PURPOSE: Surface finishing of a cemented femoral stem is a subject of controversy even though the contemporary cementing techniques have improved results. Using the Versys Heritage femoral stem, we evaluated the outcome of using a polished surface. MATERIALS AND METHODS: The subjects of this study were 95 hip arthroplasties in 82 patients and we used a cemented polished femoral stem with the 3rd generation cement technique and all the surgeries were done between October 2000 and August 2003. There were 58 male patients (64 hips) and 24 female patients (31 hips). The mean age at the time of the index arthroplasty was 52.3 years (26~74 years), and the average body mass index was 24.2+/-2.75 (19.1~29.8). The average follow up period was 80.7 months (64~109 months). All the hips were evaluated clinically by the Harris hip score and the thigh pain, and they were radiologically assessed by the cement grade and the presence of osteolysis around the femoral stem, as well as the presence of stress shielding of the proximal femur. RESULTS: At the final follow up, the Harris hip score for all the patients had improved from preoperative 58.9 (17-83) to post operative 91.7 (72~100). The cement grade was measured using Barrack's method. Of the 95 hips, 45 (47.3%) cases were grade A, 48 (50.5%) cases were grade B and 2 (2.1%) cases were grade C1 at the final follow up. There was 1 case of definite loosening. Stress shielding was noted in 65 (68.4%) cases of the zero grade and 19 (20.0%) cases of the 1st grade. CONCLUSION: In this study, the cemented polished femoral stem showed excellent results at the mid term with a minimum follow up of 5 years. But a longer-term follow-up study will be needed for further understanding the implications of cemented polished femoral stem.
Arthroplasty ; Body Mass Index ; Female ; Follow-Up Studies ; Hip ; Humans ; Male ; Osteolysis ; Thigh

No abstract available.
Anemia* ; Hypothyroidism*

In this case study, we investigated the effects of robot-assisted gait training on the plasticity of motor system in a stroke patient using functional MRI. A patient who suffered from the left hemiparesis following the right MCA infarction performed gait training with a robot-assisted gait orthosis. Before and after gait training, motor performances were assessed and functional MRIs were acquired with motor activation task of affected lower limb. After gait training with a robot-assisted orthosis, the patient's motor performances were improved and cortical activities were changed. Activation in the ipsilesional primary sensorimotor cortex was increased and cortical reorganization was induced in a way that nearby regions were recruited for the movement of affected lower limb. The results of this study showed that gait training with a robot-assisted orthosis induced cortical reorganization of the motor network that resulted in enhancement of motor performance of the lower limb.

Rheumatoid arthritis (RA) and osteoarthritis (OA), two common types of arthritis, affect the joints mainly by targeting the synovium and cartilage. Increasing evidence indicates that a significant network connects synovitis and cartilage destruction during the progression of arthritis. We recently demonstrated that hypoxia-inducible factor (HIF)-2alpha causes RA and OA by regulating the expression of catabolic factors in fibroblast-like synoviocytes (FLS) or chondrocytes. To address the reciprocal influences of HIF-2alpha on FLS and chondrocytes, we applied an in vitro co-culture system using a transwell apparatus. When co-cultured with HIF-2alpha-overexpressing chondrocytes, FLS exhibited increased expression of matrix metalloproteinases and inflammatory mediators, similar to the effects induced by tumor-necrosis factor (TNF)-alpha treatment of FLS. Moreover, chondrocytes co-cultured with HIF-2alpha-overexpressing FLS exhibited upregulation of Mmp3 and Mmp13, which is similar to the effects induced by interleukin (IL)-6 treatment of chondrocytes. We confirmed these differential HIF-2alpha-induced effects via distinct secretory mediators using Il6-knockout cells and a TNF-alpha-blocking antibody. The FLS-co-culture-induced gene expression changes in chondrocytes were significantly abrogated by IL-6 deficiency, whereas TNF-alpha neutralization blocked the alterations in gene expression associated with co-culture of FLS with chondrocytes. Our results further suggested that the observed changes might reflect the HIF-2alpha-induced upregulation of specific receptors for TNF-alpha (in FLS) and IL-6 (in chondrocytes). This study broadens our understanding of the possible regulatory mechanisms underlying the crosstalk between the synovium and cartilage in the presence of HIF-2alpha, and may suggest potential new anti-arthritis therapies.
Animals ; Arthritis/genetics/*immunology/pathology ; Arthritis, Rheumatoid/genetics/immunology/pathology ; Basic Helix-Loop-Helix Transcription Factors/genetics/*immunology ; Cells, Cultured ; Chondrocytes/immunology/metabolism/*pathology ; Coculture Techniques ; Fibroblasts/immunology/metabolism/*pathology ; Gene Expression Regulation ; Interleukin-6/genetics/*immunology ; Male ; Mice ; Mice, Inbred C57BL ; Osteoarthritis/genetics/immunology/pathology ; Synovial Membrane/immunology/metabolism/*pathology ; Tumor Necrosis Factor-alpha/genetics/*immunology ; Up-Regulation

