Myasthenia gravis is usually defined as a state of abnormal fatigability. The cause of myasthenia gravis is not known. Several disorders tend to occur more frequently in patients with myasthenia gravis, such as hyperthyroidism or other thyroidal disorder. Anesthetic experiences with thymectomies for two patients with myasthenia gravis has been reported. Both of them tolerated the surgical procedures under endoteracheal Nitrous oxide-Oxygen-Halothane anesthesia well. Diagnosis and clinical features including choice of preanesthetic medication, anesthetic agents, techniques and of neuromuscular blocking agents for myasthenic patients have been discussed. Paramount importance of rigid attention to ventilation, the maintenance of a patent airway and the removal of secretions whenever necessary for the patient safety throughout operative and postoperative period has been stressed.
Anesthesia ; Anesthetics ; Diagnosis ; Humans ; Hyperthyroidism ; Myasthenia Gravis* ; Neuromuscular Blocking Agents ; Patient Safety ; Postoperative Period ; Preanesthetic Medication ; Thymectomy ; Thyroid Gland ; Ventilation

There are many difficulties in operative technique of total knee replacement of bony ankylotic knee, because it accompanies the deformity of the knee, contracture of soft tissue and bony ankylosis. It is said that there are poor gaining of post-operative range of motion and development of many problems in wound healing. We performed conversion TKR in seventeen patients who had fused knee between Jan. 1985 and Dec. 1991. After follow up of average three years and four months, we analyse the results. Sixteen patients were women and one was man. There were eight cases of tuberculosis knees, seven cases of septic knees and two cases of posttraumatic arthritis. Thirteen cases had previous knee surgery and in another four cases knee fusion developed spontaneously. Average age of patients were 35 years old. Operation was performed between ten months and twenty years averaging nine years after knee fusion. When blood chemistry and physical examination showed no findings of infection, operation was performed. We used bone cement in 8 cases and autogenous bone graft in 4 cases for large bone defect. For release of soft tissue contracture, in 8 cases, we lengthened quadriceps tendon with the method of V-Y advancement technique and in another 4 cases, performed patella tendon transfer from tibial tuberosity. Operative time was between three hours and four hours fifteen minutes, average three hours and fourty minutes. The results of these patients were as follows; 1. The postoperative average range of motion was 72° (20°-125°). The average extension lag was 9. 2. The average Hospital for Special Surgery knee rating score improved from 57 preoperatively to 84 postoperatively. 3. There were two patients who had pain on walking, but radiologically and clinically there were no loosening signs. 4. In three patients who had poor gaining of range of motion after operation, we performed arthroscopic adhesiolysis. There were two cases of transient peroneal nerve palsy which were recovered within 1 month and in another two case of deep infection with β-hemolytic streptococcus and pseudomonas, we performed knee fusion after one year ten months and one month after TKR. In conclusion, conversion TKR is a successful procedure which can obtain the restoration of function of the fused knee, especially in the cases that have adequate soft tissue condition, extensor mechanism and good bone stock.
Ankylosis ; Arthritis ; Arthroplasty, Replacement, Knee ; Chemistry ; Congenital Abnormalities ; Contracture ; Female ; Follow-Up Studies ; Humans ; Knee ; Methods ; Operative Time ; Paralysis ; Patellar Ligament ; Peroneal Nerve ; Physical Examination ; Pseudomonas ; Range of Motion, Articular ; Streptococcus ; Tendons ; Transplants ; Tuberculosis ; Walking ; Wound Healing

As the number of primary total knee arthroplasties (TKA) have increased, there has been a corresponding increase in the number of revision TKAs. The purpose of the this study is to report on the follow-up results of 50 revision TKAs, and to assess their clinical outcome. From January 1990 to December 1995, 50 revision TKAs were perfomed in 43 patients, by one surgeon. Mean follow up time was 2.5 years (range, 1 to 6 years). The mean interval from the initial arthroplasty to revision was 4.6 years (range, 3 months-12.6 years). The causes of the revision were wear of polyethylene in 29 joints (58%), infection in seven (14%) and aseptic loosening in six. The revision components were fixed with cement in all cases. Additional fixations were obtained with modular stems (femoral 11 cases, tibial 13 cases), 9 tibial metal wedges, 7 femoral augmentations, and 12 allografts. The Knee Rating Scale of Hospital for Special Surgery was used for clinical assessment. The mean flexion contracture and further flexion of knee joint were 8.8degrees (range, 0-70degrees), 98.5degrees (range, 5-135degrees) preoperatively, and 3.7degrees (range, 0-15degrees), 112degrees (range, 75-135degrees) postoperatively. The Knee Rating Scale improved from 66.5 points (range, 15-83) to 87.5 points (range, 79-98). There were two cases of complications, dislocation of patella and superficial wound problem in each case. In conclusion, wear was the most common cause of failure of primary TKA. The results of revision in infected TKA were less favorable than that of wear and loosening. The prosthetic design and thickness of polyethylene were the most important factors related to wear. The tibial component of PCA and patellar component of Miller-Galante had significant wear problems.
Allografts ; Arthroplasty* ; Contracture ; Dislocations ; Follow-Up Studies ; Humans ; Joints ; Knee Joint ; Knee* ; Passive Cutaneous Anaphylaxis ; Patella ; Polyethylene ; Wounds and Injuries

