PURPOSE: Metabolic syndrome (MS) is a clinical condition that shares many common characteristics with diabetes. However, unlike diabetes, the usefulness of MS as a prognostic entity in peripheral arterial disease is uncertain. This study evaluated the prognostic usefulness of MS in critical lower limb ischemia (CLI) patients. MATERIALS AND METHODS: We compared the 2-year clinical outcomes in 101 consecutive CLI patients (66+/-14 years; 78% men) with 118 affected limbs treated with percutaneous transluminal angioplasty (PTA) according to the presence of MS and diabetes. RESULTS: The number of MS patients was 53 (52%), of which 45 (85%) had diabetes. During a 2-year follow-up, the incidence of clinical outcomes, including reintervention, major amputation, minor amputation, and survival, was not significantly different between MS and non-MS patients; however, the incidence of minor amputation was significantly higher in diabetic than in non-diabetic patients (42% vs. 17%; p=0.011). Cox regression analysis for the 2-year primary patency demonstrated no association between MS and 2-year primary patency [hazard ratio (HR), 1.02; 95% confidence interval (CI), 0.45-2.30; p=0.961], whereas there was a significant association between diabetes and 2-year primary patency (HR, 2.81; 95% CI, 1.02-7.72; p=0.046). Kaplan-Meier analysis revealed no significant difference in the 2-year primary patency between MS and non-MS patients; however, the 2-year primary patency was lower in diabetic than in non-diabetic patients (p=0.038). CONCLUSION: As a prognostic concept, MS might conceal the adverse impact of diabetes on the prognosis of CLI patients treated with PTA.
Aged ; Aged, 80 and over ; Angioplasty/*methods ; Diabetes Mellitus/*therapy ; Female ; Humans ; Ischemia/*therapy ; Lower Extremity/*blood supply ; Male ; Metabolic Syndrome X/*therapy ; Middle Aged ; Republic of Korea ; Retrospective Studies

Seckel syndrome is a rare autosomal recessive disease. The characteristic features of Seckel syndrome include Intrauterine and postnatal growth deficiency, severe microcephaly, and a bird-like head. General appearance of our patient was characterized by Pre- and postnatal growth retardation, microcephaly, large eye, and a beaked nose. The patient had mental retardation with CNS anomalies. The CNS anomalies seen in the patient included cerebral dysgenesis and cerebellar atrophy. So, we report the case of CNS anomalies in Seckel syndrome.
Animals ; Atrophy ; Beak ; Head ; Humans ; Intellectual Disability ; Microcephaly ; Nose

A low iodine diet (LID) is the recommended preparation for radioactive iodine treatment. However, the recommended duration and stringency of LID are different among each recommendation. More stringent LID is expected in Korea because Korea is a iodine-rich region. We investigated the decrement of urine iodine excretion by two-week stringent LID for remnant thyroid ablation with radioactive iodine in Korean patients with thyroid cancer, prospectively. MATERIAL AND METHOD: From November 2006, patients who referred to our hospital for remnant ablation after total thyroidectomy were included in this study. To decrease total body iodine, our protocol included three strategies. First, we checked medication which could inhibit the radioactive iodine uptake. Second, the date of I-131 treatment was scheduled at least 3 months later if contrast agent had been used. The last strategy was two-week stringent LID education by specialized nutritionist. Before and after two-week stringent LID, 24hr-urine iodine was analyzed respectively. 24hr-urine creatinine was also analyzed for determining more valid 24hr urine sampling subgroup. RESULTS: Total 51 patients were finally enrolled. Average of 24hr-urine iodine excretion was significantly lowered (787+/-2242 -> 85+/-85 microgram/d, p=0.03) after LID and 74.4% of patients reached below the recommended urine iodine excretion level (<100 microgram/d). In subgroup (n=14), similar results was showed (505+/-666 -> 99+/-116 microgram/d, p=0.05) and 78.6% of patients met the criteria. CONCLUSION: Most patients could reach below the recommended urine iodine level after two-week stringent LID. Therefore, in our opinion, at least two-week stringent LID should be recommended in Korea.
Creatinine ; Diet ; Humans ; Iodine ; Korea ; Prospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

