Cardiac arrest caused by contralateral tension pneumothorax during one-lung ventilation - A case report –

Background@#Tension pneumothorax on the contralateral lung during one-lung ventilation (OLV) can be life-threatening if not rapidly diagnosed and managed. However, diagnosis is often delayed because the classic signs of tension pneumothorax are similar to clinical manifestations commonly observed during OLV.Case: We report a case of contralateral tension pneumothorax in a patient undergoing right upper lobectomy during OLV. The patient suffered from sudden cardiac arrest and was assisted by extra-corporeal membrane oxygenation. @*Conclusions@#Contralateral pneumothorax during OLV is rare but can occur at any time. Therefore, anesthesiologists should consider this critical complication.

Radix Polygalae Extract Attenuates PTSD-like Symptoms in a Mouse Model of Single Prolonged Stress and Conditioned Fear Possibly by Reversing BAG1

Radix Polygalae (RP) has been used to relieve psychological stress in traditional oriental medicine. Recently, cell protective, antiamnestic and antidepressant-like effects were disclosed but the possible application of RP to post-traumatic stress disorder, in which exaggerated fear memory persists, has not yet been explored. For this purpose, the effects of RP on fear behavior was examined in a mouse model of single prolonged stress and conditioned fear (SPS-CF), previously shown to mimic key symptoms of post-traumatic stress disorder. Male mice received daily oral dose of RP extract or vehicle during the SPS-CF procedure. Then fear-related memory (cohort 1, n=25), non-fear-related memory (cohort 2, n=38) and concentration-dependent effects of RP on fear memory (cohort 3, n=41) were measured in 3 separate cohort of animals. Also working memory and anxiety-like behaviors were measured in cohort 1. RP-treated SPS-CF mice exhibited attenuated contextual but not cued freezing and no impairments in the working memory and spatial reference memory performances relative to vehicle-treated SPS-CF controls. RP-treated SPS-CF and naive mice also demonstrated no difference in anxiety-like behavior levels relative to vehicle-treated SPS-CF and naive controls, respectively. In the hippocampus of SPS-CF mice, expression of BAG1, which regulates the activity of GR, was decreased, whereas RP increased expression of BAG1 in naïve and SPS-CF mice. These results suggest that RP exerts some symptomatic relief in a mouse with exaggerated fear response. RP and its molecular components may thus constitute valuable research targets in the development of novel therapeutics for stress-related psychological disorders.

Effect of Different Splints on Displacement after Closed Reduction of the Distal Radius Fractures: A Comparison of Short Arm Double Splint and Sugar-Tong Splint

PURPOSE: This study was to compare short arm double splint allowing forearm rotation with sugar tong splint in terms of loss of reduction and incidence of shoulder stiffness after closed reduction of the distal radius factures. METHODS: From June 2012 to February 2013, we retrospectively reviewed patients with distal radius fractures applied short arm double splint or sugar tong splint after closed reduction. Patients with more than 18 years old, acceptable reduction in X-ray and followed up at least 4 weeks were enrolled. Short arm double splint (SD) group was applied in 47 cases and sugar tong splint (ST) group was 34 cases. Gender, age and fracture types were not significantly different between two groups. The radiographic parameters were measured for palmar tilt, articular step-off, radial length, radial inclination, ulnar variance. The incidence and time of the reduction loss were also evaluated. In functional outcomes, the occurence of ipsilateral shoulder stiffness and the disabilities of the arm, shoulder and hand (DASH) score were evaluated with the medical records or telephone questionnaires at 6 months after initial trauma. RESULTS: Loss of reduction was occured 16 cases in SD group (34%) and 10 cases in ST group (29.4%), which did not differ significantly between the groups (p=0.169). The DASH score and shoulder stiffness were not statistically different between two groups. CONCLUSION: There was no significant difference in loss of reduction after closed reduction of distal radius fractures and functional outcomes in both groups.

