PURPOSE: The aim of this study was to determine the outcomes of fixation of AO/OTA type C2 fractures among intra-articular fractures of the distal humerus using the paratricipital approach (side to side retraction of the triceps). MATERIALS AND METHODS: From June 2008 to January 2018, 12 patients underwent an open reduction and internal fixation with the paratricipital approach and were followed-up for more than 10 months after surgery. According to the AO/OTA classification, type C2 fractures were chosen among the intraarticular distal humerus fractures. An extended posterior incision was used over the olecranon in the prone position, preserving the insertion site of the triceps brachii muscle. The fracture site was exposed by retracting the muscle side-to side through a dissection of the medial and lateral intermuscular septum of the triceps brachii muscle. The therapeutic results were assessed by the anatomical reduction of the articular surface and integrity of the metaphyseal contour in postoperative simple radiographs, complications, such as neuropathy or non-union, and the Mayo elbow performance score (MEPS) were checked to estimate the functional outcome. RESULTS: In the postoperative simple radiographs, no case showed more than 1 mm step-off and the disrupted contour of the distal humerus was recovered to normal alignment in most cases. The range of elbow joint motion in the last follow-up was 133.8° on average with a mean flexion contracture of 5.0°. The clinical results depending on the MEPS were excellent, except for two cases, which were good. Neuropathy of the ulnar nerve was observed in one patient, which was resolved after metal removal. CONCLUSION: The paratricipital approach is useful technique in AO/OTA type C2 intra-articular distal humerus fractures that provides sufficient exposure of the surgical field, without injury to the triceps brachii muscle and postoperative complications associated with the trans-olecranon approach.
Classification ; Contracture ; Elbow ; Elbow Joint ; Follow-Up Studies ; Humans ; Humerus ; Intra-Articular Fractures ; Olecranon Process ; Postoperative Complications ; Prone Position ; Ulnar Nerve

The purposes of this study were to survey the present state and problems related to curriculum and clinical clerkship of diagnostic radiology and to find out alternatives for the improvement of curriculum design in diagnostic radiology. The results of this study are as following: First, 43.3% out of professors, 70.6% out of residents and 69.4% out of students reply that they don't attain the objectives of classwork, although they finish all their classwork successfully. Second, most of them reply that classwork is oriented by professors and least participated in by students. Third, PBL(Problem-based Learning) by small group is very effective to learning. Fourth, the reasons why clinical clerkship isn't systematic are that there aren't professors-in-charge of clinical clerkship and that the schedule of clinical clerkship is irregular. Fifth, students' participation in clinical clerkship is not substantial participation, such as interpretation and procedure, but simple observation. Based on these results the points which the improvement is called for are as follows: First, professors must achieve the objectives of classwork by thorough analysis on those within limited class hours. Second, it is desirable that they apply learning methods to improve students' thinking by small group activities to their classwork. Third, professors-in-charge of clinical clerkship are surely needed.
Appointments and Schedules ; Clinical Clerkship ; Curriculum* ; Humans ; Learning ; Thinking

No abstract available.
Tumor Necrosis Factor-alpha*

PURPOSE: This study aimed to evaluate the outcomes, including the complications, of open reduction and internal fixation using a headless cannulated compression screw for a fifth metatarsal base fracture. MATERIALS AND METHODS: We retrospectively investigated 11 patients with 5th metatarsal base fracture who were treated with a headless cannulated compression screw. The mean follow-up period was 13 months (8~15 months), and the mean age was 46.5 years (21~70 years). We analyzed the patients' sex, age, time to union, amount of fracture displacement, and complications. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score was used for clinical assessment. RESULTS: The average amount of displacement decreased significantly from 3.4 mm (2.1~5.2 mm), preoperatively, to 0.4 mm (0~1.3 mm), postoperatively (p<0.001). The average bone union time was 54.1 days (41~68 days). There were no complications, such as a metal failure, irritation, and loss of a reduction. The mean AOFAS midfoot score was 97.7 (90~100) at 6 months, postoperatively. CONCLUSION: We suggest that a headless cannulated compression screw for 5th metatarsal base fracture is a useful and alternative method for a firm fixation without complications.
Ankle ; Follow-Up Studies ; Foot ; Humans ; Metatarsal Bones* ; Methods ; Retrospective Studies

