Authors measured the bone marrow pressure(B.M.P.) of 59 femoral heads in cases of either suspicious or diagnosed osteonecrosis and obtained the significant relationship between increased B.M.P. and the osteonecrosis. Increased bone marrow pressure provided both predictive and early diagnostic importance in even the preclinical stage of evolution of the disease, which subsequently had core biopsy proved osteonecrosis of femoral head. The results obstained were as follows; 1. Roentgenographically apperent osteonecrosis showed abnormal B.M.P. pattern, which were proved by the core biopsy. 2. In 21 cases of preclinical osteonecrosis, which did not show roentgenographic changes of osteonecrosis, measured B.M.P. parterns indicated as early stage of osteonecrosis in core biopsy at all. 3. The incidence of abnormal pressure pattern I was 51% and that of pattern II was 30%. 4. Enneking radiological staging did not correlate with the results of B.M.P. 5. The measurement of B.M.P. is relatively easy and simple method without any remarkable risk. The results of this study had great meaning in emphasizing the contribution of the bone marrow pressure measurement dianosing the preclinical stage of osteonecrosis, which had no roentgenographical changes and diagnostic symptoms.
Biopsy ; Bone Marrow ; Head ; Incidence ; Methods ; Osteonecrosis

Severe limitation of knee motion is a complication of operative procedures or trauma about the knee. Physical therapy and occasionally manipulation of knee with anesthesia may improve results when performed soon after the onset of motion limitation. When performed later, these have been proven less useful. This is a review of 15 patients who had severe limitation of knee motion following open operative procedures or trauma about knee and were treated by percutaneous release of adhesions under arthroscopic control. There were eleven males and four females, ranging in age from 23-67years(mean 38 years). The interval between the last open operative procedure or trauma and arthroscopic adhesiolysis ranged from three and half months to four years(mean 11.5 months). The interval between arthroscopic adhesiolysis and final follow-up evaluation ranged from 6 months to 3 years(mean 1.5 years). Average preoperative knee motion was 38.2 degrees. After arthroscopic adhesiolysis, maximum knee motion under anesthesia was 120.3 degrees and average final motion at follow-up was 101.2 degrees. The results of treatment of treatment of Tbc knee sequalae with secondary osteoarthritis and pyogenic arthritis were less favorable for motion improvement. Arthroscopic adhesiolysis seems to be a useful method of treatment in knee ankylosis. Morbidity was low, complications were few and the duration of hospital stay was short.
Anesthesia ; Ankylosis ; Arthritis ; Arthroscopy ; Female ; Follow-Up Studies ; Humans ; Knee ; Length of Stay ; Male ; Methods ; Osteoarthritis ; Surgical Procedures, Operative

We studied about 437 patients(620 hips) who were diagnosed osteoncrosis of the femoral head in Kyung Hee University Hospital during last 15 years and analysed the epidemiologic distribution and relation with other diseases. In 437 patietns, nontraumatic femoral head necrosis(NTFHN) were 340 patients(77.8%) and traumatic femoral head necrosis(TFHN) were 97 patients(22.2%). The male was more affected in ratio of 4:1, especially higher in NTFH about 4.6:1. The peak incidence of age distribution was 4th and 5th decades. The most frequent probable etiologic factors in NTFN was idiopathic(137 patients, 40.3%) and followed by alcoholic(124 patients, 36.5%), steroid induced(53 patients, 15.6%). The cases of bilateral involvement in NTFHN were 182 patient(53.5%). The steroid induced cases(69.8%) were higher than other cases in bilaterality. Liver disease was the most frequent associated disease and it was followed by diabetes mellitus and renal disease. In steroid induced cases, the underlying causes of its medication were nephrotic syndrome(12 patients), arthralgia(8 patients) and dermatologic diseases(7 patients), etc. The abnormal findings of selologic studies in NTFN were hyperlipidemia(28.1%), hyperuricemia (17.0%) and increased transmainase(18.5%) and there was contact relationship between hyperilipidemia and increased transmainase. Marked declination of Harris score was found between stage II and stage III in the course progression of NTFHN. The annual incidence of femoral head osteoncerosis increased gradually
Age Distribution ; Diabetes Mellitus ; Epidemiology ; Head ; Humans ; Hyperuricemia ; Incidence ; Liver Diseases ; Male ; Osteonecrosis

We analyzed 34 extension contracture of the knee patients after modified Judet's procedure. Male patient was 32 and female was 2. Age ranged from 19 years to 61 years average being 34 years old. Follow-up period ranged from 12 months to 7 years and 8 months average being 3 years 8 months. 1. The extension contracture of the knee were due to not only scarring of the vastus intermedius but contractures of quadriceps muscles, and finally did lead to intraarticular adhesion in all cases. 2. The results of modified Judet's procedure were excellent or good in 97% and we concluded that the modified Judet's procedure of quadricepsplasty was good method of treatment in extension contracture of the knee. 3. The extension lag after modified Judet's procedures was increased initially but overcame by physical therapy, and did not significantly increase even after release of rectus femoris. 4. Modified Judet's procedure was able to permit early physical therapy without any skin problem.
Cicatrix ; Contracture ; Female ; Follow-Up Studies ; Humans ; Knee ; Male ; Methods ; Quadriceps Muscle ; Skin

