Congenital kyphoscoliosis is an abnormal curvature of spine that is due to presence of vertebral anomalies which cause an imbalance in the longitudinal growth of the spine. Congenital kyphoscoliosis is often rigid and its correction can be difficult. It is often resistant to conservative treatment and more patients require surgical treatment than those with idiopathic curvature. The indication for the conservative treatment with Milwaukee brace is much limited. Largely Milwaukee brace is a delaying tactic to correct the spinal curvature until its growth is further advanced and it is more amenable for fusion. This paper was aimed to review our experience with 49 patients with congenital scoliosis, kyphosis and kyphoscoliosis who were treated surgically with various methods of preoperative correction, from Jan. 1968 to Dec. 1983, in special reference to new classification, proposed for common application to both kyphosis and scoliosis, and following results were obtained. 1.The average age when scoliosis was observed was 6.9 years, but the average age of surgery was deferred until 15.2 years. 2. The distribution of curve pattems were 1 cervicothoracic, 24 thoracic, 12 thoracolumbar, 7 lumbar and 1 lumbosacral curve in 45 scoliotic curves and 13 thoracic, 13 thoracolumbar and 4 lumbar curves in 30 kyphotic curves. The average degrees of deformity were most severe in thoracolumbar curves both in kyphosis and scoliosis. 3. The new morphological classification, which could be applicable to both kyphosis and scoliosis, was proposed. The type of unsegmented bar with contralateral hemivertebra was most common both in kyphosis and scoliosis. 4. Preoperative average degrees of scoliosis was 58.7 degrees and final correction was 20.6 degrees (35.1%) with loss of comection of 3.7 degrees (6.3%). Preoperative average degrees of kyphosis was 63.7 degrees and final correction was 20.1 degrees (42.5%) with loss of correction of 7.0 degrees (11.0%). 5. The surgical method with anterior and posterior fusion was the best treatment of severe kyphoscoliossis, in the aspect of final correction and loss of correction. 6. The lumbar curve was most amenable to treatment with the best final correction and the least loss of correction.
Braces ; Classification ; Congenital Abnormalities ; Humans ; Kyphosis ; Methods ; Scoliosis ; Spinal Curvatures ; Spine

A 42-year-old man presented with severe pancytopenia and uncontrolled epistaxis. The diagnosis of SLE was made and the pancytopenia was found to be due to myelofibrosis. The pulse therapy with methylprednisolone and maintenance therapy with prednisolone reversed both pancytopenia and myelofibrosis. Although myelofibrosis has been described in SLE, this coexistence must be very rare since there has been only 19 cases showing this combination. We report a case of SLE with myelofibrosis which was reversed by the treatment with glucocorticoid.
Adult ; Diagnosis ; Epistaxis ; Humans ; Lupus Erythematosus, Systemic* ; Methylprednisolone ; Pancytopenia ; Prednisolone ; Primary Myelofibrosis*

BACKGROUND: The aim of this study was to assess the relationship between acute physiologic and chronic health examination (APACHE) II and sequential organ failure assessment (SOFA) scores and outcomes of post-cardiac arrest patients treated with therapeutic hypothermia (TH). METHODS: Out-of-hospital cardiac arrest (OHCA) survivors treated with TH between January 2010 and December 2012 were retrospectively evaluated. We captured all components of the APACHE II and SOFA scores over the first 48 hours after intensive care unit (ICU) admission (0 h). The primary outcome measure was in-hospital mortality and the secondary outcome measure was neurologic outcomes at the time of hospital discharge. Receiver-operating characteristic and logistic regression analysis were used to determine the predictability of outcomes with serial APACHE II and SOFA scores. RESULTS: A total of 138 patients were enrolled in this study. The area under the curve (AUC) for APACHE II scores at 0 h for predicting in-hospital mortality and poor neurologic outcomes (cerebral performance category: 3-5) was more than 0.7, and for SOFA scores from 0 h to 48 h the AUC was less than 0.7. Odds ratios used to determine associations between APACHE II scores from 0 h to 48 h and in-hospital mortality were 1.12 (95% confidence interval [CI], 1.03-1.23), 1.13 (95% CI, 1.04-1.23), and 1.18 (95% CI, 1.07-1.30). CONCLUSIONS: APACHE II, but not SOFA score, at the time of ICU admission is a modest predictor of in-hospital mortality and poor neurologic outcomes at the time of hospital discharge for patients who have undergone TH after return of spontaneous circulation following OHCA.
APACHE ; Area Under Curve ; Cardiopulmonary Resuscitation ; Hospital Mortality ; Humans ; Hypothermia* ; Hypothermia, Induced ; Intensive Care Units ; Logistic Models ; Odds Ratio ; Organ Dysfunction Scores* ; Out-of-Hospital Cardiac Arrest* ; Outcome Assessment (Health Care) ; Retrospective Studies ; Survivors

