PURPOSE: This study analyzed the clinical and radiological results of Reudi-Allgower type II and III open tibia pilon fracture patients who underwent plate fixation after the recovery of a soft tissue injury after external fixation. MATERIALS AND METHODS: From 2010 to 2015, this study analyzed 14 patients who were treated for open tibial pilon fractures and could be followed up at least one year. The mean age was 49 years and the average follow-up period was 19 months. An emergency operation was performed for external fixation and open wounds, and secondary surgery was performed for definitive fixation using a plate. The radiological and clinical evaluations were analyzed retrospectively. Complications, such as post-traumatic osteoarthritis and wound infections were also analyzed. RESULTS: The mean duration between two-staged surgery was 21 days and the mean bone union time was 9.2 months. Three cases of delayed union and one case of nonunion were reported. The malunion did not occur in all cases. The average American Orthopaedic Foot and Ankle Society (AOFAS) score was 68 points. A limitation of the ankle motion occurred in all cases. In four cases, wound infections due to initial open wounds occurred; one patient underwent a below the knee amputation due to chronic osteomyelitis. Post-traumatic arthritis occurred in 10 cases. CONCLUSION: Severe comminuted tibial plateau open fractures of Reudi-Allgower type II and III, which are high-energy injuries that result in extensive soft tissue damage, have a higher incidence of complications, such as ulcer problems and osteomyelitis, than closed tibia plateau fractures. Post-traumatic arthritis is the most common complication of tibia plateau open fractures, and staged surgery is recommended because of the relatively satisfactory clinical results.
Amputation ; Ankle ; Arthritis ; Emergencies ; Follow-Up Studies ; Foot ; Fractures, Open ; Humans ; Incidence ; Knee ; Osteoarthritis ; Osteomyelitis ; Retrospective Studies ; Soft Tissue Injuries ; Tibia ; Ulcer ; Wound Infection ; Wounds and Injuries

BACKGROUND/AIMS: Gastrointestinal involvement in vasculitis may result in life-threatening complications. However, its variable clinical presentations and endoscopic features, and the rarity of the disease, often result in delayed diagnosis. METHODS: Clinical characteristics, endoscopic features, and histopathological findings were reviewed from medical records. RESULTS: Of 6,477 patients with vasculitis, 148 were diagnosed as primary vasculitis with upper gastrointestinal involvement. Of these, 21 cases (14.2%) were classified as large-vessel vasculitis, 17 cases (11.5%) as medium-vessel vasculitis, and 110 cases (74.3%) as small-vessel vasculitis. According to the specific diagnosis, IgA vasculitis (Henoch-Schönlein purpura) was the most common diagnosis (56.8%), followed by Takayasu arteritis (14.1%), microscopic polyangiitis (10.1%), and polyarteritis nodosa (6.8%). Gastrointestinal symptoms were present in 113 subjects (76.4%), with abdominal pain (78.8%) the most common symptom. Erosion and ulcers were striking endoscopic features, and the second portion of the duodenum was the most frequently involved site. Biopsy specimens were obtained from 124 patients, and only eight (5.4%) presented histopathological signs of vasculitis. CONCLUSIONS: Diagnosis of vasculitis involving the upper gastrointestinal tract is difficult. Because of the widespread use of endoscopy, combining clinical features with endoscopic findings may facilitate making appropriate diagnoses; however, the diagnostic yield of endoscopic biopsy is low.
Abdominal Pain ; Biopsy ; Delayed Diagnosis ; Diagnosis ; Duodenum ; Endoscopy ; Gastrointestinal Tract ; Humans ; Immunoglobulin A ; Medical Records ; Microscopic Polyangiitis ; Polyarteritis Nodosa ; Strikes, Employee ; Takayasu Arteritis ; Ulcer ; Upper Gastrointestinal Tract ; Vasculitis*

BACKGROUND/AIMS: Sulglycotide is a sulphoglycopeptide isolated from porcine duodenal mucosa. It has antiulcer and cytoprotective activity with anti Helicobacter pylori (H. pylori) effect. This study was performed to assess the therapeutic efficacy and safety of gliptide(R) (sulglycotide) in comparison with another mucosal protective agent, selbex(R) (teprenone) for the treatment of gastritis. MATERIALS AND METHODS: One hundred and twenty one patients with symptomatic erosive gastritis were randomized to receive sulglycotide (gliptide(R)) or teprenone (selbex(R)) for 4 weeks. Improvement and cure rates on endoscopic findings, improvement rates of symptoms, and eradication rates of H. pylori were compared. RESULTS: Of the 121 intention-to-treat (ITT) population, 82 patients comprised the per protocol (PP) analysis. Endoscopic cure rates and improvement rates in the sulglycotide and teprenone group were 36.7% vs. 29.5% and 41.7% vs. 37.7% in ITT and 46.3% vs. 34.2% and 53.7% vs. 43.9% in PP population, respectively. Symptom improvement rates in the sulglycotide and teprenone group were 71.7% vs. 65.6% in ITT and 85.4% vs. 75.6% in PP. Eradication rates of H. pylori were not significantly different between the groups. Results of 95% CIs for the difference in endoscopic cure rate and improvement rate, symptom improvement rate, and eradication rate of H. pylori between the two groups met the criteria for the non-inferiority of sulglycotide to teprenone. No significant adverse events were encountered during the study period. CONCLUSIONS: Gliptide(R) (sulglycotide) is not inferior to selbex(R) (teprenone) in therapeutic efficacy and is a safe and useful therapeutic agent for the treatment of gastritis.
Diterpenes ; Gastritis ; Helicobacter pylori ; Humans ; Mucous Membrane ; Sialoglycoproteins

