We performed a retrospective analysis of the results of surgical treatment of sixteen patient with comminuted fracture of the distal femur from September 1993 to August 1995 and evaluated the efficacy of the angled blade plate as one of the fixation devices used. The fractures were limited to C2 and C3 fracture classifed according to the AO classification. After an average follow-up of 13 months (range, 9 to 24 months), all of the fractures had healed. Postoperatively, the arc of flexion was limited between 90degrees and 125degrees in eight, normal arc in five, and severely restricted arc of joint motion was present unexceptionally in three patients with deep infection. In angular deformity, average 5.8degrees of valgus and 2.4degrees posterior angulation were showed. The functional results by Sanders-Swiontkowski-Rosen-Helfet rating system were showed excellent in 3, good in 7, fair in 3, and poor in 3 cases. The overall results were seen to be excellent to good in ten cases (62.5%) but in twelve patients using the angled blade plate, excellent to good results were showed 10 patients (83.3%). We attribute the favorable results in our series to restoration of the articular surface through the modified extensile approach, sufficient stable fixation using the angled blade plate with conforming to the concept of bridge plate, routinely performing the bone graft for medial buttress and bone healing, and early mobilization of the extremity.
Classification ; Congenital Abnormalities ; Early Ambulation ; Extremities ; Femur* ; Follow-Up Studies ; Fractures, Comminuted ; Humans ; Joints ; Retrospective Studies ; Transplants

BACKGROUND: Survivin belongs to the inhibitor of apoptosis family, and it has recently been found to be expressed in most solid tumors. Therefore, its expression is suggested to have prognostic significance. However, no data are available concerning the significance of survivin for the carcinogenesis of bladder cancer. METHODS: In order to induce urothelial tumor in the rat urinary bladder, 0.05% N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN) was administered to male Sprague-Dawley rats for 30 weeks. We used immunohistochemistry to investigate the expressions of survivin, HSP90, Bcl-2 and Bax in rat bladder carcinogenesis. RESULTS: Urothelial cell hyperplasia, papilloma, non-invasive urothelial carcinoma and invasive urothelial carcinoma appeared at 5, 10, 20 and 30 weeks, respectively. The expressions of survivin and HSP90 increased sequentially from normal mucosa, hyperplasia, papilloma, non-invasive urothelial carcinoma to invasive urothelial carcinoma. The expressions of Bcl-2 and Bax did not increase, however the number of cases with more than 1 of Bcl-2/Bax expression ratio increased sequentially during the progression of urothelial lesion. The expression of survivin showed a statistically significant correlation with the expression of HSP90 and the Bcl-2/Bax expression ratio. CONCLUSIONS: Our findings suggest that survivin may be involved in the carcinogenesis of rat bladder and its expression is correlated with the expression of HSP90 and the Bcl-2/Bax expression ratio.
Animals ; Apoptosis ; bcl-2-Associated X Protein* ; Butylhydroxybutylnitrosamine ; Carcinogenesis* ; Humans ; Hyperplasia ; Immunohistochemistry ; Male ; Mucous Membrane ; Papilloma ; Rats* ; Rats, Sprague-Dawley ; Urinary Bladder Neoplasms ; Urinary Bladder*

Although occasional patients with chronic myeloid leukemia (CML) have chromosomal changes other than Philadelphia chromosome early in the disease, in typical cases the 9;22 translocation remains the sole abnormality throughout the disease course in chronic phase. When disease progression occurs, however, 75-80% develop additional chromosome aberrations. These secondary changes sometimes precede the more aggressive manifestations hematologically and clinically and thus may serve as valuable prognostic indicators. ider (9) (q10)t (9;22) (q34;q11.2) is very rare and a recurrent chromosomal abnormality associated with acute lymphoblastic leukemias (ALL) and lymphoblastic crisis of CML. And ider (9) (q10)t (9;22) (q34;q11.2) is a lymphoid-specific rearrangement and the patients with this abnormality are of older age on average. They commonly show pre-B cell lineage immunophenotype and L2 morphology. We report a case of ider (9) (q10)t (9;22) (q34;q11.2) as secondary aberration in a patient with lymphoblastic crisis of CML.
Blast Crisis ; Chromosome Aberrations ; Disease Progression ; Humans ; Leukemia* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Philadelphia Chromosome ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Precursor Cells, B-Lymphoid

