Oral health condition according to distribution of periodontopathic bacterial complex / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to evaluate the association between the distribution of periodontopathic bacteria and oral conditions.METHODS: Stimulated saliva was collected from 162 adults aged 60 years and above. The prevalence and amount of periodontopathic bacteria in the saliva were analyzed using real-time PCR. Pocket depth and clinical attachment loss were examined to evaluate the oral conditions of the subjects. Patients who had at least one tooth surface involved, with a pocket depth ≥4 mm or clinical attachment loss ≥5 mm were classified as having periodontal disease.RESULTS: The detection rates of most bacteria in the orange and green complexes were more than 90%, while those of P. gingivalis and T. forsythia in the red complex were 58.6% and 61.7%, respectively. The number of bacteria in the red complex positively correlated with each other. There were no significant differences in the number of types of red complex bacteria in the saliva and the distribution of residual number of teeth and periodontal disease (P>0.05). On the other hand, the number of remaining teeth in subjects with higher bacterial density were more than those with lesser bacterial density. In addition, the occurrence of dental disease differed significantly depending on the number of P. gingivalis and T. forsythia.CONCLUSIONS: The relative amount of periodontopathic bacteria is important in the occurrence of periodontal disease, and the number of these bacteria positively correlated with each other.

Association between Executive Functions and Time Perspectives in Patients with Adults Attention-Deficit/Hyperactivity Disorder / 신경정신의학

OBJECTIVES: This study examined the association between executive functions and time perspectives in patients with adult attention-deficit/hyperactivity disorder (ADHD). The executive function including self-management to time, self-organization/problem solving, self-restraint or inhibition, self-motivation, and self-regulation of emotion was analyzed. In addition, the time perspective, including past-negative, past-positive, present-hedonistic, present-fatalistic, future-negative, and future-positive, were investigated. The correlations between the executive functions and time perspectives were analyzed in an adult ADHD patient group. METHODS: Thirty-six participants were divided into 17 in the ADHD group and 19 in the Control group. The participants conduct psychological tests including Barkley Deficits in Executive Functioning Scale (BDEFS), ADHD Self-Report Scale, and the Swedish Zimbardo Time Perspective Inventory to confirm their executive functions, attention, and time perspectives. The participants were recruited at Samsung Medical Center from April 2017 to November 2018. The collected data was analyzed using a t-test and Pearson correlation analysis. RESULTS: The adult ADHD patients group showed significantly higher scores in the BDEFS and ADHD Self-Report Scale than the control group. In time perspective scores, the adult ADHD patients group was higher in the past-negative, present-hedonistic, present-fatalistic time perspectives than the control group. In addition, the adult ADHD patients group was lower in future-positive than the control group. In the adult ADHD patients group, the future-positive time perspectives were negatively correlated with the executive functions. CONCLUSION: These results suggest that the negative time perspective is related to the executive function deficits in an adult ADHD group, particularly in the self-management of time, self-organization/problem solving, and self-motivation.

Effects of Diospyros kaki peel, Momordica charantia, and Canavalia gladiata extracts on the cariogenic traits of Streptococcus mutans / 대한구강보건학회지

OBJECTIVES: The purpose of this study is to determine methods of dental caries prevention by investigating the use of compounds of Diospyros kaki (D. kaki) peel, Momordica charantia (M. charantia), and Canavalia gladiata (C. gladiata) extracts to limit the cariogenic traits of Streptococcus mutans (S. mutans), such as their ability to proliferate and adhere to the tooth surface. METHODS: Broth microdilution and the agar spreading assay were used to determine the antimicrobial effect and minimum inhibitory concentration (MIC) of S. mutans extracts. In order to identify the adhesive ability of S. mutans at varying concentrations, culture plates were first stained with 1 ml of 0.01% crystal violet for 15 minutes at room temperature, and then eluted with 1 ml of EtOH:Acetone (8:2) solution for 15 minutes in a 37℃ incubator. Eluted solutions were then evaluated by use of a spectrophotometer at 575 nm. RESULTS: Experiments were conducted in order to investigate the effectiveness of D. kaki peel, M. charantia, and C. gladiata extracts on limiting the proliferation of S. mutans. The MIC was measured as an indication of whether the antibacterial activity of D. kaki peel, M. charantia, and C. gladiata extracts had a significant bacteriostatic effect on S. mutans. M. charantia extract was effective for growth inhibition on S. mutans at a minimum concentration of 0.25%. From the adhesion ability assay, M. charantia extract had an anti-adhesive effect. CONCLUSIONS: These results indicate that M. charantia extract demonstrates antibacterial activity and has an anti-adhesive effect on S. mutans. Due to these properties, M. charantia extract may be used to prevent dental caries.

