OBJECTIVE: Adult onset Still s disease is an acute systemic inflammatory disorder. There are no pathognomonic symptoms or specific laboratory abnormalities. In recent reports, serum ferritin concentration is increased in active disease phase and decreased after defervescence. Our purpose was to determine the clinical significance of serum ferritin as an indicator for disease activity. METHODS: Seven patients who were diagnosed as adult onset Still s disease at Samsung Medical Center between October 1994 and March 1997, were reviewed. In these patients we checked leukocyte count, ESR, CRP and serum ferritin concentrations at the time of diagnosis and during follow-up periods and recorded febrile events during follow-up periods. RESULTS: At the time of diagnosis and during febrile periods, the concentrations of ferritin were extremely high(927ng/ml to 96,650ng/ml normal 10-290.8 ng/ml). The values were unrelated to other manifestations of the disease or laboratory findings. The ferritin concentrations decreased rapidly after adequate treatment. Eleven febrile reattacks happened in 7 patients. Serum ferritin concentrations were increased in 8 febrile attacks, while leukocyte count, ESR, and CRP were increased in 5, 5, 6 febrile attacks respectively, There were 10 events of increased serum ferritin concentrations in 7 patients during follow-up periods and 8 events were related with fever. The increases of other laboratory tests were similar. CONCLUSIONS: In all patients, serum ferritin concentrations were increased at the time of diagnosis and closely related to fever. During follow-up periods, serum ferritin concentrations are helpful in monitoring disease activity and guiding decisions about treatment.
Adult* ; Diagnosis ; Ferritins* ; Fever ; Follow-Up Studies ; Humans ; Leukocyte Count ; Still's Disease, Adult-Onset*

BACKGROUND: Stellate ganglion block (SGB) is known to increase blood flow to the innervations area of the stellate ganglion. Near infrared spectroscopy reflects an increased blood volume and allows continuous, non-invasive, and bedside monitoring of regional cerebral oxygen saturation (rSO2). We investigated the influence of SGB on bilateral cerebral oxygenation using a near infrared spectroscopy. METHODS: SGB was performed on 30 patients with 1% lidocaine 10 ml using a paratracheal technique at the C6 level and confirmed by the presence of Horner's syndrome. The blood pressure (BP), heart rate (HR) and rSO2 were measured before SGB and 5, 10, 15 and 20 minutes after SGB. Tympanic temperature of each ear was measured prior to SGB and 20 minutes after SGB. RESULTS: The increments of the rSO2 on the block side from the baseline were statistically significant at 5, 10, 15 and 20 minutes. The rSO2 on the non-block side compared with the baseline, however, decreased at 15 and 20 minutes. The difference between the block and the non-block sides was significant at 15 and 20 minutes. The BP at 10, 15 and 20 minutes was increased and the HR was increased at 10 and 15 minutes. CONCLUSIONS: We observed an increment of the rSO2 on the block side from the baseline; however, the rSO2 on the non-block side decreased.
Blood Pressure ; Blood Volume ; Ear ; Heart Rate ; Horner Syndrome ; Humans ; Lidocaine ; Oxygen ; Spectrum Analysis ; Stellate Ganglion

Liver function tests before treatment showed abnormalities of liver function tests during treatment, while 15(68. 2%) of 22 patients who had abnormal liver function tests before treatment showed abnormalities during treatment. In 12 of the 25 patients who showed abnormalities of liver function tests during treatment with allopurinol, allopurinol was stopped and all patients showed improvement of liver function tests. In remaining 13 patients, 10 patients were improved and other 2 patients showed only mild abnormalities of liver function tests despite of continuing allopurinol and 1 patient was lost during follow-up. CONCLUSION: Abnormalities of liver function tests were common during treatment with allopurinol. Most patiensts who had mild abnormalities of liver functions tests during treatment with allopurinol were improved regardless of continuing allopurinol.
Allopurinol* ; Follow-Up Studies ; Gout* ; Humans ; Liver Function Tests* ; Liver*

