Biomechanical comparison of single-bundle versus double-bundle anterior cruciate ligament reconstruction: a meta-analysis

Methods@#The electronic databases MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus were searched for relevant articles comparing the outcomes of SB-ACLR versus DB-ACLR that were published until November 2019. @*Results@#Seventeen biomechanical studies were included. The anterior laxity measured using the anterior drawer test showed significantly better results in DB-ACLR when compared with SB-ACLR. In addition, outcomes of the anterior tibial translation test under a simulated pivot shift presented with better results at low flexion and 30° in DB-ACLR, compared with SB-ACLR. However, there were no significant biomechanical differences between the groups in internal rotation. @*Conclusions@#The present study demonstrated that both techniques for ACLR are associated with restoration of normal knee kinematics. DB-ACLR is superior to SB-ACLR in terms of restoration of anteroposterior stability.However, which technique yields better improvement in internal rotation laxity, and internal rotation laxity under a simulated pivot shift at a specific angle, remains unclear.Level of evidence: This is a level II meta-analysis.

Therapeutic Effects of Mesenchymal Stem Cells on a Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Model

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are the most severe cutaneous drug hypersensitivity reactions, which are unpredictable adverse drug reactions. SJS/TEN is associated with significant mortality and morbidity; however, effective treatment is difficult. Mesenchymal stem cells (MSCs) are well-known for their anti-inflammatory and tissue regeneration properties. The purpose of the present study was to verify whether MSCs could be applied for the treatment of SJS/TEN. We developed an SJS/TEN mouse model using peripheral blood mononuclear cells from a lamotrigine-induced SJS patient. MSCs were injected into the model to verify the treatment effect. In SJS model mice treated with MSCs, ocular damage rarely occurred, and apoptosis rate was significantly lower. We demonstrated a therapeutic effect of MSCs on SJS/TEN, with these cells presenting a potential novel therapy for the management of this disorder.

A Tender Fingertip Papule in an Elderly Woman / 대한피부과학회지

No abstract available.

Methods for Locating the Pores of Epidermal Cysts

No abstract available.

A Rapid Effect in Childhood Granulomatous Periorificial Dermatitis with Oral Metronidazole and Topical Tacrolimus / 대한피부과학회지

No abstract available.

Depressed Facial Scars Successfully Treated with Autologous Platelet-Rich Plasma and Light-Emitting Diode Phototherapy at 830 nm

No abstract available.

Autoerythrocyte sensitization syndrome presenting with general neurodermatitis

Autoerythrocyte sensitization syndrome (AES) was first described by Gardner and Diamond in 1955, when four women with painful bruising were depicted. Patients with AES typically present with the development of recurrent, spontaneous, painful ecchymosis, frequently preceded by a prodrome of pain or itching of the skin. The patients are sensitive to their own red blood cells injected intradermally, and underlying coagulopathies are thought to be absent. We introduce a 70-year-old woman presenting with recurrent episodes of painful bruising on the trunk and extremities.

A Case of Zosteriform Lichen Planus on the Right Scapular Area / 대한피부과학회지

No abstract available.

Multiple Digital Mucinous Cysts / 대한피부과학회지

No abstract available.

A Case of Syphilid with Nail Dystrophy / 대한피부과학회지

Syphilis, the "great imitator" of skin diseases, is a chronic systemic infectious disease with a waxing and waning course. Clinical manifestations of syphilis are variable in appearance and have been described for centuries. Especially, secondary syphilis is characterized by large diversity of presentation. They include macular, papular, papulosquamous, syphilis cornee, psoriasiform, annular en cockade, nodular, condylomata lata, malignant syphilis, mucosal lesions, loss of the hairs, and alteration of the nails. Nail involvement of syphilis includes changes on nail plate (syphilitic onychia) or periungual tissue (syphilitic paronychia). A 20-year-old man was presented with multiple erythematous broad eroded surfaced papules and macules on the scrotum and scaly exfoliated patch with erythematous swelling on the right thumb with onychodystrophy and mild tenderness on the nail. Serological screening for syphilis showed increased titer for VDRL (1:16) and TPHA (+). After intramuscular treatments with benzathine penicillin G, the skin lesions on the scrotum cleared within 1 month and the nail dystrophy showed slight improvement.

Folluculitis Decalvans of the Scalp: Improvement with Intralesional Injection of Triamcinolone Acetonide and Oral Isotretinoin / 대한피부과학회지

No abstract available.

Developed Extrapotine Myelinolysis after Hysteroscopic Myomectomy: A case report / 대한마취과학회지

Transcervical resection of endometrium is under-utilized in the treatment of dysfunctional uterine bleeding, uterine myoma and menorrhagia. The procedure is similar to transurethral resection of prostate in men with a possibility of substantial absorption of irrigation fluid. Absorption of a large volume of fluid can cause excessive intravascular volume, hyponatremia, cerebral edema and death. Severe hyponatremia leading to extrapontine myelinolysis is an extremely rare complication of this procedure. So, We report a case of developed extrapontine myelinolysis after hysteroscopic myomectomy which, however, showed complete recovery.

