The angiopathy and neuropathy is the basic mechanism causing diabetic gangrene, but the exact mechanism is still unknown. The foot is especially susceptible to diabetic complication of angiopathy and neuropathy. In such a vulnerable foot, trivial trauma may quickly lead the foot to ulceration, infection, gangrene, and to the cataclysmic amputation. Twenty nine patients with diabetic gangrene were studied, the conclution were as follow. 1. Overall incidence is 1.8%, most common age over 50 years of age, and the most common disease durstion is from 10 to 14 years. 2. The most common site is toe (56% of cases). 3. The most common predisposing factor was local pressure (41% of cases), the radiographic bone change was seen in 14% of cases. 4. The FBS level is from 200 to 300 in 35% of cases. 5. Bacterial infection was seen in 80%, and staphylococcal aureus was most common. 6. The surgical or conservative treatment were effective in 80% of cases and mortality was 14%. 7. Diabetic retinopathy was most common associated complication (47% of cases).
Amputation ; Bacterial Infections ; Causality ; Diabetes Complications ; Diabetes Mellitus ; Diabetic Retinopathy ; Foot ; Gangrene ; Humans ; Incidence ; Mortality ; Toes ; Ulcer

An immunohistochemistry for S-100 protein by biotin avidin system technique was done to evaluate the existence and distribution pattern of S-100 protein positive cells in various obtained were as follows. 1) Positive immunostaining for S-100 protein was observed in myoepithelial cell, serous acinar cell and nervous bundle in normal salivary gland. 2) Strong immunoreactivity for S-100 protein was shown in plemorphic adenoma, which was localized not only in myoepithelial cord or sheets of epithelial portion but also in chondrocytes, stellate cells of myxoid stroma and in squamous keratin pearl of mesenchymal metaplastic foci. 3) The S-100 protein was demonstrated in the tumor cells of tubular adenoma, acinic cell tumors and in epidermoid area of mucoepidermoid tumors. 4) Immunoreactivity for S-100 protein, however, was not found in the tumor cells of adenoid cystic carcinoma and adenolymphoma except for stroma reticulum cells. 5) Intensity of positive reaction for S-100 protein varied from cell to cell: Some had intense immunoreactivity, whreas others were only weakly positive or completely negative, even in myoepithelial cell nest of the same pleomorphic adenoma.

Although embryonal rhabdomyosarcoma has been frequently reported in genitourinary tract, head and neck, embryonal rhabdomyosarcoma of the biliary tree is an extremely rarte. It must be considered in differential diagnosis of jaundice in childhood. About 35 cases have been reported in world literatures, since first description on 1875, by Moxon and Wilks. We present a case of embryonal rhabdomyosarcoma of the biliary tree in a 25 months old boy with brief review of literatures. Since chief complaints of this case were jaundice and loss of appetite, the first clinical diagnosis was infectious hepatitis. On ultrasound examination, there is a space occupying lesion in right lobe of liver and it was diagnosed as hepatoma. Choledochoduodenostomy with biopsy was done. The operation revealed dilated common bile dut and both hepatic ducts which were filled with light brown jelly like materials and diagnosed as embryonal rhabdomyosarcoma on frozen and permanent senions. In gross and histologic characteristics, this tumor resembles embryonal rhabdomyosarcoma(sarcoma botryoides) in other locations. In spite of chemo-and radiotherapy after operation, the boy was died.
Child ; Male ; Female ; Humans ; Diagnosis, Differential ; Biopsy

