Cryolipolysis has become available for the noninvasive reduction of adipose tissue. A 33-year-old woman presented with wrist drop of the right arm that had first appeared 7 days previously. She had undergone cryolipolysis on both upper arms immediately prior to the onset of symptoms. A nerve conduction study showed radial neuropathy proximal to the elbow, and ultrasonography revealed focal swelling of the radial nerve at the spiral groove. Although cryolipolysis has been known as a safe method, nerve injury can result from compression and/or hypothermia during the procedure.
Adipose Tissue ; Adult ; Arm ; Elbow ; Female ; Humans ; Hypothermia ; Lipolysis ; Methods ; Neural Conduction ; Radial Nerve ; Radial Neuropathy* ; Ultrasonography ; Wrist

BACKGROUND: Portable cardiopulmonary bypass (CPB) technique has been used increasingly as a potent and effective option for emergency cardiopulmonary resuscitation (CPR) because it can maintain more stable hemodynamics and provide better survival than conventional CPR techniques. This study was designed to develop a prototype of Korean portable CPB system and, by applying it to CPR, to discriminate whether it would be superior to standard open-chest CPR. MATERIAL AND METHOD: By using adult mongrel dogs, open-chest CPR (OCPR group, n=4) and portable-CPB CPR (CPB group, n=4) were compared with respects to restoration of spontaneous circulation (ROSC), hemodynamics, effects on blood cells, blood gas patterns, biochemical markers, and survivals. Ventricular fibrillation-cardiac arrest (VF-CA) of arrest (VF-CA) of 4 minutes followed by basic life support (BLS) of 15 minutes was applied in either group, which was standardized by the protocol of American Heart Association. Then, advanced life support (ALS) was applied to either group under the support of internal cardiac massage or CPB. ALS was maintained until ROSC was achieved but not longer than 30 minutes regardless of the presence of ROSC. All of the measured values were expressed as means+/-SD percent change from baseline. RESULT: During the early ALS, higher mean arterial pressure was maintained in CPB group than in OCPR group (90+/-19 vs. 71+/-32 %; p<.05) and lower mean pulmonary arterial pressure was also maintained in CPB group than in OCPR group (105+/-24 vs. 146+/-6%; p<.05). ROSC was achieved in all dogs. Post-ROSC levels of hematocrit, RBC, and platelet were decreased and plasma free hemoglobin was increased significantly in CPB group compared to OCPR group (p<.05). Changes in blood gas patterns, lactate, and CK-MB levels were not different between groups. Early mortality was seen in 3 dogs in OCPR group (survival time 31+/-36 hours) and 2 in CPB group (228+/-153 hours, p=ns). The remainders in both groups showed prolonged survival. CONCLUSION: These findings indicate that portable CPB can be effective to maintain stable hemodynamics during cardiac arrest, to achieve ROSC and to prolong survival. Further study is needed to refine the portable CPB system and to meet clinical challenges.
Adult ; American Heart Association ; Animals ; Arterial Pressure ; Biomarkers ; Blood Cells ; Blood Platelets ; Cardiopulmonary Bypass* ; Cardiopulmonary Resuscitation* ; Dogs* ; Emergencies* ; Heart Arrest* ; Heart Massage ; Hematocrit ; Hemodynamics ; Humans ; Lactic Acid ; Mortality ; Plasma

