BACKGROUND: Generally, in order to decrease the fetal exposure time from anesthetic drugs, anesthetic induction is conducted after the completion of surgical preparation in general anesthesia for cesarean section. However, this method, in decreasing the fetal exposure time from anesthetic drugs, has been regarded as also aggravating the feeling of anxiety and fear of the patients. The purpose of this research is to compare the result of anesthetic induction conducted before and after surgical preparation in relation to the well-being of the newborn. METHODS: Fifty healthy women scheduled for elective cesarean section, not in labor, with no signs of fetal distress were randomly divided into 2 groups. Group A (n = 25) started anesthetic induction after surgical preparation and group B (n = 25) started before surgical preparation. Induction to delivery (I-D) interval and uterine incision to delivery (U-D) interval were measured and for the evaluation of the neonatal outcome, blood gas analysis at umbilical vein and artery, 1 and 5 min Apgar scores, and neurobehavioral test at 15 min, 2 hr and 24 hr of age, respectively, were performed. RESULTS: There was a significant difference in the I-D interval (P < 0.05) but no significant difference in the U-D interval between the two groups. Blood gas analysis, acid-base status, Apgar score and neurologic and adaptive capacity score (NACS) all did not differ significantly between the two groups. CONCLUSIONS: From our results, the induction before surgical preparation did not seem to affect neonatal well-being significantly. Therefore, when patients without fetal distress are very anxious, anesthetic induction before surgical preparation would reduce the patient's anxiety and fear without neonatal depression in general anesthesia for cesarean section.
Anesthesia, General* ; Anesthetics ; Anxiety ; Apgar Score ; Arteries ; Blood Gas Analysis ; Cesarean Section* ; Depression ; Female ; Fetal Distress ; Humans ; Infant, Newborn ; Pregnancy ; Umbilical Veins

The periosteum provides a good cell source for bone formation because it possesses osteoprogenitors. In this study, the osteogenic activity of the rabbit periosteum and periosteal cells was investigated. The periosteum was harvested from the long bone surface of New Zealand White rabbits. The periosteal cells were isolated from the periosteum and expanded. In vitro examination, the morphological changes, mineralization, and osteogenicity of the periosteal cells were evaluated. The amount of osteocalcin released was measured to check the maximal activity of the cells. The periosteum and periosteal cells-scaffold composites were transplanted into athymic mice to observe the in vivo bone formation. Radiological and histological changes were checked every 2 weeks. The isolated periosteal cells were uniformly proliferated in a monolayer culture, and mineral deposition was confirmed after 10 weeks. The osteogenic markers such as osteopontin, osteonectin, type I collagen, and alkaline phosphatase were expressed from the periosteal cells after 2 weeks. Osteocalcin was expressed after 3 weeks and was maximally expressed at 4 weeks. In 3-dimensional culture, the periosteal cells were well adhered and proliferated on the poly L-lactic-co-glycolic acid scaffold. The periosteal cells-scaffold composite transplant produced of osteoid without calcification in vivo. Radiological examination showed minimal changes of bone formation during the experimental period. However, the periosteum transplant was converted to a cartilaginous structure at 2 weeks, bony calcification after 4 weeks, and complete bony trabecula and marrow space formation at 12 weeks. The radiological bone density also increased during the experimental period. The periosteum may be one of good cell sources for osseous tissue engineering. Engineered periosteal cells may be used for the treatment of nonunion, osteolysis, avascular necrosis and fusion of the spine.
Alkaline Phosphatase ; Animals ; Bone Density ; Bone Marrow ; Collagen Type I ; Mice ; Mice, Nude ; Necrosis ; Osteocalcin ; Osteogenesis ; Osteolysis ; Osteonectin ; Osteopontin ; Periosteum* ; Rabbits ; Spine ; Tissue Engineering

