PURPOSE: Extrapleural fat hypertrophy is thought to be associated with findings of chronic pleural or pulmonary parenchymal diseases, and more favours clinical course of benign disease rather than malignant disease which is rapidly progressive. Recently, however, we observed frequent extrapleural fat hypertrophy in CT scens of lung cencer patients, especially those with complicated ones. We studied the frequency of extrapleural fat hypertrophy and the relationship between the extrapleural fat hypertrophy and the complications of lung cancer. MATERIALS AND METHODS: We retrospectively analized the CT findings in 95 patients with primary lung cancer. 85 patients were confirmed pathologically and 10 patients were confirmed by clinical and radiological follow-up studies. RESULTS: Among the 95 patients, 79 patients were associated with more than one complications(Lung collapse, pneumonia, pulmonary tuberculosis., pleural reaction, pleural metastasis, empyema, chest wall invasion). Extrapleural fat hypertrophy was observed in 43(54%) patients with complication, and 2(13% ) patients without complication. The frequency of the extrapleural fat hypertrophy was 40%(14/35) in patients with only parenchymal complicated patients, 33%(2/6) in patients with only pleural complication, and 71%(27/38) in patients with both parenchymal and pleural complications. CONCLUSION: Extrapleural fat hypertrophy was more frequently observed in complicated lung cancer patients rather than non-complicated, and higher frequency of the extrapleural fat hypertrophy was noted in those with more than two complications. It was concluded that extrapleural fat hypertrophy in lung cancer patients was non-specific finding caused by associated complication. Its mechanism is thought to be chronic pleural irritation and negative thoracic pressure.
Empyema ; Follow-Up Studies ; Humans ; Hypertrophy* ; Lung Neoplasms* ; Lung* ; Neoplasm Metastasis ; Pneumonia ; Retrospective Studies ; Thoracic Wall ; Tuberculosis, Pulmonary

OBJECTIVES: This study was carried out to assess psychosocial distress of lead workers and to examine the relationship between lead exposure indices and psychosocial distress. METHODS: The study design was cross-sectional and research subjects were 234 lead workers in primary smelting industry. General characteristics, job characteristics and social support were obtained by self-administered questionnaire and history taking. Psychosocial distress was measured using PWI(Psychosocial Well-being Index), a 45-item self-administered instrument. Blood lead(PbB), zinc protoporphyrin(ZPP), -aminolevulinic acid in urine(ALAU) were selected as indicators of lead exposure. RESULTS: There was significant difference in PWI according to lead exposure level and job characteristics. The results of correlation analysis showed that PWI was significantly correlated with PbB(r=0.203, P=0.002). CONCLUSIONS: Our results supported the association between lead exposure and psychosocial distress. The inclusion of psychosocial distress measurement as a special health examination for lead workers was highly recommended for the effective health management.
Humans ; Osmeriformes ; Questionnaires ; Research Subjects ; Zinc

BACKGROUND: Laparoscopic surgery in the Trendelenburg position affects the cardiopulmonary system and may also influence intraocular pressure (IOP). The purpose of this study was to compare the effects of propofol and sevoflurane anesthesias on IOP change during laparoscopic hysterectomy. METHODS: Thirty-one women were randomly allocated to either a propofol (P-group, n = 15) intravenous anesthesia group or a sevoflurane (S-group, n = 16) inhaled anesthesia group with fentanyl-N2O/O2-vecuronium. Heart rate, mean arterial pressure, plateau airway pressure, ETCO2, and IOP were measured before induction (T1), 10 min after induction (T2), 10 min after pneumoperitoneum in the Trendelenburg position (T3), and 5 min after pneumoperitoneum deflation in the horizontal position (T4). RESULTS: IOP was significantly decreased in both groups after induction. IOP was increased in both groups after pneumoperitoneum in the Trendelenburg position, but IOP in the sevoflurane group was significantly higher than that in the propofol group. CONCLUSIONS: Propofol intravenenous anesthesia may be a better choice for IOP control during laparoscopic surgery.
Anesthesia* ; Anesthesia, Intravenous ; Arterial Pressure ; Female ; Head-Down Tilt ; Heart Rate ; Humans ; Hysterectomy* ; Intraocular Pressure* ; Laparoscopy ; Pneumoperitoneum ; Propofol*

