PURPOSE: The purpose of this study is to evaluate the clinical and radiologic results of using Acutrak screws for treating ankle medial malleolar fracture. MATERIALS AND METHODS: We reviewed 38 cases of ankle medial malleolar fracture treated with Acutrak screws from February 2005 to May 2008. RESULTS: In clinical result, there were 30 exellent cases, 7 good cases, 1 fair case. In radiologic result, there is no case with reduction loss. Average union time is 10.5 weeks. CONCLUSION: We conclude that Acutrak screw fixation is a useful method for ankle medial malleolar fracture, there are many advantages in accurate anatomical reduction, small incision, short operative time.
Animals ; Ankle ; Operative Time

OBJECTIVE: The purpose of this study was to evaluate the fistulographic features of malfunctioning axillary loop-configured arteriovenous grafts and the efficacy of percutaneous interventions in failed axillary loop-configured arteriovenous grafts. MATERIALS AND METHODS: Ten patients with axillary loop-configured arteriovenous grafts were referred for evaluation of graft patency or upper arm swelling. Fistulography and percutaneous intervention, including thrombolysis, percutaneous transluminal angioplasty and stent placement, were performed. Statistical analysis of the procedure success rate and the primary and secondary patency rates was done. RESULTS: Four patients had graft related and subclavian venous stenosis, two patients had graft related stenosis and another four patients had subclavian venous stenosis only. Sixteen sessions of interventional procedures were performed in eight patients (average: 2 sessions / patient) until the end of follow-up. An interventional procedure was not done in two patients with central venous stenosis. The overall procedure success rate was 69% (11 of 16 sessions). The post-intervention primary and secondary patency rates were 50% and 63% at three months, 38% and 63% at six months and 25% and 63% at one year, respectively. CONCLUSION: Dysfunctional axillary loop-configured arteriovenous grafts almost always had subclavian venous and graft-related stenosis. Interventional treatments are helpful to overcome this and these treatments are expected to play a major role in restoring and maintaining the axillary loop-configured arteriovenous loop grafts.
Adult ; Aged ; Angioplasty, Balloon/*methods ; Arteriovenous Shunt, Surgical/*methods ; Blood Vessel Prosthesis Implantation/*methods ; Chronic Disease ; Constriction, Pathologic/therapy/ultrasonography ; Female ; Follow-Up Studies ; Graft Occlusion, Vascular/*therapy/ultrasonography ; Humans ; Kidney Failure, Chronic/*complications/therapy ; Male ; Middle Aged ; *Renal Dialysis ; Subclavian Vein/ultrasonography ; Survival Analysis ; Treatment Outcome ; Vascular Patency

Myoma is the most common tumor in gynecologic field. As ultrasonography because popular in antenatal care, the more cases of myoma and those adverse effects during pregnancy are more frequently detected. The management of myoma during pregnancy is conservative, but in rare circumstances, surgical intervention including myomectomy may be required. We have experienced a case of protruded subserosal myoma with the uterine cervix in midtrimester of pregnancy. The patient was managed surgically by transvaginal myomectomy and had successfully maintained pregnancy. We report a case of protruded subserosal myoma through pelvic floor in pregnancy with brief review of literatures.
Cervix Uteri ; Female ; Humans ; Myoma* ; Pelvic Floor* ; Pregnancy Trimester, Second ; Pregnancy* ; Ultrasonography

BACKGROUND/AIMS: Midazolam is widely used as a form of conscious sedation during endoscopy because of its rapid onset and safety. However, its relatively long half-life and paradoxical reactions are still a concern for doctors and patients. Flumazenil is a competitive benzodiazepine antagonist that acts to reverse the sedative and hypnotic effects of midazolam but its role and adequate dose have not been fully documented. This study evaluated the effect of a fixed dose of flumazenil on the recovery from sedative endoscopy by midazolam. METHODS: First study: 100 patients who received 0.05 mg/kg midazolam for conscious sedation were randomized into two groups: intravenous 0.25 mg flumazenil and a placebo. All patients were assessed using OAA/S (Observers Assessment of Alertness/Sedation Scale) scale (responsiveness, speech, facial expression and ptosis of eyelid) before the endoscopy, immediately after the procedure and every 5 minutes thereafter. The recovery time was defined as the time at which the OAA/S scale reached the pre-endoscopy level. Second study: In 40 patients, the OAA/S scale was assessed only after full recovery without any exogenous stimuli. The total dose of midazolam and the procedure time were assessed. RESULTS: The flumazenil group demonstrated a significantly shorter recovery time than the placebo group (p<0.0001). These results were not affected by age, gender, total midazolam dose and procedure time. There was a larger difference in the recovery time between the two groups in the second study than in the first. CONCLUSIONS: A fixed low dose flumazenil significantly reduced the recovery time after sedative endoscopy by midazolam. Flumazenil will be helpful for the early return to daily activities and for preventing post sedative complication.
Benzodiazepines ; Conscious Sedation ; Endoscopy* ; Facial Expression ; Flumazenil* ; Half-Life ; Humans ; Hypnotics and Sedatives ; Midazolam*

