Inje University Sanggye Paik Hospital Research Articles

Comparison of Clinical Characteristics in Patients with Febrile Seizures Based on Prior COVID-19 Infection

Purpose: Febrile seizures (FSs) are neurological events associated with fever, typically occurring in children between 6 months and 5 years of age in the absence of central nervous system infection. Growing evidence suggests that coronavirus disease 2019 (COVID-19) can cause immune system dysregulation. This study compared the clinical characteristics of patients with FS based on whether they had experienced prior COVID-19 infection.Methods: A retrospective analysis was conducted of the medical records of 114 patients with FS who visited Inje University Sanggye Paik Hospital between January 2019 and December 2022. Results: The study cohort included 70 (61.4%) boys and 44 (38.6%) girls, with a mean age of 22.99±11.68 months at seizure onset. Among the 114 patients with FS, 19 had a history of COVID-19, while 95 did not. These groups differed significantly in the interval between the onset of fever and seizure. Specifically, when using a 12-hour threshold for analysis, a significantly greater proportion of patients with a history of COVID-19 exhibited intervals exceeding 12 hours compared to those without such a history. No significant differences were noted regarding sex, age, seizure frequency, personal history of FS, or family history of FS or epilepsy between the groups.Conclusion: Pediatric patients with FS and prior COVID-19 infection exhibited longer intervals between the onset of fever and seizure compared to those without previous COVID-19 infection. This finding suggests that COVID-19 may influence the mechanisms underlying FS. To better understand this relationship, long-term follow-up studies with larger cohorts are warranted.

Prostate-specific antigen density as the best predictor of low- to intermediate-risk prostate cancer: a cohort study.

Evaluation of prostate cancer (PCa) when serum prostate-specific antigen (PSA) level is vaguely elevated is complicated. This is because serum PSA levels only reflect the number of prostate epithelial cells. We aimed to compare PSA and various prostate volume-related factors to determine which one can best predict PCa in patients with a PSA level of 2.5-20 ng/mL. Patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsy at the Inje University Sanggye Paik Hospital between January 2018 and July 2021 and who had a PSA level of 2.5-20 ng/mL were retrospectively identified (n=275). Among them, based on biopsy results, patients were divided into cancer group and non-cancer groups, and age, PSA, total prostate volume (TPV), peripheral zone volume (PZV), peripheral zone PSA density (PZ-PSAD), transitional zone-PSAD (TZ-PSAD), and PSAD were compared and analyzed using receiver operating characteristic (ROC) and univariate analyses. The areas under ROC curves (AUCs) for age, total PSA, TPV, PZV, PZ-PSAD, TZ-PSAD, and PSAD for predicting PCa in patients with a PSA level of 2.5-20.0 ng/mL were 0.678, 0.680, 0.671, 0.639, 0.731, 0.736, and 0.764, respectively. In univariate and multivariate analysis, all categorical variables were divided based on the cut-off value and used to predict PCa. Those with a PSAD of ≥0.218 ng/mL2 were found to be at an increased risk of PCa than those with a PSAD of <0.218 ng/mL2 [odds ratio (OR) =3.51; 95% confidence interval (CI): 1.306-9.415], which was the best result, followed by TZ-PSAD with a cut-off value of 0.353. At a PSAD level of 0.218 ng/mL2, 85.0% of the PCa group could avoid unnecessary biopsy and 61.4% of the non-PCa group could reduce missed diagnosis when the TRUS findings were inaccurate. PSAD may inform biopsy decisions as the best predictor of PCa when TRUS findings are ambiguous in patients with a PSA level of 2.5-20.0 ng/mL.

