PURPOSE: Many clinical guidelines recommend apolipoprotein B (apoB) measurement, particularly in subjects with metabolic syndrome or type 2 diabetes. Recently, we developed a new equation to estimate serum apoB (apoBE). We validated the clinical relevance of apoBE and compared the performance of the equation with conventional lipid measurements and direct measurement of apoB. MATERIALS AND METHODS: Study subjects were recruited from patients who visited the Health Screening Center at Kangbuk Samsung Hospital between January and December 2009 for routine medical examinations (n=78125). For analysis of coronary calcium score, we recruited study subjects from the same institution between January 2007 and December 2010 (n=16493). RESULTS: apoBE was significantly correlated with serum high-sensitivity C-reactive level {r=0.18 [95% confidence interval (CI), 0.18–0.19]} in partial correlation analysis adjusted for age, sex, and body mass index. apoBE was associated with a Framingham risk score indicating more than moderate risk (10-year risk ≥10%), the presence of microalbuminuria, and the presence of coronary artery calcium in multivariate logistic regression analysis. These associations were comparable to those of directly-measured serum apoB [odds ratio per 1 SD 3.02 (2.75–3.27) vs. 2.70 (2.42–3.02) for a Framingham risk score indicating more than moderate risk, 1.31 (1.21–1.41) vs. 1.35 (1.25–1.45) for the presence of microalbuminuria, and 1.33 (1.26–1.41) vs. 1.31 (1.23–1.38) for the presence of coronary calcium score respectively]. These findings were also consistently observed in subgroup analysis for subjects with type 2 diabetes. CONCLUSION: The associations between cardiovascular surrogate markers and apoBE were comparable to those of directly-measured apoB.
Apolipoproteins B ; Apolipoproteins* ; Biomarkers* ; Body Mass Index ; Calcium ; Cardiovascular Diseases* ; Coronary Vessels ; Humans ; Logistic Models ; Mass Screening

Tsutstugamushi disease is a major febrile disease that generally occurs in the fall in Korea with hemorrhagic fever with renal syndrome and leptospirosis. This disease is often accompanied by interstitial pneumonia, acute renal failure and liver failure. The causative agent, namely Orientia tsutsugamushi, is transmitted to humans through the bite of a laval trombiculid mite, which is commonly known as a chigger. A 78 year old man was admitted in October 2004 with intractable fever and a drowsy mentality. Two weeks earlier, he visited a private clinic complaining of a simple skin rash. He was treated with antihistamine and steroid, but his symptoms were aggravated and he was referred to our hospital. His physical examination and laboratory findings showed a septic shock status. The maculopapular rash had spread over his face, chest, abdomen and extremities. Eschar was observed in lower back area but it was too difficult to distinguish it from other skin rashes. His chest X-ray appeared as diffuse nodular patchy consolidations in the bilateral lung parenchyme. He was treated with a mechanical ventilator and doxycycline under th suspicion of Tsutstugamushi disease. However, he suffered multiorgan failure accompanied by acute respiratory distress syndrome, acute renal failure and acute hepatitis. He was treated in the intensive care unit for approximately 12 weeks and his general condition was recovered.
Abdomen ; Acute Kidney Injury ; Aged ; Doxycycline ; Exanthema ; Extremities ; Fever ; Hemorrhagic Fever with Renal Syndrome ; Hepatitis ; Humans ; Intensive Care Units ; Korea ; Leptospirosis ; Liver Failure ; Lung ; Lung Diseases, Interstitial ; Orientia tsutsugamushi ; Physical Examination ; Respiratory Distress Syndrome, Adult ; Scrub Typhus ; Shock, Septic ; Thorax ; Trombiculidae ; Ventilators, Mechanical

