PURPOSE: To evaluate the clinical usefulness and limitation of FLAIR (fluid attenuated inversion recovery) MR sequence in various intracranial pathologic conditions. MATERIALS AND METHODS: In prospective fashion, we used a 1.0T MR unit to obtain FLAIR sequence MR images, together with T1-weighted (TIWI), proton-density weighted (PDWI), and T2-weighted spin echo images (T2WI) in 24 patients with various intracranial diseases. Forty-two lesions in 24 patients were classified into three categories: nonhemorrhagic noncavitary lesions (n=20), hemorrhagic lesions (n=10), and cavitary lesions (n=12). Hemorrhagic lesion was divided into two types; type 1 showed high signal intensity on both T1WI and T2WI and type 2 showed marked low signal intensity on T2WI such as hemosiderin. Cavitary lesion was defined as one with signal intensity which paralleled CSF on all pulse sequences. Visually, we compared the lesion conspicuity on FLAIR with that on T2WI. Quantitatively, we also compared lesion/white matter (WM) contrast, lesion/WM contrast to noise ratio (CNR), lesion/CSF contrast, and lesion/CSF CNR on FLAIR with those on T2WI. RESULTS: For visual conspicuity of nonhemorrhagic noncavitary lesions and type 1 hemorrhagic lesions, FLAIR was superior to PDWI and T2WI, but for type 2 hemorrhangic lesions, PDWI and T2WI were superior to FLAIR. For cavitary lesions, there was no significant difference between T2WI and FLAIR. In the quantitative assessment of nonhemorrhagic noncavitary lesions, FLAIR was superior to PDWI for lesion/CSF contrast, and CNR, and lesion/WM contrast, but for lesion/WM CNR FLAIR was inferior to PDWI. For lesion/CSF contrast in cavitary lesions, FLAIR was superior to PDWI. There was no significant difference between PDWI and FLAIR for hemorrhagic lesions types 1 and 2. In assessing nonhemorrhagic noncavitary lesions, FLAIR was superior to T2WI for lesion/CSF contrast, but for lesion/WM CNR, FLAIR was inferior to T2WI. In cavitary lesions, T2WI was superior to FLAIR for lesion/WM contrast and CNR. In type 2 hemorrhagic lesions, there was no significant difference between T2WI. CONCLUSION: The FLAIR sequence is more useful than T2WI for the detection of nonhemorrhagic noncavitary lesions, but in the evaluation of cavitary and hemorrhagic lesions, it has limitations. The results suggest that the FLAIR sequence can be used as a complementary imaging sequence, but should not replace the routine T2WI.
Diagnosis* ; Hemosiderin ; Humans ; Noise ; Prospective Studies

Urinary tract infection (UTI) is one of the most common complications after radical cystectomy and orthotopic neobladder reconstruction. This study investigated the incidence and implicated pathogen of febrile UTI after ileal neobladder reconstruction and identify clinical and urodynamic parameters associated with febrile UTI. From January 2001 to May 2015, 236 patients who underwent radical cystectomy and ileal neobladder were included in this study. Fifty-five episodes of febrile UTI were identified in 46 patients (19.4%). The probability of febrile UTI was 17.6% and 19.8% at 6 months and 24 months after surgery, respectively. While, Escherichia coli was the most common implicated pathogen (22/55, 40.0%), Enterococcus spp. were the most common pathogen during the first month after surgery (18/33, 54.5%). In multivariate logistic regression analysis, ureteral stricture was an independent risk factor associated with febrile UTI (OR 5.93, P = 0.023). However, ureteral stricture accounted for only 6 episodes (10.9%, 6/55) of febrile UTI. Most episodes of febrile UTI occurred within 6 months after surgery. Thus, to identify risk factors associated with febrile UTI in the initial postoperative period, we assessed videourodynamics within 6 months after surgery in 38 patients. On videourodyamic examination, vesicoureteral reflux (VUR) was identified in 16 patients (42.1%). The rate of VUR presence in patients who had febrile UTI was not significantly different from those in patients without febrile UTI (50% vs. 39.3%, P = 0.556). Patients with febrile UTI had significantly larger residual urine volume (212.0 ± 193.7 vs. 90.5 ± 148.2, P = 0.048) than those without. E. coli and Enterococcus spp. are common pathogens and ureteral stricture and residual urine are risk factors for UTI after ileal neobladder reconstruction.
Aged ; Anti-Bacterial Agents/therapeutic use ; Cystectomy/adverse effects ; Enterococcus/isolation & purification ; Escherichia coli/isolation & purification ; Female ; Humans ; Ileum/*surgery ; Incidence ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications ; Reconstructive Surgical Procedures ; Retrospective Studies ; Risk Factors ; Urinary Bladder Neoplasms/*surgery ; Urinary Tract Infections/drug therapy/*epidemiology/etiology/microbiology ; Urodynamics

