Purpose: The purpose of this study was to determine whether the direct anterior approach (DAA) can be applied to hemiarthroplasty for treatment of unstable femoral intertrochanteric fractures in elderly patients. Materials and Methods: We conducted a retrospective review of 34 cases (34 patients) who underwent bipolar hemiarthroplasty using a DAA from February 2019 to April 2020. The mean age of the patients was 82.68 years (range, 67-95 years). A cementless distal fixation hip system was used in all cases. Operation time, total amount of blood loss, intraoperative and postoperative fractures, infections, and reoperations were measured. The patients performed weight-bearing walking as tolerated immediately after surgery. Measurement of migration of the greater trochanter (GT) and progressive subsidence of the femoral stem was performed using follow-up radiographs. Results: The mean operative time was 83.50 minutes (range, 60-120 minutes). The mean amount of bleeding was 263.53 mL (range, 112-464 mL). Walking started a mean of 3.03 days (range, 3-4 days) after surgery. There was no case of progressive migration of the GT more than 5 mm even though it was not fixed. There were no cases of infection, dislocation, or reoperation. Conclusion Bipolar hemiarthroplasty using the DAA for treatment of unstable femoral intertrochanteric fractures could be considered a useful option that provides many advantages in elderly patients.

PURPOSE: Panendothelial markers such as factor VIII, CD34, CD31, CD105 (endoglin) and D2-40 are useful to identify proliferating endothelium that is related to tumor invasion. This study was designed to identify the correlation between the expressions of panendothelial and lymphatic vessel markers in preoperative biopsy specimens and the clinicopathologic factors. METHODS: Preoperative biopsy specimens from 72 patients were immunostained for CD105, CD34, CD31, Factor VIII and D2-40. The microvessel and lympathic vessel densities (MVD and LVD) were counted in dense vascular foci (hot spots) on a x200 field in each specimen. The correlation between these factors and the clinicopathologic parameters were analyzed. RESULTS: The MVD by CD105 showed statistically significant correlation with tumor emboli, the T-stage, nodal metastasis and the stage, and the MVD by CD34 had statistically significant correlation with tumor emboli, nodal metastasis and the stage. The lympathic vessel density (LVD) by D2-40 showed a statistically significant correlation with tumor emboli, the T-stage and nodal metastasis. CONCLUSION: The MVD by CD105 and the LVD by D2-40 in preoperative biopsy specimens of colorectal cancers may be useful markers for the prediction of invasiveness.
Biopsy* ; Colorectal Neoplasms* ; Endothelium ; Factor VIII ; Humans ; Lymphatic Vessels* ; Microvessels ; Neoplasm Metastasis

