No abstract available.
Abdominal Wall ; Abscess ; Humans

Pulmonary hypertension is an uncommon but serious complication of systemic lupus erythematosis (SLE).Usually its outcomes are ominous and may progress to heart failure and even sudden death.The pathophysiology is still unknown, but several mechanisms,such as pneumonitis,vasculitis,thromboembolism or thrombosis in situ have been proposed.There is no definitive therapy for this condition.Although supportive measures with vasodilators remain the mainstay of treatment,the responses are generally disappointing. We describe a case of improvement of pulmonary hypertension in SLE treated with cyclophosphamide pulse therapy as documented by hemodynamic data. Immunosuppressive treatment with cyclophosphamide was effective in this condition,suggested an immune mediated pathogenesis.
Cyclophosphamide* ; Heart Failure ; Hemodynamics ; Hypertension, Pulmonary* ; Lupus Erythematosus, Systemic* ; Thrombosis ; Vasodilator Agents

BACKGROUND: The role of stratum corneum has been known to be the major barrier against percutaneous absorption. The change of osmotic gradient onto stratum corneum may affect the permeability barrier function though its mechanism has not been explained. OBJECTIVE: In this study, we have tested hyperosmolar glucose solution (1M, 0.1M) over the living skin or the separated epidermal sheets to determine the penetration-related pharmacokinetics such as absorption, saturation, diffusion kinetics in vivo or in vitro. METHODS: The hyperosmolar glucose patches were applied to 10 healthy volunteers' forearm skin to analyze the absorption profiles through stratum corneum. For investigating the role of osmotic pressure influencing the disposition of glucose, in vitro two compartment model was used to characterize the pharmacokinetics of glucose through epidermal sheets. RESULTS: The quantitative assay of applied hyperosmolar glucose from sequentially stripped stratum corneum of volunteers revealed the high glucose/protein ratio and steep concentration gradient at the uppermost layers down to lower layers. The pharmacokinetic profile of hyperosmolar glucose in vitro shows both the saturation delay pattern and steady flux pattern regarding glucose diffusion. CONCLUSION: The stratum corneum act as a major permeation barrier against glucose disposition, though the concentration-dependent pharmacokinetics by its osmotic gradient were rather different. Thus, the osmolarity-related event over stratum corneum might be a considerable factor during percutaneous absorption.
Absorption ; Diffusion ; Forearm ; Glucose* ; Kinetics ; Osmotic Pressure ; Permeability ; Pharmacokinetics* ; Skin ; Skin Absorption ; Volunteers

Background: Open reduction and internal fixation is the standard treatment for a displaced medial malleolus fracture (MMFx), achieving ankle stability and bony union to prevent post-traumatic arthritis. Previous fixation techniques including tension band wiring and unicortical screw fixation are not optimal for fixation of small fragments in MMFx due to their small size and poor manipulability. Here, we describe a novel surgical method using mini-screws only for fixation of small fragments in MMFx. Methods: We conducted a retrospective consecutive study of patients who underwent surgery using mini-screws for small fragment MMFx between April 2013 and March 2018. We reviewed the patients’ clinical characteristics and assessed the fracture features radiographically. Clinical outcomes were assessed by measuring the range of motion of both ankle joints and investigating symptomatic implants. We reviewed the radiographic outcomes of the medial malleolus and the functional outcomes using the Foot and Ankle Outcome Score (FAOS) at the last follow-up. Results: Nine patients were included in the study. The minimal follow-up period was 27 months. There was no incidental bone breakage during the procedure. All MMFx healed without reduction loss, nonunion, or implant failure at the last follow-up. Two patients had mild osteoarthritic changes of the ankle joint. The mean FAOS score of the patients was 80.99 (range, 65.44–98.42). No patients required removal of the hardware. Conclusions Fixation of comminuted fractures of the medial malleolus using mini-screws for young adult patients is a straightforward and simple technique. Safe fixation of the anterior and posterior colliculi reduces the risk of implant irritation symptoms that necessitate implant removal.

