The introduction of the strong clover-leafed nail combined with the principle of reaming out the medullary canal and the development of image intensifiers has been extended the indications of the in tramedullary nailing. In this report, an attempt was made to introduce the method and to verify the indications and advantage of retrograde intramedullary nailing of humeral shaft fractures, as compared with the conventionally accepted methods.
Fracture Fixation, Intramedullary ; Humerus ; Methods

Generally, the hemolytic disease of newborn caused by anti-c is characterized by the abnormal titer of anti-c in mother's serum and neonatal progressive jaundice caused by IgG induced hemolytic anemia. A female neonate delivered by cesarean section was admitted to Hangang Sacred Hospital due to severe jaundice and apnea on Jul. 7 1998. On admission, laboratory work up was revealed immune hemolytic anemia, but no incompatibility of ABO and Rh(D) system between mother and baby. Minor blood groups of mother and this second baby was ce and Cce. The serologic examination showed positive direct and indirect Coombs' test and the cause of jaundice was proved as the result of hemolytic disease due to anti-c via antibody screening and identification. After 2 times of exchange transfusion, the jaundice was subsided. So we reported a case of hemolytic disease due to anti-c with review of previous literatures.
Anemia, Hemolytic ; Apnea ; Blood Group Antigens ; Cesarean Section ; Coombs Test ; Erythroblastosis, Fetal* ; Female ; Humans ; Immunoglobulin G ; Infant, Newborn ; Jaundice ; Mass Screening ; Mothers ; Pregnancy

No abstract available.
Immunocompromised Host* ; Kluyvera* ; Sepsis*

Balancing the rates of cell proliferation and cell death is important in maintaining normal tissue homeostasis. The relationship among apoptosis, cell proliferation and factors influencing apoptosis according to the histologic types in chemically induced mammary tumorigenesis appears important in understanding the pathogenesis of breast carcinoma. In this study, we investigated alterations in the kinetics of cell proliferation and apoptosis during rat mammary tumorigenesis induced by 7, 12-dimethylbenzanthracene (DMBA) and we related these changes to the expressions of bcl-2, p53, and TGF-beta. Seven-week-old female Sprague-Dawley rats were divided into an experimental group (20 mg/ml DMBA by oral intubation) and a control group. The results were as follows. 1. In the experimental group, breast tumors occurred in twenty two of fifty nine rats(37.3%, 22/59), and the total number of tumors was 100 (4.5 2.0/rat). The histological classification was infiltrating ductal carcinomas (n=5), ductal carcinomas with focal invasion (n=10), intraductal carcinomas (n=36), adenomas accompanied with intraductal proliferation (n=35), intraductal proliferation (n=9), and adenomas (n=5); 2. The differentiation of terminal end bud into alveolar bud (AB) in the experimental group was significantly lower than that of the control group (p<0.05); 3. BrdU labeled tumor cells were mainly located at the peripheral portion of tumor cell nests. BrdU labeling indices were highest in ductal carcinomas, less pronounced in intraductal proliferation, and lowest in adenomas, whereas apoptosis levels were highest in adenomas, less pronounced in intraductal proliferation, and lowest in ductal carcinomas (p<0.05); 4. p53 protein was not expressed in any breast tumors. Although the expression of bcl-2 protein was highest in infiltrating and focal infiltrative ductal carcinomas (58.3%), compared with adenomas, intraductal proliferation, and intraductal carcinomas (p<0.05), the extent of its expression was less than 1% of all tumor cells; 5. TGF-beta was mainly expressed in the central portion of tumor cell nests rather than in peripheral portion, and TGF-beta immunoreactive tumor cells displayed good differentiation and did not reveal BrdU immunoreactivity. TGF-beta labeling index of infiltrating and focal infiltrative ductal carcinomas was significantly higher than that of intraductal carcinomas, intraductal proliferation, and adenomas (p<0.05). Based on these results, it is thought that high cell proliferation and the suppression of apoptosis are closely associated with DMBA-induced rat mammary carcinogenesis. However, the suppression of apoptosis is not related to p53 mutation, bcl-2, and TGF-beta. TGF-beta seems to be reversely related to tumor cell proliferation but closely associated with the progression of the tumor, especially an invasion of breast carcinomas.
9,10-Dimethyl-1,2-benzanthracene ; Adenoma ; Animals ; Apoptosis* ; Breast Neoplasms ; Bromodeoxyuridine ; Carcinogenesis* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Cell Death ; Cell Proliferation* ; Classification ; Female ; Homeostasis ; Humans ; Kinetics ; Rats* ; Rats, Sprague-Dawley ; Transforming Growth Factor beta

The second case of this serial reports under the title of unusual cutaneous manifestations of connective tissue diseases is a woman with primary idiopathic dermatomyositis who developed cutaneous ulcerations on her arms and legs, which is thought to b a rare manifestation of adult dermatomyositis. These multiple ulcerations are about bean sized, polymorphous, and grouped on the poikilodermatous lesional skin. In this patient these ulcerative lesions became regressive and healed with disfiguring scars after the activity of the disease has controlled by prednisolone and methotrexate.
Adult ; Arm ; Cicatrix ; Connective Tissue Diseases* ; Connective Tissue* ; Dermatomyositis* ; Female ; Humans ; Leg ; Methotrexate ; Prednisolone ; Skin ; Ulcer*

