High tibial osteotomy is a useful procedure in the treatment of early stage osteoarthritis of the knee which is confined to the medial compartment. But long term follow-up study of high tibial osteotomy has not been provided yet and its prerequisite for a successful result still remains unrevealed. Since the osteoarthritis can progress after the osteotomy, it may result in the loss of correction and recurrence of pain and require conversion to total knee replacement arthroplasty. We studied clinically and radiologically the long term result of high tibial osteotomy in 11 patients(16 knees) who had been treated at the Department of Orthopaedic surgery of Seoul Paik Hospital during the period from January, 1978 to May, 1989, and follow-up for longer than 4 years. Preoperative mean varus angle was 6.4 degrees and immediate postoperative mean valgus angle was 8.6 degrees and final mean valgus angle was 4.7 degrees. The average loss of correction angle was 3.9 degrees. At 2-year follow-up, the results of 16 knees were as follows; excellent in six knees, good in seven knees. The final results at average 7.2-year follow-up were excellent in four knees, good in six knees and one knee was converted to total knee replacement arthroplasty. The results showed deterioration of clinical results and loss of correction with time after osteotomy. However, in more than half of the cases the results were good or excellent at the final follow-up, We, therefore, conclude that high tibial osteotomy is still a useful procedure in osteoarthritis of the knee if performed with a precise surgical technique and an adequate overcorrection more than 10 degrees.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Knee ; Osteoarthritis ; Osteotomy ; Recurrence ; Seoul

No abstract available.
Appointments and Schedules* ; Hepatitis B Vaccines* ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Infant, Newborn* ; Vaccination*

BACKGROUND AND OBJECTIVES: Fulminant invasive fungal sinusitis (IFS) is an aggressive, destructive disease most commonly affecting the immunocompromised hosts. This study aimed to investigate the clinical features of invasive fungal sinusitis and to determine its prognostic factors. MATERIALS AND METHOD: Fifteen cases of invasive fungal sinusitis were retrospectively reviewed. Prognosis was analyzed according to predisposing factors including the underlying disease, the extent of disease, the mycotic species, and treatment modalities. RESULTS: Overall 5-year survival rate of the patients with IFS was 60%. There was significant survival gain in the group for which underlying disease was well controlled (p=0.04). There was no difference in survival in terms of mycotic species and extent of disease at presentation. No statistically significant difference in survival was observed between the conservative surgery and the radical surgery group. CONCLUSION: Survival is usually determined at the very early period of treatment. The most important prognostic factor is not the surgical modalities including wide surgical resection or conservative debridement, but the optimal control of underlying disease.
Causality ; Debridement ; Fibrinogen ; Humans ; Immunocompromised Host ; Prognosis ; Retrospective Studies ; Sinusitis* ; Survival Rate

Backround and Objectives: Mucocele of the paranasal sinuses could be developed as secondary to trauma, tumor or surgical manipulation. This study was conducted to investigate clinical eatures of paranasal sinus mucocele following endoscopic sinus surgery and to determine the effect of endoscopic wide marsupialization for the treatment of mucocele. MATERIALS AND METHODS: Thirty-five patients with paranasal sinus mucocele who were diagnosed and surgically treated at Seoul National University Hospital from Nov. 1996 through Dec. 2002 were retrospectively analyzed by their medical records and radiological imaging. RESULTS: The most common chief complaint of patients with mucocele were ocular symptoms including periorbital swelling, proptosis and headache. Previous sinus operation, especially endoscopic sinus surgery was the most common cause of mucocele, which developed at mean period of 50 months after surgery. Most commonly involved sinuses were ethmoid and frontal sinuses. Thirty-three out of 35 patients underwent endoscopic wide marsupialization of the mucocele cavity, and the other two patients were treated via external approaches. No recurrence was observed until mean followup of 33 months. CONCLUSION: One should suspect the possibility of mucocele recurrence if a patient complains of ocular symptoms several years after endoscopic sinus surgery. Meticulous operation and postperative treatment, and regular followup are needed for patients who underwent endoscopic sinus surgery because of a possible development of mucocele as a late complication. Although transnasal endoscopic wide marsupialization for the treatment of mucocele showed safe and good results, long term follow-up data is needed to establish it as the gold standard for treatment of paranasal sinus mucocele.
Exophthalmos ; Follow-Up Studies ; Frontal Sinus ; Headache ; Humans ; Medical Records ; Mucocele* ; Paranasal Sinuses ; Recurrence ; Retrospective Studies ; Seoul