Ipsilateral Mydriasis after Open Reduction of a Left Blow Out Fracture: A case report / 대한마취과학회지

Perioperative unilateral mydriasis is a disturbing finding, which is suggestive of acute intracranial pathology during general anesthesia. In addition, the assessment of an abnormal neurological injury is limited during general anesthesia, with anisocoria requiring special consideration. The case of a 27 year old healthy male patient, with ipsilateral mydriasis found near the end of surgery of open reduction for left blow out fracture, was experienced. The patient's pupils were bilaterally equal four hours after uneventfully surgery. The possible causes of unilateral mydriasis include the effects of anesthetic agents, stellate ganglion block, impaired venous return from head and neck, an acute intracranial mass lesion or hemorrhagic event, direct eye trauma, pre-existing medical or surgical conditions (Adie's tonic pupil, artificial eye etc.) and inadvertent direct deposition of alpha-adrenergic or anticholinergic agents in the eye. The understanding and diagnosis of unusual mydriasis during general anesthesia requires knowledge of the autonomic nerve pathways and pharmacology of the eye. In this case, the myadriasis of the left eye was considered to have resulted from the absorption of 1:100.000 topical epinephrine infiltrated into the lower eyelid via episcleral vessels.

Hydrohemothorax and Subclavian Artery Laceration during Internal Jugular Vein Cannulation: A case report / 대한마취과학회지

Central venous cannulation via an internal jugular vein has become a common procedure in the management and monitoring of severely ill patients. Although complications such as carotid artery puncture or pneumothorax have been reported, hemothorax is relatively uncommon. We describe a case of hydrohemothorax and subclavian artery laceration which occurred during right internal jugular vein cannulation. A 44-year-old female patient was admitted for laparoscopic adrenalectomy under general anesthesia. For central venous pressure monitoring, central venous cannulation performed. However, dilator overinsertion injured the right subclavian artery. This led to a massive ipsilateral hydrohemothorax requiring thoracotomy for subclavian artery repair. This case suggests that central venous cannulation should be done carefully and improves awareness of the potential for dilator induced injury.

Anesthetic Management of Emergent Cesarean Section in a Patient with Allergic Reaction to an Antibiotic: A case report / 대한마취과학회지

Allergic reactions developed in parturients can cause fetal asphyxia and some difficulties in anesthetic management. We performed general anesthesia for an emergent cesarean section on 30 yrs old woman who showed an allergic reaction to an antibiotic. Dyspnea, urticaria, sweating, generalized edema and fetal bradycardia suddenly occurred after an intravenous injection of the antibiotic. Dexamethasone 10 mg was administered intravenously. General anesthesia was induced with pentothal and succinylcholine. Despite of severe airway edema, endotracheal intubation was successful. During the operation, the allergic signs became decreased. After the operation, no additional problems were evident. Potential epitopes should be removed in susceptible parturients and medical staff should be familiar with anesthetic management in allergic patients during pregnancy.

Incidence and Significance of Negative Hematuria in Patients with Urolithiasis Visiting the Emergency Room with Flank Pain

PURPOSE: This research was conducted to determine the incidence of negative hematuria in patients with urolithiasis in Korea and the significance during evaluation of a patient' s complaining of flank pain. METHODS: We evaluated 363 consecutive patients who were suspected of having urolithiasis and who underwent intravenous urography (IVU). All patients underwent urinalysis and a urine dipstick test (UDT). We evaluated the sensitivity, the specificity, the positive predictive value and the negative predictive value of UDT, urinalysis and a combination of these two tests, and we compared the rates of incidence of negative hematuria. In addition, we estimated the relation between the RBC count and the severity of the ureteral obstruction. RESULTS: The IVU was positive in 206 of the 363 patients. The incidence of negative hematuria for urinalysis, UDT, and the combination were 9.2%, 8.7% and 6.3%, respectively. Thirteen patients (3.6%) had another disease. There was no correlation between the degree of ureteral obstruction and the incidence of negative hematuria (p= 0.713). Also, no correlation was established between the degree of ureteral obstruction and RBC count (p=0.742). CONCLUSIONS: In patients with urolithiasis, the incidences of negative hematuria for urinalysis, UDT and a combination of the two tests were 9.2%, 8.7% and 6.3%, respectively. The presence or absence of hematuria in patients with acute renal colic should not determine whether a more definitive study is performed.

