The Relationship between Opioids Use, Cortisol and DHEAS / 한국호스피스완화의료학회지

PURPOSE: Fatigue, energy loss, feeling of helplessness, poor appetite, pain besides general weakness are major symptoms presented to terminally ill cancer patients. These symptoms are similar to those that appeared with adrenal insufficiency. Also, for terminally ill cancer patients who are hospitalized for palliative care, opioid agents are prescribed to control moderate to severe pain. We studied the relationship of opioid agents and adrenal insufficiency. METHODS: From November 2013 through June 2014, we monitored the serum level of cortisol and dehydroepiandrosterone sulfate (DHEAS, serum) in 55 cancer patients who were over 18 years old and were treated at a hospice center. We also checked the treatment period and dosage of opioid agents. RESULTS: The DHEAS level, treatment period and dosage of opioid agents did not have significant correlation. Correlation between the serum cortisol level and the opioid agent treatment period was not significant either, but the serum cortisol level was positively correlated with the dosage of opioid agents (P value 0.0322). CONCLUSION: This study did not identify a novel link between treatment period, dosage of opioid agents and adrenal insufficiency. But, the DHEAS level was mostly below the normal level in patients who were treated with opioid agents.

Posterior Double PCL Sign; A Case Report of Unusual MRI Finding of Bucket-handle Tear of Medial Meniscus: A Case Report / 대한정형외과학회잡지

Among the MRI signs of meniscal bucket handle tears, a double posterior cruciate ligament (PCL) sign manifests on the sagittal images as a low signal band anterior and parallel to the PCL. The mesially displaced fragment may be confined to the intercondylar notch. However, the torn fragment is rarely displaced to the posterosuperior region of the PCL. If it does occur, separation at the anterior horn may be assumed. We propose this type of lesion be called the posterior double PCL sign in contrast to the ordinary double PCL sign. We present a case showing the 'posterior double PCL sign' accompanying an anterior cruciate ligament injury.

Early Loosening of Femoral Component after Primary Total Knee Arthroplasty : Report of 4 Cases

The mechanism of the loosening after arthroplasty is considered that micromotion makes a gap between implant and bone, the subsidence of implant and osteolysis around the implant. The loosening of femoral component after total knee arthroplasty(TKA) might be related to the improper support of posterior condylar area, the causes of which may be inaccurate osteotomy, improper cementing technique and poor bone quality, etc. The authors found four cases of flexed displacement and osteolysis around the femoral component after TKA. The types of implant were one case of PS type and three cases of High Flex PS type. Revision arthroplasty was done in three patients who had severe clinical symptoms with diffuse bone loss around the distal femur. We evaluated the mechanism of the early loosening by clinical and radiologic assessment of four patients.

The Reverse Sural Artery Flap for Soft Tissue Defect of Foot and Ankle in Diabetic Patient / 대한정형외과학회잡지

PURPOSE: A reverse sural artery flap is a useful method for the soft tissue coverage of the lower leg, around the foot and ankle. We present our experience with the reverse sural artery flap for the coverage of a soft tissue defect due to ulceration, necrosis, and trauma in diabetic patients. MATERIALS AND METHODS: We treated 5 diabetic patients who showed soft tissue defects around their lower leg, foot and ankle. The causes of the soft tissue defect were an ulcer and infection in 4 cases, and trauma in 1 case. The sites of the soft tissue defect were around the ankle in 2 cases. In the other cases, the defect site were the lower third of the leg, the hind foot, the foot dorsum. The mean follow up period was 12.4 months. The size of the soft tissue defect ranged from 4 x 3 cm to 15 x 10 cm. RESULTS: All the flaps survived. The donor site was covered with a split thickness skin graft. There was no recurrence of the soft tissue defect during the follow-up period. Conclusion: The reverse sural artery flap is a valuable method for covering certain types soft tissue defect of foot and ankle in diabetic patients.

Diffuse Idiopathic Skeletal Hyperostosis Associated with Dysphonia and Dysphagia: A Case Report / 대한척추외과학회지

We encountered a rare case of diffuse idiopathic skeletal hyperostosis (DISH) associated with dysphonia and dysphagia. An 80 year-old man developed progressive dysphonia and dysphagia. The radiology study, esophagogram and nasopharyngoscopic exam revealed the esophagus and the posterior wall of the nasopharynx to be severely compressed by the unfused osteophyte of the 3rd and 4th cervical intervertebral space. It was thought that the osteophyte formation was caused by not merely DISH but degenerative changes due to a concentration of stress around the unfused hyperostosis. A resection of the osteophyte was performed, which resolved the clinical symptoms. The follow-up radiology study, esophagogram and nasopharyngoscopic exam showed that the osteophyte had disappeared.

