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Arthroscopic Treatment of Septic Arthritis of the Shoulder: Technical Pearls to Reduce the Rate of Reoperation

  • Kwon, Ji Eun;Park, Ji Soon;Park, Hae Bong;Nam, Kyung Pyo;Seo, Hyuk Jun;Kim, Woo;Lee, Ye Hyun;Jeon, Young Dae;Oh, Joo Han
    • Clinics in Shoulder and Elbow
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    • v.23 no.1
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    • pp.3-10
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    • 2020
  • Background: The aim of this study was to evaluate clinical experience with arthroscopic debridement for septic arthritis of the shoulder joint and to report on our patient outcomes. Methods: The retrospective analysis included 36 shoulders (male:female, 15:21), contributed by 35 patients (mean age, 63.8 years) treated by arthroscopy for septic arthritis of the shoulder between November 2003 and February 2016. The mean follow-up period was 14.3 months (range, 12-33 months). An additional posterolateral portal and a 70° arthroscope was used to access the posteroinferior glenohumeral (GH) joint and posteroinferior subacromial (SA) space, respectively. Irrigation was performed with a large volume of fluid (25.1±8.1 L). Multiple suction drains (average, 3.3 drains) were inserted into the GH joint and SA space and removed 8.9±4.3 days after surgery. Intravenous antibiotics were administered for 3.9±1.8 weeks after surgery, followed by oral antibiotic treatment for another 3.6±1.9 weeks. Results: Among the 36 shoulders, reoperation was required in two cases (5.6%). The average range of motion achieved was 150.0° for forward flexion and T9 for internal rotation. The mean simple shoulder test score was 7.9±3.6 points. Nineteen shoulders (52.8%) had acupuncture or injection history prior to the infection. Pathogens were identified in 15 shoulders, with Staphylococcus aureus being the most commonly identified pathogen (10/15). Both the GH joint and the SA space were involved in 21 shoulders, while 14 cases involved only the GH joint and one case involved only the SA space. Conclusions: Complete debridement using an additional posterolateral portal and 70° arthroscope, a large volume of irrigation with >20 L of saline, and multiple suction drains may reduce the reoperation rate.

Oxidative Stress, Chromatin Remodeling and Gene Transcription in Inflammation and Chronic Lung Diseases

  • Rahman, Irfan
    • BMB Reports
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    • v.36 no.1
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    • pp.95-109
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    • 2003
  • Inflammatory lung diseases are characterized by chronic inflammation and oxidant/antioxidant imbalance. The sources of the increased oxidative stress in patients with chronic inflammatory lung diseases such as asthma and chronic obstructive pulmonary disease (COPD) derive from the increased burden of inhaled oxidants, and from the increased amounts of reactive oxygen species (ROS) generated by several inflammatory, immune and various structural cells of the airways. Increased levels of ROS produced in the airways is reflected by increased markers of oxidative stress in the airspaces, sputum, breath, lungs and blood in patients with lung diseases. ROS, either directly or via the formation of lipid peroxidation products such as 4-hydroxy-2-nonenal may play a role in enhancing the inflammation through the activation of stress kinases (JNK, MAPK, p38) and redox sensitive transcription factors such as NF-${\kappa}B$ and AP-1. Recent evidences have indicated that oxidative stress and pro-inflammatory mediators can alter nuclear histone acetylation/deacetylation allowing access for transcription factor DNA binding leading to enhanced pro-inflammatory gene expression in various lung cells. Understanding of the mechanisms of redox signaling, NF-${\kappa}B$/AP-1 regulation, the balance between histone acetylation and deacetylation and the release and expression of pro- and anti-inflammatory mediators may lead to the development of novel therapies based on the pharmacological manipulation of antioxidants in lung inflammation and injury. Antioxidants that have effective wide spectrum activity and good bioavailability, thiols or molecules which have dual antioxidant and anti-inflammatory activity, may be potential therapeutic agents which not only protect against the direct injurious effects of oxidants, but may fundamentally alter the underlying inflammatory processes which play an important role in the pathogenesis of chronic inflammatory lung diseases.

