¹⁸FFET PET is a useful tool for treatment evaluation and prognosis prediction of anti-angiogenic drug in an orthotopic glioblastoma mouse model / 한국실험동물학회지

O-2-¹⁸F-fluoroethyl-l-tyrosine ([¹⁸F]FET) has been widely used for glioblastomas (GBM) in clinical practice, although evaluation of its applicability in non-clinical research is still lacking. The objective of this study was to examine the value of [¹⁸F]FET for treatment evaluation and prognosis prediction of anti-angiogenic drug in an orthotopic mouse model of GBM. Human U87MG cells were implanted into nude mice and then bevacizumab, a representative anti-angiogenic drug, was administered. We monitored the effect of anti-angiogenic agents using multiple imaging modalities, including bioluminescence imaging (BLI), magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET/CT). Among these imaging methods analyzed, only [¹⁸F]FET uptake showed a statistically significant decrease in the treatment group compared to the control group (P=0.02 and P=0.03 at 5 and 20 mg/kg, respectively). This indicates that [¹⁸F]FET PET is a sensitive method to monitor the response of GBM bearing mice to anti-angiogenic drug. Moreover, [¹⁸F]FET uptake was confirmed to be a significant parameter for predicting the prognosis of anti-angiogenic drug (P=0.041 and P=0.007, on Days 7 and 12, respectively, on Pearson's correlation; P=0.048 and P=0.030, on Days 7 and 12, respectively, on Cox regression analysis). However, results of BLI or MRI were not significantly associated with survival time. In conclusion, this study suggests that [¹⁸F]FET PET imaging is a pertinent imaging modality for sensitive monitoring and accurate prediction of treatment response to anti-angiogenic agents in an orthotopic model of GBM.

A Case of Recurrent Vertigo in Vestibular Schwannoma Treated with Chemical Labyrinthectomy / 대한평형의학회지

Vestibular schwannoma (VS) can have various symptoms and almost half of the patients have balance problems. Some patients with VS can suffer from recurrent vertigo mimicking Meniere's disease. We present the case of a 61-year-old male patient who was suffering from recurrent vertigo due to VS while symptoms improved by chemical labyrinthectomy with gentamicin. We consider that chemical labyrinthectomy can be an option in the treatment of patients with recurrent vertigo for VS.

Surface Characteristics and Biocompatibility of Micro Arc Oxidized Titanium Alloy / 대한정형외과연구학회지

PURPOSE: The aim of this research was to characterize micro arc oxidized titanium (MAO-Ti), accompanied by biocompatibility test in vivo as well as in vitro in comparison to the different types of surface modification; machined, blasted and plasma spray. MATERIALS AND METHODS: XRD and SEM investigations were performed in order to assess the structure and morphology. Biologic and morphologic responses to the osteoblast cell lines (Saos-2) were then examined, using Promeg(R) proliferation assay, alkalinephosphatase activity, alphavbeta3 integrin expression and cytoskeleton staining (Rhodamine-Phallodine). The analysis of gene expression for osteocalcin and collagen I was done through RT-PCR. RESULTS: MAO-Ti showed more activity on osteointegration and cell differentiation compared to other types of surface modification. CONCLUSION: In summary, MAO-Ti appears to exhibit more favorable biocompatibility than the compared groups in vitro and in vivo as well.

Intraarterial mechanical thrombectomy for the treatment of postoperative cerebral infarction: a case report / 대한마취과학회지

Perioperative ischemic stroke is an uncommon event associated with significant morbidity and mortality. The complexity of the surgical procedure and surgery induced hypercoagulable status also influence the incidence of stroke. The management of stroke involves a decision regarding the quickest suitable revascularization method. Endovascular mechanical thrombectomy, such as intra-arterial mechanical thrombectomy (IAMT), can restore vascular patency of the vessels, providing an alternative or synergistic method to restore blood flow. Although, there are no recommended treatment guidelines, IAMT is eligible to be a treatment of choice for perioperative ischemic stroke. We experienced a case of a patient who demonstrated hemiplegia and aphasia, the early symptom of acute ischemic stroke, in the post-anesthesia care unit and performed IAMT successfully. Thus we report the case with a review of the relevant literature.

