Clinical Features of Iridocorneal Endothelial Syndrome in Korean Patients

Purpose@#To document the distribution and clinical features of iridocorneal endothelial (ICE) syndrome in its various subtypes observed in patients who visited a single institution in Korea. @*Methods@#A retrospective analysis was conducted on the medical records of patients diagnosed with ICE syndrome at the Department of Ophthalmology, Yeungnam University Hospital, from 1993 to 2023. The cases were classified into Chandler syndrome, progressive iris atrophy, and iris nevus syndrome based on the severity of corneal and iris abnormalities. We also examined the presence of glaucoma, corneal edema, and iris abnormalities at diagnosis. @*Results@#In all, 22 eyes from 21 patients with ICE syndrome were included. The mean age at diagnosis was 56.6 ± 16.1 years with a female predominance (20 patients, 95.5%). The syndrome was primarily unilateral (20 patients, 95.5%). Subtypes included 9 eyes with Chandler syndrome (40.9%), 7 eyes with progressive iris atrophy (31.8%), and 6 eyes with iris nevus syndrome (27.3%). Glaucoma was present in 15 eyes (68.2%), with 8 eyes (36.4%) undergoing glaucoma surgery. Of the 7 eyes that had trabeculectomy as initial glaucoma surgery, six experienced poor intraocular pressure control leading to Ahmed valve implantation in 4 cases. Corneal edema was noted in 10 eyes (45.5%) at diagnosis progressing to corneal decompensation in 6 eyes (27.3%). @*Conclusions@#ICE syndrome in Korea predominantly affects middle-aged women and occurs unilaterally with Chandler syndrome being the most common subtype. Given the high risk for glaucoma development, suboptimal outcomes of trabeculectomy, and significant risk for corneal decompensation, ongoing management efforts are essential for glaucoma and corneal function preservation.

Exosomes Secreted During Myogenic Differentiation of Human Fetal Cartilage-Derived Progenitor Cells Promote Skeletal Muscle Regeneration through miR-145-5p

BACKGROUND@#Currently, there is no apparent treatment for sarcopenia, which is characterized by diminished myoblast function. We aimed to manufacture exosomes that retain the myogenic differentiation capacity of human fetal cartilagederived progenitor cells (hFCPCs) and investigate their muscle regenerative efficacy in myoblasts and a sarcopenia rat model. @*METHODS@#The muscle regeneration potential of exosomes (F-Exo) secreted during myogenic differentiation of hFCPCs was compared to human bone marrow mesenchymal stem cells-derived (hBMSCs) exosomes (B-Exo) in myoblasts and sarcopenia rat model. The effect of F-Exo was analyzed through known microRNAs (miRNAs) analysis. The mechanism of action of F-Exo was confirmed by measuring the expression of proteins involved in the Wnt signaling pathway. @*RESULTS@#F-Exo and B-Exo showed similar exosome characteristics. However, F-Exo induced the expression of muscle markers (MyoD, MyoG, and MyHC) and myotube formation in myoblasts more effectively than B-Exo. Moreover, F-Exo induced greater increases in muscle fiber cross-sectional area and muscle mass compared to B-Exo in a sarcopenia rat. The miR-145-5p, relevant to muscle regeneration, was found in high concentrations in the F-Exo, and RNase pretreatment reduced the efficacy of exosomes. The effects of F-Exo on the expression of myogenic markers in myoblasts were paralleled by the miR-145-5p mimics, while the inhibitor partially negated this effect. F-Exo was involved in the Wnt signaling pathway by enhancing the expression of Wnt5a and b-catenin. @*CONCLUSION@#F-Exo improved muscle regeneration by activating the Wnt signaling pathway via abundant miR-145-5p, mimicking the remarkable myogenic differentiation potential of hFCPCs.

