No abstract available.

No abstract available.
Barium* ; Child* ; Humans ; Intussusception* ; Ultrasonography*

Avulsion injury of the flexor digitorum profundus tendon from distal phalanx is considered as a rare injury. Accrording to the classification by Leddy and Pacter, this case is Type III, which is a large bony fragment retained by the tendon. The distal pulley prevents retraction beyond the middle phalanx. We are reporting a case with brief review of literatures.
Classification ; Tendon Injuries ; Tendons

Factor XIII (fibrin stabilizing factor) has roles of stabilizing clot and cross-linking fibrin polymer, so the congenital factor XIII deficient patient has clot unstability and delayed bleeding episodes. We experienced a case of 11 years old girl who had experienced delayed umbilical healing, several episodes of intraabdominal and intracranial hemorrhage. But her coagulation screening studies with prothrombin time, aPTT (activated partial thromboplastin time), bleeding time showed normal value at each episode. These findings suggested typical features of congenital factor XIII deficiency. We used semiquantitative method to diagnose Factor XIII deficiency and quantify Factor XIII. We has treated her successfully with prophylactic fresh frozen plasma through plasmapheresis from two donors.
Bleeding Time ; Child ; Factor XIII Deficiency* ; Factor XIII* ; Female ; Fibrin ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Mass Screening ; Plasma ; Plasmapheresis ; Polymers ; Prothrombin Time ; Reference Values ; Thromboplastin ; Tissue Donors

Purpose: To report a case of actinomycosis infection originating in the orbitonasal cavity that quickly invaded the cerebrum.Case summary: A-57-year-old male with a history of right tooth extraction 7 days before the first visit presented with right eyelid swelling and pain that had developed 4 days prior to the visit and had become increasingly worse. The best-corrected visual acuity was light perception. The intraocular pressure of the patient was 37 mmHg in the right eye. Eyelid abscess, subconjunctival hemorrhage, and severe chemosis was observed. Orbital computed tomography showed multiple air pockets and enhancing soft tissue along the periorbital, maxillary, and ethmoid sinus. Emergent endoscopic sinus surgery, lateral canthotomy, and intravenous antifungal treatment were performed due to suspicion of mucormycosis infection. Two days after treatment, exenteration combined with otolaryngology and neurosurgery were performed, as brain magnetic resonance imaging scans indicated that intraorbital lesions had invaded the dura and frontal sinus. On Day 8 of treatment, Actinomyces odontolyticus was identified and intravenous Ampicillin was administered. Despite systemic antibiotic treatment, the infection could not be controlled. The patient died 28 days after treatment due to persistent intracranial hemorrhage and brain edema. Conclusions For patients with severe eyelid swelling with a history of tooth extraction, actinomycosis infection should be considered. Delays in diagnosis and treatment of this infection could lead to serious consequences.