Pilot study for a novel delta carotid sinus massage in increasing parasympathetic tone: a randomized, prospective, cross-over, comparative study with conventional method

OBJECTIVE: This study examined the efficacy of new delta carotid sinus massage (CSM) versus conventional CSM (CM). METHODS: This prospective, cross-over study was conducted on 26 healthy volunteers with a normal sinus rhythm. CM and delta CSM (DM) were performed in all participants. In both cases, the CSM was performed, where the maximal carotid pulse was palpated. DM differed from CM in that the physician moves the palpating finger in the opposite direction of the carotid pulse at least twice. The mean and longest R-R intervals and mean and lowest heart rates (HRs) at the baseline and during the procedure for each technique were compared. The mean differences between the baseline and procedure R-R intervals and the HRs for each technique were also evaluated. RESULTS: The baseline mean and longest R-R intervals and baseline mean and lowest HRs were similar both groups (P>0.05). The procedure DM mean and longest R-R intervals (22.7±3.1, 26.4±4.9) were significantly greater than the CM corresponding values (22.0±3.1, 24.6±3.5; P<0.001, P=0.003). Procedure DM mean and lowest HRs (67.3±9.7, 58.6±10.7) were significantly lower than the CM corresponding values (69.4±10.0, 61.8±8.9; P=0.001, P=0.003). The differences in the R-R interval and HR between the procedure and baseline were significant (mean and longest R-R intervals with CM [1.3±1.5 and 2.1±1.9] vs. DM [2.0±1.4 and 3.8±3.1], P<0.001, P=0.004; mean and lowest HRs with CM [4.2±4.3 and 5.8±4.6] vs. DM [6.3±4.6 and 9.1±6.5], P<0.001, P=0.005). CONCLUSION: DM is more effective in generating a more potent vagal tone than CM.

Association between Quantitative Electroencephalography Findings and Cognitive-Behavioral Characteristics in Attention Deficit/Hyperactivity Disorder : A Retrospective Cross-Sectional Study / 신경정신의학

OBJECTIVE: This study examined the association between the wave form in quantitative electroencephalography (QEEG) and the cognitive and behavioral characteristics measured by the Korean version of Wechsler Intelligence Scale for Children 4th edition (K-WISC-IV), Korean version of the attention deficit/hyperactivity disorder Rating Scale (K-ARS), and Korean version of Child Behavior Checklist (K-CBCL) in children diagnosed with ADHD. METHOD: A retrospective cross-sectional study was performed on children aged 8 to 13 years, who were diagnosed with ADHD at Samsung Medical Center from November 2011 to March 2017. A total of 57 ADHD children were selected by a medical chart review. Their QEEG findings and psychological test results, including K-WISC-IV, K-CBCL, and K-ARS (n=42), were collected. The QEEG was analyzed by the ranges of Hz: delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), and beta (12–25 Hz) and transformed to the z-scored relative power. The collected data were analyzed using Pearson and Partial correlation analysis. RESULTS: The Letter-Number Sequencing scores of K-WISC was positively correlated with fronto-central alpha. The hyperactivity/impulsivity scores of K-ARS were positively correlated with the theta/beta ratio. Among the items of K-CBCL, social immaturity was positively correlated with delta and theta, and negatively correlated with alpha. Social competence was negatively correlated delta and theta, and positively correlated with alpha. CONCLUSION: These results suggest that the resting state QEEG results of children with ADHD may reflect their cognitive and behavioral characteristics, especially in working memory/executive function, hyperactivity/impulsivity, and sociality.

