Allografts or autografts of bone-tendon unit have been used for ligament injuries or deficiencies after limb salvage operation for malignant bone tumors around joints. While the remodeling process of the ligament or tendon of the allograftor autograft and the microscopic and biomechanical changes of tendon-bone graft interface have been widely investigated, little is known about the ultrastructural and biochemical changes of the transitionall zone in tendon-bone junction. This study was performed to analyzed the ultrastructural and biochemical changes of the transitional zone after tendon-bone auto-and allo-grafting. A total of twenty four rabbits were divided into two group. In 12 animals(allograft group), two Achilles ten-don-bone unit per each animal were taken and transplanted to another rabbit after preservation below -70degrees C for 2 weeks. In the other 12 animals(autograft group), the Achilles tendon-bone unit was harvested from one side and transplanted to the other side of the rabbit. After operation, their legs were immobilized with short leg cast for 4 weeks, and then mobilized freely. Four animals in each group were sacrificed at four, eight and sixteen-weeks after the transplantation, and their grafted Achilles tendon-bone interfaces were used for analysis of the ultrasturctural and biochemical changes. The following results were obtained. 1. Histologically new cartilage cells were observed at postoperative 16 weeks with local presence of faint tidemark in the autograft group but not in the allograft group. Complete remodeling of the transitional zone had not observed histologically in both groups. 2. Ultrasturctural analysis revealed no definite differences between both groups. However, the slightly rapid appearance of parallelism and cross-striation of microfibrils in the autograft group and time-related restoration of fibers and fibroblasts were observed. 3. From biochemical analysis, type I collagen concentratin was increased, and an early rapid increase of type III collagen and glycosaminoglycan were also observed. In conclusion, these data suggested that type III collagen and glycosaminoglycan are important in stabilization of grafted tendon-bone unit, especially in the transitional zone. The histological and biochemical changes in allograft group were relatively similar to that of autograft group although the allograft group showed the delayed pattern of remodeling. Therefore, the tendon- allograft could be used as a good substitute for the autograft for tendon or ligament reconstruction when no suitable autograft is available.
Allografts ; Animals ; Autografts ; Cartilage ; Collagen Type I ; Collagen Type III ; Fibroblasts ; Joints ; Leg ; Ligaments ; Limb Salvage ; Microfibrils ; Rabbits* ; Tendons ; Transplants*

No abstract available.
Giant Cell Arteritis*

Gastritis cystica superficialis (GCS) is a rare lesion which is characterized by glandular hyperplasia with regeneration and degeneration in the mucosa and muscularis mucosa. Recently, GCS is revealed as precancerous lesion, but most report has been associated with those found at the site of a gastroenterostomy. So, we report two cases with GCS who had not previous gastric surgery. A 45-year-old woman visited for epigastric discomfort and another 4Q-year-old woman for epigastric pain. They had not undergone any gastric surgery. The gastroscopy discovered one polyp on anterior wall of greater curvature, upper body and another polyp in the center of the fold of greater curvature, lower body. We removed it by snare polypectomy and the histologic finding showed the character of GCS.
Female ; Gastritis* ; Gastroenterostomy ; Gastroscopy ; Humans ; Hyperplasia ; Middle Aged ; Mucous Membrane ; Polyps ; Regeneration ; SNARE Proteins

PURPOSE: Leptin, a product of the ob gene, is a 16-KDa protein that is mainly expressed in the adipose tissue and involved in the regulation of body weight. Elevated levels of serum leptin is noted in pregnant woman and the placenta is the site of nonadipose tissue production of leptin. In this study, we investigated the effect of serum leptin concentrations on fetal growth to estimate the effect of leptin on fetal growth. METHOD: Leptin concentrations were measured in venous and arterial cord blood and maternal serum at birth using a specific radioimmunoassay employing human recombinant leptin(Human Leptin RIA kit; Linco research, St. Louis, Mo). Thirty two full term pregnant women(n=32) had no medical complications and delivered the healthy babies(male=14, female=18). RESULTS: Serum leptin levels were 1.51 - 19,36 ng/ml(mean 7.16, SD 3.76) in arterial cord blood and 1.59 - 16.18(mean 7.47, SD 4.08) in venous cord blood and there was no difference between arterial and venous cord blood. Serum concentrations in arterial and venous cord blood were positively correlated with birth weight(r=0.7181, 0.6970; p<0.0001). There was no correlation in maternal BMI, maternal serum leptin and cord blood leptin concentrations. CONCLUSION: These findings suggest that cord blood leptin independently contributes to fetal body weight regardless of maternal serum leptin and body weight.
Adipose Tissue ; Birth Weight* ; Body Weight ; Female ; Fetal Blood* ; Fetal Development ; Fetal Weight ; Humans ; Hypertension, Pregnancy-Induced* ; Leptin* ; Parturition* ; Placenta ; Pregnancy* ; Pregnant Women ; Radioimmunoassay

