PURPOSE: This study was to evaluate the clinical usefulness of 99mTc-MDP bone scintigraphy for assessing vascular ingrowth into the ocular implants after enucleation or evisceration. MATERIALS AND METHODS: Twenty-four patients (M:F=7:17, mean age: 36 years), who buried a coralline hydroxyapatite after uncomplicated enucleation or evisceration surgery were studied. Dynamic and static scintigraphy on the orbit fossa were obtained after injection of 740 MBq 99mTc-MDP to evaluate the status of vascularization. The study was performed from the 3 to 33 weeks after surgery. According to the visual analysis, activity greater than nasal bridge was graded as 4, equal to the nasal bridge as 3, less than nasal bridge but greater than normal orbit as 2, greater than normal orbit but less than grade 2 as 1. Uptake ratio was also calculated by measuring the implants activity (H) and contralateral orbit activity (N). Grading score and uptake ratio were compared with clinical outcome of vascularization. Additionally, we also analyzed the vascularization status as time lapse between primary surgery and scintigraphic study and surgical methods. RESULTS: Twenty-one patients who had bone scintigraphy at 11 weeks after surgery showed increased uptake above grade 2 and greater H/N ratio than 1.56. Of these, 19 patients who had drilling surgery for permanent peg application showed adequate bleeding during the procedure. The activity grade and uptake ratio were inversely correlated with vascular ingrowth. Higher than grade 2 or greater than 1.56 in H/N ratio seemed to be an indicator for better prognosis. Accomplishment of vascularization was not affected by the surgical way such as enucleation or evisceration. CONCLUSION: 99mTc-MDP bone scintigraphy can be a useful method to evaluate the vascularized status of implants. Adequate time for 99mTc-MDP bone scintigraphy may be 11-20 weeks after enucleation or evisceration.
Durapatite* ; Hemorrhage ; Humans ; Orbit ; Prognosis ; Radionuclide Imaging* ; Technetium Tc 99m Medronate*

Infection in primary total hip arthroplasty may cause catastrophic results and is the major reason for implant failure. The purpose of this study was to evaluate the utility of the hip joint fluid culture as a method of predicting the possibility of a hip joint infection by calculating the sensitivity, specificity and accuracy. We performed 628 primary total hip arthroplasty and aerobic and anaerobic bacterial cultures for hip joint fluid between January 1989 and June 1996. The hip joint fluid culture was routinely performed to evaluate the utility of the femoral head for bone banking. Thirty-two cases out of the 628 hips showed positive intraoperative culture and 596 cases showed negative intraoperative culture. The isolated organisms from 32 positive cultures were 11 for Staphylococcus aureus, eight for Staphylococcus coagulase negative, seven for Enterococcus, three for E.coli and one each for Enterobacter, Acinetobacter and Pseudomonas. Anaerobic culture was negative in all cases. In the positive intraoperative culture cases, none had delayed infection during the follow-up period. But in the negative intraoperative culture cases, one case had acute infection and two cases had delayed infection. In the case with acute infection, Staphylococcus aureus was isolated and on two cases with delayed infection, Enterococcus and Staphylococcus coagulase negative were isolated, respectively. All 32 positive culture cases were fa~lse positive and 595 negative culture cases were true negative and one negative culture case was fa~lse negative. The sensitivity of the hip joint culture was 0%, the specificity was 94.9% and the accuracy was 0%. The specificity of hip joint fluid culture in primary total hip arthroplasty was high, hut the sensitivity score was zero. Therefore, the hip joint fluid culture should not be used for a routine check of infection status in primary total hip arthroplasty. We recommend the hip joint fluid culture in revision arthroplasty or hips in which infection is clinically suspected.
Acinetobacter ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Bone Banks ; Coagulase ; Enterobacter ; Enterococcus ; Follow-Up Studies ; Head ; Hip Joint* ; Hip* ; Pseudomonas ; Sensitivity and Specificity ; Staphylococcus ; Staphylococcus aureus

