Bisphosphonate is notable for the treatment of osteoporosis in the world. But recently if Bisphosphonate is taken for a long time, it causes an insufficiency fracture by suppression of bone turn-over and it is reported rarely on femur neck. Here we report a case of insufficiency fracture on ipsilateral femur neck in woman treated with long term Bisphosphonate therapy.
Female ; Femur ; Femur Neck ; Fractures, Stress ; Humans ; Osteoporosis

Compared with acromioclavicular dislocation, dislocation of the clavicle at its sternal end is uncommon and accounts for 3% of all injuries to the shoulder girdle. Furthermore, the posterior dislocation of the sternoclavicular joint is relatively a rare injury compared to the other types of sternoclavicular dislocation. We report this case since we have experience with similar cases of traumatic posterior dislocation at the sternoclavicular joint, which were successfully treated with x-ray guided reduction.
Clavicle ; Dislocations ; Shoulder ; Sternoclavicular Joint

A 49 years old male patient suffering from liver cirrhosis and diabetes mellitus was admitted with complaints of chest pain and hematemesis. Three years ago, the patient received a transfusion of unknown blood components, presumed platelet concentrates. During the pretransfusion testing, we found irregular antibodies with the antibody-screening test and identified the antibody as anti-Xga. An antiglobulin test was done as a part of a cross-match and all compatible units of packed red cells were transfused. No transfusion reaction was observed.
Antibodies ; Blood Group Incompatibility ; Blood Platelets ; Chest Pain ; Coombs Test ; Diabetes Mellitus ; Hematemesis ; Humans ; Liver Cirrhosis ; Liver Diseases* ; Liver* ; Male ; Middle Aged

BACKGROUND: Fibrin-related markers (FRM) such as fibrin monomer (FM) and D-dimer (DD) are considered useful biological markers for the diagnosis of disseminated intravascular coagulation (DIC). However, no studies on the diagnostic performance of different FRMs have been published in Korea. The aim of this study was to evaluate the diagnostic performance of FM for DIC in comparison with DD. METHODS: The reference limit of FM was determined based on plasma sample data obtained from 210 control individuals. To evaluate diagnostic performance, FM data from the plasma samples of 139 patients with DIC-associated diseases were obtained for DIC scoring. FM was measured by immunoturbidimetry using STA-LIATEST FM (Diagnostica Stago, France). Patients were classified according to the DIC score as non-DIC, non-overt DIC, or overt DIC. ROC curve analyses were performed. RESULTS: The reference limit in the control individuals was determined to be 7.80 microg/mL. Patients with DIC-associated diseases were categorized as non-DIC (N=43), non-overt DIC (N=80), and overt DIC (N=16). ROC curve analyses showed that the diagnostic performance of FM was comparable to DD in both non-overt DIC and overt DIC (P=0.596 and 0.553, respectively). In addition, FM had higher sensitivity, specificity, positive predictive value, and negative predictive value than DD for differentiating overt DIC from non-DIC. CONCLUSIONS: This study demonstrated that the diagnostic performance of FM for DIC was comparable to DD. FM might be more sensitive and more specific than DD in the diagnosis of overt DIC, but not non-overt DIC.
Area Under Curve ; Biological Markers/blood ; Disseminated Intravascular Coagulation/blood/*diagnosis ; Fibrin Fibrinogen Degradation Products/*analysis/immunology/standards ; Humans ; Immunoassay/*methods/standards ; Nephelometry and Turbidimetry/*methods/standards ; ROC Curve ; Reagent Kits, Diagnostic ; Reference Values