PURPOSE: Nuclear Factor-kappaB p65 (NF-kappaB p65) and nuclear Factor-kappaB1 p50 (NF-kappaB p65) have been shown to play roles in cell proliferation, apoptosis, cytokine production and oncogenesis. This study was designed to investigate the expressions of NF-kappaB p65 and NF-kappaB p50 proteins in premalignant lesions and colorectal adenocarcinoma. METHODS: Paraffin sections of 20 normal mucosa specimens, 20 low grade tubular adenoma specimens, 20 high grade tubular adenoma specimens and 64 adenocarcinoma specimens were analyzed immunohistochemically for the expressions of NF-kappaB p65 and NF-kappaB p50 proteins. RESULTS: The expressions of NF-kappaB p65 and NF-kappaB p50 proteins were significantly higher in the adenocarcinoma tissue compared with that in the normal mucosa, the low grade tubular adenoma and the high grade tubular adenoma tissues. The frequency of a NF-kappaB p50 expression was higher in the poorly differentiated histologic grade specimens, in the presence of nodal metastasis and in the high stage specimens. There were significant correlations between the NF-kappaB p65 and NF-kappaB p50 proteins. CONCLUSION: The expressions of NF-kappaB p65 and NF-kappaB p50 proteins may play a role in the pathogenesis of colorectal carcinoma.
Adenocarcinoma ; Adenoma ; Apoptosis ; Cell Proliferation ; Cell Transformation, Neoplastic ; Colorectal Neoplasms ; Mucous Membrane ; Neoplasm Metastasis ; NF-kappa B ; Paraffin ; Proteins

PURPOSE: The purpose of this study was to evaluate the results of treating senile osteoporotic peritrochanteric fracture with proximal femoral nail antirotation (PFNA). MATERIALS AND METHODS: Between November 2006 and December 2007, 21 patients older than 65 years of age with intertrochanteric and subtrochanteric fractures were treated with PFNA. The mean duration of follow-up was 12.9 months and the mean age was 74.5 years. RESULTS: The mean operation time was 48.8 minutes (range: 25-90 minutes). The time to ambulation averaged 7.9 days. Eighty point nine percent (17 cases) of the patients returned to their previous walking status at 6 months after operation. The average T-score was -3.3. Eighteen cases (85.7%) achieved acceptable reduction and the mean time to radiologic bony union was 17.4 weeks. The average amount of PFNA blade sliding was 4 mm and the neck-shaft angle was changed to 1.3 degrees varus displacement at the final follow-up. The complications included pulmonary edema in 1 case and protrusion of the PFNA blade into the hip joint in 1 case. CONCLUSION: Because of the reduced operation time, favorable walking ability and low rate of complications, PFNA is an acceptable alternative for fixation of senile osteoporotic peritrochanteric fracture.
Displacement (Psychology) ; Femur ; Follow-Up Studies ; Hip Fractures ; Hip Joint ; Humans ; Nails ; Osteoporosis ; Pulmonary Edema ; Walking

In the present study, we examined the p53 mRNA expression in neuronal cell injury using a hypoxia and reoxygenation model of neuronal toxicity in hippocampal CA1 and CA3 regions. Reoxygenation for 6 hours to 3 days, after an exposure to hypoxic condition for 2 hours, produced a significant increase in p53 mRNA expression both in CA1 and CA3 regions compared to those in the control. In order to determine whether these changes in p53 mRNA expression in CA1 and CA3 have an effect on hypoxia-induced apoptotic or necrotic changes, TUNEL and H & E staining were applied to the hippocampal neurons. Interestingly, the CA1 region only showed most of strong TUNEL positive reaction whereas TUNEL positive reaction was weak in the CA3 region at reoxygenation time points. In addition, one of the particular morphological changes in CA1 neurons is the shrinkage of some neurons although most of neurons showed normal. However, the prominent neuronal changes in the CA3 region was that there were extensive red neurons containing eosinophilic cytoplasm and several dark neurons showing pyknotic nuclei, expanded perineuronal spaces, and cork-screw processes which are considered to typical necrotic degeneration. These results suggest that increased p53 expression might play important roles in hippocampal cell injury and their molecular mechanisms underlying cell injury may strongly depends upon the different properties of each hippocampal regions.
Anoxia* ; Apoptosis ; Cytoplasm ; Eosinophils ; In Situ Nick-End Labeling ; Necrosis ; Neurons ; RNA, Messenger*

