No abstract available.
Cardiology*

We have performed three total wrist arthroplasty of Meuli type on the dominant wrist of three female patients who have been suffering from the classical rheumatoid arthritis for more than two years, and after follow them for average twenty months postoperatively, we have found, even the complications and reoperation rate after total wrist arthroplasty are reported high in literature, three patients have reasonably satisfied with the remarkable relief of pain and the functional abilities of their wrists. It is our belief, even if the total wrist arthroplasty is also still in controversy, that in those patients with bilateral wrist involvement by the rheumatoid arthritis in whom arthrodesis was done on one wrist, then a total wrist arthroplasty on dominant wrist is a most prefer way to reconstruct the disabled wrists.
Arthritis, Rheumatoid ; Arthrodesis ; Arthroplasty ; Female ; Humans ; Reoperation ; Wrist

Seventeen cases of Kienbock's disease were treated since 1982, and analysed their clinical outcomes to confine the pathogenesis and to make sure the best way to treat them in various stages. It was not related to trauma around wrist joint (35.3%) but significantly closed to ulnar negative variances(64.7%). Ulnar tilt angle was increased definitely upto 28.9° compared with normal value (22°) in ulnar negative variance, but volar tilt angle was within normal limits. The packing with tensor fascia lata or palmaris longus tendon after the complete excision of avascular lunate could not prevent the collapse of carpal bones at long-term follow-up. But the triscaphe fusion was most effective to maintain the normal wrist anatomy, and radial shortening than ulnar lengtherning is thought to be more effective in wrist biomechanics of kienbock's disease with ulnar negative variances.
Carpal Bones ; Clinical Study ; Fascia Lata ; Follow-Up Studies ; Osteonecrosis ; Reference Values ; Tendons ; Wrist ; Wrist Joint

No abstract available in English.
Clinical Study ; Humans ; Upper Extremity

We found that the packing of a rolled tensor fascia lata flap after the excision of avascular lunate was reasonably effective in relieving symptoms in 4 patients with advanced Kienbock's disease, even though there was still some residual postoperative loss of wrist motion and grip strength, and the slightly progressive tendencies of earpal collapse and translation as well as rotational deformities of scaphoid. Pre-operatively all patients had pain and limited motion of the wrist as well as weakness of grip. Roentgenographically all had sclerosis, fragmentation and collapse of the lunate. They were analysed each two cases in advanced stage II and III according to the classification by Lichtman. Most had symptoms for longer than two and half years. After removal of the avascular lunate through a dorsal incision, a rolled tensor fascia lata flap was packed to fit the defect. Patients were followed for an average of sixteen months. All were improved clinically but there were somewhat postoperative progress in carpal collapse, translation and rotational deformities of scaphoid roentgenographically.
Classification ; Congenital Abnormalities ; Fascia Lata ; Fascia ; Hand Strength ; Humans ; Osteonecrosis ; Sclerosis ; Wrist

No abstract available.

When the non-union gap in a long bone is more than half of the diameter of the bone at that level, it presents a significant challenge to traditional bone grafting technique. Even if there are several good ways for this problem, such as shortening, traditional various bone grafting, electrical stimulation and free vascularized bone graft, most of these techniques have some difficulties to maintain the stability of fracture post-operatively, and we have to keep their extremities into a cast or external fixator so long. So we have attempted to treat the large osseus gap non-union in long bone with fixation of heavy duty or condylar plate on one side of fracture for fracture stability, a long tibial corticocancellous strut graft on the other side of fracture for fracture stability and rapid bony union, and extensive cancellous chip bone graft between the plate and tibial graft to enhance the bony union. We have experienced 9 cases of large osseus gap non-union in long bone with this technique from March 1981 to September 1986 at the department of orthopaedic surgery, St. Mary's hospital, Catholic University Medical College. 1. Their, 7 males and 2 females, average age was 38 years old, with a range of 24 to 53 years old. The distribution of the involved bone was 6 femur, 2 humerus, 1 radius and ulna with 1.4 years of average duration of non-union, ranged from 7 months to 2.4 years. The average gap from normal bone to normal bone was 4.8cm, with a range of 2.7cm to 7.4cm. The average number of previous surgical procedures was 4, with a range of 2 to 7. Four of the nine patients had quiescent osteomyelitis. 2. Post-operative immobilization with splint or cast was applied for 6 weeks for upper extremity and 8 weeks for lower extremity followed by active R.O.M. exercise and non-weight bearing crutch walking. 3. Five of the nine cases(55.6%) had completely bony union. This occured on an average 8 months post-operatively and was faster in the forearm bones and femur than in the humerus. An additional cancellous bone graft was done in two. But other two of the patients had subsequent amputation because of recurrent and uneontrollable osteomyelitis stirred up by the surgery. 4. This procedures was proved to be one of valuable adjuvant method in treatmqnt of large osseous gap non-union of long bones.
Amputation ; Bone Transplantation ; Electric Stimulation ; External Fixators ; Extremities ; Female ; Femur ; Forearm ; Humans ; Humerus ; Immobilization ; Lower Extremity ; Male ; Methods ; Osteomyelitis ; Radius ; Splints ; Transplants ; Ulna ; Upper Extremity ; Walking

