PURPOSE: To evaluate the surgical results of distal radioulnar fractures managed by open reduction and internal fixation for the fractures of the distal radius and excision of the fractured fragments and ECU tenodesis for the comminuted fractures of ulnar head and neck. METHODS: Six cases of combined fractures of the distal radius and ulna were enrolled. Distal radius fractures were fixed by ORIF with AO locking plate without bone graft. The comminuted fragments of distal ulnar head and neck were excised and the tenodesis using half strip of ECU was added to stabilize the proximal ulnar stumps. After immobilization for 6 weeks, active ROM exercise started. The change of radial inclination and volar tilt, the ulnar shift and collapse of carpal bone and ulnar impingement were investigated with simple X-ray. Patients were assessed with residual subjective symptoms and modified Mayo wrist score (MMWS). All were female and average age was 68(58~75) years. Average follow up was 23(10~50) months. RESULTS: Resting pain was absent in all patients but heavy lift made them feel weakness and discomfort intermittently. All patients returned to the normal daily activities except one patient handicapped by hemiplegia. The average range of motion and grip power was 89% and 85% compared to the contralateral side respectively. The average MMWS was 87(75~95). The postoperative loss of the reduction of the distal radius was not observed in follow up X-ray. CONCLUSION: ORIF of distal radius fractures associated with the excision of the distal ulnar fragments and stabilization procedure using half strip of ECU may be one good method for the treatment of the fractures of the distal radius combined with the comminuted distal ulnar fractures difficult to be managed by ORIF. The intermittent weakness felt in this method made it not suitable in young active patient doing heavy work. AO locking plate was strong enough to maintain reduction until bone union.
Carpal Bones ; Disabled Persons ; Female ; Follow-Up Studies ; Fractures, Comminuted ; Hand Strength ; Head ; Hemiplegia ; Humans ; Immobilization ; Neck ; Radius ; Radius Fractures ; Range of Motion, Articular ; Tenodesis ; Transplants ; Ulna ; Wrist

Background: Folliculitis decalvans and dissecting cellulitis are types of primary neutrophilic cicatricial alopecia characterized by permanent hair loss. Clinicopathological differentiation is poorly described in literature. Objective: This study aimed to determine the clinicopathological distinction between folliculitis decalvans and dissecting cellulitis. Methods: A retrospective review was conducted in 45 patients diagnosed with dissecting cellulitis and folliculitis decalvans between 2011 and 2021. We reviewed the clinical features using electronic medical records, clinical photographs, and histopathologic features. Results: Clinically, middle-aged men with folliculitis decalvans showed polytrichia (80%) and papulopustules (55%), while young men with dissecting cellulitis had deeply seated nodules (84%). Histopathologically, follicular plugging was more frequently observed in dissecting cellulitis (80%) than in folliculitis decalvans (50%). There was a difference in the depth of inflammation between the two types. Conclusion A difference in clinical manifestations was observed according to the depth of inflammation. These findings may contribute to the differential diagnosis of primary neutrophilic cicatricial alopecia.

A 63-year-old male presented with a painful skin lesion on the left side of the neck and upper chest approximately two months prior to presentation. Diffuse erythematous to purplish-colored sclerotic patches were observed. He had been treated with intravenous antibiotics for two weeks for cellulitis, but the lesion did not improve. Punch biopsy, and neck computed tomography (CT) with contrast enhancement were performed to differentiate between cellulitis and scleroderma. Histopathological examination revealed infiltration of pleomorphic and poorly differentiated tumor cells extending into thickened collagen bundles, and mitotic activity. Based on histologic and radiologic findings, the patient was suspected to have poorly differentiated carcinoma, and further evaluation of the origin of the carcinoma was performed. A subareolar mass on the left breast was observed on chest CT, and a needle biopsy was performed; results were consistent with findings from the skin biopsy. Finally, the patient was diagnosed with carcinoma en cuirasse, a subtype of cutaneous metastasis of breast cancer, was transferred to oncology, and underwent palliative chemotherapy.

