The femoral neck in children is dense and is small in diameter and its periosteum is thicker and stronger than that of an adult. Thus, fractures of the femoral neck in children, unlike the 60-year-old woman, are rare and usually require severe violence and this accounts for the high frequency of associated injuries. Since these fractures are rare and the femoral neck in children has many anatomic and physiologic differences, we have to consider some factors that work against treatment of these fractures. Twenty seven cases of fractures of the femoral neck in children which were treated at Severance Hospital, Yonsei University College of Mediicne from Jan. 1971 to Dec. 1980 were analyzed both clinically and radiologically and the following results were obtained. 1. Among the 27 patients, the ratio of boys and girls was 2:1 and the highest incidence was between the ages of 3 and 5 years. 2. The main course of fractures was traffic accidents, 14 cases (51.9%) and the other causes were falling from a height (37.0%) and a few cases of a slip and a fall. 3. According to the classification of Delbet and Colonna, the cervico-trochanteric fracture (40.8%) was the commonest type and 13 cases (48.1%) were displaced fractures. 4. Common associated injuries were pelvic bone fractures, skull fractures, cerebral concussion and soft tissue injuries. 5. Fifteen cases (55.6%) were treated by conservative treatment and ten cases (37.0%) by closed reduction & internal fixation. 6. 23 of the 27 cases were followed for from 6 months to 10 years, average 19 months. The results were analyzed according to Ratliffs assessment and 14 cases (60.9%) showed good results. 7. Total cases with complications were 14 (60.9%), the commonest complication being coxa vara (40.8%) and the other main complications being premature epiphyseal closure (39.1%) and avascular necrosis (30.1%). 8. Secondary treatment was done in 6 cases and correction osteotomy was done in 4 cases which had showed a poor result. 9. Finally, factors affecting results were type of fracture, degree of displacement, maintenance of reduction, interval between injury and treatment, complications and patients age. 10. The authors recommend closed reduction and internal fixation with some threaded pins for all type II and type III fractures.
Accidental Falls ; Accidents, Traffic ; Adult ; Brain Concussion ; Child ; Classification ; Clinical Study ; Coxa Vara ; Female ; Femur Neck ; Humans ; Incidence ; Middle Aged ; Necrosis ; Osteotomy ; Pelvic Bones ; Periosteum ; Skull Fractures ; Soft Tissue Injuries ; Violence

BACKGROUND: Patients with cardiac diseases who have structural defects in their heart bring about metabolic insult such as preoperative acid-base imbalance. Cardiac operation requires many nonphysiologic procedures such as extracorporeal circulation, hypothermia, and hemodilution. We studied the acid-base status of surgical heart diseases pre-operatively, during extracorporeal circulation, and post-operatively and researched the treatment indications of acid-base disturbances. MATERIAL AND METHOD: From January 1997 to May 1999, fifty two cases of open heart surgery were carried out under extracorporeal circulation, which divided into a set of pediatric and adult groups, congenital and acquired groups, non-cyanotic and cyanotic groups, The alpha-stat arterial blood gas analysis was done in each group during the preoperative period, during the operation with extracorporeal circulation, and during the postoperative period. RESULT: Before surgery, all patients present metabolic acidosis, PaO2 was low in adult group and acquired group and compensatory respiratory alkalosis was noted in cyanotic group. During extracorporeal circulation, adult group revealed alkalosis and normal in acquired group. Pediatric group presents low PaCO2, metabolic acidosis and respiratory alkalosis. Congenital group and non-cyanotic group showed non-compensatory alkalosis trend and non-compensatory respiratory acidosis were observed in cyanotic group during extracorporeal circulation. Postoperative acid-base status of adult group was recovered to normal and the standard bicarbonate was increased in the acquired group. All of the pediatric, congenital non-cyanotic, and cyanotic groups revealed the lack of buffer base. CONCLUSION: In Preoperative period, correction of metabolic acidosis was required in pediatric, congenital and non-cyanotic groups, while treatment of metabolic acidosis and low PaCO2 were required in adult and acquired groups. In the cyanotic group, metabolic acidosis and respiratory alkalosis needed to be corrected preoperatively. Using the extracorporeal circulation, minimal correction was required except acquired group which showed normal acid-base balance. In postoperative period, restriction of bicarbonate was required for acquired group while increase of buffer base was required for pediatric, congenital, non-cyanotic, and cyanotic groups.
Acid-Base Equilibrium ; Acid-Base Imbalance ; Acidosis ; Acidosis, Respiratory ; Adult ; Alkalosis ; Alkalosis, Respiratory ; Blood Gas Analysis ; Extracorporeal Circulation* ; Gases* ; Heart Diseases* ; Heart* ; Hemodilution ; Humans ; Hypothermia ; Postoperative Period* ; Preoperative Period* ; Thoracic Surgery

