The fat embolism is a complication which occurs rarely in cases of long bone of lower extremity and pelvic bone fractures or after severe injury of soft tissue, and may result in an embolism in the lungs, brain, heart, kidneys and other important vessels when fat globules flow from bone marrow into such areas. There has been much adverse criticism about the pathogenesis of fat embolism including the incidence, diagnosis and treatment of it, and studies on this subject have been prevalent in recent years. The following results have been obtained through the study of 9 cases of fat embolism at the Department of Orthopaedic Surgery, Dong San Medical Center, Keimyung University during the period from 1973 to 1984. 1. By sex and age distribution, most of the patients were under the age of 40 and there were more male than female patients. 2. Seven cases were caused by traffic accidents and two were caused by falls accompanied by multiple fractures of the femur and pelvic bone. 3. Symptoms generally occured within 48 houres after trauma, however some cases were within 12 houres, some were 5 days and others 12 days. Clinical symptoms which were present at the time admission revealed increased erythrocyte sedimentation tates and decreased hemoglobin and platelete in most cases. Bilateral infiltrates and cotton ball appearances were found in all cases on thoracic radiology, but no fat globules were found in the urine or in frozen sections of clotted blood. 4. Blood gas analysis was performed in 4 cases and Pa02 under 60mmHg found in all cases increased gradually after treatment. 5. Of the 9 cases with fat embolism 6 cases completely recovered and three cases expired.
Accidental Falls ; Accidents, Traffic ; Age Distribution ; Blood Gas Analysis ; Blood Platelets ; Blood Sedimentation ; Bone Marrow ; Brain ; Clinical Study ; Diagnosis ; Embolism ; Embolism, Fat ; Female ; Femur ; Fractures, Multiple ; Frozen Sections ; Heart ; Humans ; Incidence ; Kidney ; Lower Extremity ; Lung ; Male ; Pelvic Bones

The Subtrochanteric fracture requires long period healing time and is difficult for treatment because it occurs in bone that is predominantly cortical and high stress concentrates in this region. The Subtrochanteric fracture is difficult for the reduction and maintenance because many of these fractures are comminuted from high velocity trauma and the angulation rotation occurs by the influence of the surrounding large and powerful muscles. During the period of February, 1980 to April, 1985, 62 cases of Subtrochanteric fractures were admitted and treated at the Department of Orthopedic Surgery, School of Medicine, Keimyung University, and results were obtained as follows: 1. Of 62 cases, 42 in man and 20 in woman and diffuse in ages. 2. Causes of Subtrochanteric fractures were 32 cases of traffic accidents, 21 cases of fall or slip down, 5 cases of others, and 3 cases of pathologic fractures. 3. Of 62 cases, Type I by Zickel classification was predominant (33 cases), and Type III-A, “three-part spiral fracture“ by Seinsheimer was predominant (24 cases). 4. The better results can be achieved through the bone graft in severe comminuted fracture and through the provision of good cortical load-bearing medially between the fragment during the reduction and fixation. 5. Earlier bone union and low complication of metallic failure and nonunion were achieved with Compression Hip Screw rather than Jewett nail. 6. The causes for the 6 metallic failure cases were comminuted fracture of medial cortical bone, failure in contact and fixation of medial free fragment, and weight bearing before complete union was achieved. 7. There was a breakage in nail-plate junction when Vitalium jewett nail was used. Also there were breakage and loosening of screws when Stainless steel Jewett nail was used. 8. Further studies in the advantages and disadvantages of Zickel nail, Ender nail, Compression Hip Screw, and Kuntscher nail treatment of subtrochanteric fracture are needed.
Accidents, Traffic ; Classification ; Clinical Study ; Female ; Femur ; Fractures, Comminuted ; Fractures, Spontaneous ; Hip ; Hip Fractures ; Humans ; Muscles ; Orthopedics ; Stainless Steel ; Transplants ; Weight-Bearing

