At Orthopaedic Department of Kyung Hee University Hospital, we performed 50 total knee replacement in 32 patients who had suffered from rheumatoid arthritis during the period from Aug. 1982 to Dec. 1987. We studied these cases and compared the results of total knee replacement surgery in preoperative ambulatory patients(group I ) with those in preoperative non-ambulatory patients(group II ). 1. Preoperatively, 19 patients were able to walk, and 13 patients were unable to walk. 2. 7 patients of bilateral TKR(36.8%) were included in group I, and 11 patients (86.9%) in group II. 3. The improvement of range of motion after TKR was greater in group II (34 degrees) and in group I, average postoperative range of motion was similar to the average preoperative ROM. 4. Flexion contracture was more markedly improved in group II. 5. In group I, the average preoperative knee rating score by Hospital for Special Surgery rating system was 38.8 and improved to 93.4 postoperatively. In group II, the average preoperative knee rating score was 27.4 and improved to 85.7 postoperatively. 6. Postoperatively most of the patients were able to walk without support except one cases of infection(group I ) and the other who had severe rheumatoid involvements in other joints (group II ). 7. Preoperative evaluation for involvements of cervical spine and surrounding soft tissue structure was necessary endotracheal anesthesia. 8. There was 2 cases of complications in group I, and 4 cases in group II.
Anesthesia, Endotracheal ; Arthritis ; Arthritis, Rheumatoid ; Arthroplasty, Replacement, Knee ; Contracture ; Humans ; Joints ; Knee ; Range of Motion, Articular ; Spine

We have experienced an unusual case of hemorrhagic renal cyst in the rt. kidney at 58 years old woman. The Rt. kidney was enlarged, and showed a few subcapsular ischemic areas The color of kidney was dark brown. As the cyst at lower pole of rt. kidney was dissected, hemorrhagic fluid visualized in the cystic cavity. The final pathologic finding was renal cyst associated with malignant change and renal cell carcinoma at another renal parenchyma. Herein, hemorrhagic renal cyst, a rare clinical entity, was reported with review of literatures.
Carcinoma, Renal Cell ; Female ; Humans ; Kidney ; Middle Aged

Four total knee arthroplasties were performed in 3 patients with the diagnosis of classical Charcot's joints associated with syphilis during past 4 years from 1985 to 1988. All patients had positive reaction in serology test(VDRL, TPHA). We corrected the bone loss and severe joint instability with allograft or autogenous bone grafting and ligament balancing. The knee score was increased from preoperative 37 points to postoperative 87.3 points. We expect that total knee arthroplasty may be the alternative treatment to the conservative treatment or knee arthrodesis in Charcots joints.
Allografts ; Arthrodesis ; Arthropathy, Neurogenic ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Bone Transplantation ; Diagnosis ; Humans ; Joint Instability ; Knee ; Ligaments ; Syphilis

BACKGROUND: Laparoscopic gynecologic surgery is a standard procedure today for its small skin incision and short hospital admission stay. However pneumoperitoneum (PP) and Trendelenberg position induce adverse effects in hemodynamics and pulmonary gas exchange. The purpose of this study is to evaluate the effects of propofol compared with enflurane for pulmonary gas exchange in the Trendelenberg position and pneumoperitoneum. METHODS: Twenty women were randomly allocated to either the enflurane (n = 10) or propofol (n = 10) with fentanyl-N2O/O2 anesthesia. PaCO2, PaO2, PETCO2 were checked at pre-PP, 10 min after PP, 30 min after PP, and 10 min after CO2 deflation. In addition the Vd/Vt ratio was calculated according to the Bohr equation. Vital sign and peak airway pressure were checked at each stage. RESULTS: PaCO2 and PETCO2 increased and PaO2 decreased significantly during PP in both groups. Vd/Vt increased significantly in the enflurane group at 30 min after PP. Peak airway pressure increased significantly in both groups. Blood preassure and heart rate were not changed significantly. All of the parameters were not significantly different between groups. CONCLSIONS: Propofol compared with enflurane did not show any advantage in gas exchange during gynecologic laparoscopic surgery under Trendelenberg position and PP.
Anesthesia* ; Enflurane* ; Female ; Gynecologic Surgical Procedures ; Heart Rate ; Hemodynamics ; Humans ; Laparoscopy* ; Pneumoperitoneum ; Propofol* ; Pulmonary Gas Exchange ; Skin ; Vital Signs