Cementless Total Hip Arthroplasty for Osteonecrosis of the Femoral Head: A Follow-up Study for 10+ Years

PURPOSE: The aim of this study was to assess the outcome of cementless total hip arthroplasty (THA) in cases of osteonecrosis of the femoral head. MATERIALS AND METHODS: We studied long-term outcomes for 54 patients (72 hips). Mean duration of follow-up was 13.5 years. Clinical outcomes were evaluated by the Harris Hip Score. Radiographic evaluation from the preoperative and follow-up periods included assessment of the fixation of the femoral and acetabular components, polyethylene wear, osteolysis, and radiolucent line. RESULTS: The mean Harris Hip Score improved from a preoperative value of 51.9 points to 89.4 at final follow-up. Regarding the femoral components, there was radiographic evidence of stable bony ingrowth in 69 hips, stable fibrous ingrowth in 2 hips and unstable fixation in 1 hip. There was a radiolucent line of less than 1 mm in 7 hips, and femoral osteolysis in 27 hips. Regarding the acetabular components, there was radiographic evidence of stable fixation in 68 hips, unstable fixation in 4 hips, and osteolysis in 39 hips. There was a significant correlation between (i) failure of components and (ii) femoral osteolysis, acetabular osteolysis, polyethylene thickness, linear wear rate per year, or total linear wear. CONCLUSION: The findings of this study show favorable long term results, both clinical and radiographic, using cementless total hip replacement arthroplasties. However, the revision rates for the Harris-Galante acetabular components were high. Wear of the load? weight? bearing surface continues to limit the long-term success rate of THA, and improved design of the acetabular components should be considered.

Diagnostic Accuracy of Computed Tomography for the Lymph Node Staging of Endoscopically Resectable Early Gastric Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: Accurate staging of the lymph nodes (LNs) before endoscopic mucosal resection (EMR) is important. We evaluated the accuracy of CT for LN staging in patients the endoscopically resectable early gastric cancer (EGC). METHODS: The medical records of 155 EGCs patients who had undergone an operation were analyzed. The pre-operatively performed multidetector CT scans and the post-operative histopathologic findings were reviewed for comparing the LN staging with that using the Japanese classification system. Endoscopically resectable EGC was defined as EGC without LN metastasis and also the EGC that satisfied the EMR criteria according to the Japanese guideline. RESULTS: The diagnostic efficacy of CT for LN staging of all the enrolled EGC patients was as follow: accuracy 65.2%, overstaging rate 29.7%, understaging rate 5.2%. The overall accuracy and the overstaging rate of CT for LN staging of endoscopically resectable EGC were as follows: EGC without LN metastasis [69.8% (97/139), 30.2% (42/139)], EGC satisfying extended criteria [72.5% (58/80), 27.5% (22/80)] and EGC satisfying limited criteria [79.2% (19/24), 20.8% (5/24)]. The accuracy of the EMR criteria for predicting node negative EGC were as follows: the extended criteria 98.8% (79/80), the limited criteria 100% (24/24). CONCLUSIONS: Our study showed that prediction of LN metastasis before EMR according to CT staging had limited value due to the tendency of overestimation. Therefore, we should preferentially consider the treatment strategy according to the EMR criteria.

Contrast-induced Nephropathy in Patients Undergoing Percutaneous Coronary Angiography and its Clinical Characteristics / 대한신장학회지

PURPOSE: Contrast media-induced nephropathy (CIN) following coronary angiography is associated with an increased mortality and morbidity. We investigated the incidence of nephrotoxicity, clinical characteristics, laboratory characteristics and risk factors of CIN in patients undergoing coronary angiography. METHODS: We retrospectively evaluated the medical records of 555 patients who had undergone coronary angiography at the Sanggye Paik Hospital, from January 2004 to December 2005. We defined CIN as any increase in the creatinine value of more than 0.5 mg/dL or 50% of baseline value. RESULTS: Among 555 patients, CIN developed in 10 of 48 patients (20.8%) with renal insufficiency (serum creatinine > or =1.4 mg/dL) and in 7 of 507 patients (1.4%) without renal insufficiency (p or =65 years were the significant predictors of CIN. There were no statistical differences in contrast type and volume according to the development of CIN. CONCLUSION: Our data supported the assumption that renal insufficiency, congestive heart failure, hyperuricemia and anemia may be the risk factors of developing CIN.