Synovium-Derived Mesenchymal Stem Cell-Based Scaffold-Free Fibrocartilage Engineering for Bone–Tendon Interface Healing in an Anterior Cruciate Ligament Reconstruction Model

BACKGROUND@#Current tendon and ligament reconstruction surgeries rely on scar tissue healing which differs from native bone-to-tendon interface (BTI) tissue. We aimed to engineer Synovium-derived mesenchymal stem cells (Sy-MSCs) based scaffold-free fibrocartilage constructs and investigate in vivo bone–tendon interface (BTI) healing efficacy in a rat anterior cruciate ligament (ACL) reconstruction model. @*METHODS@#Sy-MSCs were isolated from knee joint of rats. Scaffold-free sy-MSC constructs were fabricated and cultured in differentiation media including TGF-b-only, CTGF-only, and TGF-b + CTGF. Collagenase treatment on tendon grafts was optimized to improve cell-to-graft integration. The effects of fibrocartilage differentiation and collagenase treatment on BTI integration was assessed by conducting histological staining, cell adhesion assay, and tensile testing. Finally, histological and biomechanical analyses were used to evaluate in vivo efficacy of fibrocartilage construct in a rat ACL reconstruction model. @*RESULTS@#Fibrocartilage-like features were observed with in the scaffold-free sy-MSC constructs when applying TGF-band CTGF concurrently. Fifteen minutes collagenase treatment increased cellular attachment 1.9-fold compared to the Control group without affecting tensile strength. The failure stress was highest in the Col + D + group (22.494 ± 13.74 Kpa) compared to other groups at integration analysis in vitro. The ACL Recon + FC group exhibited a significant 88% increase in estimated stiffness (p = 0.0102) compared to the ACL Recon group at the 4-week postoperative period. @*CONCLUSION@#Scaffold-free, fibrocartilage engineering together with tendon collagenase treatment enhanced fibrocartilaginous BTI healing in ACL reconstruction.

Inhibitory Effect of Topical Cartilage Acellular Matrix Suspension Treatment on Neovascularization in a Rabbit Corneal Model

BACKGROUND@#The extracellular matrix (ECM) of articular cartilage has an inhibitory effect on vascularization, yet clinical utilization has been technically challenging. In this study, we aimed to fabricate a biologically functional ECM powder suspension from porcine articular cartilage that inhibits neovascularization (NV). @*METHODS@#The digested-cartilage acellular matrix (dg-CAM) was prepared by sequential processes of decellularization, enzymatic digestion and pulverization. Physicochemical properties of dg-CAM were compared with that of native cartilage tissue (NCT). Cellular interactions between human umbilical vein endothelial cells (HUVECs) and dg-CAM was evaluated with proliferation, migration and tube formation assays compared with that of type I collagen (COL) and bevacizumab, an anti-angiogenic drug. We then investigated the therapeutic potential of topical administration of dg-CAM suspension on the experimentally induced rabbit corneal NV model. @*RESULTS@#The dg-CAM released a significantly larger amount of soluble proteins than that of the NCT and showed an improved hydrophilic and dispersion properties. In contrast, the dg-CAM contained a large amount of collagen, glycosaminoglycans and anti-angiogenic molecules as much as the NCT. The inhibitory effect on NV of the dg-CAM was more prominent than that of COL and even comparable to that of bevacizumab in inhibiting the HUVECs. The therapeutic potential of the dg-CAM was comparable to that of bevacizumab in the rabbit corneal NV model by efficiently inhibiting neovessel formation of the injured cornea. @*CONCLUSION@#The current study developed a dg-CAM having anti-angiogenic properties, together with water-dispersible properties suitable for topical or minimally invasive application for prevention of vessel invasion.

Inhibitory Effect of Topical Cartilage Acellular Matrix Suspension Treatment on Neovascularization in a Rabbit Corneal Model

BACKGROUND@#The extracellular matrix (ECM) of articular cartilage has an inhibitory effect on vascularization, yet clinical utilization has been technically challenging. In this study, we aimed to fabricate a biologically functional ECM powder suspension from porcine articular cartilage that inhibits neovascularization (NV). @*METHODS@#The digested-cartilage acellular matrix (dg-CAM) was prepared by sequential processes of decellularization, enzymatic digestion and pulverization. Physicochemical properties of dg-CAM were compared with that of native cartilage tissue (NCT). Cellular interactions between human umbilical vein endothelial cells (HUVECs) and dg-CAM was evaluated with proliferation, migration and tube formation assays compared with that of type I collagen (COL) and bevacizumab, an anti-angiogenic drug. We then investigated the therapeutic potential of topical administration of dg-CAM suspension on the experimentally induced rabbit corneal NV model. @*RESULTS@#The dg-CAM released a significantly larger amount of soluble proteins than that of the NCT and showed an improved hydrophilic and dispersion properties. In contrast, the dg-CAM contained a large amount of collagen, glycosaminoglycans and anti-angiogenic molecules as much as the NCT. The inhibitory effect on NV of the dg-CAM was more prominent than that of COL and even comparable to that of bevacizumab in inhibiting the HUVECs. The therapeutic potential of the dg-CAM was comparable to that of bevacizumab in the rabbit corneal NV model by efficiently inhibiting neovessel formation of the injured cornea. @*CONCLUSION@#The current study developed a dg-CAM having anti-angiogenic properties, together with water-dispersible properties suitable for topical or minimally invasive application for prevention of vessel invasion.

