The result of forty cases of rheumatoid arthritis according to New York criterion, who underwent multiple operations(up to 10) in multiple joints hetween 1983 and 1986 were evaluated in 3 years and 8 months in average(range; 18 months to 5 years 2 months)postoperatively. The joints operated upon were knee, ankle, shoulder, elbow, wrist and finger joints. The surgery performed were 65 arthroscopic synovectomies, 17 total joint replacement(16 knees and 1 elbow) and 7 arthrodesis(1 knee, 1 ankle and 5 wrists). There were 10 males and 30 females, 27 “clsssic” and 13 “definite” rheumatoid arthritis according to the classification of American Rheumatism Association.Functional capacity of the patient was graded as I, II,III and IV according to the ARA. The final clinical results were graded as “excellent”, “good”, “fair” and “poor” according to the modified citeria of Sledge et al(20). The relationship between number of cases of recurred synovitis and various factors such as sex, classification according to the ARA, number of joints involoved and extent of synovectomy in the knee joint was analyzed statistically with chi-square test of the contingency table.The results are as follows; 1. The final results were 22 “excellent”(55.0%), 16 “good”(40.0%) (altogether 95% of cases were satisfactory) and 2 fair (5.2%), but there was no “poor” result. 2. All cases showed functional improvement, the commonest mode of improvement being from preoperative grade II to postoperative grade I(19 out of 40 cases, 47.5%). 3. There were 9 cases of recurrence of synovitis following arthroscopic synovectomy(22.5 %). They were controlled by medication in 2 cases, and by reoperation in 5 cases (resynovectomy ; 3, joint replacement; 1, arthrodesis ; 1). 4. The factors such as sex, classification and number of joints involved were not significantly correlated c the recurrence rate although there was a tendency of frequent recurrences in cases of female, classic RA and multiple joint involovement (P>0.05). 5. In the knee joint there was significantly less recurrence rate in total synovectomy cases (1/20, S.0%) than in anterior synovectomy cases (7/22, 31.8%) (P<0.01). 6. There was no recurrence following total joint replacment or arthrodesis. In conclusion the combined surgery of arthroscopic synovectomy, joint replacement and arthrodesis in the multiple joints was effective in relief of pain and effusion and improvement of functional capcity of the rheumatoid patient if proper medical treatment was given postoperatively.
Ankle ; Arthritis, Rheumatoid ; Arthrodesis ; Classification ; Elbow ; Female ; Finger Joint ; Humans ; Joints ; Knee ; Knee Joint ; Male ; Recurrence ; Reoperation ; Rheumatic Diseases ; Shoulder ; Synovitis ; Wrist

BACKGROUND: The purpose of this study was to measure and compare the optimum depth of the internal jugular venous catheterization between the right and left side. METHODS: Forty-four patients were enrolled for this study and divided into two groups (22 patients each). The optimum depth of the catheterization was calculated using the sum of two component (A and B); the advanced length of the catheter from the level of the cricoid cartilage (A) and the distance from the catheter tip to the junction of the superier vena cava and right atrium (B). RESULT: The optimum depths of the internal jugular venous catheterization were 16.0 1.0 cm (right) and 18.4 1.5 cm (left) respectively. Left side was significantly longer than right side (p<0.05). In this study, we experienced some complications; arterial punctures (5 cases) and migration of the catheter to the opposite subclavian vein (1 case). Five complications were associated with left internal jugular venous cannulation and one was associated with the right side cannulation. CONCLUSION: We concluded that the optimum depth of the internal jugular venous catheterization was longer in the left side than in the right side.
Catheterization* ; Catheters* ; Cricoid Cartilage ; Heart Atria ; Humans ; Punctures ; Subclavian Vein

Acute fatty liver is rare but life threatening complication and usually manifests late in pregnancy. The mean gestational age onset of symptoms has been reported 35-37 weeks of gestation. Recently, several reports revealed acute fatty liver can develops in the second trimester of pregnancy. Recent reports suggest that early diagnosis and delivery decreased the mortality of fetus and mother. We have experienced a case of the second trimester onset acute fatty liver, in pregnancy so we report the case with brief review.
Early Diagnosis ; Fatty Liver* ; Female ; Fetus ; Gestational Age ; Humans ; Mortality ; Mothers ; Pregnancy ; Pregnancy Trimester, Second*

