A survey of the literature on the treatment of ruptures of deltoid ligament associated with fracture of distal part of fibula is controversial. Some authors advocated surgical repair of the ruptured deltoid ligament based on the theoretical consideration, while others advocated non-operative treatment based on the clinical consideration. We studied the results in forty-five patients who were treated for disruption of the deltoid ligament and a distal fibular fracture. The length of follow-up in our series was twelve to twenty-four months, with an average of fifteen months. When the fibular fracture was adequately reduced and medial clear space was returned to its normal width, the 91 percents both of patients of being treated with repair of deltoid ligament and patients of being treated without repair had a good or excellent results.
Clinical Study ; Fibula ; Follow-Up Studies ; Humans ; Ligaments ; Rupture

Basaloid squamous cell carcinoma is a rare and aggressive variant of squamous cell carcinoma, which mostly occurs in the upper aerodigestive tracts. Basaloid squamous cell carcinoma also typically arises in the anal canal, but is extremely rare in the lower gastrointestinal tract. A 70-year-old man presented with loose stool and intermittent hematochezia 2 months ago. Colonoscopy showed an ulceroinfiltrative mass on the rectosigmoid colon from 16 cm to 18 cm above the anal verge. Conventional colonoscope could not pass through the lesion but it was possible with pediatric colonoscope. Abdominal CT scan showed 1.6 cm sized wall thickening with circumferential luminal narrowing in the rectosigmoid colon and multiple ill-defined low density masses in both lobes of the liver. Therefore, colon cancer with liver metastasis was suspected. However, basaloid cells were noted on histologic examination, and they were weakly positive for synaptophysin on immunohistochemical study. After palliative lower anterior resection, histologic examination of the resected specimen revealed basaloid differentiation with keratin pearls, and tumor cells were positively stained with high molecular weighted cytokeratin (34BE12) and CK 5/6. Thus, the patient was finally diagnosed with basaloid squamous cell carcinoma of rectosigmoid colon with distant metastases.
Aged ; Carcinoma, Squamous Cell/*diagnosis/pathology/surgery ; Colonoscopy ; Colorectal Neoplasms/*diagnosis/pathology/surgery ; Humans ; Immunohistochemistry ; Keratins/metabolism ; Liver Neoplasms/radiography/secondary ; Lung Neoplasms/radionuclide imaging/secondary ; Male ; Positron-Emission Tomography ; Synaptophysin/metabolism ; Tomography, X-Ray Computed

We report case of a 14-year-old girl with systemic lupus erythematosus who initially presented with acute lupus pneumonitis. She had a 4-week history of exertion for the past 4 weeks, and was transferred from a regional hospital due to abnormality on chest radiographs. Chest radiographs revealed bilateral infiltration and pleural effusion on both lower lung fields. We assumed her to be infected and prescribed antibiotics. The response to antibiotics was ineffective, and viral, bacterial, and mycobacterial cultures were negative. Antinuclear and anti-dsDNA antibodies in serum were positive. The open lung biopsy revealed diffuse alveolar damage. She was diagnosed as having acute lupus pneumonitis in systemic lupus erythematosus and recovered gradually after receiving corticosteroids. Acute lupus pneumonitis may be considered even though interstitial lung involvement in systemic lupus erythematosus is relatively rare in pediatric practice and its diagnosis is difficult.
Adolescent ; Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Antibodies ; Biopsy ; Humans ; Lung ; Lung Diseases ; Lupus Erythematosus, Systemic ; Pleural Effusion ; Pneumonia ; Thorax

