Long segmental fixation with TSRH posterior instrumentation for 19 patients who had unstable thoracolumbar fracture was performed between October 1992 and April 1995. The patients were followed for an average of 22 months. Measurements of the deformity angle, kyphosis, vertebral height, and the intervertebral angle were made. The patients were divided into 2 groups according to configurations of instruments for lower segmental fixation. For one group, only hooks were used, and for the others group pedicular screws and lateral offset hooks were used together at the same segment. Therefore, the purpose of this study is to anlyze the correctability following long segmental fixation and to compare one segmental fixation using both screws and lateral offset hook systems with two segmental fixation using hook systems for distal fixation. There was an overall correction of kyphosis at follow-up of 6.9degrees (27.1%) after a loss of 4.3degrees from operative correction. Overall correction of deformity angle was 8.2degrees (32.2%). Loss of vertebral height at final follow-up was 4.4%. And loss of intervertebral angle was 2.0degrees at follow-up. There was no difference of overall results between the hook group and the pedicular screw with lateral offset hook group. However, there was a significant improvement of the correction of kyphosis and restoration of vertebral height in patients who underwent operation within 7 days after injury, as compared to delayed operation. Therefore, the timing of surgery is the most important factor in order to correct the deformity caused by unstable thoracolumbar fractures. There was no significant loss of correction and no metallic failure. Therefore, rodding long with the method of one segment distal fixation using screws and lateral offset hook together can provide excellent correctability, maintenance of correction, preservation of distal lumbar joints, prevention of implant failure and complication.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Joints ; Kyphosis

Bacteriological index(BI) was calculated by slit-skin smears taken from the earlobe and the dorsal surfaces of the proximal phalanges of the index finger and of the great toe in 110 lepromatous leprosy patients who have been treated regularly by antileprosy chemotherapy. The bacteriaI indices from the three sites were compared, and the results were as follows. 1) Sixteen patients whose BI of the earlobe smear was 4. 0 in average shawed the highest degree of positivity of M. leprae in the smears taken from the finger and the great toe. 2) ln seventy-four patients whose BI of the earlobe smear was l. 0 or higher, eight (10.8%) showed higher BI in smears taken from both the finger and the great toe, fifteen (20. 3%) and twenty-seven(36. 5%) showed approximately the same BI in smears taken from the finger and the great toe, respectively, 3) In thirty-six patients whose BI of the earlobe smear was negative, twelve (33. 3%) showed higher BI in smears taken from both the finger and the great toe. 4) The mean value of BI of the three sites was 3.7 in the earlobe, 3. 2 in the finger and 3. 0 in the great toe. Comparing the BI of the three sites, the finger and the great toe were found to have comparable BI with the earlobe, although the BI of the earlobe was highest. The authors concluded that it was quite reasonable to include the finger and the great toe in slit-skin smears for M. leprae identification, particularly when the BI of the earlobe was negative. A follow-up investigation seems mandatory.
Drug Therapy ; Fingers* ; Follow-Up Studies ; Humans ; Leprosy, Lepromatous ; Mycobacterium leprae* ; Mycobacterium* ; Skin* ; Toes*

We studied the natural history of asymptomatic early avascular necrosis of the femoral head in forty-three patients(forty-three hips) who had been treated with arthroplasty due to progressed avascular necrosis of femoral head but had no symptoms in the other side. All initial lesions were classified with Ficat staging and International classification(ARCO). The duration until symptom onset and radiologic evidence of disease progression were evaluated. The average follow up period was over 37 months. Among forty-three hips, twenty-nine cases(67.4%) remained asymptomatic until last follow up but fourteen cases(32.6%) were symptomatic during the follow up, and twenty-six cases(60.5%) did not progress on the radiography but seventeen cases(39.5%) progressed to Ficat stage 3 or 4. Fifteen cases of IA, IIA, IB-cental and II B-central without lateral lesion did not occur symptom and didnt progress to Ficat stage 3 or 4 over a period of average 47 months(24-71 months). But fourteen cases of IB, IC, g B and II C progressed to Ficat stage 3 or 4 and they were all lateral lesion. These results suggest careful observation only can be done in the case of small involvement(less than 15%) and medial or central lesion relatively over a long period of time but for the large involvement(more than 30%) and especially lateral lesion, aggressive surgical treatment may be considered even though the early stage of disease for the prevention of progression. However it will need more period of time to accurately compare the results of various methods of treatment.
Arthroplasty ; Disease Progression ; Follow-Up Studies ; Head* ; Hip ; Natural History* ; Necrosis* ; Radiography

