PURPOSE: The purpose of this article is to show the efficacy of a bioabsorbable polylactide (PLA) screw for treating syndesmotic injuries of ankle fractures. MATERIALS AND METHODS: Ten patients who underwent an open reduction and internal fixation operation for ankle fractures that had syndesmotic injuries from Dec. 1992 to Feb. 1997 were enrolled into the study. There were 6 men and 4 women. The average age of the patients was 42.6 years and the average follow-up period was 2 years 7 months. The cases were analyzed by clinical and radiological findings at the time of their last follow-up evaluation. RESULTS: According to the clinical results, there was statistically no significant difference between finding an average of 15.8 degrees of dorsiflexion and 45.8 degrees of plantar flexion of the ankle on the affected side of the individuals and that of 17.8 degrees of dorsiflexion and 48.5 degrees of plantar flexion on their normal contralateral side. Upon radiological analysis, the medial clear space was decreased from 7.3+/-1.8 mm to 3.1+/-1.0 mm, the tibio-fibular clear space was decreased from 7.8+/-0.9 mm to 4.9+/-0.5 mm and the tibio-fibular overlap increased from 4.6+/-1.8 mm to 10.5+/-1.4 mm. Also there was no pain and instability in the affected side in any of the patients at the time of the last follow-up. CONCLUSION: A bioabsorbable PLA screw is a good implant for stabilizing syndesmotic injuries of the ankle fractures because there is no evidence of a significant osteolysis resulting around the implant, there is a gradual transfer of stress to the surrounding bone, and there is no requirement for a subsequent removal.
Ankle Fractures* ; Ankle Injuries* ; Ankle* ; Female ; Follow-Up Studies ; Humans ; Male ; Osteolysis

PURPOSE: Kawasaki disease(KD) manifests a systemic vasculitis of unknown etiology in young children. Vascular endothelial growth factor(VEGF), vascular cell adhesion molecule-1(VCAM-1) and interleukin-1 beta(IL-1beta) may play important roles in the pathogenesis of KD. Intravenous immunoglobulin(IVIG) and methylprednisolone(MP) are therapeutically effective for KD, however, the precise mechanisms of the two drugs are still unknown. We investigated the therapeutic efficacy of IVIG and/or MP for KD in vitro. METHODS: Human umbilical vein endothelial cells(HUVEC) obtained from umbilical cords of healthy newborns were cultured. After HUVEC were treated with IL-1beta, the effect of IVIG and/or MP on the in vitro activation of HUVEC were assessed by cell proliferation and reverse transcription-polymerase chain reaction-detected expression of mRNA coding for VEGF, VCAM-1, and IL-1beta. RESULTS: IVIG and MP down-regulated the expression of VEGF mRNA induced by IL-1beta(P<0.05, respectively) significantly. The combination of both showed a synergistic effect on the expressions with a dose dependent manner of MP compared to the IVIG or MP alone respectively(P<0.05). IVIG and MP down-regulated the expression of VCAM-1 mRNA induced by IL-1beta(P<0.05, respectively). The combination of both showed a synergistic effect on the expressions with a dose dependent manner of MP(P<0.05). IVIG and MP down-regulated the expression of IL-1beta mRNA induced by IL-1beta(P<0.001, P<0.05, respectively). The combination of both showed a synergistic effect on the expressions with a dose dependent manner of MP(P<0.001). CONCLUSION: These results suggested that IVIG and MP are therapeutically effective for KD in vitro as well as in vivo.
Cell Adhesion ; Cell Proliferation ; Child ; Clinical Coding ; Human Umbilical Vein Endothelial Cells ; Humans* ; Immunoglobulins, Intravenous ; Infant, Newborn ; Interleukin-1 ; Interleukin-1beta ; Methylprednisolone* ; Mucocutaneous Lymph Node Syndrome ; RNA, Messenger* ; Systemic Vasculitis ; Umbilical Cord ; Umbilical Veins* ; Vascular Cell Adhesion Molecule-1* ; Vascular Endothelial Growth Factor A*

PURPOSE: To assess CT findings of pulmonary sarcoidosis and correlate these with sACE level and PFT. MATERIALS AND METHODS: Between 1989 and 1995, 14 patients (4 men and 10 women, aged between 28 and 55 years) with histologically confirmed pulmonary sarcoidosis were consecutively selected. HRCT scans were performed in 12 patients and conventional CT scans in two. CT findings were reviewed by three radiologists, and were correlated with the index of disease activity based on sACE level and pulmonary function test. RESULTS: Pulmonary parenchymal abnormalities were seen in all patients ; small nodules of less than 3 mm in diameter were seen in eight. Other abnormalities were nodules of more than 3 mm in diameter (n=7), confluent nodules (n=5), ground glass opacity (n=5), patchy areas of consolidation with air bronchogram (n=5), and architectural distortion (n=3). The upper lung zone was more frequently involved than the middle or lower zone. In ten patients, the peripheral interstitum was predominantly involved, while only three patients showed predominant peribronchovascular involvement. Lymphadenopathy was noted in 13. There was no correlation between sACE level, the results of a pulmonary function test and the extent of parenchymal involvement. CONCLUSION: HRCT is valuable for the identification, characterization, and determination of the extent to which parenchymal lung is involved in sarcoidosis. The extent of this involvement does not correlate with sACE level and pulmonary function test results.
Female ; Glass ; Humans ; Lung ; Lymphatic Diseases ; Male ; Respiratory Function Tests ; Sarcoidosis ; Sarcoidosis, Pulmonary* ; Tomography, X-Ray Computed

