A study on the correlation between outbreak of allergic rhinitis and airborne pollen in September

PURPOSE: Various studies have investigated factors related to the prevalence of allergic rhinitis (AR). We studied the correlation between the outbreaks of AR and airborne pollen in September. METHODS: According to data from the National Health Insurance Service, the number of AR cases was increased from 2012 to 2016. During the same period, the number of patients with upper respiratory tract infection, respiratory virus detection rate, air pollutants, and concentration of airborne pollen were correlated with the occurrence of AR in correlation analysis. RESULTS: The number of patients with AR showed increasing biphasic patters in the spring and fall with the peak reached in September (278,487±12,894), while April marked the fifth-highest figure with 241,570±132,677. The concentration of airborne pollen was highest at 4,450 grains/m³ in May, followed by 3,597 grains/m³ in April, marking its peak in the spring. September marked the third-highest level at 1,619 grains/m³. According to the monthly correlation between the number of patients with AR and pollen, Seoul and Daejeon showed correlations of ρ=0.929 (P=0.022) and ρ=0.955 (P=0.011), respectively, in September. There were no significant correlations among AR, air pollutants, and respiratory virus detection rate. CONCLUSION: Based on this study, the monthly number of patients with AR was the highest in September. In September, we found the correlation between allergic rhinitis and pollen, although there are regional limitations, regarding outbreaks in the number of patients with AR. Further research and attention are needed to prepare measures against airborne weed pollen during the fall.

A Case of Klinefelter Syndrome with Refractory Seizure in Infant / 대한소아신경학회지

Klinefelter syndrome a genetic disorder with various clinical manifestations. Neurological symptoms, such as seizures, are rarely reported with Klinefelter syndrome, and it response well to anti-epileptic drugs. A 5-month-old boy visited the Inha university hospital due to jerking movements and hiccups. The patient had been diagnosed with Klinefelter syndrome at birth and had a medical history of admission to the neonatal intensive care unit due to opisthotonus and ocular deviation at 26 days of age. The patient's serum testosterone level was decreased and his anti-Müllerian hormone level was increased. The brain image examination was normal and the electoencephalography and other blood test results showed no specific findings. However, after admission, the patient recurred generalized tonic-clonic-seizures recurred intermittently even after the administration of antiepileptic drugs. This paper reports a case of non-febrile seizures in a child with Klinefelter syndrome who presented with a refractory course.

Real-World Treatment Patterns among Patients with Advanced Gastric Cancer in South Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to understand patient treatment patterns, outcomes, and healthcare resource use in cases of metastatic and/or locally recurrent, unresectable gastric cancer (MGC) in South Korea. MATERIALS AND METHODS: Thirty physicians reviewed charts of eligible patients to collect de-identified data. Patients must have received platinum/fluoropyrimidine first-line therapy followed by second-line therapy or best supportive care, had no other primary cancer, and not participated in a clinical trial following MGC diagnosis. Data were summarized using descriptive statistics. Kaplan-Meier analysis was used to describe survival. RESULTS: Of 198 patients, 73.7% were male, 78.3% were diagnosed with MGC after age 55 (mean, 61.3 years), and 47.0% were current or former smokers. The majority of tumorswere located in the antrum/pylorus (51.5%). Metastatic sites most often occurred in the peritoneum (53.5%), lymph nodes (47.5%), and liver (38.9%). At diagnosis, the mean Charlson comorbidity indexwas 0.4 (standard deviation, 0.6). The most common comorbidities were chronic gastritis (22.7%) and cardiovascular disease (18.7%). Most patients (80.3%) received second-line treatment. Single-agent fluoropyrimidine was reported for 22.0% of patients, while 19.5% were treated with irinotecan and a fluoropyrimidine or platinum agent. The most common physician-reported symptoms during second-line treatment were nausea/vomiting (44.7%) and pain (11.3%), with antiemetics (44.7%), analgesics (36.5%), and nutritional support (11.3%) most often used as supportive care. Two-thirds of inpatient hospitalizations were for chemotherapy infusion. Outpatient hospitalization (31.6%) and visits to the oncologist (58.8%) were common among second-line patients. CONCLUSION: Most patients received second-line treatment, although regimens varied. Understanding MGC patient characteristics and treatment patterns in South Korea will help address unmet needs.

