We performed 34 metatarsal distraction lengthenings in 17 patients for the treatment of brachymetatarsia from May 1994 to December 2001. The average amount of lengthening was 15.6 mm(35.9%), range: 10.1 - 22.9 mm(18.8 - 64.1%). The average healing index was 75 days/cm(range, 49 - 119 days/cm). Complications included five cases of pin site infection, 3 cases of under-correction and 1 case of plantar angulation. All the pin site infections were well responded to oral antibiotics, but reduced the lengthening speed. In two cases, the early removal of fixator resulted in under-correction. The early removal was occurred by either patient's impatience to wear fixator or physician's hasty. In one case, it was not possible to distract because of the osteoporotic change of osteotomized segment during distraction. Plantar angulation of first metatarsal resisted to bone remodeling was corrected by wedge osteotomy. The expected joint stiffness was not paid any attention in all cases. Non-union, fracture and any neuovascular complications were not observed. We have found that the metatarsal lengthening by callotasis under the close physician's supervision of those problems, especially plantar angulation of first metatarsal, is safe and reliable procedure.
Anti-Bacterial Agents ; Bone Remodeling ; Humans ; Joints ; Metatarsal Bones ; Organization and Administration ; Osteogenesis, Distraction* ; Osteotomy

No abstract available.
Apolipoproteins* ; Genotype* ; Humans ; Myocardial Infarction*

OBJECTIVE: We analyzed the clinical and radiologic features of posterior apophyseal ring separation (PARS) with lumbar disc herniation and suggest the proper management options according to the PARS characteristics. METHODS: We reviewed case series of patients with PARS who underwent surgery of lumbar disc herniation. Preoperative symptoms, neurologic status, Body Mass Index, preoperative and postoperative Visual Analogue Scale (VAS) and Korean-Oswestry Disability Index (K-ODI) scores, operation types were obtained. PARS size, locations, the degree of resection were assessed. RESULTS: PARS was diagnosed in 109 (7.5%) patients among 1448 patients given surgical treatment for single level lumbar disc herniation. There were 55 (50.5%) small PARS and 54 (49.5%) large PARS. Among the large PARS group, 15 (27.8%) had lower endplate PARS of upper vertebra at the level of disc herniation. Thirty-nine (72.2%) were upper endplate PARS of lower vertebra. Among the group with upper endplate PARS of lower vertebra, unresected PARS was diagnosed in 12 (30.8%) cases and resected PARS was diagnosed in 27 (69.2%) cases. VAS and K-ODI scores changes were 3.6+/-2.9 and 5.4+/-6.4 in the unresected PARS group, 5.8+/-2.1 and 11.3+/-7.1 in the resected PARS group. The group with upper endplate PARS of lower vertebra showed significant difference of VAS (p=0.01) and K-ODI (p=0.013) score changes between unresected and resected PARS groups. CONCLUSION: The large PARS of upper endplate in lower vertebra should be removed during the surgery of lumbar disc herniation. High level or bilateral side of PARS should be widely decompressed and arthrodesis procedures are necessary if there is a possibility of secondary instability.
Arthrodesis ; Body Mass Index ; Humans ; Neurologic Manifestations ; Spine

The lumbar intraspinal epidural ganglion cyst has been a rare cause of the low back pain or leg pain. Ganglion cysts and synovial cysts compose the juxtafacet cysts. Extensive studies have been performed about the synovial cysts, however, very little has been known about the ganglion cyst. Current report is about two ganglion cysts associated with implicative findings in young male patients. We discuss about the underlying pathology of the ganglion cyst based on intraoperative evidences, associated disc herniation at the same location or severe degeneration of the ligament flavum that the cyst originated from in young patients.
Ganglion Cysts ; Humans ; Leg ; Ligaments ; Low Back Pain ; Male ; Synovial Cyst

A 55-year-old-male patient had acute lower back pain and radiculopathy with high spiking fever, which indicated pyogenic discitis. Intravenous antibiotics were administered but a high spiking fever and elevated laboratory findings indicated an infection. Therefore, surgery was performed. However, histological diagnosis revealed tophaceous gout. A diagnosis of spinal gout should be considered when there are clinical presentations of acute back pain and fever, especially in patients with acute back pain and a prior history of hyperuricemia or gout.
Anti-Bacterial Agents ; Back Pain ; Diagnosis ; Discitis* ; Fever ; Gout ; Humans ; Hyperuricemia ; Low Back Pain ; Radiculopathy ; Spine* ; Spondylarthropathies*

