No abstract available.

Rhabdomyolysis is a complex medical condition in which insufficient energy supply to muscles results in the destruction of skeletal muscle and leakage of toxic intracellular substances into the systemic circulation. The common cause of rhabdomyolysis is a direct traumatic injury; however, it can also occur due to non-traumatic factors, including infection, toxins, and drugs. Rhabdomyolysis as an adverse effect of antipsychotic medication is not well understood. Peripheral neuropathy is a rare complication of rhabdomyolysis. Here, we present a case of a 22-year-old woman who presented to the emergency department with right thigh pain following an antipsychotic drug overdose and 3 days of loss of consciousness. There was no history of trauma to her leg. Physical examination, diagnostic testing, and imaging indicated a diagnosis of rhabdomyolysis and peripheral neuropathy. The patient underwent an incision with drainage, a muscle biopsy, and was treated with hydration, after which her condition improved, and she was discharged. Follow-up testing indicated lasting nerve injury. Peripheral neuropathy can occur even in patients with rhabdomyolysis without compartment syndrome. Awareness of this rare complication may help in initiating early interventions to minimize irreversible sequelae.

To determine the frequencies of the genotypes of NAT2 gene in healthy Korean populations and to identify the high-risk genotypes of NAT2 gene in colorectal cancer patients, 115 healthy controls and 109 cancer patients were analyzed using polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP). The distribution of NAT2 polymorphism in healthy Korean was found to be 7.8% of S/S genotype, 48.7% of S/F genotype, and 43.5% of F/F genotype. And the frequency of phenotypes was 8% of slow acetylator and 92% of rapid acetylator. S/S genotype of colorectal cancer patients was slightly more frequent than that of healthy controls(11.9% vs 7.8%). The relative risk of S/S genotype to colorectal cancer was estimated to be 1.41, taking the risk of F/F genotype as a baseline(1.00). These results suggest that the distribution of frequencies of NAT2 genotypes is very unique in Korean characterized by extremely low frequency of slow acetylator geno type(S/S) in comparison to the other ethnic groups. And the slow acetylator genotype(S/S) in Korean was found to be more susceptible to colon cancer. Therefore, S/S genotype may have a certain role an colonic carcinogenesis in Korean.
Carcinogenesis ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms* ; Ethnic Groups ; Genetic Predisposition to Disease* ; Genotype ; Humans ; Korea* ; Phenotype

In order to determine the contamination status of contact lens care system by Acanthamoeba, a nation-wide survey was carried out for the detection of amoeba from the storage cases and contact lenses solution of 739 asymptomatic lens wearers (238 male and 501 female). Subjects consisted of 280 residents in Youngnam, 270 in Honam, and 189 in Chungbu provinces. Acanthamoeba was demonstrated from 141 (19.1%) lens care systems. No significant difference of contamination status was observed between male (19.7%) and female (18.8). However, the contamination rate from Honam province (28.1%) were significnatly higher than those from Youngnam (16.1%) and Chungbu (10.6%) provinces. The isolation rate for Acanth-amoeba was higher in systems of daily wear soft lens (20.0%), extended wear soft lens (23.1), and hard lens (18.8%) than in system of disposable lens. The contamination rate was the higher in the sysems using chemical disinfection alone (19.8%) for disinfection. The contamination rate in systems of combined disinfection with chemicals and intermittent boiling ranged 7.0% to 8.3%, and it was different according to the boiling frequency a week. More attention should be paid to hygeneic maintenance of contact lens care system for the prevention of contact lens-related Acanthamoeba keratitis.
Acanthamoeba Keratitis ; Acanthamoeba* ; Amoeba ; Contact Lenses ; Disinfection ; Female ; Humans ; Korea* ; Male

Background: Acellular dermal matrix (ADM) is widely used for prosthetic breast reconstruction. Although many studies have investigated the efficacy and complications of ADM in prosthetic breast reconstruction, studies on drainage and seroma formation according to the size of ADM manufactured using the same process are lacking. This study analyzed drainage and seroma formation according to the size of sterile ADM. Methods: From January 2011 to June 2018, the authors retrospectively reviewed the medical charts of patients who underwent direct-to-implant breast reconstruction using MegaDerm at a single institution. The ADMs used were classified as small or large groups. The two groups were compared in terms of the volume and duration time of two closed-suction drains (supramuscular and submuscular drains). Seroma and infection risk were also analyzed. Results: Of 344 patients, 69 were included. Among them, 22 patients were in the small-ADM group and 47 patients were in the large-ADM group. The supramuscular drain volume (P=0.295) and time (P=0.365) were not significantly different between the two groups. However, the submuscular (P=0.001) and total drain volume (P=0.004) were higher in the large-ADM group. In addition, seroma occurred significantly more frequently in the large-ADM group (P=0.048), but there was no significant difference in minor infections (P=0.088). Conclusions The size of sterile ADM affected drainage and seroma formation, with a larger size increasing drain volume and seroma risk. This study could provide a clinical basis for the safe usage of large sterile ADM.

