Guide wire fracture during percutaneous coronary intervention / 영남의대학술지

Guide wire fracture during percutaneous coronary intervention (PCI) is rare. It can cause fatal complications such as thrombus formation, embolization, and perforation. Guide wire fracture could occur during intervention for severely calcified stenotic lesions, and rarely from distal small branches of stenotic lesions. There are several methods for its management depending on the material character, position, length of the remnant, and the patient's condition. If percutaneous retrieval was not achieved, the surgical procedure should be considered for prevention of potential risks, although the remnant guide wire does not usually cause complications. We experienced a patient with a guide wire fracture during PCI, and managed to prevent its complications through surgical removal of the remnant wire. We report this case here.

Acute Myocardial Infarction with Simultaneous Thrombosis of Multiple Coronary Arteries

Simultaneous thrombosis of multiple coronary arteries in acute myocardial infarction is very rare in clinical settings. Its mechanism is not yet clear, but patients displaying multivessel simultaneous thrombosis tend to have poor clinical outcomes. Hence, it is important to recognize this condition and provide timely and proper management. We report a case of simultaneous thrombosis involving multiple coronary arteries in a patient with ST-segment elevation myocardial infarction.

Unusual Presentation of a Metastatic Tumor to the Temporal Bone: Severe Otalgia and Facial Paralysis

Metastatic temporal bone tumors are rare diseases and they are usually clinically asymptomatic, so it is difficult to diagnose them. Breasts are the most common sites of temporal bone metastasis. Tumors of lung, kidney, gastrointestinal tract, prostate gland, larynx and thyroid gland are the other sites. The pathogenesis of the temporal bone is most commonly related to the hematogenous route. We present the case of a 78-year-old man with facial paralysis combined with severe otalgia. This patient was initially diagnosed with Bell's palsy. However, based on the radiologic findings, the patient was diagnosed with lung cancer with temporal bone metastasis.

Parathyroid Hormone 1-34(Teriparatide) Treatment in Pelvic Insufficiency Fractures: A Report of Two Cases

As a result of aging population, the incidence of pelvic insufficiency fracture has been increasing. Pain-related immobility caused by pelvic insufficiency fractures may result in a serious dependency and high mortality with preexisting comorbidities. We present two cases of pelvic insufficiency fracture in elderly patients which had good clinical outcome by parathyroid hormone 1-34(teriparatide) treatment as well as a literature review.

The Ratio Between the Percentage of Lymphocytes and Glucose Levels in Pericardial Fluid as a Method to Diagnose Tuberculous Pericarditis / 대한내과학회지

BACKGROUND/AIMS: Adenosine deaminase (ADA) is a valuable biochemical marker for pericardial effusion (PE) and may be useful for diagnosing tuberculous pericarditis (TPE) in patients with PE. However, no definite cut-off or borderline values for ADA currently exist to distinguish TPE from other PE etiologies. In this study, we identified other useful parameters and characterized their relationship with ADA as a method for diagnosing TPE. METHODS: From June 2004 to November 2011, 42 patients underwent pericardiocentesis due to moderate or severe PE, as confirmed by echocardiography or chest computed tomography (CT). Patients were subdivided into TPE and non-TPE (NTPE) groups. We analyzed ADA (p) (the pericardial ADA) and %Lymph (p)/Glucose (p) (the ratio between the percentage of lymphocytes and glucose levels in PE). RESULTS: We defined the cut-off value of ADA (p) as 48.5 IU/L, and that of %Lymph (p)/Glucose (p) as 0.678%.dL/mg. In a multivariate logistic regression analysis, an odds ratio (OR) of 44.24 and a 95% confidence interval (CI) of 2.85-686.97 were observed in patients with an ADA (p) > or = 48.5 IU/L (p = 0.023). An OR of 20.39 and a 95% CI of 1.06-392.93 were observed in patients with a %Lymph (p)/Glucose (p) > or = 0.678%.dL/mg (p = 0.046). The combination of ADA (p) and %Lymph (p)/Glucose (p) had a higher positive predictive value (PPV, 80.0%) and specificity (Sp, 93.8%) than either ADA (p) (PPV, 47.4%; Sp, 68.8%) or %Lymph (p)/Glucose (p) (PPV, 69.2%; Sp, 87.5%) alone. CONCLUSIONS: %Lymph (p)/Glucose (p) is a useful parameter for distinguishing TPE from other pericardial diseases if combined with an ADA (p) > or = 48.5 IU/L.

