Many injuries of the hand have been occured in these days because of frequent industrial hazards and frequent handling of tools in modern civilizing life. A voluminous amount of literature has been recently concerned with many problems and questions posed by tendon surgery. Many investigations have been devoted to discussion of suture materials, tendon suturing, grafting, healing, rate of healing, nutrition and related clinical and laboratory endeavors. Because of these efforts, the designation of Zone II as“no man's land” is no longer significant and should be called “skilled man's land”. With regard to to secondary reconstructive surgery, in cases without much scarring and few associated lesions, we routinely select the one-stage graft and use early motion in the postoperative programs. This paper aimed to review our experience with 215 patients with flexor tendon injuries in hand who were treated with primary repair or tendon graft with average follow up of 8.5 months from June, 1973 to May, 1987 and the following results were obtained. 1. The most frequent site of injury was Zone V. 2. The over all end result of primary repair was satisfactory in 86.5% by White and Kleinert criteria. 3. The over all end result of tendon graft in Zone Il was satisfactory in 51.0% by White and Kleinert criteria. 4. In Zone lI, primary repair obtained satisfactory result in 36.4% but the tendon graft obtained satisfactory result in 51.0%. 5. In tendon graft, the preoperative stste was supposed to have close relation to postoperative result and the duration from injury to graft was supposed to have little relation to postoperative results. 6. In primary repair, the cases using Bunnells suture technique obtained satisfactory result in 85.1% and the cases using modified Kesslers suture technique obtained satisfactory result in 91.2%.
Cicatrix ; Clinical Study ; Follow-Up Studies ; Hand ; Humans ; Suture Techniques ; Sutures ; Tendon Injuries ; Tendons ; Transplants

The pubic bone is an unusual site for an aneurysmal bone cyst. This case, a 15year old male patient, was diagnosed as an aneurysmal bone cyst in the superior ramus of the right pubic bone. He was treated by complete excision of the superior ramus and on five years follow up no problems were noted in terms of weight bearing as well as hip function or evidence of recurrence.
Aneurysm ; Bone Cysts ; Follow-Up Studies ; Hip ; Humans ; Male ; Pubic Bone ; Recurrence ; Weight-Bearing

PURPOSE: It is not clear that the development of glomerular injury and aggravation by tumor necrosis factor alpha (TNF-alpha) is related to intrarenal or serum concentration of TNF-alpha. So, we studied the relationship between the concentration of TNF-alpha and aggravation of glomerular damage in the Henoch-Schonlein nephritis(HSN) and idiopathic nephrotic syndrome(INS). METHODS: We collected the sera and urines of 21 patients with Henoch-Schonlein purpura(HSP) and 22 patients with INS visited Chungbuk National University hospital from March 1998 to March 2001. The concentration of TNF-alpha in the sera and urines were measured by sandwich ELISA. RESULTS: Serum TNF-alpha levels in the HSP patients with renal involvement were significantly higher than those without renal involvement(P=0.009). But urine TNF-alpha levels have no correlation with renal involvement(P=0.088). In the HSN patients, proteinuria have a significant correlation with serum TNF-alpha levels(P=0.004) but less correlation with urine TNF-alpha levels(P=0.053). Otherwise, proteinuria have no correlation with serum TNF-alpha levels(P=0.763) but have a significant correlation with urine TNF-alpha levels(P=0.007) in INS. CONCLUSION: These result suggest that the serum concentration of TNF-alpha would be important to glomerular involvement in HSP. And, it is interesting that proteinuria shows a significant relation with serum TNF-alpha levels in the HSN, but with urine TNF-alpha levels in the INS. This means the major production of TNF-alpha may be originated by extrarenal inflammation in the HSN and by intrarenal tubulo-interstitial damage due to proteinuria in the INS.
Chungcheongbuk-do ; Enzyme-Linked Immunosorbent Assay ; Humans ; Inflammation ; Nephritis* ; Nephrotic Syndrome* ; Proteinuria* ; Tumor Necrosis Factor-alpha*

Acute encephalopathy with thalamotegmental involvement occurs in infants and young children and is thought to be a postviral or postinfectious brain disease. This disease is preceded for several days by fever and symptoms of upper respiratory infection. The symptoms are followed by the rapid evolution of stupor and coma, associated with generalized seizures and decerebrate rigidity. In this disease, the computed tomography (CT) or brain magnetic resonance imaging demonstrate symmetrical focal lesions in the thalami and brainstem tegmentum. We report two cases of acute encephalopathy with thalamotegmental involvement and remaining motor dysfunction in infants.
Brain ; Brain Diseases ; Brain Stem ; Child ; Coma ; Decerebrate State ; Fever ; Humans ; Infant* ; Magnetic Resonance Imaging ; Seizures ; Stupor