The Efficacy of Bimodality Therapy for Organ Preservation in Locally Advanced Bladder Tumor / 대한비뇨기과학회지

PURPOSE: We evaluate the efficacy of bimodality therapy for organ preservation in locally advanced bladder tumors. MATERIALS AND METHODS: A total of 23 patients with a clinical stage T2- T4aN0M0 bladder tumor were included in our study and treated with transurethral resection or partial cystectomy by chemotherapy. They are composed of T2: 6, T3: 11, T4a: 6 cases in stage, W.H.O. LMP (low malignant potencial): 1, low grade: 9, high grade: 13 cases in pathologic grade. The followed chemotherapy regimens were composed of M-VAC (methotrexate 30mg/m2, vinblastine 3mg/m2, adriamycin 30mg/m2, cisplatin 70mg/m2), S-MEC (methotrexate 30mg/m2, epirubicin 50mg/m2, cisplatin 100mg/ m2), and gemcitabine (100mg/m2)-cisplatin (70mg/m2) in 10, 8, and 5 cases, respectively. The evaluation of response was performed by transurethral biopsy, urine cytology, CT, and MRI after more than 4 cycles of postoperative chemotherapy. RESULTS: A complete response was achieved in 10 patients (43.5%), and a partial response occurred in 3 patients (13.0%) to give an overall response rate of 56.5%. The mean duration of complete responses was 35.5 months. Eight of 23 patients are still alive. The mean duration of the follow-up was 41.6 months, and their 5-year survival rate was 33.3%. Low stage, initial response to therapy, and no evidence of hydronephrosis were all significant predictors for an increased probability of organ preservation. CONCLUSIONS: Transurethral resection or partial cystectomy followed by chemotherapy result in long-term bladder preservation in a significant proportion of responding patients, and may be a comparable therapy to trimodality therapy in select patients in locally advanced bladder tumors.

The Effects of Various Stressful Conditions on Erection and Manifestation of Oxytocin Positive Neuron of Apomorphine in Mice / 대한비뇨기과학회지

PURPOSE: The aim of this study was to demonstrate whether various stressful conditions have effects on the erection and manifestation of oxytocin positive neurons of the paraventricular nucleus (PVN) in mice. MATERIALS AND METHODS: Thirty, 10-weeks old mice were divided into 4 groups: control (A), stress only (B), apomorphine only (C) and apomorphine with stress treated (D) groups. Chronic restraint and forced swimming stresses were induced. Apomorphine (80ug/kg) was subcutaneously injected every 3 days, and after 14 days the brains of the mice were extracted, and treated with immunohistochemistry. The data were analyzed by optical density and Student's t-test. RESULTS: One of group D was died of excessive stress. The erection rates of groups C, D, A and B were 80, 64, 20 and 0%, respectively. The number of oxytocin-positive neurons in the PVN of groups C, A, D and B were 215, 205, 201 and 190, respectively (p=0.07). The optical density of the oxytocin-positive neurons of the erection group was significant higher than that of the non-erection group (125 vs. 105, p<0.01). CONCLUSIONS: The erectile function was decreased under stressful condition, which was improved by administration of apomorphine. Apomorphine has a relationship with the oxytocin-positive neurons in the PVN; therefore, it is one of the important factors in inducing an erection.

In vitro evaluation of fracture resistance of various thickness fiber-reinforced composite inlay fpd / 대한치과보철학회지

STATE OF PROBLEM: In dentistry, the minimally prepared inlay resin-bonded fixed partial denture (FPD) made of new ceromer / fiber-reinforced composite (FRC) was recently introduced. However, the appropriate dimensions for the long-term success and subsequent failure strength are still unknown. PURPOSE: The aim of this study was to investigate the most fracture-resistible thickness combination of the ceromer / FRC using a universal testing machine and an AE analyzer. MATERIAL AND METHODS: A metal jig considering the dimensions of premolars and molars was milled and 56-epoxy resin dies, which had a similar elastic modulus to that of dentin, were duplicated. According to manufacturer's instructions, the FRC beams with various thicknesses (2 to 4 mm) were constructed and veneered with the 1 or 2 mm-thick ceromers. The fabricated FPDs were luted with resin cement on the resin dies and stored at room temperature for 72 hours. AE (acoustic emission) sensors were attached to both ends, the specimens were subjected to a compressive load until fracture at a crosshead speed of 0.5 mm/min. The AE and failure loads were recorded and analyzed statistically. RESULTS: The results showed that the failure strength of the ceromer / FRC inlay FPDs was affected by the total thickness of the connectors rather than the ceromer to FRC ratio or the depth of the pulpal wall. Fracture was initiated from the interface and propagated into the ceromer layer regardless of the change in the ceromer / FRC ratio. CONCLUSION: Within the limitations of this study, the failure loads showed significant differences only in the case of different connector thicknesses, and no significant differences were found between the same connector thickness groups. The application of AE analysis method in a fiber-reinforced inlay FPD can be used to evaluate the fracture behavior and to analyze the precise fracture point.

