No abstract available.
Child* ; Humans ; Leukemia*

Commonly used internal devices to fix the stable and unstable intertrochanteric fractures are fixed nail plate (Jewett nail, Holt nail), sliding nail plate (compression hip screw) and intramedullary device (Ender, Harris nail). The choice of internal device is influenced by the general coditions of patients, the pattern of fracture and the personal preference of surgeon. There are many reports that sliding nail plate appears to give better result than fixed nail plate because the latter device leads to high failure rate. Twenty nine unstable intertrochanteric fractures treated with Jewett nail plate (group I) and sliding compression hip screw (group II) between 1981 and 1988 were reviewed after minimal twelve months follow up. Group I comprised of fourteen cases, Group II, of fifteen. There were seventeen males and twelve females. The ages ranged from thirty-two to seventy-eight years, the average age being 57.8 years. Eighteen cases were caused by slip down; eight, traffic accident; and three, fall down. The average operation time was 124 minutes in group I and 148 minutes in group II. The average amout of blood loss was 1024cc in group I and 1040cc in group II. The average time to union was 13 weeks in group I and 12.9 weeks in group II. In Jewett nail plate fixed group, there were three complication; one coxa vara, and superior migration of nail, and one subcapital fracture and one superficial wound infection. In sliding compression hip screw group, one was complicated with coxa vara. Above results suggest that the use of Jewett nail plate in unstable intertrochanteric fracture could be got good results with method using compression hip screw.
Accidents, Traffic ; Coxa Vara ; Female ; Femur ; Follow-Up Studies ; Hip Fractures ; Hip ; Humans ; Male ; Methods ; Wound Infection

PURPOSE: Although the pudendal nerve terminal motor latency (PNTML) is normally used, there is no definite test that accurately reflects the function of the pudendal nerve. This study was undertaken to determine the relative accuracy of the various methods in measuring the function of the pudendal nerve. METHODS: Thirty one female patients (age 51.3+/-15.7) with a defecation disorder (constipation 20, fecal incontinence 11) were evaluated prospectively using a neurophysiologic test and balloon reflex manometry. Five parameters such as the right and left PNTML, anal mucosal electrosensitivity, latency and the amplitude of the rectoanal contractile reflex (RACR) were analyzed statistically for their correlation. RESULTS: There was no significant inter-test correlation among the parameters. However, the intra-test correlations between the parameters such as the right and left PNTML (r=0.9629, P<0.001)/latency and the RACR amplitude (r= -0.3770, P=0.0366) were found to be significant. CONCLUSION: The accuracy of these tests in evaluating the pudendal neuropathy could not be determined. However, because it can be assumed that a measurement of the RACR in addition to RNTML is technically accurate, it there will need to be more study for it to be used as an alternative to a PNTML measurement.
Defecation ; Fecal Incontinence ; Female ; Humans ; Manometry ; Prospective Studies ; Pudendal Nerve* ; Pudendal Neuralgia ; Reflex

The Kaposi's sarcoma, which was found in an immunosuppressed patient of renal transplantation, may have been developed by long term use of immunosuppressant agent after the renal transplantation. The case was a 29-year-old woman who was diagnosed as chronic renal failure in 1988, and since then, she had been on CAPD until May, 1997. After the renal transplantation in May 1997, the patient has been prescribed cyclosporin and prednisone as immunosuppressant agent. In June 1997, she showed clinical symptom of Kaposi's sarcoma with multiple papules and nodules in the skin and viscera, such as ureter, urinary bladder, stomach, duodenum and subcutaneous tissue of the chest. Multiple excisional biopsies were carried out in the skin, ureter, urinary bladder, stomach and duodenum. All of excisional biopses indicated nodular stages with extensive proliferation of spindle shaped, somewhat pleomorphic cells which have slit-like vascular spaces, proliferation of small vessels, and extravasation of erythrocytes. These lesions nearly diminished after sytemic chemotherpy, excision and discontinuity of immunosuppressive agents.
Adult ; Biopsy ; Cyclosporine ; Duodenum ; Erythrocytes ; Female ; Humans ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Kidney Transplantation ; Peritoneal Dialysis, Continuous Ambulatory ; Prednisone ; Sarcoma, Kaposi* ; Skin ; Stomach ; Subcutaneous Tissue ; Thorax ; Ureter ; Urinary Bladder ; Viscera

