Surgical Repair of Tibialis Anterior Muscle Herniation Using a Synthetic Mesh That Was Beneath the Fascia after a Military Training Program: A Case Report

Tibialis anterior muscle herniation is the most common type of skeletal muscle herniation of the lower legs. The treatment of muscle herniation relies on the patient's symptoms. For patients with chronic large fascial defects, fascial grafting with synthetic mesh can be considered. In this case of a patient who was exposed to excessive strain on his lower legs during a military training program, the use of a secure repair technique with synthetic mesh was required. This paper presents a case of tibialis anterior muscle herniation that was treated successfully with a monofilament knitted polypropylene mesh covered by the tibialis anterior fascia. The advantages of this technique include early rehabilitation and an early return to work. No significant difference in the clinical results compared to other methods were observed and there were no complications. The military training program appeared to have aggravated the patient's symptoms of tibialis anterior muscle herniation. On the other hand, larger scale study will be needed to determine if this program actually affects the clinical outcomes.

Changes in medical care due to the absence of internal medicine physicians in emergency departments

OBJECTIVE: Especially in emergency departments (EDs), a lack of internal medicine (IM) residents in charge causes difficulties in medical care and ED overcrowding. Thus, protocols without IM residents in EDs is needed. This study aimed to investigate changes in medical care when emergency medicine residents replaced the roles of IM residents. METHODS: This study was conducted at a single-site ED of a university medical center. The study group contained patients admitted to the IM department between September and December 2015, during which IM residents were absent in the ED. The control group contained patients admitted to the IM department between September and December 2014, during which IM residents were present in the ED. Changes in medical care between the presence and absence of IM residents in the ED were studied by comparing admission rates from the ED, length of ED stay, duration of hospitalization, and concordance of diagnoses between admission and discharge by the IM department. RESULTS: The study group contained 2,341 patients; the control group contained 2,215 patients. Admission rates from the ED increased by 53.4% (95% confidence interval [CI], P < 0.001); lengths of stay decreased by 15.1% (95% CI, P < 0.001); and durations of hospitalization in the pulmonology department decreased by 38.4% (95% CI, P=0.001). Concordance of diagnoses between admission and discharge decreased by 14.2% in the cardiology department (95% CI, P=0.021). CONCLUSION: Lengths of stay were reduced without critical declines in diagnostic concordance rates when emergency medicine physicians, instead of IM residents in the ED, decided upon admissions of IM patients.

Usefulness of the Biochemical Markers in the Elderly Hip Fracture Patients / 대한정형외과연구학회지

PURPOSE: The authors evaluated the usefulness of the biochemical markers in the elderly hip fracture patients. MATERIALS AND METHODS: Eighty-two hip fractures above 65 years old were enrolled in this study. Serum level of C-telopeptide, osteocalcin, parathyroid hormone, 25-hydroxyvitamin D, calcium were checked and bone mineral density was assessed by DXA. RESULTS: 83% vitamin D deficiency and 43% calcium insufficiency were observed. There were statistically significance between C-telopeptide and osteocalcin, calcium and 25-hydroxyvitamin D, and calcium and DXA results in the Chi-Square test. Spearmann correlation coefficient results showed that there were statically significant correlations between C-telopeptide and osteocalcin, calcium and DXA results. In the multiple logistic regression analysis results, calcium had the statically significant correlations with DXA results. CONCLUSION: There was correlation between bone turnover markers and vitamin D deficiency, and calcium insufficiency was observed in the elderly hip fracture patients.

Usefulness of the Biochemical Markers in the Elderly Hip Fracture Patients / 대한정형외과연구학회지

PURPOSE: The authors evaluated the usefulness of the biochemical markers in the elderly hip fracture patients. MATERIALS AND METHODS: Eighty-two hip fractures above 65 years old were enrolled in this study. Serum level of C-telopeptide, osteocalcin, parathyroid hormone, 25-hydroxyvitamin D, calcium were checked and bone mineral density was assessed by DXA. RESULTS: 83% vitamin D deficiency and 43% calcium insufficiency were observed. There were statistically significance between C-telopeptide and osteocalcin, calcium and 25-hydroxyvitamin D, and calcium and DXA results in the Chi-Square test. Spearmann correlation coefficient results showed that there were statically significant correlations between C-telopeptide and osteocalcin, calcium and DXA results. In the multiple logistic regression analysis results, calcium had the statically significant correlations with DXA results. CONCLUSION: There was correlation between bone turnover markers and vitamin D deficiency, and calcium insufficiency was observed in the elderly hip fracture patients.

