A Retrospective Analysis of Bone Marrow Examination Results from a Single Center Institution: In What Situations Is Bone Marrow Examination Helpful?

Objective@#Bone marrow (BM) examinations are performed to evaluate hematological abnormalities. Focusing on patients with cytopenia, we aimed to determine the circumstances under which a BM examination can assist in the diagnosis of hematologic diseases. @*Methods@#The medical records of 738 patients who underwent BM examination from March 2011 to March 2019 at Soonchunhyang University Seoul Hospital were reviewed. In total, 234 patients underwent a BM examination to identify the cause of cytopenia. Excluded from the analysis were BM examinations performed to diagnose specific diseases and evaluate disease status. @*Results@#Results suggesting suboptimal outcome (n=6) or BM invasion of solid tumors (n=13) were excluded. Immune thrombocytopenic purpura patients (n=52) with normal BM examination results were also excluded. One hundred sixty-three patients who underwent BM examination to determine the cause of cytopenia were included in the analysis. A comparison of non-specific results (n=56) to those pointing to an underlying hematologic disease (n=107) showed that patients with severe neutropenia or severe thrombocytopenia were more likely to be diagnosed with a hematologic disease. Specifically, as the number of severe cytopenias increased, the likelihood of a hematologic disease diagnosis was significantly augmented. Patients with end-stage renal disease, autoimmune disease, or liver cirrhosis were more likely to receive non-specific results. @*Conclusion@#In conclusion, seeking the underlying disease or drug should be a primary target for patients with cytopenia. In cases of severe cytopenia in more than one lineage, BM examination should be strongly considered to diagnose an underlying hematologic disease.

Medical Issues and Opinions of Obstetrics Regarding Abortion Law Amendment

There have been ongoing social discussions on revision of the abortion law since the Constitutional Court ruled it nonconformity to the constitution on April 11, 2019. Thus, Korean Society of Obstetrics and Gynecology, Korean Society of Maternal Fetal Medicine, Korean College of Obstetricians and Gynecologists, and Korean Association of Obstetricians and Gynecologists organized 'special committee for abortion law' to support social discussion on the revision of the abortion law, and they prepared official opinions of obstetrics for medical issues including doctors' right to refuse abortion. In the future, the committee will continue to adapt to changes of medical environment especially after the revision of the abortion law by collecting its members' feedbacks.

Medical Issues and Opinions of Obstetrics Regarding Abortion Law Amendment

There have been ongoing social discussions on revision of the abortion law since the Constitutional Court ruled it nonconformity to the constitution on April 11, 2019. Thus, Korean Society of Obstetrics and Gynecology, Korean Society of Maternal Fetal Medicine, Korean College of Obstetricians and Gynecologists, and Korean Association of Obstetricians and Gynecologists organized 'special committee for abortion law' to support social discussion on the revision of the abortion law, and they prepared official opinions of obstetrics for medical issues including doctors' right to refuse abortion. In the future, the committee will continue to adapt to changes of medical environment especially after the revision of the abortion law by collecting its members' feedbacks.

Comparison of the rheological properties of four root canal sealers / 国际口腔科学杂志·英文版

The flowability of a root canal sealer is clinically important because it improves the penetration of the sealer into the complex root canal system. The purpose of this study was to compare the flowabilities of four root canal sealers, measured using the simple press method (ISO 6876), and their viscosities, measured using a strain-controlled rheometer. A newly developed, calcium phosphate-based root canal sealer (Capseal) and three commercial root canal sealers (AH Plus, Sealapex and Pulp Canal Sealer EWT) were used in this study. The flowabilities of the four root canal sealers were measured using the simple press method (n=5) and their viscosities were measured using a strain-controlled rheometer (n=5). The correlation between these two values was statistically analysed using Spearman's correlation test. The flow diameters and the viscosities of the root canal sealers were strongly negatively correlated (ρ=-0.8618). The viscosity of Pulp Canal Sealer EWT was the lowest and increased in the following order: AH Plus<Sealapex<Capseal (P<0.05). All of the tested root canal sealers showed characteristic time- and temperature-dependent changes in their rheological properties. The viscosities measured using the strain-controlled rheometer were more precise than the flowabilities measured using the simple press method, suggesting that the rheometer can accurately measure the rheological properties of root canal sealers.

