PURPOSE: The Singh index which is based on a plain radiograph has commonly used in assessing the grade of osteoporosis. We studied value of the Singh index in assessing the grade of osteoporosis by obtaining reliability of the Singh index and correlation between the Singh index and bone mineral density. MATERIALS AND METHODS: Six observers assessed radiographs of 60 patients suspected osteoporosis. The interobserver and intraobserver agreement of the Singh index were obtained by using kappa statistics. The bone mineral density of proximal femur was measured by dual energy X-ray absorptiometry in all patients, and then the results of bone mineral density were compared with those of Singh index by using percentage of variance. RESULTS: The kappa values of interobserver agreement ranged from 0.28 to 0.76 (mean value: 0.45) and the strength of the agreement was moderate. The percentage of variance of BMD which was explained by Singh index was 7.1%. CONCLUSIONS: The results of this study suggest that the Singh index has low clinical value in assessing the grade of osteoporosis
Absorptiometry, Photon ; Bone Density ; Femur ; Humans ; Osteoporosis*

We report a case of esthesioneuroblastoma with intracranial extension treated with surgical resection and chemotherapy. A 5-year-old child presented with visual disturbance, and was subsequently found to have a huge sized mass in the anterior skull base, suprasellar region and lateral ventricle. A bifrontal craniotomy with excision of the tumor through subfrontal and interhemispheric approach was performed. The patient received postoperative chemotherapy according to Tandem protocol. A follow-up magnetic resonance(MR) image showed that the tumor showed partial regression, however, there was no change in tumor size in lateral ventricle. Second operation with excision of remnant mass through a transcallosal approach was performed. MR image, 9 months after first operation showed the postoperative change in frontal area without enhancing mass. By employing staged operation and chemotherapy, the authors obtained good results in the treatment of esthesioneuroblastoma with intracranial extension.
Child ; Child, Preschool ; Craniotomy ; Drug Therapy ; Esthesioneuroblastoma, Olfactory* ; Follow-Up Studies ; Humans ; Lateral Ventricles ; Skull Base

OBJECTIVE: To examine the relationship between hypertension prevalence and the four commonest anthropometric measurements for obesity(body mass index(BMI), wasit-hip ratio(WHR), waist circumference(WC) and body fat in Korean adults. METHODS: We studied the cross-sectional association of the anthropometric indices and blood pressure in 1,197 individuals( who were participants in the population-based cohort study). Hypertension was defined as blood pressure 160/95 mmHg or current use of antihypertensive medication. Informations on life-style factors were obtained from personal interview. RESULTS: There were close associations between BMI, WHR and WC with blood pressure in both men and women. After age adjustment, BMI and WC showed significantly positive correlation with systolic and diastolic blood pressure levels in both men and women. Odds ratio(ORs) of being hypertensive were estimated comparing the highest to the lowest quantile, adjusting for age, smoking status, alcohol intake levels, education attainment. The simultaneously adjusted ORs of being hypertensive, comparing the highest vs the lowest categories, was for BMI 2.0(95% confidence interval(CI)=0.9-3.2) in men and 3.2 (95% CI=1.7-6.1) in women, for WC 2.1(95% CI=1.0-4.4) in men and 3.1(95% CI=1.6-5.9) in women, for fat(%) 4.2(95% CI=1.9-9.5) in men and 2.1(95% CI=1.2-3.6) in women. CONCLUSION: In addition to measures of overall obesity(BMI) as well as central obesity(WHR, WC), body fat(%) was independently associated with prevalence of hypertension. Among obesity indices, body fat was the most predictor variable in hypertensive state in male and BMI was in female.
Adipose Tissue ; Adult* ; Blood Pressure ; Cohort Studies ; Education ; Female ; Humans ; Hypertension* ; Male ; Obesity ; Odds Ratio ; Prevalence* ; Smoke ; Smoking

