1. Two hundred and fifty cases of fractures of the tibia treated at the orthopedic department of the Catholic Medical College during period of January, 1966 to September, 1971 were subjected to analysis. 2. The evaluation was done according to the classification of Ellis. Among 250 cases of the tibial fractures 120 being mild grade, 63 moderate grade and 67 severe grade. 3. Of 6 groups, 1st group was treated with toe to groin cast, 2nd group was treated with functional below the knee cast, 3rd group was treated with pin & plaster, 4th group was treated with 1–2 screw fixation & wiring, 5th group was treated with plate fixation and 6th group was treated with intramedullary nailing. 4. The healing time is almost proportional to the severity of the fracture grade and also the better prognosis largely depends on the mild grade. 5. We experienced 9 cases of non-union (3.6%), 19 cases of delayed union (7.6%) in most of moderate and severe grade.
Classification ; Fracture Fixation, Intramedullary ; Groin ; Knee ; Orthopedics ; Prognosis ; Tibia ; Tibial Fractures ; Toes

Blunt trauma severe enough to cause fracture of the long bones of the lower extremity may seriously damage adjacent arteries either by direct or indirect force. Diagnosis of disruption or thrombosis by this combination of injuries, is frequently delayed until the opportunity to salvage the extremity is lost. This error will result in an excessively high amputation rate. From September 1971 to August 1972, six Cases with or without fracture were treated at the Orthopedic Department of the Catholic Medical College. Of these six, three resulted in amputation by losing the chance to make the early diagnosis of injury.
Amputation ; Arteries ; Diagnosis ; Early Diagnosis ; Extremities ; Lower Extremity ; Orthopedics ; Thrombosis ; Vascular System Injuries

BACKGROUND AND OBJECTIVES: Mechanisms of restenosis following successful coronary angioplasty (PTCA) are knownasvascularsmoothmuscle cells(VSMCs)proliferationandmigration, elastic recoil or vascular wall remodeling. Paclitaxel whose effect on the stabilization of microtubles leads to cell death is highly lipophilic, permitting easy pass through cell membrane, and has a long-term antiproliferative effect. This study was performed to evaluate effect of paclitaxel on VSMCs proliferation and whether locally delivered paclitaxel can prevent stenosis and neointimal formation in rat carotid artery injury model. MATERIALS AND METHODS: Cultured VSMCs were exposed to sequential concentrations of paclitaxel in vitro, and proliferation inhibition was analyzed with 3H-thymidine incorporation. Paclitaxel of a suitable concentration was applied to the endothelium-denuded carotid artery of Fisher 344 inbred rats for 20 minutes. Angiogram and morphometric analysis of carotid artery was performed after 2 weeks. RESULTS: 3H-thymidine incorporation in cultured VSMCs was decreased dose-dependently from the concentration of 0.1 micromol/L (2,454+/-149cpm/ microgram protein) to 100 micromol/L (1,323+/-69cpm/ microgram protein) of paclitaxel by single and 20-minute exposure in the presence of platelet-derived growth factor (p<0.005). In the absence of platelet-derived growth factor, the decrement of 3H-thymidine incorporation was evident above the concentration of 5 micromol/L of paclitaxel. To evaluate in vivo effect, paclitaxel (0.1 or 1 micromol/L) was administered into the endothelium-denuded carotid artery by balloon injury and incubated for 20 minutes. Percent stenoses (32.2+/-9.8%) of paclitaxel-treated group was less than those (46.3+/-7.5%) of control group on histologic analysis (p<0.01). Paclitaxel-treated group also had wider lumen on carotid angiogram and less neointimal thickening than control on histologic examination (p<0.005). CONCLUSION: Proliferation of VSMCs was effectively inhibited and neointimal formation and luminal stenosis was prevented in rat carotid artery injury model by single, brief and local delivery of low-dose paclitaxel. This strategy could be applied to clinical settings for the prevention of restenosis after PTCA.
Angioplasty ; Animals ; Carotid Arteries* ; Carotid Artery Injuries ; Cell Death ; Cell Membrane ; Constriction, Pathologic ; Neointima ; Paclitaxel* ; Phenobarbital ; Platelet-Derived Growth Factor ; Rats*

