Percutaneous Thrombin Injection Based on Computational Fluid Dynamics of Femoral Artery Pseudoaneurysms

Objective@#To analyze the computational fluid dynamics (CFD) of femoral artery pseudoaneurysm (FAP), identify a suitable location and timing for percutaneous thrombin injection (PTI) based on this analysis, and report our clinical experience with the procedure. @*Materials and Methods@#CFD can be used to analyze the hemodynamics of the human body. An analysis using CFD recommended that the suitable location of the needle tip for PTI is at the center of the aneurysm sac and the optimal timing for starting PTI is during the early inflow phase of blood into the sac. Since 2011, seven patients (three male and four female; median age, 60 years [range, 43–75 years]) with FAP were treated with PTI based on the devised suitable location and time. Prior to the procedure, color Doppler ultrasonography was performed to determine the location and timing of the thrombin injection. @*Results@#The technical success rate of the PTI was 100%. The amount of thrombin used for the procedure ranged from 200 IU to 1000 IU (median, 500 IU). None of the patients experienced any symptoms or signs of embolic complications during the procedure. Follow-up CT images did not reveal any embolism in the lower extremities and showed complete thrombosis of the pseudoaneurysm. @*Conclusion@#Based on our study of CFD, PTI administered centrally in the FAP during early inflow, as seen on color Doppler, can be an effective technique.

Physical Therapists’ Awareness of Dementia and Attitude

Purpose@#The purpose of this study was to find out the personal characteristics of physical therapists, dementia awareness and dementia attitude, and to find out what relationship is there between personal characteristics and dementia awareness and dementia attitude. @*Methods@#Participants in this study surveyed physical therapists who are members of the Association of Korean Physical Therapists on their awareness of dementia, and conducted online surveys from January 28 to February 27, 2021. The survey questions used in the survey consisted of 29 questions in total, including 9 general characteristics of the participant, 10 questions on perception of dementia, and 10 attitudes toward dementia. All 104 participants were surveyed, and 100 surveys were analyzed, excluding 4 surveys with insufficient responses. @*Results@#In this study, the correct answer rate for all items in the dementia awareness sub-item was 65%, and the dementia attitude-related sub-items were generally positive. However, there was no significant correlation between personal characteristics such as gender, age, educational background, treatment target, treatment experience and dementia awareness, and no correlation with dementia attitude was significant. @*Conclusion@#Regardless of personal characteristics such as gender, age, treatment target, and treatment experience, a positive attitude and correct recognition of dementia can improve the quality of treatment with dementia patients and increase the reliability of patients and caregivers.

Physical Therapists’ Awareness of Dementia and Attitude

Purpose@#The purpose of this study was to find out the personal characteristics of physical therapists, dementia awareness and dementia attitude, and to find out what relationship is there between personal characteristics and dementia awareness and dementia attitude. @*Methods@#Participants in this study surveyed physical therapists who are members of the Association of Korean Physical Therapists on their awareness of dementia, and conducted online surveys from January 28 to February 27, 2021. The survey questions used in the survey consisted of 29 questions in total, including 9 general characteristics of the participant, 10 questions on perception of dementia, and 10 attitudes toward dementia. All 104 participants were surveyed, and 100 surveys were analyzed, excluding 4 surveys with insufficient responses. @*Results@#In this study, the correct answer rate for all items in the dementia awareness sub-item was 65%, and the dementia attitude-related sub-items were generally positive. However, there was no significant correlation between personal characteristics such as gender, age, educational background, treatment target, treatment experience and dementia awareness, and no correlation with dementia attitude was significant. @*Conclusion@#Regardless of personal characteristics such as gender, age, treatment target, and treatment experience, a positive attitude and correct recognition of dementia can improve the quality of treatment with dementia patients and increase the reliability of patients and caregivers.

