A case of gouty polyarthropathy accompanied with carpal tunnel syndrom is reporte, in a 70 year old man. The patient was treated by removal of tophaceous materials surgically in both knee and right wrist joints for the relief of pain. There was a relatively good result postoperatively in the aspect of pain free motion of joints, but he was died of the complication of gouty nephropathy 4 months later after discharge.
Arthritis ; Gout ; Humans ; Joints ; Knee ; Wrist ; Wrist Joint

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Objective To investigate hemorrhagic transformation (HT) and outcomes in acute ischemic stroke.Methods The demographics,vascular risk factors,imaging and other clinical data in patients with acute ischemic acute were collected retrospectively and compared.Using the susceptibility weighted imaging (SWI) to diagnose HT,and the patients were divided into either a HT group or a non-HT group.The modified Rankin scale was used to evaluate the clinical outcomes.Multivariate logistic regression analysis was used to determine the independent risk factors for HT and poor outcome in HT patients.Results A total of 96 patients with acute ischemic stroke were enrolled and 34 of them had HT (35.4％).The age (66.21 ± 7.04 years vs.61.21 ±13.42 years; t =2.020,P=0.046) and infarct volume (3.88 ±2.20 cm3 vs.1.96 ± 1.37 cm3; t =5.67,P=0.001) in the HT group were significantly older or larger than those in the non-HT group.The proportions of hypertension (58.8％ vs.30.6％;x2 =7.228,P=0.007),diabetes (29.4％ vs.6.5％;x2 =9.293,P=0.002),atrial fibrillation (35.3％ vs.3.2％;x2=18.128,P=0.000),and cardiogenic cerebral embolism (35.3％ vs.3.2％ ; P =0.000) were significantly higher than those in the non-HT group,while the proportion of small arterial occlusive stroke was significantly lower than that in the non-HT group (38.2％ vs.62.9％ ;P =0.032).Multivariate logistic regression analysis showed that age (odds ratio [OR] 1.168,95％ confidence interval [CI] 1.059-3.412; P =0.021),infarct volume (OR 3.461,95 ％ CI 1.317-6.270; P =0.044) and atrial fibrillation (OR 1.284,95％ CI 1.117-2.903; P =0.015) were the independent risk factors for HT.In the HT patients,age (69.46 ±7.17 years vs.64.19 ±6.31 years; t =2.248,P =0.032) in the poor outcome group was significantly older than that in the good outcome group.The proportions of hypertension (84.6％ vs.42.9％ ;x2 =781,P =0.016),diabetes (50.0％ vs.14.3％ ;x2 =6.053,P =0.014),cardiogenic cerebral embolism (61.5％ vs.19.0％ ; P =0.025) and hematoma HT (76.9％ vs.19.0％ ;x2 =11.104,P =0.001) were significantly higher than those in the good outcome group.Multivariate logistic regression analysis showed that the diabetes (OR 2.151,95％ CI 1.179-3.218; P =0.023),atrial fibrillation (OR 4.136,95％ CI1.010 to 8.413; P =0.046) and hernatoma HT (OR 2.134,95％ CI 1.219-4.452; P =0.039) were the independent risk factors for the poor outcomes of HT patients at 3 months after symptom onset.Conelusions The incidence of HT in patients with acute ischemic stroke was 35.4％.Age,infarct volume and atrial fibrillation were the independent risk factors for HT,and diabetes,atrial fibrillation and hematoma HT were the independent risk factors for the poor outcomes in HT patients at 3 months after symptom onset.