BACKGROUND: Erythropoietin (EPO) is crucial to red blood cell regulation. Since the recombinant EPO was clinically available, it has been widely used in the treatment of anemia associated with disorders such as chronic renal failure, cancer and acquired immunodeficiency syndrome. Ex vivo therapy of recombinant EPO, however, requires large dose and frequent administration, which gives a financial impact to the patients. To make in vivo delivery system of EPO will be valuable to the patients who need EPO for a long time. METHODS: We have tried to make an in vivo EPO delivery system using transduced vascular smooth muscle cells with EPO gene in a rat model. Recombinant retroviral vector containing EPO gene was made employing LXSN and LNFX plasmid. Recombinant retrovirus was produced from PA317 packaging cell. Infection of the vascular smooth muscle cells with the virus and selection with G418 was done in vitro. These transduced cells were transplanted to the balloon-injured carotid artery, and hemoglobin and hematocrit as well as reticulocyte were measured in sequence. RESULTS: The virus titer was ten times greater in case of LNFEp than LEpSN, whereas EPO production from infected vascular smooth muscle cell was similar between LEpSN and LNFEp vectors (67mU/106cell/day and 68mU/106cell/day, respectively). The levels of hemoglobin and hematocrit increased gradually after transplantation of the transduced cells with LEpSN, reached to peak after 3 weeks (18.4+/-0.63gm/dL in case of hemoglobin and 50.7+/-0.62% in case of hematocrit) and remained thereafter. The percentage of reticulocyte was elevated from the 4th day to the 14th day after transplantation and returned to normal. CONCLUSION: The low dose required to the elevation of RBC mass and long sustained effect of transduced smooth muscle cell could make this gene therapy feasible to the clinical conditions.
Acquired Immunodeficiency Syndrome ; Anemia ; Animals ; Carotid Arteries ; Erythrocytes ; Erythropoietin* ; Genetic Therapy* ; Hematocrit ; Humans ; Kidney Failure, Chronic ; Models, Animal ; Muscle, Smooth, Vascular ; Myocytes, Smooth Muscle ; Plasmids ; Product Packaging ; Rats* ; Reticulocytes ; Retroviridae ; Viral Load ; Zidovudine*

PURPOSE: The safety of radiation therapy after breast reconstruction using transverse rectus abdominis myocutaneous(TRAM) flap is still being debated, and few studies exist on the outcome of irradiation after immediate TRAM breast reconstruction. Some authors presented satisfactory outcomes after adjuvant radiation therapy on reconstructed breast with pedicled TRAM flap, while others reported significant post radiation changes of the flap. Effect of radiation therapy on TRAM flap was evaluated to see whether adjuvant radiation therapy was tolerable. METHODS: 1000 immediate TRAM breast reconstruction was done by a single surgeon from July, 2001 to December, 2009. Among them 105 patients required adjuvant radiation therapy because of advanced disease or locoregional recurrence. Fat necrosis, radiation fibrosis, mastectomy skin flap necrosis, need for secondary touch up procedures, patient satisfaction were evaluated. RESULTS: The incidence of fat necrosis was 10.5% and significant radiation fibrosis occurred in only one patient. Delayed wound problem did not occur during or after irradiation. Secondary touch-up procedures were performed in 12.3%, the most common being fat graft(8.6%). Average patient satisfaction score was 8.62/10, which was not significantly different from the authors' previous report involving all the TRAM patients(8.50). CONCLUSION: Radiation therapy did not increase the complication rate significantly. Aesthetic result was affected but was tolerated in most cases. The fear of adjuvant radiation is not a negative factor in selecting immediate breast reconstruction with TRAM flap.
Breast ; Breast Neoplasms ; Fat Necrosis ; Female ; Humans ; Incidence ; Mammaplasty ; Mastectomy ; Necrosis ; Patient Satisfaction ; Radiation Pneumonitis ; Rectus Abdominis ; Recurrence ; Skin

