Eighty four patients with 104 calcaneal fractures which were treated at the dept. of orthopaedic surgery, Inchon Christian Hospital from October, 1979 to September, 1983 were clinically analysed and the results were as follows; 1. 72 patients were male and 12 patients were female. The male were more injuried in the ratio of 6:l. 2. Their ages were ranged from 6 yrs. to 66 yrs. (average; 35.4 yrs.) and the half of the patients were occured at the 3rd and 4th decade. They admitted for average 7.6/7 weeks. 3. The main cause was a fall from a height in 62 patients (73.8%) and its average height was 4.5m. 4. The open fractures were occured in 13 feet (12.5%) and the spine fracture was associated in 16 patient (19%). 5. The 104 cases were classified according to the Rowe and Essex-Lopresti classification. Fractures involving subtalar joint were 74 feet (71.2%) and the Rowes type V were 58 feet(55.8%). 6. The 22 cases were treated by elosed reduction and axial pin fixation, 10 cases were treated by open reduction and the subtalar fusion was done at 2 cases. Others were treated by cast immobilization with or without closed reduction. The satisfactory result was obtained in 64 cases(61.5%). 7. The most common problem after any treatment was persistent foot pain, especially beneath the lateral malleolus.
Calcaneus ; Classification ; Clinical Study ; Female ; Foot ; Fractures, Open ; Humans ; Immobilization ; Incheon ; Male ; Spine ; Subtalar Joint

Skeletal Class III malocclusions are growth-related discrepancies, and the problems are more severe until growth is complete. Causes of skeletal Class III malocclusion are classified into mandibular overgrowth, maxillary deficiency, and combination of the two. Face mask has been recommended for treatment of Class M malocclusion with maxillary deficiency in the early time of growth. Numerous experiments were performed and clinical studies have been reported on face mask ; nevertheless, studies on profile changes and stability after treatment of face mask are considered to be somewhat insufficient. The author selected 50 patients who can be checked for follow-up. They had been diagnosed as skeletal Class III malocclusion with maxillary deficiency and then treated with face mask ; the sample group was divided according to sex, treatment beginning age, palatal suture opening(intraoral appliance). For each group, changing pattern of facial profile and stability of treatment observed, and comparison with 20 Korean normal children(Angle's Class I ). The following results were obtained. 1. Skeletal, dental, and soft tissue measurements indicated more changes in the amounts of maxillary forward movement during face mask treatment. 2. R.P.E. group showed more significant maxillofacial changes and La-Li group showed more dental changes. 3. Growth changes of maxilla induced in the treatment group during wearing face mask were much more than those of normal group. 4. Growth changes of maxilla in the treatment group after treatment of face mask were less than those of normal group. From the obtained data, it can be concluded that. there was a stimulative effect on forward growth of maxilla during the use of face mask however, on removal of face mask, the stimulative effect was eliminated and undergrowth tendency of maxilla resumed.
Follow-Up Studies ; Humans ; Malocclusion ; Masks* ; Maxilla ; Sutures

