BACKGROUND: The criteria established by Light et al in 1972 have been used widely for the differential diagnosis of the pleural effusions in transudates and exsudates. However, in recent years, several reports have agreed that these criteria misclassified an important number of effusions. For this reason, different parameters have been proposed for differentiation the transudates from exudates. Nevertheless, all these alternative parameters have not been better than the past criteria of Light et al. In response the usefulness of two parameters for differentiation pleural transudate from exudates were evaluated : pleural fluid cholinesterase level and pleural fluid to serum cholinesterase ratio. METHODS: A total of forty-three patient with know causes of the pleura effusion by diagnostic thoracentesis were studied. The following criteria for differentiating the pleural effusions in transudates and exsudates were analyzed : Light's criteria, the pleural fluid cholesterol level, the pleural fluid to serum cholesterol ratio. the pleural fluid cholinesterase level, and the pleural fluid to serum cholinesterase ratio. RESULTS: The conditions of forty-three patients were diagnosed. Ten were classified as having transudates and thirty-three as exudates. The percentage of effusions misclassified by each parameter was as follows : Light's criteria, 9.3% ; pleural fluid cholesterol, 2.3% ; pleural fluid to serum cholesterol ratio, 2.3% ; pleural fluid cholinesterase, 4.7% ; and pleural fluid to serum cholinesterase ratio, 2.3%. CONCLUSIONS: The pleural fluid to serum cholinesterase ratio is one of the accurate criteria for differentiating pleural transudates from exudates. If further studies confirm these results, the cholinesterase ratio could be used as the first step in the evaluation of pleural effusion and if evaluated together with the other criteria, the differentiation of pleural transudate from exsudates will become more accurate.
Cholesterol ; Cholinesterases* ; Diagnosis, Differential* ; Exudates and Transudates* ; Humans ; Pleura ; Pleural Effusion

No abstract available.
Membranes* ; Pregnancy* ; Rupture*

This research was carried out a to investigate the food habit and preference of parents'social and economic level with 681 children (145 of Kindergarten, 300 of Children, 236 of Adolescences) in Seoul and Gyeonggi area using questionnaires. The parents' income level divided into 2 groups, less than 4 million won and equal or greater than 4 million won. Most of the middle years were over-weighing but kindergarten and adolescences had standard weights. The majority of parents had Bachelor degrees, most of father were office workers, majority of mothers of kindergarten with parents' income level less than 4 million won were professional women and mothers of the rest of the groups were mostly house wives. The middle years with parents income level less than 4 million son were skipping meals most frequently, but other groups didn't show much differences in their eating habits. All age groups showed that they like meats the most and dislike vegetables the worst. All age groups also showed that they mostly eat out 1-2 times a week and the next was 3-4 times a week. All age groups preferred ice creams, fruits, juices and snacks for their desserts. The middle years with parents' income equal or greater than 4 million won also showed high preference on strawberry and chocolate flavored milk, burgers and pizzas. The food s that preferred to eat when dining out were Chinese foods (Ja-jang-myeon and sweet and sour pork) for kindergarten group, Korean foods (kalbi and bulgogi) for the middle years with parents' income level less than 4 million won, family restaurant food (steak and rib) for the middle years with parents' income level equal or greater than 4 million won and Korean foods (kalbi and bulgogi) for the adolescences. The preferred cooking methods were roast (fish and sea weeds) for the kindergarten, roasted meat for the middle years, Kimchi and bean paste pot stew for the adolescences with parents' income level less than 4 million won and roasted meats for the adolescences with parents' income level equal or greater than 4 million won. The results showed that the adolescences with higher parental income lever preferred meats.
Adolescent ; Asian Continental Ancestry Group ; Cacao ; Child ; Cooking ; Eating ; Fathers ; Female ; Food ; Food Habits ; Food Preferences ; Fragaria ; Fruit ; Humans ; Ice Cream ; Meals ; Meat ; Milk ; Mothers ; Parents ; Surveys and Questionnaires ; Restaurants ; Snacks ; Spouses ; Vegetables ; Weights and Measures

PURPOSE: Depression is common in patients with chronic renal failure on maintenance hemodialysis, though success rate of treatment is low. This study aimed to investigate the features and severity of the depressive symptoms and nutritional indices, and significant changes after antidepressant treatment. METHODS: The authors assessed 45 patients. Diagnosis of depression was made using DSM-IV-TR and the depressive symptoms were evaluated using Hamilton Rating Scale for Depression via semi- structured interview. Subjective global assessment, anthropometric measurements and nutritional indices such as Kt/V, nPCR were examined. Depressive patients were treated for 8 weeks with SSRI (citalopram), and all the variables were examined again after the treatment. RESULTS: 19 (42.2%) patients were diagnosed as depression. Nutritional status was not different between patients with depression and those without depression. Compared to non-depressed patients, depressed patients showed significantly higher depressed mood, guilty feeling, suicide idea, psychic and somatic anxiety, lower work and activities, psychomotor retardation, sleep disturbances, general somatic symptoms and hypochondriasis. After antidepressant treatment, depressed mood, guilty feeling, suicide idea, psychic anxiety, initial insomnia, middle insomnia, early awakening, work and activities and general somatic symptoms were improved significantly. TSF (p<0.05), handgrip strength (p<0.01) and hematocrit (p<0.05) were significantly increased. CONCLUSION: Antidepressant treatment is helpful not only for the improvement of depressive symptoms such as sleep and somatic symptoms but for the improvement of quality of life. Proper treatment should be more actively attempted for the hemodialytic patients with depression.
Anxiety ; Depression ; Hematocrit ; Humans ; Hypochondriasis ; Kidney Failure, Chronic ; Nutrition Assessment ; Nutritional Status ; Quality of Life ; Renal Dialysis ; Sleep Initiation and Maintenance Disorders ; Suicide ; Tosyl Compounds

