The authors have treated 30 cases of trochanteric fracture of the femur from June 1987, to July 1988 at Dong Suwon General Hospital. The 30 cases included, 8 Condylocephalic Kuentscher nailing, 9 Ender nailing, 7 Multiple pinning, 5 Antegrade Kuentscher nailing and 1 Row plating. 1. The shape of condylocephalic Kuentscher nail should be designed differently, contoured circular arc in anteroposterior and angled in lateral plane. In the anteroposterior plane : The length of the radius of the arc is measured by following way. 1) Design the shape of the nail on the X-ray film of the normal femur which was taken in full internal rotation of the leg. 2) Make three points in the femoral film. One is A, midcentral point of the femoral canal of the isthmus. Point B is center of upper lateral quadrant of the femoral head. Point C is apart from medial cortex 5-7mm at the level of entry portal of the nail. 3) Make point D: Draw the perpendicular lines from the right middle of the AB and AC. These lines meet at the point D. AD is radius of the arc of nail. Draw an arc measuring by the length of AD and mold the nail following the arc. In the lsteral plane ; The nail is bent into three or four segments and the length of the longest segment should not be exceeded the permissible length of straight nail, the latter is distance from entry portal of the nail to anterior cortex of the femur where the tip of the inserted nail is impinged, about 15cm. 2. Two different types of the Ender nailings are used depend on the type of the fracture. In intertrochanteric fracture, the trochanter is remained in the distal fragment and acts as the crane post to fix the proximal fragment(interfragmental compression screw fixation) by horizontal screw inserted through the lateral cortex of the distal fragment into medial cortex of the proximal fragment and fixed with another screw inserted into the distal fragment by tension band wiring. In transtrochanteric frscture, the proximal fragment is fixed by two different kinds of the nails, prior to the nailing medial displacement of the distal fragment is not reduced. The first nail is driven along the medial wall of the medullary canal of the distal fragment, the tip of the nail comes out of the fracture site and impinges to the inferomedeial aspect of the head along the out side of the neck. The nail is inserted into the head after correction of nail direction. The second and third nails are inserted through the medullary canal of the fragments. The proximal fragment is fixed between two nail groups. 3. Antegrade Kuentscher nailing is used for undisplaced trochanteric fracture with segmental fracture or comminuted, segmental subtrochanteric fracture. The open reduction and fixation is preferable in comminuted segmental subtrochanteric fracture for its accurate reduction. The authors msde additional several holes, transverse, sagittal (at the dorsum of the nail) oblique holes around the nail, so the interlocking screw can be easily inserted to the nail when the insertion of the screw through the transverse holes are difficult. 4. It's extremely important to study the fracture carefully when the surgeon plans to use the multiple pinning for trochanteric fracture. The fracture configuration has to be determined in regard to expect stability after local pinning especially in lateral plane. The fracture is fixed by horizontal pin, low angle pin, curved buttress pin(or screw) solidly, not parallel as in neck fracture. The curved buttress rush pin should be inserted as acting as the anteromedial or posteromedial buttress.
Femur ; Fungi ; Gyeonggi-do ; Head ; Hospitals, General ; Leg ; Neck ; Radius ; X-Ray Film

BACKGROUND/AIMS: The natural history of severe erosive reflux disease in Korea remains uncertain. We aimed to evaluate endoscopic follow-up results in subjects with severe reflux esophagitis under routine clinical care. MATERIALS AND METHODS: A total 61,891 subjects underwent an upper endoscopic examination in the health check-up program from January 2007 to December 2013. We reviewed medical charts of patients who had been diagnosed with severe reflux esophagitis. The severity of reflux esophagitis was determined by the Los Angeles (LA) classification system. Patients underwent at least one follow up endoscopy after diagnosis of severe reflux esophagitis. We classified the patients into two groups; regressed in severity and remained unchanged, according to follow up endoscopic status. RESULTS: Based on endoscopic findings, 5,938 subjects (9.6%) were found to have reflux esopohagitis: 121 subjects (0.2%) in LA-C; 39 subjects (0.06%) in LA-D. Among 31 patients who had endoscopic follow-up, 23 patients (74.2%) showed regression from LA C/D to LA A/B or minimal change disease or normal. The mean follow up duration was 42.2 months in regression group and 53.2 months in no change group. All patients had been treated with proton pump inhibitors (PPIs) on a regular or on-demand basis. Age, sex, smoking, alcohol, exercise, hypertension, diabetes mellitus, dyslipidemia, sliding hiatal hernia, body mass index, waist circumference and duration of PPIs therapy did not significantly influence regression of severe reflux esophagitis. CONCLUSIONS: The majority of severe reflux esophagitis patients under routine clinical care showed improvement on endoscopic follow-up.
Body Mass Index ; Classification ; Diabetes Mellitus ; Diagnosis ; Dyslipidemias ; Endoscopy* ; Esophagitis ; Esophagitis, Peptic* ; Follow-Up Studies* ; Gastroesophageal Reflux ; Hernia, Hiatal ; Humans ; Hypertension ; Korea* ; Natural History ; Nephrosis, Lipoid ; Proton Pump Inhibitors ; Smoke ; Smoking ; Waist Circumference