Clinical Significance of National Patients Sample Analysis: Factors Affecting Mortality and Length of Stay of Organophosphate and Carbamate Poisoned Patients / 대한의료정보학회지

OBJECTIVES: This study considered whether there could be a change of mortality and length of stay as a result of inter-hospital transfer, clinical department, and size of hospital for patients with organophosphates and carbamates poisoning via National Patients Sample data of the year 2009, which was obtained from Health Insurance Review and Assessment Services (HIRA). The utility and representativeness of the HIRA data as the source of prognosis analysis in poisoned patients were also evaluated. METHODS: Organophosphate and carbamate poisoned patients' mortality and length of stay were analyzed in relation to the initial and final treating hospitals and departments, as well as the presence of inter-hospital transfers. RESULTS: Among a total of 146 cases, there were 17 mortality cases, and the mean age was 56.8 +/- 19.2 years. The median length of stay was 6 days. There was no inter-hospital or inter-departmental difference in length of stay. However, it significantly increased when inter-hospital transfer occurred (transferred 11 days vs. non-transferred 6 days; p = 0.037). Overall mortality rate was 11.6%. The mortality rate significantly increased when inter-hospital transfer occurred (transferred 23.5% vs. non-transferred 7.0%; p = 0.047), but there was no statistical difference in mortality on inter-hospital and inter-department comparison at the initial treating facility. However, at the final treating facility, there was a significant difference between tertiary and general hospitals (5.1% for tertiary hospitals and 17.3% for general hospitals; p = 0.024), although there was no significant inter-departmental difference. CONCLUSIONS: We demonstrated that hospital, clinical department, length of stay, and mortality could be analyzed using insurance claim data of a specific disease group. Our results also indicated that length of stay and mortality according to inter-hospital transfer could be analyzed, which was previously unknown.

The Usefulness of Intraoperative Radiography for Prevention of Malalignment of the Cemented Femoral Stem / 대한고관절학회지

PURPOSE: The purpose of this study was to evaluate the usefulness of our method, which estimated femoral stem alignment using a c-arm when the broach was inserted, for prevention of femoral stem malalignment. MATERIALS AND METHODS: A total of 103 hips were enrolled in this study. All patients underwentprimary hip arthroplasty from October 2011 to February 2013. The study was conductedretrospectively. Intraoperative estimated femoral stem alignments and final femoral stem alignments were classified into three groups. Multinomial logistic regression analysis was performed for analysis of factors (age, sex, diagnosis, body mass index, femoral stem size, osteoporosis, and proximal demur geometry) thatmight affect intraoperatively estimated femoral stem alignment. RESULTS: The distribution of intraoperative estimated femoral stem alignment was 80(78%) in the neutral group, 18(17%) in the varus group, and 5(5%) in the valgus group. The distribution of final femoral stem alignment was 100(97%) in the neutral group, 2(2%) in the varus group, and 1(1%) in the valgus group. There was no statistically significant factor affecting the intraoperatively estimated femoral stem alignment. CONCLUSION: Intraoperative estimated femoral stem alignment using a c-arm is an effective method for prevention of femoral stem malalignment.

