Virtual reality simulator’s effectiveness on the spine procedure education for trainee: a randomized controlled trial / 대한마취과학회지

Background@#Since the onset of the coronavirus disease 2019 pandemic, virtual simulation has emerged as an alternative to traditional teaching methods as it can be employed within the recently established contact-minimizing guidelines. This prospective education study aimed to develop a virtual reality simulator for a lumbar transforaminal epidural block (LTFEB) and demonstrate its efficacy. @*Methods@#We developed a virtual reality simulator using patient image data processing, virtual X-ray generation, spatial registration, and virtual reality technology. For a realistic virtual environment, a procedure room, surgical table, C-arm, and monitor were created. Using the virtual C-arm, the X-ray images of the patient’s anatomy, the needle, and indicator were obtained in real-time. After the simulation, the trainees could receive feedback by adjusting the visibility of structures such as skin and bones. The training of LTFEB using the simulator was evaluated using 20 inexperienced trainees. The trainees’ procedural time, rating score, number of C-arm taken, and overall satisfaction were recorded as primary outcomes. @*Results@#The group using the simulator showed a higher global rating score (P = 0.014), reduced procedural time (P = 0.025), reduced number of C-arm uses (P = 0.001), and higher overall satisfaction score (P = 0.007). @*Conclusions@#We created an accessible and effective virtual reality simulator that can be used to teach inexperienced trainees LTFEB without radiation exposure. The results of this study indicate that the proposed simulator will prove to be a useful aid for teaching LTFEB.

Comparison of Malnutrition Risk between Patients with Liver Cirrhosis and Viral Hepatitis Carrier: A Single Center Study / 대한소화기학회지

BACKGROUND/AIMS: It is well-known that patients with chronic liver disease commonly have nutritional deficiency. In the present study, we investigated the differences in malnutrition risk between patients with liver cirrhosis and viral hepatitis carrier. METHODS: Patients with chronic liver disease who have been hospitalized at Konyang University Hospital from May 2012 to April 2013 were analyzed retrospectively. The malnutrition risk was divided into three categories (low, intermediate, and high) according to Konyang University Hospital Malnutrition Screening, which include BMI, serum albumin, total lymphocyte count (TLC), hemoglobin, weight change, appetite, and dysphagia, within 24 hours of hospitalization. RESULTS: Among a total of 460 patients, 313 had liver cirrhosis (LC), and 147 were viral hepatitis carriers. Age (p<0.001), serum albumin level (p<0.001), TLC (p=0.011), hemoglobin (p<0.001) and serum cholesterol level (p=0.005) were significant different between the two groups. However, there were no difference in height, weight, and BMI. The malnutrition risk of the patients with viral hepatitis carrier was significantly lower than that of the patients with LC (p<0.001). In addition, among 313 patients with LC, malnutrition risk of the patients with Child-Pugh class A (n=150) was significantly lower than that of the patients with class B (n=90) or C (n=73) (p<0.001). CONCLUSIONS: Viral hepatitis carrier group had significantly lower malnutrition risk than LC group. The risk of malnutrition in Child-Pugh class A group was significantly lower than that in class B or C group.

Pulmonary embolism and deep vein thrombosis related to oral contraceptive use

Pulmonary embolism (PE) and deep vein thrombosis (DVT) is a serious medical problem causing considerable morbidity and mortality. Risk factors of thrombosis are surgery, trauma, pregnancy, tumor, oral contraceptive as well as genetic risk factors though genetic risk factors were found in about 5% to 10% of cases. Yasmin, a combined oral contraceptive containing ethinylestradiol 30 microg and drospirenon 3 mg was launched in the United Kingdom in 2002. We had experienced a patient, 24-year-old young woman with left inguinal pain on ambulation, and edema of left leg four months after taking Yasmin. We performed chest pulmonary angiography computed tomography (CT) and lower extremity venogram CT. She was diagnosed to PE in both lower lobes and DVT below the level of left external iliac vein, and treated by low molecular weight heparin and warfarin. We report this case with brief review of literatures.

