PURPOSE: We reviewed the radiological outcomes and survival rate of the total hip arthroplasty (THA) with AML(R) (Anatomic Medullary Locking, DePuy, Warsaw, IN, USA) hip prosthesis on long-term follow-up. MATERIALS AND METHODS: From May 1988 to December 1990, 93 hip arthroplasties were performed on 77 patients in our hospital. In this study, 30 patients, of whom 41 hips underwent the procedure, were alive and able to be included. Follow-up was average of 21.4 years. The mean patient age was 45 years (35-60 years) at the time of operation. Of the hip procedures included in our study, the reasons for THA were osteonecrosis of the femoral head in 25 hips, rheumatoid arthritis in 3 and acetabular dysplasia in 2. We analyzed the wear rate of the polyethylene, osteolysis of the femur and acetabulum and stress shielding of the femur on the follow-up radiographs. In addition, we investigated the survival rate of the prosthesis and causes of revision in the last follow-up. RESULTS: The polyethylene wear rate of the surviving acetabular cup was 0.15 mm/yr. Acetabular osteolysis was detected in 33 hips and was mostly in zone 2 and 3. Femoral osteolysis was showed in 32 hips in zone 1 and 7. Stress shielding over grade 3 was found in 5 of 21 femoral stems in over 13.5 mm in diameter. The grade of stress shielding did not progress with follow-up. Of the 33 hips, 26 (63.4%) cups were revised for polyethylene wear and osteolysis. There were 6 (21%) femoral stems revised for osteolysis. CONCLUSION: The cause of a high revision rate of the prosthesis was polyethylene wear and osteolysis. We predict that THA using AML(R) prosthesis with wear-resistant bearing surfaces could increase the survival rate on long-term follow-up over 20 years.
Acetabulum ; Arthritis, Rheumatoid ; Arthroplasty ; Femur ; Follow-Up Studies ; Head ; Hip ; Hip Prosthesis ; Humans ; Osteolysis ; Osteonecrosis ; Polyethylene ; Prostheses and Implants ; Survival Rate ; Tacrine ; Ursidae

PURPOSE: We assumed that an obese patient has a high rate of postoperative wounds, but there is no objective data showing the relationship between the body mass index (BMI) and the rate of postoperative wounds in Korea. We describe the relationship of BMI and rates of postoperative wound complications. MATERIALS AND METHODS: From September 2005 to February 2006, 772 patients undergoing elective gastrectomy surgery due to gastric cancer were enrolled in a retrospective study to measure postoperative wound complications. A preoperative history, physical examination and daily progress notes were reviewed retrospectively from the medical records. Postoperative wound complications were detected from the elective medical record and from a doctor in charge statement. RESULTS: The total number of patients was 772, the mean age of the patients was 57+/-11.2 years and the sex ratio (male/female) was 1.82:1. Postoperative wound complication rates were different among the BMI groups (BMI<20 kg/m2 vs 20< or =BMI< or =25 kg/m2 vs >25 kg/m2), and patients with a BMI>25 kg/m2 that underwent gastrectomy had a significantly higher wound complication rate (4.6%) than underweight and normal weight patients (0.9% and 1.6%, respectively) (P=0.038). CONCLUSION: Overall, there was a statistical correlation between BMI and the postoperative wound complication rate. Overweight (BMI>25 kg/m2) patients that underwent gastrectomy had a higher wound complication rate than normal body weight (BMI< or =25 kg/m2) patients. Further studies will be required with a larger population and prospectively designed study considering other factors that affect the wound complication rate.
Body Mass Index* ; Gastrectomy ; Humans ; Ideal Body Weight ; Korea ; Medical Records ; Overweight ; Physical Examination ; Retrospective Studies ; Sex Ratio ; Stomach Neoplasms* ; Thinness ; Wounds and Injuries*

