BACKGROUND: We investigated the effectiveness of fibular strut allograft augmentation of proximal humerus fractures to prevent varus deformity in patients over the age of 65 years with insufficient medial support. METHODS: We analyzed the clinical and radiological outcomes of locking plate fixation with adjunct fibular strut allograft augmentation in 21 patients with proximal humeral fractures. The inclusion criteria were age (65-year-old or older); presence of severe medial comminution; inadequate medial support; and those who could participate in at least a one year follow-up. The average age was 76.4 years. We analyzed each patient's Constant score, our indicator of clinical outcome. As radiological parameters, we analyzed time-to-bone union; restoration of the medial hinge; difference between the immediately postoperative and the last follow-up humeral neck-shaft angles;; and anatomical reduction status, which was assessed using the Paavolainen method. RESULTS: A successful bone union was achieved in all patients at an average of 11.4 weeks. We found that the average Constant score was 74.2, showing a satisfactory outcome. The average difference in the humeral neck-shaft angles between the immediately postoperative time-point and at the final follow-up was 3.09°. According to the Paavolainen method, the anatomical reduction was rated excellent. The medial hinge was restored in 14 of 21 patients. Although we did not find evidence for osteonecrosis, we found that a single patient had a postoperative complication of screw cut-out. CONCLUSIONS: Fibular strut allografting as an adjunct treatment of proximal humeral fractures may reduce varus deformity in patients with severe medial comminution.
Allografts ; Congenital Abnormalities* ; Follow-Up Studies ; Humans ; Humerus* ; Methods ; Osteonecrosis ; Postoperative Complications ; Shoulder Fractures ; Transplantation, Homologous

The purpose of this study was to investigate the patency rates and the histologic findings of neoen- dothelialization according to the length of implanted polytetrafluoroethylene (PTFE) with an internal diameter of 3 mm. Under the operating microscope, grafts of 8 and 24 mm in length were implanted in the right carotid arteries of thirty rabbits by interrupted end-to-end microanastomosis. They were divided into two groups according to the length of implanted PTFE. Each group compised fifteen rabbits. All implanted grafts were 25 pm in fibril length and 0.39 mm in wall thickness. Three grafts per group were harvested at 1, 2, 4, 8, and 12 weeks after implantation respectively and all grafts were observed for patency rates and the histologic findings with light microscope and scanning electron microscope. In conclusion, there was no difference in patency rates according to the length of implanted PTFE and histologically the formation of neointima and subintimal tissue was delayed and incomplete in longer implanted PTFE.
Carotid Arteries ; Neointima ; Polytetrafluoroethylene* ; Rabbits ; Transplants

Metabolic acidosis (MA) is associated with increased proteolysis, increased osteoclast activity and blunted cardiac muscle response, but the effect of MA on various clinic al parameters in CAPD patients is not well known. To evaluate the effects of MA on serum albumin level and other nutritional parameters in CAPD patients, we studied 106 CAPD patients retrospectively who have had monthly biochemical measurement and urea kinetic studies every 6 months for more than 2 years. The patients were divided into three groups according to their mean total CO2 (tCO2) level of the 2-year follow-up (Group l; mean tCO2 < 22mM/L, Group ll; 22mM/L < or = mean tCO2 < 26mM/L, and Group lll; mean tCO2 > or = 26mM/L), and the clinical, biochemical, and urea kinetic data were compared among the three groups. 1)The mean age of the subjects was 46.9+/-12.2 years with a sex ratio of 1.2:1, the mean CAPD duration 28.3+/-21.8 months, mean body weight (Bwt) 59.0+/-8.9kg, %Bwt/IBW 104.1+/-11.5%, %LBM/Bwt 75.5+/-11.1% and well-nourished patients by subjective global assessment (SGA) were 65%. 2)The mean BUN, creatinine, total protein and albumin of all patients were 55.6+/-13.6mg/dL, 12.3+/-3.5mg/dL, 6.6+/-0.7g/dL and 4.0+/-0.4g/dL, respectively. In urea kinetic study, the mean NPCR, weekly Kt/ Vurea, SCCr and RRF were 0.96+/-0.16g/kg/day, 2.02+/-0.37, 63.7+/-18.4L/week/1.73m2, and 0.99+/-1.32ml/ min, respectively. 3)The mean age was significantly higher in group l (51.0+/-10.8) than those of group ll (47.0+/-12.4) and lll (42.6+/-11.4) (P<0.05). %Bwt/IBW of group l (114.4+/-15.8%) was also significantly higher than those of group ll (104.6+/-12.6%) and lll (103.5+/-13.7 %) (P<0.05), but there were no significant differences in sex ratio, CAPD duration, %LBM/Bwt, and SGA among the three groups. 4)The mean tCO2 in group l, group ll, and group lll were 20.6+/-1.2mM/L, 23.9+/-1.1mM/L, and 27.3+/-0.8mM/L, respectively. Compared to group lll, group l had significantly higher BUN (61.1+/-14.3 vs. 46.1+/-7.2mg/dL, P<0.05) and serum albumin (4.04+/-0.31 vs. 3.75+/-0.39g/dL, P<0.05), in spite of comparable dialysis dose and albumin loss into dialysate. 5)NPCR (1.02+/-0.21g/kg/day vs. 0.88+/-0.14g/kg/ day, P<0.05) and ultrafiltration volume (1.4+/-0.4 vs. 1.0+/-0.3, P<0.05) were significantly higher in group l than those of group lll. But there were no significant differences in Kt/Vurea, SCCr, RRF, and 24-hour dialysate loss of protein/albumin among the three groups. 6)No differences were observed among the three groups in the changes of body weight, %Bwt/IBW, %LBM/Bwt, BUN, albumin, NPCR, and RRF from the baseline values after the 2-year follow-up. 7)There were significant inverse correlations between the mean tCO2 level and NPCR (r=-0.33, P<0.001), %Bwt/IBW (r=-0.32, P<0.001), RRF (r=-0.29, P<0.005), and serum albumin level (r=-0.24, P<0.05). But, creatinine, %LBM/Bwt, and Kt/Vurea did not show any correlation with the mean tCO2 level. 8)Using stepwise multiple regression analysis, NPCR (beta=-0.3491, P<0.001), %Bwt/IBW (beta=-0.046, P<0.001), and ultrafiltration volume (beta=-0.0012, P< 0.005) were independent factors affecting the mean tCO2 level. In conclusion, low total CO2 level in long-term CAPD patients may reflect increased protein intake and mild to moderate degree of metabolic acidosis may not affect the nutritional status of well-dialyzed CAPD patients.
Acidosis* ; Body Weight ; Creatinine ; Dialysis ; Follow-Up Studies ; Humans ; Myocardium ; Nutritional Status ; Osteoclasts ; Peritoneal Dialysis, Continuous Ambulatory* ; Proteolysis ; Retrospective Studies ; Serum Albumin* ; Sex Ratio ; Ultrafiltration ; Urea

