Consensus Document on Perioperative Antithrombotic Management: Part 1. A Review / 대한내과학회지

The prevalence of ischemic heart disease is steadily growing as populations age. Antithrombotic treatment is a key therapeutic modality for the prevention of secondary cerebro-cardiovascular disease. Patients with acute coronary syndrome or who are undergoing percutaneous coronary intervention must be treated with dual antiplatelet therapy for a mandatory period. The optimal perioperative antithrombotic regimen remains debatable; antithrombotics can cause bleeding. Inadequate antithrombotic regimens are associated with perioperative ischemic events, but continuation of therapy may increase the risks of perioperative hemorrhagic complications (including mortality). Many guidelines on the perioperative management of antithrombotic agents have been established by academic societies. However, the existing guidelines do not cover all specialties, nor do they describe the thrombotic and hemorrhagic risks associated with various surgical interventions. Moreover, few practical recommendations on the modification of antithrombotic regimens in patients who require non-deferrable interventions/surgeries or procedures associated with a high risk of hemorrhage have appeared. Therefore, cardiologists, specialists performing invasive procedures, surgeons, dentists, and anesthesiologists have not come to a consensus on optimal perioperative antithrombotic regimens. The Korean Platelet-Thrombosis Research Group presented a positioning paper on perioperative antithrombotic management. We here discuss commonly encountered clinical scenarios and engage in evidence-based discussion to assist individualized, perioperative antithrombotic management in clinical practice.

Consensus Document on Perioperative Antithrombotic Management: Part 2. Case Study / 대한내과학회지

Given the progressive improvements in antithrombotic strategies, management of cardiovascular disease has become sophisticated/refined. However, the optimal perioperative management of antithrombotic therapy in patients with acute coronary syndrome or who are scheduled for percutaneous coronary intervention remains unclear. Assessments of the thrombotic and hemorrhagic risks are essential to reduce the rates of mortality and major cardiac events. However, the existing guidelines do not mention these topics. This case-based consensus document deals with common clinical scenarios and offers evidence-based guidelines for individualized perioperative management of antithrombotic therapy in the real world.

Spontaneous Coronary Artery Dissection Mimicking Coronary Spasm Diagnosed by Intravascular Ultrasonography

Spontaneous coronary artery dissection (SCAD) is a rare and occasionally life-threatening cause of acute coronary syndrome. Patients may present with clinical scenarios ranging from angina pectoris to cardiogenic shock to sudden cardiac death, and it may be a potentially life-threatening condition if not recognized. However, its etiology, pathophysiology and optimal therapeutic strategies have not been well understood. SCAD is diagnosed on the basis of coronary angiography, but complementary techniques as such intravascular ultrasound (IVUS) and optical coherence tomography should be considered for diagnostic clarification where appropriate. Likewise, the selection of treatment strategy depends upon the clinical manifestation, location and the extent of dissection and amount of ischemic myocardium at risk. Herein, we present the case of a 35-year-old woman who presented with acute myocardial infarction. She was diagnosed by IVUS with spontaneous diffuse dissection of the left anterior descending artery without atheroma, treated with percutaneous coronary stenting, and had a favorable clinical course and was discharged on medical therapy.

Inter- and Intra-observer Variability of a Cervical OPLL Classification Using Reconstructed CT Images

