PURPOSE: This study examined the association between the pre-operative body mass index (BMI) and the post total hip replacement arthroplasty result, as well as postoperative change in the life quality of patients diagnosed with femur head avascular necrosis (AVN). MATERIALS AND METHODS: Patients diagnosed with femur head AVN undergoing total hiparthroplasty (THA) with a ceramic-ceramic articular surface from March 2005 to May 2011 were analyzed retrospectively. The Harris hip score (HHS), 36-item short-form health survey (SF-36) score, radiological examination, and complications at two years or longer after THA in the 4 groups were analyzed in terms of the BMI (underweight group, normal weight group, overweight group, and obesity group). RESULTS: The normal body weight group showed the best result(94.36+/-7.51) in all scores but the difference was not significant. In the SF-36 physical scores, obese group showed the greatest improvement. Complications occurred frequently in the underweight(50%) and obese groups(19.5%). In particular, periprosthetic fractures (P=0.002) and pneumonia (P=0.005) occurred frequently in the underweight group. CONCLUSION: The impacts of obesity and underweight on the clinical outcome after surgery are insignificant but patients with an abnormal BMI can expect a high quality of life after surgery.
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Body Mass Index* ; Femur Head Necrosis* ; Femur Head ; Femur ; Health Surveys ; Hip* ; Humans ; Ideal Body Weight ; Necrosis ; Obesity ; Overweight ; Periprosthetic Fractures ; Pneumonia ; Postoperative Complications ; Quality of Life* ; Retrospective Studies ; Thinness

There was no specific criteria of white cell count to determine the therapy of hyperleukocytosis in chronic myelogenous leukemia (CML). Therapeutic leukapheresis usually indicated in acute myelogenous leukemia with over 100,000/mm3 of white blood cell, leukocyte infiltration and leukostasis with over 100,000/mm3 of white blood cell, and hairy cell leukemia with no response to drug and splenectomy. Leukapheresis can reverse the hyperleukocytic syndrome rapidly, be used immediately without having to wait for the result of allopurinol to reduce the risk of uric acid nephropathy and decrease the tumor cell mass so as to minimize the extent of cytolysis- induced hyperuricemia, hyperkalemia and hyperphosphatemia. We report a case of 56-year-old man presented right lower leg pain, gait disturbance who was diagnosed CML 4 years before. He showed right popliteal artery obstruction in doppler sonogram and immediatly started leukapheresis. After two therapeutic leukapheresis, symptoms were improved and popliteal blood flow was improved by follow-up doppler sonogram. As a result, we consider that leukapheresis without use of anticoagulant or thrombolytic agents is effective therapy in CML associated leukocytosis and vascular obstruction.
Allopurinol ; Arteries* ; Cell Count ; Fibrinolytic Agents ; Follow-Up Studies ; Gait ; Humans ; Hydroxyurea* ; Hyperkalemia ; Hyperphosphatemia ; Hyperuricemia ; Leg* ; Leukapheresis* ; Leukemia, Hairy Cell ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Leukemia, Myeloid, Acute ; Leukocytes ; Leukocytosis ; Leukostasis ; Middle Aged ; Popliteal Artery ; Splenectomy ; Uric Acid

The first metatarsophalangeal joint injury is common in professional soldiers and athletes. But this was rarely reported. A professional soldier has varus instability in the first metatarsophalangeal joint due to hyperextension. In the MR Imaging, weavy appearance in lateral collateral ligament and high signal change in plantar plate was shown. So he has surgical treatment using reconstructive procedure. At first, 4th extensor digitorum longus tendon was splitted longitudinally and harvested, second triangular shape reconstruction on lateral joint line was done using harvested tendon. One year later, fifteen degrees was limited compared with intact side. Reconstruction using 4th extensor digitorum longus tendon in traumatic dynamic hallux varus was good method.
Athletes ; Collateral Ligaments ; Hallux ; Hallux Varus ; Humans ; Joints ; Metatarsophalangeal Joint ; Military Personnel ; Tendons

