For the nonunion of humeral shaft, there have been many methods of treatment. We are aimed to analyse the causes of nonunion of humeral shaft fracture and present the direction of treatment. We reviewed total 21 cases which were diagnosed as delayed or nonunion of humeral shaft and analysed the causes. l. Initial method of treatment was surgical in 19 out of 21 cases. Among these 19 cases, 14 cases were operated with internal fixation with plate and screw. 2. The most common cause of nonunion was inadequate internal fixation in 26 cases(81%) in which were unstable fixation in 13 cases, choice of inadequate internal fixator in 11 cases, and failure of operative technique in 2 cases. Other causes were distraction between fracture fragments in 4 cases(13%) and open comminuted fracture in 2 cases. 3. Eighteen cases of established nonunion due to inadequate internal fixation were treated by rigid fixation with longer and broader plate and bone graft, and 1 case interlocking IM nailing, 1 case Ender nailing and 1 case bone graft only. 4. Union was obtained in all cases at least in 5 months. And there were no specific complications. In conclusion, surgeons should contemplate the operative indication and principles in primary treatment. In treatment of nonunion, surgeons should treat by more longer and broder internal fixator and additional bone graft.
Fractures, Comminuted ; Humerus ; Internal Fixators ; Methods ; Surgeons ; Transplants

PURPOSE: We evaluated the prevalence and characteristics of breakthrough cancer pain (BTcP) in Korean patients admitted with cancer pain. MATERIALS AND METHODS: In-hospital patients with cancer pain completed a questionnaire concerning severity of background cancer pain (BCP), prevalence and treatment for BTcP, sleep disorders, and satisfaction with cancer pain treatment. Medical records showing medications for BCP and BTcP were also evaluated. RESULTS: Total 609 patients with controlled BCP enrolled. Mean age of the patients was 59.5 years old, and 59% were male. Of all patients, 177 (29%) complained of BTcP. No clinical characteristic predicted BTcP. Of the 177 patients with BTcP, 56% did not receive treatment for BTcP. Patients with BTcP showed significant association with a sleep disorder and dissatisfaction with pain control, compared to those without BTcP (p < 0.0001 and p=0.0498, respectively). Oxycodone-immediate release was the most commonly used short-acting analgesic, followed by intravenous morphine. CONCLUSION: The prevalence of BTcP was 29% in patients admitted with controlled BCP. Although the patients had well-controlled BCP, BTcP showed association with a lower quality of life in patients with cancer. More medical attention is needed for detection and management of BTcP.
Humans ; Inpatients* ; Male ; Medical Records ; Morphine ; Prevalence ; Quality of Life ; Sleep Disorders

Persistent vesical dysfunction is often encountered after long term bladder overdistension caused by urinary retention. Experimentally, acute overdistension has also been implicated in the pathogenesis of the response to partial outlet obstruction. In the present study, we evaluated the expression of iNOS in the partially obstructed rat bladder and presupposed that NO is responsible for the prolonged micturition problem after partial outlet obstruction of the rat bladder. Female Sprague-Dawley rats weighing 150~200g were used. Individual bladders were obtained from unoperated control rats, and from rats at 6, 12, 48, 72 hours, 5 and 7 days after partial urethral obstruction. Total RNA was extracted from each of these tissue. The expression of mRNAs were assessed by Northern blot analysis. The band intensity of the autoradiographs measured by densitometry were compared between the obstructed and control group. The expression of mRNA for iNOS was detected in the control rats. The expression showed a sharp increase at 6 hours (342% increase) after obstruction and returned to normal by 24 hours. In this study, we show that iNOS increases in the rat bladder after operation and these results suggest that overproduction of NO may be a possible mechanism for the prolonged bladder dysfunction after partial bladder outlet obstruction.
Animals ; Blotting, Northern ; Densitometry ; Female ; Humans ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type II* ; Rats* ; Rats, Sprague-Dawley ; RNA ; RNA, Messenger* ; Urethral Obstruction ; Urinary Bladder Neck Obstruction* ; Urinary Bladder* ; Urinary Retention ; Urination

No abstract available.

