Vnrus deformity is a common finding in patients who are candidates for toial knee replacement arthropiasty. To obtain excellent clinical results and to maintain well-aligned and stable prosthetic components in patients who have such a deformity, adequate ligament balancing as well as accurate cone.ction of bony alignment is required. But many technical problems are encountered. Especially the bony defect on the medial aspect of the tibia after adequate bone cutting and ligament imbalance with laxity in the lateral side and contracture in the medial side. Total knee replacement arthroplasty with 43 patients(56 cases) to be mcre than 10 degrees of varus of tibio-femoral angle was done by a single surgeon and reviewed retrospectively. The diagnosis was osteoarthritis in 46 cases, rheumatoid arthritis in 9 cases. The average follow up period was average 33 months(l-7 years). Preoperative varus deformity of average 13.5 degree., was corrected to valgus 6.69 degrees at last follow-up. Postoperative range of motion was 122.5 degree. And the mean knee society score improved from 24.8 to 87.2 postoperatively and the function score improved from 23.6 to 83.9 postoperatively. At self-assements, 88.2% of the patients was very satisfied or somewhat satisfied. Total knee replacement ;u1hroplasty in the patients with vaus deformity is effective procedure to corri.ct deformity and improve clini- c;1 and functional status, but long-term follow up period is required for changing alignment.
Arthritis, Rheumatoid ; Arthroplasty* ; Arthroplasty, Replacement, Knee* ; Congenital Abnormalities* ; Contracture ; Diagnosis ; Follow-Up Studies ; Humans ; Knee ; Ligaments ; Osteoarthritis ; Range of Motion, Articular ; Retrospective Studies ; Tibia

Weber-Christian disease is an inflammatory disease of subcutneious fat tissue which is clinically characterized by relapsing, febrile, nodular, nonsuppurative pannicutilitiy. The cause is unknown, but the disease has been attributed to an autoimmune reaction, infectioris, halogen compounds, sarcoidosis, SLE and a-antitrypsin deficiency. We report here in a case of Weber-Christian disease in a 8-year-old girl, who had indurated erythemataus subcutaneous nodules on the extremities, buttock and trunk accompanied by various general symptoms such as fever, malaise, arthralgia and edema of the abclorren and legs. This case was successfully treated with dapsone,
Arthralgia ; Buttocks ; Child* ; Dapsone ; Edema ; Extremities ; Female ; Fever ; Humans ; Leg ; Panniculitis, Nodular Nonsuppurative* ; Sarcoidosis

We report a case of infantile acute hemorrhagic edema in a 15-month-old boy. The patient showed multiple, bean to walnut-sized, red to purple-colored, indurated purpura with a cockade pattern on the face, earlobes, and extremities. Edema of the hands, feet, and earlobes was also observed. Laboratory examinations showed thrombocytosis, decreased serum CH50, and ketone in the urine. A skin biopsy taken from indurated purpura on the lower leg exhibited findings of acute leukocytoclastic vasculitis. Direct immunofluorescence examination showed deposition of IgM along the dermo-epidermal junction and C3 in the dermal vessel walls. With-out specific management except for fluid therapy to correct dehydration, the skin lesions cleared completely in 2 weeks, and recurrence has not observed.
Biopsy ; Dehydration ; Edema* ; Extremities ; Fluid Therapy ; Fluorescent Antibody Technique, Direct ; Foot ; Hand ; Humans ; Immunoglobulin M ; Infant ; Leg ; Male ; Purpura ; Recurrence ; Skin ; Thrombocytosis ; Vasculitis

We reviewed radiographs of 11 patients with 17 total knee replacement arthroplasty(TKRA) cases. These patients had a residual flexion contracture over 20 degree after TKRA that corrected spontaneously during follow-up. The mean age of patients was 46.5 years(range, from twenty nine to sixty six). Seven patients were bilateral cases and all knees were cases of rheumatoid arthritis. The mean preoperative flex- ion contracture was 53.8 and immediately postoperative contracture was 23.5. The remaining flexion contracture after TKRA was completely corrected during follow-up period in all cases. We measured the distance from upper margin of tibial components to a certain point on the fibula. This point is on a line perpendicular to long axis of the tibia, drawn from a certain point on the fibula. This dis- tance was measured on postoperative radiographs and radiographs with improved flexion contracture, and the differences calculated. There was no significant difference between the two distances. Although the number of cases are small, we conclude that flexion contracture might be corrected to the extent of 20-30 degree by soft tissue stretching rather than bone subsidence.
Arthritis, Rheumatoid* ; Arthroplasty, Replacement, Knee ; Axis, Cervical Vertebra ; Contracture* ; Fibula ; Follow-Up Studies ; Humans ; Knee ; Tibia

