Upper thigh skeletal muscle index predicts outcomes in liver transplant recipients

Purpose@#The skeletal muscle index (SMI) at the L3 level is widely used to diagnose sarcopenia. The upper thigh (UT) also reflects changes in whole-body muscle mass, but no study has examined this using the UT to diagnose sarcopenia in liver transplantation (LT). This study aimed to determine an optimal cut-off value for UT-SMI and investigate how sarcopenia diagnosed by UT-SMI correlates with outcomes in LT recipients. @*Methods@#In this retrospective study of 332 LT patients from 2018 to 2020, we investigated the association between sarcopenia diagnosed by UT-SMI and patient outcomes after LT. @*Results@#The cut-off values for UT-SMI were 38.3 cm 2 /m 2 for females (area under the curve [AUC], 0.927; P < 0.001) and 46.7 cm 2 /m 2 for males (AUC, 0.898; P < 0.001). The prevalence of sarcopenia diagnosed by UT-SMI was 33.4% in our cohort. Patient and graft survival rates in the UT-SMI sarcopenia group were significantly poorer than those in the UT-SMI non-sarcopenia group (P < 0.001 and P < 0.001). UT-SMI was an independent prognostic factor for patient survival (hazard ratio [HR], 2.182; 95% confidence interval [CI], 1.183–4.025; P = 0.012) and graft survival (HR, 2.227; 95% CI, 1.054–4704; P = 0.036) in our multivariable Cox analysis. @*Conclusion@#We confirmed that sarcopenia diagnosed by UT-SMI is associated with outcomes in LT recipients. In addition, UT-SMI was identified as an independent prognostic factor for patient survival and graft survival. Therefore, UT-SMI could be a good option for CT-based evaluations of sarcopenia in LT recipients.

Hepatic venous territory mapping in living donor liver transplantation using right liver graft: an objective parameter for venous reconstruction

Purpose@#This study evaluated the clinical implication of hepatic venous territory mapping in living donor liver transplantation. @*Methods@#Living donor liver transplantations performed using right graft since 2017 were included. Hepatic venous volume mapping was started in 2019. Risk factors for graft failure and overall survival were analyzed. Analysis for factors related to occlusion of reconstructed vein was performed. @*Results@#Among 445 patients included, 213 underwent hepatic venous mapping. Hepatic venous mapping itself was not a significant factor for graft (hazard ratio [HR], 0.958; 95% confidence interval [CI], 0.441–2.082; P = 0.913) and overall survival (HR, 0.627; 95% CI, 0.315–1.247; P = 0.183). Inferior hepatic vein occlusion was a significant risk factor for both graft survival (HR, 8.795; 95% CI, 1.628–47.523; P = 0.012) and overall survival (HR, 11.13; 95% CI, 2.460–50.300; P = 0.002). In a subgroup with middle hepatic vein reconstruction, occlusion was a significant risk factor for overall survival (HR, 3.289;95% CI, 1.304–8.296; P = 0.012). In patients with middle hepatic vein reconstruction whose venous territory volumes were measured, right anterior volume of ≥300 cm 3 was protective for vein occlusion (OR, 0.317; 95% CI, 0.152–0.662; P = 0.002). In patients with V5 reconstruction, V5 volume of ≥150 cm 3 was protective for vein occlusion (OR, 0.253; 95% CI, 0.087–0.734; P = 0.011). @*Conclusion@#Inferior and middle hepatic vein reconstruction has significant impact on clinical outcome. Hepatic venous territory mapping can provide an objective measure for successful reconstruction of venous branches.

Impact of Nursing Organizational Culture and Nursing Practice Environment on Generational Conflict in Organization among Hospital Nurses / 간호행정학회지

Purpose@#This study aimed to identify the impact of nursing organizational culture and nursing practice environment on generational conflict in organization among hospital nurses. @*Methods@#This study utilized a cross-sectional design.The participants consisted of 214 nurses working at two tertiary general hospitals, which were located in B city. Data were collected from January 15 to January 31, 2022, using self-report questionnaires. Data were analyzed by descriptive statistics, one-way ANOVA, independent t-test, Pearson's correlation coefficient and multiple regression analysis using IBM/SPSS 28.0 for Windows. @*Results@#The mean generational conflict in organization was 2.60±0.74 points on a 5-point scale. Multiple regression indicated that the factors influencing generational conflict in organization included relation-oriented nursing organizational culture (β=-.29, p<.001), hierarch-oriented nursing organizational culture (β=-.29, p<.001), hierarch-oriented nursing organizational culture (β=.17, p=.006) and clinical career, and these variables explained 23.0% of generational conflict in organization. @*Conclusion@#The findings of this study suggest that it is necessary to improve relation-oriented nursing organizational culture and avoid hierarch-oriented nursing organizational culture to decrease generational conflict in organization.

