BACKGROUND: The purpose of this study was to determine the shape of the distal femur of Korean women compared with the prostheses currently available in Korea. METHODS: Morphometric data (5 parameters) were measured in 356 resected femurs of Korean women undergoing primary total knee arthroplasty (TKA) utilizing the LCS knee implant (DePuy). The data were then compared with 5 additional contemporary TKA implant systems. RESULTS: Implant designs based on Caucasian population data do not ideally match the distal femoral morphology of Korean women. Overhang at the anterior mediolateral width was observed in 84.8% for the LCS while a gender-specific implant resulted in undercoverage of the bone in 86%. Posterior overhang was observed in up to 51.2%. Most implant designs have a narrower intercondylar notch than the morphologic data of Korean women. CONCLUSIONS: Since there is some difference between the shape of distal femur of Korean women and that of the implants, surgeons should have this in mind when selecting an implant for a patient. These data may also be used as a guideline for future prosthetic design options for Korean women population.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*instrumentation/statistics & numerical data ; Asian Continental Ancestry Group/*statistics & numerical data ; Cohort Studies ; Female ; Femur/*anatomy & histology/*surgery ; Humans ; Knee Joint/surgery ; Middle Aged ; Prosthesis Design ; Republic of Korea

Matched sibling bone marrow transplantation (BMT) in severe aplastic anemia (SAA) has been known as the treatment of choice in children and young adults. To overcome graft failure, second stem cell transplantation showed good results in previous studies. Here we report two cases of aplastic anemia patients with late graft failure and resulted in successful complete recovery after selective CD34+ cell boost infusion. The patients previously underwent allogeneic BMT from HLA-matched sibling donors and the engraftment was achieved although their CBC started to decrease respectively 3 months and 11 months after transplantation. Both patients received selective CD34+ cell infusion without additional conditioning therapy. Their CBC showed significant improvement and they are doing well without transfusion or complications. From this study we suggest that selected CD34+ cell boost treatment can be a promising curative treatment for late graft failure after matched sibling BMT in SAA patients.
Anemia, Aplastic ; Behavior Therapy ; Bone Marrow Transplantation ; Child ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Siblings ; Stem Cell Transplantation ; Tissue Donors ; Transplants ; Young Adult

Mirizzi syndrome is commonly defined as a common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct. Mirizzi syndrome has traditionally been treated surgically. However, there are several case reports and small series describing endoscopic and percutaneous alternatives to open surgery. We encountered two cases of type I Mirizzi syndrome that was successfully treated endoscopically. We report these cases with a review of the relevant literature.
Cystic Duct ; Hepatic Duct, Common ; Mirizzi Syndrome*

PURPOSE: To evaluate the long-term (over 10 years) clinical and radiologic results of LCS (low contact stress, Depuy, USA) total knee arthroplasty (TKA) retrospectively. MATERIALS AND METHODS: Out of 57 cases who underwent TKA with LCS knee system between June 1994 and August 1995, 33 cases could be analysed clinically and radiographically. Clinical analysis was performed according to flexion contracture, ROM, Knee Society Clinical Rating System (KSCRS) and Hospital for Special Surgery (HSS) score system. Radiographic analysis was performed according to the roentgenographic evaluation criteria of American Knee Society. Complications and survival rate were evaluated. RESULTS: Average flexion contracture was improved from 10.0degrees preoperatively to 3.7degrees at final followup and average ROM was improved from 104.0degrees preoperatively to 115.3degrees at final follow-up (p<0.05). Average HSS score was improved from 49.5 preoperatively to 80.1 at final follow-up and average KSCRS score was also improved from 77.2 to 152.5. Average tibio-femoral angle was changed from 3.3degrees varus preoperatively to 3.5degrees valgus at final follow-up. There were 4 complications, including infection in two cases and fracture dislocation of polyethylene implant in two cases respectively. Ten year survival rate was 94.1 percent. CONCLUSION: LCS TKA showed excellent results and good survival rate at more than ten years followup. However, more cases should be necessary for statistic significance.
Arthroplasty* ; Contracture ; Dislocations ; Follow-Up Studies ; Knee* ; Polyethylene ; Retrospective Studies ; Survival Rate

