Shoulder dislocation is the most common dislocation presenting to the emergency department. In old age, the attempt of closed reduction is made with caution in order to prevent iatrogenic fracture around the shoulder. We report two cases of iatrogenic fractures of humeral shaft and anatomical neck in female patients older than 70 years old, which occurred during the manual closed reduction. One patient was proved as first-time and the other was recurrent. In addition, the second case had a massive irreparable rotator cuff tear. Those patients were treated successfully with humeral nailing and reverse total shoulder arthroplasty, respectively.
Arthroplasty ; Dislocations ; Emergency Service, Hospital ; Female ; Fracture Fixation, Intramedullary ; Humans ; Humeral Fractures* ; Neck ; Rotator Cuff ; Shoulder Dislocation* ; Shoulder* ; Tears

PURPOSE: To report a case of hemorrhagic lymphangiectasia treated with surgical excision and confirmed by pathologic examination. CASE SUMMARY: A 21-year-old man presented with spontaneous hyperemia of his right eye of 1 week duration. The patient had a history of tuberculous retinal vasculitis and uveitis 1 year prior, but there was no active lesion during regular follow-up. There was no history of trauma, visual disturbance, diplopia, ocular pain, or any sign of systemic disease. Slit lamp examination showed tortuous dilatation of blood-filled lymphatic vessels on temporal conjunctiva of the right eye. The lesion did not change during the 4 weeks of follow-up and local excision biopsy was made for final diagnosis and treatment. Pathologic examinations revealed thin-walled lymphatic vessels with localized dilatation which contained blood in the lumen consistent with hemorrhagic lymphangiectasia. There was no sign of recurrence until 2 months after the operation. CONCLUSIONS: Hemorrhagic lymphangiectasia should be considered in patients with recurrent or longstanding localized tortuous subconjunctival hemorrhage.
Biopsy ; Conjunctiva ; Dilatation ; Diplopia ; Eye ; Follow-Up Studies ; Hemorrhage ; Humans ; Hyperemia ; Lymphatic Vessels ; Recurrence ; Retinal Vasculitis ; Uveitis ; Young Adult

BACKGROUND : Truncal vagotomy produces a reduction in bile flow, an increased gallbladder volume, a delay in gallbladdr emptying, decrease in resting pressure, and decreased contraction following stimulation with cholecystokinin. Retrospective studies have suggested that vagotomy can be responsible for a 4 to 6 fold increase in the 4% to 5% control rate of cholelithiasis noted in the Framingham study. The measurement of the gallbladder ejection fraction by using Tc-99m DISIDA scintigraphy is suitable for the study of the motor functions of the gallbaldder. A gallbladder ejection fraction of less than 35% is highly predictive of the presence of gallbladder disease and is a good indicator of a favorable outcome following a cholecystectomy. METHODS : Between January 1995 and December 1996, 24 patients (truncal vagotomy + pyloroplasty, 5; truncal vagotomy partial + gastrectomy + Billroth I, 4; truncal vagotomy + partial gastrectomy + Billroth II, 12; total gastrectomy, 3) and 18 healthy volunteers were investigated prospectively by Tc-99m DISIDA scintigraphy for the measurement of the gallbladder ejection fraction. RESULTS : In normal subjects, the mean value of the gallbladder ejection fraction was 70.8%, and in patients after a gastric operations, it was 66.0% (p>0.05). Three (25.0%) of the 12 patients with a truncal vagotomy, partial gastrectomy, and Billroth II gastrojejunostomy had gallbladder ejection fractions of less than 35% (p<0.05). CONCLUSIONS : There was no difference in the gallbladder ejection fractions between the control group and the patients after gastric operations, including a truncal vagotomy. However there was a significant difference between the patients with a truncal vagotomy, partial gastrectomy, and Billroth II anastomosis and those receiving other gastric operations.
Bile ; Cholecystectomy ; Cholecystokinin ; Cholelithiasis ; Gallbladder Diseases ; Gallbladder* ; Gallstones ; Gastrectomy ; Gastric Bypass ; Gastroenterostomy ; Healthy Volunteers ; Humans ; Prospective Studies ; Radionuclide Imaging* ; Vagotomy ; Vagotomy, Truncal

