As one of many cell-many cell-based cartilage repairing methods, transplantation of chondrocyte-embedded-collagen gels in cartilage defect was performed for more satisfactory regeneration of cartilage. The authors performed this study to investigate whether the TGF-beta1 treatment of chondrocytes can do some additional synergistic effect on the transplantation of chondrocyte-embedded-collagen gels for crtilage repair. Chondrocytes were isolated from the articular cartilage of newborn Sprague-Dawley rats. Chondrocytes cultured for 10 days in monolayer were embedded in the 0.45% type I collagen gel. Full-thickness cartilage defect was made in the patellar groove of adult Sprague-Dawley rats. Chondrocytes culdefect was made in the patellar groove of adult Sprague-Dawley rats. The cartilage defects were treated with the following methods in a total of 200 animals, which were assigned to 5 different groups of 40 rats. In the control group, the deffect was left without any treatment, in group I, the defect was filled with collagen gel only, in group II, with collagen gel coontaining 10 ng/ml concentration of TGF-beta1, in group III, with collagen gel containing chondrocytes, and in group IV, with collagen gel containing chondrocytes and TGF-beta1. At 1, 2, 4, 8, 12 weeks after the operation, eight rats of each group were sacrificed, and their distal femurs were harvested for the histologic and biomechanical tests. The section s were stained with hematoxilin and eosin. Alcian-blue, and Safranin-O. Regenerated cartilage was analyzed by the semiquantitative histological grading system. Point indentation test was performed as a biomechanical evaluation, and the stiffness was calculated. The results of the histological grading system revealed that the scores gradually increased with time in all groups, and the scores of group III and IV were higher than those of control, group I and II. The biomechanical study showed that the stiffness gradually increased to reach a plateau level in each group. In control, group I and II, the stiffness increased up to the eighth week and remained around the increased level at the twelfth week, and did not show any statistically significant difference between the groups. In group III and IV, the stiffness was higher than in control group, and increased markedly at the fourth week and the increased level was maintained onwards. The results of this study showed that the transplantation of chondrocyte-embedded-collagen gels enhanced the healing process, and the treatment of TGF-beta1 demonstrated at least partially significant improvement.
Adult ; Animals ; Cartilage ; Cartilage, Articular* ; Chondrocytes ; Collagen ; Collagen Type I ; Eosine Yellowish-(YS) ; Femur ; Gels ; Humans ; Infant, Newborn ; Rats* ; Rats, Sprague-Dawley ; Regeneration ; Transforming Growth Factor beta1

BACKGROUND: Improved diagnostic and therapeutic strategies for infective for infective endocarditis such as proposed diagnostic criteria, Duke criteria and echocardiography resulted to increased life-spans of patients. METHODS: Retrospective analysis of medical records including medical history, laboratory data such as echocardiographic data and blood culture, and clinical outcomes was done for 106 patients with clinical diagnosis of infective endocarditis at Seoul National University Hospital from January 1990 to May 2000. Then we analysed differences of clinical features between elderly patients aged > or =60-years and the adult patients aged <60-years with infective endocarditis. RESULTS: The elderly patients >or=60-year are cases of 14%(15/106) and the mean ages are 67+/-8 years in elderly patient, 38+/-12 years in the adults patients respectively. Valvular heart disease was the most common predisposing heart disease with 9 cases(40%) followed by prosthetic valve endocarditis 2 cases (13%) in elderly patients, and there was no significant difference of frequencies with adult patients (valvular heart diseases, 33%; prosthetic valvular heart diseases, 25%). Although culture positive rates were not different with two groups: 47%(7/15) in elderly patients and 45%(41/91) in adult patients, the most common pathogen was staphylococcal species in elderly patients(27%, 4/15) but streptococcus species, in the adult patients(25%, 26/106, p<0.05). The frequencies of embolic complication were not different between two groups(20%, 3/15 vs 22%, 20/91: Elderly vs adult, respectively), but congestive heart failure was more developed in elderly patients, 33%(5/15) than in adult patients, 10%(9/91, p<0.05). Surgical intervention was more required in the elderly(47%, 7/15) than in adult patients(22%, 20/91, p<0.05). Out of 106 patients, 11 died and the overall mortality was 10.4%(11/106). In-hospital death was more common in the elderly than in adult patients: 4 cases(27%) vs 8%(7/91), p<0.05. Determinants of in-hospital death were patients with 60 years of age and older, Staphylococcus aureus endocarditis, and the presence of congestive heart failure(p<0.05) in univariate analysis. CONCLUSION: Infective endocarditis in elderly patients(age> or =60) had more poor outcomes than adult patients(age<60) such as the development of congestive heart failure, the need of surgical intervention, and the high mortality rate.
Adult ; Aged* ; Diagnosis ; Echocardiography ; Endocarditis* ; Estrogens, Conjugated (USP) ; Heart ; Heart Diseases ; Heart Failure ; Heart Valve Diseases ; Humans ; Medical Records ; Mortality ; Retrospective Studies ; Seoul ; Staphylococcus aureus ; Streptococcus