Comparison of Postoperative Nausea and Vomiting between Gynecologic Surgery and Cesarean-Section during Intravenous Patient-Controlled Analgesia with Fentanyl / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare the incidence of postoperative nausea and vomiting (PONV) in patients undergoing major gynecologic surgery with those undergoing Cesarean-section during intravenous patient-controlled analgesia (PCA). METHODS: Seventy two patients received general anesthesia with enflurane. Group 1 patients underwent major gynecologic surgery, and group 2 patients were parturients who underwent Cesarean-section. Postoperatively, fentanyl was continuously infused i.v. using Accufuser PLUS (basal, 2 ml/h; bolus, 0.5 ml; lockout interval, 15 min) containing fentanyl 25microgram/kg in saline. PONV was evaluated at 6, 12, 24 and 36 h after starting continuous infusion and compared in the two groups. RESULTS: The incidence of PONV was significantly lower in group 2 (14%) than in group 1 (67%) (P < 5). CONCLUSIONS: Our results show that the incidence of PONV was lower for Cesarean-section than for gynecologic surgery.

Therapy of Pulmonary Embolism under Cardiopulmonary Bypass during Bipolar Endoprosthesis of the Hip / 대한마취과학회지

Although the occurrence of fatal pulmonary embolism may be diminishing, it still accounts for a substantial proportion of postoperative deaths in the middle-aged and older persons, especially among those undergoing major orthopedic surgery, despite improvements in patient management. We experienced cardiac arrest during bipolar endoprosthesis. Cardiopulmonary resuscitation was started and the transesophageal echocardiogram showed right heart failure. We suspected acute pulmonary thromboembolism and decided to perform thromboembolectomy with cardiopulmonary bypass. A massive old blood clot and a 1.0 x 1.5 cm thrombus were removed from both pulmonary arteries. However, despite massive fluid therapy and the use of inotropic agent, the patient failed to recover successfully with postoperative management in the intensive care unit.

Prediction of Poor Outcome in Comatose Survivors after Cardiopulmonary Resuscitation with Somatosensory Evoked Potentials and Proton Magnetic Resonance Spectroscopy

PURPOSE: The study was conducted to examine the usefulness of somatosensory evoked potentials (SEP) and proton magnetic resonance spectroscopy (1H-MRS) in predicting poor outcomes for comatose survivors after cardiopulmonary resuscitation. METHODS: We investigated 36 patients who were comatose after cardiac arrest. Among them, 35 had short latency SEP, and 27 had 1H-MRS. Both tests were performed in 26 patients. To estimate the cerebral outcome, we used the cerebral performance category (CPC) to classify the outcomes for our patients as good (CPC 1-2) or poor (CPC 3-5). RESULTS: Of the 36 patients, 11(31%) presented with good outcomes (CPC 1-2). A bilaterally absent N20 peak (n=35) predicted poor outcomes with a sensitivity of 54.2% and a specificity of 100%. A lactate-positive resonance (n=27) predicted poor outcomes with a sensitivity of 78.9% and a specificity of 100%. Using a combination of a bilaterally absent N20 peak and a lactate-positive resonance (n=26) predicted poor outcomes with a sensitivity of 94.4% and a specificity of 100%. CONCLUSION: The combination of a bilaterally absent N20 peak and a lactate-positive resonance is better than either alone in predicting poor outcomes in patients who are comatose after cardiac arrest.

The Effect of Monitored Anesthesia Care using Alfentanil and Ketorolac in Patients Undergoing Endoscopic Sinus Surgery / 대한마취과학회지

BACKGROUND: Monitored anesthesia care (MAC) has become increasingly important as a means of ensuring patient comfort, safety and satisfaction during surgery under local anesthesia. The purpose of this study was to evaluate the effect of monitored anesthesia care using alfentanil and ketorolac in patients undergoing endoscopic sinus surgery (ESS). METHODS: We studied 47 adult patients premedicated with glycopyrrolate 0.2 mg and midazolam 0.02 mg/kg IV. Using a 5.0 endotracheal tube, 5 L/min of oxygen was delivered via mouth. A mixture of 30 mg of ketorolac and 2,500microgram of alfentanil in 25 ml of saline was infused to patients at a rate of 1microgram/kg/min alfentanil after a bolus injection of 5microgram/kg alfentanil before operation. During operations we monitered vital signs, SpO2, OAA/S (Observer's Assessment of Alertness/Sedation) scale and BIS scores. Six hours postoperatively we assessed patient degree of satisfaction via NRS (1-10) with the anesthetic technique and side effects. RESULTS: Mean duration of drug infusion was 35 +/- 10.1 min, and the mean infusion rate of alfentanil was 1.09 +/- 0.23microgram/kg/min. Significant differences were observed between OAA/S scale scores at 10 min and 30 min after drug infusion and those in the waiting room (4.63, 4.65 vs 5, P <0.05)(Fig. 4). The mean patient satisfaction score was 8.3 out of 10, and 93.6% (44/47) of patients said they would recommend this anesthetic technique to others for ESS. CONCLUSIONS: Our results suggest that MAC using a mixture of alfentanil and ketorolac during ESS is a good way of relieving patient anxiety and pain without respiratory depression or excessive sedation. This study also showed a high level of patient satisfaction for those undergoing ESS under local anesthesia.