Towards Understanding Tuberculosis- Related Issues in North Korea: A Narrative Review of North Korean Literature / 결핵및호흡기질환

Background@#North Korea is one of the 30 countries with the highest tuberculosis (TB) and drug-resistant TB burdened. To understand the medical issues and research trends associated with TB in North Korea, we performed a comprehensive review of articles related to clinical and laboratory research on TB published in North Korean medical journals. @*Methods@#We reviewed all types of TB-related articles published in nine North Korean medical journals (Yebang ŭihak: Preventive medicine; Koryo ŭihak: Korea Medicine; Chosŏn ŭihak: Chosun Medicine; Naekwa: Internal Medicine; Soa, sanbuinkwa: Pediatrics, Obstetrics, and Gynecology, Surgery; Ŭihak: Medicine; Kich’o ŭihak: Basic Medicine; and Chosŏn yakhak: Chosun Pharmacy). We classified the articles according to the type and field of study and analyzed the data qualitatively to gain insights. @*Results@#We reviewed 106 articles (one- or two-page length) written in Korean, including reviews (n=43), original articles (n=52), and case reports (n=8). They were classified as follows: articles on diagnosis (n=52, 49%) and treatment (n=39, 37%). None of the studies investigated the commercialized molecular diagnosis systems such as Xpert MTB/RIF. Directly Observed Treatment, Short-course was reported as the basic treatment approach. Furthermore, six studies used Korean traditional medicines for treating TB, with one of them containing snake venom. @*Conclusion@#The articles were not sufficiently detailed. Original articles on the treatment of multi-drug resistant TB were not found, and those on latent tuberculosis infection and nontuberculous mycobacteria were limited. To understand the current medical issues associated with TB in North Korea, articles from these nine journals were not sufficient.

Factors Affecting Compliance With Weight-Bearing Restriction and the Amount of Weight-Bearing in the Elderly With Femur or Pelvic Fractures

Objective@#To determine the factors affecting the amount of weight-bearing during gait training in the elderly patients who underwent internal fixation after femur or pelvic fractures and how well they performed the weight-bearing restriction as directed by the physiatrist. @*Methods@#In this retrospective chart review study, we measured the amount of weight-bearing on the affected side in 50 patients undergoing internal fixation surgery and rehabilitation after femur or pelvic fracture using a force plate. Patients receiving non-weight-bearing or partial weight-bearing education were considered to perform weight-bearing restriction well when the amount of weight-bearing was <50 lb. Furthermore, regression analysis was performed to determine the effects of postoperative complications, age, cognitive function, and pain on weightbearing restriction. @*Results@#Variables affecting the amount of weight-bearing were age (r=0.581, p<0.001), weight-bearing education type (r=0.671, p<0.001), manual muscle strength of hip flexion on the non-affected side (r=-0.296, p=0.037), hip abduction (r=-0.326, p=0.021), knee extension (r=-0.374, p=0.007), ankle plantar flexion (r=-0.374, p=0.008), right hand grip strength (r=-0.535, p<0.001), Korean version of Mini-Mental State Examination (r=-0.496, p<0.001), Clinical Dementia Rating (r=0.308, p=0.03), and pain visual analog scale scores (r=0.318, p=0.024). The significant predictor of the amount of weight-bearing among these variables was age (β=0.448, p=0.001). The weight-bearing restriction adherence rate was significantly lower, at 22%, for patients aged ≥65 years as compared to 73% for those <65 years. @*Conclusion@#Age was a major variable affecting the amount of weight-bearing. Compliance with weight-bearing restriction was significantly lower in patients aged ≥65 years than in patients <65 years.

The evaluation of Fat Saturation Fast Spin-Echo T2WI for Patients with Acute Spinal Trauma

PURPOSE: To determine the usefulness of fat saturation fast spin-echo T2WI for patients with mild acute trauma of the spine. MATERIALS AND METHODS: Between July 1998 and June 2002, 36 patients with acute spinal trauma underwent MRI within four months of injury. One, whose clinal symptoms indicated neurological paralysis, was excluded form our study. A superconductive 1.0-T MRI scanner was used, and conventional T1W1, T2WI, and additional fat-saturation fast spin-echo T2WI were performed. Two radiologists compared conventional T2-weighted sagittal imaging and fat-saturation T2-weighted sagittal imaging in terms of the extension of increased high signal intensities in soft tissue and vertebral bodies, bone marrow signal change, disk herniation, and signal change of the disk. RESULTS: The detection rate of focal high signal intensities in soft tissue and bone marrow was significantly higher at fat-saturation fast spin-echo T2WI than at conventional T2WI. CONCLUSION: Fat-saturation fast spin-echo T2WI is useful for the evaluation of patients with mild acute spinal trauma without neurological impairment.