This study aims to determine the effects of formaldehyde exposure on self-reported symptoms of respiratory-eye mucosa and integumentary system during anatomy practices among Korean medical students. Data were collected using the web-based survey. Study subjects in 1st and 2nd grade medical student, and having anatomy dissection in medical college and medical graduate school. A total of 463 students from the 14 medical college and medical graduate school participated in this study. The results show that 261 (56.4%) of the participants responded feeling discomfort above moderate at anatomy dissection. After anatomy dissection, 104 (43.2%) students responded aggravating the symptom allergic rhinitis, xerophthalmia and so on. 209 (95.0%) of them responded the new symptom's appearance. In the result of multiple logistic regression, women (OR: 2.000, 95% CI: 1.169~3.421) and the students with feeling discomfort (OR: 3.190, 95% CI: 1.807~5.632) were more likely to increase the risk of pre-existing respiratory · eye mucosal system symptom's aggravation than the counter parts. For pre-existing integumentary system symptom's aggravation, risk is significantly higher in elder age group (OR: 2.612, 95% CI: 1.187~5.750) and with disapproval protective equipments (OR: 2.217, 1.006~4.885). In case of new symptom's appearance, people with feeling discomfort above moderate (OR: 5.097, 95% CI: 1.075~24.160) in respiratory · eye mucosal system were more likely to increase the risk of new symptom's appearance. And for integumentary system, risk was higher in people with feeling discomfort (OR: 1.921, 95% CI: 1.218~3.031), in woman (OR: 1.711, 1.090~2.686) and without enough protective equipments preparation (OR: 1.953, 1.189~3.210). This study confirms the protective equipments for minimizing exposure from chemicals for cytological fixation (e,g formaldehyde) is not worn enough and students in anatomy dissection experience discomfort and disease after anatomy dissection. Therefore, this study indicates that the safe guideline in anatomy dissection should be enhanced and institutional strategy to protect student's right of health should be provided.
Female ; Formaldehyde* ; Humans ; Integumentary System* ; Logistic Models ; Mucous Membrane* ; Rhinitis, Allergic ; Students, Medical* ; Xerophthalmia

Methods: In the breast cancer registry of our institution, 18,790 patients received curative surgery for stage I–III breast cancer between January 1995 and June 2016. Of those patients, only 87 (0.5%)underwent salvage local treatment for isolated nodal recurrence on the axillary lymph nodes (ALNs) (n = 58), supraclavicular lymph nodes (SCNs) (n = 17), or internal mammary lymph nodes (IMNs) (n = 12). Results: The median follow-up duration after regional oligo-recurrence was 49 months (range: 6–194 months). For patients with recurrence of ALN, SCN, or IMN, the 5-year progression-free survival (PFS) and overall survival (OS) rates were 40.0%, 32.1%, and 25.0%, respectively (p = 0.3) and 62.7%, 70.0%, and 58.3%, respectively(p = 0.97). In the multivariable analysis for PFS, age at recurrence ≥ 65 years, disease-free interval < 24 months, non-luminal A subtype, and in-field failure (marginally significant) were found to be risk factors (RFs). However, the location of the tumor was not a significant factor for PFS (p = 0.71). When we stratified patients by the number of RFs, the 5-year PFS rates were 67.5% for patients with ≤ 1 RF and 7.3% for those with > 1 RF (p < 0.01). For patients with ≤ 1 RF, the 5-year PFS rates were 73.5% in the ALN group and 51.1% in the SCN/IMN group (p = 0.09).For patients with > 1 RF, the 5-year PFS rates were 7.3% in the ALN group and 7.1% in the SCN/IMN group (p = 1.00). Conclusion In breast cancer patients with regional oligo-recurrence, clinical outcomes after salvage treatment were favorable in patients with ≤ 1 RF, while patients with > 1 RF had poor prognoses irrespective of the location of recurrence.

