OBJECTIVE: Estrogen is a major regulator/modulator of bone metabolism, and bone loss in estrogen deficiency is associated with increased bone turnover, But the mechanism for estrogen action on bone metabolism is still unknown. Recent studies have suggested that the increase in bone loss induced by estrogen deficiency is mediated by increased paracrine production of bone resorbing cytokines. Among cytokines, 1nterleukin-6(IL-6) is released from osteoblasts in estrogen deficiency and increases bone resorption by stimulation of osteoclastic activities and recruitment. Thus we performed this study to evaluate the effect of ovariectomies on bone mineral density and IL-6 in cultured monocytes of peripheral blood and bone marrow. METHODS: The experimental animals were 13 female Sprague-Dawley rats that were 8 weeks of age and weighed an average of 188.5 gram at the beginning of the study. Bilateral ovariectomies were performed in all rats from a ventral approach. Bone mineral density(BMD) of the total body, spine and level of IL-6 of cultured monocytes of peripheral blood and bone marrow were measured before and 8 weeks after ovariectomy. RESULTS: 1) BMD of total body and spine were lower after ovariectomy(0.257+/-0.069g/cm2, 0,208+/-0.005g/cm2) than before ovariectomy (0.276+/-0.005g/cm2, 0.229+/-0.011g/cm2), respectively (P<0.01). 2) Although IL-6 level of cultured monocytes in peripheral blood tended to be higher after ovariectomy than before ovariectomy, this difference was not statistically significant (P>0.05). 3) IL-6 level of cultured monocytes in bone marrow was higher after ovariectomy(82.78+/-4.99pg/ml) than before ovariectomy(48.85+/-2.42pg/ml)(P<0.05). CONCLUSION: It is possible that increased production of IL-6 in estrogen deficiency induced by ovariectomy occurs in the local environment of bone or bone marrow rather than in the pheripheral blood and stimulates bone resorption.
Animals ; Bone Density* ; Bone Marrow ; Bone Resorption ; Cytokines ; Estrogens ; Female ; Humans ; Interleukin-6* ; Metabolism ; Monocytes ; Osteoblasts ; Osteoclasts ; Ovariectomy* ; Rats* ; Rats, Sprague-Dawley ; Spine

BACKGROUND: Vascular dementia is common cause of dementia, second to the dementia of Alzheimer desease. However in Asia and many developing countries, the incidence of vascular dementia exceeds that of Alzheimer's disease. Though many stroke-related factors related the nature of vascular injury, e.g. infarction and hemorrhage, have not assessed yet. Clarifying the difference of electroencephalograpy and clinical prognosis between infarction and hemorrhage, the aim of this study was to elucidate the role of nature of vascular injury. METHODS: to reduce confounding factors, the study population was restricted to the patients of single hemispheric striatocapsular infarction and hemorrhage saving cortex. On admission, we checked the KMMSE and FIM scores and using quantified EEG, we analyzed occipital peak frequency and the relative background alpha, theta and delta spectra power taken from 16 derivations by averaging twenty-2 -sec epoch in infarction, hemorrhage patients and elderly controls. After 6 months follow up, we compare the MMSE, FIM score between infarction and hemorrhage group. RESULTS: 1) Compared with infarction group, hemorrhage groups had a significantly bilateral lower occipital peak freqauency and background bilateral alpha spectra power. 2) In hemorrhage group, there is lower tendency in K-MMSE after 6 month follow up compared to infarction group. CONCLUSION: This study suggests that hemorrhage show more bilateral electrophysiological dysfunction than infarction group and possible grave prognosis for vascular dementia compared to infarction group.
Aged ; Alzheimer Disease ; Asia ; Dementia ; Dementia, Vascular ; Developing Countries ; Electroencephalography* ; Follow-Up Studies ; Hemorrhage* ; Humans ; Incidence ; Infarction* ; Prognosis* ; Vascular System Injuries

Nine scaphoid non-unions, which were treated by through curettage of the scar tissue on pseudarthrosis, iliac bone grafts between the fragments and Herbert screws fixation, were analysed. The average follow up period from operation was 16.9 months. The interval between the fracture and the time of the operation ranged from 10 months to 48 months(average 21.6 months). Average union time was 14 weeks after operation. The initial radiologic cystic changes disappeared and overall clinical results were improved. Mean postoperative range of motion of the wrist was flexion 55 and extension 45°. Three of them had DISI deformity preoperatively which their scapholunate angles (mean 104°) has been corrected after reduction (mean 75°). In one case among three DISI deformities, partial radial styloidectomy and triscaphe fusion were added (to bone graft and Herbert screw fixation). A case of incorrect positioning of the screw and a case of neuroma were complicated. Treatment of scaphoid nonunion with curettage of the scar tissue and iliac bone graft and Herbert screw fixation seems to be encouraging to regain the normal anatomy of scaphoid and function of the wrist.
Cicatrix ; Congenital Abnormalities ; Curettage ; Follow-Up Studies ; Neuroma ; Pseudarthrosis ; Range of Motion, Articular ; Transplants ; Wrist

