may be triggered by azosemide, spironolactone, triamterene, and xipamide, and the possible mechanism concerned may be directed to cellular membranes. However with the negative result of knowed photosensitizers like hydrochlorthiazid and furosemide, there may be other possibilities for the explenation of phototoxicity. Thus further stirdies may be necessary to investigate more details about the cliscrepancies in greates detail.
Agar ; Baths ; Candida albicans* ; Candida* ; Dermatitis, Phototoxic ; Dermis ; Diuretics ; Erythrocytes ; Furosemide ; Glucose ; Humans ; Membranes ; Photosensitizing Agents ; Spironolactone ; Triamterene ; Water ; Xipamide

BACKGROUND: Diuretic agents are widely used in the treatment of variable diseases. Although some diuretics may cause photosensitive reactions, this has been a relatively neglwted area of investigation. OBJECTIVE: The study was undertaken to examine whether or not the diuretic agents could cause phototoxicity with the photohemolysis test and with the Candida albica as test. METHOD: Photohemolysis test: Fresh human red blood cells (RHC) were washed and diluted to 200 fold of original volume with TCM buffer. Test compound suspension, were added to the diluted blood at the final concentration of 10 M. Each sample was irradiated with 50 J/cm of UVA, and control samples were incubated in water bath with light shielding. After additional incubation in a dark water bath for 30 minutes the sarnples were centrifuged. After adding Drabkins reagent, measurement of absorbance of the supernatents by speetrophotometer at 420, 540, 550nm were performed. The degree of photohemolysis was determined by comparing the results wiith the control solution. Candide elbicens test wenty microliter of each solution of arious diuretics were applied to Sabourauds dextrose agar plate in which Candida albicanp had been diffusely applied previously. Four hours after the application, 80 J/cm of UVA was irradiated. The irraicated plates and nonirradiated controls were incubated in a darlI room for 48 hours, and were examined clearzones arround the drugs as the mean of positive results fcir the phototoxic potential of the drugs. RESULTS: The photohemolyeii; vaIues of azosemide, spironolaetonet, iamterene, and xipamide at 420, 540, and 550nm were 70.57%/28.36%/31.61%/83.65%/16.40%/15.21%/75.66%/25.40%/28.17%, and 14.02%/9.11%/8.99% respectively, which exceeds the mear,injful positive value of above 5 , With the Candida olbicans test all teat solution at concentration of 1% and 5% showed negstive results. CONCLUSION: A phototoxic reaction may be triggered by azosemide, spironolactone, triamterene, and xipamide, and the possible mechanism concerned may be directed to cellular membranes. However with the negative result of knowed photosensitizers like hydrochlorthiazid and furosemide, there may be other possibilities for the explenation of phototoxicity. Thus further stirdies may be necessary to investigate more details about the cliscrepancies in greates detail.
Agar ; Baths ; Candida albicans* ; Candida* ; Dermatitis, Phototoxic ; Dermis ; Diuretics ; Erythrocytes ; Furosemide ; Glucose ; Humans ; Membranes ; Photosensitizing Agents ; Spironolactone ; Triamterene ; Water ; Xipamide

To attempt a rigorous definition of the structure of the accessory spleen (AS) in the Chinese hamster, we examined twenty-one animals, and found AS in 5 animals (23.8%), which were over 7-month-old. The AS had no connection with the main spleen and was seen as a dark red oval organ (0.7 mm x 1.5 mm), which was embedded in the adipose tissue near the tail of the pancreas. It was demarcated from the adipose tissue and some pancreatic tissue. The organ was encapsulated by thin collagenous connective tissue and smooth muscle fibers, and contained lymphatic nodules, reticular fibers, nodular central arterioles, macrophages and megakaryocytes. Notably the incidence of AS appeared to increase with age in the Chinese hamsters.
Adipose Tissue/anatomy & histology ; Age Factors ; Animals ; Connective Tissue/anatomy & histology ; Cricetinae ; Cricetulus/*anatomy & histology ; Erythrocytes/cytology ; Lymphocytes/cytology ; Muscle, Smooth/anatomy & histology ; Pancreas ; Spleen/*anatomy & histology/cytology

