Purpose: Dislocation is the second most common cause of failure, after implant loosening, in revisional THA (Total hip arthroplasty), and its evaluation and treatment still remain controversial issue. This study was undertaken to evaluate the risk factors after THA using the posterolateral approach and posterior soft tissue repair. Materials and Methods: Between January 1998 and May 2003, 211 consecutive primary total hip replacement arthroplasties using the posterolateral approach and posterior soft tissue repair were performed by the same surgeon. To compare the dislocation groups (6 cases) with the non-dislocation groups (205 cases), we randomized 120 of the non-dislocation cases. The risk factors for hip dislocation were categorized into patient factors and surgical factors. Patient factors included gender, age, preoperative diagnosis, underlying systemic disease, and alcoholic history. Surgical factors included position of the component (acetabular version and inclination, femoral anteversion), leg length discrepancy, and sum of anteversions of the cup and stem. Their parameters were measured on postoperative radiographs. Statistics were performed with Fishe`s Exact test and T test. Results: Dislocations occurred at an overall incidence rate of 2.8% (6/211cases). There were 4 (1.9%) cases of anterior dislocations and 2 (0.9%) cases of posterior dislocations. Dislocations occurred on average at postoperative day 6.1 and all dislocated hips were reduced with the closed method, except for one case that was treated surgically. There was no statistical significance in patient factors between the two groups, except for neurologic disease and alcoholic history. However, the sum of the acetabular and femoral anteversions in the anterior dislocation group was larger than that of the non-dislocation group by approximately 19 degrees. Conclusion: Our results demonstrated that by using the posterior approach and repair of soft tissue, the posterior dislocation rate after total hip replacement arthroplasty can be reduced and the sum of the acetabular and femoral anteversions had more influence on dislocations after THAs than did either anteversion alone.
Acetabulum ; Alcoholics ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Diagnosis ; Dislocations ; Hip Dislocation* ; Hip* ; Humans ; Incidence ; Leg ; Risk Factors*

OBJECTIVE: To systematic analyze the change of the annual distribution and indications, age distribution of the patients and chromosomal results according to patient's age and indications in midtrimester genetic amniocentesis METHODS: This study conducted between 1985 and 2004 collected 3,672 amniocenteses procedure which were done at College of Medicine, after prenatal genetic counceling for mothers who have high risk for carrying chromosomally abnormal babies. RESULTS: 1. The incidence of amniocentesis had been in gradual increase since the 1980''s, however, the number has increased sharply for the patiences in mid 1990's. 2. Of the 3,672 amniocentesis cases, 32.2% was maternal age 30 to 34 which was most common age group and followed by age 35 to 39 was 29.9% and age 25 to 29 was 27.8%. 3. The indications for amniocentesis were advanced maternal age (36.1%), abnormal maternal serum markers (31.7%) and abnormal ultrasonographic findings which implies chromosomal abnormality (9.6%). In the 1980's, amniocentesis had earlier been used primarily for those in advanced maternal age groups, at least 35 years older. Recently maternal serum markers and ultrasonography play an important role as an indicator for the amniocentesis. 4. From the 3,672 cases, 3,556 cases showed normal diploidy and 116 cases abnormal karyotype which consisted 3.16%. In autosomal disorders, 36 Down syndrome, 15 Edward syndrome, 2 Patau syndrome were diagnosed. In Sex chromosomal anomaly, 5 Turner syndrome, 6 47XYY, and 2 Klinefelter syndrome. Add to that 31 translocation including 21 Reciprocal translocation and 10 Robertsonian translocation, and 8 deletions and 4 mosaicisms were diagnosed. Of the 354 cases with abnormal ultrasonic findings, 19 (5.4%) resulted in chromosomal anomaly. Of the 1,164 casaes with positive maternal serum markers, 42 (3.6%) resulted in chromosomal anomaly. Those who had abnormal ultrasonographic findings implying chromosomal abnormality were found to have correlation with chromosomal abnomality than other indications. CONCLUSION: Midtrimester genetic amniocentesis is an important diagnostic tool in prenatal diagnosis, of which the annual incidence has been recently increased abruptly. Not only maternal age, but the maternal serum markers and ultrasonograms should be considered in prenatal counseling. Amniocentesis should be well informed to the general population.
Abnormal Karyotype ; Adult ; Age Distribution ; Amniocentesis* ; Biomarkers ; Chromosome Aberrations ; Counseling ; Cytogenetics* ; Diploidy ; Down Syndrome ; Female ; Humans ; Incidence ; Klinefelter Syndrome ; Maternal Age ; Mothers ; Pregnancy ; Pregnancy Trimester, Second ; Prenatal Diagnosis ; Turner Syndrome ; Ultrasonics ; Ultrasonography