Tolerability and Outcomes of First-Line Pemetrexed-Cisplatin Followed by Gefitinib Maintenance Therapy Versus Gefitinib Monotherapy in Korean Patients with Advanced Nonsquamous Non-small Cell Lung Cancer: A Post Hoc Descriptive Subgroup Analysis of a Rand / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We recently reported on a randomized, open-label, phase 3 trial comparing pemetrexed-cisplatin chemotherapy followed by gefitinib maintenance therapy (PC/G) with gefitinib monotherapy in patients with non-small cell lung cancer (NSCLC). Here, we report on a post hoc subgroup analysis of that study assessing the demographics and disposition of the Korean patient subgroup, and comparing the tolerability of PC/G and gefitinib monotherapy and the tumor response with respect to epidermal growth factor receptor (EGFR) status. MATERIALS AND METHODS: Patients, who were ≥ 18 years, chemonaïve, Korean, light ex-smokers/never-smokers with advanced NSCLC, were randomly assigned (1:1) to PC/G or gefitinib monotherapy. Treatment-emergent adverse events (TEAEs) were graded, and tumor response was measured as change in lesion sum from baseline at best response. The study was registered with ClinicalTrials. gov, NCT01017874. RESULTS: Overall, 111 Korean patients were treated (PC/G, 51; gefitinib, 60). Between-arm characteristics were balanced and similar to those of the overall population. Treatment discontinuations due to adverse events were low (PC/G: 1, 2.0%; gefitinib: 7, 11.7%). Overall, 92 patients (82.9%) reported ≥ 1 TEAE (PC/G, 44; gefitinib, 48); few patients (PC/G, 16; gefitinib, 7) reported severe TEAEs; the most frequent was neutropenia (PC/G arm) and elevated alanine aminotransferase (gefitinib arm). The lesion sum was decreased by PC/G treatment in most patients, regardless of EGFR mutation status, while gefitinib monotherapy reduced the lesion sum in EGFR-positive patients but had no effect in EGFR-negative patients. CONCLUSION: Our results confirm that both PC/G and gefitinib were well tolerated in Korean patients, regardless of EGFR status; however, patients with EGFR wild-type NSCLC may not benefit from gefitinib monotherapy.

Gemcitabine Plus Cisplatin for Advanced Biliary Tract Cancer: A Systematic Review / Journal of the Korean Cancer Association, 대한암학회지

Evidence suggests that combined gemcitabine-cisplatin chemotherapy extends survival in patients with advanced biliary tract cancer (BTC). We conducted a systematic review in order to collate this evidence and assess whether gemcitabine-cisplatin efficacy is influenced by primary tumor site, disease stage, or geographic region, and whether associated toxicities are related to regimen. MEDLINE (1946-search date), EMBASE (1966-search date), ClinicalTrials. gov (2008-search date), and abstracts from major oncology conferences (2009- search date) were searched (5 Dec 2013) using terms for BTC, gemcitabine, and cisplatin. All study types reporting efficacy (survival, response rates) or safety (toxicities) outcomes of gemcitabine-cisplatin in BTC were eligible for inclusion; efficacy data were extracted from prospective studies only. Evidence retrieved from one meta-analysis (abstract), four randomized controlled trials, 12 nonrandomized prospective studies, and three retrospective studies supported the efficacy and safety of gemcitabine-cisplatin for BTC. Median overall survival ranged from 4.6 to 11.7 months, and response rate ranged from 17.1% to 36.6%. Toxicities were generally acceptable and manageable. Heterogeneity in study designs and data collected prevented formal meta-analysis, however exploratory assessments suggested that efficacy did not vary with primary tumor site (gallbladder vs. others), disease stage (metastatic vs. locally advanced), or geographic origin (Asia vs. other). Incidence of grade 3/4 toxicities was not related to gemcitabine dose or cisplatin frequency. Despite individual variation in study designs, the evidence presented suggests that gemcitabine-cisplatin is effective in patients from a diverse range of countries and with heterogeneous disease characteristics. No substantial differences in toxicity were observed among the different dosing schedules of gemcitabine and cisplatin.

