Ipsilateral fractures of the femoral neck and shaft represent many difficulties in diagnosis and treatment. The femoral neck fracture of this injury is commonly missed on initial evaluation. The overlooked femoral neck fracture may lead to higher risk of complications such as avascular necrosis of the femoral head, nonunion and coax vara. The authors reviewed nine cases of ipsilateral femoral neck and shaft fracture treated in our clinic from September 1989 to May 1995, and average follow-up period was 33 months(range, 12 to 101 months). The results obtained were as follows : 1. The most common cause of injury was traffic accident, and three femoral neck fractures were missed initially. 2. The most common site of femoral neck fractures was basicervical in 7 cases, and that of shaft fracture was middle 1/3 shaft in 5 cases. 3. The most common associated injury was ipsilateral knee injury(6 cases). 4. Five cases were treated with femoral reconstruction nail, two with multiple neck-pinning and retrograde interlocking IM nail, one with multiple screws for neck fracture and long dynamic compression plate for shaft fracture, and the other, multiple neck-pinning and antegrade interlocking IM nail. 5. The complications were a refracture of the shaft after removal of interlocking nail and a delayed union of shaft fracture which had been treated by reconstruction nailing. Coxa vara, delayed union and metal loosening were found in femoral neck fracture site, but all that were clinically acceptable. In conclusion, the fracture of femoral neck should be kept in mind not to be lost in case of high velocity-femoral shaft fracture, and if found, it should be treated with anatomical and rigid internal fixation in femoral neck fracture having first priority. Recently reconstruction nail for the treatment of these fractures was widely used, but that is technically difficult and might destroy the neck fracture during shaft fracture fixation. We recommend retrograde interlocking nail followed by multiple neckpinning might be safe and stable fixation for the ipsilateral neck and shaft fracture.
Accidents, Traffic ; Coxa Vara ; Diagnosis ; Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Fracture Fixation ; Head ; Knee ; Neck ; Necrosis

OBJECTIVE: To define whether lactase-deficient subjects are intolerable to even a pack of milk(200ml) and whether milk intolerance in the patients with IBD is only due to lactose malabsorption, we performed this study. METHODS: We evaluated 32 healthy adults and 12 patients with active stage of inflammatory bowel disease(IBD) who had not received antibiotics therapy within the previous 3 weeks. Thirty-two healthy adults underwent H2-breath test with 200, 400, 600 and 800ml of milk at 1st, 2nd, 3rd and 4th day of study, respectively. We measured their end-expiratory hydrogen concentrations and asked them to record the gastrointestinal symptoms. Twelve patients with IBD were tested only with 200ml of milk. Lactose malabsorption was defined as the increase of 20ppm over basal H2 concentration and lactose intolerance as having two or more of the following symptoms; abdominal pain, diarrhea, borborygmus and flatus. RESULTS: The prevalence of lactase deficiency was 72%(23 of 32 subjects) at 800ml of milk(lactose 40g). Among the lactase-deficient subjects, lactose intolerance at 200ml of milk(lactose 10g) was noticed only in 13%(3 of 23 subjects). In the patients with active stage of IBD, the frequency of milk intolerance at 200ml of milk was 50%(6 of 12 subjects), which was higher than in the healthy adults(9%). But the prevalence of lactose malabsorber in the patients with IBD at 200ml of milk(17%) was not higher than in the healthy adults(16%). CONCLUSION: Most of lactase-deficient subjects(87%) can ingest one pack of milk without lactose intolerance. The increased prevalence of lactose intolerance in the patients with IBD at 200ml of milk is not originated from lactose malabsorption, but probably from incomplete colonic compensation salvage.
Abdominal Pain ; Adult ; Anti-Bacterial Agents ; Colon ; Compensation and Redress ; Diarrhea ; Drinking* ; Flatulence ; Humans ; Hydrogen ; Inflammatory Bowel Diseases* ; Lactase* ; Lactose Intolerance* ; Lactose* ; Milk* ; Prevalence

