Postero-medio-anterior approach of the ankle for the pilon fracture

A good view of the operative field is important for better reduction and fixation in surgical treatment of fractures. The exposure of the ankle joint for the pilon fracture is commonly through the anterior approach, or combined with the medical approach. But sometimes it is still difficult to have complete viewing of the articular surface and to apply internal fixation by that approach. In recent years, we developed a "postero-medio-anterior" approach of the ankle joint by one incision. This approach provides an excellent exposure of the anterior, medial and posterior aspects of the ankle joint with a clear view of the articular surface. In our 45 cases of pilon fracture during 1991 to 1995, there was no incisional injury to the neurovascular bundle. Superficial wound edge necrosis was noted in two cases which healed later without further procedure. Therefore, we recommend this approach as a simple and reliable incision for open reduction of pilon fractures.

Cross-reactivity of Tyrophagus putrescentiae with Dermatophagoides farinae and Dermatophagoides pteronyssinus in urban areas

BACKGROUND

Tyrophagus putrescentiae (TP) have cohabited with D. pteronys-sinus (DP) and D. farinae (DF) in more than 25% of houses in urban areas of Korea, and many atopic subjects have also been cosensitized to TP and Dermatophagoides species.

OBJECTIVE

We evaluated the cross-reactivity of TP with DF and DP in atopic subjects of urban inhabitants.

METHODS

The cross-reactivity was evaluated with inhibition ELISA and immunoblotting. Allergenic components of TP were evaluated with IgE immunoblotting of the sera from 25 individual atopics. All enrolled subjects lived in urban areas.

RESULTS

In ELISA inhibition with pooled sera, all TP, DP, and DF extract inhibited TP-specific IgE by more than 90%, and the 50% inhibitory concentrations of TP, DP, and DF extract were 0.4 microg/mL, 0.8 microg/mL and 0.8 microg/mL, respectively. The maximum inhibition, however, of DP-specific and DF-specific IgE by TP extracts was 32% and 29%, respectively. With six individual sera, the TP-specific IgE was also inhibited by more than 88% with DF extract in all cases. In inhibition immunoblotting, all of the TP, DP, and DF extracts completely inhibited the TP-specific IgE bands at a concentration of 2.0 microg/mL. Fifteen allergenic components in TP were found. Among them, the 16-kD allergen was most prevalent (52%) and its IgE binding was completely inhibited by 0.1 microg/mL of purified Der f2 and it also bound with 2 different monoclonal antibodies to the group 2 allergen of Dermatophagoides species.

CONCLUSIONS

Our results suggested considerable cross-reactivity between TP and the two Dermatophagoides species in urban areas where TP and Dermatophagoides species cohabit. The 16-kD allergen, which shared common epitopes with the group 2 allergen of Dermatophagoides, is one of the most prevalent allergens of TP.

Anaphylaxis to venom of the Pachycondyla species ant

BACKGROUND

In the southeastern United States, imported fire ants have caused systemic reactions with a high incidence. On the contrary, in Korea Pachycondyla species ants (P chinensis and P solitaria), and the family Formicidae, which are in the genus Pachycondyla and the subfamily Ponerinae, have only occasionally caused systemic reactions.

OBJECTIVE

We sought to assess whether commercially available imported fire ant extract would be useful in treating patients with anaphylaxis induced by venom from a Pachycondyla species ant.

METHODS

Serum samples were collected from 2 women who had anaphylaxis induced by Pachycondyla species ant venom and from 6 volunteers with no history of having been stung. Specific IgE to Pachycondyla species ant extracts was measured by means of ELISA and possible allergenic components by immunoblot. Cross-reactivity between Pachycondyla chinensis, P solitaria, and imported fire ant extracts was also measured by inhibitory ELISA.

RESULTS

Skin prick test responses were strongly positive to the extract of P chinensis (1:20 wt/vol) in the patient. Ten healthy volunteers exhibited negative responses. The 2 patients' sera exhibited high ELISA values, with absorbencies of 0.78 and 0.61 for P chinensis and 0.83 and 0.68 for P solitaria, respectively, and negative ELISA values for the extract of imported fire ants (absorbency <0.01). Imported fire ants showed no inhibition of the IgE binding to P chinensis or P solitaria. Possible allergenic components of Pachycondyla species ant extracts are 29- and 27-kd proteins and, less frequently, 16 kd proteins.

