Tibial plateau fractures are a common injury which often produce major disability. The extent of actural damage is always greater than that suggested by X-ray, a situation which, if not appreciated, can easily lead to a complacent surgical attitude. Although recent studies suggest that early knee motion and perhaps better surgical technique have improved clinical end-results, still recent series show unaccepatble results in 20-40 percent of cases. The authors analyzed the 37 cases of the tibial plateau fractures treated at the Department of Orthopaedics, Catholic University Medical College, Kang-Nam St. Mary's Hospital and following results were obtained. 1. The highest incidence was in the 5th decade and the next was 4th, and most frequent cases of trauma was pedestrian car accident(83%). 2. The most common fracture type was type VI by Schatzker classification and next was type II. 3. Among 37 cases, 27 were treated by open reduction and internal fixation and 14 out of those 27 cases meeded bone graft for the elevation of the tibial articular surface. 4. According to Blokker's criteria(1984), 32(86.6%) out of 37 cases had satisfactory result. Among 5 cases of unsatisfactory results 3 cases developed varus tilting of the tibial plateau more than 10 during the early stage (6–12 weeks post operation) of follow-up and those 3 were Schatzker's type VI fracture. 5. It is thought that open anatomical reduction of articular surface bone graft, internal fixation and early joint motion are the best way for the treatment of depressed or displaced fracture. 6. It is found tha Schatzker's type VI fracture has a tendency to develop varus tilting through the proximal tibial fracture before it unites completely.
Classification ; Follow-Up Studies ; Humans ; Incidence ; Joints ; Knee ; Tibial Fractures ; Transplants

Fractures of the hip in children are rare. The reported incidence is low. It is known that the force required to fracture the bone in childhood is of great magnitude. Rang(1983) reported several important differences between childhood and adult fractures. And Morrissy (1980) also reported differences in treatment. The complications of the femoral neck fractures in children are avascular necorsis, premature epiphyseal closure, nonunion, coxa vara, and infection. The reported incidence of avascular necrosis varies from 20 to 60 percent. Many methods of trestment for this complications are introduced up to now. However, a definite method could not be found. Therefore, we reported two cases of femoral neck fracture which complicated the avascular necrosis for whom non-weight bearing trestment after osteosynthesis were given for 16 and 25 months, respectively. In these two cases, we could obtain the following results. Fracture union was not hindered by avasculsr necrosis of the femoral head. Non-weight bearing could prevent the collapse of necrotic head, and seemed to help revascularization of the necrotic head.
Adult ; Child ; Coxa Vara ; Femoral Neck Fractures ; Femur Neck ; Head ; Hip ; Humans ; Incidence ; Methods ; Necrosis ; Prognosis

BACKGROUND: Recent studies have shown that blood transfusions, and especially red blood cells, are associated with potential adverse outcomes. This study was designed to investigate the effects of red blood cell transfusion according to the hematocrit on the clinical outcomes after cardiac surgery. METHODS: The 433 patients who were undergoing cardiac surgery were randomized to two groups. One group was transfused red blood cells with a hematocrit of 20%, and the other group was transfused red blood cells with a hematocrit of 20~25%. The amounts of intraoperative and postoperative transfusion and various parameters of the clinical outcomes were checked. RESULTS: In the hematocrit <20% group, the amount of infused crystalloid during operation was larger than that of the hematocrit >20% group, and the postoperative hemoglobin and hematocrit were lower than that of the hematocrit >20% group. But there were no differences of the amounts of intraoperative and postoperative transfusion, the use of inotropics, the platelet count, the prothrombin time (PT), the activated partial thromboplastin time (aPTT), the levels of aspartate aminotransferase (AST), the levels of alanine aminotransferase (ALT), blood urea nitrogen (BUN), serum creatinine (Cr), brain natriuretic peptide (BNP) and creatine kinase MB (CK-MB), the extubation time and the ICU stay time between the two groups. CONCLUSION: A hematocrit lower than 20% was tolerated by the cardiac surgical patients and it was not related to the postoperative morbidity and outcomes.
Alanine Transaminase ; Aspartate Aminotransferases ; Blood Transfusion ; Blood Urea Nitrogen ; Creatine Kinase ; Creatinine ; Erythrocyte Transfusion ; Erythrocytes ; Hematocrit ; Hemoglobins ; Humans ; Isotonic Solutions ; Natriuretic Peptide, Brain ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; Thoracic Surgery

