Longitudinal Change in Myocardial Function and Clinical Parameters in Middle-Aged Subjects: A 3-Year Follow-up Study

Background@#Metabolic syndrome (MetS) is closely associated with the aging process. However, changes in metabolic conditions and cardiac function that occur in middle aged population remain unclear. We evaluated longitudinal changes in metabolic parameters and cardiac function during a 3-year period in subjects with suspected MetS. @*Methods@#We studied 191 participants with suspected MetS at baseline and after 3 years. Anthropometric parameters, including waist circumference (WC), and metabolic parameters, including fasting blood glucose and lipid profile were measured. Conventional echocardiography with two-dimensional speckle tracking was performed. @*Results@#Mean age was 56.2±4.4 years, and there were 97 women (50.8%). Men had increased WC and triglycerides (TG) (WC 91.2±6.8 cm vs. 84.0±8.0 cm, P<0.001; TG 184.4±116.3 mg/dL vs. 128.2±53.6 mg/dL, P<0.001), and reduced global longitudinal strain (GLS) (–15.4%±2.1% vs. –17.1%±2.0%, P<0.001) compared to women. After 3.4 years, values of WC and TG did not change in men but increased in women (all P<0.05). The absolute value of left ventricular (LV) GLS did not change in men but was reduced in women (P=0.011). Change in TG was independently associated with worsening of LV GLS only in women (standardized β, –0.309; 95% confidence interval, –0.130 to –0.009; P=0.025). @*Conclusion@#In middle aged population, a vulnerable period for metabolic disturbance, cardiac remodeling tended to progress, which was prominent in women. Progression of adiposity and dyslipidemia after menopause may accelerate subclinical cardiac remodeling in middle-aged women. Lifestyle modification and medical interventions may help prevent further cardiac dysfunction in these subjects.

Longitudinal Change in Myocardial Function and Clinical Parameters in Middle-Aged Subjects: A 3-Year Follow-up Study

Background@#Metabolic syndrome (MetS) is closely associated with the aging process. However, changes in metabolic conditions and cardiac function that occur in middle aged population remain unclear. We evaluated longitudinal changes in metabolic parameters and cardiac function during a 3-year period in subjects with suspected MetS. @*Methods@#We studied 191 participants with suspected MetS at baseline and after 3 years. Anthropometric parameters, including waist circumference (WC), and metabolic parameters, including fasting blood glucose and lipid profile were measured. Conventional echocardiography with two-dimensional speckle tracking was performed. @*Results@#Mean age was 56.2±4.4 years, and there were 97 women (50.8%). Men had increased WC and triglycerides (TG) (WC 91.2±6.8 cm vs. 84.0±8.0 cm, P<0.001; TG 184.4±116.3 mg/dL vs. 128.2±53.6 mg/dL, P<0.001), and reduced global longitudinal strain (GLS) (–15.4%±2.1% vs. –17.1%±2.0%, P<0.001) compared to women. After 3.4 years, values of WC and TG did not change in men but increased in women (all P<0.05). The absolute value of left ventricular (LV) GLS did not change in men but was reduced in women (P=0.011). Change in TG was independently associated with worsening of LV GLS only in women (standardized β, –0.309; 95% confidence interval, –0.130 to –0.009; P=0.025). @*Conclusion@#In middle aged population, a vulnerable period for metabolic disturbance, cardiac remodeling tended to progress, which was prominent in women. Progression of adiposity and dyslipidemia after menopause may accelerate subclinical cardiac remodeling in middle-aged women. Lifestyle modification and medical interventions may help prevent further cardiac dysfunction in these subjects.

Reduction Plan of ‘Undeterminable’ in the Unexpected Antibody Screening by the Microcolumn Agglutination Automated Instrument / 대한수혈학회지

