PURPOSE: Although acute nonspecific mesenteric lymphadenitis (ANML) is probably common cause of abdominal pain in children, which can be severe enough to be an abdominal emergency, the clinical features of mesenteric lymphadenitis are not clear. Also, a differential diagnosis with acute appendicitis (APPE) is indispensable to avoid serious complications. The clinical features of ANML were determined, and the risk factors for differential diagnosis with APPE were analyzed. METHODS: Between November 2000 and May 2001, data from 26 patients (aged 1 to 11 years) with ANML and 21 patients (aged 2 to 13 years) with APPE were reviewed. ANML was defined as a cluster of five or more lymph nodes measuring 10 mm or greater in their longitudinal diameter in the right lower quadrant (RLQ) without an identifiable specific inflammatory process on the ultrasonographic examination. There were risk factors on patient's history, physical examination, and laboratory examination; the location of abdominal pain, abdominal rigidity, rebound tenderness, fever, nocturnal pain, the vomiting intensity, the diarrhea intensity, the symptom duration, and the peripheral blood leukocytes count. RESULTS: Of the 26 ANML patients and 21 APPE patients, abdominal pain was noted on periumbilical (76.9% vs 14.2%), on RLQ (11.5% vs 71.4%), with abdomen rigidity (7.6% vs 80.9%), with rebound tenderness (0.0% vs 76.1%)(p<0.05), in the lower abdomen (11.5% vs 14.2%), and at night (80.8% vs 100.0%) (p>0.05). The clinical symptoms were vomiting (38.4% vs 90.4%), the vomiting intensity (1.5+/-0.7 [1~3] /day vs 4.5+/-2.9 [1~10] /day), diarrhea (65.3% vs 28.5%) (p<0.05), and fever (61.5% vs 76.2%)(p>0.05). The period to the subsidence of abdominal pain in the ANMA patients was 2.5+/-0.5 (2~3) days. The laboratory data showed a significant difference in the peripheral blood leukocytes count (8,403+/-1,737 [5,900~12,300] /mm3 vs 15,471+/-3,749 [5,400~20,800] /mm3)(p<0.05). Discriminant analysis between ANML and APPE showed that the independent discriminant factors were a vomiting intensity and the peripheral blood leukocytes count and the discriminant power was 95.7%. CONCLUSION: The clinical characteristics of ANML were abrupt onset of periumbilical pain without rigidity or rebound tenderness, a mild vomiting intensity, normal peripheral leukocytes count, and relatively short clinical course. If the abdominal pain persist for more than 3 days, and/or the vomiting intensity is more than 3 times/day, and/or the peripheral leukocytes count is over 13,500/mm3, abdominal ultrasonography is recommended to rule out APPE.
Abdomen ; Abdominal Pain ; Appendicitis* ; Child ; Diagnosis, Differential* ; Diarrhea ; Emergencies ; Fever ; Humans ; Leukocytes ; Lymph Nodes ; Mesenteric Lymphadenitis* ; Physical Examination ; Risk Factors ; Ultrasonography ; Vomiting

PURPOSE: This study aimed to evaluate the efficacy of simultaneous computed tomography (CT) and quantitative CT (QCT) in patients with osteoporotic hip fracture (OHF) by analyzing the osteoporosis detection rate and physician prescription rate in comparison with those of conventional dual-energy X-ray absorptiometry (DXA). MATERIALS AND METHODS: This study included consecutive patients older than 65 years who underwent internal fixation or hip arthroplasty for OHF between February and May 2015. The patients were assigned to either the QCT (47 patients) or DXA group (51 patients). The patients in the QCT group underwent QCT with hip CT, whereas those in the DXA group underwent DXA after surgery, before discharge, or in the outpatient clinic. In both groups, the patients received osteoporosis medication according to their QCT or DXA results. The osteoporosis evaluation rate and prescription rate were determined at discharge, postoperative (PO) day 2, PO day 6, and PO week 12 during an outpatient clinic visit. RESULTS: The osteoporosis evaluation rate at PO week 12 was 70.6% (36 of 51 patients) in the DXA group and 100% in the QCT group (P < 0.01). The prescription rates of osteoporosis medication at discharge were 70.2% and 29.4% (P < 0.001) and the cumulative prescription rates at PO week 12 were 87.2% and 60.8% (P=0.003) in the QCT and DXA groups, respectively. CONCLUSION: Simultaneous CT and QCT significantly increased the evaluation and prescription rates in patients with OHF and may enable appropriate and consistent prescription of osteoporosis medication, which may eventually lead to patients' medication compliance.
Absorptiometry, Photon ; Ambulatory Care Facilities ; Arthroplasty ; Hip Fractures ; Hip ; Humans ; Medication Adherence ; Osteoporosis ; Prescriptions