Comparison of alveolar ridge preservation methods using three-dimensional micro-computed tomographic analysis and two-dimensional histometric evaluation

PURPOSE: This study evaluated the efficacy of alveolar ridge preservation methods with and without primary wound closure and the relationship between histometric and micro-computed tomographic (CT) data. MATERIALS AND METHODS: Porcine hydroxyapatite with polytetrafluoroethylene membrane was implanted into a canine extraction socket. The density of the total mineralized tissue, remaining hydroxyapatite, and new bone was analyzed by histometry and micro-CT. The statistical association between these methods was evaluated. RESULTS: Histometry and micro-CT showed that the group which underwent alveolar preservation without primary wound closure had significantly higher new bone density than the group with primary wound closure (P<0.05). However, there was no significant association between the data from histometry and micro-CT analysis. CONCLUSION: These results suggest that alveolar ridge preservation without primary wound closure enhanced new bone formation more effectively than that with primary wound closure. Further investigation is needed with respect to the comparison of histometry and micro-CT analysis.

Surgical extraction of mandibular third molar in pterygomandibular space: a case report

Impacted mandibular third molars are located between the second mandibular molar and mandibular ramus. However, ectopic mandibular third molars with heterotopic positions are reported in the subcondylar or pterygomandibular space. The usual cause of malposition is a cyst or tumor, and malposition without a pathology is rare. This case report described an impacted mandibular third molar in the pterygomandibular space without any associated pathology.

The effect of rhBMP-2 on delta12-PGJ2 induced osteoblastic differentiation and mineralization / 대한치주과학회지

Prostaglandin plays a significant role in the local control of bone metabolism associated with periodontal disease. delta12-PGJ2 is a natural PGD2 metabolite that is formed in vivo in the presence of plasma. It is known for delta12-PGJ2 to stimulate calcification in osteoblastic cells. Bone morphogenetic protein(BMP) stimulated osteoblastic differentiation in various types of cells and greatly enhanced healing of bony defects. The purpose of this study was to evaluate the effect of rhBMP-2 on delta12-PGJ2 induced osteoblastic differentiation and mineralization in vitro. A human osteosarcoma cells line Saos-2 were cultured. In the test groups, 10-7M of delta12-PGJ2 or mixture of 10-8M of delta12-PGJ2 and 100ng/ml of rhBMP-2 or 100ng/ml of rhBMP-2 were added to culture media. After 1 day, 2 days and 4 days of culture period, the cell number was measured. Alkaline phosphatase activity was measure at 3 days. Reverse transcription polymerase chain reaction(RT-PCR) was performed to determine the expression of mRNA of bone matrix protein at 8 hours, 1 day and 7 days. The ability to produce mineralized nodules in rat osteoblasts(MC3T3-E1) was evaluated at 21 days. The results were as follows : 1. rhBMP-2 or mixture of rhBMP-2 and delta12-PGJ2 inhibited cell proliferation of human osteosarcoma cells. 2. rhBMP-2 or mixture of rhBMP-2 and delta12-PGJ2 stimulated alkaline phosphatase activity significantly higher than delta12-PGJ2 alone. 3. rhBMP-2 or mixture of rhBMP-2 and delta12-PGJ2 stimulated mineralization compared to delta12-PGJ2 alone. 4. mRNA of alkaline phosphatase, BMP-2, cbfa 1, Type I collagen were detected in the group treated with delta12-PGJ2/rhBMP-2, rhBMP-2 alone, delta12-PGJ2 alone. These results show that mixture of delta12-PGJ2 and rhBMP-2 causes more bone formation than delta12-PGJ2 alone while the bone formation effects of mixture of delta12-PGJ2 and rhBMP-2 are less than those of rhBMP-2 alone. Further researches would be necessary to clarify the interactions of these agents.

