The wrist joint is often involved in the early stages of the rheumatoid arthritis (RA) and is regarded as a main target of the disease. Since the wrist plays a key role in the articulations of the upper extremities, appropriate treatment of this joint will preserve the patient's work ability and independence. When surgical intervention is considered, determining the disease extent is as important as the type of rheumatoid involvement. This can be achieved by performing an extensive clinical and functional assessment of the extremities. In addition, understanding radiological findings also helps to determine the type of rheumatoid destruction, and the subsequent treatment algorithms. Success of surgical management depends on a well-considered strategy in the timing of different procedures. Prophylactic surgery, such as a synovectomy of the joint or tendon could be performed in the early stages to prevent further destruction and deformation. As destruction at the radiocarpal level progresses in the later stages of the disease, reconstructive surgery such as partial joint fusion combined with ulnar head resection, total wrist fusion or wrist arthroplasty could be considered. In the event of severe destruction, definitive stabilization by total wrist fusion is indicated. A pain-free, stable wrist joint often outweighs immobility.
Arthritis, Rheumatoid ; Arthrodesis ; Arthroplasty ; Extremities ; Head ; Joints ; Oxalates ; Synovitis ; Tendons ; Upper Extremity ; Wrist ; Wrist Joint

BACKGROUND: Apoptosis plays a crucial role in carcinogenesis, as well as in development and tissue homeostasis. Terminal deoxyribonucleotidyl transferase mediated neck end labelling (TUNEL) and in situ nick end labelling (ISEL) have been used to investigate the apoptosis in tissues. Since the introduction of the M30 monoclonal antibody to overcome drawbacks of TUNEL and ISEL, the apoptosis in various tumors, with the exception of pulmonary carcinomas, has been studied. In this study, attempts were made to examine the correlation of apoptosis in non-small cell carcinomas, using both M30 and the expression of p53 protein, with the clinicopathological factors. MATERIAL AND METHOD: Forty five patients with surgically resected non-small cell carcinomas were included. Immunohistochemical staining with M30 and p53 monoclonal antibody were performed, and their expressions compared with the clinicopathological features. The overall survival time and recurrence-free survival time were calculated, and the factors influencing the survival time analyzed using a univariate analysis. The effects of the expression stati of M30 and p53 on the risks of cancer related to both death and recurrence were evaluated using a multivariate analysis. RESULT: The p53 positive group had many more M30 positive cells than the p53 negative group (p53 positive group; 61.7+/-26.8 cells vs. p53 negative group; 45.6+/-29.6 cells, p=0.005) and significantly more p53 positive patients showing at least 10 positive cells (apoptotic index, AI > or =1) on M30 staining (p53 positive group; 52.4% [11/21] vs. p53 negative group 16.7% [4/24], p=0.025). In the univariate analysis, the survival times in relation to smoking (pack-year), performance status (PS) and AI showed significant differences. The multivariate analysis demonstrated the relative risk (R.R) of cancer death increased almost 7.5-fold (R.R 7.482; 95% CI 1.886~29.678; p=0.004) and the risk of recurrence almost 3.8-fold (R.R 3.795; 95% CI; 1.184~12.158; p=0.025) in the high AI (> or =1) compared to the low AI (<1) group. There was no prognostic effect of p53 expression on the survival time or risk of cancer death and recurrence. CONCLUSION: In non-small cell lung carcinomas, M30 immunohistochemistry was an excellent method for analyzing apoptosis; the high apoptotic index could be an adverse prognostic predictive factor.
Apoptosis* ; Carcinogenesis ; Cell Death ; DNA Nucleotidylexotransferase ; Homeostasis ; Humans ; Immunohistochemistry ; In Situ Nick-End Labeling ; Lung Neoplasms ; Lung* ; Multivariate Analysis ; Neck ; Recurrence ; Smoke ; Smoking

The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.