The early diagnosis of osteonecrosis of the femoral head is difficult because the radiologic change usually appears after some pregression of the disease process. The value of bone marrow pressure measurement for esily detection of the osteonecrosis has been studied by many authors. We measured bone marrow pressure in avascular femoral head and compared with patient's age, stage of osteonecrosis and radiological types. And also we measured bone marrow pressure in osteoarthritic hip. The results were following:l. In 95% of osteonecrosis of the femoral head, BMP is increased. 2. There is no correlative change between BMP and radiological stage. 3. In steroid induced osteonecrosis, BMP increase is predominent after provocative test. 4. Radiological type seems to influence more significant BMP change than radiological stage. 5. The diagnostic accuracy of the early stage of osteonecrosis of the femoral head is 97% in average. 6. Osteoarthritic hip also shows increased BMP. 7. Baseline pressure is highest in greater trochanteric area, but subchondral area shows most sensitive change. 8. The provocative pressure is lower than baseline pressure in the necrotic center of the head. The increase of the BMP of the femoral head osteonecrosis not specific butvery sensitive. But the measurement of BMP of the femoral head is very useful method for early detection of AVN of the femoral head.
Bone Marrow ; Early Diagnosis ; Femur ; Head ; Hip ; Methods ; Osteonecrosis

Cleidocranial dysostosis is a rare congenital developmental disorder in which membranous bones fail to ossify sufficiently, particularily in the calvarium and the clavicles where fibrous tissue replaces the bone. Authors report two cases of cleidocranial dysostosis occurred in a 44-year-old woman and her 19-year-old son.
Adult ; Clavicle ; Cleidocranial Dysplasia ; Female ; Humans ; Mothers ; Skull ; Young Adult

BACKGROUND: Headache is one of the most common disorders, and shows ethnic or geographic diversities. Moreover, the prevalence and epidemiologic characteristics of headache, especially in people living in an island area, is lacking. Therefore, we investigated the prevalence and subtypes of headache in an island area of Korea. METHODS: We collected the demographic and clinical data of all residents living in the survey island area. A neurologist interviewed 352 respondents in a face-to-face method. The specific headache diagnosis was based on the diagnostic criteria of the International Headache Society. RESULTS: The survey island area represented a typical aging society like that of a rural area in Korea. Tension-type headache was the most common type. The prevalence of migraine, tension-type headache, and other headache were 4.0%, 7.1%, and 1.7%, respectively. Migraine with aura occupied 1.7% and migraine without aura occupied 2.3%. Episodic tension-type headache occupied 6.5% and chronic tension-type headache occupied 0.6%. Migraine showed a peak prevalence below the third decade of age and tension-type headache showed a peak prevalence above the sixth decade. CONCLUSIONS: This study showed a characteristic pattern of the prevalence of headache in an island area of Korea. We thought this low prevalence of headache might be due to not only subject age but also social-environmental factors. This study may be helpful in understanding headaches and can provide some basic information for future studies.
Aging ; Surveys and Questionnaires ; Diagnosis ; Epidemiology ; Headache* ; Korea* ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Prevalence ; Tension-Type Headache

BACKGROUND: Rosacea is a chronic skin disease which primarily affects the face. There have been many basic and clinical studies on rosacea in the West, but little in Korea. OBJECTIVE: This study was to investigate clinical features of rosacea in Korea and to compare them with those in the West. METHODS: During a 20-month period, 67 patients diagnosed as having rosacea were examined for their clinical presentations by means of personal interview. RESULTS: Erythema and telangiectasia were found in almost all of the 67 patients. Comparing with the results in the West, flushing and telangiectasia were more common whereas papules, pustules, and rhinophyma were less common with no case of ocular complaints or migraine. CONCLUSION: Because early detection and treatment is necessary to prevent the progression of rosacea, it is important to realize that rosacea is not uncommon in Korea and to recognize its somewhat different clinical manifestations from those in the West.
Erythema ; Flushing ; Humans ; Korea ; Migraine Disorders ; Rhinophyma ; Rosacea* ; Skin Diseases ; Telangiectasis