Three-Dimensional Spheroid Culture Increases Exosome Secretion from Mesenchymal Stem Cells

BACKGROUND: Mass production of exosomes is a prerequisite for their commercial utilization. This study investigated whether three-dimensional (3D) spheroid culture of mesenchymal stem cells (MSCs) could improve the production efficiency of exosomes and if so, what was the mechanism involved. METHODS: We adopted two models of 3D spheroid culture using the hanging-drop (3D-HD) and poly(2-hydroxyethyl methacrylate) (poly-HEMA) coating methods (3D-PH). The efficiency of exosome production from MSCs in the 3D spheroids was compared with that of monolayer culture in various conditions. We then investigated the mechanism of the 3D spheroid culture-induced increase in exosome production. RESULTS: The 3D-HD formed a single larger spheroid, while the 3D-PH formed multiple smaller ones. However, MSCs cultured on both types of spheroids produced significantly more exosomes than those cultured in conventional monolayer culture (2D). We then investigated the cause of the increased exosome production in terms of hypoxia within the 3D spheroids, high cell density, and non-adherent cell morphology. With increasing spheroid size, the efficiency of exosome production was the largest with the least amount of cells in both 3D-HD and 3D-PH. An increase in cell density in 2D culture (2D-H) was less efficient in exosome production than the conventional, lower cell density, 2D culture. Finally, when cells were plated at normal density on the poly-HEMA coated spheroids (3D-N-PH); they formed small aggregates of less than 10 cells and still produced more exosomes than those in the 2D culture when plated at the same density. We also found that the expression of F-actin was markedly reduced in the 3D-N-PH culture. CONCLUSION: These results suggested that 3D spheroid culture produces more exosomes than 2D culture and the non-adherent round cell morphology itself might be a causative factor. The result of the present study could provide useful information to develop an optimal process for the mass production of exosomes.

Repair of Partial Thickness Cartilage Defects Using Cartilage Extracellular Matrix Membrane-Based Chondrocyte Delivery System in Human Ex Vivo Model

Treatment options for partial thickness cartilage defects are limited. The purpose of this study was to evaluate the efficacy of the chondrocyte-seeded cartilage extracellular matrix membrane in repairing partial thickness cartilage defects. First, the potential of the membrane as an effective cell carrier was investigated. Secondly, we have applied the chondrocyte-seeded membrane in an ex vivo, partial thickness defect model to analyze its repair potential. After culture of chondrocytes on the membrane in vitro, cell viability assay, cell seeding yield calculation and cell transfer assay were done. Cell carrying ability of the membrane was also tested by seeding different densities of cells. Partial defects were created on human cartilage tissue explants. Cell-seeded membranes were applied using a modified autologous chondrocyte implantation technique on the defects and implanted subcutaneously in nude mice for 2 and 4 weeks. In vitro data showed cell viability and seeding yield comparable to standard culture dishes. Time dependent cell transfer from the membrane was observed. Membranes supported various densities of cells. Ex vivo data showed hyaline-like cartilage tissue repair, integrated on the defect by 4 weeks. Overall, chondrocyte-seeded cartilage extracellular membranes may be an effective and feasible treatment strategy for the repair of partial thickness cartilage defects.

