To define the effectiveness of C-reactive protein (CRP) as indicator for early detection of the post-operative infection, it is essential to exclude possible normal changes of CRP influenced by surgery itself. We analyzed 44 patients who had done orthopaedic surgeries without any evidence of infection preoperative and postoperatively from May to Aug. 1995 at Dongsan medical center, Keimyung University. We checked the levels of Erythrocyte sedimentation rate (ESR) and CRP levels at preoperative and postoperative 1, 3, 5, 7, 9, 11, 13, 15, 17, 19 and 21st day in all cases. In all cases, ESR increased up to 60mm/hr maximally and CRP increased to more than 10mg/dl at least one occasion within the first 3 weeks postoperatively. However CRP showed more rapid changes than ESR. The mean value of the CRP was increased maximally (7.2mg/dl) at 3 day after operation and then decreased rapid until 11 day. ESR was also increased at 3 day after operation, but it sustained high level until 21 day after operation. CRP appears to be more sensitive and rapid indicator as an acute phase reactant for the operation itself because CRP revealed more earlier and accentuated change after the operation. The changes of CRP showed same pattern regardless of operation time, use of tourniquet, use of transfusion and gender. In conclusion, within 3 day after operation, the high titer of CRP can not to be an indicator for early detection of the infection, because normal high titer can be developed by surgery itself. If there notes persistent high titer or more increasing pattern of CRP after postoperative 3 day or abnormal high titer of CRP after 11 day postoperatively, infection may be highly suspicious.
Blood Sedimentation ; C-Reactive Protein ; Humans ; Tourniquets

During intraocular surgery including cataract, air bubbles occasionally enter the anterior chamber during irrigation. The influences of these air bubbles on the cornea endothelium, however, have yet to be known. The purpose of this study is to investigate the effects of bubbles on the rabbit corneal endothelium during irrigation and aspiration mode in experimental phacoemulsification. After anesthesia, the anterior chamber was irrigated and aspirated for 1 minute with balanced salt solution. The rabbits were then randomly divided into 4 groups. In group 1, corneal endothelial irrigation and aspiration were performed without air bubbles for 1 minute. In group 2, corneal endothelial irrigation was performed in the presence of air bubbles in the anterior chamber for 1 minute. In group 3, corneal endothelial irrigation and aspiration were performed in the presence of air bubbles in the anterior chamber for 1minute. In group 4, corneal endothelial irrigation was performed with silicone oil at 50 mmHg pressure in the presence of air bubbles in the anterior chamber for 1 minute. In group 1, the cornea endothelial cells showed normal F-actin without cell damage. In group 2, a ring shaped endothelial cell destruction area adjacent to the border was found along the margin of the air bubble. In group 3, similar ring-shaped lesion found in group 2 were observed but with more extensive cell destruction. In group 4, a partial number of cell to cell separation was found without endothelial cell destruction. In conclusion, air bubbles in the anterior chamber during irrigation with balanced salt solution showed destructive changes in rabbit corneal endothelial cell.
Actins ; Anesthesia ; Anterior Chamber ; Cataract ; Cell Separation ; Cornea ; Endothelial Cells ; Endothelium ; Endothelium, Corneal* ; Phacoemulsification ; Rabbits ; Silicone Oils

OBJECTIVE: Chronic subdural hematoma(CSDH) is usually treated by burr hole trephination and hematoma evacuation with closed drainage and the surgical result is relatively good in most reported series. But, some patients experience the recurrence of CSDH. We study the clinical factors related to the recurrence of CSDH. METHODS: 213 consecutive patients with CSDH who were treated with burr hole trephination and hematoma evacuation with closed drainage. The medical records, radiologic findings were reviewed retrospectively and clinical factors associated with the recurrent CSDH were analysed statistically. RESULTS: 8.4%(18 cases) of the 213 patients who were treated due to CSDH were recurred. The demographic variables such as age, sex, coexisting diseases were not related to the recurrence. The preoperative hematoma thickness and postoperative hematoma thickness were not associated with the recurrence. The only factor related to the recurrence is postoperative hematoma density in this study. CONCLUSION: This study shows that postoperative hematoma density was strongly related to the recurrence of CSDH. However, several factors associated with the recurrent CSDH were reported in the liletrature. Thus, further study will be needed to uncover the factors related to the recurrence of CSDH. Chronic subdural hematoma(CSDH);Recurrence;Postoperative hematoma density.
Drainage ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Medical Records ; Recurrence ; Retrospective Studies ; Trephining