The Relationship between Parental Attention Deficit Hyperactivity Disorder Characteristics, Executive Function and Parental Emotional Distress / 신경정신의학

OBJECTIVES: Attention deficit hyperactivity disorder (ADHD) is a disease of high heritability. Parents of children with ADHD have high parenting stress and low parenting efficacy. In this study, we assessed parents' characteristics including inattention, hyperactivity, impulsivity, executive function, anxiety/depression severity level, child's ADHD symptom severity, and parents' emotional distress level. The relationships between severity of ADHD symptoms in children, cognitive and emotional characteristics in parents, as well as parenting stress and parenting efficacy were evaluated. METHODS: 96 parents participated in the study. Each parent assessed their child's ADHD symptom severity, their own ADHD symptom severity, as well as executive function, depression, anxiety, parenting stress and parenting efficacy. Collected data was analyzed using multiple regression analysis. RESULTS: The mean ADHD Rating Scale score of 53 children was 22.91 (±9.63). Of these, 26 (49.0%) were taking medication. Eight (8.3%) of the 96 parents had psychiatric illnesses and 12 (12.5%) had the possibility of ADHD. Mothers showed significantly higher levels of parenting stress (p < 0.001), depression (p=0.006), and parenting efficacy (p < 0.001) compared with fathers. The children's ADHD symptoms, severity, and parental depression were related to high parenting stress. The ADHD symptoms of parents were associated with high parenting stress (p=0.032). Parental executive function was significantly associated with low parenting efficacy (p=0.015). CONCLUSION: Children's ADHD symptoms severity, parental depression and ADHD symptom severity were significantly associated with high parenting stress. Parental executive function was significantly associated with low parenting efficacy. In addition to treating the children with ADHD, evaluation and treatment of parents' symptoms is needed in order to reduce parenting stress and provide a stable parenting environment.

Quality of Life According to Location of Integrated Binocular Visual Field Defect in Normal-Tension-Glaucoma Patients

PURPOSE: To investigate the relationship between vision-related quality of life (QOL) and integrated binocular visual field (IVF) defect and the difference in QOL based on the location of visual field defects in Korean normal tension glaucoma (NTG) patients. METHODS: Two hundred monocular visual fields from 100 patients diagnosed with normal tension glaucoma in at least one eye were integrated using the best location method, and the mean deviation (MD) of whole, superior, and inferior IVF was calculated. We analyzed the correlations between subscales of the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) and each calculated MD using Spearman correlation. After adjusting for confounding factors of age, visual acuity of the better eye, number of medications, and education level, the impact of IVF loss on the composite score of the NEI VFQ-25 was evaluated using multivariate linear regression analysis. RESULTS: The MDs of whole and inferior IVF were significantly associated with 7 of 12 NEI VFQ-25 subscales, and the superior IVF was associated with 3 subscales (p < 0.05). After adjusting confounding variables, the composite score of the NEI VFQ-25 showed significant correlation with whole, superior, and inferior IVF. The adjusted R2 and beta coefficient of the regression line were highest in the whole IVF (Adjusted R2 = 0.451, beta = 1.12), followed by the inferior and superior IVF (Adjusted R2 = 0.438, 0.395, beta = 0.95, 0.85). CONCLUSIONS: The IVF of Korean NTG patients can effectively reflect patient QOL, and the inferior IVF was significantly associated with more subscales of NEI VFQ-25 than was the superior IVF. However, overall QOL of patients is thought to be determined by severity of visual field loss rather than its location.