No abstract available.
Mediastinum* ; Neuroblastoma*

Carcinoid is a tumor that primarily affects the intestinal tract, which arises from entero-chromaffin cells. Rectal carcinoid tumor is a relatively rare neoplasm originated in Kul-chitszky cell and clinicians have the difficulties in predicting their malignant potential and in proper treatment. These cells are found to increase in the distal small intestine, are common in the appendix, and then decrease within the mucosa of the colon from cecum to rectum. In the cumulative world literature, the incidence of carcinoids of rectum is slightly higher than 10 percent. All of these tumors are within reach of the rigid procto-sigmoidoscope, most being located between 4 and 13 cm from the anal verge. Eighty five percent are found on the anterior and lateral walls. The tumors are usually submucosal and light yellowish or reddish color. The vast majority of rectal carcinoid tumors are be-nign, which can be treated by local excision safely. Lesions larger than 2 cm and invading the muscular wall of the rectum should be considered malignant, which are treated by more radical surgery such as abdominoperitoneal resection. We experienced a case of rectal carcinoid tumor, which was excised by endoscopic polypectomy, so we present this case with a review of relevant literatures.
Appendix ; Carcinoid Tumor* ; Cecum ; Colon ; Incidence ; Intestine, Small ; Mucous Membrane ; Rectum

PURPOSE: We evaluated the frequency of detection of small hepatic cystic lesion(SHC) on abdominal CT films and its significance in patients with extrahepatic malignancies. METHODS AND MATERIALS: We retrospectively reviewed the abdominal CT films of a total 1112 patients to determine the frequency of detection of SHC, and 62 patients who had both extrahepatic malignancies and SHC were selected. A total 106 SHC determined as benign or malignant in 40 patients was analyzed according to the size(< 1 cm, 1 2cm), the number(1, 2 4, >4), the margin(well-defined, iil-defined),and the location(central, peripheral) of individual cystic lesions. The findings of follow-up CT and ultrasonography and the results of biopsy were also reviewed. The frequency of combined renal cyst was also considered. RESULT: SHC of those 62 patients were classified as benign(27 patients, 43.6%), malignant(13 patients, 20. 9%), or undetermined(22 patients, 35.5%) by the follow-up CT, ultrasonography, and biopsy. Most benign SHC (74.4%) measured under 1 cm, but 75% of the malignant SHC were in 1 -2cm in size. The percentage of the malignancy in one and two to four SHC was 37.5% and 40%, respectively. The margin of SHC was ill-defined in 67.9% of the benign and 64.3% of the malignant lesions. SHCs were mainly located at the periphery of the liver(benign :62.7%, malignant: 64.3%). Coexisting renal cyst was rare. CONCLUSION: SHC is not uncommon finding(13.2%) in patients with extrahepatic malignancy and has a high probablity of metastasis when it is larger than 1 cm, which should be closely followed and intensively studied further.
Biopsy ; Follow-Up Studies ; Humans ; Incidence* ; Neoplasm Metastasis ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography

