No abstract available.
Knee Joint* ; Knee*

The anterior approach to arthrodesis of the cervical spine has become a widely accepted. However, anterior interbody fusion in the presence of the posterior instability may be complicated by the bone graft dislodgement, kyphotic deformity or nonunion. As an attempt to prevent this complications, anterior cervical plate after graft placement was introduced. Although, anterior cervical plates provide excellent fixation for the anterior column, potential risk for injury to the spinal cord, soft tissues or screw loosening leading to dysphagia has been reported. Morscher, of Switzerland, has developed an anterior cervical spine locking plate(CLSP) system that attempts to prevent the migration and looseing of screw by using a cross-split screw head that can be locked into the plate. The secondary advantage of this system is the limination of the required posterior cortex purchase. The authors reviewed 42 patients in whom the CLSP system was applied for the treatment of degenerative disease or trauma. With a mean followup of 18 months, all 42 patients went on to fusion. One patient had screws placed in the discal space, hardware failure occurred in two patients. There was no iatrogenic injury to the spinal cord or esophagus. In conclusion, the CLSP system provides a reliable fusion with minimal complications. It should be considered in multilevel anterior cervical arthrosis and cervical fractures.
Arthrodesis ; Congenital Abnormalities ; Deglutition Disorders ; Esophagus ; Follow-Up Studies ; Head ; Humans ; Spinal Cord ; Spine ; Switzerland ; Transplants

No abstract available.
Pulmonary Aspergillosis*

BACKGROUND: The purpose of this study is to administer conservative treatment in 30 patients diagnosed with idiopathic frozen shoulder, following the suggested frozen shoulder rehabilitation program and to assess the clinical outcome using a prospective study. METHODS: Thirty patients diagnosed with idiopathic frozen shoulder, treated with steroid hormone injection on the articular joint with an intra-articular steroid (triamcinolone 40 mg + lidocaine 4 ml) injection and started on stepwise shoulder extension exercise were chosen. The subjects were divided into two groups of 15 people each with one group undergoing rehabilitation with continuous passive motion (CPM) and the other group without it. Follow-ups were done before rehabilitation and at 4-week intervals with the 24th being the final week. At every follow-up, passive range of motion (ROM) was measured and surveys on pain and clinical score were administered. RESULTS: In the last follow-up, both groups showed statistically significant improvements in all evaluation criteria. However, no statistical difference in all values of the ROM and Constant score evaluation criteria was observed between the groups. Only in the last follow-up, group 1 had a visual analog scale (VAS) score of 2.4 +/- 2.1 points, which was lower, with statistical significance, than the VAS score of group 2, which was 4.4 +/- 3.1 points (p<0.001). CONCLUSIONS: Study using CPM in treatment of frozen shoulder has been inadequate, meaning that there is still room for improvement and need for more study on setting a more specific protocol and guidelines for this procedure.
Bursitis* ; Follow-Up Studies ; Humans ; Joints ; Lidocaine ; Motion Therapy, Continuous Passive ; Prospective Studies ; Range of Motion, Articular ; Rehabilitation ; Shoulder ; Visual Analog Scale

BACKGROUND: Proximal humerus fracture is considered to be the third most common fracture for patients aged 65 years or older. Conservative treatment has been known to treat most of humerus fracture. However, fractures with severe displacement or dislocation may require surgical treatment. Intramedullary fibular allograft with a locking plate is frequently used in patients accompanying medial metaphyseal disruption. In this study, author intends to evaluate clinical and imaging results based on patients who underwent surgical treatment using fibular allograft with a locking plate. METHODS: This study is conducted prospectively at Wonju Severance Christian Hospital, targeting patients who previously underwent surgical treatment using open reduction and intramedullary fibular allograft with a locking plate between 2011 and 2015. A total of 26 patients were evaluated on the following: postoperational clinical assessment measuring Constant score, American Shoulder and Elbow Society (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Postoperational imaging assessments are evaluated via measuring the neck-shaft angle. The study subject were Neer classification type 3, 4 proximal humerus fracture cases with disrupted medial hinge and having cortical comminution in the region of the surgical neck. RESULTS: The average period of progression was 22.5 months, and the average age of patients was 72.6 years. At the final follow-up, the average Constant, average ASES, and average DASH scores were 80.1, 78.5, and 20.6 respectively. The average neck-shaft angle was 127.5°. CONCLUSIONS: In conclusion, fibular allograft augmentation with a locking plate showed satisfying results in both clinical and imaging studies.

BACKGROUND: Endocrine pancreas tumor is a rare disease which incidence is less than 2% of all pancreatic tumors. But it comprises various types of tumor and usually secretes several hormones from one type of tumor although the patient with this tumor complains of sole symptom associated with only one hormone. The mechanism and clinical significance of multiple hormone secretion in the endocrine pancreas tumom are not yet clearly defined. METHODS: We analyzed retrospectively the clinicopathologic features of 20 cases which were operated at Seoul National University Hospital during the period between February 1989 and May 1998. RESULTS: The most common tumor was insulinoma (13 cases) and the second most common tumor was nonfunctioning tumor (6 cases). There was one case of somatostatinoma. Most of the patients with insulinoma complained of neuroglycopenic symptoms. There were 9 cases (45.0%) in which the tumors secreted more than two kinds of hormones, 7 cases in insulinoma, 2 cases in nonfunctioning tumors. Whether the tumor secreted multiple hormones was detected by the method of immunohistochemical staining. Though the tumors secreted more than two kinds of hormones, the patients with the tumors complained of symptoms which were associated with the cell type most strongly stained by immunohistochemical method. Whether or not the tumors secreted multiple hormones was not associated with the pathologic features such as tumor size, histologic patterns of the tumor, status of tumor cell differentiation and malignancy. CONCLUSION: From this results, we suggest that endocrine tumors of the pancreas secreted multiple hormones not by the mechanism of dedifferentiation from already differentiated endocrine cells but by the mechanism of neogenesis of multipotent islet stem cells. Since the relationship between the function of multiple hormone secretion in the endocrine pancreas tumors and islet stem cell would be significant, further study should be needed to find out the function of stem cells and application of stem cells to clinical use.
Cell Differentiation ; Endocrine Cells ; Humans ; Incidence ; Insulinoma ; Islets of Langerhans ; Pancreas* ; Rare Diseases ; Retrospective Studies ; Seoul ; Somatostatinoma ; Stem Cells

