From retrospective review of 111 tibial fractures treated by interlocking intramedullary nailing, 38 operative errors in 28 cases(25%) were included in this study. The errors were classified into two categories. The first category included eighteen errors that related to fracture reduction; nine angular malalignments, four failures in closed nailing to open the fracture site, two peroneal nerve palsies, two shortenings of tibial length(more than 1cm), and one rotational malalignment. The second category comprised twenty errors that related to the nailing itself; eight protrusions of proximal nail tip, five overdistractions of fracture gap (more than 3mm), four additional fragmentations, two mistakes in interlocking screw insertion, and one ankle joint injury by the distal nail tip. Functional results of those 28 cases at the last follow-up(average, 17.5 months; range, 9 to 29 months) were excellent or good in only 60.8 per cent, while the control group treated by adequate operative technique showed excellent or good results in 92.8 per cent.
Ankle Joint ; Fracture Fixation, Intramedullary ; Paralysis ; Peroneal Nerve ; Retrospective Studies ; Tibial Fractures

BACKGROUND: Melanocytes grown in pure monolayer culure lack many of the cellular interactions that exist in vivo. This can be partially overcome by growing melanocytes together with other epidermal cells in skin equivalent models. OBJECTIVE: The objective of the present study was to grow human melanocytes in human epidermis reconstructed on dermal substrates in vitro and to examine their response to UV radiation. METHODS: The skin equivalents were prepared by seeding cultured human keratinocytes together with cultured human melanocytes(in a ratio of 5%) onto de-epidermized dermis. After 7 days of culture, they were exposed to UVB irradiation(total 150m J/cm over 5days). On day 12 of air exposure the sections of the skin equivalents were prepared for histology. The structure of the skin equivalents was studied following staining with hematoxylin and eosin. Melanocytes were characterized by DOPA staining and by immunohistochemistry. RESULTS: Melanocytes were localized singly within the basal layer of the reconstructs. Melanin was also visible both in the melanocytes and in neighboring keratinocytes. There was an increase in melanocyte size and dendricity following UV irradiation. Melanocytes became positive to staining with HMB-45 antibody following UV irradiation. CONCLUSION: Our results indicate that melanocytes grown in reconstructed human epidermis are functional and capable of responding to UV irradiation.
Dermis ; Dihydroxyphenylalanine ; Eosine Yellowish-(YS) ; Epidermis* ; Hematoxylin ; Humans* ; Immunohistochemistry ; Keratinocytes ; Melanins ; Melanocytes* ; Skin

In connective tissue diseases, autoantibodies cause pulmonary interstitial inflammation and fibrosis, and patients require treatment with an immunosuppressive agent such as a steroid. Dermatomyositis is an incurable, uncommon form of connective tissue disease that occasionally causes diffuse pulmonary inflammation leading to acute severe respiratory failure. In such cases, the prognosis is very poor despite treatment with high-dose steroid. In the present case, a 46-year-old man was admitted to our hospital with dyspnea. He was diagnosed with dermatomyositis combined with cryptogenic organizing pneumonia (COP) with respiratory failure and underwent treatment with steroid and an immunosuppressive agent, but the COP was not improved. However, the respiratory failure did improve after treatment with intravenous immunoglobulin, which therefore can be considered a treatment option in cases where steroids and immunosuppressive agents are ineffective.
Autoantibodies ; Connective Tissue Diseases ; Cryptogenic Organizing Pneumonia* ; Dermatomyositis* ; Dyspnea ; Fibrosis ; Humans ; Immunoglobulins* ; Immunosuppressive Agents ; Inflammation ; Lung Diseases, Interstitial ; Middle Aged ; Pneumonia ; Prognosis ; Respiratory Insufficiency ; Steroids