Objective To compare the effect of clustered acupuncture of the scalp combined with constraint induced movement therapy (CIMT) with that of conventional acupuncture of the body points plus conventional rehabilitation intervention after cerebral infarction using blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI).Methods Thirty acute cerebral infarction patients with hemiplegia were equally divided into two groups at random.The test group received the clustered acupuncture of the scalp combined with CIMT,while the control group received the body point acupuncture plus conventional rehabilitation intervention.Before and after two weeks of treatment,blood oxygenation level-dependent functional magnetic resonance imaging at 3.0 T was performed during a passive digital opposition movement.The volume and intensity of the activated areas were compared.Fugl-Meyer assessment (FMA) was carried out as well.Results The most pronounced activation appeared in the contralateral somatosensory motor cortex for both groups.There was no significant difference in average FMA scores between the two groups before the treatment,but after the treatment the averages were significantly different.An increase in activated volume and intensity in the contralateral SMC was observed in both groups after the treatment,but the test group showed a much larger change in both activated volume and intensity.Conclusion The clustered acupuncture of the scalp combined with CIMT can achieve a more significant improvement in functional recovery after acute cerebral infarction than conventional acupuncture of the body points plus conventional rehabilitation intervention.Such combined therapy is worthy of application in clinical practice.

Breast carcinoma has been infrequently reported in children. About 25 cases have been reported in world literatures since first description in 1913, by Bryan. We present a case of juvenile breast carcinoma in a 17 months old girl with brief review of literatures. Grossly, the submitted specimen is grayish white and measured by 1.3x1.0x0.8 cm in size. It is not encapsulated and its cut surfaces are homogeneous. Microscopic examination showed a neoplastic proliferation of duct cells forming mainly glandular spaces with focal papillary pattern, solid sheets or cribriform pattern. The glandular spaces were filled with collections of PAS-positive eosinophilic secretory materials. The individual cell varied from columnar to polygonal and showed moderate hyperchromatism and variation of nuclear size. Mitoses and necrosis are not found. Tumor cell invasion into the stroma was found.
Child ; Male ; Female ; Humans

Because clinical course of the Legg-Calve'-Perthes disease (LCPD) is varied and unpredictable, it is important that pediatric orthopedists have to know prognostic factors of LCPD in order to choose proper method of treatment. The most universally accepted prognostic factor is the patient's age at the onset of the disease, and most patient's who are less than 5 years old have been treated non-operatively. However, we believe that the extent of involvement of the femoral head is more important in this age group and that operative treatment can get good results in cases of servere head involvement. The purpose of this study is to evaluate the efficacy of femoral varus osteotomy in patients before the age of 5 years with severe involvement. We reviewed 18 patients (23 hips) who were less than 5 years old with Catterall group III (5 patients, 7 hips) or IV (13 patients, 16 hips) involvement from June 1984 to June 1994. Femoral varus osteotomies were performed in all cases. We followed up more than 2 years (range, from 24 to 130 months) and analysed clinical and radiological results. The results were as follows: 1. The mean duration from onset of the disease to the stage of repair was 16 months (range, from 8 to 27 months). 2. 2 hips (28.6%) in group III and 12 hips (75%) in group IV showed radiographic head at-risk signs. 3. Clinically all hips in group III showed good result. However, among the 16 hips in group IV, 13 hips were rated good and 3 hips were fair. Overall, 20 hips (86.9%) showed good result. 4. Radiologically all hips in group III showed good result, whereas in group IV, 10 hips were rated good and 6 hips were fair. Overall, 17 hips (78.9%) showed good result. We concluded that femoral varus osteotomy in patients less than 5 years old with severe involvement might shorten the course of disease and might be effective method.
Child* ; Child, Preschool* ; Fibrinogen ; Head ; Hip ; Humans ; Legg-Calve-Perthes Disease* ; Osteotomy*