Clinical Results after a Rehabilitation Program for Lateral Epicondylitis of the Elbow / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the clinical effectiveness of a rehabilitation program for the patients with lateral epicondylitis. MATERIALS AND METHODS: Twenty-three patients with lateral epicondylitis were included from April 2009 to October 2009 and all the patients were treated with a rehabilitation program for 6 weeks. The evaluation at baseline and at 12 weeks after rehabilitation included the subjective assessment of symptoms and the objective assessment with measuring the grip strength and muscle power of the wrist extensors and flexors and the forearm supinators and pronators. After 6 months, subjective satisfaction was evaluated via telephone calls. The data was analyzed using the Wilcoxon signed rank test (SPSS ver. 16.0). RESULTS: At 12 weeks, the subjective satisfaction was improved in on the three questionnaires. The grip strength increased from 25.1 kg to 37.8 kg (p<0.05). On the Biodex analysis, there was significant difference at the wrist extensors. At 6 months, 21 cases had excellent or good results according to the score and 2 cases complained of remaining pain. CONCLUSION: Our rehabilitation program is thought to be good treatment for the patients with lateral epicondylitis, and it is a practical and precautionary step for the cases of lateral epicondylitis if the patients themselves are educated to volutarily participate in the program.

Clinical Analysis of Pheochromocytoma and Abdominal Paragangliomas / 대한내분비외과학회지

PURPOSE: We compared clinical characteristics between pheochromocytoma and abdominal paragangliomas and identified predictive factors of malignancy. METHODS: Between November, 1995 and January, 2011, we retrospectively reviewed the medical records of 145 patients with pheochromocytoma and abdominal paraganglioma at Samsung Medical Center. We compared two tumors (pheochromocytoma vs abdominal paraganglioma) about a potential of hypersecretion of cathecholamines and identified predictive factors of malignancy by analysis of clinical characteristics, biochemical markers, tumor features. Their postoperative results were also evaluated. RESULTS: This study included 103 (71%) pheochromocytomas and 42 (29%) abdominal paragangliomas. Eighty-six percent were benign and 14% were malignant. Patients with paraganglioma were more predominantly men and exhibited a higher malignancy rate (P<0.01) than pheochromocytoma patients. Most (95%) pheochromocytoma was hyperfunctional, but abdominal paraganglioma were hyperfunctional in 74%. There were no significant differences in biochemical markers between the pheochromocytoma and paraganglioma groupd. When compared with benign tumor, malignant tumors were significantly related with higher mean PASS (P<0.01) and higher 24-hour urinary VMA (P=0.02), but not with larger tumor size. CONCLUSION: It is not easy to distinguish malignant from benign tumors by clinical characteristics and pathologic features in the management of pheochromocytoma and paraganglioma. We should keep in mind that abdominal paraganglioma can be also hyperfunctional in many pheochromocytoma patients and has a higher risk of malignancy.

Postoperative Outcomes in Patients Undergoing Adrenalectomy for Primary Aldosteronism / 대한내분비외과학회지

PURPOSE: Primary aldosteronism (PA) is characterized by hypertension (HTN), hypokalemia, suppressed plasma renin activity, and inappropriate aldosterone secretion. The purpose of this study was to analyze postoperative results on blood pressure (BP), and to determine the factors associated with resolution of HTN after adrenalectomy for PA. METHODS: One hundred eight patients (66 females and 42 males) with a mean age of 46 years underwent adrenalectomy for PA between January 1, 1996 and September 30, 2009. Their clinical characteristics and biochemical parameters were reviewed retrospectively. RESULTS: All patients had HTN preoperatively and 20 patients (18.1%) had uncontrolled HTN. Hypokalemia was evident in 89.1% of patients, cardiovascular events in 4.5% and cerebrovascular events in 8.2%. There was a significant decrease in both systolic BP and diastolic BP postoperatively, as compared with that before operation. Median systolic BP decreased from 150 mmHg to 125 mmHg at the last follow-up (P<0.01), and median diastolic BP decreased from 93.5 mmHg to 81.5 mmHg (P<0.01). Sixty two (57.4%) patients were cured of HTN and did not require any hypertensive agent, and 38 (35.1%) patients had an improvement in BP control, whereas 9 (8.3%) patients had no change in BP. Univariate analysis showed that duration of HTN and more than two HTN treatment agents were independent factors predicting sustained hypertension after surgery. CONCLUSION: The duration of HTN and the severity of HTN are factors influencing persistence of HTN after operation for a PA.

