The aseptic loosening has emerged as one of the most common and serious long term complications, which requires the revision of total hip replacement arthroplasty. We studied the radiologic finding of the aseptic loosening in 79 patients of uncemented total hip replacement arthroplasty which had been performed in our hospital from March 1991 to December 1994. We evaluated the white reaction lines, osteolysis state, translation and migration in postoperative and last follow-up radiographies. The white reactive lines around the femoral stem and the acetabular cup were most frequent in zone IV and zone II. But it was not progressive and need more long term follow-up evaluations to confirm whether these lines are related to loosening or not. In assessment for stable state, the more stable at initial fixations, the better state of long term stability. Some patients have pain without loosening but all patients with loosening have pain. Press fit is the most important factor of the late stability. The osteolysis is not directly proportional to femoral loosening in this study, but it might be due to short follow up time.
Acetabulum ; Arthroplasty* ; Arthroplasty, Replacement, Hip* ; Follow-Up Studies ; Hip ; Humans ; Osteolysis

The incidence of herniated lumbar disc under the age of 19 years is increasing due to increased sports activity of teenager and development of diagnostic methods. 33 cases of herniated lumbar disc of the teenager was analyzed at Department of Orthopaedic Surgery, Dong-A College of Medicine from March 1990 to May 1994. The results were obtained as follows: 1) Among 413 patients, 33 patients(7.9%) were teenagers and the sex ratio was 2.3:1 in male to female. 2) Average intervals between the onset of clinical symptoms and the admission were 13.2 months. 3) 20 cases(60.6%) had a definite trauma history, and among these cases, 14 cases(70.0%) were associated with sports activity. 4) The most common level of herniation was L4-5 in 29 cases(64.4%), straight leg raising test was positive in 32 cases(97.0%), sensory change in 13 cases(39.4%), motor weakness in 10 cases(30.3%). 5) Among positive MRI findings(32 cases), 17 cases(53.1%) were the protruded type. 6) Among 23 operative cases, 21 cases had excellent or good results.
Adolescent ; Female ; Humans ; Incidence ; Intervertebral Disc ; Leg ; Magnetic Resonance Imaging ; Male ; Sex Ratio ; Spine ; Sports

STUDY DESIGN: We report two cases of symptomatic spinal epidural lipomatosis (SEL) associated with long-term use of steroid medication OBJECTIVES: The purpose of this study was to assess the clinical characteristics, diagnosis and treatment of symptomatic spinal epidural lipomatosis. SUMMARY OF LITERATURE REVIEW: Spinal epidural lipomatosis is a condition in which excess adipose tissue is deposited circumferentially about the spinal cord in the epidural space. It can present neurologic symptoms including back pain, radiculopathy or cauda equina. Magnetic resonance imaging is the most helpful dignostic means and should be used initially if suspected. Treatment is decompressive laminectomy and debulking of fat. MATERIALS AND METHODS: Two cases of lumbar epidural lipomatosis with neurologic symptoms were discussed and evaluated by physical examination, postmyelography CT and MRI. RESULTS: Two cases were treated with decompressive laminectomy and debulking of fat. Increased accumulation of the fatty tissue was seen predominently in posterior and posterolateral epidural space of the spinal canal, displacing and compressing the lumbar spinal cord anteriorly. Both gross and histologic evaluation revealed overgrowth of unencapsulated normal appearing fat consistent with spinal epidural lipomatosis. One case was demonstrated gradual improvement in symtoms after operation but the other was died due to medical problems. CONCLUSION: The authors reviewed the literature and reported the results of operative treatment of patients with lumbago, radicular pain and intermitent claudication caused by epidural lipomatosis of lumbar spine and degenerative spinal stenosis.
Adipose Tissue ; Back Pain ; Cauda Equina ; Diagnosis ; Epidural Space ; Humans ; Laminectomy ; Lipomatosis* ; Low Back Pain ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Physical Examination ; Radiculopathy ; Spinal Canal ; Spinal Cord ; Spinal Stenosis ; Spine

