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

Forearm bone fractures are difficult to manage, because of their special functions (pronation and supination) and peculiar anatomy. Authors have experienced 68 cases of various types of forearm bone fractures from January, 1968 to December, 1971. They were analized as following. 1. Out of 68 patients, males were 54 cases (79.4%) and females were 14 cases (30.6%). Among them, 91.2% of the cases were occured in people over 15 years old. About 47% of the cases were caused by automobile accidents. 2. Both forearm bone fractures were 51 cases (75%), and most common site of the fractures were mid 1/3(66.2%). Stable (transverse or incomplete) fractures were 24%, and unstable(comminuted, segmental, oblique or spiral) fractures were 76%. Open fractures were 26.5% 3. Conservative treatment was given to 41 cases (60.3%), and open reduction & internal fixation was given to 27 cases (39%). 4. A comparison has been made between the groups treated by conservative method and open reduction & internal fixation. 1) Average healing time of open reduction group was 19.5 weeks and conservative group was 16.4 weeks. 2) Non-union was occured in 7.4% of conservative treatment group, and 22.7% of open reduction group. 3) Satisfactory functional results were shown in 23.5% of conservative group and 54.5% of open reduction & internal fixation group. 4) Rotational deformities were noticed in 53.3% of the conservative treatment group and 54.5% of the open reduction group (No difference was noticed). 5) Angulatory deformities were shown in 70.4% of the conservative treatment group and 44.4% of the open reduction group. 5. Three cases were complicated by cross unoin, and no postoperative wound infection was noted. But two cases of open fracture developed to chronic osteomyelitis.
Automobiles ; Congenital Abnormalities ; Female ; Forearm ; Fractures, Bone ; Fractures, Open ; Humans ; Male ; Methods ; Osteomyelitis ; Surgical Wound Infection

Sixty six Colles' fracture were treated with radial slab or U-cast (sugar tong splint), from January 1982 through May 1984 at the Department of Orthopaedic Surgery of St. Mary Hospital. A prospective study was made and was evaluated under the subjective criteria of Gartland and Werley, and the objective criteria of Scheck. The results of this study were as follows: 1. All of 66 cases was closed fracture and the incidence was high in females who aged over 6thdecades. 2. In 43 cases of stable fracture, 18 (94.7 %) out of 19 cases treated with radial slab and 21 (87.5%) out of 24 cases treated with U-cast showed satisfactory result. 3. In 23 cases of unstable fracture, 6 (54.6%) out of 11 cases treated with radial slab and 9 (75%) out of 12 cases treated with U-cast showed satisfatory result. 4. As a result, we found that the result of the treatment with radial slab was superior to the U-cast for the stable Colles fracture, however, all of two methods were not staisfatory for the unstable Colles fracture although the U-cast group showed better result.
Colles' Fracture ; Female ; Fractures, Closed ; Humans ; Incidence ; Prospective Studies

Since last August, 29 cases of synovial punch biopsy have been carried out with Franklin-Silverman needle which was used in liver biopsy, instead of the specialized needle for the synovium. Authors report the applicable utility of Franklin-Silverman needle for the synovial biopsy, diagnostic value of this procedure and histopathologic findings of the results. The rate of the technical success to abtain synovial tissue was about 76%. Complications after procedure have been very rarely encountered, consisting of mild transient hemarthrosis. In 17 cases, the histopathologic changes was compatible with their clinical findings. In the remainders, we experienced the failures to get synovial tiasue at all in 7 cases and to give the significant synovial changes in 5 successful specimens. Fortunately, the important diagnostic aid was achieved in 3 cases which were conformed early diagnosis of tuberculous arthritis. This needle biopsy was also thought to contribute to rule out the gouty arthritis from other hyperuricemic conditions. But the histologic changes were non specific inflammatory findings in the synovial mambrane of rheumatoid arthritis, osteoarthritis, traumatic and infectious arthritis.
Arthritis ; Arthritis, Gouty ; Arthritis, Infectious ; Arthritis, Rheumatoid ; Biopsy ; Biopsy, Needle ; Early Diagnosis ; Hemarthrosis ; Liver ; Needles ; Osteoarthritis ; Synovial Membrane

