BACKGROUND: As anti-retroviral therapy has improved and the life expectancy of patients' with HIV in Korea has increased, an increased number of surgical procedures have been performed in this population. Therefore, in the current study, we investigated the trend in surgery conducted on patients with HIV in our hospital over the last 5 years. METHODS: We retrospectively reviewed the medical records of HIV-infected patients who underwent surgery under general or local anesthesia at our hospital between 2005 and 2010. RESULTS: The total number of surgeries performed in HIV-infected patients in the 5-year period was 95. Of these, 23 (24%) were performed under general anesthesia and 72 (76%) under spinal anesthesia. Anorectal surgery was the most commonly performed surgery (71 cases, 76%). The postoperative complication rate was 5.3% (3 cases of pneumonia and 2 of wound infection), with general anesthesia and time to discharge being identified as contributory factors. Preoperative CD4+ T cell count was not significantly associated with complications. CONCLUSION: This study was the first to analyze the trends in surgical procedures performed in HIV-infected patients in Korea. Our study may be beneficial as a reference for clinicians who manage patients with HIV.
Acquired Immunodeficiency Syndrome ; Anesthesia, General ; Anesthesia, Local ; Anesthesia, Spinal ; Cell Count ; HIV ; Humans ; Korea ; Life Expectancy ; Medical Records ; Pneumonia ; Postoperative Complications ; Retrospective Studies ; Wounds and Injuries

A revision total hip arthroplasty (THA) that anticipated massive bleeding and the need for blood transfusion was scheduled. The patient was a 73-year-old man who had well controlled hypertension. A combined spinal and epidural anesthesia was performed. Dexmedetomidine was administered from the beginning of the arterial and central line catheterization, until the end of the operation. During the 10 hours and 30 minutes surgery, the estimated blood loss was about 7,000 mL, with a total infused red blood cell amount of 14 units, total fresh frozen plasma of 6 units, a total crystalloid of 6,850 mL and of colloid 1,500 mL. The Ramsay sedation score was maintained within 3 and the hemodynamic condition was stable. We found that dexmedetomidine can be safely used for sedation, even during an operation requiring massive transfusions and a prolonged operation time.
Aged ; Anesthesia, Epidural ; Anesthesia, Spinal ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Blood Transfusion ; Catheterization ; Catheters ; Colloids ; Dexmedetomidine ; Erythrocytes ; Hemodynamics ; Hemorrhage ; Hip ; Humans ; Hypertension ; Isotonic Solutions ; Plasma

PURPOSE: To report a case of epithelioid hemangioendothelioma of the lacrimal sac. METHODS: A 51-year-old woman was admitted to our hospital because of tearing on the left eye. Nasolacrimal duct stenosis was found on dacryocystogram. After observation of 2 months, the tearing became worse and a palpable mass at the medial canthal area was noted. Orbital computed tomography showed the tumor of the left lacrimal sac and complete excision of the tumor and sac was performed. RESULTS: Pathologic diagnosis of the excised mass was epithelioid-hemagioendothelioma. There was no evidence of recurrence until last follow-up at postoperative 4 months.
Constriction, Pathologic ; Diagnosis ; Female ; Follow-Up Studies ; Hemangioendothelioma, Epithelioid* ; Humans ; Middle Aged ; Nasolacrimal Duct ; Orbit ; Recurrence ; Tears

PURPOSE: To evaluate the effect of different doses of intravitreal triamcinolone acetonide on diffuse diabetic macular edema. METHODS: In a retrospective study, 44 eyes with diffuse diabetic macular edema were treated with an intravitreal injection of 4 mg (n=12 eyes), 8 mg (n=17) or 25 mg (n=15) of triamcinolone acetonide (TA). Optical coherence tomography, best-corrected logMAR visual acuity and Goldmann tonometry were performed at baseline, 1 week, and 1, 3, 6, 9 and 12 months after treatment. Mean follow-up was 9.8 months (standard deviation=2.3) with a range of 5-12 months. RESULTS: The duration of intravitreal TA effects on macular thickness and visual acuity increased with increasing dosage. An observed increase in intraocular pressure induced by TA was not significantly associated with dosage. CONCLUSIONS: In patients with diffuse diabetic macular edema who receive intravitreal TA, effects may last longer after a dosage of 25 mg, than after lower doses of 8 mg or 4 mg.
Adult ; Aged ; Aged, 80 and over ; Diabetic Retinopathy/*complications/drug therapy/pathology ; Dose-Response Relationship, Drug ; Female ; Follow-Up Studies ; Glucocorticoids/*administration & dosage ; Humans ; Injections ; Intraocular Pressure ; Macular Edema/diagnosis/*drug therapy/etiology ; Male ; Middle Aged ; Retrospective Studies ; Time Factors ; Tomography, Optical Coherence ; Treatment Outcome ; Triamcinolone Acetonide/*administration & dosage ; Visual Acuity ; Vitreous Body

