PURPOSE: To compare clinical outcomes of the tumor prosthetic replacement and osteosynthetic fixation for pathologic fracture of skeletal metastatic lesion of the proximal femur. MATERIALS AND METHODS: From 1994 May to 2009 May, medical records of 22 patients who underwent tumor prosthetic replacement with tumor resection (group 1) and 15 others (16 hips) who underwent osteosynthetic fixation without tumor resection (group 2) were reviewed. The mean age of overall patients were 59 (group 1) and 60 (group 2). Mean follow up periods were 23 and 11 months. The oncological and functional results were evaluated with Kaplan-Meier methods and Musculoskeletal Tumor Society (MSTS) scoring system, 1993. The statistical evaluation was assessed with Log rank test and t-test. RESULTS: The mean survival periods were 24 months in group 1 and 11months in group 2. The 1 year survival rates were 86% in group 1 and 50 % in group 2, and 2 year survival rates were 29.7% in group 1 and 9.4% in group 2. The mean MSTS functional score were 26.4 (19-30), 87.9% in group 1 and 15.3 (10-23), 51.0% in group 2. CONCLUSION: The results of tumor resection and prosthetic replacement in selected cases was better than osteosynthetic fixation without tumor resection for metastatic bone tumors around proximal femur in oncological and functional aspects.
Femur ; Follow-Up Studies ; Fractures, Spontaneous ; Humans ; Joints ; Medical Records ; Survival Rate

No abstract available.
Otitis Media* ; Otitis*

Primary aldosteronism is present in approximately 1% of unselectd hypertensive patients. Adrenal adenoma is a known as one of the surgically curable form of the hypertension. Hypertension is one of the contributing factors for the development of aortic dissection. Cincurrence of aortic dissection in patient with primary aldosteronism is extemely rare. Only one case wasconfirmed by autopsy and reported in the world literature. We report a case of DeBakey type 3 anortic aneursm in a 49-year old hypertensive female patient with primary aldosteronism due to left adrenal adenoma. She underwent left adrenalectomy uneventfully after stabilization of her blood pressure with maximal medical management including nitroprusside, aldactone, enalapril and inderal.
Adenoma ; Adrenalectomy ; Autopsy ; Blood Pressure ; Enalapril ; Female ; Humans ; Hyperaldosteronism ; Hypertension ; Middle Aged ; Nitroprusside ; Propranolol ; Spironolactone

The two most common causes of acute arterial occlusion are embolism and thrombosis in sity. They are mainly originated from the cardiovascular sources. About 70-80 per cent of occlusions occur in the axial limb vessels. Therapeutic options include supportive measures, pharmacologic treatment, surgery, and non-operative interventions. There have been several successful case reports using percutaneous aspiration thromboembolectomy with the advent of new instruments and technical imprevement. We report a case of 70-year-old male with acute anterior wall myocardial infaction who experienced acute embolic arterial occlusion of the left popliteal artery from mural thrombus in the left ventricular apex. It wan managed successfully by percutaneous aspiration thromboembolectomy.
Aged ; Embolism ; Embolism and Thrombosis ; Extremities ; Humans ; Male ; Popliteal Artery ; Thrombosis

PURPOSE: The aim of this study was to compare the results between early and delayed reconstruction of the anterior cruciate ligament (ACL) in patients with combined medial collateral ligament (MCL) injuries. MATERIALS AND METHODS: From February 2001 to January 2007, fifty-five patients who had undergone ACL reconstruction for combined ACL and MCL injuries and who were followed for more than 18 months were included in this study. The Tegner Activity Score, the Lysholm Knee Scoring Scale, the interval to recover 90degrees of motion, the Lachman test, the anterior and valgus laxity noted on stress radiograph, and the International Knee Documentation Committee (IKDC, 1993) documentation were recorded and compared between the early reconstruction group, which underwent ACL reconstruction within 3 weeks, and the delayed reconstruction group, which underwent ACL reconstruction after 3 weeks. RESULTS: At the final follow up, the Tegner score was 7.4 in the early reconstruction group and 7.6 in the delayed reconstruction group. The Lysholom score was 90.5 and 91.3, respectively (p>0.05). All the cases were rated near normal or normal on the IKDC subjective assessment. The early reconstruction group needed a longer time to recover motion and especially in the female patients. However, there was no statistical difference between the groups for the final range of motion, in addition to the Lachman test and the anterior or valgus laxity. CONCLUSION: In this study, satisfactory clinical and radiological results were obtained in both the early and delayed reconstruction groups. The early reconstruction of the ACL seems to be one of the surgical options for reconstruction of acute ACL injury combined with torn MCL.
Anterior Cruciate Ligament ; Collateral Ligaments ; Female ; Follow-Up Studies ; Humans ; Knee ; Range of Motion, Articular

Background: and Purpose: Verbal and nonverbal fluency tests are the conventional methods for examining executive function in the elderly population. However, differences in impairments result in fluency tests in patients with mild cognitive impairments (MCIs) and Alzheimer’s disease (AD) and in neural correlates underlying the tests still necessitate concrete evidence. Methods: We compared the test performances in 27 normal controls, 28 patients with MCI, and 20 with AD, and investigated morphological changes in association with the test performances using structural magnetic imaging. Results: Patients with AD performed poorly across all the fluency tests, and a receiver operating characteristics curve analysis revealed that only category fluency test discriminated all the 3 groups. Association, category, and design fluency tests involved temporal and frontal regions, while letter fluency involved the cerebellum and caudate. Conclusions Category fluency is a reliable measure for screening patients with AD and MCI, and this efficacy might be related to morphological correlates that underlie semantic and executive processing.