BACKGROUND: Effective cardiopulmonary resuscitation (CPR) should provide acceptable hemodynamics for the vital organs during cardiac arrest and early restoration of spontaneous circulation that guarantees long-term, neurologically intact survival. CPR using heart-lung bypass has been suggested as an option for that use. This study was designed to determine the effectiveness of standard CPR techniques, closed-vs. open-chest CPR, which could be used in the future study verifying the role of heart-lung bypass CPR. MATERIAL AND METHOD: By using adult mongrel dogs, closed-chest CPR (CCCPR, n=4) and open-chest CPR (OCCPR, n=5) were compared with respects to hemodynamics, restoration of spontaneous circulation (ROSC), and survival. Ventricular fibrillation-cardiac arrest (VF-CA) was induced by electrical shock in all animals. After 4 minutes of cardiac arrest, basic life support (BLS) was applied for 15 minutes and followed by advanced life support (ALS). ALS was maintained until achi ving ROSC but not longer than 30 minutes regardless of the recovery. Resuscitation procedures in either group were standardized by adopting the protocol of American Heart Association. RESULT: Prearrest baseline hemodynamic data was not different between two groups. During resuscitation, substantially higher systolic pressure was maintained in OCCPR group than in CCCPR group (45+/-15 vs. 33+/-11 mmHg during BLS, 83+/-36 vs. 44+/-15 mmHg during ALS; p=NS). Mean pulmonary arterial pressure went up to the level of mean systemic arterial pressures in CCCPR group and to half of that in OCCPR group, and had kept higher in CCCPR group throughout CPR (32+/-10 vs. 22+/-4 mmHg during BLS and 32+/-15 vs. 24+/-10 mmHg during ALS; p=NS). ROSC was obtained in 4 of 5 dogs receiving open-chest CPR and 2 of 4 closed-chest CPR. Prolonged survival was noted in all dogs in OCCPR group (6 to 1440 hours) but not in CCPR group (p<.05). CONCLUSION: These findings indicate that open-chest CPR can be more effective t maintain hemodynamics during cardiac arrest and to obtain restoration of spontaneous circulation and survival. Further experiment will be designed to compare heart-lung bypass CPR with open-chest CPR.
Adult ; American Heart Association ; Animals ; Arterial Pressure ; Blood Pressure ; Cardiopulmonary Bypass* ; Cardiopulmonary Resuscitation ; Dogs ; Heart Arrest ; Hemodynamics ; Humans ; Resuscitation ; Shock ; Ventricular Fibrillation

BACKGROUND: Recent technological developments have introduced a new method to identifying M. tuberculosis complex DNA in clinical samples directly. The direct amplification test (DAT) is approved for identifying M. tuberculosis complex in respiratory specimens that are smear-positive for acid-fast bacilli (AFB). When there is a discrepancy between the AFB smear and DAT, no information on their clinical utility is currently available. In this study, the diagnostic reliability of DAT was investigated in suspected pulmonary tuberculosis patients whose sputum AFB smear was negative. METHODS: From June 1, 1998 through May 30, 1999, 909 patients with presumed active pulmonary tuberculosis were enrolled. A sputum AFB stain, culture, DAT and /or biopsy were performed. using the criteria of clinical tuberculosis or confirmed tuberculosis, the positive predictive value of DAT in diagnosing pulmonary tuberculosis was investigated. RESULTS: The positive predictive value of DAT was 82.1% by the clinically active tuberculosis criteria. However, it decreased to 61.5% when diagnosis was restricted to only to culture positive or biopsy proven cases. The false positive rate of DAT was 18.0%. CONCLUSION: The DAT is a valuable diagnostic method in suspected patients whose sputum AFB is was negative.
Biopsy ; Diagnosis* ; DNA ; Humans ; Polymerase Chain Reaction* ; Sputum* ; Tuberculosis ; Tuberculosis, Pulmonary*

It has been hypothesized that jobs that have both high psychological demands and low decision latitude ('job strain") can lead to musculoskeletal disorder. The objective of this study was to test whether job strain was correlated with the presence of work-related musculoskeletal disorder, especially myofascial pain syndrome (MPS). Information on demographic factors, confounders such as household load and taking care of children or not, and scores for decision latitude, job demand, and social support was obtained by self-administered questionnaire, which had been developed in Korean language, by adopting NIOSH instrument and Extended Karasek Model (16 items). All subjects were also examined by rehabilitation medicine specialists for musculoskeletal disorders. Subjects (n=370) could be categorized into 4 groups, these were, housewives(n=89), shipyard CAD workers(n=89), general female workers(n=79; nurses, insurance counselors, public officials, clerks, etc), and telephone directory assistance operators(n=113). Results from univariate analyses indicated that all demographic factors, all confounders, scores for decision latitude and social support were not associated with the risk of musculoskeletal disorder. However, score for job demand was higher in musculoskeletal disorder cases than others. In subgroup analysis, this association was convinced again, in telephone directory assistance operators. Job strain model showed that the group of telephone directory assistance operators was high-strain group, and OR of musculoskeletal disorder was 2.446 (95% C.I. : 1.174, 5.096), when comparing this with the low strain group. In conclusion, job strain is a risk factor for work-related musculoskeletal disorder.
Child ; Counseling ; Demography ; Family Characteristics ; Female ; Humans ; Insurance ; Myofascial Pain Syndromes ; National Institute for Occupational Safety and Health (U.S.) ; Questionnaires ; Rehabilitation ; Risk Factors ; Specialization ; Telephone