The Absolute Lymphocyte Count Is Associated with the Prognosis in Patients with Peripheral T-Cell Lymphoma, Not Otherwise Specified

IntroductionPeripheral T-cell lymphomas (PTCLs) are a heterogeneous group of tumors that belong to the category of aggressive lymphomas and are roughly subdivided into specified and not otherwise specified (NOS) types. Clinically, the International Prognostic Index (IPI) has been the effective prognostic model to discriminate the prognosis of patients with PTCL-NOS. Also, Prognostic Index for T-cell lymphoma (PIT) has been proposed, which further modified to the Bologna score (modified PIT, mPIT). However, no simple prognostic marker has been satisfactory in predicting treatment outcomes in patients with PTCL-NOS. In this study, we investigate the association between absolute lymphocyte count at diagnosis and the prognosis of patients with PTCL-NOS.MethodsAs a retrospective study, we searched the Lymphoma Registry of Asan Medical Center and Inje University Sanggye Paik Hospital. From April 2001 to Jun 2016, we identified 131 patients diagnosed with PTCL-NOS initially treated with CHOP or CHOP-like regimens. Patients diagnosed with PTCLs other than PTCL-NOS and primary cutaneous lymphoma were excluded. Event-free survival (EFS) was calculated from the date of diagnosis to the date of disease progression, treatment failure, relapse, or death from any cause. Overall survival (OS) was calculated from the date of diagnosis to the date of death from any cause. Lymphopenia was defined as absolute lymphocyte count < 1000 / μL. The association between clinical characteristics and response was analyzed by the Fisher's exact test. Survival curves were analyzed by the Kaplan-Meier method and compared with the log-rank test.ResultsAmong 131 patients, 42 (32.1%) patients showed lymphopenia, 58 (44.3%) patients showed B symptoms, and 46 (35.1%) patients showed bone marrow involvement. The median absolute lymphocyte count was 1392/μL (range, 61-10092/μL). According to the International Prognostic Index (IPI) scores, 33 (25.2%) patients belonged to the low risk group (L), 36 (27.5%) to the low-intermediate risk group (LI), 38 (29.0%) to the high-intermediate risk group (HI), and 24 (18.3%) to the high risk group (H).In univariate analysis, treatment outcomes including CR, EFS, and OS were associated with lymphopenia, B symptoms, performance status, lactate dehydrogenase, extranodal involvement, Ann Arbor stage, IPI risk group, and the Prognostic Index for T-cell lymphoma (PIT) risk groups. After multivariate analysis, lymphopenia was independently associated with CR (≥1000 vs. <1000, odd ratio [OR]: 2.899, 95% confidence interval [CI]: 1.229-6.841, P=0.015), EFS (≥1000 vs. <1000, hazard ratio [HR]: 0.523, 95% CI: 0.339-0.807, P=0.003), and OS (≥1000 vs. <1000, HR: 0.599, 95% CI: 0.375-0.955, P=0.031). IPI risk group was also associated with CR (L/LI vs. HI/H, P <0.001), EFS (P <0.001), and OS (P <0.001).ConclusionsAbsolute lymphocyte count is an independent prognostic factor for the patients with PTCL-NOS. Lymphopenia (<1000/μL) at diagnosis was associated with worse prognosis of patients with PTCL-NOS. Because the absolute lymphocyte count easily obtained from the initial complete blood count, it seems to be simple prognostic factors to estimate the prognosis of patients with PTCL-NOS. The larger scaled study is warranted to confirm our result. DisclosuresNo relevant conflicts of interest to declare.

Staged Revision of Infected-hip Arthroplasty Using an Antibiotics-loaded Intra-articular Cement Spacer: Impact on Cemented and Cementless Stem Retention.