We analysed a series of 35 patients with primary cerebellar hemorrhage, diagnosed by computerized tomography scanning from 1985 to 1988. They constituted 6.6% of spontaneous intracerebral hemorrhage(35 out of 530) who were admitted during the same period. There were 13 men and 22 women. The site of hemorrhage was vermis in 15 patients and hemisphere in 20 patients. On admission, the Glasgow Coma Scale(GCS) value was less than 10 in 15 patients(42.3%) and not less than 10 in 20 patients(57.1%). Quadrigeminal cistern was normal in 11 patients(31.4%), partially obliterated in 15 patients(42.9%) and completely obliterated in 9 patients(25.7%). The largest diameter of the hematoma was less than 3cm in 15 patients(42.9%) and larger than 3cm in 20 patients(57.2%). Hydrocephalic change was observed in 21 patients(60%). The hematoma was removed via suboccipital craniectomy in 16 patients(45.7%) and managed conservatively in 11 patients(31.4%). In 8 patients(22.9%), external ventricular drainage was performed. The method of treatment was different according to the GCS value on admission, the status of the quadrigeminal cistern, the presence of hydrocephalic change, and the size of hematoma. Overall mortality rate was 22.9%. These results suggested that the conservative treatment can be done in patients with (1) high GCS value(not less than 10), (2) patent quadrigeminal cistern, (3) absent hydrocephalic change, and (4) small sized hematoma(less than 3cm). If not surgical treatment should be considered.
Coma ; Drainage ; Female ; Hematoma ; Hemorrhage* ; Humans ; Male ; Mortality

BACKGROUND: The Ki-67 protein is a biomarker associated with cell proliferation and a valuable negative prognostic factor in non-small cell lung cancer. We investigated the Ki-67 protein expression in resected non-small cell lung cancer to evaluate the impact on clinicopathological characteristics and postoperative prognosis. MATERIAL AND METHOD: Using monoclonal antibody Ki-67, we immunohistochemically examined 38 surgically resected non-small cell lung cancers to determine Ki-67 Labeling Index (LI). We analysed the differences of clinicopathological characteristics and postoperative recurrence and survival between High Ki-67 Group (LI> or =20%) and Low Ki-67 Group (LI<20%). RESULT: The Ki-67 LIs were heterogenous and a mean values was 20.0+/-20.05%. There were no significant differences in age, sex, smoking, TNM stage, and vascular invasion between High Ki-67 Group and Low Ki-67 Group. A High Ki-67 Group was significantly associated with squamous cell type, poor differentiation, and lymphatic invasion (p< or =0.05). High Ki-67 Group showed a trend of lower survival (median 47.2 vs. 96.5 months, p=0.312) and lower disease-free survival (median 18.2 vs. 72.3 months, p=0.327) than Low Ki-67 Group. CONCLUSION: These results indicate that increased Ki-67 protein expression may be a negative prognostic factor and showed a trend of shortened survival and disease-free survival. To evaluate the pivotal role of Ki-67 protein expression, a long-term follow-up and further study are required.
Carcinoma, Non-Small-Cell Lung ; Cell Proliferation ; Disease-Free Survival ; Follow-Up Studies ; Immunohistochemistry ; Lung Neoplasms* ; Lung* ; Prognosis ; Recurrence ; Smoke ; Smoking

PURPOSE: To find out the problem of modified Bosworth method and improve the method of operation. MATERIALS AND METHODS: 21patients treated with modified Bosworth method were evaluated after a minium follow-up period of two years. The results were analysed clinically and reontgenographically. RESULTS: In postoperative X-ray evaluation, the coracoclavicular interval of the operated side was decreased by an average of 0.8 mm compared with that of the normal side. There was no significant difference in coracoclavicular interval between after screw removal and last follow-up. Loosening of the screw was seen in 3 of the 5 cases overcorrected by more than 2 mm and the result was fair in two of them. A satisfactory result was obtained in 17 (81.1%) of the 21 cases. CONCLUSION: Modified Bosworth method for acute complete acromioclavicular dislocation yields better results provided the overcorrection and anterior displacement of the clavicle are appropriately protected.
Acromioclavicular Joint ; Clavicle ; Dislocations* ; Follow-Up Studies

PURPOSE: The authors report their experience and analyze the risk factors associated with difficulties in the removal of tibial intramedullary nails. MATERIALS AND METHODS: During the period from January 1996 to March 2001, 35 ACE(R) intramedullary nails were removed from healed tibial fractures. The authors analyzed risk factors associated with difficulties in nail removal. The five patients who had difficulties (Group I) were compared with 30 patients who had uneventful removal (Group II) in parameters of age, gender, duration of nail in situ, nail diameter, nail length, and the level of fracture. RESULTS: Younger age of patients (p=0.04) was the only significantly associated risk factors. Gender (p=0.61), the duration of time in situ (p=0.20), nail diameter (p=0.41), the length of nail (p=0.31) and the level of fracture (p=0.22) were not associated risk factors. CONCLUSION: It is suggested that patients undergoing the removal of ACE nails must be warned of possible difficulties that may be encountered.
Humans ; Risk Factors ; Tibia ; Tibial Fractures*