PURPOSE: To evaluate the use of CT in patients with vocal cord paralysis due to extralaryngeal cause s ,andto use CT for the assessment of extralaryngeal diseases causing vocal cord paralysis. MATERIALS AND METHODS: Weprospectively studied the results of CT in 41 patients with vocal cord paralysis in whom laryngoscopy revealed nolaryngeal cause and physical examination demonstrated no definite extralaryngeal cause. The extralaryngeal causeof vocal cord palsy was determined after comprehensive clinical diagnosis. Enhanced CT scans were acquired fromthe skull base and continued to the level of the aorticopulmonary window. We used CT to assess the detection ratefor extralaryngeal causes and to extimate the extent of extralaryngeal disease and the distribution of lesions. RESULTS: CT revealed that in 20 of 41 patients(49%) the extralarygeal causes of vocal paralysis were as follows :thyroid cancer(n=10), nodal disease(n=6), esophageal cancer(n=2), neurogenic tumor(n=1), aortic aneurysm(n=1).Lesions were located on the left side in 13 patients(65%), and in the tracheoesophageal groove in 15(75%). CONCLUSION: In patients with vocal cord paralysis in whom no definite lesion is seen on physical examination, CT could be a useful primary imaging method for the assessment of extralaryngeal causes.
Diagnosis ; Humans ; Laryngoscopy ; Paralysis ; Physical Examination ; Skull Base ; Thyroid Gland ; Tomography, X-Ray Computed ; Vocal Cord Paralysis* ; Vocal Cords*

To clarify the prognostic factors influencing clinical outcome, the authors retrospectively analyzed 50 cases of thoracolumbar vertebral junction fracture treated at our hospital between September 1989 and October 1992. The age of the patients ranged from 23 to 75 years(median 49 years) and the male-to-female ratio was 33:17. Falling was the major mode of injury(m=27). The kyphotic angle between fractured vertebrae and the ratio of neural canal encroachment was measured in a simple X-ray and a computed tomography(CT) of the thoracic spine. An ANOVA test was performed to evaluate the predicting factors to determine the final outcome. The kyphotic angle and loss of height of vertebral body were not significantly correlated with the neurological status of the patients. However, the ratio of the compromised area of the neural canal was closely correlated with the neurological outcome(p value<0.05). The worst prognosis was found in patients with fracture-dislocation. In conclusion, it is suggested that early surgical intervention must be considered in the neurologically compromised patients whose CT demonstrates neural canal encroachment by bony fragments.
Humans ; Neural Tube ; Prognosis ; Retrospective Studies ; Spine

To clarify the prognostic factors influencing clinical outcome, the authors retrospectively analyzed 50 cases of thoracolumbar vertebral junction fracture treated at our hospital between September 1989 and October 1992. The age of the patients ranged from 23 to 75 years(median 49 years) and the male-to-female ratio was 33:17. Falling was the major mode of injury(m=27). The kyphotic angle between fractured vertebrae and the ratio of neural canal encroachment was measured in a simple X-ray and a computed tomography(CT) of the thoracic spine. An ANOVA test was performed to evaluate the predicting factors to determine the final outcome. The kyphotic angle and loss of height of vertebral body were not significantly correlated with the neurological status of the patients. However, the ratio of the compromised area of the neural canal was closely correlated with the neurological outcome(p value<0.05). The worst prognosis was found in patients with fracture-dislocation. In conclusion, it is suggested that early surgical intervention must be considered in the neurologically compromised patients whose CT demonstrates neural canal encroachment by bony fragments.
Humans ; Neural Tube ; Prognosis ; Retrospective Studies ; Spine