Fractures of the phalanges of the hand are very common. Many are minor and likely to have a good result. However many other phalangeal fractures cause significant and prolonged disability. Non-union of the tubular bones of the hand are uncommon occurrence, but are often associated with functional deficits. The authors have reviewed 7 cases of non-union of the phalanges which were treated in the department of orthopaedic surgery, National Medical Center from 1978 to 1985. The results were summarized as follows: 1. The non-union of phalangeal bone was defined by clinical symptoms and signs and roentgenological examination. 2. The incidence of non-union of phalangeal bone fractures was 0.9% (7/771 cases.) 3. of 7 patients, there were 6 in male and 1 in female. 4. Non-union occurred more commonly in the second decade and the group between 10 and 30 years of age. 5. Seven cases, all were the right handed, but injury was developed in the left hands except two cases. 6. The causes of non-union were thought as open wound (7 cases), type of fracture (simple or comminution:3 cases), inadequate immobilization (4 cases) and overtraction (1 case). 7. of 7 cases, 4 cases were treated with bone peg graft and K-wire fixation and 2 cases with excision of distal fragment. 8. The clinical union was 9 weeks in average.
Clinical Study ; Female ; Fractures, Bone ; Hand ; Humans ; Immobilization ; Incidence ; Male ; Transplants ; Wounds and Injuries

No abstract available.
Animals ; Female ; Hysterectomy* ; Ovariectomy* ; Rats* ; Spine* ; Tibia*

Intravenous leiomyomatosis is a rare neoplasm characterized by intravenous growth of histologically benign smooth muscle cell tumor. We report a case of intravenous leiomyomatosis with right atrial extension in a 19-year-old woman. Various surgical techniques and approaches have been previously reported. In this case, the tumor was removed with a single-stage approach via laparotomy without cardiopulmonary bypass.
Cardiopulmonary Bypass ; Female ; Heart Atria* ; Humans ; Laparotomy ; Leiomyomatosis* ; Myocytes, Smooth Muscle ; Vascular Neoplasms ; Young Adult

BACKGROUND: The electrocardiogram may provide valuable information regarding the identity of the culprit coronary artery and the location of obstructing lesion within the artery, which may be of guidance in selecting the therapeutic modality. Previous studies have concluded that changes in lateral leads (I, aVL, V5, V6) are predictive of left circumflex coronary artery obstruction in inferior wall acute myocardial infarction. Elect-rocardiographic criteria for determining the location of the obstructing lesion, however, have not been well established. The purpose of this study is to investigate the patterns of ST segment depression in lateral leads in inferior wall acute myocardial infarction and the obstruction site of culprit artery according to ST segment depression in lateral leads. METHODS: We examined 78 patients with inferior wall acute myocardial infarction analizing their electrocardiogram and coronary angiography which performed during acute hospitalization. RESULTS: Of the fifty-five patients in which the culprit artery could be determined, 1)in 41 the culprit artery was the right coronary artery (19 proximal to the right ventricular branch and 22 distal), and in 14 the left circumflex coronary artery (7 proximal to the first obtuse marginal branch or involving a high first obtuse marginal branch, and 7 with distal obstruction). 2)Significant ST depression (ST< or =1 mm) in leads I and aVL was more common in right coronary artery obstruction (p<0.05 and p=0.01 respectively) than left circumflex artery. 3)It was difficult to define the location of obstruction with ST segment change of lateral precordial leads (V5, V6). CONCLUSIONS: In acute inferior wall myocardial infarction, ST segment depression in lateral limb leads (I, aVL) can be indicative of the right coronary artery obstruction and the ST segment depression pattern in lateral precordial leads was not indicative of the site of obstruction.
Arteries ; Coronary Angiography ; Coronary Vessels ; Depression* ; Electrocardiography ; Extremities ; Hospitalization ; Humans ; Inferior Wall Myocardial Infarction ; Myocardial Infarction*

