Total knee arthroplasty is indicated for painful joints, with or without deformity, secondary to rheumatoid arthritis, osteoarthritis, traumatic arthritis, and certain other forms of nonseptic arthropathy. Many patients with arthritic knees have symetrical involvement and thus require a bilateral operation. Staged bilateral arthroplastis were performed with many drawbacks such as prolonged hospitalization, repeated anesthetic risks, and increased cost. Simultaneous bilateral arthroplasty under one anesthesia by two teams offers several advantages over staged procedure. We studied the results of 145 total knee arthroplasties, performed over a five-year period, to compare unilateral(group I;45 knees), staged bilateral(group II; 24 knees), and simultaneous bilateral arthroplasties(group III; 76 knees) by 2 team approach. Duration of mean follow-up was 1 year and 9 months. The results are as flollows; 1. The mean anesthetic times were 189 minutes, 312 minutes, and 218 minutes for the group I,II,III, respectively. 2. The mean blood loss was 1075ml for the group I, 1644ml for the group II, and 1902ml for the group III. 3. The hospitalization period was 74.1 days in two stage procedures, while it was 48.6 days in simultaneous bilateral procedures. 4. Knee scores by Knee Rating Scale of Hospital for Special Surgery were increased to 85.3 points, 80.7 points, and 85.4 points for group I,II,III, respectively. 5. There were no difference in complication among three groups. 6. Group III had advantages such as reduced anesthetic risk, reduced rehabilitation period, and decreased cost.
Anesthesia ; Arthritis ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Congenital Abnormalities ; Follow-Up Studies ; Hospitalization ; Humans ; Joints ; Knee ; Osteoarthritis ; Rehabilitation

OBJECTIVE: This study was investigated on the relationship the degrees of proteinuria with the maternal characteristics, maternal and the neonatal outcomes. The correlation between the result of single urine protein- to-creatinine ratio and the amount of 24 hour urine protein was also investigated. METHODS: From December 1999 to June 2002, 63 patients were enrolled in this study. They were divided into two groups by the degree of proteinuria at 24 hour urine, single urine and dip stick test, respectively. Each two groups was compared with the maternal characteristics, gestational age, the maternal and the neonatal outcomes. The correlation between single urine protein-to-creatinine ratio and the amount of 24 hour urine protein was analyzed statistically. RESULTS: Each two groups of single urine and dip stick test had no differences in maternal characteristics, gestational age, maternal and the neonatal outcomes. However, in two of 24 hour urine, massive proteinuria group had poor maternal and neonatal outcomes compared with control group (p value 0.01). Single urine protein-to-creatine ratio and the amount 24 hour urine protein had borderline correlation (p value 0.064). CONCLUSION: The presence of proteinuria influences on maternal and neonatal outcomes. Moreover, the massive proteinuria group had more maternal and neonatal complication than control group. The result of single urine protein-to-creatine ratio had borderline correlation with the amount of protein in 24 hour urine collection.
Female ; Gestational Age ; Humans ; Hypertension, Pregnancy-Induced* ; Pregnancy ; Pregnancy* ; Proteinuria* ; Urine Specimen Collection

Emergent abdominal surgery in cirrhotic patients with ascites can result in dismal postoperative outcomes such as sepsis and hepatic failure. In the present case, small bowel resection followed by anastomosis by the hand-sewn method was performed for small bowel strangulation caused by an umbilical hernia; deceased donor liver transplantation was performed one week after the bowel resection because of deterioration of hepatic function. To the best of our knowledge, this is the first case of liver transplantation performed at only one week after small bowel resection; and although we obtained a good result, the optimal time to perform liver transplantation in this situation requires further evaluation.
Ascites ; Hernia, Umbilical* ; Humans ; Liver Failure ; Liver Transplantation* ; Sepsis ; Tissue Donors*

