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.

Objective: The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. Conclusion This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

Objective: The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. Conclusion This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

PURPOSE: To evaluate the postoperative outcome of the multiple slit on plaque plication technique for the treatment of Peyronie's disease. MATERIALS AND METHODS: We retrospectively evaluated 22 patients who underwent plaque incision with penile plication for the surgical treatment of Peyronie's disease, who had failed medical treatment between 2009 and 2014. Patients were grouped by preoperative degree of penile curvature into Group I: mild (n=5, 22.7%), Group II: moderate (n=11, 50.0%), and Group III: severe (n=6, 27.3%). After a thorough review of the medical records, we evaluated (a) the correction of the curvature; (b) sexual function; and (c) any penile shortening or other complications. RESULTS: The mean postoperative follow-up period was 39 months. Complete correction of the curvature was attained in 21 patients (95.5%). As an inevitable complication, minimal penile shortening (<1.5 cm) was reported by 14 patients (82.4%) but did not adversely affect sexual intercourse (0%), and all patients found the extent of penile shortening to be acceptable. Nineteen patients had good erectile function (International Index of Erectile Function >21). The most frequent complication was subcutaneous penile edema in three patients (13.6%), which was resolved within about 3 months following surgery. CONCLUSIONS: As a modified technique, multiple slit on plaque with plication is a simple, minimally-invasive and effective technique for correcting penile curvature regardless of curvature severity. The degree of penile curvature does not significantly predict the amount of penile length loss.
Coitus ; Edema ; Focal Adhesions ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Penile Induration* ; Retrospective Studies

Neovesical-urethral anastomotic stricture is a complication of orthotopic neobladder, with a reported incidence of 2.7% to 8.8%. Strictures of the neovesico-urethral anastomotic site can be treated with regular self-dilation, but high-grade strictures require a surgical procedure involving incision by electrocautery or cold knife. Here we describe a grade III neovesical-urethral anastomotic stricture after an orthotopic bladder substitution that was successfully treated by use of a ureteral dilation balloon catheter.
Catheters ; Cold Temperature ; Constriction, Pathologic ; Electrocoagulation ; Incidence ; Ureter ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Bladder Neoplasms ; Urinary Diversion

Bezoars are collections or concretions of indigestible foreign material that accumulate and coalesce in the gastrointestinal tract. Treatment options include dissolution with enzymes, endoscopic removal or aspiration, and surgery. The outcome differs according to the treatment method. A 57-year-old man was admitted with a 1-month history of epigastric pain. On gastrofiberscopy, an approximately 2-cm deep ulcer was seen on the lesser curvature of the antrum and three huge bezoars were found. In order to remove the first one, we injected Coca-Cola into it directly. It took 20 minutes to cut up and 1 hour to remove completely. To decrease the procedure time, we changed the injection fluid to urokinase for the remaining two bezoars. It took 9 and 10 minutes to cut up the second and third bezoars, respectively, and 1 hour to remove them completely. We report a case of phytobezoars treated successfully by endoscopic injections of Coca-Cola and urokinase.
Bezoars ; Gastrointestinal Tract ; Humans ; Middle Aged ; Ulcer ; Urokinase-Type Plasminogen Activator

Gastrointestinal stromal tumor (GIST) is an uncommon mesenchymal tumor of the gastrointestinal tract and is generally located in the stomach and small intestine. They usually present with abdominal pain, gastrointestinal bleeding, and palpable mass. Some patients present with rare symptoms that are more common in malignant GIST. Malignant GIST combined with a liver abscess has not been reported yet in the literatures. We report a case of 67-year-old woman who suffered from liver abscess combined by malignant GIST with central necrosis and fistula in the ileum. She complained of fever, chills, and abdominal pain. Abdominal CT scan showed huge liver abscess and ileal mass with air pocket. Small bowel series showed contrast material filling into the ileal GIST mass. An operation was performed and the final diagnosis was malignant GIST of the ileum with invasion into the sigmoid colon and urinary bladder.
Aged ; Diagnosis, Differential ; Female ; Gastrointestinal Stromal Tumors/*diagnosis/pathology/surgery ; Humans ; Ileal Neoplasms/*diagnosis/pathology/surgery ; Liver Abscess/*etiology ; Neoplasm Invasiveness ; Proto-Oncogene Proteins c-kit/analysis ; Reagent Kits, Diagnostic

