There are many difficulties in operative technique of total knee replacement of bony ankylotic knee, because it accompanies the deformity of the knee, contracture of soft tissue and bony ankylosis. It is said that there are poor gaining of post-operative range of motion and development of many problems in wound healing. We performed conversion TKR in seventeen patients who had fused knee between Jan. 1985 and Dec. 1991. After follow up of average three years and four months, we analyse the results. Sixteen patients were women and one was man. There were eight cases of tuberculosis knees, seven cases of septic knees and two cases of posttraumatic arthritis. Thirteen cases had previous knee surgery and in another four cases knee fusion developed spontaneously. Average age of patients were 35 years old. Operation was performed between ten months and twenty years averaging nine years after knee fusion. When blood chemistry and physical examination showed no findings of infection, operation was performed. We used bone cement in 8 cases and autogenous bone graft in 4 cases for large bone defect. For release of soft tissue contracture, in 8 cases, we lengthened quadriceps tendon with the method of V-Y advancement technique and in another 4 cases, performed patella tendon transfer from tibial tuberosity. Operative time was between three hours and four hours fifteen minutes, average three hours and fourty minutes. The results of these patients were as follows; 1. The postoperative average range of motion was 72° (20°-125°). The average extension lag was 9. 2. The average Hospital for Special Surgery knee rating score improved from 57 preoperatively to 84 postoperatively. 3. There were two patients who had pain on walking, but radiologically and clinically there were no loosening signs. 4. In three patients who had poor gaining of range of motion after operation, we performed arthroscopic adhesiolysis. There were two cases of transient peroneal nerve palsy which were recovered within 1 month and in another two case of deep infection with β-hemolytic streptococcus and pseudomonas, we performed knee fusion after one year ten months and one month after TKR. In conclusion, conversion TKR is a successful procedure which can obtain the restoration of function of the fused knee, especially in the cases that have adequate soft tissue condition, extensor mechanism and good bone stock.
Ankylosis ; Arthritis ; Arthroplasty, Replacement, Knee ; Chemistry ; Congenital Abnormalities ; Contracture ; Female ; Follow-Up Studies ; Humans ; Knee ; Methods ; Operative Time ; Paralysis ; Patellar Ligament ; Peroneal Nerve ; Physical Examination ; Pseudomonas ; Range of Motion, Articular ; Streptococcus ; Tendons ; Transplants ; Tuberculosis ; Walking ; Wound Healing

No abstract available.
Compliance* ; Humans ; Psychopathology*

BACKGROUND: Leptin, produced in the adipose tissue, is involved in the regulation of body weight. The release of the leptin is increased in obese adults even in children. This study investigated whether the serum leptin in cord blood was related to babys birth weight and metabolic parameters. METHODS: 71 pairs of singleton pregnancy babies and their mother were studied. Babies are classified in LGA (large for gestational age), AGA (appropriate for gestational age), SGA (small for gestational age) three groups. After delivery, cord blood and maternal venous blood samples were drawn. We measured the plasma leptin, insulin-like growth factor (IGF)-1, insulin and proinsulin in cord and maternal serum. RESULTS: The concentration of leptin from cord blood was increased in LGA babies and decreased in SGA babies compued with the level in AGA babies. There was positive correlatian (r=0.55, p<0.01) between the plasma leptin level in cord and birth weight. There were positive correlatian between both the plasma proinsulin (r=0.37, p<0.01) and IGF-1 (r=0.32, p<0.01) and birth weight, too. But there was no difference between female and male baby's cord blood leptin level. In multiple regression analysis, cord blood leptin level was found independent factor related to birth weight ( p=0.001) CONCLUDION : The plasma leptin, proinsulin and IGF-1 is correlates to the birth weight. These data provide evidence that leptin and proinsulin are highly related to the nutritional status already during the fetal periods, and effect on the intrauterine fetal growth.
Adipose Tissue ; Adult ; Birth Weight* ; Body Weight ; Child ; Female ; Fetal Blood* ; Fetal Development ; Humans ; Insulin ; Insulin-Like Growth Factor I ; Leptin* ; Male ; Mothers ; Nutritional Status ; Parturition* ; Plasma ; Pregnancy ; Proinsulin

