Takayasu's arteritis is a chronic inflammatory disease of unknown etiology involving the thoracic and abdominal aorta and its major branches. In some cases other vessel such as renal arteries, coronary arteries, and even pulmonary arteries may be involved. Total aortography is very important, because the clinical features are determined by the extent and severity of the specific artery involved in the occlusive phase of the disease. We report a case of Takayasu's arteritis type IV in a 38 year man with pulmonary arterial involvement and pulmo-nary hypertension.
Aorta, Abdominal ; Aortography ; Arteries ; Arteritis* ; Coronary Vessels ; Hypertension ; Hypertension, Pulmonary* ; Pulmonary Artery ; Renal Artery ; Takayasu Arteritis*

PURPOSE: Abdominal obesity is encountered as a risk factor for cardiovascular diseases. However, the anthropometric cut-off value to estimate the cardiovascular risk, has not been suggested. This study was designed to find the relationship between the abdominal fat and various parameters of obesity to find the cardiovascular risk factors related to abdominal obesity and to establish practical methods to measure them. METHODS: Twenty seven obese Korean adolescents of moderate to severe degree and 22 healthy adolescents were enrolled. The body mass index (BMI), arm circumference and skinfold thickness were measured. Furthermore, blood lipid, sugar, insulin and four different cytokines' levels were checked and the distribution of body composition was measured by bioelectrical impedance analysis. The subcutaneous and intra-abdominal fat thickness by abdominal ultrasonography (US) and the total and intra-abdominal fat area by abdominal computerized tomography (CT) were measured in the obese group. RESULTS: The most accurate method to measure abdominal fat in children is abdominal CT and the fat mass measured by bioelectrical impedance was strongly correlated with it (r=0.954). It was also correlated with arm circumference, fat thickness measured by abdominal US, BMI, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and triglyceride level. CONCLUSION: Abdominal CT is the most accurate method to measure intra-abdominal fat, and it can be replaced by abdominal US for cost effectiveness. The screening methods that can be used at school or in outpatient basis include bioelectrical impedance, waist/hip ratio, and arm circumference. The cardiovascular risk factors include leptin, triglyceride and insulin level.
Abdominal Fat ; Adolescent ; Alanine Transaminase ; Arm ; Aspartate Aminotransferases ; Body Composition ; Body Mass Index ; Cardiovascular Diseases ; Child ; Cost-Benefit Analysis ; Diagnosis* ; Electric Impedance ; Humans ; Insulin ; Intra-Abdominal Fat ; Leptin ; Mass Screening ; Obesity* ; Obesity, Abdominal ; Outpatients ; Pediatric Obesity* ; Risk Factors ; Skinfold Thickness ; Tomography, X-Ray Computed ; Triglycerides ; Ultrasonography

No abstract available.
Humans* ; Mesenchymal Stromal Cells*

OBJECTIVE: Delirium is very common in orthopedic elderly patients and increase comorbidity and mortality rates. By controling the risk factors of delirium, prevention strategy can be effective and reduce negative outcomes. The purpose of this study was to explore the usefulness of delirium risk assessment with some simple collateral questionaires. METHODS: The subjects were 50 elderly patients (≥65 years old) who admitted to a department of orthopedic surgery for operations of lower extremity fractures. They were evaluated with Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Confusion Assessment Method and Korean Dementia Screening Questionnaire (KDSQ) by psychiatrists. The demographic data, medical histories, and orthopedic chart were checked through medical records of patients. RESULTS: 27 subjects (54.0%) were diagnosed as delirium. There was a significant difference between delirium group and control group with all KDSQ scores. Depressive category of KDSQ score had the highest correlation (coefficient=0.399) and can be independent risk factor of delirium (p=0.045). CONCLUSION: Cognitive impairment and depressive symptoms have high correlation with delirium. We found that just a few questions of cognitive impairment and depressive symptoms by caregivers can evaluate the risk factors of delirium. The simple collateral questionaires can be useful tool for exploring delirium risk factors.
Aged* ; Caregivers ; Cognition Disorders ; Comorbidity ; Delirium* ; Dementia ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Lower Extremity* ; Mass Screening ; Medical Records ; Methods ; Mortality ; Orthopedics ; Psychiatry ; Risk Assessment ; Risk Factors