Delayed Diagnosed Stage 1, 2 Distractive Flexion Injury of the Cervical Spine

STUDY DESIGN: Retrospective study. PURPOSE: To examine the clinical and radiologic characteristics of patients with stage 1 and 2 distractive flexion injury according to Allen's classification and who were not diagnosed immediately after injury, and to analyze the outcomes of surgical treatments. OVERVIEW OF LITERATURE: For the diagnosis of stage 1 and 2 distractive flexion injury in the lower cervical spine, attention should be paid when performing radiographs as well as when interpreting the radiographs. METHODS: The study was conducted on 10 patients (group 1) with stage 1 or 2 distractive flexion injury and who were not diagnosed immediately after injury from January 2003 to January 2009. The control group (group 2), 16 distractive flexion injury patients who were diagnosed immediately were selected. The simple radiographs, the degree of soft tissue swelling and the magnetic resonance imaging findings of the two groups were compared, and the clinical and radiologic results were examined. RESULTS: The degree of the prevertebral soft tissue swelling of group 1 was lower in group 1, and it was statistically significant (p = 0.046). The fusion was achieved in all cases (100%) in group 1, however, re-displacement as well as the loss of reduction occurred in one case, despite of delayed fusion and good clinical result. In group 2, bone fusion was achieved in 15 cases of 16 cases (94%). CONCLUSIONS: For the diagnosis of stage 1 and 2 distractive flexion injury in the lower cervical spine, it is desirable to perform computed tomography if diagnosis is not clear. Even if the diagnosis is delayed, stage 1 and 2 distractive flexion injury could be readily reduced by traction, and the treatment outcomes are considered to be comparable to those of the patients diagnosed immediately after injury.

Effects of Combined Antiplatelets on Bleeding in Off-Pump Coronary-Artery Bypass Surgery / 영남의대학술지

BACKGROUND: Antiplatelet agent administration is critical in managing coronary-artery disease, but there is a concern regarding operation-related bleeding and an increase in blood transfusion in such, especially when delivering combined antiplatelet agents. This study was conducted to evaluate the effect of the administration of antiplatelet agents on off-pump coronary-artery bypass surgery (OPCAB). METHODS: From March 2003 to December 2009, 49 patients who had undergone OPCAB were collected retrospectively. The patients were divided into three groups according to the administration of antiplatelet agents before the OPCAB operation: 21 patients were given an aspirin agent (group 1), 19 patients were given combined agents (aspirin+clopidogrel) (group 2), and nine patients were not given any antiplatelet agent (group 3). The three groups' perioperative hematologic and coagulation profiles, including their platelet counts, hemoglobin levels, hematocrit, prothrombin times, and aPTTs (activated partial thromboplastin times), and their postoperative bleeding, related complications, transfusion requirements, and operation times, were compared. RESULTS: The operation time in group 2 was 4.3 hours, longer than those in the two other groups, and urgent operation was significantly most frequent in group 2 (63%). The amount of blood loss and the number of patients who received blood transfusion were not different in the three groups. The perioperative hemoglobin level, hematocrit, platelet count, prothrombin time, and aPTT were also not significantly different among the three groups. CONCLUSION: The continuous administration of antiplatelet agents to the patients in this study did not increase their postoperative bleeding or operation-related complications. Therefore, OPCAB may well be considered even if combined antiplatelet agents are being administered.

Intracardiac Tumor Presenting as Complete Atrioventricular Block

No abstract available.