Lipomas of the heart are benign neoplasms and have rarely been described. Due to the fact that they normally cause no symptoms, diagnosis is often purely accidental. Because of the rarity of these tumors, it seems worthwhile to present an example studied at autopsy. It was associated with the sudden death of a 15-year-old boy. The tumor arose from the wall of the left ventricle and occupied the pericardial cavity, measuring 13x7x6 cm in size. The tumor was whitish-yellow, translucent, and soft. Microscopically, the tumor was composed of mature adipose tissue which extended between muscle fibers. This current case, the giant cardiac lipoma is believed to produce disturbances of the conduction system and distrubances of cardiac filling.

BACKGROUND: Flecainide is an antiarrhythmic agent that is used primarily in the treatment of cardiac arrhythmias. Some evidences also suggest that flecainide can participate in alveolar fluid clearance and inflammatory responses. This experiment was aimed to evaluate the effects of flecainide on sepsis induced acute lung injury in a rat model. METHODS: Rats were treated with subcutaneous infusion of saline or flecainide (0.1 or 0.2 mg/kg/hr) by a mini-osmotic pump. Subcutaneous infusion was started 3 hours before and continued until 8 hours after intraperitoneal injection of saline or endotoxin. Animals were sacrificed for analyses of severity of acute lung injury with wet to dry (W/D) ratio and lung injury score (LIS) in lung and inflammatory responses with level of leukocyte, polymorphonuclear neutrophils (PMNs) and inteleukin-8 (IL-8) in bronchoalveolar lavages fluid (BALF). RESULTS: Flecainide markedly improved dose dependently sepsis induced acute lung injury as analysed by W/D ratio (from 2.24 ± 0.11 to 1.76 ± 0.09, p < 0.05) and LIS (from 3 to 1, p < 0.05), and inflammatory response as determined by leukocyte (from 443 ± 127 to 229 ± 95, p < 0.05), PMNs (from 41.43 ± 17.63 to 2.43 ± 2.61, p < 0.05) and IL-8 (from 95.00 ± 15.28 to 40.00 ± 10.21, p < 0.05) in BALF. CONCLUSIONS: Flecanide improve sepsis induced acute lung injury in rats by controlling inflammatory responses.
Acute Lung Injury* ; Animals ; Arrhythmias, Cardiac ; Bronchoalveolar Lavage ; Flecainide* ; Infusions, Subcutaneous ; Injections, Intraperitoneal ; Interleukin-8 ; Leukocytes ; Lung ; Lung Injury ; Models, Animal ; Neutrophils ; Rats ; Sepsis*

A 3-year-old boy with Wilms' tumor had unusual severe hypertension, polydipsia, polyuria, and hypokalemia. Physical examination on admission was unremarkable except for the presence of a smooth, firm mass in the right abdomen. Computerized tomography showed a tumor occupying upper two thirds of the right kidney. Plasma renin activity and aldosterone concentration were markedly elevated, 37.7 mg/ml/hour (normal supine 0.15-2.33 mg/ml/hour) and 120.1 ng/dl (normal supine 1 to 16 ng/dl), respectively. His hypertension, varied from 150/90 mmHg as high as 240/180 mmHg, was not effectively controlled by antihyperensive drugs. Because of concern for the complications of hypertension, a right nephrectomy was performed on the sixth hospital day. At laparotomy, there was no evidence of mechanical compression of the renal artery by the tumor. The tumor, about 8 cm in diameter, was confined within the renal capsule without involvement of the renal blood vessels at the hilum. Histopathologically, it was characteristic Wilms' tumor of favorable histology. On electron microscopy, the tumor cells contained many electron dense secreting granules in the cytoplasm, suggesting that the tumor itself was the source of the renin and cause the clinical manifestations. Shortly after nephrectomy, signs and symptoms were relieved dramatically, and plasma renin activity and aldosterone concentration were also decreased to normal.
Abdomen ; Aldosterone ; Blood Vessels ; Child* ; Child, Preschool ; Cytoplasm ; Humans ; Hypertension* ; Hypokalemia* ; Kidney ; Laparotomy ; Male ; Microscopy, Electron ; Nephrectomy ; Physical Examination ; Plasma ; Polydipsia* ; Polyuria* ; Renal Artery ; Renin ; Wilms Tumor*

