No abstract available.
Mitral Valve*

The incidence of the interochanteric fracture of femur is increasing and this increase is likely to continue for many years due to increase of traffic accident and old people. The primary goal in the treament of an elderly patient with an intertrochanteric fracture is to return the patient to his prefracture activity as soon as possible. Rapid mobilization of a pain free patient helps to prevent skin ulceration, pneumonia, urinarystasis, thromboembolic disease and other complications of confinement to bed in the eldery. For there reasons, treatment of intertrochanteric fractures by surgical methods has become the standard procedure. The authors treated 53 cases of intertrochanteric fractures from March 1978 to February 1985 with Ender nail or sliding screw plate. The results obtained as follows: l. In the 34 cases where sliding screw plates were used, the patients average age was 49.4 years old and in the 19 cases where Ender nails were used, the average in age was 63.2 and therefore, compared to the sliding screw plate, the patients using Ender nails were about 13.8 years older. 2. In the cases where Ender nails were used, the average operation hours took in the average of 55 minutes and whereby, in the cases where sliding dcrew plates were used, took in the average of 125 minutes, and during the operation time, the amout of hemorrhage in the cases of Ender nail was about 150ml and the sliding scew plate resulted in about 610ml. 3. The average weight bearing period in the cases which Ender nails were used took in the average of 2.5 weeks, where by the sliding scew plates took in the average of 9.8 weeks. 4. In the cases where Ender nails were used, the radiological bony union time was about 12.7 weeks and the sliding screw plate took about 16.1 weeks. 5. In the cases of Ender nail, if, in the geriatric age, the indication is chosen well, it will result in a benefial treatment method.
Accidents, Traffic ; Aged ; Femur ; Hemorrhage ; Hip Fractures ; Humans ; Incidence ; Methods ; Pneumonia ; Skin Ulcer ; Weight-Bearing

Reconstruction in the head and neck region uses a wide range of surgical flaps for defect closure. The methods range from local, mostly myocutaneous flaps, and skin grafts to free microsurgical flaps. Reconstructive surgery must conserve the appearance and mimic the original function. Moreover, the donor-site defect needs to be reduced, with no resulting functional or aesthetic impairment. To achieve these goals, a thin reliable flap that is close to the face and neck region with a good match of the skin texture and a smooth, hairless skin surface is needed. So we used a flap from the shoulder region which provides an optimum skin texture to match the neck and face. This supraclavicular flap is a fasciocutaneous island flap, which has a vascular pedicle extending from the transverse cervical artery with two accompanying veins. Moreover, the tunneling method improves the donor site by reducing scarring. We hereby introduce the anatomic characteristics and effectiveness of this method.
Arteries ; Cicatrix ; Head* ; Humans ; Myocutaneous Flap ; Neck* ; Shoulder ; Skin ; Surgical Flaps ; Tissue Donors ; Transplants ; Veins

PURPOSE: Microvascular reconstructive surgery has become an integral part of the treatment of head and neck cancer patients. This review of 121 free flaps for head and neck cancer patients performed over the last 11 years was done to evaluate circulatory crisis, salvage, and secondary reconstruction and to investigate which factors may contribute to these rates. METHOD: Nine emergent explorations among 121 head and neck reconstruction with free flaps were reviewed to analyze detection of vascular crisis, the time interval from detection of circulatory crisis to exploration, operation procedures and results, and secondary reconstructions. Emergent exploration was done with our protocol. RESULT: Nine free flaps exhibited signs of vascular problems between 1 day and 6 days postoperatively. The emergent exploration rate of this series was 7.4% (9/121). The salvage rate was 55.6% (5/9), giving an overall flap viability of 96.7% (117/121). In our study, preoperative radiation therapy, positive smoking history, alcohol consumption history, combined disease such as diabetes mellitus and hypertension, recipient vessels and types of vascular anastomosis were not related to the causes of circulatory crisis. The mean time interval between the onset of clinical recognition of impaired flap perfusion and re-exploration of the salvaged 5 flaps was 3.2 hours, that of failed 4 flaps was 11.25 hours. CONCLUSION: Despite high overall success rate, relatively low salvage rate may be attributed to late detection of circulatory crisis and in long time interval between detection and exploration. We conclude that early detection of circulatory crisis and expeditious re-exploration are a matter of great importance for the success of salvage operation.
Alcohol Drinking ; Diabetes Mellitus ; Free Tissue Flaps ; Head ; Head and Neck Neoplasms ; Humans ; Hypertension ; Neck ; Perfusion ; Smoke ; Smoking

PURPOSE: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea. METHODS: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. RESULTS: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7+/-8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. CONCLUSIONS: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.
Aged ; Angiography ; Choroid ; Ethnic Groups ; Eye ; Female ; Fluorescein ; Humans ; Hypertension ; Incidence ; Korea ; Macular Degeneration ; Male ; Membranes ; Photography ; Retinaldehyde ; Smoke ; Smoking ; Specialization

