Entrapment of the popliteal artery is a rare cause of ischemia of the lower extremities in young males. The development of local occlusive or aneurysmal changes of the popliteal artery is caused by abnormal anatomical relationships between vascular and musculotendinous structures in the popliteal fossa. A 55-year-old male patient visited Yonsei University College of Medicine with the chief complaint of claudication in his right calf. He had undergone stent insertion in the right popliteal artery for peripheral artery occlusive disease 2 years earlier. Lower extremity CT angiography showed stent fracture and in-stent thrombosis. He underwent femoral-to-popliteal artery bypass surgery. Postoperative lower extremity CT angiography showed that the vein graft was compressed between the medial head of the gastrocnemius and the semimembranosus muscle. However, the blood flow was normal and his pain was relieved.
Aneurysm ; Angiography ; Arteries ; Head ; Humans ; Ischemia ; Lower Extremity ; Male ; Middle Aged ; Muscles ; Popliteal Artery ; Stents ; Thrombosis ; Transplants ; Veins

Background/Aims: The aim of this study was to evaluate the trend of incidence and prevalence of systemic lupus erythematosus (SLE) in South Korea from 2005 to 2015. Methods: From 2005 to 2015, individuals with SLE were identified from the National Health Insurance database, which records information on almost all Koreans. SLE was defined according to the International Classification of Diseases, 10th revision (ICD-10), code M32. The incidence was calculated per 100,000 person-years. The prevalence was calculated per 100,000 people and stratified by year, age group, sex, region, and income. Results: The annual prevalence of SLE increased slightly from 21.25/100,000 people in 2005 to 35.45/100,000 people in 2015. In contrast, the annual incidence of SLE decreased slightly from 5.42/100,000 person-years in 2005 to 3.6/100,000 person-years in 2015. The prevalence and incidence of SLE were 10- and 6-fold higher in women than in men, respectively. The peak age of prevalence and incidence was 30 to 39 years in 2005; in 2015, the peak age of prevalence was 30 to 49 years and of incidence was 20 to 49 years. Regional variation was observed in both incidence and prevalence of SLE. Jeju province showed the highest prevalence of SLE (44.54/100,000 person-years), and Gwangju province showed the highest incidence of SLE (6.98/100,000 person-years) in 2015. The income status did not affect the prevalence or incidence of SLE except in patients without income who received medical aid. Conclusions The incidence of SLE has declined, but the prevalence has increased in Korea in recent years. Peak age of SLE trend to right shift in Korea.

Exclusively dopamine producing retroperitoneal paragangliomas are extremely rare. We have experienced the first Korean case managed successfully based on the proper evaluation. A 26-year-old female patient came to our attention after the accidental detection of an adrenal mass. She had no symptoms and denied any family history. Laboratory evaluations were normal but serum dopamine (425 ng/L) and 24-hour urine dopamine levels (1,565.3 microg/day) were elevated. She underwent laparoscopic right adrenalectomy. Histopathological diagnosis was a paraganglioma. After operation, dopamine levels in serum and 24-hour urine dropped to 0.09 ng/L and 388.4 microg/day. Dopamine producing paraganglioma elicit no clinical symptoms. Only the dopamine level is elevated in serum and 24-hour urine samples. Surgical resection without using preoperative alpha blockage is the treatment of choice. The prognosis for patients with this tumor tends to be poor because the diagnosis is usually delayed due to lack of symptoms.
Adrenal Glands ; Adrenalectomy ; Adrenergic alpha-Antagonists ; Adult ; Dopamine ; Female ; Humans ; Korea ; Paraganglioma ; Pheochromocytoma ; Porphyrins ; Prognosis

