The mainstay of diagnosing scrub typhus is through serologic testing. However, because of the delay of several days from the onset of the illness to the increase in the antibody titer, diagnosis can be difficult in the early stage of the illness. The aim of this study was to determine the clinical usefulness of adenosine deaminase activity (ADA) in diagnosing scrub typhus. A total of 104 patients were enrolled during the study period. Of these patients, 59 patients were diagnosed with scrub typhus and the mean serum ADA level was 46.7+/-11.6 U/L. High serum ADA levels strongly supported the diagnosis of scrub typhus, especially in patient without eschar. The remaining 44 patients did not have scrub typhus and 95% (42/44) of them had normal serum ADA levels. Therefore, evaluating serum ADA level could help diagnose patients with acute febrile disease such as scrub typhus, especially in its early stage of disease progression.
Adenosine ; Adenosine Deaminase ; Disease Progression ; Humans ; Orientia tsutsugamushi ; Scrub Typhus ; Serologic Tests

The mainstay of diagnosing scrub typhus is through serologic testing. However, because of the delay of several days from the onset of the illness to the increase in the antibody titer, diagnosis can be difficult in the early stage of the illness. The aim of this study was to determine the clinical usefulness of adenosine deaminase activity (ADA) in diagnosing scrub typhus. A total of 104 patients were enrolled during the study period. Of these patients, 59 patients were diagnosed with scrub typhus and the mean serum ADA level was 46.7+/-11.6 U/L. High serum ADA levels strongly supported the diagnosis of scrub typhus, especially in patient without eschar. The remaining 44 patients did not have scrub typhus and 95% (42/44) of them had normal serum ADA levels. Therefore, evaluating serum ADA level could help diagnose patients with acute febrile disease such as scrub typhus, especially in its early stage of disease progression.
Adenosine ; Adenosine Deaminase ; Disease Progression ; Humans ; Orientia tsutsugamushi ; Scrub Typhus ; Serologic Tests

We report a case of coronary fistula between the left anterior descending and main pulmonary artery complicating acute non-Q wave myocardial infarction. A 27-year-old man visited emergency department because of severe chest pain lasting two hours. The electrocardiogram showed ST segment elevation in precordial leads V3~6. Cardiac enzymes were as follows;CK-MB:36.44 IU/L T-T:0.489 ng/mL, CPK:542 IU/L, and LDH:475 IU/L. The thallium-201 dipyridamole stress perfusion scan showed perfusion defect and reversed redistribution in the anteroseptal wall. The coronary angiogram revealed coronary artery fistula between the proximal left anterior descending artery and main pulmonary artery without significant stenoses of coronary arteries. The result of ergonovine test was negative. After micro-coil embolization to the coronary fistula, symptoms were improved. Follow-up thallium-201 scan showed normalized blood flow in the left anteroseptal wall.
Adult* ; Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Vessels ; Dipyridamole ; Electrocardiography ; Emergency Service, Hospital ; Ergonovine ; Fistula* ; Follow-Up Studies ; Humans ; Myocardial Infarction* ; Perfusion ; Pulmonary Artery*

PURPOSE: The purpose of this study was to evaluate the early and midterm results of superficial femoral artery (SFA) stenting with self-expanding nitinol stents and to identify the factors affecting patency. MATERIALS AND METHODS: SFA stenting was performed in 165 limbs of 117 patients from January 2009 to December 2013. Patients were followed-up for the first occurrence of occlusion or stenosis based on computed tomography and duplex scan results and a decrease in ankle brachial index of >15%. RESULTS: During the follow-up period (mean, 15.3+/-3.2 months), no early thrombotic reocclusions occurred within 30 days, but in-stent restenosis developed in 78 limbs. The primary patency rates at 6, 12, 18, and 24 months were 78%, 66%, 42%, and 22%, respectively, and the secondary patency rates were 85%, 72%, 58%, and 58%, respectively. TASC II C or D lesions, stent length >8 cm, number of patent tibial arteries and diabetes were significantly associated with reintervention. CONCLUSION: The midterm results of stenting for SFA occlusive disease were disappointing because the primary and secondary patency rates at two years were 22% and 58%, respectively. Reintervention after SFA stenting remains a major problem, particularly in patients with diabetes mellitus or long TASC II C or D lesions.
Ankle Brachial Index ; Constriction, Pathologic ; Diabetes Mellitus ; Endovascular Procedures ; Extremities ; Femoral Artery* ; Follow-Up Studies ; Humans ; Stents* ; Tibial Arteries

