Development of acetabulum and epiphysis of the femoral head following reduction in seventy-four patients with ninty-one congenitally dislocated hips were assessed radiologically. Acetabular index, CE angle of Wiberg, neck-shaft angle of the femur and overgrowth of the pelvis and femur were measured according to the various treatment. To evaluate results, the method of treatment was divided into four groups; closed reduction, open reduction, open reduction combined with pelvic osteotomy and modified Klisic operation (open reduction, pelvic osteotomy, femoral osteotomy and so on). Each treatment was compared with three subgroups according to ages; first subgroup was belong to patients under one year of age, second from one year to three years, third over three years. This paper agrees to Harris (1976) and Lindstrom (1979) about improvement of acetabular index and CE angle of Wiberg that showed a rapid rate of repair in the first 6 months and thereafter slowly progressed to normal range of degree. Overgrowth of pelvis and femur was also noticed in cases of hips treated pelvic and/or femoral osteotomy, moreover even in cases of open reduction only. The goal of this preliminary investigation may be supposed to propose the idea which method of treatment to the first visiting patient will approach the most satisfactory final result.
Acetabulum ; Dislocations ; Epiphyses ; Femur ; Head ; Hip ; Humans ; Methods ; Osteotomy ; Pelvis ; Reference Values

Two cases of cavernous hemangioma of the cauda equina are presented. Cavernous hemangioma of the cauda equina is rare vascular malformation. This is the fifth and sixth case of cavernous hemangioma of the cauda equina in the literature. These cases are female patients. MRI is more sensitive method than spinal myelography and CT in diagnosis of cavernous hemangioma of the cauda equina. Total removal was possible without immediate post-operative complication.
Cauda Equina* ; Diagnosis ; Female ; Hemangioma, Cavernous* ; Humans ; Magnetic Resonance Imaging ; Myelography ; Vascular Malformations

PURPOSE: The aim of this study was to determine an appropriate energy level of breakfast with less risk of chronic disease for Korean adults. METHODS: Using data from the 2007~2009 Korean National Health & Nutrition Examination Survey, from a total of 12,238 adults aged 19~64, the final 7,769 subjects were analyzed except subjects who were undergoing treatment for cancer or metabolic disorder. According to the percent of breakfast energy intake versus their estimated energy requirement (EER), the subjects were divided into four groups: < 10% (very low, VL), 10~20% (low, L), 20~30% (moderate, M), > or = 30% (sufficient, S). All data were analyzed on the metabolic risk and nutritional state after application of weighted value and adjustment of sex, age, residential area, income, education, job or jobless, and energy intake using a general linear model or logistic regression. RESULTS: The subjects of group S were 16.9% of total subjects, group M 39.2%, group L 37.6%, and group VL 6.3%. The VL group included more male subjects, younger-aged (19 to 40 years), urban residents, higher income, higher education, and fewer breakfasts eaters together with family members. Among the 4 groups, the VL group showed the highest waist circumference, while the S group showed the lowest waist circumference, body mass index, and serum total cholesterol. The groups of VL and L with lower intake of breakfast energy showed high percent of energy from protein and fat, and low percent of energy from carbohydrate. With the increase of breakfast energy level, intake of energy, most nutrients and food groups increased, and the percentage of subjects consuming nutrients below EAR decreased. The VL group showed relatively higher intake of snacks, sugar, meat and eggs, oil, and seasonings, and the lowest intake of vegetable. Risk of obesity by waist circumference was highest in the VL group by 1.90 times of the S group and the same trend was shown in obesity by BMI. Risk of dyslipidemia by serum total cholesterol was 1.84 times higher in the VL group compared to the S group. Risk of diabetes by Glu-FBS (fasting blood sugar) was 1.57 times higher in the VL group compared to the S group. CONCLUSION: The results indicate that higher breakfast energy level is positively related to lower metabolic risk and more desirable nutritional state in Korean adults. Therefore, breakfast energy intake more than 30% of their own EER would be highly recommended for Korean adults.
Adult* ; Body Mass Index ; Breakfast* ; Cholesterol ; Chronic Disease ; Dyslipidemias ; Ear ; Education ; Eggs ; Energy Intake ; Humans ; Korea ; Linear Models ; Logistic Models ; Male ; Meat ; Nutrition Surveys* ; Obesity ; Ovum ; Seasons ; Snacks ; Vegetables ; Waist Circumference

