BACKGROUND: Since the first introduction of radioimmunoassay for the quantification of the thyroidstimulating hormone (TSH), more advanced analytical methods have been developed and used in laboratories. However, they are still inconvenient in that they require time-consuming procedures, special safety in handling isotopes, expensive equipment, and a highly qualified expert. METHODS: As an immunoassay system for the rapid measurement of TSH in serum, we have developed a new analytical system based on immunochromatographic assay with fluorescencelabeled anti-TSH monoclonal antibodies. The assay system is composed of a test strip housed within a cartridge and a laser-fluorescence scanner for quantification. The strip contains a sample pad, an absorption pad, and a nitrocellulose membrane where a captured antibody is immobilized and antigen-antibody reaction occurs. Fifty microL of serum was added to 50 microL of a detector solution and the mixture was loaded onto the well of the sample pad on the cartridge. After incubation for 12 min, the cartridge was quantified with the laser-fluorescence scanner. RESULTS: The calibration curve displayed linearity (R=0.95) at concentrations of 1-40 mIU/L. Intraand inter-assay imprecisions were determined to be CVs within 10%. Analytical recovery was 93.9% at 3 different concentrations and the detection limit was 0.868 mIU/L of TSH. The new assay system correlated well with an Abbott AxSYM for quantification of TSH (R=0.97, slope 0.94, N=20). CONCLUSIONS: The TSH measurement system developed in this study showed good reproducibility. However, our TSH quantification system needs some improvement to be used in the medical field because of its low analytical sensitivity. With enhanced performance in analytical sensitivity, introduction of a whole-blood type strip, and a more miniaturized fluorescence scanner, we expect the TSH analytical system to be used for point-of-care testing in the near future.
Absorption ; Antibodies, Monoclonal ; Antigen-Antibody Reactions ; Calibration ; Collodion ; Fluorescence* ; Immunoassay ; Immunochromatography* ; Isotopes ; Limit of Detection ; Membranes ; Radioimmunoassay ; Thyrotropin*

PURPOSE: Authors investigated the associated findings and their value in the diagnosis of anterior cruciate ligament(ACL) injury in MR image. MATERIAL AND METHODS: The knee MR images of 47 patients with ACL injury(complete; 24, partial; 23) and 61 patients with normal ACL confirmed by the knee arthroscopy or operation were reviewed retrospectively. The degree of anterior translocation of tibia and the degree of posterior cruciate ligament(PCL) buckling were evaluated. The prevalence and pattern of associated adjacent bone, ligament and meniscus injuries were studied. RESULTS: The means( +/- 2standard errors) of anterior translocation were different significantly in statistical analysis(p<0.001, student t-test) between injury group(7.51 +/- 1.16mm) and normal group(-0.56 +/- 0.92mm). In the level of 5mm of anterior translocation for the criteria of ACL injury, the sensitivity, specificity, accuracy were 78.7%, 89.5%, 84.3% for each. The means of PCL buckling ratio were also different statistically b. etween injury group(0.23 +/- 0.02) and normal group(0.17 +/- 0.01)(p<0.001). In the level of 0.20 for diagnostic criteria of ACL injury, the sensitivity, specificity, accuracy were 71.4%, 83.6%, 78.4% for each. Thirty one medial meniscus tear(66%), thirteen lateral meniscus tear(28%), ten medial collateral ligament injury(28%), one PCL injury (2%) were associated with ACL injury. The twenty nine bone marrow changes were found in twenty patients {43%) which included acutely injured seven patients. In acute cases, the bone marrow changes were depicted as diffuse or focal high signal intensity lesions in lateral femoral or tibial condyles in contrast to the changes in chronic cases depicted as focal low signal intensity lesions in variable location. Lateral femoral condylar notch depression were found in nine patients(19%) and avulsion fractures of anterior tibial spine in four patients(9%). CONCLUSION: The associated findings with ACL injury (anterior translocation, buckling of PCL, associated bone, ligament and meniscus injuries) are considered to be helpful in the diagnosis of ACL injury on Knee MR images, when the findings of anterior cruciate ligament itself are not confirmative.
Anterior Cruciate Ligament* ; Arthroscopy ; Bone Marrow ; Collateral Ligaments ; Depression ; Diagnosis ; Humans ; Knee ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Prevalence ; Retrospective Studies ; Sensitivity and Specificity ; Spine ; Tibia

