The Incidence of Osteoporosis and the Related Factors Among Injured Sites in Above 50 Year-old Patients with Fractures Caused by Low-energy Trauma / 대한골다공증학회지

OBJECTIVES: To compare the incidence of osteoporosis and the related factors among fracture sites in above 50 year-old patients with fractures caused by low-energy trauma. MATERIALS AND METHODS: Seven hundred and fourteen patients with fracture from low energy trauma were evaluated retrospectively. By the Dual-energy x-ray absorptionmetry, we measured bone mineral density (BMD) at lumbar spine and proximal femur, and compared the incidence of osteoporosis, age, sex, body mass index (BMI), previous fracture history, past osteoporosis medication history according to each fracture sites. RESULTS: BMD was decreased according to increasing age with statistical significance (P<0.001). Sex has no significant difference according to fracture site (P=0.141). Average age of patients with osteoporotic fracture was 73.8, 72.8, 66.3, 73.4, 78.3 years old according to fracture site as T-spine, L-spine, distal radius, proximal humerus and proximal femur, respectively. There was significant difference among groups (P<0.001). Average BMI related with osteoporotic fracture site was 22.9 kg/m2, 22.7 kg/m2, 23.4 kg/m2, 23.0 kg/m2, 21.7 kg/m2, respectively and it showed significant difference among groups (P<0.001). Average bone mass and T-score related with osteoporotic fracture site was 0.587 g/cm2 (-3.5), 0.614 g/cm2 (-3.1), 0.647 g/cm2 (-2.6), 0.597 g/cm2 (-3.1), 0.554 g/cm2 (-3.5), with significant difference among groups (P<0.001). Previous fracture history had no significant difference among groups (P=0.078). Previous osteoporosis medication history had significant difference among the groups (P<0.001). CONCLUSIONS: In low-energy traumatic fracture, age, BMI and previous osteoporosis medication history are significantly related factors with BMD and osteoporotic fracture. Early diagnosis of osteoporosis and osteoporotic medication use is effective for decrease incidence of low-energy osteoporotic fracture.

Comparison of the Radiologic Outcomes following the Kinds of Implants in Treating Unstable Osteoporotic Intertrochanteric Fracture / 대한골다공증학회지

OBJECTIVES: To determine whether kinds of implants would influence on the radiologic outcomes in the treatment of unstable osteoporotic intertrochanteric fractures. MATERIALS AND METHODS: In this retrospective study, radiologic outcomes of 151 patients with unstable osteoporotic intertrochanteric fractures undergoing surgical treatments were compared based on the types of fixation implants as follows : PFNA (53 cases, group I), gamma nail 3(31 cases, group II), CHS with TSP (43 cases, group III), and helical blade type LCP-DHS with TSP (24 cases, group IV). On the follow-up radiographs after operations, we assessed differences of bone union durations, neck-shaft ankle changes, lag screw or helical blade slippages, and varus alpha angle changes among the study groups. RESULTS: All the radiologic outcomes evaluated in this study were not significantly different among the study groups. The average bone union durations of the group I, II, III and IV were 17.7, 18.0, 18.2, and 17.8 weeks, respectively (P=0.429). The average variation of neck-shaft angle of the group I, II, III and IV were 3.6degrees, 3.1degrees, 3.7degrees and 2.9degrees, respectively (P=0.273). The average lag screw or blade slippage of the group I, II, III and IV were 5.1 mm, 3.3 mm, 3.6 mm and 2.7 mm, respectively (P=0.154). The average variation of varus alpha of the group I, II, III and IV were 5.3degrees, 4.7degrees, 4.1degrees and 4.6masculine, respectively (P=0.894). CONCLUSIONS: This study indicates that four typical types of fixation implants for treating unstable osteoporotic intertrochanteric fractures would not lead to differences in postoperative radiological outcomes.

Result of Total Knee Arthroplasty in Pre-operative Adreanal Insufficiency Patients / 대한정형외과연구학회지

