BACKGROUND: It is controversial whether the delay of surgery for acute appendicitis by physician results in higher morbidity. Our present study explores this problem of physician delay on the postoperative outcome of patients with acute appendicitis. MATERIAL AND METHODS: Among 432 patients admitted for the presumptive diagnosis of acute appendicitis between Jan., 1995 and Dec., 1997, 358 patients with pathologically proven acute appendicits were analyzed. Physician delay from the hospital admission to the surgery was evaluated in relation to the stage of the disease at operation and postoperative outcome. RESULTS: Postoperative complications occurred signifficantly higher in advanced appendicitis group, than in simple appendicitis group. Postoperative oral consumption started significantly later and hospital days are significantly prolonged in those group. Both patient and physician delays significantly affect the stage of the disease. The finding that physician delay correlated with the stage, however, was denied by multivariate analysis. CONCLUSION: On the contrary to the patient delay, physician delay does not affect the stage of the acute appendicitis nor lead to increased incidence of postoperative complication. Physician delay to clarify the diagnosis is a reasonable strategy and it does not affect the outcome adversely.
Appendicitis* ; Diagnosis ; Humans ; Incidence ; Multivariate Analysis ; Postoperative Complications

The authors have experienced a case of histiocytosis-X. A 7-year-old male patient had three tender masses, one on the right parietal region, another on the left parietal region, the other on the left occipital region and revealed exophthalmus on his left side. Plain skull films showed multiple punched out skull defects and on lumbar spine films, collapse of body of second lumbar vertebra was detected. Among the masses, the largest right parietal one was excised totally. The final diagnosis revealed histiocytosis-X on pathologic basis and he was given subsequent chemotheraphy.
Child ; Diagnosis ; Histiocytosis, Langerhans-Cell* ; Humans ; Male ; Rabeprazole ; Skull ; Spine

Anterior cruciate ligament (ACL) rupture leads to weakened quadriceps muscle strength and a decline in proprioception, impairing the neuromuscular control of the lower extremities. ACL reconstruction, aimed at addressing such structural and functional instability, has become a primary treatment method for young and active patients. Consequently, there have been significant advancements in surgical techniques, resulting in improved clinical outcomes. However, achieving successful outcomes after ACL reconstruction is not solely dependent on the surgery itself; pre- and postoperative rehabilitation and management are equally crucial. A well-designed functional recovery program based on medical evidence before and after ACL reconstruction plays a vital role in restoring function to preinjury levels. The process of the functional recovery program, from presurgery to sports return, should adhere to certain principles. These principles involve prompt and accurate clinical diagnosis and patient classification after injury, systematic programs addressing joint swelling and inflammation control, reduction of arthrogenic muscle inhibition, restoration of range of motion, muscle strength recovery, and proprioception restoration. Postoperatively, it is essential to go beyond traditional methods (such as range of motion restoration and muscle strengthening) by implementing a functional recovery program that includes enhancement of proprioception and neuromuscular control system from the early stages, considering the biological healing response of the graft. This comprehensive approach is vital for achieving optimal outcomes in the recovery of function after ACL reconstruction.

Primary meningeal melanomatosis is a rare, aggressive variant of primary malignant melanoma of the central nervous system, which arises from melanocytes within the leptomeninges and carries a poor prognosis. We report a case of primary meningeal melanomatosis in a 17-year-old man, which was diagnosed with 18F-fluorodeoxyglucose (F-18 FDG) PET/CT, and post hoc F-18 FDG PET/MRI fusion images. Whole-body F-18 FDG PET/CT was helpful in ruling out the extracranial origin of melanoma lesions, and in assessing the therapeutic response. Post hoc PET/MRI fusion images facilitated the correlation between PET and MRI images and demonstrated the hypermetabolic lesions more accurately than the unenhanced PET/CT images. Whole body F-18 FDG PET/CT and post hoc PET/MRI images might help clinicians determine the best therapeutic strategy for patients with primary meningeal melanomatosis.
Adolescent ; Brain Neoplasms/*diagnosis/radionuclide imaging ; Fluorodeoxyglucose F18/diagnostic use ; Humans ; *Magnetic Resonance Imaging ; Male ; Melanoma/*diagnosis/radionuclide imaging ; Meningeal Neoplasms/*diagnosis/radionuclide imaging ; *Positron-Emission Tomography and Computed Tomography ; Radiopharmaceuticals/diagnostic use ; Whole Body Imaging

