The methods of reconstruction for chronic Iigamentous instability of the knee have changed much since the concept of rotary instability was introduced by Slocum and Larson in 1968. The first step to successful management of these probrams is the accurate dlagnosis of the type or types of the instability that exist. Appropriate operative procedures should then be selected according to the type and degree of the instability as well as the age, general conditlon and the function demand of the patient. The stability can be restored passively by a near anatomical. repair of the injured ligaments, and can be reinforced actively by a proper muscle or tendon transplantation, such as the five-one procedure for anteromedial rotary instability. Nineteen knees of active, well motivated patients were operated on for chronic knee instabilities according to these new concepts. Although the follow-up period was relatively short, the results of the procedures was generally satisfactory.
Follow-Up Studies ; Humans ; Knee ; Ligaments ; Surgical Procedures, Operative ; Tendons

Fractures of the hip are usually classified first according to their anatomic location. Isolated fractures of the lesser or greater trochanter are not common and rarely requir surgery, Femoral neck fractures, intertrochanteric fractures, and subtrochanteric fractures are common categories that usually require open reduction and internal fixation. These fractures most often occur in elderly patients. The prognosis of these three major categories of hip fractures seems to be entirely different because of their anatomic characteristics. Seventy three cases of hip fractures were experienced at the Department of Orthopedic Surgery, Eul-Ji General Hospital over the period from Jan. 1975 to Aug. 1980 and the following results were obtained. 1. Of the 73 hip fractures, femoral neck fractures were 28 cases (38.5%), intertrochanteric fractures were 23 cases (31.5%), subtrochanteric fractures 11 cases (15%), and acetabular, fractures 11 cases (15%). 2. Traffic accident was the major cause of hip fractures in our series. 42 cases (57.2%) were caused by traffic accident, whereas 27 cases (37.0%) by a fall from the height. 3. Hip fractures occured most frequently in the age group from 31 to 50 years (53.5%). Male to female ratio was 2:1. 4. Cases caused by traffic accident visited hospital earlier than the others. 5. The most common type was Garden's type IV (53.6%) in the femoral neck fractures, Boyd-Griffins type Il (47.8%) in the intertrochanteric fractures, and Fielding's type II (54.5%) in the subtrochanteric fractures. 6. Metal devices used to fix hip fractures were Knowles pin, Jewett nail plate, compression hip screw, plate and screws, and Kuntscher nail. Internal fixation was done anatomical reduction has been achieved in stable fractures, and Dimon-Hughston reduction in unstable fractures. 7. Postoperative cast immobillzation was performed in 13 cases of 21 femoral neck fractures, 15 cases of 22 intertrochanteric fractures and 6 cases of 11 subtrochanteric fractures. The average duration of immobilization was 10 to 12 weeks. 8. Incidence of avascular necrosis in femoral neck fractures was 16.7%, nonunion in intertrochanteric fractures was 11.8%, and nonunion is subtrochanteric fractures was 12.5%.
Accidents, Traffic ; Acetabulum ; Aged ; Clinical Study ; Female ; Femoral Neck Fractures ; Femur ; Hip Fractures ; Hip ; Hospitals, General ; Humans ; Immobilization ; Incidence ; Male ; Necrosis ; Orthopedics ; Prognosis

A herniated lumbar intervertebral disc has been the most common cause of low back pain and sciatica since Mixter and Barr reported it in 1934. Our methods of treatment were the conservative treatment and the excision of the herniated disc for a limited number of carefully selected cases. The results of disc surgery relate to a number of factors, unquestionably the most important being patient selectivity. We emplopyed Finneson's lumbar disc surgery predictive score card to determine the relationship between patient selection and the outcome of lumbar disc surgery in operative cases. This report is to give a clinical review of 46 cases of the herniated disc upon which surgical removal were performed at Eul-Ji General Hospital from March 1981 to July 1982. The results were obtained as follows: 1. The most common age group were 21 to 40 year old. 2. In 46 surgically treated cases, 34 cases were male (74%) and 12 cases were female (26%). 3. The bulging of disc was found in 25 cases and the ruptured disc was found in 14 cases. The most common site of the lesion was L4-5 intervertebral disc with 30 cases (65%) and the next L5-Sl intervertebral disc with 10 cases (22%). 4. The outcomes of lumbar disc surgery were evaluated at follow-up as good in 77 per cent, fair in 11 per cent, marginal in 7 per cent and poor in 5 per cent of the patients. 5. The predictive scores of each result category were averaged and were as follows; Good: 77.1, Fair: 67.3, Marginal: 58.0, Poor: 40.0 6. The average predictive scores of each result category fell within the anticipated parameters of the score card. 7. The score card may be utilized as reliable system for presurgical patient selection.
Female ; Follow-Up Studies ; Hospitals, General ; Humans ; Intervertebral Disc ; Intervertebral Disc Displacement ; Low Back Pain ; Male ; Patient Selection ; Sciatica