PURPOSE: Although platelet-rich plasma (PRP) potentiate the wound healing activity of adipose-derived stem cells (ADSCs), its effect cannot be sustained for a prolonged period of time due to short duration of action. This led us to design and produce platelet-rich fibrin (PRF), in an effort to develop a tool which lasts longer, and apply it on wound healing. METHODS: Two symmetrical skin defects were made on the back of seven nude mice. ADSCs were applied to each wound, combined with either PRP or PRF. The wound area was measured over 14 days. By day 16, the wound was harvested and histologic analysis was performed including counting of the blood vessel. RESULTS: The healing rate was more accelerated in PRP group in the first 5 days (p<0.05). However, PRF group surpassed PRP group after 6 days (p<0.05). The average number of blood vessels observed in the PRF group was 6.53 +/- 0.51, compared with 5.68 +/- 0.71 for the PRP group. CONCLUSION: PRF exerts a slow yet pervasive influence over the two-week course of the wound healing process. Thus, PRF is probably more beneficial for promoting the activity of ADSCs for a sustained period of time.
Acceleration ; Animals ; Blood Platelets ; Blood Vessels ; Fibrin ; Mice ; Mice, Nude ; Platelet-Rich Plasma ; Skin ; Stem Cells ; Wound Healing

PURPOSE: We evaluated the clinical/laboratory characteristics and progress of pediatric patients hospitalized for pneumonia and laboratory-confirmed H1N1 influenza infection. METHODS: A total of 101 patients were enrolled. They were divided into 2 groups: group 1 with a fast respiration rate for age (n=66) and group 2 with an appropriate respiration rate for age (n=35). We retrospectively reviewed the medical charts to collect data on the hospitalized patients. RESULTS: Patients were significantly older in group 1 than in group 2 (median age, 7 vs. 4 years, p<0.001) and 59.0% were between 6 and 8 years of age. Sixteen patients (24.2%) in group 1 had underlying medical conditions, most of whom had asthma, and 50 were previously healthy. Oxygen saturation on admission day was significantly lower in group 1 than in group 2 (92% vs. 98%, p<0.001) and 42 patients (63.6%) in group 1 had hypoxia (oxygen saturation <= 92%). The frequency of lymphopenia was significantly higher in group 1 than in group 2 (n=59 vs. 11, p<0.001). Some patients in group 1 received systemic corticosteroid therapy, intravenous immunoglobulin infusion and oxygen supplement (n=28, n=16, n=48, respectively). The frequency of systemic corticosteroid therapy and oxygen supplement was higher in group 1 than in group 2 (p<0.001 for each). CONCLUSION: H1N1 influenza infection complicated by pneumonia can cause severe illness in previously healthy children more than 6 years old and in children with uncontrolled allergic disease. Multi-center studies are needed to evaluate the clinical and epidemiologic characteristics of pediatric patients with 2009 H1N1 influenza.
Anoxia ; Asthma ; Child ; Humans ; Immunoglobulins ; Influenza, Human ; Lymphopenia ; Oxygen ; Pneumonia ; Respiratory Rate ; Retrospective Studies ; Tachypnea

PURPOSE: To determine the efficacy of the N-terminal fragment of B-type natriuretic peptide (NT-proBNP) as a useful diagnostic method in children with incomplete Kawasaki disease (KD). METHODS: Ninety-six patients who were diagnosed as having KD between January 2008 and June 2009 were enrolled in the study. American Heart Association recommendations for diagnosis were used, and patients were divided into the complete KD and incomplete KD groups. Blood tests including NT-proBNP were performed on admission day. Nineteen patients who had other febrile diseases other than KD were enrolled as control. RESULTS: Thirty-three patients (34%) had incomplete KD. Change in the lips and oral cavity and conjunctivitis were the most common clinical features, but their frequency was lower than complete KD (76% vs 98%, 76% vs 90%). Patients with incomplete KD exhibited significantly higher NT-proBNP level than that of control (1,407.7+/-1633.5 pg/mL vs 126.2+/-135.5 pg/mL, p<0.001). An NT-proBNP cutoff value of 158 pg/mL provided a sensitivity of 81% and a specificity of 74% for diagnosis of incomplete KD. CONCLUSION: NT-proBNP assay can be clinically useful for the diagnosis of incomplete KD, if the patient has persistent fever, change in the lips and oral cavity, and conjunctivitis, and if the patient with those symptoms is suspected to have incomplete KD.
American Heart Association ; Child ; Conjunctivitis ; Fever ; Hematologic Tests ; Humans ; Lip ; Mouth ; Mucocutaneous Lymph Node Syndrome ; Natriuretic Peptide, Brain ; Peptide Fragments ; Sensitivity and Specificity