The Short Term Results of All-inside Arthroscopic Repair of the Triangular Fibrocartilage Complex Type 1B Tear by Knotless Suture Anchor

PURPOSE: We studied the short term results of the arthroscopic repair of 1B type triangular fibrocartilage complex (TFCC) tear using a knotless suture anchor. METHODS: We evaluated 23 patients who underwent all-inside arthroscopic TFCC repair using a knotless suture anchor. The average follow-up duration was 6.6 months (range, 3-10 months). Mean duration of symptom was 10.9 months (range, 1 week-7 years). The arthroscopic finding documented 15 type 1B, 2 1B with 1D, and 6 1B with 2C lesions. All showed the positive hook test. The concomitant pathologies were 16 scapholunate injuries and 10 lunotriquetral injuries. TFCC tears were repaired by the knotless suture anchor. The Wafer procedure was done for 2C lesions. RESULTS: According to Mayo modified wrist score, the result was excellent in 4, good in 14 and fair in 5. Nineteen patients (82.6%) could return to his job or hobby. CONCLUSION: The all-inside arthroscopic repair using knotless suture anchor for TFCC 1B tear can provide good results. The appropriate management should be done for the concomitant pathologies for the better results.

Leptin: A Multifunctional Role as an Immunomodulator in Mycobacterial Lung Disease

Leptin is a 16 kDa protein which consists of 167 amino acids. Leptin is considered as one of the adipokines, secreted by white adipocytes, and is the product of the obese (ob) gene. Recently, leptin is recognized as the immuno-stimulator which belongs to the same class of long chain helical cytokines such as interleukin (IL)-6. Leptin is related to the immune responses evoked by Mycobacterium tuberculosis infection. Thus, studies of association between immunomolecules including leptin and tuberculosis may contribute to provide an essential solution regulating adverse immune responses in several mycobacterial diseases. Leptin has a multifunctional role in the secretion of acute-phase cytokines including IL-1beta and tumor-necrosis factor-alpha (TNF-alpha), and links to T helper 1 (Th1) immune response. Moreover, the binding of leptin to leptin receptor (LepR) is important in that this binding involves janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway. In addition, the activation of LepR mediates extra-cellular signal-regulated kinase (ERK) and phosphoinositide 3 kinase (PI3K) pathways. Furthermore, many studies suggest that leptin may play a critical role in respiratory diseases including chronic obstructive pulmonary disease (COPD) and asthma as well as tuberculosis. These findings indicate that leptin is one of the important regulators for immune responses in respiratory diseases. We herein discuss the multifunctional role of leptin in mycobacterial lung disease, especially focusing on the related pathway to immune responses.

Comparison of Saphenous Vein and PTFE Grafts for Above the Knee Femoropopliteal Bypass Grafting / 대한흉부외과학회지

BACKGROUND: Femoropopliteal artery bypss grafting is an effective form of treatment for infrainguinal artery occlusive disease in those patients who have either intermittent claudication or resting critical ischemia. The objective of this analysis was to evaluate the long-term patency of a femoropopliteal bypass graft that is classified as an above- the-knee saphenous vein graft or an above-the-knee PTFE (polytetrafluoroethylene) graft. MATERIAL AND METHOD: From January 1998 to February 2005, 103 above-the-knee femoro-popliteal bypasses were performed on 87 patients. There were 74 male and 13 female patients with a mean age of 65.7+/-9.6 (range: 31~82). The surgical indications were intermittent claudication in 65 cases (74.7%), foot ulceration in 2 cases (2.3%), foot necrosis in 10 cases (11.5%) and toe necrosis in 10 cases (11.5%). For the bypass graft, a reversed saphenous vein was used in 31 limbs and a polytetrafluoroethylene (PTFE) prosthesis was used in 72 limbs (6 mm: 27 limbs, 8 mm: 45 limbs). The perioperative risk factors were diabetes mellitus in 33 cases (37.9%), hypertension in 47 cases (54.0%), a history of ischemic heart disease in 13 cases (14.9%) and smoking in 72 cases (82.8%). RESULT: There were three perioperative deaths (3.4%) and seven late deaths (8.3%). Major leg amputation was necessary in 12 patients (13.8%) during the entire course of the study. The primary patency rate at 5 years for the vein grafts, the 8 mm-PTFE grafts and the 6 mm-PTFE grafts were 84.7%, 77.4% and 74.2%, respectively and the overall primary patency rate was 78.7%, and there were no significant statistical differences among the graft groups. By using multivariate analysis, the number of patent tibial arteries was determined to be a significant factor that influenced the primary graft patency rate (p<0.005), but risk factors such as diabetes mellitus, ischemic heart disease, smoking and age had no statistically significant affect on the primary graft patency rates. CONCLUSION: The great saphenous vein is considered the most durable conduit for infrainguinal revascularization, but the overall results of this study show that saphenous vein and PTFE grafts have comparable patency rates when used above the knee in patients with claudication or critical ischemia. The use of PTFE above the knee is a reasonable alternative for a femoro-poplitael bypass and it is associated with acceptable long term patency rates.