CONCLUSION

Our data suggest that patients who have had an anaphylactic reaction to a Pachycondyla species ant might not benefit from immunotherapy with an imported fire ant extract. Immunotherapy with the extract of Pachycondyla species ants is expected to be highly effective.

Identification and characterization of the major allergen of the Humulus japonicus pollen

BACKGROUND

Pollen of Humulus japonicus has been known as one of the important causes of pollinosis in Korea and China. To date, the major allergen of H. japonicus has not been determined.

OBJECTIVE

To identify the major allergen of H. japonicus pollen and characterize its biochemical properties.

METHODS

With the sera of 29 patients reactive to H. japonicus, the major allergen of H. japonicus was determined from the results of IgE immunoblotting and ELISA inhibition. The biochemical properties of the major allergen of H. japonicus were evaluated by lectin blotting assay and 2-dimensional PAGE blot. N-terminal amino acid sequences were determined by the Edman degradation method. The suggested major allergen was purified by DEAE anion exchange and gel filtration chromatography.

RESULTS

Twenty-nine sera contained IgE bound to the 10, 16, 20, 29 and 42 kDa proteins of H. japonicus in immunoblot analysis. A protein of 10 kDa was the most prevalent allergen in the sera of H. japonicus-reactive patients (72%). The ELISA optical density of H. japonicus-specific IgE was not inhibited by pollen extracts of birch, oak, rye grass and mugwort. The 10-kDa allergen was neither stained with PAS nor bound with ConA and five other lectins. The isoelectric point of the 10-kDa allergen was approximately pH 5.1. We sequenced the N-terminal amino acids of the 10-kDa allergen, which was not homologous with any previously characterized allergen. The 10-kDa allergen could be purified with DEAE anion exchange and gel filtration chromatography. Maximum inhibitions of H. japonicus-specific IgE ELISA by whole extract of H. japonicus and purified 10-kDa allergen were more than 97 and 88%, respectively, while the 50% inhibitory concentration of the whole extract of H. japonicus and purified 10 kDa were 38 and 20 ng/mL, respectively.

CONCLUSION

The 10-kDa peptide could be a major allergen of H. japonicus. Its isoelectric point was 5.1 and it did not bind with lectins. The N-terminal amino acid sequence of the 10-kDa major allergen was also determined.

Effect of a mixed culture on co-oxidation during the degradation of saturated hydrocarbon mixture

Two bacterial strains, Pseudomonas aeruginosa K1 and Rhodococcus equi P1, were used to degrade cyclo-alkanes (such as decalin) by a co-oxidation mechanism. Both strains possessed the capacity to degrade a broad range of n-alkane mixtures (C7 to C28) within 24 h of incubation. Strain P1 rapidly degraded 10 gl-1 pristane within 24 h of incubation (mu = 0.36 h-1 and Yx/s = 0.6). The addition of hexadecane as a growth substrate (above 0.5%, v/v) resulted in complete degradation of 1% (v/v) decalin by strain P1 via a co-oxidation mechanism. Co-oxidation to degrade decalin or pristane by strain K1 proved unsuccessful. Strain P1 was able to degrade decalin totally in a saturated hydrocarbon mixture. Strain K1 was only able to degrade hexadecane from the hydrocarbon mixture, but its degradation rate was higher than that of strain P1. Therefore, there was competition for the hexadecane needed to co-oxidize decalin. As a result, degradation of the hydrocarbon mixture, especially decalin, was incomplete in a mixed culture of strain P1 and K1. Serial addition of hexadecane (twice) allowed complete degradation of the remaining decalin by strain P1. Also, the biodegradation rate of the hydrocarbon mixture by a microbial population from gasoline-contaminated soil was delayed by addition of strain K1 to the population, while the addition of strain P1 resulted in an increase in the biodegradation rate.