A Case of Autologous Tragal Perichondrium Graft in a Patient with Mooren's Ulcer

PURPOSE: To report the effectiveness of an autologous tragal perichondrium graft for an active Mooren's ulcer. CASE SUMMARY: A 49-year-old male was referred to our clinic with Mooren's ulcer in his left eye. On the first visit, the ulcer involved the entire 360 degrees of the peripheral cornea and the visual acuity was 0.04. As the ulcer did not respond to medical treatment and progressed rapidly, the authors decided on surgical treatment. First, the involved cornea and nearby conjunctiva were removed and the defect was successfully reconstructed with autologous tragal perichondrium and allogenic limbal graft. The progression of corneal ulceration ceased after surgery and the patient's symptoms remarkably improved. Additionally, the graft showed rapid vascularization and engraftment within a week. However, as the opacity evolved and progressed to the central cornea, penetrating keratoplasty (PKP) was performed 5 months after the perichondrial graft. There was no rejection and corneal translucency was kept clear with low-dose steroid eye drops until 6 months after PKP without any sign of limbal deficiency. The patient's final best corrected visual acuity was 0.125. CONCLUSIONS: The present study shows that autologous tragal perichondrium graft is an effective method of treatment for active Mooren's ulcer by defect reconstruction and results in survival of the co-transplanted graft as well as maintaining corneal functions.

Measurement of Volume of a Swallow for Liquid Swallowing in Healthy Young Adults

PURPOSE: The aim of this study is to estimate one mouthful volume in a single swallow and average volume per swallow (AVS) in multiple swallows in the situation of toxic liquid poisoning. METHODS: Thirty five men and 35 women were included in this study. Each subject was asked to drink one swallow and three consecutive swallows from bottle containing water and a bottle containing saline separately. We calculated one mouthful volume in a single swallow and AVS in three swallows. One mouthful volume and AVS were compared according to sex and content, respectively. One mouthful volume of water and saline was then compared with AVS of each. RESULTS: Sixty seven adults(34 men; 26.9+/-3.2 years, 33 women; 25.6+/-2.4 years) completed the study. Men had larger one mouthful volume of water(49.1+/-19.9 ml vs 39.7+/-10.2 ml, p=0.02) and saline(20.7+/-10.9 ml vs 14.0+/-4.6 ml, p=0.004) and AVS of water(28.5+/-11.9 ml vs 21.5+/-5.9 ml, p=0.004) and saline(11.9+/-6.3 ml vs 7.9+/-2.0 ml, p=0.001) than women. One mouthful volume and AVS of saline swallow were lower than those of water swallow. AVS of three consecutive swallows was lower than one mouthful volume in water and saline swallow. CONCLUSION: We suggest that one mouthful volume in a single swallow is 21 ml in men and 14 ml in women and AVS in multiple swallows is 12 ml in men and 8 ml in women. AVS in multiple swallows is two-threefold lower than reference values(20~30 ml) commonly used in poisoning study.

Preventable Trauma Deaths Rates and Management Errors in Emergency Medical System in Korea

PURPOSE: The objectives of this study were 1) to estimate the preventable death rate in emergency medical system in Korea 2) to determine factors that affect preventability of trauma deaths 3) to identify management errors involved in preventable deaths. METHODS: The records of a 202 patients who died in the emergency departments or shortly after admission due to trauma at nine hospitals in three regions between from July 1, 2003, to June 30, 2004 were retrospectively reviewed by nine board certified physicians in emergency medicine using professional panel study methodology. Each panelist independently reviewed prehospital records, medical records, x-ray films, and inter-hospital transfer records using a structured survey format and preventability was determined by a unanimous agreement rule. The management errors that contributed to a preventable death were determined and classified as "structure-related"and "process-related"errors. RESULTS: Preventable deaths related to all management errors account for 39.6% of all trauma deaths. Whereas, 25.7% of preventable deaths were related to management errors in the studied hospitals. The preventability of trauma deaths were determined by the cause of death and the severity of injury. A total of 389 management errors are identified. Management errors occurred mostly in emergency departments (51.1%) and, in prehospital delivery (21.8%). Most of these errors were found to be processrelated (81.2%) rather then structure-related (18.8%). CONCLUSION: Preventable death rates in Korea are higher than other developed countries, which implies there is much to be improved in the quality of emergency medical services. We found this to be true especially, for processrelated errors, which need to be regularly assessed, and policy established that reduces preventable deaths.

