The types of patellar component of total knee replacement prostheses are dome-shape, metalbacked, anatomically shaped, and press fit condylar type, etc. The fixation of inset patella type is achieved with bone cement supplemented by a central peg and a small extended flange around the circumference, providing resistance to torsional and shear loads. From October 1990 to June 1992, 53 cases in 40 patients had total knee arthroplasties. Ortholoc II implant was used in all patients. Cementless femoral and tibial component were used. But, cement was used in patellar component. The average follow up was 29 months(range 21-40 months). There were 37 women and 3 men and the average age was 51 years(range 22-71 years). The diagnosis of 40 patients was osteoarthritis in 25, rheumatoid arthritis in 9, infection sequelae in 6. For alignment of the patellar and congruency of the patellofemoral joint, additional retinacular release was done in 7 cases. The average preoperative Hospital for Special Surgery(H.S.S) knee rating score was 50.7 point, which improved to 89.4 point at last follow up. Postoperative patellar pain was 4 cases. In the roentgenorgraphic follow up, ratellar subluxation was 2 cases and lateral tilting of the patella was 5.9 degrees in 10 cases. The average patellar depth was 20.8mm preoperatively and 21.6mm postoperatively. In the Merchant's view, the preoperative lateral patellofemoral angle of Laurine was average 14.3 degree, which changed to average 16.4 degree at last follow up, and the preoperative Merchant's congruence angle was average 14 degrees, which decreased to average
Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Knee ; Male ; Osteoarthritis ; Patella ; Patellofemoral Joint ; Prostheses and Implants

Patellofemoral complications are the most frequent problems in total knee arthroplasty. In the literature, the subject of patella resurfacing and nonresurfacing is controversial. Twenty-seven osteoarthritic patients who received bilateral total knee prostheses were studied to evaluate the advantages and disadvantages of patella resurfacing prospectively. Only patients with mild patellofemoral disease were included in the study. The Ortholoc modular implant was used in all cases. Cementless femoral and tibial component were used. But, if we resurfaced the patella, cement was used. In all patients, patella resurfacing had been done in the left knee but not in the right knee. For the clinical analysis, We used Knee Rating Score of the Hospital for Special Surgery(HSS), For the roentgenographic analysis, We used Laurin's lateral patellofemoral angle & Merchant's congruence angle. In the follow up, blind test for patellar pain was performed to compare between right and left knee joint clinically. The average age was 61 years(range 28-72 years) and the average follow up was 21 months(range 12-27 months). Preoperative ROM was 104.4 degrees in right side and 106.7 degrees in left side. Postoperative ROM was 112.7 degrees in right side and 109.6 degrees in left side. Preoperative HSS Knee Rating Score was 53.1 point in right side and 54.8 point in left side. Postoperative HSS Knee Rating Score was 81.5 point in right side and 81.2 point in left side. In the plain knee AP view, preoperative tibiofemoral angle was varus 7.0 degrees in right side and varus 5.6 degrees in left side. Postoperative tibiofemoral angle was valgus 5.1 degrees in right side and valgus 4.9 degrees in left side. Preoperative Merchant's congruence angle was 14.9 degrees in right side and 15.3 degrees in left side. Postoperative Merchant's congruence angle was
Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Humans ; Knee ; Knee Joint ; Knee Prosthesis ; Patella ; Prospective Studies ; Range of Motion, Articular

The AO internal fixation system(the Fixateur Interne) is effective in reducing and stablizing a variety of unstable thoracolumbar fracture patterns. It is relatively effective in decompressing the canal of retropulsed bony fragments associated with burst fracture. Sixty-Two patients with unstable thoracolumbar spine fractures were treated with the AO internal fixator. They were followed for an average of 21 months(range 15-29 months). A compartive radiographic analysis of kyphosis and vertebral height was made using pre-operative, post-operative and follow-up radiogram. Changes in neural canal compromise were measured in 18 cases of burst fractures. Failure of instrumentation occured in 9 cases which were carefully analyzed. Recently, we've constructed the system of which the Schanz screws would be directed divergently in sagittal plane in the hope that the load to the screws might be reduced, thus the failure rate.
Follow-Up Studies ; Hope ; Humans ; Internal Fixators ; Kyphosis ; Neural Tube ; Spine

