BACKGROUND: This retrospective comparative study aims to evaluate the surgical outcomes and complications of two surgical methods for simple fractures of the humeral shaft; minimally invasive anterior plating and open reduction combined with internal fixation. METHODS: A total of 26 patients with humeral shaft simple fractures, who had surgery between June 2009 and September 2013 and were followed-up at least 12 months, were included in our analysis. They were divided into two groups; group 1 comprised of 12 patients who underwent minimally invasive anterior plating and group 2 comprised of 14 patients who underwent an open reduction and internal fixation. The clinical outcomes, radiological results, and complications were compared and analyzed. RESULTS: We found that bone union was achieved in all patients, and the mean union periods were 20.7 +/- 3.34 and 20.3 +/- 3.91 weeks for groups 1 and 2, respectively. In most patients, we found that shoulder and elbow functions were recovered. At 12 months post-operation, we found that the Korean Shoulder Scoring system, the University of California at Los Angeles score and Mayo elbow performance score were 91.4 +/- 7.97, 33.4 +/- 1.15, and 90.8 +/- 2.23 for group 1, and 95.2 +/- 1.53, 33.3 +/- 1.43, and 90.17 +/- 1.85 for group 2. In terms of complications, we found that 2 patients had radial nerve palsy after open reduction and internal fixation, but all cases spontaneously resolved within 6 months. Complications such as infection and loss of fixation were not reported. CONCLUSIONS: Both minimally invasive anterior plating and open reduction with internal fixation produced satisfactory outcomes in the treatment of simple fractures of the humeral shaft.
California ; Elbow ; Fracture Fixation, Internal ; Humans ; Humeral Fractures ; Humerus* ; Paralysis ; Radial Nerve ; Retrospective Studies ; Shoulder

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitive disease showing various radiographic and clinical manifestations. Its clinical course has not been fully understood. Here I describe a case of a 23-year-old immunocompetent man with frequently relapsing ABPA. He was asthmatic. He visited our hospital because of a chronic cough. Laboratory examination showed eosinophilia with increased total and Aspergillus-specific IgE as well as positive skin reaction to Aspergillus fumigatus. Radiologic feature was a dense consolidation. Histology showed organizing pneumonia with eosinophilic infiltration. On the diagnosis of ABPA, he was treated with systemic steroid and itraconazole. Although treatment response was excellent, he suffered from recurrent ABPA three times thereafter in the form of fleeting mass-like consolidation.
Aspergillosis, Allergic Bronchopulmonary* ; Aspergillus fumigatus ; Cough ; Diagnosis ; Eosinophilia ; Eosinophils ; Humans ; Immunoglobulin E ; Itraconazole ; Lung ; Pneumonia ; Recurrence ; Skin ; Young Adult

Postoperative pain control is one of the main concern for the anesthesiologist. Intermittent narcotic injections caused inadequate pain relief in many patients. Periodic injections could improve analgesia with increased incidence of undesirable side effects including respiratory depression, nausea, vomiting, and urinary retenion. Balanced analgesia may lessen these complications without reducing analgesic effect. I assessed the effect of balanced analgesia using morphine, ketorolac and droperidol. Each 20 gynecological patients were allocated to one of four groups Morphine(initial bolus 2mg followed by 48mg continousi.v. for 2 days) or ketorolac(initial bolus 30mg, follwed by 120mg continousi.v. for 2 days) was continously injected in group 1 and group 2, respectively. In group 3, half doses of morphine and ketorolac in group 1, 2 was used in combinstion. 5mg of droperidol was added to group 3 drugs in group 4. There were no significant changes in blood pressure and heart rate in all groups. Onset time of analgesic effect was faster in morphine containing groups 1, and 4, and the effect was better in all three morphine containing group 1, 3 and 4 than ketorolac group 2. Untoward effects were least in ketorolac group 2. Droperidol could prevent nausea and vomiting, however led to increased incidence of somnolence. It could be concluded that balanced analgesia with morphine, ketorolac and droperidol with fine titration would be better than intravenous morphine or ketorolac alone.
Analgesia* ; Blood Pressure ; Droperidol* ; Heart Rate ; Humans ; Incidence ; Ketorolac* ; Morphine* ; Nausea ; Pain, Postoperative* ; Respiratory Insufficiency ; Vomiting

