Purpose: We evaluated the results of cementless acetabular revisions performed with morselized bone grafting and screw-fixed hemispherical cups with different surface treatments. Materials and Methods: Forty hips, which had been followed for more than 10 years, were included in this study. Reconstruction was performed with 10 hydroxyapatite (HA)-coated cups and 30 porocoated ones. The mean followup time was 12 years and 1 months (range, 10 years to 15 years). Re-revision or radiographic loosening was considered as an endpoint of follow-up. Results: The average Harris hip score improved from 52 points to 75 points. During the follow-up period, radiographic loosening was observed in 17 hips. The loosened implants were HA-coated cups in 8 hips and porocoated ones in 9 hips. In 14 of these, re-revision of the cups was performed. The re-revision rate was 20% for the porocoated cups and 80% for the HA-coated cups. There were 2 hips with liner wear, which had undergone liner and head changes. Bone grafts were united in all the hips. The average time to union was 5.2 months (range, 2 to 9 months), and the average time to incorporation was 12 months (range, 5 to 18 months). Conclusion: Our results imply that HA-coated cups have a significantly higher failure rate compared with the porocoated ones (P<0.05) after a minimum follow-up of 10 years. Morselized bone grafting with use of a porocoated cup is an effective modality, which can restore the bone loss of the acetabulum in revision total hip arthroplasty.
Acetabulum* ; Arthroplasty, Replacement, Hip ; Bone Transplantation ; Durapatite ; Follow-Up Studies* ; Head ; Hip ; Transplants

PURPOSE: The purpose of this study was to analyze the radiologic findings of primary epiploic appendagitis, with particular attention to the correlation of ultrasonographic, clinical, CT, MR and surgical findings. MATERIALS AND METHODS: Among 14 patients with primary epiploic appendagitis who presented with the rapid onset of a very localized pain and tenderness, we performed ultrasonography in all, CT in eight, and MRI in four of these eight. Surgery was performed in two patients. Follow-up examinations were performed using US, CT and MRI (n=2), US and CT (n=2), US alone (n=2), and with regard to clinical features (n=12). RESULTS: US performed in 14 patients revealed the presence in all of small, well-defined, ovoid, noncompressible hyperechoic (n=12) or isoechoic (n=2) solid masses attached to the colonic wall, without bowel wall change and without communication with bowel lumen. CT performed in 8 patients showed varying hyperattenuating fatty lesions in the same location in the abdomen, without other inflammatory process. MRI findings of four patients were helpful for further evaluation of internal architecture. CONCLUSION: In primary epiploic appendagitis, US findings were sufficiently characteristic to allow accurate diagnosis and valuable for the differential diagnosis of other acute conditions of the abdomen.
Abdomen ; Colon ; Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Ultrasonography

Amniotic fluid embolism, one of the leading causes of maternal death, is a rare event, however, it can cause maternal death and neonatal morbidity when it unrecognized and untreated effectively. Its pathogenesis is unclear and clinical presentations are variable without standardized means of confirming diagnosis. We experienced one case of neonatal hypoxic ischemic encephalopathy possibly due to maternal amniotic fluid embolism, which was diagnosed by brain MRI, EEG and maternal uterine pathology. We report this case with a brief review of literatures.
Amniotic Fluid* ; Brain ; Diagnosis ; Electroencephalography ; Embolism, Amniotic Fluid* ; Female ; Hypoxia-Ischemia, Brain* ; Magnetic Resonance Imaging ; Maternal Death ; Pathology ; Pregnancy

Spasticity is common stroke in patients, and its management has been considered as one of the major problems in stroke rehabilitation. The goal of this study was to determine if transcutaneous electrical nerve stimulation(TENS) and acupuncture would reduce the muscle spasticity. To estimate the efficacy of electrical stimulation for the treatment of spasticity TENS(100 Hz, asymmetric bipolar pulse current) was applied to the skin over the extensor muscles of spastic limbs for 20 minutes, once a day in six stroke patients. In addition, acupuncture was also applied to the acupoints of extensor muscles of all extremities and face for 20 minutes twice a day to determine the efficacy of acupuncture for the treatment of spasticity in six stroke patients. As controls subjects, six stroke patients were examined without TENS or acupuncture treatment. In experimental groups, the efficacy of treatment was measured 1, 5, 10, 15 days and 20 days after treatment with either TENS or acupuncture using the spasticity measurement methods (modified Ashworth scale, ankle clonus score, and H/M ratio). Based on the results from the present study, we have concluded that the H/M ratios of affected spastic limbs were significantly higher than those of unaffected limbs (p<0.05). TENS and acupuncture therapies lessened the spasticity of affected limbs of stroke patients when measured with the modified Ashworth scale however not with the H/M ratios nor with the ankle clonus scores.
Acupuncture Points ; Acupuncture* ; Ankle ; Electric Stimulation ; Extremities ; Humans ; Muscle Spasticity ; Muscles ; Rehabilitation ; Skin ; Stroke* ; Transcutaneous Electric Nerve Stimulation*