Substantial ACL ruptures are not common in adolescence or childhood. During this period, ACL tibia avulsion fractures are more common than substantial ACL ruptures are. However, recent advancements in MRI and increases in adolescent sports activity have led to increased diagnosis of substantial ACL ruptures. Many physeal-sparing ACL reconstruction methods have been reported. However, some physeal-sparing ACL reconstructions are associated with poor outcomes because of laxity in the reconstructed ligament and discordance in the isometric point. We report a 14-year-old male patient with a chronic substantial ACL rupture and a longitudinal medial meniscus tear who was treated with ACL reconstruction and all-inside meniscal repair, which spares the femoral physis and reduces tibia physeal injury with an Achilles allograft.
Adolescent ; Anterior Cruciate Ligament Reconstruction ; Humans ; Ligaments ; Male ; Menisci, Tibial ; Rupture ; Sports ; Tibia ; Transplantation, Homologous

BACKGROUND: The tumor necrosis factor (TNF) is believed to play an important role in the pathophysiology of osteoarthritis (OA). Evidence shows that genetic polymorphisms make substantial contributions to the etiology of OA. METHODS: We investigated the genotypes TNF-alpha and TNF-beta in 301 OA patients and 291 healthy subjects as controls. We employed a polymerase chain reaction-restriction fragment length polymorphism and a polymerase chain reaction-single strand conformation polymorphism assay to identify the genotypes TNFA -G308A and TNFB +G252A, respectively. RESULTS: For TNFA -G308A, the percentages of genotypes GG, AG, and AA were 26.3% (79/301), 62.5% (188/301), and 11.3% (34/301) in OA patients and 88.7% (258/291), 11.3% (33/291), and 0% (0/291) in controls. For TNFB +G252A, the percentages of genotypes GG, AG, and AA were 15.3% (46/301), 41.9% (126/301), and 42.9% (129/301) in OA patients and 12% (35/291), 52.6% (153/291), and 35.4% (103/291) in controls. There were significant differences in genotypes and alleles of TNFA -308 between OA patients and controls (p<0.0001) and in alleles of TNFB +252 (p=0.0325). The risk of OA was significantly higher for carriers of the TNFA -308A allele and the TNFB +252 AA homozygote (p=0.0224). CONCLUSIONS: The results suggest close relationships between TNFA -G308A and TNFB +G252A polymorphisms and individual susceptibility to OA in the Korean population.
Alleles ; Genetic Predisposition to Disease ; Genotype ; Homozygote ; Humans ; Lymphotoxin-alpha ; Osteoarthritis ; Polymorphism, Genetic ; Tumor Necrosis Factor-alpha

BACKGROUND: Adiponectin is an adipocytokine that is highly specific to adipose tissue. In contrast to other adipocytokine, the adiponectin levels are decreased in obesity and/or type 2 diabetes. There are few studies regarding the correlation between the adiponectin concentration and obesity in children. Thus, whether the serum adiponectin concentrations are associated with adiposity in children was investigated. METHODS: One hundred and sixty four subjects were selected from the participants in an ongoing study on the relationship between birth weight and insulin resistance in children. The current weights, heights, body fat percentages, waist circumferences, blood pressures, lipid profiles and insulin resistance, by the HOMA method, were measured in all the subjects. The serum adiponectin concentrations were determined by a validated sandwich ELISA, using a human adiponectin-specific antibody. RESULTS: The serum adiponectin concentration was negatively correlated with the body mass index, waist circumference, systolic blood pressure, insulin resistance by HOMA and serum triglycerides, and positively correlated with the serum HDL cholesterol level. The serum adiponectin concentrations in the boys were significantly lower than in the girls. In a multiple regression analysis, the serum adiponectin concentration was strongly associated with waist circumference and gender. CONCLUSION: It is concluded that there was an inverse relationship between the serum adiponectin concentration and abdominal adiposity in children. However, further studies on independent gender differences on adiponectin are needed.
Adiponectin* ; Adipose Tissue ; Adiposity ; Birth Weight ; Blood Pressure ; Body Height ; Body Mass Index ; Child* ; Cholesterol, HDL ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Insulin Resistance ; Obesity* ; Triglycerides ; Waist Circumference ; Weights and Measures

BACKGROUND/AIMS: Percutaneous ethanol injection therapy (PEIT) is widely used for the treatment of hepatocellular carcinoma (HCC). However, its long-term therapeutic efficacy is not verified in Korea, one of hepatitis B virus (HBV) endemic areas. Thus, this study was to assess its efficacy and prognostic factors affecting tumor-free survival following PEIT in Korean HCC patients. METHODS: From 1997 to 1999, 100 consecutive patients who had 1 to 3 HCC nodules of maximum diameter less than 3 cm and underwent PEIT were enrolled. Therapeutic efficacy, overall and tumor-free survival rates were assessed during follow-up periods. RESULTS: In 83 patients, HCC nodules were completely ablated by PEIT. The cumulative 1, 2, and 3 year overall survival rates were 98%, 96%, and 88%, respectively. The cumulative 1, 2, and 3 year tumor-free survival rates were 73%, 50%, and 37%, respectively. Larger tumors (> or = were associated with a higher local recurrence rate. CONCLUSIONS: These results demonstrate that PEIT is therapeutically useful in patients with HCC less than 4 in number and less than 3 cm in diameter. However, since multiple or large tumors are associated with low tumor-free survival or high local recurrence rates, PEIT for these tumors and the subsequent post-treatment follow-up should be performed carefully.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/mortality/*therapy ; Ethanol/*administration & dosage ; Humans ; Injections, Intralesional ; Korea ; Liver Neoplasms/mortality/*therapy ; Male ; Middle Aged ; Neoplasms, Multiple Primary/mortality/therapy ; Survival Rate

