Bee venom stimulation of a lung meridian acupoint reduces inflammation in carrageenan-induced pleurisy: an alternative therapeutic approach for respiratory inflammation

Respiratory inflammation is a frequent and fatal pathologic state encountered in veterinary medicine. Although diluted bee venom (dBV) has potent anti-inflammatory effects, the clinical use of dBV is limited to several chronic inflammatory diseases. The present study was designed to propose an acupoint dBV treatment as a novel therapeutic strategy for respiratory inflammatory disease. Experimental pleurisy was induced by injection of carrageenan into the left pleural space in mouse. The dBV was injected into a specific lung meridian acupoint (LU-5) or into an arbitrary non-acupoint located near the midline of the back in mouse. The inflammatory responses were evaluated by analyzing inflammatory indicators in pleural exudate. The dBV injection into the LU-5 acupoint significantly suppressed the carrageenan-induced increase of pleural exudate volume, leukocyte accumulation, and myeloperoxidase activity. Moreover, dBV acupoint treatment effectively inhibited the production of interleukin 1 beta, but not tumor necrosis factor alpha in the pleural exudate. On the other hand, dBV treatment at non-acupoint did not inhibit the inflammatory responses in carrageenan-induced pleurisy. The present results demonstrate that dBV stimulation in the LU-5 lung meridian acupoint can produce significant anti-inflammatory effects on carrageenan-induced pleurisy suggesting that dBV acupuncture may be a promising alternative medicine therapy for respiratory inflammatory diseases.

Surgical Outcomes of Anterior Cervical Fusion Using Deminaralized Bone Matrix as Stand-Alone Graft Material: Single Arm, Pilot Study

OBJECTIVE: To investigate the safety and efficacy of demineralized bone matrix (DBM) as a bone graft substitute for anterior cervical discectomy and fusion (ACDF) surgery. METHODS: Twenty consecutive patients treated with ACDF using stand-alone polyestheretherketone (PEEK) cages (Zero-P) with DBM(CGDBM100) were prospectively evaluated with a minimum of 6 months of follow-up. Radiologic efficacy was evaluated with a 6-point scoring method for osseous fusion using plain radiograph and computed tomogrpahy scans. Clinical efficacy was evaluated using the visual analogue scale (VAS), Owestry disability index (ODI), and short-form health questionnaire-36. The safety of the bone graft substitute was assessed with vital sign monitoring and a survey measuring complications at each follow-up visit. RESULTS: There were significant improvements in VAS and ODI scores at a mean 6-month follow-up. Six months after surgery, solid fusion was achieved in all patients. Mean score on the 6-point scoring system was 5.1, and bony formation was found to score at least 4 points in all patients. There was no case with implant-related complications such as cage failure or migration, and no complications associated with the use of CGDBM100. CONCLUSION: ACDF using CGDBM100 demonstrated good clinical and radiologic outcomes. The fusion rate was comparable with the published results of traditional ACDF. Therefore, the results of this study suggest that the use of a PEEK cage packed with DBM for ACDF is a safe and effective alternative to the gold standard of autologous iliac bone graft.

Comparative Study of Posterior Lumbar Interbody Fusion via Unilateral and Bilateral Approaches in Patients with Unilateral Leg Symptoms

OBJECTIVE: We investigated the clinical and radiological advantages of unilateral laminectomy in posterior lumbar interbody fusion (PLIF) procedure comparing with bilateral laminectomy, under the same procedural condition including bilateral instrumentation and insertion of two cages, in patients with degenerative lumbar disease with unilateral leg symptoms. METHODS: We retrospectively reviewed 124 consecutive cases of PLIF via unilateral or bilateral approach between January 2006 and April 2010. In 80 cases (bilateral group), two cages were inserted via bilateral laminectomy, and in 44 cases (unilateral group), via unilateral laminectomy. The average follow-up duration was 29.5 months. The clinical outcomes were evaluated with the Visual Analogue Scale (VAS) and the Oswestry disability index (ODI). The fusion rates and disc space heights were determined by dynamic standing radiographs and/or computed tomography. Operative times, intra-operative and post-operative blood losses and hospitalization periods were also evaluated. RESULTS: In clinical evaluation, the VAS and ODI scores showed excellent outcomes in both groups. There were no significant differences in term of fusion rate, but the perioperative blood loss and the operative time of the unilateral group were lower than that of the bilateral group. CONCLUSION: Unilateral laminectomy can minimize the operative time and perioperative blood loss in PLIF procedure. However, the different preoperative disc height between two groups is a limitation of this study. Despite this limitation, solid fusion and satisfactory symptomatic improvement could be achieved uniquely by our surgical method. This surgical method can be an alternative surgical technique in patients with unilateral leg pain.

