Rheumatoid arthritis is a chronic inflammatory systemic disease of young or middle aged adults, characterized by destructive and proliferative changes in synovial membrane, periarticular structure, skeletal muscle and perineural sheaths. Eventually, joints are destroied, ankylosed and deformed. Moderate anemia is occured frequently in rheumatoid arthritis patients, and these patients show abnormalities of iron metabolism such as lower serum iron concentration and occurance and distribution of iron in the synovial membrane. It has been suggested that the mechanism of iron deposits in rheumatoid arthritis is continuous oozing of blood from vascular granulation tissue into the synovial cavity and this lead the patient to anemia. We collected samples from serum and knee joint fluid in 21 cases of rheumatoid arthritis for chemical estimation of the ferritin concentration by radioimmunoassay, and compared with that of osteoarthritis. The following results were obtained: 1. The mean hemoglobin concentration(11.4gm %) in rheumatoid arthritis was lower than osteoarthritis(13.4gm %). 2. The mean serum ferritin concentration(118. 4ng/ml) in rheumatoid arthritis was lower than osteoarthritis(135. 6ng/ml), on the contrary in synovial fluid rheumatoid arthritis(279.8ng/ml) showed higher than osteoarthritis(190. 4ng/ml). 3. The mean ratio of synovial fluid ferritin on serum ferritin was 2. 36 in rheumatoid arthritis, in contrast with l. 4 in osteoarthritis. There was significant correlation between the ferritin concentration in synovial fluid and serum. 4. Serial check of ferritin concentration in synovial fluid during treatment would be thought meaningful criteria for determination of progress.and effectiveness of treatment.
Adult ; Anemia ; Arthritis, Rheumatoid ; Ferritins ; Granulation Tissue ; Humans ; Iron ; Joints ; Knee Joint ; Metabolism ; Middle Aged ; Muscle, Skeletal ; Osteoarthritis ; Radioimmunoassay ; Synovial Fluid ; Synovial Membrane

No abstract available.
Ligaments* ; Sutures*

The head injuried patient with skeletal trauma is a challege to the orthopedic surgeon. The orthopedist initially may face the difficult management of fracture and dislocation in the patient associated with head injury. The management of the injuries to the head takes precedence over extremity injuries initially, but the orthopedist must be managed aggresively with assumption that full neurologic recovery will occur. This report analysed the treatment and results in 85 cases fracture and dislocation with head injury among the 59 patients at the Chungnam National University Hospital during the period ranging from March, 1980 to March, 1983. End result obtained are as follows: 1. The sex ratio between the male and female was 3.9: 1 and the prevalent age distribution was from 21 to 30 years of age. 2. The motorcycle accident was most common cause of the trauma and the next most frequent one was the automobile accident. 3. Type of head injury were contusion or concussion, intracranial hemorrhage, linear skull fracture, depressed skull fracture and open skull fracture. 4. Better result were obtained by operative treatment in femur fracture, especially spastic group. 5. The incidence of delayed diagnosis was 8 cases and the delay in diagnosis ranged from 15 to 95 days with an average of 38 days. 6. We, consulting with neurosurgeon, must assume that full neurologic recovery will take place and so open reduction and internal fixation should be carried out as quickly as possible.
Age Distribution ; Automobiles ; Chungcheongnam-do ; Clinical Study ; Contusions ; Craniocerebral Trauma ; Delayed Diagnosis ; Diagnosis ; Dislocations ; Extremities ; Female ; Femur ; Head ; Humans ; Incidence ; Intracranial Hemorrhages ; Male ; Motorcycles ; Muscle Spasticity ; Neurosurgeons ; Orthopedics ; Sex Ratio ; Skull Fracture, Depressed ; Skull Fractures

We report a 19-year-old man with hyperkeratosis of nipple and areola which is a part of an epidermal nevus. He did not have a history of endocrinopathy or synthetic steroid therapy. The lesion, a fingertip sized verrucous dark browncolored macule on left upper back, had spread into left-anterior chest wall and had involved nipple and areola to make them hyperkerstotic and verrueous. Histologic section from the on left areola showed hyperkeratosis, papillomatosis, acanthosis and increased pigmentation in the basal cell layer. Chernical peeling with 30% trichloroacetic showed favorable response.
Humans ; Nevus ; Nipples ; Papilloma ; Pigmentation ; Thoracic Wall ; Trichloroacetic Acid ; Young Adult

A randomized, prospective study was conducted between October, 1994 and April, 1996 to compare the efficacy and safety of warfarin (group I) with dextran (group II) for the prevention of DVT after hip arthroplasty. 109 cases in 106 patients were included in the study. There were 60 cases in group I and 49 cases in group IL Risk factor for DVT were analysed before surgery and prophylactic modalities were performed. Color doppler was performed to all patients by one muskuloskeletal radiologist on 5th 8th post operative day and on 6 weeks after operation. DVT occurred in ten ( 16.6% ) of the 60 patients in group I, six ( 12.2% ) of the 49 patients in group II. but, this difference was not significant ( p= 0.582 ). Statistical analysis for the risk factors of age, sex, operation time, anesthetic method and operation method were performed and there were no statistical difference. Only statistical significance was a higher rates of DVT in cemented hip arthroplasty (p=0.028). There were seven proximal thigh DVT and nine calf DVT. We confirmed with sequential color doppler image that all cases of DVT except two complicated cases were resolved within 8 weeks after treatment: one case was expired for the reason of PE, and the other case had thigh hematoma during the treatment with warfarin. We could detect only one case of late onset DVT.
Arthroplasty* ; Dextrans ; Hematoma ; Hip* ; Humans ; Prospective Studies ; Risk Factors ; Thigh ; Venous Thrombosis* ; Warfarin

