Risk Factors in Stability after Immobilization of the Distal Radius in Unstable Fractures in Children / 대한정형외과학회잡지

Purpose@#Distal radius fractures in youth are treated conservatively in most cases, but there are some cases of redisplacement in the follow-up period after cast immobilization, even after complete reduction. This study examined the risk factors of redisplacement in reduced unstable distal radius fractures. @*Materials and Methods@#From February 2011 to June 2018, 44 unstable distal radius fractures were managed with a closed reduction and cast immobilization. The patients were aged between 6 and 14 years. The cases of redisplacement were analyzed with the fracture characteristics (fracture obliquity, fracture level ratio, ulnar fracture combined), cast qualities (gap index, cast index, 3 point index, and radius-2nd metacarpal angle) and host factors (age, sex). @*Results@#The mean angulation in the union was 9.2° (0°–32.8°). In the categorical grouping 29 cases were within 10° angulation, and 15 cases were more than 10°. No significant differences in the factors of the cast indices or host factors were noted. The meaningful factor was the fracture level calculated by the relative width of the fracture site divided by the sum of width of diaphysis and epiphysis (p=0.001) and combined ulnar fracture (p=0.019). @*Conclusion@#Unstable distal radius fractures should be treated with more stubborn guidelines lest the fracture loses its anatomical alignment. In particular, in patients with less remodeling power, operative treatment would secure a better result if the fracture occurs in a more proximal location.

Upper Extremity Injuries in Youth Baseball Players / 대한정형외과학회잡지

The elbow and shoulder in young baseball players are prone to injuries. The internal factors of sports injuries are the fragility of the bones and joints of growing children and adolescents. The main external factors of injuries are the competition and eagerness of adolescent players and the motivation of hard-work. Baseball injuries have many causes, including fast rotation and movement of a load from the trunk to arm, repetitive incorrect placement of the arm in the throwing position, too-many throwing practices, etc. Orthopedic surgeons have generally focused on surgical procedure to cure, but it is time to consider and share the methods of injury prevention.

Gutter Splint for Ingrown Toe Nail in Young Patients / 대한족부족관절학회지

PURPOSE: Ingrown toenails are a common disease in the adolescent period and the treatments could be more conservative for this early stage of the disease. This study is a case series on the results of a gutter splint for an adolescent ingrown toe nail as a simple, comfortable treatment method. MATERIALS AND METHODS: From 2011 to 2018, 22 patients (mean age, 12.2 years; range, 8~15 years) with ingrown toenails were treated with a gutter splint. There were 16 boys and 6 girls with 7 patients on both great toes, and additional 4 both corners of a nail, giving a total of 33 splints. Flat, plastic straws and glue or suture were used to protect the nail corners under local anesthesia. The medical records were reviewed retrospectively and phone calls were made to obtain the long-term results. RESULTS: Fifteen splints were fixed with a suture and the other 18 splints were fixed with glue. There were 9 cases of recurrence out of 33 gutter splints, 8 out of 15 sutured splints and 1 out of 18 glued splints (p=0.010). There was no gender (p=0.383) or age (p=0.305) difference in the number of recurrences. CONCLUSION: For growing people, ingrown nails can be cured easily by conservative treatment for a transiently shortened or broken toenail. The glued gutter splint had a reasonable success rate as a first line treatment.

Trampoline-related injuries in Korea

The growing popularity of trampolines in Korea has resulted in a significant increase in the number of injuries associated with their use. However, little research has been conducted into trampoline-related injuries in Asian countries, including Korea and the incidence and characteristics of trampoline-related injuries have rarely been reported. In a review of the very few studies on these injuries in Korea, the mean age at injury was younger than has been reported in previous studies from other countries, and 46% of patients experienced fracture. Most injuries (82%) occurred in commercial facilities. In Korea, the safety management of trampolines is insufficient. Hence, safety guidelines for the use of trampolines should be recommended by relevant medical professionals.

A huge mass causing colonic obstruction at the hepatic flexure

No abstract available.