Focal segmental glomerulosclerosis (FSGS) is a relatively common glomerular disease which is known to be the final pathway of glomerular injuries caused by variable etiologies. There are some renal diseases that are known to have a tendency of familial inheritance such as adult polycystic kidney disease, thin glomerular basement membrane disease, and Alport's syndrome, nephrotic syndrome with many other diseases. Fanconi et al. described the familial occurrence of the nephrotic syndrome first. Since then, a number of other reports have described the cases of nephrotic syndrome within families, though only a handful of families were confirmed as FSGS with histologic evidence. Recently, reports of familial occurrence of FSGS are increasing in number. These patients have been found to be steroid-resistant and unresponsive to immunosuppressive drugs, and most of them progressed to the end stage renal disease. The specific factors leading to glomerular change are not clearly known, but a genetic predisposition has been postulated. A number of reports pointed out the importance of HLA type as a genetic factor related to the pathogenesis of FSGS but the genetic and immunological linkages in FSGS have not been clearly defined yet. We report cases with 4 patients in two unrelated families with HLA-A24 recovered from FSGS after kidney transplantation.
Child* ; Genetic Predisposition to Disease ; Glomerular Basement Membrane ; Glomerulosclerosis, Focal Segmental* ; Hand ; HLA-A24 Antigen* ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Nephritis, Hereditary ; Nephrotic Syndrome ; Polycystic Kidney, Autosomal Dominant ; Wills

PURPOSE: To analyze the clinical results of treatment for infected total knee arthroplasty(TKA). MATERIALS AND METHODS: Between October 1993 and March 2003, 20 patients with infection after TKA were treated at our department. The average follow-up period was 3 years 8 months and the average age was 65.5 years(range, 50-79); there were 18 females and two men. Infected TKAs were managed with several methods ; 16 patients were treated two-stage reimplantation, 2 arthrodesis, and 2 debridement and polyethylene insert change. We assessed knee function before and after revision, according to the knee rating system of the Hospital for Special Surgery. RESULTS: Prior to revision operation, the average knee score in 16 reimplantation cases was 49.3 points and the average range of motion was 64.9 degrees. After revision, the average knee score was 80.5 points and the average range of motion was 90.3 degrees. Two of them relapsed within postoperative two weeks, and then we performed debridement. There was one recurrence of infection after debridement and polyethylene insert change and then we performed two stage reimplantation. Two patients had complete union at each 4, 5 months after arhtrodesis. CONCLUSION: Thoughtful method of treatment should be decided and precise operative technique should be performed in managing infected TKA.
Arthrodesis ; Arthroplasty* ; Debridement ; Female ; Follow-Up Studies ; Humans ; Knee* ; Male ; Polyethylene ; Range of Motion, Articular ; Recurrence ; Replantation