BACKGROUND: Chronic fatigue is a common symptom in primary care setting in Korea and classified into medically explained and unexplained according to the precipitating factors. The medically explained chronic fatigue may be associated with many well-known physical and psychological conditions and the medically unexplained chronic fatigue is classified into chronic fatigue syndrome and idiopathic chronic fatigue. The chranic fatigue syndrome is an illness that has unknown etiology and severe disabling fatigue and has been known to most physicians and public since mid-1980's. Many researches are ongoing in developed countries, although the pathophysiology and treatment of this syndrome are controversial. But in Korea, the researches for chronic fatigue and the chronic fatigue syndrome are very rare. Our goal was to assess the clinical characteristics of chronic fatigue and the chronic fatigue syndrome in Korea. METHODS: The study subjects were chronic fatigue patients visiting the chronic fatigue clinic in Kangbuk Samsung Hospital from Feb. 1. 1998 to Aug. 31. 1998 After medical history, physical examination, laboratary tests and questionnare(including fatigue, anxiety and depression scales), the study subjects were classified into the medically explained(psychological disorder and physical disorder group) and unexplained chronic fatigue patient groups(the chronic fatigue syndrome group and idiopathic chronic fatigue group). RESULTS: The final study subjects were 97 patients(psychologicsl disorder(20), physical disorder(20), idiopathic chronic fatigue(27), chronic fatigue syndrome(30)). Compared to the explained chranic fatigue group, uraxphined chronic fatigue group had higher female ratio, lower body mass index, lower blood pressure, higher fatigue scale scores, and the higher prevalence of anxiety and insomnia. CONCLUSIONS: From aur results, unexplained chronic fatigue patients had higher fatigue severity and higher prevalence of anxiety and insomnia than the explained chronic fatigue patients. Although there are limitations to generalizing the results of this study(selection bias), it is significant in that it is the first study of the chronic fatigue syndrome in Korea.
Anxiety ; Body Mass Index ; Depression ; Developed Countries ; Fatigue Syndrome, Chronic* ; Fatigue* ; Female ; Humans ; Hypertension ; Korea* ; Physical Examination ; Precipitating Factors ; Prevalence ; Primary Health Care ; Sleep Initiation and Maintenance Disorders

The aim of this study was to assess the adaptive changes in plasma level of atrial natriuretic peptide(ANP) and its atrial mRNA expression in experimental rat model of chronic renal failure(CRF). Male Sprague-Dawley rats weighing 250-300g were divided into control rats, sham operated rats and 5/6 nephrectomized rats. CRF was induced by 5/6 nephrectomy, in that two thirds of the left kidney was ligated and the contralateral kidney was removed 1 week later. In the rats with 2/3 pole ligation, there were no significant changes in mean arterial pressure(MAP), heart rate, BUN and serum creatinine compared to sham operated rats. Expression of atrial ANP mRNA showed initially higher values and plasma renin activity(PRA) was lower than the sham operated rats. After 5/6 nephrectomy, MAP, heart rate, BUN and serum creatinine increased, and PRA showed the sustained lower values than the control rats. The changing pattern of plasma ANP level was similar to the that of ANP mRNA expression that showed biphasic peaks with the first increase at 1 to 3 days and the second increase at 28 days after nephrectomy. There were a significant positive correlation between plasma ANP level and MAP, and a negative correlation between plasma ANP and PRA. These results suggest that the secretion and the synthesis of ANP respond rapidly to the reduced renal mass, and ANP may play an important regulatory role during the renal adapting process in rats with experimental CRF.
Animals ; Atrial Natriuretic Factor* ; Creatinine ; Heart Rate ; Humans ; Kidney ; Kidney Failure, Chronic* ; Ligation ; Male ; Models, Animal ; Nephrectomy ; Plasma* ; Rats* ; Rats, Sprague-Dawley ; Renin ; RNA, Messenger*

Actinomycosis is a rare entity which presents some difficulties in establishing a correct preoperative diagnosis. Many actinomycotic pelvic infections in women are related to IUD use and the colonization rate appears to increase in accordance with the duration of IUD use. So, all women in IUD use are recommended to make cervicovaginal smear and pelvic infection associated with IUD use should be suspected to have actinomycoses. We report a case which presented painful mass on right upper and lower quadrant of abdomen of a 40-year-old women. We identified sulfur granules by histopathologic exam of surgically resected specimen. Eventually it proved to be pelvic and abdominal actinomycosis associated with the use of an intrauterine device. Because variable clinical pictures and infrequency of the disease make the diagnosis more difficult, increased alertness of clinicians and microbiologists to the presence of anaerobic organism as the cause of infection are needed to make an earlier and more correct diagnosis of actinomycoses and to further avoid any inappropriate treatment.
Abdomen ; Actinomycosis ; Adult ; Colon ; Diagnosis ; Female ; Humans ; Intrauterine Devices ; Pelvic Infection ; Pelvis ; Sulfur

