OBJECTIVES: The standard metrics used to monitor the progression of acute kidney injury (AKI) include markers such as serum creatinine, blood urea nitrogen, and estimated glomerular filtration rate (eGFR). Moreover, neutrophil gelatinase-associated lipocalin (NGAL) expression has been reported to modulate oxidative stress. METHODS: We aimed to evaluate the usefulness of serum NGAL levels for monitoring renal function after radical nephrectomy (RN). We prospectively collected data from 30 patients who underwent RN. We analyzed serum NGAL and creatinine at 6 time points: preoperative day 1, right after surgery, 6 hours after surgery, postoperative day (POD) 1, POD 3, and POD 5. We compared these measurements according to the eGFR values (classified as chronic kidney disease stage III; CKD III or not) using data obtained 3 months after surgery. RESULTS: The mean age was 65.5 years (range, 45–77 years), and the male-to-female ratio was 2:1. At the last follow-up examination, there were 12 patients (40%) with CKD III. Using receiver operating characteristic analysis, we found that serum creatinine on POD 5 (area under the curve [AUC], 0.887; P= 0.000) and NGAL at 6 hours after LRN (AUC, 0.743, P= 0.026) were significant predictors of CKD III. The development of CKD III after LRN was associated with the serum creatinine level on POD 5 and the NGAL at 6 hours after surgery. CONCLUSIONS: Compared to serum creatinine, serum NGAL enabled earlier prediction of postoperative CKD III. Therefore, serum NGAL measured 6 hours after surgery could be a useful marker for managing patients after RN.
Acute Kidney Injury ; Blood Urea Nitrogen ; Creatinine ; Early Diagnosis* ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Kidney ; Lipocalins* ; Nephrectomy* ; Neutrophils* ; Oxidative Stress ; Prospective Studies ; Renal Insufficiency, Chronic ; ROC Curve

OBJECTIVE: The adolescent presentation of tethered cord syndrome (TCS) is well-recognized, but continues to pose significant diagnostic and management controversies. The authors conducted a retrospective study of clinical outcomes after surgical intervention in 24 school-aged children, adolescents, and young adults with TCS. METHODS: All 83 patients with a lipomyelomeningocele (LMMC) underwent untethering surgery for caudal cord tethering between 1987 and 2007. The clinical charts and follow-up data were reviewed. Of these patients, 24 school-aged children, adolescents, and young adults with TCS were studied with respect to the clinical, radiologic, pathologic features, and surgical outcomes. RESULTS: Untethering procedures were performed in 24 patients (age range, 7-25 years) for TCS of various origins (lipoma, lipomyelomeningocele, and tight filum terminale). Specific circumstances involving additional tugging of the already tight conus, and direct trauma to the back precipitated the onset of symptom in 50% of the patients. Diffuse and non-dermatomal leg pain, often referred to the anorectal region, was the most common presenting symptom. Progressive sensorimotor deficits in the lower extremities, as well as bladder and bowel dysfunction, were also common findings, but progressive foot and spinal deformities were noted less frequently. The most common tethered lesions were intradural lipomas, thickened filum and fibrous band adhesions into the placode sac. The surgical outcome was gratifying in relation to pain and motor weakness, but disappointing with respect to resolution of bowel and bladder dysfunction. Of the 24 patients with TCS, pre-operative deficits improved after surgery in 14 (58.3%), remained stable in 8 (33.4%), and worsened in 2 (8.3%). CONCLUSION: The pathologic lesions of tethered cord syndrome in school-aged children, adolescents, and young adults, are mostly intradural lipomas and tight filum. It is suggested that the degree of cord traction results in neurologic dysfunction in late life due to abnormal tension, aggravated by trauma or repeated tugging of the conus during exercise. Early diagnosis and adequate surgical release might be the keys to the successful outcome in school-aged children, adolescents, and young adults with TCS.
Adolescent ; Child ; Congenital Abnormalities ; Conus Snail ; Early Diagnosis ; Follow-Up Studies ; Foot ; Humans ; Leg ; Lipoma ; Lower Extremity ; Meningomyelocele ; Neural Tube Defects ; Neurologic Manifestations ; Retrospective Studies ; Traction ; Urinary Bladder ; Young Adult

