This study was aimed to furnish the data of facial bone fracture which was related regional and social environment and to aid diagnosis and treatment of the fracture. This is the retrospective and clinicostatical study on 625 patients with facial bone fracture. The patients were treated in the Dept. of Oral and Maxillofacial Surgery of Wonkwang University Hospital from Jan. 1, 1993 to Dec. 31, 1997. The result were as follows : The facial bone fractures occured most frequently in the twenties(32.3%) and male were predominent(77.4%) than female. The most frequent etiologic factor of facial bone fracture was fall down(42.8%) and midface fracture was traffic accident(63.4%). The most common site of fracture was symphysis(51.1%) and angle(29.7%), condyle(27.5%), ZMC(13.4%) were next in order of frequency. Of the 626 patients, 590 patients(89.5%) were treated with open reduction and only 36 patients(10.5%) were treated with closed reduction. In the blow, the ratio of angle fracture(50%) is especially high(the overall ratio 29.7%) and in the Out car TA, the ratio of ZMC fracture(34.6%) is especially high(the overall ratio 13.4%). In the fall-down, the ratio of symphysis(58.4%) and condyle fracture(33.6%) is especially high(the overall ratio 51.1%, 27.5%). Postoperatives complication were found in 35(5.6%) of 626 patients, in which mouth opening limitation(3%) was the most common. Above results suggest that early diagnosis and treatment of fracture site, systemic condition and associated injuries are nessary, and cooperative treatment with medical department should be performed.
Diagnosis ; Early Diagnosis ; Facial Bones* ; Female ; Humans ; Male ; Mouth ; Retrospective Studies ; Social Environment ; Surgery, Oral

OBJECTIVE: Helicopter ambulance transport (HAT) is a highly resource-intensive facility that is a well-established part of the trauma transport system in many developed countries. Here, we review the benefit of HAT for neurosurgical patients in Korea. METHODS: This retrospective study followed neurotrauma patients who were transferred by HAT to a single emergency trauma center over a period of 2 years. The clinical benefits of HAT were measured according to the necessity of emergency surgical intervention and the differences in the time taken to transport patients by ground ambulance transport (GAT) and HAT. RESULTS: Ninety-nine patients were transferred to a single university hospital using HAT, of whom 32 were taken to the neurosurgery department. Of these 32 patients, 10 (31.3%) needed neurosurgical intervention, 14 (43.8%) needed non-neurosurgical intervention, 3 (9.4%) required both, and 11 (34.4%) did not require any intervention. The transfer time was faster using HAT than the estimated time needed for GAT, although for a relatively close distance (<50 km) without ground obstacles (mountain or sea) HAT did not improve transfer time. The cost comparison showed that HAT was more expensive than GAT (3,292,000 vs. 84,000 KRW, p<0.001). CONCLUSION: In this Korean-based study, we found that HAT has a clinical benefit for neurotrauma cases involving a transfer from a distant site or an isolated area. A more precise triage for using HAT should be considered to prevent overuse of this expensive transport method.
Air Ambulances* ; Ambulances ; Developed Countries ; Emergencies ; Humans ; Korea ; Neurosurgery ; Retrospective Studies ; Trauma Centers ; Triage

