No Abstract Available.
Hidradenitis*

Os subfibulare is a accessory bone arround the lateral maleolus, but it is different from many other accessory bones in foot and ankle in its development related to trauma and frequent symptoms of ankle instability. Accessory bone is a developmental anomaly which fails to unite to main secondary ossification center and usually asymptomatic. But os subfibulare is developed by recurrent ankle sprains in younger age or non-union of avulsion fracture of anterior talofibular ligament and causes instability of ankle. We experienced two cases of symptomatic os subfibulare in adolecents and report them with review of literatures.
Ankle ; Ankle Injuries ; Foot ; Ligaments

In order to investigate the efficacy and safety of oral cilazapril, a new angiotensin converting enzyme inhibitor, on essential hypertension, a single daily dose of 2.5 to 5.0mg cilazapril was administered in 30 hypertensive patients with diastolic blood pressure in the range of 95??15mmHg while off all other anti-hypertensive agents for 10 weeks. Blood pressure and heart rate were measured every 2 weeks. The complete blood count with platelet count, blood chemistry by SMA-12 including lactic dehydrogenase and serum electrolytes, and urinalysis were performed at 4th and 10th week of therapy. The electrocardiography was performed at the beginning and the end of treatment period. Any kinds of side effects were actively questioned by the examining physicians. The following results were obtained : 1) The mean age was 49.2 years, and the ratio of male-to-female was 1 : 1.3. 2) Blood pressure started to fall significantly within 2 weeks of treatment with cliazpril 2.5mg(M+/-S.E., 15.4+/-17.4mmHg vs 138.5+/-23.3, 100.3+/-6.2 vs 89.4+/-6.6, p<0.05), and after 6 weeks of treatment with a mean dosage of 2.84mg. diastolic blood pressure of all subjects was maintained below 90mmHg throughout the rest of trial. 3) Pulse rate or body weight were not significantly changed during the entire treatment period(69.3+/-6.0/min vs 10th week : 69.0+/-7.7, 64.7+/-7.4kg vs 63.6+/-6.7, p>0.05). 4) There were no significant changes in blood chemistry including blood sugar, cholesterol and electrolytes, except mild changes of serum creativine and alkaline phosphatase values. 5) Hematologic findings, urinalysis and electrocardiographic findings remained unchanged. 6)Side effects were mostly mild in nature without potentially serious episodes(dry cough : 20%, indigestion, headache, dizziness, in order), but there was 1 cases in whom the dosage was redyced due to postural hypotension. From the above results, cilazapril with the dosage of 2.5 to 5.0mg was effectvie and well tolerated in essential hypertensive patients with diastolic blood pressure of 95 to 115mmHg, and cilazapril seems to be appropriate for monotherapy of mild to moderate hypertensive patients.
Alkaline Phosphatase ; Antihypertensive Agents ; Blood Cell Count ; Blood Glucose ; Blood Pressure ; Body Weight ; Chemistry ; Cholesterol ; Cilazapril* ; Cough ; Dizziness ; Dyspepsia ; Electrocardiography ; Electrolytes ; Headache ; Heart Rate ; Humans ; Hypertension ; Hypotension, Orthostatic ; Oxidoreductases ; Peptidyl-Dipeptidase A ; Platelet Count ; Urinalysis

Metal-on-metal (MoM) total hip replacement (THR) and hip resurfacing have an advantage of low wear rate and greater stability by larger head size and different characteristics of wear mechanism, tribology, lubrication or generating wear debris compared to conventional metal-on-polyethylene THR. Although the mid- or long term clinical reports of second generation MoM THR were excellent, concerns about local and systemic effect by metal particles or metal ions were remained. Recently, reports have emerged of abnormal soft-tissue reactions to metal particles or metal ions and some hip resurfacing implants were expelled from the market due to high revision rate. This article includes the history of MoM THR, tribology, the biologic effect of metal particles and ions, the clinical results of MoM THR and the issues regarding the problems associated with hip resurfacing.
Arthroplasty, Replacement, Hip* ; Head ; Hip ; Ions ; Lubrication