The Simple Predictive Factors of Emergency Endoscopy for Non-variceal Acute Upper Gastrointestinal Bleeding

BACKGROUND/AIMS: Although endoscopy is an important diagnostic method for acute upper gastrointestinal bleeding (AUGIB), the guideline of emergency endoscopy for AUGIB is not yet established. This study was performed to assess the predictive factors of emergency endoscopy for non-variceal AUGIB. MATERIALS AND METHODS: From June 2006 to December 2008, the medical records of 283 patients with non-variceal AUGIB treated in Kangdong Sacred Heart Hospital were retrospectively analyzed. Patients were divided into two groups: emergency endoscopic procedure group or non-procedure group. We compared the factors for predicting the necessity of emergency endoscopic hemostasis. RESULTS: Among 283 patients, 194 were in the emergency endoscopic procedure group and 89 were in the non-procedure group. No significant differences in age, co-morbidities, drug history, and chief complaints were observed. After adjustment of several factors including syncope, systolic blood pressure, nasogastric (NG) tube irrigation and digital rectal examination findings, hemoglobin decline of more than 2 g/dL after 6 hours, prothrombin time, BUN and BUN/creatinine ratio that showed significant differences between the two groups, bloody NG aspiration was the only significant predictive factor (hazard ratio 13.69: P<0.001). CONCLUSIONS: Bloody NG aspiration was a simple factor for predicting emergent endoscopic procedure in non-variceal AUGIB patients.

A Case of Peritoneal Mesothelioma without a History of Asbestos Exposure / 대한소화기학회지

Peritoneal mesothelioma is an unusual disease which diffusely involves the peritoneal surface. The incidence is approximately one per 1,000,000, and one fifth to one third of all mesothelioma are peritoneal in origin. Asbestos exposure is linked to the development of peritoneal mesothelioma as a significant etiology, but further investigation shoud be conducted. Abdominal sonography, abdominal CT and cytologic examination of ascitic fluid are used to confirm the diagnosis, but rarely provides proper diagnosis. Laparoscopy with biopsy is the most common diagnostic method for definite diagnosis of mesothelioma. Cytoreductive surgery and intraperitoneal chemotherapy have been suggested for better survival since the median survival after the initial diagnosis is near to 50 months. This report describes a case of 73-years-old male patient presented with abdominal pain and distension. This patient had not been exposed to asbestos. Abdominal sonography and CT showed massive ascites, multiple omental masses and peritoneal thickening. It was difficult to distinguish peritoneal mesothelioma from carcinomatosis. Laparoscopy and peritoneal biopsy was conducted and immunostaining examination confirmed the diagnosis of peritoneal mesothelioma.

Adjacent Segment Degeneration After Spinal Fusion In Lumbar Degenerative Disorders / 대한척추외과학회지

STUDY DESIGN: A retrospective radiological assessment was conducted. OBJECTIVES: An attempt to analyze the degenerative change of an intervertebral disc for adjacent segment degeneration in lumbar degenerative diseases. LITERATURE REVIEW SUMMARY: A review of the literature failed to uncover any documented study examining the quantitative analysis of the degenerative change of the intervertebral disc for adjacent segment degeneration. METHODS: This study was based on 45 patients, treated operatively or conservatively at this hospital, between April 1995 and July 2004. 39 and 6 cases of operative and conservative treatments, respectively, were performed. In the 39 operative treatments, there were 34 cases of fusion and 5 of discectomy. Dynamic X-ray and MRI were performed at the initial evaluation, and again more than 2 years later. In the 34 fusion cases, the upper and lower adjacent segments of the fused level were studied, and in the 11 non-fusion cases (conservative treatment or discectomy), the L3-4, L4-5 and L5-S1 level were studied. The instability of the dynamic X-ray and Thompson grade changes of the disc on MRI were also evaluated. Statistical analysis was carried out using the Wilcoxon signed rank test. RESULTS: Adjacent segment degeneration was found in 10 of the 34 cases (29.4%) on plain X-ray. The average Thompson grades of the 33 upper segment cases were 2.6 and 3.4 preoperatively and postoperatively (P=0.000), and for the 24 of the lower segment cases were 2.9and 3.2 (P=0.033), respectively. No statistical increase in the Thompson grade was found in the non-fusion group. CONCLUSIONS: The adjacent discs of the fusion group showed statistically meaningful degeneration on MRI, but this was not correlated with adjacent segment degeneration on plain X-ray. Various anatomical and functional factors must be considered in the evaluation of adjacent segment disease.