Aneurysm after Surgical Ligation of Patent Ductus Arteriosus: A Case Report

Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases. A rare complication occurring after its surgical treatment is the development of an aneurysm, and we report the radiologic findings in a case in which this occurred after surgical ligation.

Correlation of VEGF with contrast enhancement on dual-phase dynamic helical CT in liver tumors: preliminary study

The purpose of this preliminary study is to elucidate that vascular endothelial growth factor (VEGF) influences contrast enhancement of hepatic tumors on computed tomography (CT). Fourteen patients with hepatic tumors (11 hepatocellular carcinomas; 3 metastatic cancers) underwent a dual-phase dynamic helical CT or computed tomographic hepatic arteriography. The attenuation of each mass was determined as hyperattenuation, isoattenuation or hypoattenuation with respect to the adjacent nontumorous parenchyma. Gun-needle biopsy was done for each tumor, and paraffin sections were immunostained with anti- VEGF antibody by the avidin-biotin-peroxidase complex method. The pathologic grade was made by intensity (1 +, 2+, 3+) and area (+/-, 1 +, 2+). The tumor ranged 2.0-14.0 cm in size (mean, 5.8 cm). In arterial phase, the intensity was not correlated with the degree of enhancement (p=0.086). However, the correlation between the attenuation value of hepatic arterial phase and the area of positive tumor cells was statistically significant (p=0.002). VEGF may be the factor that enhances the hepatic mass with water-soluble iodinated contrast agent in CT.

Tuberculous Aneurysm of the Abdominal Aorta: Endovascular Repair Using Stent Grafts in Two Cases

Tuberculous aneurysm of the aorta is exceedingly rare. To date, the standard therapy for mycotic aneurysm of the abdominal aorta has been surgery involving in-situ graft placement or extra-anatomic bypass surgery followed by effective anti-tuberculous medication. Only recently has the use of a stent graft in the treat-ment of tuberculous aortic aneurysm been described in the literature. We report two cases in which a tuberculous aneurysm of the abdominal aorta was success-fully repaired using endovascular stent grafts. One case involved is a 42-year-old woman with a large suprarenal abdominal aortic aneurysm and a right psoas abscess, and the other, a 41-year-old man in whom an abdominal aortic aneurysm ruptured during surgical drainage of a psoas abscess.

Three Dimensional Spiral CT of the Tracheobronchial Tree: Determination of the Optimal Window Settings

PURPOSE: To determine optimal window settings for measuring the inner diameter of the trachea and both mainbronchi by spiral CT. MATERIALS AND METHODS: Chest PA radiography and spiral CT scanning were performed in ten healthy adult volunteers. Three dimensional images were reconstructed (minimal threshold value : -1000HU ; maximal threshold value : from -200 to -900HU, of 50HU intervals) to measure the inner diameter of the trachea and both main bronchi. The results of 3D spiral CT were compared with those of chest radiography. RESULTS: The inner diameters of the trachea, right main bronchus, left main bronchus-I (1cm below the tracheal carina) and left mainbronchus-II (2cm below the tracheal carina) measured by chest radiograph and 3D spiral CT were not significantly different at maximal threshold values of -400 ~ -550HU, -450 ~ -550HU, -450 ~ -600HU and -500 ~ -600HU, respectively (p>0.05). The differences in the results of the two series were statistically significant at other threshold values however (p<0.05). CONCLUSION: We determined optimal window settings for measuring the inner diameter of the trachea and both main bronchi by spiral CT. The optimal maximal threshold values were somewhat different according to measured sites of the trachea and both main bronchi.