A corticocancellous core was removed from both femurs and tibias in 5 skeletally immature pigs. The cavity was treated with 5%, 25% phenol cautery, cryosurgery, and normal saline irrigation (control). The animals were sacrified after 7days. The extent of the bone necrosis was assessed by gross examination, simple radiography, MRI evaluation and histological examination with tissue mapping. After cryosurgery, the extent of necrosis was most profound in the depth of 2.0-9.0mm beyond the cavity wall. The effect of 25%-phenol was next to cryosurgery, with a depth of 1.0-3.0mm of necrosis. 5%-phenol made necrosis with the depth of 1.0-2.5mm. Very mild degree of necrosis with the width of 0.5-1.0mm was found along the cavity wall even in control group. On MRI, signal change was well visualized on T2 weighted coronal section and it was quite coincided with the extent of bone necrosis proved by histological tissue mapping to all cases. When the epiphyseal plate was open or very close to the cavity, curettage itself, 5%- and 25%-phenol cautery and cryosurgery all produced mild ischemic necrosis along the provisional calcification zone of physeal plate. These findings suggest that cryosurgery made more profound necrosis beyond cavity than phenol cautery and MRI is very sensitive and specific to find osteonecrosis along the cavity wall after phenol cautery or cryosurgery. When epiphyseal plate is open or very close to the cavity, phenol cautery, or cryosurgery, or even curettage itself could produce an ischemic necrosis to the physeal plate itself.
Animals ; Cautery* ; Cryosurgery* ; Curettage ; Femur* ; Growth Plate ; Magnetic Resonance Imaging ; Necrosis* ; Osteonecrosis ; Phenol* ; Radiography ; Swine ; Tibia*

Cortical dysplasia(CD) represents a spectrum of neuropathologic changes reflecting a derangement of the normal process of neocortical development. We have presented 32 patients who underwent cortical recectiom for intractable seizures and demonstrated the neuropathologic features, which could be explained by a disturbance in the process of neural development in the farm. It could be characterized by light microscopic features: cortical laminar disorganization, neurons in the molecular layer, subpial re=ants of granule calls, remnants of marginal glioneuronal heterotopia, neuronal heterotopia in the white matter, polymicrogyria, neuronal cytomegaly and balloon cell change. Even though cortical dyslamimtion was the consistent finding of all the cases, the neuronal cytomegaly and balloon cell change were diagnostic hallmarks in the study. The cytomegatic neurons were strongly reactive to silver impregration and to immunohistochemical marrkers of neurons, such as neurofilament protein (NF, 68 and 200 kDa) and neuron-specific enolase(NSE). They showed hypertrophic endoplmmic reticul= and increased number of mitochondria in their cytoplasm and incomplete synapses in electron microscopic study. The balloon cells were positively stained by glial fibrillary acidic protein, NSE and vimentin and were filled with intermediate filaments in their cytoplasm. These results indicated that both cytomegalic neurons and balloon cells are produced by faulty cell differentiation involving neuroblast in the former, and both neuronal and glial stem cell lines in the latter.
Cell Differentiation ; Cytoplasm ; Glial Fibrillary Acidic Protein ; Humans ; Intermediate Filaments ; Malformations of Cortical Development* ; Mitochondria ; Neurons ; Seizures ; Silver ; Stem Cells ; Synapses ; Vimentin

PURPOSE: The development of fever in neutropenic cancer patients is frequently a sign of infection. Infection remains the major cause of death in the patient with cancer, primarily as a consequence of the profound alterations of normal host defences which result from the malignancy, its treatment or both. Fever in the patient with neutropenia is generally recognized as an indication of the need for prompt initiation of antibiotic therapy, but in spite of intensive efforts to identify infections in these patients and to institute appropriate antibiotic therapy, high mortality rate have continued to occur. This study was performed to identify the current etiologic agents, differences in frequency and/or type of infection in patients with hematologic malignacy as compared to those with solid tumor and to assess the period of neutropenia and treatment. METHODS: Between May 1994, and Feburuary 1994, we retrospectively evaluated 84 febrile episodes occurring in 46 patients with neoplastic diseases which were identified at Korea university hospital. Neutropenic fever has been defined as three episode of elevation of temperature above 38degrees C or a single elevation above 38.5degrees C in neutropenic patient (granulocyte<500/mm3) RESULTS: 1) Eighty-four episodes of fever and neutropenia were identified in 47 patients whose mean age was 6.6 years. 2) Thirty-three patients had leukemia or lymphma, representing 70.2% of the episodes of fever and neutropenia. 3) Microbiologically documented infection, clinically documented infection and unexplained fever accounted for 13%, 23%, 64% of the febrile episodes respectively. 4) Gastroenteritis and pharyngitis were the most common type of infection. 5) The common organism were Escherichia coli, Klebsiella pneumoniae, Staphyrococci aureus were common in decreasing order. 6) The mean duration of febrile neutropenia was 11.9 days in hematologic malignacy and 6.5 days in solid tumor. 7) The mean duration of receiving G-CSF was 13.1 days in hematologic malignancy and 5.8 days in solid tumor. 8) There was no significant difference in duration of neutropenia, times of receiving treatment and ANC level at fever in patients with MDI compared to CDI or UF. CONCLUSIONS: Gram negative bacilli are dominant pathogens of neutropenic fever in Korea university hospital.
Cause of Death ; Drug Therapy* ; Escherichia coli ; Febrile Neutropenia* ; Fever ; Gastroenteritis ; Granulocyte Colony-Stimulating Factor ; Hematologic Neoplasms ; Humans ; Klebsiella pneumoniae ; Korea ; Leukemia ; Mortality ; Neutropenia ; Pharyngitis ; Retrospective Studies