Fat embolism is a significant complication following total joint arthroplasty. Fat embolism syndrome has both pulmonary and neurologic manifestations that can be life threatening. But, with appropriate fluid management, adequate ventilation, and the prevention of hypoxemia, outcome is usually excellent. We experienced fat embolism following bilateral total knee replacement. A 65-year-old woman had a surgery under general anesthesia. There was no specific anesthetic problems during the operation. After bilateral tourniquet release, O2 saturation decreased to 85% and neurologic symptom was developed. With adequate supportive treatment including mechanical ventilation, she was cured without complication.
Aged ; Anesthesia, General ; Anoxia ; Arthroplasty* ; Arthroplasty, Replacement, Knee* ; Embolism, Fat* ; Female ; Humans ; Joints ; Neurologic Manifestations ; Respiration, Artificial ; Tourniquets ; Ventilation

Alexander disease (ALXD) is a rare demyelinating disease of the white matter of the brain that is caused by a mutation in the glial fibrillary acidic protein (GFAP) gene. The overexpression of GFAP in astrocytes induces a failure in the developmental growth of the myelin sheath. The neurodegenerative destruction of the myelin sheath of the white matter is accompanied by an accumulation of abnormal deposits of Rosenthal fibers in astrocytes, which is the hallmark of ALXD. The disease can be divided into four groups based on the onset age of the patients: neonatal, infantile, juvenile, or adult. Early-onset disease is more severe, progresses rapidly, and results in a shorter life span than late-onset cases. Magnetic resonance imaging and genetic tests are mostly used for diagnostic purposes. Pathological tests of brain tissue for Rosenthal fibers are definitive diagnostic methods. Therapeutic strategies are being investigated. Ceftriaxone, which is an enhancer of glial glutamate transporter (GLT-1) expression, is currently in clinical trials for the treatment of patients with ALXD. To date, there are no clinically available treatments. The cause, pathology, pathophysiology, inheritance, clinical features, diagnosis, and treatment of ALXD will be reviewed comprehensively.
Adult ; Age of Onset ; Alexander Disease* ; Amino Acid Transport System X-AG ; Astrocytes ; Brain ; Ceftriaxone ; Demyelinating Diseases ; Diagnosis ; Glial Fibrillary Acidic Protein ; Humans ; Magnetic Resonance Imaging ; Methods ; Myelin Sheath ; Pathology ; Wills

No abstract available.
Biopsy, Fine-Needle ; Neck

PURPOSE: We prospectively analyzed the clinical results of auto-iliac cancellous bone graft with autologous bone marrow mononucleated cell implantation for osteonecrosis of the femoral head. MATERIALS AND METHODS: In a prospective evaluation, 45 hips in 37 patients with osteonecrosis of the hip were treated with auto-iliac cancellous bone graft after core decompression combined with implantation of autologous bone marrow cells. The average duration of clinical follow up of the patients was 32 months. Core decompression of the femoral head was performed and most of the necrotic part of the head was removed. Auto-iliac cancellous bone grafting was then done to fill up the defect, and this was followed by cell therapy with implantation of autologous monocytes isolated from the iliac bone marrow. RESULTS: The mean Merle d' Aubigne and Postel score improved from 11.6 points preoperatively to 15.5 points. Collapse of the femoral head developed in 13 hips, of which 12 hips showed an extensive lesion on the preoperative radiogram. Total hip replacement surgery was performed in 9 hips: 8 hips were due to progressive collapse of the femoral head with clinical deterioration, and 1 hip was due to postoperative bacterial infection. The preoperative stages of the 8 hips that were converted to THRA were stage II in 1 hip, stage III in 4 hips and stage IV in 3 hips. The head preservation rate according to the preoperative stage was 94.4% in stage II, 77.8% in stage III and 66.7% in stage IV. CONCLUSION: Auto-iliac cancellous bone grafting combined with implantation of autologous bone marrow cells after core decompression showed a good clinical results on the short term follow-up. Long term follow-up studies are still necessary to validate this point.
Arthroplasty, Replacement, Hip ; Bacterial Infections ; Bone Marrow ; Bone Marrow Cells ; Bone Transplantation ; Decompression ; Follow-Up Studies ; Head ; Hip ; Humans ; Monocytes ; Osteonecrosis ; Prospective Studies ; Tissue Therapy ; Transplants

