Fractures of the acetabulum are relatively uncommon, but because they involve a major weight bearing joint in the low extremity, they assume great clincal importance. The principle of management for this fracture is as for any other displaced intra-articular fracture, nsmely that anstomical reduction is essential for good long term function of the obtained by closed means, but more often, open reduction followed stable internsl fixation allowing early active or passive motion will be required. In the past, the achievement of this ideal, that is anatomical reduction, has been difficult because technical problems such as those caused by complicated anatomy, difficulty with surgical exposure, severe comminution in many cases, and major associated injuries. We classified the acetabular fractures of 71 patients with 72 hips from 1980 to 1987 and clinical analysis was performed on 51 hips allowing the possible follow-up evaluation beyond the 12 months. Following results were obtained. 1. The most common associated injury was the pelvic bone fracture(25.5%). 2. The most common types of fracture on each classification were posterior wall fracture in Letournel(37.5%), posterior acetabular fracture in Rowe & Lowell(42.3%), central fracture- dislocation without involving of weight bearing dome of acetabulum in Carnesale(23.9%). 3. According to calssification method, the interpretation for characteristics of fracture type and frequency of acetabular fracture was very different each other. 4. The Leournels classification was relatively simple and could contain with many types of fracture and was helpful to determine the index of treatment. 5. The prognosis of linear undisplaced fracture and posterior fracture was better than acetabular medial, superior and bursting fracture in both conservative and operative treatment. 6. The posterior wall fracture with widely displaced fracture or joint instability, acetabular dome fracture, intraarticular fragment was absolute indication for operative treatment. 7. The treatment result and prognosis was influenced to the accurate classification of fracture type, anatomical reduction and rigid internal fixation.
Acetabulum ; Classification ; Dislocations ; Extremities ; Follow-Up Studies ; Hip ; Humans ; Intra-Articular Fractures ; Joint Instability ; Joints ; Methods ; Pelvic Bones ; Prognosis ; Weight-Bearing

PURPOSE: The purpose of this study is to help diagnosis migraine and tension-type headache in children with chronic recurrent headache by comparing clinical characteristics of migraine and tension-type headache. METHODS: We performed a clinical analysis of 89 children diagnosed as migraine and/or tension-type headache by using international headache society classification with the aid of Prenky's criteria of migraine and Jay's category of tension-type headache. RESULTS: The diagnosed group consisted of 39 children with migraine, 40 tension-type headache cases and coexisting migraine and tension-type headache in 10 cases. In the location of the headache, the incidence of temporal area was significantly higher in the migraine than in tension-type headache(P<0.001) and the incidence of occipital area was significantly higher in the tension-type headache than in migraine(P<0.01). In migraine, 27 cases(69.2%) had pulsating headache which was significantly higher than in the tension-type headache(P<0.001). In tension-type headache, 18 cases(45.0%) had dull headaches which were significantly higher than in migraine(P<0.01). Nausea, vomiting, dizziness, relief of headache after sleep, photophobia, and visual disturbance among associated symptoms with headache were significantly higher in migraine than tension-type headache(P<0.05). The incidence of family history of headache in migraine(71.8 %) was higher than in the tension-type headache(40.0%)(P<0.01). CONCLUSION: Diagnostic criteria are significant in diagnosis of migraine and tension-type headache. The characteristics of headache are overlapped in both headache types and there are differences of expression for headache in children, so there is a problem in diagnosing of headache type. The international Headache Society Classifications are useful for children, but there are problems that diagnostic criteria are too strictly applied to children.
Child* ; Classification ; Diagnosis ; Dizziness ; Headache ; Humans ; Incidence ; Migraine Disorders* ; Nausea ; Photophobia ; Tension-Type Headache* ; Vomiting

