No abstract available.
Hypopituitarism*

A follow-up study was made of 26 knees of 21 patients who underwent arthroscopic synovectomy between October 1982 and August 1983 in Catholic Medical College and Center. The patient's ages ranged from 3 to 66 years of age. There were 14 female patients and 7 male patients in this series. The follow-up period of all patients was a minimum of twelve months to a maximum of 20 months. The average follow-up of the whole group was 16.8 months. The abnormal findings were rated from 0 to 4 according to Marmors rating system. Final clinical evaluations of the patients were done according to the modified criteria of Sledge et al. The results were as follows; 1. Rheumatoid Arthritis Of 14 knees, 3 joints(21.4%) were rated “excellent”, 6(42.9%) were “good”, and 5(35.7%) were “fair”. There was no case of “unimproved”. 2. Juvenile Rheumatoid Arthritis The results of all 5 knees were satisfactory. Of 5 knees, 4 joints(80%) were rated excellent and one joint (20%) was good. 3. There were 3 knees of osteoarthritis, 3 knees of chronic synovitis and one knee of pigmented villonodular synovitis. Their final results were all satisfactory. Three joints were rated excellent and the other 3 joints were good. 4. Of 26 knees, as a whole, 10 joints (38.5%) were rated “excellent”, 11 joints (42.3%) were “good”, 5 joints (19.2%) were “fair” and no joint was “unimproved”. There were 5 recurrences of active synovial disease in this series, and these patients all were “classic” rheumatoid arthritis. But surprisingly the average patient in this group of recurrence did well even after recurrence. These patients all had less pain and effusion than before operation. 5. The major cause of unsatisfactory results other than recurrence of synovitis were articular degeneration (joint space narrowing) and patellofemoral osteoarthritis (4 knees). 6. A good range of motion with the shortest rehabilitation period can be expected if alternate flexion and extension splints are applied on alternate days for less than a week following the surgery. In conclusion, one may state that the arthroscopic synovectomy is worth considering for the treatment of various kinds of synovitis of the knee joint and when the rheumatoid process follows a favourahle course.
Arthritis, Juvenile ; Arthritis, Rheumatoid ; Female ; Follow-Up Studies ; Humans ; Joints ; Knee Joint ; Knee ; Male ; Osteoarthritis ; Range of Motion, Articular ; Recurrence ; Rehabilitation ; Splints ; Synovitis ; Synovitis, Pigmented Villonodular

Management of patients with unstable fracture or fracture-dislocation of thoraco-lumbar spine continues to be controversial. One area of disagreement involves spinal fusion with internal fixation for prevention of later spinal instability. Intemal fixation of the spine without fusion has been advocated in the treatment of the unstable thoraco-lumbar fracture or dislocation. During the period of January 1981 to March 1984, thirty-two patients underwent fixation by Harrington distraction rod without fusion for the treatment of thoraco-lumbar fractures. Eight cases among them had second operation for the removal of the Harrington rods in 13.4months after Harrington rod fixation and were followed up clinically and radiolagically for 1 year at the Department of Orthopaedic Surgery, St. Mary's Hospital, Catholic Medical College and Center. The rationales for this procedure were to minimize the number of permanently stabilized segments and to provide more spinal mobility. We have expected that spontaneous fusion of vertebral body occur by the prolonged immobilization with Hamngton distraction rods. After the Harrington rods, the average conection rate of kyphotic angle was 41.8% and average correction rate of height of collapsed vertebral body or displacement of vertebral body was 42.3% at one year follow up. Instrumentations in eight patient were removed at 13.4 months after the initial surgery and the patients were followed up for one year. At the time of removal of instrumentation, unilateral partial facetectomy was done for histologic examination of the facet joint which is above the lower Harrington hook in four patients. The average correction rate of kyphotic angle was 37.5% and the average correction rate of height of collapsed or displaced vertebral body was 40.6% at one year after the removal of H-rods. The range of spine motions were incresed gradually. But histologic findings of the immobilized facet joint revealed fibrillation, fissures, thinning of the normal cartilagenous surface, decreased cartilagenous cellularity, and vascular tidemark invasion which are characteristics of osteoarthritis. Through this study, we obtained following conclusions: 1. Immediate Harrington distraction rodding was effective for the anatomic reduction of the collapsed vertebral body. And it provided immediate spinal stability, and spontaneous fusion of vertebral body. 2. Prolonged immobilization of the spine by Harrington rods is believed to have deleterious effect on articular cartilage of the immobilized facet joint as the degenerative changes of the cartilage of the facet joint was consistently found in this study. And it was regarded as a predisposing factors in the development of symptomatic arthritis of the spine. 3. If a fractured and collapsed vertebral body can be reduced by Harrington distraction rods, a spontaneous fusion of vertebral body occur. Harrington rodding without fusion could be one of the useful surgeries for management of the fractures and fracture-dislocation of the spine.
Arthritis ; Cartilage ; Cartilage, Articular ; Causality ; Dislocations ; Follow-Up Studies ; Humans ; Immobilization ; Osteoarthritis ; Spinal Fusion ; Spine ; Zygapophyseal Joint

