PURPOSE: This study characterizes the short-term outcomes of ceramic coated metal-on-metal (MoM) large head total hip arthroplasty (THA) in prospectively selected patients aged 70 to 75 years. MATERIALS AND METHODS: Eighteen patients (18 hips) between the ages of 70 and 75-years old with THA using ceramic-coated MoM large heads between June 2014 and December 2014 were evaluated. We prospectively selected patients younger than 70 years for bipolar hemiarthroplasty and older than 75 years for conventional THA. There were one case of osteoarthritis, 8 cases of femur neck fracture, and 9 cases of intertrochanteric fracture. All patients underwent clinical and radiological follow-up at 6 weeks, 6 and 12 months, and every year postoperatively. The mean duration of follow-up was 24.2 months (range, 18–34 months). RESULTS: The average Harris hip score at the final follow-up was 81.0, except one case which was ultimately converted to conventional THA due to acetabular cup loosening. Radiographically, mean acetabular cup inclination was 45.8°(range, 38–56°) and anteversion was 20.1° (range, 11–25°). The average femoral head size was 48.7 mm. All stems were neutral-positioned except 1 varus-positioned stem. There was 1 case of a soft tissue infection, 3 patients complained of persistent groin pain, and no dislocations occurred. CONCLUSION: Ceramic coated large MOM articulation (ACCIS) have many complications: cup loosening, groin pain, which can lead to fatal outcomes in the elderly patients. Especially in patients with communicated intertrochanter fracture (AO 31-A22, 23), careful attention should be paid to the choice of surgical option.
Acetabulum ; Aged ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Ceramics ; Dislocations ; Fatal Outcome ; Femoral Neck Fractures ; Follow-Up Studies ; Groin ; Head ; Hemiarthroplasty ; Hip ; Humans ; Osteoarthritis ; Prospective Studies ; Soft Tissue Infections

Chronic neutrophilic leukemia(CNL) is a rare disorder characterized by persistent neutrophilia of mature cell type without evidence of infection, hepatosplenomegaly, elevated neutrophil alkaline phosphatase score and the absence of Philadelphia chromosome We report a typical case of CNL with multiple myeloma(IgG-lambda type) in 68 years old female. Many neutrophils had toxic granule and vacuole. The peripheral blood smear showed neutrophlic leukocytosis(50,940/microliter, neutrophil 94%) with rare immature form. The cytogenetic study showed normal karyotype without Philadelphia chromosome. She was diagnosed as multiple myeloma with paraproteinemia, lytic bone lesion of skull, and immature plasma cells in bone marrow.
Aged ; Alkaline Phosphatase ; Bone Marrow ; Cytogenetics ; Female ; Humans ; Karyotype ; Leukemia, Neutrophilic, Chronic* ; Multiple Myeloma* ; Neutrophils ; Paraproteinemias ; Philadelphia Chromosome ; Plasma Cells ; Skull ; Vacuoles

Upper gastrointestinal bleeding occurs so rapidly that emergency measures are required to avoid exsanguination. Many diseases cause bleeding from the gastrointestinal tract. Patients with upper gastrointestinal bleeding must be quickly assessed and resuscitated. An endoscopy is the diagnostic procedure of choice because of its high rate of accuracy and immediate therapeutic potential. An endoscopy however, must be performed only following adequate resuscitation and clinical assessment of the patient. Recently, reports have described the usefulness of endoscopic O-ring band ligation in the management of upper gastrointestinal bleeding. Endoscopic O-ring band ligation is mucosal ligation using intraluminal negative pressure with an elastic O-ring. We performed an emergency endoscopy in 3 patients who had massive or recurrent episodes of upper gastrointestinal bleeding, identified as having resulted from Dieulafoy lesion and Anisakiasis. We tried to perform an endoscopic ligation using an O-ring band, and were successful in achieving hemostasis. Our conclusion is that endoscopic ligation using an O-ring band can be used effectively to control active upper gastrointestinal bleeding resulting from Anisakiasis and a Dieulafoy lesion.
Anisakiasis ; Emergencies ; Endoscopy ; Exsanguination ; Gastrointestinal Tract ; Hemorrhage* ; Hemostasis ; Humans ; Ligation* ; Resuscitation

