Risk Factors of Fixation Failure in Femoral Neck Fractures

Purpose@#Internal fixation after a femoral neck fracture (FNF) is one of the conventional treatment options for the young and active elderly patients. However, fixation failure of internal fixation is a probable complication. The treatment of fixation failure after a primary internal fixation of the FNF remains a challenge. @*Materials and Methods@#Between July 2002 and March 2017, 83 patients who underwent internal fixation after FNF were retrospectively analyzed. Radiological assessments, including Pauwels’ angle, fracture level, reduction quality, and bone union, were measured, preoperatively and postoperatively.Moreover, intraoperative variables such as time to surgery, surgical time, and estimated blood loss were also evaluated. @*Results@#The patients were divided into the fixation failure and the non-failure groups. Among the 83 patients, 17 cases (20.5%) of fixation failure after the primary internal fixation of the FNF were identi-fied. When comparing the two groups according to the radiographic data, Pauwels’ angle and the reduction quality based on Garden’s angle showed significant differences (p<0.001). Moreover, when comparing the intraoperative variables, unlike the surgical time and estimated blood loss, significant differences were noted in the time interval from injury to surgery and specifically in whether the surgery was performed within 12 hours after injury (p<0.001). @*Conclusion@#Pauwels’ angle, reduction quality, and time to surgery are the major factors that can predict the possibility of internal fixation failure of the FNF. Early and accurate anatomical reduction is needed to decrease complications after the internal fixation of the FNF.

Clinical Study on Safety, Clinical Indicators of Polydioxanone Sutures Inserted into Vastus Medialis Muscle in Degenerative Knee Osteoarthritis

Objective@#Physiologically, the vastus medialis muscle is the first muscle to undergo muscle atrophy, and it was thought that pain in patients with knee osteoarthritis could be reduced if this muscle could be strengthened and stabilized. The purpose of this study was to prove the effectiveness in knee osteoarthritis using polydioxanone sutures that have been tried in other musculoskeletal areas. Method: Forty knee osteoarthritis patients voluntarily participated in the study, and divided into 30 polydioxanone suture needle (MEST-B2375 produced by Ovmedi Co.) and 10 sham needle (without suture). And the needles were inserted into the vastus medialis muscle. In all patients, safety evaluation including blood tests and ultrasonography as well as efficacy evaluation including isometric maximal contractile strength of quadriceps muscle, weight bearing pain, impression of change, quadriceps angle, rescue drug intake were evaluated up to 30 weeks after the procedure. @*Results@#Isometric maximal contractile strength showed a significant improvement at 4 weeks after the procedure in the polydioxanone suture group, and the weight-bearing pain showed a significant improvement at every visit in the polydioxanone suture group compared with baseline values. Patient global impression of change score showed significant improvement at 20 and 30 weeks, and clinical score showed improvement at every visit. @*Conclusion@#Insertion of polydioxanone sutures showed improvement in muscle strength and knee pain by supporting and fixation of the vastus medialis muscle in patients with degenerative knee osteoarthritis. Insertion of polydioxanone sutures is considered to have a therapeutic effect in knee osteoarthritis patients.

Reliability and Validity of the Korean Version of the Kenny Music Performance Anxiety Inventory / 신경정신의학

Methods@#Three hundred and sixty-nine students in art high school completed a battery of measures, including the Korean version of the KMPAI, State-Trait Anxiety Inventory (STAI), Liebowitz Social Anxiety Scale (LSAS), Center for Epidemiologic Studies-Depression Scale (CES-D), and Frost Multidimensional Perfectionism Scale-Korean version (FMPS-K). The construct validity of the Korean version of KMPAI was examined by performing explorative factor analysis. The reliability was assessed by the internal consistency using Cronbach’s alpha. @*Results@#Explorative factor analysis for the construct validity showed that the Korean version of KMPAI was composed of seven factors (factor 1: Worry/dread and Negative cognitions; factor 2: Proximal somatic anxiety and Worry about performance; factor 3: Depression/hopelessness; factor 4: Parental empathy–Memory–Controllability; factor 5: Generational transmission of anxiety;factor 6: Trust; factor 7: Rumination), explaining 61% of the total variance. The T Concurrent validity with the other scales (STAI, LASA, CES-D, and FMPS-K) was statistically significant. The Cronbach’s alpha value for the internal consistency of the Korean version of KMPAI was excellent (r=0.961). @*Conclusion@#The Korean version of the KMPAI is a reliable and valid instrument for measuring music performance anxiety in Korea.

