No abstract available.
Ankle*

A functional upper airway obstruction due to a vocal cord dysfunction(VCD) is characterized by a paradoxical adduction of the vocal cords throughout the respiratory cycle with no obvious organic cause for the obstruction. It commonly occurs paroxysmally and imitates acute asthmatic attacks, often in patients with coexisting asthma. They present with episodes of dyspnea associated with inspiratory wheezing that persists despite conventional asthma treatment and a flattening of the inspiratory limb of the flow-volume curve; an adduction of the vocal cord during inspiration. Failure to recognize concurrent vocal cord dysfunction and asthma has led not only to the excessive use of bronchodilators and corticosteroids, but also to intubation and tracheostomy. Here, we report a case of coexistent obstructive pulmonary disease and functional upper airway obstruction due to a vocal cord dysfunction where a bronchoscopy showed a paradoxical vocal cord motion and typical features of a variable extrathoracic obstruction and a lower airway obstruction on the Flow-volume loop during a symptomatic period.
Adrenal Cortex Hormones ; Airway Obstruction* ; Asthma ; Bronchodilator Agents ; Bronchoscopy ; Dyspnea ; Extremities ; Humans ; Intubation ; Lung Diseases, Obstructive* ; Respiratory Sounds ; Tracheostomy ; Vocal Cord Dysfunction* ; Vocal Cords*

BACKGROUND: Joint symptoms frequently occur in the course of antituberculous chemotherapy and tend to be ignored and overlooked, but in some cases, they are often very troublesome in obstructing ordinary life. Joint symptoms that develop during antituberculous chemotherapy need to be understood, but there are few materials describing them systematically. METHOD: This study enrolled 33 patients with tuberculosis treated with first line antituberculous agents for more than 6months. In the course of treatment, joint symptoms not associated with specific cause, such as pre-existing joint disease or trauma, were investigated and compared with those of the asymptomatic group, We confirmed the incidence of joint symptoms and factors associated with them. RESULTS: Nineteen of 33 patients (58%) had joint symptoms. Joint symptoms developed 1.9±1.4 months after the beginning of chemotherapy and lasted for 3.6±2.5 months. IN 18 of 19 symptomatic patients, multiple joints were involved : shoulder(10 patients, 53%), knee(10,53%), finger(6,32%). Joint symptoms were expressed as pain(19 patients, 100%), stiffness(7,37%) and/or swelling (3,16%). Fourteen patients (74%) took analgesics to relieve their symptoms and in 2 patients, antituberculous agents were discontinued because of the severity of their symptoms. The symptoms seem to be caused by agents other than pyrazinamide, but it was very difficult to identify the definite causative agent. In age, sex, underlying disease and serum uric acid level, no significant differences were noted between the two groups. CONCLUSIONS: Although joint symptoms are common during antituberculous chemotherapy, their development is difficult to predict. Because some joint symptoms can become very bothersome, the physician should pay close attention to these symptoms.
Analgesics ; Arthralgia ; Drug Therapy* ; Humans ; Incidence ; Joint Diseases ; Joints* ; Pyrazinamide ; Tuberculosis ; Uric Acid

Fractures of the shaft of the radius and ulna occur commonly in children and are usually treated by closed reduction and plaster cast immobilization. Anatomic reduction is seldom necessary because of the remodelling potential in the child under 10 years of age, whereas the bones of children older than 10 years of age have less capacity to remodel and the diaphyseal fracture is unstable. In case of either unacceptable reduction or unstable fractures in adolescent patients, an operative treatment is required. In five children older than 12 years of age for whom conservative treatment had hailed, we treated a closed intramedullary nailing using a distal radial and proximal ulnar approach, and followed up for 1 year or more. All fractures healed within 6 weeks. No nonunion, cross-union or refrature occured. Another advantages of this method are negliable cosmestic defect and easy removal of the internal fixation device under local anesthesia. We think that closed intramedullary nailing with rush pin is a safe and reliable method to treat unstable forearm fracture in children older than 12 years of age.
Adolescent ; Anesthesia, Local ; Casts, Surgical ; Child ; Forearm ; Fracture Fixation, Intramedullary ; Humans ; Immobilization ; Internal Fixators ; Methods ; Radius ; Ulna

