In Situ Gelling Hydrogel with Anti-Bacterial Activity and Bone Healing Property for Treatment of Osteomyelitis

BACKGROUND: Despite the development of progressive surgical techniques and antibiotics, osteomyelitis is a big challenge for orthopedic surgeons. The main aim of this study is to fabricate an in situ gelling hydrogel that permits sustained release of antibiotic (for control of infection) and growth factor (for induction of new bone formation) for effective treatment of osteomyelitis. METHODS: An in situ gelling alginate (ALG)/hyaluronic acid (HA) hydrogel containing vancomycin (antibiotic) and bone morphogenetic protein-2 (BMP-2; growth factor) was prepared by simple mixing of ALG/HA/Na₂HPO₄ solution and CaSO₄/vancomycin/BMP-2 solution. The release behaviors of vancomycin and BMP-2, anti-bacterial effect (in vitro); and therapeutic efficiency for osteomyelitis and bone regeneration (in vivo, osteomyelitis rat model) of the vancomycin and BMP-2-incorporated ALG/HA hydrogel were investigated. RESULTS: The gelation time of the ALG/HA hydrogel was controlled into approximately 4 min, which is sufficient time for handling and injection into osteomyelitis lesion. Both vancomycin and BMP-2 were continuously released from the hydrogel for 6 weeks. From the in vitro studies, the ALG/HA hydrogel showed an effective anti-bacterial activity without significant cytotoxicity for 6 weeks. From an in vivo animal study using Sprague-Dawley rats with osteomyelitis in femur as a model animal, it was demonstrated that the ALG/HA hydrogel was effective for suppressing bacteria (Staphylococcus aureus) proliferation at the osteomyelitis lesion and enhancing bone regeneration without additional bone grafts. CONCLUSIONS: From the results, we suggest that the in situ gelling ALG/HA hydrogel containing vancomycin and BMP-2 can be a feasible therapeutic tool to treat osteomyelitis.

JAK/STAT Pathway Modulates on Porphyromonas gingivalis Lipopolysaccharide- and Nicotine-Induced Inflammation in Osteoblasts / 치위생과학회지

Bacterial infection and smoking are an important risk factors involved in the development and progression of periodontitis. However, the signaling mechanism underlying the host immune response is not fully understood in periodontal lesions. In this study, we determined the expression of janus kinase (JAK)/signal transducer and activator of transcription (STAT) on Porphyromonas gingivalis lipopolysaccharide (LPS)- and nicotine-induced cytotoxicity and the production of inflammatory mediators, using osteoblasts. The cells were cultured with 5 mM nicotine in the presence of 1 µg/ml LPS. Cell viability was determined using MTT assay. The role of JAK on inflammatory mediator expression and production, and the regulatory mechanisms involved were assessed via enzyme-linked immunosorbent assay, reverse transcription-polymerase chain reaction, and Western blot analysis. LPS- and nicotine synergistically induced the production of cyclooxgenase-2 (COX-2) and prostaglandin E₂ (PGE₂) and increased the protein expression of JAK/STAT. Treatment with an JAK inhibitor blocked the production of COX-2 and PGE₂ as well as the expression of pro-inflammatory cytokines, such as tumor necrosis factor-α, interleukin-1β (IL-1β), and IL-6 in LPS- and nicotine-stimulated osteoblasts. These results suggest that JAK/STAT is closely related to the LPS- and nicotine-induced inflammatory effects and is likely to regulate the immune response in periodontal disease associated with dental plaque and smoking.