BACKGROUND: Degenerative lumbar scoliosis (DLS) progresses with aging after 50-60 years, and the genetic association of DLS remains largely unclear. In this study, the genetic association between collagen type II alpha 1 (COL2A1) gene and DLS was investigated. METHODS: COL2A1 gene polymorphism was investigated in DLS subjects compared to healthy controls to investigate the possibility of its association with COL2A1 gene. Based on a single nucleotide polymorphism (SNP) database, SNP (rs2276454) in COL2A1 were selected and genotyped using direct sequencing in 51 patients with DLS and 235 healthy controls. The SNP effects were analyzed using three models of codominant, dominant, and recessive. Logistic regression models were calculated for odds ratios (ORs) with 95% confidence intervals (CIs) and corresponding p-values, controlling age and gender as co-variables. RESULTS: SNP (rs2276454) in COL2A1 was significantly associated with the degenerative lumbar scoliosis in the codominant (OR, 1.90; 95% CI, 1.17 to 3.10; p = 0.008) and dominant models (OR, 3.58; 95% CI, 1.59 to 9.29; p = 0.001). CONCLUSIONS: The results suggest that COL2A1 is associated with the risk of DLS in Korean population.
Aged ; Asian Continental Ancestry Group ; Collagen Type II/*genetics ; Female ; Humans ; *Lumbar Vertebrae ; Male ; Middle Aged ; Polymorphism, Single Nucleotide ; Scoliosis/ethnology/*genetics

OBJECTIVES: Cerebral infarction as a macrovascular complication in patients with diabetes mellitus is frequent. However, mechanisms for the development of cerebral infarction were not well known until today. The aims of this study were 1) to determine the relationship between the fibrinogen B beta 448 polymorphism and fibrinogen levels in patients with cerebral infarction, and 2) to assess usefulness of fibrinogen B beta 448 polymorphism as a marker of cerebral infarction in patients with diabetes mellitus. METHODS: We studied 60 diabetes mellitus patients, 26 diabetes mellitus patients with cerebral infarction, 17 cerebral infarction patients, and 121 normal controls. Fibrinogen B beta 448 genotype was determined by the PCR-RFLP method using restriction enzyme Mnl I. RESULTS: Fibrinogen levels in each patient group were not significantly different from one another. Fibrinogen B beta 448 genotype frequencies of the patient groups did not significantly differ from those of the normal controls. CONCLUSION: This study didn't show the relationship between the fibrinogen B beta 448 polymorphism and fibrinogen levels in patients with cerebral infarction. Moreover, these data didn't suggest the fibrinogen B beta 448 polymorphism as a marker of cerebral infarction in patients with diabetes mellitus. Further studies are needed to find the other polymorphic sites of fibrinogen gene which can affect the levels of fibrinogen.
Cerebral Infarction* ; Diabetes Mellitus* ; Diabetes Mellitus, Type 2 ; Fibrinogen* ; Genotype ; Humans

OBJECTIVES: Paraoxonase is a high-density-lipoprotein- associated enzyme capable of hydrolysing lipid peroxides. Thus it might protect lipoproteins from oxidation. It has two isoforms, which arise from a glutamine (A isoform) to arginine (B isoform) interchange at position 192. More recently, Ruiz et al. investigated the relationship between the paraoxonase genetic polymorphism and coronary heart disease in a case-control study of NIDDM in France. We investigated the correlation between the polymorphism of paraoxonase gene and cardiovascular disease in Korean diabetic patients. METHODS: Of 106 patients with NIDDM, 50 had confirmed cardiovascular disease (coronary heart disease or ischemic stroke). The other 56 patients had no history of such disease and ECG abnormality. An additional control group of non-diabetic, healthy subjects (N=55) was selected. The polymorphism of paraoxonase gene was assessed by PCR-RFLP in their blood leukocytes DNA. RESULTS: The healthy control revealed paraoxonase genotype frequencies of 18.1% AA, 36.4% AB and 45.5% BB. The NIDDM group revealed paraoxonase genotype frequencies of 11.3% AA, 39.6% AB, 49.1% BB. The genotype frequencies did not differ between healthy control with diabetic group. The genotype frequencies did not differ between diabetic group with coronary heart disease and diabetic control group (AA ; 8.4% vs 12.5%, AB ; 45.8% vs 37.5%, BB ; 45.8% vs 50.0%). There was also no difference in genotype frequencies between diabetic group with ischemic stroke and diabetic control (AA ; 11.5% vs 12.5%, AB ; 38.5% vs 37.5%, BB ; 50.0% vs 50.0%). In multiple logistic regression analysis with other risk factors, hypertension emerged as the most related factors for cardiovascular disease, but paraoxonase genotype was not associated with the presence of cardiovascular disease. CONCLUSION: In Korean diabetic patients, the polymorphism of paraoxonase gene might not be associated with the presence of coronary heart disease or ischemic stroke.
Arginine ; Aryldialkylphosphatase* ; Cardiovascular Diseases ; Case-Control Studies ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Diabetes Mellitus, Type 2 ; DNA ; Electrocardiography ; France ; Genotype* ; Glutamine ; Heart Diseases ; Humans ; Hypertension ; Leukocytes ; Lipid Peroxides ; Lipoproteins ; Logistic Models ; Polymorphism, Genetic ; Protein Isoforms ; Risk Factors ; Stroke*

