Purpose of the study. The purpose of this study was to evaluate the result of treatment of the infected total knee arthroplasty by two-stage revision. Material. Out of twenty eight total knee arthroplasty revisions, 13 revisions were performed for infected total knee arthroplasties between 1985 and l.996. Two cases of infected total knee arthroplasties were treated by immediate replacement and four cases by arthrodesis. Seven infected total knee arthroplasties had been revised by two-stage revision and followed-up for 38.6 months in average (range, 18-105 months). They were one male and six female patients of 61.6 years old in average. The primary cause of arthroplasty was osteoarthritis in all. Infection was diagnosed by preoperative aspiration, culture of the pus from draining sinus and culture of surgical specimen. Five cases revealed positive growth of causative bacteria, while two were not identified. METHOD: The protocol for two-stage revision began with tbe removal of infected implants and cement. The surrounding bony and soft tissue were thoroughly debrided and cleaned. The dead space between femur and tibia was filled with antibiotics-impregnated cement spacer and beads. Wound was closed and the leg was placed in soft knee brace. Patients received intravenous antibiotic therapy based on culture results for 4-6 weeks. Reimplantation was followed using total condylar prosthesis of posterior stabilizing type in five and semiconstrained type in two cases. RESULT: Two-stage revision was successful in six cases. One case revealed the recurrence of infection eleven months after reimplantation and underwent the repetition of the same two-stage procedure. At the final follow-up, the average Hospital for Special Surgery score was 81.l points, the average Knee Society knee score was 78.6 points and the average functional score was 76.7 points. Patients could regain average 100 degrees of knee flexion. CONCLUSION: The result of two-stage revision for infected total knee arthroplasty was satisfactory, showing that this can be the method of choice for infection treatment and functional restoration. This procedure using antibiotics-impregnated cement spacer and beads can control infection and improve functional results.
Anti-Bacterial Agents* ; Arthrodesis ; Arthroplasty* ; Bacteria ; Braces ; Female ; Femur ; Follow-Up Studies ; Humans ; Knee* ; Leg ; Male ; Osteoarthritis ; Prostheses and Implants ; Recurrence ; Replantation ; Suppuration ; Tibia ; Wounds and Injuries

BACKGROUND: It is well known that coronary arterial thrombosis plays an important role in the pathogenesis of acute coronary syndrome and this has focused interest on the role of the fibrinolytic system, especially tissue plasminogen activator(t-PA) and plasminogen activator inhibitor-1(PAI-1), which are major determinants of fibrinolytic system. But there are considerable variations in the reported association between these two components and acute coronary syndrome. METHODS: To evaluate association between t-PA, PAI-1 and myocardial infarction, plasma level of t-PA and PAI-1 in resting state and after venous occlusion were measured and analysed in patients with previous myocardial infarction at least 6 months after the acute phase, who showed less than 70% luminal narrowing angiographically and control group. The relationship between t-PA, PAI-1 antigen and activity and relation to age, serum triglyceride, cholesterol, and peak creatine kinase(CK) enzyme were also analyzed. RESULTS: 1) In resting state, there was a significant difference of plasma level of both t-PA and PAI-1 antigen, activity between patient and control group(10.72+/-3.28 vs 8.16+/-4.03ng/ml, 0.53+/-0.34 vs 0.02+/-0.07U/ml, 26.24+/-8.30 vs 20.82+/-8.82ng/ml, 14.62+/-5.97 vs 6.99+/-6.44U/ml)(p<0.05), and resting plasma level of PAI-1 activity showed a good correlation with peak creatine kinase(CK) enzyme(r=0.76, p<0.01). 2) After venous occlusion, plasma level of t-PA antigen was significantly increased(8.16+/-4.03 vs 9.87+/-3.86ng/ml)(p<0.05) whereas t-PA activity and PAI-1 antigen were not significantly changed in control group. In patient group, t-PA antigen, t-PA activity and PAI-1 antigen were significantly inceased after venous occlusion(10.72+/-3.28 vs 14.66+/-5.41ng/ml, 0.53+/-0.34 vs 1.41+/-1.69U/ml, 26.24+/-8.30 vs 29.87+/-8.78ng/ml)(p<0.05). PAI-1 activity was significantly decreased after venous occlusion in both groups(6.99+/-6.44 vs 6.06+/-5.99U/ml, 14.62+/-5.97 vs 12.67+/-6.46U/ml)(p<0.05). CONCLUSION: Both fibrinolytic and anti-fibrinolytic systems are augmented in resting and after fibrinolysis stimulation test in patient group. These findings suggested a impairment of fibrinolytic system in patient group and a possibility that both elevated plasma levels of t-PA and PAI-1 may be markers of coronary artery disease.
Acute Coronary Syndrome ; Cholesterol ; Coronary Artery Disease ; Creatine ; Fibrinolysis ; Humans ; Myocardial Infarction* ; Phenobarbital ; Plasma* ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators* ; Plasminogen* ; Thrombosis ; Tissue Plasminogen Activator* ; Triglycerides