Difference in H2O2 toxicity between intact renal tubules and cultured proximal tubular cells

The present study was undertaken to examine the response to H2O2 and t-butylhydroperoxide (t-BHP) in various in vitro model systems of renal proximal tubules: rabbit renal cortical slices, freshly isolated rabbit proximal tubules, rabbit primary cultured proximal tubular cells, and opossum kidney (OK) cells. t-BHP increased lactate dehydrogenase release and lipid peroxidation in a concentration-dependent manner over the concentration range of 0.2 to 3 mM in cortical slices, whereas H2O2 caused a similar concentration-dependent increase in both parameters at 5-100 mM. The sensitivity of isolated tubules to both peroxides was similar to that of cortical slices. In primary cultured cells and OK cells, however, the cytotoxicity of H2O2 was identical to that of t-BHP. The cytotoxicity of t-BHP was not different among all the systems examined. The specific activity of catalase in cortical slices was similar to that of isolated tubules, but it was much higher than that of primary cultured cells or opossum kidney cells. Glutathione (GSH) peroxidase activity was not different among all the systems examined. The expression of catalase mRNA in cortical slices and isolated tubules was higher than that in primary cultured cells, whereas those of superoxide dismutase, glutathione peroxidase, or beta-actin were not different among the systems. These results indicate that intact proximal tubules are more resistant to H2O2 than are cultured proximal tubular cells, and the resistance is due to a higher specific activity of catalase resulting from the increased expression of its mRNA.

Expression of a recombinant branched chain alpha-oxo acid dehydrogenase complex E2 (BCOADC-E2) in insect cells and its immunoreactivity to autoimmune sera

Preparation of a pure autoantigen by way of recombinant DNA technology has an important value in an accurate diagnosis or prognosis of an autoimmune disease. BCOADC-E2 subunit, a mitochondrial protein, has been known to be the autoantigen of primary biliary cirrhosis (PBC), a chronic autoimmune liver disease, as well as idiopathic dilated cardiomypathy (IDCM), a chronic autoimmune heart disease. Recombinant form of this molecule had been expressed in E. coli but with low yield and severe degradation. Furthermore, sera from IDCM patients failed to recognized BCOADC-E2 molecule produced in prokaryotic expression system. In this study, a recombinant bovine BCOADC-E2 fusion protein has been expressed in insect cells using baculovirus expression system and analyzed anti-BCOADC-E2 reactivity in sera from patients with PBC or with IDCM. Optimal production of the recombinant fusion protein has been achieved at 20 multiplicity of infection (MOI), and the protein was affinity-purified using metal-binding resins. The affinity-purified BCOADC-E2 protein was successfully recognized by sera from PBC patients, but not by sera from IDCM patients suggesting that the different auto-immune response against BCOADC-E2 is needed to be elucidated in terms of epitope recognition.

Identification of Tyrophagus putrescentiae allergens and evaluation of cross-reactivity with Dermatophagoides pteronyssinus

House dust mites are the most common cause of allergic sensitization in respiratory allergic patients in the world. Tyrophagus putrescentiae (TP), which was followed by Dermatophagoides farinae (DF) and Dermatophagoides pteronyssinus (DP), has been reported as the third most common house mite in Korea. We previously reported that many respiratory allergic patients had become concomitantly sensitized to DP, DF and TP. The aims of this study were to identify the allergic components of TP and to evaluate the cross-reactivity between TP and DP. The allergenic components of TP and DP extracts were determined with SDS-PAGE and IgE immunoblotting analysis. The cross-reactivity as evaluated by ELISA inhibition and inhibitory immunoblotting experiments. According the SDS-PAGE, the protein components of the two extracts were somewhat different, although a few components displayed identical molecular weights. The 18 kD protein of TP was the most prevalent allergen in the sera of patients sensitized to TP and DP. Both of the maximum inhibition percentages of optic densities of TP-specific IgE in ELISA with TP and DP extract were 100%, respectively and the 50% inhibitory dose (ID50) of TP extract and DP extract were 0.01 micrograms/ml and 0.02 micrograms/ml, respectively. Maximum inhibition of optic densities of DP-specific IgE in ELISA with TP and DP extracts were 29% and 100%, respectively and the ID50 of DP extract was 0.007 micrograms/ml. On inhibitory immunoblotting of DP specific IgE, 5 micrograms/ml of TP extract completely inhibited 16 kD without inhibiting the other allergic component. Whereas, on inhibitory immunoblotting of TP-specific IgE, 5 micrograms/ml of DP extract completely inhibited all the IgE binding components of TP. These results suggested that the major allergen of TP may be the 18 kD component and we also concluded that TP allergens have a strong cross-reactivity with DP extracts, but that DP allergens only have partial cross-reactivity with TP extracts.