BACKGROUND/AIMS: Noncardiac chest pain (NCCP) is substernal, squeezing chest pain, unrelated to the cardiac problem. Our study aimed to define the prevalence and clinical characteristics of reflux esophagitis in NCCP patients in Korea. MATERIALS AND METHODS: We reviewed medical records of patients who visited Department of Cardiology, St. Paul's Hospital due to chest pain and had normal coronary arteriography and who had received endoscopy within 6 months. Patients diagnosed with peptic ulcer or gastric cancer were excluded. The patients were classified into two groups according to their endoscopic results; the reflux esophagitis group and the control group. RESULTS: Two hundred seventeen NCCP patients were enrolled and 96 patients (44.2%) were diagnosed with reflux esophagitis: 68 patients (31.3%) with minimal change esophagitis; 26 patients (12.0%) with Los Angeles (LA) grade A; 2 patients (0.9%) with LA grade B. There were no patients with severe erosive reflux disease. There were no significantly different characteristics in the reflux esophagitis group and the control group. CONCLUSIONS: The prevalence of reflux esophagitis in NCCP patients in Korea was 44.2%. Most patients had mild reflux esophagitis.
Angiography ; Cardiology ; Chest Pain* ; Endoscopy ; Esophagitis ; Esophagitis, Peptic* ; Gastroesophageal Reflux ; Humans ; Korea* ; Medical Records ; Peptic Ulcer ; Prevalence* ; Stomach Neoplasms ; Thorax*

BACKGROUND/AIMS: Anxiety and depression are associated with reflux symptoms in patients with gastroesophageal reflux disease (GERD). The purpose of this study is to investigate whether the anxiety and depression in patients with GERD will improve with anti-secretory treatment. MATERIALS AND METHODS: Participants who had taken upper endoscopic evaluation and who had symptoms of heartburn or acid regurgitation more than once a week were included through questionnaires. The hospital anxiety and depression scale was used to compare the scores before and after anti-secretory drug (proton pump inhibitor [PPI] or histamine-2 receptor blocker [H2 blocker]) treatment for four weeks. RESULTS: Eighty-four out of a total 94 patients were randomly assigned to a four week treatment, in which, 46 and 38 patients were each assigned to PPI and H2 blocker, respectively. Regardless of the type of treatment, anxiety scores decreased significantly from 5.8+/-3.8 to 5.2+/-3.9 after treatment (P=0.033). Depression scores of 6.3+/-3.4 before treatment reduced to 5.5+/-3.4 after treatment (P=0.011). Anxiety scores and depression scores decreased significantly after treatment in the H2 blocker group. In the response group, anxiety and depression showed significant improvement (P=0.008, P=0.011). CONCLUSIONS: Regardless of the type of drugs, anti-secretory therapy is helpful in treating symptomatic GERD patients, not only in relieving symptoms, but also in relieving anxiety and depression accompanied with GERD.
Anxiety ; Depression ; Gastroesophageal Reflux ; Heartburn ; Histamine H2 Antagonists ; Humans ; Proton Pump Inhibitors ; Surveys and Questionnaires

