• 대한족부족관절학회지
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• 제17권1호
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• pp.34-39
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• 2013

Purpose: To evaluate the effectiveness of intraoperative stress test for diagnosis of occult Lisfranc injury. Materials and Methods: Between April 2009 and October 2012, 21 patients with occult Lisfranc injuries underwent intraoperative stress test and internal fixation. There were 11 males and 10 females with an average age of 45.3 years (range, 23~79 years). Injuries were caused by traffic accident in 10 cases, indirect force (twisting injury) in 8 cases, and crush in 2 cases, falling from a height in 1 case. Unstable injuries on stress radiograph in occult injury of Lisfranc joint were treated by open reduction or closed reduction and fixation with cannulated screw or K-wire. Radiological evaluation was assessed according to preoperative and postoperative diastasis between $1^{st}$ and $2^{nd}$ metatarsal base. Results: Assoicated injuries were 9 cases of metatarsal fractures, 6 cases of cuneiform fractures and 6 cases of both metatarsal and cuneiform fractures. Medial and middle column fixation was in 13 cases, and three columns fixation was in 8 cases. Initial diastasis between $1^{st}$ and $2^{nd}$ metatarsal base was 2.8 mm (1.3~4.7 mm) on AP radiograph and postoperative diastasis between $1^{st}$ and $2^{nd}$ metatarsal base was 1.2 mm (0.5~2.4 mm) on AP radiograph. Conclusion: Even there is no sign of clear Lisfranc injury, it is necessary to pay attention and give evaluation on circumstances of occult Lisfranc injuries with metatarsal or cuneiform fractures. Intraoperative stress test is helpful to diagnose an occult Lisfranc injury. For unstable injuries on stress radiographs of occult Lisfranc joint injury, operative treatment with open or closed reduction and internal fixation is useful method.

• 대한관절경학회지
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• 제5권2호
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• pp.124-130
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• 2001

목적 : 급성 족 관절 골절에서 족 관절경을 이용하여 관절내 잠재 손상의 관찰 및 발생을 예측하기 위한 인자를 알아보고자 하였다. 대상 및 방법 : 50명의 전위가 심하지 않은 급성 족 관절 환자 50명을 대상으로 전향적인 방법으로, 족 관절경을 시행하여 관절내 각 부위에서의 잠재 손상의 종류를 조사하였으며, 족 관절 골절을 Lauge-Hansen, AO 및 골절의 해부학적 위치에 따라 분류하여 특정한 유형에서 잠재 손상의 빈도가 증가되는가를 관찰하였다. 결과 : 50례의 족 관절 골절 중 37례에서 잠재 손상이 관찰되었으며, 전위된 골편을 포함한 유리체가 25례에서 관찰되었고, 31례에서 다양한 종류의 연골 손상이 관찰되었다. 방사선 사진상 관찰되지 않는 잠재 골절이 3례에서, 전하 경비 인대의 경골 부착부에서의 견열 골편이 6례에서 각각 관찰되었다. 환자의 연령, 성별, 수상기전 및 족 관절 골절의 여러 유형과 잠재 손상 발생 빈도와의 연관성은 관찰되지 않았다(p>0.05). 결론 : 단순 족 관절 골절에서 다양한 종류의 잠재 손상이 관찰되었으며, 족 관절경은 잠재 손상의 관찰뿐만 아니라 그 치료에도 매우 유용한 방법으로 사료되었으나, 족 관절 골절에서 잠재 손상의 발생을 정확히 예측하기는 어려웠다.