Injuries Associated with the 580 km University Student Grand Voluntary Road March: Focus on Foot Injuries

College student volunteers (n = 142) completed a 580 km road march for 21 consecutive days. Each volunteer carried a backpack that weighed 14.1 +/- 1.4 kg on the average. We investigated the incidence and location of blisters associated with the road march using a foot map along with other injuries. Overall, 95.1% of the subjects (135 of 142) sustained one or more injuries. All injured subjects had foot blisters, and 18% had other foot injuries. The most common locations of blister development were the right 5th toe (61%) and the left 5th toe (57%). The little toes seem to have been subjected to the greatest friction and shearing forces. March-related injuries, excluding foot injuries, were ankle pain (12.7%), knee pain (12.7%) and Achilles tendon pain (7.7%). Six subjects (4.2%) needed extra medical treatment for more than 2 weeks prior to returning to their daily lives after completion of the march due to associated injuries. The present study observed a very high incidence rate of injuries (95.1%) associated with the 580 km university students grand road march. These injuries posed an obstacle against completion of the road march and against returning to daily life. Active preventive interventions such as physical therapy and customized reinforced shoes and education program are recommended for reducing incidence rate and severity of injuries.

Cardiovascular Manifestations and Clinical Course after Acute Carbon Monoxide Poisoning

PURPOSE: The aim of this study was to evaluate the cardiovascular manifestations and clinical course in patients with acute carbon monoxide poisoning. METHODS: A retrospective study was conducted over a 36 month period on consecutive patients who visited an emergency medical center and were diagnosed with acute carbon monoxide poisoning. A standardized data extraction protocol was performed on the selected patients. RESULTS: A total of 293 patients were selected during the study period. Cardiac manifestations were observed in 35.2% (n=103) of the patients: hypotension in 11 patients (3.8%), ECG abnormalities in 44 patients (15.0%) and cardiac enzyme abnormalities in 103 patients (35.2%). Echocardiography was performed on 56 patients with cardiac toxicity: 12 patients had abnormal results (5 patients with global hypokinesia and 7 patients with regional wall akinesia). Five patients died within 3 hours after ED admission, and the remaining patientswere discharged alive. At 3 months after discharge, none of these patients had died.The SOFA scores in the severe cardiac toxicity group and non-severe cardiac toxicity group at the time of arrival were 2.53+/-2.29 and 2.19+/-2.12, respectively (p=0.860). CONCLUSION: Cardiovascular manifestations occurafter acute CO poisoning at arateof 35.2%. Even those with severe cardiovascular toxicity recovered well within 10 days after admission. Therefore, the importance of cardiac toxicity after acute CO poisoning is not significant initself in the clinical course, and the short-term prognosis of cardiac toxicityis unlikely to be unfavorable in acute CO poisoning.

Application of 3D Surface Scanners in Forensic Science and Medicine ( I ): Digital Storage of Human Skeletons and Development of Appraisal Methods for Incident Scenes / 대한법의학회지

The aim of this project was to use 3D scanning data collected at incident scenes and various evidence to 1) develop surveying methods based on 3D data consisting of overall and detailed scene evidence, captured by long-range and micros-canner, which can be shared by personnel working in different fields such as forensic medicine, video analysis, physical analysis, traffic engineering, and fire investigation; 2) create digital storage for human skeletons and set the foundation for virtual anthropology; and 3) improve the credibility of 3D evidence by virtual remodeling and simulation of incident scenes and evidence to provide a basis for advanced and high-tech scientific investigation. Two complete skeletons of male and female were scanned using 3D micro-scanner. Each bone was successfully reproduced and assembled in virtual space. In addition, recreating evidence scheduled for invasive examination by creating RP (rapid prototype) was possible. These outcomes could play an important role in setting up the new field of virtual anthropology. Case-specific surveying methods were developed through analysis of 3D scanning data collected by long-range surface scanners at the scenes of vehicular accidents, falls, shootings, and violent crimes. A technique and recording method was also developed for detecting forged seals by micro-scanning the pressure exerted on the seal. Appraisal methods developed in this project could be utilized to secure 3D data of human skeletal remains and incident scenes, create a standard for application, and increase objectivity, reproducibility, and accuracy of scanning methods. We plan to develop case-specific 3D data analysis techniques to improve the credibility of analysis at the NFS and to establish a 3D data collection and analysis team.