Capsular Imbrication and Bankart Repair in Traumatic Anterior Shoulder Instability : Effect of Subscapularis Tendon Division on Internal Rotator Strength and Shoulder Function / 대한정형외과학회잡지

PURPOSE: To evaluate the function of the shoulder and the effect of the division of the subscapularis tendon on the strength of the inter-nal rotator after capsular imbrication and Bankart repair. MATERIALS AND METHODS: From January, 1996 to December, 2000, we reviewed thirty cases of traumatic anterior shoulder instability, which underwent capsular imbrication and Bankart repair. The follow up period was minimally one year. The clinical results were evaluated using the ASES (American Shoulder and Elbow Surgeons) score and the muscle power of the internal rotator as measured by a myometer. RESULTS: All cases showed satisfactory results; nineteen cases (63%) were excellent, and eleven cases (37%) were good. Mean value of ASES score increased from 78.6 (60-82) ponts to 94.5 (84-100) points. Mean value of the score increased was 16 (14-38) points. Postoperatively, the muscle power of the internal rotator compared with contralateral was increased in 12 cases (40%), decreased in 17 cases (57%), and was the same in one case (3%). There was no cases of deterioration of function, recurrence or requiring revision surgery. CONCLUSION: In capsular imbrication and Bankart repair, the division of the subscapularis tendon did not produce a significant adverse effect in the strength of the internal rotator. We believe that this is one of the useful treatment methods in traumatic anterior shoulder insta-bility, because it provides stability and a good range of motion.

Efficacy and Toxicity of Gemcitabine Based Chemotherapy for Advanced Urothelial Cancer / 대한비뇨기과학회지

PURPOSE: To evaluate the response and toxicity of gemcitabine and cisplatin combination chemotherapy in advanced transitional cell carcinomas. MATERIALS AND METHODS: Twenty two patients with advanced transitional cell carcinoma received gemcitabine combined chemotherapy. Nineteen of them were scheduled to receive 1,000mg/m2 gemcitabine intravenously for 30 minutes on days 1, 8, and 15 and 70mg/m2 cisplatin for 1 hour on day 1 of a 28-day cycle. In addition, 3 patients with decreased renal function were scheduled to receive 1,200mg/m2 gemcitabine on day 1, 8, and 15. The toxicity of each cycle and the response after more than 4 cycles were evaluated. RESULTS: There were 5 complete responses and 4 partial responses in the 15 assessable patients, giving an overall response rate 60%. The toxicity was primarily hematologic, with 3 out of 22 patients (14%) with grade 3 thrombocytopenia, 10 out of 22 patients (45%) with grade 1 & 2 leukopenia and 10 out of 22 patients (45%) having grade 1 & 2 anemia. The most common non-hematologic toxic response was nausea and vomiting. CONCLUSIONS: Gemcitabine based chemotherapy for advanced transitional cell carcinoma has larger response rate compared to M-VAC. Furthermore, it has much less systemic toxicity than M-VAC combination chemotherapy.

Seminal Vesicular Cyst Causing Recurrent Epididymitis / 대한비뇨기과학회지

A case history is presented of a seminal vesicular cyst which caused recurrent epididymitis in a young boy. Seminal vesicular cyst is an uncommon disorder and is usually asymptomatic. Endoscopic cannulation of the cyst has been found to be the most useful diagnostic test. At first, the patient was managed by dilation of the orifice of ejaculatory duct in order to facilitate drainage. However, he suffered from incontinence and sustained retrovesical cystic mass. We therefore excised the seminal vesicular cyst by transvesical approach.

Testis Tumor: A Review of 42 Cases / 대한암학회지

PURPOSE: This study was performed in order to evaluate the clinical characteristics, effect of treatment and prognosis in patients with testicular tumors. MATERIALS AND METHODS: We retrospectively reviewed 42 patients with testicular tumor treated at our hospital. We analyzed the pathologic classification, clinical stage, preoperative tumor markers, treatment methods, clinical characteristics, and prognosis. RESULTS: The histologic type was seminoma in 11, teratoma in 10, yolk sac tumor in 5, embryonal cell carcinoma in 4, mixed type in 8 and secondary neoplasm in 4. Clinically, 31 patients were stage I, 2 stage IIa, 2 stage IIb, 1 stage IIc, 6 stage IV. Following orchiectomy, 22 patients underwent surveillance, 12 chemotherapy, 4 radiation therapy, 1 retroperitoneal lymph node dissection (RPLND), 2 radiation plus chemotherapy, and 1 radiation plus chemotherapy and RPLND. The 10-year survival rate was 90.9% in the cases of seminoma. Similarly, the 10-year survival rate was 96.0% in the cases of non-seminomatous germ cell tumors (NSGCT). CONCLUSION: In our study, patients with testicular tumor revealed an excellent survival rate. Testicular tumors are solid tumors that have a possibility of complete remission by additional chemotherapy or radiation following radical surgery. Therefore, early detection and aggressive treatment were mandatory.