BACKGROUND AND OBJECTIVES: Tonsillectomy is a very common surgical procedure in otolaryngology. Steroid is often given to decrease postoperative morbidity from the procedure. This study was designed to determine the intraoperative and postoperative efficacy of the intravenous administration of dexamethasone sodium phosphate, the long-acting steroid, before or after tonsillectomy. MATERIALS AND METHODS: Sixty children aged between 3 to 15 years were divided into three groups. Twenty children received intravenous dexamethasone sodium phosphate (1 mg/kg up to 15 mg) before undergoing sharp dissection tonsillectomy (group I). Another twenty children received it after operation (group II). The third group was control and did not receive the intravenous dexamethasone sodium phosphate (group III). Intraoperatively blood loss, surgical and anesthesia time were checked. After the operation, each child was evaluated for pain, oral intake, vomiting, body temperature, and bleeding. RESULTS: There were no statistically significant differences noted in blood loss, surgical time, anesthesia time, pain score, oral intake, vomiting, and postoperative bleeding among the three groups of patients. CONCLUSION: The results showed that a single dose of the intravenous dexamethasone sodium phosphate did not affect the postoperative morbidity in children undergoing sharp dissection tonsillectomy.
Administration, Intravenous ; Anesthesia ; Blood Loss, Surgical ; Body Temperature ; Child ; Dexamethasone* ; Hemorrhage ; Humans ; Otolaryngology ; Sodium ; Tonsillectomy* ; Vomiting

The long-term studies of total knee arthroplasty (TKA) have confirmed reliable relief of pain and maintenance of function. However there have been few generalized studies of factors influencing the results of TKA. We evaluated retrospectively 187 TKAs (137 patients) which had been performed between January 1987 and May 1995. The follow-up period was from one year to eight years (mean, 3 years and 8 months). There were 133 knees of osteoarthritis (OA), 43 knees of rheumatoid arthritis (RA) and 11 knees of other causes including septic knee sequelae. We considered the preoperative factors as age, sex, side (right or left), body weight, height, primary disease, flexion contracture (FC), further flexion (FF), range of motion (ROM) of joint, deformity of varus and valgus and pain score, muscle strength score, instability score, total knee score according to the knee rating scale of the Hospital for Special Surgery (HSS). We considered the clinical results as FC, FF, ROM, pain, muscle strength, instability, total knee score according to the knee rating scale of the HSS and the radiological results as Roentgenographic Evaluation and Scoring System of American Knee Society and radiolucent line more than 2mm in width. We evaluated the clinical and radiological results of TKAs followed up more than I year and analyzed the results based on above factors. The results were as follows: 1. The preoperative factors influencing final FC were not the primary disease and FC, but the FF and ROM. The preoperative factors influencing final FF and ROM were the primary disease, the FF and ROM. 2. The pain, muscle power, instability scores were improved but there was no significant factor influencing them. The HSS knee scores were higher in OA group than RA group postoperatively. 3. There was no preoperative factor influencing the complication, revision, the radiological results. The preoperative factors influencing the results of TKA were the FF, ROM and the primary disease.
Arthritis, Rheumatoid ; Arthroplasty* ; Body Weight ; Congenital Abnormalities ; Contracture ; Follow-Up Studies ; Joints ; Knee* ; Muscle Strength ; Myalgia ; Osteoarthritis ; Range of Motion, Articular ; Retrospective Studies

Nineteen revision total knee arthroplasties (TKAs) performed from March 1991 to March 1995 were evaluated to determine the clinical and roentgenographic results and the problems in revision TKA. The mean age was 63 years (range, 23-85 years) and the mean follow-up time was 19 months (range, 12 months-4.4 years). The primary revisions were done in eighteen knees and a re-revision, in one. Four revision TKAs were performed for failed unicompartmental arthroplasty and fifteen, for failed TKA. The mean interval from initial to revision TKA was 4.1 years (range, 3.3 years-5 years) in failed unicompartmental arthroplasty and 5.7 years (range, 4 months-14 years) in failed TKA. The initial diagnosis was degenerative arthritis in 16 knees, tuberculous arthritis in two and rheumatoid arthritis in one. The main cause of revision for both of the failed unicompartmental arthroplasties and failed TKAs was aseptic loosening. The HSS knee score improved from 43+/-14 to 82+/-7 in the failed unicompartmental arthroplasties and from 46+/-16 to 79+/-14 in the failed TKAs. The clinical success rate of revision TKA was 78%. The coronal tibiofemoral angle improved from valgus 0.2degrees to valgus 5.1degrees. At final follow-up, radiolucent line greater than 2mm in width was found around femoral component in one knee. In our series, four complications were occurred. One knee was fused due to mas-sive bone loss and ipsilateral femur shaft fracture. Deep wound infections were developed in two knees and loss of fixation after tibial tuberosity osteotomy in one. In conclusion, significant improvements of clinical and radiological results were achieved in revision TKA but the success rate was relatively low and the complication rate was relatively high compared with primary TKA. So, especially appropriate skillful surgical techniques and postoperative cares were required to overcome the soft tissue problem and infection which was encountered in revision TKA.
Arthritis ; Arthritis, Rheumatoid ; Arthroplasty* ; Diagnosis ; Femur ; Follow-Up Studies ; Knee* ; Osteoarthritis ; Osteotomy ; Wound Infection

