BACKGROUND: Procalcitonin (PCT) is a relatively new marker for bacterial infections, and its diagnostic utility has been variable across the studies. We investigated the diagnostic utility of PCT for the patients with blood culture-positive sepsis, and compared it with that of C-reactive protein (CRP). METHODS: In 1,270 consecutive blood samples, PCT and CRP were simultaneously measured and results were compared according to the five categories of PCT concentrations (<0.05 ng/mL; 0.05-0.49 ng/mL; 0.5-1.99 ng/mL; 2-9.99 ng/mL; > or =10 ng/mL). In 506 samples, they were further analyzed according to the result of blood culture. PCT and CRP were measured using enzyme-linked fluorescent assay (bioMerieux Co., France) and rate nephelometry (Beckman Coulter Co., USA), respectively. Their diagnostic utilities were compared using ROC curves. RESULTS: The mean concentrations of CRP in five categories of PCT were 15.4 mg/L, 42.1 mg/L, 101.2 mg/L, 125.0 mg/L, 167.1 mg/L, respectively (P<0.0001). Both PCT and CRP showed significant differences between the two positive and negative groups of blood culture (PCT, 8.47 vs 2.44 ng/mL, P=0.0133; CRP, 110.48 vs 59.78 mg/L, P<0.0001). The areas under the ROC curves (95% confidence interval) for PCT and CRP were 0.720 (0.644-0.788) and 0.558 (0.478-0.636), respectively, and showed a significant difference (P=0.005). CONCLUSIONS: The diagnostic utility of PCT is superior to that of CRP for the patients with blood culture-positive sepsis. PCT seems to be reliable for sepsis diagnosis, and may provide useful information for the critically ill patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological Markers/blood ; C-Reactive Protein/*analysis ; Calcitonin/*blood ; Child ; Child, Preschool ; Enzyme-Linked Immunosorbent Assay ; Humans ; Infant ; Infant, Newborn ; Middle Aged ; Nephelometry and Turbidimetry ; Protein Precursors/*blood ; ROC Curve ; Reagent Kits, Diagnostic ; Sensitivity and Specificity ; Sepsis/*diagnosis

Distal thumb injuries are a common and difficult problem for hand surgeons. Coverage of soft tissue on the fingers may be difficult due to the size of the defect or the limitation of local flap mobilization. However, the variable anatomy of the dorsal hand vascular system sometimes prevents successful flap harvest. The purpose of this study was to clarify the vascular anatomy of the dorsal side of the thumb and the first web for the flaps. Twenty six hands (13 right and 13 left hands) from Korean embalmed cadavers were dissected. A catheter was inserted into the radial artery in the forearm, and the red colored latex (Latex 671, Dupont Industry, France) was injected until the dorsum of the hand was colored. The arrangement of the first dorsal metacarpal artery (FDMA) and its branches were vary and classified into three categories according to their branching patterns; Both dorso-ulnar thumb branch (DUTB) and dorso-radial index branch (DRIB) arose from the FDMA (10 cases, 38.5%). Each DUTB and DRIB arose separately from the radial artery (5 cases, 19.2%). The DUTB and the DRIB originated from the princeps pollicis artery and the radial artery, respectively (11 cases, 42.3%). The typical course of the FDMA and its branches ran overlying the first dorsal interosseous muscle in 17 cases of the 26 specimens (65.4%). However, in nine cases (34.6%) the DRIB ran on the first dorsal interosseous muscle and the DUTB had a deep course within the substance of the first dorsal interosseous muscle. The FDMA flap represents a good option to cover defects for the thumb. These anatomical findings in the present study could provide useful knowledge of flaps for dorsal aspect of the thumb and the first web.
Arteries ; Cadaver ; Catheters ; Fingers ; Forearm ; Hand ; Latex ; Muscles ; Radial Artery ; Thumb

BACKGROUND: Treatment of toenail onychomycosis requires long term oral medication of antifungal agent. So many factors such as preferred treatment option can affect the compliance and cure rate. OBJECTIVES: The objective of the present study was to identify most preferred treatment options for toenail onychomycosis patients. METHODS: This study was undertaken on 190 patients treated toenail onychomycosis, who visited Hanyang University Guri hospital, Konkuk University hospital and Asan Medical center during the period between March 2008 to April 2008. RESULTS: 1. Mean age of patients was 53.5+/-15.5 years old, 108 patients (56.8%) were female and 82 patients (43.2%) were male. 2. Mean duration of disease was 7 years 11 months (7.9+/-8.8 years). 3. The motives of treatment for toenail onychomycosis were 'ugly appearance' (39.8%) and 'pruritus' (33.9%). 4. Seventy six percent of patients had history of treatment for toenail onychomycosis. Most of them (43%) visited dermatologist's office and 14% of them used folk remedy. 5. Continuous therapy was the most common method (47%) in previous treatment. And it was the most common treatment option irrespective of age, disease duration and gender. 6. The most preferred treatment option was also continuous therapy (57%). And 69% of patients who received continuous therapy preferred it, but it was only 48% in pulse therapy group and 38% in weekly pulse therapy group. 7. Sixty six percent of the toenail onychomycosis patients had associated disease. CONCLUSIONS: Continuous therapy was the most convenient method for toenail onychomycosis patients who visited general hospital.
Compliance ; Female ; Hospitals, General ; Humans ; Nails ; Onychomycosis

