As trochanteric fractures frequently occur in the elderly patients and complications such as pneumonia, thrombo-embolic disease, decubitus ulcer, and urinary tract infection are common, early mobilization after open reduction and internal fixation with hip nail are the standard treatment. Since 1931 when Smith-Peterson first introduced a tri-flanged nail, further more, since 1941 when Jewett pioneered the one-piece nail by adding a solid plate to a Smith-Peterson nail, numorous implants including threaded pins, screws, nails, and plates have been modified and desiged for fractured hips till now to achieve early ambulation and to maintain stable reduction. In 1955 Pugh and Ken introduced a sliding nail-plate and Schumpelick described the use of sliding screw-plate, which was modified further by Callender and Holt pioneered the concept of heavy nail in 1963. Recently compression sliding screw-plate is popular. Also many surgeons such as Evans, Dimon and Hughston, Sarmiento, and Boyd and Anderson have attempted to provide stable fixation of fracture by altering the position of fracture fragments to improve the mechanical resistances of bone to disruptive forces of weight-bearing. The surgical procedures of open reduction and internal fixation were carried out and followed for more than 6 months on 45 intertrochanteric fractures at Department of Orthopedic Surgery, Seoul National University Hospital, from Jan. 1968 to June. 1975 and the results were observed as follows. 1. Of 45 cases of inter-trochanteric fractures 28 cases occurred in man, 17 cases in woman and each mean age was 54 years in man, 74 years in woman. 2. Of fixation devices, Smith-Peterson nail-plates were used in 19 cases, Jewett nails in 15 cases, compression sliding screw-plates in 9 cases, Smith-Peterson nail in 1 case, and Ken sliding nail-plate in 1 case. 3. Stable fractures occurred in 10 cases were fixed internaly after anatomical reduction. 4. Dimon-Hughston reductions and Jewett Nailing were achieved in 11 cases of 12 unstabIe fractures and had disadvantages such as some limitation of R.O.M. of the affected hip, shortening, and valgus deformity. 5. Of 9 unstable fractures treated by compression sliding screw-plate 7 cases were reduced as anatomicaly as possible and 2 cases were reduced non-anatomicaly because of impossible anatomical reduction but good results were obtained except one failed nailing. 6. Of 7 failures, 6 cases resuIted from failures of nailing during operation and only 1 failure resulted in varus defermity after Dimen-Hughston reduction with Jewett nail.
Aged ; Congenital Abnormalities ; Early Ambulation ; Female ; Hip ; Hip Fractures ; Humans ; Orthopedics ; Pneumonia ; Pressure Ulcer ; Seoul ; Surgeons ; Urinary Tract Infections ; Weight-Bearing

No abstract available.
Aorta* ; Endothelium-Dependent Relaxing Factors*

To evaluate the influence of intraoperative irradiation on the healing of jejunal anastomosis, an experimentalstudy was undertaken using a total of 150 rats. The bursting pressure of the normal jejunum was obtained in groupI. Group II was subjected to resection and anastomosis, and group III was irradiated on the anastomosed jejunumwith a single dose of 1,000 rads. Healing process was evaluated by measuring bursting pressure of the anastomosedjejunum on each postoperative day from 2nd to 14th, and on 21 th day. Bursting pressure was tested by inflatingthe loop of gut with water, and bursting sites were observed. The resuls obtained are summarized as follows; 1.The bursting pressure of the anastomosed jejunum retained normal strength by the 7th postoperative day in thenonirradiated group, whereas by the 11th postoperative day in the irradiated group. 2. Irradiation caused delay inthe healing of anastomosis of the jejunum until the 10th postoperative day; but after then, there was nosignificant difference in bursting pressure between both groups. 3. In the jejunal segments with normal strength,bursting occurred exclusively at the non-anastomotic site in both groups; Bursting started along the mesentericborder in the non-irradiated group, whereas rupture usually occurred on the antimesenteric border in theirradiated group. in the jejunal segments with subnormal strength, bursting usually started on the mesentericborder of the anastomotic site in both groups. The results indicate that intraoperative irradiation with a singledose of 1,000 rads causes no harmful effect on the healing of anastomosis of the jejunum in rats. Therefore, thisstudy suggests the possibility of more effective clinical application of intraoperative irradiation.
Animals ; Intestine, Small ; Jejunum ; Rats ; Rupture ; Water

Leiomyoma of the rectum is a rare tumor and it usually present in 40 to 60 year-old individuals, and it is more frequent in men. It originates from either the muscularis mucosa or muscularis externa and those arising from the muscularis mucosa are typically small and they are identified incidentally in patients who are undergoing sigmoidoscopy. In contrast, the larger leiomyomas arising from the muscularis externa generally present symptoms that are consistent with rectal stenosis or a rectal mass. Endoscopic ultrasonography can help to define the tumor location, extension and size. Surgical resection is the treatment for most leiomyomas of the rectum, but endoscopic electroexcision is a safe and appropriate treatment for small polypoid rectal leiomyoma. We report here on a case of a semipedunculated rectal leiomyoma in a 59 year-old female patient. It was found incidentally during a colonoscopic examination and it was diagnosed by endoscopic ultrasonography. We performed endoscopic mucosal resection with colonoscopic snare electrocoagulation.
Constriction, Pathologic ; Electrocoagulation ; Endosonography ; Female ; Humans ; Leiomyoma ; Male ; Mucous Membrane ; Rectum ; Sigmoidoscopy ; SNARE Proteins