STUDY DESIGN: A retrospective study. OBJECTIVES: To determine the indications of fusing the proximal thoracic curve when treating an idiopathic thoracic scoliosis with segmental instrumentation. SUMMARY OF BACKGROUND DATA: Failure to recognize a significant proximal thoracic curve often results in postoperative shoulder asymmetry due to relative overcorrection of the lower thoracic curve. With segmental instrumentation that enhances the correction of the instrumented curve, the double thoracic curve pattern that needs fusion of both the proximal and the distal thoracic curves needs to be redefined. MATERIALS AND METHODS: Forty thoracic AIS patients with a right lower thoracic curve > 40 and a left proximal thoracic curve > 25 treated by segmental pedicle screw instrumentation were analyzed after a minimum follow up of 2 years. RESULTS: Of the 40 patients, 18 were treated by fusion of both the proximal and the distal curves while 22 were treated by fusion of the distal curve only. The postoperative shoulder height difference(SHD, mm) was 0.9 x preoperative SHD(mm) + 5.3 for the both curve fusion and 0.6 x preoperative SHD(mm) + 12 for the distal curve fusion(linear regression), showing that proximal thoracic curve fusion improved the SHD when the left shoulder was level with or higher than the right. CONCLUSIONS: An idiopathic thoracic scoliosis with a proximal thoracic curve > 25 and level or elevated left shoulder should be considered a double thoracic curve pattern and treated by both the proximal and the distal curve fusion when using a segmental instrumentation.
Adolescent* ; Follow-Up Studies ; Humans ; Retrospective Studies ; Scoliosis* ; Shoulder

BACKGROUND: This study was prospectively performed to evaluate the clinical spectrum and risk factors of gastroesophageal reflux disease (GERD) in health check-up subjects. METHODS: A prospective survey was performed for 752 subjects, aged 18-79 years, who visited the health promotion center. The subjects were asked to complete a questionnaire, and the risk of GERD was calculated by logistic regression analysis with regard to several variables, including smoking, alcohol, exercise, body mass index, fasting glucose, cholesterol, triglyceride and anti-H. pylori immunoglobulin G (IgG). Non-erosive reflux disease (NERD) was defined as the presence of heartburn and/or acid regurgitation for at least once per week. RESULTS: 752 subjects were classified into three groups: 65 erosive reflux disease (ERD) subjects (8.6%), 66 NERD subjects (8.8%) and 621 control group subjects (82.6%). For the 65 ERD subjects, typical reflux symptoms were found in 19 (29.2%), less frequent reflux or atypical symptoms were found in 38 (58.5%) and no symptoms were found in 8 (12.3%). A Los Angeles grade A score was noted in 48 subjects (73.8%), a B score was noted in 11 (17.0%), and a C score was noted in 6 (9.2%). There was no correlation between the grade of reflux esophagitis and the severity of symptoms. The positive rate of H. pylori IgG in the ERD was 36.4%, and this was significantly lower than the rates for the NERD (60%) and control groups (65.3%); this resulted in the odds ratio of ERD in the absence of H. pylori infection to be 5.079 (95% CI: 1.907-13.530). CONCLUSIONS: The prevalence rate of GERD in health check-up subjects was 17.4%. There was no correlation between the grade of ERD and the severity of the reflux symptoms. The relative risk of GERD in Koreans was significantly low in the H. pylori IgG positive subjects.
Body Mass Index ; Cholesterol ; Esophagitis, Peptic ; Fasting ; Gastroesophageal Reflux* ; Glucose ; Health Promotion ; Heartburn ; Immunoglobulin G ; Logistic Models ; Odds Ratio ; Prevalence ; Prospective Studies ; Risk Factors* ; Smoke ; Smoking ; Triglycerides ; Surveys and Questionnaires

STUDY DESIGN: A retrospective study. OBJECTIVES: To determine the necessity of autogenous iliac grafting in selective thoracic fusion with segmental pedicle screw fixation in AIS SUMMARY OF BACKGROUND DATA: Though autografting is the gold standard for scoliosis surgeries, the frequency of complications makes this procedure a problem. In AIS patients subject to selective thoracic fusion, segmental pedicle screw instrumentation enabling a rigid fixation may offer satisfactory fusion with mixed graft of local bone and allograft, negating the need of autogenous cancellous grafting. METHODS: Fifty-eight AIS patients subjected to selective thoracic fusion by segmental pedicle screw fixation were analyzed. Group I consisted of 29 patients with autogenous iliac cancellous graft. Group II consisted of 29 cases with mixed graft of local bone and commercial allograft. The results were graded into union, probable union, probable nonunion and nonunion by the clinical results and radiological results after minimum follow up of 1 year. RESULTS: In group I, the fusion status was union in 21 and probable union in 8 patients with no probable nonunion or nonunions. In Group II, the fusion status was union in 13 and probable union in 16 cases with no probable nonunion or nonunions. There was no significant difference in results between two groups CONCLUSIONS: In AIS patients subject to selective thoracic fusion by segmental pedicle screw fixation, local bone and allograft mixed graft may be used as an alternative to autogenous iliac bone
Adolescent* ; Allografts* ; Autografts ; Follow-Up Studies ; Humans ; Retrospective Studies ; Scoliosis ; Transplantation, Autologous ; Transplants*

