No abstract available.

We studied the natural history of asymptomatic early avascular necrosis of the femoral head in forty-three patients(forty-three hips) who had been treated with arthroplasty due to progressed avascular necrosis of femoral head but had no symptoms in the other side. All initial lesions were classified with Ficat staging and International classification(ARCO). The duration until symptom onset and radiologic evidence of disease progression were evaluated. The average follow up period was over 37 months. Among forty-three hips, twenty-nine cases(67.4%) remained asymptomatic until last follow up but fourteen cases(32.6%) were symptomatic during the follow up, and twenty-six cases(60.5%) did not progress on the radiography but seventeen cases(39.5%) progressed to Ficat stage 3 or 4. Fifteen cases of IA, IIA, IB-cental and II B-central without lateral lesion did not occur symptom and didnt progress to Ficat stage 3 or 4 over a period of average 47 months(24-71 months). But fourteen cases of IB, IC, g B and II C progressed to Ficat stage 3 or 4 and they were all lateral lesion. These results suggest careful observation only can be done in the case of small involvement(less than 15%) and medial or central lesion relatively over a long period of time but for the large involvement(more than 30%) and especially lateral lesion, aggressive surgical treatment may be considered even though the early stage of disease for the prevention of progression. However it will need more period of time to accurately compare the results of various methods of treatment.
Arthroplasty ; Disease Progression ; Follow-Up Studies ; Head* ; Hip ; Natural History* ; Necrosis* ; Radiography

The purpose of this study was to investigate the gaps of bone-acetabular component interface, the initial mechanical stability and the effects of adjuvant screw fixation in the press-fitted two different shaped porous-coated acetabular components. Semi-hemispherical Harris-Galante II cup and full hemispherical Trilogy cup were press-fitted with or without adjuvant screw fixation in 40 bovine femur. The gaps of bone-implant interface were measured in each radiography of all specimen and axial compression tests and rotational stability tests were performed using servohydraulic tension-compression machine. There was significantly smaller gap at polar 1/3 region in the specimen implanted with Trilogy cup. But the adjuvant screw fixation did not affect the amount of gap. There was no significant statistical difference in axial load and rotational stability test in each situations of fixation. This study demonstrates that the initial mechanical stability is not influenced by the shape of semi-hemispherical Harris-Galante II cup and full hemispherical Trilogy cup and also independent of adjuvant screw fixation. But smaller gap of Trilogy cup at the polar 1/3 region indicates the possibility that less amout of wear debris of polyethylene or metal will be deposited and therefore less osteolysis or cup loosening will occur, but this hypothesis should be confirmed by the long-term clinical follow-up.
Acetabulum* ; Arthroplasty, Replacement, Hip* ; Femur ; Follow-Up Studies ; Osteolysis ; Polyethylene ; Radiography

The authors reviewed both the clinical and radiographic results of 36 bipolar hemiarthroplasty using the porous-coated Harris-Galante uncemented femoral stem performed for avascular necrosis in 30 patients from January 1985 to June 1992. The average age was about 45.6 years and the average follow-up was fifty-four months. Clinical results by the Harris evaluation method were excellent in 33 cases, good in 2 cases, and fair in 1 case. The radiographic fixation of the femoral stem at final follow-up was bony ingrowth fixation in 31 cases, fibrous ingrowth fixation in 4 cases, and unstable fixation in 1 case. There was neither medial nor superior migration of the bipolar cup of more than two millimeters.
Follow-Up Studies ; Head* ; Hemiarthroplasty* ; Humans ; Necrosis*

No abstract available.
Borrelia burgdorferi* ; Borrelia* ; Ixodes* ; Korea* ; Lyme Disease* ; Ticks*

PURPOSE: We have evaluated the outcome of the operative treatment of Achilles tendon rupture and analyzed the prognostic factors related to the results. MATERIALS AND METHODS: Subjective assessment of symptoms, range of ankle motion and isokinetic ankle strength was performed on 50 patients during a 1-year follow up. We used a clinical scoring system reported by Leppilahti et al to evaluate the results. RESULTS: The overall results were excellent in 18 (36%), and good in 16 (32%), fair in 10 (20%), and poor in 6 (12%) cases. Lower activity level (P<0.001), presence of systemic disease (P<0.001), later return to physical exercise (P=0.044), and previous Achilles tendon symptoms (P=0.015) were associated with unsatisfactory strength results. An older age (P<0.001) and later return to strenuous activities (P=0.005) were associated with unsuccessful overall results. CONCLUSIONS: We think that a clinical scoring system, including subjective and objective assessment, is good protocol to find the prognostic factors related to the results after the operative treatment of Achilles tendon rupture. The patient group with poor prognostic factors present a challenge for rehabilitation.
Achilles Tendon* ; Ankle ; Exercise ; Follow-Up Studies ; Humans ; Rehabilitation ; Rupture*