OBJECTIVES: The present study was designed to investigate the effect of ginseng saponin and its major active metabolite on the HPA axis under acute stress-i.c.v. injection stress, and immobilization stress, and to examine whether nitric oxide is involved in the mechanism of ginseng saponin on the HPA axis under acute stress. METHODS: In the experiment to study the effect of ginseng on HPA axis during stress, various dose of GTS were injected intracerebroventricularly(i.c.v.) or intraperitoneally(i.p.). Plasma corticosterone levels were measured 30 min after the i.c.v. injection stress. Immobilization stress was applied for 30 min and then blood was cellected for the assays of plasma corticosterone levels immediately after the completion of immobilization stress. To determine the active ginsenosides that can affect the stressinduced plasma corticosterone levels, various dose of each gisendosides(Rb1, Rb2, Rc, Re, Rf, Rg1, 20(S)-Rg3, and 20(R)-Rg3) were injected i.c.v. or i.p.. In the experiment to determine the involvement of the nitric oxide in the inhibitory effect of ginseng on the HPA, NG-Nitro-L-arginine methyl ester(L-NAME) and ginsenosides were coadministered i.c.v. or i.p., and plasma corticosterone levels were measured 30 min after stress was applied. RESULTS: First, the present study showed that ginseng total saponin, ginsenoside Rg3(S form), and ginsenoside Rc administered i.c.v. attenuated the intracerebroventricular injection stress-induced increase in plasma corticosterone levels, and these effects were removed by nitric oxide co-injection. Second, ginseng total saponin and ginsenoside Rc administered i.p. attenuated the immobilization stress-induced increase in plasma corticosterone levels, but ginsenoside Rg3(S form) did not attenuate the immobilization stress-induced increase in plasma corticosterone levels. The attenuative effects of ginseng total saponin and ginsenoside Rc in the immobilization stress-induced increase in plasma corticosterone levels were not affected by L-NAME co-injection. CONCLUSION: This study suggests that ginseng saponin attenuated stress-induced increase in plasma corticosterone levels and these effects were mediated by different mechanisms according to the components of ginseng saponin, and routes of administration.
Animals ; Axis, Cervical Vertebra ; Corticosterone* ; Ginsenosides ; Immobilization ; Mice* ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitroarginine ; Panax* ; Plasma* ; Saponins*

PURPOSE: To review clinical and radiological results after open reduction and internal fixation with T plate for unstable distal clavicle fractures. MATERIALS AND METHODS: From July. 1999 to December 2002, nine patients with distal clavicle Neer type II fractures were treated by open reduction and internal fixation with T plate. The bony union was confirmed by plain radiography. The clinical results were analyzed according to the classification by Kona et al. RESULTS: Average time to fracture union was 8 weeks in all cases. The functional results were as follows: excellent in 7 cases and good in 2 cases. Screw loosening occurred in one case, but bony union was achieved. CONCLUSION: We recommend T plate fixation as another treatment method for unstable distal clavicle fractures.
Classification ; Clavicle* ; Humans ; Radiography

BACKGROUND: The aim of this study was to estimate the minimum effective volume (MEV) of 1.5% mepivacaine for ultrasound-guided supraclavicular block by placing the needle near the lower trunk of brachial plexus and multiple injections. METHODS: Thirty patients undergoing forearm and hand surgery received ultrasound-guided supraclavicular block with 1.5% mepivacaine. The initial volume of local anesthetic injected was 24 ml, and local anesthetic volume for the next patient was determined by the response of the previous patient. The next patient received a 3 ml higher volume in the case of the failure of the previous case. If the previous block was successful, the next volume was 3 ml lower. MEV was estimated by the Dixon and Massey up and down method. MEV in 95, 90, and 50% of patients (MEV95, MEV90, and MEV50) were calculated using probit transformation and logistic regression. RESULTS: MEV95 of 1.5% mepivacaine was 17 ml (95% confidence interval [CI], 13-42 ml), MEV90 was 15 ml (95% CI, 12-34 ml), and MEV50 was 9 ml (95% CI, 4-12 ml). Twelve patients had a failed block. Three patients received general anesthesia. Nine patients could undergo surgery with sedation only. Only one patient showed hemi-diaphragmatic paresis. CONCLUSIONS: MEV95 was 17 ml, MEV90 was 15 ml, and MEV50 was 9 ml. However, needle location near the lower trunk of brachial plexus and multiple injections should be performed.
Anesthesia, General ; Brachial Plexus ; Forearm ; Hand ; Humans ; Mepivacaine ; Needles

