No abstract available.
Korea*

After Kilian first described apondylolisthesis in 1854, there has been diverse opinions over the surgical treatment of the spondylolisthesis: in situ fusion vs. reduction and fusion, PLIF vs. PLF, and instrumentation vs. non-instrumentation. The advantages of the instrumentation are rigid fixation, better union rate of grafted bone and early rehabilitation after surgery. The disadvantages are long operation time and increased chance of the wound infection. The purpose of this retrospective study is to review the clinical results and fusion rate of 41 patients who were treated with decompression and posterolateral fusion in situ with autograft with or without instrumentation from January 1986 to June 1992. 1. Among 41 patients, 20 patients were degenerative type and 21 were isthmic type, and most commonly involved level was L4-5(46.4%). 2. Fusion was obtained in all patients. 3. Clinically 11 of 15 patients(73.4%) showed excellent or good results in instrumentation group, and 19 of 26 patients(73.0%) showed excellent or good results in non-instrumentation group. 4. Postoperative complications developed in two cases(13.3%) with instrumentation and five cases(19.2%) without instrumentation. Comparing with the non-instrumentation, we could not find great advantage of the instrumentation on the clinical results or union rate, although instrumentation showed a little better result.
Autografts ; Decompression ; Humans ; Postoperative Complications ; Rehabilitation ; Retrospective Studies ; Spondylolisthesis ; Transplants ; Wound Infection

The methodological and statistical validity of 382 original articles published in the Journal of the Korean Medical Association, from January 1980 to December 1989 was reviewed by the author-devised c heck list consisting of 21 items (14 items for methodological validity and 7 items for methodology, and of 297 articles using statistical analyses a total of 290 articles (97.6%) were found to contain at least one error in statistical methods used. The mean and standard deviation of 'validity score of one article', defined as the total number of valid items devided by the total number of applicable items and then multiplied by 100, were 43.8 and 15.2, respectively. The distribution of validity score was as follows ; over 60 (57 articles, 14.9%), 30 to 59 (266 articles, 69.6%), and under 30 (59 articles, 15.5%). The proportion of articles, of which validity score was over 60, was significantly higher in descriptive study (19.4%) than in analytic study (8.4%, p = 0.003). Also the articles of over 60 in validity score were more frequent in survey (15.9%) than in experiment (8.2%), and in cross-sectional study (16.8%) than in longitudinal study (10.6%), but this finding was not statistically significant. The averaged validity score of two year period was highest in 1984-1955 (50.24), and lowest in 1986-1987 (38.85). There was no significant time trend of the averaged validity score over 10 years(p>0.1). These results suggest that medical articles published in Korea, 1980-1989, were short of their expected quality, and there have been no evidence of improvement with time. It is concluded that a basic training in biostatistical methods in the medical postgraduates and residencies, more consultation of medical investigators with statistician or other experts, and careful review by someone knowledgeable in biostatistics or research design before accepting a manuscript are needed. In addition, refutation should be allowed for the controversial point through the journal.
Biostatistics ; Cross-Sectional Studies ; Humans ; Internship and Residency ; Korea* ; Longitudinal Studies ; Research Design ; Research Personnel

It is necessary for medical readers or reviewers to assess critically the methodological and statistical validity of medical articles before accepting their results or conclusion. The authors develope d a validity-assessing checklist of 21 items. Among them 14 items for methodological validity included the followings : clear statement of research hypothesis or specific aims, suitable focus, definition of study population (or subjects), eligibility criteria, exclusion criteria, appropriateness of samples, description of methods in detail, desconclusion of accuracy, description of reliability, presence of control, susceptability bias, performance bias, detection bias, transfer bias. The last 5 items are applicable only to analytic study. And 7 errors to statistical validity : incomplete description of basic data, statistical test performed yet not defined, incomplete description of power or confidence interval, inadequate description of measures of central tendency or dispersion, incorrect analysis, multiplicity on hypothesis testing, unwarranted conclusion. The first 3 items are 'errors of omission', and the other are 'errors of commission'. The authors suggest the checklist be very helpful, but not perfect. Critical mind is needed, which enables someone to distinguish minor errors from major fallacies.
Bias (Epidemiology) ; Checklist*

