It has been well known that ischemia reperfusion injury to skeletal muscle following an acute arterial occlusion causes significant morbidity and mortality. There are many causes of reperfusion injury, but the oxygen free radicals have a significant role. During ischemia the ATP is catalyzed to hypoxanthine anaerobically and hypoxanthine dehydrogenase is converted to xanthine oxidase under the presence of O2 resulting in the production of cytotoxic oxygen free radical, which are harmful to muscle. The reactivity of superoxide dismutase(SOD), one of the major antioxidant enzymes, is increased against the formation of the superoxide radical during reperfusion. SOD metabolyzes the superoxide radical to H2 O2 and O2.The severity of ischemic damage deports on the duration of muscle ischemia. The reversible changes in the muscle occur afar 2 hours of ischemia and recover within 24 hours after reperfusion. After 6 hours ischemia, irreversible damage occurs and causes necrosis of muscle. The authors performed the resent study to investigate the changes of Mn-SOD and the effects of allopurinol, the inhibitor of xanthine oxidase, by measuring the immunoreactivitiy of the ischemic reperfused rectus femoris muscle of rats after 2 hours and 6 hours ischemia and timely reperfusion. A total of 176 healthy spraque-Dawley rats weighing from 200 gm to 250 gm were used. Under urthane(3.0 gm/kg.,IP) anesthesia, a lower-abdominal incision was made and the left common iliac artery was ligated by using a vascular clamp for 2 hours and 6 hours. Rectus femoris muscle was obtained at 0 hour, 1 hour, 2 hours, 24 hours, and 48 hours after removal of the vascular clamp. The specimens were sectioned in 14micro miter thickness with a cryostat. The immunoreactivities of Mn-SOD were observed by using Mn-SOD antibodies. The result were as follows. 1. The immunoreactivies of Mn-SOD around sarcolemma were stronger than those on the sarcoplasm. 2. The immunoreactivities of Mn-S0D after 2 hours of ischemia increased to moderate or weak reactivities at 1 hour and 2 hours of reperfusion and returned to week or trace reactivities at 24 hours and 48 hours of reperfusion 3. The pretreatment of allopurinol decreased the immunoreactivies of Mn-SOD during reperfusion. The pattern of changes of SOD immunoreactivies were similar, but the range of changes significantly decreased. 4. The immunoreactivies of Mn-SOD after 6 hours of ischemia increased after 6 hours of ischemia increased after reperfusion and showed peak at 2 hours and 24 hours specimen. After 48 hours in the reperfused group, the reactivities slightly decreased. 5. After 6 hours in the ischemia-reperfused group, the pretreatment of allopurinol decreased the immunoreactivies of Mn-SOD during reperfusion, but the effects were weak. These results suggest that the immunoreactivities of the 6 hours ischemia reperfused group were higher than those of 2-hours ischemia reperfused group in the rectus femoris muscle of rats and that allopurinol pretreatment can be credited with decreasing ischemia reperfusion injury within a reversible period.
Adenosine Triphosphate ; Allopurinol ; Anesthesia ; Animals ; Antibodies ; Free Radicals ; Hypoxanthine ; Iliac Artery ; Ischemia ; Mortality ; Muscle, Skeletal ; Necrosis ; Oxygen ; Quadriceps Muscle* ; Rats* ; Reperfusion Injury* ; Reperfusion* ; Sarcolemma ; Superoxide Dismutase* ; Superoxides ; Xanthine Oxidase

We performed 15 cases of modified Bristow procedures for recurrent anterior instability of shoulder from january, 1987 to december, 1992 and the following results were obtained. 1. The patient's age at initial dislocation varied from 15 years to 29 years of age. 2. The most common cause of the recurrent anterior instability of shoulder was sport injury(6 cases) and next were traffic accident, hanging with one hand. 3. The average loss of external rotation of shoulder after operation were 10 degrees and internal rotation were 7 degrees. 4. The post-operative complication and recurrence were not observed. 5. End results were excellent in 7 and good in 5 by Rowe's grading system. 6. Strict attention to bone block placement was mandatory and decreased the risk of screw malpo-sition.
Accidents, Traffic ; Dislocations ; Hand ; Recurrence ; Shoulder ; Sports

No abstract available.
Edema* ; Hydrops Fetalis*

Trigeminal neuropathy os characterized by unremitting facial pain, no evident trigger point and facial sensory change. According to Jannetta, in trigeminal neuropathy, the offending artery is not necessarily in contact with the root entry zone(REZ) but any site of the nerve. We have recently experienced a 48-year-old woman with symptoms and signs compatible with trigeminal neuropathy and explored the CP angle. SCA was crossing just anterior to the trigeminal root and one small arterial loop was lying on the pons close to the root entry zone(REZ) but neither of them was in diirect contact with the nerve. Teflon felt was inserted between the arteries and nerve and secured with silk and beriplast for fear that they should contact by changing position. Immediately after the operation the facial pain and pre-existing facial sensory change were completely gone.
Arteries ; Deception ; Facial Pain ; Female ; Fibrin Tissue Adhesive ; Humans ; Microvascular Decompression Surgery* ; Middle Aged ; Polytetrafluoroethylene ; Pons ; Silk ; Trigeminal Nerve Diseases* ; Trigeminal Neuralgia ; Trigger Points

