No abstract available.

No abstract available.
Myositis Ossificans* ; Myositis*

BACKGROUND: Spinal anesthesia potentiates sedative drug effects. We speculated that an acute decrease in tonic afferent input by spinal anesthesia would decrease the level of consciousness and thereby increase susceptibility to sedative drugs. The experiments were approached with the assumption that the amount of sedative would reduce in the following order: first, the group without spinal anesthesia, second, the group with unilateral spinal anesthesia, and third, the group with conventional spinal anesthesia. METHODS: Patients in group 1 (n = 20) were given midazolam without spinal anesthesia and patients in group 2 (n = 20) received unilateral spinal anesthesia. Those patients who after 20 minutes had a sensory level of T9-11 and a motor block of 3 in dependent side, no sensory block, and a motor block of 0 in the non-dependent side were included. In group 3 (n = 20), patients received conventional spinal anesthesia, and those patients who after 20 minutes had a sensory level of T9-11 and a motor block of 3 were included. The amount of midazolam administered at 33microgram/kg/min to a Bispectral Index score (BIS) of 80 was measured. RESULTS: The dose of midazolam administered to a BIS of 80 was significantly lower in group 3 than in group 1 or group 2. CONCLUSIONS: The sensitivity of sedatives was in the following order: the group with conventional spinal anesthesia, the group with unilateral spinal anesthesia, and the group not administered spinal anesthesia.
Anesthesia, Spinal* ; Consciousness ; Humans ; Hypnotics and Sedatives ; Midazolam*

PURPOSE: We analyzed the clinical outcome of osteosarcoma developed in distal radius and the effect of delayed treatment on prognosis. MATERIALS AND METHODS: Twelve patients with distal radius osteosarcoma were analysed. We categorized patients into two groups of standard treatment or non-standard treatment. The patients of standard treatment group are all stage IIB and non-standard treatment group includes five stage IIB and one stage III. RESULTS: Five-year overall survival and disease-free survival rates of standard treatment group were 100% and 83%. Five-year overall survival rate of non-standard treatment group was 44%. Between two group, there are differences in age, tumor size, surgery type, symptom duration. CONCLUSION: Distal radius osteosarcoma have good prognosis than other extremity osteosarcoma. Survival rate of non-standard treatment group were lower than standard treatment group. Although the prognosis of non standard treatment group is poorer, the duration till death was longer than that of other sites with similar condition. Further multi-institutional study should be needed.
Disease-Free Survival ; Extremities ; Humans ; Osteosarcoma ; Prognosis ; Radius ; Survival Rate

No abstract available.
Calcinosis*

Ankylosing spondylitis is an inflammatory disorder of unknown etiology that primarily affect, the spine, the axial skeleton, and the large proximal joints of the body with striking tendancy toward fibrosis with secondary ossification and ankylosis of involved joints. This study was carried out to analyse clinical manifestation, evaluate disease activity indicator and set up diagnostic work-up. 38 cases of ankylosing spondylitis were studied at Department of Orthopedic Surgery, Seoul National University from Oct. 1987 to Mar. 1989. Following results were obtained. l. Average age was 28.5 years and all patients were male. 2. Low back pain was the most frequent symptom(63%) and back stiffness was next(13%). 3. S-I joint change on x-ray was the most frequently found abnormalities(100%) and HLA B27 (+) was next(97%). 4. SI/S ratio was inversely correlated with duration of symptom and seems to be significant durng the early phase of disease. 5. As a disease activity indicator, CRP was more reliable than ESR during follow up.
Ankylosis ; Clinical Study ; Fibrosis ; Follow-Up Studies ; Humans ; Joints ; Low Back Pain ; Male ; Orthopedics ; Seoul ; Skeleton ; Spine ; Spondylitis, Ankylosing ; Strikes, Employee

In patients disabled by severe rheumatoid and degenerative arthritis of both knees, bilateral total knee arthroplasty(TKA) afforded much functional improvement in pain relief and function. Postoperative results of bilateral TKA was described as being similiar to those observed among patients with single joint replacement. The purpose of this study is to evaluate the etiology and postoperative result of bilateral TKA performed on 32 knees in 16 patients at Department of Orthopedic Surgery, Seoul National University Hospital from Mar. 1985 to Oct. 1988. In our series, there were 15 females and only 1 male, their mean age was 53 years. Duration of follow up was ranged from 1 to 4 years and 5 months being average 1 year and 6 months. The results were as follow. 1. Cheif complaints were pain in 18 cases(100%) and difficulty in walking in 15 cases(82%). 2. Preoperative etiology was rheumatoid arthritis in 11 cases and degenerative arthritis in 7 cases. 3. Knee joint function by HSS(Hospital for Special Surgery) knee rating score was increased from 44.6 points preoperatively to 81.2 points postoperatively. 4. The tibiofemoral angle was changed from 1.4 degree varus to 4 degree valgus. 5. The prothesis type used were PFG(Press Fit Condylar) in 22 knees, Miller-Galante in 8 knees, AMK in 3 knees, PCA in 2 knees and unicompartmental type in 1 knee. 6. Complication were 1 case of knee fusion due to concomittant tuberculous arthritis and mild joint effusion in 6 knees. 7. Bilateral one-stage arthroplasty may be considered as an alternative procedure.
Arthritis ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Female ; Follow-Up Studies ; Humans ; Joints ; Knee ; Knee Joint ; Male ; Orthopedics ; Osteoarthritis ; Passive Cutaneous Anaphylaxis ; Seoul ; Walking

