The tibial condylar fractures involving the articular surface can produce some disability of the knee joint because it is frequently accompanied by soft tissue injury to the ligaments and menisci. Accurate anatomical reduction and rigid internal fixation with early motion is known to decrease the complications. During a period of 10 years, from January 1978 to December 1987, we treated 105 tibial condylar fractures at Severance Hospital. Of the above, 77 cases have been analyzed according to the classification, cause of injury, method of treatment, final result and complication. The 77 cases were classified as follows ; total condylar depression 17(22%), undisplaced 16 (21 %), split compression 16(21 %), comminuted 14 (18%), local compression 5 (7%), split 1 (1%) and others 8(10%). Among these, 59 cases revealed the result of “ACCEPTABLE” according to Porter's criteria. Of the conservative group, 86% obtained the rating of “ACCEPTABLE” and 67% of the operative group did as well. Possible complications include traumatic arthritis (9), limited motion (9), wound infection (6), instability (3), angular deformity (2), intraarticular loose body (2), nonunion (1) and myositis ossificans.
Arthritis ; Classification ; Clinical Study ; Congenital Abnormalities ; Depression ; Knee Joint ; Ligaments ; Methods ; Myositis Ossificans ; Soft Tissue Injuries ; Wound Infection

BACKGROUND: It is important to know the location, number, size and shape of bullae before thoracotomy or VATS bullectomy. Chest X-ray and chest CT may be used but with some limitation. The purpose of this study was to compare the diagnostic value of thoracography with that of chest X-ray in preoperative detection of bullae. Meterial and Method: Thoracography was performed by injection of non-ionic water-soluble dye into pleural space in 22 primary spontaneous pneumothoraces, which underwent thoracotomy or VATS bullectomy. Chest X-ray and thoracography were compared through operative finding. RESULTS: Sensitivity and accuracy of thoracography (75% and 72.7%) were higher than those of chest X-ray (30% and 36.4%). However, specificity of thoracography (50%) was lower than that of chest X-ray (100%). There were no complications during or after thoracography. CONCLUSION: Thoracography is a safer and more useful method for preoperative detection of bullae when compared with chest X-ray.
Pneumothorax* ; Sensitivity and Specificity ; Thoracic Surgery, Video-Assisted ; Thoracotomy ; Thorax ; Tomography, X-Ray Computed

BACKGROUND: Monocytes/macrophages play a central role in determining the host response during Gram-negative infection through secretion of a variety of mediators after stimulation of LPS. Even though cytokine production has been shown to play an important role in host defense during sepsis cytokine release may also lead to tissue injury. Thus, regulation of macrophage response to LPS is critical for host survival during Gram-neg-alive sepsis. In animals exposed to nonlethal doses of endotoxin a characteristic hyporesponsiveness to subsequent administration of endotoxin has been observed. This phenomenon was knowm as 'LPS tolerance'. However, little information is availavble regarding the underlying mechanism of U)S tolerance. METHOD: Peripheral blood monocyte(PBMC) was isolated from peripheral blood of normal volunteers by adhesion purification method. To evaluate conditions to obtain LPS tolerance. preculture was carried out with LPS at 10ng/ml for 24 hours. For stimulation culture plates were washed two times and were stimulated with LPS at 1ng/ml for 4, 6 and 26 hours. To assess the underlying mechanisms of LPS tolerance, autologous serum, PMA, anti-CD14 Ab, Indomethacin or PGF2 were added to preculture solution respectively. Cytokine concentrations in culture supernatants were measured using ELISA for TNF-α and IL-8 and mRNA of TNF-α and IL-8 were determined by Northern blot analysis. RESULTS: The exposure of PBMC to low dose of LPS suppressed the cytokine production and mRNA expression of TNF-α, but not IL-8. Anti-CDl4 Ab partially recovered production of TNF-α which was suppressed by preculture with low dose LPS. The preculture with PMA induces US tolerance, as preculture with low dose LPS. CONCLUSION: LPS tolerance to TNF-α is regulated pretranslationally and is influenced by protein kinase C pathway and CD14.
Animals ; Blotting, Northern ; Dinoprost ; Enzyme-Linked Immunosorbent Assay ; Healthy Volunteers ; Indomethacin ; Interleukin-8* ; Macrophages ; Monocytes* ; Protein Kinase C ; RNA, Messenger ; Sepsis ; Tumor Necrosis Factor-alpha*

