No abstract available.
Child* ; Evoked Potentials, Auditory, Brain Stem* ; Humans

The modified Phemister technique, which fixes the acromioclavicular joint with a k-wire and fixes the coronoid process and clavicle with a sling, has often been used as surgical treatment for dislocation of the acromioclavicular joint. This technique has the advantage of allowing early rehabilitation exercises with accurate anatomical reduction and firm fixation. On the other hand, some complications have been reported, such as infection, deformation recurrence, fixation complications, erosion of the distal clavicle or fracture of the sling, and secondary arthritis. This study presents a patient who experienced shoulder pain and functional impairment after conservative treatment for a sling area insufficiency fracture that arose from using the modified Phemister technique. Locking screw plate fixation with tricortical iliac bone grafting and matchstick-shaped cancellous bone grafting were used, and successful outcomes were achieved. This paper reports this case with a review of the relevant literature.

No abstract available.
Vitelline Duct*

PURPOSE: It is well recognized that apoptosis is important in embryonic development, homeostatic control of normal tissues, carcinogenesis, tumor development and cancer therapy. Several papers have been reported the phenomenon of radiation-induced apoptosis and suggested its potential relevance to cancer radiotherapy. It has been shown that apoptosis is regulated by various cytokines. But the relationship between radiation induced apoptosis and cytokines have not fully understood in detail, yet. MATERIALS AND METHODS: In this study, we performed to determine the role of cytokine in the radiation -induced apoptosis of rat's small intestine. The rats were divided into 6 groups according to the sacrifice day (1, 2, 3, 5, 7, 14 days) after whole body irradiation with single dose of 8 Gy. RESULTS: Radiation induced intestinal damage was noted from first day of radiation and the most active regeneration was seen in the groups of 5 days after radiation. Abundant apoptosis were observed in damaged crypts of small intestine 1 day after radiation. Afterwards, the number of apoptosis was gradually diminished, but the second peak of apoptosis was noted in 5 days after radiation. On immunohistochemical study, IL-1, and TNF were expressed 1 day after radiation, but not expressed after that. IL-6 was expressed with strong positivity in 1, 3 days after radiation. CONCLUSION: A apoptosis seems to be the important mechanism of radiation induced small intestinal damage, and is possibly induced by the release of cytokines, such as IL-1, IL-6, TNF, in view the simultaneously increased appearance of apoptosis and cytokines. The second peak of increased apoptosis is thought to be related to remodeling of active regenerative activity, and it is not associated with cytokine expression.
Animals ; Apoptosis* ; Carcinogenesis ; Cytokines* ; Embryonic Development ; Female ; Interleukin-1 ; Interleukin-6 ; Intestine, Small* ; Pregnancy ; Radiotherapy ; Rats* ; Regeneration ; Whole-Body Irradiation

Though exercise T1-201 myocardial perfusion-scintigraphy is an important test in the diagnosis and evaluation of coronary artery disease, this test is limited in cases with poor physical conditions and unstable angina and the physical characteristics of thallium are not ideal for nuclear imaging of the myocardium. Recently, technetium-99m-labelled agent(99mTc-MIBI) has been developed to improved the quality of imaging and for easy usage in myocardial perfusion scan. Therefore, we performed dipyridamole 99mTc-MIBI myocardial scintigraphy and coronary angiography on 25 subjects who were suspeced to have coronary artery disease and the results obtanined were as follows ; 1) The overall diagnostic sensitivity of dipyridamole 99mTc-MIBI perfusion scintigraphy was 73.4%, while specificity was 66.7%. 2) Per vessel sensitivity for coronary artery disease diagnosis by the test was 71.4% and a per vessel specificity for coronary artery disease was 95.7%. 3) In all 75 coronary arteries, LAD had a sensitivity of 66.7%(10/15) and a specificity of 100%(10/10); RCA had a sensitivity of 75%(6/8) and a specificity of 82.4%(14/17); LCX had a sensitivity of 60%(3/5) and a specificity of 100%(20/20). 4) After infusion of dipyridamole, the most frequent adverse effect was chest pain which was seen in 8 cases(32%). The headache was seen in 7 cases(28%). Most of the symptoms were mild in severity and subsided spontaneously but 3 subjects were severe enough to require intravenous administration of aminophylline. In conclusion, dipyridamole 99m2011-06-17Tc-MIBI myocardial perfusion scintigraphy is a useful and safe test for diagnosis of coronary artery disease.
Administration, Intravenous ; Aminophylline ; Angina, Unstable ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Dipyridamole* ; Headache ; Myocardial Perfusion Imaging* ; Myocardium ; Perfusion ; Perfusion Imaging ; Sensitivity and Specificity ; Thallium

