PURPOSE: To evaluate the questions of hand and wrist section of Korean orthopedic in-training examination (KOITE). METHODS: We analyzed questions of hand and wrist section of KOITE between 2010 and 2014. The weight of hand and wrist section was calculated and topics were thoroughly analyzed. The construct of questions were evaluated and taxonomic classifications were also performed. The frequency of presentations of physical examinations and radiologic evaluations in diagnosis and treatment related questions were analyzed. The coverage of available references which were recommended by Korean Orthopedic Association (KOA) were analyzed. RESULTS: Sixty one out of 500 questions (weight: 12.2%) were related with hand and wrist section. Disease (30/61, 48.2%) was more commonly asked than trauma, however most frequently asked topic with a broad classification was fractures and dislocations (19/61, 31.1%). The description only questions (46/61, 75.4%) were most commonly asked construct of question. According to taxonomic classification, taxonomy B (diagnosis; 27/61, 44.3%) was most frequently asked. The Campbell's operative orthopedics (54/61, 88.5%) and textbook of KOA (53/61, 86.9%) were representative references covering questions most widely. CONCLUSION: This analysis of hand and wrist section of KOITE could be used as the check-up tools for resident training programs of each training hospitals.
Classification ; Diagnosis ; Dislocations ; Education ; Hand* ; Korea ; Orthopedics* ; Physical Examination ; Wrist*

Hemangioma is a common tumor which can occur in any part of the body. It can develop in any area the hand. Hemangioma of the hand usually presents with swelling, pressure pain, accompanied by motion restriction. Rarely it has throbbing pain. We report the case of a 21-year-old woman who had a hemangioma of flexor digitorum superficialis tendon sheath in second finger with restriction of motion and were treated by surgical intervention.
Female ; Fingers ; Hand* ; Hemangioma* ; Humans ; Tendons* ; Young Adult

Cranioplasty has long been performed by many physicians with different materials from the prehistoric era. Among the materials, methyl methacrylate has been known to be the superior to any other substitutes since 1940s in biologic, chemical and physical characteristics and its availability. So the authors review 72 patients who underwent cranioplasty with methyl methacrylate at out hospital from 1985 to 1989. The clinical analyses were as follow : 1) There was male predominance and epidural hematomas, compound, comminuted depressed fractures by traffic accidents or fall down injuries were the main causes of craniectomy. 2) The location of defects was mainly frontal and/or parietal area and average size of defects was 17cm2 in plain skull film measurements. 3) The cosmetic results were satisfactory. 4) Complication rate was 6% and there was no mortality.
Accidents, Traffic ; Hematoma ; Humans ; Male ; Mortality ; Rabeprazole ; Skull

PURPOSE: We use many electronic devices for treating patients in our emergency department. Several studies have reported an association between electromagnetic field exposure and risk of cancer and other diseases. Our purpose was to measure the intensity of power-frequency magnetic fields in the emergency department and evaluate the conditions exceeded regulation guidelines for power-frequency magnetic fields. METHODS: Extremely low frequency magnetic fields were measured at 78 ordinary working spots in our tertiary hospital's emergency department (ED) and evaluated according to national regulatory guidelines and SWEDAC. Each spot was measured four times. During measurement, every electrical device in the emergency department was turned on. RESULTS: The average intensity of the magnetic fields in our emergency department was 0.99+/-1.27 mG. The maximum intensity was 8.3 mG, which was found in the pediatric section. CONCLUSION: The power-frequency magnetic field intensities of the various sections of our ED did not exceed national regulatory guidelines. However, pediatric and the minor emergency section showed magnetic fields intensities far above 2 mG. We found these high values outside the pediatric and waiting sections, where the electrical cabinet panel was located. We conclude that the electrical cabinet panel should be shielded and that similar studies are needed for other emergency departments.
Electromagnetic Fields ; Electronics ; Electrons ; Emergencies ; Emergency Service, Hospital ; Environmental Exposure ; Humans ; Magnetic Fields ; Magnetics ; Magnets