No abstract available.
Hematuria*

2268 cases of low back pain were analysed at the low back pain clinic, Department of Neurosurgery, Yongdong Severance Hospital Yonsei University College of Medicine from January to July 1986. 1) About 85.4% were in between 20's and 50's of age groups. 30's(25.7%) and 40's(24.7%) were common. Teenagers were about 5.9%. Male to female ratio was 1 : 1.1. 2) By occupations housewives were most common(40.5%), office workers 26.4% light workers 13.2%, and students 12.7% in order. But drivers(2.4%) and heavy workers(1.9%) were relatively rare. 3) About 30.7% of all patients had some history of trauma. Among them lifting was most common in 45.8%, exercise 17.8%, and traffic accident 10.8%. 4) About 37.8%(860 cases) had had various treatments before they came to our clinic. Among them, 63.6% had visited to other hospitals. 98 cases had had lumbar disc surgery at other hospitals. Among 860 cases physical therapies were 33.8%, acupunctures 22.8%, herb medications 13.4%, moxibustions 12.5%, chiropractics 5.5%, and religious methods 1.4%. 5) Diagnostic work up were done in 85%. Plain spine X-rays were taken in 97.8%, spine CT scan 53.7%, and myelography(Iopainidol) 7.6%. 6) Etiology of the low back pain were herniated lumbar disc 44.8%, mechanical low back pain syndromes 26.4%, degenerative spondylosis 22.1%, traumas 2.8%, spinal cord tumors 1.3%, failed back surgery syndromes 1.1%, spondylolysis 0.9%, spondylolisthesis 0.3% and infections 0.3%. 7) About 15.8% of all patients were admitted. Surgical treatments were done in 12.1%(275 cases), among them chemonucleolysis with chymopapain(Discase) were 6.6%(151 cases), lumbar discectomy 5.5%(122 cases) and posterior lumbar interbody fusion 2 cases. 8) In the past history 98 cases(4.3%) had had lumbar disc surgery at the other hospitals. Among them, 8 cases were reoperated.
Accidents, Traffic ; Adolescent ; Diskectomy ; Female ; Humans ; Intervertebral Disc Chemolysis ; Lifting ; Low Back Pain* ; Male ; Neurosurgery ; Occupations ; Spinal Cord Neoplasms ; Spine ; Spondylolisthesis ; Spondylolysis ; Spondylosis ; Tomography, X-Ray Computed

A 33-year-old woman was presented with dyspnea and chest discomfort after indigesting approximately 500ml of oil paint brush washing fluid. Hypoxic symptoms and radiographic infiltrates rapidly progressed. The patient was intubated and received mechanical ventilation. Bronchoalveolar lavage and transbronchial lung biopsies were performed. The CT scan of the lung showed bilateral extensive pneumonitis with necrosis and the lung tissue pathologic findings showed diffuse alveolar damage with extensive necrosis and numerous lipidladen macrophages. After intensive medical care with mechanical ventilation, her symptoms and radiological findings improved.
Adult ; Biopsy ; Bronchoalveolar Lavage ; Dyspnea ; Eating* ; Female ; Humans ; Lung ; Macrophages ; Necrosis ; Paint ; Pneumonia* ; Respiration, Artificial ; Thorax ; Tomography, X-Ray Computed

We identified the early and late prognostic factors of acute myocardial infarction, and evaluated the clinical differences and the prognosis between Q-wave myocardial infarction and non-Q wave myocardial infarction. Total 146 patients who were managed from Jan 1987 to Aug. 1989 at hallym University hospital were evaluated. According to the presence or absence of Q wave on electrocardiogram, the patients were divided into two groups : a Q wave myocardial infarction group(QMI) and a non-Q wave myocardial infarction group (NQMI). Among 146 patients 109 patients(74.7%) had QMI and 37 patients(25.3%) had NQNI. The mean age, male to female ratio and serum cholesterol level were similar in both groups. But peak level of CPK was significantly higher in the QMI group than that in the NQMI group(P<0.01). Left ventricular end-systolic dimension and ratio of left ventricular dimension to wall thickness in the QMI group were significantly higher than that in the NQMI group(P<0.01). There were no significant differences between two groups in the incidences of mortality, postinfarction angina and re-infarction. During the in-hospital period female gender, old age(more than 60 years), Killip class at admission, early reinfarction and a history of hypertension were significant prognostic factors. main causes of death during the in-hospital period were ventricular tachyarrthymia, heart failure and cardiogenic shock. The incidences of mortality, heart failure and post-infarction angina during a mean follow-up period of 14 months (6~30months) were same in the two groups. The late prognostic factors were old age(more than 60 years), Killip class at admission, heart failure occured during follow-up period(P<0.001) and a history of diabetes mellitus(P<0.05). The patients with late postinfarction angina had more dilated left ventricular end-systolic demension(P<0.05) and lower fractional shortening(P<0.01) than those of patients without late postinfraction angina. There were no significant difference in long term survival rate between QMI group and NQMI group. Further prospective study should be performed to clarify the short and long term prognosis in patients with acute myocardial infarction treated by reperfusion.
Cause of Death ; Cholesterol ; Electrocardiography ; Female ; Follow-Up Studies ; Heart Failure ; Humans ; Hypertension ; Incidence ; Male ; Mortality ; Myocardial Infarction* ; Prognosis ; Reperfusion ; Shock, Cardiogenic ; Survival Rate

The authors analysed 6 cases of lumbosacral tumors simulating lumbar disc diseases. Spine CT scan is the important diagnostic method for the investigation of lumbar disc diseases. But if the clinical feature is not correlated with lumbar CT scan, myelography must be performed to see any cauda equina tumor. At myelography, contrast medium should be run well up to the thoracic segments routinely, especially if no defect is found in the lumbar area.
Cauda Equina ; Myelography ; Spine ; Tomography, X-Ray Computed

No abstract available.
Adult* ; Cerebrospinal Fluid* ; Humans

The authors experienced a case of atypical type of idiopathic central serous chorioretinopathy that has bullous retinal pigment epithelium detachment and multiple leaking points. So, we report this case with the review of the literatures.
Central Serous Chorioretinopathy* ; Retinal Pigment Epithelium