Biomechanical Analysis of Fusion Segment Rigidity Upon Stress at Both the Fusion and Adjacent Segments: A Comparison between Unilateral and Bilateral Pedicle Screw Fixation

PURPOSE: The purpose of this study was to investigate the effects of unilateral pedicle screw fixation on the fusion segment and the superior adjacent segment after one segment lumbar fusion using validated finite element models. MATERIALS AND METHODS: Four L3-4 fusion models were simulated according to the extent of decompression and the method of pedicle screws fixation in L3-4 lumbar fusion. These models included hemi-laminectomy with bilateral pedicle screw fixation in the L3-4 segment (BF-HL model), total laminectomy with bilateral pedicle screw fixation (BF-TL model), hemi-laminectomy with unilateral pedicle screw fixation (UF-HL model), and total laminectomy with unilateral pedicle screw fixation (UF-TL model). In each scenario, intradiscal pressures, annulus stress, and range of motion at the L2-3 and L3-4 segments were analyzed under flexion, extension, lateral bending, and torsional moments. RESULTS: Under four pure moments, the unilateral fixation leads to a reduction in increment of range of motion at the adjacent segment, but larger motions were noted at the fusion segment (L3-4) in the unilateral fixation (UF-HL and UF-TL) models when compared to bilateral fixation. The maximal von Mises stress showed similar patterns to range of motion at both superior adjacent L2-3 segments and fusion segment. CONCLUSION: The current study suggests that unilateral pedicle screw fixation seems to be unable to afford sufficient biomechanical stability in case of bilateral total laminectomy. Conversely, in the case of hemi-laminectomy, unilateral fixation could be an alternative option, which also has potential benefit to reduce the stress of the adjacent segment.

Surgical Treatment of the Fifth Metatarsal Base Fracture Using Multiple Kirschner Wires / 대한족부족관절학회지

PURPOSE: The purpose of this study is to evaluate the clinical and radiographic results of internal fixation using multiple Kirschner wires (K-wires) for the fifth metatarsal base fracture. MATERIALS AND METHODS: We retrospectively reviewed 14 patients with a displaced fifth metatarsal base fracture. We measured the distance of fracture displacement on the foot oblique radiograph pre- and post-operatively. We evaluated the clinical results using the visual analog pain scale at six weeks and three months postoperatively and the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score at six months postoperatively. RESULTS: In our series, 10 cases were zone I fracture and four cases were zone II fracture. We achieved anatomical reduction and bony union in all of our cases. The average time to bone union was 43 days. The degree of pain around the fifth metatarsal base was significantly decreased after surgery. The average AOFAS score was 95 at six months postoperatively. CONCLUSION: Multiple K-wire fixation is a relatively simple fixation method for displaced fifth metatarsal base fractures. If we place a K-wire into the medial cortex of the fifth metatarsal, we could prevent proximal migration of the K-wire.

The Relationship of Anger Expression and Alexithymia with Coronary Artery Stenosis in Patients with Coronary Artery Diseases

This study examined the relationship between anger expression or alexithymia and coronary artery stenosis in patients with coronary artery diseases. 143 patients with coronary artery diseases (104 males and 39 females) were enrolled in this study. The severity of their coronary artery stenosis was measured by angiography. The Anger Expression Scale and the Toronto Alexithymia Scale were used to assess the level of anger expression and alexithymia. The more stenotic group (occluded by 75% or more) exhibited a significantly higher level of alexithymia than the less stenotic group (occluded by less than 25%). Multiple regression anaylsis on the extent of stenosis also revealed that regardless of gender and age, the coronary artery disease patients with higher alexithymia were likely to show a greater level of stenosis. However, no significant differences were found on either the anger-in or anger-out subscale scores between the two groups. These results suggest that alexithymia is associated with the severity of coronary artery stenosis in patients with coronary artery disease. However, both anger expression and anger suppression were not shown to be associated with the severity of coronary artery stenosis.

Clinical Characteristics and Short-term Treatment Response in Patients with Obsessive-Compulsive Disorder / 대한정신약물학회지

OBJECTIVE: The aim of this study was to describe and evaluate the clinical data and short-term treatment response in patients with obsessive-compulsive disorder (OCD) based on an outpatient setting. METHODS: A group of patients with OCD underwent mean 12-weeks treatment with selective serotonin reuptake inhibitors. The patients were divided into two groups according to treatment response, defined as a reduction of the Yale-Brown Obsessive Compulsive Scale total score >35% and CGI of 1 or 2. RESULTS: 1) Among the 249 patients, 24.1% had checking type and 23.7% washing type. Among these two types, 31.9% had mood disorder, 15.0% had anxiety disorder and 24.5% personality disorder as co-morbidity. One hundred fourteen patients (45.8%) responded to the treatment and 135 (54.2%) did not. The responders decreased Y-BOCS scores from 27.9+/-7.2 at baseline to 21.3+/-6.4 and 19.3+/-3.8 at post-treatment 8 and 12 weeks, respectively (repeated measure ANOVA, p=0.039). There were no differences among the treatment responses to serotonin reuptake inhibitors. CONCLUSION: About half of the OCD patients showed a response to pharmacological treatment using SSRI in the outpatient clinic setting for 12 weeks. Long-term and contrast studies of OCD may elucidate further clinical aspects of this disorder in the future.

