Ankle arthrodesis has been regarded as a good operative treatment for post traumatic and rheumatoid arthritis of ankle, and ankle arthroplasty has been also developed with several types, from 1970, by Lord & Marotte. Ankle arthroplasty is more functional & less cosmetic troublesome than arthrodesis, and with more developed prosthesis design, more good result will come. The authors operated 6 cases of total ankle arthroplasty for posttraumatic and rheumatoid arthritis of ankle, which were also indications of arthrodesis, and introduce the results and operative problems of ankle arthroplasty.
Ankle ; Arthritis, Rheumatoid ; Arthrodesis ; Arthroplasty ; Prosthesis Design

Amyloidosis is a rare systemic disease caused by extracellular deposition of insoluble protein. Systemic amyloidosis is subclassified into idiopathic primary and secondary form. The cause of secondary amyloidosis includes tuberculosis, familial Mediterranean fever, rheumatoid arthritis and multiple myeloma. We report a case of tuberculosis-related, secondary systemic amyloidosis which involved liver, spleen, kidneys, stomach, urinary bladder and lymph nodes.
Amyloidosis* ; Arthritis, Rheumatoid ; Familial Mediterranean Fever ; Kidney ; Liver ; Lymph Nodes ; Multiple Myeloma ; Spleen ; Stomach ; Tuberculosis* ; Urinary Bladder

BACKGROUND: The purpose of our study was to evaluate the accuracy of reduction based on postoperative computed tomography (CT) images after arthroscopic stabilization using tightrope system for unstable distal clavicle fracture. METHODS: Twelve patients with distal clavicle fracture combined with coracoclavicular (CC) ligament injury (type II, V) who received arthroscopically assisted fixation using a flip button device were evaluated for accuracy of reduction using 3-dimensional postoperative CT scan by measuring the degree of distal clavicular angulation and clavicular shortening. RESULTS: Immediate postoperative plain radiograph confirmed restoration of the CC distance (CCD) in 10 patients. At final follow-up, the CCD remained reduced anatomically on plain radiographs in these patients. All patients showed excessive posterior angulation and shortening compared to the opposite side. The average Constant score recovered to 94.8 at final follow-up. CONCLUSIONS: Indirect reduction and arthroscopic subacromial approach with flip button fixation of unstable distal clavicle fractures demonstrated favorable clinical results despite unavoidable posterior angulation of distal clavicle and shortening the total length of clavicle.
Arthroscopy ; Clavicle ; Follow-Up Studies ; Humans ; Ligaments ; Tomography, X-Ray Computed

PURPOSE: The purpose of this study was to evaluate the accuracy of Tc-99m DTPA diuretic renal scans in children upper urinary tract. MATERIALS AND METHODS: We reviewed diuretic renal scans of 14 pediatric patients (age range: 3 days to 4 years) with unilateral hydronephrosis diagnosed by ultrasonography. Diuretic renal scan was done using Tc-99m DTPA and standardized protocol. In 3 neonates, diuretic renal scans were performed within 1 week and 3-7 months after birth. RESULTS: Six patients required pyeloplasty and eight were managed conservatively. All 6 patients requiring pyeloplasty were diagnosed as having ureteropelvic junction obstruction in the diuretic renal scan. In these 6 patients, post-operative renal scans at 3-12 months after surgery were converted to nonobstructive pattern in 5 and a nonobstructive patterns in 1. In 3 patients who underwent diuretic renal scan within 1 week after birth., nonobstructive patterns of initial scan were coverted to obstructive patterns in the follow-up scan. However, all patients with nonobstructive diuretic renal scans performed after the neonatal period did well on serial ultrasonography and showed favorable clinical outcome without progression to obstruction. CONCLUSION: Tc-99m DTPA diuretic renal scan with standarized protocol is useful in assessing suspected ureteropelvic junction obstruction in children as an initial diagnostic or post-operative follow-up modality. Nonobstructive or indeterminate scan RESULTS in the neonatal period requires follow-up scan to monitor development of the obstructive pattern.
Child* ; Follow-Up Studies ; Humans ; Hydronephrosis ; Infant, Newborn ; Kidney Pelvis ; Parturition ; Pentetic Acid* ; Radioisotope Renography* ; Ultrasonography ; Urinary Tract*