PurposeCurrently, standard management of a peri-prosthetic infection is a two-stage revision precedure. However, removal of well-fixed cement is technically demanding and associated with numerous potential complications. For theses reasons, two-stage revision with preservation of the original femoral stem can be considered and several previous studies have achieved successful results. While most prior studies used cemented stems, the use of cementless stems during arthroplasty has been gradually increasing; this study aims to assess the comparative effectiveness of a two-stage revision of infected hip arthroplasties at preserving cemented and cementless stems.Materials and MethodsBetween December 2001 and February 2017, Inje University Sanggye Paik Hospital treated 45 cases of deep infections following hip arthroplasty with a two stage revisional arthroplasty using antibiotics-loaded cement spacers. This approach was applied in an effort to preserve the previously implanted femoral stem. Of these 45 cases, 20 were followed-up for at least two years and included in this analysis. Perioperative clinical symptoms, radiological findings, function and complications during insertion of an antibiotics-loaded cement spacer were analyzed in this study.ResultsPeri-prothetic infections were controlled in 19 of the 20 included cases. Clinical outcomes, as assessed using the Harris hip score, Western Ontario and McMaster University score, also improved. Importantly, similarly improved outcomes were achieved for both cemented and cementless femoral stems.ConclusionIn cases of deep infection following hip arthroplasty, two-stage revision arthroplasty to preserve the previously implanted femoral stem (cemented or cementless) effectively controls infections and preserves joint function.

Evaluation of hematologic profile may be needed for patients treated with oxcarbazepine.

PurposeThe major side effects of treatment with oxcarbazepine (OXC) are skin rash and hyponatremia. Hematologic side effects are reported rarely. The aim of this study was to investigate the rate and types of the hematologic side effects of OXC.MethodsThe medical records of 184 patients diagnosed with epilepsy or movement disorder and on OXC monotherapy, at the Department of Pediatrics of Inje University Sanggye Paik Hospital from July 2001 to July 2018, were retrospectively reviewed.ResultsOf the 184 patients, 10 (5.4%) developed leukopenia in addition to pancytopenia and 2 (1.0%) developed pancytopenia. Leukopenia developed in 11 days to 14 years after OXC administration and was more frequent in males than in females (male vs. female, 9 vs. 1; Fisher exact test, P<0.05). Of the eight patients with leukopenia alone, 7 continued OXC treatment; 6 improved without intervention; 1 was lost to follow-up; and 1 received a reduced OXC dose, who improved after intervention. Pancytopenia developed within 2 months of initiation of OXC treatment. Both patients initially continued OXC. One improved within 1 month and continued treatment with OXC, but the other showed progression of the side effect, leading to the discontinuation of OXC and subsequent improvement within 1 month. There were no significant differences in the ages of the patients, OXC dose, and duration of OXC treatment between patients with and without these side effects of OXC (P >0.05, t -test).ConclusionOXC-induced leukopenia is not rare and may result in pancytopenia. Patients being treated with OXC should be regularly monitored for abnormal complete blood count profiles.

Another Assessment of Fat Degeneration of Retracted Supraspinatus Muscle.

BackgroundThe purpose of this study was to assess the relevance of preoperative magnetic resonance imaging (MRI) evaluation by occupation ratio (OR) at maximum diameter of supraspinatus muscle.MethodsPatients from the Inje University Sanggye Paik Hospital who received rotator cuff repair and underwent pre- and postoperative MRI were selected as subjects of this study. On T1-weighted MRIs, OR of fat and muscle at Y-shaped view, OR at a location on supraspinatus muscle where its diameter was maximum on coronal view, and pre- and postoperative Goutallier Classification and changes in the tangent sign were measured. Statistical significance of postoperative OR was assessed regarding time from symptom onset to surgery, size of rotator cuff tear, preoperative OR, and the difference between ORs measured at maximum diameter of supraspinatus muscle and Y-shaped view.ResultsPreoperative OR at Y-shaped view was 52.28 ± 8.57 (32.5–65.3). Preoperative OR difference between maximum diameter and Y-shaped view was 13.76 ± 10.51 (2.38–42.04), and Pearson correlation coefficient was 0.604 (p=0.001). Postoperative OR at Y-shaped view was 63.77 ± 9.35 (37.3–76.1). Pearson correlation coefficient of pre- and postoperative Goutallier Classification was -0.579 (p=0.002) and Pearson correlation coefficient of the postoperative difference between ORs measured at maximum diameter of supraspinatus muscle and Y-shaped view was -0.386 (p=0.047).ConclusionsFatty degeneration of supraspinatus muscle in rotator cuff tear patients should be evaluated not only in the conventional Y-shaped view, but also at location of maximum diameter of supraspinatus muscle to establish patients’ therapeutic plan.

