Background and Objectives: De-escalation of dual-antiplatelet therapy through dose reduction of prasugrel improved net adverse clinical events (NACEs) after acute coronary syndrome (ACS), mainly through the reduction of bleeding without an increase in ischemic outcomes. Whether the benefits of de-escalation are sustained in highly thrombotic conditions such as ST-elevation myocardial infarction (STEMI) is unknown. We aimed to assess the efficacy and safety of de-escalation therapy in patients with STEMI or non-STsegment elevation ACS (NSTE-ACS). Methods: This is a pre-specified subgroup analysis of the HOST-REDUCE-POLYTECH-ACS trial. ACS patients were randomized to prasugrel de-escalation (5 mg daily) or conventional dose (10 mg daily) at 1-month post-percutaneous coronary intervention. The primary endpoint was a NACE, defined as a composite of all-cause death, non-fatal myocardial infarction, stent thrombosis, clinically driven revascularization, stroke, and bleeding events of grade ≥2 Bleeding Academic Research Consortium (BARC) criteria at 1 year. Results: Among 2,338 patients included in the randomization, 326 patients were diagnosed with STEMI. In patients with NSTE-ACS, the risk of the primary endpoint was significantly reduced with de-escalation (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.48– 0.89; p=0.006 for de-escalation vs. conventional), mainly driven by a reduced bleeding. However, in those with STEMI, there was no difference in the occurrence of the primary outcome (HR, 1.04; 95% CI, 0.48–2.26; p=0.915; p for interaction=0.271). Conclusions Prasugrel dose de-escalation reduced the rate of NACE and bleeding, without increasing the rate of ischemic events in NSTE-ACS patients but not in STEMI patients.

Trigger wrist is a relatively rare disease compared to trigger finger, which is the most common disorder found in hands. Patients with trigger wrist usually complain about the following symptoms: snapping and clicking or triggering around carpal tunnel with or without mild to moderate median neuropathy. There are a total of five cases of trigger wrist: three cases of anomalous muscle belly of flexor digitorum superficialis and two cases of fibroma around flexor tendon sheath within carpal tunnel. This study reports on two of those cases: one with anomalous muscle and the other with fibroma of flexor tendon sheath. Accurate examination and proper diagnosis are mandatory to obviate improper and time-wasting treatment for patients with trigger wrist.
Adult ; Female ; Fibroma ; Humans ; Male ; *Tenosynovitis/physiopathology/radiography/surgery ; *Wrist/physiopathology/radiography/surgery

BACKGROUND AND OBJECTIVES: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician's diagnostic and therapeutic approaches for BPPV. MATERIALS AND METHODS: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. RESULTS: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). CONCLUSION: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.
Surveys and Questionnaires ; Delivery of Health Care ; Dizziness ; Electronic Mail ; Korea ; Otolaryngology ; Otolithic Membrane ; Public Opinion ; Vertigo

PURPOSE: Distal radius fractures involving distal radioulnar joint (DRUJ) are common. After the fracture treatment, pain on the ulnar side of wrist, limitation of forearm rotation and instabilities can be remained. The purpose of this study was to address the importance of anatomical reduction for DRUJ injuries. METHODS: Of 115 cases with a distal radius fracture involving DRUJ, 61 cases involving sigmoid notch of the radius or having a ulnar styloid process base fracture were evaluated. At an average of six months follow-up, their final outcomes were investigated using radiologic findings, functional disabilities of the arm, shoulder and hand (DASH) and visual analogue scale (VAS) pain scores and wrist motion of pronation/supination. RESULTS: Satisfied radiologic reduction rate was 73.8%(45/61) in average, which was most favorable in external fixator group (82.4%, 28/34). The mean functional DASH score was 29.0 points and mean VAS for pain was 5.0. The mean range of wrist motions for pronation/supination was 59.5degrees/55.7degrees. CONCLUSION: Distal radius fractures involving DRUJ should be classified into the basic categories of unstable distal radius fracture, and immediate anatomical reduction is needed by operative treatment to avoid painful forearm rotation.
Arm ; Colon, Sigmoid ; External Fixators ; Follow-Up Studies ; Forearm ; Hand ; Joints ; Radius ; Radius Fractures ; Shoulder ; Wrist

BACKGROUND/AIMS: Home oxygen therapy (HOT) costs a great deal every year and demand for the service is growing. In Korea, health insurance has covered HOT since November 1, 2006. The objective of this study was to evaluate clinical features of patients who used long-term HOT due to chronic respiratory failure and to determine the appropriateness of oxygen prescriptions. METHODS: Between November 2006 and April 2010, patients prescribed long-term HOT were enrolled in the study at a tertiary university referral hospital and their medical records and telephone survey information were evaluated. In total, 340 patients were evaluated retrospectively. RESULTS: Regarding the initial indications for HOT, their mean PaO2 was 49.8 mmHg and mean SpO2 was 82.2%. Underlying diseases included chronic obstructive pulmonary disease (COPD, 19.8%), lung cancer (12.6%), and interstitial lung disease (11.2%). The admission rate within 1 year was 53.4% and the average number of admissions was 1.64/patient. Other underlying diseases for which oxygen was prescribed, despite not meeting the insurance coverage criteria, were lung cancer (36.6%) and interstitial pneumonia (16.6%). CONCLUSIONS: Home oxygen prescriptions have increased since health insurance coverage was extended. However, cases of oxygen prescriptions frequently do not meet the coverage criteria. It is important to discuss extending the coverage criteria to other disease groups, such as interstitial lung disease and lung cancer, in terms of cost-effectiveness. Further, physicians prescribing oxygen therapy should be educated regarding the criteria.
Adult ; Aged ; Aged, 80 and over ; Cause of Death ; Chronic Disease ; Eligibility Determination ; Emergency Service, Hospital ; Female ; *Home Care Services, Hospital-Based ; Hospitalization ; *Hospitals, University ; Humans ; Insurance Coverage ; Insurance, Health ; Kaplan-Meier Estimate ; Male ; Middle Aged ; *Oxygen Inhalation Therapy ; Patient Compliance ; Program Evaluation ; Republic of Korea ; Respiratory Insufficiency/diagnosis/etiology/mortality/*therapy ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Young Adult

