It is often difficult to achieve bony union and eradicate infection in treating infected non-unions of the fractured long bones. Authors carried out a clinical analysis of the 35 infected non-union cases, all aged 21 years or older, treated and followed for 6 months to 6 years from July 1979 to July 1988 in order to determine the possible factors which might influence the time required for attaining union. The results were as follows: l. In 22 of the 35 infected non-unions, the primary fracture site was open (62.9%). The remaining 13 cases (37.1% ) were the closed fractures associated with postoperative infection. 2. The sites of infected non-union were tibia in 19 (54.3%), femur in 13 (37.1%), and upper extremity in 3 (8.6%) cases. Tibia was more often involved in open fractures (63.6%). Femur, on the other hand, was more involved in closed fractures (61.5%). 3. After an average of 3.3 times of bony procedures, primary fixation was left in place in 15 (42.9%), external fixation was required in 11 (31.4%), and internal fixation was performed in 9 (25.7%). Bone graft was performed in 26 cases (74.3%). 4. Time required for achieving union was 7.1 month with stable primary fixation and 21.7 months with unstable primary fixation. Femur and tibia united at 10.5 (mean; ranged from 4 to 29) and 7.0 (mean; ranged from 3 to 19) months, respectively. 5. Bony union was delayed as the number of prior surgical procedures before successful treatment increased; the time for union was significantly shorter when either stable primary fixation or external fixation was combined with bone grafting. 6. Firmer bony union was achieved after performing Osteoperiosteal decortication with autogenous cancellous bone graft even in the presence of remaining infection at the non-union site.
Bone Transplantation ; Femur ; Fractures, Closed ; Fractures, Open ; Hand ; Tibia ; Transplants ; Upper Extremity

No abstract available.
Spine*

We report a case of lupus vulgaris following BCG vaccination in a 12-year-old male. The patient was vaccinated against tuberculosis on right shoulder 6 months ago. The erythemstous papular eruptions began to develop on the BCG vaccinated site 2 weeks after vaccination. The eruptions progressed to be pruritic, erythematous plaque which was flat, crescent shaped, and centrally covered by adherent scales for 6 months. Histopathological findings revealed tubercles and tuberculoid structures composed of epitheloid cells and Langhans giant, cells in the dermis. Caseation necrosis within the tubercles was slight or absent. In addition, there was an infiltrate of mononuclear cells around the tubercles. The skin lesions cleared after 6 months of treatment with oral isoniazid 300mg daily.
Child ; Dermis ; Humans ; Isoniazid ; Lupus Vulgaris* ; Male ; Mycobacterium bovis* ; Necrosis ; Shoulder ; Skin ; Tuberculosis ; Vaccination* ; Weights and Measures

PURPOSE: To see the stability and error in the diffusion-weighted magnetic resonance (MR) imaging technique in the experimental models and to observe the signal intensities in the early cerebral lesions of the animal models. MATERIALS AND METHODS: Diffusion coefficients of acetone and distilled water were measured by diffusion-weighted MR image and were compared with actual values. Differentiation of diffusion from perfusion were done at the resin flow phantom. The signal intensities caused by early parenchymal changes were measured in normal, hypovolemic, and embolic, and dead animal models by using diffusion-weighted image and compared with pathoIogic finding and vital staining. RESULTS: Diffusion coefficients of acetone and distilled water were 4.48 x 10-3 and 2.72 x 10-3 which were very close to the actual values. Diffusion-weighted MR image obtained at flow phantom was not affected by flow (perfusion) at the 100-400 of b-factor range. Animal study done at that b-factor range revealed a significant signal difference between the left and right sides only at the embolic model induced by polyvinyl alchol particles (p<0.05). These changes were not detected in microscopic finding but could be identified in vital staining. CONCLUSION: Diffusion-weighted MR image can be used to detect early parenchymal change when the appropriate b-factor range was applied.
Acetone ; Animals ; Diffusion* ; Hypovolemia ; Models, Animal ; Models, Theoretical* ; Perfusion ; Polyvinyls ; Water

