Necrotizing fasciitis (NF) is a deep infection of the subcutaneous tissue that progressively destroys fascia and fat; it is associated with systemic toxicity, a fulminant course, and high mortality. NF most frequently develops from trauma that compromises skin integrity, and is more common in patients with predisposing medical conditions such as diabetes mellitus, atherosclerosis, alcoholism, renal disease, liver disease, immunosuppression, malignancy, or corticosteroid use. Most often, NF is caused by polymicrobial pathogens including aerobic and anaerobic bacteria. NF caused by Staphylococcus aureus as a single pathogen, however, is rare. Here we report a case of NF that developed in a healthy woman after an isolated shoulder sprain that occurred without breaking a skin barrier, and was caused by Staphylococcus aureus as a single pathogen.
*Arm ; Coagulase/metabolism ; Fasciitis, Necrotizing/*etiology/microbiology/pathology/surgery ; Female ; Humans ; Middle Aged ; Shoulder Joint/*injuries ; Sprains and Strains/*complications ; Staphylococcal Infections/*etiology/microbiology ; Staphylococcus aureus/enzymology/isolation & purification

PURPOSE: To evaluate the radiological and clinical outcomes of the operative treatment for the unstable distal radius fractures with displaced ulnar styloid process fractures. MATERIALS AND METHODS: From 2002 to 2005, 17 patients with unstable distal radius fractures with displaced ulnar styloid process fractures were treated operatively, using external fixation or internal fixation for distal radius and open reduction with tension band wiring for ulnar styloid process fractures. We evaluated postoperative outcomes with Mayo wrist score, range of motion, ulnar side wrist pain, wrist stress test, grip strength as well as radiological evaluation. RESULTS: All ulnar styloid process fractures were completely united, and according to Mayo wrist score, 7 cases(41%) were excellent, 8 cases(47%) were good. 14 cases(82%) had no ulnar wrist pain and 15 cases(88%) had grip strength more than 50% when compared with the normal side. Posterior instability of ulnar head occurred at 1 case. CONCLUSION: We got acceptable clinical and radiological results of operative treatment of ulnar styloid process fractures and concluded that ulnar styloid process fractures combined with distal radius fractures should be carefully evaluated and treated operatively according to their fracture types.
Exercise Test ; Hand Strength ; Head ; Humans ; Radius ; Radius Fractures ; Range of Motion, Articular ; Wrist

BACKGROUND: The aim of this study was to estimate the prevalence and incidence of type 1 diabetes mellitus (T1DM) in Korea. In addition, we planned to do a performance analysis of the Registration Project of Type 1 diabetes for the reimbursement of consumable materials. METHODS: To obtain nationwide data on the incidence and prevalence of T1DM, we extracted claims data from July 2011 to August 2013 from the Registration Project of Type 1 diabetes on the reimbursement of consumable materials in the National Health Insurance (NHI) Database. For a more detailed analysis of the T1DM population in Korea, stratification by gender, age, and area was performed, and prevalence and incidence were calculated. RESULTS: Of the 8,256 subjects enrolled over the 26 months, the male to female ratio was 1 to 1.12, the median age was 37.1 years, and an average of 136 new T1DM patients were registered to the T1DM registry each month, resulting in 1,632 newly diagnosed T1DM patients each year. We found that the incidence rate of new T1DM cases was 3.28 per 100,000 people. The average proportion of T1DM patients compared with each region's population was 0.0125%. The total number of insurance subscribers under the universal compulsory NHI in Korea was 49,662,097, and the total number of diabetes patients, excluding duplication, was 3,762,332. CONCLUSION: The prevalence of T1DM over the course of the study was approximately 0.017% to 0.021% of the entire population of Korea, and the annual incidence of T1DM was 3.28:100,000 overall and 3.25:100,000 for Koreans under 20 years old.
Diabetes Mellitus, Type 1* ; Epidemiology* ; Female ; Humans ; Incidence ; Insurance ; Korea* ; Male ; National Health Programs ; Prevalence

