The goal of total knee replacement is to relieve pain, to stabilize joint movement and to correct deformity. It is indicated for patients with rheumatoid arthritis, osteoarthritis and severe post-traumatic arthritis. The author analyzed 71 patients(106 cases), who received the PFC type of total knee replacement from August 1992 and the results were as follows; 1. Among the 71 patients, male was 8 patients and female was 63 patients whose average age was 56 years and average follow up period was 24 months, ranged from 8 months to 3 years 8 months. 2. Rheumatoid arthritis was the most common cause with 31 patients(56 cases) followed by osteoarthritis with 39 patients(49 cases). There was also one patient(1 case) that showed bony union of the knee due to old tuberculosis. The average duration of the illness was 12 years and the average weight of the patients was 57.7kg. 3. Flexion contracture decreased from an average of 21 degrees to 5 degrees after the operation. The range of motion increased from an average of 92 degrees before the operation to 117 degrees afterwards in cases of rheumatoid arthritis and decreased slightly from 108 degrees to 106 degrees in cases of osteoarthritis. 4. The tibiofemoral angle was corrected from an average 1.5 degrees varus before the operation to an average 6.7 degrees valgus after operation. Eighty seven percent of patients with rheumatoid arthritis showed valgus deformity and seventy eight percent of degenerative osteoarthritis patients showed varus deformity preoperatively. 5. Radiographically, the joint line position shifted an average 2.3mm in rheumatoid arthritis and an average 0.3mm in osteoarthritis. The component position, the femoral flexion was an average 89.6 degrees in the anteroposterior view, an average 87 degrees in the lateral view. 6. The thickness of the patella measured in the operating room of 61 cases was an average 21mm and after resection of patella, the remaining bone measured an average of 13.6mm. 7. To achieve soft tissue balance, 29 patients(33 cases) underwent medial stripping and 23 patients(30 cases) had patella lateral release. 8. The Insall Knee Rating Score was used to evaluate the results. The results were 69 cases excellent, 33 cases good, 3 fair and 1 poor. Ninety two percent of the patients had good or excellent results in average 24 months follow-up. 9. The complications consisted of one case of delayed deep infection, one case of patellar subluxation and one case of supracondylar fracture of the femur.
Arthritis ; Arthritis, Rheumatoid ; Arthroplasty, Replacement, Knee ; Congenital Abnormalities ; Contracture ; Female ; Femur ; Follow-Up Studies ; Humans ; Joints ; Knee ; Male ; Operating Rooms ; Osteoarthritis ; Patella ; Range of Motion, Articular ; Tuberculosis

The lymphoepithelial cyst (LEC) rarely occurs in the thyroid gland. The LEC has been thought to be related to developmental rest, namely solid cell nest, which is derived from ultimobranchial body. We report a case of lymphoepithial cyst in a 34- year-old woman clinically diagnosed with Hashimoto's thyroiditis. The cyst was located in mid to lower portion of the left lobe. It was a single unilocular cyst, which for the most part was lined with squamous epithelium, and at certain foci with ciliated columnar epithelium. The cyst wall showed a dense lymphocytic infiltration, numerous lymphoid follicles with germinal centers and admixed thyroid follicles. This morphology is similar to the branchial cleft cyst, with the exception of the thyroid follicles in the cyst wall. Near the cyst were several solid epidermoid cell nests. Immunohistochemical stain of this cyst-lining epithelium and solid cell nests showed CEA positivity. In view of the similarity in histomorphology and CEA positivity to branchial cleft cyst of the lateral neck, the LEC of the thyroid could also have been of branchial origin. However, the admixed thyroid follicles in the cyst wall suggests that the LEC of the thyroid gland might have derived from another branchial cleft as a ultimobranchial body, because it has the potential for thyroid follicular differentiation.
Branchial Region* ; Branchioma ; Epithelium ; Female ; Germinal Center ; Humans ; Neck ; Thyroid Gland* ; Thyroiditis ; Ultimobranchial Body

The modality of treatment for malignant or benign aggressive tumors in the shoulder includes radical or wide removal of the lesion, accompanied by chemotherapy or radiotherapy. With the introduction of chemotherapy, advance in surgical techniques, and improvements in radiographic imaging studies, the shoulder resection with reconstruction or replantation is a limb-sparing surgical option to be considered for bony and soft-tissue tumors in and around the shoulder, but amputation is used still if inevitable. We treated 16 tumors in or around the shoulder from June 1986 to August 1991: thirteen shoulder resections, two shoulder disarticulations, and one forequarter nine patients, reconstructed with a free fibular graft in two or with a allograft and myocutaneous flap in two. Chemotherapy or radiotherapy were followed if indicated. Function of the hand after the operations should be nearly normal. Mean rating for functional results was 69% (range 43-97%) by criteria of Enneking et al. During the follow-up of the mean 4 years and 1 month, a distant metastasis occurred in one case, leading to death and a local recurrence was noted in another one, indicating the forequarter amputation. Our experience indicates that shoulder resection with reconstruction or replantation can to be used for limb salvage in selected patient with tumors in or around the shoulder.
Allografts ; Amputation ; Disarticulation ; Drug Therapy ; Follow-Up Studies ; Hand ; Humans ; Limb Salvage ; Myocutaneous Flap ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Replantation ; Shoulder ; Transplants

