No abstract available.
Korea* ; Metabolism, Inborn Errors*

A 40-year-old woman had a pruritic, vesiculobullous eruption of her face for 6 weeks with no evidence of systemic disease. A biopsy showed subepidermal blisters and dermal infiltrates of neutrophilic inflammatory cells. Direct immunofluorescence demonstrated thick linear deposits of IgG and C3 along the basement membrane zone. The cleavage plane was identified to be just beneath the lamina densa. Using Western immunoblots, the patient's IgG autoantibodies were found to recognize type VII proeollagen. Moderate starting doses of systemic prednisolone gave a good response for this patient with an early inflammatory form of epidermolysis bullosa acquisita.
Adult ; Autoantibodies ; Basement Membrane ; Biopsy ; Blister ; Blotting, Western ; Epidermolysis Bullosa Acquisita* ; Epidermolysis Bullosa* ; Female ; Fluorescent Antibody Technique, Direct ; Humans ; Immunoglobulin G ; Neutrophils ; Prednisolone

Cytologic findings of malignant cells obtained by fine needle aspiration from a huge retroperitoneal malignant fibrous histiocytoma were described. The smears contained numerous malignant cells, isolated or in clusters, in a bloody background. The malignant cells had abundant pleomorphic foamy or acidophilic cytoplasm with occasional multilobated vesicular nuclei and prominent nucleoli. Dual differentiation, both histiocytic and fibroblastic types, and neutrophilic inflammatory background were diagnostic of this neoplasm. The report indicated that study of aspiration cytology specimen from a soft tissue tumor was a valuable adjunct to histologic examination.
Biopsy

No abstract available.
Hydronephrosis*

BACKGROUND: Peripheral blood stem cell transplantation in children has some difficulties compared with adult cases. Despite the children's total blood volume is small, they have a relatively higher volume of blood per weight than adults. Also, it is hard for the children to maintain 2 central vein during leukapheresis to shorten the time consumed. We compared the artery-harvest and central vein-harvested group for possible risk and stem cell yield in pediatric patients with malignancies. METHODS: From August, 1995 to January, 1997, 21 leukapheresis was performed by 7 patients. The patients who could have 2 central veins for leukapheresis were included in vein-harvested group and the patients who could have only 1 central vein were included in artery-harvested group. The peripheral vein was not used for leukapheresis. COBE Spectra(COBEBCT, Lakewood, CO) was used and priming was done by packed RBCs in patients weighing less than 20kg. Stem cell yield was assessed by MNC, CD34+, CFU-GM, respectively. During leukapheresis, the patients were closely monitored for change in vital sign, evidence for thrombosis, bleeding, hypocalcemia, etc. RESULTS: There was no serious complication in each group of patients. After the leukapheresis, WBC and platelet count decreased but Hb level was increased due to reinfusion of primed packed RBCs. Average flow rate was higher in vein-harvested group but there was no difference in time consumed and results in stem cell assay. CONCLUSION: Peripheral stem cell harvest in children by radial artery can be performed safely and easily without an increased risk or complication. In younger children, it is possible to achieve even more higher stem cell yield. If the patient is unable to maintain 2 central vein for leukapheresis, transient radial arterial catheterization is a safe and convenient method.
Adult ; Blood Volume ; Catheterization* ; Catheters* ; Child ; Colony-Forming Units Assay ; Granulocyte-Macrophage Progenitor Cells ; Hemorrhage ; Humans ; Hypocalcemia ; Leukapheresis ; Peripheral Blood Stem Cell Transplantation ; Platelet Count ; Radial Artery ; Stem Cells* ; Thrombosis ; Veins ; Vital Signs

The potential for nerve regeneration and recovery of its function exists in the presence of a suitable pathway for regenerating axon and endoneurial tube can serve as nerve conduit for regenerating axon in fresh nerve graft. But value of degenerated nerve as donor nerve has not been established till now. This experiment assessed the chronologic influence of fresh and degenerated nerve graft on axonal growth for 10mm gap of sciatic nerve in rabbit and how long degenerated nerve was ahle to serve as a nerve conduit microscopically. Electromicroscopically, the regenerating axons which were ohserved in the degenerated nerve graft had more abundant unmyelinated fibers and revealed abundant collagen fibers in the endoneurium. And these regenerating axons became gradually surrounded with newly developed basal lamina and decreased the collagen fibers at l2 week of degenerated nerve graft. Histologically, myelinated axons which were observed in central area of the degenerated nerve graft at 8 week of degenerated nerve graft were relatively thinner, but a definite structural difference of regenerating axons was not found except reduction of number compared with those of tresh nerve graft. The numher of myelinated axons was 6,072+/-l42 in normal sciatic nerve, 4,479+/- 157 in fresh nerve graft group, and 2,968+/-168 in the degenerated nerve graft group. Difference of the number of myelinated axons between fresh and degenerated nerve graft group was significant stati stically(P<0.05). These results showed that the ability of a degenerated nerve graft as a passage for the regenerating axons and it can be employed as one of the favorable nerve conduits.
Axons ; Basement Membrane ; Collagen ; Humans ; Myelin Sheath ; Nerve Regeneration ; Peripheral Nerves ; Sciatic Nerve* ; Tissue Donors ; Transplants*