Predictive Factors Affecting the Clinical Course of Patients With Diverticulitis: Who Needs Hospital Management?

PurposeThe aim of this study is to determine the predictable factors that affect the clinical course, especially the hospital stay, the operation performed, and to determine factors that will be helpful in deciding whether in-hospital or outpatient treatment is appropriate.MethodsWe retrospectively collected medical data for patients who had been diagnosed with acute diverticulitis at Inje University Sanggye Paik Hospital between January and December 2016. In total, 117 patients were enrolled in this study. We examined clinical factors, including age, sex, body mass index, pain, body temperature, white blood cell count, C-reactive protein, nil per os (NPO) time, hospital duration, computed tomography (CT) findings, location of diverticulitis, operation performed, and presence of comorbidity (e.g., hypertension and diabetes mellitus).ResultsIn the multivariate analysis, the statistically significant factor related with hospital duration was the presence of perforation on the CT scan (P < 0.001). Longer NPO time was related with pain score (>7) (P = 0.011). Operations were mainly performed in patients with left-sided colonic diverticulitis (P = 0.012).ConclusionWe suggest a perforation finding on the CT scan, a severe pain score at least above 7 on a numeric rating pain scale, and a left-sided lesion are absolute indications for in-hospital management.

Utility of serum eosinophil-derived neurotoxin (EDN) measurement by ELISA in young children with asthma

BackgroundThis study was done to compare the efficacy of a recently developed eosinophil-derived neurotoxin (EDN) ELISA kit (“BioTracer™ K® EDN ELISA Kit”) to a commercially available EDN ELISA kit (“MBL EDN ELISA Kit”) and demonstrate the usefulness of serum EDN measurement in young asthmatic children. MethodsForty-eight children with physician-diagnosed asthma (Asthma group) and 31 age-matched normal controls (Control group) were recruited from the Asthma and Allergy Center at Inje University Sanggye Paik Hospital, Seoul, Korea from January 2010 to September of 2012. EDN levels in each serum specimen were measured 2 times using the: 1) BioTracer™ K® EDN ELISA Kit and 2) MBL EDN ELISA Kit at the Inje University Sanggye Paik Hospital laboratory. EDN level measurements in each serum specimen were compared. ResultsEDN measurements from the BioTracer™ K® EDN ELISA Kit correlated well with those from the MBL EDN ELISA Kit: r = 0.9472 at the Inje University Sanggye Paik Hospital laboratory. These r values were considered both clinically relevant (i.e., r > 0.85) and statistically significant (p < 0.0001). EDN measurements from both kits positively correlated with asthma symptom severity (p < 0.0001). No serious adverse events occurred during the study. ConclusionsThe BioTracer™ K® EDN ELISA Kit was accurate and useful in measuring EDN levels in young asthma patient serum. Because of our kit's distinct advantages and utility, we suggest this kit can be used for the timely diagnosis, treatment, and monitoring of asthma in asthma patients of all ages, especially those too young to perform pulmonary function tests.

Henoch-Schonlein Purpura in Children Hospitalized at a Tertiary Hospital during 2004-2015 in Korea: Epidemiology and Clinical Management.

