Background: Recently, deep learning techniques have been used in medical imaging studies. We present an algorithm that measures radiologic parameters of distal radius fractures using a deep learning technique and compares the predicted parameters with those measured by an orthopedic hand surgeon. Methods: We collected anteroposterior (AP) and lateral X-ray images of 634 wrists in 624 patients with distal radius fractures treated conservatively with a follow-up of at least 2 months. We allocated 507 AP and 507 lateral images to the training set (80% of the images were used to train the model, and 20% were utilized for validation) and 127 AP and 127 lateral images to the test set. The margins of the radius and ulna were annotated for ground truth, and the scaphoid in the lateral views was annotated in the box configuration to determine the volar side of the images. Radius segmentation was performed using attention U-Net, and the volar/dorsal side was identified using a detection and classification model based on RetinaNet. The proposed algorithm measures the radial inclination, dorsal or volar tilt, and radial height by index axes and points from the segmented radius and ulna. Results: The segmentation model for the radius exhibited an accuracy of 99.98% and a Dice similarity coefficient (DSC) of 98.07% for AP images, and an accuracy of 99.75% and a DSC of 94.84% for lateral images. The segmentation model for the ulna showed an accuracy of 99.84% and a DSC of 96.48%. Based on the comparison of the radial inclinations measured by the algorithm and the manual method, the Pearson correlation coefficient was 0.952, and the intraclass correlation coefficient was 0.975. For dorsal/ volar tilt, the correlation coefficient was 0.940, and the intraclass correlation coefficient was 0.968. For radial height, it was 0.768 and 0.868, respectively. Conclusions The deep learning-based algorithm demonstrated excellent segmentation of the distal radius and ulna in AP and lateral radiographs of the wrist with distal radius fractures and afforded automatic measurements of radiologic parameters.

PURPOSE: This study was performed in order to determine the changes over time in preventable and potentially preventable traumatic death rates, and to assess the factors that affected the deaths of trauma patients which occurred in Korean pre-hospital and hospital settings. METHODS: All trauma deaths occurring either in the emergency department (ED) or after admission at twenty Korean hospitals between August 2009 and July 2010 were retrospectively analyzed. The deaths were initially reviewed by a team of multidisciplinary specialists and classified into non-preventable, potentially preventable, and preventable deaths. Only preventable and potentially preventable deaths were the subject of our analysis. Structured data extraction included patient demographics, vital signs, injury severity, probability of survival, preventability of mortality, reported errors in the evaluation and management of the patient, and classification of error types (system, judgment, knowledge). RESULTS: During the study period, 446 trauma victims died in the ED or within 7 days after admission. The mean age was 52 years, 74.1% were men and the mean time from injury to death was 35.6 hours. The most common cause of death was head injury (44.7%) followed by hemorrhage (30.8%) and multi-organ failure (8.0%). The rates of preventable/potentially preventable deaths were 35.2% overall and 29.8% when limited to patients surviving to admission. Of all death classifications, 31.2% were potentially preventable and 4.0% were preventable. Errors leading to preventable death occurred in the emergency department (51.2%), pre-hospital setting (30.3%) and during inter-hospital transfer (60.8%). Most errors were related to clinical management (48.4%) and structural problems in the emergency medical system (36.5%). CONCLUSION: The preventable death rates for Korean trauma victims were higher than those found in other developed countries, possibly due to poorly established emergency medical systems for trauma victims in pre-hospital and hospital settings. A system wide approach based on the emergency medical system and well-developed in-hospital trauma teams should be adopted in order to improve the quality of care of trauma victims in Korea.
Cause of Death ; Craniocerebral Trauma ; Demography ; Developed Countries ; Emergencies ; Emergency Medical Services ; Hemorrhage ; Humans ; Judgment ; Korea ; Male ; Retrospective Studies ; Specialization ; Vital Signs

