Femur neck fracture is well known as one of the major death cause after trauma in elderly patients, and unsolved fracture due to its frequent association with complications such as avascular necrosis and nonunion. Through meticulous evaluation of the patient, hip and surgeon's experiences, reduction of mortality and morbidity as well as rapid recovery of the patient to the preinjury social and ambulatory status without local complications and revision after treatment is urgently needed. Many factors about this fracture in itself were noted, but we have analyzed 18 femur neck fracture of the patients older than 50 years preliminarily according to age, fracture pattern, osteoporosis, etiology and method of treatment with its delay in association with major complications especially avascular necrosis and nonunion. The results are as follows; 1. Of these 18 fractures, 11 were in females, 8 were caused by minor trauma such as slipdown accident and 4 were associated with definite osteoporosis according to the Sing's classification. 2. Fracture pattern of these 18 are undisplaced in 4, displaced subcapital in 11, displaced transcervical in 3. 11 fractures in the patients older than 60 year are composed of 3 undisplaced or impacted fractures and 8 displaced subcapital fractures. 3. These 18 fractures were treated by closed reduction and internal fixation with multiple pins in 13, and hemiarthroplasty in 4, but one was not treated to die after discharge from hospital. 4. Undisplaced or impacted fractures and 3 displaced transcervical fractures were not associated with any complications such as avascular necrosis or nonunion. But 4 of 6 displaced subcapital fractures were complicated by avascular necrosis, 3 of which were reduced in the varus position within 1 week, and the other was reduced in the good position on 1 week after trauma. There was no complication in 2 displaced subcapital fractures reduced in valgus position within 3 days after trauma. According to the above results, the prognosis of the femur neck fracture is dependent upon the fracture pattern and delay in its treatment. So it is inevitable to reduce the fracture in anatomical or valgus position as early as possible. But the arthroplasty may be needed in displaced subcapital fractures delayed for several days, with its reluction in extreme varus position or impossible and with preexisting disease in the same hip joint (total hip replacement).
Aged* ; Arthroplasty ; Cause of Death ; Classification ; Female ; Femoral Neck Fractures* ; Femur Neck* ; Femur* ; Hemiarthroplasty ; Hip ; Hip Joint ; Humans ; Methods ; Mortality ; Necrosis ; Osteoporosis ; Preexisting Condition Coverage ; Prognosis

Trauma is one of the causes of lymphedema. However, we usually do not consider it as a cause of the lymphedema, thus, we often fail to take care of the patients properly. We report a patient with post traumatic lymphedema and the result of complex decongestive therapy, and reviewed the clinical, lymphoscintigraphic findings and treatment.
Humans ; Lymphedema*

Epidermolytic keratosis palmaris is a rare disease which shows clinical findings of Unna Thost keratoderma and histopathologic of epidermolytic hyperkeratosis. We report herein a case of epidermolytic keratosis palmaris et plantaris in a 16-month-old female baby. Light microscopy shows marked hyperkeratosis, large irregular keratohyalin granules, and large clear spaces in the granular and upper spinous layers. Eletron microscopic findings shows that the clear spaces are areas of cytoplasm filled with a fibrillar material and cellular organelles. Abnormal clumping of tonofilament and keratohyalin is also present.
Cytoplasm ; Female ; Humans ; Hyperkeratosis, Epidermolytic ; Infant ; Intermediate Filaments ; Keratoderma, Palmoplantar* ; Keratosis* ; Microscopy ; Organelles ; Rare Diseases