BACKGROUND: In this study, we attempted to generate RBCs from CD34+ cells in cord blood using a 3-step culture protocol and also evaluated a change in immunophenotypic characteristics and expression profile according to erythropoietin (EPO) concentrations and culture duration. METHODS: Using mini-MACS columns, CD34+ cells were isolated from cord blood. The culture procedure comprised three steps. For each step, cells were cultured sequentially for 7 days in a serum free liquid medium with a specific combination of growth factors for 21 days. [1st step: Flt3-ligand (Flt3-L), thrombopoietin and stem cell factor (SCF); 2nd step: IGF-1, SCF and EPO; and 3rd step: IGF-1 and EPO] To evaluate the effect of EPO on proliferation and differentiation, cells were cultured with different EPO concentrations (0, 3, 10 & 20 U/mL). Cell count and morphology were monitored during the culture. For phenotyping, antibodies to CD34, CD38, CD45 and glycophorin A (GPA) were used. The expression profile of cultured cells was analyzed by 17, 000-gene microarray analysis. RESULTS: As EPO concentration increased, cell expansion was also increased, showing a maximum expansion at 20 U/mL. The cell population showed a gradual decrease in expression of CD34 and CD45, whereas the expression of GPA was not prominent in any conditions. However, we observed increased expression in some genes associated with erythropoiesis (e.g. glycophorin A, rhesus blood group CcEe antigens). CONCLUSIONS: This study shows that erythropoietin enhances the proliferation of hematopoietic progenitor cells. Our culture system did not achieve pure production of RBCs, but induced expression changes that indicated erythroid differentiation.
Antibodies ; Cell Count ; Cells, Cultured ; Erythropoiesis ; Erythropoietin ; Fetal Blood* ; Glycophorin ; Hematopoietic Stem Cells ; Humans ; Insulin-Like Growth Factor I ; Intercellular Signaling Peptides and Proteins ; Microarray Analysis ; Stem Cell Factor ; Thrombopoietin

PURPOSE: Wilms tumor is the most common malignant renal tumor in children. We investigated the epidemiology, clinical features and treatment outcome of the children with Wilms tumor in Korea during the recent 10 years. METHODS: Two hundred forty six patients were enrolled between January 1991 and December 2000 from 26 major hospitals in Korea. The data regarding the clinical features including sex, age, pathologic type, prognostic factor and treatment outcome of patients were analyzed retrospectively by review of patient's medical records. Kaplan-Meier survival curves were constructed, The differences between groups were analyzed by log-rank test. RESULTS: There were 130 males and 116 females. The incidence between the age of 1~4 years was the highest with 66.2%. The annual incidence rate per 1, 000, 000 population varied from 1.9 to 2.1. The 10 years overall survival rate according to sex, clinical stage, pathologic type and relapse were as follows: 88.6% in male, 90.9% in female, 100% in stage I, 94.7% in stage II, 92.1% in stage III, 63.4% in stage IV, 85.7% in stage V, 95.3% in favorable histology, 64.1% in unfavorable histology, 94.8% in non-relapse, and 40.9% in relapse. The relapse rate was 12%. The 10 years overall survival rate of 246 patients were 89.1%. CONCLUSION: Our results could provide the most recent and important clinical information on Wilms tumor of children in Korea.
Child ; Epidemiology* ; Female ; Humans ; Incidence ; Kaplan-Meier Estimate ; Korea* ; Male ; Medical Records ; Recurrence ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Wilms Tumor*

