OBJECTIVE: Acupotomy is a modern acupuncture method that includes modern surgical methods. Since acupotomy is relatively more invasive than filiform acupuncture treatment, it is important to establish the safety profile of this practice. To justify further large-scale prospective observational studies, this preliminary study was performed to assess the feasibility of the approach and investigate the safety profile and factors potentially associated with adverse events (AEs). METHODS: This was a prospective pilot study that assessed the feasibility of a large-scale forthcoming safety study on acupotomy treatment in a real-world setting. The feasibility (call response rate, drop-out rate, response rate for each variable and recruitment per month) and safety profile (incidence, type, severity and causality of AEs, and factors potentially associated with AEs) were measured. RESULTS: A total of 28 participants joined the study from January to May 2018. A follow-up assessment was achieved in 258 (1185 treatment points) out of 261 sessions (1214 treatment points). The response rate via telephone on the day after treatment was 87.3%. There were 8 systemic AEs in all the sessions (8/258; 3.11%) and 27 local AEs on the total points treated (27/1185; 2.28%). Severe AEs did not occur. Total AE and local AE occurrence were associated with blade width and the number of needle stimulations per treatment point. CONCLUSION: The findings suggest that it could be feasible to analyze the safety of acupotomy in a real-world setting. Moreover, the primary data on some relevant AEs could be determined. We are planning large-scale prospective studies based on these findings. TRIAL REGISTRATION Clinical Research Information Service (CRIS) KCT0002849 (https://cris.nih.go.kr/cris/search/detailSearch.do/11487).
Humans ; Feasibility Studies ; Prospective Studies ; Pilot Projects ; Acupuncture Therapy/methods* ; Research Design ; Treatment Outcome

Background: In pityriasis versicolor, systemic antifungal agents may be indicated for widespread or refractory lesions rather than topical treatment. Oral ketoconazole is an effective treatment for pityriasis versicolor. To our knowledge, this is the first meta-analysis to compare antifungal agents one-to-one. Objective: To compare the effectiveness of oral azole antifungal agents (fluconazole, itraconazole, and ketoconazole) one-to-one in pityriasis versicolor. Methods: A computerized search was performed in different databases, including PubMed, Cochrane, EMBASE, OVID Medline, KoreaMed, KISS, and MedRIC. Seven randomized controlled trials were included. Further, statistical analyses of the extracted outcome data from the studies were performed using Rex Software (ver. 3.0.1). Results: A total of 1,828 records were identified. The results of the meta-analysis including seven studies revealed no significant differences in the mycological cure rates between fluconazole and ketoconazole (risk ratio [RR]: 1.01, 95% confidence interval [CI]: 0.93∼1.09, p=0.8246), fluconazole and itraconazole (RR: 1.14, 95% CI: 0.81∼1.60, p=0.4512), and ketoconazole and itraconazole (RR: 1.07, 95% CI: 0.96∼1.20, p=0.2265). Conclusion There was no superiority in the therapeutic effect of any drug among the oral azole antifungals used in pityriasis versicolor.

Background: In pityriasis versicolor, systemic antifungal agents may be indicated for widespread or refractory lesions rather than topical treatment. Oral ketoconazole is an effective treatment for pityriasis versicolor. To our knowledge, this is the first meta-analysis to compare antifungal agents one-to-one. Objective: To compare the effectiveness of oral azole antifungal agents (fluconazole, itraconazole, and ketoconazole) one-to-one in pityriasis versicolor. Methods: A computerized search was performed in different databases, including PubMed, Cochrane, EMBASE, OVID Medline, KoreaMed, KISS, and MedRIC. Seven randomized controlled trials were included. Further, statistical analyses of the extracted outcome data from the studies were performed using Rex Software (ver. 3.0.1). Results: A total of 1,828 records were identified. The results of the meta-analysis including seven studies revealed no significant differences in the mycological cure rates between fluconazole and ketoconazole (risk ratio [RR]: 1.01, 95% confidence interval [CI]: 0.93∼1.09, p=0.8246), fluconazole and itraconazole (RR: 1.14, 95% CI: 0.81∼1.60, p=0.4512), and ketoconazole and itraconazole (RR: 1.07, 95% CI: 0.96∼1.20, p=0.2265). Conclusion There was no superiority in the therapeutic effect of any drug among the oral azole antifungals used in pityriasis versicolor.

Purpose: Proper use of antibiotics during emergency abdominal surgery is essential in reducing the incidence of surgical site infection. However, no studies have investigated the type of antibiotics and duration of therapy in individuals with abdominal trauma in Korea. We aimed to investigate the status of initial antibiotic therapy in patients with solitary abdominal trauma. Methods: From January 2015 to December 2015, we retrospectively analyzed the medical records of patients with solitary abdominal trauma from 17 institutions including regional trauma centers in South Korea. Both blunt and penetrating abdominal injuries were included. Time from arrival to initial antibiotic therapy, rate of antibiotic use upon injury mechanism, injured organ, type, and duration of antibiotic use, and postoperative infection were investigated. Results: Data of the 311 patients were collected. The use of antibiotic was initiated in 96.4% of patients with penetrating injury and 79.7% with blunt injury. Initial antibiotics therapy was provided to 78.2% of patients with solid organ injury and 97.5% with hollow viscus injury. The mean day of using antibiotics was 6 days in solid organ injuries, 6.2 days in hollow viscus. Infection within 2 weeks of admission occurred in 36 cases. Infection was related to injury severity (Abbreviated Injury Scale of >3), hollow viscus injury, operation, open abdomen, colon perforation, and RBC transfusion. There was no infection in cases with laparoscopic operation. Duration of antibiotics did not affect the infection rate. Conclusion Antibiotics are used extensively (84.2%) and for long duration (6.2 days) in patients with abdominal injury in Korea.

