OBJECTIVE: The aim of the present study was to provide clinical consensus and evidence regarding initial treatment strategies for the pharmacological treatment of social anxiety disorder (SAD) in Korea. METHODS: We prepared a questionnaire to derive a consensus from clinicians regarding their preference for the pharmacological treatment of SAD in Korea. Data regarding medication regimens and psychotropic drugs used during initial treatment, the doses used, and the pharmacological treatment duration were obtained. Responses were obtained from 66 SAD experts, and their opinions were classified into three categories (first-line, second-line, third-line) using a chi-square analysis. RESULTS: Clinicians agreed upon first-line regimens for SAD involving monotherapy with selective serotonin reuptake inhibitors (SSRIs) or the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine, or combined therapy using antidepressants with betablockers or benzodiazepines on a standing or as-needed basis. First-line psychotropic drug choices for initial treatment included the following: escitalopram, paroxetine, sertraline, venlafaxine, and propranolol. The medication dosage used by domestic clinicians was found to be comparable with foreign guidelines. Domestic clinicians tended to make treatment decisions in a shorter amount of time and preferred a similar duration of maintenance treatment for SAD when compared with foreign clinicians. CONCLUSION: This study may provide significant information for developing SAD pharmacotherapy guidelines in Korea, especially in the early stage of treatment.
Antidepressive Agents ; Anxiety Disorders ; Anxiety ; Benzodiazepines ; Citalopram ; Consensus ; Drug Therapy ; Korea ; Paroxetine ; Propranolol ; Psychotropic Drugs ; Serotonin Uptake Inhibitors ; Sertraline ; Venlafaxine Hydrochloride

BACKGROUND: We present here the annual data of the intensive care unit (ICU) module of the Korean Nosocomial Infections Surveillance System (KONIS) from July 2010 through June 2011. METHODS: We performed a prospective surveillance of nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 130 ICUs in 72 hospitals using KONIS. Nosocomial infection (NI) rates were calculated as the number of infections per 1,000 patient-days or device-days. RESULTS: A total of 3,757 NIs were found: 1,978 UTIs (1,949 cases were urinary catheter-associated), 1,092 BSIs (with 932 being central line-associated), and 687 PNEUs (410 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTIs) was 3.87 cases per 1,000 device-days (95% confidence interval, 3.70-4.05), and the urinary catheter utilization ratio was 0.86 (0.859-0.861). The rate of central line-associated BSIs was 3.01 per 1,000 device-days (2.82-3.21), and the utilization ratio was 0.53 (0.529-0.531). The rate of ventilator-associated PNEUs (VAPs) was 1.75 per 1,000 device-days (1.59-1.93), and the utilization ratio was 0.40 (0.399-0.401). Although both the ventilator utilization ratiosand the urinary catheter utilization ratios were lower in hospitals with 400-699 beds than thosein hospitals with 700-899 beds ormore than 900 beds, the rates of VAPsand CAUTIs were higher in hospitals with 400-699 beds than thosein hospitals with 700-899 beds or more than 900 beds. CONCLUSION: The risk of acquiring VAP and CAUTI is higher in the ICUs of 400-699 bed hospitals than in ICUs oflarger hospitals. Therefore, ongoing targeted surveillance and implementation of proven infection control strategies are needed especially for hospitals having fewer than 700 beds.
Benzamides ; Cross Infection ; Infection Control ; Critical Care ; Intensive Care Units ; Pneumonia ; Prospective Studies ; Urinary Catheters ; Urinary Tract Infections ; Ventilators, Mechanical

BACKGROUND/AIMS: Propranolol can prevent variceal bleeding by ameliorating portal hypertension. We conducted this study to determine the effect of propranolol on portal hypertension and the optimal required dose in Korean cirrhotic patients. METHODS: This study prospectively evaluated 50 patients with cirrhosis who exhibited variceal bleeding. The hepatic venous pressure gradient (HVPG), portal venous flow, heart rate (HR), and blood pressure were assessed both at baseline and at 3 months after the treatment. The initial dose of propranolol (20 mg) was subsequently adjusted until the target HR was reached. Patients in whom HVPG reduced by >20% or to less than 12 mmHg were defined as responders. RESULTS: Propranolol significantly (p<0.01) reduced the HVPG (-21+/-26%, mean+/-standard deviation), portal venous flow (-25+/-21%), HR (-20+/-13%), and blood pressure (-3+/-13%). Twenty-nine patients were responders, and the optimal required dose was 154.4 mg. The main complication was dizziness (24%), but this was not serious enough to require medication withdrawal. CONCLUSIONS: Propranolol is safe and effective at reducing portal pressure in Korean cirrhotic patients. An effective improvement in portal hypertension requires the dose to be increased until the target HR is reached.
Blood Pressure ; Dizziness ; Esophageal and Gastric Varices ; Fibrosis ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension, Portal* ; Liver Cirrhosis* ; Liver* ; Portal Pressure* ; Propranolol* ; Prospective Studies* ; Venous Pressure