Cervicofacial Emphysema and Pneumomediastinum Following Pediatric Adenotonsillectomy

Many patients regard tonsillectomy as a minor operation because it is performed frequently. Although tonsillectomy is considered a relatively safe surgical procedure, numerous complications have been described. The common complications are hemorrhage, infection, and following anesthesia, aspiration, cardiac arrhythmia, and laryngeal trauma. Cervicofacial emphysema and pneumomediastinum are rarely observed sequelae of surgical intervention in the upper aerodigestive tract. Although these complications resolve spontaneously in most cases, a few cases result in tension pneumothorax and other life-threatening conditions. Symptoms include chest pain, neck pain, dyspnea and odynophagia. Treatment involves frequent assessment of the airway and extent of the emphysema. The authors of the present study report of a patient who developed pneumomediastinum shortly after an adenotonsillectomy as well as a review of the related literature.

Radiofrequency-Assisted Uvulopalatoplasty with Tonsillectomy for the Treatment of Mild to Moderate Obstructive Sleep Apnea

BACKGROUND AND OBJECTIVES: In radiofrequency surgery, energy is usually delivered to the submucosal tissue of the palate through a special probe in order to reduce the volume and rigidity (palatal channeling). However, the same probe can be used to make cuts in the free edge of the soft palate, as in laser-assisted uvulopalatoplasty [radiofrequency-assisted uvulopalatoplasty (RAUP)]. The objective of the current study was to evaluate the role of RAUP with tonsillectomy for the treatment of mild or moderate obstructive sleep apnea (OSA). MATERIALS AND METHODS: Eighty-two patients with mild to moderate obstructive sleep apnea (5< or =AHI<30, BMI<30) were included in this clinical trial. All patients received RAUP with tonsillectomy. Patients were followed for six months and were asked to respond to a questionnaire regarding standard visual analogue score pattern. Assessment was performed prior to the surgery and was repeated six month postoperatively. Visual analogue scores were measured for the parameters of pain, speech deficits, dysphagia and snoring (according to the partner). The Epworth sleepiness scale (ESS) was also utilized. Polysomnography was conducted preoperatively and was repeated six months postoperatively. RESULTS: There were significant differences in improvement of snoring, ESS and AHI before and after the procedure, and the success rate of the surgical treatment was 62%. Postoperative pain, speech disturbance, dysphagia were decreased two weeks after the operation. CONCLUSION: The results of the study suggest that RAUP with tonsillectomy is an effective treatment for patients with mild to moderate obstructive sleep apnea.

Clinical Comparison of Post-Tonsillectomy Pain : Tonsillectomy Using Cold Instrument Versus Tonsillectomy Using Electrocautery

BACKGROUND AND OBJECTIVES: Tonsillectomy is one of the most common operations in otolaryngology and is performed with various surgical techniques. It seems that there is no superior technique regarding post-tonsillectomy pain. We attempted to identify preferable methods of tonsillectomy in clinical practice by comparing the levels of postoperative pain. MATERIALS AND METHODS: Between June 2009 and Jan 2010, 80 cases of tonsillectomy were performed. In Group A (age : 10-15 years, 40 cases), 20 cases involved tonsillectomy via snare. The other 20 underwent tonsillectomy using electrocautery. The same surgical division was applied in Group B (25-40 ages, 40 cases). All tonsillectomies were performed under general anesthesia by the same surgeon. RESULT: The mean duration of postoperative pain after tonsillectomy by snare and tonsillectomy by electrocautery in Group A was 5.2+/-2.1 and 6.7+/-3.7, respectively. The mean duration of postoperative pain after tonsillectomy by snare and tonsillectomy by electrocautery in Group B was 7.4+/-1.4 and 10.8+/-3.2, respectively. The results indicate that electrocautery is the more painful method of the two tested methods. The difference in post-tonsillectomy pain was statistically significant between the surgical methods. CONCLUSION: It seems that snare tonsillectomy is a useful method for reducing post-tonsillectomy pain compared with that after electrocautery tonsillectomy.