Chronic Kidney Disease as an Independent Risk Factor for Thromboembolism in Patients with Atrial Fibrillation / 대한내과학회지

BACKGROUND/AIMS: The CHADS2 scoring system has been widely used to stratify thromboembolic risk associated with atrial fibrillation. Chronic kidney disease (CKD) is associated with increased risk of stroke in patients with atrial fibrillation (AF) but has not yet been included in risk-scoring systems. We analyzed the difference in thromboembolic risk of patients with AF and a moderate risk of stroke according to the presence of CKD. METHODS: Of 1,952 patients with AF, 451 with a CHADS2 score of 1 were divided into two groups according to the presence of CKD, and thromboembolic events were analyzed. Each group was further classified by the antithrombotic regimen used: warfarin or aspirin. RESULTS: Of the 451 patients, 94 with CKD had a significantly higher risk for thromboembolic complications than the 357 patients without CKD (hazard ratio [HR], 3.630; 95% confidence interval [CI], 1.565-8.422; p = 0.003). Patients with CKD who were on aspirin had a higher risk for thromboembolic events than those on warfarin (HR, 5.203; 95% CI, 1.056-25.633, p = 0.043). However, in patients without CKD, the aspirin group did not have a higher risk of thromboembolic events than the warfarin group (HR, 0.803; 95% CI, 0.225-2.867, p = 0.735). CONCLUSIONS: In Korean patients with AF and a CHADS2 score of 1, CKD may be an independent thromboembolic risk factor. In patients with CKD, warfarin may be superior to aspirin for lowering thromboembolic risk.

Gender Differences Associated with Pain Patterns and Psychological Variables in Chronic Musculoskeletal Pain Patients

OBJECTIVE: To investigate gender differences in pain patterns and psychological variables among patients with chronic musculoskeletal pain. METHOD: Thirty-five male and thirty-eight female patients who visited our outpatient clinic due to chronic musculoskeletal pain were evaluated using a questionnaire survey. Chronic musculoskeletal pain was defined as pain lasting longer than 6 months. Patients were evaluated with visual analogue scale (VAS), pain site, pain duration and frequency. Beck depression inventory, state-trait anxiety index, somatization scale of symptom checklist-revised, symptom interpretation questionnaire, and pain catastrophizing scale were checked for psychological variables. Correlations among each variable were evaluated statistically. RESULTS: Female patients with chronic musculoskeletal pain recorded higher scores on number of pain site, pain catastrophizing scale, rumination, magnification and catastrophic attribution than male patients (p<0.05). In female patients, VAS was correlated significantly with depression, static anxiety, somatization, catastrophizing thought. rumination, magnification, helpless, and catastrophic attribution. Pain frequency was correlated significantly with somatization, catastrophizing thought, rumination, and helpless. Number of pain site was correlated with somatization, catastrophizing thought, magnification, and helpless. The correlation between pain patterns and psychological variables was also observed in male patients, but statistically less significant than female patients. CONCLUSION: We found gender difference associated with pain patterns and psychological variables in chronic musculoskeletal pain patients. Consideration of psychological factors may be important for management in female patients with chronic musculoskeletal pain.

The Relation of Menarcheal Age to Anthropometric Profiles in Korean Girls

The aim of this study was to represent the trend of early menarche and to assess the association of age at menarche with anthropometric profiles of Korean children and adolescents. A cross sectional survey was conducted with 13,371 girls aged 10 to 18 yr, recruited nationwide from April, 2005 to March, 2006. Height, weight and waist circumference of the subjects were measured; and the subjects self-reported their ages at menarche. We found that the menarcheal girls were taller (P<0.05 for the girls between 10 and 14 yr) and heavier (P<0.05 for the girls between 10 and 18 yr) than non-menarcheal ones. Menarcheal girls also showed higher body mass index (BMI), and greater waist circumference than non-menarcheal ones. Significant differences were represented according to the age at menarche in terms of BMI, waist circumference, % body fat mass, waist hip ratio and neck circumference as well as height and weight (P<0.05). In conclusion, girls who matured early were taller and heavier in early adolescence than those who matured later.

