Inferior Mesentery Artery and Internal Iliac Artery Preservation with Covered Self-Expanding Stents during Endovascular Aneurysm Repair

We report an endovascular aneurysm repair in a patient with isolated bilateral common iliac artery aneurysms, a prominent inferior mesentery artery (IMA), and bilateral proximal internal iliac artery (IIA) aneurysms using covered self-expanding stents to preserve the IMA and bilateral internal iliac arteries. A follow-up computed tomography angiography was obtained at 1 month. Pelvic circulation was well preserved without bowel ischemia. IMA and bilateral IIA preservation with covered self-expanding stents during endovascular aneurysm repair is a safe and effective method.

Risk factors for postoperative delirium in the elderly patients with intertrochanteric facture / 中华创伤杂志

Objective To investigate the risk factors of postoperative delirium in elderly patients with intertrochanteric facture.Methods This retrospective analysis was conducted on 256 patients aged over 65 years treated with internal fixation of intertrochanteric facture between January 2012 and December 2013.Incidence and risk factors of postoperative delirium were documented.Results Incidence of postoperative delirium was 14.8％ (38/256).Risk factors of postoperative delirium included body mass index (BMI) less than 20 kg/m2 (P ＜ 0.05),preoperative hemoglobin (Hb) less than 100 g/L (P ＜ 0.05),atrial fibrillation (P ＜ 0.05),low sodium (P ＜ 0.05),preoperative total protein less than 60 g/L (P ＜ 0.05),preoperative waiting time more than 4 days (P ＜ 0.05),preoperative cognitive impairment (P ＜ 0.05),operation time more than 2.5 hours (P ＜ 0.05),perioperation blood loss more than 1,000 ml (P ＜ 0.05),and more than two kinds of medical conditions (P ＜ 0.05).Logistic regression identified three independent factors for postoperative delirium:preoperative waiting time more than 4 days (P ＜ 0.05,OR =2.74),BMI less than 20 kg/m2 (P ＜ 0.05,OR =13.27),preoperative cognitive impairment (P ＜ 0.05,OR =4.47),and operation time more than 2.5 hours (P ＜ 0.05,OR =4.56).Conclusions Risk factors of postoperative delirium in elder patients with femoral intertrochanteric fracture are complicated.Therefore,overall situation should be taken into consideration and comprehensive and effective treatment should be formulated to prevent the occurrence of postoperative delirium.

Two Cases of Tumefactive Lesion: Demyelinating Disease Versus Brain Tumor

No abstract available.

Alpha-Type 1 Polarized Dendritic Cells Loaded with Apoptotic Allogeneic Breast Cancer Cells Can Induce Potent Cytotoxic T Lymphocytes against Breast Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Various tumor antigens can be loaded onto dendritic cells (DCs) to induce a potent cytotoxic T lymphocyte (CTL) response in DC-based immunotherapy against breast cancer. However, in the clinical setting, obtaining a sufficient number of autologous tumor cells as a source of tumor antigens is a laborious process. We therefore investigated the feasibility of immunotherapy using breast-cancer-specific CTLs generated in vitro by use of alpha-type 1 polarized DCs (alpha DC1s) loaded with ultraviolet B-irradiated cells of the breast cancer cell line MCF-7. MATERIALS AND METHODS: alphaDC1s were induced by loading allogeneic tumor antigen generated from the MCF-7 UVB-irradiated breast cancer cell line. Antigen-pulsed alphaDC1s were evaluated by morphological and functional assays, and the breast-cancer-specific CTL response was analyzed by cytotoxic assay. RESULTS: The alphaDC1s significantly increased the expression of several molecules related to DC maturation without differences according to whether the alphaDC1s were loaded with tumor antigens. The alphaDC1s showed a high production of interleukin-12 both during maturation and after subsequent stimulation with CD40L, which was not significantly affected by loading with tumor antigens. Breast-cancer-specific CTLs against autologous breast cancer cells were successfully induced by alphaDC1s loaded with apoptotic MCF-7 cells. CONCLUSION: Autologous DCs loaded with an allogeneic breast cancer cell line can generate potent breast-cancer-specific CTL responses. This may be a practical method for cellular immunotherapy in patients with breast cancer.

