BACKGROUND: Multiple approaches for nipple reconstruction exist, and none is considered superior to all others. The star flap is one of the most popular methods for nipple reconstruction, but gradual height loss is a major concern. We present a new modification of the star flap that incorporates a de-epithelialized dermal flap, along with the associated surgical results. METHODS: We reviewed the medical records of patients who underwent nipple reconstruction using the modified star flap method. The design was different from the conventional star flap in that the lateral wings were changed into a trapezoidal shape and de-epithelialized dermal flaps were added. The patients were followed up at 2, 4, 6, and 12 months postoperatively, and nipple height was measured. The postoperative nipple height achieved using the modified method was compared with that obtained using the traditional method. RESULTS: From February 2013 to June 2017, 32 patients received surgery using the modified star flap, and 18 patients who underwent nipple reconstruction before 2013 comprised the conventional method group. All patients had undergone breast reconstruction with an abdominal tissue-based flap. The mean follow-up period was 14.4 months in the modified method group and 17.3 months in the conventional method group. The mean maintenance of projection at 12 months postoperatively was 56.28%±18.58% in the modified method group, and 44.23%±14.15% in the conventional method group. This difference was statistically significant (P<0.05). CONCLUSIONS: The modified method using a de-epithelialized dermal flap provides reliable maintenance of projection in patients who have undergone abdominal tissue-based breast reconstruction.
Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Medical Records ; Methods ; Nipples ; Surgical Flaps

The Endeavor Resolute® (ER) is a zotarolimus-eluting stent (ZES) with a biocompatible BioLinx polymer. This study prospectively compared the clinical outcomes of 2 versions of ZES, ER and Endeavor Sprint® (ES), in patients with multivessel disease. A total of 488 patients who underwent multivessel percutaneous coronary intervention (PCI) were divided into 2 groups the ER group (n=288) and the ES group (n=200). The primary endpoint was a composite of major adverse cardiac events (MACE) consisting of death, myocardial infarction, and target vessel revascularization after 12 months. In all patients, the prevalence of diabetes was higher in the ER group (42.7% vs. 31.0%, p=0.009). The rate of post-PCI Thrombolysis in Myocardial Infarction flow grade 3 was higher in the ER group (100.0% vs. 98.0%, p=0.028). There were no between-group differences in the in-hospital, 1-month and 12-month clinical outcomes. In the propensity score matched cohort (n=200 in each group), no differences were observed in the baseline and procedural characteristics. There were no statistical differences in the rates of in-hospital, 1-month and 12-month events (12-month MACE in the ER and ES groups: 6.0% vs. 3.5%, p=0.240, respectively). The safety and efficacy of both versions of ZES were comparable in patients with multivessel disease during a 12-month clinical follow-up.
Cohort Studies ; Coronary Artery Disease ; Drug-Eluting Stents ; Follow-Up Studies ; Heart ; Humans ; Multicenter Studies as Topic ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Polymers ; Prevalence ; Propensity Score ; Prospective Studies ; Stents

BACKGROUND/AIMS: The resistance rate of Helicobacter pylori is gradually increasing. We aimed to evaluate the efficacy of levofloxacin-based third-line H. pylori eradication in peptic ulcer disease. METHODS: Between 2002 and 2014, 110 patients in 14 medical centers received levofloxacin-based third-line H. pylori eradication therapy for peptic ulcer disease. Of these, 88 were included in the study; 21 were excluded because of lack of follow-up and one was excluded for poor compliance. Their eradication rates, treatment regimens and durations, and types of peptic ulcers were analyzed. RESULTS: The overall eradiation rate was 71.6%. The adherence rate was 80.0%. All except one received a proton-pump inhibitor, amoxicillin, and levofloxacin. One received a proton-pump inhibitor, amoxicillin, levofloxacin, and clarithromycin, and the eradication was successful. Thirty-one were administered the therapy for 7 days, 25 for 10 days, and 32 for 14 days. No significant differences were observed in the eradication rates between the three groups (7-days, 80.6% vs 10-days, 64.0% vs 14-days, 68.8%, p=0.353). Additionally, no differences were found in the eradiation rates according to the type of peptic ulcer (gastric ulcer, 73.2% vs duodenal/gastroduodenal ulcer, 68.8%, p=0.655). CONCLUSIONS: Levofloxacin-based third-line H. pylori eradication showed efficacy similar to that of previously reported first/second-line therapies.
Amoxicillin ; Clarithromycin ; Compliance ; Follow-Up Studies ; Helicobacter pylori* ; Helicobacter* ; Humans ; Levofloxacin ; Peptic Ulcer* ; Ulcer