OBJECTIVE: The purpose of this study was to analyze outcomes and identify prognostic factors in patients with cerebral metastases from non-small cell lung cancer (NSCLC) treated with gamma knife radiosurgery (GKS) particularly, focusing on associations of biomarkers and systemic treatments. METHODS: We retrospectively reviewed the medical records of 134 patients who underwent GKS for brain metastases due to NSCLC between January 2002 and December 2012. Representative biomarkers including epidermal growth factor receptor (EGFR) mutation, K-ras mutation, and anaplastic lymphoma kinase (ALK) mutation status were investigated. RESULTS: The median overall survival after GKS was 22.0 months (95% confidence interval [CI], 8.8–35.1 months). During follow-up, 63 patients underwent salvage treatment after GKS. The median salvage treatment-free survival was 7.9 months (95% CI, 5.2–10.6 months). Multivariate analysis revealed that lower recursive partition analysis (RPA) class, small number of brain lesions, EGFR mutation (+), and ALK mutation (+) were independent positive prognostic factors associated with longer overall survival. Patients who received target agents 30 days after GKS experienced significant improvements in overall survival and salvage treatment-free survival than patients who never received target agents and patients who received target agents before GKS or within 30 days (median overall survival: 5.0 months vs. 18.2 months, and 48.0 months with p-value=0.026; median salvage treatment-free survival: 4.3 months vs. 6.1 months and 16.6 months with p-value=0.006, respectively). To assess the influence of target agents on the pattern of progression, cases that showed local recurrence and new lesion formation were analyzed according to target agents, but no significant effects were identified. CONCLUSION: The prognosis of patients with brain metastases of NSCLC after GKS significantly differed according to specific biomarkers (EGFR and ALK mutations). Our results show that target agents combined with GKS was related to significantly longer overall survival, and salvage treatment-free survival. However, target agents were not specifically associated with improved local control of the lesion treated by GKS either development of new lesions. Therefore, it seems that currently popular target agents do not affect brain lesions themselves, and can prolong survival by controlling systemic disease status.
Biomarkers ; Brain ; Carcinoma, Non-Small-Cell Lung ; Follow-Up Studies ; Humans ; Lymphoma ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis* ; Phosphotransferases ; Prognosis ; Radiosurgery* ; Receptor, Epidermal Growth Factor ; Recurrence ; Retrospective Studies ; Salvage Therapy

Subgenus classification of Acanthamoeba remains uncertain. Twenty-three reference strains of Acanthamoeba including 18 (neo)type-strains were subjected for classification at the subgenus level by riboprinting. PCR/RFLP analysis of 18S rRNA gene (rDNA). On the dendrogram reconstructed on the basis of riboprint analyses, two type-strains (A. astronyxis and A. tubiashi) of morphological group 1 diverged early from the other strains and were quite distinct from each other. Four type-strains of morphological group 3, A. culbertsoni, A. palestinensis, A. healyi were considered taxonomically valid, but A. pustulosa was regarded as an invalid synonym of A. palestinensis. Strains of morphological group 2 were classified into 6 subgroups. Among them, A. griffini which has an intron in its 18S rDNA was the most divergent from the remaining strains. Acanthamoeba castellanii Castellani, A. quina Vil3, A. lugdunensis L3a, A. polyphaga Jones, A. triangularis SH621, and A. castellanii Ma strains belonged to a subgroup, A. castellanii complex. However, A. quina and A. lugdunensis were regarded as synonyms of A. castellanii. The Chang strain could be regarded as A. hatchetti. Acanthamoeba mauritaniensis, A. divionensis, A. paradivionensis could be considered as synonyms of A. rhysodes. Neff strain was regarded as A. polyphaga rather than as A. castellanii. It is likely that riboprinting can be applied for rapid identification of Acanthamoeba isolated from the clinical specimens and environments.
Acanthamoeba/genetics ; Acanthamoeba/classification* ; Animal ; DNA, Protozoan/analysis ; Polymerase Chain Reaction/methods* ; Polymorphism, Restriction Fragment Length* ; RNA, Protozoan/genetics ; RNA, Protozoan/analysis* ; RNA, Ribosomal, 18S/genetics ; RNA, Ribosomal, 18S/analysis*

