Introduction: Triple Arthrodesis is the preferred surgical treatment of stage III Adult Acquired Flatfoot Deformity. However, studies have reported subsequent midfoot degenerative arthrosis, with medial column instability. Materials and methods: This is a retrospective study using prospectively collected registry data from a single tertiary institution. Between 2007 to 2014, all patients who had undergone Triple Arthrodesis with concomitant percutaneous Tendo-Achilles lengthening were included. Patients with previous foot surgery, revision surgeries, and concomitant surgical procedures were excluded. We aim to report on our two years outcomes using the hindfoot and midfoot AOFAS and VAS scores, as well as radiographic parameters such as first-metatarsal declination angle, medial cuneiform calcaneal angle, navicular height, medial cuneiform – first metatarsal cuneiform angle, calcaneal pitch and medial longitudinal arch. Results: There were 22 feet from 21 patients that met the criteria of having undergone Triple Arthrodesis with concomitant percutaneous Tendo-Achilles lengthening. Hindfoot and midfoot American Orthopaedic Foot and Ankle Society (AOFAS) scores improved by an average of 34.6 and 36.7 points at 24-months post-surgery (p<0.001). Between six months to two years post-operatively, there was evidence of mid-foot sagging as shown with an increase in CalcanealFirst metatarsal angle by a mean of 5.1° (p=0.001). Additionally, a decrease in the Calcaneal Pitch Angle by 2.9° (p=0.003) and Cuneiform-Calcaneal angle by 5.5° (p=0.000). Navicular Height also decreased significantly by 2.8mm (p=0.001) over this period. A total of 18 (85.6%) reported overall satisfaction being met at the time of a phone survey, at an average of 8.3 years (range 5.8 to 12.4) postsurgery. One patient required an ankle replacement, and another had removal of hardware done. Conclusion: Triple arthrodesis with concomitant TendoAchilles lengthening results in significant improvement in AOFAS mid-foot and hindfoot scores at two years. At two years mark, there was features of mid-foot sagging postoperatively, despite continued improvement in AOFAS scores. Eighteen of the 21 patients were satisfied with the outcomes, on a phone survey, at an average of 8.3 years postsurgery.

Introduction: The current standard treatment for ankle syndesmosis injury is static screw fixation. Dynamic fixation was developed to restore the dynamic function of the syndesmosis. The purpose of this study was to determine that which of static screw fixation and dynamic fixation is better for treatment of ankle syndesmosis injury in pronationexternal rotation fractures. Materials and methods: Thirty patients were treated with dynamic fixation (DF group) and 28 patients with static screw fixation (SF group). The primary outcome was Olerud–Molander Ankle Outcome Score. The secondary outcome were Visual Analogue Scale score and American Orthopedic Foot and Ankle Society score, radiographic outcomes, complications and cost effectiveness. To evaluate the radiographic outcome, the tibiofibular clear space, tibiofibular overlap, and medial clear space were compared using the pre-operative and last follow-up plain radiographs. To evaluate the cost effectiveness, the total hospital cost was compared between the two groups Results: There was no significant difference in primary outcome. Moreover, there were no significant difference in secondary outcome including Visual Analogue Scale score and American Orthopedic Foot and Ankle Society score and radiographic outcome. Two cases of reduction loss and four cases of screw breakage were observed in the SF group. No complication in the DF group was observed. Dynamic fixation was more cost effective than static screw fixation with respect to the total hospital cost. Conclusion: Although dynamic fixation provided similar clinical and radiologic outcome, dynamic fixation is more cost effective with fewer complications than static screw fixation in ankle syndesmosis injury of pronation-external rotation fractures.

Obstructive sleep apnea is a prevalent sleep disorder characterized by partial or complete obstruction of the upper airway. Continuous positive airway pressure is the first-line therapy for most patients, but adherence is often poor. Alternative treatment options such as mandibular advancement devices, positional therapy, and surgical interventions including upper airway stimulation target different levels and patterns of obstruction with varying degrees of success. Drug-induced sleep endoscopy enables the visualization of upper airway obstruction under conditions mimicking sleep. In the era of precision medicine, this additional information may facilitate better decision-making when prescribing alternative treatment modalities, with the hope of achieving better adherence and/or success rates. This review discusses the current knowledge and evidence on the role of drug-induced sleep endoscopy in the non-positive airway pressure management of obstructive sleep apnea.