PURPOSE: An animal model with experimental uremia is an important research tool for the study of pathophysiological events that take place during chronic renal failure. Among the several techniques of making uremic models, the two-stage 5/6 nephrectomized rat model is the most popular method, but this modality has some disadvantages. The aim of this study was to simplify the complicated method for experimental uremic animal models in the rat. MATERIALS AND METHODS: Forty Sprague-Dawley rats were used for this study. They were divided into three groups: 20 in the experimental group, 10 in the control group, and 10 in the Sham operation group. The ligation of the left renal vessels and 2/3 right renal partial nephrectomy using the 3-0 Silk tie of renal parenchyme were performed simultaneously in the experimental group. The BUN and serum creatinine were measured in all groups in intervals of every two weeks for a total time of nine weeks after nephrectomy. The kidneys of experimental rats were harvested and analyzed histologically. RESULTS: One week after operation, BUN and creatinine of the experimental group were increased compared to the control group and Sham operation group (p<0.001). At 9 weeks, increased levels of BUN and creatinine were maintained in the experimental group (p<0.001). Histologically, fibrotic changes of partially nephrectomized kidneys and decreased numbers of microorgans, such as the glomeruli and tubules, were observed in the experimental group. Four rats (4/20) in the experimental group died during this experiment. CONCLUSIONS: To induce chronic renal failure in rats, the one-stage procedure (2/3 nephrectomy using the suture tie and ligation of contralateral renal vessels) is an acceptable method with a low mortality rate.
Animals ; Creatinine ; Kidney ; Kidney Failure, Chronic* ; Ligation ; Models, Animal ; Models, Theoretical* ; Mortality ; Nephrectomy ; Rats* ; Rats, Sprague-Dawley ; Renal Insufficiency ; Silk ; Sutures ; Uremia

The diagnosis of allergic rhinitis in clinical practice is frequently based on a skin prick test. The measurement of serum levels of specific IgE can be used as an alternative test to the skin prick test. Therefore, we tried to demonstrate the relationship between a skin prick test and Fluoro-Allergo-Sorbent Test (FAST) system in allergic rhinitis patients. In this study, we evaluated the results of skin prick tests and FAST allergens in 90 patients who were confirmed to have allergic rhinitis. The agreement between the skin prick test and FAST was statistically significant for D. pteronyssinus and D. farinae, while less significant for the other allergens. FAST is time and cost-efficient in specific IgE detect, while it shows high-agreement for only a few allergens. As a result, it is considered that there will be some limit in applying the FAST.
Allergens ; Diagnosis ; Humans ; Immunoglobulin E ; Rhinitis* ; Skin*

Current therapies for autoimmune diseases are not cures but merely palliatives, aimed at reducing symptoms. For the most part, these treatments provide nonspecific suppression of the immune system and thus do not distinguish between a pathogenic autoimmune response and a protective immune response. Recently emerging evidence not only has indicated the involvement of members of the TNF receptor/ligand superfamilies but also has revealed exciting innovative strategies for the treatment of autoimmune diseases and other chronic inflammatory diseases without depressing the immune response in general. In this review, we will discuss the regulatory mechanisms of TNF receptor/ligand family members, such as HVEM/ LIGHT, 4-1BB/4-1BBL, and GITR/GITRL that regulate T and B cell functions and participate in the process of inflammatory diseases. We will also discuss how intervening in the costimulatory pathways mediated by these molecules might have some potential as a therapeutic approach to immune disorders.
Animals ; Apoptosis ; Autoimmune Diseases/immunology/metabolism/pathology ; B-Lymphocytes/immunology/physiology ; Dendritic Cells/physiology ; Human ; Inflammation/*immunology ; Lymphocyte Activation/immunology ; Models, Biological ; Receptors, Tumor Necrosis Factor/*physiology ; T-Lymphocytes/immunology/physiology ; Tumor Necrosis Factor/immunology/*physiology

BACKGROUND: The valve area derived from the Gorlin formula has been used clinically for decades as an index of severity on the assessiment of valve stenosis, in spite of some limitations on Gorlin formula studied in aortic stenosis and mitral bioprostheses. It had been shown that Gorlin valve area varied if the hemodynamic conditions during measurement are changed. Valve resistance has been proposed as an alternative hemodynamic indicator, but initially this index was not used because it was unlikely to remain constant at different flow rates. Recently valve resistance provided a better indices of hemodynamic obstruction than mitral valve area, and these stenotic indices usually estimated by angiographic method and we studied the valve resistance by Doppler echocardiographic measurement. METHOD AND RESULT: To compare the clinical implication about these stenotic indices measured by echcoardiography and cardiac catheterization, we studied 41 patients of mitral stenosis with normal sinus rhythm. The results were as follows ; 1) In catheterization, increased heart rate, mean pressure gradient and decreased diastolic time was observed, but mitral area, resistance, cardiac output and mitral flow was not different. 2) Linear regression analysis showed negative correlation of mitral valve resistance and Gorlin mitral area(echocardiography r=-0.84, catheterization r=-0.84)(p<0.001). 3) Correlation coefficeint of mitral valve area and mitral valve resistance between echocardiography(r=0.87) and catheterization(r=0.82) showed positive correlation(p<0.001). CONCLUSION: These results suggest that mitral valve resistance by echocardiography is a useful method in the evaluation of the severity of mitral stenosis.
Aortic Valve Stenosis ; Bioprosthesis ; Cardiac Catheterization* ; Cardiac Catheters* ; Cardiac Output ; Catheterization ; Catheters ; Constriction, Pathologic ; Echocardiography ; Echocardiography, Doppler* ; Heart Rate ; Hemodynamics ; Humans ; Linear Models ; Mitral Valve Stenosis* ; Mitral Valve*