Cutaneous bronchogenic cyst is a benign congenital anomaly of the embryonic foregut and is an extremely rare lesion. This lesion is localized in the suprasternum, neck, mandible, and shoulders. The authors experienced this diseases in a 7-year-old male with a palpable mass on the anterior chest wall since birth. The mass was soft, non-tender, well demarcated and 5x4 cm in size. The histopathologic finding was a ciliated pseudostratified columnar respiratory epithelium at the cyst inner wall. The histopathologic diagnosis was a cutaneous bronchogenic cyst. The differential diagnosis includes branchial cleft cyst, thyroglossal duct cyst, teratoma, and cutaneous ciliated cyst. The purpose of this report is to document a cutaneous bronchogenic cyst, located on the anterior chest wall, an unusual localization of this lesion. Since this cyst has a potential for malignancy, treatment should consist of complete excision with follow-up.
Branchioma ; Bronchogenic Cyst* ; Child ; Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Male ; Mandible ; Neck ; Parturition ; Respiratory Mucosa ; Shoulder ; Teratoma ; Thoracic Wall* ; Thorax* ; Thyroglossal Cyst

PURPOSE: Laparoscopic surgery has become the mainstream surgical operation due to its stability and feasibility. Even for liver surgery, the laparoscopic approach has become an integral procedure. According to the recent international consensus meeting on laparoscopic liver surgery, laparoscopic left lateral sectionectomy (LLS) might be a new standard of care for left lateral surgical lesions. This study was designed to compare open LLS to laparoscopic LLS. METHODS: In total, 82 patients who had undergone LLS at Chonnam National University Hwasun Hospital between 2008 and 2015 were enrolled in this study. Among them, 59 patients underwent open LLS and 23 underwent laparoscopic LLS. These two groups were compared according to general characteristics and operative outcomes. RESULTS: The data analysis results showed that laparoscopic liver resection is superior to open liver resection in terms of the amount of bleeding during the operation and the duration of hospital stay. There was no statistical difference between the two groups in terms of operation time (p value=0.747). The amount of bleeding during the operation was 145.5±149.4 ml on average for the laparoscopic group and 320±243.8 ml on average for the open group (p value=0.005). The mean duration of hospital stay was 10.7±5.8 days for the laparoscopic surgery group and 12.2±5.1 days for the open surgery group (p value=0.003). CONCLUSION: This study showed that laparoscopic LLS is safe and feasible, because it involves less blood loss and a shorter hospital stay. For left lateral lesions, laparoscopic LLS might be the first option to be considered.
Consensus ; Hemorrhage ; Humans ; Jeollanam-do ; Laparoscopy ; Length of Stay ; Liver ; Standard of Care ; Statistics as Topic

Median cleft face syndrome is diagnosed by two or more of the following anomalies : ocular hypertelorism, cranium bifidum occultum, median cleft nose, median cleft lip and median cleft premaxilla. The most consistent and prominent ocular finding associated with this syndrome is hypertelorism. We experienced a case of median cleft face syndrome which had orbital hypertelorism, cranium bifidum occultum, bifid cleft nose, V-shaped frontal hairline, and polysyndactly. We report this case with a brief review of the associated literature.
Cleft Lip ; Encephalocele ; Hypertelorism ; Nose ; Orbit

Cushing's disease (CD) is a rare disorder characterized by the overproduction of adrenocorticotropic hormone due to a pituitary adenoma that ultimately stimulates excessive cortisol secretion from the adrenal glands. Prior to the detection of pituitary adenomas, various clinical signs of CD such as central obesity, moon face, hirsutism, and facial plethora are usually already present. Uncontrolled hypercortisolism is associated with metabolic, cardiovascular, and psychological disorders that result in increased mortality. Hence, the early detection and treatment of CD are not only important but mandatory. Because its clinical manifestations vary from patient to patient and are common in other obesity-related conditions, the precise diagnosis of CD can be problematic. Thus, the present set of guidelines was compiled by Korean experts in this field to assist clinicians with the screening, diagnoses, and treatment of patients with CD using currently available tests and treatment modalities.
Adrenal Glands ; Adrenocorticotropic Hormone ; Corticotropin-Releasing Hormone ; Cushing Syndrome ; Diagnosis* ; Hirsutism ; Humans ; Hydrocortisone ; Korea ; Mass Screening ; Mortality ; Obesity, Abdominal ; Petrosal Sinus Sampling ; Pituitary ACTH Hypersecretion ; Pituitary Neoplasms