BACKGROUND: Ultraviolet B (UVB) radiation is a major harmful environmental factor causing cutaneous changes such as sunburn, skin aging and skin cancer. Excessive UVB irradiation induces apoptosis of keratinocytes through several molecular pathways. However, the precise molecular mechanisms have been underinvestigated. OBJECTIVE: The purpose of this study was to investigate expression levels of apoptosis-related genes in UVB- irradiated HaCaT ketratinocyte cell lines. METHODS: Cells were irradiated by UVB at various doses (0, 100, 200 and 400 mJ/cm2). Expression levels of caspases, Bax, Bcl2, and Bcl-XL were confirmed by RT-PCR analysis and western blotting. RESULTS: Expression of cytochrome C was increased followed by activation of caspase-3, 8 and 9 in UVB-irradiated HaCaT cells. Furthermore, the expression of Bcl-XL was decreased from UVB 200 mJ/cm2 and Bcl2 was decreased weakly from UVB 400 mJ/cm2, implying that the expression of Bcl-XL is more sensitive to UVB. Interestingly, the down-regulation of Bcl-XL may be mediated by proteasome dependent pathways. CONCLUSION: Excessive UVB-irradiated HaCaT cells undergo apoptotic cell death following activation of caspases; degradation of Bcl-XL is particularly sensitive to UVB.
Apoptosis ; Caspase 3 ; Caspases ; Cell Death ; Cytochromes c ; Down-Regulation ; Keratinocytes ; Proteasome Endopeptidase Complex ; Skin Aging ; Skin Neoplasms ; Sunburn

BACKGROUND: Ultraviolet B (UVB) radiation is a major harmful environmental factor causing cutaneous changes such as sunburn, skin aging and skin cancer. Excessive UVB irradiation induces apoptosis of keratinocytes through several molecular pathways. However, the precise molecular mechanisms have been underinvestigated. OBJECTIVE: The purpose of this study was to investigate expression levels of apoptosis-related genes in UVB- irradiated HaCaT ketratinocyte cell lines. METHODS: Cells were irradiated by UVB at various doses (0, 100, 200 and 400 mJ/cm2). Expression levels of caspases, Bax, Bcl2, and Bcl-XL were confirmed by RT-PCR analysis and western blotting. RESULTS: Expression of cytochrome C was increased followed by activation of caspase-3, 8 and 9 in UVB-irradiated HaCaT cells. Furthermore, the expression of Bcl-XL was decreased from UVB 200 mJ/cm2 and Bcl2 was decreased weakly from UVB 400 mJ/cm2, implying that the expression of Bcl-XL is more sensitive to UVB. Interestingly, the down-regulation of Bcl-XL may be mediated by proteasome dependent pathways. CONCLUSION: Excessive UVB-irradiated HaCaT cells undergo apoptotic cell death following activation of caspases; degradation of Bcl-XL is particularly sensitive to UVB.
Apoptosis ; Caspase 3 ; Caspases ; Cell Death ; Cytochromes c ; Down-Regulation ; Keratinocytes ; Proteasome Endopeptidase Complex ; Skin Aging ; Skin Neoplasms ; Sunburn