A Case of Wernicke's Encephalopathy Associated with Hyperemesis Gravidarum / 대한주산의학회잡지

Wernicke's encephalopathy, characterized by ataxia, nystagmus, confusion, due to thiamine deficiency, can be a lethal disease without appropriate treatment such as thiamine supplement. The thiamine defect could be from poor oral intake because of hyperemesis gravidarum as well as alcoholic disease. Radiologically, Wernicke's encephalopathy presents the abnormality around the 3rd and the 4th ventricle and periaqueductal area. We now present the case of Wernicke's encephalopathy associated with hyperemesis gravidarum with the radiologic finding and reviewing other literature.

A Case of Thanatophoric Dysplasia Type II Prenatally Diagnosed at 20 Gestational Weeks / 대한산부인과학회지

Thanatophoric dysplasia is a lethal skeletal dysplasia due to the dysfunction of endochondral ossification characterized by short limbs, narrow chest, micromelia, cranial dysplasia. Tavormina described in 1995 that the dysfunction of endochondral ossification is due to the missence mutation of the gene presenting the Fibrblast Growth Factor Receptor 3. Thanatophoric dysplasia is classified as two types. The type I is characterized by the curved short limbs and severe platyspondyly, and the type II by the kleeblattschadel (cloverleaf deformity) and straight short limbs. Both are destined to the death a few days after the delivery due to the pulmonary hypoplasia from the hypoplastic thorax. We experienced a case of thanatophoric dysplasia on antenatal ultrasound examination and then pregnancy was terminated by vaginal delivery. Now, with the review of literature, we report the case of thanatophoric dysplasia confirmed by clinical features and radiological finding.

Associated anomalies and perinatal outcomes in the fetus with single umbilical artery / 대한산부인과학회지

OBJECTIVE: To evaluate the pattern of associated structural anomalies, perinatal outcomes and obstetrical complications in fetuses with single umbilical artery. METHODS: 27 fetuses with a single umbilical artery were detected between May 1995 and June 2005 at our hospital. All medical records were reviewed for maternal demographics, associated anomalies, karyotypic analysis, pregnancy complications and perinatal outcome. RESULTS: Of the 27 fetuses, 1 (3.7%) was terminated and 1 (3.7%) was expired. 13 fetuses (48.1%) had an associated structural anomalies. The structural anomalies found in association with single umbilical artery were in the cardiovascular system (6 cases, 46.2%), urogenital system (6 cases, 46.2%), central nervous system (3 cases, 23.1%), neuromuscular system (3 cases, 23.1%) and gastrointestinal system (1 case, 7.7%). 6 cases (46.2%) among these had multiple malformations. Karyotypic analyses were available only in 3 cases and one of these was chromosomally abnormal. CONCLUSION: Scanning the umbilical cord should be one of the essential parts of the second trimester ultrasonographic examination. When single umbilical artery is detected, a detailed ultrasonographic examination including fetal echocardiography and fetal karyotyping should be recommended for search of associated structural and chromosomal abnormalities.

Transcriptional Regulation of the Estrogen Receptor alpha Gene by Testosterone in Cultures of Primary Rat Sertoli Cells / 대한내분비학회지

BACKGROUND: We wanted to identify the presence of the estrogen receptor (ER) alpha in Sertoli cells and gain insight on the regulation of the ER alpha gene expression by testosterone in Sertoli cells. The transcriptional regulation of the ER alpha gene was investigated in primary Sertoli cell cultures by in situ hybridization and reverse transcription-polymerase chain reaction (RT-PCR). METHODS: Primary Sertoli cell culture was performed. The expression levels of ER alpha and ER beta mRNA in Sertoli cells were detected by Northern blot, RT-PCR, immunocytochemistry and in situ hybridization. RESULTS: The ovary, testis and epididymis showed a moderate to high expression of ER alpha while the prostate, ovary and LNCap cells showed the ER beta expression. ER alpha mRNA and protein were detected in the germ cells and Sertoli cells by in situ hybridization and immunocytochemistry. The level of ER alpha mRNA was gradually decreased in a time-dependent manner after testosterone treatment, and the changes of ER alpha mRNA were dependent on the concentration of testosterone. Androgen binding protein and testosterone-repressive prostate message-2 (TRPM-2) mRNA were reduced at 24 hour by estradiol, while the transferrin mRNA was not affected. ER alpha mRNA was strongly detectable in the testes of 7 days-old-rats, but it was gradually decreased from 14 to 21 days of age. The primary Sertoli cells also showed the same pattern. The ER alpha gene expression was also regulated by testosterone in the Sertoli cells prepared from the 14- and 21-day old rats. CONCLUSIONS: These results suggest that ER alpha is transcriptionally regulated by testosterone and it may play some role in the Sertoli cells.

