PURPOSE: The incidence of genitourinary tuberculosis(tbc) has consistently declined as results of effective chemotherapy and health care. But it still has significant associated morbidity. The pathogenesis of prostatic and epididymal tbc remains obscure. To assess the progress of tuberculous infection in sex accessory organs including prostate, epididymis and testis, prospective clinical study was performed. MATERIALS AND METHODS: Of the 58 male patients with genitourinary tbc during a 8-year period(1989-1996), 23 patients (39.7%) had tuberculosis in sex accessory organs. Thirty patients who demonstrated tuberculosis in at least one organ amomg prostate, epididymis, testis and bladder were evaluated. The conclusive diagnosis was made on the basis of isolation of Mycobacterium tuberculosis, histopathology. A patients with organ confined tbc was considered to be caused by metastatic spread of infection. RESULTS: In 12(40%) of 30 patients tubercle bacilli were detected in urine. 14(87.5%) of the 16 patients with tuberculous epididymitis and 10(76.9%) of the 13 patients with tuberculous prostatitis were considered to have an infection extended through the metastatic spread. Three(25%) patients had tuberculous cystitis directly extended from the tuberculous prostatitis. All three tuberculous orchitis were secondary to the tuberculous epididymitis. CONCLUSIONS: The results suggest that the route of infection of tuberculosis in the prostate and the epididymis are mainly through the hematogenous spread and direct extension of infection is likely deveploped by descending spread.
Cystitis ; Delivery of Health Care ; Diagnosis ; Drug Therapy ; Epididymis ; Epididymitis ; Humans ; Incidence ; Male ; Mycobacterium tuberculosis ; Orchitis ; Prospective Studies ; Prostate ; Prostatitis ; Testis ; Tuberculosis* ; Urinary Bladder

PURPOSE: This report describes the results of a survey of the characteristics of pertussis in children from a single institution and compares it to data from the Korea Centers of Disease Control (KCDC). METHODS: We retrospectively evaluated the medical records of 17 and 6 patients diagnosed with pertussis and parapertussis, respectively, at Soonchunhyang University Bucheon Hospital from January 2005 to January 2017. RESULTS: Of the 17 patients with pertussis, 9 were under 1 year of age (52.9%), 3 were aged between 1 and 10 years (17.6%), and 5 were over 10 years of age (29.4%). Seven patients (41.2%) had never received diphtheria-tetanus-acellular pertussis vaccines, of which 5 were infants below 2 months of age and 2 were 10 years old and lived in China. Four patients showed the initial symptoms of cough in China. The sources of infection were the parents (2 cases) and the siblings (8 cases). All patients showed prolonged severe cough and the average duration of cough was 26 days. Severe symptoms, including dyspnea, cyanosis, apnea, and seizures, were observed in the children under 2 months of age. According to the recent 10-year KCDC data, the highest rate of pertussis diagnosis was noted in infants (47.8%), followed by adolescents (18.7%). Six patients with parapertussis also presented with prolonged severe cough without any other severe symptoms. Lymphocytosis was not found, unlike the patients with pertussis. CONCLUSION: The possibility of pertussis and parapertussis should be considered among patients with prolonged severe cough, especially in infants and adolescents.
Adolescent ; Apnea ; Bordetella parapertussis ; Bordetella pertussis ; Child ; China ; Cough ; Cyanosis ; Diagnosis ; Diphtheria-Tetanus-acellular Pertussis Vaccines ; Dyspnea ; Gyeonggi-do ; Humans ; Infant ; Korea ; Lymphocytosis ; Medical Records ; Parents ; Retrospective Studies ; Seizures ; Siblings ; Whooping Cough

Recent progress in medical informatics enable to use various medical regardless of time or place, to make a diagnostic and therapeutic plan, with increasing need about health of general population. There are many homepages on the web, which provide medical common senses, hospital information. and medical counseling on the web. Virtual Hospital, which is comprehensive medical information system on the web, has medical counseling program with various health information such as self-diagnosis, first-aid treatment information, drug information, Q and A, and so on. The aim of this study is to examine the content and purpose of medical counseling on the web. The subjects consisted of 277 counsels which visited 'Medical Counseling' in the Virtual Hospital for December 1996 through May 1997. Many questioners wanted to consult about their symptoms, to know prevention and treatment strategies, and to know specific medical knowledge. The most common questions are as follows: general and unspecified, digestive, musculoskeletal, and skin problems. These findings suggest medical counseling may be used to supplement the lack of direct medical Interviews with doctors.
Computer Communication Networks ; Counseling* ; Information Systems ; Internet* ; Medical Informatics ; Skin

