OBJECTIVE: It has been known that the posterior pedicle screw fixation provides good mechanical stability in unstable burst fracture. But, posterior fixation without anterior column support may not be adequate to withstand the axial load and to keep the corrected kyphotic angle. We present results of one stage fixation by posterior approach in unstable burst fracture. METHODS: Nine patients with unstable burst fracture were treated with posterior fixation and intervertebral fusion using titanium mesh cages and pedicle screws. The canal decompression was achieved by laminectomy and partial pediculectomy through the posterior approach. In all cases, the short segment fixation and anterior column support with cage were performed on the one stage operation. RESULTS: Of nine patients, seven was satisfied with excellent clinical results except two cases of the Frankel's grade A. All patients had good stabilization of spinal column and enough decompression without any neurological complications. It was possible to maintain the corrected kyphotic angle with the circumferential stabilization(three column fixation). CONCLUSION: The anterior and posterior column fixation through the posterior approach provides good stability and decompression in the patients with unstable burst fracture.
Decompression* ; Humans ; Laminectomy ; Spine* ; Titanium

PURPOSE:CCL17, CCL27 and CCL18 have attracted significant interest with regard to understanding the mechanisms of T cell trafficking. We tested whether levels of serum CCL17, CCL27 and CCL18 would be useful markers for atopic dermatitis (AD) in children. METHODS:Serum concentrations of CCL17, CCL27, CCL18, total IgE and eosinophil cationic protein (ECP) in AD (n=40) and healthy control (n=40) children were compared. The correlation between the studied parameters and activity of AD was investigated. The severity of AD was assessed according to the SCORAD (scoring atopic dermatitis) index. The serum concentrations of CCL17, CCL27 and CCL18 were measured by means of ELISA. RESULTS:The levels of all studied parameters were significantly higher in children with AD than those of control subjects. A positive correlation was found between the levels of CCL17, CCL18 and CCL27 and the SCORAD index in AD children (P<0.05, P<0.001 and P<0.001) The correlation of CCL17 and CCL27 concentrations with severity appears to be age-dependent because a stronger correlation was found in AD children over the age of 2 years than those with younger than 2 years of age. A weaker correlation in AD children younger than 2 years may be attributed to higher concentrations of these chemokines because higher concentrations of these chemokines were detected in control subjects younger than 2 years (CCL17=205+/-281 pg/mL, CCL27=999+/-783 pg/mL) than those of older than 2 years.(CCL17=49+/-54 pg/mL; P= 0.012, CCL27=630+/-820 pg/mL; P=0.041, respectively) CONCLUSION:Our findings suggest that levels of serum CCL17, CCL27 and CCL18 can be used as useful markers for the severity of AD.
Chemokines ; Child* ; Dermatitis, Atopic* ; Enzyme-Linked Immunosorbent Assay ; Eosinophil Cationic Protein ; Humans ; Immunoglobulin E

No abstract available.
Humans ; Infant* ; Infant, Newborn ; Infant, Premature*

We report a case of primary mucosa-associated lymphoid tissue (MALT) lymphoma in the esophagus that manifested as a large submucosal tumor (SMT). Primary esophageal lymphoma is very rare, occurring in less than 1% of all patients with gastrointestinal lymphoma. Only a few cases of MALT lymphoma in the esophagus have been reported in the English literature. A 53-year-old man was referred to Dongguk University Ilsan Hospital (Goyang, Korea) in July 2012 for further evaluation and treatment of an esophageal SMT. Endoscopy showed a cylindrically elongated submucosal mass with normal overlying mucosa in the mid esophagus, 25-30 cm from the incisor teeth. He underwent surgery to confirm the diagnosis. Pathologic findings showed diffuse small atypical lymphoid cells which were stained with Bcl-2, CD20, but not with CD3, CD5, CD23, Bcl-6, or cyclin D1. These cells showed a positive monoclonal band for immunoglobulin heavy chain gene rearrangement. Based on the pathological, immunohistochemical, and molecular biological features, the esophageal mass was diagnosed as extranodal marginal zone B-cell lymphoma of the MALT type.
Antigens, CD20/metabolism ; Bone Marrow/pathology ; Esophageal Neoplasms/*diagnosis/pathology/surgery ; Gastroscopy ; Humans ; Immunohistochemistry ; Lymphoma, B-Cell, Marginal Zone/*diagnosis/pathology/surgery ; Male ; Middle Aged ; Mucous Membrane/pathology ; Proto-Oncogene Proteins c-bcl-2/metabolism ; Tomography, X-Ray Computed