The Incidence of Pediatric Trampoline Injury: Statistics from a Single Institution / 대한정형외과학회잡지

PURPOSE: Recently, there has been increasing number of trampoline injuries at our pediatric orthopedic clinic and emergency room. Therefore, this study is to analyze the prevalence of the trampoline injuries with emergency room surveillance. MATERIALS AND METHODS: Between September 2015 and February 2017, all patients under the age of 15 years, who visited emergency room of a teaching hospital with trauma and referred to the department of orthopedic surgery, was included; the cause of trauma was analyzed. The severity of injury was also evaluated and compared according to the cause of injury. RESULTS: There were a total of 1,807 patients under the age of 15 years who visited our emergency room during the study period. There were a total of 71 trampoline injuries (3.9%). There were 28 patients below the age of 5 years, and among them, 14 minor injury were recorded; 43 patients were over the age of 5 years and with 4 minor, 20 moderate, and 19 severe injuries. In the age between 5 and 15 years, the prevalence of mild injury was lower in trampoline injury compared with those of other sports injuries (9.3% vs. 34.0%) and the prevalence of severe injury was higher in trampoline injury (44.2% vs. 26.3%) (p=0.002). CONCLUSION: Our findings indicate that the incidence of trampoline injury was lower than other country, but it was more severe than injuries from other sports. With increasing incidence of trampoline injuries, parents should be more mindful that trampolines are not safe and stricter supervision may be necessary.

Trampoline-related injuries in Korea

The growing popularity of trampolines in Korea has resulted in a significant increase in the number of injuries associated with their use. However, little research has been conducted into trampoline-related injuries in Asian countries, including Korea and the incidence and characteristics of trampoline-related injuries have rarely been reported. In a review of the very few studies on these injuries in Korea, the mean age at injury was younger than has been reported in previous studies from other countries, and 46% of patients experienced fracture. Most injuries (82%) occurred in commercial facilities. In Korea, the safety management of trampolines is insufficient. Hence, safety guidelines for the use of trampolines should be recommended by relevant medical professionals.

Evaluation of the Efficacy and Safety of DA-9601 versus Its New Formulation, DA-5204, in Patients with Gastritis: Phase III, Randomized, Double-Blind, Non-Inferiority Study

This study compared the efficacy of DA-9601 (Dong-A ST Co., Seoul, Korea) and its new formulation, DA-5204 (Dong-A ST Co.), for treating erosive gastritis. This phase III, randomized, multicenter, double-blind, non-inferiority trial randomly assigned 434 patients with endoscopically proven gastric mucosal erosions into two groups: DA-9601 3 times daily or DA-5,204 twice daily for 2 weeks. The final analysis included 421 patients (DA-5204, 209; DA-9601, 212). The primary endpoint (rate of effective gastric erosion healing) and secondary endpoints (cure rate of endoscopic erosion and gastrointestinal [GI] symptom relief) were assessed using endoscopy after the treatment. Drug-related adverse events (AEs), including GI symptoms, were also compared. At week 2, gastric healing rates with DA-5204 and DA-9601 were 42.1% (88/209) and 42.5% (90/212), respectively. The difference between the groups was −0.4% (95% confidence interval, −9.8% to 9.1%), which was above the non-inferiority margin of −14%. The cure rate of gastric erosion in both groups was 37.3%. The improvement rates of GI symptoms with DA-5204 and DA-9601 were 40.4% and 40.8%, respectively. There were no statistically significant differences between the two groups in both secondary endpoints. AEs were reported in 18 (8.4%) patients in the DA-5204 group and 19 (8.8%) in the DA-9601 group. Rates of AE were not different between the two groups. No serious AE or adverse drug reaction (ADR) occurred. These results demonstrate the non-inferiority of DA-5204 compared to DA-9601. DA-5204 is as effective as DA-9601 in the treatment of erosive gastritis. Registered randomized clinical trial at ClinicalTrials.gov (NCT02282670)

A Case of Primary Small Bowel Melanoma Diagnosed by Single-Balloon Enteroscopy

Although metastasis from cutaneous malignant melanoma to the small intestine is not uncommon, primary small bowel melanoma (SBM) is extremely rare. This case report describes a rare case of primary SBM, diagnosed by single-balloon enteroscopy. A 74-year-old man presented with recurrent melena. Upper endoscopy and colonoscopy were unremarkable. Abdominal computed tomography (CT) revealed an ileal mass with ileo-ileal intussusception. Subsequent single-balloon enteroscopy identified an ileal tumor, which was histologically diagnosed as melanoma. Extensive clinical examination did not reveal any primary cutaneous lesions. To the best of our knowledge, this is the first case of primary SBM in South Korea.