Relapsing polychondritis, a rare multisystem disease, is characterized by wide spread potentially destructive inflammatory lesions, involving cartilaginous structures throughout the body. Auricular chondritis is the most frequent presenting sign of this disease, with arthritis being the second. Other clinical menifestations include nasal chondritis, scleritis, damage to tracheobroncheal cartilage, and cardiovascular and renal involvement. We experienced three cases of relapsiug polychondritis. One case is 66 year old male with bilateral auricular chondritis with histologic confirmation, episcleritis, polyarthritis, periarterial vasculitis, and sensorineural hearing loss. Another case is 42 year old male with respiratory, nasal, auricular chondritis and psoriasis with arthritis. The third case is 46 year old female with three year history of relapsing polychondritis, presenting bilateral auricular and nasal chondritis and severe respiratory tract involvement with histologic confirmation. We also reviewed the other case reports of relapsing polychondritis in Korea. The major presenting manifestations of relapsing polychondritis in Korea were respiratory tract symptoms of dyspnea, cough, and sputum. That is, auricular chondritis was less frequent thari laryngotracheal-bronchial involvement.
Adult ; Aged ; Arthritis ; Cartilage ; Cough ; Dyspnea ; Female ; Hearing Loss, Sensorineural ; Humans ; Korea ; Male ; Middle Aged ; Polychondritis, Relapsing* ; Psoriasis ; Respiratory System ; Scleritis ; Sputum ; Vasculitis

PURPOSE: In Korea, emergency department overcrowding in large hospitals have caused social concern. Moreover, patients with low socioeconomic status visit the emergency department more frequently. This kind of visitation also causes a burden on the national budget, but emergent patient should be treated in emergency department regardless of economic state. So, on establishment of policy about the patient with low socioeconomic status, the frequency of emergency visitation alone is difficult to obtain a sufficient basis for policy-making. METHODS: We retrospectively analyzed adult patients with a disease who visited the Pusan Wide-regional Emergency Center in 2015. Korean Triage and Acuity Scale level I, II or III were defined as emergency, and level IV or V was defined as non-emergency. The ratio of emergency and non-emergency was compared in the National Health Insurance and Medicaid database. RESULTS: The number of patients with National Health Insurance was 16,208 (90.3%) and with Medicaid was 1,737 (9.7%). Among those with National Health Insurance, there were 12,720 (78.5%) emergency cases and 3,488 (21.5%) non-emergency cases. Among those with Medicaid, 1,379 (79.4%) emergency cases and 358 (20.6%) non-emergency cases. Between National Health Insurance and Medicaid, there was no statistically significant difference in the ratio of emergency and non-emergency (p=0.380) CONCLUSION: Accessibility of emergency and non-emergency patients with National Health Insurance and Medicaid to Pusan Wide-regional Emergency Center was not different.
Adult ; Budgets ; Busan ; Emergencies* ; Emergency Service, Hospital ; Humans ; Insurance Coverage* ; Insurance* ; Korea ; Medicaid ; National Health Programs ; Retrospective Studies ; Social Class ; Triage

We report our initial experience with laparoscopic radical cystectomy of an orthotopic neobladder. A 68 years old male patient with muscle invasive, organ confined, and transitional cell carcinoma of the bladder underwent operation. The operation specimen was extracted through the 5 cm sized, muscle splitting incision in the umbilical trocar site. The urinary diversion was achieved by ileal W-neobladder through a removal site of a specimen. The orthotopic neobladder was sutured to the urethra intracorporeally. Operation time and blood loss were 11 hours and 450 ml, respectively. The patient was discharged on the 14th postoperative day. Laparoscopic radical cystectomy, which involves the orthotopic neobladder creation, is feasible, although difficult and technically demanding. With growing experience, laparoscopic radical cystectomy can be an alternative to open technique.
Aged ; Carcinoma, Transitional Cell ; Cystectomy* ; Humans ; Laparoscopy ; Male ; Surgical Instruments ; Urethra ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Diversion

PURPOSE: We evaluated the differences between radiologically measured size and pathologic size of renal tumors. MATERIALS AND METHODS: The data from 171 patients who underwent radical or partial nephrectomy for a renal tumor at Ajou University Hospital were reviewed. Radiologic tumor size, which was defined as the largest diameter on a computed tomographic scan, was compared with pathologic tumor size, which was defined as the largest diameter on gross pathologic examination. RESULTS: Mean radiologic size was significantly larger than mean pathologic size for all tumors (p=0.019). When stratified according to radiologic size range, mean radiologic size was significantly larger than mean pathologic size for tumors <4 cm (p=0.003), but there was no significant difference between the sizes for tumors 4-7 cm and >7 cm. When classified according to histologic subtype, mean radiologic size was significantly larger than mean pathologic size only in clear cell renal cell carcinomas (p=0.002). When classified according to tumor location, mean radiologic size was significantly larger than mean pathologic size in endophytic tumors (p=0.043) but not in exophytic tumors. When endophytic tumors were stratified according to radiologic size range, there was a significant difference between the mean radiologic and pathologic sizes for tumors <4 cm (p=0.001) but not for tumors 4-7 cm (p=0.073) and >7 cm (p=0.603). CONCLUSIONS: Our results suggest that in planning a nephron-sparing surgery for renal tumors, especially for endophytic tumors of less than 4 cm, the tumor size measured on a computed tomography scan should be readjusted to get a more precise estimate of the tumor size.
Carcinoma, Renal Cell ; Humans ; Kidney ; Nephrectomy