PURPOSE: The inducible isoform of heme oxygenase(HO), HO-1, responds to hypoxia. HO-1 regulates vascular smooth muscle tone through carbon monoxide production. To investigate the possible role of HO-1 in low-flow priapism, we examined the expression and activity of HO-1 in artificially induced veno-occlusive priapism in rat. MATERIALS AND METHODS: Fourteen male Sprague Dawley rats were divided into 2 groups with 7 rats each. In the first group, low-flow priapism was induced using a vacuum-constriction device and a constriction rubber band; in the second group, low-flow priapism was induced using papaverine. We measured the expression level and activity of HO-1 in penile tissues after time periods of 0(control), 2, 3, 4, 8, 12, 24, and 48 hours. At the same time, the expression levels of i-NOS, e-NOS, and beta-actin(control) in penile tissues were also measured. RESULTS: In both groups, expression of HO-1 and HO-1 enzyme activities in penile tissue significantly increased in a time dependent fashion(p<0.01). However, there was no difference in the expression of i-NOS and e-NOS in both groups at any time period. CONCLUSIONS: HO-1 was induced over time in rats with artificially induced veno-occlusive priapism. Induction of HO-1 may play a protective role against hypoxic injury, but may also play an important role in the vicious cycle observed for low flow priapism. Increasing induction of HO-1 against hypoxic injury in a prolonged erectile state promotes sustained dilatation of corporal smooth muscle, and this may aggravate low-flow priapism.
Animals ; Anoxia ; Carbon Monoxide ; Constriction ; Dilatation ; Heme Oxygenase (Decyclizing) ; Heme Oxygenase-1* ; Heme* ; Humans ; Male ; Muscle, Smooth ; Muscle, Smooth, Vascular ; Papaverine ; Priapism* ; Rats* ; Rats, Sprague-Dawley ; Rubber

STUDY DESIGN: A case report. OBJECTIVES: To report and discuss an extremely uncommon cause of lumbar plexopathy seat belt injury. SUMMARY OF LITERATURE REVIEW: For patients who undergo traffic accidents, most cases of seat belt injury cause trauma to the lower torso. Seat belt injury is associated with variable clinical problems such as vascular injury, intestinal injury (perforation), vertebral injury (flexion-distraction injury), chest wall injury, diaphragmatic rupture/hernia, bladder rupture, lumbosacral plexopathy, and other related conditions. MATERIALS AND METHODS: A 38-year-old male truck driver (traffic accident victim) who suffered monoplegia of his right leg due to lumbar plexus injury without spinal column involvement. Injury to a lumbar plexus and the internal vasculatures originated from direct compression to internal abdominal organs (the iliopsoas muscle and internal vasculatures anterior to the lumbar vertebrae) caused by the seat belt. We have illustrated an extremely uncommon cause of a neurologic deficit from a traffic accident through this case. RESULTS: Under the impression of traumatic lumbar plexopathy, we managed it conservatively, and the patient showed signs of recovery from neurologic deficit. CONCLUSIONS: We need to review the lumbar plexus pathway, in patients with atypical motor weakness and sensory loss of the lower extremities which are not unaccompanied by demonstrable spinal lesions. Therefore, close history taking, physical examination and comprehension of injury mechanism are important in the diagnosis.
Accidents, Traffic ; Adult ; Comprehension ; Diagnosis ; Hemiplegia ; Humans ; Leg ; Lower Extremity ; Lumbosacral Plexus ; Male ; Motor Vehicles ; Neurologic Manifestations ; Physical Examination ; Rupture ; Seat Belts* ; Spine ; Thoracic Wall ; Torso ; Urinary Bladder ; Vascular System Injuries

Renal cell carcinoma (RCC) is one of the most malignant tumors in urology, and due to its insidious onset patients frequently have advanced disease at the time of clinical presentation. Thus, early detection is crucial in management of RCC. To identify tumor specific proteins of RCC, we employed proteomic analysis. We prepared proteins from conventional RCC and the corresponding normal kidney tissues from seven patients with conventional RCC. The expression of proteins was determined by silver stain after two-dimensional polyacrylamide gel electrophoresis (2D-PAGE). The overall protein expression patterns in the RCC and the normal kidney tissues were quite similar except some areas. Of 66 differentially expressed protein spots (p<0.05 by Student t-test), 8 different proteins from 11 spots were identified by MALDI-TOF-MS. The expression of the following proteins was repressed (p<0.05); aminoacylase-1, enoyl-CoA hydratase, aldehyde reductase, tropomyosin alpha-4 chain, agmatinase and ketohexokinase. Two proteins, vimentin and alpha-1 antitrypsin precursor, were dominantly expressed in RCC (p<0.05).
Aged ; Aldehyde Reductase/analysis ; Amidohydrolases/analysis ; Carcinoma, Renal Cell/*metabolism/pathology ; Comparative Study ; Electrophoresis, Gel, Two-Dimensional ; Enoyl-CoA Hydratase/analysis ; Female ; Fructokinases/analysis ; Humans ; Kidney Neoplasms/*metabolism/pathology ; Male ; Middle Aged ; Proteome/*analysis ; Proteomics/*methods ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ; Tropomyosin/analysis ; Ureohydrolases/analysis ; Vimentin/analysis ; alpha 1-Antitrypsin/analysis

