The result of forty cases of rheumatoid arthritis according to New York criterion, who underwent multiple operations(up to 10) in multiple joints hetween 1983 and 1986 were evaluated in 3 years and 8 months in average(range; 18 months to 5 years 2 months)postoperatively. The joints operated upon were knee, ankle, shoulder, elbow, wrist and finger joints. The surgery performed were 65 arthroscopic synovectomies, 17 total joint replacement(16 knees and 1 elbow) and 7 arthrodesis(1 knee, 1 ankle and 5 wrists). There were 10 males and 30 females, 27 “clsssic” and 13 “definite” rheumatoid arthritis according to the classification of American Rheumatism Association.Functional capacity of the patient was graded as I, II,III and IV according to the ARA. The final clinical results were graded as “excellent”, “good”, “fair” and “poor” according to the modified citeria of Sledge et al(20). The relationship between number of cases of recurred synovitis and various factors such as sex, classification according to the ARA, number of joints involoved and extent of synovectomy in the knee joint was analyzed statistically with chi-square test of the contingency table.The results are as follows; 1. The final results were 22 “excellent”(55.0%), 16 “good”(40.0%) (altogether 95% of cases were satisfactory) and 2 fair (5.2%), but there was no “poor” result. 2. All cases showed functional improvement, the commonest mode of improvement being from preoperative grade II to postoperative grade I(19 out of 40 cases, 47.5%). 3. There were 9 cases of recurrence of synovitis following arthroscopic synovectomy(22.5 %). They were controlled by medication in 2 cases, and by reoperation in 5 cases (resynovectomy ; 3, joint replacement; 1, arthrodesis ; 1). 4. The factors such as sex, classification and number of joints involved were not significantly correlated c the recurrence rate although there was a tendency of frequent recurrences in cases of female, classic RA and multiple joint involovement (P>0.05). 5. In the knee joint there was significantly less recurrence rate in total synovectomy cases (1/20, S.0%) than in anterior synovectomy cases (7/22, 31.8%) (P<0.01). 6. There was no recurrence following total joint replacment or arthrodesis. In conclusion the combined surgery of arthroscopic synovectomy, joint replacement and arthrodesis in the multiple joints was effective in relief of pain and effusion and improvement of functional capcity of the rheumatoid patient if proper medical treatment was given postoperatively.
Ankle ; Arthritis, Rheumatoid ; Arthrodesis ; Classification ; Elbow ; Female ; Finger Joint ; Humans ; Joints ; Knee ; Knee Joint ; Male ; Recurrence ; Reoperation ; Rheumatic Diseases ; Shoulder ; Synovitis ; Wrist

Lymphangioma is composed of lymphatic tissue and filled with clear or chylous fluid that develops most often in the skin and subcutaneous tissue of neck but relatively rare in extremities. It is perhaps a congnital malformation rather than a true neoplasm, and so most of these lesions are usually present at birth and have a tendency to grow very slowly. If it is developed with a cavernous type of lymphangioma, it will have more aggressive and infiltrative tendency because their margin is usually adhesive with adjacent normal tissue. A case of cavernous lymphangioma on the right wrist of an eight month old female infant, treated by surgical excision is followed up over one year and presented here with a review of the literature.
Adhesives ; Extremities ; Female ; Humans ; Infant ; Lymphangioma ; Lymphoid Tissue ; Neck ; Parturition ; Skin ; Subcutaneous Tissue ; Wrist

On 26 December 2004, a huge tsunami struck the coasts of South Asian countries and it resulted in 29,729 deaths and 16,665 injuries in Sri Lanka. This study characterizes the epidemiology, clinical data and time course of the medical problems seen by a Korean disaster medical assistance team (DMAT) during its deployment in Sri Lanka, from 2 to 8 January 2005. The team consisting of 20 surgical and medical personnel began to provide care 7 days after tsunami in the southern part of Sri Lanka, the Matara and Hambantota districts. During this period, a total of 2,807 patients visited our field clinics with 3,186 chief complaints. Using the triage and refer system, we performed 3,231 clinical examinations and made 3,259 diagnoses. The majority of victims had medical problems (82.4%) rather than injuries (17.6%), and most conditions (92.1%) were mild enough to be discharged after simple management. There were also substantial needs of surgical managements even in the second week following the tsunami. Our study also suggests that effective triage system, self-sufficient preparedness, and close collaboration with local authorities may be the critical points for the foreign DMAT activity.
Adolescent ; Adult ; Aged ; Asia, Southeastern ; Child ; Child, Preschool ; Emergency Medical Services/organization & administration/statistics & numerical data ; Female ; Geography ; Humans ; Infant ; Infant, Newborn ; International Cooperation ; Korea ; Male ; *Medical Assistance ; Middle Aged ; *Natural Disasters ; Patients/classification/*statistics & numerical data ; *Relief Work ; Retrospective Studies ; Sri Lanka