A Case of Hydronephrosis as a Complication of Pelvic Actinomycotic Abscess / 대한신장학회잡지

Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by an anaerobic gram- positive organism Actinomyces israelii. It is commonly associated with an intrauterine device(IUD) and can mimick pelvic or intra-abdominal malignant neoplasm. Ureteral obstruction leading to hydronephrosis is a rare complication of tubo-ovarian abscess. We experienced a case of hydronephrosis as a complication of pelvic actinomycotic abscess. The patient was a 46-year-old women presenting with fever and right flank pain. Leukocytosis and pyuria were present and a hydronephrosis was diagnosed by intravenous pyelography. Ultrasonography and a computerised tomography revealed a mass in right adnexum compressing the right ureter. Removal of retroperitoneal abscess and salphingo-oophorectomy were done and the diagnosis of actinomycosis was made by pathologic finding of resected mass. Postoperatively, the patient was treated with second-generation cephalosporin successfully.

The effect of PDGF-BB loaded TCP/ chitosan microgranules on new bone formation / 대한치주과학회지

The purpose of this study was to evaluate newly fabricated tricalcium phosphate(TCP)/chitosan microgranuls as bone substitutes. TCP/chitosan microgranules were fabricated by dropping TCP-chitosan suspension into the NaOH/ethanol solution. The size of microgranules could be controllable via airflow rate. PDGF-BB was loaded into the fabricated granules via freeze-drying methods(300 ng/20 mg). To evaluate cell proliferation, cultured osteoblasts cell lines(MC3T3-E1) was dropped on the BioOss(R), chitosan microgranules, TCP/chitosan microgranules and cultured for 1, 7, 14, and 28 days. Scanning electron microscopic observation was done after 7 days of culture and light microscopic examination was done after 28 days of culture. PDGF-BB release from the microgranules was tested. Rabbit calvarial defects(8 mm in diameter) were formed and chitosan, TCP/chitosan, PDGF-TCP/chitosan microgranules, and BioGran(R) were grafted to test the ability of new bone formation. At SEM view, the size of prepared microgranules was 250-1000 um and TCP powders were observed at the surface of TCP/chitosan microgranules. TCP powders gave roughness to the granules and this might help the attachment of osteoblasts. The pores formed between microgranules might be able to allow new bone ingrowth and vascularization. There were no significant differences in cell number among BioOss(R) and two microgranules at 28 day. Light and scanning electron microscopic examination showed that seeded osteoblastic cells were well attached to TCP/chitosan microgranules and proliferated in a multi-layer. PDGF-BB released from TCP/chitosan microgranules was at therapeutic concentration for at least 1 week. In rabbit calvarial defect models, PDGF-TCP/chitosan microgranules grafted sites showed thicker bone trabeculae pattern and faster bone maturation than others. These results suggested that the TCP/chitosan microgranules showed the potential as bone substitutes.

Acute Eosinophilic Pneumonia Associated with Amitriptyline in a Hemodialysis Patient

Drugs are well known causes of eosinophilic lung disease. In many patients, drug-induced eosinophilic lung disease presents with transient eosinophilic infiltrates that disappear after discontinuation of the drug. Some patients, however, experience a fulminant, acute eosinophilia-like disease. Recently, we experienced a case of amitriptyline-associated acute eosinophilic pneumonia with respiratory failure in a diabetic hemodialysis patient. Eight days after treatment with amitriptyline, sudden fever, chill, dry cough and dyspnea developed. Subsequently, multiple patch consolidations appeared on the chest radiographs. Bronchoalveolar lavage (BAL), established a diagnosis of acute eosinophilic pneumonia. After immediate discontinuation of amitriptyline, a rapid clinical and radiological improvement was observed. The present case indicates that the possibility of acute eosinophilic pneumonia should be fully considered in dialysis patients developing unexplained respiratory symptoms while on amitriptyline therapy.

