ABSTRACT
Purpose: To analyze the clinical and radiological results of Huckstep nailing in the treatment of acute femoral fractures and femoral nonunion, and to report the easy and non-fluoroscopic technique of targeting the locking screw holes by making double cortical windows. Materials and Methods: This study examined a total of fifteen femoral fractures treated with Huckstep nailing between January 1999 and January 2004. The fractures included six acute fractures (five closed and one open) and nine nonunions (four infective and five aseptic). The reoperative status, number of interventions, time to union and complications were analyzed. Ten male and 5 female patients with an average age of 42 years (range, 18-70) were followed up for a mean of 26 months (range, 16 months to 6.4 years). A new method of double cortical windows for targeting the screw holes were performed in seven cases without fluoroscopic aid. Results: Radiographic union was achieved after a mean of 15.3 weeks in those with an acute fracture and after a mean of 24.6 weeks in those with nonunion. One open fracture was fixed initially using a monofixator followed by Huckstep nail 4 weeks later when the open wound had healed. A bone graft was performed in two cases of nonunion, and Hydroxyapatite/Tricalcium phosphate granules were grafted in three cases of nonunion. Partial knee ankylosis resulted in 6 cases of nonunion at the final follow-up because the nonunion cases had undergone an average of 4.3 surgical procedures at other hospitals over an average of 11.8 months before performing Huckstep nailing. One acute case without proximal screw fixation resulted in dynamization and femoral shortening of 2 cm. Conclusion: Huckstep nailing provides stable fixation sufficient to enable early knee motion and weight bearing until the fracture heals in both acute fracture and nonunion. The new method of double cortical windows allows the easy targeting of screw holes without fluoroscopic aid.
Subject(s)
Female , Humans , Male , Ankylosis , Femoral Fractures , Femur , Follow-Up Studies , Fractures, Open , Knee , Transplants , Weight-Bearing , Wounds and InjuriesABSTRACT
PURPOSE: To evaluate the results and effectiveness of laminoplasty in which autogenous spinous process grafts were used for the treatment of cervical spondylotic radiculomyelopathy. MATERIALS AND METHODS: Sixteen patients with cervical spondylotic radiculomyelopathy were treated by laminoplasty from October 2001 to June 2004. The average follow-up period was 28 months (range, 14-47 months), the average age of the patients was 58 years old (range, 33-74 years old), and there were 14 men and 2 women. The operative procedure was a modified Itoh's laminoplasty with and H-beam shaped strut bone graft, which was harvested by sacrificing the spinous process. The results of the operative procedure were evaluated with a Pavlov ratio in a radiologic study and the JOA score and recovery rate by Hirabayashi in the clinical study. RESULTS: At the final follow-up, the average JOA score increased from 7.8 to 13.2. The recovery rate was 58.7%. The Pavlov ratio improved from 0.58 to 0.93 post-operatively and to 0.92 at the final follow-up. The brace was removed at an average of 6 weeks and there was no change in the Pavlov ratio until union. There was neither evidence of instability in flexion and extension of the cervical spine nor neurologic aggravation and complications. CONCLUSION: Laminoplasty using an autogenous spinous process in patients with cervical spondylotic radiculomyelopathy produced stability and could produce sufficient decompression. The advantages of an autogenous spinous process graft are: an early return to normal activity by shortening the period of the need for a brace, and no extra-cost and complications with the autogenous iliac graft, allograft, heterograft, or hydroxyapatite spacer. It can be considered as the optimal surgical procedure due to providing complete union at the last follow-up and no complications in the radiologic and clinical studies.
Subject(s)
Female , Humans , Male , Middle Aged , Allografts , Braces , Decompression , Durapatite , Follow-Up Studies , Heterografts , Spine , Surgical Procedures, Operative , TransplantsABSTRACT
PURPOSE: This prospective study conducted to estimate mortality and activity of hip fracture among persons over 50 years of age, in Jeju island, Korea during the year 2002. MATERIALS AND METHODS: One hundred forty-nine patients among 150 patients over 50 years of age who lived in Jeju island and sustained a femoral neck or intertrochanteric fracture during the year 2002 were followed-up for average 2 years. Standardized annual mortality ratio was calculated and comparison was made between hip fracture patients and general population in Jeju island. RESULTS: One hundred forty-nine patient were followed-up (35 in men, 114 in women). The mean age of patients was 77.4 years (range 50-98 years). Mortality at 2 years (range, 1.6-2.6 years) was 28.2% (42 patients), mortality at 1 year was 16.8% (25 patients) and mortality at 6 months was 12.1% (18 patients). Patients who were classified as poor (Halpin grade III and IV) increased in number from preoperative 11 patients to postoperative 37 patients. CONCLUSION: Considering 28.2% of high mortality and 25.2% of poor activity who can not do outside activity at average 2 year follow up, the hip fracture is life threatening risk factor of elderly. Prevention falling and hip fracture risk is needed.
