We report the good results of two stage treatment in split depression type pilon fractures. A retrospective study of 9 cases among the 12 cases of split depression type pilon fractures from January 2009 to December 2015, who underwent two stage treatment of pilon fractures with minimum 24 months follow-up. And mean follow-up periods are 29 (24-41) months. In the first stage of the operation, reduction of articular surface using minial incision and external fixation were performed. As soft tissue heals, locking compression plate fixation was done with MIPO (Minimally Invasive Plate Osteosynthesis) technique. Radiographic evaluation was graded by the criteria of Burwell and Charnley. And functional assessment of ankle were evaluated by American Orthopaedic Foot and Ankle Society ankle-hindfoot score. Fractures were united in all cases within 17 (12-24) weeks. Radiologic results were showed anatomical reduction in 8 cases and the mean AOFAS score is 87.8 (80-96). The mean range of ankle motion is 44 degree. There are one superficial wound complications and 3 cases of ankle osteoarthritis. Two stage treatment of split depression type pilon fractures is one of the good treatment methods, because of definitive second stage operation is more easier after first stage opertation designed to get early anatomical reduction, and shows good radiological and clinical outcomes.

We evaluated the radiologic, clinical results and the complications of minimally invasive percutaneous medial plate fixation in distal tibial metaphyseal fracture. From January 2010 to December 2016, 31 patients with distal tibial fracture treated by medial plate fixation using Minimal Invasive Plate Osteosynthesis (MIPO) technique were analyzed. The duration of followup was more than 1 year. We evaluated clinical results by IOWA ANKLE rating system, union time by simple X-ray and complication. The bone union was achieved in all cases at average 16.7 weeks. Average IOWA ANKLE rating score was 90.3 point. At the last follow-up, there was no non-union, angular deformity more than 5 degrees or infection. We concluded that minimal invasive percutaneous medial plate fixation for distal tibial metaphyseal fractures is a safe and useful method if there is no medial wound problem, and it is important to pay close attention to prevent angular deformity during surgery.

Transcutaneous bilirubinometer(TcB) has been performed in patients who visited the outpatient clinic with jaundice, and the major factors and natural course of long-term hyperbilirubinemia were investigated. From January 2011 to December 2016, a review was made based on 61 electronic medical records that conform to the conditions of patients who visited outpatient clinic with neonatal jaundice. TcB values were measured to confirm the natural progress data of jaundice in the study sub-jects. We collected information on gestational age, birth weight, mode of delivery, Apgar score, patient and maternal blood type, feeding type and perinatal problems at outpatient visits. Feeding type was classified into breastfeeding, formula feed-ing, and mixed feeding. Total of 61 patients, 31 were born by vaginal delivery, and 30 were delivered by Caesarean section. 32 patients were male, and 29 were female. The mean gestational age was 38.07 ± 1.52 weeks and the mean birth weight was 3.04 ± 0.45 kg. Most of the infants were supplied by breastfeeding (39.3%) or mixed feeding (44.3%). The TcB values of the patients ranged from 10.0 to 19.0 mg/dL, when they visited for the first time with jaundice. The mean age was 11.64 ± 7.52 days and the mean body weight was 3.27 ± 0.66 kg. The range of TcB values at the next outpatient visit was 7.0 to 18.0 mg/dL. Initially measured TcB value was divided by 15.0 mg/dL and analyzed using Pearson Chi-square method, and the TcB value was significantly lower only in the delivery through Caesarean section (p=0.03). The changes in TcB values tend-ed to decrease during the follow-up period. The proportion of breast-feeding or mixed breast milk was slightly higher at 90.6% in the previous method of breastfeeding compared to those in the group with higher TcB values (p=0.009) (Table 3). When patients with mild jaundice visit the outpatient clinic and check the birth method and the main feeding method at the time of the visit, it is considered to be possible to reduce the number of examinations and to provide accurate information to the parents, thereby reducing the excessive interruption of breastfeeding.

It was intended to evaluate whether it would be helpful to perform implant procedures in asymptomatic patients. Patients who underwent implant removal after fracture surgery carried out at chosun university hospital from January 1, 2011 to December 31, 2014. The average follow up period after the implant removal was 21.9 months (12-52 months), with 69 men and 39 women. A short form-36 questionnaire was used to compare the one day before and 12 months after implant removal surgery. After implant removal, the physical condition of the patient improved statistically significantly, but the improvement in mental health showed a slight increase, but there was no statistical significance. Implant removal in asymptomatic patients does not necessarily help the quality of their lives. It would be desirable to make a decision through sufficient consultation with a patient rather than a routine decision.

