With the increased participation in sports activity, there is an increased tendency of anterior cruciate ligament (ACL) injuries in children and adolescents. Nonsurgical management including activity modification, bracing, and physical therapy, is best used for patients with partial tears involving < 50% of the ACL diameter. In patients with complete ruptures, chronological, physiological, and skeletal maturity must be assessed to select the appropriate surgical technique. This paper reviews the management of ACL tears in skeletally immature patients.
Adolescent* ; Anterior Cruciate Ligament* ; Braces ; Child* ; Humans ; Rupture ; Sports ; Tears

PURPOSE: Acute kidney injury (AKI) is a common, serious complication in rhabdomyolysis patients. Early recognition and adequate therapy in rhabdomyolysis-related AKI are essential to reducing mortality. However, existing biomarkers, such as plasma creatinine, have several limitations for early detection of AKI. Novel parameters have recently been studied for greater reliability in prediction and staging of AKI in critically ill patients in the emergency department. The aim of this study is to evaluate the role of certain parameters for early prediction and staging of AKI in adults with acute non-traumatic rhabdomyolysis. METHODS: Eighty eight patients with adult non-traumatic rhabdomyolysis, who were admitted to the emergency intensive care unit (ICU) from Dec 2013 to Nov 2014, were enrolled in this observational cohort study. AKI was defined according to the Acute Kidney Injury Network (AKIN) criteria. Diagnostic characteristics of initial laboratory parameters were analyzed using the area under the receiver operating characteristic (ROC) curve. RESULTS: Of the 88 patients, 60 patients (68.2%) developed AKI during the ICU stay. The ROC curve for plasma neutrophil gelatinase-associated lipocalin (NGAL) showed the highest sensitivity (81.7%) and specificity (78.6%) among initial parameters. In pairwise comparison, the areas under the curve (AUCs) for plasma NGAL and serum creatinine were 0.868 (95% confidence interval [CI]: 0.779-0.931) and 0.765 (95% CI: 0.662-0.849), respectively. A statistically significant difference was observed in both (p=0.047). Plasma NGAL levels increased significantly as the stage of AKI progressed, using AKIN criteria (p<0.001). CONCLUSION: Plasma NGAL can be a reliable parameter for early prediction and approximate staging of AKI in adult non-traumatic rhabdomyolysis in the emergency department.
Acute Kidney Injury* ; Adult ; Biomarkers ; Cohort Studies ; Creatinine ; Critical Illness ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intensive Care Units ; Lipocalins ; Mortality ; Neutrophils ; Plasma ; Rhabdomyolysis* ; ROC Curve ; Sensitivity and Specificity

Percutaneous mitral balloon valvuloplasty (PMBV) is the treatment of choice for mitral stenosis. Only a few reported cases have been reported in PMBV patients worldwide. In this study, a case of a 34 year-old female with infective endocarditis a year after PMBV is presented. The patient presented with fever, and peripheral vascular symptoms. Transthoracic echocardiography showed vegetation on the anterior mitral leaflets and Staphylococcus Viridans was isolated from blood cultures. The patient was successfully treated with Amoxicillin + Clavulate and Gentamicin. Further studies on the correlation between PMBV and infective endocarditis are needed.
Amoxicillin ; Balloon Valvuloplasty* ; Echocardiography ; Endocarditis* ; Female ; Fever ; Gentamicins ; Humans ; Mitral Valve Stenosis ; Staphylococcus

Traumatic triangular fibrocartilage complex (TFCC) injuries require multidisciplinary approach and plan. Trauma to TFCC can lead to instability of the distal radioulnar joint (DRUJ). Injury to TFCC is classified as a stable type that does not cause unstable lesions for DRUJ or unstable type that can cause instability of DRUJ. According to the location and severity of the injury, arthroscopic debridement or arthroscopic repair may be considered. In the ulnar side avulsion of TFCC, which could cause DRUJ instability, arthroscopic examination should be performed to identify an accurate location of the damaged structures, followed by arthroscopic debridement and repair. In the event of TFCC and DRUJ injuries with ulnar positive variance, arthroscopic TFCC repair or ulnar shortening osteotomy after arthroscopic debridement could be considered to solve the instability and ulnar side pain. However, if peripheral TFCC tear with ulnar impaction syndrome and DRUJ instability, it combined operation of ulnar shortening osteotomy and TFCC foveal fixation could be considered. An accurate classification of TFCC and DRUJ injuries is necessary. It is important to resolve and prevent recurrence of ulnar wrist pain caused by instability.
Arthroscopy ; Classification ; Debridement ; Joint Instability ; Joints* ; Osteotomy ; Recurrence ; Tears ; Triangular Fibrocartilage* ; Wrist