PURPOSE: Recombinant human growth hormone is an effective therapy for short-statured children born small for their gestational age (SGA). This single-arm, multicenter, phase III clinical study of such children was designed to assess the efficacy and safety of treating them with recombinant human-growth-hormone (Eutropin(TM) Inj.) for 6 months. METHODS: Between 2005 and 2007, 30 treatment naive, prepubertal, short-statured SGA-born children were recruited as participants. Eutropin(TM) Inj. was administered for 6 months with a subcutaneous dose of 0.48 mg/kg/wk. The primary endpoint was the change in height velocity from the baseline to month 6. Various parameters were checked to obtain secondary outcome measures and to meet safety criteria. RESULTS: Height velocity significantly increased from 5.36 +/- 1.59 cm/yr at baseline to 10.66 +/- 2.03 cm/yr at month 6 (P < 0.0001). Secondary outcome measures (height velocity at month 3, height SDS for chronological age (CA), weight SDS for CA, bone maturation, and IGF-I and IGFBP-3 levels) were also significantly increased. Eutropin(TM) Inj. was well tolerated and safe over 6 months of treatment. CONCLUSION: The clinical efficacy and safety of Eutropin(TM) Inj. was demonstrated for the 6 month treatment of prepubertal children with short stature due to SGA. Further long-term study is needed.
Child ; Gestational Age ; Human Growth Hormone ; Humans ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Outcome Assessment (Health Care)

BACKGROUND: Carcinoembryonic antigen (CEA) is a glycoprotein on cellular surface, which is highly condensed in embryonic tissue and tumor of various kinds. Previous study found out that CEA may grow with various cancer or other diseases other than cancer as well. Besides, it is widely known that smoking also influences the rise in CEA. Among the same smokers, some of them show high CEA figures in serum when others remain in normal range. There are those whose pulmonary function is not influenced by smoking when that of others are susceptible to it. Therefore, this study was undertaken with an aim to study the relationship between serum CEA and pulmonary function by investigating how the change in pulmonary function caused by smoking influences serum CEA. METHODS: From Nov, 1997 to Feb, 2001, this study carried out tests on adult male smokers ages 35 to 64 who visited a hospital located in Kang Nung city. The subjects were divided into two groups: one group of 29 subjects with high CEA with over 6.0 ng/ml with normal colon study; the other group, which is the CEA normal group, consisted of 58 subjects selected through age adjusted random sampling. Data on personal information, smoking and clinical history was collected from a questionnaire. CEA was tested using radioimmunoassay of Abott. Pulmonary function was examined using Analyzer assembly Vmax 20C from Sensormedics Company. These examinations was limited to those who have been screened not to have cancer by chest X-ray, abdominal ultrasonography, and duodenofibroscopy. RESULTS: Smoking per day for the group with high serum CEA was 1.3 pack ( 0.4 pack), which was found to be significantly higher compared to that of normal group (P<0.01). Pack-years with high serum CEA group was 32.6 13.5 which was also comparatively higher than that of the normal group with 22.4 10.9 (P<0.01). Pulmonary function test indicated that FEV1 for the group with high serum CEA was 3.0 0.5 L, which marked lower than that of the normal group with 3.4 0.5 L (P<0.05). After compensating for age and pack years, FEV1 decreased in proportion to the rise in CEA. CONCLUSION: This study has established a link between serum CEA and daily smoking, pack years, and pulmonary function and found that FEV1 was inversely proportionate to the rise in CEA regardless of corrected pack years and daily smoking. Consequently, serum CEA alone is thought to be related to the pulmonary function. Therefore, it is advised that smokers with high serum CEA need to take heed of the influence on pulmonary function.
Adult ; Carcinoembryonic Antigen* ; Colon ; Glycoproteins ; Humans ; Male* ; Radioimmunoassay ; Reference Values ; Respiratory Function Tests ; Smoke ; Smoking ; Thorax ; Ultrasonography ; Surveys and Questionnaires