OBJECTIVE: So called "minimally invasive procedures" have evolved from chemonucleolysis, automated percutaneous discectomy, arthroscopic microdiscectomy that are mainly working within the confines of intradiscal space to transforaminal endoscopic technique to remove herniated epidural disc materials directly. The purpose of this study is to assess the result of endoscopic spinal surgery and favorable indications in the thoracolumbar spine. METHODS: The records of 71 patients, 73 endoscopic procedures, were retrospectively analysed. Yeung Endoscopic Spine Surgery system with 7 mm working sleeve and 25degrees viewing angle was used. The mean follow up period was 6 months (range,3-9). RESULTS: Operated levels were from T12-L1 disc down to L5-L6 or S1 disc. Of 71 cases, 2 patients underwent transforaminal endoscopic surgery twice due to recurrence after initial operation. MacNab's criteria was used to assess the outcome. Favorable outcome, excellent or good, was seen in 78% (57 procedures) of the patients. Among 11 fair outcomes, only 1 procedure was followed by secondary open procedure, laminectomy with discectomy. Two of 5 poor outcomes were operated again by same procedure which resulted in fair outcomes. One patient with aggravated cauda equina syndrome remained poor and a lumbar fusion procedure was performed in other patient with poor outcome. There were 2 postoperative discitis that were treated with conservative care in one and anterior lumbar interbody fusion in the other. CONCLUSION: Evolving technology of mechanical, visual instrument enables minimal invasive procedure possible and effective. The transforaminal endoscopic spinal surgery can reach as high as T12-L1 disc level. The rate of favorable outcome is mid-range among reported endoscopic lumbar surgery series. Authors believe that the outcome will be better as cases accumulate and will be able to reach the rate of standard open microsurgery.
Discitis ; Diskectomy ; Diskectomy, Percutaneous ; Follow-Up Studies ; Humans ; Intervertebral Disc Chemolysis ; Intervertebral Disc Displacement ; Laminectomy ; Microsurgery ; Polyradiculopathy ; Recurrence ; Retrospective Studies ; Spine

Vagal nerve activity has been known to play a crucial role in the induction and maintenance of atrial fibrillation (AF). However, it is unclear how the distribution and concentration of local acetylcholine (ACh) promotes AF. In this study, we investigated the effect of the spatial distribution and concentration of ACh on fibrillation patterns in an in silico human atrial model. A human atrial action potential model with an ACh-dependent K+ current (I(KAch)) was used to examine the effect of vagal activation. A simulation of cardiac wave dynamics was performed in a realistic 3D model of the atrium. A model of the ganglionated plexus (GP) and nerve was developed based on the "octopus hypothesis". The pattern of cardiac wave dynamics was examined by applying vagal activation to the GP areas or randomly. AF inducibility in the octopus hypothesis-based GP and nerve model was tested. The effect of the ACh concentration level was also examined. In the single cell simulation, an increase in the ACh concentration shortened APD90 and increased the maximal slope of the restitution curve. In the 3D simulation, a random distribution of vagal activation promoted wavebreaks while ACh secretion limited to the GP areas did not induce a noticeable change in wave dynamics. The octopus hypothesis-based model of the GP and nerve exhibited AF inducibility at higher ACh concentrations. In conclusion, a 3D in silico model of the GP and parasympathetic nerve based on the octopus model exhibited higher AF inducibility with higher ACh concentrations.
Acetylcholine* ; Action Potentials ; Atrial Fibrillation* ; Autonomic Nervous System ; Computer Simulation* ; Ganglion Cysts ; Humans* ; Octopodiformes

Intravenous leiomyomatosis is a rare benign smooth muscle tumor arising from uterine muscle or vascular wall. The disease grows into pelvic venous channel, and can extend to inferior vena cava, and, in exceptional cases, right side of the heart. A case of intravenous leiomyomatosis is presented with a brief review of literatures. A 42-year-old woman presented with one month history of vague right lower quadrant pain and leg swelling. Six years before admission, she had undergone total abdominal hysterectomy for leiomyoma of the uterus and excision of recurred mass and right salpingo-oophorectomy 32 months ago. During the follow-up, right adnexa mass was detected and the size grew progressively, so transferred to our hospital. CT scan and venograpy revealed out the large pelvic cavity mass and intravenous extension to right common iliac vein, bifurcation of IVC. Preoperative tumor embolization followed by resection of recurred pelvic tumor, removal of intravenous tumor via internal iliac vein venotomy and left salpingo-oophorectomy were done. After the operation, the symptoms were relieved and the patient resumed her normal activity.
Adult ; Animals ; Female ; Follow-Up Studies ; Heart ; Humans ; Hysterectomy ; Iliac Vein ; Leg ; Leiomyoma ; Leiomyomatosis ; Mice ; Myometrium ; Smooth Muscle Tumor ; Tomography, X-Ray Computed ; Uterus ; Vena Cava, Inferior