Bleeding from a Tuberculous Gastric Ulcer in a Hemodialysis Patient / 대한신장학회잡지

The incidence of Tuberculosis among the patients with end-stage renal disease(ESRD) has increased up to 16 times of that in the general population. The impairment of the cellular immunity in the ESRD patients may have a role in the pathogenesis. Extrapulmonary tuberculous manifestations such as lymph node, peritoneum, and pleura involvement are more frequent in the ESRD patients than in the general population. However, there has been no case of upper gastrointestinal(UGI) bleeding as a result of a gastric tuberculosis in the ESRD patient on hemodialysis. Here we report an unusual case of a hemodialysis patient with UGI bleeding secondary to a tuberculous gastric ulcer. A 31-year-old female on hemodialysis was admitted with melena. Endoscopy revealed a benign gastric ulcer with a visible bleeding vessel at the base, located in the anterior wall of the antrum. An exploratory laparotomy showed multiple, round, small and yellow nodules on the visceral peritoneum as well as a 1-cm sized gastric ulcer. After gastric resection, a histological examination including peritoneal nodules demonstrated chronic granulomatous inflamation with caseous necrosis and giant cells. The patient has been on antituberculosis medication and followed up in the outpatient department without any event for 8 months.

Endurance Exercise Training before Hemodialysis : An Effective Therapeutic Modality for End-stage Renal Disease Patients / 대한신장학회잡지

Forty-six patients receiving maintenance "conventional" hemodialysis were studied before and after a 12-week conditioning program to determine the effects of physiologic and psychosocial functions. The subjects were assigned at random to either a exercise(n=25) or a control group(n=21). The subjects in the exercise group performed a combination of bicycle ergometry and treadmill walking two or four times a week for a total exercise time of 10-40 min per session. A low-level graded exercise treadmill stress test(GXT) were administered before and after training. Hematological and serum lipid profiles were also determined before and after training. Following training, there were improvements in physical work capacity(PWC) for the GXT(p<0.05). Also there was increase in physical fitness(p<0.05) compared with control. Although no significant differences in low-density-lipoprotein cholesterol, high-density-lipoprotein cholesterol and triglyceride, significant difference was observed for total cholesterol. Additionally, no significant changes were seen in hematological parameters, but psychosocial functions improved significantly after training. This study demonstrated that exercise training before hemodialysis can improve exercise capacities, physiologic and psychosocial functioning in end-stage renal disease patients. Thus, exercise training seems to have beneficial effects on physiologic and psychosocial functioning in hemodialysis patients, and should be considered as a therapeutic modality for their medical management and rehabilitation.

Vascular Endothelial Growth Factor Expression in Human Trohoblast Cell Line

No Abstract Available.

Vascular Endothelial Growth Factor Expression in Human Trohoblast Cell Line

No Abstract Available.