BACKGROUND: Blood-foreign interaction cause activation of coagulation and inflammatory process that may lead to multiorgan dysfunction and determine the surgical outcomes.Of the methods for assessing the biocompatibility,the platelet adhesion study is considered as the most valuable evaluation step in blood-foreign interaction.As the most studies have used in-vitro or ex-vivo conditions,we have developed a technique of quantification for platelet adhesion on the blood contact surface by using in-vivo injection of radioactive platelets. MATERIAL AND METHOD: A coupled bypass circuit was designed to connect the proximal and descending thoracic aorta in 6 piglets(20~25 Kg).One side of the circuit tube was consisted of a heparin coated PVC tube(10mm in ID, n=6, Experimental group),and the other,a non-heparin coated PVC tube(10mm in ID, n=6, Control group).After cannulation,the blood was circulated through the circuit for 2 hours. Platelet concentrate was prepared from homologous pig blood 24 hours before the experiment.The platelet concentrate was incubated with Tc-99m-HMPAO for 30 min and then centrifuged for 10 min.The supernatant was discarded and the radio-labeling efficacy was measured.The radio-labeled platelet concentrate was mixed with the autologous plasma to make the volume 5 ml,and the mixture was injected intravenously into the experimental animal.After 2 hour circulation, 5 pieces of the specimen(10mm in length each)were obtained from each PVC tube.The radioisotopes were counted with a gamma counter(Cobra II,Packard,USA),and the ratio of radioisotope count was compared between the control and experimental group. RESULT: The radioisotope count number was 537.3221.1 Ci/min in the control group and 311.1 184.5 Ci/min in the experimental group(p=0.0104).The ratio between the groups was 1 to 0.58 (p=0.004). CONCLUSION: In vivo quantification using technetium-99m-HMPAO labeled platelets is simple and reproducible in evaluating platelet adhesion on a foreign surface.We suggest this technique to be a useful tool for blood compatibility test.
Aorta, Thoracic ; Blood Platelets ; Heparin ; Plasma ; Radioisotopes

PURPOSE: This study was performed to evaluate the treatment results, prognostic factors and complication rates in patients with locally advanced cancer of uterine cervix after radiotherapy with high-dose rate (HDR) brachytherapy. MATERIALS AND METHODS: One hundred and twenty patients with a locally advanced (stages IIB~IVA according to FIGO classification) carcinoma of the uterine cervix were treated with radiotherapy at the Department of Radiation Oncology, Samsung Medical Center between September 1994 and December 2001. The median age of the patients was 61 years (range 29 to 81). Sixty-one, 56 and 3 patients had FIGO stage IIB, III, and IV diseases, respectively. All patients were given external beam radiotherapy over the whole pelvis (median 50.4 Gy) and HDR intracavitary brachytherapy, with a median of 4 Gy per fraction, to point A. Twenty-one patients received chemotherapy, of which 13 and 21 received neoadjuvant chemotherapy and concurrent chemotherapy, respectively, during the first and fourth weeks of external beam radiotherapy. The chemotherapy was not randomly assigned and the median follow-up time was 28.5 months (range: 6~100 months). RESULTS: The three- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 64.4 and 57.0%, and 63.7 and 60.2%, respectively. The 5-year OS and DFS rates of the patients at stages IIB, III and IV were 602, 57.9 and 33.3%, and 57.4, 65.4 and 33.3%, respectively. Univariate analysis indicated that the FIGO stage, overall treatment time (OTT) and treatment response were significant variables for the OS (p=0.035, p=0.0649 and p=0.0009) and of the DFS (p=0.0009, p=0.0359 and p=0.0363). Multivariate analysis showed that the treatment response was the only significant variable for the OS (p=0.0018) and OTT for the DFS (p=0.0360). The overall incidence of late complications in the rectum and bladder were 11.7 and 6.7%, respectively. In addition, insufficiency fractures were observed in 7 patients (5.8%). CONCLUSION: The results of this study suggest that radical radiotherapy with HDR brachytherapy was appropriate for the treatment of locally advanced uterine cervix cancer. Also, the response after treatment and OTT are significant prognostic factors.
Brachytherapy ; Cervix Uteri* ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Fractures, Stress ; Humans ; Incidence ; Multivariate Analysis ; Pelvis ; Radiation Oncology ; Radiotherapy* ; Rectum ; Urinary Bladder

