BACKGROUND: The objective of this study was to identify a consensus on definition, diagnosis, treatment, and prognosis of frozen shoulder (FS) among shoulder specialists. METHODS: A questionnaire composed of 18 questions about FS—definition, classification, utilization of diagnostic modalities, the propriety of treatment at each stage, and prognosis—was sent to 95 shoulder specialists in Korea. Most questions (15 questions) required an answer on a 5-point analog scale (1, strongly disagree; 5, strongly agree); three questions about the propriety of treatment were binary. RESULTS: We received 71 responses (74.7%). Of the 71 respondents, 84.5% agreed with the proposed definition of FS, and 88.8% agreed that FS should be divided into primary and secondary types according to the proposed definition. Only 43.7% of the respondents agreed that FS in patients with systemic disease should be classified as secondary FS. For the diagnosis of FS, 71.9% agreed that plain radiography should be used and 64.8% agreed ultrasonography should be used. There was a high consensus on proper treatment of FS: 97.2% agreed on education, 94.4%, on the use of nonsteroidal anti-inflammatory drugs; 76.1%, on intra-articular steroid injections; and 97.2%, on stretching exercise. Among all respondents, 22.5% answered that more than 10% of the patients with FS do not respond to conservative treatment. CONCLUSIONS The survey revealed a general consensus among shoulder specialists on the definition and treatment of FS. However, classification of FS was found controversial.

Cholestatic liver cirrhosis (CLC) eventually proceeds to end-stage liver failure by mediating overwhelming deposition of collagen, which is produced by activated interstitial myofibroblasts. Although the beneficial effects of Rhus verniciflua Stokes (RVS) on various diseases are well-known, its therapeutic effect and possible underlying mechanism on interstitial fibrosis associated with CLC are not elucidated. This study was designed to assess the protective effects of RVS and its possible underlying mechanisms in rat models of CLC established by bile duct ligation (BDL). We demonstrated that BDL markedly elevated the serological parameters such as aspartate aminotransferase, alanine transaminase, total bilirubin, and direct bilirubin, all of which were significantly attenuated by the daily uptake of RVS (2 mg/kg/day) for 28 days (14 days before and after operation) via intragastric route. We observed that BDL drastically induced the deterioration of liver histoarchitecture and excessive deposition of extracellular matrix (ECM), both of which were significantly attenuated by RVS. In addition, we revealed that RVS inhibited BDL-induced proliferation and activation of interstitial myofibroblasts, a highly suggestive cell type for ECM production, as shown by immunohistochemical and semi-quantitative detection of α-smooth muscle actin and vimentin. Finally, we demonstrated that the anti-fibrotic effect of RVS was associated with the inactivation of Smad3, the key downstream target of a major fibrogenic cytokine, i.e., transforming growth factor β (TGF-β). Simultaneously, we also found that RVS reciprocally increased the expression of Smad7, a negative regulatory protein of the TGF-β/Smad3 pathway. Taken together, these results suggested that RVS has a therapeutic effect on CLC, and these effects are, at least partly, due to the inhibition of liver fibrosis by the downregulation of Smad3 and upregulation of Smad7.
Actins ; Alanine Transaminase ; Aspartate Aminotransferases ; Bile Ducts ; Bilirubin ; Collagen ; Down-Regulation* ; Extracellular Matrix ; Fibrosis* ; Ligation ; Liver Cirrhosis ; Liver Failure ; Liver* ; Models, Animal ; Myofibroblasts ; Negotiating ; Rhus* ; Transforming Growth Factors ; Up-Regulation* ; Vimentin

PURPOSE: The purpose of this study was to evaluate the 3 dimensional accuracy of impression taking on the newly developed healing abutment and impression coping combined system comparing conventional pick-up type impression. MATERIALS AND METHODS: For 10 patients who had a single missing tooth on molar area, dental implants (SuperLine; Dentium, Seoul, Korea) were placed and healing abutment (MyHealing; Raphabio Co., Seoul, Korea) abutments were connected. After 3 months, transfer type impression with MyHealing and pick-up type impression with impression coping were performed twice in the same patients, and master models were fabricated. Customized prosthetic abutments (Myplant; Raphabio Co., Seoul, Korea) were milled and connected to the master casts. Through a dental scanner (Scanner S600; Zirkonzahn, South Tyrol, Italy), the master casts were converted into virtual casts. The length and angulation differences between casts were measured using 3 dimentional analysis program (Geomagic Qualify 12; Geomagic, Morrisville, NC, USA). Statistical significance was calculated using Kruskal Wallis test and Mann-Whitney U test (alpha=.05). RESULTS: The length differences between the two systems were 0.032 mm in sagittal plane, and 0.029 in coronal plane, and 0.023 mm in horizontal plane. The angulation differences were 0.755#x00B0; in sagittal plane, and 1.275#x00B0; in coronal plane, and 0.420#x00B0; in horizontal plane. CONCLUSION: The accuracy of newly developed healing abutment system is similar to that of conventional pick-up impression. The new system can reduces chair time by not using separate impression coping.
Dental Implants ; Humans ; Molar ; Seoul ; Tooth

