Modified Suturing Techniques in Carotid Endarterectomy for Reducing the Cerebral Ischemic Time

Objective@#: Carotid endarterectomy (CEA) is an effective surgical procedure for treating symptomatic or asymptomatic patients with carotid stenosis. Many neurosurgeons use a shunt to reduce perioperative ischemic complications. However, the use of shunting is still controversial, and the shunt procedure can cause several complications. In our institution, we used two types of modified arteriotomy suture techniques instead of using a shunt. @*Methods@#: In technique 1, to prevent ischemic complications, we sutured a third of the arteriotomy site from both ends after removing the plaque. Afterward, the unsutured middle third was isolated from the arterial lumen by placing a curved Satinsky clamp. And then, we opened all the clamped carotid arteries before finishing the suture. In technique 2, we sutured the arteriotomy site at the common carotid artery (CCA). We then placed a curved Satinsky clamp crossing from the sutured site to the carotid bifurcation, isolating the unsutured site at the internal carotid artery (ICA). After placing the Satinsky clamp, the CCA and external carotid artery (ECA) were opened to allow blood flow from CCA to ECA. By opening the ECA, ECA collateral flow via ECA-ICA anastomoses could help to reduce cerebral ischemia. @*Results@#: The modified suture methods can reduce the cerebral ischemia directly (technique 1) or via using collaterals (technique 2). The modified arteriotomy suture techniques are simple, safe, and applicable to almost all cases of CEA. @*Conclusion@#: Two modified arteriotomy suture techniques could reduce perioperative ischemic complications by reducing the cerebral ischemic time.

The Amelioration Effect of the Ethanolic Extract of Cnidium officinale in Mice with Imiquimod-induced Psoriasis-like Skin Lesion

Psoriasis is an auto-immune skin disease, which is characterized by the excessive generation of plaques on the skin with typically a long-lasting red, itchy and scaly symptoms. Imiquimod, which has been used for the treatment of external genital warts, actinic keratosis, and superficial basal cell carcinoma, induced of psoriasis-like skin disorders with skin erythema and thickness in mice. In the present study, we tried to find the bioactive herbal extract against imiquimod-induced psoriasis-like skin disorder in mice. During the searching of the herbal extract with anti-psoriatic effect, the ethanolic extract of Cnidium officinale ameliorated imiquimodinduced psoriasis-like skin disorder in mice. The morphological evaluation, H&E staining and Psoriasis Area and Severity Index (PASI) score showed that ear and back thickness, and erythema induced by imiquimod were significantly reversed after the treatment of the cream of the ethanolic extract of C. officinale. The overexpressed myeloperoxidase (MPO) and keratin 6A levels were decreased by the treatment of C. officinale cream. Also, IFN-γ, c-fos and IκB-α mRNA levels, which are related to the progression of psoriasis, were reduced by C. officinale cream. Thus, the ethanolic extract of C. officinale ameliorated psoriasis-like skin disorder induced by imiquimod and might be the therapeutic agent for psoriasis.

Role of CD74 and Its Relationship with Macrophage Migration Inhibitory Factor in Osteosarcoma Tumorigenesis / 대한정형외과학회잡지

PURPOSE: CD74 (cluster of differentiation 74) is a type II transmembrane protein that associates with MHC-II (major histocompatibility complex-II) molecules and binds with the macrophage migration inhibitory factor (MIF), which is known to be associated with tumorigenesis. The purpose of this study was to examine the relationship between CD74 with MIF and the role of CD74 in osteosarcoma tumorigenesis. MATERIALS AND METHODS: A correlation between CD74 with MIF was examined using immunohistochemistry (IHC) of tissues from patients with osteosarcoma (n=45). The mRNA expression of CD74 from patient-derived primary cells of osteosarcoma (n=22) was examined by a real-time polymerase chain reaction. The role of CD74 and in cisplatin-resistance of osteosarcoma was examined using WST-1 and colony forming assay. RESULTS: Of the 45 patients, 25 patients (55.6%) had a high level of expression in both CD74 and MIF by IHC. High level of MIF expression was observed in 40 patients (88.9%). We detected that mRNA expression of CD74 was higher in cells of all osteosarcoma patients (n=22) examined than in the control cells (hFOb 1.19). After cisplatin treatment, the inhibition of cell proliferation and suppression of colony formation were reduced in osteosarcoma cells expressing CD74. Interestingly, the effect of inhibiting anchorage independent growth was activated after cisplatin treatment in the cells with very high expression CD74 mRNA. CONCLUSION: This study suggests that the level of CD74 expression correlates with that of MIF expression. Moreover, CD74 might have a role in cisplatin resistance of osteosarcoma.