Background: Rapidly mutating (RM) Y-chromosomal short tandem repeats (Y-STRs) have been demonstrated to increase the possibility of distinguishing between male relatives due to a higher mutation rate than conventional Y-STRs. Massively parallel sequencing (MPS) can be useful for forensic DNA typing as it allows the detection of sequence variants of many forensic markers. Here, we present sequence variations of 31 Y-STRs including nine RM Y-STRs (DYF387S1, DYF399S1, DYF404S1, DYS449, DYS518, DYS570, DYS576, DYS612, and DYS627), their frequencies, distribution, and the gain in the number of alleles using MPS. Methods: We constructed a multiplex MPS assay capable of simultaneously amplifying 32 Y-chromosomal markers, producing amplicons ranging from 85–274 bp. Barcoded libraries from 220 unrelated males from four populations—African Americans, Caucasians, Hispanics, and Koreans—were generated via two-step polymerase chain reaction and sequenced on a MiSeq system. Genotype concordance between the capillary electrophoresis (CE) and MPS method and sequence variation of Y-STRs were investigated. Results: In total, 195 alleles were increased by MPS compared to CE-based alleles (261 to 456). The DYS518 marker showed the largest increase due to repeat region variation (a 3.69-fold increase). The highest increase in the number of alleles due to single nucleotide polymorphisms in the flanking region was found in DYF399S1. RM Y-STRs had more diverse sequences than conventional Y-STRs. Furthermore, null alleles were observed in DYS576 due to primer-binding site mutation, and allele drop-outs in DYS449 resulted from low marker coverage of less than the threshold. Conclusion The results suggest that the expanded and discriminative MPS assay could provide more genetic information for Y-STRs, especially for RM Y-STRs, and could advance male individualization. Compiling sequence-based Y-STR data for worldwide populations would facilitate the application of MPS in the field of forensic genetics and could be applicable in solving male-related forensic cases.

Objective: To investigate the effect of tumor necrosis factor (TNF)-alpha on the production of macrophage migration inhibitory factor (MIF), which might have important roles in the immune mediated inflammatory response of Behcet's syndrome. Methods: Sixty two patients with Behcet's syndrome and thirty healthy controls were included in this study. The concentrations of TNF-alpha in sera were determined by enzyme-linked immunosorbent assay (ELISA). Peripheral blood mononuclear cells (PBMCs) from eleven patients with Behcet's syndrome were cultured for 48 hours with various concentration of TNF-alpha. The concentrations of MIF in sera and culture supernatants were determined by ELISA. Results: Serum levels of TNF-alpha were significantly higher in patients with Behcet's syndrome than in healthy controls. TNF-alpha dose-dependently increased MIF production from PBMCs in patients with Behcet's syndrome. Serum levels of TNF-alpha tended to correlate with serum levels of MIF, although did not reach statistical significance. Conclusion: Upregulation of MIF production by increased levels of TNF-alpha in patients with Behcet's syndrome might be related to the pathogenesis of Behcet's syndrome.
Behcet Syndrome* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Macrophages* ; Tumor Necrosis Factor-alpha* ; Up-Regulation*

There are many different approaches to ultrasound-guided supraclavicular brachial plexus block (US-SCBPB), and each has a different success rate and complications. The most commonly performed US-SCBPB is the corner pocket approach in which the needle is advanced very close to the subclavian artery and pleura. Therefore, it may be associated with a risk of subclavian artery puncture or pneumothorax. We advanced the needle into the central part of the neural cluster after penetrating the sheath of the brachial plexus in US-SCBPB. We refer to this new method as the "central cluster approach." In this approach, the needle does not have to advance close to the subclavian artery or pleura. The aim of this study was to evaluate the clinical outcomes of the central cluster approach in US-SCBPB.
Brachial Plexus* ; Needles ; Pleura ; Pneumothorax ; Punctures ; Subclavian Artery ; Ultrasonography

Underserved area is a region that has a lack of healthcare resources. In the context of Korea, however, there are not enough detailed criteria for underserved areas. In this study, we aimed to develop indicators for underserved area through Delphi technique. We systematically reviewed the existing measure of underserved area. Sixty indicators were extracted as candidates across four domains in secondary medical care. Four domains are demand, medical resource, quality of care, and health outcome. To develop indicator, two round Delphi survey was conducted among 15 professional experts such as professionals and public administrators. In conclusion, 2 final indicators (accessibility, medical utilization) was determined as an appropriate measure in order to designate underserved area for secondary medical services. Using our criteria from Delphi technique, 36 areas were found as underserved areas for the secondary medical care.
Administrative Personnel ; Delivery of Health Care ; Delphi Technique ; Humans ; Korea

