We analysed the 16 cases of the perilunate dislocations (PLD) and fracture-dislocations (PLFD) to study the distribution of the different forms and provides additional information about the perilunate pattern of injury. The cases were followed at least 1 year and an average of 2 years and 3 months. The results were as follows: l. All of the cases, the direction of the dislocation was dorsal. The PLD was 4 cases (25%) and PLFD was 12 cases (75%). The transscapholid perilunate fracture-dislocation (TS-PLFD) was the most common type. 2. Scaphoid fracture was present in 9 cases (56%), It was transverse fracture in the middle 1/3. 3. Missed or delayed diagnoses were noted in 3 cases (18%). 4. Overall functional results were graded as exellent in 2 cases (13%), good in 9 cases (56%), fair in 3 cases (18%) and poor in 2 cases (13%).
Delayed Diagnosis ; Dislocations

The number of end-stage renal disease (ESRD) patients is progressively growing with more than 60,000 ESRD patients on renal replacement therapy in Korea. The mortality risk in ESRD patients is approximately 10 to 20-fold higher compared to the general population, which is mainly attributed to prevalent cardiovascular disease in these patients. However, the risk factors for cardiovascular disease in ESRD patients are different from the general population, and useful biomarkers for predicting cardiovascular mortality are not completely defined. The nationwide multicenter Clinical Research Center (CRC) for ESRD program was initiated in Korea not only to elucidate the incidence and prevalence of cardiovascular disease in ESRD patients but also to identify potential risk factors including various biomarkers for cardiovascular disease. A prospective cohort of 864 incident hemodialysis patients, from 34 dialysis centers of the CRC for ESRD in Korea, was followed up for 36 months, and the clinical outcome of these patients was reviewed. This article presents the recent data from the CRC for ESRD program, and, in addition, brief reviews on key risk factors and potential biomarkers for cardiovascular disease in ESRD patients.
Biomarkers ; Cardiovascular Diseases ; Cohort Studies ; Dialysis ; Humans ; Incidence ; Kidney Failure, Chronic ; Korea ; Prevalence ; Prospective Studies ; Renal Dialysis ; Renal Replacement Therapy ; Risk Factors

BACKGROUND/AIMS: Endoscopic sclerotherapy is an accepted treatment for the patients with esogeal variceal bleeding, but endoscopic varicea1 band ligation, introduced by Stiegmann et al in 1986, is a new form of endoscopic treatment method, and may be safer. This study is performed to compare the effectiveness and safety of the two techniques. METHODS: We compared endoscopic sclerotherapy and endoscopic ligation in 10~8 patients who had recently bled from esophageal varices. We assessed the hemostatic efficacy for bleeding varices, the number of sessions of treatments needed to eradicate varices, the incidence of complications, rebleeding rate and survival rate of the patients by two techniques. RESULTS: Active bleeding was well controlled by sclerotherapy in all of six patients, and ligation in all of five patients by the initial treatment. The mean number of treatment sessions required to achieve eradication did not significantly differ between sclerotherapy and ligation(2.4+0.8 vs 1.8+ 1.0 sessions). Complications were less comman in ligation than sclerotherapy; chest discomfort(5.6% vs 29.6%), fever(3,7% vs 16.7%), esophageal ulcer(0% vs 5.6%), esophageal stricture(0% vs 3.7%). The rate of recurrent bleeding was significantly lower in the patients treated with ligation(p<0.05). The overall rate of survival was significantly higher in the patients treated with ligation(p<0.05), The days of hospitalization was significantly shorter in the patients treated with ligation than sclerotherapy(14.8+-7.0 vs 21.0+-9.7 days). CONCLUSIONS: The patients with esophageal variceal bleeding treated with endoscopic ligation have fewer treatment-related complications, lower rates of rebleeding and better survival rates.
Esophageal and Gastric Varices* ; Esophagus* ; Hemorrhage ; Hospitalization ; Humans ; Incidence ; Intestines* ; Ligation* ; Sclerotherapy* ; Stomach* ; Survival Rate ; Thorax ; Varicose Veins

No abstract available.
Appendicitis* ; Child* ; Humans

Odontogenic keratocyst (OKC) accounts for 3-11% of all odontogenic cysts. OKC is a benign intra-osseous odontogenic tumor, but what makes this cyst special is its aggressive behavior and high recurrence rate. OKC is relatively aggressive compared to other odontogenic cysts, but its malignant transformation is considered extremely rare. Squamous cell carcinoma associated with odontogenic keratocysts have rarely been reported in the medical literature. We recently experienced a case of a 63-year-old man finally confirmed with squamous cell carcinoma of the mandible, which was initially diagnosed as a benign odontogenic keratocyst. Surgical resection was performed as definitive treatment. Therefore, we present this unique case with a review of the literature.