Waldenstr m's macroglobulinemia (WM) is a rare lymphoproliferative disorder characterized by lymphocytic tumor infiltration of the bone marrow and monoclonal IgM gammopathy. There had been anecdotal reports of pleural involvement in WM. We experienced a case of WM with pleural involvement and reported here for the first time in Korea with review of literature. A 73-year-old male patient was admitted to our hospital due to dizziness and general weakness. Serum protein electrophoresis showed M-peak in the gamma-globulin region, which was revealed as IgM kappa macroglobulin by serum and urine immunoelectrophoresis. He complained headache, visual disturbance and epistaxis associated with hyperviscosity syndrome and plasma filtration and combination chemotherapy was performed immediately. Symptoms and laboratory parameters such as serum IgM level and globulin fraction were markedly improved thereafter. But during the treatment, insidiously progressive exertional dyspnea was developed and the chest X-ray showed bilateral pleural effusion. The pleural fluid contained abundant plasmacytoid lymphocytes with reactive mesothelial cells. His dyspnea was completely resolved with clearing of the radiographic pleural effusion after continued steroid therapy.
Aged ; Bone Marrow ; Dizziness ; Drug Therapy, Combination ; Dyspnea ; Electrophoresis ; Epistaxis ; Filtration ; gamma-Globulins ; Headache ; Humans ; Immunoelectrophoresis ; Immunoglobulin M ; Korea ; Lymphocytes ; Lymphoproliferative Disorders ; Male ; Plasma ; Pleural Effusion ; Thorax ; Waldenstrom Macroglobulinemia*

OBJECTIVE: The purpose of this study is to evaluate the role of cold knife conization in the diagnosis and treatment of cervical neoplasia. METHODS: Sixty patients were divided into diagnostic and therapeutic conization group and then indication of conization, PAP smear, colposcopy directed biopsy, cone margin and residual lesion of each group were compared respectively. RESULTS: If the difference of PAP and colposcopy directed biopsy was 2 grades or more, upper limit of the lesion was invisible, squamocolumnar junction was not seen, PAP V or invasive cancer was suspected, diagnostic conization was performed in 22 patients. Six cases of follow-up group had cone margin (-) and no recurrence. Sixteen cases of immediate TAH (total abdominal hysterectomy) group had 2 cases of cone margin (+) with residual disease. There were 4 cases of cone margin (-) with residual lesion. If the difference of PAP and colposcopy directed biopsy was 1 grade or less, upper limit of the lesion was visible, squamocolumnar junction was seen and invasive cancer was ruled out, therapeutic conization was performed in 38 cases. All of therapeutic conization group had cone margin (-). Thirty two cases were follow up group and six cases were immediate TAH group. Three of follow up group had recurrences and delayed TAH was performed. There was no residual lesion in the specimen of immediate TAH group. CONCLUSION: The precise dignosis and treatment of cervical neoplasia was capable with cold knife conization. The more aggressive lesion or the more cases of cone margin (+) was diagnosed, the more residual lesion was found. Thorough follow up should be done after treatment of cervical neoplasia because of the possibility of residual disease even after documentation of cone margin (-).
Biopsy ; Colposcopy ; Conization* ; Diagnosis ; Follow-Up Studies ; Humans ; Recurrence

Necrotizing fasciitis is a rapidly progressing soft-tissue infection that affects the subcutaneous fascia and dermis, and characteristically spares the underlying muscle. Most cases represent a synergistic or mixed bacterial infection of aerobes and anaerobes. A variety of etiologies have been reported. Herein, two cases of necrotizing fasciitis of the right thigh secondary to perforated appendicitis, an extremely rare complication, are reported. Both cases recovered following aggressive surgical and medical therapies. The delay in diagnosis and radical surgical excision are frequent and significant contributory factors in the high reported mortality rate. A high index of suspicion, followed by prompt surgical intervention with broad-spectrum antibiotic therapy, seems to be the most important prognostic factor in these difficult cases.
Appendicitis* ; Bacterial Infections ; Dermis ; Diagnosis ; Fascia ; Fasciitis, Necrotizing* ; Mortality ; Thigh

Acinic cell carcinoma (ACC) is an uncommon malignant tumor of the salivary glands that is difficult to diagnose. It grows slowly and shows distant metastasis rarely. We experienced a case of recurrent ACC in the parotid gland with cardiac metastasis and hypertrophic osteoarthropathy. The 29-year-old man had been suffering from severe multiple bones and joints pain for 2 months. Ten years earlier, he underwent superficial parotidectomy due to a right subauricular mass. The mass was diagnosed with ACC. After surgery, the tumor recurred twice. Then the patient was diagnosed with cardiac metastasis via positron emission tomography-computed tomography and trans-thoracic echocardiography. He also had hypertrophic osteoarthropathy with multiple bone metastasis. He was given palliative radiotherapy and conservative treatment. ACC in the parotid gland with cardiac metastasis and hypertrophic osteoarthropathy has not yet been reported in literature. From this case, it is recommended to evaluate multiple distant metastasis in the ACC of the parotid gland when joint and bone pain are present.
Adult ; Carcinoma, Acinar Cell* ; Echocardiography ; Electrons ; Humans ; Joints ; Neoplasm Metastasis* ; Parotid Gland* ; Parotid Neoplasms ; Radiotherapy ; Salivary Glands