Background: Open reduction and internal fixation is the standard treatment for a displaced medial malleolus fracture (MMFx), achieving ankle stability and bony union to prevent post-traumatic arthritis. Previous fixation techniques including tension band wiring and unicortical screw fixation are not optimal for fixation of small fragments in MMFx due to their small size and poor manipulability. Here, we describe a novel surgical method using mini-screws only for fixation of small fragments in MMFx. Methods: We conducted a retrospective consecutive study of patients who underwent surgery using mini-screws for small fragment MMFx between April 2013 and March 2018. We reviewed the patients’ clinical characteristics and assessed the fracture features radiographically. Clinical outcomes were assessed by measuring the range of motion of both ankle joints and investigating symptomatic implants. We reviewed the radiographic outcomes of the medial malleolus and the functional outcomes using the Foot and Ankle Outcome Score (FAOS) at the last follow-up. Results: Nine patients were included in the study. The minimal follow-up period was 27 months. There was no incidental bone breakage during the procedure. All MMFx healed without reduction loss, nonunion, or implant failure at the last follow-up. Two patients had mild osteoarthritic changes of the ankle joint. The mean FAOS score of the patients was 80.99 (range, 65.44–98.42). No patients required removal of the hardware. Conclusions Fixation of comminuted fractures of the medial malleolus using mini-screws for young adult patients is a straightforward and simple technique. Safe fixation of the anterior and posterior colliculi reduces the risk of implant irritation symptoms that necessitate implant removal.

Purpose: This study examined the current status of counseling services provided by the Korea Counseling Center for Fertility and Depression, analyzing the characteristics of peripartum women and baby-rearing mothers and establishing guidelines for providing psychological support, and suggesting measures for improving the system. Methods: Data on 3,660 peripartum women & their spouses and baby-rearing mothers counseled through the service over the last 4 years were collected and a demographic analysis was conducted. By analyzing the clinical information of 216 peripartum women and 219 baby-rearing mothers who have registered with the Center and received routine counseling services, factors affecting depression were identified. Finally, a paired sample t-test was conducted to verify the effect of counseling services. Results: An overall 20.4% of pregnant women & their spouses were screened for high risk for depression, of whom 27.3% received registered counseling services; further, 26.2% of baby-rearing parents were at high-risk group for depression, of whom 25% received registered counseling services. Results of a logistic regression analysis suggested that, for peripartum women, level of education and conflicts with partner and family were the crucial factors predicting moderate or severe depression. For baby-rearing mothers, obstetric history of spontaneous abortion was the crucial predicting factor. Conclusion For the early detection and prevention of peripartum depression, screening tests that start from early pregnancy should be routinely administered. Further, continuous management—covering the periods before and after childbirth—should be provided by establishing organic ties between domestic projects.

Purpose: This study aimed to review the history and examine the current service system of the Korea Counseling Center for Fertility and Depression (KCCFD) by analyzing the characteristics of its users, and to suggest measures to improve the system. Methods: Data on 883 infertile patients counseled through the KCCFD’s counseling service over the last 2 years were collected for a demographic analysis. The clinical information of 396 female subjects who received regular counseling after registration were analyzed to investigate factors influencing depression. Finally, a matching sample t-test was conducted to verify the effects of the counseling service. Results: The screening test showed that 50.7% of the infertile patients in our study were registered at our centers and received registered counseling. A total of 27.6% of the subjects was identified as being at high-risk for depression, and 71.3% of those at high-risk received registered counseling. The logistic regression analysis showed that being a homemaker, having a history of psychiatric disorder, and having undergone in vitro fertilization three or more times were significant factors that predict moderate or more severe depression. The female infertility patients who underwent counseling showed a significant decrease in depression, anxiety, general stress, and infertility stress. Conclusion Screening tests need to be performed prior to assisted reproductive technology if any of the 3 risk factors is present. The rate of registered counseling, regular follow-up using psychological tests, and cross-linkages with affiliated agencies should serve as the metrics for the quality control of the counseling service. Early detection of individuals at high-risk for depression calls for an activated liaison among affiliated agencies and expanded regional centers.