PURPOSE: Symptomatic and/or malignant changes in hepatic cysts require surgical treatment, but there are few comparative studies with respect to the safety and long-term effectiveness. We compared the resection and non-resection of hepatic cysts from the view point of recurrence and complications. METHODS: We reviewed 24 patients who underwent surgery for hepatic cysts between 1990 and 2001 at a single institution. There included 15 resections and 9 non-resections. RESULTS: The median age was 59 years, with a male to female sex ratio of 9: 15. The median size of the dominant cyst was 12 cm, and 22 patients presented with symptoms. We treated 12 simple cysts, 3 polycystic liver diseases (PCLD), 3 cystadenomas, 1 cystadenocarcinoma, 2 hamartomas, 1 hydatid cyst, 1 traumatic cyst and 1 other. The causes requiring an operation were peritoneal irritation in 7, a mass effect such as early satiety or jaundice in 5, possible malignancy in 4, associated hepatobiliary diseases in 3, increase of cyst sizes in 2 and another disease in 2. We performed 5 right lobectomies, 2 left lobectomies, 1 left lateral segmentectomy, 3 non-anatomical resections, 3 cyst excisions, and 1 total hepatectomy for liver transplantation in the resection group. 6 unroofings and 3 fenestrations were performed in the non-resection group, in which a laparoscopic approach was applied in 3 cases. The incidence of postoperative complications were uncommon in both groups, whereas resection decreased the recurrence rate significantly (P=0.003). CONCLUSION: Resection is a safe and effective procedure to lower the recurrence of all cystic lesions in the liver.
Cystadenocarcinoma ; Cystadenoma ; Echinococcosis ; Female ; Hamartoma ; Hepatectomy ; Humans ; Incidence ; Jaundice ; Liver ; Liver Diseases ; Liver Transplantation ; Male ; Mastectomy, Segmental ; Postoperative Complications ; Recurrence ; Sex Ratio

Noncystic fibrosis bronchiectasis is a chronic respiratory disease that carries high socioeconomic and medical burdens and is caused by diverse respiratory illnesses. To improve clinical outcomes, early recognition, active treatment of exacerbations, and prevention of further exacerbations are essential. However, evidence for the treatment and prevention of acute exacerbation of noncystic fibrosis bronchiectasis, especially in children, is lacking. Therefore, the evidence- and consensus-based guidelines for medical and nonmedical treatment strategies for noncystic fibrosis bronchiectasis in children and adolescents were developed by the Korean Academy of Pediatric Allergy and Respiratory Disease using the methods recommended by the Grading of Recommendations Assessment, Development, and Evaluation working group with evidence published through July 2, 2020. This guideline encompasses evidence-based treatment recommendations as well as expert opinions, addressing crucial aspects of the treatment and management of non-cystic fibrosis bronchiectasis in children. This includes considerations for antibiotics and airway clearance strategies, particularly in areas where evidence may be limited. Large, well-designed, and controlled studies are required to accumulate further evidence of management strategies for noncystic fibrosis bronchiectasis in children and adolescents.

Noncystic fibrosis bronchiectasis is a chronic respiratory disease that carries high socioeconomic and medical burdens and is caused by diverse respiratory illnesses. To improve clinical outcomes, early recognition, active treatment of exacerbations, and prevention of further exacerbations are essential. However, evidence for the treatment and prevention of acute exacerbation of noncystic fibrosis bronchiectasis, especially in children, is lacking. Therefore, the evidence- and consensus-based guidelines for medical and nonmedical treatment strategies for noncystic fibrosis bronchiectasis in children and adolescents were developed by the Korean Academy of Pediatric Allergy and Respiratory Disease using the methods recommended by the Grading of Recommendations Assessment, Development, and Evaluation working group with evidence published through July 2, 2020. This guideline encompasses evidence-based treatment recommendations as well as expert opinions, addressing crucial aspects of the treatment and management of non-cystic fibrosis bronchiectasis in children. This includes considerations for antibiotics and airway clearance strategies, particularly in areas where evidence may be limited. Large, well-designed, and controlled studies are required to accumulate further evidence of management strategies for noncystic fibrosis bronchiectasis in children and adolescents.

