Two small-breed dogs and two cats, with an average body weight of 4.88 kg (range: 4.3–5.5 kg), suffered hindlimb lameness due to luxation with or without fractures of the tarsocrural joint. These patients underwent tarsocrural arthrodesis with epoxy putty external skeletal fixator. The animals’ skins were incised minimally, and the articular cartilage of the tarsocrural joint was removed, followed by autogenous cancellous bone grafting. Epoxy putty and positive Centerface®, pins with diameters 1.2 mm and 2.0 mm, were used for connecting bar and as a full pin fixation, respectively. All the patients regained the ability to bear weight on the affected limb within 3–7 days and resumed a normal gait within 9–15 weeks. The external skeletal fixator frame was removed within 13–17 weeks without major complications. Tarsocrural arthrodesis using epoxy putty external skeletal fixator resulted in excellent outcomes without severe postoperative complications in this study. Epoxy putty external skeletal fixator can be a valuable surgical option for tarsocrural arthrodesis in patients weighing less than 5.5 kg.

Two small-breed dogs and two cats, with an average body weight of 4.88 kg (range: 4.3–5.5 kg), suffered hindlimb lameness due to luxation with or without fractures of the tarsocrural joint. These patients underwent tarsocrural arthrodesis with epoxy putty external skeletal fixator. The animals’ skins were incised minimally, and the articular cartilage of the tarsocrural joint was removed, followed by autogenous cancellous bone grafting. Epoxy putty and positive Centerface®, pins with diameters 1.2 mm and 2.0 mm, were used for connecting bar and as a full pin fixation, respectively. All the patients regained the ability to bear weight on the affected limb within 3–7 days and resumed a normal gait within 9–15 weeks. The external skeletal fixator frame was removed within 13–17 weeks without major complications. Tarsocrural arthrodesis using epoxy putty external skeletal fixator resulted in excellent outcomes without severe postoperative complications in this study. Epoxy putty external skeletal fixator can be a valuable surgical option for tarsocrural arthrodesis in patients weighing less than 5.5 kg.

PURPOSE: To evaluate superiority of a night float (NF) system in comparison to a traditional night on-call (NO) system for surgical residents at a single institution in terms of efficacy, safety, and satisfaction. METHODS: A NF system was implemented from March to September 2017 and big data analysis from electronic medical records was performed for all patients admitted for surgery or contacted from the emergency room (ER). Parameters including vital signs, mortality, and morbidity rates, as well as promptness of response to ER calls, were compared against a comparable period (March to September 2016) during which a NO system was in effect. A survey was also performed for physicians and nurses who had experienced both systems. RESULTS: A total of 150,000 clinical data were analyzed. Under the NO and NF systems, a total of 3,900 and 3,726 patients were admitted for surgery. Mortality rates were similar but postoperative bleeding was significantly higher in the NO system (0.5% vs. 0.2%, P = 0.031). From the 1,462 and 1,354 patients under the NO and NF systems respectively, that required surgical consultation from the ER, the time to response was significantly shorter in the NF system (54.5 ± 70.7 minutes vs. 66.8 ± 83.8 minutes, P < 0.001). Both physicians (90.4%) and nurses (91.4%) agreed that the NF system was more beneficial. CONCLUSION: This is the first report of a NF system using big data analysis in Korea, and potential benefits of this new system were observed in both ward and ER patient management.
Electronic Health Records ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Internship and Residency ; Korea ; Medical Staff ; Mortality ; Statistics as Topic ; Vital Signs

PURPOSE: To investigate surgical outcomes between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) groups for a main stone sized 15 to 30 mm and located in the lower-pole calyx. MATERIALS AND METHODS: Patients who underwent PNL or RIRS for a main stone sized 15 to 30 mm and located in the lower-pole calyx were retrospectively reviewed. Each patient in the RIRS group was matched to one in the PNL group on the basis of calculated propensity scores by use of age, sex, body mass index, previous treatment history, stone site, maximum stone size, and stone volume. We compared perioperative outcomes between the unmatched and matched groups. RESULTS: Patients underwent PNL (n=87, 66.4%) or RIRS (n=44, 33.6%). After matching, 44 patients in each group were included. Mean patient age was 54.4+/-13.7 years. Perioperative hemoglobin drop was significantly higher and the hospital stay was longer in the PNL group than in the RIRS group. The operative time was significantly longer in the RIRS group than in the PNL group. Stone-free rates were higher and complications rates were lower in the RIRS group than in the PNL group without statistical significance. The presence of a stone located in the lower-anterior minor calyx was a predictor of stone-free status. CONCLUSIONS: RIRS and single-session PNL for patients with a main stone of 15 to 30 mm located in the lower-pole calyx showed comparable surgical results. However, RIRS can be performed more safely than PNL with less bleeding. Stones in the lower-anterior minor calyx should be carefully removed during these procedures.
Adult ; Aged ; Female ; Hemoglobins/metabolism ; Humans ; Kidney Calculi/pathology/*surgery ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Nephrectomy/adverse effects/*methods ; Nephrostomy, Percutaneous/adverse effects/*methods ; Prognosis ; Propensity Score ; Retrospective Studies ; Treatment Outcome

