Although joint infection with severe destruction remains a serious problem and severe bone loss is relative contraindication of arthrodesis, knee arthrodesis is most commonly a salvage procedure. Its goals are to relieve pain and restore the patient to functional level of activity. The purpose of this study is to evaluate the results and complications of Ilizarov method for knee arthrodesis in the presence of infection. We retrospectively reviewed the records of twelve patients who had managed with knee arthrodesis with Ilizarov method. Indications for the operation included a infected skeletal defect secondary severe open trauma in four patients, an infection at the site of an arthroplasty in three (with failure of previous arthrodesis with monofixator in one), an infected charcot joint in four and one pyogenic arthritis spreading from osteomyelitis of proximal tibia. The average age of the patients at the time of operation was fifty-three years (range twenty-two to eighty years). Follow-up averaged 17 months. The minimum follow up periods was 9 months. Average duration of Ilizarov fixator application was 7.2 months. In 3 cases we performed corticotomy and internal bone transport to treat large bone defect (17cm, 8cm, 6.5cm). Autoiliac bone graft was done in fusion site in two cases, and in three cases we performed bone graft at the docking site. Solid osseous union occured in each patient. There was no reinfection and nonunion. Average shortening was 3.4 cm. Complications were related to pin tract. When last seen, all patients were free of pain and could walk without cruthes or cane. Despite its pin tract problems, bulky cumbersome and expensive apparatus, the Ilizarov method is one of effective method for knee arthrodesis in the presence of infection and large bone loss especially.
Arthritis ; Arthrodesis* ; Arthropathy, Neurogenic ; Arthroplasty ; Canes ; Follow-Up Studies ; Humans ; Ilizarov Technique* ; Joints ; Knee Joint* ; Knee* ; Osteomyelitis ; Retrospective Studies ; Tibia ; Transplants

BACKGROUND: Although it is known that patients wth peripheral vascular disease are at high risk for coronary arterial disease, however, it has not been determined that patients with coronary artery disease(CAD) correlates with peripheral vascular disease(PVD). This study was designed to determine the prevalence and clinical characteristics of peripheral vascular disease(PVD) in patients with coronary artery disease(CAD). METHODS: A total of one hundred seventy-eight patients with CAD confirmed by coronary angiogram(145 male, age 58.5+/-10.1) were included in this study from February 1992 to May 1994. Coronary and peripheral angiograms were performed in all patients and the patients were divided into two groups; patients with PVD dand patients without PVD. Clinical characteristics were compared between two groups. RESULTS: Peripheral vascular disease was present in 49 patients(27.5%) among 178 CAD patients. The mean age of patients with PVD was significantly older than that of patients without PVD. The hypertension was statistically significant difference between two groups(P<0.05). There were no major differences in the number of risk factors or number of stenotic coronary arteries in patients with and without PVD. CONCLUSION: The prevalence of PVD in patients with CAD was high and it is reasonable to state that most common risk factors for coronary and peripheral atherosclerosis were age, hypertension and obesity.
Atherosclerosis ; Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Hypertension ; Male ; Obesity ; Peripheral Vascular Diseases* ; Prevalence ; Risk Factors

PURPOSE: To evaluate the utillity of three phases of spiral CT in the diagnosis of stomach cancer. MATERIALS AND METHODS: Between August 1994 and March 1995, thirty eight patients with stomach cancer, demonstrated on spiral CT, underwent surgery. Twenty-eight cases were advanced and ten were early. There were 27 men, and 11 women, and their average age was 52.8 years old (33-77). After ingestion of 600 - 700ml of water, 120 - 140ml of nonionic contrast material was injected intravenously. Spiral CT scanning was performed in 10mm slice thickness and of 10 mm/sec table speed. Three phase images were obtained at 25 sec (arterial phase), 60-65 sec (venous phase) and 4min (equilibrium phase) after the start of bolus injection. On each phase, CT findings were compared with pathologic results, and tumor detectibility, depth of tumor invasion and lymph node metastasis was analysed. RESULTS: Thirty of the 38 carcinomas (79%) were detected on the arterial phase, 33 (81%) on the venous phase and 30 (79%) on the equilibrium phase. Depth of tumor invasion was measured accurately in 27 of 38 cases (71%): T1 -4/10 (40%), T2 - 8/11 (73%), T3 - 13/15 ( 87% ), T4 - 2/2 ( 100% ). We overstaged one case of T1 as T2 and two cases of T2 as T3, and understaged one case of T2 as T1 and two cases of T3 as T2. Among the 16 enlarged lymph nodes larger than 8mm, 13 cases were positive on pathologic examination and the sensitivity was 65%. CONCLUSION: With three-phase spiral CT scanning, we obtained 71% accuracy of depth of tumor invasion. The venous phase is most useful for tumor detection and for determining depth of tumor invasion and lymph node metastasis.
Diagnosis ; Eating ; Female ; Humans ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Stomach Neoplasms* ; Stomach* ; Tomography, Spiral Computed* ; Water

