PURPOSE: To prepare the appropriate guideline in choosing the internal fixatives for the intertrochanteric fractures of the femur in the elderly. MATERIALS AND METHODS: We reviewed 95 cases of intertrochanteric fractures of the femur from January, 1999 to December, 2003. We fixed the fracture with Proximal Femoral Nail in 37 cases (PFN group), Dynamic Hip Screw in 56 (DHS group), Dynamic Condylar Screw in 2 cases (DHS group). We reviewed operation time, blood loss during operation, changes in neck-shaft angle and sliding of lag screw. RESULTS: There were no significant differences in the parameters between the 2 groups in stable fracture. In unstable fractures, operation time in PFN group and DHS group revealed 103.9 and 128.2 minutes respectively; mean amount of blood loss during operation revealed 523.2 and 573.1 ml respectively. Mean changes in the neck-shaft angle at final follow-up in PFN group and DHS group revealed 4.6 degrees and 4.1 degrees; sliding of lag screw averaged 3.4 and 6.5 mm respectively. Among the DHS group, cases of additional fixation with trochanteric supporting plate revealed 3.1 degrees of changes in neck-shaft angle and 4.2 mm of lag screw sliding. CONCLUSION: In cases of stable fractures, any fixative might suffice. In cases of unstable fractures, there were no significant differences in results of treatment between these two groups, however, PFN group revealed shoter operation time and less blood loss during operation. It seemed to be necessary to apply additional fixation with trochanteric supporting plate when using DHS in unstable cases.
Aged* ; Femur* ; Fixatives* ; Follow-Up Studies ; Hip ; Hip Fractures* ; Humans

PURPOSE: To evaluate the ultrasonographic and CT findings of hepatosplenic tuberculosis MATERIALS AND METHODS: We retrospectively reviewed the ultrasonographic and CT findings of confirmed hepatosplenic tuberculosis in 12patients. Six were men and six were women ; their average age was 41, and most were in their twenties. Lesions ofthe liver and spleen, as well as associated findings such as abdominal tuberculosis and other organ involvement oftuberculosis were analyzed. RESULTS: There were three cases of hepatic tuberculosis, seven of splenictuberculosis, and two of hepatosplenic involvement of tuberculosis. On the basis of the ultrasonographic and CTfindings, hepatosplenic tuberculosis was classified as one of two patterns : miliary or micronodular, ormacronodular. The micronodular type was more common (9/12 cases) being characterized by innumerable micronodules,and with easy coalescence in the liver and spleen in five of the nine cases. The macronodular type of low densitymass was noted in the other three patients. Splenomegaly was noted in 12 cases and hepatomegaly in ten. Pulmonarytuberculosis-including the miliary type(n=5)-was noted in eight patients. Associated abdominal tuberculosis suchas lymphadenopathy with central low density and peripheral rim enhancement (n=6), tuberculous peritonitis(n=3),highly attenuated ascites(n=6), adrenal tuberculosis(n=1), renal tuberculosis(n=1), ovarian abscess(n=1), psoasabscess(n=1), and systemic tuberculosis such as central nervous system tuberculoma(n=2), cervicallymphadenopathy(n=4) and tuberculous spondylitis(n=1) were noted. CONCLUSION: Ultrasonography and CT werevaluable in the detection and diagnosis of hepatosplenic tuberculosis
Central Nervous System ; Diagnosis ; Female ; Hepatomegaly ; Humans ; Liver ; Lymphatic Diseases ; Male ; Retrospective Studies ; Spleen ; Splenomegaly ; Tuberculosis* ; Tuberculosis, Gastrointestinal ; Tuberculosis, Hepatic ; Ultrasonography