Purpose: The safety and efficacy of minimally invasive techniques in congenital heart surgery were tested in this study. Materal and method: Between July 1997 and November 1997, a total of 46 children were underwent minimally invasive cardiac operations at Seoul National University Children's Hospital. Age and body weight of the patients averaged 34.6+/-41.8 (Range: 1~148) months and 14.5+/-9.9 (Range: 3.0~40.0) kg, respectively. Twenty eight patients were male. Preoperative surgical indications included 15 atrial septal defects, 25 ventricular septal defects, 1 foreign body in aorta, 3 partial atrioventricular septal defects, 1 total anomalous pulmonary venous connection (cardiac type), and 1 tetralogy of Fallot. After creating a small lower midline skin incision starting as down as possible from the sternal notch, a vertical midline sternotomy extended from xyphoid process to the level of the second intercostal space, where one of the T-, J-, I-or inverted C-shaped lower lying mini-sternotomy was completed with a creation of unilateral right or bilateral trap door sternal opening. A conventional direct aortic and bicaval cannulation was routine. RESULT: A mean length of skin incision was 6.1+/-1.0 (range: 4.0~9.0) cm. A mean distance between the suprasternal notch and the upper most point of the skin incision was 4.0+/-1.1 (range: 2.0~7.0) cm. Mean cardiopulmonary bypass time, aortic cross-clamp time, and the operation time were 62.9+/-20.0 (range: 28~147), 29.8+/-12.8 (range: 11~79), and 161.1+/-34.5 (range: 100-250) minutes. A mean total amount of postoperative blood transfusion was 71.0+/-68.1 (range: 0~267) cc. All patients were extubated mean 11.3+/-13.8 (range: 1~73) hours after operation. A mean total amount of analgesics used was 0.8+/-1.8 (range: 0~9) mg of morphine. The mean duration of stay in intensive care unit and hospital stay were 35.0+/-32.2 (range: 10~194) hours and 6.2+/-2.0 (range: 3~11) days. There were no wound complications and hospital deaths. CONCLUSION: This short-term experience disclosed that the minimally invasive technique can be feasibly applied in a selected group of congenital heart disease as well as is cosmetically more attractive approach.
Analgesics ; Aorta ; Blood Transfusion ; Body Weight ; Cardiopulmonary Bypass ; Catheterization ; Child* ; Deception ; Foreign Bodies ; Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Morphine ; Seoul ; Skin ; Sternotomy ; Surgical Procedures, Minimally Invasive ; Tetralogy of Fallot ; Thoracic Surgery* ; Wounds and Injuries

Triggering at the wrist during active flexion and extension of the fingers or wrists is very rare. It is caused by tumors, inflammation, and anomalous muscle belly. We report two cases of trigger wrist caused by synovial hypertrophy and fibroma of flexor tendon.
Fibroma ; Fingers ; Hypertrophy ; Inflammation ; Muscles ; Tendons ; Wrist

To accurately assess the potential hazard of exposure to ionizing radiation from portable radiographs taken in the emergency department,.a study was performed to measure such radiation at different distances from the edge of an irradiated field during portable cervical spine, portable chest radiographs, and portable anteroposterior pelvis radiographs. For all three types of portable radiographs, radiation exposure is high at the edge from the beam. However, radiation exposure is deceased at 20, 40, 80, 160cm away from the beam. This study confirms and supports the evidence that although radiation exposure is dependent on distance from the primary radiograph beam, exposure in the ED is minimal. Medical personnel should not have to leave a patient care area for fear of undue acute and chronic radiation exposure while portable radiographs are performed in the ED. By using protective garments and standing appropriate distance away from the patient, continuous patient care can be maintained while portable radiographs are taken in the ED.
Emergencies* ; Emergency Service, Hospital* ; Humans ; Patient Care ; Pelvis ; Radiation, Ionizing ; Radiography, Thoracic ; Spine

Functioning adrenal cortical tumors are originated form a distinct zone(zonna glomerulosa, zonna fasciculata or zonna reticularis) or the transitonal zone of adrenal gland. Each zone of the gland is regulated by their specific hormons or cytokines, and their signal transduction systems are different. The oncogenes of many endocrine tumors were mutated proteins involved in signal transduction, however gip is the only reported oncogene in adrenal cortical tumors. Therefore we decided to reevaluate whether gsp might be detected as an oncogene in several different functioning adrenal tumors, and we also tested whether CREB protein is a tentative oncogene or not. In our study, gsp was not detected in 13 patients, however gip was not also detected unexpectedly. There were no mutations in the phosporylation site of CREB("P" box) in adrenal cushing syndrome. We concluded that gip was not a oncogene detected frequently in adrenal cortical tumor, and CREB protein was not considered as a tentative oncogen, because there might be no amplification of the signals due to its extreme distal component of PKA or PKC system.
Adrenal Glands ; Cushing Syndrome ; Cyclic AMP Response Element-Binding Protein ; Cytokines ; Humans ; Oncogenes ; Signal Transduction