PURPOSE: To evaluate the incidence and risk factors associated with osteoarthritis after a reconstruction of the anterior cruciate ligament (ACL) using a patellar tendon autograft after an average follow-up period of more than 10 years. MATERIALS AND METHODS: The study examined 56 cases that were selected from 118 cases who underwent an arthroscopic reconstruction of the ACL using a patella tendon autograft a minimum of 8 years ago and were available for follow up. The mean age at the time of the reconstruction was 31.3 years (19-58 years), and the average follow up period was 10.6 years (8.6-13.8 years). At the last follow up, the presence of osteoarthritis on the weight-bearing antero-posterior and lateral, and Merchant's radiographs, was assessed using the Kellgren and Laurence classification. The correlation between the development of osteoarthritis and the clinical results (Lysholm knee score, Lachman test, Pivot-shift test, return to preinjury activity), the radiological results (anterior laxity, persistent anterior subluxation), the interval from injury to the reconstruction, the patient age at the time of the reconstruction, the presence of an accompanying meniscal injury, and the patient's gender were examined. RESULTS: Among the 56 cases, osteoarthritis was detected in 23 (41%) (grade II, 18 cases; grade III, 5 cases), and in regard to the lesion sites, the medial compartment was detected in all cases, the lateral compartment in 12 cases and the patello-femoral compartment in 11 cases. Among them, 19 cases were accompanied with a meniscal injury (OR, 10.336; p = 0.001), and a significant increase in osteoarthritis was detected in those cases with a interval from the injury to the reconstruction of more than 6 months (OR, 4.611; p=0.030), and in those aged more than 26 years at the time of the reconstruction (OR, 5.038; p=0.023). However, there was no correlation between the development of osteoarthritis and the clinical outcome, radiological anterior laxity and continuous anterior subluxation, and genders (p>0.05). CONCLUSION: Osteoarthritis developed in 41% of cases, and developed more frequently in those cases with an accompanying meniscal injury, older patients at the time of the reconstruction, or in those with a longer interval from the injury to reconstruction.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Autografts* ; Classification ; Follow-Up Studies* ; Humans ; Incidence ; Knee ; Knee Joint ; Osteoarthritis* ; Patellar Ligament* ; Risk Factors ; Weight-Bearing

Neurocysticercosis (NCC) is the most common central nervous system parasite infection, frequently produces seizure, headache, or hydrocephalus as clinical manifestations. Cerebral vasculitis is an infrequent complication of the clinical phenotype of NCC. Moreover, NCC involving basal cerebral arteries, including distal internal carotid artery or middle cerebral artery, has rarely been reported. Therefore, we present a case of NCC with moyamoya-like basal cerebral arterial steno-occlusive disease with an emphasis on the differential diagnosis.

No abstract available.
Carcinoma, Hepatocellular* ; Esophageal and Gastric Varices ; Infarction

The tumors containing ganglion cells are rare in the pituitary gland. These tumors are divided into two groups. The first group is the cases of mixed gangliocytoma-adenoma that contained both gangliocytoma and pituitary adenoma elements in the same tumor and the second group is those of gangliocytoma that contained only gangliocytoma element. Since the first description by Kiyono in 1926, 45 cases have been reported. The most common presentation of these tumors is acromegaly and the cases of Cushings disease and galactorrhea-amenorrhea also have been reported. In immunohistochemical study, hypothalamic-releasing hormones are stained in gangliocytoma cells and adenohypophyseal hormones are stained in adenoma cells. The releasing hormones stained in gangliocytoma element and the pituitary hormones stained in adenoma elements are usually closely related but unrelated cases also have been reported. We report a case of a 41 year-old lady with acromegaly which was diagnosed as mixed gangliocytoma-adenoma after surgical removal of the pituitary tumor.
Acromegaly* ; Adenoma ; Adult ; Ganglion Cysts ; Ganglioneuroma ; Humans ; Pituitary Gland* ; Pituitary Hormones ; Pituitary Hormones, Anterior ; Pituitary Neoplasms

PURPOSE: To determine the motion distribution of bipolar hip prosthesis, we performed experimental and clinical analyses. MATERIALS AND METHODS: In the experimental studies, component motion was examined according to surface lubrication, cup angle, and acetabular reaming in fresh-frozen cadaveric bone. In the clinical examination, thirty patients with a bipolar hip prosthesis were examined by fluoroscopy. RESULTS: In the experimental condition when both joints were well lubricated, motion occurred mainly at the inner joint. However, slight motion of the outer joint appeared in terminal abduction if the acetabular cup angle was low and joint pressure was applied. When the only the outer joint was lubricated, motion occurred mostly at the outer joint. When both joints were not lubricated, motion occurred at outer joint unless the acetabular reaming was performed. In every situation having acetabular reaming, motion occurred only at the inner joint. Clinically, motion distribution varied between patients. However, we found a predominant contribution was made by the outer joint, in contrast to theoretical prediction, and the persistence of the combined motion of two joints in the majority of the patients studied (67-70 percent). CONCLUSION: We found that the motion was combined in both outer and inner joint in two-thirds of patients, and that outer motion was more predominated.
Acetabulum ; Cadaver ; Fluoroscopy ; Hip Prosthesis* ; Hip* ; Humans ; Joints ; Lubrication