LIMITED OR LE FORT I DOWN FRACTURE ACCESS FOR WIDESPREAD OSTEOMYELITIS OF MAXILLA (광범위한 상악골 골수염의 제한적 접근법과 Le Fort I 하방 골절을 통한 접근법)

  • Go, Taek-Su;Lee, Won;Kim, In-Soo;Cha, Hyun-Suk;Han, Hyung-Uck;Seo, Woon-Kyung;Park, Su-Hyun;Yun, Kyoung-In
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.31 no.5
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    • pp.436-439
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    • 2005
  • Purpose: To compare the case of widespread maxillary osteomyelitis treated through different approach. Method: We report the two case of osteomyelitis. In a case, we had gradually removed the small amount of sequestrum for several times. In the other case, intended Le Fort I fracture was done to approach the lesion. Result: In the gradual sequestrectomy case, bone formations were found after 4 months. In the other case, after intended Le Fort I down fracture, sequestrectomy of Lt. maxilla was done with the labiobuccal alveolar bone preserved for the prosthodontic treatment.

Skin Sensitization Study of Bee Venom (Apis mellifera L.) in Guinea Pigs

  • Han, Sang-Mi;Lee, Gwang-Gill;Park, Kyun-Kyu
    • Toxicological Research
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    • v.28 no.1
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    • pp.1-4
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    • 2012
  • Bee venom (Apis mellifera L., BV) has been used as a cosmetic ingredient for antiaging, anti-inflammatory and antibacterial functions. The aim of this study was to access the skin sensitization of BV, a Buehler test was conducted fifty healthy male Hartley guinea pigs with three groups; Group G1 (BV-sensitization group, 20 animals), group G2 (the positive control-sensitization group, 20 animals), and group G3 (the ethyl alcohol-sensitization group, 10 animals). The exposure on the left flank for induction was repeated three times at intervals of one week. Two weeks after the last induction, the challenge was performed on the right flank. No treatment-related clinical signs or body weight changes were observed during the study period. The average skin reaction evaluated by erythema and edema on the challenge sites and sensitization rate in the BV-sensitization group at 30 hours were 0.0 and 0%, respectively, which are substantially low compared with in positive control group (average skin reaction: 0.55, sensitization rate: 40%) and identical with in vehicle control group, representing a weak sensitizing potential. The average skin reaction and sensitization rate observed at 54 hours were 0.0 and 0% in the BV-sensitization group, respectively, and 0.25 and 20% in the positive control group, respectively. It was concluded that BV classified to Grade I, induced no sensitization when tested in guinea pigs and may provide a developmental basis for a cosmetic ingredient or external application for topical uses.

Self-Management Knowledge, Self-Management, Physiological Indexes, and Symptoms Experience according to Dialysis Methods (투석방법에 따른 자가관리 지식, 자가관리, 생리적 지표와 증상경험)

  • Moon, Jeong Hwa;Shin, Yun Hee
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.25 no.3
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    • pp.220-230
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    • 2018
  • Purpose: This study was a cross-sectional study comparing differences in self-management knowledge, self-management, physiologic indexes, and symptoms experience for two methods of dialysis. Methods: Participants were 90 patients on hemodialysis and 91 on peritoneal dialysis at A hospital. Results: There was no significant difference between the two groups for knowledge of self-management. A comparison of the categories in the evaluation of self-management showed that patients in the peritoneal dialysis group took better care of their dialysis access route (F=17.61, p<.001) and dialysis schedule (F=4.30, p=.040). The physiologic indexes between the two dialysis groups showed that hemoglobin levels were higher in the hemodialysis group (F=5.28, p=.023). The product of serum calcium and phosphate was higher in the peritoneal dialysis group (F=11.42, p=.001). Serum sodium level was also higher in the peritoneal dialysis group (t=5.36, p<.001) while serum albumin level (t=-3.36, p=.001) and mean arterial blood pressure (t=-2.50, p=.013) were higher in hemodialysis patients. There were no significant differences in the proportion of uncomfortable experiences between the two groups. Conclusion: Medical personnel should consider differences in self-management knowledge/self-management, physiologic indexes, and symptoms experience for hemodialysis and peritoneal dialysis populations, and should provide adequate education accordingly and promote behavioral change to improve physiologic indexes and reduce symptoms.