BACKGROUND: The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO. METHODS: From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST. RESULTS: Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×109/L (range, 46 to 434 ×109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST. CONCLUSIONS: The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.
Anticoagulants ; Critical Illness ; Extracorporeal Membrane Oxygenation* ; Hemorrhage ; Hemostasis, Surgical ; Heparin ; Humans ; International Normalized Ratio ; Medical Records ; Partial Thromboplastin Time ; Platelet Count ; Retrospective Studies ; Tracheostomy*

Purpose: This study aims to investigate how medical schools in Korea managed their academic affairs and student support in response to the coronavirus disease 2019 (COVID-19) pandemic and their plans for the post-COVID-19 era. Methods: An online survey was conducted, and a link to a questionnaire was distributed to all the administrators of the 40 medical schools in Korea. The final analysis data involved responses from 33 medical schools and 1,342 students. Frequency analysis, cross-tabulation analysis, Fisher’s exact test, and one-way analysis of variance were applied for statistical analysis. Results: Regarding instruction methods, most medical schools in Korea transitioned from in-person learning to video-on-demand learning (51.5%) and real-time online learning (42.4%). Among the school leaders, 36.4% planned to continue offering online classes combined with in-person classes beyond the end of the pandemic. Among the students, the online class concentration and participation score was 3.0 points or lower, but the class understanding score was 3.6 points, above a moderate level. Conclusion Students cited the shorter times needed to attend school and being able to take classes repeatedly as advantages of online classes, and over one-third of medical schools intended to continue with a hybrid of in-person and online learning even after the COVID-19 pandemic restrictions end.

PURPOSE: To evaluate the therapeutic results of communited intercondylar fractures of the distal humerus that were treated by surgical treatment. MATERIALS AND METHODS: From January, 1998 to December, 2004, we reviewed fifteen cases of intercondylar fracture of the distal humerus, which were treated by surgical treatment. The follow up period ranged from six month to 5 years. The functional results were evaluated using Broberg and Morrey's functional scale according to surgical approach, type of plate and location of plating. RESULTS: The functional results were as follows; seven excellent, six good, one fair and one poor. The mean range of motion in elbow joint was 7~106 degrees. The mean functional score was 86.6 points through olecranon osteotomy, 90.5 points through Campbell's posterior approach. The mean functional score was 91.6 points in cases using 2 reconstruction plate, 78 points in cases using 1 reconstruction plate and 1/3 semitubular plate, and 86 points in case using 1 reconstruction plate and lag screws. The mean functional score was 88.9 points in cases by posterior and lateral fixation, 86 points in cases by both posterior fixation and 97 points in case by both lateral fixation. CONCLUSION: There are no significant differences in treatment outcome according to surgical approach, different plate and location of plating.
Adult* ; Elbow Joint ; Follow-Up Studies ; Humans ; Humerus* ; Olecranon Process ; Osteotomy ; Range of Motion, Articular ; Treatment Outcome

BACKGROUND AND OBJECTIVES: Food restriction increases life span, reduces aging rate and affects a wide variety of biological functions. Neurotransmitter is a substance released from the axon terminal of a presynaptic neuron on excitation, which diffuses across the synaptic cleft to either excite or inhibit the target cell. The nervous system makes use of neurotransmitters for signaling. We investigated the change of immunoreactivity of neuropeptides in olfactory bulb of rat after food restriction. MATERIALS AND METHOD: Of 10-week old Sprague-Dawley rats used in this study. six rats were killed at the beginning of the experiment. Thirty rats which had been restricted to only half of their normal voluntary mean food intake (12 g instead of 24 g per day) were killed at 3 days, 1, 2, 4 and 9 weeks after food restriction (n=6 per time point). Olfactory bulbs of the rats were cut into 40 micrometer-thick coronal sections and immunostained. RESULTS: On the layers of glomerular, outer plexiform, granular cell and subependymal zone of olfactory bulb, immunoreactivities of cholecystokinin (CCK), tyrosine hydrolase (TH), and neuropeptide-Y (NPY) were increased at one week of food restriction. On all layers, immunoreactivities of CCK and TH were increased at 2 weeks of food restriction. However, immunoreactivity of NPY was increased on the only layers of glomerular, and granular cell of olfactory bulb at week 2. After 4th week, the immunoreactivity of NPY was the same as the control group; after 9th week, the mmunoreactivity of CCK and TH were the same as the control group. CONCLUSION: Our results demonstrated that CCK, TH, and NPY could be expressed in different manners on the layers of olfactory bulb of rat after food restriction, and that food restriction may improve olfactory sensitivity owing to the change of neuropeptides.
Aging ; Animals ; Cholecystokinin ; Eating ; Nervous System ; Neurons ; Neuropeptides* ; Neurotransmitter Agents ; Olfactory Bulb* ; Presynaptic Terminals ; Rats* ; Rats, Sprague-Dawley ; Tyrosine