Purpose: This study compared the functional and cosmetic treatment outcomes of intramedullary nailing (IM nail) and minimally invasive plate osteosynthesis (MIPO) for distal tibia shaft fractures. Materials and Methods: Forty-eight patients with distal tibia shaft fractures (distal 1/3 of the diaphysis, AO/OTA [AO Foundation/ Orthopaedic Trauma Association]) 43 managed by an IM nail (n=30) or MIPO (n=18) who had minimum one-year follow-up were enrolled in this study. The radiological, functional, and cosmetic outcomes in the two groups were compared retrospectively. Results: All patients achieved bone union. The mean bone union time of the IM nail and MIPO groups was 18.5 and 22.6 weeks, respectively (p=0.078). One patient in the MIPO group showed posterior angulation and valgus deformity of more than five degrees. The mean American Orthopaedic Foot and Ankle Society (AOFAS) functional scores were similar: 83.3 in the IM nail group and 84.6 in the MIPO group (p=0.289). The most salient difference was the cosmetic result of the surgical scar. The length of the scars around the ankle in the IM nail group was significantly smaller than the MIPO group (2.6 cm vs. 10.6 cm; p=0.035). The patient satisfaction survey of surgical scars revealed a significantly higher satisfaction rate in the IM nail group than in the MIPO group (93% vs. 44%; p<0.001). Conclusion This study showed that both treatment methods for distal tibia shaft fractures have similar therapeutic efficacy regarding the radiological and functional outcomes. On the other hand, the IM nail technique showed superior cosmetic outcomes than the MIPO technique. IM nails may be more recommended in patients with high demand for cosmetic results.

An interlocking intramedullary nail is the most popular device for managing tibial shaft fractures. Interlocking screws should be inserted to prevent rotation at the fracture site, but inserting distal interlocking screws by free hand technique requires time and skill. The BrookerWills tibial nail was designed to stretch out distal metal fins after settling the nail in position. On the other hand, Brooker-Wills nails should be removed for reasons such as chronic osteomyelitis, and folding the distal metal fins is necessary. Nevertheless, many problems arise in this process. Usually, the removal of Brooker-Wills tibial nails is not attempted because of this trouble. The authors tried a new method and could fold the fins successfully in a 30-year-old Brooker-Wills tibial nail, which had to be removed to cure a chronic osteomyelitis around the nail. This paper reports the case of a 72-year-old male with a review of the relevant literature to suggest a useful method.

PURPOSE: During the first days of life, neonates born in Korean hospitals typically encounter a number of stressful and painful events. In recent investigations, it was shown that there is a dose-response effect of increasing concentration of sucrose, resulting in reduction in crying time in healthy full-term infants. We assessed the use of sucrose to reduce pain in neonates with routine blood sampling by heel prick and the use of non-sucrose sweet substances(Aspartam), Dexrtose which we use to reduce pain in neonates with the same procedure. METHODS: A total of 135 neonates born in the KonKuk University Hospital were randomly assigned to 9 experimental groups. 2ml of the test solution was given by syringe into the infant's mouth over less than one minute. After 2 minutes, the nurse lanced the infants heel immediately and gently squeezed two times, and then a bandage was applied to the wound and the foot released. Crying during sampling and during the three minutes after sampling(recovery phase) was recorded on audio tape and later the duration of crying was analysed blindly. RESULTS: There was a significant reduction in total crying time as compared with the controls. There was a significant reduction in first crying time as compared with the controls. There was a significant reduction in crying time at the end of each minute in all the groups as compared with the controls. There was no significant difference in heart rate and oxygen saturation. CONCLUSION: We conclude that sucrose, aspartam and dextrose induce an effective analgesic effect in neonates.
Bandages ; Crying ; Foot ; Glucose ; Heart Rate ; Heel ; Humans ; Infant ; Infant, Newborn* ; Mouth ; Oxygen ; Sucrose* ; Syringes ; Wounds and Injuries