PURPOSE: The purpose of this study is to investigate to effect of adrenal insufficiency on the results of TKA. MATERIALS AND METHODS: A total of 89 patients (89 knees) treated with TKA from March, 2008 to October, 2008 were enrolled in this study. Levels of serum cortisol and adrenocorticotropic hormone (ACTH) were checked preoperatively. Hydrocortisone 50~75 mg was injected to adrenal insufficient group at 7:00 AM and 4:00 PM on operative day and the following day. We evaluated the range of motion, the knee society knee score and function score at preoperatively and 2 years follow up, and compared the results between non-adrenal insufficiency group (NAI) and adrenal insufficiency group (AI). RESULTS: Cortisol and ACTH levels were reduced in 36 of 89 patients. All of 36 patients of low cortisol level do not stimulated in ACTH stimulation test. In the adrenal insufficiency group the knee society score (KSS) improved from 49.8 to 86.8 and the knee society functional score (KSFS) from 42.6 to 89.5 at 2 years follow-up. In the control group KSS rose from 51.9 to 84.3 and KSFS from 49.4 to 88.6 during the same period. In adrenal insufficient patients, there were no postoperative complication to include mortality, infection, periprosthetic fracture except skin lesions during operation or postoperatively. There was a case of rupture of quadriceps tendon on the 10th postoperative day which was treated with primary repair. CONCLUSION: Based on our study, there was no increased operative and postoperative complications except skin lesions and 1 case quadricepse tendon rupture in patients with adrenal insufficiency group.

Acute Gluteal Compartment Syndrome without Gluteal Hematoma: A Case Report / 대한고관절학회지

Acute gluteal compartment syndrome (AGCS) is a rare condition associated with trauma, drug abuse, alcohol intoxication, prolonged immobilization, hip arthroplasty and epidural anesthesia. We report the case of a 42-year-old woman presenting severe buttock pain following decreased lower extremity motor function after an incident whereby she rolled down a flight of stairs. We performed fasciotomy of the gluteal fascia in order to provide relief from acute gluteal compartment syndrome. At the 2 month follow up visit her sensory and motor function had improved. Acute gluteal compartment syndrome is a rare condition which can result in misdiagnosis or delayed diagnosis. Careful consideration is needed for patients suffering severe buttock pain.

Acute Gluteal Compartment Syndrome without Gluteal Hematoma: A Case Report / 대한고관절학회지

Acute gluteal compartment syndrome (AGCS) is a rare condition associated with trauma, drug abuse, alcohol intoxication, prolonged immobilization, hip arthroplasty and epidural anesthesia. We report the case of a 42-year-old woman presenting severe buttock pain following decreased lower extremity motor function after an incident whereby she rolled down a flight of stairs. We performed fasciotomy of the gluteal fascia in order to provide relief from acute gluteal compartment syndrome. At the 2 month follow up visit her sensory and motor function had improved. Acute gluteal compartment syndrome is a rare condition which can result in misdiagnosis or delayed diagnosis. Careful consideration is needed for patients suffering severe buttock pain.

Experience of laparoscopic-assisted radical vaginal trachelectomy for 2 patients with cervical cancer stage I / 대한산부인과내시경학회지

Because of the organized screening programs, incidence and mortality of cervical cancer has been decreased and cervical cancer is diagnosed in relatively young age women and early stages. Traditional treatments for early cervical cancer are radical hysterectomy or chemoradiation, which irreversibly destroy reproductive capacity. Radical vaginal trachelectomy could be an alternative option for young women with early cervical cancer wishing to preserve fertility. Here, we report 2 cases of our initial experiences with Laparoscopy-Assisted Radical Vaginal Trachelectomy (LARVT) for patients with cervical cancer stage I. Two cases of 29 and 31-year-old nulliparous women were diagnosed with cervical cancer IA1-IA2. They underwent LARVT with permanent cervicoisthmic cerclage with 3 cycles of adjuvant chemotherapy. LARVT can be the procedure of choice for women with early stage cervical cancer who desire a fertility preservation.

Two Case Review of Transvaginal Cervicoisthmic Cerclage / 대한주산의학회잡지

The conventional treatment of cervical incompetence is cerclage operation. In most cases, the classical surgical cerclage methods described by McDonald and Shirodkar are performed. The cervicoisthmic cerclage is beneficial for the treatment of patients who have short cervix due to conization, cervisectomy or congenital anatomical deformity of uterus. This procedure is different from the classical McDonald and Shirodkar cerclages in that the suture site is placed at the junction of the cervix and the isthmus of uterine body. There are two approaches in cervicoisthmic cerclages, transabdominal and transvaginal ones. The transvaginal cervicoisthmic cerclage is easier to perform and less dependent on uterine size compared with the transabdominal cerclage. In addition there is less chance of direct uterine handling associated with bladder laceraton or fetal loss in transvaginal cervicoisthmic cerclage. We report two cases of transvaginal cervicoisthmic cerclage for the first time in Korea, in which patients have delivered at full term by cesarean section.

