Zika virus (ZIKV) was spread to both eastward and westward from Uganda where the virus was identified approximately in 1947 by a group of arbovirus researchers. In 2015, ZIKV reached Americas with major outbreaks in Brazil. Most countries with mosquito transmitted ZIKV infection are located in tropical and subtropical areas, where ZIKV is endemic with other flaviviruses, including JEV, dengue and yellow fever virus. Approximately 40 countries in Central and South Americas and territories in South Pacific Islands and South East Asia show autochthonous ZIKV endemics. American lineage of ZIKV is known significantly to be mutated in susceptibility to host and in pathogenicity from Asian and Asian lineages approximately since 2014. Early and specific identification of ZIKV infection is very important for the effective management of patients. First of all, optimal collection of specimens for the laboratory diagnosis is required for both nucleic acid testing (NAT) and serological tests. Specimens for NAT tests and serological tests should be determined by the available laboratory resources, work-flow in each laboratory and the geographic areas of specimen collected in addition to days after showing symptoms. Testing strategy for specific differentiation among flaviviruses will vary depending on the prevalence of viruses known to be circulating in the area where the patients were exposed. NAT will be employed for the patients presenting with onset of symptoms less than 7 days. Advanced diagnostic technologies should be continuously developed for the increase of specificity and sensitivity of ZIKV diagnosis.
Americas ; Arboviruses ; Asian Continental Ancestry Group ; Biology* ; Brazil ; Clinical Laboratory Techniques* ; Culicidae ; Dengue ; Diagnosis ; Disease Outbreaks ; Epidemiology* ; Far East ; Flavivirus ; Humans ; Pacific Islands ; Prevalence ; Sensitivity and Specificity ; Serologic Tests ; South America ; Uganda ; Virulence ; Yellow fever virus ; Zika Virus*

BACKGROUND: Tourniquet pain is probably mediated by C-fiber. The ability of fentanyl to interrupt this nociceptive conduction was studied by administering either fentanyl or saline intrathecally along with hyperbaric bupivacaine for spinal anesthesia. METHOD: The incidence of tourniquet pain was evaluated in 60 patients having orthopedic surgery of the lower extremities during spinal anesthesia by administering either 30 mcg fentanyl (group 2) or saline (group 1) along with 0.5% hyperbaric bupivacaine 10 mg. We measured the maximal sensory spread of analgesia to pinprick, the incidence of tourniquet pain, and the sensory anesthesia to pinprick at the onset of tourniquet pain. RESULTS: The average maximal sensory spread of analgesia was the same in both groups (T9). The incidence of tourniquet pain was significantly greater in group 1 (33%) than in group 2 (10%). The sensory levels of anesthesia at the onset of tourniquet pain were not different in two groups. CONCLUSIONS: Intrathecal fentanyl was effective against tourniquet pain for 2 hours of the orthopedic surgery of the lower extremities.
Analgesia ; Anesthesia ; Anesthesia, Spinal* ; Bupivacaine* ; Fentanyl* ; Humans ; Incidence ; Lower Extremity ; Orthopedics ; Tourniquets*

Primary hypothyroidism can result in reactive enlargement of the pituitary gland which is indistinguishable from primary pituitary lesions in clinical presentation and on magnetic resonance imaging. A 17-year-old girl came to the hospital due to short stature, general weakness and galac-torrhea. The magnetic resonance imaging (MRI) study showed pitutary enlargement. The hormone study showed hyperprolactinemia, decreased basal growth hormone level and primary hypothyroi-dism. By thyroid replacement therapy only, mass was successfully regressed on follow up MRI after 4 months, and growth acceleration could be achieved.
Acceleration ; Adolescent ; Female ; Follow-Up Studies ; Growth Hormone ; Humans ; Hyperplasia* ; Hyperprolactinemia ; Hypothyroidism* ; Magnetic Resonance Imaging ; Pituitary Gland ; Thyroid Gland

Most of the malignant tumors of the pancreas are adenocarcinomas arising from the ductal epithelium. Primary leiomyosarcoma of the pancreas, even though it is the most common sarcoma of the pancreas, is very rare. We present a case of leiomyosarcoma of the pancreas, probably primary, with metastases to the stomach, lymph nodes, and abdominal wall. A 52-year-old woman visited the hospital with vague right upper abdominal pain and weigh loss of 6 kg for 2 months. The radiological and endoscopic examination revealed that she had a large heterogeneous mass, 11 cm in size, in the pancreatic body and tail, a 4 cm-sized mass in the paraaortic area, and a 3 cm-sized polypoid mass in the stomach. Histologically, they were all similar to one another and composed of markedly pleomorphic cells. Immunohistochemical and electron microscopic studies showed definite smooth muscle differentiation of the tumor cells. Two months later, the patient underwent an excision of a new 3 cm mass in the right lower abdominal wall, showing features of well differentiated leiomyosarcoma.
Abdominal Pain ; Abdominal Wall ; Adenocarcinoma ; Epithelium ; Female ; Humans ; Leiomyosarcoma* ; Lymph Nodes ; Middle Aged ; Muscle, Smooth ; Neoplasm Metastasis ; Pancreas* ; Sarcoma ; Stomach