Various treatment modalities for vocal process granuloma include simple observation, antireflux therapy, voice therapy, botulinum injection, and steroid inhalation, but recurrence rates are high. Surgical excision can be considered in refractory and recurrent cases. In this study, the authors report the effectiveness of surgical excision using a carbon-dioxide laser with topical Mitomycin-C for the treatment of recurrent vocal process granuloma. The study included 28 patients with recurrent vocal process granuloma despite various treatments. The vocal process granuloma was excised using a carbon-dioxide laser and 1 cc of 0.4 mg/mL topical Mitomycin-C was applied for 4 minutes. Follow-up duration was 13-33 months (mean, 21.8 months). Of 28 patients, 19 (67.9%) were cured. Two who received surgical excision as a first-line treatment, 2 who used a steroid inhaler as a first-line treatment, and 5 who previously took antireflux medication as initial treatment showed recurrence. Surgical excision using a carbon-dioxide laser with topical application of Mitomycin-C is considered effective for recurrent vocal process granuloma.

This study was designed to compare re-epithelization rate/feature of conjunctival epithelial cell on amniotic membrane and anatomical difference between normal amniotic membrane and de-epithelial amniotic membrane. Human conjunctival tissue obtained while cataract operation were used in this study. Primary cultured human conjunctival epithelial cell and fibroblast were incubated on intact amniotic membrane and de-epithelialized amniotic membrane. After incubation for 3, 5 and 7 days, re-epithelization rate was analyzed using cell tracker and microscopic feature was examined using methylene blue and hematoxylin- eosin stain. For cell marker analysis, cytokeratin 14 and vimentin antibody immunofluorescence stain were used. Clearance rate of epithelial cells on amniotic membrane using trypsin was better than using 25% alcohol. The results of reepithelization rate using cell tracker, HaCaT, conjunctival firbroblast, and epithelial cell were rapidly incubated on deepithelialized amniotic membrane. Wound healing and re-epithelization were more rapidly induced on de-epithelialized amniotic membrane on permanent amniotic membrane graft.

The aim of this study was to investigate the factors associated with cerebrospinal fluid (CSF) pleocytosis in pediatric enteroviral meningitis. A retrospective analysis of the medical records was performed in 281 patients under 18 years of age who were diagnosed with enteroviral meningitis by reverse transcription-polymerase chain reaction (RT-PCR) at Kwangju Christian Hospital from January to December 2016. Clinical symptoms and laboratory findings were compared according to the presence or absence of CSF pleocytosis. 112 children (39.9%) did not have CSF pleocytosis. When we compared the group of meningitis without pleocytosis and the group with pleocytosis, age were younger (< 2years), and the interval between onset of symptoms and the time of lumbar puncture was shorter (<24 hours), peripheral white blood cell counts were lower, but C-reactive protein (CRP) was higher in the group of meningitis without pleocytosis. Enteroviral meningitis should not be excluded even if CSF pleocytosis is not seen in patients. And enterovirus CSF RT-PCR should be performed with high suspicion in children younger than 2 years.

The aim of this study was to determine the effect of acute respiratory viral infection on Kawasaki disease. From July 2016 to June 2018, among the patients who underwent respiratory virus screening at the Kwangju Christian Hospital, those diag-nosed 88 patients with Kawasaki disease were enrolled in this study. The effects of acute respiratory viral infection on Ka-wasaki disease were compared according to whether 2nd intravenous immunoglobulin (IVIG) treatment was administered or not, and whether coronary artery complications occurred. Respiratory virus was detected in 44 out of 88 patients. 2nd IVIG treatment rates were 16% (n=7) and 27% (n=12) in the virus positive group and the virus negative group, respectively (p>0.05). The incidence of coronary artery complications was 11% (n=5) and 25% (n=11) in the virus positive group and the virus negative group, respectively (p>0.05). There was no statistically significant correlation between the 2nd IVIG admin-istration and coronary artery complications following the detection of respiratory virus in patients with Kawasaki disease. We think it is necessary to actively study the effects of acute respiratory viral infection on Kawasaki disease through large-scale studies of multiple centers in the future.

There are very few reports and limited evidence that premedication with steroids decreases early recurrence of ileocolic intussusception after a successful hydrostatic reduction. The purpose of this study was to examine the role of steroids in decreasing early recurrence of idiopathic intussusceptions. A retrospective review of children that underwent successful hydrostatic reduction was conducted. Two groups were identified: group 1 (38 cases) that received intravenous methylprednisolone (1 mg/kg/dose) on diagnosis or immediately after the reduction maneuver, and group 2 (59 cases) were not given. There were 60 boys and 37 girls ranging in age from 6 to 84 months. There were no statistical differences between the groups regarding age, sex, duration of symptoms and laboratory findings on admission. There was no significant difference (p=0.76) in the rate of early recurrent intussusception between the steroid group (15.8%, 6/38) and the non-steroid group (13.6%, 8/59). We found that premedication of children with idiopathic intussusception with methylprednisolone did not decrease early recurrence of idiopathic intussusceptions.