Human gingival fibroblasts have proven to useful as a species specific cell culture system in various system on periodontal disease and regeneration. However, their use is limited, since they are hard to obtain and lifespan is short due to replicative senescence. To overcome these disadvantages, we transfected primary human gingival fibroblasts by the E6 and E7 genes of the Human papilloma virus(HPV) 16. The full length of HPV 16 E6 and E7 was cloned from the pBR322 into BamH1 and Sal I of a pBabe vector including hygromycin B resistance. Before pBabeE6/E7 plasmid transfection, peak 8 GFP including G418 resistance was transfected into primary GF to check the transfection efficency. PBabe E6/E7 plasmid was transfected using Lipofectamine plus following manufacter's instruction into primary normal human gingival fibroblasts in 60mm dishes with FBS free DMEM. After 2 days of transfection, the cells were treated with hygromycin for 2 weeks until the transfected control cells died. The resulting hygromycin resistant colonies were pooled, and clonned, and sucessful transfection was established for immortalized gingival fibroblast cell lines. Immoralized GF cells showed stellate shape, that is similar to that of orange grains, and more rapid growth and higher proliferation than that of primary gingival fibroblasts. This cell lines overcame crisis and could be cultured over 30 subcultured, could be use for three dimentional culture, epithelial-mesenchymal interaction study.
Cell Aging ; Cell Culture Techniques ; Cell Line* ; Edible Grain ; Citrus sinensis ; Clone Cells ; Fibroblasts* ; Human papillomavirus 16 ; Humans* ; Hygromycin B ; Papilloma ; Periodontal Diseases ; Plasmids ; Regeneration ; Transfection

The ultimate goal of periodontal therapy is the regeneration of periodontal tissue and the repair of function. For more than a decade there have been many efforts to develop ma- terials and methods of treatment to promote periodontal tissue regeneration. Recently many efforts are concentrated on the regeneration potential of material used in traditional medicine. Safflower(Carthamus tinctorius L.) seed extract(SSE) have long clinically used in Korea to promote bone formation and prevent osteoporosis. The purpose of this study was to examine the effects of SSE on bone formation in human osteoblastic cell line. Human fetal osteoblastic cell line(hFOB 1.19) was cultured with DMEM and SSE(1microgram/ml, 10microgram/ml, 100microgram/ml, 1mg/ml) at 34degrees C with 5% CO2 in 100% humidity. The proliferation, differentiation of the cell was evaluated by several experiments. Cell proliferation was significantly increased at 10microgram/ml, 100microgram/ml, 1mg/ml of SSE after 3 and 7 days incubation(p<0.05). Cell spreading assay was significantly increased at 100microgram/ml of SSE after 3 days and 1microgram/ml, 10microgram/ml, 100microgram/ml, 1mg/ml of SSE after 7 days(p<0.05). Alkaline Phosphatase(ALP) level was significantly increased in 10microgram/ml, 100microgram/ml of SSE(p<0.05). Collagen synthesis was significantly increased at 10microgram/ml, 100microgram/ml, 1mg/ml of SSE(p<0.05). A quantified calcium accumulation was significantly increased at 10microgram/ml, 100microgram/ml of SSE(p<0.05). ALP and osteocalcin mRNA was expressed in 100microgram/ml of SSE by RT-PCR. These results indicate that SSE are capable of increasing osteoblasts mineralization and may play an important role in bone formation.
Calcium ; Carthamus tinctorius* ; Cell Line ; Cell Proliferation ; Collagen ; Humans ; Humidity ; Korea ; Medicine, Traditional ; Osteoblasts ; Osteocalcin ; Osteogenesis* ; Osteoporosis ; Regeneration ; RNA, Messenger

