Study on the Orthopedic Characteristics of Bicycle Injury Patients / 대한스포츠의학회지

PURPOSE: This study aimed to investigate bicycle injury patients who suffered orthopedic injuries. METHODS: From January 1, 2010 to December 31, 2014, 1,664 people visited the emergency room due to a bicycle accident. Among them, 385 patients were found to have orthopedic injuries through physical examination and imaging evaluation. Intending to evaluate whether the number of bicycle injury patients is increasing or decreasing yearly, we investigated the rate of orthopedic injuries among bicycle injury patients, the damaged areas and the extent of damage, and also investigated whether changes in frequency were correlated with sex, age, or season. RESULTS: From January 1, 2010 to December 31, 2014, a total of 237,533 people came to the emergency room. Among them, the number of bicycle injuries was 1,664 (0.7%), and 23% of the bicycle injuries (385 people) were orthopedic injuries. Among these, 77.4% were men, 44.5% were less than 20 years old, and 20% were more than 61 years old. Damage to the forearm (n=82, 21.3%) and the shoulder (n=71, 18.4%) were the most common injuries, and simple fractures affected 274 patients (71.1%), overwhelmingly more common than other patterns of damage. In combination, simple fracture and dislocations occurred in 279 cases (72.5%). CONCLUSION: Most bicycle injuries occur in young and elderly people. Fractures of the forearm and shoulder were the most common orthopedic injuries. We expect that this study will be helpful in providing information about the orthopedic characteristics of bike injuries.

Retrograde Intramedullary Nailing for Humerus Fracture in a Supine Position: Performing an Unfamiliar Procedure in a Familiar Position

Intramedullary (IM) nailing for humeral shaft fracture has provided excellent outcomes in terms of fracture biology and cosmetic appearance because of the relatively small incision involved. However, antegrade nailing causes issues such as iatrogenic rotator cuff injury. Retrograde nail fixation method could avoid cuff injury, but has shortcomings such as the need for the prone or lateral decubitus position during surgery. We report that the retrograde IM nail fixation technique performed in a supine position and some ancillary techniques for minimizing scars or complications can provide the advantages of both retrograde nailing and supine position during surgery.

Acute Pancreatitis Secondary to Ciprofloxacin Therapy in Patients with Infectious Colitis

BACKGROUND/AIMS: Ciprofloxacin is considered to be a safe and effective treatment for acute infectious colitis. However, this drug may cause drug-induced pancreatitis, albeit rarely. METHODS: From March 2007 to February 2012, we studied 227 patients who were hospitalized for infectious colitis at St. Mary's Hospital. All of the patients received ciprofloxacin therapy for the treatment of infectious colitis. We observed a few cases of rare adverse events, including ciprofloxacin-induced acute pancreatitis diagnosed based on the Naranjo algorithm. RESULTS: During ciprofloxacin therapy, seven of 227 patients (3.1%) developed rare pancreatitis as defined by the Naranjo algorithm; pancreatic enzyme activity was sporadically elevated with ciprofloxacin use. After ciprofloxacin administration, the average interval until the development of pancreatitis was 5.5 days (range, 4 to 7 days). On abdominal computed tomography, pancreatic swelling and homogenous enhancement was noted in three of seven patients. Complicating acute pancreatitis was gradually but completely resolved after cessation of ciprofloxacin administration. The mean recovery time was 11.3 days (range, 8 to 15 days). CONCLUSIONS: We observed that ciprofloxacin-induced pancreatitis may occur with an incidence of approximately 3%. Ciprofloxacin-induced pancreatitis presents a short latency, suggesting an idiosyncratic hypersensitivity reaction. Practitioners should be aware that drug-induced pancreatitis can occur during ciprofloxacin therapy.

Multiple Cancers in a Patient with Systemic Sclerosis and Aggravated Interstitial Lung Disease by Chemotherapy / 결핵및호흡기질환

Although the relationship between malignancy risk with systemic sclerosis (SSc) has been inconclusive, there are some previous studies for a positive correlation. Most patients with SSc have some degree of lung parenchymal involvement in the form of interstitial thickening and fibrosis. Interstitial lung disease is the most common pulmonary manifestation of SSc. Interstitial lung disease following chemotherapy (5-fluorouracil, leucovorin, and oxaliplatin [FOLFOX]) is an uncommon life-threatening complication and it is induced by oxaliplatin. We report a case of multiple cancers in a patient with SSc and aggravated interstitial lung disease by chemotherapy.

