Hindfoot Endoscopy for the Treatment of Posterior Ankle Impingement Syndrome: A Comparison of Two Methods (a Standard Method versus a Method Using a Protection Cannula) / 대한족부족관절학회지

PURPOSE: The purpose of this study is to compare the clinical results between two different methods of hindfoot endoscopy to treat posterior ankle impingement syndrome. MATERIALS AND METHODS: Between January 2008 and January 2014, 52 patients who underwent hindfoot endoscopy were retrospectively reviewed. Two methods of hindfoot endoscopy were used; Group A was treated according to van Dijk and colleagues' standard two-portal method, and group B was treated via the modified version of the above, using a protection cannula. For clinical comparison, the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, time required to return to activity, and the presence of complications were used. RESULTS: There was no statistically significant difference in the AOFAS scores at the final follow-up, and there was also no statistically significant difference in the times for the scores to return to the preoperative level. There were no permanent neurovascular injuries and wound problems in either group. CONCLUSION: Use of protection cannula may provide additional safety during hindfoot endoscopy. We could not prove whether protection cannula can provide superior safety for possible neurovascular injury. Considering the possible safety and risk of using additional instrument, the use of this method may be optional.

Comparison of Outcomes between AutoPulse(TM) and Manual Compression in Out-of-hospital Cardiac Arrest Patient

PURPOSE: This study compared the outcomes of AutoPulseTM compression with manual compression provided by 119 paramedics in out-of-hospital cardiac arrest patients. METHODS: Between March and December 2016, a total of 221 out-of-hospital cardiac arrest patients were included for analysis. The patients included were categorized as the AutoPulseTM compression group and manual compression group. Patient's age, sex, pre-hospital intubation, bystander cardiopulmonary resuscitation (CPR), initial cardiac rhythm, time from arrest to CPR and CPR duration were reviewed retrospectively. The initial pH, lactate level, white blood cell (WBC) count, delta neutrophil index (DNI), and targeted temperature management status were collected. As clinical outcomes, the return of spontaneous circulation (ROSC), hospital and intensive care unit (ICU) length of stay, survival rate, and cerebral performance category (CPC) scale at discharge were analyzed. RESULTS: The initial rhythm and CPR duration were similar in the two groups. On the other hand, the pre-hospital intubation rate and pre-hospital CPR duration were significantly higher in the AutoPulseTM group than the manual group (32.9% vs. 12.7%, p < 0.001; 15.2 vs. 11.9 minutes, p=0.002). The ROSC rate, hospital and ICU length of stay, CPC scale and survival rate at discharge as the clinical outcome were similar in the AutoPulseTM group and manual group. The pH was lower and the lactate level was significantly higher in the AutoPulseTM group than the manual group (6.91 vs. 6.96, p=0.007; 12.8 vs. 11.4 mmol/L, p=0.031), but the WBC and DNI were similar in the two groups. CONCLUSION: The use of AutoPulseTM provided by 119 paramedics in out-of-hospital cardiac arrest patients is not associated with better clinical outcomes.

Diabetes and Depressive Symptoms in Korean Women: The Fifth Korean National Health and Nutrition Examination Survey (2010-2011) / 가정의학회지

BACKGROUND: The purpose of this study was to investigate the association between diabetes and depressive symptoms among Korean women. METHODS: We performed an analysis of data for 6,572 women aged 30 or over obtained from the Fifth Korean National Health and Nutrition Examination Survey conducted in 2010 to 2011. We examined the presence of depressive symptoms and the treatment of depression according to diabetes status. RESULTS: The presence of depressive symptoms was observed in 22.6% of subjects with diabetes. In the multiple logistic regression model, diabetes was associated with an increased risk of depressive symptoms (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.20 to 1.21) but the treatment of depression among diabetics was less common (OR, 0.54; 95% CI, 0.54 to 0.55). Uncontrolled diabetes (glycosylated hemoglobin > or = 7%) was associated with an increased risk of depressive symptoms (OR, 1.71; 95% CI, 1.69 to 1.73) among diabetics. CONCLUSION: Physicians should manage individuals with diabetes in consideration of the presence of depressive symptoms, especially in those with uncontrolled diabetes.