Biopsy has proved to be of value in the diagnosis of many inflammatory and malignant diseases, and needle biopsy of the synovial membrane in arthritis is well established and often employed as the final diagnostic aid in patient with joint disease. Authors have carried out synovial needle biopsy in 76 joints with Franklin-Silverman needle used commonly in liver biopsy. The results obtained were as followa; 1) Of seventy five biopsies attempted, adequate amount of tiasue was obtained in 51 of 53 knee cases (96.2%), 11 of 14 wrists (78.6%). 3 of 5 elbows (60%), 1 of 3 ankles (33.3%). Adequate amount of tissue was obtained in 66 cases and the overall succese rate was 88%. 2) Histopathological diagnosis was made in 53 of 75 cases (70.7%). In 12 cases, correct specimens were obtained but proved to be incompatible with the diagnosis done by either clinical data or open biopsy. 3) Histopathological diagnoses were made in 25 of 35 cases of rheumatoid arthritis (71.4%) 14 of 18 cases of tuberculous arthritis (77.8%), 7 of 13 cases of degenerative arthritis (53,8%), 4 of 6 cases of suppurative arthritis (66.7%), 2 cases of traumatic arthritis (100%), and one case of villonodular synovitis (100%). 4) The complications resulting from this proedure were pare; mild transient hemarthrosis was found in only 5 cases We also discovered that for an accurate diagnosis multiple specimens should be obtained because otherwise the specimens were too small to interprete histopathologically. In addition we concluded that the success rate depended not upon the sorts of needle used but rather more upon the biopsy technique. Franklin-Silverman needle biopsy proved to be a simple, safe and reliable procedure for diagnosis of the synovial diseases in which conventional arthrotomy is inadvisable and other diagnostic procedures are inadequate.
Ankle ; Arthritis ; Arthritis, Infectious ; Arthritis, Rheumatoid ; Biopsy ; Biopsy, Needle ; Diagnosis ; Elbow ; Hemarthrosis ; Humans ; Joint Diseases ; Joints ; Knee ; Liver ; Needles ; Osteoarthritis ; Synovial Membrane ; Synovitis ; Wrist

The tibial fracture apt to be encountered many complicationa including delayed or non-union. Many authors reported aeveral methods of early detection of the complication. Among them, it has been known that interoeseous phlebography is one of the simplest and valuable method to predict the delayed or non-union. Puranen and Kaski(1974) reported that the osteomedullography was valuable in early detection of delayed union and in deciding whether a bone graft is indicated. We performed ostemedullogram in the cases of tibial fracture since July, 1974. In this paper, we presented the caaes which showed unusual findings, and dicussed the method of evaluation of these findings. The results obtained as follows; 1. The positive Kaski signs did not always mean the completness of union of fracture. It only indicated that the union was going on. 2. Even in cases in which Kaski signs are positive, the final decision for bone graft have to depend upon the clinical and physical findings and simple roentgenogram. 3. The negative Kaski signs did not always mean the possible development of delayed or non-union. Usually it indicated only delaying of union, and the treatment should not solely depend on only the osteomedullographic findings. 4. Even in cases in which bridging callus is well formed around both fracture ends, also in cases of solidly united fracture Kaski signs were sometimes completely negative. This osteomedullography is clinically easily to apply in all cases of tibial fracture, and give us a lot of information concerning with fracture healing. We have to pay attention to the false nagative cases. In those cases we have to depend more on clinical test and simple roentgenogrm.
Bony Callus ; Fracture Healing ; Methods ; Phlebography ; Tibial Fractures ; Transplants

Two cases of acquired absence of forearm bone secondary to compound comminuted fractures were treated by reconstructive surgery, which consist of surgical construction of one-bone forearm. The results of treatment were referred and the review of the literature was done concerning about surgical reconstruction of one-bone forearm.
Forearm ; Fractures, Comminuted

No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

Polypeptide antigen as isolated from adult worms of Clonorchis sinensis by means of diluted HCl-extraction method. Preliminary intradermal examination with those polypeptide antigen(CPT) were performed on patients of clonorchiasis, paragonimiasis and metagonimiasis and the result of the intradermal test with CPT antigen were compared with those of Clonorchis protein fraction(CPF) and Veronal buffer saline extraction (VBS) antigen. The result of the examination were summerized as follows: When 0.05 ml (1 microgram) of CPT was injected intradermally, the positive intradermal reaction appeared in 42.7 per cent (37 of 82) on the patients of clonorchiasis. The sizes of the wheal and erythema with CPT antigen was smaller than that of CPF and VBS antigen. Intradermal reaction with CPT antigen was carried out for other parasitic diseases, such as paragonimiasis and metagonimiasis. The result indicated that CPT antigen may be showed no cross reactions. Clonorchiasis pateints who with negative reaction to CPT antigen, reacted negatively to CPF and VBS antigens.
parastiology-helminth-trenmatoda ; Paragonimus ; Clonorchis sinensis ; Metagonimus ; clonorchiasis ; paragonimiasis ; metagonimiasis ; immunology ; skin test ; erythema ; Clonorchis protein fraction ; Veronal buffer saline extraction ; antigen

Metacercariae of a kind of Levinseniella species were found from a brackish water crabs, Macrophthalmus japonicus de Haan, in the brackish area of Hyungsan river of Kyungpook province. Habitats were the epigastric and progastric regions of Macrophthalmus japonicus. One hundred and seventy five crabs out of 178 examined (98.3 per cent) were infested with metacercariae of Levinseniella species. The infested number of metacercariae in each crabs was average 100 ea. The excystation of metacercaria has not developed in vitro (both saline and tyrode's solution). Many eggs were observed in the metacercariae maintained for 24 or 48 hours in the water-bath. No differences were observed between semi-adult fluke from rat host and those maintained for 24 or 48 hours in vitro.
parasitology-helminth-trematode ; Levinseniella ; Macrophthalmus japonicus ; crab ; epidemiology ; tyrode's solution ; saline