PURPOSE: To find out whether or not the computed tomographic (CT) classification systems of the calcaneal fracture are efficient in illuminating displaced posterior facet fragment and the degree of displacement can be evaluated by analyzing serial CT images. MATERIALS AND METHODS: Seventy-seven hundred calcaneal fractures were classified by CT classification systems including Sanders classification, and the sagittal rotation angle of the posteior facet fragment was measured on the plain lateral radiograph. Among the serial axial CT images, a number of images with the cortical bone embedded in the cancellous portion were recorded and any significant relationship between each data were evaluated. RESULTS: The conventional CT classification systems are rather insufficient in illuminating the extent of sagittal rotatory displacement. However, the number of CT images in which the cortical radiodensity was observed showed a significantly related with the degree of displacement. CONCLUSION: The conventional CT classification of the calcaneal fractures is unsatisfactory in expressing the degree of sagittal rotatory displacement of the posterior facet fragment; this problem may be alleviated by observing the number of axial CT images in which cortical radiodensity was revealed within the calcaneal body.
Calcaneus ; Classification

Priapism is defined as a prolonged erection of the penis unrelated to sexual desire or manual stimulation. Non-ischemic priapism frequently occurs as a result of penile or perineal trauma, but the unknown etiology is rare in boys. We report a case in a 6-year-old boy who was managed successfully with conservative treatment consisting of steroid tapering and perineal ice-pack compression therapy following blood gas analysis of the cavernosum and penile duplex ultrasonography. Complete detumescence was achieved after two weeks. Thus far, the patient has had no recurrence for 6 months.
Blood Gas Analysis ; Child* ; Humans ; Male ; Pediatrics ; Penis ; Priapism* ; Recurrence ; Ultrasonography

Beta-3 adrenoceptor (B3AR) agonist which mediate detrusor relaxation has been tried as a new treatment modality for men with benign prostatic hyperplasia (BPH). However, it remains unclear whether the B3AR agonist has more clinical benefits and fewer adverse effects in men with BPH than in women. We performed a comprehensive search using multiple databases, trials registries, other sources of grey literature, and conference proceedings regardless of language or publication status and included randomized controlled trials. Two review authors independently screened the literature, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. Primary outcomes were urologic symptom scores, quality of life (QoL), and overall adverse events. We found 4 randomized controlled trials with 1,105 participants in 3 comparisons. All studies reported short-term outcomes (ranged from 8 weeks to 12 weeks). Mirabegron, tamsulosin, silodosin, fesoterodine, and tadalafil were administrated as intervention. While B3AR agonist can improve the patient-important outcomes within group (before and after treatment), B3AR agonist combination therapy with current standard BPH treatment such as alpha blocker or anticholinergic may not have additional effects on urological symptom scores and QoL compared to alpha blocker or anticholinergic monotherapy. B3AR agonist therapy with phosphodiesterase 5 inhibitor (PDE5I) showed statistical improvement on urological symptom scores or QoL compared to PDE5I monotherapy. For safety profile, B3AR agonist in all 3 comparisons may not increase adverse event rate. While B3AR agonists may be used for the treatment of lower urinary tract symptoms in men with BPH if storage symptoms with standard BPH treatment are insufficient, B3AR agonists appear to have trivial or similar effects compared to current standard BPH treatment.