Acrodysostosis is a rare multiple congenital malformation syndrome with peripheral dysostosis, nasal hypoplasia, mental retardation and growth failure. In 1968, Maroteaux and Malamut first described this disorder in three patients, and thus far now over 30 published cases have been reported worldwide. Radiographic changes include severe shortening of metacarpals, metatarsals, and phalages, cone-shaped epiphyses of the hands and feet, premature fusion of the epiphyses, and advanced bone age. Most patients do relatively well except for the problems of mental deficiency and arthritic complaints. Progressive restriction of movement of the hands, elbows, and spine may occur. Recently, we experienced a case of acrodysostosis in and 11-year-old boy who presented with short stature, short hands and feet, nasal hypoplasia, mental retardation, and typical radiographic findings including severe shortening of metacarpals, metatarsals and phalanges, cone-shaped epiphyses of the hands and feet.
Child ; Dysostoses ; Elbow ; Epiphyses ; Foot ; Hand ; Humans ; Intellectual Disability ; Male ; Metacarpal Bones ; Metatarsal Bones ; Spine

PURPOSE: This study was done to see whether neonates born to unmarried mothers have higher rates of prematurity, low birth weight, perinatal morbidity and mortality than normal married group. METHODS: 88 neonates of unmarried mothers who were admitted in our NICU during the 5-year period from January 1987 through December 1991 were evaluated, and as the control group served 276 neonates of married mothers in 12 randomly selected weeks extended over the year during the same period. In statistical analyses, all data were analyzed by x2 test, Student t-test, and regression equation. RESULTS: 1) Unmarried mothers were 19.9+/-2.5(SD) year-old, with the majority(64.8%) falling into to age group between 16 and 20 years, whereas the control group was significantly older with 28.8+/-3.9 years. 2) Sex ratio was 1.38 : 1, with male prepondering, mean gestational age 35.5+/-3.7 weeks and mean birth weight 2,240+/-640g, in the unmarried group, differing significantly from the control group with 38.5+/-37 weeks and 2,910+/-750g. 3) Incidences of prematurity and low birth weight (LBW) were 70.5% and 75.0%, and total mortality was 28.4%. These values were significantly higher than in the control group, with 22.5%, 32.2%, 7.2%, respectively, and prematurity and LBW rate were also significantly higher in both groups of the same maternal age. Birth weight of unmarried group was significantly lower than control group in the same gestational age. Gestational age, birth weight, mortality rate were not significantly correlated to maternal age in both unmarried and control groups. 4) For the neonates of unmarried mothers, the majority was delivered either by midwife or in local obstetric clinics, and most of them(57.9%) were delivered by induction. 5) Neonatal diseases were jaundice, respiratory distress syndrome(RDS) and infection in the decreasing order, and incidence of RDS was significantly higher than in control group. But the death rate of RDS only tended to be higher in the unmarried-group. CONCLUSIONS: The neonates born to unmarried mothers have significantly higher rates of prematurity, LBW and mortality, and lower birth weight than the control group in the same gestational age. For neonatal diseases, incidence of RDS was significantly higher, and its mortality was significantly higher in the unmarried-group. Awareness on the seriousness of the problems leading to preventive measures against juvenile and unmarried child births, along with improved managements of babies born to unmarried mothers are urgently advocated.
Birth Weight ; Child ; Gestational Age ; Humans ; Illegitimacy ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn* ; Jaundice ; Male ; Maternal Age ; Midwifery ; Mortality ; Mothers ; Parturition ; Sex Ratio ; Single Person*