Reconstruction of the Finger using Rerouting the Transverse Digital Palmar Arch in the Crushing or Avulsion Injured Finger

PURPOSE: In the finger, there are three major palmar arches in the arterial system. The location of this arches are constant. The middle and distal transverse arches are consistently large (almost 1 mm) and may be used for arterial vessel repairs either proximally or distally, depending on the length and direction needed. This paper describes our experiences in reconstruction and replantation of the finger using rerouting the transverse digital palmar arch. METHODS: 31 patients with injuries according to our classification were treated from March of 2005 to October of 2008. In this study the authors subdivided injuries into those with amputation distal to the insertion of the flexor digitorum profundus (Class I, 31 fingers); those with amputation distal to the insertion of the flexor digitorum superficialis (Class II, 4 fingers). Replantation was performed using the artery-only technique with neither vein nor nerve repair. Because the artery has been damaged, it is still possible to make a direct suture by transposing the arterial arch in an inverted Y to I arterial configuration or converting the arch. Venous drainage was provided by an external bleeding method with partial nail excision, medical leech, and repaired margin. RESULTS: The success rate was 87% (n=27) in class I and 75% (n=4) in class II. The authors conclude that crushing and complete avulsion injuries & amputations are salvageable, with acceptable functional results in select patients, especially those with amputation distal to the insertion of the flexor digitorum superficialis. CONCLUSION: We performed replantation and reconstruction with only-arterial transposing anastomosis successfully, resulting in good recovery of aesthetic and functional outcome. Three major digital palmar arches, especially distal two branches, give us additional treatment options. In the finger replantation and reconstructive techniques using rerouting healthy the transverse digital palmar arch increase the survival rate of the finger.

Platelet Serotonin Transporter Function and Heart Rate Variability in Patients with Panic Disorder

Many studies showed abnormal serotonin transporter (5-HTT) function and heart rate variability (HRV) in panic disorder patients. The present study investigated the relationship between HRV power spectral analysis findings and platelet serotonin uptake in panic disorder patients. Short-term HRV over 5 min and platelet serotonin transporter uptake parameters (V(max) and K(m)) were measured both in 45 patients with panic disorder and in 30 age-matched normal healthy control subjects. Low frequency power (LF) normalized unit (nu) and LF/high frequency power (HF) were significantly higher, whereas HF and HF nu were lower in the patient group than in the control group. V(max) and K(m) were all significantly lower (i.e., reflects decreased 5-HTT function) in patients with panic disorder than in normal controls. In the patient group, Km was negatively correlated with LF/HF and LF nu whereas no such correlations between them were found in the control group. By multivariate analysis based on multiple hierarchical linear regression, a low Km independently predicted an increased LF nu even after controlling for age, sex, and body mass index in the patient group. These results suggest that impaired 5-HTT function is closely related to dysregulation of autonomic nervous system in panic disorder.

A Case of Descending Necrotizing Mediastinitis

PURPOSE: Cervical necrotizing fasciitis tends to involve the deep soft tissues and spread caudally to the anterior chest and mediastinum, often resulting in major complications and death. It may rapidly spread into the thorax along fascial planes, and the associated diagnostic delay results in this descending necrotizing mediastinitis. So, aggressive multidisciplinary therapy with surgical drainage is mandatory. We present a very rare case of descending necrotizing mediastinitis with literature review. METHODS: A 53 years old male visited our department 7 days after trauma in neck. His premorbid conditions and risk factors of necrotizing fasciitis were concealed hepatoma, trauma history, chronic liver disease, and nutrition deficit. Computed tomographic scans of the head and neck region were performed in this patient: signs of necrotizing fasciitis, were seen in the platysma, sternocleidomastoid, trapezius muscle and strap muscles of the neck. Fluid accumulations involved multiple neck spaces and mediastinum. At the time, he diagnosed as necrotizing fasciitis on his neck and anterior chest. Necrotic wound was excised serially and we treated this with the Vacuum-assisted closure (VAC, Kinetics Concepts International, San Antonio, Texas) system device. After appropriately shaping the sponge and achieving additional 3 pieces drainage tubes in the pockets, continuous negative pressure of 125 mmHg was applied. The VAC therapy was applied for a period of 12 days. RESULTS: We obtained satisfactory results from wide excision, abscess drainage with the VAC system, and then split thickness skin graft. The postoperative course was uneventful. CONCLUSION: The refined technique using the VAC system can provide a means of simple and effective management for the descending necrotizing mediastinitis, with better cosmetic and functional results. Finally, the VAC system has been adopted as the standard treatment for deep cervical and mediastinal wound infections as a result of the excellent clinical outcome.