BACKGROUND: The incidence of cervical esophageal cancer is low compared with that of thoracic esophageal cancer, and the role of surgery for cervical esophageal cancer is limited compared with that of radiotherapy or chemotherapy. This study was carried out to determine the outcome of surgery for cervical esophageal cancer. MATERIAL AND METHOD: We analyzed retrospectively medical records of 43 patients who had undergone curative surgical resection for cervical esophageal cancer from January 1989 to December 2002. Follow-up loss was absent and the last follow-up was carried out in February 28, 2004. RESULT: The mean age was 60 years old and the male to female ratio was 40:3. Histologic types were squamous cell carcinoma 42 patients and malignant melanoma 1 patient. The methods used for esophageal reconstruction were gastric pull-up 32 patients, free jejunal graft 7 patients and colon interposition 4 patients. Postoperative complications occurred in 31 patients (72%), and operative mortality occurred in 7 patients (16%). Pathologic stages were I 3, IIa 14, IIb 1, III 19, and IVa 6 patients. Tumor recurrence occurred in 16 patients (44%), and the 3 and 5-year survival rates were 29.3% and 20.9%. CONCLUSION: The reported surgical results for cervical esophageal cancer showed somewhat high operative mortality, postoperative complication rates and recurrence rates and a low long-term survival rate. It is suggested that multimodality treatment including surgery is needed for the treatment of cervical esophageal cancer because radiotherapy or chemotherapy without surgery could not relieve dysphagia or resolve the tumor completely.
Carcinoma, Squamous Cell ; Colon ; Deglutition Disorders ; Esophageal Neoplasms ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Medical Records ; Melanoma ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Survival Rate ; Transplants

BACKGROUND: Remifentanil sometimes elicits cough during induction of anesthesia, as with the use of other fentanyl congeners. We designed this study to investigate the incidence of remifentanil-induced cough (RIC) in children and to evaluate the effect of injection speed on RIC. METHODS: One hundred twenty ASA physical status I-II patients, aged 3-12 yr, undergoing general anesthesia were enrolled in the study. Patients were randomly assigned to one of the three groups. Patients in Group R30 received remifentanil 1.5 microg/kg at a constant rate over 30 s. Patients in Group R45 received remifentanil 1.5 microg/kg over 45 s, and patients in Group R60 received remifentanil 1.5 microg/kg over 60 s, respectively. Episodes of cough were recorded and graded as mild (1-2), moderate (3-4), or severe (5 or more). Mean arterial pressure (MAP), heart rate (HR), and SpO2 were recorded on arrival in the operating room (baseline) and 1 min after remifentanil infusion. RESULTS: The incidence of RIC was 33.3% in Group R30 (13 of 39 patients), 17.9% in Group R45 (7 of 39 patients), and 5.0% in Group R60 (2 of 40 patients). Patients in Group R60 had a significantly lower incidence of RIC than those in Group R30 (P = 0.001). The MAP, HR, and SpO2 values were not significantly different between groups. CONCLUSIONS: When intravenous remifentanil 1.5 microg/kg was administered in pediatric patients, the incidence of RIC decreased from 33 to 5% by increasing the injection time from 30 to 60 s. Remifentanil should be administered slowly over 60 s in children to suppress cough during anesthesia induction.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Child* ; Cough* ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Operating Rooms

We report a case of Trichilemmal carcinoma in a 75-year-old man who was presented with an exophytic nodule on the lower lip. The tumor was composed of glycogen-rich cytoplasmic cells with PAS-positive, diastase-labile and had a characteristic trichilemmal keratinization. The trichilemmal carcinoma is well known to have originated from the outer root sheath of the hair follicle in the hair bearing area. It is interesting that our case had developed on the lip, an exceptional site for a follicular tumor : the hair follicle could not be seen. It might have been developed from an ectopic follicle or at the follicle of vermillion border and grew up into the lip.
Aged ; Cytoplasm ; Hair ; Hair Follicle ; Humans ; Lip*

