There is much controversy concerning the method of treatment on the tibial fracture because of frequent complications, such as non-union, delayed union and infection. Authors reviewed and analyzed 110 tibial fractures which had been treated at the Department of Orthopedic Surgery, Sung Ae General Hospital from June 1983 to March 1987 by the groups, conservative treatment, open reduction and internal fixation with compression plate and closed flexible intramedullary nailing. The results were as follows :1. In regard to the fracture location, there was no difference in the healing time among the treatment methods. The I.M. nailing group healed 1.5 weeks earlier than other groups in each location. 2. In minor and moderate severity by Ellis, the I.M. nailing group revealed better result, and in major one, the compression plate group showed better result. More complications occured in major severity. 3. Union time among the trestment methods was not affected by the fibular fractures, but most of the complications occured in the concomitant fibular fracture case. 4. In open fracture, the healing time showed no difference among the groups, and was prolonged about 2 weeks than closed fracture. In closed case, the I.M. nailing group showed good result. 5. The cases, which were reduced earlier in the conservative group, and treated within 3 days in the I.M. nailing group revesled better result. 6. The radiological union time from the definite treatment was 15.80 weeks in the conservative treatment group, 15.18 weeks in the compression plate group and 13.92 weeks in the I.M. nailing group.
Clinical Study ; Fracture Fixation, Intramedullary ; Fractures, Closed ; Fractures, Open ; Hospitals, General ; Methods ; Orthopedics ; Tibia ; Tibial Fractures

Congenital dislocation of the knee is very rare deformity and presents with anterior displacement of the tibia in relation to the femur. Early gentle manipulation and serial splintage or plaster cast is recommended for treatment and successful in the majority except the case of quadriceps contracture or late correction. We experienced two cases of bilateral congenital dislocation of the knee who had been treated with early gentle manipularion, immobilization with serial corrective dual splint, passive stretching and night splint. Our results are good in both cases.
Casts, Surgical ; Congenital Abnormalities ; Contracture ; Dislocations ; Femur ; Immobilization ; Knee ; Muscle Stretching Exercises ; Splints ; Tibia

62 cases of the fracture of the pelvis admitted to the orthpedic department of Wonju Christian Hospital during past 5 years from 1975 to 1979 were reviewed and clinical results were obtained as follows: 1. Males were frequent than females and almost 3rd to 4th decades of life. 2. The causes of injury were traffic accident, coal minor accident, and falling. 3. Stable type is the most common in this series and among the unstable types, lateral compression type is the most common and then straddle type and vertical shear type. 4. The most common complication is uro-genital injury. 5. The residual complications at the end of treatment remained in some cases, Arthritis of sacroiliac joint, Impotence, Urethral stricture, Low back pain, etc. 6. All of the cases were treated conservatively and their results were somewhat good except 4 cases. 7. Surgical treatment would be considered, if necessory, to decrease the complications and reduce hospital days.
Accidental Falls ; Accidents, Traffic ; Arthritis ; Coal ; Erectile Dysfunction ; Female ; Gangwon-do ; Humans ; Low Back Pain ; Male ; Pelvic Bones ; Pelvis ; Sacroiliac Joint ; Urethral Stricture