Current Status of Atopic Dermatitis-Related Information Available on the Internet in South Korea

BACKGROUND: Patients with atopic dermatitis (AD) often resort to the internet for disease-related information. We believe that dermatologists be informed about the current accessibility of information to patients and the potential for misleading patients into making poor treatment decisions. OBJECTIVE: The study was carried out in order to determine the nature of AD-related information available on the internet in Korea, and to identify any changes since our last survey in 2005. The quality of information offered and the involvement of medical doctors in certain websites were also investigated. METHODS: Taking into account the current search engine market share in Korea, we gathered all search results obtained from the three major search engines using the keyword 'atopy', and investigated the nature of the information retrieved. RESULTS: The search results showed less commercial sites than our previous study in 2005. There is a dramatic increase in the number of public bodies offering information about AD. In addition, the quality of information available online has improved since our last survey. CONCLUSION: The phenomenon of 'commercial overcrowding' seems to have stabilized. As AD becomes a more social phenomenon, patients are better informed than ever before. However, the information available on the internet still requires to be accompanied by consultation by dermatologists. We believe that self-regulation using a format such as the Health on the Net Foundation's code of conduct (HONcode) may improve the quality of online information accessible to patients with AD in Korea.

Comparison between intracytoplasmic sperm injection and intracytoplasmic morphologically selected sperm injection in oligo-astheno-teratozoospermia patients / 대한생식의학회지

OBJECTIVE: The aim of this study was to evaluate the efficiency of the intracytoplasmic morphologically selected sperm injection (IMSI) technique compared with conventional ICSI and previous ICSI attempts in oligo-astheno-teratozoospermia (OAT) patients. METHODS: The sperms were selected under high magnification (6,600x) and used to induce fertilization in previous ICSI patients by IMSI. These results were compared with previous conventional ICSI cycles in patients with OAT infertility. RESULTS: These results demonstrated no significant difference in the fertilization rate between IMSI and previous ICSI cycles (67.7% vs. 65.0%). However, the pregnancy and implantation rates with IMSI were significantly higher than those of the ICSI cycles (33.3% vs. 12.5% and 14.6% vs. 5.4%, respectively; p<0.05). The miscarriage rate among pregnant patients (18.2% vs. 37.5%) showed no statistically significant difference between groups. CONCLUSION: Compared to conventional ICSI, this study found that IMSI increased the IVF-ET success rates in patients with OAT.

Analysis of Factors Associated with Variability in Measures Obtained by Spectral Domain Optical Coherence Tomography

PURPOSE: To identify factors associated with variability in measures obtained by spectral domain optical coherence tomography (SD-OCT). METHODS: One hundred ninety-six subjects (370 eyes) with no ophthalmic evidence of retinopathy and with corrected visual acuities better than 0.6 were included. Macular thickness and retinal nerve fiber layer (RNFL) thickness were measured using SD-OCT and were analyzed according to sex, laterality, age, spherical equivalent and signal strength. RESULTS: The central subfield thickness was significantly lower in the female subjects (r = -0.260, p = 0.000). As age increased, average inner and outer macular thickness increased significantly (r = 0.153, p = 0.010; r = 0.193, p = 0.001). Spherical equivalent correlated negatively with central subfield thickness (r = -0.352, p = 0.000) but correlated positively with average inner macular thickness, average outer macular thickness, overall average thickness, overall macular volume, and average RNFL thickness (r = 0.181, p = 0.002; r = 0.287, p = 0.000; r = 0.346, p = 0.000; r = 0.341, p = 0.000; and r = 0.261, p = 0.000, respectively). Signal strength correlated negatively with average inner macular thickness (r = -0.136, p = 0.023). CONCLUSIONS: SD-OCT shows that retinal thickness is related to age, sex, spherical equivalent and signal strength. Analysis of retinal thickness by SD-OCT should be interpreted in the context of these findings.