Surgical Outcomes of Arthroscopic Modified Brostrom Procedure in Chronic Lateral Ankle Instability / 대한족부족관절학회지

PURPOSE: To evaluate the result of arthroscopic modified Brostrom procedure with suture anchor for chronic lateral ankle instability. MATERIALS AND METHODS: Fifty-two patients with chronic lateral ankle instability were analyzed, who underwent arthroscopic modified Brostrom procedure between December 2010 and May 2012. Clinical evaluation was performed using AOFAS scroring and Sefton grading system. RESULTS: The average AOFAS hind foot score increased from preoperative 61.9 to 88.8 at the last follow up. There were 35 excellent, 9 good, 4 fair, 4 poor results according to Sefton grading system. For one patient, lateral ankle instability recurred. CONCLUSION: Arthroscopic modified Brostrom procedure is considered to be an effective and satisfactory technique.

Study of Practical Application of Medical Assistants in Burn Center

PURPOSE: Complications and mortality rate of burn injuries are recently decreasing owing to development of systematic and special burn therapy. Whereas we are suffering from the lack of the medical manpower in burn center. In the future we might need more medical assistants to compensate these shortages. In this study we tried to search the path through these difficulties by considering the practical application of medical assistants. METHODS: We compared Korea's current situation of burn treatment with other countries in various references. Also we studied and compared recent situation of medical assistants in Korea and U.S.A. We took special considerations for Korean emergency medical technician, physical therapist and occupational therapist. RESULTS: Our study showed that we are practically using emergency medical technician, physical therapist and occupational therapist as medical assistants in various fields including burn centers. Emergency medical technician, physical therapist and occupational therapist as medical assistants can be excellent medical substitutes for shortage of manpower in our burn centers. Compared with U.S.A's current situation we are quite lacking of certain certified programs for such medical assistants. Burn therapists can be promoted from medical assistants through certain certified educational programs. CONCLUSION: We think that emergency medical technician, physical therapist and occupational therapist, who have certification concerning certain medical experience, should undergo certified educational program for burn therapy and should be used as a actual burn therapists to overcome the shortage of manpower in our burn centers.

High Voltage Electrical Injury and Prevention

PURPOSE: High voltage electrical injury mainly occurs in the industrial field. It can cause serious complications and sequelae that lead to high social and economic costs. We investigated the causes of this to try to help prevent these injuries. METHODS: We reviewed 128 patients who incurred high voltage electrical injury during a 3-years period from Jan. 1, 2006 to Dec. 31, 2008. We performed a retrospective analysis of the medical records to review the epidemiology. We also performed a survey by telephone. The survey questions addressed the following: the duration of work, wearing safety equipment, the reason for working without safety equipment, did they receive safety education, was the safety education adequate, recognition of a high tension wire before working and did they understand the effect of high voltage on the human body. RESULTS: The safety education was relatively carried out well. But most patients did not wear safety equipment even though they knew they had to wear it (92%). The major reason was discomfort of wear it (72%). The hand was the most common injury site (80%). Most injuries occurred with 22,900 volt or less (92%). In spite of safety education, many patients were unaware of the effects of electrical injury on their body. CONCLUSION: Strengthened safety education can play a significant role in preventing high voltage electrical injury. At this point, the doctors who are experienced in treating high voltage electrical injury must actively participate in this safety education. We suggest that handy safety equipment can lessen the incidence of high voltage electrical injury. It is essential to develop a handy safety glove for 22,900V with considering that the hand was the most common injury site and the most frequent voltage for injury was 22,900 volt or less.

The Incidence and Risk Factors of Psychiatric Complications in Electrical Injury

PURPOSE: Electrical injuries may cause many psychiatric complications such as depression, acute stress disorder, post-traumatic stress disorder (PTSD), etc. The purpose is to search the incidence of psychiatric complications in electrical injury and to compare its associated risk factors with other burn and trauma. METHODS: We reviewed the medical records of 709 electrically injured patients who were admitted to Hanil General Hospital from 2002 to 2007. Psychiatric complications were defined as depression, acute stress disorder and PTSD according to DSM-IV. We sorted the medical records into demographics, hospitalization, electrical voltage, injured type, extent or site of burn and type of amputation. RESULTS: Total incidence of psychiatric complications was 27.5% (Depression; 15.8%, acute stress disorder or PTSD; 17.6%). High voltage injured patients had psychiatric complications 2.38 times higher than low voltage. Incidence of psychiatric complications were 1.83 times in 6~10% of BSA, 2.01 times in 11~20% and 2.41 times in 21~30% higher than in 0~5% of BSA. If the site of burn included face, psychiatric complications occurred 1.96 times more than other sites. Patients with history of minor and major amputation showed 2.39 and 7.70 times incidence of psychiatric complications, respectively. CONCLUSION: The risk factors of psychiatric complications were high voltage electrical injury, facial burn, extent of burn and history of amputation. If the patients have risk factors, earlier psychiatric consultation may help to manage the psychiatric complications of electrical injury.

