Background: Myasthenia gravis (MG) is a rare classic autoimmune disease where immunosuppressant therapies have been successful to reduce MG attributable mortality fairly well. However, patients with refractory MG (rMG) among the actively treated MG (aMG) are nonresponsive to conventional therapy and display high disease severity, which calls for further research. We aimed to determine survival, prognosis, and clinical feature of patients with rMG compared to non-rMG. Methods: Retrospective nationwide cohort study using Korea's healthcare database between 2002 and 2017 was conducted. Patients with rMG (n = 47) and non-rMG (n = 4,251) who were aged > 18 years, followed-up for ≥ 1 year, and prescribed immunosuppressants within 2 years after incident MG diagnosis were included. Patients with rMG were defined as administered plasma exchange or intravenous immunoglobulin at least 3 times per year after receiving ≥ 2 immunosuppressants. All-cause mortality, myasthenic crisis, hospitalization, pneumonia/ sepsis, and emergency department (ED) visits were measured using Cox proportional hazard models and pharmacotherapy patterns for rMG were assessed. Results: The rMG cohort included a preponderance of younger patients and women. The adjusted hazard ratio was 2.49 (95% confidence interval, 1.26–4.94) for mortality, 3.14 (2.25–4.38) for myasthenic crisis, 1.54 (1.15–2.06) for hospitalization, 2.69 (1.74–4.15) for pneumonia/sepsis, and 1.81 (1.28–2.56) for ED visits for rMG versus non-rMG. The immunosuppressant prescriptions were more prevalent in patients with rMG, while the difference was more remarkable before rMG onset rather than after rMG onset. Conclusion Despite the severe prognosis of rMG, the strategies for pharmacotherapeutic regimens were similar in those two groups, suggesting that intensive monitoring and introduction of timely treatment options in the early phase of MG are required.

Background: Myasthenia gravis (MG) is a rare classic autoimmune disease where immunosuppressant therapies have been successful to reduce MG attributable mortality fairly well. However, patients with refractory MG (rMG) among the actively treated MG (aMG) are nonresponsive to conventional therapy and display high disease severity, which calls for further research. We aimed to determine survival, prognosis, and clinical feature of patients with rMG compared to non-rMG. Methods: Retrospective nationwide cohort study using Korea's healthcare database between 2002 and 2017 was conducted. Patients with rMG (n = 47) and non-rMG (n = 4,251) who were aged > 18 years, followed-up for ≥ 1 year, and prescribed immunosuppressants within 2 years after incident MG diagnosis were included. Patients with rMG were defined as administered plasma exchange or intravenous immunoglobulin at least 3 times per year after receiving ≥ 2 immunosuppressants. All-cause mortality, myasthenic crisis, hospitalization, pneumonia/ sepsis, and emergency department (ED) visits were measured using Cox proportional hazard models and pharmacotherapy patterns for rMG were assessed. Results: The rMG cohort included a preponderance of younger patients and women. The adjusted hazard ratio was 2.49 (95% confidence interval, 1.26–4.94) for mortality, 3.14 (2.25–4.38) for myasthenic crisis, 1.54 (1.15–2.06) for hospitalization, 2.69 (1.74–4.15) for pneumonia/sepsis, and 1.81 (1.28–2.56) for ED visits for rMG versus non-rMG. The immunosuppressant prescriptions were more prevalent in patients with rMG, while the difference was more remarkable before rMG onset rather than after rMG onset. Conclusion Despite the severe prognosis of rMG, the strategies for pharmacotherapeutic regimens were similar in those two groups, suggesting that intensive monitoring and introduction of timely treatment options in the early phase of MG are required.

Ureteral tumors are relatively uncommon, accounting for approximately 1.2% of all urothelial tumors. Metastatic ureteral tumors are even rarer. The primary lesions include breast, melanomas, bladder, colon, stomach, lung, and esophageal, prostate, ovarian, kidney, urethral and vaginal carcinomas. Patients usually have lumbar or flank pain, dysuria, frequency, and in the latter stages, anuria. We report a case of a metastatic ureteral tumor from a lung squamous cell carcinoma after complete remission.
Anuria ; Breast ; Carcinoma, Squamous Cell* ; Colon ; Dysuria ; Flank Pain ; Humans ; Kidney ; Lung* ; Melanoma ; Neoplasm Metastasis ; Prostate ; Stomach ; Ureter* ; Ureteral Neoplasms ; Urinary Bladder

Entrapment of the extensor pollicis longus tendon is reported rarely on Smith's fractures in children. In our case, a 15 year old boy with Smith's fracture received treatment of closed reduction at another hospital. When he visited our hospital, a wide gap at the fracture site was detected on radiograph and the thumb movement was limited. We have doubt the entrapment of the soft tissue, especially the tendon. We decided on open reduction. In the operation field, entrapment of the extensor pollicis longus tendon at the gap of the fracture site was found through dorsal approach. In addition, fracture treatment with K-wire fixation after reduction of extensonr pollicis longus tendon reduction was done. Therefore, we report this case with a review of the literatures.
Child ; Humans ; Tendons ; Thumb