BACKGROUND: Recently, it has been established that plateletpheresis needs more efficiency and shorter processing time. Fenwall laboratories developed a new collection chamber for CS-3000 Plus, PLT-30TM collection chamber, which can reduce the processing time with efficient collection. We evaluated the PLT-30TM collection chamber by comparing it with A-35 collection chamber that has been used as a standard collection chamber of CS-3000 Plus us. METHODS: Thirty platelet collection procedures were performed using the CS 3000 Plus with A-35 collection chamber and PLT-30TM collection chamber. The changes of the hematologic parameters between pre- and post-donation in donors and the total platelets yields and the contaminated WBCs in the plateletpheresis products were evaluated. In processing, the yield predictor calibration was adjusted to 1.00 and 1.13 in A-35 and PLT-30TM respectively. Yield predictors of pheresis were the same as 3.5x1011 in both and end point volumes were calculated from the CS-3000 Plus. Processing volume and processing times were compared between A-35 and PLT-30TM groups. RESULTS: With PLT-30TM collection chamber, 3.38+/-0.72x1011/L platelets were harvested, whereas 3.20+/- 0.73x1011/L were collected with A-35 collection chamber, which was not significantly different. But processing time with the PLT-30TM collection chamber was more reduced than that with the A-35 collection chamber by about 20 minutes (PLT-30TM : 88.6+/-8.4 min, A-35 : 106.7+/-11.7min). Collection efficiency of PLT-30TM chamber was 50.7+/-12.5% and that of A-35 chamber was 44.4 + 8.8%. The leukocyte contamination of the platelet concentrates were not statistically different(PLT-30TM: 0.0-3.6x106, A-35 : 0.1-4.1x106). CONCLUSIONS: PLT-30TM collection chamber has the advantages of shortening the donation time and decreasing the processing volume with better collection efficiency and flexibility of platelet concentrate volume.
Blood Component Removal ; Blood Platelets ; Calibration ; Humans ; Leukocytes ; Plateletpheresis ; Pliability ; Tissue Donors

No abstract available.
Adult* ; Humans ; Lower Extremity*

The diagnostic accuracy of myelography, electromyography, and clinical-neurological findings in 64 patients on whom the presence of herniated intervertebral disc was proved surgically from March, 1974 to February, 1980 in Severance Hospital was discussed and the results of this study was compared with those in comparable studies in the literature. 1. Of the cases in which operation revealed disc herniation or protrusion, the clinical neurological diagnosis was correct in 71.9%, the myelographic diagnosis was coincided in 79.7%, the electromyographic diagnosis was agreed in 73.4%. 2. In the patients which the patellar tendon reflex was weak or absent, operation revealed a herniation between L3 and L4 in 66.7%. The disc herniation bewteen L4 and L5 was noted in 93.0% of patients with weakness of the extensors of the great toe. Of the patients in whom the Achilles tendon reflex was weak or absent, operation revealed a tumbosacral disc herniation in 87.0%. 3. If the myelogram showed lumbar disc changes, these changes were confirmed at operation in the same level in all patients. 4. A disc herniation between L3 and L4 was demonstrated in aH cases of the patients had L4 denervation of the electromyographic findings. The disc herniation between L4 and L5 was seen in 93.0% of them had L5 denervation. A lumbosacral disc herniation was noted in 83.3% of them had 51 denervation. 5. Polyphasic motor units were significant in the absence of diagnosis of the herniated lumbar disc. 6. Signs of denervation in the spinal muscalature but not in the leg muscles were considered significant in patients with diagnostic problems of the lumbar radiculopathy. In summary, it is suggested that electromyography is not superior to the myeolgraphy or the clinicalneurogical examination. But the electromyography aids the surgeon in the dlagnosis of a compression lesion of a specific nerve root.
Achilles Tendon ; Denervation ; Diagnosis ; Electromyography ; Humans ; Intervertebral Disc ; Leg ; Muscles ; Myelography ; Patellar Ligament ; Radiculopathy ; Reflex ; Toes