Uterine Artery Embolization in Patients with Postpartum Hemorrhage: Clinical Efficacy and Safety of Treatment with N-Butyl-2-Cyanoacrylate

PURPOSE@#To evaluate the clinical efficacy and safety of uterine artery embolization (UAE) using N-butyl-2-cyanoacrylate (NBCA) in patients with postpartum hemorrhage (PPH).@*MATERIALS AND METHODS@#From February 2010 to May 2018, 14 patients (age: 28–39 years; mean: 33 years) underwent UAE using NBCA among 82 patients with PPH. Medical records were retrospectively reviewed to evaluate the patients characteristics, cause of PPH, embolization procedure, and outcomes.@*RESULTS@#Angiograms revealed extravasation (n = 10) or pseudoaneurysm (n = 4) in all patients. The causes of PPH were hysterotomy or hysterectomy related arterial injury (n = 11), cervical laceration (n = 2), and abnormal placentation (n = 1). UAE was performed with NBCA in all patients. Additional UAE with gelatin sponge particles was performed in two patients. Additional non-uterine artery embolization was performed in three patients. Coagulopathy was found in five (35.7%) patients. The technical and clinical success rates were 92.9% and 85.7%, respectively. One patient died from multi-organ failure eight days after UAE. One patient with abnormal placentation had pelvic organ ischemia due to multiple pelvic artery embolization.@*CONCLUSION@#UAE using NBCA is safe and effective for the patients with PPH showing extravasation or pseudoaneurysm.

Unmet Medical Service Needs in Family Caregivers of Terminal Cancer Patients / 한국호스피스완화의료학회지

PURPOSE: The unmet medical service needs of caregivers critically influence their caring for terminal cancer patients, but not much research has been done in this regard. Thus, the purpose of this study is to investigate the association between caregivers' characteristics and their unmet medical service needs. METHODS: The survey was conducted with 109 family caregivers of terminal cancer patients admitted to four hospice units. The data were collected from March 2014 through December 2014 using a structured questionnaire. The unmet medical service needs were measured using 14 items which were adopted and modified by authors. RESULTS: Seven areas of unmet medical service needs were shown to be significant. A well-educated group showed stronger needs for counsel about cancer screening and complementary-alternative medicine and health supplement food. A never-smoked group was identified with less need for sexual dysfunction counsel. Counsel about family and personal relations was more necessary for current drinkers and current workers, and less necessary for the married. Insurance counsel was more needed for a no-religion group. Occupation counsel was less necessary for healthy patients. Financial support was less necessary for the married group. CONCLUSION: Based on the results, it is highly recommended to further investigate the unmet medical service needs of family caregivers for terminal cancer patients and causes of the unmet needs.

The Diagnostic Value of Auditory Steady State Response in Patients of Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sudden sensorineural hearing loss (SSNHL) is a medical emergency when an individual experiences at least 30 dB (decibels) of sudden SSNHL, occurring over a time period of three days or less. Pure tone audiometry (PTA) is by far the most widely used to diagnose SSNHL. Besides PTA, auditory steady-state response (ASSR) is also generally accepted to predict the hearing of SSNHL patients objectively and effectively. We analyzed correlation between ASSR and PTA in SSNHL patients, compared that with the corresponding data in non-SSNHL patients, and studied the usefulness of correlation between ASSR and PTA to forecast prognosis of SSNHL in clinical applications. SUBJECTS AND METHOD: We retrospectively analyzed the charts of SSNHL patients. We analyzed the correlation between the thresholds of PTA, ASSR, and audiotory brainstem response (ABR) in SSNHL, compared that with corresponding data in non-SSNHL patients. RESULTS: There was a very strong positive linear correlation between the average hearing threshold of ASSR and PTA among the non-SSNHL patients. Furthermore, there was relatively strong positive linear correlation between the average hearing threshold of ASSR and PTA among SSNHL patients. Also there was a normal positive linear correlation between the average hearing threshold of ABR and PTA among SSNHL patients. The average hearing threshold difference between ASSR and PTA among SSNHL patients was smaller compared with non-SSNHL patients, and this was statistically significant. CONCLUSION: There was a strong correlation between the average hearing threshold of ASSR and PTA among non-SSNHL & SSNHL patients. Compared to ABR, ASSR showed greater correlation with PTA in the SSNHL patients. We concluded that ASSR could be a useful diagnostic tool in SSNHL.