BACKGROUND: The prognosis of patients admitted to intensive care unit (ICU) after cardiopulmonary resuscitation (CPR) is poor. Although the number of these patients is increasing as a consequence of emergency medical service improvements, we had no information conceiving the survival rates of patients admitted to ICU after CPR in Korea. The aim of this study was to determine the outcome of these patients. METHODS: We retrospectively evaluated all patients admitted to an ICU after CPR at an emergency room of a teaching hospital during the 24 month period from July, 2002 to July, 2004. The demographic and clinical information of each patient were recorded. These included primary diagnosis, total resuscitation time, APACHE II score (acute physiology and chronic health evaluation II score) at admission to ICU, ICU days, and hospital days. We analyzed all variables in the database and compared the data of patients who died in hospital with that of those who were discharged. RESULTS: Thirty-seven patients were admitted to the ICU after CPR in the emergency room, and 14 were discharged alive. APACHE II scores were significantly lower and Glasgow coma scales were significantly higher in survivors. CONCLUSIONS: 38% of patients who admitted to ICU after CPR in the emergency room were discharged from hospital alive. We evaluated that the severity scores of patients who receive CPR before ICU admission are important predictors of survival.
APACHE ; Cardiopulmonary Resuscitation* ; Coma ; Diagnosis ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Korea ; Physiology ; Prognosis* ; Resuscitation ; Retrospective Studies ; Survival Rate ; Survivors ; Weights and Measures

Posttransplant lymphoproliferative disorder (PTLD) is a serious complication of organ transplantation. PTLD is the disorder arising from the combined effects of Epstein-Barr virus associated lymphoid proliferation with the disruption of the normal immune control by the cytotoxic T cells. The treatment for PTLD is one of the most controversial topics in solid organ transplantation. It is well known that the initial management of PTLD is a reduction of immunosuppression. Early diagnosis and the early reduction in immunosuppression are essential even for monomorphic lymphoma. We report here on a case of the complete resolution of PTLD (diffuse large B cell lymphoma) which occurred after a drastic reduction of immunosuppression in a renal transplant recipient.
Adult ; Graft Rejection/*drug therapy ; Human ; Immunosuppressive Agents/*administration & dosage ; *Kidney Transplantation ; Korea ; Lymphoma, Large-Cell, Diffuse/*drug therapy/radiography/radionuclid imaging ; Male ; Remission Induction ; Tomography, Emission-Computed ; Tomography, X-Ray Computed

Pulmonary tuberculosis is still endemic in Korea, but esophageal tuberculosis, especially primary esophageal tuberculosis, is very rarely seen. A 76-year-old male is presented dysphagia. The clinical presentation, barium swallow study, and chest CT were suggestive of carcinoma of the esophagus. Findings that can suggest the diagnosis are enlarged lymph nodes, ulceration, and luminal narrowing. The major differential diagnosis was primary esophageal tuberculosis. This was not excluded on biopsy obtained at endoscopy. Operation was done for severe dysphagia and exclusion of malignancy. The patient was finally diagnosed as primary esophageal tuberculosis.
Aged ; Barium ; Biopsy ; Deglutition Disorders ; Diagnosis ; Diagnosis, Differential ; Endoscopy ; Esophagus ; Humans ; Korea ; Lymph Nodes ; Male ; Phenobarbital ; Tomography, X-Ray Computed ; Tuberculosis* ; Tuberculosis, Pulmonary ; Ulcer

