Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices / 대한고관절학회지

PURPOSE: To evaluate the factors affecting the bone union time and the occurrence of nonunion after intramedullary nailing of subtrochanteric femoral fractures in adults. MATERIALS AND METHODS: We retrospectively reviewed data from 31 patients (22 men and 9 women) who had undergone femoral intramedullary nailing at least 1 year post-operatively and analyzed the bone union time, nonunion rates, and factors that affected the bone union time according to the fracture classification (AO and Fielding classifications), comminution of the medial cortex, reduction method, and additional cerclage wiring. RESULTS: The average union time was 26.4 weeks. There were no differences in the bone union time according to the fracture classification, reduction method, or additional cerclage wiring. Significant differences were found in the bone union time between the medial cortex comminution and non-comminution groups. A relatively strong positive correlation was detected between the degree of post-operative displacement and the bone union time. Nonunion occurred in three cases and there was no failure of implants. CONCLUSION: The bone union time was not affected by the reduction method nor additional cerclage wiring in intramedullary nailing of subtrochanteric femur fractures. Comminution of the medial cortex and the degree of the postoperative displacement of fractures contributed to the delayed time of union.

Radiological Assessment for Morphological Diversity of Distal Fibula

PURPOSE: The purpose of this study is to determine whether the morphological consistency of distal fibula could be defined by measurement through radiological assessment as there was doubt regarding the adequacy of anatomical distal fibular plates. MATERIALS AND METHODS: Plain radiographs and computed tomography (CT) images of 300 cases from 2009 to 2012 were reviewed. The distance from the lateral vertex to the tip of the distal fibula and to the lateral margin of the shaft was measured, respectively, in order to understand the shape of the lateral curve of the distal fibula on plain radiographs. The neutral ridge was defined as a point of the lateral ridge located in the center of the antero-posterior diameter and the distance from the tip of the distal fibula to the neutral ridge was measured for determining the shape of the ridge on CT images. The angle of the lateral and posterior surface of the fibular incisura at the level of the neutral ridge was also measured. RESULTS: A statistically significant difference in the lateral vertex and margin of the fibular shaft on plain radiographs and distance from the tip of the distal fibula to the neutral ridge, angle of the fibular lateral surface on CT images was observed between male and female. The mean distance from the lateral vertex to the tip of distal fibula was 12.2+/-3.0 mm, to the lateral margin of the fibular shaft was 5.6+/-1.7 mm, distance from tip of the distal fibula to the neutral ridge was 54.9+/-6.4 mm, the fibular lateral surface angle was 52.2degrees+/-9.1degrees, and the fibular posterior surface angle was 32.5degrees+/-9.3degrees. CONCLUSION: Based on the various radiologic parameters, it was concluded that there was a wide morphological diversity of shape of lateral curve and fibular ridge.

Psychiatric Patients' Experiences of Being Restrained: A Phenomenological Study / 정신간호학회지

PURPOSE: This study was conducted to explore the meanings of Korean patients' experiences of being restrained in psychiatric wards. METHODS: Data were collected through in-depth individual interviews (N=6) and analyzed based on Merleau-Ponty's phenomenology. RESULTS: Four bodily themes of being restrained were evident: wounded body after being shocked, dented body with scarred dignity, powerless body, and reflexive body dealing with the chaotic mind. Meaning dimensions such as time, space, language, emotions, and perception were also applied and explained by the bodily themes. CONCLUSION: Psychiatric patients' bodies, under physical restraint, were not silent and simply belonging to the situation, rather were embodied as a part of their existential worlds. Based on the findings of this study, nurses can better hear and understand the bodily voices of being restrained when caring for patients in mental health settings.

A suspected case of malignant hyperthermia that was successfully treated with dantrolene administration via nasogastric tube / 대한마취과학회지

No abstract available.

