Sick Sinus Syndrome Combined with Wallenberg Syndrome: a Case Report

Cardiac arrhythmia is a rare manifestation of the Wallenberg syndrome; lesions are located in the brainstem, especially the lower medulla, which regulates sympathetic and parasympathetic activity. A 55-year-old man was admitted to the university hospital with symptoms including ataxia, left ptosis, decreased sensation of pain and temperature on the right side, left facial numbness, and dizziness. Brain magnetic resonance imaging revealed an infarction in the left dorsolateral medulla. Therefore, he was diagnosed with Wallenberg syndrome. While he underwent conservative treatment for Wallenberg syndrome, he experienced several events of self-limiting heart pounding, which required an evaluation of cardiac function. The 24-hour Holter monitor showed an increased RR interval with bradycardia and prolonged sinus pause. As a result, the diagnosis of sick sinus syndrome combined with Wallenberg syndrome was made. Sick sinus syndrome is a rare cardiac complication of the Wallenberg syndrome, and clinicians could overlook it when the initial electrocardiography shows a normal sinus rhythm. Sick sinus syndrome can cause sudden death without appropriate medical intervention. Therefore, clinicians should consider further evaluation, including a 24-hour Holter monitor, to check for the potential presence of sick sinus syndrome in the acute phase of Wallenberg syndrome.

Epidemiology of Spinal Cord Injury: Changes to Its Cause Amid Aging Population, a Single Center Study

Objective@#To investigate the epidemiologic and demographic characteristics of patients with spinal cord injury (SCI) who were admitted to a department of rehabilitation of a university hospital. @*Methods@#This was a descriptive cross-sectional study. Medical records including sex, age at injury, type of disability, traumatic or non-traumatic etiology and presence of ossification of posterior longitudinal ligament (OPLL) of patients with SCI who were admitted to the department of rehabilitation between 2012 and 2018 were reviewed. @*Results@#Of the 221 cases of SCI, 161 were traumatic and 60 were non-traumatic. The mean age at injury was 52.8 years. People aged 40–49 years showed highest proportion among overall SCI patients (19.0%). The proportion of male patients was higher in traumatic SCI at 4.96:1 than in non-traumatic SCI at 1.30:1. The most common cause of traumatic SCI was falling off (37.3%), followed by motor vehicle crash (35.4%) and tripping over (19.3%). Meanwhile, the most common cause of non-traumatic SCI was neoplasm (35.0%). Tripping over was the leading cause of traumatic SCI in patients aged ≥60 years (42.6%). A high proportion of traumatic SCI patients were found to have underlying OPLL (26.1%), particularly those who were injured by tripping over (64.5%). @*Conclusion@#The mean age of SCI patients was higher than that of previous studies. Falls was the single most common cause of traumatic SCI, and tripping over was the most common cause of injury in the elderly patients. OPLL was prevalent in patients who were injured from tripping over.

A Morphometric Study on the Mandibular Foramen and the Lingula in Korean / 체질인류학회지

Interest in the correction of jaw deformities has increased due to the development of techniques and instruments of jaw operation. The accurate position of the mandibular foramen and lingula is important for the prevention of the complications and successful inferior alveolar nerve block. This study was conducted on 104 dried mandibles (65 males, 39 females) from Korean cadaver. The positions of the mandibular foramen and lingula were measured on the coronoid notch, occlusal plane, mandibular notch, gonion, koronoid and kondylion. The structures of the mandibular foramen and lingula were determined and the thickness of ramus and the angle of mandible were measured. Independent t-tests and paired t-tests were performed to determine the statistically significant difference. The results as follows; The line between coronoid notch and posterior border of ramus was located on the same level with the tip of lingula in 42.2% of the cases, and in between the mandibular foramen and the tip of lingula in 33.8% of the cases. The occlusal plane was located on the level between the mandibular foramen and the tip of lingula in 47.7% of cases, and on the same level with the tip of lingula in 35.6% of the cases. The line between lower end of the mandibular notch to inferior border of the mandible, in parallel to the posterior border of the mandibles, met the tip of lingula in 55.8% of the cases. The mandibular foramen was located posteriorly to the midpoint on the anteroposterior (AP) width of the ramus. It was located at 57.3% of AP width from the coronoid notch and 56.5% from the occlusal plane. The mandibular foramen and the tip of lingula were located superiorly to the midpoint on the vertical height of the ramus, on the 48.5% and 35.7% of vertical distance from the coronoid notch, respectively. The mandibular foramen was located at 40% of the length on the line from the gonion to the koronion. The results of this study will provide important morphometric information to prevent the complications in mandibular surgery and also provide the basis for the development of the new techniques.