Objectives: This study was conducted to identify the level of mental health and burnout of medical staff at hospitals and public health centers, which responded to the coronavirus disease 2019 (COVID-19) in South Korea and to suggest appropriate management plans. Methods: The mental health and burnout levels of medical staff responding to COVID-19 were evaluated through an online survey conducted during the period July 1–14, 2021. To analyze the mental health status of the participants according to their demographic characteristics, the chisquare test, t-test, and an analysis of variance were conducted, followed by Scheffe post-hoc tests for pairwise comparisons. Results: A total of 773 participants were included in the study. An analysis of the clinically significant symptoms of the group showed that 29.5% had posttraumatic stress symptoms, 30.6% had depression, 15.8% had anxiety, 39.8% had somatic symptoms, and 4.5% were seen to be at risk of suicide. The average scores for burnout were as follows: 3.55±1.75 for emotional exhaustion, 2.68±1.73 for depersonalization, and 3.89±1.40 for personal accomplishment. Mental health problems and burnout were found to be high in women, those in the 20–39-year age bracket, those with less than 5 years of work experience, and public health center workers. Conclusion The medical staff responding to COVID-19 were observed to experience high levels of mental health and burnout problems. Work-related characteristics, such as younger age, lower work experience, and employment at a public health center, may have a negative impact on mental health and cause burnout. Therefore, individualized and systemic support for mental health and to prevent the burnout of medical staff responding to cases of COVID-19 is needed.

PURPOSE: To describe the MR imaging findings of post-operative change and residual/recurrent tumor following resection of the glioma and to determine whether there are any specific MR imaging findings useful for differentiation of post-operative change from a residual/recurrent tumor. MATERIALS AND METHODS: We retrospectively analysed 71 post-operative follow-up brain MR images of 26 patients who had undergone surgical resection of intracranial glioma. They consisted of 49 MRI studies of 12 patients with post-operative change and22 MRI studies of 14 patients with residual/recurrent tumors. The follow-up MRI examinations were performed fromone to 75 months after tumor resection. The lesion was defined as post-operative change when any enhancing lesion disappeared or diminished during follow-up MRI studies of at least 20 months. The diagnosis of residual/recurrent tumor was established when on MR images, lesion size increased definitively during the follow up period of between four and 66 months ; residual/recurrent tumors were surgically proven in five patients. The shape, degree of contrast enhancement and time of appearance and disappearance of the lesions were analysed. RESULTS: Post-operative change consisted of hemorrhage(n=3), marginal(n=7) and nodular(n=1) enhancement of sugical bed, adjacent dural enhancement(n=9), extracerebral fluid collection(n=4) and only tissue defect(n=1). Hemorrhage was obseved at between two and eight months ; marginal and nodular enhancement of surgical bed were seen at between three and 30 months (usually less than one year) ; dural enhancement and fluid collection were seen at between three and 75 months. Residual/recurrent tumor appeared most frequently as enhancing solid nodules(n=7) or solidand cystic masses(n=2) followed by non-enhancing solid nodules(n=3). In five of seven cases, marginal enhancement of a residual/recurrent tumor appeared after more than one year. CONCLUSION: Marginal and dural enhancement around surgical tissue defects are the most common finding of post-operative change, whereas nodular enhancementis the most frequent finding of the residual/recurrent tumor. Marginal enhancement lasting longer than one year may, however, be an early finding of residual/recurrent tumor.
Brain ; Diagnosis ; Follow-Up Studies ; Glioma* ; Hemorrhage ; Humans ; Magnetic Resonance Imaging*