Metal Fume Fever: A case report

Metal fume fever is a relatively uncommon presentation at the emergency department. It is an acute self-limited illness induced most commonly by inhalation of zinc-oxide fumes. However, it is often misdiagnosed as a viral illness because its symptoms resemble a number of pulmonary illnesses. We report the case of a 37-year-old male presenting with metal fume fever. The literature is reviewed with respect to the toxicopathophysiology, clinical presenting symptom complex, and emergency department management of metal fume fever.

Clinical Analysis of Intact Bridge Mastoidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE: Open cavity and closed cavity tympanomastoidectomy each has both advantages and disadvantages. In order to optimize advantages while reducing or eliminating disadvantages, intact bridge mastoidectomy was developed. The intact bridge mastoidectomy operation can similarly be thought of as a modified radical mastoidectomy. MATERIALS AND METHODS: Intact bridge mastoidectomy was performed in 48 ears from 1987 to 1998. To evaluate the results of intact bridge mastoidectomy, 48 cases were reviewed retrospectively. RESULTS: Among 48 patients, 24 (50%) were chronic otitis media and 12 (25%) were cholesteatomatous chronic otitis media. The methods of tympanoplasty were as follows : 11 cases of type I tympanoplasty (23%), two cases of type II tympanoplasty(4%), 21 cases of type III tympanoplasty (44%), and 14 cases of type IV tympanoplasty (29%). Postoperative air-bone gaps were improved by 12 dB in non-cholesteatoma group, and 0 dB in cholesteatoma group. The average healing period was 13.6 weeks, with 80% being healed within a period of 4 months. Postopertative complications were as follows : one case of cholesteatoma, two cases of tympanic membrane perforation, one case of wound infection, and two cases of pocket retraction. CONCLUSIONS: Although the hearing gain was not impressive, intact bridge mastoidectomy allowed adequate visualization for eradication of pathologic tissue, and desirable anatomic configurations for ossiculoplasty and tympanoplasty.

Auditory Late Response (ALR) and P300 in normal adults / 대한이비인후과학회지

BACKGROUND: Auditory evoked potentials (AEPs) have assumed an essential role in the clinical practice of auditory and several other professions. AEP classification and nomenclature systems are generally based on such aspects as the time domain (short, middle, long), anatomic origin, stimulus-response relationship. The P300 component of the human event related potential is an endogenous positive wave with a latency of 300msec or greater. OBJECTIVES: Our purpose of this study was to estimate normal values of auditory late response (ALR) and P300 in adults and use them in mapping of the brain. MATERIALS AND MEHTODS: An auditory evoked potential was performed on 40 normal adults, and a scalp surface electrode with 30 electrodes was attempted. Forty adults with normal hearing were divided into 2 groups, one consisting of thirty persons under 30 years of age and the other consisting of ten persons over 30 years of age. RESULTS: The latencies of P1, N1, P2, N1-P2 were 53.17 +/- 19.57 msec, 98.25 +/- 32.68 msec, 166.12 +/- 44.0 msec, 65.12 +/- 23.68 msec, respectively, in the whole group and 54.23 +/- 20.86 msec, 98.7 +/- 34.35 msec, 160.93 +/- 44.02 msec 62.23 +/- 25.36 msec, respectively, in the group under 30 years old, and 50.0 +/- 15.57 msec, 96.9 +/- 28.69 msec, 181.7 +/- 42.28 msec 73.8 +/- 15.69 msec, respectively, in the group over 30 years old. The P300 latencies for the whole group and the two groups were 299.37 +/- 34.01 msec, 295.16 +/- 33.36 msec, 312.0 +/- 34.49 msec, respectively. There was no significant difference in the latency and amplitude of the ALR and P300 between the two groups (p>0.05). CONCLUSION: ALR and P300 were measured in 40 normal adults. Description of the normal topography of P300 may facilitate the examination of the P300 topography in cognitive disorders. Such an examination might help ALR and P300 to serve as better diagnostic tools of cognitive disorder in adults.