BACKGROUND: This study was undertaken to evaluate the effect of plasma concentration of vitamin C is on the plasma total antioxidant status(TAS) in patients with paraquat intoxication. METHODS: As a preliminary research for this study, we measured plasma vitamin C levels, uric acid, TAS, and bilirubin from 100 healthy Koreans aged between 25-55 years. Various concentrations of vitamin C were constructed in vitro with normal pooled plasma between 1mg/dl and 100 mg/dL and TAS was measured. Both vitamin C concentrations and TAS were measured from the blood samples, taken at 0.5, 1, 2, 3, 5, 7, 9 hours after a bolus injection of vitamin C(50 mg/kg) from 7 volunteers who had been recruited from medical students at our hospital. Various amounts of vitamin C were given to 10 patients with paraquat intoxication for 5 consecutive days in the morning : first day ; 100 mg single dose, second day; 500 mg single dose, third day ; 1,000 mg single dose, fourth day : 3,000 mg single dose, and fifth day ; 3,000 mg three times every 8 hours. RESULTS: The mean value of TAS and vitamin C measured in 100 healthy Korean adults was 2.22 +/-0.16 mmol/L and 0.48+/-0.10 mg/dL. Age and sex do not influence these levels(p> 0.05, data are not presented). A direct correlation was observed between TAS and vitamin C concentrations of 1 mg/dL and 100 mg/dL both in vivo and vitro. As the vitamin C concentration was increased gradually 5 consecutive days, the TAS values increased in the same way as follows : first day(vitamin C 100 mg) 2.26+/-0.98 mmol/L, second day(vitamin C 500 mg) 2.76+/-0.78 mmol/L, third day(vitamin C 1.000 mg) 2.81+/-0.68 mmol/L, fourth day(vitamin C 3.000 mg) 3.18 mmol/L. On the fifth day when 3.000 mg of vitamin C was given by bolus intravenous injection 3 times(every 8 hours for a day), the TAS values measured one hour after the injection was 3.58+/-0.37 mmol/L. CONCLUSION: When vitamin C is used as a free radical scavenger, the loading dose and maintenance dose should be around 2278 mg intravenous bolus and 146 mg/hour. High doses of vitamin C are effective and safe for patients with acute paraquat intoxication.
Adult ; Ascorbic Acid* ; Bilirubin ; Free Radical Scavengers ; Humans ; Injections, Intravenous ; Paraquat* ; Plasma* ; Pulmonary Fibrosis ; Students, Medical ; Uric Acid ; Vitamins* ; Volunteers

Nutcracker syndrome(renal vein entrapment syndrome) is probably more common than previously suspected. The nutcracker phenomenon refers to compression of left renal vein between aorta and superior mesenteric artery that results in elevation of pressure in left renal vein and develoment of collateral veins. This syndrome occurs in relatively young and previously healthy patients and is characterized by intermittent gross hematuria due to left renal vein hypertension, at times associated with flank pain, abdominal pain or varicocele. We report a 17 years-old male patient with this syndrome presented with flank pain, abdominal pain, and intermittent gross hematuria for 3 months. Urinalysis revealed protein(-), blood(+++), many RBC with only 1% of dysmorphic RBC. IVP and cystoscopy showed no remarkable finding but doppler ultrasonography and abdominal spiral CT revealed compression of left renal vein between aorta and superior mesenteric artery. Renal venography showed compression of left renal vein and collateral circulation to left gonadal vein and the pressure gradient between left renal vein and inferior vena cava was 11mmHg. The nutcracker syndrome should be considered as one of the causes of nonglomerular hematuria. All patients with unexplained severe left flank or abdominal pain, or unilateral hematuria from the left on cystoscopy, should be studied by selective renal venography and pressure measurement in inferior vena cava and renal veins. The patient with this typical syndrome could be treated surgically, by transposition of left renal vein and resection of collateral veins as the procedure of choice to correct the underlying pathologic process and eliminate these troublesome symptoms.
Abdominal Pain ; Adolescent ; Aorta ; Collateral Circulation ; Cystoscopy ; Flank Pain ; Gonads ; Hematuria ; Humans ; Hypertension ; Male ; Mesenteric Artery, Superior ; Phlebography ; Renal Veins ; Tomography, Spiral Computed ; Ultrasonography, Doppler ; Urinalysis ; Varicocele ; Veins ; Vena Cava, Inferior