This is the study of Jaedong Jejoongwon the first westernized hospital in Korea founded in 1885. To build the groundwork for study of Jejoongwon its size location building structure and medical functions were studied. At the same time the history of jejoongwon particularly that of the time when there arose a need for its moving and expansion was studied Jaedong Jejoongwon was founded in a renovated building. The building was formerly owned by Hong Young-sik who was killed while leading the Gapsinjungbyun. According to the existing block plan of Jaedong Jejoongwon when it was opened in 1885 it was located in the place which later became a park Nowadays this park is to northwest of the Constitutional Court At that time its size was about 600 p'yung As the medical school was built from end of 1885 to early 1886 Jejoongwon was expanded to north and its size was enlarged to 862 16 p'yung Jaedong Jejoongwon reflected the characteristics of western medical system When it was opened in 1885 Jejoongwon consisted of a servants' room an assistants' room the outpatient clinic the operation room (which was also used as the pharmacy) surgical wards women's wards and general wards In 1886 as the number of patients was increased and medical school was opened the function and the structure of hospital changed The most significant change was that a new medical school building was built as the nearby buildings were bought The medical school consisted of the students' dormitory a chemistry laboratory and classrooms Moreover new functions were added to already- existed hospital building a contagious ward a waiting room for outpatients an eye ward a darkroom a room for special diagnosis and treatment and a vaccination room Also from the time when it was first opened Jejoongwon needed the expansion as too many patients came in and the medical education was started Therefore in the summer of 1886 Allen positively explored ways toward the hospital's moving. At last in early 1887 Jaedong Jejoongwon moved to Kurigae on along with the development of medical education and medical treatment shows how the modern medical system was formed and developed in Korea.
English Abstract ; History of Medicine, 19th Cent. ; Hospitals/*history ; Korea ; Medicine ; *Western World/*history

PURPOSE: To establish a database of the anthropometric measurements of soft-tissue orbits in Korean newborns. METHODS: A total of 69 normal term newborns (39 males, 30 females) in the first 48 hours after delivery, were included in the present study. Anthropometric measurements of soft-tissue orbits were taken with vernier calipers by one of the authors. With eyes closed, horizontal eyelid fissure length (HFL), lower lid height (LLH), upper lid height (ULH), intercanthal distance (ICD), and inter-outercanthal distance (IOCD) were measured and with eyes opened with a speculum, the interpupillary distance (IPD) was measured. RESULTS: There was no significant difference between either sex or between the right and left eyes. HFL was 20.8 +/- 1.2 mm, LLH and ULH were 11.1 +/- 2.3 and 16.5 +/- 2.5 mm, respectively; ICD, IPD, and IOCD were 22.9 +/- 2.1 mm, 39.8 +/- 3.0 mm, and 65.3 +/- 5.8 mm, respectively. CONCLUSIONS: Anthropometric measurements of normal Korean newborns' soft-tissue orbits in the present study can be used as basic data for the proper evaluation and growth of soft-tissue orbits.
Eye ; Eyelids ; Humans ; Infant, Newborn ; Male ; Orbit ; Surgical Instruments

Objective: Despite a high prevalence of dementia in older adults hospitalized with severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2), or so called COVID-19, research investigating association between preexisting diagnoses of dementia and prognosis of COVID-19 is scarce. We aimed to investigate treatment outcome of patients with dementia after COVID-19. Methods: We explored a nationwide cohort with a total of 2,800 subjects older than 50 years who were diagnosed with COVID-19 between January and April 2020. Among them, 223 patients had underlying dementia (dementia group). We matched 1:1 for each dementia- non-dementia group pair yielding 223 patients without dementia (no dementia group) using propensity score matching. Results: Mortality rate after COVID-19 was higher in dementia group than in no dementia group (33.6% vs. 20.2%, p=0.002). Dementia group had higher proportion of patients requiring invasive ventilatory support than no dementia group (34.1% vs. 22.0%, p=0.006). Multivariable analysis showed that dementia group had a higher risk of mortality than no dementia group (odds ratio=3.05, p<0.001). We also found that patients in dementia group had a higher risk of needing invasive ventilatory support than those in no dementia group. Conclusion Our results suggest that system including strengthen quarantines are required for patients with dementia during the COVID- 19 pandemic.

Objective: Despite a high prevalence of dementia in older adults hospitalized with severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2), or so called COVID-19, research investigating association between preexisting diagnoses of dementia and prognosis of COVID-19 is scarce. We aimed to investigate treatment outcome of patients with dementia after COVID-19. Methods: We explored a nationwide cohort with a total of 2,800 subjects older than 50 years who were diagnosed with COVID-19 between January and April 2020. Among them, 223 patients had underlying dementia (dementia group). We matched 1:1 for each dementia- non-dementia group pair yielding 223 patients without dementia (no dementia group) using propensity score matching. Results: Mortality rate after COVID-19 was higher in dementia group than in no dementia group (33.6% vs. 20.2%, p=0.002). Dementia group had higher proportion of patients requiring invasive ventilatory support than no dementia group (34.1% vs. 22.0%, p=0.006). Multivariable analysis showed that dementia group had a higher risk of mortality than no dementia group (odds ratio=3.05, p<0.001). We also found that patients in dementia group had a higher risk of needing invasive ventilatory support than those in no dementia group. Conclusion Our results suggest that system including strengthen quarantines are required for patients with dementia during the COVID- 19 pandemic.

