BACKGROUND: Ski injuries depend on many factors which involve the skier's skill, the skiing environment, and skier's equipment. The purpose of this study was to determine the factors associated with fractures by skiing accident. SUBJECT: We evaluated 566 patients with ski injuries who visited to the emergency post located in the YongPyong Ski Resorts from Nov. 1996 to Feb. 1997. Among the patients,379 patients had no fracture(group I) and 187 patients had fracture(group II). RESULT: There was no differences in mean age and sex ratio between two groups. Fractures of the lower extremities were more common than the upper extremities. Slipping was the most common injury mechanism. arming-up was done in 40% of group I and in 17% of group II. The fracture injuries were more common in the skier with intermediate(45%) skill than the beginner(29%) and the ones with advanced skill(12%). The slope with intermediate difficulty was the most frequent site of fracture accidents. The fracture group tended to choose the slope beyond their skiing ability. CONCLUSION: Our results suggest that fracture during skiing can be prevented if skiers do warming-up prior to skiing and choose slope appropriate to their skiing skill.
Emergencies ; Health Resorts ; Humans ; Lower Extremity ; Sex Ratio ; Skiing ; Upper Extremity

Intestinal microorganisms interact with various immune cells and are involved in gut homeostasis and immune regulation. Although many studies have discussed the roles of the microorganisms themselves, interest in the effector function of their metabolites is increasing. The metabolic processes of these molecules provide important clues to the existence and function of gut microbes. The interrelationship between metabolites and T lymphocytes in particular plays a significant role in adaptive immune functions. Our current review focuses on 3 groups of metabolites: short-chain fatty acids, bile acids metabolites, and polyamines. We collated the findings of several studies on the transformation and production of these metabolites by gut microbes and explained their immunological roles. Specifically, we summarized the reports on changes in mucosal immune homeostasis represented by the Tregs and Th17 cells balance. The relationship between specific metabolites and diseases was also analyzed through latest studies. Thus, this review highlights microbial metabolites as the hidden treasure having potential diagnostic markers and therapeutic targets through a comprehensive understanding of the gut-immune interaction.

BACKGROUND: There have been many efforts to augment blood flow during cardiopulmonary resuscitation. These efforts have focused on maximizing the effect of cardiac pump or thoracic pump alone. However, considering that the heart is the biggest blood reservoir and increase of intrathoracic pressure can generate blood flow, simultaneous exploitation of both mechanisms may have synergistic effect. We hypothesized that simultaneous chest constriction in addition to sternal compression by standard CPR may have additive hemodynamic effects by preventing deformation of the chest and increase of intrathoracic pressure. METHODS AND RESULTS: we built a new mechanical device to perform compression and thoracic constriction simultaneously. The device consists of two main elements. Piston in the center is to depress the sternum. Strap is to constrict the thorax circumferentially. Strap is attached to both sides of the piston. When the piston is pushed down, it depresses the sternum and pulls on the thoracic strap. To detemine sump width to produce optimal hemodynamic effect, we measured hemodynamic parameters with variable widths of sump in two dogs after induction of ventricular fibrillation. Result of the experiment showed that 10 cm wide strap was determined to be most effective. We also determined optimal depth of compression to produce maximal hemodynamic effect with animal experiments using two dogs. Animal experiments showed that the highest aortic pressure could be generated when the sternum was depressed to 5 cm. Cardiopulmonary resuscitation using a new device could generate higher systolic aortic pressure, coronary perfusion pressure and end-tidal carbon dioxide tension in comparison with standard cardiopulmonary resuscitation in a pilot animal Study Using two dogs. CONCLUSION: New cardiopulmonary resuscitation method using a mechanical device designed by us could perform sternal compression and simultaneous thoracic constriction, and generate better hemodynamic effects than standard cardiopulmonary resuscitation in pilot animal experiments.
Animal Experimentation ; Animals ; Arterial Pressure ; Carbon Dioxide ; Cardiopulmonary Resuscitation* ; Constriction ; Dogs ; Equipment Design ; Heart ; Hemodynamics ; Perfusion ; Sternum ; Thorax ; Ventricular Fibrillation