PURPOSE: To compare the radiographic results of unicompartmental knee arthroplasty using a navigation system with those using a manual alignment system. MATERIALS AND METHODS: The results of 50 cases (46 patients) of unicompartmental knee arthroplasty using a navigation system (24 patients, 25 cases) and using a manual alignment system (22 patients, 25 cases) were evaluated. Knee anteroposterior, lateral, and weight-bearing full-length lower extremity radiographs before and after the arthroplasty were used for the measurements. RESULTS: The mean postoperative femorotibial alignment was 3.6 degrees of valgus in the manual alignment group and 5.4 degrees of valgus in the navigation group. The postoperative mechanical axis measured using Kennedy and White's method was located at zone 1 in 4 cases (16%), at zone 2 or C in 21 cases (84%) in the manual group, and at zone C for all cases in the navigation group (p=0.001). In the coronal axis of the femoral component, 11 cases (44%) were excellent, 7 cases (28%) were good and, 7 cases (28%) were poor in the manual alignment group. In the navigation group, 15 cases (60%) were excellent and 10 cases (40%) were good and there were no poor results (p<0.05). In the coronal axis of the tibial component, 22 cases (88%) showed excellent results and 3 cases (12%) showed poor results in the manual alignment group. In the navigation group, all cases were showed excellent results (p>0.05). In the sagittal axis of the tibial component, 9 cases (36%) showed poor results in manual group and there were no poor results in the navigation group (p<0.05). CONCLUSION: Unicompartmental knee arthroplasty using navigation produced better results in restoring the alignment of the prosthesis and the mechanical axis of the lower extremity than that using manual alignment.
Arthroplasty* ; Axis, Cervical Vertebra ; Humans ; Knee* ; Lower Extremity ; Prostheses and Implants ; Weight-Bearing

PURPOSE: To compare the clinical? results and stability of acute and chronic reconstruction of anterior cruciate ligament (ACL). MATERIALS AND METHODS: Patients who had ACL reconstruction with a quadruple hamstring tendon and ligament anchor (LA) screw with a minimum 2-year follow-up were included in this study. Acute (within 4 weeks) reconstruction group was composed of 27 knees and chronic (over 3 months) group was 44 knees. We compared the two groups with regard to Lysholm knee score, range of motion, thigh circumference, Lachman test, Tegner activity scale, associated meniscal injuries, and anterior laxity difference by Telos stress arthrometer. RESULTS: At last follow-up, no significant differences were found between the acute and chronic groups for Lysholm score, range of motion, Lachman test, Tegner activity scale, and instrumental laxity. 16 cases (59%) of acute and 33 cases (75%) of chronic patients had a meniscal injuries of which were reparable in 5 cases (28%) and 7 cases (17%). CONCLUSIONS: Acute reconstruction of ACL had excellent clinical and radiologic results as good as the chronic group without motion problem.
Anterior Cruciate Ligament* ; Follow-Up Studies ; Humans ; Knee ; Ligaments ; Range of Motion, Articular ; Tendons ; Thigh

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by selective death of motor neurons in the central nervous system. The main cause of the disease remains elusive, but several mutations have been associated with the disease process. In particular, mutant superoxide dismutase 1 (SOD1) protein causes oxidative stress by activating glia cells and contributes to motor neuron degeneration. KCHO-1, a novel herbal combination compound, contains 30% ethanol and the extracts of nine herbs that have been commonly used in traditional medicine to prevent fatigue or inflammation. In this study, we investigated whether KCHO-1 administration could reduce oxidative stress in an ALS model. KCHO-1 administered to ALS model mice improved motor function and delayed disease onset. Furthermore, KCHO-1 administration reduced oxidative stress through gp91(phox) and the MAPK pathway in both classically activated microglia and the spinal cord of hSOD1(G93A) transgenic mice. The results suggest that KCHO-1 can function as an effective therapeutic agent for ALS by reducing oxidative stress.
Amyotrophic Lateral Sclerosis* ; Animals* ; Central Nervous System ; Ethanol ; Fatigue ; Inflammation ; Medicine, Traditional ; Mice ; Mice, Transgenic ; Microglia ; Models, Animal* ; Motor Neurons ; Neurodegenerative Diseases ; Neuroglia ; Oxidative Stress* ; Spinal Cord ; Superoxide Dismutase