PURPOSE: The present study was conducted to determine and compare the target attainment rate (TAR) between microorganism-nonspecific (Ctrough) and microorganism-specific (AUC24/MIC) targets over two weeks of teicoplanin administration according to several dose regimens for the treatment of Staphylococcus aureus in Korean patients with neutropenic fever. MATERIALS AND METHODS: One thousand virtual concentrations were obtained for each dose using the population pharmacokinetic parameters of teicoplanin adopted from a published study. Simulation of 1,000 virtual MICs was performed using the MICs of 78 clinical isolates of S. aureus collected from a hospital in Korea. Thereafter, these simulated MICs were randomly allocated to 1,000 virtual patients in whom the TARs for AUC24/MIC >125 [or 345] and Ctrough >10 [or 20] mg/L were determined. The relationship of the maintenance dose with the steady-state TAR was predicted with respect to the AUC24/MIC >125 [or 345] using logistic analysis. RESULTS: The standard dose regimen of teicoplanin showed TARs of about 70% [or 33%] and 70% [or 20%] at steady-state in cases with AUC24/MIC >125 [or 345] and Ctrough >10 [or 20] mg/L, respectively. CONCLUSION: The current standard dose regimen was predicted to be insufficient to adequately treat S. aureus in Korean patients with neutropenic fever. To assure at least an 80% TAR in this population, dose adjustment of teicoplanin should be considered.
Anti-Bacterial Agents/administration & dosage/*pharmacology/therapeutic use ; Computer Simulation ; Dose-Response Relationship, Drug ; Fever/drug therapy/microbiology ; Humans ; Microbial Sensitivity Tests ; Neutropenia/drug therapy/microbiology ; Republic of Korea ; Staphylococcal Infections/drug therapy ; Staphylococcus aureus/*drug effects ; Teicoplanin/administration & dosage/*pharmacology/therapeutic use ; Treatment Outcome

Benign intracranial hypertension (BIH) is very rare and its cause is unclear. Raised intracranial pressure in the absence of an intracranial mass or hydrocephalus (BIH or pseudotumor cerebri) has been described in association with many conditions including SLE. Several pathogenic pathways tie BIH with SLE as thrombotic obliteration of cerebral arteriolar and venous systems and immune complex deposition within the arachnoid villi that are responsible for cerebrospinal fluid (CSF) absorption. The diagnosis of BIH was confirmed by increased intracranial pressure in the absence of any abnormal radiological findings of the brain. We report a young woman with SLE and autoimmune thrombocytopenia complicated by BIH which resolved with corticosteroid therapy and osmotic diuretics.
Absorption ; Antigen-Antibody Complex ; Arachnoid ; Brain ; Cerebrospinal Fluid ; Diagnosis ; Diuretics, Osmotic ; Female ; Humans ; Hydrocephalus ; Intracranial Pressure ; Lupus Erythematosus, Systemic* ; Pseudotumor Cerebri* ; Purpura, Thrombocytopenic, Idiopathic

BACKGROUND: During the development of inflammatory responses, various cytokines including interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF), interleukin-1 (IL-1) which activate macrophages to synthesize nitric oxide (NO) and hemostatic cascades are secreted. However, effects of various factors involved in hemostasis on NO synthesis have been little known. In this report, we studied the effects of antithrombin III (AT-III) on NO synthesis by thioglycollate-elicited peritoneal macrophages of BALB/c mouse. METHODS: Macrophages were obtained from BALB/c mice injected with 3% thioglycollate and cultured with or without various reagents. Nitrite concentration was measured using a modification of Griess reaction. Immunoblot analysis for inducible nitric oxide synthase (iNOS), AT-III receptor binding study and assay of TNF secretion were performed. RESULTS: AT-III alone did not induce nitrite synthesis by macrophages. However, AT-III induced nitrite synthesis in the presence of IFN-gamma in a dose dependant manner. iNOS was also expressed in macrophages by the treatment with IFN-gamma/AT-III. Addition of 0.5mM NG-monomethyl-L-arginine markedly inhibited IFN-gamma/AT-III-induced nirtite synthesis. Treatment with 5microgram/mL polymyxin B, which inactivates LPS, did not inhibit IFN-gamma/AT- III-induced nitrite synthesis, excluding inadvertent endotoxin contamination. Addition of rabbit anti-human AT-III polyclonal IgG antibodies, but not control rabbit IgG, inhibited IFN-gamma/ AT-III-induced nitrite production. Treatment of macrophages with heparin did not augment, but inhibited both IFN-gamma/AT-III- and IFN-gamma/LPS-induced nitrite synthesis. CONCLUSION: Our results indicated that AT-III acted as a modulator of macrophage activation for L-arginine dependent NO synthesis and that AT-III might be an important molecule in the regulation of immune responses by macrophage activation to induce NO synthesis as well as in the regulation of hemostasis. Heparin was not a cofactor in the AT-III-induced NO synthesis.
Animals ; Antibodies ; Antithrombin III* ; Arginine ; Cytokines ; Hemostasis ; Heparin ; Immunoglobulin G ; Indicators and Reagents ; Interferon-gamma ; Interleukin-1 ; Macrophage Activation ; Macrophages ; Macrophages, Peritoneal* ; Mice ; Nitric Oxide Synthase Type II ; Nitric Oxide* ; omega-N-Methylarginine ; Polymyxin B ; Tumor Necrosis Factor-alpha