PURPOSE: We evaluated the effect of tamsulosin on upper and lower ureteral stones that were smaller than 10mm to identify the patient groups for which tamsulosin was most applicable. MATERIALS AND METHODS: 85 patients who were diagnosed with ureteral stones smaller than 10mm in size were enrolled in this randomized prospective study. The patients were diagnosed via intravenous pyelography and then they were followed with weekly plain abdomen films for 4 weeks. The control group(Group 1) was given an nonsteroidal antiinflammatory drug(NSAID) for pain medication, and they were instructed to ingest at least 2l of fluids daily. For the treatment group(Group 2) once daily 0.2mg tamsulosin was added. Both groups were compared for the size of stone and the days to expulsion and pain control, based upon the number of emergency room(ER) visits. The proximal and distal ureteral stones were separately evaluated, and the patients' gender, age, stone size and stone position were analyzed to identify treatment efficacy. RESULTS: The average stone size was 5.2+/-2.6mm in group 1 and 4.7+/-1.5mm in group 2(p=0.344). The success rate was 42.9% in group 1 and 76.5% in group 2(p=0.005). Group 2 showed a significant reduction for the time to stone expulsion at 12.7+/-6.6 days compared to 18.5+/-6.9 days for group 1(p=0.008). Among the subset of patients, those with distal ureteral stones smaller than 5mm alone showed a significant increase in the expulsion rate(100%, p=0.047) and a decrease of the days to expulsion(12.1+/-5.1 days, p=0.018). CONCLUSIONS: Tamsulosin increases the spontaneous expulsion rate and reduces the time to expulse ureteral stones, and it was most effective for distal stones less than 5mm in size.
Abdomen ; Emergencies ; Humans ; Prospective Studies ; Treatment Outcome ; Ureter* ; Urinary Calculi ; Urography

Spinal cord injury often leads to central neuropathic pain syndromes, such as allodynic and hyperalgesic behaviors. Electrophysiologically, spinal dorsal horn neurons show enhanced activity to non-noxious and noxious stimuli as well as increased spontaneous activity following spinal cord injury, which often called hyperexcitability or central sensitization. Under hyperexcitable states, spinal neurons lose their ability of discrimination and encoding somatosensory information followed by abnormal somatosensory recognition to non-noxious and noxious stimuli. In the present review, we summarize a variety of pathophysiological mechanisms of neuronal hyperexcitability for treating or preventing central neuropathic pain syndrome following spinal cord injury.
Animals ; Central Nervous System Sensitization ; Discrimination (Psychology) ; Neuralgia ; Neurons ; Posterior Horn Cells ; Rats ; Spinal Cord ; Spinal Cord Injuries

No abstract available.
Adenylyl Cyclases* ; Graves Disease* ; Humans ; Thyroid Gland*

OBJECTIVE: To quantify the soluble Fas ligand (sFasL) and to measure FasL-Fas complex and FasL-IgG complex in the sera of patients with various rheumatic diseases: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis (SSc), and adult onset Still? disease (AOSD). METHODS: Serum samples were obtained from 37 patients with SLE, 40 with RA, 30 with SSc, 20 with AOSD, and 40 healthy controls. The serum sFasL, FasL-Fas complex, and FasL-IgG complex were measured using a sandwich enzyme-linked immunoabsorbent assay. Hospital medical records were retrospectively reviewed for clinical and laboratory characteristics in patients with SLE. Disease activity in SLE patients was assessed by the SLE Disease Activity Index (SLEDAI) score. RESULTS: In patients with SLE, serum sFasL levels (383.1+/-208.9pg/ml) were significantly higher (p<0.001) than those of healthy controls (192.0+/-84.7pg/ml). sFasL levels in patients with RA (150.8+/-30.7pg/ml, p=0.014), SSc (115.4+/-13.5pg/ml, p<0.001), and AOSD (137.5+/-12.9pg/ml, p=0.001) were significantly lower compared with healthy controls. The frequencies of positive FasL-Fas complex and FasL-IgG complex were higher in patients with SLE (56.8%, 56.8% respectively) than in healthy controls (2.5%, 0% respectively) (p<0.001). All patients with RA or AOSD were negative for FasL-Fas complex and FasL-IgG complex. No patients with SSc were positive for FasL-Fas complex. On the other hand, the positive frequency of FasL-IgG complex was greater in patients with SSc (16.7%) than in healthy controls (0%)(p=0.012). Serum levels of FasL-IgG complexes in active SLE patients (OD 0.467+/-0.050) were tended to be lower than those in inactive SLE patients (OD 0.509+/-0.055)(p=0.060). SLEDAI score was tended to be negatively correlated with the serum levels of FasL-IgG complex in patients with SLE (r=-0.308, p=0.068). CONCLUSION: These results suggest that FasL may possibly play a role in the pathogenesis of SLE.
Adult ; Arthritis, Rheumatoid ; Fas Ligand Protein* ; Hand ; Humans ; Lupus Erythematosus, Systemic ; Medical Records ; Retrospective Studies ; Rheumatic Diseases* ; Scleroderma, Systemic

