The purpose of this study is to evaluate the effectiveness of Ilizarov external fixator in the treatment of difficult tibial fractures. We analyzed 37 cases with closed or open comminuted tibial fractures and unstable segmental fractures, treated with Ilizarov external fixator between August 1993 and August 1997. Among them, 21 cases were treated with simple application of Ilizarov external fixator. A compression of the fracture site (6 cases), translation (2 cases) and internal transportation technique (2 cases) were applied, and bone graft was applied in 5 cases. We obtained bony union in all cases with Ilizarov method except one case converted to intramedullary nailing due to delayed union. The average time required for bone union were 21 weeks in closed fractures, 26.2 weeks in open fractures. The complications developed were as follows; pin irritation in 14 cases, pin tract infection in 9 cases, adjacent joint contracture in 3 cases, delayed union in 1 case and malunion in 1 case. According to Tuckers classification, the results were graded as excellent in 18 cases, good in 14 cases, fair in 3 cases, poor in 2 cases. In conclusion, Ilizarov external fixation is one of the useful treatment option in closed or open comminuted tibial fractures and unstable segmental fractures.
Classification ; Contracture ; External Fixators* ; Fracture Fixation, Intramedullary ; Fractures, Closed ; Fractures, Open ; Ilizarov Technique ; Joints ; Tibia ; Tibial Fractures* ; Transplants ; Transportation

No abstract available in English.
Arthritis, Rheumatoid ; Clinical Study

BACKGROUND: The angiotensin-converting enzyme(ACE) plays an important role in cardiovascular disease by production of angiotensin and degradation of bradykinin. Cloning of ACE gene revealed an insertion/deletion(I/D) polymorphism according to the presence/absence of a 287 base pair fragment in the 16th intron of ACE gene, and the ACE polymophism was associated with ACE activity. The genotype DD was identified as a risk factor for myocardial infarction in several studies. We analyzed the ACE I/D polymorphism in 62 patients with myocardial infarction and 67 normal subjects. METHODS: Genomic DNA from peripheral blood was amplified by polymerase chain reaction and characterized by three ACE genotypes; two insertion alleles(genotype II), two deletion alleles(genotype DD) and heterogenous alleles(genotype ID). ACE activity was determined by spectrophotometric method utilizing the synthetic substrate. RESULTS: There was no significant difference in ACE polymorphism between patients and normal subjects. But, the frequency of genotype DD was significantly increased in the low-risk group of patients compared with the high-risk group. The multi-vessel disease was more strongly associated with genotype DD, but there was no statistical significance. The ACE activity was strongly associated with ACE polymorphism with the activity being highest in genotype DD. There was no significant difference between patients and control subjects of the same genotype. CONCLUSION: There was no significant difference in ACE polymorphism between patients and normal subjects. The frequencies for genotype II, ID, DD were 0.328, 0.537, 0.134, respectively in normal subjects. There was high frequency of genotype II compared with Caucasians. A deletion polymorphism(genotype DD) may increase the risk for myocardial infarction in lowrisk group, and the serum ACE activity was correlated with three genotypes.
Angiotensins ; Base Pairing ; Bradykinin ; Cardiovascular Diseases ; Clone Cells ; Cloning, Organism ; DNA ; Genotype ; Humans ; Introns ; Myocardial Infarction* ; Polymerase Chain Reaction ; Risk Factors

No abstract available.
Intestinal Obstruction*

Two cases of unusual giant carcinoma of the pancreas are presented. Each presented with a large tumor mass with or without cystic change, either in the head or tail portion of the pancreas. A pleomorphic gaint cell carcinoma variant (case 1) differed from an epulis type (case 2) with nuclear atypism of giant cells, but widespread metastasis in both cases reflected the accountability of spindle cell element as an important parameter for the determination of their biological behavior.
Neoplasm Metastasis

Prior to 1988, endometrial cancer was clinically staged but there was the considerable discrepancy between clinical and aetual stage. FIGO surgical staging classification of endometrial cancer(I988) provides the advanatage of recognizing the true disease distribution and extension, and more rational treatraent can be accomplished. This retrospective study was based on a clinical review of 73 patients with endometrial carcinoma from l982 through 1991 who underwent primary surgical evaluation. A11 cases were restaged ueing the newly adopted FIGO surgical staging. The distribution of FIGO clinical staging was as follows:85 patients(89.1%) were with stage I, 5(6.9%) with stage II, 2(2.7%) with stage III and 1(l.3%) with stage IV. Surgical restaging according new FlG0 classification reveald 56(76.7%) patients with stage I, 1(1.4%) with stage II, 14(19.2%) with stage III and 2(2.7%) with stage IV. Surgery upstaged 12.3% of clinical stage I patients, In clinical stage II patients, 80.0% was doenstaged. There wes no stage changing in cliaical stage III and IV patients. The acturial survival rates for surgical stages I a, I b, I c, and III were 80.0%, 77.2%, 68.4A%, and 35.0% respectively. By using FIGO surgical staging, the initial extent of endometrial cancer can be more accurately evaluated and we may predict prognosis and survival relatively well.
Classification ; Endometrial Neoplasms* ; Female ; Humans ; Prognosis ; Retrospective Studies ; Survival Rate