• Journal of Trauma and Injury
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• 제28권3호
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• pp.91-97
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• 2015

Purpose: Occult hip fracture is not evident on radiographs and the diagnosis is often missed or delayed. This study was undertaken in order to identify the clinical characteristics and complications of patients with a delayed diagnosis of an occult hip fracture. Methods: We retrospectively reviewed patients with occult hip fracture who had normal findings on initial radiographs, the diagnosis was made on additional studies between August 2006 and February 2012. Patients who were diagnosed as having occult hip fractures at the first visit were categorized as non-delayed group and those who were not diagnosed at the first visit were categorized as delayed group. Results: Non-delayed group included 43 patients (86%). In the remaining 7 patients (delayed group), the diagnosis was delayed by a mean of 9.6 days (range 3~19 days). Patients who were diagnosed with an occult fracture on the initial visit presented later than those with a delayed diagnosis (41/43 .vs. 3/7, p=0.002). Other clinical features were no difference between the two groups. Patients in the delayed diagnosis group were more likely to have fracture displacement (4/7 .vs. 0/43)15patients in non-delayed group (34.9%) needed operative treatment, whereas all delayed patients (100%) needed operative treatment. Conclusion: A delayed diagnosis of occult hip fractures was associated with increased rate of displacement and operation. In patients suspected of having occult hip fractures, additional studies should be recommended.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.125-130
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• 2013

Purpose: This study was undertaken in order to identify the characteristics of patients diagnosed with occult an hip fracture after hip trauma. Methods: We retrospectively reviewed the medical records and radiology reports of all patients who underwent hip skeletal computed tomography (CT) for suspected hip fractures but had normal initial X-rays after hip trauma between August 2006 and January 2012. The variables evaluated included age, gender, body mass index (BMI), accident mechanism, previous fracture, independence, late presentation, ability to bear weight, pain on passive rotation, tenderness of the groin area, diagnosis and treatment. Patients were divided into two groups, with hip fracture (occult hip fracture group) and without hip fracture (no fracture group) to evaluate the characteristics associated with an occult hip fracture. Results: The patients, a total of 139, had a mean age of 58.3 years and included 72 male patients(51.8%). The occult hip fracture group included 43 patients(30.9%). Of those 43, 21 patients(48.8%) had intertrochanteric or trochanteric fractures, 8 patients(18.6%) had femur neck fractures and 14 patients(32.6%) had acetabular fractures. Of the 43, 15 patients(34.9%) needed operative treatment. Age was higher in the occult hip fracture group than it was in the no fracture group($64.4{\pm}19.1$ years vs. $55.5{\pm}23.6$ years, p=0.021). A previous fracture was associated with the presence of a new fracture (p=0.014; OR=3.971, 95% CI=1.314-11.997). Conclusion: Further evaluation of patients who are older or have history of fractures is prudent, even though the initial X-rays are normal.

• 대한족부족관절학회:학술대회논문집
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• 대한족부족관절학회 2008년도 추계학술대회 및 총회
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• pp.16-16
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• 2008

• Childhood Kidney Diseases
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• 제21권1호
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• pp.31-34
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• 2017

Tumor lysis syndrome is a serious complication of malignancy, resulting from the massive and rapid release of cellular components into the blood. Generally, it occurs after initiation of chemotherapy. The onset of spontaneous tumor lysis syndrome (STLS) before anti-cancer treatment is rare and occurs mostly in Burkitt lymphoma and non-Hodgkin's lymphoma. There are only a few case reports in children. Here, we report a case of STLS secondary to T-cell acute lymphoblastic leukemia (ALL), which presented with urinary stone and subsequent acute kidney injury with severe hyperuricemia. Occult malignancy should be considered in case of unexplained acute kidney injury with extreme hyperuricemia.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제1권1호
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• pp.144-147
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• 1998

저자들은 복부 둔상 후에 발생한 담도 단독 협착을 보인 환아에서 수술적인 치료를 대신하여 내시경적 경비담도 배액술과 플라스틱 스텐트 삽입으로 증상의 호전과 2년의 추적관찰에서 재발을 보이지 않고 있는 1례를 경험하여 문헌고찰과 함께 보고하는 바이다.