BACKGROUND/AIMS: The prognosis of chronic liver disease is closely related to the development of hepatic fibrosis. Liver biopsy is the gold standard method to assess inflammatory activity and fibrosis stage, but this is associated with morbidity and mortality. This study aimed to evaluate the diagnostic value of serum hyaluronic acid, 7S domain of type IV collagen and AST/ALT ratio as markers of hepatic fibrosis in chronic hepatitis B and cirrhosis. METHODS: This study included 100 patients with chronic hepatitis B and cirrhosis. Liver biopsy and histopathologic classification were done. Serum hyaluronic acid and 7S domain of type IV collagen were measured by one step sandwich binding protein assay and radioimmunoassay using polyclonal antibody to 7S domain of type IV collagen, respectively. RESULTS: The serum concentrations of hyaluronic acid, 7S domain of type IV collagen and AST/ALT ratio in the cirrhosis group (139 +/- 98.4 ng/mL, 6.9 +/- 3.5 ng/mL, 1.6 +/- 1.5) were significantly higher (p<0.01) than those in the normal and fatty liver group (20.2 +/- 12.5 ng/mL, 3.5 +/- 0.5 ng/mL, 0.7 +/- 0.3), mild hepatitis group (32.3 +/- 52.7 ng/mL, 3.9 +/- 1.4 ng/mL, 0.7 +/- 0.4), and moderate to severe hepatitis group (68.2 +/- 72.3 ng/mL, 5.3 +/- 2.4 ng/mL, 0.8 +/- 0.4). At the cutoff value of 77 ng/mL for hyaluronic acid and 6.3 ng/mL for 7S domain of type IV collagen and 0.62 for AST/ALT ratio, the sensitivities were 81.8%, 63.6%, 90.9% and specificities were 87.3%, 88.6%, 53.1% for discriminating cirrhosis (fibrosis score: 4) from the mild to severe fibrosis (fibrosis score: 0-3). CONCLUSIONS: Serum hyaluronic acid, 7S domain of type IV collagen and AST/ALT ratio measurement may be clinically useful as markers of hepatic fibrosis in chronic hepatitis B and cirrhosis.
Adult ; Alanine Transaminase/*blood ; Aspartate Aminotransferases/*blood ; Biological Markers/blood ; Collagen Type IV/*blood ; Female ; Hepatitis B, Chronic/blood/*pathology ; Humans ; Hyaluronic Acid/*blood ; Liver/*pathology ; Liver Cirrhosis/blood/*pathology ; Male ; Prognosis ; Sensitivity and Specificity

BACKGROUND: EMR is an alternative to surgical removal of superficial neoplastic lesions of the gastrointestinal tracts. The aim of this study is to assess the diagnostic efficacy of EMR in gastric flat adenoma. METHODS: Ninety five lesions of gastric flat adenoma removed by EMR in 89 patients were enrolled in this study at Kyungpook National University Hospital from January 1999 to June 2002. We have analysed diagnostic efficacy of EMR in gastric flat adenoma. RESULTS: Tubular adenoma were 78 cases (82.1%), tubular adenoma with high grade dysplasia were 16 cases (16.8%) and villous adenoma was 1 case (1.1%). Locations were antrum 57 cases (60.0%), body 22 cases (23.1%), angle 14 cases (14.7%), pylorus 1 case (1.1%) and cardia 1 case (1.1%). Among 95 lesions of gastric flat adenoma, 26 cases (27.4%) revealed upgraded histologic diagnosis between endoscopic biopsy and EMR. Twenty two lesions (37.3%) among 59 lesions that were 1cm size or more were upgraded in the histologic staging to carcinoma or high grade dysplasia, compared with 4 lesions (11.1%) among 36 lesions less than 1cm size (p<0.01). Eight lesions (50.0%) among 16 lesions diagnosed in tubular adenoma with high grade dysplasia were upgraded in the histologic staging to carcinoma, compared with 12 lesions (15.4%) among 78 lesions diagnosed in tubular adenoma (p<0.01). Bleeding was the only complication and occurred in 24 lesions (25.3%). CONCLUSION: EMR resulted in upgrading of the histologic staging to carcinoma or high grade dysplasia in 27.4% of gastric flat adenomas.
Adenoma* ; Adenoma, Villous ; Biopsy ; Cardia ; Diagnosis ; Gastrointestinal Tract ; Gyeongsangbuk-do ; Hemorrhage ; Humans ; Pylorus

