Fifty four consecutive total knee arthroplasties were reviewed to compare the accuracy of extramedullary versus intramedullary tibial resection guides. An extramedullary guide ( Group I ) was used in 25 cases and an intramedullary guide ( Group 2 ) was used in 29 cases. Group 1 system included the LCS knee system and Group 2 system included the Whiteside Ortholoc Advantim total condylar knee system. Preoperatively, the two groups were similar, with no statistical significant differences observed in diagnosis, alignment, and patient age. Postoperative tibial component alignment angles were similar in both group (Group 1, 0.8degrees varus; Group 2, 1.1degrees varus ). In group 1, 84% of tibial components were aligned within 2degrees of the 90degrees goal and in group 2, 83% of tibial components were aligned within the same range ( p > 0.05 ). In all cases, an intramedullary guide was used to prepare the distal femur. In femorotibial angles, with group 1 averaging 4.2degrees valgus versus 4.7degrees valgus in group 2 (p > 0.05). If the optimal femorotibial angle was defined by the range from 5+/-2, it was achieved in 76% in Group 1 and 72% in Group 2 ( p > 0.05 ). This study demonstrates no significant differences between the extramedullary and intramedullary group not only in optimal tibial component alignment angle but also in optimal femorotibial angle. This means that each system is satisfactory for the tibial side, but it is more important for the surgeon to appreciate that the indications, potential limitations and sources of errors are unique to each system and to decide which system to use according to the particular case in question.
Arthroplasty* ; Diagnosis ; Femur ; Humans ; Knee*

PURPOSE: To evaluate the clinical characteristics, treatments and outcome of patients with hemorrhagic shock and encephalopathy(HSE) syndrome. METHODS: We performed a clinical study on 14 patients who were diagnosed as hemorrhagic shock and having encephalopathy syndrome in the Department of Pediatrics, from 1984 to 1998. Age, sex, clinical symptoms and physical findings at admission, the most deranged laboratory findings, radiologic findings, treatments and outcome were analyzed. RESULTS: The age of onset was 1.0+/-0.9 years and the male to female ratio was 1: 1.8. At admission, clinical findings included dehydration in 85.7%, shock in 85.7%, fever in 71.4%, vomiting in 71.4%, diarrhea in 64.3%, GI bleeding in 50%, convulsion in 42.9%, and edema in 35.7%. Altered mental state was found in 100%, hepatomegaly in 64.3%, and splenomegaly in 21.4%. Laboratory findings revealed D-dimer positive in 92.9%, the mean hemoglobin level 8.2+/-2.1g/dL, BUN 35.7+/-24.0mg/dL, creatinine 1.9+/-1.5mg/dL, AST 561.0+/-1,412.1IU/L, ALT 858.9+/-1,649.8IU/L, blood glucose 229.5+/-197.4mg/dL, ammonia 195.4+/-129.7pg/dL, and total bilirubin 4.9+/-8.2mg/dL. On serologic tests, rotavirus and Epstein-Barr virus was found in 1 patient(7.1%), respectively. The mortality rate was 78.6%. CONCLUSION: We found that shock and disseminated intravascular coagulation(DIC) played important roles in the pathogensis of HSE syndrome, and encephalopathy, hepatic and renal insufficiency, and respiratory failure were secondary complications resulting from shock and DIC. Despite vigorous treatment, the prognosis was very poor. We feel more efforts should be focused on investigating the etiology and pathophysiology of HSE to prevent as well as develop a specific therapy. (J Korean Pediatr Soc 2000;43:814-819)
Age of Onset ; Ammonia ; Bilirubin ; Blood Glucose ; Creatinine ; Dacarbazine ; Death, Sudden* ; Dehydration ; Diarrhea ; Edema ; Female ; Fever ; Hemorrhage ; Hepatic Encephalopathy ; Hepatomegaly ; Herpesvirus 4, Human ; Humans ; Infant* ; Male ; Mortality ; Pediatrics ; Prognosis ; Renal Insufficiency ; Respiratory Insufficiency ; Rotavirus ; Seizures ; Serologic Tests ; Shock ; Shock, Hemorrhagic* ; Splenomegaly ; Vomiting

No abstract available.
Meningitis, Cryptococcal*

The cutaneous metastaaes from carcinoma of breast produce four definite clinical types: inflammatory carcinoma, telangiectatic carcinoma, nodular carcinoma, and carcinoma en cuirasse. We present a case of 51-year-old woman who had purpuric, hard, sclerotic plaque with ulceration, crust and. several pea-sized hemorrhagic papulovesicular eruptions on the right chest wall for one year. Histopathological findings show metastatic ductal carcinoma but, the primary focus was not determined.
Breast ; Carcinoma, Ductal ; Female ; Humans ; Middle Aged ; Thoracic Wall ; Ulcer

