OBJECTIVE: This study is proposed to examine the relationship between bone loss after hormone replacement therapy for one year and initial bone markers. METHODS: One hundred postmenopausal women were studied for one year. At first visit, measurements were made of bone mineral density(BMD) at the lumbar spine and femoral neck, and of serum osteocalcin and urine deoxypyridinoline. After hormone replacement therapy was done for one year, BMD was rechecked. RESULTS: Serum osteocalcin was correlated with the rate of bone change(r=0.150, 0.262) and urine deoxypyridinoline was weakly correlated(r=-0.003, 0.038). The changes of femoral BMD in women with higher concentration of osteocalcin and deoxypyridinoline were significant different from those in women with normal concentration. At the lumbar spine, no significant differences were showed. In women with higher concentration of osteocalcin, the incidence of subjects with increased spine BMD was increased up to around 71.1%, which showed not significant increase compared with normal concentration of osteocalcin. And the incidence of increased spine BMD in women with higher concentration of osteocalcin was marked increased compared with the incidence of normal concentration. The level of the osteocalcin with increased spine BMD was 11.5+/-6.6 ng/ml, and the level with decreased spine BMD was 9.2+/-4.7 ng/ml, respectively. And the level of the deoxypyridinoline was 7.2+/-4.2 pmol/ mol cr in women with increased spine BMD and 7.2+/-2.7 pmol/ mol cr in women with decreased spine BMD, which was not statistically different. The concentration of deoxypyridinoline with increased and decreased in BMD in spine and femur was not statistically different. but the concentration of osteocalcin was 12.2 +/-5.5 ng/ml in significantly increased in BMD and 8.5 +/-4.5ng/ml in significantly decreased in BMD, which was showed significant different. CONCLUSION: Present study indicates that the serum osteocalcin more reflcets bone turnover changes at the menopause than deoxypyridinoline, however, the clinical utility of measurements of osteocalcin only to response to therapy is uncertain.
Bone Density* ; Female ; Femur ; Femur Neck ; Hormone Replacement Therapy* ; Humans ; Incidence ; Menopause ; Osteocalcin ; Spine

Fractures of the neck of the femur have always presented great challenges to orthopedic surgeons and still remain as one of the unsolved fracture as far as treatment and results are concerned. With life expectancy increasing with each decade, becoming more and more patients suffering from femoral neck fractures and their sequelae. The objoct of this study is to observe the relationship between the clinical results and the degree of displacement of fracture, degree of osteoporosis and duration between injury and operation in femoral neck fractures treated with multiple pin fixation. The author clinically analyzed 56 patients of the femoral neck fractures treated with closed reduction and multiple Knowles pinning followed by more than 1 year at Korea University Hospital from January 1986 to December 1991. There were 20 male and 36 female. The age of patients were ranged from 32 to 88 years(average:65.1 years) and most commonly occurred in 7th decade (23cases,41%). The most common cause was slip down(44 cases;79%). The most common type of fracture was stage III (48%) following to Gardens classification. The obtained results were as follows; 1. Union occurred in 49 cases(88%). 2. Among fifty-six cases, five cases(9%) of avascular necrosis, two cases(4%) Of non-union, two cases(4%) of malunion and one case of posttraumatic arthritis were occurred. 3. The functional results by Lunceford criteria were excellent in 30 cases(53% ), good in 13 cases(23%), fair in 5 cases(10%) and poor in 8 cases(14%). 4. Unsatisfactory results were noted in Garden stage II or IV, osteoporosis below Singh index 3 and delayed treatment over 1 week. Above results suggest that multiple Knowles pinning in femoral neck fractures offers high union rate and low complication rate, and so is also one of salvaging method of femoral head.
Agriculture ; Arthritis ; Classification ; Clinical Study ; Female ; Femoral Neck Fractures ; Femur ; Femur Neck ; Head ; Humans ; Korea ; Life Expectancy ; Male ; Methods ; Neck ; Necrosis ; Orthopedics ; Osteoporosis ; Surgeons