The Kaposi's sarcoma, which was found in an immunosuppressed patient of renal transplantation, may have been developed by long term use of immunosuppressant agent after the renal transplantation. The case was a 29-year-old woman who was diagnosed as chronic renal failure in 1988, and since then, she had been on CAPD until May, 1997. After the renal transplantation in May 1997, the patient has been prescribed cyclosporin and prednisone as immunosuppressant agent. In June 1997, she showed clinical symptom of Kaposi's sarcoma with multiple papules and nodules in the skin and viscera, such as ureter, urinary bladder, stomach, duodenum and subcutaneous tissue of the chest. Multiple excisional biopsies were carried out in the skin, ureter, urinary bladder, stomach and duodenum. All of excisional biopses indicated nodular stages with extensive proliferation of spindle shaped, somewhat pleomorphic cells which have slit-like vascular spaces, proliferation of small vessels, and extravasation of erythrocytes. These lesions nearly diminished after sytemic chemotherpy, excision and discontinuity of immunosuppressive agents.
Adult ; Biopsy ; Cyclosporine ; Duodenum ; Erythrocytes ; Female ; Humans ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Kidney Transplantation ; Peritoneal Dialysis, Continuous Ambulatory ; Prednisone ; Sarcoma, Kaposi* ; Skin ; Stomach ; Subcutaneous Tissue ; Thorax ; Ureter ; Urinary Bladder ; Viscera

No abstract available.
Perfusion*

In a case of autoimmune chronic pancreatitis that relapsed despite maintenance therapy with low-dose steroid, high- dose steroid can induce remission of the disease, and maintenance therapy of steroid is usually recommended in that case. A 57-year-old man developed epigastric pain and jaundice. The patient was diagnosed with autoimmune chronic pancreatitis. The abnormalities in the clinical, laboratory and radiologic findings improved after oral steroid therapy. After two relapsed episodes, maintenance therapy of steroid with 5 mg prednisolone/day was administrated. In the studies for follow up, the level of serum IgG was increased and abdominal computed tomography showed calcification and pseudocyst in the pancreatic tail. To our knowledge, this is a rare case of autoimmune chronic pancreatitis aggravated rapidly despite oral steroid maintenance therapy.
Follow-Up Studies ; Humans ; Immunoglobulin G ; Jaundice ; Middle Aged ; Pancreatitis, Chronic

Clevudine is a nucleoside analog of the unnatural beta-L configuration which has potent antiviral activity against hepatitis B virus (HBV). Clevudine is expected to have similar pattern of resistance profile as lamivudine. However, there was no report on the mutation associated with clevudine resistance in patients with chronic hepatitis B. We report a case of young male patient with chronic hepatitis B who presented with clevudine resistance. The patient had received lamivudine therapy for 5 months with reduced serum HBV DNA levels. Then, lamivudine was switched to clevudine monotherapy. After the 6 months of clevudine therapy, the patient developed virologic breakthrough (>1.0x10(8) copies/mL) as well as biochemical breakthrough, which was associated with the presence of rtM204I plus rtL80I mutant. After switching from clevudine to adefovir, the viral load decreased with biochemical improvement.
Adenine/analogs & derivatives/therapeutic use ; Adult ; Amino Acid Substitution ; Antiviral Agents/*therapeutic use ; Arabinofuranosyluracil/*analogs & derivatives/therapeutic use ; Base Sequence ; DNA, Viral/blood ; Drug Resistance, Multiple, Viral ; Hepatitis B e Antigens/metabolism ; Hepatitis B, Chronic/*drug therapy/genetics ; Humans ; Lamivudine/*therapeutic use ; Male ; Phosphonic Acids/therapeutic use ; Reverse Transcriptase Inhibitors/*therapeutic use

No abstract available.
Kidney Transplantation* ; Urinary Diversion*

BACKGROUND: Cerebral infarction as a complication of tuberculous meningitis (TBM) is not uncommon, but has been rarely reported. The purposes of this study were to evaluate the clinical characteristics of cerebral infarction secondary to TBM and investigate the predictive values for cerebral infarction in patients with TBM. METHODS: We prospectively collected patients with TBM for 24 months. Patients were divided into two groups, either patients with stroke or without stroke. We compared the demographic features, clinical, laboratory, and neuroradiologic findings between the two groups. We classified the stroke subtype with neuroimaging findings. RESULTS: The 26 patients were diagnosed as TBM, and 6 patients had complications with cerebral infarction. The neutrophil percentage in the cerebrospinal fluid (CSF) leukocyte were significantly higher in patients with stroke than in patients without stroke (p=0.0098). On initial CT scan, meningeal enhancement was found in 9 patients, and 4 of them complicated with stroke. However, there were no significant differences in the other clinical and laboratory features such as demographic features, interval between meningitis onset time and treatment initiation time, peripheral white blood cell count, and CSF findings. In six patients with stroke, lacunar infarctions and non-lacunar territorial infarctions were found in 3 patients, respectively. In territorial non-lacunar infarction patients, one patient died due to herniation. CONCLUSIONS: We suggest that the possibility of cerebral infarction under the treatment of TBM should be considered, when the patient shows focal neurologic signs, meningeal enhancement on the CT scan and sustained polymorphic CSF pleocytosis.
Cerebral Infarction ; Cerebrospinal Fluid ; Humans ; Infarction ; Leukocyte Count ; Leukocytes ; Leukocytosis ; Meningitis ; Neuroimaging ; Neurologic Manifestations ; Neutrophils ; Prospective Studies ; Stroke ; Stroke, Lacunar ; Tomography, X-Ray Computed ; Tuberculosis, Meningeal*