Subject(s)
Aged , Humans , Male , Femur Neck , Follow-Up Studies , Hip , Korea , Mortality , Prospective Studies , Risk FactorsABSTRACT
BACKGROUND AND OBJECTIVES: It has been suggested that inactivation of the cadherin-mediated cell to cell adhesion system plays a role in the initial steps of cancer invasion and metastasis. We investigated the relationship between the expressions of E-cadherin and beta-catenin to the clinicopathologic findings in squamous cell carcinoma of the tongue. MATERIALS AND METHOD: The expression of the E-cadherin and beta-catenin was examined immunohistochemically in 39 squamous cell carcinomas of the tongue and 5 cases of normal tissue. RESULTS: The expression of the E-cadherin and beta-catenin was reduced or absent in 15/39 (39%), 20/39 (51%) cases of the tumors examined, respectively. The reduced expression of the E-cadherin was associated with decreased histologic differentiation (p=0.001) and lymph node metastasis (p=0.006) and the reduced expression of the beta-catenin with decreased histologic differentiation (p=0.001). There were significant correlation between E-cadherin and beta-catenin expression (p=0.001). CONCLUSION: The present study demonstrates a significant down-regulation of E-cadherin, and that the beta-catenin expression in squamous cell carcinoma of the tongue is specifically associated with decreased histologic differentiation and lymph node metastasis. These results suggest that E-cadherin and beta-catenin may be useful markers of lymph node metastatic potential and valuable prognostic markers in the early stage of the disease.
Subject(s)
Humans , beta Catenin , Cadherins , Carcinoma, Squamous Cell , Cell Adhesion , Down-Regulation , Lymph Nodes , Neoplasm Metastasis , TongueABSTRACT
Binswanger's disease (BD) is an illness of hypertensive elderly patients characterised clinically by disorders of memory, mood and cognition; focal motor signs; and less often, a pseudobulbar syndrome with deterioration of gait and sphincter control. The illness is usually slowly progressive. The important pathological features of BD are widespread degeneration in the deep white matter with diffuse, patchy axonal and myelin loss, and gliosis. The more diffuse lesions in the centrum semiovale have been related to myelin rarefaction that spares the U-fibers. The MRI appearance of BD is multiple confluent white matter lesions of various sizes, many of which are quite small and concentrated around the basal ganglia and periventricular areas. We report an autopsy case of Binswanger's disease associated with Alzheimer's pathology.
Subject(s)
Aged , Humans , Alzheimer Disease , Autopsy , Axons , Basal Ganglia , Cognition , Dementia, Vascular , Gait , Gliosis , Magnetic Resonance Imaging , Memory , Myelin Sheath , Pathology , Pseudobulbar PalsyABSTRACT
BACKGROUND: Memory impairment results from various neurologic disorders. Among them, the memory loss associated with stroke is called amnesic stroke. Involved regions in the amnesic stroke are medial temporal lobe, thalamus, basal forebrain, retrosplenial region, and subcortical regions. Unilateral amnesic stroke is posterior cerebral artery territory including thalamus. Isolated infarction of hippocampal region has been rarely reported because hippocampus has dual blood supply from anterior choroidal cerebral artery and posterior cerebral artery. CASE REPORT: A 61-year old male with a history of diabetes for 6 years and hypertension for 13 years, was admitted with acute memory loss occurring 6 days before admission. He could not remember the exact date, place and recent events but could remember remote events about his personal and familial affairs. Brain MRI revealed an infarction in left hippocampal region and cerebral angiography showed multiple focal stenosis and luminal irregularity on left anterior choroidal, middle cerebral, basilar and both posterior cerebral arteries. COMMENTS: We report unilateral amnesic stroke only confined to left hippocampal region with literature review.
Subject(s)
Humans , Male , Middle Aged , Amnesia , Brain , Cerebral Angiography , Cerebral Arteries , Choroid , Constriction, Pathologic , Hippocampus , Hypertension , Infarction , Magnetic Resonance Imaging , Memory Disorders , Memory , Nervous System Diseases , Phenobarbital , Posterior Cerebral Artery , Prosencephalon , Stroke , Temporal Lobe , ThalamusABSTRACT
Plasma cell Granuloma (PCG) is a form of idiopathic inflammatory pseudotumor (IPT). It is a rare entity character-ized by a nonneoplastic proliferation of inflammatory cells dominated by a polyclonal expansion of the plasma cells. This lesion has been discovered in many parts of the body including the central nervous system. We now report two cases of plasma cell granuloma involving the brain. The first case was a 42-year-old man who presented a right hemi-paresis. He had a lesion in the convexity of the left parietal region. The second case was a 58-year-old woman who was expressed confusion and a frontal-temporal headache. She had a lesion in the convexity of the left temporal region and mastoid bone. The diagnosis of PCG was confirmed by pathological and immunohistochemical studies revealing pre-dominant plasma cells in the affected tissues.