Purpose: The purpose of this study was to prepare guidelines for the treatment of COVID-19-positive hip fractures based on the treatment experience of patients with COVID-19-positive hip fractures admitted to a COVID-19-dedicated hospital. Materials and Methods: A retrospective analysis was performed on COVID-19-positive elderly hip fracture patients treated at a COVIDdedicated hospital when the number of domestic COVID-19 infections increased rapidly. The treatment results were analyzed by comparing the complications of patients who underwent surgery at a COVID-dedicated hospital and those who did not, the time taken from surgery to surgery, and the number of visits to medical institutions. Results: The average surgery time for COVID-19 hip fracture patients in the author’s hospital was 3.74 days from the date of injury, and it took an average of 12.8 days for surgery at other hospitals. The average number of patients who visited medical institutions was 3.33 locations in the group who did not undergo surgery at the author’s hospital, which was significantly higher than the 2.83 locations in the group who had surgery. Among the patients unable to undergo surgery, no patient could not undergo surgery due to serious reasons. Conclusion The explosive increase in COVID-19 infections has delayed the time of surgery for COVID-19-positive elderly patients with hip fractures and increased the transfer rate of medical institutions, even for relatively non-dangerous causes. Clear criteria for treatment and effective policies are needed to prevent delay delays in treatment.

No abstract available.
Leiomyoma*

PURPOSE: To evaluate the embolic effect and pathologic change in the kidney after infusion of 50% acetic acidin the renal artery. MATERIALS AND METHODS: Five kidneys were embolized with 50% acetic acid mixed with saline(group A) and five were embolized with 50% acetic acid mixed with contrast medium (group B). Four rabbits(2 fromgroup A and 2 from group B) were sacrificed during the first day and the remaining six, 28 days afterembolization. To determine the effect of embolization and pathologic findings, the two groups were compared. RESULTS: Complete occlusion of the renal artery was observed in both groups; histologic findings indicatingtubular necrosis and blood clots within the renal artery were noted one day after embolization. After four weeks,complete necrosis of the renal arterial wall and tubular cells had occurred. The procedures required forembolization were easier in group B because the extent of embolization could be controlled by fluoroscopy. CONCLUSION: At 50% dilution after mixing with contrast medium, the embolie effect of acetic acid isperfect;because the embolic material is visualised the procedure was easier to control than embolization withalcohol. acetic acid can, threrfore, be used as an effective embolic agent in renal artery embolization.
Acetic Acid* ; Fluoroscopy ; Kidney ; Necrosis ; Rabbits* ; Renal Artery*

OBJECTIVE: The lateral extracavitary approach(LECA) to the thoracolumbar spine is known as one of procedure which allows not only direct vision of pathologic lesion, but also ventral decompression, and dorsal fixation of the spine through the same incision. However, some drawbacks of LECA, including the technically- demanding, time-consuming, unfamiliar surgical anatomy and excessive blood loss, make surgeons to hesitate to use this approach. This study is to provide the surgical anatomy of LECA using cadavers, for detailed informations when LECA is considered for the surgery. METHODS: We performed the 10 cadaveric studies, 7 male and 3 female, and careful dissection was carried out on right side of thoracolumbar region, except one for thoracic region. The photographs with micro-lens were taken to depict the close-up findings and for demonstrating detailed anatomy. RESULTS: The photographs and hand-drawings demonstrated the relationships among the musculature, segmental vessels and nerve roots seen during each dissection plane. The lateral branches of dorsal rami of spinal nerve and the transverse process were confirmed to be the most important landmark of this approach. CONCLUSION: We concluded that detailed anatomical findings for LECA through this step-by-step dissection would be useful during operative intervention to reduce the intraoperative complications in LECA.
Cadaver* ; Decompression ; Female ; Humans ; Intraoperative Complications ; Male ; Spinal Nerves ; Spine*

