Total knee arthroplaty has been used to treat the elderly patient who has severe arthritis but the early designs were associated with many problems, which frequently led to early failure. In 1974, the total knee arthroplasty was introduced and the reported results of this operation have improved consistantly with time. Recently the good results has been shown to treat rheumatoid patients and osteoarthritis patients less than 45 years old patients. At the department of orthopaedic surgery of Kosin Medical College, between 1984 and 1988, total knee arthroplasty was performed in 17 patients (22 kness) who had rhematioid arthritis (7 patients) and osteoarthritis (11 patients), and had followed for an average of 1 year and 8 months. The results were as follows 1. The knee that had rheumatoid arthritis had better knee scores than that of osteoarthritis. 2. The knee that remained the post cruciate lig. had better range of motion than that sacrificed. 3. The knees that had not used cement had better knee scores than that had used the cement. 4. The knees that had patella resulrfacing had better scores for pain than that had not.
Aged ; Arthritis ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Humans ; Knee ; Osteoarthritis ; Patella ; Range of Motion, Articular

Myasthenia gravis (MG) is an autoimmune disease that affects neuromuscular junctions and usually manifests with muscle weakness that exhibits diurnal variability. However, MG can present with atypical symptoms, including very rarely cases presenting with a flaccid type of dysphonia. We report the first case of spasmodic dysphonia with a final diagnosis of generalized MG, which occurred in a 32-year-old female.
Adult ; Autoimmune Diseases ; Diagnosis ; Dysphonia* ; Female ; Humans ; Muscle Weakness ; Myasthenia Gravis* ; Neuromuscular Junction ; Voice Quality

Cerebrospinal fluid (CSF) rhinorrhea has become a relatively common disease due to increasingincidents oftraffic accidents and endoscopic sinus surgeries, including skull base surgery. Improvements in surgical skills and endoscopicequipment have contributed to broadening the indicationsforendoscopic management ofCSF rhinorrhea. Precise identification of the etiology and leakage site is important for the treatment of CSF rhinorrhea. A variety of sealing techniques, such as overlay, underlay, and bath-plug, showed similar surgical outcomes. In addition, the type of graft material did not make a difference inthe surgical results. Therefore, thechoice of technique and graft material depends on the judgment of the surgeon. Endoscopic management of CSF rhinorrhea demonstrated anexcellent success rate and low morbidity. There were only few complications duringendoscopic management of CSF rhinorrhea and these were not serious. In conclusion, endoscopic management is effective for CSF rhinorrhea and should be initially considered for the treatment of CSF leakage.
Cerebrospinal Fluid ; Cerebrospinal Fluid Rhinorrhea* ; Endoscopes ; Judgment ; Skull Base ; Transplants

No abstract available.
Hemorrhoidectomy*

Rare cases of a congenital absence of the long head of the biceps tendon (LHBT) have been reported, and its incidence is unknown. In a literature review of the congenital absence of the LHBT, only 1 case was associated with posterior shoulder instability and severe posterior glenoid dysplasia. This paper reports the first case of a patient with a bilateral congenital absence of the LHBT with posterior shoulder instability without glenoid dysplasia or posterior glenoid tilt. The patient experienced a traffic accident while holding the gear stick with his right hand. After the accident, a posteroinferior labral tear with paralabral cysts was detected on the magnetic resonance images. The congenital absence of the LHBT was assumed to have affected the posterior instability that possibly increased the susceptibility to a subsequent traumatic posterior inferior labral tear. This case was identified as a posterior inferior tear caused by a traumatic ‘gear stick injury’.
Accidents, Traffic ; Hand ; Head ; Humans ; Incidence ; Shoulder ; Tears ; Tendons

No abstract available.
Abdominal Wall ; Herpes Zoster

The fungal ball is the most frequent non-invasive form of fungal sinusitis. Some authors have reported opportunistic fungus infections caused by retained foreign bodies in the maxillary sinus. Whereas previously reported foreign bodies were almost always metal materials, we report the case of a fungus ball caused by retained pieces of glass for 30 years. The patient complained of unilateral nasal obstruction. Computed tomography revealed fungal sinusitis and foreign bodies in the left maxillary sinus. The fungus ball and foreign bodies were removed via an endoscopic sinus surgery. After surgical removal, the patient became free from nasal symptoms.
Foreign Bodies* ; Fungi ; Glass* ; Humans ; Maxillary Sinus* ; Nasal Obstruction ; Sinusitis