Acute Inflammatory Facial Nerve Paralysis / 대한이비인후과학회지

Bell's palsy is the most common form of acute facial nerve disorder, which presents as an acute peripheral unilateral facial palsy of unknown cause. Ramsay-Hunt syndrome is the second most common cause of acute facial palsy, and is known to be caused by reactivation of latent varicella zoster virus. The main goal of treatment for acute inflammatory facial nerve paralysis is to speed up recovery, to facilitate the recovery more completely and to prevent other sequelae. However, some patients may have a poor recovery with permanent, disfiguring facial asymmetry despite of many kinds of treatments. Regarding the diagnostic and therapeutic issues of the two common disorders, there still exist some controversies. This article reviewed recent evidences on several important issues in evaluation and management of acute inflammatory facial nerve paralysis, and intended to provide an evidence-based framework for decision-making in the clinic.

Comparison of Exercise Indexes between Knee Extension-Flexion Exercise and Treadmill Exercise

OBJECTIVE: To obtain clinical usefulness of knee extension- flexion exercise by comparing the exercise indexes between treadmill exercise and knee extension-flexion exercise and to collect reference of exercise indexes using knee extension-flexion exercise. METHOD: Sixty four young healthy subjects participated in two modes of exercise. Subjects performed exercise using isokinetic dynamometer in one leg knee extension-flexion exercise and treadmill running using Bruce protocol in treadmill exercise. We recorded oxygen consumption, heart rate during rest and exercise. RESULTS: When comparing exercise indexes using treadmill exercise, we obtained relative exercise indexes using knee extension-flexion exercise, male 15.96%, female 15.77% in work rate, male 48.46%, female 52.53% in peak oxygen consumption, male 73.57%, female 80.82% in peak heart rate, male 65.97%, female 65.20% in oxygen pulse, male 56.07%, female 62.50% in peak tidal volume, male 82.56%, female 82.53% in peak respiratory rate, male 47.79%, female 49.48% in peak minute ventilation. In dynamic variables, we obtained male 266.82%, female 292.98% in ratio increase in oxygen consumption to increase in work rate. CONCLUSION: Knee extension-flexion exercise showed enough response to evaluate cardiorespiratory function through low work rate. Therefore knee extension-flexion exercise may be used for an exercise tolerance test in patients who cannot perform established exercise tolerance test.

Bitemporal Hemianopia Associated with Anti-Tuberculosis Medication

No abstract available.

Evaluation of Exercise Efficiency with Change in Oxygen Uptake and Work Rate in Stroke Patients

OBJECTIVE: To evaluate exercise capacity of subacute stroke patients with nonambulatory exercise stress test and to determine whether reduced exercise efficiency is associated with functional performance. METHOD: Experimental design was prospective and observational study. Eighteen patients with moderate to severe impairment after recent stroke performed exercise stress test by repeated knee flexion and extension exercise using isokinetic dynamometer. Work rate, oxygen consumption, heart rate were assessed during exercise stress test. The dynamic response, the ratio of change in oxygen uptake to change in work rate, was measured for correlation with FIM (Functional Independence Measure) scores. Occupational therapist recorded FIM scores on the day of transfer to inpatient rehabilitation unit and on discharge. Age-matched healthy group also performed exercise stress test in same settings. RESULTS: The patients group who had similar dynamic response with age-matched healthy group showed higher FIM scores than the patients group having higher dynamic response. CONCLUSION: Nonambulatory exercise stress test could be effectively used in subacute stroke patients and the ratio of change in oxygen uptake to change in work rate was a useful variable to reveal low exercise efficiency in subacute stroke patients who had a abnormal skeletal muscle metabolic capacity.