The Relations among Pain, Emotional and Cognitive-behavioral Factors in Chronic Musculoskeletal Pain Patients

OBJECTIVE: To investigate the relations among pain, emotional factors and cognitive-behavioral factors in chronic musculoskeletal pain patients. METHOD: This study was designed as a questionnaire survey. 73 patients who visited our outpatient clinics due to chronic musculoskeletal pain were evaluated. They checked visual analogue scale (VAS), pain site and frequency. Beck depression inventory (BDI) and state-trait anxiety index (STAI) were checked for evaluation of emotional factors. Somatization scale of symptom checklist-revised (SCL-R- 90) and pain catastrophizing scale (PCS) were checked for cognitive-behavioral factors. Correlations among each variable were evaluated by statistical analysis. RESULTS: VAS was correlated with pain frequency (r=0.538, p0.05). CONCLUSION: Cognitive-behavioral factors such as catastrophizing thought are strongly correlated with both pain aspects and emotional factors. Consideration of cognitive- behavioral factors as well as emotional factors may be important for management of chronic musculoskeletal pain.

Neuropathic Arthropathy of the Elbow / 대한정형외과학회잡지

PURPOSE: Neuropathic arthropathy of the elbow is extremely rare and is characterized by painless destruction of the joint due to diminished proprioception. We report five cases of neuropathic arthropathy of the elbow with review of pertinent literature. MATERIALS AND METHODS: We analyzed records of five patients who were diagnosed with neuropathic arthropathy of the elbow. There were three men and two women with a mean age of 38.6 years (range, thirteen to fifty years). The conditions associated with the arthropathy were three cases of syringomyelia, one tabes dorsalis, and one neurofibromatosis. One patient was conservatively treated and was followed periodically and others underwent operative procedures. The mean duration of follow-up was 8.5 years (range, one to nineteen years). Changes of symptoms, range of motion (ROM), and functional satisfaction were assessed. RESULTS: The conservatively treated patient maintained the function of the elbow. In the surgically treated group, one case of ulnar nerve decompression and one case of osteosynthesis of the fractured olecranon showed improvement of symptoms, ROM, and function. But two patients who underwent reconstructive procedures had decreased ROM after complication of deep infection. Concluson: Neuropathic arthropathy of the elbow causes few functional problems despite of the radiologic destruction and instability of the elbow. Therefore symptomatic management is considered more preferable than surgical correction of destruction or instability of the elbow.

A Comparative Study on the Treatment of Scaphoid Nonunion with Matti-Russe Technique and Fisk-Fernandez Technique / 대한정형외과학회잡지

PURPOSE: Established scaphoid nonunion may lead to carpal instability and osteoarthritis. The purpose of this study is to compare the clinical and radiological results of the osteosynthesis between Matti-Russe group and Fisk-Fernandez group. MATERIALS AND METHODS: Our retrospective study included 21 nonunion cases in 20 patients treated by Matti-Russe or Fisk-Fernandez technique from September 2001 to August 2006. The mean duration of follow up was 31 months. Based on the questionnaire which included clinical information and the radiologic evaluation, we compared the objective and subjective results between two surgical groups. RESULTS: There were no significant differences between two groups in respect of the postoperative satisfaction and the pain. Both the range of motion and the grip power decreased compared to that of the unaffected side, but there were no significant differences between two groups. Also, there were no significant differences in the union rate and the rate of successful correction of DISI deformity. In all cases in which DISI deformity was detected preoperatively, the deformity was corrected postoperatively. There were 7 cases of osteoarthritis, but among them only one case appeared newly after the surgery. CONCLUSION: There were no significant differences between two surgical groups in clinical and radiological results. Both techniques were effective in achieving bony union and functional recovery.