This article reviews the designated health care institution for child abuse in Korea and the compatible systems in other countries. The Korean system is ready to be commenced by a relevant law, which came into effect in July 2019. To find lessons for the designated hospital or professional system, we examined the designated institutions for rape victims, tuberculosis patients, and aftercare for emergency department-based suicide attempters. We also looked at safeguarding system of the United Kingdom, which comprises designated and named professionals, and the National Association of Children’s Hospitals and Related Institutions guidelines and specialist system in the United States. The systems in the United States and the United Kingdom may offer insight to improving the planned designated health care institution for child abuse in Korea. This includes policy issues such as qualification control of professionals, role differentiation in accordance with the hospital classification, and assigning the title of the professional and health care institutions.

Among the several rotenoids, amorphigenin is isolated from the leaves of Amopha Fruticosa and it is known that has anti-proliferative effects and anti-cnacer effects in many cell types. The main aim of this study was to investigate the effects of amorphigenin on osteoclast differentiation in vitro and on LPS treated inflammatory bone loss model in vivo. We show here that amorphigenin inhibited RANKL-induced osteoclast differentiation from bone marrow macrophages in a dose dependent manner without cellular toxicity. Anti-osteoclastogenic properties of amorphigenin were based on a down-regulation of c-fos and NFATc1. Amorphigenin markedly inhibited RANKL-induced p38 and NF-kappaB pathways, but other pathways were not affected. Micro-CT analysis of the femurs showed that amorphigenin protected the LPS-induced bone loss. We concluded that amorphigenin can prevent inflammation-induced bone loss. Thus we expect that amorphigenin could be a treatment option for bone erosion caused by inflammation.
Bone Marrow ; Down-Regulation ; Femur ; Inflammation ; Macrophages ; NF-kappa B ; Osteoclasts ; Osteoporosis ; Rotenone ; T-Lymphocytes

BACKGROUND: During 2009 pandemic period, many Koreans were infected and admitted with Influenza A/H1N1. The primary aim of this study was to evaluate whether the structures of an intensive care unit (ICU) were associated with the outcomes of critically ill patients. METHODS: This retrospective observational study examined critically ill adult patients with influenza A/H1N1, who were admitted to 24 hospitals in Korea, from September 2009 to February 2010. We collected data of ICU structure, patients and 90 days mortality. Univariate and multivariate logistic regression analysis, with backward elimination, were performed to determine the most significant risk factors. RESULTS: Of the 239 patients, mortality of 90 days was 43%. Acute physiology and chronic health evaluation (APACHE) II score (p < 0.001), sequential organ failure assessment (SOFA) score (p < 0.0001), nurse to beds ratio (p = 0.039) and presence of intensivist (p = 0.024) were significant risk factors of 90 days mortality. Age (p = 0.123), gender (p = 0.304), hospital size (p = 0.260), and ICU type (p = 0.409) were insignificantly associated with mortality. In a multivariate logistic regression analysis, patients with less than 6 SOFA score had significantly lower mortality, compared with those with more than 10 SOFA score (odds ratio 0.156, p < 0.0001). The presence of intensivist had significantly lower mortality, compared with the absence (odds ratio 0.496, p = 0.026). CONCLUSIONS: In critically ill patients with influenza A/H1N1, the severity of the illness and presence of intensivist might be associated with 90 days mortality.
Adult ; APACHE ; Critical Illness ; Health Facility Size ; Humans ; Influenza, Human ; Critical Care ; Intensive Care Units ; Korea ; Logistic Models ; Pandemics ; Retrospective Studies ; Risk Factors

