The incidences of posttraumatic avascular necrosis of the femoral head were variably reported. In 1980, Calandruccio reported its incidence of 14% in nondisplaced femoral neck fracture and 50% in displaced ones. In general, the prophylactic methods, such as core decompression, bone graft and trochanteric osteotomy were recommended for the treatment of early stages of femoral head avascular necrosis(Ficat-Arlet stage 1 or 2), while the primary replacement surgery for the advanced ones (Ficat-Arlet stage 3 or 4). One of our authors(Y.K. Chung) has performed five cases of corticocancellous bone grafts using combined autogenous free fibular graft and iliac cancellous bone graft, for the post-traumatic femoral head AVN from January 1985 to December 1989 at our hospital, and the following results are obtained: 1. Among the forty nine displaced adult femoral neck fractures, there were five eases of avascular necrosis(10. 2%). 2. There were three male patients and two female ones, and the average age of injury was 48 years old(30 to 57). 3. According to the type of fractures, there were four cases of subcapital fracture and one of transcervical fracture. All of the patients were performed closed reduction and internal fixation with compression hip screw system, including additional Knowles pinning in two cases. 4. Histological study with the excised femoral head, showed that there was no bony union between the grafted cancellous bone and the necrotic head, and the grafted bone has been changed to amorphous necrotic tissue. However, we found a solid consolidation of the grafted bone and the femoral neck portion.
Adult ; Decompression ; Female ; Femoral Neck Fractures ; Femur ; Femur Neck ; Head ; Hip ; Humans ; Incidence ; Male ; Necrosis ; Osteotomy ; Transplants

BACKGROUND: It has been reported that younger patients with lung cancer have characteristic features that differ from those in older patients. The prognosis for young patients with this disease is controversial. This study aimed to determine the clinicopathological characteristics, the survival rate, and the risk factors associated with the overall survival rate in younger patients with lung cancer. METHODS: The records of 120 young(age≤40) patients with histologically confirmed lug cancer in the Korea Cancer Center Hospital(KCCH) between Jan. 1992 to 1998, 120 older(age>40) patients were randomly selected as the controls. RESULTS: More female patients(45.0% vs. 20.0%, p<0.001) and more adenocarcinoma cases(64.2% vs. 38.3%, p<0.001) were found in the younger group, when compared to the older patients. In NSCLC, advanced disease(stage III B and IV) was more common in the younger patients(90.2%) than in the older patients(62.7%) (p<0.001). The Median survival was 8.6 months in the younger patients and 12.2 months in the older(p=0.003). In a multivariate analysis, only the advanced-stage was an independent negative prognostic factor. CONCLUSION: Lung cancer in the younger age group presents with a more advanced stage resulting in a poor survival rate, which suggests that lung cancer in this population is more aggressive than in older patients.
Adenocarcinoma ; Female ; Humans ; Korea ; Lung Neoplasms* ; Lung* ; Multivariate Analysis ; Prognosis ; Risk Factors ; Survival Rate

PURPOSE: The purpose of this study was to observe and compare the changes in the patterns of hemodynamic and blood profiles on the circuit of Extra-corporeal life support system (ECLS) by using a dual pulsatile pump (T-PLS). METHODS: An acute heart failure model using partial pulmonary artery banding was constructed in 12 piglets (20 -25kg). The animals were divided into centrifugal (n=6) and dual pulsatile pump (n=6) group. Each animal was placed on an ECLS system with a membrane oxygenator bypassing the right atrium and the aorta for 2 hours under general anesthesia. The parameters mainly observed were intra-circuit pressure changes, arterial pulsatility (pulse pressure), plasma free hemoglobin, hemodynamic changes, and other blood profiles. The parameters obtained just prior to the bypass were compared with the corresponding parameters obtained two hours after the bypass. RESULTS: Before bypass, the parameters were statistically the same between the groups. Two hours after the bypass, no significant differences were observed between the groups in ABGA, VBGA, AST/ALT, BUN/Cr, and electrolytes; the plasma free hemoglobin was 14.8+/-4.7 g/dl in the dual pulsatile group and 19.1+/-9.1 g/dl in the centrifugal group (p=NS). The pulse pressure was higher in the dual pulsatile pump than in the centrifugal pump group (35+/-8 vs. 11+/-7 mmHg, p=0.0253 mmHg). The highest circuit pressure was generated at the inlet of the membrane oxygenator and was higher in the dual pulsatile group than in the centrifugal group (173+/-12 mmHg vs. 222+/-8 mmHg, p=0.0000). CONCLUSION: The results demonstrate that a dual pulsating mechanism lessens blood cell trauma while providing physiologic pulsatile blood flow. The ECLS system using a dual pulsatile pump (T-PLS) can be useed as an effective and safe driving motor for an ECLS.
Anesthesia, General ; Animals ; Aorta ; Bays ; Blood Cells ; Blood Pressure ; Cardiopulmonary Resuscitation ; Electrolytes ; Heart Atria ; Heart Failure ; Hemodynamics ; Life Support Systems* ; Oxygenators, Membrane ; Plasma ; Pulmonary Artery