Necrotizing fasciitis is an uncommon fatal soft-tissue infection that is rapid and very destructive. It destroys the connective tissue between the skin and muscle. The microbiological causes of necrotizing fasciitis include mixed aerobic and anaerobic bacteria and group A streptococcus. Various host factors predispose to necrotizing fasciitis. Particularly, patients with diabetes mellitus, peripheral vascular disease, immunosuppression, advanced age, and intravenous drug abuse are at risk. The diagnosis of necrotizing fasciitis is based on a single or combination of clinical indicators, laboratory and radiological studies, and surgical biopsy. The prognosis for necrotizing fasciitis depends on early recognition and determination of the extent of necrosis. Here, a case of necrotizing fasciitis of the abdomen secondary to a renal biopsy, a rare complication, is reported.
Abdomen ; Abdominal Wall ; Bacteria, Anaerobic ; Biopsy ; Connective Tissue ; Diabetes Mellitus ; Fasciitis ; Fasciitis, Necrotizing ; Humans ; Immunosuppression ; Muscles ; Necrosis ; Needles ; Nephrotic Syndrome ; Peripheral Vascular Diseases ; Prognosis ; Skin ; Streptococcus ; Substance Abuse, Intravenous

PURPOSE: In this study we compared the postoperative hole closure rate and average vision between a group who assumed a face-down position for a week using gas and a group who assumed a reading position after fluid air exchage (FAX), both after receiving internal limiting membrane (ILM) peeling during vitrectomy in patients with idiopathic macular hole. METHODS: This study included 25 eyes of patients diagnosed with idiopathic macular hole that underwent vitrectomy. Group I assumed a face-down position for a week after intraocular gas tamponade after FAX during vitrectomy and Group II assumed a reading position for 3 days after only FAX. The hole closure rate and the best-corrected visual acuity (BCVA) were compared between the 2 groups 6 months postoperatively. RESULTS: The preoperative mean macular hole size was 456.2 +/- 164.1 microm in Group I and 411.2 +/- 105.7 microm in Group II and the differences between the 2 groups were not statistically significant (p = 0.647). At 6 months after surgery, the macular hole closure rate was 93% in Group I and 100% in Group II (p = 0.571) and the BCVA (log MAR) was 0.82 +/- 0.29 preoperatively and 0.92 +/- 0.35 postoperatively in Group I and 0.71 +/- 0.39 and 0.97 +/- 0.33 in Group II, respectively. The differences between the 2 groups (p = 0.09, p = 0.058) were not statistically significant (p = 0.809, p = 0.267). CONCLUSIONS: There was no significant differences in the macular hole closure rate and BCVA improvement after 6 months in patients with idiopathic macular hole who had FAX during vitrectomy and maintained only a reading position for 3 days compared with those with gas tamponade and who maintained a face-down position for a week. This surgical method is considered helpful for easing discomfort caused by a face-down position after the macular hole surgery.
Humans ; Membranes ; Retinal Perforations* ; Visual Acuity ; Vitrectomy

PURPOSE: Bone morphogenetic protein (BMP) is a potent differentiating agent for cells of the osteoblastic lineage. It has been used in the oral cavity under a variety of indications and with different carriers. However, the optimal carrier for each indication is not known. This study evaluated the bone regenerative effect of rhBMP-2 delivered with different carrier systems. MATERIALS AND METHODS: 8 mm critical-sized rat calvarial defects were used in 60 male Sprague-Dawley rats. The animals were divided into 6 groups containing 10 animals each. Two groups were controls that had no treatment and absorbable collagen membrane only. 4 groups were experimentals that contained rhBMP-2 only and applied with absorbable collagen sponge(Collatape(R)), MBCP(R), Bio-Oss(R) each. The histological and histometric parameters were used to evaluate the defects after 2- or 8-week healing period. The shape and total augmented area were stable in all groups over the healing time. RESULTS: New bone formation was significantly greater in the rhBMP-2 with carrier group than control group. rhBMP-2/ACS was the highest in bone density but gained less new bone area than rhBMP-2/MBCP(R) and rhBMP-2/Bio-Oss(R). The bone density after 8 weeks was greater than that after 2 weeks in all groups. However, rhBMP-2 alone failed to show the statistically significant difference in new bone area and bone density compared to control group. Also MBCP(R) and Bio-Oss(R) particles remained after 8 weeks healing period. CONCLUSION: These results suggest that rhBMP-2 with carrier system is an excellent inductive agent for bone formation and we can use it as the predictable bone tissue engieering technique. Future study will likely focus on the kinetics of BMP release and development of carriers that is ideal for it.
Animals ; Bone and Bones ; Bone Density ; Bone Morphogenetic Protein 2 ; Bone Morphogenetic Proteins ; Bone Regeneration ; Collagen ; Humans ; Kinetics ; Male ; Membranes ; Mouth ; Osteoblasts ; Osteogenesis ; Rats ; Rats, Sprague-Dawley ; Recombinant Proteins ; Transforming Growth Factor beta