Epidural verapamil reduces analgesic consumption after lower abdominal surgery

In this double-blind study, we administered lumbar epidural bupivacaine or bupivacaine plus verapamil to investigate the possible role of the calcium channel blocker, verapamil, in postoperative pain. One hundred patients (ASA physical class I or II) scheduled for lower abdominal surgery were randomly assigned to one of four groups. Group 1 received 10 mL of 0.5% epidural bupivacaine injected 15 min before incision, followed by 10 mL of epidural normal saline 30 min after incision. Group 2 received 10 mL of epidural normal saline injected before incision, followed by 10 mL of 0.5% epidural bupivacaine 30 min after incision. Group 3 received 10 mL of 0.5% epidural bupivacaine plus 5 mg of verapamil injected before incision, followed by 10 mL of epidural normal saline 30 min after incision. Group 4 received the same drugs as Group 3, in the reverse order. Pain and mood numeric rating scores, sedation scores, Prince Henry scores, patient-controlled cumulative postoperative analgesic consumption, and the incidence of side effects were assessed 2, 6, 12, 24, and 48 h after the operation in each group. Cumulative postoperative analgesic consumption in Groups 3 and 4 was significantly lower (P < 0.05) than that in Groups 1 and 2 24 and 48 h after surgery. There were no differences in the pain, mood, and sedation scores and the incidence of side effects among the four groups. We conclude that epidural verapamil decreases postoperative pain, possibly by interfering with normal sensory processing and by preventing the establishment of central sensitization.

IMPLICATIONS

Calcium plays an important role in pain physiology at the spinal cord level. We examined the effect of bupivacaine plus verapamil (calcium channel blocker) and of bupivacaine alone. We demonstrated that the combination, administered epidurally, resulted in less postoperative analgesic consumption than bupivacaine alone.

Small-dose fentanyl: optimal time of injection for blunting the circulatory responses to tracheal intubation

This study was designed to examine the optimal time of injection of a small dose of fentanyl during anesthetic induction to attenuate circulatory responses to laryngoscopy and tracheal intubation. One hundred seventy patients were randomly assigned to one of five groups. In Groups II, III, IV, and V, patients received fentanyl (2 microg/kg) 1, 3, 5, or 10 min before tracheal intubation, respectively. Group I patients did not receive fentanyl and served as the control group. In Groups III and IV, blood pressures were not increased, except diastolic pressure in Group III, significantly postintubation compared with preinduction values; but Groups I, II, and V showed a significant increase (P < 0.05). The 1-min postintubation values of systolic, diastolic, and mean arterial pressure in Groups III and IV were less than those in the control group (P < 0.05). Increases of heart rate in Group IV were less (P < 0.05) than those in the control group, but significant differences were not observed in Groups II, III, and V. The number of patients with tachycardia and dysrhythmia was significantly smaller in Group IV than in the control group (P < 0.05). We conclude that the most effective time to administer fentanyl to protect circulatory responses to laryngoscopy and tracheal intubation is 5 min before tracheal intubation.

IMPLICATIONS

Fentanyl is often used to reduce the hemodynamic response to tracheal intubation. However, large doses may cause unwanted side effects. Administration of fentanyl at the optimal time reduces the dose required. Our results indicate that optimal injection time of fentanyl for intubation is 5 min before intubation.