OBJECTIVES: The purpose of this study was to evaluate community mental health professionals and hospital workers attitude and awareness towards suicide. METHODS: This study investigated 264 community mental health professionals and 228 hospital workers. SOQs (Suicidal Opinion Questionnaires) were used from July 2007 to September 2007. After a factor analysis for the attitude towards suicide, the items on ethics, mental illness, religion, risk, and motivation were included in the subsequent analysis. RESULTS: There were significant differences in the attitude towards suicide according to religion, age, educational background, the marriage status, the economic position, and different professional licenses. Hospital workers' view was different from the community workers'. The hospital workers judged that suicide was due to mental illness, and suicide was high for the people in a special environment and who lacked motivation, which caused them to fall in a dangerous situation. For the lower educational group, they thought that suicide was attributable to mental illness. The awareness for suicide was significantly higher in the group with a postgraduate education, unmarried people, mental health professionals and the persons who had concern and experience with suicide. The factors that had an influence on the awareness of suicide were the items of mental illness, religion, risk and motivational factors. CONCLUSIONS: This study suggested that the factors to increase the awareness and attitude for suicide were the experience of increased education and case management of suicide. Therefore, education dealing with suicide and reinforcement of crisis management programs should be developed.
Adult ; *Attitude of Health Personnel ; *Awareness ; *Community Mental Health Services ; Female ; Health Personnel/*psychology ; Humans ; Korea ; Male ; Personnel, Hospital/*psychology ; Questionnaires ; *Suicide ; Young Adult

PURPOSE: This study aimed to evaluate the clinical course of childhood immune thrombocytopenia (ITP) and to assess the risk factors for developing chronic ITP. METHODS: The records of 64 children diagnosed with ITP from November 2005 and December 2014 at single center were retrospectively analyzed. RESULTS: The median age at diagnosis and the median platelet count were 1 year (range, 1 month to 15 years) and 9×10⁹/L (range, 0–84×10⁹/L), respectively. No patient experienced severe bleeding. Nineteen children (29.7%) spontaneously recovered their platelet count to ≥100×10⁹/L at a median of 10 days. In total 45 patients (70.3%) received intravenous immunoglobulin (IVIG) as first-line therapy, and showed platelet recovery at 1 week. The final diagnosis of 55 (85.9%) and 9 patients (14.1%) was acute and chronic ITP, respectively. Older age, absence of prior infection and insidious onset of symptoms were significantly associated with the development of chronic ITP. Among the patients who received IVIG, those with platelet count <45×10⁹/L at 1 month after IVIG showed a significantly higher incidence of chronic ITP compared to those with platelet count ≥45×10⁹/L (88.8% vs. 44.4%, P<0.01). CONCLUSION: In most patients, ITP runs a benign course and approximately 86% of them recover within 1 year of their initial diagnosis. The potential impact of the risk factors of chronic ITP on clinical practice needs to be explored and further studies are warranted to determine whether IVIG influences the course of ITP.
Blood Platelets ; Child ; Diagnosis ; Hemorrhage ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Incidence ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic* ; Retrospective Studies ; Risk Factors

PURPOSE: To investigate whether indocyanine green (ICG) staining of the internal limiting membrane (ILM) improves surgical and visual outcomes in macular hole surgery. METHODS: Three consecutive groups of patients with stage 3 and stage 4 macular hole underwent standard vitrectomy. Group I (45 eyes) underwent an adjunctive peeling of ILM stained with intravitreal application of 0.1 ml of 0.5% ICG dye, group II (23 eyes) an adjunctive ILM peeling without use of ICG dye, and group III (23 eyes) no adjunctive technique. Postoperative anatomic closure rates of the hole and the logarithm of the minimal angle of resolution (logMAR) visual acuity improvement were compared among the groups. RESULTS: The mean age was 61 years, and the mean follow-up period was 11 months. The rate of macular hole closure, as determined by optical coherence topography was 70% in group I, 61% in group II, and 61% in group III, and the difference were not statistically significant (p=0.726). The differences between preoperative and postoperative logMAR visual acuities among the three groups were not statistically significant (p=0.898). CONCLUSIONS: Intravitreal ICG-assisted ILM peeling did not improve anatomic outcomes in macular hole surgery. (Ed-confirm, something appears to be missing here)
Follow-Up Studies ; Humans ; Indocyanine Green ; Membranes* ; Retinal Perforations* ; Visual Acuity ; Vitrectomy