• Childhood Kidney Diseases
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• 제22권2호
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• pp.52-57
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• 2018

Purpose: Rhabdomyolysis is a metabolic disorder in which the content of damaged muscle cells is released into plasma. Its manifestations include asymptomatic, myalgia, gross hematuria, and complications of acute kidney injury. Because of limited data on rhabdomyolysis in children, we performed this study to determine clinical characteristics of rhabdomyolysis in children. Methods: We retrospectively reviewed the records of patients with rhabdomyolysis who were treated at the Pusan National University Children's hospital from January 2011 to July 2016. The diagnostic criteria were serum myoglobin level of ${\geq}80ng/mL$, exclusive of acute myocardial injury, cardiac arrest, and brain damage. Results: Forty-five patients were enrolled; mean age, $116{\pm}68$ months. Of these, 35 were boys and 10 were girls. Twenty-six patients experienced myalgia and 12 patients showed gross hematuria. Among these, seven patients initially had both myalgia and gross hematuria. The most common causes of rhabdomyolysis were infection, physical exertion, prolonged seizures, metabolic abnormalities, and drug addiction. Acute kidney injury (AKI) was the most common complication, followed by disseminated intravascular coagulation. Thirty-seven patients improved with sufficient fluid supply but two patients underwent hemodialysis due to deterioration of kidney function. Gross hematuria, positive occult blood test, and positive urine protein were more common in patients with AKI than in those without AKI. Conclusions: In children, infection was the most common cause of rhabdomyolysis. Most patients recovered by sufficient fluid therapy. However, in severe cases, especially in patients with underlying kidney disease, hemodialysis may be necessary in the present study.

• Journal of Trauma and Injury
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• 제21권2호
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• pp.91-99
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• 2008

Purpose: Multiple rib fracture (MRF) and a hemopneumothorax accompany with most blunt chest traumas. We aimed to analyze the factors increasing the probability of a hemopneumothorax. In addition, other injuries accompanying MRF were analyzed. Methods: We retrospectively reviewed the medical records of 154 mutiple rib fracture patients who visited our hospital between January 2005 and December 2007. The medical records were reviewed for sex, age, mechanism of injury, location, number of fractures, distance of dislocated rib fragments, and presence of complications. We measured the distance of bony dislocations by using the PACS (Picture Archiving and Communication System). Results: The average number of rib fractures was $3.7{\pm}2.1$, and the number of rib fractures significantly influenced the incidence of a hemothorax (p<0.001). The risk of a hemothorax was increased in a bilateral MRF compared to a unilateral MRF (p=0.027). The distance of dislocated rib fragments influenced the probability of a hemothorax significantly (p=0.018), and subcutaneous emphysema and lung contusion were significantly associated with a pneumothorax (p=0.021, p=0.036). Conclusion: The number of MRFs did not influence the risk for a pneumothorax, but did influence the risk for a hemothorax. The laterality, distance of dislocation, also had an influence on the risk for a hemothorax. Also, subcutaneous emphysema and lung contusion were increased in cases with a pneumothorax. We must consider the possibility of a hemothorax even when the initial chest X-ray shows no evidence of a hemothorax. If a lung contusion is present, then an occult pneumothorax must be considered.

• Journal of Trauma and Injury
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• 제22권1호
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• pp.119-122
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• 2009

Traumatic abdominal wall hernia after blunt abdominal trauma is rare. The prevalence of traumatic abdominal wall hernia in published series is approximately 1%. Recently, by the use of computed tomography has increased the number of occult traumatic abdominal wall hernias (TAWH). A 47-year-old woman presented to the emergency room soon after a traffic accident. She was fully conscious and complained of diffuse, dull, abdominal pain. She had a seat belt on at the time of the accident. Initial computed tomography showed that the lower left abdominal wall had a defect and that a part of the small bowel had herniated through the defect. During the operation, we made an incision at the defect site and confirmed the defect. The defect size was about $15{\times}5cm$. The muscle layers were repaired in layers with absorbable sutures. Prolen mesh was layed down and fixed on the site of the repaired muscle defect. After 6 months, hernia had not recurred, and no weakness of the repaired abdominal wall layers was identified. The patient's postoperative body functions were normal.