Purpose: Epidemiological data on injuries resulting from ice hockey and their management are lacking in Korea. A comprehensive analysis of such data is crucial for the effective prevention and management of ice hockey injuries. This study aimed to determine the epidemiological profile of ice hockey injuries and their management among elite Korean players. Methods: The descriptive epidemiological study involved three semiprofessional male ice hockey teams and used a retrospective self-reported questionnaire for assessment. The data collected included demographic characteristics such as player positions and stick-side preferences, injured body parts, injury types, treatment methods, and the decision-maker for returning to sports. Results: A total of 68 players were included in the study, of whom 58 (85.3%) experienced moderate-to-severe orthopedic injuries. Among the reported injuries, 93 (77.5%) occurred during the games, with player-to-player contact being the most frequent cause of such injuries. The decision to return to sports in 53 cases (44.2%) was made by the medical staff, whereas players and nonmedical staff made that decision in 67 cases (55.8%). The decision-making process of the medical staff for allowing players to return to sports was significantly associated with the player’s position and whether the injury required surgery. Conclusion The study emphasizes the high prevalence of orthopedic injuries among elite ice hockey players in Korea and the importance of injury prevention strategies. It also highlights the need for increased involvement of medical staff in return-to-play decisions to ensure successful recovery of players and their reintegration into the competition.

No abstract available.
Eating* ; Gastric Mucosa* ; Hydrochloric Acid* ; Mucous Membrane*

Esophageal variceal bleeding is a common complication of liver cirrhosis. Non-selective beta blockers (NSBB) have been established in numerous studies as one of the medical treatment for cirrhosis, especially in the primary and secondary prevention of variceal bleeding. The dose of NSBB is adjusted for a reduction in the resting heart rate by 25%, to 55 beat/min, or until the occurrence of adverse effect. The mean adjusted dose of propranolol in Korean study is 160 mg/day. Nevertheless, low dose propranolol is frequently used in real clinical field. A study by Kwon et al. showed that effect of propranolol in the prevention for esophageal rebleeding was superior in maximally-tolerable dose group of propranolol than low dose group. In this editorial, we have reviewed the studies of prevention for variceal rebleeding focusing on the dose of propranolol.
Esophageal and Gastric Varices ; Fibrosis ; Heart Rate ; Liver Cirrhosis ; Propranolol* ; Secondary Prevention

BACKGROUND: The Damus-Kaye-Stansel (DKS) procedure is a proximal MPA-ascending aorta anastomosis used to relieve systemic ventricular outflow tract obstructions (SVOTO) and pulmonary hypertension. The purpose of this study was to review the indications and outcomes of the DKS procedure, including the DKS pathway and semilunar valve function. MATERIAL AND METHOD: A retrospective review of 28 patients who underwent a DKS procedure between May 1994 and April 2006 was performed. The median age at operation was 5.3 months (13 days~38.1 months) and body weight was 5.0 kg (2.9~13.5 kg). Preoperative pressure gradients were 25.3+/-15.7 mmHg (10~60 mmHg). Eighteen patients underwent a preliminary pulmonary artery banding as an initial palliation. Preoperative main diagnoses were double outlet right ventricle in 9 patients, double inlet left ventricle with ventriculoarterial discordance in 6, another functional univentricular heart in 5, Criss-cross heart in 4, complete atrioventricular septal defect in 3, and hypoplastic left heart variant in 1. DKS techniques included end-to-side anastomosis with patch augmentation in 14 patients, classical end-to-side anastomosis in 6, Lamberti method (double-barrel) in 3, and others in 5. The bidirectional cavopulmonary shunt and Fontan procedure were concomitantly performed in 6 and 2 patients, respectively. RESULT: There were 4 hospital deaths (14.3%), and 3 late deaths (12.5%) with a follow-up duration of 62.7+/-38.9 months (3.3~128.1 months). Kaplan-Meier estimated actuarial survival was 71.9%+/-9.3% at 10 years. Multivariate analysis showed right ventricle type single ventricle (hazard ratio=13.960, p=0.004) and the DKS procedure as initial operation (hazard ratio=6.767, p=0.042) as significant mortality risk factors. Four patients underwent staged biventricular repair and 13 received Fontan completion. No SVOTO was detected after the procedure by either cardiac catheterization or echocardiography except in one patient. There was no semiulnar valve regurgitation (>Gr II) or semilunar valve-related reoperation, but one patient (3.6%) who underwent classical end-to-side anastomosis needed reoperation for pulmonary artery stenosis caused by compression of the enlarged DKS pathway. The freedom from reoperation for the DKS pathway and semilunar valve was 87.5% at 10 years after operation. CONCLUSION: The DKS procedure can improve the management of SVOTO, and facilitate the selected patients who are high risk for biventricular repair just after birth to undergo successful staged biventricular repair. Preliminary pulmonary artery banding is a safe and effective procedure that improves the likelihood of successful DKS by decreasing pulmonary vascular resistance. The long-term outcome of the DKS procedure for semilunar valve function, DKS pathway, and relief of SVOTO is satisfactory.
Aorta ; Aorta, Thoracic ; Bays ; Body Weight ; Cardiac Catheterization ; Cardiac Catheters ; Constriction, Pathologic ; Crisscross Heart ; Double Outlet Right Ventricle ; Echocardiography ; Follow-Up Studies ; Fontan Procedure ; Freedom ; Heart ; Heart Ventricles ; Humans ; Hypertension, Pulmonary ; Mitral Valve Insufficiency ; Multivariate Analysis ; Parturition ; Pulmonary Artery ; Reoperation ; Retrospective Studies ; Risk Factors ; Vascular Resistance

