The management of fractures of os calcis remains highly controversial. The fractures involving subtalar joint may cause serious and persistent disabilities. Recently, the computed tomography (CT) scan has been shown to he superior in evaluating the intraarticular fractures of calcaneus and the most widely used classification is based on the number of fragments especially seen on. Although the classification of calcaneal fractures hy CT, tongue type and joint depression type fractures hy plain radiographic views have been commonly used. Generally, closed reduction and axial fixation with metallic pin for tongue type fractures and open reduction and internal fixation for joint depression type fractures have been performed. The authors did so. The 13 fractures were tongue types and 17 fractures were joint depression types. The intraarticular calcaneal fractures of 30 feet in 26 patients who were treated at Our Lady of Mercy Hospital were analyzed in clinical and radiological aspects from Mar.1991 to Apr.1996. The results were as follows: 1. Of 30 cases, 16 fractures were treated with closed reduction and pinning, and 14 fractures were treated with open reduction and internal fixation. 2. The preoperative, postoperative and the last follow-up average Bohlers angle were 6.0, 21.0 and 20.5 respectively. 3. The preoperative, postoperative and the last follow-up average Gissanes angle was 106, 129 and 126 respectively. 4. Based on assessment of the criteria of Salama et al 19), excellent results were 5, good results were 14, fair results were 6 and poor results were 5. 5. All the five cases of poor results were tongue type fractures and they were treated with closed reduction and axial pinning. 6. Of 7 fractures using autogenous iliac bone graft, 6 fractures were good, I fracture was fair and there was no poor results. Therefore, open reduction and internal fixation for joint depression type calcaneal fractures was thought to be a good method of treatment. But we must consider whether axial fixation with metallic pin for tongue type calcaneal fractures will be a good method of treatment.
Calcaneus ; Classification ; Depression ; Follow-Up Studies ; Foot ; Humans ; Intra-Articular Fractures ; Joints ; Subtalar Joint ; Tongue ; Transplants

Degenerative lumbar spondylolisthesis requires fusion of the involved segments and decompression laminectomy because it is mechanically unstahle and usually associated with stenosis of the spinal canal. Transabdominal retroperitoneal approach through small longitudinal pararectal skin incision provides easy and safe access to L3-4 and L4-5 disc spaces with less bleeding. We thought that anterior interbody fusion enable us to restore the disc space and to reduce partially the listhesis with less hleeding and less harvest of graft hone compared to posterolateral fusion, and also without the risk of neural or dural damage which could he occurred in posterior lumbar interbody fusion 4.15.16.17). Thus, authors performed the same-day anterior and posterior spinal surgery (APSS) in 28 patients (30 disc spaces) from 1992 to 1996 and analyzed the clinical and radiological results. The most common site of involvement was L4-5 level (82.1%). The mean follow-up period was 2 years and 2 months (from l2 months to 4 years). Fusion was ohtained at 29 disc spaces (96.7%) within 24 weeks (average, I 6 weeks). The anterior displacement was corrected up to the average of 65.4% (5.8mm) postoperatively and the average of 60.7% (5.2mm) correction remained at last follow-up. The intervertebral disc space was restored up to the average of 96.9% (7.5mm) postoperatively and the average of 86.0% (6.2mm) restoration remained at last follow-up. Twenty-five out of 28 patients (89.2%) showed excellent or good clinical results hy the criteria of Kim, et al6). In conclusion, the same-day procedure of successive anterior interbody fusion, decompression laminectomy and posterior pedicular instrumentation for the degenerative lumbar spondylolisthesis associated with spinal stenosis was thought to be a good method of treatment.
Constriction, Pathologic ; Decompression ; Follow-Up Studies ; Hemorrhage ; Humans ; Intervertebral Disc ; Laminectomy ; Skin ; Spinal Canal ; Spinal Stenosis ; Spondylolisthesis* ; Transplants

