Fixation Methods for Implantable Port Chamber: Comparative Study Using Glue, Self-stabilizing Leg and Suture Fixations in Rabbits

OBJECTIVE: To evaluate the fixation strength and tissue reaction of the glue fixation and self-stabilizing leg fixation methods and to compare the results with those of the conventional tagging suture fixation method. MATER AND METHODS: Twelve healthy rabbits were selected and three different methods of implanting the port chamber were employed on the back of each rabbit. A total of thirty six port chambers were implanted with these three different methods, viz. the glue fixation method using tissue adhesive, the self-stabilizing leg method using a self-expandable stabilizing leg, and the suture fixation method. The fixation strength and the gross and histopathologic changes of each fixation method were evaluated at three days, one week, two weeks and four weeks after port implantation. RESULTS: The glue fixation method showed a good fixation strength, which was similar to that of the tagging suture method (p=0.3486). Five of the six ports (83%) implanted with the glue fixation method which were examined after two weeks showed cracks on the external surface, but this had no adverse effects on their function. A large amount of granulation tissue reaction was found at the bottom of the chamber (p=0.0025). The fixation with the self-stabilizing leg showed relatively lower fixation strength (p=0.0043), but no turning-over of the chamber occurred. The fixation strength improved with time after the first week, and minimal granulation tissue reaction was observed with this method. CONCLUSION: The glue fixation method exhibited equal fixation strength compared to the suture fixation, but showed cracking and a large amount of granulation tissue, whereas the fixation with a self-stabilizing leg showed weaker fixation strength.

Diverse VacA Allelic Types of Helicobacter pylori in Korea and Clinical Correlation

Helicobacter pylori has a diversity of vacA allelic types. The purpose of this study was to correlate the vacA status and the clinical outcome. After constructing specific primers for the vacA signal sequence, H. pylori-positive antral biopsy specimens were examined for the vacA status in 25 gastric ulcers, 31 duodenal ulcers, 22 gastric cancers, 42 chronic gastritis, and 8 gastroduodenal ulcers. The relationship between the vacA allele and the clinical disease was examined. The vacA genotype s1c/m1 is predominant in Korea (71/128, 55.5%). Other strains including s1b or s2 were not found in this study. s1c/m1 was more prominent in duodenal ulcers, than in gastric ulcers (p=0.041) and cancer (p=0.029). Seven out of 8 patients with gastric and coexistent duodenal ulcers had the s1c/m1 allele. No statistical differences in the positive rates of the s1a/m1, s1a/m2, and s1c/m2 alleles among the disease groups were found. In conclusion, s1c/m1 is the main vacA allele in Korea and it is particularly associated with duodenal ulcers.

Effects of ageing and arthritic disease on nitric oxide production by human articular chondrocytes

Nitric oxide (NO) has been considered as an important mediator in inflammatory phases and in loss of cartilage. In inflammatory arthritis, NO levels are correlated with disease activity and articular cartilage is able to produce large amounts of NO with the appropriate inducing factor such as cytokines. The old animals are shown to have a greater sensitivity to NO than young animals. This study evaluated the basal production of NO in normal and OA-affected chondroyctes from young and old patients and compared the levels of NO formation in response to IL-1beta. The results showed that the basal levels were 7-fold higher in old chondrocytes than those of young cells. However, the IL-1beta induced NO production was seen to decrease with age. Aminoguianidine (AG), a competitive inhibitor of iNOS, inhibited NO formation completely in both chondrocytes from young and old individuals. However, at the same concentration of AG it caused partial inhibition of NO and iNOS formation in chondrocytes from OA-affected individuals. In addition, although the IL-1beta induced NO production was much lesser than that of young chondrocytes, the inhibition of collagen production by IL-1beta was prominent in old chondrocytes and OA-affected chondrocytes. These results suggest that age-related differences in the regulation of NO production and collagen production, which may affect the ageing cells and osteoarthritic changes in some way.

Effects of ageing and arthritic disease on nitric oxide production by human articular chondrocytes

Nitric oxide (NO) has been considered as an important mediator in inflammatory phases and in loss of cartilage. In inflammatory arthritis, NO levels are correlated with disease activity and articular cartilage is able to produce large amounts of NO with the appropriate inducing factor such as cytokines. The old animals are shown to have a greater sensitivity to NO than young animals. This study evaluated the basal production of NO in normal and OA-affected chondroyctes from young and old patients and compared the levels of NO formation in response to IL-1beta. The results showed that the basal levels were 7-fold higher in old chondrocytes than those of young cells. However, the IL-1beta induced NO production was seen to decrease with age. Aminoguianidine (AG), a competitive inhibitor of iNOS, inhibited NO formation completely in both chondrocytes from young and old individuals. However, at the same concentration of AG it caused partial inhibition of NO and iNOS formation in chondrocytes from OA-affected individuals. In addition, although the IL-1beta induced NO production was much lesser than that of young chondrocytes, the inhibition of collagen production by IL-1beta was prominent in old chondrocytes and OA-affected chondrocytes. These results suggest that age-related differences in the regulation of NO production and collagen production, which may affect the ageing cells and osteoarthritic changes in some way.

