Growth hormone (GH) deficiency is caused by congenital or acquired causes and occurs in childhood or adulthood. GH replacement therapy brings benefits to body composition, exercise capacity, skeletal health, cardiovascular outcomes, and quality of life. Before initiating GH replacement, GH deficiency should be confirmed through proper stimulation tests, and in cases with proven genetic causes or structural lesions, repeated GH stimulation testing is not necessary. The dosing regimen of GH replacement therapy should be individualized, with the goal of minimizing side effects and maximizing clinical improvements. The Korean Endocrine Society and the Korean Society of Pediatric Endocrinology have developed a position statement on the diagnosis and treatment of GH deficiency. This position statement is based on a systematic review of evidence and expert opinions.

Indoor animal husbandry environments are inevitably contaminated with endotoxins. Endotoxin exposure is associated with various inflammatory illnesses in animals. This cross-sectional study evaluated the relationship between the degree of endotoxin exposure and the cellular and humoral immune profiles of fattening pigs. Blood samples were taken from the jugular vein of 47 pigs from ten pig farms in Korea. Whole blood cell counts and plasma immunoglobulin (Ig) classes were determined. Peripheral-blood mononuclear cells were stimulated in vitro with concanavalin A for 48 h, and cytokines released into culture supernatants were measured. The barns in which the pigs lived were assessed for endotoxin levels in the total and respirable dust by using the limulus amebocyte lysate kinetic QCL method. Low and high endotoxin exposures were defined as ≤ 30 and > 30 EU/m³, respectively. Compared to pigs with low endotoxin exposure (n = 19), highly exposed pigs (n = 28) had higher circulating neutrophil and lymphocyte (particularly B cells) counts, IgG and IgE levels, interferon-gamma (IFNγ) and interleukin (IL)-4 productions, and lower IgA levels and tumor necrosis factor-alpha (TNFα) production. The IL-4, IFNγ, and TNFα levels significantly correlated with endotoxin level and/or pig age. Constant exposure of pigs to high levels of airborne endotoxins can lead to aberrant immune profiles.
Agriculture ; Animal Husbandry ; Animals ; Blood Cell Count ; Concanavalin A ; Cross-Sectional Studies ; Cytokines ; Dust ; Endotoxins ; Horseshoe Crabs ; Housing ; Immunity, Cellular ; Immunoglobulin A ; Immunoglobulin E ; Immunoglobulin G ; Immunoglobulins ; In Vitro Techniques ; Interferon-gamma ; Interleukin-4 ; Interleukins ; Jugular Veins ; Korea ; Lymphocytes ; Methods ; Neutrophils ; Plasma ; Swine ; Tumor Necrosis Factor-alpha

Falls and fall-related injuries are common in older populations and have negative effects on quality of life and independence. Falling is also associated with increased morbidity, mortality, nursing home admission, and medical costs. Korea has experienced an extreme demographic shift with its population aging at the fastest pace among developed countries, so it is important to assess fall risks and develop interventions for high-risk populations. Guidelines for the prevention of falls were first developed by the Korean Association of Internal Medicine and the Korean Geriatrics Society. These guidelines were developed through an adaptation process as an evidence-based method; four guidelines were retrieved via systematic review and the Appraisal of Guidelines for Research and Evaluation II process, and seven recommendations were developed based on the Grades of Recommendation, Assessment, Development, and Evaluation framework. Because falls are the result of various factors, the guidelines include a multidimensional assessment and multimodal strategy. The guidelines were developed for primary physicians as well as patients and the general population. They provide detailed recommendations and concrete measures to assess risk and prevent falls among older people.
Accidental Falls ; Aging ; Developed Countries ; Geriatrics ; Humans ; Internal Medicine ; Korea* ; Methods ; Mortality ; Nursing Homes ; Quality of Life