OBJECTIVE: Post-marketing surveillance (PMS) is an adverse events monitoring practice of pharmaceutical drugs on the market. Traditional PMS methods are labor intensive and expensive to perform, because they are largely based on manual work including phone-calling, mailing, or direct visits to relevant subjects. The objective of this study was to develop and validate a PMS methodology based on the clinical data warehouse (CDW). METHODS: We constructed a archival DB using a hospital information system and a refined CDW from three different hospitals. Fluoxetine hydrochloride, an antidepressant, was selected as the target monitoring drug. Corrected QT prolongation on ECG was selected as the target adverse outcome. The Wilcoxon signed rank test was performed to analyze the difference in the corrected QT interval before and after the target drug administration. RESULTS: A refined CDW was successfully constructed from three different hospitals. Table specifications and an entity-relation diagram were developed and are presented. A total of 13 subjects were selected for monitoring. There was no statistically significant difference in the QT interval before and after target drug administration (p=0.727). CONCLUSION: The PMS method based on CDW was successfully performed on the target drug. This IT-based alternative surveillance method might be beneficial in the PMS environment of the future.
Electrocardiography ; Fluoxetine ; Hospital Information Systems ; Postal Service ; Retrospective Studies

Atypical femoral fracture related to a long-term bisphosphonate therapy has commonly been reported; however, a fracture at the site other than the femur has rarely been reported to date. Herein, we report a case of a patient on long-term bisphosphonate therapy who presented atypical tibial insufficiency fracture at the anterolateral aspect of diaphysis, without trauma. We, for the first time in Korea, present this case with a literature review.
Diaphyses ; Femoral Fractures ; Femur ; Fractures, Stress* ; Humans ; Korea ; Tibia*

BACKGROUND: The aim of the present study was to determine the population-based prevalence of diabetes mellitus (DM) and prediabetes in a rural district of Daegu City, Korea. METHODS: Between August and November 2003, a community-based health survey of adults aged 20 years and older was performed in the rural district of Dalseong-gun in Daegu City. A total of 1,806 of all eligible individuals agreed to participate. Fasting plasma glucose was measured in all participants. Two hour oral glucose tolerance was measured in the 1,773 participants for whom there was neither an established diagnosis of DM nor evidence of DM according to fasting glucose levels. The prevalence of DM and prediabetes was determined according to the 2003 criteria of the American Diabetes Association. Subjects with prediabetes were classified into one of three categories of glucose intolerance: isolated impaired fasting glucose (IFG); isolated impaired glucose tolerance (IGT); or combined IFG and IGT. RESULTS: The prevalence of DM was 12.2%. The highest prevalence rates were observed in subjects in their seventies. A total of 34.7% of all subjects who were assigned a diagnosis of DM in the present study had not been diagnosed previously. The prevalence of prediabetes was 22.7%. The highest prevalence rates were observed in subjects in their fifties. CONCLUSION: The present study identified prevalence rates of 12.2% for DM (age-standardized prevalence rate [ASR], 6.8%), and 22.7% for prediabetes (ASR 18.5%). These results emphasize the need for community health promotion strategies to prevent or delay the onset of DM in individuals with prediabetes.
Adult ; Aged ; Diabetes Mellitus ; Fasting ; Glucose ; Glucose Tolerance Test ; Health Promotion ; Health Surveys ; Humans ; Korea ; Plasma ; Prediabetic State ; Prevalence

BACKGROUND: To analyze clinical outcome of CyberKnife (CK) tumor-tracking stereotactic body radiotherapy (SBRT) for prostate cancer (Pca) according to the magnitude of intra-fractional prostate motion. METHODS: Medical records and daily treatment logs for 71 patients who received CK tumor-tracking SBRT were retrospectively analyzed. Statistical relationships between prostate motion and various outcome results, including local recurrence (LR), biochemical failure (BF), and treatment-related toxicity, were investigated in order to evaluate motion-dependent efficacy of tumor-tracking SBRT for Pca. RESULTS: In a total 71 patients, 3 (4.2%) patients with LR, 12 (16.9%) patients with BF, and 22 (31%) patients with grade-II or worse toxicities to rectal or bladder (22 to rectal, 22 to bladder and 8 patients to both) were observed in a median follow-up of 47 months. Magnitudes of intra-fractional tumor motion along superior-inferior, right-left, and anterior-posterior (AP) axes were 0.15 ± 0.31, 0.12 ± 0.19, and 0.73 ± 0.32 mm, respectively. Radial magnitude was estimated to be 1.0 ± 0.35 mm. Intra-fractional movement was not significantly correlated with tumor control. However, it was significant correlated with the incidence of grade-II or worse toxicity to rectum or bladder particularly when tumor motion was in the AP axis. CONCLUSION: Our quantitative results revealed that toxicity related to SBRT treatment was highly sensitive to intra-fractional prostate movements, although local-tumor control was not affected by such movements. Our results demonstrate that precise motion correction is essential in prostate SBRT, even if it seems to be small.
Follow-Up Studies ; Humans ; Incidence ; Medical Records ; Passive Cutaneous Anaphylaxis ; Prostate* ; Prostatic Neoplasms* ; Radiosurgery* ; Rectum ; Recurrence ; Retrospective Studies ; Urinary Bladder