Phocomelia: The Clinical Manifestation, Classification and Surgical Treatment of Korean Patients with Phocomelia / 대한정형외과학회잡지

PURPOSE: Phocomelia is an extremely rare congenital anomaly of the upper extremity. There have been no clinical reports about phocomlia in Korea except for five birth reports. We present here the clinical features, classifications and surgical treatments of our phocomelia cases. MATERIALS AND METHODS: From January 1993 to August 2007, seven patients were diagnosed as having phocomelia in 9 upper extremities at our clinic. Surgical treatments were performed for five patients on their hand anomalies. We retrospectively reviewed the medical records and radiographs of our cases, and we tried to classify them by the previously suggested systems. We evaluated the functional improvement and measured the VAS scale for parental satisfaction with the operative outcomes. RESULTS: We could not find any problems during the fetal periods or any hereditary features. The bilaterally-affected patients also had deformities of the lower extremity, while the unilaterally-affected patients did not. We couldn't classify our cases according to the Frantz and O'Rahilly system. We found that the classifications suggested by Tytherleigh-Strong and Hooper (2003) and Goldfarb et al. (2005) could be promising alternatives for classification. One upper extremity was classified as type A, one as type B, and 7 as type C by Tytherleigh-Strong and Hooper's system. Using the Goldfarb's system, two upper extremities were classified as proximal radial longitudinal dysplasia, and seven were classified as proximal ulnar longitudinal dysplasia. Three patients who underwent pollicization showed opposition and tip pinch. Two patients who underwent syndactyly division could do lateral pinch. The VAS scale for parental satisfaction with the functional improvement averaged 8.2 postoperatively. CONCLUSION: The bilateral cases had different clinical features from unilateral ones. Phocomelia could not simply be classified by the Frantz and O'Rahilly system, and it may not be a true transverse intercalary deficiency. We could gain functional improvement after operations on the hand anomalies.

Defect of 18F-FDG Uptake Observed in Infarcted Myocardium Showing Reverse Redistribution on Rest / 24-Hour Delayed 201Tl Myocardial SPECT after Acute Myocardial Infarction / 핵의학분자영상

Reverse redistribution is frequently observed after revascularization in acute myocardial infarction, and usually regarded as a predictor of viable myocardium on stress/rest and 2- to 4-hour redistribution 201Tl SPECT. However, there is not enough report of reverse redistribution in case of 24-hour delayed SPECT, which is commonly used for viability assessment. In this report, a case of reverse redistribution on rest and 24-hour delayed 201Tl SPECT is reported with use of automatic segmental quantitative analysis. The myocardium of reverse redistribution was dysfunctional on gated SPECT, and diagnosed as non-viable on 18F-FDG PET.

Association Study between 2 Single Nucleotide Polymorphisms in Estrogen Receptor 1 Gene and Korean Female Schizophrenic Patient

OBJECTIVES: Schizophrenia is equally distributed in both sexes. However, later-onset, milder psychopathology, and better outcome are associated with the females. This reason is thought to be partly due to the estrogen system. Recently, it was suggested that estrogen receptor 1(ESR1) gene polymorphisms might affect the expression of ESR1 and were associated with several psychiatric disorders. Thus, we investigated the association between two single nucleotide polymorphisms(SNPs) in the ESR1 gene and Korean schizophrenic patients in this study. METHODS: Genotype, allele, and haplotype frequencies of the two SNPs(rs 2234693 and rs 2228480) were analyzed between 218 Korean controls and 158 Korean schizophrenic patients. Also, age of onset and negative symptom scale scores according to genotypes were analyzed in the patients with schizophrenia. RESULTS: There was a significant difference in allele frequencies of rs 2234693 between the schizophrenic patients and the controls(p=0.03). Genotype distributions(p=0.03) and allele frequencies(p=0.01) of rs 2234693 were significantly different between the female schizophrenic patients and the female controls. The frequency of TC-CC genotypes compared with TT genotype in the female schizophrenic patients was significantly higher than that in the female controls(OR=2.36). The mean age of onset in the schizophrenic patients with TC-CC genotypes was significantly lower than that in the patients with TT genotype. The frequency of rs 2234693C-rs 2228480G haplotype in the female schizophrenic patients was relatively higher than that in the female controls. CONCLUSIONS: These results of our study support the possibility that the ESR1 gene polymorphisms might be involved in the susceptibility of females to schizophrenia and play a role in sex difference of schizophrenia.