We report a case of aspergillosis of the central nervous system in patient with rheumatoid arthritis (RA). A 46-year-old woman with 20-year history of RA and on treatment with corticosteroid, hydroxychloroquine and methotrexate, was admitted because of drowsiness, dizziness and dysarthria. On admission, physical examination and laboratory data showed, among other findings, disappearance of pupil reflex, positive Babinski and Chaddock reflex. Magnetic resonance imaging (MRI) of brain showed multiple high signal intensity lesion on medulla, pons, midbrain, basal ganglia, internal capsule, thalamus and hypothalmus. Stereotactic brain biopsy was performed and biopsy specimen revealed an invasive Aspergillus.
Arthritis, Rheumatoid* ; Aspergillosis* ; Aspergillus ; Basal Ganglia ; Biopsy ; Brain ; Central Nervous System ; Dizziness ; Dysarthria ; Female ; Humans ; Hydroxychloroquine ; Internal Capsule ; Magnetic Resonance Imaging ; Mesencephalon ; Methotrexate ; Middle Aged ; Physical Examination ; Pons ; Pupil ; Reflex ; Sleep Stages ; Thalamus

Recently, increasingly invasive therapeutic endoscopic procedures and more complex gastrointestinal surgeries such as endoscopic mucosal resection, endoscopic submucosal dissection, and novel laparoscopic approaches have resulted in endoscopists being confronted more frequently with perforations, fistulas, and anastomotic leakages, for which nonsurgical closure is desired. In this article, we present our experiences with the use of over-the-scope clip (OTSC) for natural orifice transluminal endoscopic surgery (NOTES) closure, prevention of perforation, anastomotic leakages, and fistula closures. The OTSC is a valuable device for closing intestinal perforations and fistulas, for NOTES closure, and for the prevention of perforation after the excision of a tumor from the proper muscle layer. Furthermore, it seems to be quite safe to perform, even by endoscopists with little experience of the technique.
Anastomotic Leak ; Fistula ; Gastrointestinal Tract* ; Intestinal Perforation ; Natural Orifice Endoscopic Surgery ; Tertiary Care Centers*

BACKGROUND: Anatomic and functional abnormalities of the systemic atrioventricular (AV) valve are common in single ventricle pathologies and continue to be associated with poor early and late outcomes in surgically palliated single ventricle patients. We aggressively performed valvuloplasty for atrioventricular valve regurgitation (AVVR) during the course toward a Fontan operation. MATERIAL AND METHOD: Between January 1995 and December 2004, 209 patients underwent a Fontan operation in our institution. We retrospectively evaluated the prevalence of AVVR and the influence of AV valve repair on outcome, and we analyzed the progression of AVVR after the Fontan operation for 168 patients where echocardiographic follow up results for more than 6 months after the Fontan operation were available. During the course toward a Fontan operation, 25 patients underwent 30 procedures for AVVR. These procedures were carried out during placement of a bidirectional cavopulmonary shunt (BCPS) for nine patients, between the time of placement of a BCPS and the Fontan operation for four patients, and during the Fontan operation for 17 patients. Five patients underwent procedures for AVVR twice. RESULT: The late mortality rate after the Fontan operation was 4.2% (n=7), with a median follow-up duration of 52 months (range, 6~123 months). Seven patients (4%) had unfavorable outcomes such as significant (moderate or severe) AVVR in six patients, and significant AV valve stenosis in one patient was determined at the last follow up after the Fontan operation. Among the seven patients, four patients underwent AV valve repair after the Fontan operation, and one patient underwent subsequent AV valve replacement. Progression to AVVR of equal to or greater than grade 2 was noted in 30 patients (18%) at the last follow up after the Fontan operation, including 12 patients that underwent previous AV valve procedures. Initial grading of AVVR, a previous AV valve operation, and specific AV valve morphology such as a common AV valve or mitral atresia were significant risk factors for the progression of AVVR after the Fontan operation. CONCLUSION: In our surgical series, a small percentage of patients showed unfavorable outcomes related to AVVR during the course toward a Fontan operation. However, a closer follow-up is required to evaluate the progression of the AVVR after a Fontan operation, especially for patients showing poor AV valve function at the first presentation and specific AV valve morphology.
Constriction, Pathologic ; Follow-Up Studies ; Fontan Procedure ; Humans ; Prevalence ; Retrospective Studies ; Risk Factors

