Typical vasculitic neuropathy commonly manifests as a subacute multiple mononeuropathy, symmetrical or asymmetrical sensori-motor polyneuropathy. Various clinical presentations of peripheral neuropathy may confuse the diagnostic approach sometimes. A 76-year old man presented progressive areflexic ascending paralysis. gait ataxia, severe vibration and position sense impairment for 1 month. We initially considered as subacute demyelinating polyneuropathy. Electrophysiologic studies showed mainly axonopathy with some evidence of demyelination. We performed sural nerve biopsy and diagnosed as vasculitic neuropathy. No laboratory data or clinical findings favored systemic vasculitic involvement. So we concluded vasculitis confined to the peripheral nerves. Vasculitic neuropathy rarely presented as large myelinated nerve fiber disease. It should be considered the clinical variability of vasculitic neuropathy so extensive studies are needed in the case of peripheral polyneuropathy with indefinite cause.
Aged ; Biopsy ; Demyelinating Diseases ; Gait Ataxia ; Humans ; Mononeuropathies ; Nerve Fibers, Myelinated ; Paralysis* ; Peripheral Nerves ; Peripheral Nervous System Diseases ; Polyneuropathies ; Proprioception ; Sural Nerve ; Vasculitis ; Vibration

OBJECTIVES: This study aimed to investigate the current status of infectious disease research in North Korea by analyzing recent trends in medical journals from North Korea in comparison with research from South Korea. METHODS: Three medical journals (Preventive Medicine, Basic Medicine, and Chosun Medicine) were analyzed from 2012 to 2016. Articles on tuberculosis (TB), malaria, and parasitic diseases were selected and classified by their subtopics and study areas. Two medical journals published in the South Korea were selected for a comparative analysis of research trends. RESULTS: Of the 2792 articles that were reviewed, 93 were extracted from North Korea journals. TB research in North Korea was largely focused on multi-drug resistant TB and extrapulmonary TB, whereas research in South Korea more frequently investigated non-tuberculous mycobacteria. Research on parasitic diseases in North Korea was focused on protozoan and intestinal nematodes, while the corresponding South Korea research investigated various species of parasites. Additionally, the studies conducted in North Korea were more likely to investigate the application of traditional medicine to diagnosis and treatment than those conducted in South Korea. CONCLUSIONS: This study presents an analysis of research trends in preventive medicine in North Korea focusing on infectious diseases, in which clear differences were observed between South and North Korea. Trends in research topics suggest a high prevalence of certain parasitic diseases in North Korea that are no longer widespread in South Korea. The large proportion of studies examining traditional medicine implies a lack of affordable medicine in North Korea.
Communicable Diseases* ; Democratic People's Republic of Korea* ; Diagnosis ; Korea ; Malaria ; Medicine, Traditional ; Parasites ; Parasitic Diseases ; Prevalence ; Preventive Medicine ; Tuberculosis

Background: In this study, we compared the incidents of humidifier disinfectants and incidents of mild hepatitis in Japan to highlight the differences in government response in the health care field in terms of “chain of responsibility”. Methods: We examined whether the three mechanisms of action and the chain of responsibility hypothesis were applied to compare the cases of Korea and Japan. The incident of Japan occurred in 1987 in Misawa city, Aomori prefecture. In the 1990s, the safety of blood products increased dramatically. However, relief for infected victims was neglected. Green Cross did not notify the parties. In Korea, in the spring of 2011, a number of lung disease patients were accidentally admitted to a hospital in Seoul, and a female patient with respiratory failure symptoms expired. The Korea Centers for Disease Control and Prevention conducted animal tests and the Ministry of Health and Welfare issued an order for forced collection of humidifier disinfectants. Results: In the case of Japan, the Ministry of Health and Welfare had to take responsibility for follow-up measures such as the investigation of the cause, so it was tied to a “chain of responsibility”. However, in the case of Korea, the Ministry of Health and Welfare was free from the chain. Conclusion Through the comparison between the cases of Japan and Korea, we confirmed that whether or not a government organization chooses to conceal responsibility depends on its past behavior, which is whether it is free from the chain of responsibility or not. Therefore, it was reaffirmed that an organization (ministry or department) free from the chain of responsibility must exist within the government.