PURPOSE: The prognosis for patients with stage IV gastric cancer is very poor. However, recently, some studies have reported benefits from a gastric resection for metastatic gastric cancer. This clinical study was performed to evaluate the effectiveness of a noncurative gastrectomy in treating stage IV gastric cancer with hepatic metastasis. MATERIALS AND METHODS: A retrospective analysis was performed on 98 gastric cancer patients who had undergone gastric resection, in spite of hepatic metastasis, between January 1990 and December 1996 at the Department of Surgery in 11 General Hospitals in Korea. RESULTS: The average age was 58 years old, and the male-to-female ratio was 69: 29. The laboratory tests were unable to predict hepatic metastasis. In 54 cases, hepatic metastasis was not identified before the surgery. The most common location of gastric cancer was antrum (72 cases). The most common gross type was Bonmann type III (78 cases). The serosa-exposed cases were 80. The peritoneal seeding was combined in 17 cases. A total gastrectomy was performed in 18 cases and a distal gastrectomy in 80. Lymph-node dissection was performed in 23 Dl, and 51 D2 cases. Hepatic resection was performed in 36 cases, The frequent histologic types were moderately differentiated and poorly differentiated tubular adenocarcinoma. Postoperative adjuvant chemotherapy was done in 70 cases. The complication rate (7%) was low. The median survival time was 15 months, with mean survival time of 18 months. The 2-year and 3-year survival rates were 23%, and 7%, respectively. In the univariate analysis, good survival was closely related to limitation of hepatic metastasis to one lobe, a few metastases to both lobes, negativity of peritoneal seeding and lymph node dissection more than D2 (p<0.05), CONCLUSIONS: An aggressive gastric resection for stage IV gastric cancer with hepatic metastasis might be beneficial in lengthening the survival period. A prospective study is needed, especiaUy one with an exact evaluation and analysis of the quality of life between the gastrectomy and nonresection groups.
Adenocarcinoma ; Chemotherapy, Adjuvant ; Gastrectomy* ; Hospitals, General ; Humans ; Korea ; Lymph Node Excision ; Middle Aged ; Neoplasm Metastasis* ; Prognosis ; Quality of Life ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

OBJECTIVES:Nitric Oxide(NO) is a toxic, inorganic, gaseous free radical produced during the metabolism of L-Arginine by NO synthase(NOS). It has been implicated in a rapidly growing number of physiological and pathophysiological processes such as cytotoxic effects against microbes and tumor cells, blood vessel dilation and neurotransmitter. Recently there is growing evidence implicating NO in immune regulation, inflammation, autoimmunity, and arthritis. We performed this study to determine a role for nitric oxide in inflammatory arthritis especially rheumatoid arthritis(RA). METHODS: We measured (1) the concentrations of nitrite, a breakdown product of nitric oxide, in serum and synovial fluid from patients with RA and osteoarthritis(OA) and in the serum of controls (2) the concentrations of nitrite in the supernatant of cultured synovial tissue with RA and OA and (3) determined whether human chondrocytes and synoviocytes can synthesize nitric oxide and if so, how production is regulated by cytokines and antirheumatic drugs. RESULTS: 1) Serum nitrite concentrations in patients with RA and OA were higher than in controls. In both disease groups synovial fluid nitrite was higher than serum nitrite. Serum and synovial fluid nitrite concenrations in RA were higher than those in OA. However, those findings are not statistically significant. 2) Although these findings are not statistically significant, the concentration of nitrite in the supernatant of cultured synavial tissue with RA was higher than that in OA. 3) IL-1beta and TNF-alpah induced the biosynthesis of NO by chondrocytes and synoviocytes. IGF-1 and TGF-beta failed to provoke the production of NO. The biosynthesis of NO required an induction period of approximately 6 hours and was inhibited by L-NMMA and cycloheximide. Dexamethasone, indomethacin, gold sodium thiomalate and methotrexate had no effect on the induction of NO biosynthesis. CONCLUSION: These results suggest a role for nitric oxide as an inflommatory mediator in inflammatory arthritis.
Antirheumatic Agents ; Arginine ; Arthritis* ; Arthritis, Rheumatoid ; Autoimmunity ; Blood Cells ; Chondrocytes ; Cycloheximide ; Cytokines ; Dexamethasone ; Gold Sodium Thiomalate ; Humans ; Indomethacin ; Inflammation ; Insulin-Like Growth Factor I ; Metabolism ; Methotrexate ; Neurotransmitter Agents ; Nitric Oxide ; omega-N-Methylarginine ; Synovial Fluid ; Transforming Growth Factor beta