Immunohistochemical Expression of p53, Bcl-2, and Ki-67 Proteins in Traditional Serrated Adenomas of Colon / 대한소화기학회지

BACKGROUND/AIMS: Serrated adenomas of the colon show mixed characteristics of both hyperplastic and adenomatous polyps. Serrated adenomas are known to progress via the serrated pathway than the adenoma-carcinoma pathway. The aim of this study was to evaluate the characteristics of traditional serrated adenomas compared to hyperplastic polyps and tubular adenomas by using immunohistochemical staining for p53, Bcl-2, and Ki-67. METHODS: Age, sex, location, size and the immunoexpression of p53, Bcl-2, and Ki-67 were retrospectively analyzed in 20 traditional serrated adenomas, 20 hyperplastic polyps, and 20 tubular adenomas from January 2007 to December 2012 at The Catholic University of Korea, Yeouido St. Mary's Hospital. RESULTS: There was no difference in Bcl-2 and p53 expression between traditional serrated adenomas and hyperplastic polyps. Ki-67 Expression of traditional serrated adenomas was higher than that of hyperplastic polyps (p=0.001). Ki-67 and p53 expression was similar between traditional serrated and tubular adenomas. Bcl-2 expression of traditional serrated adenomas was lower than that of tubular adenomas (p=0.001). Regarding the expression of p53, Bcl-2, and Ki-67 in traditional serrated adenomas, there were no statistical differences among age, sex, location, and size. CONCLUSIONS: Our study suggested that Ki-67 may be helpful in distinguishing traditional serrated adenomas from hyperplastic polyps, and p53 expression may be ineffective in distinguishing between traditional serrated and tubular adenomas. From Bcl-2 expression, it is suggested that the tumorigenesis of traditional serrated adenomas is lower than that of tubular adenomas.

Immunohistochemical Expression of p53, Bcl-2, and Ki-67 Proteins in Traditional Serrated Adenomas of Colon / 대한소화기학회지

BACKGROUND/AIMS: Serrated adenomas of the colon show mixed characteristics of both hyperplastic and adenomatous polyps. Serrated adenomas are known to progress via the serrated pathway than the adenoma-carcinoma pathway. The aim of this study was to evaluate the characteristics of traditional serrated adenomas compared to hyperplastic polyps and tubular adenomas by using immunohistochemical staining for p53, Bcl-2, and Ki-67. METHODS: Age, sex, location, size and the immunoexpression of p53, Bcl-2, and Ki-67 were retrospectively analyzed in 20 traditional serrated adenomas, 20 hyperplastic polyps, and 20 tubular adenomas from January 2007 to December 2012 at The Catholic University of Korea, Yeouido St. Mary's Hospital. RESULTS: There was no difference in Bcl-2 and p53 expression between traditional serrated adenomas and hyperplastic polyps. Ki-67 Expression of traditional serrated adenomas was higher than that of hyperplastic polyps (p=0.001). Ki-67 and p53 expression was similar between traditional serrated and tubular adenomas. Bcl-2 expression of traditional serrated adenomas was lower than that of tubular adenomas (p=0.001). Regarding the expression of p53, Bcl-2, and Ki-67 in traditional serrated adenomas, there were no statistical differences among age, sex, location, and size. CONCLUSIONS: Our study suggested that Ki-67 may be helpful in distinguishing traditional serrated adenomas from hyperplastic polyps, and p53 expression may be ineffective in distinguishing between traditional serrated and tubular adenomas. From Bcl-2 expression, it is suggested that the tumorigenesis of traditional serrated adenomas is lower than that of tubular adenomas.