Objective: : This study compared the quality of recovery (QoR) after minicraniotomy for clipping of unruptured intracranial aneurysms (UIAs) between patients with and without scalp nerve block (SNB). Methods: : Patients were randomly assigned to the SNB (SNB using ropivacaine with epinephrine, n=27) and control (SNB using normal saline, n=25) groups. SNB was performed at the end of surgery. To assess postoperative QoR, the QoR-40, a patient-reported questionnaire, was used. The QoR-40 scores were measured preoperatively, 1–3 days postoperatively, at hospital discharge, and 1 month postoperatively. Pain and intravenous patient-controlled analgesia (IV-PCA) consumption were evaluated 3, 6, 9, and 12 hours and 1–3 days postoperatively. Results: : All QoR-40 scores, including those measured 1 day postoperatively (primary outcome measure; 155.0 [141.0–176.0] vs. 161.0 [140.5–179.5], p=0.464), did not significantly differ between the SNB and control groups. The SNB group had significantly less severe pain 3 (numeric rating scale [NRS]; 3.0 [2.0–4.0] vs. 5.0 [3.5–5.5], p=0.029), 9 (NRS; 3.0 [2.0–4.0] vs. 4.0 [3.0–5.0], p=0.048), and 12 (NRS; 3.0 [2.0–4.0] vs. 4.0 [3.0–5.0], p=0.035) hours postoperatively. The total amount of IV-PCA consumed was significantly less 3 hours postoperatively in the SNB group (2.0 [1.0–4.0] vs. 4.0 [2.0–5.0] mL, p=0.044). Conclusion : After minicraniotomy for clipping of UIAs, SNB reduced pain and IV-PCA consumption in the early postoperative period but did not improve the QoR-40 scores.

A 37-year-old man with a right transfemoral amputation suffered from severe phantom limb pain (PLP). After targeting the affected supplementary motor complex (SMC) or primary motor cortex (PMC) using a neuro-navigation system with 800 stimuli of 1 Hz repetitive transcranial magnetic stimulation (rTMS) at 85% of resting motor threshold, the 1 Hz rTMS over SMC dramatically reduced his visual analog scale (VAS) of PLP from 7 to 0. However, the 1 Hz rTMS over PMC failed to reduce pain. To our knowledge, this is the first case report of a successfully treated severe PLP with a low frequency rTMS over SMC in affected hemisphere.
Adult ; Amputation ; Humans ; Motor Cortex ; Phantom Limb* ; Transcranial Magnetic Stimulation* ; Visual Analog Scale

Adult onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology. It is characterized by spiking fever, evanescent skin rash, arthritis, and various systemic manifestations. Liver involvement is common in AOSD, with up to three-quarters of the patients exhibiting elevation of hepatic enzymes or hepatomegaly. The treatment of AOSD is depends on the severity of the disease or the organ involvement. Numerous drugs have been used including nonsteroidal antiinflammatory drugs (NSAIDs), corticosteroid, and immunosuppressive agents. However, the use of intravenous immunoglobulin (IVIG) was rarely reported, and its efficacy is still controversial. We describe a patient with AOSD who developed acute severe hepatitis refractory to corti costeroid, but it was successfully treated with IVIG. An 18-year-old woman developed malaise, jaundice and nausea. One month ago, she was diagnosed as AOSD and treated with prednisolone and naproxen. Laboratory tests demonstrated marked increase of transaminase, bilirubin and ferritin. Etiologic evaluation for viral hepatitis and other causes showed negative result. In spite of methylprednisolone pulse therapy, hepatitis aggravated rapidly. After IVIG (0.4 g/ kg/day) was administered for 5 days, her systemic symptoms and hepatitis were much improved. We considered that IVIG may be a potential alternative for the treatment of AOSD, particularly refractory to conventional therapy.
Adolescent ; Adult* ; Arthritis ; Bilirubin ; Exanthema ; Female ; Ferritins ; Fever ; Hepatitis ; Hepatomegaly ; Humans ; Immunization, Passive* ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Immunosuppressive Agents ; Jaundice ; Liver ; Methylprednisolone ; Naproxen ; Nausea ; Prednisolone ; Still's Disease, Adult-Onset*