No abstract available.
Bowen's Disease*

MRI is a valuable imaging technique for the evaluation of intraarticular diseases. Accurate interpretation of joint MRI necessitates sound knowledge of anatomy. In the field of joint anatomy, in addition to the discovery of new structures, previously reported joint components of unexplained function are also detected. In this review, joint anatomy researched actively over the last decade is discussed. Joint components including the rotator cable and the superior capsule of the shoulder, posterolateral corner and the anterolateral ligament complex of the knee, and the distal tibiofibular syndesmosis of the ankle joint are introduced and correlated with their MRI features.

OBJECTIVE: The aim of the present study was to investigate the visual perception difference between ADHD children with and without sensory processing disorder, and the relationship between sensory processing and visual perception of the children with ADHD. METHODS: Participants were 47 outpatients, aged 6-8 years, diagnosed with ADHD. After excluding those who met exclusion criteria, 38 subjects were clustered into two groups, ADHD children with and without sensory processing disorder (SPD), using SSP reported by their parents, then subjects completed K-DTVP-2. Spearman correlation analysis was run to determine the relationship between sensory processing and visual perception, and Mann-Whitney-U test was conducted to compare the K-DTVP-2 score of two groups respectively. RESULTS: The ADHD children with SPD performed inferiorly to ADHD children without SPD in the on 3 quotients of K-DTVP-2. The GVP of K-DTVP-2 score was related to Movement Sensitivity section (r=0.368*) and Low Energy/Weak section of SSP (r=0.369*). CONCLUSION: The result of the present study suggests that among children with ADHD, the visual perception is lower in those children with co-morbid SPD. Also, visual perception may be related to sensory processing, especially in the reactions of vestibular and proprioceptive senses. Regarding academic performance, it is necessary to consider how sensory processing issues affect visual perception in children with ADHD.
Attention Deficit Disorder with Hyperactivity ; Child* ; Humans ; Outpatients ; Parents ; Visual Perception*

Left ventricular outflow tract (LVOT) obstruction with systolic anterior motion (SAM) of mitral valve is not only limited to patients with hypertrophic cardiomyopathy. A diagnosis of LVOT obstruction with SAM is important because conventional inotropic support may potentially aggravate hemodynamic deterioration. We present a case of LVOT obstruction with SAM in a patient who underwent an emergent surgery for ascending aortic dissection with pericardial effusion. The patient showed refractory hypotension after standard pharmacologic interventions during induction of anesthesia. Transesophageal echocardiography (TEE) revealed LVOT obstruction with SAM and it was managed appropriately under the guidance of TEE. Intraoperative TEE can play an important role in diagnosis and management of LVOT obstruction with SAM caused by pericardial effusion.
Anesthesia ; Cardiomyopathy, Hypertrophic ; Echocardiography, Transesophageal ; Hemodynamics ; Humans ; Hypotension ; Mitral Valve ; Pericardial Effusion

Necrotizing enterocolitis (NEC) is a major gastrointestinal disorder in premature infants associated with high morbidity and mortality rates. When NEC is clinically suspected, radiological and laboratory studies should be performed to confirm the diagnosis and to aid in the management of patients. As the clinical manifestations of NEC are usually nonspecific, diagnoses are often made using abdominal radiographic findings, such as pneumatosis intestinalis. Clinicians typically consider the presence of pneumatosis intestinalis on radiographs as the definite evidence of stage II NEC. Here, we report 3 cases of preterm infants who had radiographic findings of pneumatosis intestinalis but did not have any other associated laboratory and clinical evidence of NEC, except bloody stools. The infants' systemic manifestations were mild or absent, and all of them completely recovered within 2-3 days, as demonstrated by the resolution of pneumatosis intestinalis on abdominal radiographs. The combination of hematochezia and intestinal pneumatosis in preterm infants strongly suggests the diagnosis of NEC. In our cases, there was no laboratory evidence of inflammation or platelet consumption, and the clinical course was benign without any sings of surgical abdomen. Additionally, our patients had barium-induced colitis or milk protein allergy, which are other possible causes of pneumatosis intestinalis. Because pneumatosis intestinalis can result from causes other than NEC, it is important to consider clinical, laboratory, and radiological findings to confirm the diagnosis of NEC.
Abdomen ; Blood Platelets ; Colitis ; Diagnosis ; Enterocolitis, Necrotizing* ; Gastrointestinal Hemorrhage ; Humans ; Hypersensitivity ; Infant, Newborn ; Infant, Premature* ; Inflammation ; Milk Proteins ; Mortality

BACKGROUND: The Acute Physiology and Chronic Health Evaluation (APACHE) IV model has not yet been validated in Korea. The aim of this study was to compare the ability of the APACHE IV with those of APACHE II, Simplified Acute Physiology Score (SAPS) 3, and Korean SAPS 3 in predicting hospital mortality in a surgical intensive care unit (SICU) population. METHODS: We retrospectively reviewed electronic medical records for patients admitted to the SICU from March 2011 to February 2012 in a university hospital. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow test, respectively. We calculated the standardized mortality ratio (SMR, actual mortality predicted mortality) for the four models. RESULTS: The study included 1,314 patients. The hospital mortality rate was 3.3%. The discriminative powers of all models were similar and very reliable. The AUCs were 0.80 for APACHE IV, 0.85 for APACHE II, 0.86 for SAPS 3, and 0.86 for Korean SAPS 3. Hosmer and Lemeshow C and H statistics showed poor calibration for all of the models (P < 0.05). The SMRs of APACHE IV, APACHE II, SAPS 3, and Korean SAPS 3 were 0.21, 0.11 0.23, 0.34, and 0.25, respectively. CONCLUSIONS: The APACHE IV revealed good discrimination but poor calibration. The overall discrimination and calibration of APACHE IV were similar to those of APACHE II, SAPS 3, and Korean SAPS 3 in this study. A high level of customization is required to improve calibration in this study setting.
APACHE* ; Area Under Curve ; Calibration ; Discrimination (Psychology) ; Electronic Health Records ; Hospital Mortality* ; Humans ; Intensive Care Units ; Critical Care* ; Korea ; Mortality ; Physiology ; Retrospective Studies ; ROC Curve

