PURPOSE: This study was performed to evaluate clinical manifestations and findings of ultrasonogram of neonatal septic arthritis and osteomyelitis. We tried to determine the value of ultrasonogram as a tool for early diagnosis of septic arthritis and osteomyelitis. METHODS: We reviewed the records of 17 patients, who were diagnosed septic arthritis and/or osteomyelitis in Departments of Pediatrics and Orthopedic Surgery, Han dong University Sunlin Hospital in Pohang between Jan. 1994 and Sep. 1998. Radiologic findings were reviewed retrospectively according to the duration of symptoms at the onset. We compared the sensitivity of ultrasonogram with other radiologic tools done within 7 days of illness. RESULTS: We compared sensitivity of each imaging study done within 7 days of illness. 20%(3/5) had abnormality in plain radiographs, 78.6%(11/14) in ultrasonogram, 28.6%(2/7) in bone scan, and 100,0%(3/3) in MRI. Deep soft-tissue swelling around the bone was the earliest sign of acute osteomyelitis in ultrasonogram. Concurrently early septic arthritis showed deep soft tissue swelling around the joint and increased synovial effusion in ultrasonogram. CONCLUSION: Ultrasonogram is not so expensive, non-invasive, not harmful to patients, and there is no need to sedate patients for examination. Comparing with other imaging studies, the sensitivity of ultrasonogram is relatively high. Ultrasonogram is a useful diagnostic tool of septic arthritis and osteomyelitis in newbom infants.
Arthritis, Infectious* ; Early Diagnosis ; Gyeongsangbuk-do ; Humans ; Infant ; Joints ; Magnetic Resonance Imaging ; Orthopedics ; Osteomyelitis* ; Pediatrics ; Retrospective Studies ; Ultrasonography

BACKGROUND: The finding of frequent inducible nitric oxide synthase (iNOS) expression in human cancer indicates that nitric oxide has a pathological role in tumor progression. Increased expression of iNOS in human pancreatic cancer cells was also recently reported, but the clinicopathological and biological significance of the iNOS expression remains unclear. The aim of our study was to look for possible roles and clinical significance of iNOS expression in pancreatic cancer. METHODS: 72 pancreatic adenocarcinoma tissue specimens were obtained from surgical resection. We investigated the immunohistochemical expression of iNOS in respect to variable clinicopathological characteristics, proliferation activity (assayed by Ki-67 expression), apoptosis (by TUNEL stain), and microvessel density (by CD34 expression; angiogenesis). RESULTS: Immunohistochemical positivity for iNOS in pancreatic epithelial cells was observed in 48/72 (66.7%). Apoptotic index (AI) of positive iNOS expressions were significantly higher than for negative expression (p <0.001) and increasing intensity of COX-2 expression showed a trend with increasing AI (p<0.001). No significant association was found between iNOS expression and proliferation index or microvessel density in pancreatic cancer. The expression of iNOS protein did not correlated with age, bilirubin, CA 19-9, location, size, AJCC stage, differentiation, distant metastasis or patient survival. CONCLUSION: The expression of iNOS enzyme in pancreatic cancer contributes to apoptosis of tumor cells. However, we could not find any correlation between iNOS expression and cell proliferation, angiognesis or clinical characteristics. Further in vivo investigations are necessary to determine the putative role of the iNOS expression for tumor progression in human pancreatic cancer.
Adenocarcinoma ; Apoptosis ; Bilirubin ; Cell Proliferation ; Epithelial Cells ; Humans ; In Situ Nick-End Labeling ; Microvessels ; Neoplasm Metastasis ; Nitric Oxide ; Nitric Oxide Synthase Type II* ; Pancreatic Neoplasms*