PURPOSE: The prognosis for primary gallbladder cancer is very poor. Because of the lack of specific symptoms, late diagnosis, advanced stage, and ineffective treatment are typical. The purpose of the present study was to investigate the early diagnostic factors that improve the survival rate, by comparing a preoperatively diagnosed group with a postoperatively diagnosed group. METHODS: This study was a clinical analysis of our surgical experience with primary gallbladder carcinomas during the 6 years from 1992 to 1997 at Chung-Ang University in Korea. RESULTS: The incidence of gallbladder carcinomas was 0.6% of the 6132 biliary-tract operations performed during the 6 years (suspected group: unsuspected group=15:23). The sex ratio of males to females was 1 to 2.46 with female predominance. Primary GB cancer was seen most commonly in patients in their 50s and 60s, and this group accounted for 68.4% of the entire group and had a median age of 65 years. The most common clinical manifestation was right upper abdominal pain in 27 cases (71.1%). The duration of the illness in preoperatively suspected patients was much shorter than that for intraoperatively or only pathologically diagnosed patients (p=0.046) As for diagnostic methods, ultrasound and abdominal CT scans were performed, and the preoperative diagnostic accuracies were 31.6% and 69.3%, respectively. The patients were grouped according to the staging system of Nevin et al. The five stages were classified as follows: stage I (suspected group-0 cases; unsuspected group-2 cases), stage II (1 case; 5 cases), stage III (1 case; 2 cases), stage IV (7 cases; 9 cases), and stage V (6 cases; 5 cases). Adenocarcinoma was the most common type of gallbladder cancer (32 cases: suspected group-10 cases; unsuspected group-22 cases), followed by squamoadenocarcinoma (3 cases: 2 cases/1 case), neurogenic carcinoma (1 case: 1 case/0 cases), histiocytoma (1 case: 1 case/0 cases), and papillary carcinoma (1 case: 1 case/0 cases). The total cumulative 1-year, 2-year, and 3-year survival rates were 67.7%, 37.6%, and 12.1%, respectively (suspected: 46.2%, 15.4%, and 0%; unsuspected: 71.4%, 52.9%, and 23.2%). The cumulative survival rates for patients in the unsuspected group were higher than those for patients in the suspected group (p=0.008). CONCLUSION: The survival rate of the preoperatively unsuspected group was better than that of the suspected group. The survival improvement depended the invasion by the gallbladder carcinoma. We suggest that the survival rate should be improved by early detection of the gallbladder carcinoma and on extended operation. Conclusively, further evaluation of patients with etiologic factors should be done, more specific exams (CT or MRI) should be evaluated, and an acceptable operation should be done.
Abdominal Pain ; Adenocarcinoma ; Carcinoma, Papillary ; Delayed Diagnosis ; Early Diagnosis* ; Female ; Gallbladder Neoplasms ; Gallbladder* ; Histiocytoma ; Humans ; Incidence ; Korea ; Male ; Prognosis ; Sex Ratio ; Survival Rate ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: The prognosis for primary gallbladder cancer is very poor. Because of the lack of specific symptoms, late diagnosis, advanced stage, and ineffective treatment are typical. The purpose of the present study was to investigate the early diagnostic factors that improve the survival rate, by comparing a preoperatively diagnosed group with a postoperatively diagnosed group. METHODS: This study was a clinical analysis of our surgical experience with primary gallbladder carcinomas during the 6 years from 1992 to 1997 at Chung-Ang University in Korea. RESULTS: The incidence of gallbladder carcinomas was 0.6% of the 6132 biliary-tract operations performed during the 6 years (suspected group: unsuspected group=15:23). The sex ratio of males to females was 1 to 2.46 with female predominance. Primary GB cancer was seen most commonly in patients in their 50s and 60s, and this group accounted for 68.4% of the entire group and had a median age of 65 years. The most common clinical manifestation was right upper abdominal pain in 27 cases (71.1%). The duration of the illness in preoperatively suspected patients was much shorter than that for intraoperatively or only pathologically diagnosed patients (p=0.046) As for diagnostic methods, ultrasound and abdominal CT scans were performed, and the preoperative diagnostic accuracies were 31.6% and 69.3%, respectively. The patients were grouped according to the staging system of Nevin et al. The five stages were classified as follows: stage I (suspected group-0 cases; unsuspected group-2 cases), stage II (1 case; 5 cases), stage III (1 case; 2 cases), stage IV (7 cases; 9 cases), and stage V (6 cases; 5 cases). Adenocarcinoma was the most common type of gallbladder cancer (32 cases: suspected group-10 cases; unsuspected group-22 cases), followed by squamoadenocarcinoma (3 cases: 2 cases/1 case), neurogenic carcinoma (1 case: 1 case/0 cases), histiocytoma (1 case: 1 case/0 cases), and papillary carcinoma (1 case: 1 case/0 cases). The total cumulative 1-year, 2-year, and 3-year survival rates were 67.7%, 37.6%, and 12.1%, respectively (suspected: 46.2%, 15.4%, and 0%; unsuspected: 71.4%, 52.9%, and 23.2%). The cumulative survival rates for patients in the unsuspected group were higher than those for patients in the suspected group (p=0.008). CONCLUSION: The survival rate of the preoperatively unsuspected group was better than that of the suspected group. The survival improvement depended the invasion by the gallbladder carcinoma. We suggest that the survival rate should be improved by early detection of the gallbladder carcinoma and on extended operation. Conclusively, further evaluation of patients with etiologic factors should be done, more specific exams (CT or MRI) should be evaluated, and an acceptable operation should be done.
Abdominal Pain ; Adenocarcinoma ; Carcinoma, Papillary ; Delayed Diagnosis ; Early Diagnosis* ; Female ; Gallbladder Neoplasms ; Gallbladder* ; Histiocytoma ; Humans ; Incidence ; Korea ; Male ; Prognosis ; Sex Ratio ; Survival Rate ; Tomography, X-Ray Computed ; Ultrasonography

BACKGROUND: The active metabolite (1, 25-dihydroxycholecalciferol) of vitamin D (25-hydroxycholecalciferol) leads to activation of macrophages and deficiency of vitamin D seems to be involved in the risk of tuberculosis. The effects of vitamin D are exerted by interaction with the vitamin D receptor (VDR) and may be influenced by polymorphism in the VDR gene. In this study, variation in the VDR gene was investigated in Korean population with tuberculosis. METHODS: We typed three VDR polymorphisms of restriction endonuclease sites for TaqI, BsmI and FokI in 155 patients with tuberculosis and 105 healthy volunteers. RESULTS: The frequencies of FokI genotypes determined from TB patients were 29.13% for FF, 56.31% for Ff, and 14.56% for ff. We observed 1.4-fold increased prevalence of the Ff genotype in TB patients compared with normal healthy groups (p=0.0857). However, there was no significant association between the genotype groups, TB patient and normal control, for FokI polymorphism. There was also no significant association between VDR gene and tuberculosis in another polymorphism (BsmI and TaqI). CONCLUSION: Three polymorphisms (TaqI, BsmI and FokI) in the VDR gene do not appear to be responsible for host susceptibility to human tuberculosis in Korean population.
DNA Restriction Enzymes ; Genotype ; Humans ; Macrophages ; Prevalence ; Receptors, Calcitriol ; Tuberculosis ; Vitamin D ; Vitamins