Endovascular Recanalization of a Thrombosed Native Arteriovenous Fistula Complicated with an Aneurysm: Technical Aspects and Outcomes

OBJECTIVE: To evaluate the technical aspects and outcomes of endovascular recanalization of a thrombosed native arteriovenous fistula (AVF) complicated with an aneurysm. MATERIALS AND METHODS: Sixteen patients who had a thrombosed AVF complicated with an aneurysm (two radiocephalic and 14 brachiocephalic) were included in this study. Recanalization procedures were performed by mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombectomy device and adjunctive treatments. We evaluated dose of thrombolytic agent, underlying stenosis, procedure time, technical and clinical success, and complications. The primary and secondary patency rates were calculated using the Kaplan-Meier analysis. RESULTS: The thrombolytic agents used were 100000 U urokinase mixed with 500 IU heparin (n = 10) or a double dose of the mixture (n = 6). The thrombi in aneurysms were removed in all but two patients with non-flow limiting residual thrombi. One recanalization failure occurred due to a device failure. Aspiration thrombectomy was performed in 87.5% of cases (n = 14). Underlying stenoses were found in the outflow draining vein (n = 16), arteriovenous anastomosis or juxtaanastomosis area (n = 5), and the central vein (n = 3). Balloon angioplasty was performed for all stenoses in 15 patients. Two patients with a symptomatic central vein stenosis underwent insertion of a stent after balloon angioplasty. Mean procedure time was 116.3 minutes. Minor extravasation (n = 1) was resolved by manual compression. Both technical and clinical success rates were 93.8% (n = 15). The primary patency rates at 3, 6, and 12 months were 70.5%, 54.8%, and 31.3%, respectively. The secondary patency rates at 3, 6, and 12 months were 70.5%, 70.5%, and 47.0%, respectively. CONCLUSION: Thrombosed AVF complicated with an aneurysm can be successfully recanalized, and secondary patency can be prolonged with endovascular treatment.

The Protective Effect of Epigallocatechin-3-Gallate Against Gentamicin Vestibular Ototoxicity in Type I Vestibular Hair Cell of Guinea Pig / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Gentamicin (GM) is well known for its vestibulotoxicity. There have been many reports about vestibulotoxicity, however, its mechanism is still unclear. So far, it is known that GM affects the voltage-dependent K+ current and nitric oxide (NO) production. Epigallocatechin-3-gallate (EGCG) is the major component of green tea and is known to have anti-oxidative and anti-toxic effect. This study was undertaken to investigate the protective effect of EGCG against gentamicin on vestibular hair cell (VHC). MATERIALS AND METHOD: White guinea pigs (200-250 g) were rapidly decapitated and the temporal bones were immediately removed. Under a dissecting microscope, the crista ampullaris was obtained. The dissociated VHCs were transferred into a recording chamber mounted onto an inverted microscope. Whole-cell membrane currents and potentials were recorded using standard patch-clamp techniques. In addition, measurements of NO production were obtained using the NO-sensitive dye, 4,5-diamino-fluorescein diacetate (DAF-2DA). RESULTS: Type I VHCs Voltage-dependent K+ current was activated from low depolarizing stimulation. As the stimulation increased, higher current was detected. Voltage-dependent K+ current in type I VHCs was decreased when GM (200 microM) was administrated and GM effects of K+ current inhibition was significantly blocked by EGCG. Extracellular GM-induced an increase in DAF-2DA fluorescence, which thus indicates NO production in VHCs. Also, the GMinduced NO production was inhibited by EGCG. CONCLUSION: GM inhibits voltage-dependent K+ current by releasing NO in isolated type I VHCs. EGCG blocks this inhibitory effects, suggesting a protective role on GM vestibulotoxicity.

Tissue Responses to Stent Grafts with Endo-Exo-Skeleton for Saccular Abdominal Aortic Aneurysms in a Canine Model

OBJECTIVE: We evaluated the effect of close contact between the stent and the graft on the induction of endothelial covering on the stent graft placed over an aneurysm. MATERIALS AND METHODS: Saccular abdominal aortic aneurysms were made with Dacron patch in eight dogs. The stent graft consisted of an inner stent, a expanded polytetrafluoroethylene graft, and an outer stent. After sacrificing the animals, the aortas with an embedded stent graft were excised. The aortas were inspected grossly and evaluated microscopically. RESULTS: The animals were sacrificed at two (n = 3), six (n = 3), and eight months (n = 2) after endovascular repair. In two dogs, the aortic lumen was occluded at two months after the placement. On gross inspection of specimens from the other six dogs with a patent aortic lumen, stent grafts placed over the normal aortic wall were covered by glossy white neointima, whereas, stent grafts placed over the aneurysmal aortic wall were covered by brownish neointima. On microscopic inspection, stent grafts placed over the normal aortic wall were covered by thin neointima (0.27 +/- 0.05 mm, mean +/- standard deviation) with an endothelial layer, and stent grafts placed over the aneurysmal aortic wall were covered by thick neointima (0.62 +/- 0.17 mm) without any endothelial lining. Transgraft cell migration at the normal aortic wall was more active than that at the aneurysmal aortic wall. CONCLUSION: Close contact between the stent and the graft, which was achieved with stent grafts with endo-exo-skeleton, could not enhance endothelial covering on the stent graft placed over the aneurysms.