Endoscopic Characteristics of Upper Gastrointestinal Mesenchymal Tumors Originating from Muscularis Mucosa or Muscularis Propria / 대한소화기학회지

BACKGROUND/AIMS: Subepithelial tumors are occasionally found during upper gastrointestinal endoscopy. The purpose of this study was to evaluate endoscopic characteristics of mesenchymal tumors originating from muscularis mucosa or muscularis propria. METHODS: A total of 307 mesenchymal tumors of the upper gastrointestinal tract were diagnosed between March 2006 and February 2012 at Yeouido St. Mary's Hospital (Seoul, Korea). Data on endoscopic and endoscopic ultrasonographic findings were collected and analyzed by retrospectively reviewing the medical records. RESULTS: The mean size of the mesenchymal tumors originating from muscularis mucosa was significantly smaller than those originating from muscularis propria (10.5+/-6.9 mm vs. 14.3+/-13.9 mm, p=0.035). The most common locations of the mesenchymal tumors originating from muscularis mucosa and muscularis propria were esophagus (69.1%) and body of the stomach (43.3%), respectively (p<0.001). Rolling sign was more commonly observed with mesenchymal tumors originating from muscularis mucosa (80.4%, p=0.001), and cushion sign was more frequently absent with those originating from muscularis propria (72.4%, p<0.001). Internal echo was homogenous in 89.7% and 81.9% of mesenchymal tumors originating from muscularis mucosa and muscularis propria, respectively (p=0.092). CONCLUSIONS: The size, location, and movability of mesenchymal tumors originating from muscularis mucosa were different from those of mesenchymal tumor originating from muscularis propria.propria.

Three-dimensional evaluation of the relationship between nasopharyngeal airway shape and adenoid size in children / 대한치과교정학회지

OBJECTIVE: To evaluate the shapes and sizes of nasopharyngeal airways by using cone-beam computed tomography and to assess the relationship between nasopharyngeal airway shape and adenoid hypertrophy in children. METHODS: Linear and cross-sectional measurements on frontal and sagittal cross-sections containing the most enlarged adenoids and nasopharyngeal airway volumes were obtained from cone-beam computed tomography scans of 64 healthy children (11.0 +/- 1.8 years), and the interrelationships of these measurements were evaluated. RESULTS: On the basis of frontal section images, the subjects' nasopharyngeal airways were divided into the following 2 types: the broad and long type and the narrow and flat type. The nasopharyngeal airway sizes and volumes were smaller in subjects with narrow and flat airways than in those with broad and long airways (p < 0.01). Children who showed high adenoid-nasopharyngeal ratios on sagittal imaging, indicating moderate to severe adenoid hypertrophy, had the narrow and flat type nasopharyngeal airway (p < 0.01). CONCLUSIONS: Cone-beam computed tomography is a clinically simple, reliable, and noninvasive tool that can simultaneously visualize the entire structure and a cross section of the nasopharyngeal airway and help in measurement of adenoid size as well as airway volume in children with adenoid hypertrophy.

Toxic Epidermal Necrolysis by Ceftriaxone in Patient with Newly Diagnosed Systemic Lupus Erythematosus

Toxic epidermal necrolysis (TEN) is a rare disease in absolute numbers with an incidence of 2 cases per million people per year. Most cases of TEN are caused by drugs, but certain infectious diseases may have an impact on the risk. There are rare reports of TEN occurring without history of drug ingestion in systemic lupus erythematosus (SLE), appearing similar to cutaneous lupus and early TEN manifestations, such as erythema multiforme. This report describes a patient with SLE who presented with manifestations of TEN after ceftriaxone treatment. The patient was newly diagnosed with SLE and TEN occurring eight days after cessation of ceftriaxone. Considering possible etiologies, we could not exclude ceftriaxone as the cause of TEN. After intravenous immunoglobulin with glucocorticoid, clinical symptoms improved.

Tracheoesophageal Fistula in the Treatment of Gastric Variceal Hemorrhage with Sengstaken-Blakemore Tube

The Sengstaken-Blakemore tube (SB tube) is used to control esophageal or gastric variceal bleeding in emergencies, and various complications have been reported following its use. Tracheoesophageal fistula (TEF) is an extremely rare complication after SB tube insertion. We herein present a case of an 80-year-old female patient who experienced TEF after repeated insertion of the SB tube to control recurrent gastric variceal hemorrhage.