Prevention of Septal Perforation During Septal Surgery Using Inferior Turbinate Mucosa and Fibrin Glue

BACKGROUND AND OBJECTIVES: As septal surgery is being performed more and more often, the incidence of septal perforation as a complication arising from the surgery has also increased. In septal surgery, if corresponding mucoperichondrial tears occurred on both sides, autologous cartilage is usually placed between the injured mucopercondrium. However, septal perforation is sometimes found after septal surgery even after this effort. The aims of this study were to introduce a new technique for the prevention of septal perforation during septal surgery using inferior turbinate mucosa and fibrin glue and to determine its usefullness by evaluating the treatment outcome. MATERIALS AND METHODS: Between June 2005 and May 2007, 358 cases of septal surgery were performed. Bilateral mucoperichondrial tears on corresponding areas occurred in 26 cases. In Group 1 (15 cases), autologous cartilage was inserted between injured mucoperichondrium. In Group 2 (11 cases), autologous cartilage was inserted and then was repaired using fibrin glue and inferior turbinate mucosa. The authors compared the perforation rate between the two groups. RESULTS: In Group 1, septal perforation occurred in 7 of 15 patients (46.7%) and in Group 2, 1 of 11 patients (9.0%) had perforation. Perforation rates were significantly lower in Group 2. CONCLUSION: The technique of using fibrin glue and inferior turbinate mucosa may be an easy, effective method for the prevention of septal perforation during septal surgery.

Activation of Lysozyme and Lactoferrin in Endolymphatic Duct of Rats / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Secretory activity, particularly of antibacterial agents such as lysozyme and lactoferrin, is an important aspect of the mucosal defense mechanism. The development of these agents may have a direct bearing on the susceptibility of the mucosa to infection. The antibacterial secretory enzymes such as lysozymes and lactoferrins are found in various mucosal tissues, and it has been suggested that these enzymes contribut to the defense against local mucosal infection. Specifically, lysozyme and lactoferrin are important components of innate immunity against pathogens at mucosal surfaces. The purpose of this study is to identify the distribution and expression of lysozyme, lactoferrin in endolymphatic duct of rat. MATERIALS AND METHOD: Normal rats (129P3/J, 10 cases) were used for this study. The expression level and distribution of lysozyme mRNA were analyzed by RT-PCR and quantitative image analysis. RESULTS: The expression of lysozyme and lactoferrin mRNA in endolymphatic ducts of rats was compared by quantitative image analysis. The results indicate that the relative expression of lysozyme mRNA resulted as 2.5 times greater than that of lactoferrin mRNA. CONCLUSION: The distribution and expression of lysozyme and lactoferrin in the endolymphatic duct of rat were identified. The study suggests that innate immunity such as lysozyme and lactoferrin are important components of defense mechanisms along with mucociliary clearance. Additionally, the authors think that the activity of lysozymes is more effective than that of lactoferrin in the endolymphatic duct of rat.

A Case of Pulmonary Embolism associated with Intravenous Mercury Injection / 결핵

Pulmonary embolism from metallic mercury is rare. It may occur after a deliberate intravenous injection of mercury as a suicide gesture, in the presence of drug abuse or severe psychiatric disturbance, with the hope of increasing athletic and sexual performance, and accidentally during right heart catheterization while sampling blood with mercury containing syringes. We have experienced the first case of pulmonary embolism associated with intravenous mercury injection in Korea. The blood mercury level remain elevated within the toxic range to date. This may be due to the continued absorption of embolized mercury. Multifocal areas of patchy perfusion defects are in both upper lung fields on perfusion scan of lung. Few of the abnormalities of respiratory or renal function reported previously were demonstrated. We report the case of a young male patient presenting with a clinical picture of pulmonary embolism, in whom widespread deposit of metallic mercury were demonstrated throughout both lungs and elsewhere in the body.

