Although causes of restriction of knee extension in osteoarthritis are thought to be contractures involving the posterior capsule and the hamstring muscles, intercondylar notch stenosis, osteophyte, loose body, and displacement of ruptured meniscus, few studies have investigated incidence and treatment. The purpose of this study is to consider intercondylar notch stenosis and anterior impingement as major causes of flexion contracture in osteoarthritic knee and to assess their relationship through arthroscopic notchplasty. We performed arthroscopic notchplasty and debridement in sixty patients (sixty-eight cases) with more than Sflexion contracture for early osteoarthritic knee and compared flexion contracture before and after operation. The average flexion contracture was 13degrees (5degrees-35degrees) before operation and 4degrees (0degrees- 25degrees) immediately after. An average of 9degrees improvement was shown, with 29 cases ( 48% ) showing improvement of over 5degrees. Our study indicates that flexion contracture in the 29 cases (48%) improved by arthroscopic notchplasty was caused by intercondylar notch stenosis and anterior impingement. Arthroscopic notchplasty may beneficially affect those with flexion contracture in early osteoarthritic knee when conservative management of this disease has failed. This is a preliminary study on the immediate postoperative outcome, therefore, long-term follow-up and recurrence rate should be investigated in future studies.
Constriction, Pathologic ; Contracture ; Debridement ; Follow-Up Studies ; Humans ; Incidence ; Knee* ; Muscles ; Osteoarthritis ; Osteophyte ; Recurrence

Previous applications of laser bone and cartilage ablation have focused largely on the CO2 and the Nd:Yag lasers, using both the continuous wave and rapid superpulsed mode, which revealed severe thermal damage such as tissue necrosis and carbonization of the remaining tissue. In contrast, Excimer lases have provided better histologic results with minimal or no thermal damage, but the ablation rate and cutting efficiency have remained unsatisfactory. Though arthroscopic partial menisectomy has become the accepted technique for dealing with tears in menisci, division of the meniscus is sometimes difficult in the confined joint space of the knee and is associated with iatrogenic injury to the articular cartilage. The ability to quickly and safely divide or remove meniscal tissue would be a distinct advantage. The Holmium:Yag laser has many potential advantages over the CO2 laster, the Nd:Yag laser and the Excimer laser. Its principal advantages include minimal mechanical trauma to the articular cartilage, greater access to tight or restricted area of the knee joint, and its ability to function in a saline medium and to resect meniscus with minimal tissue necrosis. We have evaluated the effectiveness of the Holmium:Yag laser 74 partial menisectomies of 57 patients. Among 74 meniscal tears, there were 35 medial and 39 lateral meniscal tears. The average operation time was 33 minutes in the menisectomy and hospital stay was average 3 days. There was no significant carbonization on the surrounding tissue. Menisectomy of the posterior horn was safe and easy and there was minimal iatrogenic articular cartilage damage.
Animals ; Carbon ; Cartilage ; Cartilage, Articular ; Holmium ; Horns ; Humans ; Joints ; Knee ; Knee Joint ; Lasers, Excimer ; Lasers, Solid-State ; Length of Stay ; Necrosis ; Tears

Early MRI and arthroscopic findings were compared to evaluate the efficacy of the former for patients, who upon physical examination, were diagnosed with possihle acute ACL tears. MRI, taken between 1-21 days after injury, had to reveal complete ACL tears and arthroscopic surgery should have taken place 3-12 weeks after the injury for patients of this prospective study. Fifty such cases were initially catagorized according to five MRI patterns. Types I to V were separated by the following ACL tear characteristics: Enlarged and diffusely increased in signal, horizontally oriented, non-visualized, discontinuous and vertically oriented. The cases were then divided into two groups of arthroscopic findings; Group A included cases of complete ACL tearing and group B included those with intact or minimally torn ACLs. Of MRI types I through V, there were 31, 9, 5, 4, and I cases of each respectively. 37 cases resulted in complete ACL tears (21 type I, 6 type II, 5 type III, 4 type IV and 1 type V) and 13 cases were catagorized into group B, 10 of which had pattern type I and 3 of which had pattern type II. As result, types III, IV and V had a 100% Positive Predictive Value (PPV) whereas types I and II together had a 67% PPV vaiue. Division of the cases into the five pattern types in early MRI proved valuble for possible cases of acute ACL tears. MRI pattern types III, IV and V were correlated with definite complete ACL tears. However, caution must be taken for types I and II, the majority of the cases, for which there exists a significant possibility for misdiagnosis and consequently unnecessary arthroscopic surgery.
Arthroscopy ; Diagnostic Errors ; Humans ; Knee ; Magnetic Resonance Imaging* ; Physical Examination ; Prospective Studies