Treatment of Diabetic Macular Edema: A Comparative Study

PURPOSE: To compare the effect and complications of treatments for diabetic macular edema. METHODS: Literature review using the Korean medical database and the Korean Ophthalmological Society database was performed. Studies used consisted of patients with diabetic macular edema, comparing intravitreal triamcinolone acetonide (IVTA) injection with posterior subtenon triamcinolone acetonide (STTA) injection or intravitreal bevacizumab (IVB) injection, according to visual acuity (VA) outcomes, central macular thickness (CMT), and intraocular pressure (IOP) at 1, 3, and 6 months. RESULTS: In the three studies comparing IVTA injection with STTA injection, IVTA injection demonstrated greater improvement in VA at 1 month and CMT at 6 months. The patients who received IVTA injection had significantly higher IOP at 3 months. In the three studies comparing IVTA injection with IVB injection, IVTA injection demonstrated greater improvement in VA at 3 months and CMT at 6 months. CONCLUSIONS: The functional and anatomical improvements are achieved by IVTA injection, STTA injection, and IVB injection for diabetic macular edema, and the effect of IVTA injection is more prominent than other injection types with longer duration.

The Evaluation of Enhanced Ectasia Display Mode in Screening for Keratoconus

PURPOSE: To estimate the utility of the enhanced ectasia display mode of Pentacam in discriminating keratoconus and keratoconus suspect from normal cornea. METHODS: Corneal topography was measured using the Pentacam in keratoconus, keratoconus suspect and a normal control group. A best-fit sphere (BFS) and an enhanced best-fit sphere (EBFS) were used as reference surfaces for corneal elevation measurements, and measured values from both the anterior and posterior surfaces were compared among the three groups. Receiver operating characteristic (ROC) curves were used to identify the optimal posterior corneal elevation cutoff points for maximal sensitivity and specificity in discriminating keratoconus and keratoconus suspect from the normal control group. RESULTS: Mean anterior and posterior corneal elevation were statistically higher in keratoconus than in keratoconus suspect and normal corneas. The optimal cutoff point of posterior elevation was 23 micrometer for the keratoconus group, and this value was associated with a sensitivity and a specificity of 96.7% and 98.6%, respectively for keratoconus. The optimal cutoff point of enhanced posterior elevation was 43 micrometer for the keratoconus group, and this value was associated with a sensitivity and a specificity of 96.7% and 95.5%, respectively. CONCLUSIONS: The enhanced ectasia display mode showed similar diagnostic power to that of the conventional elevation map, and the former could be more useful in a clinical setting due to the pronounced visualization of corneal elevation.

Effect of Intracameral Triamcinolone to Control Inflammation in Rabbit Eyes

PURPOSE: To investigate the effect of intracameral triamcinolone on the control of inflammation with rupture of the posterior lens capsule during cataract surgery in rabbit eyes. METHODS: Twenty rabbit eyes were subjected to experimentally induced rupture of the posterior lens capsule and prolapse of the vitreous body into the anterior chamber. After anterior vitrectomy with and without triamcinolone, aqueous flare was measured with a laser flare meter on days 1, 3, 7, 14 and 28. RESULTS: Vitrectomized eyes with triamcinolone showed a less marked increase in postoperative aqueous flare intensity on days 14 and 28 than did those without triamcinolone (p<0.05). CONCLUSIONS: Intracameral injection of triamcinolone was beneficial for visualizing the prolapsed vitreous in the anterior chamber and for helping to control the postoperative inflammation without adverse effects.