The Clinical Results of Pressurized Cement-Augmented Richard Compression Hip Screw with Trochanteric Stabilizing Plate for Intertrochanteric Fracture Compared with Pressurized Cement-Augmented Richard Compression Hip Screw Only

PURPOSE: We analyzed the radiologic and clinical outcomes of osteosynthesis using a Richard compression hip screw (RCHS) alone or RCHS with a trochanteric stabilizing plate (TSP) in patients with an intertrochanteric fracture. MATERIALS AND METHODS: From January 2006 to December 2008, 23 patients (23 cases) underwent osteosynthesis using only RCHS and 24 patients (25 cases) underwent osteosynthesis using RCHS and TSP. We evaluated the classification of fractures, the amount of collapse and shortening, and the duration of fracture union. We used a Koval classification for the evaluation of clinical outcomes. RESULTS: The amount of collapse and shortening in the RCHS-only group was statistically greater than the amount in the RCHS-with-TSP group. The union duration of fracture was 5.3 months in the RCHS-only group and 6.6 months in the RCHS-with-TSP group. The clinical outcomes in the RCHS-with TSP-group were better than the RCHS-only group. We had one case of fixation failure in the RCHS-only group and none in the RCHS-with-TSP group. There were no perioperative systemic complications or death. CONCLUSION: In patients with unstable intertrochanteric fractures, we can prevent the cut out of the lag screw or screw loosening with the use of pressurized PMMA-augmented RCHS. However, we cannot prevent excessive collapse and shortening, especially in patients with severe osteoporosis, a small diameter of the femur neck, or concealed fractures. In the case of these patients, we recommend you to use RCHS with TSP for the prevention of excessive collapse and shortening.

Optimal Condition of Microporous Membrane for Bone Marrow Stromal Cell Allotransplantation to Stimulate Wound Healing in Vitro

PURPOSE: Major drawbacks of conventional bone marrow stromal cells (BSCs) transplantation method are mainly caused by direct transplanted cell to host cell interactions. We hypothesized that separation of the transplanted cells by a microporous membrane might inhibit most of the potential adverse effects and induce superior effect. The purpose of the study is to determine the optimal condition of the microporous membrane. METHODS: First, BSCs were placed in polyethylene terephthalate (PET) transwell inserts with 3, 8, or 12 micrometer pore size, and cultured in 24 well culture plates. After 5 days, bottoms of the plates were observed for presence of attached BSCs in monolayer and cell numbers were evaluated. Second, BSCs were placed PET, polycarbonate (PCT), and mixed cellulose esters (MCE) transwell inserts with 3 and 8 micrometer pore size, and cultured in 24 well culture plates. After 3 days, the supernatants of the media left in culture plate were analyzed for collagen, vascular endothelial growth factor (VEGF), platelet derived growth factor BB (PDGF-BB), and basic fibroblast growth factor (bFGF). Third, BSCs were placed in 15% and 70% of the PET membrane with 3 micrometer pore size. All the experimental conditions and methods were same as the second study. RESULTS: The optimal pore sizes to prevent BSC leakage were 3 micrometer and 8 micrometer. The amounts of type I collagen and three growth factors tested did not show significant differences among PET, PCT, and MCE groups. However, the collagen, VEGF, and bFGF levels were much higher in the high (70%) density group than in the low (15%) density group. CONCLUSION: This study revealed that the optimal pore size of membrane to prevent direct BSC to recipient cell contact is in between 3 micrometer and 8 micrometer. Membrane materials and pore sizes do not influence the collagen and growth factor passage through the membrane. The most striking factor for collagen and growth factor transport is pore density of the membrane.

The Usefulness of Transcutaneous Tissue Oxygen Pressure (TcpO2) for Determination of the Point of Time at Venous Revascularization

