OBJECTIVES: The purpose of this study was to evaluate and classify the synovium-like membrane as either inflammatory (foreign body-like) or immune (T-cells present), generated during the development of aseptic loosening in the patients with joint replacement arthroplasties. METHODS: We used the murine air-pouch model, developed in BALB/c mouse, to make artificial synovial cavity and assessed the cytokine responses of the synovium-like membrane to the particulate biomaterials such at pure titanium, Ti6Al4V alloy, CoCr alloy and UHMWPE. Each biomaterial injected into air-pouch of 20 mice respectively. The mRNAs of various cytokines (IL-1 beta, IL-6, TNFalpha, IL-4, gammaIFN) and TCR Calpha chain were extracted from the synovium-like membranes and RT-PCR reactions were carried out using appropriate primers. RESULTS: IL-1beta, IL-6 and TNFalpha showed an increased response to the all kinds of particulate biomaterials. IL-4, gammaIFN and TCR Calpha chain did not show any distinct responses compared to control group and various kinds of biomaterials failed to show any, significant differences from each other in cytosine responses. CONCLUSION: T-cell or immune cytokine responses had not been found in this particle reaction and it seemed to be that the osteolysis in aseptic loosening would be a biologic reaction to the particulate biomaterials due to an inflammatory process.
Alloys ; Animals ; Arthroplasty, Replacement ; Biocompatible Materials ; Cytokines ; Cytosine ; Humans ; Interleukin-4 ; Interleukin-6 ; Joints ; Macrophages ; Membranes* ; Mice ; Osteolysis ; RNA, Messenger ; T-Lymphocytes ; Titanium ; Tumor Necrosis Factor-alpha

Fixation failure is a major complication of intertrochanteric fracture. The causes of fixation failure were assessed in a series of 80 patients with intertrochanteric fractures, which had been internally fixed with either a sliding hip screw or a Gamma interlocking nail. The overall rate of fixation failure was 16.3%, in which the cutting-out of the implant from the femoral head was the only cause of the instance. The cutting-out rate was influenced by the accuracy of fracture reduction, the position of implant placement within the femoral head, and the bone mineral density. Anatomical reduction and the central placement of implant within the femoral head showed the most excellent results compared to other treatment modalities. Age, gender, fracture type and a kind of fixation implant had no significant effect. Our results showed that the intertrochanteric fractures should be reduced as anatomically as possible and it is essential that the central placement of the implant within the femoral head be obtained.
Bone Density ; Head ; Hip ; Hip Fractures* ; Humans

Aneurysmal bone cyst is relatively rare, benign tumor in the adolescent. An aneurymal bone cyst in the skull base is much more rare. This lesion is frequently accompanied with other conditions such as fibrous dysplasia, osteosarcoma, and chondroblastoma. The differential diagnosis is important;however it is difficult to make a correct diagnosis. The diagnosis is usually made from CT and pathological findings such as multi-lobulated, thin-walled cyst filled with blood. The treatment of choice is complete excision, if possible. We experienced a case of aneurysmal bone cyst arising from petrous bone, which was treated with transtemporal approach with partial excision. The patient remains free of symptom for 24 months with some tumor remaining in the clival area.
Adolescent ; Aneurysm* ; Bone Cysts* ; Chondroblastoma ; Diagnosis ; Diagnosis, Differential ; Humans ; Osteosarcoma ; Petrous Bone ; Skull Base* ; Skull*

Acrodermatitis enteropathica is a rare autosomal recessive disorder characterized by alopecia, acral and periorificial dermatitis and gastro-intestinal disturbances such as diarrhea. This syndrome is caused by malabsorption of zinc. The mean serum zinc level is usually low in untreated patients and the oral administration of zinc sulfate can clear the skin lesions and other symptoms. We report a three-month-old female baby with acrodermatitis enteropathica showing a normal serum zinc level in whom diapnosis was confirmed by typical skin lesions, clinical symptoms and response to oral zinc therapy.
Acrodermatitis* ; Administration, Oral ; Alopecia ; Dermatitis ; Diarrhea ; Female ; Humans ; Skin ; Zinc Sulfate ; Zinc*

