This review-article is aimed at shedding a light upon the nature of age-associated changes in the human skeletal system. When the anatomical, physiological and biochemical consequences of bone aging are considered together with the hardening, drying and the diminished repair capabilities of the elderly, it can be seen that fractures assume greater importance as a clinical problem in the geriatric population. Older people start out with a deficit of cortical bone, making them more fracture prone and once fractures occur, the necessary treatments (immobilization, use of casts, etc.) accelerate the rate of bone loss. In addition, aged individuals stand a higher risk for complications of the hospital and enforced bed rest that may ensue. The problems resulting from bone loss in the elderly may be partially alleviated by providing adequate health service support which should include consideration of the following points : 1. Age, sex and general health status ; 2. Habits and inclinations towards physical activities ; 3. Nutritional and endocrine background ; 4. Presence of any specific bone diseases, including osteoporosis, osteoarthritis, osteomalacia and ankylosis ; 5. Psychosocial adaptability and other behavioral elements.
Aged ; Aging ; Ankylosis ; Bed Rest ; Biology* ; Bone Diseases ; Health Services ; Humans* ; Motor Activity ; Osteoarthritis ; Osteomalacia ; Osteoporosis

This study was carried out to investigate pathogenesis of E. coli-induced cystitis by light and electron microscopy with immunocytochemistry. A group of ICR mice was intravesically given 0.3ml of E. coli DIE 174 lysate( 1000000000/ml). Another group was given E. coli lysate after acid solution(pH 4.5) washing for 30 minutes. The urinary bladders were observed at 2 hours and 24 hours after E.coli lysate irrigation. On light microscopy, submucosal edema, congestion, and perivascular neutrophilic infiltration occurred 2 hours after E. coli lysate irrigation. The congestion and acute inflammation were more pronounced 24 hours after. In cases of acid washing and E. coli lysate irrigation, mucosal acute inflammatory infiltration with edema and congestion was marked at early stage. Necrosis of transitional cells developed with time. On immunostain for E. coli, surface of transitional cells was stained 2 hours after E. coli lysate irrigation. At 24 hours after irrigation, intercellular spaces of transitional cells were stained. In cases of acid washing and E. coli lysate irrigation, entire mucosa was stained at early stage. Electron microscopically, transitional cells revealed increase of cytoplasmic processes, enlargement of cytoplasmic vesicles, and widening of intercellular spaces. There were large amounts of various shapes of lysosomes in neutrophils and monocytes infiltrated in the mucosa in acid washing groups. According to the above results, it is concluded that E. coli lysate may easily penetrate into the bladder mucosa and that the mucosal mucopolysaccharide plays as a barrier against bacterial invasion.
Animals ; Cystitis ; Cytoplasm ; Cytoplasmic Vesicles ; Edema ; Estrogens, Conjugated (USP) ; Extracellular Space ; Immunohistochemistry ; Inflammation ; Lysosomes ; Mice ; Mice, Inbred ICR ; Microscopy ; Microscopy, Electron ; Monocytes ; Mucous Membrane* ; Necrosis ; Neutrophils ; Urinary Bladder*

No abstract available.

We applied arthroscopy in the diagnosis of thirty four patients with internal derangement of the knee from March to August, 1982. Its results were compared with clinical diagnosis and arthrographic findings. We also performed arthrofomy in twenty nine patients and the final diagnosis enabled us to evaluate the diagnostic accuracy of each method. The accuracy of clinical diagnosis was 63.4%. Arthrographic findings were correct in 77.8%. The diagnostic accuracy of arthroscopy was 92.3% with one false negative case. Unnecessary operations were avoided in five patients with the assistance of negative findings of arthroscopy. Arthrography and arthroscopy were complementary in the diagnosis of internal derangement of the knee.
Arthrography ; Arthroscopy ; Diagnosis ; Humans ; Knee ; Methods

No abstract available.
Thyroid Gland* ; Thyroid Neoplasms*

Severe burns cause pathophysiological processes that result in mortality. A laboratory biomarker, red cell distribution width (RDW), is known as a predictor of mortality in critically-ill patients. We examined the association between RDW and postoperative mortality in severe burn patients. Methods: We retrospectively analyzed medical data of 731 severely burned patients who underwent surgery under general anesthesia. We evaluated whether preoperative RDW value can predict 3-month mortality after burn surgery using receiver operating characteristic (ROC) curve analysis, logistic regression, and Cox proportional-hazards regression analysis. Mortality was also analyzed according to preoperative RDW values and incidence of postoperative acute kidney injury (AKI). Results: The 3-month mortality rate after burn surgery was 27.1% (198/731). The area under the ROC curve of preoperative RDW to predict mortality after burn surgery was 0.701 (95% confidence interval [CI], 0.667–0.734; P < 0.001) with a cut-off point of 12.9. The adjusted hazard ratio in patients with RDW > 12.9 was 1.238 (95% CI, 1.138–1.347; P < 0.001). Subgroup analysis showed that the survival rate was 88.8% for the non-AKI group with RDW ≤ 12.9 and 17.6% for the AKI group with RDW > 12.9. Preoperative RDW was considered an independent risk factor for mortality (odds ratio, 1.679; 95% CI, 1.378– 2.046; P < 0.001). Conclusions: Preoperative RDW may predict 3-month postoperative mortality in patients with severe burns, while preoperative RDW > 12.9 and postoperative AKI may further increase mortality after burn surgery.