OBJECTIVE:Optimized voxel based morphometry (VBM) has been increasingly applied to investigate differences in brain morphology between a group of Alzheimer's Disease (AD) patients and control subjects. Optimized VBM permits comparison of gray matter (GM) volume at voxel-level from the entire brain. The purpose of this study was to assess the regional GM volume loss measured by optimized VBM in AD compared to controls METHODS:Twenty-three AD patients and 20 cognitively normal elderly control subjects included in this study. To improve the VBM performance, the study specific template and the probability maps were generated from the control subjects. RESULTS:Optimized VBM analysis revealed GM loss, including hippocampus, amygdala, anterior cingulate, posterior cingulate, insula, frontal lobe and middle temporal complex in the AD group as compared to normal control group CONCLUSION:The VBM results confirmed previous findings of temporal lobe and limbic lobe atrophic changes in AD, and suggest that these abnormalities may be confined to specific sites within that lobe, rather than showing a widespread distribution.
Aged ; Alzheimer Disease ; Amygdala ; Brain ; Frontal Lobe ; Hippocampus ; Humans ; Temporal Lobe

For the experimental study of neural tube defect (NTD), a surgical model has advantages over other models in a few aspects. It causes less functional derangement of cells and the NTDs can be made selectively by surgery. The authors planned to use the surgical model for the experimental study of NTD. As the first step for the studies, the chronological changes of morphology during the early postoperative period were investigated using postincubation 3-day chick embryos. The objectives of this study are (1) the morphological evaluation of the surgical model as a method for studies of open NTD, and (2) the observation of morphological changes for the first 24 hours after surgery which include 'overgrowth' appearance and the continuity between the surface ectoderm and the neuroectoderm. The morphological changes were observed by light microscope and scanning electron microscope. Immediately after surgery, typical open NTDs were observed. Morphologically they were very similar to the appearance of spontaneous (non-surgical) open NTDs. The opened neural tubes were everted progressively and they looked rather flat at 24 hours after surgery. Cellular hyperplasia ('overgrowth' appearance) was noted within 24 hours after surgery and became more prominent during the 24 hours. There was increasing continuity between the surface ectoderm and the neural tissue until 24 hours after surgery when the continuity looked almost complete. In conclusion, surgically induced NTDs are morphologically very similar to spontaneous NTDs.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals ; Chick Embryo ; *Disease Models, Animal ; Evaluation Studies as Topic ; Neural Tube Defects/etiology/*pathology ; Postoperative Period

PURPOSE: The purpose of this study was to establish general guidelines for the treatment of patients with early glottic carcinoma (T1-2N0M0), by assessing the role of primary radiotherapy and by analyzing the tumor-related and treatment-related factors that have an influence on the treatment results. MATERIALS AND METHODS: This retrospective study was composed of 80 patients who suffered from early glottic carcinoma and were treated by primary radiotherapy at Pusan National University Hospital, between August 1987 and December 1996. The distribution of patients according to T-stage was 66 for stage T1 and 14 for stage T2. All of the patients were treated with conventional radical radiotherapy using a 6MV photon beams, a total tumor dose of 60~75.6 Gy (median 68.4 Gy), administered in 5 weekly fractions of 1.8~2.0 Gy. The overall radiation treatment time was from 40 to 87 days, median 51 days. All patients were followed up for at least 3 years. Univariate and multivariate analysis was done to identify the prognostic factors affecting the treatment results. RESULTS: The five-years overall survival rate was 89.2% for all patients, 90.2% for T1 and 82.5% for T2. The local control rate was 81.3% for all patients, 83.3% for T1 and 71.4% for T2. However, when salvage operations were taken into account, the ultimate local control rate was 91.3%, T1 94.5%, T2 79.4%, representing an increase of 8~12% in the local control rate. The voice preservation rate was 89.2%, T1 94.7 %, T2 81.3%. Fifteen patients suffered a relapse after radiotherapy, among whom 12 patients underwent salvage surgery. We included T-stage, tumor location, total radiation dose, fraction size, field size and overall radiation treatment time as potential prognostic factors. T-stage and overall treatment time were found to be statistically significant in the univariate analysis, but in the multivariate analysis, only the overall treatment time was found to be significant. CONCLUSION: The high cure and voice preservation rates obtained when using a procedure, comprising a combination of radical radiotherapy and salvage surgery, may make this the treatment of choice for patients with early glottic carcinoma. However, the prognostic factors affecting the treatment results must be kept in mind, and more accurate treatment planning and further optimization of the radiation dose are necessary.
Busan ; Humans ; Multivariate Analysis ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Survival Rate ; Voice