Capnographic Monitoring for Acute Asthma in the Emergency Department Setting

BACKGROUND: The capnographic curve indices, such as the slope of expiratory upstroke or alveolar plateau quantified by using the waveform of the capnogram, are correlated with obstructive airway disease. Some studies also have shown good correlations between these indices and FEV1 or PEFR, which are objective measurements for the classification of severity in asthma. We performed this study to suggest the feasibility of using expiratory capnography for monitoring asthmatic subjects in emergency departments(ED). METHODS: One hundred adult patients diagnosed with bronchial asthma were enrolled in this study. Using main-stream-type capnography(ULTRA CAP, Nellcor, USA), the angles alpha and Q on the capnographic trace were measured; then, the slope of expiratory upstroke(S1) was calculated. Patients were allocated by using the classifying severity of asthma exacerbation of the National Asthma Education and Prevention Program(NAEPP), and the capnographic indices were compared. A measured values of the angle Q for all patients were classified into 3 categories by the percentile; then, the correlation between the category of the angle Q and the classifying severity was analyzed. RESULTS: There were significant differences in the angle Q according to the severity of the asthma. Also, there was a significant correlation between the category of the angle Q and the classifying severity of asthma exacerbation. CONCLUSION: This study suggests that expiratory capnography would be a useful monitoring technique for adult asthmatic patients and for the triage of asthmatic patients in an ED setting, provided the capnographic indices are measured as rapidly as possible. Therefore, we look forward to the development of a computerized analysis program for easy measurement and quantification of capnographic indices.

Acute Pancreatitis Following Organophosphate Intoxication: Analysis of 6 Cases

Acute pancreatitis as a complication of organophosphate intoxication has been infrequently addressed. Previous reports have suggested that acute pancreatitis may follow the oral ingestion of several organophosphates. The pathogenesis of this pancreatic damage has been studied in a few animal studies. However, the association between acute pancreatits and human organophosphate intoxication may still not be widely recognized. We experienced 6 cases described as hyperamylasemia and hyperlipasemia with a presumptive diagnosis of acute pancreatitis following organophosphate intoxication, and we analyzed them to provide human baseline data for further studies and patient management. We report these case series with an analysis and a literature review.

A study of the current ethical situation in organ transplantations in Korea / 간호학회지

This primary study was done to develop an ethical guideline for organ transplantation, a life-saving treatment which helps improve the quality of life. This study tried to identify the current situation in Korea, in terms of ethical considerations in organ transplantations. This study collected basic data in organ transplantations, in the hope that procedure of organ transplantations could be developed that would be fair to both organ donors and recipients. The immediate goals of this study were : 1)to identify staff in charge of organ transplantations and their jobs in the hospital, 2) to survey whether there exists a Hospital Ethics Committee(HEC), 3) to research what consideration are formally taken in selecting recipients, and 4) to accumulate data on how consent from donors are currently obtained. The study used a survey questionnaire and received responses from 31 hospitals out of 45 hospitals where organ transplantation are being done. Organ transplantation coordinators were found in 16 hospitals, but the job description varied among hospitals. The survey showed that all 16 hospitals with and HEC that health care personnel unnecessarily dominate the committee. The study notes that HECs should be vitalized by recruiting, as members, ethicists, theologians, patients, guardians, as well as the general public outside of the hospital. The study revealed that in selecting recipients the hospital take into account ABO blood type, histocompatibility, age, waiting time, and level of patient compliance. Finally, it was shown that in the cases of living donors the transplanting hospitals seek a formal consent, whereas there are no common consenting practice established for cadaveric donors. The study concludes with three proposals. First, a nationwide institution responsible exclusively for procurement and distribution of cadaveric organs for transplantation should be established. Second, we should rebuild the national health insurance system so that have costly organ transplantation expenses are substantially covered. Last, but certainly not least, there is a need to emphasize the HEC's committment to prepare a proper ethical guideline for organ transplantation in general.