Aldose Reductase Inhibitor Ameliorates Renal Vascular Endothelial Growth Factor Expression in Streptozotocin-Induced Diabetic Rats

PURPOSE: The vascular endothelial growth factor (VEGF) expression of podocyte is one of the well-known major factors in development of diabetic nephropathy. In this study, we investigated the effects of aldose reductase inhibitor, fidarestat on diabetic nephropathy, and renal VEGF expression in a type 1 diabetic rat model. MATERIALS AND METHODS: Twenty four Sprague-Dawley male rats which were performed intraperitoneal injection of streptozotocin and normal six rats were divided into four groups including a normal control group, untreated diabetic control group, aldose reductase (AR) inhibitor (fidarestat, 16 mg.kg(-1).day(-1)) treated diabetic group, and angiotensin receptor blocker (losartan, 20 mg.kg(-1).day(-1)) treated diabetic group. We checked body weights and blood glucose levels monthly and measured urine albumin-creatinine ratio (ACR) at 8 and 32 weeks. We extracted the kidney to examine the renal morphology and VEGF expressions. RESULTS: The ACR decreased in fidarestat and losartan treated diabetic rat groups than in untreated diabetic group (24.79 +/- 11.12, 16.11 +/- 9.95, and 84.85 +/- 91.19, p < 0.05). The renal VEGF messenger RNA (mRNA) and protein expression were significantly decreased in the fidarestat and losartan treated diabetic rat groups than in the diabetic control group. CONCLUSION: We suggested that aldose reductase inhibitor may have preventive effect on diabetic nephropathy by reducing renal VEGF overexpression.

Dyspnea after supraclavicular brachial plexus block in a morbidly obese patient due to phrenic nerve block: A case report / 대한마취과학회지

A 57-year-old woman with morbid obesity (BMI: 37.39) was scheduled for ligament reconstruction with tendon interposition of the carpometacarpal joint. A difficult supraclavicular brachial plexus block was performed using a 22-gauge regional block needle with a nerve stimulator and 40 ml of 1% mepivacaine. Approximately 10 minutes after the injection, she complained dyspnea, shortness of breath and right mid-thoracic pain. Her oxygen saturation decreased from 100% to 95%. Diagnostic workup revealed right diaphragmatic elevation caused by phrenic nerve block. General anesthesia was induced because of the unsuccessful brachial plexus block and dyspnea with chest pain. She recovered without any residual complications and was discharged on the third postoperative day. Phrenic nerve block is a common complication in supraclavicular brachial plexus block but it is usually not severe and reassurance is enough to control it. However, pre-operative physical conditions that may lead to decreased respiratory reserves, such as morbid obesity should be considered as a risk factors when conducting supraclavicular brachial plexus block.

Expression of FSHR mRNA in female genital organs / 대한산부인과학회잡지

FSH is the pivotal hormone in the regulation of ovarian function and acts by binding to specific receptor, FSH receptor (FSHR), which is belong to the family of G-protein coupled receptor. It have been considered that ovary is the only target organ of FSH because FSHR mRNA was first detected in ovarian follicles. However expression of FSHR mRNA was also detected on fallopian tube in experimental animal study and it is related wih tumorigenesis in postmenopausal women.In this study, in order to understand the FSH function in female genital organs, the ontogeny of the production profile of FSHR and the pattern of its localization in female genital organs were studied. We obtained the fresh tissues of ovary, fallopian tube, uterine body and uterine cervix with blood samples during proliferative phase in women with regular menstrual cycle. To establish FSHR mRNA expression of human internal genital organ, we studied by using in situ hybridization and quantitative competitive reverse transcription polymerase chain reaction (QC RT-PCR). To localize FSHR transcripts by in situ hybridization, we synthesized digoxigenin-labelled ssRNA probe (about 800 bp) from the cloned FSHR cDNA. For QC RT-PCR, we designed oligonucleotide primers (antisense: 5'-GGCCCTGCTCCTGGTCTCTTTG-3', sense: 3'-AACAGCGGGAGTACCTTCGG-5') which produced 799 bp sized PCR products. Simultaneously we synthesized 149 bp deleted DNA competitor by site-directed mutagenesis to quantify target FSHR mRNA expression comparing as internal control.In situ hybridization with digoxigenin-labelled ssRNA probe showed no signal above the background in primordial follicles. FSHR mRNA was first detected in the single layer of cuboidal granulosa cells surrounding primary follicles. As follicular growth progressed, FSHR mRNA expression increased gradually in antral and graafian follicles. Similary, in fallopian tube, the epithelium stained intensly. But FSHR mRNA expression was absent in uterine body including endometrium and myometrium and uterine cervix. Total RNA was extracted and quantitated by QC RT-PCR. The amounts of FSHR transcript measured were 840.00+/-516.29 in the ovarian tissue, 240.00+/-154.91 in the fallopian tube, 6.06+/-4.13 in the uterine body, 5.48+/-5.00 fg in the uterine cervix. These experiments demonstrated that FSHR mRNA is expressed in the ovary and fallopian tube, albeit only small amount was expressed in uterine body and cervix.In conclusion, the presence of FSHR mRNA in female internal genital organ with site specific pattern suggested that FSH may have some role in female genital organs during the adult reproductive cycle and may act as an factor in the tumorigenesis. Further study about the functional role and tumorigenesis of FSH should be performed in human internal genital organ.