Twenty five cases of fractures of the femur & tibia on the same leg (floating knee) in 24 patients were treated in St. Mary's Hospital, Catholic Medical College and Center during the period 1977-1985. We studied all of these patients, divided by four groups according to the methods of treatment, retrospectively with analysis of treatment and end result. Our policy of treatment for these multiple fractures in single extremity was directed toward early weight bearing, active and passive knee exercise by early open reduction and rigid internal fixation for both fractures. The results obtained were as follows: l. Of 25 cases, 20 patients were male and 5 were female. 2. The right lower extremity has constituted 56% of the cases. 3. Average age of patients were 37 years. 4. Most common level of fractures was on middle one third of femur (71.4% ) and proximal one third of tibia (46.2%). Of these 25 cases, three cases of femur and one case of tibia were segmental fractures, and one case of femur and five cases of tibia were open fractures initially. 5. Of 28 cases of femur fracture, 23 were given operative treatment and five conservative method. But out of 26 cases of tibia fracture, each half cases of fracture were treated operatively and conservatively. 6. We analysed the final results of treatment by the time of fracture union roentgenologically and five lower limb functions clinically at the termination of treatment. The average time for fracture union was 20.5 weeks for femur and 21.9 weeks for tibia roentgenologically. The acceptable clinical results could be achieved in 18 cases (72%) of early open reduction and rigid internal fixation for both tibia and femur as early as possible after accident for early knee exercises. 7. The status of fractured tibia was the most important factor to treat these multiple fractures in single extremity because of troublesome to start knee exercise and weight bearing.
Clinical Study ; Exercise ; Extremities ; Female ; Femur ; Fractures, Multiple ; Fractures, Open ; Humans ; Knee ; Leg ; Lower Extremity ; Male ; Methods ; Retrospective Studies ; Tibia ; Weight-Bearing

The significance of the physical examination is controversial since Slocum and Larson first described the concept of rotatory instability of the knee. The findings of the physical examination of the 101 knees of 95 patients from 1982 to 1985 were compared with the operative findings. The results were as follows. 1. Valgus stress test a) The valgus stress test c the knee in extension was positive in 1) combined tear of medial collateral ligament, posterior oblique ligament, either anterior or posterior cruciate ligament, 2) avulsion fracture of medial collateral ligament and 3) extensive tear of medial capsular ligament. But the test was negative when the posterior oblique ligament was intact although the medial collateral ligament and the anterior cruciate ligament were torn. b) The valgus stress test c the knee in 30° flexion was positive in all cases of torn medial collateral ligament, But it was severer in cases of positive test in full extension. 2. The varus stress test in extension was positive when the anterior or posterior cruciate ligament was torn in addition to lateral collateral ligament and posterolateral capsule. 3. The Slocum test was negative, or positive only in neutral rotation in isolated tear of the anterior cruciate ligament. 4. The Ritchey-Lachman test was positive in all cases of torn anterior cruciate ligament. 5. The posterior drawer test could be positive in cases of intact posterior cruciate ligament. 6. The pivot shift test was negative in cases of torn medial collateral ligament and posterior oblique ligament although there was associated tear of the anterior cruciate ligament. 7. The flexion rotation drawer test was positive in all cases of torn anterior cruciate ligament although there was associated tear of the medial collateral ligament. The positive test didn't always mean anterolateral rotatory instability, 8. The reversed pivot shift test was positive in cases of posterolateral rotatory instability but it was negative in cases of associated tear of posteromedial capsule. 9. The drawback of external rotation drawer test was that it depended on subjective evaluation. 10. The rotation test was very good for the rotatory instability but it could not be used in bilateral injury and the anterolateral rotatory instability of isolated tear of anterior cruciate ligament.
Anterior Cruciate Ligament ; Collateral Ligaments ; Exercise Test ; Humans ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Physical Examination ; Posterior Cruciate Ligament ; Tears

No abstract available.
Asthma* ; Child* ; Humans

No abstract available.
Lymphadenitis* ; Tuberculosis*

No abstract available.
Diagnosis* ; Infant, Newborn ; Meconium Aspiration Syndrome* ; Meconium*

No abstract available.
Anti-Bacterial Agents* ; Prevalence* ; Shigella*

No abstract available.
Lip* ; Tooth*