Characteristics of Wrist Injuries in Snowboarding

PURPOSE: The purpose of this study was to analyze the characteristics and severity of wrist injuries in snowboarding. METHODS: December 2005 to February 2008, Snowboarders who experienced wrist injures were included in this study. On the basis of the medical records and radiographic evaluation, the severity of distal radius fracture was classified according to the Arbeitsgemeinschaft fur Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) classification. RESULTS: Most of the injured snowboarders were a either of the beginner (35 cases, 46.1%) or the intermediate (27 cases, 35.5%) level. The most common cause of injury in snowboarding was a slip down (60 cases, 78.9%). Comminuted and articular fractures classified as AO types A3, B, and C, which required surgical reduction, made up 42.3% of the distal radial fractures in snowboarders. When we analyzed the differences in severity between the educated and the non-educated groups, an A2 type injury in the AO classification was the most common type of injury in the educated group (20 cases, 38.5%), it means less severe fractures ocurred in the educated group (p=0.045). The most frequent injury mechanism of fractures was slip down (48 cases, 63.2%), and a slip down backwards was the dominant type of slip down (36 cases, 75.0%) (p=0.031). CONCLUSION: Among the snowboarders in this study who suffered self-down injury to the wrist, more fractures were associated with a backwards slip down than with a forward slip down due to over extension. For educated snowboarders the severity of fracture was lower than it was for uneducated snowboarders.

The Diagnostic Value of h-FABP (hearttype fatty acid binding protein) in Acute Myocardial Infarction

PURPOSE: Heart-type fatty acid binding protein (h-FABP) is a low molecular weight (15 kDa) protein that is abundant in the cytosol and is in high concentration in the myocardium. H-FABP is released into plasma and urine early (within 1~2 hr) after onset of myocardial injury. This study was undertaken to assess the diagnostic value of a h-FABP kit. METHODS: We conducted a prospective study of 73 patients who were suspected to have acute myocardial infarction and arrived within 24 hrs after the onset of chest pain from March to August 2007. Exclusion criteria were age less than 18 years and chronic renal failure. RESULTS: Thirty-nine patients arrived within 4 hrs (63%) and 23 arrived from 4hrs to 24hrs (37%). Upon initial EKG, ST elevation was seen in 45 cases (72%), ST depression in 7 cases (11%), T-wave inversion in 4 (6%), and arrhythmia in 5 (8%). With respect to Killip classification, 33 cases were class I (53%), 18 cases were class II (29%), 4 cases were class III (6%), and 7 cases were class IV (11%). Diagnosis was AMI in 49 cases (79%), unstable angina in 6 cases (9%), and vasospasm in 1 case (1%). Sensitivity of FABP was 71.0% on arrival at an emergency department within 4 hrs, which is higher than the sensitivities of myoglobin (48.4%), CK-MB (48.4%), and troponin-I (38.7%). CONCLUSION: H-FABP is more useful than other currently available biomarkers for early detection of acute myocardial infarction patients within 4 hrs of arrival at an emergency department.

Complete Remission in a Patient with Multiple Myeloma after High Dose Melphalan and CD34+ Selected Autologous Transplantation / 대한혈액학회지

Multiple myeloma is characterized by long clinical course and drug resistance. Conventional chemotherapy results in modest survival benefit. High dose therapy with autologous stem cell transplantation results in markedly increased response rate and survival, confirmed by a randomized study. But there are any evidences yet this approach confers cure. To decrease relapse rate, several approaches are ongoing. Among them, purified CD34+ selected transplantation is an attractive approach because of reduced contamination of myeloma cells. Recently we have experienced CD34+ selected autologous transplantation in a multiple myeloma patient. After VAD induction chemotherapy, high dose melphalan (200mg/m2) with CD34+ selected autotransplantation was followed. Immunoadsorption using CeprateSC resulted in 81% purity and 42% yield. Infused CD34+ cell number was 3.1x106/kg. Absolute granulocytopenic and thrombocytopenic period was less than a week. Grade lll or more extramedullary toxicities were not observed. After high dose therapy, complete remission by immunofixation was achieved. We have experienced a case of CD34+ selected transplantation in multiple myeloma and found that it was safe in terms of short term engraftment.

Meningitis due to Listeria Monocytogenes Following Orthotopic Heart Transplantation

We report a first case of meningitis due to listeria monocytogenes after cardiac transplantation in Korea. This patient is a 40-year-old man with Dilated cardiomyopathy, he presented with intermittent dyspnea and abdominal distension for about 1 year. After cardiac transplantation, he was treated with azathioprine, cyclosporine and prednisolone for graft rejection. He was presented with intermittent fever, headache and lethargy for about 10days after cardiac transplantation. Listeria monocytogenes was isolated from blood culture and CSF culture. He was treated with intravenous penicillin G for 10days successfully and changed with ampicillin for 10days, took oral ampicillin for 10days without any complication after discharge.