Vesicoureteral Reflux in Children: Comparison of Contrast - Enhanced Voiding Ultrasonography with Radiographic Voiding Cystourethrography: Preliminary Report

PURPOSE: To compare the usefulness of contrast-enhanced voiding ultrasonography(US) with that of radiographic voiding cystourethrography(VCUG) for the diagnosis of vesicoureteral reflux(VUR) in children. MATERIALS AND METHODS: Ninety-five kidney-ureter units of 47 patients referred for investigation of VUR underwent contrast-enhanced voiding US followed by radiographic VCUG. After baseline US examination of the urinary tract, residual urine in the bladder was drained through an inserted Foley catheter and the bladder was gravity filled at a height of 1 m with normal saline. A galactose-based, microbubble-containing echo-enhancing agent (Levovist; Schering, Berlin, Germany) was then administered. The amount of this was approximately 10% of bladder capacity, and VUR was diagnosed when microbubbles appeared in the ureter or pelvo-calyceal system. Using radiographic VCUG as a reference point, the accuracy with which contrast-enhanced voiding US detected VUR was calculated. RESULTS: In 87 of 95 kidney-ureter units (91.6%), the two methods showed similar results regarding the diagnosis or exclusion of VUR, which was detected by both in 12 units, but by neither in 75. VUR was shown to occur in a total of 20 units, but in eight of these by one method only. In two units, VUR detected by contrast-enhanced voiding US was not demonstrated by radiographic VCUG; in six units, the reverse was true. In the detection of VUR, contrast-enhanced voiding US showed a sensitivity of 66.7%, a specificity of 97.4%, a positive predictive value of 85.7%, and a negative predictive value of 92.6%. CONCLUSION: Contrast-enhanced voiding US is highly specific and has high positive and negative predictive values; its sensitivity, however, is not sufficiently high. The modality appears to be a useful diagnostic tool for the detection of VUR without exposure to ionizing radiation, though to be certain of its value, more experience of its use is first required.

Subpopulation of Rabbit Articular Chondrocytes Separated by Percoll Density Gradient / 대한정형외과연구학회지

Articular chondrocytes have been known to have heterogeneity in articular cartilage. Four layers are generally recognized from the articular surface to the subchondral bone. We have used Percoll density gradients to separate chondrocytes from articular cartilage into distinct subpopulations. Non-fibrillated articular cartilage was obtained from rabbit knee. The cells were carefully layered on the top of the preformed gradient and spun. After centrifugation, we obtained four fractions: Fraction A referred boundary between 0% and 10%, fraction B from between 10% and 20%, fraction C from between 20% and 30%, and fraction D from between 40% and 50%. In the A fraction, cells are relatively larger and round in shape, while their nuclei are relatively smaller. In the cytoplasm many lipid droplets were found and rough endoplasmic reticulum were disrupted. In the D fraction, chondrocyte is small, with large nucleus which surrounded by well-developed rough endoplasmic reticulum. The type II collagen proteins were expressed strongly and more proteoglycans synthesized in fractions A and B. And chondrocytes from the fraction D divided more slowly than those from the fractions A, B, and C. We have succeeded in separating chondrocytes from articular cartilage into distinct subpopulations by Percoll density gradients, as well as characterized growth rate, histological appearances and phenotypic expression. This study is the first report about the Percoll density gradients to separate articular chondrocytes.

Recent Trends of Radiological Reduction of Intussusception in Children: A Nationwide Phone Survey to Training Hospitals in Korea