The influencing Factors of Quality of Life in Hemodialysis Patients / 대한신장학회잡지

This study was performed to evaluate the factors influencing the Quality of Life(QOL) in hemodialysis patients. Authors surveyed and analyzed the questionnaires about social characteristics, symptom, social support, satisfaction with life and quality of life. With these questionnaires, authors compared the hemodialysis patients(N=240, >6 month with hemodialysis) with the control group(N=240). Additionally authors eva- luated the anemia state, nutritional state and dialysis effect, and then analyzed the correlation between these laboratory findings and quality of life in hemodialysis patients. The results were as follows ; 1) The mean age of control group was 33.4 +/- 8.2 yrs, and the patients group was 48.812yrs. 2) Of 294 patients, 73 had the religion(75.2%), 173 had studied above high school(58.8%), 211 were married(71.8%), and 94 were homemaker(3296). Economically, 130 of 294 patients(44.2M) were the middle classes. The patients without occupation were 121 of 294 patients(41.2M), while those with occupation were 77(26.1%) and remainder were housemaker. The patients with medical insurance were 59.9%, those with 1st Medicaid were 22.4%, and those with 2nd Medicaid were 17%. 3) The causes of ESRD were CGN(29.5%), DM (22.3%), etc. Total duration of hemodialysis was 51.4 43.8 months in average, and weekly hemodialysis time was 11.541.98 hours in average. Average BMI was 20.6 +/- 2.79, and in 236 of 294 patients(80.1%), EPO was injected. Of all the complication, 96(32.9%) was cardiovascular problem. Iron storage state was relatively good in all the patients, and the mean level of PTH-i was 174.3 +/- 307.9pg/dl, hemoglobin 8.5 +/- 1.3g/dl, cholesterol 161.536.6mg/dl, total protein 6.60.5g/dl, albumin 3.960.4g/dl. The URR was 65.36.9%, and KtV was 1.3 +/- 0.3. The comparison about laboratory finding between male and female was as followed; Hb. and albumin level was signifi- cantly higher in male compared with female patients, and cholesterol, URR and Kt/V was significantly higher in female than in male. 4) The result of statistic analysis about several variables and Questionnaires. (1) The subjective and objective instrument about QOL showed positive correlation, and the QOL was correlated positively to symptom, physical health state and social support. (2) Of social characteristics, the direct influencing factors for QOL were occupation, economic state, marriage state, and educational state, whereas in- direct factors were a fee for medical treatment and social support. In clinical and laboratory characteristics, the significant factors were age, DM, symptoms, albumin, pre-dialytic creatinine, sodium and calcium. The effect of dialysis did not correlate with QOL. In conclusion, to increase QOL in dialysis pa- tients, all of the community, family, and medical team should make an effort. Firsty, the concern and the support of the community about the dialysis patients should be promoted in social welfare and the opportunity of employment. Secondly, the patients should promote the self-reliance and self- efficacy to take a share of their role in the community and a family by their own efforts. Lastly, the medical team should make an effort to decrease the symptom, to correct the anemia and malnutrition, to treat the complication, and to promote the physical activity. Through these efforts, the health of patients will be elevated. Elevation of the patient's health will increase the possibility of employment and self-reliance, and subsequently will increase the economics. If so, the burden of a fee for the medical treatment will be reduced. Additionally, if social and familial support increase, the QOL of the dialysis patients will be better.

Treatment of Radial Head Fracture / 대한정형외과학회잡지

The radial head forms articulation with radial head fossa of proximal ulna and capitellum, and it ditectly contributes pronation and supination of forearm and also flexion and extension of elbow. There were debates in treatment of radial head fracture especially in displaced or communited fracture. From January 1982 to February 1992, we experienced and analysed 29 cases of radial head fracture. They were treated with conservative treatment or operative treatment according to type The results were as follows; 1. We could get better results with open reduction and internal fixation with miniscrew than radial head excision in type 11 radial head fracture. 2. There were unfavorable results of valgus instability, weakness in all cases of radial head excision.

Influence on Changing of Area of Spinal Canal after Reduction by Posterior instrumentation in Thoracolumbar & Lumbar Burst Fractures / 대한정형외과학회잡지

There have been many debates concerning operative decompression of treatment of thoracolumbar burst fractures with retropulsed bone fragment. From March 1988 to February 1992, authors treated thirty-three thoracolumbar burst fractures by using transpedicular screw fixation and posterior fusion via the posterior approach. We attempted to reduce retropulsed fragment by ligamentotaxis alone and not to do posterolateral nor anterior decompression. After the reduction of fractured spine by posterior instrumentation, we tried to determine the efficiency of reduction of the retropulsed fragment by ligamentaxis along. As a method, we compared the change of anteroposterior, transverse to diameter and area of spinal canal of fractured spine between preoperative and the postoperative situation. The results were as follows; 1. The mean anteroposterior and transverse diameter of the spinal canal on computed tomogram film was 10.1mm & 21.8mm preoperatively & 12.4mm & 23.2mm postoperatively, showing an increase. 2. The area of spinal canal of involved spine on CT film was evaluated preoperatively & post-operatively, the mean spinal canal invasion rate decreased from 36.3% preoperatively to 14.3% postoperatively. 3. The degree of reduction of middle height on plain x-ray and reduction of spinal canal invasion on computed tomogram were statistically correlated(p < 0.01). 4. There was no correlation between the degree of canal narrowing and degree of neurologic impairment. also, there was no correlation between the reduction of retropulsed fragments and subsequent neurologic impairment. 5. There was the relatively satisfactory enlargement of the spinal canal on computed tomogram at the follow-up So we suggest that it is possible to get enough decompression through reduction of retropulsed fragment by ligamen to taxis alone without posterolateral decompression.