The overall prognosis of acute pyelonephritis is good, but the infections by extended spectrum beta-lactamase (ESBL) producing Escherichia coli (E.coli) cause poor responses to empirical antibiotic treatment, and consequently increase mortality. ESBL can hydrolyze the antibiotics with a beta-lactam ring and confer resistance to oxyimino-cephalosporins and monobactams. If the patient shows poor responses to empirical antibiotics or severe septic conditions, physicians must switch the antibiotics to other antibiotics covering resistant strains without delay. We report a case of acute pyelonephritis by extended-spectrum beta-lactamase producing E.coli in a 29-year-old woman who was empirically treated with oral ciprofloxacin as an initial treatment, but progressed to sepsis.
Adult ; Anti-Bacterial Agents ; beta-Lactamases ; Ciprofloxacin ; Escherichia ; Escherichia coli ; Female ; Humans ; Monobactams ; Prognosis ; Pyelonephritis ; Sepsis

The overall prognosis of acute pyelonephritis is good, but the infections by extended spectrum beta-lactamase (ESBL) producing Escherichia coli (E.coli) cause poor responses to empirical antibiotic treatment, and consequently increase mortality. ESBL can hydrolyze the antibiotics with a beta-lactam ring and confer resistance to oxyimino-cephalosporins and monobactams. If the patient shows poor responses to empirical antibiotics or severe septic conditions, physicians must switch the antibiotics to other antibiotics covering resistant strains without delay. We report a case of acute pyelonephritis by extended-spectrum beta-lactamase producing E.coli in a 29-year-old woman who was empirically treated with oral ciprofloxacin as an initial treatment, but progressed to sepsis.
Adult ; Anti-Bacterial Agents ; beta-Lactamases ; Ciprofloxacin ; Escherichia ; Escherichia coli ; Female ; Humans ; Monobactams ; Prognosis ; Pyelonephritis ; Sepsis

Nontraumatic cerebrospinal fluid rhinorrhea is a very rare disease that comprises 3-4% of all CSF rhinorrhea cases. The principle treatment for CSF rhinorrhea is surgery because more conservative treatments usually fail. The authors executed extracranial repair of the fistula and sphenoid sinus obliteration with abdominal fat in a 33-year old male diagnosed with nontraumatic CSF rhinorrhea not accompanied by intracranial lesion. The CSF rhinorrhea stopped after the operation, but acute hydrocephalus developed on the postoperative second day, and a ventriculospinal shunt was performed. The authors report a case of acute hydrocephalus occurring after the repair of the CSF rhinorrhea, a development that, to our knowledge, has never been reported in the literature.
Abdominal Fat ; Adult ; Cerebrospinal Fluid Rhinorrhea* ; Cerebrospinal Fluid* ; Fistula ; Humans ; Hydrocephalus* ; Male ; Rare Diseases ; Sphenoid Sinus

Churg-Strauss syndrome is a rare primary vasculitis called allergic granulomatosis angiitis. There is a substantial overlap of symptoms or signs between different vasculitides, so that a diagnosis of any vasculitis can be determined by a combination of clinical symptoms and laboratory tests. We report a case of a 54-year-old woman who had bronchial asthma, eosinophilia, peripheral polyneuropathy, pulmonary infiltrate, maxillary sinusitis, and extravascular eosinophilic infiltration on skin biopsy. So she was diagnosed as having Churg-Strauss syndrome, but she was antineutrophil cytoplasmic antibodies-negative on immunologic study. She had fever and showed cardiac involvement that was presented as cardiomegaly and pulmonary edema at chest radiography and left ventricular hypertrophy on electrocardiography. After steroid therapy, general condition and skin manifestation were rapidly improved.
Antibodies, Antineutrophil Cytoplasmic ; Asthma ; Biopsy ; Cardiomegaly ; Churg-Strauss Syndrome ; Cytoplasm ; Electrocardiography ; Eosinophilia ; Eosinophils ; Female ; Fever ; Humans ; Hypertrophy, Left Ventricular ; Maxillary Sinus ; Maxillary Sinusitis ; Middle Aged ; Polyneuropathies ; Pulmonary Edema ; Skin ; Skin Manifestations ; Thorax ; Vasculitis

We report a case of calcific bursitis of the shoulder in four-year-old boy who had severe pain and limitation of motion of the left shoulder joint for three days. Radiographs revealed the oval radiopaque lesion in the subacormial space, and the MR signal intensity of the mass was moderate on T2WI. Histological examination of the mass showed acute necrotizing inflammation with calcification.
Bursitis ; Humans ; Inflammation ; Male ; Shoulder ; Shoulder Joint