PURPOSE: The purpose of this study is to delineate the optimal time of venous revascularization for preventing the flap necrosis due to venous occlusion, and to clarify the usefulness of tissue oxygen pressure (TcpO2) in the determination of the point of time for venous revascularization. METHODS: Thirty-six, 3 x 3 cm sized epigastric island flap was elevated in left abdomen of male Sprague-Dawley rat weighing 250 gram. Flaps were randomly assigned to six groups of six flaps according to the duration of venous occlusion with microvascular clamp; 10 minutes in the group I as the control, 60 minutes in the group II, 2 hours in the group III, 3 hours in the group IV, 4 hours in the group V, and 6 hours in the group VI, respectively. Just before removal of clamp after flap was reposed in situ, the ratio of TcpO2 (tissue oxygen pressure) of the island flap to that of right abdomen was calculated in each group, and tissue specimen was harvested from the distal area of the flap for histological evaluation of vascular change. Five days later, survival area of the flap was estimated, and evaluated the correlation between the tissue oxygen pressure and the rate of flap survival. RESULTS: The TcpO2 and the survival rate of flap were decreased proportionally with the duration of venous occlusion. The ratio of the TcpO2 of the flap is decreased abruptly to below sixty percentile compared to the TcpO2 of normal tissue, and the survived area of the flap is decreased to nine-tenth of the designed size after three hours of total venous occlusion. Histologically, the number of congested vessels was increased according to venous occluded time, and proportionally increased after 3-hours of occlusion significantly. CONCLUSION: There is a close correlation between the TcpO2 and the survival rate of flaps according to the duration of venous occlusion. Therefore, the TcpO2 represents the hemodynamic changes within the flap, and thought to be an alternative effective tool in the flap monitoring for venous revascularization.

Role of Silver-containing Carboxymethyl Cellulose Dressing in the Management of Exudative Infected Wounds

PURPOSE: Wound healing is a result of complex processes whose components, such as cells, extracellular matrix, proteolytic enzymes, and their inhibitors receive effects from immune compartments, cytokines, chemokines, and growth factors. Impairment of normal physiologic response to wounding makes nonhealing chronic wounds. Wound infection and exacerbated proteolytic process may induce uncontrolled tissue degradation or exudates formation, which may result in the development of a nonhealing chronic wound. Thus proper management of wound infection and exudates is critical to prevent and treat nonhealing wound. The aim of this study is to evaluate effects of Aquacel AG, silver-containing carboxymethylcellulose dressing on treatment for exudative infected wound. METHODS: The study included 31 patients with nonhealing wound. Wound was dressed with Aquacel AG. The effect of dressing was investigated by serial bacterial culture and wound exudates assessment. Each infection and exudates control time was determined and statistically analyzed. RESULTS: Wound infection and exudates were effectively managed using Aquacel AG dressing. Mean infection and exudates control time were 3.4+/-1.2 and 5.7+/-1.4 weeks, respectively. Statistical analysis of the data indicated that infection control time correlated positively to age and exudates control time (p<0.05). CONCLUSION: There is as yet no ideal dressing for the topical treatment of chronic nonhealing wound. But silver-containing carboxymethylcellulose dressing can be used effectively for exudative, infected nonhealing wound.

Role of Silver-containing Carboxymethyl Cellulose Dressing in the Management of Exudative Infected Wounds

PURPOSE: Wound healing is a result of complex processes whose components, such as cells, extracellular matrix, proteolytic enzymes, and their inhibitors receive effects from immune compartments, cytokines, chemokines, and growth factors. Impairment of normal physiologic response to wounding makes nonhealing chronic wounds. Wound infection and exacerbated proteolytic process may induce uncontrolled tissue degradation or exudates formation, which may result in the development of a nonhealing chronic wound. Thus proper management of wound infection and exudates is critical to prevent and treat nonhealing wound. The aim of this study is to evaluate effects of Aquacel AG, silver-containing carboxymethylcellulose dressing on treatment for exudative infected wound. METHODS: The study included 31 patients with nonhealing wound. Wound was dressed with Aquacel AG. The effect of dressing was investigated by serial bacterial culture and wound exudates assessment. Each infection and exudates control time was determined and statistically analyzed. RESULTS: Wound infection and exudates were effectively managed using Aquacel AG dressing. Mean infection and exudates control time were 3.4+/-1.2 and 5.7+/-1.4 weeks, respectively. Statistical analysis of the data indicated that infection control time correlated positively to age and exudates control time (p<0.05). CONCLUSION: There is as yet no ideal dressing for the topical treatment of chronic nonhealing wound. But silver-containing carboxymethylcellulose dressing can be used effectively for exudative, infected nonhealing wound.

