Purpose: We evaluated, retrospectively, twenty hips that had undergone revision surgeries because of massive pelvic osteolysis in order to determine the retention rate of acetabular metal shells and polyethylene liner exchanges.. Materials and Methods: We performed liner exchanges for massive osteolysis around stable HG acetabular cups with severe polyethylene wear in twenty-three hips, between June 1996 and May 2003. Clinical and radiological follow-up was available for 20 hips for more than 2 years. In 18 hips, we performed curettage of the granulomatous tissue and tightly packed morselized cancellous allografts into the screw holes or the peripheral rims for the acetabular osteolytic lesions. The mean follow-up period was 3.8 years (range, 2.4 to 9.3 years) and the mean of time from the primary total hip arthroplasties to the component exchanges, was 8.2 years (range, 5.6 to 12.4 years). Results: During the follow-up period, all of the hips were functioning well, and none required any subsequent repeat surgeries. Dislocations occurred three times after the repeat operations in one hip, which was treated successfully with an abduction brace. None of the hips demonstrated a progression of the pre-existing osteolytic lesions or the development of any new osteolytic lesions. At the final follow-up, none of the acetabular components demonstrated any evidence of loosening. Conclusion: Our results demonstrated that isolated liner exchanges and debridement of the granulomatous tissue, with or without bone grafting, can be an effective alternative solution to revision of the cup for massive osteolysis around well-fixed, cementless, acetabular cups in selected patients. Retention of the pre-existing cementless acetabular cup provides less intra-operative and post-operative morbidity. However, in order to determine the longevity of the retained cementless acetabular cups, further long-term studies are necessary.
Acetabulum* ; Allografts ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Bone Transplantation ; Braces ; Curettage ; Debridement ; Dislocations ; Follow-Up Studies ; Hip ; Humans ; Longevity ; Osteolysis* ; Osteolysis, Essential ; Polyethylene ; Retrospective Studies ; Transplants*

We performed scleral grafting with autogenous temporalis fascia and autogenous conjunctiva in 32 patients (32 eyes) in scleral necrosis after pterygium excision. The average age of patients was 54.3 years (range, 38 to 74 years). Nine of them were male and twenty-three were female. The intervals between pterygium excision and scleral necrosis were from 2 months to 23 years (mean, 6.2 years). After the mean follow-up 6.6 months, in 29 eyes graft was stably adhered but in three eyes graft was melted. Conjunctival wound dehiscence and conjunctival necrosis were noticed in three eyes and one eye respectively. There were no cases showing significant difference between the preoperative and the postoperative visual acuity and intraocular pressure. Autogenous temporalis fascia appears to be a good alternative to homologous sclera for scleral reinforcement.
Conjunctiva ; Fascia* ; Female ; Follow-Up Studies ; Humans ; Intraocular Pressure ; Male ; Necrosis* ; Pterygium* ; Sclera ; Transplants* ; Visual Acuity ; Wounds and Injuries

The isolated spleen involvement is a rare presentation of Langerhans cell histiocytosis (LCH) and can lead to a misdiagnosis. We report a case of LCH in an infant presentated isolated splenomegaly and prolonged fever. A 1-month-old girl admitted due to petechiae, presented with fever for a week and splenomegaly, and showed marginal improvement on empirical treatment. The fever and progressive spleen enlargement persisted over 4 weeks and the cause remained unclear, even after thorough evaluation including bone marrow aspiration and biopsy. LCH was confirmed by splenectomy, and involvement of other organs was excluded. Splenectomy is valuable in the diagnosis of LCH presented with isolated splenomegaly without other organ involvement which may show more aggressive clinical course, but it should be limited to absolutely necessary indications.
Biopsy ; Bone Marrow ; Diagnosis ; Diagnostic Errors ; Female ; Fever of Unknown Origin ; Fever ; Histiocytosis, Langerhans-Cell ; Humans ; Infant ; Infant, Newborn ; Purpura ; Spleen ; Splenectomy ; Splenomegaly

We conducted experimental studies to evaluate the possibility of Dacron patch for artificial sclera and to gain basic data for practical approach. Forty eyes of twenty rabbits were randomly assigned to experimental or control eye in both eyes. The lamellar-thickness scleral resection was performed and followed by implantation of Dacron and homologous scleral patch respectively. We examined them after one, two, four and 12 weeks. Grossly adhesion of Dacron patch was stable after four weeks. Histologically Dacron graft evoked an outer capsule and a well-vascularized granulomatous foreign body reaction. There were fibrous and vascular ingrowth securety anchored graft to bed and adhesion was uniform and firm throughout the tissue. Attachment of homolgous graft to bed was poor after 1 week but stable after two weeks. Dacron patch appears to be a good alternative to homologous sclera for scleral reinforcement.
Fibroblasts ; Foreign-Body Reaction ; Polyethylene Terephthalates* ; Rabbits ; Sclera ; Transplants*