No abstract available.
Humans*

OBJECTIVE: To make a guideline for cytogenetic study and diagnosis through systematic analysis of types and the incidences of chromosomal abnormalities obtained from various types of congenital disorder in Korea. METHODS: The cytogenetic study was performed on 14,402 patients with suspected chromosomal abnormalities at our genetic laboratory of the medical research center between January 1, 1974 to December 31, 2004 and additionally the FISH (Fluorescence in situ hybridization) study was done on 272 patients between January 1, 1998 to December 31, 2004. RESULTS: Total number of case requiring cytogenetic study were 33 in starting year (1974) and by 1983, the number increased rapidly to 481 cases. The number of case was maximum of 894 cases in 1993 and it started to decline from 1996 to 714. Overall chromosomal aberrations were 2,100 cases (14.58%). Autosomal chromosomal abnormalities were 1,257 cases (8.73%). Among those cases, Down syndrome was 848 cases (5.89%), Edward syndrome was 38 cases (0.26%), and Patau syndrome was 6 cases (0.04%) in order of frequency. Sex chromosomal abnormalities were 843 cases (5.85%) in total. Among those cases, Turner syndrome was 527 cases (3.66%), Kleinfelter syndrome was 267 cases (1.85%). Chromosomal abnormality rate in 535 couples with recurrent spontaneous abortions was 5.98% (32 couples). And chromosomal aberration in 1068 cases with primary amenorrhea was 63.95% (683 cases). The diagnostic rate of microdeletion syndrome by FISH method was 22.71%, and marker chromosome was 20.56%. CONCLUSION: From cytogenetic analysis of 14,402 cases performed in single institute during 31 years, we performed a study on the types and the incidences of chromosomal abnormalities. We hope we could suggest a guideline for studies and treatments of congenital disorders in Korea. Along with the cytogenetic study, FISH study was also required.
Abortion, Spontaneous ; Amenorrhea ; Chromosome Aberrations ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities* ; Cytogenetic Analysis ; Cytogenetics* ; Diagnosis ; Down Syndrome ; Family Characteristics ; Female ; Hope ; Humans ; Incidence ; Korea* ; Pregnancy ; Turner Syndrome

A retrospective review of 36 patients with infective endocarditis by strict case definition was performed from 1972 through April of 1984. Male to female ratio was 1:1.25, with mean age of 19.1. Thirty of the 36 patients(83.3%) had the history of predisposing heart diseases: congenital heart disease was most frequent one below the age of 20, rheumatic heart disease between the age of 20-39 and degenerative heart disease above the age of 40. The commonest presenting symptoms were fever, dyspnea, and malaise, and the commonest signs were fever, murmur, and hepatomegaly. Average hemoglobinand hematocrit were 10.1g/dl and 30.8% respectively, showing moderate degree of anemia. White cell count was 11,600+/-5400/mm3 and erythrocyte sedimentation rate was 46+/-18mm/hr. Over four fifths of the patients demonstrated proteinuria and elevated C-reactive protein. Two thirds of the patients showed microscopic hematuria and one third showed positive rheumatoid factor. Eight patients(22.2%) showed arrhythmia and 4(11.1%) showed conduction abnormalities on electrocardiography. The commonest etiologic microorganisms were alpha-hemolytic streptococcus(30.6%) and staphylococcus aureus(22.2%). Abacteremic cases were found in 38.9% of the patients. To compared with alpha-hemolytic streptoccus endocarditis the cases caused by staphylococcus aureus showed the shorter duration of symptoms before admission, the less frequent complication, the higher fever, and the more elevated white cell counts. To penicillin, alpha-hemolytic streptococcus was sensitive in most cultures and staphylococcus arueus was resistant in half of them, and to aminoglycosides vice versa. To cefazolin, both microorganisms were sensitive in most cultures. In 18 of 24(75%) patients vegetation was visualized by echocardiography. The most frequent site of involvement was the mitral valve. And in vegetation detected group complication rate by embolism was found to be higher. The common complications were congestive heart gailure in 24(66.75%), embolism in 8(22.2%), and metastatic infection in 6(16.7%). The mortality rate of infective endocarditis was 25%, and the causes of death were cerebral embolism in 3(8.3%), septic septic shock in 3(8.3%), congestive heart failure in 2(5.6%), and mycotic aneurysmal rupture in 1(2.8%). Conclusively in infective endocarditis the author observed the increasing prevalence of degenerative heart disease as a prdisposing heart disease and increasing incidence of staphylococcus aureus as a causative microorganism. Adn the differences of clinical characteristics between staphylococcus ureus and alpha-hemolytic streptococcus endocarditis would be helpful in diagnosis and treatment of infective endocarditis as well as recognition of prognosis.
Aminoglycosides ; Anemia ; Aneurysm, Infected ; Arrhythmias, Cardiac ; Blood Sedimentation ; C-Reactive Protein ; Cause of Death ; Cefazolin ; Cell Count ; Diagnosis ; Dyspnea ; Echocardiography ; Electrocardiography ; Embolism ; Endocarditis* ; Estrogens, Conjugated (USP) ; Female ; Fever ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Heart Failure ; Hematocrit ; Hematuria ; Hepatomegaly ; Humans ; Incidence ; Intracranial Embolism ; Male ; Mitral Valve ; Mortality ; Penicillins ; Prevalence ; Prognosis ; Proteinuria ; Retrospective Studies ; Rheumatic Heart Disease ; Rheumatoid Factor ; Rupture ; Shock, Septic ; Staphylococcus ; Staphylococcus aureus ; Streptococcus