Organ Transplantation and Biomedical Ethics: An Analysis of Hospital Organ Transplantation Policy and a Proposal of Ethical Guideline / 대한이식학회지

AIMS: This study was done to develop an ethical guideline for organ transplatation, a life-saving treatment which helps improve the quality of life. METHODS: This study begins with a survey of the Korean current state of affairs concerning organ transplantation. This study used a survey questionnaire and received responses from 31 hospitals out of 45 hospitals where organ transplantation are being done. After this survey, followed by a discussion of ethical considerations in arranging organ transplants. Before proposing an ethical guideline, this study discusses a series of interesting ethical issues in transplanting(both living and cadaveric)organs including ethical foundations of organ transplantation, distributive justice and matters of donor's consent in organ transplatation. RESULTS: The foremost research for this study boils down to a survey paper titled, "An Analysis of the Current State of Affairs Concerning Organ Transplantation and Ethical Considerations in Domestic and International Hospitals." Based upon data collected from various hospitals, this work analyzes items, such as the frequency and types of organs transplanted in a hospital, the existence of organ transplant coordinator, the performance of the hospital ethics committee, and ethical considerations in obtaining consents from the living donor. Although thousands of organs are annually transplanted in domestic hospitals, virtually none of them are found to meet ethically proper standards. The paper points out the need to institutionalize a nationwide cadaveric organ distribution organization like UNOS(United Network for Organ Sharing) in the U.S., and proposes to stretch out the national health insurance to extensively cover transplanting expenses. "The Ethical Foundation of Organ Transplantation", the author counts three key ethical principles in organ transplantation: the principle of respect for autonomy; the principle of beneficence; and the principle of justice. He argues that in cases of living donor no principle should take precedence over the principle of respect for autonomy and thus it is very important for a hospital to obtain the donor's consent. As for cadaveric organ transplantation, he holds reservation because he is worried that serious shortage of organs for transplantation in conjunction with pure utilitarian considerations could change the definition of death so that the brain death gains more popularity than ever. In addition, the author claims that the proponent of organ transplantation must distinguish the moral dimension of the discussion from the legal one because otherwise she would hardly be able to defend herself from the slippery slope argument against organ transplantation. This paper concludes with a note that we must implement restrictions to avoid undesired effects if organ transplantation could ever be justified. "A Discussion of Distributive Justice in Organ Transplantation" comprises two parts. The first half delineates above mentioned ethical principles in the context of organ transplantation, while the second half goes generally over the UNOS Point System. This work is focused entirely upon cadaveric organ transplants, because the vast majority of organs available for transplants comes from cadavers and the number is still increasing. The UNOS allocates cadaveric organs based upon both medical and justice criteria. Following are summaries of the UNOS policy on organ distribution. Every potential recipient of organ transplants must be listed on the UNOS computer system waiting list. Allocation of cadaveric kidneys consider factors such as waiting time, six antigen match, panel reactive antibody, blood group and age. The UNOS Point System allocates livers to the local patients first, followed by regional and national patients respectively, in order to limit ischemic time. A recipient of liver transplant belongs to one of five(0~4) medical status levels where status 4 is the most medically urgent. At the regional and national levels pancreas are allocated first to patients with excellent HLA matches, while at the local level waiting time is the sole factor. The intestinal organ allocation system is based on two(1~2) patient status codes, ABO blood type identity and time waiting. In heart or lung tranplants ischemic time seriously matters. "A Biomedical Study of Informed Consent from the Organ Donor" investigates several topics: the relevance of the principle of respect for autonomy as the basic principle of informed consent; how the autonomy of the organ donor to be respected; and the role of the hospital ethics committee in obtaining informed consent from the donor. The author finds the principle of respect for patient's autonomy not sufficient for the basic principle of the living donor's informed consent because there is some danger in which the patient may be left uncared-for, and thus she suggests that the principle of nonmaleficence and the principle of care also be considered. That the principle of respect for autonomy turns out not sufficient even for cadaveric organ donation, and so judgment based upon the best interest of the deceased may seem appropriate for people from some special groups. A medical team must make efforts to identify the donor's competence and voluntariness, i.e., preconditions of informed consent. All the relevant medical information should be disclosed to the living donor. Once the donor makes a judgment, medical experts should respect the donor's decision. This article puts an emphasis on the role of the hospital ethics committee in such activities as identifying donor's voluntariness, confirming the disclosure, and evaluating the minority's benefit. The last work in this paper, "A Moral Theological Investigation of the Presumed Consent in Organ Transplantation" talk about Principium Riflexum(the principle of reflection) in an attempt to explain the possibility that we may harvest cadaveric organs from the deceased who while alive had never expressed their wishes concerning organ donation. To apply the principle in the context of presumed consent, the author, a Catholic priest, introduces two elements of the principle. Probabilismus allows us to feel free to choose when we face dubious matters(in dubio libetas), and by the rule of selection we are justified in choosing whatever our consciousness mandates. He takes both elements to support the presumed consent of the deceased because he believes the good that people may contribute to their neighbors by donating organs would obviously override opposing reasons. Although the author argues for the presumed consent from the deceased, he does not overlook the family grief in donating the cadaveric organs. He concludes with a suggestion that we should work to keep the public aware of cadaveric organ donation and to form public opinions education should play a key role. CONCLUSION: Researcher suggest an Ethical Guideline for Organ Transplantation as our study conclusion. 1) Body organs may be transplanted to protect the health and well-being of the patient, but not for the medical or scientific research. 2) Body organs may be taken for transplantation, only with the consent from the donor. In cases of cadaveric donors who have left no formal consent in the lifetime, they are to be presumed to refuse to donate body organs. 3) In principle, cadaveric transplantation is preferred. Living donors are limited to competent adults who have blood ties with the patient, e.g., parents, children, or siblings of the patient. However, reversible tissue like bone marrows donation may be an exception to this limitation. In particular, no living donors may be put under inappropriate pressure or influences. Body organs may be taken from the living donor only if based upon sufficient and easy-to-understand information provided, the donor voluntarily consents after (s)he deliberately balances benefits against harm. 4) Under no circumstances human bodies, organs, or tissues may be sold or purchased for transplantation. A physician should not participate in any transplanting operations if (s)he becomes to know that the transplant has been obtained through a transaction. 5) Recipients of organs for transplantation should be determined in accordance with the principle of justice on the allocation of limited medical resources. 6) When a vital, single organ is to be transplanted, the death of the donor shall have been determined by at least one physician other than the recipient's physician. 7) Transplant procedures of body organs should be undertaken (a) only by physicians who possess special medical knowledge and technical competence developed through special training, study, and laboratory experience and practice, and (b) in medical institutions with adequate facilities. 8) All decision procedures in transplanting body organs should be objective, open to parties involved, kept accurately on record, and maintained for a given period of time.

