PURPOSE: The purpose of this paper was to evaluate the treatment results according to bone union, union time, and complications, including infection of unreamed nailing of tibial fractures between closed and open fractures. MATERIALS AND METHODS: We reviewed 64 tibial shaft fractures that were treated with unreamed tibial nail. These included 42 closed fractures and 22 open fractures. RESULTS: Average union time of closed fractures was 19.8 weeks and that of open fractures was 20.2 weeks, nonunion rate were 4/42 and 3/22 in closed and open fractures. Average union time were 19.2, 20.4, 21.3 weeks in open grade I, II, llla fractures. According to the type of fractures, average union time were 18.5, 20.2, 24.6 weeks and nonunion rate were 2/29, 3/26, 2/9 in type A, B, C fractures. According to the level of fractures, average union time were 20.0, 20.3, 19.4 weeks and nonunion rate were 1/5, 4/37, 2/22 in proximal, middle, and distal fractures. There was no significant differences in average period of radiologic union, infection rate and nonunion rate between closed and open fracture group, but longer union time and higher nonunion rate in complex and comminuted fractures (P<0.05). CONCLUSIONS: We consider unreamed intramedullary nailing in the tibial shaft fractures as a good treatment modality for closed and open grade I, II, IIIa fractures
Fracture Fixation, Intramedullary ; Fractures, Closed ; Fractures, Comminuted ; Fractures, Open ; Tibial Fractures*

PURPOSE: The purpose of this study is to assist the optimal placement of sacroiliac screw by evaluating the anatomic and radiologic features of upper sacrum. MATERIALS AND METHODS: Fourteen fresh-frozen cadaveric pelvises and 13 normal adults were studied for the evaluation of morphology of first sacrum and dysplastic patterns. Measurement of anatomic parameters and CT imaging of pelvis were performed. Thirty-two patients with complicated pelvic fracture were evaluated for detection of variations in the sacral alar anatomy and slope found in upper sacral segmentation. RESULTS: The mean distance between midpoint of sacrum and sacroiliac joint was 52.75 mm. The height of first sacral body was 21.71 mm. The longest antero-posterior distance in sacral alar was 52.36 mm. The mean angle between the coronal plane of S1 vertebra and anterior aspect of the alar was 29.3 degree. The mean angle between the superior aspect of S1 vertebral body and superior edge of the alar was 34.8 degree. The mean angle between the superior aspect of S1 vertebral body and supero-posterior edge of the alar was 12.5 degree. The studies revealed about 28 to 33% of cases as dysplastic sacrum. CONCLUSIONS: We studied anatomic and radiologic features of upper sacrum in cadaveric and clinical cases to gain information on the optimal placement of sacroiliac screw.
Achilles Tendon* ; Adult ; Cadaver ; Humans ; Pelvis ; Rupture* ; Sacroiliac Joint ; Sacrum ; Spine

BACKGROUND: Food allergies have been demonstrated to play an important role in the pathogenesis of atopic dermatitis(AD), affecting around 10 to 40% of patients with AD. While immediate-type clinical reactions to food can easily be identified, the evaluation of a food allergy in the absence of immediate clinical reactions still presents diagnostic difficulties. OBJECTIVE: The purpose of this study was to evaluate the diagnostic value of the atopy patch test with regard to late-phase reactions and to evaluate the relationship between patch test and specific serum IgE level. METHODS: We performed the patch test and chemiluminescent assay(CLA) for food antigens(cow's milk, soybean milk and hen's egg) in 45 patients with AD who were suspicious of food-related symptoms and 15 normal controls. RESULTS: 1. Positive reaction of CLA in 45 patients with AD were 7/18(38.9%) for the cow's milk, 5/14(35.7%) for the soybean milk and 4/13(30.7%) for the hen's egg. 2. Positive reaction of the patch test in patients with AD were 5/18(27.8%) for the cow's milk, 6/14(42.9%) for soybean milk and 4/13(30.7%) for hen's egg, but only one(6.7%) for cow's milk in 15 normal controls. 3. A highly significant correlation to food antigens existed between patch test and CLA, but one patient showed a positive reaction in the patch test for soybean milk despite the negative reaction in CLA. 4. There was no significant statistical correlation between the severity of AD and the positive reaction rate of the patch test. 5. There were no significant statistical differences between the age of AD patients and the positive reaction rate of the patch test. CONCLUSION: The atopy patch test seems to be a valuable tool in the diagnostic work-up of food allergies in patients with AD-especially with regard to late-phase clinical reactions.
Dermatitis, Atopic* ; Food Hypersensitivity ; Humans ; Immunoglobulin E* ; Luminescent Measurements ; Milk ; Ovum ; Patch Tests* ; Soybeans