BACKGROUND AND OBJECTIVES: Reinke's edema is defined as swelling confined to the space underneath the epithelial layer known as Reinke's space. Patients suffering from Reinke's edema are known to have abnormally low fundamental frequency and high subglottic pressure. We compared the preoperative and postoperative voice results of Reinke's edema to evaluate quantitative changes of vocal function. MATERIALS AND METHODS: The voice analyses of 15 patients, who were diagnosed with Reinke's edema from 1997 January to 1998 September in Seoul National University Hospital, and 15 normal controls were undertaken with Multi-dimensional voice program (MDVP) and Aerophone II of Kay system. Eight preoperative patients, 13 postoperative patients, and 6 preoperative and postoperative patients were analyzed with respect to fundamental frequency (F0), pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ), noise-to-harmonic ratio (NHR), subglottic pressure (Psg), mean vocal efficiency, mean flow rate (MFR), maximum phonation time (MPT), and contact quotient (CQ). Using videostrobokymography, vibratory patterns of vocal folds were analyzed. RESULTS: The fundamental frequency was lower than the normal preoperative and postoperative values. The PPQ, APQ, and NHR were decreased to the normal value after operation. The subglottic pressure, although elevated preoperatively and decreased postoperatively, remained high. The mean vocal efficiency was increased to average value of normal controls after operation. The MFR, MPT, and CQ were not correlated with the course of Reinke's edema. The vocal folds vibration returned to regular pattern after operation on videostrobokymography. CONCLUSION: The fundamental frequency and subglottic pressure are not normalized after operation, and the PPQ, APQ, and NHR are good parameters of postoperative voice results. The voice therapy might help to correct the vocal habit of voice abuse and prevent recurrence after operation.
Edema* ; Humans ; Phonation ; Recurrence ; Reference Values ; Seoul ; Vibration ; Vocal Cords ; Voice*

BACKGROUND AND OBJECTIVES: Palatine tonsils and adenoids protect the human body from various pathogens entering through the pharyngeal mucosa. Many studies have been performed for the specific immunity, but the innate immunity related to cell-mediated immunity has been rarely studied. Natural killer (NK) cells, CD5+ B lymphocytes, and gamma sigma T lymphocytes are the key mediators of natural immunity. The aim of this study was to investigate the role of lymphocytes related to the innate immunity property in these lymphoid tissues by examinig the frequency and distribution of these cells. MATERIALS AND METHODS: Palatine tonsils and adenoids were obtained from 12 children and 5 adults with idiopathic tonsillar hypertrophy. Immunohistochemisty was performed to examine the distribution of the CD5+ B lymphocytes, gamma sigma T lymphocytes and NK cells, and the flow cytometry was performed for the frequency of these cells compared with that of the patient's blood. RESULTS: On immunohistochemistry, CD5+ B cells were strongly stained mainly on the interfollicular and subepithelial areas of both the palatine tonsil and adenoid. But, gamma sigma T lymphocytes, and CD56+ cells were weakly stained on the interfollicular, epithelial, and subepithelial areas of both lymphoid tissues. Flow cytometry showed no difference in the frequency of CD5+CD19+ B cells and CD3+ gamma sigma T lymphocytes in these tissues compared to that of the blood. The frequency of NK cells of these tissues was much lower than that of the blood. And the frequency of CD3+ gamma sigma T lymphocytes of adults was lower than that of children in both the palatine tonsils and blood. CONCLUSION: In the palatine tonsils and adenoids, there were no active immune cells related to innate immunity, except for the CD5+ B lymphocytes in the non-stimulating state. And the innate immunity of the lymphoid tissues has possibility of association with the changing activity according to age.
Adenoids* ; Adult ; B-Lymphocyte Subsets ; B-Lymphocytes ; Child ; Flow Cytometry ; Human Body ; Humans ; Hypertrophy ; Immunity, Cellular ; Immunity, Innate* ; Immunohistochemistry ; Killer Cells, Natural ; Lymphocytes* ; Lymphoid Tissue ; Mucous Membrane ; Palatine Tonsil* ; T-Lymphocyte Subsets ; T-Lymphocytes