BACKGROUND: Nefopam is a centrally acting non-opioid analgesic agent. Its analgesic properties may be related to the inhibitions of monoamine reuptake and the N-methyl-D-aspartate (NMDA) receptor. The antinociceptive effect of nefopam has been shown in animal models of acute and chronic pain and in humans. However, the effect of nefopam on diabetic neuropathic pain is unclear. Therefore, we investigated the preventive effect of nefopam on diabetic neuropathic pain induced by streptozotocin (STZ) in rats. METHODS: Pretreatment with nefopam (30 mg/kg) was performed intraperitoneally 30 min prior to an intraperitoneal injection of STZ (60 mg/kg). Mechanical and cold allodynia were tested before, and 1 to 4 weeks after drug administration. Thermal hyperalgesia was also investigated. In addition, the transient receptor potential ankyrin 1 (TRPA1) and TRP melastatin 8 (TRPM8) expression levels in the dorsal root ganglion (DRG) were evaluated. RESULTS: Pretreatment with nefopam significantly inhibited STZ-induced mechanical and cold allodynia, but not thermal hyperalgesia. The STZ injection increased TRPM8, but not TRPA1, expression levels in DRG neurons. Pretreatment with nefopam decreased STZ-induced TRPM8 expression levels in the DRG. CONCLUSIONS: These results demonstrate that a nefopam pretreatment has strong antiallodynic effects on STZ-induced diabetic rats, which may be associated with TRPM8 located in the DRG.
Animals ; Ankyrins ; Chronic Pain ; Diabetic Neuropathies ; Diagnosis-Related Groups ; Ganglia, Spinal ; Humans ; Hyperalgesia ; Injections, Intraperitoneal ; Models, Animal ; N-Methylaspartate ; Nefopam* ; Neuralgia* ; Neurons ; Rats* ; Streptozocin

BACKGROUND AND OBJECTIVE: Epidermal growth factor receptor(EGFR) and TGF beta1 have been known as a central regulator in airway remodeling. There have been some reports demonstrating expression of EGFR and TGF beta1 in airway mucosa of asthmatic patients. However, the expression of EGFR and TGF beta1 in bronchial epithelium of TDI-induced asthmatics has not been observed. The aim of this study was to observe expression of EGFR and TGF beta1 and evaluate their roles in pathogenic mechanism of TDI-induced asthma. METHODS: EGFR and TGF beta1 expression were compared using immunohistochemistry technique in bronchial mucosa from 22 subjects with TDI-induced asthma(group I: 10 newly diagnosed, group II: 12 TDI-induced asthma patients with persistent asthma symptoms for more than 5 years after diagnosis), 7 non-asthmatics undergoing pneumonectomy from lung tumor, and 3 healthy subjects. The intensity of expression was analyzed by two observers. The grade of intensity was presented from 0 to 3. Subepithelial basement membrane (SBM) thickness was measured using an image analyzer. RESULTS: EGFR expression was significantly higher in asthmatic patients than in wntrois (p>0.05), while no significant difference were nosed in TGF beta1 expression (p>0.05). There was no significant difference in EGFR expression between group I and II (p>0.05). However, grade of TGF beta1 expression was significantly higher in group II than those of group I (p<0.05). There was a significant difference in EGFR/TGF beta1 ratio between between group I and II (2.31+/-0.27 vs 1.28+/-0.11, p<0.05). SBM thickness of TDI-induced asthma was significantly higher than those of non-asthmatics (p<0.05), while there was no significant difference between group I and II (p>0.05). CONCLUSION: These findings suggest that EGFR and TGF beta1 may contribute to pathogenesis of TDI-induced asthma. However, further studies are required to evaluate the role of EGFR and TGF beta1 in the pathogenesis of TDI-induced asthma.
Airway Remodeling ; Asthma* ; Basement Membrane ; Epidermal Growth Factor* ; Epithelium ; Humans ; Immunohistochemistry ; Lung ; Mucous Membrane* ; Nose ; Pneumonectomy ; Receptor, Epidermal Growth Factor* ; Toluene 2,4-Diisocyanate* ; Toluene* ; Transforming Growth Factor beta1* ; Transforming Growth Factors*