Six Cases of Nasal Cavity and Nasopharyngeal Tuberculosis / 대한이비인후과학회지

Tuberculosis of the nasal cavity and nasopharynx is extremely rare. The diagnosis is frequently delayed because of unfamiliarity with the disease. It is difficult to make an accurate diagnosis of tuberculosis of the nasal cavity and nasopharynx on imaging findings alone; a biopsy is required to confirm the diagnosis and to differentiate it from malignancy and the other conditions. The authors have experienced 6 cases of tuberculosis of the nasal cavity and nasopharyx. We report them with review of literatures.

Thoracoscopic Needle Aspiration Biopsy for a Centrally Located Solitary Pulmonary Nodule

Thoracoscopic needle aspiration is a good alternative for a centrally-located solitary pulmonary nodule (SPN) suspected of being lung cancer without severe pleural adhesion. The authors report the technique of thoracoscopic needle aspiration biopsy in a SPN just in the medial aspect of the truncus anterior pulmonary artery and the right upper lobe bronchus.

Surgical Management for Pulmonary Artieriole Rupture During Subclavian Vein Catheterization: A Case Report / 대한구급학회지

We experienced an extremely unusual case of a 37-year-old woman who suffered from hemothorax soon after subclavian vein catheterization. Many case reports of a hemothorax or hematoma after central vein catheterization through the great vessels, such as the subclavian vein and internal jugular vein, have been published. However, this rare case showed a pinpoint-sized active bleeding site from a pulmonary arteriole rupture. During an emergency operation using thoracoscopy-assisted minithoracotomy, this bleeding site was successfully managed by primary repair.

Selective Embolization for Post-Endoscopic Sphincterotomy Bleeding: Technical Aspects and Clinical Efficacy

OBJECTIVE: The objective of this study was to evaluate the technical aspects and clinical efficacy of selective embolization for post-endoscopic sphincterotomy bleeding. MATERIALS AND METHODS: We reviewed the records of 10 patients (3%; M:F = 6:4; mean age, 63.3 years) that underwent selective embolization for post-endoscopic sphincterotomy bleeding among 344 patients who received arteriography for nonvariceal upper gastrointestinal bleeding from 2000 to 2009. We analyzed the endoscopic procedure, onset of bleeding, underlying clinical condition, angiographic findings, interventional procedure, and outcomes in these patients. RESULTS: Among the 12 bleeding branches, primary success of hemostasis was achieved in 10 bleeding branches (83%). Secondary success occurred in two additional bleeding branches (100%) after repeated embolization. In 10 patients, post-endoscopic sphincterotomy bleedings were detected during the endoscopic procedure (n = 2, 20%) or later (n = 8, 80%), and the delay was from one to eight days (mean, 2.9 days; +/- 2.3). Coagulopathy was observed in three patients. Eight patients had a single bleeding branch, whereas two patients had two branches. On the selective arteriography, bleeding branches originated from the posterior pancreaticoduodenal artery (n = 8, 67%) and anterior pancreaticoduodenal artery (n = 4, 33%), respectively. Superselection was achieved in four branches and the embolization was performed with n-butyl cyanoacrylate. The eight branches were embolized by combined use of coil, n-butyl cyanoacrylate, or Gelfoam. After the last embolization, there was no rebleeding or complication related to embolization. CONCLUSION: Selective embolization is technically feasible and an effective procedure for post-endoscopic sphincterotomy bleeding. In addition, the posterior pancreaticoduodenal artery is the main origin of the causative vessels of post-endoscopic sphincterotomy bleeding.

