The previous reports about Supracondylar-Condylar Fracture of the femur which extends to articular surfaces revealed poor results in general, regardless of the methods of treatment. But those results are thought to be much alleviated if they are treated according to the principles of ASIF. Fifteen cases of Supracondylar-condylar fractures of the femur from 13 patients were treated by open reduction and rigid internal fixation during last 3 years at Department of Orthopedic Surgery, Early mobilization of knee joint was permissible in most of the cases without loss of fixation or other complications during convalescence Subsequently, greatifying results were obtained as observed in varying period of follow up days.
Convalescence ; Early Ambulation ; Femur ; Follow-Up Studies ; Humans ; Knee Joint ; Orthopedics

Two patients with flexor paralysis of the elbow due to brachial plexus injury and three patients with flexor paralysis of the wrist and fingers due to Volkmann's contracture were treated by transplantation of the gracilis muscle which was detached at both ends and transferred to replace the biceps and long finger flexors, preserving its long and lax neurovascular pedicle. At eleven to fifteen months after operation, the strength and flexion of the elbow were satisfactory and the additional cosmetic effect was obtained. This method should be performed only after a complete study of the patient's general functional needs and the condition of the affected arm, forearm and hand.
Arm ; Brachial Plexus ; Contracture ; Elbow ; Fingers ; Forearm ; Hand ; Humans ; Methods ; Paralysis ; Wrist

PURPOSE: CD34+ cells from umbilical cord blood (UCB) were cultured with stromal cells and growth factors, and cell proliferation and megakaryocytic differentiation were observed. The purposes of this study are to find out the optimal culture condition for the megakaryocytic differentiation of CD34+ cells from UCB. METHODS: CD34+ cells of mobilized peripheral blood (PB) and UCB were cultured in IMDM at a concentration of 1x105 cells/mL for 11 days. Thrombopoietin (TPO) 5 ng/mL and 50 ng/mL, flt-3 ligand (FL) 50 ng/mL and stem cell factor (SCF) 50 ng/mL were used as growth factors. Stromal cells cultured from bone marrow (BM) mononuclear cells appeared as a single layer of fusiform adherent cells with expression of SH-2 and ASMA. RESULTS: When PB CD34+ cells were cultured with growth factors only, the cell number increased in TPO 5 ng/mL and 50 ng/mL, TPO and FL, TPO, FL and SCF group increased upto mean 2.0 (in TPO 5 ng/mL), 2.9 (in TPO 50 ng/mL), 2.4 (TPO and FL), 2.8 (TPO, FL and SCF) fold, and the expression of CD61a were mean 11.5%, 12.5%, 13.2% and 17.0%, respectively. When the stromal cells were added to the growth factors, the cell number increased upto mean 4.6, 4.9, 9.2 and 68.5 fold and CD61a were expressed in mean 43.1%, 48.4%, 35.6%, and 6.2% of cultured cells. For UCB CD34+ cells, the cell number were increased upto 7.5, 7.6, 8.2 and 23.6 fold with growth factors and stromal cells. Expression of CD61a were mean 26.0%, 34.3%, 31.5% and 23.5%, respectively. CONCLUSION: Stromal cell enhanced the cellular proliferation and megakaryocytic differentiation of UCB CD34+ cells. The combination of TPO, FL and SCF increased total cell number upto the highest value but the proportion of the CD61a+ cells were relatively low. The combination of TPO and FL induced both cellular proliferation and megakaryocytic differentiation in a large amount.
Bone Marrow ; Cell Count ; Cell Proliferation ; Cells, Cultured ; Fetal Blood* ; Intercellular Signaling Peptides and Proteins* ; Stem Cell Factor ; Stromal Cells* ; Thrombopoietin ; Umbilical Cord*

We report a case of Rumpel-Leede (RL) phenomenon, - acute dermis capillary rupture, secondary to noninvasive blood pressure (NIBP) monitoring in a patient with type 2 diabetes mellitus (DM) and hypertension. The first most likely cause is vascular fragility in microangiopathy as a result of DM and chronic steroid use. The second is the increased venous pressure during cycling of the blood pressure cuff in a hypertensive state. Anesthesiologists need to be aware that acute dermal capillary rupture, although rare, can occur in patients with long-standing DM, hypertension and chronic steroid use.
Blood Pressure ; Capillaries ; Dermis ; Diabetes Mellitus, Type 2 ; Humans ; Hypertension ; Rupture ; Venous Pressure

No abstract available.
Cavernous Sinus* ; Dura Mater ; Meningitis ; Tuberculosis*