PURPOSE: Chronic inflammatory tenosynovitis (CITS) involving the finger joint after trauma has been rarely reported. This study reports the surgical results of ten patients with CITS. MATERIALS AND METHODS: From March 2007 to June 2009, ten patients with pain, swelling and limitation of motion of the finger were diagnosed as CITS. All patients had a history of direct injury. The operation was performed at a mean of 6.6 months after the onset of symptom. Average range of motion was 54 degrees in five patients with CITS of the metacarpophalangeal joint and was 44 degrees in five patients with that of the proximal interphalangeal joint. The mean follow-up duration was 15 months. Two of ten patints showed the involvement of the bone. Tenosynovectomy was performed and four patients required volar and dorsal double incisions. In cases of the bony invasion, multiple drilling and curettage was done. RESULTS: Postoperatively, all patients showed improvement of pain and swelling and did not show recurrence. The magnetic resonance image was carried out in all patients and showed the inflammatory changes of the tendosynovium and joint capsule. Culture and PCR test for tuberculosis showed negative findings in all cases. However, anti-tuberculosis chemotheraphy for nine months was applied to three patients who showed caseous necrosis or rice body in biopsy. The mean range of motion was 66 degrees in metacarpophalangeal joint and 53 degrees in proximal interphalangeal joint. CONCLUSIONS: Magnetic resonance image appears helpful in the diagnosis and the treatment of CITS which involved the joint of hand and the operative treatment can improve the symptoms and clinical outcomes.
Biopsy ; Curettage ; Finger Joint ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Joint Capsule ; Joints ; Magnetic Resonance Spectroscopy ; Mandrillus ; Metacarpophalangeal Joint ; Necrosis ; Polymerase Chain Reaction ; Range of Motion, Articular ; Recurrence ; Tenosynovitis ; Tuberculosis

This study analyzed the services as operated by the Child Health Telephone Service Center. The Center is a toll free service operated as part of the community services of the Korean Academic Society of Child Health Nursing. The aim of the study was to describe the concerns of child caregivers regarding child health care as discussed during telephone counseling. Specific objectives were as follows: 1. To analyze the activities of the Center. 2. To describe the characteristics of caregivers who made phone calls for counseling services and also the characteristics of their children. 3. To analyze the content of the counseling sessions. 4. To analyze counseling content according to the characteristics of the caregivers and their children. Data used for the study were obtained from the counseling records for the period from Sept. to Dec. 1999, as kept by the three counselors at the Center. The total number of calls was 8,261 and that consisted of 15,150 questions. The total questions were merged into 13,236 by eliminating those questions which overlapped or were of similar content. The final 13,236 questions were used for the final analyses. Almost of the callers (98.4%) were mothers. Among them 89.6% were between 25 and 35 years of age. Geographical distribution of the callers covered the whole nation. The largest numbers who made the calls were from the Seoul metropolitan area (36%), followed by 28% from Kyung Gi Province, and 20% were from the Kyung Sang area. Among 8,261 callers, 72.8% were first users. Sex of the babies and children in question for counseling was about even for males and females and ages ranged from one month to six years. The largest group (62.5%) was the less than six month age group. The finalized 13,236 questions/problems were categorized into 11 problem areas. They were in order of frequency, physical problems, feedings and nutrient concerns, information on child rearing, growth and development, guidance on utilization of child care facilities, elimination problems, sleeping concerns, immunization related concerns, behavior problems, injury and accidents, and safety measures. The most frequent problems for counseling were physical signs and symptoms (27.3%), followed by feeding and nutrients, information on child rearing, and growth and development. Of physical problems, abnormal gastrointestinal signs and symptoms were the most frequent concern and skin problems were next at 25% and 23.3% respectively. Loose bowels, vomiting and constipation were the most frequent gastrointestinal problems. Atopic dermatitis had the highest frequency at 53.3% with diaper rash being the second highest among the skin problems. About 80% of the growth and developmental category were physical development concerns related to physiological, body growth, and motor and sensory development. This study constitutes the activity report for the first year of the Center. The findings correspond with literature reports on child health problems and parents educational needs. One recommendation from this study is that since the services of the Center are carried out only by telephone, the psychology of the counselees and the counselor relationship must be considered for better services.
Caregivers ; Child ; Child Care ; Child Rearing ; Child Health* ; Child* ; Constipation ; Counseling* ; Dermatitis, Atopic ; Diaper Rash ; Female ; Growth and Development ; Humans ; Immunization ; Male ; Mothers ; Nursing ; Parents ; Psychology ; Seoul ; Skin ; Social Welfare ; Telephone* ; Vomiting

Intramural dissection of the esophagus is a rare esophageal disorder which reveals characteristic endoscopic and radiologic features. Some authors have recognized that this injury is an intermediate stage between a transmural esophageal rupture (Boerhaave's syndrome) and an esophageal mucosal tear (Mallory-Weiss syndrome). Presenting symptoms are sudden severe retrosternal pain, hematemesis, odynophagia, and dysphagia. The diagnosis is made by contrast esophagography, esophageal endoscopy, or both. Conservative management is usually successful. Surgery should be reserved for the cases of protracted disease or perforation with mediastinitis. We report a case of spontaneous intramural esophageal dissection, in which the symptom of dysphagia did not improve with a conservative management. Then we treated with an endoscopic incision of the septum between the true and false lumens using a needle type papillotome.
Deglutition Disorders ; Diagnosis ; Endoscopy ; Esophagus* ; Hematemesis ; Mediastinitis ; Needles ; Rupture