STUDY DESIGN: A retrospective study of perioperative complications was performed in elderly patients undergoing posterior decompression and fusion for lumbar degenerative conditions. OBJECTIVES: To identify the perioperative complications and to analyze the influence of posterior decompression and fusion on the occurrence of the morbidity. SUMMARY OF BACKGROUND DATA: Because of the better long-term results, the decompression and fusion with instrumentation have been recently recommended for treatment of degenerative lumbar disease in the elderly. However, the perioperative complication rate and their correlating factors have not been adequately defined. MATERIALS AND METHODS: A retrospective review of the medical charts of fifty-one patients aged 65 years or older operated during June 1997 to July 1998 was undertaken. The minimum follow-up required for inclusion was three months. All medical and surgical perioperative complications directly related to the surgical procedure were noted. The association of fusion levels and other factors with the occurrence of perioperative complications were analyzed. RESULTS: Perioperative complications occurred in 17(33.3%) of the 51 patients. Seven patients(13.7%) had at least one major complication, 5(9.8%) had at least one minor complication and 9(17.6%) had insignificant complications. Hematoma and wound infection were the most common surgical complications. Paralytic ileus was the most common medical complication. There was no difference in the rate of perioperative complications between the long and short fusion groups. An age of more than seventy-five years at the time of surgery was associated with a higher risk of complications. There was no statistically significant relationship between the perioperative complications and sex diagnosis, operative time, type of bone grafting, amount of blood transfusion, or preoperative comorbidity of the patients. CONCLUSION: Perioperative complications were quite common in the present series, occurring in 33.3% of the patients. An age over seventy-five years was a risk factor for associated with morbidity. The number of levels fused and the comorbidity did not associated the development of the complications.
Aged* ; Blood Transfusion ; Bone Transplantation ; Comorbidity ; Decompression ; Diagnosis ; Follow-Up Studies ; Hematoma ; Humans ; Intestinal Pseudo-Obstruction ; Operative Time ; Retrospective Studies ; Risk Factors ; Wound Infection

BACKGROUND/AIMS: Gastro-esophageal reflux disease (GERD) is a chronic condition, with 50-80% of patients experiencing recurrence within one year following completion of initial treatment. The present study aimed to estimate recurrence rate and treatment response in GERD patients treated with proton pump inhibitor. METHODS: A total of 207 symptomatic GERD patients, which were confirmed by endoscopy from July 2008 till January 2009, were enrolled. They were divided into non-erosive reflux disease (NERD) group and erosive reflux disease (ERD) group by endoscopic findings. Patients were treated with lansoprazole 15 mg (NERD group) or 30 mg (ERD group) once daily for 8 weeks. The presence of symptoms was assessed in each patient at baseline and post-treatment using a questionnaire. Subsequent symptomatic recurrence on the cessation of therapy in each improved patients was checked by telephone survey or outpatient interview. RESULTS: Ninety-four patients and 113 patients were first diagnosed with NERD and ERD, respectively. The mean post-treatment follow-up period was 24.4+/-8.5 weeks. Recurrence rate was 40.0% (NERD, 43.8%; ERD, 37.1% (p=0.224)). Recurrence time was 10.1+/-5.8 weeks (NERD 9.6 weeks; ERD, 10.6 weeks (p=0.444)). Regarding the symptom improvement after 8 week therapy with lansoprazole, 89.4% (NERD, 85.1%; ERD, 92.9% (p=0.056)) of total patients were symptomatically improved. CONCLUSIONS: Forty percentage of GERD patients recurred within 6 months following the completion of 8 week therapy with lansoprazole. Recurrence rate, recurrence time, and rate of symptom improvement were not significantly different between NERD group treated with half dose and ERD group treated with full dose lansoprazole.
2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use ; Adult ; Aged ; Anti-Ulcer Agents/therapeutic use ; Female ; Follow-Up Studies ; Gastroesophageal Reflux/*drug therapy ; Gastroscopy ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Proton Pump Inhibitors/therapeutic use ; Questionnaires ; Recurrence