BACKGROUND: Among the results of an unexpected antibody screening test using IH-1000, ‘undeterminable’ results can be obtained. Repeated tests not only use reagents and consumables but also cause a turnaround time delay. Therefore, it is important to reduce the ‘undeterminable’ results and to determine the effects. METHODS: From January to early June, 2016, 2,872 cases/259,455 tests (1.11%) of ‘undeterminable’ were detected in the screening test. The factors considered to affect the ‘undeterminable’ were classified into four categories: ① reagent, ② consumables, ③ inspection environment & specimen, and ④ enhancing the equipment management. For data comparison, a chi-square test was conducted (95% confidence interval, 0.05 significant level). RESULTS: The incidence of ‘undeterminable’ cases decreased from 1.11% before management to 0.66% (P < 0.001) after Pool Cells management. The consumption of ‘LISS/Coombs Card’ decreased from 1.07% before management to 0.51% (P < 0.001) after management. By maintaining a clean inspection environment and strengthening sample management, the rate decreased from 1.11% before management to 0.66% (P < 0.001) after management. On the other hand, there was no difference in the incidence of ‘undeterminable’ between before and after IH-1000 management reinforcement. CONCLUSION: Among the factors predicted to affect the decrease in the incidence of ‘undeterminable’, the management of Pool Cells and keeping the inspection environment clean as well as improving sample management contributed the most to the reduced ‘undeterminable’. Improvements in the management of consumables, and removing dust from the inside of the equipment, had a positive impact. A continuous quality improvement theme has been adopted and it is helpful for managing and improving the predicted factors.

Experience of Rh & Others Antigen Negative Rate Elicitation in a Blood Laboratory Center / 대한수혈학회지

BACKGROUND: The demand for Rh-related and other specific antigen negative donations has increased recently, and in response, we need to improve work efficiency while decreasing reagent consumption. Thus, we desire to create a ‘table of Nambu Blood Laboratory Center's own Rh-related and other antigen negative rate’. METHODS: We analyzed the results of Rh-related specific antigen test for 2,806,330 donors using ‘PK-7300’ and the results of manual test for 10,024 other blood type antigen-related specific and compound antigens. We made a table summarizing the results using two cases. RESULTS: The negative rate of Rh-related specific antigens was approximately 12.9% for C, 41.7% for c, 49.5% for E, and 9.2% for e antigens. The negative rate of compound antigens was increased when compared with the number of inspections. The negative rate for C and e antigens was increased from 90.1% to 97.3%, and that for E, c, and JKa was increased from 7.6% to 31.6%. CONCLUSION: The negative rate table made in July 2016 has been determined to be very effective in screening for specific and compound antigen negative blood. Also it was very efficient in terms of examining and supplying the compound antigen negative blood. It would be helpful to improve the supply of specific antigen negative blood to better meet the unique needs of each medical institution.

A Typical Case of L-Transposition of the Great Arteries Initially Presented as Complete Atrioventricular Block in Middle-Aged Man

L-transposition of the great arteries (L-TGA) is a rare congenital anomaly and could cause complete atrioventricular (AV) block at relatively younger age. We present a case of 43-year-old male who complained of dizziness due to complete AV block. We confirmed L-TGA using transthoracic echocardiography and cardiac computed tomography. Permanent pacemaker was inserted without complications. No invasive treatment including corrective surgery was performed because patient's cardiac function was almost normal and the symptom was completely resolved after pacemaker insertion.

Treatment of Traumatic Esophagopleural Fistula Using the Over-the-Scope-Clip System

Esophagopleural fistula (EPF) is a rare condition that is usually accompanied by severe infection and life-threatening morbidity. Here, we report the successful treatment of an EPF by closing an esophageal orifice using the over-the-scope-clip (OTSC) system without postprocedural complications. A 41-year-old man had serious thoracic and abdominal trauma due to a traffic accident. Computed tomography revealed findings suggestive of esophageal rupture due to Boerhaave syndrome. An emergent explorative operation was performed for primary repair with the insertion of a vacuum-assisted closure device. A postoperative upper gastrointestinal series revealed an EPF tract connecting the left pleural space and distal esophagus. We performed an endoscopic procedure using the "traumatic-type"OTSC to seal the EPF, and the esophageal orifice was completely healed 2 weeks postoperatively. The OTSC system might represent a safe and feasible modality for the treatment of EPF.

Surgical Removal of a Left Ventricular Thrombus Which Showed Morphologic Changes Over Time in a Patient with Stress-Induced Cardiomyopathy

Although stress-induced cardiomyopathy (SCMP) is a reversible disease and the prognosis is usually excellent, several complications can occur and can result in fatal adverse events. The formation of left ventricular (LV) thrombus is one of these critical complications of SCMP. This report describes a case of SCMP complicated by formation of a LV thrombus that became increasingly mobile as LV contractility recovered, and for which surgical removal was performed. Here, we report a case of SCMP complicated by LV thrombus and review the literature regarding this topic.