PURPOSE: This randomized, controlled, double-blind study was designed to determine the optimal dose of remifentanil for preventing complications associated with the removal of a laryngeal mask airway (LMA) without delaying emergence. MATERIALS AND METHODS: This study randomly assigned 128 patients to remifentanil effect-site concentrations (Ce) of 0 ng/mL (group R0), 0.5 ng/mL (group R0.5), 1.0 ng/mL (group R1.0), and 1.5 ng/mL (group R1.5) during emergence. The emergence and recovery profiles were recorded. Adverse events such as coughing, airway obstruction, breath-holding, agitation, desaturation, nausea, and vomiting were also evaluated. RESULTS: The number of patients with respiratory complications such as coughing and breath-holding was significantly lower in the R1.0 and R1.5 groups than in the R0 group (p<0.05). Emergence agitation also decreased in the R1.0 and R1.5 groups (p<0.0083). The time to LMA removal was significantly longer in the R1.5 group than in the other groups (p<0.05). CONCLUSION: Maintaining a remifentanil Ce of 1.0 ng/mL during emergence may suppress adverse events such as coughing, breath-holding, and agitation following the removal of LMA without delayed awakening.
Adult ; Airway Management/*methods ; Anesthesia Recovery Period ; Anesthetics, Intravenous/*administration & dosage ; Cough/prevention & control ; Device Removal ; Dose-Response Relationship, Drug ; Double-Blind Method ; Female ; Humans ; Infusions, Intravenous ; Laryngeal Masks/*adverse effects ; Male ; Middle Aged ; Piperidines/*administration & dosage ; Postoperative Complications/prevention & control ; Psychomotor Agitation ; Vomiting/prevention & control

PURPOSE: This randomized, controlled, double-blind study was designed to determine the optimal dose of remifentanil for preventing complications associated with the removal of a laryngeal mask airway (LMA) without delaying emergence. MATERIALS AND METHODS: This study randomly assigned 128 patients to remifentanil effect-site concentrations (Ce) of 0 ng/mL (group R0), 0.5 ng/mL (group R0.5), 1.0 ng/mL (group R1.0), and 1.5 ng/mL (group R1.5) during emergence. The emergence and recovery profiles were recorded. Adverse events such as coughing, airway obstruction, breath-holding, agitation, desaturation, nausea, and vomiting were also evaluated. RESULTS: The number of patients with respiratory complications such as coughing and breath-holding was significantly lower in the R1.0 and R1.5 groups than in the R0 group (p<0.05). Emergence agitation also decreased in the R1.0 and R1.5 groups (p<0.0083). The time to LMA removal was significantly longer in the R1.5 group than in the other groups (p<0.05). CONCLUSION: Maintaining a remifentanil Ce of 1.0 ng/mL during emergence may suppress adverse events such as coughing, breath-holding, and agitation following the removal of LMA without delayed awakening.
Adult ; Airway Management/*methods ; Anesthesia Recovery Period ; Anesthetics, Intravenous/*administration & dosage ; Cough/prevention & control ; Device Removal ; Dose-Response Relationship, Drug ; Double-Blind Method ; Female ; Humans ; Infusions, Intravenous ; Laryngeal Masks/*adverse effects ; Male ; Middle Aged ; Piperidines/*administration & dosage ; Postoperative Complications/prevention & control ; Psychomotor Agitation ; Vomiting/prevention & control

No abstract available.
Adenoids* ; Carcinoma, Adenoid Cystic* ; Lacrimal Apparatus*

Lymphocytic interstitial pneumonia(LIP) is characterized by a massive infiltration of the interstitium of the lung by mature lymphocytes, plasma cells and reticuloendothelial cells. LIP may be associated with autoimmune diseases including Sjogrens syndrome, SLE, myasthenia gravis, pernicious anemia, autoimmune hemolytic anemia, and HIV or an EB virus infection. There is a possibility of LIP progressing to a pulmonary or systemic lymphoma. The therapeutic response to corticosteroids and/or immunosuppressive drugs varies. Here we report a case of LIP that was diagnosed by an open lung biopsy and clonality study. The patient was a 36 year-old man without antuimmune disease or HIV infection. He was admitted as a result of severe hypoxemia showing PaO2 of 48.3 mmHg. The patient was treated with corticosteroids after the diagnosis and had fully recovered without a sequalae or relapse.
Adrenal Cortex Hormones ; Anemia, Hemolytic, Autoimmune ; Anemia, Pernicious ; Anoxia ; Autoimmune Diseases ; Biopsy ; Diagnosis ; HIV ; HIV Infections ; Humans ; Lip ; Lung ; Lung Diseases, Interstitial* ; Lymphocytes ; Lymphoma ; Myasthenia Gravis ; Plasma Cells ; Recurrence ; Sjogren's Syndrome