The Discrepancy between Eipcondylar and Posterior Condylar Axis of Femur in Total Knee Arthroplasty

PURPOSE: This study was to measure the angle between the femoral epicondylar axis and the femoral posterior condylar axis, to clarify which axis can be used as a guideline to achieve proper rotational align- ment of femoral component in total knee arthroplasty. MATERIAL AND METHODS: From Jan. 1997 to Dec. 1998, the axial images of MRI of 121 patients who sustained acute knee injury were selected to measure the posterior-epicondylar angle(the angle between the femoral epicondylar axis and the femoral posterior condylar axis). Congenital anomaly or any fracture cases were all excluded. Comparisons were made according to gender and ages and the student t-test was used to evaluate the statistical differences. RESULTS: The mean posterior-epicondylar angle was a 4.8(+- 2.0) and there was no significant statisti- cal difference between gender and ages except 3rd decade. CONCLUSION: It can induce an insufficient external rotation of the femoral component in total knee arthroplasty, if we usually do 3 of external rotation of femoral component from the posterior condylar axis.

Treatment of Tibial Medial Bone Defect in Primary TKA

There are several rnethods to correct the tibial bony defect including resection, cement filling, autograft or allograft and metal augmentation. The purpose of this study is to find the adequate treatment method of tibia bony defect through analysis of the result with above methods. From Sep. 1993 to Dec. 1997, the authors analyzed 93 cases of tibial medial bony defect corrected by overresection of lateral condyle, allograft and metal wedge or block among 358 cases of primary total knee arthroplasty(TKA) operated at Asan Medical Center. All cases were devided into four groups according to the treatment method; group A(31 cases) with overresection of lateral condyle, group B(37 cases) with metal wedge, group C(21 cases) with metal block and group D(4 cases) with allograft. The mean follow up period was 23.6 months(12 56 months). The results were as follows, 1. There were no definite statistical difference between group A, B, C and D in HSS knee score, ROM, correction of deformity. But in group D, there is one case of loss of the correction. 2. Loosening of the implant was not noted, but 17 cases of mild bony resorption was found just beneath the implant. It was particularly prominent in group B(9 cases) than group A(5 cases) and C(3 cases). 3. Among 4 cases of allograft, one has developed collapse of allograft. 4. 3 cases of deep infection developed only in group C, which were followed by revision TKA. Although further follow up study should be carried out, we concluded that resection of lateral tibial condyle, allograft, metal augmentation is a good substitute to the correction of the tibial bony defect in primary TKA.

A case of multiple furunculosis caused by methicillin-resistant staphylococcs aureus / 대한피부과학회지

Staphylococcus aureus is one of many causative agents of the fu uncles. As the S. aureus strains resistant to penicillinase-repsistant penicillins (methicillin-resistant S. aureus, MRSA) are more frequently isolated, their accuiate identification became a very important step in selection of an appropriate therapeutic regimen. We report herein a case of multiple furunculosis caused by metkicillin-resistant S. aureus in a 11-year-old male patient, who was successfully treated with sulbactam/ampicillin and amikacin.

Two cases of nickel dermatitis showing vitiligo-like depigmentations

The authors reviewed two patients showing "vitiligo-like depigmentations" where the skin had been in close contact with a metal spectacle frame made of nickel alloy. In spite of the hypersensitivity to nickel in both patients, they showed clinical and histologic findings indicate that the formation of "vitiligo-like depigmentation" does not result from posinflammatory hypopigmentation but from chemical hypomelanosis. We could not explain the underlying mechanisms; however, the speculation that the "vitiligo-like depigmentation" may come from the direct effect of the nickel itself, prompted us to report these cases.

