Patients with severe acetabular bony deficiency in total hip revision arthroplasties need the use of autogenous or allogenic bone grafts. The Authors performed 28 cases of total hip revision arthroplasties between June 1991 and January 1995 with femoral head allograft for acetabular bony deficiencies and evaluated the clinical and radiological results according to AAOS classification. The clinical result was evaluated by D'Aubigne and Postel score. The mean score was improved from 3.9 points to 5.1 points at follow-up. In radiological evaluation, osseous union of graft was achieved within 12 month and rerevision were performed in two cases (92.8% survival rates) but radiological radiolucent line in at least one zone was seen in five hips in two year follow up. In conclusion, the results of hemispherical microporocoat cup with allogenic bone in segmental or cavitary defect using with acetabular reinforcement ring in combined deficiency were encouraging to date. Success rate of allograft reconsruction of the acetabulum results from a variety of acetabular defect. In our studies, only 40% showed stable bony fixation over short period.
Acetabulum* ; Allografts ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Classification ; Follow-Up Studies ; Head ; Hip ; Humans ; Transplants*

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

No abstract available.
Epinephrine*

No abstract available.
Epinephrine*

PURPOSE: The human carcinoembryonic antigen (CEA) is expressed in several tumor types, including colorectal cancer, and is a tumor-associated antigen used as a target for antigen-specific immunotheraphy. CEA is a self-antigen associated with development, expressed in fetal cells and rarely expressed in normal colorectal epithelial cells. The induction of immune response to CEA is very difficult. In this study, we attempted to increase the tumor immunity specific to CEA by using dendritic cells pulsed with fusion proteins of CEA and Tat (transactivator of transcription), which transduces extracellular proteins into cytoplasm and causes antigens to be presented with MHC class I pathway. METHODS: The Tat gene was amplified in the PNL4-3 HIV plasmid and then inserted into PCEP4 plasmid vector. The CEA gene was cloned from cDNA from LoVo human colorectal cell line and then amplified through polymerase chain reaction method. After cloning of PCEP4 plasmid vector, the dendritic cell was sensitized and internalized with CEA and Tat-CEA protein. Then the Western blot analysis of the expression of CEA in the gene-modified dendritic cell and the immunofluorescent staining of the expression of CEA in CEA or Tat-CEA-pulsed dendritic cell were performed. A detection of IFN-gamma-releasing CD8 cell and a cytotoxicity of T-cell were was assesed using ELISPOT assay. The Immunoglobulin (Ig) G isotypes were analyzed with enzyme-linked immunosorbent assay. The statistical significance was assessed using Students t-test. RESULTS: CEA pulsed in dendritic cells was distributed over the cell surface and TatCEA was observed in the cytoplasm. The cellular immune responses by immunization with dendritic cells pulsed with TatCEA (322/10(4) lymphocytes) were significantly increased compared with those with CEA (244/10(4) lymphocytes) by IFN-gamma ELISPOT assay (P<0.05). The cytotoxic T lymphocyte (CTL) activity using mouse T-cell, EL-4 pulsed peptide (EAQNTTYL) as target cells was 23.3+/-2.75% (E:T=1:100) in the CEA group and 22.9+/-2.23% (E:T=1:100) in the TatCEA group. In ELISA analysis of the IgG isotype, the titer of IgG2a and IgG3, representing Th1 immune response, was lower than that of IgG1, representing Th2 immune response, in both the CEA group and the TatCEA group. CONCLUSIONS: These results suggest that TatCEA could be used for the development of a tumor vaccine and cellular immunotherapy using CTLs induced in vitro.
Animals ; Blotting, Western ; Carcinoembryonic Antigen ; Cell Line ; Clone Cells ; Cloning, Organism ; Colorectal Neoplasms ; Cytoplasm ; Dendritic Cells ; DNA, Complementary ; Enzyme-Linked Immunosorbent Assay ; Enzyme-Linked Immunospot Assay ; Epithelial Cells ; Equidae ; Genes, tat ; HIV ; Humans ; Immunity, Cellular ; Immunization ; Immunoglobulin G ; Immunoglobulins ; Immunotherapy ; Lymphocytes ; Mice ; Plasmids ; Polymerase Chain Reaction ; T-Lymphocytes

Heterotopic pregnancy with coexistiong intrauterine and extrauterine pregnancy, is a rare event in natural pregnancy. However, in recent years, the increase in the incidence of pelvic inflammatory disease and use of assisted reproductive technology had led to an increase in the frequency of heterotopic pregnancy. When the diagnosis of heterotopic pregnancy is delayed, maternal mortality and morbidity may be increased, and unwanted loss of intrauterine pregnancy may occur. Therefore, the early diagnosis of heterotopic pregnancy is clinically important, and clinicians have to consider the possibility of heterotopic pregnancy and conduct careful and thorough evaluation if suspected. We experienced a case of heterotopic pregnancy in a woman in the absence of the known risk factors. She underwent underwent spontaneous abortion of intrauterine pregnancy at postoperative 4th day, after laparoscopic salpingectomy for left tubal pregnancy. We report this case with brief review of literature.
Abortion, Spontaneous ; Diagnosis ; Early Diagnosis ; Female ; Humans ; Incidence ; Maternal Mortality ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Heterotopic* ; Pregnancy, Tubal* ; Reproductive Techniques, Assisted ; Risk Factors ; Salpingectomy