The Studies of Contractile and Relaxing Responses of Abdominal Aorta and Effects of Angiotensin II Blocker(Losartan) in Spontaneously Hypertensive Rats Combined with Renovascular Hypertension / 대한신장학회잡지

This study was designed to evaluate the contractile and relaxing responses of abdominal aorta in renovascular hypertension accompanied with essential hyper- tension and to examine the effect of angiotensin II receptor blocker(losartan). An experimental renovascular hypertension accompanied with essential hypertension model was established by clipping the left renal artery of spontaneously hypertensive rats(SHR). These rats were then divided into two groups of which one was given losartan during the one week postopertion before being terminated. Ring preparations of the abdominal aorta were obtained one week after the operation. The contraction of abdominal aorta strips were induced by high potassium or norepinephrine, and relaxation produced by acetylcholine or sodium nitroprusside. The contractile and relaxing responses were recorded and compared with data obtained from the control group. In the second experiment, the rats received angiotensin Il blocker(LRAO group), losartan in the drinking water for 7 days after the induction of the renal artery stenosis operation. Then, the contractile and relaxing responses were evaluated by the same method. The following results were obtained; 1) The contractile responses to the high level potassium solution and norepinephrine in renal artery occlusion(RAO) group were significantly increased compared with SHR group(p<0.05). 2) The contractile reponses to the high level norepinephrine in LRAO group were similar to that of SHR control group. However, there was no remarkable differences for high potassium. 3) The relaxing responses to the acetylcholine were significantly reduced in the RAO group compared with the SHR group. However, there was no remarkable differences for sodium nitroprusside. 4) There were no significant differences in the acetylcholine or sodium nitroprusside induced vasodilation response between the LRAO group and SHR group. From the above result, it is suggested that re- novascular hypertension in spontaneously hypertensive rats might induce changes of vascular responses and this effects may be concerned with endothelium-dependant mechanism. And angiotensin II receptor blocker rnay prevent the development of abnormal endothelium-dependent relaxation in renovascular hypertension accompanied with essential hypertension by maintaining endothelial function.

A Case of Membranous Nephropathy Associated with a Stomach Cancer / 대한신장학회잡지

The relationship between malignancy and membranous nephropathy remains unresolved exactly, but it was suggeste d that nephrotic syndrome can be menifested as a prodrome to underlying malignancy. It has been reported that membranous nephropathy is associated with malignancy, however, a few cases were reported in Korea. We recently experienced a patient with stomach cancer which was detected during the follow-up of the membranous nephropathy. Proteinuria and microsopic hematuria disappeared after subtotal gastrectomy. We concluded that the stomach cancer might be a cause of glomerulonephritis in this case.

Contractile and relaxing responses of the contralateral renal artery in renovascular hypertensive rats / 대한내과학회지