BACKGROUND AND OBJECTIVES: The excision of submandibular gland (SMG) has been commonly used for the treatment of calculi in the hilum of SMG, since intraoral removal of the hilar stone has the potential risk of lingual nerve injury and the poor surgical field. However, it would leave loss of remained gland function and external scars after the excision. Therefore, the authors modified the intraoral retrieval techniques as the marsupialization of the Wharton's duct up to the calculi in the hilum. This study reports our clinical experience with the modified intraoral retrieval technique and the advantages of this modality for calculi in the hilum of SMG. SUBJECTS AND METHOD: SMG excision and intraoral removal with marsupialization (IRM) were used from 1994 through 2003 to treat 9 and 16 cases of calculi in the hilum of SMG, respectively. We analyzed the characteristic findings of calculi, surgical morbidities and complications by comparing two different treatment groups. RESULTS: The mean diameter of the calculi was 6.1 mm in patients with SMG excision and 7.8 mm in patients with IRM. The success rate of extraction by IRM of calculi in the hilum were 86.7%. The surgical complications were similar in both groups. The proportion of palpable calculi were significantly increased in the IRM group (92.9% vs 22.2%). We failed to remove the stone by IRM from patients, and stones were impalpable intraorally preoperatively. CONCLUSION: IRM is an excellent alternative method for the removal of palpable calculi located in the hilum of SMG. Furthermore, it would preserve the salivary gland function without external scars and with acceptable surgical complications and morbidities.
Calculi* ; Cicatrix ; Humans ; Lingual Nerve Injuries ; Oral Surgical Procedures ; Salivary Ducts ; Salivary Glands ; Submandibular Gland*

0.05) 2. The mean electric activity of the masticatory muscles was found to have decreased during more clenching than resting, but there was no statistically significant difference because of individual difference of measuring values. (p>0.05) 3. The asymmetry index of masticatory muscles in asymmetric groups was significantly greater during clenching compared with controls. (p<0.05) In conclusion, no right-left difference of muscle activities was found in patients with facial asymmetry before orthognathic surgery and 4weeks afterwards. Not only muscular functioning but also many other factors, such as occlusion, temporomandibular joint disorder and trauma, probably affect facial asymmetry and will be analyzed in future studies. And we will need long term follow-up after orthognathic surgery.]]>
Deglutition ; Electromyography ; Facial Asymmetry ; Follow-Up Studies ; Humans ; Individuality ; Masticatory Muscles ; Orthognathic Surgery ; Prognathism ; Temporal Muscle ; Temporomandibular Joint Disorders

A 32-yr-old male patient with recurrent pneumothorax associated with bronchial atresia of the subsegmental branch of the posterior segmental bronchus of the right upper lobe was successfully treated with right upper lobectomy. Before surgery, the bronchial atresia with pneumothorax was suspected on the chest radiograph and CT scans, which showed the findings of bronchocele with localized hyperinflation of the right upper lobe. The examination of surgical specimen from the resected right upper lobe suggests that the cause of the recurrent pneumothorax was the rupture of the subpleural bullae in the hyperinflated lung segment distal to the atretic bronchus.
Adult ; Bronchi/*abnormalities/pathology ; Bronchial Diseases/*diagnosis ; Human ; Male ; Pneumothorax/*diagnosis ; Respiratory System Abnormalities/*pathology ; Tomography, X-Ray Computed