PURPOSE: Necrotizing fasciitis is a rare, life-threatening, and rapidly progressive soft tissue infection associated with extensive necrosis. Despite recent advances in its management, outcomes have not improved and the mortality rate from this disease is still high. The objective of this study was to identify the predictive factors of mortality for patients diagnosed with necrotizing fasciitis in the ED. METHODS: A total of 38 necrotizing fasciitis cases diagnosed by an emergency department from January 2001 to April 2012 were retrospectively reviewed. RESULTS: Mean serum lactate levels were significantly higher in non-survivors than survivors (8.03+/-4.48 vs. 3.26+/-2.46, p=0.001). Serum glucose levels, arterial pCO2, and HCO3 values were significantly lower in non-survivors than survivors (114.75+/-78.01 vs. 203.92+/-122, p=0.027;25.02+/-6.82 vs. 32.74+/-7.06, p=0.005; 13.76+/-6.08 vs. 20.63+/-5.12, p=0.002, respectively). Microorganisms isolated included coagulase-negative Staphylococci from seven patients (18.4%), Acinetobacter baumannii from six patients (15.8%), Enterococcus faecium from five patients (13.2%), Staphylococcus aureus from five patients (13.2%), Beta-hemolytic Streptococcus from three patients (7.9%), Enterococcus faecalis from three patients (7.9%), Escherichia coli from two patients (5.3%), Pseudomonas aeruginosa from two patients (5.3%), Enterobacter cloaca from two patients (5.3%), Klebsiella oxytoca from two patients (5.3%), and Klebsiella pneumonia from two patients (5.3%). More Acinetobacter baumannii were cultured from the non-survival group than the survival group (p=0.022), while there was no statistical difference from surgical treatment between the survivor and non-survivor group (p=0.460). Interestingly, serum lactate levels above 4.0 mmol/L were a predictor of mortality in the ED (OR, 20.000; confidence interval, 1.796-222.777). CONCLUSION: Initial serum lactate levels above 4 mmol/Larea predictor of mortality in patients diagnosed with necrotizing fasciitis in the ED.
Acinetobacter baumannii ; Blood Glucose ; Cloaca ; Emergencies* ; Enterobacter ; Enterococcus faecalis ; Enterococcus faecium ; Escherichia coli ; Fasciitis, Necrotizing* ; Humans ; Klebsiella ; Klebsiella oxytoca ; Lactic Acid ; Mortality* ; Necrosis ; Pneumonia ; Pseudomonas aeruginosa ; Retrospective Studies ; Soft Tissue Infections ; Staphylococcus aureus ; Streptococcus ; Survivors

PURPOSE: Necrotizing fasciitis is a rare, life-threatening, and rapidly progressive soft tissue infection associated with extensive necrosis. Despite recent advances in its management, outcomes have not improved and the mortality rate from this disease is still high. The objective of this study was to identify the predictive factors of mortality for patients diagnosed with necrotizing fasciitis in the ED. METHODS: A total of 38 necrotizing fasciitis cases diagnosed by an emergency department from January 2001 to April 2012 were retrospectively reviewed. RESULTS: Mean serum lactate levels were significantly higher in non-survivors than survivors (8.03+/-4.48 vs. 3.26+/-2.46, p=0.001). Serum glucose levels, arterial pCO2, and HCO3 values were significantly lower in non-survivors than survivors (114.75+/-78.01 vs. 203.92+/-122, p=0.027;25.02+/-6.82 vs. 32.74+/-7.06, p=0.005; 13.76+/-6.08 vs. 20.63+/-5.12, p=0.002, respectively). Microorganisms isolated included coagulase-negative Staphylococci from seven patients (18.4%), Acinetobacter baumannii from six patients (15.8%), Enterococcus faecium from five patients (13.2%), Staphylococcus aureus from five patients (13.2%), Beta-hemolytic Streptococcus from three patients (7.9%), Enterococcus faecalis from three patients (7.9%), Escherichia coli from two patients (5.3%), Pseudomonas aeruginosa from two patients (5.3%), Enterobacter cloaca from two patients (5.3%), Klebsiella oxytoca from two patients (5.3%), and Klebsiella pneumonia from two patients (5.3%). More Acinetobacter baumannii were cultured from the non-survival group than the survival group (p=0.022), while there was no statistical difference from surgical treatment between the survivor and non-survivor group (p=0.460). Interestingly, serum lactate levels above 4.0 mmol/L were a predictor of mortality in the ED (OR, 20.000; confidence interval, 1.796-222.777). CONCLUSION: Initial serum lactate levels above 4 mmol/Larea predictor of mortality in patients diagnosed with necrotizing fasciitis in the ED.
Acinetobacter baumannii ; Blood Glucose ; Cloaca ; Emergencies* ; Enterobacter ; Enterococcus faecalis ; Enterococcus faecium ; Escherichia coli ; Fasciitis, Necrotizing* ; Humans ; Klebsiella ; Klebsiella oxytoca ; Lactic Acid ; Mortality* ; Necrosis ; Pneumonia ; Pseudomonas aeruginosa ; Retrospective Studies ; Soft Tissue Infections ; Staphylococcus aureus ; Streptococcus ; Survivors