The Influence of Choice of Pain Control Method on Analgesic effect and Postoperative Progress after Cesarean Section / 대한산부인과학회잡지

OBJECTIVE: We investigated influence of choice of pain control method on analgesic effect and postoperative course after cesarean section. METHODS: Ninety parturients were randomly allocated to three groups and each group had 30 women. The postoperative pain was controlled with classical intramuscular injection in IM group and PCA (patient-controlled analgesia)device in meperidine (D) and meperidine+diclofenac (DV) group for up to 48 hours after Cesarean section when the parturients awoke and complained pain. The parturients received intramuscular diclofenac 75 mg every 12 hours in DV group. We evaluated usefulness and safety of each pain control method on postoperative opioid requirement, numerical rating score of pain, side effect and first ambulation time for 48 hours after operation. RESULTS: Total opioid requirement was decreased almost 40-50% in DV group. Pain score lowered significantly at 6, 12 and 24 hours in DV group(p<0.05). Nausea,Vomiting and Dizziness were increased in IM group than PCA group(p<0.05). There was no difference in laboratory data including hemoglobin, hematocrit, platelet count and bleeding time in diclofenac used group. Ambulation was started earlier significalty in DV group after Cesarean section(p<0.05). CONCLUSION: We concluded that diclofenac combined PCA is the most effective and safe method in pain control after cesarean section. But it is necessary to try further evaluation of hemostatic effect of diclofenac.

The clinical study of 37 pregnancy women with aplastic anemia / 대한산부인과학회잡지

Objectives: To determine whether the clinical aspect of aplastic anemia is influenced by pregnancy. METHODS: We reviewed 37 cases of pregnant aplastic anemia patients during Jan. 1989 to Dec. 1998, and examined age, parity, progress of pregnancy, termination methods, obstetrics & neonatal complications, hematologic change, and treatment modality by medical records. RESULTS: According to onset of disease, patients were divided into pre-pregnant diagnosed group(n=12) and during-pregnancy diagnosed group(n=25). Mean age of diagnosis was 29.4yr, 89.2% were nulliparous, and 51.4% were severe aplastic anemic patients. All patients underwent 50 pregnancy. Mean gestational period was 37wks, birth weight was 2569gram, and, except in 7 cases of abortion, 43 cases were delivered transvaginally or transabdominally(51.2% vs. 48.8%). Preeclampsia, eclampsia, preterm labor, restricted growth, and distress were complicated and decreased hemoglobin, hematocrit, reticulocyte, platelet were reversed after termination in pregnancy associated group. Treatment modality during pregnancy included transfusion, steroid, anti-lymphocytic globulin, anti-thymocytic globulin and IVGV, and remission rate was 45.5% in pregnancy associated group. CONCLUSION: We concluded that pregnancy is associated with aplastic anemia as a high risk factor, and intensive treatment is needed.

A Case of Heterotopic Pregnancy Following IVF-ET / 대한산부인과학회잡지

The simultaneous existence of intrauterine and extrauterine pregnancies is known as a heterotopic pregnancy. Spontaneous heterotopic pregnancy is a rare event although its incidence has increased since the recent development of treatment of infertile women with ovulation induction or in-vitro fertilization and embryo transfer(IVF-ET).The theoretical rate of this condition was estimated to be approximately 1 in 30,000 pregnancies. The early diagnosis of heterotopic pregnancy is very difficult . So there is a high maternal morbidity and fetal loss. We reported a IVP - ET patient resulting in the successful delivery of live infant at 35weeks of gestational age from intrauterine pregnancy following surgical removal of ruptured concurrent extrauterine pregnancy.