In a murine model system, enhancement of the total IgA and rotavirus-specific IgA of suckling mice was measured by ELISA with the intestinal fluid following oral administration of murine rotavirus EC (EDIM-Cambridge) strain. In the EC strain-administered group, the geometric mean titers (GMT) of total IgAs were 512 and 91 at 1 and 2 week postinfection, respectively. On the other hand, the GMTs of the rotavirus-specific IgAs were 108 and 3 at the same periods, respectively. Thus increase in the total IgAs was 64 folds and that in the rotavirus-specific IgAs was 43 folds compared with the negative control group. As the maximal titers of both the total and rotavirus-specific IgAs were observed at 1 week decreasing until 2 weeks after infection, it is evident that the GMT of the total IgA implies that of rotavirus-specific IgA. In our ELISA system, whose specificity was verified by Western blot analysis, the total IgA in the administered group was determined to be 40-400 ng per 1 ml of the intestinal fluid. Therefore it is concluded that determination of the rotavirus-specific IgA in murine models can be a sensitive indication of rotavirus infection, and will be another promising tool in viral challenge experiments in vaccine development.
Administration, Oral ; Animals ; Blotting, Western ; Enzyme-Linked Immunosorbent Assay ; Hand ; Immunoglobulin A* ; Mice ; Mice, Inbred ICR* ; Rotavirus Infections ; Rotavirus* ; Sensitivity and Specificity

Injury of the ankle ligaments is one of the most common sports-related injuries. Although there are some debates as to the best initial treatment for an acute tear of a lateral ligament, persistent functional instability of the ankle develops in approximately 20% of patients regardless of the type of initial treatment. In these patients, late reconstruction of the lateral ankle ligaments may become necessary. Among 13 cases which have been operated with Larsen procedure using peroneus brevis tendon from March 1991 to February 1993, the 11 cases followed up over 1 year were examined clinically and radiologically. We introduced the clinical analysis and results with the brief review of the literatures. 1. The indication of surgical treatment was the ankle instability which had differences over 10° in talar tilting angle or over 3mm in anterior displacement compared wit the uninjured site. 2. The postoperative results were 5 cases in excellent and 4 in good. 3. The Larsen procedure was considered a good method to anatomically and simply stabilize both the ankle and subtalar joint and to fix tendon depending on the type of instability.
Ankle ; Collateral Ligaments ; Humans ; Ligaments ; Methods ; Subtalar Joint ; Tears ; Tendons

BACKGROUND: It is well known that the prevalence of lung cancer is higher in idiopathic pulmonary fibrosis(IPF) patients than in the general population. This high prevalence is explained by the concept of 'scar carcinoma'. There have been several reports on the prevalence of histologic type of lung cancer in IPF with conflicting results. Despite of the high smoker rate in almost all previous reports, none considered the smoking history of patients. Therefore we performed a separate studies on fibrosis associated lung cancer and smoking associated lung cancer. The purpose of this study is to investigate the proportion of lung cancer in IPF that is fibrosis assiciated and to determine the most common histologic type in fibrosis associated lung cancer in IPF. METHODS: A retrospective review of medical records and radilolgic studies was performed for cases of lung cancer with IPF. We investigated smoking history, sequence of diagnosis of lung cancer and IPF, histologic type of lung cancer and the cancer location, especially whether the location is associated with fibrosis. To evaluate the proportion of fibrous associated lung cancer, the lung cancer in IPF were categorized according to the presence of fibrosis at cancer location. RESULTS: Fifty seven patients were subjects for this analysis. Six(11%) cases were diagnosed as lung cancer during follow-up for IPF, and both diseases were diagnosed simultaneously in the others. Ninety four percent of patients were smokers and the average smoking amount was 47.1±21.9 pack-year. Among the patients with IPF and lung cancer, 42(80.8%) cases were considered as 'fibrosis associated'. The remainder was 'not fibrosis associated' and probably was due to smoking etc. Although the most frequent histologic type was squamous cell carcinoma as a whole, adenocarcinoma was the prominent histologic type in 'fibrosis associated lung cancer.' CONCLUSION: Considering the proportion of 'fibrosis not associated lung cancer' in the patients with IPF and lung cancer, significant proportion of lung cancer in IPF may not be fibrosis induced. This may influence the distribution of histologic type of lung cancer in IPF.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Diagnosis ; Fibrosis* ; Follow-Up Studies ; Humans ; Idiopathic Pulmonary Fibrosis* ; Lung Neoplasms* ; Lung* ; Medical Records ; Prevalence ; Retrospective Studies ; Smoke ; Smoking