Dynamics and Liver Disease Specific Aspects of Quality of Life Among Patients with Chronic Liver Disease in Yunnan, China

  • Che, Yan-Hua;You, Jing;Chongsuvivatwong, Virasakdi;Li, Li;Sriplung, Hucha;Yan, Yuan-Zhi;Ma, Si-Jia;Zhang, Xiaoli;Shen, Ting;Chen, He-Min;Rao, Shao-Feng;Zhang, Ru-Yi
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.12
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    • pp.4765-4771
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    • 2014
  • Background: Patients with chronic liver diseases (CLD) may have compromised health related quality of life (HRQoL). Hepatitis B virus (HBV) infection has long been the leading cause of CLD including liver cancer and cirrhosis. Knowledge on different symptom profiles of CLD should help in development of comprehensive treatment and patient care plans. Objective: To access the facets of HRQoL in chronic liver diseases throughout their spectrum of severity. Materials and Methods: A cross-sectional study was conducted in the First Affiliated Hospital of Kunming Medical University in Yunnan Province of China. Both out- and inpatients undergoing treatment protocols for different HBV related liver disease states were consecutively collected from December 2012 to June 2013. ANOVA was used to compare the mean scores of EQ-5D and chronic liver disease questionnaire (CLDQ) among 5 disease groups. The relationship between demographic variables predicting global CLDQ scores and the domains of CLDQ was analysed. Results: A total of 1040 patients including 520 without complications, 91 with compensated cirrhosis, 198 with decompensated cirrhosis, 131 with HCC and 100 with liver failure were recruited. All domains of CLDQ, the means of EQ-5D value and EQ VAS exhibited significant decline with worsening of disease severity from uncomplicated HBV to liver failure. The multivariate regression demonstrated the reduction of mean scores of CLDQ domain at advanced stage. Patients with liver failure and HCC had more HRQoL impairment than other disease states. No effect of patient gender was found. Patient age was associated with 'fatigue' and 'worry' domains (p=0.006; p=0.004) but not with other domains and global scores of CLDQ and ED-5D. Conclusions: The HRQoL in chronic hepatitis B patients is greatly affected by disease states. Care for HBV-related diseases should consider not only the outcomes of treatment strategies but also improvement in patient wellbeing.

Video-Assisted Thoracic Surgery: A Review of 52 Surgical Procedures (비디오 흉강경을 이용한 흉부수술 -52례 경험-)

  • Gang, Chang-Hui;Lee, Jun-Bok;Lee, Gil-No
    • Journal of Chest Surgery
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    • v.29 no.10
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    • pp.1138-1142
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    • 1996
  • Video-assisted thoracic surgery is a new modality that allows visualization of and access to the intrathoracic organs without making a thoracotomy Incision. 52 patients underwent thoracic procedures using this technique. There were pneumothorax in 40 patients, diffuse interstital lung disease in 6 patients, hyperhidrosis in 3 patients, pulmonary tuberculoma in 1 patient, aspergilloma in 1 patient and localized fibrous tumor of pleura in 1 patient. We had performed a variety of procedures(36 wedge resections with mechanical pleurodesis, 8 wedge resections only, 4 mechanical pleurodeses, 3 bilateral sympathectomys and 1 segmentectomy). The period of chest tube indwelling and postoperative hospitalization were 2.00 $\pm$ 1.32 days(range : 0~6 days) and 3.55 $\pm$ 1.45 days(range : 1~8 days). Four postoperative complications occurred(2 pleural effusion, 1 recurrent pneumothorax and 1 high fever). Conversion to open thoracotomy was done in 1 p tient due to massive air leakage. Patients undergoing video-assisted thoracic surgery seem to have reduced postoperative pain, shorter hospitalization, and quicker recovery times.

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Performance and carcass characteristics of Australian purebred and crossbred lambs supplemented with Rice Bran