BACKGROUND/AIMS: ALADIN gene has been known to cause achalasia, alacrima, adrenal abnormalities and a progressive neurological syndrome. A considerable proportion of achalasia patients has been known to show alacrima (decreased secretion of tear). However, the genetic mechanism between achalasia and alacrima has not been defined yet. We postulated that ALADIN gene may be involved in the occurrence of early-onset achalasia; thus, we investigated the correlation of ALADIN gene in early-onset achalasia patients. METHODS: From 1989 to 2007, patients who were diagnosed as primary achalasia before age 35 were enrolled. All of the enrolled patients were asked for (1) blood sampling for DNA, (2) Shirmer test and (3) dysphagia questionnaires. RESULTS: The ALADIN gene in exon 1, 2, 10, 11 and 12 from 19 patients was investigated (M:F = 12:7). The mean age of patients at diagnosis was 27 +/- 5 (15-35) years old. Eight out of 19 (42%) showed alacrima by the positive Shirmer test. In spite of thorough exam in the genetic study, there was no definite abnormal genetic finding in this study. CONCLUSIONS: A considerable number of achalasia patients showed alacrima. Due to the limitation of this study, it is difficult to conclude that early-onset achalasia may have significant correlations with the ALADIN gene.
Deglutition Disorders ; DNA ; Esophageal Achalasia ; Exons ; Eye Diseases, Hereditary ; Humans ; Lacrimal Apparatus Diseases

PURPOSE: The purpose of this study was to analyze the effect of the medical research curriculum on the students' satisfaction and the research self-efficacy. METHODS: The curriculum was implemented to 79 graduate medical school students who entered in 2007 and 2008. This curriculum is implemented through 3 years consisting of 5 different sub-courses: Research design, Research ethics, Medical statistics, Writing medical paper, and Presentation. The effect of this program was measured with 2 self-administered surveys to students: the course satisfaction survey and the self-efficacy inventories. The Research Self-Efficacy Scale consisted of 18 items from 4 categories: Research design, Research ethics, Data analysis, and Result presentation. The descriptive statistics, paired t-test, and analysis of covariance (ANCOVA) were implemented. RESULTS: The average point of satisfaction of the course was 2.74 out of 4, which told us that students generally satisfied with the course. The frequencies of tutoring for research course were 2 or 3 times on average and each session of tutorial lasted 1.5 to 2 hours. The research self-efficacy in three categories (Research design, Research ethics, and Result presentation) increased significantly (p<0.1). The self-efficacy of the male students was higher than females' one. The self-efficacy was not significantly different by the experience of research paper writing at undergraduate level. CONCLUSION: The curriculum showed positive results in cultivating research self-efficacy of students. There is a need for improvement of the class of Statistical analysis as students reported that it was difficult.
Curriculum ; Education, Medical, Graduate ; Equipment and Supplies ; Ethics, Research ; Humans ; Male ; Research Design ; Schools, Medical ; Self Efficacy ; Statistics as Topic ; Students, Medical ; Writing

BACKGROUND/AIMS: The incidence of Barrett's cancer is increasing in Western countries, but there have been only a few case reports of this condition in Korea. The aim of this study was to elucidate the endoscopic and pathologic characteristics of Barrett's cancer in a single center in Korea. METHODS: We retrospectively reviewed the demographic, endoscopic, and pathologic characteristics of six patients with Barrett's cancer, defined as a tumor centered above the esophagogastric junction and surrounded by Barrett's esophagus. RESULTS: All six patients were male, and three (50%) were symptomatic. Barrett's cancer had developed from short-segment Barrett's esophagus in all patients. All tumors were located on the right side of the lower esophagus and showed hyperemic mucosal changes. Three patients were treated surgically and three by endoscopic resection. All cases had pathologic evidence of Barrett's cancer. CONCLUSIONS: Early detection of Barrett's cancer requires meticulous endoscopic observations of subtle mucosal color and morphological changes around the esophagogastric junction.
Barrett Esophagus ; Esophageal Neoplasms ; Esophagogastric Junction ; Esophagus ; Humans ; Incidence ; Korea ; Male ; Retrospective Studies