We performed a clinical analysis of the 106 cadaveric renal transplants among the 479 renal allograft patients operated between Jun. 1990 and Oct. 1996 to evaluate the graft outcome in patients with high-risk donor factors. Organ procurement were performed in 73 cases(64.4%) among 113 potential donors. In the remaining 40 cases, 22 cases were given up as organ donors due to medical causes, such as severe organ failure (n=9), HBsAg(+) (n=6), cardiac arrest (n=5),and sepsis (n=2). The incidence of acute tubular necrosis was significantly higher for age >50 yr, cold ischemic time(CIT) >24 hr and prolonged hypotension (P<0.05). Serum creatinine levels at postoperative week 1 and discharge were significantly higher for age >50 yr, CIT>24 hr and prolonged hypotension (P<0.05). The rejection rate did not show any difference. The one-year and two-year graft survival rate were significantly lower for age >50 yr (57.1% vs 87.2% in 1 yr and 57.1% vs 87.2% in 2 yr), for serum Cr>3.0(50.0% vs 87.1% in 1 yr and 50.0% vs 84.8% in 2 yr), for CIT>24 hr(33.3% vs 86.6% in 1 yr and 33.3% vs 84.3% in 2 yr) and prolonged hypotension(50.0% vs 88.0% in 1 yr and 50.0% vs 84.9% in 2 yr). In the multivariate analysis of these variables, serum Cr>3.0, CIT>24 hr and prolonged hypotension were significant factors for graft outcome. A comparison of the early graft function and the graft survival between high risk group (n=75) - age>50 yr (n=7), serum creatinine>3.0 mg/dl (n=4), CIT>24 hr (n=4), history of hypertension (n=17), use of high dose inotropics (dopa>20 microgram, dobu>15 microgram, n=30), episode of cardiac arrest (n=4), prolonged hypotension (<80 mmHg over 6 hr ,n=8), existence of DIC (n=12) or proteinuria (n=23)- and the ideal group (n=31) did not show any significant difference. We conclude that selective high-risk donors can be used to facilitate the expansion of a small donor pool to overcome the organ shortage. However more efforts to develop the preoperative tests to predict the postoperative graft outcome are neccessary to avoid primary nonfunction and delayed graft function, and to achieve a successful graft survival.
Allografts ; Cadaver* ; Creatinine ; Dacarbazine ; Delayed Graft Function ; Graft Survival ; Heart Arrest ; Humans ; Hypertension ; Hypotension ; Incidence ; Kidney Transplantation* ; Multivariate Analysis ; Necrosis ; Proteinuria ; Sepsis ; Tissue and Organ Procurement ; Tissue Donors* ; Transplants

42 knees with degenerative arthritis underwent arthroscopic lavage and 7 knees underwent arthroscopic lavage combined with multiple bone drilling in between 1994 and 1995 and followed average 12 months. Clinical evaluation using the hospita1 for specia] surgery knee scores (HSS scores) was done at last follow up and classified into 4 groups: excellent (90-99), good (80-89), fair (70-79) and poor (less than 70). The results were as follows: l. Of the 42 knees of the lavage group, 6 knees (16%) was excellent, 14 knees (33%) good, ]7 knees (40%) fair and 5 (11%) knees poor. Success group (Excellent & Good) were achived in 20 knees (49%). 2. Of 17 knees treated with arthroscopic lavage comhined with multiple bone drillig resulted in excellent in 9 knees (53%), good in 4 knees (23%), fair in 2 knees (12%) and poor in 2 knees (12%). Success group were achived in 13 knees (76%). 1n conclusion, we helieve that multiple bone drilling in conjunction with arthroscopic lavage has more favorable effect on the pain relief for degenerative osteoarthritis of the knee than arthroscopic lavage only.
Follow-Up Studies ; Humans ; Knee* ; Osteoarthritis* ; Therapeutic Irrigation*

