PURPOSE: We analyzed the preoperative and postoperative clinical findings of orbital wall fracture patients between the group operated within 2 weeks (early group) and the group operated 3 weeks or later (delayed group). METHODS: Eighty three patients who had been operated from January 1997 to December 2001 were included, 68 patients were early group and 15 patients were delayed group. We analyzed retrospectively the degree of diplopia, limitation of extraocular motility and enophthalmos for more than 6 months following surgery. RESULTS: Orbital wall fracture predominantly occurred in male than in female (p>0.05), and mostly between 21 and 40 years old. The main cause was from violence and traffic accidents. The major coexisting diseases were head trauma and fractures of low extremities, especially in the group of delayed operation. The common locations of fracture were either inferior wall or combined inferior and medial walls. The early group showed less severe preoperative clinical states and better outcomes of postoperative improvement than the delayed group. However, there was no statistically significant difference between two groups in the degree of postoperative limitation of extraocular motility and enophthalmos. CONCLUSIONS: The early group tended to be less severe preoperatively and showed better postoperative outcome than the delayed group. However, the repair of orbital wall fracture was be indicated to improve clinical states even after 3 weeks following injury.
Accidents, Traffic ; Adult ; Craniocerebral Trauma ; Diplopia ; Enophthalmos ; Extremities ; Female ; Humans ; Male ; Orbit* ; Retrospective Studies ; Violence

PURPOSE: Flavobacterium indologenes is known to cause keratitis very rarely. Authors have experienced 1 case of keratitis from Flavobacterium indologenes with history of diabetes mellitus, thereby reporting it. METHODS: History taking, slit lamp examination, staining and culture, sensitivity test about antibiotics were performed on 1 case of keratitis. RESULTS: Flavobacterium indologenes was detected in staining and culture that was performed on the first visit. Piperacillin was used based on the sensitivity test about antibiotics. Improvement of corneal lesion and symptom was observed with the use of piperacillin. CONCLUSIONS: Flavobacterium indologenes can be considered as a casual pathogen in keratitis with condition susceptible to opportunistic infection such as systemic illness or abnormal ocular immunity.
Anti-Bacterial Agents ; Diabetes Complications ; Diabetes Mellitus ; Flavobacterium* ; Keratitis* ; Opportunistic Infections ; Piperacillin

PURPOSE: To report a case of high dose steroid-responsive Purtscher's retinopathy which was developed after operation for diaphragmatic laceration sustained in motorcycle accident. CASE SUMMARY: A 68-year-old man came to our hospital with complaining of decreased visual acuity in the right eye after diaphragmatic laceration operation. Best corrected visual acuity was 0.1 in the right eye. Anterior segment was nonspecific. However, afferent pupillary defect was observed. Superficial intraretinal hemorrhage, numerous cotton-wool spots, peripapillary hemorrhage, and macular edema were detected on fundus examination. Fluorescein angiography revealed capillary nonperfusion and fluorescein filling defect due to retinal hemorrhage in arteriovenous phase and fluorescein leakage from the macula and capillary nonperfusion area in the late venous phase. Accordingly, Purtscher's retinopathy was diagnosed and the patient was observed without specific treatment. After 2 weeks of observation, symptoms and fundus findings were not changed. High-dose steroid therapy was begun with injection of one gram of methylprednisone for three days, switched to oral prednisolone, and then slowly tapered in period of 3 weeks. 7 days after the treatment, visual acuity was improved to 0.2 in the right eye but afferent pupillary defect was still observed. Cotton-wool spots slightly decreased, peripapillary hemorrhage was absorbed but macular edema was remained. 14 days after the treatment, visual acuity greatly improved to 0.63 and afferent pupillary defect was not observed. Cotton-wool spots and macular edema were decreased but fluoroscein leakage from capillary nonperfusion area was remained. CONCLUSIONS: In the case of Purtscher's retinopathy, high-dose steroid therapy can be a useful management method for the improvement of visual acuity and other symptoms.
Aged ; Capillaries ; Eye ; Fluorescein ; Fluorescein Angiography ; Hemorrhage ; Humans ; Lacerations ; Macular Edema ; Motorcycles ; Porphyrins ; Prednisolone ; Pupil Disorders ; Retinal Hemorrhage ; Visual Acuity