Endometriosis of a surgical scar is rare and occurs mainly when a hysterectomy or Cesarean section was performed. We describe a 54-year-old woman with a large suprapubic mass as a definite case of a endomerioid carcinoma developing within the scar endometriosis following Cesarean section. Scar endometriosis, as well as endometriosis at other sites, can turn malignant. Endometrioid carcinoma is the most common histological pattern of malignant tumor arising in endometriosis. But clear cell carcinoma is very unusual. A case of primary clear cell carcinoma in endometriosis of a Cesarean section scar is described. To the best of our knowledge, this is the first documented case of endomerioid carcinoma developing within the scar endometriosis in Korea.
Adenocarcinoma, Clear Cell/surgery ; Adenocarcinoma, Clear Cell/pathology ; Adenocarcinoma, Clear Cell/etiology* ; Carcinoma, Endometrioid/surgery ; Carcinoma, Endometrioid/pathology ; Carcinoma, Endometrioid/etiology* ; Case Report ; Cesarean Section/adverse effects* ; Cicatrix* ; Endometriosis/physiopathology ; Female ; Human ; Middle Age ; Tomography, X-Ray Computed/methods

BACKGROUND: Cancer of the esophagus is one of the most malignant tumors with poor prognosis. The p53 gene alteration, over expression of Cyclin D1, and Ki67 index were thought to be the prognostic factors. However, their clinical significances in esophageal squamous cell carcinoma are controversial and p53 accumulation may not correlate with genetic mutation. The current study investigates their prognostic significance in squamous cell carcinoma of the esophagus. MATERIAL AND METHOD: The Subjects studied were 124 esophageal squamous cell carcinoma patients who underwent esophagectomy. The mutation of p53, over expression of Cyclin D1, Ki67 labelling index, mitotic index were examined by using an immunohistochemical staining. We compared the results and investigated the correlation with the mutation of p53, overexpression of Cyclin D1, Ki67 labelling index, mitotic index and tumor size, and duration of survival. RESULT: There was no correlation between the results in immunohistochemical staining according to age, sex, tumor size, lymph node status, and clinical stage of the disease. Mutant p53 protein was found in 69 cases (55.6%). Median survival time was 21 months in cases with negative for mutant p53 protein and 22 months in positive cases. There was no significant difference in survival (p=0.46). Median survival time was 22 months in cases with negative for Cyclin D1 and 16 months in positive cases (p=0.18). Median and mean survival time was 22 months and 36 months when Ki67 labeling index was 40 or less (102 cases). Median and mean survival was 16 months and 23 months, when Ki67 labeling index was more than 40 (22 cases). There was significant difference in survival rate (p=0.011). CONCLUSION: Positivity of p53 and cyclin D1 was not useful in predicting the prognosis in our study. There was no significant correlation among mutant p53 protein accumulation, Cyclin D1 over expression, and Ki67 labeling index. However, in several studies, PCR single strand conformational polymorphism analysis of p53 showed a correlation to the prognosis. We thought that there was a significant discordance between p53 gene mutation and mutant p53 protein accumulation. When Ki67 labeling index was more than 40, prognosis was poorer. Ki67 seems to be a prognostic factor in our study. Therefore, we confirmed the possibility of using molecular markers as prognostic factors.
Carcinoma, Squamous Cell* ; Cyclin D1* ; Cyclins* ; Esophageal Neoplasms ; Esophagectomy ; Esophagus ; Genes, p53 ; Humans ; Lymph Nodes ; Mitotic Index* ; Polymerase Chain Reaction ; Prognosis* ; Survival Rate

BACKGROUND: Goal of the initial treatment of primary spontaneous pneumothorax is re-expansion of the lung by evacuation of air from pleural space. Authors thought small caliber catheter could reach to this goal instead of conventional large bore chest tube. This retrospective study was undertaken to assess the effectiveness of 7-French (Fr) catheter for the initial treatment of primary spontaneous pneumothorax. MATERIAL AND METHOD: Between May 2003 and April 2005, 111 patients with primary spontaneous pneumothorax were managed with tube drainage; 7 Fr catheter for 86 patients and 24-French chest tube for 25 patients. We analyzed catheter indwelling time, use of analgesics, re-expansion of the lung, and catheter related problems by medical records. RESULT: Mean catheter indwelling time was 2.4+/-1.1 days in 7 Fr group and 2.3+/-1.3 days in chest tube group (p>0.05). All patients with 24 Fr catheter needed analgesics injection but never in 7Fr group. Complete re-expansion of the lung based on plane chest radiograph was obtained in 77% of 7 Fr group. The problem related with 7 Fr catheter was kinking, which showed in 5.6%. CONCLUSION: Application of the 7 Fr catheter for initial management of primary spontaneous pneumothorax was as effective as 24 Fr catheter.
Analgesics ; Catheters* ; Chest Tubes ; Drainage ; Humans ; Lung ; Medical Records ; Pneumothorax* ; Radiography, Thoracic ; Retrospective Studies