Today most developed countries provide modern medical care for most of the population. The rural area is the more neglected area in the medical and health field. In public health, the philosophy is that medical care for in maintenance of health is a basic right of man; it should not be discriminated against racial, environmental or financial situations. The deficiency of the medical care system, cultural bias, economic development, and ignorance of the residents about health care brought about the shortage of medical personnel and facilities on the rural areas. Moreover, medical students and physicians have been taught less about rural health care than about urban health care. Medical care, therefore, is insufficient in terms of health care personnel and facilities in rural areas. Under such a situation, there is growing concern about the health problems among the rural population. the findings presented in this report are useful measures of the major health problems an even more important, as a guide to planning for improves medical care systems. It is hoped that findings from this study will be useful to those responsible for improving the delivery of health service for the rural population. Objectives: -to determine the health status of the residents in the rural area. -to assess the rural population's needs in terms of health and medial care. -to make recommendations concerning improvement in the delivery of health and medical care for the rural population. Procedures: For the sampling design, the ideal would be to sample according to the proportion of the composition age-groups. As the health problems would be different by group , the sample was divided into 10 different age-groups. If the sample were allocated by proportion of composition of each age group, some age groups would be too small to estimate the health problem. The sample size of each age-group population was 100 people/age-groups. Personal interviews were conducted by specially trained medical students. The interviews dealt at length with current health status, medical care problems, utilization of medical services, medical cost paid for medical care and attitudes toward health. In addition, more information was gained from the public health field, including environmental sanitation, maternal and child health, family planning, tuberculosis control, and dental health. The sample: Sample size was one fourth of total population: 1,438. The aged 10-14 years showed the largest number of 254 and the aged under one year was the smallest number of 81. Participation in examination. Examination sessions usually were held in the morning every Tuesday, Wednesday, and Thursday for 3 hours at each session at the Namchun Health station. In general, the rate of participation in medical examination was low especially in ages between 10-19 years old. The highest rate of participation among are groups was the under one year age-group by 100 percent. The lowest use rate as low as 3% of those in the age-groups 10-19 years who are attending junior and senior hgh school in Taegu city so the time was not convenient for them to receive examinations. Among the over 20 years old group, the rate of participation of female was higher than that of males. The results are as follows: A. Public health problems. Population: The number of pre-school age group who required child health was 724, among them infants numbered 96. Number of eligible women aged 15-44 years was 1,279, and women with husband who need maternal health numbered 700. The age-group of 65 years of older was 201 needed more health care and 65 of them had disabilities (table 2). Environmental sanitation: Seventy-nine percent of the residents relied upon well water as a primary source of drinking. More than 90% of latrines were unhygienic, in structure design and sanitation (Table 15). Maternal and child health: Maternal health. Average number of pregnancies of eligible women was 4 times. There was almost no pre-and post-natal care. Pregnancy wastage. Still births was 33 per 1,000 live births. Spontaneous abortion was 156 per 1,000 live births. Induced abortion was 137 per 1,000 live births. Delivery Condition. More than 90 percent of deliveries were conducted at home. Attendants at last delivery were laymen by 76% and delivery without attendants was 14%. The rate of difficult delivery counted for 3%. Maternal death rate estimate about 35 per 10,000 live births. Child health. Consultation rate for child health was almost non existent. In general, vaccination rate of children was low; vaccination rates for children but the rate of the complete three injections were as low as 5 and 3% respectively. The number of dead children was 280 per 1,000 living children. Infants death rate was 45 per 1,000 live births (Table 16). Family planning: Approval rate of married women for family planning was as high as 86%. The rate of experiences of contraception in the past was 51%. The current rate of contraception was 37%. Willingness to use contraception in the future was as high as 86% (Table 17). Tuberculosis control: Number of registration patients at the health center currently was 25. The number indicates one eight of estimate number of tuberculosis in the area. Number of discharged cases in the pat accounted for 79 which showed 50% of active cases when discharged time. Rate of complete treatment among reasons of discharge on the past as low as 28%. There needs to be a follow up observation of the discharged cases (Table 18). Dental Problems: More than 50% of the total population have lest one or