PURPOSE: We investigated the incidence and clinical course of hypoalbuminemia and identified relevance of prognosis including mortality in extremely low birth weight infants (ELBWIs). Also, we assessed the efficacy of intravenous albumin infusion. METHODS: A retrospective study including 83 preterm infants <1,000 g of birth weight who were admitted to Ajou university hospital's neonatal intensive care unit from January 2008 to December 2012 was performed. Patients were divided into the normoalbuminemia (> or =2.5 g/dL serum albumin, n=42) group and the hypoalbuminemia (<2.5 g/dL serum albumin, n=41) group, and also the hypoalbuminemia group were subdivided into the intravenous albumin infusion group (n=36) and the control group (n=5). RESULTS: Of those 83 ELBWIs, 41 infants (49.4%) were classified as the hypoalbuminemia group. Associated conditions with hypoalbuminemia were patent ductus arteriosus (PDA, 19.5%), intraventricular hemorrhage (IVH, > or =grade III, 4.9%), necrotizing enterocolitis (NEC, > or =stage IIa, 46.3%), pneumonia (4.9%), sepsis (24.4%). In univariate analysis, there were no statistically significant differences in major morbidities such as PDA, IVH, NEC, bronchopulmonary dysplasia and mortality between the normoalbuminemia and the hypoalbuminemia groups except gestational age (26+6+/-2+1 vs. 26+0+/-1+5, P=0.045) and birth weight (868+/-117 vs. 783+/-121, P=0.002). In multivariate logistic regression, birth weight is the only meaningful factor associated with hypoalbuminemia (OR.995, 95% CI .990-.999, P=0.019). The mortality (47.2% vs. 0%, P=0.065) and morbidities did not differ between the intravenous albumin infusion and the control group. CONCLUSION: In ELBWIs, there were no significant differences in major morbidities and mortality between the hypoalbuminemia and the normoalbuminemia groups. The lower birth weight is the only factor associated with hypoalbuminemia. In addition, major morbidities and mortality rate were not affected by the albumin infusion.
Birth Weight ; Bronchopulmonary Dysplasia ; Ductus Arteriosus, Patent ; Enterocolitis, Necrotizing ; Gestational Age ; Hemorrhage ; Humans ; Hypoalbuminemia* ; Incidence ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Logistic Models ; Mortality ; Pneumonia ; Prognosis ; Retrospective Studies ; Sepsis ; Serum Albumin

Cerebral vascularization by omental transposition or transplantation to the brain has been applied in experimental and clinical cerebral ischemia. However, in these operative procedures, it has not been discussed whether arachnoid dissection would produce significant benefit in cerebral vascularization. The purpose of this experiment is to observe the effect of arachnoid dissection upon cerebral vascularization in omental transposition to the brain. Forty healthy adult cats underwent partial craniectomy with dural opening and were divided into four experimental groups; Group 1-control group, Group 2-temporal muscle covering over the brain surface, Group 3-omental transposition to the brain surface and Group 4-omental transposition with arachnoid dissection. After 3 weeks of clinical observation on the occurrence of convulsive seizures, animals were subjected to permanent occlusion of middle cerebral artery by transorbital approach. For 24 hours, neurologic deficits were checked and then animals were sacrificed to evaluate the size of cerebral infarction. The results were as follows: 1) Convulsive seizures were observed in 2 cases among all the animals, but there was no statistically significant difference in the occurrence rate among each group. 2) Animals in groups of omental transposition revealed mild neurologic deficits, as compared to those in the control group and the group of temporal muscle covering. 3) There was no statistically significant difference in the size of cerebral infarction between the control group and the group of temporal muscle covering. But in groups of omental transposition, the size of infarction was remarkably small as compared to the control group and the group of temporal muscle covering (P<0.05). 4) Of the two groups of omental transposition, the group of arachnoid dissection showed smaller size of cerebral infarction (P<0.05). 5) There was a tendency that the infarcted area enlarged progressively as neurologic deficits were severely impaired, but the difference was not statistically significant. 6) Cerebral vascularization was most effectively produced in the group of omental transposition with arachnoid dissection.
Adult ; Animals ; Arachnoid* ; Brain Ischemia ; Brain* ; Cats ; Cerebral Infarction ; Humans ; Infarction ; Middle Cerebral Artery ; Neurologic Manifestations ; Seizures ; Surgical Procedures, Operative ; Temporal Muscle

