PURPOSE: To evaluate the functional outcome after surgical treatment for displaced fractures of proximal humerus and assess the final results according to surgical methods. MATERIALS AND METHODS: Thirty-three cases with follow-up over 12 months were divided into three groups: double tension band wiring (Group I, 14), plate fixation (Group II, 10) and closed reduction with internal/external fixation (Group III, 9). The pain index, the self-assessed functional score and the range of motion were obtained. RESULTS: Anatomical reduction was best obtained in group II and fractures united in 11-16 weeks. The pain index was worst in group III and the functional score of group I (80+/-12.2%) was higher than in the others (II: 69+/-15.7%, III: 55+/- 7.9%). The range of motion was worst in group III. Complications were noted in 9 cases, which occurred mostly in group II and III. CONCLUSIONS: Double tension band wiring in displaced proximal humerus fracture demonstrated that it provides a sufficient fixation for early rehabilitation and union, while minimizing complication
Follow-Up Studies ; Humerus* ; Range of Motion, Articular ; Rehabilitation

We report a case of sarcoidosis which developed in the skin, lung and eyes in a 50-year-old woman. The skin lesions showed two types of cutaneous manifestations which were subcutaneous nodules on her back and erytrematous papules on the face for several months. Our patient's seurm angiotensin converting enzyme (ACE) level was elevated at 33.5 IU/L(reference range, 8.3-21.4 IU/L) and the purified protein derivative(PPD) skin test had a negative result. On her roentgenographic examinations, we could find multiple nodular densities with hazziness on both her lungs and radionuclides(Gallium 67) uptakes in right lower lung field. The ratio of helper to suppressor T cells was 9 in bronchial lavage. Diagnosis of sarcoidosis was made on the basis of histologic findings of non-caseating granulomas from skin and lung tissue. Treatment was initiated with oral alternate-day prednisone 40mg. The cutaneous lesions and dyspnea improved in 2 and 4 weeks respectively, and serum ACE level returned to normal in 2 months.
Bronchoalveolar Lavage ; Diagnosis ; Dyspnea ; Female ; Granuloma ; Humans ; Lung ; Middle Aged ; Peptidyl-Dipeptidase A ; Prednisone ; Sarcoidosis* ; Skin ; Skin Tests ; T-Lymphocytes

BACKGROUND: As the pleural inflammation progresses, exudative pleural fluid becomes loculated rapidly with pleural thickening. Complete drainage is important 13 prevent pleural fibrosis, entrapment and depression of lung function Intrapleural urokinase instillation therapy has been advocated as a method to facilitate drainage of gelatinous pleural fluid and to allow enzymatic debriment of pleural surface. This study was designed to investigate the Predictors of effeotiveness of intrapleural urokinase in treatment of loculated pleural effusion METHOD: Thirty-five patients received a single radiographically guided pig-tail catheter ranging in size from 10 to 12 French Twenty-two patients had tuberculous pleural effusions, and 13 had non-tuberculous postpneumonic empyemas. A total of 240,000 units of urokinase was dissolved in 240 ml of normal saline and the aliquots of 80mL was instilled into the pleura1 cavity via pig-tail catheter per every 8hr. Effectiveness of intrapleural urokinase instillation therapy was assessed by biochemical markers, ultrasonography, and technical details. A greater than 50% improvement on follow-up chest radiographs was defined as success group. RESULT: Twenty-seven of 35 (77.1%) patients had successful outcome to urokinase instillation therapy. Duration of symptoms before admission was shorter in sucess group (11.8α6.9day) than in failure group (26.62α16.5day) (P<0.05). Amount of drained fluid during urokinsse therapy was larger in success group (917.1α392.7ml) than in failure group (613.8α259.7ml) (P<0.05). Pleural fluid glucose was higher in success group (89.7 α35.9mg/dl) than in failure group (41.2α47.1mg/dl) (P<0.05). Pleural fluid LDH was lower in success group (878.4α654.31U/L) than in failure group (2711.1α973.1IU/L) (P<0.05). Honeycomb septated pattern on chest ultrasonography was observed in six of eight failure group, but none of success group(P<0.05). CONCLUSION: Longer duration of symptoms before admission smaller amount of drained fluid during urokinase therapy, lower glucose value, higher LDH value in pleural fluid examination and honeycomb septation pattern on chest ultrasonography were predictors for failure group of intrapleural urokinase instillation therapy.
Biomarkers ; Catheters ; Depression ; Drainage ; Empyema ; Fibrosis ; Follow-Up Studies ; Gelatin ; Glucose ; Humans ; Inflammation ; Lung ; Pleural Effusion* ; Radiography, Thoracic ; Thorax ; Ultrasonography ; Urokinase-Type Plasminogen Activator*