To perform the major operation for high risk patients with both serious systemic diseases and major organ complications, the monitored anesthesia care could be available as a reasonable alternative for both general and regional anesthesia when it is impossible to administer; however, the choice of analgesics and sedatives is still an important and difficult task. We present a high risk patient who suffers from neurologic complications including decreased consciousness caused by brain metastasis of lung cancer, cerebral infarction, quadriplegia and seizure as well as decreased respiratory function and bleeding tendency. When performing the operation on hip joints, we administered both dexmedetomidine as a major sedative, and remifentanil as an adjunct analgesic; as a result, we could successfully perform the monitored anesthesia care without any complications including cardiovascular instability, respiratory depression, and seizure.
Analgesics ; Anesthesia ; Anesthesia, Conduction ; Brain ; Cerebral Infarction ; Consciousness ; Dexmedetomidine ; Hemorrhage ; Hip ; Hip Joint ; Humans ; Hypnotics and Sedatives ; Lung ; Lung Neoplasms ; Neoplasm Metastasis ; Piperidines ; Quadriplegia ; Respiratory Insufficiency ; Seizures

Pulmonary edema is usually bilateral, but can be uncommonly unilateral. Although unilateral pulmonary edema (UPE) can occur owing to various etiologies, it usually occurs at a patient who has an underlying defect or abnormality in the cardiopulmonary system except a case of negative-pressure pulmonary edema. Especially UPE following general anesthesia is a rare complication in a healthy patient. Re-expansion pulmonary edema (REPE) as a cause of UPE mostly occurs when a chronically collapsed lung is rapidly re-expanded after pneumothorax. There are some reports associated with REPE following one-lung ventilation used to facilitate surgery, in which there is no chronically collapsed lung. There are, however, little reported cases of a more acute form of this complication following re-expansion after atelectasis due to only several minutes of an inadvertent main stem bronchial intubation during operation. A report of the occurrence of UPE in a healthy, young male undergoing two-jaw surgery is described.
Anesthesia, General ; Edema ; Humans ; Intubation ; Lung ; Male ; One-Lung Ventilation ; Pneumothorax ; Pulmonary Atelectasis ; Pulmonary Edema

BACKGROUND: Sevoflurane anesthesia commonly causes emergence agitation (EA) in children. One previous study has reported that the use of nitrous oxide (N2O) during the washout of sevoflurane may reduce EA by decreasing the residual sevoflurane concentration, while many animal studies suggest that N2O poses a potential risk to children. The present study was designed to compare EA in children assigned to receive sevoflurane with N2O (group N) or sevoflurane alone (group S). METHODS: We enrolled 80 children aged 3-10 years. Anesthesia was induced with 5 mg/kg thiopental sodium, 0.6 mg/kg rocuronium and 0.5 mg/kg ketorolac, and was maintained with 50% N2O and sevoflurane in group N or with sevoflurane alone in group S. The sevoflurane concentration was adjusted with a bispectral index (BIS) of 40-60. After completion of the surgery, N2O and sevoflurane were simultaneously discontinued and replaced with oxygen (O2) at 6 L/min. End-tidal sevoflurane concentration (Et Sevo) (%), BIS at the end of surgery, Et Sevo at recovery of self-respiration and emergence profiles were recorded. EA occurrence, pain score and rescue fentanyl consumption were assessed in the postanesthesia care unit. RESULTS: Et Sevo was significantly lower in group N (1.9%) than in group S (2.3%) at the end of surgery. However, there were no differences in Et Sevo at recovery of self-respiration, emergence times, the incidence of EA, pain score or dose of rescue fentanyl between the groups. CONCLUSIONS: In children undergoing adenotonsillectomy with preemptive ketorolac, anesthetic maintenance using sevoflurane alone does not affect the incidence of EA or emergence profiles compared to anesthetic maintenance using sevoflurane with N2O.
Anesthesia ; Animals ; Child* ; Dihydroergotamine* ; Fentanyl ; Humans ; Incidence ; Ketorolac* ; Nitrous Oxide ; Oxygen ; Thiopental