An Epidemiological Study of Clavicle Fractures for Koreans in the Metropolitan Area / 대한정형외과학회잡지

PURPOSE: Though clavicle fractures are the second most common fractures to occur in active adults, there have been a few epidemiological studies conducted on the Korean population in recent years. To better understand clavicle fractures, an epidemiological study reflecting the changes in current life style and injury mechanism may be important. Hence, the purpose of this study was to conduct an epidemiological study on the Korean population. MATERIALS AND METHODS: This was a retrospective study of 973 patients (977 cases) who presented with clavicle fractures from January 2000 to August 2015. Radiological results were classified by the Allman system-3 groups and 7 subgroups. The study collected information regarding gender, age at the event of injury, injury mechanism, other associated injuries, occurrence rate of each year, and seasonal variation. RESULTS: The study consisted of 627 male patients (64.4%, 1 bilateral case) and 346 female patients (35.6%, 3 bilateral cases). The mean age at the time of injury was 31.8±24.9 years (male, 31.2±22.6 years; female, 32.7±28.7 years). Midshaft clavicle fractures (Allman group I) were the most common with 758 cases (77.6%). There were 397 cases with displacement (40.6%). The occurrence of clavicle fractures decreased with increasing age in male patients and showed a bimodal distribution in female patients. Injury due to a fall from standing height was the most common mechanism of injury. There were 61 cases (6.2%) who had other associated injuries and the most common associated injury was a rib fracture. The occurrence of clavicle fractures increased with time, and falling was associated with the highest occurrence rate of clavicle fractures. CONCLUSION: The mean age of clavicle fracture was 31.8 years in a recent 15-year period. The occurrence of fracture in male patients was 1.8 times than female patients, primarily occurring as midshaft fractures. There were more cases of displacement than minimally displaced cases. The most common injury mechanism was a fall from standing height, and the occurrence of clavicle fractures has shown an increasing trend recently.

Quercetin Directly Interacts with Vitamin D Receptor (VDR): Structural Implication of VDR Activation by Quercetin

The vitamin D receptor (VDR) is a member of the nuclear receptor (NR) superfamily. The VDR binds to active vitamin D3 metabolites, which stimulates downstream transduction signaling involved in various physiological activities such as calcium homeostasis, bone mineralization, and cell differentiation. Quercetin is a widely distributed flavonoid in nature that is known to enhance transactivation of VDR target genes. However, the detailed molecular mechanism underlying VDR activation by quercetin is not well understood. We first demonstrated the interaction between quercetin and the VDR at the molecular level by using fluorescence quenching and saturation transfer difference (STD) NMR experiments. The dissociation constant (K(d)) of quercetin and the VDR was 21.15 ± 4.31 µM, and the mapping of quercetin subsites for VDR binding was performed using STD-NMR. The binding mode of quercetin was investigated by a docking study combined with molecular dynamics (MD) simulation. Quercetin might serve as a scaffold for the development of VDR modulators with selective biological activities.

Diatally-Based Medial Crural Adipofascial Flap for Coverage of Medial Foot and Ankle

PURPOSE: We report on the clinical result after coverage of a soft tissue defect on the medial foot and ankle with an adipofascial flap based on the perforator from the posterior tibia artery. MATERIALS AND METHODS: Nine patients with soft tissue defects on the medial foot and ankle area from March 2009 to May 2014 underwent the procedure. Average age was 54 years old (range, 8~82 years). There were five male patients and four female patients. The causes of the defect were trauma (4), tumor (3), and infection (2). The pivot point of transposition of this flap is the lower perforator originating from the posterior tibia artery. The fatty tissue side of this flap could be used to resurface the defect. The donor site was closed primarily with the preserved skin, and a small caliber drain tube was used. The split-thickness skin graft was grafted to the flap and the wound. If the wound was still infected, this skin graft could be performed at a later date. RESULTS: All flaps survived and normal soft tissue coverage was obtained for the medial foot and ankle of all patients after the skin graft. Normal footwear was possible for all cases because of thin coverage. There was an extension contracture on the medial ray of the foot, which was resolved by contracture release and skin graft. CONCLUSIONS: For the medial foot and ankle soft tissue defect, the medial crural adipofascial flap based on a perforator branch of the posterior tibia artery could be a good option to cover it.