No abstract available.
Masks ; Skin

PURPOSE: To report a case of acute angle-closure glaucoma secondary to spontaneous suprachoroidal hemorrhage in a hemodialysis patient. CASE SUMMARY: A 71-year-old man visited our clinic after 3 days of vision loss and ocular pain in the right eye. He had been treated with hemodialysis using heparin due to diabetic nephropathy. Visual acuity (VA) was hand motion in the right eye and 0.2 in the left eye. The intraocular pressure (IOP) was 58 mmHg in the right eye and 15 mmHg in the left eye. Gonioscopic examination revealed a closed angle in the right eye. Fundus examination of the right eye showed a massive hemorrhagic retinal detachment and ultrasound sonography revealed a dome-shaped retinal detachment with suprachoroidal hemorrhage in the right eye. The patient was treated with topical aqueous suppressants and cycloplegics. After two weeks of medical treatment, VA in the right eye was still hand motion and IOP was 8 mmHg. Gonioscopic examination showed a wide-open angle in the right eye. During the two-month observation period, VA in the right eye did not recover, however there was no sign of IOP elevation or symptoms of ocular pain. CONCLUSIONS: Spontaneous suprachoroidal hemorrhage can occur in patients who receive hemodialysis with heparin. This spontaneous suprachoroidal hemorrhage can be subsequently accompanied by acute angle-closure glaucoma. Spontaneous decrease of suprachoroidal hemorrhage, loss of angle-closure, and decline of IOP can be expected by treating with topical aqueous suppressants and cycloplegics.
Aged ; Diabetic Nephropathies ; Glaucoma, Angle-Closure* ; Hand ; Hemorrhage* ; Heparin ; Humans ; Intraocular Pressure ; Mydriatics ; Renal Dialysis ; Retinal Detachment ; Ultrasonography ; Visual Acuity

Central nervous system atypical teratoid/rhabdoid tumor (AT/RT) of infancy and childhood, a new entity among malignant pediatric brain tumors, is unique histologic entity with an extremely aggressive natural history. Histologically AT/RT is defined as a polymorphous neoplasm often featuring rhabdoid, primitive neuroectodermal tumor, epithelial, and mesenchymal components. AT/RT occurs mainly in the posterior fossa, so mimics medulloblastoma. AT/RT is characterized by the cytogenetic finding of monosomy 22 rather than i (17q). Standard chemotherapy for infant and childhood medulloblastoma, for which this entity is often mistaken, has been ineffective. Most children survive less than 12 months (mean survival: 8.5 months) after diagnosis. We report two cases of central nervous system AT/RT in young children, one of them is alive so far with multimodal treatment.
Brain Neoplasms ; Central Nervous System* ; Child ; Combined Modality Therapy ; Cytogenetics ; Diagnosis ; Drug Therapy ; Humans ; Infant ; Medulloblastoma ; Monosomy ; Natural History ; Neuroectodermal Tumors, Primitive

The rapid development of psychotropic drugs and great advancement in psychopharmacology during the past recent years has altered the strategy of pharmacotherapy for major psychiatric disorders, and in turn, an active development of various clinical practice guidelines or algorithm has taken place. However, there could be problems with applying the foreign guidelines directly to our clinical situation, due to the differences in racial characteristics, socioeconomic conditions, government policy, and clinical practices. In addition, the changes of circumstances outside of clinical situation in Korea may distort clinical practices and may go even against the trend of recent psychopharmacology. As a solution to such problems, Korean Medication Algorithm Project for Major Psychiatric Disorders (KMAP) was launched with the support from the Korean Society of Psychopharmacology and Korean Academy of Schizophrenia. However, since clinical practice guidelines and algorithms contain not only the advantages, but also disadvantages and risks, sufficient consideration must precede the development of algorithms. Hence, this review provides a discussion on the definition of clinical guideline and its limitation, its advantages and disadvantages, and the need for the development of clinical guideline in psychiatric field. Also, developing source, dissemination and implementation of clinical practice guidelines were also discussed. We hope that this review can make the purpose of KMAP clear and elicit the productive criticism on Korean algorithm.
Drug Therapy ; Hope ; Korea ; Psychopharmacology ; Psychotropic Drugs ; Schizophrenia

The platelet-rich plasma (PRP) has been advocated as a way to introduce increased concentrations of growth factors and other bioactive molecules to injured tissues in an attempt to optimize the local healing environment. A 94-yr-old woman with various comorbidities presented with a two-week history of severe cutaneous ulcer on the left dorsum of foot. It was caused by recurrent mechanical trauma and did not respond to several wound debridement and simple dressings. However, after she was completed on seven times of autologous PRP treatments, we observed complete healing of the skin lesion within 3 months. Herein, we report a case of recalcitrant cutaneous ulcer with various comorbidities and discuss about the promising possibility of autologous PRP as an effective alternative therapeutic modality.
Aged, 80 and over ; Female ; Humans ; *Platelet-Rich Plasma ; Skin Ulcer/complications/*therapy ; Treatment Outcome ; Wound Healing