BACKGROUND: Because of the common etiologic factor, such as smoking, lung cancer and chronic obstructive Pulmonary disease are often present in the same patient. The preoperative prediction of remaining pulmonary function after the resectional surgery is very important to prevent serious complication and postoperative respiratory failure. 99mTc-MAA perfusion scan has been used for the prediction of postoperative pulmonary function, but it may be inaccurate in case of large V/Q mismatching. We compared 99mTc-DTPA radioaerosol inhalation scan with 99mTc-MAA perfusion scan in predicting postoperative lung function. METHOD: Preoperative inhalation scan and/or perfusion scan were performed and pulmonary function test were performed preoperatively and 2 month after operation. We predicted the postoperative pulmonary functions using the following equations. Postpneumonectomy FEV1=Preop FEV1x% of total function of lung to remain RESULTS: 1) The inhalation scan showed good correlations between measured and predicted FEV1, FVC and FEF25-75%. (correlation coefficiency; 0.94, 0.91, 0.87 respectively). 2) The perfusion scan also showed good correlations between measured and predicted FEV1, FVC and FEF25-75%. (correlation coefficiency; 0.86, 0.72, 0.97 respectively). 3) Among three parameters, FEV1 showed the best correlations in the prediction by lung scans. 4) Comparison between inhalation scan and perfusion scan in predicting pulmonary function did not show any significant differneces except FVC. CONCLUSION: The inhalation scan and perfusion scan are very useful in the prediction of postoperative lung function and don't make a difference in the prediction of pulmonary function although the former showed a better correlation in FVC.
Humans ; Inhalation* ; Lung ; Lung Neoplasms ; Perfusion* ; Pulmonary Disease, Chronic Obstructive ; Respiratory Function Tests ; Respiratory Insufficiency ; Smoke ; Smoking