OBJECTIVE: "Paraclinoid" aneurysms include those aneurysms arising from the internal carotid artery between the site of emergence of the carotid artery from the roof of the cavernous sinus and the origin of the posterior communicating artery. The authors reviewed and analysed the results of surgical approaches to paraclinoid aneurysms treated with transcranial surgery and endovascular surgery. METHODS: Between January 1998 and May 1999, 14 patients were treated surgically through ipsilateral and contralateral pterional approaches, and anterior interhemispheric approach, and endovascular surgery for paraclinoid aneurysms. All transcranial approaches were performed by same surgeon. The medical records, neuroimaging studies and videotapes which had been recorded operations were reviewed retrospectively. RESULTS: Twelve patients presented with subarachnoid hemorrhage and ICH. Nine of fourteen patients had multiple aneurysms. Thirteen cases were small and one was a large aneurysm. Six patients were treated through ipsilateral approaches, six contralateral pterional approaches, one anterior interhemispheric approach and one primarily by GDC embolization. All aneurysms treated through contralateral approaches were multiple aneurysms. Neck clipping was performed in 9(69.2%) of the thirteen aneurysms, wrapping in four cases, among them three cases were followed by GDC embolization. The surgical outcomes were: Glasgow Outcome Scale(GOS) I 71.4%, GOS II 21.4% and GOS V 7.1%. CONCLUSION: The surgical approaches to paraclinoid aneurysms should be chosen after careful anatomical evaluation of aneurysm and its neighboring structures. 3D-CT angiography and/or the raw data of MR angiography were useful. This study supports the usefulness of the contralateral approach to paraclinoid aneurysm associated with multiple aneurysms, unruptured and small aneurysms whose dome projecting medially, superiorly and dorsally. The determination of contralateral approach to small and medially projecting paraclinoid aneurysm may be stressful to operator, thus we believe anterior interhemispheric approach is better alternated. Also we recommend the endovascular surgery after reinforcement of aneurym neck and dome in the case with difficulty in clipping.
Aneurysm* ; Angiography ; Arteries ; Carotid Arteries ; Carotid Artery, Internal ; Cavernous Sinus ; Humans ; Medical Records ; Neck ; Neuroimaging ; Retrospective Studies ; Subarachnoid Hemorrhage ; Videotape Recording

For over a half centry, physicians have suspected that patients with duodenal ulcer are offered an insurance policy against gastric carcinoma. This may be used clinically so that gastric lesion in the presence of duodenal ulcer, are considered benign. However, the duodenal ulcer may coexit with gastric cancer, Although rare in incidence of coexistence of duodenal ulcer and gastric cancer, physician always should be alert in diagnosing of gastric lesion in the presence of the duodenal ulcer. Here, we present 60 years old woman with coexitence of duodenal ulcer and gastric cancer, diagnosed by endoscopy and treated surgically.
Duodenal Ulcer* ; Endoscopy ; Female ; Humans ; Incidence ; Insurance ; Middle Aged ; Stomach Neoplasms*

For many years, the histogenesis of the granular cell tumor was controversial and this resulted in the tumor being given more than 20 synonyms. Abrikossoff, reporting on the fiist granular cell tomor, favored a muscle origin, but other authora have postulated a fibroblastic or a histiocytic origin. Recently, the concept of Schwann cell origin, supported by electron microscopic studies and immunohistochemistry of S-100 protein, has gained wider recognition. Approximately 90 cases of esophageal granular cell tumor have been reported in the literature, representing about 2% incidence of all reported granular cell tumor, In Korea, only four cases of granular cell tumors were reported in the literatures including the cases occuring in the cecum, colon, and anus until now. Recently we experienced 46-years old women with granular cell tumor of the esophagus, which might be the second case in Korean literature.
Anal Canal ; Cecum ; Colon ; Esophagus* ; Female ; Fibroblasts ; Granular Cell Tumor* ; Humans ; Immunohistochemistry ; Incidence ; Korea ; Middle Aged ; S100 Proteins