Ethanol Infusion in the Vein of Marshall in a Patient with Persistent Atrial Fibrillation

We report the case of a 64-year-old male with persistent atrial fibrillation (AF) terminated by ethanol infusion into vein of Marshall as add-on therapy. Three-dimensional automated complex fractionated atrial electrogram (CFAE) during AF revealed clustering of CFAE at perimitral isthmus (PMI) and its unipolar mapping showed rotor-like activation, which was suggested to be critical in the perpetuation of AF. AF was organized to atrial tachycardia (AT) by 100% ethanol infusion in the vein of Marshall. Adjunctive radiofrequency ablation at PMI successfully terminated AT and led to bidirectional block of PMI.

Clinical Significance of the Rectus Abdominis Muscle Free Flap for Large Diabetic Ulcer and Necrosis of the Foot

The purpose of this study was to present the clinical significance of rectus abdominis free muscle flap for large sized diabetic ulcer and necrosis of the foot to salvage limb. From June 2000 to February 2006, eleven patients were included in our study. There were seven males and four females with a mean age of 58.3 years (48~65) at the surgery. All had a history of diabetics and subsequent huge soft tissue defect caused by necrotizing abscess formation around the foot and the ankle. After complete debridement of large sized, infected necrotic tissue, susceptible intravenous antibiotics and wound care were done. After control of infection, confirmed by clinical and laboratory findings, the rectus abdominis free muscle flap was applied to cover remained large soft tissue defect and to prevent the recurrence of infection. All flaps survived and it provided satisfactory coverage for the soft tissue defect on the foot and the ankle area for a mean of 41.1 months (24~85) follow up period. All except of one patients did not have any recurrence of infection on the operation site and could salvage their limbs. The rectus abdominis free muscle flap could be recommended for large sized soft tissue defect after necrotizing abscess in diabetic foot to salvage major limb.

Reconstruction of the Pretibial Soft Tissue Lesion after Chronic Tibia Osteomyelitis using Anterolateral Thigh Perforator Flap

The purpose of this study was to present the clinical result of anterolateral thigh free flap for pretibial soft tissue lesion after chronic tibia osteomyelitis. From December 2006 to September 2008, Five patients were included in our study. 4 of 5 were superficial or localized types of chronic tibia osteomyelitis, based on the classification of Cierny and Mader. Average age at the surgery was 45 years, three were males and two were females. All had a history of chronic tibia osteomyelitis and subsequent pretbial soft tissue lesions coming from previous operations or pus drainage. Pretibial soft tissue defects included small ulcers, fibrotic, bruisable soft tissue and small bony exposures, but not large-sized bony exposures nor active pus discharge. After complete debridement of large sized pretibial soft tissue lesions and decortication of anterior tibial cortical dead bone, anterolateral thigh free flap was applied to cover remained large pretibial soft tissue defect and to prevent the recurrence of infection. All flaps survived and provided satisfactory coverage of soft tissue defect on pretibial region for 16 months' mean follow up period. No patients has had recurrence of osteomyelitis. Anterolateral thigh free flap could be recommend for large sized pretibial soft tissue defect of supreficial or localized types of chronic tibia osteomyelitis after through debridement.

The Results of Surgical Treatment for Nonunion of Phalanges in the Hand

PURPOSE: To evaluate the results of internal fixation and autogenous bone graft for the phalangeal nonunion in the hand. MATERIALS AND METHODS: From Feb. 2000 until May 2006, thirteen cases that had been treated for non-union of phalanges in the hand were investigated retrospectively. Seven cases were treated with mini-plate fixation and autogenous cancellous graft and six cases with Kirschner wire fixation and autogenous cancellous graft. We analyzed bony union period radiographically and clinical results according to Belsky's score. RESULTS: Thirteen cases obtained bony union. Seven cases of mini-plate fixation and bone graft, and six cases of K-wire fixation and bone graft achieved the bony union postoperatively on average 7.9 weeks and 6.3 weeks, respectively. Clinical results were "good" in four cases and "poor" in nine cases according to the Belsky's score. Only one of ten cases with associated injuries, such as tendon, nerve, arterial injuries and other finger fractures in the injured hand, had the good clinical result, but all three cases without associated injuries had the good one. CONCLUSION: Internal fixation and autogenous bone graft can be a successful treatment of phalangeal nonunion. However, more careful choice of surgical treatment methods and preoperative explanation of poor post-operative results or complications should be made for phalangeal nonunion with associated injuries in the finger because of poor outcome in those cases.