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

Chemokines are key factors that influence the migration and maintenance of relevant immune cells into an infected tissue or a tumor microenvironment. Therefore, it is believed that the controlled administration of chemokines in the tumor microenvironment may be an effective immunotherapy against cancer. Previous studies have shown that CCL3, also known as macrophage inflammatory protein 1-alpha, facilitates the recruitment of dendritic cells (DCs) for the presentation of tumor Ags and promotes T cell activation. Here, we investigated the role of CCL3 in regulating the tumor microenvironment using a syngeneic mouse tumor model. We observed that MC38 tumors overexpressing CCL3 (CCL3-OE) showed rapid regression compared with the wild type MC38 tumors. Additionally, these CCL3-OE tumors showed an increase in the proliferative and functional tumor-infiltrating T cells. Furthermore, PD-1 immune checkpoint blockade accelerated tumor regression in the CCL3-OE tumor microenvironment. Next, we generated a modified CCL3 protein for pre-clinical use by fusing recombinant CCL3 (rCCL3) with a non-cytolytic hybrid Fc (HyFc).Administering a controlled dose of rCCL3-HyFc via subcutaneous injections near tumors was effective in tumor regression and improved survival along with activated myeloid cells and augmented T cell responses. Furthermore, combination therapy of rCCL3-HyFc with PD-1 blockade exhibited prominent effect to tumor regression. Collectively, our findings demonstrate that appropriate concentrations of CCL3 in the tumor microenvironment would be an effective adjuvant to promote anti-tumor immune responses, and suggest that administering a long-lasting form of CCL3 in combination with PD-1 blockers can have clinical applications in cancer immunotherapy.

Chemokines are key factors that influence the migration and maintenance of relevant immune cells into an infected tissue or a tumor microenvironment. Therefore, it is believed that the controlled administration of chemokines in the tumor microenvironment may be an effective immunotherapy against cancer. Previous studies have shown that CCL3, also known as macrophage inflammatory protein 1-alpha, facilitates the recruitment of dendritic cells (DCs) for the presentation of tumor Ags and promotes T cell activation. Here, we investigated the role of CCL3 in regulating the tumor microenvironment using a syngeneic mouse tumor model. We observed that MC38 tumors overexpressing CCL3 (CCL3-OE) showed rapid regression compared with the wild type MC38 tumors. Additionally, these CCL3-OE tumors showed an increase in the proliferative and functional tumor-infiltrating T cells. Furthermore, PD-1 immune checkpoint blockade accelerated tumor regression in the CCL3-OE tumor microenvironment. Next, we generated a modified CCL3 protein for pre-clinical use by fusing recombinant CCL3 (rCCL3) with a non-cytolytic hybrid Fc (HyFc).Administering a controlled dose of rCCL3-HyFc via subcutaneous injections near tumors was effective in tumor regression and improved survival along with activated myeloid cells and augmented T cell responses. Furthermore, combination therapy of rCCL3-HyFc with PD-1 blockade exhibited prominent effect to tumor regression. Collectively, our findings demonstrate that appropriate concentrations of CCL3 in the tumor microenvironment would be an effective adjuvant to promote anti-tumor immune responses, and suggest that administering a long-lasting form of CCL3 in combination with PD-1 blockers can have clinical applications in cancer immunotherapy.

This study investigated the baseline predictors of best corrected visual acuity (BCVA) and central retinal thickness (CRT) at 6 months in patients with treatment-naive branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). This multicenter, interventional case series included 208 BRVO and 123 CRVO patients with follow-up period of 6 months or more. Outcome measures of BCVA (logMAR) included absolute change from baseline and a gain or loss of > or = 0.3 from baseline. Outcome measures of CRT included absolute change from baseline and a measurement of < or = 250 microm or > or = 400 microm at 6 months. Univariate and multiple regression analyses were done to find baseline predictors. For BRVO, younger age, worse baseline BCVA, and shorter duration of symptom were associated with more gain in BCVA. For CRVO, worse baseline BCVA was associated with more gain in BCVA. For CRT outcomes, higher baseline CRT predicted greater decrease at 6 months in both BRVO and CRVO. Younger age and better baseline BCVA were associated with an increased likelihood of measurement of a < or = 250 microm outcome for BRVO and CRVO, respectively. For CRVO, smoking was associated with greater decrease from baseline and decreased likelihood of measurement of a CRT > or = 400 microm at 6 months. In conclusion, several baseline factors including age, symptom duration, and baseline BCVA and CRT are associated with BCVA and CRT outcomes at 6 months, which may help to predict disease course for RVO patients.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Retina/*pathology ; Retinal Vein Occlusion/pathology/*physiopathology ; *Visual Acuity

