Previous studies implied association of osteoporosis with estrogen deficiency, immobilization and low calcium absorption only through epidemiological studies. There have been only a few experimental studies verifying the etiologic factors of osteoporosis in vivo condition. Authors conducted an experimental study using white rats(Sprague Dawley) in order to find out what the endocrinological and biochemical changes of experimentally induced osteoporosis are and how they behave with or against each other. White rats, eighty five in number of 3 to 6 months females and weighing 220±12.7gm were divided into four groups. They consisted of Group I(n=10) for control, Group II(n=25) for bilateral oophorectomy, Group III(n=25) for bilateral division of sciatic nerve and hip spica cast immobilization, and Group IV(n=25) for bilateral oophorectomy and bilateral division of sciatic nerve plus hip spica cast immobilization. Blood samples were taken preoperatively and postoperatively at six weeks to check Estradiol and Osteocalcin levels there of. And then, rats were sacrified immediately after the second sampling to retrieve femora for bone mineral density measurement and torsional stress test. Estradiol levels before operation were 21.4±13.3pg/ml for Group I, 31.6±3.1pg/ml for Group II, 25.6±4.5pg/ml for Group III and 33.7±4.5pg/ml for Group IV, respectively. There were no significant differences observable among the groups. Estradiol levels at six weeks postoperatively were 42.3±18.8pg/ml for Group I, 5.4±2.7pg/ml for Group II, 40.8±5pg/ml for Group III and 6.2±2.3 pg/ml for Group IV, respectively. Apparent reductions in group II and IV were proved of statistical significance. Osteocalcin levels preoperatively were 1.2±0.6ng/ml for Group I, 1.7±0.4ng/ml for Group II, 1.5±0.1lng/ml for Group III and 1.5±0.1.lng/ml for Group IV, respectively. At six weeks postoperatively they were 1.6±0.1lng/ml for Group I, 1.7±0.3ng/ml for Group II, 1.8±0.3ng/ml for Group III and 1.2±0.1lng/ml for Group IV, respectively. The differences and changes among the groups and measurements were not of statistical significance. Bone mineral contents at six weeks postoperatively were 0.248±0.03g for Group I, 0.177±0.03g for Group II, 0.226±0.04g for Group III and 0.092±0.01g in Group IV, respectively. Low values of Group II and IV compared to those of Group I and III were of statistical significance.(P=0.0001) Torsional strength of bones at six weeks postoperatively were 4.0±0.2N/m for Group I, 1.5±0.1N/m for Group II, 1.5±0.1N/m for Group III and 1.4±0.1N/m for Group IV, respectively. Decreases of experimental groups(II, III, IV) compared to that of control group(I) were of statistical significance, but differences among the experimental groups were not of significance(p>0.05). For above observations, it was possible to conclude that osteoporosis measurable by bone mineral content and torsional stress test was caused by oophorectomy and immobilization in vivo, the former of which was more rapid and profound than the latter during early phase. When both factors, i.e., oophorectomy and immobilization are exerated simultaneously. the resultant osteoporosis was found in higher degree than either factor only, but not at incremental degree as one may expect.
Absorption ; Animals ; Bone Density ; Calcium ; Epidemiologic Studies ; Estradiol ; Estrogens ; Exercise Test ; Female ; Hip ; Humans ; Immobilization ; Osteocalcin ; Osteoporosis ; Ovariectomy ; Rats ; Sciatic Nerve

PURPOSE: To evaluate the result of arthroscopic modified Brostrom procedure with suture anchor for chronic lateral ankle instability. MATERIALS AND METHODS: Fifty-two patients with chronic lateral ankle instability were analyzed, who underwent arthroscopic modified Brostrom procedure between December 2010 and May 2012. Clinical evaluation was performed using AOFAS scroring and Sefton grading system. RESULTS: The average AOFAS hind foot score increased from preoperative 61.9 to 88.8 at the last follow up. There were 35 excellent, 9 good, 4 fair, 4 poor results according to Sefton grading system. For one patient, lateral ankle instability recurred. CONCLUSION: Arthroscopic modified Brostrom procedure is considered to be an effective and satisfactory technique.
Ankle* ; Arthroscopy ; Follow-Up Studies ; Foot ; Humans ; Suture Anchors