Lateral Arm Free Flap for Small Sized Diabetic Foot Ulcer around Toes

The purpose of this study was to present the clinical analysis of the results of lateral arm free flap for small sized and infected diabetic foot ulcer around toes. From May 2006 to December 2007, Seven patients were included in our study. Average age was 52.8 years, six were males and one was female. All had infected diabetic foot ulcer and had exposures of bone or tendon structures. Ulcers were located around great toe in four patients, 4th toe in one and 5th toe in two. Three patients had osteomyelitis of metatarsal or phalanx. After appropriate control of infection by serial wound debridement and intravenous antibiotics, lateral arm flap was applied to cover remained soft tissue defects. Posterior radial collateral artery of lateral arm flap was reanastomosed to dorsalis pedis artery of recipient foot by end to side technique in all cases in order to preserve already compromised artery of diabetic foot. All flaps were designed over lateral epicondyle to get longer pedicle and averaged pedicle length was 8 cm. Two cases were used as a sensate flap to achieve protective sensation of foot. All flaps survived and provided satisfactory coverage of soft tissue defects on diabetc foot ulcers. All patients could achieve full weight-bearing ambulation. No patients has had recurrence of infection, ulceration and further toe amputations. There were three complications, a delayed wound healing of flap with surrounding tissue, a partial peripheral loss of flap and a numbness of forearm below donor site. All patients were satisfied with their clinical results, especially preserving their toes and could return to the previous activity levels. Lateral arm free flap could be recommend for infected diabetic foot ulcers around toes, to preserve toes, coverage of soft tissue defect and control of infection with low donor site morbidity.

Electron Microprobe Analysis and Tissue Reaction around Titanium Alloy Spinal Implants

STUDY DESIGN: A retrospective study of tissue surrounding titanium alloy spinal implants was performed using histological and electron microprobe analysis. PURPOSE: To identify the metal debris generated by spinal implants, and then to evaluate the electron microprobe analysis results and the histological response of soft tissue surrounding the spinal implants. OVERVIEW OF LITERATURE: Microscopic metal particles from the soft tissue surrounding joint arthroplasty have been shown to activate a macrophage response that leads to bone resorption and increased inflammation. The effect of unintended wear particles in spinal instrumentation remains a clinical concern. METHODS: Ten patients (average age, 51.3 years), 6 men and 4 women, who had undergone previous lumbar fusions using pedicle screw instrumentation and who were now undergoing revision surgery were included in the study. The tissues obtained from the adjacent area of these implants were analyzed by light microscopy, immunohistochemistry and scanning electron microscope. After the removing the spinal implants, the changes of back pain and the spinal fusion were assessed. RESULTS: There were metal particles in the soft tissue in 7 cases. Histological finding observed mild chronic inflammation surrounding the deposition of the metal particles and the anti Cotrel-Dubousset 68 positive macrophages were observed at tissue adjacent to the metal particles in 5 patients. Scanning electron microscopy of the specimens showed metallic debris within the tissue and mapping of the metallic particles revealed the distribution of titanium in the tissue in 5 cases. Nine patients had successful relief of back pain after removing the spinal implants. Improvement of the back pain may be an association macrophage response rather than the metal particle. CONCLUSIONS: The presence of metallic particles generated from spinal implants may serve as the impetus for a late-onset inflammatory response and late operative site pain.