BACKGROUND/AIMS: Superficial esophageal squamous cell carcinoma (SESCC) is being increasingly detected during screening endoscopy. Endoscopic submucosal dissection (ESD) allows for en bloc and histologically complete resection of lesions. This study assessed the technical feasibility and long-term outcomes of ESD for SESCCs. METHODS: Between January 2005 and August 2012, 27 patients with 28 SESCCs underwent ESD at Pusan National University Hospital. The en bloc and pathologically complete resection rates, complication (perforation and bleeding) rate, incidence of esophageal stricture after ESD, and overall and disease-specific survival rates were evaluated. RESULTS: The en bloc and pathologically complete resection rates were 93% and 83%, respectively. No significant bleeding occurred, and perforation with mediastinal emphysema was observed in two patients (7%). Post-ESD stricture occurred in two patients (7%) who had mucosal defects involving more than three-fourths of the esophageal circumference. During a mean follow-up of 23 months, local tumor recurrence was seen in two of four lesions with pathologically incomplete resection; one was treated by re-ESD, and the other was treated by surgical esophagectomy. The 5-year overall and disease-specific survival rates were 84% and 100%, respectively. CONCLUSIONS: ESD seems to be a feasible, effective curative treatment for SESCCs. All patients should be closely followed after ESD.
Aged ; Carcinoma in Situ/pathology/*surgery ; Carcinoma, Squamous Cell/pathology/*surgery ; Cohort Studies ; Disease-Free Survival ; Dissection ; Esophageal Neoplasms/pathology/*surgery ; Esophageal Perforation ; Esophageal Stenosis ; Esophagoscopy ; Female ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Mucous Membrane/pathology/*surgery ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local/*pathology ; Operative Time ; *Postoperative Complications ; Postoperative Hemorrhage ; Retrospective Studies ; Treatment Outcome ; Tumor Burden

A coronary arteriovenous fistula consists of a communication between a coronary artery and a cardiac chamber, a great artery or the vena cava. It is the most common anomaly that can affect coronary perfusion. Bilateral involvement of coronary fistula, however, constitutes an uncommon subgroup of coronary arteriovenous fistulas. We report a case which shows a rare occurrence of bilateral coronary arteriovenous fistula coexistent with atrial septal defect and pulmonic stenosis.
Arteries/abnormalities ; Arteriovenous Fistula/complications* ; Case Report ; Coronary Vessel Anomalies/complications* ; Heart Septal Defects, Atrial/complications* ; Human ; Male ; Middle Age ; Pulmonary Valve Stenosis/complications* ; Veins/abnormalities

PURPOSE: The purpose of this study was to establish optimal imaging acquisition conditions for the GE Advance(TM) PET imaging system by performing the acceptance tests designed by National Electrical Manufacturers Association (NEMA) protocol and General Electric Medical Systems (GEMS) test procedures. MATERIALS AND METHODS: Performance tests were carried out with 18FDG radioactivity source and phantoms by using a standard acquisition mode. Transaxial resolution and scatter fraction tests were performed with a line source and axial resolution with a point source, respectively. A cylindrical phantom made of polymethylmethacrylate (PMMA) was used to measure sensitivity, count rate losses and randoms, uniformity correction, and attenuation inserts were added to measure remaining tests. The test results were acquired in a diagnostic acquisition mode and analyzed mainly on high sensitivity mode. RESULTS: Transaxial resolution and axial resolution were measured as average of 4.65 mm and 3.98 mm at 0 cm, and 6.02 mm and 6.71 mm at 20 cm on high sensitivity mode, respectively. Average scatter fraction was 9.87%, and sensitivity was 225.8 kcps/micronCi/cc of trues. Activity at 50% deadtime was 4.6 Ci/cc, and the error of count rate correction at that activity was from 1.49% to 3.83%. Average nonuniformity for total slice was 8.37%. The accuracy of scatter correction was -0.95%. The accuracies of attenuation correction were 5.68% for air, 0.04% for water and -6.51% for polytetrafluoroethylene (PTFE). CONCLUSION: The results satisfied most acceptance criteria, indicating that the GE AdvanceTM PET system can be optimally used for clinical applications.
Electrons* ; Fluorodeoxyglucose F18 ; Polymethyl Methacrylate ; Polytetrafluoroethylene ; Positron-Emission Tomography* ; Radioactivity ; Water

PURPOSE: The increased tolerability of enteric-coated mycophenolate sodium (EC-MPS), compared to mycophenolate mofetil, among kidney transplant recipients has the potential to facilitate cyclosporine (CsA) minimization. Therefore, a prospective trial to determine the optimum EC-MPS dose in CsA-based immunosuppression regimens is necessary. MATERIALS AND METHODS: A comparative, parallel, randomized, open-label study was performed for 140 patients from four centers to compare the efficacy and tolerability of low dose CsA with standard dose EC-MPS (the investigational group) versus standard dose CsA with low dose EC-MPS (the control group) for six months in de novo kidney transplant recipients. Graft function, the incidence of efficacy failure [biopsy-confirmed acute rejection (BCAR), death, graft loss, loss to follow-up], and adverse events were compared. RESULTS: The mean estimated glomerular filtration rate (eGFR) of the investigational group at six months post-transplantation was non-inferior to that of the control group (confidence interval between 57.3 mL/min/1.73m² and 67.4 mL/min/1.73 m², p<0.001). One graft loss was reported in the control group, and no patient deaths were reported in either group. The incidence of BCAR of the investigational group was 8.7%, compared to 18.8% in the control group (p=0.137), during the study period. There were no significant differences (p>0.05) in the incidence of discontinuations and serious adverse events (SAE) between the groups. CONCLUSION: CsA minimization using a standard dose of EC-MPS kept the incidence of acute rejection and additional risks as low as conventional immunosuppression and provided therapeutic equivalence in terms of renal graft function and safety issues.
Adult ; Aged ; Cyclosporine/*administration & dosage ; Female ; Graft Rejection/*prevention & control ; Humans ; Immunosuppressive Agents/*administration & dosage ; Incidence ; Kidney Transplantation ; Male ; Middle Aged ; Mycophenolic Acid/*administration & dosage ; Prospective Studies ; Tablets, Enteric-Coated ; Time Factors