A Case Report of Tension Pneumopericardium Following Blunt Chest Trauma / 대한흉부외과학회지

A 49-year-old man visited our hospital via the emergency room. He had suffered chest trauma by falling down. His chest X-Ray showed pneumomediastinum with pneumopericardium. We checked the Chest CT, and it showed pneumopericardium without any injury to the other organs, the compressed heart and a minimal pneumothorax on the left hemithorax. Closed thoracostomy was then done under local anesthesia. We then performed open pericardiostomy under general anesthesia. We got a good result and so we report on this case.

A Retrospective Analysis of 645 Burn Patients Following High Voltage Electrical Injuries - 8 Years of Experience

PURPOSE: High voltage electrical injuries can cause serious complications and sequelae, leading to social and economic costs. We reviewed patients with high voltage electrical injuries experienced over the last 8 years. METHODS: We retrospectively reviewed the medical records of 645 consecutive patients admitted between January, 2000, and December, 2007. We noted demographics, burn type, fasciotomy time after burn injuries, distribution classified by voltage, entrance and exit of burn injuries, type of amputation and amputation rate, associated injuries and complications, death rate, electrocardiogram, and laboratory results. RESULTS: Most injuries occurred in men (99.2%), with a mean age of 38.2+/-9.3 years. Direct contact burns were the most common (62.2%), and the mean burn extent was 14.8+/-15.9%. The right upper extremity was the most common entry point, with the left lower extremity the most common exit point. The amputation rate was 22.2%. Associated injuries and complications occurred in 62.0% of cases. CONCLUSION: This research may influence diagnosis and treatment of high-voltage injuries, reducing the associated injuries and complications. Furthermore, we should protect against high voltage electrical injuries.

Metastasizing Pleomorphic Adenoma in Right Lung: A case report / 대한흉부외과학회지

A metastasizing pleomorphic adenoma originating from the parotid gland is a rare form of neoplasm. The neoplasm is a histologically benign, but clinically controversial entity. Herein, a case report of a pleuro-pneumonectomy of a metastasizing pleomorphic adenoma in the right lung is described. A 57-year-old man, who underwent resection of parotid gland due to a pleomorphic adenoma, presented with multiple metastases on the right lung, mediastinum, pericardium and intercostal muscle. The metastatic lesions were composed of a benign pleomorphic structure.

The assessment of the vascular anatomy of the inferior mesenteric artery: an autopsy study / 대한법의학회지

AIMS: The left colon receives its arterial supply from the inferior mesenteric artery (IMA). The detailed anatomical understanding of IMA is important for sigmoid colon or rectal cancer surgery. The aim of this study is to investigate the vascular anatomy of the IMA by measuring the distance from the aortic bifurcation and the length of the IMA in autopsy cases. METHODS: 41 consecutive autopsy cases were enrolled prospectively. 29 cases were males and 12 females. Mean age was 47.7+/-15.6 with a range of 12 to 82 years. The distance from the aortic bifurcation is measured between the angle of abdominal aortic bifurcation and the inferior margin of the IMA. The length of the IMA is measured between the root of the IMA and the proximal border of the first branch of the IMA. Mann-Whitney U test, Pearson's correlation coefficient, and Spearman's rho were used for statistical analysis. RESULTS: The distance from the aortic bifurcation ranged from 3 to 6.3 cm with a mean of 4.4+/-0.71 cm. The length of the IMA ranged from 2.5 to 7 cm with a mean of 4+/-0.8 cm. The distance from the aortic bifurcation and the length of the IMA had no correlations with subject's height and weight. CONCLUSIONS: The vascular anatomy of the IMA in the general population is an important information for colorectal surgeon. Clear anatomical understanding of IMA may help perform oncologically safe colorectal surgery.

A Case Related to Identifying Missing Person by the floods in 2006 / 대한법의학회지

The fifteen persons from In-jae, Kang-won do, were missing by floods on July 2006. In relation to the this case, the two unidentified corpses were found nearby So-yang lake on June and September 2007, respectively. In these cases, autosome short tandem repeats (STR) and Y-STR were used for identification. The AmpFlSTR Identifiler kit (amelogenin and 15 STRs) and the AmpFlSTR Yfiler kit (16 Y-STRs) are analysed by multiplex-PCR and automated fluorescent detection using Perkin Elmer Prism 310 DNA sequencer. Finally we could found identify the two missing persons.

