The pathogenetic mechanism of renal dysfunction in renal amyloidosis is poorly understood. To evaluate the morphologic parameters which are correlated with renal function in this disorder, we have examined renal biopsies from 14 patients with renal amyloidosis by morphometry. Of the 14 patients, 8 were male and 6 were female. They were between 41 and 70 years of age. The serum concentration of albumin and creatinine were 2.1+/-0.7 mg/dl and 1.1+/-0.5 mg/dl, respectively. The 24-hour excretion of urinary protein was 7.9+/-5.2 g. Creatinine clearance was 62+/-23 ml/min/1.73m2. The mean glomerular volume (MGV) was (2.2+/-1.3) 10(6) micrometer3. The surface density of peripheral glomerular basement membrane [Sv (PGBM/glom)] was 0.049+/-0.027 (micrometer3/micrometer3). Volume density of mesangium [Vv (mes/glom)] was 0.31+/-0.14 (micrometer3/micrometer3) and volume density of glomerular amyloid deposition [Vv (amyl/glom)] was 0.21+/-0.14 (micrometer3/micrometer3). The volume density of cortical interstitium [Vv (int/cortex)] was 0.14+/-0.09 (micrometer3/micrometer3). The serum creatinine concentration was significantly correlated with Vv (int/cortex) (r=+0.66, p<0.05). MGV was correlated with Vv (mes/glom) (r=+0.75, p<0.01) and Vv (amyl/glom) (r= +0.68, p<0.05) but showed negative correlation with Sv (PGBM/glom) (r=-0.79, p<0.01). Sv (PGBM/glom) showed negative correlation with Vv (mes/glom) (r=-0.77, p<0.01) and with Vv (amyl/glom) (r=-0.87, p<0.01). Positive correlation was observed between Vv (mes/glom) and Vv (amyl/glom) (r=+0.95, p<0.01). These results suggest that the decreased renal function in patients with amyloidosis is related to interstitial fibrosis rather than glomerular lesions. In addition, glomerular hypertrophy in these patients is related to amyloid deposition in the mesangium and peripheral glomerular basement membrane.
Amyloidosis* ; Biopsy ; Creatinine ; Female ; Fibrosis ; Glomerular Basement Membrane ; Humans ; Hypertrophy ; Male ; Plaque, Amyloid

BACKGROUND: It is a routine practice that High Frequency Jet Ventilation (HFJV) is applied through a 14~16 gauge (about 12 French (Fr.)) angiocath. The 14 Fr. suction catheter which is similar to angiocath in its internal diameter is commonly available in the operating room. We evaluated the suction catheter as a carrier of HFJV in point of ventilation, oxygenation and operating field during HFJV at microlaryngeal endoscopic surgery (MES). METHODS: Fifteen adult patients undergoing HFJV via 14 Fr. suction catheter during MES were studied. Time-based arterial blood gas analyses were done before and after HFJV. The movement of operating field was examined using laryngoscopic examination by surgeon and anesthesiologist. We also evaluated complications such as abdominal distension, barotrauma and so on. RESULTS: The mean arterial oxygen tension was maintained above 250 mmHg all the time during HFJV. The mean carbon dioxide tension was less than 51 mmHg. There were no remarkable catheter movement and complications. CONCLUSION: The 14 Fr. suction catheter is a good replacement of angiocath. It provided good operating field, ventilation and oxygenation without complications.
Adult ; Barotrauma ; Blood Gas Analysis ; Carbon Dioxide ; Catheters* ; High-Frequency Jet Ventilation* ; Humans ; Operating Rooms ; Oxygen ; Suction* ; Ventilation

BACKGROUND: This study was conducted to compare the clinical and radiological outcomes of the locking hook plate fixation (HP) technique and the single tight rope (TR) technique applied for acute high-grade acromioclavicular (AC) joint separations. METHODS: Between 2009 and 2014, 135 consecutive patients with acute AC joint separation Rockwood types III, IV, and V were subjected to surgical reconstruction. One hundred fourteen patients (84.4%) were available for retrospective evaluation. Of them, 62 and 52 were treated using the single TR group and clavicular HP group techniques, respectively. The visual analogue scale, Constant, American Shoulder and Elbow Surgeons (ASES), and Taft scores were used for clinical assessment. Postoperative shoulder range of motion was also assessed. An anteroposterior radiograph of the coracoclavicular distance (CCD) was obtained to evaluate the radiographic signs of recurrence. RESULTS: The TR group patients had better Constant, ASES, and Taft scores than the HP group patients. The loss of reduction in terms of the CCD did not differ between groups. Subacromial osteolysis was observed in 34.6% of the cases in the HP group. However, there were no significant differences in the clinical outcomes between the patients with and without osteolysis in the HP group. Subcoracoid osteolysis, drill tunnel widening, and metal displacement were observed in 3.2%, 22.6%, and 4.8% of the cases in the TR group, respectively. CONCLUSIONS: The single TR technique was relatively more effective at treating acute high-grade AC joint injuries than the HP fixation technique (level of evidence: therapeutic; retrospective comparative study, Level III).
Acromioclavicular Joint* ; Dislocations* ; Elbow ; Humans ; Joints ; Osteolysis ; Range of Motion, Articular ; Recurrence ; Retrospective Studies ; Shoulder ; Surgeons

