Neither the cause nor the correct treatment of Kienbocks disease has been clearly established, but its clinical and radiologic presentations have been distinctly defined. There are many controversies concerning therapeutic guidelines for the treatment of Kienbocks disease. The purpose of this study is to evaluate the clinical result of triscaphe fusion with radial styloidectomy of Kienbocks disease. Ten cases of stage III Kienbocks disease by Lichtmans classification were treated by triscaphe fusion with radial styloidectomy from September 1991 to March 1997. We followed up over 24 months and evaluated clinical results. In all cases, pain was relieved. The postoperative results according to Kuschners method revealed three excellent, six good and one fair. The triscaphe fusion and radial styloidectomy was considered as useful method of treatment which has clinical efficacy in Kienbocks disease.
Classification ; Osteonecrosis*

Hyperextension injury in the thoracic spine is uncommon with only a few cases documented in the literature. The mechanism of these injuries is hyperextension combined with axial or shearing force. These types of injuries are associated with a high risk of dural tears and paraplegia. A 91-year-old female presented with acute back pain from a hyperextension injury in thoracic spine with no neurological deficit. Lumbar magnetic resonance imaging showed a intervertebral disc rupture. On day 20 of hospitalization, the herniated intervertebral disc compressed the spinal cord with incomplete paraplegia. Hyperextension injuries involving the three columns are very unstable and we recommend surgical treatment as soon as possible, not only because of the initial trauma, but a ruptured disc herniation can damage the spinal cord.
Back Pain ; Female ; Hospitalization ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging ; Paraplegia ; Rupture ; Spinal Cord ; Spine ; Thoracic Vertebrae

Tibialis anterior muscle hernia is the most common hernia among lower extremity muscles. This condition can be diagnosed by physical examination and radiologic findings, especially by dynamic ultrasonography. There are surgical methods of treatment for muscle hernia, including direct repair, fasciotomy, fascial patch grafting using autologous fascia lata or synthetic mesh. We report a case of tibialis anterior muscle hernia treated with local periosteal rotational flap. Because there are several advantages to the local periosteal rotational flap, such as lack of donor site morbidity, lack of skin irritation, low cost, simplicity, and an easy approach, this technique could be an option for tibialis anterior muscle hernia.
Fascia Lata ; Hernia ; Humans ; Lower Extremity ; Muscle, Skeletal ; Muscles ; Physical Examination ; Skin ; Tissue Donors ; Transplants

Classically autologous split-thickness skin graft or flap surgery has been applied to the case of full-thickness skin defects. However, simple skin graft causes postoperative adhesion and scar contracture, and flap surgery could cause functional and aesthetic trouble due to the scar at the donor site. It is well known that the thicker dermis is transplanted, the lesser adhesion and contracture can be resulted. In spite of all advantages, this thicker layer of dermis can also cause pain, infection, hypertrophic scar and delayed healing at the donor site. Two treatments have been developed and applied to solve the problems mentioned above: one is acellular dermal matrix(Alloderm(R)) and the other is Terumo(R) as a silicon coated artificial dermis on the complex of fiberized collagen from calf skin and athecollagen. In the conventional treatment, skin graft is executed when one layer of Terumo(R) or Alloderm(R) is covered and its survival is sure. This method, however, showed certain limits in the appliance: delayed healing time, longer period of hospitalization and limits of dermis supplying, etc. We have applied multi-layer coverage of these materials with simultaneous or delayed skin graft to shorten healing time and to achieve a better effect of dermis. Among those who need flap surgery because of soft tissue defect, or when severe depression or scar contracture can be expected after surgery, a total of 13 cases have been studied: 7 multilayer Alloderm(R) graft with simultaneous thin split-thickness skin graft, and 6 multilayerTerumo(R) graft with delayed skin graft. In all cases, transplants were successful without any difficulties in healing process: no delayed healing time, no functional deficit as contracture, no contour deformity as depression or hypertrophy.
Allografts* ; Cicatrix ; Cicatrix, Hypertrophic ; Collagen ; Congenital Abnormalities ; Contracture ; Depression ; Dermis ; Hospitalization ; Humans* ; Hypertrophy ; Skin ; Tissue Donors ; Transplants