Splenic Cyst Mimicking Gastric Subepithelial Tumor Diagnosed by Endoscopic Ultrasonography

Recent research reveal that the diagnosis of gastric extraluminal compressions mimicking subepithelial tumor is increasing in numbers as esophagogastroduodenoscopy becomes widespread. Endoscopic ultrasonography is a very useful tool for differentiating extraluminal compressions from subepithelial tumors. Gastric extraluminal compressions are due to compression by either normal adjacent organs or pathologic conditions. Pathologic conditions are mainly benign, but some requires operation according to its size. We report a case of a 24-year-old female, who underwent esophagogastroduodenoscopy and was misdiagnosed with gastric subepithelial tumor. Endoscopic ultrasonographic findings showed anechoic cyst outside the gastric wall, which revealed to be a splenic cyst.

Tuberoplasty for Irreparable Massive Rotator Cuff Tears

PURPOSE: To evaluate the clinical and radiological results of arthroscopic tuberoplasty for irreparable massive rotator cuff tears. MATERIALS AND METHODS: Eleven patients underwent arthroscopic tuberoplasty for irreparable massive rotator cuff tears between December 2004 and April 2007. The mean follow-up period was 17.3 months, and the average age at the time of surgery was 61.7-year-old. Five cases underwent arthroscopic tuberoplasty and 6 cases had arthroscopic subacromial decompression and tuberoplasty, simultaneously. RESULTS: The average Constant score improved from 61.8 to 86.9 and the average UCLA score changed from 14.8 to 31.8 with 6 excellent, 3 good and 2 poor results (p=0.003). The active forward flexion improved from 111.8degrees to 154.1degrees (p=0.011). The acromiohumeral interval increased from 3.94 mm preoperatively to 4.22 mm postoperatively (p=0.12). In the poor UCLA score group, the acromiohumeral interval changed from 1.67 mm preoperatively to 0.94 mm postoperatively. CONCLUSION: Arthroscopic tuberoplasty may be a second option to relieve the pain of irreparable massive rotator cuff tears and improve the range of motion. However, good results could not be expected if the acromiohumeral interval is< 2 mm preoperatively and decreased postoperatively.

The Effect of Repeated Intraarticular Bleeding in the Synovium and Articular Cartilage: An Animal Model / 대한정형외과학회잡지

PURPOSE: We designed this study to demonstrate the pathophysiology of hemophilic arthropathy (HA) by creating an animal model for determining the effect of repeated intraarticular bleeding in the synovium and articular cartilage. MATERIALS AND METHODS: 20 normal male New Zealand white rabbits were used for this study. We injected 1 ml of autologous blood from the ear vein of the rabbits into the right knee joint three timeds a week for 18 weeks, and we injected 1 ml of normal saline into the left knee joint three times a week for 18 weeks as a control group. We examined the pathologic changes by microscopy and plain X-ray, and we determined the mRNA expression of proinflammatory cytokines in the synovium of the HA by performing real time RT-PCR at the 11th week and 18th week after starting blood-injection. We also examined the GAG and the PGE2 production in cultured chondrocytes that were extracted from the HA knees. RESULTS: At the 11th week, after blood injection there were no remarkable gross changes in the HA knees and the control knee joints. At the 18th weeks, the experimental knee joints (HA knees) showed grossly swelling and degenerative changes by X-ray. The infiltration of inflammatory cells and the synovial proliferation in the HA knee joints were compared with that in the control knee joints by microscopic examination. The expressions of the mRNA of TNF-alpha, IL-1, MMP-1 and MMP-3 in the HA synovium were increased, as determined by real time RT- PCR, as compared with that in the control knee. In the cultured chondrocytes, the GAG production was decreased and the PGE2 was increased, but the MMP-1 and MMP-3 were not changed, as determined by ELISA. CONCLUSION: Our results showed that the GAG production of chondrocytes of the HA knees was decreased and there was increased PGE2, so that the cartilage degeneration by intra-articular bleeding was caused by the decreased metabolism of chondrocytes rather than by increased catabolism of the chondrocytes. We suggest that HA was associated with synovitis and cartilage degeneration, but decreased cartilage metabolism was the major mechanism of HA.