The purpose of postoperative rehabilitation after anterior cruciate ligament (ACL) reconstruction is to restore the knee joint function by recovering the joint stability and preventing postoperative complications, such as stiffness and patello-femoral problem. Many accelerated rehabilitation programs have been introduced in order to restore the knee joint function, and performed pre-and post-operatively. Pre-operative rehabilitation programs consistof preparing the operation mentally and physically, especially the patient education is the most important point of this step. Post-operative rehabilitations and methods of the ligament reconstruction should be explained and expectation of the patients also should be fully understood by the surgeon. The main purpose of rehabilitation is to acquire contentable range of motion by regulating painand swelling of the knee joint, and to prevent atrophy of quadriceps muscles. The fundamental concepts of the post-operative rehabilitation are early knee joint extension, early weight bearing and early recover of quadriceps muscle power of the knee joint. Passive knee extension should be achieved completely within 1 week post-operatively to prevent contracture of the posterior capsule and scaring of the femoral condylar notch, but if not attained at least 2 weeks, that could bring a poor outcomes. Partial weight bearing should be started immediately if not painful, and full weight bearing could be allowed after 4 weeks. Quadriceps muscle exercise including isometric contracture should begin to start at the first day after surgery because restoration of quadriceps muscle power is important for return to activity of daily living. Electrical muscle stimulation and biofeedback would be helpful to recover quadriceps muscle power by decreasing pain and swelling of the joint effectively. Two weeks after surgery, patients could begin closed kinetic chain exercise, after that, patients could exercise the quadriceps muscle more effectively adding open kinetic chain exercise. Recently, trainings for proprioception and neuromuscular control have been emphasized in orderto improve dynamic stability of the knee joint. Nowadays, variable post-operative rehabilitation programs are introduced for regain the knee joint function, and can be differed by types of graft, concomitant injuries, and especially methods of surgery, so should be performed individually, not by standardized program.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Atrophy ; Biofeedback, Psychology ; Contracture ; Humans ; Joints ; Knee ; Knee Joint ; Ligaments ; Muscles ; Patient Education as Topic ; Postoperative Complications ; Proprioception ; Quadriceps Muscle ; Range of Motion, Articular ; Transplants ; Weight-Bearing

Purpose: To report a case of actinomycosis infection originating in the orbitonasal cavity that quickly invaded the cerebrum.Case summary: A-57-year-old male with a history of right tooth extraction 7 days before the first visit presented with right eyelid swelling and pain that had developed 4 days prior to the visit and had become increasingly worse. The best-corrected visual acuity was light perception. The intraocular pressure of the patient was 37 mmHg in the right eye. Eyelid abscess, subconjunctival hemorrhage, and severe chemosis was observed. Orbital computed tomography showed multiple air pockets and enhancing soft tissue along the periorbital, maxillary, and ethmoid sinus. Emergent endoscopic sinus surgery, lateral canthotomy, and intravenous antifungal treatment were performed due to suspicion of mucormycosis infection. Two days after treatment, exenteration combined with otolaryngology and neurosurgery were performed, as brain magnetic resonance imaging scans indicated that intraorbital lesions had invaded the dura and frontal sinus. On Day 8 of treatment, Actinomyces odontolyticus was identified and intravenous Ampicillin was administered. Despite systemic antibiotic treatment, the infection could not be controlled. The patient died 28 days after treatment due to persistent intracranial hemorrhage and brain edema. Conclusions For patients with severe eyelid swelling with a history of tooth extraction, actinomycosis infection should be considered. Delays in diagnosis and treatment of this infection could lead to serious consequences.

PURPOSE: This study was undertaken to investigate the clinical characteristics and prognostic predictors of myelodysplastic syndrome (MDS) in childhood. Method: The characteristics and laboratory findings of 20 patients seen at Asan Medical Center for the past 10 years from September 1989 to August 1998 were reviewed retrospectively with regard to the new International Prognostic Scoring System (IPSS) proposed by International MDS Risk Analysis Workshop. RESULTS: 1) In 20 children with MDS we studied, there was no age or sex predilection unique to the subgroups of MDS. 2) 19 cases (95%) out of the 20 had pallor at the time of diagnosis. Other major clinical findings were bleeding tendency in 11 (55%), fever in 8 (40%), hepatosplenomegaly in 8 (40%), and lymphadenopathy in 3 (15%). 3) The hemoglobin level was less than 10 g/dL in all cases and absolute neutrophil count (ANC) was decreased in 11 cases, thrombocytopenia in 15 cases. Pancytopenia was noted in 8 cases (40%). 4) Of the 20 cases, 9 had refractory anemia (RA), 3 refractory anemia with excess blasts (RAEB), 3 refractory anemia with excess blasts in transformation (RAEBIT), and 5 juvenile chronic myelogenous leukemia (JCML). 5) All RA patients were Intermediate (INT)-1 risk group, and all RAEB children were INT-2 risk group. The 3 cases of RAEBIT fell into INT-1, INT-2, and high risk group. Three cases of JCML were INT-1 group, and 2 cases INT-2 group. 6) Seven cases out of 13 INT-1 group had mean survival of 20.2 month (6~57 month), but only 1 out of 6 INT-2 survived. One case of high risk group succumbed to disease 50 months after diagnosis. CONCLUSION: These results showed that there was no age or sex predilection for the specific subgroup of childhood MDS. All the FAB subtypes of the childhood MDS except RA subgroup had poor survival. In this study, we found the IPSS seemed to be a prognostic predictor in childhood MDS but more cases are needed to confirm the validity of IPSS.
Anemia, Refractory ; Anemia, Refractory, with Excess of Blasts ; Child ; Chungcheongnam-do ; Diagnosis ; Education ; Fever ; Hemorrhage ; Humans ; Leukemia, Myelomonocytic, Juvenile ; Lymphatic Diseases ; Myelodysplastic Syndromes* ; Neutrophils ; Pallor ; Pancytopenia ; Prognosis ; Retrospective Studies ; Thrombocytopenia

