Purpose: This study compared minimally invasive plate osteosynthesis (MIPO) using a single small skin incision and conventional open volar locking plate fixation (OP) for distal radius fracture to identify outcome difference. Materials and Methods: Forty-three patients who underwent MIPO using a single small skin incision or OP for distal radius fractures were evaluated retrospectively. Of the patients, 21 were treated with MIPO using a single small skin incision and 22 with the OP method through the conventional volar approach. The postoperative radiographic results and clinical outcomes at the final follow-up in each group were compared. Results: All patients achieved bone union in the MIPO and OP groups. No significant differences in the bone union time, alignment, range of motion, QuickDASH, or pain score were observed. On the other hand, the size of the incision was significant: 23 mm in the MIPO group and 55 mm in the OP group (p<0.001). Conclusion MIPO technique using a single small incision showed similar satisfactory radiographic and functional outcomes compared to conventional OP for distal radius fractures. The MIPO technique using a single small incision offered advantages, including cosmetic benefits and minimal soft tissue damage, is recommended, particularly in young women and high functional demand patients.

OBJECTIVE: To evaluate mouse embryos development in conventional medium IVF-20 versus vero cell coculture. METHODS: Female ICR mice aged 6 to 8 weeks, were stimulated with 5IU PMSG and 48 hours later were injected 5IU of hCG, then female and male mice were mated. At 48 hour post-hCG injection, oviducts were dissected out and 2-cell embryos were flushed. The 2-cell embryos were cultured in IVF-20 media or media containing vero cell (African green monkey kidney epithelial cell lines) for 120 hours. Coculture techniques have been applied in mouse 2-cell embryos culture used vero cell lines. RESULTS: 1. After 48 hours culture, 60.7% and 55.7% of 2 cell embryos developed to 4 cell and morulae stage, respectively, in IVF-20 culture medium, but significantly less embryos developed to 4 cell (47.6%, p<0.05) and momlae (42.9%, p<0.05) in vero cell coculture. 2. After 72 hours culture, 51.6% of 2 cell embryos developed to blastocyst and expanded blastocyst in IVF-20 culture medium, but significantly less embryos developed to blastocyst and expanded blastocyst (25.9%, p<0.01) in vero cell coculture. 3. After 96 hours culture, 37.7% and 32.6% of 2 cell embryos similar developed to expanded blastocyst and hatching in IVF-20 culture medium and vero cell coculture, respectively. 4. After 120 hours culture, 36.9% and 37.4% of 2 cell embryos similar developed to expanded blastocyst and hatching in IVF-20 culture medium and vero cell coculture, respectively. CONCLUSION: There was no difference of embryo development rates between the two culture groups. IVF-20 medium alone gives a benefit to the viability of an embryo compared with a vero cell coculture.
Animals ; Blastocyst ; Cercopithecus aethiops ; Coculture Techniques* ; Embryonic Development ; Embryonic Structures* ; Epithelial Cells ; Female ; Humans ; Kidney ; Male ; Mice* ; Mice, Inbred ICR ; Morula ; Oviducts ; Pregnancy ; Vero Cells*

The human papillomavirus (HPV)-18 E7 (E7) oncoprotein is a major transforming protein that is thought to be involved in the development of cervical cancer. It is well-known that E7 stimulates tumour development by inactivating pRb. However, this alone cannot explain the various characteristics acquired by HPV infection. Therefore, we examined other molecules that could help explain the acquired cancer properties during E7-induced cancer development. Using the yeast two-hybrid (Y2H) method, we found that the Elk-1 factor, which is crucial for cell proliferation, invasion, cell survival, anti-apoptotic activity, and cancer development, binds to the E7. By determining which part of E7 binds to which domain of Elk-1 using the Y2H method, it was found that CR2 and CR3 of the E7 and parts 1–206, including the ETS-DNA domain of Elk-1, interact with each other. As a result of their interaction, the transcriptional activity of Elk-1 was increased, thereby increasing the expression of target genes EGR-1, c-fos, and E2F. Additionally, the colony forming assay revealed that overexpression of Elk-1 and E7 promotes C33A cell proliferation. We expect that the discovery of a novel E7 function as an Elk-1 activator could help explain whether the E7 has novel oncogenic activities in addition to p53 inactivation. We also expect that it will offer new methods for developing improved strategies for cervical cancer treatment.