PURPOSE: To validate whether FAM70B, which was found in our micro-array profiling as a prognostic marker for cancer survival, could accurately predict prognosis in patients with muscle-invasive bladder cancer (MIBC). MATERIALS AND METHODS: A total of 124 patients with MIBC were enrolled in this study. The FAM70B expression level was analyzed by real-time polymerase chain reaction by using RNA from tumor tissues. The prognostic effect of FAM70B was evaluated by Kaplan-Meier analysis and a multivariate Cox regression model. RESULTS: Kaplan-Meier estimates showed a significant difference in progression-free survival (log-rank test, p=0.011) and cancer-specific survival (log-rank test, p=0.017) according to FAM70B gene expression level. By multivariate Cox regression analysis, high FAM70B expression was predictive of cancer progression (hazard ratio [HR], 2.115, p=0.013) and cancer-specific death (HR, 1.925; p=0.033). In the subgroup analysis, high expression of FAM70B was associated with poor cancer-specific survival, progression-free survival, and overall survival in the patients who underwent cystectomy (log-rank test, p=0.013, p=0.036, p=0.005, respectively). In the chemotherapy group, FAM70B expression was associated with cancer-specific survival and progression-free survival (log-rank test, p=0.013, p=0.042, respectively). Moreover, high FAM70B expression was associated with shorter cancer-specific survival in localized or locally advanced tumor stages (log-rank test, p=0.016). CONCLUSIONS: We confirmed the significance of FAM70B as a prognostic marker in a validation cohort. Therefore, we propose that the FAM70B gene could be used to more precisely predict cancer progression and cancer-specific death in patients with MIBC.
Cohort Studies ; Cystectomy ; Disease-Free Survival ; Gene Expression ; Gene Expression Profiling ; Humans ; Kaplan-Meier Estimate ; Prognosis ; Real-Time Polymerase Chain Reaction ; RNA ; Urinary Bladder ; Urinary Bladder Neoplasms

We investigated the demographic characteristics and risk factors of Korean patients with naIve central or branch retinal vein occlusion (CRVO or BRVO). This study enrolled 41 clinical sites throughout Korea and included 557 consecutive patients with retinal vein occlusion (RVO) from May through November 2010. A total of 557 patients with new-onset RVO participated in this study. Two hundred and three (36.4%) patients were diagnosed with CRVO and 354 (63.6%) patients were diagnosed with BRVO. Comparisons between the two groups showed that the prevalence of diabetes mellitus was significantly higher in CRVO patients and hypertension was significantly higher in BRVO patients (P = 0.001 and 0.002, respectively). Poor baseline visual acuity was significantly associated with female and old age in BRVO patients (P = 0.002 and 0.013, respectively), whereas the wide intraretinal hemorrhage (CRVO, P = 0.029; BRVO, P < 0.001) and the macular ischemia (CRVO, P < 0.001; BRVO, P < 0.001) were associated with both groups. The study results show the clinical features of RVO in Korean patients. Hypertension is strongly associated with BRVO and diabetes mellitus is more strongly associated with CRVO in Korean patients with RVO. As the first nationwide study performed by the Korean Retinal Society, the results of this study can be applied to future studies on RVO.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Child ; Child, Preschool ; Demography ; Diabetes Complications ; Female ; Humans ; Hypertension/complications ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Regression Analysis ; Republic of Korea ; Retinal Hemorrhage/complications ; Retinal Vein Occlusion/complications/*diagnosis ; Risk Factors ; Sex Factors ; Young Adult

BACKGROUND: Patients with hypertrophic cardiomyopathy(HCMP) may present a wide spectrum of clinical and morphological manifestations. There was little literature regarding clinical and morphological features of HCMP in Korea. METHODS: 1) Study population : Among 18, 183 patients who unerwent echocardiography from June 1990 to Qctober 1993 at Yonsei cardiovascular center Echocardiography laboratory, 65 patients with HCMP were enrolled to study population. All patients with HCMP have at least onesegment of left ventricular wall measuring 17mm or more in thickness at end diastole. 2) Two dimensional echocardiography : All standard views were performed and recorded with Super VHS video tape. All records were reviewed and the maximal wall thickness was measured at video monitor by aid of electronic caliper of our echocardiographic machine. 3) Dopple echocardiography : Peak velocity of E and A wave and deceleration time were measured. The intracavitary peak systolic pressure gradient was also measured using continous wave Doppler at the site of abnomal mosaic pattern in color flow interrogation. RESULTS: 1) Mean age of the patients was 50+/-15 ranging from 11 to 84 and the sex ratio was 2.3:1(male:female). 2) The type 3(involving all segments except inferior wall) was the most frequently observed in Korean(47%). 3) The mid anterior septum was the most frequently involved segment(71%) and the non-obstructive type was perdominant(78%). 4) There was 17 cases of apical HCMP and 4 cases of mid ventricular obstructive type. 5) There was no significant correlation between symptoms and dynamic obstruction. 6) The EA ratio had statistically significant difference between obstructive and non-obstructive groups probably due to mitral regurgitation. CONCLUSION: The type 3 was the most frequent type of HCMP in Korean and the non-obstructive type was more frequently observed than obstructive type. Among the all left ventricular segments, the mid anterior septum was most frequently involved.
Blood Pressure ; Cardiomyopathy, Hypertrophic* ; Deceleration ; Diastole ; Echocardiography* ; Humans ; Korea ; Mitral Valve Insufficiency ; Sex Ratio