At the present day, the metallic rigid fixation is used universally in facial bone fracture surgery. However, these metallic plating system have problems associated with growth restriction in pediatric patients, intracranial migration, increase risk of infection, palpability, and exposure. To overcome these problems, absorbable devices have been developed and used in the reconstruction of pediatric craniofacial deformities before early stages and in the facial bone fracture of adult recently. However, the usefulness of fixation for the force vector affecting region was not verified. From October 2000 to August 2001, absorbable fixation system(BiosorbFX(R) Bionix Implants inc.) was used in 10 open reduction of facial bone fracture with malocclusion; 5 patients with Le Fort I or Le Fort II fracture, 1 patient with maxillary-sagittal fracture, 4 patients with mandible fracture. All the patients, the malocclusion was corrected with no complications, and stabilized fixation was achieved after average 8 months follow up period. These results show usefulness of absorbable devices for fixation of force vector affecting region.
Adult ; Congenital Abnormalities ; Facial Bones* ; Follow-Up Studies ; Humans ; Malocclusion* ; Mandible

Hepatitis B virus (HBV) affects approximately 250 million patients worldwide, resulting in the progression to cirrhosis and hepatocellular carcinoma, which are serious public health problems. Although universal vaccination programs exist, they are only prophylactic and not curative. In the HBV life cycle, HBV forms covalently closed circular DNA (cccDNA), which is the viral minichromosome, in the nuclei of human hepatocytes and makes it difficult to achieve a complete cure with the current nucleos(t)ide analogs and interferon therapies. Current antiviral therapies rarely eliminate cccDNA; therefore, lifelong antiviral treatment is necessary. Recent trials for antiviral treatment of chronic hepatitis B have been focused on establishing a functional cure, defined by either the loss of hepatitis B surface antigen, undetectable serum HBV DNA levels, and/or seroconversion to hepatitis B surface antibody. Novel therapeutic targets and molecules are in the pipeline for early clinical trials aiming to cure HBV infection. The ideal strategy for achieving a long-lasting functional or complete cure might be using combination therapies targeting different steps of the HBV life cycle and immunomodulators. This review summarizes the current knowledge about novel treatments and combination treatments for a complete HBV cure.

Purpose: The results of the TAILORx trial have shown that premenopausal patients with intermediate Oncotype Dx (ODx) recurrence score of 16–25 may benefit from adjuvant chemotherapy. In addition, the clinicopathological features showed the information complementary to ODx results. However, the characteristics may vary depending on menopausal status even in the same score. This study aimed to analyze the differences in the clinical characteristics by menopausal status. Methods: This study conducted a retrospective analysis of 756 patients with estrogen receptor-positive, human epidermal growth factor receptor 2-negative, and node-negative breast cancer who underwent the ODx test from July 2013 to December 2020 at the Severance Hospital. Results: Of the 756 patients, 261 patients were postmenopausal, and 495 were premenopausal. The premenopausal patients with a midrange ODx had similar clinicopathological features as compared to those with a high ODx. Conversely, the postmenopausal patients with a midrange ODx did not show significantly different clinicopathological features from those with a low ODx, whereas a difference was seen as compared to those with a high ODx. Conclusion In this study, unlike the postmenopausal patients, some of the clinicopathological characteristics of the premenopausal patients with a midrange ODx were closer to those with a high ODx than those with a low ODx. In the premenopausal patients with a midrange ODx, considering the baseline characteristic itself, there was a significant difference between those with a low ODx when compared with postmenopausal patients. Therefore, more aggressive treatment decisions may be helpful in premenopausal patients with a midrange ODx.

