Gastric Pneumatosis and Its Gastrofibroscopic Findings in LifeThreatening Superior Mesenteric Artery Syndrome Complicated by Anorexia Nervosa in a Child / 대한소아소화기영양학회지

A 14-year-old girl was admitted to the emergency department for excessive bile-containing vomiting and severe abdominal pain. She had been healthy until she intentionally lost 25 kg over a 6-month period. Thick, bloody bile-mixed food particles were drained from the stomach through a nasogastric tube. Abdominal computed tomography revealed huge stomach dilatation with extensive gastric pneumatosis, possible near rupture, acute pancreatitis, and a very narrow third of the duodenum, indicating superior mesenteric syndrome. Gastrofibroscopy revealed multiple hemorrhagic ulcers and numerous beadlike cystic lesions in the stomach. Laboratory examination results were notable for severe deficiencies in critical nutrients, including iron, zinc, proteins, and prealbumin, as well as undernutrition-associated endocrine complications such as hypothyroidism and hypogonadotropic hypogonadism. Excessive vomiting ceased after the endoscopic removal of stagnant gastric contents. Gastric pneumatosis improved after 3 days of supportive care.

Point-Connecting Measurements of the Hallux Valgus Deformity: A New Measurement and Its Clinical Application

PURPOSE: The aim of this study was to investigate new point-connecting measurements for the hallux valgus angle (HVA) and the first intermetatarsal angle (IMA), which can reflect the degree of subluxation of the first metatarsophalangeal joint (MTPJ). Also, this study attempted to compare the validity of midline measurements and the new point-connecting measurements for the determination of HVA and IMA values. MATERIALS AND METHODS: Sixty feet of hallux valgus patients who underwent surgery between 2007 and 2011 were classified in terms of the severity of HVA, congruency of the first MTPJ, and type of chevron metatarsal osteotomy. On weight-bearing dorsal-plantar radiographs, HVA and IMA values were measured and compared preoperatively and postoperatively using both the conventional and new methods. RESULTS: Compared with midline measurements, point-connecting measurements showed higher inter- and intra-observer reliability for preoperative HVA/IMA and similar or higher inter- and intra-observer reliability for postoperative HVA/IMA. Patients who underwent distal chevron metatarsal osteotomy (DCMO) had higher intraclass correlation coefficient for inter- and intra-observer reliability for pre- and post-operative HVA and IMA measured by the point-connecting method compared with the midline method. All differences in the preoperative HVAs and IMAs determined by both the midline method and point-connecting methods were significant between the deviated group and subluxated groups (p=0.001). CONCLUSION: The point-connecting method for measuring HVA and IMA in the subluxated first MTPJ may better reflect the severity of a HV deformity with higher reliability than the midline method, and is more useful in patients with DCMO than in patients with proximal chevron metatarsal osteotomy.

Factors Associated with Early Postoperative Complications in Patients with Cervical Spondylotic Myelopathy

STUDY DESIGN: Retrospective. OBJECTIVES: To investigate factors related to early postoperative complications of surgery for cervical spondylotic myelopathy (CSM). SUMMARY OF LITERATURE REVIEW: Factors associated with increased risk of complications from surgery for CSM are greater age, greater estimated blood loss, longer operative duration, and anterior-posterior combined procedures. MATERIALS AND METHODS: The records of patients (male 32, female 19, mean age 61 years) who underwent surgery for CSM between November 2004 and December 2014 were investigated for early postoperative complications and potentially related factors. Factors considered were age, gender, duration of symptoms, diabetes, smoking, comorbidity, preoperative Japanese Orthopedic Association (JOA) score, numbers of cervical levels involved, ossification of the posterior longitudinal ligament (OPLL), operative approach, fusion, operative duration, estimated blood loss (EBL), maximal cord compression ratio on MRI, and cord signal intensity change on T2-weighted MRI. RESULTS: Early postoperative complications were observed in 12 of 51 patients and included motor weakness in 3, pneumonia in 2, and delirium, dysphagia, hematoma, pulmonary thromboembolism, sore, seizure, wound dehiscence, and superficial infection, each in 1. Factors associated with early postoperative complications were operative duration (p=0.024), maximal cord compression ratio on MRI (p=0.009), and cord signal intensity change on T2-weighted MRI (p=0.009). The other factors were not found to correlate significantly. CONCLUSIONS: Factors associated with early postoperative complications for CSM are operative duration, compression ratio at the level of maximal cord compression on MRI, and cord signal intensity change on T2-weighted MRI.