PURPOSE: To determine the plain film findings of acute neuropathic joint in diabetic foot. MATERIALS AND METHODS: Acute neuropathic joint in diabetic foot was considered when fragmentation of the articular ends of bone and subluxation of the affected joint developed within eight weeks after clinical onset of diabetic gangrene. Eight toes of six diabetics were satisfactory to our criteria. We analyzed plain radiographic findings of the affected joint and soft tissue, interval changes in follow-up radiographs, and deformities after healing. RESULTS: The time interval between clinical onset of gangrene and bone destruction ranged from 2 weeks to 4 weeks(mean 2.6 weeks). Plain radiographs showed fragmentation of the articular ends, subluxation, and soft tissue swelling of the metatarsophalangeal joint or interphalangeal joint. The significant feature of these patients was rapid progression of the lesions. Clinically, all patients had diabetic gangrene in affected toes, however, there was no evidence of osteomyelitis in our series. Amputation was done in 2 cases, and lesions in 3 of the remaining 4 cases were repaired spontaneously with regression of gangrene, leaving radiological residua such as pointed-end, tapered-end, and ball and socket deformity. CONCLUSION: Rapid disorganization of the joint with associated evidence of soft tissue gangrene in plain radiograph is believed to be valuable for the diagnosis of diabetic osteoarthropathy.
Amputation ; Congenital Abnormalities ; Diabetic Foot* ; Diagnosis ; Follow-Up Studies ; Gangrene ; Humans ; Joints* ; Metatarsophalangeal Joint ; Osteomyelitis ; Toes

BACKGROUND: Helicobacter pylori(H. pylori) has been implicated in the pathogenesis of chronic active gastritis and peptic ulcer disease. All patients with ulcers who are infected with H. pylori receive antimicrobial therapy. Therefore diagnosis of H. pylori infection is imperative for the treatment gastritis or ulcer patients. We evaluated the four diagnostic methods and three culture media for the isolation of H. pylori. MATERIALS AND METHODS: Rapid urease test(CLO test), modified Gram stain, culture, and nested polymerase chain reaction (PCR) were performed with 108 gastroscopic biopsy specimens from patients with peptic ulcer or chronic gastritis. Among them 40 specimens were inoculated onto each of 5% sheep blood agar, e99 Yolk emulsion (EYE) agar, and 7% horse blood agar containing antibiotics. RESULTS: The positive rates were the highest by the PCR(72%), 67% by modified Gram stain, 64% by CLO test, and 57% by culture. Among the three media the horse blood agar (selective medial) gave the highest isolation rate (48%), followed by sheep blood agar (45%), and EYE agar (38%). CONCLUSION: Though PCR was the most sensitive method for the detection H. pylori modified Gram stain was sensitive enough, simple, rapid, and economical as the routine diagnostic method of H. pylori. For the culture of H. pylori combination of sheep blood agar as nonselective media and horse blood agar as selective media would show the highest isolation rate.
Agar ; Anti-Bacterial Agents ; Biopsy* ; Culture Media* ; Diagnosis ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Horses ; Humans ; Peptic Ulcer ; Polymerase Chain Reaction ; Sheep ; Ulcer ; Urease

No abstract available.
Thorax* ; Ventilators, Mechanical*

The disease of tinea capitis rarely occurs in adults. Cases infected by Trichophyton rubrum (T. rubrum) in the scalp of adults are especially rare. A 71 year-old woman presented who developed inflammatory scaly, erythematous papules and sparsely hairy patch on Rt. Side of scalp and scaly, erythematous patch with central clearing on lower abdomen and trunk. According to her history she had tinea pedis et unguium for a long time. The pruritic scaly patch had developed on scalp and trunk one week previously. We found ectothrix using KOH mount on her hair and hyphae on her toenail, toeweb, palm and trunk. T. rubrum was cultured on Sabouraud dextrose agar. A biopsy was performed on the sparsely hairy patch and we found infiltration of inflammatory cells in upper dermis and around hair follicle. Furthermore T. rubrum, which were cultured from several parts of body, were confirmed the same strain by analysis of DNA sequencing and ribosomal DNA (rDNA) nontranscribed spacer. Herein we proved a rare case of dermatophytosis in adult by the same strain, T. rubrum, identified by analysis of DNA sequencing and rDNA nontranscribed spacer, causing tinea capitis as well as tinea pedis and tinea corporis. We think that this will be useful basic data of epidemiologic study and classification of dermatophytes.
Abdomen ; Adult ; Agar ; Arthrodermataceae ; Biopsy ; Dermis ; DNA, Ribosomal ; Female ; Glucose ; Hair ; Hair Follicle ; Humans ; Hyphae ; Nails ; Scalp ; Sequence Analysis, DNA ; Sprains and Strains ; Tinea ; Tinea Capitis ; Tinea Pedis ; Trichophyton

No Abstract Available.
Head* ; Osteonecrosis* ; Rabbits*