Application of Differex(TM) system and FTA(R) technology to separation of sperm DNA from mixed stains / 대한법의학회지

Specimens from sexual crimes are generally mixed stains consisted of sperm cells(from suspect) and virginal cells(from victim). We have combined two new methods - Differex(TM) system and FTA(R) technology- to overcome shortcomings of method that has been used before to separate sperm DNA from mixed stains. This methods have shown additional benefits and similar quality than using the only Differex(TM) system to the experiment. The result of our experiment represents the possibility that Differex(TM) system and FTA(R) technology would be useful methods for DNA analysis related to sexual crimes because this system can save time, labor and contamination for experiments.

Comparative Study for DNA Extraction Methods from femurs in case of naming unidentified bodies / 대한법의학회지

In historical cases, missing persons' identification, mass disasters, and ancient DNA investigations, bone samples are often the only and always the best biological materials available for DNA typing. There are many protocols for the extraction of DNA from bone samples. In our experiment, we tested three DNA extraction protocols: Ethanol down method, Microcon(R) YM-100 and DNA IQ(TM) system. We have found that ethanol down method is not suitable to extract DNA from bone samples and Microcon(R) YM-100 is the best among these three mothods. DNA IQ(TM) System did not show better result but needed less time and labor than Microcon(R) YM-100. So, we expect using DNA IQ(TM) System is useful in case of bone samples which are not severely contaminated .

A Case Related to Identifying the Missing Person / 대한법의학회지

The application of DNA typing method after amplification by the polymerase chain reaction (PCR) of DNA derived from bone from two missing persons. In this case, short tandem repeats (STR) are used. The AmpFlSTR Identifiler loci (amelogenin and 15 STRs) are analysed by multiplex-PCR and automated fluorescent detection using Perkin Elmer Prism 310 DNA sequencer.

Simultaneous Bilateral Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: The simultaneous bilateral spontaneous pneumothorax is a rare clinical event. Contrary to the unilateral pneumothorax, the patients with simultaneous bilateral spontaneous pneumothorax sometimes complains of severe respiratory distress, cyanosis and chest pain without tention pneumothorax. It is often dangerous; therefore, the chest drain should be inserted immediately. MATERIAL AND METHOD: Between March 1994 and February 2004, 802 patients were treated in our department for spontaneous pneumothorax. Among these, the simultaneous bilateral spontaneous pneumothorax developed in 14 patients (1.7%). RESULT: Out of fourteen patients, two females and twelve males presented with simultaneous bilateral spontaneous pneumothorax. The patient age ranged between 0 and 79 years with mean age of 31.2 years. In eleven patients, this was the first episode of pneumothorax. One patient had combined hemopneumothorax and two patients had combined pyopneumothorax. Six patients had smoking history (42.8%, average 17.3 p-y). Five patients had pulmonary tuberculosis history and among these, two patients had active pulmonary tuberculosis. Three patients were died due to meconium-aspiration pneumonia (1 patient) and ARDS (Acute Respiratory Distress Syndrome) with pneumonia (2 patients). We treated these patients with nasal oxygen inhalation, chest drain insertion, thoracotomy, VATS (Video-Assisted Thoracoscopic Surgery) and chemical pleurodesis. CONCLUSION: The simultaneous bilateral spontaneous pneumothorax developed in 14 patients (1.7%) among 802 patients. Prompt insertion of chest drain is needed for a relief of severe symptoms, and to reduce the risk of recurrence, early thoracotomy or VATS should be performed rather than chest drain insertion only.

Open Ostectomy of Anterior Impingement Syndrome: Comparison of Athletes and Nonathletes / 대한정형외과학회잡지

PURPOSE: To analyse the clinical results of open treatment of anterior impingement syndrome of the ankle and to determine if being athletics or nonathletics affects the result. MATERIALS AND METHODS: This study included 54 consecutive patients who had undergone surgery with an open modality. All had been diagnosed with anterior impingement syndrome and received conservative therapy for more than at least 3 months prior to surgery. Among them, 22 patients were high-level athletes. The patients were evaluated with a physical examination and simple radiograph. A bone scan or MRI were added if necessary. The patients were categorized into four groups according to the McDermott's grading system based on the lateral radiograph. Patients with McDermott's grade 4 change and with osteochondral lesions were excluded. The results of the Ogilvie-Harris score, a visual analogue scale of the patient satisfaction and the time to return to full activity were assessed. RESULTS: The mean follow-up was 32 months, 82% of patients had good or excellent results. In general, the Ogilvie Harris score improved postoperatively. However, there was no significant difference between groups. There was no statistical significance between the athletics and non-athletics in terms of the improvement in the Ogilvie-Harris score. 91% of patients were satisfied in the final follow-up (more than 80% in the visual analogue scale). The mean time to return to full activity was 10.5 weeks with the athletes and 8.8 weeks with the nonathletes. CONCLUSION: Open surgical treatment for anterior impingement syndrome may be an effective modality regardless of the patient being an athlete or non-athlete.

