Bone marrow aspirate concentrate and matrix-induced chondrogenesis (BMIC) is an interesting treatment option for osteochondral lesions of the talus with promising short- to mid-term results. The various terminologies used to describe this surgical method need to be addressed. These include bone marrow-derived cell transplantation, matrix-induced bone marrow aspirate concentrate, and matrixassociated stem cell transplantation. BMIC is a one-stage, minimally invasive surgery performed arthroscopically or using a mini-open arthrotomy approach without a malleolar osteotomy in most cases. The lesion is replaced with hyaline-like cartilage, and treatmentrelated complications are rare. BMIC is a safe and effective treatment option and should be considered in large lesions or lesions with a prior treatment history.

BACKGROUND: Various hemodynamic changes occur during left ventriculography, such as myocardial depression, hypotension, peripheral circulatory changes, ECG changes(such as arrhythmias and conduction abnormalities) and anaphylactic reaction etc. These effects are somewhat caused by osmolality, ionic concentration of Na+, viscosity and molecular weight of contrast dye and underlying various heart disease itself during left ventriculography. We compared the hemodynamic differences between ionic(ioxaglate) and non-ionic(iopromide) low osmolar contrast agents during routine ventriculography. METHODS: In a prospective, randomized, double blind study of 124 patients underwent left ventriculography, we examined the various hemodynamic effects of the two contrast agents on left ventricle. All subjects were divided into 2 groups : ioxaglate and iopromide groups. Also, each agent was used in randomized double blind fashion in both groups ; normal control subjects(14 in ioxaglate group : 12 in iopromide group) and subjects whose ejection fraction less than 50%(12 in ioxaglate group : 16 in iopromide group). Left ventricular systolic pressure(LVSP), left ventricular end-diastolic pressure(LVEDP), maximum dP/dt, (dP/dt)/P ratio, peak - dP/dt and Tau were obtained immediately before and left ventriculography. RESULTS: 1) In total(normal+angina+MI) subjects of both groups, LVEDP(p<0.001) and maximum dP/dt(p<0.001) were increased and T(au) was reduced significantly(p<0.05). But LVSP(p<0.001) and peak - dP/dt(p<0.005) were increased significantly only in ioxaglate group. 2)In normal(control) subjects, there were no significant differences in both groups, except LVEDP that was increased by equal magnitude(p<0.001). 3) In subjects with ejection fraction less than 50%, there were no significant hemodynamic differences in both contrast agent groups bur LVEDP increased significantly in both groups(p<0.001). CONCLUSIONS: This present study showed that both ionic(ioxaglate) and non-ionic(iopromide) low osmolar contrast agents were very safe without any significant side effects except two agents caused an increase in LVEDP and did not show major differences between ioxaglate and iopromide contrast agents from a hemodynamic point of view. Two contrast agents tend to improve contractilities and diastolic properties of left ventricle since both caused an increase in maximum dP/dt and a reduce in Tau, in total subjects. This effect may be caused by cardiac compensation, probably because of osmolality, volume loading by contrast agents and secondary activation of sympathetic system immediately after injection of contrast agents. Thus, it is concluded that two ioxaglate and iopromide contrast agents amy be used safely in left ventriculography in patients with and without left ventricular dysfunction, with paying attention to an increase in LVEDP.
Anaphylaxis ; Arrhythmias, Cardiac ; Compensation and Redress ; Contrast Media* ; Depression ; Double-Blind Method ; Electrocardiography ; Heart Diseases ; Heart Ventricles ; Hemodynamics* ; Humans ; Hypotension ; Ioxaglic Acid ; Molecular Weight ; Osmolar Concentration ; Prospective Studies ; Ventricular Dysfunction, Left ; Viscosity

Sweet's syndrome is an acute febrile neutrophilic dermatosis that occurs with malignant disease, mainly myeloid hemopathies, in about 20% of cases. When associated with myelodysplasia, clinical and histologic features of Sweet's syndrome can be atypical; however its significance is still debated. We encountered a case of Sweet's syndrome associated with myelodysplastic syndrome in a 63-year-old woman. The clinical presentation strongly suggested Sweet's syndrome but, histopathologic examination showed dense histiocytic infiltration with prominent upper dermal edema and little neutrophil infiltration. In the evaluation for atypical histopathology and laboratory abnormalities, she was diagnosed with myleodysplastic syndrome by peripheral blood smear and bone marrow biopsy. Histiocytoid Sweet's syndrome is a currently accepted concept and probably has a close relation with underlying myeloid hemopathies.
Biopsy ; Bone Marrow ; Edema ; Female ; Humans ; Middle Aged ; Myelodysplastic Syndromes* ; Neutrophil Infiltration ; Sweet Syndrome*