PURPOSE: To determine treatment policy for early stage endometrial carcinoma, we analyzed the results of postoperative radiotherapy. MATERIALS AND METHODS: From Oct. 1994 to Aug. 2002, 42 patients with FIGO stage I endometrial carcinoma received postoperative radiotherapy. All patients received curative surgery and pelvic lymph node dissection was done in 26 patients. Based on the FIGO staging system, 3 were at stage IA, 21 were at stage IB and 18 were at stage IC. Histologically, there were 14 grade 1, 16 grade 2, and 12 grade 3. Nineteen patients received intracavitary brachytherapy and 23 patients did whole pelvic radiotherapy. The median period of follow-up was 41 months (22 to 100 months). RESULTS: Five-year overall survival, disease-free survival, local control, and regional control rates of all patients were 86.0%, 87.9%, 100%, and 97.5%, respectively. All failures were distant metastases in 5 patients and two patients had simultaneous regional recurrences. There was no intrapelvic failure in patients who received intracavitary radiotherapy. Grade 3 chronic complications were found in 1 patient (4.3%), who received whole pelvic radiotherapy. CONCLUSION: We achieved high rates of loco-regional control and survival by curative surgery and postoperative radiotherapy. However, we need to select the type of radiotherapy based on the risk factors for recurrence to reduce the treatment-related complication.
Brachytherapy ; Disease-Free Survival ; Endometrial Neoplasms* ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Neoplasm Metastasis ; Radiotherapy* ; Recurrence ; Risk Factors

BACKGROUND: The aim of this study was to investigate the prevalence, clinical and laboratory findings of hereditary hemolytic anemia (HHA) in Korea from 1997 to 2006 and to develop the appropriate diagnostic approach for HHA. METHODS: By the use of questionnaires, information on the clinical and laboratory findings ofHHA diagnosed from 1997 to 2006 in Korea was collected and analyzed retrospectively. A total of 431 cases were enrolled in this study from 46 departments of 35 hospitals. RESULTS: The overall frequency of HHA did not change through the 10-year period for pediatrics but did show an increasing tendency for internal medicine. The overall male to female sex ratio did not show sex predominance (1.17:1), but a significant male predominance with a ratio of 1.49:1 was seen for pediatrics while a significant female predominance with a ratio of 1:1.97 was seen forinternal medicine. Of the total cases, 74.2% (282/431) were diagnosed before the age of 15 years. The etiologies of HHA were classified as red cell membrane defects, hemoglobinopathies, red cell enzyme deficiencies and unknown causes. There were 382 cases (88.6%) of red cell membrane defects with 376 cases (87.2%) of hereditary spherocytosis and 6 cases (1.4%) of hereditary elliptocytosis, 20 cases (4.6%) of hemoglobinopathies with 18 cases (4.2%) of beta-thalassemia, a case (0.2%) of alpha-thalassemia and a case (0.2%) of Hemoglobin Madrid, 7 cases (1.6%) of red cell enzyme deficiencies with 5 cases (1.2%) of glucose-6- phosphate dehydrogenase (G-6-PD) deficiency, a case (0.2%) of pyruvate kinase (PK) deficiency and a case (0.2%) of enolase deficiency, and 22 cases (5.1%) of unknown causes. The most common chief complaint in pediatric patients was pallor and that in adult patients was jaundice. In the red cell membrane defect group of patients, the level of hemoglobin was significantly higher than in adult patients. The mean corpuscular volume, mean corpuscular hemoglobin, corrected reticulocyte count, total and indirect bilirubin level and lactate dehydrogenase levels in the hemoglobinopathy group of patients were significantly lower than the values in the red cell membrane defect group of patients. The mean concentration of G-6-PD was 0.8+/-0.7U/1012RBC in the G-6-PD deficient patients, PK was 1.7U/1010 RBC in the PK deficient patient, and the level of enolase was 0.04U/g of Hb in the enolase deficient patient. CONCLUSION: The most prevalent cause of HHA in Korea during 1997 to 2006 was hereditary spherocytosis, but HHA by other causes such as hemoglobinopathy and red cell enzyme deficiency gradually increased with the development of molecular diagnostic methods and increasing general interest. However, the etiologies of HHA need to be pursued further in 5.1% of the patients. An systematic standard diagnostic approach is needed in a nationwide prospective study for correct diagnoses and appropriate management of HHA.
Adult ; alpha-Thalassemia ; Anemia, Hemolytic, Congenital* ; beta-Thalassemia ; Bilirubin ; Cell Membrane ; Diagnosis ; Elliptocytosis, Hereditary ; Erythrocyte Indices ; Female ; Hemoglobinopathies ; Humans ; Internal Medicine ; Jaundice ; Korea* ; L-Lactate Dehydrogenase ; Male ; Oxidoreductases ; Pallor ; Pathology, Molecular ; Pediatrics ; Phosphopyruvate Hydratase ; Prevalence ; Pyruvate Kinase ; Reticulocyte Count ; Retrospective Studies* ; Sex Ratio ; Surveys and Questionnaires