PURPOSE: Osteolysis has become a major cause of aseptic loosening in total hip arthroplasty. Macrophages phagocytose wear debris from implants and release the pro-inflammatory mediators such as IL-1beta, IL-6, TNF-alpha and nitric oxide. We evaluated the effects of metal patricles on the release of bone-associated cytokines and nitric oxide from J774 mouse macrophage cell line. MATERIALS AND METHODS: Titanium-Aluminum-Vanadium (Ti6Al4V) and Cobalt-Chrome-Aluminium (CoCr) particles were loaded and nitric oxide production was measured indirectly by the nitrite assay. The effect on cell proliferation, and apoptosis were also investigated with non-isotopic proliferation assay, and ELISA to DNA and histone. The levels of two proinflammatory cytokines, IL-6 and TNF-alpha, were measured with ELISA. The modulatory effect of anti-inflammatory cytokine on the nitrite, IL-6 and TNF-alpha production was additionally investigated. RESULTS: Nitrite levels increased after administration of Ti6Al4V and CoCr particle. IL-10 and IL-4 inhibited the production of nitrite with TiAl4V particle, but not in significant amount with CoCr particles. Cellular proliferative activity decreased and apoptosis increased after administration of Ti6Al4V and CoCr particle. Levels of IL-6 and TNF-a increased with both particles. IL-10 and IL-4 inhibited the production of IL-6 and TNF-alpha in varying degrees. CONCLUSION: Our data confirmed the increased production of pro-inflammatory cytokines and nitric oxide with metal particles and the inhibitory effect of IL-10 and IL-4 on the production of these substances, and suggest differences in the specific action between different metal particles.
Animals ; Apoptosis ; Arthroplasty, Replacement, Hip ; Cell Line ; Cell Proliferation ; Cytokines* ; DNA ; Enzyme-Linked Immunosorbent Assay ; Histones ; Interleukin-10 ; Interleukin-4 ; Interleukin-6 ; Macrophages ; Mice ; Nitric Oxide ; Osteolysis* ; Tumor Necrosis Factor-alpha

PURPOSE: Osteolysis has become a major cause of aseptic loosening in total hip arthroplasty. Macrophages phagocytose wear debris from implants and release the pro-inflammatory mediators such as IL-1beta, IL-6, TNF-alpha and nitric oxide. We evaluated the effects of metal patricles on the release of bone-associated cytokines and nitric oxide from J774 mouse macrophage cell line. MATERIALS AND METHODS: Titanium-Aluminum-Vanadium (Ti6Al4V) and Cobalt-Chrome-Aluminium (CoCr) particles were loaded and nitric oxide production was measured indirectly by the nitrite assay. The effect on cell proliferation, and apoptosis were also investigated with non-isotopic proliferation assay, and ELISA to DNA and histone. The levels of two proinflammatory cytokines, IL-6 and TNF-alpha, were measured with ELISA. The modulatory effect of anti-inflammatory cytokine on the nitrite, IL-6 and TNF-alpha production was additionally investigated. RESULTS: Nitrite levels increased after administration of Ti6Al4V and CoCr particle. IL-10 and IL-4 inhibited the production of nitrite with TiAl4V particle, but not in significant amount with CoCr particles. Cellular proliferative activity decreased and apoptosis increased after administration of Ti6Al4V and CoCr particle. Levels of IL-6 and TNF-a increased with both particles. IL-10 and IL-4 inhibited the production of IL-6 and TNF-alpha in varying degrees. CONCLUSION: Our data confirmed the increased production of pro-inflammatory cytokines and nitric oxide with metal particles and the inhibitory effect of IL-10 and IL-4 on the production of these substances, and suggest differences in the specific action between different metal particles.
Animals ; Apoptosis ; Arthroplasty, Replacement, Hip ; Cell Line ; Cell Proliferation ; Cytokines* ; DNA ; Enzyme-Linked Immunosorbent Assay ; Histones ; Interleukin-10 ; Interleukin-4 ; Interleukin-6 ; Macrophages ; Mice ; Nitric Oxide ; Osteolysis* ; Tumor Necrosis Factor-alpha