BACKGROUND AND OBJECTIVES: Medial maxillectomy is commonly performed for benign and low-grade malignancies involving the lateral wall of the nose. The most frequent complications are cavity crusting, epicanthal scarring and epiphora. Silicone stent, tube fixation in lacrimal sac have been used for prophylaxis of epiphora. Authors studied for the incidence of epiphora and necessity for prophylatic procedure of epiphora in patients who underwent medial maxillectomy. MATERIALS AND METHOD: This study was performed on 26 patients treated with medial maxillectomy without additional procedure for management of epi-phora. The minimal duration of follow-up was 6 months. RESULTS: Twenty one patients were treated with medial maxillectomy only and five patients were treated with medial maxillectomy combined with irradiation. Incidence of epiphora was about 7% (2/26). All patients who complained of epiphora had inverted papilloma and underwent medial maxillectomy without irradiation. No patients treated with combination of medial maxillectomy and irradiation complained epiphora. CONCLUSION: It is not necessary to do routine prophylatic procedures for epiphora at the initial procedure.
Cicatrix ; Follow-Up Studies ; Humans ; Incidence ; Lacrimal Apparatus Diseases* ; Nose ; Papilloma, Inverted ; Silicones ; Stents

Beta-3 adrenoceptor (B3AR) agonist which mediate detrusor relaxation has been tried as a new treatment modality for men with benign prostatic hyperplasia (BPH). However, it remains unclear whether the B3AR agonist has more clinical benefits and fewer adverse effects in men with BPH than in women. We performed a comprehensive search using multiple databases, trials registries, other sources of grey literature, and conference proceedings regardless of language or publication status and included randomized controlled trials. Two review authors independently screened the literature, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. Primary outcomes were urologic symptom scores, quality of life (QoL), and overall adverse events. We found 4 randomized controlled trials with 1,105 participants in 3 comparisons. All studies reported short-term outcomes (ranged from 8 weeks to 12 weeks). Mirabegron, tamsulosin, silodosin, fesoterodine, and tadalafil were administrated as intervention. While B3AR agonist can improve the patient-important outcomes within group (before and after treatment), B3AR agonist combination therapy with current standard BPH treatment such as alpha blocker or anticholinergic may not have additional effects on urological symptom scores and QoL compared to alpha blocker or anticholinergic monotherapy. B3AR agonist therapy with phosphodiesterase 5 inhibitor (PDE5I) showed statistical improvement on urological symptom scores or QoL compared to PDE5I monotherapy. For safety profile, B3AR agonist in all 3 comparisons may not increase adverse event rate. While B3AR agonists may be used for the treatment of lower urinary tract symptoms in men with BPH if storage symptoms with standard BPH treatment are insufficient, B3AR agonists appear to have trivial or similar effects compared to current standard BPH treatment.

Identified risk factors for neonatal candidemia are low-birth weight, use of a central venous catheter, parenteral nutrition, and broad spectrum antibiotics. Candidemia is also the source of considerable morbidity endophthalmitis, meningitis, brain abscess, endocarditis, and renalare all examples of the potential consequences of candidemia abscess. In this study, we report a premature infant case whose candidemia involving candidal meningitis and multiple brain microabscesses was completely remedied through antifungal therapy without any onset of neurodevelopmental disability.
Abscess ; Amphotericin B* ; Anti-Bacterial Agents ; Brain Abscess ; Brain* ; Candidemia* ; Candidiasis ; Central Venous Catheters ; Endocarditis ; Endophthalmitis ; Fluconazole* ; Humans ; Infant, Newborn ; Infant, Premature* ; Meningitis* ; Parenteral Nutrition ; Risk Factors

Since profound hyperkalemia induces fatal arrhythmias, the recognition of its electrocardiographic manifestations is very important. The changes on the ECG correlated roughly with the severity of hyperkalemia. It has been, however, less recognized that severe hyperkalemia is associated with bradycardia. We present 14 patients with chronic kidney disease manifesting marked bradycardia in the presence or absence of hyperkalemia. It is interesting that diabetes mellitus which was complicated in 10 of 14 patients in the present study might exaggerate bradycardia with or without hyperkalemia. 9 patients, who were taking drugs such as diltiazem, beta-blocker, alpha, beta-blocker, and digoxin, developed bradycardia even when their plasma potassium concentration were moderate (<6.5 mEq/L). Therefore, we suggest that synergistic action of these drugs, hyperkalemia, diabetes mellitus, and uremic toxin in patient with chronic kidney disease might play a role in inducing bradycardia.
Arrhythmias, Cardiac ; Bradycardia* ; Diabetes Mellitus ; Digoxin ; Diltiazem ; Electrocardiography ; Humans ; Hyperkalemia ; Plasma ; Potassium ; Renal Insufficiency, Chronic*