Aspiration of foreign body, a clinical problem seen more commonly in the pediatric age group, is infrequently seen in the adult population. Although rigid bronchoscopy has been the mainstay of treatment, recently, easier manipulation, greater range of visulization, flexibility, topical anesthesia has made flexible bronchoscopy of choice for dealing with aspirated foreign body in adult. Operation increase morbidity and mortality, delay foreigh body removal. A 41-year old male was admitted to this hospital due to aspiration of pushpin. He showed high opaque density protruding in the orifice of right lower lobar bronchus. We report a case of foreign body removal by flexible bronchoscopy with brief review of the literature.
Adult ; Anesthesia ; Bronchi ; Bronchoscopy* ; Foreign Bodies ; Humans ; Male ; Mortality ; Pliability

The purposes of this study were basic data collection and evaluation of the risk factors regarding rowing injuries through an epidemiologic study. We performed a questionnaire survey from rowers who participated in the 91th Annual Sports Festival in Jinju, Gyeongnam, in October 2010. 145 rowers (male: 84, female: 61) responded to the survey. The t-test was used for comparisons for the type of injury, age, and gender. The multiple linear regression analysis and the logistic regression analysis was used for the evaluation of risk factors. Overall, 100 (69.0%) rowers had a history of injury. The incidence of overuse injuries was significantly higher than the incidence of traumatic injuries (2.07+/-2.59/rower vs. 1.46+/-2.08/rower, p=0.027). The incidence of injuries for the adult group was significantly higher than those in the youth group (4.42+/-4.45/rower vs. 2.61+/-3.63/rower, p=0.008). There was no significant difference between males and females (3.85+/-4.33/rower vs. 3.08+/-3.87/rower, p=0.275). Also, the incidence of cross-training related injury was significantly higher in traumatic injuries rather than in overuse injuries (0.92+/-1.54/rower vs. 0.5+/-1.07/rower, p=0.008). In addition, rowing injuries were more related with overuse injuries. Risk factors regarding overall rowing injuries were training time, and training using stairs. Traumatic injuries were related with diverse cross-training and time spent cross-training. Therefore, in order to reduce the incidence of rowing injuries, time and the number of cross-training sessions should be reduced. Moreover, highly risky training such as using stairs should be replaced with other low risk training methods.
Adolescent ; Adult ; Athletes ; Cumulative Trauma Disorders ; Data Collection ; Epidemiologic Studies ; Female ; Holidays ; Humans ; Incidence ; Linear Models ; Logistic Models ; Male ; Surveys and Questionnaires ; Risk Factors ; Sports

The purpose of this study is to evaluate the risk factors regarding the injuries from sports climbing through an epidemiologic study. We performed a questionnaire survey on sports climbers who participated in the 93th Annual Sports Festival in Daegu, in October 2012. Sixty-nine climbers (male: 57, female: 12) responded to the survey. The t-test was used for comparisons of the incidence of injury, according to sex and career. The multiple linear regression analysis and the logistic regression analysis were used for the evaluation of risk factors that affected the occurrence of injury. Overall, 58 (84.06%) climbers had history of injury. The incidences of climbing related injuries were higher than the incidences of cross-training related injuries. However, there were no significant difference (p=0.680). Also, there was no significant difference between males and females (p=0.467), and professionals and amateurs (p=0.076). Fifty (72.46%) out of 69 climbers had history of traumatic injuries, and 40 (57.97%) climbers had history of overuse injuries. Significant risk factors for traumatic injuries are leading (odds ratio, OR=17.854), speed (OR=45.246), and bouldering (OR=13.595). Significant risk factors for overuse injuries are leading (OR=23.252) and bouldering (OR=41.260). Significant risk factors for middle phalanx injuries, which happens most frequently in climbing related injuries, are leading (OR=20.625) and bouldering (OR=25.756). For traumatic injuries, leading, speed, and bouldering are prone to cause injuries, and leading and bouldering are significant factors for overuse injuries. Therefore, it is considered that the systematic organized training can help reduce the incidence of injury.
Athletes* ; Athletic Injuries ; Cumulative Trauma Disorders ; Daegu ; Epidemiologic Studies ; Female ; Holidays* ; Humans ; Incidence ; Linear Models ; Logistic Models ; Male ; Surveys and Questionnaires ; Risk Factors* ; Sports*