Effect of airway and tongue in facial morphology of prepubertal Class I, II children / 대한치과교정학회지

OBJECTIVE: This study examined the craniofacial morphology of young patients in their prepubertal stage showing class I, II malocclusion, by analyzing lateral cephalograms, and analyzed its relationship with tongue position, tongue space, and airway space in order to ascertain the effects of nasopharyngeal airway and tongue morphology on the form of the malocclusion. METHODS: Seventy-six patients aging from 9 to 11 were divided into two groups depending on the ANB difference on the lateral cephalogram: Experimental group (Cl II malocclusion group) showing 0 ANB difference < or = < 4.0; Control group (Cl I malocclusion group) showing 0 < ANB difference < 4.0. The tongue space, space between palate and tongue, nasopharyngeal airway space and craniofacial morphology were compared between the two groups. RESULTS: Tongue space, palate-tongue space, nasopharyngeal airway space showed no significant differences between class I and class II malocclusion groups. Hyperdivergent faces were associated with smaller nasopharyngeal airway space. Longer anterior facial height and posterior facial height were associated with larger tongue space, and greater anterior facial height were associated with lower tongue position. Smaller nasopharyngeal airway space showed smaller tongue space. CONCLUSIONS: Tongue space and nasopharyngeal airway space showed no significant differences between class I malocclusion group and class II malocclusion group. Only anterior facial height and posterior facial height had an influence on tongue space and nasopharyngeal airway space.

Treatment of anterior open bite with bimaxillary anterior segmental osteotomy and genioplasty

Skeletal anterior open bite is a difficult problem to correct in orthodontic treatment. To treat adult patients who have skeletal anterior open bite, we considered two methods. Combination treatment of orthodontics & surgery and camouflage orthodontic treatment. In adults, treatment of severe skeletal anterior open bite consists mainly of surgically repositioning the maxilla or the mandible. However, camouflage therapy is often the treatment of choice for skeletal open bite patients who have mild to moderate skeletal discrepancies when growth modification is no longer possible. But excellent results generally require careful coordination of the orthodontic and surgical phases of treatment. This is a case report of a skeletal anterior open bite patients who were treated with orthodontic treatment and orthognathic surgery. First case was diagnosed as skeletal class I malocclusion & bimaxillary protrusion with anterior open bite, and finally treatment ended for removal of open bite with orthodontic procedure and bimaxillary anterior segmental osteotomy surgery. Second case was diagnosed as skeletal class II malocclusion with open bite & mandibular retrusion, and was treated with only camouflage orthodontics because she feared to have a surgery. In a regular follow up visit after debonding we proposed to the patient advanced genioplasty, and in her agreement her facial esthetics was improved through the surgery.

Treatment of transverse deficiency with surgically assisted rapid palatal expansion in an open bite patient showing pseudomacroglossia

Anterior open bite is a condition in which maxillary and mandibular incisors do not occlude at central occlusion. It is a vertical discrepancy of the jaws and dental arches that has many etiologic factors making it difficult in diagnosis, treatment and prediction of prognosis. One of the causes of open bite is abnormal size and shape of the tongue. Macroglossia, a condition in which tongue is oversized, is caused by several factors which are not clearly identifiable, and it may be a major factor of anterior and posterior open bite. Macroglossia is subdivided into true, functional and pseudomacroglossia depending on its relative size in the oral cavity. In this case report, a patient was diagnosed as skeletal Class II with pseudomacroglossia, and was treated with SARPE in order to expand the narrowed maxillary arch and quad helix for the mandibular arch. As a result the transverse deficiency was treated. In the adult patients where no skeletal growth is expected, SARPE has shown to be effective in treating maxillomandibular transverse discrepancies in which macroglossia was accompanied as in this case.

Clinical Results of the Multiple Drilling for Osteochondral Lesion of the Medial Talar Dome / 대한정형외과학회잡지

PURPOSE: To evaluate the treatment outcomes of transmalleolar multiple drilling with a K-wire for an osteochondral lesion of the medial talar dome after an mean follow-up period of 77 months. MATERIALS AND METHODS: Among patients treated surgically for a symptomatic osteochondral lesion of the talus between March 1997 and December 2002, sixteen ankles (fifteen patients) with a medial talar dome lesion were treated by transmalleolar multiple drilling and followed-up for at least 3 years. The average age at the time of surgery was 34.4 years (range, 19-58 years). The mean follow-up period was 77 months (range, 41-107 months). RESULTS: At the latest follow-up, the average VAS at motion decreased from 6.8 to 2.1 (p=0.004). The AOFAS score improved from 64 points to 86.2 points (p=0.001). The 8 ankles in those less than thirty years of age at that time of surgery showed a VAS at motion of 1.8 and an AOFAS score of 91.1 points. In contrast, 8 ankles in those who older than thirty one years of age had a VAS at motion of 2.4 and an AOFAS score of 81.2 points. The younger group showed a significantly better AOFAS score than the older group (p=0.001). However, there was no significant difference in the VAS score (p=0.22). CONCLUSION: Multiple drilling has a good effect in pain control and ankle function for patients with an osteochondral lesion of the medial talar dome 10 mm. The procedure is particularly effective and useful in younger patients.

