After the discovery of penicillin by Fleming, a great improvement in the treatment of osteomyelitis was obtained and the mortality rate in the acute stage was markedly decreased. But, because of abuse of the antibiotics and resulting resistant organisms to antibiotics, the incidence of acute hematogenous osteomyelitis tends to increase recently. During the period of 6 years extending from 1979 to 1984, we have treated 45 cases of acute hematogenous osteomyelitis in children and clinical analysis was made about the causes of the development of chronic osteomyelitis with particular emphasis on the time interval from onset to treatment, and on the operative methods in the surgical treatments. The following results were obtained; 1. The incidence in males was 1.5 times greater than females. 2. Age incidence showed that it was most prevalent in the age group of 6 to 15 with 66.2% of the total cases. 3. The most common sites of the involvement was femur and tibia in orders. 4. Most of cases showed pain, local tenderness, pyrexia, loss of motion, swelling, and heat of the involved limbs. 5. Among the causative organisms, staphylococcus aureus was most prevalent one. 6. Cephalosporin, methicillin, gentamicin showed the highest sensitivity while penicillin showed marked resistancy (80%). 7. Time interval from onset to treatment was persistently an important factor in the development of chronicity. 8. Bone fenestration was the best method in the surgical treatments of acute hematogenous osteomyelitis in children. 9. Early diagnosis, adequate antibiotics, and early surgical decompression and drainage (esp. bone fenestration) were considered to be the essential part of management of acute hematogenous osteomyelitis in preventing its chronicity.
Anti-Bacterial Agents ; Child ; Decompression, Surgical ; Drainage ; Early Diagnosis ; Extremities ; Female ; Femur ; Fever ; Gentamicins ; Hot Temperature ; Humans ; Incidence ; Male ; Methicillin ; Methods ; Mortality ; Osteomyelitis ; Penicillins ; Staphylococcus aureus ; Tibia

Twenty-six cases of Colles fracture were treated with closed reduction and percutaneous K-wire fixation under C-arm field and then wrist was immobilized by sugar tong splint and then short arm splint from Jan. 1982 to Dec. 1985 at the department of orthopaedic surgery of St. Benedict hospital. A prospective study was made and evaluated under the subjective and objective criteria of Gartland and Werley, and the objective criteria of Scheck. The result of this study were as follow: 1. The incidence of Colles fracture was highest in 3rd decade(26.9%) and 7th decade(23.1%) respectively. In the 3rd decade the reason for the highest incidence was the job-related accident during the productive age and they were male patients. 2. The main cause of the injury was falling accident comprising of 53.8% and the male to female ratio was about equal. 3. Among the 26 cases treated with the percutaneous K-wire fixation, the result was satisfactory in 92.2% but was unsatisfactory in one case with severe comminuted fracture. 4. The percutaneous K-wire fixation for Colles fracture had less complication and more advantages such as the early disappearance of edema by early exercies, the early returning of range of motion of joint to normal, and the comfortable cast immobilization in neutral position of wrist. 5. The percutaneous K-wire fixation for Colles fracture was applicable to the concept that the anatomical reduction and maintenance would lead to the improvement of the joint function. 6. The percutaneous K-wire fixation for Colles fracture was indicated when neurologic sign developed after reduction of fracture by classic methord and when the exercise of joint was required in the old age. 7. When the articular surface of the radius was severely comminuted and the distal radius became severely osteoporotic, the result from the use of percutaneous K-wire fixation was also poor. In this case we considered the use of an external fixator.
Accidental Falls ; Arm ; Clinical Study ; Colles' Fracture ; Edema ; External Fixators ; Female ; Fractures, Comminuted ; Humans ; Immobilization ; Incidence ; Joints ; Male ; Neurologic Manifestations ; Prospective Studies ; Radius ; Range of Motion, Articular ; Splints ; Wrist