Venous thromboembolic disease is a frequent complication after total hip arthroplasty. However, in Korea, the low incidence of deep vein thrombosis after total hip arthroplasty was reported. In this study, we present the results of 82 consecutive patients(90 hips) who had a cementless total hip replacement with a Anatomic Medullary Locking Component(AML: Depuy, Warsaw, Indiana, USA) between August 1995 and September 1996 at Inha University Hospital, Korea. Postoperatively, none of the patients were treated with any known prophylatic method for deep vein thrombosis except elastic stockings. Both preoperatively and six weeks after surgery, all patients were studied by an radiologist using a portable Doppler ultrasonic velocity detector with a transmission frequency of 5 megahertz. Contrast phlebography was also done in all patients at the same time as the Doppler ultrasound. In addition, coagulation assays, a complete blood count, blood typing, and serum chemical-profile tests were done for all patients. In comparing the results of these laboratory tests from the DVT group and from the non-DVT group, we found that only eight patients(9.8%) out of eighty-two patients had DVT after total hip arthroplasty. Thrombi were found in the superficial femoral vein in five cases and in the common femoral vein in three cases. Though two(2.4%) patients showed suspicious symptoms of pulmonary embolim, their perfusion lung scans were negative. The DVT group show a significantly shorter activated partial thromboplastin time than did the non-DVT group(P<0.05). In addition, the DVT group showed significantly higher serum total protein than the total protein level of the non-DVT group(P<0.01). In this two groups, there was no difference between the results of Doppler ultrasound and the results of contrast phlebography. Consequently, the incidence of deep vein thrombosis after total hip replacement arthroplasty in Korean patients is significantly lower than incidence in patients from countries other than Korea. Doppler ultrasound was a non-invasive and the most reliable diagnostic technique for deep vein thrombosis.
Arthroplasty* ; Arthroplasty, Replacement, Hip* ; Blood Cell Count ; Blood Grouping and Crossmatching ; Femoral Vein ; Humans ; Incidence ; Indiana ; Korea ; Lung ; Partial Thromboplastin Time ; Perfusion ; Phlebography ; Stockings, Compression ; Ultrasonics ; Ultrasonography* ; Venous Thromboembolism ; Venous Thrombosis*

Fracture of the metal base of tihial components of total knee arthroplasty has heen occasionally reportecl. The most common cause of the failure of the metal hase plate was known to be a fatigue fracture around the screw hole where the strength of the metal hase plate was the weakest. We experienced a case of the fracture of the metal hase plate secondary to the t'racture of the posteromedial corner of the metal tihial condyle which was weakened due to the shoil peg hole for the base plate of MG II implant. Since the proximal portion of the posterior tihial condyle was normally thin, cutting the hone for the base plate made it thinner and wcaker than normal. Therefore stress fracture of the bone occurred and the overlying metal plate was subsequently hroken. From this experience. we concluded that the posterior peg hole may cause unwanted failure of the posteromedial corner of the tibial base plate.
Arthroplasty* ; Fractures, Stress ; Knee*

Fracture of the femur during total hip arthroplasty presents the simultaneous problems of prosthetic stability and fracture treatment. The treatment of such fractures can be complex and is one of the major challenges and this complication is associated with a high morbidity and a significant delay in convalescence. Among the 237 cases, who were treated by cementless total hip arthroplasty from Jan. 1986 to Dec. 1992, 13 cases of femoral fracture were experienced. They usually occured during insertion of prosthesis and preparation of the medullary canal. There were 6 cases of type II fracture, 1 case of type III fracture, 5 cases of type IV fracture and 1 case of type V fracture according to AAOS classification. All of the fracture healed, but the prognosis of these cases must be determined by follow up. We recommend that femoral fractures can be prevented by accurate preoperative evaluation of the size of the femoral canal, identification and management of the predisposing factors for intraoperative fractures.
Arthroplasty, Replacement, Hip ; Causality ; Classification ; Convalescence ; Femoral Fractures ; Femur ; Follow-Up Studies ; Prognosis ; Prostheses and Implants

Biopsy has proved to be of value in the diagnosis of many inflammatory and malignant diseases, and needle biopsy of the synovial membrane in arthritis is well established and often employed as the final diagnostic aid in patient with joint disease. Authors have carried out synovial needle biopsy in 76 joints with Franklin-Silverman needle used commonly in liver biopsy. The results obtained were as followa; 1) Of seventy five biopsies attempted, adequate amount of tiasue was obtained in 51 of 53 knee cases (96.2%), 11 of 14 wrists (78.6%). 3 of 5 elbows (60%), 1 of 3 ankles (33.3%). Adequate amount of tissue was obtained in 66 cases and the overall succese rate was 88%. 2) Histopathological diagnosis was made in 53 of 75 cases (70.7%). In 12 cases, correct specimens were obtained but proved to be incompatible with the diagnosis done by either clinical data or open biopsy. 3) Histopathological diagnoses were made in 25 of 35 cases of rheumatoid arthritis (71.4%) 14 of 18 cases of tuberculous arthritis (77.8%), 7 of 13 cases of degenerative arthritis (53,8%), 4 of 6 cases of suppurative arthritis (66.7%), 2 cases of traumatic arthritis (100%), and one case of villonodular synovitis (100%). 4) The complications resulting from this proedure were pare; mild transient hemarthrosis was found in only 5 cases We also discovered that for an accurate diagnosis multiple specimens should be obtained because otherwise the specimens were too small to interprete histopathologically. In addition we concluded that the success rate depended not upon the sorts of needle used but rather more upon the biopsy technique. Franklin-Silverman needle biopsy proved to be a simple, safe and reliable procedure for diagnosis of the synovial diseases in which conventional arthrotomy is inadvisable and other diagnostic procedures are inadequate.
Ankle ; Arthritis ; Arthritis, Infectious ; Arthritis, Rheumatoid ; Biopsy ; Biopsy, Needle ; Diagnosis ; Elbow ; Hemarthrosis ; Humans ; Joint Diseases ; Joints ; Knee ; Liver ; Needles ; Osteoarthritis ; Synovial Membrane ; Synovitis ; Wrist