We experienced a case of non-Hodgkin's lymphoma presented only as right side pleural effusion, that is primary effusion lymphoma (PEL), in a 75 year-old male patient in Korea where is the endemic area of tuberculosis. He visited our hospital complaining of exertional dyspnea. He did not have B symptoms. The breathing sound was decreased on the right side chest, but we could not find external lymphadenopathy or hepatosplenomegaly on physical examination. Simple chest radiograph showed right side pleural effusion. The cells of pleural fluid were lymphocyte-predominant and the pH, protein, lactate dehydrogenase, adenosine deaminase of the fluid was 7.31, 38 g/L, 381 U/L, 31 U/L, respectively. The biopsy specimen of the parietal pleura was diagnosed as non-Hodgkin's lymphoma of small lymphocytic type. Computed tomograph of the chest, abdomen and pelvis, and the biopsy of bone marrow were negative for disease. We tried up to 3 cycles of chemotherapy with adriamycin, vincristine, cyclophosphamide and prednisolone and there was a marked decrease in the amount of the pleural effusion.
Abdomen ; Adenosine Deaminase ; Aged ; Biopsy ; Bone Marrow ; Cyclophosphamide ; Doxorubicin ; Drug Therapy ; Dyspnea ; Humans ; Hydrogen-Ion Concentration ; Korea ; L-Lactate Dehydrogenase ; Lymphatic Diseases ; Lymphoma ; Lymphoma, Non-Hodgkin* ; Lymphoma, Primary Effusion ; Male ; Pelvis ; Physical Examination ; Pleura ; Pleural Effusion* ; Prednisolone ; Radiography, Thoracic ; Respiratory Sounds ; Thorax ; Tuberculosis ; Vincristine

BACKGROUND: Oxidative stress contributes to vascular diseases in patients with diabetes. As the mechanism of development and progression of diabetic vascular complications is poorly understood, this study was aimed to assess the potential role of hyperglycemia-induced oxidative stress and to determine whether the oxidative stress is a major factor in hyperglycemia-induced migration of vascular smooth muscle cells (VSMCs). METHODS: We treated primary cultured rat aortic smooth muscle cells for 72 hours with medium containing 5.5 mM D-glucose (normal glucose), 30 mM D-glucose (high glucose) or 5.5 mM D-glucose plus 24.5 mM mannitol (osmotic control). We measured the migration of VSMCs and superoxide production. Immunoblotting of PKC isozymes using phoshospecific antibodies was performed, and PKC activity was also measured. RESULTS: Migration of VSMCs incubated under high glucose condition were markedly increased compared to normal glucose condition. Treatment with diphenyleneiodonium (DPI, 10 micromol/L) and superoxide dismutase (SOD, 500 U/mL) significantly suppressed high glucose-induced migration of VSMCs. Superoxide production was significantly increased in high glucose condition and was markedly decreased after treatment with DPI and SOD. High glucose also markedly increased activity of PKC-delta isozyme. When VSMCs were treated with rottlerin or transfected with PKC-delta siRNA, nitro blue tetrazolium (NBT) staining and NAD(P)H oxidase activity were significantly attenuated in the high glucose-treated VSMCs. Furthermore, inhibition of PKC-delta markedly decreased VSMC migration by high glucose. CONCLUSION: These results suggest that high glucose-induced VSMC migration is dependent upon activation of PKC-delta, which may responsible for elevated intracellular ROS production in VSMCs, and this is mediated by NAD(P)H oxidase.
Acetophenones ; Animals ; Antibodies ; Benzopyrans ; Diabetic Angiopathies ; Glucose ; Humans ; Immunoblotting ; Isoenzymes ; Mannitol ; Muscle, Smooth, Vascular ; Myocytes, Smooth Muscle ; NADPH Oxidase ; Onium Compounds ; Oxidative Stress ; Oxygen ; Protein Kinase C ; Rats ; RNA, Small Interfering ; Superoxide Dismutase ; Superoxides ; Vascular Diseases