PurposeTo investigate the epidemiology, clinical manifestations, investigations and management, and prognosis of patients with Henoch-Schonlein purpura (HSP).MethodsWe performed a retrospective review of 212 HSP patients under the age of 18 years who were admitted to Inje University Sanggye Paik Hospital between 2004 and 2015.ResultsThe mean age of the HSP patients was 6.93 years, and the ratio of boys to girls was 1.23:1. HSP occurred most frequently in the winter (33.0%) and least frequently in the summer (11.3%). Palpable purpura spots were found in 208 patients (98.1%), and gastrointestinal (GI) and joint symptoms were observed in 159 (75.0%) and 148 (69.8%) patients, respectively. There were 57 patients (26.9%) with renal involvement and 10 patients (4.7%) with nephrotic syndrome. The incidence of renal involvement and nephrotic syndrome was significantly higher in patients with severe GI symptoms and in those over 7 years old. The majority of patients (88.7%) were treated with steroids. There was no significant difference in the incidence of renal involvement or nephrotic syndrome among patients receiving different doses of steroids.ConclusionIn this study, the epidemiologic features of HSP in children were similar to those described in previous studies, but GI and joint symptoms manifested more frequently. It is essential to carefully monitor renal involvement and progression to chronic renal disease in patients ≥7 years old and in patients affected by severe GI symptoms. It can be assumed that there is no direct association between early doses of steroids and prognosis.

Prognostic factors of neurological outcomes in late-preterm and term infants with perinatal asphyxia.

PurposeThis study aimed to identify prognostic factors of neurological outcomes, including developmental delay, cerebral palsy and epilepsy in late-preterm and term infants with perinatal asphyxia.MethodsAll late-preterm and term infants with perinatal asphyxia or hypoxic-ischemic insults who admitted the neonatal intensive care unit of Inje University Sanggye Paik Hospital between 2006 and 2014 and were followed up for at least 2 years were included in this retrospective study. Abnormal neurological outcomes were defined as cerebral palsy, developmental delay and epilepsy.ResultsOf the 114 infants with perinatal asphyxia, 31 were lost to follow-up. Of the remaining 83 infants, 10 died, 56 had normal outcomes, and 17 had abnormal outcomes: 14 epilepsy (82.4%), 13 cerebral palsy (76.5%), 16 developmental delay (94.1%). Abnormal outcomes were significantly more frequent in infants with later onset seizure, clinical seizure, poor electroencephalography (EEG) background activity, lower Apgar score at 1 and 5 minutes and abnormal brain imaging (P<0.05). Infants with and without epilepsy showed significant differences in EEG background activity, clinical and electrographic seizures on EEG, Apgar score at 5 minutes and brain imaging findings.ConclusionWe should apply with long-term video EEG or amplitude integrated EEG in order to detect and management subtle clinical or electrographic seizures in neonates with perinatal asphyxia. Also, long-term, prospective studies with large number of patients are needed to evaluate more exact prognostic factors in neonates with perinatal asphyxia.

Changes in Choroidal Thickness in Branch Retinal Vein Occlusion

Purpose: To compare the choroidal thickness of a branch retinal vein occlusion (BRVO) lesion and that of other areas in the eyes. Methods: Patients who visited the Ophthalmologic Clinic of Inje University Sanggye Paik Hospital for BRVO between March 2015 and October 2015 were reviewed retrospectively. We performed basic ophthalmologic exam and enhanced depth imaging optical coherence tomography in 48 eyes of 24 patients with BRVO. The choroidal thickness was compared in a total of 4 places, the branch retinal vein occlusion lesion, the symmetric site in the same eye, and the equivalent sites in the fellow eye by paired t-test. All measurements were performed by 2 independent observers. Results: Choroidal thickness had strong inter-observer correlation. Choroidal thickness of the BRVO lesion was significantly thicker than that in the symmetric site of same eye, the equivalent site of lesion, and the equivalent site of the symmetric site to lesion in the fellow eye. Conclusions: Choroidal thickness in acute BRVO lesions was thicker than choroidal thickness in other areas of the eyes. It is thought that both hydrostatic pressure and the effects of vascular endothelial growth factor influence choroidal thickness in the acute phase of BRVO. J Korean Ophthalmol Soc 2016;57(8):1222-1227

Risk Factors of Cystic Periventricular Leukomalacia in Preterm Infants with Gestational Ages of Less Than 32 Weeks according to Gestational Age Group