There are many problems in treatment of intertrochanteric fractures due to osteoporosis and unstable pattern of fractures in old ages and they are different from those in young ages, for example, type of fracture, degree of osteoporosis, and general condition, ect. Anthors studied about the prognostic factors of 42 cases among 88 patients with intertrochanteric fractures, who were treated and followed up from Jan. 1982 to Dec. 1987. 1. The patients under 50 years old were mainly males(94.4%) and its chief cause of injury was traffic accident or fall down(72.2%). The cause of injury over 50 years old was slip down on ground(62.9%). 2. The osteoporosis was increased according to increased age of patients and then the unstable type of fracture was increased. In yaung patients, the unstable intertrochanteric fracture was rare despite of high violent injury. 3. The bone union of the follow-up patients was gained at average 13.8 weeks. 4. The sliding degree of lag screw was increased with unstable fracture and the incidence of metal protrusion into joint cavity was increased in the patients of eccentric fixation of lag screw into femoral head. 5. The all cases of complication were occured in osteoporotic patients over 50 years old and their causes were inadequate fixation of unstable fracture. 6. The most important factors in prognosis of intertrochanteric fractures are initial pattern of fractures, degree of osteoporosis and adequacy of reduction state(postop.).
Accidents, Traffic ; Follow-Up Studies ; Head ; Hip Fractures ; Humans ; Incidence ; Joints ; Osteoporosis ; Prognosis

Current medicine is a living science which is developing rapidly. It seems that coming up with the rapid development of medicine by the conventional educational system has some limitation, since the development is too rapid. Development of internet-based medical educational program(IMEP) would be a kind of solution. To overcome the limitation, we developed an IMEP which could be used either on the File Transfer Protocol(FTP) or World Wide Web(WWW), and tested whether it would meet the requirements of our purpose. The IMEP of ours functioned satisfactorily. IMEP for WWW was accessed by far more frequently than IMEP for FTP by the visitors. Frame-typed HTML files were displayed 2 times faster than plain HTML files. HTML files which hid the graphic data behind were displayed more quickly than conventional HTML files. CGI programs were considered to be necessary tools for bidirectional communications between the host and clients on the IMEP. A small PC server worked properly as well as a large server when the access was confined to a small number of visitors. We concluded that IMEP was an excellent adjuvant method of education to make up the gap between the conventional educational system and the rapid development of medicine.
Education ; Education, Medical ; Internet

PURPOSE: To evaluate the clinical significance of the multiple increased uptake lesions other than in femoral heads as seen on whole body bone scan in patients with avascular necrosis of femoral heads. MATERIALS AND METHODS: One hundred and seventy three patients with clinical diagnosis of avascular necrosis of fthe emoral head underwent a bone scan using Tc-99m MDP. Increased uptake lesions other than in femoral heads were evaluated, including frequency and common sites of involvement, and correlated with clinical information and plain radiographic findings. Two hundred patients without AVN, who had undergone a bone scan, were included as a control group. RESULTS: Increased uptake lesions in extrafemoral head locations were found in 36 of 173 patients(20.8% ; the location of 79 lesions was other than the femoral head, This result is statistically different from patients without avascular necrosis of femoral head(p<0.0001). The most common site of involvement was the knee joint area(62.5%). Other lesions were located in the mid-shafts of the long bones of the lower extremities, calcaneus, proximal humerus, etc., in order of decreasing frequency. Plain radiographs of 17 lesions were nonspecific, except for three lesions showing definite changes associated with avascular necrosis. The risk factors included alcoholism, the prolonged use of steroids, renal transplantation, herbal medication and working as a working as deep-sea diver. Most patients did not complain of pain, except for two with irreversible osteonecrotic changes as seen on plain radiograph. CONCLUSION: in patients with avascular necrosis of the femur, increased uptake lesions other than in the femoral head as seen on bone scan, may represent the early stage of osteonecrosis, which shows a characteristic appearance on bone scan. In order to avoid possible misdiagnoses of multiple extrafemoral lesions as bony metastasis or traumatic lesions, in patients with avascular necrosis of the femur these should be carefully evaluated.
Alcoholism ; Calcaneus ; Diagnosis ; Diagnostic Errors ; Femur ; Head* ; Humans ; Humerus ; Kidney Transplantation ; Knee Joint ; Lower Extremity ; Necrosis* ; Neoplasm Metastasis ; Osteonecrosis ; Risk Factors ; Steroids ; Technetium Tc 99m Medronate*