Spontaneous Hemoperitoneum in Patients Taking Anticoagulants

PURPOSE: Spontaneous hemoperitoneum is not a common disease but may cause a fatal outcome. Warfarin is a coumarin anticoagulant, used widely for therapeutic and prophylactic anticoagulation. Although, it is considered a life saving medicine, it is associated with significant adverse effects including intraabdominal bleeding. Literatures about spontaneous hemoperitoneum in patients taking anticoagulants have been reported, but until now there have not been a definite establishment in diagnostic criteria and treatment strategy. METHODS: Among 209 patients who were diagnosed hemoperitoneum from Jan 2005 through May 2009, we identified 9 patients with spontaneous hemoperitoneum without any trauma history or solid organ abnormalities. All 9 patients were taking warfarin for various durations. Initially, we evaluated vital signs, laboratory, CT findings, and clinical course, retrospectively. In addition, we analyzed risk factors potentiating the pharmacologic effect of anticoagulants. RESULTS: One of the most prominent features in this study is that all patients showed prolonged international normalized ratio (6.36~15.11). One patient received an exploratory laparotomy for hemoperitoneum secondary to warfarin, presenting as a localized peritonitis in the right lower quadrant of the abdomen. Mean hospital stay was 15.2 days. Five patients were transfused with packed red blood cells (500~1,000 ml) and fresh frozen plasma (300~900 ml). All patients were discharged without any mortality. CONCLUSION: It is important to identify and confirm the factors that can potentiate the pharmacologic effect of anticoagulants, when acute abdomen is suspected in patients taking anticoagulants. If the patients are hemodynamically stable, they can be treated without surgical intervention.

The Prognostic Factors and Severity Index in Fournier's Gangrene

PURPOSE: Fournier's disease is polymicrobial necrotizing fasciitis of the perineal, perianal, or genital areas. The objective of this study was to investigate patients with Fournier's gangrene and to determine risk factors that affect mortality. METHODS: This study was a retrospective clinical study. Clinical presentations and outcomes of surgical treatments were evaluated in 27 patients with Fournier's gangrene that were treated in a single institution from January 2000 to March 2009. RESULTS: The mean age of patients was 52.8+/-14.4 yr, and the male-to-female ratio was 25:2. Among the predisposing factors, diabetes mellitus was the most common (n=8, 29.6%). The most common infection source was anorectal (n=16, 59.3%). Sepsis on admission was detected in 16 cases (59.3%). Four patients died during treatment, for an overall mortality of 14.8%. A logistic regression test showed a Fournier's gangrene severity index greater than 9 and sepsis on admission to be prognostic factors. CONCLUSION: The mortality rate was higher in patients with sepsis on admission and with a Fournier's gangrene severity index greater than nine.

Traumatic Pericardial Rupture: A Case Report

Pericardial rupture due to blunt trauma is very rare, but can lead to serious complications. It occurs mainly on the left, is found incidentally during surgery, and is seldom discovered radiologically unless accompanied by cardiac herniation. The following case describes a 53-year-old traffic-accident victim who received emergency pericardial repair and bleeding control via an exploratory thoracotomy and an exploratory laparatomy. The patient was discharged without any complication and remained healthy at six month after injury.

The Early Experience of Laparoscopic Sigmoid Colon and Rectal Cancer Resection

PURPOSE: The aim of this study is to assess the pathologic surgical outcome and short-term outcome of a laparoscopic colorectal resection at an early time on the learning curve in comparison with open surgery. METHODS: Retrospectively collected data were obtained on 49 patients who underrent a laparoscopic sigmoid colon and rectal cancer resection between May 2001 and January 2006. The compared factors were the clinicopathologic characteristics, the operation time, the postoperative recovery, and complications. RESULTS: There were no significant differences in age, sex, TNM stage, and tumor size between the laparoscopic and open-surgery groups. The operation time was significantly longer in the laparoscopic group (291.4 vs. 201.9 min P < 0.001). In the view point of postoperative recovery, the laparoscopic group showed a significant advantage in the passage of flatus. There were no significant differences in harvested LNs, proximal margin, and distal margin between the two groups. The complication rate was not significantly different, but anastomotic leakage was higher in the laparoscopic group (16.7% vs. 2%, P=0.02). CONCLUSIONS: There were no significant differences in harvested LNs, proximal margin, and distal margin between the two groups, but anastomotic leakage was higher in the laparoscopic group.

