A total of 15 revision total knee arthroplasties in infected cases had been followed for an average 31.4 moths(ranging between 1 year 4 months and 10 years) from 1983 to 1992 at Kyung Hee University Hospital. Average age of the patients was 60 years old (ranging between 27 and 80 years). Of the total 15 infected total knee arthroplasties, original diagnosis was osteoarthritis in 11 patients, rheumat,oid arthritis in three patients, and tuberculosis in one patient. In nine of 15 patients, causative orgamisms were not found. But such clinical evidences as increased erythrocyte sedimentation rate, draining sinus, local heating, intraoperative findings, and pathologic findings demonstrated the infection of total knee arthroplasty. In 15 cases, seven cases were early infection and eight were late infection. Two cases of tuberculosis were diagnosed with intraoperative pathology. The majority of prosthetic loosening was found on the tibial side. Several methods of treatment were applied to the infected cases. One-stage or two-stage reimplantation were used in seven cases, knee fusion in six cases, and conservative treatment was used in two cases. Average period from initial total knee arthroplasty to prosthesis removal of fusion is 20. 3 months(ranging between 11 months and 64 months). In cases of two stage reimplantation, antibiotic-mixed bone cement was implanted after removal of prosthesis to increase the local concentration of antibiotics. The average interval from prosthesis removal to revision in 4 cases of two stage reimplantation was 9.9 weeks(ranging between 43 days and 122 days). All patients were evaluated according to the knee rating Scale of Hospital for Special Surgery. Prior to revision operation in 7 reimplantation cases, the average knee score was 50.1 points, and the average range of motion was 70°. After revision, the average knee score was 81. 1 points. The average range of motion was 98°. Complete union was obtained in all cases of knee fusion. Even though at the time of follow up there has been no recurrence of infection after revision or fusion, long term follow up is needed. Interrmittent knee joint swelling and pus drainage were observed in conservatively treated cases.
Anti-Bacterial Agents ; Arthritis ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Blood Sedimentation ; Diagnosis ; Drainage ; Follow-Up Studies ; Heating ; Hot Temperature ; Humans ; Knee ; Knee Joint ; Osteoarthritis ; Pathology ; Prostheses and Implants ; Range of Motion, Articular ; Recurrence ; Replantation ; Suppuration ; Tuberculosis

With porcine vertebrae, the static and dynamic holding power of the pedicle screws under various conditions were measured to understand the biomechanical nature of the transpedicular screw fixation in spine. The objectives of the present study were; (1) to find the correlation between the insertion depth of the screw and the resulting holding power, (2) to determine the effect of bone cement augmentation on the screw fixation in a loosened hole, and (3) to assess the load-sharing mechanism between the cortical and the cancellous one surrounding the screw in this fixational system. The geomorphological characteristics of each porcine vertebra was measured directly with a micro-caliper. The bone mineral density of the specimens was also measured. Material with screw was holded in the fixed cross head of material testing system(Autograph E-10T). Testing force was applied and graph was obtained in the chart record. The results of the static pull-out tests in this study showed that there was a statistically-significant positive correlation between the screw diameter and the pull-out resistance(p < 0.05). The strength of the fixation did not actually increase as much as the insertion depth of the screw increased in these tests(r=0.457). In low-cycle fatigue tests, the increased number of cycles was required to clinical failure in the deeper-inserted crews. Considering the mechanical failure, a statistically-significant positive correlation between the failure cycle and the insertion depth was observed in both deep and shallow insertion groups(p < 0.05). Nonpressurized PMMA augmentation appeared to restore the ability of the screws to withstand pullout loading of the original value. On the effect of the cortical and cancellous bone, the most important factor was the cortical bone of the entrance near the screw.
Bone Density ; Fatigue ; Head ; In Vitro Techniques ; Pedicle Screws ; Polymethyl Methacrylate ; Spine

Use of electric pulp testing elicits painful response in vital teeth. In this study, we examined the excessive time from pain feeling to stimulation disconnection in clinical situation. D626D (Parkell Inc., USA.) scan type electric pulp tester was used in total of 23 young healthy individuals. Each of the right central incisors and first premolars were used as testing teeth. Stimulation disconnection was achieved by EMG in anterior belly of digastric muscle, finger span, and voice and the excessive stimulation time over the sensory threshold was recorded. As a result, we found that the short responses before the stimulation disconnection appeared following order; EMG, finger span, and voice. The EMG disconnection is suggested to be used to reduce the excessive stimulus time in electric pulp testing.
Bicuspid ; Fingers ; Incisor ; Sensory Thresholds* ; Tooth ; Voice

Acute vestibular syndrome (AVS) is characterized by the rapid onset of dizziness/vertigo accompanied by nausea/vomiting, gait unsteadiness, and nystagmus lasting a day or more. Some patients with AVS have potentially dangerous central etiologies. AVS caused by central etiologies without significant other neurologic deficit, so called pseudo-vestibular neuritis (pseudo-VN), could be difficult to be differentiated from acute vestibular neuritis. In addition to imaging studies, bedside oculomotor examination-head impulse test, nystagmus and test of skew)-is essential to identify patients with pseudo-VN. Among several central causes of AVS, brain tumor is extremely rare. We report a case of vascular tumor involving the anterior inferior cerebellum with AVS presentations.
Brain Neoplasms ; Cerebellum ; Gait ; Humans ; Neuritis ; Neurologic Manifestations ; Nystagmus, Pathologic ; Vertigo ; Vestibular Neuronitis