PURPOSE: We reviewed 604 cases of varicose veins managed in our hospital and the clinical feature and the results were analyzed between injection sclerotherapy and operative method. METHODS: Retrospective review of clinical records was done from January 1990 to June 1998. All of them were diagnosed as primary varicose veins of lower extremities. Sclerosing agents used were ethanolamine oleate, most commonly, hypertonic saline, sodium tetradecyl sulfate and sclerodex. Injections of the sclerosants were 1 to 5 times as the clinical courses. Then, elastic stocking was applied for 2 weeks. Operations were done under the spinal or general anesthesia and postoperatively remnant varicoses were managed by injection sclerotherapy. Student t-test was used in statistics. RESULTS: The distribution of age were 5th decade (36.8%), 6th decade (24.0%), 4th decade (22.2%) in order of frequency, and the mean age was 44.3 year and the male to female ratio was 1:4.0. The mean duration of illness was 12.6 year, and it was longer in female than male (13.2 vs. 8.7, p=0.02). The most common presumed predisposing factor was longstanding occupation (82% of all) and pregnancy was the 2nd in female (12.0%). Chief complaint was only cosmetic problem in 73% of patients and the others complained varicose induced symptoms and complications. Both lower extremities were involved in 41.9% and right leg was in 26.0%, left leg was in 32.1%. The locations of lesions were calf (41.4%), greater saphenous vein (34.6%), lesser saphenous vein (15.0%). Sclerotherapy was done in 48.0%, operation with sclerotherapy in 23.7%, operation only in 17.2%. The mean duration of illness in sclerotherapy group was significantly shorter than operation group (8.8 vs 14.7 year, p=0.0001). Operation methods were stab avulsion only (48.1%), greater saphenous vein stripping (37.3%) and perforator ligation (11.8%) and others. CONCLUSIONS: Injection sclerotherapy method is very effective and sufficient treatment modality in the management of lower extremity varicose vein with low recurrence and complication rate, especially in the early treated cases.
Anesthesia, General ; Causality ; Ethanolamine ; Female ; Humans ; Leg ; Ligation ; Lower Extremity ; Male ; Occupations ; Oleic Acid ; Pregnancy ; Recurrence ; Retrospective Studies ; Saphenous Vein ; Sclerosing Solutions ; Sclerotherapy ; Sodium Tetradecyl Sulfate ; Stockings, Compression ; Varicose Veins*

Familial Adenomatous Polyposis (FAP) is a rare and autosomal dominantly inherited disorder characterized by the development of hundreds to thousands of colorectal polyps. Korean Polyposis Registry was established in July, 1990 for early detection and management of the FAP patient. Recently, we have experienced in our institution a case of the FAP family kindred living in Jeju Island of Korea. Their relatives have been managed for the past 20 years and are listed in the Korean polyposis registry. Pathologic diagnosis of our proband was stage III (T3N1M0) rectal cancer with thousands of colonic polyps. Intrafamilial strife and psychologic distress was significant due to the late detection and progression to rectal cancer. Therefore, we reviewed our case of the FAP family with literature regarding the psychologic distress and the role of the regional registry.
Adenomatous Polyposis Coli ; Colonic Polyps ; Diagnosis ; Humans ; Korea* ; Pedigree* ; Polyps ; Rectal Neoplasms

OBJECTIVES: This study sought to evaluate the efficacy of collagen graft materials, as compared to other graft materials, for use in healing calvarial defects in rabbits. MATERIALS AND METHODS: Ten mm diameter calvarial defects were made in ten rabbits. The rabbits were then divided into 4 groups: control, autogenous bone graft, SureOss graft, and Teruplug graft. Bone regeneration was evaluated using histological and radiographic methods. RESULTS: Based on visual examination, no distinct healing profile was observed. At 4 weeks after treatment, histological analysis showed there was no bone regeneration in the control group; however, at 8 weeks after treatment, new bone formation was observed around the margin of the defective sites. In the autogenous bone graft group, new bone formation was observed at 4 weeks after treatment and mature bone was detected around the grafted bone after 8 weeks. In the SureOss graft group, at 4 weeks after treatment, acute inflammatory and multinuclear cells were noted around the grafted materials; at 8 weeks after treatment, a decrease in graft materials coupled with new bone formation were observed at the defective sites. In the Teruplug graft group, new bone formation was detected surrounding the bone margin and without signs of inflammation. There were statistically significant differences observed between the graft and control group in terms of bone density as evidenced by radiographic analysis using computed tomography (P<0.05), particularly for the autogenous bone graft group (P<0.001). CONCLUSION: These results suggested that autogenous bone, SureOss and Teruplug have the ability to induce bone regeneration as compared to an untreated control group. The osteogenic potential of Teruplug was observed to be lower than that of autogenous bone, but similar to that of SureOss.
Bone Density ; Bone Regeneration ; Collagen ; Durapatite ; Inflammation ; Osteogenesis ; Porifera ; Rabbits ; Transplantation, Homologous ; Transplants