Adjacent Segment Degeneration After Spinal Fusion In Lumbar Degenerative Disorders / 대한척추외과학회지

STUDY DESIGN: A retrospective radiological assessment was conducted. OBJECTIVES: An attempt to analyze the degenerative change of an intervertebral disc for adjacent segment degeneration in lumbar degenerative diseases. LITERATURE REVIEW SUMMARY: A review of the literature failed to uncover any documented study examining the quantitative analysis of the degenerative change of the intervertebral disc for adjacent segment degeneration. METHODS: This study was based on 45 patients, treated operatively or conservatively at this hospital, between April 1995 and July 2004. 39 and 6 cases of operative and conservative treatments, respectively, were performed. In the 39 operative treatments, there were 34 cases of fusion and 5 of discectomy. Dynamic X-ray and MRI were performed at the initial evaluation, and again more than 2 years later. In the 34 fusion cases, the upper and lower adjacent segments of the fused level were studied, and in the 11 non-fusion cases (conservative treatment or discectomy), the L3-4, L4-5 and L5-S1 level were studied. The instability of the dynamic X-ray and Thompson grade changes of the disc on MRI were also evaluated. Statistical analysis was carried out using the Wilcoxon signed rank test. RESULTS: Adjacent segment degeneration was found in 10 of the 34 cases (29.4%) on plain X-ray. The average Thompson grades of the 33 upper segment cases were 2.6 and 3.4 preoperatively and postoperatively (P=0.000), and for the 24 of the lower segment cases were 2.9and 3.2 (P=0.033), respectively. No statistical increase in the Thompson grade was found in the non-fusion group. CONCLUSIONS: The adjacent discs of the fusion group showed statistically meaningful degeneration on MRI, but this was not correlated with adjacent segment degeneration on plain X-ray. Various anatomical and functional factors must be considered in the evaluation of adjacent segment disease.

Comparative Study of Glycolic Acid Peeling vs. Tretinoin Peeling in Facial Pigmentary Lesions / 대한피부과학회지

BACKGROUND: Chemical peels using glycolic acid and tretinoin are known to be safe and effective for treating facial pigmentary lesions. OBJECTIVE: We evaluated and compared the efficacy of tretinoin and glycolic acid peeling for facial pigmentary lesions by using a digital camera and L*a*b* color scale in Adobe Photoshop 5.5(R) METHODS: Thirty eight patients with facial pigmentary lesions were treated with 50% glycolic acid and 1% tretinoin peelings. The treatment was performed 2-3 times per week for a period of 2 weeks and a half. Exposure time was 2 minutes for the glycolic acid and 6 hours for the tretinoin. Before and after the treatment, pigmentary lesions were evaluated using self evaluation forms and the L*a*b* color system (Commission International de I'Eclairage) in Adobe Photoshop 5.5(r) (Adobe Systems Incorporated, USA). Corneometer (Corneometer(r) CM820, Courage Khazaka Electronic GmbH, Germany) was used for the evaluation of skin hydration before and after the treatment. RESULTS: Facial pigmentary lesions were significantly improved in 10 out of 38 patients after 50% glycolic acid peeling and in 12 out of 38 patients after 1% tretinoin peeling. The state of hydration of the treated skin improved significantly after the peeling using both 50% glycolic acid and 1% tretinoin. CONCLUSION: Topical 1% tretinoin peeling is as effective as 50% glycolic acid peeling in the treatment of facial pigmentary lesions and more frequent peeling results in quicker improvement than the previous studies without significant side effects.

Lymph Node and Skin Metastasis as a Manifestation of a Male Breast Carcinoma / 대한피부과학회지

Breast carcinoma in men is very rare but is a potentially life-threatening neoplasm. The most common form of clinical presentation is a painless, firm, retroareolar mass. However, in some cases, primary focus of the tumor may not be detected but present with metastatic lesions. We report a case of male breast carcinoma presented with axillary lymph node enlargement and subsequent erythematous infiltration of chest wall in a 60-year-old man. Histopathologic examination showed invasive ductal carcinoma of breast, and both estrogen and progesterone receptors were weakly positive.