Purpose: The aim of the study was to determine the incidence of cystic periventricular leukomalacia (PVL) and identify the risk factors for cystic PVL in preterm infants with gestational age (GA) less than 32 weeks according to gestational age group. Methods: The medical records and brain imaging were reviewed for preterm infants with less than 32 weeks GA who lived more than 4 weeks and admitted to the neonatal intensive care unit at Inje University Sanggye Paik Hospital from January 2009 to June 2015. We determined the incidence and the risk factors for the development of cystic PVL in preterm infants according to GA group. Results: Incidence of cystic PVL was 15.1% (26/172). Multivariate analysis showed that intraventricular hemorrhage (IVH) [P=0.006, odds ratio (OR) 5.478, 95% confidence interval (CI) 1.641-18.285), oxygen uses over 28 days (P=0.025, OR 3.086, 95% CI 1.152-8.264), and NEC (P=0.042, OR 3.731, 95% CI 1.047-13.333) were independent risk factors for the developmental of cystic PVL. Subgroup analysis showed that pregnancyinduce hypertension and IVH were independent risk factors in preterm infants with GA of less than 28 weeks. Also, oxygen uses over 28 days and culture proven sepsis were independent risk factors in preterm infants with GA of 28 +0 -31 +6 weeks. Conclusion: These results suggest that pregnancy-induce hypertension and IVH may increase the risk for the subsequent development of cystic PVL in preterm infants with GA of less than 28 weeks, and oxygen uses over 28 days and culture proven sepsis may increase in preterm infants with GA of 28 +0 -31 +6 weeks.

Mo1403 Gastrojejunal Tube Feeding: a Potential New Treatment for Sphincter of Oddi Dysfunction Type III (SODPPP) Patients With Severe Post-Prandial Pain

Mo1403 Gastrojejunal Tube Feeding: a Potential New Treatment for Sphincter of Oddi Dysfunction Type III (SODPPP) Patients With Severe Post-Prandial Pain Tae Joo Jeon*, Byung Kyu Park, Laith H. Jamil, Simon K. Lo Cedars-Sinai Medical Center, Los Angeles, CA; Division of Gastroenterology, Inje University Sanggye Paik Hospital, Seoul, Korea (the Republic of); Division of Gastroenterology, National Health Insurance Service Ilsan Hospital, Goyang-si, Korea (the Republic of) Background: ERCP and Sphincterotomy had been widely used to evaluate and treat the Sphincter of Oddi dysfunction (SOD) type III condition until their benefit was disputed by the recent EPISOD study. Unfortunately, there is no proposed alternative to manometry-directed sphincterotomy at the present moment. Aim: To determine if gastrojejunal tube (PEGJ) feeding may have therapeutic benefits for SODPPP patients. Method: All SODPPP patients without sustained improvement after bi-ductal sphincterotomies were offered percutaneous endoscopic gastrostomy-jejunostomy tube (PEGJ) feeding. SOD III was defined by pancreatic or biliary type pain without a dilated duct or abnormal pancreatic or liver tests. PEGJ was placed in the usual fashion and inserted into the proximal antrum. PEGJ’s tip location in the proximal jejunum was confirmed with fluoroscopy. Strict NPO was kept within the first 4-6 weeks. PEGJ feeding was maintained as long as these patients needed feeding to provide nutrition or pain relief. Results: Nine highly symptomatic SODPPP patients underwent PEGJ tube insertion for feeding. All were female. Median age was 41 years old (25-53). Median duration of SOD symptoms was 27 months (22-96). All but one patient had elevated pancreatic or biliary sphincter pressure. Only one patient did not have a prior cholecystectomy. Eight patients had sphincterotomy and experienced pain improvement for a short duration (median; 8 weeks) before recurrence of symptoms. The mean duration of tube feeding was 5.08 months (S.E 1.83). Seven patients reported dramatic pain improvement. Six had less number of hospitalizations or ER visits after PEGJ feeding. Five patients were satisfied with the procedure and could return to normal daily activities while on tube feeding. Only 1 patient was not satisfied because of the lack of effectiveness. The demand of analgesics was decreased in 5 patients. Complications included prolonged tube insertion site pain-2, pinkish drainage-1, and nausea-1. Persistent insertion site pain was the reason for tube removal on day 7 in on patient. There were 4 tube malfunctions (J-tube dislodgement-2, tube coiling-1, broken tube-1). PEGJ had since been removed in 5 patients (no benefit-1, dramatic clinical improvement-1, husband’s disagreement-1, unsightly catheter-1, insertion site pain1). Interestingly, those 2 patients who had tube removal due to personal issues eventually requested PEGJ re-insertion. Conclusion: PEGJ feeding may have therapeutic benefits for the subset of highly symptomatic SOD III patients with postprandial pain exacerbations. It may represent a breakthrough in the management of these patients and should be confirmed by a larger, prospective clinical study.