We report a case of pneumonia caused by Aspergillus terreus and cytomegalovirus (CMV) in a patient with acute myleogenous leukemia (AML) after remission induction chemotherapy. A 19-year-old woman underwent chemotherapy for AML. Twenty-three days after completing chemotherapy, she experienced a neutropenic fever with a rapidly-progressive pulmonary infiltration. In those days, her serum galactomannan immunoassay was 4.7 and she was treated with intravenous voriconazole (6 mg/kg q12h for 2 doses, followed by 4 mg/kg q12h) because of persistent fever and radiological worsening, despite the administration of amphotericin B deoxycholate (1 mg/kg q24h) for 7 days. A chest CT showed wedge-shaped consolidation with a central hypodense lesion and an air-crescent sign in the right middle lobe. With maintenance therapy of oral voriconazole for 10 weeks, a partial response was shown and neutrophil count was still less than 100/mm3. A lobectomy of the right middle lobe was performed. A. terreus was discovered from the lung tissue. At the same time, giant cells with intranuclear inclusions were found and immunohistochemical staining for CMV was positive. Ganciclovir (5 mg/kg q12h) was added to voriconazole therapy for 3 weeks after surgery, and then cord blood hematopoietic stem cell transplantation (HSCT) was performed. During HSCT, foscarnet (60 mg/kg q12h) was substituted for ganciclovir, and both antiviral agents were used alternatively due to CMV DNAemia. After 83 days from HSCT, the patient achieved successful engraftment and discharged without worsening the pneumonia.
Amphotericin B ; Antiviral Agents ; Aspergillus ; Cytomegalovirus ; Deoxycholic Acid ; Drug Combinations ; Female ; Fetal Blood ; Fever ; Foscarnet ; Ganciclovir ; Giant Cells ; Hematopoietic Stem Cell Transplantation ; Humans ; Immunoassay ; Intranuclear Inclusion Bodies ; Leukemia ; Leukemia, Myeloid, Acute ; Lung ; Mannans ; Neutrophils ; Pneumonia ; Pyrimidines ; Remission Induction ; Thorax ; Triazoles ; Young Adult

PURPOSE: To determine whether analyte levels in serum laboratory tests and arterial blood gas analysis (ABGA) are helpful for differentiating between generalized seizures and syncope in the emergency department (ED). METHODS: Patients over 18 years old who presented to an ED of a tertiary care hospital with a transient loss of consciousness within 4 hours were selected to be in either the seizure (n=166) or syncope groups (n=168). After exclusion for criteria, we used ROC curves to determine AUC, optimal cut-off value, sensitivity, and specificity, depending on time (4 hour, 2 hour, 1 hour and 0.5 hour). We also did multivariate logistic regression. RESULTS: A total of 75 seizure group patients and 78 syncope group patients were studied. There were significant between group differences in total CO2 content, LDH, ammonia, pH, bicarbonate and lactate. AUC (area under the curve) values for blood tests were: 0.720 (tCO2), 0.686 (LDH), 0.737 (ammonia), 0.798 (pH), 0.710 (bicarbonate) and 0.770 (lactate). All AUC values were increased as the time from symptoms to ED arrival was shortened (except for LDH). On multivariate logistic regression analysis, pH (OR=9.587, 95% CI, 2.573-35.723. p=0.001) and ammonia (OR=3.932, 95% CI, 1.324-11.613, p=0.014) were statistically significant independent predictive factors. CONCLUSION: Serum laboratory testing and ABGA, especially serum ammonia and arterial pH, may be helpful for differentiating between generalized seizure and syncope in patients who experience a transient loss of consciousness and who come to the ED within 4 hours after the appearance of symptoms. But further evaluation is needed.
Ammonia ; Area Under Curve ; Bicarbonates ; Blood Gas Analysis ; Diagnosis, Differential ; Emergencies ; Hematologic Tests ; Humans ; Hydrogen-Ion Concentration ; Lactic Acid ; Logistic Models ; ROC Curve ; Seizures ; Sensitivity and Specificity ; Syncope ; Tertiary Healthcare ; Unconsciousness

Radiofrequency (RF) myolysis is a minimally invasive treatment by create thermal energy in targeted uterine fibroid and cause the aseptic necrosis of leiomyoma cells. Unlike hysterectomy which is considered to be the most common treatment of uterine leiomyoma, RF myolysis can preserve the uterus, and unlike myomectomy which can preserve the uterus but requires the hospitalization and general anesthesia, it can be performed as outpatient procedure using only sedation for pain relief without additional need for medication. There are many published studies reporting the pregnancy complications and outcomes after myomectomy, but few studies regarding pregnancy and myolysis are available. We have experienced a full term vaginal delivery after RF myolysis of subserosal myoma and hereby we report our case with a brief review.
Anesthesia, General ; Hospitalization ; Humans ; Hysterectomy ; Leiomyoma ; Myoma ; Necrosis ; Outpatients ; Pregnancy ; Pregnancy Complications ; Uterus