Kyphoscoliosis is a deformity of the costovertebral skeletal structures characterized by an anterior flexion (kyphosis) and lateral curvature (scoliosis) of the patient's vertebral column.(1)) In kyphoscoliosis, lung volume and compliance is reduced due to the change of vertebral column. The work of breathing is increased by abnormal mechanism of the thorax and by increased airway resistance resulting from small lung volume. Airway management and respiratory problems are common and spinal deformities can cause difficulties with regional anesthesia. We had experienced a successful spinal anesthesia for closed reduction and internal fixation (CRIF) and proximal femoral nail (PFN) of fractured intertrochanteric femur in a patient with extremely severe thoracolumbar kyphoscoliosis.
Airway Management ; Airway Resistance ; Anesthesia ; Anesthesia, Conduction ; Anesthesia, Spinal ; Compliance ; Congenital Abnormalities ; Femur ; Humans ; Kyphosis ; Lung ; Nails ; Scoliosis ; Spine ; Thorax ; Work of Breathing

BACKGROUND AND OBJECTIVES: Endothelial dysfunction is widely observed in diabetes mellitus, resulting in diabetic vascular complications. Kruppel-like factor 2 (KLF2) is implicated as being a key molecule that maintains endothelial function. We evaluated the expression of KLF2 in endothelial cells cultured in high glucose and investigated its functional implication in a diabetic animal model. SUBJECTS AND METHODS: Human umbilical vein endothelial cells (HUVECs) were cultured in physiologically high glucose (35 mM) condition. The Otsuka Long Evans Tokushima Fatty (OLETF) strain of rat was used as an excellent model of obese type II diabetes, and their lean littermates are Long Evans Tokushima Otsuka (LETO) rats. RESULTS: In HUVECs cultured in physiologically high glucose condition, FOXO1 was activated whereas KLF2 and endothelial nitric oxide synthase (eNOS) expression was near completely abolished, which was completely reversed by FOXO1 small interfering ribonucleic acid. In the vessels harvested from the OLETF rats, the animal model of type II diabetes, KLF2 and eNOS expression were found depleted. When vascular remodeling was induced in the left common carotid artery by reduction of blood flow with partial ligation of the distal branches, greater neointimal hypertrophy was observed in OLETF rats compared with the control LETO rats. CONCLUSION: KLF2 suppression in endothelial cells by high glucose is a possible mechanism of diabetic endothelial dysfunction. The strategy of replenishing KLF2 may be effective for preventing diabetic vascular dysfunction.
Animals ; Carotid Artery, Common ; Diabetes Mellitus ; Diabetic Angiopathies ; Endothelial Cells ; Glucose ; Human Umbilical Vein Endothelial Cells ; Hypertrophy ; Ligation ; Models, Animal ; Nitric Oxide Synthase Type III ; Rats ; Rats, Inbred OLETF ; RNA ; Sprains and Strains

BACKGROUND: Somatosensory evoked potential (SSEP) has been used to help minimize neurologic morbidity during spinal surgery. But, SSEP is affected by various factors, namely technical errors, anesthetics and physiologic aspects (systemic blood pressure, temperature, blood gas tensions). We experienced 40 cases of spinal surgery done with total intravenous anesthesia under SSEP monitoring. We reviewed these cases with the availability of total intravenous anesthesia during SSEP monitoring. METHODS: Forty patients, ASA class I-II, free of neurologic disease and scheduled for elective spinal surgery were randomly selected for the study. All of the operations were performed under general anesthesia employing the method of total intravenous anesthesia with propofol and fentanyl, and monitored by SSEP. We recorded latency and amplitude of SSEP in the pre-induction, post-induction, during-instrument insertion and post-distraction periods. RESULTS: There were no statistical differences in latencies among pre-induction, post-induction, screw insertion and post-distraction period. The amplitude of the post-induction period was statistically higher than pre-induction period (p<0.05), but there were no differences in other periods. None of cases showed abnormal findings (i.e., delay of latency over 10% or decrease of amplitude over 50%). CONCLUSIONS: SSEP monitoring may be helpful in identifying potentially neurologically threatening surgical maneuvers during spinal surgery. To achieve better outcomes, we should consider the effects of various factors on SSEP. Total intravenous anesthesia may be useful method, which has lifter influence on SSEP monitoring.
Anesthesia, General ; Anesthesia, Intravenous* ; Anesthetics ; Blood Pressure ; Evoked Potentials* ; Evoked Potentials, Somatosensory ; Fentanyl ; Humans ; Propofol