Somatosensory evoked potentials(SEPs) reflect the functional integrity of the central neural pathways, and as such may be used to assess function that remains during variety of cerebral insults. To evaluate the utility of SEPs during cerebral ischemic deterioration due to aneurysmal subarachnoid hemorrhage, SEPs were measured in 43 patients with subarachnoid hemorrhage, among them 24 patients had no cerebral ischemic deterioration(group 1) and 19 patients had cerebral ischemic deterioration(group 2). In group 1, central conduction time(CCT) were measured on the day of admission(CCT1), the seventh day(CCT2), and the twenty-first day(CCT3) after aneurysmal rupture. In group 2, CCT were measured on the day of admission(CCT1), during(CCT2) and after resolution(CCT3) of cerebral ischemic deterioration. CCT2 of the both cerebral hemispheres were different significantly between two group(p=0.01). In group 2, there was stastically significantly difference between CCT1 and CCT2(p<0.01), and significant correlation between clinical grade and CCT was noted, especially in grade III, and IV. Therefore it is suggested that the central latencies of the SEPs are seemed to be a sensitive tools as indicators of the onset and extent of a cerebral ischemic deterioration due to aneurysmal subarachnoid hemorrhage.
Aneurysm* ; Cerebrum ; Evoked Potentials, Somatosensory* ; Humans ; Neural Pathways ; Rupture ; Subarachnoid Hemorrhage*

We have experienced 3 cases of dural arteriovenous malformation(AVM). Among them, 2 cases were traumatic and one case was congenital origin. The need for careful preoperative definition of all feeding vessels by selective cerebral angiography is stressed. Most frequent arterial feeders were the tentorial, middle meningeal, occipital artery and meningeal branches of vertebral artery. A complete neuroradiological investigation was essential for adequate treatment. Common symptoms were headache and troublesome tinnitus aurium. More serious neurological deficiencies may occur as result of disturbance in cerebral hemodynamics. Direct shunting of arterial blood into the transverse and sigmoid sinus caused a considerable increase of the sagital sinus pressure and elevation of intracranial pressure(ICP). ICP decreased following obliteration of dural AVM by muscle embolization with ligation of external carotid artery in one case. Operative isolation of the transverse sinus and sigmoid sinus by craniectomy or craniotomy and dural section is considered by far the most successful treatment. Purpose of this communication is, therefore, to describe the clinical and radiological features and various types of surgical procedure in 3 cases with dural AVM.
Arteries ; Arteriovenous Malformations* ; Carotid Artery, External ; Cerebral Angiography ; Colon, Sigmoid ; Craniotomy ; Headache ; Hemodynamics ; Ligation ; Tinnitus ; Vertebral Artery

BACKGROUND : Fibronectins (FNs) are adhesive glycoproteins that have variable primary structures owing to cell type-specific splicing of the FN precursor mRNA. FNs can be classified as plasma (p-FN) and cellular (c-FN) types, and c-FN may play a role as a marker of malignancies. CEA and CA 125 have been reported as useful tumor markers, but FNs have not studied adequately in gastric cancers. METHODS : We evaluated the clinical significance of urinary and plasma c-FN in thirty-five patients who were operated on our department due to gastric cancer from January 1997 to August 1997. The c-FN level was determined by enzyme immunoassay using a FIBRONECTIN EIA kit (Takara Shuzo Co., Kyoto, Japan). RESULTS : The levels of urine c-FN in gastric cancer patients (215.6 470.2) were higher than those in the control groups (94.1 63.0 ng/mgCr) and also showed a tendency to increase with advancing of tumor growth. A higher rate of increased urine c-FN also was identified in patients with distant metastasis than in patients without distant metastasis (6/8 vs. 10/27, p=0.05). However, p-FN didn't showed any differences according to extent of tumor invasion and/or presence of distant metastasis. Other parameters, such as age, sex, preoperative tumor size, and depth of invasion, were not correlated with urine and plasma c-FN. CONCLUSIONS : Urine c-FN may be useful as a new tumor marker in gastric cancer and can be helpful in early detection of metastasis and peritoneal seeding, but further studies and follow up are needed for complete clinical application.
Adhesives ; Biomarkers, Tumor ; Fibronectins* ; Glycoproteins ; Humans ; Immunoenzyme Techniques ; Neoplasm Metastasis ; Plasma ; RNA, Messenger ; Stomach Neoplasms*