BACKGROUND/AIMS: Midazolam is widely used as a form of conscious sedation during endoscopy because of its rapid onset and safety. However, its relatively long half-life and paradoxical reactions are still a concern for doctors and patients. Flumazenil is a competitive benzodiazepine antagonist that acts to reverse the sedative and hypnotic effects of midazolam but its role and adequate dose have not been fully documented. This study evaluated the effect of a fixed dose of flumazenil on the recovery from sedative endoscopy by midazolam. METHODS: First study: 100 patients who received 0.05 mg/kg midazolam for conscious sedation were randomized into two groups: intravenous 0.25 mg flumazenil and a placebo. All patients were assessed using OAA/S (Observers Assessment of Alertness/Sedation Scale) scale (responsiveness, speech, facial expression and ptosis of eyelid) before the endoscopy, immediately after the procedure and every 5 minutes thereafter. The recovery time was defined as the time at which the OAA/S scale reached the pre-endoscopy level. Second study: In 40 patients, the OAA/S scale was assessed only after full recovery without any exogenous stimuli. The total dose of midazolam and the procedure time were assessed. RESULTS: The flumazenil group demonstrated a significantly shorter recovery time than the placebo group (p<0.0001). These results were not affected by age, gender, total midazolam dose and procedure time. There was a larger difference in the recovery time between the two groups in the second study than in the first. CONCLUSIONS: A fixed low dose flumazenil significantly reduced the recovery time after sedative endoscopy by midazolam. Flumazenil will be helpful for the early return to daily activities and for preventing post sedative complication.
Benzodiazepines ; Conscious Sedation ; Endoscopy* ; Facial Expression ; Flumazenil* ; Half-Life ; Humans ; Hypnotics and Sedatives ; Midazolam*

BACKGROUND: Angiotensin-converting enzyme inhibitors(ACEi) do not decrease plasma angiotensin II levels in chronic use to the same extent as in acute use. this reincrease in angiotensin II level is explained either by a renin-mediated reactive rise in plasma angiotensin I or by non-ACE dependent angiotensin II generation. The aim of this study was to compare the additive effects of an ACEi and angiotensin II receptor antagonist(AT1a) in antiproteinuric effect, hyperkalemia, and hypotension. METHODS: 58 outpatients with chronic renal insufficiency were included and they were randomly classified into two groups : Group I(prescribed AT1a only), Group II(AT1a and ACEi combination therapy), and the changes of serum creatinine, the amount of proteinuria, the developement of hyperkalemia, and hypotension were evaluated. RESULTS: In group I, the amount of proteinuria decreased to 92.8% of initial amount at 1 month after the start of drugs. 2 of 28 patients(7.1%) developed hyperkalemia, and serum creatinine did not change (1.686+/-1.415mg/dL 1.821+/-1.301mg/dL, p=0.289). But in combination therapy group, serum creatinine level increased from baseline value of 1.466+/-0.619mg/dL to 1.800+/-0.881mg/dL(p=0.05), proteinuria did not change (101% of initial amount), and 7 of 30 patients(23.3%) developed hyperkalemia. CONCLUSION: Combination therapy seems to have no additive antiproteinuric effect, but serum creatinine and potassium levels should be closely monitered during the combination therapy.
Angiotensin I ; Angiotensin II* ; Angiotensins* ; Creatinine ; Humans ; Hyperkalemia ; Hypotension ; Outpatients ; Peptidyl-Dipeptidase A* ; Plasma ; Potassium ; Proteinuria ; Receptors, Angiotensin* ; Renal Insufficiency, Chronic

Plain radiographs of an 88-year-old woman who had experienced vomiting and abdominal distention for 3 days revealed a severely obstructed ileus, and abdominopelvic computed tomography revealed an incarcerated Morgagni hernia. The endoscope was passed through the constrictions from the diaphragmatic indentations and a thin catheter was placed for decompression. The obstructive ileus regressed markedly after the procedure; the patient underwent elective laparoscopic repair of the hernia 1 week later. This is believed to be the first case of endoscopic preoperative decompression for an incarcerated Morgagni hernia.
Aged, 80 and over ; Catheters ; Colonoscopy ; Constriction ; Decompression ; Endoscopes ; Female ; Hernia ; Hernia, Diaphragmatic ; Humans ; Ileus ; Vomiting