BACKGROUND: Vitamin D has pleiotropic effects important for the proper functioning of multiple organ systems. We investigated whether serum 25-hydroxyvitamin D [25(OH)D] levels influenced hospitalization-free survival in patients with chronic kidney disease (CKD). METHODS: In this prospective study, serum levels of 25(OH)D were measured in 210 patients with CKD in the winter of 2009. Data regarding hospitalizations were collected over the subsequent 3 years. RESULTS: Vitamin D deficiency, as defined by a serum 25(OH)D level below 15 ng/mL, was observed in 76.7% of the patients. The mean 25(OH)D serum level was 13.6 ± 7.8 ng/mL in predialysis patients (n = 62) and 11.3 ± 6.7 ng/mL in dialysis patients (n = 148). During the follow-up, 107 patients (28 predialysis and 79 dialysis) were hospitalized because of infectious (33.6%) or cardiovascular diseases (23.4%). Predialysis and dialysis groups were divided into 2 subgroups based on the median 25(OH)D serum level. Kaplan-Meier analysis revealed that the risk of hospitalization was significantly lower in both predialysis and dialysis patients with above-median serum 25(OH)D levels (log-rank test; P = 0.043 and 0.002, respectively). Multivariate Cox proportional hazards models also demonstrated that the risk of hospitalization was significantly lower for patients with higher serum 25(OH)D levels in both the predialysis (hazard ratio, 0.963; 95% confidence interval, 0.93-0.99) and dialysis groups (hazard ratio, 0.955; 95% confidence interval, 0.91-0.99). CONCLUSION: A lower serum 25(OH)D level predicted poorer hospitalization-free survival in both predialysis and dialysis CKD patients.
Cardiovascular Diseases ; Dialysis* ; Follow-Up Studies ; Hospitalization ; Humans ; Kaplan-Meier Estimate ; Proportional Hazards Models ; Prospective Studies* ; Renal Insufficiency, Chronic* ; Vitamin D ; Vitamin D Deficiency

BACKGROUND: The most noted rearrangement identified in acute promyelocytic leukemia (APL) involves the PML and RARa genes, which results in the formation of the PML/RARa gene fusion. In the fluorescence in situ hybridization (FISH) for PML/RARa, the two signals may coincidentally overlap in normal nuclei. We investigated whether a new RARa rearrangement probe could discriminate the false-positive fusion signal of the PML/RARa translocation probe. METHODS: A total of 51 cases, which showed the results from 1% to the borderline level by PML/ RARa FISH, were re-tested with the RARa rearrangement probe. Also, we compared the RARa FISH with the PML/RARa FISH on 16 patients with newly diagnosed APL and performed the RARa FISH on 20 bone marrow specimens without hematologic malignancies in order to set up the cut-off value. RESULTS: The cut-off for the RARa FISH was determined as 1.02%. For patients with newly diagnosed APL, the PML/RARa FISH showed positive signals in 95.3+/-6.5% of the cells and RARa FISH showed positive signals in 97.0+/-7.0% (r=0.83). Of a total of 41 cases consisting of hematological disorders other than APL, five cases showed results equal to or greater than 5% with PML/RARa FISH and one case showed a positive result with RARa FISH. Of 10 follow-up APL cases, seven cases showed results equal to or greater than 5% with the PML/RARa FISH and four cases showed positive results with the RARa FISH. CONCLUSIONS: The cut-off value for the RARa FISH is 1.02% and we consider RARa FISH as the proper method for follow-up of APL.
Bone Marrow ; Fluorescence* ; Follow-Up Studies* ; Gene Fusion ; Hematologic Neoplasms ; Humans ; In Situ Hybridization* ; Leukemia, Promyelocytic, Acute*

BACKGROUND: Phlebotomy performed for laboratory testing has the potential to cause anemia in newborns and infants. This study investigated the minimum specimen volume required for an automated immunohematology analyzer DAYmate S. METHODS: Three combinations of tubes were evaluated: I. 6 mL EDTA tube, II. 0.5 mL microtainer (on top of 3 mL EDTA tube), and III. 1 mL sample cup (on top of 6 mL EDTA tube). ABO/RhD cell typing was done using centrifuged red cells; unexpected antibody screening was carried out using plasma, and Type & Screening was conducted using whole blood samples. The lowest specimen volume capable of performing 10 repetitive tests without errors was investigated. RESULTS: ABO/RhD cell typing could be performed from I. 30 μL, II. 25 μL, and III. 25 μL. Unexpected antibody screening could be performed from I. 170 μL, II. 150 μL, and III. 140 μL. According to the hematocrit levels, Type & Screening could be performed from 30%, I&III 650 μL, II. 800 μL; 40%, I&III 650 μL, II. 900 μL; and 50%, I&III 1,000 μL, II. Testing using specimen volumes below 1,000 μL was difficult. CONCLUSION: By separating red cells and plasma, pre-transfusion testing of ABO/RhD cell typing and unexpected antibody screening could be conducted with very small specimen volumes using DAYmate S compared to Type & Screening using whole blood. The application of small-sized sample tubes was more competitive and this is expected to be very useful for preventing iatrogenic anemia in neonates and infants less than 4 months old.
Anemia ; Edetic Acid ; Hematocrit ; Humans ; Infant ; Infant, Newborn ; Mass Screening* ; Phlebotomy ; Plasma