OBJECTIVE: To introduce a newly designed arm sling and to compare the effects on a shoulder subluxation. METHOD: Sixteen hemiplegic patients with shoulder subluxation were evaluated by a simple X-ray with and without the slings and the vertical and horizontal distances on the plain AP views were measured. The newly designed arm sling was compared in terms of the effects of correction with a pouch sling and a Bobath sling. The arm sling designed for this study was developed for the purpose of maintaining patients' hands in a functional position and performing ROM exercise of the shoulder easily. The mean values of the vertical and horizontal distance were compared to determine if there was significant difference of function between the new sling and the conventional slings. Variables such as comfort, choice, and easiness for donning and doffing of the arm slings were evaluated by questions. RESULTS: The new sling provided the patients with good vertical correction of the subluxation (p<0.05) but did not increase the horizontal distance significantly. According to the responses to the questions, the new sling was more comfortable than the conventional slings. CONCLUSION: These results support the effectiveness and the comfort of a new sling to decrease subluxation in hemiplegia. Further study on the long term effects or complication of the new sling is recommended.
Arm ; Hand ; Hemiplegia ; Humans ; Pilot Projects* ; Shoulder*

Background: The coronavirus disease pandemic has directly impacted global health. In developing countries, health service problems are more serious because of the lack of healthcare infrastructure. In this situation, if medical needs could be predicted, it would be helpful to bridge the medical gap with the provision of appropriate medical support. Objective: The aim of this study was to evaluate the association between climate change and skin diseases in developing countries to better prepare for medical missions. Methods: From 2012 to 2016, except for 2014, we visited a mission site located in Luzon, Philippines, every July.We retrospectively reviewed 499 patient data as well as weather information. Results: The total number of patients decreased each year. The climate change analysis using Pearson correlation showed that the temperature and ultraviolet index tended to increase every year (r2 =0.99, 0.93, respectively; p＜ 0.05). Conversely, humidity and rainfall decreased (r2 =−0.99, −0.96, respectively; p＜0.05). The Cochran–Armitage test showed that the rate of infectious skin disease diagnoses decreased every year compared to that of eczematous diseases. Conclusion The total number of patients decreased by approximately 50% during medical service. We believe that the improvement in living standards and hygiene through continuous medical support has influenced the change in the incidence of skin diseases. Climate change was also thought to have affected the rate of skin disease diagnoses; in fact, the rate of infectious disease diagnoses tended to decrease compared to that of eczematous diseases. This analysis would be helpful for preparing for medical support.

Background: The coronavirus disease pandemic has directly impacted global health. In developing countries, health service problems are more serious because of the lack of healthcare infrastructure. In this situation, if medical needs could be predicted, it would be helpful to bridge the medical gap with the provision of appropriate medical support. Objective: The aim of this study was to evaluate the association between climate change and skin diseases in developing countries to better prepare for medical missions. Methods: From 2012 to 2016, except for 2014, we visited a mission site located in Luzon, Philippines, every July.We retrospectively reviewed 499 patient data as well as weather information. Results: The total number of patients decreased each year. The climate change analysis using Pearson correlation showed that the temperature and ultraviolet index tended to increase every year (r2 =0.99, 0.93, respectively; p＜ 0.05). Conversely, humidity and rainfall decreased (r2 =−0.99, −0.96, respectively; p＜0.05). The Cochran–Armitage test showed that the rate of infectious skin disease diagnoses decreased every year compared to that of eczematous diseases. Conclusion The total number of patients decreased by approximately 50% during medical service. We believe that the improvement in living standards and hygiene through continuous medical support has influenced the change in the incidence of skin diseases. Climate change was also thought to have affected the rate of skin disease diagnoses; in fact, the rate of infectious disease diagnoses tended to decrease compared to that of eczematous diseases. This analysis would be helpful for preparing for medical support.