Endomyocardial biopsy often fails to show myocardial inflammation for patients with clinically suspected myocarditis. The serum isoforms of troponin T (cTnT) level is a very sensitive marker of myocardial injury and it is elevated even in the absence of myocardial inflammation. We investigated the correlations for myocardial injury, virus titers and inflammation in acute viral infection. Using the murine coxsackievirus group B3 (CVB3) myocarditis model, the histopathologic findings and virus titers in mouse hearts were compared with the serum cTnT levels measured by ELISA at various time points. Viable virus titers in the hearts peaked at 3 days after infection (8.22+/-0.13 log10 PFU/100 mg of heart); they decreased at day 7 and no viable virus was detected from day 14. Myocardial inflammation was minimal at day 3, peaked at day 7 and markedly decreased at day 14. The individual serum TnT levels were significantly increased at day 3 (7.37+/-1.46 ng/ml), persisted to day 7 (0.73+/-0.08 ng/ml), and normalized at day 14. Serum cTnT levels were correlatable with virus titers in the heart (r=0.744, P <0.01), but the serum cTnT levels were not correlated with the degrees of inflammation. Using the less myocarditic strain of CVB3, similar relationships were observed between the changes for the serum cTnT levels and the heart virus titers. During the course of viral infection, myocardial injury precedes the pathologic evidence of inflammation, and the elevated cTnT levels provide evidence of myocardial injury even in the absence of any histologic findings of myocarditis.
Acute Disease ; Animals ; Coxsackievirus Infections/*pathology ; Enterovirus B, Human/isolation & purification/pathogenicity/*physiology ; Female ; Heart/*virology ; Hela Cells ; Humans ; Inflammation/*immunology ; Mice ; Mice, Inbred BALB C ; Myocardial Infarction/immunology/*pathology ; Myocarditis/immunology/pathology/*virology ; *Myocardium/immunology/pathology ; Research Support, Non-U.S. Gov't ; Troponin T/blood ; Virus Replication

In generalized amyloidosis, involvement of heart is not rare, but development fo severe conduction distubance in cardiac amyloidosis is a rare presentation in a clinical situation. We report the first case in Korea of cardiac amyloidosis with complete atrioventricular block, which was confirmed by endomyocardial biopsy. A 59-year-old woman was admitted due to drowsy mentality. We observed a severe atrioventricular conduction disturbance on the electrocardiogram and a marked hypertrophied ventricular wall and a granular sparkling appearance within the wall, a characteristic feature in cardiac infiltration of amyloidosis, on the echocardiography. Endomyocardial biopsy was performed and revealed extensive deposition of amorphous eosinophilic materials within the cardiac muscle cells. Polarizing illumination after Congo-red staining showed typical green birefrigence. We performed a insertion of permanent pacemaker(VVI type) for the treatment of complete atrioventricular block.
Amyloidosis* ; Atrioventricular Block* ; Biopsy ; Echocardiography ; Electrocardiography ; Eosinophils ; Female ; Heart ; Humans ; Korea ; Lighting ; Middle Aged ; Myocytes, Cardiac

Sorafenib is an oral multikinase inhibitor with clinical activity against hepatocellular carcinoma (HCC) and renal cell carcinoma. Administration of sorafenib carries a variety of adverse cutaneous reactions. Common adverse effects induced by sorafenib include hand-foot skin reactions, facial erythema, splinter subungual hemorrhage, and alopecia. Although erythema multiforme (EM) related to sorafenib has been reported, delayed-type cutaneous hypersensitivity reactions are rare in patients treated with sorafenib and there has been no case of Stevens-Johnson syndrome (SJS) reported so far. We recently experienced 3 cases of delayed-type cutaneous hypersensitivity related to administration of sorafenib. The first case was a 47-year female had targetoid erythematous rashes on her arms 12 days after starting sorafenib for HCC. The rashes spread from the arms to the trunk rapidly except for the hands and feet, and erosive lesions developed in the oral mucosa and lips. She was diagnosed as SJS. The second case was an 81-year-old male had maculopapular eruptions with multiple targetoid lesions on the trunk, arms, and legs 10 days after starting sorafenib for his HCC. There was no evidence of mucosal involvement. He was diagnosed with EM. The last one was a 20-year-old female developed generalized maculopapular eruptions in the whole body 10 days after starting sorafenib for the treatment of HCC. All 3 patients completely recovered after discontinuation of sorafenib.
Aged, 80 and over ; Alopecia ; Arm ; Carcinoma, Hepatocellular ; Carcinoma, Renal Cell ; Erythema ; Erythema Multiforme ; Exanthema ; Female ; Foot ; Hand ; Hemorrhage ; Humans ; Hypersensitivity* ; Hypersensitivity, Delayed ; Leg ; Lip ; Male ; Mouth Mucosa ; Skin ; Stevens-Johnson Syndrome ; Young Adult