Although there are several methods for treating fractures of long bones in lower extremity, nonunion has often developed. Cave(7) (1960) has defined nonunion as a fracture in which the reparative processes have come to a comeplete standstill. The factors of nonunion have been known as infection, extensive soft tissue injury, interposition of the soft tissue, disturbance of the blood supply, insecure fixation and distraction of the fracture site. Authors carried out retrospective study of the 36 nonunions of the long bones of the lower extremities, who were treated at the Orthopedic Department, Kang-Nam St. Mary's Hospital from July 1981 to May 1987, to find out the relationship between type of fracture and type of non-union, and the reasons of the non-union of the tibia and femur. The results are as follows : 1. Among 36 cases of nonunion, 22 cases(61%) were comminuted fractures, and 8(67%) out of 12 cases of tibial nonunion were open fractures. 2. Hypervascular nonunion was prevalent in femur ; 15 out of 24 cases of femur fractures were hypervascular, while 7 of 12 cases of tibial fracture were avascular nonunion. 3. The main causes of the femoral nonunion were the insecure fixation, failure of anatomical reduction of the medial buttress at the fracture site, and impaired blood supply of the fracture ends in orders. 4. Among all 36 cases of nonunion 20 cases were hypervascular, and 16 cases were avascular type. 12(75%) out of 16 cases of avascular nonuion were comminuted fractures. 5. All three cases of the femoral nonunion which was induced by the failure of interlocking K-nail, had fracture within 7.5cm from the interlocking hole. 6. Six cases of nonunion having large bone defect and failed nonunion after repeated bone graft procedure were successfully treated by the graft plus the total invasive type of electrical stimulator.
Femur ; Fractures, Comminuted ; Fractures, Open ; Lower Extremity ; Orthopedics ; Retrospective Studies ; Soft Tissue Injuries ; Tibia ; Tibial Fractures ; Transplants

Tuberous sclerosis is an autosomal dominant disorder of cellular differentiation that affect the brain, skin, heart, kidney and other organs. We experienced three cases of tuberous sclerosis that affect multiple organs in mother and two daughters. We report these cases with brief review and related literatures.
Brain ; Heart ; Humans ; Kidney ; Mothers* ; Nuclear Family* ; Skin ; Tuberous Sclerosis*

In Korea, all domestic made test systems for detecting antibodies in HIV-1 contain the antigens from human immunodeficiency type 1 (HIV-1) subtype B. However, because HIV-1 subtype O is significantly different in amino acid sequences from all other subtypes of HIV-1, there has been a need for developing a test for detecting antibodies in subtype O. For this purpose, the entire nucleotide sequence corresponding to the extracellular domain of the transmembrane glycoprotein of HIV-1 subtype O was synthesized with consideration of Escherichia coli cordon usage. Various regions of the extracellular domain were cloned into E. coli expression vectors and tested for levels of protein production. The nucleotide sequence, named ECTM, that can encode a 129 amino acid-long peptide, was found to be expressed at a high level in E. coli. The protein of approximately 17 kDa specifically reacted with sera from individuals infected with HIV-1 subtype O. The ECTM protein was purified to near homogeneity by the CM-T gel chromatography, using concentrated, denatured inclusion bodies. In Western blot analysis, the purified viral antigen reacted with sera from individuals infected with subtype O more efficiently than subtype B. The enzyme linked immunoabsorbent assay (ELISA) system was developed using the subtype O viral protein and compared with the commercially available kit lacking the antigens from subtype O. The ELISA kit containing the subtype O antigen ECTM alone efficiently reacted with sera from individuals infected with subtype O. The subtype O antigen-containing kit produced a positive absorbence even when sera were diluted 512-fold, suggesting a high sensitivity. The commercially available kit also reacted with subtype O sera, but produced a negative result at a dilution of 8-fold. Our results suggest that the currently available kit may not be able to efficiently detect subtype O sera and that the viral protein developed in this study may be added to the current system to maximize the detection of sera from individuals infected with subtype O.
Amino Acid Sequence ; Antibodies ; Base Sequence ; Blotting, Western ; Chromatography, Gel ; Clone Cells ; Enzyme-Linked Immunosorbent Assay ; Escherichia coli ; Glycoproteins ; HIV* ; HIV-1* ; Humans* ; Inclusion Bodies ; Korea ; O Antigens