BACKGROUND: Recombinant human erythropoietin (rHuEPO) is an essential and well-established treatment for renal anemia. Rcently, clinicians have moved toward administration of high dose rHuEPO to reduce the inconvenience and time efficient.We aimed to determine whether high dose subcutaneous (SC) epoetin alfa is as efficient and safe as the usual dose for treating anemia in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: Twenty-four patients on CAPD were randomly assigned to a high-usual dose group (n=12) and an usual-high dose group (n=12) with a variable interval for 48 weeks. Patients received 10 times treatments by scheduled visiting during Period I lasting 24 weeks and received 4 times treatments by scheduled visiting in Period II lasting 24 weeks by cross-over. The high dose was 10,000 IU and the usual dose was 4,000 IU epoetin alfa regimen. If hematocrit was out of the targeted range, 30~39%, the interval of epoetin alfa was changed within 50% of the previous interval. RESULTS: Fifteen patients, out of 24, completed the study (8 patients in the high-usual dose group; 7 patients in the usual-high dose group). Mean hemoglobin levels at randomization and after 12, 24, 36 and 48 weeks were 10.8+/-1.1, 11.5+/-0.9, 11.5+/-1.5, 11.4+/-1.5, 11.5+/-0.8 g/dL, respectively, in high-usual dose group compared with 11.2+/-0.8, 11.4+/-1.2, 11.2+/-0.9, 11.2+/-1.4, 11.4+/-0.9 g/dL, respectively, in usual-high dose group. The mean weekly epoetin alfa dosages at randomization and after 12, 24, 36 and 48 weeks were 83.6+/-38.1, 87.1+/-35.8, 89.4+/-34.2, 60.1+/-25.1, 62.8+/-30.7 IU/kg/week, respectively, in high-usual dose group compared with 69.8+/-31.6, 64.9+/-12.2, 69.9+/-46.1, 78.8+/-29.3, 75.9+/-16.4 IU/kg/week, respectively, in usual-high dose group. No statistically significant differences between the two groups were apparent for hemoglobin levels or mean weekly epoetin alfa dosages. Treatment interval at Period I and Period II were 13.3+/-5.3, 8.2+/-4.3 days in high-usual dose group compared with 7.0+/-2.5, 13.4+/-4.0 days in usual-high dose group with statistically significant differences. Treatment interval in high dose was about two times as longer as usual dose. Adverse events were generally mild and transient, and pain on injection site following subcutaneous administration was rarely reported. CONCLUSIONS: This study demonstrates that epoetin alfa 10,000 IU is as efficient and safe as 4,000 IU with a similar weekly dose in CAPD patients. Epoetin alfa 10,000 IU administration can reduce frequency of injections by about one half.
Anemia ; Cross-Over Studies* ; Erythropoietin ; Hematocrit ; Humans ; Peritoneal Dialysis, Continuous Ambulatory* ; Random Allocation ; Epoetin Alfa

PURPOSE: The objectives of this study are to describe the outcome of adolescent idiopathic scoliosis (AIS) patients treated with Video Assisted Thoracoscopic Surgery (VATS) plus supplementary minimal incision in the lumbar region for thoracic and lumbar deformity correction and fusion. MATERIALS AND METHODS: This is a case series of 13 patients treated with VATS plus lumbar mini-open surgery for AIS. A total of 13 patients requiring fusions of both the thoracic and lumbar regions were included in this study: 5 of these patients were classified as Lenke type 1A and 8 as Lenke type 5C. Fusion was performed using VATS up to T12 or L1 vertebral level. Lower levels were accessed via a small mini-incision in the lumbar area to gain access to the lumbar spine via the retroperitoneal space. All patients had a minimum follow-up of 1 year. RESULTS: The average number of fused vertebrae was 7.1 levels. A significant correction in the Cobb angle was obtained at the final follow-up (p = 0.001). The instrumented segmental angle in the sagittal plane was relatively well-maintained following surgery, albeit with a slight increase. Scoliosis Research Society-22 (SRS-22) scores were noted have significantly improved at the final follow-up (p < 0.05). CONCLUSION: Indications for the use of VATS may be extended from patients with localized thoracic scoliosis to those with thoracolumbar scoliosis. By utilizing a supplementary minimal incision in the lumbar region, a satisfactory deformity correction may be accomplished with minimal post-operative scarring.
Adolescent ; Child ; Female ; Humans ; Male ; Scoliosis/*surgery ; Thoracic Surgery, Video-Assisted/*methods ; Treatment Outcome

Mycoplasma pneumioniae has a unique genomic composition, cellular biology, and a fastidious nature as the smallest cell-free living oranism that lacks a cell wall. Previous studies have suggested that a clinical manifesta tion of a M. pneumoniae infection is a consequence of a host immune response, particularly involving cellular immunity. Adenosine deaminase (ADA) is the main T-lymphocyte enzyme, and its activity is high in diseases where cellular immunity is stimulated. Therefore, its activity is useful for diagnosing a tuberculous pleural effusion. A pleural effusion is found in 5-20% of Mycoplasma pneumonia patients. However, there are few reports of high ADA activity in a mycoplasmal pleural effusion. Here we report a case of Mycoplasma pneumoniae infection established by a polymerase chain reaction and serologic tests, accompanying high ADA activity in a pleural effusion.
Adenosine Deaminase* ; Adenosine* ; Cell Wall ; Humans ; Immunity, Cellular ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pleural Effusion* ; Pneumonia* ; Pneumonia, Mycoplasma* ; Polymerase Chain Reaction ; Serologic Tests ; T-Lymphocytes

PURPOSE: In pediatric acute respiratory failure patients requiring mechanical ventilator support, mortality is seldom related to respiratory disease alone, but more generally to multiple organ dysfunction syndrome. The purpose of this study is to evaluate whether early changes in the SOFA score (Delta-SOFA) are more effective for predicting the outcome than a single assessment upon admission for pediatric acute respiratory failure patients requiring mechanical ventilator support. METHODS: The medical records of pediatric patients with acute respiratory failure requiring mechanical ventilator support for more than 72 hours in the PICU of the Asan Medical Center Children's Hospital, Seoul, Korea, between January 2008 and May 2009 were retrospectively reviewed. RESULTS: Early Delta-SOFA showed a significantly stronger correlation with patient mortality compared with the initial SOFA score, PRISM III score and PELOD score (P<0.05). When analyzing the trends in the SOFA score during the first 72 hours, the mortality rate was significantly higher in children with increased and unchanged SOFA scores 72 hours after admission than in children with a decreased SOFA score. (14.5% vs. 42.9%, P<0.05) CONCLUSION: Regardless of the initial SOFA score, early serial evaluation of the SOFA scores during the first 3 days of PICU admission is a better indicator of the prognosis than a single assessment obtained at admission in acute respiratory failure patients mechanically ventilated for more than 3 days.
Child ; Humans ; Korea ; Medical Records ; Multiple Organ Failure ; Prognosis ; Respiratory Insufficiency ; Retrospective Studies ; Ventilators, Mechanical