OBJECTIVES: To analyze factors associated with elderly falls in a community dwelling, a comparatively important, but somewhat neglected, health matter. METHODS: Data came from personal interview surveys using a questionnaire of 552 people aged 65 or older living in a community. Socioeconomic, and health related characteristics were investigated as independent variables and experiences of falling in the previous year as the dependent variable. RESULTS: 118(21.4%) of the elderly subjects experienced a fall in the previous year. 24 subjects experienced more than two falls, accounting for 20.3% of the elderly fall victims studied. Factors affecting the falls were families living together, level of daily activity, heart disease, and aconuresis;, therefore an elderly person who lives alone, lives independently, has heart disease, or suffers urinary incontinence had a demonstrated increased chance of falling. CONCLUSION: Groups at risk for falling included elderly persons living alone, living independently, suffering heart disease, or experiencing urinary incontinence. When an elderly fall prevention program is developed and implemented, these results should be considered.
Accidental Falls ; Aged* ; Heart Diseases ; Humans ; Prevalence* ; Questionnaires ; Urinary Incontinence

The present study was aimed at investigating whether there are changes in the expression of nitric oxide synthase (NOS) in relation with the unclipping-induced fall of blood pressure in two-kidney, one clip (2K1C) hypertension. Male Sprague-Dawley rats were made 2K1C hypertensive by clipping the left renal artery for four weeks. Sham-clipped rats served as control. The expression of endothelial constitutive (ec) NOS proteins and tissue levels of NO metabolites were determined in the kidney. Systolic blood pressure was significantly increased in clipped rats compared with that in the control. The development of hypertension was associated with decreases in the expression of ecNOS proteins and tissue levels of NO metabolites in the clipped kidney. The blood pressure at twenty-four hours after removal of the renal arterial clip fell to the control level. Accordingly, in the unclipped kidney, the expression of ecNOS proteins and tissue contents of NO metabolites were increased to the control level. The contralateral kidney was not affected by the development or reversal of hypertension. It is suggested that an enhanced expression of ecNOS in the unclipped kidney is an important component in the reversal of renovascular hypertension.
Animals ; Blood Pressure ; Humans ; Hypertension ; Hypertension, Renovascular* ; Kidney ; Male ; Nitric Oxide Synthase* ; Nitric Oxide* ; Rats ; Rats, Sprague-Dawley ; Renal Artery

Generally, colon lipoma is mildly symptomatic or asymptomatic. However, sometimes it may present with symptoms, such as pain, constipation, obstruction, or bleeding and may be the leading point for intussusception, particularly in large size (>20 mm). Giant colon lipoma may warrant the removal to exclude confusion with other lesions that have a malignant potential and to control symptoms. Currently, surgical resection should be considered for giant lipoma more than 20 mm in diameter due to the high risk of perforation or bleeding, especially when the lesion is broadly-based. We report here a case of spontaneous resolution acquired after endoscopic partial resection for the symptomatic giant colon lipoma with broad-base requiring surgery.
Colonic Neoplasms/*diagnosis/surgery/therapy ; Colonoscopy ; Humans ; Lipoma/*diagnosis/surgery/therapy ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome

Tetrahydroisoquinoline(THI) alkaloids can be considered as cyclized derivatives of simple pthylamines and many of them, especially with 6,7-disubstitution, demonstrate relatively high affinity for catecholamines. In the present study, pharmacological action of limited series of THI has been examined using rat isolated atria and aorta. In addition, (H) prazosin displacement binding study with THI compounds using rat brain homogenates was performed to find out if these probes to have a-adrenoceptor affinity. In isolated rat atria, all THls and dobutamine increased heart rate and contractile force. In the presence of propranolol, the concentration response curves of YS 49 and YS 51 shifted to the right resulting in 8.07+0.84 and 7. 93+0.11 of pA values, respectively. The slope of each compound was not deviated from unity, indicating that these chemicals are highly competitive at the cardiac beta1-adrenoceptors. YS 49, YS 51 and higenamine showed alpha1- adrenoceptor affinity in rat brain in which the dissociation constant(K,) was 2.75, 2.81 and 1.02pM, respectively. It is concluded, therefore, that THI alkaloids have considerable affiniyt to alpha1-adrenoceptors in rat aorta and atria. while these probes show relatively high affinity for cardiac beta1-adrenoceptors. The authors speculate that it is worthy investigating whether these chemicals are useful in the management of vasospasm of aneurysmal subarachnoid hemorrhage.
Alkaloids* ; Animals ; Aorta* ; Brain* ; Catecholamines ; Dobutamine ; Heart Rate ; Prazosin ; Propranolol ; Rats* ; Subarachnoid Hemorrhage ; Vasodilation