PURPOSE: To compare the change in higher-order aberrations (HOAs) in the treatment of myopia between two different Wavefront-guided excimer ablations: laser in situ keratomileusis (LASIK) and laser assisted subepithelial keratomileusis (LASEK). METHODS: One hundred and four eyes of 52 patients were treated with wavefront-guided LASIK while 104 eyes of 54 patients were treated with wavefront-guided LASEK. Pupil size, best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), manifest refraction, corneal topography, pachymetry, and wavefront aberrations were examined preoperatively. BCVA, UCVA, manifest refraction, and wavefront aberrations were measured at 1 and 3 months postoperatively. The Hartmann-Shack aberrometer (WaveScan, VISX) was used to measure the overall wavefront aberrations for scotopic pupils. RESULTS: The wavefront error of HOAs did not increase postoperatively in either group compared with preoperative values. Normalized polar Zernike coefficients compared between preoperative and postoperative values showed a statistically significant increase in spherical aberration term in the wavefront-guided LASIK group (p<0.001). Comparing normalized polar Zernike coefficients values between the two groups, the spherical and 2nd coma aberrations at postoperative 1 month in wavefront-guided LASEK were significantly higher than those of the wavefront-guided LASIK group (p=0.002, both). CONCLUSIONS: HOAs did not increase in either wavefront-guided LASIK or wavefront-guided LASEK compared to the previous conventional methods. However, the average RMS wavefront error of the HOAs was lower in the wavefront-guided LASIK group at 1 month postoperatively (p=0.0004).
Coma ; Corneal Topography ; Humans ; Keratectomy, Subepithelial, Laser-Assisted ; Keratomileusis, Laser In Situ* ; Myopia ; Pupil ; Visual Acuity

PURPOSE: To compare the abilities of radionuclide salivagrams (RS) and videofluoroscopic swallow studies (VFSS) to diagnose aspiration in children with aspiration pneumonia. METHODS: The records of children who were referred to the Asan Medical Center between April, 2006 and April, 2012 and who underwent both VFSS and RS to evaluate their recurrent aspiration pneumonia were reviewed (n=67). The aspiration positivity rates of the two tests were determined. The agreement between the tests was assessed by using the kappa statistic. RESULTS: VFSS was more frequently positive (n=26, 39%) than RS (n=23, 34%) (p=0.68). In the 11 children who repeat two test, Repeated examination increased positive rate in each tests (n=11), repeated RS (54%, p=1) is more frequent positive than repeated VFSS (46%, p=0.37). If a cumulative positive test had been defined as at least one positive result, the positive rate of two test was 56% (p<0.05). There was a fair agreement between RS and VFSS (kappa=0.26). CONCLUSION: The RS and VFSS positivity rates in children with aspiration pneumonia were similar but there was fair agreement between the two tests. This result suggests that these investigations to demonstrate aspiration are not interchangeable but complementary.
Child ; Humans ; Pneumonia ; Pneumonia, Aspiration