BACKGROUND: The hepatic and neuropsychiatric disorders caused by long term excessive alcohol abuse have been well documented. However the pathogenesis and clinical characteristics of cardiovascular disorder caused by excessive alcohol abuse has not been documented. Many patients diagnosed as idiopathic dilated cardiomyopathy(IDCM) are apt to have a history of heavy alcohol consumption and are categorized as having alcoholic ardiomyopathy(ACM). METHODS: Twenty men(agedd 32 to 63 yrs, mean age 48.6 yrs) with dilated dcardiomyopathy, with the history of excessive alcohol abuse, were analyzed with fifteen patients with IDCM as control. RESULTS: The most common alcoholic beverage consumed in ACM is Diluted soju(85.0%) followed by Takju(10.0%), beer(5.0%). Average daily alcohol consumption is 134.5+/-40.3 g, frequency of alcohol intake in a week 5.4+/-1.4 times, total life time dose of ethanol 20.0+/-7.8kg/kg of body weight and duration of alcohol intake 26.9+/-8.4 years. There were no significant differences in symptoms between the two groups. In electrocardiography, atrial fibrillation is more frequent in ACM group(40%) than IDCM group(20%). In ACM group, serum concentrations of triglyceride and total cholesterol are higher than IDCM group, but no differences in serum HDL-cholesterol, SGOT, SGPT concentrations. In echocardiography, left ventricular systolic internal dimension and right ventricular internal dimension is smaller and ejection fraction is larger in ACM group than IDCM group. CONCLUSION: We studied the clinical, laboratory, electrocardiographic and echocardiographic characteristics of alcoholic cardiomyopathy comparing with idiopathic dilated cardiomyopathy.
Alanine Transaminase ; Alcohol Drinking ; Alcoholic Beverages ; Alcoholics* ; Alcoholism ; Aspartate Aminotransferases ; Atrial Fibrillation ; Body Weight ; Cardiomyopathy, Alcoholic* ; Cardiomyopathy, Dilated ; Cholesterol ; Echocardiography* ; Electrocardiography ; Ethanol ; Humans ; Triglycerides

PURPOSE: The extent of the loss of heterozygosity (LOH) has been used as the genetic parameter for the classification and staging of some solid tumors. Breast cancers such as ductal carcinoma in situ (DCIS), and invasive and metastatic lesions, are frequently observed to contain heterogeneous tumor foci. To delineate the relation between the LOH and the progression of breast cancers, three successive histological sites in a tumor lesion were analyzed for LOH events. METHODS: We tested 111 tumor site including DCIS, and invasive, and metastatic lymph nodes from 50 breast cancers for LOH using 5 microsatellite makers on 8 chromosomal arms (3p, 4p, 5q, 8p, 9p, 13q, 17p, & 18q). RESULTS: Twenty-four of 34 breast cancers showing intratumoral histological heterogeneity had common chromosomal losses in the heterogeneous tumor sites, as well as having divergent losses that were restricted to a part of tumor lesion (mean divergent loss, 2.32). The number and frequency of heterogeneous chromosomal losses were not significantly related with age, tumor size, and stage. Overall, at least one chromosomal loss was detected in 48 cases, and incidences of LOH in each chromosome were 27.1~63.3%. A large fraction (58%) of breast cancer patients had 2 to 4 chromosomal losses, and chromosome 8p was most frequently lost (63%). When comparing the number of chromosomal losses in nine cases with all of three progressive lesions, the lost extent was greater in the DCIS (mean losses, 4.44) than in the invasive sites (mean losses, 3.1) and the metastatic lymph nodes (mean losses, 2.9). Moderate-level chromosomal losses involving 3-5 chromosomes were significantly related with lymph node metastasis (p=0.006) and the advanced tumor stage (p<0.005), whereas low-level losses involving 1~2 chromosomes and high-level losses involving 6~7 chromosomes were more common in DCIS and early-stage diseases. CONCLUSION: The DCIS, invasive, and metastatic sites of a breast cancer patient contained common and divergent chromosomal losses. This indicates the concurrent expansion of different subclones was derived from a common ancestor clone, in which an optimal range of chromosomal losses, rather than high-level chromosomal losses, was more frequently associated with lymph node metastasis and the advanced tumor stages.
Arm ; Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Classification* ; Clone Cells ; Humans ; Incidence ; Loss of Heterozygosity ; Lymph Nodes ; Microsatellite Repeats ; Neoplasm Metastasis ; Population Characteristics

A dual mobility acetabular component has a structure that combines a polyethylene liner and a femoral head, unlike the general design of acetabular cups, making the dissociation of a polyethylene liner highly unlikely. In addition, it increases the range of motion and reduces the possibility of dislocations by increasing a jump distance. A fifty-one-year-old male who had received total hip arthroplasty with the dual mobility acetabular component visited a hospital for a posterior hip dislocation 10 weeks after the operation. At the emergency room, closed reduction was performed and the dislocation was reduced. However, plain imaging test revealed polyethylene liner dissociation after the closed reduction. Revision surgery was performed. We will report a rare case of early dislocation of the dual mobility acetabular component and dissociation of polyethylene liner accompanied with a literature review.
Acetabulum* ; Arthroplasty, Replacement, Hip ; Dislocations* ; Emergency Service, Hospital ; Femur Head ; Head ; Hip Dislocation ; Hip Joint ; Hip Prosthesis ; Humans ; Male ; Polyethylene* ; Range of Motion, Articular