Thoracic outlet syndrome is a relatively common disease. However, costoclavicular syndrome as a condition secondary to nonunion of a displaced fracture of the clavicle is very rare. Most clavicular fractures in adults are united with no or minimal persistent symptoms. Also, symptomatic nonunion of a displaced fracture of the clavicle is rare. A 55-year-old male initially presented with persistent forearm pain after slip-down was initially diagnosed with simple muscle strain. However, he was given a delayed diagnosis of costoclavicular syndrome, caused by compression of the subclavian artery due to trauma in the fibrotic nonunion of the right clavicle without apparent symptoms. We obtained satisfactory results by surgical treatment. Here we report this case with a review of the literature.
Adult ; Clavicle ; Delayed Diagnosis ; Forearm ; Humans ; Male ; Muscles ; Sprains and Strains ; Subclavian Artery ; Thoracic Outlet Syndrome

Peptic ulcer remains an important public health concern due to an aging society and the increasing use of non steroidal anti-inflammatory drugs (NSAIDs). Perforated peptic ulcer is a major life-threatening complication of peptic ulcer. While the preferred treatment is surgery, conservative treatment does not result in significantly different outcomes in young, hemodynamically stable patients. However, conservative treatment of perforated peptic ulcer is associated with high failure rates in elderly patients. We report a case of an 87-year-old patient with a perforated peptic ulcer with contrast agent leakage. The patient was treated conservatively without complications; the treatment included non per os (NPO), insertion of a Levin tube, intravenous antibiotics, and a proton pump inhibitor.
Aged* ; Aged, 80 and over ; Aging ; Anti-Bacterial Agents ; Humans ; Peptic Ulcer ; Peptic Ulcer Perforation ; Proton Pumps ; Public Health ; Stomach Ulcer*

Vertebral hemangioma is a slow-growg, benign tumor which is often discovered incidentally during evaluation of neck or back pain.1,2 It is easily demonstrated by spine MRI, but in some cases did not show typical radiological appearance. In that case, Tc-99m RBC SPECT may be another confirmatory diagnostic tool. We report a case of vertebral hemangioma diagnosed with the assistance of Tc-99m RBC SPECT.
Hemangioma* ; Magnetic Resonance Imaging ; Neck ; Spine ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: The purpose of this study was to define the experience of nursing education in the Jinju area of Gyeongsang-Namdo from the 1940s to 1960s. METHODS: An oral history study was done using personal interviews with 8 nurses who graduated in nursing in Gyeong Nam area during the period under study. RESULTS: In this study, the individual's educational background before entering the nursing school, school life, and life as a nurse after graduating from nursing school were defined. CONCLUSION: For most of the respondents, their educational background before entering nursing school was middle school. They studied very hard in poor surroundings. After graduation from a nursing school, they worked in hospitals, public health centers, midwifery centers, and schools. Half of the respondents had experience as a midwife. Their income as a midwife was relatively high at that time. They all had positive identities and lived a life devoted to the individual, society, and the nation.
Surveys and Questionnaires ; Education, Nursing ; History of Nursing ; Hospitals, Public ; Humans ; Midwifery ; Schools, Nursing

PURPOSE: The purpose of this study is to evaluate the clinical results of retrograde intramedullary fixation of metacarpal shaft fractures using two pre-bent Kirschner wires. MATERIALS AND METHODS: Between March 2006 and May 2008, 19 cases (17 patients) of metacarpal shaft fractures were treated with the retrograde intramedullary Kirschner-wire fixation and followed at least one year. The exclusion criteria were thumb metacarpal fractures, comminuted fractures and irreducible metacarpal spiral shaft fracture by closed manipulation. At final follow up all the cases were assessed with total active motion(TAM), rotational deformity, bony union and angular deformity based on the plain radiographes. RESULTS: At the last follow-up, all cases achieved bony union. Five cases showed less than 5degrees of dorsal angular deformity. The average union period was 6.3 weeks (range, 5-9weeks). Fifteen cases (79%) showed excellent results, four cases good results based on TAM. No case showed rotational deformity. Two cases had skin irritation by distal wire end, which was subsided after wire removal. CONCLUSIONS: In patients with a metacarpal shaft fracture, retrograde intramedullary fixation using two pre-bent K-wires can provide satisfactory clinical results.
Bone Wires ; Congenital Abnormalities ; Follow-Up Studies ; Fractures, Comminuted ; Humans ; Skin ; Thumb

PURPOSE: To assess the results of an arthroscopic repair for traumatic peripheral tears of triangular fibrocartilage complex (TFCC, Palmer type Ib). MATERIALS AND METHODS: 10 patients with traumatic peripheral TFCC tear were treated with outside-in technique with arthroscope and evaluated with an average follow-up of 19 months (range, 15 to 28 months). The clinical outcomes were assessed with investigation of pain, range of motion, grip strength, return to job and patient's satisfaction. RESULTS: The arthroscopic repair of traumatic peripheral TFCC tear resulted in significant pain relief and increase in functional ability of wrist, that is, 8 excellent, 1 good and 1 fair results. At last follow-up, the average of flexion was 79° (range 76~86°), average of extension was 78° (range 70~84°), average pronation was 85° (range 75~91°) and average supination was 87° (range 79~92°). Nine patients except one were back to their original job. CONCLUSION: Arthroscopic repair of traumatic peripheral TFCC tear could be used for pain relief and increase in functional ability of wrist.
Arthroscopes ; Follow-Up Studies ; Hand Strength ; Humans ; Pronation ; Range of Motion, Articular ; Supination ; Tears* ; Triangular Fibrocartilage* ; Wrist