Purpose: The purpose of this study was to evaluate the clinical and radiological results of total hip arthroplasty using a proximal modular femoral stem in patients who had secondary coxarthrosis associated with a deformed femur. Materials and Methods: Forty-two patients (45 hips) with secondary coxarthrosis were evaluated after primary total hip arthroplasty using an S-ROM proximal modular femoral stem, between January 2001 and March 2004. The average follow-up was 44 months (range, 24 to 60 months). The mean age of the patients was 48.5 years old and there was a predominance of female patients (65.5%). The preoperative diagnoses included 26 cases of developmental dysplasia of the hip, 13 cases of sequalae of LCP, 2 cases of epiphyseal dysplasia, 3 cases of sequalae of pyogenic arthritis, and 1 case of congenital coxa vara. Results: The average Harris hip score improved from 52.2 points to 85.5 points. All the femoral stems demosntrated stable fixation, which included 37 cases by bony ingrowth and 8 cases by stable fibrous ingrowth. Neither osteolysis nor progressive radiolucent lines around the femoral stems were found at the latest follow-up. Postoperative complications included: 2 cases of hip dislocations, 1 case of periprosthetic fracture, 1 case of infected cup loosening, and 1 case of sciatic nerve palsy. Overall, forty-one hips (91.9%) exhibited excellent or good clinical results at the most recent follow-up. Conclusion: For advanced secondary coxarthrosis, total hip arthroplasty with use of a proximal modular femoral stem yielded good mid-term results based on clinical and radiological criteria.
Arthritis ; Arthroplasty, Replacement, Hip* ; Coxa Vara ; Diagnosis ; Female ; Femur* ; Follow-Up Studies ; Hip Dislocation ; Hip* ; Humans ; Osteoarthritis, Hip* ; Osteolysis ; Periprosthetic Fractures ; Postoperative Complications ; Sciatic Neuropathy

A wide range of denomination has been used for inflammatory myofibroblastic tumor (IMT). IMT is not entirely homogeneous, even though it shows some overlapping histologic features such as haphazard proliferation of spindle cell and polymorphic chronic inflammatory cell infiltraion. The spindle cell is considered to be of myofibroblastic origin but follicular dendritic cell origin was reported recently. IMT is known as nonneoplastic, aberrant inflammatory response. However, IMT could show local invasion, recurrence, vascular invasion, and malignant transformation, and clonal characteristics and aneuploidy of IMT support the hypothesis that IMT may be a neoplastic process. In order to define the nature of spindle cell of IMT, immunohistochemical stains for smooth muscle actin (SMA), vimentin (VMT), lysozyme, S-100 protein, cytokeratin, CD21 were done. Additional immunohistochemical stains for MIB-1 for proliferating activity and LMP (latent membrane protein) for Epstein-Barr virus (EBV) were done. IMTs were composed of each 2 cases from lung, liver and lymph node and one case from common bile duct, maxillary sinus, bladder and thigh, and were histologically subclassified according to Coffin et al. Nine cases (90%) were positive for SMA and VMT, but no correlation between SMA and VMT immunoreactivity and histologic types was identified. Five cases (50%) were positive for lysozyme and S-100 protein, and histologic type III was negative for lysozyme and S-100 protein, and immunoreactivity for S-100 protein was different according to the histologic subtypes. All 11 cases were negative for CD21 and EBV LMP. MIB-1 labelling index was less than 1% in all cases. In summary, the spindle cell is regarded as myofibroblastic origin rather than follicular dendritic cell origin. Relationship with EBV is not clear, and negligible MIB-1 reaction suggests that IMT might have a good prognosis.
Actins ; Aneuploidy ; Coloring Agents ; Common Bile Duct ; Dendritic Cells, Follicular ; Herpesvirus 4, Human ; Immunohistochemistry ; Keratins ; Liver ; Lung ; Lymph Nodes ; Maxillary Sinus ; Membranes ; Muramidase ; Muscle, Smooth ; Myofibroblasts* ; Prognosis ; Recurrence ; S100 Proteins ; Thigh ; Urinary Bladder ; Vimentin