The Effectiveness of 6-month Treatment with Citalopram in Korean Panic Disorder Patients: A Prospective, Open-labeled, Multi-Center Trial / 대한정신약물학회지

OBJECTIVE: The authors examined the efficacy of citalopram, and its effect on the quality of life in patients with panic disorder. METHOD: Seventy three patients who had panic disorder were recruited for this study. They did not have major depression and other axis I diseases. They were scheduled to be examined 4 times (at baseline, 4, 12 and 24 weeks) and took citalopram for 24 weeks with a flexible dosing schedule. The primary efficacy variables were the response and remission rates (response: HAMA total score decreased by at least 50% from baseline; remission: HAMA total score < or = 7). Other variables included the Hamilton Rating Scale for Depression, Panic Disorder Severity Scale (PDSS), Acute Panic Inventory, Clinical Global Impression Scale and Sheehan Disabilities Scale (SDS). RESULTS: The number of patients who completed 24 weeks of treatment was 33 (45.2%). Forty patients who were dropped out consisted of 4 patients with symptom improvement and 36 patients with failure to return. Response/remission rates were 56.2/31.5% in the last-observation-carried-forward methods and 87.9/69.7% in the observed case data. Treatment with citalopram improved anxiety and depressive symptoms during 24 weeks on all efficacy measures. By a completed patient analysis, citalopram also significantly improved the disability scores on SDS. In this study, any serious adverse effects were not observed. CONCLUSION: Treatment with citalopram was effective and well-tolerated for the patients with panic disorder, and also improved quality of life in the patients.

The Priming Effect of the Old Age People with Mild Cognitive Impairment / 신경정신의학

OBJECTIVES: In this study, the cognitive characteristics, especially priming effect, of above 50 years old age group who had less than 25 points in K-MMSE were investigated. METHODS: In this study, an implicit memory test measuring priming effect was made and adminis-tered to old age people who had less than 25 points in K-MMSE in screening session. To control the effect of age, educational level and intelligence, demographic variables were measured, and the subtests of KWIS, vocabulary and block design were administered. Descriptive statistical analysis of the two priming measures and correlational analysis between variables were done. To test the effect of cognitive functioning on priming effect multiple regression analysis was done. RESULTS: Correlational analysis revealed priming score obtained from correct identification response was positively correlated with K-MMSE and ADAS-Cog. And priming score obtained from mean reaction time was positively correlated with age and negatively correlated with vocabulary substest of KWIS. The regression analysis results indicated general cognitive functioning measured by ADAS-Cog has significant effect on priming score obtained from correct identification response, whereas age has significant effect on priming score obtained from mean reaction time. CONCLUSIONS: The results revealed that as cognitive deterioration progresses priming effect which identify primed stimulus correctly diminish, and as one grow older within age 50 to 70, priming effect which identifies primed stimulus quickly increase.

Two Case of Peripartum Cardiomyopathy / 대한산부인과학회잡지

Peripartum cardiomyopathy is defined as a syndrome of cardiac failure occurring in tbe latter part of pregnancy or in the puerperium, without obvious cause and without prior evidence of heart disease. Despite its infrequency, this clinical problem may have devastating consequences upon maternal and fetal outcome. It is important to recognize the association of cardiac failure and pregnancy as a separate syndrome so that, once identified, peripartum cardiomyopathy can be treated promptly and aggressively. We experienced two cases of peripartum cardiomyopathy, and report these cases with a brief review of the literatures.