The emergency arteriography have been performed in a total of 13 patiens with extermity trauma, including 9fractures, 3 blunting traumas, and 1 penetrating injury. over 17 months period. The indications were as follows:absent or diminishe pulse, swelling, sensory or motor deficit , and hypotension. Patients with an absent pulse,the most reliable indication of arterial injury, should have immediate arteriography. The superficial femoralartery was commonly injured especially with distal femoral shaft fracture. The most common arteriographic findingswas arterial occlusion.
Angiography ; Emergencies ; Extremities ; Humans ; Hypotension

No abstract available.
Abscess*

No abstract available.
Arteriovenous Fistula*

Epstein's syndrome is a rare disease whish is characterized by the association of thrombocytopenia, macrothrombocytopathia, nephritis and deafness. We experienced a case of Epstein's syndrome in a 12 years old male patient who was presented with a life long history of bleeding, usually as epistaxis, bilateral sensorineural deafness and hematuria with proteinuria starting in late childhood. Hematologic studies showed thrombocytopenia with giant platelets and anemia. A bone marrow aspirate revealed the megakaryocytes to be adequate in number and many giant size platelets. Platelet do not respond to addition of A and epinephrine; collagen and ristocetin induced agglutination response is decreased. It is difficult to be certain the association of thrombocytopenia with giant platelets, nephritis and deafness constitutes a new hereditary disease with a distinct pathogenesis or if it is an expansion of the well recognized Alport's syndrome of hereditary nephritis deafness. We report a case of Epstein's syndrome syndrome with brief review of related literatures.
Agglutination ; Anemia ; Blood Platelets ; Bone Marrow ; Child ; Collagen ; Deafness ; Epinephrine ; Epistaxis ; Genetic Diseases, Inborn ; Hematuria ; Hemorrhage ; Humans ; Male ; Megakaryocytes ; Nephritis ; Nephritis, Hereditary ; Proteinuria ; Rare Diseases ; Ristocetin ; Thrombocytopenia

BACKGROUND: Recently, inireaing numbers of chemotherapeutic agens are being used to treat cancer patients. Mucocutaeous complications are commonly sen in association with the administration of these medicaticins. OBJECTIVE: We conducted a study in cancer chemotherapy patient so determine the suspected chemotherapeutic agents ancl frequency of various mucocutaneous side effects in these patients. METHODS: The study involved 140 patients admitted from Decerrae 1993 to September 1994 for cancer chemot herapy at Korea University Guro Hospital. RESULTS: The mucocutaneous side effects during chemotherapy were alopecia(55%), hyperpig mentation(32.9%), stomatitis(20%), phlebitis(12.9%), flushing(8.6%) descending order. Visual grade II, IV alopecia patients were most common, but as the chemot retpy cycle increased so, the severer the alopecia. Although the onset of the alopecia were variake many patients experienced alopcia within 17 to 24 days after the start of chemotherapy. Serpeitie supravenous fluorouracil hyperpigmentation were commor,(17.9%), Diffuse and longitudinal or horizontal band like nail pigmentation were observed, and, pigmented macules were also observei, epecially on the palms and digits. Stomatitis usually developed within 10 days after the start of chemotherapy and it persist ed for about 7 days and the most of the lesions were resolved spor Laeously. Other clinical manifestations accompanied with chmotherapy were tinea infection(16.4%), acne(7.1%), oral thrush (7%), white nail band(4.3%), pruritus(2.9%) in descending order. CONCLUSION: So, physiciars need to be aware of the widely divergnal cutaneous reactions which may occur with the use of antiancer medications.
Alopecia ; Candidiasis, Oral ; Drug Therapy* ; Fluorouracil ; Humans ; Hyperpigmentation ; Korea ; Pigmentation ; Stomatitis ; Tinea

No abstract available.
Pulmonary Edema*

PURPOSE: We evaluated the frequency of detection of small hepatic cystic lesion(SHC) on abdominal CT films and its significance in patients with extrahepatic malignancies. METHODS AND MATERIALS: We retrospectively reviewed the abdominal CT films of a total 1112 patients to determine the frequency of detection of SHC, and 62 patients who had both extrahepatic malignancies and SHC were selected. A total 106 SHC determined as benign or malignant in 40 patients was analyzed according to the size(< 1 cm, 1 2cm), the number(1, 2 4, >4), the margin(well-defined, iil-defined),and the location(central, peripheral) of individual cystic lesions. The findings of follow-up CT and ultrasonography and the results of biopsy were also reviewed. The frequency of combined renal cyst was also considered. RESULT: SHC of those 62 patients were classified as benign(27 patients, 43.6%), malignant(13 patients, 20. 9%), or undetermined(22 patients, 35.5%) by the follow-up CT, ultrasonography, and biopsy. Most benign SHC (74.4%) measured under 1 cm, but 75% of the malignant SHC were in 1 -2cm in size. The percentage of the malignancy in one and two to four SHC was 37.5% and 40%, respectively. The margin of SHC was ill-defined in 67.9% of the benign and 64.3% of the malignant lesions. SHCs were mainly located at the periphery of the liver(benign :62.7%, malignant: 64.3%). Coexisting renal cyst was rare. CONCLUSION: SHC is not uncommon finding(13.2%) in patients with extrahepatic malignancy and has a high probablity of metastasis when it is larger than 1 cm, which should be closely followed and intensively studied further.
Biopsy ; Follow-Up Studies ; Humans ; Incidence* ; Neoplasm Metastasis ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography