Procalcitonin (PCT) was discovered as a useful marker for bacterial infection. Following its discovery, there have been a substantial number of clinical studies conducted to evaluate the presence of bacterial infections, and to guide antibiotic treatment by the stratified levels of PCT. Clinical evidence suggests that antibiotic treatment by PCT-guided antibiotic stewardship has been associated with a reduction in antibiotic usage without an increase in adverse outcomes. The use of PCT was approved by the Food and Drug Administration in the United States of America in 2017 to guide antibiotic treatment in sepsis and lower respiratory tract infections (LRTIs). In Korea, the use of PCT for sepsis and for pneumonia was approved in 2015 and 2022, respectively. This review will discuss the clinical utility of PCT on antibiotic stewardship in the management of sepsis and LRTIs including pneumonia.

Melanoacanthoma is an extremely rare pigmented benign mixed epithelial tumor of both melanocytes and keratinocytes. A 52-year-old female presented an asymptomatic, slightly elevated, 1. 2 cm x 0. 8 cm, dark black-colored plaque on her right buttock of 2 years' duration. Histopathologic finding of the plaque shows hyperkeratosis, focal parakeratosis, follicular plugging, acanthosih, papillomatosis and pseudo-horn cyst in the epidermis. The tumor is composed of basaloid and squarnous cells with many foci of clusters and whorls of melanin pigment-laden cells. Electron microscopic finding reveals many scattered melanocytes in the entire epidermis. Melanin granules are found mostly in the melanocytes but can also be found in a few keratinocytes.
Buttocks ; Epidermis ; Female ; Humans ; Keratinocytes ; Melanins ; Melanocytes ; Middle Aged ; Papilloma ; Parakeratosis

Subcutaneous fat necrosis of the newborn is an uncommon disorder which is characterized by multiple erythematous subcutaneous nodules and plaques appearing in the first week to a month of life. The chief precipitating factors presumably concerned in this disease are obstetric trauma, anoxia and cold exposure. We observed a case of subcutaneous fat necrosis of the newborn in which intrauterine asphyxia and preeclampsia had occured.
Anoxia ; Asphyxia ; Humans ; Infant, Newborn* ; Necrosis* ; Pre-Eclampsia ; Precipitating Factors ; Subcutaneous Fat*

Twenty-eight cases of initial psoriasis were studied with histochemical methods in an attempt to obtain changes of acid mucopolysaccharides and mast cells. Early psoriatic lesions (pin head sized) and clinically uninvolved skin at distances of 2-4cm from the psoriatic lesions were excised respectively. The results are as follows; 1. Dermal changes were more prominent than the epidermal changes in almost all specimens in early psoriatic lesions. The main features of the dermal changes were perivascular inflammatory infiltrate which were consisted mainly of lymphoid cells. 2. Inflammatory infiltrate in the region of epidermal a.lteration and papillary edema is par ticulary striking. R. Among the 26 cases, the amount of acid mucopalysaccharides of initial lesion was lesser in 14 cases, greater in 4 cases and same in 8 cases as compared with clinically normal skin. 4. The number of mast cells of initial psoriatic lesion as compared with clinically normal skin was increased(p<0. 01).
Dermis* ; Edema ; Glycosaminoglycans ; Head ; Lymphocytes ; Mast Cells* ; Psoriasis* ; Skin ; Strikes, Employee

PURPOSE: Stress distribution and mandible distortion during lateral movements are known to be closely linked to bruxism, dental implant placement, and temporomandibular joint disorder. The present study was performed to determine stress distribution and distortion patterns of the mandible during lateral movements in Class I, II, and III relationships. METHODS: Five Korean volunteers (one normal, two Class II, and two Class III occlusion cases) were selected. Finite element (FE) modeling was performed using information from cone-beam computed tomographic (CBCT) scans of the subjects' skulls, scanned images of dental casts, and incisor movement captured by an optical motion-capture system. RESULTS: In the Class I and II cases, maximum stress load occurred at the condyle of the balancing side, but, in the Class III cases, the maximum stress was loaded on the condyle of the working side. Maximum distortion was observed on the menton at the midline in every case, regardless of loading force. The distortion was greatest in Class III cases and smallest in Class II cases. CONCLUSIONS: The stress distribution along and accompanying distortion of a mandible seems to be affected by the anteroposterior position of the mandible. Additionally, 3-D modeling of the craniofacial skeleton using CBCT and an optical laser scanner and reproduction of mandibular movement by way of the optical motion-capture technique used in this study are reliable techniques for investigating the masticatory system.
Bruxism ; Cone-Beam Computed Tomography* ; Dental Implants ; Finite Element Analysis* ; Incisor ; Malocclusion* ; Mandible ; Mastication* ; Masticatory Muscles ; Reproduction ; Skeleton ; Skull ; Stomatognathic System ; Temporomandibular Joint Disorders ; Volunteers

No abstract available.
Plasmapheresis* ; Postpartum Period* ; Pregnancy*

BACKGROUND: To improve sinus rhythm conversion, the Cox maze III procedure with narrow mazes (width: < or =3.0 cm) was performed in combination with left atrial volume reduction. METHODS: From October 2007 to April 2013, 87 patients with atrial fibrillation (paroxysmal in 3, persistent in 14, and permanent in 70) underwent the Cox maze procedure concomitant with another cardiac procedure. They were followed-up with serial electrocardiographic and echocardiographic studies. We used 24-hour Holter monitoring tests to evaluate postoperatively symptomatic patients. RESULTS: At the mean follow-up time of 36.4 months, 81 patients (94.2%) had sinus rhythm and two were on anti-arrhythmic medication (one on a beta-blocker and the other on amiodarone). Five patients (5.8%) with postoperative recurrent and persistent atrial fibrillation never experienced sinus rhythm conversion; however, they did not require any medication for rate control. On postoperative echocardiography, the left atrial A waves were more frequently observed after concomitant mitral valve repair than after concomitant mitral valve replacement (82.4% vs. 40.4%, respectively; p<0.001). CONCLUSION: For the Cox maze procedure, narrow mazes and atrial volume reduction resulted in excellent sinus rhythm conversion without the preventive use of anti-arrhythmic drugs, and they did not affect the presence of the left atrial A waves on echocardiography.
Atrial Fibrillation ; Echocardiography ; Electrocardiography ; Electrocardiography, Ambulatory ; Follow-Up Studies ; Humans ; Mitral Valve

BACKGROUND: Smaller guiding catheter had a problem with poor backup support during the transradial coronary intervention which resulted in higher failure rate. This study sought to prove the usefulness of deep seating technique which improves the backup support of the guiding catheter required to deliver interventional materials during the transradial coronary intervention. METHODS: Thirthy-five patients(23 males) were included in this study since March 1998 to August 1999. Clinical presentation of these patients were stable angina(7 patients), unstable angina(17 patients), acute myocardial infarction(11 cases). The mean age was 68+/-8 years. The treated vessel was left anterior descending artery in 22, left circumflex artery in 2 and right coronary artery in 11 of 35 vessels. RESULT: Twenty-six lesions were treated with stents, 3 with PTCA, and 6 with rotablator. Procedural success were achieved in 33 out of 35 cases(94%). Guiding catheters were used mostly with 6 Fr(30/35). In the left coronary system, usual Judkins left type was used in most of the patients(24/26, 92%), and in right coronary Judkins, Amplatz and multipurpose catheters were used similiarly. Hypotension and sinus bradycardia was encountered in one case without clinical significance and there was no dissection in all patients. CONCLUSION: Deep seating technique is a safe and effective technique without major adverse event during the transradial coronary intervention in selected cases.
Arteries ; Bradycardia ; Catheters ; Coronary Vessels ; Humans ; Hypotension ; Stents

BACKGROUND: Smaller guiding catheter had a problem with poor backup support during the transradial coronary intervention which resulted in higher failure rate. This study sought to prove the usefulness of deep seating technique which improves the backup support of the guiding catheter required to deliver interventional materials during the transradial coronary intervention. METHODS: Thirthy-five patients(23 males) were included in this study since March 1998 to August 1999. Clinical presentation of these patients were stable angina(7 patients), unstable angina(17 patients), acute myocardial infarction(11 cases). The mean age was 68+/-8 years. The treated vessel was left anterior descending artery in 22, left circumflex artery in 2 and right coronary artery in 11 of 35 vessels. RESULT: Twenty-six lesions were treated with stents, 3 with PTCA, and 6 with rotablator. Procedural success were achieved in 33 out of 35 cases(94%). Guiding catheters were used mostly with 6 Fr(30/35). In the left coronary system, usual Judkins left type was used in most of the patients(24/26, 92%), and in right coronary Judkins, Amplatz and multipurpose catheters were used similiarly. Hypotension and sinus bradycardia was encountered in one case without clinical significance and there was no dissection in all patients. CONCLUSION: Deep seating technique is a safe and effective technique without major adverse event during the transradial coronary intervention in selected cases.
Arteries ; Bradycardia ; Catheters ; Coronary Vessels ; Humans ; Hypotension ; Stents

OBJECTIVE: The purpose of this study was to review factors used to determine whether a patient with an unruptured intracranial aneurysm is treated using surgical therapy or endovascular therapy. METHODS: We retrospectively reviewed the records of 68 patients with 74 unruptured intracranial aneurysms who underwent embolization with Guglielmi Detachable Coil (GDC) or surgical occlusion at our institution between April 1990 and December 2005. Surgical clipping was performed in 58 consecutive patients (16 men and 42 women) with 63 unruptured intracranial aneurysms, and endovascular coiling was performed in 10 consecutive patients (4 men and 6 women) with 11 unruptured intracranial aneurysms. There were no standard selection criteria, irrespective of whether the patient was treated with endovascular coil therapy or with neurosurgical clip occlusion. RESULTS: Out of 58 patients who underwent surgical treatment, 3 (5.2%) had fair outcome. Each of these 3 had risk factors for surgical intervention: calcification, wide neck, or thrombosed giant aneurysm. GDC embolization in 1 (10%) patient with an unruptured pericallosal artery aneurysm resulted in a fair outcome due to infarction. CONCLUSION: Management decisions in patients with unruptured intracranial aneurysms require accurate assessment of the risk factors (such as aneurysm size, location, presence of calcification and/or atheroma, and patient age).
Aneurysm ; Arteries ; Humans ; Intracranial Aneurysm ; Male ; Neck ; Patient Selection ; Plaque, Atherosclerotic ; Retrospective Studies ; Risk Factors ; Surgical Instruments