  • Flakemore, Aaron Ross;Otto, John Roger;Suybeng, Benedicte;Balogun, Razaq Oladimeji;Malau-Aduli, Bunmi Sherifat;Nichols, Peter David;Malau-Aduli, Aduli Enoch Othniel
    • Journal of Animal Science and Technology
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    • v.57 no.10
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    • pp.36.1-36.9
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    • 2015
  • Background: This study examined the effects of dietary supplementation with rice bran, sire breed and gender on live animal performance and carcass characteristics in Australian crossbred and purebred Merino lambs. Methods: Forty-eight lambs balanced by sire breed (Dorset, White Suffolk, Merino) and gender (ewe, wether) were randomly allocated into three dietary supplementation groups (Control- 24 lambs fed wheat/barley-based pellets, Low- 12 animals fed a 50/50 ratio of wheat-based/rice bran pellets, and High- 12 lambs fed rice bran pellets). The Rice bran pellets replaced 19 % of the barley component of the feed. Animals were group-fed at the rate of 1000 g of the supplement per head per day with ad libitum access to lucerne hay as the basal diet and water. The duration of the feeding trial was 49 days with an initial 21-day adjustment period. Results: Sire breed differences were evident for initial (p < 0.0002) and final (p < 0.0016) liveweights, hot carcass (p < 0.0030) and cold carcass (p < 0.0031) weights, as well as dressing percentage (p < 0.0078), fat thickness (p < 0.0467), yield grade (p < 0.0470) and rib eye area (p < 0.0022) with purebred Merino under-performing compared to the crossbreds. Concentrate feed conversion efficiency, costs per unit of liveweight gain and over the hooks income were comparable between treatments regardless of the observed trend where the high supplementation group tended to show lower feed intake (745.8 g/day) compared to both the control (939.9 g/day) and low supplementation groups (909.6 g/day). No significant differences (p > 0.05) were observed between treatments for live animal performance, carcass characteristics, gender and their second-order interactions. Conclusions: Results indicate that Rice bran can be utilised as a cost-effective supplementary feed source in genetically divergent sheep over a 49-day feeding period without detrimental effects on overall live animal performance or carcass characteristics.

NQO1-Knockout Mice Are Highly Sensitive to Clostridium Difficile Toxin A-Induced Enteritis

  • Nam, Seung Taek;Hwang, Jung Hwan;Kim, Dae Hong;Lu, Li Fang;Hong, Ji;Zhang, Peng;Yoon, I Na;Hwang, Jae Sam;Chung, Hyo Kyun;Shong, Minho;Lee, Chul-Ho;Kim, Ho
    • Journal of Microbiology and Biotechnology
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    • v.26 no.8
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    • pp.1446-1451
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    • 2016
  • Clostridium difficile toxin A causes acute gut inflammation in animals and humans. It is known to downregulate the tight junctions between colonic epithelial cells, allowing luminal contents to access body tissues and trigger acute immune responses. However, it is not yet known whether this loss of the barrier function is a critical factor in the progression of toxin A-induced pseudomembranous colitis. We previously showed that NADH:quinone oxidoreductase 1 (NQO1) KO (knockout) mice spontaneously display weak gut inflammation and a marked loss of colonic epithelial tight junctions. Moreover, NQO1 KO mice exhibited highly increased inflammatory responses compared with NQO1 WT (wild-type) control mice when subjected to DSS-induced experimental colitis. Here, we tested whether toxin A could also trigger more severe inflammatory responses in NQO1 KO mice compared with NQO1 WT mice. Indeed, our results show that C. difficile toxin A-mediated enteritis is significantly enhanced in NQO1 KO mice compared with NQO1 WT mice. The levels of fluid secretion, villus disruption, and epithelial cell apoptosis were also higher in toxin A-treated NQO1 KO mice compared with WT mice. The previous and present results collectively show that NQO1 is involved in the formation of tight junctions in the small intestine, and that defects in NQO1 enhance C. difficile toxin A-induced acute inflammatory responses, presumably via the loss of epithelial cell tight junctions.

Categorization of medical activities in the essential surgical field that require criminal immunity -As part of solving the manpower shortage in essential medical hospitals in the surgical field- (형사면책이 필요한 외과계 필수의료행위의 범주화 - 외과계 필수의료 병원 인력난 해결을 위한 일환으로 -)

  • Phils Kim
    • The Korean Society of Law and Medicine
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    • v.24 no.1
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    • pp.101-130
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    • 2023
  • Korea has very easy access to tertiary hospitals, including university hospitals, among OECD countries, and patients can reach the emergency room of a university hospital within 1-2 hours. However, there are many so-called 'essential medical' blind spots where people die because they do not receive surgery in time. In particular, in the case of essential medical care in the surgical field, despite basic surgery, there is a shortage of medical staff to perform outpatient surgery in emergency situations at university hospitals. Although this lack of manpower has a problem with low insurance premiums for surgery, it also has a very large impact on the burden of criminal liability for medical malpractice, which increases the incidence in case of emergencies. Here, we propose crime immunity to solve the manpower shortage of converged smart surgical essential medical (SES) hospitals. Currently, the medical community agrees on the need for crime immunity, but it is an ambiguous scope of immunity that has not reached a national consensus. We would like to present clear standards for essential medical practices (surgery) that require criminal immunity.