BACKGROUND: Dizziness is a common complaint in patients presenting to the emergency room and that has various pathologic causes. This study investigate the clinical differences in dizziness between the central origin and the peripheral origin and to provides the clues far diagnosis and proper treatment. METHODS: We analysed 290 patients with dizziness during 12 months period prospectively, who visited in ED, Inha University Hospital from Jan. 1997 to Dec. 1997. We analysized sex ratio, characteristics of the dizziness, associated past illness, associated symptoms, severity, results of the special radiologic study, nystagmus type, and causes of central origin and peripheral origin dizziness. RESULTS: Male to female ratio was 1:1.4 in central origin(n=165) and 1:2.0 in peripheral origin(n=125). Most common age group was 11th decade in both groups. According to the characteristics of the dizziness, rotation sense was the main complaint of the peripheral origin dizziness. Most common past illness was hypertension in both groups. MRI has diagnostic priority than CT scan in central origin dizziness. Types of nystagmus has some significant differences between two groups. CONCLUSION: Dizziness may represented as a sign of significant pathological neurologic status especially in central origin. So we must precisely evaluate the patient history, neurologic examination of the inner ear and CNS, and special radiologic study incliding MRI.
Diagnosis ; Dizziness* ; Ear, Inner ; Emergency Service, Hospital ; Female ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Male ; Neurologic Examination ; Prospective Studies ; Sex Ratio ; Tomography, X-Ray Computed

No abstract available.
Child* ; Guillain-Barre Syndrome* ; Humans

Decubitus ulcer is often seen in the skin and underlying tissue of debilitated or immobilized patients as the result of prolonged pressure and impaired circulation. It manifests chiefly as an ulcer over bony prominences, but tumefaction is an extremely unusual presentation. A 53-year old male, a paralytic of the lower extremity for 18 years, developed a recurrent decubital ulcer despite repeated surgical repair, from which a rapidly growing, large fungating mass grew within a month. The last resected mass was bosselated and measured 15x9x3 cm with a major area of cicatrix-like induration, interdigitated with skeletal muscle bundles at the central area. Microscopically, the mass was composed of an upper half of active granulation tissue layer and a deeper half of dense, poorly cellular, fibrocollagenous bundles admixed with florid proliferation of atypical fibroblasts, but the absence of mitosis and the multifocal admixture of active inflammatory process-granulation tissue formation seemed to help exclude genuine fibromatosis, nodular fasciitis or proliferative myositis. We assume that this rapidly growing pseudofibromatosis is an additional manifestation of a prolonged decubitus ulcer, possibly related to the modified reparative process of decubitus ulcer following repeated excisions, for which we propose a term of decubitoma.

When the non-union gap in a long bone is more than half of the diameter of the bone at that level, it presents a significant challenge to traditional bone grafting technique. Even if there are several good ways for this problem, such as shortening, traditional various bone grafting, electrical stimulation and free vascularized bone graft, most of these techniques have some difficulties to maintain the stability of fracture post-operatively, and we have to keep their extremities into a cast or external fixator so long. So we have attempted to treat the large osseus gap non-union in long bone with fixation of heavy duty or condylar plate on one side of fracture for fracture stability, a long tibial corticocancellous strut graft on the other side of fracture for fracture stability and rapid bony union, and extensive cancellous chip bone graft between the plate and tibial graft to enhance the bony union. We have experienced 9 cases of large osseus gap non-union in long bone with this technique from March 1981 to September 1986 at the department of orthopaedic surgery, St. Mary's hospital, Catholic University Medical College. 1. Their, 7 males and 2 females, average age was 38 years old, with a range of 24 to 53 years old. The distribution of the involved bone was 6 femur, 2 humerus, 1 radius and ulna with 1.4 years of average duration of non-union, ranged from 7 months to 2.4 years. The average gap from normal bone to normal bone was 4.8cm, with a range of 2.7cm to 7.4cm. The average number of previous surgical procedures was 4, with a range of 2 to 7. Four of the nine patients had quiescent osteomyelitis. 2. Post-operative immobilization with splint or cast was applied for 6 weeks for upper extremity and 8 weeks for lower extremity followed by active R.O.M. exercise and non-weight bearing crutch walking. 3. Five of the nine cases(55.6%) had completely bony union. This occured on an average 8 months post-operatively and was faster in the forearm bones and femur than in the humerus. An additional cancellous bone graft was done in two. But other two of the patients had subsequent amputation because of recurrent and uneontrollable osteomyelitis stirred up by the surgery. 4. This procedures was proved to be one of valuable adjuvant method in treatmqnt of large osseous gap non-union of long bones.
Amputation ; Bone Transplantation ; Electric Stimulation ; External Fixators ; Extremities ; Female ; Femur ; Forearm ; Humans ; Humerus ; Immobilization ; Lower Extremity ; Male ; Methods ; Osteomyelitis ; Radius ; Splints ; Transplants ; Ulna ; Upper Extremity ; Walking