Sjogren's syndrome is an autoimmune disease causing eye or dry mouth from the lymphocytic infiltration in the lacrimal gland and the salivary gland, and is classified as primary or secondary based on the absence or presence of complicating systemic rheumatic diseases. Extraglandular systemic lesions involving organs such as the lungs, liver, and kidney are seen, and renal involvement of these is reported to occur in 20% to 50% of patients with primary Sjogren's syndrome, and most commonly manifested with a tubulointerstitial nephritis. But a little over 20 cases with glomerulonephritis have been reported in the literature review, and only one case was reported in Korea. Glomerulonephritis is a late sequelae in the course of the disease, and is most attributed to deposition of immune complexes. Membranoproliferative glomerulonephritis are the most common glomerular lesions and only one case of minimal change nephrotic syndrome was reported in the literature review, and no previous case was reported in Korea. We report a minimal change nephrotic syndrome that is concurrently manifested with sicca complex in a case of Sjogren's syndrome.
Antigen-Antibody Complex ; Autoimmune Diseases ; Glomerulonephritis ; Glomerulonephritis, Membranoproliferative ; Humans ; Kidney ; Korea ; Lacrimal Apparatus ; Liver ; Lung ; Mouth ; Nephritis, Interstitial ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Rheumatic Diseases ; Salivary Glands ; Sjogren's Syndrome*

Hyponatremia resulting from ingestion of large volumes of bowel preparation solution has been reported in patients with alternated renal water handling like renal failure or old age. Colonoscopy-induced hyponatremia was known to be related with an increase in serum arginine vasopressin concentration. Ingestion of bowel preparation solution can lead to diarrhea associated with nausea, vomiting and dehydration, often resulting in raised plasma concentrations of antidiuretic hormone. Besides, non- osmotic stimuli for arginine vasopressin concentrations can be provoked by nausea, vomiting, and intestinal hyperactivity during bowel preparation and colonoscopic procedure. We have experienced three cases of hyponatremia resulting from ingestion of bowel preparation solution for colonoscopy. The factors leading to increased arginine vasopressin secretion seem to be nausea, vomiting and intestinal hyperactivity during bowel preparation for colonoscopy.
Arginine Vasopressin ; Colonoscopy* ; Dehydration ; Diarrhea ; Eating* ; Humans ; Hyponatremia* ; Nausea ; Plasma ; Renal Insufficiency ; Vomiting

Paroxysmal nocturnal hemoglobinuria (PNH) is a acquired clonal disorder of the hematopoietic stem cells characterized by chronic intravascular hemolysis, venous thrombosis, deficient hematopoiesis. Kidney involvement is usually benign and secondary to chronic deposition of hemosiderin. But, acute renal failure may rarely occur in association with a hemolytic crisis or thrombotic complication. Hemolytic crisis is precipitated by nonspecific factors, such as infection, surgery and transfusion. A 69-year- old man was admitted to our hospital who developed acute renal failure after operation of anal fistula. He was diagnosed with PNH accompanied with deep vein thrombosis later. After being treated by hemodialysis and oral low dose steroid, he was discharged with full recovery of renal function. But, he frequently was developed acute renal failure with crisis of PNH despite taking low dose steroid. So, we report a case of PNH with recurrent acute renal failure without precipitating factors.
Acute Kidney Injury* ; Hematopoiesis ; Hematopoietic Stem Cells ; Hemoglobinuria, Paroxysmal* ; Hemolysis ; Hemosiderin ; Kidney ; Precipitating Factors ; Rectal Fistula ; Renal Dialysis ; Venous Thrombosis