Purpose: We hereby would like to compare on the basis of the initial 12 hips and latter 18 hips by analyzing the initial results of the minimal incision total hip arthroplasty of 30 hips we experienced. Materials and Methods: For the period of December 2004 through June 2005, we performed the total hip arthroplasty with minimal incision in 10cm or shorter using the posterolateral approach on 25 patients (30 hips) whose BMI(body mass index) is 30 or lower. We compared by analyzing results of the initial 12 cases and 18 latter cases. Results: The average BMI was 23.7. There weren`t statistically meaningful differences the change in the hemoglobin value of pre-op and post-op, necessity of blood transfusion, position of component, and the Harris hip score 6 weeks after operation. But, the average initial operation time of 124 minutes was remarkably reduced to 65 minutes in average in the latter operation and the length of a skin incision was reduced from the average 9.2 cm in the initial operation to an average of 8.1cm in the latter operation. There wasn't the malposition of acetabular cup and femoral stem. Conclusion: Although we need more statistical data through more cases and the analysis of long-term results, we think that, to surgeons with much experience in the conventional total hip arthroplasty, the total hip anthroplasty using minimal incision for patients with BMI of 30 or below would be a useful approach having the advantage in a cosmetic aspect.
Acetabulum ; Arthroplasty, Replacement, Hip* ; Blood Transfusion ; Hip ; Humans ; Learning Curve* ; Learning* ; Skin

Many drugs can result in a variety of pathologic reactions in the lung, especially the cytotoxic drugs. Amongcytotoxic drugs bleomycin is a prototype. Bleomycin-related pulmonary toxicity is usually known as dose-dependent and can be enhanced with concurrent oxygen therapy, irradiation, or other chemotherapeutic agents. The incidence of bleomycin-induced pulmonary toxicity has been reported as varying from 2 to 46%, and 1% of fatal lung disease. We describe the radiographic and HRCT findings of bleomycin-related pulmonary toxicity developed in two patients: one in ovarian teratocarcinoma, the other malignant lymphoma patient. Chest radiographs and HRCT of these patients showed ground-glass opacities, consolidation, linear and reticular opacities, and interlobular septal thickening. These abnormalities were bilateral, and symmetrical and were found predominantly in the area of mid-and lower-lung zone.
Bleomycin ; Humans ; Incidence ; Lung Diseases ; Lung* ; Lymphoma ; Oxygen ; Radiography, Thoracic ; Teratocarcinoma

Primary pulmonary amyloidosis is a rare disease, and is classified as either tracheobronchial or parenchymal ; the latter is also divided into nodular and diffuse alveolar septal forms. The alveolar form is extremely rare and usually produces reticular and nodular opacities. We describe a case of alveolar septal pulmonary amyloidosis manifested as multiple small nodules on chest radiograph and disseminated micronodules mainly in centrilobular and subpleural location without reticular opacities, on HRCT.
Amyloidosis* ; Radiography, Thoracic ; Rare Diseases

Purpose: In medical education, peer assessment is considered to be an effective learning strategy. Although several studies have examined agreement between peer and faculty assessments regarding basic life support (BLS), few studies have done so for advanced resuscitation skills (ARS) such as intubation and defibrillation. Therefore, this study aimed to determine the degree of agreement between medical students’ and faculty assessments of ARS examinations. Methods: This retrospective explorative study was conducted during the emergency medicine (EM) clinical clerkship of fourth-year medical students from April to July 2020. A faculty assessor (FA) and a peer assessor (PA) assessed each examinee’s resuscitation skills (including BLS, intubation, and defibrillation) using a checklist that consisted of 20 binary items (performed or not performed) and 1 global proficiency rating using a 5-point Likert scale. The prior examinee assessed the next examinee after feedback and training as a PA. All 54 students participated in peer assessment. The assessments of 44 FA/PA pairs were analyzed using the intraclass correlation coefficient (ICC) and Gwet’s first-order agreement coefficient. Results: The PA scores were higher than the FA scores (mean±standard deviation, 20.2±2.5 [FA] vs. 22.3±2.4 [PA]; P<0.001). The agreement was poor to moderate for the overall checklist (ICC, 0.55; 95% confidence interval [CI], 0.31 to 0.73; P<0.01), BLS (ICC, 0.19; 95% CI, -0.11 to 0.46; P<0.10), intubation (ICC, 0.51; 95% CI, 0.26 to 0.70; P<0.01), and defibrillation (ICC, 0.49; 95% CI, 0.23 to 0.68; P<0.01). Conclusion Senior medical students showed unreliable agreement in ARS assessments compared to faculty assessments. If a peer assessment is planned in skills education, comprehensive preparation and sufficient assessor training should be provided in advance.