Intertrochanteric fractures of femur were increasing in their incidence in morden life. The compression hip screw and Ender nail are popular treatment modalities of the interochanteric fracture of femur. We had tried to clarify the complications of intertrochanteric fracture according to the treatment modality-compression hip screw and Ender nail. We obtained the results as followings with the patients who had intertrochanteric fracture of femur which were managed by compression hip screw (56 cases) and Ender nail (22 cases) through the period of March 1987 to June 1993. The summary of the results; 1. Mechanical complications were developed in 9 patients(16%), 9 complications in the group with compression hip screw and 7 patients(32%), 12 complications in Ender nail. 2. Local complications were developed in 4 patients(7%) in compression hip screw and 10 patients (46%) in Ender nail and the most common local complication was the knee joint pain(7 patients; 32%). 3. Statistically, more significant decrease of neck-shaft angle was shown with group using Ender nail for unstable fracture than stable fracture group and compression hip screw group. 4. The degree of shortening was incrased in group with Ender nail than in group with compression hip screw, but there was no statistical significance. 5. The grade of osteoporosis was not related to the change of neck-shaft angle and shortening and also to the development of mechanical complication. According to the above results, compression hip screw was a more stable fixation device than Ender nail in the unstable intertrochanteric fracutre.
Femur ; Hip ; Hip Fractures ; Humans ; Incidence ; Knee Joint ; Osteoporosis

The use of external fixator is popular in the treatment of open tibial fracture, severe comminuted fracture and segmental fracture, which minimizes further soft tissue injury and provides rigie fixation. The purpose of this study was to determine the complications and effectiveness of external fixation for treating the fractures of tibia. 33 patients with tibial fracture had been treated with external fixator from April 1993 to April 1994 at the orthopaedic department of Kang Dong Catholic General Hospital. We analysed 23 cases(21 patients) which could be followed up more than 12 months. The results were as follows; 1. Average duration with external fixator was 15.1 weeks. 2. Average time of bone union was 22.9 weeks. 3. 6 cases of pin tract infection were developed and they were treated with curettage and drainage, local antibiotics therapy, pin translation, or removal of external fixator. 4. The delayed union were developed in 5 cases, angulation deformity in 1 case, chronic osteomyelitis in 2 cases and soft tissue defect in 1 case. 5. Secondary operations caused by delayed union, valgus deformity, skin defect and bone exposure, were performed in 6 cases. 6. The use of external fixator provided good result in open fracture, intraarticular comminuted fracture, segmental fracture, and multiple injury, but chronic osteomyelitis and articular stiffness were developed in some cases.
Anti-Bacterial Agents ; Congenital Abnormalities ; Curettage ; Drainage ; External Fixators ; Fractures, Comminuted ; Fractures, Open ; Hospitals, General ; Humans ; Multiple Trauma ; Osteomyelitis ; Skin ; Soft Tissue Injuries ; Tibia ; Tibial Fractures

We experienced a case of unusual complication following esophageal reconstruction. In 1969, accidentally the patient swallowed lye and was developed benign esophageal stricture one year later. In 1972, esophageal reconstruction with right colon was done but pus was drained out of the abdominal wound. After then wound disruption and healing were repeated. In 1996, stenosis of colonic graft was found and resection of stenotic area and end to end anastomosis was done. We concluded that it was developed inflammatory change of graft by intraoperative infection.
Abscess* ; Colon ; Constriction, Pathologic* ; Esophageal Stenosis ; Humans ; Lye ; Postoperative Complications ; Suppuration ; Transplants ; Wounds and Injuries