Effect of the education interval and method on improving Patients' plaque control ability / 대한구강보건학회지

OBJECTIVES: This study aimed to evaluate the effect of oral health education interval and toothbrushing instruction, the difference between the demonstration-only method and the demonstration with chairside practice toothbrushing instruction method, and the effect of initial patient plaque control ability on the plaque index. METHODS: Patients (n=60) were randomly assigned to receive a 1-week, 2-week, or 3-week interval of oral health education and toothbrushing instruction. Each group was further subdivided into the demonstration-only group and the demonstration with chairside practice group. Patients were categorized as having "good", "fair", or "poor" initial plaque control ability, based on the Turesky modification of the Quigley-Hein plaque index (TQHI). Patients attended five sessions during which they received oral health education and toothbrushing instruction of the modified Bass technique. Plaque evaluation was performed at each visit using the TQHI. RESULTS: The plaque index tended to improve from the first visit to the fifth visit, but there were no significant differences between the 1-week, 2-week, and 3-week education interval. The demonstration with the chairside practice group showed significantly greater improvements in the plaque index, compared to the demonstration-only group. In the good, fair, and poor plaque control ability groups, the plaque index improved gradually from the first to the fifth visit. When plaque control was poor, the improvement in the plaque index increased to a greater degree after oral health education and toothbrushing instruction. CONCLUSIONS: The results of this study may be helpful for suggesting appropriate individualized oral hygiene management methods to improve plaque control ability.

Clinical and Microbiological Study about Efficacy of Air-polishing and Scaling and Root-planing

The efficacy of air-polishing on subgingival debridement, as compared to scaling and root planning (SRP), was evaluated clinically and microbiologically. Fifteen patients diagnosed as chronic periodontitis, and having single-root tooth over 5 mm of pocket depth symmetrically in the left and right quadrant, were investigated. Subgingival debridement was performed by SRP and air-polishing. The results were evaluated and compared clinically and microbiologically. Probing pocket depth (PPD), bleeding on probing (BOP), relative attachment level (RAL) and change of gingival crevicular fluid (GCF) were assessed before treatment, and at 14 and 60 days after treatment. Microbial analysis was done pre-treatment, post-treatment, and at 14 and 60 days after treatment. Results of air polishing showed that post treatment, the PPD and BOP decreased, and attachment gain was observed. There was no clinical difference when compared to SRP. The volume of GCF decreased at 14 days, and increased again at 60 days. Compared to SRP, there was a statistical significance of the volume of GCF at 60 days in air-polishing. In the microbial analysis, high-risk bacteria that cause periodontal disease were remarkably reduced. They decreased immediately after treatment, but increased again with the passage of time. Thus, our results show that subgingival debridement by air-polishing was effective for decrease of pocket depth, attachment gain, decrease of GCF and inhibition of pathogens. Further studies are required to compare air-polishing and SRP, considering factors such as degree of pocket depth and calculus existence.

Prognostic Factors after Intra-Articular Hyaluronic Acid Injection in Ankle Osteoarthritis

PURPOSE: The goal of this study was to identify baseline prognostic factors of outcome in ankle osteoarthritis patients after intra-articular hyaluronic acid injection. MATERIALS AND METHODS: Patients with ankle osteoarthritis who received hyaluronic acid injection therapy were retrospectively reviewed. Each patient received weekly intra-articular hyaluronic acid injections (2 mL) for 3 weeks. Six predictors including gender, age, symptom duration, radiographic osteoarthritis stage, radiographic subchondral cyst, and fracture history were evaluated. Visual analogue scale (VAS) and patient satisfaction were evaluated as outcome measures. These predictors and outcome measurements were included in a logistic regression model for statistical analysis. RESULTS: Total of 40 consecutive patients (21 male, 19 female) were included in this study. Mean age was 60.6. Average follow up period was 13 months. The mean VAS recorded 3, 6, and 12 months after the first injection was 3.6 (SD 2.54, p<0.001), 4.33 (SD 2.9, p<0.001), and 5.3 (SD 2.7, p=0.0071), respectively, when compared to baseline VAS. Early stage disease was identified as an independent predictor associated with 'positive VAS outcome' at 3 and 6 months. Early stage disease and duration of pain less than 1 year were independent predictors associated with higher satisfaction. CONCLUSION: While hyaluronic acid injection for ankle osteoarthritis is a safe and effective treatment, careful selection of patients should be made according to the above prognostic predictors.