Duodenal intramural hematoma is mostly caused by blunt abdominal trauma. It is also less commonly reported as a complication of anticoagulation therapy or as a blood dyscrasia, and as a complication of diagnostic/ therapeutic endoscopy. The presentation of these patients is abdominal pain, vomiting, fever and hematochezia, and this is rarely accompanied with intestinal obstruction, severe pancreatitis and acute peritonitis as its complications. The diagnosis is made clear by performing abdominal ultrasonography and abdominal computed tomography. We reported here on one case of intramural duodenal hematoma and hemoperitoneum after performing endoscopic hemostasis in a chronic renal failure patient who was on maintenance hemodialysis.
Abdominal Pain ; Diagnosis ; Duodenum ; Endoscopy* ; Fever ; Gastrointestinal Hemorrhage ; Hematoma* ; Hemoperitoneum* ; Hemostasis, Endoscopic ; Humans ; Intestinal Obstruction ; Kidney Failure, Chronic* ; Pancreatitis ; Peritonitis ; Renal Dialysis ; Ultrasonography ; Vomiting

BACKGROUND: Since 2003, the Korean Society of Pathologists (KSP) has been officially providing medical advisory services (MAS). We reviewed the cases submitted to the KSP between 2003 and 2014. METHODS: In total, 1,950 cases were submitted, most by private health insurance companies. The main purposes of the consultations were to clarify the initial diagnoses and to assign a proper disease classification code. We comprehensively reviewed 1,803 consultation cases with detailed information. RESULTS: In spite of some fluctuations, the number of submitted cases has been significantly increasing over the 12 study years. The colon and rectum (40.3%), urinary bladder (14.2%), and stomach (6.9%) were the three most common tissues of origin. The most common diagnoses for each of the three tissues of origin were neuroendocrine tumor (50.7%), non-invasive papillary urothelial carcinoma (70.7%), and adenocarcinoma (36.2%). Regardless of the tissue of origin, neuroendocrine tumor of the digestive system was the most common diagnosis (419 of 1,803). CONCLUSIONS: In the current study, we found that pathologic consultations associated with private health insurance accounted for a large proportion of the MAS. Coding of the biologic behavior of diseases was the main issue of the consultations. In spite of the effort of the KSP to set proper guidelines for coding and classification of tumors, this review revealed that problems still exist and will continue to be an important issue.
Adenocarcinoma ; Classification ; Clinical Coding ; Colon ; Consultants* ; Diagnosis ; Digestive System ; Humans ; Insurance, Health ; Neuroendocrine Tumors ; Rectum ; Referral and Consultation ; Stomach ; Urinary Bladder

PURPOSE: To generate a Korean specific brain template, especially in patients with Alzheimer's disease (AD) by optimizing the voxel-based analysis. MATERIALS AND METHODS: Three-dimensional T1-weighted images were obtained from 123 subjects who were 43 cognitively normal subjects and patients with 44 mild cognitive impairment (MCI) and 36 AD. The template and the corresponding aprior maps were created by using the matched pairs approach with considering differences of age, gender and differential diagnosis (DDX). We measured several characteristics in both our and the MNI templates, including in the ventricle size. Also, the fractions of gray matter and white matter voxels normalized by the total intracranial were evaluated. RESULTS: The high resolution template and the corresponding aprior maps of gray matter, white matter (WM) and CSF were created with the voxel-size of 1 x 1 x 1 mm. Mean distance measures and the ventricle sizes differed between two templates. Our brain template had less gray matter and white matter areas than the MNI template. There were volume differences more in gray matter than in white matter. CONCLUSION: Gray matter and/or white matter integrity studies in populations of Korean elderly and patients with AD are needed to investigate with this template.
Aged ; Alzheimer Disease ; Brain ; Diagnosis, Differential ; Humans ; Mild Cognitive Impairment

Background: Peripheral nerve injury is a complication that can occur after general anesthesia. It significantly impairs the patient’s quality of life and may lead to permanent disability. Nerves in several areas can be damaged during the perioperative period, but it is very rare that numbness of the lower lip is caused after general anesthesia. Case: A 73-year-old man with diabetes mellitus underwent urological surgery under general anesthesia. The day after surgery, he complained of numbness on the right lower lip caused by a mental nerve injury. Diabetic mononeuropathy or neurapraxia related to mechanical compression was considered a possible cause. The symptoms resolved spontaneously after six weeks. Conclusions Mental nerve injury is a rare perioperative complication in surgical patients under general anesthesia. In this case, patients should be reassured and advised to avoid injuries to the mouth and lips. However, specific treatment is not required.