OBJECTIVES: Purpose of this study is investigation the influence of intravenous and oral bisphosphonate to bone union and clinical results in patient treated with plate fixation in an osteoporotic distal radius fracture. MATERIALS AND METHODS: The medical records of 160 patients with an osteoporotic distal radius fracture treated with plate fixation in our hospital between January 2008 and April 2012 were reviewed retrospectively. The patients were classified by 3 groups; who did not administrate bisphosphonate after surgery as Group I (n=69), administrated oral bisphosphonate after surgery as Group II (n=44), and administrated intravenous bisphosphonate as Group III (n=47). After surgery, bone union, radiologic parameters, disabilities of the DASH score and range of motion of wrist were assessed. RESULTS: Mean time of bone union was 6.7 weeks in Group I, 6.8 weeks in Group II, and 7.1 weeks in Group III. There was no significant difference between three groups (P=0.571). Bone union rate on 6weeks shows no significant differences between three groups (P=0.16). Three groups also have no significant differences in all radiologic and clinical parameters. CONCLUSION: This study shows that early initiation of oral and Intravenous bisphosphonate did not affect bone union and clinical results compared to group who did not administrate bisphosphonate result in patient treated with plate fixation in an osteoporotic distal radius fracture.
Humans ; Medical Records ; Osteoporosis ; Radius Fractures ; Radius ; Range of Motion, Articular ; Retrospective Studies ; Wrist

Emergency Medicine is a medical specialty that provides comprehensive emergency care. The spectrum of emergency medicine includes humanity as well as medical care for emergency patients. Since the Korean Society of Emergency Medicine has been established and the training course for emergency residents has begun, quality improvement of the training course still remains to be one of the most important issues in emergency medicine. This report is to understand the current status of training of emergency residents and to improve the quality of training of emergency residents. The survey was performed with questionnaires regarding current status of training and opinions to improve quality of training. The questionnaires were sent to all emergency physicians and emergency residents registered to the Korean Society of Emergency Medicine via an electronic mail or a printed letter. The response rates were 49.6% for emergency physicians and 35.8% for emergency residents. On the basis of the result of this survey, we suggest five proposals for improving the quality of resident training course. These include complete adherence of each institution to training guidelines presented by the Korean Society of Emergency Medicine, development of the education program compatible to each institution, shortening of length of training duration from 4 years to 3 years, promotion of the training environment, and introduction of evaluation examination to the training course.
Education ; Electronic Mail ; Emergencies* ; Emergency Medical Services ; Emergency Medicine ; Humans ; Internship and Residency ; Quality Improvement ; Surveys and Questionnaires

OBJECTIVE: To determine whether the duration and timing of prophylactic antibiotics influence maternal postoperative infectious morbidity in cesarean section performed at tertiary center. METHODS: This study was a prospective, randomized trial. Pregnant women who underwent cesarean section between December 2008 and September 2009 at tertiary center were enrolled and divided into two groups: Group A, antibiotic prophylaxis was applied for 24 hours and Group B, antibiotic prophylaxis was applied for 48 hours. First generation of cephalosporin was administrated within 30 minutes prior skin incision or after cord clamping. The occurrence of postoperative infectious morbidity such as febrile morbidity, wound infection, endometritis, urinary track infection, pneumonia, sepsis and pelvic abscess and hospital stays were compared. RESULTS: There were 413 pregnant women enrolled and then randomized into 220 for group A and 197 for group B. No demographic differences were observed between two groups. The infectious morbidity was 1.9% (8/413) and wound infection was the most common postoperative infections morbidity. No significant difference was found between the groups for infectious morbidity and hospital stays. Also timing of prophylactic antibiotics did not result in significant difference for infectious morbidity. CONCLUSION: Short course of prophylactic antibiotics has been shown to be as efficacious as multidose of prophylactic antibiotics for preventing infectious morbidity in cesarean section and timing did not influence on infections morbidity. Further studies focusing on duration and timing of prophylactic antibiotics for cesarean section are needed.
Abscess ; Anti-Bacterial Agents ; Antibiotic Prophylaxis ; Cesarean Section ; Constriction ; Endometritis ; Female ; Humans ; Length of Stay ; Pneumonia ; Pregnancy ; Pregnant Women ; Prospective Studies ; Sepsis ; Skin ; Track and Field ; Wound Infection

PURPOSE: Plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) binds to low-density lipoprotein. The levels of Lp-PLA2 reflect the plaque burden, and are upregulated in acute coronary syndrome (ACS). We investigated the diagnostic value of Lp-PLA2 levels and found that it might be a potential biomarker for ACS. MATERIALS AND METHODS: We classified 226 study participants into three groups: patients without significant stenosis (control group), patients with significant stenosis with stable angina (SA group), and patients with ACS (ACS group). RESULTS: Lp-PLA2 and high-sensitivity C-reactive protein (hs-CRP) levels were significantly greater in the ACS group than in the SA group (p=0.044 and p=0.029, respectively). Multivariate logistic regression analysis revealed that Lp-PLA2 levels are significantly associated with ACS (odds ratio=1.047, p=0.013). The addition of Lp-PLA2 to the ACS model significantly increased the global chi2 value over traditional risk factors (28.14 to 35.602, p=0.006). The area under the receiver operating characteristic curve for Lp-PLA2 was 0.624 (p=0.004). The addition of Lp-PLA2 level to serum hs-CRP concentration yielded an integrated discrimination improvement of 0.0368 (p=0.0093, standard error: 0.0142) and improved the ability to diagnose ACS. CONCLUSION: Lp-PLA2 levels are related to plaque stability and might be a diagnostic biomarker for ACS.
1-Alkyl-2-acetylglycerophosphocholine Esterase/*blood ; Acute Coronary Syndrome/*blood/physiopathology ; Aged ; Aged, 80 and over ; Angina Pectoris ; Biological Markers/blood ; C-Reactive Protein/*metabolism ; Coronary Angiography ; Female ; Humans ; Lipoproteins, LDL/*blood ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Plaque, Atherosclerotic/blood ; ROC Curve ; Risk Factors