No abstract available.
Calcium* ; Estrogens* ; Female ; Metabolism* ; Ovulation Induction* ; Ovulation*

No abstract available.
Leiomyoma*

Aspirin(ASA) and NSAIDs can induce bronchoconstriction in 10~20% of adult asthmatics patients. Inhalation of lysine-ASA(L-ASA) has been described as an alternative method for diagnosis of ASA-sensitive asthma. To further understand the characterlstics of ASA-sensitive asthmas. we studied 38 asthmatic patients with ASA -sensitivity (36 intrinsic and 2 extrinsic asthma) proven by L-ASA bronchoprovocation test (BPT). Most were female (male to female ratio was 27:73). Twenty (53%) of them had no previous history of adverse reactions when exposed to ASA. Twenty nine (79%) had rhino-sinusitis symptoms. Early asthmatic response was observed in 16 (42%) patients, late only response in 16(42%), and dual response in 6(16%) patients. The threshold of L-ASA to provoke a positive response ranged from 11.2 to 180 mg/ml and most (68.3%) had a positive response after the inhalation of 180 mg/ml. Concurrent sensitivity to sulfite was noted in 14 (36%) patients, followed by sensitivity to tartrazine in one (3%) patient. None showed a positive response to sodium benzoate. After the avoidance from ASA/ NSAIDs with administration of anti-asthmatic medications, symptom and medication scores reduced in 26(87%) patients among 30 followed patients. They were classified into the improved group: four (13%) patients belonged to the not-improved group. There were no significant differences in clinical characteristics between the improved and not- improved group (p>0.05). In conclusion, L-ASA BPT could be considered as a useful method to diagnose ASA -sensitive asthma and be used to screen the causative agent for asthmatic patients with intrinsic type, especially in female patients with rhino-sinusitis and/or nasal polyp, even though they do not have arty history of adverse reactions. Cessation of exposure and proper treatment may allow to reduce symptom and medication scores.
Adult ; Anti-Inflammatory Agents, Non-Steroidal ; Asthma* ; Bronchoconstriction ; Diagnosis ; Female ; Humans ; Inhalation ; Nasal Polyps ; Sodium Benzoate ; Tartrazine

Sacral perineural cyst is one group of extradural meningeal cyst at the sacral region. These lesions are distinguished from other spinal cysts because perineural cyst does not communicate with subarachnoidal space. Fluid filled cysts may compress adjacent nerve roots causing low back pain and sciatica which are dramatically improved by surgical excision. Differential diagnosis from other cysts can be accomplished by failure of collection of dye into cyst by initial myelography. C-T myelography rules out other mass lesions and often reveals communication of perineural cyst that filled with contrast medium. Magnetic resonance imaging well demonstrates three dimensinnal configures of an intraspinal cystic mass in initial study. However it is important to recognize that these cysts are one of causes of radiculopathy. We report three cases of sacral perineural cysts with radiculopathy.
Diagnosis, Differential ; Low Back Pain ; Magnetic Resonance Imaging ; Myelography ; Radiculopathy ; Sacrococcygeal Region ; Sciatica ; Tarlov Cysts*