PURPOSE: Medical direction is an integral part of proper prehospital care, which is performed by EMS providers. In Gyunggi province, a number of measures have been implemented to improve the direct medical direction system. We aimed to report on the process and results of the newly implemented medical direction system. METHODS: This is a descriptive analysis of the newly implemented medical direction system for community EMS providers from June 2014 to October 2014. Direct medical direction was requested by emergency medical technicians (EMTs) during the study period, as follows: when a destination hospital was selected, EMTs requested medical direction from the physicians at the destination hospital. During the study period specially-trained advanced EMTs were permitted to perform intravenous (IV) access for fluid or glucose infusion without direct medical direction. EMTs were asked to complete records when they requested direct medical direction and performed IV access without medical direction. These records were collected and used in the analysis. RESULTS: Of 5949 direct medical direction requests, 5527 were analyzed; 2958 (53.5%) cases were requested to the destination hospitals, 2569 (46.5%) were requested to the centralized dispatch center. 'Patient evaluation' was the most common reason for EMTs to request medical direction to the destination hospitals (1680, 54.4%) and centralized dispatch center (980, 38.1%). EMTs' degree of satisfaction did not differ significantly between destination hospitals and the centralized dispatch center (4.12+/-0.82 and 4.09+/-0.84, p=0.053). IV access rate for hypotensive patients increased 6.1% during the study period compared to the same period of 2013 (17.6% and 11.5%, p<0.01). CONCLUSION: We found that it is feasible to request direct medical direction to the destination hospitals and perform IV access for fluid or glucose infusion without direct medical direction for specially-trained advanced EMTs. Continuing efforts to establish an optimized medical direction system would be required for proper pre-hospital care.
Emergency Medical Service Communication Systems ; Emergency Medical Services ; Emergency Medical Technicians ; Glucose ; Humans ; Korea

The continuous epidural anesthesia is an effective method for postoperative pain control and improvement of pulmonary function. A 39-year-old man was scheduled for postoperative intestinal obstruction. After adhesiolysis under the general anesthesia, epidural anesthesia was done for postoperative pain control. Because an accidental dural puncture was noticed, the adjacent interspace of epidural anesthesia was tried and catheter was inserted. Respiratory depression, hypotension, loss of consciousness and cardiac arrest were developed about 20 minutes after the first injection of 1% lidocain 10ml. Endotracheal intubation was performed and the respiration was controlled using 100% oxygen. Self respiration and alert mentality returned after 180 minutes. No CSF leakage, delayed onset time, severe hypotension, complete recovery may be the result of subdural anesthesia and postoperative hypoxia. But radiological examination was not performed.
Adult ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Anoxia ; Catheters ; Heart Arrest* ; Humans ; Hypotension ; Intestinal Obstruction ; Intubation, Intratracheal ; Oxygen ; Pain, Postoperative* ; Punctures ; Respiration ; Respiratory Insufficiency ; Unconsciousness

T cell immunoglobulin mucin domain (TIM)-3 is an immunomodulatory molecule and upregulated in T cells by several cytokines. TIM-3 also influences mast cell function but its transcriptional regulation in mast cells has not been clarified. Therefore, we examined the transcript level and the promoter activity of TIM-3 in mast cells. The TIM-3 transcript level was assessed by real-time RT-PCR and promoter activity by luciferase reporter assay. TIM-3 mRNA levels were increased in HMC-1, a human mast cell line by TGF-beta1 stimulation but not by stimulation with interferon (IFN)-alpha, IFN-lambda, TNF-alpha, or IL-10. TIM-3 promoter -349~+144 bp region relative to the transcription start site was crucial for the basal and TGF-beta1-induced TIM-3 promoter activities in HMC-1 cells. TIM-3 promoter activity was increased by overexpression of Smad2 and Smad4, downstream molecules of TGF-beta1 signaling. Our results localize TIM-3 promoter activity to the region spanning -349 to +144 bp in resting and TGF-beta1 stimulated mast cells.
Cytokines ; Humans ; Immunoglobulins ; Interferons ; Interleukin-10 ; Luciferases ; Mast Cells ; Mucins ; RNA, Messenger ; T-Lymphocytes ; Transcription Initiation Site ; Transforming Growth Factor beta1 ; Tumor Necrosis Factor-alpha