We reviewed 174 total hip arthroplasty (25 were revision procedure) and 65 bipolar hemiarthroplasty procedure followed by more than 6 months at Chungnam National University Hospital from July, 1992 to March, 1995. These were performed on 189 male and 50 female patients. We have followed up average 45.8 months and obtained following results; The dislocation rate is 3.76% (9 of 239 cases) and the dislocation rate of revision arthroplasties (16%: 4 of 25 cases) is higher than those of primary hip arthroplasties (2.6%: 5 of 214 cases). Among Nine dislocations, 8 cases (89%) were between fifth and seventh decade and all cases are men. All dislocations occured within 5 weeks postoperatively. Because 6 of 9 cases were due to poor compliance, the patient's cooperation during postoperative recovery is essential to prevent postoperative dislocation. The capsulectomy, surgical approach, or immobilization of patients after operation are unrelated to dislocaton. For the prosthetic factors, 7 cases dislocated posteriorly is appeared that the plane of the cup was between 3 and 9 degrees of anteversion, and also less than the normal range. Stable outcome without surgical operation was achieved in 7 of 9 dislocation. Among 2 patients who had recurrent dislocation after optimum conservative treatment, one had infected arthroplasty and the other had a impinged anterior thick capsule formation around the head. We concluded that the predisposing factors for dislocation after hip arthroplasty is multifactorial.
Arthroplasty* ; Arthroplasty, Replacement, Hip ; Causality ; Chungcheongnam-do ; Compliance ; Dislocations* ; Female ; Head ; Hemiarthroplasty ; Hip* ; Humans ; Immobilization ; Male ; Reference Values

No abstract available.
Decompression* ; Head* ; Osteonecrosis*

Between 1984 and 1996, 8 patients who were suffered from stage g Kienbock's disease underwent interpositional arthroplasty using pronator quadratus pedicled bone. Patients comprised 2 males and 6 females, with an average age of 33 years(range 19-47). Range of motion of the wrist, residual pain, grip strength, and carpal height ratio of the patients were analyzed. The follow-up period was between 1.5 years and 12.5 years(average 5.5 years). The arc of flexion-extension of the wrist was increased from average 74 degrees preoperatively to 96 degrees postoperatively. Among eight patients, five were free of pain and three had intermittent pain during heavy work. None of eight patients had any discomfort in daily work and changed his or her occupation. The grip strength was average 83% of the normal side. Carpal height ratio was average 0.48 preoperatively and was not changed postoperatively. Clinical results, assessed by Lichtman-Evans criteria, showed 4 good and 4 fair. The interpositional arthroplasty using pronator quadratus pedicled bone was considered as a very effective method for the treatment of stage III Kienbock's disease.
Arthroplasty* ; Female ; Follow-Up Studies ; Hand Strength ; Humans ; Male ; Occupations ; Osteonecrosis* ; Range of Motion, Articular ; Wrist

Hip arthroscopy has been useful for resolving unexplained pains of the hip joint, despite its clinical applicability came after many other joints. Surgical indications have been increasing recently. Moreover, additional surgical techniques allow both the anatomy and function to return to its normal state. Recently, the concepts and treatments for extra-articular pathologies, such as deep gluteal syndrome, ischiofemoral impingement, subspinal impingement and iliopsoas impingement as well as classic indication, such as femoroacetabular impingement, acetabular labral tear, loose bodies, and synovial osteochondromatosis have been introduced. We present a diagnosis and treatment for diverse indications of hip arthroscopy, preoperative considerations, surgical technique and postoperative rehabilitation.
Acetabulum ; Arthroscopy* ; Chondromatosis, Synovial ; Diagnosis ; Femoracetabular Impingement ; Hip Joint ; Hip* ; Joints ; Pathology ; Rehabilitation ; Tears

We performed a retrospective analysis of twenty-four consecutive hip arthroplasties (Total Hip Arthroplasty 18, Bipolar Arthroplasty 1, Cup revision 5) during which intraoperative frozen sections were analyzed to identify the occult active infection. We also reviewed the data such as laboratory findings (ESR, CRP), intraoperative culture, hip joint sonographic evaluation and permanent histologic section. Among the twenty-four patients those who received hip arthroplasties, 10 cases received revisional hip arthroplasties due to painful hip prosthesis loosening, 9 cases with infected hip prosthesis, 3 cases with infection after open reduction and internal fixation due to hip fracture and 2 cases with septic hip sequelae. Intraoperative frozen section had been obtained during staged revisional hip arthroplasties to determine the presence of active infection. We considered positive for infection if it shows more than 10 PML/HPF (Polymorphonuclear leukocyte /high power field) in at least 5 distinct microscopic fields from intraoperative tissue frozen section and postponed implantation of prosthesis. If it shows less than 5 PML/HPF, we performed revisional hip prosthesis implantation. We decided the implantation based on patient's condition, laboratory findings and intraoperative tissue conditions if it shows between 5 and 10 PML/HPF from intraoperative frozen section. At last follow up, 20 of 21 patients who had a revisional hip arthroplasties as below 10 PML/HPF from intraoperative frozen section remained free of infection (Specificity; 95%). We concluded that analysis of the intraoperative frozen sections is a reliable predictor as a guide to sepsis for the successful hip joint arthroplasties.
Arthroplasty* ; Arthroplasty, Replacement, Hip ; Follow-Up Studies ; Frozen Sections* ; Hip Joint ; Hip Prosthesis ; Hip* ; Humans ; Leukocytes ; Prostheses and Implants ; Retrospective Studies ; Sepsis* ; Ultrasonography