Purpose: The results of the TAILORx trial have shown that premenopausal patients with intermediate Oncotype Dx (ODx) recurrence score of 16–25 may benefit from adjuvant chemotherapy. In addition, the clinicopathological features showed the information complementary to ODx results. However, the characteristics may vary depending on menopausal status even in the same score. This study aimed to analyze the differences in the clinical characteristics by menopausal status. Methods: This study conducted a retrospective analysis of 756 patients with estrogen receptor-positive, human epidermal growth factor receptor 2-negative, and node-negative breast cancer who underwent the ODx test from July 2013 to December 2020 at the Severance Hospital. Results: Of the 756 patients, 261 patients were postmenopausal, and 495 were premenopausal. The premenopausal patients with a midrange ODx had similar clinicopathological features as compared to those with a high ODx. Conversely, the postmenopausal patients with a midrange ODx did not show significantly different clinicopathological features from those with a low ODx, whereas a difference was seen as compared to those with a high ODx. Conclusion In this study, unlike the postmenopausal patients, some of the clinicopathological characteristics of the premenopausal patients with a midrange ODx were closer to those with a high ODx than those with a low ODx. In the premenopausal patients with a midrange ODx, considering the baseline characteristic itself, there was a significant difference between those with a low ODx when compared with postmenopausal patients. Therefore, more aggressive treatment decisions may be helpful in premenopausal patients with a midrange ODx.

Purpose: The results of the TAILORx trial have shown that premenopausal patients with intermediate Oncotype Dx (ODx) recurrence score of 16–25 may benefit from adjuvant chemotherapy. In addition, the clinicopathological features showed the information complementary to ODx results. However, the characteristics may vary depending on menopausal status even in the same score. This study aimed to analyze the differences in the clinical characteristics by menopausal status. Methods: This study conducted a retrospective analysis of 756 patients with estrogen receptor-positive, human epidermal growth factor receptor 2-negative, and node-negative breast cancer who underwent the ODx test from July 2013 to December 2020 at the Severance Hospital. Results: Of the 756 patients, 261 patients were postmenopausal, and 495 were premenopausal. The premenopausal patients with a midrange ODx had similar clinicopathological features as compared to those with a high ODx. Conversely, the postmenopausal patients with a midrange ODx did not show significantly different clinicopathological features from those with a low ODx, whereas a difference was seen as compared to those with a high ODx. Conclusion In this study, unlike the postmenopausal patients, some of the clinicopathological characteristics of the premenopausal patients with a midrange ODx were closer to those with a high ODx than those with a low ODx. In the premenopausal patients with a midrange ODx, considering the baseline characteristic itself, there was a significant difference between those with a low ODx when compared with postmenopausal patients. Therefore, more aggressive treatment decisions may be helpful in premenopausal patients with a midrange ODx.

Neonatal Gaves disease is a relatively rare condition due to transplacental passage of Thyroid-stimulating antibody(TSAb) from a mother with active or inactive Graveses disease or autoimmune thyroiditis. A 11-day-old female newborn was referred to our department of pediatrics from a local clinic because of low level T4(3.55microg/dl) concurrent with high level TSH (501.74uIU/ml) on the 5th day neonatal metabolic screening. But, our repeated laboratory data showed very high serum T4(59.6microg/dl), T3(1,600ng/dl), suppressed TSH(0.43uIU/ml), and the presence of TSH receptor antibody. Her mother was treated with propylthiouracil(PTU) for Graves disease during pregnancy. Therefore, we thought it was a delayed-onset neonatal hyperthyroidism, because the fetal thyroid gland was initially suppressed by antithyroid drug taken during pregnancy. After initiating antithyroid drug therapy for the hyperthyroid nature, TSH levels became elevated again, while thyroid hormone levels decreased. Maternal and infant blood samples at the 23th day after birth were examined for serum autoantibodies directed towards the TSH receptor(Thyrotropin-binding inhibitory immunoglobulin:TBII, Thyroid-stimulating antibody:TSAb, Thyroid-stimulating blocking antibody:TSBAb) and high levels of TBII and TSAb were detected. About 2 months after birth, TBII and TSAb decreased within normal limit, and then we could stop antithyroid medication in safety. We report here a case of neonatal Graveses disease with very high level of T4 and T3, but firstly presented as hypothyroid nature on neonatal screening because of the maternally transferred antithyroid drug, PTU.
Autoantibodies ; Drug Therapy ; Female ; Graves Disease ; Humans ; Hyperthyroidism ; Infant ; Infant, Newborn ; Mass Screening ; Mothers ; Neonatal Screening ; Parturition ; Pediatrics ; Pregnancy ; Receptors, Thyrotropin ; Thyroid Gland ; Thyroiditis, Autoimmune