BACKGROUND: Fibrin-related markers (FRM) such as fibrin monomer (FM) and D-dimer (DD) are considered useful biological markers for the diagnosis of disseminated intravascular coagulation (DIC). However, no studies on the diagnostic performance of different FRMs have been published in Korea. The aim of this study was to evaluate the diagnostic performance of FM for DIC in comparison with DD. METHODS: The reference limit of FM was determined based on plasma sample data obtained from 210 control individuals. To evaluate diagnostic performance, FM data from the plasma samples of 139 patients with DIC-associated diseases were obtained for DIC scoring. FM was measured by immunoturbidimetry using STA-LIATEST FM (Diagnostica Stago, France). Patients were classified according to the DIC score as non-DIC, non-overt DIC, or overt DIC. ROC curve analyses were performed. RESULTS: The reference limit in the control individuals was determined to be 7.80 microg/mL. Patients with DIC-associated diseases were categorized as non-DIC (N=43), non-overt DIC (N=80), and overt DIC (N=16). ROC curve analyses showed that the diagnostic performance of FM was comparable to DD in both non-overt DIC and overt DIC (P=0.596 and 0.553, respectively). In addition, FM had higher sensitivity, specificity, positive predictive value, and negative predictive value than DD for differentiating overt DIC from non-DIC. CONCLUSIONS: This study demonstrated that the diagnostic performance of FM for DIC was comparable to DD. FM might be more sensitive and more specific than DD in the diagnosis of overt DIC, but not non-overt DIC.
Area Under Curve ; Biological Markers/blood ; Disseminated Intravascular Coagulation/blood/*diagnosis ; Fibrin Fibrinogen Degradation Products/*analysis/immunology/standards ; Humans ; Immunoassay/*methods/standards ; Nephelometry and Turbidimetry/*methods/standards ; ROC Curve ; Reagent Kits, Diagnostic ; Reference Values

PURPOSE: Microsurgery is an essential technique in plastic and reconstructive surgery. However, microsurgical suturing and handling of the instrument are difficult for beginners, and who requires a steep learning curve. Therefore, methods for improving the technical skill are needed. The authors describe the value of a small stereoscopic microscope as a training tool. MATERIALS AND METHODS: A small stereoscopic microscope was used to help improve the microsurgical skill. Monofilament 10-0 Nylon and a surgical rubber globe were used as a suture material and education material, respectively RESULT: Stereoscopic view of the operation field was obtained and basic microsurgical suture was possible. CONCLUSION: The stereoscopic microscope is an effective training tool for beginners of microsurgery with benefits in cost and usefulness in small place.
Handling (Psychology) ; Hypogonadism ; Learning Curve ; Microsurgery ; Mitochondrial Diseases ; Nylons ; Ophthalmoplegia ; Plastics ; Rubber ; Sutures

BACKGROUND AND OBJECTIVES: The polysomnography is essential for diagnosis of obstructive sleep apnea-hypopnea (OSAH) and provides important objective information. But, in fact, there are some difficulties for comprehensive interpretation of multiple indices from the polysomnogram. This study was designed to find out which polysomnogram indices were significant to respiratory distress indices (RDI) and apnea index (AI) on statistical correlation and which other indices should be considered together for proper management plan apart from RDI and AI (respiratory index). SUBJECTS AND METHOD: We evaluated 40 patients whose RDI were over 5 as the result of overnight polysomnography before any management from February 2003 to September 2003 at Eulji medical center. By multiple linear regression analysis, we studied the relationship of RDI and AI as dependent variables to ST, O2 desaturation events (O2DE), lowest O2 saturation (LoO2), slow wave sleep portion (S3&S4), arousal index (ArI), body-mass index (BMI) and age. We also studied the relationship of ST as an dependent variable to O2DE, LoO2, S3&S4, ArI, BMI, and age. RESULTS: 1) There were significant correlations between RDI and O2DE, ArI as was true between AI and O2DE, ArI (p<0.05). And there was no significant difference in the degree of the correlation between RDI and AI. 2) Other variables such as ST, LoO2, S3&S4, BMI and age were not significant. 3) ST had no significant correlation with respiratory index and any other variables (p<0.05). CONCLUSION: Because the respiratory index may not the entire physical status during sleep for OSAH patients, multiple indices (such as LoO2, BMI, ST, S3&S4, age) should be considered together apart from the respiratory index for proper management plan.
Apnea ; Arousal ; Diagnosis ; Humans ; Linear Models ; Polysomnography* ; Sleep Apnea, Obstructive