PURPOSE: The annual incidence of aplastic anemia (AA) in Asian countries is higher than in Western countries. The pathogenesis in AA has been investigated in hematopoiesis and immunology. Recently, the survival rate and the quality of life of the patients with AA have been steadily improved by the development of a variety of treatments such as the immunosuppressive therapy (IST), and hematopoietic stem cell transplantation (HSCT). The Korean Society of Pediatric Hematology-oncology retrospectively investigated the incidence, treatment strategies, survival rate, and time to become independent from transfusion in patients with AA, who were diagnosed from January 1st, 1991 to December 31st, 2000 in Korea. METHODS: All the questionnaires were sent to a group of training hospitals, and we collected about 600 questionnaire forms from 27 hospitals. However, 493 reports were available for data analysis. RESULTS: The male and female ratio in AA is 1.1 (259 males vs. 234 female). The median age at diagnosis is 9 years old (range; 0.8~16 years old). The annual incidence of children with AA in Korea is 4.5 per million on the basis of Korean pediatric population. In etiology, there are 20 cases (4.1%) in congenital and others in acquired AA. In acquired AA, the cause of illness was not identifiable for most of the patients, but 1 patient had hepatitis-associated AA, and 3 patients developed the illness after medication. According to the initial laboratory data at diagnosis, the peripheral blood findings showed that hemoglobin is 7.1+/-2.4 g/dL, white blood cell 3, 200/microL (200~16, 550), absolute neutrophil counts 670/microL (0~12, 487), platelets 19, 000/microL (1, 000~500, 000), and corrected reticulocytes 0.18% (0.0~4.7). The bone marrow examination revealed that cellularity was below 25% in 348 patients, and over 25% in 105 patients. In the available data, 269 patients (54.6%) were diagnosed of severe aplastic anemia (SAA) and 224 patients of non-SAA (NSAA). HSCT were done for 96 patients (19.5%) and others received another treatments such as the IST. The anti-thymocyte globulin (ATG) or anti-lymphocyte globulin (ALG) treatment was done for 263 cases, corticosteroids for 259, cyclosporine A (CSA) for 215, and anabolic steroids for 138. The combination IST including ATG or ALG plus corticosteroid plus CSA were applied to 154 children with AA, and transfusion only in 37, as conservative care. In case of those patients with HSCT, the time from diagnosis to transplantation was 12 months (1~144 months) and the sources of stem cells were bone marrow in 82 cases, growth factor mobilized peripheral blood in five, and cord blood in six. There were 57 patients transfused below 40 units of blood products before HSC transplantation. Graft rejection was identified from 16 patients, and booster transplantations were done for 12 patients among them. In complications of HSCT, the graft versus host disease was developed in 20 patients and viral diseases in 12 cases including the CMV, herpetic infection, and hepatitis. Also, one patient suffered from veno-occlusive disease. The overall survival rate in children with AA is 64.3%. The survival rate in HSCT is better than that IST (76.9% vs. 62.6%, P< 0.05). In IST, overall survival rate in very SAA showed lower than SAA and NSAA, and in SAA lower than NSAA in case of absolute neutrophil count below 200/microL (P< 0.05). There was no significant difference in terms of the sex, age at beginning of treatment. In HSCT, transfusion was not related to the survival rate. However, overall survival rate is better in short interval between diagnosis and HSCT than in long interval (P< 0.05). There was no significant difference in the probability of transfusion independence according to treatment strategies, even though it was 71.0% in HSCT and 12.8% in immunosuppressive therapy at the end point of survey (P=0.47). The response pattern was as follows. There were 155 cases of complete response, 110 of partial response and 120 of no response in spite of various treatments. The relapse after treatment was found in 11 patients after IST, of which 6 patients experienced more than 2nd relapse. The median time between the end of treatment and relapse was 16 months (6~84 months). Only three cases developed into other diseases (1 case into acute myeloid leukemia and 2 cases into myelodysplastic syndrome). The median time from diagnosis to the end of treatment was 62 months (0.5~174 months). In fatal cases, the median time between diagnosis and death was 29 months (0~144 months) despite several therapeutic strategies. CONCLUSION: In Korea, the annual incidence of children with AA is 4.5 per million. This result is similar to the ones reported in other Asian countries, but higher than those in Western countries. Although a lot of children with AA received various therapies including IST or HSCT, new treatment strategies have to be developed to improve the survival rate and the quality of life of children with AA
Adrenal Cortex Hormones ; Allergy and Immunology ; Anemia, Aplastic* ; Antilymphocyte Serum ; Asian Continental Ancestry Group ; Bone Marrow ; Bone Marrow Examination ; Child* ; Cyclosporine ; Diagnosis ; Epidemiology* ; Female ; Fetal Blood ; Graft Rejection ; Graft vs Host Disease ; Hematopoiesis ; Hematopoietic Stem Cell Transplantation ; Hepatitis ; Humans ; Incidence ; Korea* ; Leukemia, Myeloid, Acute ; Leukocytes ; Male ; Neutrophils ; Quality of Life ; Surveys and Questionnaires ; Recurrence ; Reticulocytes ; Retrospective Studies* ; Statistics as Topic ; Stem Cells ; Steroids ; Survival Rate ; Virus Diseases

