Malignant fibrous histiocytoma, which is interesting because of its pleomorphic nature, is a rare soft tissue sarcoma possibly arising from histiocyte. The tumors are usually situated in the skin or subcutaneous tissues, especially of the extremities, but they may also involve deeper structures, such as the retroperitoneum or genital organs. Herin we report a case of malignant fibrous histiocytoma in the retroperitoneal space and discuss the pathologic and clinical features.
Extremities ; Genitalia ; Histiocytes ; Histiocytoma, Benign Fibrous ; Histiocytoma, Malignant Fibrous* ; Retroperitoneal Space ; Sarcoma ; Skin ; Subcutaneous Tissue

PURPOSE: To compare the effect of medial rectus recession in consecutive esotropes who had previous monocular medial rectus resection and lateral rectus recession and in non- accommodative esotropes (NAET) with small angle of deviation who had no prior operation. METHODS: We studied the results of unilateral medial rectus recession at postoperative 2 and 6 months in 7 consecutive esotropes and 19 NAET with deviation angle around 20 PD, and analyzed the corrected amount for 1 mm medial rectus recession. We regarded deviated angle of+/-8 PD at orthophoria as successful operation. RESULTS: The abosolute value of remained deviation in consecutive esotropes and NAET were 4.86+/-5.67 PD and 9.05+/-3.95 PD at postoperative 2 months, and 5.42+/-7.89 PD and 8.26+/-4.45 PD at postoperative 6 months, respectively. There were significant differences between at postoperative 2 and 6 months (p<0.05). The success rates in consecutive esotropes and NAET at postoperative 2 months were 86% and 42%, and 71% and 47%, respectively at postoperative 6 months, which were no significant differences (p>0.05). The average amount of corrected deviation for 1 mm recession at postoperative 6 months was 5.84 PD in consecutive esotropes and 2.97 PD in NAET, which were significant differences (p<0.05). CONCLUSION: Unilateral medial rectus recession in consecutive esotropes may be a useful and first choice of operation procedure when considering second operation. The amount of correction for 1 mm medial rectus recession is larger in consecutive esotropes than in NAET, possibly due to previous resection of medial rectus or release of fat adhesion. Therefore the amount of medial rectus recession in consecutive esotropia should be determined after considering the degree of abduction and operative findings.
Esotropia*

There are many procedures for the treatment of acromioclavicular separation but there are still controversies concerning the best management of these injuries. The cases of 20 acromioclavicular separations and 3 distal end fractures of clavicle were treated by conservative method with modified Kenny Howard sling-halter using long arm cast at the department of Orthopedic Surgery, College of medicine,Ewha Womans University, during the thirty six months period from March 1982 to February 1985. The following results were obtained. 1. The average duration of immobilization was 5 weeks at the grade II of acromioclavicular separation and fracture of distal end of clavicle and 6 weeks at the grade III of acromioclavicular separation. 2. The functional results were 17 excellents(73.8%), 5 goods(21.9%), and 1 fair(4.3%). 3. The complications were 3 frozen shoulders(13.0%), 2 subluxations(8.6%), and 1 skin necrosis on the elbow(4.3%). 4. The authors immobilized the upper extremity with long arm cylinder cast of 90° flexion position instead of initial harness, so that it was applied easily and the patient felt very comfortable. 5. When the fracture and severe displacement were occurred at the midthird of the clavicle, it could be reduced and maintained with the long arm cylinder cast and strap.
Arm ; Clavicle ; Female ; Humans ; Immobilization ; Methods ; Necrosis ; Orthopedics ; Skin ; Upper Extremity

BACKGROUND: Nasal bone fractures are managed by closed reduction within the 2-week period, and are managed by secondary correction after this time. There is little literature on the delayed reduction for nasal bone fractures beyond the 2-week duration. We report our experience with nasal fractures, which were reduced beyond this period. METHODS: A retrospective review was performed for all patients who had undergone closed reduction of isolated nasal bone fracture. Patients were included for having undergone reduction of nasal bone fractures at or more than 2 weeks after the injury. Medical records were reviewed for demographic information, injury mechanism, fracture type, delay in treatment, and cause for delay. Postoperative outcomes were evaluated using computed tomography images. RESULTS: The review identified 10 patients. The average reduction time was 22.1 days. Five of patients underwent reduction between days 15 and 20, and the remaining five patients underwent reduction between days 21 and 41. The postoperative outcomes were excellent in 8 patients and good in 2 patients. CONCLUSION: Outcomes were superior for nasal fractures with displaced end plates and multiple fracture segments. Our study results appears to support delayed reduction of isolated nasal fractures in the presence of factors that delay bony reunion.
Fractures, Multiple ; Humans ; Medical Records ; Nasal Bone* ; Retrospective Studies ; Reunion