BACKGROUND: It is often difficult to make a diagnosis of cardiac ischemia in patients attending emergency department (ED) with symptoms of acute coronary syndromes (ACS) because existing cardiac markers are not sensitive for reversible myocardial ischemia. Ischemia modified albumin (IMA) has recently been shown to be an early and sensitive marker of myocardial ischemia. We investigated the usefulness of ischemia modified albumin (IMA) as an early triage marker for ACS and tried to establish a newly standardized albumin-adjusted IMA index which has been expected to be more sensitive and accurate than conventional IMA value. METHODS: We enrolled 209 consecutive patients (men 95, women 114) who presented to the ED with symptoms suggestive of ACS from June to July, 2005. All patients were classified to ACS group (n=42) and others (n=167) based on diagnosis of cardiologists. The ideal cutoff value of IMA was calculated by the receiver operating characteristic (ROC) curve analysis and diagnostic utilities of combination tests (myoglobin, CK-MB, troponin T and EKG) were compared with those of IMA. The albumin-adjusted IMA index was calculated and applicated from the results of correlation assay between serum albumin concentration and IMA value. RESULTS: Mean IMA level (U/mL) of ACS group was significantly higher than that of non-ACS group (P<0.05) and sensitivity and specificity was 92.9% and 35.9% at a cutoff value of 85.1 U/mL, respectably. In combination with conventional cardiac markers, the sensitivity increased to 96.3%. IMA value had a negative lnear relationship with serum albumin concentration (YIMA= -23.1Xalbumin+200, R=0.99) and albumin-adjusted IMA index was calculated as [IMA index = serum albumin conc. (g/dL) x 23 + IMA (U/mL) -100]. The sensitivity and specificity was 97.6% and 34.1% at a cutoff value of 83.3 IMA index, respectively. CONCLUSIONS: IMA is a useful sensitive marker for the identification of ACS in patients with normal cardiac markers and EKG finding and follow-up combination testing may be required to rule out other diseases. The calculated albumin-adjusted IMA index is recommended to make a diagnosis of ACS more sensitively.
Acute Coronary Syndrome* ; Diagnosis ; Electrocardiography ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Humans ; Ischemia* ; Mass Screening* ; Myocardial Ischemia ; ROC Curve ; Sensitivity and Specificity ; Serum Albumin ; Triage ; Troponin T

The possibility of a large quantity of information outflow has been growing since patients' private and medical information is being transmitted to inside and outside of the hospital because of the country's medical record computerization system. Accordingly, it has been threatening patient's privacy and the duty of confidentiality of medical people, and the introduction of security policy is needed which is required for patient information protection. We evaluated medical treatment facilities of diagnostic information security management by conducting questionnaire survey of medical documentation office about their standard of medical information security management, range of medical information access sanction to inside users, outside users' request for information and it's purpose. In the data of medical information user identification and authentication, about the grant of the ID and Password to official in charge, "All have it" has the most high percentaged as 60.0%, "Officer who's most needful have it" is the second as 15.7%, "one's post share it" is the third as 12.9%, but treatment facilities all show similar distribution. About the request for information by patients, All medical institution opened the information on occasion that patients themselves visited the institute and asked information, but in case of telephone inquiry, the only score 0.08 of the institutes accepted. This research, I hope, could be utilized for basic materials for medical recorder who control medical information to manage medical information security and to evaluate operation, and for individual hospital to manage the bound of opening to public and authority to access considering specificity of medical information, and supervisor. Also, the Goverment should set up a definite legal support about the political and technological plan to protect private information in the medical record.
Academies and Institutes ; Computer Security ; Confidentiality ; Financing, Organized ; Hope ; Humans ; Medical Records ; Privacy ; Surveys and Questionnaires ; Sensitivity and Specificity ; Telephone

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is a drug-resistant tumor. The expression of a multidrug resistant gene, P-glycoprotein (P-gp) is a major mechanism of drug resistance. The aims of our study were, firstly, to observe the expression rate of P-gp in HCC tissue obtained by percutaneous fine needle aspiration (PCNA) from stage IV HCC patients; secondly to examine the association between P-gp and chemotherapeutic response; and finally to investigate the correlation between p53 protein expression and P-gp expression. Subjects and METHODS: We studied 29 cases of stage IV HCC treated by systemic chemotherapy. Expression of P-gp and p53 were evaluated by immunohistochemical staining of HCC tissue with human monoclonal antibody, JSB-1 (Anti P-gp) and DO-7 (Anti p53), respectively. We analyzed the results of immunohistochemical staining of HCC tissues of the patients in relation to chemotherapeutic response and other clinical characteristics. RESULTS: The expression rate of P-gp was 27.6%. Partial response to anti-cancer chemotherapy was observed in 16.7% of the patients. Although we could not see a statistically significant association between P-gp expression and chemotherapeutic response, none of the responsive patients showed P-gp expression. p53 protein expression was found in 45% of the patients. There was no significant correlation between p53 protein expression and P-gp expression. CONCLUSIONS: Although the number of our study subjects was small, chemotherapy- responsive patients didn't show P-gp expression. P-gp expression might be used as a predictor of response to potentially toxic anti-cancer chemotherapy in HCC patients. Further study is warranted to confirm our results.
Biopsy, Fine-Needle ; Carcinoma, Hepatocellular* ; Drug Resistance ; Drug Therapy* ; Humans ; P-Glycoprotein*