Falls and fall-related injuries are common amongst the elderly population and have deleterious effects on the quality of life or independence in daily living in the elderly. Falling is also associated with substantial morbidity, mortality, nursing home admission, and an increase in medical costs. Given that Korea has shown an extreme demographic shift with its population aging at the fastest pace among developed countries, assessment of fall risks and implementing intervention strategies to the high-risk population are getting more important. The guidelines for the prevention of falls were developed first by The Korean Association of Internal Medicine and The Korean Geriatric Society. These guidelines were developed by an adaptation process and the use of an evidence-based method; 4 guidelines were retrieved by systematic review and by the AGREE (appraisal of guidelines for research and evaluation) II process and 7 statements were made based on the grading of evidence, and these recommendations followed the GRADE (grades of recommendation, assessment, development, and evaluation) framework. Given that falls result from a various combination of many factors, the guidelines contain multidimensional assessment measures and multimodal strategies to prevent falls. These guidelines were developed not only for use by primary physicians but also for patients and the general population. Therefore, these guidelines provide detailed recommendations and concrete measures for the assessment of the risk of a fall and to prevent falls amongst the elderly population.
Accidental Falls ; Aged ; Aging ; Developed Countries ; Humans ; Internal Medicine ; Korea* ; Mortality ; Nursing Homes ; Quality of Life

Falls and fall-related injuries are common in older population and have deleterious effects to the quality of life or independence of daily living in the elderly. Falling is also associated with substantial morbidity, mortality, nursing home admission and the increase of medical costs. Because Korea has shown extreme demographic shift with its population aging at the fastest pace among developed country, assessment of fall risks and intervention to high risk population are getting more important. The guideline for prevention of falls was developed first by The Korean Association of Internal Medicine and The Korean Geriatric Society. This guideline was developed by adaptation process as evidence-based method; four guidelines were retrieved by systematic review and the Appraisal of Guidelines for Research and Evaluation II process, seven statements were made with the grading of evidence and recommendations followed the Grades of Recommendation, Assessment, Development, and Evaluation framework. Because falls result from various combinations of many factors, the guideline contains multidimensional assessment and multimodal strategy to prevent falls. This guideline was developed for not only primary physician but also patients and general population, therefore it provides detailed recommendations and concrete measures to assess the risk and prevent falls in older people.
Accidental Falls ; Aged ; Aging ; Developed Countries ; Humans ; Internal Medicine ; Korea* ; Mortality ; Nursing Homes ; Quality of Life

BACKGROUND: Many patients received transfusion in emergency department because of blood loss. There are few studies on massive transfusion for non-traumatic patients. This study investigated mortality and risk factor for non-traumatic bleeding patients who received transfusion. METHODS: Non-trauma patients who received transfusion at the emergency department for 3 years from March 2009 to February 2011 were enrolled. The patients who are younger than 15 years, trauma patients, and transfused FFP or platelet alone are excluded. Medical records was investigated retrospectively. We investigated predictive factors for MT on non-trauma patients and predictive factors for mortality on MT patients. RESULTS: Among 1655 non-trauma patients, 150 patients (9.24%) received MT. The age of MT group was younger than that of non-MT group and systolic bloor pressure, diastolic blood pressure, mean arterial pressure were significantly lower. Base excess, pH, lactate levels were significantly different between MT and non-MT group. Intensive care unit length of stay was longer, mortality of 24 hours was higher and survival discharge was lower than non-MT group. Mortality rate of MT group was 20.7% which was significantly higher than non-MT group's 9.3%. FFP:RBC ratio was higher in MT group than non-MT group. Among the MT group, non-survival group used higher FFP:RBC ratio product than survival group. On multivariate analysis, sBP, MAP, lactate, pH, BE were significant as predictors of MT. CONCLUSION: For non-trauma patients in emergency department, if sBP, MAP, lactate, pH, BE are abnormal, massive transfusion could be expected. Like trauma patients, basic scoring system that can predict MT would be necessary and useful.
Arterial Pressure ; Blood Platelets ; Blood Pressure ; Blood Transfusion* ; Emergencies* ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Intensive Care Units ; Lactic Acid ; Length of Stay ; Medical Records ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Risk Factors