Background: Cage subsidence after oblique lumbar interbody fusion (OLIF) induces restenosis and adversely affects patient outcomes. Many studies have investigated the causes of subsidence, one of which is endplate fracture (EF). This study aimed to identify predictors of EF after OLIF. Methods: This retrospective study reviewed consecutive patients who underwent OLIF at a single institute between August 2019 and February 2022. A total of 104 patients were enrolled. The patients’ demographic data and surgical details were collected through chart reviews. Radiographic variables were measured. Related variables were also analyzed using binomial logistic regression, dividing each group into those with versus without EF. Results: EF occurred at 30 of 164 levels (18.3%), and the binary logistic analysis revealed that sex (odds ratio [OR], 11.07), inferior endplate concave depth (OR, 1.95), disc wedge angle (OR, 1.22), lumbar lordosis (OR, 1.09), pelvic incidence (OR, 1.07), sagittal vertical axis (OR, 1.02), sacral slope (OR, 0.9), L3–4 level (OR, 0.005), and L4–5 level (OR, 0.004) were significantly related to EF. Conclusions OLIF in older Asian patients should be performed carefully after recognizing the high possibility of EF and confirming the factors that should be considered preoperatively.

BACKGROUND: Reactive oxygen species (ROS) contribute to development of neuropathic pain. A neuropathic pain syndrome was produced in rats following prolonged hindpaw ischemia/reperfusion injury, creating an animal model of complex regional pain syndrome-Type I (CRPS-I). This study was designed to evaluate the validity of this model for ROS and pain research. Herein we show superoxide produces N-methyl-D-aspartate (NMDA) mediated mechanical allodynia. METHODS: Male adult SD rats were used for neuropathic pain model. Plasma superoxide production rates of before ischemia (BI) and 5 min after reperfusion (JR) were measured via cytochrome C reduction in the presence of xanthine (without xanthine oxidase, kinetics, 550 nm). Mechanical allodynia was measured in both hindpaws. Activation of NMDA receptor subunit 1 (P-NR1) of lumbar spinal cord (L4-L6) in accordance with the change of allodynia was analyzed by the Western blot. RESULTS: Allopurinol-inhibitable, xanthine oxidase-mediated plasma superoxide production was increased at AR. Mechanical allodynia was present in both hindpaws as early as 1 hr after reperfusion, and lasted at least 1 week. The expression of P-NR1 was the highest at 3 days after reperfusion when the withdrawal threshold was the lowest point. SOD significantly blocked P-NR1 activation. CONCLUSIONS: This study suggests that ischemia/reperfusion injury induced neuropathic pain model is a good candidate for the research fields of ROS and pain mechanism. The generation of ROS, especially superoxide is partly responsible for NMDA-mediated mechanical allodynia.
Adult ; Animals ; Blotting, Western ; Central Nervous System Sensitization ; Cytochromes c ; Hindlimb ; Humans ; Hyperalgesia ; Ischemia ; Kinetics ; Male ; Models, Animal ; N-Methylaspartate ; Neuralgia ; Plasma ; Rats ; Reactive Oxygen Species ; Reperfusion ; Spinal Cord ; Superoxides ; Xanthine ; Xanthine Oxidase

The rare 'burned out' phenomenon in germ cell tumors is known as the presence of an extragonadal germ cell tumor with a spontaneously regressed testicular tumor found in common metastatic sites, including the retroperitoneal, mediastinal, supraclavicular, cervical, and axillary lymph nodes; lung; and liver. We report a patient who presented with a retroperitoneal extragonadal germ cell tumor with a spontaneously regressed testicular tumor.
Humans ; Liver ; Neoplasms, Germ Cell and Embryonal ; Retroperitoneal Neoplasms ; Seminoma ; Testicular Neoplasms ; Testis