Patients with severe lung injury and hemorrhagic shock, may develop acute respiratory failure syndrome during resuscitation, and may require extracorporeal membrane oxygenation (ECMO) support to ensure adequate oxygenation to sustain life. In this case study, a 69 year-old female was hit by a motor vehicle whilst riding her bicycle. She was in a state of hemorrhagic shock due to polytrauma and was resuscitated with massive fluid transfusion during the initial management. After admission to the intensive care unit, she suffered from hypoxia which required mechanical ventilation using 100% oxygen. However, hypoxia did not improve, so she was placed on venoveno ECMO support after 4 days of intensive care treatment. Although trauma and bleeding are considered as relative contraindications for ECMO support, veno-veno ECMO allows for lung rest, and improvement of pulmonary function.

Patients with severe lung injury and hemorrhagic shock, may develop acute respiratory failure syndrome during resuscitation, and may require extracorporeal membrane oxygenation (ECMO) support to ensure adequate oxygenation to sustain life. In this case study, a 69 year-old female was hit by a motor vehicle whilst riding her bicycle. She was in a state of hemorrhagic shock due to polytrauma and was resuscitated with massive fluid transfusion during the initial management. After admission to the intensive care unit, she suffered from hypoxia which required mechanical ventilation using 100% oxygen. However, hypoxia did not improve, so she was placed on venoveno ECMO support after 4 days of intensive care treatment. Although trauma and bleeding are considered as relative contraindications for ECMO support, veno-veno ECMO allows for lung rest, and improvement of pulmonary function.

Central hypoventilation syndrome is a rare and fatal condition resulting from various central nervous system disorders that is characterized by a failure of automatic breathing. We report a case of central hypoventilation syndrome following posterior circulation stroke whose pulmonary function was improved by respiratory rehabilitation. A 59-year-old woman with a history of hemorrhagic stroke of the bilateral cerebellum was hospitalized due to pneumonia. A portable ventilator was applied via tracheostomy, recurrent episodes of apnea and hypercapnia impeded weaning. A respiratory rehabilitation program including chest wall range of motion exercise, air stacking exercise, neuromuscular electrical stimulation (NMES) on abdominal muscles, upper extremity ergometer, locomotor training, high-frequency chest wall oscillator, mechanical insufflation, and exsufflation was employed, as spirometry showed a severe restrictive pattern. A spontaneous breathing trial was started, and a portable ventilator was applied for 8 hours, only during nighttime, to prevent sudden apneic event. After 4 weeks of treatment, follow-up spirometry showed much improved respiratory parameters. This case suggests that respiratory rehabilitation can improve pulmonary function parameters and quality of life in central hypoventilation syndrome.
Abdominal Muscles ; Apnea ; Central Nervous System Diseases ; Cerebellum ; Electric Stimulation ; Female ; Follow-Up Studies ; Humans ; Hypercapnia ; Hypoventilation ; Insufflation ; Middle Aged ; Pneumonia ; Quality of Life ; Range of Motion, Articular ; Rehabilitation ; Respiration ; Respiratory Center ; Spirometry ; Stroke ; Thoracic Wall ; Tracheostomy ; Upper Extremity ; Ventilators, Mechanical ; Weaning

No abstract available.
Humans ; Multiple Myeloma ; Xanthomatosis

OBJECTIVE: To investigate the effect of physical therapy (PT) intervention on spasticity in patients with cerebral palsy (CP), and to assess the degree of deterioration of spasticity when regular PT is interrupted in those patients. METHODS: We recruited 35 children with spastic CP who visited our hospital for PT, and whose Modified Tardieu Scale (MTS) scores were serially recorded including before and after a 10-day public holiday time frame period. The outcome measures were the angle of range of motion (ROM) of dorsiflexion of the ankle joint (R1 and R2) in the knee flexion and extension positions as assessed using the MTS. RESULTS: The range of dorsiflexion of the ankle joint (R1 and R2) after the holiday period was significantly decreased as compared with that measured ROM noted before the holiday period, regardless of the knee position, age, or gross motor function. The dynamic component of the MTS (R2–R1) showed a slight decrease in the knee flexion position. CONCLUSION: Interruption of regular PT aggravated spasticity and decreased ankle joint ROM in children with spastic CP. Our findings suggest that regular PT in the care continuum for children with CP is crucial for the maintenance of ROM in the spastic ankle joints.
Ankle Joint ; Cerebral Palsy ; Child ; Continuity of Patient Care ; Holidays ; Humans ; Knee ; Muscle Spasticity ; Outcome Assessment (Health Care) ; Range of Motion, Articular

The pneumatic colorectal injury caused by high pressure compressed air are rare and can be fatal. Herein, we present a case of 45-year-old male who developed sudden onset of severe abdominal pain after cleaning the dust on his pants with high pressure compressed air gun dust cleaner. Emergent exploratory laparotomy was done which findings are a huge rectal perforation with multiple serosal and subserosal tear in sigmoid to splenic flexure of colon. Anterior resection with left hemicolectomy, and temporary transverse colostomy was performed. Postoperative course was uneventful. Recently, prognosis is generally favorable because of prompt diagnosis and emergent surgical management.
Abdominal Pain ; Colon ; Colon, Sigmoid ; Colon, Transverse ; Colostomy ; Compressed Air ; Diagnosis ; Dust ; Humans ; Laparotomy ; Male ; Middle Aged ; Prognosis ; Rectum ; Tears