Full skin auto-grafts are required for reconstruction of skin burns and trauma scars. However, currently available clinical approaches such as sheet skin graft, mesh skin grafts, artificial skin graft, and in vivo skin expansion have limitations due to their potential danger for secondary damage and scar formation at the donor site, and discomfort during skin expansion. We developed an advanced bioreactor system and evaluated its function in skin expansion using porcine full skin. The reactor was designed as a pneumatic cylinder type, was programmed to adjust the pressure and the operating time. The system was composed of culture chamber unit, environmental control unit, and monitoring unit. Skins were expanded at 200 kPa pneumatic force and the expanded skins were analyzed by immunohistochemistry and histology. Furthermore we carried out auto-grafting experiment of the expanded skins in vivo using Yucatan pigs and skins were harvested and histologically analyzed after 8 weeks. The results showed that the bioreactor expanded skins to 160% in 4 hours. Histological analysis of the expanded skins revealed that epidermal cells and dermal fibroblasts were viable and remained integrity. The results of auto-grafting experiment indicated that fibrosis and scars were not detected in the grafted skins. This study demonstrates that the newly developed skin bioreactor enabled to obtain large sized full skin rapidly and successful grating.
Bioreactors* ; Burns ; Cicatrix ; Fibroblasts ; Fibrosis ; Humans ; Immunohistochemistry ; Skin* ; Skin, Artificial ; Swine ; Tissue Donors ; Transplants

Pneumomediastinum, pneumothorax and subcutaneous emphysema are uncommon in pediatric practice, but they may be rarely ocured in association with respiratory distress and excessive ressusciation in the neonatal period, and as a complication of bronchial asthma, measles in childhood. And also, there was a report of a few cases that developed to pneumomediastinum and subcutaneous emphysema caused by vomiting in patient of diabetic coma. It is rare so far in this country that above events are complicated by miliary tuberculosis, but they may lead the patient to fatal and lifethreatening conditions, even though we perform a considerable medical treatment for that. We presnted 3 cases of 6 month 20 days old female infant, and each 10 year and 11 year old boys, developed to pneumomediastinu, pneumothorax and subcutaneous emphysema, and suddenly expired during hospital treatment of miliary tuberculosis. And, we reviewed the literatures, too.
Asthma ; Child ; Diabetic Coma ; Female ; Humans ; Infant ; Measles ; Mediastinal Emphysema* ; Pneumothorax* ; Subcutaneous Emphysema* ; Tuberculosis, Miliary* ; Vomiting

BACKGROUNDS: The education by the family physician. is important for more practical primary care medicine education. In this study, we try to know the presnent state of education and the future and the number of education resource and how to multiply this resource. METHODS: we have got the list of family physicians who have their clinic in Seoul by the help of the Korean Academy of Family Medicine. And we performed telephone questionary. We also asked the demographic factors RESULTS: 134 persons were asked questionary by the telephone. 17persons were joining in education. Trainee by the 3rd grade hospitals was the major, the next was by 2nd grade hospital, and doctors who did not have the training. 14 persons have begun education by asking of the training hospital, 3 persons wanted it, but none thought it beneficial to them. 44 persons wanted to join education in the future, and there was no difference between the 3rd and the 2nd grade hospital trainee. CONCLUSION: There was no difference between the 3rd and 2nd grade hospital trainee but 2nd grade hospital trainee was less joining than the 3rd. This shows that the 2nd grade hospital trainee can be the good pool of the future education if there are adequate supply. So many adequate supply is necessary.
Demography ; Education* ; Humans ; Physicians, Family* ; Primary Health Care ; Seoul* ; Telephone