PURPOSE: This was a methodological research to develop an instrument to assess the emotional response of family members of physically restrained patients. METHODS: A primary instrument with 68 questions was developed based on literature review and semi-structured interviews with family members. A group of experts revised individual questions and removed 4 irrelevant questions. This secondary instrument, then, was tested with 199 family members of physically restrained patients in intensive care units of a university hospital. The validity and reliability of the instrument were tested by factor analysis. RESULTS: After item analysis, 3 questions with a correlation coefficient under .30 were discarded and the questions with a factor loading under .45 on Varimax Rotation were also removed. After factor analysis on the final 37 questions, 7 factors were identified; avoidance, shock, helplessness, grudge, depression, anxiousness, and acceptance. The total variance explained was 55.63%. The reliability of this instrument was 0.93 of Cronbach's alpha. CONCLUSION: This instrument was statistically reliable and valid to measure family's emotional response to physical restraints of the patients. This instrument can be useful in assessing the effects of nursing interventions for family members of restrained patients.
Adolescent ; Adult ; Child ; Emotions ; Family/*psychology ; Female ; Humans ; Intensive Care Units ; Interviews as Topic ; Male ; Middle Aged ; *Program Development ; Questionnaires ; Reproducibility of Results ; *Restraint, Physical

PURPOSE: We evaluated the impact of positive surgical margins as an independent predictive factor for biochemical recurrence after radical retropubic prostatectomy. MATERIALS AND METHODS: Data on 122 patients who underwent radical prostatectomy during the last eight years were retrospectively analyzed with respect to the incidence, number, and sites of positive surgical margins, as well as biochemical recurrence. Biochemical recurrence was defined as a serum prostate-specific antigen (PSA) level of 0.2ng/ml or greater and rising on at least two postoperative measurements. The mean follow-up was 33.4 months (6.0-104.0). RESULTS: Surgical margins were positive in 51 patients (41.8%), of whom 35 (68.6%) and 16 (31.4%) had positive margins of 1 and more than 1, respectively. The most frequent site of positive margin was the apex/ urethra, and the other frequent sites were bladder neck, posterior, anterior, and lateral portion in order of frequency. The overall biochemical recurrence rate was 35.2% (43 patients). The time to recurrence was significantly shorter in patients with positive margins than in patients with negative margins (p<0.05). Five-year recurrence-free probability was 29.5% and 74.7% in the group with positive margins and in the group with negative margins, respectively. However, the number of positive margins did not seem to have a significant influence on disease recurrence (p>0.05). We could not identify the site that showed a significant influence on biochemical recurrence compared to other sites (p>0.05). Finally, the multivariate Cox proportional hazards analyses revealed that the presence of positive margins was independently associated with time to recurrence(p<0.05). CONCLUSIONS: Our data indicate that the surgical margin status is an independent predictor of biochemical recurrence. However, longer follow-ups and a larger sample size are necessary to understand the influence of positive margins on survival. In addition, improvement in surgical technique, which can avoid positive margins, is required.
Follow-Up Studies ; Humans ; Incidence ; Neck ; Prostate-Specific Antigen ; Prostatectomy* ; Recurrence* ; Retrospective Studies ; Sample Size ; Urethra ; Urinary Bladder

Background and Objectives: The purpose of this study is to evaluate value of diagnostic tool for vocal cord palsy utilizing artificial intelligence without laryngoscopeMaterials and Method A dataset consisting of recordings from patients with unilateral vocal cord paralysis (n=54) as well as normal individuals (n=163). The dataset included prolonged pronunciations of the vowels /ah/, /u/, /i/, and vocal cord data from paralyzed patients. Various acoustic parameters such as Mel-frequency cepstral coefficients, jitter, shimmer, harmonics-to-noise ratio, and fundamental frequency statistics were analyzed. The classification of vocal cord paralysis encompassed paralysis status, paralysis degree, and paralysis location. The deep learning model employed the leave-one-out method, and the feature set with the highest performance was selected using the following methods. Results: Vocal Cord Paralysis Classifier: The classifier accurately distinguished normal voice from vocal cord paralysis, achieving an accuracy and F1 score of 1.0. Paralysis Location Classifier: The classifier accurately differentiated between median and paramedian vocal cord paralysis, achieving an accuracy and micro F1 score of 1.0. Breathiness Degree Classifier: The classifier achieved an accuracy of 0.795 and a mean absolute error of 0.2857 in distinguishing different degrees of breathiness. Conclusion Although the small sample size raises concerns of potential overfitting, this preliminary study highlights distinctive acoustic features in cases of unilateral vocal fold paralysis compared to those of normal individuals. These findings suggest the feasibility of determining the presence, degree, and location of paralysis through the utilization of acoustic parameters. Further research is warranted to validate and expand upon these results.