BACKGROUND/AIMS: Diabetic nephropathy is a growing cause of end-stage renal failure, and renal transplantation is considered the best option for survival in patients who experience such renal failure. Patients with diabetes are older and frequently have comorbidity, and only a minority of these patients is considered for renal transplantation. The survival rate of patients having diabetes treated with transplantation has improved, although the long-term prognosis has not been determined. This study examined the clinical outcome of renal transplantation in patients having diabetes compared to that in nondiabetic patients. METHODS: We compared diabetic (n=70) and nondiabetic (n=355) groups of patients for whom medical records were available for more than 3 months at our hospital from March 1998 to August 2008. RESULTS: The recipients were significantly older in the diabetic group (50.6+/- 10.5 vs. 39.8+/- 10.8 years), while donor age was significantly younger in that group (33.2+/- 9.0 vs. 37.5+/- 1.3 years). Cardiovascular events occurring after transplantation were more frequent in the diabetic group (11/70 vs. 10/355). Kaplan-Meier curves for cumulative survival of the renal allograft and patient survival revealed no difference between the two groups. The allograft survival rate in the diabetic group was 100% at 5 years and 79% at 10 years posttransplantation. In the nondiabetic group, the renal allograft survival rate was 98% at 5 years and 75% at 10 years. The patient survival rates did not differ significantly: 100% vs. 99% at 5 years and 91% vs. 91% at 10 years for the diabetic and nondiabetic groups, respectively. CONCLUSIONS: In our study, the long-term survival of renal transplantation in patients with diabetes equaled that of nondiabetic patients. Graft survival was also comparable between the two groups. Therefore, kidney transplantation may be another therapeutic option for end-stage diabetic nephropathy.
Comorbidity ; Diabetic Nephropathies ; Graft Survival ; Humans ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Medical Records ; Prognosis ; Renal Insufficiency ; Survival Rate ; Tissue Donors ; Transplantation, Homologous ; Transplants

PURPOSE:BK virus associated nephropathy (BKVAN) affects 1-10% of kidney transplant (KT) patients and it produces a progressive destruction of allograft. Reducing immunosuppression is the only way to save the graft, while it needs tight monitoring of the graft rejection and graft survival is poorer in advanced case. Leflunomide has immunosuppressive effect and also antiviral activity. Addition of leflunomide may improve BK virus clearance and graft survival. METHODS:6 KT patients with biopsy proven BKVAN (Histological pattern B) were treated with leflunomide and reduced immunosuppression. All patients were monitored with serial determination of viral load in blood and graft function. RESULTS:BKVAN was diagnosed at 14 months (7-28) post transplant, at that time median serum creatinine concentration was 2.8 mg/dL (1.8-3.6). 12.5 months (6-16) later of leflunomide treatment, median serum creatinine was 2.3 mg/dL and no graft loss was found. CONCLUSION:Leflunomide therapy with reduced immunosuppression may be effective in the treatment for BKVAN.
Biopsy ; BK Virus ; Creatinine ; Graft Rejection ; Graft Survival ; Humans ; Immunosuppression ; Isoxazoles ; Kidney ; Kidney Transplantation ; Transplantation, Homologous ; Transplants ; Viral Load ; Viruses

PURPOSE: To evaluate the clinical results of 6 mm iris-fixated phakic intraocular lens (Artisan(R) lens) implantation in myopic patients. METHODS: Forty eyes of 23 myopic patients underwent 6-mm Artisan(R) phakic IOL implantation and were followed-up for over 6 months. We prospectively analyzed the efficacy, stability, predictability, change of astigmatism, endothelial cell count, pupil diameter, degree of decentration, subjective satisfaction and complications. RESULTS: The preoperative mean spherical equivalent was -9.46 D, and postoperative spherical equivalent was -0.70D at 1 month, -0.55D at 3 months, -0.54D at 6 months, -0.78D at 12 months and remained stable during the follow-up period. The preoperative mean astigmatism was -1.88D and postoperative astigmatism was -0.87D at 6 months. Postoperative uncorrected visual acuity (UCVA) was more than 0.8 in 85% of the eyes at 1 month, 91% at 3 months, 95% at 6 months, and 89% at 12 months. The spherical equivalent refraction after surgery was within 1.0D of emmetropia in 78% of eyes at 1 month, 80% at 3 months, 88% at 6 months, and 64% at 12 months. There was no significant decrease in the endothelial cell count during the follow-up period. Preoperative scotopic pupil diameters were significantly decreased at 1 month and the mean decentration of the lens was 0.38 mm. Patient satisfaction was generally high. Complications included the transient elevation of intraocular pressure in 1 eye, corneal edema in 4 eyes, iritis in 1 eye, traumatic dislocation in 1 eye and iris atrophy in 2 eyes. CONCLUSIONS: The 6-mm Artisan(R)phakic IOL implantation may be an effective surgical procedure for myopic patients who cannot undergo corneal refractive surgery, as it provided good visual results, predictability, patient satisfaction, and short-term safety.
Astigmatism ; Atrophy ; Corneal Edema ; Dislocations ; Emmetropia ; Endothelial Cells ; Follow-Up Studies ; Humans ; Intraocular Pressure ; Iris ; Iritis ; Patient Satisfaction ; Phakic Intraocular Lenses ; Prospective Studies ; Pupil ; Refractive Surgical Procedures ; Visual Acuity