BACKGROUND/AIMS: Gastric variceal bleeding is a severe complication of cirrhosis, and it has a high mortality rate. This study was conducted to evaluate the efficacy of n-butyl-2-cyanoacrylate injection therapy for patients suffering with gastric variceal bleeding. METHODS: A total of 86 patients diagnosed with gastric variceal bleeding underwent endoscopic n-butyl-2-cyanoacrylate (Histoacryl(R)) injection therapy at our department between April, 2002 and July, 2005, with a mean follow-up period of 44 weeks (range: 2 to 136 weeks). The initial hemostasis rate and the rebleeding rate of endoscopic sclerotherapy were analyzed. Also, the cumulative survival rate was analyzed according to the status of hepatocellular carcinoma and hyponatremia, the MELD score, the Child-Pugh score and the amount of injected Histoacryl(R). RESULTS: The initial hemostasis rate of Histoacryl(R) injection therapy was 93% and the 1 month rebleeding rate was 16.1%. The total number of session for treating the initial hemostasis was 1.2+/-0.4 and the total volume of Histoacryl(R) was 2.7+/-1.2 mL. The cumulative rebleeding-free rates for the patients treated by the Histoacryl(R) injection method at 1 month, 12 months and 34 months period were 95.1%, 83.2% and 74%, respectively. The cumulative survival rates were 78.3% at 1 month, 61.9% at 12 months and 54.6% at 34 months, respectively. No thromboembolic phenomenon occurred. According to the Cox's proportional hazards analysis, only the MELD score (<15) was an independent predicting factor for survival of the patients with gastric variceal bleeding. CONCLUSIONS: Endoscopic sclerotherapy using n-butyl-2-cyanoacrylate was a safe and effective hemostatic method for patients with gastric variceal bleeding. Also, the MELD score (<15) contributed to predicting survival of the patients with gastric variceal bleeding.
Adult ; Aged ; Aged, 80 and over ; Enbucrilate/*analogs & derivatives/therapeutic use ; Esophageal and Gastric Varices/*therapy ; Female ; Gastrointestinal Hemorrhage/mortality/*therapy ; Hemostasis, Endoscopic ; Humans ; Male ; Middle Aged ; *Sclerotherapy ; Survival Rate ; Treatment Outcome

BACKGROUNDS/AIMS: Doppler ultrasongraphy is used to evaluate hemodynamic alternations in patients with liver cirrhosis. Purpose of this study was to determine the interequipment variability of Doppler indices in portal and splenic vein in cirrhosis. METHODS: Blood velocity, diameter, flow and congestive index in portal and splenic vein were measured by Doppler ultrasonography in 30 patients with cirrhosis using two different machines. RESULTS: Portal venous velocities measured by HDI-5000 and SSD-5000 were 8.72+/-3.69 cm/sec, 12.21+/-2.84 cm/sec, respectively which showed significant difference (P<0.001). Measured portal blood flows and congestive indices also had significant difference between HDI-5000 and SSD-5000 (P<0.01). Splenic venous velocity by HDI-5000 was 8.55+/-2.71 cm/sec, which was lower than that of 12.32+/-3.11 cm/sec by SSD-5000 (P<0.001). Splenic blood flows measured by HDI-5000 and SSD-5000 were 390.73+/-260.98 mL/min, 595.01+/-346.53 mL/min, respectively, showing significant difference (P=0.015). However, no differences were in the diameters of portal and splenic vein between HDI-5000 and SSD-5000. CONCLUSION: Doppler indices in portal and splenic vein showed significant interequipment variability. Therefore, in liver cirrhosis, hemodynamic investigations using different Doppler ultrasonographic machines is inappropriate.
Adult ; Aged ; Blood Flow Velocity ; Female ; Humans ; Liver Cirrhosis/*ultrasonography ; Male ; Middle Aged ; Ultrasonography, Doppler/*instrumentation

We evaluated the two classification systems of children's ankle fractures, the anatomical (Salter-Harris) and the mechanism of injury (Dias-Tachdjian) classifications, in terms of their usefulness and inter-observer variations. An ideal or useful classification system should comprise any possible types of injury, be easily remembered, and have little inter-observer variations. Five observers were asked to classify 57 physeal fractures of the ankle according to each classification systems. Fifty-four (94%) fractures were classifiable with Salter-Harris anatomical classification system. If we adopt the recently developed Peterson's anatomical classification system, the other three fractures could also be classified. In contrast, the mechanism of injury classification system of Dias and Tachdjian could be applied to 44 (77%) fractures. Though the mechanism of injury classification system was more cumbersome to understand, each observer successfully memorized both classification systems. For observer variations, calculated by kappa statistics, there was an acceptable level of agreement for overall classification by both systems. The results indicate that both classification systems of children's ankle fracture have reproducibility within an acceptable range of inter-observer variation. The Dias-Tachdjian's system needed to be upgraded to a more comprehensive one to include some variant types of ankle injuries.
Ankle Fractures* ; Ankle Injuries ; Ankle* ; Child ; Classification* ; Humans ; Observer Variation