The Significance of Cardiac Sympathetic Nerve Imaging with 123I-Metaiodobenzylguanidine for Predicting the Occurrence of Ventricular Tachycardia in Patients with Idiopathic Dilated Cardiomyopathy

BACKGROUND AND OBJECTIVE: Ventricular arrhythmia is an important cause of death in patients suffering with idiopathic dilated cardiomyopathy (IDCM). The decreased uptake or increased "washout" of 123I-metaiodobenzylguanidine (MIBG)-derived radioactivity is associated with a worse prognosis or severe disease in patients with cardiac diseases. SUBJECTS AND METHODS: Forty patients (28 men, mean age: 56.5+/-13.0 years) with angiographically proven IDCM were studied and divided into 2 groups: the patients with clinically documented ventricular tachycardia (VT) and IDCM (group A; 17 patients), and the patients without VT, but with IDCM (group B; 23 patients). The normal control group (7 men, mean age 62.4+/-7.9) was compared theses patients. 123I-MIBG was evaluated by the early (15 min) and delayed (3hours) uptake, the heart to mediastinum uptake (H/M) ratio and the global and regional washout ratio (WOR) that was defined as the [early H uptake-delayed H uptake]/early H uptake. The clinical variables, echocardiographic parameters and 123I-MIBG-derived parameters were compared among three groups. RESULTS: There were no significant differences in age and the echocardiographic parameters between the groups A and B. A significant negative correlation was present between the early inferior wall H/M ratio and the LVEDD (Spearman's correlation, r=-0.412, p=0.08), and the early inferior H/M ratio and the LVESD (Spearman's correlation, r=-0.463, p=0.03). Only the delayed lateral wall uptake was significantly lower in group A than that in group B (23.3+/-5.3 versus 27.8+/-8.4, respectively p=0.042). The regional WOR was not statically different among the three groups. CONCLUSION: Cardiac 123I-MIBG SPECT partially reflects the vulnerability for the occurrence of VT in patients suffering with IDCM. These results support the feasibility of using cardiac 123I-MIBG SPECT as a prognostic tool in IDCM patients.

Prenatal Ultrasonographic Diagnosis of Klippel-Trenaunay-Weber Syndrome / 대한산부인과학회지

Klippel-Trenaunay-Weber syndrome is a rare congenital disorders which is characterized by the presence of multiple hemangiomata, arteriovenous fistulas and unilateral limb hypertrophy. There has been some reports that Klippel-Trenaunay-Weber syndrome was diagnosed at birth or infant, but the prenatal diagnosis was very difficult in pregnant women who have not family history. Recently, the prenatal diagnosis of Klippel-Trenaunay-Weber syndrome has been occasionally reported according to improvement of prenatal ultrasound. We recently experienced two cases of Klippel-Trenaunay-Weber syndrome. So we report our cases with brief review of literature.

Peripartum Cardiomyopathy: 12 Cases / 대한산부인과학회지

OBJECTIVE: Our objective was to describe the clinical characteristics, diagnosis and treatment of 12 cases of peripartum cardiomyopathy (PPCM). METHODS: We retrospectively reviewed 12 cases of PPCM diagnosed by clinical and echocardiographic criteria between Jan 1997 and Dec 2004. RESULTS: The incidence of PPCM was 1 in 576 deliveries. The most common clinical and laboratory findings were dyspnea (100%), pulmonary edema (83.3%), and tachycardia (83.3%). The mean left ventricular ejection fraction (EF) was 34.2% (range, 23-44.6%), and the mean fractional shortening (FS) on echocardiography was 15.9% (range, 10.2-23%). Eight patients (67%) were diagnosed after delivery, and four patients (33%) were diagnosed before delivery. The mean interval from the onset of symptoms to evaluation with echocardiography was 72 hours (range, 7 hr-10 day). Suspicion and evaluation of PPCM was delayed in discharged women, our period of inexperience, and during the antepartum period. We did not observe any mortality case in our study population. Six patients improved, while three patients showed persistent ventricular dysfunction at follow-up echocardiography. CONCLUSION: All of our patients represented with the symptoms and sings of congestive heart failure, although which were similar to those of late pregnancy. Therefore, we suggest that PPCM should be considered and evaluated, whenever peripartum dyspnea, pulmonary edema, and tachycardia especially develop.

Inhibition of Viability and Genetic Change in Hypoxia-treated Lung Pericytes / 결핵및호흡기질환

BACKGROUND: Lung pericytes are important constituent cells of blood-air barrier in pulmonary microvasculature. These cells take part in the control of vascular contractility and permeability. In this study, it was hypothesized that change of lung pericytes might be attributable to pathologic change in microvasculature in acute lung injury. The purpose of this study was how hypoxia change proliferation and genetic expression in lung pericytes. METHODS: From the lungs of several Sprague-Dawley rats, performed the primary culture of lung pericytes and subculture. Characteristics of lung pericytes were confirmed with stellate shape in light microscopy and immunocytochemistry. 2% concentration of oxygen and 200muM CoCl2 were treated to cells. Tryphan blue method and reverse transcription-polymerase chain reaction were done. RESULTS: 1. We established methodology for primary culture of lung pericytes. 2. Hypoxia inhibited cellular proliferation in pericytes. 3. Hypoxia could markedly induce vascular endothelial growth factor(VEGF) and smad-2. 4. Hypoxia-inducible factor-1alpha (HIF-1alpha)was also induced by 2% oxygen. CONCLUSION: Viability of lung pericytes are inhibited by hypoxia. Hypoxia can stimulate expression of hypoxia-responsive genes. Pericytic change may be contributed to dysfunction of alveolar-capillary barrier in various pulmonary disorders.

