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

No abstract available.
Osteomyelitis* ; Radionuclide Imaging*

Drash syndrome, which was first reported by Denys et al. in 1967 is a complex disorder which associates a nephropathy, Wilms' tumor, and male pseudohermaphroditism. The common denominator is a nephropathy. The nephropathy may be associated with either genital abnormalities or Wilms' tumor, and these associations are called incomplete form of Drash syndrome. This syndrome appears early in life and the first sign usually is genital ambiguity. The nephropathy presents with proteinuria, hematuria and hypertension, and eventually progresses to end stage renal failure. Renal biopsy may reveal a variety of glomerular and interstitial changes. Wilms' tumor may appear as s mass on ultrasound or it may not be recognized until nephrectomy or even autopsy. We report on a boy with nephropathy and genital abnormalities. A nephrotic syndrome with hypertension was present when first seen at 15 days of age. The karyotype was 46, XY and external genitalia was ambiguous. The nephrotic syndrome and signs of renal insufficiency persisted and he died at the age of 40 days. Histopathologic findings of kidney at autopsy revealed those of diffuse mesangial sclerosis. The case was presented with brief review of literatures.
46, XY Disorders of Sex Development ; Autopsy ; Biopsy ; Denys-Drash Syndrome* ; Disorders of Sex Development ; Genitalia ; Hematuria ; Humans ; Hypertension ; Karyotype ; Kidney ; Male ; Nephrectomy ; Nephrotic Syndrome ; Proteinuria ; Renal Insufficiency ; Sclerosis ; Ultrasonography ; Wilms Tumor

The term endometriosis refers to ectopic endometriume. It most often involves the pelvic organs, including ovaries, broad and round ligaments, fallopian tubes, cervix, vagina and the pouch of Douglas. We report a case of vesical endometriosis in a 4- year old female patient and review literature. Segmental resection of this mass with involved bladder resulted in cure and this lesion was confirmed histologically as endometriosis of the bladder.
Cervix Uteri ; Endometriosis* ; Endometrium ; Fallopian Tubes ; Female ; Humans ; Ovary ; Round Ligament of Uterus ; Urinary Bladder ; Vagina

INTRODUCTION: Premature ejaculation is the most prevalent form of male sexual dysfunction, but its cause has not been well established. Recently some studies indicated that penile sensitivity is decreased in men with premature ejaculation. MATERIALS AND METHODS: To clarify the association between penile sensitivity and premature ejaculation, we evaluated penile sensitivity in 18 patients with premature ejaculation without erectile dysfunction and neurologic deficit, and 15 normal potent male volunteers by SMV-5 digital vibrometer (Teknologue, Tokyo, Japan), which has higher precision and reproducibility than analogue type biothesiometers. Vibration thresholds were recorded at the glans penis, penile shaft, and frenulum of the penis in flaccid and erectile state induced by PGE1 10 ug. We also recorded those at ulnar process and medial maleolus of the tibia. RESULTS: There was no difference in vibration threshold at the ulnar process and the medial maleolus of the tibia between the two groups (p>0.05). And we found no difference in penile sensitivity at the glans penis, penile shaft, frenulum of the penis between the two groups, in both erectile and flaccid states (p>0.05). Penile sensitivity was decreased in erectile state compared to flaccid state, but it is not statistically significant (p>0.05). CONCLUSION: Based on our results, penile hypersensitivity measured by SMV-5 vibrometer does not appear to be a major factor contributing to premature ejaculation. And further study aimed at other somatic or cognitive factors awaits implementation.
Alprostadil ; Erectile Dysfunction ; Humans ; Hypersensitivity ; Male ; Neurologic Manifestations ; Penis ; Premature Ejaculation* ; Tibia ; Vibration ; Volunteers

BACKGROUND: Victims of trauma in the emergency room(ER) suffer from kinds of discomforts derived from their physical injury and psychological instability. Although discomforts may be varied by the patient's characteristics and environmental factors such as medical personnel or facilities in ER, an active control for the discomfort should be required because it may affect an outcome of treatment and prognosis of illness. The purpose of this study is to analyze the distressing factors which traumatized patients have been experienced in the ER and to improve the management of trauma patients in the future. METHODS: From January 1, 1996 to June 30, 1996, we tried to interview patients about the painful experiences in ER before the decision of his or her discharge from ER. We analyzed the data on age, sex, religion, educational level, injury severity score(ISS), the most unpleasant experience, sleep deprivation, and friar for death. RESULTS: The 126 patients were enrolled in this study. The patients consisted of 93 male and 33 female, their mean age was 45 years old and mean ISS was 7.86. About seventy one percent of the patients complained unpleasant experiences during the stay in the ER. Of these, pain at the injury sites was the most frequent complaint (66.7%). The sleep deprivation was showed about sixty percent of the total patient and the most common cause of this was also due to pain(40%). Nineteen percent of the patients answered that they have felt the fear for death. There were statistically significant differences in degree of the ISS whether the fear for death and unpleasant experience were or not. When the patients demarked with whether the presence of pain, the occurrence of sleep deprivation, and fear for death were statistically related to the pain. However, the data was denoted no direct relationship with pain according to sex, educational level, or religion. CONCLUSION: The trauma patient admitted to ER suffered from various stressful conditions including not only their physical injury but care personnel or unstable environmental factors in ER. Therefore, emergency medical personnel has to understand some possible distresses of the patients and need to reduce them to provide more careful and proper managements.
Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Sleep Deprivation