Hemodilution, which is usually induced by autotransfusion, cardiopulmonary bypass and replace-ment therapy for blood loss, has some advantages in saving blood, improving blood flow and reducing the work-load of myocardium. But the safety and compensatory mechanism can be jeopardized by multiple factors, such as changes in inspired oxygen fraction (FIO,), cardiovascular diseases and drugs with potent cardiovascular actions, because of the disadvantageous hemodynamic changes and reduction of oxygen carrying capacity during hemodilution. Calcium channel blockers (CCB), which have recently gained a great popularity in treating several cardiovascular diseases, can affect cardiovascular system and compensatory mechanism during hemodilution. Therefore, to evaluate the effect of CCB on acute isovolemic hemodilution under the condition of hypoxia, we observed the parameters of hemodynamics and oxygen transport during acute isovolemic hemodilution after bleeding (20 ml/kg) in 16 experimentally induced hypoxic (FIO 0.15) dogs divided into verapamil and diltiazem treated groups. The results were as follows; 1) Hemodynamics; (a) In verapamil treated group, mean arterial pressure (MAP) was lower during experiment, but after hemodilution, central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) increased greater than in diltiazem treated group. Verapamil showed a greater negative inotropic effect. (b) Verapamil brought more vasodilatory effect than diltiazem. A significant increase of pul-monary vascular resistance (PVR) appeared after hypoxia, which meant hypoxic pulmonary vasocon-striction in diltiazem treated group. (c) In both groups, cardiac output (CO) was maintained well but heart rate (HR), MAP and rate pressure product (RPP) were decreased afrter hypoxia, bleeding and hemodilution. CCB reduce the work load of heart and myocardial oxygen consumption, thereby protect the myocardium. This effect was greatest after bleeding. 2) Oxygen transport; (a) Arterial oxygen tension (PaO2) was increased after hypoxia, bleeding and hemodilution in both groups and arterial carbon dioxide tension (PaCO2) was decreased after hemodilution in verapamil treated group. Ventilation-perfusion mismatch was improed in both groups, more prominently in verapamil treated group. (b) Oxygen flux (O2Flux) and oxygen consumption (VO2) were maintained well in both groups but oxygen extraction ratio (O2ER) after hypoxia and bleeding, and arterial and mixed venous oxygen content difference (Ca-vO2) after hypoxia were increased in diltiazem treated group. After hemodilu-tion, O2ER was decreased in both groups and Ca-VO2, was decreased in verapamil treated group. In diltiazem treated group, pH of arterial blood (pHa) and mixed venous oxygen tension (PvO2) were decreased after hypoxia, and PvO2 were decreased after hypoxia, and , was also decreased after hemodilution. Oxygen deficit was not seen in either group and oxygen utilization was more satisfactory in verapamil treated group. 3) After hemodilution with dextran-40, colloid osmotic pressure (COP) increased and ionized calcium (Ca++) decreased in both groups. The above findings indicated that use of CCB during acute isovolemic hemodilution in hypoxic dogs is safe because CCB showed adequate maintenance of cardiac output without any sign of heart failure or reduction of myocardial work despite a negative inotropic effect and vasodilatory effect hemodynamically, and also revealed improvement of ventiltion-perfusion mismatch and smooth maintenance of oxygen transport. Both of the effects were more prominent with verapamil than diltiazem in an equimolar dose.
Animals ; Anoxia ; Arterial Pressure ; Blood Transfusion, Autologous ; Calcium Channel Blockers* ; Calcium Channels* ; Calcium* ; Carbon Dioxide ; Cardiac Output ; Cardiopulmonary Bypass ; Cardiovascular Diseases ; Cardiovascular System ; Central Venous Pressure ; Colloids ; Natural Resources ; Diltiazem ; Dogs* ; Heart ; Heart Failure ; Heart Rate ; Hemodilution* ; Hemodynamics ; Hemorrhage ; Hydrogen-Ion Concentration ; Myocardium ; Osmotic Pressure ; Oxygen ; Oxygen Consumption ; Pulmonary Wedge Pressure ; Vascular Resistance ; Verapamil

The purpose of the study is to investigate the changes of the blood aqueous barrier, the flow rate and IOP after cyclocryotherapy in the white rabbits. After cyclocryotherapy we injected intravenously a dose of 25mg/kg of fluorescein sodium and sampled the aqueous humor at 1 and 2 hour and measured the concentration of flouorescein sodium by means of HPLC(High Performance Liquid Chromatography). By the comparision study among the control group, 4 times cyclocryotherapy application group and 8 times cyclocryotherapy applications group during experimental period, the results were summarized as follows. 1. In the control group, the mean aqueous amount was 0.297+0.020ml, the flow rate was 3.282+0.426 ul/min. 2. In the cyclocryotherapy group, IOP was significantly decreased during experimental period. It was found that the IOP in the 8 times cyclocryotherapy application group was more decreased than that in the times cyclocryotherapy application group after 2 weeks. 3. There was marked increase of the concentration of fluorescein sodium in aqueous humour after acute cyclocryotherapy, but it was decreased to normal level at 4 weeks. The difference between the two groups was not found. 4. The flow rate was markedly decreased after acute cycrocryotherapy and was almost back to normal 4 weeks in two groups. There was difference between the two groups. 5. In Electron microscopic study, many wide intercellular gaps between the nonpigmented and pigmented epithelium are observed but the nucleus of the nonpigmented and pigmented epithelium are well preserved on the day of experiment. From 7 days the nucleus, and both nonpigmented and pigmented epithelium are markedly decreased in number. By 28 days the cytoplasm is shrunken, nucleus has disappeared, and a capillary near pig-ment epithelium obstructed but the basement membrane of thest cells is well pres-erved. 6. After cyclocryotherapy, The IOP decreased progressively during experimental period, but the flow rate was almost back to normal at 4 weeks. From the result we can deduce the outflow facility was not influenced by cyclocryotherapy. And so it was suggested from electron microscopic study that IOP lowering effect of cyclocryotherapy was due to quantitiative destruction of aqueous production.
Aqueous Humor ; Basement Membrane ; Blood-Aqueous Barrier* ; Capillaries ; Cytoplasm ; Epithelium ; Fluorescein ; Rabbits* ; Sodium