BACKGROUND: Optimal blood culture performance is critical for successful diagnosis and treatment of sepsis. To understand the status of blood culture, we investigated several aspects of the procedure at 9 university hospitals. METHODS: The process of ordering blood culture sets and sampling volume for adults and children was investigated from January 2010 to April 2010, while the positive rate of detection and growth of skin contaminants were compared in 2009. Microbial growth in aerobic and anaerobic bottles was investigated prospectively. RESULTS: A majority of the hospitals used 2 sets of bottles for adults and 1 bottle for children. The average blood volume in each set was 7.7 mL for adults and 2.1 mL for children. The positive rate of microorganisms was 8.0%, and the isolation rate of the normal flora of the skin was 2.1%. Bacterial growth rates in aerobic and anaerobic bottles only were 31.8% and 24.5% respectively. CONCLUSIONS: Ordering blood culture sets and sampling volumes did not comply with CLSI guidelines. However, the rate of positive cultures and skin contamination rates were acceptable. Anaerobic bottles are useful in enhancing the yield of microorganisms.
Adult ; Bacteremia/blood/*microbiology ; Bacteria, Aerobic/isolation & purification ; Bacteria, Anaerobic/isolation & purification ; Blood/microbiology ; Child ; Hospitals, University ; Humans ; Prospective Studies ; Republic of Korea ; Skin/microbiology

The purpose of this study is to establish a gene delivery system for interstitial tissue-specific protein expression in mice testes using modified recombinant baculovirus. Green fluorescent protein (GFP)-expressing recombinant baculovirus (GFP-baculovirus), in which the insect cell-specific polyhedron promoter was replaced by the cytomegalovirus (CMV)-IE promoter, was used to transfect testicular cells in vitro, and for intra-tunica albuguineal injection of the interstitial tissue of the testis. GFP expression was monitored in frozen testes sections by fluorescence microscopy. Expression of GFP in testicular tissues was also assessed by reverse transcription polymerase chain reaction (RT-PCR), and protein expression was assessed by Western blot. Testicular cells in vitro were infected efficiently by modified recombinant GFP-baculovirus. Intra-tunica albuguineal injection of GFP-baculovirus into the mouse testis resulted in a high level of GFP expression in the interstitial tissues. RT-PCR analysis clearly showed GFP gene expression in the testis, particularly interstitial tissues. Intra-tunica albuguineal injection of a modified baculovirus that encoded recombinant rat insulin-like growth factor binding protein (IGFBP)-5 resulted in an increase in IGFBP-5 in testis and semen. In conclusion, we have developed an efficient delivery system for gene expression in vivo in testicular cells, particularly cells of the interstitial tissue using intra-tunica albuguineal injection of a modified recombinant baculovirus. This method will be particularly relevant for application that requires gene delivery and protein expression in the testicular cells of the outer seminiferous tubule of the testis.
Animals ; Baculoviridae ; genetics ; COS Cells ; Cercopithecus aethiops ; Cytomegalovirus ; genetics ; Gene Expression ; physiology ; Gene Transfer Techniques ; Green Fluorescent Proteins ; genetics ; metabolism ; HeLa Cells ; Humans ; Injections ; Insulin-Like Growth Factor Binding Protein 5 ; genetics ; metabolism ; Male ; Mice ; Microscopy, Fluorescence ; Promoter Regions, Genetic ; genetics ; Rats ; Testis ; cytology ; physiology

BACKGROUND: This study analysed patterns of requests for repeated blood cultures and the microorganisms isolated in follow-up cultures. METHODS: The frequencies and intervals of repeated blood cultures performed during January and February of 2010 at seven university-affiliated hospitals in Korea were evaluated. Results of microbiological cultures at follow-up were analysed with respect to pathogen replication, immune clearance, appearance of new pathogens, and skin contaminants. RESULTS: Among 3,072 patients who received repeated blood cultures, the average number of requests was 3.2. Of the 5,241 follow-up blood culture events recorded, durations of 1, 2, and 3 days between cultures were identified for 23.1%, 21.4%, and 15.0% of events, respectively. Relative to each initial culture, persistent pathogen growth in subsequent culture(s) accounted for 2.3% of events, whereas immune clearance was confirmed in 8.5% of events. Previously undetected pathogens were isolated in 5.2% of the follow-up cultures, the majority of which grew after an interval of six days. Skin contaminants were detected in 7.6% of the repeated cultures, and 76.1% of the follow-ups displayed no growth of microorganisms. CONCLUSION: The most common numbers of repeat culture requests were two and three, and these were typically performed within three days of the initial culture. Among the follow-up cultures, new pathogens were identified in 5.2%, and the majority of this group likely presented for follow-up during a new disease episode.
Follow-Up Studies ; Humans ; Korea ; Sepsis ; Skin