BACKGROUND: Bulla is an air-filled space within the lung parenchyma resulting from deterioration of the alveolar tissue. Molecular mechanism of the formation of the bulla is not well described. Fibroblast growth factor(FGF)-7, bone morphogenetic protein(BMP) receptor, and transforming growth factor(TGF)-beta receptor are known to have a stimulatory or inhibitory role in the lung formation. We investigated to see if these growth factor or cytokine receptors are involved in the bulla formation by immunohistochemical staining of bullous lung tissues from patients with primary spontaneous pneumothorax. MATERIAL AND METHOD: Bullous lung tissues were obtained from 31 patients with primary spontaneous pneumothorax, including 30 males and 1 female from 15 to 39 years old. The bullous tissues were obtained by video-thoracoscopic surgery and/or mini-thoracotomy and fixed in formalin. Blocks of the specimens were embedded with paraffin and cut into 5~6 micrometer thick slices. The sections were deparaffinized and hydrated and then incubated with primary antibodies against FGF-7, BMP-RII, or TGF-RII. RESULT: Of the 31 patients, 24 were TGF-RII positive including 18 strong and 6 weak positives. Observation with high magnification showed that strong immunostaining was detected in the boundary region between bullous and normal lung tissues. In contrast, all of the sections were negative with FGF-7 or BMP-RII antibodies. CONCLUSION: These results suggest that overexpression of TGF-beta RII may be involved in the formation of bulla, although further molecular studies are needed to find out more detailed molecular mechanisms.
Adult ; Antibodies ; Female ; Fibroblasts ; Formaldehyde ; Humans ; Lung ; Male ; Paraffin ; Pneumothorax* ; Receptors, Cytokine ; Transforming Growth Factor beta

BACKGROUND: The objectives of our study were to assess the effects of oxidative stress on the proliferation, differentiation and apoptosis of human bone marrow stromal cell (BMSC)-derived osteoblasts and to explore pathways by which osteoblast cell apoptosis was induced. METHODS: Mononuclear cells including BMSCs were cultured to osteoblastic lineage. Different doses of hydrogen peroxide (H2O2) were added to the culture media. The colony forming units-fibroblastic (CFU-Fs) were stained with crystal violet and alkaline phosphatase (ALP). The MTT assay was done to see the effect of H2O2 on cell viability. The effect of H2O2 on osteocalcin gene expression was determined by RT-PCR. The matrix calcification measurement was performed. FACS analysis was performed to determine the osteoblasts apoptosis. Caspase-3, -8 and 9 activity assay and cytochrome c release were measured. RESULTS: The size and number of ALP (+) CFU-Fs were also decreased by H2O2 treatment. When compared with the control group, H2O2 significantly decreased the total number of cells of each culture well during MTT assay. H2O2 significantly diminished expression of osteocalcin mRNA. N-acetylcystein (NAC) blocked the diminution of cell viability and the inhibition of osteocalcin mRNA expression by H2O2. H2O2 reduced matrix calcification. FACS analysis revealed H2O2 increased percentage of apoptotic cells. Addition of H2O2 resulted in the increase of caspase-9 and -3 activity but not caspase-8, and release of cytochrome c to the cytosol. CONCLUSION: These data suggest that, in primary human BMSCs, oxidative stress inhibits proliferation of stromal cells and inhibits the differentiation to osteoblastic lineage. In addition, oxidative stress induces apoptosis of human BMSC-derived osteoblasts and this may be mediated by mitochondrial pathway of apoptotic signal.
Alkaline Phosphatase ; Apoptosis ; Bone Marrow* ; Caspase 3 ; Caspase 8 ; Caspase 9 ; Cell Survival ; Culture Media ; Cytochromes c ; Cytosol ; Gene Expression ; Gentian Violet ; Humans* ; Hydrogen Peroxide ; Mesenchymal Stromal Cells ; Osteoblasts* ; Osteocalcin ; Oxidative Stress* ; RNA, Messenger ; Stromal Cells