No abstract available.
Brain Stem* ; Classification* ; Hemorrhage*

PURPOSE: The clinical significance of preoperative serum levels of CEA and CA19-9, levels of CEA and CA19-9 in peritoneal washing fluid and free cancer cells in peritoneal washing fluid in gastric cancer patients were evaluated in this study. MATERIALS AND METHODS: Serum and peritoneal levels of CEA and CA19-9 and peritoneal washing cytology in 115 patients with gastric cancer were analyzed with respect to the prognostic factors using univariate and multivariate analysis. RESULTS: Positive rate of serum CEA and CA19-9 was 16.5%, 13.0%. And that of peritoneal washing CEA, CA19-9 and cytology was 15.7%, 7.8% and 9.6%. A univariate analysis showed that tumor markets in serum and peritoneal washing fluid and peritoneal washing cytology had significant correlations with the progression of the tumors, and patients with positive serum or peritoneal tumor markers had poorer survival after operation than did the patients with negative tumor markers. But in a multivariate analysis showed that only peritoneal CA19-9 was an independent risk factor. And combination of these five markers provided rnore predictable prognostic informations in a multivariate analysis. CONCLUSION: Combination of serum or peritoneal levels of CEA, CA19-9 and washing cytology appeared to be a useful marker for managing gastric cancer patients.
Humans ; Multivariate Analysis ; Risk Factors ; Stomach Neoplasms ; Biomarkers, Tumor

PURPOSE: Sling procedures have been used successfully for the treatment of all type of female stress urinary incontinence. Polypropylene mesh has more biocompatibility with less erosion rate over other synthetic sling materials. We investigated the objective, subjective success rate, satisfaction on pubovaginal sling operation using polypropylene mesh in stress urinary incontinence women. MATERIALS AND METHODS: Between November 2001 and July 2002, thirty three women with stress urinary incontinence underwent polypropylene mesh sling procedure were analyzed. Preoperative evaluations included the patient's history, a physical examination, urinalysis, a urodynamic test, incontinence staging with Stamey grade, Balivas type, and so forth. A 1.5x20cm polypropylene mesh was placed under the bladder neck to proximal urethra. Postoperatively, the patients were evaluated with a symptom questionnaire, physical examination, uroflowmetry, and postvoid residual volume at 3 day, 3 months. RESULTS: The average follow-up period was 164.6 days (minimum; 2 months). The average operation time was 83.6 minutes (including the anesthesia). No major intra-operative, post-operative complication occurred. No patient has permanent retention, erosion, or repeated surgery. The 22 patients (66.7%) were completely continent, 11 (33.3%) had an improvement, subjectively. The 27 patients (81.8%) were completely continent, 6 (18.2%) had an improvement, objectively. The treatment result was showed satisfactory by all patients (very satisfaction; 20 (60.6%), satisfaction; 13 (30.4%)). The follow-up period, valsalva leak point pressure, Pdetmax, opened bladder neck at rest, preop. urgency, preop. and postop. urge incontinence, total score of preop. and postop. Urge syndrome were related to subjective success rate, satisfaction statistically (p<0.05). CONCLUSION: Placement of a polypropylene mesh under the bladder neck to proximal urethra provides a simple, safe, inexpensive and effective method to correct stress urinary incontinence.
Female ; Follow-Up Studies ; Humans ; Neck ; Physical Examination ; Polypropylenes* ; Surveys and Questionnaires ; Residual Volume ; Risk Factors* ; Urethra ; Urinalysis ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Urge ; Urodynamics

PURPOSE: Authors investigated the associated findings and their value in the diagnosis of anterior cruciate ligament(ACL) injury in MR image. MATERIAL AND METHODS: The knee MR images of 47 patients with ACL injury(complete; 24, partial; 23) and 61 patients with normal ACL confirmed by the knee arthroscopy or operation were reviewed retrospectively. The degree of anterior translocation of tibia and the degree of posterior cruciate ligament(PCL) buckling were evaluated. The prevalence and pattern of associated adjacent bone, ligament and meniscus injuries were studied. RESULTS: The means( +/- 2standard errors) of anterior translocation were different significantly in statistical analysis(p<0.001, student t-test) between injury group(7.51 +/- 1.16mm) and normal group(-0.56 +/- 0.92mm). In the level of 5mm of anterior translocation for the criteria of ACL injury, the sensitivity, specificity, accuracy were 78.7%, 89.5%, 84.3% for each. The means of PCL buckling ratio were also different statistically b. etween injury group(0.23 +/- 0.02) and normal group(0.17 +/- 0.01)(p<0.001). In the level of 0.20 for diagnostic criteria of ACL injury, the sensitivity, specificity, accuracy were 71.4%, 83.6%, 78.4% for each. Thirty one medial meniscus tear(66%), thirteen lateral meniscus tear(28%), ten medial collateral ligament injury(28%), one PCL injury (2%) were associated with ACL injury. The twenty nine bone marrow changes were found in twenty patients {43%) which included acutely injured seven patients. In acute cases, the bone marrow changes were depicted as diffuse or focal high signal intensity lesions in lateral femoral or tibial condyles in contrast to the changes in chronic cases depicted as focal low signal intensity lesions in variable location. Lateral femoral condylar notch depression were found in nine patients(19%) and avulsion fractures of anterior tibial spine in four patients(9%). CONCLUSION: The associated findings with ACL injury (anterior translocation, buckling of PCL, associated bone, ligament and meniscus injuries) are considered to be helpful in the diagnosis of ACL injury on Knee MR images, when the findings of anterior cruciate ligament itself are not confirmative.
Anterior Cruciate Ligament* ; Arthroscopy ; Bone Marrow ; Collateral Ligaments ; Depression ; Diagnosis ; Humans ; Knee ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Prevalence ; Retrospective Studies ; Sensitivity and Specificity ; Spine ; Tibia