Thromboembolic complications (TECs) are clinically important sequelae of nephrotic syndrome (NS). The incidence of TECs in children is approximately 2%-5%. The veins are the most commonly affected sites, particularly the deep veins in the legs, the inferior vena cava, the superior vena cava, and the renal veins. Arterial thrombosis, which is less common, typically occurs in the cerebral, pulmonary, and femoral arteries, and is associated with the use of steroids and diuretics. Popliteal artery thrombosis in children has been described in cases of traumatic dissection, osteochondroma, Mycoplasma pneumoniae infection, and fibromuscular dysplasia. We report of a 33-month-old girl with bilateral iliac and popliteal arterial thrombosis associated with steroid-resistant NS due to focal segmental glomerulosclerosis. Her treatment involved thrombectomy and intravenous heparinization, followed by oral warfarin for 8 months. Herein, we report a rare case of spontaneous iliac and popliteal arterial thrombosis in a young child with NS.
Child* ; Child, Preschool ; Diuretics ; Female ; Femoral Artery ; Fibromuscular Dysplasia ; Glomerulosclerosis, Focal Segmental* ; Heparin ; Humans ; Iliac Artery ; Incidence ; Leg ; Mycoplasma pneumoniae ; Nephrotic Syndrome ; Osteochondroma ; Pneumonia, Mycoplasma ; Popliteal Artery ; Renal Veins ; Steroids ; Thrombectomy ; Thrombosis* ; Veins ; Vena Cava, Inferior ; Vena Cava, Superior ; Warfarin

PURPOSE: The etiology of hemolytic anemia can be classified as either cellular or extracellular defects of red blood cells. The aim of this study was to investigate the clinical and laboratory findings of hemolytic anemia concerning its etiological classification. METHODS: Clinical and laboratory findings of the patients with hemolytic anemia treated from January 1987 to May 2002 at Severance Hospital were analyzed retrospectively. They were divided into two groups based on the types of red cell defects(group I : erythrocytic defect, group II : extraerythro cytic defect). RESULTS: Twenty one cases were included in group I, thirty four cases in group II, and three cases were unclassified. In group I, nineteen cases(90.5%) were diagnosed as hereditary spherocytosis and were proved to have red cell membrane disorders while two cases(9.5%) were shown to have red cell enzyme deficiencies. In group II, thirteen cases(38.2%) were noted as autoimmune hemolytic anemia, eleven cases(32.4%) as traumatic or microangiopathic hemolytic anemia, four cases(11.8%) as drug induced hemolytic anemia, two cases(5.9%) were related with systemic lupus erythematosus and one case(2.9%) with malignancy. Hemoglobin at the time of diagnosis(7.5 g/dL vs. 6.2 g/dL, P< 0.05) and the incidence of splenomegaly(85.7% vs. 18.2%, P<0.05) were higher in group I though blood urea nitrogen(9.0/0.4 mg/dL vs. 27.8/1.6 mg/dL, P<0.05) was higher in group II. CONCLUSION: Comparing the clinical features of pediatric hemolytic anemia, we concluded as following: In cases associated with extraerythrocytic defect, blood tests revealed significant initial lower hematocrit with higher level of BUN and Cr while cases with erythrocytic defect, splenomegaly were more common noted.
Anemia, Hemolytic* ; Anemia, Hemolytic, Autoimmune ; Cell Membrane ; Classification* ; Erythrocytes ; Hematocrit ; Hematologic Tests ; Humans ; Incidence ; Lupus Erythematosus, Systemic ; Retrospective Studies ; Splenomegaly ; Urea