Neuroinflammation such as reactive gliosis and microglial activations are important pathological findings of ALS. We present a first autopsy case of ALS in Korea related with neuroinflammatory change. A 67-year-old ALS patient suddenly expired due to accidental head trauma. Gross autopsy finding showed marked atrophic change in spinal cord. Pathological finding include a marked loss of motor neurons, reactive gliosis and microglial infiltrations. These findings suggest neuroinflammation may play a role in pathogenesis of ALS.
Aged ; Amyotrophic Lateral Sclerosis ; Autopsy ; Craniocerebral Trauma ; Gliosis ; Humans ; Korea ; Motor Neurons ; Spinal Cord

Despite improvements in dialysis care, the mortality of patients with end-stage renal disease(ESRD) remains high. One factor that has so far received little attention, but which might contribute to morbidity and mortality, is the timing of referral to the nephrologist. We performed a retrospective analysis in 358 patients(male 275, female 151) who were initiated renal replacement therapy first at this hospital from Jan 1995 to Dec 1996. Patients were defined by the time of first nephrology as early referral(E, n=163) encountered after more than 8 weeks; late early referral(LE, n=19) encountered between 8 weeks and 4 weeks; late referral(L, n=55) encountered from 1 week to 4 weeks; urgent referral(U, n= 121) encountered less than 1 week. There were no differences in age, gender, primary renal disease, cause of dialysis, and renal replacement therapy modalities. However, there were significant differences in rnean arterial pressure and serum phosphate levels between these 4 groups. The mean arterial pressures (mmHg) were 109.15 +/- 17.16, 105.37+/-18.76, 117.24 +/- 27.24 and 116.98+/-24.26 for E, LE, L and U, respectively(p<0.05, compared E to U). In the U group, serum phosphate levels were elevated at initiation of dialysis compared to the E group(6.39+/-1.72 vs 7.29 +/- 3.54mg/dL, p<0.05). One year mortality in the U group had on increased tendency compared to the E group, especially earlier mortality(7.4% vs 14.9N, p>0.05). In the E group, there was more controlled blood pressure and serum phosphate levels compared to the U group at initiation of renal replacement therapy, but other parameters were not significantly different among the 4 groups. Delays in initiation of renal replacement therapy may result in patients entering dialysis in a compromised state, therefore adequate long-term predialysis care by a nephrologist is important. Socioeconomic - and medical factors respon-sible for late referral and late initiation of dialysis need to be evaluated and corrected to further improve the outcome of these patients.
Arterial Pressure ; Blood Pressure ; Dialysis* ; Female ; Humans ; Mortality ; Nephrology ; Referral and Consultation* ; Renal Replacement Therapy ; Retrospective Studies

Purpose: Giant cell tumors (GCTs) are common benign primary bone tumors and are well known for their locally aggressive performance and tendency to recur. The purpose of this study was to analyze the effects of denosumab and risk factors for recurrent spinal GCTs. Materials and Methods: We searched PubMed, EMBASE, Web of Science, and Cochrane Library databases to identify differences between individuals treated with and without denosumab and risk factors for spinal GCT recurrence. Patient data, including age, sex, tumor resection range, location, denosumab use, Campanacci grade, and radiotherapy, were documented. Comparable factors were evaluated using odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs). Results: Sixteen studies were included. The overall incidence of spinal GCT recurrence was 29%. Campanacci grade III tumors showed better recurrence outcomes than grades I and II (OR, 16.36; 95% CI, 4.19–63.93; p<0.001). Gross total resection (OR, 0.09;95% CI, 0.04–0.19; p<0.001), radiotherapy (OR, 0.27; 95% CI, 0.11–0.65; p=0.004), and the use of denosumab during subtotal resection (OR, 2.95; 95% CI, 1.07–8.17; p=0.04) were important factors for reducing recurrence. Conclusion Clinicians must consider the effects of gross total resection, radiotherapy use, and denosumab use in cases of subtotal resection during spinal GCT treatment. So far, many researchers have used denosumab in spinal GCT, but none have clearly suggested an endpoint. Most studies, however, recommend using it for more than 6 months.