OBJECTIVE: To examine the clinical factors and brain lesion locations related to the patterns of dysphagia in stroke patients in a rehabilitation hospital. METHODS: The medical records of 116 stroke patients who underwent a videofluoroscopic swallowing study (VFSS) between January 2010 and January 2015 in a rehabilitation hospital were reviewed retrospectively. The swallowing-related parameters were assessed using a VFSS. The brain lesion locations were classified as the cortex, basal ganglia, thalamus, midbrain, pons, medulla, cerebellum, and others (subarachnoid or intraventricular hemorrhage). The ambulation ability was assessed using functional ambulation categories (FACs). The independence in the activities of daily living and the degree of cognitive impairment were assessed using the Korean versions of the modified Barthel index (K-MBI) and Mini-Mental State Examination (K-MMSE), respectively. After adjusting for the potential confounding factors in multivariate analysis, the odds ratios and confidence intervals of the stroke brain lesions were calculated and the clinical factors for predicting the VFSS findings were determined. RESULTS: Among the 116 patients, 35 (27%) had an impaired oral stage and 58 (50%) had aspiration. The impaired oral stage was associated significantly with the onset time, basal ganglia stroke, dietary and fluid intake methods at the time of the VFSS, symptoms of dysphagia, FACs, K-MBI, and K-MMSE. Aspiration was correlated with a pontine stroke, methods of dietary and fluid intakes at the time of the VFSS, symptoms of dysphagia, FACs, and K-MBI. Multivariate analysis showed that the pontine stroke and methods of dietary and fluid intake at the time of VFSS predicted aspiration after adjusting for the potential confounding factors. In subgroup analysis of the diet type, the liquid and semisolid aspirations were correlated with the dietary and fluid intake methods and pontine stroke, respectively. CONCLUSION: Patients with a pons lesion stroke, who are on a modified diet (fluid thickening and tube feeding), have higher risks of aspiration. This provides evidence for precise clinical reasoning in this specific patient group.
Activities of Daily Living ; Aspirations (Psychology) ; Basal Ganglia ; Brain ; Cerebellum ; Cognition Disorders ; Deglutition Disorders ; Deglutition* ; Diet ; Humans ; Medical Records ; Mesencephalon ; Multivariate Analysis ; Odds Ratio ; Oral Stage ; Pons ; Rehabilitation ; Retrospective Studies ; Stroke* ; Thalamus ; Walking

Pseudomyxoma peritonei is a very rare condition, and even rarer in patients with history of cancer. A 70-year old woman with a history of breast cancer was admitted with abdominal pain and distention. Abdominal computed tomography revealed ascites collection, diffuse engorgement and infiltration of the mesenteric vessel, suggesting peritonitis or peritoneal carcinomatosis. Diagnostic paracentesis was attempted several times, but a sufficient specimen could not be collected due to the thick and gelatinous nature of the ascites. Therefore, the patient underwent diagnostic laparoscopy for tissue biopsy of the peritoneum, which indicated pseudomyxoma peritonei. However, the origin of the pseudomyxoma peritonei could not be identified intraoperatively due to adhesions and large amount of mucoceles. Systemic chemotherapy was performed using Fluorouracil, producing some symptomatic relief. After discharge, abdominal pain and distention gradually worsened, so at 18 months after initial diagnosis the patient received palliative surgery based on massive mucinous ascites and palpable mass at the omentum. The patient expired after surgery due to massive bleeding.
Abdomen/diagnostic imaging ; Aged ; Antimetabolites, Antineoplastic/therapeutic use ; Ascites ; Breast Neoplasms/pathology ; Colonoscopy ; Female ; Fluorouracil/therapeutic use ; Humans ; Laparoscopy ; Peritoneal Neoplasms/*diagnosis/drug therapy/pathology ; Peritoneum/pathology ; Pseudomyxoma Peritonei/*diagnosis/drug therapy/pathology ; Tomography, X-Ray Computed

Squamous cell carcinoma of the ovary is rare. It is considered to be associated with benign cystic teratoma, Brenner tumor and ovarian endometriosis which undergo malignant degeneration in their epithelial layers. Although ovarian metastasis from advanced cervical cancer is well known, however, ovarian metastasis from microinvasive cervical cancer is extremely rare. Because there are few reports about squmaous cell carcinom of the ovary, the pathogenesis is still not well known. Recently we experienced a case of squamous cell carcinoma in ovary presenting 109 months after surgical therapy of a microinvasive cervical cancer. We report this case with a brief review of literature and possible pathogenesis.
Brenner Tumor ; Carcinoma, Squamous Cell* ; Endometriosis ; Female ; Neoplasm Metastasis ; Ovary* ; Teratoma ; Uterine Cervical Neoplasms*

Squamous cell carcinoma of the ovary is rare. It is considered to be associated with benign cystic teratoma, Brenner tumor and ovarian endometriosis which undergo malignant degeneration in their epithelial layers. Although ovarian metastasis from advanced cervical cancer is well known, however, ovarian metastasis from microinvasive cervical cancer is extremely rare. Because there are few reports about squmaous cell carcinom of the ovary, the pathogenesis is still not well known. Recently we experienced a case of squamous cell carcinoma in ovary presenting 109 months after surgical therapy of a microinvasive cervical cancer. We report this case with a brief review of literature and possible pathogenesis.
Brenner Tumor ; Carcinoma, Squamous Cell* ; Endometriosis ; Female ; Neoplasm Metastasis ; Ovary* ; Teratoma ; Uterine Cervical Neoplasms*