Analysis of Failure Cause of Acetabular Components Among Total Hip Replacement Arthroplasties Using RB Wagner Acetabular Cup

PURPOSE: The purpose of this study was to analyze the cause of failure of acetabular component cases after metal-on-metal primary total hip arthroplasty using RB Wagner acetabular cup. MATERIALS AND METHODS: Between January 1993 and January 2005, we retrospectively studied failure cause of 27 patients who underwent acetabular revision surgery among 468 consecutive cementless total hip arthroplasties using RB Wagner acetabular component. The duration of primary arthroplasty to revision ranged from 5.1 years to 11.5 years (mean 9.2 years). The clinical evaluation was performed using preoperative and last follow-up modified Harris hip scores. The radiological evaluation was performed in terms of the stability, such as inclination, anteversion, cup size, acetabular bone coverage, osteolysis, radiolucency and gap. RESULTS: The average Harris hip scores was 49.6 preoperatively and 91.3 at the most recent follow-up. In revision cases, the score was 41.2 to 51.7. Among 468 cases, 27 patients underwent revision surgery (7%, 27/468) and there was no osseointegration in all cases. The radiological evaluation in revision cases revealed inclination (46.04+/-5.328, p=0.0031), anteversion (14.14+/-2.95, p=0.584), cup size (54 mm+/-2.5, p=0.042) and acetabular bone coverage (67.9%+/-4.77, p=0.003). Focusing on the relation between disease entities, there was relatively high risk in patients with hip dysplasia (Fisher's exact test, p=0.0095). CONCLUSION: Although Wagner acetabular cup relatively showed as high survival rate as 93%, failure rate is significantly high in dysplastic hip patients.

Successful Percutaneous Coronary Intervention for Acute Coronary Syndrome in a Patient With Severe Hemophilia A

Patients with hemophilia generally have a reduced frequency of coronary artery disease compared to the general population. As advances in the management of hemophilia have increased their life expectancy, the prevalence of coronary artery disease also has increased. However, there are no standard treatment guidelines for coronary artery disease in patients with hemophilia, especially in the field of coronary intervention. We report the case of a patient with severe hemophilia A who presented with acute coronary syndrome and was successfully treated with percutaneous coronary intervention.

A case of three-vessel coronary artery spasm presenting with aborted sudden cardiac death / 대한내과학회지

A 51-year-old female patient was referred to the emergency department with a 5-h history of resting chest pain. The patient, who had been diagnosed with variant angina six months previously, had not used her medications within two days of presentation. Electrocardiography (ECG) revealed a T wave inversion on lead I, AVL, and all precordial leads. Two hours later, the patient's chest pain was suddenly aggravated with an ST segment elevation noted from leads V2-6, leading to shock. Emergency management, including cardiopulmonary resuscitation (CPR), was initiated. Coronary angiography showed diffuse multifocal narrowing of three vessels; however, the vessels recovered following the intracoronary injection of nitroglycerin. The patient went into cardiac arrest two more times during continuous nitroglycerin infusion. The attacks were managed using CPR and sublingual nifedipine. Here, we describe a rare case of life-threatening three-vessel coronary vasospasm and its successful management with calcium channel blockers.

Multiple Sequential Complications After Sirolimus-Eluting Stent Implantation: Very Late Stent Thrombosis, Stent Fracture, In-Stent Restenosis, and Peri-Stent Aneurysm

A 55-year-old male patient presented with an acute myocardial infarction. A sirolimus-eluting stent (SES) was implanted in the proximal left anterior descending artery (LAD). Eight months later, there was a newly developed distal LAD lesion. An additional SES was implanted. Twenty-eight months after the index procedure of primary coronary intervention, the electrocardiogram showed ST elevation in the precordial leads and an emergency coronary angiogram showed diffuse stent thrombosis (ST) in the proximal LAD. Thirty-four months after the index procedure, coronary angiography showed a large peri-stent coronary aneurysm in the proximal LAD and focal in-stent restenosis (ISR) at the proximal edge of the distal LAD stent. On fluoroscopy, a fracture was noted in the middle part of the distal SES. A zotarolimus- eluting stent (ZES) was deployed and overlapped the restenosis and fracture sites. Forty months after the index procedure, there were no changes in the size of the aneurysm or in the other stent complications including the fracture and restenosis. At present, the patient has remained asymptomatic for eight months.