PURPOSE: Despite of the high MMR vaccine coverage, the mumps outbreaks is continued in most developed countries including South Korea. To evaluate the effectiveness of MMR vaccine, we carried out mumps outbreak investigation in one kindergarten. METHODS: In Dec. 2006, a mumps outbreak occurred in a kindergarten. Retrospective study was conducted among 212 respondents (205 children and 7 teachers) in 230 study populations (study participation rate: 92%). To define mumps cases, a questionnaire survey, telephone survey, and mumps antibody test with serum were conducted. MMR vaccination status was verified in 198 children using children's vaccination records, National Immunization Registration System and/or medical records of private clinics or hospitals. RESULTS: Over 90% children had received one dose of MMR vaccination. However, 2nd dose of MMR vaccination rate was 45.1%. Attack rates of mumps were 22.9%(22/96) for one dose MMR vaccinees and 3.3%(3/92) for two doses vaccinees. MMR vaccine effectiveness of two doses over one dose was 86%. Mumps attack rate in one dose MMR vaccinees increased by the duration after MMR vaccination. Among all mumps cases, asymptomatic mumps infection identified by IgM positive or IgG over 10,000mIU/ml was 58% (26/ 45). CONCLUSIONS: MMR one dose coverage rate was high(92.1%), but the second dose vaccination rate was very low (45.1%). Mumps attack rate was increased by the duration after the MMR vaccination, and the maximum effectiveness of one dose MMR vaccination was low (77.1%). Therefore, to prevent mumps outbreaks in the kindergarten, second MMR vaccination should be scheduled in 4 years old age, and the coverage rate should be increased over 90%. Further studies for the effectiveness of MMR two doses after 5 and more years are needed.
Child ; Surveys and Questionnaires ; Developed Countries ; Disease Outbreaks ; Humans ; Immunization ; Immunoglobulin G ; Immunoglobulin M ; Measles-Mumps-Rubella Vaccine ; Medical Records ; Mumps ; Mumps Vaccine ; Republic of Korea ; Retrospective Studies ; Telephone ; Vaccination

BACKGROUND AND OBJECTIVES: Conditions of inferior turbinate other than hypertrophy are rare and its morphology of inferior turbinate is variable. Therefore, the diagnosis of this fatal disease is often delayed. In the present study, histopathologic characteristics of inferior turbinate lesions associated with delayed diagnosis are determined by reviewing the clinical and diagnostic outcomes in patients with inferior turbinate lesions. MATERIALS AND METHOD: The medical records of patients who underwent endoscopic inferior turbinate biopsy following histopathologic evaluation from 2002 to 2013 were retrospectively reviewed, including the previous medical history, physical examination, radiologic findings, histopathologic results, therapy, and follow-up examination. RESULTS: A total 21 patients were included. The most common primary symptoms were nasal obstruction and frequent epistaxis. Diagnosed were 9 benign tumors, 7 malignant tumors, 2 infectious lesions, and 3 autoimmune lesions. Six of 21 patients visited more than three different hospitals before visiting our hospital. One-third of the cases with delayed diagnosis were malignant tumors, which included mucosal melanoma and natural killer/T cell lymphoma. CONCLUSION: In patients with nasal obstruction unresponsive to multiple therapeutic attempts, inferior turbinate neoplasia should be suspected to avoid delaying diagnosis and proper treatment.
Biopsy ; Delayed Diagnosis* ; Diagnosis* ; Epistaxis ; Follow-Up Studies ; Humans ; Hypertrophy ; Lymphoma ; Medical Records ; Melanoma ; Nasal Obstruction ; Pathology* ; Physical Examination ; Retrospective Studies ; Turbinates*