Metastases to the skin from bladder carcinoma are very the rare and rate is 1 to 2% of the cutaneous metastases. A 61-year-old man presented with 4 months history of well demarcated erythematous eroded nodules on the both inguinal areas which developed 3 years later after the diagnosis of carcinoma of the urinary bladder had been made. Histological examination of the skin lesion revealed atypical cells having hyperchromatic and pleomorphic nuclei which were similar to those of the urinary bladder. We report herein a case of cutaneous metastasis from carcinoma of the urinary bladder in a 61-year-old man.
Cytochrome P-450 CYP1A1 ; Diagnosis ; Humans ; Middle Aged ; Neoplasm Metastasis* ; Skin ; Urinary Bladder*

Sebaceous carcinoma is a malignant tumor derived from the adnexal epithelium of sebaceous glands and is usually located on the meibomian glands of the eyelid, but may occur on the extraocular sites. We present two cases of sebaceous carcinoma developed on the unusual site. The first case was 66-year old woman, who had 2.2X3.0cm sized, yellowish, verrucous surfaced plaque on the abdomen for 20 years. The second case of 79-year old man had annular shaped erythematous greasy patch with peripherally located flat plaque on the left scapular area for 1 month. His past medical history included subtotal gastrectomy for early gastric cancer(type IIa) and could not find any recurrence or metastasis for 4 years duration. The histopathologic examination revealed irregular, variable sized tumor lobules. Each lobule was composed of sebaceous and undifferentiated cells showing considerable variation in the shape and size of their nuclei and prominent nucleoli. On the basis of clinicopathologic examination we diagnosed first case as sebaceous carcinoma and second case as Muir-Torre syndrome.
Abdomen ; Aged ; Epithelium ; Eyelids ; Female ; Gastrectomy ; Humans ; Meibomian Glands ; Muir-Torre Syndrome* ; Neoplasm Metastasis ; Recurrence ; Sebaceous Glands

BACKGROUND: The aging of the patient population is one of rhe most important factirs influencing health care delivery. Currently 5% of the Korean population is elderly, defined as older than 65years of age, with this group projected to increase to 13.1% by the year 2021. Cardiovascular disease is the leading cause of death and of disability in the elderly age group. mong them, coronary heart disease is the most importane. METHOD: Study population composed of 216 patients who were admittied to the hospital with first acute myocardial infarction and they were divided into two groups according to the age(older than 65 years of age vs younger). Clonical features, risk factors of coronary heart disease, in-hospital outcome and complication were compared in elderly patients and others group. Results : 1) The risk factors of coronary heart disease is similar to younger patients but pattern of chest pain is less typical than younger patients. 2) Clinical presentation of elderly patients is similar to younger patients except Killip class on admission.(1.66vs 1.91,P=0.04) 3) In-hospital mortality of elderly patients in higher than younger patients. In addition to an increased incidence of death, recurrent ischemia, stroke, AV block, ventricular arrythmia, pulmonary edema occured more frequently with advanced age. 4) Especially in the thrombolytic therapy group, in-hospital death, reinfarction and recurrent ischemia is higher than primary PTCA group in elderly patients. CONCLUSIONS: Diagnosis of acute chest pain is difficult in elderly patients and in-hospital mortality and morbidity is higher than in younger patients. Thus more accurate diagnosis and discriminative therapeutic modality is needed.
Aged ; Aging ; Arrhythmias, Cardiac ; Atrioventricular Block ; Cardiovascular Diseases ; Cause of Death ; Chest Pain ; Coronary Disease ; Delivery of Health Care ; Diagnosis ; Hospital Mortality ; Humans ; Incidence ; Ischemia ; Myocardial Infarction* ; Pulmonary Edema ; Risk Factors ; Stroke ; Thrombolytic Therapy

Lentigo maligna(LM) is a pigmented lesion that occurs on the sun-exposed skin of an older patients and may become lentigo maligna melanoma(LMM). Currently the percentage of LM type melanoma appears to be increasing, and this rise has been attributed to increasing UV radiation exposure. In addition to UV radiation, estrogen and progesterone, and nonpermanent hair dyes have been proposed as risk factors. A case is a 66-year-old female with a 3 years history of pigmented patch. She had a gradually enlarging irregular bordered brown to black mottled patch on the right temple area. Histologic examination revealed atypical melanocytes along the basal layer of atrophic epidermis, arranged in solitary units and small nests. Perilesional skin showed many scattered melanophages and regressing nevus cell nests which suggested preexisting nevus underwent regressive change. On the basis of clinicopathologic examination we diagnosed this case as lenigo maligna arising from nevocytic nevus and then we removed the lesion by wide surgical excision and could not find any recurrence until now.
Aged ; Epidermis ; Estrogens ; Female ; Hair Dyes ; Humans ; Hutchinson's Melanotic Freckle* ; Lentigo* ; Melanocytes ; Melanoma ; Nevus* ; Progesterone ; Recurrence ; Risk Factors ; Skin

