Objective: Primary frozen shoulder causes significant pain and progressively restricts shoulder movements. Diagnosis is made clinically based on patient history and physical examination. Management is mainly non-invasive owing to its self-limiting clinical course. However, clinical practice guidelines for frozen shoulder have not yet been developed in Korea. The developed guidelines aim to provide evidence-based recommendations for the diagnosis and treatment of frozen shoulder. Methods: A guideline development committee reviewed the literature from four databases (PubMed, Embase, Cochrane Library, and KMbase). Using the Population, Intervention, Comparator, and Outcome (PICO) framework, the committee formulated two backgrounds and 16 key questions to address common clinical concerns. Recommendations were made using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Results: Diabetes, thyroid disease, and dyslipidemia significantly increase the risk of developing a frozen shoulder. Although frozen shoulder is often self-limiting, some patients may experience long-term functional disabilities. Ultrasound and magnetic resonance imaging should be used as adjunctive tools alongside clinical diagnosis, and rather than as independent diagnostic methods. Noninvasive approaches, such as medications, physical modalities, exercises, electrical stimulation, and manual therapy, may reduce pain and improve shoulder function. Other noninvasive interventions have limited evidence, and their application should be based on clinical judgment. Intra-articular steroid injections are recommended for treatment, and physiotherapy or hydrodilation with steroid injections can also be beneficial. Conclusion These guidelines provide evidence-based recommendations for diagnosing and treating primary frozen shoulder.

Background/Aims: Infliximab (IFX) has proven effective as rescue therapy in steroid-refractory acute severe ulcerative colitis (ASUC), however, the long-term real-world data are scarce. Our study aimed to assess the long-term treatment outcomes of IFX in a real-life cohort. Methods: We established a multicenter retrospective cohort of hospitalized patients with ASUC, who met Truelove and Witt’s criteria and received intravenous corticosteroid (IVCS) or IFX during index hospitalization between 2006 and 2016 in 5 university hospitals in Korea. The cohort was systematically followed up until colectomy, death or last follow-up visit. Results: A total of 296 patients were followed up for a mean of 68.9 ± 44.0 months. During index hospitalization, 49 patients were treated with IFX; as rescue therapy for IVCS failure in 37 and as first-line medical therapy for ASUC in 12. All patients treated with IFX avoided colectomy during index hospitalization. The cumulative rates of rehospitalization and colectomy were 20.4% and 6.1% at 3 months and 39.6% and 18.8% at the end of follow-up, respectively. Patients treated with IFX presented with significantly shorter colectomy-free survival than IVCS responders (P= 0.04, log-rank test). Both cytomegalovirus colitis and Clostridioides difficile infection (CDI) were the significant predictors of colectomy in the overall study cohort (hazard ratios of 6.57 and 4.61, respectively). There were no fatalities. Conclusions Our real-world cohort study demonstrated that IFX is an effective therapeutic option in Korean patients with ASUC, irrespective of IFX indication. Aggressive vigilance for cytomegalovirus colitis and CDI is warranted for hospitalized patients with ASUC.

Background/Aims: Infliximab (IFX) has proven effective as rescue therapy in steroid-refractory acute severe ulcerative colitis (ASUC), however, the long-term real-world data are scarce. Our study aimed to assess the long-term treatment outcomes of IFX in a real-life cohort. Methods: We established a multicenter retrospective cohort of hospitalized patients with ASUC, who met Truelove and Witt’s criteria and received intravenous corticosteroid (IVCS) or IFX during index hospitalization between 2006 and 2016 in 5 university hospitals in Korea. The cohort was systematically followed up until colectomy, death or last follow-up visit. Results: A total of 296 patients were followed up for a mean of 68.9 ± 44.0 months. During index hospitalization, 49 patients were treated with IFX; as rescue therapy for IVCS failure in 37 and as first-line medical therapy for ASUC in 12. All patients treated with IFX avoided colectomy during index hospitalization. The cumulative rates of rehospitalization and colectomy were 20.4% and 6.1% at 3 months and 39.6% and 18.8% at the end of follow-up, respectively. Patients treated with IFX presented with significantly shorter colectomy-free survival than IVCS responders (P= 0.04, log-rank test). Both cytomegalovirus colitis and Clostridioides difficile infection (CDI) were the significant predictors of colectomy in the overall study cohort (hazard ratios of 6.57 and 4.61, respectively). There were no fatalities. Conclusions Our real-world cohort study demonstrated that IFX is an effective therapeutic option in Korean patients with ASUC, irrespective of IFX indication. Aggressive vigilance for cytomegalovirus colitis and CDI is warranted for hospitalized patients with ASUC.

Innominate artery injury by blunt chest trauma is rarely reported. This report describes a 40-year-old male who had innominate artery dissection and pseudoaneurysm caused by blunt chest trauma and was treated successfully by ascending aorta to innominate artery bypass graft. The patient recovered without any complications and was discharged one week after the operation.
Adult ; Aneurysm, False ; Aorta ; Brachiocephalic Trunk* ; Humans ; Male ; Thorax* ; Transplants

Percutaneous suture closure device is known as relatively safe and convenient tool, which can decrease not only bed rest period of patient but also time consuming effort of manual compression of doctor after femoral artery puncture. However [C1], there are also some reports on complication of its use. We report a 62-year-old male patient who had femoral artery endarteritis [0] with pseudoaneurysm as a complication of percutaneous suture closure device after percutaneous coronary angiography [C2]. He was treated successfully by appropriate antibiotics and vessel reconstruction using autologous saphenous vein patch.
Aneurysm, False ; Angioplasty, Balloon, Coronary ; Anti-Bacterial Agents ; Bed Rest ; Coronary Angiography ; Endarteritis* ; Femoral Artery ; Humans ; Male ; Middle Aged ; Punctures ; Saphenous Vein ; Sutures*

