We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nailing for femoral shaft fractures to improve its application and prevent implant-derived complications.
Adult ; Aged ; Female ; Femoral Fractures/radiography/*surgery ; Fracture Fixation, Internal/*adverse effects/methods ; Hip Fractures/*etiology/radiography ; Humans ; Iatrogenic Disease ; Male ; Middle Aged

The association of skin tumors and long-term use of hydroxyurea is recently recognized. We report a case of a patient who developed squamous cell carcinoma on the face during long-term treatment with hydroxyurea for polycythemia vera. As hydroxyurea is frequently used to treat myeloproliferative diseases, we suggest the clinical awareness of the increased risk of skin cancers in patients with long-term hydroxyurea therapy.
Carcinoma, Squamous Cell* ; Humans ; Hydroxyurea* ; Polycythemia Vera ; Skin ; Skin Neoplasms

PURPOSE: To evaluate the clinical outcome, patient's satisfaction and complications of vaginal tape procedure for the surgical treatment of female stress urinary incontinence. MATERIALS AND METHODS: 56 women with stress urinary incontinence underwent vaginal tape procedures. Preoperatively, patients were evaluated history taking, physical examination, one hour pad test and urodynamic study. Postoperative clinical outcome, patient's satisfaction, complications and success rates for Stamey grade, valsalva leak point pressure (VLPP), or maximal urethral colsing pressure (MUCP) were evaluated. RESULTS: 42 patients (75%) were cured, 8 patients (14.3%) were improved, and 6 patients (10.7%) were failed on 1 year after vaginal tape procedures. 43 patients (76.8%) were satisfied with vaginal tape procedure. Also, 43 patiens (76.8%) would like to recommend vaginal tape procedure to others. There was no significant difference of success rate according to Stamey grade, VLPP, MUCP (p>0.05). Postoperatively, voiding difficulty and urgency were newly developed at 3 (5%) and 4 (7%) patients respectively, and their satisfaction were lower than others. CONCLUSION: We considered that vaginal tape procedure was a safe, effective, and minimal invasive treatment for female stress urinary incontinence. But, careful attention to postoperative voiding difficulty and urgency might be needed to improve patient's satisfaction.
Female ; Humans ; Physical Examination ; Surgical Mesh ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urodynamics

PURPOSE: Surface finishing of a cemented femoral stem is a subject of controversy even though the contemporary cementing techniques have improved results. Using the Versys Heritage femoral stem, we evaluated the outcome of using a polished surface. MATERIALS AND METHODS: The subjects of this study were 95 hip arthroplasties in 82 patients and we used a cemented polished femoral stem with the 3rd generation cement technique and all the surgeries were done between October 2000 and August 2003. There were 58 male patients (64 hips) and 24 female patients (31 hips). The mean age at the time of the index arthroplasty was 52.3 years (26~74 years), and the average body mass index was 24.2+/-2.75 (19.1~29.8). The average follow up period was 80.7 months (64~109 months). All the hips were evaluated clinically by the Harris hip score and the thigh pain, and they were radiologically assessed by the cement grade and the presence of osteolysis around the femoral stem, as well as the presence of stress shielding of the proximal femur. RESULTS: At the final follow up, the Harris hip score for all the patients had improved from preoperative 58.9 (17-83) to post operative 91.7 (72~100). The cement grade was measured using Barrack's method. Of the 95 hips, 45 (47.3%) cases were grade A, 48 (50.5%) cases were grade B and 2 (2.1%) cases were grade C1 at the final follow up. There was 1 case of definite loosening. Stress shielding was noted in 65 (68.4%) cases of the zero grade and 19 (20.0%) cases of the 1st grade. CONCLUSION: In this study, the cemented polished femoral stem showed excellent results at the mid term with a minimum follow up of 5 years. But a longer-term follow-up study will be needed for further understanding the implications of cemented polished femoral stem.
Arthroplasty ; Body Mass Index ; Female ; Follow-Up Studies ; Hip ; Humans ; Male ; Osteolysis ; Thigh

Background: We developed an assay to measure DNA-incorporated 6-thioguanine (DNATG) and validated its clinical applicability in Korean pediatric patients with acute lymphoblastic leukemia (ALL) in order to improve individualized thiopurine treatment and reduce the life-threatening cytotoxicity. Methods: The DNA-TG assay was developed based on liquid chromatography-tandem mass spectrometry, with isotope-labeled TG-d3 and guanine-d3 as internal standards.This method was applied to 257 samples of pediatric ALL patients. The DNA-TG level was compared with erythrocyte TG nucleotide (RBC-TGN) level in relation to the TPMT and NUDT15 genotypes, which affect thiopurine metabolism, using Spearman’s rank test and repeated measure ANOVA. Results: For DNA-TG quantification, a linearity range of 10.0-5,000.0 fmol TG/µg DNA;bias for accuracy of –10.4% –3.5%; coefficient of variation for intra- and inter-day precision of 3.4% and 5.8% at 80 fmol TG/µg DNA and of 4.9% and 5.3% at 800 fmol TG/µg DNA, respectively; and recovery of 85.7%–116.2% were achieved without matrix effects or carry-over. The median DNA-TG level in the 257 samples was 106.0 fmol TG/µg DNA (interquartile range, 75.8–150.9). There was a strong correlation between DNA-TG and RBC-TGN levels (ρ = 0.68,ρ < 0.0001). The DNA-TG/RBC-TGN ratio was significantly higher in NUDT15 intermediate metabolizers (*1/*2 and *1/*3) than in patients with wildtype alleles (ρ < 0.0001). Conclusions This simple and sensitive method for measuring DNA-TG level can improve therapeutic drug monitoring for thiopurine treatment.

