Shoulder kinematics is important, as it is associated with shoulder arthropathy and pain mechanisms. Various static and dynamic analysis methods are prevalent for shoulder kinematics. These include 2-dimensional plane x-ray, computed tomography, and magnetic resonance imaging, cadaver study, electromagnetic motion analysis, transcortical bone pins technique, and in vivo 3-dimensional motion analysis. Although these methods provide the value of the shoulder kinematics angle, they are unable to explain why such changes occur. Since each method has its pros and cons, it is important to understand all factors accurately, and to choose a method that best meets the purpose of the researcher.
Biomechanical Phenomena* ; Bone Nails ; Cadaver ; Magnetic Resonance Imaging ; Magnets ; Methods ; Shoulder*

Osteomyelitis of the patella is a very uncommon condition that occurs mostly in the pediatric population. In addition to its rarity, nonspecific and variable clinical presentations usually lead to postponement in making the correct diagnosis. Moreover, it is often missed as prepatellar bursitis or septic arthritis of the knee. Nonetheless making early diagnosis and initiating prompt treatment is most important to preventing this condition from becoming chronic. In this case report, the authors encountered this rare condition of the patella in a child that was first misdiagnosed with pyogenic arthritis or prepatellar bursitis of the knee. The delay in making the diagnosis led to intractable progression of the disease, and sequestrectomy was required to stabilize the condition.
Arthritis ; Arthritis, Infectious ; Bursitis ; Child* ; Diagnosis ; Early Diagnosis ; Humans ; Knee ; Osteomyelitis* ; Patella

We performed this study to evaluate the prevalence of reflux esophagitis and/or hiatal hernia in patients referred to a medical center and to examine the relationship between endoscopic reflux esophagitis and hiatal hernia. The study was carried out in 1,010 patients referred to Yong Dong Severance Hospital for upper gastrointestinal endoscopy because of symptoms related to the gastrointestinal tract from September 1994 to March 1996. The presence of hiatal hernia was defined as a circular extension of the gastric mucosa of 2 cm or more above the diaphragmatic hiatus. Reflux esophagitis was found in 5.3% of patients, hiatal hernia in 4.1%, duodenal ulcer in 7.2% and gastric ulcer in 8.2%. The prevalence rates of reflux esophagitis and hiatal hernia in males were significantly higher than those in females. Thirty-two percent of patients with reflux esophagitis had hiatal hernia. In patients without reflux esophagitis, hiatal hernia was found in only 2.5% (p<0.01). There was no significant association between the presence of hiatal hernia and the degree of esophagitis on endoscopy. Duodenal ulcer was the second most common endoscopic abnormality found in patients with reflux esophagitis. The prevalence rate of reflux esophagitis and/or hiatal hernia at a medical center is relatively low compared to peptic ulcer disease and other reports from the Western countries. Our study confirms the close association between reflux esophagitis and hiatal hernia.
Adolescence ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Endoscopy, Gastrointestinal ; Esophagitis, Peptic/epidemiology ; Esophagitis, Peptic/complications* ; Female ; Hernia, Hiatal/epidemiology ; Hernia, Hiatal/complications* ; Human ; Korea/epidemiology ; Male ; Middle Age ; Sex Factors