PURPOSE: Non-Hodgkins lymphoma (NHL) is recognized as not a single disease but a group of diseases heterogeneous in biology and clinical characteristics. Recently, a new pathologic classification system, the REAL classification, has been introduced into the clinic. Although REAL classification has tried to define the subtypes biologically more correctly, its clinical usefulness has not been established yet. A retrospective study was performed to define the clinical characteristics of Korean NHLs according to the REAL classification and to determine its clinical usefulness. MATERIALS AND METHODS: Pathologies of NHLs managed at 3 major hospitals in Korea between 1989 and 1995 were reviewed with immunophenotyping to determine the pathologic subtypes according to REAL classification. Clinical characteristics at the presentation and treatment outcomes of the eligible patients were analyzed. To determine the differences from the NHLs in the western countries, data of Non-Hodgkins Lymphoma Classification Project (NHLCP) were also compared. RESULTS: Total 802 cases were eligible for this study. Although it was similar to NHLCP study that B-cell subtypes were the majority and diffuse large B-cell lymphoma was the most common subtype, the proportion of T-cell subtypes were much higher in our patient population than in the western population. It was because peripheral T-cell lymphomas, angiocentric lymphoma in particular, were more common and follicular lymphomas were less common in our patients. Eleven common pathologic subtypes could be classified into 3 prognostic groups. Marginal zone B-cell lymphoma and lymphoplasmacytoid lymphoma of which 5-year overall survival rate (5-yOSR) were > 80% were classified in the good prognostic group. Precursor T-lymphoblastic lymphoma was classified in the poor prognostic group because its 5-yOSR was less than 30%. The other 9 subtypes were classified in the intermediate prognostic group with S-yOSR of 30-79%. CONCLUSION: The clinical. character' tics and prognoses of Korean NHLs could be defined according to REAL classification. These information would be helpful for the clinicians in formulating treatment strategies of Korean NHLs according to REAL classification.
B-Lymphocytes ; Biology ; Classification* ; Hodgkin Disease* ; Humans ; Immunophenotyping ; Korea ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Lymphoma, Follicular ; Lymphoma, Non-Hodgkin ; Lymphoma, T-Cell, Peripheral ; Pathology ; Prognosis ; Retrospective Studies ; Survival Rate ; T-Lymphocytes ; Tics ; Waldenstrom Macroglobulinemia

Malnutrition is common in continuous ambulatory peritoneal dialysis(CAPD) patients. Previous studies showed that 18-56% of CAPD patients were suffering from varying degrees of malnutrition. Malnutrition reflects inadequate dialysis or improper dietary intake, leading to a reduction in lean body mass(LBM). Monitoring of LBM, therefore is important for long-term nutritional assessment of CAPD patients. At present, dual energy X-ray absorptiometry(DEXA) is known to accurately predict body compositions in normal and dialysis patients. To determine the most convenient and cost effective tool for LBM measurement, the present cross- sectional study was carried out assessing LBM by DEXA as well as by four other techniques: anthropometry, bioelectrical impedance analysis, infrared interactance and creatinine kinetics. 1) Subjects were 15 men and women each, all clinically stable with a mean CAPD duration of 35.5 months. The mean concentration of serum albumin was 3.9+/-0.5g/dl, normalized protein catabolic rate (NPCR) 0.98+/-0.16g/kg/day, KT/Vurea 2.08+/-0.34 and standardized creatinine clearance(SCCr) 65.8+/-22.1 l/week/1.73m2. 2) Significant correlations between LBM measured by DEXA and LBM measured by other methods were found(r >0.833, p<0.05). Compared with DEXA, the best result was found with anthropometry as it had the highest r value in both measurements of LBM and %LBM(r values are 0.899 and 0.908, respectively). 3) The mean prediction error and root mean squared prediction error was lowest between LBM by anthropometry and that by DEXA. 4) LBM showed no correlation with serum albumin, NPCR, KT/Vurea, and SCCr. In conclusion, anthropometry accurately predicts LBM and may be a suitable alternative tool compared to DEXA in stable CAPD patients.
Anthropometry ; Body Composition ; Creatinine ; Dialysis ; Electric Impedance ; Female ; Humans ; Kinetics ; Male ; Malnutrition ; Nutrition Assessment ; Peritoneal Dialysis, Continuous Ambulatory* ; Serum Albumin