Clinical Evaluation and Patch Test with Vegetables in Housewife' s Hang Eczema / 대한피부과학회지

The importance of vegetables as a allergen for the development of hand eczema has been a matter of debate. The aim of this study was to evaluate the clinical manifestations of hand eczema and to investigate the role of vegetables in the hand eczema of Korean housewives. In this study, clinical evaluatons and patch tests with Hollister-Stier standard allergens and 22 vegetable allergens wer performed in 32 patients with housewife's hand eczema. The results are summarized as follows : 1. The prevalence was highest in fourth(59.4%) and third(25.0%) decades of life and the peak age of onset was third(53.1%) and fourth(31.3%) decades. 2. Only 3 of 32 patients(9.4%) had past histories of atopic dermatitis ; however, childrens of 12 patients(37.5%) had atopic dermatitis. 3. The common skin signs were fissuring(90.6%), scaling(78.1%), erythema(75.0%), hyperkeratosis(71.9%), lichenification(62.5%), and vesicle(43.8%) in descending order. 4. The common aggravating factors were soap or detergent(93.8%), water(90.6%) and rubber glove(25.0%). 5. The most common involved areas of hand eczema were fingers including fingertips and fingertips only. 6. The results of patch test using vegetable allergens with 10 normal controls were all negative. Of the 32 patients with hand eczema, 13(37.5%) showed positive patch test with standard allergens and 5(15.6%) showed positive with vegetable allergens. 7. Among 30 standard allergens, cinnamic alcohol(9.4%). potassium dichromate(9.4%), nickel sulfate(6.3%), and wool wax alcohol(6.3%) were the common allergens which showed positive reactions. Of the 22 vegetable allergens, garlic, Chinese cabbage juice, Chinese cabbage extract, cucumber juice, spinach extract, potato juice showed weak positive reactions in only one patient(3.1%) respectively. From the above results contact sensitivity to vegetables is not significant in Korean housewives with hand eczema.

Behcet's Syndrome in Korea: A Look at the Clinical Picture

Behcet's syndrome is being detected increasingly in Korea. To collect and document information concern- ing the clinical picture as it is records of patients seen in our clinic in the period between November 1983 and March 1986 were used as source material. In summary, it was found that (1) the total number of patients who had two majors symptoms at least were 410, including 170 men and 240 women; (2) Patients in their thirties were the most common, the mean age being 34.6 years; (3) according to Lehner's classification, the order of frequency of the different types was mucocutaneous (52%), ocular (33), arthritic (14%) and neurologic (1%) and according to Shimizu's classification, it was incomplete (39%), suspected (37%), and complete (24%); (4) oral ulcers, which had observed in 407 patients were the most frequent major symptom, followed by genital ulcers in 338 patients.

A Study of HLA Antigens in Behcet's Syndrome

Fifty-two Korean patients with Behcet's syndome were typed for HLA antigens. 52 apparently healthy Korean subjects were used as controls; 42 for HLA-A, B, C and all 52 for HLA-DR typing. HLA-B5 and DRw8 presented significantly high frequencies in all patiens. According to Shimizu's classification, HLA-B5 and DRw8 were significantly increased in the complete type; B5 in the incomplete type; DR3 in the suspected-possible type. According to Lehner's classification, HLA-DR3 was significantly increased in the neurological type; B5 in the ocular type; B5 in the ocular type. We confirmed the association of HLA-B5 with the severity of Beh et's syndrome. A relation might exist between DRw8, DR3 and Behcet's syndrome.

Patch Test in the Suspected Cosmetic Contact Dermatitis / 대한피부과학회지

Of the 166 cases of suspected cosmetic contact dermatitis, 92 showed positive reactions to one or more of the allergens of the commercial test kits or patients, own coametics by patch test. Tincture of benzoin, ammoniated mercury, cinnamic alcohol and benzyl salicylate were the most commonly identified agents. By product category, skin care produts dominated as the cause of the cosmetic conact dermatitis. However, it was suspected that the most common sensitizer may be present in the eye-make up preparations. The positive rate of foreign cosmetics was more than 2 fold higher than the domestic ones.

A Case of Carcinoma Erysipelatoides Originating in an Internal Organ / 대한피부과학회지

We present a case of carcinoma erysipelatoides which or iginated from an internal organ. The patient was a 50 year-old female who had peritoneal carcinomatosis, She presented an erythematous lesion resembling erysipelas on her right breast. Histopathologic findings were consistent with metastatic adenocarcinoma but clinically it was not associated with carcinoma of the breast.