Injuries to extensor tendons can be as serious as those of digital flexors. These injuries require accurate approximation, appropirate splinting and careful mobilization. Scarring which always occurs following injury can provoke greater problems in digital extensor injuries than in flexor tendons. The loss of 2mm of excursion of extensor tendon at level of the proximal interphalangeal joint may results in a 50 percent loss of motion of the finger. A special problem associated with extensor tendon healing is loss of gliding. This study was carried was carried out to evaluate the results of the extensor injuries according to their etiology, location and type of treatment. Seventy six lesions in fifty patients treated for extensor tendon injuries were analysed for the comparison of the results of specific treatment. The follow up was from 1 to 3 years with average of 19 months. Following results were obtained. l. Among 50 patients, 16 cases (32%) were acute and 34 cases (68%) were chronic. 2. The etiology were crushing in 19 cases (30%), knife or glass in 20 cases (40%), and avulsion in 8 cases (16%) etc. 3. Mallet finger were observed in 14 tendons, buttonhole in 10 tendons. Nine tendons were injured at the metacarpophalangeal level and 16 tendons were injured at wrist level. 4. Percentage of satisfactory result which means less than 15 degrees of extension loss were 68.1 % in primary repair and plication, and 30.7% in tendon transfer or graft. 5. Prognosis was better when the lesion was proximal to MP joint, and results were more favorable in primary repair and plication than tendon transfer graft.
Cicatrix ; Fingers ; Follow-Up Studies ; Glass ; Humans ; Joints ; Prognosis ; Splints ; Tendon Injuries ; Tendon Transfer ; Tendons ; Transplants ; Wrist

Rheumatoid arthritis is a chronic inflammatory systemic disease of young or middle aged adults, characterized by destructive and proliferative changes in the synovial membrane, periarticular structures, skeletal muscle and perineural sheath. Eventually, the joints are destroyed, ankylosed and deformed. Therfore, the aim of treatment is to keep the inflammatory process at a minimum, thereby preserving the joint motion, maintaining the health of muscle supplying motor power about the joint and preventing secondary joint stiffness and deformity. Surgical treatment in rheumatoid arthritis has progressed and there have been advances in the relief of pain and increase in the range of motion. Among them the results of total knee arthroplasty (TKA) have improved steadily during the past decade due to refinements in design, fixation, and surgical technique. At orthopedic department of seoul national university hospital, we performed 31 total knee replacement in 18 patients who had suffered from rheumatoid arthritis during the period from Aug. 1982 to Dec. 1988. Following results were obtained. 1. Knee score increased from 37.8 to 76.9. 2. Tibio-femoral angle was corrected from 0.9° valgus to 5.3° valgus. 3. Conplications were peroneal nerve palsy in 3 knees, instability in 1 knee, tuberculous arthritis in 1 knee. 4. In 25 out of 31 knees, good functional results were obtained.
Adult ; Arthritis ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Congenital Abnormalities ; Humans ; Joints ; Knee ; Middle Aged ; Muscle, Skeletal ; Orthopedics ; Paralysis ; Peroneal Nerve ; Range of Motion, Articular ; Seoul ; Synovial Membrane

From Sept. 1987 to Mar. 1993, 14 cases of pelvic bone tumors took surgical treatment. Male to female ratio was 7:7, with an average age of 31.9 years. Pathological diagnosis were chondrosarcoma 7(1 ; secondary), metastatic thyroid cancer 2, and each one case of giant cell tumor, desmoplastic fibroma, metastatic synovial sarcoma, malignant fibrous histiocytoma(MFH), and enchondroma. According to the Enneking's classification for the type of surgical resection, we performed 4 cases of type II+III resection, 4 type IA, 2 type I+II, 2 type III, and each one of II and IIA+III. Types of reconstruction were hip fusion(3 cases), heat treated autogenous bone graft combined with total hip replacement arthroplasty(4), bone graft(2), cement spacer(1) or saddle prothesis(1). Simple resection was done for 3 cases. Wide surgical margin was achieved in 12 cases, marginal margin in 1 and intralesional magin in 1. Complications occurred in 3 cases(21.4%) : 1 graft failure ; 1 lymphedema ; and 1 delayed union. The average follow-up period was 27.4(8-60) months. During follow up, lung metastasis developed in MFH case but no local recurrence was noted in all. By the criteria of American Musculoskeletal Tumor Society(MSTS), the average score for functional activities was 21(70% of normal). The function of the extremity with reconstructed or undestroyed pelvic ring was better than that with disrupted pelvic ring(functional scores ; 24.6 vs 12.3 respectively). Due to the Korean life style using hypocaust, fused hip was not good for indoor activity. For the malignant pelvic bone tumor not involving femoral neurovascular bundle, limb-salvage using internal pelvectomy and reconstruction of pelvic ring can be indicated as a surgical procedure, instead of the hindquarter amputation.
Amputation ; Arthroplasty, Replacement, Hip ; Chondroma ; Chondrosarcoma ; Classification ; Diagnosis ; Extremities ; Female ; Fibroma, Desmoplastic ; Follow-Up Studies ; Giant Cell Tumors ; Hip ; Hot Temperature ; Humans ; Life Style ; Lung ; Lymphedema ; Male ; Neoplasm Metastasis ; Pelvic Bones ; Recurrence ; Sarcoma, Synovial ; Thyroid Neoplasms ; Transplants