OBJECTIVE: To compare the slot-scan digital radiography (SSDR) of the lower extremity region and the computed radiography (CR) method with respect to the image quality and radiation exposure. MATERIALS AND METHODS: We enrolled 54 patients who underwent both the SSDR and CR of the lower extremities. The study evaluated and statistically compared the image quality of four features (outer cortex, inner cortex, trabeculae and intermuscular fat) at six different levels (pelvis, hip, femur, knee, tibia and ankle) between each method. The image quality was evaluated using a visibility scale, and the entrance skin dose was measured using a dosimeter at three different levels of a phantom (hip, knee, and ankle). RESULTS: The mean image visibility scale values for the SSDR method were significantly higher than for the CR method. The entrance skin dose for the SSDR method was 278 micro Gy at each level, compared to the entrance skin doses of the CR method, which were 3,410 micro Gy for the hip, 1,152 micro Gy for the knee, and 580 microGy for the ankle. CONCLUSION: Both the image quality and patient entrance skin dose data suggest that the SSDR method is superior to the CR method for the lower extremity musculoskeletal examination.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lower Extremity/*radiography ; Male ; Middle Aged ; Radiation Dosage ; *Radiographic Image Enhancement/methods ; *Tomography, X-Ray Computed/methods ; Young Adult

Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) that presents with abdominal pain, weight loss, and diarrhea. Although the etiology has not been fully elucidated, both environmental and genetic causes are known to be involved. In chronic inflammatory conditions such as IBD, B lymphocytes are chronically stimulated, and they induce monoclonal expansion of plasma cells, sometimes resulting in monoclonal gammopathy of undetermined significance. Immunomodulators that are commonly used to control inflammation, such as tumor necrosis factor-α (TNF-α) blockers could increase the possibility of hematologic malignancy. The pathogenesis of multiple myeloma in association with TNF-α inhibitor therapy is attributed to decreased apoptosis of plasma cell populations. Here, we describe a case of a 36-year-old male patient who was diagnosed with immunoglobulin A subtype smoldering multiple myeloma during the treatment for CD with infliximab and adalimumab. We report this case along with a review of the literature on cases of multiple myeloma that occurred in conjunction with CD.
Abdominal Pain ; Adalimumab ; Adult ; Apoptosis ; B-Lymphocytes ; Crohn Disease* ; Diarrhea ; Hematologic Neoplasms ; Humans ; Immunoglobulin A ; Immunologic Factors ; Inflammation ; Inflammatory Bowel Diseases ; Infliximab ; Male ; Monoclonal Gammopathy of Undetermined Significance ; Multiple Myeloma* ; Necrosis ; Plasma Cells ; Tumor Necrosis Factor-alpha ; Weight Loss