The annual incidence of Plasmodium vivax malaria that reemerged in the Republic of Korea (ROK) in 1993 increased annually, reaching 4,142 cases in 2000, decreased to 864 cases in 2004, and once again increased to reach more than 2,000 cases by 2007. Early after reemergence, more than two-thirds of the total annual cases were reported among military personnel. However, subsequently, the proportion of civilian cases increased consistently, reaching over 60% in 2006. P. vivax malaria has mainly occurred in the areas adjacent to the Demilitarized Zone, which strongly suggests that malaria situation in ROK has been directly influenced by infected mosquitoes originating from the Democratic People's Republic of Korea (DPRK). Besides the direct influence from DPRK, local transmission within ROK was also likely. P. vivax malaria in ROK exhibited a typical unstable pattern with a unimodal peak from June through September. Chemoprophylaxis with hydroxychloroquine (HCQ) and primaquine, which was expanded from approximately 16,000 soldiers in 1997 to 200,000 soldiers in 2005, contributed to the reduction in number of cases among military personnel. However, the efficacy of the mass chemoprophylaxis has been hampered by poor compliance. Since 2000, many prophylactic failure cases due to resistance to the HCQ prophylactic regimen have been reported and 2 cases of chloroquine (CQ)-resistant P. vivax were reported, representing the first-known cases of CQ-resistant P. vivax from a temperate region of Asia. Continuous surveillance and monitoring are warranted to prevent further expansion of CQ-resistant P. vivax in ROK.
Antimalarials/administration & dosage ; Chemoprevention ; *Disease Outbreaks ; Drug Resistance ; Humans ; Malaria, Vivax/drug therapy/*epidemiology/parasitology/prevention & control ; Military Personnel ; Plasmodium vivax/drug effects/*physiology ; Republic of Korea/epidemiology

Background: Plasmodium vivax malaria has a persistent liver stage that causes relapse, and introducing tafenoquine to suppress relapse could aid in disease eradication. Therefore, we assessed the impact of tafenoquine introduction on P. vivax malaria incidence and performed a cost-benefit analysis from the payer’s perspective. Methods: We expanded the previously developed P. vivax malaria dynamic transmission model and calibrated it to weekly civilian malaria incidences in 2014–2018. Primaquine and tafenoquine scenarios were considered by assuming different relapse probabilities, and relapse and total P. vivax malaria cases were predicted over the next decade for each scenario. We then estimated the number of cases prevented by replacing primaquine with tafenoquine. The cost and benefit of introducing tafenoquine were obtained using medical expenditure from a nationwide database, and a cost-benefit analysis was conducted. A probabilistic sensitivity analysis was performed to assess the economic feasibility robustness of tafenoquine introduction under uncertainties of model parameters, costs, and benefits. Results: Under 0.04 primaquine relapse probability, the introduction of tafenoquine with relapse probability of 0.01 prevented 129 (12.27%) and 35 (77.78%) total and relapse cases, respectively, over the next decade. However, under the same relapse probability as primaquine, introducing tafenoquine had no additional preventative effect. The 14-day primaquine treatment cost was $3.71. The tafenoquine and the glucose-6-phosphate dehydrogenase rapid diagnostic testing cost $57.37 and $7.76, totaling $65.13. The average medical expenditure per malaria patient was estimated at $1444.79. The cost-benefit analysis results provided an incremental benefit-cost ratio (IBCR) from 0 to 3.21 as the tafenoquine relapse probability decreased from 0.04 to 0.01. The probabilistic sensitivity analysis showed an IBCR > 1, indicating that tafenoquine is beneficial, with a probability of 69.1%. Conclusion Tafenoquine could reduce P. vivax malaria incidence and medical costs and bring greater benefits than primaquine.

Shoulder kinematics is important, as it is associated with shoulder arthropathy and pain mechanisms. Various static and dynamic analysis methods are prevalent for shoulder kinematics. These include 2-dimensional plane x-ray, computed tomography, and magnetic resonance imaging, cadaver study, electromagnetic motion analysis, transcortical bone pins technique, and in vivo 3-dimensional motion analysis. Although these methods provide the value of the shoulder kinematics angle, they are unable to explain why such changes occur. Since each method has its pros and cons, it is important to understand all factors accurately, and to choose a method that best meets the purpose of the researcher.
Biomechanical Phenomena ; Bone Nails ; Cadaver ; Magnetic Resonance Imaging ; Magnets ; Methods ; Shoulder

