The reported clinical results following revision of failed cemented hip arthroplasties have varied. The most improtaint aspect of revision surgery, especially in case of removal of well injected femoral cement need not be daunting if certain essential principles are understanding. The prohlem is hasically that of a tuhe (cement) fixed within another tube (femur). Otherwise, any attempt to work between the two will cause the instruments to skid off the cement and penetrate the femoral cortex. Therefore, on the first step to deal with the problem and theoretical ground, we have investigated the mode of fracture in bone cement. Prior to this study, a comparision of various cement strength been published by A.J.C. Lee, University of Exetcr, UK is rviewed for our reference. As far as cement crack is concerned, the re are three modes of fracture, namely, mode I, mode II and mode III. As seen in the Fig. 5, mode I fracture is defined to be the fracture under symmetic loading, which is perpendicular to the crack surface. Mode II fracture is the fracture under anti-symmetric loading, which is parallel to the crack surface. In mode III, the loading is perpendicular to both crack surface and the plan of the paper. On the left is the situation shown when using osteotome to crush the cement Fig. 6. The prohlem here is of dynamical nature, however, this kind of prohlem has not been solved yet. Prediction of the direction of propagation is possible by assuming the static nature when the osteotome just gets inside the cement. Small element with distance and angle from the osteotome tip under stress is also,shown on the left, Here, th mode of fracture is mode I. ∂θθ is obstained from fracture mechanics as this, and the direction of crack propagation is given by solving ∂θθ = o,i.e, the direction of maximum ∂θθwhich turns out to be 0=0. When chisel is used, the mode of fracture is th combined mode, i. e. Mode I + Mode II (Fig. 7). In an angiogous approach to the previous one, aθθis obtained, thus, the direction of propagation is given by solving ∂θθ/∂θ = 0. which results in θ=(−)α, the half of the included angle of the chisel, Note, however, that the direction of propagation given here is the initial direction of crack propagation. In practiee, the crack often gets curves, however, this phenomena is governed by other factors neglected in this presentation, such as inhomogenity, state of stress of bone, cement and stem, etc, Thus, quantitative study is required in addition to so've these phenomenon.
Arthroplasty ; Hip Prosthesis ; Hip ; Mechanics

No abstract available.
Cardioplegic Solutions* ; Heart Diseases* ; Heart* ; Hemodynamics* ; Humans

A flow cytometric analysis of the nuclear DNA content of solid tumors using paraffin-embedded tissues has become available since 1983, and its ploidy pattern has been designated as an important prognostic parameter in many human tumors. Hepatocellular carcinoma(HCC) is one of the most common malignant tumors among Koreans, but little information is consolidated about the significance of ploidy pattern. We measured the nuclear DNA content of 62 surgically resected HCCs and 45 non-neoplastic tissues from the surrounding parenchyma by flow cytometry. Aneuploid was detected in 18 cases(29.0%) in HCCs and 2 cases(4.4%) in nonneoplastic hepatic parenchyma(p<0.005). Correlations between the DNA ploidy pattern and various clinicopathologic findings of HCCs were analized. The mean tumor size was significantly different(p<0.05) between the aneuploid group(8.8 cm) and the diploid group(6.1 cm). Mean age of the aneuploid group was younger(47 year) than the diploid group(51 years), but the difference was not statistically significant(p=0.052). The DNA pattern did not show any meaningful correlation with the gross and microscopic features of HCC except for the presence of capsule. These results suggest that DNA ploidy correlates with growth rate of the tumor and it may be a possibly useful prognostic factor in HCCs.
Humans ; Carcinoma, Hepatocellular

No abstract available.
Bone Density* ; Child* ; Glucocorticoids* ; Humans ; Nephrotic Syndrome*

No abstract available.

BACKGROUND: The increase of the incidence of autoimmune diseases and the autoimmune pathogenesis of vitiligo were reported. OBJECTIVE: We studied the frequency of autoimmune disorders and positivity of antinuclear antibody in Korean vitiligo patients. METHODS: Vitiligo patients (439 patients) and control subjects (197 patients) were interviewed about their history of autoimmune diseases. Laboratory studies including complete blood cell count, urine analysis, blood chemistry, fasting blood sugar, thyroid function test (T3, free T4, TSH), and antinuclear antibody were performed for the screening of autoimmune disorders. RESULTS: The diseases associated with vitiligo were microcytic hypochromic anemia (3.64%), non-insulin dependent diabetes mellitus (2.96%), thyroid disease (3.96%), atrophic gastritis, and alopecia areata. In the control subjects, the associated diseases were microcytic hypochromic anemia (1.62%), non-insulin dependent diabetes mellitus (4.65%), and thyroid disease (3.49%). These results show that the frequency of autoimmune disorders in vitiligo patients is not significantly higher than that in control subjects. Six (54.5%) out of 11 vitiligo patients with thyroid disease were diagnosed as having thyroid disease for the first time. Four (0.91%) out of 438 vitiligo patients showed positive to antinuclear antibody. Positivity of antinuclear antibody was not higher in vitiligo patients than that in control subjects (1.16%). CONCLUSION: Frequency of autoimmune diseases and positive reaction to antinuclear antibody in vitiligo patients were not significantly higher than those in control subjects.
Alopecia Areata ; Anemia, Hypochromic ; Antibodies, Antinuclear ; Autoimmune Diseases ; Blood Cell Count ; Blood Glucose ; Chemistry ; Diabetes Mellitus ; Fasting ; Gastritis, Atrophic ; Humans ; Incidence ; Mass Screening ; Thyroid Diseases ; Thyroid Function Tests ; Vitiligo*