It has been reported that the maintenance of proper ligament balance around the knee joint and the proper location of tibio-femoral joint line position are very important factors for obtaining good knee joint function after the total knee replacement arthroplasty. but, yet the exact effect of the change of joint line on the result of total knee replacement arthroplasty has not been elucidated. The purpose of this study is to evaluate the effect of the change of joint line on the patellar position and the postoperative knee joint function as well as the effect of antero-posterior offset of tibial component on the clinical result. The authors performed the clinical and radiological analysis of 85 knees, in which total knee replacement arthroplasty was performed and followed over 1 year. Tibio-femoral joint line changed from -7mm to +6.8mm (average -0.07) and in this range, the change of joint line did not influence the clinical result and the patellar position. As tibio-femoral joint line migrated proximally, the patella migrated distally and as tibio-femoral joint line migrated distally, the patella migrated proximally. Postoperative pain decreased as the patella and patellar articular surface moved proximally. As the patellar bone height from tibial tuberosity decreased postoperatively. The range of motion decreased. Antero-ppsterior offset of tibial component distributed from -4.2mm to +4.5mm (average 0.62mm) and no effect on cllinical result in this range. In conclusion, it may be suggested that the change of joint line in total knee replacement arthroplasty must be changed as little as possible for the good postoperative range of motion and relief of pain.
Arthroplasty* ; Arthroplasty, Replacement, Knee* ; Joints* ; Knee ; Knee Joint ; Ligaments ; Pain, Postoperative ; Patella ; Range of Motion, Articular

This study sought to demonstrate bone mineral density (BMD) conditions in elderly female patients with knee osteoarthritis (OA) undergoing total knee arthroplasty (TKA). In addition, we sought to determine whether their BMD conditions differ from those of community-based females without knee OA. Finally we sought to determine whether clinical statuses are related to BMD in the knee OA patients. BMD conditions in 347 female patients undergoing TKA and 273 community-based females were evaluated. Additionally, comparative analyses of BMD between age and body mass index-matched knee OA groups (n=212) and the control groups (n=212) were performed. In the pre-matched knee OA group, regression analyses were performed to determine whether preoperative clinical statuses were related to BMD. Considerable prevalence of coexistent osteoporosis (31%) was found in the pre-matched knee OA patients undergoing TKA. We found no significant differences of the BMD T-scores and the prevalence of osteoporosis between the age and body mass index-matched knee OA and control groups. In the pre-matched knee OA patients, poorer preoperative clinical scores were related to poorer BMD T-scores in the proximal femur and/or lumbar spine. Our study suggests that more attention should be paid to identify and treat osteoporosis in elderly female patients with advanced knee OA undergoing TKA.
Aged ; Aged, 80 and over ; *Arthroplasty, Replacement, Knee ; Body Mass Index ; Bone Density ; Female ; Humans ; Knee Joint/pathology/surgery ; Osteoarthritis, Knee/*epidemiology/*surgery ; Osteoporosis/*epidemiology

PURPOSE: We compared pathogen recovery rates by obtaining two blood cultures instead of one blood culture containing 1ml and collecting a larger volume, 1 to 3ml. METHODS: Total of 750 blood specimens from 250 patients with fever, a temperature higher than 39degrees C and suspected bacteremia were obtained. Each patient had two samples of blood, A (1ml) and B (4ml), obtained at 30-minute interval from separate sites of extremities and B was divided into B1 (1ml) and B2 (3ml). Each sample was inoculated into aerobic culture media. Patients were excluded if two samples of blood were not obtained or if the isolate represented a contaminant. RESULTS: A pathogen was isolated in 19 (7.6%) of 250 patients and 37 (4.9%) of 750 specimens. In 7 patients, the pathogen was isolated with all the culture methods and in 12 patients, one or more of the cultures yielded no growth. The pathogen recovery rates were 53% (10/19) in A and B1, 89% (17/19) in B2 and 68% (13/19) in A+B1. No difference was detected between A or B1 and A+B1 (P>0.05) and the pathogen recovery rate for B2 was significantly greater than that for A or B1 (P<0.05), but no significant differences were found in pathogen recovery when B2 was compared with A+B1. CONCLUSION: Increasing volume of blood from 1 to 3ml inoculated into blood culture bottles improves detection of bacteremia in pediatric patients and spares patients the cost and pain of an additional venipuncture.
Bacteremia* ; Child* ; Culture Media ; Extremities ; Fever ; Humans ; Phlebotomy