No abstract available.
Pilomatrixoma*

BACKGROUND: Cutaneous adverse reactions are often observed during chemotherapy with epidermal growth factor receptor (EGFR) inhibitors including papulopustular eruptions, xerosis and paronychia. OBJECTIVE: To investigate and compare the cutaneous adverse reactions induced by EGFR inhibitors including erlotinib, gefitinib and cetuximab which have commonly been used as chemotherapeutic agents in Korea. METHODS: We reviewed cutaneous adverse effects through the medical records and clinical photographs of 43 Korean patients who had been treated with erlotinib, gefitinib or cetuximab at Pusan Paik Hospital between June 2003 and January 2010. RESULTS: Papulopustular eruptions occurred in 28 patients (65.1%); they were easily controlled by topical benzoyl peroxide, clindamycin and a retinoid, or by oral minocycline and tetracycline. There were no significant differences in incidence, duration and severity grades of papulopustular eruptions among EGFR inhibitors. In contrast to previous studies, the frequency and severity of papulopustular eruptions were not significantly correlated with treatment responses to EGFR inhibitors. Xerosis appeared in 14 patients (41%), and was easily controlled by topical emollients and steroids, and by systemic steroids and antihistamines. Paronychia occurred in 8 patients (18.6%) and were controlled by conservative treatments. CONCLUSION: Papulopustular eruptions, xerosis and paronychia are common cutaneous adverse reactions associated with EGFR inhibitors and there are no significant differences in adverse cutaneous reactions among EGFR inhibitors. As these cutaneous adverse reactions are relatively easily controlled with treatment, it will be helpful to detect and treat these adverse reactions early, including reassuring the patients, which should increase compliance of patients during treatment with EGFR inhibitors.
Antibodies, Monoclonal, Humanized ; Benzoyl Peroxide ; Clindamycin ; Compliance ; Emollients ; Epidermal Growth Factor ; Histamine Antagonists ; Humans ; Incidence ; Medical Records ; Minocycline ; Paronychia ; Quinazolines ; Receptor, Epidermal Growth Factor ; Steroids ; Tetracycline ; Cetuximab ; Erlotinib Hydrochloride

Objectives: This study was conducted to evaluate burnout and its associated factors among coronavirus disease 2019 (COVID-19) frontline healthcare workers. Methods: We analyzed the nationwide burnout evaluation scale data collected from 774 COVID-19 frontline healthcare workers in South Korea from July 1 to 14, 2021. Along with demographic variables and work-related information, the Maslach Burnout Inventory–General Survey and the list of stress factors were used to assess burnout and its associated stressors. Results: The study participants were predominantly female (86.2%) and the majority were nurses (78.8%). Among them, 53.0% felt emotionally exhausted, 34.5% were cynical, and 45.5% experienced decreased professional efficacy. The most common stressors were “insufficient rewards” (85.0%) and “excessive workload” (72.5%). Factors such as excessive workload, interpersonal relationships at work, and stress from insufficient rewards were correlated with higher levels of exhaustion and increased cynicism. Insufficient rewards and stress about family infection were associated with increased professional efficacy. Conclusion Stress related to the work environment, rather than that from potential infection, was associated with exhaustion and cynicism in the COVID-19 frontline healthcare workers.

BACKGROUND: Incidence rate of ureterolithiasis has been increasing worldwide in general, with an especially rapid increase in the elderly, over 65 years of age. Therefore, the characteristics of geriatric patients diagnosed with uureterolithiasis in an Emergency Center were examined. METHODS: A total of 613 consecutive patients who were diagnosed with ureterolithiasis through computed tomography from January 2012 to March 2014 were analyzed retrospectively. The patients were divided in two groups: the geriatric group and nongeriatric group. RESULTS: Among the 613 patients, there were 64 geriatric patients (> or =65 years, 10.4%) and 549 nongeriatric patients (<65 years, 89.6%). In the geriatric patients, 13 patients (20.3%) appeared without any pain or with atypical types of pain, while 39 of the nongeriatric patients (7.1%) had no pain or atypical symptoms, presenting a statistically significant difference (p<0.001). Gastrointestinal symptoms such as nausea and vomiting were more common in geriatric patients than in nongeriatric patients (42.2% vs. 29.9%, p=0.044), while lower positive rate of microscopic hematuria was reported (78.1% vs. 90.5%, p=0.002). Furthermore, in geriatric patients, the positive rate of costovertebral angle tenderness was lower and distal ureter stones were found to be more common, while urine pH and serum creatinine levels were higher. CONCLUSION: In comparison to nongeriatric patients, geriatric patients with ureterolithiasis showed lower rates of renal colic and hematuria, while showing higher rates of having gastrointestinal symptoms such as nausea and vomiting. Thus, differences between these two groups should be considered in evaluating geriatric patients to prevent complications which may be caused from the late diagnosis of ureterolithiasis.
Aged ; Creatinine ; Delayed Diagnosis ; Emergencies* ; Geriatrics ; Hematuria ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Nausea ; Renal Colic ; Retrospective Studies ; Ureter ; Ureterolithiasis* ; Vomiting