OBJECTIVE: In rheumatoid arthritis(RA) patients, HLA-B27 has been mainly found with the same frequency as in the normal population. An increased frequency of HLA-B27 in RA has, however, repeatedly been found in northern Sweden and in Filand. The results concerning the association of HLA-B27 to the outcome of the disease have been contradictory in RA. In RA, the presence of I-ILA-B27 has shown to be a prognostic index for cervical spine subluxation. There has been no report regarding the association between RA and HLA-B27 in the Korean population. METHODS: 188 patients with RA were randomly selected from the patients who were diagnosed at Rheumatism Center of Hanyang University iHospital from October 1994 to June 1995 to establish the frequency of HLA-B27 in RA and to investigate the possible influence and prognostic significance on clinical outcome including atlantoaxial subluxations. RESULTS: The results were as follows: 1) HLA-B27 was present in 12.2% of the RA patients studied. The relative risk(RR) and etiologic fraction(EF) of HLA-B27 were 5.99 and 0. 1019 respectively. 2) The rheumatoid factor was positive in 79.8% of the total patients, 73.9% in HLA-B27 positive patients, and 80.6% in HLA-B27 negative patients. HLA-B27 was not associated with the presence of rheumatoid factor in this study. 3) HLA-B27 was not associated with the duration of morning stiffness, Ritchie index, extraarticular manifestations, the number of swollen joints, ARA functional class, ESR, C-reactive protein, or hemoglobin. HLA-B27 was not associated with the positivity of ANA and antiperinuclear factor. 4) HLA-B27 was not associated with the positive rate of erosion and Steinbrocker class in peripheral joints. 5) Atlantoaxial subluxation was present in 13% of HLA-B27 positive patients and 17% of HLA-B27 negative patients. The involvement of atlantoaxial joint including narrowing of lateral facet joints was 26.1% in HLA-B27 positive patients and 20.6% in HLA-B27 negative patients. Subaxial subluxation was presented in only 1 case in HLA-B27 negative group of total patients. HLA-B27 was not associated with the cervical changes in RA. CONCLUSIONS: An increased freuency of HLA-B27 in RA patients was significantly found in Korea(RR=5.99, EF=0.1019). However, patients with HLA-B27 had a similiar clinical profile to patients without HLA-B27 and HLA-B27 positivity did not further contribute to the severity with respect to clinical and laboratory variables or to radiological progression in peripheral joints or cervical spine.
Arthritis, Rheumatoid* ; Atlanto-Axial Joint ; C-Reactive Protein ; HLA-B27 Antigen* ; Humans ; Joints ; Rheumatic Diseases ; Rheumatoid Factor ; Spine ; Sweden ; Zygapophyseal Joint

OBJECTIVES: Polymerase chain reaction (PCR) technology was eamine synovial fluid and peripheral T cells in patients with rheumatoid arthritis(RA) to determine the preferential usage of the T cell receptor(TCR) variable region(V) gene. METHODS: Oligonucleotide primers specific for individual TCR Vfi gene families were used to amplify the TCR gene products in a semiquantitative assay of their relative utilization in unselected T cell populations. RESULTS: The result of Vfi utilization was generally heterogenous, similar with previous reports. However, the mean expression of Vfi16 and Vfi18 in RA was more preferentially utilized compared to normal donors. The usage of Vfi in peripheral blood from 3 patients with RA demonstrated restrictions in Vfi16, Vfi 20 and Vfi18 genes, respectively. Analyses of synovial fluid resulted in restriction in Vfi12, Vfi20 and Vfi20, respectively. Although there was no significant pattern of skewed Vfi gene mean usage when comparing the synovial fluids with the peripheral blood T cells from RA patients, there were significant biased Vfi genes, Vfi12, V~I and Vfi20, each 3 patients. As the HLA type is a determining factor in shaping TCR repertoire of peripheral T cells, we compared the Vfi utilization in HLA-DR4 expressing groups that have susceptibility and gene dosage effect in disease progression. It was a little different that comparing the pattern of Vfi usage in peripheral blood and synovial fluid from RA patients between HLA-DR4 positive and negative group. CONCLUSION: The results were consistent with the conclusion that the increased Vfi family T cells infiltrate synovium and are dependent on each patient and may be involved in inducing and maintaining the synovitis that characterizes RA. The different outcome of each patient may be due to the difference in disease duration, genetic background and geographic region. A more important factor may be the stage of disease, because epitope 'induced immune reaction may change over time. Therefore, selecting patients early in the course of disease may be important and may facilitate the need for more in-depth TCR analysis in the future.
Arthritis, Rheumatoid* ; Bias (Epidemiology) ; Disease Progression ; DNA Primers ; Gene Dosage ; Genes, T-Cell Receptor ; HLA-DR4 Antigen ; Humans ; Polymerase Chain Reaction ; Synovial Fluid ; Synovial Membrane ; Synovitis ; T-Lymphocytes ; Tissue Donors