Pulmonary alveolar proteinosis(PAP) is a disorder in which an insoluble, proteinaceous material, rich in phospholipid, is deposited on alveoli and bronchioles. Several cases were reported since 1986, and the numbers of patients is increasing in Korea. Although the pathogenesis and causative treatment of PAP is not well known, whole lung lavage is the only consistently successful treatment. We report 2 cases of PAP which were confirmed by open lung biopsy with electron microscopy and clinically improved by whole lung lavage with a review of literature.
Biopsy ; Bronchioles ; Bronchoalveolar Lavage* ; Humans ; Korea ; Lung* ; Microscopy, Electron ; Pulmonary Alveolar Proteinosis*

OBJECTIVES: This study investigated the toxic effects of cadmium on placental function and reproduction in rats. For this study, the mRNA levels of the placental prolactin-growth hormone (PRL-GH) gene family, placental trophoblast cell frequemcy and reproductive data were analyzed. METHODS: Pregnant F344 Fisher rats (200 g+/-23 g) were intraperitoneally injected with 0, 0.5, and 5.0 mg/kg B.W/day of cadmium (CdCl2) dissolved in saline from days 7-11 or 16-20 of pregnancy, and were sacrificed at days 11 or 20, respectively. The mRNA levels were analyzed by Northern blot hybridization and reverse transcription-polymerase chain reaction. The hormone concentration was analyzed by radioimmunoassay and the frequemcy of the placental trophoblast cells was observed by histochemical study. Reproductive data were surveyed at day 20 of the pregnancy and after the births. Statistical analysis was carried out using the SAS program (version 8.1). RESULTS: The mRNA levels of the PRL-GH gene family were reduced dose dependently by cadmium. The mRNA levels of Pit-1a and -b isotype genes were also reduced by cadmium. The hormone concentration of PL-Iv and -II was decreased by cadmium. During the second half of pregnancy (days 11-21), a high dose of cadmium exposure significantly reduced the frequency of spongiotrophoblast and trophoblast giant cells that secrete the PRL-GH hormones. In the last stage of pregnancy (day 20), a high dose of cadmium exposure induced the apoptosis of spon-giotrophoblast cells in the junctional zone of the placenta. Reproductive data such as placental and infant weight, number of live fetuses were decreased, and number of resorptions and dead fetuses, post-implantation loss were increased significantly in the cadmium exposed group compared with the control. CONCLUSIONS: Cadmium disrupts the functions of the placenta and these effects leads to reproductive disorders in rats.
Animals ; Apoptosis ; Blotting, Northern ; Cadmium* ; Fetus ; Giant Cells ; Humans ; Infant ; Parturition ; Placenta ; Pregnancy ; Radioimmunoassay ; Rats* ; Reproduction* ; RNA, Messenger ; Trophoblasts

Background: Psoriasis imposes a significant treatment burden on patients, particularly impacting well-being and quality of life (QoL). The psychosocial impact of psoriasis treatments remains unexplored in most patient populations. Objective: To assess the impact of adalimumab on health-related QoL (HRQoL) in Korean patients with psoriasis. Methods: This 24-week, multicenter, observational study, assessed HRQoL in Korean patients treated with adalimumab in a real-world setting. Patient-reported outcomes (PROs) including European Quality of Life-5 Dimension scale (EQ-5D), EQ-5D VAS, SF-36, and DLQI were evaluated at week 16 and 24, versus baseline. Patient satisfaction was assessed using TSQM. Results: Among 97 enrolled patients, 77 were assessed for treatment effectiveness. Most patients were male (52, 67.5%) and mean age was 45.4 years. Median baseline body surface area and Psoriasis Area and Severity Index (PASI) scores were 15.00 (range 4.00~80.00) and 12.40 (range 2.70~39.40), respectively. Statistically significant improvements in all PROs were observed between baseline and week 24. Mean EQ-5D score improved from 0.88 (standard deviation [SD], 0.14) at baseline to 0.91 (SD, 0.17) at week 24 (p=0.0067). The number of patients with changes in PASI 75, 90, or 100 from baseline to week 16 and 24 were 65 (84.4%), 17 (22.1%), and 1 (1.3%); and 64 (83.1%), 21 (27.3%), and 2 (2.6%), respectively. Overall treatment satisfaction was reported, including effectiveness and convenience. No unexpected safety findings were noted. Conclusion Adalimumab improved QoL and was well-tolerated in Korean patients with moderate to severe psoriasis, as demonstrated in a real-world setting. Clinical trial registration number (clinicaltrials.gov: NCT03099083).