BACKGROUND: Pain is one of the most common presenting complaints in the emergency department(ED) and adequate analgesia for painful conditions is an important goal of emergency medical practice. This study was designed to investigate on the actual condition regarding the use of analgesic injections for traumatized patients in the field of ED and to reconsider the concern and methods of pain management in the future. METHOD: We carried out a prospective, noninterventional observational clinical study of adult patients presenting with acute trauma in the ED. Using a numeric rating scale ranging from 0 to 10, patients quantified their pain intensity on arriving at the ED and on one hour after analgesic administrations in the cases of analgesic use or after initial Assessment in the cases of no analgesic use. They also were interviewed about the level of their satisfaction to pain relief before leaving the ED. RESULTS: Seventy eight percent of all patient received analgesic injections(nonsteroidal antiinflammatory drugs; 62%, opioids; 16%) and the remaining 22 patients(22%) were treated without analgesics. At the time of secondary assessment to pain, initial pain score in the cases of analgesic administration decreased. Patients who are beyond fair in the level of satisfaction were recorded for only 18% of all patient even though 78% of patients received analgesic injections. CONCLUSION: Our data illustrate that the patient of trauma commonly receive analgesic injections in the ED but their levels of satisfaction are under fair. This finding suggests that the concern and methods of pain management have to be reconsidered through the understanding of analgesic pharmacology and pattern of pain relief by analgesics.
Adult ; Analgesia ; Analgesics ; Analgesics, Opioid ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Pain Management* ; Pharmacology ; Prospective Studies

Diabetic nephropathy is characterized by one or a combination of the following lesions: (1) glomerular involvement with three distinctive patterns: diffuse glomerulosclerosis, nodular glomerulosclerosis, and exudative lesions; (2) arteriolo sclerosis; (3) urinary tract bacterial infection with pyelonephritis and sometimes emphysematous pyelonephritis. Emphysematous pyelonephritis is an uncommon life-threatening and acute suppurative infection of the kidney, and usually occurs in diabetic female patients. It is characterized by the production of intraparenchymal gas. Glucose fermentation has been considered the main cause of the gas formation. We presented two illustrative nephrectomy cases of emphysematous pyelonephritis in addition to the typical pathologic features of diabetic nephropathy.
Bacterial Infections ; Diabetic Nephropathies* ; Female ; Fermentation ; Glucose ; Humans ; Kidney ; Nephrectomy ; Pyelonephritis* ; Sclerosis ; Urinary Tract

Complications after a median sternotomy incision, which is used currently in most open heart surgery, are serious, although it is infrequent. Reconstruction of the sternal defect resulting from dehiscence of median sternotomy is still big challenge to the most plastic surgeons. Since vascularized greater omentum was transposed to eliminate mediastinal wound problems, many vascularized regional muscle flaps became mainstay in reconstruction of median sternotomy wound. We treated 13 patients with median sternotomy dehiscence between October of 1993 and March of 1998. In two patients, the wound problems were so confined to superficial tissue that debrided and closed primarily. Eleven patients with deep wound infection were managed with vigorous debridement of all necrotic tissues and resultant defects were covered with regional muscle flaps: rectus myocutaneous flap(3) and bilateral pectoralis advancement flap(8). We used the pectoralis major advancement flaps without counter incision at humeral insertion site and the dissections were limited only medial to the anterior axillary line to preserve the axillary fold. In five patients with larger defects, we elevated muscle and cutaneous flaps separately to make these flaps more mobile. Large portion of two rectus abdominis flaps could not survive, whereas pectoralis advancement flaps had mo special wound problems. Only one patient developed fistula due to remained wire, regardless to flap surgery.
Debridement ; Fistula ; Humans ; Omentum ; Rectus Abdominis ; Sternotomy* ; Thoracic Surgery ; Wound Infection ; Wounds and Injuries

No abstract available.
Biopsy* ; Child* ; Humans