BACKGROUND: Although bone scan might be useful to detect incomplete atypical femoral fractures (AFFs) earlier than radiographs, there is no study on predicting further progression to a complete fracture among incomplete AFFs. Our purposes are to determine whether bone scan detects impending complete fracture among incomplete AFFs. METHODS: We reviewed 18 patients (20 AFFs) who underwent bone scan at the diagnosis of incomplete AFF and were not treated with prophylactic fixation. A diagnosis of impending complete fracture was made, when the femur completely fractured within 6 months after the scan. We correlated radioisotope uptake with the impending complete fracture to calculate sensitivity, specificity, positive predictive value and negative predictive value of bone scan. RESULTS: Thirteen AFFs (65%, 13/20) showed a positive uptake in bone scan. Among the 13, only one femur was completely fractured within 6 months. None of the 7 femurs without uptake in bone scan fractured. In diagnosing impending complete fracture, the sensitivity of bone scan was 100% and negative predictive value was 100%. However, the specificity (36.8%) and positive predictive value (7.7%) were quite low. CONCLUSION: Bone scan has no significant role in detecting the impending complete fracture, and a positive uptake does not mean the necessity of prophylactic fixation of incomplete AFF.
Diagnosis ; Femoral Fractures* ; Femur ; Humans ; Sensitivity and Specificity

Klinefelter syndrome is the most common chromosomal abnormality, with a 47, XXY karyotype and typical clinical findings of infertility, hypogonadism, reduced body hair, gynecomastia, tall stature, and incresed gonadotropins and decreased testosterone levels. In addition to this classic description, several other diseases have been discribed in Klinefelter syndrome such as unilateral renal aplasia, autoimmune disease, diabetes mellitus, sexual precoxity, renal cell carcinoma, intravesical ureterocele, and osteoporosis. The incidence is 1 in 400-1,000 of the population and urological abnormalities are not common. However a case of Klinefelter syndrome associated with multicystic dysplastic kidney has not been not reported up to date. Therefore, we describe a 1- day-year old baby boy who presented with Klinefelter syndrome with unilateral multicystic kidney dysplastic disease, plus with a brief review of the literature.
Autoimmune Diseases ; Carcinoma, Renal Cell ; Chromosome Aberrations ; Diabetes Mellitus ; Gonadotropins ; Gynecomastia ; Hair ; Humans ; Hypogonadism ; Incidence ; Infant, Newborn* ; Infertility ; Karyotype ; Klinefelter Syndrome* ; Male ; Multicystic Dysplastic Kidney* ; Osteoporosis ; Testosterone ; Ureterocele

PURPOSE: The purpose of this study was to perform a comparative analysis of training methodology between accessibility and needs for cardiopulmonary resuscitation (CPR) in the community. METHODS: This population-based nationwide study used a structured questionnaire via telephone survey in 2011-2012. The study was conducted by stratified cluster sampling to assess the impact of age, gender, and geographic regions (n=1,000). The contents of the questionnaire consisted of awareness, prior training status, and willing methodology of public CPR training. RESULTS: Thirty-eighty percent of respondents (n=381) had previously been taught CPR. Military service, education facility/ school, and workplace were 3 major resources of public CPR training among previously educated subjects (45%, 23%, and 9%, respectively). Seventy-two percent of trainees had been taught less than an hour and only 60% were trained using an individual manikin for CPR practice. Fifty-nine percent (n=593) had willingness to participate in CPR education and 40% of subjects wished to learn in a hospital or health care facility. Place of CPR training showed a major difference between previous experiences and willing groups in the community. Women and elders were more likely to learn CPR. Almost all respondents wanted short-duration learning (<1 hour), however, it was similar in the groups. CONCLUSION: In the scope of the public, training site showed a significant discrepancy between previous accessibility and needs of layperson. They prefer a highly accessible location and method with relatively short-practice programs.
Cardiopulmonary Resuscitation* ; Surveys and Questionnaires ; Delivery of Health Care ; Education ; Female ; Health Services Needs and Demand ; Humans ; Learning ; Manikins ; Military Personnel ; Telephone