Average anteversion of the femur is 15.3 degree. Ultrasound, computerized tomogram, and three dimensional reconstruction from CT or MRI have been used for more accurate measurement of the anteversion. There are two methods in measuing anteversion angle from CT scan:one is by drawing a mid line through long axis of the femoral neck (conventional method). Another is by drawing a line from the center of the head to that of the neck at the base of the trochanter using several cut slices (Murphy’s method). We compared these methods with fluoroscopic measurement of the Anteversion. We traced the change of the anteversion before and after closed femoral intramedullary (IMO) nailing to evaluate the origin of malrotation of the femur. 1. Normal anteversion angles were measured in 15 cases. Average anteversion angle was 6.9 degrees by conventional method, 12.3 degrees by Murphy’s method, and 12.2 degrees by fluoroscope. 2. Anteversion angles were measured after IM nailing in 18 cases. Average was 17 degrees by Murphy’s method and 15.2 degrees by fluoroscope. Mean of difference between these two methods sea 6.3 degrees. That was 1.7 degrees in normal side. 3. Change of the anteversion angle between before and after IM nailing was measured in 17 cases by fluoroscope. Average anteversion angle before the operation was 11.9 degrees and it was change to 15.8 degrees after operation. Mean of these change was 7.1 degrees. 4. Pereperative traction provides important information on change of anteversion. Reduction excessive flexion of proximal fragment was a origin of change of anteversion during nailing procedure. Conclusion : Malrotation of the femur after IM nailing must be keep in mind and it may be preventable by fluoroscopic control of the rotation in nailing procedure.
Femur ; Femur Neck ; Fracture Fixation, Intramedullary ; Head ; Magnetic Resonance Imaging ; Methods ; Neck ; Traction ; Ultrasonography

To fill the large bone defect after bone and soft tissue tumor resection, there are several options such as tumor prosthesis, bone cement with intramedullary nail, autogenous bone graft and allograft. We had used isotrophic autogenous bone graft by using the heat-treated bone removed from tumor site. We analyzed the periods for junctional union and regeneration of autoclaved or low-heat treated groups, and compared these two methods to know which method is better for reconstruction of the bone defect after tumor resection. From Jan. 1987 to Sept. 1993, twelve patients took heat-treated autogenous bone graft: 6 auto- claved, and 6 low heat-treated. Each group had 10 places of junction sites between host and grafted bone. The tumors were 2 cases of osteosarcoma, 3 parosteal osteosarcoma, 2 Ewing's sarcoma, 2 malignant soft tissue tumors, 1 giant cell tumor, and 2 metastases from thyroid cancer and synovial sarcoma. The graft sites were 4 in humerus, 4 pelvis and 4 femur. Two cases showed marginal surgical margin and others wide surgical margin. Here we compare4 the difference between autoclaved group(120℃, 2 atm., 20 min) and low heat-treated group(65℃, 30 min. in water) on the aspect of complications and period to achieve junctional union to host bone. Average follow-up period was 25.3(11 to 88) months. Graft related complications in autoclaved group were bone resorption(2 sites), fracture of grafted bone(2). For low heat-treated group there was no such complication. Nonunion occurred in 3 sites for autoclaved group and 1 for low heat-treated group. Average period for junctional union was 7.3 months(5 to 10 months) for autoclaved group and 6.1 months(5 to 9 months) for low heat-treated group. With these results, heat treated bone autograft may have several advantages such as easy accessi- bility, low cost and anatomical reconstruction of the bone defect. The low heat-treated autogenous bone graft may have more advantages than that of the autoclaved one, and this method may be ratio- nalized to fill the large bone defect made by tumor resection.
Allografts ; Autografts ; Femur ; Follow-Up Studies ; Giant Cell Tumors ; Hot Temperature ; Humans ; Humerus ; Methods ; Neoplasm Metastasis ; Osteosarcoma ; Pelvis ; Prostheses and Implants ; Regeneration ; Sarcoma, Ewing ; Sarcoma, Synovial ; Thyroid Neoplasms ; Transplants