PURPOSE: This study was undertaken to learn the usefulness, cost-effectiveness and safety of intraoperative transesophageal echocardiography(ITEE) during open heart surgery for congenital heart diseases. METHODS: The usefulness and safety of ITEE were assessed in 254 patients who underwent open heart surgery for congenital heart diseases from January 1, 2001 to June 30, 2003, with retrospective chart reviews and a simple relative cost analysis. RESULTS: Among 254 open heart surgery patients, ITEE was not performed in 47 cases. The majority of cases were atrial septal defect(15 cases, 32%), ventricular septal defect(16 cases, 34%), ASD and VSD(three cases, 6.4%). In the other five smaller babies(weight range 2.7-3.1 kg), the ITEE probes couldn't pass the patient's esophagus. In 207 cases, ITEE were performed without any major complications. Residual abnormalities were identified by ITEE in six cases(2.9%), requiring surgical revisions : four cases with right ventricular outflow tract pressure gradient, one case of residual mitral regurgitation and one case of residual aortic stenosis and supravalvular pulmonary stenosis. If these six cases had not directly returned to bypass for surgical revision of the initial repair at the same operation, the additional fee of reoperation after leaving operation room were estimated to be won47,496,346(won7,916.057 per patient). In contrast, the costs of performing ITEE in all open heart surgical patients(207 patients) stood to total won82,800,000(won400,000 per patient). CONCLUSION: ITEE was not considered to be a beneficial diagnostic modality in terms of cost effectiveness in this study. But, the routine use of ITEE during most open heart surgery for congenial heart defects may be warranted as it produces no major complication, improves postoperative care, and comforts surgeon's feelings.
Aortic Valve Stenosis ; Cost-Benefit Analysis ; Costs and Cost Analysis ; Echocardiography, Transesophageal* ; Esophagus ; Fees and Charges ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Mitral Valve Insufficiency ; Postoperative Care ; Pulmonary Valve Stenosis ; Reoperation ; Retrospective Studies ; Thoracic Surgery

Substernal extension of a goiter into the thoracic inlet endows a generally benign neck mass with morbid potential. The reported incidence varies between 1% and 15% of all thyroidectomies performed. Whether all patients with a substernal goiter should undergo an operation or whether the operation should be performed selectively remains controversial. From May 1989 to March 1996, 10 patients underwent thyroidectomies for substernal goiters, and those cases of resected substernal goiters have been reviewed to access the symptoms and signs that brought patients to surgery: the size and the position of goiter, the preoperative work-up, the risk associated with the operation, and the histopathologic state of the goiter. There were 3 male and 7 female patients, and their ages ranged from 40 to 68 years. The chief complaints were cervical mass (4), dyspnea (2), facial edema (1) and chest pain (1). No symtomatic cases (2) were also found. The average mass size was 8.4 cm (5-14 cm) and the average weight was 109 gm (41-350 gm). Although chest film was the most used, computed tomography was by far the most useful study. Thyroid scans often failed to show the substernal goiter. Fine-needle aspiration was not helpful because of inaccessibility. In the majority of the patients (7 cases), the substernal goiters were removed by a cervical incision. Three cases of goiters located deep to the carina level required a combined cervical and sternotomy approach or thoracotomy. In the cervical incision group, the complications were transient hypocalcemia (1) and unilateral recurrent laryngeal nerve injury (1). In the combined cervical and sternotomy approach or thoracotomy, unilateral recurrent laryngeal nerve injury (1) and bilateral recurrent laryngeal nerve injury (1) and mediastinitis (1) were the complications. An occult papillary carcinoma, which was not identified preoperatively, was found in one case. Removal was almost always accomplished via cervical incision and with low morbidity and no deaths. Also, the substernal goiters revealed unusual symptoms and signs, such as dyspnea, facial edema and chest pain, compared to usual thyoid goiters and were relatively bigger in size. In conclusion, most substernal goiter above the carinal level could be removed by cervical incision with a low rate of complication. The threat of compression, the substantial chance of malignancy, and the safety of resection mean that the presence of a substernal goiter is an indication for surgery.
Bays ; Biopsy, Fine-Needle ; Carcinoma, Papillary ; Chest Pain ; Dyspnea ; Edema ; Female ; Goiter ; Goiter, Substernal* ; Humans ; Hypocalcemia ; Incidence ; Male ; Mediastinitis ; Neck ; Recurrent Laryngeal Nerve Injuries ; Sternotomy ; Thoracotomy ; Thorax ; Thyroid Gland ; Thyroidectomy

