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

To evaluate the clinical significance of atrioventricular blocks in acute inferior myocardial infarction, we reviewed the clinical recordes of 75 patients who were diagnosed as acute inferior myocardial infarction with or without associated atrioventricular conduction blocks and compared the difference in clinical observation and laboratory data including coronary angiography between these two groups of patients. We also followed the clinical courses of atrioventrticualr block during admission among the patients with blocks. 1) 40% of 75 patients had atrioventricualr block associated with acute inferior myocardial infarction and there were 7 first-degree, 8 second-degree and 15 third-degree atrioventricular blocks. 2) There was no statistically significant differences between two groups in mean age ; Killip classification : incidence of previous prodromal angina ; incidende of associated initial symptoms such as dyspnea, nausea, and syncope ; risk factors such as smoking, hypertension and previous muocardial infarction and incidence of complication such as ventricular arrhythmias and heart faliure. 3) The peak serum CK(1,442.9+/-1,703.6 vs. 1,942.8+/-2,022.9IU/L, P<0.01)and LDH(1,014.7+/-429.7 vs. 1,579.2+/-1,544.9 IU/L, P<0.01) levels were significantly higher in the patients group with atrioventricualr blocks than in the patient grouop without blocks. 4) Left ventricualr resting ejection fraction obtained by radinuclide geted blood pool heart scan was significantly less in the patient group with atrioventricular blocks than in the patient group without blocks. 5) The prevalence of multivessel disease and that of associated left anterior descending artery lesion showe no differences between two patient groups. 6) Hospatal mortality of two patient groups were 9.8% and 16.6% respectively and had no statistical significance. 7) Among the patients who had associated atrioventricualr blocks, 70% of patients showed temporary course of block for mean 4.8days, and 6.7% developed permanent first degree block.
Arrhythmias, Cardiac ; Arteries ; Atrioventricular Block ; Classification ; Coronary Angiography ; Dyspnea ; Heart ; Humans ; Hypertension ; Incidence ; Infarction ; Inferior Wall Myocardial Infarction* ; Mortality ; Nausea ; Prevalence ; Risk Factors ; Smoke ; Smoking ; Syncope

BACKGROUND: Myasthenia gravis is an autoimmune neuromuscular disorder that shows increased sensitivity to nondepolarizing muscle relaxants. Atracurium is eliminated by Hofmann elimination and ester hydrolysis. We studied the onset and duration of atracurium in patients with myasthenia gravis. METHODS: Ten patients undergoing thymectomy for myasthenia gravis and ten patients of ASA Class I-II without liver, kidney and neuromuscular disease for orthopedic surgical procedures were assigned. Anesthesia was induced with thiopental (4~5 mg/kg) and maintained with inhalation of N2O:O2 (1:1) and enflurane (1.0~2.0 vol%). Atracurium (0.5 mg/kg) was given as a muscle relaxant and then intubation was performed after twitch response was depressed more than 80%. Neuromuscular relaxation was assessed by TOF (T1) at the adductor pollicis with supramaximal stimulation of ulnar nerve at 2 Hz every 12 seconds. The onset and the duration of 5, 25, 50, 75% recovery time of T1 and the recovery index were recorded. RESULTS: Onset of block was shortened and recovery time of 5, 25, 50, 75% and recovery index were prolonged in patients with myasthenia gravis. Conlusions: In patients with myasthenia gravis, atracurium induced rapid onset time and prolonged recovery time of 5, 25, 50, 75% and recovery index.
Anesthesia ; Atracurium* ; Enflurane ; Humans ; Hydrolysis ; Inhalation ; Intubation ; Kidney ; Liver ; Myasthenia Gravis* ; Neuromuscular Diseases ; Orthopedic Procedures ; Relaxation ; Thiopental ; Thymectomy* ; Ulnar Nerve

PURPOSE: As the incidence of primary hyperparathyroidism is on the increase, a 26-year experience of primary hyperparathyroidism is described along with a review of the literature. METHODS: A total of 113 patients underwent surgery at Seoul National University Hospital from 1981 to 2006. Age, sex, presenting symptoms, biochemical analyses, imagefindings, operative findings, histopathology, and information on follow-ups were retrospectively investigated. Furthermore, patients were divided into two period groups and comparative analysis was performed. RESULTS: Among the 113 patients, 41 patients (36.3%) were male and 72 patients (73.7%) were female. The mean age of the patients was 51 years. Thirty-two patients (28.3%) were incidentally discovered and among the symptomatic patients, the presence of a urinary stone was the most frequent presentation. The average serum calcium level and PTH level were 12.4 mg/dl and 452.36 pg/ml, respectively. The calcium level of all patients was normalized the day after surgery, and the PTH level of all patients was reduced remarkably after surgery. Preoperative imaging studies included ultrasonography, computer tomography (CT), and scans such as a (99m)Tc-sestamibi scan and a ²⁰¹Tl-⁹⁹Tc subtraction scan. The sensitivities of CT, the (99m)Tc-sestamibi scan and ²⁰¹Tl-⁹⁹Tc subtraction scan were 80.2%, 68.8% and 75.4%, respectively. Unilateral neck exploration was performed in 97 cases (85.8%), and bilateral neck exploration was carried out in the remaining 16 cases (14.2%). Histopathology revealed 102 cases (90.3%) of adenoma, 3 cases (2.7%) of hyperplasia, 7 cases (6.2%) of carcinoma, and one case that was indeterminate between adenoma and hyperplasia. Fifty-six patients (49.6%) developed transient hypocalcemia, and onepatient required a second surgery due to postoperative bleeding. There was one case of a recurrent carcinoma during a mean follow-up period of 18.7 months. CONCLUSION: Primary hyperparathyroidism is on the increase and is a surgically curative disease. Understanding the nature of the disease is necessary for detection and management.
Adenoma ; Calcium ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Hyperparathyroidism, Primary* ; Hyperplasia ; Hypocalcemia ; Incidence ; Male ; Neck ; Parathyroidectomy ; Retrospective Studies ; Seoul* ; Ultrasonography ; Urinary Calculi

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*

Marfan syndrome is an inheritable connective tissue with protean clinical manifestations involving the ocular, skeletal and cardiovascular system. It is well estabalished that a clinical hall marker and the major cause of morbidity in Marfan syndrome is aortic root dilatation and associated aortic dissection which begins just above the coronary ostia in ascending aorta. We report a rare case of Marfan syndrome with aortic dissection which began just below left subclavian artery in descending aorta. A 20-years old woman was admitted to Soonchunhyang hospital because of sudden onset of back pain. On phsical examination, she had characteristic Marfanoid feature. Chest X-ray and Echocardiography showed cardiomegaly and severe dilatation of ascending aorta. Chest CT and aortography showed severe aneurysm of ascending aorta and aortic dissection of descending aorta with intimal flap. she was treated with medical treatment because of poor general condition.
Aneurysm ; Aorta ; Aorta, Abdominal* ; Aorta, Thoracic ; Aortic Aneurysm* ; Aortography ; Back Pain ; Cardiomegaly ; Cardiovascular System ; Connective Tissue ; Dilatation ; Echocardiography ; Female ; Humans ; Marfan Syndrome* ; Subclavian Artery ; Thorax ; Tomography, X-Ray Computed ; Young Adult