The Natural History of High-Grade Partial Thickness Rotator Cuff Tears: The Conversion Rate to Full Thickness Tears and Affecting Factors

Background@#Information regarding the progression of high-grade partial thickness rotator cuff tears (PTRCTs) is scarce. We aimed to assess the clinical outcome and the conversion rate to full thickness tears in patients with high-grade PTRCTs who underwent nonoperative treatment and to determine the factors associated with tear progression. @*Methods@#A total of 52 patients with high-grade PTRCTs, which were detected by magnetic resonance imaging or ultrasonography (USG), were treated conservatively between 2010 and 2017. They were followed up with USG at 6- to 12-month intervals for a mean of 34 months (range, 12–105 months). The average patient age was 57 years (range, 34–70 years), and 34 patients were women. Age, sex, body mass index, arm dominance, symptom duration, subscapularis tendon involvement, tear location, and trauma history were compared between patients with and without conversion to full thickness tears. @*Results@#A substantial percentage of high-grade PTRCTs progressed to full thickness tears (16/52, 30.8%). According to KaplanMeier analysis, the full thickness conversion rate was 30.8% at 3 years and 64% at 4 years. The full thickness conversion rate was higher in patients with subscapularis tendon involvement (p = 0.012). @*Conclusions@#A considerably large proportion of high-grade PTRCTs progressed to full thickness tears. Therefore, regular monitoring of tear progression should be considered after conservative treatment of high-grade PTRCTs, particularly in patients with subscapularis tendon involvement.

Stress Fracture of the Proximal Clavicle after Parallel Bars Exercise in a Young Male / 대한정형외과학회잡지

Although acute traumatic fractures of the clavicle are relatively common, stress fractures of the proximal clavicle are extremely rare. Stress fractures of the clavicle have often been reported after a radical neck dissection or radiation but rarely occur during excessive repetitive exercise in professional athletes. The authors report a case of a stress fracture of the proximal clavicle during exercise in a young man with no specific preceding factors, which has not been reported in the Korean literature.

Effect of Sarcopenia on Postoperative Mortality in Osteoporotic Hip Fracture Patients

BACKGROUND: Few studies have investigated the effects of sarcopenia on postoperative outcomes including mortality rates following surgery for osteoporotic hip fractures. The purpose of the present study was to determine the prevalence of sarcopenia and the relationship between sarcopenia and 1- and 5-year mortality rates in a consecutive series of patients with osteoporotic hip fractures. METHODS: Among patients who underwent hip surgery for osteoporotic hip fractures, this study included 91 patients subjected to abdominal computed tomography within 1 year of hip surgery. We defined sarcopenia using sex-specific cut-off points for the skeletal muscle index at the level of the third lumbar vertebra. All patients were divided into 2 groups according to the presence or absence of sarcopenia and the 1- and 5-year mortality rates were compared. To confirm factors affecting mortality in addition to sarcopenia, we examined patient age, sex, American Society of Anesthesiologists grade, location of fracture, type of surgery, and bone mineral density. RESULTS: The 1- and 5-year mortality rates were 20.9% and 67.2%, respectively. Among the 45 patients with sarcopenia, the 1- and 5-year mortality rates were 22.2% and 82.7%, respectively. Of the 46 patients without sarcopenia, the 1- and 5-year mortality rates were 19.6% and 52.7%, respectively. Results of the Kaplan-Meier analysis showed that sarcopenia did not affect the 1-year mortality rate (P=0.793), but had a significant effect on the 5-year mortality rate (P=0.028). Both perioperative sarcopenia (P=0.018) and osteoporosis (P=0.000) affected the 5-year mortality rate. CONCLUSIONS: Sarcopenia increases the risk of 5-year mortality in patients with osteoporotic hip fractures.

