Osteoid osteoma is a distinctive benign lesion characterized by a less then 2 cm, pea-like mass of abnormal bone (nidus). The common sites of osteoid osteoma are femur, tibia, humerus, spine and talus. Mastoid tip, clavicle, acetabulum, coccyx, rib, hamate, scapula and scaphoid are rare sites of osteoid osteoma. Osteoid osteoma of the patella is also very rare and on review of literatures we could find only one reported case which was treated by surgical excision. We also experienced one case of osteoid osteoma located at the patella, so we report this case with review of literatures.
Acetabulum ; Clavicle ; Coccyx ; Femur ; Humerus ; Mastoid ; Osteoma, Osteoid* ; Patella* ; Ribs ; Scapula ; Spine ; Talus ; Tibia

No abstract available.
Knee*

The short term beneficial effect of arthroscopic excision of synovial tissue in knees with rheumatoid arthritis have been well documented. The purpose of this study to report the results of synovectomy in patients with rheumatoid arthritis who have been observed at least 3 years. We analysed the clinical result with modified Laurin criteria, radiologic change and patients own satisfaction degree with survey. The results were as follows; 1. The preoperative symptoms were pain (100%), swelling (100%), decreased range of motion (83%) and joint tenderness (74%), and those were improved postoperatively to 43%, 60%, 11%, 43% each other. 2. Among the laboratory parameters, C-reactive protein (CRP) was improved most significantly (pvalue =0.026). 3. On simple supine A-P X-rays, the width of medial joint space and lateral joint space were compared to preoperatively and postoperatively. The width of medial joint space was 4.33mm preoperatively, and it was changed to 3.22mm at last follow up (p=0.032). Those of lateral joint space was changed from 4.24mm preoperatively to 3.27mm at last tollow up (p=0.106). 4. The grade of articular cartilage damage was related with severity of preoperative symptoms and the patients with low grade of articular cartilage damage showed more postoperative improvement. The result of operation was related to symptom duration, degree of X-ray change and degree of cartilage damage. 5. 58% ot patients were satisfied to results of synovectomy, 28% were answered neither satisfied nor ansatisfied and 14% were unsatisf'ied to operation. We concluded the arthroscopic synovectomy of the knee joints was effective procedure to improve the clinical symptoms, range of knee motion and to alleviate the inflammatory reaction at mid-term period al'ter the operation. So we consider this procedure is a palliative treatment that modified and alleviate the progression of rheumatoid arthritis of knee joints.
Arthritis, Rheumatoid* ; C-Reactive Protein ; Cartilage ; Cartilage, Articular ; Follow-Up Studies ; Humans ; Joints ; Knee Joint* ; Knee* ; Palliative Care ; Range of Motion, Articular

Reye syndrome is a rapidly progressive encephalopathy with hepatic dysfunction, which often begins several days after apparent recovery from a viral illness, especially varicella or influenza A or B. Salicylate use was identified as a major precipitating factor for the development of Reye syndrome. With the recommendation to avoid use of salicylates in children, Reye syndrome has virtually disappeared in recent years. We report a case of Reye syndrome in a 5-month-old infant who had been treated with intravenous immunoglobulin and aspirin under the diagnosis of Kawasaki disease, and showed symptoms of sudden onset of irritability, rigidity, decreased activity, vomiting, poor appetite, lethargy, liver dysfunction without jaundice, coagulopathy, and hyperammonemia.
Appetite ; Aspirin ; Chickenpox ; Child ; Humans ; Hyperammonemia ; Immunoglobulins ; Infant ; Influenza, Human ; Jaundice ; Lethargy ; Liver Diseases ; Mucocutaneous Lymph Node Syndrome ; Precipitating Factors ; Reye Syndrome ; Salicylates ; Vomiting

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

The total knee arthroplasty (TKA) is now an established treatment of severe arthritis of the knee joint. The results of TKA estimate good result in mid-90% of patient. But most of assessing method was based on the evaluation methods, made by surgeons, so the patients own evaluation of success may different from the assessment of the surgeons. Especially the Korean life style is different from western style because Korean need more flexed knees for sitting position on the floor. But there no paper about patient subjective satisfactory result of Korean in the authors knowledge. So we studied the satisfactory degree about the outcome of TKA in Korean by the survey. A total 90 patients (103 cases), had undergone TKA were asked to complete a questionnaire-the questionnaire composed of question; ""are you satisfactory with operation?""and the answer; ""very satifactory, generally satisfactory, improved, no change or aggravated-about their satisfaction with the outcome of surgery. The results were as follows; 1.Of 90 patients, 90.3% were satisfied with the outcome of TKA. 2. The patints were satisfied 100% in avascular necrosis of femoral condyle, 83.8% in degenerative osteoarthritis, and 93.6% in rheumatoid arthritis. 3. The satisfactory degree had no relations with age, prevalent period, bilaterality and the evaluation period after the TKA (P>0.05). 4. There was a significant difference in knee scores between the patients who satisfied or not (P<0.05) and the satisfactory degree had a correlation with the points of knee score and amelioration rate of knee and function scores.
Arthritis ; Arthritis, Rheumatoid ; Arthroplasty* ; Humans ; Knee Joint ; Knee* ; Life Style ; Necrosis ; Osteoarthritis ; Surveys and Questionnaires