Background: /Aim: Atezolizumab plus bevacizumab and lenvatinib are currently available as first-line therapy for the treatment of unresectable hepatocellular carcinoma (HCC). However, comparative efficacy studies are still limited. This study aimed to investigate the effectiveness of these treatments in HCC patients with portal vein tumor thrombosis (PVTT). Methods: We retrospectively included patients who received either atezolizumab plus bevacizumab or lenvatinib as first-line systemic therapy for HCC with PVTT. Primary endpoint was overall survival (OS), and secondary endpoints included progressionfree survival (PFS) and disease control rate (DCR) determined by response evaluation criteria in solid tumors, version 1.1. Results: A total of 52 patients were included: 30 received atezolizumab plus bevacizumab and 22 received lenvatinib. The median follow-up duration was 6.4 months (interquartile range, 3.9-9.8). The median OS was 10.8 months (95% confidence interval [CI], 5.7 to not estimated) with atezolizumab plus bevacizumab and 5.8 months (95% CI, 4.8 to not estimated) with lenvatinib (P=0.26 by log-rank test). There was no statistically significant difference in OS (adjusted hazard ratio [aHR], 0.71; 95% CI, 0.34-1.49; P=0.37). The median PFS was similar (P=0.63 by log-rank test), with 4.1 months (95% CI, 3.3-7.7) for atezolizumab plus bevacizumab and 4.3 months (95% CI, 2.6-5.8) for lenvatinib (aHR, 0.93; 95% CI, 0.51-1.69; P=0.80). HRs were similar after inverse probability treatment weighting. The DCRs were 23.3% and 18.2% in patients receiving atezolizumab plus bevacizumab and lenvatinib, respectively (P=0.74). Conclusion The effectiveness of atezolizumab plus bevacizumab and lenvatinib was comparable for the treatment of HCC with PVTT.

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) has been an established treatment for indicated early gastric cancer (EGC) without deterioration of quality of life (QOL) compared with surgical resection. The aim of this study was to evaluate long-term QOL in patients undergoing ESD for EGC. METHODS: Patients scheduled to undergo curative ESD for EGC were prospectively enrolled from 12 institutions between May 2010 and December 2011. Assessments of QOL with Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire-core (QLQ-C30) and a gastric cancer-specific questionnaire (STO22) were performed at baseline and at 7 days, 3 months, and 6 months after ESD. RESULTS: A total of 666 subjects were assessed for QLQ-C30 and QLQ-STO22. The mean QLQ-C30 score was 69.5 at baseline, 68.8 at 7 days, 73.1 at 3 months, and 73.2 at 6 months. The global health status on the EORTC QLQ-C30 was significantly improved after 3 and 6 months (p=0.0003 and p<0.0001, respectively). The QLQ-C30 and STO22 scores were not significantly different, or they only slightly deteriorated between before and immediately after ESD, but they were significantly improved after 3 and 6 months (p<0.05). CONCLUSIONS: QOL did not deteriorate immediately after ESD, and it improved more significantly at up to 6 months in patients who underwent curative ESD for EGC without significant complications.
Cohort Studies* ; Global Health ; Humans ; Prospective Studies* ; Quality of Life* ; Stomach Neoplasms*

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) is an effective treatment for early gastric cancer (EGC) that has demonstrated a minimal risk of lymph node metastasis in retrospective studies. We sought to prospectively evaluate the short-term outcomes of ESD treatment in EGCs. METHODS: A prospective multicenter cohort study of neoplasms 3 cm or less in diameter at endoscopic size evaluation was performed in 12 Korean ESD study group-related university hospitals and the National Cancer Center. Resected specimens were evaluated by the central pathologic review board. RESULTS: A patient cohort (n=712) with a total of 737 EGCs was analyzed. The margin-freeen bloc resection rate was 97.3%, and curative resection of 640 lesions (86.8%) was achieved. Lower curative resection rates were associated with lesions 2 to 3 cm in size prior to ESD compared with lesions 2 cm or less in size (78.6% vs 88.1%, respectively, p=0.009). Significant factors associated with noncurative resection were moderately or poorly differentiated histological type, posterior wall tumor location, tumor size larger than 3 cm, ulceration, and submucosal invasion. Delayed bleeding occurred in 49 patients (6.9%), and 12 patients (1.7%) exhibited perforations. CONCLUSIONS: ESD is an effective treatment with a high curative resection rate for EGCs that meets relatively conservative pre-ESD indications. Long-term survival outcomes should be evaluated in follow-up studies.
Cohort Studies* ; Endoscopy ; Follow-Up Studies ; Hemorrhage ; Hospitals, University ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prospective Studies* ; Retrospective Studies ; Stomach Neoplasms* ; Ulcer