Purpose: With the increasing incidence of recompression fractures after vertebroplasty or kyphoplasty, this study analyzed the risk factors that affect the occurrence of recompression vertebral fractures, such as cement distribution, existence of avascular necrosis (Kummell’s disease), type of procedures, bone mineral density, sex, and age. Materials and Methods: Two hundred and thirty-eight patients who underwent vertebroplasty or kyphoplasty at the author’s clinic from 2005 to 2015 were enrolled in this study. The patients were divided into four groups according to the distribution of injected cement. The patients were classified as type 1 and type 2 when injected cement was contacted only to the upper or lower endplate of the body respectively. They were classified as type 3 when both the upper and lower endplates were contacted by injected cement. When neither the upper nor the lower endplate was contacted, the patients were called type 4. This study statistically evaluated the effects of the risk factors, including the cement distribution on the incidence of recompression vertebral fracture after vertebroplasty or kyphoplasty. Results: There were 59 cases (24.8%) of recompression fracture after vertebroplasty or kyphoplasty, among the 238 cases. According to the analysis, the recompression of the vertebral body after vertebroplasty or kyphoplasty occurred more often when the compression fracture was accompanied by osteonecrosis at the body (p<0.05). The patients who had injected cement distributed at both upper and lower plate simultaneously (type 3) had a lower incidence of recompression fracture of the vertebral body after vertebroplasty or kyphoplasty (p=0.008). In addition, the kyphoplasty group had a lower incidence of recompression after the procedure than vertebroplasty group (p=0.02). Conclusion Careful attention should be given to these patients with osteonecrosis at the compression fracture level through a preoperative evaluation. In addition, if the injected cement does not contact both the upper and lower endplates, careful observation is required during the follow-up period based on the high incidence of vertebral recompression fractures proven through this study. Further technical and biomechanical research and efforts will be needed to make the cement contact both endplates.

Globally, cancer research has been considered one of the most important field of biomedical researches. Recently, in Korea, there are increasing concerns about cancer research and the development of national cancer control programme. For the efficient investment in cancer research at the national level, strategic approach is needed based on the nationwide information about current status of research. However even the basic data on cancer research have not been systematically collected, and are not available when necessary. The aim of this study is to assess current status of cancer research. For this purpose, this study applied two round Delphi method in which fifteen experts in cancer research fields participated. They rated each items on the initial list at the first round, and modified their responses at the second round. Panels responded that pathogenesis of cancer, research and development of cancer drug, and oncogene, etc. are the most urgent and important research fields. They assessed national level of cancer research as being 49.6% of the world highest level. Coefficient of variation tended to be lowered with the iteration. Predictive stability was evaluated to be lower in items of urgency than in items of importance and research level. Although this study shares the same limitations in the selection of the experts with many other Delphi studies, it provides a primary data that would be required to plan the national strategy of the cancer research.
Delphi Technique ; Forecasting ; Investments ; Korea ; Oncogenes ; Technology Assessment, Biomedical

Background: Healthy life expectancy is a well-recognized indicator for establishing health policy goals used in Korea’s Health Plan. This study aimed to explore Koreans’ healthy life expectancy and its gender, income, and regional disparities from 2008 to 2020. Methods: This study was conducted on the entire population covered by health insurance and medical aid program in Korea. The incidence-based “years lived with disability” for 260 disease groups by gender, income level, and region was calculated employing the methodology developed in the Korean National Burden of Disease Study, and it was used as the number of healthy years lost to calculate health-adjusted life expectancy (HALE). Results: Koreans’ HALE increased from 68.89 years in 2008 to 71.82 years in 2020. Although the gender disparity in HALE had been decreasing, it increased to 4.55 years in 2020. As of 2020, 5.90 years out of 8.67 years of the income disparity (Q5–Q1) in HALE were due to the disparity between Q1 and Q2, the low-income groups. Income and regional disparities in HALE exhibited an increasing trend, and these disparities were higher in men than in women. Conclusion A subgroup with a low health level was identified through the HALE results, and it was confirmed that improving the health level of this population can reduce health inequalities and improve health at the national level. Further exploration of the HALE calculation methodology may help in the development of effective policies such as prioritizing interventions for health risk factors.