Clinical Comparative Study of Continuous Method and Internal Perforating Method for Nasal Lateral Osteotomy

Recently many studies have demonstrated that perforating method of lateral nasal osteotomy causes less edema and echymosis than those of continuous method of lateral nasal osteotomy. For lessening the damage of nasal mucosa, authors performed continuous nasal lateral osteotomy(NLO) with an aid of silastic strip insertion into the subperiosteal pocket on the medial side of nose along the line of osteotomy. NLO was performed in 5 patients for correction of bony abnormality. In each patient, internal perforating NLO was performed on one side of nasal bone using 2-mm straight osteotome and protected continuous NLO was performed on the other side using 4-mm curved guided osteotome. The condition of nasal mucosa was checked using endoscopy immediately after the procedure. On postoperative days 2, 7, 14, and 21 the degrees of ecchymosis and edema of each side evaluated using clinical photos(Canon EOS 300D). Mild edema and ecchymosis were observed in both sides on postoperative days 2, 7, 14, there were no significant differences between right side and left side. This study confirmed that concerning postoperative ecchymosis and edema there were no significant differences between in protected continuous NLO and in perforating NLO. We conclude that whatever the technique of NLO, the degrees of post operative edema and ecchymosis may depends on the degree of nasal soft tissue trauma.

Plantar Corn Caused by Epidermal Cyst

Plantar corn is a circumscribed and sharply demarcated hard mass of traumatic hyperkeratosis, which has a central core impacting the dermis deeply and causes pain while walking. The cause of the corn is the mechanical stress to the skin induced by several causative factors; extrinsic(tight shoes) or intrinsic(bony prominence), or combined(the claw toe). We found 7 cases of patients with a painful recurrent plantar corn which had an epidermal cyst under its lesion. These corns and cysts were excised totally and there was no recurrence in all cases during two to four months follow-up period. We think that an epidermal cyst may be another intrinsic factor for the development of a plantar corn. So, an epidermal cyst should be considered once in a recurrent plantar corn to be recalcitrant against popular treatments.

Surgical Result of Interbody Fusion in Thoracic Disc Herniation: Anterior Transthoracic Approach and Posterior Approach Performed by using Cage

OBJECTIVE: Thoracic disc herniation is an uncommon cause of thoracic cord compression. Experience with decompressive laminectomy for thoracic disc herniation proved disappointing and stimulated the development of anterior transpleural approach that does not require retraction of the spinal cord. This study is performed to evaluate the effectiveness of interbody fusion using cage in thoracic disc herniation by retrospectively analyzing data on operations performed at our institution. METHODS: There were eight patients who had undergone operation for single thoracic disc herniation between January 1997 and May 2001. There were five men and three women. All patients presented with pain and/or neurological deficits. Affeted levels were as follows, four patients at T11-T12, two patients at T10-T11, T9-T10 and T12-L1 respectively one case. An anterior transthoracic approach were performed in seven patients. Posterior approch was performed one patient. In all cases, carbon cage instrumentation was used. The mean follow up period was 32.6month(25-57 months). Cases were reviewed to evaluate the efficacy, surgical results, and complication of the operation. RESULTS: An adequate disectomy was achieved in all eight cases. Symptomatic improvement was shown in eight patients. There was no operative mortality. Postoperative follow up imaging studies, especially plain radiography demonstrated no instrumentation failure. CONCLUSION: Interbody fusion by using carbon cage is considered useful for thoracic disc herniation without significiant injury in thoracic structure and improvement of symptoms.

Responses of Lumbar Spinomesencephalic Tract Neurons to Antidromic Activation of Spinocervical Tract Neurons