In shape and dimensions, the tibial plateaus are asymmetric with the larger medial tibial plateau and both have a posterior inclination with respect to the shaft of the tibia. Maximizing tibial coverage is an impotant consideration in total knee arthroplasty to provide stahility and load transfer and to improve long-term survival rate of the implants. Most tihial tray designs are symmetric, but several asymmetric designs are available. We evaluated the proximal tibial resection surface during total knee aithroplasty to delineate the tibial plateaus in korean. After tihial bone cut during 100 TKA procedures, the outline of tibial resection suiface was traced and rotational axis of true tibial component was marked intraoperatively. A line was drawn at the maximal anteroposterior (AP) diameter of lateral tibial condyle with parallel to rotational axis of component, and then a transverse axis was drawn at the midpoint of maximal AP diameter of 1ateral tibial condyle. Anteroposterior 10, 20, 30., 40% and midpoint from the media1 and lateral peripheries were calculated manually. The average AP medial 10, 20, 30 and 40% dimensions were 34.7, 43.8, 48.0 and 43.2mm, respectively. The average AP lateral 10, 20, 30 and 40% dimensions were 30.2, 38.4, 42.0 and 40.9mm, respectively. The ratio of medial/lateral AP dimensions 10, 20, 30 and 40% from periphery were 116.9, 114.7, 114.5 and 106.4%, respectively. From these data, we know the asymmetry of the proxirnal tibia1 plateaus in korean. We hope that rnore data will be ohtained in multicenter studies and it will help us to select tibia1 tray and to design the tibial component in korean. But, more accurate standard measures will he need to minimize an error of measurements.
Arthroplasty* ; Axis, Cervical Vertebra ; Hope ; Knee* ; Survival Rate ; Tibia

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 occurrence of atrial fibillation during an electrophysiologic study or catheter ablation in patients with accessory pathways is a common problem and sometimes complicates the localization and ablation procedure of accessory pathways. In patients with sustained atrial fibrillation, it is often time-consuming to terminate atrial fibrillation by drugs or electrical cardioversion. We performed successful radiofrequency catheter ablation in a patient with right-sided accessory pathway during atrial fibrillation requiring repeated electrical cardioversion. The target site was determined by activation mapping and morphology of unipolar electrogram at a site of early ventricular activation.
Atrial Fibrillation* ; Catheter Ablation ; Electric Countershock ; Humans

PURPOSE: Although varicose veins are very common in adults, the mechanism of the disease has not been established. Degradation of the extracellular matrix is regulated by various matrix metallopreteinases (MMPs) and their inhibitors tissue inhibitor of metallaproteinase (TIMPs). This study was performed to analyse the relationship between venous wall degeneration and expression of these matrix proteinases. METHODS: Twelve great saphenous vein (GSV) segments from 7 patients without varicose veins (control) and 86 GSV segments from 18 patients (22 limbs) with varicose veins (C2,4,5EPASPR) were used for this study. Light microscopic examination was used in the evaluation of vein wall degeneration, immunohistochemistry and Western blotting for the expression of MMPs (MMP-1, MMP-2, MMP-9 and MMP-13) and TIMPs (TIMP-1 and TIMP-2), and zymography for gelatinolytic activity of MMP-2 and MMP-9 were performed. RESULTS: MMP-9 was more strongly expressed in the vein wall of both control and patient groups, especially in the endothelial cells and medial muscle layers and TIMP-2 followed. The expression of MMP-9 was closely related to the degree of venous wall degeneration. Activated MMP-2 and MMP-9 were observed in both groups and expressed more in the proximal GSV of the patients. In the Western blotting, the expression of MMP-9 and TIMP-1 were significantly higher than other MMPs and TIMP-2 in the patients with varicose veins. CONCLUSION: MMP-9 is much more expressed in the wall of degenerative veins. This matrix-degrading enzyme may play an important role in the degeneration of venous wall followed by its remodeling.
Adult ; Blotting, Western ; Endothelial Cells ; Extracellular Matrix ; Humans ; Immunohistochemistry ; Light ; Matrix Metalloproteinases ; Metalloproteases ; Muscles ; Saphenous Vein ; Tissue Inhibitor of Metalloproteinase-1 ; Tissue Inhibitor of Metalloproteinase-2 ; Varicose Veins ; Veins