Alcohol intoxication is often a contributory factor to the accidental head injury and may greatly aggravate the situation due to respiratory depression, cerebral edema and alteration in clotting mechanisms. Blood alcohol level was measured in 1261 patients with head injury attending the emergency room of Chung-Ang university hospital during one year from July, 1988. Blood alcohol concentration over 0.5g/L was defined as positive. The results are as followed : 1) Among 1261 patients of head injury, 89 patients showed positive blood alcohol level(7.05%). The mean blood alcohol concentration was 1.673g/L. 2) The male to female ration was 8.9 : 1 and majority of patients were 3rd and 4th decade. 76.6 percent of blood alcohol positive patients were attended between 8pm and 4am. 3) The common mechanisms of injury in blood alcohol positive group were pedestrian road traffic accidents(27.1%), fall down(24.7%) and home accidents(14.6%). 4) The level of consciousness on admission was significantly worse in the blood alcohol positive group than in the control group(P<0.01). 5) The common associated injuries were mostly in the extremities(22.5%) and chest(6.7%), but there was no significant difference in both group. 6) The prognosis was worse in the blood alcohol postive group than in the control group(P<0.01).
Brain Edema ; Brain* ; Consciousness ; Craniocerebral Trauma ; Emergency Service, Hospital ; Female ; Humans ; Male ; Prognosis ; Respiratory Insufficiency

Necrotizing fasciitis is a life-threatening soft tissue infection involving skin, subcutaneous tissue, and superficial fascia. We report a case of necrotizing fasciitis that developed in a 76- year-old female patient taking low-dose methotrexate and prednisolone for rheumatoid arthritis (RA). A computed tomography scan of the neck during the initial work-up showed soft tissue swelling, loss of fat planes, and mild heterogeneous enhancement in the right lateral neck, suggesting cellulitis. The lesions were associated with skin necrosis and multiple bullae rapidly expanded to the right anterior chest in spite of empirical antibiotic therapy. Surgical debridement was immediately performed, and soft tissue biopsy from the lesions showed the pathologic finding consistent with necrotizing fasciitis. The skin wound defect was reconstructed by a flap operation with split-thickness skin graft. This case shows the development of necrotizing fasciitis in a elderly patient taking methotrexate and low-dose steroid for RA and highlights early recognition and prompt surgical debridement for successful management.
Aged ; Arthritis, Rheumatoid* ; Biopsy ; Cellulitis ; Debridement ; Fasciitis, Necrotizing* ; Female ; Humans ; Methotrexate ; Neck ; Necrosis ; Prednisolone ; Skin ; Soft Tissue Infections ; Subcutaneous Tissue ; Thorax ; Transplants ; Wounds and Injuries

Extramedullary hematopoiesis (EMH) is occasionally reported in idiopathic myelofibrosis and is generally found in the liver, spleen, and lymph nodes several years after diagnosis. Myelofibrosis presenting as spinal cord compression, resulting from EMH tissue is very rare. A 39-yr-old man presented with back pain, subjective weakness and numbness in both legs. Sagittal magnetic resonance imaging showed multiple anterior epidural mass extending from L4 to S1 with compression of cauda equina and nerve root. The patient underwent gross total removal of the mass via L4, 5, and S1 laminectomy. Histological analysis showed islands of myelopoietic cells surrounded by fatty tissue, consistent with EMH, and bone marrow biopsy performed after surgery revealed hypercellular marrow and megakaryocytic hyperplasia and focal fibrosis. The final diagnosis was chronic idiopathic myelofibrosis leading to EMH in the lumbar spinal canal. Since there were no abnormal hematological findings except mild myelofibrosis, additional treatment such as radiothepary was not administered postoperatively for fear of radiotoxicity. On 6 month follow- up examination, the patient remained clinically stable without recurrence. This is the first case of chronic idiopathic myelofibrosis due to EMH tissue in the lumbar spinal canal in Korea.
Adult ; *Cauda Equina ; Chronic Disease ; *Hematopoiesis, Extramedullary ; Humans ; Male ; Primary Myelofibrosis/*complications ; Spinal Cord Compression/*etiology