Although only a small portion of patients with hypertension have renal hypertension, studies regarding renal hypertension may provide insight into the pathophysiology of essential hypertension. An increased vascular reactivity to vasoconstrictor substances has been observed both in clinical hypertension and in animal models of hypertension. This study was designed to evaluate the contractile and relaxing responses of the contralateral renal artery in renovascular hypertension and to provide an explanation of one of the mechanisms of renovascular hypertension. METHODS: In the first experiment, an experimental renovascular hypertension model was established by clipping the left renal artery of Sprague-Dawley rats. These rats were then divided into two groups of which one was given enalapril during one week post-operation before being terminated. Ring preparations of the contralateral side of the renal artery were obtained one week after the operation. The contraction of renal artery strips were induced by high potassium or norepinephrine, and the relaxation of them were produced by acetylcholine or sodium nitroprusside. The contractile and relaxing responses were recorded and compared with the data obtained from control group. In the second experiment, the rats received angiotensin converting enzyme inhibitor, 5mg percent enalapril in the drinking water for 7 days after induction of renal artery stenosis operation. Then, the contractile and relaxing responses were evaluated by the same method as control group. RESULTS: 1) The contralateral renal artery of renovascular hypertensive rats showed significantly increased contractile responses to the high potassium or norepinephrine as compared with that of control group (p<0.05). 2) Increased contractile reponses of the renal artery to the high potassium or norepinephrine were normalized to the control group level when enalapril was given. 3) The relaxing responses by acetylcholine were reduced on the contralateral renal artery in renovascular hypertensive rats as compared with that of the control group. However, no remarkable differences were noted between them with the sodium nitroprusside. 4) There were no significant differences in the acetylcholine or nitroprusside induced vasodilation response between enalapril-given renovascular hypertensive rats and control rats. CONCLUSION: These results suggest that endothelial dysfunctions may lead to renal hypertension and that enalapril(ACE inhibitor) may prevent the development of renal hypertension by maintaining endothelial function.

Contractile and relaxing responses of the contralateral renal artery in renovascular hypertensive rats / 대한내과학회지

Although only a small portion of patients with hypertension have renal hypertension, studies regarding renal hypertension may provide insight into the pathophysiology of essential hypertension. An increased vascular reactivity to vasoconstrictor substances has been observed both in clinical hypertension and in animal models of hypertension. This study was designed to evaluate the contractile and relaxing responses of the contralateral renal artery in renovascular hypertension and to provide an explanation of one of the mechanisms of renovascular hypertension. METHODS: In the first experiment, an experimental renovascular hypertension model was established by clipping the left renal artery of Sprague-Dawley rats. These rats were then divided into two groups of which one was given enalapril during one week post-operation before being terminated. Ring preparations of the contralateral side of the renal artery were obtained one week after the operation. The contraction of renal artery strips were induced by high potassium or norepinephrine, and the relaxation of them were produced by acetylcholine or sodium nitroprusside. The contractile and relaxing responses were recorded and compared with the data obtained from control group. In the second experiment, the rats received angiotensin converting enzyme inhibitor, 5mg percent enalapril in the drinking water for 7 days after induction of renal artery stenosis operation. Then, the contractile and relaxing responses were evaluated by the same method as control group. RESULTS: 1) The contralateral renal artery of renovascular hypertensive rats showed significantly increased contractile responses to the high potassium or norepinephrine as compared with that of control group (p<0.05). 2) Increased contractile reponses of the renal artery to the high potassium or norepinephrine were normalized to the control group level when enalapril was given. 3) The relaxing responses by acetylcholine were reduced on the contralateral renal artery in renovascular hypertensive rats as compared with that of the control group. However, no remarkable differences were noted between them with the sodium nitroprusside. 4) There were no significant differences in the acetylcholine or nitroprusside induced vasodilation response between enalapril-given renovascular hypertensive rats and control rats. CONCLUSION: These results suggest that endothelial dysfunctions may lead to renal hypertension and that enalapril(ACE inhibitor) may prevent the development of renal hypertension by maintaining endothelial function.