Measurement of blood lead (PbB) and blood zinc protoporphyrin (ZPP) are most common biological indices to identify the individual at risk for excess or the health sequences by lead exposure. Because PbB is known most important and reliable index of lead exposure, PbB is often regarded as a gold standard to detect lead exposure. But in Korea PbB is a secondary test item of detailed health check-up with positive finding of screening test in most occasion. Our lead standard requires all lead workers to take annual heath-check twice a year for investigation of their health effect due to lead exposure. Blood ZPP is one of most important index to detect high lead absorption in lead workers as a screening test. Measurement of blood ZPP is known well to correlate with PbB in steady state of exposure in most lead workers and is often used as a primary screening test to detect high lead absorption of lead workers with the advantage of simplicity, easiness, portability and low cost. The current cut-off criteria of blood ZPP for further detailed health check-up is 100 ng/dl which is supposed to match the level of 40 ng/dl of PbB according to our standard. Authors tried to investigate the validity of current criteria of cut-off level(100 ng/dl) of blood ZPP and possible another better cut-off level of it to detect the lead workers whose PbB level over 40 ng/dl. The subjects in our study were 212 male workers in three small scale storage battery industries. Blood ZPP, PbB and hemoglobin(Hb) were selected as the indices of lead exposure. The results were as follows. 1. The mean of blood ZPP, PbB and Hb in lead workers were 79.5+/-46.7 ng/dl, 38.7+/-15.1 ng/dl, and 14.8+/-1.2 g/dl, respectively. There were significant differences in blood ZPP, PbB and Hb by industry(P<0.01). 2. The percents of lead workers whose blood ZPP were above 100 ng/dl in the group of work duration below 1, 1-4, 5-9 and above 10 years were 8.6%, 17.2%, 47.6%, and 50.0%, respectively. The percents of lead workers whose PbB were above 40 ng/dl in those were 31.4%, 40.4%, 71.4%, and 86.4%, respectively. 3. The percents of lead workers whose PbB were below 40 ng/dl, 40-59 ng/dl and above 60 ng/dl were 54.7%, 34.9% and 10.4%, respectively. Those of lead workers whose blood ZPP were below 100 ng/dl, 100-149 ng/dl and above 150 ng/dl were 79.2%, 13.7% and 7.1%, respectively. 4. Simple linear regression of PbB on blood ZPP was statistically significant(P<0.05) and as PbB was 40 ng/dl, blood ZPP was 82.1 ng/dl. 5. While the highest sensitivity and specificity of blood ZPP test to detect lead workers with PbB over 40 ng/dl were observed in the cut-off level of 50 ng/dl and 100 ng/dl of blood ZPP, respectively, the highest validity(sensitivity+specificity) of blood ZPP to detect lead workers with PbB over 40 ng/dl was observed in the cut-off level of around 70 ng/dl of blood ZPP. But even with optimal cut-off level of around 70 ng/dl of blood ZPP, still 25.0% of false negative and 20.7% false positive lead workers were found. As the result of this study, it was suggested that reconsideration of current blood ZPP cut-off of our lead standard from 100 ng/dl to somewhat lower level such as around 70 ng/dl and the inclusion of PbB measurement as a primary screening test for lead workers was highly recommended for the effective prevention of lead workers.
Absorption ; Humans ; Korea ; Linear Models ; Male ; Mass Screening ; Sensitivity and Specificity ; Zinc*

BACKGROUND AND OBJECTIVES: Ramsay Hunt syndrome is herpes zoster of the facial nerve, frequently associated with VIII cranial nerve involvement, but on rare occasions other cranial nerves are affected as well. We tried to show that Ramsay Hunt symdrome should be recognized as a cranial polyneuropathy characterized by damage to cranial nerves, especially the facial nerve and the auditory-vestibular nerve. MATERIALS AND METHOD: 11patients suffered from auricular vesicles, otalgia, facial palsy, and vertigo. Group A included 8 patients of acute peripheral vestibulopathy with Ramsay Hunt syndrome. Group B included only 3patients of Ramsay Hunt syndrome. Each patient received a battery of tests, including neurological examination, audiometry, vestibular function test. RESULTS: The lesion site of Ramsay HHhhunt syndrome was right in 5cases and left in 6cases. Electronystagmography showed 3cases of right acute peripheral vestibulopathy, 5cases of left, and 3cases of disequilibrium. Site of Ramsay hunt syndrome and that of vestibulopathy was same in 8cases of Group A. 3cases was observed in Ramsay Hunt syndrome patients that hearing loss and vestibulopathy was same site. Facail nerve palsy improved without recovery of vestibular function. Cranial examination and imaging study like brain CT or temporal MRI showed no abnormal finding. CONCLUSION: Although Ramsay Hunt syndrome usually presents with the classical triad of pain, vesicles and facial nerve paralysis, it must be kept in mind that it is a cranial polyneuropathy. In our study, there was few association between facial nerve palsy recovery and acute peripheral vestibulopathy.
Audiometry ; Brain ; Cranial Nerves ; Earache ; Electronystagmography ; Facial Nerve ; Facial Paralysis ; Hearing Loss ; Herpes Zoster ; Herpes Zoster Oticus* ; Humans ; Magnetic Resonance Imaging ; Neurologic Examination ; Paralysis ; Polyneuropathies ; Vertigo ; Vestibular Function Tests ; Vestibular Neuronitis