BACKGROUND: Many autopsy studies have shown that the extent of extracranial carotid and coronary artherosclerosis is correlated and B-mode ultrasonographic intima-media thickness(IMT) and histologic IMT have been good correlation. In recent years. as it has been reported that IMT of carotid artery had something to do with risk factors of atherosclerosis and occurrence of coronary artery disease, in this study, we tried to investigate if the grade of atherosclerosis in B-mode ultrasonography of carotid artery could predict coronary artery disease and have something to do with the severity of coronary artery disease. METHODS: We classified the patients who were examined coronary angiography into control group without significant(>50%) stenosis(11 patients) and coronary artery disease(CAD) group(45 patients) according to the existence of significant stenosis, and we subdivided CAD group into single vessel disease(SVD) group(25 patients) and multivessel disease(MVD) group(20 patients). Practicing B-mode ultrasonography of common carotid artery(CCA), carotid artery bifurcation(BIF) and internal carotid artery(ICA), we measured IMT and IMT/L(lumen diameter) of each segment. Adding all values of each segment, we got mean aggregated IMT and mean aggregated IMT/L. RESULTS: 1) As IMT of left BIF in both six segments, control group was 0.55+/-0.16mm, SVD group was 0.71+/-0.36mm and MVD group was 1.02+/-0.61mm. So compared with control group and SVD, MVD group were significantly thick. As IMT/L, control group was 0.07+/-0.02, SVD group 0.08+/-0.05 and MVD group was 0.13+/-0.08. So compared with control group and SVD, MVD group was ignificantly high. 2)IMT of BIF in three segments, control group was 0.59+/-0.16mm, CAD group was 0.82+/-0.47mm and MVD group was 0.90+/-0.54mm. So compared with control group and CAD, MVD group were significantly thick. Also as IMT/L of BIF, compared with control group(0.07+/-0.02) and CAD(0.10+/-0.06), MVD(0.11+/-0.07) group was high.= 3) As mean aggregated IMT, control group was 0.57+/-0.34mm, CAD group was 0.69+/-0.45mm, SVD group was 0.63+/-0.12mm and MVD group was 0.74+/-0.21mm. So CAD group was thicker than control group and MVD group was thicker than SVD group. As mean aggregated IMT/L, control group was 0.07+/-0.03, CAD group was 0.10+/-0.05, SVD group was 0.09+/-0.01 and MVD group was 0.11+/-0.03. So CAD group was higher than control group and MVD group was higher than SVD group. CONCLUSION: These data support use of the mean aggregated B-mode ultrasonographic IMT and IMT/L in carotid bifurcation for correlation with the status of coronary atherosclerosis.
Atherosclerosis ; Autopsy ; Carotid Arteries* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Risk Factors ; Ultrasonography

PURPOSE: We examined the risk factors for postoperative ileus, and we investigated whether the duration of postoperative nasogastric tube (NGT) use affects the rate of postoperative ileus in patients undergoing radical cystectomy with urinary diversion. MATERIALS AND METHODS: A total of 101 patients underwent radical cystectomy with urinary diversion from 1999 to 2003. We examined the demographic and perioperative variables of patients who developed postoperative ileus and those who did not. We divided the patients into two groups; a group of patients who had the NGT removed within 24 hours and a group of patients who had the NGT removed at first flatus. We compared the two groups for the incidence of ileus and for the clinical variables. RESULTS: Postoperative ileus was observed in 23 patients (23%). The demographic data for both groups were not different in terms of age and the American Society of Anesthesiology (ASA) score. Also, the operative time, estimated blood loss, the type of diversion and the postoperative complication rates were not significantly different for the two groups (p>0.05). However, the risk of postoperative ileus was significantly higher for those patients who took a polyethylene glycol bowel preparation than for those who took a sodium phosphate bowel preparation (40%:18%, p=0.02). No significant difference in the prevalence of ileus was found between the patients whose NGT were removed within 1 days and those patients whose NGT was removed beyond 2 days (25%:22%, p>0.05). CONCLUSIONS: The results of our study suggest that the use of sodium phosphate for bowel preparation may reduce postoperative ileus and that early NGT removal after cystectomy is not correlated with ileus.
Anesthesiology ; Cystectomy* ; Flatulence ; Humans ; Ileus* ; Incidence ; Intestinal Obstruction ; Operative Time ; Polyethylene Glycols ; Postoperative Complications ; Prevalence ; Risk Factors* ; Sodium ; Urinary Diversion