Paget's Disease of Bone: 1 Case Report / 대한정형외과학회잡지

Paget's disease is a disorder of middle or older aged persons in which abnormal osteoclastic and osteoblastic activity spontaneously occurs within the affected portion of any particular bone or bones. This causes a gradual gross structural alteration through continuous remodeling. The occurance of Pagets disease is extremely rare in China, Japan, Middle East, and Africa. We have experienced one case of Paget's disease of bone affecting the spine and femur, which is reported in this paper with brief review of literature.

Lumbar Epidural Venography in the Diagnosis of Lumbar Disc Herniation / 대한정형외과학회잡지

Epidural venography is a relatively simple and highly accurate method in the diagnosis of lumbar disc herniation. Angiographic visualization of the epidural vein has been tried and investigated by intraosseus injection of contrast agent into lumbar spinous process and intravascular injection into iliac vein since first report in 1954. Recently, lumbar epidural venography is instituted by selective catheterization of ascending lumbar vein or internal iliac vein. Lumbar epidural venography is valuable for the diagnosis of herniated lumbar disc, not demonstrated by myelography. Especially, lumbar epidural venography is more accurate than myelography in the diagnosis of L5-Sl disc herniation and in the case of extreme lateral herniation. Other advantages of epidural venography are low incidence of complication and ease of performance. Epidural venography may be recommended as an alternative rnethod rather than as adjunctive to myelography. We report 20 cases of epidural venography, compared with myelographic and operative findings.