Between Jan. 1990 and Sep. 1996, 462 renal allografts were carried out at the Ulsan University College of Medicine and Asan Medical Center. This study was undertaken to evaluate a clinicopathologic features, to document a relationship between dosage and duration of the corticosteroids, and to figure out a treatment strategy of avascular necrosis(AVN) of bone in 13 cases of AVN of the femoral head following renal transplantation. A control group of 15 cases were randomly selected among 462 cases of renal allografts to do a comparative study with 13 cases of AVN. The diagnosis of AVN of bone was made on the basis of plain radiographs and MRI or bone scan. 1) The incidence of AVN was 2.8%(13/462). 2) In entire cases, affected site of bone was the femoral head. The main clinical manifestations were hip joint pain, limitation of weight bearing and motion. The mean onset of first bone symptoms of AVN was 5.5 months(1~9 months). 3) Clinical parameters such as age, sex, type and duration of preoperative dialysis, type of donor, rate of body weight change, and duration of follow up had no relation with the prevalence of AVN. 4) The mean total doses of corticosteroids at 1, 3, 6, and 12months post-transplantation were not differ significantly between the two groups. 5) Biochemical parameters, such as BUN/Cr., Ca, /P, /ALP., AST/ALT, cholesterol, glucose, total protein, and albumin had no relation save the preoperative BUN, total protein. 6) The mean duration of diagnosis of this condition were 12.9 months(range, 9~31 months), 6.7 months(range, 1~12 months), 6.9 months(range, 1~14 months) by X-ray, MRI, and bone scan respectively. 4/12(33.3%) cases of AVN was diagnosed by magnetic resonance imaging(MRI) at the time of the first clinical bone symptoms. 7) In AVN group, conservative management were performed in 2 cases, core decompression in 7 cases, and total hip replacement arthroplasty(THRA) were performed in 4 cases of AVN of the femoral head. From this study, we could not illustrate the precipitating factors in transplant recipients using steroid following renal transplantation. We considered that prognosis of AVN depends entirely on early diagnosis using MRI or bone scan, and proper treatment according to the stage of this condition.
Adrenal Cortex Hormones ; Allografts ; Arthroplasty, Replacement, Hip ; Body Weight Changes ; Cholesterol ; Chungcheongnam-do ; Decompression ; Diagnosis ; Dialysis ; Early Diagnosis ; Follow-Up Studies ; Glucose ; Head ; Hip Joint ; Humans ; Incidence ; Kidney Transplantation* ; Magnetic Resonance Imaging ; Necrosis* ; Precipitating Factors ; Prevalence ; Prognosis ; Tissue Donors ; Transplantation ; Ulsan ; Weight-Bearing

Patient death with a functioning graft(DFG) has been a predominant cause of graft loss. According to conventional graft survival(C-GS) analysis, DFG is considered as a graft failure. However, such survival analysis may obscure immunologic graft loss and distort the overall graft results as well as risk factors affecting the graft survivals. In functional graft survival(F-GS) analysis, the DFG is considered as censored data(in which the graft survived until patient death) which is more closely related with the immunologic graft loss. We designed our study to identify the differences and significance of F-GS compared to C-GS. From April 1984 to October 1995, 1242 living donor kidney transplantations under cyclosporine were performed at Yonsei University Medical Center. At least a 1-year follow-up was possible in all the patients. The graft survival rate was calculated by both C-GS and F-GS analyses. The recipient's and the donor's ages, the donor-recipient relationship, the degree of HLA matching, the degree of ABO blood type matching, the episodes of acute rejection within 1 year, and the presence of diabetes mellitus were monitored as risk factors affecting the graft survival in the two analysis methods. Univariate and multivariate analyses for risk factors were done by the Kaplain-Meier method and the Cox proportional harzard model. The C-GS rate were 96.3% at 1 year, 81.8% at 5 years, and 58.4% at 10 years compared to 98.5%, 88.1%, and 67.9%, respectively in the F-GS analysis. Elderly recipients(> or =50), elderly donors(> or =50), presence of acute rejection within 1 year post-transplant, ABO blood type minor mismatching, and diabetic recipients were risk factors affecting long-term graft survival in the C-GS analysis. However, elderly recipients and diabetic recipients were no longer considered as risk factors in the F-GS analysis. In fact, elderly recipients or diabetic recipients showed equal or even better graft survivals in the F-GS analysis compared with younger or non-diabetic recipients. The differences between the C-GS and the F-GS analyses in such subgroups suggests that the primary cause of graft loss in these groups was non-immunologic. Death with functioning graft(DFG) needs to be considered in analyzing kidney-transplant outcomes. Hence, we propose that all transplant graft survival data be presented in two ways, by conventional and functional graft analyses.
Academic Medical Centers ; Aged ; Cyclosporine ; Diabetes Mellitus ; Follow-Up Studies ; Graft Survival* ; Humans ; Kidney Transplantation ; Living Donors ; Multivariate Analysis ; Risk Factors ; Transplants*