Skeletal anterior open bite is a difficult problem to correct in orthodontic treatment. To treat adult patients who have skeletal anterior open bite, we considered two methods. Combination treatment of orthodontics & surgery and camouflage orthodontic treatment. In adults, treatment of severe skeletal anterior open bite consists mainly of surgically repositioning the maxilla or the mandible. However, camouflage therapy is often the treatment of choice for skeletal open bite patients who have mild to moderate skeletal discrepancies when growth modification is no longer possible. But excellent results generally require careful coordination of the orthodontic and surgical phases of treatment. This is a case report of a skeletal anterior open bite patients who were treated with orthodontic treatment and orthognathic surgery. First case was diagnosed as skeletal class I malocclusion & bimaxillary protrusion with anterior open bite, and finally treatment ended for removal of open bite with orthodontic procedure and bimaxillary anterior segmental osteotomy surgery. Second case was diagnosed as skeletal class II malocclusion with open bite & mandibular retrusion, and was treated with only camouflage orthodontics because she feared to have a surgery. In a regular follow up visit after debonding we proposed to the patient advanced genioplasty, and in her agreement her facial esthetics was improved through the surgery.
Adult ; Esthetics ; Follow-Up Studies ; Genioplasty ; Humans ; Malocclusion ; Mandible ; Maxilla ; Open Bite ; Orthodontics ; Orthognathic Surgery ; Osteotomy ; Retrognathia

In spite of decrease in prevalence, yet tuberculosis is not rare disease in Korea and the morbidity is over one percent. Because extrapulmonary tuberculosis is less common than that of lung, quick and accurate diagnosis is not easy and there may be some problems in selecting the methods and the times to treat it. Especially, each or combination of abdominal lymphadenitis and duodenal tuberculosis are so rare that differential diagnosis from other common or rare diseases is difficult, and much attention is required to diagnose and treat those. Recently we experienced a case of tuberculous lymphadenitis accompanied by duodenal bulbar tuberculosis which had been conceived as submucosal tumor at endoscopy and diagnosed by explorative operation. So we report this case with review of related literatures.
Diagnosis ; Diagnosis, Differential ; Endoscopy ; Korea ; Lung ; Lymphadenitis ; Prevalence ; Rare Diseases ; Tuberculosis* ; Tuberculosis, Lymph Node*

The area of endoscopic application has been continuously expanded since its introduction in the last century and the frequency of its use also increased stiffly in the last decades. Because gastrointestinal endoscopy is naturally exposed to diseased internal organs and contact with pathogenic materials, endoscopy mediated infection or disease transmission becomes a major concern in this field. Gastrointestinal endoscopy is not for single use and the proper reprocessing process is a critical factor for safe and reliable endoscopy procedures. What needed in these circumstances is a practical guideline for reprocessing the endoscope and its accessories which is feasible in the real clinical field to guarantee acceptable prevention of pathogen transmission. This guideline contains principles and instructions of the reprocessing procedure according to the step by step. And it newly includes general information and updated knowledge about endoscopy-mediated infection and disinfection. Multiple societies and working groups participated to revise; Korean Association for the Study of the Liver, the Korean Society of Infectious Diseases, Korean College of Helicobacter and Upper Gastrointestinal Research, the Korean Society of Gastroenterology, Korean Society of Gastrointestinal Cancer, Korean Association for the Study of Intestinal Diseases, Korean Pancreatobiliary Association, the Korean Society of Gastrointestinal Endoscopy Nurses and Associates and Korean Society of Gastrointestinal Endoscopy. Through this cooperation, we enhanced communication and established a better concordance. We still need more researches in this field and fill up the unproven area. And our guidelines will be renewed accordingly.