Acute Isolated Tear of Gluteus Medius in Young Male / 대한고관절학회지

The hip rotator cuff tear usually develops in the middle-aged through gradual degenerative changes, similar to rotator cuff tears in the shoulder. An acute tear in the hip abductor by a traumatic event in young ages is very uncommon. The authors experienced an unusual case of an acute traumatic tear isolated to the gluteus medius in a young male; thus, we report the treatment results in this rare case with a review of the literature.

Early Clinical Outcomes after Subacromial Injection of Ketorolac in Patients with Shoulder Impingement Syndrome: A Comparison with Steroid Injection / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare the clinical results between the subacromial injection of the ketorolac and that of the corticosteroid in patients with subacromial shoulder impingement syndrome. MATERIALS AND METHODS: Twenty patients with shoulder impingement syndrome received an injection of 60 mg ketorolac and were evaluated in terms of visual analogue scale (VAS), range of motion (ROM) and Constant-Murley score. The outcomes are compared with the data of patients treated by 40 mg triamcinolone injection, retrospectively. RESULTS: There was no significant difference in the demographics, VAS, ROM, and Constan-Murley score between the two groups before the injection. At the 4 weeks follow-up, pain improvement was significantly greater in the corticosteroid group (2.7±1.53) than in the ketorolac group (4.9±2.08; p=0.001). However 12 weeks after the injection, there was no significant difference in pain improvement between the two groups (ketorolac: 2.9±2.32, corticosteroid: 2.6±1.82; p=0.707). The Constant-Murley score at the final follow-up improved from 33.5 to 52.1 in the corticosteroid group, and from 39.0 to 56.6 in the ketorolac group (p=0.677). ROM was increased in both groups, and external rotation was significantly greater in the ketorolac group than in the corticosteroid group at the final follow-up (ketorolac: 29.3°±9.90°, corticosteroid: 20.8°±7.99°; p=0.005). CONCLUSION: In this study, ketolorac provided an effect equivalent to triamcinolone in the treatment of subacromial shoulder impingement syndrome at 12 weeks after the injection. This result could offer better opportunities to manage patients with diabetes or local and systemic side effects of repetitive use of corticosteroids.

Humeral Shaft Fracture Sustained during Arm Wrestling in Young Males / 대한스포츠의학회지

Humeral shaft fracture sustaining arm wrestling is rare, but occurs intermittently. We treated 15 cases of humeral shaft spiral fractures occurred during arm wrestling for fun since 2007. Average age was 22.47±2.69 years, average body mass index was 22.67±2.06 kg/m2. There was no prominent tendency for the fractures to occur at a certain phase of the match. Fractured level and length of each case were measured in the plain radiographs and compared with those of previous reports. Eight cases (53.3%) had an associating medial butterfly fragment, and the time taken until the fracture occurred was longer than that of simple spiral fracture (15.62±9.03 seconds vs. 7.85±2.67 seconds, p=0.048). Fractures were distributed mid to distal one third of humerus, the length of fracture was 7.93±2.69 cm and involved 25.43%±8.24% of humeral length. All cases except one treated surgically using plate and screws and returned their full activities within postoperative 3 months. Although arm wrestling is a simple and joyful sport, participants should be aware of the risks of injury during arm wrestling, especially for the amateur players.

Locating Femoral Insertion of Superficial Medial Collateral Ligament and Posterior Oblique Ligament Using Adjacent Structures: Magnetic Resonance Imaging Study / 대한정형외과학회잡지

PURPOSE: Anatomical medial knee reconstruction is crucial to the recovery of the knee joint. Our purpose is to determine the location of femoral insertion of the superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) from the attachment site of the adductor magnus and medial gastrocnemius tendon with MRI results. MATERIALS AND METHODS: A total of 200 knee magnetic resonance imaging results were retrospectively measured. The boundary of femoral insertion of sMCL and POL was marked and measured on the sagittal image. The attachment site of the adductor magnus tendon and medial gastrocnemius tendon was identified. The lineal, anterior-posterior and proximal-distal distances were measured from the attachment site to the center of the femoral insertion of sMCL and POL. RESULTS: The average size of sMCL and POL was as follows—sMCL: length of 13.5±1.7 mm, width of 10.9±0.3 mm and POL: length of 9.4±1.3 mm, width of 6.1±0.5 mm. The lineal distances from the insertion of the adductor magnus tendon and medial gastrocnemius tendon to the center of the sMCL and POL were measured—distances to the sMCL: 17.1±3.8 mm, 15.9±3.2 mm; distances to the POL: 11.9±2.9 mm, 8.2±2.7 mm. CONCLUSION: This study will help determine the location of the femoral attachment site of sMCL and POL by identifying the attachment section of the adductor magnus tendon and medial gastrocnemius tendon. Moreover, this study will guide the reconstruction of sMCL and POL when palpation of the bony structures become difficult.