Survivorship analysis is a useful way of expressing the long term results of joint replacement. With the increase of follow up period in total knee replacement, it has became possible to predict the survival rate of implants in total knee replacement. The survivorship of total knee replacement in 145 consecutive patients(209 knees) between 1982 and 1988 with follow-up period of up to 10 years was estimated by Dobbs' method(1980), and we analyzed, clinically and radiologically, 116 patients(177 knees) which were followed up more than 2 years(from 2 years to 10 years, average 6 years and 4 months). Also, we evaluated the knee function according to the functional knee scores of Hospital for Special Surgery. 1. The average age at operation was 55.6 years(from 19 years to 75 years). Male was 12 patients and female was 104 patients. 2. There were osteoarthritis in 83 knees(46.5%), rheumatoid arthritis in 71 knees(40.0%), secondary osteoarthritis in 18 knees(10.0%), tuberculous arthritis in 3 knees (2.0%), and Charcot joint in 2 knees(1.5%). 3. The Hospital for Special Surgery functional knee and pain scores was improved from average 43 points preoperatively to average 84 points postoperatively. The results were satisfactory in 162 knees(91.4%, excellent in 64.0% and good in 27.4%). 4. Revision surgery was performed in 15 knees of the 209 knees(7.2%), due to aseptic loosening in 9 knees(4.3%) and septic loosening in 6 knees(2.9%). 5. Survival rate of total knee replacement with reliability was 87.7%, 8 years after operation for 145 patients, 209 knees. In summary, total knee replacement is a relatively satisfying and predictable procedure which can obtain the relief of pain, restoration of function, and long term survivorship.
Arthritis ; Arthritis, Rheumatoid ; Arthropathy, Neurogenic ; Arthroplasty, Replacement, Knee ; Female ; Follow-Up Studies ; Humans ; Joints ; Knee ; Male ; Osteoarthritis ; Survival Rate

There are many reports about the snapping syndrome in the hip, shoulder, ankle, but the snapping knee has rarely been reported. In general, the symptom of this disease was relatively tolerable for that seldom requires operative treatment. We experienced one case of snapping knee, for which the pain, easy fatigability and feeling of instability on both knee joint were main complaints. During an exploratory operation, we confirmed the gracilis and semitendinosus tendon passing over the medial tibial condyle. The clinical, radiologic and operative findings were reviewed.
Ankle ; Hip ; Knee Joint ; Knee ; Shoulder ; Tendons

The major purpose for the use of autotransfusion is to prevent the transmission of blood borne infectious agents, such as human immunodeficiency virus and non-A & non-B hepatitis virus. To evaluate the efficacy and quality of autolgous shed blood for autotransfusion, eighty patients who had total knee arthroplasty from Dec. 1992 to Mar. 1994, were included in one of two groups: Group I, who received the autotransfusion, or Group II, who did not. Each group included 20 patients of unilateral TKR and 20 patients of bilateral TKR. The Orth-evac system(Deknatel, USA) was used to salvage drained blood in the first six hours after the operation. All of the patients were evaluated for the postoperative blood loss, transfusion requirements, hemoglobin, hematocrit, platelet count, blood pressure and body temperatures. l. In bilateral TKR, the reinfusion of shed blood reduced the requirements for homologous blood by 41.4%(1.2 pints in group I versus 2.9 pints in group II). In unilateral TKR, it was decreased to 36.4%(0.4 pint in group I vs 1.1 pint in group II). 2. In bilateral TKR, the requirements for homologous transfusion was decreased from 95% of patients in control group to 55% in group I .In unilateral TKR, it was decreased from 60% to 20%. 3. There were four patients who had high fever above 39℃ after autotransfusion. 4. At the immediate postoperative period there were two patients who had hypovolemic shock in group I patients who had bilateral TKR. 5. There was no clotting abnormality, no transfusion reaction and no thromboembolic disease in group I patients. In conclusion, the reinfusion of autologous shed blood after TKR is an acceptable alternative to the homologous transfusion without untoward effect.
Arthroplasty, Replacement, Knee ; Blood Transfusion, Autologous ; Body Temperature ; Fever ; Hematocrit ; Hepatitis Viruses ; HIV ; Humans ; Knee ; Platelet Count ; Postoperative Hemorrhage ; Postoperative Period ; Shock ; Transfusion Reaction