OBJECTIVE: To evaluate the efficacy of the twisting-off method in transvaginal removal of the pedunculated submucous myoma. METHODS: After paracervical block and vaginal dressing with Povidone iodine, the myoma was grasped at its widest diameter and twisted to avulse it from its attatchment. Several kinds of grasping instruments, ie. kelley clamp, tenaculum, ring forcep, was used. If there was bleeding from its detachment site, vaginal gauze or tampon was inserted for bleeding control. RESULTS: The procedure was perfomed successfully on all 33 patients (100%). In most patients, bleeding was scanty in amount. But in one patient, emergency hysterectomy was performed because of massive uterine bleeding. The myoma varied greatly in size. Largest volume was 62.24 cm3, and mean volume was 13.79 cm3. Pathology revealed classic leiomyomas in most cases. Some showed endocervical polyp or endometrial polyp. Follow up examination was done, and its mean interval was eighteen weeks and no patient was recurred. CONCLUSION: The transvaginal removal of pedunculated submucous myoma utilizing grasping instruments may be an effective and safe procedure and the complication is minimal. Twisting-off method was may be a safe alternative to abdominal myomectomy and hysterectomy. Reproductive capacity can be preserved, also.
Anesthesia, Obstetrical ; Bandages ; Emergencies ; Follow-Up Studies ; Hand Strength ; Hemorrhage ; Humans ; Hysterectomy ; Leiomyoma ; Myoma* ; Pathology ; Polyps ; Povidone-Iodine ; Surgical Instruments ; Uterine Hemorrhage

The preoptic area and anterior hypothalamus plays a pivotal role in body temperature regulation, and damage in this region causes hyperthermia. This hyperthermia is particularly troublesome because of the possibility that it may reflect an occult infectious process. We report a case of fever of unknown origin in a patient after removal of neoplasm involving the hypothalamus. A 29-year old man underwent craniotomy and removal of hypothalamic choroid meningioma. Seventy days after the removal of his tumor, his body temperature began to rise. But, there was no evidence of infection, inflammatory disease, metabolic disease, drug fever and recurred tumor. Repeated administration of antipyretic agent did not reduce body temperature. So, we considered that the elevated temperature had a central basis. The patient was treated with chlorpromazine in an attempt to lower his temperature. This drug reduced successfully his body temperature.
Adult ; Body Temperature ; Body Temperature Regulation ; Chlorpromazine ; Choroid ; Craniotomy ; Fever of Unknown Origin* ; Fever* ; Humans ; Hypothalamic Neoplasms* ; Hypothalamus ; Hypothalamus, Anterior ; Meningioma ; Metabolic Diseases ; Preoptic Area

A 63-year-old woman was admitted due to right upper quadrant abdominal pain. She was going through hemodialysis due to end stage renal disease and taking calcium polystyrene sulfonate orally and rectally due to hyperkalemia. Colonoscopy showed a circular ulcerative mass on the proximal ascending colon. Biopsy specimen from the mass showed inflammation and necrotic debris. It also revealed basophilic angulated crystals which were adherent to the ulcer bed and normal mucosa. These crystals were morphologically consistent with calcium polystyrene sulfonate. She was diagnosed with calcium polystyrene phosphate induced colonic necrosis and improved with conservative treatment.
Colonic Diseases/chemically induced/complications/*pathology ; Colonoscopy ; Female ; Humans ; Kidney Failure, Chronic/complications/*diagnosis ; Middle Aged ; Necrosis ; Polystyrenes/*adverse effects