BACKGROUND: Goblet cell hyperplasia is a critical pathological feature in hypersecretory diseases of the airways. A bacterial infection of the lung is also known to induce inflammatory responses, which can lead to the overproduction of mucus. Recently, mucin synthesis in the airways has been reported to be regulated by neutrophilic inflammation-induced epidermal growth factor receptor (EGFR) expression and activation. In addition, it was reported that migration of the activated neutrophils is dependent on the matrix metalloproteinases (MMPs), especially MMP-9. In this study, bacterial lipopolysaccharide (LPS)-induced goblet cell hyperplasia and mucus hypersecretion by EGFR cascade, resulting from the MMPs-dependent neutrophilic inflammation were investigated in the rat airways. METHODS: Pathogen-free Sprague-Dawley rats were studied in vivo. Various concentrations of LPS were instilled into the trachea in 300microliter PBS (LPS group). Sterile PBS (300microliter) was instilled into the trachea of the control animals (control group). The airways were examined on different days after instilling LPS. For an examination of the relationship between the LPS-induced goblet cell hyperplasia and MMPs, the animals were pretreated 3 days prior to the LPS instillation and daily thereafter with the matrix metalloproteinase inhibitor (MMPI; 20 mg/Kg/day of CMT-3; Collagenex Pharmaceuticals, USA). The neutrophilic infiltration was quantified as a number in five high power fields (HPF). The alcian blue/periodic acid-Schiff (AB/PAS) stain were performed for the mucus glycoconjugates and the immunohistochemical stains were performed for MUC5AC, EGFR and MMP-9. Their expressions were quantified by an image analysis program and were expressed by the percentage of the total bronchial epithelial area. RESULTS: The instillation of LPS induced AB/PAS and MUC5AC staining in the airway epithelium in a time- and dose-dependent manner. Treatment with the MMPI prevented the LPS-induced goblet cell hyperplasia significantly. The instillation of LPS into the trachea induced also EGFR expression in the airway epithelium. The control airway epithelium contained few leukocytes, but the intratracheal instillation of LPS resulted in a neutrophilic recruitment. A pretreatment with MMPI prevented neutrophilic recruitment, EGFR expression, and goblet cell hyperplasia in the LPS-instilled airway epithelium. CONCLUSION: Matrix metalloproteinase is involved in LPS-induced mucus hypersecretion, resulting from a neutrophilic inflammation and EGFR cascade. These results suggest a potential therapeutic role of MMPI in the treatment of mucus hypersecretion that were associated with a bacterial infection of the airways.
Animals ; Bacterial Infections ; Coloring Agents ; Epidermal Growth Factor* ; Epithelium ; Glycoconjugates ; Goblet Cells ; Hyperplasia ; Inflammation ; Leukocytes ; Lung ; Matrix Metalloproteinases ; MMPI ; Mucins ; Mucus* ; Neutrophils* ; Rats ; Rats, Sprague-Dawley ; Receptor, Epidermal Growth Factor* ; Trachea

BACKGROUND: Goblet cell hyperplasia is a critical pathological feature in hypersecretory diseases of the airways. A bacterial infection of the lung is also known to induce inflammatory responses, which can lead to the overproduction of mucus. Recently, mucin synthesis in the airways has been reported to be regulated by neutrophilic inflammation-induced epidermal growth factor receptor (EGFR) expression and activation. In addition, it was reported that migration of the activated neutrophils is dependent on the matrix metalloproteinases (MMPs), especially MMP-9. In this study, bacterial lipopolysaccharide (LPS)-induced goblet cell hyperplasia and mucus hypersecretion by EGFR cascade, resulting from the MMPs-dependent neutrophilic inflammation were investigated in the rat airways. METHODS: Pathogen-free Sprague-Dawley rats were studied in vivo. Various concentrations of LPS were instilled into the trachea in 300microliter PBS (LPS group). Sterile PBS (300microliter) was instilled into the trachea of the control animals (control group). The airways were examined on different days after instilling LPS. For an examination of the relationship between the LPS-induced goblet cell hyperplasia and MMPs, the animals were pretreated 3 days prior to the LPS instillation and daily thereafter with the matrix metalloproteinase inhibitor (MMPI; 20 mg/Kg/day of CMT-3; Collagenex Pharmaceuticals, USA). The neutrophilic infiltration was quantified as a number in five high power fields (HPF). The alcian blue/periodic acid-Schiff (AB/PAS) stain were performed for the mucus glycoconjugates and the immunohistochemical stains were performed for MUC5AC, EGFR and MMP-9. Their expressions were quantified by an image analysis program and were expressed by the percentage of the total bronchial epithelial area. RESULTS: The instillation of LPS induced AB/PAS and MUC5AC staining in the airway epithelium in a time- and dose-dependent manner. Treatment with the MMPI prevented the LPS-induced goblet cell hyperplasia significantly. The instillation of LPS into the trachea induced also EGFR expression in the airway epithelium. The control airway epithelium contained few leukocytes, but the intratracheal instillation of LPS resulted in a neutrophilic recruitment. A pretreatment with MMPI prevented neutrophilic recruitment, EGFR expression, and goblet cell hyperplasia in the LPS-instilled airway epithelium. CONCLUSION: Matrix metalloproteinase is involved in LPS-induced mucus hypersecretion, resulting from a neutrophilic inflammation and EGFR cascade. These results suggest a potential therapeutic role of MMPI in the treatment of mucus hypersecretion that were associated with a bacterial infection of the airways.
Animals ; Bacterial Infections ; Coloring Agents ; Epidermal Growth Factor* ; Epithelium ; Glycoconjugates ; Goblet Cells ; Hyperplasia ; Inflammation ; Leukocytes ; Lung ; Matrix Metalloproteinases ; MMPI ; Mucins ; Mucus* ; Neutrophils* ; Rats ; Rats, Sprague-Dawley ; Receptor, Epidermal Growth Factor* ; Trachea