Cerebral amyloid angiopathy(CAA) is a nonspecific disease entity that has been associated with a number of neuropathologic conditions, the most prominent being dementia and cerebral hemorrhage. It occurs more commonly than is generally appreciated, with implications that may be overlooked. As amyloid deposits are found in the vessels of the leptomeninges and cerebral cortex, the location and size of the hematoma, with cortical and subarachnoid extension, help to differentiate amyloid angiopathy from other causes of intracerebral hemorrhage in the elderly. It has, in addition, characteristic pathological features, and the existence of these, together with the occurance of nontraumatic normotensive spontaneous primary cerebral hemorrhage in the elderly, should indicate the existence of CAA. The authors report a case of cerebral amyloid angiopathy-related intracerebral hemorrhage.
Aged ; Amyloid* ; Cerebral Amyloid Angiopathy ; Cerebral Cortex ; Cerebral Hemorrhage* ; Dementia ; Hematoma ; Humans ; Plaque, Amyloid

Successful recovery from brain ischemia is limited due to poor vascularization surrounding the ischemic zone. Cell therapy with strong angiogenic factors could be an effective strategy to rescue the ischemic brain. We investigated whether cartilage oligomeric matrix protein (COMP)-Ang1, a soluble, stable and potent Ang1 variant, enhances the angiogenesis of human cord blood derived endothelial progenitor cells (hCB-EPCs) for rescuing brain from ischemic injury. COMP-Ang1 markedly improved the tube formation of capillaries by EPCs and incorporation of EPCs into tube formation with human umbilical vein endothelial cells (HUVECs) upon incubation on matrigel in vitro. COMP-Ang1 stimulated the migration of EPCs more than HUVECs in a scratch wound migration assay. The transplanted EPCs and COMP-Ang1 were incorporated into the blood vessels and decreased the infarct volume in the rat ischemic brain. Molecular studies revealed that COMP-Ang1 induced an interaction between Tie2 and FAK, but AKT was separated from the Tie2-FAK-AKT complex in the EPC plasma membrane. Tie2-FAK increased pp38, pSAPK/JNK, and pERK-mediated MAPK activation and interacted with integrins alphanubeta3, alpha4, beta1, finally leading to migration of EPCs. AKT recruited mTOR, SDF-1, and HIF-1alpha to induce angiogenesis. Taken together, it is concluded that COMP-Ang1 potentiates the angiogenesis of EPCs and enhances the vascular morphogenesis indicating that combination of EPCs with COMP-Ang1 may be a potentially effective regimen for ischemic brain injury salvage therapy.
Angiogenesis Inducing Agents ; Animals ; Blood Vessels ; Brain ; Brain Injuries* ; Brain Ischemia ; Capillaries ; Cartilage Oligomeric Matrix Protein ; Cell Membrane ; Cell- and Tissue-Based Therapy ; Fetal Blood ; Human Umbilical Vein Endothelial Cells ; Humans ; Integrins ; Ischemia ; Morphogenesis ; Rats ; Salvage Therapy ; Stem Cells ; Wounds and Injuries