Arthroscopic Treatment for Calcific Tendinitis of Origin of Long Head of Triceps

A 55-year-old female experienced acute left shoulder pain without specific trauma. Radiography showed calcific deposits in the inferior part of the glenoid fossa. Magnetic resonance arthrography showed calcific deposits in the origin of the long head of triceps brachii muscle. Conservative treatment failed to resolve the symptoms; therefore, arthroscopic surgery was performed. The patient experienced immediate and dramatic pain relief, and normal shoulder motion was demonstrated 1 year after surgery. In conclusion, although rare, calcific tendinitis of the triceps brachii muscle, which causes shoulder pain, should be included in the differential diagnosis of acute shoulder pain. Arthroscopic surgery is a treatment option for chronic cases and those resistant to conservative treatment.

Arthroscopic Treatment for Calcific Tendinitis of Origin of Long Head of Triceps

A 55-year-old female experienced acute left shoulder pain without specific trauma. Radiography showed calcific deposits in the inferior part of the glenoid fossa. Magnetic resonance arthrography showed calcific deposits in the origin of the long head of triceps brachii muscle. Conservative treatment failed to resolve the symptoms; therefore, arthroscopic surgery was performed. The patient experienced immediate and dramatic pain relief, and normal shoulder motion was demonstrated 1 year after surgery. In conclusion, although rare, calcific tendinitis of the triceps brachii muscle, which causes shoulder pain, should be included in the differential diagnosis of acute shoulder pain. Arthroscopic surgery is a treatment option for chronic cases and those resistant to conservative treatment.

Characterizing the Progression of Varying Types of Calcific Tendinitis around Hip / 대한고관절학회지

PURPOSE: To assess the progression of clinical symptoms and disease course of calcific tendinitis in the hip region according to types of calcification. MATERIALS AND METHODS: Among patients with the hip pain, 28 patients (21 males and 7 females; mean age 51 years, range 32-74 years) showing calcified lesions in simple radiography without other possible sources of pain were analyzed retrospectively. Twelve patients displayed a symptom duration of less than three weeks (acute; average=1+/-0.9 week) and 16 displayed greater than three weeks (chronic; average=21.0+/-19.5 weeks). Lesions were classified as nodular (11, 39.3%), nodular-fragmented (13, 46.4%), or amorphous (4, 14.3%). Initial symptoms, progression of clinical features, radiological findings and prognosis were investigated and analyzed according to calcification type. RESULTS: In 15 patients (53.6%), lesions were located superior to the great trochanter. On average, the acute group was younger (44.58 vs. 55.44 years, P=0.006), suffered more (mean pain Numeric Rating Scale [NRS], 6.3 vs. 3.8; P<0.001), and recovered more (difference between initial and follow-up NRS, 5.1 vs. 2.63; <<0.001) than the chronic group. The mean length of initial lesions was longer in the acute group than the chronic group (15.8 vs. 9.1 mm, P=0.008). When compared to patients with distinctive margins (15, 53.6%), those with nondistinctive margins showed better improvement (difference between initial and follow-up NRS, 4.7 vs. 2.8; P=0.01) and more significant decrease in lesion size (difference between initial and follow-up length, 10.8 vs. 2.6 mm; P=0.003). CONCLUSION: Calcific tendinitis occurring in the hip area displayed a variety of characteristics. Although complaining of more severe pain in the initial phase, patients with acute pain or calcific lesions with nondistinctive margins showed better symptom improvement when compared to their counterparts.