PURPOSE: To evaluate the clinical significance of the multiple increased uptake lesions other than in femoral heads as seen on whole body bone scan in patients with avascular necrosis of femoral heads. MATERIALS AND METHODS: One hundred and seventy three patients with clinical diagnosis of avascular necrosis of fthe emoral head underwent a bone scan using Tc-99m MDP. Increased uptake lesions other than in femoral heads were evaluated, including frequency and common sites of involvement, and correlated with clinical information and plain radiographic findings. Two hundred patients without AVN, who had undergone a bone scan, were included as a control group. RESULTS: Increased uptake lesions in extrafemoral head locations were found in 36 of 173 patients(20.8% ; the location of 79 lesions was other than the femoral head, This result is statistically different from patients without avascular necrosis of femoral head(p<0.0001). The most common site of involvement was the knee joint area(62.5%). Other lesions were located in the mid-shafts of the long bones of the lower extremities, calcaneus, proximal humerus, etc., in order of decreasing frequency. Plain radiographs of 17 lesions were nonspecific, except for three lesions showing definite changes associated with avascular necrosis. The risk factors included alcoholism, the prolonged use of steroids, renal transplantation, herbal medication and working as a working as deep-sea diver. Most patients did not complain of pain, except for two with irreversible osteonecrotic changes as seen on plain radiograph. CONCLUSION: in patients with avascular necrosis of the femur, increased uptake lesions other than in the femoral head as seen on bone scan, may represent the early stage of osteonecrosis, which shows a characteristic appearance on bone scan. In order to avoid possible misdiagnoses of multiple extrafemoral lesions as bony metastasis or traumatic lesions, in patients with avascular necrosis of the femur these should be carefully evaluated.
Alcoholism ; Calcaneus ; Diagnosis ; Diagnostic Errors ; Femur ; Head* ; Humans ; Humerus ; Kidney Transplantation ; Knee Joint ; Lower Extremity ; Necrosis* ; Neoplasm Metastasis ; Osteonecrosis ; Risk Factors ; Steroids ; Technetium Tc 99m Medronate*

Right sided aortic arch is commonly accompanied by congenital heart disease, but abnormally originated left subvlavian artery can be acompression of trachea or esophagus by ducturs arteriosus or ligamentum arteriosus. But right sided aortic arch compressing superior vena cava has not been reported in Korea.We exerienced a case of right sided aortic arch with left subclavian artery compressing the superior vena cava, resulting in superior vena cava syndrome. So we report this case with brief review of literature.
Aorta, Thoracic* ; Arteries ; Esophagus ; Heart Defects, Congenital ; Subclavian Artery ; Superior Vena Cava Syndrome* ; Trachea ; Vena Cava, Superior*

OBJECTIVE: The degree of pain relief and complications after treatment for chronic pelvic pain due to endometirosis were evaluated. METHODS: This study was performed in sixty three patients of endometriosis who have diagnosed by laparoscopy. They were divided in three groups by treatment regimen, Mirena(R) only group (Group A), Mirena(R) plus low-dose MPA group (Group B) and high-dose MPA only group (Group C). After six months, we evaluated the result of treatment by the degree of pain relief and complications of each treatment regimen. RESULTS: The degree of pain relief in Group B was significantly higher than in Group A (p<0.05), and significant difference was not found between Group B and Group C. The frequency of irregular bleeding in Group B was significantly lower than Group A (p<0.05), but not than Group C. The frequency of weight gain in Group B was significantly lower than Group C (p<0.01), but not than Group A. However the frequency of breast tenderness in Group B was significantly higher than Group A (p<0.01), but not than Group C. CONCLUSION: Mirena(R) plus low-dose MPA combined treatment is as effective as high-dose MPA treatment in pain relief with lower side-effects.
Breast ; Endometriosis ; Female ; Hemorrhage ; Humans ; Laparoscopy ; Pelvic Pain ; Weight Gain

Shaken baby syndrome develop as a form of child abuse, with the majority of cases occurring during the first year of life. It results from extreme rotational cranial acceleration and deceleration effects induced by violent shaking of an infant. The characteristic injuries include subdural and subarachnoid hemorrhages, and retinal hemorrhages. We experienced three cases of shaken baby syndrome. Although the history of trauma was little known, all of these cases had subdural hemorrhages. We present the cases with a review of related literature.
Acceleration ; Child ; Child Abuse ; Deceleration ; Hematoma, Subdural ; Humans ; Infant ; Retinal Hemorrhage ; Shaken Baby Syndrome* ; Subarachnoid Hemorrhage

The authors reviewed angiographic findings of 96 cases of ruptured anterior communicating artery aneurysms that were operated at the Department of Neurosurgery of Hanyang University Hospital from Jan. 1986 to June 1990. The results were summarized as follows ; 1) Asymmetricity of caliber of A1 was observed in 71.9%(69/96) and which was 3 times more frequent than that of reported incidence of control group(2~23%). 2) The incidence of predominance of left A1 was 54.2%(53/96) and that of right A1 was 17.7%(17/96). Among them, predominant A1 was operated as afferent artery of aneurysm in 94.2%(65/69). 3) Of 69 cases in which a unilateral A1 showed predominance, the direction of aneurysm was opposite to the side of predominant A1 in 66.7%(46/69) and ipsilateral to the predominant A1 in only 2.9%(2/69). 4) Above findings suggest that it is desirable to approach the anterior communicating artery aneurysm via the side of predominant A1 when the direction of aneurysm is uncertain on cerebral angiogram.
Aneurysm ; Arteries ; Cerebral Angiography ; Incidence ; Intracranial Aneurysm* ; Neurosurgery