Heterotopic pregnancy with coexistiong intrauterine and extrauterine pregnancy, is a rare event in natural pregnancy. However, in recent years, the increase in the incidence of pelvic inflammatory disease and use of assisted reproductive technology had led to an increase in the frequency of heterotopic pregnancy. When the diagnosis of heterotopic pregnancy is delayed, maternal mortality and morbidity may be increased, and unwanted loss of intrauterine pregnancy may occur. Therefore, the early diagnosis of heterotopic pregnancy is clinically important, and clinicians have to consider the possibility of heterotopic pregnancy and conduct careful and thorough evaluation if suspected. We experienced a case of heterotopic pregnancy in a woman in the absence of the known risk factors. She underwent underwent spontaneous abortion of intrauterine pregnancy at postoperative 4th day, after laparoscopic salpingectomy for left tubal pregnancy. We report this case with brief review of literature.
Abortion, Spontaneous ; Diagnosis ; Early Diagnosis ; Female ; Humans ; Incidence ; Maternal Mortality ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Heterotopic* ; Pregnancy, Tubal* ; Reproductive Techniques, Assisted ; Risk Factors ; Salpingectomy

We present an unusual case in which a patient was diagnosed with the preeclampsia associated with a partial hydatidiform mole and bilateral theca-lutein cysts. The patient newly developed proteinuric hypertension at 16 weeks' gestation. Ultrasound findings showed small multiple cystic spaces in the placenta and a live singleton fetus. Triploid 69, XXX was confirmed at karyotype analysis. Intrauterine fetal death was found at 18 weeks' gestation and termination of pregnancy was performed, and a partial hydatidiform mole was confirmed at pathologic examination. Torsion of bilateral theca-lutein cysts was developed at postpartum one week. Detorsion and aspiration of the bilateral theca-lutein cysts were performed under the laparoscopy.
Female ; Fetal Death ; Fetus ; Humans ; Hydatidiform Mole ; Hypertension ; Karyotype ; Laparoscopy ; Placenta ; Postpartum Period ; Pre-Eclampsia ; Pregnancy ; Triploidy

OBJECTIVE: The objective of this study is to evaluate the safety and the clinical efficacy of the laparoscopic myomectomy through analyzing several operation factors. METHODS: There were 185 cases of laparoscopic myomectomy between January 2004 and December 2008 at the department of obstetrics and gynecology in Hanyang University Guri Hospital. Retrospectively many factors of the operation were analyzed. The factors include the size, number and type of the myoma, BMI (body mass index), operation method, operation time, and complication and the prognosis of the operation. RESULTS: For the type of myomas, 115 (62.2%) cases were intramural myomas, 38 (20.5%) cases were subserosal types and 32 (17.3%) cases were mixed types. The average diameter of the biggest myoma was 6.67+/-0.16 cm (range, 2.5~15 cm) and the average number of the myoma was 2.07+/-0.15 (range, 1~15). Previous operation history and pelvic adhesion did not show correlation with the operation time. The size, type and number of myoma and the operation methods showed correlation with the operation time. According to myoma size and number, we divided the cases into two groups, low risk group (122 cases) and high risk group (63 cases). The analysis showed that post-operation hemoglobin drop (2.89+/-0.10 g/dL vs. 4.03+/-0.23 g/dL) and blood transfusion amount (2.89+/-0.10 pints vs. 4.03+/-0.23 pints) as well as the operation time (137.58+/-4.37 min vs. 193.73+/-9.88 min) showed noticeable increase in the high risk group. CONCLUSION: This statistics show that laparoscopic myomectomy is now being applied to patients with larger and more myomas. Factors affecting operation time were the weight of myomas, number of myomas, type of myomas, number of trocars and methods of resected myomas removal. Also, operation time and post-operative hemoglobin drop increased in the high risk group.
Blood Transfusion ; Gynecology ; Hemoglobins ; Humans ; Laparoscopy ; Myoma ; Obstetrics ; Prognosis ; Retrospective Studies ; Surgical Instruments

The incisional hernia through trocar site is an uncommon complication of gynecologic laparoscopy. Its incidence is less than 1% and most of them are occurring through 10 mm trocar site. Small bowel herniation through 5 mm trocar site is very rare. Furthermore, 5 mm trocar site bowel herniation with drain tube in situ has not yet been reported. We present a case of small bowel herniation through 5 mm trocar site with drain tube in situ and its reduction by laparoscopy with a brief review of literature.
Drainage ; Hernia ; Incidence ; Laparoscopy ; Surgical Instruments