Owing to the mass production of recombinant human erythropoietin(rHuEPO), anemia in hemodialysis patients is effectively treated by intravenous or subcutaneous injection of rHuEPO at each dialysis session. But considerable portion of patients being injected rHuEPO have the resistance of EPO treatment. The most common cause of EPO resistance is caused by functional and storage iron deficiency and followed by chronic inflammation, hyperparathyroidism and aluminum intoxication in its incidence. But the rHuEPO resistance is not fully explained by these causes. In the present study, the relationship between nPCR reflecting daily protein intake and the weekly doses of rHuEPO required to maintain hemoglobin levels at approximately 10gm/dL was analyzed in 34 hemodialysis patients All subjective patients of 34 hemodialysis were injected rHuEPO subcutaneously and divided into two group:Group A composing 22 hemodialysis patients is nPCR<1.0gm/kg/day and Group B with 12 hemodialysis patients is nPCR>=1.0gm/kg/day. There were no significant differences in age, duration of hemodialysis, serum ferritin, serum iron, TIBC, transferrin saturation(%) of each group. The patients who had serum ferritin below 100 micro gm/dL or transferrin saturation(%) below 20% were excluded in this study. The weekly rHuEPO doses in patients with Group B was lower than those of patients with Group A(58.7627+/-20.465IU/kg/week vs 80.4317+/-38.6258IU/kg/week, P=0.041). Moreover Serum albumin levels in Group A were significantly lower than those of Group B(3.6522+/-0.4461gm/dL vs 4+/-0.3606gm/dL, P=0.031) and Kt/V in Group B were significantly higher than those of Group A (1.145+/-0.2049+/-1.4021+/-0.2981, P=0.021). Serum parathyroid hormone levels were significantly higher in Group A than those of Group B(171.9783+/-150.3378 pg/dL vs 72.8809+/-79.7226 pg/dL, P=0.049). But other various factors including serum aluminum, body mass index and acute phase reactant proteins such as C-reactive protein and ESR had no significant differences in each group. CONCLUSION: Our result showed that nPCR presenting daily protein intake is related with rHuEPO response and the patient's nutritional status. So we think that the nutrition aspect in EPO treatment should be considered. However, to prove this relationships completely between nutritional factors and rHuEPO response, further study shoud be needed.
Aluminum ; Anemia ; Body Mass Index ; C-Reactive Protein ; Dialysis ; Ferritins ; Humans ; Hyperparathyroidism ; Incidence ; Inflammation ; Injections, Subcutaneous ; Iron ; Nutritional Status ; Parathyroid Hormone ; Renal Dialysis ; Serum Albumin ; Transferrin

Atrophying pityriasis versicolor is a rare variant of pityriasis versicolor. Clinically, atrophying pityriasis versicolor is characterized by well defined, slightly scaly, depressed macules and patches with minimal symptoms. The etiology of the atrophy is unknown, though several hypotheses have been suggested, including immune reaction to antigens of Malassezia species. A 23-year-old male was presented with multiple, slightly brown colored macules and patches on the chest and back. In the potassium hydroxide preparation, lots of yeasts and hyphae were found. A histopathologic study showed multiple yeasts and hyphae on the stratum corneum, focal epidermal thinning, and perivascular lymphocytic infiltration on the upper dermis. The patient was treated with 100 mg itraconazole a day with topical antifungal agents. After 3 weeks of treatment, clinical improvement and mycological improvement were achieved. We present an additional case of atrophying piryriasis versicolor developed on the chest and back with the review of the relevant literature.
Antifungal Agents ; Atrophy ; Dermis ; Humans ; Hydroxides ; Hyphae ; Itraconazole ; Malassezia ; Male ; Pityriasis ; Potassium ; Potassium Compounds ; Thorax ; Tinea Versicolor ; Yeasts ; Young Adult

Metabolic acidosis is a well-recognized complication of chronic hemodialyzed patients. The metabolic acidosis in stable hemodialyzed patients is mainly resulted from the consequences of the inability to excrete nonvolatile acid and the patients daily protein intake. So severe metabolic acidosis in patients on hemodialysis is known as an independent determinant of protein catabolic rate and high mortality rate but the moderate degree of metabolic acidosis in stable patients on maintenace hemodialysis can be explained by the patients nutritional status. On the other hand, patients having adequate daily protein intake could have lower total CO2 levels than those of patients having inadequately lower daily protein intake. To identify this relationship, we analyzed correlations between pre-hemodialysis total CO2 and various factors reflecting the patient's nutritional status in 37 patients on stable hemodialysis. The total CO2 was ranged from 15.6 to 26.5mMol/L. Among various factors, total CO2 had negative linear correlation with normalized protein catabolic rate(nPCR) reflecting the patient's daily protein intake indirectly(Y= -0.0371X+1.75, r=-0.1319, P=0.014). Moreover, metabolic acidosis having CO2 lower than 18mMol/L may modulate protein kinetics as showing steeper slope than those of more than 18mMol/L(Y=-0.1321 X +3.342, r2=0.1074 vs Y=-0.03373X+1.7543 r2=0.1001, P=0.0001). However other factors including serum albumin, body mass index, pre-hemodialysis BUN, and Kt/V, had no correlation with the total CO2. The result suggested that moderately lower pre- hemodialysis total CO2 ranging from 18 to 26.5 mMol/L was usually resulted from the high intake of the patient's daily protein intake and should be of no concern in stable patients on maintenance hemodialysis and it may use as a parameter of nutritional status. However metabolic acidosis having CO2 lower than 18mMol/L may modulate protein-kinetics, which may make the protein catabolic rate increased and can not reflect the patient's nutritional status. But it should be recommended that further studies should be needed to confirm this factor.
Acidosis ; Body Mass Index ; Hand ; Humans ; Kinetics ; Mortality ; Nutritional Status* ; Renal Dialysis ; Serum Albumin