PURPOSE: To assess the prevalence of various radiological reduction methods for childhood intussusception in training hospitals by means of a nationwide phone survey, and to demonstrate recent trends in this area by comparing the findings with those obtained in a survey conducted six years earlier. MATERIALS AND METHODS: Forty-seven radiologists and 36 residents in 83 (university, 54; general, 29) of 91 nationwide training hospitals were asked by telephone 1) to identify their currently used radiological reduction method, and to state 2) whether sedation was used for patient preparation, 3) how many times they had experienced bowel perforation during the previous six years, 4) whether ultrasonography was used for diagnostic purposes and 5) the grade of resident involved in night duty. The results were compared with those obtained during a 1993 survey of training hospitals in Seoul. RESULTS: 1) Air and barium reduction were used with equal frequency (40%, 33/83). Gastrografin reduction was used in six, hospitals (7%) barium reduction and ultrasonography-guided hydrostatic reduction in five (6%), and ultrasonography-guided hydrostatic reduction in four (5%), while in two (2%), air and barium reduction were used to an equal extext. Compared with the results of the 1993 survey, the use of barium reduction had decreased from 62 to 40%, though the use of air reduction showed an increase, from 5 to 40%. The frequency with which other methods were used showed no significant change. 2) In 82% of cases (68/83), patients were not sedated during preparation; the 1993 figure of 87% was thus not significantly different. 3) With regard to the incidence of perforation during the last six years, between one and three cases had been encountered at each of 30 hospitals. Air reduction was used at 17 of these (57%), and barium reduction at ten (33%). At each of five hospitals at which 3 -5 cases had occurred, air reduction had been used in all cases. 4) Ultrasonography was employed for the diagnosis of intussusception at 78/83 hospitals (94%); among these 83, this mode was always employed at 26 (31%). 5) At the majority of hospitals (42%), night duty residents were grade two, while grade one were employed at 30%, grade three at 23%, and grade four at 5%. CONCLUSION: For radiological reduction air and barium are currently used with equal frequency at training hospitals in Korea. Compared with 1993, air reduction is being used more but barium reduction less.

Behavioral and Emotional Problems for the Patient with Duchenne Muscular Dystrophy

OBJECTIVE: To identify psychological disturbance occurring in Duchenne Muscular Dystrophy (DMD) children. METHOD: Fifty one DMD children aged from 5 up to 14 years and 51 age matched healthy children were evaluated. Korean child behavioral cheak list (K-CBCL) was used to evaluate psychological problems in DMD and healthy control children. Korean Wechsler Intelligence Scale for children were performed in DMD children to evaluate cognitive function. To evaluate children's functional level, Brooke's scale for upper extremities and Vignos' scale for lower extremities were used. A correlational analysis was performed between age and total IQ score and K-CBCL subscales. RESULTS: K-CBCL profiles of the DMD children and control group revealed that DMD children obtained significantly lower scores on social, school, total social competence scales (P<0.01) and significantly higher scores on withdrawn, somatic complaints, anxious/depressed, immaturity, attention problems, internalizing problem, total behavior problems and emotional ability (P<0.01). Correlations of the age and functional level of the DMD group with each social scale of the CBCL resulted in significant negative relationship on social, school, and total social competence scales (P<0.01) and significant positive relationship on withdrawn, somatic complaints, anxious/depressed, immaturity, internalizing problems and total behavior problems (P<0.01). Correlational analysis of IQ score of the DMD group and each scale of the CBCL revealed no significant relationships except school (P<0.05) and total behavioral problem (P<0.05). CONCLUSION: We concluded that DMD children suffer from wide spectrum of psychological disturbance such as somatic complaints, attention and emotional problems in addition to expected psychological problems due to chronic disease and its progression. Thus, for the successful rehabilitation, these various emotional disturbances need proper treatment.

Interstitial Laser Photocoagulation with Diode Laser Unit in Bovine Liver

PURPOSE: To evaluate the extent of tissue coagulation during interstitial laser photocoagulation (ILP) innormal bovine liver, using a diode laser unit and various parameters, and to determine whether the procedure isapplicable to clinical practice.. MATERIALS AND METHODS: Using an 18-gauge needle, experimental interstitiallaser photocoagulation (ILP) was carried out in normal bovine liver. On the basis of differing parameters, threegroups were established. For group I, a single photofiber with laser power of 1, 3 and 5 watts and an exposuretime of 60, 180, 300, 420 or 600 seconds was used. For groups II and III, four needles were fixed at a distance of1cm and 1.5cm ; in each case a needle fixation device was used, as well as a laser distributor for simultaneouslaser exposure of photofibers. As a control, four photofibers were placed as for groupIII, but to compare groups IIand III, each photofiber was exposed to a laser of 3 watts 300 seconds, without using a laser distributor. Toevaluate the range of tissue coagulation, specimens were analyzed both with regard to cross-sectional grossfindings and histopathologically . RESULTS: The largest diameter of thermal coagulation necrosis in Group I was15x15mm, and this was ball-shaped. Coalescence of coagulation between each photofiber was observed in Group II,and this was up to 25 mm in diameter. In Group III and controls, coalescence was not found, though the extent oftissue coagulation increased with increasing wattage and exposure time. The extent of charring at the center ofcoagulation also increased with increasing wattage. Smoke bubbles emanating from the coagulation area wereobserved, and during ILP involving a single photofiber, increased from 3 watts, applied for 300 seconds.CONCLUSION: Using an 8-gauge needle and a diode laser ILP, we have shown that a range of tissue coagulationacutely ablates normal bovine liver. In selective cases, the procedure could be applied to clinical trials.