The Effect of Compressive Dressubg ib tge Amount of Postoperrative Bleeding after Total Hip Replacement Arthroplasty

Purpose: Compressive hip dressings have been used to decrease the amount of postoperative bleeding after total hiparthroplasty. However, there is no data showing that a compressive dressing is effective. This study evaluated the effect of compressive dressings on the level of postoperative bleeding after total replacement arthroplasty. Materials and Methods: This prospective randomized clinical trail included 80 consecutive primary total hip arthroplasties in 72 patients. The 80 hips were randomly assigned to a compressive dressing group or a non-compressive dressing group using a table of random numbers. Forty-two hips in 37 patients were treated using the compressive dressing and the remaining 38 hips in 35 patients were treated using a non-compressive dressing. The patients were followed up for an average of 10.3 months. In all patients, a hemovac suction drain was inserted postoperatively. Results: The mean level of bleeding was 626.6 mL in the compressive group and 693.8 mL in the non-compressive group. There was no statistical difference between the two groups (P=0.416). Moreover, the incidence of postoperative complications including dislocation, nerve injury, symptomatic deep vein thrombosis and heterotopic ossification was similar in both groups. Conclusion: These results suggest that the compressive dressing has no significant effect on the amount of postoperative bleeding and clinical results after total hip arthroplasty.

Primary Malignant Fibrous Histiocytoma of the Mesoappendix: Report of a Case

A primary malignant fibrous histiocytoma (MFH) is a soft tissue sarcoma of mesenchymal origin. A primary MFH occurs most commonly in the extremities and the trunk in adults, but rarely in the alimentary tract. We report a case of MFH of the mesoappendix in a 49-year-old male who presented with a periappendiceal abscess. To the best of our knowledge, this is the first report of MFH in the large intestinal tract, including the appendix, in Korea. The patient recovered well after a right hemicolectomy and was given adjuvant chemotherapy.

The Effect of Old Age on the Development of Postoperative Complication in Surgery for Gastric Carcinoma

PURPOSE: Despite the fact that the number of elderly in the population has increased due to the improvement in medical skills and equipment and an increased interest in health, there is a view common among patients, guardians, and even the surgeons that the prognosis after surgery in the elderly is not optimistic. We examined the effect of old age on the prognosis after surgery in patients who were to undergo surgery after being diagnosed with gastric cancer. The effect of old age on the development of postoperative complications was evaluated. METHOD: Five hundred and seventy three patients, who underwent surgery for gastric cancer from January 1994 to December 1998 at Wonju Christian Hospital under Yonsei University Wonju College of Medicine, were analyzed retrospectively. The patients were divided into those older and younger 70 years of age. The presence of an underlying disease, the physical condition according to ASA(American Society of Anesthesiologist) classification, the extent of the resection, the TNM stage according to the AJCC (American Joint Committee on Cancer), and the operation time were examined. The effects of age on the postoperative complications in the study and control groups were also evaluated. RESULTS: Among the 573 patients, 515 were under 70 years and 58 were older than 70. Those older than 70 years, showed significant differences with physical condition (P<0.001), the presence of an underlying disease (P=0.043), M stage of TNM staging (P=0.001), hospital days (P<0.001), and operation time (P=0.026). CONCLUSION: Age itself did not correlate with the development of postoperative complications (P=0.193). The presence of an underlying disease affected the development of postoperative complications regardless of age or gender. Therefore, surgery can be performed safely when the patient's condition is evaluated thoroughly before surgery and the operation is carried out as scheduled.

The Clinical Value of Venography Prior to Arteriovenous Fistula Creation

PURPOSE: Maturation failure after arteriovenous fistula (AVF) creation is a major problem that determines the early success of a fistula for hemodialysis. Therefore the pre-operative evaluation of venous status is widely recommended for obtaining a favorable AVF result. To assess the effectiveness and significance of venography as a pre-operative vein evaluation mode, we compared the short-term and long-term results of AVF according to the performance of pre-operative venography. METHOD: Two hundred forty patients who underwent AVF from March 2002 to May 2004 were enrolled in this study. We performed pre-operative venography on selected patients with equivocal physical findings such as small vein, interrupted venous drainage and arm edema. The clinical manifestations and AVF results such as the early failure rate and patency rate by performance of venography were reviewed retrospectively. RESULT: Pre-operative venography was performed in 86 patients (35.8%). The mean age, proportion of female gender and prevalence of diabetes was significantly higher in the venography group compared to the non-venography group. Among the 86 cases of venography, 53 cases (61.6%) contained one or more abnormal venous findings. Small or turbulent veins at the planned operation site were found in 36 cases (41.9%), thrombosis or sclerotic change of veins were found in 8 cases, disappearance of veins were found in 8 cases and stenosis of the central vein was found in one case. We changed the planned AVFs according to the venography findings in 43 cases (50.0%). For this reason, the proportion of upper fistulas and graft fistula was significantly increased in the venography group. The fistula maturation failure rate in the venography group was 5.8% (5/86), which was significantly lower than that of the non-venography group. The one-year and two-year patency rate of the venography group were 86.8% and 83.5% respectively, which was also significantly higher than those rates of the non-venography group (74.9% and 73.4%, for one-year and two-year patency rate, respectively)(P=0.03). CONCLUSION: The selective application of venography for pre-operative venous mapping is valuable for the selection of the type of AVF, and it produces good results with a superior maturation rate and patency rate.