Interrupted aortic arch may be defined as a discontinuity of the aortic arch. This uncommon anomaly was first described by Steidele in 1778 and was later classified into 3 types by Celoria and Patton. We experienced the case of a 25-year-old male with an interrupted aortic arch(Type B) which was well supplied by collateral circulations. Ligation of collateral supplies and a Y-graft replacement from ascending aorta to descending thoracic aorta and left subclavian artery was done. Postoperative aortogram revealed no collateral circulations and good continuity of the aorta without narrowing of the anatomic site. During the period of 2-month follow up, the patient was able to lead a relatively active life.
Adult ; Aorta ; Aorta, Thoracic ; Collateral Circulation ; Equipment and Supplies ; Follow-Up Studies ; Humans ; Ligation ; Male ; Subclavian Artery

Sialadenoma papilliferum (SP) is a rare benign neoplasm that normally arises from the minor salivary glands, particularly in the palate. SP is normally encountered in older men with an exophytic papillary surface growth. In the present study, an SP of the hard palate of a 69-year-old woman was examined immunohistochemically. Myoepithelial cell markers, such as S-100, smooth muscle actin and vimentin, were observed in the basal or luminal layer of tumor cells, indicating that myoepithelial cells participate in the pathogenesis of SP. In addition, cytokeratin 7 was also strongly detected in the tumor cells, suggesting that excretory ductal epithelial cells have a role in its histogenesis. A review of the literature of immunohistochemical studies on SP showed that the expression and co-expression of cytokeratins and myoepithelial cell markers have been reported in tumor cells. These results suggested that excretory duct cells and myoepithelial cells participate in the pathogenesis of SP.
Actins ; Aged ; Epithelial Cells ; Female ; Humans ; Immunohistochemistry ; Keratin-7 ; Keratins ; Male ; Muscle, Smooth ; Palate ; Palate, Hard ; Phenobarbital ; Salivary Glands, Minor ; Vimentin

OBJECTIVE: We compared the expression pattern of progesterone receptor, integrin 3, cyclooxygenase-2 (COX-2) in in-phased endomerium of patient with the disease related implantation and control group, and tried to confirm the clinical efficacy of the immunohistochemical markers for discrimination of occult uterine receptivity defect in in-phase endometrium. STUDY DESIGN: Endometrial tissues were obtained from 60 women with normal (group 1; n = 20), uterine synechiae (group 2; n = 15), and endometriosis (group 3; n = 25). On 7 ~ 8 days after ovulation (POD 7 ~ 8), sex hormone levels were measured and immunohistochemical staining of PR, integrin 3, and COX-2 expression were performed. RESULTS: PR was decreased in the group 2 and increased in the group 3 comparing with the group 1. integrin 3 expression was significantly decreased in the group 2 and 3. COX-2 expression was significantly decreased in the group 2. But, in the group 3, COX-2 expression was slightly increased in glandular epithelial cells, and significantly increased in stromal cells. CONCLUSIONS: In-phase biopsies from patients with endometriosis and uterine synechiae showed different expression pattern of integrin 3, COX-2, and PR compared to the control. The aberrant expression of immunohistochemical markers be associated with occult uterine receptivity defect and produce the useful diagnostic method.
Biopsy ; Cyclooxygenase 2* ; Discrimination (Psychology) ; Endometriosis ; Endometrium* ; Epithelial Cells ; Female ; Gynatresia ; Humans* ; Ovulation ; Progesterone* ; Receptors, Progesterone* ; Stromal Cells

The rate of malignant transformation in porokeratosis (PK) lesions is approximately 7.5%, and linear PK demonstrates the highest rate of malignancy. An 83-year-old woman presented with a rapidly enlarging mass on her left arm. Variably sized erythematous scaly patches were scattered across the left half of her trunk and arm. Additionally, generalized variably sized brownish annular patches with a hyperkeratotic outer ring were observed on her face, trunk and bilateral arms. A skin biopsy was performed on 3 lesions-a yellowish to erythematous appearing mass, an erythematous scaly patch, and a brownish annular patch. Histopathological evaluation of these 3 lesions revealed squamous cell carcinoma, actinic keratosis, and PK, respectively. The final diagnosis was disseminated superficial PK with linear PK on the left side of the body, and actinic keratosis and squamous cell carcinoma confined to the linear PK lesions. We report a case which represents the progressive and stepwise malignant transformation of PK into squamous cell carcinoma.
Aged, 80 and over ; Arm ; Biopsy ; Carcinoma, Squamous Cell ; Diagnosis ; Female ; Humans ; Keratosis, Actinic ; Porokeratosis* ; Skin