No abstract available.
Otoacoustic Emissions, Spontaneous*

Transaminase enzymes, alanine (ALT) and aspartate transaminase (AST), have been reported to be raised and implicated to have prognostic value in hepatocellular carcinoma (HCC). Ki67, a marker of cellular proliferative activity, has also been noted to be increased in HCC. A study was conducted at the Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur to determine the possible association of proliferative activity, as determined by Ki67, with the transaminase enzymes. 31 cases of histologically diagnosed HCC who underwent tumour resection were retrieved from departmental archives. The patients' ages ranged between 40 to 79 years with a mean of 58.3 years. There was a male preponderance with M:F = 2.9:1. Ethnic Chinese formed 83.9% of the cases. 4 microm sections, cut from the formalin-fixed, paraffin-embedded tumour tissue block of each case, were immunohistochemically stained with Ki67 (DAKO monoclonal MIB-1) using the commercial DakoCytomation EnVision+System-HRP kit. The latest ALT and AST levels, assayed within 7 days prior to tumour resection, were retrieved from the patients' case records. 24 (77.4%) HCC demonstrated elevation of either ALT and/or AST. 27 (87.1%) HCC were immunopositive for Ki67. Ki67 immunoexpression was significantly correlated with raised transaminases (p<0.05). Hypothetically, the mechanism by which this phenomenon may occur may simply be release of transaminases due to destruction of hepatocytes by the cancer. Thus rising levels of the transaminases could signal a more rapid growth of the tumour and these routinely performed tests can be of prognostic value in management of HCC patients.
Aspartate aminotransferase assay ; Alanine aminotransferase measurement ; Primary carcinoma of the liver cells ; prognostic ; Excision

The ability of CT sanning of the mediasinum to distinguish specific tissue densitie and to display in a transverse plane often provides unique diagnsotic information unobtainable with conventional radiographic methods. We retrospectively analyzed the CT findings of 20 cases of proven mediastinal masses at the Departement of Radiology, St. Mary's Hospital, Catholic Medical College from Feb. 1982 to June 1984. CT scans were performed witha Siemens Somatom 2 scanner. The technical factors involved were tube voltage 125 kVp, exposure time 5 seconds,230 mAs, 256x256 matrices, and pixel size 1.3mm. 8mm slices were obtained at 1cm interval or magnifying scans were obtained. After pre-contrast scans, contrast scans were routinely taken with rapid drip-infusion of contrast media(60% Conray, 150cc). The results obtained were as follows; 1. Among 20 cases, 11 were tumors, 4 infectious masses and 5 aneurysms of great vessels, tortuous brachicephalic artery and pericardial fat pad. In each case CT showed accurate location, extent, and nature of the masses. 2. Solid tumors were thymic hyperplasias, thymoma,thymus carcinoid, neurilemmoma and germ cell tumors(seminoma, embryonal cell carcinoma). Internal architecture was homogeneous in thymoma, thymus carcinomoid, neurilemmoma, seminoma but inhomogeneous in thymic hyperplasias andembryonal cell carcinoma. CT number ranged from 16 to 49 HU and were variably enhanced. 3. Cystic tumors consistedof teratomas, cystic hygroma, and neurilemmoma. Teratomas contained calcium and fat, inhomogeneous mass withstrongly enhancing wall. Cystic hygroma was nonenhancing mass with HU of 20. 4. All of germ cell tumors (2 teratomas and one each of seminoma and embryonal cell carcinoma) and one of 2 thymic hyperplasias had calciumdeposit. 5. Tuberculous lymphadenopapthies presented as a mass in the retrocaval pretracheal space and hilarregion with HU ranging from 34 to 64 and enhancement was variable. Mediastinal abscess was alsmost not enhancing,presenting as an inhomogeneous mass of 21 HU with mottled air densities. 6. Aneurysm of great vessels, tortuouobrachiocephalic artery and pericardial fat pad which were often misinterpretted as mediastinal tumor on the conventional radiographic study could be easily distinguishable on CT scan.
Abscess ; Adipose Tissue ; Aneurysm ; Arteries ; Calcium ; Carcinoid Tumor ; Germ Cells ; Lymphangioma, Cystic ; Neoplasms, Germ Cell and Embryonal ; Neurilemmoma ; Retrospective Studies ; Seminoma ; Teratoma ; Thymoma ; Thymus Gland ; Thymus Hyperplasia ; Tomography, X-Ray Computed

