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

The hemodynamic interactions of lidocaine and diltiazem during halothane anesthesia were studied using eight mongrel dogs. The animals were anesthetized with inhalation of 1.0 MAC of halothane(GroupH) continuously throughout the experiment. 30 minutes after the inhalated and end-tidal halothane concentration reached equilibrium, 0.2 mg/kg of diltiazem was given intravenously over 2.0 min. From that point 8 ug/kg/min of diltiazem was continuously infused (group HD). Then a small dose of lidocaine(group HD1; iv bolus 1.5 mg/kg over l min, followed by continuous iv infusion at the rate of O.l mg/kg/min for 30 min) and a large dose of lidocaine (group HDI; iv bolus 1.0 mg/kg over I min, followed by continuous iv infusion at the rate of 0.3 mg/kg/min for 30 min) were administered serially. In group HD, PR interval increased significantly(22.2%) and coronary perfusion pressure decreased significantly(l9.3%), compared with group H. Compared with group H, significant increase in PR interval(44.4%), and decreases in diastolic arterial blood pressure(28%), mean arterial blood pressure(20.1%) and rate pressure product(35.2%) occured in group HD1. In group HDL, a significant decrease in heart rate(20.7%) and coronary perfusion pressure(33.0%) also occured, compared with group H. No significant changes in oxygen transport and consumption existed among groups. The most significant result of the injection of lidocaine diltiazem during halothane anesthesia in dogs was increase in PR interval. Even in high doses of lidocaine, only slight hemody- namic depression resulted and no significant changes in tissue oxygenation occurred. Therefore, the combined administration of diltiazem and lidocaine in clinical doses during halothane anes- thesia in dogs is a relatively safe administrative method.
Anesthesia* ; Animals ; Depression ; Diltiazem* ; Dogs* ; Halothane* ; Heart ; Hemodynamics* ; Inhalation ; Lidocaine* ; Oxygen ; Perfusion

PURPOSE: This study evaluated the treatment effectiveness and proper radiation dose of helical tomotherapy (HT) in spine oligometastases from gastrointestinal cancers. MATERIALS AND METHODS: From 2006 to 2010, 20 gastrointestinal cancer patients were treated with HT for spine oligometastases (31 spine lesions). The gross tumor volume (GTV) was the tumor evident from magnetic resonance imaging images fused with simulation computed tomography images. Clinical target volume (CTV) encompassed involved vertebral bodies or dorsal elements. We assumed that the planning target volume was equal to the CTV. We assessed local control rate after HT for 31 spine metastases. Pain response was scored by using a numeric pain intensity scale (NPIS, from 0 to 10). RESULTS: Spine metastatic lesions were treated with median dose of 40 Gy (range, 24 to 51 Gy) and median 5 Gy per fraction (range, 2.5 to 8 Gy) to GTV with median 8 fractions (range, 3 to 20 fraction). Median biologically equivalent dose (BED, alpha/beta = 10 Gy) was 52 Gy10 (range, 37.5 to 76.8 Gy10) to GTV. Six month local control rate for spine metastasis was 90.3%. Overall infield failure rate was 15% and outfield failure rate was 75%. Most patients showed pain relief after HT (93.8%). Median local recurrence free survival was 3 months. BED over 57 Gy10 and oligometastases were identified as prognostic factors associated with improved local progression free survival (p = 0.012, p = 0.041). CONCLUSION: HT was capable of delivering higher BED to metastatic lesions in close proximity of the spinal cord. Spine metastases from gastrointestinal tumors were sensitive to high dose radiation, and BED (alpha/beta = 10 Gy) higher than 57 Gy10 could improve local control.
Disease-Free Survival ; Gastrointestinal Neoplasms ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Radiotherapy, Intensity-Modulated ; Recurrence ; Spinal Cord ; Spine ; Treatment Outcome ; Tumor Burden

The carpal injury is difficult to diagnose due to anatomical complexity and the like. So, in order to get radiological knowledge of normal wrist, the authors measured the values which will be described on the wrist PA and lateral roengenogram obtained from 440 normal wrists(male : 188 cases, female : 252 cases) in randomly selected patients. The following results were obtained. l. Ulnar variance(mm±standard deviation): Total 1.1±1.2 : negative variance : 9.3%, positive variance : 56.1%, 2. Scapholunate Gap(mm±standard deviation): Total 0.4±0.7, 3. Ulnar Tilt(degrees±standard deviation): Total 23.6±5.3, 4. Volar Tilt, 5. Carpal height rstio : Total 0.52±0.05 male 0.53±0.04 female 0.51±0.05 : Total 13.1±5.9, 6. Carpal ulnsr distance ratio Total 0.05±0.05, 7. Scapholunate Angle : Total 49.9'±10.1', 8. Capitatolunate Angle Total 17.5'±10.0', 9. Radiolunate Angle Total 8.8'±6.7', 10. Carpal width ratio Total 0.72±0.08 11. Carpal thickness ratio Total 0.49±0.07.
Female ; Humans ; Male ; Wrist