SEM Observation on the Weathering Human Hair after Burial / 체질인류학회지

This study was undertaken to investigate the morphological changes of hair according to weathering after burial and to offer basic data for forensic science. To examine the effect of weathering degree, the 45 hairs buried for 5~50 years were taken from deceased individuals in tombs in Korea. The morphological changes in weathering hair shafts of the scalp were investigated using the scanning electron microscopes. There were little morphological differences of weathering depending on the regions of burial. The weathering changes includes exclusion of cuticle, separation of hair cortex and hollow formation in the medulla according to the burial period. These results could provide basic data to the field of forensic medicine.

The Position of Mandibular Canal in the Sections of the Mandible / 체질인류학회지

The complications and sequelae after the mandibular surgery are related to inferior alveolar neurovascular bundles, which pass through the mandibular canal. The knowledge of their positions would decrease the risk of mandibular surgery dramatically and would be used for the development of the new surgical techniques. This study was undertaken to clarify the anatomical position of mandibular canal for the mandibular surgery. Forty four mandibules (23 males and 21 females average 66.5 years) obtained from the collection of Hanyang medical college were studied. The location of mandibular canal in the sections between premolars and molars were measured. The obtained results were as follows; At first, the mandibular canal lay lingual to the distal part of the body of the mandible. It then ran anteriorly and to the buccal part of the mandible between the first and the second premolars. In the sections between premolars and molars, the distance between the mandibular canal and the lower border of mandibular body was 8.9+/-1.9 mm at the position of the first molar, the distance between the deepest point of the alveolar socket and the mandibular canal was 9.5+/-3.5 mm at the second molar, which was the narrowest point. The results of this study would be useful to decrease the risk of the mandibular surgery and to develop the new techniques for mandibul surgery in the field of the dentistry and maxillofacial surgery.

The Effects of Ischemic Preconditioning and K(ATP) channel Activation on the Expression of the PKC-epsilon, NF-kappaB and AP-1 in Ischemia-reperfused Rat Heart / 체질인류학회지

This study was aimed to elucidate the effects of K(ATP) activation during IPC on the PKC-epsilon, NF-kappaB and AP-1 in ischemia-reperfused rat hearts. SD male rats weighting from 300 to 350 g were split into 9 groups, such as sham control (S), IPC, 3 cycles of 5 min ischemia and 5 min reperfusion, continuous preconditioning (CP), 8 cycles of 5 min ischemia and 5 min reperfusion, K(ATP) opening (KO) with pinacidil (1.0 mg/kg), K(ATP) blocking with glibenclamide (1.0 mg/kg) injection, ischemia (IS), 30 min ischemia, IPC followed by IS, 8) K(ATP) blocking and IPC followed by IS (KB+IPC+IS), IS and K(ATP) opening (KO+IS). Heart were subjected to ligation of left descending coronary artery and reperfusion in groups of IPC, CP, IS with or without IPC. Immunohistochemistry and Western blotting for PKC-epsilon, NF-kappaB and AP-1 were performed at 3, 6, 24 hours after reperfusion or treatment. Immunoreactivities against PKC-epsilon antibody were observed stronger in the groups of IPC, KO, IPC+IS and KO+IS than groups of KB, IS and KB+IPC+IS. NF-kappaB activation and translocation were only observed in the groups of including 30 min ischemia and reperfusion. AP-1 activation and translocation were opposite to the results of PKC-epsilon activation. In the group of CP, KB, IS and KB+IPC+IS, reactivities of AP-1 antibody were stronger than IPC+IS, KO+IS, and weaker in the groups of S, IPC and KO. These results suggest that K(ATP) opening with IPC or pharmacological methods may direct effect on the PKC-epsilon activation and that K(ATP) blocking has effect on the AP-1 activation and translocation in the heart of ischemiareperfused of rats.

Effects of Repetitive Ischemic Preconditioning on the Expression of Cu,ZnSOD and MnSOD in Rectus Femoris Muscles of Rats / 체질인류학회지

The present study was performed to investigate the dynamics of Cu,ZnSOD and MnSOD expression following courses of reperfusion after repetitive ischemic preconditioning on the left rectus femoris muscle of Spraque-Dawley rats. Nine or thirty five weeks-old rats were subjected to three, six and ten cycles of ischemic preconditioning that was 5 min ischemia and 5 min reperfusion at the left common iliac artery. Left rectus femoris muscle was isolated 0, 3, 6, 24 and 72 hours of reperfusion after ischemic preconditioning and assayed by immunohistochemical staining with anti-Cu,ZnSOD and anti-MnSOD antibodies. The results were as follows; The immunoreactivities of Cu,ZnSOD and MnSOD were increased in the repectitive three and six cycles of ischemic preconditioning. However, after the repetitive ten cycles of ischemic preconditioning, the Cu,ZnSOD immunoreactivities were decreased in the nine weeks-old rats while MnSOD immunoreactivities were decreased in thirty five weeks-old rats. These findings suggest that severe damayes result from decrease of Cu,ZnSOD in nine weeks-old rats and decrease of MnSOD in thirty five weeks-old rats after ten cycles of ischemic preconditioning.