Effects of Agonistic and Antagonistic Isometric Contraction on Motor Evoked Potentials in the Forearm

OBJECTIVE: To evaluate the effect of agonistic and antagonistic isometric contraction on the motor evoked potentials (MEP). METHOD: The MEP responses of right flexor carpi radialis (FCR) and extensor carpi radialis (ECR) muscles were simultaneously recorded during constant isometric flexion and extension of wrist. The intensities of isometric flexion and extension were 30%, 50%, and 100% of maximal voluntary contraction, which were achieved by isokinetic dynamometer. Background electromyographic activities in surface and needle electrodes were used for selective contraction. RESULTS: In agonistic muscles, the amplitudes of MEP responses were significantly increased according to the intensity of isometric contraction. In antagonistic muscles, the amplitudes of MEP responses in ECR were significantly increased with increasing intensity of isometric flexion. The amplitudes of MEP responses in FCR were increased with increasing intensity of isometric extension in spite of suppression in H-reflex of FCR during isometric extension. CONCLUSION: In antagonistic muscles, facilitation of MEP response in ECR and FCR during isometric contraction was occurred as in the agonistic isometric contraction.

The effect of hyaluronan on osteogenesis in allogeneic bone grafting

A Case of Primary Choriocarcinoma of The Fallopian Tube / 대한부인종양콜포스코피학회잡지

Choriocarcinoma is a relatively rare malignancy of which characteristic is rapid metastasis to the other organs. It is related to the previous gestation or originated from the teratoma. Choriocarcinoma is mostly originated from the intrauterine chorionic villi, but it is rarely originated from the utreine cervix, fallopian tube, ovary, vagina and pelvic cavity. Primary choriocarcinoma of the fallopian tube is exceedingly rare and it is originated from ectopic tubal pregnancy, tubal migration from the intrauterine pregnancy or intratubal teratoma. 9 Symptoms and signs of the choriocarcinoma originated from the ectopic pregnancy are abdominal pain, vaginal bleeding, palpable adnexal mass, positive pregnancy test and amenorrhea. Thus it is difficult to distinguish choriocarcinoma from ectopic pregnancy on the basis of symptoms before the microscopic diagnosis presented.20 Effective treatment of choriocarcinoma is chemotherapy. Additional operation is possible. B-HCG is a useful measure for the follow up. We experienced a 36-year-old multigravida Korean woman who was diagnosed as the rupture of ectopic pregnancy after left salpingectomy in our hospital and then confirmed primary choriocarcinoma of the fallopian tube without metastasis on microscopic finding. Postoperative chemotherapy was performed with methotrexate. The follow up of disease is still on going at two month intervals and she has remained healthy, We report this case with review of literatures.

Adenomyoma of the common bile duct / 한국간담췌외과학회지

A fifty year old Korean female was admitted with a few months history of general malaise. On admission, positive HBs Ag, negative HBs Ab and HBe Ag was negative. The liver function tests showed AST 274 U/L, ALT 126 U/L, CEA 1.87 ng/ml. With the clinical impression of chronic hepatitis B, abdominal CT and ERCP were performed and demonstrated a narrowing of the distal common bile duct suggesting a malignant etiology. The Whipple's procedure was done. The intraoperative finding revealed neoplastic involvement of the distal 1 cm of the common bile duct with severe narrowing and proximal dilatation. Microscopic findings demonstrated cystically dilated ductular structures and intervening irregular hypertrophic smooth muscle bundles.

Comparative Study of H.R Neuropsychological Battery Results between Urban and Rural Children / 中国临床心理学杂志

Objective: To compare the H.R neuropsychological functions of urban and rural children and to elucidate possible affecting factors. Methods:57 urban children and 54 rural children between 6.5～7.5 ages were assessed on the Halstead-Reitan Neuropsychological Battery. Results:①The scores of Category, Touch Operating, and Proceeding subtests in H.R.B of urban children were significantly higher than those of rural children.②There were significant differences in parenting behaviors between the parents of urban children and rural children.③There were significant correlations between parenting behaviors and H.R.B performance. Conclusion: Parenting behavior could be an influential factor in the development of neuropsychological functioning in children.

