Recently autogenous nerve graft was usually used for segmental defect of peripheal nerve injury. In case of inappropriate size or amount of donor nerve graft, there were many studies included nerve regeneration with special nerve conduit material. To compare the result of autogenous nerve graft with that of silicone tubing method in segmental defect of sciatic nerve, the experiments were carried out on adult rats with autogenous nerve graft on the left side and silicone tubing on the right side. The results were as follows; 1. Myelinated nerve fibers were larger in silicone tubing method than autogenous nerve graft at postop. 4 weeks. 2. There was no difference in nerve regeneration in both groups at postop. 12 weeks. 3. Some atrophic changes were showed in denervated muscles in both groups at postop. 4 weeks. Skeletal muscle changes between the two groups were meagre. 4. Perineural adhension was rare in silicone tubing group in contrast to autogenous nerve graft group. 5. Nerve Conduction Velocity was similar between autogenous nerve graft and silicone tubing method after 4 weeks postoperatively. In conclusion, this study suggests that silicone tubing can be useful method to repair the large nerve gaps and has a potential clinical utilization in large segmental nerve defect.
Adult ; Animals ; Autografts ; Humans ; Methods ; Muscle, Skeletal ; Muscles ; Nerve Fibers, Myelinated ; Nerve Regeneration ; Neural Conduction ; Rats ; Sciatic Nerve ; Silicon ; Silicones ; Tissue Donors ; Transplants

OBJECTIVE: Adult onset Still s disease is an acute systemic inflammatory disorder. There are no pathognomonic symptoms or specific laboratory abnormalities. In recent reports, serum ferritin concentration is increased in active disease phase and decreased after defervescence. Our purpose was to determine the clinical significance of serum ferritin as an indicator for disease activity. METHODS: Seven patients who were diagnosed as adult onset Still s disease at Samsung Medical Center between October 1994 and March 1997, were reviewed. In these patients we checked leukocyte count, ESR, CRP and serum ferritin concentrations at the time of diagnosis and during follow-up periods and recorded febrile events during follow-up periods. RESULTS: At the time of diagnosis and during febrile periods, the concentrations of ferritin were extremely high(927ng/ml to 96,650ng/ml normal 10-290.8 ng/ml). The values were unrelated to other manifestations of the disease or laboratory findings. The ferritin concentrations decreased rapidly after adequate treatment. Eleven febrile reattacks happened in 7 patients. Serum ferritin concentrations were increased in 8 febrile attacks, while leukocyte count, ESR, and CRP were increased in 5, 5, 6 febrile attacks respectively, There were 10 events of increased serum ferritin concentrations in 7 patients during follow-up periods and 8 events were related with fever. The increases of other laboratory tests were similar. CONCLUSIONS: In all patients, serum ferritin concentrations were increased at the time of diagnosis and closely related to fever. During follow-up periods, serum ferritin concentrations are helpful in monitoring disease activity and guiding decisions about treatment.
Adult* ; Diagnosis ; Ferritins* ; Fever ; Follow-Up Studies ; Humans ; Leukocyte Count ; Still's Disease, Adult-Onset*

No abstract available.
Compartment Syndromes*

Liver function tests before treatment showed abnormalities of liver function tests during treatment, while 15(68. 2%) of 22 patients who had abnormal liver function tests before treatment showed abnormalities during treatment. In 12 of the 25 patients who showed abnormalities of liver function tests during treatment with allopurinol, allopurinol was stopped and all patients showed improvement of liver function tests. In remaining 13 patients, 10 patients were improved and other 2 patients showed only mild abnormalities of liver function tests despite of continuing allopurinol and 1 patient was lost during follow-up. CONCLUSION: Abnormalities of liver function tests were common during treatment with allopurinol. Most patiensts who had mild abnormalities of liver functions tests during treatment with allopurinol were improved regardless of continuing allopurinol.
Allopurinol* ; Follow-Up Studies ; Gout* ; Humans ; Liver Function Tests* ; Liver*

Background: The brain magnetic resonance imaging (MRI) findings seen in patients with Bell's palsy are abnormal contrast enhancement of affected facial nerves. Previous evaluation included mainly patients who had experienced palsy for several weeks and there are no studies to date on patients with late stage of Bell’s palsy. This study investigated the findings of MRI of Bell's palsy after 3 months of symptom onset to assess how long the enhancement last. Methods: Among the patients with Bell's palsy (idiopathic unilateral facial palsy) who visited the hospital, 9 patients who underwent contrast-enhanced MRI of the internal auditory canal after 3 months of symptom onset were reviewed retrospectively. MRI examination results were investigated along with the patient's clinical symptoms and electrodiagnostic test results. Based on the MRI results, the frequency of abnormal contrast enhancement and contrast-enhanced areas were investigated. Results: 9 patients were included. 6 of them did MRI imaging because of incomplete recovery of facial palsy and the others did because of complication of facial palsy including synkinesis and hemifacial spasm. Time interval between symptom onset and evaluation was 17 months (3-84). Of 9 patients, 2 showed abnormal enhancement of affected nerve and they performed MRI after 5 months and 12 months of symptom onset, respectively. Conclusions Abnormal enhancement of facial nerve in Bell’s palsy could last up to one year. This awareness can be helpful in interpretation of MRI of Bell’s palsy.