Service diversification is recognized as an important strategy against turbulent environmental change. This study is designed to find out the trend of service diversification in Korean health care organizations and also to identify factors associated with the degree of service diversification. Data were collected from 69 hospitals out of 71 hospitals with over 300 beds. Important findings are summarized below. 1. Types of diversification are closely related to hospital size. Large hospitals have a tendency to provide sophisticated service requiring specialized skills and equipment, while small hospital have concentrated their efforts on health screening programs. 2. The more competitive and bigger hospitals are, the greater number of services that provide. Also, hospitals operating rational management information systems provide more services. Contrary to the expectation, hospitals with a low performance during last 3 years showed more service diversification. 3. A trend of more diversification was observed in hospitals whose chief executive officer used a prospector strategy. 4. A multiple regression analysis revealed that bed size, competitive environment, degree of rational management, and the growth pattern were significantly associated with teh service diversification.
Delivery of Health Care ; Health Facility Size ; Hospital Bed Capacity ; Management Information Systems ; Mass Screening

Background:Insulin dependent diabetes mellitus(IDDM) is known to be a disease characterized by a deficiency of insulin caused by destruction of the pancreatic beta-cells. It has been suggested that the clinical and immunological characteristics of IDDM in Korean are different from those of Caucasian. This study was undertaken to investigate the clinical characteristics and the prevalence of autoimmune markers in type I diabetic children and their prediabetic siblings in Korea. METHODS:Insulin autoantibody(IAA), antiglutamic acid decarboxylase(Anti-GAD) antibody, thyroid autoantibodies such as antithyroid antibody(ATA) and antimicrosomal antibody(AMA), and rheumatoid facter(RF) in 54 type I diabetic children have been measured. Diabetic autoimmune antibodies were also measured in 48 siblings. RESULTS: 1)Clinical characteristics of type I diabetic children were that age of onset was 8.6+/-4.4 years, duration of diabetes was 4.1+/-3.3 years. C-peptide at onset of diabetes was fasting 0.7+/-0.5ng/ml, and postprandial 1.2+/-0.5ng/ml, and HbA1c was 12.5+/-4.3%. 2)The positivity of IAA and anti-GAD antibody of type I diabetic children was 74% and 50% respectively. ATA and AMA positivity of type I diabetic children was 3.7% and 5.6%. however RF was not detected at all. Among the diabetic siblings, 48 persons for anti-GAD antibody, 21 for IAA, 27 for ICA were measured but 1 case was positive for IAA. 3)Clinical characteristics of type I diabetic children were not specific different between IAA and anti-GAD antibody positivity. But the mean age of onset of type I diabetic children was younger in case of both positivity of IAA and anti-GAD antibody than both negativity(7.8 vs 11.4 years old, P<0.05). 4)A case in whose brothers are diagnosed as IDDM has shown that autoantibody of elder brother was positive in both IAA and anti-GAD antibody, and younger brother was also strongly positive in IAA. Another case in whose sisters were IDDM, has shown that, while elder sister was positive in IAA, younger sister strongly positive in both IAA and anti-GAD antibody. 5)In a case of identical twin brother, the elder is type I diabetic child and the younger is normal, elder brother's onset of age was 6 years and 8 months old, and titer of anti-GAD antibody was measured as strong positive. Both ICA and anti- GAD antibody were negative in normal younger brother. First phase insulin release in IV GTT and the insulin levels in oral GTT showed reduction from the normal level in normal brother, and repeat check up showed normal ranges but on-going study is needed under observation. CONCLUSION: The prevalence of autoantibody positivity of type I diabetic children of Korea in this study were IAA 74%, and anti-GAD antibody 50%. Cases with both IAA and anti-GAD antibody positive were shown to be earlier onset. Though titers of auto-antibody in IDDM twins, brothers and sisters were strongly positive, auto-antibodies in siblings of IDDM patients were detected only one case with IAA positive(0.47%). We suggest that the pathogenesis of IDDM in Korean is different from foreign countries in terms of prevalence of autoimmune antibodies and more numbers of diabetic siblings should be tested for further study.
Age of Onset ; Antibodies* ; Autoantibodies ; C-Peptide ; Child* ; Diabetes Mellitus, Type 1 ; Fasting ; Humans ; Infant ; Insulin ; Korea ; Prevalence* ; Reference Values ; Siblings* ; Thyroid Gland ; Twins, Monozygotic