BACKGROUND: The purposes of the present study are to evaluate the subsidence and nonunion that occurred after anterior cervical discectomy and fusion using a stand-alone intervertebral cage and to analyze the risk factors for the complications. METHODS: Thirty-eight patients (47 segments) who underwent anterior cervical fusion using a stand-alone polyetheretherketone (PEEK) cage and an autologous cancellous iliac bone graft from June 2003 to August 2008 were enrolled in this study. The anterior and posterior segmental heights and the distance from the anterior edge of the upper vertebra to the anterior margin of the cage were measured on the plain radiographs. Subsidence was defined as > or = a 2 mm (minor) or 3 mm (major) decrease of the segmental height at the final follow-up compared to that measured at the immediate postoperative period. Nonunion was evaluated according to the instability being > or = 2 mm in the interspinous distance on the flexion-extension lateral radiographs. RESULTS: The anterior and posterior segmental heights decreased from the immediate postoperative period to the final follow-up at 1.33 +/- 1.46 mm and 0.81 +/- 1.27 mm, respectively. Subsidence > or = 2 mm and 3 mm were observed in 12 segments (25.5%) and 7 segments (14.9%), respectively. Among the expected risk factors for subsidence, a smaller anteroposterior (AP) diameter (14 mm vs. 12 mm) of cages (p = 0.034; odds ratio [OR], 0.017) and larger intraoperative distraction (p = 0.041; OR, 3.988) had a significantly higher risk of subsidence. Intervertebral nonunion was observed in 7 segments (7/47, 14.9%). Compared with the union group, the nonunion group had a significantly higher ratio of two-level fusion to one-level fusions (p = 0.001). CONCLUSIONS: Anterior cervical fusion using a stand-alone cage with a large AP diameter while preventing anterior intraoperative over-distraction will be helpful to prevent the subsidence of cages. Two-level cervical fusion might require more careful attention for avoiding nonunion.
Adult ; Aged ; Biocompatible Materials ; Cervical Vertebrae/pathology/radiography/*surgery ; Diskectomy ; Female ; Humans ; *Internal Fixators ; Intervertebral Disk Degeneration/*surgery ; Ketones ; Male ; Middle Aged ; *Postoperative Complications ; Prosthesis Failure ; Radiculopathy/surgery ; Regression Analysis ; Risk Factors ; Spinal Cord Diseases/surgery ; Spinal Fusion/*methods ; Treatment Outcome

OBJECTIVES: Gastroptosis is defined as a condition in which the gastric angel is located below the interiliac line in standing position in the UGI barium study. The present study was designed to evaluate its prevalence, relation to clinical symptoms, body weight and gastric emptying time. METHODS: Two hundred-twenty seven consecutive subjects undertaken a UGI barium study for general check-up. We analyzed age, sex distribution, body weight percentile according to ideal body weight, and clinical manifestations. Gastric emptying scan was performed with a semi-solid test meal (2mCi of labeled (99m)Tc-suifur colloid-scrambled egg) on 12 healthy, asymptomatic subjects and 17 patients with gastroptosis. RESULTS: Twenty-one (9.3%) of the 227 subjects had gastroptosis. The ratio of male to female was 1 to 4.57. In age, three (16.7%) of the patients were below the age 40, 14(8.9%) were between 40 to 49, 4(7.8%) were above 50. According to the percentile of ideal body weight, 4(8.6%) of the 14 subjects were under the 90 percentile, 15(12.6%) of the 179 subjects were between 90 to 110 percentile, and 2(0.02%) of the 94 were above 110 percentile, which significantly higher in that of under 110 percentile of ideal body weight. The symptoms, which were complained in 8 of the 21 patients, were epigastric discomfort, belching, hunger pain, constipation, and nausea. The mean gastric emptying time (T1/2) was 69.8min and 92.6min in control and gastroptosis group, respectively. T1/2 was delayed in 7(63.6%) patients with symptomatic gastroptosis and 1 control. CONCLUSION: The gastroptosis was more common in female and lower body weight group and had a tendency of delay in T1/2z. We consider that gastroptosis may be one of the possible cause of non-ulcer dyspepsia in Korea.
Barium ; Body Weight ; Constipation ; Dyspepsia ; Eructation ; Female ; Gastric Emptying ; Humans ; Hunger ; Ideal Body Weight ; Korea ; Male ; Meals ; Nausea ; Prevalence ; Sex Distribution