PURPOSE: Partial obstruction of the rat bladder outlet induces a rapid hypertrophy characterized by increased smooth muscle content and collagen deposition. This increased collagen is likely to reduce the quality of the contraction and compliance of the bladder wall. Also it has been reported that an alteration in the ratio of type I and III collagen may be more important than the amount of collagen in determining compliance. To evaluate the genetic basis of collagen deposition in the partially obstructed rat bladder, the author observed the change of proalpha1(I) collagen, proalpha1(III) collagen, proalpha(IV) collagen and matrix-metalloproteinase(MMP)-2 mRNA after partial urethral obstruction. MATERIALS AND METHODS: Female Sprague-Dawley rats weighing 150-200g were used. Individual bladders were obtained from unoperated rats, and from rats at 6, 12, 48, 72, hours, 5 and 7 days after partial urethral obstruction and sham operation. Total RNA was extracted from each of these tissue, The expression of mRNAs were assessed by Northern blot analysis. The band intensities of the autoradiographs measured by densitometry were compared between the obstructed and sham group. RESULTS: Partial urethral obstruction induced a gradual increase in bladder weights, The expression of mRNA for proalpha1(I) collagen was generally attenuated within 24hours after obstruction. In extended period of obstruction, the expression of mRNA for proalpha1(I)collagen reached a peak at day 3-5(219% increase), and remained elevated through day 7. The expression of mRNA for proalpha1(I)collagen was coregulated with that of pro alpha1(I) collagen, however, the mean ratio to control value of band intensity for proalpha1(III)collagen mRNA was 2 times higher than that of proalpha1(I) collagen, during days 3-7. The expression of mRNA for proalpha1(IV)collagen showed a sharp increase at 48 hours(438% increase)after obstruction earlier than proalpha1(I)collagen and proalpha1(III)collagen mRNA. In extended period of obstruction the expression reached a peak at 72 hours(883% increase) and the mean ratio to control value of band intensity for proalpha alpha collagen mRNA was much higher than those of proalpha1(I) collagen and proalpha1(III) collagen. The expression of MMP-2 mRNA increased from 48hours after obstruction, and reached a peak at day 3-5. CONCLUSIONS: These results sugges that the increase of collagen in the rat bladder after partial urethral obstruction results from an increase of expression of collagen genes, and the decrease of bladder wall compliance results from an increased transcription of type I collagen gene and increase of the ratio of proalpha1(III)collagen to proalpha1(I)collagen mRNA. Because expression of proalpha1(I), (III), (IV) collagen and MMP-2 mRNA increased sharply after 48hours, it is suggested that genetic events leading to remodeling of bladder start at 48hours after partial urethral obstruction.
Animals ; Blotting, Northern ; Collagen Type I* ; Collagen* ; Compliance ; Densitometry ; Female ; Humans ; Hypertrophy ; Muscle, Smooth ; Rats* ; Rats, Sprague-Dawley ; RNA ; RNA, Messenger* ; Urethral Obstruction ; Urinary Bladder* ; Weights and Measures

BACKGROUND: There are some studies concerning fasting insulin and insulin resistance in normal healthy Korean adults, but none exists especially for adolescence. Therefore, we investigateck insulin resistance and its related factors in adolescence. METHODS: We analyzed 582 10th grade high school students. Height, weight, abdominal circumference, systolic and diastolic blood pressure, fasting glucose, total cholesterol, hemoglobin were measured. Fasting state and parent's and student's previous medical history were guestioned. We used Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) as an indicator of insulin resistance. RESULTS: By HOMA-IR 2.15, the subjects were divided into the insulin sensitive and the resistant groups. Two groups showed significant differences in body mass index, systolic diastolic blood pressure, fasting glucose, fasting insulin, total cholesterol and abdominal circumference (P <0.05). HOMA-IR was strongly related to the body mass index (r=0.53) and abdominal circumference (r=0.52), but weakly related to the total cholesterol (r= 0.20). According to logistic regression analysis of HOMA-IR, the odds ratio of the body mass index was 1.17 and that of abdominal circumference was 1.06 (P <0.05). CONCLUSION: HOMA-IR showed strong relationship with body mass index, abdominal circumference, but showed weak relationship with total cholesterol. There was no significant correlation with the parent's diabetic medical history. Therefore we conclude that in adolescence the body mass index or the abdominal circumference is far more important factor than the parent's diabetic history.
Adolescent* ; Adult ; Blood Pressure ; Body Mass Index ; Cholesterol ; Fasting ; Glucose ; Homeostasis ; Humans ; Insulin Resistance* ; Insulin* ; Logistic Models ; Odds Ratio ; Seoul*

BACKGROUNDS: Pituitary hyperplasia can mimic pituitary adenoma. In MRI, enlarged pituitary gland is enhanced homogenously with upward convexity of the superior margin of the gland .The best definition of hyperplasia in the pituitary hyperplasia seems to be a multiplication of one or more cell types. But definition, etiology and clinical courses of this disease are not clear, METHOD: We reviewed clinical symptoms, MRI, and pathologic findindings in 6 patients with pituitary hyperplasia. RESULT: 1. Major clinical symptoms were headache (100%), visual field defect (84%), polyuria/polydipsia (64%), and irregular mensturation (32%). Other symptoms were amenorrhea (16%) and galactorrhea (16%). 2. Three of five cases showed abnormal responses to combined pituitary function test, 3. MRI findings were pituitary hyperplasia (4), macroadenoma (l), and microadenoma (1). 4. In two operated cases, there was no adenoma. One case showed hyperplasia of lactotroph cells, the other was hyperplasia of gonadotroph cells confirmed by the examination of immunocytochemistry. CONCLUSION: Pituitary hyperplasia should be considered in patients with enlarged pituitary gland without focal mass lesion.
Adenoma ; Amenorrhea ; Female ; Galactorrhea ; Gonadotrophs ; Headache ; Humans ; Hyperplasia* ; Immunohistochemistry ; Lactotrophs ; Magnetic Resonance Imaging ; Pituitary Function Tests ; Pituitary Gland ; Pituitary Neoplasms ; Pregnancy ; Visual Fields

