In order to observe the differences in fixability and stability of the acetabular cup through the differences in cup size in relation to the size of acetabular reaming, we analyzed 75 cases of porous coated acetabular cup of Harris-Galante type which be followed up more that two years. All cases were divided into two group ; the first group (On line fit :45 cases) used with acetabular cup equal in size to the last reaming size and the second group (Press fit : 30 cases) used with acetabular cup 2mm larger than the last reaming size. For initial stability, all cases were fixed with acetabular screws. Both groups were analyzed for presence of gap, change of acetabular inclination, presence of radiolucent line, degree of displacement of vertical distance, stability and clinical results. The results were as follows; 1. The average Harris hip score was improved from 55.8 points preoperatively to 90.2 points postoperatively in the first group, from 56.9 points to 91.2 points in the second group, Clinical results are excellent in 39 cases, good in 4 cases, fair in 2 cases in the first group, and excellent in 29 cases and good in 1 case in the second group. 2. The gap between the acetabular cup and acetabulum was found initially at 17 zones in the first group but no gap at final follow up. In the second group, the gap was found at 23 zones and finally remained less that 1 mm gap was found at 3 cases in zone B1. 3. No radiologic instability of acetabular cup by Martell evaluation was noted in both 1st and 2nd group. Our data suggests that initial gap between acetabular cup and acetabulum in microporous coated acetabular cup were replaced with new bone and also, radiologic stability and good clinical results could be obtained in the second group used with acetabular cup 2 mm larger than the last reaming size.
Acetabulum ; Arthroplasty, Replacement, Hip ; Clinical Study ; Follow-Up Studies ; Hip

PURPOSE: To describe chronic rectal mucosal damage after pelvic radiotherapy (RT) for cervical cancer and correlate these findings with clinical symptoms and radiation dose. MATERIALS AND METHODS: Thirty-two patients who underwent pelvic RT were diagnosed with radiation-induced proctitis based on endoscopy findings. The median follow-up period was 35 months after external beam radiotherapy (EBRT) and intracavitary radiotherapy (ICR). The Vienna Rectoscopy Score (VRS) was used to describe the endoscopic findings and compared to the European Organization for Research and Treatment of Cancer (EORTC)/Radiation Therapy Oncology Group (RTOG) morbidity score and the dosimetric parameters of RT (the ratio of rectal dose calculated at the rectal point [RP] to the prescribed dose, biologically effective dose [BED] at the RP in the ICR and EBRT plans, alpha/beta = 3). RESULTS: Rectal symptoms were noted in 28 patients (rectal bleeding in 21 patients, bowel habit changes in 6, mucosal stools in 1), and 4 patients had no symptoms. Endoscopic findings included telangiectasia in 18 patients, congested mucosa in 20, ulceration in 5, and stricture in 1. The RP ratio, BEDICR, BEDICR+EBRT was significantly associated with the VRS (RP ratio, median 76.5%; BEDICR, median 37.1 Gy3; BEDICR+EBRT, median 102.5 Gy3; p < 0.001). The VRS was significantly associated with the EORTC/RTOG score (p = 0.038). CONCLUSION: The most prevalent endoscopic findings of RT-induced proctitis were telangiectasia and congested mucosa. The VRS was significantly associated with the EORTC/RTOG score and RP radiation dose.
Constriction, Pathologic ; Endoscopy ; Estrogens, Conjugated (USP) ; Follow-Up Studies ; Hemorrhage ; Humans ; Mucous Membrane ; Proctitis ; Radiation Injuries ; Rectum ; Telangiectasis ; Ulcer ; Uterine Cervical Neoplasms

BACKGROUND: HBsAg carriers are 6-12% of population in Korea. The patients knowledge on hepatitis B and regular follow-up tests are important, because HBsAg carriers have infectivity and the disease may progress without symptoms. We surveyed their knowledge on the hepatitis B and the frequency of follow-up blood test and sonogram. METHODS: From March 1993 through September 1994, 630 patients who were diagnosed as HBsAg positive and Anti-HBs negative in a health promotion center of college hospital were surveyed by mailing questionnaire. The questionnaire included the result of HBV viral marker test, transmission routes, complications, and prevention methods of Hepatitis B, frequency of follow-up test, and doctors recommendation. RESULTS: Of the 490 questionnaires excluded the 140 questionaires returned due to wrong address, 100 were answered, making the reply rate 20.4%. As for the result of HBV marker test, 64% answered their HBV marker as HBsAg positve, 10% answered HBsAg negative, and 26% answered I dont know. 65% answered that they are HBV carrier. As for the mode of transmission, 59% answered that HBV is transmitted by blood, 57% from carrier mother at birth, 29 % by sexual intercourse. 76% of responders know that vaccination is needed for preventing vertical transmission. When making score on their knowledge, significant differences were showed according to education, income and doctors recommendation about regular follow-up test. The number of persons who took regular blood test every 6 to 12 months were 56(56%), and the number of persons who took regular abdominal ultrasonogram were 39(39%). The number of patients who were recommended regular follow-up by doctor was 76%. In this group, 51 persons(67.0%) took regular blood test and 35 persons(35%) took regular sonogram so this frequency is significantly higher than the other group(each 20.8%, 16.7%). CONCLUSIONS: The knowledge on hepatitis B in HBsAg positive patients is relatively low and the frequency of regular follow-up test is significantly higher in the group who took doctors recommendation. So it is very important that HBsAg carriers must be educated about the infectivity, preventive methods, and regular follow-up for early detection of complication like hepatocellular cancer.
Biomarkers ; Coitus ; Education ; Follow-Up Studies* ; Health Promotion ; Hematologic Tests ; Hepatitis B Surface Antigens ; Hepatitis B* ; Hepatitis* ; Humans ; Korea ; Liver Neoplasms ; Mothers ; Parturition ; Postal Service ; Ultrasonography ; Vaccination ; Surveys and Questionnaires