BACKGROUND: There are several studies that report the relationship between leukocytosis and cardiovascular disease mortality. Most of these studies stand on the basis that atherosclerosis is mediated by inflammatory process. By the same token, preoperative white blood cell count is suggested as an independent predictable factor of postoperative mortality and morbidity in coronary artery bypass grafting. The purpose of this study is to define the influence of preoperative white blood cell count on postoperative morbidity and mortality after coronary artery bypass grafting. MATERIAL AND METHOD: The medical records of the 133 patients who had undergone isolated coronary artery bypass grafting at Inha University Hospital from 1996 to 2003 were reviewed. Patients were evenly divided into four groups, and named as group A, B, C, and D respectively based on their preoperative white blood cell count in ascending order. The number of patients in each group were 33 with exception of 34 in group A. The range of white blood cell count were from 1.3 x 10(3)/microL to 5.9 x 10(3)/microL in group A, from 6.0 x 10(3)/microL to 7.0 x 10(3)/microL in group B, from 7.1 x 10(3)/microL to 8.9 x 10(3)/microL in group C, and from 8.9 x 10(3)/microL to 16.9 x 10(3)/microL in group D. RESULT: The number of patients with recent myocardial infarction was 0 in group A, 2 (6.1%) in group B, 4 (12.1%) in group C, and 8 (24.3%) in D group, showing proportional increase to the white blood cell count (p<0.01). There were six postoperative deaths; 1 (2.9%) in group A, 1 (3.0%) in group B, 2 (2.6%) in group C, and 2 (6.1%) in group D (p=0.44), showing no significant difference between the groups. Postoperative wound infection occurred in 3 patients; all 3 patients were in group D, showing that postoperative wound infection is closely related to the preoperative white blood cell count. CONCLUSION: The association between preoperative white blood cell count and postoperative mortality could not be defined. The incidence of postoperative wound infection was found to be proportional to the preoperative white blood cell counts.
Atherosclerosis ; Blood Cells ; Cardiovascular Diseases ; Coronary Artery Bypass* ; Coronary Vessels* ; Humans ; Incidence ; Leukocyte Count* ; Leukocytes* ; Leukocytosis ; Medical Records ; Mortality ; Myocardial Infarction ; Surgical Wound Infection

BACKGROUND: Thoracoscopic R3 (above the third rib)sympathicotomy has been performed as an effective method in treating palmar hyperhidrosis because it is effective in eliminating the symptoms of hyperhidrosis and has lower degree of compensatory hyperhidrosis than that of sympathectomy. Most of the results published were based on the short-term follow up. So we evaluated the intermediate term follow up results of the R3 sympathicotomy. MATERIAL AND METHOD: From April 1999 to August 2001, ninety-four patients with palmar hyperhidrosis had been treated by R3 sympathicotomy at the Inha University Hospital. Follow-up study was completed for 76 patients (male 38, female 38) and average follow-up period were 25+/-9.1 (15~50) months. The sympathetic trunk passing above the upper border of third rib was divided by electric cautery. The patient's satisfaction after surgery was estimated using the analogue scale from score 0 to 100 (100 means perfect satisfaction). RESULT: The scale of patient's satisfaction immediately after operation was 92.36+/-9.93. After 15 months, the scale of satisfaction was decreased to average 71.80+/-20.24 and it is statiscally significant. The cause of dissatisfaction were compensatory hyperhidrosis and recurrence of symptom. The degree of sweating immediately after operation was mean 0 and after 15 months it increased to mean 1.5. The degree of the compensatory hyperhidrosis immediately after operation was mean 1 and it increased to mean 5 after 15 months. CONCLUSION: R3 sympathicotomy has excellent therapeutic results immediately after operation but therapeutic effectiveness is becoming to decrease 15 months after operation. The common causes of dissatisfaction are compensatory hyperhidrosis and recurrence of hyperhidrosis.
Cautery ; Female ; Follow-Up Studies* ; Humans ; Hyperhidrosis* ; Recurrence ; Ribs ; Sweat ; Sweating ; Sympathectomy