Obstructive sleep apnea is a prevalent sleep disorder characterized by partial or complete obstruction of the upper airway. Continuous positive airway pressure is the first-line therapy for most patients, but adherence is often poor. Alternative treatment options such as mandibular advancement devices, positional therapy, and surgical interventions including upper airway stimulation target different levels and patterns of obstruction with varying degrees of success. Drug-induced sleep endoscopy enables the visualization of upper airway obstruction under conditions mimicking sleep. In the era of precision medicine, this additional information may facilitate better decision-making when prescribing alternative treatment modalities, with the hope of achieving better adherence and/or success rates. This review discusses the current knowledge and evidence on the role of drug-induced sleep endoscopy in the non-positive airway pressure management of obstructive sleep apnea.

Desmoplastic small round cell tumour (DSRCT) is a very rare malignant tumour which commonly presented as an intraabdominal tumour. It has a distinct histological and immunophenotypic characteristic which differentiates it from other types of small blue cell tumour such as Ewing’s sarcoma, primitive neuroectodermal tumour, neuroblastoma and malignant mesothelioma. Apart from the abdomen, it may also originate from other region of the body including the reproductive organs.
Neoplasms

Humans ; Neoplasms ; drug therapy ; genetics ; pathology

Caffeine is a very popular compound widely available in various beverages. It is generally regarded as safe, but several lethal outcomes have been reported after large overdoses. A 21-year-old woman was brought to the emergency department (ED) after ingestion of approximately 100 caffeine tablets, each containing 200 mg, resulting in a total amount of about 20,000 mg of caffeine. She was very irritable and complained about nausea, vomiting, and headaches. While the initial electrocardio graphy (ECG) showed ventricular bigeminy, most of the patient's symptoms were gone after supportive care with anti-emetics and benzodiazepine. The rhythm was converted to a sinus rhythm without anti-arrhythmics. Because caffeine tablets are unavailable in Korea, acute large-dose caffeine overdoses have been relatively rare. However, there is an increasing risk of caffeine exposure through highly concentrated "energy drinks" or caffeine tablets from purchases on-line. Thus, physicians should be prepared to deal with the severe toxic effects of an acute caffeine over-dose.
Anti-Arrhythmia Agents ; Antiemetics ; Benzodiazepines ; Beverages ; Caffeine ; Eating ; Emergencies ; Female ; Headache ; Humans ; Korea ; Nausea ; Tablets ; Vomiting

BACKGROUND: Clostridium difficile is the major cause of antibiotic-associated diarrhea (AAD) and pseudomembranous colitis (PMC). The aim of this study was to develop the nested PCR assay for direct detection of toxigenic C. difficile in stool specimens and to evaluate the usefulness of the method. METHODS: Specificity of newly designed primers are tested with 36 reference strains of intestinal flora. Lower detection limit of nested PCR for B toxin gene in C. difficile was determined using 10-fold serial dilutions of C. difficile ATCC 9689. One hundred and two clinical stool samples were cultured for detection of C. difficile on cycloserine-cefoxitin- fructose agar and the PCR assay for detection of toxin B gene in C. difficile isolates was performed. Nested PCR assay for direct detection of toxin B gene in clinical samples was also performed. RESULTS: Nested PCR assay showed negative amplification results in intestinal floras except C. difficile ATCC 9689. Lower detection limit of nested PCR for toxin B gene was 10 4 CFU/mL. Sensitivity of nested PCR assay compared to culture method was 100% (29/29), and the specificity was 68% (50/73). CONCLUSION: Nested PCR assay showed high sensitivity in direct detection of toxin B gene in C. difficile isolates even after administration of metronidazole, so the assay could be used in initial diagnosis and follow-up tests of AAD and PMC.
Agar ; Clostridium difficile* ; Clostridium* ; Diagnosis ; Diarrhea ; Enterocolitis, Pseudomembranous ; Follow-Up Studies ; Fructose ; Humans* ; Limit of Detection ; Metronidazole ; Polymerase Chain Reaction* ; Sensitivity and Specificity