Objective: Endoscopic hemostasis is a key treatment for variceal upper gastrointestinal bleeding. However, the effects of early endoscopy in variceal upper gastrointestinal bleeding have not been sufficiently studied. This study investigated the effects of the use of the critical pathway (CP) for upper gastrointestinal bleeding. Methods: The study was designed as a ‘before and after’ study. A group of patients diagnosed with variceal upper gastrointestinal bleeding from January 1, 2011, to December 31, 2014, and CP activated patients from January 1, 2015, to December 31, 2018, were reviewed retrospectively. The study endpoints included an analysis of the following in the two groups: time from emergency department (ED) arrival to endoscopy, number of blood transfusions, hospitalization period, intensive care unit (ICU) admission, 30-day mortality. Results: From January 1, 2011, to December 31, 2018, 207 patients were admitted with variceal upper gastrointestinal bleeding, and 137 patients with a Blatchford score of 7 or higher were included in the study. Of these, 88 patients visited before the implementation of CP and 49 patients visited thereafter. The time from ED arrival to endoscopy was 218.1±201.7 minutes in the CP activated group, which was about 200 minutes shorter (P=0.046) than the non-CP group. There was no statistical difference in 30-day mortality, transfusion, emergency room hospitalization time, number of ICU admissions, and hospitalization days (P=0.348, P=0.394, P=0.651, P=0.164, and P=0.069). Conclusion After CP, the time to endoscopy was significantly shortened, but it did not reduce mortality.

Idiopathic chronic ulcerative enteritis (ICUE) is a rare disease with a mortality rate exceeding 75%, which manifests as an ulceration of the small bowel in the absence of a recognizable cause. It is diagnosed by biopsy. A 31-year-old man who had a 10-year history of recurrent episodes of abdominal pain was admitted with a 10-day occurrence of abdominal pain and fever. Upper endoscopy showed multiple active ulcers from duodenal second to distal portion. Colonoscopy revealed diffuse ulcerations at the terminal ileum. Colonic findings were normal. The patient was treated with intravenous antibiotics, systemic steroids, and total parenteral nutrition in the intensive care unit. Ten days after admission, the patient fell into shock due to massive hematochezia and underwent an emergency surgical resection, which revealed Meckel's diverticulum. Bleeding was uncontrolled and the following day surgical resection and intraoperative endoscopy of the highly involved jejunum revealed severe ulcerative bleeding. Microscopic examination revealed ulcerations with pseudopolyps and granulation tissue and no evidence of vasculitis, suggestive of ICUE.
Abdominal Pain ; Adult ; Anti-Bacterial Agents ; Biopsy ; Colon ; Colonoscopy ; Emergencies ; Endoscopy ; Enteritis ; Fever ; Gastrointestinal Hemorrhage ; Granulation Tissue ; Hemorrhage ; Humans ; Ileum ; Intensive Care Units ; Jejunum ; Meckel Diverticulum ; Parenteral Nutrition, Total ; Rare Diseases ; Shock ; Shock, Septic ; Steroids ; Ulcer ; Vasculitis

PURPOSE: This study was performed to determine whether the anion gap, the base excess, the lactate, and the strong ion gap obtained in the emergency department correlate with the prognosis and whether the strong ion gap is the most useful marker compared to the prognostic ability of the anion gap, the base excess, and the lactate. METHODS: We reviewed the records of 106 patients admitted to the intensive care unit via the emergency department. We measured the anion gap, the base excess, and the lactate and we calculated strong anion gap by using a formula. We divided the patients into survivors and nonsurvivors and compared the prognostic abilities of the four variables by using the Student's t-test and receiver operator characteristic curves. RESULTS: The mean age of the patients was 67+/-14, and the numbers of males and females were similar (58 males vs 48 females). The number of survivors was 92 (86.7%), and that of nonsurvivors was 14 (3.2%). The anion gap ( 24.8+/-8.8 vs. 16.4+/-4.8 mmol/L, p value=0.000), the base excess (-11.9+/-8.7 vs. -3.49+/-6.5 mmol/L, p value = 0.001), the lactate (9.1+/-7.7 vs. 4.5+/-3.1 mmol/L, p value = 0.011 ) and the strong ion gap (16.6+/-3.6 vs. 10.9+/-3.7, p value=0.000) of the nonsurvivors were higher. All of the four varibles were associated with the prognosis, but among them, the strong ion gap discriminated most strongly with an area under the receiver operator characteristic curve of 0.866 (95% confidence interval, 0.787 to 0.92). CONCLUSION: The initial emergency-department acid-base variables, the anion gap, the base excess, the lactate and the strong ion gap have prognostic abilities, but the strong ion gap is the variable that most strongly predicts of mortality.
Acid-Base Equilibrium ; Critical Illness* ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Intensive Care Units ; Lactic Acid ; Male ; Mortality ; Prognosis ; Survivors