Strangulated Umbilical Hernia Misdiagnosed as CAPD Peritonitis / 대한신장학회지

Abdominal wall hernias are a common problem in patients treated with continuous peritoneal dialysis. Although most patients with abdominal wall hernia are asymptomatic, some patients may present with abdominal pain or, if the hernia is incarcerated or strangulated, with signs and symptoms of peritonitis. It is often difficult to differentiate abdominal catastrophe such as peritonitis secondary to strangulated hernia from CAPD peritonitis. Because their clinical manifestations are similar, several biochemical markers including amylase and lactic acid have been recently used as an indicator of abdominal catastrophe. We report a case of strangulated umbilical hernia with perforation misdiagnosed as CAPD peritonitis. The patient was operated 36 hours after the first inspection but expired due to overwhelming sepsis, 257 days after the admission to hospital.

Early Detection of Perforation of the Right Ventricle by a Permanent Pacemaker Lead

Ventricular perforation is a rare complication of permanent cardiac pacemaker implantation. We report here on a 68-year-old woman with a dual chamber permanent pacemaker that had been implanted one month earlier, and she suffered cardiac perforation from the pacemaker lead. Frequent follow-up via12-lead surface electrocardiography and chest radiography and the proper work-up for pacemaker implantation are needed for detecting rare complications after pacemaker implantation.

The Effects of Bone Regeneration of the Dermal Collagen Matrix(AlloDerm(R)) Graft in the Rabbit Calvarium

This study was undertaken to investigate possibility of the allogenic type I collagen inducing osteoinduction or osteoconduction at critical sized bone defect in the rabbit. Twenty Newzealand white rabbit, weighted from 2.8kg to 3.5kg, were used in this study. The skull was exposed and two bony defects were created with diameter of 10mm. Group I(n=10), the bony defects was grafted from the other side bone. Group II(n=10), the bony defects was grafted by the allogenic type I collagen with bone morphogenic protein(BMP). Group III(n=10), the bony defects was grafted by the allogenic type I collagen only. Group IV(n=10), the bony defects was lefted with no grafts. The grafted bones and allogenic type I collagen were investigated with radiologic densitometry, histologic analysis and immunohistochemistry after 12 weeks. No major difference was observed in the gross finding between Group I, II, III, but dura mater was exposed in bony defect,the Group IV. The radiologic study demonstrated more bony opacity in the Group I, but the other groups did not demonstrate a significant difference. In the histologic study, grafted bone edge was completely consolidated with original bone in group I and new bone ingrew into the grafted allogenic type I collagen(group II, III),but there is no bone regeneration from the original bony edge in the group IV. The percent of the new bone formation by cross-sectional area was considered statistically significant at a p value of less than 0.05(p<0.05). In the immunohistochemistry study about BMP antibodies, the group IV demonstrated osteogenic activity in front of advancing original bone edge, in which the osteoblast stained strongly for BMP antibodies, but other group does not demonstrated any osteoblastic expression. There was no immunologic rejection. In conclusion, this results do not demonstrate that the allogenic type I collagen is useful for bone substitute, but the characters of the collagen, such as pliability, easy-handling, sponge-like structure, are useful in interpositional bone graft substitutes. The further evaluation of long term results about the resorption, immunologic tissue reaction, response of applied tissue growth factor to the allogenic collagen is needed.

A Case of Extramedullary Progression Despite of Serologic Improvement in a Patient Treated with Thalidomide for Multiple Myeloma

Thalidomide is an anti-angiogenic agent widely used in patients with multiple myeloma. The response to therapy is commonly monitored using serum and/or urine M protein, as these are known to reflect the tumor burden. Although extramedullary plasmacytomas are tissues with high neovascularization, it has been suggested in some reports that the response to thalidomide in these patients may be inferior, despite changes in the serum M protein level. Herein, we report the case of a patient who newly developed hepatosplenic extramedullary plasmacytoma, despite reduction in the serum M protein level following thalidomide treatment.