BACKGROUND: In mitral stenosis with atial fibrillation, it is known that there is a significant linear correlation between end-diastolic mitral pressure gradient(EDMG) in cardiac catheterization and the corresponding RR interval. And using this, the equations to calculate the mitral valve area(MVA) in several heart retes has been inducing. However, as cardiac catheterization has a limitation not to be practiced repeatedly in all patients due to invasive procedure. In this study, using transthoracic doppler echocardiography, we tried to investigate the correlation of EDMG, RR interval and MVA and we tried to get the nomogram to predict MVA in different heart rates using it. METHODS: We made 9 patients an abject of this study whose measured MVA is from 0.5cm2 to 1.55cm2 by pressure half time(PHT) method among patients who have no any valvular heart disease except mitral stenosis with atrial fibrillation and whose condition is stable. We investigated the linear correlation between EDMG and RR interval, RR interval=a×EDMG+b(a ; slope, b ; intercept), using doppler echocardiography. We got the equation and nomogram to make an estimate of MVA with multiple regression analysis using the relation of measured MVA, slope and intercept. RESULTS: There was a linear correlation between EDMG and RR interval in all the patients. There was a mutual correlation of slope=53.0×(measured MVA)−101.2 between measured MVA and slope. There was a negative correlation of intercept=1,497−470×(measured MVA) between measured MVA and intercept. Using these, we could get multiple regression analysis equation, estimated MVA=0.0113×slope−0.0007×intercept+2.2497 and nomogram to estimate MVA. CONCLUSION: We could get the nomogram to estimate MVA easily using doppler echocardiography in mitral stenosis with atrial fibrillation.
Atrial Fibrillation ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography, Doppler ; Heart ; Heart Rate ; Heart Valve Diseases ; Humans ; Methods ; Mitral Valve Stenosis ; Mitral Valve ; Nomograms

PURPOSE: Chemotherapy is associated with the side effects including damage to the mitochondrial DNA. Doxorubicin (DOX) serves as a chemotherapeutic agent for the patients with breast cancer or prostate cancer. DOX causes muscle weakness and fatigue. We investigated the effects of treadmill exercise on DOX-induced apoptosis and mitochondrial dysfunction in relation to central fatigue. For this study, we used the rat model of DOX-induced muscle damage. METHODS: DOX (2 mg/kg) was intraperitoneally injected 1 time per week for 4 weeks. Treadmill running continued 5 days per week for 4 weeks. Muscle strength and fatigue index in the gastrocnemius were measured. Immunohistochemistry for the expressions of tryptophan hydroxylase (TPH) and 5-hydroxytryptamine (5-HT) in the dorsal raphe was conducted. We used western blot analysis for the expressions of Bax, Bcl-2, and caspases-3 in the gastrocnemius. Mitochondrial function in the gastrocnemius was also evaluated. RESULTS: DOX treatment decreased muscle strength with increase of fatigue index in the gastrocnemius. Mitochondria function was deteriorated and apoptosis in the gastrocnemius was enhanced by DOX treatment. Expressions of TPH and 5-HT in the dorsal raphe were increased by DOX treatment. Treadmill exercise attenuated DOX-induced muscle fatigue and impairment of mitochondria function. Apoptosis in the gastrocnemius was inhibited and over-expression of TPH and 5-HT was suppressed by treadmill exercise. CONCLUSIONS Apoptosis was enhanced and mitochondria function was deteriorated by DOX treatment, resulting in muscle weakness and central fatigue. Treadmill exercise suppressed apoptosis and prevented deterioration of mitochondria function in muscle, resulting in alleviation of muscle weakness and central fatigue during DOX therapy.