PURPOSE: Henoch-Shonlein purpura(HSP) is a systemic vasculitis that involves multiple organs, especially the kidney, which is the most important organ in determining the prognosis of the disease. The morbidity of HSP nephritis in adults is low and there have been little research done on its clinical course so far. Therefore, we have compared the clinical course of HSP nephritis in children and adults in Korea. METHODS: We retrospectively analyzed 81 cases of HSP nephritis in children younger than 15 years of age, and 25 cases of adults older than 15 years of age who were admitted to Yonsei University Medical College Severance Hospital from Jan. 1986 to May 2003. RESULTS: The male to female ratio was 1.5:1 in children and 1.3:1 in adults. The incidence of HSP nephritis for both age groups was found to be increased during the autumn and winter. Infection was the predisposing factor in 39 cases(48.1%) of children, 16 cases(64.0%) of adults, and drugs were the predisposing factor in 8 cases(9.9%) of children and 4 cases (16.0%) of adults. All patients initially presented with microscopic hematuria. Thirteen cases (16.0%) of children and 7 cases(28.0%) of adults initially showed proteinuria of nephrotic range. Thirty four cases(42.0%) of children and 4 cases(16.0%) of adults showed normal urinalysis after treatment. Asymptomatic urinary abnormalities were found in 41 cases(50.6%) of children and 18 cases(72.0%) of adults. Complications such as nephrotic syndrome and hypertension were found in 3 cases(3.7%) of children and 2 cases(8.0%) of adults. Three children(3.7%) and 1(4.0%) adult required dialysis or renal transplantation. Follow-up renal biopsies were performed on 21 children, of whom 10 cases(47.6%) did not show any histologic change, 9 cases(42.9%) showed low grade changes, and 2 cases(9.5%) showed high grade changes. Prognosis was gloomy when proteinuria of nephrotic range and high grade of abnormal histology were present at diagnosis, and there was no significant difference between the two groups(P<0.05) CONCLUSION: This study showed that there was no difference in terms of the clinical features and courses between the children and adults with HSP nephritis. Proteinuria of nephrotic range and the severity of abnormal histologic changes at diagnosis were found to be associated with a bad prognosis, therefore we recommend that patients with these features require long term follow-up and management.
Adult* ; Biopsy ; Causality ; Child* ; Diagnosis ; Dialysis ; Female ; Follow-Up Studies ; Hematuria ; Humans ; Hypertension ; Incidence ; Kidney ; Kidney Transplantation ; Korea ; Male ; Nephritis* ; Nephrotic Syndrome ; Prognosis ; Proteinuria ; Purpura, Schoenlein-Henoch* ; Retrospective Studies ; Systemic Vasculitis ; Urinalysis

PURPOSE: Henoch-Shonlein purpura(HSP) is a systemic vasculitis that involves multiple organs, especially the kidney, which is the most important organ in determining the prognosis of the disease. The morbidity of HSP nephritis in adults is low and there have been little research done on its clinical course so far. Therefore, we have compared the clinical course of HSP nephritis in children and adults in Korea. METHODS: We retrospectively analyzed 81 cases of HSP nephritis in children younger than 15 years of age, and 25 cases of adults older than 15 years of age who were admitted to Yonsei University Medical College Severance Hospital from Jan. 1986 to May 2003. RESULTS: The male to female ratio was 1.5:1 in children and 1.3:1 in adults. The incidence of HSP nephritis for both age groups was found to be increased during the autumn and winter. Infection was the predisposing factor in 39 cases(48.1%) of children, 16 cases(64.0%) of adults, and drugs were the predisposing factor in 8 cases(9.9%) of children and 4 cases (16.0%) of adults. All patients initially presented with microscopic hematuria. Thirteen cases (16.0%) of children and 7 cases(28.0%) of adults initially showed proteinuria of nephrotic range. Thirty four cases(42.0%) of children and 4 cases(16.0%) of adults showed normal urinalysis after treatment. Asymptomatic urinary abnormalities were found in 41 cases(50.6%) of children and 18 cases(72.0%) of adults. Complications such as nephrotic syndrome and hypertension were found in 3 cases(3.7%) of children and 2 cases(8.0%) of adults. Three children(3.7%) and 1(4.0%) adult required dialysis or renal transplantation. Follow-up renal biopsies were performed on 21 children, of whom 10 cases(47.6%) did not show any histologic change, 9 cases(42.9%) showed low grade changes, and 2 cases(9.5%) showed high grade changes. Prognosis was gloomy when proteinuria of nephrotic range and high grade of abnormal histology were present at diagnosis, and there was no significant difference between the two groups(P<0.05) CONCLUSION: This study showed that there was no difference in terms of the clinical features and courses between the children and adults with HSP nephritis. Proteinuria of nephrotic range and the severity of abnormal histologic changes at diagnosis were found to be associated with a bad prognosis, therefore we recommend that patients with these features require long term follow-up and management.
Adult* ; Biopsy ; Causality ; Child* ; Diagnosis ; Dialysis ; Female ; Follow-Up Studies ; Hematuria ; Humans ; Hypertension ; Incidence ; Kidney ; Kidney Transplantation ; Korea ; Male ; Nephritis* ; Nephrotic Syndrome ; Prognosis ; Proteinuria ; Purpura, Schoenlein-Henoch* ; Retrospective Studies ; Systemic Vasculitis ; Urinalysis