The Macular Buckling Procedure for Retinal Detachment Associated with a Macular Hole in High Myopia

PURPOSE: To evaluate the long-term anatomical and functional results of macular buckling for retinal detachment associated with a macular hole in high myopia. METHODS: Eleven consecutive highly myopic eyes with retinal detachment and macular holes were retrospectively studied between January 2002 and September 2010. All cases developed after pars plana vitrectomy for internal limiting membrane removal, for the treatment of retinal detachment associated with a macular hole, or vitreomacular traction with a macular hole. Macular buckling with an episcleral sponge was performed for all cases. The mean follow-up period after macular buckling was 45.1 months (range from 12 to 102 months). Retinal reattachment and macular hole closure after the surgery and best-corrected visual acuity before and after the surgery were evaluated. RESULTS: Nine out of 11 eyes were successfully treated with the macular buckling procedure. In the remaining 2 eyes, retinal re-detachment occurred with anterior proliferative vitreoretinopathy. In these eyes, successful retinal attachment occurred after reoperation with silicone oil tamponade. Optical coherence tomography (OCT) was performed after the surgery in 10 out of 11 eyes and the macular hole closure rate was 30%. The mean best corrected visual acuity went from counting fingers preoperatively to 0.06 postoperatively. CONCLUSIONS: The macular buckling procedure is effective for retinal detachment associated with a macular hole in high myopia, especially following an unsuccessful pars plana vitrectomy with removal of inner retinal traction.

Three Dimensional CT-based Virtual Patellar Resection in Female Patients Undergoing Total Knee Replacement: A Comparison between Tendon and Subchondral Method

BACKGROUND: Due to its small size, variable shape, and lack of distinct anatomical landmarks, osteoarthritic knees make a precise patellar resection extremely difficult. METHODS: We performed virtual patellar resection with digital software using three dimensional computed tomography scans of knees from 49 patients who underwent primary total knee replacement at our hospital. We compared 2 commonly used resection methods, the tendon method (TM) and the subchondral method, to determine an ideal resection plane with respect to the symmetry and thickness of the patellar remnant. RESULTS: The TM gave a thicker resected patella, and a less oval cut surface shape, which gives better coverage for a domed prosthesis. Both methods, however, gave a symmetric resection both superior-inferiorly, as well as mediolaterally. CONCLUSIONS: Although TM appears statistically better with respect to the thickness and cut surface shape, only further intraoperative studies with long-term clinical follow-up may provide us with the most appropriate patellar resection method.

Optimal Pelvic Inlet and Outlet Radiograph Angles in Korean Patients / 대한정형외과학회잡지

PURPOSE: Until now, pelvic injuries have been evaluated with 45degrees inlet and 45degrees outlet radiographs. Following these customary guidelines may not produce the best plane to evaluate pelvic injury due to variability of pelvic anatomy. Recent data based on the American population suggested 25degrees and 60degrees as the optimal angle for each inlet and outlet views, respectively. We hypothesized that inlet and outlet radiographic views to examine the clinically relevant landmarks vary from routine 45degrees inlet and outlet views and aimed to find optimal angles for Korean patients. MATERIALS AND METHODS: One hundred consecutive patients, aged between 30 to 60 years (50 male and 50 female patients), without pelvic ring disruption or fractures who had undergone routine axial pelvic computed tomography scans were retrospectively identified. The optimal inlet and outlet angles required to profile the clinically relevant pelvic anatomy were quantified for each patient. RESULTS: The optimal inlet angle to profile the anterior body of S1 and S2 required an average caudal tilt of 24.2degrees and 27.9degrees, respectively. The average outlet angle perpendicular to the body of S1 was 54.8degrees and perpendicular to S2 was 52.3degrees. The optimal angles were the same for male and female patients and were independent of patient age. CONCLUSION: Screening inlet and screening outlet radiographs made at 25degrees and 55degrees, respectively, are recommended for viewing clinically relevant osseous pelvic anatomy in Koreans.