BACKGROUND/AIMS: Ulcerative colitis (UC) is a chronic disease that characteristically has a relapsing and remitting course. Probiotics might possibly induce remission in the treatment of active UC. Aims of our study were to assess the efficacy of VSL#3 on clinical response and colonic tissue cytokine concentration changes in patients with active UC. METHODS: Twenty-four eligible patients with mild to moderate UC received open-label VSL#3 4 sachets daily in 2 divided doses for 8 weeks. The disease activity pre- and post-VSL#3 therapy was assessed by ulcerative colitis disease activity score and colonic tissue cytokine profiling done at baseline and at week 8. RESULTS: Twenty-four patients (mean age, 43.7 years; range, 20-70 years; male/female, 15/9) were enrolled and 2 patients did not have the final endoscopic assessment. A total of 22 patients were analyzed. Intent to treat analysis demonstrated remission in 45.8% of subjects (n=11); partial response in 20.8% (n=5); no change or worse in 25.0% (n=6) of subjects. The mean ulcerative colitis disease activity index (UCDAI) scores decreased from 7.09+/-1.81 to 1.45+/-1.29 in patients with a remission (p<0.001). The mean endoscopic scores had also significantly decreased from 1.91+/-0.54 to 0.63+/-0.50 in patients with a remission (p<0.001). The concentrations of colonic cytokines did not change significantly during treatment in patients with a remission. CONCLUSIONS: Our study demonstrated that VSL#3 is effective in achieving clinical responses and remissions in patients with mild-to moderately active UC, further supporting the potential role in UC therapy.
Adult ; Aged ; Colitis, Ulcerative/*therapy ; Cytokines/metabolism ; Drug Administration Schedule ; Humans ; Male ; Middle Aged ; Probiotics/*therapeutic use ; Severity of Illness Index

BACKGROUND/AIMS: Colonoscopic polypectomy should be performed on the five to seven hour of clock (standard position). However, outcomes of polypectomy at non-standard positions have not yet been investigated. This study was to compare the clinical outcomes of colonoscopic polypectomy including procedure time, status of resection margin and complications between standard and non-standard position. METHODS: Patients who underwent screening colonoscopy were prospectively recruited from Oct 2011 to Feb 2012 at Dongguk University Ilsan Hosptial, Goyang, Korea. Standard position was defined as polyps which were located from 5 to 7 hour of clock on colonoscopic view. RESULTS: A total of 168 adenomatous polyps of 114 patients were investigated. Mean size of polyp was 7.1+/-3.2 mm. The most common shape of polyps was sessile in 77 cases (45.8%). Mean overall procedure time per patient was 25.5+/-12.3 min. 130 adenomatous polyps were resected in standard position (77.4%) and 38 polyps were in non-standard position (22.6%). Overall complete resection rate was 63.7% and immediate bleeding rate was 9.8%. There was no significant difference in overall polypectomy time per polyp (2.9+/-1.3 min vs. 3.0+/-1.8 min, P=0.32). Complete resection rates and complication were not statistically different. CONCLUSIONS: There was no difference according to procedure time, status of resection margin and complications between standard position and non-standard position. Colonoscopic polypectomy is thus safe and feasible on any position.
Adenomatous Polyps ; Colonic Polyps ; Colonoscopy ; Hemorrhage ; Humans ; Korea ; Mass Screening ; Polyps ; Prospective Studies

PURPOSE: Laparoscopy-assisted distal gastrectomy (LADG) is gaining wider acceptance for the treatment of early gastric cancer. However, firm evidence supporting the long-term outcome after LADG for gastric cancer is unknown. This study compared long-term quality of life after LADG versus an open distal gastrectomy (ODG) for early gastric cancer. METHODS: This study included 29 patients who underwent LADG and 57 patients who underwent ODG for the treatment of stage I gastric cancer. Quality of life was evaluated based on the Korean version of EORTC QLQ-C30 (version 3.0) and EORTC QLQ-STO22 one year after surgery. All patients underwent a Billroth II gastrectomy for stage I gastric cancer between January 2003 and December 2004. RESULTS: A total of 86 (58%) out of 154 patients responded to the questionnaire. Demographic features showed no difference between the two groups of patients for age, sex, depth of invasion, lymph node metastasis except for tumor size and the number of retrieved lymph nodes. The mean score for global health status was not statistically different (LADG, 60.3+/-20.4 vs ODG, 57+/-20.6; P=0.413). The total score of 21 items related to stomach cancer (EORTC QLQ-STO22) also was not statistically different (LADG, 68.9+/-64.9 vs ODG, 94.5+/-97.3; P=0.340). CONCLUSION: Based on the results of the Korean version of EORTC QLQ-C 30 (version 3.0) and EORTC QLQ-STO22, LADG does not seem to have any long-term benefit over ODG on 'quality of life'.
Gastrectomy* ; Gastroenterostomy ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Quality of Life* ; Surveys and Questionnaires ; Stomach Neoplasms

