Fifty-eight primary total hip arthroplasties with hyhrid cemented femoral component using contemporary cementing technique and cementless acctahular cup were followed for a minimum 3 year(ranged, 36 to 67 months, mean 4.1 years). Thc average age of the patients at the time of the operation was 54 years(ranged, 22 to 73 years). The preoperative common diagnosis were avascular necrosis of femoral head in 38 hips and miscellaneou. in 20 hips. The mean Harris hip score was 61 in preoperative and 91 in postoperative at last Follow-up. 5-1 hips(92%) were rated excellent and good clinically. One hip was revised for aseptic loosening of the femoral stem at 52 months follow-up. Radiographically no acetahular component was loose. Three femoral stems were definitely loose, one stem was classfied as prohahle loosenine and another one was ratde as possible loosening. There was no progressive radiolucent dermaation ol' cement-hone interf'ace in stable fermoral steni. Non progressive cement-bone radiolucency was lound seven hips in zone 1, two hips in zone 6, one hip in zone 2 and one hip in zone 7 at last follow-up. There were two postoperalive dislocations. Other complications included superficial infection(two hips) and sciatic nervc palsy(one hip). Our experience showed that the hyhrid hip replaccment with improved cementing technique provided satisfactory results at minimum 3 year follow-up study and emphasized the importantance of careful cementing techniques in survival ot cemented I'cmoral stem.
Arthroplasty* ; Arthroplasty, Replacement, Hip* ; Diagnosis ; Dislocations ; Dronabinol ; Follow-Up Studies ; Head ; Hip ; Humans ; Necrosis

Olivary hypertrophic degeneration (OHD) is caused by lesions in dentato-rubro-olivary pathway(myoclonic triangle) and responsible for palatal myoclonus and other involuntary movements. We report the clinical features and magnetic resonance imaging(MRI) findings of 5 patients with OHD. All patients had previous brainstem hemorrhage mainly involving pontine tegmentum in four patients and right superior cerebellar peduncle in one patient T2-weighted MR] revealed round or oval shaped high signal area in the ventral or ventrolateral portion of the medulla. Their clinical presentations were as followings: palatal myoclonus (4 case), ocular myoclonus (3 case), pharyngeal and laryngeal myoclonus (2 case), limb myoclonus (2 case), head shaking (I case) and perioral tremulous movement (1 case). The frequency of myoclonus was 70-170/minute and the median time interval between the insult of the primary lesion and the onset of myoclonic symptoms was 2 months. OHD shown as hyperintense lesions on T2 weighted MRI should be differentiated from ischemic, neoplastic or other pathologic lesions. The characteristic clinical presentations and the location of primary lesions involving myoclonic triangle may be helpful in differential diagnosis from primary medullary lesions.
Brain Stem ; Brain* ; Diagnosis, Differential ; Dyskinesias ; Extremities ; Head ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Myoclonus

Recently various types of dopamine receptors have been proved to exist in human central nervous system. And the understanding of the of specific function is expected to improve therapeutic effect as well as to reduce undesirable side-effect of current antipsychotic and antiparkinson treatment. Since the dopamine autoreceptor is known to be more sensitive to dopaminergic drugs, there is a growing concern about its functional role in neuropsyhiatric disease. Besides ligand binding studies, recent advances in molecular biology make it possible to quantitate mRNA coding for specific receptors which gives more direct information about its rate of synthesis at the gene level. It is documented that chronic antipsychotics treatment enhances the sensitivity of dopamine autoreceptor, but changes in its mRNA expression have never been investigated yet. Using male Sprague-Dawley rats, 6-hydroxydopamine was injected into left median forebrain bumdle to test whether D2 receptoe mRNA found in midbrain is coding for autoreceptors. And antipsychotic drugs, haloperidol, sulpiride, and clozapine, were administered daily for 2 weeks in order to evaluate their effect on dopamine autoreceptor mRNA, expression. The quantitation of mRNA expression was performed using ribonuclease protection assay. After 6-hydroxydopamine injection, significant reduction in D2, both D2L and D2S, receptor mRNA expression was observed in left midbrain compared with right side. The ratios of D2L/beta-actin and D2S/beta-actin- mRNA in left midbrain were 23.3% and 21.6% of that in right side respectively. Significant expression was demonstrated after repetitive haloperidol and sulpiride, but not after clozapine treatment ; D2S mRNA was increased after haloperidol treatment, while sulpiride enhanced D2L mRNA expression. However, the relative ratio of D2L and D2S mRNA expression in rat midbrain was not changed after repetitive administration of antipsychotic drugs used in this study. These result suggest ; first, the major proportion of mesencephalic D2 receptor mRNA is coding for autoreceptor ; second, the D2 receptor mRNA expression is increases after chronic haloperidol and sulpiride, ut not after clozapine treatment, which may be related to development of extrapyramidal side to alter the relative ratio of D2L and D2S mRNA expression in rat midbrain.
Animals ; Antipsychotic Agents* ; Autoreceptors ; Central Nervous System ; Clinical Coding ; Clozapine ; Dopamine ; Dopamine Agents ; Haloperidol ; Humans ; Male ; Mesencephalon ; Molecular Biology ; Oxidopamine ; Prosencephalon ; Rats* ; Rats, Sprague-Dawley ; Receptors, Dopamine ; Ribonucleases ; RNA, Messenger* ; Sulpiride