Venous malformations has been shown to be the most common intracranial vascular malformation autopsy and clinical series. Cerebral venous malformation is associated with different frequnecies of epileptic seizures. Only in about 25% of cases are venous malformation diagnosed because of the occurrence of epileptic seizures. We report a case of 4 year-old female patient with status epilepticus caused by venous angioma in the right temporal lobe of the brain.
Autopsy ; Brain* ; Child, Preschool ; Epilepsy ; Female ; Hemangioma* ; Humans ; Status Epilepticus* ; Temporal Lobe ; Vascular Malformations

Methylmalonic acidemia (MMA) is a heterogeneous inborn error of propionate metabolism and its management frequently includes a low-protein diet to minimize precursors of methylmalonic acid and reduce its concentration in body tissues. In the long- term follow-up, renal dysfunction in these patients has been increasingly recognized. Tubulointerstitial nephritis is the most frequent renal complications and has been reported in the small number of renal biopsy specimens from young children previously by others. We report a case of a 18-year-old girl with MMA and renal dysfunction in whom renal biopsy demonstrated chronic tubulointerstitial nephritis.
Adolescent ; Biopsy ; Child ; Diet, Protein-Restricted ; Diethylpropion ; Female ; Follow-Up Studies ; Humans ; Metabolism ; Methylmalonic Acid ; Nephritis, Interstitial*

PURPOSE: Henoch-Schonlein purpura (HSP) is a multisystem disorder affecting predominantly skin, gastrointestinal tract, joint and kidneys, as well as the central nervous, cardiopulmonary and musculoskeletal system. Most patients with renal involvement have a good prognosis. However, some patients develop end-stage renal disease. Therefore, severity of renal involvement is considered to contribute to the outcome. The aim of this study was to evaluate the clinical renal risk and prognostic factors of HSP. METHODS: We had collected the clinical and laboratory data of 125 patients with acute HSP who visited Chungbuk National University Hospital from March 1992 to April 2002. Data were expressed as the mean+/-SD and statistical analysis was performed using Wilcoxon rank sum test, Mantel-Haenszel test, Fisher's Exact test, Student t-test. p<0.05 was considered as significant. RESULTS: The patient population consisted of 87 boys and 38 girls ranging from 1 to 14 years in age. Recurrance number of purpura in the HSP patients with renal involvement were significantly higher than those without renal involvement (p<0.01). 24-hour urine protein/creatinine ratio in the HSP patients with renal involvement were significantly higher than those without renal involvement (p< 0.01). But serum C3, C4, CH50, anti-streptolysin titers and so forth had no correlation with renal involvement. In the HSN patients, 24-hour creatinine and creatinine clearance have no correlation with renal involvement. Fifteen of 87 boys (17.2%) in this study developed scrotal involvement, which showed no significantly difference in patients with or without renal involvement. CONCLUSION: It is important that 24-hour urine protein/creatinine ratio at acute stage shows a significant relation with renal involvement. Results suggest that recurrence number of purpura are important to renal involvement in HSP. Based on these findings, futher prospective and/or controlled studies among more patients are thus necessary in order to prevent renal involvement in HSP.
Chungcheongbuk-do ; Creatinine ; Female ; Gastrointestinal Tract ; Humans ; Joints ; Kidney ; Kidney Failure, Chronic ; Musculoskeletal System ; Prognosis ; Purpura ; Purpura, Schoenlein-Henoch* ; Recurrence ; Risk Factors* ; Skin ; Systemic Vasculitis

PURPOSE: Angiotensin II plays a potent role in renal injury not only by vasoconstrictive effects but also by biochemical effects. We investigated the effect of angiotensin II on ZO-1 (zonular occludens-1), a component of the slit diaphragm domain connecting slit diaphragm structure and actin cytoskeleton, in the glomerular epithelial cells (podocytes) for the glomerular damage. We tried to find that this effect could be prevented by losartan, an angiotensin II type 1 receptor blocker. METHODS: Glomerular epithelial cells were treated with various concentrations of angiotensin II and losartan. The distribution of ZO-1 was observed by confocal microscope and the change of ZO-1 expression was measured by Western blotting and RT-PCR. RESULTS: The intensities of fluorescences and bands of ZO-1 protein were decreased by angiotensin II in a dose-dependent manner by confocal microscopy and Western blot analysis, respectively. ZO-1 also moved from peripheral to inner cytoplasm and lost its linear pattern. These distributional changes of ZO-1 protein by angiotensin II were reversed by losartan in a dose-dependent manner. Angiotensin II reduced the amount and mRNA expresssion of ZO-1 which were also reversed by losartan. CONCLUSION: Angiotensin II decreases the amount of ZO-1 protein and changes its localization through angiotensin II type 1 receptor. These findings suggest that angiotensin II-added condition induces the cytoplasmic translocation and suppresses the production of ZO-1 in podocytes at transcriptional level, and could be prevented by angiotensin receptor antagonists.
Actin Cytoskeleton ; Adherens Junctions ; Angiotensin II Type 1 Receptor Blockers ; Angiotensin II* ; Angiotensin Receptor Antagonists ; Angiotensins* ; Blotting, Western ; Cytoplasm ; Diaphragm ; Epithelial Cells* ; Losartan ; Microscopy, Confocal ; Podocytes ; Receptor, Angiotensin, Type 1 ; RNA, Messenger