Background/Aims: The histologic status of the immune-tolerant (IT) phase of chronic hepatitis B relative to long-term outcomes is unclear. This study aimed to discover how the serological criteria currently in use correspond to histologic criteria in determining the IT phase and indication for liver biopsy. Methods: Patients in the serological IT phase determined by positive hepatitis B e antigen, hepatitis B virus (HBV) DNA ≥106 IU/mL, and normal or minimally elevated alanine aminotransferase (ALT) ≤60 IU/L, who underwent liver biopsy at three different hospitals were included. The distribution of the histologic IT phase, defined as fibrosis of stage 1 or less and inflammation of grade 1 or less, was compared with that of the serological IT phase. The risk factors for the incidence of liver-related events, such as hepatocellular carcinoma, liver cirrhosis, liver transplantation, and death, were also analyzed. Results: Eighty-two (31.7%) out of 259 clinically suspected IT phase patients belonged to the histologic IT phase. Age over 35, high AST, and low albumin were useful for ruling out the histologic IT phase. Risk factors predicting liver-related events were age and significant fibrosis stage. There was no significant difference in the proportion of histologic IT phase and clinical prognosis between normal ALT and mildly elevated ALT groups. However, even in patients with normal ALT, age was an important factor in predicting the presence of the histologic IT phase. Conclusions A significant number of patients who belonged to the serological IT phase were not in the histologic IT phase. Patients over 35 years and those with high AST, low albumin, and low HBV DNA levels were more likely to experience poor long-term clinical outcomes. Therefore, additional histologic assessment should be considered.

Background/Aims: Sorafenib is the first approved systemic treatment for advanced hepatocellular carcinoma (HCC). However, its clinical utility is limited, especially in Asian countries. Several reports have suggested the survival benefits of hepatic arterial infusion chemotherapy (HAIC) for advanced HCC with main portal vein tumor thrombosis (PVTT). This study aimed to compare the efficacy of sorafenib-based therapy with that of HAIC-based therapy for advanced HCC with main PVTT. Methods: Advanced HCC patients with main PVTT treated with sorafenib or HAIC between 2008 and 2016 at Korea University Medical Center were included. We evaluated overall survival (OS), time-to-progression (TTP), and the disease control rate (DCR). Results: Seventy-three patients were treated with sorafenib (n=35) or HAIC (n=38). Baseline characteristics were not significantly different between groups, except the presence of solid organ metastasis (46% vs 5.3%, p<0.001). The median OS time was not significantly different between the groups (6.4 months vs 10.0 months, p=0.139). TTP was longer in the HAIC group than in the sorafenib group (2.1 months vs 6.2 months, p=0.006). The DCR was also better in the HAIC group than in the sorafenib group (37% vs 76%, p=0.001). Subgroup analysis, which excluded patients with extrahepatic solid organ metastasis, showed the same trends for the median OS time (8.8 months vs 11.1 months, p=0.097), TTP (1.9 months vs 6.0 months, p<0.001), and DCR (53% vs 81%, p=0.030). Conclusions HAIC-based therapy may be an alternative to sorafenib for advanced HCC with main PVTT by providing longer TTP and a better DCR.

The prognostic role of resting pulmonary hyperinflation as measured by residual volume (RV)/total lung capacity (TLC) in chronic obstructive pulmonary disease (COPD) remains poorly understood. Therefore, this study aimed to identify the factors related to resting pulmonary hyperinflation in COPD and to determine whether resting pulmonary hyperinflation is a prognostic factor in COPD. In total, 353 patients with COPD in the Korean Obstructive Lung Disease cohort recruited from 16 hospitals were enrolled. Resting pulmonary hyperinflation was defined as RV/TLC > or = 40%. Multivariate logistic regression analysis demonstrated that older age (P = 0.001), lower forced expiratory volume in 1 second (FEV1) (P < 0.001), higher St. George Respiratory Questionnaire (SGRQ) score (P = 0.019), and higher emphysema index (P = 0.010) were associated independently with resting hyperinflation. Multivariate Cox regression model that included age, gender, dyspnea scale, SGRQ, RV/TLC, and 6-min walking distance revealed that an older age (HR = 1.07, P = 0.027), a higher RV/TLC (HR = 1.04, P = 0.025), and a shorter 6-min walking distance (HR = 0.99, P < 0.001) were independent predictors of all-cause mortality. Our data showed that older age, higher emphysema index, higher SGRQ score, and lower FEV1 were associated independently with resting pulmonary hyperinflation in COPD. RV/TLC is an independent risk factor for all-cause mortality in COPD.
Aged ; Dyspnea/diagnosis/physiopathology ; Exercise Test ; Exercise Tolerance ; Female ; Forced Expiratory Flow Rates/physiology ; Forced Expiratory Volume ; Humans ; Lung/*physiopathology ; Male ; Middle Aged ; Prognosis ; Pulmonary Disease, Chronic Obstructive/*diagnosis/mortality/physiopathology ; Pulmonary Emphysema/*diagnosis/mortality/physiopathology ; Republic of Korea ; Residual Volume/*physiology ; Respiratory Function Tests ; Surveys and Questionnaires ; Total Lung Capacity/*physiology ; Vital Capacity ; Walking/physiology