Propofol attenuates ischemia-reperfusion injury in the isolated rat heart

The purpose of this study was to examine the direct effects of propofol on ischemia-reperfusion injury using an isolated Langendorff rat heart preparation. Hearts were perfused with Krebs-Henseleit (K-H) solution (control); intralipid; or 10, 30, and 100 microM propofol. Hearts were rendered globally ischemic for 25 min, then reperfusion was begun with K-H solution for 30 min. Treatment with 100 microM propofol delayed the onset of contracture during ischemia compared with control or intralipid treatments (6.4 +/- 2.1 vs 4.4 +/- 1.4 or 4.1 +/- 0.7 min, respectively; P < 0.05). During reperfusion, 100 microM propofol increased coronary flow and reduced lactate dehydrogenase release compared with control or intralipid treatments. After 30 min of reperfusion, left ventricular developed pressure (LVDP) returned to 55 and 76 mm Hg in the 30 and 100 microM propofol-treated groups, respectively, whereas LVDP was 39 mm Hg in the control group. The hearts treated with 100 microM propofol showed significantly lower left ventricular end-diastolic pressure compared with the control or intralipid groups 30 min after reperfusion (29 +/- 13 vs 48 +/- 5 or 48 +/- 11 mm Hg, respectively; P < 0.05). In histological evaluation, control and intralipid hearts had increased injury severity scores compared with hearts treated with 100 microM propofol (1.8 +/- 0.9 and 1.7 +/- 0.8 vs 1.0 +/- 0.7, respectively; P < 0.05). In conclusion, we suggest that propofol administered before and during global myocardial ischemia has cardioprotective effects on ischemia-reperfusion injury.

IMPLICATIONS

It is important to protect the heart from injury by ischemia and reperfusion. The current study demonstrates that in the isolated rat heart, propofol attenuates mechanical, biochemical, and histological changes causes by ischemia and reperfusion.

Blockade of myocardial ATP-sensitive potassium channels by ketamine

BACKGROUND

The adenosine triphosphate (ATP)-sensitive potassium (KATP) channel underlies the increase in potassium permeability during hypoxia and ischemia. The increased outward potassium current during ischemia may be an endogenous cardioprotective mechanism. This study was designed to determine the effects of ketamine on KATP channel in rat hearts.

METHODS

Inside-out and cell-attached configurations of patch-clamp techniques and 3 M potassium chloride-filled conventional microelectrodes were used to investigate the effect of ketamine on KATP channel currents in single rat ventricular myocytes and on the action potential duration of rat papillary muscles, respectively.

RESULTS

Ketamine inhibited KATP channel activity in rat ventricular myocytes in a concentration-dependent manner. In the inside-out patches, the concentration of ketamine for half-maximal inhibition and the Hill coefficient were 62.9 microM and 0.54, respectively. In a concentration-dependent manner, ketamine inhibited pinacidil- and 2,4-dinitrophenol-activated KATP channels in cell-attached patches. The application of ketamine to the intracellular side of membrane patches did not affect the conduction of single-channel currents of KATP channels. Ketamine increased the action potential duration, which was then shortened by pinacidil in a concentration-dependent manner.

CONCLUSIONS

Ketamine inhibited KATP channel activity in a concentration-dependent manner. These results suggest that ketamine may attenuate the cardioprotective effects of the KATP channel during ischemia and reperfusion in the rat myocardium.

Epidural morphine plus ketamine for upper abdominal surgery: improved analgesia from preincisional versus postincisional administration

Increased postoperative pain may be caused by central nervous system plasticity, which may be related to actions of N-methyl-D-aspartic acid (NMDA) receptors on neurons in the dorsal horn of the spinal cord. Opioids act mainly on presynaptic receptors and reduce neurotransmitter release, while ketamine antagonizes NMDA receptors and prevents wind-up and long-term potentiation. Thus, we postulated that central nervous system sensitization would be prevented more effectively by the preoperative use of these two drugs simultaneously, and the effect of preemptive analgesia would be demonstrated. Ketamine, 60 mg, and morphine, 2 mg, were injected epidurally through an indwelling catheter that was inserted at the T7-8 interspace in 60 ASA physical status class 1-2 patients. The drugs were injected before induction of anesthesia (Group 1; n = 30) or immediately after removal of a surgical specimen (Group 2; n = 30). An additional 2 mg of morphine was injected when the patients complained of resting pain. The analgesic effect was assessed by the time from first analgesic injection to second dose and the number of patients who needed supplemental injections. Complications were also noted. The duration of analgesia was longer (P < 0.01) in Group 1 (31.1 +/- 16.0 h) than in Group 2 (21.1 +/- 12.0 h), and the proportion of patients who needed supplemental injections was decreased (P < 0.05) in Group 1 (56.7%) compared with Group 2 (90.0%). The incidence of adverse effects was not different between the two groups. In conclusion, preoperative administration of morphine and ketamine is more effective in reducing postoperative pain than it is when given during the operation.