Usefulness of Trans-Radial Coronary Angiography in Wonju

BACKGROUND AND OBJECTIVES: Recent data about trans-radial approach showed its usefulness in achieving the high procedural success rate and low local complications even though the size of the radial artery is small compared to that of the femoral artery. Therefore, we want to evaluate the size of the radial artery and the feasibility of the trans-radial coronary angiography as a routine technique. MATERIALS AND METHOD: Trans-radial coronary angiography (TRCA) was successful in 619 cases. The size of the radial artery was measured using 2D-ultrasonography. TRCA was tried with 4 Fr catheters. We divided the cases into two groups; early phase, 106 cases and late phase, 513 cases and compared the procedure time, catheter number used, and complications between 2 groups. RESULTS: The size of the radial artery was 2.7+/-0.4 mm in diameter and this of the men was larger than that of women (p 0.05). TRCA was performed successfully in 513 cases among 521 cases of late phase (98.5%) and crossover to femoral artery occurred in 8 cases (1.5%). The fluoroscopic time and total procedure time of the late phase (6.5+/-4.0 min, 22.9+/-11.3 min) were significantly lower than those of early phase (11.5+/-6.3 min, 31.2+/-13.7 min) (p<0.01). The average number of catheters used for coronary angiography was 1.8+/-1.0. There were 6 cases (1%) of radial artery occlusion and 1 case (0.2%) of radial artery perforation without hand ischemia. CONCLUSION: Based on the adequate size of the radial artery, high success rate and low complications, TRCA might be a safe and become a routine diagnostic technique.

A Case of Hemorrhagic Fever with Renal Syndrome Complicated by Retroperitoneal Hematoma and Hemothorax / 대한신장학회잡지

Hemorrhagic fever with renal syndrome frequently found in Korea is a acute infectious disease caused by Hantaan virus. Its clinical manifestations include high fever, cardiovascular collapse, hemorrhagic tendency and acute renal failure. Many patients with hemorrhagic fever with renal syndrome show hemorrhagic tendency such as subconjunctival hemorrhage and mucocutaneous petechia. In vital organs such as lung, kidney, spleen, brain, and pituitary, hemorrhage occasionally occurs spontaneously or by minor trauma. As a results, hematemesis, hemoptysis, melena and gross hematuria can be developed in some patients. Anemia and circulatory shock may result from large hematoma formed in third spaces like retroperitoneal and pleural space. But retroperitoneal hematoma and hemothorax was rarely reported. We report a case of hemorrhagic fever with renal syndrome complicated by retroperitoneal hematoma and hemothorax with review of literatures.

Production and Characterization of Murine Monoclonal Antibodies ( MAbs ) which Specifically Recognize B-Subunit of Human Chorionic Gonadotropin ( HCG ) / 대한면역학회지

We have constructed several panels of MAbs which specifically recognize B-subunit of HCG (BHCG). Splenocytes from Balb/c mice immunized with B-subunit of HCG were fused with SP2/o-Ag14 myeloma cells by PEG method. Fifteen different hybridorna clones (individually named as mG10.127, mG10.61, mG9.5, mG9.18, rnG9.20, mG6.3, mG6.36, mG6.8, mG7.31, mG7.79, mG9.11, mG9.51.6, mG9.51.12, mH4.17, and mH4.4) were obtained by indirect ELISA screening and three to five successive cloning procedures. The distinct features of these MAbs were determined by specificity, western blot, isotyping, and isoelectrofocusing. All of the MAbs except mG9.20 and mG6.8 specifically bind to BHCG without cross- reaction with B-subunit of LH (BLH). In western blot analysis, all of the MAbs bind to non-denatured form of BHCG suggesting that the MAbs recognize conformation-dependent epitope of BHCG. This new panels of MAbs to BHCG should be useful for developing diagnostic reagent such as pregnancy, choriocarcinoma, Down's syndrome as well as for the fine quantitation of serum or urinary HCG.

A Case of Cystic Myxoma in the Left Atriym

Cardiac myxomas are the most common type of primary cardiac tumor. Approximately 86% of myxoma occur in the left atrium, and over 90% are solitary. Most myxoma are gelatinous and solid, although central hemorrhage or infarction may occur in some case. Rarely is the myxoma calcified. We experienced the case of a 52-year-old man transthoracic echocardiography revealed central echolucency within large mass. At operation, a globular, smooth surfaced mass was found attached to the interatrial septum of left atrium. The cut-surface shows central cystic degeneration within extensive patch hemorrhage and multiple small cysts.

A Case of Autoimmune Hypoglycemia Due to Insulin Receptor Antibody Associated with Empty Sella Syndrome / 대한내분비학회지

No abstract available.