Ictal vomiting is a rare clinical manifestation of temporal lobe epilepsy. This manifestation is considered a clinical lateralizing sign pointing toward seizure activity within the nondominant temporal lobe. However, we have experienced a case of ictal vomiting associated with temporal lobe epilepsy within the dominant hemisphere. The ictal vomiting occurred early in the course of the seizure when rhythmic discharges predominantly involved the left temporal lobe. This patient underwent a left anterior temporal lobectomy and experienced markedly reduced seizure frequency for more than 2 years.
Anterior Temporal Lobectomy ; Epilepsy ; Epilepsy, Temporal Lobe* ; Humans ; Seizures ; Temporal Lobe* ; Vomiting*

PURPOSE: The education of the patients is an effective component of comprehensive care, especially in patients with epilepsy. We developed an epilepsy educational program designed to improve the knowledge and understanding of the natural clinical course, the treatment, and prognosis of epilepsy. We evaluated the efficacy of this educational program to epilepsy patient's knowledge of their disorder and quality of life. METHODS: We studied 224 patients with epilepsy from Dongsan Epilepsy Center. All patients completed the Knowledge and Quality of Life in Epilepsy-31 (QOLIE-31) questionnaire before a one-day educational program was completed. Six months after the educational program was given, patients completed the same questionnaire. The results of the two surveys were compared. RESULTS: In the initial questionnaire, about 60% of the patients thought that epilepsy is not related with head trauma. About 40% of the patients thought that epilepsy is a genetic disorder. Over 80% of the patients thought that behavior changes are not related to epilepsy. Over 90% of the patients had correct responses about taking antiepileptic drugs. However, only 60% of the patients had their ideas regarding proper social activity correct. After completing the educational course, the results of the follow-up questionnaires were markedly improved concerning the patients' knowledge of epilepsy. In contrast, the quality of life measures changed a little. CONCLUSION: An epilepsy educational program for patients improves their knowledge of epilepsy. This study was performed with only one education workshop, which is not sufficient to improve the quality of life measures. A well-regulated, systematic educational program is needed to efficiently improve the lives of epileptic patients.
Anticonvulsants ; Craniocerebral Trauma ; Education* ; Epilepsy* ; Follow-Up Studies ; Humans ; Prognosis ; Quality of Life* ; Surveys and Questionnaires

Cryopreservation is able to store the surplus pre-embryos for freezing and furthermore thawing and transfer in a subsequent cycle. Cryopreserving cells which are maintaining their viability are the very complex process. This study has been carried out in order to find the effects of cryopreservation steps, freezing media and embryonic stages on the rates of viability and development of cryopreserved mouse embryos. Female ICR mice (6~8 weeks old) were induced to superovulate by sequential intraperitoneal injection of 5 IU PMSG and 5 IU hGC 48h apart. Mouse embryos were collected according to its developmental stage after the injection of hCG. Embryos were cryopreserved not only by cryoprotectant step (1 step~ 4 step) but also in a variety of media (HTF, IVF medium, D-PBS) and cell stage. The results were as follows: There is no clear advantage in these freezing media of rapid method, but 4 cell and 8 cell of slow method (2, 3, 4 step) have advantage in D-PBS. The development of embryos according to cell stage become greater in 8 cell stage. In the treatment steps of cryopreservation, the development of embryo to blastocyst was similar among rapid method, but the development of 4 cell and 8 cell embryos to blastocyst according to slow method was better than rapid method.
Animals ; Blastocyst ; Cryopreservation* ; Culture Media* ; Embryonic Structures* ; Female ; Freezing ; Humans ; Injections, Intraperitoneal ; Mice* ; Mice, Inbred ICR

The interventional procedure is a percutaneous treatment modality using various devices such as a guide-wire and a catheter under a minimal incision. It is usually done under a fluoroscopy (X-ray radiography) guidance, therefore the operator would be exposed to X-ray irradiation. Recently, a new procedure using a master-slave robotic system is proposed for the intervention procedure, especially in the era of vascular disease. Many state of art intervention robots are under development and this approach can drastically reduce radiation exposure by replacing human effort by a robotic system for high radiation exposure procedures. However, robotic intervention is still more expensive and needs more efficient end effector and easier human interface for a safer and faster procedure. This article provides a comprehensive summary of vascular intervention and necessity of the vascular intervention robot system.
Catheters* ; Fluoroscopy ; Humans ; Radiation Exposure ; Vascular Diseases

Rabies is a fatal infection of the central nervous system acquired most often through a virus transmitted in saliva by a rabid animal. It is important to rapidly and accurately identify the rabies virus so that appropriate rabies preventive measures can be initiated to the general population. However, the diagnosis of clinical rabies is difficult and is often not made until after death of the patient. Early in the course of illness, the most reliable diagnostic test is a nuchal skin biopsy including hair follicles with fluorescent antibody staining or with PCR. We report a case of rabies diagnosis with hair follicle from a patient suspected of having the infection. It is the first case reported in Korea that the diagnosis of rabies was made on a skin biopsy.
Animals ; Biopsy* ; Central Nervous System ; Diagnosis* ; Diagnostic Tests, Routine ; Hair Follicle* ; Hair* ; Humans ; Korea ; Neck* ; Polymerase Chain Reaction ; Rabies virus ; Rabies* ; Saliva ; Skin*