The Prognostic Factors of Neurologic Recovery in Spinal Cord Injury

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate and compare the factors affecting recovery of spinal cord injury following cervical and thoracolumbar spine injuries. SUMMARY OF LITERATURE REVIEW: Several authors have reported the factors to predict the prognosis of spinal cord injury, but the objective prognostic factors are still controversial. MATERIALS AND METHODS: From June 2006 to March 2013, a total of 44 patients with spinal cord injury were evaluated. Prognostic factors analyzed were sex, age, neurologic status, fracture type, time to operation, use of steroid, and signal change on MRI. We analyzed the relation between each factor and the neurologic recovery. The mean follow-up period was 12 months. The neurologic recovery was analyzed by the ASIA impairment scale at the first and the last neurologic examination. RESULTS: Among 44 patients, 15 sustained complete cord injury while 29 had incomplete cord injury. Significant neurologic recovery using the ASIA impairment scale was evaluated in the incomplete spinal cord injury group. Among this group, the prognosis for Brown-sequard syndrome is better than for central cord syndrome and anterior cord syndrome. There was no significant difference in other factors (fracture site, time to operation, use of steroid or signal change on MRI). CONCLUSIONS: The prognosis in spinal cord injury is determined by the initial neurologic damage and neurologic recovery is not related with the fracture type, time to operation, use of steroid and signal change on MRI.

The Effect of Teriparatide in Women with Osteoporosis after Lumbar Posterolateral Fusion or Posterior Lumbar Interbody Fusion

STUDY DESIGN: Retrospective study. OBJECTIVES: To investigate radiologic and clinical outcomes of teriparatide in women with osteoporosis after instrumented lumbar posterolateral fusion (PLF) or posterior lumbar interbody fusion (PLIF). SUMMARY OF LITERATURE REVIEW: Teriparatide accelerated lumbar posterolateral fusion in women with postmenopausal osteoporosis. MATERIALS AND METHODS: Eighty-six women older than 65 years old with osteoporosis underwent PLF or PLIF with bone graft between Februar, 2011 ato May, 2012 pPatients were divided into four group: teriparatide group with local bone (A-1: 13 patients;, teriparatide group with composite bone (A-2: 27 patients; non-teriparatide group with local bone (B-1: 14 patients; and non-teriparatide group with composite bone (B-2: 32 patients). At 3, 6, and 12 months postoperatively, the Oswestry Disability Index (ODI), visual analog scale (VAS), fusion rate, and period of bone union were evaluated. RESULTS: VAS and ODI improved after surgery in all groups, but no significant differences were notell among the groupses Further, there was no significant difference among the groups for agef fusion level, and fusiops(p>0.05). Fusion rate was 94.44% in the A-1 group, 92.59% in the A-2 group, 79.17% in the B-1 group, and 76.92% in the B-2 group. Average period of bone union was 3.25 months, 3.65 months, 5.67 months, anand 5.65 months respectively. Fusion rate and average bone union time made no significant differeneen among the groups divided by graft materials (p>0.05). However, those in the teriparatide group were significantly superior to those in the non-teriparatide group (p<0.05). CONCLUSIONS: In women with osteoporosis after PLF or PLIF with bonegraft, teriparatide showed superiority in the rate of fusion and the period of bone union.

The Outcomes of Short and Long Segment Posterior Instrumentation of Thoracolumbar Burst Fractures with a Load Sharing Score of 7 or More

STUDY DESIGN: Retrospective. OBJECTIVES: To investigate outcomes between short and long segment posterior instrumentation of thoracolumbar burst fractures with a load sharing score of 7 or more. SUMMARY OF LITERATURE REVIEW: Short segment instrumentation has been recommended in thoracolumbar burst fractures with a load sharing score of 6 or less, and long segment instrumentation has been recommended for those with a score of 7 or more. However, this standard is controversial. MATERIALS AND METHODS: From March 2006 to January 2014, 45 patients with thoracolumbar fractures with a load sharing score of 7 or more were treated with posterior instrumentation. They were divided into two groups: short (group S) and long segment (group L) groups. Radiologic results were evaluated on the basis of the kyphotic angle and anterior column height. Complications were also reviewed. RESULTS: Groups S and L consisted of 13 and 32 patients and had mean ages of 48.3 and 47.3 years, respectively. In group S, the anterior column height increased from 56.62% to 76.23% postoperatively, and remained at 71.15% at follow-up. The kyphotic angle decreased from 16.27degrees to 7.55degrees postoperatively, and was 13.17degrees at follow-up. In group L, the anterior column height recovered from 49.67% to 70.52% postoperatively, and was 63.73% at follow-up. The kyphotic angle decreased from 20.08degrees to 6.80degrees postoperatively, and was 14.18degrees at follow-up. The changes in the anterior column height and kyphotic angle were not significantly different between groups S and L. Seven cases had complications and the number of cases with complications was not significantly different between groups S and L. CONCLUSIONS: Short and long segment instrumentation of thoracolumbar fractures with a load sharing score of 7 or more did not achieve significantly different results.