Background: Peripheral nerve injury is a complication that can occur after general anesthesia. It significantly impairs the patient’s quality of life and may lead to permanent disability. Nerves in several areas can be damaged during the perioperative period, but it is very rare that numbness of the lower lip is caused after general anesthesia. Case: A 73-year-old man with diabetes mellitus underwent urological surgery under general anesthesia. The day after surgery, he complained of numbness on the right lower lip caused by a mental nerve injury. Diabetic mononeuropathy or neurapraxia related to mechanical compression was considered a possible cause. The symptoms resolved spontaneously after six weeks. Conclusions Mental nerve injury is a rare perioperative complication in surgical patients under general anesthesia. In this case, patients should be reassured and advised to avoid injuries to the mouth and lips. However, specific treatment is not required.

Background: Osteomas are benign, slow-growing bone tumors that can be classified as central, peripheral, or extraskeletal. Central osteomas arise from the endosteum, peripheral osteomas from the periosteum, and extraskeletal osteomas within the muscle. Frontal peripheral osteomas are mainly encountered in plastic surgery. In this study, we retrospectively analyzed the clinical data of patients with frontal peripheral osteomas. Methods: We retrospectively reviewed the medical records of patients who visited our hospital with frontal peripheral osteomas between January 2014 and June 2022. We analyzed the following variables: age, sex, tumor type (sessile or pedunculated), single or multiple, size, history of head trauma, operation, and recurrence. Results: A total of 39 patients and 41 osteomas were analyzed, of which 29 osteomas (71%) were sessile and 12 osteomas (29%) were pedunculated. The size of the osteomas ranged from 4 to 30 mm, with an average size of 10 mm. The age of patients ranged from 4 to 78 years with a mean age of 52 years. There were seven men (18%) and 32 women (82%), and the man-to-woman ratio was 1:4.6. Two patients (5%) had multiple masses, with two osteomas in each, while only two patients (5%) had a history of head trauma. Twenty-nine patients (74%) underwent ostectomy by a direct approach, and none of the patients experienced recurrence. Conclusion The epidemiologic data of our study will help plastic surgeons encounter frontal peripheral osteomas in the field to provide proper management for their patients.

Purpose: This study was done to assess the therapeutic effect of trazodone, an antidepressant agent in combination with sildenafil in patients with erectile dysfunction (ED) and decreased libido with normal serum testosterone level. Materials and Methods: From March 2005 to February 2006, 90 patients with ED complaining of decreased libido but whose serum testosterone level was within normal range were screened and enrolled in this study. The subjects were randomly treated by sildenafil only (group 1) and combination of sildenafil with trazodone (group 2). Patients received trazodone for at least 3 consecutive months, with daily doses starting at 50 mg. By intention-to-treat basis, the period of study was extended by 9 month. The intention-to-treat population included 39 sildenafil recipients and 35 sildenafil with trazodone recipients. The patients were asked to make up two questions, Q1: 'Did you experience improvement of erection after treatment?' and Q2: 'Did you experience improvement of libido after treatment?' and the change of International index of erectile function (IIEF) scores before and after the treatment were analyzed to assess the efficacy of treatment. Results: After 3 month treatment period, 70% of group 1 and group 2 answered 'yes' to Q1. Twenty seven percents of group 1 and 51% of group 2 answered 'yes' to Q2 and 20% of group 1 and 24% of group 2 answered 'yes' to both Q1 and Q2. In the intention-to-treat population, seventy-two percents of group 1 and 71% of group 2 answered 'yes' to Q1 and 28% of group 1 and 52% of group 2 answered 'yes' to Q2, 21% of group 1 and 26% of group 2 answered 'yes' to both Q1 and Q2. The change of IIEF scores before and after the treatment at 3 month and 9 month showed similar results. Both group 1 and group 2 showed significant improvement on scores of IIEF-5 and question 15 of IIEF after treatment (p<0.01). Meanwhile, only group 2 showed significant improvement on question 11 and 13 of IIEF after the treatment compared to group 1 (p<0.05). Two patients with high dose of trazodone complained of headache and drowsiness, but the symptoms disappeared by dose reduction. Conclusions: The combination therapy of trazodone with sildenafil increased libido and sexual satisfaction on patients with ED. Therefore, combination of trazodone with sildenafil might be considered in ED patients of decreased libido with normal serum testosterone level rather than sildenafil monotherapy.
Erectile Dysfunction ; Headache ; Humans ; Libido ; Male ; Piperazines ; Purines ; Reference Values ; Sleep Stages ; Sulfones ; Testosterone ; Trazodone ; Sildenafil Citrate