Evaluation of Bone Cutting Error of the Total Knee Arthroplasty with Computer-assisted Navigation

PURPOSE: To investigate the degree of bone cutting errors and its deviation and to evaluate the differences between a planned value before sawing and an achieved value after sawing in total knee arthroplasty (TKA) with computer-assisted navigation system. MATERIALS AND METHODS: 95 knees of 95 patients(81 females and 14 males) who underwent TKA with computer-assisted navigation (Orthopilot(R), AESCULAP) were studied. The planned value according to cutting block position and the achieved value according to achieved cutting planes were measured and compared. The bone cutting error which means a difference between the achieved value and the planned valued in each plane were statistically analysed. RESULTS: On each cutting planes, there were significant differences between planned values and measured values in coronal and sagittal plane of tibia and sagittal plane of femur (respectively p=0.0008, p=0.0002, p<0.0001), but coronal plane of femur showed insignificant difference (p=0.39). There was significant difference between bone cutting errors with valgus 0.05degrees (SD+/-0.66) in coronal plane and extension 0.47degrees (SD+/-0.91) in sagittal plane of femur and valgus 0.31degrees (SD=+/-0.80) in coronal plane band extension 0.21degrees (SD+/-2.09) in sagittal plane of tibial cutting (respectively p=0.0012, p<0.0001). CONCLUSION: Achieved values of bone cutting in coronal and sagittal plane of tibia and sagittal plane of femur on TKA were significantly different from planned values. The deviation of bone cutting errors showed valgus and extension in both femur and tibia. The bone cutting errors in sagittal plane were more significant than the coronal plane. Surgeons should take this bone cutting errors into consideration on operation.

Large Aneurysmal Bone Cyst of the Posterior Archofa Lumbar Vertebraina Child Treated with En Bloc Excision: A Case Report / 대한정형외과학회잡지

We present a case of an 8 year-old girl with a large aneurysmal bone cyst (ABC) of the 4th lumbar vertebra that involved the adjacent posterior element and which was treated by an en bloc excision. An aneurysmal bone cyst is an uncommon lesion. Among lesions that involve the extremities, standard treatment with curettage and a bone graft or other alternatives, such as embolization and radiation therapy, may be sufficient; but those that involve the spinal column require special consideration because of its anatomical and biomechanical complexity. We removed a large aneurysmal bone cyst from the posterior element of the lumbar spine with an en bloc excision without fusion or instrumentation and the clinical result was satisfactory. At the 1-year follow-up, there was no evidence of clinical recurrence or radiological instability. We describe a case of a large aneurysmal bone cyst of a lumbar vertebra of a child and present a review of the pertinent literature.

Assessment of Validity, Reliability and Responsiveness of Korean Knee Injury and Osteoarthritis Outcome Score(KOOS) for the Knee Injury / 대한정형외과학회잡지

PURPOSE: To assess the suitability of the Korean KOOS (Knee injury and osteoarthritis outcome score) as a patient-centered clinical measurement of the validity, reliability and responsiveness to the treatment of knee injuries. MATERIALS AND METHODS: One hundred and eight patients who had experienced an arthroscopic ACL reconstruction or a menisectomy between Jan. 2002 and Jun. 2003 were examined immediately after surgery, and 6 and 12 months after surgery. The SF-36 and Lysholm knee scale were administered simultaneously to each case in order to calculate the inter-item correlation. RESULTS: Measurements of the test-retest reliability showed that all intra-class coefficients (ICC) were measured as r=0.75-0.89 and Cronbach's alpha was 0.73-0.81. Regarding the validity, there was a strong correlation with the SF-36 and the Lysholm, subscales (SF-36 vs KOOS: Physical functioning vs ADL (r=0.67)/Physical functioning vs Sports and recreational activities (r=0.61)/Bodily pain vs Pain (r=0.63)). In terms of the responsiveness, the average score measured preoperatively, and three, six and nine months showed a gradual increase. The effect size of pain, symptoms and ADL at postoperative 6 months was 0.8-1.1. A larger effect size was observed in the QOL (1.5) and sports and recreational function (1.3) at 3 months after surgery (n=25). CONCLUSION: The validity, reliability and responsiveness of the Korean KOOS was confirmed and is considered to be a useful clinical metrology for a knee injury.