Background: The measurement of health levels and monitoring of characteristics and trends among populations and subgroups are essential for informing evidence-based policy decisions.This study aimed to examine the burden of disease in Korea for both the total population and subgroups in 2020, as well as analyze changes in disease burden from 2008 to 2020. Methods: We employed the methodology developed in the Korean National Burden of Disease and Injuries Study to calculate disability-adjusted life years (DALYs) by sex, causes, region, and income level from 2008 to 2020. DALYs were derived by combining years of life lost and years lived with disability. Results: In 2020, the burden of disease for the Korean population was estimated to be 25,439 DALYs per 100,000 population, reflecting a 13.8% increase since 2008. The leading causes of DALYs were diabetes mellitus, followed by low back pain and ischemic stroke. A sex-specific gap reversal was observed, with the disease burden for men surpassing that of women starting in 2017. Furthermore, variations in disease burden were identified across 250 regions and income quintiles. Conclusion It is imperative to establish appropriate health policies that prioritize the diseases with significantly increasing burdens and subgroups experiencing high disease burdens. The findings of this study are expected to serve as a foundation for developing healthcare policies aimed at improving the health levels of Koreans and achieving health equity.

Purpose: A nationwide study (2012-2017) of preventable trauma death rates (PTDR) showed a 15.3% decrease after Regional Trauma centers were initiated. However, in non-trauma centers with an Emergency Department there is limited data of preventable mortality in trauma patients. Therefore, the purpose of this retrospective study was to investigate preventable mortality in trauma patients in a nonregional trauma center and determine the effect of initiating a Trauma Team. Methods: There were 46 deaths of trauma patients recorded in the National Health Insurance service Ilsan Hospital (NHISIH) in South Korea from January 2019 to December 2021. These patients’ preventable deaths were analyzed by an expert panel review considering the implementation of the Trauma Team in April 2020. Results: All deaths were attributable to blunt trauma with an average Injury Severity Score of 26.0 ± 19.2, Revised Trauma Score of 5.05 ± 3.20 and Trauma and Injury Score of 56.6 ± 41.3. The most frequent cause of death was traumatic brain injury followed by respiratory arrest. The most frequent error was delayed transfusion followed by delayed treatment of bleeding. Treatment errors occurred the most in the Emergency Room followed by the Intensive Care Unit. The PTDR of patients before the involvement of a Trauma Team (January 2019 to March 2020) and after the Trauma Team was initiated in April 2020 decreased from 27.27% to 4.27%, respectively (p = 0.021). Conclusion The introduction of a dedicated Trauma Team in a non-regional trauma center significantly reduced the overall PTDR in trauma patients.

"The prenatal diagnosis of spine bifida include the combined use of maternal serum alpha-fetoprotein (MSAFP) screening and fetal sonography. Sonographically, spina bifida is characterized by direct signs of the visualization of the spinal defect, and indirect signs of the cranial markers : the lemon sign, the banana sign, and ventriculomegaly. These ultrasonographic signs are more accurate in defining the cranial malformations associated with spina bifida than evaluation of the spine. Recently, three cases of spina bifida which was diagnosed as ""splaying"" of the posterior ossification centers, meningomyelocele sac at the lumbosacral area, lemon sign, banana sign and ventriculomegaly by ultrasonography at 21+2 gestational weeks in a 32 years old nullipara, at 21+2 gestational weeks in a 26 years old nullipara, at 23+6 gestational weeks in a 26 years old multipara were experienced at our department. We present this cases with a brief review of literatures"
Adult ; alpha-Fetoproteins ; Humans ; Mass Screening ; Meningomyelocele ; Musa ; Prenatal Diagnosis ; Spinal Dysraphism* ; Spine ; Ultrasonography