PURPOSE: This study was a retrospective survey to examine economic feasibility of home care services for patients with diabetic foot. METHODS: The participants were 33 patients in the home care services (HC) group and 27 in the non-home care services (non-HC) group, all of whom were discharged early after inpatient treatment. Data were collected from medical records. Direct medical costs were calculated using medical fee payment data. Cost-effectiveness ratio was calculated using direct medical costs paid by the patient and the insurer until complete cure of the diabetic foot. Effectiveness was the time required for a complete cure. Direct medical costs included fees for hospitalization, emergency care, home care, ambulatory fees, and hospitalization or ambulatory fees at other medical institutions. RESULTS: Mean for direct medical costs was 11,118,773 won per person in the HC group, and 16,005,883 won in the non-HC group. The difference between the groups was statistically significant (p=.042). Analysis of the results for cost-effectiveness ratio showed 91,891 won per day in the HC patients, and 109,629 won per day in the non-HC patients. CONCLUSION: Result shows that the cost-effectiveness ratio is lower HC patients than non-HC patients, that indicates home care services are economically feasible.
Costs and Cost Analysis ; Diabetic Foot ; Emergency Medical Services ; Fees and Charges ; Fees, Medical ; Home Care Services ; Hospitalization ; Humans ; Inpatients ; Insurance Carriers ; Medical Records ; Retrospective Studies

PURPOSE: To evaluate the characteristics of CT findings in differential diagnosis of cervical lymphadenopathy. MATERIALS AND METHODS: We evaluated CT findings of histopathologically proved 32 cases of tuberculous lymphadenitis, 12 cases of nodal lymphoma, 29 cases of metastasis from March 1986 to Dec. 1992, retrospectively. We analyzed age and sex distribution, location of lymphadenopathy, internal nodal density, feature of contrast enhancement, extracapsular spread and nodal calcification. RESULTS: Tuberculous lymphadenitis was more preponderant in young female (mean;32) and CT showed internal low density(91%) with irregular thick marginal enhancement(46.9%), predilection for spinal accessory node(71.9%), and nodal calcification(5/32). Nodal lymphoma showed predilection for internal jugular chain (100%) and had conglomerated homogeneous internal node structures(83%). Metastasis showed old male preponderance (mean :52 years), predilected at internal jugular chain(89.7%),internal low density(93.3%) with regular thin marginal enhancement(44.8%), extracapsular spread(41.4%), and nodal calcification(2 cases of nodal metastasis of papillary type thyroid cancer). CONCLUSION: We concluded that CT evaluation of the chracteristics of lymphadenopathy is helpful for differential diagnosis of cervical lymphadenopathy.
Diagnosis, Differential* ; Female ; Humans ; Lymphatic Diseases* ; Lymphoma ; Male ; Neoplasm Metastasis ; Retrospective Studies ; Sex Distribution ; Thyroid Gland ; Tuberculosis, Lymph Node

This report concerns a rare malignant smooth muscle neoplasm of the skin and the subcutaneous tissue, which was examined immunohistochemically and ultrastructurally. It occured in a 48-year-old female patient who had suffered from painful nodules on the left shoulder. The nodules were removed and diagnosed as a benign fibrohistiocytic tumor. One year after local excision, multiple nodules were detected by physical examination at the previous operation site. Grossly, thirteen well-defined small nodules had spread in the dermis and the subcutaneous tissue, of which nine were located from lower dermis to the subcutaneous tissue and four were in the subcutaneous tissue. Histologically, each nodule consisted mainly of epithelioid tumor cells having eosinophilic or clear plump cytoplasm and round to oval nuclei with small nucleoli, and some peripheral spindle tumor cells. The tumor cells were negative for PAS reaction with and without diastase digestion or alcian blue. Immunohistochemically, tumor cells were positive for smooth muscle actin and vimentin. Ultrastructurally, the tumor cells showed actin filaments and dense bodies in cytoplasm. This case was diagnosed as an epithelioid leiomyosarcoma of the skin and the subcutaneous tissue with local metastasis one year after local excision.
Actin Cytoskeleton ; Actins ; Alcian Blue ; Amylases ; Cytoplasm ; Dermis ; Digestion ; Eosinophils ; Female ; Humans ; Leiomyosarcoma* ; Middle Aged ; Muscle, Smooth ; Neoplasm Metastasis ; Periodic Acid-Schiff Reaction ; Physical Examination ; Shoulder ; Skin* ; Subcutaneous Tissue ; Vimentin

No abstract available.
Haemophilus* ; Prevalence* ; Sputum*