A Clinical Result of Modified Phemister Method for Acute Acromioclavicular Dislocation / 대한정형외과학회잡지

There are many procedures for the treatment of acute A-C injury which have many complications such as limitation of shoulder motion, post traumatic arthritis, recurrence of dislocation etc. From September 1985 to February 1992 at Haesung Hospital, Ulsan, 62 patients with grade I complete A-C dislocation had been treated surgically by modified Phemister method. We report 42 cases with at least 1 year follow up. The following results are obtained. 1. There are no limitation of shoulder motion in all cases. 2. The comparision of coraco-clavicular interval after surgery(1.43mm) with that of follow up (2.13mm) shows no significant difference. 3. We experience 15 cases who have resorption of distal clavicle or arthritic change in x-ray film. 4. Clinical results shows that excellent in 20 cases, good in 10 cases, fair in 11 cases, poor in 1 case. From the above result, we suggest the modified phemister method is good procedure in the treatment of acute A-C dislocation.

Clinical Measurement of the Distal Thigh Atrophy / 대한정형외과학회잡지

The distal thigh atrophy is a frequently associated sigh in the presence of knee pathology, and it is usually proved by the difference of the distal thigh circumference using tapeline measurement. But the proper position of measurement is known at this moment. From January of 1988 to December of 1991, we have 320 patients who had knee problems. Among them, 50 patients were selected as a sample of this study. We measured distal thigh circumference of normal and abnormal side by patella and also real circumference and area by taking cross sectional C-T image at each point of measurement. The obtained data are analysed by SPSS for statistical treatment. And the results are as follows: 1) We notice the largest difference on the point of 10cm above superior pole of patella. 2) The vastus medialis is the most conspicuously atrophied muscle among quadriceps and the atrophy of hamstring is minimal. 3) We have experienced the largest difference in cruciate ligament injury but a little difference in meniscus pathology. 4) There is no significantly difference between tapeline measurement and real circumference. As a conclusion of study, The position of 10cm above from the patella upper pole is the best site of clinical measurement of distal thigh circumference, and the muscle mainly associated with artophy is vastus medialis.

Posterior Cruciate Ligament Injury Combined with Patellar Fracture: Report of Four cases / 대한정형외과학회잡지

One of the patellar function is to protect the femoral condyle from direct blowing to knee, so it is known that ligament injuries of the knee are rare in the presence of patellar fracture. We experienced four cases of posterior cruciate ligament injury associated with patellar fracture. Unfortunately, three cases were initially neglected, and one case was identified by visualization on avulsed posterior tibial spine in plain X-ray film. We reviewed these cases and obtained several results as follows; 1. Among four cases, three cases(75%) are fractured at the lower pole of patella without displacement and one case is a longitudinal fracture. 2. We consider possible two mechanisms of this injury; first, in flexed knee, posteriorly directed force on the proximal tibia produces posterior cruciate ligament injury followed by avulsed fracture at the lower pole of patella. Second, by fall on a flexed knee, the load is sustained on the inferior pole of the patella first and continuously drives the tibia backwards producing posterior cruciate ligament injury. We recommend that all surgeon should be aware of possibility of the ligament injury in the presence of patellar fracture, especially in lower pole fracture.