The aim of present study was to evaluate the influence of periodontal status of adjacent tooth and loading time to the prevalence of red complex of implant sulcus. In 97 patients, partially edentulous subjects with endosseous root-form implants were selected. All subjects were medically healthy and had not taken systemic antibiotics and professional plaque control 3 months before sampling. The number was as follows: clinically healthy implants:161, clinically unhealthy implants:22, clinically healthy adjacent teeth:73, clinically unhealthy adjacent teeth:38. All teeth and implants of each patient were examined probing depth(PD), modified sulcus bleeding index(mSBI), and modified plaque index(mPI), and samples of subgingival plaque were obtained at each site with sterile curet or fine paper points, then the plaque transferred to PBS. Obtained samples were examined for the presence of P. gingivalis, T. forsythensis, and T. denticola by the polymerase chain reaction (PCR). The relationship among clinical parameters and the colonizations by the 3 bacterial species from adjacent teeth and implants region were analyzed by student t-test (p<0.05). The results of this study were as follows: 1. mPI and mSBI of implant increased with increasing of same indices of adjacent tooth(p=0.03,0.001), but not in the PD . 2. The mPI, mBI, PD of implants was higher when red complex exist. 3. The prevalence of red complex was higher when the periodontal condition is unhealthy. 4. The prevalence of red complex of implants has no significant relation to the probing depth of adjacent tooth. 5. Prevalence of P. gingivalis, T. forsythensis of implants increased with loading time. (p=0.02,0.018) These results shows the importance of oral hygiene and supportive periodontal therapy.
Anti-Bacterial Agents ; Colon ; Hemorrhage ; Humans ; Oral Hygiene ; Polymerase Chain Reaction ; Prevalence ; Tooth

Leiomyoma is the most common benign tumor of the esophagus, but it still occurs rarely as compared with the incidence of carcinoma in this area. Most of leiomyomas may manifest itself with unusual and inconsistent symptoms, and found incidentally during endoscopic or radiographic examination. Those who menifested symptoms are included as dysphagia and vague pain mostly. We experienced recently two cases with esophageal leiomyoma who underwent successful surgical resection and endoscopic enucleation, respectively.
Deglutition Disorders ; Esophagus* ; Incidence ; Leiomyoma*

Cryptococcosis is recognized as one of the most important complications in an organ transplant recipient. Cryptococcosis occurs in 2.5-39% of renal transplant recipients. This infection generally presents as symptomatic disseminated disease with an accelerated clinical course, involves multiple sites including the central nervous system, lungs, and skin. And if diagnosis or treatment is delayed, the prognosis is generally poor. The asymptomatic infection is rare and there are no case reports of asymptomatic disseminated cryptococcosis after renal transplantation in Korea. We experienced a case of asymptomatic cryptococcal multi-organ infection detected incidentally in a 51-year-old male received a living related renal transplant 35 months earlier for end-stage renal disease due to diabetic nephropathy. We treated successfully with amphotericin B and fluconazole and hereby report this case with a review of the relevant literature.
Amphotericin B ; Asymptomatic Infections ; Central Nervous System ; Cryptococcosis ; Diabetic Nephropathies ; Fluconazole ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation ; Korea ; Lung ; Male ; Middle Aged ; Prognosis ; Skin ; Transplants

Reversible posterior leukoencepalopathy syndrome (RPLS) was noted by a reversible syndrome of headache, altered mental status, seizure, and visual loss associated with findings indicating predominantly posterior leukoencephalopathy on imaging studies. We report a successful treatment of RPLS after secondary ABO incompatibility kidney transplantation with blood pressure control. A 41-year-old female whose primary kidney disease was chronic glomerulonephritis had graft failure developed after living donor kidney transplantation (1st kidney transplantation). She was admitted to our hospital for 2nd ABO incompatibility kidney transplantation. She had undergone 6 times of plasmapheresis and received additional two doses of rituximab (375 mg/m2) and intravenous immunoglobulin (0.5 g/kg) before kidney transplantation. She received basiliximab induction therapy, tacrolimus, steroid and mycophenolate mofetile after transplantation. The ABO antibody titer had been low (below 1:1) and evidences of rejection were not detected. Generalized tonic clonic type seizure, eyeball deviation, facial cyanotic change and loss of consciousness occurred at post operation 7th day. Several minutes later, she recovered her consciousness without disability and neurologic deficit. She did not represent attacks any more after we controlled blood pressure without withdrawal of immunosuppressants or dose reduction.
Adult ; Antibodies, Monoclonal ; Antibodies, Monoclonal, Murine-Derived ; Blood Pressure ; Consciousness ; Female ; Glomerulonephritis ; Headache ; Humans ; Immunoglobulins ; Immunosuppressive Agents ; Kidney ; Kidney Diseases ; Kidney Transplantation ; Leukoencephalopathies ; Living Donors ; Neurologic Manifestations ; Plasmapheresis ; Posterior Leukoencephalopathy Syndrome ; Recombinant Fusion Proteins ; Rejection (Psychology) ; Seizures ; Tacrolimus ; Transplants ; Unconsciousness ; Rituximab