PURPOSE: 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans are frequently performed for the screening or staging of malignant tumors. This study aimed to assess the usefulness of 18F-FDG PET/CT in detection of gastric cancer recurrence after curative gastrectomy. MATERIALS AND METHODS: Eighty nine patients who had undergone curative gastrectomy due to gastric cancer and had 18F-FDG PET/CT and contrast CT scans within 2 weeks for surveillance in asymptomatic patients (n = 11) or to clarify suspected recurrence (n = 78) were consecutively collected and retrospectively analyzed. They had clinical follow-up for at least 12 months after PET/CT and CT scans. RESULTS: Fifteen of the 89 patients (16.9%) were diagnosed with recurrent gastric cancer in 21 organs. Forty one organs showed an increase in FDG uptake, and only 9 of these organs were diagnosed with recurrent gastric cancer by 18F-FDG PET/CT. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the 18F-FDG PET/CT were 42.9%, 59.7%, 29.3%, 78.2%, and 57.3%, respectively. On the CT scan, 18 of 21 recurrent gastric cancers were detected, and 7 cases were in agreement with the 18F-FDG PET/CT. The sensitivity and specificity of the CT scan were 85.8% and 87.3%, respectively, which are superior to the 18F-FDG PET/CT. When we diagnosed a recurrence based on either 18F-FDG PET/CT or CT scans, the sensitivity increased to 95.2% and the specificity decreased to 45.6%, when compared with the contrast CT scan alone. CONCLUSION: 18F-FDG PET/CT is an insufficient diagnostic method in detection of recurrence after curative gastrectomy, and even less accurate than contrast CT scan alone.
Adult ; Aged ; Aged, 80 and over ; Female ; Fluorodeoxyglucose F18/*diagnostic use ; *Gastrectomy ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/*diagnosis ; Positron-Emission Tomography/*methods ; Stomach Neoplasms/*diagnosis/*surgery ; Tomography, X-Ray Computed/*methods

BACKGROUND/AIMS: The diagnostic value of 2-18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET)/CT in the detection of colon carcinoma and adenoma was evaluated retrospectively. METHODS: Between May 2007 and June 2008, 102 patients (42 males and 60 females: age range, 28-89 years) underwent both FDG PET/CT and colonoscopy in < a 3 month interval. FDG uptake on PET/CT was divided into physiologic and pathologic uptake by a nuclear medicine specialist. Pathologic confirmation was obtained in all patients. RESULTS: Forty-three patients had no abnormal findings on both FDG PET/CT and colonoscopy. One hundred five and 59 colonic lesions were detected on FDG PET/CT and colonoscopy, respectively. Eleven of 24 lesions with pathologic FDG uptake were histologically-confirmed to be malignancies. Among 18 lesions with physiologic FDG uptake, 1 carcinoma and 1 adenoma were revealed. One carcinoma, 25 adenomas, and 11 hyperplastic polyps did not reveal FDG uptake. Interpretation of pathologic FDG uptake in the colon had a sensitivity of 84.6% and 28.2%, a specificity of 90.4% and 88.1%, a positive predictive value of 45.8% and 45.8%, and a negative predictive value of 98.4% and 77.8% for carcinomas and adenomas, respectively. CONCLUSIONS: FDG PET/CT is a very useful diagnostic method for the detection of colon cancer, but the sensitivity is low for adenomas, which may need further evaluation, such as a screening endoscopy.
Adenoma ; Colon ; Colonic Neoplasms ; Colonoscopy ; Endoscopy ; Humans ; Male ; Mass Screening ; Nuclear Medicine ; Polyps ; Positron-Emission Tomography ; Retrospective Studies ; Sensitivity and Specificity ; Specialization