Surgical excision of the subcutaneous tissues, with or without skin excision in the axillary hair-bearing area, has been the treatment of choice for Treating axillary a osmidrosis for the several decades. However, long periods of postoperative immobilization of a shoulder joint, partial necrosis of skin flaps or hematoma and the possibility of unsightly scars are frequent complications. For the purpose of reducing these complications, we performed ultrasonic aspiration of subcutaneous fat of the axilla, including the apocrine gland, using ultrasonic liposuction technique under confirmation of endoscopy via one small skin incision. From November 1997 to December 1998, a total of 134 patients (93 women and 41 men) received surgery for bilateral axillary osmidrosis on an outpatient basis. Sixty patients were evaluated more than 6 months after surgery. Among these patients, 6patients complained of a persistent foul odor(10%). Five patients received secondary ultrasonic aspiration for persistent foul odor and were then cured. We concluded that our method has several advantages such as 1) preservation of skin flap vascularity for the prevention of flap necrosis and axillary hair, 2) minimal scarring and bleeding, 3) shorter operation time and postoperative immobilization of the shoulder joint, 4) increased patient comfort, and 5) a safer operative method for recurred cases as a secondary method.
Apocrine Glands ; Axilla ; Cicatrix ; Endoscopy ; Female ; Hair ; Hematoma ; Hemorrhage ; Humans ; Immobilization ; Lipectomy ; Necrosis ; Odors ; Outpatients ; Shoulder Joint ; Skin ; Subcutaneous Fat ; Subcutaneous Tissue ; Ultrasonics*

Arthroscopic repair of an isolated teres minor tendon tear without associated shoulder joint pathology has not been reported in the literature. We report on a case of isolated teres minor tendon tear after trauma. The patient complained of severe shoulder pain and progressive limited range of motion 4 months after the injury. Magnetic resonance imaging showed a full-thickness tear of the teres minor tendon at its musculotendinous junction and arthroscopic repair was performed. At 2 years follow-up, satisfactory clinical and radiological outcomes were observed with return to pre-injury level. Here, the authors report this case and provide a review of literature.
Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Pathology ; Range of Motion, Articular ; Shoulder Joint ; Shoulder Pain ; Tears* ; Tendons*

Sacral pressure sores have been treated by a variety of surgical methods. complete treatment needs wide excision and coverage with healthy tissue which has constant and sufficient blood supply. Use of gluteus maximus muscle flap with or without overlying skin is a revolutionary method because of the reliability of blood supply. However, it is technically a little bit complicated, and future reconstruction for recurrent decubitus is especially limited in paraplegic patients. The development of gluteal perforator-based flap with para-sacral perforator introduce a new treatment modality for the sacral pressure sores. Total 10 cases of sacral pressure sores were treated with gluteal perforator-based flap. There were minimal postoperative complications except wound dehiscence in one case. This flap has a many advantage of no transection or sacrifice of the gluteus maximus muscle, elevation time for the flap is short, reliable blood flow of the perforator, large rotation arc and no post-operative hindrance to walking in patients who are not paraplegic. The disadvantages of this perforator-based flaps are the anatomical variation in the location of perforators and the need for technically careful dissection.
Humans ; Postoperative Complications ; Pressure Ulcer* ; Skin ; Walking ; Wounds and Injuries

A defective HIV-1 helper virus DNA, pHyPC, was assembled by deleting the RNA packaging signal, env, nef and the 3'LTR sequences. HIV-1 like virus particles that carry the HIV-1 receptor, CD4 were generated by coexpression of pHyPC and plasmid DNAs encoding different chimeric CD4 proteins. The CD4 particles, sharing the CD4 ectodomain, precisely fused to different membrane anchors. CD4(+) particles specifically bound to HIV-1 Env expressing cells, but any signs of infection into these cells were not detected. Binding was only partially blocked by either polyclonal anti-CD4 antibodies or by high concentrations of soluble CD4. Suprisingly, CD4(+) particles also adsorbed to HeLa, CHO, NIH3T3 and COS-7 cells in the absence of HIV-1 Env expression. Adsorption was comparable in strength and speed to the highly specific CD4-Env interaction. CD4(-) particles exhibited only background levels of binding. Cell binding was CD4- dependent, but it was independent of the cell type from which the CD4(+) particles originated. Interestingly, CD4-dependent/Env-independent binding was only found when CD4 was present on virus particles. This suggests that the micro-environment of CD4 on virus particles uniquely expose this new cell binding activity. Its high affinity could explain in part why infection of Env(+) cells by CD4(+) particles was not detected. Further experiments will be required to evlauate whether this strong membrane interaction could represent one step in the multiple-step viral entry process.
Adsorption ; Animals ; Antibodies ; COS Cells ; DNA ; Helper Viruses ; HIV-1* ; Membranes ; Plasmids ; Product Packaging ; RNA ; Virion