Multiple Familial Trichoepitheliomas Associated with Milia / 대한피부과학회지

We present a case of multiple familial trichoepithelioma associated with milia. A 11-year-old girl had symmetrically distributed, multiple, skin-colored papules on her face, some of which were pinhead sized whitish papules. Her mother and relatives had a similar skin lesion on their face. The histological findings of these lesions showed the typical findings of trichoepithelioma and those of milia.

Treatment of Multiple Warts with High Dose Cimetidine Therapy / 대한피부과학회지

BACKGROUND: Warts are often a difficult treatment problem for dermatologists. Cimetidine is a H2 histamine receptor antagonist that has been used mainly to treat peptic ulcer disease. The successful use of cimetidine in the treatment of viral warts has been reported previously using doses of 40 mg/kg/day and has the advantage of being painless and easy to administer. OBJECTIVE: In this study we evaluated the effect of cimetidine as an immunomodulating agent on multiple warts. METHODS: We have now treated 24 patients, including 7 children, with multiple viral warts on the hands, feet or faces with high dose cimetidine for 3 or 4 months (14 female, 10 male, age range 6 - 46 years). RESULTS: Of the 24 patients who completed the study, 19 patients (79.2%) had either complete resolution or partial resolution of their warts within 3 months of cimetidine therapy without any adverse effects. CONCLUSION: This study confirms that high-dose cimetidine therapy is beneficial and safe in the treatment of recalcitrant and multiple warts.

A Case of Drug Eruption Caused by Quinolones / 대한피부과학회지

The drug eruptions caused by quinolones are rarely reported. The patient took norfloxacin for several days prior to admission and was admitted due to systemic erythematous maculopapular eruptions. For the treatment of urinary tract infection, he was treated with pefloxacin via intravenous route, and then the symptom of drug eruption became aggravated. After termination of treatment, the symptom reduced. The causative agent was identified by intradermal test and confirmed by accidental rechallenge with levofloxacin which is an another quinolone. We report herein the case of drug eruption caused by several quinolones which was confirmed by intradermal test and incidental administration of the drug.

A Case of Dermatofibroma associated with Follicular Basal Cell Hyperplasia / 대한피부과학회지

Various epidermal changes may be present in the overlying epidermis of dermatofibroma. Follicular basal cell hyperplasia is a relatively rare epidermal change found in 2-23% of dermatofibroma and it should be differentiated from basal cell carcinoma. We report a case of dermatofibroma associated with focal basal cell hyperplasia and a review of the literature.

A Case of Meckel's Enterolith / 대한소화기내시경학회지

The term enterolith refers to concretions formed within the gastrointestinal tract. Enteroliths are thought to result from stasis and are usually found proximal to an area of stricture or within diverticulum. Meckel's diverticulum occurs in 1% to 3% of the population at autopsy and is the most common congenital anomaly of the gastrointestinal tract. Common complications of Meckel's diverticulum include hemorrhage, infection, inflammation, and intussusception. However, enterolith formation in a Meckel's diverticulum, which referred to as Meckel's enterolith, is rare. A 58-year-old female who experienced constipation and low abdominal pain for 20 years, was admitted due to severe low abdominal pain for 3 days. A 3 2 cm sized, lozenge-shaped radiopaque stone with peripheral dense calcification and radiolucent center, located between two areas of stricture in the distal ileum, was observed in abdominal radiograph, abdominal sonogram, small bowel study, and CT scan. Pathologic findings after surgery reveal an enterolith in Meckel's diverticulum without ectopic gastric mucosa. The case of Meckel's enterolith is herein reported.

A Case of Hydrogen Peroxide Induced Colitis / 대한소화기내시경학회지

Hydrogen peroxide has been used for various medical purposes and also recommended in the disinfection process for endoscopes. However, hydrogen peroxide as a cause of chemical colitis or disinfectant colitis has been infrequently reported. The endoscopic findings of hydrogen peroxide induced colitis revealed pseudomembranous-like enteritis such as white plaques, erythema, foamy liquid, patchy, granularity, and ulcerations, resulting from effervescence caused by the release of oxygen from the breakdown of hydrogen peroxide. A 36 year-old single male, who had 30 ml of 3% hydrogen peroxide inserted into his anus the day before due to sexual reasons, was hospitalized as a result of suffering from hematochezia, tenesmus, and lower abdominal pain. Colonoscopy revealed discrete or confluent white plaques adherent to the colonic mucosa, severe erythema on the surrounding mucosa, patchy granularity, and scattered ulcerations up to 28 cm from the anal verge. Pathologic finding revealed inflammatory cells infiltration, variable sized vacuoles, vascular congestion, hemorrhage, fibrin deposition and ulcerations with regenerating epithelium in the lamina propria, consistent with acute mucosal injury caused by hydrogen peroxide. A case of hydrogen peroxide induced colitis is herein reported.