No abstract available.
Cytomegalovirus* ; Humans*

Neurofibromatosis type 1 is characterized by cutaneous neurofibromas and pigmented lesions of the skin called cafe au lait spots. Although neurofibromatosis type 1 represents a major risk factor for the development of malignancy, especially of nervous system tumors, malignant lymphoma rarely occurs in a patients with neurofibromatosis type 1. Recently, a 77-year-old woman with neurofibromatosis type 1 was diagnosed as non-Hodgkin's Lymphoma (diffuse large B cell). She had multiple cafe au lait spots, neurofibromas and right axillary lymph node enlargement. An abdominal CT scan demonstrated a left pelvic mass and para-aortic lymphadenopathy. Because non-Hodgkin's Lymphoma in a neurofibromatosis patient has never been reported in Korea, herein, we describe this case and include a review of the literature.
Aged ; Cafe-au-Lait Spots/complications/pathology ; Female ; Human ; Lung Neoplasms/*complications/pathology/radiography ; Lymphoma, Non-Hodgkin/*complications/pathology/radiography ; Neurofibromatosis 1/*complications/pathology/radiography ; Tomography, X-Ray Computed

BACKGROUND: In contrast to tuberculous pleurisy, tuberculous empyema is a chronic active infectious disease of the pleural cavity that is frequently accompanied by cavitary or advanced pulmonary lesions. The condition requires long-term anti-tuberculous medication with external drainage. The clinical features and treatment outcome of tuberculous empyema are unclear despite the high prevalence of tuberculosis in Korea. METHODS: From January 1991 through April 2004, 17 patients diagnosed with tuberculous empyema in Kyungpook National University Hospital were enrolled in this study. Their medical records and chest radiographs were reviewed. RESULTS: Twelve patients(71%) had a history of tuberculosis and six of the 12 patients were under current anti-tuberculous medication. Productive cough, fever, and dyspnea were the main complaints. There was no predominance between the right and left lungs. Nine patients(53%) had far-advanced pulmonary tuberculosis, two(12%) had a cavitary lesion, and seven(41%) had a pyopneumothorax on the chest radiograph. All eight cases in whom the data of pleural fluid WBC differential count was available showed polymorphonuclear leukocyte predominance. Eight patients(47%) had other bacterial infections as well. The overall rates of a positive sputum AFB smear and culture for M. tuberculosis were 71% and 64%, respectively. The positive AFB smear and culture rates for M. tuberculosis from the pleural fluid were 33% and 36%, respectively. Twelve of the 16 patients(75%) were treated successfully. Three underwent additional surgical intervention. Two patients (12%) died during treatment. CONCLUSION: Tuberculous empyema is frequently accompanied by advanced pulmonary lesions, and polymorphonuclear leukocytes are predominant in the pleural fluid. Other accompanying bacterial infections in the pleural cavity are also common in tuberculous empyema patients. Therefore, tuberculous empyema should be considered in differential diagnosis of patients with polymorphonuclear leukocyte-predominant pleural effusion. In addition, more active effort will be needed to achieve a bacteriological diagnosis in the pleural fluid.
Bacterial Infections ; Communicable Diseases ; Cough ; Diagnosis ; Diagnosis, Differential ; Drainage ; Dyspnea ; Empyema ; Empyema, Tuberculous* ; Fever ; Gyeongsangbuk-do ; Humans ; Korea ; Lung ; Medical Records ; Neutrophils ; Pleural Cavity ; Pleural Effusion ; Prevalence ; Radiography, Thoracic ; Sputum ; Treatment Outcome ; Tuberculosis ; Tuberculosis, Pleural ; Tuberculosis, Pulmonary