PURPOSE: To report the results of acetabular revisions performed with the cementless, hemi-spherical porous coated component supported by viable host bone and minimal allobone graft for acetabular deficiencies. MATERIALS AND METHODS: A retrospective study was completed for 22-revision acetabular components, using the cementless hemispherical porous coated prosthesis and minimal femoral head allograft. There was an average follow up of 48 months, with a range of 24 to 84 months. Radiographic measurements were performed in several aspects; cup-allograft contact, inclination, vertical and horizontal migration of acetabular cup, and acetabular zone by modified zone of DeLee and Charnley, in which location, size and progression or non-progression of radiolucent zone were recorded. The acetabular deficiencies were classified by the American Academy of Orthopaedic Surgeons Committee and were type I in 2 hips (9%), type II in 12 hips (55%), and type III in 8 hips (36%). Twenty acetabular cup cases of Harris-Galante II were used in this study, 1 case of Harris- Galante I, and 1 case of Duraloc. The average size of the cup was 57(44-66) mm. RESULTS: The average cup-allograft contact was 72.5% in 19 cases and we could not differentiate the margin between the host bone and the allograft in 3 cases. There was no significant vertical or horizontal migration of acetabular cup. Radiolucent zones in follow-up radiographs were 8 cases in zone IA, 4 cases in zone IB, 4 cases in zone IIB, 9 cases in zone IIC, 8 cases in zone IIIA, and 7 cases in zone IIIB. One case showed 2 mm radiolucent area in zone IIC and another case showed 3 mm radiolucent area in zone IIB, but the radiolucencies were not progressive. The remaining cases showed less than 0.5 mm radiolucent area or no radiolucent zone. The average period of bony incorporation was 13.1 months. CONCLUSIONS: We suppose that acetabular revision with the cementless hemispherical porous coated cup supported by viable host bone and minimal bone graft produces good results.
Acetabulum* ; Allografts ; Follow-Up Studies ; Head ; Hip ; Prostheses and Implants* ; Retrospective Studies ; Transplants

It is well studied about the composition of tear and it`s function, but not about the proportion of tear proteins in the dry eye, in which tear volume is reduced and tear film is unstable. Therefore, we performed this study to determine the proportion of tear proteins. This study involved 150 subjects, 50 volunteers and 100 outpatients who visited Ophthalmologic department from January to December in 1997. Dry eye was classified into mild and severe dry eyes. Four fractions of tear protein were demonstrated by electrophoresis. The proportion of tear proteins in fraction 1 to 4 were 31.0+/-5.9%(mean+/-standard deviation), 2.9+/-1.3%, 40.8+/-5.5%, 25.2+/-5.2%, in control group, 33.4+/-7.1%, 3.4+/-3.0%, 41.6+/-7.7%, 21.5+/-4.8% in mild dry eye group, 37.5+/-11.4%, 3.2+/-2.2%, 40.3+/-9.1%, 19.5+/-5.3% in severe dry eye group respectively. With severty of the dry eye, the proportion of fraction 1 was increased and the proportion of fraction 4 was decreased, both of which were statistically significant difference(P<0.01). In proportion to the severity of dry eye, the proportion of tear proteins became unstable. For the diagnosis and management of the dry eye,we consider the supplement of the decreased portion of tear proteins.
Diagnosis ; Electrophoresis ; Humans ; Outpatients ; Tears* ; Volunteers

No abstract available.
Humans*

STUDY DESIGN: A retrospective analysis of 166 patients was undertaken to observe radiologically the changes of adjacent segments at follow-up more than three years after lumbar fusion. OBJECTIVES: The purpose of this study is to analyse the changes of adjacent segments and to correlate these changes to the length of using level and to the degree of deviation from physiologic lumbar lordosis. The authors also correlate these radiologic changes to the clinical symptoms. MATERIALS AND METHODS: In simple x-ray, authors observed traction spur, disc space narrowing, endplate sclerosis and vacuum phenomenon of adjacent segments. Authors used Gelb's criteria in segmental lordosis angle(SLA) and Katz's classification in clinical results. RESULTS: The average age was 49.6 years old and the average follow-up period was 57.2 months(4 years and 9.2 months). We observed radiologically the traction spurs in 35 cases(21.1%), end-plate sclerosis in 32 cases(19.3%), disc space narrowing in 33 cases(19.9%) and the vacuum phenomenon in 10 cases(6.0%). The numbers of fusion segments and the degree of unphysiologic segmental lordosis angle in fusion segments were related with the frequency and degree of changes of adjacent segments(P<0.05). The clinical results showed satisfaction in 142 cases(85.5%), unsatisfaction in 24 cases(14.5%) and low back pain in 24 cases(14.5%), leg pain in 11 cases(6.6%) and extension of fusion level in 4 cases(2.4%). In low back pain patients more than two kinds of radiological changes were frequently observed than the patients without low back pain(P<0.05). CONCLUSIONS: The radiological changes of adjacent segments were more frequently observed in long fusion and in fusion with unphysiologic lumbar lordosis angle. And these changes are frequently associated with low back pain. Thus long fusion and fusion with unphysiologic lumbar lordosis angle should be avoided if possible.
Animals ; Classification ; Follow-Up Studies* ; Humans ; Leg ; Lordosis ; Low Back Pain ; Retrospective Studies ; Sclerosis ; Spinal Fusion* ; Traction ; Vacuum

No abstract available.

No abstract available.
Hantaan virus* ; Hemorrhagic Fever with Renal Syndrome* ; Prevalence*