BACKGROUND: Severe acute lung injury(ALI), also known as the adult respiratory distress syndrome(ARDS), is a heterogenous nature of dynamic and explosive clinical synrome that exacts a mortality of approximately 50%. Endotoxin(ETX) is an abundant component of the outer membrane of gram-negative bacteria capable of inducing severe lung injury in gram-negative sepsis and gram-negative bacterial pneumonia, which are among the most common predisposing causes of ARDS. The influx of PMNs into airway tissue is a pathological hallmark of LPS-induced lung injury. And th3re is a substantial evidence suggesting that cytokines are important mediators of lung injury in gram-negative sepsis. However, the kinetics of phagocytes and cytokines by an exact time sequence and their respective pathogenic importance remain to be elucidated. This study was performed to investigate the role of phagocytes and proinflammatory cytokines in ETX-induced ALl through a time course of changes in the concentration of protein, TNFa and IL-6, and counts of total and its differential cells in BALF. The consecutive histologic findings were also evaluated. METHOD: The experimental animals, healthy male Sprague-Dawley, weighted 200+/-50g, were divided into controland ALI-group. ALI was induced by an intravenous administration of ETX, 5mg/kg. Above mentioned all parameters were examined at 0(control), 3, 6, 24, 72 h after administration of ETX. TNFa and IL-6 conc. in BALE were measured by a bioassay. RESULTS: The protein concentration and total leukocyte count(TC) in BALF was significantly increased at 3h compared to controls(p<0.05). The protein conc. was significantly elavated during observation period, but TC was significantly decreased at 72h(p<0.05 vs. 24h). There was a close relationship between TC and protein cone. in BALF(r = 0.65, p <0.001). The PMN and monocyte count was well correlated with TC in BALF, and the correlation of PMN(r=0.97, p<0.001) appeared to be more meaningful than that of monoeyte(r = 0.61, p<0.001). There was also a significant correlation between protein cone. and PMN or monocyte count in BALF(PMN vs. monocyte r = 0.55, p<0.005 vs. r = 0.64, p<0.001). The count of monocyte was significantly elavated during observation period though a meaningful reduction of PMN count in BALF at 72h, this observation suggested that monocyte may, at least, partipate in the process of lung injury steadly. In this sudy, there was no relationship between IL-6 and TNFt conc., and TNFa but not IL-6 was correlated with TC(r 0.61, p <0.05) and monocyte(r = 0.67, p<0.05) in BALF only at 3, 6h after ETX introduced. In particular, the IL-6 cone. increased earlier and rapidly peaked than TNFz cone. in BALF. In histologic findings, the cell counts of lung slices were increased from 3 to 72h(p<0.001 vs. NC). Alveolar wallthickness was increased from 6 to 24h(p<0.001 vs. NC). There was a significant correlation between the cell counts of lung slices and alveolar wall-thickness(r= 0.61, p<0.001). This result suggested that the cellular infiltrations might be followed by the alterations of interstitium, and the edematous change of alveolar wall might be most rapidly recovered to its normal condition in the process of repair. CONCLUSION: We concluded that although the role of PMIN is partly certain in ETX-induced ALI, it is somewhat inadequate to its known major impact on ALL Alveolar macrophage and/or non-immune cells such as pulmonary endothelial or epithelial cells, may be more importantly contributed to the initiation and perpetual progression of ETX-induced ALI. The IL-6 in ETX-induced ALI was independent to TNFa, measured by a bioassay in BALF. The early rise in IL-6 in BALF implies multiple origins of the IL-6.
Acute Lung Injury* ; Administration, Intravenous ; Adult ; Animals ; Biological Assay ; Cell Count ; Cytokines ; Epithelial Cells ; Gram-Negative Bacteria ; Humans ; Interleukin-6 ; Kinetics ; Leukocytes ; Lung ; Lung Injury ; Macrophages, Alveolar ; Male ; Membranes ; Monocytes ; Mortality ; Phagocytes* ; Pneumonia, Bacterial ; Rats, Sprague-Dawley ; Sepsis

The percutaneous endoscopic gastrostomy is used for nutritional support in patients requiring prolonged tubal feeding. Unfortunately, numerous complications, such as infection, stomal leak, fever, local pain, ileus and tube occlusion, have been reported since its introduction. The buried bumper syndrome is a rare but well-recognized long-term complication. The tight anchorage between the internal and external bumpers leads to gastric mucosal erosion and embedding of the internal bumper into the gastric wall, obstructing feeding. Our case involves an elderly patient with a buried bumper syndrome complicated by an abdominal wall abscess. A similar case has not been reported in Korea before. This article reports our findings and management with a review of the literature.
Abdominal Wall ; Abscess ; Aged ; Fever ; Gastrostomy ; Humans ; Ileus ; Korea ; Nutritional Support