Humans ; Incisor ; Lip ; Osteotomy ; Tooth

To investigate potential health risks associated with exposure to metals from an abandoned metal mine, the authors studied people living near an abandoned mine (n=102) and control groups (n=149). Levels of cadmium, copper, arsenic, lead, and zinc were measured in the air, soil, drinking water, and agricultural products. To assess individual exposure, biomarkers of each metal in blood and urine were measured. beta2-microglobulin, alpha1-microglobulin, and N-acetyl-beta-glucosaminidase and bone mineral density were measured. Surface soil in the study area showed 2-10 times higher levels of metals compared to that of the control area. Metal concentrations in the groundwater and air did not show any notable differences between groups. Mean concentrations of cadmium and copper in rice and barley from the study area were significantly higher than those of the control area (p<0.05). Geometric means of blood and urine cadmium in the study area were 2.9 microgram/L and 1.5 microgram/g Cr, respectively, significantly higher than those in the control area (p<0.05). There were no differences in the levels of urinary markers of early kidney dysfunction and bone mineral density. The authors conclude that the residents near the abandoned mine were exposed to higher levels of metals through various routes.
Aged ; Cadmium/*blood/*urine ; Copper/blood/urine ; Environmental Exposure ; *Environmental Monitoring ; Female ; *Food Contamination ; Hordeum ; Humans ; Korea ; Lead/blood/urine ; Male ; Middle Aged ; *Mining ; Oryza sativa ; Risk Factors ; Soil Pollutants/analysis ; Water Pollutants, Chemical/analysis ; Zinc/blood/urine

BACKGROUND: Mucin producing cystic neoplasms, such as mucinous cystic tumor (MCT) and intraductal papillary mucinous tumor (IPMT) of the pancreas, are uncommon but become increasing in their incidences. The pathologic classification and biologic potential of these neoplasmsremain the subject of controversy. METHODS: The Gastrointestinal Pathology Study Group of the Korean Society of Pathologists analyzed the clinicopathologic characteristics of 85 casesof MCT and 72 cases of IPMT and examined the expression patterns of p53, CEA and MUC1. RESULTS: IPMT was located largely in the head, and showed connection with the main pancreatic duct (MPD, 68.1%), no ovarian-like stroma (0/72), and presence of intervening intratumoralnormal or atrophic parenchyma. On the other hand, MCT was located largely in thetail (73%), and showed common ovarian-like stroma (66/80), rare connection with the MPD(7/85) and no intervening pancreatic parenchyma. CEA and p53 immunoexpressions weresignificantly increased from adenoma through borderline to carcinoma, but MUC 1 was expressedonly in the invasive carcinoma among cases of MCT and IPMT. CONCLUSIONS: The tumorlocation, ovarian-like stroma, connection with the MPD and intratumoral intervening nonneoplastictissue were helpful in the differential diagnosis between IPMT and MCT. CEA and p53expressions can be indicators of malignancy, while MUC 1 expression can indicate invasion.
Adenoma ; Classification ; Diagnosis, Differential ; Hand ; Head ; Incidence ; Korea* ; Mucins* ; Pancreas* ; Pancreatic Ducts ; Pathology ; Prevalence*

OBJECTIVES: The respiratory compensation threshold(RCT) is thought to be one of parameters by some for the evaluation of physical performance despite its controversial status. The purpose of this investigation is to establish the reference values of the RCT in healthy Korean adults, and to examine the usefulness of this parameter in evaluating physical performance. METHODS: Symptom-limited maximal exercise test by Bruce protocol was carried out, and RCT and AT were determined by the aid of the computerized V-slope method, along with the VO2 max, in 441 healthy Korean adults consisting of 284 men and 157 women aged from 20`s to 60`s. In addition, correlation between RCT and AT was observed, and regression equations of the RCT were also derived. RESULTS: The RCT VO2 was tended to decrease with age in men, but not in women and the RCT VO2 of women was 26-30% less than that of men. The ratio of RCT VO2 to VO2 max (RCT VO2/VO2 max) was tended to increase with age and the RCT V was significantly correlated with AT VC4 and VO2 max in both sexes. CONCLUSION: Our study reveals that the RCT is another useful submaximal index along with the AT in evaluating physical performance. The regression equation of the RCT was RCT VO2(L/min)=1.4232-0.0102 A(age in year)+0.0204 W(weight in kg)-0.4889 S (sex, coded O for males and 1 for females).
Adult* ; Anaerobic Threshold ; Compensation and Redress* ; Exercise Test ; Female ; Humans ; Male ; Reference Values