Two Cases of Ovarian Pregnancy / 대한산부인과학회잡지

No abstract available.

A Clinical Study Following Macrosurgical Procedures for Tubal REversal / 대한산부인과학회잡지

From January 1989 to December 1994, 105 cases of Macrosugical tubal reversal were performed and 87 cases of them were followed up for more than 1 year postoperatively in the Department of Obstetrics and Gynecology, Pohang St. Mary's Hospital. The result were as follows;1. The mean age of the patients was 31.7 years and 93.1% of them had been sterilized by laparoscopic sterilization. 2. Average inteval between sterilization and tubal reversal was 43.3 months. 3. The reasons for requesting reversal of sterilization were remarrigae 41.5%, chagne of attitude 33.3%, loss of children 25.2%. 4. The distributions of the site of tubal anastomosis were isthmic-ampullar 58.6%, isthmic-isthmic 24.1%, cornual-isthmic 8.1%. 5. The postoperative tubal length was 5.0 cm or more in 78.0%. 6. The overall pregnancy rate after tubal reversal was 68.9% and the outcome of the pregnancy was as follows; term pregnancy 74.6%, premature delivery 1.8%, opontaneous abortion 10.9%, ectopic pregnancy 9.1%, pregnancy state 3.3%.

Ventriculoureteral Shunt Operation for Treatment of Recurrent Abdominal Pseudocyst Complicating Ventriculoperitoneal Shunt: Case Report and Technical Note

We report a case of ventriculoureteral shunt to reise malfunctioning ventriculoperitoneal shunt in a 30-year-old man. The patient had 4 times recurrent pseudocyst filled with cerebrospinal fluid caused by complications at the distal end of the abdominal catheter. The presence of an abdominal pseudocyst can be detected by performing an ultrasound examination of the abdomen. We shall describe the operative technique of the ventriculoureteral shunt procedure without nephrectomy by reimplantation of the ureter and a psoas hitch.

Concept of brain death and medical utilization / 대한이식학회지

No abstract available.

Traumatic Aneurysm in the Posterior Cranial Fossa: Case Report

The traumatic intracranial aneurysm within the posterior cranial fossa is extremely rare. The case of a 18-year-old boy who developed an saccular aneurysm lately in the posterior fossa after a blunt head injury is reported. Repeated follow-up angiography demonstrated an saccular aneurysm at the junction of vertebral artery and posterior inferior cerebellar artery. Early brain MRI disclosed neither aneurysm nor mass. Late brain MRI revealed a partially thrombosed saccular aneurysm at the cerebello pontine angle. Follow-up MRI and angiography is recommended if traumatic aneurysm is suspected.

Microsurgical Structure of Conus Medullaris

To identify the corresponding cord segment for each root at the level of conus medullaris, a dissecting microscopic study was carried out on the spinal cord of 14 adult cadavers. We measured following contents:1) the longitudinal extent of the medullary segment of origin of each root:2) the distance from the lowest rootlet of the conus to the highest portion of the medullary segment of each root:3) the distance from the conus tip to the lowest portion of the medullary segment of each root:4) the morphological features of root-spinal cord juncton, intrathecal anastomoses, and others. We measured on the basis of the last rootlet ecause of no clear distinction between the conus and filum terminale. Our values showed considerable variation from one case to another. The average length of the whole lumbar and sacral segment was 50 mm and 30 mm, respectively. The S-1 root was the largest. Intrathecal intersegmental anastomoses were found in all cases examined, and usually consisted of small caliber rootlets connecting the spinal roots of adjacent segments. We emphasize the importance of microsurgical structure of conus medullaris when performing an operation of dorsal root entry zone or myelotomy for the relief or spasticity or intractable pain of lower extremities.