The sparsity of publication concerning CT findings of tuberculous arthritis prompted authors to retrospectively evaluate 12 patients with tuberculous arthritis for characteristic CT findings. In each patient, the diagnosis of tuberculous arthritis was confirmed by surgery or biopsy. The CT examinations were evaluated by two radiologists retrospectively. Involved joints were the hip joint in seven patients, the sacroiliac joint in three parients, and the shoulder and ankle joint in one patients each. CT features included subchondral bony erosion(12 patients), soft tissue mass in the joint space(nine), widenining of the joint space(eight), ipsilateral muscle atrophy(eight), thickening of the joint capsule(seven), intra-articular effusion(six), soft tissue abscess(five),and bony sclerosis(four). In seven patients with the duration of symptoms less than 1 year, thickening of joint capsule and intra-articular effusion were the predominent findings, while bony sclerosis, gross bone destruction, and soft tissue mass in joint space were seen in five patients with the duration of symptoms longer than 1 year. Our results indicate that CT is useful in the diagnosis of tuberculous arthritis by demonstrating characteristic pathologic changes of the joint space, soft tissue abnormality and bony involvement.
Ankle Joint ; Arthritis* ; Biopsy ; Diagnosis ; Hip Joint ; Humans ; Joint Capsule ; Joints ; Publications ; Retrospective Studies ; Sacroiliac Joint ; Sclerosis ; Shoulder

BACKGROUND: Systematic care is not well provided in patients with terminal cancer and their families in Korea. Unnecessary hospitalization, multiple emergency room visits for controlling acute symptoms and the use of unqualified alternative care services are typical health care utilization patterns in such patients. We operated home-based hospice-palliative care services to help these patients and their families at a university-based family practice setting. Our experience is presented for the development of care model of hospice-palliative care services. METHODS: We investigated the demographic characteristics, the clinical findings and the utilization of medical care services of 72 terminally ill cancer patients before and after enrollment to hospice-palliative care unit from April 25, 2003 to April 21, 2005. RESULTS: The frequency of emergency room visits and the number of hospitalizations were decreased by Wicoxon Signed Ranks Test after the enrollment to home-based hospice-palliative care service unit. The duration of emergency room visits decreased from 7.7 hours to 0.3 hours and the duration of hospitalization decreased from 6.5 days to 0.0 days in median. The cost per emergency room visits decreased from 268,801 won to 153,816 won and the cost per hospitalization decreased from 285,491 won to 106,294 won in median. CONCLUSION: Home-based hospice-palliative care services can be an efficient and effective model for the care of terminally ill cancer patients at a low cost.
Delivery of Health Care ; Emergency Service, Hospital ; Family Practice* ; Hospitalization ; Humans ; Korea ; Palliative Care ; Patient Care Team ; Terminally Ill

BACKGROUND: Lichen planus is a chronic papulosquamous disease characterized by various clinical manifestations of the skin, mucosa, hair, and nails. Various drugs or physical treatments for lichen planus have been proposed, but the efficacies are often disappointing and controversial. Linear lichen planus is a rare variant of lichen planus, which accounts for 0.2~0.6% of all patients with lichen planus. Systemic corticosteroids remain the most widely used treatment for lichen planus. However, there have been no clinical studies on the effectiveness of this therapy on linear lichen planus despite the fact that linear lichen planus usually lasts for more than 1 year and occasionally results in cosmetic problems. OBJECTIVE: This study evaluated the efficacy and safety of oral methylprednisolone therapy for linear lichen planus. METHODS: Retrospective study was performed by reviewing the medical records and clinical photographs of 12 linear lichen planus patients treated with oral methylprednisolone. The analyses of treatment response to oral methylprednisolone therapy, adverse effects, and recurrence were performed. RESULTS: All the 12 patients who completed the oral methylprednisolone therapy achieved complete response. Most patients showed a marked improvement 1 to 2 weeks after starting oral methylprednisolone therapy. Three of the 12 patients showed recurrence at 9 to 14 weeks after cessation of the treatment. Oral methylprednisolone therapy was generally well-tolerated and no serious adverse effects were observed. CONCLUSION: Oral methylprednisolone therapy is an efficacious, safe, and tolerable treatment modality for linear lichen planus.
Adrenal Cortex Hormones ; Cosmetics ; Hair ; Humans ; Lichen Planus ; Lichens ; Medical Records ; Methylprednisolone ; Mucous Membrane ; Nails ; Recurrence ; Retrospective Studies ; Skin