Comparison of New Fractures after Treatment with Alendronate or Raloxifene in Patients with Osteoporotic Compression Fracture Treated with Cement Augmentation / 대한골다공증학회지

BACKGROUNDS: The purpose of this study was to examine the incidence of new fractures after treatment with alendronate or raloxifene in patients with compression fractures treated with cement augmentation. METHODS: 140 patients with compression fracture treated with vertebroplasty or kyphoplasty between January 2007 and January 2013 were divided into 3 groups, an unmedicated group (n=31), an alendronate group (n=49), and a raloxifene group (n=60). The incidence of new fractures in 3 groups were investigated. RESULTS: The incidence of new fractures was 29% (9 cases) in unmedicated group, 20% (10 case) in alendronate group, and 26% (16 case) in raloxifene group. Average period to new fracture was 16.2 months in alendronate group and 21.5 months in raloxifene group. CONCLUSIONS: After treatment with alendronate or raloxifene, BMD increased and incidence of new fractures decreased in patients with osteoporotic compression fracture treated with vertebroplasty or kyphoplasty. Patients with alendronate showed numerical improvement in BMD and incidence of new fractures than raloxifene. But, incidence of new fractures in spine and other site showed no statisically significant.

Impact of Physician's Education on Adherence to Tuberculosis Treatment for Patients of Low Socioeconomic Status in Bangladesh / 전남의대학술지

Successful tuberculosis control depends on good adherence to treatment. Yet, limited data are available on the efficacy of methods for improving the adherence of patients of low socioeconomic status. We evaluated the impact of physician-provided patient education on adherence to anti-tuberculosis medication in a low socioeconomic status and resource-limited setting. A pre-/post-intervention study was conducted at a suburban primary health care clinic in Bangladesh where an intensive education strategy was established in May 2006. Treatment outcomes of tuberculosis patients from March 2005 to April 2006 (pre-intervention) and from May 2006 to December 2007 (post-intervention) were compared. Among 354 patients, 198 (56%) were treated before intervention and 156 (44%) were treated after intervention. Cumulative adherence to anti-tuberculosis medication was significantly greater in the intervention group than in the control group in univariate and multivariate analyses. Physician's education can contribute to increasing the adherence of patients in resource-limited settings.

Impact of Physician's Education on Adherence to Tuberculosis Treatment for Patients of Low Socioeconomic Status in Bangladesh / 전남의대학술지

Successful tuberculosis control depends on good adherence to treatment. Yet, limited data are available on the efficacy of methods for improving the adherence of patients of low socioeconomic status. We evaluated the impact of physician-provided patient education on adherence to anti-tuberculosis medication in a low socioeconomic status and resource-limited setting. A pre-/post-intervention study was conducted at a suburban primary health care clinic in Bangladesh where an intensive education strategy was established in May 2006. Treatment outcomes of tuberculosis patients from March 2005 to April 2006 (pre-intervention) and from May 2006 to December 2007 (post-intervention) were compared. Among 354 patients, 198 (56%) were treated before intervention and 156 (44%) were treated after intervention. Cumulative adherence to anti-tuberculosis medication was significantly greater in the intervention group than in the control group in univariate and multivariate analyses. Physician's education can contribute to increasing the adherence of patients in resource-limited settings.

Results of Non-Operative Treatment of the Zone I, II Fifth Metatarsal Base Fracture / 대한족부족관절학회지

PURPOSE: To evaluate the results of conservative treatment of zone I, II 5th metatarsal base fracture. MATERIALS AND METHODS: Between May 2004 and June 2010, a total of 58 patients of zone I, II 5th metatarsal base fractures were included in this study. The mean length of follow-up was 13.5 months (12~36 months). All of the patients were treated with full-weight-bearing short leg cast immobilization for 4 weeks and wooden sole shoes for 4 weeks. The results were evaluated about the radiographic union, the midfoot scale of American Orthopaedic Foot and Ankle Society (AOFAS), the tenderness on fracture site and other complications. RESULTS: All patients were able to return to their prior levels of activity. The mean time for union as shown on radiographs was 45.5 days, and the mean midfoot scale of AOFAS was 99.7 points. There were no nonunions or refractures during the follow-up. CONCLUSION: The conservative treatment with full-weight-bearing short leg cast and wooden sole shoes seems to give good results for zone I, II 5th metatarsal base fracture.