Allergic reaction to recombinant human insulin

Seong Jin Choi, Min Kwan Kwon, Moon Park, Soo Ya Bae, Hyun Ho Oh, Jong Ho Lee, Ji In Moon, Chan Sun Park, Jong Chul Won, Kyung Soo Ko, Byoung Doo Rhee, Jung Min Kim Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul; Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

The relationship between primary headache and constipation in children and adolescents.

PurposeMany patients presenting with headache also complain of constipation; the relationship between these two symptoms has not been explored in detail. The aim of this study was to investigate the association between primary headache and constipation.MethodsThis retrospective study included all children who attended the Inje University Sanggye Paik Hospital complaining of headache, and who had been followed up for at least 100 days. Patients were divided into 2 groups: group A, in whom the headache improved after treatment for constipation, and group B, in whom headache was not associated with constipation.ResultsOf the 96 patients with primary headache, 24 (25.0%) also had constipation (group A). All 24 received treatment for constipation. Follow-up revealed an improvement in both headache and constipation in all patients. Group B contained the remaining 72 children. Comparison of groups A and B indicated a significant difference in sex ratio (P=0.009, chi-square test). Patients with probable tension-type headache were more likely to be in Group A (P=0.006, chi-square test).ConclusionResolution of constipation improves headache in many patients diagnosed with primary headache, especially those with probable tension-type headache. We suggest that either constipation plays a key role in triggering headache, or that both constipation and headache share a common pathophysiology.

Optimal timing of endoscopic clipping for determining the resection line for laparoscopy-assisted distal gastrectomy.

Pre-operative endoscopic clipping for determining the resection line in patients with early gastric cancer has been used safely, and its efficacy has been demonstrated. However, the optimal timing of endoscopic clipping for determining the resection line in early gastric cancer patients undergoing laparoscopy-assisted distal gastrectomy has not been investigated. A retrospective analysis of 92 patients with early gastric cancer who underwent gastric resection after endoscopic clipping at Inje University Sanggye Paik Hospital (Seoul, Korea) was performed. We analyzed the clinical and endoscopic features of patients, number of clips, time from clipping to surgery, and number of patients showing detachment of clips from the gastric wall before surgery. Patients were categorized according to the following two groups: group A included patients whose clips were applied within one day before surgery and group B included patients whose clips were applied more than one day before surgery. Of the 92 patients, 56 were included in group A and 36 were included in group B. In 11 patients (12.0%, five in group A and six in group B, p=0.329), the clips were detached from the gastric wall before surgery. The mean time from clipping to surgery did not differ significantly between the detached and non-detached groups (11 patients, mean 4.6±4.6 days vs. 81 patients, mean 3.0±4.0 days, p=0.227). The timing of endoscopic clipping for localization of tumors in early gastric cancer patients undergoing gastrectomy is not important for determining the resection line.