BACKGROUND: Confluent and reticulated papillomatosis (CRP) is a rare cutaneous disorder, characterized by persistent, scaling brown papules, patches, and plaques located on the trunk, neck, axillae, and shoulders. Many different treatments with variable success have been attempted, and oral minocycline treatment is effective in most patients with CRP. There were a few case reports of CRP responding to topical retinoid, but no clinical studies on the efficacy of the topical retinoid treatment for CRP have been reported. OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of the topical tretinoin treatment for CRP. METHODS: A retrospective study was performed based on the medical records and clinical photographs of patients with CRP treated with 0.025% tretinoin cream. RESULTS: Nine patients (4 men and 5 women) were enrolled in the study. The mean age of the patients was 17.4 (11~34) years and the mean age at onset of CRP was 15.1 (3~33) years. The duration of disease varied from 1 month to 7 years. Six of the nine patients showed complete remission, and CRP lesions improved markedly after averagely 6.2 weeks from the beginning of the topical tretinoin treatment. The treatment response was better in patients without itch than in patients with itch (p=0.048). Adverse effects were detected in 3 patients, and were mild irritant contact dermatitis to the topical tretinoin. CONCLUSION: We think that topical 0.025% tretinoin treatment is an effective and safe treatment modality for CRP and this treatment can be an alternative or additional modality to the systemic treatment.
Axilla ; Dermatitis, Contact ; Humans ; Male ; Medical Records ; Minocycline ; Neck ; Papilloma ; Retrospective Studies ; Shoulder ; Tretinoin

PURPOSE: The short-term safety and efficacy of zoledronic acid for the treatment of skeletal metastasis was evaluated in patients with hormone-refractory prostate cancer. PATIENTS AND METHODS: A total of 19 hormone-refractory prostate cancer patients with bone metastases were enrolled. All patients received up to six infusions of zoledronic acid (4mg, given intravenously over 15 minutes, every 3-4 weeks). Safety was assessed by monitoring a`dverse events and serum creatinine levels. Efficacy was assessed by monitoring skeletal-related events, brief pain inventory score, quality of life score, type of pain medication, and analgesic score. Mean age of patients was 67.3 years (46-86 years), mean time from diagnosis of bone metastases was 27.6 months (0-117 months), and mean time from diagnosis of hormone-refractory disease was 7.5 months (0-26 months). RESULTS: There was no clinically significant change in serum creatinine levels. Eleven adverse events (musculoskeletal disorders and systemic disorders) in 8 patients were classed as having a possible relationship to study drug. Fifteen patients completed six courses of zoledronic acid infusion. There were no significant changes in the brief pain inventory composite scores, quality of life questionnaire scores or analgesic score. No new skeletal-related events developed during the treatment period. CONCLUSION: Zoledronic acid administered in this study as a 15-minute infusion demonstrated an acceptable and well-known safety profile in patients with refractory prostate cancer with bone metastases. However, prospective placebo- controlled clinical trials are required to elucidate the efficacy of zoledronic acid.
Aged ; Aged, 80 and over ; Antineoplastic Agents, Hormonal/therapeutic use ; Bone Density Conservation Agents/adverse effects/therapeutic use ; Bone Neoplasms/drug therapy/secondary ; Creatinine/blood ; Diphosphonates/adverse effects/*therapeutic use ; Drug Resistance, Neoplasm ; Humans ; Imidazoles/adverse effects/*therapeutic use ; Male ; Middle Aged ; Prospective Studies ; Prostatic Neoplasms/*drug therapy/pathology ; Quality of Life ; Treatment Outcome