Glucocorticoids are usually given according to a standard dosing protocol regardless of individual difference. We evaluated the pharmacokinetic characteristics of methylprednisolone and the degree of interpatient variation in stable Korean renal transplant recipients during the period of 15-21 days after transplantation. This study included 23 renal transplant recipients, 13 males and 10 females, who received kidneys from living donors with stable graft function and without episode of acute rejection. On the study day at 8 A.M., 16.3mg of ethylprednisolone sodium succinate (i.v.) was administered to each patient instead of usual dose (20mg) of prednisolone (p.o.) after sampling of 7cc of baseline blood and additional blood samples were drawn after starting infusion. Plasma was separated and analyzed for methylprednisolone level using high performance liquid chromatography (HPLC) assay, and parameters for pharmacokinetics were calculated. There was significant interpatient variation in the pharmacokinetics of methylprednisolone in our patients group. There was no significant difference in the pharmacokinetic parameters between patients with and without side effects of steroid. Korean renal transplant recipients had higher volume of distribution than black renal transplant recipients; lower clearance than white renal transplant recipients; longer t1/2 than both black and white renal transplant recipients. Even if the number of patients included in this study was too small to reach conclusion, the differences in the pharmacokinetics of glucocorticoids do not seem to be a significant risk factor for side effects of steroid after transplantation. It may be necessary to individualize the dose of a glucocorticoid to achieve an optimal effect and also we need to establish a new steroid regimen protocol for Korean renal transplant recipients.
Chromatography, Liquid ; Female ; Glucocorticoids ; Humans ; Individuality ; Kidney ; Kidney Transplantation ; Living Donors ; Male ; Methylprednisolone* ; Pharmacokinetics ; Plasma ; Prednisolone ; Risk Factors ; Sodium ; Succinic Acid ; Transplantation* ; Transplants

BACKGROUND: The p38 mitogen-activated protein kinases (p38Map kinases) are a family of prolinedirected serine/threonine kinases. At least four isoforms of p38Map kinases have been identified; however, their physiological significances remain to be understood. Recently, the role of p38Map kinase in insulin-stimulated glucose uptake has been suggested. The present study aimed to investigate which isoform(s) were responsive to insulin stimulation. In addition, the activities of p38 Map kinase isoforms that may participate in the insulin's antiapoptotic function in CHO-IR cells were also determined. METHODS: Chinese hamster ovary cells, expressing wild- or mutated human insulin receptors (CHO-IR cells), were used to investigate whether insulin can stimulate any of the isoform(s) of the p38Map kinases. The p38Map kinase activity was determined by measuring the degree of 32P-labelling of ATF-2 protein, a specific substrate of p38Map kinase. A DNA laddering assay was performed to examine the degree of apoptosis and a RT-PCR analysis to determine which isoform(s) of the p38Map kinases were expressed in response to insulin. RESULTS: p38Map kinase activation by insulin was sharply suppressed in only the CHO-IR/A1018K cells, which lack the intrinsic tyrosine kinase activity of insulin receptors. Insulin stimulation of p38Map kinase was insensitive to SB203580, an inhibitor of the alpha(alpha)-and beta(beta)-isoforms of p38Map kinases. Moreover, orthovanadate, known as a specific stimulator of the gamma(gamma)-and delta(delta-) isoforms, stimulated the p38Map kinase activity in CHO-IR cells. Insulin increased the degree of mRNA expression of the delta-isoform, but not that of the alpha-isoform p38Map kinase. Interestingly, PD98059, an inhibitor of ERK, suppressed p38Map kinase stimulation, as well as the antiapoptotic protection of cells by insulin. As insulin was found to still protect ERK-lacking cells (CHO-IR/ SOS) from apoptosis, any substantial role(s) of ERK might be excluded. CONCLUSION: Our data suggest that insulin may stimulate the activity and expression of the-isoform of p38Map kinase in a MEK1/2-dependent manner. The involvement of the delta-isoform of p38Map kinase in insulin's antiapoptotic protection was also suggested, but remains to be investigated further to clarify the nature of its mechanism of action
Animals ; Apoptosis ; Cricetinae ; Cricetulus ; DNA ; Female ; Glucose ; Humans ; Insulin ; Ovary ; p38 Mitogen-Activated Protein Kinases ; Phosphotransferases* ; Protein Isoforms ; Protein-Tyrosine Kinases ; Receptor, Insulin ; RNA, Messenger ; Vanadates