BACKGROUND: Melasma is a common, acquired, symmetrical hypermelanosis that occurs on sun exposed areas of the skin. It is more prevalent among Asian women than among Caucasian women. Many different treatment modalities have been used with various efficacies, but none of them have been completely satisfactory. Arbutin is a naturally occurring gluconopyranoside that may reduce tyrosinase activity, which is a rate-limiting enzyme for melanin production. OBJECTIVE: The purpose of this study was to investigate the depigmenting effect and safety of a mask that contains 2% arbutin for the treatment of melasma. METHODS: A total of 54 female volunteers with melasma were enrolled in this randomized, double-blind, 8-week treatment study. The patients were instructed to apply an arbutin-containing mask or an arbutin-free mask once a day for 8 weeks. The assessment of outcomes included the Melasma Area and Severity Index (MASI) score, colorimetric value (L*), overall patient satisfaction and investigator assessment score (evaluated using photography). RESULTS: The arbutin-containing mask significantly increased the right and left colorimetric values (L*) after the 8-week treatment (p<0.05) compared to the arbutin-free mask. The MASI score was decreased more in the arbutin mask group (p>0.05). The arbutin mask scored better than the control in patient satisfaction and investigator assessment. No significant adverse reactions were observed. CONCLUSION: The arbutin mask appears to be effective and well-tolerated when used for the treatment of melasma.
Arbutin ; Asian Continental Ancestry Group ; Female ; Humans ; Hydrogel ; Hyperpigmentation ; Masks ; Melanins ; Melanosis ; Monophenol Monooxygenase ; Patient Satisfaction ; Research Personnel ; Skin ; Solar System

PURPOSE: Community-Acquired Pneumonia (CAP) is a common cause of mortality and serious morbidity. Regardless of the condition of the patients, almost all are hospitalized. And it seems to be a standard procedure to obtain blood cultures before the administration of antibiotics in suspected pneumonic patients. Recent studies show that the blood cultures don't affect the treatment of the patients with CAP. Accordingly, this study was designed to examine the usefulness of the blood cultures routinely performed and to evaluate the stratification of the patients with CAP by Pneumonia Severity Index (PSI) in the Emergency Department (ED). METHODS: Research subjects were patients over 16 years old who had been diagnosed with CAP in a general hospital between January and December 2008 and were admitted by way of the ED. We evaluated their records retrospectively. RESULTS: A total of 261 patients were diagnosed with CAP. According to the PSI, 155 (59%) of the 261 were classified as being in the low risk group and 106 (41%) in the high risk group. Blood cultures were positive in 13 of 261 (5%). Three of 13 patients belonged to the low risk group, and 10 to the high risk group. Antibiotics were changed in 43 of 261 patients. Nineteen of those belonged to the low risk group and 24 to the high risk group. Of the 13 bacteremic patients, blood cultures results altered therapy for 4 patients. CONCLUSION: Most often, blood cultures performed in the ED do not alter the therapy of patients with CAP. But we do recommend blood cultures for the high risk group.
Anti-Bacterial Agents ; Community-Acquired Infections ; Emergencies ; Hospitals, General ; Humans ; Pneumonia ; Research Subjects ; Retrospective Studies ; Severity of Illness Index

Selective cervical nerve root block is executed for patients who have symptoms of cervical radiculopathy for diagnostic and therapeutic purposes. However several catastrophic complications caused by this procedure have been reported including neurological complications. A 43-year-old male received a C5 selective cervical nerve root block procedure due to continuous radiating pain even after cervical discectomy and interbody fusion was performed. At the time of the procedure, the contrast outline revealed reflux of the nerve root and epidural space. But after the procedure was performed, the patient experienced decreased sensation in the upper and low extremities as well as motor paralysis of both extremities. Our sspecting diagnosis was anterior spinal artery syndrome but both sensory and motor functions were subsequently recovered within a few hours after the procedure was completed. Due to the difficult nature of this case, we reported these complications and reviewed current literature related to this study.
Adult ; Anterior Spinal Artery Syndrome ; Diskectomy ; Epidural Space ; Extremities ; Humans ; Injections, Spinal ; Male ; Paralysis ; Quadriplegia ; Radiculopathy ; Sensation ; Spinal Nerve Roots