BACKGROUND: Traumatic cardiac injury is very rare but mortality is very high when the diagnosis and management are delayed. We reviewed our case retrospectively. MATERIAL AND METHOD: From March 1995 to July 2003, 17 patients were diagnosed as having traumatic cardiac rupture. Five patients were stabbed, seven patients were motor vehicle accidents, four patients had fallen down, and the cause was unknown in one patient. Emergency operations were done and six patients were operated under CPB. RESULT: Four patients died during or after operation. The mean ICU stay period was 3.86+/-3.35 days and the mean hospital stay was 18.27+/-14.99 days. No mortality was observed in those whose vital signs were stable in the operating room. CONCLUSION: Preoperative vital status was very important and thoracic traumatic patient should be suspected as having cardiac injury.
Diagnosis ; Emergencies ; Heart Injuries ; Humans ; Length of Stay ; Mortality ; Motor Vehicles ; Operating Rooms ; Retrospective Studies ; Vital Signs

A 4-day-old patient with Down syndrome (DS) visited out patient department (OPD) because of jaundice and VSD. Peripheral blood smear showed 21% of myeloblast. After 4 weeks of observation, WBC count was 55,100/mm3 (blast 90%). BM aspirate showed AML (M7) and treatment was started with low dose Ara-C (20 mg/m2 for 21 days). After remission, maintenance therapy was done with low dose Ara-C (16 mg/m2 for 21 days), 6-TG (40 mg/m2 for 21 days) and low dose IL-2 (0.5 106U/m2 for 21 days) alternatively for 2 years. The patient remained in complete remission and VSD was corrected at 9 months of age. This case shows that remission can be achieved with low dose Ara-C and it can be maintained thereafter with low dose Ara-C, 6-TG and IL-2. Low dose IL-2 has the advantage of selectively activating immune cells with high affinity receptors, low treatment related morbidity, good compliance which can be injected at OPD. As the patients with DS have defect in IL-2 secretion, IL-2 may have an beneficial effects on treating AML in DS.
Compliance ; Cytarabine ; Down Syndrome* ; Drug Therapy* ; Granulocyte Precursor Cells ; Humans ; Interleukin-2* ; Jaundice ; Leukemia, Myeloid, Acute*

Lymphangioma(or cystic hygroma) of the chest wall is rare case. We experienced one such case in a 16-year-old girl who complained of a large recurrent mass on her right upper post erolateral chest wall which had developed several years ago. The diagnosis was made following a physical examination, chest magnetic resonance imaging(MRI), and radio isotope (RI) lymphangiogrphy and was confirmed by a histopathological examination. We performed total excision of the lesion followed by a repeated sclerosing therapy with intralesional injection of Vibramycin.
Adolescent ; Diagnosis ; Doxycycline ; Female ; Humans ; Injections, Intralesional ; Lymphangioma* ; Physical Examination ; Thoracic Wall* ; Thorax*

Supravalvular aortic stenosis is an uncommon, congenital narrowing of the ascending aorta which originates just distal to the level of the ostium of the coronary artery. We conducted a successful surgical treatment in a 39 year- old female patient with a congenital supravalvular aortic stenosis and aortic regurgitation who did not show signs of William's syndrome. After we performed an inverted Y-shaped aortotomy toward the noncoronary sinus and right coronary sinus, pantaloon shaped prosthetic patch(Vascutek, Ino, USA) was used to repair the narrowing sinotubular junction. The aortic valve was replaced concommittently using Sorin Bicarbon 19mm. Her postoperative course was uneventful. The patient discharged at 9th postoperative day in good health.
Aorta ; Aortic Stenosis, Supravalvular* ; Aortic Valve ; Aortic Valve Insufficiency* ; Coronary Sinus ; Coronary Vessels ; Female ; Humans

BACKGROUND: Patients who are considered for major pulmonary resection are generally evaluated by spirometry and clinical assessment to predict morbidity and mortality. Despite this, none has yet proved to be a convenient and reliable estimate of risk. MATERIAL AND METHOD: A retrospective analysis was performed in 167 patients who were diagnosed for lung cancer, bronchiectasis, pulmonary tuberculosis, and other benign pulmonary disease, and who underwent major lung resections. The relationship of 25 preoperative or postoperative variables to 19 postoperative events were classified into categories as operative mortality, pulmonary or cardiovascular morbidity, and other morbidity was assessed. Logistic regression analysis and x2 analysis were used to identify the relationship of the operative risk factors to the grouped postoperative complications. RESULT: The best single predictor of complications was the percent predicted postoperative diffusing capacity (pulmonary morbidity, p<0.009; cardiovascular morbidity, p<0.003: overall morbidity, p<0.004). CONCLUSION: The diffusing capacity of the lung for carbon monoxide was an important predictor of postoperative complications than the spirometry, and it usually should be a part of the evaluation of patients being considered for pulmonary resection.
Bronchiectasis ; Carbon Monoxide ; Humans ; Logistic Models ; Lung ; Lung Diseases ; Lung Neoplasms ; Mortality* ; Postoperative Complications ; Retrospective Studies ; Risk Factors* ; Spirometry ; Tuberculosis, Pulmonary