OBJECTIVES: The purpose of this study is to provide the basic data for anatomy of proximal tibia by real measurement, to determine the morphologic fitness between the proximal tibia of Korean and the tibial prosthesis in total knee arthroplasty, and consequently to provide basic data for development of prosthesis that appropriate to Korean. MATERIALS AND METHODS: The anteroposterior length and mediolateral length of proximal tibia were measured for 173 knees of 117 patients who underwent total knee arthroplasty. Also, obtained data from intraoperative measure of proximal tibia were analysed according to patient's age, sex and disease. RESULTS: The results show that average mediolateral length of proximal tibia is 72.7 +/- 4.0mm, average anteroposterior length of medial plateau is 48.0 +/- 3.1mm, and average anteroposterior length of lateral plateau is 39.8 +/- 2.9mm. The mediolateral length of proximal tibia and the anteroposterior length of medial tibial plateau are significantly larger than tibial prosthesis designed by 5 different companies. The morphological differences according to disease entity are significantly larger in osteoarthritic patient group than in other disease entity. The significant difference according to patient's age is not found. CONCLUSION: The results of this study show the morphologic discrepancy between the proximal tibia of Korean and the tibial prostheses, and the development of design of tibial prosthesis for Korean should be considered.
Arthroplasty* ; Humans ; Knee* ; Prostheses and Implants* ; Prosthesis Design ; Tibia*

We analyzed 34 extension contracture of the knee patients after modified Judet's procedure. Male patient was 32 and female was 2. Age ranged from 19 years to 61 years average being 34 years old. Follow-up period ranged from 12 months to 7 years and 8 months average being 3 years 8 months. 1. The extension contracture of the knee were due to not only scarring of the vastus intermedius but contractures of quadriceps muscles, and finally did lead to intraarticular adhesion in all cases. 2. The results of modified Judet's procedure were excellent or good in 97% and we concluded that the modified Judet's procedure of quadricepsplasty was good method of treatment in extension contracture of the knee. 3. The extension lag after modified Judet's procedures was increased initially but overcame by physical therapy, and did not significantly increase even after release of rectus femoris. 4. Modified Judet's procedure was able to permit early physical therapy without any skin problem.
Cicatrix ; Contracture ; Female ; Follow-Up Studies ; Humans ; Knee ; Male ; Methods ; Quadriceps Muscle ; Skin

Water intoxication from intravascular absorption of non-electrolyte irrigating fluid is a well-known and often serious complication of TURP(transurethral resection of the prostate). The amount of fluid absorbed is related to the time elapsed, number of venous sinuses opening during resection and the height of the irrigation container. A 78-year-old male patient was performed TURP under spinal anesthesia. During the operation, chest discomfort, peripheral cyanosis, sinus bradycardia, drowsy mental state, hypoxemia, metabolic acidosis, severe hyponatremia, and pulmonary edema appeared. We had made a decision to stop operation immediately and transported to ICU. Endotracheal intubation and controlled mechanical ventilation with positive end expiratory pressure were performed and NaCI 240mEq, NaHCO3 240mEq, furosemide 20mg and 20% mannitol 200ml were injected for four hours. Three hours and forties minutes. after operation, reoperation was done for bleeding control. In consequence of reoperation, the patient began to improve in condition and came to settle in vital signs. We could extubate at dawn on the following day without any problem. We report this case and its management with the review of the relevant literatures.
Absorption ; Acidosis ; Aged ; Anesthesia, Spinal ; Anoxia ; Bradycardia ; Cyanosis ; Furosemide ; Hemorrhage ; Humans ; Hyponatremia ; Intubation, Intratracheal ; Ions ; Male ; Mannitol ; Positive-Pressure Respiration ; Pulmonary Edema ; Reoperation ; Respiration, Artificial ; Sodium ; Thorax ; Transurethral Resection of Prostate* ; Vital Signs ; Water ; Water Intoxication

Idiopathic hypertrophic cranial pachymeningitis (IHCP) is a rare disease, which causes chronic progressive inflammation and thickening of the basal dura mater and produces multiple cranial neuropathies, headache, ataxia, and seizure. A 40 year-old man presented with a continuous, diffuse, dull headache with left periorbital pain, exophthalmos, ptosis and loss of visual perception. Brain MRI revealed thickened, highly enhanced pachymeninges in all supratentorial areas in association with the left cavernous sinus. A subsequent meningeal biopsy showed non-specific chronic inflammations of the pachymeninges. The patient dramatically responded to steroid therapy. To our knowledge, this is an extremely rare case of IHCP associated with Tolosa-Hunt syndrome. (J Korean Neurol Assoc 19(1):56~59, 2001
Adult ; Ataxia ; Biopsy ; Brain ; Cavernous Sinus ; Cranial Nerve Diseases ; Dura Mater ; Exophthalmos ; Headache ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Meningitis* ; Rare Diseases ; Seizures ; Tolosa-Hunt Syndrome* ; Visual Perception