PURPOSE: Treatment for malignant colonic obstruction consists of a multiple-staged emergency operation. In recent years, some authors have reported low morbidity and mortality rates using self-expandable metallic stents. This study is designed to evaluate the usefulness of self-expandable metallic stents in patients with malignant colonic obstruction. METHODS: The records of 38 patients who had undergone surgery for malignant colonic obstruction at our institution between January 2004 and August 2006 were reviewed retrospectively. Seventeen patients were treated with elective surgery after stent insertion, bowel decompression, and bowel preparation (stent group), and 21 patients were treated with emergency surgery without stent insertion (control group). RESULTS: There were no significant differences in age, sex, tumor node metastasis (TNM) stage, or cancer position between the two groups (elective operation after stent insertion vs. emergency operation). Of the 17 patients who underwent elective operation after stent insertion, primary anastomosis was possible in 15 (88.2 vs. 57.1% in the control group), with a lower need for a colostomy (11.8 vs. 42.9% in the control group, P=0.036). Also, the number of patients with severe complications (17.6 vs. 47.6% in the control group, P=0.048) and the hospital stay (10.82 vs. 13.43 days in the control group, P=0.032) were significantly lower in the study group. CONCLUSION: Placement of a self-expandable metallic stent for malignant colonic obstruction is a safe and effective procedure. It can reduce the colostomy, mortality, and morbidity rates and the hospital fee for treatment.
Colon ; Colostomy ; Decompression ; Emergencies ; Fees and Charges ; Humans ; Length of Stay ; Neoplasm Metastasis ; Retrospective Studies ; Stents

The purpose of the present study is to evaluate the biological stability of the zirconia/alumina composite abutment by histologic and radiographic examination in clinical cases. 17 partially edentulous patients (5 men and 12 women, mean age 47) were treated with 37 implants. The implants were placed following the standard two-stage protocol. After a healing period of 3 to 6 months, zirconia/alumina composite abutments were connected. All radiographs were taken using paralleling technique with individually fabricated impression bite block, following insertion of the prosthesis and at the 3-, 6-, 12-month re-examinations. After processing the obtained images, the osseous level was calculated using the digital image in the mesial and distal aspect in each implant. An ANOVA and t-test were used to test for difference between the baseline and 3-, 6-, 12 months re-examinations, and for difference between maxilla and mandible. Differences at P <0.05 were considered statistically significant. For histologic examination, sample was obtained from the palatal gingiva which implant functioned for 12 months. Sections were examined under a light microscope under various magnifications. Clinically, no abutment fracture or crack as well as periimplantitis was observed during the period of study. The mean bone level reduction(+/-standard deviation) was 0.34 mm(+/- 0.26) at 3-months, 0.4 2mm(+/- 0.30) at 6-months, 0.62 mm(+/- 0.28) at 12-months respectively. No statistically significant difference was found between baseline and 3-, 6-, 12-months re-examinations (p > 0.05). The mean bone level reduction in maxilla was 0.33(+/-0.25) at 3-months, 0.36(+/-0.33) at 6-months, 0.56(+/-0.26) at 12-months. And the mean bone level reduction in mandible was 0.35(+/-0.27) at 3-months, 0.49(+/-0.27) at 6-months, 0.68(+/-0.30) at 12-months. No statistical difference in bone level reduction between implants placed in the maxilla and mandible. Histologically, the height of the junctional epithelium was about 2.09 mm. And the width was about 0.51 mm. Scattered fibroblasts and inflammatory cells, and dense collagen network with few vascular structures characterized the portion of connective tissue. The inflammatory cell infiltration was observed just beneath the apical end of junctional epithelium and the area of direct in contact with zirconia/alumina abutment. These results suggest the zirconia/alumina composite abutment can be used in variable intraoral condition, in posterior segment as well as anterior segment without adverse effects.
Female ; Male ; Humans

Atypical insufficiency fracture of the femur following prolonged bisphosphonate use is well described. Regardless of the cause, insufficiency fracture of the acetabulum is extremely rare, and no reports have described insufficiency fractures of the acetabulum that are associated with prolonged bisphosphonate use. This report demonstrates the possibility of insufficiency fracture at the acetabulum following long-term alendronate use and the necessity of particular care in managing insufficiency fractures in “frozen” bone. We describe two cases of insufficiency fracture of the acetabulum following 6 years of alendronate use. Given the patients' medical histories and bone biopsy findings, these insufficiency fractures were thought to be attributable to alendronate use. One case involved the left hip and the presence of pelvic fractures on the opposite side. The patient was treated using cementless total hip arthroplasty (THA), which failed 1 year after surgery. The hip was revised with a massive bone graft and a supportive wire mesh. The other case was managed via THA with a Ganz reinforcement ring due to concerns regarding the use of a cementless implant.
Acetabulum* ; Alendronate* ; Arthroplasty, Replacement, Hip* ; Biopsy ; Femur ; Fractures, Stress* ; Hip ; Humans ; Transplants