Purpose: In medical education, peer assessment is considered to be an effective learning strategy. Although several studies have examined agreement between peer and faculty assessments regarding basic life support (BLS), few studies have done so for advanced resuscitation skills (ARS) such as intubation and defibrillation. Therefore, this study aimed to determine the degree of agreement between medical students’ and faculty assessments of ARS examinations. Methods: This retrospective explorative study was conducted during the emergency medicine (EM) clinical clerkship of fourth-year medical students from April to July 2020. A faculty assessor (FA) and a peer assessor (PA) assessed each examinee’s resuscitation skills (including BLS, intubation, and defibrillation) using a checklist that consisted of 20 binary items (performed or not performed) and 1 global proficiency rating using a 5-point Likert scale. The prior examinee assessed the next examinee after feedback and training as a PA. All 54 students participated in peer assessment. The assessments of 44 FA/PA pairs were analyzed using the intraclass correlation coefficient (ICC) and Gwet’s first-order agreement coefficient. Results: The PA scores were higher than the FA scores (mean±standard deviation, 20.2±2.5 [FA] vs. 22.3±2.4 [PA]; P<0.001). The agreement was poor to moderate for the overall checklist (ICC, 0.55; 95% confidence interval [CI], 0.31 to 0.73; P<0.01), BLS (ICC, 0.19; 95% CI, -0.11 to 0.46; P<0.10), intubation (ICC, 0.51; 95% CI, 0.26 to 0.70; P<0.01), and defibrillation (ICC, 0.49; 95% CI, 0.23 to 0.68; P<0.01). Conclusion Senior medical students showed unreliable agreement in ARS assessments compared to faculty assessments. If a peer assessment is planned in skills education, comprehensive preparation and sufficient assessor training should be provided in advance.

BACKGROUND: It is controversial that an electrocardiography (EEG) is valuable in evaluation of patients with headache. The purpose of this study was to determine whether EEG brain mapping can be a useful indicator for evaluating the analgesic efficacy of treatment on the patient with an occipital headache. METHODS: We did an EEG on 20 patients with occipital headaches at the peri-laser application period. The laser was radiated for 3 minutes a third of the total distance from the external occipital protuberance to the mastoid process on the superior nuchal line. An EEG was taKen before laser radiation as control use, and at 10, 30 and 60 minutes after laser radiation by 32 channel electrodes (international 10 20 system). The EEG mapping was red for the high electric potential and blue for the low electric potential. RESULTS: Compared with control group, the alpha wave increased significantly in parieto-occipital and occipital region at 60 minutes after laser radiation (P < 0.05). DarK red color was increased especially in occipital region at 60 minutes after laser radiation, compared with EEG mapping before laser radiation. Good and Fair improvements were observed in 55% of the patients with occipital headaches. CONCLUSIONS: We conclude that EEG can be a valuable indicator in the evaluation of analgesic efficacy of treatment in the patients suffering from occipital headaches. Pain scores were assessed by the patient with the visual analogue scale (VAS).
Brain Mapping ; Electrocardiography ; Electrodes ; Electroencephalography* ; Headache* ; Humans ; Mastoid

PURPOSE: The purpose of this study was to assess the relative diagnostic capability of magnetic resonance angiography(MRA) and CT angiography(CTA) in the evaluation of intracranial aneurysm. MATERIALS AND METHODS: MRA and CTA were performed in 14 intracranial aneurysms (Including four which were ruptured) confirmed in the II patients involved by conventional angiography(CA). The size(in largest dimension) of the aneurysms ranged between 3 mm and 20 mm and the mean was 10.5 mm. For MRA, the 3D TOF method, with magnetization transfer suppression, wasused at 1.5T. For CTA, twenty seconds after beginning the injection of contrast media(100mL with use of a power injector at the rate of 3 mL/sec), CT scanning(30-second exposure and 60-mm length) was performed with a table speed of 2 mm/sec and a section thickness of 2mm. The resulting data were reformatted by MIP. MRA and CTA were compared with regard to the detection of aneurysms and their neck, size, shape, direction, intensity and relationship to adjacent bony structures or vessels. RESULTS: All aneurysms were clearly visualized with CTA. Inone case with a 3-mm aneurysm, however, this was not defined on MRA. Of the 13 aneurysms demonstrated by both MRA and CTA, eight were seen equally well with both modalities. CTA was considered to be superior to MRA in fivecases, either because calcification in the aneurysm wall was seen only on CTA(n = 3) or because the relationship with adjacent bony structures were seen better with CTA(n = 2). With CTA, the intensities of the aneurysm were homogeneous in all cases ; with MRA, however, the intensities of three large aneurysms were different. CONCLUSION: MRA and CTA may be useful in the evaluation of intracranial aneurysm, CTA has specific advantages over MRA inthe evaluation of large aneurysms, calcification of aneurysm wall and relationship with adjacent bony structure.
Aneurysm ; Angiography* ; Cerebral Angiography ; Intracranial Aneurysm* ; Magnetic Resonance Angiography* ; Neck