Report from ADRG: A Study on the Clinical Manifestations of Childhood Atopic Dermatitis in Korea / 대한피부과학회지

BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing disease with genetic and environmental background. Many factors may act as triggers and affect the course of the disease. However, little is known about the factors affecting the disease severities in Korean childhood AD. OBJECTIVE: The aim was to document the distinct characteristics of childhood AD in Korea and to determine which manifestations are prone to be present in the settings of different severity of the disease. METHOD: The clinical manifestations, past medical and family history, and inducing or aggravating factors were studied in patients, who participated in the open lectures for childhood AD patients in three provinces of Korea. The severity of the disease was evaluated using the Eczema Area and Severity Index (EASI) and the factors affecting the severity of the disease were determined. Skin prick tests with four allergens, Dermatophagoides pteronyssinus, milk, peanut and egg, were also carried out. RESULTS: Of the 93 patients, 38.7% had the disease onset between the age of three and six, while 17.2% had it between the age of seven and fifteen. Sixty-five percent of the patients had family members with a history of atopic diseases, such as AD, asthma, allergic rhinitis and allergic conjunctivitis. In order of frequency, the patients either had a history of or presently accompanying infantile eczema, allergic rhinitis, asthma or allergic conjunctivitis. Among the patients, 27% took herbal medication. The most frequently involved site was the flexural area. The most common aggravating factors were sweating in hot environment, wool fabric and stress. When AD patients were categorized into mild, moderate and severe groups by EASI, the older onset age, the longer duration, facial distribution, history of taking herbal medication, cholinergic condition, wool fabric and stress were found to be significant factors influencing the severity of the disease. Skin prick test with the four major allergens revealed the highest prevalence in Dermatophagoides pteronyssinus. CONCLUSION: The age of onset of AD was higher than that has been reported. Many suffered from infantile dermatitis and had other accompanying atopic diseases. Aggravating factors should be avoided to minimize the risk of disease aggravation. Based on the fact that late onset age, duration, facial distribution, history of taking herbal medication, cholinergic condition, wool and stress were the statistically significant factors, we may predict the severity or the course of the disease.

The Validity of Intraoperative Brainstem Auditory Evoked Potentials (BAEPs) for the Postoperative Hearing Impairments in Microvascular Decompression (MVD) / 대한마취과학회지

BACKGROUND: Intraoperative brainstem auditory evoked potentials reduced the sensorineural hearing loss (SNHL) after microvascular decompression (MVD) This study was performed to evaluate the validity of BAEP parameters of latency or amplitude to SNHL. METHODS: 557 patients out of 930 hemifacial spasm patients performed MVD, who were free from hearing impairment preoperatively, were enrolled in this study. Maximal changes of BAEPs wave V latency and amplitude during MVD were retrospectively sought according to postoperative SNHL. Sensitivity, specificity and positive predictability of wave V latency and amplitude were also sought according to the postoperative SNHL with a critical value of 1.0 msec prolongation and 40% decrease, respectively. RESULTS: Wave V latency of BAEPs prolonged less in patients with normal hearing outcome (0.44 +/- 0.63 msec) than in the patients with temporary or permanent SNHL (1.23 +/- 0.56 msec, 1.33 +/- 0.33 msec). Wave V amplitude also decreased less in the patients with normal hearing outcome (5.4 +/- 15.8%) than in the patients with transient or permanent SNHL (42.8 +/- 31.7%, 60.0 +/- 34.7%). While sensitivity, specificity and predictability of prolongation of wave V latency at a value of 1.0 msec for SNHL, were 52.5%, 76.4% and 14.7%, respectively, those of decrease in the amplitude of wave V for SNHL at a value of 40% were 35.0%, 93.6% and 29.8%, respectively. CONCLUSIONS: Decrease of the amplitude of wave V seems to have higher specificity, predictability and lower sensitivity for SNHL than the prolongation of wave V latency.