Reconstruction of Diabetic Foot Ulcers by Regional Flap Surgery / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the value of regional flap surgery for diabetic foot ulcers combined with infection or bone and tendon exposure. MATERIALS AND METHODS: We reviewed eight patients, nine cases of diabetic foot ulcers, which were treated by regional flap surgery. There were two Wagner's grade 2 ulcers and six Wagner's grade 3 ulcers. We performed four reversed sural artery neurocutaneous flaps, two lateral supramalleolar flaps, two medial plantar artery flaps and one first dorsal metatarsal artery flap. RESULTS: Seven of nine flaps completely survived after regional flap surgery. One partial and one complete flap necrosis occurred. One partially necrotized flap needed an additional skin graft. One completely necrotized flap needed free rectus abdominis myocutaneous flap surgery. There were two new ulcers, which were treated by free flap surgery. No patient needed amputation above the ankle joint. CONCLUSION: Satisfactory results were obtained by regional flap surgery for diabetic foot ulcers. Regional flap surgery is regarded as an effective treatment modality for diabetic foot ulcer combined with bone and tendon exposure with infection.

Bone Ongrowth of Hydroxyapatite-Coated ABG Acetabular Cups / 대한정형외과학회잡지

PURPOSE: To evaluate the efficacy of the smooth surface hydroxyapatite (HA)-coated acetabular cup in total hip arthroplasty. MATERIALS AND METHODS: From March 1992 to June 1998, 289 smooth surface HA coated acetabular cups were implanted. This study included 29 retrieved cups that had been in situ for an average of 54.9 months. The three dimensional acetabular cups were converted into two dimensional figures using a digital camera, and the ratio of bone ongrowth and HA absorption were calculated using a computer imaging analysis system (analySIS-pro 3.0, Soft Imaging System GmbH, Germany). The central hole and the peripheral 12 holes were excluded from total surface area of the cup, which was divided into 3 surfaces by 2 circular grooves. RESULTS: Bone ingrowth was noted in 26 of the 29 cases; in 11 cases (37.9%) on the central surface, 12 cases (41.3%) on the middle surface and 8 cases (27.5%) on the peripheral surface. Bone ongrowth was noted in 22 cases (75.8%) on the medial groove and in 21 cases (72.4%) on the lateral groove. The average rate of bone ongrowth was 13.8 percent. HA absorption was noted in all cases and averaged 60.5 percent. CONCLUSION: Bone ongrowth on the smooth surface HA-coated acetabular cup was very scant. Bone ongrowth was seen more on the grooves than on the surfaces. We believe that a rough surface would enhance bone growth on HA-coated acetabular cup.

Total Hip replacement with AML Prosthesis for Avascular Necrosis of the Femoral Head / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the clinical and radiographic results of the primary total hip arthroplasty with uncemented AML (anatomic medullary locking) hip prosthesis for avascular necrosis of the femoral head. MATERIALS AND METHODS: Forty-nine patients (65 hips) had a primary total hip arthroplasty between May 1987 and March 1992. Average follow-up was 9.6 years. The mean age of the patients was 46.9 years. The canal fit of the stem at the proximal canal and isthmus level was obtained from postoperative radiograph. Components stability, stress shielding, polyethylene wear and periprosthetic osteolysis were evaluated from serial follow up radiographs. RESULTS: The average Harris Hip Score was to 92.1 points at the last follow-up. Twelve hips (18.5%) had a good fit at both the proximal canal and isthmus level and 15 hips (23.1%) had a poor fit at both levels. All twelve hips that had a good fit at both the proximal canal and isthmus level had bone ingrowth. Thirty-three hips (56.3%) had femoral osteolysis. Twenty-one hips (32.3%) had acetabular osteolysis. Fourteen hips had acetabular and femoral osteolysis. The overall rate of revision was 16.7% (11 hips). Ten cases were revised because of excessive polyethylene wear and osteolysis. Revision of the femoral component for aseptic loosening was only one case. CONCLUSION: The result of our study suggests that total hip arthroplasty using the AML hip prosthesis with an ACS (acetabular cup system) polyethylene liner should be monitored closely for catastrophic wear of the polyethylene liner. We recommend early revision arthroplasty in case of excessive wear of the ACS polyethylene liner.