Age-related Outcome of Arthroscopic Repair of Isolated Type II Superior Labral Anterior to Posterior Lesions

BACKGROUND: Repair of superior labral anterior to posterior (SLAP) lesion in patients older than 40 years is controversial. The purpose of this study was to evaluate clinical outcomes of arthroscopic repair of SLAP lesions between younger and older patient groups. METHODS: We reviewed 50 patients with isolated type II SLAP lesions who underwent arthroscopic repair. Patients were divided into 2 groups: group 1 included 20 patients aged or =40 years. Functional outcome at the final follow-up was assessed using a visual analog scale for pain and satisfaction, American Shoulder and Elbow Surgeons form, Constant score, University of California at Los Angeles score, and periodic change in range of motion (ROM). Anatomical outcome was evaluated using computed tomography (CT) arthrography at least 1 year after surgery. RESULTS: No significant differences in functional scores or postoperative ROM were observed between the 2 groups. In group 2, later recovery of ROM (forward flexion, p=0.025; internal rotation, p=0.034) and lower satisfaction score (p=0.06) were observed for atraumatic patients (n=16) compared to patients with traumatic injury (n=14). Fifteen patients in group 1 (15/17, 88%) and 21 patients in group 2 (21/26, 81%) demonstrated a healed labrum on postoperative CT arthrography, and this difference was not significant. CONCLUSIONS: The results of this study suggest that arthroscopic repair of type II SLAP lesions can yield good functional and anatomical outcomes regardless of age, if patient selection is adequate. However, the delay in ROM recovery and lower satisfaction, particularly in older patients without traumatic injury, should be considered.

Age-related Outcome of Arthroscopic Repair of Isolated Type II Superior Labral Anterior to Posterior Lesions

BACKGROUND: Repair of superior labral anterior to posterior (SLAP) lesion in patients older than 40 years is controversial. The purpose of this study was to evaluate clinical outcomes of arthroscopic repair of SLAP lesions between younger and older patient groups. METHODS: We reviewed 50 patients with isolated type II SLAP lesions who underwent arthroscopic repair. Patients were divided into 2 groups: group 1 included 20 patients aged or =40 years. Functional outcome at the final follow-up was assessed using a visual analog scale for pain and satisfaction, American Shoulder and Elbow Surgeons form, Constant score, University of California at Los Angeles score, and periodic change in range of motion (ROM). Anatomical outcome was evaluated using computed tomography (CT) arthrography at least 1 year after surgery. RESULTS: No significant differences in functional scores or postoperative ROM were observed between the 2 groups. In group 2, later recovery of ROM (forward flexion, p=0.025; internal rotation, p=0.034) and lower satisfaction score (p=0.06) were observed for atraumatic patients (n=16) compared to patients with traumatic injury (n=14). Fifteen patients in group 1 (15/17, 88%) and 21 patients in group 2 (21/26, 81%) demonstrated a healed labrum on postoperative CT arthrography, and this difference was not significant. CONCLUSIONS: The results of this study suggest that arthroscopic repair of type II SLAP lesions can yield good functional and anatomical outcomes regardless of age, if patient selection is adequate. However, the delay in ROM recovery and lower satisfaction, particularly in older patients without traumatic injury, should be considered.

A Case of Common Bile Duct Cancer That Completely Responded to Combination Chemotherapy of Gemcitabine and TS-1

Common bile duct (CBD) cancer is a relatively rare malignancy that arises from the biliary epithelium and is associated with a poor prognosis. Here, we report a case of advanced metastatic CBD cancer successfully treated by chemotherapy with gemcitabine combined with S-1 (tegafur+gimeracil+oteracil). A 65-year-old male presented with pyogenic liver abscess. After antibiotic therapy and percutaneous drainage, follow-up computed tomography (CT) showed an enhanced nodule in the CBD. Biopsy was performed at the CBD via endoscopic retrograde cholangiopancreatography, which showed adenocarcinoma. Additional CT and magnetic resonance imaging showed multiple small nodules in the right hepatic lobe, which were confirmed as metastatic adenocarcinoma by sono-guided liver biopsy. The patient underwent combination chemotherapy with gemcitabine and S-1. After nine courses of chemotherapy, the hepatic lesion disappeared radiologically. Pylorus-preserving pancreaticoduodenectomy was performed, and no residual tumor was found in the resected specimen. Three weeks after the operation, the patient was discharged with no complications. Through 3 months of follow-up, no sign of recurrence was observed on CT scan. Gemcitabine combined with S-1 may be a highly effective treatment for advanced cholangiocarcinoma.