Subcutaneous Fascial Pedicled Lateral Supramalleolar Flap

Soft-tissue reconstruction of the foot and ankle has long been a challenge for reconstructive surgeons. Limitations in the available local tissue and donor-site morbidity restrict the options. In an effort to solve these difficult problems, the authors have begun to use a subcutaneous fascial pedicled lateral supramalleolar flap. This report presents the authors' experience with five patients treated with this flap. The patients' ages ranged from 26 to 72 years; four of the patients were male and one was female. The cause of the soft-tissue defects involved acute trauma and malignant melanom. All flaps survived and provided satisfactory coverage of the defect. Compared with the classic lateral supramalleolar flap, when the perforating branch is interrupted in its course, it is possible to elevate this subcutaneous fascial pedicled flap. The distally based flap with a compound pedicle which is continuous with a vascular axis and a band of subcutaneous fascial pedicle has long pedicle. This procedure is valuable for remote defect of the foot. It is believed that this flap is versatile and effective and is a good addition to the available techniques used by reconstructive surgeons for coverage of the foot and ankle.

The Impacts of Obesity on Psychological Well-being: A Cross-sectional Study about Depressive Mood and Quality of Life / 예방의학회지

OBJECTIVES: The aim of this study was to assess whether individuals who visit clinics to ask medical help for obesity treatment depict comparable levels of depression, body dissatisfaction, eating psychopathology and lower quality of life. METHODS: This is a cross sectional study with 534 females who sought treatment for their obesity or overweight being recruited in seven clinical units in Seoul, Korea. The patients group was divided into two groups. The group 1 consisted of the patients with BMI >25 kg/m2. The women who showed BMI < or =25 kg/m2 among patients recruited for this study were classified as the group 2. The control group (group 3) was composed of 398 healthy females who have never tried to lose weight. RESULTS: We found that group 1 had higher frequency of more than moderate level of depression than group 2 and group3 did. Both patients groups showed greater eating disordered attitudes and behaviors regardless of obese condition than the control group. Group1 showed relatively lower level of quality of life than group2 and group3 in terms of the quality of life related to physical well-being. In addition, the control group reported higher quality of life in psychological health than both patients groups did. CONCLUSIONS: In conclusion, it is necessary for clinicians to make a careful evaluation of depressive tendency and eating disorders when obese women seek for medical help. The combination of medical treatment and psychological approach for obese women would result in higher quality of life.

Acute Myelopathy due to Ruptured HNP in Cervical OPLL Patient: Case Report / 대한척추외과학회지

Ossification of the posterior longitudinal ligament (OPLL) is an uncommon disorder that may be associated with slowly progressing neurological symptoms. We encountered a case of acute cervical myelopathy due to a ruptured disc in an asymptomatic patient with OPLL, who was surgically managed by the anterior approach and fusion. We report the case with a review of the relevant literature.

The Correlation between Outcome Evaluation Systems after Anterior Cruciate Ligament Reconstruction

PURPOSE: The purpose of this study was to evaluate the correlation between various subjective, objective tests and real functional performances of the patients after ACL reconstruction. METHOD: Twenty-four patients after ACL reconstruction using 12 hamstring autograft and 12 Achilles allograft were evaluated. Lysholm knee score, IKDC subjective score, Knee Outcome Survey score and Tegner activity score were evaluated for the subjective outcome value. Static instability tests, Biodex dynamometer and hop tests were done for the objective outcome value. Three functional performance tests(FPTs) such as carioca test, shuttle run test and co-contraction test were done for deciding the real performance ability of the patients. Each score system was compared with FPT results. RESULTS: The results of Hamstring group were better than those of Achilles group, but there was no statistical significance. IKDC subjective score, single leg hopping test, and quadriceps power in low velocity of biodex dynamometer tests had a positive correlation with the total FPT results. CONCLUSION: IKDC subjective score, one leg hopping test showed significant correlation with functional performance test and they can be used as effective methods to decide whether the subjects after ACL reconstruction can return to sports activity.