PURPOSE: The Pediatric Risk of Mortality(PRISM) III score was developed from the Physiologic Stability Index(PSI) to assess pediatric ICU mortality and Provide an objective data as a severity index. Although the PRISM score has been applied to many comparisions and analyses in previous studies, there are few reports applied to pediatric intensive care patients in Korea. To evaluate the effectiveness of the PRISM III score as a severity index for expecting mortality and find important variables influencing mortality, we applied this scoring scale to pediatric neurologic patients admitted to the ICU and analyzed the data statistically. METHODS: Data collection was done by careful review of medical records and scored each clinical variable. The outcome at discharge was determined as non-survival, survival, and hopeless discharge. Determination of mortality in the hopeless discharge group was done within 48 hours after discharge by telephone interview. The study populations were classified into four groups; CNS infection(26 patients), acute encephalopathy(31 patients), status epilepticus(35 patients) and cerebrovascular disorder(4 patients). The difference of the PRISM III score between the survival group and non-survival group was compared by using the nonparametric Mann~Whitney test in the entire study population and for each diagnostic group. To confirm the degree of fitness between the actual mortality and Predicted mortality, the Hosmer-Lemeshow goodness-of-fit test, a multiple logistic regression model was used. All clinical variables used for scoring were compared for survivals and non-survivals by the Chi-square test. f values <0.05 were considered significant. RESULTS: The PRISM III score was significantly higher in the non-survival groups than in the survival group. Predicted mortality from the PRISM III score has fitted to actual mortality According to the results of analyses in each diagnostic groups, the PRISM III score was higher in non-survivals of the acute encephalopathy and CNS infection groups, but statistically insignificant in the cerebrovascular disorders and status epilepticus groups. The important variables of the PRISM III score associated with mortality were mental state, Pupil reflex, systolic blood pressure, acidosis, blood sodium level blood creatinine level, blood glucose level, and PT/PTT. , CONCLUSION: The PRISM III score is helpful in predicting mortality in pediatric intensive care neurologic patients, especially those in the acute encephalopathy or the CNS infection groups. However, this score was not useful in the status epilepticus group, and insignificant in cerebrovascular group. Due to the smallness of the study group, more massive and comprehensive studies are needed as a follow up to this study.
Acidosis ; Blood Glucose ; Blood Pressure ; Cerebrovascular Disorders ; Creatinine ; Data Collection ; Follow-Up Studies ; Humans ; Critical Care* ; Interviews as Topic ; Korea ; Logistic Models ; Medical Records ; Mortality* ; Pupil ; Reflex ; Sodium ; Status Epilepticus

No abstract available.
Peristalsis*

Colonna capsular arthroplasty is a two-stage procedure for congenital dislocation of the hip, but is not suitable for congenital subluxation. The bone architecture of the femoral head should approach the nearly normal and the child preferably should be more than three years old and less than eight if the best functional result is to be obtained. These brief case reports of five patients who could be followed for from one year and one month to more than seventeen years document the fact that the procedure may produce a hip with an excellent roentgenographic appearance and enduring satisfactory function.
Arthroplasty ; Child ; Dislocations ; Head ; Hip ; Humans

PURPOSE: To compare the pullout strength and insertion torque of proximally tapered screw (PT) with fully tapered screw (FT) and to investigate the correlation between the pullout strength and bone mineral density, morphology of pedicle, and insertion torque of the screw in osteoporotic lumbar spine. MATERIALS AND METHODS: Fifteen osteoporotic lumbar vertebrae from four white human cadavers were used. Bone mineral density, pullout strength and insertion torque were measured by dual energy x-ray absorptiometry, MTS and torque screw driver individually. RESULTS: The FT screw provided greater pullout force and insertion torque than the PT screw in 12 of 15 vertebrae tested (p<0.01). Pullout strength was correlated with insertion torque in PT (r=0.666, P=0.0006) and FT (r=0.464, P=0.19) screws. CONCLUSIONS: Results of this study indicate that the FT screws provide higher pullout strength and insertion torque than PT screws in osteoporotic lumbar spine and suggest that the development of tapered minor diameter may lead to an improved pedicle screw with high pullout strength and insertion torque. Nevertheless, further study is needed to investigate the effect of tapering the minor diameter on the mechanical bending strength of the screw.
Absorptiometry, Photon ; Bone Density ; Cadaver ; Humans ; Lumbar Vertebrae ; Spine* ; Torque