PURPOSE: This study was conducted in order to evaluate effect and efficiency of selective spinal nerve root block for neuropathic pain patients with lower leg radiating pain. MATERIALS AND METHODS: A total of 113 patients were evaluated and follow-up periods were a minimum of 12 months. They were divided into two groups: group A included 41 patients with neuropathic pain and group B included 72 patients with simple lower leg radiating pain. RESULTS: Fourteen (34.1%) patients in group A and 45 (62.5%) patients in group B had favorable results for selective spinal nerve block (p<0.05). Visual analog scale (VAS) was improved from 7.57 to 5.23 at 12 months in group A and from 7.11 to 3.49 at 12 months in group B. CONCLUSION: The initial treatment period for group A was significantly later than in group B. For patients with neuropathic pain and radiculopathy, early assessment was recommended and early selective spinal nerve block could be a good treatment option for neuropathic pain patients.
Follow-Up Studies ; Humans ; Leg ; Neuralgia* ; Radiculopathy* ; Spinal Nerve Roots* ; Spinal Nerves ; Visual Analog Scale

PURPOSE: This study was conducted to identify predictors of serious poisoning in patients with snake bite based on initial findings. METHODS: We conducted a retrospective study of patients with snake bite who were treated at the emergency department between January 2010 and December 2016. The patients were divided into two groups according to the severity of symptoms based on the traditional snakebite severity grading scale. The mild poisoning group (MP) was classified as those who had a grade I snakebite severity during the hospital stay, and the severe poisoning group (SP) was classified as patients who had grade I at the time of admission, but progressed to grade II-IV during hospitalization. Initial clinical manifestations and laboratory findings of the two groups were compared. RESULTS: Bite to hospital time intervals of SP were longer than those of MP (p=0.034), and the local effect score (LES) was higher in SP (p<0.001). Laboratory analyses revealed that creatine phosphokinase (p=0.044), creatine phosphokinase MB isoenzyme (CK-MB, p=0.011) and serum amylase (p=0.008) were significantly higher in SP. LES, CK-MB and serum amylase were significant prognostic predictors as indicated by univariate logistic regression analysis. Multivariate analysis revealed the following two significant predictors: LES (odds ratio=3.983, p<0.001) and serum amylase (odds ratio=1.020, p=0.017). CONCLUSION: In managing cases of snake bites, clinical manifestations and laboratory findings must be carefully evaluated. LES and serum amylase are predictive factors for severe poisoning, which is especially important to rapid determination of the intensive care of the patient.
Amylases ; Creatine Kinase ; Critical Care ; Emergencies* ; Emergency Service, Hospital* ; Hospitalization ; Humans ; Length of Stay ; Logistic Models ; Multivariate Analysis ; Poisoning ; Retrospective Studies ; Snake Bites* ; Snake Venoms ; Snakes*

With the increase of industrialization, leisures, sports activities and traffic, the risk of trauma has increased markedly. Midfacial bones are relatively common sites of trauma, and are difficult sites of correct reduction and reconstruction, because midface is composed of mostly thin cortical bone surrounding cavities filled with either air or fat with discrete areas of bony condensation. A clinical study on 208 patients with midfacial bone fracture who visited Sanggye Paik Hospital during 5 years(1990~1995) was done by analyzing sex, age, cause, fracture site, treatment method, complication and involvement of other body part, etc. The results obtained were as follows : 1. The occurrence was more frequent in male than in female with ratio of 2.7 : 1 and most frequently in twenties. 2. Traffic accident was the most common cause of midface fractures. 3. Zygoma was the most frequently occurred site(50%) of midface fractures. 4. Simple fracture(75%) was more frequently occurred than compound fracture(25%). 5. As treatment method, open reduction(76.4%) was used more frequently than closed reduction(23.6%) 6. Generally, operations are done in 5 days after admission(59.1%), and intermaxillary fixation was done in 78.4% of cases. 7. Teeth and alveolar bone damages were occurred in 32.2% of cases. 8. Other injuries that were related to midface fracture occurred in 63.3% of cases. 9. Post-operative complications occurred in 9% of cases.
Accidents, Traffic ; Female ; Fractures, Bone ; Humans ; Leisure Activities ; Male ; Sports ; Tooth ; Zygoma