Nucleoplasty as an Alternative Intradiscal Therapy in Patients with Lumbar Disc Herniation

OBJECTIVE: The nucleoplasty ablates, coagulates and decompresses the nucleus pulposus by way of high-density plasma field rather than by way of high thermal energy. The authors intended to describe the effects, indications and technical details of nucleoplasty. METHODS: From August 2001 to January 2002, the authors performed nucleoplasty for 40 consecutive patients (45 levels) and evaluated the short-term(mean 3 months) result after the procedure according to Macnab criteria. Exclusion criteria were same for the other percutaneous procedures, significant or ruptured, sequestered disc material, spinal stenosis, spinal instability, etc. Intraoperative discogram was prerequisite for determination of the precise causative level. Average operation time was 40 minutes, and patients discharged on the next day after the procedure. RESULTS: Male was outnumbered female by 21 to 19 and age was ranged from 20 to 67 years old(mean: 42.9). Procedures were performed at single level in 35 cases and at two levels in 5 cases. The L4-5 level was the most commonly involved. According to Macnab's outcome criteria, excellent and good outcome was achieved in 35 patients(87.5%), and fair and poor outcome was in 3(7.5%) and 2(5%) patients, respectively. CONCLUSION: Nucleoplasty by using coblation method in patients with lumbar disc herniation shows immediate relief of leg and back pain in 87.5% of the patients during the short span of follow-up. However, data collection with respect to the lengthening of population number and follow-up span, and refinement of strict inclusion/exclusion criteria are prerequisite in near future.

Rosacea: Clinical Study of 67 Cases

BACKGROUND: Rosacea is a chronic skin disease which primarily affects the face. There have been many basic and clinical studies on rosacea in the West, but little in Korea. OBJECTIVE: This study was to investigate clinical features of rosacea in Korea and to compare them with those in the West. METHODS: During a 20-month period, 67 patients diagnosed as having rosacea were examined for their clinical presentations by means of personal interview. RESULTS: Erythema and telangiectasia were found in almost all of the 67 patients. Comparing with the results in the West, flushing and telangiectasia were more common whereas papules, pustules, and rhinophyma were less common with no case of ocular complaints or migraine. CONCLUSION: Because early detection and treatment is necessary to prevent the progression of rosacea, it is important to realize that rosacea is not uncommon in Korea and to recognize its somewhat different clinical manifestations from those in the West.

Analysis of World WideWeb-Based Queries on Alopecia: Conditions for Estabilishing an Efficient Telemedicine System / 대한피부과학회지

No Abstract Available.

Detection of Human Herpesvirus 8 DNA Sequences in Classic Kaposi's Sarcoma, Premalignant and Malignant Cutaneous Epithelial Tumors / 대한피부과학회지

BACKGROUND: Human herpesvirus 8 (HHV8) has been detected in all forms of Kaposi's sarcoma (KS). The role of HHV 8 in dermatologic diseases other than KS is controversial. Some studies based on polymerase chain reaction (PCR) findings suggest an association between HHV8 and epithelial tumors of the skin. OBJECTIVE: To assess the presence of HHV8 sequences in classic KS and some premalignant and malignant cutaneous epithelial tumors by nested PCR and find out any variations in HHV8 DNA by direct sequencing. METHODS: In total 71 sample tissues were obtained from Korean patients: 5 classic KS, 12 Bowen's disease (BD), 19 actinic keratosis, 14 squamous cell carcinomas and 21 basal cell carcinomas. The first and nested PCR were performed to amplify the fragments of HHV8 open read frame (ORF) 26 and ORF 75 which were directly sequenced by dideoxy termination methods. RESULTS: HHV8 DNA sequences were found in 3 of 5 classic KS (60%) and in 1 of 12 BD. Other epithelial tumors were negative for HHV8. On sequencing PCR products, substitutions at 1033 C->T, 1086 C->T, and 1139 A->C were detected in ORF 26 of all 4 positive PCR products. In 2 of 3 KS positive for ORF 26, substitution was detected at 237 G->A in ORF 75. CONCLUSION: All of our Korean samples were included in the Zong's C strain. This study suggests that C strain is predominant in classic KS in Korea. But it is rare in non-KS cutaneous epithelial tumors. Studies of the length difference in the HHV8 genome should follow.