PURPOSE: To analyze the MR imaging features of multiple sclerosis (MS) in spinal cord. MATERIALS AND METHODS: Nine MR (magnetic resonance) images of six patients with suspected MS were retrospectively evaluated in active phase (n=6) and inactive phase (n=3) before and after Gadolinium-DTPA administration. RESULTS: In all patients with clinically active phase, plaques of spinal cord appeared as high signal intensity on T2-weighted image with isointense cord swelling on Tl-weighted images. All lesions were enhanced on Gd-DTPA enhanced Tl-weighted images. The patterns of enhancement were nodular, circumferential rim-like, and segmental. On follow-up images in 3 patients who became clinically stable, all enhancing lesions disappeared. CONCLUSION: MR is a good modality in detection of spinal MS, and Gd-DTPA-enhanced MR is valuable in differentiating active MS from stable MS.
Follow-Up Studies ; Gadolinium DTPA ; Humans ; Magnetic Resonance Imaging ; Multiple Sclerosis* ; Retrospective Studies ; Spinal Cord*

BACKGROUND: Long-term phototherapy can induce the changes of photoaging and it is reported that there is an increased chance of cutaneous squamous cell carcinomas in patients exposed to large amounts of UV radiation. OBJECTIVE: The main objective was to investigate the degree of photoaging and the presence of p53 mutations in normal skin in patients undergoing long-term phototherapy. METHOD: We performed hematoxylin-eosin and special stains, p53 and p21 immunohistochemical stains and polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) on the normal skin of patients subject to long-term UV therapy. RESULT: 1. The typical features of photoaging were not observed in patients undergoing long-term UV therapy. 2. In p53 immunohistochemical staining performed at 1 week after cessation of long-term PUVA treatment, the patient group with a culmulated UV dosage of more than 1,000J/cm2 demonstrated an increased number of p53 positive epidermal cells compared to exposed as well as unexposed normal skins. 3. The patterns of p21 immunohistochemical staining performed at 1 week after cessation of long-term PUVA and UVB treatments were similar to that of p53 immunohistochemical staining performed at 1 week after cessation of phototherapy. 4. In p53 immunohistochemical staining performed at 4 months after cessation of UV treatment, the number of p53 positive epidermal cells decreased significantly compared to that of p53 positive epidermal cells found at 1 week after cessation of UV treatment. 5. The mutation of p53 genes was not found in PCR-SSCP analysis of biopsied skins done at 1 week after cessation of long-term PUVA and UVB treatment. CONCLUSION: Long-term phototherapy did not induce the typical changes of photoaging and p53 overexpression in the epidermis of UV treated skin was a reactive process. Therefore, UV therapy can be a relatively safe treatment modality, although a closer observation for cutaneous malignancy is warrented in the patients whose cumulated UV dosage is much higher than 1,000J/cm2.
Aging* ; Carcinoma, Squamous Cell ; Coloring Agents ; Epidermis ; Genes, p53 ; Humans* ; Phototherapy ; Skin*

The cutaneous synthesis of vitamin D in response to ultraviolet radiation exposure is the most important factor in maintaining vitamin D balance in Man. The skin is not only the site of vitamin D synthesis, but also a target organ for calcitriol(1, 25-dihydroxy-vitamin D) which is naturally occuriag, hormonally active form of vitamin E. It is now known that calcitriol inhibits the proliferation of epidermal cells and induces her differentiation. In this study, epidermal keratinocytes and melanocytes were isilated from the neonatal foreskin, and were culturod using a MCDB 153 and modified TIC media, respectively. And then various concentratioris of calcipotriol(MC 903), a synthetic aralogue of calcitriol, were added to each culture. The effects of calcipotriol on the growth of human keratinocytes and melanocytes were investigated. The results were as follows : 1. The addition of calopotriol to human keratinocyte and melalocyte cultures inhibited their proliferation in a dosdependent manner. 2. Calcipotriol had no effects on the melanization process of the melanocyte. 3. Calcipotriol was found to inhibit the proliferation, however it induced the terminal differentiation of cultured keratinocytes, as judged by morphologicai changes. The decreased density of kerationcytes, The formation of cornified cells, and the cellular destruction in a concentration of 10 M of calcipotriol were observed. 4. By using the light atid the electron microscope, we observed that the epidermal thickness was decreased and terminal differentiation was facilitateir. Living Skin Equivalent (LSE) according to the increasing concentration of calcipotriol. A]i)parent cytotoxic effects were observed in 10 M, 10 M of calcipotriol. In summary, the above results indicate that the addition of calcipotriol to the in vitro culture system of human keratinocyte and melanocyte induces the biologic process of terminal differentiation of keratinocytes and inhibits proliferation of keratinoytes and melanocytes in a dose-dependent manner.
Calcitriol ; Cholecalciferol* ; Foreskin ; Humans* ; Keratinocytes* ; Melanocytes* ; Skin ; Tics ; Vitamin D ; Vitamin E ; Vitamins*