Two Cases of Mercury Exanthem / 대한피부과학회지

We herein report two cases of systemic contact dermatitis probably due to inhalation of mercury. The first case is a 13 year-old boy who developed generalized erythema and dyspnea following the use of a coin-bleaching solution of unknown ingredient in his room. And the second case is a 10 year-old boy who developed generalized scarlatiniform eruptions on his trunk and flexural aspect of his extremities after hreaking a clinical thermometer. The typical clinical feature, the inverted triangular shaped erythema on flexural aspect of inner thigh, were appeared in both patients. On patch testing, they showed positive reactions to mercury and other mercury compounds.

A Case of Angiommunoblastic Lymphadenopathy / 대한피부과학회지

Herein we report a 51-year-old male with angioimmunoblastic lymphadenopathy who had developed rnaculopapular eruptions after the administration of crystalline penicillin, acetylsalicylic acid and sulpyrine. Skin biopsy showed mild lyrnphohistiocytic infiltration and extravasated RBCs around the blood vessels in the upper dermis. He had run a progressively downhill course in spite of vigorous chemotherapy and ultimately died.

Humoral Immunity of Each Subgroup in Behcet's Syndrome / 대한피부과학회지

Various immunologic studies were performed for the investigation of humoral immunity in 30 patients with Behcet's syndrome who had been registered in Behcet Special Clinic of Severance Hospital: direct immunofluorescent staining, quantitation of serurn Ig, complement by immunoelectrophoresis and B-cell by EAC-rosette method. The results can be summerized as follows: 1. Direct immunofluorescent staining occurs in biopsies from patients with Behcets syndrome: 11 of the 30 patients(36. 7%). Among them, vascular fluorescene with C3 was noted in 10 of 11 patients (90. 9%), in addition of IgG, IgA, IgM, and fibrinogen on dermoepidermal junction or vessel. 2. The results of direct immunofluorescence staining showed different tendency according to biopsy sites and clinical types: 5 of 10(50%,) in the specimens from oral mucosa, 5 of 13(38.5%) from leg, 1 of 3(33.3%,) from genitalia, and 0 of 7(0%) from other sites: higher in complete and incomplete types than in suspected and possible types. 3. Immunofluorescent staining rates were statistically not significant according to sex, age and Lehner's classification. 4. Serum IgG, IgA, IgM, C3, C4 and B-cell were statistically not significant between DIF positive and negative groups. Therefore it is considered that vascular deposits of immune complexes and activation of complements by immune omplexes may be a role of pathogenetic mechanisms of Behcet's syndrorne.

A Case of Fiddler's Neck / 대한피부과학회지

Fiddler's neck was first described by Peachey and Matthews in 1978 to denote a condition characterized by focal lichenification and pigmentation on the left side of violinist and violist neck just below the angle of the jaw. The etiologic facters are friction, local pressure, occlusion, poor hygiene and sweating. In only a few cases has a specific hypersensitivity to one or more of the ch!n rest material(wood, lacquer, dye) or the metallic fixing been found responsible. We report a case of 15-year-old female patient with Fiddler's neck who has played the violin for 8 years.

A Case of Benign Cephalic Histiocytosis / 대한피부과학회지

A 18-month-old girl was seen because of an yellowish brown papular eruptions on the face, earlobes and neck of one year duration. A skin biopsy specimen revealed circumscribed cellular infiltrates composed of predorninantly pleornorphic histiocytes. Electron microscopy of biopsy material disclosed numerous worm like particles and coated vescles in limited area of the cell cytoplasm, consistent with the findinga described in benign cephalic histiocytosis. After six months of her first visit, the individual papules became flattened.

Six Cases of Allergic Contact Cheilitis / 대한피부과학회지

The vermilion border of the lips has a modifed epithelium, which is much more likely to develop allergic contact sensitivity reactions than oral mucosa. Allergens in contact with both the oral mucosa and the lips oftens produce only cheilitis. Allergic contact cheilitis may result from topical medicaments, dentifrices, cosmetics, foods, plants or metals. We present six cases of allergic contact cheilitis confirmed by patch test. The toot4paste was incriminated in 2 cases, the lipstick in 3 cases and the bubble gum in one rase as producing chelitis respectively.