PURPOSE: Henoch-Schonlein purpura(HSP) is a systemic vasculitis, characterized by cutaneous purpura, abdominal pain, arthralgia and renal involvement. The clinical features of HSP have been reasonably well documented but there are still many gaps in our understanding of HSP. The aim of this study was to present the clinical features of 125 children with HSP and compare them with previous reports, placing particular emphasis on clinical information. METHODS: We collected the clinical data of 125 patients with acute HSP who visited Chungbuk National University Hospital from March 1992 to April 2002. Data were expressed as the mean or mean +/-SD and statistical analysis was performed using Chi-square approximation. P<0.05 was considered as significant. RESULTS: The patient population consisted of 87 boys and 38 girls ranging in age from one to 14 years. HSP occurs throughout the year, but this study shows seasonal skewing, with most patients presenting from fall through spring and a paucity of cases in summer. All patients had non-throm bocytopenic purpura concentrated on the buttocks and lower extremities. Purpuric lesions were also scattered on the arms and occaisionally on the face and ears, but the trunk was largely spared. A recurrence of purpura was defined as the reappearance of a rash or other symptoms following resolution of disease for at least two weeks. The mean number of recurrences was 0.51. Eighty eight patients(70.4%), 18 patients(14.4%) and 67 patients(53.6%) complained of abdomianl pain, gastroin testinal bleeding and arthralgia, respectively. Nephritis occurred in 48(38.4%) patients. Fifteen boys (17.2%) developed epididymitis. Neurologic features occurred in 13(10.4%) and two(15%) of these were seizures. CONCLUSION: HSP all showing purpura as defined is characterized by various clinical features, including abdominal pain, arthralgia, epididymitis and nephritis which could occur before the appearance of purpura. Therefore, we suggest that the possibility of HSP should be considered in children before invasive procedures, even if the above symptoms and signs present without purpura.
Abdominal Pain ; Arm ; Arthralgia ; Buttocks ; Child ; Chungcheongbuk-do ; Ear ; Epididymitis ; Exanthema ; Female ; Hemorrhage ; Humans ; Lower Extremity ; Male ; Nephritis ; Prognosis ; Purpura ; Purpura, Schoenlein-Henoch* ; Recurrence ; Seasons ; Seizures ; Systemic Vasculitis

BACKGROUND: Pseudomonas aeruginosa is a clinically important pathogen that causes opportunistic infections and nosocomial outbreaks. Recently, the type III secretion system (TTSS) has been shown to play an important role in the virulence of P. aeruginosa. ExoU, in particular, has the greatest impact on disease severity. We examined the relationship among the TTSS effector genotype (exoS and exoU), fluoroquinolone resistance, and target site mutations in 66 carbapenem-resistant P. aeruginosa strains. METHODS: Sixty-six carbapenem-resistant P. aeruginosa strains were collected from patients in a university hospital in Daejeon, Korea, from January 2008 to May 2012. Minimum inhibitory concentrations (MICs) of fluoroquinolones (ciprofloxacin and levofloxacin) were determined by using the agar dilution method. We used PCR and sequencing to determine the TTSS effector genotype and quinolone resistance-determining regions (QRDRs) of the respective target genes gyrA, gyrB, parC, and parE. RESULTS: A higher proportion of exoU+ strains were fluoroquinolone-resistant than exoS+ strains (93.2%, 41/44 vs. 45.0%, 9/20; P< or =0.0001). Additionally, exoU+ strains were more likely to carry combined mutations than exoS+ strains (97.6%, 40/41 vs. 70%, 7/10; P=0.021), and MIC increased as the number of active mutations increased. CONCLUSIONS: The recent overuse of fluoroquinolone has led to both increased resistance and enhanced virulence of carbapenem-resistant P. aeruginosa. These data indicate a specific relationship among exoU genotype, fluoroquinolone resistance, and resistance-conferring mutations.
ADP Ribose Transferases/genetics ; Anti-Bacterial Agents/*pharmacology ; Bacterial Proteins/genetics ; Bacterial Toxins/genetics ; Carbapenems/pharmacology ; Drug Resistance, Bacterial/*drug effects ; Fluoroquinolones/*pharmacology ; Genotype ; Humans ; Microbial Sensitivity Tests ; Multilocus Sequence Typing ; Mutation ; Pseudomonas aeruginosa/*genetics/isolation & purification/pathogenicity ; Sputum/microbiology ; Virulence