No abstract available.
Rectal Fistula*

Osteochondroma is the most common of the benign bone tumors. They are probably developmental malformations rather than true neoplasms. But rarely they develope in a joint, especially in the ankle joint. We reported a case of intraarticular osteochondromatosis of ankle joint.
Ankle Joint ; Ankle ; Joints ; Osteochondroma ; Osteochondromatosis

BACKGROUND: Aprotinin, which is a nonspecific serine protease inhibitor, has an antiinflammatory and thrombogenic effect. However, it has an antithrombogenic effect during the cardiopulmonary bypass. This study was performed to evaluated the effects of aprotinin on the activated clotting time(ACT) and the total amount of the heparin used during the cardiopulmonary bypass. MATERIAL AND METHOD: From December 1998 to November 1999, 82 consecutive patients electively underwent open heart surgery at Gachon medical school. The patients were older than 18 years. Eighty two patients were classified into a control group(group C, n=36) and a aprotinin-treated group(group A, n=46). Body weight, height, body surface area(BSA), pump time(PT), aortic cross clamping time(ACCT), and body temperature(BT) were determined. Total amount of heparin and protamine during the CPB were also measured. ACT was determined before heparin administration, at 20, 40 and 60 minutes after heparin administration, and after protamine administration. RESULT: No significant differences were noted in either group in body weight, height, BSA, BT, and the total amoun of heparin and protamine. Group A demonstrated a significant(p<0.05) increase in age, PT, ACCT, and ACT at 20, 40, and 60 minutes after heparin administration. CONCLUSION: In summary, the use of aprotinin prime resulted in an increase in ACT. The total amount of heparin in aproinin-treated patient was similar to that of the control group in spite of having the prolonged pump time. Therefore aprotinin may reduce the requirement of heparin.
Aprotinin* ; Body Height ; Body Weight ; Cardiopulmonary Bypass ; Constriction ; Heart* ; Heparin* ; Humans ; Schools, Medical ; Serine Proteases ; Thoracic Surgery*

BACKGROUND: A technique that improves the efficiency of alveolar ventilation should decrease the pressure required and reduce the potential for lung injury during mechanical ventilation. High PaCO2 can be permitted to lower airway pressures as in permissive hypercapnia (PH). Intratracheal pulmonary ventilation (ITPV) was developed to allow a decrease in physiological dead space during mechanical ventilation. We compared the effect of hybrid ventilation (HV) as a modification of ITPV with PH on the decrease of tidal volume and airway pressures in rabbits with acute respiratory failure. METHODS: Tracheostomy was performed in 7 rabbits ventilated under volume-controlled mode in the supine position. Arterial blood gas analysis, airway pressures, and dead space ventilation were measured at respiratory rate of 20/min as control values. Oleic acid (OA) of 0.06 ml/kg was injected to induce acute respiratory failure. Tidal volume (VT) was elevated to maintain PaCO2 in the normal range. The same parameters were measured as OA values. Then VT was reduced to the control level to allow PH. HV was initiated by inserting a reverse thrust catheter (RTC) into the endotracheal tube. HV consists of a pressure-controlled mode of mechanical ventilation and ITPV while flushing fresh gas continuously via the RTC. Respiratory parameters were compared under control, OA, PH and HV conditions. RESULTS: Oleic acid injection decreased PaO2 from 401+/-35 mmHg to 129+/-39 mmHg, increased VT from 42+/-5 ml to 52+/-10 ml, and increased VD/VT ratio from 0.65+/-0.07 to 0.71+/-0.07. During PH, the increase in PaCO2 was accompanied by the increase in VD/VT ratio from 0.71+/-0.07 to 0.79+/-0.03 and by the decrease of peak inspiratory pressure (PIP) from 19.4+/-4.0 cmH2O to 16.8+/-3.1 cmH2O. PaCO2 was lowered from 50+/-5 mmHg in PH to 39+/-5 mmHg in HV with a lower VT. VD/VT ratio in HV was as low as that in control. CONCLUSION: HV is an effective and easy-to-use ventilatory modality to reduce PaCO2 and airway pressures by the reduction in VD/VT ratio in acute respiratory failure model.
Blood Gas Analysis ; Catheters ; Flushing ; Hydrogen-Ion Concentration ; Hypercapnia ; Lung Injury ; Oleic Acid ; Pulmonary Ventilation* ; Rabbits* ; Reference Values ; Respiration, Artificial ; Respiratory Insufficiency* ; Respiratory Rate ; Supine Position ; Tidal Volume ; Tracheostomy ; Ventilation