The Safety of Entrance Reference Line in Endoscopic Carpal Tunnel Release: A Cadaveric Anatomical Evaluation

OBJECTIVE: The purpose of this study is to investigate the anatomic relationship between the neurovasular structures and transverse carpal ligment(TCL) to avoid complications during endoscopic carpal tunnel release. METHODS: Sixteen fresh cadaver hands from 3 men and 5 women(age range, 58~74 years) were used. Neurovascular structures around the TCL were meticulously dissected under a loupe magnification and several morphometric indices were calculated. RESULTS: We found an average length of TCL is 41mm and average distance between the TCL distal margin and superficial palmar arch along the flexor tendon of the ring finger is 9.2mm. In 3 hands, the looped ulnar artery, coursed 1 to 4mm radial to hook of hamate, continuing to the superficial palmar arch. During radial-to-ulnar flexion of the wrist, the looped ulnar artery beyond the hook of hamate shifts more radially (2 to 7mm) with proximal carpal bone. We also noted a Berretini branch located adjacent to the edge of the distal TCL. CONCLUSION: It is appropriate to transect the ligament at least 4mm radial from the radial margin of the hook of hamate or transect the proximal ligament in the radially deviated hand position to protect ulnar neurovascular structure. The proximal portal could be made just ulnar to the palmaris longus tendon to avoid the vascular injury in the proximal portion of the TCL.

Transrectal Sonographically Guided Drainage of Tuboovarian Abscess (TOA) / 대한산부인과학회잡지

OBJECTIVE: We report six patients with tuboovarian abscess (TOA) drained through sonographically guided transrectal route, in whom percutaneous or transvaginal approach was not accessible due to the risk of pelvic organ. METHOD: This procedure was performed under the guidance of transrectal ultrasound. Six patients with aged 25-42 years (mean 31.6 years), who had appendectomy(1), C/S(2), hyterectomy(1) and no operaion Hx(2). Size of abscess cavity was variable from three to eight centimeter. Catheter was removed when drainage amount was reduced less than 10 cc and the patient becomes afebrile. RESULT: Drainage was successfully done in all patients without any complication to the procedure. Fecal contamination was not occurred after transrectal drainage due to abdominal pressure and gravity ought to empty the abscess cavity. There was no problem in defecation due to the catheter and in its expulsion by defecation. Catheter was removed after 3-8 days (mean 6 days) without recurrent abscess. CONCLUSION: Transrectal drainage of abscess performed with ultrasound guidance is a safe, feasible procedure, which is well tolerated by patient and relatively easy procedure.

Eosinophilic Granuloma of Lumbar Spine in Old Patient: 1 Case Report / 대한척추외과학회지

Eosinophilic granuloma of bone is a self-limited condition, characteristically a disease of children and young adults. It is the most benign variant of histiocytosis X. It is most common in skull, but any bone may be affected. Vertebral involvement occurs in about 10 to 15%. This benign bone destructive lesion is characterized by the presence of Langerhans cells contain Birbeck granules, infilitration of histiocytes and eosinophilic leukocytes unknown origin. We report a eosinophilic granuloma in lumbar spine of old patient.

Augmentation Cystoplasty with Mainz Pouch in Tuberculous Contracted Bladder / 대한비뇨기과학회지

A variety of surgical techniques for augmentation cystoplasty have been developed. To evaluate the clinical availability of the augmentation cystoplasty using the Mainz pouch, We reviewed 8 patients with tuberculous contracted bladder who underwent construction of a Mainz pouch. Preoperative frequency was dramatically improved in all of 8 patients. Mean bladder capacity increased from 36 ml preoperatively to 534ml postoperatively. On the uroradiologic study, preoperative hydronephrosis was improved or stable in 9 of l0 renal units and was aggravated in 1 renal unit. Preoperative vesicoureteral reflux disappeared in all of 3 patients. Urodynamic study revealed mean residual urine of 70ml and maximal intravesical pressure during contraction of 65cmH2O after cystoplasty. There were no significant complications which required surgical revision.