OBJECTIVE: To compare the clinical efficacy between nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen in knee osteoarthritis according to ultrasonographic findings. METHODS: We administered 12 mg of NSAIDs (lornoxicam) plus misoprostol 300microgram or 1,950 mg of acetaminophen in 40 randomly selected patients who fulfilled the ACR criteria for knee osteoarthritis. The effectiveness of these drugs on osteoarthritis was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. In addition, we performed ultrasonography of the knee joints and assessed length of capsular distension, length of medial and lateral osteophyte, amount of joint effusion, and the presence of synovial proliferation. RESULTS: There were significant correlations between WOMAC score and length of capsular distension and length of medial/lateral osteophyte. At 6 weeks, both lornoxicam and acetaminophen-treated patients had significant lower levels of WOMAC score compared to the entry into the trial (p<0.01 and p<0.05, respectively). As compared the clinical efficacy between the two groups, the lornoxicam-treated patients showed a greater decrease in WOMAC score than patients treated with acetaminophen (p=0.026). When we further divided the patients into the subgroups according to the sonographic severity, the patients with severe capsular distension (> or =0.7 cm) or severe medial osteophyte (length of osteophytes > or =0.4 cm) showed better responses to lornoxicam than to acetaminophen in terms of the reduction of WOMAC score (p=0.008 for severe capsular distension, p=0.03 for severe medial osteophyte). However, in the subgroup with mild forms of capsular distension (<0.7 cm) or medial osteophytes (<0.4 cm), no difference was found in the reduction of WOMAC score 6 weeks after treatment with lornoxicam versus acetaminophen. CONCLUSIONS: Patients with osteoarthritis of the knee had significantly greater improvements in pain score over 6 weeks with lornoxicam than with acetaminophen, particularly in patients with severe forms of capsular distension and medial osteophyte on joint ultrasonography. Ultrasonography could be an useful tool to determine the usage of NSAIDs versus acetaminophen in knee osteoarthritis patients.
Acetaminophen* ; Anti-Inflammatory Agents, Non-Steroidal ; Humans ; Joints ; Knee Joint ; Knee* ; Misoprostol ; Ontario ; Osteoarthritis ; Osteoarthritis, Knee* ; Osteophyte ; Ultrasonography

OBJECTIVES: This study aimed at clarifying the character of cerebral artery vasospasm on rabbit model by observing the vascular responses to nitric oxide and endothelin-1 treatment at different time points. MATERIALS AND METHODS: Twenty-eight rabbits undertook vertebrobasilar angiographies on the postoperative 2nd day and the 7th day after subarachnoid hemorrhage operation. The animals were divided into the vasospasm and the non-vasospasm group accroding to the result of vertebrobasilar angiographies. After sacrificing the animal, the vascular ring of harvested basilar artery was suspended in Krebs solution organ chamber for observation of isometric tension change in response to nitric oxide (NO) and endothelin-1 under high (95% O2 / 5% CO2) and low (95% N2 / 5% CO2) O2 tension. To investigate NO-dependent the vascular relaxation response, acetylcholine (10-7-3x10-4 M) was applied to basilar artery ring preconcentrated with histamine (10-6-10-5 M) in the organ chamber. The vascular contraction response was observed by applying endothelin-1 (10-11-3x10-8 M) into the organ chamber. RESULTS: The angiography showed vasospasm in seven of fifteen rabbits of the postoperative-2-day group (64.3+/-11.2%) and seven of fifteen rabbits of the postoperative-7-day (64.9+/-10.9%). On the postoperative-2-day, all the vascular response to NO and endothelin-1 under both high and low O2 tension was not significantly different between the vasospasm developed basilar artery and the vasospasm undeveloped one. On the postoperative-7-day, the vascular relaxation response to NO under high O2 tension was significantly different between the vasospasm developed basilar artery and the vasospasm undeveloped one (p=0.029). However, the vascular relaxation response to NO under low O2 tension was not significantly different. The vascular contraction response to endothelin-1 under high O2 tension was significantly different between the vasospasm developed basilar artery and the vasospasm undeveloped one (p=0.032). However, the vascular contraction response to endothelin-1 under low O2 tension was not significantly different. CONCLUSION: This experiment suggest that the vasospasm of the postoperative-2-day have different character from that of the postoperative-7-day in the rabbits. This suggestion may play some roles in the future study of the subarachnoid hemorrhage model. the study of the vasospasm mechanism of human, and developing antispasmodic drugs.
Acetylcholine ; Angiography ; Animals ; Basilar Artery* ; Cerebral Arteries ; Endothelin-1* ; Histamine ; Humans ; Nitric Oxide* ; Parasympatholytics ; Rabbits ; Relaxation ; Subarachnoid Hemorrhage