Mechanism of Azaline B-induced Apoptosis in Rat Testis / 대한비뇨기과학회지

PURPOSE: To identify the mechanism of azaline B-dependent apoptosis, the regulation of Fas and FasL genes has been investigated. MATERIALS AND METHODS: Azaline B was subcutaneously injected into Sprague-Dawley rats. The levels of Fas receptor (Fas) and Fas ligand (FasL) were detected by reverse transcription-polymerase chain reaction (RT- PCR). Azaline B-dependent apoptosis was determined by terminal deoxynucleotidyl transferase-mediated dUTP nick and labeling (TUNEL) and DNA fragmentation assay. Transacting factor of FasL promoter was identified by DNase I footprinting and DNA mobility shift assay. RESULTS: The azaline B-treated testis (250microgram/kg body wt/day) had decreased to 70+/-2.5% and 38+/-1.8% of the normal testis weight at 3 and 5 days after the injection, respectively, but the weights of the testis were not changed after pretreatment of follicle-stimulating hormone (FSH) and testosterone. Apoptosis of the testis was detected by DNA fragmentation assay and TUNEL assay after the azaline B treatment. The levels of Fas and FasL mRNA were increased by the treatment of azaline B in both time- and dose-dependent manners. In DNase I footprinting assay with FasL promoter, the nuclear factor prepared from control was bound with at least four sites: SP-1 binding site at 283, NF-kappa B binding site at 219, TATA at 132 and the gamma-interferon response element (gamma-IRE) at 78. gamma-IRE was completely protected by the nuclear extract prepared from azaline B-treated rat testis. In DNA mobility shift assay, the binding activity of gamma-IRE binding protein was increased after azaline B treatment. CONCLUSIONS: These results suggest that Fas-FasL system may be important to azaline B-dependent apoptosis in rat testis and that gamma-IRE binding protein is related to the azaline B-dependent regulation of FasL gene.

Rising Incidence of Hip Fracture in Gwangju City and Chonnam Province, Korea

The purpose of study was to determine the incidence of hip fracture in 2001, to compare this with that of 1991, and to identify possible causes of change. Patients aged 50 yr or more living in Gwangju City and Chonnam Province, Korea, and who sustained a fracture of the hip during 2001 were investigated. Only patients who were admitted to hospitals for primary treatment of the first hip fracture were selected. There were 1,152 patients. A comparison of fracture incidences for 1991 and 2001 showed considerable increase during the 10-yr period. The total annual number of hip fractures rose from 247 in 1991 to 1,152 in 2001 and the fracture incidence also increased remarkably from 3.3 persons per 10,000 population in 1991 to 13.3 in 2001, representing a 4-fold increase over 10-yr. The reasons for this rising trend of hip fracture were not fully explained. However, an increase in the elderly population, an increase in osteoporosis, and an increase in injurious falls could partly account for the observed increase.