Postpartum hemorrhage is an important cause of maternal mortality and morbidity. Especially uterine atony is the most common cause of postpartum hemorrhage. Conventional method to control postpartum uterine atonic bleeding is based on the use of oxytocin and ergot preparations. Prostaglandin F2alpha analogue such as carboprost can be used to promote contraction when these agents fail to produce uterine contraction. Prostaglandin E1 analogue, misoprostol has uterotonic effect by oral or vaginal administration. They are used to induce labor and first or mid trimester abortion. In postpartum uterine atonic bleeding, misoprostols cannot be used via oral or vaginal route. Recently we have experienced that postpartum uterine atonic bleedings unresponsive to conventional methods were controlled by rectal misoprostols. So we report these cases with a brief review of literatures.
Administration, Intravaginal ; Alprostadil ; Carboprost ; Dinoprost ; Hemorrhage* ; Maternal Mortality ; Misoprostol* ; Oxytocin ; Postpartum Hemorrhage ; Postpartum Period* ; Uterine Contraction ; Uterine Inertia

Systolic time interval measurements were made sequentially during second, third trimesters and postpartum period. Recordings were made in the supine position after bed rest for at least five minutes in order to obtain a steady state. In second trimester, pre-ejection period index (PEPI) was significantly shortened and left ventricular ejection period index(LVETI) remained normal while PEP/LVET decreased. Four possible mechanisms may be involved to account for the alterations in hemodynamic changes during this period(late stage of second trimester) : (1) increased metabolic demands of pregnancy: (2) hemodynamic effects of hypervolemia: (3) circulatory adjustments secondary to an arteriovenous shunt-like effect of the placental circulation: (4) cardiovascular effect of steroid hormone. The third trimester was characterized-by a markedly shortened LVETI, a prolonged PEPI and PEP/LVET. This findings are consistent with impaired left ventricular performance and are probably due to decreased left ventricular preload resulting from diminished venous return secondary to inferior vena caval obstruction by the large gravid uterus. In the postpartum period, the PEPI and PEP/LVET remained elevated and the LVETI shortened in the supine position. It is concluded that alterations in systolic time intervals occur normally during the course of uncomplicated pregnancy and persist into the postpartum period.
Bed Rest ; Female ; Hemodynamics ; Humans ; Placental Circulation ; Postpartum Period* ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third* ; Supine Position ; Systole* ; Uterus

PURPOSE: In this study, the medication effects of Milnacipran and Pregabalin, as well known as fibromyalgia treatment medicine, in fibromyalgia syndrome patients were compared through the change of BOLD signal in pain related functional MRI. MATERIALS AND METHODS: Twenty fibromyalgia syndrome patients were enrolled in this study and they were separated into two groups according to the treatment medicine: 10 Milnacipran (MLN) treatment group and 7 Pregabalin (PGB) treatment group. For accurate diagnosis, all patients underwent several clinical tests. Pre-treated and post-treated fMRI image with block-designed pressure-pain stimulation for each group were obtained to conduct the statistical analysis of paired t-test and two sample t-test. All statistical significant level was less than 0.05. RESULTS: In clinical tests, the clinical scores of the two groups were not significantly different at pre-treatment stage. But, PGB treatment group had lower Widespread Pain Index (WPI) and Brief Fatigue Inventory (BFI) score than those of MLN treatment group at post-treatment stage. In functional image analysis, BOLD signal of PGB treatment group was higher BOLD signal at several regions including anterior cingulate and insula than MLN treatment group at post-treatment stage. Also, paired t-test values of the BOLD signal in MLN group decreased in several regions including insula and thalamus as known as 'pain network'. In contrast, size and number of regions in which the BOLD signal decreased in PGB treatment group were smaller than those of MLN treatment group. CONCLUSION: This study showed that MLN group and PGB group have different medication effects. It is not surprising that MLN and PGB have not the same therapeutic effects since these two drugs have different medicinal mechanisms such as antidepressants and anti-seizure medication, respectively, and different detailed target of fibromyalgia syndrome treatment. Therefore, it is difficult to say which medicine will work better in this study.
Antidepressive Agents ; Diagnosis ; Fatigue ; Fibromyalgia* ; Follow-Up Studies* ; Humans ; Magnetic Resonance Imaging* ; Prostaglandins B ; Thalamus ; Pregabalin