Effect of a Trochanter-stabilizing Plate in Unstable IntertrochantericFractures : A Clinical and Biomechanical Study

PURPOSE: To evaluate the effectiveness of a trochanter-stabilizing plate (TSP) for the treatment of unstable intertrochanteric fractures. MATERIALS AND METHODS: In the clinical aspect of the study, 48 patients who were treated surgically for unstable intertrochanteric fractures were evaluated. One group of patients was treated with CHS [spell out with 1st use] only (group 1, n=23) and the other group was treated with CHS and TSP (group 2, n=25). In the biomechanical aspect of the study, an AO type A2.2 intertrochanteric fracture was reproduced in 10 proximal femur models. Five models were reduced and fixed using CHS only (group 1) and 5 models were fixed using CHS with TSP (group 2). A load of 750 N (300 cycles) was applied using Instron. RESULTS: In the clinical aspect of the study, the extent of lag screw sliding, greater trochanter lateralization, and neckshaft angle varus change was less in group 2 than in group 1. In the biomechanical aspect of the study, the extent of lag screw sliding was less in group 2 than in group 1, but the neck-shaft angle varus change was greater in group 2 than in group 1. CONCLUSION: The use of TSP is effective for the buttress effect on the proximal fragment. It decreases the excessive sliding of the lag screw, lateral displacement of the greater trochanter, and neck-shaft angle varus change. Therefore, TSP may be a useful treatment for unstable intertrochanteric fractures.

A case of Hyperstimulated Corpus luteal cyst torsion in Pregnancy after In vitro Fertilization / 대한산부인과학회잡지

Ovarian torsion is the fifth most common condition in gynecologic surgical emergencies, with an incidence of 2.7% occuring mainly in women of reproductive age. It is an uncommon but well recognized complication of ovarian stimulation, especially when ovarian hyperstimulation syndrome occurs. Patients with ovarian torsion normally present with an acute abdomen, necessitating an exploratory laparotomy, with removal of the organ when necrosis is evident. Ultrasound may suggest the diagnosis of adnexal torsion. If the ovarian tumor is a luteal cyst, it is also standard to administer progesterone after surgical treatment, although how efficient this treatment is in preventing miscarriage is questionable. A documented case of adnexal torsion associated with in vitro fertilization is hyperstimulated enlarged corpus luteal cyst. Emergency left salpingo-oophorectomy was done and have concluded a successful pregnancy after exogenous progesterone support. We report a case of enlarged corpus luteal cyst torsion in early pregnancy with a brief review of literatures.

Study on the plasma lipid level in term pregnant women / 대한산부인과학회잡지

No abstract available.

EEG Findings in Acute Carbon Monoxide Intoxication (Clinical and Prognostic Significance of EEG)

To determine the clinical and prognostic significance of EEG study in acute carbon monoxide intoxication, the EEGs of 107 patients, whom the study was performed relatively early in the course of intoxication, were analyzed and compared with the clinical courses and CT brain scans retrospectively. The final outcome of the patients consisted of 78 cases of recovery, 20 cases of prolonged coma and 9 cases with delayed neurologic sequeles. Statistically, there was no evidence of the age and sex influencing the clinical outcome or EEG finding. The EEG abnormalities depended upon the level and duration of unconsciousness, showing more abnormal EEG in the patient with deeper and longer coma. Many serial EEGs revealed almost parallel improvement to the clinical recovery but not always. Usually the EEG abnormality had the tendency to persist a little longer than the clinical. The patterns and grades of EEG abnormalities were also important to provide the prognostic significance. Almost all of the patients revealing, rarly in the course, some normal alpha background or high amplitude regular 1.5-2.5 Hz slow waves which looked like triphasic wave would be recovered soon or later. The irregular geneeralized delta slow waves, not responding to the outer stimuli suggested poor prognosis and prolonged coma. The abnormal CT brain scan such as low density in basal ganglia and/or white matter also showed some prognostic value, but not that of EEG studies. The development of delayed neurologic sequeles, however, could not be predicted by EEG or CT brain scan.