Congenital nephrotic syndrome(CNS) is a rare disease defined by nephrotic syndrome at birth or within the 1st year of life. This study is performed to investigate a classification based on clinicopathology and to evaluate the clinical course and prognosis according to types of CNS. We performed retrospective clinical study with chart review in 8 patients who were diagnosed as CNS from 1980 to 1995. The results were as follows: Their ages at the onset of illness ranged from birth to 7 months (median 2.2 months) and there were 7 males and 1 female. There were proteinuria, hypoalbuminemia and edema in all cases, accompanied with ascites(7cases), hematuria(5cases), hepatosplenomegaly(2cases), umbilical hernia(1case) and inguinal hernia(1case). A classification of these based on clinicopathology showed CNS of Finnish type in 2 patients, congenital syphilitic nephrotic syndrome in 2, mesangial glomerulosclerosis, minimal change disease, Drash syndrome and undefined CNS in 1 each. Of the 8 patients with CNS, 3 died of sepsis and renal failure, 1 responded to steroid and cyclosporin therapy and is alive at 20 months, 1 responded to penicillin, 1 discharged voluntarily, and 2 were lost to follow-up. In conclusion, it had been considered that all forms of CNS except the secondary ones have a very poor prognosis. But if the appropriate management including early renal transplantation is established under the definite diagnosis which is based on clinicopathology, we can expect long term survival, normal growth and development for the child of CNS.
Child ; Classification ; Cyclosporine ; Denys-Drash Syndrome ; Diagnosis ; Edema ; Female ; Growth and Development ; Humans ; Hypoalbuminemia ; Kidney Transplantation ; Lost to Follow-Up ; Male ; Nephrosis, Lipoid ; Nephrotic Syndrome* ; Parturition ; Penicillins ; Prognosis ; Proteinuria ; Rare Diseases ; Renal Insufficiency ; Retrospective Studies ; Sepsis

PURPOSE: To evaluate the perioperative changes of the relationship between tibial posterior slope and ground surface and the factors which influence the perioperative changes of the relationship between tibial posterior slope and ground surface following total knee arthroplasty. MATERIALS AND METHODS: Between Sept. 2005 and Feb. 2006, 94 consecutive primary total knee arthroplasty with posterior cruciate ligament-retaining type performed in 50 patients by one surgeon. Posterior slope of the proximal tibia resection in extramedullary guide was fixed at 5degrees. All the retrieved patients wore a 90degrees ankle brace and stood on the ground during radiographic examination. We prospectively analyzed the measurement of tibial posterior slope angle, the angle between tibial posterior slope and ground surface and the angle between a midline from 1st metatarsal shaft to talus and ground surface on preoperative and postoperative 2-weeks radiographs. RESULTS: On preoperative radiograph, average of tibial posterior slope angle is 11.3degrees and 11.5degrees in right and left knee, respectively. Angle between tibial posterior slope and ground surface is an average of 8.8degrees and 9.5degrees in right and left knee, respectively. On postoperative 2-weeks radiograph, tibial posterior slope angle is an average of 9.3degrees and 9.1degrees in right and left knee, respectively. Angle between tibial posterior slope and ground surface is an average of 6.2degrees and 6.4degrees in right and left knee. There are significant differences between tibial posterior slope angle and the angle between tibial posterior slope and ground surface on preoperative and postoperative 2-weeks radiograph (p<0.05). CONCLUSION: According to ankle lateral angle, it is possible that tibial posterior slope associated with the ground surface may decrease at erect posture in total knee arthroplasty. This may lead to overly decrease tibial posterior slope associated with the ground surface at comfortable erect posture in total knee arthroplasty.
Ankle ; Arthroplasty* ; Braces ; Humans ; Knee* ; Metatarsal Bones ; Posture* ; Prospective Studies ; Talus ; Tibia

PURPOSE: To evaluate the liver parenchyma according to the echo patterns of CSS (compound spatial sonography), and to correlate them with the extent of hepatic fibrosis and the serum aminotransferase level. MATERIALS AND METHODS: The CSS images were classified into the following three echo patterns: type I, a normallooking echo; type II, hyperechoic or hypoechoic nodules scattered in a normal-looking echo; type III, a severely heterogeneous echogenic or hypoechoic honeycomb-like echo. The CSS findings were correlated with the histopathology findings in 63 patients with HBV. The serum aminotransferase levels and the occurrence of acute exacerbation in 168 patients with HBV, with and without a progressed parenchymal echo pattern, and who were followed up more than 1-year period, were compared. The interobserver agreement between the two radiologists for assessing the parenchymal echo pattern was scored. RESULTS: The correlation between the CSS pattern and hepatic fibrosis was statistically significant (correlation coefficient = 0.58, p < 0.05). The baseline serum aminotransferase level was not significantly different between the patients with and without a progressed parenchymal echo pattern. However, the rate of acute exacerbation was higher in patients with a progressed parenchymal echo pattern (p < 0.05). The interobserver agreement was good (k statistic = 0.63, 0.78). CONCLUSION: The liver parenchymal pattern based on the 5-12 MHz CSS is a useful and objective tool for diagnosing and monitoring HBV related chronic liver disease.