Drug eruption is a cutaneous reaction caused by various drugs, which include antibiotics, antipyretics, anti-inflammatory analgesics, antidepressants, antituberculosis drugs, etc. Drug eruptions caused by antituberculosis drugs are relatively uncommon and there have been no previous reports in Korea which caused simultaneously by isoniazid and rifampin. A 57-year-old female patient, who was treated with antituberculosis drugs, was seen with generalized erythematous maculopapular eruption. We performed patch test and prick test with the antituberculosis drugs and could confirm a drug eruption caused by isoniazid and rifampin. And we performed desensitization to isoniazid for an optimal antituberculosis regimen and completed the treatment with isoniazid, successfully.
Anti-Bacterial Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Antidepressive Agents ; Antipyretics ; Drug Eruptions* ; Female ; Humans ; Isoniazid* ; Korea ; Middle Aged ; Patch Tests ; Rifampin*

BACKGROUND: Dendritic cell (DC)-based vaccines are currently being evaluated as a novel strategy for tumor vaccination and immunotherapy. However, inducing long-term regression in established tumor-implanted mice is difficult. Here, we show that deoxypohophyllotoxin (DPT) induces maturation and activation of bone marrow-derived DCs via Toll-like receptor (TLR) 4 activation of MAPK and NF-kappaB. METHODS: The phenotypic and functional maturation of DPT-treated DCs was assessed by flow cytometric analysis and cytokine production, respectively. DPT-treated DCs was also used for mixed leukocyte reaction to evaluate T cell-priming capacity and for tumor regression against melanoma. RESULTS: DPT promoted the activation of CD8+ T cells and the Th1 immune response by inducing IL-12 production in DCs. In a B16F10 melanoma-implanted mouse model, we demonstrated that DPT-treated DCs (DPT-DCs) enhance immune priming and regression of an established tumor in vivo. Furthermore, migration of DPT-DCs to the draining lymph nodes was induced via CCR7 upregulation. Mice that received DPT-DCs displayed enhanced antitumor therapeutic efficacy, which was associated with increased IFN-gamma production and induction of cytotoxic T lymphocyte activity. CONCLUSION: These findings strongly suggest that the adjuvant effect of DPT in DC vaccination is associated with the polarization of T effector cells toward a Th1 phenotype and provides a potential therapeutic antitumor immunity.
Animals ; Dendritic Cells ; Immunotherapy ; Interleukin-12 ; Lymph Nodes ; Lymphocyte Culture Test, Mixed ; Lymphocytes ; Mice ; Phenotype ; Podophyllotoxin ; T-Lymphocytes ; Toll-Like Receptors ; Up-Regulation ; Vaccination ; Vaccines

BACKGROUND: Since the bioavailability of itraconazole capsule is influenced by patients gastric acidity, it results in treatment failure due to its low dissolution and subsequent low absorption when administered in fasting. Itraconazole Melt-Extrusion tablet has been lately developed in order to improve its dissolution profile. It is the first clinical study to evaluate the efficacy and safety of itraconazole Melt-Extrusion tablet in Korea. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of itraconazole melt-extrusion tablet 400mg daily for 1 week(pulse therapy) for hyperkeratotic type of tinea pedis and manus. METHODS: A clinical and mycological investigation was made of 812 outpatients with hyperkeratotic type of tinea pedis and/or tinea manus who had visited at 52 general hospitals under the lead of the Korean Dermatological Association from June to December, 1998. Patients confirmed by clinically and microscopically as hyperkeratotic type of tinea pedis and/or tinea manus were administered 2 tablets twice a day for one week and followed up for 8 weeks from the start of the medication. RESULTS: The results were summarized as follows; 1. Clinical symptoms of hyperkeratotic type of tinea pedis and/or tinea mauns were significantly improved at the end of study, week 8(p<0.001). 2. Clinical response rate, defined as more than 50% decrease of the sum of the clinical symptom scores, was 79.3%(512/646). 3. Mycological cure rate, dafined as both culture and KOH negative at week 8, was 78.2%(244 /312). 4. 40(5.5%) patients, of the 727 patients evaluable for drug safety evaluation, were reported to have adverse event. CONCLUSION: Itraconazole Melt-Extrusion tablet 400mg/day for 1 week (pulse therapy) is effective and safe in the treatment of hyperkeratotic type of tinea pedis and/or tinea manus.
Absorption ; Biological Availability ; Fasting ; Gastric Acid ; Hospitals, General ; Humans ; Itraconazole* ; Korea ; Outpatients ; Tablets ; Tinea Pedis* ; Tinea* ; Treatment Failure