BACKGROUND/AIMS: The diagnostic value of 2-18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET)/CT in the detection of colon carcinoma and adenoma was evaluated retrospectively. METHODS: Between May 2007 and June 2008, 102 patients (42 males and 60 females: age range, 28-89 years) underwent both FDG PET/CT and colonoscopy in < a 3 month interval. FDG uptake on PET/CT was divided into physiologic and pathologic uptake by a nuclear medicine specialist. Pathologic confirmation was obtained in all patients. RESULTS: Forty-three patients had no abnormal findings on both FDG PET/CT and colonoscopy. One hundred five and 59 colonic lesions were detected on FDG PET/CT and colonoscopy, respectively. Eleven of 24 lesions with pathologic FDG uptake were histologically-confirmed to be malignancies. Among 18 lesions with physiologic FDG uptake, 1 carcinoma and 1 adenoma were revealed. One carcinoma, 25 adenomas, and 11 hyperplastic polyps did not reveal FDG uptake. Interpretation of pathologic FDG uptake in the colon had a sensitivity of 84.6% and 28.2%, a specificity of 90.4% and 88.1%, a positive predictive value of 45.8% and 45.8%, and a negative predictive value of 98.4% and 77.8% for carcinomas and adenomas, respectively. CONCLUSIONS: FDG PET/CT is a very useful diagnostic method for the detection of colon cancer, but the sensitivity is low for adenomas, which may need further evaluation, such as a screening endoscopy.
Adenoma ; Colon ; Colonic Neoplasms ; Colonoscopy ; Endoscopy ; Humans ; Male ; Mass Screening ; Nuclear Medicine ; Polyps ; Positron-Emission Tomography ; Retrospective Studies ; Sensitivity and Specificity ; Specialization

We report a case of a 25-year old man with chronic kidney disease with secondary hyperparathyroidism who had persistent elevation of serum parathyroid hormone level after the immediate total parathyroidectomy and autotransplantation. To localize supernumerary (ectopic) parathyroid gland, we checked Tc-99m MIBI scintigraphy, MDCT and PET-CT. Contrast-enhanced MDCT showed a small strong enhancing lesion over left bracheocephalic vein, and PET-CT showed multiple brown tumors. We removed the supernumerary parathyroid gland and got a rapid drop of parathyroid hormone level.
Hyperparathyroidism, Secondary ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroidectomy ; Renal Insufficiency, Chronic ; Technetium Tc 99m Sestamibi ; Veins

Secondary hyperparathyroidism is one of the most common complications of patients with chronic kidney disease (CKD). Mandibular enlargement, metastatic pulmonary calcification, and gastric mucosal calcinosis are rare complications in these patients. The defect of calcium and phosphorus metabolism may precipitate pathologic calcification at diverse organs and soft tissue, and change bone architecture. In case of involving periarticular area, patients usually present with localized swelling, pain, and reduced mobility in affected sites. However, in case of organ involvement, except in an advanced stage of disease, there are no specific symptoms. Among these patients, treatment strategies include tight control of calcium and phosphate levels, parathyroidectomy for hyperparathyroidism, renal transplantation, and local excision of calcific lesions. We report a case of mandibular enlargement, metastatic pulmonary calcification, and gastric mucosal calcinosis due to CKD with improvement 3 months after medical and surgical treatment.
Calcinosis ; Calcium ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary ; Kidney ; Kidney Transplantation ; Parathyroidectomy ; Phosphorus ; Renal Insufficiency, Chronic

Hot tub lung has been described as a pulmonary illness associated with exposure to nontuberculous mycobacteria, mainly hot bathtub water contaminated with Mycobacterium avium complex (MAC) and hence the name. Although not entirely clear, its etiology has been thought to involve either an infection or a hypersensitivity pneumonitis secondary to MAC. Herein, we describe 2 female patients (60 and 53 years old) admitted to our hospital with hot tub lung, and both of whom worked in a public bath. Both women were initially admitted following several months of exertional dyspnea and cough. The patients had been working as body-scrubbers in a public bath for several years. Their chest CT scans showed bilateral diffuse ground-glass opacities with multifocal air-trappings and poorly defined centrilobular nodules in both lungs. Pathological findings from lung specimens revealed small non-necrotizing granuloma in the lung parenchyme with relatively normal-looking adjacent alveoli. Discontinuation of working in the public bath led to an improvement in symptoms and radiographic abnormalities, without antimycobacterial therapy.
Alveolitis, Extrinsic Allergic ; Baths ; Cough ; Dyspnea ; Female ; Granuloma ; Humans ; Lung ; Mycobacterium avium Complex ; Nontuberculous Mycobacteria ; Thorax