Comparison of Interpleural Block and Paravertebral Block with Bupivacaine for Pain Relief after Cholecystectomy / 대한마취과학회지

The adverse effects of pain in post-surgery or trauma patients are well documented. A reliable, safe approach to achieving unilateral analgesia in multiple contiguous thoracic dermatomes would be of great benefit to anesthesiologists in acute pain setting following thoracic or upper abdominal surgery. The aim of this study of post-cholecystectomy pain was to compare two methods of postoperative analgesia with interpleural block and paravertebral block with bupivacaine. Thirty otherwise healthy patients who had undergone elective cholecystectomy through a subcostal incision were randomly allocated to two groups of fifteen patients each and given either interpleural block(group 1) or paravertebral block(group 2) with 20 ml 0.5% bupivacaine mixed with 1:200,000 epinephrine through a single catheter. The degree of analgesia was assessed by a verbal rating scale, Prince Henry pain score and a visual analogue scale(VAS 1-10 cm ; O=no pain, 10=worst pain). These pain scores and vital signs were assessed just before and 10, 20, 30, 60 and 120 minutes after injection of bupivacaine. The onset time of analgesia was similar in both groups(6.6+/-3.74 minutes in group 1 and 5.5+/-2.88 minutes in group 2), but the duration of analgesia was significantly longer in group 1(6.5+/-1.92 hours) than group 2(4.5+/-2.17 hours)(p<0.05). In both groups Prince Henry pain scores significantly decreased 10 minutes after injection of bupivacaine and VAS also significantly decreased 10 and 20 minutes after injection(p<0.05), but there was no significant difference between two groups. The systolic blood pressure decreased 10 minutes after the injection of bupivacaine in both groups(Group 1-3.7%, Group 2-6.5%) and the diastolic blood pressure decreased 10 minutes after the injection of bupivacaine only in group 1(2.5%), (p<0.05), however, these changes in arterial blood pressure were of minimal clinical significance. There is no complication in group 1, but 2 out of 15 patients in group 2 showed bilateral blockade without any serious hemodynamic derangement clinically. In conclusion, both techniques showed similarity in the onset and the degree of analgesia except the duration of analgesia, and presented only a few minor complications. Therefore, we feel that paravertebral block can be used in case that coexisting pulmonary or pleural pathology limits the use of interpleural block for post-cholecystectomy pain management. Furthermore, either of the two techniques may be used alternatively in management of thoracic or upper abdominal pain according to technical skill and preference of anesthesiologists.

Hemodynamic and Metabolic Changes during Orthotopic Liver Transplantation in Dogs / 대한마취과학회지

Skilled and experienced anestheia is of great importance for patients undergoing orthotopic liver transplantation, because of multiple preexisting medical problems in such patients as well as the intraoperative problems of rapid hemodynamic, metabolic, and coagulation changes. In this study, the intraoperative hemodynamic and laboratory data were analyzed in ten dogs that underwent an orthotopic liver transplantation procedure by veno-venous bypass using Biopump. Liver transplantation can be divided into three distinct periods: stage I, or preanhepatic stage, which begins with the induction of anesthesia and continues until cross clamping of portal vein and IVC; stage II, or anhepatic stage, which begins at the anhepatic time and continues until the donor liver is reperfused by the recipients circulating blood; and stage III, or postanhepatic stage, which begins at the time of reperfusion and continues until the end of surgical procedure. The hemodynamic changes at the time of IVC and portal vein cross clamping were decreases in CVP, PCWP, and pulmonary artery pressure in spite of using Biopump. The significant metabolic alternations during anhepatic stage were decrease in blood glucose levels and increase in blood lactate levels. The more significant hemodynamic changes occurred at the time of reperfusion. Systolic pressure decreased suddenly to 58+/-6 mmHg and cardiac output decreased to 1.08+/-0.1l L/min. However heart rate, pulmonary artery pressure, CVP, and PCWP did not change significantly. During stage III, hyperglycemia occurred quite frequently. Significant abnormal coagulation chages could not be found, probably because the dogs were healthy. In conclusion, during anhepatic stage, we have to compensate for alternations of fluid balance. At the time of reperfusion, we should prevent severe hemodynamic changes and treat them immediately if they occur. However, it seems that glucose administration is not necessary to the liver recipient during stage II because there is no significant hemodynamic depression due to hypoglycemia at this time and hyperglycemia occurs later.