OBJECTIVE: To quantify the soluble Fas ligand (sFasL) and to measure FasL-Fas complex and FasL-IgG complex in the sera of patients with various rheumatic diseases: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis (SSc), and adult onset Still? disease (AOSD). METHODS: Serum samples were obtained from 37 patients with SLE, 40 with RA, 30 with SSc, 20 with AOSD, and 40 healthy controls. The serum sFasL, FasL-Fas complex, and FasL-IgG complex were measured using a sandwich enzyme-linked immunoabsorbent assay. Hospital medical records were retrospectively reviewed for clinical and laboratory characteristics in patients with SLE. Disease activity in SLE patients was assessed by the SLE Disease Activity Index (SLEDAI) score. RESULTS: In patients with SLE, serum sFasL levels (383.1+/-208.9pg/ml) were significantly higher (p<0.001) than those of healthy controls (192.0+/-84.7pg/ml). sFasL levels in patients with RA (150.8+/-30.7pg/ml, p=0.014), SSc (115.4+/-13.5pg/ml, p<0.001), and AOSD (137.5+/-12.9pg/ml, p=0.001) were significantly lower compared with healthy controls. The frequencies of positive FasL-Fas complex and FasL-IgG complex were higher in patients with SLE (56.8%, 56.8% respectively) than in healthy controls (2.5%, 0% respectively) (p<0.001). All patients with RA or AOSD were negative for FasL-Fas complex and FasL-IgG complex. No patients with SSc were positive for FasL-Fas complex. On the other hand, the positive frequency of FasL-IgG complex was greater in patients with SSc (16.7%) than in healthy controls (0%)(p=0.012). Serum levels of FasL-IgG complexes in active SLE patients (OD 0.467+/-0.050) were tended to be lower than those in inactive SLE patients (OD 0.509+/-0.055)(p=0.060). SLEDAI score was tended to be negatively correlated with the serum levels of FasL-IgG complex in patients with SLE (r=-0.308, p=0.068). CONCLUSION: These results suggest that FasL may possibly play a role in the pathogenesis of SLE.
Adult ; Arthritis, Rheumatoid ; Fas Ligand Protein* ; Hand ; Humans ; Lupus Erythematosus, Systemic ; Medical Records ; Retrospective Studies ; Rheumatic Diseases* ; Scleroderma, Systemic

BACKGROUND: There are few epidemiological studies on patch test with additional batteries in Korea. OBJECTIVE: We report the results of patch tests with additional batteries which are relatively uncommonly used in contact dermatitis patients. METHODS: Standard patch testing was performed with Finn chamber on Scanpor tape. We used additional batteries including cosmetic and fragrance series which are commonly used, and the others including 14 batteries(so-called ""other"" batteries). RESULTS: Over the last 8 years, 719 patients (male 184, female 535) were tested in our contact, dermatitis clinic. 178 patients (24.8%) were tested with both Standard and other batteries, In other batteries, rubber additive series were most frequently used (9.2%), and textile colours finish (4.3%) and hairdressing series (3.6%) were used in order of frequency. Rarely performed batteries were (meth) acrylate ser ies, photographic chemicals series, wood set, oil & cooling fluid series, and various allergens. Patients tested with steroid batteries did not show positive reactions. CONCLUSION: We suggest that 6 batteries ((meth)acrylate series, photographic chernicals series, wood set, oil & cooling fluid series, various allergens, steroid battery) have law testing frequencies and positive rates. A more organized multicenter study is required.
Allergens ; Dermatitis ; Dermatitis, Contact ; Epidemiologic Studies ; Epidemiology ; Female ; Humans ; Jurisprudence ; Korea ; Patch Tests* ; Rubber ; Textiles ; Wood