PURPOSE: To find out the possible role of 1,25(OH)2 vitamin D3 [1,25(OH)2D3] and parathyroid hormone (PTH) as intrinsic factors in urinary calcium stone formers (SFs), we investigated their relationship with serum and urinary biochemical parameters. MATERIALS AND METHODS: A total of 326 calcium SFs (male: 204, female: 122) were enrolled and underwent outpatient metabolic evaluations including 1,25(OH)2D3 and PTH as well as serum and 24-hour urinary biochemical parameters. As control, 163 age- and sex-matched (2:1) individuals (non-SFs) who have never urinary stone episode were included. RESULTS: 1,25(OH)2D3 level was positively correlated with urinary calcium excretion (r=0.347, p<0.001). The hypercalciuric group and recurrent SFs had higher serum 1,25(OH)2D3 levels than the normocalciuric group (p<0.001) and first SFs (p=0.050). In the adjusted multiple linear regression analysis, serum 1,25(OH)2D3 level (beta=0.259, p<0.001) and serum PTH level (beta=-0.160, p<0.001) were significantly correlated with urinary calcium excretion. The patients in highest tertile of 1,25(OH)2D3 had a more than 3.1 fold risk of hypercalciuria than those in the lowest tertile (odds ratio=3.14, 95% confidence interval: 1.431-6.888, p=0.004). No correlation was observed between PTH and 1,25(OH)2D3 (R=0.005, p=0.929) in calcium SFs, while a negative correlation was found in controls (R=-0.269, p=0.001). CONCLUSION: 1,25(OH)2D3 was closely correlated with urinary calcium excretion, and high 1,25(OH)2D3 levels were detected in the hypercalciuric group and in recurrent SFs. However, 1,25(OH)2D3 was not correlated with PTH in calcium SFs. These findings suggest that 1,25(OH)2D3 might be important intrinsic factor for altered calcium regulation in SFs.
Adult ; Calcium/metabolism/*urine ; Female ; Humans ; Kidney Calculi ; Linear Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Parathyroid Hormone/blood/*physiology/urine ; Vitamin D/*analogs & derivatives/blood/physiology/urine

Valacyclovir is an oral antiviral agent used in the treatment of herpesvirus infection. Although neuropsychiatric symptoms may accompany the use of this drug, valacyclovir is increasingly used to treat herpes zoster, as it is more effective when orally administered. This paper reports one case of neurotoxicity of valacyclovir in patients with end stage renal disease who were undergoing maintenance hemodialysis. Valacyclovir can induce life-threatening neurotoxicity, especially in end stage renal disease patients despite the appropriate dose reduction. Furthermore, Valacyclovir-induced neurotoxicity can be effectively managed by intensive hemodialysis.
Herpes Zoster ; Herpesviridae Infections ; Humans ; Kidney Failure, Chronic ; Renal Dialysis*

The aim of this study was to evaluate the incidence of and risk factors for the development of diabetic retinopathy (DR) and progression to proliferative DR (PDR) in Korean patients. Patients diagnosed with type 2 diabetes and followed for more than 5 years at a university-based clinic since 2000 were consecutively enrolled in this retrospective cohort study. Based on the DR classification at the initial and final visits, the incidence and progression of DR was determined and patient characteristics were compared according to DR progression. Hazard ratios of each putative risk factor for DR progression were calculated with a multivariate Cox proportional hazard model. Rate of DR development and progression to PDR were 32.1/1,000 and 26.2/1,000 person-years, respectively. A longer duration of diabetes and higher mean HbA1c level were significant risk factors for the development of DR. Regarding progression to PDR, higher mean HbA1c level, higher standard deviation of HbA1c, and higher urine albumin-to-creatinine ratio were significant risk factors. The rates of development of DR and progression to PDR in Koreans with type 2 diabetes are lower than those reported over the last decade. An inadequate blood glycemic control is the common risk factor for development and progression of DR.
Adult ; Aged ; Causality ; Comorbidity ; Diabetes Mellitus, Type 2/*epidemiology ; Diabetic Retinopathy/*epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Risk Factors ; Socioeconomic Factors ; Tertiary Care Centers/*statistics & numerical data