The effect of elevated mixed venous oxygen tension(PvO2) on the diffuse alveolar hypoxia was studied in dogs using venovenous(VV) extracorporeal lung assist(ECLA). Six mongrel dogs were mechanically ventilated with the continous infusion of pentobarbital. A double lumen tube was inserted via the right external jugular vein and was eonnected with the ECLA cireuit to establish a VV bypass. A Kurare oxygenator 0.3m2 was chosen to obviate the use of homologous blood for priming. The total volume of the ECLA circuit was 150mL Without ventilating the oxygenator during VV ECLA, we decreased F1O2 from 0.21 to 0.1 via 0.15 to evaluate the hypoxic repsonse of lung. Stepwise reductions in F1O2 0.21 to 0.l caused the arterial oxygen tension(PvO2) and (PvO2 to decrease while the mean pulmonary arterial pressure(MPAP) and pulmonary vascular resistance(PVR) progressively increased. We hypothesized that the reduction of F1O2 without aceompanying decrease of PvOmight not induce hypoxic pulmonary vasoconstriciton(HPV) which was proved at low F1O2 with low PvO VV ECLA was tried on another 7 dogs while monitoring arterial oxygen saturation(SaO2) and mixed venous oxygen saturation(SvO2) by two oximetrix catheters. The elevation of SvO2 during VV ECLA was followed by the elevation of SaO2 We compared MPAP and PVR at high F1O2 with those at low F1O2with VV ECLA while making SaO2 equal. PvO2 were 39+/-11mmHg at F1O2 0.21 and 62+/-11mmHg at F1O2 0.15 with VV ECLA. PvO2 were 30+/-8mmHg at F1O2 0.15 and 53+/-10mmHg at F1O2 0.1 with VV ECLA. MPAP and PVR were 18+/-5mmHg and 176+/-56 dyne sec/cm5 at F1O2 0.21 and 19+/-4mmHg and 198+/-94 dyne sec/cm5 at F1O2 0.15 with VV ECLA . MPAP and PVR were 25 5 mmHg and 430+/-250 dyne. sec/ cm5 at F1O2 0.15 and 25+/-5mmHg and 400+/-197 dyne sec/cm5 at F1O2 0.1 with VV ECLA. Decrease of F1O2 from 0.21 to 0.15 and from 0.15 to 0.1 did not cause significant ehanges in MPAP and PVR during VV ECLA. Our findings indicate that small increase of PvO2 by VV ECLA may prevent or diminish hypoxic resyonse of the whole lung.
Animals ; Anoxia ; Catheters ; Dogs* ; Jugular Veins ; Lung* ; Oxygen ; Oxygenators ; Pentobarbital ; Pulmonary Circulation*

Respiratory Insufficiency*

The gene encoding the 66 kilodalton (kDa) protein of Borrelia hermsii HS1 was cloned and sequenced. Chromosomal DNA was prepared from purified B. hermsii and used in construction of genomic library. The library was screened for positive clones by 314 bp DIG-labeled probe synthesized on the basis of the part of the sequence of B. hermsii. Positive clone was subcloned into p2ErO vector and was designated as pBH11. pBH11 were subcloned into pBluscript vector and were designated as pBH11-1 (500 bp), pBH11-2 (800 bp), pBH11-3 (600 bp) and pBH11-4 (800 bp). The plasmids were sequenced and determined the nucleotide sequence of p66. The open reading frame of the p66 consisted of 1803 base pairs coding for 600 amino acid protein. The basic information on the p66 gene of B. hermsii HS1 obtained from this study will be useful for further analysis and experiment of pathogenesis of the borrelia.
Base Pairing ; Base Sequence ; Borrelia* ; Clinical Coding ; Clone Cells* ; Cloning, Organism* ; DNA ; Genomic Library ; Open Reading Frames ; Plasmids