BACKGROUND: Adequate evaluation and monitoring for pre-eclamptic paturient and capable assistance before induction for anesthesiologist, must be taken to avoid sudden severe maternal hypertension with intubation during a Rapid Sequence intravenous induction. Such event predispose the paturient to intracranial hemorrhage and pulmonary hypertension with pulmonary edema. To diminish danger of hypertension that can be developed during general anesthesia and facilitate control of blood pressure, 24 women presenting for cesarean section were studied. METHODS: All received 17.9+/-2.6ml of 0.5% bupivacaine, including 3ml of test dose, through the epidural catheter inserted in T12-L1 interspace using 18 gauge Tuohy needle to the patients with a lateral decubitus position. We measured blood pressure and heart rate in 5, 10, 15, 20, 30, 45, and 60 minutes after injection of 0.5% bupivacaine and 15 minutes after transferred to recovery room. RESULTS: The blood pressure of the patients started to decrease in 5 minutes and most decreased in 20 minutes after injection, the heart rate had little change but decreased significantly in 45 minutes. Apgar Scores of the neonates at 1 and 5 minutes were 7.3+/-2.0 and 9.2+/-1.5. The patients used ephedrine and crystalloid solution for correction of hypotension were 6 of 24 women and had no any systemic toxicity or neurologic symptoms by local anesthetics(bupivacaine). CONCLUSION: Continuous epidural anesthesia for cesarean section in preeclamptic patients is recommended for safe anesthesia.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Blood Pressure ; Bupivacaine ; Catheters ; Cesarean Section* ; Ephedrine ; Female ; Heart Rate ; Humans ; Hypertension ; Hypertension, Pulmonary ; Hypotension ; Infant, Newborn ; Intracranial Hemorrhages ; Intubation ; Needles ; Neurologic Manifestations ; Pregnancy ; Pulmonary Edema ; Recovery Room

PURPOSE: For separation of RBC from cord blood, it is important to minimize RBC contamination without significant loss of nucleated cells using sedimentation agent that is safe for human use. This study was performed to investigate the possibility of replacing 6% hydroxyethylstarch (HES) with 10% pentastarch (PS) which is a lower molecular weight hetastarch-analog that is cleared from the circulation rapidly. METHODS: After dilution of cord blood till hematocrit 25%, PS or HES were added by the ratio of 7:1 and 5:1 respectively. Sedimentation was performed for 2 hours by gravity. RESULTS: PS was used in 14 cases with volume of 72.4+/-22.3 mL (45~126 mL) and HES in 8 cases with volume of 58.4+/-8.0 mL (50~70 mL). Sedimentation rate has reached at plateau by 90 minutes in PS group and it was slightly faster than in HES group. Recovery rate of nucleated cells and residual RBC were 82.9+/-10.7%, 7.6+/-5.4% in PS group, and 84.0+/-4.7%, 10.7+/-2.3% in HES group. There were no significant differences between the two groups (P=0.657, 0.219). Cell viabilities were high in both groups; 92+/-3% before separation and 97+/-2% in PS group and 98+/-3% in HES group. CD34+ cells were 0.75+/-0.28% before separation and 0.64+/-0.21% in PS group and 0.60+/-0.30% in HES group (P=0.690). CFU-GM after 2 week culture were 27.4+/-20.0 per 1 105 mononuclear cells in PS group and 22.9+/-8.6 in HES group (P=0.856). CONCLUSION: These results demonstrated that PS has similar efficacy to HES for separation of RBC from umbilical cord blood. Considering its rapid clearance and faster sedimentation rate, PS can replace HES for RBC separation in cord blood banking.
Cell Survival ; Fetal Blood* ; Granulocyte-Macrophage Progenitor Cells ; Gravitation ; Hematocrit ; Humans ; Hydroxyethyl Starch Derivatives* ; Molecular Weight

PURPOSE: Recently Wilms tumor gene (WT1) transcripts have been detected in leukemia regardless of the disease subtype and the specific DNA markers suggesting that WT1 gene might be a useful panleukemic marker for monitoring minimal residual disease (MRD). This study was performed to investigate the expression of WT1 gene by a quantitative methods and to find the prognostic value of WT1 gene in childhood acute leukemia. METHODS: From the mononuclear cells isolated from bone marrow aspirates and peripheral bloods of 22 childhood acute and chronic leukemia patients, mRNA were extracted for the reverse transcriptase-polymerase chain reactions (RT-PCR). Relative levels of WT1 gene expression was calculated by using the value in K562 cell line to be 1.00 as a positive control. RESULTS: The sensitivity of detection of MRD with WT1 primers was 10 4 and comparable to that of bcr/abl expression in K562 cells and a patient with CML in blast crisis. WT1 gene expression was detected in 17 of 22 (77%) patients; 9/10 of acute lymphoblastic leukemia (ALL), 6/10 acute myelogenous leukemia (AML), 1 acute mixed lineage leukemia (AMLL) and 1 chronic myelogenous leukemia (CML) in blast crisis. In 4 AML patients who received autologous peripheral blood stem cell transplantation (PBSCT), two patients relapsed after reappearance of WT1 gene expression in bone marrow aspirates and the remaining two were in complete remission without expression of WT1 gene. CONCLUSION: These results show that WT1 gene expression is frequently noted in childhood acute leukemia and can be a useful sensitive marker for the detection of MRD comparable to bcr/abl transcripts. WT1 gene can be used as a panleukemic marker for the MRD monitoring for the evaluation of the remission status and in predicting early relapse in children with acute leukemia in the molecular levels. It may also be a useful tool for the detection of leukemic cell contamination in the process of peripheral blood stem cell transplantation.
Blast Crisis ; Bone Marrow ; Cell Line ; Child ; Gene Expression ; Genetic Markers ; Humans ; K562 Cells ; Leukemia* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemia, Myeloid, Acute ; Neoplasm, Residual ; Peripheral Blood Stem Cell Transplantation ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Recurrence ; RNA, Messenger ; Wilms Tumor