Metronidazole is a widely used antibiotic for the treatment of anaerobic bacterial infections. Metronidazole-induced encephalopathy (MIEP) is a rare but potentially reversible disease. The mechanism of MIEP remains unclear, and differences in the neurotoxic effects of oral versus intravenous (IV) metronidazole administration have not yet been determined. We report the case of a Crohn's disease (CD) patient who experienced encephalopathy immediately after a single IV dose of metronidazole following long-term exposure to the oral form of the drug. The 64-year-old man with intractable CD experienced a sudden change in mental status, aphasia, and muscle weakness after IV administration of metronidazole. He had previously taken metronidazole orally for 13 years and received intermittent IV metronidazole treatments for CD exacerbation. Brain magnetic resonance imaging (MRI) showed high-intensity signals in the bilateral medial thalamus and the midbrain and pontine tegmentum on fluid-attenuated inversion recovery images. After discontinuation of metronidazole, the high-intensity brain MRI signals resolved and the patient's mental status dramatically improved; however, the patient exhibited mild cognitive dysfunction 2 months after the onset of encephalopathy.
Aphasia ; Bacterial Infections ; Brain ; Brain Diseases* ; Brain Diseases, Metabolic ; Crohn Disease* ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Magnetic Resonance Imaging ; Mesencephalon ; Metronidazole ; Middle Aged ; Muscle Weakness ; Pontine Tegmentum ; Thalamus

The poisoning information database (PIDB) provides clinical toxicological information on commonly encountered toxic substances in Korea. The aim of this study was to estimate the coverage rate of the PIDB by comparing the database with the distribution of toxic substances that real poisoning patients presented to 20 emergency departments. Development of the PIDB started in 2007, and the number of toxic substances increased annually from 50 to 470 substances in 2014. We retrospectively reviewed the medical records of patients with toxic exposure who visited 20 emergency departments in Korea from January to December 2013. Identified toxic substances were classified as prescription drug, agricultural chemical, household product, animal or plant, herbal drug, or other. We calculated the coverage rate of the PIDB for both the number of poisoning cases and the kinds of toxic substances. A total of 10,887 cases of intoxication among 8,145 patients was collected. The 470 substances registered in the PIDB covered 89.3% of 8,891 identified cases related to poisoning, while the same substances only covered 45.3% of the 671 kinds of identified toxic substances. According to category, 211 prescription drugs, 58 agricultural chemicals, 28 household products, and 32 animals or plants were not covered by the PIDB. This study suggested that the PIDB covered a large proportion of real poisoning cases in Korea. However, the database should be continuously extended to provide information for even rare toxic substances.
Adolescent ; Adult ; Aged ; Animals ; Animals, Poisonous ; Child ; Child, Preschool ; Databases, Factual ; Drugs, Chinese Herbal/poisoning ; Emergency Service, Hospital ; Female ; Humans ; Infant ; Male ; Middle Aged ; Pesticides/poisoning ; Plants, Medicinal/poisoning ; Poisoning/*epidemiology ; Prescription Drugs/poisoning ; Republic of Korea ; Retrospective Studies ; Young Adult