Fecal Microbiota Transplantation for Refractory and Recurrent Clostridium difficile Infection: A Case Series of Nine Patients / 대한소화기학회지

BACKGROUND/AIMS: Fecal microbiota transplantation (FMT) is a highly effective therapy for refractory and recurrent Clostridium difficile infection (CDI). Despite its excellent efficacy and recent widespread use, FMT has not been widely used in South Korea thus far. We describe our experience with FMT to treat refractory/recurrent CDI. METHODS: We conducted a chart review of patients who underwent FMT for refractory/recurrent CDI at Inha University Hospital, between March 2014 and June 2016. The demographic information, treatment data, and adverse events were reviewed. FMT was administered via colonoscopy and/or duodenoscopy. All stool donors were rigorously screened to prevent infectious disease transmission. RESULTS: FMT was performed in nine patients with refractory/recurrent CDI. All patients were dramatically cured. Bowel movement was normalized within one week after FMT. There were no procedure-related adverse events, except aspiration pneumonia in one patient. During the follow-up period (mean 11.4 months), recurrence of CDI was observed in one patient at one month after FMT due to antibiotics. CONCLUSIONS: FMT is a safe, well-tolerated and highly effective treatment for refractory/recurrent CDI. Although there are many barriers to using FMT, we expect that FMT will be widely used to treat refractory/recurrent CDI in South Korea.

Refractory pseudomembranous colitis that was treated successfully with colonoscopic fecal microbial transplantation

Pseudomembranous colitis (PMC) is a nosocomial and opportunistic infection caused by Clostridium difficile. PMC is related to the use of antibiotics leading to intestinal dysbiosis and an overgrowth of C. difficile. Metronidazole or vancomycin is considered to be the standard therapy for the management of PMC. However, PMC has a 15%-30% recurrence rate and can be refractory to standard treatments, resulting in morbidity and mortality. Here we describe a patient who experienced refractory PMC who was treated with fecal microbiota transplantation. A 69-year-old woman was admitted to the hospital with consistent abdominal pain and diarrhea, which had been present for 5 months. She was diagnosed with PMC by colonoscopy and tested positive for C. difficile toxin. Even though she took metronidazole for 10 days, followed by vancomycin for 4 weeks, her symptoms did not improve. Because of her recurrent and refractory symptoms, we decided to perform fecal microbiota transplantation. Fifty grams of fresh feces from a donor were obtained on the day of the procedure, mixed with 500 mL of normal saline, and then filtered. The filtered solution was administered to the patient's colon using a colonoscope. After the procedure, her symptoms rapidly improved and a follow-up colonoscopy showed that the PMC had resolved without recurrence.

Recurrence and Its Impact on the Health-related Quality of Life in Patients with Gastroesophageal Reflux Disease: A Prospective Follow-up Analysis

BACKGROUND/AIMS: Limited data exist on the outcome of gastroesophageal reflux disease (GERD) treatment and its impact on the health-related quality of life (HRQoL) in the Asian population. This study aims to evaluate the treatment outcomes, to investigate the factors associated with recurrence, and to evaluate the impact of the treatment outcome on the HRQoL in a Korean GERD population. METHODS: This was a prospective, multicenter study involving a total of 824 GERD patients. The response to treatment was assessed at week 4 (or week 8 for the patients who did not achieve complete resolution [CR] at week 4). The EQ-5D questionnaire was used at baseline, end of treatment, and first recurrence to assess the HRQoL. To assess GERD symptoms, contact of patients by phone at 1, 6, and 12 months following treatment was carried out. RESULTS: CR was achieved in 65.6% and recurrence was observed in 47.8% following treatment. CR and recurrence rates did not differ by the presence of esophagitis. Multivariate analysis revealed that acid regurgitation (odds ratio 2.249; 95% confidence interval 1.293-3.912; P = 0.004) and both acid regurgitation and heartburn (odds ratio 2.330; 95% confidence interval 1.392-3.901; P = 0.001) were independent risk factors for GERD recurrence. EQ-5D scores were more improved in patients with CR than in those without CR, and worsened more during follow-up in patients with recurrence than in those without recurrence. CONCLUSIONS: We should achieve complete symptom relief and attempt to prevent recurrence in GERD patients to improve their HRQoL.