No abstract available.
Blood Platelets ; Mean Platelet Volume ; Urticaria

BACKGROUND: The incidence and etiology of hepatocellular carcinoma (HCC) vary widely according to race and geographic regions. The insertional mutagenesis of adeno-associated virus 2 (AAV2) has recently been considered a new viral etiology of HCC. The aim of this study was to investigate the frequency and clinical characteristics of AAV2 in Korean patients with HCC. METHODS: A total of 289 unrelated Korean patients with HCC, including 159 Hepatitis-B-related cases, 16 Hepatitis-C-related cases, and 114 viral serology-negative cases, who underwent surgery at the Samsung Medical Center in Korea from 2009 to 2014 were enrolled in this study. The presence of AAV2 in fresh-frozen tumor tissues was investigated by DNA PCR and Sanger sequencing. The clinical and pathological characteristics of AAV2-associated HCC in these patients were compared with previous findings in French patients. RESULTS: The AAV2 detection rate in Korean patients (2/289) was very low compared with that in French patients (11/193). Similar to the French patients, the Korean patients with AAV2-related HCC showed no signs of liver cirrhosis. The Korean patients were younger than the French patients with the same AAV2-associated HCC; the ages at diagnosis of the two Korean patients were 47 and 39 yr, while the median age of the 11 French patients was 55 yr (range 43-90 yr). CONCLUSIONS: AAV2-associated HCC was very rare in Korean patients with HCC. Despite a limited number of cases, this study is the first to report the clinical characteristics of Korean patients with AAV2-associated HCC. These findings suggest epidemiologic differences in viral hepatocarcinogenesis between Korean and European patients.
Adult ; Asian Continental Ancestry Group ; Capsid Proteins/genetics ; Carcinoma, Hepatocellular/etiology/*pathology/virology ; DNA, Viral/chemistry/genetics/metabolism ; DNA-Binding Proteins/genetics ; Dependovirus/*genetics/isolation & purification/pathogenicity ; Female ; Humans ; Incidence ; Inverted Repeat Sequences/genetics ; Liver Neoplasms/etiology/*pathology/virology ; Male ; Middle Aged ; Parvoviridae Infections/complications/epidemiology ; Polymerase Chain Reaction ; Republic of Korea ; Sequence Analysis, DNA ; Viral Proteins/genetics

BACKGROUND: Doppler variable of mitral inflow have been used to assess left ventricular siastolic function indirectly. Pulmonary venous flow(PVF) variables could supplement mitral inflow in the estimation of left ventricular diastolic function. The purpose of this study are to assess the feasibility of PVF measurement by using transthoracic pulsed wave Doppler echocardiogram and to estimate the LV end-diastolic pressure with PVF parameters. METHODS: Fifty six patients underwent transthoracic pulsed wave Doppler echocardiagraphy (HP Sonos 1500) within 2 hours before left heart catheterization for the measurement of left ventricular pressure. RESULTS: 1) Measurement of transthoracic PVF was feasible in 50 patients(89.3%). 2) The difference between the duration of pulmonary venous reversal flow and mitral A wave(D difference, delta D) was strongly correlated with left ventricular end diastolic pressure(r=0.73, p<0.01). PVF reversal duration exceeding that of mitral A wave predicted left ventricular end diastolic pressure > or =12mmHg(sensitivity 90.6%, specificity 50.0%). CONCLUSION: PVF could be assessed with transthoracic Doppler ultrasound with good feasibility. PVF may be an important parameter in the evaluation of left ventricular diastolic function. PVF reveral duration exceeding that of mitral A wave would be a marker of elevated left ventricular end diastolic pressure(> or =12mmHg). Plumonary venous flow . Transmitral inflow . Left ventricular end diastolic pressure. Transthorasic doppler echocardiography.
Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography, Doppler* ; Humans ; Sensitivity and Specificity ; Ultrasonography ; Ventricular Pressure

Reactions to Hymenoptera stings are classified into local reactions, large local reactions, systemic anaphylactic reactions, systemic toxic reactions, and unusual reactions. They are also classified into immediate and delayed reactions. The most frequent clinical patterns are large local and systemic anaphylactic reactions. The skin, and the gastrointestinal, respiratory, and cardiovascular systems can be involved. A variety of unusual or unexpected reactions, such as acute encephalopathy, acute renal failure, nephrotic syndrome, silent myocardial infarction, diffuse alveolar hemorrhage, rhabdomyolysis, and cataracts, occur in a temporal relationship to insect stings. Here, we report a 31-year-old woman with delayed generalized edema, weight gain, and unusual reactions 24 hours after bee sting.
Acute Kidney Injury ; Adult ; Anaphylaxis ; Bees ; Bites and Stings* ; Brain Diseases ; Cardiovascular System ; Cataract ; Edema ; Female ; Hemorrhage ; Humans ; Hymenoptera* ; Insect Bites and Stings ; Myocardial Infarction ; Nephrotic Syndrome ; Rhabdomyolysis ; Skin ; Weight Gain