BACKGROUND: Stellate ganglion block, which is one of the effective therapeutic tools for treating herpes zoster has been advocated by many investigators. However its efficacy is controversial at present. OBJECTIVE: This study was conducted to examine the role of stellate ganglion block in the prevention of postherpetic neuralgia and relationships between the time of this treatment and the outbreak of postherpetic neuralgia. METHODS: Twenty patients over the age of fifty with herpes zoster were included in this study. Before treatment, we randomly divided patients into two groups, A and B. Group A was treated with stellate ganglion block and acyclovir and group B was treated with acyclovir alone. Also we subdivided each group by starting treatment time into group 1 and 2. Group 1 was defined as the patients who began treatment within 2 weeks of the onset of the skin lesion. We observed the severity of pain and the incidence of postherpetic neuralgia according to each group.
Acyclovir ; Herpes Zoster* ; Humans ; Incidence ; Neuralgia, Postherpetic ; Research Personnel ; Skin ; Stellate Ganglion*

In glaucoma filtering surgery, we conducted subconjunctival injection of Mitomycin-C(MMC) 12 hours before and after surgery, and examined histologic findings of the filtering bleb, and condition of the anterior chamber which ensued after the injection. We divided 15 full-grown rabbits into three groups, and for each group, administered subconjunctivally 0.1cc of 0.002%, 0.004%, and 0.008% MMC, respectively. The subconjunctival injection of MMC before surgery was given to the right eye and post-surgical injection to the left, and we examined the results 1, 2, 4, 7, and 14 days after the administration.In conclusion, subconjunctival injection of MMC 12 hours before glaucoma filtering surgery is shown to be more effective than the injection after the surgery.
Anterior Chamber ; Blister* ; Filtering Surgery* ; Glaucoma* ; Mitomycin* ; Rabbits

Human uniparental gestations such as androgenetic hydatidiform moles provide a model to evaluate the integrity of parent-specific gene expression,-i.e, genomic imprinting,- in the absence of a complementary parental genetic contribution. Several imprinted genes are characterized so far including the insulin-like growth factor-2 gene (IGF2) coding for a fetal growth factor and the Hl9 gene whose normal function is unknown but which is likely to act as an untranslated mRNA for its tumor-suppressing function. IGF2 is expressed exclusively from the paternal allele while Hl9 from the maternal allele. Such an alternate expression is quite interesting because both Hl9 and IGF2 genes are located close to each other on chromosome 11p15.5. An in situ hybridization analysis has shown strong expression of Hl9 and IGF2 alleles in nine hydatidiform moles. Especially, a prominent expression of Hl9 and IGF2 was detected in cytotrophoblast and the cellular localization was almost paralleled in Hl9 and IGF2 transcripts . Hl9 and IGF2 genes could be expressed either biallelically or monoallelically in the moles. However, IGF2 biallelic expression did not affect allele-specificity of Hl9 expression.. These results suggest that both H19 and IGF2 transcripts are expressed in the same cells and that the functional imprinting of H19 and IGF2 genes in hydatidiform moles can be controlled individually and independently of each other.
Alleles ; Chromosome Aberrations* ; Clinical Coding ; Female ; Fetal Development ; Genomic Imprinting* ; Humans* ; Hydatidiform Mole* ; In Situ Hybridization ; Insulin-Like Growth Factor II* ; Parents ; Pregnancy ; RNA, Messenger ; Trophoblasts

From Mar. 1985 to Dec. 1992, 170 cases of osteosarcoma, which were proved histologically were admitted in our department at least one time. Among them we analysed 89 cases of Ennekings stage IIB who took limb-salvage(54) or amputation(35) and followed our protocol, with non-randomized retrospective study. The average age of the 89 patiens was 17.0 years(7 to 57). Fifty-four cases of salvage group took neoadjuvant chemotherapy, 35 cases of amputation group took neoadjuvant or adjuvant chemotherapy. The result revealed prevalences of 2/54, 0/35 as to local recurrence; 15 of 54, 17 of 35 as to metastasis; 14 of 54, 15 of 35 as to death. Of the 2 patients who had a local recurrence, one died of metastasis and the other was lost follow up. According to Kaplan-Meier's plot 5-year continuously disease free survival rate for whole 89 cases of stage IIB was 43.1%, for salvage group 56.4%, for amputation group 34.0%. There were no signifcant difference in survival rate between salvage and amputation groups(p>0.05, by log-rank test). This result means the limb-salvage operation for Enneking's stage IIB osteosarcoma does not hinder patients survival.
Amputation ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Osteosarcoma ; Prevalence ; Recurrence ; Retrospective Studies ; Survival Rate