Blue rubber bleb nevus syndrome is a rare disorder that is characterized by multiple recurrent vascular malformations, such as hemangioma, and these primarily involve the skin and the gastrointestinal tract. It may also involve the brain, liver, lungs, and skeletal muscles. A 14-year-old female visited our hospital with a chief complaint of dizziness; upon examination, we found multiple recurrent hemangiomas on the skin and gastrointestinal tract. We were able to diagnose her as suffering from blue rubber bleb nevus syndrome and we treated her with methylprednisolone (2 mg/kg/day for 1 month and 1 mg/kg/day for additional 3 months). We report on this case along with a review of the literature.
Adolescent ; Female ; Gastrointestinal Neoplasms/*diagnosis/therapy ; Hemangioma/*diagnosis/therapy ; Humans ; Nevus, Blue/*diagnosis/therapy ; Skin Neoplasms/*diagnosis/therapy ; Syndrome

Objective: To evaluate the efficacy and safety of 8 weeks of resistance circuit training in people with paraplegia due to spinal cord injury. Methods: Participants were randomized into experimental and control groups. Although the intensity and sequence of movements of the exercise programs were identical in both groups, the resting time between sets was limited to 1 minute in the experimental group. In the control group, the participants were allowed to rest until they were comfortable. Both groups received 8 weeks of training twice per week. Before and after the program, muscle mass, body fat percentage, fat mass, blood pressure, heart rate, muscle strength and muscular endurance were evaluated, and 6-minute propulsion test was conducted. Additionally, the safety of the program was assessed. Results: Twenty-two individuals with paraplegia were enrolled (11 in each group). After the training program, the experimental group showed a significant decrease in the resting blood pressure and improvement in the upper extremity muscle mass, strength, and endurance (p<0.05). Each variable showed significant inter-group differences (p<0.05). Furthermore, none of the participants showed autonomic adverse events, musculoskeletal side effects, or discomfort. Conclusion The results show that resistance circuit training programs with short resting intervals are superior to the usual resistance exercise programs in improving the blood pressure and physical strength and are safe for people with upper thoracic level injuries at T6 or higher.

Nineteen highly pathogenic avian influenza (HPAI) H5N8 viruses were isolated from wild birds in the Donglim reservoir in Gochang, Jeonbuk province, Korea, which was first reported to be an outbreak site on January 17, 2014. Most genes from the nineteen viruses shared high nucleotide sequence identities (i.e., 99.7% to 100%). Phylogenetic analysis showed that these viruses were reassortants of the HPAI H5 subtype and the H4N2 strain and that their hemagglutinin clade was 2.3.4.4, which originated from Eastern China. The hemagglutinin protein contained Q222 and G224 at the receptor-binding site. Although the neuraminidase protein contained I314V and the matrix 2 protein contained an S31N substitution, other mutations resulting in oseltamivir and amantadine resistance were not detected. No substitutions associated with increased virulence and enhanced transmission in mammals were detected in the polymerase basic protein 2 (627E and 701D). Non-structural-1 was 237 amino acids long and had an ESEV motif with additional RGNKMAD amino acids in the C terminal region. These viruses caused deaths in the Baikal teal, which was unusual, and outbreaks occurred at the same time in both poultry and wild birds. These data are helpful for epidemiological understanding of HPAI and the design of prevention strategies.
Amantadine ; Amino Acids ; Animals ; Base Sequence ; Birds ; China ; Disease Outbreaks ; Hemagglutinins ; Influenza in Birds* ; Jeollabuk-do ; Korea* ; Mammals ; Neuraminidase ; Oseltamivir ; Poultry ; Virulence

In order to determine the status of Enterobius vermicularis infection among schoolchildren in suburban areas of Myanmar, 761 primary schoolchildren in 3 different townships around Yangon City were subjected to a survey using cello-tape anal swabs. The subjected schoolchildren were 383 boys and 378 girls who were 5-7 years of age. Only 1 anal swab was obtained from each child. The overall egg positive rate of E. vermicularis was 47.2% (359 positives), and sex difference was not remarkable (48.6% in boys and 45.8% in girls). However, the positive rate was the highest in South Dagon (54.6%) followed by Hlaing Thayar (43.8%) and North Dagon (34.8%). This difference was highly correlated with the living standards of the people in each township. Nucleotide sequence of the 5S rDNA from the eggs on the cello-tape (2 children) revealed 99.7% identity with that of E. vermicularis reported in GenBank. The results indicated that E. vermicularis infection is highly prevalent among primary schoolchildren around Yangon, Myanmar.
Animals ; Child ; Child, Preschool ; Enterobiasis/diagnosis/*epidemiology/*parasitology ; Enterobius/genetics/*isolation & purification ; Female ; Humans ; Male ; Myanmar/epidemiology ; Parasite Egg Count ; Prevalence ; Students/statistics & numerical data

We report case of a 14-year-old girl with systemic lupus erythematosus who initially presented with acute lupus pneumonitis. She had a 4-week history of exertion for the past 4 weeks, and was transferred from a regional hospital due to abnormality on chest radiographs. Chest radiographs revealed bilateral infiltration and pleural effusion on both lower lung fields. We assumed her to be infected and prescribed antibiotics. The response to antibiotics was ineffective, and viral, bacterial, and mycobacterial cultures were negative. Antinuclear and anti-dsDNA antibodies in serum were positive. The open lung biopsy revealed diffuse alveolar damage. She was diagnosed as having acute lupus pneumonitis in systemic lupus erythematosus and recovered gradually after receiving corticosteroids. Acute lupus pneumonitis may be considered even though interstitial lung involvement in systemic lupus erythematosus is relatively rare in pediatric practice and its diagnosis is difficult.
Adolescent ; Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Antibodies ; Biopsy ; Humans ; Lung ; Lung Diseases ; Lupus Erythematosus, Systemic ; Pleural Effusion ; Pneumonia ; Thorax