PURPOSE: To evaluate the usefulness of Gd-DTPA enhanced MR imaging in determining the metastatic lymph nodes in uterine cervical carcinoma. MATERIALS AND METHODS: Sixty nine patients with histologically proven cervical carcinoma underwent Gd-DTPA enhanced MR imaging. One hundred and thirty-eight pelvic regions(69 right,69 left) in 69 patients were analyzed for lymph node metastases. Pelvic lymph nodes were considered to be abnormal if they were greater than lcm in diameter and were enhanced on postcontrast T1 weighted images. RESULTS: Metastatic lymph nodes were found in 22 pelvic regions by surgicopathologic examinations. On MR imaging there were 14 true positives, 106 true negatives, 10 false positives and 8 false negatives. Gd-DTPA enhanced MR image had an accuracy of 86.9%, a sensitivity of 58.3%, a specificity of 91.4%, a positive predictive value of 58.3% and negative predictive value of 92.9% in evaluation of pelvic lymph node metastases. CONCLUSION: MR imaging with contrast enhancement may be useful in the evaluation of pelvic lymph node metastases in patients with uterine cervical carcinoma.
Gadolinium DTPA ; Humans ; Lymph Nodes* ; Magnetic Resonance Imaging* ; Neoplasm Metastasis ; Pelvis ; Sensitivity and Specificity

PURPOSE: Hypothalamic hamartomas are non-neoplastic malformations which are composed of hyperplastic neuronal tissue of varying size. Clinically, they are characterized by gelastic seizure, precocious puberty, and behavioral and psychiatric disorders. This study was performed to examine the various features of hypothalamic hamartomas such as neurologic manifestations, other clinical manifestations, and EEG and brain MRI findings. Response to AEDs or outcome of operation on hypothalamic hamartoma was evaluated. METHODS: Eleven patients who were admitted to Seoul National University Children's Hospital from July 1986 to January 1997 and diagnosed as hypothalamic hamartoma by brain MRI or CT were enrolled in this study. Clinical manifestations and EEG were reviewed retrospectively through the medical records. The size and type of the hypothalamic hamartoma on brain MRl were analyzed. RESULTS: 1) The range of age at visit was 1yr 9mo to 17yr 2mo (mean 10yr 8mo), and the age at onset was 1yr 1mo to 14yr to 2mo (mean 5yr 8mo). Six patients were male and five were female. 2) The clinical manifestations included gelastic seizure (n=9), behavioral and psychiatric disorders (n=9), other types of seizure (n=8), and precocious puberty (n=6). Other types of seizure were complex partial seizure (n=3), generalized tonic seizure(n=3), and infantile spasm (n=2). 3) The interictal EEG findings included focal spike discharges (n=8), diffuse delta slowings (n=1), hypsarrhythmia (n=1), and normal record (n=1). The focal spike discharges originated from the temporal (n=2), fronto-temporal (n=1), occipital (n=3), or frontal area(n=2). 4) The brain MRI showed that the size of the hypothalamic hamartomas was 2.47+/-1.12cm, and the origin of the tumors was tuber cinereum (n=6) or tuber cinereum and mamillary body (n=5). All lesions were isointense on T1-weighted image relative to normal gray matter, with a sessile attachment to the hypothalamus, and were not enhanced by Gadolinium. 5) Operations were done in 5 cases, those were subtotal removal of the tumor (n=4), and gamma knife radiosurgery (n=1). Seizures were not completely controlled in all but one case on which gamma knife radiosurgery was done. CONCLUSIONS: The hypothalamic hamartomas presented variable clinical pictures including gelastic seizure, precocious puberty, and behavioral and psychiatric disorders. The gelastic and other types of seizure associated with hypothalamic hamartomas were refractory to medication and might be controlled by total removal of the tumor.
Brain ; Electroencephalography ; Female ; Gadolinium ; Hamartoma* ; Humans ; Hypothalamus ; Infant ; Infant, Newborn ; Magnetic Resonance Imaging* ; Male ; Mamillary Bodies ; Medical Records ; Neurologic Manifestations ; Neurons ; Puberty, Precocious ; Radiosurgery ; Retrospective Studies ; Seizures ; Seoul ; Spasms, Infantile ; Tuber Cinereum

The alterations in the localization of keratinocyte membrane glycoconjugates in allergic contact dermatitis were investigated in guinea pig skin treated with topical application of 2.4-dinitro-chlorobenzene. We employed the avidin-biotin complex(ABC) method for the detection of localization of 10 commercially available lectins labelled with biotin: Con-A, SBA, WGA, DBA, UEA-1, RCA-1, PNA, HP, MPA, and ECA. Staining with WGA showed a remarkably decreased intensity in basal and spinous layers of the allergic skin in comparison to those of the control skin, suggesting loss of terminal sialic acids in cell membrane glycoconjugates. The other lectins showed no remarkable difference in the staining patterns between the normal and the allergic ski. The results suggest that epidermal cell membrane glycoconjugates undergoes selective perturbations in acute allergic contact dermatitis, and that the keratinocytes might be an active part of the cutaneous immune system.