Aged ; Antigens, CD34 ; analysis ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Proto-Oncogene Proteins c-bcl-2 ; analysis ; Solitary Fibrous Tumors ; metabolism ; pathology

Objective To report the clinical features and inwardly rectifying potassium channel 18 (KCNJ18) gene mutation in a group of patients with thyrotoxic periodic paralysis (TTP).Methods Fiftyseven TTP cases (55 male and 2 female) were collected in our clinic from July 2002 to October 2011.The KCNJ18 gene was directly sequenced in 57 TTP patients and 50 health Chinese controls through the nested PCR.According to the results of gene screening,the clinical features of KCNJ18 patients and non-KCNJ18 patients were retrospectively summarized and analyzed.Results In 4 male patients with TPP,we found 3 novel heterogeneous mutations (p.Q126X,p.K360T,p.E388K) and 1 reported mutation (p.A200P) in the KCNJ18 gene.The age of onset was 19-25 years old,and the duration ranged from 2 to 8 hours.The 4 patients all presented severe muscle weakness.The attacks of muscle weakness preceded overt symptoms of hyperthyroidism in the 4 patients. Three patients showed recurrent weakness during the 13-28 months follow-up,while the episodic weakness never appeared when patients got euthyroid. Conclusions The mutations in the KCNJ18 gene are responsible for a part of Chinese patients with TPP.The patients with KCNJ18 mutations have a shorter disease course,severer manifestation,and higher prevalence of recurrence as compared with those TPP patients without KCNJ18 mutations.

Objective To evaluate the clinical outcome of external bracket fixation in the treat- ment of complex tibia diaphysis fracture involving intra-articular fractures.Methods Forty-two cases of complex tibia diaphysis fracture with proximal and distal intra-articular fractures treated surgically in our hospital from January 1999 to January 2004 were analyzed.The complex tibia diaphysis fractures were categorized according to the AO classification as type C2 (multiple segments fracture) and type C3 (ir- regular fracture),proximal and distal intra-articular fractures in 23 and 19 cases,respectively.Definite operation was done within one week.Twenty-two cases were treated with simple external fixator,and 20 cases treated with screws and external fixator.Results All the 42 cases were followed-up regularly. According to AO evaluation of the knee and ankle joint movement,83% (35/42 cases) of the cases gained satisfactory functional outcome,14% (6/42 cases) had quite satisfactory results and 2% (1/42 case) had unsatisfactory functional outcome.Conclusion External bracket fixation can obtain outcome of relative length of the tibia and fibula,tube structure reconstruction,smoothness of the articular surface and the parallel and symmetric relation of knees and ankles for complex tibia diaphysis fracture with proxi- mal and distal intra-articular fracture.The arthritis resulting in pain in movement and restriction of func- tion is considered to be the most important factor affecting the joint function.Early functional exercise is important for best recovery of knee and ankle function.

Soft tissues, which are widespread in body, are derived from a common primitive mesenchyme and the tumors arising from them tend to closely resemble the prototype tissue in varying degree. Some soft tissue tumors have benign course, which can be cured by local excision and the other have malignant course being resistant to therapy and resulting in recurrence to other organ of tissues. The authors reviewed 279cases of soft tissue tumors which had been treated at Department of Orthopedic Surgery in Severance Hospital, Yonsei University College of Medicine from January 1983 to December 1987. 1. Among 279cases of soft tissue tumors, 257(92.1%) were benign and 22(7.9%) were malignant. 2. Benign soft tissue tumors were common two times in female, and malignant tumors were relatively common in male. 3. Common sites of soft tissue tumors were 92 csses about the knee, 69 csses in the hand and wrist, 44 cases in the foot, 26 cases in the leg, 15 cases in the thigh, 14 cases about the elbow, 10 cases in the arm and foresrm. 4. The most common benign tumors was ganglion which was followed by Baker's cyst, hemangioma, fibromatosis, lipoma, epidermal cyst in decreasing order of incidence. Among malignant tumors, fibrosarcoma, malignant fibrous histiocytoma, malignant schwannoma, synovial sarcoma, leiomyosarcoma were common. 5. Most of the benign tumors was taken by locsl excision, and malignant tumors were were trested by wide resection with combination of chemotherapy. 6. Local recurrences of benign tumors were developed in 26(10.1%) out of 257cases, especially in fibromatosis and hemangioma.
Arm ; Clinical Study ; Drug Therapy ; Elbow ; Epidermal Cyst ; Extremities ; Female ; Fibroma ; Fibrosarcoma ; Foot ; Ganglion Cysts ; Hand ; Hemangioma ; Histiocytoma, Malignant Fibrous ; Humans ; Incidence ; Knee ; Leg ; Leiomyosarcoma ; Lipoma ; Male ; Mesoderm ; Neurilemmoma ; Orthopedics ; Popliteal Cyst ; Recurrence ; Sarcoma, Synovial ; Thigh ; Wrist