Retroperitoneal fibrosis is a slowly progressing syndrome that is a part of a systemic fibrosing disease. Most causes are idiopathic, whereas the remainder are associated with methysergide ingestion, malignancy, or aneurysm of abdominal aorta. The pathogenesis is unclear, but the evidences supporting systemic autoimmune process are present, i.e. the apprearance of autoimmune antibodies, especially antinuclear antibody, positive direct or indirect Coombs' test, and the association with immune thrombocytopenia. Effective treatment with corticosteroid is another suggestion of autoimmune nature of this disease. We experienced a case of retroperitoneal fibrosis with immune thrombocytopenic purpura and positive antinuclear antibody. A 44-years old man who was in splenectomy state due to immune thrombocytopenic purpura for 15 years visited us for obstructive uropathy caused by retroperitoneal fibrosis. He was treated with double J catheter insertion in both ureters, and oral medication of corticosteroid and tamoxifen. Renal failure and thrombocytopenia was improved after treatment and the retroperitoneal fibrotic mass size decreased.
Adult ; Aneurysm ; Antibodies ; Antibodies, Antinuclear ; Aorta, Abdominal ; Autoimmune Diseases ; Catheters ; Coombs Test ; Eating ; Humans ; Methysergide ; Purpura, Thrombocytopenic, Idiopathic* ; Renal Insufficiency ; Retroperitoneal Fibrosis* ; Splenectomy ; Tamoxifen ; Thrombocytopenia ; Ureter

Purpose: Burn injury has high clinical heterogeneity and worse prognosis in severely burned patients. Clustering algorithms using unsupervised methods to identify groups with similar trajectories in heterogeneous disease patients can provide insight into mechanisms of disease pathogenesis. This study analyzed routinely collected biomarkers to evaluate mortality prediction, find clinical meanings for these or their subtypes, and evaluate patterns. Methods: This retrospective cohort study included patients aged >18 years, between July 2012 and June 2021. All eligible patients received fluid resuscitation and survived for at least 7 days. Characteristics of clinical interest to the physician at 4 clinically important time points were evaluated. Results: Eligible patients were divided into 4 subgroups according to these time points: from 1st week to 4th week. Total of 1,249 patients admitted within 2 days after burns and receiving fluid resuscitation were included. Mean Harrell’s C-index of pH was the highest (0.816), followed by platelets (0.807), creatinine (0.796), red cell distribution width (RDW, 0.778), and lactate (0.759). Longitudinal profiles among biomarkers were different. Conclusion The main predictors were pH, platelets, creatinine, RDW, and lactate. Creatinine and RDW showed consistent patterns. The other markers varied according to patient condition. Thus, these markers could provide clues into underlying mechanisms and predict mortality.