Acute onset of shock presented in a 23 years old male patient due to gastrointestinal bleeding. He had been in a car crash 49 days before presentation. On initial presentation, a small amount of intraperitoneal hemorrhage had been seen on a CT scan. An emergency selective superior mesenteric artery (SMA) arteriography revealed a pseudoaneurysm in the branch of SMA, but successive embolization of the terminal branch controlled the bleeding. It is hard to initially diagnose an aneurysm as the cause of spontaneous gastrointestinal bleeding in a patient that has suffered an abdominal trauma, so it poses a therapeutic challenge. Recognition of an aneurysm, and its early diagnosis based on the patient's past history, and its adoption as a judicious diagnostic tool are essential in the management of such patients.
Aneurysm ; Aneurysm, False* ; Angiography ; Early Diagnosis ; Emergencies ; Hemorrhage* ; Humans ; Male ; Mesenteric Artery, Superior* ; Shock ; Tomography, X-Ray Computed ; Young Adult

BACKGROUND/AIMS: There have been only a few endoscopic studies of lower intestinal lesions of malignant lymphoma. The aims of this study were to classify the ileocolonic lymphomas according to the colonoscopic findings and to reveal the clinicopathological relationship according to the classes. METHODS: Subjects were 24 cases of ileocolonic lymphomas. We evaluated the clinicopathological features according to their endoscopic findings. RESULTS: The chief complaints were abdominal pain, bleeding, and abdominal mass. Twenty-six lesions from 22 patients, excluding 2 multiple lymphomatous polyposis, were endoscopically classified as follows: fungating (10 lesions), ulcerofungating (7 lesions), infiltrative (5 lesions), ulceroinfiltrative (3 lesions), and ulcerative (1 lesion). The location of the lesions was the terminal ileum in 11 lesions, the colon in 10 lesions, and both regions in 5 lesions. Within the large bowel, the cecum was involved most frequently, followed by the ascending colon and the remainder. Most of pathological types were the diffuse large cell and the large cell immunoblastic. There was no relationship between the endoscopic findings and the histologic types. Eight cases were manifested as intussusception. CONCLUSIONS: Ileocolonic lymphomas can be classified endoscopically into five types. Among the types, fungating and ulcerofungating types are the most frequent.
Abdominal Pain ; Cecum ; Classification* ; Colon ; Colon, Ascending ; Colonoscopy* ; Hemorrhage ; Humans ; Ileum ; Intussusception ; Lymphoma* ; Ulcer

BACKGROUND AND OBJECTIVES: In a recent multicenter trial probucol was found to reduce stent restenosis by improving the lumen dimension. The probucol was administered for 2 weeks before, and 4 weeks after, stenting. The release of the drug at the site of a vascular injury, via polymer-coated stents, helps achieve an effective local concentration. The feasibility of a probucol stent coating in reducing in-stent restenosis was assessed. MATERIALS AND METHODS: The probucol loading and in vitro release were assessed using BiodivYsioTM stents, in a 50 mg/mL probucol solution. After being dip-coated with probucol (n=8), or a control (n=8) solution, the stents were implanted in 8 pigs. Angiography and histopathological analyses were performed 28 days later. RESULTS: The total probucol loading was 52+/-16 microgram/stent, with no release for up to 72 hours after loading. No pig died until sacrifice. On angiography, the reference and minimum lumen diameters showed no significant differences between the two groups, with similar diameters stenosis (8.7+/-3.68 vs. 13.3+/-4.18%, p=0.120). On histomorphometry, the injury scores, vessel, lumen and neointimal areas showed no significant differences between the groups, with similar areas of stenosis (23.1+/-12.39 vs. 25.2+/-8.22%, p=0.671). The degrees of re-endothelialization, inflammation and smooth muscle cell proliferation were not significantly different. CONCLUSIONS: Probucol can be loaded onto a polymer-coated stent, and does not release from the stent for up to 72 hours after loading. About 52 microgram probucol per stent does not reduce in-stent restenosis in porcine coronary arteries.
Angiography ; Antioxidants ; Constriction, Pathologic ; Coronary Disease ; Coronary Vessels ; Inflammation ; Myocytes, Smooth Muscle ; Probucol ; Stents* ; Swine ; Vascular System Injuries