BACKGROUND: Celecoxib, a COX-2 specific inhibitor, has recently been used for the treatment of rheumatoid arthritis. However, the molecular and cellular mechanisms of celecoxib against RA inflammation remain to be defined. To elucidate the action mechanism of celecoxib on inflammatory cells, we investigated the effect of celecoxib on the production of two important mediators of inflammation, nitric oxide and PGE2 METHODS: RAW 264.7 cells stimulated with LPS were preincubated with various concentrations of celecoxib (from 10(-8) to 10(-5) M) and 10muM hydrocortisone, respectively. The production of NO and PGE2, the end products of iNOS and COX-2 genes, were estimated in culture supernatants by Greiss method and EIA, respectively. The expression of iNOS gene, COX-2 gene, NF-kappaB, and I-kappaB were determined by RT-PCR and western blot analysis. RESULTS: Celecoxib and hydrocortisone inhibited the production of NO and PGE2 in dose dependent manner, when RAW 264.7 cells were stimulated with LPS. The expression of iNOS was also down-regulated by celecoxib and hydrocortisone. Interestingly, COX-2 gene differentially expressed according to the dose of celecoxib, a decrease with lower dose (10(-8) M) but an increase with higher dose (10(-5) M). NF-kappaB binding activity was decreased by lower dose of celecoxib, whereas was not affected by higher dose of it. The expression of I-kappaB was suppressed by higher dose of celecoxib. CONCLUSION: The celecoxib strongly suppressed the production of NO and PGE2 in LPS-stimulated RAW264.7 cells. The decrease of NO seems to be linked to the inhibition of iNOS by celecoxib. The lower and higher dose of celecoxib differentially regulated the COX-2 expression and NF-kappaB activity
Arthritis, Rheumatoid ; Blotting, Western ; Celecoxib ; Cyclooxygenase 2* ; Dinoprostone* ; Hydrocortisone ; Inflammation ; Inflammation Mediators ; Macrophages* ; NF-kappa B ; Nitric Oxide*

Hepatocellular cell carcinoma (HCC) is one of the most common and malignant neoplasm in the world. Waldenstrom's macroglobulinemia (WM) is a rare B-lymphocyte neoplasia characterized by monoclonal production of IgM Igs and by a marrow containing a diffuse infiltrate of plasmocytoid lymphocytes. A 67-year-old man was admitted because of multiple site pain, especially right flank and posterior neck pain. Physical examination showed hepatomegaly. Laboratory findings were as follows; total protein 8.6 g/dL, albumin 3.1 g/dL with monoclomal protein(IgM-lamda). Hepatitis C virus(HCV) infection was detected by polymerase chain reaction(PCR). Computed tomography and celiac angiography disclosed HCC. Aspiration biopsy of the liver revealed HCC. Magnetic resonance imaging showed compression fracture and epidural mass in cervical spines. Bone marrow examination revealed normocellularity with an increase of lymphoplasmacytic series. He was diagnosed as having WM and HCC. HCC is frequently associated with other malignancies. As the site of the extrahepatic primary cancer, the stomach ranked first. WM is also known for its association with an increased incidence of a second neoplasm, most of which are less differentiated lymphomas. but an association with a non-lymphoreticular malignancy is quite rare. We report first case of synchronous HCC with bone metastasis and WM (IgM,lamdatype) in korean with chronic hepatitis C.
Aged ; Angiography ; B-Lymphocytes ; Biopsy, Needle ; Bone Marrow ; Bone Marrow Examination ; Carcinoma, Hepatocellular* ; Fractures, Compression ; Hepacivirus ; Hepatitis C ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Hepatomegaly ; Humans ; Immunoglobulin M ; Incidence ; Liver ; Lymphocytes ; Lymphoma ; Magnetic Resonance Imaging ; Neck Pain ; Neoplasm Metastasis ; Neoplasms, Second Primary ; Physical Examination ; Spine ; Stomach ; Waldenstrom Macroglobulinemia*

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. Frequent sites of extrahepatic metastasis are the lung, adrenal gland, bone, etc. But, cutaneous metastasis from HCC is rare event. Several cases of subcutaneous seeding after percutaneous transhepatic biopsy or aspiration of liver were reported, however, most of these cases had solitary nodular lesion which was located at the biopsy site. We experienced a case of multiple cutaneous metastasis on whole body from HCC which was not related to percutaneous transhepatic biopsy of liver in a 34-ear-ld male patient. Thus, we report a case of multiple cutaneous metastasis from HCC with brief review of related literature.
Adrenal Glands ; Biopsy ; Carcinoma, Hepatocellular* ; Humans ; Liver ; Lung ; Male ; Neoplasm Metastasis*