A Case of Cytomegalovirus-associated Giant Gastric Ulcer in a Patient Who Healed by Discontinuing Immunosuppressive Therapy

Cytomegalovirus (CMV) is not a rare infection and is frequently observed in immuoncompromised patients. CMV infection is usually asymptomatic in immunocompetent patients however it can be a major cause of morbidity and mortality in immunocompromised patients. The diagnosis of CMV gastric ulcer is not easy because of the absence of characteristic endoscopic features and the difficulty in the identification of infection by routine histologic examinations. We experienced a case of CMV-associated giant gastric ulcer in a patient receiving immunosuppressive therapy. She was a 45-year-old woman with dermatomyositis and had received steroid therapy to control her disease. Epigastric pain developed during therapy and upper endoscopy revealed a gastric ulcer. Despite proton pump inhibitor therapy, her epigastric pain aggravated and follow-up endoscopy revealed a huge gastric ulcer approximately 10 cm in diameter. Histologic findings showed intracellular inclusion bodies after immunostaining which confirmed CMV-associated gastric ulcer. Steroid therapy was discontinued and she received proton pump inhibitors without antiviral agents. Her symptoms improved and follow-up endoscopy revealed successful healing of the CMV-associated gastric ulcer. If an unusual gastric ulcer develops in the immunocompromised patients, CMV gastric ulcer should be suspected and examination for inclusion bodies using CMV immunostaining should be considered.

Ectopic Human Fasciola hepatica Infection by an Adult Worm in the Mesocolon

We report here an ectopic case of Fasciola hepatica infection confirmed by recovery of an adult worm in the mesocolon. A 56-year-old female was admitted to our hospital with discomfort and pain in the left lower quadrant of the abdomen. Abdominal CT showed 3 abscesses in the left upper quadrant, mesentery, and pelvic cavity. On surgical exploration, abscess pockets were found in the mesocolon of the sigmoid colon and transverse colon. A leaf-like worm found in the abscess pocket of the mesocolon of the left colon was diagnosed as an adult fluke of F. hepatica. Histologically, numerous eggs of F. hepatica were noted with acute and chronic granulomatous inflammations in the subserosa and pericolic adipose tissues. Conclusively, a rare case of ectopic fascioliasis has been confirmed in this study by the adult worm recovery of F. hepatica in the mesocolon.

Randomized, Controlled, Multi-center Trial: Comparing the Safety and Efficacy of DA-9701 and Itopride Hydrochloride in Patients With Functional Dyspepsia

BACKGROUND/AIMS: Therapies of functional dyspepsia (FD) are limited. DA-9701 is a novel prokinetic agent formulated with Pharbitis semen and Corydalis Tuber. We aimed to assess the efficacy of DA-9701 compared with itopride in FD patients. METHODS: Patients with FD randomly received either itopride 50 mg or DA-9701 30 mg t.i.d after a 2-week baseline period. After 4 weeks of treatment, 2 primary efficacy endpoints were analyzed: the change from baseline in composite score of the 8 dyspeptic symptoms and the overall treatment effect. Impact on patients' quality of life was assessed using the Nepean Dyspepsia Index (NDI) questionnaire. RESULTS: We randomly assigned 464 patients with 455 having outcome data. The difference of the composite score change of the 8 symptoms between the 2 groups was 0.62, indicating that DA-9701 was not inferior to itopride. The overall treatment effect response rate was not different between the groups. When responder was defined as > or = 5 of the 7 Likert scale, responder rates were 37% of DA-9701 and 36% of itopride group. Patients receiving DA-9701 experienced similar mean percentage of days with adequate relief during the 4-week treatment period compared with those receiving itopride (56.8% vs 59.1%). Both drugs increased the NDI score of 5 domains without any difference in change of the NDI score between the groups. The safety profile of both drugs was comparable. CONCLUSIONS: DA-9701 significantly improves symptoms in patients with FD. DA-9701 showed non-inferior efficacy to itopride with comparable safety.

Delayed Flumazenil Injection after Endoscopic Sedation Increases Patient Satisfaction Compared with Immediate Flumazenil Injection

BACKGROUND/AIMS: Flumazenil was administered after the completion of endoscopy under sedation to reduce recovery time and increase patient safety. We evaluated patient satisfaction after endoscopy under sedation according to the timing of a postprocedural flumazenil injection. METHODS: In total, 200 subjects undergoing concurrent colonoscopy and upper endoscopy while sedated with midazolam and meperidine were enrolled in our investigation. We randomly administered 0.3 mg of flumazenil either immediately or 15 minutes after the endoscopic procedure. A postprocedural questionnaire and next day telephone interview were conducted to assess patient satisfaction. RESULTS: Flumazenil injection timing did not affect the time spent in the recovery room when comparing the two groups of patients. However, the subjects in the 15 minutes injection group were more satisfied with undergoing endoscopy under sedation than the patients in the immediate injection group according to the postprocedural survey (p=0.019). However, no difference in overall satisfaction, memory, or willingness to undergo a future endoscopy was observed between the two groups when the telephone survey was conducted on the following day. CONCLUSIONS: This study demonstrated that a delayed flumazenil injection after endoscopic sedation increased patient satisfaction without prolonging recovery time, even though the benefit of the delayed flumazenil injection did not persist into the following day.

