PURPOSE: This study was designed to evaluate the accuracy of ultrasound in detecting and estimating the size of pneumothorax METHODS: This was a prospective study with convenience sampling, based on researcher availability. Inclusion criteria were chest pain, sudden dyspnea, and chest trauma. Bedside ultrasound examination was performed to determine the presence of "lung sliding" and "comet tail" artifacts in order to rule out pneumothorax and the location of "lung point" when pneumothorax was detected. RESULTS: There were 97 patients enrolled; The cause of pneumothorax was spontaneous in 64 cases and traumatic in 33 cases. The Pearson correlation coefficient between ultrasound estimates and pneumothorax size by Collins method on erect chest X-ray was 0.874 (p<0.000), and the coefficient between ultrasound estimates and pneumothorax size on computed tomography was 0.820 (p<0.000). CONCLUSION: Ultrasound is more sensitive and specific than supine chest X-ray and even erect chest PA for the diagnosis of pneumothorax. Ultrasound allowed skilled physicians to approximate the size of pneumothorax accurately with good correlation with results obtained by both computed tomography and erect chest X-ray.
Artifacts ; Chest Pain ; Diagnosis ; Dyspnea ; Humans ; Pneumothorax* ; Prospective Studies ; Thorax ; Ultrasonography*

Authors report a case of a painless acute dissecting aneurysm of the descending aorta in a patient who presented with unexplained hypotension followed by simultaneous paraplegia and right arm monoparesis. To our knowledge, case like this has not been reported previously. Magnetic resonance imaging of the brain and spine revealed hemodynamic cerebral infarction and extensive cord ischemia, respectively. Computerized tomography angiography confirmed a dissecting aneurysm of the descending aorta. The cause of the brain infarction may not have been embolic, but hemodynamic one. Dissection-induced hypotension may have elicited cerebral perfusion insufficiency. The cause of cord ischemia may be embolic or hemodynamic. The dissected aorta was successfully replaced into an artificial patch graft. The arm monoparesis was improved, but the paraplegia was not improved. In rare cases of brain and/or spinal cord infarction caused by painless acute dissecting aneurysm of the aorta, accurate diagnosis is critical because careless thrombolytic therapy can result in life-threatening bleeding.
Aneurysm, Dissecting* ; Angiography ; Aorta* ; Aorta, Thoracic ; Arm ; Brain ; Brain Infarction ; Cerebral Infarction ; Diagnosis ; Hemodynamics ; Hemorrhage ; Humans ; Hypotension ; Infarction* ; Ischemia ; Magnetic Resonance Imaging ; Paraplegia ; Paresis ; Perfusion ; Spinal Cord Ischemia ; Spinal Cord* ; Spine ; Thrombolytic Therapy ; Transplants

Epithelial differentiation and morphogenesis in skin and oral mucosa were elucidated using various experimental tools. However, tongue epithelial differentiation has not been examined properly yet. In this study, we identified the relationship between morphological changes and localizations of differentiation markers, such as cytokeratins and PAX 9 in mice embryonic tongue development. Protective barrier formation and localization pattern of cytokeratins in tongue epithelium were examined with toluidine blue staining and immunohistochemistry respectively. Localization patterns of PAX 9 and Cytokeratin 14 were coincided during tongue epithelium development. In addition, compared with Ki67 localizations, marker for cell proliferation, localization patterns of PAX 9 and Cytokeratin 14 would suggest that these factors would involve in tongue barrier formation through cell proliferation. Based on these results, tongue epithelial differentiation would begin at E14 with the specific localizations of PAX 9 and Cytokeratin 14 prior to protective barrier formation then Cytokeratin 1, keratinization marker, would involve in protective barrier and filiform papillae formations.
Animals ; Antigens, Differentiation ; Cell Proliferation ; Epithelium ; Immunohistochemistry ; Keratin-14 ; Keratins ; Mice ; Morphogenesis ; Mouth Mucosa ; Skin ; Tolonium Chloride ; Tongue