PURPOSE: The purpose of this study was to perform a comparative analysis of training methodology between accessibility and needs for cardiopulmonary resuscitation (CPR) in the community. METHODS: This population-based nationwide study used a structured questionnaire via telephone survey in 2011-2012. The study was conducted by stratified cluster sampling to assess the impact of age, gender, and geographic regions (n=1,000). The contents of the questionnaire consisted of awareness, prior training status, and willing methodology of public CPR training. RESULTS: Thirty-eighty percent of respondents (n=381) had previously been taught CPR. Military service, education facility/ school, and workplace were 3 major resources of public CPR training among previously educated subjects (45%, 23%, and 9%, respectively). Seventy-two percent of trainees had been taught less than an hour and only 60% were trained using an individual manikin for CPR practice. Fifty-nine percent (n=593) had willingness to participate in CPR education and 40% of subjects wished to learn in a hospital or health care facility. Place of CPR training showed a major difference between previous experiences and willing groups in the community. Women and elders were more likely to learn CPR. Almost all respondents wanted short-duration learning (<1 hour), however, it was similar in the groups. CONCLUSION: In the scope of the public, training site showed a significant discrepancy between previous accessibility and needs of layperson. They prefer a highly accessible location and method with relatively short-practice programs.
Cardiopulmonary Resuscitation* ; Surveys and Questionnaires ; Delivery of Health Care ; Education ; Female ; Health Services Needs and Demand ; Humans ; Learning ; Manikins ; Military Personnel ; Telephone

BACKGROUNDS/AIMS: Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) is an uncommon subtype of primary liver cancer that has rarely been reported in detail. This study was performed in order to evaluate the clinicopathological characteristics and prognostic factors of cHCC-CC in single center. METHODS: The clinicopathological features of patients diagnosed and operated with cHCC-CC at Chonbuk National Hospital between July 1998 and July 2007 were retrospectively studied by comparing them with patients with only hepatocellular carcinoma (HCC) who had undergone a hepatic resection during the same period. RESULTS: Ten out of 152 patients who had undergone a hepatic resection were diagnosed with cHCC-CC and thus included in this study (M : F=8 : 2, median age: 52+/-11.1 years). According to the parameters of the 7th American Joint Committee on Cancer T staging, there were 76 (50.0%), 44 (28.9%), 9 (5.9%), 18 (11.8%) and 5 (3.3%) patients with T stages 1, 2, 3a, 3b and 4, respectively. The overall survival period was longer in the HCC only group (68+/-40.4 months) than in the combined cHCC-CC group (23+/-40.1 months) (p<0.0001). The 5-year survival rate was 10% in the cHCC-CC group and 60% in the HCC group (p<0.0001). The disease free survival for patients with cHCC-HCC and HCC were 16+/-37.4 and 51+/-44.3 months, respectively (p<0.0001). Univariate analysis revealed that age, gender, transarterial chemoembolization (TACE), and T stage were statistically significant in terms of patient's overall survival. However, there were no significant clinicopathological factors identified by the multivariate analysis. CONCLUSIONS: Even after the hepatic resection in the HCC, the prognosis is poorer if the patient has cholangiocellular components compared to the usual HCC.
Carcinoma, Hepatocellular* ; Cholangiocarcinoma* ; Disease-Free Survival ; Humans ; Joints ; Liver Neoplasms ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; Survival Rate

OBJECTIVE: To investigate the effect of Comprehensive Hand Repetitive Intensive Strength Training (CHRIST) on upper limb function in children with cerebral palsy using motion analysis. METHOD: The subjects in this study included 19 children (10 males, 9 females, mean age=8.8 years) with cerebral palsy. The experimental group (n=10) received CHRIST and general rehabilitation therapy. The control group (n=9) received a home program as well as general rehabilitation therapy. Both groups received 30 sessions of CHRIST or home program training for 60 minutes per session 3 times a week during the 10-week period. The reaching movements were captured by a motion analysis system. Kinematic variables including movement time (MT), mean velocity (MV), normalized jerk score (NJS), mean angular velocity (MAV) and normalized jerk score of the shoulder, elbow and wrist joint with comfortable and fast speed were analyzed between groups and the pre-post training group. RESULTS: After pre- and post-training experimental group, MT, MV, NJS, MAV of shoulder, elbow, wrist and NJS of elbow and wrist improved significantlyin reaching movement of both comfortable and fast speed (p<0.05). However, After pre- and post-training control group, MV improved significantlyin reaching movement of only comfortable speed (p<0.05). Between two groups, MT and MAV of the elbow at comfortable speed and NJS of the elbow at fast speed were statisticallysignificant (p<0.05). CONCLUSION: CHRIST proved to be an effective intervention for improving upper limb extremity function of reaching movement in children with cerebral palsy.
Cerebral Palsy ; Child ; Elbow ; Extremities ; Female ; Hand ; Humans ; Male ; Muscle Strength ; Resistance Training ; Shoulder ; Upper Extremity ; Wrist ; Wrist Joint