BACKGROUND: Although the association between serum cholesterol levels and cerebrovascular disorder has been extensively studied, the relationship between cholesterol levels and outcome following ischemic stroke remains to be established. We evaluated the association between serum triglyceride levels and the early prognosis of acute ischemic stroke. METHODS: Among 1096 patients who were admitted to the Neurology department of Chonnam National University Hospital from June 2005 to April 2007, 598 consecutive patients with acute ischemic stroke were enrolled in this study. Patients were divided into five groups based on serum triglyceride levels. RESULTS: The level of triglyceride was significantly lower in patients with 4 or more improvement in NIHSS score than in patients without improvement (100.4 versus 135.0 mg/dl, p<0.001). In a univariate analysis, thrombolytic therapy (p<0.001), atrial fibrillation (p<0.001), lower total cholesterol (p=0.001), lower LDL cholesterol (p=0.019) and previous statin therapy (p=0.042) were also associated with a better functional outcome. After adjustment for known confounding variables, multivariate and survival analysis showed that a lower triglyceride level above the normal range remained an independent predictor of better functional outcome (p=0.002). Previous statin therapy and thrombolytic therapy were also independent predictors for better functional outcome (p=0.044;p<0.001). However, extremely low triglyceride level (<50.0 mg/dl) was associated with poor functional outcome after an acute ischemic stroke. CONCLUSIONS: These results suggest that serum triglyceride measurements in acute ischemic stroke could be helpful in predicting clinical improvement. Further prospective studies are required to determine whether triglyceride is an independent predictor for better functional outcome.
Atrial Fibrillation ; Cerebrovascular Disorders ; Cholesterol ; Cholesterol, LDL ; Confounding Factors (Epidemiology) ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Neurology ; Prognosis ; Reference Values ; Stroke ; Thrombolytic Therapy

PURPOSE: The purpose of this study is to evaluate the outcome of laparoscopic (LA) vs. open appendectomy (OA) in children under 12 years old with perforated appendicitis. METHODS: We reviewed the medical files of 156 children who underwent LA (n=96), OA (n=59), and conversion (CO) (n=1), and compared duration of operation, length of hospital stay, incidence of wound infection, mechanical ileus, intra-abdominal abscess (IAA), and re-admission. RESULTS: Compared to OA, LA resulted in longer duration of operation (58.32+/-17.105 min vs. 44.27+/-18.735 min; p=0.001), but fewer wound infections (2.1% vs. 10.2%; p=0.054), and fewer cases of mechanical ileus (0% vs. 5.1%; p=0.053). No differences in the length of hospital stay (5.85+/-1.824 days vs. 6.10+/-3.027 days; p=0.526), IAA (2.1% vs. 1.7%; p=1.000), or re-admissions (2.1% vs. 5.1%; p=0.369) were observed. CONCLUSION: We report that although LA showed an association with longer duration of operation compared to OA, it is superior to OA with regard to incidence of wound infection and mechanical ileus.
Abdominal Abscess ; Appendectomy ; Appendicitis ; Child ; Humans ; Ileus ; Incidence ; Length of Stay ; Wound Infection