Vulvar squamous cell carcinoma (SCC) consists of two different etiologic categories: human papilloma virus (HPV)-associated (HPV (+)) and HPV-non-associated (HPV (−)). There have been no genome-wide studies on the genetic alterations of vulvar SCCs or on the differences between HPV (+) and HPV (−) vulvar SCCs. In this study, we performed whole-exome sequencing and copy number profiling of 6 HPV (+) and 9 HPV (−) vulvar SCCs and found known mutations (TP53, CDKN2A and HRAS) and copy number alterations (CNAs) (7p and 8q gains and 2q loss) in HPV (−) SCCs. In HPV (+), we found novel mutations in PIK3CA, BRCA2 and FBXW7 that had not been reported in vulvar SCCs. HPV (−) SCCs exhibited more mutational loads (numbers of nonsilent mutations and driver mutations) than HPV (+) SCCs, but the CNA loads and mutation signatures between HPV (+) and HPV (−) SCCs did not differ. Of note, 40% and 40% of the 15 vulvar SCCs harbored PIK3CA and FAT1 alterations, respectively. In addition, we found that the SCCs harbored kataegis (a localized hypermutation) in 2 HPV (+) SCCs and copy-neutral losses of heterozygosity in 4 (one HPV (+) and 3 HPV (−)) SCCs. Our data indicate that HPV (+) and HPV (−) vulvar SCCs may have different mutation and CNA profiles but that there are genomic features common to SCCs. Our data provide useful information for both HPV (+) and HPV (−) vulvar SCCs and may aid in the development of clinical treatment strategies.

PURPOSE: Activation of the innate immune system and chronic low-grade inflammation are thought to be involved in the pathogenesis of atherosclerosis and also thought to be associated with type 2 diabetes and its complications. As a receptor for bacterial lipopolysaccharide and heat-shock proteins, Toll-like receptor 4 (TLR4) is one of the central regulators of the immune response. Recent studies have reported an association between TLR4 polymorphisms and diabetes and its complications in Caucasian populations. MATERIALS AND METHODS: In this study, we analyzed the association between TLR4 gene polymorphisms in patients with features of type 2 diabetes and healthy controls in Korea. Two polymorphisms of the TLR4 gene (Asp299Gly and Thr399Ile) were examined in 225 diabetic patients and 153 healthy controls using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and single-strand conformation polymorphism (SSCP). RESULTS: No Asp299Gly or Thr399Ile mutations were detected in any of the 378 subjects. Seven subjects from each group who had slightly different SSCP patterns were selected for sequencing, but we found no TLR4 polymorphisms on Exon3. The Asp299Gly and Thr399Ile TLR4 gene polymorphisms were absent in both groups, which was similar to the results for Japanese and Chinese Han subjects. CONCLUSION: Our data and other Asian data suggest that a racial difference can be found in the frequency of the TLR4 polymorphism.
Adult ; Amino Acids/genetics ; Base Sequence ; Female ; Humans ; Korea ; Male ; Middle Aged ; Molecular Sequence Data ; Mutation/genetics ; Polymorphism, Genetic/*genetics ; Toll-Like Receptor 4/*genetics

OBJECTIVES: Adiponectin is strongly associated with diabetes in the Western population. However, whether adiponectin is independently associated with impaired fasting glucose (IFG) in the non-obese population is unknown. METHODS: The serum adiponectin, insulin resistance (IR), and waist circumference (WC) of 27,549 healthy Koreans were measured. Individuals were then classified into tertile groups by gender. IFG was defined as a fasting serum glucose of 100-125 mg/dL without diabetes. IR was calculated using the homeostasis model assessment of insulin resistance (HOMA-IR). The association of adiponectin and IFG was determined using logistic regression analysis. RESULTS: WC and adiponectin were associated with IFG in both men and women. However, the association of WC with IFG was attenuated in both men and women after adjustment for the HOMA-IR. Adiponectin was still associated with IFG after adjustment for and stratification by HOMA-IR in men and women. Strong combined associations of IR and adiponectin with IFG were observed in men and women. Multivariate adjusted odds ratios (ORs) (95% confidence interval [CI]) among those in the highest tertile of IR and the lowest tertile of adiponectin were 9.8 (7.96 to 12.07) for men and 24.1 (13.86 to 41.94) for women. CONCLUSION: These results suggest that adiponectin is strongly associated with IFG, and point to adiponectin as an additional diagnostic biomarker of IFG in the non-diabetic population.
Adiponectin ; Fasting ; Female ; Glucose ; Homeostasis ; Humans ; Insulin Resistance ; Logistic Models ; Male ; Odds Ratio ; Waist Circumference