OBJECTIVE: Morphological studies have demonstrated that the spinocervical tract (SCT) neurons have their target cells not only in the lateral cervical nucleus (LCN) but also within the lumbosacral segments of the spinal cord. The study is aimed at investigating the possibility of collateral segmental actions of SCT neurons upon spinomesencephalic tract (SMT) neurons in the lumbar spinal cord. METHODS: Extracellular microelectrode recordings were made from lumbar (L3-L6) spinomesencephalic tract (SMT) neurons on adult male cats antidromically activated by stimulation of midbrain. The effects of stimulating dorsolateral funiculus (DLF) were recorded at cervical cord at C3 and rostral C1 levels, below and above the termination of SCT axons in LCN. RESULTS: Thirty-nine cells responded to the stimulation of cervical DLF stimulation. Among them thirty-four cells that showed excitatory responses, twenty-three cells were more excited by the stimulation at C3 and five cells by the C1 stimulation, and six cells showed similar responses to C3 and C1 stimulations. Inhibitory responses were recorded in five. Four inhibited cells showed their inhibitory responses to both C3 and C1 stimulation, and one cell was inhibited by C3 stimulation. Histologically, the location of recording sites of SMT cells responding to stimulation of upper cervical DLF was widely distributed in the lamina II-VII of gray matter inhibitory responses were found in lamina V-VII CONCLUSION: These results suggest that there is a functional coupling between the SCT and SMT neurons, and that the linkage might be formed either segmentally between SMT neurons and axon collaterals of SCT neurons or suprasegmentally via cells in the lateral cervical neurons with axons descending to the lumbar cord.

Relationship between blood leptin and non-alcoholic fatty liver in obese male adolescent / 대한내과학회지

BACKGROUND: The non-alcoholic fatty liver is characterised by accumulation of triglycerides within liver parenchymal cells without intake of alcohol. Leptin is produced by peripheral adipose cells and it's blood concentrations are positively correlated with blood insulin levels, independent of body mass index. Non-alcoholic fatty liver is associated with insulin resistance and hyperinsulinemia even in lean subjects. Therefore, we aimed to elucidate whether hyperleptinemia is associated with non-alcoholic fatty liver, independent of age and obesity. METHODS: The age, weight, BMI and blood laboratory data such as LFT, lipid profiles, insulin, and leptin were analyzed on 26 control subjects and 30 non-alcoholic fatty liver subjects with BMI above 25 kg/m2 in male adults. RESULTS: There was no significant difference in their age, height, weight, and BMI between normal control group and non-alcoholic fatty liver group. But, blood triglyceride, leptin, and insulin level of patients with non-alcoholic fatty liver were significantly higher than those of normal control group. CONCLUSION: Blood leptin levels of non-alcoholic fatty liver group were significantly higher than that of control group. Thus, high circulating leptin concentrations may play a role in the pathogenesis of non-alcoholic fatty liver, regardless of age and obesity.

A Case of Esophagopleural Fistula Treated by Endoscopic Injection of Histoacryl in Boerhaave's Syndrome / 대한소화기내시경학회지

Boerhaave's syndrome is a spontaneous tear through all the layers of the left lateral wall of the esophagus just above the diaphragm, produced by a sudden increase in esophageal pressure. Boerhaave's syndrome is a rare but grave syndrome, with a mortality rate around 40%. Most affected patients are middle-aged men who experience violent vomiting after heavy eating or alcohol intake or both. Vomiting followed by the abrupt onset of pain, dyspnea, and/or shock are the major symptoms. The most important diagnostic tool may be an upright chest X-ray. However, esophagograms and/or a chest CT may be required to locate the lesion. The management of esophagopleural fistula must be individualized, and both the patient's condition and the specific characteristics of the fistula must be considered. Successful management of patients must include adequate nutritional support and effective therapy of the associated empyema. A case of esophagopleural fistula complicated by Boerhaave's syndrome, which was successfully treated by endoscopic injection of Histoacryl , in herein reported.

A Case of Crohn? Disease Associated with Pyoderma Gangrenosum and Peripheral Arthritis / 대한류마티스학회지

The Crohn? disease is a inflammatory bowel disease and it? symptoms are nonspecific. The extraintestinal manifestations of Crohn? disease are arthritis, pericholangitis, erythema nodosum, pyoderma gangrenosum, uveitis, episcleritis, and miscellaneous. Arthritic manifestations caused by Crohn? disease belong to seronegative spondyloarthropathies and are divided into peripheral arthritis, spondylitis, and sacroiliitis. And peripheral arthritis in Crohn? disease usually worsen with exacerbation of bowel inflammation but pyoderma gangrenosum, the most severe skin lesion, bears little relationship to the activity or extent of the colitis. A 53 year-old man presented peripheral arthritis on multiple joints and necrotizing ulcerative skin lesion on abdomen and left knee. He had undergone T-loop colostomy due to recurrent anal fistula. Colonoscopy and biopsy of colonic mucosa showed Crohn? disease. We report a case of Crohn? disease associated with pyoderma gangrenosum and peripheral arthritis with relevant review of literatures.