We report various causes of acute abdominal aortic occlusion, a condition which is infrequent but usually ends catastrophically. The three cases are embolic occlusion by myxoma, thrombotic occlusion of aortic aneurysm, and thrombosis of an atherosclerotic aorta; the first two causes are very rare clinical presentations. All patients showed leg paralysis, pain, and severe ischemic symptoms. Diagnosis was done by emergent-CT (computed tomography) scan and surgery was performed urgently. Nevertheless, all patients died in the early postoperative period. As acute aortic occlusion is infrequent, its diagnosis may be delayed. The mortality rates remains high even with urgent surgical care.
Aorta ; Aorta, Abdominal* ; Aortic Aneurysm ; Diagnosis ; Humans ; Leg ; Mortality ; Myxoma ; Paralysis ; Postoperative Period ; Thrombosis

PURPOSE: Genomic instability of microsatellite in patients with defects in the mismatch repair system of DNA resulting in replication error (RER) has a high risk of accumulating mutations in oncogene and tumor suppressor gene. In this study, we evaluated the incidence of microsatellite instability (MI) in renal cell carcinoma (RCC) by comparing polymerase chain reaction (PCR)-amplified sequences from frozen samples of normal and tumor tissue from affected patients. MATERIALS AND METHODS: Analysis of MI using the PCR based assay was performed in total 25 cases of RCC, including 21 clear cell types and 4 papillary types. MI of tumor DNA was observed as the occurrence of additional or absence of constitutional autoradiographic signals, or as at least a two to threefold increase or decrease of intensity of the autographic signals in comparison to the corresponding normal tissue DNA. Total 11 microsatellite loci were studied; 4 loci at 3p (D3S1274, D3S1296, D3S1300, D3S1313), 3 loci at 9p (IFNA, D9S1747, D9S171) and 4 loci at 17p (D17S513, D17S695, TP53, D17S261). RESULTS: Twenty-one of 25 RCC (84%) displayed MI in at least one informative locus. MI was found in 15 of 25 cases (60%) at 3p region and 7 of 25 cases (28%) at 9p region. All of them were clear cell type of RCC. MI was detected in 11 cases (44%) at 17p region, 7 of them were clear cell type. In all 4 cases of papillary type, MI was observed only at 17p region. CONCLUSIONS: These results suggest that alterations of 3p region might occur in the early stage of tumorigenesis in RCC. The DNA mismatch repair system may play an important role in tumorigenesis of RCC and MI analysis could be a useful method to detect early genetic alterations in RCC. Genetic alterations in tumorigenesis of RCC may have some differences according to the histologic characteristics.
Carcinogenesis ; Carcinoma, Renal Cell* ; DNA ; DNA Mismatch Repair ; Genes, Tumor Suppressor ; Genomic Instability ; Humans ; Incidence ; Microsatellite Instability ; Microsatellite Repeats* ; Oncogenes ; Polymerase Chain Reaction

OBJECTIVE: The aim of this study was to assess the clinical outcomes and bone fusion rates after insertion of hollow cages or cages with bone substitutes for treatment of disc protrusion in the cervical spine. METHODS: We performed a retrospective review of 93 patients who had undergone cage-assisted anterior cervical spine fusion. Patients were treated with hollow cages (N=52) or with cages with bone substitutes (N=41). Initial and follow up radiologic data were analyzed using Vavruch bone fusion criteria. RESULTS: Clinical outcomes including preoperative and postoperative pain and functional scores were not significantly different between the two patient groups. The over-all fusion rates differed between the two groups: patients treated with hollow cages demonstrated an average fusion rate of 84.6%, while patients treated with cages with bone substitutes demonstrated an average fusion rate of 87.8%, but these differences were not significant 24 months after surgery. At 18 months after surgery, the fusion rates of patients treated with cages with bone substitutes were significantly different from those of patients treated with hollow cages. Among patients who received bone substitutes, patients who received DBM exhibited better fusion outcomes than patients treated with other bone materials after 18 months of follow-up. CONCLUSION: Patients who are surgically treated with anterior cervical spine fusion for disc protrusion using cages with bone substitutes may achieve earlier fusion than patients treated with hollow cages, although both groups show similar final fusion rates.
Bone Substitutes ; Cervical Vertebrae ; Female ; Follow-Up Studies ; Humans ; Pain, Postoperative ; Retrospective Studies ; Spinal Fusion ; Spine