PURPOSE: The purpose of this study was to quantify and compare the expressions of CRP and M-CSF in the gingival tissues of the patients with chronic periodontitis associated to hypertension. METHODS: Gingival tissue samples were obtained during periodontal surgery or tooth extraction. Clinically healthy gingival tissue samples from systemically healthy 12 patients were categorized as group 1 (n=12). Inflammatory gingival tissue samples from patients with chronic periodontitis were categorized as group 2 (n=12). Inflammatory gingival tissue samples from patients with chronic periodontitis associated with hypertension were categorized as group 3 (n=12). Tissue samples were prepared and analyzed by Western blotting. The quantification of CRP and M-CSF were performed using a densitometer and statistically analyzed by one-way ANOVA followed by Tukey test. RESULTS: There were significant differences between group 1 and group 2 and between group 1 and group 3 in both CRP and M-CSF. The differences between group 2 and group 3 were not statistically significant in both proteins. However, the expression levels of CRP and M-CSF in hypertensive inflammatory gingiva showed increased tendency compared to non-hypertensive inflammatory gingiva. CONCLUSIONS: It is suggested that CRP and M-CSF might be used as inflammatory and bone resorption markers in periodontal diseased tissue. It is assumed that hypertension may be associated with the progression of periodontal inflammation and alveolar bone resorption.
Blotting, Western ; Bone Resorption ; C-Reactive Protein ; Chronic Periodontitis ; Gingiva ; Humans ; Hypertension ; Inflammation ; Macrophage Colony-Stimulating Factor ; Macrophages ; Proteins ; Tooth Extraction

OBJECTIVE: The purpose of this study was to determine the anatomic relationships between neurovascular structures and the transverse carpal ligament so as to avoid complications during endoscopic carpal tunnel surgery. METHODS: Twenty-eight patients (age range, 35-69 years) with carpal tunnel syndrome were entered into the study. We examined through wrist magnetic resonance imaging in three different positions (neutral, radial flexion, and ulnar flexion) and determined several anatomic landmark (distance from the hamate hook to the median nerve, ulnar nerve, and ulnar vessel) based on the lateral margin of the hook of the hamate. The median nerve and ulnar neurovascular structure were studied with the wrist in the neutral, ulnar, and radial flexion positions. RESULTS: The ulnar neurovascular structures usually passed just over or ulnar to the hook of the hamate. However, in 12 hands, a looped ulnar artery coursed 0.6-3.3 mm radial to the hook of the hamate and continued to the superficial palmar arch. The looped ulnar artery migrates on the ulnar side of Guyon's canal (-5.2-1.8 mm radial to the hook of the hamate) with the wrist in radial flexion. During ulnar flexion of the wrist, the ulnar artery shifts more radially beyond the hook of the hamate (-2.5-5.7 mm). CONCLUSION: It is appropriate to transect the ligament greater than 4 mm apart from the lateral margin of the hook of the hamate without placing the edge of the scalpel toward the ulnar side. We would also recommend not transecting the transverse carpal ligament in the ulnar flexed wrist position to protect the ulnar neurovascular structure.
Anatomic Landmarks ; Carpal Tunnel Syndrome ; Hamate Bone ; Hand ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Median Nerve ; Ulnar Artery ; Ulnar Nerve ; Wrist

Tuberculous involvement of the esophagus is very rare even in the presence of extensive pulmonary tuberculosis or in the endemic area. This is resulted from local extension to the esophagus from contiguous tuberculosis organs or miliary spread. Such secondary involvement is more common than primary tuberculosis, in which there is no evidence of tuberculosis elsewhere. The diagnosis of esophageal tuberculosis may be difficult. So the radiologic, endoscopic, histologic findings and clinical feature including the response to chemotherapy may be needed to avoid misdiagnosis. Most cases can be treated successfully with antituberculosis medication. A 67-year-old man was admitted to our hospital complaining of swallowing difficulty for 2 months. On the gastrofibroscopic examination, 22 cm sized protruding mass with central deep ulceration was discovered at the mid-esophagus. The biopsy showed the ulcer with chronic granulomatous inflammation and multinucleated giant cells consistent with tuberculosis. After antituberculosis medication, the lesion of esophageal tuberculosis was healed completely remaining minimal ulcer scar.
Aged ; Biopsy ; Cicatrix ; Deglutition ; Diagnosis ; Diagnostic Errors ; Drug Therapy ; Esophageal Neoplasms* ; Esophagus ; Giant Cells ; Humans ; Inflammation ; Tuberculosis* ; Tuberculosis, Pulmonary ; Ulcer

