Objective: The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. Conclusion This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

Objective: The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. Conclusion This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

Calcific tendinitis of the longus colli is an inflammatory disease caused by calcium hydroxyapatite crystal deposition in the longus colli tendon of the prevertebral space. It is also known as retropharyngeal calcific tendinitis or prevertebral tendinitis. The typical imaging characteristics of this entity are calcifications on the superior insertion of the longus colli tendons at the C1-2 level and fluid collection in the retropharyngeal space. However, we introduce a case of acute longus colli tendinitis without definite calcification deposition on image findings.
Durapatite ; Tendinopathy* ; Tendons

An intramedullary spinal cord metastasis (ISCM) rarely develops in systemic cancer but is indicative of a poor prognosis. A 56-year-old man was admitted due to weakness of the lower extremities. He had received radiotherapy 3 months prior for a brain metastasis that had developed 1 year after achieving a complete response from chemotherapy for extended stage small cell lung cancer. Although the brain lesion had improved partially, ISCM from the cervical to lumbar-sacral spinal cords, which was accompanied by a leptomeningeal dissemination, was diagnosed based on magnetic resonance imaging of the spine and cerebrospinal fluid cytology. Finally, he died of sudden cardiac arrest during treatment. This is the first case of ISCM involving the whole spinal segments. Physicians should be aware of the subsequent development of ISCM in lung cancer patients with a previously known brain metastasis who present with new neurological symptoms.
Brain ; Death, Sudden, Cardiac ; Humans ; Lower Extremity ; Lung ; Lung Neoplasms ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Small Cell Lung Carcinoma ; Spinal Cord ; Spine

No abstract available.
Lung ; Thorax

BACKGROUND: There has been no consensus on the best way to prevent hypotension during epidural anesthesia. We undertook the present study to evaluate the effect of ephedrine infusion along with fluid preloading in prevention of hypotension. METHODS: Eighty patients undergoing total abdominal hysterectomy were divided into 4 groups. The Group 1 and 2 were preloaded with 1000 ml lactated Ringer's solution(LR), Group 3 with 200 ml LR, and Group 4 with 500 ml of colloid(10% pentastarch) solution. In the group 1, normal saline was infused at 12 ml/min after bupivacaine injection into epidural space. In the Group 2, 3, and 4, ephedrine(mixed in normal saline) was infused after beginning of anesthesia at 1 mg/min. RESULTS: Systolic arterial pressure after epidural blockade was significantly lower in preloading of only LR(Group 1) than those with ephedrine infusion groups(Group 2, 3, and 4). In all groups the heart rate was not changed significantly during the course of the study. The central venous pressure increased after fluid preloading in all groups, but the magnitude of increase was relatively small in Group 3. Hypotension occurred in 45% of the patients who received only LR(Group 1) vs 10% of those who received pentastarch(Group 4)(p<0.05). The incidence of hypotension(20%) was same in Group 2 and 3. CONCLUSIONS: Infusion of ephedrine could be an alternative method to prevent hypotension during epidural anesthesia. Similar incidence of hypotension in Groups 2 and 3 challenges our perception of the value of crystalloid preload.
Anesthesia ; Anesthesia, Epidural* ; Arterial Pressure ; Bupivacaine ; Central Venous Pressure ; Consensus ; Ephedrine* ; Epidural Space ; Heart Rate ; Humans ; Hypotension* ; Hysterectomy ; Incidence

BACKGROUND: Endotracheal intubation is a common procedure in anesthesia, which can usually be accomplished easily. However, if the attempt is unexpectedly difficult the patient may be seriously at risk. If we can anticipate difficult intubation by assessing the airways in advance, anesthesiologists can plan the safest and most effective way of managing tracheal intubation. The purpose of this study is to evaluate a correlation between airway assessment factors and laryngoscopic grades for predicting difficult intubation. METHODS: The data were collected from a total of 427(male 189) patients older than 16 years of age undergoing non-emergency surgery. Seven airway assessment factors, measured at three levels of severity, were evaluated. Airway assessment factors include inter incisor gap, Samsoon and Young classification, thyromental distance, head and neck movement, body weight, history of difficult intubation and buck teeth. RESULTS: There was a significant correlation between total airway score and laryngoscopic grade. The incidence of difficult intubations was 9 out of 427 patients. Samsoon and Young classification, thyromental distance, head and neck movement, history of difficult intubation were significantly independent airway factors for predicting difficult intubations. Increase of total airway score represents the risk of difficult intubations. CONCLUSION: We suggest that total airway score could be used as a valuable predictor for assessing difficult intubations.
Anesthesia ; Body Weight ; Classification ; Head ; Humans ; Incidence ; Incisor ; Intubation* ; Intubation, Intratracheal ; Neck ; Tooth

Boophilus microplus (Canestrini, 1887) female specimens were subjected to scanning electron microscopy for the observation of surface fine structures. Morphological characteristics observed were summarized as follows: The palpi were wider than long, and compressed, ridged dorsally and laterally. There were usually four pairs of ventro-internal setae on the articles. The hypostome dentition was usually 4/4 but occasionally 5/5. The basis capituli were hexagonal dorsally and the porose area was distinct with the holes developed well. There were numerous folds resembling finger prints around the female genital pore. A pair of anal lobes with specified setae on them was also recognized as one of the morphological characteristics.
parasitology ; arthropoda ; electron microscopy ; tick ; Boophilus microplus

The surface fine structures of Ixodes persulcatus (Schulze, 1930) male and female specimens were observed by means of a scanning electron microscope. A brief review on the biology of the ticks and their disease relationships was also presented. The sexual dimorphism of the specimen was marked; the male was quite smaller than the female. The genital groove was well developed and deep, the anal groove was distinct and characteristically extending anteriorly around the anus. The 4th article was much reduced and situated on the top of the 3rd article ventrally. The hypostome dentition was usually 3/3. The bottom of the basis capitulum of the male specimen was strictly straight in shape. This species was regarded as one of the most important vectors for infectious diseases of migrating birds.
parasitology ; arthropoda ; electron microscopy ; tick ; Ixodes persulcatus

During February 1982 to Septemner 1983, a total of 105 domestic ducks (Anas platyrhynchos var. domestica Linnaeus) were collected from Ichon Gun, Puasn City, Chunchon City, Yanggu Gun, Taejeon City and unknown areas in Korea. In the results, six trematode and one nematode species of helminth parasites were obtained and described as follows: Amphimerus anatis Yamaguti, 1933, Echinostoma miyagawai Ishii, 1932, Echinochasmus japonicus Tanabe, 1926, Cryptocotyle sp., Notocotylus attenuatus (Rudolphi, 1809) Kossack, 1911, Apatemon sp, and nematode species, Heterakis gallinarum Schrank, 1788. From this collection, Amphimerus anatis Yamaguti, 1933, Echinochasmus japonicus Tanabe, 1926, Genus Cryptocotyle Luhe, 1899 and genus Apatemon Szidat, 1928 were firtstly recorded in Korea.
parasitology-helminth-trematoda ; duck ; Anas platyrhyncos var. domestica ; epidemiology ; Amphimerus anatis Echinostoma miyagawai ; Echinochasmus japonicus ; Cryptocotyle sp. ; Notocotylus attenuatus ; Heterakis gallinarum ; Amphimerus anatis