BACKGROUND: Dobutamine stress echocardiography(DSE) is useful detection of coronary artery disease as a noninvasive test. The purpose of this study is to find predicting factors of multivessel disease (MVD) in DSE. METHODS: Sixty-five patients suspicious of coronary artery disease excluding myocardial infarction on clinical base had undergone DSE and coronary arteriography. We divided the patient group into normal group (22 patients), single vessel disease(SVD) group(25 patients) and multivessel disease (MVD) group (18 patients) according to the findings of the findings of coronary angiogram. DSE findings and hemodynamic change during stress were analyzed and compared in these groups. We defined MVD on DSE as findings of new or aggravating regional wall motion abnormalities in 2 or more coronary artery territories, and significant stenosis on coronary angiogram as stenosis of 50% or more. RESULTS: 1) The numbers of diseased vessel evaluated by DSE showed significant correlation with those evaluated by coronary angiogram. 2) Resting, low-dose and peak-dose wall motion scores were significantly different among 3 groups, being higher in MVD group than in SVD and normal group. 3) Total administered dose of dobutamine in MVD group was significantly lower than that of normal group. 4) Heart rate at peak-dose showed significant difference among 3 groups, but product of heart rate and systolic blood pressure at peak-dose was not significantly different. 5) Frequency of ST segment change was significantly higher in multicessel disease group CONCLUSION: DSE reflects severity of coronary artery disease. and frequency of resting regional wall motion abnormally. wall motion score in low-dose and paak stress seems to be useful as a predictor of multivessel disease. Value of total administered dose of dobutamine, hemodynamic changes and ST segment changes as a MVD remains to be proved.
Angiography ; Blood Pressure ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Dobutamine* ; Echocardiography, Stress* ; Heart Rate ; Hemodynamics ; Humans ; Myocardial Infarction

BACKGROUND: Dobutamine stress echocardiography(DSE) is useful detection of coronary artery disease as a noninvasive test. The purpose of this study is to find predicting factors of multivessel disease (MVD) in DSE. METHODS: Sixty-five patients suspicious of coronary artery disease excluding myocardial infarction on clinical base had undergone DSE and coronary arteriography. We divided the patient group into normal group (22 patients), single vessel disease(SVD) group(25 patients) and multivessel disease (MVD) group (18 patients) according to the findings of the findings of coronary angiogram. DSE findings and hemodynamic change during stress were analyzed and compared in these groups. We defined MVD on DSE as findings of new or aggravating regional wall motion abnormalities in 2 or more coronary artery territories, and significant stenosis on coronary angiogram as stenosis of 50% or more. RESULTS: 1) The numbers of diseased vessel evaluated by DSE showed significant correlation with those evaluated by coronary angiogram. 2) Resting, low-dose and peak-dose wall motion scores were significantly different among 3 groups, being higher in MVD group than in SVD and normal group. 3) Total administered dose of dobutamine in MVD group was significantly lower than that of normal group. 4) Heart rate at peak-dose showed significant difference among 3 groups, but product of heart rate and systolic blood pressure at peak-dose was not significantly different. 5) Frequency of ST segment change was significantly higher in multicessel disease group CONCLUSION: DSE reflects severity of coronary artery disease. and frequency of resting regional wall motion abnormally. wall motion score in low-dose and paak stress seems to be useful as a predictor of multivessel disease. Value of total administered dose of dobutamine, hemodynamic changes and ST segment changes as a MVD remains to be proved.
Angiography ; Blood Pressure ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Dobutamine* ; Echocardiography, Stress* ; Heart Rate ; Hemodynamics ; Humans ; Myocardial Infarction

BACKGROUND: Myocardial contractile dysfunction is often noticed without myocardial infarction, it may be due to myocardial stunning or hibernation. There are several case reports of myocardial stunning in patients with variant angina, but effect of recurrent myocardial spasm on myocardial contratile function in human is not well established. METHODS: To evaluate the effect of recurrent spasm-induced myocardial ischemia on myocardial contractile function, we analyzed the ejection fraction(by area-length method) and regional wall motion(by centerline method) at before and after intracoronary nitroglycerin in variant angina group and control group. Variant angina group consisted of 15 patients(LAD ; 10 patients, RCA ; 5 patients) and normal control group consisted of 6 patients. RESULTS: Ejection fraction increment after nitroglycerin infusion was not significant in normal control group, but that in variant angina group was significant(p<0.05). Pre-NG shortening fraction of LAD territory on both RAO and LAO view in patients with spasm in LAD was significantly lower than that in patients without spasm in LAD(RAO ; p<0.05, LAO ; p<0.01). On LAO view pre-NG shortening fraction of LAD territory in 6 patients with spasm and without significant fixed lesion was lower than that in patients without spasm in LAD(p<0.05). Shortening fraction increment after nitroglycerin infusion in LAD territory on both RAO and LAO view was significant in patients with spasm in LAD(RAO ; 0.05, LAO ; p<0.01), but that in LCX or RCA territory and that in LAD territory of patients without spasm in LAD was not significant. Shortening fraction increment after nitroglycerin infusion in RCA territory on LAO view was significant in patients with spasm in RCA(p<0.05), but that in LAD or LCX territory and that RCA territory of patients without spasm in RCA and was not significant. CONCLUSION: These observations suggest that recurrent coronary artery spasm results in reversible dysfunction of the ventricular global and regional contractility, and myocardial stunning may be the cause of this phenmenon.
Coronary Vessels* ; Hibernation ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Myocardial Stunning ; Nitroglycerin ; Spasm*