Autonomic dysreflexia is a syndrome characterized by severe hypertension, headache, sweating that is seen in spinal cord injury population. It can be a life-threatening problem if not promptly recognized and treated. Since the most common cause is bladder distention, it is essential that the urologist sh6fild be familiar with this syndrome. Two hundred ninety four patients with spinal cord injury were reviewed for the prevalence rate and clinical manifestations of autonomic dysreflexia. The time of onset post-injury, precipitating causes, presenting symptoms and management were analyzed. 42 patients (34.4%) of 122 patients with lesion above T6 level exhibited autonomic dysreflexia. The majority of patients (61.9%) had manifested signs and symptoms of autonomic dysreflexia within the first year. The precipitating causes were bladder distention (69.0%), bowel distention (23.8%) and urinary tract infection (7.1%). The presenting symptoms of autonomic dysreflexia were headache (88.1%), sweating (88.1%), hot flushing (28.6%), chest discomfort, hyperpnea and spasm. The management of autonomic dysreflexia include prompt bladder erupting, bed rest and appropriate bowel preparation. In conclusion, prompt recognition and appropriate management of autonomic dysreflexia are essential to prevent life-threatening sequelae.
Autonomic Dysreflexia* ; Bed Rest ; Flushing ; Headache ; Humans ; Hypertension ; Prevalence ; Spasm ; Spinal Cord Injuries* ; Spinal Cord* ; Sweat ; Sweating ; Thorax ; Urinary Bladder ; Urinary Tract Infections

Since the first report by Tansini in 1896, the latissimus dorsi muscle free flap has been widely used for various types of soft tissue defect due to reliable anatomy with a sufficient diameter of neurovascular pedicle and a sizable muscle. However, for relatively small soft tissue defect, latissimus dorsi free flap offers several distinct disadvantages of donor site including loss of the posterior axillary fold and flattening of the posterolateral chest wall, weakness of upper arm strength in extension, adduction and internal rotation. We treated three patients having various types of soft tissue defect using segmental latissimus dorsi muscular free flap depending on its descending branch of thoracodorsal neurovascular pedicles. There were no serious complications during 18 months of mean follow-up. We concluded that this method has some advantages such as no weakness of strength of the upper arm including walking on crutches, preserving the posterior axillary fold, preventing winging of the scapula and increased chance of using a flow-through technique. Here we present our cases of reconstruction of soft tissue defect using segmental latissimus dorsi free flap with a review of the literature.
Arm ; Crutches ; Follow-Up Studies ; Free Tissue Flaps* ; Humans ; Scapula ; Superficial Back Muscles* ; Thoracic Wall ; Tissue Donors ; Walking

BACKGROUND: The Cobas(R) Integra is a new automated chemistry analyzer with continuous and random-access features for routine chemistries, specific proteins, electrolytes, therapeutic drugs and drugs of abuse. The system maintains 68 test-specific reagent cassettes on board and have test principles of absorbance photometry, immunoturbidometry, fluorescence polarization and ISE measurements. We evaluated the usefulness of Cobas(R) Integra in the aspect of accuracy, precision, linearity, comparison study, test speed and general performance. METHODS: We evaluated the analytical performance of the Cobas(R) Integra for T. bilirubin, CRP, BUN, creatinine, sodium, potassium, chloride, valproic acid, phenytoin and carbamazepine according to NCCLS guidelines (EP5-T2, EP6-P, EP9-T and GP10-T). RESULTS: In accuracy study, error ranges(%) of most test items, except sodium and chloride, were within analytic goals. In within-run and between-run precision study, Coefficient of variation (CV, %) of most items, except sodium, were lower than limits suggested by College of American Pathologists Survey 1991. The linearities were maintained well in the range of medically significant levels and were statistically acceptable (p<0.001). The comparison study for most items, except sodium and chloride, indicated good correlation with Hitachi 747 and TDx FLx(TM) and correlation coefficients (r) were above 0.98. Throughput was about 450 tests/hr. CONCLUSIONS: Cobas(R) Integra showed satisfactory accuracy, precision, linearity, good correlation with other analyzers and high throughput. So, we concluded that Cobas(R) integra is highly suitable for not only routine use but also emergency tests in medium to large-sized hospitals because of its high productivity and reliability.
Bilirubin ; Carbamazepine ; Chemistry* ; Creatinine ; Efficiency ; Electrolytes ; Emergencies ; Fluorescence Polarization ; Phenytoin ; Photometry ; Potassium ; Sodium ; Street Drugs ; Valproic Acid