BACKGROUND/AIMS: Anxiety and depression are associated with reflux symptoms in patients with gastroesophageal reflux disease (GERD). The purpose of this study is to investigate whether the anxiety and depression in patients with GERD will improve with anti-secretory treatment. MATERIALS AND METHODS: Participants who had taken upper endoscopic evaluation and who had symptoms of heartburn or acid regurgitation more than once a week were included through questionnaires. The hospital anxiety and depression scale was used to compare the scores before and after anti-secretory drug (proton pump inhibitor [PPI] or histamine-2 receptor blocker [H2 blocker]) treatment for four weeks. RESULTS: Eighty-four out of a total 94 patients were randomly assigned to a four week treatment, in which, 46 and 38 patients were each assigned to PPI and H2 blocker, respectively. Regardless of the type of treatment, anxiety scores decreased significantly from 5.8+/-3.8 to 5.2+/-3.9 after treatment (P=0.033). Depression scores of 6.3+/-3.4 before treatment reduced to 5.5+/-3.4 after treatment (P=0.011). Anxiety scores and depression scores decreased significantly after treatment in the H2 blocker group. In the response group, anxiety and depression showed significant improvement (P=0.008, P=0.011). CONCLUSIONS: Regardless of the type of drugs, anti-secretory therapy is helpful in treating symptomatic GERD patients, not only in relieving symptoms, but also in relieving anxiety and depression accompanied with GERD.
Anxiety ; Depression ; Gastroesophageal Reflux ; Heartburn ; Histamine H2 Antagonists ; Humans ; Proton Pump Inhibitors ; Surveys and Questionnaires

To protect patient autonomy when confronting death, the importance of advance directives (ADs) has recently became an issue and gradually accepted in Korea. However, in real practice, ADs were not completed by patients but their families in most cases. To analyze the current situation of performing ADs, we reviewed medical charts of 214 terminal cancer patients admitted to the hospice center from October 2012 to September 2013. Seventy-six (35.5%) patients completed ADs. All ADs were completed by patients themselves. The most common reason for not completing ADs was poor physical and/or mental condition. As a proxy, the majority of patients preferred their spouses (55.3%). Few patients wanted life sustaining treatment (1.3%), however palliative sedation was accepted in 89.5%. The median timing of ADs after admission was three (0-90) days, and duration of survival since ADs was 22 (1-340) days. In conclusion, approximately one third of terminal cancer patients completed ADs by themselves. Considering that patient's poor condition is the main reason for not completing ADs, earlier discussion regarding ADs is necessary to enhance patients' participation.
Adolescent ; Adult ; Advance Directives/psychology/*statistics & numerical data ; Aged ; Aged, 80 and over ; Female ; Hospices/*statistics & numerical data ; Humans ; Male ; Middle Aged ; Neoplasms/*mortality/psychology ; *Palliative Care ; Republic of Korea ; *Terminal Care ; Young Adult

To protect patient autonomy when confronting death, the importance of advance directives (ADs) has recently became an issue and gradually accepted in Korea. However, in real practice, ADs were not completed by patients but their families in most cases. To analyze the current situation of performing ADs, we reviewed medical charts of 214 terminal cancer patients admitted to the hospice center from October 2012 to September 2013. Seventy-six (35.5%) patients completed ADs. All ADs were completed by patients themselves. The most common reason for not completing ADs was poor physical and/or mental condition. As a proxy, the majority of patients preferred their spouses (55.3%). Few patients wanted life sustaining treatment (1.3%), however palliative sedation was accepted in 89.5%. The median timing of ADs after admission was three (0-90) days, and duration of survival since ADs was 22 (1-340) days. In conclusion, approximately one third of terminal cancer patients completed ADs by themselves. Considering that patient's poor condition is the main reason for not completing ADs, earlier discussion regarding ADs is necessary to enhance patients' participation.
Adolescent ; Adult ; Advance Directives/psychology/*statistics & numerical data ; Aged ; Aged, 80 and over ; Female ; Hospices/*statistics & numerical data ; Humans ; Male ; Middle Aged ; Neoplasms/*mortality/psychology ; *Palliative Care ; Republic of Korea ; *Terminal Care ; Young Adult

Acute hepatitis E occur commonly as outbreaks in endemic areas, but can occur sporadically in other part of the world. Acute hepatitis E has been reported rarely in Korea. A case of concurrent acute hepatitis E virus (HEV) infection and hyperthyroidism was reported in an inactive hepatitis B surface antigen carrier. We experienced two cases of concomitant acute HEV infection in patients with hyperthyroidism. The first case had acute HEV infection with subclinial hyperthyroidism while taking propylthiouracil. The second case suffered from acute HEV infection in a patient with Graves' disease intractable to propylthiouracil. Herein, we suggest the possible association between HEV infection and hyperthyroidism.
Acute Disease ; Adult ; Female ; Hepatitis E/*complications ; Humans ; Hyperthyroidism/*complications/virology ; Male