So far with the advancement in treatment modalities for malignant bone and soft tissue sarcomas the survival rate become higher. Till now there are some questions who can survive. Temporary procedure not affecting the treatment schedule would have more advantages than primary permanent one. When there is higher possibility of survival, this can be switched to permanent one. From Dec. 1986 to Jan. 1994, we had performed 40 cases of temporary arthrodesis after segmental resection of malignant bone and soft tissure tumors around the knee by using intramedullary nail andbone cement. Thirty eight cases of bone tumors[osteosarcoma(33), malignant fibrous histiocytoma(MFH)(3), chondrosarcoma(1), Ewing's sarcoma(1)] and 2 cases of soft tissue sarcomas[MFH(1), squamous cell carcinoma(1)] were analysed. Types of intramedullary nail used were rigid(Huckstep, 23 cases) or flexible(Ender, 17 cases). Six cases(15%) showed mechanical implant failure due to fracture (Huckstep;5, Ender;1) between 2 to 20 months after operation. Rearthrodesis using Ender nail and bone cement(5) or arthroplasty using Kotz prosthesis(1) were done for fractured cases. The other complicaitons were deep infection(2), peroneal nerve palsy(2), or transfixing screw fracture(2). Second reconstruction procedure was carried out in 2 cases with arthroplasty using Kotz prothesis. For IM nail, multiple Ender nailing seems to be superior to the Huckstep in mechanical strength. Contrary to the primary permanent reconsturction of the bone defect, this procedure has several advantages: 1) simple and does not hinder postoperative chemotherapy, 2) even in the extensively involved cases, can save the limb if the neurovascular structures are spared, 3) in Stage III, can save the salvagable limb, 4) economic and immediate stability can be helpful in the patient's quality of life, 5) two years later, when the survival approaches plateau, we can switch to another kinds of salvage operation, 6) Ender nail was superior to Huckstep in mechanical stability, 7) can be used for children expecting leg lengthening near puberty. It is useful for sarcoma patients around knee who require prolonged chemotherapy anbd whose life expectancy is relatively unexpectable.
Adolescent ; Appointments and Schedules ; Arthrodesis ; Arthroplasty ; Child ; Drug Therapy ; Epithelial Cells ; Extremities ; Humans ; Knee ; Leg ; Life Expectancy ; Peroneal Nerve ; Puberty ; Quality of Life ; Sarcoma ; Survival Rate

MAGE (melanoma antigen gene) is a tumor specific shared antigen, presented by HLA class I molecules, which is recognized by cytotoxic T lymphocytes. MAGE proteins are expressed in malignant tumor cells, in contrast to no expression in normal or benign tissues except for testis and placenta. MAGE might be a potential target for immunotherapy of malignant tumors. However, its biological aspects associated with cell cycle are not yet described. The flow cytometry is a useful tool for objective and quantitative analyses of heterogenous tumor cell population. To understand the status of MAGE related to cell cycle and its relationship with p53 as the G1 checkpoint regulator, p21, and PCNA as a proliferative index, we investigated expression of MAGE-3 protein, mutant p53, p21, and PCNA by flow cytometry and immunohistochemical stain. In addition, double stains for MAGE-3/p53, p53/PCNA, and p53/p21 were analysed with bivariate flow cytometry. DNA histograms using MAGE-3/PI (DNA) and p53/PI (DNA) were also analysed. The cell line (PNUH- 12) used for this study originated from a hypopharyngeal squamous cell carcinoma, which has point mutation (exon 7, C-->G) of p53. The expression rate of MAGE-3 was 83%, PCNA 85%, and p53 81%. No expression for p21 was identified. MAGE-3 was expressed in cytoplasm, while both PCNA and p53 were expressed in nuclei of tumor cells. With bivariate analyses, coexpression rates of MAGE-3/p53 and p53/PCNA were 0.96 and 0.97, respectively. Both MAGE-3 and p53 showed constantly high level throughout the cell cycle. These results suggest that expression of MAGE-3 and mutant p53 is not dependent on the cell cycle. p21 seems to be inactivated.
Carcinoma, Squamous Cell* ; Cell Cycle ; Cell Line* ; Coloring Agents ; Cytoplasm ; DNA ; Flow Cytometry* ; Immunotherapy ; Mutant Proteins ; Placenta ; Point Mutation ; Proliferating Cell Nuclear Antigen* ; T-Lymphocytes, Cytotoxic ; Testis