The Effect of Knee Osteoarthritis and Unilateral Total Knee Arthroplasty on Balance

OBJECTIVE: To assess the effect of knee osteoarthritis (OA) and unilateral total knee arthroplasty (TKA) on balance. METHOD: Fifteen patients with bilateral knee OA and fifteen patients with unilateral TKA and fifteen healthy adults were assessed by computerized dynamic posturography. The posturography test was performed 3 times at 6 different simulated conditions. We evaluated anteroposterior sway of center of gravity and strategy score of OA group, TKA group and healthy adults group. We compared the equilibrium scores of each group with normal data reported previously. We also compared strategy scores of each group. RESULTS: Patients with bilateral knee OA and unilateral TKA showed lower equilibrium scores than normal one at the condition 4, 5, 6. But patients with unilateral TKA did not show significant equilibrium score difference as compared with bilateral knee OA patients. Patients with bilateral knee OA and unilateral TKA showed significantly lower strategy scores than normal one at the condition 4, 5, 6 (p<0.05). But patients with unilateral TKA did not show significant strategy score difference as compared with bilateral knee OA patients. CONCLUSION: Patients with bilateral knee OA showed deficit of dynamic postural control due to proprioceptive dysfunction. And TKA did not affect proprioceptive change in knee osteoarthritis.

The Effect of GivMohr Slings on Shoulder Subluxation in Hemiplegic Patients

OBJECTIVE: To compare the radiological corrective effect for shoulder subluxation among GivMohr & other slings in hemiplegic patients. METHOD: Fifteen hemiplegic patients with flaccid upper limb were included. The vertical distance (VD), horizontal distance (HD) & joint distance (JD) on the plain AP views of the shoulders were measured. GivMohr sling was compared with 2 conventional slings, which were forearm cuff type extension sling and Bobath sling, in the effects of correction. RESULTS: The mean values of VD and JD of hemiplegic shoulder increased compared to unaffected side, but those of HD was not different between them. In Bobath sling, VD was significantly reduced and HD was not changed. However, JD was increased as other studies. GivMohr sling and forearm cuff type extension sling showed corrective effect in VD and JD (p<0.05). When compared with these two slings, there were no significant differences in VD and JD. CONCLUSION: The results show that GivMohr sling reduces shoulder subluxation as other slings. This new sling is helpful for patients with flaccid upper limbs to reduce shoulder subluxation.

Acute Leukemia and Myelodysplasitc Syndrome During Pregnancy A Single Institutional Experience of 4 Cases / 대한산부인과학회잡지

We have reviewed the medical records of 4 pregnant patients with concomitant acute leukemia at our institution in conjunction with determining the delivery process in order to reduce complications associated with the delivery. Of the 4 patients, three cases were diagnosed as acute leukemia and the other as myelodysplastic syndrome. One experienced an incomplete abortion at gestational age of 10 weeks, after remission induction chemotherapy. The remaining three patients made delivery at full term by Cesarean section. Our observation indicated that Cesarean delivery was advisable for these three patients. Most of the patients had thrombocytopenia or anemia. Before the Cesarean section or dilatation or evacuation, transfusion was undertaken to prevent hemorrhage or severe anemia. In the cases of refractoriness to blood transfusion, a greater amount was transfused. After Cesarean section, some complications were reported such as fever, delayed wound repair, and vaginal bleeding. Based on the our observations, we are of the opinion that pregnant women with acute leukemia or myelodysplastic syndrome can be managed even in those cases where the state of leukemia is not in complete remission or chemotherapy-induced cytopenia is. And the proper measures are timely undertaken to prevent complications associated with delivery.