We report a case of rabbit syndrome in a 28-year-old man with chronic active epilepsy and mental retardation. He developed fine and rhythmic perioral involuntary movements with mild parkinsonism several months after he had been administered with neuroleptics. His movements had a rhythmic pattern consisting of 2-3 Hz with a resting period for 1- 2 seconds. They were remarkably reduced with benztropine. Parkinsonism also improved with benztropine.
Adult ; Antipsychotic Agents ; Benztropine ; Dyskinesias ; Epilepsy ; Humans ; Intellectual Disability ; Parkinsonian Disorders

For undercorrected esotropia after bilateral medial rectus(MR) recession, we performed unilateral or bilateral MR rerecession, unilateral rerecession or marginal myotomy of the recessed medial rectus muscle combined with lateral rectus(LR) resection, or unilateral LR resection. The correction of deviation was 15 delta in unilateral 2.0mm MR rerecession. Bilateral 2.0mm MR rerecession corrected 20 to 25 delta of esodeviation, but undercorrection was noted in one case. With unilateral 2.0mm rerecession or marginal myotomy of the recessed medial rectus muscle combined with 5.5mm or 8.0mm LR resection, the correction of deviation was 26 to 29 delta, and there was no under- or overcorrection. The corrective effect of this procedure was therefore greater and more stable than that of bilateral 2.0mm MR rerecession. Unilateral 8.0mm LR resection performed 3 months after bilateral MR recession showed correction of 15 delta, whereas the same procedure performed 3 weeks after bilateral MR rerecession showed correction of 24 delta. Unilateral LR resection procedure seems to be more efficacious for residual esotropia if performed as soos as possible within 3 months after sufficient bilateral MR recession or rerecession.
Esotropia* ; Methods ; Reoperation

No abstract available.
Foot ; Hand

Objectives: . The aim of the present study was to evaluate audiologic and vestibular functions in patients with lateral semicircular canal (LSCC) dysplasia/aplasia. Methods: . We conducted a retrospective study of a patients with LSCC dysplasia and aplasia at tertiary referral center. The subjects included 15 patients with LSCC dysplasia or aplasia, with or without combined inner ear anomalies. Medical history, temporal bone computed tomography scans, pure-tone audiograms, and vestibular function test results were analyzed. Results: . LSCC anomaly was identified in 15 patients (20 ears). Nine patients had unilateral LSCC dysplasia only and showed a mean pure-tone average of 45.5±28.7 dB, while three patients (33.3%) among them had normal hearing. Six patients had bilateral LSCC dysplasia/aplasia combined with other inner ear anomalies and profound bilateral hearing loss. Notably, only four out of 15 patients (26.7%) had dizziness symptoms. On caloric test, patients with isolated LSCC dysplasia showed a 51.8%±29.3% level of canal paresis (eight out of nine patients showed anomalies), whereas patients with bilateral LSCC dysplasia/aplasia presented bilateral vestibular loss. One patient with isolated LSCC underwent video-head impulse test; horizontal canal gain decreased to 0.62 (17% asymmetry) and anterior canal gain was 0.45 (52.6% asymmetry), whereas posterior canal gain was normal. Conclusion . Bilateral LSCC dysplasia/aplasia is comorbid with other inner ear anomalies and presents as profound bilateral hearing loss and vestibulopathy. In contrast, isolated unilateral LSCC dysplasia presents as ipsilateral horizontal canal paresis. Hearing function in isolated LSCC dysplasia is usually, but not always, impaired with varying severity.