Essential thrombocythemia is one type of the related chronic myeloproliferative disorders that also include poly-cythemia vera, chronic myelogenous leukemia, and idiopathic myelofibrosis. It is a rare disorder of unknown origin characterized by thrombocytosis, excessive megakaryocytes, hemorrhage, and thrombotic complication. Several cases of ischemic stroke in essential thrombocythemia have been reported, but cerebral infarction combined with cerebral hemorrhage has been very rare and has not been reported in Korea. We report a case of cerebral infarction and chronic subdural hematoma in a pateint with essential thrombocythemia. A 59-year-old woman with essential thrombocythemia was admitted with mild left hemiparesis that developed 3 days prior. She had a history of minor trauma 15 days prior. A brain MRI showed an infarction in the right temporal lobe and a chronic subdural hematoma in the right frontoparietal area. A cerebral angiography revealed an occlusion of the M2 portion of the right middle cerebral artery.
Brain ; Cerebral Angiography ; Cerebral Hemorrhage ; Cerebral Infarction* ; Female ; Hematoma, Subdural, Chronic* ; Hemorrhage ; Humans ; Infarction ; Korea ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Magnetic Resonance Imaging ; Megakaryocytes ; Middle Aged ; Middle Cerebral Artery ; Myeloproliferative Disorders ; Paresis ; Primary Myelofibrosis ; Stroke ; Temporal Lobe ; Thrombocythemia, Essential* ; Thrombocytosis

PURPOSE: Skin reactivity to different allergens may vary with age, since the degree and type of sensitization may be related not only to genetic factors but also to the intensity and duration of exposure to the allergens. The aim of this study was to evaluate profile of sensitization to airborne allergens according to age in children with allergic asthma. METHODS: We performed skin prick tests with 12 common airborne allergens in children with clinically diagnosed asthma, and analyzed the results of 313 patients with at least one positive response. Patients were arbitrarily divided into four groups, according to their age: group I(3 to 7 yrs; n=80), group II(7 to 10 yrs; n=93), group III(10 to 13 yrs; n=85), and group IV(13 to 17 yrs; n=55). The allergens tested were grouped into 5 classes : house dust mites, cockroach, animal danders, molds, and pollens. Atopy index and class index were calculated as the number of allergens and classes to which responses had been positive, respectively. RESULTS: In all groups, the most common positive allergic reaction was to house dust mites. Positive reactions to cat fur, mugwort, and ragweed among the allergens, and animal danders and pollens among the classes, tended to increase from group I to group IV(P<0.05). Atopy index increased with age(P<0.05). Class index also increased with age(P<0.05). Sensitization to more than one class of allergens occurred in 62.3% of the patients, and the percentage of these polysensitized patients tended to increase from group I to group IV(P<0.05). CONCLUSION: In children with allergic asthma, the positive number of allergens and their classes by skin prick test increased with the age of the patients. This phenomenon was associated with age- related increase in the frequency of polysensitized patients.
Allergens ; Ambrosia ; Animals ; Artemisia ; Asthma* ; Cats ; Child* ; Cockroaches ; Dander ; Fungi ; Humans ; Hypersensitivity ; Mites ; Pollen ; Pyroglyphidae ; Skin Tests ; Skin*