OBJECTIVE: Perfusion computed tomography (PCT) has the ability to measure quantitative value and produce maps of mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV). We assessed cerebral hemodynamics by using these parameters and acetazolamide (ACZ) challenge for pre- and post-procedural evaluation in patients with unilateral cerebrovascular stenotic disease. METHODS: Thirty patients underwent pre-procedural PCT with ACZ challenge, and 24 patients (80%) was conducted follow up PCT after angioplasty with same protocol. The mean MTT, CBF, and CBV were measured and compared in both middle cerebral arterial (MCA) territories before and after ACZ challenge. Hemispheric ratio and percent change after ACZ challenge were calculated before and after angioplasty. RESULTS: The mean stenosis rate was 76.6%. Significant increases in MTT (32.6%, p=0.000) and significant decreases in CBF (-14.2%, p=0.000) were found in stenotic side MCA territories. After ACZ challenge, there were significant changes in MTT (37.4%, p=0.000), CBF (-13.1%, p=0.000), and CBV (-10.5%, p=0.001) in pre-procedural perfusion study. However, no significant increases were found in MTT, or decreases in CBF and CBV in post-procedural study. There were no significant changes after ACZ challenge also. In addition, the degrees of these changes (before and after ACZ challenge) were highly correlated with the stenotic degrees in pre-procedural perfusion study. CONCLUSION: PCT with ACZ challenge appears to be a useful tool to assess the cerebral perfusion status especially in patients with unilateral symptomatic stenotic disease.
Acetazolamide* ; Angioplasty ; Blood ; Blood Volume ; Constriction, Pathologic ; Follow-Up Studies ; Hemodynamics ; Humans ; Perfusion*

This study examined whether amifostine (WR-2721) could attenuate memory impairment and suppress hippocampal neurogenesis in adult mice with the relatively low-dose exposure of acute radiation syndrome (ARS). These were assessed using object recognition memory test, the terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling assay, and immunohistochemical markers of neurogenesis [Ki-67 and doublecortin (DCX)]. Amifostine treatment (214 mg/kg, i.p.) prior to irradiation significantly attenuated the recognition memory defect in ARS, and markedly blocked the apoptotic death and decrease of Ki-67- and DCX-positive cells in ARS. Therefore, amifostine may attenuate recognition memory defect in a relatively low-dose exposure of ARS in adult mice, possibly by inhibiting a detrimental effect of irradiation on hippocampal neurogenesis.
Acute Radiation Syndrome/drug therapy/*immunology/psychology ; Amifostine/*pharmacology/therapeutic use ; Animals ; Apoptosis/immunology ; Gamma Rays/*adverse effects ; Hippocampus/immunology ; Immunohistochemistry ; In Situ Nick-End Labeling ; Male ; Memory/*radiation effects ; Mice ; Mice, Inbred ICR ; Neurogenesis/immunology ; Radiation-Protective Agents/*pharmacology/therapeutic use

Electroretinography (ERG) is a reliable diagnostic tool for the diagnosis of retinal disease. It measures electric potentials occurring in the retina in response to light stimulation. In this study, we examined the normal electroretinogram using the Handheld Multispecies ERG (HMsERG) in Shih Tzu dogs. ERG recordings were performed in twelve eyes of six healthy Shih Tzu dogs. Dogs were anesthetized with a combination of medetomidine and ketamine. Proparacaine eye drops were also applied as a topical anesthetic. Tropicamide eye drops were applied for mydriasis. After 20 min of dark adaptation, we recorded the amplitudes and implicit times of the b-waves of the rod, standard rod and cone (Std R&C), high-intensity rod and cone (Hi-int R&C), and cone systems, and responses of the cones and inner retina by flicker light stimulation (cone flicker). Results showed that mean the amplitudes of a-waves of Std R&C, Hi-int R&C, and the cone responses were 141.25 microV, 173.00 microV, and 12.92 microV, respectively. The b-waves of the rod responses ranged from 141.58 to 155.25 microV; the Std R&C was 314.75 microV, the Hi-int R&C was 329.42 microV, the cones were 37.75 microV, and the flicker responses were 64.08 microV. The b/a ratios for the Std R&C, Hi-int R&C, and the cone response were 2.29, 1.94, and 3.71, respectively. Mean implicit time of the a-wave of the Std R&C was 15.12 ms, of Hi-int R&C was 13.42 ms, and of the cone response was 7.22 ms. The b-wave of the rod responses ranged from 68.12 to 72.68 ms, of Std R&C were 37.28 ms, of Hi-int R&C were 41.90, of the cone responses were 38.12 ms, and of the cone flicker responses were 22.80 ms. We believe that these parameters can be used as reference "normal" ERGs ranges for Shih Tzu dogs using the HMsERG under medetomidine and ketamine anesthesia.
Animals ; Dog Diseases/diagnosis ; Dogs/*physiology ; Electroretinography/instrumentation/*veterinary ; Retinal Diseases/diagnosis/veterinary ; Time Factors