PURPOSE: Acute aortic diseases, such as aortic dissection and aortic aneurysm, can be life-threatening vascular conditions. In this study, we compared outcomes before and after the implementation of a critical pathway (CP) for patients with acute aortic disease at the emergency department (ED). MATERIALS AND METHODS: This was a retrospective observational cohort study. The CP was composed of two phases: PRE-AORTA for early diagnosis and AORTA for prompt treatment. We compared patients who were diagnosed with acute aortic disease between pre-period (January 2010 to December 2011) and post-period (July 2012 to June 2014). RESULTS: Ninety-four and 104 patients were diagnosed with acute aortic disease in the pre- and post-periods, respectively. After the implementation of the CP, 38.7% of acute aortic disease cases were diagnosed via PRE-AORTA. The door-to-CT time was reduced more in PRE-AORTA-activated patients [71.0 (61.0, 115.0) min vs. 113.0 (56.0, 170.5) min; p=0.026]. During the post-period, more patients received emergency intervention than during the pre-period (22.3% vs. 36.5%; p=0.029). Time until emergency intervention was reduced in patients, who visited the ED directly, from 378.0 (302.0, 489.0) min in the pre-period to 200.0 (170.0, 299.0) min in the post-period (p=0.001). The number of patients who died in the ED declined from 11 to 4 from the pre-period to the post-period. Hospital mortality decreased from 26.6% to 14.4% in the post-period (p=0.033). CONCLUSION: After the implementation of a CP for patients with acute aortic disease, more patients received emergency intervention within a shorter time, resulting in improved hospital mortality.
Acute Disease ; Adult ; Aged ; Aneurysm, Dissecting/diagnosis/mortality/*surgery ; Aorta ; Aortic Aneurysm/diagnosis/mortality/*surgery ; Aortic Diseases/diagnosis/mortality/*surgery ; *Critical Pathways ; Emergency Service, Hospital/*organization & administration ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Outcome and Process Assessment (Health Care) ; Postoperative Complications/mortality ; Republic of Korea/epidemiology ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Vascular Surgical Procedures/*methods

BACKGROUND: Redo coronary artery bypass grafting (CABG) is still associated with increased morbidity and mortality as compared to the first-time operation. Further, the application of the off-pump technique to redo CABG is limited due to technical difficulties. The aim of this retrospective study was to analyze early and midterm results after redo CABG and compare the outcome of redo on-pump and off-pump CABG. METHODS: From June 1996 to October 2011, elective redo CABG was performed in 32 patients. Mean age was 64.8 years (on pump 64.3 years vs. off pump 65.5 years; p=0.658), and 21 patients were male. Among these patients, 14 (43.8%) underwent on-pump CABG, and 18 (56.2%) underwent off-pump CABG. RESULTS: Internal thoracic artery was used in 22 patients (68.8%), and total arterial revascularization was achieved in 17 patients (53.1%). The average number of distal anastomoses was 2.13, and the rate of incomplete revascularization was 43.8%. The rate of total arterial revascularization was higher in the off-pump group (14.3% vs. 83.3%, p<0.001), and the use of saphenous vein graft was more in the on-pump group (78.6% vs. 16.7%, p<0.001). Overall hospital mortality was 3.1% (n=1) and was comparable in both groups (on pump 7.1% vs. off pump 0%; p=0.249). Postoperative complications occurred in 9 patients (64.2%), and the rate of complications was high in the on-pump group without statistical significance (64.2% vs. 33.3%, p=0.082). The mean follow-up duration was 5.4 years, and overall survival at 10 years was 86.0%+/-10.5%. There was no significant difference in the 10-year survival rate between the two groups (79.6% vs. 100%, p=0.225). CONCLUSION: Redo CABG can be safely performed with acceptable mortality. Redo off-pump coronary artery bypass is feasible with low mortality and morbidity, comparable target vessel bypass grafting, and long-term survival. The off-pump technique might be considered a safe option for redo CABG in high-risk patients.
Coronary Artery Bypass* ; Coronary Artery Bypass, Off-Pump ; Follow-Up Studies ; Hospital Mortality ; Humans ; Male ; Mammary Arteries ; Mortality ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Saphenous Vein ; Survival Rate ; Transplants