While endovascular aneurysm repair (EVAR) is prevailing for the treatment of abdominal aortic aneurysm (AAA) in modern vascular practice, PURPOSE: we conducted nationwide questionnaire survey to investigate the current status of AAA treatment and their results in Korea. METHOD: We reviewed the replies from 28 hospitals (33 departments) to the questionnaire inquiring annual number, clinical features, mode of treatment and results of AAA patients during the period from Jan. 2000 to Jul. 2004. Results: 980 AAA patients were reported including 292 ruptured AAA (29.8%) and 688 non-ruptured AAA (70.2%). For treatment of AAA, 834 (85.1%) surgical repairs (SRs) and 111 (11.3%) endovascualr aneurysm repairs (EVARs) were performed while 35 patients (3.6%) died of AAA rupture before operation. The locations of AAA were infrarenal in 889 (90.7%), juxtarenal in 62 (6.3%), and suprarenal in 29 patients (3.0%). Among 834 patients undergoing SR, 577 patients (69.2%) had non-ruptured AAAs and 257 patients (30.8%) had ruptured AAAs. Mean operative mortality rate was 4.1% after elective SRs, 30.7% after SR for ruptured AAAs, and 2.3% after EVARs. The reported brand name of stent graft devices were various including domestic custom-made in 56 (50.5%), imported brand in 18 (16.2%) while 37 (33.3%) stent grafts were not reported their brand name. The frequencies of type I and III endoleaks after EVAR were reported 5.8% and 5.8% respectively in 86 patients with an available data. CONCLUSION: SR has been used as a major treatment option in Korea for the treatment of AAA patients while EVAR is increasing. The mortality rate of SR of AAA was comparable to western multi-center trial reports but mortality or morbidity rates of EVAR were unable to know in this questionnaire survey.
Aneurysm ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Blood Vessel Prosthesis ; Endoleak ; Humans ; Korea* ; Mortality ; Questionnaires* ; Rupture ; Treatment Outcome

BACKGROUND/AIMS: The aims of this study were to determine subgoups of functional dyspesia and to evaluate the short-term effect of cisapride in patients with functional dyspepsia in Korea. METHODS: 1025 patients, with a mean age of 42.6 years, with symptoms of functional dyspepsia, were recruited consecutively and upper gastrointestinal symptoms were investigated by interview in 41 hospitals in Korea. In an open, multicenter trial, 1025 patients received Smg of cisapride three times a day (TID) for at least .2 weeks for the treatment of symptoms of functional dyspepsia. When necessary, the dose of cisapride was increased to 10mg TID and the duration of therapy was extended to 4 weeks. RESULTS: The most frequently reported symptoms of functional dyspepsia were epigastric discomfort or fullness (85%), bloating (70%), belching (53%), early satiety (52%) and epigastric pain (46%) retrospectively. Subgroups of functional dyspepsia were as follows; dysmotility-like 73.5%, ulcer-like 39.7%, reflux-like 13.0%, and unspecified dyspepsia 14.0%. However, 33.2% of subjects with functional dyspepsia could be classified into more than one subgroup. Upper gastrointestinal symptoms were decreased to average 50.3% (range; 42.2 to 59.2%) after 2 weeks of cisapride treatment and to 25% (19.2 to 29.9%) after 4 weeks. cisapride therapy resulted in good or excellent improvement in 59.0% of the patients after two weeks, in 75% of patients after 4 weeks. Adverse events were occurred in 52 patients (5.8% of all patients), most commonly, loose stools or diarrhea (3.5%), abdominal pain (1.1%), and dizziness (0.3%). The majority of adverse events was mild and transient in nature and led to premature discontinuation of treatment in 4 patients. CONCLUSIONS: Although the majorities of patients with functional dyspepsia have dysmotility like symptoms in Korea, there is such overlap among the dyspepsia subgroups. Most patients responded well to a short therapeutic trial with cisapride without significant side effects.
Abdominal Pain ; Cisapride* ; Diarrhea ; Dizziness ; Dyspepsia* ; Eructation ; Humans ; Korea* ; Retrospective Studies