BACKGROUND: Pulmonary atresia with intact ventricular septum is morphologically heterogeneous, and the surgical outcome remains suboptimal compared to other complex congenital heart defects. We evaluated the long-term results for repair of pulmonary atresia with intact ventricular septum. MATERIAL NAD METHOD: Between January 1992 and June 2004, 38 patients underwent repair of pulmonary atresia with intact ventricular septum. The average age was 18 days (2~382 days). The average Z-value of the tricuspid annulus diameter was -3.1 (-5.6~0.8). Thirteen (36%) patients had right ventricle-to-coronary artery fistulas, and 4 (11%) patients had right ventricle-dependent coronary circulation. Average follow-up was 55 months (3 months~12.2 years). RESULT: Twenty-four patients underwent initial right ventricle (RV) decompression and 14 patients underwent systemic-to-pulmonary arterial shunt only. The average size of the tricuspid annulus of the patients who underwent RV decompression was significantly larger than that of the patients who underwent systemic-to-pulmonary arterial shunt only (Z-value -2.2 vs. -4.8, p= 0.000). There were 5 (13%) early and 1 late deaths. Early deaths occurred in 3 patients who had undergone RV decompression, and in 2 patients who had undergone systemic-to-pulmonary arterial shunt only (p=1.0). Biventricular repair was achieved in 12 (32%) patients, single ventricular repair in 8 (21%), and one and a half ventricular repair in 4 (11%) patients. Nine (24%) patients are waiting for the definitive repair. Kaplan-Meier survival at 5 and 8 years was 83.2%, respectively. CONCLUSION: Most of the deaths occurred after the initial palliation. Overall long- term survival was satisfactory. Early mortality should be reduced with careful preoperative evaluation and proper surgical strategy.
Mortality

BACKGROUND: Most patients with malignant esophageal stricture are surgically incurable at the time of presentation. The aim of this study was to determine the safety and efficacy of endoscopic expandable metal stent for palliation of dysphagia caused by malignant stricture. METHODS: From January 2000 to December 2001, thirty-two expandable metal stents (Nitis(R) Taewoong Med. Co. Korea, 6 uncovered, 12 covered, 14 double stents for antimigration, 18 mm diameter) were placed in 28 consecutive patients with dysphagia caused by malignancy. Dysphagia score, complications, reintervention, survival length after stent placement were evaluated. RESULTS: This study consisted of 23 men and 5 women. The patients were composed of 13 esophageal carcinomas, 11 gastro-esophageal junction cancers or cardiac cancers, 3 lung cancers, 1 breast cancer. Immediate improvement of dysphagia symptom was seen after initial stent placement in 27 patients (96%). Dysphagia score decreased from 3.0 (+/-0.51) to 1.06 (+/-0.77) after stent placement. There was one death due to hemorrhage after the procedure. There was no stent migration. Restenting was required in 4 cases due to tumor ingrowth (1/4) and overgrowth (3/4) and average interval to restenting was 95 days. Mean survival length was 109 days. CONCLUSION: Expandable metal stents offer excellent rapid palliation of malignant dysphagia. In a small subset of patients who received chemoradiation before stent placement, major complications such as bleeding, perforation, were observed.
Breast Neoplasms ; Constriction, Pathologic ; Deglutition Disorders ; Esophageal Stenosis ; Female ; Heart Neoplasms ; Hemorrhage ; Humans ; Korea ; Lung Neoplasms ; Male ; Stents*

BACKGROUND: We evaluated the early and mid-term results for repair of Ebstein's anomaly. MATERIAL AND METHOD: Between January 1989 and June 2004, 29 patients underwent repair of Ebstein's anomaly. The median age was 11.4 years (4 days-50 years). Tricuspid insufficiency equal to or greater than grade 3 was present in 21 (72.4%) patients. Surgical techniques included tricuspid valve repair with vertical plication of the atrialized ventricle (n=14), Carpentier's technique (n=7), tricuspid valve replacement (n=4), systemic-to-pulmonary arterial shunt (n=2), tricuspid valve repair (n=1), and Fontan operation (n=1). Bi-directional cavopulmonary shunt (BCPS) was required in 5 patients. Among the 2 neonates, one patient underwent successful biventricular repair, and the other patient underwent systemic-to-pulmonary arterial shunt. Follow-up was possible in 21 patients (75%), and the average follow-up was 37.6 months (3 months~11.3 years). RESULT: There were 1(3.4%) early and 1 late deaths. Reoperation was required in 4 patients. Two patients underwent tricuspid valve re-replacement, and the other 2 tricuspid valve repair. At recent follow-up, only 2 patients showed tricuspid insufficiency equal to or greater than grade 3, and most patients showed clinical improvement. Excluding the patients who underwent tricuspid valve replacement, the actuarial rate of freedom from reoperation at 1 and 5 years were 94.7% and 79.0%, respectively. CONCLUSION: Tricuspid valve repair was possible in most patients with good mid-term outcome. Most patients showed clinical and hemodynamic improvement. Indications for the BCPS should be clarified.
Ebstein Anomaly* ; Follow-Up Studies ; Fontan Procedure ; Freedom ; Heart Bypass, Right ; Hemodynamics ; Humans ; Infant, Newborn ; Reoperation ; Tricuspid Valve