The flexion contracture of knee was developed in long-standing knee joint arthritis like degenerative osteoarthritis and rheumatoid arthritis. One of the objectives in total knee replacement arthro-plasty (TKA) is to correct flexion deformity which is the frequent consequence of rheumatoid arthritis (RA) and osteoarthritis (OA). We defined the severe flexion contracture as above 30degrees deformity of knee joint. A review of 337 primary TKA was carried out between August 1989 and March 1995. We found that such deformity was present in 106 Knees (31.5%) of knees before the operation. We analysed the changing pattern and amount of improvement in flexion contracture with 70 knees, which we can follow up over 1 year (average 28.9 months). We corrected flexion contracture deformity only 62.7% in RA (29.2degrees out of 46.5degrees) and 85% in OA (30.4degrees out of 36.8degrees ). So the remaining flexion contracture immediate after TKA is 17.3degrees in RA and 6.4degrees in OA. After the operation, we educate the patient and care person to perform the knee joint stretching by intermittent gentle passive extension exercise for residual flexion contracture. In RA, the remaining flexion contracture immediate after TKA would be improved in follow-up period. At 1 year after TKA, the degree of flexion contracture was not significantly different between in RA ( 7.4degrees) and OA ( 5.0degrees) (independent t-test, P>0.05). The angle of further flexion of knee joint was not increased after TKA compare to preoperative angle, but the range of motion of knee joint was increased, so the increased range of motion was influenced only by the corrected flexion contracture degree. The American Knee Society Knee and Function scores were improved after the TKA (P<0.05). So we recommand that in RA, there is no need to correct the severe flexion contracture completely and it is permissible to remained residual flexion contracture within 1/3 of initial deformity, but in OA, correct the flexion contracture deformity completely during TKA procedure as possible.
Arthritis ; Arthritis, Rheumatoid ; Arthroplasty* ; Arthroplasty, Replacement, Knee* ; Congenital Abnormalities ; Contracture ; Follow-Up Studies ; Humans ; Knee ; Knee Joint ; Osteoarthritis ; Range of Motion, Articular

PURPOSE: There are a few reports in the literature that deal with the results of total knee replacement arthroplasty in young rheumatoid arthritis patients. This study was undertaken to evaluate the results of total knee replacement arthroplasty in rheumatoid arthritis patients under the age of 45 years. MATERIALS AND METHOD: Between 1989 and 1993, 43 total knee replacement arthroplasties were performed in 26 adults with rheumatoid arthritis. The age at operation ranged from 23 to 45 years old (average 36.3 years). Of these, four patients (six knees) were lost to follow-up, so 37 knees in 22 patients were available for the follow-up evaluation at a mean 7.8 years (5-8.9). RESULTS: Preoperative flexion contracture was found in 33 knees (89.2%) among 37 knees and it was corrected by operation from 33.1 to 2.6 postoperatively. So the range of motion also improved by an average of 25.6 compare with preoperative state. At the time of final follow-up, six patients were free of pain and 15 patients had mild pain during weight-bearing state, but one patient, with loosening evidence complained of occasional moderate pain. The American Knee Society knee score was improved from a mean of 37.9 points preoperatively to 84.9 points postoperatively. There were 22 excellent, 14 good and one poor (loosening case) results. All patients were able to walk after the operation from 11 non-ambulators and 11 ambulators, assisted with a walking device in preoperative state. The average functional score also improved from 11.9 points to 86.8 points. Radiographic evaluation revealed a radiolucency rate of 43.2%, and revealed radiolucent line adjacent to 3 femoral and 15 tibial components. Almost all of the patients (91%) were satisfied with the result of operation, subjectively. Only one patient had a revision because of subsidency and loosening of a tibial prosthesis. CONCLUSIONS: We considered that total knee replacement arthroplasty for patients with rheumatoid arthritis and was less than 45 years old provided satisfactory and effective results.
Adult ; Arthritis, Rheumatoid* ; Arthroplasty* ; Arthroplasty, Replacement, Knee* ; Contracture ; Follow-Up Studies ; Humans ; Knee ; Lost to Follow-Up ; Middle Aged ; Prostheses and Implants ; Range of Motion, Articular ; Walking ; Weight-Bearing