PURPOSE: Cyclin D1 and bcl-2 are involved in cell proliferation and apoptosis in tumor development and are commonly expressed in breast cancer. But there are few clinical reports on the correlation between cyclin D1 and bcl-2 expression. This study was designed to analyze the correlations of cyclin D1 and bcl-2 and their clinical implications in breast cancer. METHODS: Immunohistochemical expression of cyclin D1 and bcl-2 were studied in 342 infiltrative ductal carcinoma cases and were compared with clinicopathologic parameters such as age, tumor size, histologic grade, lymph node status, p53, c-erbB2 and hormone receptors. RESULTS: Cyclin D1 expression was found in 86 of 342 cases (25.1%). Bcl-2 was positive in 227 of 342 cases (66.4%). Bcl-2 overexpression was associated with the high expression of cyclin D1 (p=0.001). Correlation was detected between both cyclin D1 and bcl-2 and hormone receptor positivity (p<0.001). There was a reverse correlation between bcl-2 and histologic grade, p53, c-erbB2. And the bcl-2 overexpression group showed better disease free survival rates at 3-year follow up. CONCLUSION: Higher expression of cyclin D1 was associated with bcl-2 overexpression. Positive estrogen receptor expression was associated with high cyclin D1 and bcl-2 expression. Bcl-2 tends to correlate with a positive clinical outcome.
Apoptosis ; Breast Neoplasms ; Carcinoma, Ductal ; Cell Proliferation ; Cyclin D1 ; Cyclins ; Disease-Free Survival ; Estrogens ; Follow-Up Studies ; Lymph Nodes ; Prognosis

The pigmented purpuric lichenoid dermatitis of Gougerot-Blum is a subtype of the pigmented purpuric dermatoses characterized by small red-brown lichenoid papules that coalesce to form plaque lesions. This disorder usually persists for months to years and is resistant to conventional therapy. Pentoxifylline has been used to treat various dermatologic diseases, but its effectiveness in pigmented purpuric lichenoid dermatitis has not been reported. We tried oral pentoxifylline treatment, 400mg twice a day on a 63-year-old man with pigmented purpuric lichenoid dermatitis. A response was observed within 2 weeks. And after 8weeks, the skin lesion showed much improvement and therapy was discontinned. Four month later, he had a recurrence on the leg. He was treated again with pentoxifylline and after 3 weeks, the recurrent lesion showed resolution.
Dermatitis* ; Humans ; Leg ; Middle Aged ; Pentoxifylline* ; Recurrence ; Skin ; Skin Diseases

BACKGROUND: Inducible heat shock protein 70s (iHSP70) are expressed by stressful stimuli that result in protein denaturation, and are thought to assist in the maintenance of cellular integrity and viability. In addition, iHSP70 is known to be a sensitive marker of neuronal injury. To my best knowledge, no previous studies have been documented on iHSP70 induction by nociceptive impulse transmission through peripheral nerves not by direct neural damage. The purpose of this study was to examine the hypothesis that iHSP70 can be expressed in the nervous system, which is related to the dental nociceptive pathway, by tooth pulp inflammation. METHODS: The pulp of rat mandibular molars was exposed. Animals were sacrificed at 1, 4, and 7 days after pulpal exposure, and the pulps were evaluated histologically. Also, iHSP70 levels were examined in the Gasserian ganglion (GG) and the trigeminal sensory nucleus (TSN). RESULTS: At 4 days after pulpal exposure, iHSP70 was significantly more expressed in the ipsilateral GG than in the contralateral GG. In the histological study, inflammation was found in the entire pulp tissue at 4 days. There were no significant differences in iHSP70 levels between the ipsilateral TSN and the contralateral TSN. Also, there were no significant differences in iHSP70 expression of GG and TSN between both sides at 1 and 7 days after pulpal exposure. CONCLUSIONS: These results suggest that iHSP70 can be expressed in the GG at 4 days after pulpal exposure by nociceptive impulses due to pulpal inflammation.
Animals ; Heat-Shock Proteins* ; Hot Temperature* ; HSP70 Heat-Shock Proteins* ; Inflammation ; Molar ; Nervous System ; Neurons ; Peripheral Nerves ; Protein Denaturation ; Rats* ; Tooth ; Trigeminal Ganglion