The goal of fracture treatment is to restore the patient to pre-injury function level. But the outcome assessment after orthopedic interventions has usually focused on physician-defined parameters of technical success, such as fracture union, alignment and range of motion rather than patient function and quality of life. However, the correlation among improvements in these parameters and functional status, psychosocial well being is inconsistent and weak in the elderly. Therefore authors assessed the functional status after surgical intervention of hip fractures in the elderly with functional recovery score(FRS). Independence in basic activities of daily living, in instrumental activities of daily living, in mobility, freedom from pain and intact memory were assessed in 133 hip fractures in the elderly. The hip fractures in the elderly resulted in 24.8% loss of function after the first year. The older the age, the more the loss of function after surgery of hip fractures. The more functional loss was observed in female patients and in patients with poor postoperative radiological results, but statistically insignificant (P>0.05). The more functional loss was observed in patients with underlying medical disease preoperatively and it was statistically significant (P<0.05). We recommend the evaluation of functional status in the elderly after hip fractures.
Activities of Daily Living ; Aged* ; Female ; Freedom ; Hip Fractures* ; Hip* ; Humans ; Memory ; Orthopedics ; Quality of Life ; Range of Motion, Articular

Rheumatoid patients have poor bone quality and also have an increased incidence of sepsis, delayed wound healing, and general overall complications. It is the purpose of this paper to assess the clinical and roentgenographic results of ABG total hip replacement in rheumatoid arthritis. Twenty-six total hip arthroplasties done in seventeen patients with rheumatoid arthritis were studied prospectively. The average follow-up was 3 years and 4 months, with a minimum follow-up of 2 years and 7 months. The average age of the patients was 49.7 years (range 36-63) and there were sixteen females and one male. All patients fulfilled the 1987 revised criteria and there were eleven cases of protrusio acetabuli. All patients except two were taking oral steroids, nineteen cases were classed as Singhs index 1, five cases as Singhs index 2, and two cases as Singhs index 3. The Charnley approach with a trochanteric osteotomy was employed in all patients. Cup fixation was achieved with two spikes in twenty-one cases, two spikes and one screw in five cases, and in all cases the acetabular cup was angled at less than 45 from the horizontal. There was a gap between the acetabular cup and the acetabulum at DeLee and Charnley zone 1 in three cases, and at zone 2 in six cases. At 2 years, there was no radiolucency, reactive line or any sign of bone resorption. The development of cancellous and cortical densification was seen in Gruen's zone 2 and 6 for the first time in the 1 year radiographs. It became more prominent in the 2 year radiographs. The reactive bone line first became visible at the 6 month follow-up in the Gruen's zone 3 and 5. These lines extended more proximally, but it did not involve the proximal HA coated portion. Cortical hypertrophy of diaphysis was seen at Gruen's zone 3 and 5 in five cases. Rounding off of calcar was visible at zone 7 in six cases. There were no radiological changes of the femoral side in fourteen cases and the acetabular side in seven cases. There was one case of wire breakage, one case of trochanteric separation, and one case of intraoperative splitting of calcar. The result of the study indicated that the development of osseointegration in rheumatoid arthritis might be slow, but the clinical and radiological results were satisfactory. Further prospective follow up is necessary to determine whether the favorable early result of HA coated implant are maintained over longer periods.
Acetabulum ; Arthritis, Rheumatoid* ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Bone Resorption ; Diaphyses ; Durapatite* ; Female ; Femur ; Follow-Up Studies ; Hip ; Humans ; Hypertrophy ; Incidence ; Male ; Osseointegration ; Osteotomy ; Prospective Studies ; Sepsis ; Steroids ; Wound Healing