The authors made an attempt to classify the supracondylar extension-valgus fracture according to the direction and location of the fracture line based on the radiographic manifestation. This new classification helps to dictate the model of treatment, possible sequence of reduction and the causes of deformity of the elbow after treatment. During the last 12 years of this study, 200 supracondylar fractures of the humerus were treated in the Kyung Hee University Hospital. Of the cases 82 were extension-valgus fractures. The results were as follows: 1. The supracondylar extension-valgus fracture were classified into 5 types: Type I: fish-tail fracture (14 cases) Type II : obtuse fish-tail fracture (27 cases) Type III: oblique fracture (16 cases) Type IV: oblique fracture with comminution of lateral column (14 cases) Type V: Transverse fracture (11 cases) 2. The displacement of the distal fragment in the fish-tail fracture is severe but it can be reduced easily by manipulation. Once reduction has been obtained, the fracture is stable and maintained by a long arm cast with acute flexion of the elbow alone. There is no need of percutaneous pinning. Among 14 cases of type I fracture there was no cubitus varus deformity. 3. The line of the obtuse fish-tail fracture lies distal to fish-tail fracture. This is unstable so it is necessary to percutaneous pinning. 4. The oblique fracture is produced by the hyperextension of the elbow and degrees of the obliquity of the fracture line were 12 to 20 degrees (Av. 14 degrees). The valgus angles in opposit elbows were 9 to 25 degrees (Av. 16 degrees). The forearm must be pulled into valgus position during the reduction of the fracture. 5. Type IV fracture occures under 4 years old, and more commonly in girls. This is unstable, so it is necessary to percutaneous pinning.
Arm ; Child ; Classification ; Congenital Abnormalities ; Elbow ; Female ; Forearm ; Humans ; Humerus

The ankle is a modified complex hinge joint consisting of the distal tibio-fibula joint (Syndesmosis), and the ankle joint proper(hinge joint), and is important in weight bearing, standing and walking. So, the goals of treatment of ankle fracture are anatomical positioning of talus in the mortise and regaining a smooth articular suface. Unless these requisites are achieved by treatment, post-traumatic arthritis is likely to occur. We analyzed 120 cases of ankle fracture, most of which were treated surgically by A-0 method, in Department of Orthopaedic Surgery, Hyundai Haesung Hospital from January, 1982 to December 1985. The results are as follows; 1. The most common victim was 3rd–4th decades man, and the cause was direct blow. 2. The most common type was pronation-external rotation type of Lauge-Hansen classification, and Type A of Danis-Weber type. 3. The more favorable result was noted in Danis-Weber type A than type B and type C,and noted worst result in pilon fracture. 4. Favorable results can be gained by semi-tubular plate in fibular fracture than any other fixation material. 5. On application of semi-tubular plate, there were no significant differences in results between that placed posteriorly and that placed laterally. 6. We did not transfix the distal tibio-fibular joint in stable Danis-Weber type C injury without any specific sequellae. 7. We obtained better result by removal of transfixing screw 6 weeks after operation. 8. We obtained good results with only 3 weeks immobilization after operation.
Ankle Fractures ; Ankle Joint ; Ankle ; Arthritis ; Classification ; Immobilization ; Joints ; Methods ; Talus ; Walking ; Weight-Bearing

In dealing with lateral condylar injuries of humerus, the chance of pitfalls and having a poor functional result with poor management is much greater because it is a physeal injury involving intraarticular surface. Lateral condylar physeal injuries of distal humerus have been regarded as Salter-Harris Type IV injury. But indeed, true Salter-Harris type IV injury of lateral condyle of distal humerus are rare. It should be regarded as Salter-Harris type II injury. Previously Milch classified the lateral condyle fracture of distal humerus as type I and type II after Stimson's description. It seems to be most useful to plan therapeutic modalities by classification of lateral condyle fracture on the basis of stage of displacement proposed by Jakob et al and Milch's type. Authors performed clinical analysis about lateral condyle fracture of distal humerus in children. Among 79 cases, who were treated at department of orthopaedic surgery, Hyundai haesung hospital from Mar. 1982 to Mar. 1988, it was possible to follow up in 30 cases. The result were as follows ; 1. The age incidence was confined from age of 3 to age of 12. Peak age was around 6. 2. Most of fractures were Milch's type II (75 cases) in contrast to Milch's type I (4 cases). 3. Precise differentiation of stage I and II displacement was needed for evaluation of stability of fracture and planning treatment modalities. 4. In case of stage II displacement, cast immobilization alone was insufficient. K-wire fixation was needed for prevention of displacement and better result. 5. In all of cases(30 cases) overgrowth of lateral condyle and spur formation were noticed but it has no clinical disabilities. 6. There were no significant differences of outcome between different fracture types and different stage of displacement. But significant differences of outcome were noticed how treatment performed. Accurate anatomical reduction and stable fixation was needed. 7. 2 cases of severe cubitus varus(20') were occured. In 21 cases, carrying angle were changed, valgus change were more common than varus change. It was thought to be relative undergrowth of lateral condyle of humerus and malunion as its causes. 8. In all cases, there were no loss of R.O.M.
Child ; Classification ; Clinical Study ; Follow-Up Studies ; Humans ; Humerus ; Immobilization ; Incidence