OBJECTIVE: We investigated the incidence of the vascular abnormalities associated with spontaneous intracerebral hemorrhage (ICH) using three-dimensional computed tomographic angiography (3D-CTA). METHODS: We prospectively assessed consecutive 76 patients with spontaneous intracerebral hemorrhage (ICH) who underwent 3D-CTA between June 2003 and May 2005. The patients with a recent history of trauma or mainly subarachnoid hemorrhage were excluded. We investigated relationship between vascular abnormality and ICH location. The findings of 3D-CTA were classified as one of three patterns with ICH; type A (without evidence of vascular abnormality), type B (with no vascular abnormality as the source of hemorrhage, but with incidental vascular abnormality), and type C (presence of a vascular abnormality as the source of hemorrhage). RESULTS: Sites of ICH were lobar 26, basal ganglia 23, thalamus 17, posterior fossa 6 and dominant intraventricular hemorrhage (IVH) 4. Among 76 patients, sixteen (21.1%) vascular abnormalities were noted excluding 13 cases of stenoocclusive disease. Sixteen cases included 6 cases of cerebral aneurysms (7.9%), 5 moyamoya diseases (6.6%), 4 arteriovenous malformations (5.3%) and 1 dural sinus thrombosis (1.3%). Lobar ICH (30.8%) had a higher vascular abnormalities than other types, and younger age (<40) group had a higher incidence of vascular abnormalities than old age group. The patterns of 3D-CTA include sixty cases (79.0%) of type A, 6 cases (7.8%) of type B and 10 cases (13.2%) of type C. The vascular abnormalities were found in 8 (13.5%) of 59 hypertensive patients and 8 (47.0%) of 17 non-hypertensive patients (p=0.006). CONCLUSION: 3D-CT angiography is considered a useful screening tool for ICH patients with suspected cerebrovascular abnormalities and should be considered in such clinical settings, especially in lobar type and in non-hypertensive younger patients.
Angiography* ; Arteriovenous Malformations ; Basal Ganglia ; Cerebral Hemorrhage ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Mass Screening* ; Prospective Studies ; Sinus Thrombosis, Intracranial ; Subarachnoid Hemorrhage ; Thalamus

Productivity analysis of physician is one of essential factors for the optimal health manpower planning. Among 690 physicians operating clinic and registered on the Kyeongsangnamdo Medical Association, 623 physicians were studied with a structural questionnaire from April 1 to May 31, 1990. This study covers the general characteristics and productivity of physicians and attempts to find relevant determinants of their productivity through stepwise multiple regression analysis based on collected data. The major results were as follows. First, physicians were more prevalent 35~44 group (38.2%) in age, male (95.8%) in sex, specialist (76.5%) in specialization, city (78.0%) in geographical location. Age group of 35-54 and specialist were more prevalent in cities than in counties, while age group of 25-44 and 55 over and general practitioner in counties (p<0.001). Second, daily outpatient load of all physician were 77.1 persons on average. Age group of 35~44 had the most outpatient load (90.3 persons) among all age group, 6~10 years group (94.2 persons) in years of duration of practice, 11 hours per day group (83.4 persons) in working hours per day. Specialists had more outpatient load (82.6 persons) than general practitioners (61.1 persons) and physicians in cities had more (80.2 persons) than physicians in counties (66.3 persons). Daily average outpatient load of physicians were significantly different by their age, speciality, number of assistants and years of practice (p<0.001) and working location (p<0.05), but not significantly different by working hours per day of physician (p>0.1). Third, the productivity of physicians operating clinic were significantly affected by the three factorsnumber of assistants of physician, age of physician and duration of practice at the current clinic. Age of physician had negative regression coefficient.
Efficiency* ; General Practitioners ; Health Manpower ; Humans ; Male ; Outpatients ; Surveys and Questionnaires ; Specialization

Transmission electron microscopy of an Acanthamoeba isolate (KA/L5) from a contact lens case revealed bacterial endosymbionts within cytoplasm of the amoebae. The Acanthamoeba isolate belonged to the morphological group II. Based on the polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) of 18S ribosomal RNA coding DNA (rDNA), the isolate was identified as A. lugdunensis. Strain typing by isoenzyme analysis using isoelectric focusing (IEF) and mitochondrial (Mt) DNA RFLP revealed that the isolate was closely related with KA/L1, the most predominant type of isolates from contact lens storage cases, KA/E2, a clinical isolate, KA/W4, previously reported to host endosymbionts, and L3a strains of A. lugdunensis. The endosymbionts were similar to those of KA/W4 in aspects that they were randomly distributed in both trophozoites and cysts, and were rod-shaped bacteria measuring approximately 1.38 x 0.50 microns. But the number of endosymbionts per amoeba was significantly lower than that of KA/W4. They were neither limited by phagosomal membranes nor included in lacunaelike structure.
Acanthamoeba/microbiology* ; Acanthamoeba/cytology ; Animal ; Bacteria/isolation & purification* ; Colony Count, Microbial ; Contact Lenses* ; Cytoplasm/microbiology ; Symbiosis*