Treatment of Systemic Arterial Supply to Lower Lobe of Left Lung (Operation vs. Embolotherapy): Comparison of Two Cases and Literature Review / 대한흉부외과학회지

Systemic arterialization of lung with/without sequestration (Sequestration/Anomalous Origin of Left Pulmonary Artery, AOLPA) is a rare form of congenital anomalous systemic arterial supply to the lungs. In this anomaly, the arterial supply of one or more arteries of the basal segments of the lower lobe derives from an aberrant vessel arising from the aorta. We report two adult cases of systemic arterialization of normal basal segments of left lower lobe lung with/without sequestration. The one (AOLPA) was treated by left lower basal segmentectomy and the other (Sequestration) by therapeutic angiographic embolization. Based on the favorable follow-up result in our patients, although lobectomy (segmentectomy) is the basic treatment modality, embolotherapy could also be a mode of treatment that could be selectively applied to elderly, infirm patients or high risk patients with poor pulmonary function.

Distal Tibial Articular Surface Angle in the Coronal Plane in Koreans / 대한족부족관절학회지

PURPOSE: The purpose of this study is to find out the normal distal tibial articular surface angle in coronal plane in Koreans. This would be helpful as the basic data for ankle reconstruction after trauma or deformity correction. MATERIALS AND METHODS: Weight bearing anteroposterior radiographs of 123 normal ankles were reviewed. A line parallel to the shaft of the tibia was made. Another line was drawn parallel to the articular surface of the distal tibia. The superolateral angle that subtended by these two lines was measured. RESULTS: There were 72 males and 51 females. The mean age overall was 35.7 years old. The mean age for males was 31.9 (28~36) years old. The mean age for females was 41.1 (37~45) years old. The mean distal tibial articular surface angle was 90.8 degrees. The mean distal tibial articular surface angle for males was 91.5 degrees and for females 89.9 degrees. CONCLUSION: The mean distal tibial articular surface angle in coronal plane for Koreans is 90.8 degrees. We can avoid the error of the varization at the ankle alignment when the correction was performed vertical or minimal valgus to tibia tuberosity axis in Korean people.

Open Treatment of Anterior Impingement Syndrome of the Ankle in Elite Level Soccer Players / 대한족부족관절학회지

PURPOSE: We assessed the results of open treatment of anterior impingement syndrome of the ankle in elite level soccer players and concomitant injuries were idenfied. MATERIALS AND METHODS: We retrospectively reviewed twenty one elite level soccer players diagnosed with anterior impingement syndrome who underwent open debridement between January 1997 and January 2002. All were men and the mean age at the operation was 21 years (range 16 to 27). The mean follow-up duration was 31 months (13 to 71). Concomitant abnormalities were idenfied through physical examination, bone scan and MRI. On a preoperative lateral radiograph, patients were classified according to McDermott's stage. Anteromedial or anterolateral approach was used at the operation and osteophyte was removed with osteotome and rongeur. When chronic ankle instability was accompanying, we performed Modified Brostrom-Gould procedure and for osteochondral lesion, multiple drilling was applied. The Ogilvie-Harris scoring system was used as a clinical scale to evaluate pain, swelling, stiffness and limitation of activity. The results were scored as excellent (15 to 16 points), good (13 to 14) and otherwise unsatisfactory. The time to return to full activity including sports activity was determined. RESULTS: Eighteen of twenty one patients had an excellent outcome. Three patients were graded unsatisfactory and two of them abandoned their career due to the persistence of residual pain. Concomitant abnormalities were found including twelve cases of chronic ankle instability, three cases of osteochondral lesion and two cases of flexor hallucis longus tendinitis. CONCLUSION: Open debridement was successfully applied to the elite level soccer player with anterior impingement syndrome of the ankle. Considerable coexistence of other abnormalities such as chronic ankle instability may encourage us to consider additional operative procedure.