OBJECTIVES: To evaluate cognitive reserve in Korea using Korean version of Cognitive Reserve Index questionnaire (K-CRIq) and to investigate the effects of gender and age on cognitive reserve. METHODS: Three hundred and fifty-eight healthy subjects aged 25–85 years old in one community participated in the study. K-CRIq was developed and administered to all subjects to assess the effects of gender and age on cognitive reserve. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were administered to subjects over 65 years old to test concurrent validity. RESULTS: Age and gender as well as their interaction significantly affected Cognitive Reserve Index (CRI) score. Men had higher cognitive reserve than women over 45 years old, but at younger ages there was no gender difference in cognitive reserve. CRI score and sub-scores were strongly associated with the MMSE and MoCA. CONCLUSION: The results indicate that the gender effect on cognitive reserve is disappearing in the young generation in Korea. Scores in neuropsychological tests are predicted well by the CRI score.
Aging ; Cognitive Reserve* ; Female ; Healthy Volunteers ; Humans ; Korea* ; Male ; Methylenebis(chloroaniline) ; Neuropsychological Tests

BACKGROUND: Several studies have suggested that proton pump inhibitor (PPI) use is associated with adverse renal outcomes, but obvious evidence for this association is lacking. We investigated the association between PPI use and adverse renal outcomes in patients who had undergone percutaneous coronary intervention. METHODS: Of the 1,284 patients hospitalized for percutaneous coronary intervention between January 2007 and May 2012, 934 patients with baseline estimated glomerular filtration rate greater than 60 mL/min/1.73 m2 were enrolled. Multivariable Cox models were used to examine whether PPI use was associated with acute and chronic adverse renal outcomes. RESULTS: In adjusted time-dependent Cox models, PPI use was associated with acute kidney injury (hazard ratio [HR], 1.46; 95% confidence interval [95% CI], 1.05–2.02), especially in patients aged 65 years or younger (HR, 2.08; 95% CI, 1.09 3.96) or in patients with diabetes (HR, 2.00; 95% CI, 1.23–3.25). In multivariable Cox models, the association between duration of PPI use and chronic kidney disease development was not statistically significant (HR of heavy users, 1.50; 95% CI, 0.61–3.67), but a longer duration of PPI use was associated with mild renal progression in patients younger than 65 years (HR of heavy users, 2.24; 95% CI, 1.09–4.60). CONCLUSION: Our results suggest that PPI use increases the risk of AKI development, and that PPI use is more significantly associated with acute and chronic renal injuries in younger patients.
Acute Kidney Injury ; Coronary Artery Disease* ; Coronary Vessels* ; Glomerular Filtration Rate ; Humans ; Kidney Failure, Chronic ; Percutaneous Coronary Intervention ; Proportional Hazards Models ; Proton Pump Inhibitors ; Proton Pumps* ; Protons* ; Renal Insufficiency, Chronic ; Risk Factors