Intraneural Ganglion of the Digital Nerve of the Hand: A Case Report

Intraneural ganglia in the upper extremity are rare, and the involvement of the digital nerve of hand has not been reported. The following case report demonstrates a 57-year-old woman with a symptomatic nodular mass on the thenar area of the left hand. Magnetic resonance images showed a lobulated, homogeneous mass of high signal intensity on T2-weighted images and low signal intensity with peripheral enhancement on T1-weighted images. Excisional biopsy and histopathologic examination revealed an intraneural ganglion of the digital nerve of the thumb. Her symptom disappeared immediately after the surgery, and has remained free of abnormal sensation and parestheia for the 3-year follow-up period.

A Comparison of Sugar Tong Splint and Radial Gutter Short Arm Splint after Closed Reduction of Distal Radius Fracture

PURPOSE: Various methods of immobilization exist in the nonsurgical treatment of the distal radius fracture, among which sugar tong splint is the most commonly used. In this study, we observed the results after treating the distal radius fracture with radial gutter short arm splint without elbow immobilization. MATERIALS AND METHODS: Among the fracture of distal radius who have been under conservative treatment after closed reduction, 48 patients (from January to December of 2005) were treated with sugar tong splint, and 57 patients (from January to December of 2007) were treated with radial gutter short arm splint. The loss of reduction after closed reduction of the two groups was compared. The types of fractures were determined as either stable or unstable based on the fracture segment. Follow up examination of the stability was performed 8 weeks later. RESULTS: There were 105 patients (male, 52; female, 53) with mean age of 50.2. Of the 57 patients with the sugar tong splint, loss of reduction was shown in 11 cases out of the 31 unstable fractures and none in 17 stable fractures. In the radial gutter short arm splint group, 12 cases out of 33 unstable fractures showed loss of reduction. Only one case in 24 stable fractures treated by the radial gutter splint has failed. There was no statistically significant difference in the reduction loss rate between the two immobilizing methods (p-value=0.37), as well as the type of reduction loss (p-value>0.05). CONCLUSION: Sugar tong splint and radial gutter short arm splint had no difference in maintaining reduction. Sugar tong splint has been considered as the most effective method of maintaining reduction by preventing rotation of the forearm and flexion-extension of the elbow. Furthermore, radial gutter short arm splint can minimize limitation of the elbow motion and daily life activity. Based on our results, radial gutter short arm splint, which only immobilize the wrist joint, had a good results as well.

The Optimal Threshold for Detection of BNP in Congestive Heart Failure and Variables Impact on BNP Concentration

PURPOSE: This study was conducted in order to determine a cut-off value of BNP for use in our hospital, and to obtain mean values of BNP as correlated to various factors and to underlying disease. After classification of patients into groups according to disease severity and prognosis, we analyzed the correlation between the concentration of mean BNP and severity of disease. METHODS: 1040 patients who visited the emergency department of the hospital between July 1, 2004 and July 31, 2005 and whose BNP values were measured were enrolled in the study. RESULTS: The optimal threshold BNP concentration for detection of heart failure was 296 pg/mL. The mean BNP concentration in female patients without underlying disease and heart failure was increased significantly and in patients with CRF, the cut-off value of BNP for a CHF was 413 pg/ml. In patients with more than two types of underlying disease, significant increase in mean BNP concentration was found in patients with hypertension. As indicated by New York Heart Association Killip classification, the left ventricular ejection fraction and prognosis, the BNP value is correlates both with the severity of heart failure and with its prognoses. CONCLUSION: The BNP concentration used as a clinical indicator in our hospital is much higher than the cut-off value of 100pg/mL. In patients without CHF, women are higher in mean BNP concentration. A significantly higher mean BNP concentration was found in patients with hypertension. We find that BNP concentration is related both to the severity of heart failure and to prognoses.