BACKGROUND AND OBJECTIVES: Recent evidence indicates that the membrane voltage and Ca2+ clocks jointly regulate sinoatrial node (SAN) automaticity. However, the mechanism of heart rhythm acceleration of the subsidiary pacemaker (SP) during beta-adrenergic stimulation is still unknown. Here we tested the hypothesis that the heart rate acceleration of the SP by beta-adrenergic stimulation involves synergistic interactions between both clock mechanisms. SUBJECTS AND METHODS: We performed optical mapping and pharmacological interventions in 15 isolated Langendorff-perfused canine right atriums (RA). The SP model was produced by ligation of the SAN artery at the mid portion of the sulcus terminalis. RESULTS: In the 6 RAs with an intact SAN, 1 micromol/L isoproterenol infusion increased the heart rate from 82+/-9 to 166+/-18 bpm (102%) with late diastolic Cai elevation (LDCAE) at the superior SAN. However, in the 6 SP models, the heart rate increased from 55+/-10 bpm to 106+/-11 bpm (92%, p=0.005) without LDCAE at the earliest activation site. The isoproterenol induced heart rate increase was reversed to 74+/-5 bpm (33% from baseline) by administering an infusion of the funny current blocker ZD 7288 (3 micromol/L, n=3), whereas, it was suppressed to 69+/-7 bpm (24% from baseline) by sarcoplasmic reticulum (SR) Ca2+ emptying with administering ryanodine (10 micromol/L) plus thapsigargin (200 nmol/L, n=3). The isoproterenol induced heart rate increase was completely abolished by combined treatment with funny current blocker and SR Ca2+ emptying (n=3). CONCLUSION: Acceleration of the Ca2+ clock in the SP plays an important role in the heart rate acceleration during beta-adrenergic stimulation, and this interacts synergistically with the voltage clock to increase the heart rate.
Acceleration ; Arteries ; Calcium Channels ; Heart ; Heart Atria ; Heart Rate ; Isoproterenol ; Ligation ; Membranes ; Mustard Compounds ; Pyrimidines ; Ryanodine ; Sarcoplasmic Reticulum ; Sinoatrial Node ; Sympathetic Nervous System ; Thapsigargin

BACKGROUND/AIMS: This study was to evaluate the clinical significance of infusion-related reaction (IRR) of rituximab in diffuse large B-cell lymphoma (DLBCL) patients who received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) as a first-line chemotherapy. METHODS: The medical records of 326 patients diagnosed with DLBCL were re trospectively analyzed. Both doctor's progress records and nursing records were reviewed. IRR was graded according to the National Cancer Institute Common Terminology Criteria. RESULTS: IRR was not associated with overall survival (OS) or progression-free survival (PFS) of DLBCL patients as compared to those who did not have IRR (OS: median 78.0 months vs. 69.0 months, p = 0.700; PFS: median 65.4 months vs. 64.0 months, p = 0.901). IRR grade did not affect OS or PFS. B symptoms was independently associated with IRR (hazard ratio [HR], 1.850; 95% confidence interval [CI], 1.041 to 3.290; p = 0.036). Further, bone marrow involvement was independently associated with re-IRR (HR, 4.904; 95% CI, 0.767 to 3.118; p = 0.029). CONCLUSIONS Our study shows that IRR of rituximab is not associated with OS or PFS of DLBCL patients who received R-CHOP. Furthermore, our study suggests a need for more careful observation for IRR in patients with B symptoms or bone marrow involvement.

BACKGROUND: Tuberculosis is associated with hypercoagulation; however, there are few reports of cases thromboembolism and tuberculosis at the same time in the real world. The purpose of this study was to report the incidence and clinical course of thromboembolism in patients diagnosed with tuberculosis. MATERIALS AND METHODS: We retrospectively analyzed the data of patients who were diagnosed with both tuberculosis and thromboembolism including pulmonary thromboembolism (PTE) or deep vein thrombosis (DVT) at Seoul National University Boramae Medical Center from January 2000 through March 2015. RESULTS: Among the 7905 tuberculosis patients, 49 (0.6%) exhibited PTE, DVT, or both at or after the time of tuberculosis diagnosis. All patients treated for tuberculosis started with isoniazid, ethambutol, rifampicin, and pyrazinamide. Eight patients were switched to treatment with second-line medication because of resistance or adverse events. About half of the patients (n = 21, 44.7%) had thrombosis at the time of tuberculosis diagnosis. Of 48 patients treated for thromboembolism, 36 received warfarin. A total of 20 patients improved symptom caused by thrombosis, and 10 patients were confirmed cure by image study such as computed tomography or doppler ultrasonography. Eight patients who were treated with warfarin had persistent thrombosis. Five patients (10.2%) experienced major bleeding that required hospitalization. All of these bleeding events were associated with warfarin therapy. CONCLUSIONS Careful attention to PTE/DVT is needed at the time of diagnosis of tuberculosis and during anti-tuberculosis therapy. Warfarin therapy administered with anti-tuberculosis medication requires frequent monitoring to prevent major bleeding.