BACKGROUND: Carvedilol is a beta- and alpha-receptor blocker, a direct inhibitor of smooth muscle cell proliferation and migration, and produces a significant suppression of neointimal hyperplasia in rat carotid injury model. We tested whether carvedilol stent coating is effective in preventing neointimal formation in a porcine model of stent restenosis. METHODS: BiodivYsio phosphorylcholine-coated stents were dip-coated with carvedilol at the concentrations of 0, 7, 96 and 154 micrometer/stent by the immersion in a methanolic carvedilol followed by the evaporation of the solvent. Thirty-two stents, 8 stents per each concentration, were deployed in the porcine coronary arteries. The treatment effect was assessed at 28 days after stent implantation. RESULTS: Angiographic minimal lumen diameter and late loss index were similar among the four groups. On histomorphometry, neointimal area decreased by 58% and lumen area increased by 20%, resulting in a 58% reduction of percent in-stent stenosis in 7 micrometer carvedilol/stent (p=0.002, 0.008 and 0.004, respectively, 7 micrometer vs. 0 micrometer carvedilol/stent). Modest change in neointimal and lumen area was observed in 96 and 154 micrometer carvedilol/stent. A proliferating nuclear cell antigen-positive cells was noted 7.78 +/- 2.97% in 7 micrometer carvedilol/stent vs. 17.82 +/- 1.45% in 0 micrometer carvedilol/stent (p=0.0001). CONCLUSION: A Low dose carvedilol stent coating produces a significant inhibition of neointimal hyperplasia in a porcine model of stent restenosis. This study provides a potential therapeutic benefit of carvedilol coating in the prevention of human stent restenosis.
Animals ; Constriction, Pathologic ; Coronary Vessels ; Humans ; Hyperplasia ; Immersion ; Methanol ; Myocytes, Smooth Muscle ; Rats ; Stents*

Primary rectal mucosa-associated lymphoid tissue (MALT) lymphoma is a particularly rare disease, comprising <1% of gastrointestinal lymphomas. Although antibiotic therapy has been demonstrated effective for gastric MALT lymphoma, the optimal treatment for MALT lymphoma of the rectum is unknown. Radiotherapy or surgery is often used to treat limited stage MALT lymphoma of the rectum. Here, we describe a case of a 44-year-old-man, who was diagnosed with primary MALT lymphoma of the rectum through colonoscopy. Other staging evaluations, including upper gastrointestinal endoscopy, abdomino-pelvic CT, chest CT, 18F fludeoxyglucose-positron emission tomography, and a bone marrow examination showed no other abnormalities, except stage IA para-rectal lymphadenopathy. The patient received 2 months of radiotherapy without major toxicity. A follow-up abdomino-pelvic CT scan revealed marked improvement in the volume of rectal lymphoma and adjacent lymph nodes. Mucosal nodularity of the lower rectum had completely regressed at the follow-up endoscopy and complete remission was confirmed with a biopsy.
Biopsy ; Bone Marrow Examination ; Colonoscopy ; Endoscopy ; Endoscopy, Gastrointestinal ; Follow-Up Studies ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone ; Rare Diseases ; Rectum ; Thorax