Reconstruction of Large Femur and Tibia Defect with Free Vascularized Fibula Graft and Locking Plate

PURPOSE: The reconstruction of femur and tibia defects following tumor resection remains a surgical challenge. The clinical outcome of free vascularized fibula graft (VFG) reconstruction with locking plate for massive femur and tibia defects of more than 10 cm that were secondary to skeletal tumor resection is reported. MATERIALS AND METHODS: Thirteen patients with a mean follow-up of 3.3 years were reviewed. Seven patients received vascularized fibula grafts in the femur and six in the tibia. The mean bony defect of the femur and tibia was more than 10 cm and the length of the grafted fibula was more than 15 cm. All defects were stabilized with long locking plates. RESULTS: All patients were free of disease at final follow-up; All VFGs were transferred successfully. All patients had a successful outcome with bony union. Stress fractures of the grafted fibula had occurred but the locking plate stabilized the fracture and healed until the last follow-up. All patients were able to walk without a brace after a mean of 9 months postoperatively. CONCLUSIONS: VFG with locking plate is a reliable reconstructive procedure for massive femur and tibia defects.

Experiences and Views of a Pilot Emergency Medicine Sub-internship Program: A Focus Group Study of Learners and Teachers

PURPOSE: The aim of this study was to explore participants' experiences and views of a pilot emergency medicine (EM) sub-internship program. METHODS: A pilot 4-week EM sub-internship program involving four academic emergency departments was developed and implemented at the beginning of fourth-year in medical school. Three focus group discussions were separately conducted with ten students, six supervising residents, or four faculty physicians upon completion of the program. Each 60- to 90-minute discussion was recorded, transcribed, and coded by two assessors independently. Contents were thematically analyzed and group interaction examined. RESULTS: The participants identified several strengths of the program, including an opportunity to treat a variety of acute diseases for the first time, an opportunity to apply a symptom-based practice, an opportunity to experience a dynamic workplace, and an opportunity to receive help with career-planning. Commonly identified weaknesses of the program were placed into three categories: 1) not enough bedside teaching time, 2) the workload of the educators, which impacts program efficiency, and 3) a variety of learning experience among the students. Ideas for improving the program included an announcement about the program in advance, the development of faculty skills, the development of new content, and a validation of the evaluation methods and institutional support. CONCLUSION: The EM sub-internship appears to be effective in preparing fourth-year medical students for many of the challenges they will face in the future. However, continuous efforts to strengthen the program are required. These study results will help EM educators develop their own sub-internship program.

Primary Amyloidosis of the Urinary Tract / 대한비뇨기과학회지

Primary localized amyloidosis of the urinary tract is very rare disease. A 72-year-old man, with a history of urethral injury, had a stricture of the anterior urethra about 6cm in length. A segmental resection of urethra and urethroplasty, with penile skin flap, was performed. The resected urethral segment was diagnosed as urethral amyloidosis. There was no involvement of amyloidosis oin the other organs (heart, gastrointestinal system, joint, kidney, skin etc) and no underlying disease (multiple myelomas, rheumatism, cancer, chronic inflammation etc). Also, a 75-year-old woman, with a history of intermittent gross hematuria, had a stricture of the lower ureter. During diagnostic ureteroscopy, there was an irregular mucosal change of her lower ureter. An intraoperative biopsy showed ureteral amyloidosis. Here, we report on these two cases of primary amyloidosis of the urinary tract.

First-line Treatment Modality in Children with Complete Duplicating System Complicated with Ureterocele or Ectopic Ureter: Ureteropyelostomy / 대한비뇨기과학회지

PURPOSE: A complete duplicated collecting system complicated with an ectopic ureter or ureterocele results in renal damage due to a ureteral obstruction or reflux. The clinical outcome of ureteropyelostomy in complicated complete duplicated collecting system was evaluated. MATERIALS AND METHODS: 20 children received a ureteropyelostomy for either an ectopic ureter or ureterocele with a complete duplicated collecting system anomaly. The median age was 3.2 months. Of the children, 11 had ureteroceles including 7 cecoureteroceles, and 9 had ectopic ureters. The associated anomalies were 3 UPJ obstructions of the lower pole and 9 VUR. All received a ureteropyelostomy. The lower pole ureter was used as the common ureter except in 2 cases with a lower ureter in poor condition. A lower pole pyeloplasty was combined in 3 cases with UPJ obstructions of the lower pole. A distal ureteral stump was left open except in the cecoureterocele in order to prevent VUR. Their clinical courses were followed up with an ultrasonogram and 99mTc-DMSA scan. The median follow-up after surgery was 17.8 months. RESULTS: A reduced upper pole hydronephrosis was observed in 19 patients and an improvement in the differential renal function was noted in 17 patients on the follow-up studies. All ureteroceles had either disappeared or were reduced in size. 7 patients showed an intermittent asymptomatic bacteriuria and 1 patient showed symptomatic UTI who required an ureteroneocystostomy during the follow-up. CONCLUSIONS: A ureteropyelostomy is recommended as a first-line treatment modality for patients with a complicated complete duplicated collecting system owing to the lower chance of secondary surgery, the prevention of deterioration in the bladder function and the possibility of early correction.