PURPOSE: The environmental factors human rhinoviruses (HRVs) and house dust mites (HDMs) are the most common causes of acute exacerbations of asthma. The aim of this study was to compare the chemokine production induced by HRVs in airway epithelial cells with that induced by other respiratory viruses, and to investigate synergistic interactions between HRVs and HDMs on the induction of inflammatory chemokines in vitro. METHODS: A549 human airway epithelial cells were infected with either rhinovirus serotype 7, respiratory syncytial virus (RSV)-A2 strain, or adenovirus serotype 3 and analyzed for interleukin (IL)-8 and regulated on activation, normal T-cell expressed and secreted (RANTES) release and mRNA expression. Additionally, activation of nuclear factor (NF)-kappaB and activator protein (AP)-1 were evaluated. The release of IL-8 and RANTES was also measured in cells stimulated simultaneously with a virus and the HDM allergen, Der f1. RESULTS: HRV caused greater IL-8 and RANTES release and mRNA expression compared with either RSV or adenovirus. NF-kappaB and AP-1 were activated in these processes. Cells incubated with a virus and Der f1 showed an increased IL-8 release. However, compared with cells incubated with virus alone as the stimulator, only HRV with Der f1 showed a statistically significant increase. CONCLUSIONS: IL-8 and RANTES were induced to a greater extent by HRV compared with other viruses, and only HRV with Der f1 acted synergistically to induce bronchial epithelial IL-8 release. These findings may correspond with the fact that rhinoviruses are identified more frequently than other viruses in cases of acute exacerbation of asthma.
Adenoviridae ; Antigens, Dermatophagoides ; Arthropod Proteins ; Asthma ; Chemokine CCL5 ; Chemokines ; Cysteine Endopeptidases ; Epithelial Cells ; Humans ; Interleukin-8 ; Interleukins ; NF-kappa B ; Pyroglyphidae ; Respiratory Syncytial Viruses ; Rhinovirus ; RNA, Messenger ; Sprains and Strains ; T-Lymphocytes ; Transcription Factor AP-1 ; Viruses

We investigated the antineoplastic potentials of recombinant adenovirus containing wild-type p53 cDNA (Ad5CMV-p53) for malignant gliomas. In four human glioma cell lines (U-251 and LG expressing endogenous mutant p53, and U-87 and EFC-2 expressing wild-type p53) and two rat glioma cell lines (9L and C6, each expressing mutant and wild-type p53), gene transfer efficiency determined by X-gal staining and Western blotting was varied (10-99% at 10-500 multiplicity of infection, MOI). Growth inhibitory effect was drastic (>90% at 100 MOI) in U-251 cells and only moderate or minimal in other cell lines harboring wild-type p53 or low gene transfer efficiency. Ex vivo transduction of U-251 cells with Ad5CMV-p53 suppressed the in vivo tumorigenicity of the cells. Histopathologic examination for Ad5CMV-p53 toxicity to rat brains showed inflammatory reactions in half of the tested brains at 10(8) MOI. U-251 cells were inoculated intracerebrally in nude mice and injected Ad5CMV-p53 into the tumor, in which neither the tumor suppression nor the survival benefit was observed. In conclusion, heterogeneity of the cellular subpopulations of malignant glioma in p53 status, variable and insufficient gene delivery to tumor, and adenoviral toxicity to brain at higher doses may be limiting factors to be solved in developing adenovirus-p53 gene therapy for malignant gliomas.
Adenoviruses, Human ; Animal ; Brain Neoplasms/therapy* ; Cell Division ; Gene Therapy* ; Genetic Vectors ; Glioma/therapy* ; Human ; Mice ; Mice, Nude ; Protein p53/physiology ; Protein p53/genetics* ; Rats ; Tumor Cells, Cultured

We investigated the antineoplastic potentials of recombinant adenovirus containing wild-type p53 cDNA (Ad5CMV-p53) for malignant gliomas. In four human glioma cell lines (U-251 and LG expressing endogenous mutant p53, and U-87 and EFC-2 expressing wild-type p53) and two rat glioma cell lines (9L and C6, each expressing mutant and wild-type p53), gene transfer efficiency determined by X-gal staining and Western blotting was varied (10-99% at 10-500 multiplicity of infection, MOI). Growth inhibitory effect was drastic (>90% at 100 MOI) in U-251 cells and only moderate or minimal in other cell lines harboring wild-type p53 or low gene transfer efficiency. Ex vivo transduction of U-251 cells with Ad5CMV-p53 suppressed the in vivo tumorigenicity of the cells. Histopathologic examination for Ad5CMV-p53 toxicity to rat brains showed inflammatory reactions in half of the tested brains at 10(8) MOI. U-251 cells were inoculated intracerebrally in nude mice and injected Ad5CMV-p53 into the tumor, in which neither the tumor suppression nor the survival benefit was observed. In conclusion, heterogeneity of the cellular subpopulations of malignant glioma in p53 status, variable and insufficient gene delivery to tumor, and adenoviral toxicity to brain at higher doses may be limiting factors to be solved in developing adenovirus-p53 gene therapy for malignant gliomas.
Adenoviruses, Human ; Animal ; Brain Neoplasms/therapy* ; Cell Division ; Gene Therapy* ; Genetic Vectors ; Glioma/therapy* ; Human ; Mice ; Mice, Nude ; Protein p53/physiology ; Protein p53/genetics* ; Rats ; Tumor Cells, Cultured