PURPOSE: To evaluate the radioloic findings of malignant retroperitoneal fibrosis. MATERIALS AND METHODS: Post-contrast CT (n=9) and urographic (n=7) findings of nine patients with malignant retroperitoneal fibrosis were retrospectively analyzed. Primary tumors were found to be advanced gastric cancer (n=6), early gastric cancer (n=1), breast cancer (n=1), and cervical cancer (n=1). We analyzed CT findings with regard to the site of soft tissue lesion, ureteral involvement, the presence or absence of hydronephrosis, and distant metastasis. The level and length of ureteral involvement, presence or abscence of ureteral stenosis, and ureteral displacement as seen on urography, were analyzed. RESULTS: On CT scans, enhanced soft tissue lesions (mass, 5 cases; plaque, 4 cases) encircling the abdominal aorta and IVC were noted in all cases. Thickening of the ureteral wall (n=8), hydronephrosis (n=9), and enlarged lymph node (n=5) were also seen. On urography, irregular stenosis and medial displacement of ureters from level L2 to S2 were noted in all cases. The length of ureteral involvement was 4-6.5cm. CONCLUSION: The common CT findings of malignant retroperitoneal fibrosis were enhanced soft tissue lesion encircling the abdominal aorta and IVC, hydronephrosis, and thickening of the ureteral wall. On urography, ureteral stenosis and medial displacement were seen.
Aorta, Abdominal ; Breast Neoplasms ; Constriction, Pathologic ; Humans ; Hydronephrosis ; Lymph Nodes ; Neoplasm Metastasis ; Retroperitoneal Fibrosis* ; Retrospective Studies ; Stomach Neoplasms ; Tomography, X-Ray Computed ; Ureter ; Urography ; Uterine Cervical Neoplasms

BACKGROUND: Recently, the number of internet users is rapidly increasing and internet medical counseling for medical information is also becoming frequent. The aim of this study was to assess the responses and accuracy of internet medical counseling, and compare the responses according to years and operating groups. METHODS: The subject websites were 79 websites in August, 2000, and 88 in May, 2002, which operated board-type medical counseling. We questioned a simulated case of an acute dermatologic disease. Then we analysed the response rate, the time taken to reply and the accuracy of reponses. RESULTS: The number of websites that answered the question was 38 (48.1%) in 2000, and 73 (83.0%) in 2002. The response rate was significantly higher in 2002 than 2000. Time to reply was significantly shorter in 2002 than 2000. The response rate in hospital or clinic groups was higher than in other groups. The rate to make a correct diagnosis was significantly higher in 2002 than 2000. The rate to mention prognosis and necessity of intensive treatment was significantly higher in 2002 than 2000. CONCLUSION: The response rate was higher 2002 than 2000. Time to reply and the accuracy of answer improved in 2002. The response rate was higher in hospital or clinic group than in other groups.
Counseling* ; Diagnosis ; Humans ; Internet* ; Prognosis

OBJECTIVE: To investigate the relationship between umbilical plasma erythropoietin(epo) concentrations and umbilical cord pH in high risk pregnancies. METHODS: We measured epo concentrations and gas in 103 cases of cord blood obtained from 88 cesarean section (15 of twin) composed of 39 cases of normal control (12 of normal twins), 45 cases of high risk pregnancies and 4 cases of unclassified group using an RIA kit from december,1998 to December, 1999. Statistical analysis was performed using the student's t test and regression analysis. P values less than 0.05 were considered statistically significant. RESULTS: Umbilcal plasma epo concentrations revealed significant inverse correlation (P<0.05) with umbilical acidosis and cord blood epo levels, and it were significantly higher in GDM and IUGR than normal pregnancies (control: 1.60 1.15, n=39 versus GDM: 7.78 7.18, n=11 versus IUGR: 64.77 90.57 n=10, p<0.05), but 11 cases of fetal distress and 13 cases of preeclampsia did not differ significantly from umbilical plasma epo of normal control. CONCLUSIONS: Elevated epo concentrations in cord blood indicate fetal hypoxia and It is significantly increased in IUGR and GDM, these findings show that cord blood epo may serve as a clinically useful marker for chronic fetal hypoxia.
Acidosis ; Cesarean Section ; Erythropoietin* ; Female ; Fetal Blood* ; Fetal Distress ; Fetal Growth Retardation ; Fetal Hypoxia ; Hydrogen-Ion Concentration ; Plasma ; Pre-Eclampsia ; Pregnancy* ; Umbilical Cord