Background/Aims: For metastatic renal cell carcinoma (RCC), various prognostic scoring systems have been developed. However, owing to the low prevalence of nonclear cell RCC, the three most commonly used tools were mainly developed based on patients with clear cell histology. Accordingly, this study applied three prognostic models to Korean non-clear cell RCC patients treated with first-line temsirolimus. Methods: This study analyzed data for 74 patients with non-clear cell RCC who were treated with temsirolimus as the first-line therapy at eight medical centers between 2011 and 2016. The receiver-operating characteristic (ROC) curves for the different prognostic models were analyzed. Results: Twenty-seven (36.5%), 24 (32.4%), and 44 patients (59.5%) were assigned to the poor prognosis groups of the Memorial Sloan-Kettering Cancer Center (MSKCC), International Metastatic RCC Database Consortium (IMDC), and Advanced Renal Cell Carcinoma (ARCC) risk stratification models, respectively. All three prognostic models reliably discriminated the risk groups to predict progression-free survival and overall survival (p < 0.001). The area under the ROC curve (AUC) for progression and survival was highest for the ARCC model (0.777; 0.734), followed by the IMDC (0.756; 0.724) and the MSKCC (0.742; 0.712) models. Furthermore, the sensitivity and specificity for predicting progression were highest with the ARCC model (sensitivity 63.6%, specificity 85.7%), followed by the MSKCC (sensitivity 58.2%, specificity 86.5%) and the IMDC models (sensitivity 56.4%, specificity 85.7%). Conclusions All three prognostic models accurately predicted the survival of the non-clear cell RCC patients treated with temsirolimus as the first-line therapy. Furthermore, the ARCC risk model performed better than the other risk models in predicting survival.

Background/Aims: Little is known about the national colonoscopy volume in Asian countries. This study aimed to assess the national colonoscopy volume in Korea over a 12-year period on the basis of a nationwide population-based database. Methods: We conducted a population-based study for colonoscopy claims (14,511,158 colonoscopies performed on 13,219,781 patients) on the basis of the Korean National Health Insurance Service database from 2002 to 2013. The 12-year national colonoscopy burden was analyzed according to patient age, patient sex, and healthcare facility type. Results: The overall volume of colonoscopy increased 8-fold over the 12-year period. The annual colonoscopic polypectomy rate significantly increased in all patient sex and age groups over the 12-years period (all p<0.001). The yearly colonoscopic polypectomy rate for men was significantly increased compared with that for women (2.3% vs 1.7%, p<0.001) and for the screening-age group compared with that for the young-age group (2.0% vs 1.6%, p<0.001). The yearly colonoscopic polypectomy rate relative to the total colonoscopy volume significantly increased in primary, secondary, and tertiary facilities by 2.4%, 1.9%, and 1.4% during the 12-year period (all p<0.001). In addition, the annual colonoscopy volume covered by high-volume facilities significantly increased by 1.8% in primary healthcare facilities over the 12-year period (p<0.001). Conclusions Healthcare resources should be prioritized to allow adequate colonoscopic capacity, especially for men, individuals in the screening-age group, and at primary healthcare facilities. Cost-effective strategies to improve the quality of colonoscopy may focus on primary healthcare facilities and high-volume facilities in Korea.

Colorectal cancer is the third most common cancer in Korea and the third leading cause of death from cancer. Treatment outcomes for colon cancer are steadily improving due to national health screening programs with advances in diagnostic methods, surgical techniques, and therapeutic agents.. The Korea Colon Cancer Multidisciplinary (KCCM) Committee intends to provide professionals who treat colon cancer with the most up-to-date, evidence-based practice guidelines to improve outcomes and help them make decisions that reflect their patients’ values and preferences. These guidelines have been established by consensus reached by the KCCM Guideline Committee based on a systematic literature review and evidence synthesis and by considering the national health insurance system in real clinical practice settings. Each recommendation is presented with a recommendation strength and level of evidence based on the consensus of the committee.