PURPOSE: To report a case of Roth spots, panuveitis, and infectious mononucleosis in a healthy adult. CASE SUMMARY: An immunocompetent 30-year-old male visited our clinic complaining of reduced visual acuity and a floating sense in both eyes of 2 days. He had experienced flu-like symptoms including fever, sore throat, myalgia, and malaise for 10 days before visual acuity decreased. His best-corrected visual acuity was 20/25 in both eyes and inflammatory cells were found in both the anterior chambers and the vitreous. Funduscopy revealed multiple retinal hemorrhages and Roth spots in both eyes. We prescribed topical steroid eye drops. A peripheral blood test revealed mild leukocytosis with lymphocytosis (60%) consisted of atypical lymphocyte (7%). Serologic examinations were positive for cytomegalovirus (CMV) immunoglobulin M (IgM) Ab and Epstein-Barr virus IgM Ab. A polymerase chain reaction for blood CMV was positive. The presumptive clinical diagnosis was Roth spots and panuveitis associated with infectious mononucleosis. Three weeks later, no inflammatory cells were apparent in the anterior chamber or vitreous. Best-corrected visual acuity had recovered to 20/20 in both eyes, and the retinal hemorrhage had completely disappeared. CONCLUSIONS: Roth spots and panuveitis can be present in patients with infectious mononucleosis, which should thus be included in the differential diagnosis of Roth spots.
Adult ; Anterior Chamber ; Cytomegalovirus ; Diagnosis ; Diagnosis, Differential ; Fever ; Hematologic Tests ; Herpesvirus 4, Human ; Humans ; Immunoglobulin M ; Infectious Mononucleosis ; Leukocytosis ; Lymphocytes ; Lymphocytosis ; Male ; Myalgia ; Ophthalmic Solutions ; Panuveitis ; Pharyngitis ; Polymerase Chain Reaction ; Retinal Hemorrhage ; Uveitis ; Visual Acuity

Iatrogenic vertebro-vertebral arteriovenous fistula (AVF) is an uncommon complication resulting from various procedures such as central venous catheter insertion. The incidence may be underestimated since the diagnosis is not easy because of its rarity. A central venous catheterization via the internal jugular vein was attempted in a 43-year-old female who presented for intracranial aneurysmal clipping under general anesthesia. Inadvertent arterial puncture was recognized as pulsatile arterial blood flow through the needle. The needle was removed and local compression was applied to the puncture site. The catheter was inserted via the right femoral vein. After surgery, the patient recovered from anesthesia without any complications. On postoperative day 5, thrill and bruit on the right side of the neck were noted on physical examination. Angiography confirmed vertebro-vertebral AVF, which was successfully obliterated with a stent 3 months later.
Adult ; Anesthesia ; Anesthesia, General ; Angiography ; Arteriovenous Fistula* ; Catheterization* ; Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Diagnosis ; Female ; Femoral Vein ; Humans ; Incidence ; Intracranial Aneurysm ; Jugular Veins* ; Neck ; Needles ; Physical Examination ; Punctures ; Stents

Dieulafoy's lesions are often unrecognized cause of obscure, massive gastrointestinal bleeding, reported to be 0.3~1.5% of cases of major gastrointestinal bleeding. It is characterized by severe bleeding from rupture of an exposed submucosal artery. Dieulafoy's lesion is usually occured in the lesser curvature of the stomach within 6 cm of the gastroesophageal junction. Similar lesions have also been described in the esophagus, duodenum, small intestine, colon, and rectum. The diagnosis is made by endoscopy, angiography, laparoscopy, or laparotomy. Endoscopy showed protruding and eroded artery with pulsatile bleeding or adherent thrombus. Currently, various therapeutic options are available to the endoscopist for the treatment of Dieulafoy's lesions. Therapeutic endoscopy should now become first-line therapy for Dieulafoy's lesions. We experienced a rare case of bleeding from the duodenal Dieulafoy's lesion. Endoscopic hemoclipping was performed successfully. We report this case with a review of the literature.
Angiography ; Arteries ; Colon ; Cytochrome P-450 CYP1A1 ; Diagnosis ; Duodenum ; Endoscopy ; Esophagogastric Junction ; Esophagus ; Hemorrhage* ; Intestine, Small ; Laparoscopy ; Laparotomy ; Rectum ; Rupture ; Stomach ; Thrombosis