OBJECTIVE: This study was conducted to compare the perioperative outcomes in patients with symptomatic uterine myoma who underwent laparoscopic (LM) or laparoscopically assisted myomectomy (LAM). METHODS: A total of 207 patients with myoma underwent LM or LAM in Samsung Medical Center between October 2006 and March 2010. Of them, 121 patients with LM and 50 with LAM met the inclusion criteria and were compared for the perioperative outcomes. RESULTS: The operation time was significantly shorter in the LAM group than in the LM group (111 min versus 139 min; p<.001, respectively). Estimated blood loss was significantly higher in the LAM group (p<.001). Intraoperative, early postoperative complications, hospitalization days and postoperative analgesics use were similar between the 2 study groups. CONCLUSION: LM and LAM is comparable in the perioperative outcomes in patients with symptomatic uterine myoma.
Analgesics ; Female ; Hospitalization ; Humans ; Laparoscopy ; Lipopolysaccharides ; Myoma ; Postoperative Complications

OBJECTIVE: The purpose of this study is to investigate the prognostic role of pretreatment anemia in patients with early cervical cancer who underwent radical hysterectomy. METHODS: In this study, we retrospectively enrolled patients with early cervical cancer (International Federation of Obstetrics and Gynecology stage IB to IIA) who were treated at Samsung Medical Center, Seoul, Korea, from 1996 to 2007. RESULTS: We retrospectively enrolled 805 patients. Median pretreatment hemoglobin (Hb) level was 12.8 g/dL (4.0-16.9) in all patients. Ninety-ninth out of 805 patients had pretreatment anemia (12.3%). Pretreatment anemia was significantly associated with large tumor size, advanced clinical stage, and parametrial invasion. In multivariate analysis, higher pretreatment Hb entailed better prognostic significance in disease free survival (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.078-0.99) but not in overall survival (HR, 0.94; 95% CI, 0.80-1.10). CONCLUSION: In conclusion, we found that the negative association between pretreatment Hb level and tumor size and the impact of anemia before treatment on disease free survival adjusted for other factors including clinical stage and pathological findings in early stage cervical cancer.
Anemia ; Disease-Free Survival ; Gynecology ; Humans ; Hysterectomy ; Korea ; Multivariate Analysis ; Obstetrics ; Prognosis ; Retrospective Studies ; Seoul ; Uterine Cervical Neoplasms*

OBJECTIVE: Placental site trophoblastic tumor (PSTT) is the rarest form of gestational trophoblastic disease (GTD) and the optimum management is still controversial. In this study, we analyzed the clinical features, treatment, and outcomes of 6 consecutive patients with PSTT treated in our institution. METHODS: The electronic medical record database of Samsung Medical Center was screened to identify patients with PSTT from 1994 to 2017. Medical records for the details of each patient's clinical features and treatment were extracted and reviewed. This study was approved Institutional Review Board of our hospital. RESULTS: A total of 418 cases of GTD, 6 (1.4%) patients with PSTT were identified. The median age of the patients was 31 years. The antecedent pregnancy was term in all 5 cases with available antecedent pregnancy information and the median interval from pregnancy to diagnosis of PSTT was 8 months. The median titer of serum beta human chorionic gonadotropin (β-hCG) at diagnosis was 190.9 mIU/mL. Five (83.3%) patients presented with irregular vaginal bleeding and one (16.7%) had amenorrhea. All patients had disease confined to the uterus without metastasis at diagnosis and were successfully treated by hysterectomy alone. All of them were alive without disease during the follow-up period. CONCLUSION: In this study, we observed low level serum β-hCG titer and irregular vaginal bleeding with varying interval after antecedent term pregnancy were most common presenting features of PSTT. In addition, we demonstrated hysterectomy alone was successful for the treatment of stage I disease of PSTT.
Amenorrhea ; Chorionic Gonadotropin ; Diagnosis ; Electronic Health Records ; Ethics Committees, Research ; Female ; Follow-Up Studies ; Gestational Trophoblastic Disease ; Humans ; Hysterectomy ; Korea* ; Medical Records ; Neoplasm Metastasis ; Pregnancy ; Prognosis ; Trophoblastic Tumor, Placental Site* ; Uterine Hemorrhage ; Uterus