PURPOSE: The severity of a stroke cannot be described by widely used prehospital stroke scales. We investigated the usefulness of the Kurashiki Prehospital Stroke Scale (KPSS) for assessing the severity of stroke, compared to the National Institutes of Health Stroke Scale (NIHSS), in candidate patients for intravenous or intra-arterial thrombolysis who arrived at the hospital within 6 hours of symptom onset. MATERIALS AND METHODS: We retrospectively analyzed a prospective registry database of consecutive patients included in the Emergency Stroke Therapy program. In the emergency department, the KPSS was assessed by emergency medical technicians. A cutoff KPSS score was estimated for candidates of thrombolysis by comparing KPSS and NIHSS scores, as well as for patients who actually received thrombolytic therapy. Clinical outcomes were compared between patients around the estimated cut-off. The independent predictors of outcomes were determined using multivariate logistic regression analysis. RESULTS: Excellent correlations were demonstrated between KPSS and NIHSS within 6 hours (R=0.869) and 3 hours (R=0.879) of hospital admission. The optimal threshold value was a score of 3 on the KPSS in patients within 3 hours and 6 hours by Youden's methods. Significant associations with a KPSS score > or =3 were revealed for actual intravenous administration of tissue plasminogen activator (IV-tPA) usage [odds ratio (OR) 125.598; 95% confidence interval (CI) 16.443-959.368, p<0.0001] and actual IV-tPA or intra-arterial urokinase (IA-UK) usage (OR 58.733; 95% CI 17.272-199.721, p<0.0001). CONCLUSION: The KPSS is an effective prehospital stroke scale for identifying candidates for IV-tPA and IA-UK, as indicated by excellent correlation with the NIHSS, in the assessment of stroke severity in acute ischemic stroke.
Administration, Intravenous ; Confidence Intervals ; Emergencies ; Emergency Medical Services ; Emergency Medical Technicians ; Emergency Service, Hospital ; Humans ; Logistic Models ; Methods ; National Institutes of Health (U.S.) ; Prospective Studies ; Retrospective Studies ; Stroke* ; Thrombolytic Therapy ; Tissue Plasminogen Activator ; Urokinase-Type Plasminogen Activator ; Weights and Measures

Rotor syndrome is a rare benign familial disorder characterized by chronic, fluctuating, nonhemolytic and predominantly conjugated hyperbilirubinemia with normal liver tissue. In contrast to Dubin-Johnson syndrome, there is no liver hyperpigmentation in Rotor syndrome, and BSP clearance does not show a secondary retention peak. The serum bilirubin in patients with Gilbert's syndrome is almost all unconjugated in contrast to Rotor syndrome. A 29-year-old male was admitted due to persistent jaundice. Physical examination revealed icteric sclera without hepatosplenomegaly. Laboratory findings showed increased serum bilirubin with indirect bilirubin predominance. Urinary excretion of total coproporphyrin was markedly elevated, and coproporphyrin I was 66% of total urinary coproporphyrin. Oral cholecystography showed well visualized the gallbladder, but 99mTc-DISIDA scan showed markedly decreased hepatic uptake and poor visualization of the gallbladder and biliary tract. Histology of the liver showed no abnormal finding. We report the case with the review of literature.
Adult ; Biliary Tract ; Bilirubin ; Cholecystography ; Gallbladder ; Gilbert Disease ; Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Hereditary* ; Hyperpigmentation ; Jaundice ; Jaundice, Chronic Idiopathic ; Liver ; Lymphoma ; Male ; Physical Examination ; Sclera ; Skin Neoplasms ; Survival Rate ; Technetium Tc 99m Disofenin

PURPOSE: Several scoring systems and biochemical markers have been proposed for the early prediction of acute pancreatitis. The Harmless Acute Pancreatitis Score (HAPS) is a novel scoring system to recognize acute pancreatitis patients with a non-severe clinical course. This study was conducted to evaluate the usefulness of HAPS to predict good prognosis of acute pancreatitis in the emergency department (ED). METHODS: We retrospectively reviewed the electronic medical records of patients who presented to the ED with acute pancreatitis from January 2010 to December 2011. The parameters constituting HAPS, including physical signs of peritonitis (rebound abdominal tenderness), hematocrit and serum creatinine levels were abstracted. Severe clinical course was defined as having one of the following: mortality while in hospital, necrosis as assessed by contrast CT, need for artificial ventilation or dialysis. The diagnostic performance of HAPS for predicting harmless course was evaluated by sensitivity, specificity, and predictive values. RESULTS: During the study period, 144 patients with a final diagnosis of acute pancreatitis were included. Among these 144 patients, 79 were predicted to have a non-severe course by HAPS, of whom 4 patients progressed to severe pancreatitis. The sensitivity, specificity, positive and negative predictive values were 61.5%, 81.8%, 94.9% and 27.7%, respectively. CONCLUSION: This study suggests that HAPS is simple and can be assessed within a few hours in the ED. HAPS also showed a high positive predictive value that predicts a non-severe course of acute pancreatitis. Therefore, HAPS may be used as a scoring system to identify non-severe acute pancreatitis in the ED.
Biomarkers ; Creatinine ; Dialysis ; Electronic Health Records ; Emergencies ; Emergency Service, Hospital ; Hematocrit ; Humans ; Necrosis ; Pancreatitis ; Peritonitis ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; Ventilation