PURPOSE: Childhood obesity can be complicated by hypertension, hyperlipidemia, non-alcoholic fatty liver disease, and diabetes mellitus. The aim of this study was to evaluate the prevalence of obesity and metabolic complications of children and adolescents based on the degree of obesity. METHODS: We analyzed the records of 8,880 students who received student health examinations between May 2006 and October 2008 at the Eulji General Hospital. The prevalence of obesity was evaluated by the body mass index and obesity index. A total of 1,076 obese students had blood tests. We analyzed aspartate aminotransferase (AST), alanine aminotransferase (ALT), fasting glucose, total cholesterol, and blood pressure according to the degree of obesity. RESULTS: According to the body mass index, the overall prevalence of obesity was 7.2% (7.8% of male and 6.5% of female students). Based on the obesity index, 12.3% of students (mild: 6.3%, moderate: 5.0%, and severe: 1.0%) were obese. The prevalence of hypercholesterolemia, ALT elevation, and hypertension were increased as a function of the degree of obesity (p<0.05), but hyperglycemia showed no significant differences (p=0.298). The overall prevalence of ALT elevation was 17.7% (mild obese group, 10.4%; moderate obese group, 20.5%; and severe obese group, 46.8%). The prevalence of hypercholesterolemia, hypertension, and hyperglycemia were significantly higher in the elevated ALT group (24.7%, 42.6%, and 5.2%, respectively) compared to the normal ALT group (11.1%, 29.8%, and 2.0%, respectively; p<0.05). CONCLUSION: Hypercholesterolemia, liver function test abnormalities, and hypertension were associated with the degree of obesity. We should focus our attention on managing obese children and adolescents to prevent metabolic complications.
Adolescent ; Alanine Transaminase ; Aspartate Aminotransferases ; Blood Pressure ; Body Mass Index ; Child ; Cholesterol ; Diabetes Mellitus ; Fasting ; Fatty Liver ; Female ; Glucose ; Hematologic Tests ; Hospitals, General ; Humans ; Hypercholesterolemia ; Hyperglycemia ; Hyperlipidemias ; Hypertension ; Liver Function Tests ; Male ; Obesity ; Prevalence

PURPOSE: We aimed to evaluate whether the modified Alvarado score-which is currently being used to diagnose acute appendicitis-can be applicable in the diagnosis of diseases in pregnant women. METHODS: We retrospectively analyzed the medical records of 252 pregnant women who visited our emergency department (ED) with a chief complaint of abdominal pain and a suspicion of acute appendicitis, and ultimately underwent appendix ultrasonography or appendix magnetic resonance imaging (MRI). The modified Alvarado score was calculated for each pregnant woman. A receiver operating characteristic (ROC) curve was drawn for each subject, those in the first trimester, second trimester, and third trimester, from which the best cut-off value, sensitivity and specificity were induced. RESULTS: For all 252 pregnant women who visited our ED, the area under the curve was 0.742 (p<0.001), with sensitivity and specificity of 75.41% and 62.30%, respectively, when using the value of 5 as the cut-off point for the modified Alvarado score. The area under the curve was 0.811 (p<0.001) for those in their first trimester and 0.749 (p<0.001) for those in the second trimester, while it was 0.641, with the p-value of 0.109, for those in the third trimester. CONCLUSION: There is a limitation using the modified Alvarado score alone in pregnant woman, and if there is uncertainty in the diagnosis, other imaging studies, such as appendix ultrasonography or appendix MRI, should be considered.
Abdominal Pain ; Appendicitis* ; Appendix ; Diagnosis ; Emergency Service, Hospital ; Female ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Pregnant Women* ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography ; Uncertainty

PURPOSE: In patients with altered mentality caused by drugs or unknown causes, ammonia is checked to facilitate differential diagnosis or diagnose hepatic coma. This helps early prevention and treatment of brain damage due to hyperammonemia. This study was conducted to evaluate clinical characteristics of intoxicated adult patients with hyperammonemia. METHODS: We evaluated 95 patients with hyperammonemia among intoxicated patients above the age of 15 who visited our ED from January 2013 to December 2015. We analyzed the demographic characteristics and type of poisoning substance, reason for ingestion, toxicological characteristics such as elapsed time from ingestion to hospital visit, lab, clinical progression and complications. Data were evaluated using the student's t test or Mann-Whitney U test for continuous variables, and Chi-square test and Fisher's exact test for frequency analysis of categorical variables. RESULTS: When compared to healthy individuals, patients with hyperammonemia showed statistical significance on their SOFA score (p=0.016) and poison severity score (p<0.001). Additionally, patients with hyperammonemia showed significantly different initial serum AST level (p=0.012) and maximum serum AST level during the hospital stay (p=0.026) when compared to healthy individuals. Moreover, individuals with sustained hyperammonemia compared to transient hyperammonemia showed clinically significant SOFA scores (p<0.001), poison severity scores (p=0.007), mortality rates in the ICU (p=0.021), as well as different duration of hospital stay (p=0.037), serum creatinine level (p=0.002), erythrocyte sedimentation rate (p=0.025), and serum myoglobin (p=0.015). CONCLUSION: Most poisoning-induced hyperammonemia cases were transient and recovered without special treatment. Therefore, hyperammonemia is almost non-specific among poisoning patients.
Adult ; Ammonia ; Blood Sedimentation ; Brain ; Creatinine ; Diagnosis, Differential ; Eating ; Hepatic Encephalopathy ; Humans ; Hyperammonemia* ; Length of Stay ; Mortality ; Myoglobin ; Poisoning