BACKGROUND: Nefopam is a centrally acting non-opioid analgesic agent. Its analgesic properties may be related to the inhibitions of monoamine reuptake and the N-methyl-D-aspartate (NMDA) receptor. The antinociceptive effect of nefopam has been shown in animal models of acute and chronic pain and in humans. However, the effect of nefopam on diabetic neuropathic pain is unclear. Therefore, we investigated the preventive effect of nefopam on diabetic neuropathic pain induced by streptozotocin (STZ) in rats. METHODS: Pretreatment with nefopam (30 mg/kg) was performed intraperitoneally 30 min prior to an intraperitoneal injection of STZ (60 mg/kg). Mechanical and cold allodynia were tested before, and 1 to 4 weeks after drug administration. Thermal hyperalgesia was also investigated. In addition, the transient receptor potential ankyrin 1 (TRPA1) and TRP melastatin 8 (TRPM8) expression levels in the dorsal root ganglion (DRG) were evaluated. RESULTS: Pretreatment with nefopam significantly inhibited STZ-induced mechanical and cold allodynia, but not thermal hyperalgesia. The STZ injection increased TRPM8, but not TRPA1, expression levels in DRG neurons. Pretreatment with nefopam decreased STZ-induced TRPM8 expression levels in the DRG. CONCLUSIONS: These results demonstrate that a nefopam pretreatment has strong antiallodynic effects on STZ-induced diabetic rats, which may be associated with TRPM8 located in the DRG.
Animals ; Ankyrins ; Chronic Pain ; Diabetic Neuropathies ; Diagnosis-Related Groups ; Ganglia, Spinal ; Humans ; Hyperalgesia ; Injections, Intraperitoneal ; Models, Animal ; N-Methylaspartate ; Nefopam ; Neuralgia ; Neurons ; Rats ; Streptozocin

BACKGROUND: The prevalence of Helicobacter pylori (H. pylori) infection varies between countries and between social classes. The aim of this study was to identify risk factors for with Helicobacter pylori infection in asymptomatic Korean population. METHODS: Sera were collected from 2,687 females and 3,049 males (mean age, 29.1 y; range, 1 m-79 y) in Korea from Mar 1998 through Oct 1998. All asymptomatic subjects completed assessment questionnaires. An enzyme-linked immunosorbent assay was performed to detect IgG antibody to H. pylori. RESULTS: The overall seroprevalence observed was 46.6% and showed nostatistical diffrerence between female (45.9%) and male (47.2%). The seroprevalences in children (neonate-15 y) and adult (16-79 y) were 17.2% and 66.9%, respectively. According to multivariate analysis, variables such as sex, age, geographic area, crowding (number of person per room) in childhood, economic status in childhood, and types of housing in childhood were significantly and independently associated with H. pylori seroprevalence of adults. In children, age, geographic area, income, mother's education, and drinking water source were significant risk factors of H. pylori infection. CONCLUSION: Socioeconomic condition and close person to person contact in childhood are the significant determinants for H. pylori infection in adult. Drinking water source is an another important risk factor for H. pylori infection in children, suggesting the fecal to oral transmission in Korea.
Adult ; Child ; Crowding ; Drinking Water ; Education ; Enzyme-Linked Immunosorbent Assay ; Epidemiology ; Female ; Helicobacter pylori* ; Helicobacter* ; Housing ; Humans ; Immunoglobulin G ; Korea ; Male ; Multivariate Analysis ; Prevalence ; Risk Factors* ; Seroepidemiologic Studies ; Social Class ; Surveys and Questionnaires

BACKGROUND: GenediaTM H. pylori ELISA is a newly developed diagnostic method which detects serum anti-H. pylori IgG antibody. The aim of this study was to assess the accuracy of GenediaTM H. pylori ELISA for the diagnosis of H. pylori infection in Korean population. METHODS: GenediaTM H. pylori ELISA and GAP-IgG were performed in 353 adult sera and Pyloriset-IgG EIA in 184 subjects. In children, 43 serum samples were tested with GenediaTM H. pylori ELISA. H. pylori infection was determined by rapid urease test, histology, culture or 13C-urea breath test in adults. In children, the subject was considered to be H. pylori positive if 13C-urea breath test was positive. RESULTS: In adults, the sensitivity and specificity of GenediaTM H. pylori ELISA were 93.2% and 83.5% with positive and negative predictive values of 85.1% and 92.5%. Those for GAP-IgG and Pyloriset-IgG EIA were 67.2%, 82.4%, 79.3%, 71.4% and 89.1%, 88.4%, 71.9%, 96.1%, respectively. In children, sensitivity, specificity, positive and negative predictive values of GenediaTM H. pylori ELISA were 80%, 84.8%, 61.5%, and 93.3%. Sensitivity and negative predictive value of GenediaTM H. pylori ELISA were significantly higher than those of GAP-IgG (93.2% vs. 67.2%; plt;0.005 and 92.5% vs 71.4%; p<0.005, respectively). CONCLUSION: GenediaTM H. pylori ELISA is a relatively accurate method for the serodiagnosis of H. pylori infection in Korean subjects compared to GAP-IgG. These results may suggest the clinical use of GenediaTM H. pylori ELISA for epidemiological studies of H. pylori infection in Korea.
Adult ; Breath Tests ; Child ; Diagnosis* ; Enzyme-Linked Immunosorbent Assay* ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunoglobulin G ; Korea ; Sensitivity and Specificity ; Serologic Tests ; Urease