Tissue Responses to Endovascular Stent Grafts for Saccular Abdominal Aortic Aneurysms in a Canine Model

We investigated tissue responses to endoskeleton stent grafts for saccular abdominal aortic aneurysms (AAAs) in canines. Saccular AAAs were made with Dacron patch in 8 dogs, and were excluded by endoskeleton stent grafts composed of nitinol stent and expanded polytetrafluoroethylene graft. Animals were sacrificed at 2 months (Group 1; n = 3) or 6 months (Group 2; n = 5) after the placement, respectively. The aortas embedding stent grafts were excised en bloc for gross inspection and sliced at 5 to 8 mm intervals for histopathologic evaluation. Stent grafts were patent in all except a dog showing a thrombotic occlusion in Group 2. In the 7 dogs with patent lumen, the graft overhanging the saccular aneurysm was covered by thick or thin thrombi with no endothelial layer, and the graft over the aortic wall was completely covered by neointima with an endothelial layer. Transgraft cell migration was less active at an aneurysm than at adjacent normal aorta. In conclusion, endoskeleton stent grafts over saccular aneurysms show no endothelial coverage and poor transgraft cell migration in a canine model.

Ultrasonographic Findings of the Ulnar Nerves in Cubital Tunnel Syndrome

PURPOSE: To determine useful diagnostic criteria of cubital tunnel syndrome (CTS), using ultrasonographic ulnar nerve cross-sectional areas (UNCSA) measurements. MATERIALS AND METHODS: The CTS group included 28 patients confirmed with nerve conduction study and the control group included 17 healthy adults. Ulnar nerve cross-sectional areas (UNCSA) were measured at the distal 1/3 upper arm level and in the cubital tunnel (CTN). US findings of CTS were ulnar nerve dislocation (n = 2), ulnar nerve subluxation (n = 5), ganglion (n = 1), sever elbow joint osteoarthritis (n = 1) and elbow joint valgus deformity after fracture (n = 1). UNCSA, the ratio of UNCSA in CTN to distal 1/3 upper arm level (CH ratio), and the difference of UNCSA between CTN and distal 1/3 upper arm level (CH difference) were evaluated to obtain the optimal diagnostic cutoff value of CTS, using ROC curve. RESULTS: The mean UNCSA in CTN was 0.168 cm2 in the CTS and 0.067 cm2 in the control. The CTS could be diagnosed when UNCSA, the CH ratio and the CH difference are larger than 0.096 cm2, 1.371 and 0.036 cm2 respectively. The ROC curve area was largest and the sensitivity, specificity was respectively 82.4%, 95.8%, when the CH difference was used as cutoff value. CONCLUSIONS: Ultrasound is useful for the detection of CTS pathogenic lesions in CTN. The highest diagnostic accuracy was acquired when the CH difference is larger than 0.036 cm2.

Association of Serum Gamma Glutamyltransferase and Fasting Blood Glucose among Middle Aged and Elderly in Chuncheon: Hallym Aging Study / 가정의학회지

BACKGROUND: Serum gamma-glutamyltransferase (GGT) was reported to be associated with type 2 diabetes, various cardiovascular disease risk factors, and individual components of metabolic syndrome. We performed a cross-sectional study to elucidate the relations between GGT and impaired fasting glucose (IFG). METHODS: The subject of this study included 693 adults (males 272, females 421) aged 45 years or over who have lived in Chuncheon, a suburban small-sized city. IFG was defined as elevated fasting plasma glucose (FPG) concentration of > or = 100 and or = 75th) were 1.0, 0.56, 1.57, and 2.79, respectively (P-value for trend 0.022). In women, the association between the risk of IFG and GGT was not statistically significant. CONCLUSION: This study suggests that elevated level of GGT within the normal range is an independent predictor of impaired fasting glucose in middle-aged or older men but not in women.

Comparative Study of Endovenous Laser Treatment with Different Laser Wavelength for Saphenous Vein Incompetence

PURPOSE: Limited data is available about the relative effects of laser wavelengths when conducting endovenous laser treatment (EVLT) for saphenous vein incompetence. We performed this study to compare the safety and efficacy between EVLT with using an 810 nm and a 1,320 nm laser. METHODS: 147 incompetent saphenous veins in 101 consecutive patients who were treated with EVLT were included in this study. We divided them into two groups: 810 in the nm laser group (Group A: 85 saphenous veins in 52 patients) and 1,320 in the nm laser group (Group B: 62 saphenous veins in 49 patients). The patients were evaluated with Doppler sonography to evaluate the results of the treatment at 1 and 3 months after the procedure. Symptomatic improvement was compared between the groups according to the venous clinical severity score (VCSS), the Averdeen varicose vein symptom severity score (AVSS), the complications, the recurrences and the recanlization rate. RESULTS: There was a statistically significant difference in an average linear endovenous energy density (LEED) between two groups. During the mean follow-up of 139 days in Group A and 116 days in Group B, more complications occurred in Group A (42.3%) than that in Group B (32.7%). The postoperative clinical improvement was similar between the two groups for the VCSS and AVSS. The ultrasonography (USG)-proved recanalizaton rates at postoperative 1 and 3 months were 1.2% and 4.3% in Group A and 1.6% and 1.9% in Group B, respectively. Recurrences occurred in only 2 cases in Group A. CONCLUSION: EVLT with a 1,320 nm laser had a tendency to develop fewer complications, recurrences and USG-proven recanalizations of the saphenous veins. Long-term data from large randomized prospective trials is needed to confirm the safety and efficacy of this operative procedure.