more dental problems. (Table 19) B. Medical care Problems. Incidence rate: 1. In one month. Incidence rate of medical care problems during one month was 19.6% percent. Among these health problems which required rest at home were 11.8 percent. The estimated number of patients in the total population is 1,206. The health problems reported most frequently in interviews during one month are: GI trouble, respiratory disease, neuralgia, skin disease, and communicable disease-n the order. The rate of health problems by age groups was highest in the 1-4 age group and in the 60 years of over age group, the lowest rate was the 10-14 year age group. In general, 0-29 year age group except the 1-4 year age group was low incidence rate. After 30 years old th rate of health problems increases gradually with aging. Eighty-three percent of health problems that occurred during one month were solved by primary medical care procedures. Seventeen percent of health problems needed secondary care. Days rested at those because of illness during one month were 1.7days per interviewee and 8days per patient and it accounts for 2,161 days for the total productive population in the area. (Table 20) 2. In a year. The incidence rate of medical care problems during a year was 7.8%, among them health problems which required rest at those was 37 percent. Estimated number of patients in the total population during a year was 4,600. The health problems that occurred most frequently among the interviewees during a year were: Cold (30%), GI trouble (18), respiratory disease (11), anemia (10) ,diarrhea (10), neuralgia (10), parasite disease (9), ENT (7), skin (7), headache (7), trauma (4), communicable disease (3), and circulatory disease (3)-in that order. The rate of health problems by age groups was highest in the infants group, thereafter the rate decreased gradually until the age group which showed the lowest, and then the rate increased gradually with aging. Eighty-seven percent of health problems during a year were 16 days per interviewee and 4 days per patient and it accounted for 57,335 days lost among productive age group in the area (Table 21). Among those given medical examination, the conditions observed most frequency were respiratory disease, GI trouble, parasite disease, neuralgia, skin disease, trauma, tuberculosis, anemia, chronic obstructive lung disease, eye disorders-in that order (Table 22). The main health problems required secondary medical care are as follows:(previous page). Utilization of medical care (treatment) by various medical for all health problems during one month was 73 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 82% while the rate of those who have health problems which did not required rest was 61percent (Table 23). The rate of receiving of medical care for all health problems during a year was 67 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 82 percent while the rate of those who have health problems which did not required rest was as low as 53 percent (Table 24). Types of medical facilitated used were as follows: Hospital and clinics: 32-35%. Herb clinics: 9-10%. Drugstore: 53-58%. Hospitalization. Rate of hospitalization was 1.7% and the estimate number of hospitalization among the total population during a year will be 107 persons (Table 25). Medical cost: Average medical cost per person during one month and a year were 171 and 2,800 won respectively. Average medical cost per patient during one month and a year were 1,1109 and 3,740 won respectively. Average cost per household during a year was 15,800 won (Table 26, 27).Solution measures for health and medical care problems in rural area: A. Health problems which could be solved by paramedical workers such as nurses, midwives and aid nurses etc. are as follows: 1. Improvement of environmental sanitation. 2. MCH except medical care problems. 3. Family planning except surgical intervention. 4. Tuberculosis control except diagnosis and prescription. 5. Dental care except operational intervention. 6. Health education for residents for improvement of utilization of medical facilities and early diagnosis etc. b. Medical care problems. 1. Eighty-five percent of health problems could be solved by primary care procedures by general practitioners. 2. Fifteen percent of health problems need secondary medical procedures by a specialist. C. Medical cost. Considering the economic situation in rural area the amount of 2,062 won per residents during a year will be burdensome, so financial assistance is need government to solve health and medical care problems for rural people.
Abortion, Induced ; Abortion, Spontaneous ; Adult ; Aging ; Anemia ; Bias (Epidemiology) ; Child ; Child Health ; Communicable Diseases ; Contraception ; Daegu ; Delivery of Health Care ; Dental Care ; Developed Countries ; Diagnosis ; Diarrhea ; Drinking ; Early Diagnosis ; Economic Development ; Family Characteristics ; Family Planning Services ; Female ; Follow-Up Studies ; General Practitioners ; Headache ; Health Education ; Health Services ; Hope ; Hospitalization ; Humans ; Incidence ; Infant ; Korea* ; Live Birth ; Male ; Maternal Death ; Maternal Health ; Midwifery ; Mortality ; Neuralgia ; Parasites ; Parturition ; Philosophy ; Pregnancy ; Prescriptions ; Primary Health Care ; Public Health ; Pulmonary Disease, Chronic Obstructive ; Rural Health ; Rural Population ; Sample Size ; Sanitation ; Secondary Care ; Skin ; Skin Diseases ; Specialization ; Spouses ; Students, Medical ; Toilet Facilities ; Tuberculosis ; Urban Health ; Vaccination ; Young Adult