Chronic osteomyelitis continue to be a therapeutic challenge. The osteomyelitis also implies chronic ischemia of the diseased bone ; thus systemic antibiotic treatment may not be as effective as we want. In 1972, Klemm developed a new procedure to supplement saucerization in the treatment of chronic osteomyelitis, alternative to irrigation and suction-drainage, i.e., Gentamicin-PMMA Beads. The authors analysed 35cases of the chronic osteomyelitis which were admitted and treated by sauceriztion and Gentamicin-PMMA Beads in Department of Orthopaedic Surgery, Korea Veterans Hospital from Aug. 1984 to Jan. 1988.
Gentamicins ; Hospitals, Veterans ; Ischemia ; Korea ; Osteomyelitis ; Polymethyl Methacrylate

Sixteen patients who had radial head fractures were treated with open reduction and internal fixation using Herbert screws (10 patients), and with silastic prosthetic replacement (6 patients) from March, 1992 to December, 1994 in Chungnam National University hospital. The average duration of follow up was 19.5 months. The purpose of this study is to examine the role of Herbert screw fixation and silicone replacement arthroplasty and to asscess the clinical results of two groups functionally, radiologically in raidial head fractures. By functional rating index (modified After B.F. Morrey et al), the results were classified as excellent (9 patients), good (6 patients), fair (No patient) and poor (1 patient). Nine of the ten patients treated by open reduction and internal fixation using Herbert screws had resulted in excellent or good. All patients were inserted silastic implants were showed excellent or good results. Especially, in Mason Type III radial head fractures, three of four patients treated by Herbert screws and all 5 patients treated by silastic prosthesis were considered to excellent or good results. We concluded that Herbert screw fixation or silastic prosthetic replacement had satisfactorily appeared to be the alternative treatment option for Mason Type III radial head fractures.
Arthroplasty, Replacement ; Chungcheongnam-do ; Follow-Up Studies ; Head* ; Humans ; Prostheses and Implants ; Silicones

Cyclopia is rare congenital craniofacial anomaly, in which the eyes are fused together and located in a single orbit. It is consistently associated with severe holoprosencephaly, which is the failure of cleavage of the prosencephalon with a deficit in the midline facial development. chromosomal study revealed 47, X( ), +13 (Patau syndrome).
Holoprosencephaly ; Orbit ; Prosencephalon ; Trisomy*

The goal of surgical stone management is to achieve maximal stone clearance with minimal morbidity to the patient. Because of its efficacy, efficiency and low morbidity, extracorporeal shock wave lithotripsy(ESWL) is the first-line treatment for almost all urinary calculi. However, stone clearance after ESWL has been shown to be affected by the stone burden, location, chemical composition and kidney anatomy. Especially, the success rate for ESWL is reduced in lower pole stone(LPS). Percutaneous nephrolithotomy(PNL) and retrograde ureteroscopic intrarenal surgery(RIRS) are alternative treatment options for stones refractory to ESWL such as LPS. Although effective, PNLsubjects the patient to increased morbidity compared to ESWL and RIRS. Because of its low morbidity and relatively high success rate, RIRS for LPS is an attractive treatment modality in selective patients. We report a case of multiple renal pelvis and lower calyceal stones treated with ureteroscopy.
Humans ; Kidney ; Kidney Calculi ; Kidney Pelvis* ; Shock ; Ureteroscopy ; Urinary Calculi

Long QT syndrome is a cardiac disorder of repolarization which is characterized by elctrocardiographic abnormalities including prolonged QT interval, T-wave abnormalities and polymorphic ventricular tachycardia known as Torsades de Pointes. Its clinical manifestation are recurrent syncope, seizure, and sudden death. Recently,we experienced Torsades de Pointes(TdP) by head-up tilt test in 24 year-old female patient presenting recurrent syncope and long QT interval. Beta-blocker and left cervicothoracic sympathetic ganglionectomy were not effictive, then we tried mexiletine. After mexiletine medication, the QT interval was significantly shortened and there was no more syncope.
Death, Sudden ; Female ; Ganglionectomy ; Humans ; Long QT Syndrome* ; Mexiletine ; Seizures ; Syncope ; Tachycardia, Ventricular ; Torsades de Pointes* ; Young Adult

PURPOSE: In the present study, we evaluated the validity of intravenous neostigmine administration combined with alternate prism cover test (APCT) measurement as a confirmatory diagnostic method for confusing cases of myasthenia gravis with ocular involvement. METHODS: Neostigmine was administered intravenously in 26 suspicious myasthenic diplopia patients under electrocardiographic monitoring. Distance deviation at primary position was evaluated with APCT at 5, 10, 15, 20, and 30 minutes after intravenous injection of neostigmine. Margin reflex distance was also evaluated at each time point. RESULTS: Seven of 26 patients were diagnosed as myasthenic diplopia based on a positive neostigmine test. Among these patients, 6 had strabismus at the primary position and 5 patients had ptosis. In patients who showed positive results, all 6 patients showed improvement of strabismus. However, ptosis was not improved in 1 patient. The improvement of strabismus and ptosis reached a peak at 10 to 15 minutes after neostigmine administration. CONCLUSIONS: Intravenous neostigmine administration combined with APCT is a rapid, objective and safe method in hard-to-diagnose cases of myasthenia gravis with ocular involvement. When performing the neostigmine test for myasthenia gravis with ocular involvement, not only the lid position but also strabismus should be evaluated quantitatively to avoid a false negative results.
Diagnosis* ; Diplopia ; Electrocardiography ; Humans ; Injections, Intravenous ; Methods ; Myasthenia Gravis* ; Neostigmine* ; Reflex ; Strabismus