BACKGROUND: The lateral radiograph-based system described by Tsuyama is used widely to classify ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. However, OPLL is a complex 3-dimensional (3-D) lesion, not a simple and uniplanar one, which is often difficult to identify on a lateral radiograph. Furthermore, its reliability among spine surgeons has not been investigated. Given the popularity of a reconstructed computed tomography (CT), this study examined the inter- and intra-observer reliability of lateral radiograph-based OPLL classification using that modality. METHODS: Five spine surgeons independently reviewed the lateral radiograph, axial CT, 2-D (sagittal) and 3-D reconstructed CT images of 108 OPLL patients on 2 separate occasions. Based on these images, the reviewers classified each OPLL case according to the Tsuyama's system. The kappa values were used to assess the statistical reliability. RESULTS: The inter- and intra-observer kappa values were only 0.51 and 0.67 for the lateral radiograph, even in combination with the axial CT images, 0.70 and 0.85 for 2-D CT images, and 0.76 and 0.86 for 3-D CT images, respectively. These kappa values showed a good-to-excellent range for the 2-D and 3-D reconstructed CT images while those of the lateral radiograph indicated a fair range. According to the OPLL types, the inter- and intra-observer reliability was low in the continuous type and high in the circumscribed type on the lateral radiograph. However, the low reliability of the continuous type on lateral radiograph was overcome somewhat using 2-D and 3-D reconstructed CT images. CONCLUSIONS: The inter- and intra-observer kappa values were only 0.51 and 0.67 for the lateral radiograph, even in combination with the axial CT images, 0.70 and 0.85 for 2-D CT images, and 0.76 and 0.86 for 3-D CT images, respectively. These kappa values showed a good-to-excellent range for the 2-D and 3-D reconstructed CT images while those of the lateral radiograph indicated a fair range. According to the OPLL types, the inter- and intra-observer reliability was low in the continuous type and high in the circumscribed type on the lateral radiograph. However, the low reliability of the continuous type on lateral radiograph was overcome somewhat using 2-D and 3-D reconstructed CT images.

Factors Affecting Patients' Graft Choice in Anterior Cruciate Ligament Reconstruction

BACKGROUND: Multiple studies have reported that allografts are acceptable alternatives to autografts for anterior cruciate ligament (ACL) reconstructions. Our clinical practice allows patient involvement in graft decision-making. This study examined the patients' preference for graft selection and the factors affecting their decision. METHODS: Patients scheduled to undergo an ACL reconstruction surgery (n = 129) at a university medical center in Korea were enrolled in this study. Information leaflets with graft descriptions were provided prior to hospital admission, and the patients were allowed to choose one of two surgical graft types. The patients were asked to complete a questionnaire that reflected their decision-making processes, and the patients' trends and factors affecting their choice of graft were analyzed based on their responses. RESULTS: Most patients (54.3%) selected autografts for the ACL reconstruction. The surgeon's explanation was the most important factor affecting the final patient decision followed by the information derived from Internet searches. Patients who derived the majority of their understanding of the graft types from the Internet chose allografts at significantly higher rates. CONCLUSIONS: Patient graft selection is a reasonable way of designating the type of surgical procedure. Most patients selected autografts for their ACL reconstruction. However, patients who performed significant Internet-based research tended to prefer allografts.

A study of Smartpeg(TM)'s lifetime according to sterilization for implant stability / 대한치과보철학회지

PURPOSE: Resonance Frequency Analysis(RFA) technique can be used as an effective method in measuring the implant stability and documenting the clinical results. This technique also determines how stable the implant is before performing a prosthetic practice. Having become one the guidelines of the implant therapy whose final objective is the immediate loading, the Osstell(TM) mentor is giving a lot of information to the clinicians recently. In this communication, experiments were performed to investigate how reliable the measured ISQ values by Osstell(TM) mentor are, and to see if those are also stable even after sterilization. As five objectives: 1) How stable measured ISQ values after fixation Smartpeg(TM)s for 400 times. 2) How stable measured ISQ values after 'attach-detach'Smartpeg(TM)s for 400 times. 3) How stable measured ISQ values after clinical sterilization methods. 4) How stable measured ISQ values after repeatedly sterilization in autoclave for 10 times. 5) What is the critical temperature which is lost the magnetism of Smartpeg(TM). MATERIALS AND METHODS: Clinical sterilization methods(Autoclave sterilization, Dentistar sterilization, Ultra violet sterilization, Vacuum dry unit sterilization, Boiling water sterilization, combined H(2)O(2) and Alcohol sterilization). Smartpeg(TM)s. D3 Block bone(3x9x2cm). Osstem implant(phi 4.1-10mm). Osstell(TM) mentor. Individual experiment was used 8 number of Smartpeg(TM)s and they had measured to ISQ values of before experiment and after experiment. RESULTS: 1. The measured ISQ values did not change after fixation Smartpeg(TM)s for 400 times. 2. There was no significant changes in the measured ISQ values of 'attach-detach Smartpeg(TM)s' for 400 times. 3. The measured ISQ values did not change after the usual clinical sterilization methods. 4. The measured ISQ values did not change after sterilization in autoclave for 10 times. 5. It was impossible to exactly measure the critical temperature which is lost the magnetism of Smartpeg(TM)s. But, the results was resulted to lost its magnetism in higher temperature than 150 degrees C/10 minute. CONCLUSION: The measured ISQ values showed insignificant differences in case of no changes in the magnetism of the Smartpeg(TM)s. It seems that the Smartpeg(TM)s can be used repeatedly in every measurement if the original magnetisms of the Smartpeg(TM)s can be recognized. There seems to be no significant changes in the measured ISQ values of 'attach-detach Smartpeg(TM)s' only if the screw pitches were unimpaired. The clinical sterilization methods seems acceptable because the result was resulted to lost its magnetism in higher temperature than 150 degrees C/10minute.