BACKGROUND/AIMS: The influence of the endoscopist on the polyp detection rate (PDR) is underappreciated in clinical practice. Moreover, flat lesions or lesions of the proximal colon are more difficult to detect. Here, we evaluated the differences in the PDR and the characteristics of detected polyps according to the experience of the colonoscopist. METHODS: We collected data on 2,549 patients who underwent screening colonoscopy performed by three fellows. The PDR was calculated according to the percentage of patients who had at least one polyp (method A) and according to the percentage of detected lesions (method B). The primary outcome included the change in the PDR, and the secondary outcome included the change in the characteristics of the detected polyps with increasing experience of the colonoscopist. RESULTS: No proportional correlation was found between the PDR and increasing experience in colonoscopy with method A; however, with method B, the PDR increased after 400 colonoscopies (p=0.0209). With method B, the detection rates of small polyps (<5 mm) (p=0.0015) and polyps in proximal sites (p=0.0050) increased after 300 colonoscopies. CONCLUSIONS: Our study demonstrated that the quality of a colonoscopy, measured by using the PDR, may increase when performed by experienced fellows.
Colon ; Colonic Polyps ; Colonoscopy ; Humans ; Mass Screening ; Polyps*

OBJECTIVE: The purpose of this study was to evaluate the complications of Transobturator tape (TOT) in the surgical treatment for stress urinary incontinence and their management. METHODS: From March 2005 to October 2007, 206 patients diagnosed with stress urinary incontinence were operated using TOT at Chonnam National University Hospital. We reviewed medical records and analyzed the data according to age, parity, menopausal state, concomitant operations and complications. RESULTS: Mean age of the patients was 52.6+/-10.5 years and mean parity was 2.9+/-1.4. 91 patients (44.2%) were in postmenopausal state and 201 patients (97.6%) had other concomitant gynecologic operations. There were no intraoperative complications such as vaginal injury or bladder perforation. Postoperatively, there were 2 cases (1.0%) of vulva hematoma, 6 cases (2.9%) of urinary retention, 4 cases (1.9%) of de novo urgency and 4 cases (1.9%) of vaginal erosion. CONCLUSION: The surgical treatment using TOT is thought to be safe and effective means for the management of stress urinary incontinence. Although rare, complications may occur, therefore surgeons must be aware of the management of each complications.
Female ; Hematoma ; Humans ; Intraoperative Complications ; Medical Records ; Parity ; Suburethral Slings ; Urinary Bladder ; Urinary Incontinence ; Urinary Retention ; Vulva

The original version of this article contained misspelled name of author. The name of Figueroa Arturo is replaced with Arturo Figueroa.

Ursolic acid (UA), a type of pentacyclic triterpenoid carboxylic acid purified from natural plants, can promote skeletal muscle development. We measured the effect of resistance training (RT) with/without UA on skeletal muscle development and related factors in men. Sixteen healthy male participants (age, 29.37+/-5.14 years; body mass index=27.13+/-2.16 kg/m2) were randomly assigned to RT (n=7) or RT with UA (RT+UA, n=9) groups. Both groups completed 8 weeks of intervention consisting of 5 sets of 26 exercises, with 10~15 repetitions at 60~80% of 1 repetition maximum and a 60~90-s rest interval between sets, performed 6 times/week. UA or placebo was orally ingested as 1 capsule 3 times/day for 8 weeks. The following factors were measured pre-and post-intervention: body composition, insulin, insulin-like growth factor-1 (IGF-1), irisin, and skeletal muscle strength. Body fat percentage was significantly decreased (p<0.001) in the RT+UA group, despite body weight, body mass index, lean body mass, glucose, and insulin levels remaining unchanged. IGF-1 and irisin were significantly increased compared with baseline levels in the RT+UA group (p<0.05). Maximal right and left extension (p<0.01), right flexion (p<0.05), and left flexion (p<0.001) were significantly increased compared with baseline levels in the RT+UA group. These findings suggest that UA-induced elevation of serum irisin may be useful as an agent for the enhancement of skeletal muscle strength during RT.
Adipose Tissue ; Body Composition ; Body Mass Index ; Body Weight ; Exercise ; Glucose ; Humans ; Insulin ; Insulin-Like Growth Factor I ; Male ; Muscle Strength* ; Muscle, Skeletal ; Resistance Training*