PURPOSE: Alteration in the serum level of thyroid hormone can occur following open heart surgery due to major stress and hemodilution after extracorporeal circulation but these changes have been ignored. The purpose of this study is to evaluate the changes of thyroid hormone level after open heart surgery and if these changes influence the prognosis. METHODS: We evaluated 26 children who had undergone open heart surgery from Sept. 1994 to Jun. 1996 at Korea University Hospital. Five ml of blood were collected before surgery, immediately after surgery and 24 hours after surgery. The blood was centrifused and the serum stored at -40degrees C until examinations were made. Serum T3, T4, reverse T3 were measured by sensitive and specific radioimmunoassay. RESULTS: The mean T3 level was 1.49 +/- 0.50ng/ml (normal 0.08-2.0ng/ml) at pre op, 0.75 +/- 0.40ng/ ml immediately after surgery and 0.69 +/- 0.50ng/ml 24 hours after surgery. The mean T4 level was 10.73 +/- 4.40ug/dl (normal 6.1-11.8 microgram/dl) at pre op, 5.80 +/- 1.90ug/dl immediately after surgery and 5.60 +/- 2.10ug/dl 24 hours after surgery. The mean TSH level was 1.69 +/- 1.13uIU/ml (normal 0.25-4.0 uIU/ml) at pre op, 1.37 +/- 0.80uIU/ml immediately after surgery and 1.61 +/- 1.00uIU/ml 24 hours after surgery. Serum T3 and T4 levels in cardiac surgical patients were significantly reduced (P<0.01), and serum reverse T3 levels were significantly increased (P<0.05), and serum TSH levels were not significantly different in comparison with the preoperative state. CONCLUSION: We conclued that patients with congenital heart disease who underwent open heart surgery show euthyroid sick states like other severely ill patients. It is likely that reduction in T3 and T4 without increased TSH represents an adaptive response by the body to minimize catabolism when undergoing major stress.
Child ; Extracorporeal Circulation ; Heart Defects, Congenital ; Heart* ; Hemodilution ; Humans ; Korea ; Metabolism ; Prognosis ; Radioimmunoassay ; Thoracic Surgery* ; Thyroid Gland*

Pulmonary actinomycosis is a chronic suppurative disease usually caused by Actinomyces israelii, characterized by suppuration, sinus tract formation, and purulent discharge containing yellowish "sulfur granules". It is usually caused by aspiration of contaminated material from mouth or oropharynx. The diagnosis of pulmonary actinomycosis is difficult and its initial clinical manifestations mimic tuberculosis or neoplasm. We experienced a case of thoracic actinomycosis in a 47-year old male patient who had complained of cough, chest pain and fever for 2 months. The diagnosis was confirmed pathologically by ultrasonography guided gun-biopsy of pleural mass and thoracoscopic wedge biopsy of parenchymal lung lesion.
Actinomyces ; Actinomycosis* ; Biopsy ; Chest Pain ; Cough ; Diagnosis ; Fever ; Humans ; Lung ; Male ; Middle Aged ; Mouth ; Oropharynx ; Suppuration ; Tuberculosis ; Ultrasonography

This article describes methods used to produce a RBRVS (resource-based relative value scales), a common scale from two specialties (internal medicine and general surgery) and explains the newly developed extrapolation process within each specialty. To produce a common scale, we selected six 'same' services as linking services common to both specialties. Then we used the bi-weighted least squares method to locate all the same services on a single, common scale. By using the same method, we tried to extrapolate all the services within each specialty, not by the method of Kelly et al, dividing all the services within the specialty into families (small homogeneous groups of services) to apply charge-based ratios. To compare both methods, we extrapolated all the services of general surgery according to each method. With the correlation analysis to compare both results to American RVUs, we found that general surgery's RVUs from our own extrapolation method turned out to be more highly correlated with American RVUs than from Kelly's extrapolation method. Consequently, extrapolation with bi-weighted least squares method gave reasonable results.
Human ; *Internal Medicine ; Least-Squares Analysis ; *Relative Value Scales