Practical Issues in the Psychopharmacotherapy during Pregnancy and Lactation / 대한정신약물학회지

Although the pregnancy period has typically been viewed as a time of emotional well-being, recent data do not substantiate this optimistic view for women with prior histories of depression. This paper will review the natural history of depression in pregnancy. The potential risks to the mother and the fetus when the psychiatric illness goes untreated will be reviewed. Also to be discussed are: the potential teratogenicity of each class of psychotropic medication, the treatment dilemmas, the possible alternatives when prescribing psychotropic medications and the decision-making guidelines regarding the discontinuation of medications. The risk of major depression in the postpartum period in the overall population and the likelihood of recurrence will be reviewed, and prophylactic strategies will be covered also.

The Relationship between Perceived Stress and Coping Strategies in Patients with Coronary Artery Disease / 신경정신의학

OBJECTIVES: The objective of this study was to investigate the relationship between perceived stress and coping strategies in 138 patients with coronary artery diseases. METHODS: Global assessment of recent stress(GARS) scale and perceived stress response inventory(PSRI) were used to measure perception for stressors and stress responses. Coping scale was used to measure coping strategies. RESULTS: Scores of perceived stress related to work, job, interpersonal area, changes in relationship, sickness or injury, financial area, and overall global areas showed significant positive correlations with escape-avoidance. Also scores of perceived stress related to sickness or injury, financial problems, overall global areas showed significant correlations with accepting responsibility. Scores related to financial area showed significant positive correlation with planful problem solving and positive reappraisal. Escape-avoidance had a significantly positive correlation with negative emotional response, lowered cognitive function and general negative thinking, self-depreciative thinking, impulsiveaggressive thinking, general somatic symptoms, specific somatic symptoms, passive-responsive careless behavior and impulsive-aggressive behavior. Distancing had a significantly positive correlation with negative emotional response, lowered cognitive function and general negative thinking, general somatic symptoms and passive-responsive careless behavior. Confrontive coping, self-control, seeking social support, accepting responsibility, planful problem solving, and positive reappraisal were more frequently used in men than in women. Education had a significantly positive correlation with confrontive coping, self-control, seeking social support, accepting responsibility, planful problem solving, and positive reappraisal. CONCLUSION: The above results suggest that coping strategies of patients with coronary artery disease may be affected by types of perceived stressors, sex, and level of education, and that escapeavoidance and distancing may be the most ineffective coping strategies used in these patients.

Development of a Cognitive Rehabilitation Program for Patients with Schizophrena / 신경정신의학

OBJECTS: The purpose of this study was to investigate the effects of cognitive differentiation training program-Korean version(a training program of attention and conceptual abilities) on cognitive function, psychopathology and problem solving skills in patients with schizophrenia. METHODS: A total of patients diagnosed as schizophrenia using DSM-IV were randomly assigned to 2 groups. The training group went through a total of 22 sessions of cognitive differentiation training (60min/sessionX2sessions/wkX11wks). The attention-placebo control group received psychoeducation program during the same period. Arithmetic, vocabulary, similarities, picture completion of Wechsler Adult Intelligence Scale-Korean version, Positive and Negative Syndrome Scale, and Social Problem Solving Scales were administered to all patients, both before and after the training program. RESULTS: In the arithmetic scores(F=6.35, af=1, p=0.018) of Wechsler Adult Intelligence Scale-Korean version, and total scores(F=6.35, af=1, p=0.018) and problem solving skill scale scores (F=4.88, af=1, p=0.036) of social problem solving scale, interaction effects of training was significant. CONCLUSION: Our findings suggest that cognitive differentiation training program-Korean version is effective on improving auditory attention and problem solving skills in patients with schizophrenia.

8MHz RF Capacitive Heating on Rabbit Lung / 대한치료방사선과학회지

The usefulness of hyperthermia for cancer therapy has been established. The purpose of the present investigation was to access feasibility of heating normal lung and the temperature and power requirement were compared with that for liver as solid organ in rabbits by using radiofrequent heating machine. In this study, 20 rabbits were divided into 2 groups according to the heating site and the method of temperature measurement ; in group I : lung heating and temperature measuring in skin, esophagus and lung parenchyme ; in group ll : liver heating and temperature measuring in skin and liver parenchyme. The results were as follows ; 1) When the maximum temperature was almost same in lung heating group and liver heating group, the power for liver heating was lesser required than the power for lung heating (p<0.05). 2) The temperature of esophagus for the measurement of mediastinum temperature was 1.1+/-0.9 degrees C higher than the temperature of lung parenchyme (p<0.05). Therefore the above findings suggest lung, air containing organ, is well heated as same as liver, solid organ. So more active trials of lung heating in the lung cancer must be likely considered. But whets the lung is heated, the esophageal temperature is higher than lung parenchyme, so the mediastinum damage must be considered seriously.