BACKGROUND: In terms of localizing value, the clinical features of small lesion confined to thalamus are of great interest. The clinical manifestations frequently comprise hemiparesis, hemianesthesia, and neuropsychological abnormalities and the main cause of thalamic infarct is thought to be an arteriolopathy. To better understand the relationship between the location of thalamic lesion and clinical features, we studied the charateristics of patients with thalamogeniculate artery(TGA) territory infarction, which is most common site of thalamic infarction. METHODS: We reviewed 732 ischemic stroke patient registered to our stroke database over 4-year period. On the basis of MRI, we identified 33 cases of small thalamic infarction(<2cm). Among them, 21 cases had a lesion purely confined to TGA territory. RESULTS: The clinical type of manifestations were sensorimotor(10), pure sensory(7), hemiataxia+sensory(2), hemiataxia+ sensorimotor(1) and involunatry movement(1), respectively. No cases had neuropsychological abnormalities. Only 19% of total cases developed classical Dejerine-Roussy syndrome on short term follow-up. Most patients had hypertension and/or diabetes with the absence of large vessel abnormalities on MRA, but none had the cardioembolic source. CONCLUSION: The lesion sizes of pure sensory thalamic infarction were relatively small. The classical Dejerine-Roussy syndrome had been originally described as the effect of TGA occlusion but uncommon in our series.
Arteries* ; Follow-Up Studies ; Humans ; Hypertension ; Infarction* ; Magnetic Resonance Imaging ; Paresis ; Stroke ; Thalamic Diseases ; Thalamus

OBJECTIVE: To assess factors related to standing balance in patients with knee osteoarthritis (OA). METHODS: In total, 37 female patients with painful knee OA were included. Pain, knee alignment, and Kellgren and Lawrence grade were evaluated accordingly. Static standing balance was measured with a force-platform system under two different conditions: static standing with eyes open (EO) and eyes closed (EC) for 30 seconds. The mean speed (mm/s) of movement of the center of pressure in the anteroposterior (AP) and mediolateral directions and the mean velocity moment (mm2/s) were analyzed for assessment of static balance. RESULTS: In the univariate regression analysis, age and knee alignment showed statistically significant relationships with the mean speed in the AP directions with EO. In the multiple linear regression model, age and knee alignment were positively associated and disease severity was negatively associated with mean speed in the AP directions with EO. However, the variables for EC static measurements were not significantly correlated with age, pain, knee alignment, or radiographic severity (p>0.05). CONCLUSION: These findings show that the worse balance was associated with advanced age, less varus knee malalignment, and mild radiographic changes. Pain was not associated with standing balance.
Eye ; Female ; Humans ; Knee ; Linear Models ; Osteoarthritis ; Osteoarthritis, Knee

In view of this pandemic, as of February 2020, South Korea has the second highest number of confirmed cases in the world. Herein, we report four confirmed coronavirus disease 2019 (COVID-19) cases in the early stage of the pandemic in South Korea and describe the identification, diagnosis, clinical course, and management, including one patient’s initial mild symptoms at presentation and their progression to pneumonia on day 21 of illness. Within 48 hours of hospitalization, all four patients underwent evaluation for initial laboratory parameters, COVID-19 polymerase chain reaction (PCR), and chest computed tomography (CT) findings. All four mild COVID-19 patients were discharged, and they were re-examined 14 days after discharge. Despite all four of them being asymptomatic, one patient was re-admitted after confirmation of COVID-19 through PCR viral nucleic acid detection. She could be discharged after 7 days with two subsequent negative COVID-19 PCR at 24-hour intervals. Patients with mild COVID-19 generally have normal follow-up chest CT scans after discharge, even if the early chest CT definitely indicates pneumonia. Re-hospitalized patients with COVID-19 PCR positive results after discharge were not related to her initial chest CT, lab, symptoms compared other three patients.