Comparative Study between the Group with Lateral Retinacular Release and the Group without Lateral Retinacular Release Following Total Knee Arthroplasty

PURPOSE: We compared the results of total knee arthroplasties combined with lateral retinacular release with those without lateral retinacular release. MATERIALS AND METHODS: Results of 277 total knee arthroplasties from 1996 to 2002, follow up for at least one year ( average follow-up periods : 32 months). Lateral retinacular release was performed in 190 knees (70.1%) and not performed in 87 knees (29.9%). The clinical results of total knee arthroplasties were evaluated by the Knee Scoring System of hospital for Special Surgery (HSS) and range of motion. The patello-femoral complications were evaluated by tilt and displacement of patella at the last follow-up Hughston 's view. Osteonecrosis and fracture of patella were evaluated by simple x-ray. RESULTS: HSS score and range of motion improved postoperatively in both groups, but there was no sig-nificant difference between the two groups. There were 3 cases (3.4%) with patellar subluxations and 1 case (1.1%) with patellar dislocation in the group without lateral retinacular release. There was no avascu-lar necrosis or fracture of patella in either group. CONCLUSION: We suggest that lateral retinacular release can be performed without great risk of potential patellar complications in total knee arthroplasties requiring lateral retinacular release for proper patellar tracking.

Comparison of Clinical Results between Bipolar Hemiarthroplasty and Compression Hip Screw on Unstable Intertrochanteric Fractures of the Femur in Elderly Patients

PURPOSE: To investigate postoperative incidence of complications and functional results between two groups, primary bipolar hemiarthroplasty and internal fixation with compression hip screw on unstable intertrochanteric fractures of the femur with severe osteoporosis in elderly patients. MATERIALS AND METHODS: 78 cases treated under unstable intertrochanteric fractures of the femur with severe osteoporotic elderly patients from March 1997 to August 2001 who have been followed up for more than a year were evaluated retrospectively between the group of bipolar hemiarthroplasty, 38 cases out of 60 cases and group of compression hip screw, 40 cases out of 59 cases. The incidence of complications and functional ability according to Merle d'Aubigne scale and the mortality rate were compared using student t-test. RESULTS: The means of Merle d'Aubigne scale for the hemiarthroplasty group and the compression hip screw group were at the last follow up, 15.0 and 13.6 respectively. The differences were statistically significant (p=0.04). Bipolar group revealed significant differences in general (18%) and mechanical complications (5%) between two groups (p0.05). CONCLUSION: We consider that primary bipolar hemiarthroplasty would be better method in the treatment of the unstable femoral intertrochanteric fracture with severe osteoporosis but we need much longer follow up.

Rapid Detection of Duplication/Deletion of the PMP22 Gene in Patients with Charcot-Marie-Tooth Disease Type 1A and Hereditary Neuropathy with Liability to Pressure Palsy by Real-time Quantitative PCR using SYBR Green I Dye

Mutations and altered gene dosage of the peripheral myelin protein (PMP22) gene in chromosome 17p11.2-12 are the main causes for hereditary neuropathies, accounting for approximately 70% of all cases. Patients with duplication of the PMP22 develop Charcot-Marie-Tooth disease type 1A (CMT1A) and deletion of one PMP22 allele leads to hereditary neuropathy with liability to pressure palsy (HNPP). Twenty patients with CMT1A, 17 patients with HNPP, and 18 normal family members and 28 normal controls were studied by real-time quantitative PCR using SYBR Green I on the ABI 7700 Sequence Detection System. The copy number of the PMP22 gene was determined by the comparative threshold cycle method and the albumin was used as a reference gene. The PMP22 duplication ratio ranged from 1.45 to 2.06 and the PMP22 deletion ratio ranged from 0.42 to 0.64. The PMP22 ratio in normal controls, including normal family members, ranged from 0.85 to 1.26. No overlap was found between patients with CMT1A or patients with HNPP and normal controls. This method is fast, highly sensitive, specific, and reproducible in detecting PMP22 duplication and deletion in CMT1A and HNPP patients, respectively.