OBJECTIVE: The objective of this study is to delineate clinical features and specific diagnostic and therapeutic implications of spinal metastasis occurring as the initial manifestation of malignancy(SM-IMM)-a less common event than spinal metastasis in the setting of previously established malignancy(SM-PEM). METHODS: The authors reviewed retrospectively the clinical records of 19 patients in SM-IMM group at Korean Cancer Center Hospital between January 1, 2000 and December 31, 2001 and analyzed symptom duration, primary origin, treatment modality and survival time. Then 287 cases of SM-PEM group were searched for primary origin. RESULTS: Thyroid cancer(36.8%), metastasis of unknown origin(31%), liver cancer(10.5%) and stomach cancer (10.5%) were found as primary tumor in SM-IMM group. But in SM-PEM group lung cancer was most frequent primary tumor(22%), breast cancer(17%), stomach cancer(7.3%) and liver cancer (7.3%) followed. Primary pathology was confirmed with spinal decompressive surgery(7 cases), biopsy of spinal lesion(5 cases), and biopsy of other sites except spine(7 cases). Patients in SM-IMM group showed short symptom duration and multi-segmental involvement at diagnosis. And post-treatment survival time was short except thyroid cancer in spite of aggressive treatment(mean survival time, 2.7 months). CONCLUSION: SM-IMM group showed different profile from SM-PEM group on primary origin. And in the diagnosis of primary origin in SM-IMM group, important clues were provided with history taking, physical examination and PET.
Biopsy ; Breast ; Diagnosis ; Humans ; Liver ; Liver Neoplasms ; Lung Neoplasms ; Neoplasm Metastasis* ; Pathology ; Physical Examination ; Retrospective Studies ; Stomach ; Stomach Neoplasms ; Thyroid Gland ; Thyroid Neoplasms

The following experiment was performed to clarify distributional changes of the Ly1, L3T4, Ly2 positive T cells and IgM positive B cells 1, 4, 8, 12 and 40 weeks after birth. Thymus, spleen and lymph node were removed and immunohistochemical staining such as avidin -biotin -peroxidase complex method was used. The results obtained from above epxperiment were as follows; 1. Ly1 positive T cells were decreased after 8 weeks in the thymus and spleen. these were decreased after 40 weeks in the lymph node. 2. There was no difference L3T4 positive T cells in the thymus, but in the spleen decrease of cell number was shown after 40 weeks. 3. Ly2 postive T cells were decreased after 4 weeks in the thymus, after 40 weeks in the spleen. There was no change of distribution in the lymph node. 4. There was no difference distribution of IgM positive B cells. The results suggest that the age related decrease of the immunity is caused by decrease of cellular immunity related to T cell depletion.
Animals ; Avidin ; B-Lymphocytes ; Cell Count ; Immunity, Cellular ; Immunoglobulin M ; Lymph Nodes* ; Mice* ; Parturition ; Spleen ; T-Lymphocytes ; Thymus Gland

BACKGROUND: It has been well demonstrated that trypsin inhibitor can stimulate the secretion of cholecystokinin. Camostat mesylate (C20H22N4O5 CH3SO3H) is a synthetic trypsin inhibitor. We demonstrated the effect of camostat mesylate on the chemical composition of bile and the crystallization in gallbladder-stone patients. METHODS: Gallbladder bile sample from 22 patients with GB stones were analyzed. In 11 patients, camostat mesylate (Foy-pan ) was administered orally in a dosage of 600 mg per day for more than 5 days, and the results of the bile analysis were compared to those of 11 controls. RESULTS: The total protein concentration in the camostat group was lower than that in control group (0.21+/-0.10 vs 0.24+/-0.06 g/dl) but the difference was not significant (p=0.41). The total bile acid concentration in the camostat group was significantly lower than that in the control group (5.47+/-1.56 vs 6.85+/-1.32 g/dl, p=0.04). The concentrations of cholesterol and phospholipid were lower in the camostat group (0.35 +/- 0.19 vs 0.44 +/- 0.11 g/dl, 2.10 +/- 1.19 vs 2.92 +/- 0.93, respectively), but the differences were not statistically significant (p=0.20, p=0.09, respectively). The total lipid concentration which reflects the concentrated magnitude of the bile, was significantly lower in the camostat group (7.93 +/- 2.87 vs 10.20 +/- 2.01 g/dl, p=0.04). The cholesterol saturation index didn't demonstrate a significant difference between the two groups (1.06 +/- 0.27 vs 0.95 +/- 0.31, p=0.38). Crystallization in the bile from cholesterol stone patients, was observed every day for 7 days. Crystallizations was less frequent in the camostat group, but the difference was not statistically significant (1/6 vs 4/8, p=0.39). DISIDA (disofenin iminediacetate) scans were performed in 3 healthy volunteers to observe the changes in the radioactivities and the volumes of the gallbladders before and after the administrations of camostat. The peak radioactivities, the transittime to the peak radioactivity, and the gallbladder volume at the peak radioactivity in the scan after the administration of camostat were lower than in the corresponding values before the administration. CONCLUSIONS: Camostat mesylate lowers the concentration of all bile components. We assume that the effects of Camostat mesylate are mediated by CCK, which enhances gallbladder motility and limits the concentrating function of the gallbladder.
Bile* ; Cholecystokinin ; Cholesterol ; Crystallization* ; Gallbladder* ; Healthy Volunteers ; Humans ; Mesylates* ; Radioactivity ; Trypsin