The Predictive Factors to Participation in Cervical Cancer Screening Program / 예방의학회지

OBJECTIVES: To examine the screening rate of cervical cancer in women and to find out the predictive factors for participation in cervical cancer screening programs within their life-time and within the last two years. METHODS: The data was based on self-reported questionnaires from 1,613 women whose ages ranged from 26 to 60 years; this survey was performed between December 1999 and January 2000. This study analyzed the predictive factors for participation in cervical cancer screening programs within their life-time and within the last two years. A logistic regression analysis was performed in order to derive the significant variables from the predisposing factors (demographic factor, health promotion behavior, reproductive factor), intervention factors (information channel, relation with medical staff), and proximal factors (attitude, social influence, self-efficacy). All analyses were performed by the PC-SAS 6.12. RESULTS: Our analyses showed that the screening rate for the women who received a cervical cancer screening (Pap smear) more than once within their life-time was 56.1% while those who had received one within the last two years was 34.5%. The significant factors for participation in cervical cancer screening program within their life-time were their income, married age, health promotion score, relation with medical staffs, social influence, and self-efficacy. On the other hand, age, number of pregnancies, menarche age, relation with medical staffs, social influences, and self-efficacy were significant factors for those being screened within the last two years. The predictive power of the logit model within their life-time was 68.8% and that within the last two years was 66.6%. CONCLUSION: The predictive factors for participation in cervical cancer screening program within their life-time are different from those for within the last two years, and that women's relations with medical staffs and social influences were the critical factors impacting on cervical cancer screening rates.

Diffuse Eosinophilic Gastroenteritis with Antral Obstruction: A Case Report

Eosinophilic gastroenteritis is a rare disease characterized by tissue eosinophilia that can involve different layers of the gut wall and cause various gastrointestinal symptoms. We describe the UGI and CT findings of a case of diffuse eosinophilic gastroenteritis with tumor-like antral obstruction due to thickening of the submu-cosa and muscle layer in a 21-year-old male.

A Study on the Behavioral Factors Related to Stomach Cancer Screening among Adults in a Rural Area / 한국역학회지

The purpose of this study was to investigate the behavioral factors related to stomach cancer screening among adults in a rural area. The number of subjects were 270 who were consisted of 133(49.3%) of male and 137(50.7%) of female. To predict the behavior, we used the health belief model. Using methodology was self-questionnaire which included the perceived health status, the severity for stomach cancer, preventive knowledge for stomach cancer, the threat for stomach cancer, the experience of cue to action, the benefit of cancer screening and the barrier of participating screening. The associations between the behavioral factors and the experience and intention of examination of endoscopy were evaluated by the odds ratio(OR). The results were as follows : 1. 78.1% of subjects responded that they had the good health, and 56.3% of them perceived the severity of stomach cancer. The 49.6% of them were evaluated as the moderate on the preventive knowledge for stomach. Also 39.3% had the threat for stomach cancer, and 79.2% had the experience of cue to action. The almost of respondents thought the endoscopy as available method for stomach cancer screening. The major barrier factors on stomach cancer screening were fear to endoscopy, discomfort for endoscopy, high cost of examination and lack of time. 2. Although the experience for examination of endoscopy was showed to the difference by sex, age, educational level and BMI, it was not significant. However, the experience for examination of endoscopy was showed to the significant difference by the perceived health status(OR:3.47, 95% CI:1.27-9.51), the preventive knowledge for stomach cancer(OR:0.42, 95% CI:0.19-0.96) and the experience of cue to action(OR:2.57, 95% CI:1.05-6.34). 3. Also although the intention for examination of endoscopy was showed to the differences by sex, age and BMI, it was not significant. However, the intention for examination of endoscopy was showed to the significant difference by the benefit for endoscopy(OR:2.35, 95% CI:1.02-5.42) and the experience of stomach cancer screening(OR:3.47, 95% CI:1.78-6.78). In case of the preventive knowledge for stomach cancer and the experience of cue to action, it did not influence to the intention for examination of endoscopy.