PURPOSE: Authors investigated the associated findings and their value in the diagnosis of anterior cruciate ligament(ACL) injury in MR image. MATERIAL AND METHODS: The knee MR images of 47 patients with ACL injury(complete; 24, partial; 23) and 61 patients with normal ACL confirmed by the knee arthroscopy or operation were reviewed retrospectively. The degree of anterior translocation of tibia and the degree of posterior cruciate ligament(PCL) buckling were evaluated. The prevalence and pattern of associated adjacent bone, ligament and meniscus injuries were studied. RESULTS: The means( +/- 2standard errors) of anterior translocation were different significantly in statistical analysis(p<0.001, student t-test) between injury group(7.51 +/- 1.16mm) and normal group(-0.56 +/- 0.92mm). In the level of 5mm of anterior translocation for the criteria of ACL injury, the sensitivity, specificity, accuracy were 78.7%, 89.5%, 84.3% for each. The means of PCL buckling ratio were also different statistically b. etween injury group(0.23 +/- 0.02) and normal group(0.17 +/- 0.01)(p<0.001). In the level of 0.20 for diagnostic criteria of ACL injury, the sensitivity, specificity, accuracy were 71.4%, 83.6%, 78.4% for each. Thirty one medial meniscus tear(66%), thirteen lateral meniscus tear(28%), ten medial collateral ligament injury(28%), one PCL injury (2%) were associated with ACL injury. The twenty nine bone marrow changes were found in twenty patients {43%) which included acutely injured seven patients. In acute cases, the bone marrow changes were depicted as diffuse or focal high signal intensity lesions in lateral femoral or tibial condyles in contrast to the changes in chronic cases depicted as focal low signal intensity lesions in variable location. Lateral femoral condylar notch depression were found in nine patients(19%) and avulsion fractures of anterior tibial spine in four patients(9%). CONCLUSION: The associated findings with ACL injury (anterior translocation, buckling of PCL, associated bone, ligament and meniscus injuries) are considered to be helpful in the diagnosis of ACL injury on Knee MR images, when the findings of anterior cruciate ligament itself are not confirmative.
Anterior Cruciate Ligament* ; Arthroscopy ; Bone Marrow ; Collateral Ligaments ; Depression ; Diagnosis ; Humans ; Knee ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Prevalence ; Retrospective Studies ; Sensitivity and Specificity ; Spine ; Tibia

College student volunteers (n = 142) completed a 580 km road march for 21 consecutive days. Each volunteer carried a backpack that weighed 14.1 +/- 1.4 kg on the average. We investigated the incidence and location of blisters associated with the road march using a foot map along with other injuries. Overall, 95.1% of the subjects (135 of 142) sustained one or more injuries. All injured subjects had foot blisters, and 18% had other foot injuries. The most common locations of blister development were the right 5th toe (61%) and the left 5th toe (57%). The little toes seem to have been subjected to the greatest friction and shearing forces. March-related injuries, excluding foot injuries, were ankle pain (12.7%), knee pain (12.7%) and Achilles tendon pain (7.7%). Six subjects (4.2%) needed extra medical treatment for more than 2 weeks prior to returning to their daily lives after completion of the march due to associated injuries. The present study observed a very high incidence rate of injuries (95.1%) associated with the 580 km university students grand road march. These injuries posed an obstacle against completion of the road march and against returning to daily life. Active preventive interventions such as physical therapy and customized reinforced shoes and education program are recommended for reducing incidence rate and severity of injuries.
Adult ; Blister/complications/*epidemiology ; Body Mass Index ; Female ; Foot Injuries/complications/*epidemiology ; Humans ; Incidence ; Male ; Pain/epidemiology/etiology ; Questionnaires ; Spine/radiography ; Students ; Time Factors ; Universities ; *Walking ; Young Adult