A Case of Crohn? Disease Associated with Pyoderma Gangrenosum and Peripheral Arthritis / 대한류마티스학회지

The Crohn? disease is a inflammatory bowel disease and it? symptoms are nonspecific. The extraintestinal manifestations of Crohn? disease are arthritis, pericholangitis, erythema nodosum, pyoderma gangrenosum, uveitis, episcleritis, and miscellaneous. Arthritic manifestations caused by Crohn? disease belong to seronegative spondyloarthropathies and are divided into peripheral arthritis, spondylitis, and sacroiliitis. And peripheral arthritis in Crohn? disease usually worsen with exacerbation of bowel inflammation but pyoderma gangrenosum, the most severe skin lesion, bears little relationship to the activity or extent of the colitis. A 53 year-old man presented peripheral arthritis on multiple joints and necrotizing ulcerative skin lesion on abdomen and left knee. He had undergone T-loop colostomy due to recurrent anal fistula. Colonoscopy and biopsy of colonic mucosa showed Crohn? disease. We report a case of Crohn? disease associated with pyoderma gangrenosum and peripheral arthritis with relevant review of literatures.

Aortic Valve Replacement with Pulmonary Autograft in Patient with Congenital Aortic Stenosis : Ross Procedure without Homograft: one case report / 대한흉부외과학회지

This is a genuine case report of the Ross operation without the use of homografts or heterografts in reconstruction of the right ventricular outflow tract. A 8-year-old boy with congenital aortic stenosis underwent aortic valve replacement with a pulmonary autograft and right ventricular outflow tract reconstruction with a pericardial conduit bearing autologous aortic monocusp. The postoperative echocardiography and cardiac angiography revealed good ventricular function and competent neoaortic valve. He has been followed up for 19 months.

Simultaneous Revascularization for Coronary Artery Stenosis and Peripheral Vascular Disease / 대한흉부외과학회지

There was no significant difference in morbidity and mortality between those that received simultaneous operation for coronary artery disease and peripheral vascular disease versus those that received coronary artery bypass graft alone. Simultaneous operation is also cost effective. A 46 year-old patient with resting chest pain and intermittent claudication was diagnosed as unstable angina and Leriche's syndrome. We performed simultaneous revascularization for coronary artery stenosis with internal mammary artery and right gastroepiploic artery and a bifurcated vascular graft interposition between in the aorta, left common iliac and right femoral arteries for Leriche's syndrome. The postoperative coronary angiogram and aortogram revealed a good patency of the arterial conduits and vascular graft. He has been followed for 12 months without any problem.

Analysis of Surgical Risk Factors in Pulmonary Aspergilloma / 대한흉부외과학회지

BACKGROUND: The purpose of this study is to analyze the types of complications, the incidences of complications, and preoperative and postoperative risk factors affecting the incidence of the complication. MATERIAL AND METHOD: Between August 1990 and August 1997 in Asan Medical Center, 42 patients(24 men and 18 women) underwent surgical resection for pulmonary aspergilloma. The mean age was 46.6+/-11.5 years(range 29 to 69 years). Hemoptysis(90%) was the most common presentation. Pulmonary tuberculosis was the most common predisposing cause(81%). The associated diseases were bronchiectasis(n=11), active puolmonary tuberculosis(n=9), diabetes mellitus(n=8), lung carcinoid(n=1), and acute myeloblastic leukemia(n=1). Lobectomy was done in 32 cases(76%), segmentectomy or wedge resection in 4, pneumonectomy in 2, and lobectomy combined with segmentectomy in 4. RESULT: Operative mortality was 2%. The most common postoperative complication was persistent air leakage(n=6). The variables such as age, sex, pulmonary function test, amount and duration of hemoptysis, associated diseases(diabetes mellitus, active pulmonary tuberculosis), mode of preoperative management(steroid, antifungal agent, bronchial arterial embolization), and modes of operative procedures were statistically insignificant. The radiologic extent of infiltration to normal lung parenchyme was statistically significant(p=0.04). CONCLUSION: We conclude that the extent of the infiltration to normal lung parenchyme in preoperative radiologic studies should be carefully evaluated to reduce the postoperative complications in surgery for pulmonary aspergilloma.