BACKGROUND: Since the international guideline of Helicobacter pylori eradication therapy was introduced into Korea, many reports about eradication outcomes have been documented. These data were published mostly from referred university hospital. However, in Korea, majority of patients has been treated with H.pylori eradication regimen in primary care setting. This study was performed to investigate the eradication rate of H. pylori in primary care office of Seoul, Korea. METHODS: Total 173 patients with H.pylori-positive gastroscopy results received eradication regimen-mainly one week PPI based triple therapy-from January 1998 to March 2003. Four weeks after completion of medication, urea breath test, biopsy and CLO test were performed to detect H.pylori. RESULTS: Total eradication rate was 87.9%. The eradication rate of male and female were 90.3% and 84.3%, respectively (p>0.05). The eradication rate of patients older than younger than 60 was 81.5% vs 89.0%, respectively (p>0.05). There was no statistical significance in annual eradication rate. In eradication rate, there was no significant difference among PPI regimen (omeprazole, rabeprazole, pantoprazole). Whether endoscopic diagnosis is gastric ulcer or duodenal ulcer, there was no statistical difference in eradication rate between them. In the same way, there was also no statistical difference between peptic ulcer and H.pylori associated gastritis. CONCLUSION: The current eradication rate of H. pylori in primary care setting of Korea was 87.9%. H.pylori eradication rate in primary care setting was not much different from that in referred hospital in Korea, but it was lower than that reported by controlled trials of 1995 (initial times of introduction of international guide line into Korea). So far, the results have been acceptable, but there still remains to be investigated in PPI-based triple therapy as H.pylori eradication in primary care setting in the future of Korea.
Biopsy ; Breath Tests ; Diagnosis ; Drug Therapy ; Duodenal Ulcer ; Female ; Gastritis ; Gastroscopy ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea* ; Male ; Peptic Ulcer ; Primary Health Care* ; Rabeprazole ; Seoul ; Stomach Ulcer ; Urea

Chronic idiopathic inflamatory bowel disease, espcaially Crohn's disease, is frequently complicated with low gastrointestinal stricture. Besides medical treatment of active inflammation, there is no specific, conservative approach to this complication, Repetitive surgery with extensive resections, leading to short bowel syndrome, is often necessary. Balloons have been used for a variety of gastrointestinal stenoses including esophageal, small intestinal, and colonic stricture. Balloon dilation offers many theoretical advantages (safety, and patient comfort) over dilation with bougies. Especially, the availability of large diameter balloon dilators, which pass through the biopsy channel of standard endoscopes (through-the scope balloon or TTS balloon), has promised efficient direct-vision dilatation of strictures without the need of guide wires or fluoroscope. We report a case of colonic Crohn's stricture dilated successfully using TTS balloon catheter.
Biopsy ; Catheters ; Colon* ; Constriction, Pathologic* ; Crohn Disease ; Dilatation ; Endoscopes ; Humans ; Inflammation ; Short Bowel Syndrome

Brunner's gland hamartomas are rare duodenal tumors with characteristic pathologic featmes. The usual clinical presentation is nonspecific symptoms, obstructive symptoms, or intestinal bleeding. The majority of these tumors are less than 3 cm in diameter. In cases of larger size, the manifestations are usually intestinal obstruction or intestinal bleeding. The cases with massive gastrointestinal bleeding and severe anemia, requiring transfusion are rare. The diagnosis is made by radiologic studies and gastroduodenoscopy. The treatment of Brunner's gland hamartomas should be conservative, since they are not premalignant, However, the lesions originate in the submucosa, so the confimative diagnosis usually cannot be made by endoscopie biopey. For definitive diagnosis and relief of symptoms, the lesions must be removed surgically or endoscopically. Endoscopic excision is indicated if the tumar is pedunculated. We recently experienced a case of Brunner's gland hamartoma of about 5.5 cm in diameter with intestinal bleeding, requiring transfusion and intussusception. Preoperative diagnosis was submucosal tumor, such as lymphoma, with duodeno-duodenal intussusception. After surgical removal, the resected specimen showed the histologic features of Bruaner's gland hamartoma.
Anemia* ; Diagnosis ; Duodenum ; Hamartoma* ; Hemorrhage ; Intestinal Obstruction ; Intussusception* ; Lymphoma