BACKGROUND: Current guidelines of advanced trauma life support recommend open thoracotomy when pericardiocentesis reveals bloody pericardial effusion in patients with blunt chest trauma. However, open thoracotomy may not be always required for treating patients alive until arriving emergency department, because rapid accumulation of the blood into pericardial space results in immediate death at scene. We report our experiences of treating traumatic pericardial effusion, and discuss the therapeutic modality in patients with traumatic pericardial effusion. METHODS: The study consisted of 37 patients(20 males and 17 females with the mean age 42) sustaining traumatic pericardial effusion. The patients were divided according to treatment modality into 3 groups(group I : patients receiving conservative management, group II : patients treated with pericardiocentesis, group III : patients required emergency thoracotomy). We compared clinical presentations, hemodynamic profiles and echocardiographic findings among three groups. RESULTS: Cardiac tamponade was present in 14 of 37 patients. Pericardiocentesis was performed in 13 patients, and open thoracotomy in 4 patients. Pericardiocentesis was curative in 9 patients. Thoracotomy was performed in only 3(24%) of 13 patients required pericardiocentesis. 3(75%) of 4 patients having moderate or severe pericardial effusion from penetrating injury were required open thoracotomy. CONCLUSION: In selected patients who have traumatic pericardial effusion by blunt chest injury, pericardiocentesis may be curative, and thoracotomy may not be inquired as long as bleeding via indwelling pericardial catheter is not sustained after pericardiocentesis.
Advanced Trauma Life Support Care ; Cardiac Tamponade ; Catheters ; Echocardiography ; Emergencies ; Emergency Service, Hospital ; Female ; Hemodynamics ; Hemorrhage ; Humans ; Male ; Pericardial Effusion* ; Pericardiocentesis ; Thoracic Injuries ; Thoracotomy ; Thorax

PURPOSE: To report a case of recovery of bilateral cortical blindness in a patient with posterior reversible encephalopathy syndrome. CASE SUMMARY: A 46-year-old female visited the ophthalmology department due to abrupt visual acuity decrease. Ten days earlier, she had received conservative management due to anemia caused by menorrhagia and uterine prolapse. She underwent a gynecological operation to remove a uterine myoma two days previously, and was given a blood transfusion postoperatively because of excessive bleeding. After the transfusion, she complained of acute blurred vision. Her best corrected visual acuity (BCVA) was hand motion 10 cm in both eyes. There were no abnormal specific findings except retinal dot hemorrhage at the temporal side in the left eye on fundus examination. Her pupillary light reflex was normal and optical coherence tomography examination was unremarkable in both eyes. However, flash visual evoked potential findings showed reduced P100 amplitude in both eyes and she was diagnosed with posterior reversible encephalopathy syndrome based on brain magnetic resonance imaging. After close observation without any treatment, the symptoms gradually improved. Finally, her BCVA recovered to 1.0 and P1 and P100 amplitudes were restored to normal range in both eyes at 16 weeks from the first diagnosis. CONCLUSIONS: A patient complained of bilateral visual loss without other neurological symptoms after chronic blood loss and blood transfusion. She recovered visual acuity completely with prompt diagnosis of posterior reversible encephalopathy syndrome and close observation only.
Anemia ; Blindness, Cortical ; Blood Transfusion ; Brain ; Diagnosis ; Evoked Potentials, Visual ; Female ; Hand ; Hemorrhage ; Humans ; Leiomyoma ; Magnetic Resonance Imaging ; Menorrhagia ; Middle Aged ; Ophthalmology ; Posterior Leukoencephalopathy Syndrome* ; Reference Values ; Reflex ; Retinaldehyde ; Tomography, Optical Coherence ; Uterine Prolapse ; Vision Disorders* ; Visual Acuity

Sacroccygeal teratoma(SCT) occurs in every 40,000 births and is the most common tumor in newborns. SCT predominantly develops in females and is almost always located in the gonadal or coccygeal region. Althoug the majority of tumors are usually benign, malignant degeneration is common and the prognosis is generally guraded. Therefore the early prenatal diagnosis and treatment are very important. The authors observed a case of SCT which was diagnosed by ultrasonagrapy at 30 weeks' gestation following IVF-ET procedure. Surgical removal of SCT of newborn was performed successfully following cesarean delivery at 38 weeks' gestation. The authors report this case with a brief review of the literatures.
Female ; Gonads ; Humans ; Infant, Newborn ; Parturition ; Pregnancy ; Prenatal Diagnosis ; Prognosis ; Sacrococcygeal Region ; Teratoma* ; Ultrasonography*