The reconstruction of soft tissue defects on the leg remains a difficult challenge for plastic surgeons. If the defect is large and complicated by bone or joint defects, and excellent result can be obtained with free tissue transfer. In cases with no bony problem, no severe osteomyelitis and small medium-sized defects local flap is more acceptable than free tissue transfer because of its simple onestage and reliable operation. Fasciocutaneous turnover flaps revolve around the lack of criteria for safely designing these random pattern flaps as well as the risk of donorsite problems. Vertically-based deep fascia turnover flaps nourished by the subfascial plexus within deep fascia were used successfully for reconstruction of the leg in 5 patients. A vertically-based deep fascia turnover flap consists of deep fascia of the leg and its subfascial and epifascial plexus. As musculofascial, septofascial and periosteofascial branches these contribute to a richly anastomosing vascular network within deep fascia. Unlike adipofascial turnover flaps, the transversely-oriented deep fascia turnover flap keeps its subcutaneous layer with its intact vascular plexus so that the overlying skin is adequately perfused, even in patients with sizable flaps or extremely thin skin. Between March 1998 and February 1999, five cases underwent this procedure to reconstruct soft tissue defect on the leg. The advantages of this method are fast, safelyelevated preservation of the superficial vascular plexus, thus preserving the shape of the leg minimizing donor site scar and hypertrophy.
Cicatrix ; Fascia* ; Humans ; Hypertrophy ; Joints ; Leg* ; Osteomyelitis ; Skin ; Tissue Donors

Actinomycosis is a rare anaerobic, gram-positive bacterial infection caused by Actinomyces, which is a normal flora in the gastrointestinal and female genitourinary tracts. The cervicofacial area is a common infection site for actinomycosis, while nasal cavity is rare. Generally, standard treatment of the disease is a long term antibiotics therapy. However, a treatment strategy for nasal actinomycosis has not been established due to its rarity. We present a case of nasal actinomycosis that was managed by surgical removal. A 49-year-old woman visited our clinic with epistaxis and foul odor and nasoendoscopy showed a mass in patient's right nasal cavity. The mass comprised of Actinomyces was easily removed by endoscopic surgery. Further histopathologic examination revealed that the surrounding tissues did not contain Actinomyces, so we stopped applying antibiotics to the patients. No recurrence has been observed for 26 months. We report this rare case of nasal actinomycosis with a literature review regarding treatment.
Actinomyces ; Actinomycosis* ; Anti-Bacterial Agents ; Epistaxis ; Female ; Gram-Positive Bacterial Infections ; Humans ; Middle Aged ; Nasal Cavity* ; Odors ; Patient Rights ; Recurrence

PURPOSE: To evaluate functional results and complications after minimally invasive plate osteosynthesis through an anterior approach for distal tibial fractures, including pilon fracture. MATERIALS AND METHODS: Between March 2007 and December 2008, thirteen patients with fractures of the distal tibia were treated with minimally invasive plate osteosynthesis through an anterior approach, and were followed for a mean of 16.2 months (range, 12-30 months). Fractures according to the AO/OTA classification were six 43A, four 43B and three 43C. We analyzed functional results by bone union, postoperative complications, and the Olerud and Molander ankle scoring system. RESULTS: All fractures were united after a mean of 15.7 weeks (range, 12 to 24 weeks) except one case. There were 2 cases of superficial wound infection, one case of fibular shortening and metal failure, and two cases of tibialis anterior tendon adhesion. The average functional score was 79 points (range, 35-95 points) and results were four excellent, six good and three fair. CONCLUSION: Minimally invasive plate osteosynthesis through an anterior approach may be used for distal tibial fracture with medial soft tissue injury, and has an advantage in that the metaphyseal and distal articular fracture are fixed at the same time through a single incision However, it should be approached with caution because of the risk of complications due to the anterior approach, such as iatrogenic injury of the tibialis anterior tendon.
Animals ; Ankle ; Humans ; Imidazoles ; Nitro Compounds ; Postoperative Complications ; Soft Tissue Injuries ; Tendons ; Tibia ; Tibial Fractures ; Wound Infection