PURPOSE: Septic arthritis of the knee is a relative rare complication of the arthroscopic anterior cruciate ligament reconstruction, but inadequate treatment of this complication may lead to a devastating conse- quence of a chronic infection. Moreover, no guidelines have been proposed for the treatment of patients with knee infections after the anterior cruciate ligament reconstruction. To determine the optimal diagno- sis and treatment recommendation, we performed this study. MATERIALS AND METHODS: We performed retrospective study of the knee joint infections after the arthroscopic anterior cruciate ligament reconstruction between August 1993 and August 1998, Of the 420 patients who reviewed arthroscopic ACL reconstruction during this period from one surgeon, we experi- enced 4 cases(0.95%) of postoperative deep infections of the knee. RESULTS: All 4 patients were male, and the average age was 32 years(range from 19 to 43). Two patients had acute(< 2 weeks), two patients had subacute infections(2 weeks to 2 months). The acute cases had more severe symptoms, and positive cultures from knee joint aspirates. All patients underwent immediate open(1 case), or arthroscopic irrigation and debridement. One patient underwent repeat irriga- tion and debridement. The graft was removed from all patients in acute cases. CONCLUSION: The clinical symptoms, and the infected organism were more helpful than the peripheral blood counts in the diagnosis of a deep infection of the knee. Arthroscopic lavage, and debridement com- bined with intravenous antibiotics were effective treatment options. Clinical symptoms were more severe in acute cases, and early graft removal is an adequate method of surgical treatment.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Anti-Bacterial Agents ; Arthritis, Infectious* ; Debridement ; Diagnosis ; Humans ; Knee Joint ; Knee* ; Male ; Retrospective Studies ; Therapeutic Irrigation ; Transplants

Actinomycosis, in which the principal causative agent in man is known to Actinomyces israelii, is a chronic, suppurative diseases characterized by extensive fibrosis, multiple abscesses, and formation of sinus tracts that drain suppurative exudates. On the basis of the anatomical sites involved; it can be subclassified into the cervicofacial form, which is the most common form, pulmonary form and abdominal form. Kidneys are rarely affected. Clinically, radiologically, and at operation it is difficult to differentiate the renal actinomycosis from renal tuberculosis and renal carcinoma. The prognosis is excellent after nephrectomy followed by appropriate antibiotic therapy. We presented a case of renal actinomycosis with a brief review of the literatures.
Male ; Humans

No abstract available.
Lasers, Gas*

PURPOSE: We report a distinctive lesion in the articular cartilage of the talar dome in anterior bony impingement syndrome of the joint. MATERIALS AND METHODS: Arthroscopic debridement was done in 68 ankles under the diagnosis of anterior impingement syndrome of the ankle joint between October 1994 and June 1996. There were 6 tram track lesions of talar dome of the 68 ankles. We evaluated arthroscopic findings of tramtrack lesion, injury mechanism, and treatment results according to the criteria of Ogilvie-Harris DJ et al. RESULTS: All six male patients were professional or collegiate soccer players. Average age was 29 years (26 to 34). All 6 cases were dorminant ankles. Trauma history was not definite in all 6 cases. All 6 patients were anterior impingement syndrome of the ankle and treated by arthroscopic removal of osteophytes. The cartilage lesions were full thickness defects, located in the anterior half of the medial aspect of the talar dome and were longitudinal with variable widths resembling a tram track, thus named ""tram track lesion"". Tram track lesion and osteophytes were contacted by ankle dorsiflexion. Overall, good and excellent results were achieved in five patients at a mean follow up of twenty-seven months. Two cases had recurrences of osteophytes. CONCLUSIONS: Tram track lesion of talar dome occurred by repeated scratching of the osteophyte of distal tibia and treated effectively by arthroscopic removal of osteophyte and debridement.
Ankle ; Ankle Joint ; Arthroscopy ; Cartilage ; Cartilage, Articular ; Debridement ; Diagnosis ; Diphenhydramine ; Follow-Up Studies ; Humans ; Joints ; Male ; Osteophyte ; Recurrence ; Soccer ; Tibia

No abstract available.
Child* ; Glomerulonephritis, IGA ; Hematuria* ; Humans ; Nephritis* ; Purpura, Schoenlein-Henoch*

We studied the efficiency of various bone grafts in the assessment of new bone formation by tetracycline labeling in sixty rabbits. The rabbits were divided into four different groups. Vascularized tibial cortical segment(Group I), devascularized free cortical graft without intramedullary reaming (Group II-A), devascularized cortical graft with intramedullary reaming(Group II-B) and autoclaved free cortical graft(Group III) were evaluated by quantitative analysis of new bone formation after double labeling with tetracycline. Group I was found to produce most abundant periosteal new bone formation, and followed by Group II-A. Group II-B and Group IU showed approximately same amount of new bone formation. While endosteal new bone formation was predominant in Group II-A, periosteal new bone formation was more predominant in Group II-B. Intramedullary reaming seemed to inhibit endosteal bone formation in devascularized free cortical graft by interfering with the ingrowth of the vascular channels and granulation tissue through the medullary cavity.
Granulation Tissue ; Osteogenesis ; Rabbits ; Tetracycline ; Transplants

