PURPOSE: The mobile bearing, low contact stress, total knee replacement arthroplasty has proven successful with a high long-term survival rate and a low complication rate. Over 1,200 LCS knee has been successful with 97% survival. MATERIALS AND METHODS: However, we found fifteen knees showing early failure of mobile meniscal bearings with fracture, dislocation, and early wear, in some cases within three years. This caused the knee to subluxate and the bearings to dislocate. All fifteen knees had good surgical results with high HSS scores, normal valgus alignment, adequate sizing of the implants, lack of changes in the prosthese/bone interface as evidenced by the x-rays, and good ligament balancing. RESULTS: The reasons of the failure were: 1. Proportionately overweight patients. 2. Probable poor polyethylene quality due to air gamma radiation sterilization of the implant. 3. Overuse by the patients, causing undue load on the polyethylene. All patients with meniscal bearing failure had undergone revision surgery with good surgical results. CONCLUSIONS: We feel this merits further study to determine the relationship between the load and size of polyethylene mass in the rate of wear. While there are studies in the importance of thickness in relation to wear, we found no study on the effect that load has on the mass of polyethylene. We recommend a larger polyethylene tibial implant and rotating platform prostheses be used for an overweight patient and/or patient with high level of activity, both of which forecast a high load on the implant.
Arthroplasty* ; Arthroplasty, Replacement, Knee* ; Dislocations ; Gamma Rays ; Humans ; Knee ; Ligaments ; Overweight ; Polyethylene ; Prostheses and Implants ; Sterilization ; Survival Rate

Pseudomembranous colitis, although uncommon, is an important complication of antibiotics that is related to a variety of deleterious effects on the gastrointestinal tract. Rifampicin is one of the 1st line agents in the treatment of tuberculosis and a large number of patients are exposed to its potential adverse effects. We report upon a patient that had diarrhea due to pseudomembranous colitis after receiving antitubeculous medication, and which was probably caused by rifampicin. A 77-year-old man was admitted with diarrhea of three weeks duration. One month previously, he suffered from left pleuritic chest pain and left pleural effusion was noticed at chest X-ray. One week prior to the onset of diarrhea, he was started on empirically isoniazid, rifampicin, ethambutol and pyrazynamide as antituberculous medication. On admission, he complained of diarrhea, left pleuritic chest pain, dyspnea and sputum. On physical examination, breathing sound was decreased in the left lower lung field and bowel sound increased. Pleural biopsy revealed chronic granulomatous infalmmation, which was compatible with tuberculosis. Sigmoidoscopy showed whitish to yellowish pseudomembrane with intervening normal mucosa, and his stool was positive for C.difficle toxin. He was diagnosed as pseudomembranous colitis and treated with oral metronidazole and vancomycin. The diarrhea did not recur after reinstitution of the anti-tuberculous medication without rifampicin. In patients with severe diarrhea receining anti-tuberculous medication, rifampicin induced pseudomembranous colitis should be excluded.
Aged ; Anti-Bacterial Agents ; Biopsy ; Chest Pain ; Clostridium difficile ; Diarrhea ; Dyspnea ; Enterocolitis, Pseudomembranous* ; Ethambutol ; Gastrointestinal Tract ; Humans ; Isoniazid ; Lung ; Metronidazole ; Mucous Membrane ; Physical Examination ; Pleural Effusion ; Respiratory Sounds ; Rifampin* ; Sigmoidoscopy ; Sputum ; Thorax ; Tuberculosis ; Vancomycin

Pulmonary mucormycosis is an opportunistic infection in patients with severe underlying illness such as immunocompromised diseases or uncontrolled diabetes mellitus. While patients with leukemia and lymphoma usually resent with diffuse parenchymal disease, diabetic patients usually have a localized endobronchial disease involving central airways. We report upon a case of pulmonary mucormycosis in diabetes mellitus patient presenting as an endobronchial mass, which was cured with antifungal therapy, rigid bronchoscopic mass removal and right pneumonectomy.
Diabetes Mellitus ; Humans ; Leukemia ; Lymphoma ; Mucormycosis* ; Opportunistic Infections ; Pneumonectomy

BACKGROUND AND OBJECTIVES: Deep neck space infections, which affect soft tissues and fascial components of the head and neck, were frequently encountered in the preantibiotic era, but their frequency has been remarkably reduced after the development of chemotherapeutic agents and antibiotics. However, they may still result in significant morbidity and mortality despite the use of chemotherapeutic agents and antibiotics. The purposes of this study has been to assess clinical findings and the effectiveness of the treatment of deep neck infection through statistical analysis. MATERIALS AND METHODS: A retrospective study was performed on 86 cases of deep neck space infections in patients admitted for diagnosis and treatment during a 9-year period from January 1988 to December 1996. RESULTS: All cases were treated with either conservative treatment only as in 47 cases (55%), or surgical drainage and antibiotics as in 33 cases (33%), or surgical drainage with tracheostomy and antibiotics as in 6 cases (7%). At the end of the treatment, 83 cases were cured of the disease and 3 cases were reported to have complications. CONCLUSION: We concluded that treatment of deep neck infection requires knowledge of the natural history of the disease and a detailed understanding of anatomy. Management guidelines include (1) hospitalization, (2) culture and sensitivity tests, (3) antibiotic therapy, (4) diagnostic radiographic procedures, and (5) surgical intervention.
Anti-Bacterial Agents ; Diagnosis ; Drainage ; Head ; Hospitalization ; Humans ; Mortality ; Natural History ; Neck* ; Retrospective Studies ; Tracheostomy