PURPOSE: To evaluate the radiographic and clinical outcomes of patients with displaced proximal humerus fractures (two-part and three-part) treated with the Polarus interlocking nail, comparing their fractures types. MATERIALS AND METHODS: There were 22 patients with displaced proximal humerus fractures. There were 10 surgical neck (SN) and 1 anatomical neck (AN) two-part fractures and 10 greater tuberosity/surgical neck (GT/SN) and 1 GT/AN three-part fractures. All patients were surgically treated solely with the Polarus interlocking nail using a closed technique. Functional assessment was obtained using the American Shoulder and Elbow Surgeons (ASES) score, which grade outcomes as excellent (>75), satisfactory (50~75), poor (<50) results. Radiographic outcome measurements included fracture alignment (neck-shaft angle), loosening of screw, fixation and hardware failure, and malunion and nonunion. RESULTS: Overall, the average ASES score was 80.2 (range 46.0 to 98.0). There were 15/22 (68.2%) excellent, 6/22 (27.3%) satisfactory, and 1/22 (4.5%) poor results. All shoulders healed radiographically without evidence of avascular necrosis of the humeral head. When comparing patients with two-part fractures (n=11) with patients having three-part fractures (n=11), there were statistically significant differences with ASES outcome measures (p<0.05). But, there were no statistically significant differences in age-related analysis (p>0.05). CONCLUSION: Both displaced two-part fractures and three-part GT/SN fractures can have above satisfactory functional and radiographic outcomes with the Polarus interlocking nail using a closed technique. Even though displaced three-part GT/SN fractures in elderly osteopenic patients (>60 years), we treated successfully with the Polarus interlocking nail.
Aged ; Elbow ; Humans ; Humeral Head ; Humerus* ; Neck ; Necrosis ; Outcome Assessment (Health Care) ; Shoulder

OBJECTIVES: Protein kinase C(PKC), a calcium and phospholipid dependent enzyme, is activated by lead in vitro at picomolar concentrations. However, the effect of lead on PKC has never been studied in a human population. The purpose of the study was to evaluate whether lead exposure was associated with PKC mediated-phosphorylation in erythrocytes among lead workers. METHODS: Two hundred and twelve lead workers were studied. To determine the levels of phosphorylation in vivo, an in vitro back phosphorylation technique was used by adding PKC and gamma-32P to preparations of erythrocyte membranes. We measured back phosphorylations of erythrocyte membrane proteins, spectrin, and 52 kDa and 48 kDa, as an indirect measure of PKC activation in vivo. RESULTS: The mean(SD) age and exposure duration was 39.1(10.0) years and 8.1(6.5) years, respectively. Tibial lead ranged from 0.8 to 290.8 microgram Pb/g bone mineral with a mean(SD) of 34.4(35.2) microgram Pb/g bone mineral. The means(SD) of back phosphorylation levels of the three proteins were 540.7(304.1), 198.6(78.2), and 247.7(83.3) photostimulated luminescence units(PSL), respectively, by phosphoimager. After adjustment for potential confounding factors, tibial lead and exposure duration were significantly and inversely associated with back phosphorylation levels. One unit of increase in tibial lead(1 microgram Pb/g bone mineral) is associated with a decline in spectrin, band 4.9 52 kDa, and band 4.9 48 kDa back phosphorylation levels by 1.4(P<0.05), 0.34(P<0.05), and 0.47(P<0.01), respectively. However, there were no associations between the back phosphorylation levels and either blood lead or ZPP levels. CONCLUSIONS: These findings suggest that the PKC activity in erythrocytes is increased by chronic lead exposure and that erythrocyte membrane protein phosphorylation may be a biomarker of lead exposure.
Calcium ; Erythrocyte Membrane ; Erythrocytes* ; Humans ; Luminescence ; Phosphorylation ; Protein Kinase C* ; Protein Kinases* ; Spectrin