BACKGROUND: Previous reports have suggested that alleles at the plasminogen activator inhibitor-1 (PAI-1) gene are associated with increased risk of developing coronary artery disease, including myocardial infarction and stroke through their effect on PAI-1 levels. Method: We attempted to search English literatures for all reports of possible effects of PAI-1 gene on cardiovascular disease in human published prior to November 1998. We used a Mantel-Haenszel method (fixed effect model) and random effect model, respectively, to perform a meta-analysis of 7 case-control studies that provided information related to the effects of PAI-1 gene on risk of cardiovascular disease. RESULTS: From 7 studies for diagnosed cardiovascular disease, the relative frequencies of the three genotypes among controls was (5G/5G) (homozygous normal), 24.5%; (4G/5G) (heterozygous), 48.2%, and (4G/4G) (homozygous for the mutant, 675 GGGG), 27.3%. These relative frequencies in cases were 21.7% for 5G/5G, 48.0% for 4G/5G, and 30.3% for 4G/4G. In fixed effect model, compared with those with genotype (5G/5G), the overall odds ratio (OR) for cardiovascular disease among those with (4G/5G) was 1.12 (95% CI, 0.93 to 1.34), and it was 1.20 (1.01 to 1.44) for the (4G/4G) genotype. For five studies with myocardial infarction as the outcome, the overall OR of myocardial infarction was 1.20 (0.99 to 1.47) for those with (4G/5G) and 1.24 (1.00, 1.54) for those with (4G/4G) genotypes, respectively. CONCLUSION: Our findings provide support for the weak association between PAI-1 gene and cardiovascular disease, in particular, myocardial infarction.
Alleles ; Cardiovascular Diseases* ; Case-Control Studies* ; Coronary Artery Disease ; Genotype ; Humans ; Myocardial Infarction ; Odds Ratio ; Plasminogen Activator Inhibitor 1* ; Plasminogen Activators ; Polymorphism, Genetic* ; Stroke

No abstract available.
Liver* ; Neoplasm Metastasis*

Adenosquamous carcinoma originating in the stomach is relatively rare, and the occurrence of such tumor is interesting with respect to its histogenesis. We describe three cases of gastric adenosquamous carcinoma in a 39-year-old man, a 58-year-old woman and a 52-year-old man. They were grossly classified as Borrmann type III or II, revealing no difference from usual advanced gastric adenocarcinomas. Microscopically three cases showed well or moderately differentiated squamous cell carcinoma component occupying large areas of the tumors. Areas of transition from glandular to squamous epithelium were frequently observed. Metastatic foci in the regional lymph nodes also were consisted of two elements. On immunohistochemical study, CEA immunoreactivity was found not only in adenocarcinoma component but also in squamous cell components, in comparison to cytokeratin which was detected only in squamous areas. The immunohistochemical findings of CEA reactivity in both components, and the presence of microscopic transitional zones support the hypothesis of squamous metaplasia occurring in an already existing adenocarcinoma in the development of adenosquamous carcinoma of the stomach.
Female ; Male ; Humans ; Adenocarcinoma ; Neoplasm Metastasis

Cervical adenocarcinoma represents approximately 3-6% of the uterine cervical neoplasms. Recently, its relative incidence tends to be increased in contrast to squamous cell carcinoma. Sixty nine cases from 1985 to 1990 diagonsed as adenocarcinoma of the cervix by radical or total hysterectomy were analyzed to know their histopathological characteristics and related prognostic factors. The results wer as follows. (1) The age distribution ranged from 24 to 60 years and the mean age was 44 years and 47 years in adenocarcinoma in situ and invasive adenocarcinoma, respectively. Staging by FIGO classification showed the range from stage 0 to IIb, of which 63.8% was stage Ib. (2) Cases were composed of 7 cases of adenocarcinoma in situ(10%) and 62 cases of invasive adenocarcinomas(90%). The latter included 16 cases of adenosquamous carcinoma and 46 cases of pure adenocarcinoma which showed endocervical, endometrioid, clear cell, minimal deviation adenocarcinoma subtypes. The most frequent subtype was endocervical adenocarcinoma(51%) and the endometrioid subtype showed slightly higher incidence rate(13%) in comparison to the previous studies. (3) Coexistent squamous lesions ranging from mild dysplasia to invasive carcinoma were found in 4 out of 7 cases(57%) of adenocarcinoma in situ and 18 out of 62 cases(29%) of invasive adenocarcinoma. Severe dysplasia and carcinoma in situ comprised most(77%) of them. (4) Analyses of histopathological and clinical characteristics of adenocarcinoma of the uterine cervix revealed positive correlations between tumor size or mucin leakage and depth of invasion. The prognostic factors in relation to lymph node metastasis were considered to be th stage of disease, the size of tumor, mucin leakage in the stroma, and histologic subtypes.
Incidence ; Adenocarcinoma ; Neoplasm Metastasis