Authors measured the length of the auricle of both sides, and the length of face to know the medicolegal significance of them in 265 medicolegal autopsy cases. The data were analyzed by anthropometric study method to gain the ear-face height index (auricular length x 100/facial length). The results were as follows: 1. The relationship between the ear-face height indices of the length of life is statistically significant (r=0.34; p<0.001). 2. The relationship between the ear-face height indices of the length of life is higher than in females than males (males: r=0.28, females: r=0.51). 3. In the natural deaths and homicide cases, the relationship between the ear-face height indices of the length of life is higher than the accidental deaths and suicide cases, however, the natural death cases only show statistically significant relationship between the ear-face height indices of the length of life (p<0.05).
Anthropometry ; Autopsy* ; Ear* ; Female ; Homicide ; Humans ; Longevity ; Male ; Suicide

Cytomegalovirus (CMV) is one of the most important opportunistic infections in transplant recipients. Tests for CMV-specific T cell responses have been proposed to change the current risk stratification strategy using CMV assays. We evaluated the usefulness of pre-transplant CMV-specific T cell assays in kidney transplant (KT) candidates for predicting the development of CMV infection after transplantation comparing the results of the overlapping peptides (OLPs)-based enzyme-linked immunospot (ELISPOT) assay and the commercial QuantiFERON-CMV assay. We prospectively enrolled all cases of KT over a 5-month period, except donor CMV-seropositive and recipient seronegative transplants that are at highest risk of CMV infection. All the patients underwent QuantiFERON-CMV, CMV OLPs-based pp65, and immediate-early 1 (IE-1)-specific ELISPOT assays before transplantation. The primary outcome was the incidence of CMV infection at 6 months after transplant. The total of 47 KT recipients consisted of 45 living-donor KTs and 2 deceased-donor KTs. There was no association between positive QuantiFERON-CMV results and CMV infection. However, 10 of 34 patients with phosphoprotein 65 (pp65)- or IE-1-specific ELISPOT results higher than cut-off value developed CMV infections compared with none of 13 patients with results lower than cut-off value developed CMV. The OLPs-based ELISPOT assays are more useful than the QuantiFERON-CMV assay for predicting CMV infection. Patients with higher CMV-specific T cell immunity at baseline appear to be more likely to develop CMV infections after KT, suggesting that the abrupt decline in CMV-specific T cell responses after immunosuppression, or high CMV-specific T cell responses due to frequent CMV activation before KT, may promote CMV infection.
Cytomegalovirus ; Enzyme-Linked Immunospot Assay* ; Humans ; Immunity, Cellular ; Immunosuppression ; Incidence ; Interferon-gamma Release Tests ; Kidney* ; Opportunistic Infections ; Peptides ; Prospective Studies ; Tissue Donors ; Transplant Recipients*

Adrenal myelolipoma (AML) is a rare, usually benign, and nonfunctioning tumor. About 7-15% of adrenal incidentalomas are AMLs, composed of normal hematopoietic elements and mature adipose tissue. AML is usually unilateral and < 4 cm. It is often discovered incidentally on abdominal computed tomography or magnetic resonance imaging. It is related to a chronic increase in adrenocorticotropic hormone, such as that observed in patients with congenital adrenal hyperplasia, Cushing disease, Conn's syndrome, and pheochromocytoma. Here, we report a 28-year-old man diagnosed with non-salt-losing congenital adrenal hyperplasia with huge bilateral AMLs and a literature review.
Adipose Tissue ; Adrenal Hyperplasia, Congenital* ; Adrenocorticotropic Hormone ; Adult ; Humans ; Hyperaldosteronism ; Magnetic Resonance Imaging ; Myelolipoma* ; Pheochromocytoma ; Pituitary ACTH Hypersecretion