PURPOSE: The present study was performed to determine the optimum conditions(RPM, load, sharpness of drill) for drilling human cortical bone with standard drill, and to evaluate the histological changes occuring in bone after drilling. MATERIALS AND METHODS: in experiment I, we measured temperature elevations and the durations of temperature elevation in cadaveric femoral cortices at specific distances from the drill hole wall while drilling. The effects of drilling force, speed and new versus worn drill on the termperature were determined. In experiment II, we also measured temperature elevations in the same manner in porcine femoral cortices and evaluated the histological changes occuring in bone after drilling. RESULTS: In experiment I, the most significant temperature elevation(68.4degrees C ) was found when worn drill was used. The lower drilling force and faster speed resulted in 55.1degrees C and 45.8degrees C temperature elevation, respectively. However, drill diameter was not a significant factor for temperature elevation. In experiment II, greater heat production was measured with worn drill, at lower drilling forces, at faster drill speed. The acute histologic reactions in bone were hyperemia, degeneration of osteocytes, change in bone stainability, tears, and fragmentation of the bone edges around the drill holes. The observed histological changes were proportional to the amount of trauma produced, that is, the greater the degree of thermal irritation, the greater the degree of histologic activity. CONCLUSION: In cortical drilling, greater heat production was measured with worn drill, at lower drilling forces, at faster drill speed and the greater the degree of thermal irritation, the greater the degree of histologic activity. A further study of the reaction of bone to drilling at longer intervals of time at different conditions may possibly show whether aseptic thermal necrosis could be prevented.
Cadaver ; Hot Temperature* ; Humans ; Hyperemia ; Necrosis* ; Osteocytes ; Thermogenesis*

BACKGROUND: It is well known fact to the patients of duodenal ulcer that their condition is frequently accompanied with reflux esophagitis. Therefore this condition is called an "acid-related disorder" because it is commonly associated with increased acidity. But there has been disputes on the effect of Helicobacter pylori eradication in these two conditions and whether H. pylori infection may have a protective role in reflux esophagitis. Only few reports have dealt with the prevalence of reflux esophagitis and gastroesophageal reflux in patients with peptic ulcer. The aim of this study is to estimate the prevalence of gastroesophageal reflux and to analyze the pattern ofthe pathologic reflux in peptic ulcer patients. MATERIALS AND METHODS: The study population consisted of 57 patients with endoscopically confirmed duodenal and/or gastric ulcer who all underwent 24hr ambulatory esophageal pH monitoring. RESULTS: The prevalnace of gastroesophageal reflux in peptic ulcer patients was 54.2% and 54.5% in gastric ulcer, and 62.5% in duodenal ulcer, 50% in combined ulcer, respectively. The prevalence of gastroesophageal reflux in the control group was 22.7%. CONCLUSION: We discovered significantly higher prevalence of gastroesophageal reflux in patients with peptic ulcer disease than in those without it. In conclusion, the presence or absence of gastroesophageal reflux must be considered in the setting of peptic ulcer disease management.
Disease Management ; Dissent and Disputes ; Duodenal Ulcer ; Esophageal pH Monitoring ; Esophagitis, Peptic ; Gastroesophageal Reflux* ; Helicobacter pylori ; Humans ; Peptic Ulcer* ; Prevalence ; Stomach Ulcer ; Ulcer

No abstract available.

PURPOSE: This study examined the wear pattern of the articular cartilage of the medial tibial plateau with or without a functional ACL in patients with degenerative osteoarthritis of the knee. MATERIALS AND METHODS: Between July 2003 and May 2004, 71 cases (52 patients) of total knee arthroplasty due to degenerative osteoarthritis of the knee were enrolled in this study. The intraoperative evaluations such as a test for the functional status of the ACL and the wear pattern of medial tibial plateau were performed, and the associations with the physical examinations such as, range of motion (ROM), Lachman test and pivot shift test, and tibio-femoral angle (TFA), were analyzed. RESULTS: There were 43 cases with a functional ACL, and the wear pattern of the medial tibial plateau was differentiated as anteromedial and central in 8 cases (18.6%), central in 30 cases (69.8%), and central and posteromedial in 5 cases (11.6%). There were 28 cases with a non- functional ACL and the wear pattern of the medial tibial plateau was differentiated as anteromedial and central in 1 case (3.6%), central in 2 cases (7.2%), and central and posteromedial in 25 cases (89.2%). In the group with the non-functional ACL, the most prevalent wear pattern was central and posteromedial (p<0.001). CONCLUSION: In patients with degenerative osteoarthritis of the knee without a functional ACL, the wear pattern of the articular cartilage of the medial tibial plateau was more posteromedially than patients with a functional ACL.
Arthroplasty ; Cartilage, Articular* ; Humans ; Knee* ; Osteoarthritis* ; Physical Examination ; Range of Motion, Articular