The influence of lead exposure on renal function was studied. Three hundred forty two male lead exposed workers who worked in 3 storage battery factories, 5 secondary smelting factories and 3 litharge making factories, and 60 male control workers who were not exposed to lead occupationally were chosen for this study. Blood lead (PbB), zinc protoporphyrin in whole blood (ZPP) and delta-aminolevulinic acid in urine (DALA) were selected as indicators of lead exposure. As indicators of renal function blood urea nitrogen(BUN) , serum creatinine(S-Cr), serum uric acid (S-UA), N-acetyl-beta-D-glucosaminidase in urine (NAG) and urine protein (U-TP) were selected. While the mean values of lead exposure indicators of lead workers were significantly different from non-exposed ones, the mean values of renal function indicators of exposed except S-UA were significantly different from non-exposed. The frequency of workers whose value of renal function indicators were over the nor mal criteria (BUN>20 mg/dl ; S-Cr>1.2 mg/dl ; S-UA>7.0 mg/dl ; NAG>8.0 U/liter; U-TP>8.0 mg/dl) by the level of lead absorption in terms of PbB, ZPP and DALA were calculated. Age adjusted odds ratio of over the normal value of BUN and NAG were statistically significant by the level of ZPP and that of BUN only showed the dose-dependant relationship. But the frequency of over the normal criteria of renal function indicators were not increased by the level of PbB and DALA. On stepwise multiple regression using renal function indicators as a dependent variable and each lead exposure indicator and age as independent variables, only BUN, NAG and U-TP were contributed by the lead exposure indicators. It was found that only NAG of renal function indices was most reliable indicator who showed dose-response relationship with lead exposure and the measurement of NAG for lead workers whose relatively high exposure is highly recommended.
Absorption ; Acetylglucosaminidase ; Aminolevulinic Acid ; Humans ; Male ; Occupations* ; Odds Ratio ; Osmeriformes ; Reference Values ; Urea ; Uric Acid ; Zinc

OBJECTIVES: To evaluate whether a relation between blood lead and zinc proto porphyrin(ZPP) was modified by gender in Korean lead workers. METHODS: A cross-sectional study was conducted with 1,304 male and 101 female subjects in 1997. The relation between blood lead and ZPP were evaluated with linear, exponential, and quadratic models. Then, the different effect of gender on the relation was examined by adding the interaction terms in the each model. RESULTS: Mean+/-SD of blood lead and ZPP level was different between male(27.7+/-10 microgram /dl and 51.3+/-23.4 microgram/dl) and female subjects(22.5+/-9.2 microgram/dl and 78.7+/-38.6 microgram/dl). After adjusting for possible confounders, the effect modification by gender was significant in linear(beta=1.119, p<0.001), exponential(beta=Exp(0.008), p<0.05), and quadratic model(beta= 1.388, p<0.001). In separate analysis, a quadratic relation between blood lead and ZPP was shown in male lead workers(beta=0.036, p<0.001), but an exponential relation in female lead workers(n=Exp(0.029), p<0.001). CONCLUSION: Our data showed that the increasing rate of ZPP in female were always higher than in male lead workers, suggesting that females were more susceptible to occupational lead exposure than males.
Cross-Sectional Studies ; Female ; Humans ; Male ; Zinc*

PURPOSE: This study was performed to compare the results between PFNA (Proximal Femoral Nail Antirotation) and PFN (Proximal Femoral Nail) in the treatment of peritrochanteric fracture. MATERIALS AND METHODS: The patient group with PFNA (n=24, group I) was taken from operations between February, 2007, and March, 2008, whereas the PFN patient group (n=24, group II) were taken from January, 2005, to January, 2007. Both groups were carefully compared with regard to operation time, estimated blood loss, amount of transfusion, ICU care, amount of drainage, average duration of admission, intra- and postoperative complications, radiologic union, Tip Apex Distance (TAD), the change of neck shaft angle, the sliding length of lag screw, Jensen's functional score, and Paker and Palmer's mobility score. RESULTS: The results of our study showed statistical (P<0.05) advantages of PFNA over PFN where estimated blood loss, amount of drainage, rate of complication, neck and shaft angle, and sliding length were concerned. However, there was no statistical significance between the two groups regarding the other areas that were examined (p>0.05). CONCLUSION: PFNA appears to be more effective than PFN for the treatment of peritrochanteric fractures of the proximal femur.
Drainage ; Femur ; Humans ; Nails ; Neck