BACKGROUND: The aim of the study was to evaluate the biochemical effects of recombinant human thyroid stimulating hormone (rhTSH) as an adjunct to radioiodine (RI) treatment of a differentiated thyroid carcinoma (DTC). We retrospectively reviewed the clinical response rates of DTC patients treated with RI after thyroid hormone withdrawal and compared with those after rhTSH stimulation. METHOD: We included the patients treated with RI for locally recurrent DTC from February 1, 2002 to August 31, 2005 and followed with diagnostic studies at our hospital. Forty totally (or near totally) thyroidectomized adults were included in this study. Nine patients underwent RI treatment after rhTSH stimulation while euthyoid on L-thyroxine (LT4), and 31 patients were treated with RI after thyroid hormone withdrawal. The clinical response was defined as >25% decrease in serum thyroglobulin (Tg) level on LT4 3 months after the RI treatment. RESULTS: In each group, serum Tg levels were significantly decreased 3 months after the RI treatment. And we found that 77.8 and 71.0% of those prepared by rhTSH and LT4 withdrawal, respectively, had clinical responses 3 months after the RI treatment by our criteria and there was no significant difference in response rates between two groups (P=0.238). CONCLUSIONS: Given the biases that exist in retrospective studies, at the current time we cannot recommend the routine use of rhTSH to prepare RI treatment of DTC. However, our study provided preliminary evidence that rhTSH effectively aided RI treatment of DTC at least to an equivalent degree as LT4 withdrawal.
Adult ; Bias (Epidemiology) ; Humans* ; Retrospective Studies* ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyrotropin ; Thyrotropin Alfa ; Thyroxine

BACKGROUND: The aim of the study was to evaluate the biochemical effects of recombinant human thyroid stimulating hormone (rhTSH) as an adjunct to radioiodine (RI) treatment of a differentiated thyroid carcinoma (DTC). We retrospectively reviewed the clinical response rates of DTC patients treated with RI after thyroid hormone withdrawal and compared with those after rhTSH stimulation. METHOD: We included the patients treated with RI for locally recurrent DTC from February 1, 2002 to August 31, 2005 and followed with diagnostic studies at our hospital. Forty totally (or near totally) thyroidectomized adults were included in this study. Nine patients underwent RI treatment after rhTSH stimulation while euthyoid on L-thyroxine (LT4), and 31 patients were treated with RI after thyroid hormone withdrawal. The clinical response was defined as >25% decrease in serum thyroglobulin (Tg) level on LT4 3 months after the RI treatment. RESULTS: In each group, serum Tg levels were significantly decreased 3 months after the RI treatment. And we found that 77.8 and 71.0% of those prepared by rhTSH and LT4 withdrawal, respectively, had clinical responses 3 months after the RI treatment by our criteria and there was no significant difference in response rates between two groups (P=0.238). CONCLUSIONS: Given the biases that exist in retrospective studies, at the current time we cannot recommend the routine use of rhTSH to prepare RI treatment of DTC. However, our study provided preliminary evidence that rhTSH effectively aided RI treatment of DTC at least to an equivalent degree as LT4 withdrawal.
Adult ; Bias (Epidemiology) ; Humans* ; Retrospective Studies* ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyrotropin ; Thyrotropin Alfa ; Thyroxine