Vasoconstrictive effect of several topicsl corticosteroids was measured using laser Doppler flowmeter. Hydrophilic ointment base, 1% hydrocortisone cream, 0.1% clocortolone pivalate cream, and 0.25% desoxymethasone cream were applied on both forearms of 20 volunteers. To augment the vasoconstrictive effect of the corticosteroids, We had cut off the blood flow to forearms for 4 minutes by tourniquet. The reactive hyperemia was measured by laser Doppler flowmeter and the ares under the curve were calculated by digitizer aided by a computer. The mean areas of esch drugs were in the following order : hydrophilic ointment base, 0.1% clocortolone pivalate cream, 1% hydrocortisone crearn and 0.25% desoxymethasone cream. However, the standard deviations were too large for the difference to be statistically significant. We concluded that laser Doppler flowmeter is not suitable for the measurement of vasoconstrictive effect of corticosteroid.
Adrenal Cortex Hormones ; Desoximetasone ; Flowmeters* ; Forearm ; Humans* ; Hydrocortisone ; Hyperemia ; Tourniquets ; Vasoconstriction ; Volunteers

BACKGROUND: Angiotensin convertiong enzyme inhibitors have been shown to exert favorable effects on the left ventricular remodeling process associated with ventricular dilation after coronary occlusion. However, the effects of such therapy on global and regional left ventricular remodeling after coronart artery reperfusion have not been characterized, nor have such effects been assessed after exercise training. METHODS AND RESULTS: Female Sprague-Dawley rats(n=80) were randodmized into 4 groups at 5 days after 45 minutes of left coronary artery occlusion followed by reperfusion. Animals completion the experiment included : Untreated Sedentary group(n=20), Untreated with Swimming Exercise group(n=21), Captopril Treated Sedentary group(n=18) and Captoril Treated with Exercise group(n=21). At 3 weeks after randomization, global and regional morphologic changes of the left ventricle(LV) were examined from mid-ventricular transverse slices which were perfusion-fixed at a constant aortic pressure of 60mmHg and a left ventricular cavity pressure of 10mmHG. At rest and during exercise, compared to untreated rats, the captopril treated animals showed significantly decreased LV weight/tibial length ratio(LV/TL)(p<0.01),increased LV cavity area and dimension(both p<0.01), decreased total myocardial area and noninfarcted area(both p<30.001) and reduced wall thicknesses in the noninfarcted and infarcted regions(both p<0.001). Compared to treated and untreated dsedentary rats, exercise significantly increased LV/TL(p<0.05) and epicardial and endocardial areas in the infarcted zone(both p<0.05) and decreased transmurality(p<0.01). Exercise decreased LV cavity area in the captopril treated groups(42.3+/-10.4 vs. 40.4+/-6.0mm2),whereas exercise increased LV cavity area in the untreated groups(33.5+/-8.9 vs. 39.1+/-6.2mm2)(p<0.05). CONCLUSION: These findings provide evidence in rats for evidence in rats for exaggerated left ventricular dilation and supperssion of compensatory myocardial hypertrophy globally and in the infarct zone with 3 weeks of captopril treatment following coronary artery reperfusion with acute nontransmural myocardial infarction. In addition, the effects of captopril on LV dilation and suppression of global and regional hypertrophic response were partially reversible by swimming exercise.
Angiotensins ; Animals ; Arterial Pressure ; Arteries ; Captopril ; Coronary Occlusion ; Coronary Vessels* ; Enzyme Inhibitors ; Female ; Humans ; Hypertrophy ; Myocardial Infarction ; Myocardial Reperfusion ; Random Allocation ; Rats* ; Rats, Sprague-Dawley ; Reperfusion* ; Swimming ; Ventricular Remodeling*

Despite significant advances in obstetric and pediatric health care, Streptococcus agalactiae(Lancefield group B β-hemolytic Streptococcus, GBS) remains one 91 the most prevalent and devastating pathogens in peripartum women and their newborn infants. It may cause urinary tract infection, chorioamnionitis and endometritis, bacteremia, and cesarean wound infection in the peripartum period. It was Pasteur who first identified microbes in the blood and lorchia of septic women. After that, in 1938 the isolation of S. agalactiae from three mortally ill women was reported, thereby implicating it as another cause of puerperal sepsis. S. agalactiae is now one of the most common causes of neonatal sepsis and meningitis in the United States. However, in Korea there have been only twenty-three cases of neonatal meningitis and/or sepsis due to group B β-hemolytic streptococcus reported. Recent studies have noted other serious infections in adults, including bacteremia, pneumonia, cellulitis, osteomyelitis, meningitis, and endocarditis. In Korean adults no case of pneumonia due to S. agalactiae has been reported till now. As minimal inhibitory concentration of penicillin was reported to be higher for S. agalactiae than for S. pyogenes, minimal inhibitory concentration of penicillin for S. agalactiae should be tested. Herein we describe the course of a case of S. agalactiae pneumonia and bacteremia in a 74-year-old diabetic man, and we review the literatures.
Adult* ; Aged ; Bacteremia ; Cellulitis ; Chorioamnionitis ; Delivery of Health Care ; Endocarditis ; Endometritis ; Female ; Humans ; Infant, Newborn ; Korea ; Meningitis ; Osteomyelitis ; Penicillins ; Peripartum Period ; Pneumonia* ; Pregnancy ; Sepsis ; Streptococcus agalactiae* ; Streptococcus* ; United States ; Urinary Tract Infections ; Wound Infection