Ovarian mature cystic teratoma containing benign prostatic tissue is rare and only 11 cases have been reported in the literature to date. We report a case of mature cystic teratoma of the ovary containing prostatic tissue. A 23-year-old female patient came to our hospital complaining of irregular menstruation for 3 months. Her menarche had occurred when she was 13 years old. The patient showed no evidence of virilization nor of endocrinopathy. A goose-egg-sized mass was palpable in the left lower abdomen on physical examination. Ultrasonography revealed a cystic ovarian mass with internal echogenecity. Microscopic finding was consistent with that of usual mature cystic teratoma except for a 1.5 cm focus of prostatic and bladder tissues. Prostatic tissue demonstrated strong immunoreactivity for prostatic specific antigen (PSA), prostatic alkaline phosphatase (PAP) and cytokeratin 7. Basal cells of the prostate glands were positive for high molecular weight cytokeratin (34betaE12). Although ovarian mature cystic teratoma containing prostatic tissue has been reported as a rare occurrence, a careful examination with immunohistochemical staining may increase the detection of prostatic tissue in mature cystic teratoma of the ovary.
Abdomen ; Adolescent ; Alkaline Phosphatase ; Female ; Humans ; Keratin-7 ; Keratins ; Menarche ; Menstruation ; Molecular Weight ; Ovary ; Physical Examination ; Prostate ; Teratoma* ; Ultrasonography ; Urinary Bladder ; Virilism ; Young Adult

Glucagon-like peptide-1 (GLP-1) receptor agonists are efficacious glucose-lowering medications with salient benefits for body weight and cardiovascular events. This class of medications is now recommended as the top priority for patients with established cardiovascular disease or indicators of high risk. Until the advent of oral semaglutide, however, GLP-1 receptor agonists were available only in the form of subcutaneous injections. Aversion to needles, discomfort with self-injection, or skin problems at the injection site are commonly voiced problems in people with diabetes, and thus, attempts for non-invasive delivery strategies have continued. Herein, we review the evolution of GLP-1 therapy from its discovery and the development of currently approved drugs to the unprecedented endeavor to administer GLP-1 receptor agonists via the oral route. We focus on the pharmacokinetic and pharmacodynamic properties of the recently approved oral GLP-1 receptor agonist, oral semaglutide. Small molecule oral GLP-1 receptor agonists are currently in development, and we introduce how these chemicals have addressed the challenge posed by interactions with the large extracellular ligand binding domain of the GLP-1 receptor. We specifically discuss the structure and pharmacological properties of TT-OAD2, LY3502970, and PF-06882961, and envision an era where more patients could benefit from oral GLP-1 receptor agonist therapy.

BACKGROUND: T lymphocytes that bear CD3 but lack CD4 and CD8 (Double negative T cells, DN T cells) are normally present early in ontogeny in the fetal thymus, but constitute only a small proportion of adult thymocytes and peripheral blood. Since DN T TCR alpha beta+ cells have been found to accumulate in the lymphoid organs of lpr and gld mice and to be expanded in patients with autoimmune diseases, their functional properties are now of considerable interest. METHOD: Sixty four rheumatoid arthritis (RA) patients and 24 healthy volunteers were studied from Jan 1997 to Feb 1998. The whole blood from the patients and controls were analyzed by flow cytometry (Elite ESP, Coulter, USA) and XL-II software after the cells were stained with trifluorochrome monoclonal antibodies (anti-CD4-FITC/anti-CD8-PE/anti-CD3-PE-Cy5, anti-CD3-FITC/anti-CD19-PE/anti-CD45-PE-Cy5, anti-CD3-FITC/ CD16+56-PE) (Immunotech, Coulter, USA). We reviewed patient records to find out the inflammatory parameters and Ritchie index. RESULTS: We confirmed the presence of DN T cells in peripheral blood of healthy volunteers and RA patients. DN T cells were lower in RA patients (mean+/-SD; 6.44%+/-4.46), when compared to healthy volunteers (mean+/-SD; 9.97%+/-4.50) (p=0.001). There was no clinical correlations between DN T cells and inflammatory parameters. CONCLUSION: Our study showed that the DN T cells in normal control were about 10% of CD3 positive T cells and the cells were significantly lower in RA patients. Although we did not identify whether these cells have either TCR alpha beta or TCR gamma delta, we could conclude that these cells are not expanded in RA patients. We would like to continue this study further 1) to identify TCR the DN T cells have and 2) to monitor the changes after treatment.
Adult ; Animals ; Antibodies, Monoclonal ; Arthritis, Rheumatoid* ; Autoimmune Diseases ; Flow Cytometry ; Healthy Volunteers ; Humans ; Mice ; Receptors, Antigen, T-Cell, alpha-beta ; Receptors, Antigen, T-Cell, gamma-delta ; T-Lymphocytes* ; Thymocytes ; Thymus Gland