Acute Isolated Pisiform Dislocation: A Case Report / 대한정형외과학회잡지

There are few reports of an isolated dislocation of the pisiform. An isolated dislocation of the pisiform without other injuries involving the carpal bones is particularly uncommon. This type of injury can be neglected in the acute period. We report a case of an isolated dislocation of the pisiform without a carpal bone injury in a young man treated primarily with a closed reduction, pinning and immobilization.

Serum Levels of TGF-beta1, TIMP-1 and TIMP-2 in Patients with Lumbar Spinal Stenosis and Disc Herniation

STUDY DESIGN: The serum levels of transforming growth factor-beta 1 (TGF-beta1), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) and TIMP-2 were measured by enzyme-linked immunosorbent assay. PURPOSE: To compare the serum levels of TGF-beta1, TIMP-1 and TIMP-2 between patients with lumbar spinal stenosis and disc herniation. OVERVIEW OF LITERATURE: It has been reported that increased concentrations of TGF-beta1, TIMP-1 and TIMP-2 in the ligamentum flavum might be a possible pathogenesis for ligamentum flavum hypertrophy in spinal stenosis. However, it is not determined whether this phenomenon in spinal stenosis is a local or systemic problem. METHODS: The concentrations of TGF-beta1, TIMP-1 and TIMP-2 were quantitatively analyzed by ELISA in the ligamentum flavum and serum of patients with lumbar spinal stenosis (n=16) and disc herniation (n=16). The thickness of ligamentum flavum was measured on axial T1-weigted magnetic resonance image. The biochemical and radiological results were compared for the two conditions. RESULTS: The thickness of the ligamentum flavum was larger in patients with spinal stenosis compared with that with disc herniation (p=0.001). The mean concentrations of TGF-beta1, TIMP-1, and TIMP-2 in the ligamentum flavum were significantly higher in patients with spinal stenosis than those with disc herniation (all, p < 0.05). However, the difference in serum levels of TGF-beta1 (p=0.464), TIMP-1 (p=0.146) and TIMP-2 (p=0.794) was not significant between the lumbar spinal stenosis and disc herniation patients. CONCLUSIONS: Despite increased levels of TGF-beta1, TIMP-1, and TIMP-2 in the ligamentum flavum of spinal stenosis patients compared to disc herniation patients, the serum levels of TGF-beta1, TIMP-1 and TIMP-2 were very similar in both groups. These results indicate that the role of TGF-beta1, TIMP-1 and TIMP-2 on hypertrophy of the ligamentum flavum in spinal stenosis patients is a local phenomenon, not systemic.

An Amendment and Comparison of the Nomina Anatomica between South and North Korea / 체질인류학회지

The purpose of this study is to modify the Korean Nomina Anatomica terminology of surface anatomy. This paper suggests that 19 terms in skeletal system, 9 terms in muscle system and 15 terms in movement area. Main principles of the modification are as follows ; 1. The terminology of surface anatomy must be modify to Korean native terms from old ones. 2. The terminology of anatomy text books must be modify in area of apply anatomy.