Several recent clinical trials reported that intralymphatic immunotherapy (ILIT) for some allergens, such as cat dander and pollen, induce tolerance more rapidly than conventional subcutaneous or sublingual immunotherapy, have a comparable duration of effect after only 3 injections, and do not provoke serious local or systemic reactions. However, the efficacy and safety of ILIT are using Dermatophagoides farinae (Df), Dermatophagoides pteronyssinus (Dp), and dog, which are indoor allergens that are commonly found globally, need to be evaluated. Furthermore, use of multiple allergens in ILIT should be investigated. We assessed the clinical efficacy and adverse effects of ILIT using aqueous Df, Dp, dog, and cat allergens or mixtures thereof in patients with allergic rhinitis. A total of 11 subjects with AR sensitized to Df, Dp, cat, and/or dog allergens received 3 intralymphatic inguinal injections of sensitized allergen extract (HollisterStier, New Orleans, LA, USA). Clinical parameters were assessed before ILIT, and 4 months and 1 year after the first injection. Rhinitis symptoms were alleviated and quality of life was improved 4 months after ILIT (P=0.012 and P=0.007, respectively), and these improvements lasted for 1 year after ILIT (P=0.047 and P=0.009, respectively). However, we observed 2 cases of anaphylaxis, one case of a moderate-to-severe systemic hypersensitivity reaction and the other case of a severe local reaction at the injection site after ILIT. In conclusion, ILIT can rapidly improve allergy symptoms and quality of life, and this effect lasts for 1 year. In hypersensitized patients, however, ILIT can provoke severe systemic and/or local hypersensitivity reactions when performed using aqueous allergen extracts.
Allergens ; Anaphylaxis ; Animals ; Cats ; Dander ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Dogs* ; Dust* ; Humans ; Hypersensitivity* ; Immunotherapy* ; Pilot Projects* ; Pollen ; Pyroglyphidae* ; Quality of Life ; Rhinitis ; Rhinitis, Allergic ; Sublingual Immunotherapy ; Treatment Outcome

BACKGROUND: Since the bioavailability of itraconazole capsule is influenced by patients gastric acidity, it results in treatment failure due to its low dissolution and subsequent low absorption when administered in fasting. Itraconazole Melt-Extrusion tablet has been lately developed in order to improve its dissolution profile. It is the first clinical study to evaluate the efficacy and safety of itraconazole Melt-Extrusion tablet in Korea. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of itraconazole melt-extrusion tablet 400mg daily for 1 week(pulse therapy) for hyperkeratotic type of tinea pedis and manus. METHODS: A clinical and mycological investigation was made of 812 outpatients with hyperkeratotic type of tinea pedis and/or tinea manus who had visited at 52 general hospitals under the lead of the Korean Dermatological Association from June to December, 1998. Patients confirmed by clinically and microscopically as hyperkeratotic type of tinea pedis and/or tinea manus were administered 2 tablets twice a day for one week and followed up for 8 weeks from the start of the medication. RESULTS: The results were summarized as follows; 1. Clinical symptoms of hyperkeratotic type of tinea pedis and/or tinea mauns were significantly improved at the end of study, week 8(p<0.001). 2. Clinical response rate, defined as more than 50% decrease of the sum of the clinical symptom scores, was 79.3%(512/646). 3. Mycological cure rate, dafined as both culture and KOH negative at week 8, was 78.2%(244 /312). 4. 40(5.5%) patients, of the 727 patients evaluable for drug safety evaluation, were reported to have adverse event. CONCLUSION: Itraconazole Melt-Extrusion tablet 400mg/day for 1 week (pulse therapy) is effective and safe in the treatment of hyperkeratotic type of tinea pedis and/or tinea manus.
Absorption ; Biological Availability ; Fasting ; Gastric Acid ; Hospitals, General ; Humans ; Itraconazole* ; Korea ; Outpatients ; Tablets ; Tinea Pedis* ; Tinea* ; Treatment Failure