No abstract available.
Angiofibroma ; Carbon ; Carbon Dioxide ; Lasers, Gas

We examined 990 self-referred men with one of urologic diseases over age 50 years to compare clinical usefulness of digital rectal examination(DRE), serum PSA level, and transrectal ultrasonography of the prostate(TRUS) in a screening program for prostatic cancer. Biopsy was performed in 201(20%) cases, of which 20 percent was diagnosed as prostate cancer. Sensitivity of DRE was 68%, specificity was 91%, and positive predictive value was 53%, respectively. Positive predictive values are 26% in cases with serum PSA level above 4ng/ml, 36% in cases with serum PSA above 10ng/ml and 40% for TRUS, respectively. When serum PSA below 4ng/ml and negative DRE, the positive predictive value was merely 6%. But when serum PSA above 10ng/ml and positive DRE, the positive predictive value increased to 72%. When serum PSA below 4ng/ml, negative DRE and negative TRUS, the positivepredictive value was merely 7%. However when serum PSA above 10ng/ml, positive DRE and positive TRUS, the positive predictive value was 80%. We conclude that DRE has greater diagnostic effect than the serum PSA level greater than 10ng/ml or hypoechoic area on TRUS and DRE with a serum PSA concentration is considered as an effective screening method of prostatic cancer in all urologic patients over 50 years of age. If DRE and serum PSA level are normal, there is no reason to proceed with TRUS and/or biopsy of the prostate.
Biopsy ; Digital Rectal Examination* ; Humans ; Male ; Mass Screening ; Prostate* ; Prostatic Neoplasms* ; Sensitivity and Specificity ; Ultrasonography* ; Urologic Diseases

PURPOSE: Bone morphogenetic proteins (BMPs) play an important role in the formation of cartilage and bone, as well as regulating the growth of chondroblasts and osteoblasts. In this study, we investigated whether recombinant human BMP adenoviruses are available for ex vivo gene therapy, using human fibroblasts and human bone marrow stromal cells in an animal spinal fusion model. MATERIALS AND METHODS: Human fibroblasts and human bone marrow stromal cells were transduced with recombinant BMP-2 adenovirus (AdBMP-2) or recombinant BMP-7 adenovirus (AdBMP-7), referred to as AdBMP-7/BMSC, AdBMP-2/BMSC, AdBMP-7/HuFb, and AdBMP-2/HuFb. We showed that each cell secreted active BMPs by alkaline phosphatase staining. Since AdBMP-2 or AdBMP-7 tranducing cells were injected into the paravertebral muscle of athymic nude mice, at 4 weeks and 7 weeks, we confirmed that new bone formation occurred by induction of spinal fusion on radiographs and histochemical staining. RESULTS: In the region where the AdBMP-7/BMSC was injected, new bone formation was observed in all cases and spinal fusion was induced in two of these. AdBMP-2/BMSC induced bone formation and spinal fusion occurred among one of five. However, in the region where AdBMP/HuFb was injected, neither bone formation nor spinal fusion was observed. CONCLUSION: The osteoinductivity of AdBMP-7 was superior to that of AdBMP-2. In addition, the human bone marrow stromal cells were more efficient than the human fibroblasts for bone formation and spinal fusion. Therefore, the results of this study suggest that AdBMP-7/ BMSC would be the most useful approach to ex vivo gene therapy for an animal spinal fusion model.
Adenoviridae* ; Alkaline Phosphatase ; Animals ; Bone Morphogenetic Protein 7 ; Bone Morphogenetic Proteins ; Cartilage ; Chondrocytes ; Fibroblasts ; Genetic Therapy* ; Humans* ; Mesenchymal Stromal Cells ; Mice ; Mice, Nude ; Osteoblasts ; Osteogenesis ; Spinal Fusion* ; Spine