Legg-Calve-Perthes disease is a hip disorder of undetermined etiology, occurring in children and characterized by necrosis and repair of the proximal femoral epiphysis. Many methods of the treatment were reported with good result and the goals of them were prevention of deformity of femoral head and secondary osteoarthritis of femoral head with concept of containment. The purpose of this study is to determine the significance of soft tissue release operation in patient of Legg-Calve-Perthes disease, whose prognosis will be poor by clinical and rsdiological evaluation at diagnosis. Soft tissue release operation was carried out 21 hips of 19 patients of Legg-Calve-Perthes disease at Severance Hospital from January 1986 to October 1987 and satisfactory result was obtained. We consider our method as new, effective treatment modality and its significance is to reduce abnormal pressure to femoral head, to restore normal range of motion, to avoid recurrent ischemia, and, finally, to avoid progression of deformity by soft tissue release operation.
Child ; Congenital Abnormalities ; Containment of Biohazards ; Diagnosis ; Epiphyses ; Head ; Hip ; Humans ; Ischemia ; Legg-Calve-Perthes Disease ; Methods ; Necrosis ; Osteoarthritis ; Prognosis ; Reference Values

Congenital scoliosis is a structural deformity due to congenital anomaly of the spine. After Winter's report in 1973, congenital scoliosis is said to be progressive in 75% of cases, and 50% are rapidly progressive, serious and demand treatment. And thus, most of them need more aggressive and early treatment compared with idiopathic scoliosis. The prognosis depends on the type, angle and flexibility of the curvature, and the age of patient. The authors reviewed the results of operative treatment for the congenital scoliosis that had been treated from Jan. 1984 to Dec. 1993 at the orthopedic department of Yonsei University College of Medicine, and the results as follows. 1. The age distribution of the patients was from 2 years to 14 years, and the mean was 8.4 years. Five male patients and two female patients were operated. 2. The involved spinal segments of the primary curve were 2 cases of thoracolumbar, 3 cases of lumbar. There were two cases of double major curves. 3. According to MacEwen's classification, the types of vertebral anomaly were 4 cases of hemivertebra, 2 cases of miscellaneous and one case of wedge vertebra. 4. The levels of apical vertebra were each 1 case of T3, T9, Ll, L2, L4 respectively and each 2 cases of T12, L3 respectively. 5. The methods of operation included 1 case of resection of rib, 4 cases of posterior fusion, 1 case of combined anterior and posterior hemiepiphysiodesis and fusion, and 1 case of hemivertebra excision with spine fusion. 6. The curvature of spine on admission ranged form 10 degrees to 63 degrees, and the mean angle was 35.5 degrees. And, we followed up postoperatively from 1 year to 10 years, and the mean follow up period was 32 months. The final correction angles were from
Age Distribution ; Classification ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Male ; Orthopedics ; Pliability ; Prognosis ; Pseudarthrosis ; Ribs ; Scoliosis ; Spine

Objective To investigate the clinical characteristics and methods of diagnosis and treatment of granular lymphocytic leukemia (LGLL).Methods Clinical data of 3 patients with LGLL were retrospectively analyzed and relevant literature was reviewed.Results 3 patients were all onset with lymphocytosis,whose conditions progressed slowly.The diagnosis of 2 patients was T-LGLL with immunological characteristics of CD3+ CD4 CD8+ CD56-CD57+.The other patient' s diagnosis was NK-LGLL,whose immunological characteristic was CD3-CD4-CD8-CD56+ CD57-.Two of them didn' t need any treatment.One of them was treated with cyclosporine because of agranulocytosis and recurrent infection.Conclusions LGLL is a group of heterogeneous diseases,which clinical characteristic and prognosis are different.Flow cytometric immunopheotype,TCR Vβ analysis and TCR gene rearrangement are helpful to diagnosis.