First-line Treatment Modality in Children with Complete Duplicating System Complicated with Ureterocele or Ectopic Ureter: Ureteropyelostomy / 대한비뇨기과학회지

PURPOSE: A complete duplicated collecting system complicated with an ectopic ureter or ureterocele results in renal damage due to a ureteral obstruction or reflux. The clinical outcome of ureteropyelostomy in complicated complete duplicated collecting system was evaluated. MATERIALS AND METHODS: 20 children received a ureteropyelostomy for either an ectopic ureter or ureterocele with a complete duplicated collecting system anomaly. The median age was 3.2 months. Of the children, 11 had ureteroceles including 7 cecoureteroceles, and 9 had ectopic ureters. The associated anomalies were 3 UPJ obstructions of the lower pole and 9 VUR. All received a ureteropyelostomy. The lower pole ureter was used as the common ureter except in 2 cases with a lower ureter in poor condition. A lower pole pyeloplasty was combined in 3 cases with UPJ obstructions of the lower pole. A distal ureteral stump was left open except in the cecoureterocele in order to prevent VUR. Their clinical courses were followed up with an ultrasonogram and 99mTc-DMSA scan. The median follow-up after surgery was 17.8 months. RESULTS: A reduced upper pole hydronephrosis was observed in 19 patients and an improvement in the differential renal function was noted in 17 patients on the follow-up studies. All ureteroceles had either disappeared or were reduced in size. 7 patients showed an intermittent asymptomatic bacteriuria and 1 patient showed symptomatic UTI who required an ureteroneocystostomy during the follow-up. CONCLUSIONS: A ureteropyelostomy is recommended as a first-line treatment modality for patients with a complicated complete duplicated collecting system owing to the lower chance of secondary surgery, the prevention of deterioration in the bladder function and the possibility of early correction.

Prostate Volume Variation with Age: Community-based Survey in Namhae Region / 대한남성과학회지

PURPOSE: The size of prostate increases with age, but there has been few Korean data on the prostate size in the general population. We thereby report the size of prostate with respect to age in Korean men residing in Namhae, Korea. MATERIALS AND METHODS: To determine the prostate size, 1421 men from Namhae, Korea underwent transrectal ultrasonography. Size of the prostate was estimated as a weight by the elliptical method. RESULTS: The mean prostate weight was 33.5 10.6 ml. The relationship between prostate volume and age was statistically significant in 1421 men (Pearson correlation coefficient=0.156, p=0.0001). Also, between the normal group and the groups of men with lower urinary tract symptoms (LUTS), there was significant correlation with age (Pearson correlation coefficient=0.162, p=0.0001), while results were insignificant with size (Pearson correlation coefficient= 0.170, p=0.0001). CONCLUSIONS: Size and rate of growth of the prostate were smaller compared to the Western society, nevertheless, prostate size increased with age. For accurate and reasonable age-specific size of the prostate of Korean male, more community based multicenter study will be needed with more refined measurement techniques such as step-section planimetry for the prostatic volume estimation.

Two cases of spontaneous rupture of the kidney / 대한비뇨기과학회지

Spontaneous rupture of the kidney with subcapsular or perinephric hemorrhage usually occurs secondary to various kinds of underlying diseases such as benign malignant tumor. vascular disease and infection etc. We experienced 2 cases of spontaneous rupture of the kidney secondary to renal cell carcinoma in a 44-year-old female and adult Wilms' tumor in a 17-year-old male.

A case of extragonadal germ cell tumor / 대한비뇨기과학회지

Extragonadal germ cell tumors are rare. accounting for approximately 38 of all germ cell tumors. Debate continues over whether these lesions originate from extragonadal site or are metastatic disease from an undetected testis primary tumor. Recently. we experienced a case of extragonadal mixed germ cell tumor in a 26-year-old male who showed complete response by combination chemotherapy with cisplatin. etoposide. and bleomycin(PVpB) and have remained disease tree for about 14 months since diagnosis. Herein we report the case with brief review of the literature.