BACKGROUND: The active metabolite (1, 25-dihydroxycholecalciferol) of vitamin D (25-hydroxycholecalciferol) leads to activation of macrophages and deficiency of vitamin D seems to be involved in the risk of tuberculosis. The effects of vitamin D are exerted by interaction with the vitamin D receptor (VDR) and may be influenced by polymorphism in the VDR gene. In this study, variation in the VDR gene was investigated in Korean population with tuberculosis. METHODS: We typed three VDR polymorphisms of restriction endonuclease sites for TaqI, BsmI and FokI in 155 patients with tuberculosis and 105 healthy volunteers. RESULTS: The frequencies of FokI genotypes determined from TB patients were 29.13% for FF, 56.31% for Ff, and 14.56% for ff. We observed 1.4-fold increased prevalence of the Ff genotype in TB patients compared with normal healthy groups (p=0.0857). However, there was no significant association between the genotype groups, TB patient and normal control, for FokI polymorphism. There was also no significant association between VDR gene and tuberculosis in another polymorphism (BsmI and TaqI). CONCLUSION: Three polymorphisms (TaqI, BsmI and FokI) in the VDR gene do not appear to be responsible for host susceptibility to human tuberculosis in Korean population.
DNA Restriction Enzymes ; Genotype ; Humans ; Macrophages ; Prevalence ; Receptors, Calcitriol ; Tuberculosis ; Vitamin D ; Vitamins

OBJECTIVE: To investigate the association of genetic background between MTHFR A1298C genotype and male infertility. MATERIALS AND METHODS: We compared 377 infertile males with 396 healthy fertile males with one or more offspring. Infertile males were classified into four subtypes (281 azoospermia, 26 oligoasthenoteratozoospermia (OAT), 59 severe OAT and 11 remnants) by World Health Organization (WHO). Pyrosequencing analysis for MTHFR (methylenetetrahydrofolatereductase) A1298C variation was performed on polymerase chain reaction (PCR) product of study group. To validate pyrosequencing data of A1298C variation for randomly selected 50 samples, we compared the pyrosequencing result with the PCR-RFLP (Restriction Fragment Length Polymorphism) result of MTHFR A1298C genotype. RESULTS: We studied MTHFR A1298C variation by pyrosequencing. A1298C variation data (1298 AC; p=0.2166 and 1298 CC; p=0.5056) of MTHFR gene was no significant difference in between fertile and infertile males. CONCLUSION: The genetic analysis in MTHFR gene didn't appear genetic difference in Korean fertile and infertile males. We require further study for MTHFR gene in infertile males.
Avena ; Azoospermia ; Genotype ; Humans ; Infertility, Male ; Korea* ; Male* ; Oxidoreductases* ; Polymerase Chain Reaction ; World Health Organization

Rifampicin is a macrocyclic antibiotic which is used extensively for treatment against Mycobacterium tuberculosis and other mycobacterial infections. Recently, a number of studies have focused on the immune-regulatory effects of rifampicin. Therefore, we hypothesized that rifampicin may influence the TLR2 expression in LPS-activated RAW 264.7 cells. In this study, we determined that rifampicin suppresses LPS-induced TLR2 mRNA expression. The down-regulation of TLR2 expression coincided with decreased production of TNF-alpha. Since NF-kappaB is a major transcription factor that regulates genes for TLR2 and TNF-alpha, we examined the effect of rifampicin on the LPS-induced NF-kappaB activation. Rifampicin inhibited NF-kappaB DNA-binding activity in LPS-activated RAW 264.7 cells, while it did not affect IKKalpha/beta activity. However, rifampicin slightly inhibited the nuclear translocation of NF-kappaB p65. In addition, rifampicin increased physical interaction between pregnane X receptor, a receptor for rifampicin, and NF-kappaB p65, suggesting pregnane X receptor interferes with NF-kappaB binding to DNA. Taken together, our results demonstrate that rifampicin inhibits LPS-induced TLR2 expression, at least in part, via the suppression of NF-kappaB DNA-binding activity in RAW 264.7 cells. Thus, the present results suggest that the rifampicin-mediated inhibition of TLR2 via the suppression of NF-kappaB DNA-binding activity may be a novel mechanism of the immune-suppressive effects of rifampicin.
DNA ; Down-Regulation ; Mycobacterium tuberculosis ; NF-kappa B ; Receptors, Steroid ; Rifampin ; RNA, Messenger ; Toll-Like Receptor 2 ; Toll-Like Receptors ; Transcription Factors ; Tumor Necrosis Factor-alpha