The brachial plexus palsy is a rare complication of a clavicle fracture, occurring in 0.5% to 9.0% of cases. This condition is caused by excessive callus formation, which can be recovered by a spur resection and surgical fixation. In contrast, only seven cases have been reported after surgical reduction and fixation. A case of progressive brachial plexus palsy was observed after fixation of the displaced nonunion of a clavicle fracture. The symptom were improved after removing the implant.
Bony Callus ; Brachial Plexus Neuropathies ; Brachial Plexus ; Clavicle ; Paralysis ; Thoracic Outlet Syndrome

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the influence of gender on the polysomnographic differences between men and women with obstructive sleep apnea (OSA). SUBJECTS AND METHOD: A retrospective review was performed of 110 patients who snore (91 males, 19 females) and were suspected of OSA. Polysomnography was performed for each patient. Gender comparison of polysomnographic parameters were made by performing Mann-Whitney U-tests. RESULTS: OSA was observed about five times more often in men than in women. Women were significantly older but were not heavier than men. Sleep structure showed no significant differences between men and women except that stage 1 sleep was observed more in men and stage 2 sleep more in women, respectively. The apnea hypopnea index (AHI) and non-rapid eye movement sleep were higher in men, but rapid eye movement sleep AHI in women was not different to men. The total and respiratory arousal indices (AI) and oxygen desaturation index (ODI) were higher in men than in women. CONCLUSION: The fact that more stage 1 sleep and the greater AHI, AI and ODI were found in men suggest that sleep quality may be worse in men than in women patients.
Apnea ; Arousal ; Eye Movements ; Female ; Humans ; Male ; Oxygen ; Polysomnography ; Retrospective Studies ; Sleep Apnea, Obstructive ; Sleep, REM

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging disease caused by the SFTS virus (family Bunyaviridae, genus Phlebovirus). A 77-year-old female farmer was bitten by a tick and developed a fever 5 days later, resulting in admittance to the emergency room. The laboratory findings showed elevated liver enzyme levels, thrombocytopenia, and leukopenia. Lymphoma was suspected based on computed tomography results. After confirming SFTS virus infection via the polymerase chain reaction, a bone marrow biopsy revealed hemophagocytic lymphohistiocytosis (HLH). HLH is rarely observed in patients with SFTS and few studies have reported the presence of SFTS in bone marrow. Here, we report a case of SFTS that was initially mistaken for a lymphoma, and was accompanied by HLH.
Aged ; Biopsy ; Bone Marrow ; Bunyaviridae ; Emergency Service, Hospital ; Farmers ; Female ; Fever* ; Humans ; Leukopenia ; Liver ; Lymphohistiocytosis, Hemophagocytic* ; Lymphoma ; Polymerase Chain Reaction ; Thrombocytopenia* ; Ticks

BACKGROUND: Although phenotypic heterogeneity of psoriasis is suggested by the alternate activation of either T-helper (Th)1-related or Th17-related cytokines, little is known about the mRNA levels of inflammatory cytokines. OBJECTIVE: To investigate whether there is differential expression of Th1-related and Th17-related inflammatory cytokine genes 1) between psoriatic patients and healthy controls, and 2) between patients with different psoriasis phenotypes. METHODS: Twenty-five patients with psoriasis (10 with guttate psoriasis and 15 with plaque psoriasis) and 5 healthy volunteers were enrolled in this study. The mRNA levels of circulating cytokines (interleukin [IL]-2, IL-12p40, interferon-γ, IL-17A, IL-22, and IL-23R) were measured by real-time reverse transcription polymerase chain reaction. RESULTS: The comparison between psoriatic and healthy control samples revealed that IL-12p40, IL-17A, and IL-22 mRNA levels were significantly higher (approximately 4∼6 folds) in the patients with psoriasis. The mRNA levels of these six cytokines in the blood did not differ between the guttate and plaque psoriasis groups. CONCLUSION: We found that the mRNA levels of blood inflammatory cytokines (IL-12p40, IL-17A, and IL-22) were significantly elevated in patients with psoriasis compared to the levels in healthy controls, but they did not significantly differ between patients with guttate and plaque type psoriasis.
Cytokines* ; Gene Expression* ; Healthy Volunteers ; Humans ; Interleukin-12 Subunit p40 ; Interleukin-17 ; Phenotype ; Polymerase Chain Reaction ; Population Characteristics ; Psoriasis ; Reverse Transcription ; RNA, Messenger