Pneumoperitoneum associated with a pneumothorax, pneumomediastinum, and subcutaneous emphysema during intubation and positive ventilation has rarely been reported. In general, such a pneumoperitoneum requires conservative treatment; therefore, it should be distinguished from pneumoperitoneum associated with a hollow viscus perforation. Our case involved a 47-year-old man treated with intubation and positive ventilation for the maintenance of airway patency. Not only a pneumothorax, pneumomediastinum and subcutaneous emphysema but also free intra-abdominal gas was observed on the chest X-ray. No evidence of a hollow viscus perforation was found on physical examination and the upper gastrointestinal series. The patient was treated conservatively for 10 days; then, the pneumoperitoneum, the pneumothorax, the pnenumomediastinum, and the subcutaneous emphysema disappeared. In this report, we reviewed the clinical significance and the anatomical relation of pneumoperitoneum associated with a pneumothorax, pneumomediastinum, and subcutaneous emphysema.
Humans ; Intubation* ; Mediastinal Emphysema* ; Middle Aged ; Physical Examination ; Pneumoperitoneum* ; Pneumothorax* ; Subcutaneous Emphysema ; Thorax ; Ventilation*

A 46-year-old male patient developed jaundice after 23 days' treatment of propylthiouracil (PTU) for Graves' disease. Serum alkaline phosphatase was elevated markedly with moderate increase in serum aminotransferase, and the peak level of total bilirubin was 7.3 mg/dL. After withdrawal of PTU, serum aminotransferase and bilirubin began to decrease simultaneously, and completely normalized. One week after the discharge from hospital, he received radioiodine treatment for Graves' disease, but he showed aggravation of hyperthyroidism and ophthalmopathy. So we prescribed methimazole inevitably 16 days' after the radiodiodine treatment. He developed jaundice again after 69 days' treatment of methimazole, but the pattern of hepatotoxicity was slightly different from that of the previous PTU-nduced hepatotoxicity. Serum aminotransferase increased slightly and quickly normalized after discontinuance of methimazole, but serum total bilirubin increased continuously and reached to 24.6 mg/dL. Eosinophilia was prominent and the result of liver biopsy was compatible with cholestatic jaundice. The patient was treated with prednisolone and recovered from jaundice rapidly.
Alkaline Phosphatase ; Bilirubin ; Biopsy ; Eosinophilia ; Graves Disease ; Humans ; Hyperthyroidism ; Jaundice ; Jaundice, Obstructive ; Liver ; Male ; Methimazole* ; Middle Aged ; Prednisolone ; Propylthiouracil*

The PFC (Press Fit Condylar) knee was first implanted clinically in 1984 with retention of posterior cruciate ligament. Thereafter PFC modular version had been developed at 1988 with option of posterior cruciate ligament substitution and minor design changes. We classified the 170 patients, 252 knees which underwent the PFC total knee arthroplasty in the period from January 1988 to May 1995 into three groups. In group I, 62 patient. Had 93 total knee arthroplasties with insertion of the original PFC total knee prosthesis with retention of posterior cruciate ligament from January 1988 to October 1991. In group Iia, 51 patients had 74 total knee arthroplasties with insertion of the modular PFC total knee prosthesis with retention of posterior cruciate ligawient from November 1991 to May 1995. In group III, 57 patients had 85 total knee arthroplasties with insert.ion of the modular PFC total knee prosthesis with substitution of posterior cruciate ligament from November 1991 to May l995. Average follow-up periods were 7 years 5 months in group I and 3 years 2 months in group Iia and Ilb. Clinical and radiographic results were similar among the group I, Iia and llb except slight better scores in group Iia and Iib than group I, even though group IlI and IlI had short follow-up periods, Postoperative implant wear was developed at 5 knees in group I, 1 knee in group Iia and not developed in group Ilb. Implant loosening was developed at 1 knee only in group 1. Revisional arthroplasty was performed to 7 knees in group I, 1 knee in group Iia and not in group 1Ib. In conclusion, posterior cruciate ligament substitution group had no difference in functional results with the retention group. In the problem of implant wear, posterior cruciate ligament substitution group was superior to the retention group but similar in loosening.
Arthroplasty* ; Follow-Up Studies ; Humans ; Knee Prosthesis ; Knee* ; Posterior Cruciate Ligament ; Postoperative Period