Noncystic fibrosis bronchiectasis is a chronic respiratory disease that carries high socioeconomic and medical burdens and is caused by diverse respiratory illnesses. To improve clinical outcomes, early recognition, active treatment of exacerbations, and prevention of further exacerbations are essential. However, evidence for the treatment and prevention of acute exacerbation of noncystic fibrosis bronchiectasis, especially in children, is lacking. Therefore, the evidence- and consensus-based guidelines for medical and nonmedical treatment strategies for noncystic fibrosis bronchiectasis in children and adolescents were developed by the Korean Academy of Pediatric Allergy and Respiratory Disease using the methods recommended by the Grading of Recommendations Assessment, Development, and Evaluation working group with evidence published through July 2, 2020. This guideline encompasses evidence-based treatment recommendations as well as expert opinions, addressing crucial aspects of the treatment and management of non-cystic fibrosis bronchiectasis in children. This includes considerations for antibiotics and airway clearance strategies, particularly in areas where evidence may be limited. Large, well-designed, and controlled studies are required to accumulate further evidence of management strategies for noncystic fibrosis bronchiectasis in children and adolescents.

Noncystic fibrosis bronchiectasis is a chronic respiratory disease that carries high socioeconomic and medical burdens and is caused by diverse respiratory illnesses. To improve clinical outcomes, early recognition, active treatment of exacerbations, and prevention of further exacerbations are essential. However, evidence for the treatment and prevention of acute exacerbation of noncystic fibrosis bronchiectasis, especially in children, is lacking. Therefore, the evidence- and consensus-based guidelines for medical and nonmedical treatment strategies for noncystic fibrosis bronchiectasis in children and adolescents were developed by the Korean Academy of Pediatric Allergy and Respiratory Disease using the methods recommended by the Grading of Recommendations Assessment, Development, and Evaluation working group with evidence published through July 2, 2020. This guideline encompasses evidence-based treatment recommendations as well as expert opinions, addressing crucial aspects of the treatment and management of non-cystic fibrosis bronchiectasis in children. This includes considerations for antibiotics and airway clearance strategies, particularly in areas where evidence may be limited. Large, well-designed, and controlled studies are required to accumulate further evidence of management strategies for noncystic fibrosis bronchiectasis in children and adolescents.

Atopic dermatitis is one of the most common chronic skin inflammatory diseases in children. Appropriate treatment is difficult due to chronic course with frequent exacerbations, especially in children. Treatment requires caution due to a lack of safety data and information regarding the long-term prognosis of management strategies. The Korean Academy of Pediatric Allergy and Respiratory Disease (KAPARD) published the Atopic Dermatitis Treatment Guidelines in 2008, which has been used to direct atopic dermatitis treatment. Accumulating evidence suggests that the guidelines need to be updated regarding bathing methods (duration of bath, temperature, etc.), wet wrap therapy, and topical treatments in line with environmental changes over time and changes in the management strategies of atopic dermatitis. This KAPARD guidelines for atopic dermatitis applied an adaptation based on a systematic review and analysis of selected literature. They are intended to support front-line doctors treating pediatric and adolescent patients with atopic dermatitis in making reasoned, safe, effective empirical treatment decisions. In Part I of the KAPARD guidelines for atopic dermatitis, we included evidence-based skin care management strategies and topical treatment options.

Atopic dermatitis is the most common chronic inflammatory skin disease in children and adolescents. The Korean Academy of Pediatric Allergy and Respiratory Disease published the Atopic Dermatitis Treatment Guideline in 2008, which has been helpful in atopic dermatitis treatment until now. Various reports on the development and effectiveness of new drugs have suggested that there is a need to develop and revise old treatment guidelines. Part 1 aimed to provide evidence-based recommendations for skin care management and topical treatment for atopic dermatitis. Part 2 focuses on systemic treatment, novel therapeutics, and adjuvant therapy. The goal of this guideline is intended to assist front-line doctors treating pediatric and adolescent atopic dermatitis patients make safer, more effective, and more rational decisions regarding systemic treatment, novel therapeutics, and adjuvant therapy by providing evidence-based recommendations with a clear level of evidence and benefit regarding treatment.