The Korea Acute Myocardial Infarction Registry (KAMIR) was the first nationwide registry data collection designed to track outcomes of patients with acute myocardial infarction (AMI). These studies reflect the current therapeutic approaches and management for AMI in Korea. The results of KAMIR could help clinicians to predict the prognosis of their patients and identify better diagnostic and treatment tools to improve the quality of care. The KAMIR score was proposed to be a predictor of the prognosis of AMI patients. Triple antiplatelet therapy, consisting of aspirin, clopidogrel and cilostazol, was effective at preventing major adverse clinical outcomes. Drug-eluting stents were effective and safe in AMI patients with no increased risk of stent thrombosis. Statin therapy was effective in Korean AMI patients, including those with very low levels of low density cholesterol. The present review summarizes the 10-year scientific achievements of KAMIR from admission to outpatient care during long-term clinical follow-up.
Humans ; *Myocardial Infarction/diagnosis/mortality/therapy ; Predictive Value of Tests ; Quality Improvement ; Quality of Health Care ; *Registries ; Republic of Korea/epidemiology ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome

Despite the high prevalence of benign hepatic cysts, they rarely exhibit symptoms. Radiologic studies such as ultrasonography or computed tomography disclose these cysts incidentally. Occasionally, large cysts may compress organs next to them, resulting in accompanying symptoms in patients. Recently, some reports have shown that treatment with minocycline chloride instillation into the cyst, after aspiration of cystic fluid, produces good results. First, we instilled doxycycline into the cyst after aspiration of the cyst with a resultant decrease in size. We aspirated 25% of the cyst followed by instillation of minocycline chloride (200 mg in 10 ml of 2% lidocaine) into the recurrent cyst which became larger 45 days later. In the other case we succeeded in making the cyst decrease in 4 months with no recurrence by an instillation of minocycline chloride (500 mg in 10 ml of 2% lidocaine) following aspiration of 25% of the cyst. We report, with references, both cases in which we have succeeded.
Doxycycline ; Humans ; Minocycline* ; Prevalence ; Recurrence ; Ultrasonography

A 21-year-old female presented with uncontrolled hypertension. Neck, abdomen, chest computed tomography angiogram showed moderate stenosis in the left common carotid artery and the left subclavian artery, and multiple severe stenosis in the transitional area between the descending thoracic aorta and the abdominal aorta. Transthoracic echocardiography and aortography revealed that the pressure gradient between the descending thoracic aorta and the abdominal aorta was 80 mmHg. She underwent angioplasty with stent implantation. After stent implantation, claudication improved significantly, and the pressure gradient decreased to 18 mmHg. The blood pressure was normalized with single anti-hypertensive medication, and no adverse clinical event occurred during five-year follow-up.
Abdomen ; Angioplasty ; Aorta, Abdominal ; Aorta, Thoracic ; Aortography ; Arteritis ; Blood Pressure ; Carotid Artery, Common ; Constriction, Pathologic ; Echocardiography ; Female* ; Follow-Up Studies ; Humans ; Hypertension* ; Neck ; Stents ; Subclavian Artery ; Takayasu Arteritis* ; Thorax ; Young Adult