PURPOSE: Negative pressure wound therapy (NPWT) is an adjunct therapy using negative pressure to remove fluid from open wounds through a sealed dressing and a specialized tubing that is connected to a collection container. NPWT is suitable for acute and chronic wound condition because it was designed to accelerate granulation formation on deep wound. Therefore, we performed this study to assess the effectiveness of NPWT for various wound condition in burn center. METHODS: We enrolled 17 patients who were treated with NPWT from January 2014 to April 2016. We analyzed the characteristics and outcomes of the patients through retrospectively. RESULTS: Among 17 patients, there were 13 patients for contact burn, 2 patients for electrical injury, 1 patient for diabetic foot ulcer and 1 patient for Flame burn. Most of the contact burn victims were injured by the exposure of relatively low temperature for a long time and some of them were injured under the condition of sensory deterioration including spinal cord injury, diabetes or sedatives. Wound coverage was accomplished by split thickness skin graft (STSG) in 12 patients. Local flap was done in 1 patient. STSG with local flap was done in 3 patients. And there were 1 patient who got a conservative management. The duration of NPWT application was from 8 days to 101 days (average 36.2 days). CONCLUSION: NPWT showed good clinical outcomes under various wound condition. Therefore, we think that it can be a new treatment paradigm for difficult wound management in burn center.
Bandages ; Burn Units* ; Burns* ; Diabetic Foot ; Humans ; Hypnotics and Sedatives ; Negative-Pressure Wound Therapy* ; Retrospective Studies ; Skin ; Spinal Cord Injuries ; Transplants ; Ulcer ; Wound Healing ; Wounds and Injuries

BACKGROUND: Estimated glomerular filtration rate (eGFR) is a widely used index of kidney function. Recently, new formulas such as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations or the Lund-Malmö equation were introduced for assessing eGFR. We compared them with the Modification of Diet in Renal Disease (MDRD) Study equation in the Korean adult population. METHODS: The study population comprised 1,482 individuals (median age 51 [42-59] yr, 48.9% males) who received annual physical check-ups during the year 2014. Serum creatinine (Cr) and cystatin C (CysC) were measured. We conducted a retrospective analysis using five GFR estimating equations (MDRD Study, revised Lund-Malmö, and Cr and/or CysC-based CKD-EPI equations). Reduced GFR was defined as eGFR <60 mL/min/1.73 m2. RESULTS: For the GFR category distribution, large discrepancies were observed depending on the equation used; category G1 (≥90 mL/min/1.73 m2) ranged from 7.4-81.8%. Compared with the MDRD Study equation, the other four equations overestimated GFR, and CysC-based equations showed a greater difference (-31.3 for CKD-EPI(CysC) and -20.5 for CKD-EPI(Cr-CysC)). CysC-based equations decreased the prevalence of reduced GFR by one third (9.4% in the MDRD Study and 2.4% in CKD-EPI(CysC)). CONCLUSIONS: Our data shows that there are remarkable differences in eGFR assessment in the Korean population depending on the equation used, especially in normal or mildly decreased categories. Further prospective studies are necessary in various clinical settings.
Adult ; Aged ; *Algorithms ; Creatinine/blood ; Cystatin C/blood ; Female ; Glomerular Filtration Rate/*physiology ; Humans ; Male ; Middle Aged ; Renal Insufficiency, Chronic/physiopathology ; Retrospective Studies

PURPOSE: This study was planned to evaluate the effect of plant extracts contained dressing material which is rich in procyanidins for treatment of deep second degree burn. METHODS: This study conducted from September 1, 2013 to February 28, 2014. Patients with the deep dermal burn wound which is larger than 200 cm2 were enrolled in this study. The test material was applied total 3 times every 2 days when the wounds were relatively clean, with thin eschar and scab removed and the dermal layer exposed. The test and control sites were treated with hydro-foam equally. The effectiveness was evaluated by comparing the re-epithelialization rates between the test and control sites. Two burn surgeons blindly evaluated for re-epithelialization. Evaluation of adverse reaction was also performed during study period. RESULTS: Total of 40 patients were enrolled. Mean total body surface area burned% was 12.3+/-5.5% and the test material was first applied at mean post burn day # 7.2+/-2.0.The re-epithelialization period was 9.0+/-1.7 days in the test site and 11.1+/-2.0 days in the control site. In the test site, re-epithelialization was 2.1+/-1.0 days faster than in the control site (P<0.0001). There was no significant adverse reaction during study period. CONCLUSION: The plant extracts contained dressing material which is rich in procyanidins accelerates wound healing time and shows the safety.
Bandages* ; Body Surface Area ; Burns* ; Humans ; Plant Extracts* ; Proanthocyanidins* ; Re-Epithelialization ; Wound Healing ; Wounds and Injuries