Related Factors with Decreased Physical Function in the Community-Dwelling Elderly in Chuncheon: Hallym Aging Study(HAS) / 한국역학회지

This study was conducted to elucidate the related factors with the decreased physical function in the community- dwelling elderly in Chuncheon. We used data obtained from Hallym Aging Study(HAS) from January to May in 2007. The participants were 505 elderly aged 65 years or over after excluding those who didn't complete physical function test and aged < 65. The measurement of physical function was based on the "Health Aging and Body Composition Study Physical Performance Battery(H-ABC PPB)" that included semi-tandem stance, tandem stance, single leg stance, 6m general walk, 6m narrow walk, and chair stand test. And we also included grip strength test. Overall physical function based on H-ABC PPB decreased with age in both men and women. Smoking appeared to increase the risk of decreased function of chair stand in women (adjusted OR=3.8, 95% CI=1.2-12.6). Regular exercise was found to reduce the risk of decreased physical function in both men(Balance OR=0.5, 95% CI=0.2-1.0; Usual walk OR=0.4, 95% CI=0.2- 0.9) and women(Balance OR=0.4, 95% CI=0.2-1.0; Usual walk OR=0.3, 95% CI=0.1- 0.9); Narrow walk OR=0.2, 95% CI=0.1-0.8). Higher level of education seemed to be associated with higher functional performance. It needs further researches on the effect of education on the physical function of the elderly in this population.

Association of obesity indices with physiological markers for cardiovascular disease among middle age and elderly in Chuncheon : Hallym Aging Study / 한국역학회지

PURPOSE: This study was performed to evaluate association of obesity indices with physiological markers for cardiovascular disease(CVD) in community dwelling middle aged and elderly populations. METHODS: We evaluated cross-sectional association of obesity indices with physiological markers for CVD using the data of Hallym Aging Study(HAS) conducted in 2004. Information on general characteristics and medical histories were collected by trained interviewers. Also obesity indices including waist circumference(WC), waist to hip ratio(WHR), body mass index(BMI), and body fat mass(BFM), and physiological markers of CVD including systolic blood pressure(SBP), diastolic blood pressure(DBP), triglyceride(TG), high density lipoprotein cholesterol(HDL-C), total cholesterol(TC), and fasting blood sugar(FBS) were measured by clinical staffs. 589 out of the 922 participated in HAS were enrolled in the final analysis, excluding 333 who had been diagnosed and medicated due to obesity-related diseases. Age and gender specific correlation coefficients between obesity indices and physiological markers for CVD were calculated by partial spearman correlations using SAS ver 9.1. RESULTS: The strength of correlation of obesity indices and physiological markers of CVD changed with age. The correlations between SBP, DBP, TG and HDL-C and obesity indices were attenuated with age, whereas those of TC, FBS and LDL-C were increased among the elderly. These patterns were similar in both gender. CONCLUSIONS: These findings show that more appropriate obesity indices according to age are needed to evaluate the association between these indices and CVD risks.

Emergency Repair Using Cervico-median Sternotomy for Cervicothoracic Penetrating Injury

A great variety of penetrating injuries is happening due to the increasing population and violence today. An optimal surgical approach is the key factor for successful repair of a complicated penetrating injury. A 23-yearold woman fell down the stairs from the second floor and received cervico-thoracic penetration injury due to a metalic bar. The metalic bar ruptured the right jugular vein and penetrated the left upper and lower lung. Under cervico-median sternotomy, neck vessels were repaired and the left thorax was successfully entered to repair the damaged lung through the mediastinal pleura. With this approach, the patient's position did not need to be changed during operation, while reduced the operation time compared to the conventional approach (cervical incision and standard thoracotomy).