Clinical Analysis of Outpatient Treatment for a Spontaneous Pneumothorax

PURPOSE: In the Emergency Department, inpatient and invasive treatment of pneumothorax patients have been causing overcrowding and higher medical costs, both of which are considered to be an important factors that affect adversely the clinical activities in the Emergency Department. For this reason, on the assumption that it would be meaningful to treat pneumothorax patients as outpatients by utilizing small-caliber catheters and Heimlich valve insertions, we examined the effects of such treatment and compared it with the results for patients treated with a closed thoracostomy. METHODS: A comparative study of the success rates, the complications, and the recurrence rates was done by comparing the results obtained by applying a of a small-caliber catheter and Heimlch valve insertion to the 47 spontaneous pneumothorax patients included in this study with the results for the same number of patients treated with a closed thoracostomy. After the small-caliber catheter and Heimlch valve insertion, we also examined the factors that affected success. RESULTS: The number of patients who were successfully treated for a pneumothorax by using a small-caliber catheter and a Heimlch valve insertion on the basis of ambulant care was 20 (47%), which is less than the 42 patients (89%) that were successfully treated by using a closed thoracostomy. In the follow-up assessment at six months, relapse of the pneumothorax had developed in 3 (15%) out of the 20 patients that have undergone the Heimlich valve insertion treatment and in 2 (8%) out of the 26 patients that had undergone a closed thoracostomy. While no complications developed in the group that had been treated by using a the small-caliber catheter and Heimlich valve insertion, the group treated by using a the closed thoracostomy showed the development of a hemothorax in 2 patients, subcutaneous emphysema in 7 patients, and pleural effusion in 2 patients. The medical expenses for the patients treated by using the small-caliber catheter and Heimlch valve insertion were less than these for the patient treated using a closed thoracostomy. There were no differences in age, sex, onset times, major symptoms, sizes of the pneumothorax based on the success or failure of the small-caliber catheter and Heimlich valve insertion treatment. However, all the patients that ended up with failure were found to have bleb when they underwent the operation. CONCLUSION: The success rate of ambulatory treatment with a small-caliber catheter and Heimlich valve insertion was 43%, which was lower than the value for inpaitient treatment using a closed thoracostomy. However, as there are no complications and as the medical expenses are smaller, the former treatment is thought to be of greater use in emergency treatment by physicians who are less-experienced in a closed thoracostomy and in the on-site emergency care.

Significance of the Poisoning Severity Score as a Prognostic Factor in Poisoning

PURPOSE: The clinical factors that help to determine the management in the emergency department for acute poisoning are the type of toxic material and the amount, the cause of poisoning, and the toxidrome. Especially, when one cannot obtain much information about the type of toxic material and the amount from history taking, the most important factor in deciding whether a patient should be hospitalized or discharged is the toxidrome. The Poisoning Severity Score is a standardized system for scoring clinical signs and symptoms due to poisoning. This study was conducted to see if the Poisoning Severity Score on arrival at the emergency department might be used as a prognostic factor and, to see if there are any other factors that might be used to deciding on treatment plans and whether to hospitalize or discharge a patient. METHODS: Retrospective chart reviews of poisoned patients who had visited the Emergency Department of Ansan Hospital of Korea University were used in this study. Age, sex, the time taken to arrive at the emergency department after poisoning, the type of toxic material and the cause of poisoning, the mean arterial pressure, the pulse pressure, the respiratory rate, the body temperature, the initial Poisoning Severity Score, the AST, the serum creatinine level, the anion gap, and the base excess were checked. Also, the use of activated charcoal, gastric lavage, antidotes, hemodialysis/hemoperfusion, and mechanical ventilation, as well as the final Poisoning Severity Score and the clinical progress were checked. RESULTS: In cases of high initial poisoning, the final Poisoning Severity Score was, with statistical significance, much higher than it was in cases of low initial poisoning. Also, in cases of high final Poisoning Severity Scores, the mechanical ventilation rate and the death rate were higher than they were in cases of low final Poisoning Severity Scores, and this difference was statistically significant. In cases of high final Poisoning Severity Scores, mean age was older, and the intentional poisoning rate, the hemodialysis/ hemoperfusion rate, the base excess, and the initial Poisoning Severity Score were higher than in cases of low final Poisoning Severity Score. CONCLUSIONS: We have concluded that the initial Poisoning Severity Score can be a useful factor for giving a prognosis and for deciding on hospitalization and on a therapeutic plan. Also, we have concluded that multiple variables, such as the patient's age, the type of toxic material, the cause of poisoning, and the base excess are significant factors that can complement the initial Poisoning Severity Score in deciding on a hospitalization and therapeutic plan. Consequently, early evaluation of the type of toxic material and the cause of poisoning from history taking and early measurement of the initial Poisoning Severity Score and the variables mentioned above are of utmost importance in formulating a prognosis and deciding on the need for hospitalization.