The Scleroderma is a chronic inflammatory disease of the connective tissue with involvement of the skin and other organs. It can be a manifestation of various disorders and occasionally acroosteolysis in the phalanges. Acroosteolysis is characterized by bone resorption or destruction in the phalanges, while the base is preserved. The pathogenesis of acroosteolysis in patients with scleroderma is a blood-flow disorder that is mainly associated with an abnormal accumulation of collagen in all tissues, microangiopathy and infections in the phalanges. The phalanges in patients with scleroderma are prone to continuous infections as a felon or skin ulcers due to atrophy of the subcutaneous tissue, dry and sclerotic skin, or a disorder of the immune system. We experienced a patient who had acroosteolysis with scleroderma of the phalanges, and this was associated with a felon. We report on this case along with a brief review of the literature.
Acro-Osteolysis ; Atrophy ; Bone Resorption ; Collagen ; Connective Tissue ; Humans ; Immune System ; Skin ; Skin Ulcer ; Subcutaneous Tissue

Traumatic dislocation of the peroneus longus tendon is an often unrecognized injury which has been reported to occur most commonly during sports activity. Most acute cases with early detection can be treated by simple repair of the tendon or retinaculum using one of several procedures available. Accurate treatment through a comprehensive evaluation of the ankle injury prevents suboptimal and sometimes unrecorrectable outcomes. The authors experienced concomitantly the peroneus longus tendon dislocation associated with a trimalleolar fracture of the ankle. We report this case a brief review of the literature.
Animals ; Ankle ; Ankle Injuries ; Dislocations ; Sports ; Tendons

BACKGROUND: Doxapram hydrochloride is a respiratory stimulant that produces arousal effects in patients under anesthesia. We investigated the effects of doxapram on the recovery time and BIS index of patients administered desflurane inhalational anesthesia. METHODS: 40 patients who underwent general anesthesia using desflurane that had an ASA physical status of I or II received either 1 mg/kg of doxapram hydrochloride (doxapram group, n = 20) or normal saline (control group, n = 20) IV at end of surgery. Anesthetic recovery after the injection of doxapram was then determined based on the time to eye opening in response to verbal command, hand squeezing on command, time to extubation, and Aldrete recovery score. BIS index, systolic blood pressure, tidal volume and heart rate were recorded every minute for up to thirteen minutes. RESULTS: The doxapram group showed significantly shorter times to emergence based on eye opening in response verbal command (sec) (409 +/- 114 vs 320 +/- 116), hand squeezing on command (sec) (458 +/- 119 vs 351 +/- 114) and extubation (sec) (491 +/- 103 vs 418 +/- 79) compared to control group. The BIS score was not significantly different between the two groups. CONCLUSIONS: The Bis index was not significant higher in the doxapram group, with the exception of the measurement recorded at 2 minutes, however the recovery time from desflurane inhalational anesthesia was faster in the doxapram group than the control group.
Anesthesia ; Anesthesia, General ; Arousal ; Blood Pressure ; Doxapram ; Eye ; Hand ; Heart Rate ; Humans ; Isoflurane ; Tidal Volume

PURPOSE: To evaluate the result of forearm shaft fracture treated by modified interlocking intramedullary nail (Acumed, Hillsbrough, IN, USA). MATERIALS AND METHODS: 15 patients with fracture of radius, ulna, radio-ulna shaft treated by modified interlocking intramedullary nail from December 2003 to February 2007 were analyzed. Modified interlocking intramedullary nail has paddle blade tip and fluted rod, so the distal screw fixation was not needed but had relatively firm fixation. It has advantages including short operation time, small operation scar. The average follow up period was 8.3 months (range, 5~15 months). We analyzed the results by average union time and the functional results according to Anderson's criteria. RESULTS: The mean duration of union was 9.8 weeks in radius and 11.4 weeks in ulna. The average range of motion of forearm was 74.6 degree in supination and 72 degree in pronation.. Functional results assessed by Anderson were rated excellet in 12 cases, satisfactory in 3 cases. We found no complications such as delayed union, non-union, neurovascular injury and infection. CONCLUSION: Modified interlocking intramedullary nail (Acumed, Hillsbrough, IN, USA) is a viable therapeutic alternative in the management of forearm shaft fracture.
Cicatrix ; Follow-Up Studies ; Forearm ; Humans ; Nails ; Pronation ; Radius ; Range of Motion, Articular ; Supination ; Ulna