BACKGROUND: Nitric Oxide (NO) induced by NO synthase is known to be associated with hyperdynamic circulation and collateralization by vascular remodeling in patients with cirrhosis. METHODS: To assess the significance of peripheral NO activity in patients with cirrhosis, we measured the production of NO metabolites, nitrate and nitrite, using the nitrate/nitrite colorimetric assay with Griess reagents in the peripheral venous blood of 95 cirrhotic patients with or without clinical portal hypertension (PHT), and in the peripheral venous blood of 32 control patients without liver disease. RESULTS: The peripheral NO activities in cirrhotic patients with clinical PHT, cirrhotic patients without clinical PHT, and non-liver disease control patients were 86.1+/-40.6 micro mol/L, 83.5+/-47.2 micro mol/L and 52.3+/-38.4 micro mol/L, respectively. NO activity was significantly higher in cirrhotic patients than in non-liver disease control patients (p<0.05), while there was no significant difference of NO activity between the cirrhotic patients with or without clinical PHT. Peripheral NO activities in cirrhotic patients with Child-Pugh classification A, B, and C were 84.9+/-45.5 micro mol/L, 81.9+/-53.2 micro mol/L and 86.4+/-39.8 micro mol/L, respectively; these results were not significantly different. A significant correlation of NO activity with the biochemical profiles of the serum albumin level, bilirubin level and prothrombin time were not defined. CONCLUSIONS: Peripheral NO activity was increased in cirrhotic patients, but it did not reflect the degree of clinical portal hypertension and the function of the hepatic reserve in this study. For a precise analysis of the association of NO and hyperdynamic circulation with collateralization in cirrhosis, intrahepatic or portal NO activity might be considered rather than peripheral NO activity.
Bilirubin ; Classification ; Fibrosis ; Humans ; Hypertension, Portal ; Indicators and Reagents ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; Nitric Oxide Synthase ; Nitric Oxide* ; Prothrombin Time ; Serum Albumin

BACKGROUND: Fungal sinusitis (mycetoma)is distinguished from chronic sinusitis in the aspect of unilateral maxillary sinus involvement. We aimed to elucidate the mechanism of localization in fungal sinusitis by comparing the inflammatory cells infiltrating into the mucosa. MATERIALS AND METHOD: Study subjects were 10 patients with chronic sinusitis involving the maxillary sinus and 10 patients with fungal sinusitis (mycetoma of the maxillary sinus). Pathological mucosa of the maxillary sinus near the ostium were obtained during endoscopic sinus surgery. We counted the number of basophils, eosinophils, neutrophils, plasma cells, and lymphocytes within 1 mm2 (2 mmX0.5 mm)of the central, superficial area of the lamina propria of the pathological mucosa, under a light microscope (X400)using eye reticule. RESULTS: The average numbers of basophils, eosinophils, neutrophils, plasma cells, lymphocytes, and the total inflammatory cells in chronic sinusitis were 7, 50, 71, 231, 647, and 1,008, respectively: and in fungal sinusitis, the numbers were 5, 36, 18, 444, 676, and 1,180. In chronic sinusitis, neutrophils were significantly increased when compared to those of fungal sinusitis patients. In fungal sinusitis, infiltration of plasma cells was significantly increased when compared to that of chronic sinusitis. And for both groups, plasma cells and lymphocytes were the two most predominant inflammatory cells. CONCLUSION: The increased plasma cells in non-invasive fungal sinusitis could be the mechanism for the localization of the fungal lesion within the maxillary sinus, possibly by producing immunoglobulin against fungi.
Basophils ; Eosinophils ; Fungi ; Humans ; Immunoglobulins ; Lymphocytes ; Maxillary Sinus* ; Mucous Membrane* ; Neutrophils ; Plasma Cells ; Sinusitis*

BACKGROUND AND OBJECTIVES: As septoplasty has been performed more often in recent years, the incidence of septal perforation as one of its complications has also been increased. Authors aimed to elucidate the etiology and clinical characteristics of the septal perforation. MATERIALS AND METHODS: Fifty-eight patients with septal perforation were diagnosed between 1991 and 1998 at the Department of Otolaryngology, Asan Medical Center. Of them, 46 were male and 12 were female, and their ages ranged from 14 to 76 years of age (mean : 47 years). Medical records were retrospectively reviewed to investigate the etiology, clinical symptoms, and treatment results. RESULTS: The most common cause of septal perforation was associated with nasal surgery (41 patients ; 72%) such as submucous resection (22 patients), septoplasty (10 patients), and transseptal pituitary tumor surgery (7 patients). Malignancy involving the nasal septum was the second common cause (8 patients ; 14%). Nasal stuffiness was the most common complaint (36 patients ; 62%), followed by crust formation (24 patients ; 41%), and nasal bleeding (7 patients ; 12%). Around three quarters of patients had perforation smaller than 10 mm in diameter and the cartilaginous septum was the most common site of perforation (88%). Eleven patients not responding to medical treatment underwent surgical repair with a success rate of 91%. CONCLUSIONS: This study shows that most of the septal perforations are caused by previous nasal surgery involving the nasal septum. Surgeons should be very careful not to make a bilateral corresponding mucosal tear during the septal surgery. If this occurs, meticulous suture-repair with interposition of graft should be applied. For the chronic symptomatic perforation that is refractory to medical treatment, surgical repair using flap and grafts could be performed with a success rate of 90%.
Chungcheongnam-do ; Epistaxis ; Female ; Humans ; Incidence ; Male ; Medical Records ; Nasal Septal Perforation* ; Nasal Septum ; Nasal Surgical Procedures ; Otolaryngology ; Pituitary Neoplasms ; Retrospective Studies ; Transplants