OBJECTIVE: The purpose of this study was to evaluate the physicochemical properties and cytocompatibility of microporous, spherical biphasic calcium phosphate(BCP) ceramics with a 60/40 hydroxyapatite/beta-tricalcium phosphate weight ratio for application as a bone graft substitute. MATERIALS AND METHODS: Microporous, spherical BCP granules(MGSB) were prepared and their basic characteristics were compared with commercially available BCP(MBCP; Biomatlante, France) and deproteinized bovine bone mineral(Bio-Oss; Geistlich-Pharma, Switzerland, BBP; Oscotec, Korea). Their physicochemical properties were evaluated by scanning electron microscopy, X-ray diffractometry, Fourier-transform infrared spectroscopy, inductively coupled plasma atomic emission spectrometer, and Brunauer-Emmett-Teller method. Cell viability and proliferation of MC3T3-E1 cells on different graft materials were evaluated. RESULTS: MGSB granules showed a chemical composition and crystallinity similar with those in MBCP, they showed surface structure characteristic of three dimensionally, well-interconnected micropores. The results of MTT assay showed increases in cell viablity with increasing incubation times. At 4d of incubation, MGSB, MBCP and BBP showed similar values in optical density, but Bio-Oss exhibited significantly lower optical density compared to other bone substitutes(p < 0.05). MGSB showed significantly greater cell number compared to other bone substitutes at 3, 5, and 7d of incubation(p < 0.05), which were similar with those in polystyrene culture plates. CONCLUSION: These results indicated the suitable physicochemical properties of MGSB granules for application as an effective bone graft substitute, which provided compatible environment for osteoblast cell growth. However, further detailed studies are needed to confirm its biological effects on bone formation in vivo.
Bone Substitutes ; Calcium* ; Cell Count ; Cell Survival ; Ceramics* ; Crystallins ; Microscopy, Electron, Scanning ; Osteoblasts ; Osteogenesis ; Plasma ; Polystyrenes ; Spectrum Analysis ; Switzerland ; Transplants*

BACKGROUND: After the resurgence of endemic malaria case in 1993, the number of malaria cases is increasing in succeeding years and most of patients were soldiers who served in the northern parts of Kyeonggi-do and Kangwon-do. Because group donations of blood from soldiers are frequent in these area, it is possible that donated blood from these area cause malaria. So we examined blood donation history of malaria patients to know their donation behavior. METHODS: The subject was 1,671 malaria patients who were diagnosed in 1997 and referred to blood transfusion research institute and their past donation history, time and frequency of donation were examined. The database consisted of malaria patients and blood donors who are known to be related with transfusion-transmitted malaria has been retrieved at each red cross blood center for every blood donors. The results were analyzed from January to December, 1998. RESULTS: About 60% (1,017) of 1,691 malaria patients in 1997 had donated their blood before diagnosis. The number of one time donation was 268; two time 289; more than three time was 460. Two hundred thirty six donors were checked by malaria registry file. In 236 donors, 92 cases were diagnosed with malaria, 96 cases were suspected to have malaria, 48 cases were namesakes. Conclusion: Because some malaria patients donate their blood after their diagnosis, it would be necessary to operate 'the computerized retrieving programme'to detect their donation after the diagnosis. Also, an education for malaria patients for their risk of transmitting malaria and strict history taking from donors for malaria will be required.
Academies and Institutes ; Blood Donors* ; Blood Transfusion ; Diagnosis ; Education ; Gangwon-do ; Gyeonggi-do ; Humans ; Malaria* ; Military Personnel ; Red Cross ; Tissue Donors