BACKGROUND: Adrenal medullary transplants into the subarachnoid space have been demonstrated to reduce pain sensitivity. This analgesia most likely results from the release of neuroactive substances, particularly catecholamines and opioid peptides from the transplanted cells into spinal cord. METHODS: Isolated bovine chromaffin cells were encapsulated with alginate and poly-L-lysine prior to implantation into rat's subarachnoid space to protect them from host immune system. And then catecholamines from encapsulated chromaffin cells were measured quantitatively in vitro by High Performance Liquid Chromatograph. The animals were randomized into 2 groups, one of which received microencapsulated chromaffin cells and the other empty capsules. The effects of such implants were evaluated on the pain behavior resulting from a chronic constriction injury of the rat sciatic nerve for 30 days. RESULTS: Catecholamine concentration in cerebrospinal fluid (CSF) was analyzed. Data (mean SD) are considered significant at P <0.05 (ANOVA for repeated measure and Dunnett's test). Continuous release of catecholamine and met-enkephalin with responsiveness to nicotine stimulation was measured from encapsulated cells in vitro. A significant reduction of allodynic response to acetone evaporation was observed in the animals implanted with cell loaded capsules compared to control animals with empty capsules. Catecholamine concentration in CSF was higher in the cell loaded capsule group. There were no complications related to implantation. CONCLUSION: We found that encapsulated chromaffin cells released continuously catehcolamines and opioids peptides in vitro and in the CSF. Those results may prove chromaffin cell's anagesic effect indirectly.
Acetone ; Analgesia ; Analgesics, Opioid ; Animals ; Capsules ; Catecholamines* ; Cerebrospinal Fluid ; Chromaffin Cells* ; Constriction ; Drug Compounding ; Enkephalin, Methionine ; Immune System ; Nicotine ; Opioid Peptides ; Peptides ; Rats ; Sciatic Nerve ; Spinal Cord ; Subarachnoid Space

BACKGROUND: The intrathecal grafting of adrenal chromaffin cells as a potential analgesic source, to delivery analgesic substances such as catecholamines and opioid peptides, is known to be effective at treating acute and chronic pain in several animal pain models. We tested whether the intrathecal implantation of encapsulated bovine chromaffin cells reduces cold allodynia in a rat model of neuropathic pain induced by chronic constriction injury of the sciatic nerve. METHODS: Bovine adrenal medullary chromaffin cells microencapsulated in sodium alginate-poly-l-lysin-alginate (APA) were implanted into the subarachnoid space of rats (n = 10) and foot cold sensitivity was investigated using an acetone test. At the end of the study, histology and capsule catecholamine production were evaluated. RESULTS: A significant reduction in cold allodynia was observed in animals implanted with chromaffin cells. In addition, the suppression of cold allodynia was reversed by naloxone. Abundant clusters of viable chromaffin cells stained with neutral red, were observed in the retrieved implants and after nicotine stimulation, and catecholamine was quantified. An ultrastructural study showed no fibrotic reaction against capsules, or disorganised capsules. CONCLUSIONS: These results suggest that intrathecal encapsulated chromaffin cells act as "mini pumps", which continuously deliver analgesic substances and produce analgesia in this chronic pain model of nerve injury-without immunosuppressant.
Acetone ; Analgesia ; Animals ; Capsules ; Catecholamines ; Chromaffin Cells* ; Chronic Pain ; Constriction ; Foot ; Hyperalgesia* ; Models, Animal ; Naloxone ; Neuralgia ; Neutral Red ; Nicotine ; Opioid Peptides ; Rats* ; Sciatic Nerve ; Sodium ; Spinal Cord* ; Subarachnoid Space ; Transplants

BACKGROUND: A ring implantation in the tricuspid annulus requires many interrupted mattress sutures for correction of tricuspid regurgitation (TR). In this study, tricuspid ring annuloplasty was performed by 2-0 polypropylene continuous suture instead of multiple interrupted 2-0 polyester mattress sutures, and the efficacy of the method was evaluated. MATERIALS AND METHODS: This study included 20 patients who underwent tricuspid ring annuloplasty by continuous suture between May 2009 and July 2010. Four of the patients had an isolated TR, and the rest had a left-sided cardiac lesion. The concomitant tricuspid annuloplasty was performed after the left-sided heart surgery was completed and a Duran flexible ring prosthesis was used. RESULTS: There was no perioperative mortality or conduction problem. More than a moderate degree of TR was improved to less than a mild degree after the procedure. After the ring annuloplasty, the right atrial volume decreased from 123.7+/-69.2 mL to 74.5+/-37.4 mL, and the mean right atrial pressure was lowered from 18.7+/-12.2 mmHg to 8.9+/-5.5 mmHg. CONCLUSION: The continuous "over and over" suture may be a useful procedure for fixing the ring to the annulus and making an intentional annular placation in performing tricuspid ring annuloplasty.
Atrial Pressure ; Humans ; Polyesters ; Polypropylenes ; Prostheses and Implants ; Sutures ; Thoracic Surgery ; Tricuspid Valve ; Tricuspid Valve Insufficiency