The rare 'burned out' phenomenon in germ cell tumors is known as the presence of an extragonadal germ cell tumor with a spontaneously regressed testicular tumor found in common metastatic sites, including the retroperitoneal, mediastinal, supraclavicular, cervical, and axillary lymph nodes; lung; and liver. We report a patient who presented with a retroperitoneal extragonadal germ cell tumor with a spontaneously regressed testicular tumor.
Humans ; Liver ; Neoplasms, Germ Cell and Embryonal ; Retroperitoneal Neoplasms ; Seminoma ; Testicular Neoplasms ; Testis

No abstract available.
Humans ; Telangiectasis

Regardless of the preoperative morphology and the type of operation, left ventricular outflow tract obstruction (LVOTO) after biventricular repair of double outlet right ventricle (DORV) may develop. This report presents our 10-yr experience with surgical management of LVOTO after biventricular repair of DORV. Between 1996 and 2006, 15 patients underwent reoperation for subaortic stenosis after biventricular repair of DORV. The mean age at biventricular repair was 23.3+/-18.3 months (1.1-64.2). Biventricular repairs included tunnel constructions from the left ventricle to the aorta in 14 cases and an arterial switch operation in one. The mean left ventricle-to-aorta peak pressure gradient was 54.0+/-37.7 mmHg (15-140) after a mean follow-up of 9.5+/-6.3 yr. We performed extended septoplasty in nine patients and fibromuscular resection in six. There were no early or late mortality. There was one heart block and one aortic valve injury after an extended septoplasty, and two and one after a fibromuscular resection. No patient required reoperation for recurrent subaortic stenosis. The mean pressure gradient was 11.2+/-11.4 mmHg (0-34) after a mean follow-up of 5.6+/-2.7 yr. Extended septoplasty is a safe and effective method for the treatment of subaortic stenosis, especially in cases with a long-tunnel shaped LVOTO.
Blood Pressure/physiology ; Child, Preschool ; Double Outlet Right Ventricle/pathology/*surgery ; Female ; Heart Defects, Congenital/pathology/surgery ; Humans ; Infant ; Male ; Postoperative Complications/*surgery ; Reoperation ; Retrospective Studies ; Treatment Outcome ; *Ventricular Outflow Obstruction/etiology/surgery

BACKGROUND: Recently, the prevalence of diabetes mellitus and its complications have been increased in Korea and they cause many socioeconomic losses in both patients and their families. But, there are neither sufficient medical assistance including concern of medical personnel nor social assistance in Korea nowadays. OBJECTIVES: In this study, we tried to reduce the risk of amputation and preserve the function of the foot by an early evaluation, proper treatment and consultation by dermatologists. METHODS: We randomly chose 18 cases of diabetic foot ulcer and took care of them with proper and earlier debridement, dressing, antibiotics and cooporation with departments of internal medicine, especially endocrinology, nephrology and division of infectious disease. After healing of the ulcer, we recommended specially designed shoes and foot care products to prevent the recurrence of the foot problems. RESULTS: The average duration of diabetes was 18 years and preexisting complications were neuropathy, nephropathy, vasculopathy and/or foot deformities. The precipitating factors of foot ulcer were burn, callus, fungal infection, bony deformity or trauma. Three cases underwent toe amputation and one case with severe vasculopathy was transferred to the vascular surgery. Average healing time was 14 weeks. CONCLUSION: Proper evaluation and management of diabetic foot ulcer patients with multidisciplinary approach should achieve good wound healing. Consequently, it can reduce the risk of amputation and improve the quality of life in the patient with diabetic foot ulcer. Among them, dermatologists who has a point of view of both a medical and surgical doctor may play a pivotal role in the management of diabetic foot ulcer.
Amputation ; Anti-Bacterial Agents ; Bandages ; Bony Callus ; Burns ; Communicable Diseases ; Congenital Abnormalities ; Debridement ; Diabetes Mellitus ; Diabetic Foot* ; Endocrinology ; Foot ; Foot Deformities ; Foot Ulcer ; Humans ; Internal Medicine ; Korea ; Medical Assistance ; Nephrology ; Precipitating Factors ; Prevalence ; Quality of Life ; Recurrence ; Shoes ; Toes ; Ulcer* ; Wound Healing