PURPOSE: The purpose of this study was to identify the relationship between psychosocial factors and symptom experience of patients with cardiovascular disease over a 6-month follow-up period. METHOD: Baseline data for each of the 138 patients were collected. Eighteen patients were dropped for a final total of 120 patients in the present study. To monitor patients' symptom experience after discharge, each patient was interviewed by telephone, and interviewed directly with a questionnaire at each clinic visit. RESULTS: Mean scores for hostility, anger, anxiety, and depression were 51.63, 22.87, 48.95, and 41.21, respectively. Mean scores for the level of symptom experience at discharge, 3 months and 6 months after discharge were 32.83, 24.79, and 26.70, respectively. There were significant differences in the level of hostility by gender, BMI, job, and monthly income. Also the differences in the level of anxiety and depression were statistically significant according to gender and existence of spouse. In the regression analysis, depression was identified as the significant factor associated with symptom experience at discharge, 3 months, and 6 months after discharge. CONCLUSION: This study presented baseline data to elucidate whether psychosocial factors were associated with the progression of cardiovascular diseases. Accordingly, it suggests that nurses need to take into consideration psychosocial factor as well as physiological factor in symptom management for patients with cardiovascular disease.
Ambulatory Care ; Anger ; Anxiety ; Cardiovascular Diseases* ; Depression ; Follow-Up Studies* ; Hostility ; Humans ; Psychology* ; Surveys and Questionnaires ; Spouses ; Telephone

Objective: Intractable massive oronasal bleeding can become a life-threatening condition. The success rate of conventional bleeding control methods other than transarterial embolization (TAE) is not expected to be high. We investigated the efficacy of Sengstaken-Blakemore tube (SBT) balloon tamponade in patients with sustained and intractable oronasal bleeding secondary to facial injury. Methods: This study is a retrospective chart review from traumatic patients with sustained and intractable oronasal bleeding who were admitted to the emergency center of Ajou University Hospital and Soonchunhyang University Bucheon Hospital from January 2014 to December 2016. Results: Twelve patients were included in the study, of whom nine (75%) were male. The median age was 31 years (range, 20–73 years). Bleeding was controlled in 11 of the 12 patients (91.7%) either temporarily or definitively. One patient without hemostasis underwent TAE. TAE was performed in an additional three patients out of the 11 patients with hemostasis who experienced continued nasal bleeding after the removal of SBTs. There were no complications from performing the procedure. Conclusion Using SBTs as a hemostatic tool will aid patients with life-threatening intractable oronasal bleeding. Furthermore, this method may be used in patients with continual and intractable oronasal bleeding after facial trauma as a bridging procedure from the emergency department or the intensive care unit to the interventional radiology.

Objective: Carotid artery stenting (CAS) is currently widely used for the treatment of carotid artery stenosis. The objective of this study was to analyze the outcomes of CAS performed in a single institution. Methods: We retrospectively analyzed 313 CAS cases from January 2007 to December 2020, including 206 (66%) symptomatic and 107 (34%) asymptomatic cases. Procedure-related morbidity and mortality were assessed. Rates of periprocedural (≤30 days after CAS) and postprocedural ipsilateral strokes (>30 days after CAS) were also assessed. Logistic regression analysis was used to identify risk factors for the periprocedural complication, in-stent restenosis (ISR), and ipsilateral stroke. Results: The success rate of CAS was 98%. Among 313 cases, 1 patient died due to hyperperfusion-related intracerebral hemorrhage (ICH). The CAS-related mortality rate was 0.31%. The overall incidence of periprocedural complications is 5.1%. A risk factor for periprocedural complication was a symptomatic carotid artery stenosis (7.3% vs. 0.9%, p=0.016). Twenty cases of ISR occurred during 63.7±42.1 months of follow-up. The overall incidence of ISR was 10.2% (20/196). A risk factors for ISR were diabetes mellitus (17.6% vs. 5.7%, p=0.008) and patients who used Open-cell stents (19.6% vs. 6.9%, p=0.010). The overall incidence of ipsilateral stroke is 5.6%. A risk factors for ipsilateral stroke was ISR (95% CI, p=0.002). Conclusions CAS is a safe and effective procedure for carotid artery stenosis. Although the incidence of complications is low, fatal complication such as hyperperfusion- related ICH can occur. To prevent hyperperfusion-related ICH, several methods such as strict blood pressure (BP) control, intentional less widening of stenotic segment should be used. To prevent ISR or stroke occurrence, special attention should be paid to patients who have ISR or ipsilateral stroke risk factors.