PURPOSE: The relationship between the biophysical and biochemical processes of gallbladder bile and nitric oxide is still not well known. In this study, the correlation between nitric oxide production and the degree of biliary tract inflammation was investigated and the levels of nitrate/nitrite (NOx) and stable metabolite of nitric oxide in the serum proposed for assessing the severity of biliary tract inflammation. METHODS: Eighty two patients with biliary tract inflammation who underwent operative treatment between March and July 2002 were included in this study. Of the 82 patients, there were 31 and 51 men and women, respectively. The mean age was 53, ranging from 21 to 82 years. The subjects were divided into three groups, GB stone (n=42), and acute cholecystitis (n=27), and cholangitis (n= 13). The severity of biliary tract inflammation was assessed using the WBC count, total bilirubin count, GB wall thickness on pathology, bile duct stone detected on ultrasonography, open conversion of cholecystectomy, pyrexia and tenderness/rebound tenderness on physical examination. The serum NOx concentrations were analyzed according to the groups, clinicopathological, laboratory and radiological findings. The serum NOx levels were measured using the Griess reaction after conversion of all nitrates to nitrites. RESULTS: The nitrate/nitrite levels in the GB, acute cholecystitis and cholangitis groups were 70.0+/-44.6, 126.8+/-54.5 and 142.0+/-44.6mumol/L, respectively, with statistical differences between the three groups (P< 0.05). The NOx level in patients with pyrexia, hyperbilirubinemia, leukocytosis, GB wall thickness on pathology and open conversion were markedly increased compared with the control group (P<0.05). These data demonstrate the relationship between the intensity of nitric oxide and the severity of biliary tract inflammation. CONCLUSION: Measurement of the NOx concentration in patients with biliary tract inflammation provides information about the severity and course of the disease. These results suggest there is a correlation between nitric oxide and the degree of biliary tract inflammation.
Bile ; Bile Ducts ; Biliary Tract* ; Bilirubin ; Biochemical Processes ; Cholangitis ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Female ; Fever ; Gallbladder ; Humans ; Hyperbilirubinemia ; Inflammation* ; Leukocytosis ; Male ; Nitrates ; Nitric Oxide ; Nitrites ; Pathology ; Physical Examination ; Ultrasonography

BACKGROUND: Small proportions of all the elderly stroke patients receive recombinant tissue plasminogen activator (r-tPA) therapy, although old age is not a proven contraindication to intravenous thrombolytic therapy for acute ischemic stroke. The purpose of this study was to identify reasons for exclusion from r-tPA therapy and factors associated with the decision of r-tPA use in elderly patients with acute ischemic stroke. METHODS: From the acute stroke registries of 22 domestic university hospitals taking the r-tPA therapy from January 2007 to May 2010, we extracted data of all acute ischemic stroke patients who were aged 80 or over and arrived within onset 3 hours. For all patients, we assessed the eligibility of r-tPA therapy using National Institute of Neurological Disorders and Stroke (NINDS) r-tPA trial criteria. For eligible patients, we compared all clinical variables between patients who were treated with r-tPA and those who were not, and analyzed potential factors related to the decision of r-tPA use. RESULTS: A total of 494 patients were included in this study. 255 patients (51.6%) were excluded by NINDS r-tPA trial criteria and the major reasons for exclusion were minor neurological deficit (53.7%) and clinical improvement (17.3%). Among 239 patients who were eligible for r-tPA, 162 (32.8%) patients received r-tPA and 77 (15.6%) did not. Multivariable analysis showed that younger age, shorter time-delay from onset to admission, non-smoker, no history of prior stroke, good pre-stroke functional status and severe initial neurological deficit were independently associated with the decision of r-tPA use in the elderly stroke patients predictors for r-tPA treatment. CONCLUSION: In very elderly patients, mild neurological deficit on arrival and rapid clinical improvement in neurological symptoms were the main reasons for exclusion from thrombolytic therapy.
Aged ; Hospitals, University ; Humans ; National Institute of Neurological Disorders and Stroke ; Registries ; Stroke ; Thrombolytic Therapy ; Tissue Plasminogen Activator