Bone defect of the long bone continues to challenge orthopedic surgeons. It is usually very difficult to obtain union. Ilizarov ext. fixation has recently gained popularity as a multifactorial approach to the management of tibial bone defect because nonunion, bone defects, limb shortening, and deformity can all be addressed simultaneously with the Ilizarov apparatus. From February 1992 to May 1993 at the department of orthopedic surgery, Inje University Pusan Paik Hospital, 9 patients aged from 8 to 37 years were treated for tibial bone defect. The causes were open comminuted fractures with initial bone loss and bone defect after removal of infected necrotic bone. Bony defect size was ranged from 2cm to 14cm, averaging 7.2cm. Bony defects were gradually closed by the Ilizarov's internal bone transport technique, and final equalization of leg length discrepancy was achieved by means of external lengthening technique. Soft tissue defects were treated with secondary closure, split thickness skin graft, and muscle flap. The average healing index was 42.8 days/cm. According to Paley's classification the complications were developed as follows; The problem included pin tract infection(9), knee flexion contracture(4), and intractable pain(1), the obstacles included delayed union(3) and premature consolidation(1), the complication included nonunion(9) and equinus ankle(1). At an average 1 years follow up, according to Paley and Catagnl's classification, body and functional results were either excellent or good in 7 cases. So, we recommend that Ilizarov technique is very useful treatment for open fracture with bone loss, bone defect after removal of infected necrotic bone and limb shortening.
Busan ; Classification ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Fractures, Comminuted ; Fractures, Open ; Humans ; Ilizarov Technique ; Knee ; Leg ; Orthopedics ; Skin ; Surgeons ; Tibia ; Transplants

PURPOSE: Early identification of neonatal sepsis is a global issue because of limitations in diagnostic procedures. The objective of this study was to compare the diagnostic accuracy of neutrophil CD64 and C-reactive protein (CRP) as a single test for the early detection of neonatal sepsis. METHODS: A prospective study enrolled newborns with documented sepsis (n=11), clinical sepsis (n=12) and control newborns (n=14). CRP, neutrophil CD64, complete blood counts and blood culture were taken at the time of the suspected sepsis for the documented or clinical group and at the time of venipuncture for laboratory tests in control newborns. Neutrophil CD64 was analyzed by flow cytometry. RESULTS: CD64 was significantly elevated in the groups with documented or clinical sepsis, whereas CRP was not significantly increased compared with controls. For documented sepsis, CD64 and CRP had a sensitivity of 91% and 9%, a specificity of 83% and 83%, a positive predictive value of 83% and 33% and a negative predictive value of 91% and 50%, respectively, with a cutoff value of 3.0 mg/dL for CD64 and 1.0 mg/dL for CRP. The area under the receiver-operating characteristic curves for CD64 index and CRP were 0.955 and 0.527 (P<0.01), respectively. CONCLUSION: These preliminary data show that diagnostic accuracy of CD64 is superior to CRP when measured at the time of suspected sepsis, which implies that CD64 is a more reliable marker for the early identification of neonatal sepsis as a single determination compared with CRP.
Blood Cell Count ; C-Reactive Protein ; Humans ; Infant, Newborn ; Neutrophils ; Phlebotomy ; Prospective Studies ; Sensitivity and Specificity ; Sepsis

C-kit-negative gastrointestinal stromal tumors (GISTs) are uncommon, and there have been few reports about the diagnosis and treatment of c-kit-negative GISTs in the stomach. We report the case of a patient who was diagnosed with a huge and atypical GIST in the stomach. The GIST was completely resected and finally diagnosed as c-kit-negative GIST based on immunohistochemical staining of tumor cells, which were negative for CD117 and CD34 and positive for Discovered on GIST-1 (DOG1). C-kit-negative GISTs could be treated by complete resection and/or imatinib, which is the same treatment for c-kit-positive GISTs.
Diagnosis ; Gastrointestinal Stromal Tumors* ; Humans ; Proto-Oncogene Proteins c-kit ; Stomach* ; Imatinib Mesylate

Immunoglobulin G4-related disease (IgG4-RD) can involve any organ. The majority of reported cases involve IgG4-RD of the biliary tract or pancreas, while only two cases of pericarditis have been reported. A 58-year-old man visited the outpatient clinic of our institution with a seven-day history of progressive dyspnea. Based on his transthoracic echocardiogram and transesophageal echocardiogram, he was diagnosed with constrictive pericarditis. The histopathology of his pericardiectomy revealed the cause of constrictive pericarditis to be IgG4-RD. Prednisolone (40 mg) was initiated after the pericardiectomy. As the patient's symptoms resolved, he was discharged and followed-up on an outpatient basis. This is the first case report of constrictive pericarditis caused by IgG4-RD in Korea.
Ambulatory Care Facilities ; Biliary Tract ; Dyspnea ; Humans ; Immunoglobulin G ; Immunoglobulins* ; Inflammation ; Korea ; Middle Aged ; Outpatients ; Pancreas ; Pericardiectomy ; Pericarditis ; Pericarditis, Constrictive* ; Prednisolone