Evaluation of Chronic Patellar Tendinitis by Utrasonography and MR Imaging

PURPOSE: To evaluate the usefulness of magnetic resonance imaging(MRI) and ultrasonography(US) for thediagnosis of jumper's knee in high school basketball players. MATERIALS AND METHODS: In order to detect clinicalcases of jumper's knee, 40 sites of patellar tendon in 20 knees of ten basketball players were assessed by anevaluation of personal history and physical examination. US and MRI were used for detecting compatible findings ofthis condition ; the diagnostic criteria were hypoechoic focus with focal thickening as seen on US, and increasedsignal intensity with focal thickening as seen on MRI. As an early finding of jumper's knee a new sonographiccriterion of focal hypoechoic focus with or without focal thickening, was also applied. RESULTS: At 19 of 40sites(48%), clinical jumper's knee was diagnosed. For the detection of this condition according to known cliteria,sensitivity and specificity were, respectively, 63% and 100%(US) and 32% and 90%(MRI). Using the new criterion,the sensitivity and specificity of US were 84% and 76%, respectively. CONCLUSION: On the basis of known US andMRI criteria for jumper's knee, the sensitivity and specificity of US were higher than those of MRI. We suggestthat hypoechoic focus without focal thickening oas seen on US, is an early finding of jumper's knee.

Intra-arterial Port Implantation for Intraarterial Chemoinfusion

PURPOSE: To evaluate, using various port systems, the technique and complications of intra-arterial portimplantation in visceral (mainly hepatic) arteries for intra-arterial chemoinfusion. MATERIALS AND METHODS: Weretrospectively evaluated 30 cases of intra-arterial port implantation in 29 patients. Angiography was performedin all cases, and insertion of an implantable polyurethane port catheter was followed by angiographic exchangewhich, utilizing a .035" hydrophilic guide wire, targeted the artery. If a change in the direction of flow wasrequired, arterial flow control was performed, using an enbolie coil. In order to insert the subcutaneous portchamber, an incision approximately 4cm long was made at the puncture site and subcutaneous tissue was dissected.The port chamber was inserted into the subcutaneous pocket and fixed with a black-silk tagging suture. When thefemoral artery was punctured, the port chamber was inserted into the supra-or infrainguinal area; when the leftsubclavian artery was used, the port chamber was inserted into the lateral one third of the left clavicle. Theport systems used in the procedure were as follows : 5.8F Port-A-Cath (SIMS, Deltec, U.S.A.)(n=20) ; 5.2F A-Port(Therex, U.S.A.)(N=5); 5F PU-Anthron(Deny, Japan)(n=4) ; 5.2F R-Port(Therex, U.S.A.)(n=1). The subcutaneouschambers were inserted into the infrainguinal (n=22), suprainguinal (n=6) or subclavian area(n=2). RESULTS: Theprocedure was technically successful in all 30 cases. Port catheter tips were located in the hepatic arteryproper(n=11), the right hepatic(n=9), gastroduodenal (n=6), common hepatic (n=2), inferior mesenteric (n=1) andinternal iliac artery(n=1). In 12 cases, flow was controlled using embolic coils. Follow-up study was performed in23 cases, with a mean follow up period of 55.8 (11-161) days. Complications were noted in four cases ; two wereprocedure related and two were catheter related. CONCLUSION: Intra-arterial port implantation is a safe procedureand can be performed easily by skilled radiologists; long-term observation is, however, still needed.

A Case of Recurrent Fetal Cystic Hygroma with Polycystic Kidney / 대한산부인과학회잡지

This is a case report of a cystic hygroma with polycystic kidney in a fetus which was suspected by ultrasonography and was confirmed by autopsy. Recently, we have experienced this case in 25-year old woman repeatedly and we report that with a brief review of relevant literature.

Direct Electrothrombosis of a Pseudoaneurysm after Obliteration of a Carotid Cavernous Fistula:Treatment with Guglielmi Detachable Coils: Case Report

Carotid-cavernous fistulaes are traumatic in origin in over two thirds of all cases. Occlusion of these lesions by endovascular techniques or open surgical approaches is usually indicated. The current treatment of choice is occlusion by use of the intraarterial detachable balloon technique. Pseudoaneurysm, one of the complications after employment of the detachable balloon technique, develop at the balloon placement site after balloon deflation. Its incidence is approximately 44% in the literature. But peudoaneurysms are difficult to treat using endovascular techniques with detachable balloon or coils. The authors report that one case with a pseudoaneurysm who had abducens nerve palsy was treated successfully using Guglielmi detachable coils(GDC). His 6th cranial nerve palsy was improved within 6 weeks.

Etiologic studies in amenorrhea / 대한산부인과학회잡지

No abstract available.