A 9-year-old boy showed orofacial dyskinesia and psychic symptoms shortly after open heart surgery with deep hypothemia and cardiopulmonary bypass for congenital cyanotic heart disease. The choreothetosis progressed to be generalized and accompanied by mental deterioration. This involuntary movement partially responded only to repetitive administration of sedatives. After 3 month the patient expired with sudden development of ventricular tachycardia and cardiogenic shock.
Cardiopulmonary Bypass* ; Child ; Dyskinesias ; Heart Diseases ; Humans ; Hypnotics and Sedatives ; Hypothermia* ; Male ; Movement Disorders ; Shock, Cardiogenic ; Tachycardia, Ventricular ; Thoracic Surgery

Familial isolated primary hyperparathyroidism(FIPH) is associated with multiple endocrine neoplasia type 1 (MEN1) syndrome, primary hyperparathyroidism accompanied by jaw-tumor syndrome, and familial hypocalciuric hypercalcemia. FIPH may be an early stage of MEN1 or an allelic variant of MEN1. Thymic carcinoid tumor is a rare tumor in MEN1 syndrome. Here, the authors report the case of a 40-year-old man diagnosed with recurrent thymic carcinoid tumor and FIPH. Both the patient and his elder sister had been previously diagnosed to have FIPH with a novel frameshift mutation in the MEN1 gene. Initially, the patient underwent thymectomy because of an incidental finding of a mediastinal mass in his chest X-ray, and had remained asymptomatic over the following 4 years. Pancreas computed tomography conducted to evaluate MEN1 syndrome revealed anterior and middle mediastinal masses, and resultantly, massive mass excision was performed. Histological findings disclosed atypical carcinoids with infiltrative margins. In view of the thymic carcinoid tumor relapse that occurred in this patient, the authors recommend that regular pancreas and pituitary imaging studies be conducted for FIPH associated with a MEN1 gene mutation.
Adult ; Carcinoid Tumor* ; Frameshift Mutation ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary* ; Incidental Findings ; Multiple Endocrine Neoplasia Type 1 ; Pancreas ; Recurrence ; Siblings ; Thorax ; Thymectomy

PURPOSE: We investigated coagulation disorders in Korean patients of idiopathic avascular necrosis of the femoral head. MATERIALS AND METHODS: Ten laboratory parameters related with coagulation pathway were measured and analyzed in fifty-three patients with idiopathic avascular necrosis of the femoral head and compared the results with those of thirty-one healthy persons. RESULTS: Differences in the values of plasminogen activator inhibitor and D-dimer in the two groups were statistically significant (p<0.05). The number of three or four abnormal parameters in the patient group was nearly twice that of the control. Hypofibrinolytic activity, determined by increased plasminogen activator inhibitor and lipoprotein(a), were observed in eleven cases (20.8%) of the patient group. CONCLUSION: The abnormal results that were observed in the patient group may contribute to the predisposition of thrombotic venous occlusion in the head of the femur, leading to avascular necrosis of the femoral head.
Femur ; Head* ; Humans ; Lipoprotein(a) ; Necrosis* ; Plasminogen Activators