OBJECTIVE: Prenatal cytogenetic diagnosis is limited to metaphase karyotype analysis of cultured cells obtained by amniocentesis or chorionic villus sampling. Moreover, genome wide analysis cannot be performed by FISH analysis using specific probe. Array comparative genomic hybridization (CGH) offers a number of advantages over conventional cytogenetic analysis and FISH. Microarray CGH can be highly comprehensive, amenable to very high resolution, sensitive and fast. The objective of this study was to determine the clinical use of cDNA microarray CGH for detection of fetal aneuploidy. METHODS: 21 amniotic fluid samples and 6 chorionic villi samples were obtained from 27 pregnant women in 9-19 gestational weeks. Genomic DNA was extracted from each sample and amplified. For cDNA microarray CGH analysis, test DNA sample and reference DNA sample were labeled with Cy3-dUTP and Cy5-dUTP, respectively. Each sample of labeled test and reference DNA was hybridized to microarray. The result was analysed with axon scanner and compared with cytogenetic analysis and FISH. RESULTS: In 27 cases, 3 cases with trisomy 21 and 1 case with trisomy 18 had increased hybridization signals on chromosome 21 and chromosome 18. One case with 45,X had decreased signals on chromosome X. One case with 46,X,i(Xq) had decreased signal on short arm of chromosome X and increased signal on long arm. And one case with 47,XYY had two fold increased signal on Y chromosome. cDNA microarray based CGH correctly identified fetal aneuploidy in all of the 7 cases with aneuploid fetuses. CONCLUSION: Prenatal genetic diagnosis by cDNA microarray-based CGH is an useful, innovative, rapid and accurate method. It is promising technique allowing rapid screening for whole chromosomal changes including aneuploidy, and may augment standard karyotyping techniques for prenatal genetic diagnosis by providing additional molecular information. This method may aid the discovery and description of minor genetic aberration, potentially enhancing future prenatal genetic diagnostic application.
Amniocentesis ; Amniotic Fluid ; Aneuploidy* ; Arm ; Axons ; Cells, Cultured ; Chorionic Villi ; Chorionic Villi Sampling ; Chromosomes, Human, Pair 18 ; Chromosomes, Human, Pair 21 ; Comparative Genomic Hybridization* ; Cytogenetic Analysis ; Cytogenetics ; Diagnosis ; DNA ; DNA, Complementary* ; Down Syndrome ; Female ; Fetus ; Genome ; Humans ; Karyotype ; Karyotyping ; Mass Screening ; Metaphase ; Oligonucleotide Array Sequence Analysis ; Pregnancy ; Pregnant Women ; Prenatal Diagnosis* ; Trisomy ; Y Chromosome

A xanthoma is an abnormal localized collection of histiocytic tissue containing lipid. It is not a true tumor, but is a reactive histiocytic proliferation often secondary to alternations in serum lipids. Xanthoma lesions are seen in the skin and tendons, and may occur at other sites, such as the stomach and arytenoepiglottic fold. However, a xanthoma is rare in the bladder, with only 9 reported cases. Here, a case of a xanthoma of the bladder detected incidentally during cystoscopic examination for a gross hematuria is reported.
Hematuria ; Skin ; Stomach ; Tendons ; Urinary Bladder* ; Xanthomatosis*

PURPOSE: To assess the usefulness of MRI in the preoperative diagnosis of breast implant-relatedcomplications. MATERIALS AND METHODS: Thirty four breast implants in 17 patients were examined. Eight breasts hada history of repeated surgery due to rupture and in eight others, simultaneous interstitial silicone injection hadbeen performed. MR images of the 34 implants were prospectively analyzed for implant-related complications,without prior clinical information, and the findings were compared with the results of surgery. RESULTS: Theimplant-related complications seen on MRI were infections in three cases, seromas in two, and implant malpositionin two. The linguine sign was seen in eight cases and intraparenchymal silicone in 17. Among the 32 removedimplants, rupture was genuine in ten cases (nine, extracapsular; one, intracapsular). In evaluating the MRfindings of implant rupture, the linguine sign showed 80% sensitivity, 100% specificity and 93.8% accuracy.Intraparenchymal silicon also revealed high sensitivity (90%), but relatively low specificity and accuracy (63.7%and 71.9%, respectively); this was due to the difficulty of differentiating granulomas still present after aprevious rupture from injected silicone material. MRI was useful for visualization of implant migration, thedirect relationship of extended or extruded silicone in extracapsular rupture and the localization of siliconegranulomas, as seen on multiplanar images. The extent of infection was clearly demonstrated on contrast enhancedscan. There was relatively good correlation between the degree of contracture seen on physical examination andthat seen on MRI. CONCLUSION: MRI was an effective and useful method for the preoperative evaluation ofimplant-related complications; degree of contracture was successfully predicted.
Breast Implants ; Breast* ; Contracture ; Diagnosis ; Granuloma ; Humans ; Magnetic Resonance Imaging* ; Physical Examination ; Prospective Studies ; Rupture ; Sensitivity and Specificity ; Seroma ; Silicones

Isolated dislocation of all five carpometacarpal joints is extremely rare, only eleven cases had been reported since 1873. In Korea, we have not seen it probably. We experienced one case of isolated dislocation of all five carpometacarpal joints with a good result in I year after closed reduction and internal fixation.
Carpometacarpal Joints* ; Dislocations* ; Korea