BACKGROUND: Post-transplant infections by antibiotic-resistant bacteria (ARB) are increasing in prevalence because of the wide use of broad-spectrum antibiotics. At our center, the perioperative prophylaxis for liver transplant recipients consistes of cefoperazone/sulbactam and ampicillin. When the recipient develops signs of infection, the initial antibiotics are empirically replaced with meropenem and vancomycin. We analyzed the epidemiology of ARB to assess the appropriateness of replacing empirical antibiotics during the first month after liver transplantation. METHODS: We reviewed 88 patients who had undergone living donor liver transplant between January 2006 and September 2007. RESULTS: Two hundred and seventy-six strains of bacteria were microbiologically documented in 75 liver transplant recipients. The most common bacteria was Staphylocococcus aureus (27%), followed by coagulase-negative staphylococci (CNS, 20%), Enterococcus species (18%) and Klebsiella species (7%). Our data on the resistance pattern showed that 87.8% and 71.4% of the S. aureus and CNS were resistant to methicillin, respectively; 88% of the Enterococcus species were resistant to ampicillin and 24% to vancomycin; and 62% of all enteric gram-negative bacilli (GNB) were resistant to 3rd generation cephalosporins. No strains of meropenem-resistant GNB were detected. Only one glucose non-fermentative GNB was resistant to all antibiotics except aminoglyco sides and colistin. CONCLUSIONS: Mainly methicillin-resistant gram- positive bacterial strains, including S. aureus and CNS, can colonize in early period after transplantation. According to the epidemiologic data on the high prevalence of antibiotic-resistant organisms, the empirical treatment regimen at our center is considered as appropriate. However, shifting down to less-broad-spectrum antibiotics after the pathogens are confirmed is essential to lowering the rate of ARB.
Ampicillin ; Anti-Bacterial Agents ; Bacteria ; Cephalosporins ; Colistin ; Colon ; Enterococcus ; Glucose ; Humans ; Klebsiella ; Liver ; Liver Transplantation ; Living Donors ; Methicillin ; Methicillin Resistance ; Prevalence ; Thienamycins ; Transplants ; Vancomycin

Prostate cancer is the most common type of male cancer worldwide. Although radical prostatectomy (RP) is advised for prostate cancer in patients with a life expectancy of more than 10 years by various guidelines, most elderly men still do not undergo the procedure regardless of increasing life expectancy. This study aimed to determine whether RP is suitable for patients with prostate cancer aged 75 years or older. A retrospective study of patients who underwent RP at 6 institutions between 2005 and 2012 was conducted. Patients were divided into 2 groups at the time of surgery: 65-69 years (younger group) and 75 years or older (older group). We compared clinical characteristics, pathological results, complication rates, and recurrence-free survival between the two groups. Compared with the younger group, the older group had significantly higher preoperative serum prostate-specific antigen level, pre- and postoperative Eastern Cooperative Oncology Group (ECOG) performance status grade, hypertension prevalence, and Gleason score at biopsy and RP. However, except urinary incontinence, there were no statistically significant differences in the peri- and post-operative complications. After median follow-up periods of 36 months (younger group) and 40 months (older group), the biochemical recurrence-free survival rates were not significantly different (P = 0.581). Although the urinary incontinence rate was higher in the older group, RP was a suitable option for selected Korean men aged 75 years or older with limited complication rates and excellent outcomes similar to those for patients aged 65-69 years.
Age Factors ; Aged ; Biopsy ; Disease-Free Survival ; Humans ; Hypertension/epidemiology ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Grading ; Prostate-Specific Antigen/blood ; Prostatectomy ; Prostatic Neoplasms/mortality/pathology/*surgery ; Republic of Korea ; Retrospective Studies

PURPOSE: To evaluate the relative value of arterial, portal and delayed phase images in the measurement of hepatic metastatic mass arising from gastrointestinal malignant tumor using spiral CT. MATERIALS AND METHODS: Thirty-three with 45 metastatic tumors of the liver underwent tri-phasic spiral CT. For this purpose one or two lesions were chosen in each patient whose primary tumor was shown to be stomach cancer(n=15), colon cancer(n=16), or ileal cancer(n=1). Tumor size ranged from 1 to 12.2 (mean, 4.3)cm. Arterial, portal and delayed phase images were obtained at 30 -35 seconds, 70 -75 seconds, and 3 minutes, respectively, after the injection of contrast materials. Using a work station, two radiologists independently measured the longest diameter of the selected lesions, and a second measurement was taken three days later. Contrast, as well as intra-and interbserver differences among the three phases, was statistically analysed. RESULTS: Intra- and interobserver difference were, espectively, 2.3 and 3.8 mm during the portal phase; 3.3 and 4.6 mm during the arterial phase; and 2.9 and 4.5 mm during the delayed phase. ANOVA with Tukey's multiple comparison showed that none of these differences were statistically significant. Contrast between mass and liver parenchyma was especially clear during the portal phase (p=0.0001, using the Kruskal-Wallis CONCLUSION: Intra- and interobserver differences in the measurement of hepatic metastatic tumors were statistically insignificant during all three phases. The least difference and best contrast were seen during the portal phase.
Colon ; Contrast Media ; Humans ; Liver ; Stomach ; Tomography, Spiral Computed*