Pattern of Recurrence after Curative Resection of Gastric Cancer / 대한암학회지

PURPOSE: Despite radical lymph node dissection and combined resection, the operative result of progressive gastric cancer remains unsatisfactory. The prognosis of gastric cancer has not been improved. In case of recurred gastric cancer, the problem is low curative resection rate. We tried to study the pattem of recurrence after curative resection for gastric cancer. MATERIALS AND METHODS: We had retrospectively analyzed the recurrence pattern of 191 patients who recurred after curative resection of gastric cancer. We analyzed the interval between operation and recurrence, primary tumor location, tumor histologic type, Borrmann's type, pathologic stage, DNA ploidy pattem and lymph node metastasis. RESULT: The number of recurred gastric cancer patients was 191. The M: F ratio was 2.03: 1. Seven cases were early gastric cancer. The interval between operation and recurrence was from 1 month to 130 months. The early recurrence within 24 months was found in 147 patients (77.0%), the intermediate recurrence from 25 months to 60 months was found in 38 patients (19.9%), the late reeurrence after 60 months was found in 6 patients (3.1%). The pattems of recurrence were as follows: loco-regional recurience, including lymph node and site of anastomosis, was found in 51 cases, liver metastasis in 37 cases, peritoneal metastasis in 74 cases, extraperitoneal metastasis in 29 cases including Virchows node. In undifferentiated cancer, peritoneal metastasis was higher than in other histologic types (p<0.05). 59 cases was found in stage IV, 47 cases in stage IIIb, 43 cases in stage IIIa, 31 cases in stage II, 8 cases in stage Ib, and 3 cases in stage Ia. We found peritoneal metastasis was very high in stage IIIb. The 5-year survival was better in loco-regional group than that of other patterns of recurrence. CONCLUSION: Recurrence after operation was found within 24 months, that in most of patients, so the follow up is very important in this period and the recurred pattem after curative resection for gastric cancer was related with cell differentiation of primary tumor and stage. In local recurrence, the survival rate was higher than the other pattern of recurrence.

A comparative study on dental arch dimension of high school females according to the region of residence and facial type / 대한치과교정학회지

This study was performed to compare the dental arch dimensions of urban and rural high school females according to the region of residence and facial type. A model and cephalometric analysis was made from 48 urban and 48 rural high school females. The results of this study were obtained as follows: 1. Arch width in the urban group were similar to the rural group. 2. Lingual arch length at upper 1st premolar level in the urban group was larger than the rural group and lingual arch length at lower canine level in rural group was larger than the urban group. 3. Palatal height at canine level in the rural group was higher than the urban group. 4. Palatal heights at 2nd premolar and 1st molar level had correlation with the VERT index. In comparison of lingual arch dimensions according to Rickett's facial group, palatal heights at 2nd premolar and 1st molar level in dolichofacial group were lower than other groups.

Cushing's Syndrome due to Adrenocortical Carcinoma: Anesthetic Experience with Two Cases / 대한마취과학회지

Anesthetic experience with unilateral adrenalectomy for two patients (ll-year-old and 19- year-old female) with Cushings syndrome due to adrenocortical carcinoma has been reported. Anesthesia was induced with intravenous thiopental followed by nitrous oxide-oxygen-halothane and Pancuronium (Mioblock) for muscular relaxation. An endotracheal semi-closed circle absorption techniqne with controlled respiration was employed. The Patient tolerated well the anesthesia and surgery with appropriate cardiovascular control using hydrocortisone, whole blood and fluid replacement under continuous monitoring of B.P., E.C.G., C.V.P., and urine output. Importance of optimal preparation of the patient with Cushings syndrome, sufficient sedation, smooth induction, complete analgesia, good mucular relaxation, adequate alveolar ventilation and of proper cardiovascular control has been stressed and discussed together with the hazards of postoperative adrenal insufficiency.