An Epiderniological Study of Contact Dermatitis: I . Multicenter Trials / 대한피부과학회지

The present work is the first joint epidermiological study of contact dermatitis carried out by the Korean Contact Dermatitis Research Group which was organized in 15i8p. For the past 2 years total 937 patients with contact dermatitie and suspected contact dermatitis have been routinely patch tested with Hollister-Stier standard battery (28 different antigens) by using Finn Chamber at 10 different General Hospitals which were located around Seoul area. The MOHL index was quite different from the western data, which was characterized with less male, rare leg ulcer and less occupational cases. However, housewife hand eczema cases were more common. The most common senaitiaers were ammoniated mercury, nickel sulfate, potassium dichromate, cinnamic alcohol, neomycin sulfate, paraphenylendiamine, balsam of Peru and thimerosal in order of frequency.

Investigation of Cell Mediated Immunity in Patients with Behcet's Syndrome, Using the DNCB Sensitization / 대한피부과학회지

Various immunologic investigations of 159 patients with Behqets syndrome undertaken included; the DNCB sensitization test, total T-cells and T-cell subsets and the lymphocyte transformation test using PHA. The percentage of positive esponsiveness to DNCB decreased in the order of possible (65%), suspected (60%), incomplete (37%) and complete type (37%), The number of patients with impaired LTT was larger in the group of patients with DNCB( + ) responsiveness (seventeen of 32) than in DNCB(+) group (six of 25), There was significant impairment of cell mediated immunity in Behcets syndrome compared to normal subjects, when analyzed by the impaired LTT and decreased proportions of helper T-cells.

Two Cases of Angiokeratoma Circumscriptum / 대한피부과학회지

We report two cases of angiokeratoma circumcriptum. One of them was 20 year- old male, who had multiple dark erythematous 0.5 cm to 2 cm sized keratotic papules and nodules surrounding irregular shaped erythema scattered or grouped on the right lower leg. The other case was 36 year-old male, who had Q. 7 cm sized dark erythematous papules and 2 cm sized dark brown colored nodule with central ulceration on the medial part of the left upper thigh, The two patients had skin lesions at birth. Histopathologic finding disclosed markedly dilated vessels containing many red blood cells mainly in the papillary dermis, which in some, were surrounded by elongated rete ridge. Cavernous hemangioma like lesion was present in the lower dermis and subcutaneous fat in case 2.

The Effect of Combination Treatment with Oral Etretinate (Ro 10 - 9359) and Vitamin E on Psoriasis Vulgaris / 대한피부과학회지

Etretinate(Ro 10-9359), an aromatic analogue of vitamin A acid, has been known to be effective in the treatment of psoriasis, Darier's disease, pityriasis rubra pilaris, ichthyosis, and palmoplantar keratoderma when administered orally. In this experiment, we compared the therapeutic and side effects between a group with high dose therapy(initially 75mg of etretinate a day) and an another group with low dose therapy(initially 40mg of etretinate a day). We also observed whether the pretreatment followed by combined treatment with vitamin E could potentiate the therapeutic effect as well as reduce the side effects of oral etretinate. This experiment comprised 102 moderate to severe psoriatic patients. The following results were obtained from this experiment. 1. Fifty-six among 92 patients(61%) who were treated with etretinate for more than 4 weeks showed good to excellent therapeutic effect. 2 The high dose therapy was more effective, but showed more side effects than low dose therapy. 3 Vitamin E did not potentiate the effect of etretinate. In low dose therapy, the pretreatment followed by combined treatment with vitamin E showed a tendency to reduce the side effects of etretinate.

Two Cases of Malignant Histiocytosis / 대한피부과학회지

Two cases of malignant histiocytosis, in which skin involvement was a prominent finding at initial clinical presentation, are reported. 1nteresting histopathologic findings, including Langerhans granule in one case and numerous eosinophils in another, were observed. In one case remission was achieved with BACOP chemotherapy (Bleomycin, Adriamycin, Cyclophosphamide, Vincristine, and Prednisone). In the other case, the patient died nine months after the onset of the disease without any treatment.