The survey on branchial anomalies was conducted by Korean Association of Pediatric Surgeons. A total of 173 cases were reported, which were managed by 36 members and cooperators during the three years from January 1, 1993 through December 31, 1995. The following results were obtained by retrospective analysis of the 173 cases of branchial anomalies. The presenting symptoms were cervical mass in 101 cases, pit with or without discharge in 71, cervical abscess in 47 and respiratory difficulty in 3. The average age of the patients with cervical abscess was 52 months. Seventy(79%) of 89 patients with branchial anomalies and a cystic mass had their first clinical manifestations by 1 year of age, while 40(51%) of 78 patients with only a branchial cyst had their first clinical manifestation in first year of life. Radiologic studies were carried out in 77 patients(43%). The preferred diagnostic modalities were ultrasonography(47 patients), simple neck radiogram(l9) and CT scan(17). Preoperative diagnosis was correctly made in 156(91%) of 173 patients. Seventeen patients were incorrectly diagnosed as thyroglossal duct cyst in 5 patients, cystic hygroma in 4, dermoid cyst in 3, and lymphadenopathy in 3. There were no remarkable difference in sex and laterality of presentation but bilateral lesions were found in 9(5%) patients and unusual locations of the anomalies were the manubrium, left subclavicular area, median cervial area, preauricular and parotid area. There were 78(45%) patients with cyst, 52(30%) patients with sinus, 35(20%) patients with fistula and 8(5%) patient with skin tag. Embryological classification was possible in only 64(37%) patients. The 2nd branchial anomaly was present in 50 (78%), the 1st branchial anomaly in 10(18%), and the 3rd or 4th branchial anomaly in 4(6%). Histopathological study of the lining epithelium(N=134) is recorded that 45% were lined with squamous epithelium, 17% with respiratory epithelium, 6% with. squamous and respiratory epithelium, 14% with inflammatory change. Lymphoid tissue was common(62%) in the wall of the lesions. Twelve(7%) of 158 patients had postoperative complications including wound complication, recurrence and facial nerve palsy.
Abscess ; Branchioma ; Child ; Classification ; Dermoid Cyst ; Diagnosis ; Epithelium ; Facial Nerve ; Fistula ; Humans ; Korea ; Lymphangioma, Cystic ; Lymphatic Diseases ; Lymphoid Tissue ; Manubrium ; Neck ; Paralysis ; Postoperative Complications ; Recurrence ; Respiratory Mucosa ; Retrospective Studies ; Skin ; Surgeons ; Thyroglossal Cyst ; Wounds and Injuries

Tatrate resistant acid phosphatase (TRAP) has been widely used as histochemical marker to identify osteoclast in studies of bone metabolism. However, the value of TRAP as an osteoclast marker is still in discussion. Authors isolated and characterized the cells from synovium of 6 patients of sero-positive rheumatoid arthritis and 4 patients of osteoarthritis, and observed the activity of acid phosphatase (AP) and TRAP. The activity of TRAP was negative in cell cultures in early phase, but the activity of TRAP was increased with time, and at one week the activity of TRAP was as strong as that of AP. If the cultured tissue contained bone, there were observed TRAP positive mononuclear cells and giant cells even in early phase of cultures (1 day, 3 day), and the phenotype of these cells were same as that of osteoclasts and osteoclast precursors by immunocytochemistry. In conclusion, the activity of TRAP was positive in cultured macrophage. TRAP is not a specific marker for osteoclast, and its use for the identification of osteoclast seems meaningful only in the early stage of cell culture.
Acid Phosphatase ; Arthritis, Rheumatoid ; Cell Culture Techniques ; Giant Cells ; Humans ; Immunohistochemistry ; Macrophages ; Metabolism ; Osteoarthritis ; Osteoclasts ; Phenotype ; Synovial Membrane