PURPOSE: To investigate mid-term clinical outcomes of various methods of scapholunate reconstruction for chronic scapholunate instability. METHODS: We retrospectively reviewed 11 patients diagnosed as chronic scapholunate instability, from 2005 to 2013 and followed up for more than one year after surgery. 7 patients were treated with Garcia technique of triple ligament reconstruction, 2, bone-ligamemt-bone repair, and 2, dorsal capsulodesis. Mean age was 42 years (range, 23-61 years). The right side was involved in 6 patients, and the left in 5. The follow-up period averaged 42 months (range, 13-125 months). The postoperative functional outcomes were assessed with Modified Mayo wrist score (MMWS), disability of the arm, shoulder and hand (DASH) score and range of motion. The postoperative radiologic results were analyzed with the change of scapholunate angle and distance. RESULTS: The mean MMWS score improved from 65 preoperatively to 77 postoperatively (p=0.072). The mean DASH score improved from 29.4 (range, 18.3-43.3) preoperatively to 12.7 (range, 0-38.3) postoperatively (p=0.003). The dorsiflexion increased from 67° to 78°, the volar flexion decreased from 51° to 45°, the supination increased from 69° to 88°, and the pronation increased from 62° to 66°. The SL angle changed from 55° preoperatively to 51° postoperatively, the mean SL distance changed from 3.4 mm preoperatively to 1.7 mm postoperatively. CONCLUSION: The chronic scapholunate instability is amenable to various techniques and postoperative functional outcomes improved satisfactory.
Arm ; Follow-Up Studies ; Hand ; Humans ; Ligaments* ; Pronation ; Range of Motion, Articular ; Retrospective Studies ; Shoulder ; Supination ; Wrist

Recent reports have described an increasing incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in patients who do not exhibit established risk factors for healthcare exposure. We report two cases of CA-MRSA bacteremia complicated by vertebral osteomyelitis. Both of CA-MRSA isolates were resistant to beta-lactam agents, but susceptible to clindamycin, trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin, and tetracycline. Both isolates carried staphylococcal cassette chromosome mec (SCCmec) type IVA, and were identified as sequence type (ST) 72 by mlultilocus sequence typing (MLST). However, the Panton-Valentine leukocidin (PVL) gene was not identified.
Bacteremia ; Bacterial Toxins ; Ciprofloxacin ; Clindamycin ; Delivery of Health Care ; Exotoxins ; Gentamicins ; Humans ; Incidence ; Leukocidins ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Osteomyelitis ; Risk Factors ; Tetracycline ; Trimethoprim, Sulfamethoxazole Drug Combination

Recent reports have described an increasing incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in patients who do not exhibit established risk factors for healthcare exposure. We report two cases of CA-MRSA bacteremia complicated by vertebral osteomyelitis. Both of CA-MRSA isolates were resistant to beta-lactam agents, but susceptible to clindamycin, trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin, and tetracycline. Both isolates carried staphylococcal cassette chromosome mec (SCCmec) type IVA, and were identified as sequence type (ST) 72 by mlultilocus sequence typing (MLST). However, the Panton-Valentine leukocidin (PVL) gene was not identified.
Bacteremia ; Bacterial Toxins ; Ciprofloxacin ; Clindamycin ; Delivery of Health Care ; Exotoxins ; Gentamicins ; Humans ; Incidence ; Leukocidins ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Osteomyelitis ; Risk Factors ; Tetracycline ; Trimethoprim, Sulfamethoxazole Drug Combination

Hepatic duct diverticulum is a rare form of choledochal cyst that does not fit into the most widely used Todani classification system. Because of its rarity, it may be difficult for clinicians to diagnose and treat it. Here, we present a case of left hepatic diverticulum in a 57-year-old woman with epigastric pain. At presentation, there were mild elevations in the liver function tests. Computed tomography and magnetic resonance cholangiopancreatography showed diverticulum-like cystic lesion with sludge ball near the confluence portion of both intrahepatic bile duct, but the origin of the lesion could not be identified. The clinical impression was type II choledochal cyst. Surgical excision was planned due to recurrent abdominal pain. The operative findings revealed diverticulum arising from left hepatic duct. Histopathology confirmed the lesion to be diverticulum lined by biliary epithelium. The patient had no postoperative complication and no further symptoms since the operation.
Abdominal Pain ; Bile Ducts ; Bile Ducts, Intrahepatic ; Cholangiopancreatography, Magnetic Resonance ; Choledochal Cyst ; Classification ; Diverticulum ; Epithelium ; Female ; Hepatic Duct, Common ; Humans ; Liver Function Tests ; Middle Aged ; Postoperative Complications ; Sewage