BACKGROUND: Proton beam radiotherapy (PBT) has shown to provide high radiation dose to tumors and to save surrounding normal tissues because of its physical characteristics, Bragg peak. In the current study, we report the early outcomes for pediatric patients with intracranial gliomas treated with PBT and compared PBT plan (pencil beam scanning and double scattering) with intensity modulated radiotherapy (IMRT) plan and three dimensional-conformal radiotherapy (3D-CRT) plan.METHODS: Clinical data from 18 consecutive children with intracranial gliomas who underwent PBT from May 2007 to April 2012 was collected. The median follow-up duration was 16 months (range 6-69).RESULTS: There were 9 patients with brain stem glioma, 2 patients with optic pathway glioma, 2 patients with low grade glioma (LGG), 2 patients with anaplastic astrocytoma (AA) and 3 patients with glioblastoma multiforme (GBM). The median overall survival for patients with brain stem glioma was 11 months. Patients with optic pathway glioma, LGG or AA were all alive without progression except one patient. Among patients with GBM, one patient had no evidence of disease 25 months after PBT. When PBT plan was compared to those of IMRT and 3D-CRT for patients with LGG or AA and one patient with brain stem glioma by DVH analysis, PBT showed better sparing effect on normal tissue compared to IMRT and 3D-CRT, especially in low dose area.CONCLUSION: PBT could be delivered safely and effectively to pediatric patients with gliomas. For confirming the clinical benefits of PBT, further follow-up is necessary.
Astrocytoma ; Brain Stem ; Child ; Follow-Up Studies ; Glioblastoma ; Glioma ; Humans ; Organ Sparing Treatments ; Pediatrics ; Proton Therapy ; Protons

OBJECTIVE: The Histoculture Drug Response Assay (HDRA), which measures chemosensitivity using minced tumor tissue on drug-soaked gelfoam, has been expected to overcome the limitations of in vitro chemosensitivity test in part. We analyzed interim results of HDRA in malignant gliomas to see if the test can deserve further clinical trials. METHODS: Thirty-three patients with malignant gliomas were operated and their tumor samples were examined for the chemosensitivity to 10 chosen drugs by HDRA. The most sensitive chemotherapy regimen among those pre-established was chosen based on the number of sensitive drugs or total inhibition rate (IR) of the regimen. The response was evaluated by 3 month magnetic resonance image. RESULTS: Among 13 patients who underwent total resection of the tumor, 12 showed no evidence of disease and one patient revealed progression. The response rate in 20 patients with residual tumors was 55% (3 complete and 8 partial responses). HDRA sensitivity at the cut-off value of more than one sensitive drug in the applied regimen showed a sensitivity of 100%, specificity of 60% and predictability of 70%. Another cut-off value of >80% of total IR revealed a sensitivity of 100%, specificity of 69%, and predictability of 80%. For 12 newly diagnosed glioblastoma patients, median progression-free survival of the HDRA sensitive group was 21 months, while that of the non-sensitive group was 6 months (p=0.07). CONCLUSION: HDRA for malignant glioma was inferred as a feasible method to predict the chemotherapy response. We are encouraged to launch phase 2 clinical trial with chemosensitivity on HDRA.
Disease-Free Survival ; Gelatin Sponge, Absorbable ; Glioblastoma ; Glioma ; Humans ; Magnetic Resonance Spectroscopy ; Neoplasm, Residual ; Pilot Projects ; Sensitivity and Specificity

PURPOSE: To characterize the prognostic factors and evaluate the inadequate empirical antibiotic therapy for patients with bloodstream infection. METHODS: We reviewed retrospectively the medical records of all adult patients with bloodstream infections detected from November 1, 2002, to June 30, 2003. Clinical and microbiological characteristics were recorded, and the adequacy of empirical antimicrobial therapy was determined in each case. A multiple logistic regression analysis with SPSS 11.5 was used to determine the prognostic factors for mortality related to bloodstream infections. RESULTS: Escherichia coliand Klebsiella spp. were the most commonly isolated organisms, and the main sources were the intra-abdominal (40.4%), the urinary tract (28.7%), and pneumonia (36.8%). Approximately 19.1% of the patients died. Statistical analysis of independent risk factors showed that mortality was significantly related to inadequate empirical antibiotic therapy (OR 34.72, p=0.019), renal insufficiency (OR 10.54, p=0.011), the rapidity of fatal diseases (OR 4.77, p=0.018), and the severity of sepsis (OR 3.58, p=0.031). Patients with inadequate empirical antibiotic therapy had a 50% survival rate. The main reason for the administration of an inadequate antibiotic therapy was the presence of antibiotic-resistant bacteria and/or fungal infections. CONCLUSION: Better understanding of the correlation between mortality and prognostic factors may improve the outcome for patients with bloodstream infections. Inadequate antibiotic therapy is the most important influence on the outcome for such patients. Our data suggest that clinical efforts aimed at reducing the occurrence of inadequate antibiotic therapy could improve the outcomes for bacteremic patients.
Adult ; Anti-Bacterial Agents ; Bacteremia ; Bacteria ; Emergencies* ; Emergency Service, Hospital* ; Escherichia ; Humans ; Klebsiella ; Logistic Models ; Medical Records ; Mortality ; Pneumonia ; Prognosis ; Renal Insufficiency ; Retrospective Studies ; Risk Factors ; Sepsis ; Survival Rate ; Urinary Tract