Detection of Human Herpesvirus 8 DNA Sequences in Classic Kaposi's Sarcoma, Premalignant and Malignant Cutaneous Epithelial Tumors / 대한피부과학회지

BACKGROUND: Human herpesvirus 8 (HHV8) has been detected in all forms of Kaposi's sarcoma (KS). The role of HHV 8 in dermatologic diseases other than KS is controversial. Some studies based on polymerase chain reaction (PCR) findings suggest an association between HHV8 and epithelial tumors of the skin. OBJECTIVE: To assess the presence of HHV8 sequences in classic KS and some premalignant and malignant cutaneous epithelial tumors by nested PCR and find out any variations in HHV8 DNA by direct sequencing. METHODS: In total 71 sample tissues were obtained from Korean patients: 5 classic KS, 12 Bowen's disease (BD), 19 actinic keratosis, 14 squamous cell carcinomas and 21 basal cell carcinomas. The first and nested PCR were performed to amplify the fragments of HHV8 open read frame (ORF) 26 and ORF 75 which were directly sequenced by dideoxy termination methods. RESULTS: HHV8 DNA sequences were found in 3 of 5 classic KS (60%) and in 1 of 12 BD. Other epithelial tumors were negative for HHV8. On sequencing PCR products, substitutions at 1033 C->T, 1086 C->T, and 1139 A->C were detected in ORF 26 of all 4 positive PCR products. In 2 of 3 KS positive for ORF 26, substitution was detected at 237 G->A in ORF 75. CONCLUSION: All of our Korean samples were included in the Zong's C strain. This study suggests that C strain is predominant in classic KS in Korea. But it is rare in non-KS cutaneous epithelial tumors. Studies of the length difference in the HHV8 genome should follow.

Clinical Evaluation of Arsenical Keratosis / 대한피부과학회지

BACKGROUND: Arsenics have been used for various medical purposes. These arsenics can cause different kinds of cutaneous and internal malignancies. The arsenic-induced malignancies can be fatal or cause severe morbidity. OBJECTIVE: For early detection and prevention of the arsenic-induced malignancies, the authors analyzed the clinical characteristics of arsenic-induced skin diseases. METHODS: Medical records of 15 patients(10 males, 5 females) with arsenical keratosis(AK) during a period from September 1994 to October 1999 were reviewed. Interview, physical examinations, skin biopsy, and laboratory tests were performed. RESULTS: 14 patients used Korean proprietary pills(KPP, "Hwan-Yak"), which were suspected to contain certain amount of arsenics, as a drug for treatment of certain diseases such as vitiligo(4 patients, 26.7%), laceration, syphilis, etc. The other formulation of medication was Salvarsan injection. Age at KPP or Salvarasan medication was from seven to thirty-five years old. Duration of medication was from one month to four years. Bowen's disease(BD), squamous cell carcinoma(SCC) and basal cell carcinoma(BCC) were detected in ten(66.7%), three(20%) and one(6.7%) patients, respectively. One(6.7%) patient had lung cancer. Sites of predilection were palmoplantar area(100%) for AK, trunk(60%) for BD and lower extremities(45%) for SCC and BCC. CONCLUSION: Chronic exposure to arsenic can induce the cutaneous and systemic malignancies. To prevent these malignancies, strict managements and supervising programs on certain arsenic-containing drugs(probably KPPs) are required, and regular cutaneous and systemic examinations for the patients with AK should be performed.

A Comparison of Outcomes In Surgical Repair of Varicocele / 대한비뇨기과학회지

No abstract available.

A Case of Follicular Mucinosis / 대한피부과학회지

We report a case of follicular mucinosis in a 12-year-old girl. She had an erythematous indurated plaque with an ill-defined border on the chin. A biopsy specimen showed reticular degeneration, cystic space formation, and abundant mucin deposition in pilosebaceous follicles. She had been treated with topical corticosteroid for 3 months. The skin lesion was completely resolved.