Initial Results after Implantation of Coronary Artery Stents with Antiplatelet Agents

Backgound: The placement of stents in coronary arteries has been shown to reduce acute closure and restenosis in comparison to balloon angioplasty. However, clinical use of intracoronary stents is impeded by the subacute stent thrombosis and hemorrhagic complications associated with the anticoagulant regimen. It's known that the complete stent deployment with high pressure inflation and new antiplatelet agents are effective in reduction of subacute thrombosis and hemorrhage. So we evaluated initial results (success and complication rate) after high pressure-stent deployment with new anticoagulation protocol. METHODS: One hundred and ninety one patients with 201 lesions were treated with 231 stents of various types. The high pressure balloon inflation and antiplatelets agents were used in all cases. Final high pressure balloon inflation guided by IVUS were performed in 23 consecutive cases with incomplete stent deployment according to angiographic findings. RESULTS: 1) The indications of stenting (n=210) were De novo in 124 (59%), bailout procedure in 57 (27%), suboptimal result after PTCA in 19 (8%), and restenosis after PTCA in 14 (6%). The location of lesions were LAD in 101, RCA in 67, circumflex in 28, ramus intermedius in 3, and LMT artery in 2 lesions. Angiographic morphologic characteristics were type A in 2, type B in 158 (B1: 57, B2: 101), and type C in 22 lesions. 2) The angiographic and clinical success rate was 96% (192/201) and 92% (186/201) respectively. 3) In angiographic analysis, the baseline average reference vessel dirmeter was 3.33+/-0.35 mm. Baseline minimum lumen diameter (MLD) was 0.58+/-0.29 mm, with baseline percent diameter stenosis of 82.86+/-8.64%. The final stent diameter was 3.37+/-0.29 mm, with mean final percent stenosis of 0.63+/-8.25. The mean MLD after stenting was significantly increased (p12atm) (p<0.001). The length of lesions in GR I (cook), GR II, and Micro II stents were significantly longer than ones in PS, Cordis, Wiktor, Nir (p<0.001). 4) In intravascular ultrasound analysis, the mean lumen CSA at the tightest point within stent increased 11%, from 8.4+/-2.4 mm2 at the intial intravascular ultrasound to 9.4+/-2.1 mm2 at the final intravascular ultrasound (p<0.001). 5) The procedural and postprocedural complications were 2 acute closures associated with AMI and emergent CABG, 1 subacute closure which was revascularized by bail out stenting, 5 major hemorrhage requiring transfusion associated with 1 CVA and 2 metabolic acidosis induced by acute renal failure, and 5 death. CONCLUSION: The high pressure stent deployment procedure and new anticoagulation protocol associating tidopidine and aspirin without coumadin or prolonged heparin infusion allow us to obtain an acceptably low subacute thrombosis or bleeding complication rate. These results are encouraging and allow a wide use of coronary stenting.

A Case of Partial Left Ventriculectomy in a Patient with End-stage Dilated Cardiomyopathy

The end-stage dilated cardiomyopathy is usually treated with cardiac transplantation although some limited success have also been obtained in selected patients using dynamic cardiomyoplasty or medical assist devices. Recently, a new surgical alternatives, called partial left ventriculectomy (PLV) was introduced by Randas J. V Batista in 1995. A 40-year-old man who had end-stage dilated cardiomyopathy refractory to optimal doses of medicines underwent partial left ventriculectomy (Batista's operation), which reduces ventricular volume to improve left ventricular function. The left ventricular ejection fraction increased from 20 % to 58 % at 4 month after operation.

A Case of Transcatheter Alcohol Ablation of the Septum in a Patient of Hypertrophic Obstructive Cardiomyopathy

Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by inappropriate myocardial hypertrophy that occurred in the absence of an obvious cause for the hypertrophy and dynamic left ventricular outflow tract obstruction, caused by asymmetrical septal hypertrophy and systolic anterior motion of the anterior mitral leaflet. The pathophysiological abnormality in HOCM is diastolic dysfunction, abnormal stiffness of the left ventricle with resultant impaired ventricular filling and impaired vasodilator reserve (perhaps related to the thickened and narrowed small intramural coronary arteries found in HOCM). During the early course of this progressive disease, treatment consists of negative inotropic drugs. Surgery has been the only therapeutic option in patients with hypertrophic cardiomyopathy who are resistant to drug treatment and sequential pacemaker therapy. We describe a novel catheter-based technique that may replace surgical myocardial reduction. The technique is interventional infarction of a portion of the interventricular septum by the infusion of alcohol into a selectively catheterized septal artery.