PURPOSE: Endometriosis is a condition where uterine mucosal tissue is located outside the uterus, and may be pelvic or extrapelvic. Extrapelvic endometriosis is a diagnostic challenge due to its very low incidence. The aim of this study was to analyze the clinical features of extrapelvic endometriosis in order to help diagnosis and treat this condition. METHODS: Between January 1998 and May 2005, 6 patients diagnosed with extrapelvic endometriosis after surgery at our hospital were retrospectively reviewed by a telephone interview. RESULTS: All cases were women in their reproductive years, with a median age of 37.5 years (range 34~50 years). Five of the six cases had a prior medical history of a caesarean section and 1 case had episiotomy during a normal vaginal delivery. Five cases were located in the lower abdomen and 1 case was located in the perineum. All patients presented with a surgical scar mass associated with pain and size that increased during menstruation. The median mass size was 2.5 cm (range 1~3.4 cm). The mass was found after a median interval of 13 months (range 1~45 months) from pelvic surgery. All cases were suspected of having extrapelvic endometriosis due to their specific clinical features, and 2 of them were confirmed by fine needle aspiration cytology (FNAC). All the patients were treated with a surgical excision. There was no recurrence after a median follow up of 27 months (range 4~86 months). CONCLUSION: Patients with a surgical scar mass associated with pain that increases in size during menstruation should be suspected of having extrapelvic endometriosis and be treated by a complete surgical excision to prevent a recurrence.
Abdomen ; Biopsy, Fine-Needle ; Cesarean Section ; Cicatrix ; Diagnosis ; Endometriosis* ; Episiotomy ; Female ; Follow-Up Studies ; Humans ; Incidence ; Interviews as Topic ; Menstruation ; Mucous Membrane ; Perineum ; Pregnancy ; Recurrence ; Retrospective Studies ; Uterus

Impaired fasting glucose (IFG) is one of significant risk factors of developing diabetes. The persons with IFG are, thus, an important target group for primary prevention of diabetes. It is well known that plasma homocysteine concentration may be increased in poor folate nutritional status. Elevated level of plasma homocysteine is considered as a marker of enhanced oxidative stress. In addition, the protective effect against oxidative stress may be diminished in poor antioxidative nutrient status as vitamin C. It is, therefore, important to maintain adequate nutritional status of folate and vitamin C in the patients with type 2 diabetes or IFG. This study was performed to determine the effects of supplementation of folic acid or vitamin C on plasma concentrations of homocysteine, oxidized LDL, and lipids and on the activity of plasma anti-oxidative enzyme in patients with IFG. A total of 97 patients with IFG were participated voluntarily with written consents. They were divided into one of the four experimental groups; Control (C), Folatesupplemented (F), Ascorbate-supplemented (A), and Folate plus ascorbate-supplemented (FA). The subjects in C were taken placebo, those in F were supplemented 1 mg of folate, those in A were received 1,000 mg of vitamin C, and those in FA were given 1 mg of folate plus 1,000 mg of vitamin C daily for 4 weeks. No change in plasma concentrations of vitamin C, lipids, and oxidized LDL and the activity of GSH-Px were observed in vitamin C-supplemented group (A + FA) and folate-supplemented group (F + FA) compared to the placebo group (C + A). Only the folate-supplemented group (F + FA) had significantly increased average serum folate concentration and lowered plasma homocysteine concentration compared to the placebo group (C + A). Thus, it should be recommended the patients with IFG to increase folate intake through diets and, if it is not sufficient, to take folic acid supplements to prevent the development of complications induced by hyperhomocysteinemia as well as oxidative stress.
Adult ; Ascorbic Acid ; Diet ; Fasting ; Folic Acid ; Glucose ; Homocysteine ; Humans ; Hyperhomocysteinemia ; Lipoproteins, LDL ; Nutritional Status ; Oxidative Stress ; Plasma ; Primary Prevention ; Risk Factors ; Vitamins