OBJECTIVE: To assess the usefulness of the somatosensory evoked potentials in correlating with various clinical features and in predicting the functional outcome in patients with stroke. METHOD: The subjects were 57 patients with first stroke. Somatosensory evoked potential study was performed at the time of transfer to the rehabilitation department. Data of somatosensory evoked potential with median and tibial nerve stimulations were obtained and classified as normal (group 1), abnormal (group 2), and no response group (group 3). Modified Barthel index (MBI), motor and sensory functions were evaluated at the time of transfer and discharge. RESULTS: MBI score was statistically different among the 3 groups based on the findings of median and tibial nerve SSEP at the time of transfer, but not different at the time of discharge. Motor function was statistically different among the 3 groups at the time of transfer and discharge. Sensory function was statistically different among the 3 groups at the time of transfer, but not different at the time of discharge. CONCLUSION: Even though SSEP study reflects the functional status of the patients and correlates well with the findings of brain image, it has limitation in predicting outcome of the patients with stroke.
Brain ; Evoked Potentials, Somatosensory* ; Humans ; Rehabilitation ; Sensation ; Stroke* ; Tibial Nerve

OBJECTIVE: To investigate the anatomy of the ulnar nerve according to the degree of elbow flexion and to obtain optimal elbow position for ulnar nerve conduction study. METHODS: Eleven elbows in nine cadavers were dissected. We estimated the 10 cm elbow segment to be the distance between 2 points, 4 cm distal and 6 cm proximal to the center of the cubital tunnel, which was determined to be the halfway point between the medial epicondyle and olecranon with elbow position in extension and 45o, 90o, 135o flexion. Anatomical measurements of the actual length of ulnar nerve, distance between medial epicondyle and ulnar nerve, and distance between medial epicondyle and olecranon were obtained in each position. The actual length of the ulnar nerve was measured between two points of the ulnar nerve closest to the landmarks of the estimated 10 cm with flexible ligature. RESULTS: The actual lengths of ulnar nerve were 10.23 cm, 10.00 cm, 9.44 cm, and 9.08 cm in elbow extension, and 45o, 90o, 135o flexion, respectively. The difference between actual length and estimated lengths were least in 45o elbow flexion (p=0.0001). The distance between medial epicondyle and olecranon increased with increasing elbow flexion (p=0.0001). However, there was no difference in the distance between medial epicondyle and ulnar regardless of the elbow position. As a result, the ulnar nerve seemed to have migrated anteriorly in the cubital tunnel with increasing elbow flexion. CONCLUSION: This study suggest that the optimal angle in ulnar nerve conduction study would be 45o flexion, under the condition that the distance measurement is through the halfway point between the medial epicondyle and olecranon.
Cadaver ; Elbow* ; Ligation ; Olecranon Process ; Ulnar Nerve*

We describe four cases of feline progressive histiocytosis (FPH) including three females (one intact, two spayed) and one castrated male cat, with a mean age of 5.95 years at diagnosis. Masses were found under the skin of head, lip, neck, and vulva. Histologically, proliferative round cells had ovoid nuclei, foamy eosinophilic cytoplasm, distinct cytoplasmic processes, and mitotic figures. Immunohistochemically, all cases were positive for Iba1 and MHC II (Dako). One case showed cytoplasmic positive staining for E-cadherin. To the best of our knowledge, this is the first documented report of FPH in Korea.

BACKGROUND: Recently, increased levels of high-mobility group box 1 protein (HMGB1) have been identified in various inflammatory conditions and infections. However, no studies have evaluated the HMGB1 level in nontuberculous mycobacterial (NTM) lung disease, and compared it to mycobacterial lung disease. METHODS: A total of 60 patients newly diagnosed with NTM lung disease, 44 culture-positive pulmonary tuberculosis (TB) patients, and 34 healthy controls, were included in this study. The serum HMGB1 concentrations were quantified using HMGB1 enzyme-linked immunosorbent assay kits. RESULTS: Serum HMGB1 level in patients with pulmonary TB or NTM lung disease, was significantly lower than that of the healthy controls. In addition, the serum HMGB1 level in TB patients was significantly lower than patients with NTM lung disease. However, the levels in NTM patient subgroups did not differ according to the causative species, disease progression, and disease phenotype. CONCLUSION: Although low levels of serum HMGB1 has the potential to be a marker of mycobacterial lung disease, these levels were unable to differentiate disease progression and disease phenotype in NTM lung diseases.
Disease Progression ; Down-Regulation* ; Enzyme-Linked Immunosorbent Assay ; HMGB1 Protein ; Humans ; Lung Diseases* ; Lung* ; Nontuberculous Mycobacteria ; Phenotype ; Tuberculosis ; Tuberculosis, Pulmonary*