PURPOSE: Transforming growth factor-Bs (TGF-Bs) are prototypic multifunctional negative growth factors that inhibit the growth of many cell types. TGF-B type I and II receptors(RI, RII) are transmembrane receptors containing cytoplasmic serine/ threonine kinase domain and have been implicated in mediating TGF-B activity. Because a heteromeric complex of RI and RII is required for TGF-B signal transduction, cancer cells may reduce the expression of either RI or RII to escape from growth inhibition of TGF-B. We examined the correlation between the growth inhibitory activity of TGF-B1 and the genetic expression of RI &RII genes in human breast cancer cell lines. MATERIALS AND METHODS: We examined the growth inhibitory activity of TGF-B1 in 5 breast cancer cell lines by incorporation of [3H] thymidine. To investigate the correlation between TGF-B1 insensitivity and genetic change of TGF-B receptor genes (RI, RII), Southem blot analysis, Northern blot analysis, and Western blot analysis were performed. We also examined whether microsatellite instability(RER) was associated with RII mutation. RESULTS: We found that 3 breast cancer cell lines (MCF-7, YCC-B101, YCC-B151) were resistant to growth inhibitory effect of TGF-B1. MCF-7 cell line expressed no detectable RII mRNA and RII protein, but showed normal structure of RII gene and normal expression of RI gene. And we did not find any abnormal expression of mRNA, protein, and genetic structure of RI &RII in YCC-B101 and YCC-B151. CONCLUSION: Our results suggest that aquired resistance to the growth inhibitory effect of TGF-B1> could be transcription regulation system of RII in MCF-7 cell line, and could be postreceptor signal transduction pathway in YCC-B101 and YCC-B151 cell lines.
Blotting, Northern ; Blotting, Western ; Breast Neoplasms* ; Breast* ; Cell Line ; Cytoplasm ; Genetic Structures ; Humans* ; Intercellular Signaling Peptides and Proteins ; MCF-7 Cells ; Microsatellite Repeats ; Negotiating ; Protein-Serine-Threonine Kinases ; RNA, Messenger ; Signal Transduction ; Thymidine ; United Nations

BACKGROUND AND OBJECTIVES: We sought to investigate the relationship between levels of high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the infarct size and left ventricular (LV) volume after acute myocardial infarction (MI). SUBJECTS AND METHODS: Eighty-six patients with acute ST-elevation MI underwent delayed enhancement multidetector computed tomography immediately after they underwent percutaneous coronary intervention to determine the infarct size. LV function and remodeling were assessed by echocardiography. Hs-CRP and NT-proBNP were measured at admission, 24 hours and two months later. RESULTS: Both hs-CRP and NT-proBNP at 24 hours showed a positive correlation with infarct size and a negative correlation with LV ejection fraction at the baseline and two months later. NT-proBNP at two months correlated with infarct size, LV ejection fraction, and LV end diastolic and systolic volume indices at two months. In patients with high NT-proBNP levels at 24 hours and two months, infarct size was larger and LV ejection fraction was lower. NT-proBNP was higher in patients who developed LV remodeling at two months: 929 pg/mL vs. 134 pg/mL, p=0.002. In contrast, hs-CRP at two months showed no relationship to infarct size, LV function, or LV volumes at two months. CONCLUSION: Elevated hs-CRP level 24 hours after the onset of acute MI is associated with infarct size and LV dysfunction, whereas elevated levels of NT-proBNP 24 hours and two months after the onset of acute MI are both correlated with infarct size, LV dysfunction, and LV remodeling.
C-Reactive Protein* ; Echocardiography ; Humans ; Multidetector Computed Tomography ; Myocardial Infarction* ; Percutaneous Coronary Intervention