OBJECTIVES: To document the clinical characteristics of Korean male patients with rheumatoid arthritis that are different from those of female counterparts. METHODS: Six hundred and seventy-five patients who had met the ACR criteria for rheumatoid arthritis were included in the study. Clinical and laboratory data were retrospectively reviewed and radiologic features of hands and feet were graded by Steinbroker's method. RESULTS: The female : male ratio in the total patients studied is 567 : 108 (5.25). The symptom onset age was 39.5 +/- 11.8 in woman and 44.0 +/- 11.3 in men. The functional class at the time of diagnosis and the incidence of anemia showed little significant difference. Among the extraarticular manifestations, only interstitial lung disease was more common in males. There were significant differences between both sexes on positivity of antiperinuclear factor, C-reactive protein, and titer of rheumatoid factor in the seropositive groups, but not on rheumatoid factor positivity. Radiologically there was no significant difference in the hands and feet joints between males and females. Higher dosage of steroid was initially prescribed for male patients. CONCLUSIONS: The males seem to have slightly more active disease and to show significant differences in antiperinuclear factor positivity, the titer of rheumatoid factor and C-reactive protein, and lung involvement. However, we failed to demonstrate that the disease in males was more severe than compared to that of their female counterparts.
Age of Onset ; Anemia ; Arthritis, Rheumatoid* ; C-Reactive Protein ; Diagnosis ; Female ; Foot ; Hand ; Humans ; Incidence ; Joints ; Lung ; Lung Diseases, Interstitial ; Male* ; Retrospective Studies ; Rheumatoid Factor

Herniation of the synovium from the joint space into perioarticular soft tissues is a relatively common complication of adult rheumatoid arthritis, but rare in juvenile rheumatoid arthritis. The most completely described is the popliteal cysts. However, cysts have rarely been reported in the arm. Authors experienced a case of a boy with systemic form of juvenile rheumatoid arthritis who have bicipital synovial cysts in both arm and report this with a review of literature.
Adult ; Arm ; Arthritis, Juvenile* ; Arthritis, Rheumatoid ; Humans ; Joints ; Male ; Popliteal Cyst ; Synovial Cyst ; Synovial Membrane

OBJECTIVES: To isolate and culture of human muscle cells by manipulating culture conditions. METHODS: Muscle samples were obtained during total hip replacement or bedside muscle biopsy. We isolated myoblasts from freshly obtained human muscle tissue by trypsin and collagenase digesion. RESULTS: Selective isolation of myoblasts was identified through histologic examination by light-microscope. We identified monoc]onal antibodies(Leu-19) as molecular markers in human skeletal muscle were expressed. CONCLUSIONS: This study demonstrated that it had been possible to culture morphologically and immunelogically identifiable myoblasts isolated from human skeletal muscle tissue.
Arthroplasty, Replacement, Hip ; Biopsy ; Collagenases ; Humans* ; Muscle Cells* ; Muscle, Skeletal ; Myoblasts ; Trypsin

It's now well recognized that the cervical spine is commonly affected in rheumatoid arthritis(RA) and that subluxation of the atlas is frequently present and may occasionally be fatal. It is not widely appreciated, however, that some rheumatoid patients may develop fractures of the odontoid process in association with relatively minimal trauma or no trauma at all. This is a fracture caused by erosion and osteoporosis of the odontoid process due to rheumatoid synovitis, aging and steroid therapy. In addition, another cause is a dynamic load produced from the instability accompanying atlantoaxial subluxation working on the odontoid in cervical extension. We evaluated a patient with RA who had a fracture of the odontoid process. Following diagnosis she underwent surgery for which the prognosis was excellent.
Aging ; Arthritis, Rheumatoid* ; Diagnosis ; Humans ; Odontoid Process ; Osteoporosis ; Prognosis ; Spine ; Synovitis