Acute phlegmonous infection of the gastrointestinal tract is characterized by purulent inflammation of the submucosa and muscular layer with sparing of the mucosa. The authors report a rare case of acute diffuse phlegmonous esophagogastritis, which was well diagnosed based on the typical chest computed tomographic (CT) findings and was successfully treated. A 48-yr-old man presented with left chest pain and dyspnea for three days. Chest radiograph on admission showed mediastinal widening and bilateral pleural effusion. The patient became febrile and the amount of left pleural effusion is increased on follow-up chest radiograph. Left closed thoracostomy was performed with pus drainage. A CT diagnosis of acute phlegmonous esophagogastritis was suggested and a surgery was decided due to worsening of clinical condition of the patient and radiologic findings. Esophageal myotomies were performed and the submucosal layer was filled with thick, cheesy materials. The patient was successfully discharged with no postoperative complication.
Acute Disease ; Cellulitis/complications/*diagnosis/radiography ; Drainage ; Esophagitis/complications/*diagnosis/surgery ; Gastritis/complications/*diagnosis/surgery ; Humans ; Klebsiella Infections/diagnosis ; Klebsiella pneumoniae/isolation & purification ; Male ; Middle Aged ; Pleural Effusion/etiology/radiography ; Thoracostomy ; Tomography, X-Ray Computed

PURPOSE: The aim of this study was to describe the experience of teaching emergency management and cardiopulmonary resuscitation to medical students in Busan. METHODS: Study participants were 59 medical students in Busan. An eight-day curriculum in the emergency management and cardiopulmonary resuscitation was developed. They completed all class sessions and two drill/practical examinations taught by our interdisciplinary team from July 21 through 30, 2003. Each class is approximately 2 hours and reading assignments are given at the end of each class. Also included are practical, table-top and team-building exercises. The participants completed self-reported questionnaires for the education. RESULTS: About establishment and environment of the education, respondents answered with `very good' were 14%. About overall theoretical lecture, respondents answered with `very helpful' were lower than 40%. Especially, favorable evaluation for the medical lectures was lower than that of other lectures. Students generally enjoyed their emergency medicine experience as it is often their first opportunity to assume primary responsibility for patient care. About overall practices, respondents answered with 'very helpful' were higher than 60%. CONCLUSION: The authors found that medical students prefer opportunities to hone procedural skills than to hear theoretical lectures. Also, medical students are welcome to hear theoretical lectures that consists of emergency management related contents, not academically medical contents. This curriculum should be tailored to fulfill learner's requirements.
Busan* ; Cardiopulmonary Resuscitation* ; Curriculum ; Surveys and Questionnaires ; Education ; Emergencies* ; Emergency Medicine ; Exercise ; Humans ; Lectures ; Patient Care ; Students, Medical*

In 2008, the Korean Centers for Disease Control and Prevention (KCDC) initiated Korean Community Health Survey (KCHS), the first nationwide survey to provide data that could be used to plan, implement, monitor and evaluate community health promotion and disease prevention program. This community-based cross-sectional survey has been conducted by 253 community health centers, 36 community universities and 1,500 interviewers. The KCHS standardized questionnaire is developed jointly by KCDC staff, a working group of health indicators standardization subcommittee and 16 metropolitan cities and provinces with 253 regional sites. The KCHS was administered by trained interviewers and the quality control of KCHS was improved by introduction of computer-assisted personal interview in 2010. The questionnaire was reviewed annually so that revised and/or new questions could be added based on public health policy. The additional questions included the fixed and rotating cores, emerging issues and optional modules. The standardized questionnaire of KCHS covered a wide variety of health topics, which could be used to assess the prevalence of personal health behaviors related to causes of disease. The KCHS data allows that the differences of health issues among provinces can be directly compared. Furthermore, the provinces can use these data for their own cost-effective health interventions to improve health promotion and disease prevention.
Centers for Disease Control and Prevention (U.S.) ; Community Health Centers ; Cross-Sectional Studies ; Health Behavior ; Health Promotion ; Health Surveys ; Humans ; Organothiophosphorus Compounds ; Prevalence ; Public Health ; Quality Control ; Surveys and Questionnaires