BACKGROUND AND OBJECTIVES: We evaluated the utility of two-dimensional (2D) and three-dimensional (3D) left ventricular (LV) global myocardial deformity parameters for assessing LV diastolic function by comparing invasive measures of LV performance. SUBJECTS AND METHODS: Echocardiography and LV pressure were assessed in 39 patients. Myocardial LV longitudinal, circumferential, and radial deformations, as well as area strain, were evaluated utilizing 2D and 3D speckle tracking software. The 2D early diastolic strain rate (2D-SRe) was measured from the 3 apical and 3 short axis views. The 3D diastolic index (3D-DI) was calculated by the % change of global strain during the first one-third of the diastolic period. LV end diastolic pressure (LVEDP) and the rate of LV pressure change (dP/dt) were collected using a pressure-conducted catheter and tau was calculated. RESULTS: dP/dt(min) were related to early mitral annular velocity (e'), 2D-SRe(long), 2D-SRe(radial), as well as 3D-DI(long), and 3D-DI(as). Additionally, LVEDP was associated with the ratio of mitral early diastolic velocity (E) to 2D-SRe(long), 2D-SRe(circ), 2D-SRe(radial), 3D-DI(long), 3D-DI(circ), and 3D-DI(as). E/2D-SRe(long), E/2D-SRe(radial), E/3D-DI(long), and E/3D-DI(as) were comparable with E/e' in predicting patients with elevated LVEDP. Among those patients with E/e' of 8 to 15, E/3D-DI(long) provided incremental value in identifying those with LVEDP > or =15 mm Hg. CONCLUSION: 2D-SRe(long), 2D-SRe(radial), 3D-DI(long), and 3D-DI(as) were related to LV relaxation, and the ratios of E to those parameters were associated with LVEDP. In addition, among patients with indeterminate E/e', E/3D-DI(long) offered incremental value in predicting elevated LVEDP, suggesting it may provide supplementary information in the evaluation of LV diastolic function.
Axis, Cervical Vertebra ; Blood Pressure ; Catheters ; Congenital Abnormalities ; Diastole ; Echocardiography ; Humans ; Relaxation ; Sprains and Strains ; Track and Field ; Ventricular Pressure

PURPOSE: Blowout fracture is an outward fracture of the orbital wall. That usually occurs at inferior or medial wall of the orbit. The main pathophysiology is high intraocular pressure derived from impact of trauma. Among the four orbital wall, the medial wall is thinnest and most vulnerable to trauma. Many kinds of methods were introduced for correction of medial orbital wall fracture. Recently, transnasal endoscopic reconstruction methods were widely used. Endoscopic methods had many advantages. However, we experienced some cases of postoperative maxillary sinusitis. This study was planned to find out the effectiveness of middle meatal antrostomy after endoscopic reconstruction of medial orbital wall fracture. METHODS: This study was retrospective analysis of 28 patients who underwent transnasal endoscopic repair of medial orbital wall fracture. The 18 male and 10 female patients were ranged from 17 to 57 years of age(mean, 30.9 years). Among 28 patients, randomly selected 17 patients underwent middle meatal antrostomy as additional procedure by the same surgeon. After at least 12 months of follow-up period, we examined the nasal symptom, endoscopic and CT findings. RESULTS: One patient complained of nasal obstruction in middle meatal antrostomy group and four patients complained nasal symptoms in non middle meatal antrostomy group. On the endoscopic findings, three patients of non middle meatal antrostomy group had continuous nasal discharge. But middle meatal antrostomy group had no abnormal endoscopic findings. The abnormal CT finding(abnormal mucosal hypertrophy) were detected in four patient of non middle meatal antrostomy group. There were no abnormal CT findings in middle meatal antrostomy group. The data were statistically significant at comparative study. CONCLUSION: Authors think that the middle meatal antrostomy has some advantages as a additional procedure of endoscopic reconstruction of medial orbital wall fracture. Especially, it is good at preventing post- operative maxillary sinusitis. But, more larger group and strict application of disease entity are need for correct evaluation of middle meatal antrostomy effect.
Female ; Follow-Up Studies ; Humans ; Intraocular Pressure ; Male ; Maxillary Sinus ; Maxillary Sinusitis ; Nasal Obstruction ; Orbit* ; Orbital Fractures* ; Retrospective Studies