Intracellular pH regulation of osteoblasts is of a great importance in the process of bone formation and resorption, and has been suggested to be mediated via intracellular Ca2+ and cAMP messenger systems. To elucidate the mechanism of modulation of intracellular pH by parathyroid hormone and PMA(Phorbo1-12-myristate-13-acetate), effects of these agonists on the individual transporter system, Na+-H+ antiporter and Cl−-HCO3-(−OH−) exchanger, were investigated. Intracellular pH and Ca2+ were measured by using the fluorescent dye BCECF and fura-2, respectively, in UMR-106 cell monolayer grown on glass coverslip. Addition of tumor promotor, PMA(luM) caused 0.14 unit pH rise of resting intracellular pH(pHi) and 38% increase of the initial rate of pHi recovery after cytosolic acid load. Perfusion of Cl−-free solution resulted in rapid cytosolic alkalinization of which the rate was increased 26% by preincubation of PMA. Ca2+ ionophore, ionomycin (1uM) decreased resting pHi by 0.17 unit, but had no effect on the initial rate of pHi recovery after cytosolic acid load. However, the addition of ionomycin augmented the initial rate of pHi increase after Cl−-depletion outside the cells by 34% over the control. Stimulation of cells with parathyroid hormone(10-8M) caused an initial acidification (0.27 unit) followed by cytosolic alkalinization, with inhibiting effect on the initial rate of pHi recovery after acid load (42%). But parathyroid hormone did not have any significant effect on the rate of pHi increase after Cl−-depletion. PMA caused a sustained increase of intracellular Ca2+, of which the peak depended on the concentration of Ca2+ in extracellular medium. Ionomycin caused a transient increase of Ca2+ but PTH had no significant increase of intracellular Ca2+ in the concentration range of 10-6M to 10-12M tested. 10-8M PTH increased cAMP levels by about 10-fold and 10-10M PTH did by 1.6-fold. PMA, which increased cytosolic Ca2+ concentration, also had an stimulatory effect on cAMP production in the concentration range of 10-5M to 10-6M by 2-fold. These findings suggest that in UMR-106 cells Ca2+ and cAMP can influence pHi by altering the activity of pHi regulatory transporter system, and parathyroid hormones modulate pHi by inhibiting Na+-H+ antiporter via intracellular increase of cAMP, which is probably accounts for the inhibitory effect of parathyroid hormone on the proliferation of osteoblasts.
Cytosol ; Fura-2 ; Glass ; Hydrogen-Ion Concentration ; Ion Transport ; Ionomycin ; Osteoblasts ; Osteogenesis ; Parathyroid Hormone ; Perfusion

Changes of deviated angle in monocular exotropic patients with amblyopia were studied in 18 patients who had undergone occlusion therapy to investigate the possibility that occlusion may have an influence on the amount of preexisting exodeviation and fixation. Average follow up time was 9.7 months and average age was 6.3 years old. The size of the deviation angle was changed from 27.00 +/- 6.57 Prism diopter(PD) to 21.05 +/- 10.07 PD at near fixation, and from 28.56 +/- 8.67 PD to 22.05 +/- 10.08 PD at distance fixation(P<0.001). The size of deviation angle decreased more than 6 PD in 7 cases(38.9%) at near fixation and in 8 cases(44.4%) at distance fixation. The preference pattern was changed from monocular to alternating type in 14 cases(77.8%). After occluson in monocular exotropic patients with amblyopia, the visual acuity was improved and deviated angle was changed more than 6 PD. The changed angle was decreased or increased, but one patient was increased less than 5 PD. The remained deviation of angle after occlusion was less than 10 PD in 2 patients and fixation pattern was changed to exophoria in 1 patient. This results were not required surgical treatment in 3 patients. This result suggest that we should be attempt to treat by occlusion before surgery, because the occlusion therapy is helpful to improvement of visual acuity, deviated angle and fixation pattern.
Amblyopia* ; Exotropia* ; Follow-Up Studies ; Humans ; Visual Acuity

PURPOSE: Although adjuvant chemotherapy after resection of gastric cancer is a popular practice in Korea, there are still controversies about the effectiveness of the treatment. The fact that the relatively less effective drugs have been used and the rarity of large-scaled controlled studies may be partially responsible for the controversies. FP(5-FU, Cisplatin) combination is one of the most active regimen against advanced gastric cancer, consistently showing a response rate of 50~60%. We tried the FP chemotherapy as an adjuvant treatment for high-risk patients after curative resection of gastric cancer. MATERIALS AND METHODS: Between February 1992 and June 1996, 35 patients with completely resected high-risk gastric cancer(postoperative stage III or IV except thase with M1) received six courses of FP chemotherapy. Endpoints were toxicities of treatment, relapse free survival, and overall survival. RESULTS: With a median follow-up time of 17.1 months, Kaplan-Meier estimates of 2-year overall survival was 63.3% and relapse free survival estimates was 49%. There were no differences between stage III and IV patients in terms of overall survival or relapse free survival. Hematologic and non-hematologic toxicities were tolerable for most of the patients. CONCLUSION: Postoperative FP combination chemotherapy was tolerable for patients with high-risk(stage III and IV) gastric cancer. It is too early to determine the long term survival rates for this patients, but 2-year overall and relapse free survival were comparable to that of historical non-cisplatin containing regimens. Randomized phase III studies are warranted.
Chemotherapy, Adjuvant ; Cisplatin* ; Drug Therapy* ; Drug Therapy, Combination ; Fluorouracil* ; Follow-Up Studies ; Humans ; Korea ; Recurrence ; Stomach Neoplasms* ; Survival Rate