OBJECTIVES: To investigate the effect of granulocyte colony stimulating factor (G-CSF) and granulocyte macrophage colony stimulating factor (GM-CSF) on expression of matrix metalloproteinase-2, 9 (MMP-2, 9) mRNA in mouse embryos. Materials and METHOD: From October 1997 to December 1998, morula stage mouse embryos were cultured for 48 hours with G-CSF and GM-CSF at concentrations of 0.1 pg/ml, 1 pg/ml, 10 pg/ml, 100 pg/ml, 1 ng/ml and 10 ng/ml, respectively. Embryos not treated with G-CSF or GM-CSF were served as control. Reverse transcription-polymerase chain reaction (RT-PCR) has been used to examine the expression of MMP-2, 9 mRNA in developed blastocysts. Following reverse transcription, strategically designed nested primers, optimized for specificity, were used for amplification from the cDNA equivalent of a single embryo. The products were then verified by restriction enzyme digestion and sequence analysis. Results were analyzed with Kolmogorov-Smirnov test and analysis of variance (ANOVA). The statistical significance was defined as p< 0.05. RESULTS: The relative quantities (relative volume x intensity) of MMP-2 mRNA expressed in embryos of all G-CSF treatment groups were significantly increased than in the control, especially in 10, 100 pg/ml and 1 ng/ml treatment groups. The relative quantities of MMP-2 mRNA in all GM-CSF treatment groups were also significantly increased than in the control, especially in 100 pg/ml treatment group. The relative quantities of MMP-9 mRNA of all GM-CSF treatment groups except 10 ng/ml group were significantly increased than in the control, especially 10, 100 pg/ml and 1 ng/ml treatment group. However, the relative quantity of MMP-9 mRNA was significantly increased in only 10 ng/ml G-CSF treatment group than in the control and other treatment groups. CONCLUSION: This study suggests that G-CSF and GM-CSF may increase the m-RNA expression of MMP-2 or 9 in mouse blastocysts with the concentration-specific manner.
Animals ; Blastocyst ; Colony-Stimulating Factors* ; Digestion ; DNA, Complementary ; Embryonic Structures* ; Granulocyte Colony-Stimulating Factor ; Granulocyte-Macrophage Colony-Stimulating Factor* ; Granulocytes* ; Matrix Metalloproteinase 2* ; Mice* ; Morula ; Reverse Transcription ; RNA, Messenger ; Sensitivity and Specificity ; Sequence Analysis

OBJECTIVES: To examine the in vitro interactions of blastocyst attachment using type I collagen. MATERIALS AND METHODS: ICR mice were used and follicular growth was stimulated by pregnant mare serum gonadotropin and human chorionic gonadotropin. On day 4 of pregnancy, the uteri were removed and blastocysts were flushed. Mixtures of 1mL sterile water, 0.5mL DMEM, 2mL type collagen solution and 0.5mL 0.1M NaOH were prepared and transferred to an incubator where the collagen solution polymerized. Blastocysts were transferred to dishes previously coated with type I collagen. CMRL 1066 was used as the basic culture medium. It was supplemented with 1mM glutamine and 1mM sodium pyruvate plus 50 IU/ml penicillin and 50 mg/ml streptomycin. During the first 4 days the culture medium was supplemented with 20% fetal calf serum and thereafter with 20% heat inactivated human cord serum. All blastocysts were initially cultured for 2 days without media change. After 2 days, fresh medium was renewed daily. The stages of embryo growth were examined and recorded everyday under a dissecting microscope and classified according to the standard in vivo criteria set forth by Witschi. RESULTS: By 48h, nearly all blastocysts had attached to the surface of collagen pad. Following adhesion to the collagen pad, the blastocysts maintained their 3-dimensional integrity in contrast to control. The embryos in collagen pad were not flattening and kept polarity and spherical shape during culture. The polar trophoblast invaded the type I collagen downward unlike the horizontal growth in control. In the developmental stage of mouse blastocyst, there were significant differences between control and type I collagen group during day 4 and 5 culture. CONCLUSION: Blastocyst development was better in type I collagen group than control. Therefore, in vitro culture study using type I collagen could provide improved model for the establishment of blastocyst implantation study.
Animals ; Blastocyst ; Chorionic Gonadotropin ; Collagen ; Collagen Type I* ; Embryo Implantation ; Embryonic Structures* ; Female ; Glutamine ; Gonadotropins ; Hot Temperature ; Humans ; Incubators ; Mice* ; Mice, Inbred ICR ; Penicillins ; Polymers ; Pregnancy ; Pyruvic Acid ; Sodium ; Streptomycin ; Trophoblasts ; Uterus ; Water