[Testing the criterion-related validity of a mental health assessment tool in Korean adults]

This study was conducted to testing the criterion-related validity of a mental health assessment tool which developed based on a Korean culture. Criteria scale for this tool were MMPI and CMI(M-R). The study subject were 100 male and female aged 20 or more with quota sampling. The data was collected from August 16. to August 26, 1989. The data obtained from 85 subjects were analysed using S.P.S.S. (Statistical Package for the Social Science). As a result, there are no significant correlation between Mental Health Assessment Tool and MMPI and CMI except Mf (Masculinity-Femininity) Subscale of MMPI. This result means the MMPI and CMI was not related to tool which developed based on medical model from ethic perspectives, although the tool which had been developed in American Modified to Korean situation. So I dare to say that only the absence of mental illness does not means mental health and the diagnosis of mental illness is not the only criteria of a mental health.

[Study on folk caring in Korea for cultural nursing]

Care is a central concept of nursing. Nursing would not exist without caring. Care and quality of life are closely related. Human behavior is a manifestation of culture. We can say that caring and nursing care are expression of culture. The nurse must understand the relationship of culture with care for ensure quality nursing care. But knowledge of cultural factors in nursing is not well developed. Time and in-depth study are needed to find meaningful relationships between culture and care. Nurses recognized the importance of culturally appropriate nursing. There are two care systems in culturally based nursing. The folk care system and the professional nursing care system. The folk care system existed long before the professional nursing care system was introduced into this culture. If the discrepancy between these two care systems is great, the client may receive inappropriate nursing care. Culture and subcultures are diverse and dynamic in nature. Nurses need to know the caring behaviors, patterns, and their meaning in their own culture. In Korea we have taken some first step to study cultural nursing phenomena. It is not our intent necessarily to return to the past and develop a nationalistic of nursing, but to identify the core of traditional caring and relate that to professional nursing care. Our Assumptions are as follows: 1) Care is essential for human growth, well being and survival. 2) There are diverse and universal forma, expressions, patterns, and processes of human care that exist transculturally. 3) The behaviors and functions of caring differ according to the social structure of each culture. 4) Cultures have folk and professional care values, beliefs, and practices. To promote the quality of nursing care we must understand the folk care value, beliefs, and practices. We undertook this study to understand caring in our traditional culture. The Goals of this study were as follows: 1) To identify patterns in caring behavior, 2) To identify the structural components of caring, and 3) To understand the meaning and some principles of caring. We faced several questions in this study. Who is the care-giver? Who is the care-recipient? Was the woman the major care-giver at any time? What are the patterns in caring behavior? What art the principles underlying the caring process? We used an interdisciplinary team approach, composed of representatives from nursing and anthropology, to contribute in-depth understanding of caring through a sociocultural perspective. A Field study was conducted in Ro-Bong, a small agricultural kinship village.(ABSTRACT TRUNCATED AT 400 WORDS)

[Theoretical models of causative factors in depression: a review of the literature for nursing]

This literature review was undertaken to explore theoretical models of depression for their potential usefulness in nursing research and practice. Depression has been accounted for by numerous theories or models of causation: 11 theories selected from psychology, medicine and psychoanalysis and supported by empirical or experimental research were reviewed. These theories identify a variety of precipitating and predisposing factors that may affect the individual's depression. Aggression-turned-inward theory, object loss theory, ego functioning theory, personality organization theory, behavioral theory, learned helplessness theory, cognitive theory, genetic factors, and biological theories conceptualize predisposing factors. Only life stressors theory identifies precipitating factors. Each of these theories contributes to an understanding of depression, but many of them use overlapping and interrelated factors. It is also evident from recent research that there are multiple causes for depression involving an interactive effect among predisposing and precipitating factors that are both biological and psychological in origin. That is, a single theory is not useful, but perhaps a unified theory could be developed that would be helpful to nursing. This review points to the need for continuing development and testing of theories that would integrate the multiple conceptualizations of depression.