Infectious mononucleosis is an acute infectious disease occurring predominantly in older children and young adults due to primary Epstein-Barr virus infection. The clinical picture is extremely variable in both severity and duration. The disease in children is generally mild. It is characterized clinically by fever, exudative or membranous pharyngitis, generalized lymphadenopathy, and splenomegaly. Rarely, it complicates neurologic involvement such as cranial nerve palsy, meningoencephalitis, and transverse myelitis, hematologic involvement such as hemolytic anemia, immune thrombocytopenic purpura, and aplastic anemia, rupture of spleen, myocarditis, interstitial pneumonia, and orchitis, etc. We experienced a case of infectious mononucleosis with pleural effusion and ascites in a 5-year-old male with the chief complaint of fever, sore throat and vomiting 3 days prior to admission. The diagnosis was made on the clinical findings, immunologic findings and the typical findings of peripheral blood smear. On peripheral blood smear, leukocytosis with atypical lymphocytosis were seen. On immunologic study, anti-VCA IgM and IgG were positive by ELISA method. We reported this case and reviewed related literatures briefly.
Anemia, Aplastic ; Anemia, Hemolytic ; Ascites* ; Child ; Child, Preschool ; Communicable Diseases ; Cranial Nerve Diseases ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Fever ; Herpesvirus 4, Human ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Infectious Mononucleosis* ; Leukocytosis ; Lung Diseases, Interstitial ; Lymphatic Diseases ; Lymphocytosis ; Male ; Meningoencephalitis ; Myelitis, Transverse ; Myocarditis ; Orchitis ; Pharyngitis ; Pleural Effusion* ; Purpura, Thrombocytopenic, Idiopathic ; Rupture ; Spleen ; Splenomegaly ; Vomiting ; Young Adult

BACKGROUNDMany studies have shown that positive surgical margin and biochemical recurrence could impact the life of patients with prostate cancer treated with radical prostatectomy. With more and more patients with prostate cancer appeared in recent 20 years in China, it is necessary to investigate the risk of positive surgical margin and biochemical recurrence, and their possible impact on the prognosis of patients treated with radical prostatectomy. In this study, we analyzed the characteristics of patients with prostate cancer who had undergone radical prostatectomy in Macau area and tried to find any risk factor of positive surgical margin and biochemical recurrence and their relationship with the prognosis of these patients.

METHODSFrom 2000 to 2009, 149 patients with prostate cancer received radical prostatectomy and were followed up. Among these patients, 111 received retropubic radical prostatectomies, 38 received laparoscopic radical prostatectomies. All patients were followed-up on in the 3rd month, 6th month and from that point on every 6 months after operation. At each follow-up a detailed record of any complaint, serum prostate-specific antigen (PSA), full biochemical test and uroflowmetry was acquired.

RESULTSThe average age was (69.0 ± 6.1) years, preoperative average serum PSA was (10.1 ± 12.1) ng/ml and average Gleason score was 6.4 ± 1.3. The incidence of total complications was about 47.7%, the incidence of the most common complication, bladder outlet obstruction, was about 26.8%, and that of the second most common complication, urinary stress incontinence, was about 16.1% (mild 9.4% and severe 6.7%). The incidence of positive surgical margin was about 38.3%. The preoperative serum PSA ((13.4 ± 17.6) ng/ml), average Gleason score (7.1 ± 1.3) and pathological T stage score (7.0 ± 1.4) were higher in patients with positive surgical margins than those with negative margins ((8.0 ± 5.8) ng/ml, 6.0 ± 1.2 and 5.4 ± 1.4, respectively) (P = 0.004, P = 0.001 and P = 0.001, respectively). A univariate analysis showed that positive surgical margin had a positive statistical association with serum PSA (P = 0.007), Gleason score (P < 0.001), pathological T stage score (P < 0.001) and biochemical recurrence (BCR) (P = 0.035). The most common location of a positive surgical margin was in the apex of the prostate, which was about 63% (36/57). Sixty-four percent (23/36) of patients with positive surgical margin in apex were also involved in prostate lobe; other locations were prostate lobe (23%, 13/57), seminal vesicle (9%, 5/57). The multivariate analysis showed that positive surgical margin had a positive statistical association with Gleason score (P = 0.03) and pathological T stage score (P = 0.02). Neither univariate analysis or multivariate analysis showed any statistical relationship between BCR and any other risk factors covered in this study.

CONCLUSIONSPositive surgical margin is associated with pre-operative PSA, Gleason score, pathological T stage and biochemical recurrence. Earlier diagnosis and improved techniques of dissection of prostate apex could decrease the incidence of positive surgical margins.

Aged ; Humans ; Male ; Middle Aged ; Prostate-Specific Antigen ; blood ; Prostatectomy ; methods ; Prostatic Neoplasms ; blood ; pathology ; surgery ; Risk Factors