Benign chorioangioma of the placenta is the most common primary tumor of the placenta similar to hamartoma. Most small-sized tumors do not make any clinical problem, but uncommon large tumors (>5 cm in diameter) may produce both maternal and fetal complications, such as polyhydramnios, preterm labor, fetal hydrops, microangiopathic hemolytic anemia, disseminated intravascular coagulation, intrauterine growth restriction, preeclampsia and placental abruption. In this respect, the diagnosis and management of chorioangioma and its complication should be done appropriately. We report a case of chorioangioma presenting with polyhydramnios, preterm labor, fetal anemia and fetal hydrops, diagnosed by antenatal ultrasonography and postnatal placental histologic examination, and live born baby with the brief review of the literature related to this type of tumor.
Abruptio Placentae ; Anemia* ; Anemia, Hemolytic ; Diagnosis ; Disseminated Intravascular Coagulation ; Female ; Hamartoma ; Hemangioma* ; Hydrops Fetalis* ; Obstetric Labor, Premature ; Placenta* ; Polyhydramnios ; Pre-Eclampsia ; Pregnancy ; Ultrasonography

The role of alveolar macrophages (AMs) in the pathogenesis of asthma is still unknown. The aim of the present study was to investigate the effects of AM in the murine model of asthma. AMs were selectively depleted by liposomes containing clodronate just before allergen challenges, and changes in inflammatory cells and cytokine concentrations in bronchoalveolar lavage (BAL) fluid were measured. AMs were then adoptively transferred to AM-depleted sensitized mice and changes were measured. Phenotypic changes in AMs were evaluated after in vitro allergen stimulation. AM-depletion after sensitization significantly increased the number of eosinophils and lymphocytes and the concentrations of IL-4, IL-5 and GM-CSF in BAL fluid. These changes were significantly ameliorated only by adoptive transfer of unsensitized AMs, not by sensitized AMs. In addition, in vitro allergen stimulation of AMs resulted in their gaining the ability to produce inflammatory cytokines, such as IL-1beta, IL-6 and TNF-alpha, and losing the ability to suppress GM-CSF concentrations in BAL fluid. These findings suggested that AMs worked probably through GM-CSF-dependent mechanisms, although further confirmatory experiments are needed. Our results indicate that the role of AMs in the context of airway inflammation should be re-examined.
Animals ; Asthma/*immunology ; Bronchoalveolar Lavage Fluid/chemistry/cytology/immunology ; Cytokines/biosynthesis/immunology ; Disease Models, Animal ; Female ; Immunization ; Immunomodulation/*immunology ; Inflammation/*immunology ; Leukocytes/immunology ; Macrophages, Alveolar/*immunology ; Mice ; Mice, Inbred C57BL ; Ovalbumin/immunology

Streptococcus salivarius meningitis is very uncommon, and most cases are iatrogenic, occurring after invasive procedures such as spinal anesthesia or lumbar puncture etc.. Post-traumatic occurrence of this infection is especially rare. A 20-year-old man with a previous history of skull base fracture was seen at the emergency department with signs of acute bacterial meningitis. The CSF had a few gram positive cocci with neutrophilic pleocytosis, which were identified as S. salivarius by the Vitek system (bioMerioux, Inc., Hazelwood, MO, USA), rapid ID 32 Strep (bioMerieux, Marcy-l'Etoile, France) and 16S rRNA sequencing. The microorganism showed intermediate resistance to penicillin (MIC=0.25 microg/mL) but was susceptible to cefotaxime (MIC=0.25 microg/mL) and vancomycin (MIC= 0.75 microg/mL). The patient was treated with ceftriaxone and vancomycin. He also had his CSF leakage repaired by an endoscopic approach. To our knowledge, this is the first case of S. salivarius meningitis reported in Korea.
Anesthesia, Spinal ; Cefotaxime ; Ceftriaxone ; Cerebrospinal Fluid Rhinorrhea ; Emergencies ; Gram-Positive Cocci ; Humans ; Korea ; Leukocytosis ; Meningitis ; Meningitis, Bacterial ; Neutrophils ; Penicillins ; Skull ; Skull Base ; Skull Fractures ; Spinal Puncture ; Streptococcus ; Vancomycin ; Young Adult