OBJECTIVE: Red cell distribution width (RDW) is associated with mortality in patients with community- acquired pneumonia (CAP). However, little is known about the effect of changes in RDW during treatment on mortality. Thus, the objective of this study was to evaluate the association between RDW changes and mortality in hospitalized patients with CAP. METHODS: Retrospective analyses were performed using medical records of patients hospitalized for CAP from April 2008 to February 2014. The abstracted laboratory values included RDW (from days one to four), clinical variables, and pneumonia severity index (PSI) scores. The ΔRDW(n-1) was defined as the change in RDW calculated as: (RDW(day1)-RDW(day-n))/RDW(day1)×100 (%), where ‘day n’ refers to hospital day. RESULTS: During the study period, a total of 1,069 patients were hospitalized for CAP. The 30-day mortality was 100/1,069 (9.4%). The median RDW at baseline was 14.1% (range, 11.1 to 30.2) and differed significantly between survivors and non-survivors (P<0.05). There were 470 patients with available serial RDW data (30-day mortality 58/470 [12.3%]). Of those, age, PSI score, blood urea nitrogen level, total protein concentration, albumin level, RDW at day 1, and the ΔRDW₄₋₁ differed significantly between survivors and non-survivors. Multivariate Cox regression analysis showed that the significance of the relationship between ΔRDW₄₋₁ and 30-day mortality risk remained after adjusting for age, PSI score, RDW at day 1, total protein concentration, and initial albumin level. CONCLUSION: RDW change from day 1 to day 4 was an independent predictor of mortality in patients with CAP.
Blood Urea Nitrogen ; Erythrocyte Indices ; Erythrocytes* ; Humans ; Medical Records ; Mortality ; Pneumonia* ; Retrospective Studies ; Survivors

BACKGROUND/AIMS: The eradication rate of the first-line triple therapy (a proton pump inhibitor, clarithromycin, and amoxicillin) for Helicobacter pylori infection has gradually decreased in Korea. We evaluated whether clinical parameters, clarithromycin resistance, and CYP2C19 genotype can affect the eradication failure. METHODS: A total of 203 patients with H. pylori-positive chronic gastritis were consecutively enrolled. They received clarithromycin-based triple therapy for 7 days. A clarithromycin resistance test was performed by detection of A2142G and A2143G point mutations in H. pylori 23S rRNA. The CYP2C19 genotype was examined for polymorphism G681A of exon 5 and G636A of exon 4 by polymerase chain reaction with restriction fragment length polymorphism. Eradication was assessed by a ¹³C-urea breath test 4 weeks after treatment. RESULTS: Of 203 patients, 190 completed the study. The eradication rate was 64.0% according to intention-to-treat analysis and 68.4% by per-protocol analysis. CYP2C19 genotypes were identified as follows: 75 poor metabolizers, 75 intermediate metabolizers, and 40 rapid metabolizers. Nonetheless, this polymorphism was not significantly associated with eradication failure (p = 0.682). Clarithromycin resistance was detected in 33/190 patients (17.4%), and their eradication rate was zero. Clarithromycin resistance (odds ratio [OR], 19.13; 95% confidence interval [CI], 9.35 to 35.09) and female gender (OR, 1.73; 95% CI, 1.15 to 4.25) were significantly associated with eradication failure. The other clinical parameters such as age, cigarette smoking, alcohol intake, the body mass index, hypertension, and diabetes were not significantly associated with eradication. CONCLUSIONS Clarithromycin resistance and female gender are factors affecting H. pylori eradication failure in patients with chronic gastritis.

Oleanolic acid is a natural triterpenoid that exists widely in foods and some medicinal herbs. The purpose of this study was to determine the antimicrobial activity of oleanolic acid against Streptococcus mutans strains isolated from a Korean population. Antimicrobial activity against these bacteria was evaluated by minimal inhibitory concentration (MIC) and time kill curves. The tolerance of human gingival fibroblasts and human periodontal ligaments to oleanolic acid was tested using a methyl thiazolyl tetrazolium (MTT) assay. The MIC90 value of oleanolic acid for both S. mutans and S. sobrinus isolated from Koreans was 8 microg/ml. Oleanolic acid showed bactericidal effects against S. mutans ATCC 25175T and S. sobrinus ATCC 33478T at 1 x MIC (8 microg/ml) and had no cytotoxic effects against KB cells at this dose. The results suggest that oleanolic acid could be useful in the future development of oral hygiene products for the prevention of dental caries.
Bacteria ; Dental Caries ; Fibroblasts ; Humans ; KB Cells ; Oleanolic Acid ; Oral Hygiene ; Periodontal Ligament ; Plants, Medicinal ; Streptococcus ; Streptococcus mutans ; Streptococcus sobrinus