Histiocytic sarcoma is a malignant proliferation of cells showing morphologic and immunophenotypic features similar to those of mature tissue histiocytes and is known for its rapid progression and poor prognosis. We describe a case of histiocytic sarcoma diagnosed by bone marrow biopsy. A 64-yr-old male was admitted for fever and weight loss that persisted for 8 months. The patient died undiagnosed on the 7th hospitalization day. A bone marrow biopsy performed just before the patient's death revealed diffuse proliferation of large pleomorphic neoplastic cells with large, round to oval nuclei, vesicular chromatin, and abundant foamy cytoplasm. These cells were positive for histiocytic markers, CD68, lysozyme, CD21, and S-100 protein, but negative for B-cell, T/NK-cell, and epithelial cell markers, thus confirming the presence of histiocytic sarcoma.
Antigens, CD/metabolism ; Antigens, CD31/metabolism ; Antigens, Differentiation, Myelomonocytic/metabolism ; Bone Marrow/*pathology ; Fever/diagnosis ; Histiocytic Sarcoma/*diagnosis/pathology/radiography ; Humans ; Male ; Middle Aged ; Muramidase/metabolism ; S100 Proteins/metabolism ; Tomography, X-Ray Computed

PURPOSE: The purpose of this study was to assess the natural history and perinatal outcomes of twin gestations according to chorionicity. METHODS: We retrospectively reviewed the medical records of 99 monochorionic (MC) and 206 dichorionic (DC) twin gestations delivered at Il Sin Christian Hospital in Busan between January 2002 and December 2007. The incidences of twin-to-twin transfusion syndrome (TTS) and selective intrauterine growth restriction (sIUGR), as well as perinatal morbidity and mortality, were evaluated. RESULTS: MC twins had a lower gestational age (35.7 vs. 36.6 weeks, P=0.03) at birth and a higher incidence of intrauterine fetal loss (10% vs. 1.5%, P<0.001) than DC twins. The incidence of intrauterine fetal loss was higher in MC sIUGR than in DC sIUGR (19% vs. 2.5%, P=0.025) twins. The number of admissions to the neonatal intensive care unit (NICU; 31% vs. 16%, P=0.042), and the incidence of periventricular leukomalacia (7% vs. 0%, P=0.031), and respiratory distress syndrome with surfactant treatment (27% vs. 11%, P=0.049) were higher in MC than DC twins. The incidences of sIUGR and TTS were 21 and 9% among the MC twins. The incidences of intrauterine fetal loss were higher in MC twins with TTS [6 of 9 (67%)] or sIUGR [4 of 21 (19%)] than uncomplicated MC twins (P<0.001). The frequency of admission to the NICU (P=0.001), the length of hospital stay (P=0.033), the prevalence of periventricular leukomalacia (P=0.011), and intraventricular hemorrhage (P=0.007) were also higher in MC with TTS or sIUGR than in uncomplicated MC twins. CONCLUSION: The incidence of neonatal complications was higher in MC twins, especially those gestations complicated by TTS or sIUGR.
Chorion ; Female ; Fetofetal Transfusion ; Gestational Age ; Hemorrhage ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Length of Stay ; Leukomalacia, Periventricular ; Medical Records ; Natural History ; Parturition ; Pregnancy ; Prevalence ; Retrospective Studies

OBJECTIVE: Previous studies have reported that the immune response of hepatitis B vaccine is decreased in preterm or low birth weight babies compared to healthy term babies. To evaluate this notion, we investigated the positive seroconversion rate of hepatitis B antibody after hepatitis B vaccination according to gestational age and birth weight. METHODS: We retrospectively studied medical records about the positive seroconversion rate of a total of 968 infants who were given DNA recombinant hepatitis B vaccine as scheduled at Il Sin Christian Hospital, Busan from January 2002 to Mar 2007. RESULTS: The postive seroconversion failure rate (non-responder or poor-responder) of hepatitis B antibody by gestational age was 15.6% (<28 weeks), 11.4% (>28 weeks, <32 weeks), 5.8% (>32 weeks, <37 weeks), and 1.9% (<37 weeks). The postive seroconversion failure rate by birth weight was 16.7% (< 1,000 g), 15% (>1,000 g, <1,500 g), 5% (>1,500 g, <2,000 g), and 2% (>2,000 g). CONCLUSION: The seropositive rate of hepatitis B antibody after hepatitis B vaccination decreased as the gestational age and the birth weight decreased. And gestational age more than 37 weeks and birth weight above 2,000 g were independently associated with a higher seropositive rate of hepatitis B antibody after hepatitis B vaccination.
Birth Weight ; DNA ; Gestational Age ; Hepatitis ; Hepatitis B ; Hepatitis B Vaccines ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Medical Records ; Parturition ; Retrospective Studies ; Vaccination