PURPOSE: The aim of this study was to assess the risk factors of nonunion after surgical treatment of acute scaphoid fractures. MATERIALS AND METHODS: Predictable risk factors were investigated retrospectively in 70 patients with an acute scaphoid fracture. The risk factors involved sex, age, profession, smoking, fracture location, fracture gap distance, type of lunate, ulnar variance, fixation method, and surgical approach. At twelve months after surgery, analysis was conducted to identify the factors for prognosis toward bone healing or failure. RESULTS: Sixty-four patients (91%) demonstrated radiological union after a mean time of 2.8 months. The average scapholunate angle was 52degrees at the final follow up. Professional heavy work, smoking, fracture of proximal pole were associated with a significantly decreased likelihood of healing. CONCLUSION: The patients who have the risk factors of nonunion such as heave work, smoking and fracture of proximal pole should be treated carefully.
Follow-Up Studies ; Humans ; Prognosis ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking

PURPOSE: Malignant tumors of the hand occurred very rarely and optical surgical treatment and prognosis are not clearly established. We report the clinical characteristics and treatment outcomes of primary and metastatic bone and soft tissue tumors during last twenty years with a review of literatures. MATERIALS AND METHODS: We reviewed 20 cases of malignant tumors in the hand (7 cases of acrometastasis, 9 cases of malignant melanoma, 2 cases of chondrosarcoma and 2 cases of squamous cell carcinoma) retrospectively. RESULTS: Patients of early Clark stage (I to III) of malignant melanoma survived after wide resection or ray amputation. But patients with late Clark stage (IV to V) expired associated with distant metastasis. All seven patients with acrometastasis expired in 6.3 months after diagnosis of metastasis. Two patients with chondrosarcoma survived without recurrence. Among patients with squamous cell carcinoma, one patient is free of disease after wide resection, but the other was dead due to metastasis. CONCLUSION: Good results might be attained after surgical treatment of malignant tumors of the hand by proper surgical technique to minimize loss of hand function and systemic evaluation of metastasis.
Amputation ; Carcinoma, Squamous Cell ; Chondrosarcoma ; Hand ; Humans ; Melanoma ; Neoplasm Metastasis ; Prognosis ; Recurrence

Respiratory syncytial virus (RSV) is a common cause of respiratory tract infection in children. Although previously considered as children's virus, the increasing number of patients who receive immunosuppression after transplantation of bone marrow and solid organs highlighted the role of RSV as a pathogen for opportunistic infection. We report a case of community-acquired respiratory syncytial virus pneumonia in a patient with newly diagnosed leukemia, resulting in acute respiratory distress syndrome (ARDS).
Bone Marrow ; Child ; Humans ; Immunosuppression ; Leukemia ; Opportunistic Infections ; Pneumonia ; Respiratory Distress Syndrome, Adult ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Transplants ; Viruses

PURPOSE: As clinical manifestations of thoracic outlet syndrome are vague pain or symptoms in upper extremity, the diagnosis of the disease is delayed or misdiagnosed as cervical HNP, shoulder pathologies, or peripheral neuropathies. In that reason, many patients spend time for unnecessary or ineffective treatments. We report the results of our thoracic outlet syndrome cases, which were treated by conservative care or surgical treatment. MATERIALS & METHODS: Twenty five cases, diagnosed as thoracic outlet syndrome since 1999, were reviewed retrospectively. Physical examinations including Adson's and reverse Adson's test, hyperabduction test, costoclavicular maneuver, and Roo's test, plain radiography of shoulder and cervical spine, MRI of neck or brachial plexus, and EMG were checked. If subjective symptoms were not improved after conservative treatments over three months, surgical treatment were performed. Nine patients were performed operative treatment and the others had conservative treatment in outpatient clinic. Postoperative improvement of symptoms and the follow up period, and the results of conservative care were reviewed. RESULTS: Among five physical examinations, mean 1.75 tests were positive, and EMG has little diagnostic value. MRI were performed in twenty cases and compression of brachial plexus were found in 6 cases (30%). Ten patients out of 16 conservative treatment group had excellent improvement of symptoms, and 5 had good results. Eight patients out of 9 operative treatment group had excellent improvement with mean 5.1 months of follow-up period. CONCLUSION: Diagnosis of thoracic outlet syndrome is difficult due to bizarre and vague symptoms. However if the diagnosis is suspected by careful physical examinations, radiologic studies, or nerve conduction studies, conservative care should be done as initial treatment and at least after three months, reassess the patient's condition. If the results of conservative treatment is not satisfactory and still the thoracic outlet syndrome is suspected, surgical treatment should be considered. Conservative treatment and operative technique are the valuable for the treatment of this disease.
Ambulatory Care Facilities ; Brachial Plexus ; Follow-Up Studies ; Humans ; Neck ; Neural Conduction ; Peripheral Nervous System Diseases ; Physical Examination ; Retrospective Studies ; Shoulder ; Spine ; Thoracic Outlet Syndrome ; Upper Extremity