Epithelioid hemangioendothelioma is a rare vascular tumor, which occurs in the lung, liver, bone, and soft tissue. Hypertrophic osteoarthropathy is a syndrome characterized by subperiosteal new bone formation, joint effusion and clubbing, and may be associated with cyanotic heart disease, chronic pulmonary disease, liver disease, and other miscellaneous diseases. The activation of endothelium and platelets has been suggested to be involved in the development of hypertrophic osteoarthropathy. We report a rare case of hypertrophic osteoarthropathy, which developed in association with hepatic epithelioid hemangioendothelioma with pulmonary metastasis. We also discuss the role of vascular endothelial growth factor in its pathogenesis.
Adult ; Biopsy ; Blood Platelets/metabolism ; Endothelium/metabolism ; Femur/radiography ; Hemangioendothelioma, Epithelioid/*complications/*pathology ; Human ; Lung/pathology ; Lung Neoplasms/*complications/pathology ; Male ; Osteoarthropathy, Secondary Hypertrophic/*complications/*pathology ; Vascular Endothelial Growth Factor A/metabolism ; Vascular Neoplasms/*diagnosis/pathology

OBJECTIVE: The purpose of this study is to examine the difference between the numbers of patients in rheumatoid arthritis (RA) who are eligible to TNF inhibitors by the past Korean National Health Insurance reimbursement guideline and by the disease activity score with 28-joint assessment (DAS28) based criteria. METHODS: Data were obtained from a multi-center registry for biologics users in Korean RA patients, BIOlogics Pharmacoepidemiologic StudY (BIOPSY). DAS28 was calculated based on either ESR or CRP, and DAS28 of more than 5.1 or between 3.2 and 5.1 with radiographic changes was defined as a cut-off point for the initiation of TNF inhibitors. For the maintenance criteria, we used both of improving in DAS28 score (>1.2) and low disease activity (DAS 28<3.2). Differences between the numbers in each step by two criteria were described with Chi-square test and Kappa agreement. RESULTS: Of the 489 patients in BIOPSY, 299 were included in this study. Among them, 278 patients (93.0%) were eligible of TNF inhibitors when we applied the new initiation criteria with DAS28-ESR, and 244 patients (81.6%) were indicated for TNF inhibitors with DAS28-CRP. For the maintenance criteria, a low disease activity (DAS28<3.2) in 3 months after starting TNF inhibitors is too strict for achieving (33.6% with DAS28-ESR and 50.0% with DAS28-CRP). Instead, decreasing DAS28 by more than 1.2 is more reasonable as a tool for deciding early responsiveness of TNF inhibitors in RA patients (81.2% both with DAS28-ESR and DAS28-CRP). CONCLUSION: Our results show that the candidates for TNF inhibitors will be enormously changed according to a change in the reimbursement criteria. To define appropriate patients to receive TNF inhibitors, a further study with regard to the impact of changes in the reimbursement criteria on the outcomes of RA patients will be required.
Arthritis, Rheumatoid ; Biological Products ; Biopsy ; Humans ; National Health Programs

To develop a clinical practice guideline for vaccination in patients with autoimmune inflammatory rheumatic disease (AIIRD), the Korean College of Rheumatology and theKorean Society of Infectious Diseases developed a clinical practice guideline according to the clinical practice guideline development manual. Since vaccination is unlikely to cause AIIRD or worsen disease activities, required vaccinations are recommended. Once patients are diagnosed with AIIRD, treatment strategies should be established and, at the same time, monitor their vaccination history. It is recommended to administer vaccines when the disease enters the stabilized stage. Administering live attenuated vaccines in patients with AIIRD who are taking immunosuppressants should be avoided. Vaccination should be considered in patients with AIIRD, prior to initiating immunosuppressants. It is recommended to administer influenza, Streptococcus pneumoniae, hepatitis A, hepatitis B, herpes zoster, measlesmumps- rubella virus, human papillomavirus, and tetanus-diphtheria-pertussis vaccines in patients with AIIRD; such patients who planned to travel are generally recommended to be vaccinated at the recommended vaccine level of healthy adults. Those who live in a household with patients with AIIRD and their caregivers should also be vaccinated at levels that are generally recommended for healthy adults.