We performed standardized anterior-posterior radiographs of the normal ankle on 50 males and 50 females to determine the validity of current radiographic landmarks of the ankle syndesmosis separation. The average tibiofibular overlap was 6.9+/-2.1mm. The tibiofibular clear space was measured 4.1+/-0.9mm overall. The ratio of the tibiofibular overlap to the fibular width averaged 48+/-14%. Our data show that for 95% confidence intervals, the values for the syndesmosis separation are : (1) tibiofibular overlap less than 2.7mm, (2) tibiofibular clear space greater than 5.9mm, (3) tibiofibular overlap: fibular width ratio less than 24%. According to current diagnositc criterion of tibiofibular overlap under 10mm, 87% of this cohort was defined as syndesmosis separation. Other current criteria of tibiofibular clear space over 5 mm and tibiofibular overlap: fibular width ratio less than 24%, the false positivity was only 7% and 2%, respectively. Therefore the tibiofibular clear space and the tibiofibular overlap: fibular width ratio are more reliable diagnositc criteria for syndesmosis separation than the tibiofibular overlap.
Adult* ; Ankle Joint* ; Ankle* ; Cohort Studies ; Female ; Humans ; Male

Open fractures of the tibial shaft have a high incidence of complication and often result in poor outcomes. The most common method of stabilization is the external fixation by way of the Ilizarov method but the small diameter interlocking intramedullary nailing has also been introduced. The purpose of this study is to analyze the result of Ilizarov method and to compare its results with those of delayed intramedullary nailing used in the treatment of open tibial shaft fractures. We analyzed 81 patients with open tibial shaft fractures, treated using Ilizarov external fixator, or by delayed locked intramedullary nailing between January 1987 and December 1994. The follow-up period was an average 14.5 months. Out of the 81 patients, 58 patients were treated by nails and 23 patients by Ilizarov external fixators. Both groups were given the same initial management but the operation of the nailing group was delayed until proper soft tissue coverage and healing of the wound were evident. In the Ilizarov method group, 58 fractures obtained union within 26 to 53 weeks (average of 32.8 weeks) and in the nailing group, 23 fractures showed union within 14 to 51 weeks (average of 21.2 weeks). There was a significant difference between the two groups (P<0.05). Complications in the Ilizarov group included 4 nonunions, 12 delayed unions, 3 malalignments, 14 wound infections and 13 stiff ankles. There were no nonunion, 10 delayed unions, 8 malalignments, 6 wound infections and 11 stiff ankles in the nailing group. In this study, the Ilizarov group had more delayed unions and nonunions took a longer period of time to obtain the union, and had a more limited range of motion in the ankle, than the nailing group. The nailing group was easier to manage, especially in the soft tis-sue procedure, and it did not require a high level of compliance while having a relatively low risk of malunion.
Ankle ; Compliance ; External Fixators* ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Fractures, Open ; Humans ; Ilizarov Technique ; Incidence ; Range of Motion, Articular ; Wound Infection ; Wounds and Injuries

Neurofibroma, one of the peripheral nerve tumor, is a complex benign tumor arising from skin, deep soft tissue, nerve tissue and bone. The incidence of peripheral nerve tumor is relatively low and it may occur either solitarily or diffusely. Plexiform neurofibroma, a type of neurofibroma, develops characteristically in the patients with von Recklinghausen's disease and its exact incidence is unknown. The case reports of solitary plexiform neurofibroma not associated with von Recklinghausen's disease were extremely rare. We reported a case of solitary plexiform neurofibroma on the median nerve.
Humans ; Incidence ; Median Nerve* ; Nerve Tissue ; Neurofibroma ; Neurofibroma, Plexiform* ; Neurofibromatosis 1 ; Peripheral Nervous System Neoplasms ; Skin

We describe an extra-articular triplane fracture of distal tibia in a twelve-year-old boy. This variant of the triplane fracture has been largely ignored in the literature. The clinical significance of recognizing this fracture is that, although it constitutes an epiphyseal fracture, it remains extra-articular. We treated this case by open reduction and internal fixation of both distal tibia and fibula. However, unlike the standard triplane fracture that exits through the tibiot alar joint, this variant may be treated acceptably with less that an anatomical reduction, therefore avoiding the need for surgical management.
Fibula ; Humans ; Joints ; Male ; Tibia