Unstable femoral intertrochanteric fractures are characterized by comminution of the posteromedial cortex, resulting in a fragment of variable size containing the lesser trochanter. Need for fixation of the fracture fragment of lesser trochanter remained controversial. We assessed the superior and medial migration of the fracture fragment of lesser trochanter, bone union, change of hip flexor power, limitation of motion and clinical results in a 29 unstable femoral intertrochanteric fractures which had been internally fixed with gamma interlocking nail (14 cases), compression hip screw (10 cases) and anatomical bent plate (5 cases). The fracture fragment of lesser trochanter was fixed with long trans-fixation screw in the cases of the anatomical bent plate. Superior migration of the fracture fragment of lesser trochanter is statistically different between Gamma interlocking nail and the other operations (P<0.05). Medial migration, bone union, change of hip flexor power, LOM and clinical results are not statistically different in the each operations (P>0.05). Although the stability could be provided by trans-fixation of the fracture fragment of lesser trochanter because the fragment acts as a buttress, clinical results was not influenced whether the fixation of the fracture fragment of lesser trochanter was done or not. We conclude that additional trans-fixation screw doesn t need if major fracture site was firmly fixed through any operation.
Femur* ; Hip ; Hip Fractures*

Treatments for restoring the function and esthetics of missing teeth include fixed bridge, partial denture, orthodontic movement, implantation and autotransplantation. However, there is no absolute indications for each techniques. Due to undevelopment of root and root resorption after autotransplantation, the success rate of autotrans-plantation over the past decades have been low. Recently. with the study on biological principles of the healing of periodontal ligament, the success rate of autotransplantation began to improve. We report the cases of successful autotransplantation which resulted in ideal healing of periodontal ligament, gingiva and alveolar bone.
Autografts* ; Denture, Partial ; Denture, Partial, Fixed ; Esthetics ; Gingiva ; Periodontal Ligament ; Root Resorption ; Tooth*

OBJECTIVES: Posttraumatic stress disorder(PTSD) has been primarily associated with emotional problems. Recently, however, the impact of PTSD on cognitive processes has interested a growing number of researchers. The current study is aimed at investigating the cognitive aspects of PTSD at both behavioral and neurological levels. METHODS: We recruited individuals with PTSD who survived the Daegu subway explosion in 2003 as well as non-PTSD individuals as a control group. To evaluate the inhibitory processes and the neural mechanisms, we had these individuals perform the negative priming task simultaneously with functional MRI scanning. RESULTS: Behaviorally, the negative priming effect was intact in the control group but was not evident in the PTSD group. In the imaging results, only the PTSD group showed the negative priming effect (i.e., increased activation of the negative priming condition as opposed to the neutral condition) in the dorsolateral prefrontal cortex, anterior cingulate cortex, and inferior temporal gyrus. The PTSD group also showed increased activity for the positive priming condition as opposed to the neutral condition in the claustrum. These results confirm and extend the previous findings that the integrity of the ACC is compromised in the trauma survivors due to disrupted white matter tract. CONCLUSIONS: The current results suggest that deteriorated performance of the PTSD group may be due to the functional problem as well as the structural abnormalities.
Basal Ganglia ; European Continental Ancestry Group ; Explosions ; Gyrus Cinguli ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Prefrontal Cortex ; Railroads ; Stress Disorders, Post-Traumatic ; Survivors

PURPOSE: FP(5-FU, Cisplatin) combination is one of the most active regimen for the advanced gastric cancer with a response rate of 50~60%. In spite of this high response rate, there is little evidence that FP regimen results in survival benefit for patients with advanced gastric cancer. This study was performed to evaluate the efficacy and toxicity of this regimen with the addition of levamisole, an immunomodulatory agent, known as enhancing the antitumor effects of 5-FU in other cancer. MATERIALS AND METHODS: Previously untreated patients with metastatic or recurrent gastric cancer were treated with 5-FU(1000 mg/M2 civ, D1~5), cisplatin(60 mg/M2 iv, Dl) every 3 weeks, and levamisole(150 mg/day, Dl~3) every 2 weeks. The major endpoints were response rate, response duration, and toxicities. RESULTS: Between June 1992 and Aug. 1996, thirty three patients were included in this study. Patients received 2~18 cycles of chemotherapy(median 5). Among the evaluable 31 patients, 18 patients(58%, 95% C.I. 40.4~75.7) showed objective responses including one(3.2%) clinical complete response. The median response duration was 7.7 months(95% C.I. 3.6~11.8). During total of 189 cycles of chemotherapy, 79 episodes(41.7%) of leucopenia were observed. There was no death from concurrent infection. CONCLUSION: FPL combination therapy is at least as effective as conventional FP chemotherapy, but resulted in somewhat more myelosuppression.
Cisplatin* ; Drug Therapy ; Drug Therapy, Combination* ; Fluorouracil* ; Humans ; Levamisole* ; Stomach Neoplasms