Changes of Heart Rate Variability during Dipyridamole Infusion and Dipyridamole-Induced Myocardial Ischemia: Clinical Usefulness for the Detection of Myocardial Ischemia

BACKGROUND AND OBJECTIVE: Myocardial ischemia evokes autonomic reflexes, which in turn can influence the ischemic events. The heart rate variability (HRV) provides a useful, noninvasive clinical tool for studying the autonomic activity. Only a few studies have reported results on the spectral modifications during myocardial ischemia in humans. Our aim was to evaluate the changes in the RR interval variability during dipyridamole infusion and dipyridamole-induced myocardial ischemia. SUBJECTS AND METHODS: The study population included 38 patients, with stable or unstable angina (group AP, n=20), and sex matched healthy controls (group C, n=18). The ECG was continuously recorded before and during the dipyridamole infusion, for use in a later off-line spectral analysis. We investigated the following variables: the mean and variance of the RR interval, low and high frequency powers (LF and HF, respectively) and their normalized units (LFnu and HFnu), the LF ratio (the ratio of the LF power at peak stress and in the basal state), the HF ratio and the LF/HF ratio. The changes in the HRV parameters were analyzed and compared, before and after the dipyridamole infusion, for both groups. RESULTS: The dipyridamole injection was characterized by a reduction in all the spectral components in group C. In group AP, the dipyridamole injection significantly decreased the HF power and HFnu, but increased the LF power, with a resultant significant increase in the LFnu and LF/HF ratio. The LF ratio decreased from 1.00+/-0.00 to 0.55+/-0.17 (p<0.017) during the dipyridamole infusion in group C, but increased from 1.00+/-0.00 to 2.84+/-0.8 (p<0.032) in group AP. The difference in the LF ratio between groups AP and C was significant (p<0.001). CONCLUSION: Information on myocardial ischemia can be extracted from the analysis of the HRV. The LF ratio was the most valuable parameter for discriminating the patients from the control subjects.

A Study on the Accuracy of the record base of the Complete Denture to the Master Cast according to Kinds of Resin and Polymerization Method / 대한치과보철학회지

STATEMENT of THE PROBLEM: The record base in fabricating procedures of the complete denture, as a temporary form for reproducing denture base, is used to record upper and lower jaw relation and to align artificial teeth and try-in it in the mouth. The accuracy of jaw relation record is affected by the accuracy, stiffness and stability of the record base. So, the accuracy of record base is the most important requirements of jaw relation records. PURPOSE of STUDY: The purpose of this study was to evaluate the gap that occurred over the palatal area of a maxillary record base fabricated with autopolymerizing resin and light-curingresin. METHODS AND MATERIAL: The maxillary record bases were fabricated out of autopolymerizing resin that is used the most frequently in clinics and light-curing resin that attracts special attentionfor its several merits. The light-curing resin was made by two kinds of polymerization methods, which are one step curing method and multiple step curing method. All record bases were cut in certain positions of the master cast 1 hour and 1 day later after fabrication and the accuracy of the master cast was measured and analyzed with a microscope. RESULTS: A pattern of gap formation between the record base and the maxillary cast was observed in all specimens. According to kinds of resins, autopolymerizing resin was significantly more accurate than light-curing resin. There was no statistical difference according to time lapse, and in all three groups, the maximum discrepancy occurred at the posterior border in the midpalatal region. CONCLUSLON: The autopolymerizing resin is better than light-curing resin, and multiple step curing method is more accurate than one step curing method when using light-curing resin.

Biochemical and Molecular Changes in Response to Environmental Hormones / 대한내분비학회지

No Abstract Available.

Emphysematous pyelonephritis : a case report and review of the literature / 영남의대학술지

Emphysematous pyelonephritis is a necrotizing renal infections characterized by intrarenal and occasional perirenal gas production. Although uncommon (89 cases in the literature), it occurs almost exclusively in diabetic patients (87% of the cases). Prompt and aggressive management is required to sahage these patients. We describe a recent case of a diabetic woman with emphysematous pyelonephritis due to E. Coll, successfully managed with unilateral nephrectomy.