No abstract available.
Anesthesia, Local* ; Arthroscopy* ; Knee*

No abstract available.
Spine*

Sarcoidosis is a multisystem granulomatous disorder commonly affecting young adults. Diagnosis is confirmed by evidence of non-caseating granuloma in more than one organ. A case is presented where the diagnosis was made on a bone marrow biopsy, the first case in Korea. A 54-year-housewife was admitted because of multiple variable sized, skin papules and macules, who showed pancytopenia and evidence of liver cirrhosis on ultrasound. We performed skin biopsy and bone marrow biopsy, which showed non-caseating granulomas. The chest CT, opthalmologic examination was performed and showed the involvement of sarcoidosis of mediastinal lymph nodes and uvea. Multiple joints of both hands and feet also seemed to be involved in view of simple X-ray. By this case, we emphasize the significance of bone marrow biopsy in the sarcoidosis with pancytopenia.
Biopsy ; Bone Marrow* ; Diagnosis ; Foot ; Granuloma ; Hand ; Humans ; Joints* ; Korea ; Liver Cirrhosis ; Liver* ; Lymph Nodes ; Pancytopenia ; Sarcoidosis* ; Skin* ; Tomography, X-Ray Computed ; Ultrasonography ; Uvea* ; Young Adult

Pulmonary Embolism can develop in variable conditions, and presents with nonspecific symptoms and signs. If diagnosis is delayed, it can be resulted in catastrophic results. Therefore, early diagnosis and adequate treatment is crucial in Pulmonary Embolism. Lung Perfusion Scan is useful screening test. Negative result can exclude pulmonary embolism, But, perfusion defects don't always mean pulmonary embolism. To find the better methods of interpretation of king perfusion scan and To evaluate the clinical course and outcomes of the patients, in whom pulmonary embolism was suspected by lung perfusion scan, we reviewed the clinical records of 49 cases suspected by lung perfusion scan at Seoul National University Hospital during the period of January, 1995 to July, 1996. The results are as follows. First impression of cases in which PE was present at time of admission were pulmonary embolism (63%), heart diseases (26%), and pneumonia (11%) in orders. Underlying diseases of cases in which PE developed during admission were malignancy (36.5%), 10-I (22.7%), sepsis (13.7%), and SLE (9.1%) in orders. The predisposing factors were operation (20%), cancer (16%), immobility (16%), connective tissue disease (16%), heart dis. (10%), old age (10%), and preg/pelvic dis. (8%) The results of lung perfusion scan were HPPE 40cases(26.8%), IPPE 21 cases(14.1%), LPPE 88 cases(59.l %) and cases(%) of treatment in these cases were HPPE 34 cases(85%), IPPE 9 cases(42,9%), IPPE 0 case(0.0%). Treatments were heparin and warfarin (69.5%), heparin alone (8.2%), warfarin alone (2.0%), embolectomy(4.1%), thrombolytics (20%), IVC filter (2.0%), and no treatment (12.2%) In 34 cases (694%), follow up could be done, and 5 cases were recurred (10.2%). The causes of recurrence was incomplete anticoagulant therapy (3 cases) 2rnd recurrence of predisposing factor (2 cases). Expired case due to pulmonary embolism was one who was expired just before trial of thrombolytie therapy. CONCLUSION: Efforts should be made to shorten the interval from onset of Sx to Dx, ie, high index of suspision.
Causality ; Connective Tissue Diseases ; Diagnosis ; Early Diagnosis ; Follow-Up Studies ; Heart ; Heart Diseases ; Heparin ; Humans ; Lung* ; Mass Screening ; Perfusion* ; Pneumonia ; Pulmonary Embolism* ; Recurrence ; Seoul ; Sepsis ; Warfarin