Mechanism of Castration-induced Apoptosis of Ventral Prostate in Rat / 대한내분비학회지

BACKGROUNDS: Castration-induced androgen deprivation triggers a sequence of events, which activates apoptotic cell death of the androgen-dependent epithelial cells within the rat ventral prostate. To investigate the mechanism of castration-dependent apoptosis in the rat ventral prostate, the regulation of apoptosis-related genes was been investigated. METHODS: Azaline B was subcutaneously injected into Sprague-Dawley rat. The Fas receptor (Fas), Fas ligand (FasL) and bcl-2 mRNA, as well as the protein levels were detected by RT-PCR and Western blot analyses. Azaline B-dependent apoptosis was determined using TUNEL and a DNA fragmentation assay. The transacting factor of the FasL promoter was identified by DNA footprinting and a DNA mobility shift assay. RESULTS: The rat prostate was regressed after castration, with and the involuted ventral prostate regenerated by testosterone pretreatment, but not by that with FSH. Apoptosis of the ventral prostate was detected, after castration, using toluidine blue staining, a TUNEL assay and an apoptotic DNA fragmentation assay. The levels of Fas, FasL mRNA and protein were increased after castration. In the DNase I footprinting assay, using the FasL promoter and a nuclear extract prepared from a control prostate, at least two sites were protected: the SP-1 binding site at -283 bp and the prostate-unidentified factor(P-UF) binding site at -247 bp. The SP-1 binding activity vanished in the nuclear extract prepared from castrated rats. In the DNA mobility shift assay, the SP-1 binding activity was slightly decreased after castration. Both the Bcl-2 mRNA and Bcl-2 protein were downregulated after castration. CONCLUSION: These results suggest that the Fas/FasL system and Bcl-2 may be important to castrationdependent apoptosis in the rat ventral prostate, with SP-1 related to the castration-dependent regulation of the FasL gene

Mechanism of Castration-induced Apoptosis of Ventral Prostate in Rat / 대한내분비학회지

BACKGROUNDS: Castration-induced androgen deprivation triggers a sequence of events, which activates apoptotic cell death of the androgen-dependent epithelial cells within the rat ventral prostate. To investigate the mechanism of castration-dependent apoptosis in the rat ventral prostate, the regulation of apoptosis-related genes was been investigated. METHODS: Azaline B was subcutaneously injected into Sprague-Dawley rat. The Fas receptor (Fas), Fas ligand (FasL) and bcl-2 mRNA, as well as the protein levels were detected by RT-PCR and Western blot analyses. Azaline B-dependent apoptosis was determined using TUNEL and a DNA fragmentation assay. The transacting factor of the FasL promoter was identified by DNA footprinting and a DNA mobility shift assay. RESULTS: The rat prostate was regressed after castration, with and the involuted ventral prostate regenerated by testosterone pretreatment, but not by that with FSH. Apoptosis of the ventral prostate was detected, after castration, using toluidine blue staining, a TUNEL assay and an apoptotic DNA fragmentation assay. The levels of Fas, FasL mRNA and protein were increased after castration. In the DNase I footprinting assay, using the FasL promoter and a nuclear extract prepared from a control prostate, at least two sites were protected: the SP-1 binding site at -283 bp and the prostate-unidentified factor(P-UF) binding site at -247 bp. The SP-1 binding activity vanished in the nuclear extract prepared from castrated rats. In the DNA mobility shift assay, the SP-1 binding activity was slightly decreased after castration. Both the Bcl-2 mRNA and Bcl-2 protein were downregulated after castration. CONCLUSION: These results suggest that the Fas/FasL system and Bcl-2 may be important to castrationdependent apoptosis in the rat ventral prostate, with SP-1 related to the castration-dependent regulation of the FasL gene

A Case of Spina Bifida Diagnosed by Prenatal Ultrasonography / 대한산부인과학회잡지

In prenatal diagnosis of neural tube defects, maternal serum alpha-fetoprotein (MSAFP) level in second trimester is used as a screening test. However, it shows low sensitivity with high false positive rate. Also, alpha-fetoprotein and acetylcholinesterase in amniotic fluid through amniocentesis is used, but it is an invasive technique with low sensitivity. Recently, due to improved prenatal sonography, typical sonographic findings of spina bifina are reported and contributed to early diagnosis and detection of possible co-existing abnormalities. We report a case of spina bifida detected at 21 weeks of pregnancy by prenatal sonograph at our institution with a brief review of literature.