In vascular smooth muscle cells (VSMCs), induction of the heme oxygenase-1 (HO-1) confers vascular protection against cellular proliferation mainly via its up-regulation of the cyclin-dependent kinase inhibitor p21(WAF1/CIP1) that is involved in negative regulation of cellular proliferation. In the present study, we investigated whether the phytochemical curcumin and its metabolite tetrahydrocurcumin could induce HO-1 expression and growth inhibition in rat VSMCs and, if so, whether their antiproliferative effect could be mediated via HO-1 expression. At non-toxic concentrations, curcumin possessing two Michael-reaction acceptors induced HO-1 expression by activating antioxidant response element (ARE) through translocation of the nuclear transcription factor E2-related factor-2 (Nrf2) into the nucleus and also inhibited VSMC growth triggered by 5% FBS in a dose-dependent manner. In contrast, tetrahydrocurcumin lacking Michael-reaction acceptor showed no effect on HO-1 expression, ARE activation and VSMC growth inhibition. The antiproliferative effect of curcumin in VSMCs was accompanied by the increased expression of p21(WAF1/CIP1). Inhibition of VSMC growth and expression of p21(WAF1/CIP1) by curcumin were partially, but not completely, abolished when the cells were co- incubated with the HO inhibitor tin protoporphyrin. In human aortic smooth muscle cells (HASMCs), curcumin also inhibited growth triggered by TNF-alpha and increased p21(WAF1/CIP1) expression via HO-1-dependent manner. Our findings suggest that curcumin has an ability to induce HO-1 expression, presumably through Nrf2-dependent ARE activation, in rat VSMCs and HASMCs, and provide evidence that the antiproliferative effect of curcumin is considerably linked to its ability to induce HO-1 expression.
Active Transport, Cell Nucleus ; Animals ; Aorta/cytology ; Cell Nucleus/metabolism ; Cell Proliferation/*drug effects ; Cells, Cultured ; Curcumin/analogs & derivatives/*pharmacology ; Cyclin-Dependent Kinase Inhibitor p21/biosynthesis/metabolism ; Gene Expression Regulation ; Heme Oxygenase (Decyclizing)/biosynthesis/genetics/*physiology ; Heme Oxygenase-1/biosynthesis/genetics/*physiology ; Humans ; Metalloporphyrins/pharmacology ; Muscle, Smooth, Vascular/drug effects/*physiology ; Myocytes, Smooth Muscle/drug effects/*physiology ; NF-E2-Related Factor 2/metabolism ; Protoporphyrins/pharmacology ; Rats ; Regulatory Sequences, Nucleic Acid ; Response Elements ; Tumor Necrosis Factor-alpha/pharmacology

BACKGROUND: Residual pleural thickening(RPT) develops in about 50% of tuberculous pleurisy(PLTB). Some reports have suggested that elevated TNF-α and impaired fibrinolysis could be the cause of RPT, but until now, the mechanism and predictors of RPT have not been well known. TGF-β has been known to promote fibrogenesis and is increased in tuberculous pleural fluid(PF). PLTB and malignant pleurisy(PLMAL) manifest lymphocyte-dominant exudative pleural effusion, and it has clinical implications in the differentiation of the two diseases, based on the findings of pleural effusion. We performed this study to compare pleural fluid TNF-α, TGF-β, and fibrinolytic parameters between PLTB and PLMAL, and to find the predictors of RPT in PLTB. METHODS: Thirty-five PLTB and 14 PLMAL patients who were admitted to the Asan Medical Center from February 1997 to August 1999 were enrolled. All PLTB patients were prescribed a primary, short-course, anti-tuberculosis regimen. TNF-α, tissue plasminogen activator (tPA), plasminogen activator inhibitor 1 (PAI-1), plasminogen, α2-antiplasmin, and D-dimer were measured in both PF and PB, TGF-β was measured only in PF. Clinical characteristics, TNF-α, TGF-β, and fibrinolytic parameters were compared between patients with RPT less than 2 mm and patients with more than 2 mm of the thirty patients who completed the anti-tuberculosis treatment. RESULTS: The levels of TNF-α, tPA, PAI-1, plasminogen, α2-antiplasmin, and D-dimer in PF were higher than those in peripheral blood (PB) in PLTB, whereas only plasminogen, α2-antiplasmin, and D-dimer were higher in PF than in PB in PLMAL. Pleural fluid TNF-α, TGF-β, PAI-1, plasminogen, α2-antiplasmin were increased in PLTB compared with PLMAL, but these factors did not show any further advantages over ADA in differentiation between PLTB and PLMAL. TNF-α, TGF-β, and fibrinolytic parameters did not show any differences between patients with RPT less than 2 mm and patients with RPT more than 2 mm. CONCLUSION: Our data suggest that TNF-α, TGF-β, and fibrinolytic parameters may play some role for the development of RPT in PLTB, but they failed to predict the occurrence of RPT in PLTB. Also these parameters did not seem to have any advantages over ADA in differentiating between two diseases.
Chungcheongnam-do ; Fibrinolysis ; Humans ; Plasminogen ; Plasminogen Activator Inhibitor 1 ; Pleural Effusion ; Pleural Effusion, Malignant* ; Tissue Plasminogen Activator ; Transforming Growth Factor beta* ; Tuberculosis, Pleural ; Tumor Necrosis Factor-alpha*