BACKGROUND: In patients with severe chronic lung diseases even a small pneumothorax can result in life-threatening respiratory distress. It is important to treat the attack by chest tube drainage until the lung expands. Pneumothorax with a persistent air leak that does not resolve under prolonged tube thoracostomy suction is usually treated by open operation to excise or oversew a bulla or cluster of blebs to stop the air leak. Pleurodesis by the instillation of chemical agents is used for the patient who has persistent air leak and is not good candidate for surgical treatment. When the primary trial of pleurodesis with common agent fails, it is uncertain which agent should be used f or stopping the air leak by pleurodesis. It is well known tbat inappropriate drainage of hemothorax results in severe pleural adhesion and thickening. Based on this idea, some reports described a successful treatment with autologous blood instillation for pneumothorax patients with or without residual pleural space. We tried pleurodesis with autologous blood for pneumothorax with persistent air leak and then we evaluated the efficacy and safety. METHODS: Fifteen patients who had persistent air leak in the pneumothorax complicated from the severe chronic lung disease were enrolled. They were not good candidates for surgical treatment and doxycycline pleurodesis failed to stop up their air leaks. We used a mixture of autologous blood and 50% dextrose for pleurodesis. Effect and complications were assessed by clinical outcome, chest radiography and pulmonary function tests. RESULTS: The mean duration of air leak was 18.4 :1:6.16 days before ABP (autologous blood and dextrose pleurodesis) and 5.2 ± 1.68 days after ABP, The mean severity of pain was 2.3 ± 0.70 for DP(doxycycline pleurodesis) and 1.7 ± 0.59 for ABDP (p<0.05). There was no other complication except mild fever. Pleural adhesion grade was a mean of 0.6 ± 0.63. The mean dyspnea scale was 1.7 ± 0.46 before pneumothrax and 2.0 ± 0.59 after ABDP (p>0.05). The mean FEV1 was 1.47 ± 1.01 before pneumothorax and 1.44 ± 1.00 after ABDP (p>0.05). Exɡpt in 1 patient, 14 patients had no recurrent pneumothorax. CONCLUSION: Autologous blood pleurodesis (ABP) was successful for treatment of persistent air leak in the pneumothorax. It was easy and inexpensive and involved less pain than doxycycline pleurodesis. It did not cause complications and severe pleural adhesion. We report that ABP can be considered as a useful treatment for persistent air leak in the pneumothorax complicated from the severe chronic lung disease.
Blister ; Chest Tubes ; Doxycycline ; Drainage ; Dyspnea ; Fever ; Glucose ; Hemothorax ; Humans ; Lung ; Lung Diseases ; Pleurodesis* ; Pneumothorax* ; Radiography ; Respiratory Function Tests ; Suction ; Thoracostomy ; Thorax

Intra-carotid urokinase (UK) infusion in 20 patients with acute internal carotid artery (ICA) territorial ischemic stroke achieved immediate recanalization in 45% and the clinical outcome in patients with recanalization was superior to that of patients without recanalization. The procedure was most effective in patients with smaller arterial occlusions: 7 of 10 patients with MCA branch occlusions (M2 to M4) achieved recanalization compared to only 2 of 10 with distal ICA or M1 occlusions, which should be an important issue for the critical evaluation of the efficacy of thrombolytic therapy (TT). Hemorrhagic transformation was observed in 9 patients on CT scan; petechial hemorrhage in 5 and intraparenchymal hematoma formation in 4. Among 4 patients with hematoma formation, clinical deterioration was seen in 3 cases and the angiography at the immediate end of the UK infusion showed recanalization in only one patient. The average dose of UK in patients with parenchymal hematoma formation was higher than that of patients without hemorrhagic transformation (123.3 x 10(4) units vs 101 x 10(4) units). The administration of a large dose of UK, probably more than 100 x 10(4) units, and the absence of immediate recanalization seemed to increase the risk of parenchymal hematoma formation. Despite the effort of investigators, the in-hospital time delay for the TT was significant which was mainly related to the time consuming preparation for angiography especially during night. A more effective system for the earlier intervention of acute ischemic stroke needs to be developed.
Adult ; Aged ; Angiography ; Brain Ischemia/*drug therapy/radiography ; Carotid Artery Thrombosis/*drug therapy/radiography ; Female ; Human ; Male ; Middle Age ; Support, Non-U.S. Gov't ; Thrombolytic Therapy/*methods ; Tomography, X-Ray Computed ; Urinary Plasminogen Activator/*administration & dosage