PURPOSE: To evaluate the usefulness of internal fixation with plate in treating infected nonunion of long bone. MATERIALS AND METHODS: From March 1993 to February 2004, ten patients who underwent internal fixation with plate and cancellous bone graft on account of infected nonunion of long bone were retrospectively examined. The medical treatment were composed of thorough and adequate debridement of necrotic tissue, irrigation and plate fixation. Two patients were operated on with bridging plate method. Autologous cancellous bone graft was performed in 6 patients. In 2 cases, it was performed 4 weeks after internal fixation. RESULTS: In 9 patients, radiographic union appeared on the average of 6.8months and infections were cured before union occurred. CONCLUSION: Internal fixation with plate is a useful method for the solid fixation in the treatment of infected nonunion. The general concern was that the inserted hardware worsened the infection, which was overcomed with the operative techniques as bridging plate, debridement and cancellous bone graft.
Debridement ; Humans ; Retrospective Studies ; Transplants

PURPOSE: We investigate the effect of osteoprotegerin (OPG) on activation of osteoclastogenesis and NF-kappaB activation by PMMA (Polymethyl methacrylate) particles in osteoclast precursor cells. MATERIALS AND METHODS: Osteoclast precursor cells (CSF-1 dependent) were obtained from whole bone marrow of C57BL mouse. Four experiments included 1) different dose of RANKL (Receptor Activator of NF-kappaB ligand) treatment (0, 1, 10, 40 ng/ml) 2) PMMA treatment +/- RANKL 3) PMMA treatment with different dose of RANKL 4) PMMA treatment +/- OPG. After treatments, cultured cells were stained with TRAP (Tartrate resistant alkaline phosphatase). The activity of NF-kappaB DNA nuclear translocation was detected by EMSA (electrophoretic mobility shift assay). RESULTS: The experiments with RANKL on osteoclast precursors differentiation demonstrated a dose-dependent stimulation of osteoclastogenesis (p<0.05). Control cultures without RANKL had no osteoclasts, while maintenance in 1 ng/ml of RANKL results in low level osteoclast formation. PMMA particles activated osteoclastogenesis in RANKL-primed osteoclast precursor cells. And the effect of particles on osteoclastogenesis were dependent on RANKL concentration (p<0.03). OPG treatment significantly decreased osteoclast formation and NF-kappaB DNA binding activity by PMMA particles in osteoclast precursor cells. CONCLUSION: OPG inhibits activation of osteoclast formation and NF-kappaB DNA binding activity by PMMA particles through RANK-RANKL pathway.
Animals ; Bone Marrow ; Cells, Cultured ; DNA ; Electrophoretic Mobility Shift Assay ; Mice ; Mice, Inbred C57BL ; NF-kappa B* ; Osteoclasts* ; Osteoprotegerin ; Polymethyl Methacrylate*