A Case of Esophageal Fibrovascular Polyp That Induced Asphyxia during Sleep

Esophageal fibrovascular polyps are rare, benign, submucosal tumors of the upper digestive tract that usually have an indolent course until the lesion attains a very large size. The most frequent complaints associated with these tumors include dysphagia and foreign body sensation. However, a long pedunculated polyp can regurgitate into the pharynx or oral cavity and cause asphyxia and sudden death if the larynx is occluded. We describe the case of a 51-year-old man who experienced snoring and occasional asphyxia during sleep. Upper endoscopy was performed, which indicated the presence of a pedunculated esophageal polyp that regurgitated into the vocal cords. The polyp was removed using a polypectomy snare and was confirmed to be a fibrovascular polyp based on pathologic examination findings. Three months after the excision of the polyp, the patient was found to be doing well without any further occurrence of asphyxia or sleep disturbances.

A Case of Esophageal Actinomycosis without Treatment in an Immunocompetent Patient

Actinomycosis is a rare, chronic disease, mainly caused by Actinomyces israelii that are present in the normal flora of the oral cavity and gastrointestinal tract. Opportunistic infection can occur if there is a break in the mucosal barrier or immunosuppressant condition. Factors that precipitate actinomycosis include surgery, inflammation, perforation, and intrauterine contraceptive devices. Esophageal actinomycosis is an extremely rare presentation, especially in immunocompetent patients. We report an unusual case of esophageal actinomycosis in an immunocompetent patient with review of the natural course of esophageal actinomycosis without treatment.

A Case of Chronic Cough Caused by Achalasia Misconceived as Gastroesophageal Reflux Disease

Cough is one of the most common symptoms that causes patients to seek outpatient medical care. If cough persists longer than 8 weeks, common causes of chronic cough, such as upper airway cough syndrome, asthma, and gastroesophageal reflux disease (GERD), should be considered. Although not a common cause of chronic cough, achalasia may cause symptoms very similar to reflux that can lead to its misdiagnosis as GERD. In this report, a 40-year-old woman presenting with chronic cough was initially diagnosed with GERD; however, her symptoms were refractory to conventional GERD treatment. Finally, she was diagnosed with achalasia. Her cough improved completely after pneumatic dilatation. Achalasia is a rare disease accompanied by dysphagia or regurgitation. If cough presumably due to GERD does not respond to treatment, or if the cause of chronic cough is uncertain, physicians should suspect achalasia.

Analysis of Risk Factors for the Posterolateral Articular Depression and Status of Posterolateral Fragment in Lateral Condylar and Bicondylar Tibial Plateau Fractures with Joint Depression

PURPOSE: To evaluate risk factors of posterolateral articular depression and characteristics of the posterolateral fragment in lateral condylar and bicondylar tibial plateau fractures with joint depression. MATERIALS AND METHODS: We reviewed 48 patients of Schatzker type II and type V (type II 34, type V 14) and evaluated risk factors of posterolateral articular depression according to the posterolateral fragment, fibular fracture, and Schatzker classification. We evaluated the position of articular depression and anterolateral fracture line of the posterolateral fragment and measured anterior to posterior lengths of the posterolateral fragment. RESULTS: Posterolateral articular depression was found in 20 of 34 cases (59%) with coexisting posterolateral fragment and in 16 of 21 cases (76%) with coexisting fibular fracture. There was a significant difference in the occurrence of posterolateral articular depression with the existence of the posterolateral fragment and fibular fracture (p<0.001). Multivariate regression analysis revealed that fibular fracture increased the occurrence of posterolateral articular depression (odds ratio 24.5, 95% confidence interval 2.2-267.2). Fifty-seven percentage of the anterolateral fracture line of the posterolateral fragment existed posterior to the anterior margin of the fibular head. CONCLUSION: This study showed that fibular fracture affects posterolateral articular depression in Schatzker type II and V tibial plateau fractures. Selecting a fixation device and performing fracture reduction requires a careful consideration since the anterolateral fracture line of the posterolateral fragment exists posterior to the anterior margin of the fibular head.