Intra-articular Calcaneal Fractures Treated with Open Reduction and Internal Fixation: A Comparative Study between Groups with and without Bone Graft

PURPOSE: This study compares the clinical results of open reduction and internal fixation with and without bone graft for the treatment of intra-articular calcaneal fractures. MATERIALS AND METHODS: Twenty-five patients who had open reduction and internal fixation for intra-articular calcaneal fractures and available for at least 1 year of follow-up were included in this study. Fifteen cases were operated with bone graft. Period to bone union and functional evaluation score were compared between both groups with analysis of complications. RESULTS: Bone union was achieved in all cases with average bone union time of 11.6 weeks and 12.8 weeks in group with and without bone graft respectively. Creighton-Nebraska Health Foundation (CNHF) functional score was 86.5 points and 80.3 points respectively. The period to bone union and the CNHF score in the comparison of two groups were statistically insignificant. Complications were observed in four cases of group without bone graft and 5 cases of group with bone graft. CONCLUSION: This study indicates that bone graft does not play a significant role in bone union and functional outcome when intra-articular calcaneal fractures are treated with open reduction and internal fixation.

Limited Open Reduction and Intramedullary Nailing of Proximal Femoral Shaft Fracture

PURPOSE: To evaluate the result of treatment of proximal femoral shaft fracture with limited open reduction and intramedullary nailing. MATERIALS AND METHODS: Fifteen patients who had limited open reduction and intramedullary nailing due to proximal femoral shaft fracture for follow-up for more than 12 months were selected between March 2001 and December 2005. The clinical and radiologic results were analyzed. Winquist-Hansen classification and OTA/AO classification were used. RESULTS: Thirteen cases achieved bone union and 2 cases showed delayed union. The mean bone union period was 21.3 weeks (14~32). There was no postoperative infection. Nonunion was observed in 2 cases of which bone union was acquired with the exchange of intramedullary nail and bone graft in one case and with the additional plate fixation and bone graft in the other case. CONCLUSION: Treating proximal femoral shaft fracture with limited open reduction and intramedullary nailing seems to be a technique to manage proximal femoral shaft fracture that has combined fracture or ipsilateral femoral fracture or is unable to acquire acceptable reduction with closed reduction.

A Case of Recurrent Paragonimiasis

Pulmonary paragonimiasis is a food-borne zoonosis, which is acquired from eating the raw or undercooked freshwater crabs or crayfish (crustaceans). It was highly endemic in Korea the late 1960's. However, human paragonimiasis is still sporadically occuring because of pupularization of Korean traditional crab dishes and is one of the lung disease which needs differential diagnosis. Recently, we experienced a case of pulmonary paragonimiasis in a 55 years man with dyspnea, dry cough and abdominal pain. The patient had hypereosinophilia and pulmonary infiltrates with pleural effusion, which did not improve on antibiotics. Diagnosis was confirmed by sputum with Paragonimus westermani ova, which was treated with praziquantel for two days at a daily dosage of 75 mg/kg. The patient was readmitted to the hospital 1 month following first treatment with recurrence of symptoms and he was cured by a second course of praziquantel.

The Effects of p21 on Bladder Cancers / 대한비뇨기과학회지

Purpose: p21 protein is an inhibitor of cyclin-dependent kinases, which may be able to arrest the cell cycle at the G1 phase by inhibiting DNA replication through the interaction with proliferating cell nuclear antigen. From experimental studies, p21 has been considered a tumor suppressor gene. Herein, the effects of p21 on the development, stage, grade, recurrence, progression and patient's survival in human bladder cancers were evaluated. Materials and Methods: The mRNA expression levels of p21 were examined in 149 tumor specimens obtained from patients with primary bladder cancer and in 18 normal bladder mucosae using real-time polymerase chain reaction (PCR). Results: p21 was significantly expressed in human bladder tumor tissues at high levels (7.11+/-0.69pg/ml), but was not expressed in the normal bladder mucosae. Compared with invasive bladder cancer (5.03+/-0.95), the p21 expression levels were significantly enhanced in superficial bladder cancer (7.96+/-0.88pg/ml) (p=0.0250); whereas, the grade was not related to the expression of p21. The levels of p21 expression were enhanced in non-recurred (9.33+/-1.38) and non-progressed (8.13+/-0.86) compared with recurred (6.03+/-0.75) and progressed (3.67+/-0.52) patients (each p<0.05). The level of p21 expression was significantly correlated with the disease free survival in patients the bladder cancers. Conclusions: The enhanced expression of p21 is strongly associated with the development of bladder cancer. Moreover, increased expressions of p21 are also positively associated with the low rate of recurrence and progression of bladder cancer. Conversely, an enhanced expression of p21 provides a survival benefit for patients with bladder cancer. These results suggest that p21 might be useful as a marker in assessing tumor diagnosis, recurrence, progression and the survival in human bladder cancer patients.

Transluminal Removal of a Fractured and Embolized Indwelling Central Venous Catheter in the Pulmonary Artery

Vascular catheters are associated with complications such as infection, thrombosis and stenosis. The embolization of a venous catheter fragment is a rare complication. A 39-year-old woman underwent placement of a totally implantable venous access device for chemotherapy to treat a recurrent liposarcoma of the left thigh. The "pinch-off sign" was noted on a routine chest X-ray but that was ignored. Three-months after implantation of the intravenous access device, the indwelling central catheter was fractured and embolized to the pulmonary trunk. The catheter in the pulmonary trunk was successfully removed through a percutaneous femoral vein approach using a pigtail catheter and goose neck snare.

Rapid Detection of Mycoplasma pneumoniae and Antimicrobial Susceptibilities of the M. pneumoniae Isolates

The throat swabs obtained from 1,098 adults and 432 children patients with respiratory diseases were examined for Mycoplasma pneumoniae infection detected by culture and polymerase chain reaction (PCR). Antimicrobial susceptibilities of the resulting 60 M. pneumoniae isolates were evaluated by testing minimum inhibitory concentrations (MICs) of erythromycin, minocycline, tetracycline, josamycin, sparfloxacin, ofloxacin, and ciprofloxacin by a broth micro-dilution method. In a preliminary screening, the detection rate of M. pneumoniae by PCR was 29.2% (277/948) for the adults and 28.3% (90/318) for the children. In the second survey, the isolation rate of M. pneumoniae by culture was 29.3% (44/150) for the adults, and 14.0% (16/114) for the children. The PCR detection rate was 36.7% (55/150) for the adults and 23.7% (27/114) for the children. The MIC90s of the M. pneumoniae isolates were 0.015 mg/ml for erythromycin, lower than 0.03 mg/ml for josamycin, 0.06 mg/ml for sparfloxacin and minocycline, 0.12 mg/ml for tetracycline, 0.5 mg/ml for ofloxacin and CFC-222, and 1.0 mg/ml for ciprofloxacin. The isolates were susceptible to erythromycin, josamycin, sparfloxacin, minocycline, tetracycline, and ofloxacin, but the 63.3% of them was resistant to ciprofloxacin. These results indicate that the PCR method has a significant potential as a rapid and sensitive method for early detection of M. pneumoniae infection in clinical specimens as compared with the culture method, but the PCR method could not provide any information concerning the biological chracteristics of M. pneumoniae strains. Erythromycin, josamycin, sparfloxacin, minocycline, and tetracycline could be recommended as the antimicrobial agents of choice in Korea.