OBJECTIVES: The stress response involves the activation of the hypothalamic-pituitary-adrenal(HPA) axis and the sympathetic nervous system. Corticosteroids have been clearly demonstrated to cause anti-inflammatory and/or immnosuppressive effects in man including granulocytosis in part by decreasing migration into tissue, especially damaged tissues(myocardium), and circulating relative lymphocytopenia. To test whether automated measurements of the the increased serum cortisol-induced hematologic changes in the leukocyte differential significance or not in the initial differential diagnosis of acute myocardial infarction in acute chest pain syndromes. METHODS: 101 consecutive patients with myocardial infarction or myocardial ischemia presenting to the emergency room of Seoul Adventist Hospital with acute chest pain from January 1993 to August 1995(Retrospective group) and from December 1995 to March patients compatible with exclusion criteria in myocardial infarction were excluded. We measured automated leukocyte differential and serial CK-MB level in both groups, and the intial serum cortisol levels in prospective infarction group. RESULTS: 1) Total leukocyte and granulocyte counts were increased in acute myocardial infarction(p<0.01). 2) In acute myocardial infarction group, lymphocyte counts were slightly increased(p<0.05), but relative lymphocytes percentage more significantly decreased(p<0.01). 3) Serum cortisol levels are significantly raised early in the course of the acute myocardial infarction and prior to the elevation of the specific cardiac enzymes on the basis of analytic results of prospective infarction group. 4) Cortisol-induced changes in leukocyte differential were noted with time passes into reverse approximately 4 days later in our study. 5) The leukocyte differential does not shows significant changes in the retrospective myocardial ischemia group, so we arrive in careful conclusion that serum cortisol level seems does not increase. 6) No sexual differences were noted in leukocyte differential. CONCLUSIONS: The serum cortisol level and cortisol-induced leukocyte differential are helpful for initial differential diagnosis of acute myocardial infarction in acute chest pain sysdrome.
Adrenal Cortex Hormones ; Axis, Cervical Vertebra ; Chest Pain* ; Diagnosis, Differential* ; Emergency Service, Hospital ; Granulocytes ; Humans ; Hydrocortisone* ; Infarction ; Leukocytes* ; Lymphocyte Count ; Lymphocytes ; Lymphopenia ; Myocardial Infarction ; Myocardial Ischemia ; Prospective Studies ; Retrospective Studies ; Seoul ; Sympathetic Nervous System ; Thorax*

Everybody knows that toads are not eatable because of their toxins. But water toads are very similar to frogs morphologically, so fried water toads are eaten by some people on occasion. It has been studied that the granular glands of the toads secrete toxins known as digoxin-like immunoreactive substances (DLIS) such as bufogenins and bufotoxins. DLIS have cross-reactivity with micro particle enzyme immunoassay for the quantitative mea surement of digoxin. We report a case of DLIS poisoning in 56-year-old male patient who showed vomiting, syn cope, and marked bradyarrhythmia with block (heart rate down to 29 beats per minute) after ingestion of the fried water toads (Bufo stejnegeri Schmidt).
Bradycardia ; Digoxin ; Eating* ; Humans ; Immunoenzyme Techniques ; Male ; Middle Aged ; Poisoning* ; Vomiting

Neutrophils are also known to acquire the characteristics of dendritic cells (DCs) under the appropriate conditions. In this study, neutrophils were cultivated in vitro in the presence or absence of compounds modulating their survival in an attempt to characterize the expression profile of the DC markers. Higher MHC-II, CD80, CD86, CD83, and CD40 expression levels were detected on the surface of the cultured neutrophils for 24 h than on the freshly isolated cells. The annexin V-positive cells showed a higher expression level of the DC markers than the annexin V-negative cells. The population of neutrophils double stained with annexin V and the DC markers increased after being incubated with agonistic anti-Fas Ab. LPS, the anti-apoptotic compound, decreased the CD86 and MHC-II expression levels but 50-60% of the DC marker-positive cells were detected in the annexin V-positive cells. In contrast, CD80, CD86, CD83, and HLA-DR mRNA levels increased in the GM-CSF-treated neutrophils but not in the anti-Fas Ab-treated neutrophils. T cell proliferation was inhibited by co-culturing them with anti-Fas Ab- or LPS-treated neutrophils at a high neutrophil:T cell ratio. However, the superantigen-mediated T cell proliferation was increased by the LPS-treated neutrophils but decreased by the anti-Fas Ab-treated neutrophils. There was a lower level of interferon-gamma production in the T cells co-cultured with anti-Fas Ab-treated neutrophils than with the LPS-treated neutrophils. This suggests that apoptotic neutrophils express DC markers on their surface and the differential expression of DC markers might have a detrimental effect on the immune reaction.
Antigen Presentation ; Antigens, CD/biosynthesis ; Antigens, CD95/pharmacology ; Antigens, Differentiation/*biosynthesis ; *Apoptosis ; Cells, Cultured ; Dendritic Cells/*metabolism ; Humans ; Lipopolysaccharides/pharmacology ; Lymphocyte Activation ; Neutrophils/*metabolism/physiology ; T-Lymphocytes/immunology