BACKGROUND: The p38 mitogen-activated protein kinases (p38Map kinases) are a family of prolinedirected serine/threonine kinases. At least four isoforms of p38Map kinases have been identified; however, their physiological significances remain to be understood. Recently, the role of p38Map kinase in insulin-stimulated glucose uptake has been suggested. The present study aimed to investigate which isoform(s) were responsive to insulin stimulation. In addition, the activities of p38 Map kinase isoforms that may participate in the insulin's antiapoptotic function in CHO-IR cells were also determined. METHODS: Chinese hamster ovary cells, expressing wild- or mutated human insulin receptors (CHO-IR cells), were used to investigate whether insulin can stimulate any of the isoform(s) of the p38Map kinases. The p38Map kinase activity was determined by measuring the degree of 32P-labelling of ATF-2 protein, a specific substrate of p38Map kinase. A DNA laddering assay was performed to examine the degree of apoptosis and a RT-PCR analysis to determine which isoform(s) of the p38Map kinases were expressed in response to insulin. RESULTS: p38Map kinase activation by insulin was sharply suppressed in only the CHO-IR/A1018K cells, which lack the intrinsic tyrosine kinase activity of insulin receptors. Insulin stimulation of p38Map kinase was insensitive to SB203580, an inhibitor of the alpha(alpha)-and beta(beta)-isoforms of p38Map kinases. Moreover, orthovanadate, known as a specific stimulator of the gamma(gamma)-and delta(delta-) isoforms, stimulated the p38Map kinase activity in CHO-IR cells. Insulin increased the degree of mRNA expression of the delta-isoform, but not that of the alpha-isoform p38Map kinase. Interestingly, PD98059, an inhibitor of ERK, suppressed p38Map kinase stimulation, as well as the antiapoptotic protection of cells by insulin. As insulin was found to still protect ERK-lacking cells (CHO-IR/ SOS) from apoptosis, any substantial role(s) of ERK might be excluded. CONCLUSION: Our data suggest that insulin may stimulate the activity and expression of the-isoform of p38Map kinase in a MEK1/2-dependent manner. The involvement of the delta-isoform of p38Map kinase in insulin's antiapoptotic protection was also suggested, but remains to be investigated further to clarify the nature of its mechanism of action
Animals ; Apoptosis ; Cricetinae ; Cricetulus ; DNA ; Female ; Glucose ; Humans ; Insulin ; Ovary ; p38 Mitogen-Activated Protein Kinases ; Phosphotransferases* ; Protein Isoforms ; Protein-Tyrosine Kinases ; Receptor, Insulin ; RNA, Messenger ; Vanadates

BACKGROUND: Trichloroacetic acid(TCA) chemical peel has been used for variable skin lesions. However, the effect of TCA chemical peel on acne scars has not been studied. OBJECTIVE: The object of this study is to evaluate the effect of TCA chemical peel on atrop hic acne scars. METHOD: Twenty three patients with atrophic acne scars, who were treated with TCA chemical peel were included. The patieits were interviewed for evaluation of the therapeutic efficacy of TCA chemical peel regarding the number of treatment and satisfaction rates. RESULTS: Those who received treatment for more than 6 times with good or excellent results were 13 out of 15 patients, whereas, those who received treatment for 4 times with good or excellent results were 4 out of 7 patients Thus, chemical peel on acne scars showed that the more often the treatment was carried out, the better the therapeutic effect. There was no significant complication. CONCLUSION: TCA chemical peel is safe and effective for the treatment of atrophic acne scars.
Acne Vulgaris* ; Cicatrix* ; Humans ; Skin ; Trichloroacetic Acid

A 20-year-old man developed necrotizing fasciitis of the left chest wall complicating acupuncture. Necrotizing fasciitis is a highly morbid soft tissue infection that rarely involves the upper torso. In the past, there has been few report on necrotizing fasciitis complicating acupunture in the English literature (based on a MEDLINE search covering 1966 to 2005). We present this extremely unusual case of a patient after taking acupuncture who survived severe necrotizing fasciitis of the chest wall following wide debridement of the necrotic tissue and broad-spectrum antibiotic therapy.
Acupuncture* ; Debridement ; Fasciitis, Necrotizing* ; Humans ; Soft Tissue Infections ; Thoracic Wall* ; Thorax* ; Torso ; Young Adult