OBJECTIVE: To evaluate the pregnancy outcome, designate the predicting factor of neonatal thrombocytopenia, and reevaluate the treatment scheme of idiopathic thrombocytopenic purpura (ITP) in pregnancy. METHODS: Medical records of 83 patients(98 deliveries) who were diagnosed as having ITP and delivered at the Department of Obstetrics and Gynecology, Yonsei University College of Medicine from January 1990 to May 1999 were reviewed. For statistical analysis Chi-square test and Fisher's exact test were used. RESULTS: Among various maternal characteristics, inability to raise platelet counts more than 100,000/mm3 by any means of treatment, categorized as ""poor response to treatment"", could be designated as the predicting factor of neonatal thrombocytopenia (p<0.05). Pregnant women treated with prednisolone had significantly greater chance of having preterm delivery (p<0.001). The occurrence of postpartum anemia requiring transfusion was higher in the group undertaking cesarean section (p<0.05). Although a control group was missing, the pregnancy outcome was poor in the category of pregnancy induced hypertension(PIH) and preterm labor being 17.3% and 33.7%, respectively. CONCLUSION: The ITP patient should be carefully monitored during the antenatal care visits because of the increased incidence in adverse pregnancy outcome such as PIH and preterm labor. Neonatal thrombocytopenia could be predicted in the presence of inability to raise platelet counts to more than 100,000/mm3 by any means of treatment. Cesarean section should not be performed routinely under the indication of ITP due to the accompanynig morbidity and low incidence of bleeding sequalae in the neonate. The accompanying complications of prednisolone treatment raises questions and warnings about its usage, therefore a prospective study is warranted to evaluate the effect and complications of prednisolone treatment.
Anemia ; Cesarean Section ; Female ; Gynecology ; Hemorrhage ; Humans ; Incidence ; Infant, Newborn ; Medical Records ; Mortuary Practice ; Obstetric Labor, Premature ; Obstetrics ; Platelet Count ; Postpartum Period ; Prednisolone ; Pregnancy Outcome ; Pregnancy* ; Pregnant Women ; Purpura, Thrombocytopenic, Idiopathic ; Thrombocytopenia* ; Thrombocytopenia, Neonatal Alloimmune

BACKGROUND: Total obstruction of the left main coronary artery is a common cause of sudden death but is rarely seen in patients who survive to undergo diagnostic evaluation or treatment. METHODS: During twenty six-year period, we encountered 5 patients with chronic total obstruction of the left main coronary artery out of about 4,000 patients who underwent coronary angiography. RESULTS: All patients have undergone coronary bypass surgery. These patients present with increasingly severe angina. A right dominat coronary anatomy is always found, usually with well-developed right-to-left collaterals. Left ventricular function was severely impaired in two patients out of five patients. CONCLUSIONS: The results of surgical revascularization in our patients and others described in the literature can support the safety and efficacy of this approach.
Coronary Angiography ; Coronary Vessels* ; Death, Sudden ; Humans ; Ventricular Function, Left

Conventional dual chamber pacing (DDD) preserves atrioventricular synchrony but depend on appropriate sinus node function to achieve physiological heart rate with exercise by atrial tracking. Other indirect indicators of metabolic demand have been used to modulate pacing rate increases with exercise including sensing of pH, respiratory rate, ventricular repolarization and oxygen saturation. The activity sensing approach is unique in that noise generated by activity modulates the response and empirical programming of the unit allows for attaining the desired rate for a given level of activity. Physiologic rate increases can be obtained in patients with sinus node dysfunction or even atrial fibrillation. The lead can either be positoned in the atria for patients without atrial fibrillation or AV conduction disturbance or in the ventricle. We present two cases of rate responsive pacing using the Activitrax.
Atrial Fibrillation ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Noise ; Oxygen ; Respiratory Rate ; Sick Sinus Syndrome ; Sinoatrial Node

No abstract available.
Streptococcus*