Radiological Assessment for Morphological Diversity of Distal Fibula

1 Copyright c 2014 The Korean Fracture Society. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Received May 14, 2013 Revised August 8, 2013 Accepted December 8, 2013 Address reprint requests to: Su-Young Bae, M.D., Ph.D. Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, Dongil-ro 1342, Nowon-gu, Seoul 139-707, Korea Tel: 82-2-950-1399ᆞFax: 82-2-950-1398 E-mail: youngos@paik.ac.kr 원위 비골의 형태학적 다양성의 방사선 계측 결과

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

241 Copyright c 2013 The Korean Fracture Society. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Received April 24, 2013 Revised June 11, 2013 Accepted July 27, 2013 Address reprint requests to: Yong-Woon Shin, M.D. Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul 139-707, Korea Tel: 82-2-950-1032ᆞFax: 82-2-934-6342 E-mail: woonysos@paik.ac.kr 관절 함몰을 동반한 외과 및 양과 경골 고평부 골절에서 후외측 관절 함몰의 위험 인자 및 후외측 골편의 양상 분석

Comparative Study of a Single-Incision Laparoscopic and a Conventional Laparoscopic Appendectomy for the Treatment of Acute Appendicitis

PurposeFor the treatment of acute appendicitis, a conventional laparoscopic appendectomy (LA) has been widely performed. Recently, the use of single incision laparoscopic surgery (SILS) is increasing because it is believed to have advantages over conventional laparoscopic surgery. In this study, we compared SILS and a conventional LA.MethodsWe analyzed the 217 patients who received laparoscopy-assisted appendectomies between August 2010 and April 2012 at Inje University Sanggye Paik Hospital. One hundred-twelve patients underwent SILS, and 105 patients underwent LA. For the two groups, we compared the operation times, postoperative laboratory results, postoperative pain, hospital stay, and postoperative complications.ResultsThe patients' demographics, including body mass index, were not significantly different between the two groups. There were 6 perforated appendicitis cases in the SILS group and 5 cases in the LA group. The mean operative time in the SILS group was 65.88 ± 22.74 minutes whereas that in the LA group was 61.70 ± 22.27 minutes (P = 0.276). There were no significant differences in the mean hospital stays, use of nonsteroidal antiinflammatory drugs, and wound infections between the two groups.ConclusionPostoperative pain, complications and hospital stay showed no statistically significant differences between the SILS and the LA groups. However, our SILS method uses a single trocar and two latex tubes, so cost savings and reduced interference during surgery are expected.

Comparison of Clinical Manifestation and Laboratory Findings between H1N1 and Influenza B Infection

Purpose: Influenza virus is one of the most important viruses that cause the respiratory infection seasonally. In April 2009, H1N1 was detected in America and Mexico and then there was pandemic in Korea. We investigated the difference of clinical and laboratory findings between the infections of H1N1 and Influenza B. Methods: We have retrospectively studied the patients under age of 15 years who visited Inje University Sanggye Paik Hospital from August 2009 to April 2010. Evaluation for influenza infection was performed by rapid antigen test or multiplex reverse transcriptase polymerase chain reaction. Complete blood count with differential counts, C-reactive protein and chest X-ray were checked. Results: Enrolled patients were 2,226 in H1N1-infected group and 288 in influenza B-infected group. Seasonal variation was that H1N1 in autumn and winter but influenza B in spring. The male-to- female sex ratio was same as 1.23 in each group. The mean age of H1N1-infected group was higher than influenza B-infected group (P<0.001). Fever was developed similarly in both groups (P=0.114). However, cough, sputum, rhinorrhea, vomiting, diarrhea, and headache were more prevalent in influenza B infection compared to H1N1 infection (P<0.001). Pneumonia development and admission rate were higher in influenza B infection compared to H1N1 infection (P<0.001, respectively). Conclusion: Although H1N1 infection spread rapidly, H1N1 caused not so severe symptoms than influenza B. Because of the possibility that influenza epidemic will develop repeatedly in the future, we need to evaluate more about different characteristics depending on the virus subtype and prepare for them.