Tuberculosis, which is caused by Mycobacterium tuberculosis (M. tb), is one of the most important infectious diseases in the world. Although many functional studies have been conducted on M. tb proteins in the post-genomic era, little is known about the function of many proteins expressed specifically during latency. Previously, we reported that Rv2041c from M. tb H37Rv is highly expressed under conditions of low pH and hypoxia, which represent the in vitro mimicry of latent tuberculosis. In the present study, increased expression levels of Rv2041c under hypoxia and low pH in vitro culture was confirmed by RT-PCR. Interestingly, Rv2041c showed significantly increased expression among genes of the same operon and genes belonging to the same functional group. Finally, the immune responses elicited by the recombinant (r) Rv2041c protein were investigated using ex vivo and in vivo models of M. tb infection. A significantly high level of pro-inflammatory cytokines such as TNF-alpha, IL-6, and IL-12p40 was detected in a dose-dependent manner by treatment of murine bone marrow-derived macrophages with rRv2041c protein. In addition, IFN-gamma and TNF-alpha secretion increased after stimulation with purified Rv2041c protein to lymphocytes from latent and active TB mice in a modified Cornell model. In conclusion, our findings suggest that Rv2041c is a new T-cell antigen and could be a potential vaccine candidate against M. tb infection by inducing a strong cellular immune response.
Animals ; Anoxia ; Communicable Diseases ; Cytokines ; Hydrogen-Ion Concentration ; Immunity, Cellular ; Interleukin-12 Subunit p40 ; Interleukin-6 ; Latent Tuberculosis ; Lymphocytes ; Macrophages ; Mice ; Mycobacterium ; Mycobacterium tuberculosis ; Operon ; Proteins ; T-Lymphocytes ; Tuberculosis ; Tumor Necrosis Factor-alpha

BACKGROUND: Mycobacterium tuberculosis (Mtb) heparin binding hemagglutinin (HBHA) is an Ag known to evoke effective host immune responses during tuberculosis infection. However, the molecular basis of the host immune response to HBHA has not been fully characterized. In this study, we examined the molecular mechanisms by which HBHA can induce the expression of proinflammatory cytokines in macrophages. METHODS: HBHA-induced mRNA and protein levels of proinflammatory cytokines were determined in bone marrow-derived macrophages (BMDMs) using RT-PCR and ELISA analysis. The roles of intracellular signaling pathways for NF-kappaB, PI3-K/Akt, and MAPKs were investigated in macrophage proinflammatory responses after stimulation with HBHA. RESULTS: HBHA robustly activated the expression of mRNA and protein of both TNF-alpha and IL-6, and induced phosphorylation of NF-kappaB, Akt, and MAPKs in BMDMs. Both TNF-alpha and IL-6 production by HBHA was regulated by the NF-kappaB, PI3-K, and MAPK pathways. Furthermore, PI3-K activity was required for the HBHA-induced activation of ERK1/2 and p38 MAPK, but not JNK, pathways. CONCLUSION: These data suggest that mycobacterial HBHA significantly induces proinflammatory responses through crosstalk between the PI3-K and MAPK pathways in macrophages.
Cytokines ; Enzyme-Linked Immunosorbent Assay ; Hemagglutinins ; Heparin ; Interleukin-6 ; Lectins ; Macrophages ; Mycobacterium tuberculosis ; NF-kappa B ; p38 Mitogen-Activated Protein Kinases ; Phosphorylation ; RNA, Messenger ; Tuberculosis ; Tumor Necrosis Factor-alpha

BACKGROUND: BMI alone may not serve as an index of obesity because it does not reflect body composition. The present study aimed to compare arterial stiffness as assessed by the brachial-ankle pulse wave velocity (ba-PWV) among groups defined by body fat percentage (pBF) and BMI. METHODS: This cross-sectional study was based on 1,700 participants (1,044 men and 656 women) who completed a health screening examination at a national hospital between January 2011 and February 2016. Participants were divided into four groups according to BMI and pBF: normal fat and normal weight (NFNW); excessive fat and normal weight (EFNW); normal fat and obese (NFO); and excessive fat and obese (EFO). The ba-PWV and other cardiometabolic factors were compared among the four groups in men and women separately. RESULTS: For both sexes, the NFNW group had a lower metabolic risk compared to that in the other groups (EFNW, NFO, and EFO). After adjusting for multiple variables, the NFO males had a significantly lower ba-PWV compared to those in the other groups, including NFNW males. The NFO group had significantly more skeletal muscle mass and muscle mass compared the other groups (P < 0.05). Among women, the NFNW group had a significantly lower ba-PWV compared the other groups, even after adjusting for multiple variables. CONCLUSION: Lower pBF in obese men may be associated with improved cardiovascular risk.
Adipose Tissue* ; Body Composition ; Cross-Sectional Studies ; Female ; Humans ; Male ; Mass Screening ; Muscle, Skeletal ; Obesity ; Pulse Wave Analysis* ; Sex Characteristics ; Vascular Stiffness*