An Analysis on the Factors Associated with Cancer Screening in a City / 한국역학회지

This study is aimed at preparing basic data required for establishment of a cancer screening program by examining the status of cancer screenings performed by residents in a community and the factors that have an effect on determination for a cancer screening by residents. Cervix, breast and stomach cancers were chosen as target cancers of the study due to the fact that merits of screening for these cancers have been proved by studies done in different countries. In order to find out the status of cancer screening and the factors having an effect on the determination for a cancer screening, 10 Dongs and a total of 1988 people were selected as study area and subjects by a random cluster sampling method, and the subjects were questioned on different aspects by questionnaires. Additionally, in order to find out how cancer screening is performed at medical facilities and how cancer screening is recommended by doctors, medical facilities doing cancer screening were also questioned. The results of the study are as follows: 1. In the case of the screening of the stomach cancer, 16.1% of male subjects and 25.6% of female subjects turned out to have had one or more screening for the cancer. In the cases of the breast and the cervical cancers, 21.6% and 62.6% of the subjects turned out to have had one or more screenings respectively. 2. As to the screening for the stomach cancer, there was a tendency that more of the subjects with lower level education, excepting those without education, had themselves screened for the cancer. Higher screening rates were shown by the subjects in higher ages, those who visited doctors regularly. 3. As to the screening rate by education levels, a high rate of screening was shown by the subjects with above-university education level and there was not a big difference between the screenings done for high school graduates and for those with lower education levels. Regarding the rates of screening by age groups the screening rate turned out to be higher with the higher ages. Screening rates, checked on the basis of the income levels, did not show a big differences between income levels. 4. The highest rate of screening for the breast cancer was shown by the subjects with postgraduate level of education and regarding the rate by income level, a slightly higher level was shown by the subjects with the monthly income of the 2,010,000 won, but the difference between the rates of screening by subjects at different income levels was overall not significant. 5. The rates for selecting the health screening facilities were higher in orders of the reasons that 1) they were close: 2) service was excellent and 3) equipment and facilities were good. Based on the above-mentioned results obtained by the study, it is anticipated that this study will play a vital role as basic data for the development and execution of cancer screening program for a community, and the analysis, done on the basis of the status of the cancer screening, of the factors related to the determination for the cancer screening showed that for the development of a cancer screening program, factors like income levels, education levels, whether people consult doctors regularly and the local government' care for health in a community should be considered, and in addition to which active participation of doctors in the program is also requested.

MR Imaging Findings of Fatigue Fractures of Lower Extremity in Young Soldiers

PURPOSE: To evaluate the MR imaging findings of fatigue fractures of the lower extremity in young soldiers. MATERIALS AND METHODS: In 22 cases of fatigue fractures of the lower extremity in young soldiers proven byclinical findings and radiological follow up, the MRI findings were retrospectively evalvated. All patients weremale and aged between 19 and 21 years. As seen on MRI, the bone marrow edema, intramedullary low signal intensityband, cortical fracture line, periosteal reaction, surrounding soft tissue edema, and enhancement pattern wereanalyzed and the site of involvement was determined in the axial plane. RESULTS: The locations of fatiguefractures of the lower extremity were the tibia (n=12), fibula (n=8), femur (n=1) and second metatarsus (n=1). Alloccurred in diaphyses: the junction of the proximal and middle (n=10), middle (n=9), proximal (n=2), and distalshaft (n=1). The sites of involvement were the posteromedial (n=6) and medial side (n=6) of the tibia, and theentire portion of the fibula(n=5) in the axial plane. MRI findings were bone marrow edema in 20 cases,intramedullary low signal intensity band in 14 (which were continuous with the cortex or cortical fracture line),cortical fracture line in 13, and periosteal reaction and surrounding soft tissue edema in all. Ongadolinium-enhanced images, enhancement was seen in the bone marrow in 19 cases, in the subperiosteal region in18, and in the surrounding soft tissue in 22. CONCLUSION: In fatigue fractures of the lower extremity in youngsoldiers, the main locations were the tibia and fibula, and characteristic MR imaging findings were intramedullarylow signal intensity bands, which were continuous with the cortex or cortical fracture line and often accompaniedby bone marrow edema, periosteal reaction, and surrounding soft tissue edema.