No abstract available.
Female ; Humans ; Myiasis

BACKGROUND: Confluent and reticulated papillomatosis (CRP) is a rare cutaneous disorder, characterized by persistent, scaling brown papules, patches, and plaques located on the trunk, neck, axillae, and shoulders. Many different treatments with variable success have been attempted, and oral minocycline treatment is effective in most patients with CRP. There were a few case reports of CRP responding to topical retinoid, but no clinical studies on the efficacy of the topical retinoid treatment for CRP have been reported. OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of the topical tretinoin treatment for CRP. METHODS: A retrospective study was performed based on the medical records and clinical photographs of patients with CRP treated with 0.025% tretinoin cream. RESULTS: Nine patients (4 men and 5 women) were enrolled in the study. The mean age of the patients was 17.4 (11~34) years and the mean age at onset of CRP was 15.1 (3~33) years. The duration of disease varied from 1 month to 7 years. Six of the nine patients showed complete remission, and CRP lesions improved markedly after averagely 6.2 weeks from the beginning of the topical tretinoin treatment. The treatment response was better in patients without itch than in patients with itch (p=0.048). Adverse effects were detected in 3 patients, and were mild irritant contact dermatitis to the topical tretinoin. CONCLUSION: We think that topical 0.025% tretinoin treatment is an effective and safe treatment modality for CRP and this treatment can be an alternative or additional modality to the systemic treatment.
Axilla ; Dermatitis, Contact ; Humans ; Male ; Medical Records ; Minocycline ; Neck ; Papilloma ; Retrospective Studies ; Shoulder ; Tretinoin

PURPOSE: To evaluate the impact of postoperative radiotherapy (PORT) on patterns of failure and survivals in uterine carcinosarcoma patients treated with radical surgery. MATERIALS AND METHODS: Between October 1998 and August 2010, 19 patients with stage I-III uterine carcinosarcoma received curative hysterectomy and bilateral salpingo-oophorectomy with or without PORT at Seoul National University Hospital. Their hospital medical records were retrospectively reviewed. PORT and non-PORT groups included 11 and 8 patients, respectively. They were followed for a mean of 22.7 months (range, 7.8 to 126.6 months). RESULTS: At 5 years, the overall survival rates were 51.9% for entire, 61.4% for PORT, and 41.7% for non-PORT groups, respectively. There was no statistical difference between PORT and non-PORT groups with regard to overall survival (p = 0.682). Seven out of 19 (36.8%) patients showed treatment failures, which all happened within 12 months. Although the predominant failures were distant metastasis in PORT group and loco-regional recurrence in non-PORT group, there was no statistically significant difference in loco-regional recurrence-free survival (LRRFS) (p = 0.362) or distant metastasis-free survival (DMFS) (p = 0.548). Lymph node metastasis was found to be a significant prognostic factor in predicting poor LRRFS (p = 0.013) and DMFS (p = 0.021), while the International Federation Gynecology and Obstetrics (FIGO) stage (p = 0.043) was associated with LRRFS. CONCLUSION: Considering that adjuvant radiotherapy after surgical resection was effective to decrease loco-regional recurrence and most treatment failures were distant metastasis, multimodal therapy including surgery, radiotherapy, and chemotherapy might be an optimal treatment for uterine carcinosarcoma patients.
Carcinosarcoma ; Gynecology ; Humans ; Hysterectomy ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Obstetrics ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Survival Rate ; Treatment Failure ; Uterus

BACKGROUND: Past decades of division have led to substantial differences in medical environments between South and North Korea. However, little is known about North Korea's medical status and research field, especially regarding endocrinology. In this study, we report the characteristics of North Korea's articles regarding endocrine-related diseases. METHODS: Among the nine medical journals, articles published in Internal Medicine between 2006 and 2015 were reviewed. A total of 2,092 articles were included; among them, 96 articles were associated with endocrinology. We analyzed these articles according to the disease categories they focused on and evaluated their features. RESULTS: Articles related to diabetes mellitus accounted for 55.2% (n=53) and those to thyroid disease accounted for 28.1% (n=27). Other disease categories, including adrenal gland (n=1), pituitary gland (n=1), and osteoporosis (n=3), comprised minor portions. Regarding diabetes mellitus, more than half the articles (n=33) focused on treatment and complications. Experimental studies were conducted with old hypoglycemic drugs or natural substances for the treatment of hyperglycemia. Regarding thyroid disease, articles related to hyperthyroidism were the most common (51.9%, n=14), followed by thyroid nodule/cancer (18.5%, n=5). Unique article features were short length, no figures, and less than five references. CONCLUSION: North Korea's endocrinology articles mainly focused on diabetes mellitus and thyroid disease. Persistent studies have been carried out in North Korea with dedication despite the poor medical environment. We hope that this study will be the beginning of mutual medical exchange and collaboration between North and South Korea.
Adrenal Glands ; Cooperative Behavior ; Democratic People's Republic of Korea ; Diabetes Mellitus ; Endocrine System Diseases* ; Endocrinology ; Hope ; Hyperglycemia ; Hyperthyroidism ; Hypoglycemic Agents ; Internal Medicine ; Korea ; Osteoporosis ; Pituitary Gland ; Thyroid Diseases ; Thyroid Gland