PURPOSE: To evaluate the role of a preoperative bone scan in determining the operative treatment methodof a femoral neck fracture. MATERIALS AND METHODS: Between January 2001 and December 2003, 62 out of 257 patients, who underwent a preoperative bone scan after a femoral neck fracture were included. The fractures was classified according to the stage of Garden. The uptake of the Tc-99m methylenediphosphonate (99mTc-MDP) isotope was estimated visually, and categories as -2 (the femoral head activity in the fractured side is general reduction compared with the opposite side), -1 (the activity is partial reduction), 0 (the activity is normal) and 1 (the activity is general increase ). RESULTS: 62 patients, 17 male and 45 female, with a mean age of 67.4 years (range 18 to 93) were investigated. Of the 19 patients with Garden stages I and II 17 were 0, and 1 each were -1 and -2. Eighteen patients were operated on with multiple pinning, and 1 with bipolar hemiarthroplasty. Of the 43 patients with Garden stages III and IV 37 were -2, 4 were -1 and 2 were 0. Thirty-eight patients were operated on with bipolar hemiarthroplasty. Four patients were operated on with total hip arthroplasty. One patient was operated on with multiple pinning. The operative method was changed in only 1 of the 62 patients due to the bone scan finding. CONCLUSION: The isotope uptake of the preoperative bone scan after a femoral neck fracture generally corresponded with the degree of fracture displacement. Therefore, a preoperative bone scan seems to play no significant role in determining the operative treatment method of a femoral neck fracture.
Arthroplasty, Replacement, Hip ; Female ; Femoral Neck Fractures* ; Femur Neck* ; Head ; Hemiarthroplasty ; Humans ; Male

Background: Anti-heparin/platelet factor 4 (PF4) antibodies may trigger severe thrombotic complications in hemodialysis (HD) patients. Tetrameric PF4 has a high affinity for extracellular DNA, which is a key component of neutrophil extracellular traps (NETs); therefore, the interactions between anti-heparin/PF4 antibodies and NETs can contribute to prothrombotic events. This prospective observational study included both incident and maintenance HD (MHD) patients. Methods: Anti-heparin/PF4 antibody levels were measured by enzyme-linked immunosorbent assay; an optical density > 1.8 was regarded as clinically significant. In incident HD patients, we additionally measured serum nucleosome levels as representative markers of NETs, and the contributions of anti-heparin/PF4 and increased serum nucleosome levels to the primary functional patency loss of vascular access was assessed. Results: The frequency of anti-heparin/PF4 antibodies was significantly higher in incident HD patients compared to MHD patients (23.6% vs. 7.7%). Serum nucleosome levels, as well as the white blood cell counts, neutrophil counts, and high-sensitivity C-reactive protein levels, were significantly higher in anti-heparin/PF4 antibody-positive patients compared to the control. Platelet counts tended to be lower in the patients with anti-heparin/PF4 of >1.8 than in the controls. Relative risk calculations showed that the presence of anti-heparin/PF4 antibodies increased the risk of primary functional patency failure by 4.28-fold, and this risk increased further with higher nucleosome levels. Furthermore, in the anti-heparin/PF4 antibody-positive group, the time to first vascular intervention was much shorter, and the risk of repeated intervention was higher, compared to the controls. Conclusion In incident HD patients, the presence of anti-heparin/PF4 antibodies was associated with increased NET formation; this could be a strong predictor of vascular access complications.

Uterine torsion, which most often occurs during pregnancy, is rare. Torsion of a nongravid uterus is extremely rare and is associated with pelvic adhesions, uterine leiomyomas, or uterine anomalies. We experienced a case of uterine torsion, with a huge subserosal leiomyoma and multiple intramural leiomyomas, in a postmenopausal woman, one that showed the most extreme degree of rotation among the known cases of uterine torsion. Necrosis of the uterus and both adnexae was observed. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. We present this case with a brief review of the relevant literature.
Female ; Humans ; Hysterectomy ; Leiomyoma ; Necrosis ; Postmenopause ; Pregnancy ; Urogenital Abnormalities ; Uterus