A Clinical Study of Anesthesia for Cesarean Section / 대한마취과학회지

Anesthesia for cesarean section involves consideration of Loth maternal and fetal welfare. The choice of anesthesia for cesarean section is controversial. Regional analgesic techniques may be least harmful to the fetus, but suffer definite drawbacks; they are time-consuming, and therefore not always applicable when urgent surgery is indicated; are associated with a definite failure rate even in skilled hands, and require considerable technical ability and practice. Recently there has been progressive increase in the use of balanced anesthesia for cesarean section, it produces little or no hemodynamic and acid-base disturbance in the mother and infant if administered skillfully. The value of muscle relaxants to facilitate endotracheal intubation and pulmonary ventilation and to permit the use of light general anesthesia. From November, 1971 to October, 1973 there were 1,432 deliveries, of which 1,284 were delivered vaginally and 148 (10.3%) by cesarean section. Of the cesarean section group, 139 were performed under general anesthesia and 9 were performed under regional anesthesia. The characteristic difference for our series was that most of all cases were emergency cesarean section (71.6%). The major indication for surgery was that of a previous cesarean section (45.3%), the second most common cause was dystocia (42.9%), and the others are as following order; Hemorrhage (5.4%), toxemia (3.4%), and others (3.4%). In our study, we adopted two different general anesthetic techniques for cesarean section. Patients were randomly assigned to two groups: Group I: 112 patients, thiopental-succinylcholine-nitrous oxide-oxygen (67:33) anesthesia. Group II: 25 patients, thiopental-succinylcholine-nitrous oxide-oxygen (50:50) supplemented with 0.5~1.0% of halothane anesthesia. All patients were pre-oxygenated for 3 5 minutes and anesthesia was then induced with thiopental sodium 125~250mg, followed by succinylcholine 40~50 mg to facilitate intubation. Pressure was maintained on the cricoid cartilage to prevent regurgitation following loss of consciousness. After the affects of succinylcholine showed signs of wearing off, relaxation was maintained with 0.1% succinylcholine drip or 40~80 mg of gallamine. Anesthesia was maintained with nitrous oxide 4 l/min. and oxygen 2 l/min. and/or nitrous oxide 2 l/min. and oxygen 2 l/min. supplemented with 0.5~1.0% of halothane. Respiration was carefully controlled by manually so as not to producing hyperventilation. The clinical condition of newbron infant in general anesthesia series of 135 cases, mean minute apgar score were good (7~10) in 91.8 percent, fair (4~6) in 6.7 per cent, and poor (1~3) in 1.5 per cent. And 90.4 per cent of babies born within 10 minutes of induction to delivery time interval (IDI) had mean apgar score of 8. 8, 5.8 per cent were delivered after 11 to 15 minutes of IDI with decreased mean apgar score of 7.6, and 3.7 per cent were delivered after over 15 minutes of IDI had mean apgar score of 7. 6. A short IDI appears to be advantageous from the standpoint of the newborn. Of the 144 infants, 6. 9 per cent of newbron infants(10) received intermittent positive pressure breathing by face mask and 3.5 per cent(5) received oxygen through an endotracheal tube for the resuscitation. Neonatal death occurred only 1(0.69%) case out of 144 infants, which caused by severe fetal. distres associated with toxemia of pregnancy. There were no maternal death or anesthetic complication.. At the conclusion, the technique of general anesthesia with thiopental-succinylcholine-nitrous oxide-oxygen and/or supplemented with 0.5~1.0% of halothane was proved to be safe for mother and child, and showing a wide acceptance of general anesthesia for cesarean section(94%) at the Kyung Hee University Hospital.