Relationship of End tidal PCO2 a n d Arterial PCO2 in Acute Critically Ill Patients

BACKGROUND: The CO2 concentration in exhaled gases is intrinsically linked to tissue metabolism, ventilation, and pulmonary circulation. In hemodynamically stable patients, the end-tidal CO2(PetCO2) is known to be a good index of arterial CO2 (PaCO2). However, the PetCO2 has some limitations in predicting PaCO2 in emergent patients with unstable vital signs. OBJECTIVE: We evaluated the relationship of PetCO2 and PaCO2 and the validity of the difference between PetCO2 and PaCO2(PaCO2-PetCO2) for various clinical situations. MATERIAL AND METHOD: A prospective analysis was performed in endotracheally intubated patients, who presented at the Korea University Emergency Medical Center during a 14-month period from January 2003 to February 2004. Patients were divided into three groups; respiratory insufficiency of cardiopulmonary cause (Group A), respiratory insufficiency of extracardiopulmonary cause (Group B), cardiac arrest with any cause (Group C). Group A was subdivided into two subgroups; A1 with a history of chronic lung disease disease and A2 with no history of chronic lung disease history. In each group, the mean of PaCO2-PetCO2 was calculated and multiple comparison was performed in each groups by using a one-way ANOVA test, and the 95% confidence interval of PaCO2 - PetCO2 was calculated. P a C O2 and PetCO2 were evaluated by using a linear regression analysis. The calculation was performed using the SPSS for windows version 10.0, and p values of less than 0.05 were considered significant. RESULT: A total of 59 patients were included in this study. Twenty-five patients were in Group A, (18 in A1 and 7 in A2), 26 in Group B, and 8 in Group C. The linear regression data showed the relation between PaCO2 and PetCO2 to be statistically significant in the Groups A2, B, and C. The values of the difference of PaCO2-PetCO2 were 22.1+/-3.26 mmHg in Group A, 33.7+/-7.21 mmHg in Group A1, 17.6+/-3.06 mmHg in Group A2, 5.3+/-1.45 mmHg in Group B, and 21.2+/-4.73 mmHg in Group C. The 95% confidence intervals of PaCO2-PetCO2 were 15.37- 28.81 mmHg in Group A, in group A1, 16.07-51.35 mmHg in group A1, 11.11-24.03 mmHg in Group A2, 2.33-8.31 mmHg in Group B, and 10.03-32.42 mmHg in Group C. CONCLUSION: In patients with chronic pulmonary disease, who are endotracheally intubated for assisted ventilation, the PetCO2 do not reflect the PaCO2 and also the value of PaCO2-PetCO2 is not a good parameter for determining pathological status. However, in patients with acute cardiopulmonary disease and during cardiopulmonary resusciatation, the PetCO2 does not reflect the quantitative value of PaCO2, but may be used in predicting the tendency of PaCO2 to increase. In endotracheally intubated patients with extracardiopulmonary cause, PetCO 2 reflects the quantitative index of PaCO2 and the value of PaCO2-PetCO2 may be a good index for monitoring pathological conditions.

Change of Interstitial Cells of Cajal (ICC) and Intestinal Motility in Murine Small Bowel Obstruction / 대한해부학회지

Interstitial cells of Cajal (ICC) are the pacemakers in gastrointestinal slow wave, and also transduce signal inputs from the enteric nervous system to smooth muscle. The abnormal motility corresponded to a lack or decreasing of ICC and a disruption of electrical slow waves. So we developed partial obstruction model in murine small intestine and investigated changes in the ICC networks and electrical activity in the obstructed bowel using c-kit immunohistochemistry and intracelluar electrophysiological techniques. Two weeks following the onset of a partial obstruction, the small intestine increased in diameter and muscular hypertrophy was developed oral to the obstruction site. ICC were absent or only weak at 1 ~25 mm oral to the occlusion site, and this disruption was accompanied by the loss of electrical slow wave. ICC networks and slow waves were normal appearance aboral to the clip. In conclusion, The present results showed that partial intestinal obstruction induced the loss of ICC networks and slow waves. These result will provide a valuable aid for understanding pathogenesis of intestinal motility disorder, and this model may be an important tool for evaluating genetic or molecular factor for the therapeutic opportunities of motility disorder in human.