BACKGROUND: Endotoxin, the component of outermembrane of gram negative organism, plays an important role in the initiation and amplification of inflammatory reaction by its effects on inflammatory cells. Until recently, there have been continuing efforts to delinate the mechanisms of the signal trasduction pathway of endotoxin stimuli on inflammatory cells. By uncovering the mechanisms of signal transduction pathway of endotoxin stimuli, we can expect to have tools to control the excessive inflammatory responses which sometimes may be fatal to the involved host. It was generally accepted that endotoxin exerts its inflammatory effects through inflammatory cytokines that are produced by endotoxin-stimulated inflammatory cells and there were some reports on the importance of protein kinase C and protein tyrosine kinase activation in the production of inflammatory cytokines by endotoxin. So we evaluated the effect of pretreatment of protein kinase C inhibitors (H7, Staurosporin) and protein tyrosine kinase inhibitors(Herbimycin, Genistein) on the endotoxin-stimulated cytokines(IL-8 & TNF-alpha) mRNA expression. METHOD: Peripheral blood monocytes were isolated from healthy volunteers by Ficoll-Hypaque density gradient method and purified by adhesion to 60mm Petri dishes. Endotoxin(LPS 100ng/ml) was added to each dishes except one control dish, and each endotoxin-stimulated dishes was preincubated with H7, Staurosporin(protein kinase C inhibitor), Herbimycin or Genistein(protein tyrosine kinase inhibitor) respectively except one dish. Four hours later the endotoxin stimulation, total RNA was extracted and Northern blot analysis for IL-8 mRNA and TNF-alpha mRNA was done. RESULT: Endotoxin stimulation increased the expression of IL-8 mRNA and TNF-alpha mRNA expression in human peripheral blood monocyte as expected and the stimulatory effect of endotoxin on TNF-alpha mRNA expression was inhibited by protein kinase C inhibitors(H7, Staurosporin) and protein tyrosine kinase inhibitors (Herbimycin, Genistein). The inhibitory effect of each drugs was increased with increasing concentration. The stimulatory effect of endotoxin on IL-8 mRNA was also inhibited by H7 and protein tyrosine kinase inhibitors (Herbimycin, Genistein) dose-dependently but not by Staurosporin. CONCLUSION: Protein kinase C and protein tyrosine kinase are involved in the endotoxin induced signal transduction pathway in human peripheral blood monocyte.
Blotting, Northern ; Cytokines ; Healthy Volunteers ; Humans ; Interleukin-8 ; Monocytes* ; Phosphotransferases ; Protein Kinase C* ; Protein Kinases* ; Protein-Tyrosine Kinases* ; RNA ; RNA, Messenger ; Signal Transduction* ; Tumor Necrosis Factor-alpha

PURPOSE: This study was conducted in order to investigate the therapeutic effect of closed reduction according to a classification in patients with nasal bone fracture. METHODS: The study was conducted retrospectively on 186 patients with a mean age of 38 years (range: 7 to 80 years). All patients were diagnosed by clinical and radiologic examination, and then classified according to Hwang's classification by computed tomography. The patients were further classified by their age, gender, causes of fracture, operation timing after fracture, concurrent facial bone fracture, and complications. All patients underwent the same reduction and treatment protocol and were then followed up regularly for at least three months. RESULTS: The cause of the fracture was slip down, and the highest prevalence was shown in the 20s. The mean operation timing after fracture was 4.1 days (range: 1 to 14 days), and it tended to be longer in the case of defected septal bone or more severe fracture. The most common concurrent facial bone fracture was orbital blow-out fracture, and zygomaticomaxillary complex and maxillary fracture occured frequently. The largest number of complications occurred in class III and IIBs patients, and the main complication was postoperative pain. CONCLUSION: Results of nasal bone closed reduction on the 186 patients showed that serious complications rarely occurred. Closed reduction is generally an effective treatment for nasal bone fracture. However, in the case of severe concurrent septal bone fracture or comminuted fracture with depression, open reduction should be considered. Further study with a larger number of patients and further classification is required.
Classification ; Clinical Protocols ; Depression ; Facial Bones ; Fractures, Bone ; Fractures, Comminuted ; Humans ; Maxillary Fractures ; Nasal Bone* ; Orbit ; Orbital Fractures ; Orthopedics ; Pain, Postoperative ; Prevalence ; Retrospective Studies*

PURPOSE: This study was performed to evaluate the usefulness of proximal femoral nail antirotation (PFNA) for internal fixation of femur trochanteric fractures. MATERIALS AND METHODS: We operated on 36 femur trochanteric fracture patients with performing PFNA from September, 2006 to November, 2008 and we analyzed the operation time, the blood loss, the union time, the tip apex distance (TAD), the Cleveland index, the sliding distance of the blade and the complications. We also evaluated the clinical results according to the recovery of ambulatory function and the functional recovery score. RESULTS: The mean operation time was 54 minutes and the mean amount of blood loss amount was 119cc. Thirty two cases progressed to union within 4 months and 4 cases also progressed to union within 6 months without a further operation. The mean TAD was 16mm and the mean sliding distance was 3.8 mm. Clinically, the mean loss of ambulation ability was 1.2 grades and the Jensen functional recovery score was 1.8. There was one case of back out of the blade, but there was no skin problem. There were no significant complications. CONCLUSION: The findings from this study indicate that PFNA is a useful and reliable choice for the treatment of trochanteric fracture of the femur.
Femoral Fractures ; Femur ; Humans ; Nails ; Skin ; Walking