PURPOSE: The purpose of our study is to evaluate the diagnostic significance of clinical findings, WBC count, ESR, CRP, simple X-ray, ultrasonography and bone sanning in neonates. MATERIALS AND METHODS: From January 1995 to May 1998, we have experienced 14 cases of pyogenic osteomyelitis and pyogenic arthritis in neonates. The mean age of patients was 16.7 days and the involved sites were 6 cases of pyogenic arhtritis of hip, 5 cases of pyogenic arthritis of hip with proximal femur osteomyelitis, 2 cases of pyogenic arthritis of shoulder with proximal humerus osteomyelitis and 1 case of proximal tibia osteomyelitis. RESULTS: The most frequent clinical signs were local swelling and pseudoparalysis of involved extremity. Laboratory findings showed that elevated ESR was in 11/14 (79%), positive CRP in 6/8 (75%), leukocytosis in 6/14 cases (43%). Abnomal findings in simple X-ray was in 7/13 (54%), positive bone scanning findings in 3/8 (37.5%), positive ultrasonographic findings in 11/11 cases (100%). CONCLUSIONS: ITherefore we concluded that careful physical examination and ultrasonography were important for early diagnosis of bone or joint infection in neonates
Arthritis ; Diagnosis* ; Early Diagnosis ; Extremities ; Femur ; Hip ; Humans ; Humerus ; Infant, Newborn* ; Joints* ; Leukocytosis ; Osteomyelitis ; Physical Examination ; Shoulder ; Tibia ; Ultrasonography

PURPOSE: Acute kidney injury is a critical complication in patients intensive care unit (ICU) and shows high mortality. After development of continuous renal replacement therapy (CRRT), there were many conflicting data for patient survival. We want to find out which parameter shows strong correlation in the survival of patients undergoing CRRT in intensive care unit. METHODS: Total 85 patients were enrolled who had been treated with CRRT in ICU. We compared the differences in clinical parameters between survivors with non-survivors. RESULTS: Mean age of the patients was 62.0+/-15.6 and 57 patients were male (67.1%). Out of 85 patients, 39 patients survived (45.9%). Mean duration of CRRT was 103.5+/-178.8 hours and mean Acute Physiology And Chronic Health Evaluation (APACHE) III score was 90.6+/-22.6. There were significant differences between survivors and non-survivors in APACHE III score (p=0.004), time to initiation of CRRT (p=0.05), systolic blood pressure at initiation of CRRT (p=0.001), arterial [H+] (50.18 vs. 84.19, p=0.001), respectively. But there was no difference in the age, sex, the level of pre CRRT blood urea nitrogen, duration of ICU admission, hypoxemia and hemoglobin level. CONCLUSION: Earlier initiation of CRRT and protection from metabolic acidosis were strongly associated with the survival of the patient with acute kidney injury in ICU.
Acidosis ; Acute Kidney Injury ; Anoxia ; APACHE ; Blood Pressure ; Blood Urea Nitrogen ; Hemodiafiltration ; Hemoglobins ; Humans ; Intensive Care Units ; Male ; Prognosis ; Renal Replacement Therapy ; Survivors

BACKGROUND: Propofol is a useful induction agent, but it can cause hypotention and bradycardia. Meanwhile, ephedrine has alpha-vasoconstriction and beta-cardiac stimulant effect. The purpose of this study was to assess the hemodynamic effects of adding various doses of ephedrine to propofol to obtund adverse hemodynamic response and to determine the optimal dose. METHODS: Unpremedicated 120 ASA physical status I adult patients (20~50yrs) scheduled for elective surgery were randomly allocated into four groups according to the doses of ephedrine added to propofol (1%, 20 ml). Group 1 (control group) was given propofol alone and 10, 15 and 20 mg of ephedrine was added to propofol in Group 2, 3 and 4, respectively (n=30 for each group). Propofol was loaded at 150 ml/hr using a syringe pump and no response to verbal command was ascertained as the end-point of induction. Vital signs and SpO2 were checked every 1 min during the induction period. RESULTS: In group 1, there was a significant decrease in both systolic and diastolic pressure prior to intubation. Group 2 and 3 showed relatively stable hemodynamic changes and significant systolic or diastolic changes occured only in the pre or post 1 min periods of intubation. But, in pulse rate, group 3 showed significant change 1 and 2 min after intubation, in contrary to group 2. Group 4 showed significant changes in systolic and diastolic pressure 1 and 2 min after intubation, and in pulse rate throughout the postintubation period. CONCLUSIONS: Ephedrine 10mg may be safely employed to reduce the hemodynamic changes during induction preiod with propofol.
Adult ; Anesthesia* ; Blood Pressure ; Bradycardia ; Ephedrine* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Propofol* ; Syringes ; Vital Signs