Neutropenia is a common finding in pediatrics with 1.5-9% of children (without malignancy) presenting to hospital found incidentally to be neutropenic. The majority of these pediatric patients with transient neutropenia present with infectious symptoms with an infectious agent proven in approximately 50% of cases, most commonly viral in nature. 270 children, who were diagnosed with influenza infection at the Chosun University Hospital during a 8-year period, were included in the study. Clinical and laboratory feature were analyzed. 46 patients (17%) were neutropenic with no identifiable cause other than the influenza. The incidence of leukopenia was significantly higher in association with influenza B than influenza A (24.0% vs 12.3%). Period from the onset of fever to lymphopenia was significantly longer in association with neutropenia (+) group than neutropenia (−) group. Recovery period of neutropenia was mean 4 days (range 3-7 days). We conclude that mild, transient neutropenia is common among patients with influenza infection and advise that it should not cause alarm or invite specific investigation unless severe or prolonged.

Coronary artery complications are the most severe complications in Kawasaki disease (KD). Its cause is unclear but superantigens are considered to influence KD. This study aimed to determine whether coronary artery complications and level of Nterminal pro-brain natriuretic peptide (NT-proBNP) are associated with Mycoplasma pneumoniae (MP) in patients with KD. We studied 142 pediatric patients diagnosed with KD. MP immunoglobulin M (IgM) antibody examination was conducted. All patients underwent echocardiography, and coronary artery dilatation was defined as a coronary Z-score >2.0. We also evaluated their NT-proBNP findings. The independent t-test and Pearson chi-squared test were used to analyze betweengroup differences; a p-value <0.05 was considered statistically significant. Forty children were MP IgM positive. MP IgMpositive patients were older than MP IgM-negative patients. There was no significant difference in the clinical manifestations between the groups. Comparison of the mean Z-score of the coronary artery revealed that only the Z-score of the left anterior descending artery was significantly different between the groups. However, the number of patients with coronary artery dilatation was not significantly different between the groups. Our findings demonstrated no relationship between MP infection and coronary artery dilatation or NT-proBNP levels in patients with KD.

Proximal femoral fractures are common in older adults. Zimmer natural nail (ZNN, Cephalomedulary Asia; Zimmer, Warsaw, IN, USA) known as useful in immobilizing the fractures of the proximal femoral fractures, have a critical complications like femoral head perforation and cut through in pelvic bone. We report a case that the femoral head perforation by the hip screw occured within 2 months of the operation, and 8 months after operation, the hip screw is completely separated from the metal body and cut through the pelvis.

Monitored anesthesia care (MAC) has been described as a specific anesthesia service for diagnostic or therapeutic procedures performed under local anesthesia along with sedation and analgesia, titrated to a level preserving spontaneous breathing and airway reflexes. Radio-frequency ablation (RFA) is a kind of methods to remove benign thyroid nodules (BTNs) by inducing the irreversible injuries with the use of an ultrasound-guided RF electrode placed inside the nodules. A 37 years old, 157 cm, 81 kg woman underwent RFA of BTNs under MAC. We present with a case report where laryngospasm under MAC was resolved by the use of positive pressure ventilation without any complications.

Laparoscopy is frequent used to assist the diagnosis and treatment of various surgical department. However, complications associated with the procedure including pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumopericardium, and air embolism have been reported. Incidence of subcutaneous emphysema during extraperitoneal laparoscopic surgery has been reported 99%. We report the case of a 76 years old female patient who had subcutaneous emphysema and hypercarbia during retroperitoneal laparoscopic nephrectomy. After developing hypercapnia, we increased the minute ventilation and lowered the CO2 gas insufflation pressure. Until the end of the operation, the patient’s vital signs did not change and end tidal CO2 was not increased any more.

Several bacterial species from the Burkholderia cepacia complex (Bcc) are opportunistic pathogens that lead to infections in patients with underlying lung disease, such as cystic fibrosis, as well as in immunocompromised individuals. Included in the Bcc, Burkholderia contaminans is an emerging pathogen in cystic fibrosis patients. However, this is the first report case of sepsis due to Burkholderia contaminans without cystic fibrosis in child. And we report that successful treatment of sepsis due to Burkholderia contaminans in the child, through antibiotic therapy.