BACKGROUND/AIMS: An ectopic opening of the common bile duct (CBD) into the duodenal bulb is known to cause biliary tract diseases or peptic ulcer. Yet such a case is extremely rare and the clinical significance of this malformation has not yet been clarified. METHODS: Ten patients with an ectopic opening in the duodenal bulb and who were treated at 4 hospitals in the Chungcheong province area were enrolled. Their clinical and radiographic features and the treatment for their combined biliary diseases were retrospectively analysed. RESULTS: The mean age of the ten patients was 73 years (range: 38~84 years, 8 men, 2 women) Eight of 10 patients had clinical signs and symptoms (RUQ abdominal pain: 5, epigastric pain: 3, fever: 3, Melena: 1). The two patients without symptoms were incidentally found to have an ectopic orifice during the evaluation for bile duct dilatation and a regular health check-up, respectively. Nine had duodenal ulcer scars or bulb deformities. Four had active duodenal ulcers and one of them had bleeding from the active duodenal ulcer, which was treated by endoscopic sclerotheraphy. Six of the 10 patients (60%) had biliary tract diseases (CBD stones: 4, cholangitis without CBD stone: 1, IHD stone: 1). Cholangiography was used for evaluation in 9 patients, and it showed dilatation of the CBD or IHD in 7 (78%), a tapered common bile duct at the distal CBD in 7 (78%) and a hook-shaped distal CBD in 8 (89%). Six patients' biliary tract diseases were treated endoscopically (ERCP: 4, PTCS: 2). Duodenal perforation occurred in 1 (10%), who was successfully managed by medical treatment. CONCLUSIONS: An ectopic opening of the CBD in the duodenal bulb is frequently associated with recurrent duodenal ulcer and biliary tract disease. Combined biliary tract disease can be successfully treated endoscopically.
Bile Ducts ; Biliary Tract Diseases ; Cholangiography ; Cholangitis ; Cicatrix ; Common Bile Duct ; Congenital Abnormalities ; Dilatation ; Duodenal Ulcer ; Hemorrhage ; Humans ; Male ; Peptic Ulcer ; Retrospective Studies

Anatomical variation in the abdominal aorta is common and extremely important. We found a rare variation of the abdominal aorta in a Korean male cadaver during a routine dissection course. The superior mesenteric artery gives off a small branch for the descending colon, named accessory left colic artery due to its distribution. The inferior mesenteric artery arises normally from the abdominal aorta and supplied the sigmoid colon and the upper part of the rectum. This variation was rare and it has not been reported previously in Korean. Knowledge of the arterial variation in this region is considerable important during abdominal surgery and invasive procedures. The authors describe this previously unreported case and discuss the clinical implications of such a variant with a brief review of the literature.
Aorta, Abdominal ; Arteries ; Cadaver ; Colic ; Colon, Descending ; Colon, Sigmoid ; Humans ; Male ; Mesenteric Artery, Inferior ; Mesenteric Artery, Superior ; Rectum

Anaphylaxis is one of major causes of morbidity and mortality during anesthesia. Muscle relaxants are the most common cause of anaphylaxis during anesthesia. A 54-year-old woman was scheduled for thyroidectomy. She had no history of allergy and had never previously undergone general anesthesia, Lidocaine, propofol and vecuronium were injected sequentially to induce general anesthesia. Two minutes after the vecuronium injection, severe hypotension, tachycardia and bronchospasm developed, and delayed skin rashes appeared. The patient recovered without any significant complications after immediate proper intensive care. The operation was delayed and a skin test was performed on the 7th day after discharge. She revealed a positive skin test for vecuronium. The anesthesia was re-induced without muscle relaxant and maintained with propofol and remifentanil infusion. Surgery was completed uneventfully, and the patient recovered without any adverse reaction.
Anaphylaxis ; Anesthesia ; Anesthesia, General ; Bronchial Spasm ; Exanthema ; Female ; Humans ; Hypersensitivity ; Hypotension ; Critical Care ; Lidocaine ; Middle Aged ; Muscles ; Piperidines ; Propofol ; Skin Tests ; Tachycardia ; Thyroidectomy ; Vecuronium Bromide

Anaphylaxis is one of major causes of morbidity and mortality during anesthesia. Muscle relaxants are the most common cause of anaphylaxis during anesthesia. A 54-year-old woman was scheduled for thyroidectomy. She had no history of allergy and had never previously undergone general anesthesia, Lidocaine, propofol and vecuronium were injected sequentially to induce general anesthesia. Two minutes after the vecuronium injection, severe hypotension, tachycardia and bronchospasm developed, and delayed skin rashes appeared. The patient recovered without any significant complications after immediate proper intensive care. The operation was delayed and a skin test was performed on the 7th day after discharge. She revealed a positive skin test for vecuronium. The anesthesia was re-induced without muscle relaxant and maintained with propofol and remifentanil infusion. Surgery was completed uneventfully, and the patient recovered without any adverse reaction.
Anaphylaxis ; Anesthesia ; Anesthesia, General ; Bronchial Spasm ; Exanthema ; Female ; Humans ; Hypersensitivity ; Hypotension ; Critical Care ; Lidocaine ; Middle Aged ; Muscles ; Piperidines ; Propofol ; Skin Tests ; Tachycardia ; Thyroidectomy ; Vecuronium Bromide