We have never seen any method to cope basically with complicated situation and problems around medical reimbursement rates here in Korea since 1977 witnessed by the beginning of medical insurance. By the way researchers concerned are beginning to propose some kinds of innovative and detailed ideas to government these days. They are Diagnosis-related group(DRG)and Resource-based relative value scale(RBRVS). In the light of this situation it is so encouraging that our government can come up with that and move. In case of RBRVS research we have already been reaching even to the level of reviewing and revising methodology for its further development after naive pilot study on internal medicine and general surgery last year. However there might be something different conditions between USA and Korea to apply the same Dr. Hsiao's method and it must be vital to check so called 'total work approach' compared with 'intra-service work approach' before expanding to the whole medical fields. According to the 'Intra-service approach', the physician's work is supposed to be divided into three sub-works by the name of intraservice work, pre, and post service work. These sub-works, again should be merged together to be the pre-postwork subset through some statistical methods of the estimation process applied by Dr. Hsiao's methodology in RBRVS development later on. But in this paper that estimation process was not taken because we could have real values for all of those surveyed items related to just one specialty, OB & GY. Instead, we used some statistical comparison procedures relevant to demographic characteristics, reliability & validity and correlation analysis with American RVU(Relative value unit) between the total work and merged total work from intraservice work approach. The unit of analysis was individual physicians of OB & GY and 300 physicians were selected for each approach through statistical sampling method based on national population of OB & GY physicians in korea. And also with the thankful help of Advisory committee under Korean Association of OB & GY, questionnaires were made and mailed to the subjects, two times. As a result there were not any statistically significant differences in demographic characteristics between the two approaches except for the variable 'Response time for the questionnaire', but in other sections of comparisons, response rate, representative values, reliability & validity test, correlation analysis with American RVU, all showed 'Total approach' was not only more rational and statistically meaningful than ,'Intra-service approach' but also had considerable merits. But we are not absolutely sure about this paper's robustness. Because of some limitations, we'd rather like to suggest further researches should be followed. In that sense the first thing would be a research for the influence of doctor's haracteristics, especially 'frequency' on the rating of work and the way to define total work more clearly.
Advisory Committees ; Gynecology* ; Insurance ; Internal Medicine ; Korea ; Obstetrics* ; Pilot Projects ; Postal Service ; Surveys and Questionnaires

BACKGROUND: Differential diagnosis of lymphocytic pleural effusion is difficult even with many laboratory findings. Nitric oxide(NO) level is higher in the sputum or exhaled breath of patients with active pulmonary tuberculosis than in those without tuberculosis. In addition, there are some reports about the increased level of NO metabolites in body fluids of cancer patients. However, there is no data on the NO levels in the pleural fluid of patients with tuberculous pleurisy. Method : The serum and pleural fluid NO in the patients with acute lymphocytic pleural effusion were analyzed. RESULTS: Of total 27 patients, there were 14 males and average age of patients was 48 years. The final diagnosis was tuberculous pleurisy in 17 cases and malignant pleural effusion in 10. The pleural fluid NO level was 540.1+/-116.4 micrometerol in the tuberculous pleurisy patients and 383.7+/-71.0 micrometerol in the malignant pleural effusion patients. The serum NO level was 624.7+/-142.0 micrometerol in tuberculous pleurisy patients and 394.4+/-90.4 micrometerol in malignant pleural effusion patients. There was no significant difference in the serum and pleural fluid NO level between the two groups. The NO level in the pleural fluid showed a significant correlations with the pleural fluid neutrophil count, the pleural fluid/serum protein ratio, and pleural fluid/serum albumin ratio (p<0.05 in each). The protein concentration, leukocyte and lymphocyte count in the pleural fluid were significantly higher in the tuberculous pleurisy patients than the malignant pleural effusion patients (p<0.05 in each). CONCLUSION: NO is not a suitable marker for a differential diagnosis of lymphocytic pleural effusion. However, the NO level in the pleural fluid might be associated with the neutrophil recruitment and protein leakage in the pleural space.
Body Fluids ; Diagnosis ; Diagnosis, Differential* ; Humans ; Leukocytes ; Lymphocyte Count ; Male ; Neutrophil Infiltration ; Neutrophils ; Nitric Oxide* ; Pleural Effusion* ; Pleural Effusion, Malignant ; Sputum ; Tuberculosis ; Tuberculosis, Pleural ; Tuberculosis, Pulmonary