Clubfoot or talipes equinovarus is the most common congenital anomaly of the foot observed in children as well as in adults. This deformity should be treated immediately after birth, and so the cases of old neglected clubfeet are quite rare now. Moreover, in the cases of old neglected clubfoot, it is very difficult to get satisfactory results because there will be secondary adaptive changes in the tarsal bones and surrounding soft tissues. Therefore, clubfeet are considered to be one of many things requiring on or more of the many different types of treatment. The authors have experienced to treat nine cases of old neglected clubfoot from May, 1978 to April, 1988 at the Department of Orthopedic Surgery, St. Mary's Hospital, and reported herewith. 1. Their average age was 14.8 years old (3 to 25 yesrs old). There were one bilateral clubfeet, left foot in 5 cases and right foot in 4 cases. 2. According to the age of the patients and severity of deformities, two patients from three to ten years old were treated with soft-tissue release and serial casting, and seven patients after ten years old were treated by soft-tissue release, various osteotomies and triple arthrodesis. Postoperative management consisted of long leg cast for first four weeks and short leg walking cast for another four to eight weeks. 3. The results were estimated by the talo-calcaneal index according to Beatson et al(3)radiologically and their external appearance of corrected foot subjectively. The talo-calcaneal index was improved from 17.8° to 37° after operation and all of patients satisfied with the results of their operation.
Adult ; Arthrodesis ; Child ; Clubfoot ; Congenital Abnormalities ; Foot ; Humans ; Leg ; Orthopedics ; Osteotomy ; Parturition ; Tarsal Bones ; Walking

BACKGROUND: The stratum corneum presents a significant barrier to transdermal drug delivery. Approaches to improve percutaneous absorption of drugs have included iontophoresis and skin penetration enhancers. Oleic acid has been studied as a skin penetration enhancer for drugs, primarily via its action mainly on the stratum corneum lipid structure. OBJECTIVE: The purpose of this study was to assess the interaction between oleic acid and stratum corneum lipids in vivo. METHODS: Male hairless mice were treated topically with oleic acid. Barrier function was assessed by transepidermal water loss measurement and ultrastructural observation with ruthenium tetroxide (RuO₄) staining. RESULTS: Oleic acid in propylene glycol had a profound effect on epidermal barrier function and was found to be concentration dependent. Moreover, ultrastructural examination with RuO4 post-fixation demonstrated that there were marked alterations in the stratum corneum lipid structure. CONCLUSION: This study provides direct evidence that oleic acid increases the epidermal permeability through a mechanism involving the stratum corneum lipid membrane perturbation via the lacunae formation within the stratum corneum.
Animals ; Humans ; Iontophoresis ; Male ; Membranes ; Mice ; Mice, Hairless ; Oleic Acid* ; Permeability ; Propylene Glycol* ; Ruthenium ; Skin ; Skin Absorption ; Water

A 61-year-old male was presented with oozing crusted erythematous skin lesions on the ex-tensor site of the right forearm, the extensor site of the left forearm, left calf, right shin, and the right portion of the buttock. He was diagnosed as having multiple pagetoid Bowen's disease by H&E staining, special staining and by an electron microscopic examination. He was treated with a topical application of 5-flurouracil cream and cryosurgery. The skin lesions were mostly healed after 7 months. We herein report a case of multiple pagetoid Bowen's disease on the sun-protected area that may be caused by arsenic ingestion.
Arsenic ; Bowen's Disease* ; Buttocks ; Cryosurgery ; Eating ; Forearm ; Humans ; Male ; Middle Aged ; Skin