BACKGROUND: During the secondary survey of advanced cardiac life support (ACLS), differential diagnosis to seek the cause of cardiac arrest is an important step in patient who failed to restore spontaneous circulation after the primary survey and resuscitation. This study was to evaluate the role of transesophageal echocardiography (TEE) for assessing the cause of cardiac arrest during the secondary survey of ACLS. METHOD: We performed biplane TEE during cardiopulmonary resuscitation (CPR) in 52 consecutive patients (31 male, 21 female, mean age: 58 years old) with cardiac arrest who failed to restore spontaneous circulation after the primary survey and resuscitation attempt. Initial presenting ECG rhythm was ventricular fibrillation in 7, asystole in 25, and pulseless electrical activity in 20 patients. TEE was performed immediately if spontaneous circulation was not restored after the primary survey and resuscitation. Possible causes of cardiac arrest were detected in 23 patients (44%) by TEE. Positive findings were observed in 3 (43%) of 7 patients with ventricular fibrillation, 12 (48%) of 25 patients with asystole, and 8 (40%) of 20 patients with pulseless electrical activity. TEE findings were as followings : pericardial effusion in 10, aortic dissection in 5, occlusion of mitral orifice by a thrombus or a mass in 2, main pulmonary artery thrombus in 2, thrombotic occlusion of the prosthetic valve in 1, hypertrophic cardiomyopathy in 1, and aortic stenosis in 1. Interventions including pericardiocentesis (n=10) and emergency thoracotomy (n=1) were attempted during resuscitation. Spontaneous circulation was restored in 16 patients (31%). One patient was discharged alive. CONCLUSION: TEE is an useful diagnostic tool to identify the cause of cardiac arrest during the secondary survey of ACLS.
Advanced Cardiac Life Support* ; Aortic Valve Stenosis ; Cardiomyopathy, Hypertrophic ; Cardiopulmonary Resuscitation ; Diagnosis, Differential* ; Echocardiography, Transesophageal* ; Electrocardiography ; Emergencies ; Female ; Heart Arrest* ; Humans ; Male ; Pericardial Effusion ; Pericardiocentesis ; Pulmonary Artery ; Resuscitation ; Thoracotomy ; Thrombosis ; Ventricular Fibrillation

BACKGROUND/AIMS: A recent study reported that entecavir had inferior efficacy in nucleos(t)ide analogue (NA)-experienced chronic hepatitis B (CHB) patients compared to NA-naïve patients. We sought to compare the efficacy of tenofovir disoproxil fumarate (TDF) in NA-experienced and NA-naïve CHB patients. METHODS: We retrospectively enrolled 252 consecutive patients who had a serum hepatitis B virus (HBV) DNA level greater than 2,000 IU/mL at the initiation of TDF treatment and who received TDF for at least 6 months. Complete virologic suppression (CVS) was defined as undetectable serum HBV DNA. We generated a multivariate Cox proportional-hazard model to examine predictive factors that were independently associated with time to CVS. RESULTS: The mean age of patients was 48.2 years, and the cohort included 181 NA-naïve patients and 71 NA-experienced patients. The median duration of TDF treatment was 14.4 (interquartile range, 9.5-17.8) months. A total of 167 (92.3%) of 181 NA-naïve patients achieved CVS, and 60 (84.5%) of 71 NA-exposed patients achieved CVS. Forty-nine (89.1%) of 55 patients who previously took an NA aside from adefovir and 11 (68.8%) of 16 adefovir-experienced patients achieved CVS. In multivariable analysis, previous adefovir exposure significantly influenced time to CVS (hazard ratio, 0.37; 95% confidence interval, 0.19-0.72; P=0.003), after adjusting for HBeAg positivity, baseline HBV DNA level and cirrhosis. CONCLUSIONS: Tenofovir had inferior efficacy in adefovir-experienced CHB patients compared to NA-naïve patients. The response of patients with previous adefovir exposure to TDF monotherapy should be monitored closely.
Cohort Studies ; DNA ; Fibrosis ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Retrospective Studies ; Tenofovir*