PURPOSE: In 2000, the American Heart Association and International Liaison Committee on Resuscitation published guidelines for CPR (Cardiopulmonary Resuscitation), and these guidelines were revised in 2005. Many physicians perform CPR differently than suggested by these guidelines. We investigated guideline conformation rates for CPR by non-emergency physicians. METHODS: From January 1st, 2005, to December 31st, 2005, and from January 1st, 2007, to September 30th, 2007, 103 in-hospital CPR cases were enrolled. We separated the 103 cases into two groups: 2005 patients and 2007 patients. Fifty-two cases in the 2005 group and 51 cases in the 2007 group were enrolled. The defibrillation method, defibrillation energy, epinephrine use, and atropine use were analyzed. RESULTS: Nineteen cases (82.6%) in the 2005 group and three cases (21.4%) in the 2007 group were performed using the appropriate defibrillation method (p=0.0002). Seventeen cases (73.9%) in the 2005 group and four cases (28.6%) in the 2007 group received the appropriate defibrillation energy (p=0.0069). Seven cases (14.0%) in the 2005 group and 16 cases (32.0%) in the 2007 group used the appropriate epinephrine dose (p=0.0325). Fourteen cases (28.0%) in the 2005 patient group and 14 cases (29.2%) inthe 2007 patient group used the appropriate atropine dose (p=0.8983). CONCLUSION: Although CPR guidelines were renewed in 2005, many physicians do not follow these guidelines. We suggest that adequate information, education, feedback, and further study are needed for guideline conformation.
American Heart Association ; Atropine ; Cardiopulmonary Resuscitation ; Electric Countershock ; Epinephrine ; Humans ; Nerve Growth Factors ; Resuscitation ; S100 Proteins

There have been ongoing social discussions on revision of the abortion law since the Constitutional Court ruled it nonconformity to the constitution on April 11, 2019. Thus, Korean Society of Obstetrics and Gynecology, Korean Society of Maternal Fetal Medicine, Korean College of Obstetricians and Gynecologists, and Korean Association of Obstetricians and Gynecologists organized 'special committee for abortion law' to support social discussion on the revision of the abortion law, and they prepared official opinions of obstetrics for medical issues including doctors' right to refuse abortion. In the future, the committee will continue to adapt to changes of medical environment especially after the revision of the abortion law by collecting its members' feedbacks.

There have been ongoing social discussions on revision of the abortion law since the Constitutional Court ruled it nonconformity to the constitution on April 11, 2019. Thus, Korean Society of Obstetrics and Gynecology, Korean Society of Maternal Fetal Medicine, Korean College of Obstetricians and Gynecologists, and Korean Association of Obstetricians and Gynecologists organized 'special committee for abortion law' to support social discussion on the revision of the abortion law, and they prepared official opinions of obstetrics for medical issues including doctors' right to refuse abortion. In the future, the committee will continue to adapt to changes of medical environment especially after the revision of the abortion law by collecting its members' feedbacks.

BACKGROUND: Cervical tuberculous lymphadenopathy is a very common disease with a similar incidence to pulmonary tuberculosis. Dendritic cells play a role of initial antigen presentation of this illness. Nevertheless, the precise role of these antigen-presenting cells according to the clinical features in unclear. The aim of this study was to determine the clinical implication of dendritic cell infiltration in the cervical lymph nodes. METHODS: A review of the clinical characteristics was carried out retrospectively based on the clinical records and radiography. Immunohistochemical staining was performed on the available histology specimens of 72 cases using the S-100b polyclonal antibody for dendritic cells. The number of dendritic cells with tuberculous granuloma were determined. A x2 test, unpaired T test and multiple logistic regression analysis were performed. RESULTS: Thirty percent of subjects had previous or concurrent pulmonary TB. Twenty one percent of cases showed a positive reaction on the AFB stain. Within a granuloma, the number of infiltrated dendritic cells was 113.0+/-7.0. The incidence of fever and cough decreased with increasing infiltration of dendritic cells Multivariate regression analysis showed that the infiltration of dendritic cells could significantly contribute to fever. CONCLUSION: Overall, dendritic cells can control a Mycobacterium tuberculosis infection and modulate the immune response, as well as resolve the clinical manifestations of TB lymphadenopathy.
Antigen Presentation ; Antigen-Presenting Cells ; Cough ; Dendritic Cells* ; Fever ; Granuloma ; Incidence ; Logistic Models ; Lymph Nodes ; Lymphatic Diseases ; Mycobacterium tuberculosis ; Radiography ; Retrospective Studies ; Tuberculosis ; Tuberculosis, Lymph Node* ; Tuberculosis, Pulmonary