A 57-year old man who was admitted to an emergency room of a tertiary hospital with hemoptysis developed malarial fever 19 days later and then died from severe falciparum malaria 2 days later. He had not traveled outside of Korea for over 30 years. Through intensive interviews and epidemiological surveys, we found that a foreign patient with a recent history of travel to Africa was transferred to the same hospital with severe falciparum malaria. We confirmed through molecular genotyping of the MSP-1 gene that Plasmodium falciparum genotypes of the 2 patients were identical. It is suggested that a breach of standard infection control precautions resulted in this P. falciparum transmission between 2 patients in a hospital environment. This is the first report of a nosocomial transmission of falciparum malaria in Korea.
Africa ; Amino Acid Sequence ; Animals ; Cross Infection/parasitology/*transmission ; Fatal Outcome ; Humans ; Korea ; Malaria, Falciparum/parasitology/*transmission ; Male ; Merozoite Surface Protein 1/chemistry/genetics ; Middle Aged ; Molecular Sequence Data ; Plasmodium falciparum/chemistry/genetics/*isolation & purification ; Protozoan Proteins/chemistry/genetics ; Sequence Alignment ; Travel

The purpose of this study is to evaluate prospectively the effect of different bonding systems and retention grooves on the clinical performance of resin restorations in non-carious cervical lesions (NCCLs). Thirty-nine healthy adults who had at least 2 NCCLs in their premolar areas were included in this study. One hundred and fifty teeth were equally assigned to six groups: (A) Scotchbond Multi-Purpose (SBMP, 3M ESPE, St. Paul, MN, USA, 4th generation bonding system) without retention grooves; (B) SBMP with retention grooves; (C) BC Plus (Vericom Co., Anyang, Gyeonggido, Korea, 5th generation bonding system) without retention grooves; (D) BC Plus with retention grooves; (E) Adper Prompt (3M ESPE, Seefeld, Germany, 6th generation bonding system) without retention grooves; (F) Adper Prompt with retention grooves. All cavities were filled with a hybrid composite resin, Denfil (Vericom Co., Anyang, Gyeonggido, Korea) by one operator. Restorations were evaluated at baseline and at 6-month recall, according to the modified USPHS (United States Public Health Service) criteria. Additionally, clinical photographs were taken and epoxy resin replicas were made for SEM evaluation. At 6-month recall, there were some differences in the number of alpha ratings among the experimental groups. But, despite the differences in the number of alpha ratings, there was no significant difference among the 3 adhesive systems (p > 0.05). There was also no significant difference between the groups with or without mechanical retention (p > 0.05). Follow-ups for longer periods than 6 months are needed to verify the clinical performance of different bonding systems and retention grooves.
Adhesives ; Adult ; Bicuspid ; Follow-Up Studies ; Germany ; Gyeonggi-do ; Humans ; Korea ; Prospective Studies* ; Public Health ; Tooth ; United States Public Health Service

Injuries to the internal jugular vein rarely occur in Korea. However, neck veins are damaged more frequently than any other structure by neck stab injuries, and jugular venous injuries are caused almost exclusively by penetrating neck trauma. Vascular injury is the leading cause of death from trauma. Bleeding from injury to jugular veins is a main contributing factor of mortality as a result of penetrating neck trauma. When we meet a patient of neck stab injury, we must do a careful physical examination and some selective special diagnostic studies. Patients with penetrating neck injuries who are taken directly to the operating room are those with severe external hemorrhage and expanding hematoma and those who are hemodynamically unstable despite of resuscitation. A 22-year-old woman received a stab injury to the neck. On the neck CT scan, the patient was revealed to have a pseudoaneurysm caused by transection of the internal jugular vein. The patient recovered well from the injury as a result of a selective operation, an end-to-end anastomosis. We report that case of a penetrating neck injury resulting in transection of the internal jugular vein and give a review of other reported cases.
Aneurysm, False ; Cause of Death ; Female ; Hematoma ; Hemorrhage ; Humans ; Jugular Veins* ; Korea ; Mortality ; Neck Injuries ; Neck* ; Operating Rooms ; Physical Examination ; Resuscitation ; Tomography, X-Ray Computed ; Vascular System Injuries ; Veins ; Young Adult