OBJECTIVE: To analyze the complications of percutaneous transthoracic needle biopsy using CT-based imaging modalities for needle guidance in comparison with fluoroscopy in a large retrospective cohort. MATERIALS AND METHODS: This study was approved by multiple Institutional Review Boards and the requirement for informed consent was waived. We retrospectively included 10568 biopsies from eight referral hospitals from 2010 through 2014. In univariate and multivariate logistic analyses, 3 CT-based guidance modalities (CT, CT fluoroscopy, and cone-beam CT) were compared with fluoroscopy in terms of the risk of pneumothorax, pneumothorax requiring chest tube insertion, and hemoptysis, with adjustment for other risk factors. RESULTS: Pneumothorax occurred in 2298 of the 10568 biopsies (21.7%). Tube insertion was required after 316 biopsies (3.0%), and hemoptysis occurred in 550 cases (5.2%). In the multivariate analysis, pneumothorax was more frequently detected with CT {odds ratio (OR), 2.752 (95% confidence interval [CI], 2.325–3.258), p < 0.001}, CT fluoroscopy (OR, 1.440 [95% CI, 1.176–1.762], p < 0.001), and cone-beam CT (OR, 2.906 [95% CI, 2.235–3.779], p < 0.001), but no significant relationship was found for pneumothorax requiring chest tube insertion (p = 0.497, p = 0.222, and p = 0.216, respectively). The incidence of hemoptysis was significantly lower under CT (OR, 0.348 [95% CI, 0.247–0.491], p < 0.001), CT fluoroscopy (OR, 0.594 [95% CI, 0.419–0.843], p = 0.004), and cone-beam CT (OR, 0.479 [95% CI, 0.317–0.724], p < 0.001) guidance. CONCLUSION: Hemoptysis occurred less frequently with CT-based guidance modalities in comparison with fluoroscopy. Although pneumothorax requiring chest tube insertion showed a similar incidence, pneumothorax was more frequently detected using CT-based guidance modalities.
Biopsy ; Biopsy, Needle ; Chest Tubes ; Cohort Studies ; Cone-Beam Computed Tomography ; Ethics Committees, Research ; Fluoroscopy ; Hemoptysis ; Image-Guided Biopsy ; Incidence ; Informed Consent ; Lung Neoplasms ; Multivariate Analysis ; Needles ; Pneumothorax ; Referral and Consultation ; Retrospective Studies ; Risk Factors

On page 323, the grant number was incorrectly numbered as HI15C1234. The correct number is HI15C3390.

Purpose: We aimed to develop a novel method for orthotopic colon cancer model, using tissue adhesive in place of conventional surgical method. Materials and Methods: RFP HCT 116 cell line were used to establish the colon cancer model. Fresh tumor tissue harvested from a subcutaneous injection was grafted into twenty nude mice, divided into group A (suture method) and group B (tissue adhesive method). For the group A, we fixed the tissue on the serosa layer of proximal colon by 8-0 surgical suture. For the group B, tissue adhesive (10 μL) was used to fix the tumor. The mortality, tumor implantation success, tumor metastasis, primary tumor size, and operation time were compared between the two groups. Dissected tumor tissue was analyzed for the histology and immunohistochemistry. Also, we performed tumor marker analysis. Results: We observed 30% increase in graft success and 20% decrease in mortality, by using tissue adhesive method, respectively. The median colon tumor size was significantly increased by 4 mm and operation time was shortened by 6.5 minutes. The H&E showed similar tumor structure between the two groups. The immunohistochemistry staining for cancer antigen 19-9, carcinoembryonic antigen, cytokeratin 20, and Ki-67 showed comparable intensities in both groups. Real-time quantitative reverse transcription analysis showed eight out of nine tumor markers are unchanged in the tissue adhesive group. Western blot indicated the tissue adhesive group expressed less p-JNK (apototic marker) and more p-MEK/p-p38 (proliferation marker) levels. Conclusion We concluded the tissue adhesive method is a quick and safe way to generate orthotopic, colon cancer model.