Early and Mid-term Results of Operation for Acute Limb Ischemia / 대한흉부외과학회지

Background: Even though there were developments in various treatment techniques for acute limb ischemia, this disease is both life threatening and limb threatening. We investigated early and mid-term results of operation for acute limb ischemia with symptoms, the combined diseases, location of occlusion, complication in our patients. Meterial and Method: A retrospective review was conducted in 54 patients (43 men, 11 women, mean age 67.2 years) presenting with acute limb ischemia due to arterial thrombosis or embolism between Jan. 1996 and Dec. 2003, initially underwent thromboembolectomy. Result: In 33 patients (61.1%) the timeinterval from the onset of symptom to admission was within 24 hours. Causes of acute limb ischemia were embolic occlusion (27.8%), native arterial thrombosis (66.7%), and bypass graft thrombosis (5.6%). The distribution of arterial occlusion location was at 8 aortoiliac (14.8%) and 43 distal to femoral (79.6%) and brachial (5.6%). Clinical categories were grade I in 64.8%, IIa in 24.1%, IIb in 7.4%, and III in 3.7%. All the patients were received embolectomy. Underlying diseases were heart disease (72.2%), hypertension (33.3%), cerebrovascular accident (16.7%) and diabetes (18.5%). History of smoking was noted in 96.3% of the cases. Mortality rate was 5.6% and overall amputation rate was 9.3% (5/54). The 1-year limb salvage rate was 93.62%. Postoperative complications were 1 wound infection, 1 GI bleeding, 3 acute renal failure, and 1 compartment syndromes. The functional outcomes of the salvaged limb according to the recommended scale for gauging changes in clinical status, revised version in 1997 were +3 in 68.5%, +2 in 9.3%, +1 in 7.4%, -1 in 5.6%, -2 in 3.7%, and -3 in 5.6%. Conclusion: This study revealed 5.6% mortality and the amputation rate was 9.3%. We have retrospectively shown good results from early diagnosis & early operation. To improve outcome, early diagnosis and understand the underlying diseases, prompt treatment and operation would be appreciated.

The Result of the Anterior Cruciate Ligament Reconstruction over 40 Years Old of Age

PURPOSE: The purpose of the current study was to examine treatment outcome after anterior cruciate ligament (ACL) reconstruction in patients older than 40 years of age and determine the factors affecting the outcome. SUBJECTS AND METHODS : Clinical results obtained from 60 cases from 60 patients older than 40 years of age at the time of surgery and 58 cases from 58 patients younger than 40 years of age who underwent ACL reconstruction between August 1988 to January 2002, return to sports activity, and stress radiographs using Telos instrument were compared. RESULTS: The Lysholm knee score was improved from the preoperative score of 54.0 points to the postoperative score of 92.9 in patients older than 40 years of age and was improved from 56.2 points to 92.2 points in patients younger than 40 years of age. Clinical outcome was excellent in 51 cases (85%) and good in 9 cases (15%) in patients older than 40 years of age and was excellent in 47 cases (81.0%) and good in 11 cases (19.0%) in patients younger than 40 years of age. The rate of returning to preoperative sports activity was high in 36 cases (60%) in patients older than 40 years of age and 48 cases (82.8%) in patients younger than 40 years of age. According to Telos stress radiography, the preoperative difference of 11.2 mm was decreased to the postoperative difference of 3.1 mm in patients older than 40 years of age and the preoperative difference of 10.7 mm was decreased to the postoperative difference of 2.9 mm in patients younger than 40 years of age. Clinical outcome did not show significant correlation with age, gender, surgery method, the presence of additional injury, and the rate of return to sports activity before receiving injury(p>0.05). CONCLUSION: Age was not a factor interfering with the outcome of surgery for ACL injury, and satisfactory outcome could be obtained with ACL reconstruction even in patients older than 40 years of age.

Experimental Study of Avascular Necrosis of the Femoral Head in the Puppy / 대한정형외과학회잡지

PURPOSE: To observe the morphological changes of the femoral head following vascular infarct produced by surgical devascularization of the capital femoral epiphysis in a mongrel puppy model. MATERIALS AND METHODS: Forty-six mongrel, weaned puppies, 7 to 9 weeks old, and between 1.5 to 2.5 kg in weight, were experimentedupon. They were divided into three groups: 12 underwent only simple capsular incision (Group A), 18 underwent ligamentum teres disruptionwith temporary subluxation of the hip joint (Group B), and 16 underwent both ligamentum teres and posterior retinacular arterydisruption (Group C). Three to five puppies in each experimental group were periodically sacrificed at 2 weeks and at 1, 2, 5 months, postoperatively. Both femurs, extracted from the sacrificed puppies, were studied by eye, radiographically and histologically. RESULTS: Puppies from the single (Group B) and double devascularization groups (Group C) showed definite findings of vascular infarct macroscopically, radiologically, and histologically. These findings were more frequent and severe in the group with the double infarct thanthe single infarct. CONCLUSION: Morphological changes similar to those seen in human Legg-Calve-Perthes' disease (LCPD) were observed in puppy specimens. This puppy model of LCPD may be useful for experimental studies.