OBJECTIVE: To evaluate for the clinical analysis on abruptio placenta, we examined its incidence, diagnostic methods, symptom and sign, perinatal mortality, and recurrence rate. METHODS: We reviewed the medical records of the 396 cases of abruptio placenta among 72.580 deliveries, from Jan. 1, 1990 to Dec. 31, 1997, at St. Mary, Kang Nam St. Mary, and Holy Family Hospital of Catholic University. RESULTS: The total incidence of abruptio placenta was 0.51%, the incidence plotted by age from 1993 to 1997 has shown that the age incidence was higher in 20-24years old(0.7%), and over 35years old (0.8%). 42.5% of the case occurred between 32 to 37weeks of gestational age, 39.6% was over 37weeks. 38% of the patient was diagnosed before delivery with ultrasonography and the most common complaint was vaginal bleeding. The complication of abruptio placenta is as follows, Couvelaire uterus occurred in 26cases(7.0 %), DIC in 10cases(2.7 %), ARF in 4cases (1.1 %), and uterine rupture in 1case(0.3 %). Perinatal mortality including 41cases of stillbirth was 19.9 %(73cases) but no maternal death was noted. A history of abruptio placenta increased risk of a similar incident in a subsequent pregnancy by 19 cases(4.6 %: 9.0 fold)complicated with 13 cases of pregnancy induced hypertension(76.5 %). CONCLUSION: The incidence of abruptio placenta plotted by age have shown higher in 20-25years old and over 35 years old, hypertensive women experienced abruptio placenta are more likely to have higher graded recurrent rate in subsequent pregnancy, and abruptio placenta is major obstetric bleeding disease causing serious maternal and fetal complication.
Adult ; Dacarbazine ; Female ; Gestational Age ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Maternal Death ; Medical Records ; Perinatal Mortality ; Placenta* ; Pregnancy ; Recurrence ; Stillbirth ; Ultrasonography ; Uterine Hemorrhage ; Uterine Rupture ; Uterus

PURPOSE: Severe acidosis by various causes can lead to multi-organ dysfunction including cardiac dysfunction (CD) due to myocardial injury. The aims of this study are to investigate CD in newborn infants with severe acidemia at the first day of life and to evaluate the effect on myocardial injury according to the type and the severity of acidosis. METHODS: This was a retrospective study of infants > or =34 weeks of gestational age with severe acidemia (pH<7.2) at the first day of life. Infants treated by inotropics due to CD were defined as CD group. To evaluate myocardial injuries, various cardiac enzymes were measured using a commercial kit. RA group (pCO2>60 mmHg) and non-RA group (pCO2< or =60 mmHg) were classified based on the presences of respiratory acidosis. Severe base excess (BE) group (BE<-10) and mild BE group (BE> or =-10) were classified based on the degree of BE. RESULTS: The levels of CK-MB and myoglobin had significant negative relation with BE. CD group had higher incidences of seizure and mortality and higher levels of CK-MB and cTnI than those of non-CD group. Severe BE group had higher incidences of CD and seizure and higher levels of CK-MB, myoglobin and cTnI than those of mild BE group. Non-RA group had higher levels of CK-MB and myoglobin than those of RA group. CONCLUSION: At the first day of life, the newborn infants with severe metabolic acidosis have high incidences of CD and myocardial injury. Aggressive monitoring and appropriate treatment for CD according to myocardial injury should be recommended in the newborn infants with severe metabolic acidosis.
Acidosis ; Acidosis, Respiratory ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Newborn ; Myoglobin ; Retrospective Studies ; Seizures

A 75-year-old man was referred to our hospital with intestinal obstruction caused by intussusception. Abdominal computed tomography (CT) revealed seven polypoid masses in the small intestine, while chest CT revealed a mass in the right lower lobe. Preoperative laboratory tests showed white blood cell (WBC) and neutrophil differential counts of 63,630/mm3 and 95%, respectively. The serum granulocyte colony-stimulating factor (G-CSF) was 114 pg/mL, which was elevated (normal range, <18.1 pg/mL). After resection of the small bowel, the WBC count decreased to 20,510/mm3. The pathology showed a poorly differentiated carcinoma with sarcomatous components confirmed by positive immunostaining of cytokeratin (AE1/AE3) and vimentin in the small intestine. Furthermore, immunohistochemistry with specific monoclonal antibodies against G-CSF was positive. A lung biopsy revealed the same histological findings as the small intestine lesion. Therefore, the patient was diagnosed as having a G-CSF producing sarcomatoid carcinoma of the lung with metastasis to the small intestine.
Aged ; Antibodies, Monoclonal ; Biopsy ; Carcinosarcoma ; Granulocyte Colony-Stimulating Factor ; Granulocytes ; Humans ; Immunohistochemistry ; Intestinal Obstruction ; Intestine, Small ; Intussusception ; Keratins ; Leukocytes ; Lung ; Neoplasm Metastasis ; Neutrophils ; Thorax ; Vimentin

Intravascular leiomyosarcomas of the femoral vein are extremely rare. Our patient was initially diagnosed with a deep vein thrombosis based on ultrasonography and venography. The thrombectomy specimen consisted of typical spindle cells with variable anaplasia arranged in a fasciculating and interlacing pattern. The final diagnosis was proved to be an intravascular leiomyosarcoma confirmed by immunohistochemical studies for smooth muscle actin, desmin, vimentin, CD34 and CD68.