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

No abstract available.
Adenocarcinoma*

The purpose of this study is to compare the biologic properties of tendon to hone healing and hone to hone healing in knee ligament reconstruction. The lateral 4mm of patellar tendon which was detached from its tihial insertion site either subperiostcally(group I) or with a bone block(group II) was implanted and fixed using pullout method to the proximal tihia. Ten rabbits were killed at each of four time periods (two, four, eight and twelve weeks after the implantation), and the histological and biomechanical characteristics of thc graft healing sites were evaluated. Serial histological analysis of tendon to hone healing group revealed organization of the healing site similar to normal tendon to hone attachment by twelve weeks, while hone to bone healing group demonstrated direct hony union by eight weeks. The tension failure test for the patellapatellar tendon graft - tihia complex revealed that group II had significantly higher values than group I at four and eight weeks. The findings ot this study demonstrated that bone to hone healing has more rapid process than tendon to hone healing, although no significant difference was noted once the healing has matured. We can suggest lhat the duration and extent of postoperative protection of the knee for pntients who had a reconstruction of a ligament using hone - lendon autograft should be longer and higher than lor patients who had a reconstruction using hone - tendon hone autogralf.
Autografts* ; Dronabinol ; Humans ; Knee ; Ligaments ; Patellar Ligament* ; Rabbits* ; Tendons* ; Transplants

No abstract available.
Synovitis, Pigmented Villonodular*

No abstract available.
Child* ; Humans ; Thyroid Gland*

Arthroscopic surgery of the knee is now a widely performed orthopedic technique. Of this, arthrosoopic surgery of discoid meniscus is one of the most technically demanding procedures of this field. In our experience, discoid meniscus was appeared to be frequently accompanied with villous hypertrophied synovium, which obstructed the arthroscopic view. The purpose of this study is to prove the presence of synovial hypertrophy in discoid meniscus and to develop an adequate portal of entry for successful arthroscopic surgery of discoid meniscus. 155 cases of arthroscopy of the knee were performed at the Department of Orthopedic Surgery, College of Medicine, Seoul National University between January 1987 and March 1988. Of these, 25 cases were discoid menisci and they were all lateral. Operative findings were observed through arthroscopy and they were also reviewed by recorded video tapes in 25 cases of arthroscopic surgery of discoid meniscus and 57 cases of non-discoid meniscal lesions for the presence of synovial hypertrophy. Synovial biopsy was performed in selected cases with synovial hypertrophy for observation of histological findings. Hypertrophied synovium in discoid meniscus was mainly localized in anterior compartment and intercondylar area of tibia. Therefore, when conventional anterolateral or anteromedial portals were used, much difficulty was confronted because hypertrophied synovium obstructed the visual field and crowding with surgical instruments was occurred in restricted space of discoid meniscus. Much more clear visual field was obtained when the medial midpatellar portal was used instead of conventional portals. The conclusions of this study are as follows : 1. The incidence of discoid meniscus was 16.1%. 2. Synovial hypertrophy was present in all 25 cases of discoid meniscus and 21 cases among 57 non-discoid meniscal lesions(35%) on operative findings 3. Synovial biopsy of hypertrophied synovium showed irritative nonspecific inflammatory lesions but there was no histologicsl differences between discoid and non-discoid meniscus. 4. Medial midpatellar portal is considered to be better approach than conventional portals for clear visual field and less crowding with instruments in arthroscopic surgery of lateral discoid meniscus.
Arthroscopy ; Biopsy ; Crowding ; Hypertrophy ; Incidence ; Knee ; Orthopedics ; Seoul ; Surgical Instruments ; Synovial Membrane ; Tibia ; Visual Fields

BACKGROUND: The purpose of this study was to investigate the mechanism of endothelium-dependent and independent responses to endothelins (ETs) in porcine coronary artery. METHODS: The vascular rings of left anterior descending artery or left circumflex artery from 7 pigs were suspended in conventional organ chambers for the measurement of isometric force. To evaluate relaxation responses, vascular rings with endothelium were exposed to ET-1 and ET-3. To evaluate contraction responses, vascular rings with and without endothelium were exposed to ET-1 and ET-3 in the presence or absence of BQ 123 (ET(A) receptor antagonist) or TAK-044 (ET(A) and ET(B) receptor antagonist). RESULTS: Transient relaxation responses of vascular rings occurred after exposure of ET-1 and ET-3. These transient responses disappeared after preincubation with N-nitro-L arginine. There was an increased contractions of vascular rings according to increasing concentration of ET-1 and ET-3. The initial responses were enhanced in vascular rings without endothelium in ET-1 and ET-3. In vascular rings with endothelium, the contraction responses were more reduced in vascular rings with preincubation of BQ 123 than in vascular rings without BQ 123 in ET-1. In vascular rings without endothelium, the contraction responses were more reduced in vascular rings with preincubation of TAK-044 than in vascular rings without TAK-044 in ET-1. CONCLUSION: ET(B) receptor on the endothelium might mediate the transient vasodilator responses to ET-1 and ET-3 through release of nitric oxide in porcine coronary artery. ET(A) and ET(B) receptor on vascular smooth muscle cells might mediate vasoconstrictor responses to ETs.
Arginine ; Arteries ; Coronary Vessels* ; Endothelins* ; Endothelium ; Muscle, Smooth, Vascular ; Nitric Oxide ; Receptors, Endothelin ; Relaxation ; Swine

Meigs' syndrome is defined as a hydrothorax with ascites and a pelvic tumor, both of which resolve on removal of the tumor. Pseudo-Meigs' syndrome is a variant not possessing the original tumor cell types described by Meigs. Both these syndromes should be considered in otherwise healthy women who present with either new or recurrent hydrothorax and ascites. Pseudo-Meigs' syndrome occurs with the clinical triad of (1)ascites, (2)pleural effusion and (3)Brenner tumors, struma ovarii, benign thecomas, extreme ovarian edema, uterine leiomyomas or other benign pelvic tumors. A case of Pseudo-Meigs' syndrome associated with Brenner tumor is presented with a brief review of literatures.
Ascites ; Brenner Tumor ; Edema ; Female ; Humans ; Hydrothorax ; Leiomyoma ; Meigs Syndrome ; Struma Ovarii ; Thecoma

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