PURPOSE: Virtual colonoscopy (VC) is a newly developing non-invasive technique used to detect polyps and cancers of the colon. The aim of this study is to assess the efficacy of VC in the detection of synchronous polyps or cancers in preoperative patients as well as metachronous polyps of postoperative colorectal cancer patients. METHODS: Both VC and conventional colonoscopy (CFS) were performed on 40 patients with colorectal cancer (10 cases of preoperative state and 30 cases of postoperative follow-up) during Sep. 2002 to June 2003 in Daegu Catholic Medical Centre, Catholic University of Daegu, Republic of Korea. The success rate and the detection rate of polyps or cancers along with the locations and sizes of masses and the findings of anastomotic site were compared between VC and CFS. RESULTS: The entire colon was clearly visualized by CFS in all cases. In the preoperative group, VC was successfully performed in 8 out of 10 cases (80%). 8 out of 10 cancers, 4 out of 4 polyps (5 mm or more in diameter) and 3 out of 6 polyps (5 mm or less in diameter) were identified. The success rate of VC in the postoperative group were 58% of low anterior resection (LAR) from cecum to hepatic flexure, 89% of LAR, 45% of right hemicolectomy (RHC) from hepatic flexure to splenic flexure, 63% of LAR, 45% of RHC from splenic flexure to sigmoid colon, and 53% of LAR, 72% of RHC in rectum. The causes of failure were inadequate bowel distension and retained fluid. In postoperative group, VC identified only 3 of 7 polyps(5 mm or more in diameter), 1 of 10 polyps (5 mm or less in diameter) and 1 of 1 recurrent cancer. The anastomotic site was clearly seen by VC in 9 of 19 cases (47%) of LAR and 3 of 11 cases (27%) of RHC. VC also identified 28 extracolonic findings. CONCLUSIONS: Although the efficacy of VC in postoperative colorectal cancer follow up seems to be disappointing, but it can be used as an alternative method for patients with incomplete conventional colonoscopy due to anastomotic site stricture or for other failed cases. Further technological advancement of VC is needed in order for it to replace conventional colonoscopy as a postoperative follow-up test.
Cecum ; Colon ; Colon, Sigmoid ; Colon, Transverse ; Colonography, Computed Tomographic* ; Colonoscopy ; Colorectal Neoplasms* ; Constriction, Pathologic ; Daegu ; Follow-Up Studies ; Humans ; Polyps ; Rectum ; Republic of Korea

BACKGROUND/AIMS: Despite of increasing numbers of reports on intraductal papillary mucinous tumor (IPMT), there is still difficulty in its' diagnosis, treatment and prediction of prognosis. The purpose of this multicenter study was to evaluate the clinico-pathological features of IPMT in Korea and suggest the prediction criteria of malignancy in IPMT. METHODS: We retrospectively reviewed the clinico-pathological data of 208 patients who underwent operations with IPMT between 1993 and 2002 at 28 institutes in Korea. RESULTS: Of the 208 patients with a mean age of 60.5+/-9.7 years, 147 were men and 61 were women. 124 patients underwent pancreatoduodenectomy, 42 distal pancreatectomy, 17 total pancreatectomy, 25 limited pancreas resection. Benign cases were 128 (adenoma (n=62), borderline (n=66)) and malignant cases were 80 (non-invasive (n=29), invasive (n=51)). A significant difference in 5-year survival was observed between benign and malignant group (92.6% vs. 65.3%; p=0.006). Of the 6 factors (age, location, duct dilatation, tumor appearance, main duct type, and tumor size) that showed the statistical difference in univariate analysis between benign and malignant group, we found three significant factors (tumor appearance (p=0.009), tumor size (p=0.023), and dilated duct size (p=0.010)) by multivariate analysis. CONCLUSION: Although overall prognosis of IPMT is superior to ordinary pancreatic cancer, more curative surgery is recommended in malignant IPMT. Tumor appearance (papillary), tumor size (> or =30 mm) and dilated duct size (> or = 12 mm) can be used as preoperative indicators of malig-nancy in IPMT.
Academies and Institutes ; Diagnosis ; Dilatation ; Female ; Humans ; Korea* ; Male ; Mucins* ; Multivariate Analysis ; Pancreas* ; Pancreatectomy ; Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Prognosis ; Retrospective Studies