BACKGROUND/AIMS: Immunogenetic factors may play a role in determining the susceptibility of an individual to viral infection. CCR5 promoter polymorphisms are known to be associated with HIV infection. However, there has been no report on the association between CCR5 promoter polymorphism and HBV infection. Therefore, we investigated the relationship between the CCR5 promoter polymorphism and HBV infection. METHODS: A total of 377 patients were classified into two groups according to their HBV infection status: (1)he spontaneous clearance group (SC); HBsAg (-), anti-HBc (+), anti-HBs (+) (2)he chronic HBsAg (+) carrier group (CC); HBsAg (+), anti-HBc (+), anti-HBs (-). CCR5 polymorphisms were detected by employing matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS)- based SNP scoring assay, termed Restriction Fragment Mass Polymorphism (RFMP), which exploits the differences in molecular masses between the common allele and rare allele bases of interest. RESULTS: We found that the genotype frequencies of CCR5 A59029G significantly differed between the SC group (n=138) and CC group (n=239) (P<0.05). The CCR5 59029A allelic genotype was associated with an increased risks of chronic infection rather than spontaneous clearance (P=0.002), and the presence of the CCR5 59029G allele was significantly associated with the spontaneous clearance of HBV (P=0.001). Strong linkage disequilibrium between the CCR5-59029 and the CCR5-59353 polymorphic variants was identified. None of the 377 subjects had the CCR5-32 bp deletion mutation. CONCLUSIONS: The CCR5 promoter polymorphisms at position 59029 might play a role in the clearance of HBV infection. This primary experimental evidence needs further studies to clarify the clinical usefulness of CCR5 promoter polymorphisms as a target for the screening or treatment of HBV infection.
Adult ; English Abstract ; Female ; Genetic Predisposition to Disease ; Genotype ; Hepatitis B/*genetics ; Hepatitis B virus/genetics ; Humans ; Male ; Middle Aged ; *Polymorphism, Genetic ; Promoter Regions (Genetics)/*genetics ; Receptors, CCR5/*genetics

Displaced fracture of the ankle are probably the most common skeletal injury managed today by open reduction and internal fixation. But, it is recommended that metallic implant might be removed to restore normal biomechanical forces on hone and to reduce discomfort directly under the skin. in order to reduce the resources needed for the removal of metallic fixation devices, absorbable impiants of biodegradable synthetic polymers were deveioped. However reports of clinical application of such implants have so far been very few. This prospective study represents the good resuits in 15 displaced non-comminuted closed malleolar fractures of the ankle treated using hiodegradahle internal fixation in department of orthopedic surgery of Kwang Myung Sung Ae general hospitai from June I 995 to December 1996. The results were as follows 1. All cases were united and the average time for union was 7.6 weeks. 2. As a results of comparison with normal side, a restriction of 10 degrees or more of dorsiflexion of the ankle joint was present in 4 cases, a restriction of 20 degrees or more of plantar tlexion was present in 2 cases, a restriction of supination was present in 3 cases and a restriction of plantar flexion was present in 4 cases. 3. According to Phillips functional scoring scale, 4 cases were excellent, 7 cases good, 4 cases fair and no cases were poor. 4. There were no complications in all cases.
Ankle ; Ankle Joint ; Orthopedics ; Polymers ; Prospective Studies ; Skin ; Supination