BACKGROUND: Intravenous fentanyl has been used for acute postoperative pain management, but has not always provided reliable adequate analgesia, including patient-controlled analgesia (PCA). The purpose of this study was to investigate the efficacy of time-scheduled decremental infusion of fentanyl for postoperative analgesia. METHODS: Ninety-nine patients, aged 20-65 years, undergoing laparoscopic-assisted hysterectomy using total intravenous anesthesia (TIVA) were randomly assigned into one of the three groups. Their background infusions of fentanyl diluent (2 ml/hr of diluent was equivalent with 0.5 microg/kg/hr of fentanyl) with PCA were maintained at the fixed-rate of 2 ml/hr until the postoperative 24 hr (FX2-2-2), or at the decremental rates of 6.0, 4.0, 2.0 ml/hr (D6-4-2) and 8.0, 4.0, 2.0 ml/hr (D8-4-2). The visual analogue score (VAS), incidence of inadequate analgesia, frequency of PCA intervention, and side effects were evaluated. RESULTS: VAS was significantly higher in FX2-2-2 than in D6-4-2 and D8-4-2 until postoperative 3 hr (P < 0.05). After postoperative 4 hr, VAS was significantly higher in FX2-2-2 than D8-4-2 (P < 0.05). The incidence of inadequate analgesia of FX2-2-2 was significantly greater than D6-4-2 (P = 0.038) and D8-4-2 (P < 0.001) until postoperative 1 hr. None of the patients had ventilatory depression, and postoperative nausea and vomiting were not significant among the groups. CONCLUSIONS: The time-scheduled decremental background infusion regimens of fentanyl, based on the pharmacokinetic model, could provide more effective postoperative pain management after TIVA, and the side effects and the risk for morbidity were not different from the fixed-rate infusion regimen.
Analgesia ; Analgesia, Patient-Controlled* ; Anesthesia, Intravenous* ; Fentanyl* ; Humans ; Hysterectomy ; Incidence ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Respiratory Insufficiency

We present a case of recurrent left atrial myxoma which occurred 7 years and 10 months after initial operation despite resection of originaltumor and adjacent atrial septum. This is the first case report of recurrence in Korea. Among the possible causes of recurrence, regrowth from pretumorous focus seems to be the most suggesting one in this case. Histopathologic findings of recurrent myxoma showed increased cellularity with active proliferation and nuclear hyperchromasia. These findings, together with the rapidity of regrowth, suggest that recurrent myxoma may have 'wilder' behavior. Prolonged postoperative observation is important, even if ample resection was done at the initial operation including atrial septum.
Atrial Septum ; Korea ; Myxoma* ; Recurrence*

BACKGROUND: The present work was designed to examine the altered expression of peritoneal AQP-1 and water transport of peritoneal membrane during the long-term peritoneal dialysis with hypertonic glucose solution in rats. METHODS: Eighteen Sprague-Dawley male rats were randomly divided into 2 groups: control rats (n=6) with peritoneal catheter but not dialyzed; rats with peritoneal dialysis (PD) (n=12) were dialyzed with 4.25% glucose dialysate for all exchanges. Before completion of the study, 4 animals in PD group were euthanized owing to nonfunctional catheters or peritonitis, leaving 14 animals for the analysis. Dialysis exchanges were performed 3 times a day with 25 mL/each exchange for 12 weeks. Immunoperoxidase staining was performed using monoclonal anti-AGE antibody and polyclonal anti-AQP-1 antibody. The slides were read by 5 different examiners in a blind fashion. The staining intensity was graded semiquantitively from 0 to 3. The peritoneal membrane function was assessed by performing one-hour peritoneal equilibration tests every 6 week for comparing transport characteristics. Peritoneal membrane transport rate was assessed by D/P of urea nitrogen and D/Do of glucose. Water transport of peritoneal membrane was assessed by D/P of sodium at 12 week. RESULTS: The expression of peritoneal AQP-1 was increased in rats with PD, compared to control rats. Consistent with this, D/P of sodium in rats with PD was significantly decreased compared to control rats (0.58+/-0.04 vs 0.86+/-0.07, p<0.05), indicating high peritoneal water permeability in response to long-term peritoneal dialysis. Moreover, rats with PD were associated with significantly lower D/Do of glucose and higher D/P of urea nitrogen, suggesting high peritoneal membrane transport. CONCLUSION: High expression of peritoneal AQP-1 was associated with an increased peritoneal water permeability in response to long-term peritoneal dialysis with 4.25% glucose for 12 weeks. The underlying mechanisms for the increased AQP-1 expression need to be examined whether it is due to the continuous exposure to the dialysis solution containing high glucose concentration itself or compensatory effects of slowly developed concomitant ultrafiltration failure in chronic peritoneal dialysis.
Animals ; Catheters ; Dialysis ; Glucose ; Glucose Solution, Hypertonic ; Humans ; Male ; Membranes ; Nitrogen ; Peritoneal Dialysis* ; Peritonitis ; Permeability ; Rats* ; Rats, Sprague-Dawley ; Sodium ; Ultrafiltration ; Urea ; Water*