PURPOSE: Acute lymphoblastic leukemia (ALL) accounts for approximately 75% of all cases of childhood leukemia. We investigated epidemiology, clinical and laboratory features and treatment outcome of the children with ALL in Korea during recent 5 years. METHODS: One thousand forty nine patients were enrolled between January 1994 and December 1998 from 37 major hospitals in Korea. The data regarding the clinical and laboratory features including age, WBC counts at diagnosis, immunophenotype, morphology, cytogenetics and treatment outcome of patients were analyzed retrospectively by review of patient's medical records. Kaplan-Meier survival curves were constructed. The differences between groups analyzed by log-rank test. RESULTS: There were 597 males and 452 females. The distribution between the age 2 and 5 years is most common in 46.1%. The annual incidence rate per 100,000 population varied from 1.6 to 2.2. The 5 year event free survival (EFS) rates according to good prognostic factors were as follows: 67% bet ween 1-9 year of age at diagnosis, 69% in under 10,000/mm3of initial WBC count, 74% in early pre-B cell CALLA ( ) immunophenotype, 65% in L3 morphology, 68% in no CNS invasion. Most of patients were treated by CCG treatment protocol. The 5 year EFS was 63%. Main complications were sepsis (21.8%) and hemorrhage (12.5%). The relapse rate was 15.6%. The common causes of death were sepsis, DIC, pneumonia, relapse. CONCLUSION: Our results could provide the most recent and important information about acute lymphoblastic leukemia of children in Korea.
Cause of Death ; Child ; Clinical Protocols ; Cytogenetics ; Dacarbazine ; Diagnosis ; Disease-Free Survival ; Epidemiology* ; Female ; Hemorrhage ; Humans ; Incidence ; Kaplan-Meier Estimate ; Korea* ; Leukemia ; Male ; Medical Records ; Pneumonia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Precursor Cells, B-Lymphoid ; Recurrence ; Retrospective Studies ; Sepsis ; Treatment Outcome

PURPOSE: To analyze the improvement in the patient self-evaluation for shoulder function and range of motion after arthroscopic subacromial decompression for shoulder impingement syndrome. Materials and Method: We performed a study of 21 patients out of 45 patients who could be assessed preoperatively and at 6 weeks and 3, 6, 9 and 12 months, using the standardized method of Research Committee of American Shoulder & Elbow Surgeons. We used two-sample unequal variance student t-test and Mann-Whitney U test to compare the initial findings. RESULTS: Nineteen patients were satisfied subjectively at 12 months after operation. Pain improvement was significant at 6 weeks. The total score of patient self-evaluation, put on a coat and manage using the toilet improved at 3 months, while sleep on painful side, wash back, comb hair, reach a high shelf and lift 5 kg above the shoulder improved at 6 months. Throwing a ball overhead improved at 9 months. The gain in range of motion was not noticeable except for internal rotation, which improved from T11 to T8. CONCLUSION: We found an arthroscopic subacromial decompression to be an effective method for treating impingement syndrome of the shoulder. Functional recovery could improve during a prolonged period despite of early relief of pain.
Animals ; Comb and Wattles ; Decompression* ; Diagnostic Self Evaluation ; Elbow ; Follow-Up Studies* ; Hair ; Humans ; Range of Motion, Articular ; Shoulder Impingement Syndrome* ; Shoulder*

PURPOSE: The purpose of this study was to measure the strains of normal and lax anterior cruciate ligament (ACL) under serial loading using specially designed ACL strain analyzer (ASA) during arthroscopic examination. MATERIALS AND METHODS: The study is based on sixty-eight patients. Before the arthroscopic examination, all cases were divided into three groups according to their laxity based on Lachman test, KT2000 arthrometer, and magnetic resonance imaging. During arthroscopic examination, the ASA was connected with ACL using anteromedial portal with the knee flexed in 90. Under serial loading to ACL, the strains were illustrated and calculated. RESULTS: A statistically significant differences had been shown in strains between normal and lax ACL. Using ANOVA test, the ASA results according to preoperatively divided groups showed no significant differences between all groups and each loads. CONCLUSION: We had designed newly diagnostic method for estimate of ACL laxity, and measured the strains of lax ACL compared with normal ACL. This diagnostic method will be helpful to establish treatment plan for injuried ACL during arthroscopic examination.
Anterior Cruciate Ligament* ; Humans ; Knee ; Magnetic Resonance Imaging