Bronchial Brushing Cytologic Finding of Primary Pulmonary Adenoid Cystic Carcinoma Misinterpretated as Small Cell Carcinoma: A Case Report with Literature Review

An adenoid cystic carcinoma is a very rare primary pulmonary neoplasm. Bronchial washing and brushing cytological findings of pulmonary adenoid cystic carcinoma have rarely been described. Here, we report the bronchial brushing cytological findings of an adenoid cystic carcinoma, finally diagnosed in a 71-year-old female patient. The low-power view showed moderate cellularity and cohesive clusters of small to medium-sized cells. The high-power view revealed distinct nuclear moldings, a coarse chromatin pattern, and inconspicuous nucleoli, which was favorable to a diagnosis of small cell carcinoma. However, apoptotic bodies, nuclear debris, and mitoses were not seen frequently. The bronchial biopsy showed solid, trabecular, and cribriform patterns in small cells. Periodic acid Schiff staining disclosed globular basement membrane-like materials, and the immunohistochemical staining revealed the presence of myoepithelial cell components, strongly suggestive of a salivary gland type tumor, compatible with an adenoid cystic carcinoma. In this report, we describe the exfoliative cytological features of a pulmonary adenoid cystic carcinoma with emphasis on some diagnostic pitfalls.

Vimentin and Survivin Expression Rates as Prognostic Factors in Medulloblastoma

BACKGROUND: A medulloblastoma is a primitive neuroepithelial tumor of the cerebellum that occurs in children and metastasizes through the cerebrospinal fluid. It is highly malignant and invasive, and the 5-year survival rate is only 60%. Surgical resection techniques, radiation, and chemotherapy have improved the overall survival but the patients suffer life-long cognitive dysfunctions or endocrine abnormalities as the side effects of treatment. Therefore it is essential to identify prognostic markers to determine the appropriate treatment strategy in order to minimize the side effects. METHODS: This study evaluated the immunohistochemical differentiation and survival rate with synaptophysin, glial fibrillary acidic protein, epithelial membrane antigen, vimentin and primitive neuroepithelial marker nestin of 55 paraffin-embedded medulloblastomas, using a tissue microarray. The expression of survivin, the apoptotic inhibitor, and the survival rate with regard to the proliferation index of Ki-67 were also investigated. RESULTS: The group testing positive to vimentin, a mesenchymal differentiation marker, had a worse prognosis and there was a strong correlation between vimentin expression and nestin expression. Patients with a survivin expression rate >35% had a significantly poorer clinical course and there was a correlation between the survivin expression rate and Ki-67 expression rate. CONCLUSION: In conclusion, vimentin and survivin are negative prognostic markers in medulloblastomas.

Solitary Fibrous Tumor Arising from Stomach: CT Findings

Solitary fibrous tumors are spindle-cell neoplasms that usually develop in the pleura and peritoneum, and rarely arise in the stomach. To our knowledge, there is only one case reporting a solitary fibrous tumor arising from stomach in the English literature. Here we report the case of a 26-year-old man with a large solitary fibrous tumor arising from the stomach which involved the submucosa and muscular layer and resembled a gastrointestinal stromal tumor in the stomach, based on what was seen during abdominal computed tomography. A solitary fibrous tumor arising from the stomach, although rare, could be considered as a diagnostic possibility for gastric submucosal tumors.

A Case of Placenta Increta Presenting as Delayed Postabortal Intraperitoneal Bleeding in the First Trimester

Placenta increta is an uncommon and life-threatening complication of pregnancy characterized by complete or partial absence of the decidua basalis. Placenta increta usually presents with vaginal bleeding during difficult placental removal in the third-trimester. Although placenta increta may complicate first and early secondtrimester pregnancy loss, the diagnosis can be very difficult during early pregnancy and thus the lesion is difficult to identify. We encountered with a woman who was diagnosed with placenta increta after receiving emergency hysterectomy due to intraperitoneal bleeding 2 months after an uncomplicated dilatation and curettage in the first trimester. Therefore, we report this case with a brief review of the literature.