A Morphological Study of the Extensor Tendons and Juncturae Tendinum on the Dorsum of the Hand / 대한정형외과학회잡지

PURPOSE: To clarify the morphological patterns of the extensor tendon and juncturae tendinum on the dorsum of the hand. MATERIALS AND METHODS: Fifty eight hands of cadavers were dissected to evaluate the morphological patterns of the extensor tendon and juncturae tendinum. RESULTS: The tendon of extensor indicis proprius and extensor digitorum communis (EDC) to the index finger arose and terminated at a single tendon. The EDC to the long finger arose as a single tendon, divided into two slips and then converged again to form a single tendon. The EDC to the ring finger arose as double tendons, divided into three or four slips and converged again into double tendons. The EDC to the little finger was usually absent (72%). The extensor digiti minimi arose and terminated as double tendons. The juncturae tendinum (JT) between the EDC tendons to the index finger and those to the long finger were of type I (thin filamentous type). The JT between EDC tendon to the long finger and those to the ring finger consisted of 16% in type I, 31% in type II (thick filamentous type) and 53% in type III (tendinous type). There were 14% of type II JT and 86% of type III JT between the ring and small fingers. CONCLUSION: A knowledge of both the usual and possible variations of the extensor tendon and the juncturae tendinum is useful in the identification and repair of these structures.

The Changes of the Generation of Superoxide Free Radical and the Activity of Antioxidant Enzymes after Streroid Therapy in Nasal Polyps / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An intranasal topical and a systemic steroid therapy produce clinical improvement in patients with nasal polyps, but the mechanisms of their action are not clear. Recently, reactive oxygen species such as oxygen free radicals were identified as the potent toxic agents in various pathologic conditions including nasal polyps. The purposes of this study were to reveal the steroid effect on the generation of oxygen free radicals and exmaine the activities of various antioxidant enzymes in human nasal polyps. MATERIALS AND METHODS: Forty patients who received endoscopic sinus surgery due to chronic paranasal sinusitis with nasal polyps were classified into four groups; Group I included 10 specimens with no medication, group II included 10 specimens with oral steroid medication, Group III included 10 specimens with intranasal topical steroid therapy, group IV included 10 specimens with both oral and intranasal topical steroid therapy. We measured the generation of oxygen free radicals and activity of antioxidant enzymes, (SOD, GSH-Px, and CAT) and compared each group using electrophotometric analysis. RESULTS: The generation of oxygen free radicals were lowered in group II, III, and IV, compared to group I. Group IV showed the lowest level in the generation of oxygen free radicals. The activities of SOD, GSH-Px, and CAT, which are specific scavengers of oxygen free radicals, increased significantly in groups II, III, and IV (p<0.05). CONCLUSION: These results suggest that oxygen free radicals may play an important roles in the formation of nasal polyps. The mechanism of steroid action in the treatment of polyps may be explained in the decreased generation of oxygen free radicals and the increased activity of antioxidant enzymes in some ways.

A Case of Multiple Dermoid Cyst of the Floor of the Mouth / 대한이비인후과학회지

A multiple dermoid cyst is a rare tumor in the floor of the mouth. It presents as abnormal cystic development in the midline as a result of displaced or enclaved embryonic epithelium during the midline closure of the first and second bilateral branchial arches. Dermoid cyst is classified inot three categories according to its histological type; dermoid, epidermoid, and teratoma. The treatment of choice is complete surgical excision and prognosis is excellent. We present a recently encountered case of a multiple dermoid cyst in the floor of the mouth; the cyst was removed using the intraoral approach.

A Case of Tuberculosis of Thyroid Gland / 대한이비인후과학회지

Tuberculosis of the thyroid gland is extremely rare, with only a few reported cases in the recent literature. The diagnosis is based entirely upon the histological picture of the tubercle, which consists of aggregates of mononuclear epithelial cells, giants cells, and a border of lymphocytes. Tuberculosis may involve the thyroid gland in two main forms. One common form spreads to the thyroid as part of generalized dissemination, and the other one is focal or caseous tuberculosis of the thyroid, presenting as a nodule, thyroiditis, an abscess, or a carcinoma-like mass. The differential diagnosis from malignancy and other non tuberculous granulomatous lesion is impossible upon the clinical ground. Surgical intervention is essential in order to establish the definitive diagnosis and to exclude the possibility of tumors. We experienced a case of the tuberculosis of the thyroid gland presenting with palpable thyroid nodule in a 44 year-old female patient. She was clinically and biochemically euthyroid and her CT scans demonstrated multiple low density in both thyroid gland with strands in the subcutaneous fat layer. The mass was removed surgically and confirmed to be tuberculosis.