PURPOSE: This investigation was performed in order to improve the health care of radiation workers, to predict a risk, to minimize the radiation exposure hazard to them and for them to realize radiation exposure danger when they work in radiation area in hospital. METHODS AND MATERIALS: The documentations checked regularly for personal radiation exposure in four university hospitals in Pusan city in Korea between January 1, 1993 and December 31, 1997 were analyzed. There were 458 persons in this documented but 111 persons who worked less then one year were excluded and only 347 persons were included in this study. RESULTS: The average of yearly radiation exposure of 347 persons was 1.52+/-1.35 mSv. Though it was less than 50mSv, the limitaion of radiation in law but 125 (36%) people received higher radiation exposure than non-radiation workers. Radiation workers under 30 year old have received radiation exposure of mean 1.87+/-1.01 mSv/year, mean 1.22+/-0.69 mSv between 31 and 40 year old and mean 0.97+/-0.43 mSv/year over 41year old ( p<0.001). Men received mean 1.67+/-1.54 mSv/year were higher than women who received mean 1.13+/-0.61 mSv/year ( p<0.01). Radiation exposure in the department of nuclear medicine department in spite of low energy sources is higher than other departments that use radiations in hospital ( p<0.05). And the workers who received mean 3.69+/-1.81 mSv/year in parts of management of radiation sources and injection of sources to patient receive high radiation exposure in nuclear medicine department ( p<0.01). In department of diagnostic radiology high radiation exposure is in barium enema rooms where workers received mean 3.74+/-1.74 mSv/year and other parts where they all use fluoroscopy such as angiography room of mean 1.17+/-0.35 mSv/year and upper gastrointestinal room of mean 1.74+/-1.34 mSv/year represented higher radiation exposure than average radiation exposure in diagnostic radiology ( p<0.01). Doctors and radiation technologists received higher radiation exposure of each mean 1.75+/-1.17 mSv/year and mean 1.60+/-1.39 mSv/year than other people who work in radiation area in hospital ( p<0.05). Especially young doctors and technologists have the high opportunity to receive higher radiation exposure. CONCLUSION: The training and education of radiation workers for radiation exposure risks are important and it is necessary to rotate worker in short period in high risk area. The hospital management has to concern health of radiation workers more and to put an effort to reduce radiation exposure as low as possible in radiation areas in hospital.
Adult ; Angiography ; Barium ; Busan ; Delivery of Health Care ; Documentation ; Education ; Enema ; Female ; Fluoroscopy ; Hospitals, University ; Humans ; Jurisprudence ; Korea ; Male ; Nuclear Medicine

There are occasions when standard techniques of reconstructive surgery for traumatic injury, tumor resection, and correction of congenital anomalies cannot be used as a result of the unavailability of tissues, absence of healthy vascular pedicle or excessive morbidity in donor area. It is established that autogenous skin, muscle, bone, and other composite tissue can retain their viability in varying degree as a prefabricated `flap with vascular pedicle implantation and the survival rate of these flaps has increased with tissue expansion or PGE1 infusion. The purpose of this study was to demonstrate the reliability of the secondary or prefabricated rectus abdominis musculocutaneous flap, and to evaluate the effect of the several factors on the survival routes of these flaps. Fifty New Zealand white rabbits weighing from 250 to 350 gm were used for the study. On the abdominal area bipedicled skin flaps are elevated as a random pattern flaps and were prefabricated using with rectus muscle. The fifty flaps were studied. They were divided into the five groups as follows; group I, 10 x4 cm classic axial pattern transverse rectus abdominis muscle (TRAM ) flaps were made as a control group (n = 10); groupII, 10 x4 cm random pattern bipedicled skin flaps were prefabricated using right rectus muscle with the delay procedure(n = 10); group III, 5 x4 cm prefabricated musculocutaneous flap were made same as group II on the right, side, tissue expansion was performed on the left side (n = 10); group IV, same procedure was performed as group II, and in addition postoperative intravenous infusion of PGE1 was given(n = 10); group V, same procedure was performed as group III, and in addition postoperative intravenous infusion of PGE1 and tissue expansion was performed(n = 10). Flap survival rates of each group were evaluated and compared. The following results were obtained: 1. Survival rates of prefabricated flaps were lower than that of classic axial pattern flaps regardless of using tissue expansion and PGE1 infusion(p < 0.05). 2. In making a comparison between flap with and without PGE1 infusion, survival rates of prefabricated flaps infused with PGE1 were higher than that of flaps without PGE1 infusion. 3. The prefabricated flaps managed with tissue expansion had higher survival rates than that of flaps without using tissue expansion. 4. The survival rates of prefabricated flaps managed in combination with tissue expansion and PGE1 infusion were significantly higher than that of other groups except control group. In conclusion, this study demonstrated the significance of combiring use of tissue expansion and PGE1 infusion in a prefabricated musculocutaneous flaps as a reliable method.
Alprostadil ; Humans ; Infusions, Intravenous ; Myocutaneous Flap ; Rabbits* ; Rectus Abdominis ; Skin ; Survival Rate ; Tissue Donors ; Tissue Expansion