Gastrointestinal Endoscopy under Sedation with a Continuous Infusion of Propofol / 대한소화기내시경학회지

BACKGROUND AND AIMS: Propofol is a short-acting intravenous sedative-hypnotic agent that can be used as a hypnotics for upper gastrointestinal endoscopy. A study was conducted to evaluate the effectiveness and safety of propofol as a hypnotic agent for upper gastrointestinal endoscopy. METHODS: From June to October 1998, twenty eight patients undergoing upper gastrointestinal endoscopy were to receive propofol. Vital signs and peripheral oxygen saturation (SpO2) were monitored by pulse oximetry during continuous infusion of propofol. Propofol (1% solution) was initially infused by 26.7 mg/kg/hr until loss of eyelash reflex and then titrated to 6-10 mg/kg/hr according to the patient's response and vital sign. Propofol infusion was discontinued while the endoscopic fiber was removed. Recovery time was defined from discontinuation of infusion to positive Romberg test. Evaluation was made from the endoscopists' assessment, patients' satisfaction, patients' recall of the procedure, and consciousness of the patients. RESULTS: It was discovered that systolic, diastolic pressure and heart rate were significantly decreased, compared to control group. But clinically significant changes were not found. Apnea did not exist. And the respiration rate was significantly increased during propofol infusion. Peripheral oxygen saturation (SpO2) was transiently decreased during endoscopy. 14 patients (50%) complained of transient dizziness. Pain and redness over the infusion site was not found. The mean total dose of propofol was 133.6 mg. The mean infusion time of propofol was 6.2 minutes. Mean response and recovery time was 3.7 2.1, 20.9 5.4 minutes. Endoscopists' assessment and patients' comfort for endoscopy were satisfactory. When we asked 28 patients about willingness to undergo the same procedure in the future, 27 patients (96.4%) agreed. Degree of amnesia after examination revealed total amnesia in 27 patients (96.4%), partial amnesia in 1 patients (3.6%), and recall was not. CONCLUSIONS: Propofol has beneficial effects as hypnotic for upper gastrointestinal endoscopy without significant alteration in cardiopulmonary parameters. Patients' and endoscopists' assessment is good. This suggest that propofol may be used more frequently as a kind of premedication, especially in the cases of repeated endoscopy.

Expression pattern of Hepatitis B Viral Core Antigen (HBcAg) and Surface Antigen (HBsAg) in Liver of the Inactive HBsAg Carriers

To understand better the complex natural course of HBV infection, the expression patterns of HBcAg and HBsAg in the liver of 51 inactive serum HBsAg carriers (24 CPH and 27 NPD) were studied by immunohistochemical methods. The inactive serum HBsAg carriers were devided into 3 groups by the following expression patterns of serum HBeAg/anti-HBe status and tissue HBcAg and HBsAg. Pattern A (18 cases) : HBeAg+, cHBcAg+ (94.4%), mHBsAg+ (61.1%), pATTERN B (14 cases) : anti-HBe+, nHBcAg+, cHBsAg+, Pattern C (19 cases) : anti-HBe+, HBcAg-, cHBsAg+ (89.5%). There were no significant differences between CPH and NPD, lthough the core free pattern was more common in the latter. The cHBcAg was expressed in 17 of 18 (94.4%) HBeAg seropositive cases but only one of 33 cases with serum anti-HBe, suggesting that the cHBcAg is intimately related to HBeAg. Since the inactive HBsAg carriers also expressed cHBcAg and/or mHBsAg, the necro-inflammatory activity of HBV infected liver is assumed to depend on the host immune response rather than their presence alone