BACKGROUNDS/AIMS: To find independent predictors that affect the survival in patients with hepatic metastasis of colorectal cancer after surgery and to devise a risk scoring system. METHODS: Among 150 patients who underwent hepatic resection after diagnosis of colorectal cancer with hepatic metastasis between March 1994 and February 2009, we analyzed clinical, pathologic and outcome data retrospectively. RESULTS: The 1-year survival rate was 83%, and the 5-year survival rate was 35%. Nine factors were found to be independent predictors of adverse outcome by univariate analysis: stage of primary tumor, CA19-9 >36 U/ml, extrahepatic disease, distribution of the hepatic tumor, number of hepatic tumors >3, largest hepatic tumor >5 cm, total size >10 cm, CEA >10 ng/ml, and metachronous cancer. The last two of these criteria were also significant risk factors on multivariate analysis. When these criteria were used as a risk scoring system, assigning one point for each criterion and dividing the cases into A, B and C groups, the total score was highly predictive of outcomes (p<0.001). No patients in group C (6 to 9 points) were long-term survivors. CONCLUSIONS: Long-term outcome can be predicted from nine criteria that are readily available for all patients. Patients meeting up to two criteria (group A) are more likely to have a favorable outcome compared to the three or over (groups B and C). This scoring system may offer an easy, rapid, and reliable prognostic indicator of survival outcome after hepatic resection in patients with hepatic metastasis from colorectal cancer.
Colorectal Neoplasms ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Risk Factors ; Survival Rate

PURPOSE: We wanted to evaluate the clinical results and the radiological and arthroscopic findings of femoroacetabular impingement (FAI) in young Taekwondo players and to investigate the rate of returning-to-play Taekwondo and the recurrence rate. MATERIALS AND METHODS: Twenty Taekwondo players (16 males and, 4 females) who were arthroscopically treated for FAI from September 2003 to July 2008 were retrospectively analyzed. Their mean age was 21.6 years old (range: 17 to 32 years) and the mean follow up was 33.7 months (range: 24 to 71 months). Plain radiographs and 3 dimensional computed tomography were taken in all patients and magnetic resonance arthrography was performed in 11 with suspicious soft tissue lesions. Labral injury, cartilage injury and associated lesions were evaluated by arthroscopy. The preoperative and postoperative visual analogue scale (VAS), the modified Harris hip score (MHHS), the sports frequency score (SFS), and the non-arthritic hip score (NAHS) were compared. We investigated the rate of returning-to-play at postoperative 1 year and at postoperative 2 years and the recurrence rate within 2 years after surgery. RESULTS: There were 10 cam types, 1 pincer type and 9 mixed types. The mean alpha angle improved from 65.8 degrees preoperatively to 43.2 degrees postoperatively (p<0.001). Acetabular labral tears were accompanied in all cases and the most common tear site and type were at 2 o'clock and degenerative tear, respectively. In descending order, the acetabular cartilage injuries were located in the anterosuperior, posteroinferior and anterior portion, respectively. The femoral cartilage injuries were mostly located in the anterosuperior portion. The range of motion at the final follow-up showed improvement in all except abduction (p=0.262). The VAS, MHHS and SFS showed statistically significant improvement (p<0.001). The NAHS was improved, but without statistical significance (p=0.31). The rates of returning-to-play at postoperative 1 year and postoperative 2 years were 85% (17/20) and 75% (15/20), respectively. The recurrence rate within postoperative 2 years was 15% (3/20). CONCLUSION: As screening test for FAI in young Taekwondo players is necessary at the beginning of Taekwondo. Arthroscopic treatment in symptomatic Taekwondo players is an effective procedure that can improve the postoperative exercise frequency and function. Returning-to-play Taekwondo is associated with the clinical improvements and the patients' will.
Arthrography ; Arthroscopy ; Cartilage ; Femoracetabular Impingement ; Follow-Up Studies ; Hip ; Humans ; Magnetic Resonance Spectroscopy ; Male ; Mass Screening ; Range of Motion, Articular ; Recurrence ; Retrospective Studies ; Sports ; Sulfides