PURPOSE: The PaO2/FiO2 (P/F) ratio, oxygenation index (OI) and the ventilation index (VI) have been used as parameters of acute respiratory failure. This study was conducted to evaluate the relationship between the prognosis and early changes in the respiratory parameters in pediatric patients with acute lung injury (ALI). METHODS: This is a retrospective study of 97 patients who had ventilator care for more than 3 days due to acute respiratory failure between January 2008 and May 2009 in PICU of Asan Medical Center. RESULTS: The mean age was 3.7+/-5.0 years. This study included 58 males and 39 females. The mortality rate was 27.8%. There was no significant difference between the survivors and non-survivors in the initial P/F ratio, OI and VI. However, these parameters improved in the survivor group, unlike the non-survivor group whose parameters remained unchanged or worsened. When comparing the receiver operating characteristic (ROC) curve of the initial respiratory parameters and the changes in parameters for 3 days, the area under the ROC curves representing the changes in respiratory parameters for 3 days was significantly greater than that of initial respiratory parameters, thus indicating the parameter changes are more reliable predictors of mortality than the initial parameters. CONCLUSION: Early changes in respiratory parameters such as the P/F ratio, OI and VI, rather than initial parameters themselves, are more directly related to the prognosis of pediatric patients with ALI and would be useful in determining optimal treatment and predicting the prognosis.
Acute Lung Injury ; Child ; Female ; Humans ; Male ; Oxygen ; Prognosis ; Respiratory Insufficiency ; Retrospective Studies ; ROC Curve ; Survivors ; Ventilation ; Ventilators, Mechanical

BACKGROUND: The objective of this study is to demonstrate the relationship between the volume of a parathyroid adenoma and the preoperative biochemical parameters in patients undergoing surgery for primary hyperparathyroidism. METHODS: The medical records of 68 patients who underwent a parathyroidectomy for a single parathyroid adenoma were retrospectively reviewed. The volume of the adenoma was estimated using its measured size and a mathematical formula. The correlation between the volume of the parathyroid adenoma and the preoperative laboratory data was assessed. RESULTS: There were no correlations between the estimated volume of the adenoma and the serum calcium, alkaline phosphatase and parathyroid hormone levels. However, the volume of the adenoma was associated with the preoperative level of serum phosphorus. After excluding 5 adenomas with cystic degeneration, a positive correlation was noted between the adenoma volume and the preoperative levels of alkaline phosphatase and parathyroid hormone. CONCLUSION: The preoperative serum levels of calcium, alkaline phosphatase and parathyroid hormone are of limited use to predict the volume of the parathyroid adenoma in patients with a single parathyroid adenoma. We suggest that the absence of a correlation between the volume of the adenoma and the biochemical parameters can be attributed to the cystic degeneration of the adenomas.
Adenoma ; Alkaline Phosphatase ; Calcium ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Medical Records ; Parathyroid Hormone ; Parathyroid Neoplasms ; Parathyroidectomy ; Phosphorus ; Retrospective Studies

Background: The association between endovascular treatment (EVT) case volume per hospital and clinical outcomes has been reported, but the exact volume threshold has not been determined. This study aimed to examine the case volume threshold in this context. Methods: National audit data on the quality of acute stroke care in patients admitted via emergency department, within 7 days of onset, in hospitals that treated ≥ 10 stroke cases during the audit period were analyzed. Ischemic stroke cases treated with EVT during the last three audits (2013, 2014, and 2016) were selected for the analysis. Annual EVT case volume per hospital was estimated and analyzed as a continuous and a categorical variable (in quartiles). The primary outcome measure was 1-year mortality as a surrogate of 3-month functional outcome. As post-hoc sensitivity analysis, replication of the study results was examined using the 2018 audit data. Results: We analyzed 1,746 ischemic stroke cases treated with EVT in 120 acute care hospitals. The median annual EVT case volume was 12.0 cases per hospital, and mortality rates at 1 month, 3 months, and 1 year were 12.7%, 16.6%, and 23.3%, respectively. Q3 and Q4 had 33% lower odds of 1-year mortality than Q1. Adjustments were made for predetermined confounders. Annual EVT case volume cut-off value for 1-year mortality was 15 cases per year (P < 0.02). The same cut-off value was replicated in the sensitivity analysis. Conclusion Annual EVT case volume was associated with 1-year mortality. The volume threshold per hospital was 15 cases per year.