No Abstract Available.
Arthroplasty* ; Knee*

No abstract available.
Pleural Effusion*

Since 1982, many countries have reported outbreaks or sporadic cases by enterohemorrhagic Escherichia coli (E. coli) serogroup strains, mainly E. coli O157 : H7. Hemorrhagic E. coli induces hemolytic uremic syndrome (HUS) in 10 to 15% of cases in infants and young chilidren. HUS is a clinical syndrome of hemolytic anemia, acute renal failure, and thrombocytopenia. We experienced a case of E. coli O8 as the causative organism of hemorrhagic colitis and hemolytic uremic syndrome in 16 year-old man. Hemorrhagic colitis was diagnosed by the sigmoidoscopy and E. coli O8 was identified in the stool culture. Hemolytic uremic syndrome was clinically diagnosed. A conservative management including total parenteral nutrition, plasma exchange transfusion, hemodialysis and continuous arteriovenous hemofiltration with dialysis resulted in a complete recovery of the patient. We herein report this manifestations of E. coli O8 and discuss the therapeutic issues related to hemorrhagic colitis and hemolytic uremic syndrome.
Acute Kidney Injury ; Adolescent ; Anemia, Hemolytic ; Colitis ; Dialysis ; Disease Outbreaks ; Enterohemorrhagic Escherichia coli ; Escherichia coli* ; Escherichia* ; Hemofiltration ; Hemolytic-Uremic Syndrome* ; Humans ; Infant ; Parenteral Nutrition, Total ; Plasma Exchange ; Renal Dialysis ; Sigmoidoscopy ; Thrombocytopenia

We present a case of Aspergillus septic hip arthritis in an immunocompetent patient with undiagnosed recurrent pulmonary aspergillosis who underwent arthroscopic surgery. Biopsy specimens of synovium revealed fungal hyphae, confirming Aspergillus infection. Aspergillus septic hip arthritis can occur in immunocompetent patients, and arthroscopy can be a noninvasive surgical option in these cases.
Arthritis ; Arthritis, Infectious* ; Arthroscopy ; Aspergillus* ; Biopsy ; Female* ; Hip* ; Humans ; Hyphae ; Pulmonary Aspergillosis* ; Synovial Membrane

BACKGROUND: Adenocarcinoma of the esophagus has been reported to be increasing in incidence in a number of regions throughout the world, while the incidence of squamous cell carcinoma (SCCA) of the esophagus is mostly stable or decreasing. To evaluate the increasing tendency of adenocarcinoma of the esophagus. METHODS: we studied retrospectively the records of patients with histologically proven esophageal cancer between 1970 and 1999 at the Yonsei Medical Center. RESULTS: Total cases of esophageal cancer were 969 patients of which the cases of adenocarcinoma and SCCA were 27 patients and 918 patients, respectively. The ratio of esophageal adenocarcinoma to SCCA was 0.0375 in the 1970s, 0.0241 in the 1980s and 0.0292 in the 1990s. There was no statistical difference (p=0.811) in the ratios of adenocarcinoma of the esophagus between the three consecutive 10-year groups. CONCLUSION: In conclusion, unlike the US and other western countries, it seems that the ratio of esophageal adenocarcinoma compared to SCCA has not increased among patients with esophageal carcinoma at the Yonsei Medical Center.
Adenocarcinoma/*epidemiology ; Carcinoma, Squamous Cell/*epidemiology ; Chi-Square Distribution ; Esophageal Neoplasms/*epidemiology ; Human ; Korea/epidemiology ; Middle Age ; Prevalence ; Retrospective Studies

No abstract available.
Biopsy* ; Hematuria*

Citrin is a liver-type mitochondrial aspartate-glutamate carrier encoded by the SLC25A13 gene, and its deficiency causes adult-onset type II citrullinemia and neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD). Here, the authors investigated clinical findings in Korean infants with NICCD and performed mutation analysis on the SLC25A13 gene. Of 47 patients with neonatal cholestasis, three infants had multiple aminoacidemia (involving citrulline, methionine, and arginine) and galactosemia, and thus were diagnosed as having NICCD. Two of these three showed failure to thrive. The laboratory findings showed hypoproteinemia and hyperammonemia, and liver biopsies revealed micro-macrovesicular fatty liver and cholestasis. The three patients each harbored compound heterozygous 1,638-1,660 dup/ S225X mutation, compound heterozygous 851del4/S225X mutation, and heterozygous 1,638-1,660 dup mutation, respectively. With nutritional manipulation, liver functions were normalized and catch-up growth was achieved. NICCD should be considered in the differential diagnosis of cholestatic jaundice in Korean infants.
Amino Acids/blood ; Calcium-Binding Proteins/*deficiency ; Cholestasis, Intrahepatic/*etiology/genetics ; Citrullinemia/genetics ; Humans ; Infant ; Membrane Transport Proteins/genetics ; Mitochondrial Proteins/genetics ; Mutation ; Organic Anion Transporters/*deficiency