PURPOSE: To evaluate the prevalence of bladder neck contracture (BNC) and its risk factors in patients undergoing radical prostatectomy in Korea. MATERIALS AND METHODS: We analyzed data from 488 patients with prostatic cancer who underwent radical prostatectomy performed by seven surgeons in seven hospitals, including 365 open radical prostatectomies (ORPs), 99 laparoscopic radical prostatectomies (LRPs), and 24 robot-assisted laparoscopic radical prostatectomies (RARPs). Patients with BNCs were compared with those without BNCs to identify the risk factors for BNC occurrence. RESULTS: Overall, BNCs occurred in 21 of 488 patients (4.3%): 17 patients (4.7%) who underwent ORP, 4 patients (4%) who underwent LRP, and no patients who underwent RARP. In the univariate analysis, men with BNCs had a longer length of time before drain removal (12 days vs. 6.8 days, p<0.001), which reflected urinary leakage through the vesicourethral anastomosis. In the multivariate analysis, the length of time before drain removal was the only predictor of BNC (odds ratio, 1.12; p=0.001). Intraoperative blood loss was higher in patients with BNC, but the difference was not statistically significant. CONCLUSIONS: The most significant factor related to BNC occurrence after radical prostatectomy in our study was the length of time before drain removal, which reflects urinary leakage from the vesicourethral anastomosis. The proper formation of a watertight anastomosis to decrease urinary leakage may help to reduce the occurrence of BNC.
Contracture ; Humans ; Male ; Multivariate Analysis ; Neck ; Prevalence ; Prostatectomy ; Prostatic Neoplasms ; Risk Factors ; Urinary Bladder ; Urinary Bladder Neck Obstruction

The calcium sensing receptor (CaSR) plays an important role for sensing local changes in the extracellular calcium concentration ([Ca2+]o) in bone remodeling. Although the function of CaSR is known, the regulatory mechanism of CaSR remains controversial. We report here the regulatory effect of caveolin on CaSR function as a process of CaSR regulation by using the human osteosarcoma cell line (Saos-2). The intracellular calcium concentration ([Ca2+]i) was increased by an increment of [Ca2+]o. This [Ca2+]i increment was inhibited by the pretreatment with NPS 2390, an antagonist of CaSR. RT-PCR and Western blot analysis of Saos-2 cells revealed the presence of CaSR, caveolin (Cav)-1 and -2 in both mRNA and protein expressions, but there was no expression of Cav-3 mRNA and protein in the cells. In the isolated caveolae-rich membrane fraction from Saos-2 cells, the CaSR, Cav-1 and Cav-2 proteins were localized in same fractions (fraction number 4 and 5). The immuno-precipitation experiment using the respective antibodies showed complex formation between the CaSR and Cav-1, but no complex formation of CaSR and Cav-2. Confocal microscopy also supported the co-localization of CaSR and Cav-1 at the plasma membrane. Functionally, the [Ca2+]o- induced [Ca2+]i increment was attenuated by the introduction of Cav-1 antisense oligodeoxynucleotide (ODN). From these results, in Saos-2 cells, the function of CaSR might be regulated by binding with Cav-1. Considering the decrement of CaSR activity by antisense ODN, Cav-1 up-regulates the function of CaSR under normal physiological conditions, and it may play an important role in the diverse pathophysiological processes of bone remodeling or in the CaSR- related disorders in the body.
Bone Neoplasms ; Calcium/*metabolism ; Caveolins/*metabolism ; Cell Fractionation ; Cell Line, Tumor ; Cell Membrane/*metabolism ; Humans ; Microscopy, Confocal ; Oligoribonucleotides, Antisense/pharmacology ; Osteosarcoma ; Receptors, Calcium-Sensing/antagonists & inhibitors/*metabolism ; Research Support, Non-U.S. Gov't ; Up-Regulation