Background: The major complications of spinal anesthesia are hypotension and bradycardia. In normal condition, hypotension stimulates baroreceptor reflex and compensatory tachycardia is occured. But during spinal anesthesia, there is possibility of a blockade of cardiac sympathetic nerve fibers which would result in increased vagal tone and depress compensatory baroreceptor reflex which is activated during hypotension. Atropine is an anticholinergic agent whose predominant cardiovascular effect was known as increasing heart rate at clinical dose. The purpose of this study was to evaluate hemodynamic effect of atropine during spinal anesthesia. Methods: We compared heart rate, systolic, diastolic and mean arterial pressures and cardiac output in 26 patients of ASA physical status 1, 2 before and after intravenous injection of atropine sulfate 0.01 mg/Kg during spinal anesthesia. Hemodynamic parameters were measured just prior to and 1, 2, 3, 4, 5, 10 minutes after atropine sulfate intravenous injection. The data were analyzed by repeated measures ANOVA. Results: Heart rate, mean blood pressure and diastolic blood pressure after atropine sulfate injection increased with significance. Conclusion: These findings suggest that during spinal anesthesia atropine is effective to produce tachycardia with a dosage of 0.01 mg/Kg in humans. Also hypotension might be improved because atropine makes mean blood pressure and diastolic blood pressure increase.
Anesthesia, Spinal* ; Arterial Pressure ; Atropine* ; Baroreflex ; Blood Pressure ; Bradycardia ; Cardiac Output ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Injections, Intravenous ; Nerve Fibers ; Tachycardia

In order to correlate the frequency of neuroendocrine cells with pathologic parameters in gastric adenocarcinomas, immunoperoxidase staining for neuron specific enolase was performed on 250 consecutive cases of surgically resected gastric adenocarcinomas(201 advanced gastric carcinomas[AGCs], 49 early gastric carcinomas[EGCs] and 2 cases of gastric carcinoid tumors. Of the 252 cases of gastric carcinomas, pure exocrine carcinomas were 174 cases(69%), pure neuroendocrine(NE) carcinomas 2 cases(0.8%), mixed exocrine and NE carcinomas 32 cases(12.7%), and exocrine carcinomas with occasional NE cells 44 cases(17.5%). The frequency of gastric carcinomas with NSE-positive cells increased with age proportionally. NSE positivity was higher in polypoid or fungating tumors(AGC Borrmann type I, II, EGC I and IIa) than ulcerative or scirrhous tumors. There was no significant difference in frequency of NSE-positive cells by histologic type and differentiation of gastric adenocarcinomas. The above findings reflect that most gastric carcinomas are heterogeneous in their constituents and suggest that both exocrine and neuroendocrine carcinomas are the expression of the extreme ends of the exocrine-endocrine differentiation spectrum based on the assumption that they develop from the pluripotent stem cells differentiating into both exocrine endocrine carcinomas.

No abstract available.
Ultrasonography*

BACKGROUND: The purpose of this study is to compare clinical and radiological outcomes between trans-acromial fixation with Kirschner's wire (K-wire) and AO locking hook plate fixation for acute acromioclavicular (AC) joint dislocation. METHODS: This study included 61 patients who underwent either closed reduction and trans-acromial fixation with K-wire (group A, 23 patients) or open reduction and internal fixation with AO locking hook plate (group B, 38 patients). Pain on a visual analogue scale (VAS) score, the University of California Los Angeles (UCLA) shoulder score, the American Shoulder and Elbow Surgeons (ASES) score, and active range of motion (ROM) were used in the functional evaluation. For radiological evaluation, coracoclavicular distance (CCD) was measured on both clavicular anteroposterior view and compared between groups. RESULTS: At one-year follow-up, no significant differences in VAS pain score, UCLA shoulder score, ASES score, and active ROM were observed between groups, despite five cases (22.7%, 5/23) of complication in group A. The side-to-side difference between normal and affected CCD was 2.4 ± 2.2 mm in group A and 0.2 ± 0.7 mm in group B. This difference showed a statistical significance between groups (p<0.001). CONCLUSIONS: For the treatment of acute AC joint dislocation, the K-wire trans-acromial fixation group showed a significantly greater CCD than the AO locking hook plate group. In addition, during the follow-up period, much higher incidence of complication related to implant was observed in the trans-acromial fixation group. Although clinical outcomes between groups were not significantly different, these results should be interpreted carefully.
Acromioclavicular Joint* ; California ; Dislocations* ; Elbow ; Follow-Up Studies ; Humans ; Incidence ; Joints ; Range of Motion, Articular ; Shoulder ; Surgeons