A totally implanted venous access system was inserted in 19 children with cancer. The devices were utilized for the administration of antineoplastic drugs, parenteral fluids, antibiotics, and blood products. Total duration of implantation was 4,046 days for 23 implanted system (range 7-445 days). Complications included cather infection (0.247/100 catheter days), occlusion (0.692/100 catheter days), and dislodgement of needle (0.643/100 catheter days). There were major complications that necessitated removal of catheters, including systemic infections (0.09/100 catheter days) and complete occlusions (0.09/100 catheter days). The system was thought to be safe and convenient in chemotherapy, and permitted full physical activity.
Anti-Bacterial Agents ; Antineoplastic Agents ; Catheters ; Child* ; Drug Therapy ; Humans ; Motor Activity ; Needles ; Prospective Studies*

Juvenile idiopathic arthritis (JIA) can develop extra-articular manifestations, including growth retardation, osteopenia and chronic uveitis. However, pleuropulmonary involvement is rare. Approximately 40% of patients with JIA have abnormal pulmonary function tests without pulmonary symptoms, with the commonest abnormality in carbon monoxide diffusing capacity, but clinically evident pulmonary parenchymal disease in JIA is extremely uncommon. We describe a 15-year-old male with JIA who presented with dyspnea due to interstitial lung disease.
Adolescent ; Arthritis ; Arthritis, Juvenile Rheumatoid* ; Bone Diseases, Metabolic ; Carbon Monoxide ; Dyspnea ; Humans ; Lung Diseases ; Lung Diseases, Interstitial ; Lung* ; Male ; Respiratory Function Tests ; Uveitis

PURPOSE: Surgical excision has been the primary treatment for hepatoblastoma and hepat-ocellular carcinoma. However, at presentation, only one third of such tumors are surgically resectable. Without operation, the disease is fatal. Therefore, neoadjuvant chemotherapy has been introduced for conversion of the unresectable tumors into the resectable ones. We studied th e effects of chemotherapy for hepatic malignancy in children. METHODS: Between November 1986 and August 1993, 30 children presented with hepatoblastomas or heptocellular carcinoma, which were diagnosed by histology. We analysed the laboratory findings of hepatic tumors and the outcome of chemotherapy. RESULTS: Laboratory findings revealed mild anemia, elevated SGOT/SGPT, and extremely increased AFP level. Twenty-six among 30 patients entered into surgery or neoadjuvant chemotherapy. Initial complete resection of tumor was attempted in 11 case, and was successful in 9 cases. Fifteen cases with initially unresectable tumors were treated with chemotherapy including cisplatin and/or doxorubicin. Nine of 15 showed significant reduction in tumor size, and delayed resection of the primary lesion was possible. But one case did not respond to chemotherapy, and 5 cases was droped out due to death(n=2) and refusal of chemotherapy(n=3). Twenty p atients were enrolled in survival analysis. Over-all 3 year survival rate was 61%, and 2 year survival rates of hepatoblastoma and hepatocellular carcinoma were 85% and 33% respectively(P=0.06). According to the stage, 2 year survival rate of stage I and III were 87% and 75% respectively. None of patient with metastasis survived at 16 months. Chemotherapy was tolerable in most patients and its principal toxicities were myelosuppression and fever. Three patients developed decreased left ventricular shortening fraction and their cumulative dose of doxorubicin were 771mg/m2, 557mg/ m2, and 390mg/ m2. CONCLUSIONS: Chemotherapy including cisplatin and/or doxorubicin is an effective treatment in inducing surgical resectability in hepatoblastomas which are unresectable at diagnosis.
Anemia ; Carcinoma, Hepatocellular* ; Child* ; Cisplatin ; Diagnosis ; Disulfiram ; Doxorubicin ; Drug Therapy* ; Fever ; Hepatoblastoma* ; Humans ; Neoplasm Metastasis ; Survival Rate

OBJECTIVE: To determine whether the use of contrast enhancement (especially its extent) predicts malignant brain edema after intra-arterial thrombectomy (IAT) in patients with acute ischemic stroke. METHODS: We reviewed the records of patients with acute ischemic stroke who underwent IAT for occlusion of the internal carotid artery or the middle cerebral artery between January 2012 and March 2015. To estimate the extent of contrast enhancement (CE), we used the contrast enhancement area ratio (CEAR)-i.e., the ratio of the CE to the area of the hemisphere, as noted on immediate non-enhanced brain computed tomography (NECT) post-IAT. Patients were categorized into two groups based on the CEAR values being either greater than or less than 0.2. RESULTS: A total of 39 patients were included. Contrast enhancement was found in 26 patients (66.7%). In this subgroup, the CEAR was greater than 0.2 in 7 patients (18%) and less than 0.2 in the other 19 patients (48.7%). On univariate analysis, both CEAR > or =0.2 and the presence of subarachnoid hemorrhage were significantly associated with progression to malignant brain edema (p<0.001 and p=0.004), but on multivariate analysis, only CEAR > or =0.2 showed a statistically significant association (p=0.019). In the group with CEAR > or =0.2, the time to malignant brain edema was shorter (p=0.039) than in the group with CEAR <0.2. Clinical functional outcomes, based on the modified Rankin scale, were also significantly worse in patients with CEAR > or =0.2 (p=0.003) CONCLUSION: The extent of contrast enhancement as noted on NECT scans obtained immediately after IAT could be predictive of malignant brain edema and a poor clinical outcome.
Brain Edema* ; Brain* ; Carotid Artery, Internal ; Humans ; Infarction* ; Middle Cerebral Artery ; Multivariate Analysis ; Stroke ; Subarachnoid Hemorrhage ; Thrombectomy*