The os subfibulare is a relatively uncommon bony anomaly of the foot. It is usually found between the malleolus and talus and ossifies during adolescence or preadolescence. It can be demonstrated on routine anteroposterior ankle film of the foot. In 4 patients presented, the abnormality caused pain and frequent episodes of ankle strain. The pain was relieved in all patients treated by excision of the accessory bone.
Adolescent ; Ankle ; Foot ; Humans ; Talus

To find the medical insurance utilization of workers when suffering from low back pain, an analysis was made toward the data of medical insurance benefits matched with the general characteristics of 10,183 workers, who were registered continuously from 1993 to 1995 at a medical insurance cooperation for industrial workers. The results were as follows; 1. The period prevalence of the medical insurance utilization for low back pain for 3 years from 1993 to 1995 was calculated as 17.1% for male workers and 19.4% for female workers. Most common cause of utilization was other dorsopathies including the herniation of lumbar discs. 2. The utilization rate increased significantly as the present age and the age joining the company got older(p<0.001). As the duration of employment got longer, the utilization rate of the male showed the tendency to increase and that of the female increased significantly(p<0.05). Among male workers employed at cement and concrete manufacturing companies showed higher utilization rate and among female laborers showed significantly higher utilization rate than clerical workers(p<0.01). 3. Annual utilization rate for low back pain didn't show any difference, but the portion of other dorsopathies among cause of utilization showed the tendency to increase from 1993 to 1995. 4. The mean number of claims for outpatient medical care for low back pain differed significantly by age, working duration, type of industries, income level(p<0.05), and the mean of total visiting days for care of low back pain differed siginificantly by working duration. In conclusion, considering the fact that the medical insurance utilization for low back pain increased annually and other dorsopathies including the herniation of dorsopathies were increasing, an effective preventive or management program for low back pain toward worker employed at industries were required.
Employment ; Female ; Humans ; Insurance Benefits ; Insurance* ; Low Back Pain* ; Male ; Outpatients ; Prevalence

BACKGROUND: The purpose of this study was to identify the characteristics of injuries of school-aged children transported via emergency medical services (EMS) that occurred in schools by comparing with injuries that occurred outside of school. METHODS: Data from the 119 EMS from 2012 to 2014 were analyzed. School and non-school injuries were analyzed in children 6 to 17 years of age. The epidemiologic characteristics were assessed according to school-age groups; low-grade primary (6–8 years), high-grade primary (9–13 years), middle (13–15 years) and high (15–17 years) school. Gender-stratified multivariable logistic regression analysis was conducted to estimate the risks of school injury in each age group. RESULTS: During the study period, a total of 167,104 children with injury were transported via 119 ambulances. Of these injuries, 13.3% occurred at schools. Boys accounted for 76.9% of school injuries and middle school children accounted for a significantly greater proportion (39.6%) of school injuries (P < 0.001). The most frequent mechanisms of injury at school were falls (43.8%). The peak times for school injury occurrence were lunch time (13:00–13:59) in all age groups. Multivariate regression identified the risky age groups as high-grade primary (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.09–1.20) and middle school-aged boys (OR, 1.82; 95% CI, 1.74–1.90) and middle school-aged girls (OR, 1.30; 95% CI, 1.21–1.40). CONCLUSION: Notable epidemiologic differences exist between in- and out-of-school injuries. The age groups at risk for school injuries differ by gender.
Accidental Falls ; Ambulances ; Child ; Emergencies* ; Emergency Medical Services* ; Epidemiology ; Female ; Humans ; Korea* ; Logistic Models ; Lunch