BACKGROUND AND OBJECTIVES: There have been many studies concerning histologic changes and effectiveness of specific treatment in the experimentally induced sinusitis model, but there are few studies about natural course of paranasal sinusitis. This study aimed to analyze the natural course of sinusitis and the influence of stress on the natural disease course. MATERIALS AND METHOD: Natural ostia of 120 rabbits were occluded and reopened at 10 days after occlusion. Rabbits were divided into six groups according to duration from reopening to sacrifice. Each group was sacrificed at 1, 4, 8, 12, 19, 26 days after reopening of the natural ostium. Each group was divided into a control and stress subgroups. Radiologic, gross and histologic findings were analyzed. RESULTS: Percentage of rabbits showing partial or total haziness was highest at 3 days after reopening in the control subgroup and at 11 days in the stress subgroup. Percentage of the rabbits showing moderate or severe amount of pus in the sinus on gross examination was highest at 4 days in both subgroups. Degree of epithelial loss was most severe at 4 days in both subgroups. Subepithelial thickness was largest and inflammatory cell infiltrations were most severe at 8 days in both subgroups. Although there was a lack of statistical significance, stress subgroups showed more severe gross, radiologic, and histologic findings than those of control subgroups. CONCLUSION: This study shows that maxillary sinusitis is induced by natural ostium occlusion only and is improved with time without any treatment, and that stress might influence the severity of maxillary sinusitis.
Maxillary Sinus* ; Maxillary Sinusitis* ; Rabbits* ; Sinusitis ; Suppuration

BACKGROUND AND OBJECTIVES: Patients with Kawasaki disease (KD) are clinically heterogeneous because its diagnosis is based solely on clinical observation and there are no definitive biomarkers. We dissected the clinical heterogeneity of KD patients using the KD-associated genetic variants. METHODS: We performed a genetic association analysis in several KD subgroups categorized by clinical characteristics using the KD-associated variants of the B lymphoid tyrosine kinase (BLK; rs6993775) and Fc gamma receptor II a (FCGR2A; rs1801274) in a large number of case (n=1,011) and control (n=4,533) samples. RESULTS: BLK and FCGR2A were very significantly associated with KD in Korean KD patients (odds ratio [OR],1.48; p=4.63×10⁻¹¹ for BLK, and OR, 1.26; p=1.42×10⁻⁴ for FCGR2A). However, in KD subgroup analysis, we found that neither BLK nor FCGR2A were associated with either incomplete Kawasaki disease (iKD) type patients or those older than 5 years of age (p>0.2), suggesting that patients with iKD or those older than 5 years of age are a unique subgroup of KD. In genetic association analysis after excluding iKD patients and those older than 5 years old, we found that BLK was associated with all KD subgroups, whereas FCGR2A was specifically associated with male KD patients younger than 1 year of age (OR, 2.22; p=2.35×10⁻⁵). CONCLUSIONS: KD is a clinically and genetically heterogeneous disease. These findings will provide new insights into the clinical and genetic heterogeneity of KD.
Biomarkers ; Diagnosis ; Genetic Heterogeneity ; Genome-Wide Association Study ; Humans ; Male ; Mucocutaneous Lymph Node Syndrome ; Polymorphism, Single Nucleotide ; Population Characteristics ; Protein-Tyrosine Kinases

Background and Objectives: Kawasaki disease (KD) is an acute systemic vasculitis that affects the coronary arteries. Abnormal immune reactions are thought to contribute to disease pathogenesis. The effect of immunoglobulin (Ig) isotype (IgG, IgA, IgM, and IgE) on inflammatory data and clinical outcomes of patients with KD was examined. Methods: Ig levels in 241 patients with KD were measured during the acute, subacute, convalescent, and normal phases of the disease. Results: Compared with reference Ig values, IgG, IgA, and IgM levels were significantly higher in the subacute phase, while IgE levels were elevated in 73.9% (178/241) of patients with KD in all clinical phases. However, high IgE levels were not associated with clinical outcomes, including intravenous immunoglobulin unresponsiveness and coronary artery lesions (CALs).Significantly more CALs were observed in the high IgA group than in the normal IgA group (44.7% vs. 20.8%, respectively; p<0.01). In addition, IgA levels in the acute phase (p=0.038) were 2.2-fold higher, and those in the subacute phase were 1.7-fold higher (p <0.001), in the CAL group than in the non-CAL group. IgA concentrations increased along with the size of the coronary artery aneurysm (p <0.001). Furthermore, there was a strong correlation between IgA levels and CAL size (r=0.435, p<0.001), with a high odds ratio of 2.58 (p=0.022). Conclusions High IgA levels in patients with KD are prognostic for the risk of CALs.