The influence of clonidine on the analgesic effect of epidural fentanyl was investigated in 45 patients who underwent total abdominsl hysterectomy by epidural admistration of fentanyl 100 g alone, clonidine 150ug alone, or in combination of the two drugs. Changes in the mean arteral pressure and pulse rate were observed after drug administration, and the analgesic effects was assessed by measuring analgesic duration, pain score, sedation score, and side effects. Analgesic duration was prolonged with improved quality by adding 150 ug of clonidine to 100 ug of epidural fentanyl. Mean arteral pressure and pulse rate were decreased more in fentanyl plus clonidine group than each drug alone group. But these changes were restored rapidly by injection of small dose of vasopressor. The clonidine alone group showed the least analgesic effect among three groups indicatings that clonidine would not be a sole analgesic agent and would be used as an adjunct to other opiate such as fentanyl.
Clonidine* ; Fentanyl* ; Heart Rate ; Humans ; Hysterectomy

The absence of a gallbladder is a very rare anomaly. While it is usually asymptomatic, it can cause biliary colic symptoms. For these reasons, gallbladder agenesis can be misdiagnosed as a hepatobiliary disease and is diagnosed correctly after surgery. This condition may also be detected through an autopsy for other causative diseases. Abdominal ultrasonography is used as a diagnostic method to detect gallbladder agenesis. Hepatobiliary scintigraphy, magnetic resonance cholangiopancreatography, and endoscopic cholangiopancreatography are also used to make a more accurate diagnosis. In the emergency room, however, gallbladder agenesis can still be misdiagnosed as acute or chronic cholecystitis, leading to the detection of gallbladder agenesis in the operating room. Although some cases of gallbladder agenesis detected in adults during surgery have been reported in Korea, there are no reports of gallbladder agenesis in pediatric patients to date. This paper reports a case of gallbladder agenesis in a symptomatic child that was detected incidentally by a radiographic examination.
Adult ; Autopsy ; Child ; Cholangiopancreatography, Magnetic Resonance ; Cholecystitis ; Colic ; Diagnosis ; Emergency Service, Hospital ; Gallbladder ; Humans ; Korea ; Methods ; Operating Rooms ; Pediatrics ; Radionuclide Imaging ; Ultrasonography

BACKGROUND: Previous studies have suggested synergistic analgesic drug interactions between NSAIDs and opioids in neuropathic and inflammatory pain models. The aim of this study was to investigate the analgesic drug interaction between intraperitoneal (IP) ketorolac and morphine in radiant thermal stimulation rat. METHODS: Initially, we assessed the withdrawal latency time of the hindpaw to radiant thermal stimulation every 15 min for 1 hour and every 30 min for next 1 hour after IP normal saline 5 ml (control group). The latency time was changed into percent maximal possible effect (%MPE). Next, IP dose response curves were established for the %MPE of morphine (0.3, 1, 3, 10 mg/kg) and ketorolac (3, 10, 30 mg/kg) to obtain the ED50 for each agent. And we confirmed that the IP morphine effect was induced by opioid receptor through IP morphine followed by IP naloxone. At last, we injected three doses of IP ketorolac (3, 10, 30 mg/kg) mixed with one dose of morphine (2 mg/kg) for fixed dose analysis. RESULTS: IP morphine delayed the paw withdrawal latency time dose dependently, but not ketorolac. ED50 of IP morphine was 2.1 mg/kg. And the IP morphine effect was reversed to control level by IP naloxone. IP ketorolac + morphine combination showed no further additional effects on paw withdrawal latency time over morphine only group. CONCLUSIONS: IP ketorolac did not produce antinociceptive effect during radiant thermal stimulation. There was neither additional nor synergistic analgesic interaction between IP morphine and ketorolac in thermal stimulation rat.
Analgesics, Opioid ; Animals ; Anti-Inflammatory Agents, Non-Steroidal ; Drug Interactions ; Ketorolac* ; Morphine* ; Naloxone ; Rats* ; Receptors, Opioid

Infective endocarditis by Hemophilus species is very rare:there are only 22 reported-cases of Hemophilus paraphrophilus endocarditis. We report a case of Hemophilus paraphrophilus endocarditis in a middle-aged woman with cerebral embolism and hemorrhage.
Endocarditis* ; Female ; Haemophilus ; Haemophilus paraphrophilus* ; Hemorrhage* ; Humans ; Intracranial Embolism*