Intravenous leiomyomatosis (IVL) is a rare neoplasm that is characterized by a histologically benigh-looking smooth muscle cell tumor growing within the uterine and the extrauterine venous system. We report here on patient had a uterine and extrauterine leiomyoma that extended into the right atrium through the inferior vena cava. A 19-year old female patient was suffering from dyspnea, swelling of the lower extremity, abdominal pain and abdominal distension. She had total abdominal hysterectomy performed at a private clinic due to uterine leiomyoma 4 months previously. 4 months after the first operation, we again completely excised the recurred intraperitoneal tumor mass. At 6 months after the re-operation, the tumor mass recurred intraperitoneally. A preoperative abdominal CT scan and an echocardiogram revealed multiple tumor masses that were located intraperitoneally and they extended to the right atrium. We performed intraperitoneal tumor excision and removal of the intravenous tumor mass via the right iliac vein by the one-stage approach. At present, the patient has shown a clinically favorable outcome except for local recurrence of tumor mass in the pelvic cavity. The cure of this complex disease emphasizes the need for a planned systemic approach by a multidisciplinary surgical team. We present here an unusual case of intravenous leiomyomatosis that originated from the uterus and it extended to the inferior vena cava and right atrium.
Abdominal Pain ; Dyspnea ; Female ; Heart Atria ; Humans ; Hysterectomy ; Iliac Vein ; Leiomyoma ; Leiomyomatosis* ; Lower Extremity ; Myocytes, Smooth Muscle ; Recurrence ; Tomography, X-Ray Computed ; Uterus ; Vena Cava, Inferior ; Young Adult

BACKGROUND: In this study, we examined diabetic patients scheduled for elective coronary artery bypass surgery to determine whether there is an association between autonomic dysfunction and intraoperative hemodynamic instability, and if perioperative autonomic function tests are effective predictors for diabetic patients at greatest risk for hemodynamic events during the intraoperative period. METHODS: We examined 52 patients, 25 without diabetes (nonDM group) and 27 with diabetes (DM group). Preoperative autonomic function tests included are the valslava maneuver (valsalva ratio, valsalva index, strain response), change in heart rate with deep breathing (I/E ratio), change in heart rate (30:15 ratio, stress response) and diastolic blood pressure (L-S(d)) while standing. Anesthesia was established with midazolam, fentanyl, isoflurane and vecuronium. Several hemodynamic variables such as heart rate (HR), mean arerial pressure (MAP), central venous pressure (CVP), mean pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure (PCWP), systemic vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), cardiac output (CO), and cardiac index (CI) were obtained at the following times: before induction; after induction; after intubation; after skin incision and after sternotomy. RESULTS: The DM group had a significantly diminished response compared with the nonDM group in the valsalva ratio, valsalva index, 30:15 ratio, and L-S(d). The remaining tests (I/E ratio, strain response, stress response) showed similar but nonsignificant diminished trend response in the DM group. Most patients had one or more abnormal test results in this group (76%), whereas in the control group most patients did not show any abnormal test results (74.1%). The comparison of hemodynamic response between the DM group and non-DM group reveal a significant difference between times within each group but not between groups. CONCLUSIONS: This study indicates that increased hemodynamic instability during the intraoperative period is not an obligatory association with diabetes and autonomic dysfunction and is not detected bypreoperative autonomic function tests in patients with coronary artery disease and diabetes mellitus when anesthesia is induced and maintained with a large dose of opioid and anesthetic agent which has minimal hemodynamic effects.
Anesthesia ; Blood Pressure ; Cardiac Output ; Central Venous Pressure ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Diabetes Mellitus ; Fentanyl ; Heart Rate ; Hemodynamics* ; Humans ; Intraoperative Period ; Intubation ; Isoflurane ; Midazolam ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Respiration ; Skin ; Sternotomy ; Vascular Resistance ; Vecuronium Bromide