BACKGROUND: The occurrence of an outbreak of food-borne infectious disease requires a hospital to do extended role. There has been no report of an outbreak and an outbreak management of food-borne infectious diseases in a hospital. Therefore, this report of an outbreak and management of Shigellosis in the hospital would help others to manage further cases. METHODS: This was a descriptive study for an infection control program for food-borne infectious diseases in a hospital. RESULTS: There was a shigellosis outbreak at a university hospital in Seoul between December 3 and 30, 2001, Five hundred eighty four were affected, of which 81 cases were suspected and 86 cases were confirmed Shigella sonnei in fetal culture. The source of infection was identified as a lunch box or seaweed rolled rice that was contaminated and was supplied from the S-catering facility. The infection control team had developed the various strategies to control the outbreak and implemented them. The strategies included an epidemiology investigation, the removal of infection sources, medical treatment and isolation of patients, education and management of public relationship, environmental control, withdrawal of medical students' training, prevention and control of asymptomatic cases, intensive care unit strong financial support, analysis and management various data and the construction of cooperation and reporting system with the public health system CONCLUSION: This outbreak was controlled by effective team approach. The effective management of an outbreak of food-borne infectious diseases requires a systematic infection control, public relationship strategies for the reputation of the hospital, and the cooperation with a public health system.
Communicable Diseases ; Dysentery, Bacillary* ; Education ; Epidemiology ; Financial Support ; Humans ; Infection Control* ; Intensive Care Units ; Lunch ; Public Health ; Seaweed ; Seoul ; Shigella sonnei

BACKGROUND: The 5-level triage tool, the Korean Triage and Acuity Scale (KTAS), was developed based on the Canadian Triage and Acuity Scale and has been used for triage in all emergency medical institutions in Korea since 2016. This study evaluated the association between the decrease in level number and the change in its relative importance for disposition in the emergency department (ED). METHODS: Using the registry of the National Emergency Department Information System (NEDIS) ver. 3.1, data regarding consecutive emergency patients from March 2017 to October 2017 were reviewed retrospectively. Reconfiguring KTAS levels, a total of 15 multinomial logistic regression models (KTAS_0 to KTAS_14), including the KTAS, its variants, and covariates were constructed to determine significant factors affecting ED disposition. The relative importance of each model was obtained using a dominance analysis. RESULTS: A total of 79,771 patients were included in the analysis. In the model KTAS_0, the KTAS and 8 covariates were found to be significantly related to ED disposition. The KTAS and the decision maker of each ED visit, whether it was the physician or others, had the largest relative importance, 34.8% and 31.4%, respectively (P < 0.001). In other models of KTAS variants, including 4-level, 3-level and 2-level, the rates of the KTAS decreased to 31.8% (interquartile range [IQR], 28.9–34.2), 26.4% (IQR, 23.2–31.0), and 18.7% (IQR, 7.5–24.9), respectively (P = 0.016). On the other hand, the rates for covariates tended to be larger for smaller triage levels and so there was a significant interaction effect between the KTAS and the covariates according to the triage level (P < 0.001). CONCLUSION: The 5-level triage tool, the KTAS, had the largest relative importance among the predictors affecting ED disposition only at its original level. Therefore, it is recommended that no attempt should be made to reduce the number of levels in the triage tool.
Cohort Studies ; Emergencies ; Emergency Service, Hospital ; Hand ; Humans ; Information Systems ; Korea ; Logistic Models ; Registries ; Retrospective Studies ; Triage