PURPOSE: To evaluate prospectively the results of interventional radiologic placement of tunneled centralve-nous catheters, and subsequent complications. MATERIALS AND METHODS: Between April 1997 and April 1998, a totalof 557 tunneled central venous catheters were percutaneously placed in 517 consecutive patients in aninterventional radiology suite. The indications were chemotherapy in 533 cases, total parenteral nutrition in 23and transfusion in one. Complications were e-valuated prospectively by means of a chart review, chest radiography,central vein angiography and blood/catheter culture. RESULTS: The technical success rate for tunneled centralvenous catheter placement was 100% (557/557 cases). The duration of catheter placement ranged from 4 to 356 (mean,112 +/-4.6) days; Hickman catheters were re-moved in 252 cases during follow-up. Early complications included 3cases of pneumothorax(0.5%), 4 cases of local bleeding/hematoma(0.7%), 2 cases of primary malposition(0.4%), and 1case of catheter leakage(0.2%). Late complications included 42 cases of catheter-related infection(7.5%), 40 casesof venous thrombosis (7.2%), 18 cases of migration (3.2%), 5 cases of catheter / pericatheter of occlusion(0.8%),and 1 case of pseudoa-neurysm(0.2%) . The infection rate and thrombosis rate per 1000 days were 1.57 and 1.50,respectively. CONCLUSIONS: The technical success rate of interventional radiologic placement of tunneled centralvenous catheters was high. In comparison to conventional surgical placement , it is a more reliable method andleads to fewer complications.
Angiography ; Catheters ; Central Venous Catheters* ; Drug Therapy ; Follow-Up Studies ; Humans ; Parenteral Nutrition, Total ; Prospective Studies ; Thorax ; Thrombosis ; Veins ; Venous Thrombosis

PURPOSE: To evaluate the usefulness of functional MR imaging (fMRI) for the determination of languagedomi-nance and to assess differences in language lateralization according to activation task or activated area. MATERIALS AND METHODS: Functional maps of the language area were obtained during word generation tasks (noun andverb) and a reading task in ten patients (9 right handed, 1 left handed) who had undergone the Wada test. MRexaminations were performed using a 1.5T scanner and the EPI BOLD technique. The SPM program was employed for thepostprocessing of images and the threshold for significance was set at p<0.001 or p<0.01. A lateralization indexwas calculated from the number of activated pixels in three hemispheric re-gions (whole hemisphere, frontal lobe,and temporoparietal lobe), and the results were compared with those of Wada tests. The results for lateralizationof language area were compared among stimulation tasks and regions and used for calculation of lateralizationindices. RESULTS: During the Wada test, nine patients were left dominant and one patient was right dominant forlan-guage. Language dominance based on activated signals in each hemisphere was consistent with the results of theWada test in 87.5% (verb and noun generation tasks) and 90% (reading task) of patients. Language domi-nancedetermined by activated signals in the frontal lobe was consistent in 87.5%, 75%, and 80% of patients in eachstimulation task (verb generation, noun generation, and reading), respectively. The consistency rate of ac-tivatedsignals in the temporoparietal lobe was 87.5%, 87.5% and 80% of patients in each task. The mean val-ue of thelateralization index, calculated on the basis of activated signals in the temporoparietal lobe was higher thanthat in the hemisphere or frontal lobe. The verb generation task showed a higher lateralization index than thenoun generation or reading task. CONCLUSION: The lateralization index was higher in the verb generation task andin the region of the tem-poroparietal lobe than in other stimulation tasks or regions. fMRI is a potentiallyuseful non-invasive method for the determination of language dominance.
Frontal Lobe ; Hand ; Humans ; Magnetic Resonance Imaging*

Giant cell interstitial pneumonia, a synonym of (for) hard metal pneumoconiosis, is a unique form of pulmonary fibrosis resulting from an exposure to hard metal dust. A case of biopsy-proved giant cell interstitial pneumonia in the absence of appropriate history of exposure to hard metal dust is reported. The patient presented with clinical features of chronic interstitial lung disease or idiopathic pulmonary fibrosis. He worked in a chemical laboratory at a fertilizer plant(,)where he had been exposed to various chemicals such as benzene and toluene. He denied having any other hobby in his house or job at work which may have exposed him hard metal dust(.) High-resolution CT scan revealed multi-lobar distribution of ground glass opacity with peripheral and basal lung predominance. The retrieved fluid of bronchoalveolar lavage contained asbestos fiber and showed neutrophil predominance. Surgical lung biopsy was performed for a definite diagnosis. Lung specimen showed alveolar infiltration of numerous multinucleated giant cells with mild interstitial fibrosis. Upon detailed examination of the lung tissue, one asbestos body was found. An analysis for mineral contents in lung tissue was performed. Compared to with the control specimen, the amount of cobalt and several hard metal components in the lung tissue of this patient was ten times higher. We speculated that the inconsistency between occupational history and the findings of pathologic and mineralogical analyses could be explained by the difference in individual immunologic reactivity to hard metal dust despite the relatively small amount of unrecognized environmental exposure (ED: It's hard to understand what this phrase is trying to say).
Asbestos ; Benzene ; Biopsy ; Bronchoalveolar Lavage ; Cobalt ; Diagnosis ; Dust ; Environmental Exposure ; Fibrosis ; Giant Cells* ; Glass ; Hobbies ; Humans ; Idiopathic Pulmonary Fibrosis ; Lung ; Lung Diseases, Interstitial* ; Neutrophils ; Pneumoconiosis ; Pulmonary Fibrosis ; Toluene ; Tomography, X-Ray Computed

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis.Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis.Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.