BACKGROUND: To investigate the mechanisms of myocardial ischemia induced changes of electrophysiological properties, influences of various ischemic-simulated Tyrode's solutions on the changes of action potential characteristics were examined. METHOD: Action potential characteristics were measured during superfusion with various ischemic-simulated solutions (modified physiologic salt solution: MPSS) by the method of conventional microelectrode technique in rat atrial fibers. RESULTS: Hypoxic-, hyperkalemic-, and mixed-MPSS decreased 'maximum diastolic potential' (MDP) and 'action potential amplitude' (APA), however, no significant changes of MDP and APA were observed by acidic- and glucose-free-MPSS. 'Maximum velocity of phase 0 depolarization' (dV/dt(max)) and 'time for 90% repolarization' (APD90) significantly decreased during hypoxic- and mixed-MPSS superfusion, and hyperkalemic-MPSS also decreased the dV/dt(max) and APD90. However, no significant changes in dV/dt(max) and APD90 were observed by acidic- and glucose-free-MPSS. The decreasing effects of dV/dt(max) and APD90 by the MPSSes were attenuated when the MPSSes were replaced with normal Tyrode's solution. DPCPX (2x10(-6)M), a purinergic antagonist, inhibited the decreasing effects of APD90 at 5, 10, and 20 min superfusion of the mixed-MPSS, and glibenclamide (10(-6)M), a K(ATP) channel blocker, inhibited those at 10 and 20 min superfusion of the mixed-MPSS. Diclofenac (10(-6)M), a cyclooxygenase inhibitor inhibited only those at 20 min superfusion of the mixed-MPSS. CONCLUSION: The primary factors for changing the electrophysiological characteristics during ischemic insults could be hypoxia and high-extracellular K+, and the mechanisms of the electrophysiological changes are inferred that adenosine through purinoceptors is involved initially, and followed by K(ATP) channel and prostanoids.
Action Potentials* ; Adenosine ; Animals ; Anoxia ; Diclofenac ; Glyburide ; Ischemia ; Microelectrodes ; Myocardial Ischemia ; Prostaglandin-Endoperoxide Synthases ; Prostaglandins ; Rats* ; Receptors, Purinergic

Despite the well-known bleeding diathesis in patients with end-stage liver disease, inappropriate hypercoagulation is also emerging as a major concern. Pulmonary thromboembolism (PTE) is a major cause of perioperative morbidity and mortality during liver transplantation (LT). Flat-line thromboelastography is reported to predict PTE during LT. In this case, a 52-year-old woman with hepatocellular carcinoma underwent living-related LT. During the pre-anhepatic phase, one unit of apheresis platelets was transfused because of thrombocytopenia (32,000 /ml). After 20 minutes, blood pressure became unstable and circulatory collapse suddenly developed. In the middle of cardiopulmonary resuscitation, transesophageal echocardiography was immediately conducted, which revealed flail thrombi in the right atrium. Rotational thromboelastometry (ROTEM) conducted at that time was surprisingly flat in 4 channels, contradictory to the finding of hypercoagulation. This finding lead to a management dilemma during LT. Flattening in ROTEM requires caution in interpretation of severe hypocoagulation or ongoing PTE.
Blood Component Removal ; Blood Platelets* ; Blood Pressure ; Carcinoma, Hepatocellular ; Cardiopulmonary Resuscitation ; Disease Susceptibility ; Echocardiography, Transesophageal ; Female ; Heart Atria ; Hemorrhage ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Middle Aged ; Mortality ; Platelet Transfusion* ; Pulmonary Embolism* ; Shock ; Thrombelastography* ; Thrombocytopenia