PURPOSE: To determine whether viscoelastic materials are effective to protect the corneal endothelium from air bubble damage. METHODS: Human eye bank (n=12) and rabbit (n=22) eyes underwent a standardized phacoemulsification procedure with or without viscoelastic material [1% sodium hyaluronate (Healon(R)), 1.4% sodium hyaluronate (Healon GV(R)), 3% sodium hyaluronate with 4% chondroitin sulfate (Viscoat(R))]. The integrity of the endothelium was examined after the procedure with F-actin staining and scanning electron microscopy (SEM). RESULTS: In the phacoemulsification experiment without viscoelastic material, with Healon, and with Healon GV, the endothelium of both human and rabbit corneas had many areas of cell loss in a pattern consistent with air bubble damage. But with Viscoat, endothelial cells remained intact. CONCLUSIONS: We found that Viscoat was effective to protect the endothelium from air bubble damage. Viscoat seems to protect the endothelium by acting as a physical barrier.
Actins ; Chondroitin Sulfates ; Cornea ; Endothelial Cells ; Endothelium ; Endothelium, Corneal ; Eye Banks ; Humans ; Hyaluronic Acid ; Microscopy, Electron, Scanning ; Phacoemulsification* ; Viscoelastic Substances*

Protein losing enteropathy (PLE) due to systemic lupus erythematosus (SLE) is relatively uncommon. PLE may be appeared sequentially after the diagnosis of SLE or concurrently with SLE. In most of concurrent cases, PLE was diagnosed one of various symptoms of SLE. Cases of PLE as the initial and only clinical presentation of SLE have been rarely reported. We described a 30-year old woman with general edema and abdominal distension was diagnosed PLE after stool alpha 1 antitrypsin clearance test. Her symptoms were getting worse even though the treatment with intravenous albumin. She was finally diagnosed PLE associated with SLE by additional laboratory findings (positive antinuclear antibody and anti-dsDNA IgG and low C3, C4 and CH50). She was treated with high dose of steroids and her symptoms were improved.
alpha 1-Antitrypsin ; Antibodies, Antinuclear ; Diagnosis ; Edema ; Female ; Humans ; Immunoglobulin G ; Lupus Erythematosus, Systemic* ; Protein-Losing Enteropathies* ; Steroids

PURPOSE: The goal of this study was to characterize the morphology of the mucinous layer on rabbit, bovine, owl, and human corneal endothelial cells. METHODS: Corneoscleral buttons were fixed using cetylpyridinium chloride to stabilize "mucus" and the tissue was prepared for transmission electron microscopy. Photomicrographs were measured to determine the thickness of the endothelial and epithelial mucinous layer in the central cornea. RESULTS: The endothelial mucinous layer was seen as a nearly uniform electrodense region on the apical aspect of the endothelium. It was found to be 0.9 microm, 0.9 microm, 0.9 microm, and 0.5 microm thick in rabbit, bovine, owl, and human, respectively. The owl endothelium had an additional less electrodense layer with a granular appearance and a thickness of about 200 microm. The mucinous layer on the epithelium was similar in appearance to that on the endothelium and across species. CONCLUSIONS: The morphologic similarity of the endothelial and epithelial mucinous layers is a serendipitous finding that should prove valuable in experimental design. Ultimately, it is hoped that studies of the posterior corneal surface will deepen our knowledge of endothelial protection.
Adult ; Animal ; Cytokines/pharmacology ; Endothelium, Corneal/ultrastructure ; Endothelium, Corneal/metabolism* ; Endothelium, Corneal/cytology ; Human ; Microscopy, Electron ; Mucins/ultrastructure ; Mucins/metabolism* ; Owls ; Rabbits ; Staining and Labeling