The Apnea Test for the Determination of Brain Death

By the criteria for the determination of brain deathe established in The Korean Medical Association, an appneic patient's PaCO2 must be greater than 50 torr before apnea can be attributed to brain death. Blood gases were analized in 35cases of brain death by the conventional criteria. The data of PaCO2, pH, PaCO2 in the apnea test of the cases were erratic, but a PaCO2 had increased 50 torr in each patient esaily. To perform the apnea test satisfactorily, it is essential to keep oxygen catheter deep into the tracheal tube by at least 10cm for adequate appneic oxygenation, and indwelling arterial catheters were available for rapid, timed blood sampling. And to determine the accuracy of blood gas measurements, duplicate samples drawn less than 4seconds apart were sent to clinical lagoratory in each test. The apneic test is a crucial rapid and safe performance for the determination of brain death. I recognize.

Initial CT Findings of the Early Death after Head Injury

We examined the initial CT findings of the early(within on week) death after head injury, retrospectively. The patient population consisted of 182 patients who were admitted to the Soonchunhyand University Chonan Hospital, and were examined by CT, from August 1986 to May 1990 after head injury. We compared clinical features and radiological findings between the group of focal lesion and the group of diffuse lesion. The focal lesion was found in 47.8%, while the diffuse lesion was found in 45.6%. Statistically significant differences were found in the age, Glasgow Coma Score(GCS) on admission, injury Severity Score(ISS), hypotension, and hypoxia. The focal lesion was more common in the aged, while the diffuse lesion was common in the young(less than 40 years of age). Patients with high GCS(more than 8) constitued 25.3% of the focal lesion, while only 6.0% of the duffuse lesion had the high GCS. ISS was higher than 30 in 67.5% of the diffuse lesion, while 32.2% of the focal lesion had ISS of 30 or more. The causes of injury was pedestrian traffic accident in 46.5% and passanger's traffic accident in 31.8%. Midline shift(more than 3mm), compressed ventricles, and obliteration of the suprasellar cistern and quadrigeminal cistern were observed in 34.1%, 82.4%, 67.6%, and 58.2%, respectively. Lesions with severe midline shift were focal in 93.1% and lesions without midline shift were diffuse in 88.4%(P<0.005). Cranial vault fracture was noticed in 68.2%, and basal skull fracture was found in 28.8%. The frequency of basal skull fracture was high in the diffuse lesion(P<0.005). In this study, we could presumed that 17.2% to 25.3% of the patients with focal lesions could be saved, if proper treatment was given. Since the diffuse lesion was responsible for nearly half of the early death after head injury, proper treatment or prevention should be made. Prevention of the diffuse lesion seems to be possible by correction of hypotension and hypoxia for the diffuse lesions were intimately related to them. At any event, further studies on the diffuse brain injury are required.

Results of Decompressive Craniectomy in Severe Head Injury

We present a retrospective study on 63 patients who underwent decompressive craniectomy from April 1985 to June 1990. All patients were comatose(Glasgow Coma Score;3-8) at the time of operation. There were 42 males and 21 females with an age range of 7 to 80 years(mean age, 43 years). Bifrontal craniectomy was performed in 15 patients(23.8%) and frontotemporoparietal craniectomy was done in 48 patients(76.2%). Pupils were abnormal in 41 patients(65.1%) on arrival. However, those became abnormal in 60 patients(95.2%) preoperatively. Fourty nine of the 63 patients died within the first 30 days of surgery (operative mortality, 77.8%). Late mortality was 3.2%, making the total mortality for this series 81.0%. Only eight patients(12.7%) could have favorable outcome(good recovery and moderate disability). The operative method did not affect on the prognosis. The most common primary mass lesion was acute subdural hematoma(35 patient;55.6%). Skull fracture was found in 48 patients(76.2%). Postoperative CT scanning were obtained in 18 patients(28.6%). Moderate to marked degree of edema was found in 14 patients(77.8%). Delayed lesions were found in 13 patients(72.2%). Intracerebral hematoma was the most common delayed lesion. In nine patients(50.0%), the degree of midline shift was more severe than the preoperative CT scans. These results stroly suggested that the WDCE was not an effective surgical method due to its high mortality, morbidity and possible harmful effect such as enhanced edema formation and hastened delayed lesions.