Familial adenomatous polyposis (FAP) is an hereditary autosomal dominant disease characterized by development of hundreds to thousands of adenomatous polyps in the colon and rectum. The common symptoms are bloody stool, diarrhea, and abdominal pain. The average age at onset of symptoms is 33 years. Because of inevitable progression to malignancy, it is necessary to remove the entire colonic and rectal mucosa. Current surgical options are total proctocolectomy with permanent ileostomy, trans-abdominal colectomy with ileorectal anastomosis (IRA), and restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Recently IPAA can give optimum control of colorectal polyposis in FAP patients with an acceptable incidence of postoperative complications and satisfactory functional results. We experienced one case of FAP who had malignacy in the remained rectum after subtotal colectomy. IPAA was done and the result was satisfactory.
Abdominal Pain ; Adenomatous Polyposis Coli* ; Adenomatous Polyps ; Colectomy* ; Colon ; Diarrhea ; Humans ; Ileostomy ; Incidence ; Mucous Membrane ; Postoperative Complications ; Proctocolectomy, Restorative ; Rectum*

No abstract available.
China*

BACKGROUND: The angiotensin-converting enzyme(ACE) plays an important role in cardiovascular disease by production of angiotensin and degradation of bradykinin. Cloning of ACE gene revealed an insertion/deletion(I/D) polymorphism according to the presence/absence of a 287 base pair fragment in the 16th intron of ACE gene, and the ACE polymophism was associated with ACE activity. The genotype DD was identified as a risk factor for myocardial infarction in several studies. We analyzed the ACE I/D polymorphism in 62 patients with myocardial infarction and 67 normal subjects. METHODS: Genomic DNA from peripheral blood was amplified by polymerase chain reaction and characterized by three ACE genotypes; two insertion alleles(genotype II), two deletion alleles(genotype DD) and heterogenous alleles(genotype ID). ACE activity was determined by spectrophotometric method utilizing the synthetic substrate. RESULTS: There was no significant difference in ACE polymorphism between patients and normal subjects. But, the frequency of genotype DD was significantly increased in the low-risk group of patients compared with the high-risk group. The multi-vessel disease was more strongly associated with genotype DD, but there was no statistical significance. The ACE activity was strongly associated with ACE polymorphism with the activity being highest in genotype DD. There was no significant difference between patients and control subjects of the same genotype. CONCLUSION: There was no significant difference in ACE polymorphism between patients and normal subjects. The frequencies for genotype II, ID, DD were 0.328, 0.537, 0.134, respectively in normal subjects. There was high frequency of genotype II compared with Caucasians. A deletion polymorphism(genotype DD) may increase the risk for myocardial infarction in lowrisk group, and the serum ACE activity was correlated with three genotypes.
Angiotensins ; Base Pairing ; Bradykinin ; Cardiovascular Diseases ; Clone Cells ; Cloning, Organism ; DNA ; Genotype ; Humans ; Introns ; Myocardial Infarction* ; Polymerase Chain Reaction ; Risk Factors

Acoustic stimulation test(AST), is currently being used as an alternative tool of nonstress test (NST). However, there are no standard guideline for analysis of AST. Computerized numerical analysis of AST would be helpful for development of diagnostic criteria of AST. Fifty-one normal pre-term pregnancies entered to this study after conventional 20-minutes NST and 10-minutes AST. Acoustic stimulations were performed using Fetal Acoustic Stimulator (Model 146, Corometrics, US). We analyzed the FHR response after acoustic stimulation using our on-line computerized FHR analysis system, HYFM-I & II software. The changes of loss of signal, baseline FHR, variability, number of fetal movements, and number of FHR accelerations were analyzed numerically. The loss of signal was increased about 2 fold(122.61%). The baseline FHR was increased from 144.57bpm to 156.81bpm(8.5%) after acoustic stimulation. Number of fetal movements was increased about 2 fold(from 2.1 to 4.12/10 minutes). FHR variability was also increased from 17.81 bpm to 26.37 bpm. After AST, number of FHR accelaration was increased 55.47%(10sec 10bpm) and 68.42%(15sec 15bpm), respectively. In this study, we acrumulated elemental FHR data using computerized system after AST. These data would be helpful in the accurate analysis of AST and also enable us to develop the objective interpretation system for AST.
Acceleration ; Acoustic Stimulation* ; Acoustics* ; Female ; Fetal Heart* ; Fetal Movement ; Heart Rate, Fetal* ; Pregnancy ; Pregnancy*