Expression Pattern of Nitric Oxide Synthases in Rat Skeletal Muscle after Cyclic Episodes of Short Ischemia and Reperfusion / 체질인류학회지

The ischemic preconditioning was initially identified as a protective maneuver induced by brief periods of ischemia followed by reperfusion. Although ischemic preconditioning can reduce ischemic injury of heart, skeletal muscle and neuronal tissue, it's protective mechanism remains elusive. Recently, several investigations suggest the associations of nitric oxide with protection from ischemic injury. Nitric oxide synthesized by a member of nitric oxide synthase (NOS) family has been known to increase or decrease the ischemic injury. The purpose of this study was to observe the expression patterns of NOS 1, NOS 2 and NOS 3 in the rat skeletal muscle after cyclic episodes of short ischemia and reperfusion. Nine and thirty-five weeks-old male Sprague-Dawley rats were divided into control and cyclic short ischemia and reperfusion groups. The experimental group was further divided into 3 groups based on cycles of short ischemia and reperfusion. For cyclic short ischemia and reperfusion, left commom iliac artery was occluded 3, 6 and 10 times for 5 minutes ischemia followed by 5 minutes reperfusion using rodent vascular clamps. The animals were sacrificed at hours 0, 3, 6, 24 and 72 after reperfusion and the left rectus femoris muscles were removed. The expression profiles and distribution of NOS 1, NOS 2 and NOS 3 were examined with immunohistochemical staining. The results were as follows; In the cyclic of short ischemia and reperfusion groups, the mortality was increased with increasing of cyclic episodes at 72 hours after reperfusion, and aging. In the control group, NOS 1, NOS 2 and NOS 3 immunoreactivities showed no differenes with aging. In the 9 weeks-old rats, NOS 1 immunoreactivities were observed moderate at 24 hours after 6 times of short ischemia and reperfusion, and moderate and strong at 24 hours after 10 times of short ischemia and reperfusion. In the 35 weeks-old rats, NOS 1 immunoreactivities were observed trace or mild at 24 hours after 6 and 10 times of short ischemia and reperfusion. At 3 hours after 3 times of short ischemia and reperfusion, NOS 2 immunoreactivities were observed moderate or strong, and trace in the 9 and 35 weeks-old rats, respectively. At 3 hours after 10 times of short ischemia and reperfusion, NOS 3 immunoreactivities were observed mild or moderate, and trace or negative in the 9 and 35 weeks-old rats, respectively. In summary, the expression profile of NOS 1, NOS 2 and NOS 3 were observed differently with increasing episodes of short ischemia and reperfusion. The alteration was the most prominent in NOS 3 than in NOS 1 and NOS 2. These results suggest that the alteration of NOS 3 known to protect tissue against ischemic injury may be associated with increasing mortality after multiple episodes of short ischemia and reperfusion.

Review of Trochanteric approach in 285 Total Hip Arthroplasties / 대한정형외과학회잡지

This paper is a consecutive series of total hip arthroplasties were performed over 6 years period by the same group surgeons utilizing the Charnley method as well as the lateral approach with trochanteric osteo. tomy. Trochanteric reattachment was accomplished in 285 hips and method of reattachment were basically standard Charnley technique which we used in most of our series. In addition, some modification of original Charnley technique which we used in early this trial were also included for this study. As far as trochanteric complications are concerned, there are 18 cases of hips where there was wire breakage, proximal drift of greater trochanter and 6 established cases of nonunion also reported. By the use of wire mash, we have performed a revisional surgery which has re-inforced of the greater trochanter. This was the case when the greater trocyhanter was very osteoporotic. Finally, biomechanical considerations of the re-attachment of the greater trochanter and new Charnley staple clamp method were introduced with review of our cases and analysed for technical failures.

Untreated Congenital Vertical Talus Associated with Tarsal Codlition: A Case Report / 대한정형외과학회잡지

Congenital vertical talus associating tarsal coalition, which is a very anomalous condition and causes severe rigid flat foot, is presented with literary reviews. This case was treated with soft tissue release and triple arthrodesis.