Even though the nonketotic hyperglycemia is a metabolic disorder, it complicates hemic- horea-hemiballism rarely. Moreover, generalized chorea-ballism associated with nonketotic hyperglycemia in diabetes mellitus is very rare, so it has not been reported in Korean literature. Although the precise pathophysiologic mechanisms of these disorders are still poorly understood, deficiency of gamma aminobutyric acid (GABA) in nonketotic hyperglycemia or reduced GABAnergic inhibition by striatal lesion may increase inhibitory output to subthalamic nucleus. These result loss of pallidal inhibition and produce contralateral hemichorea-hemiballism. The striatal lesions, such as transient ischemia with reactive astrocytosis or small amount of petechial hemorrhage, are related with changes of magnetic resonance image (MRI) findings presumably. We report a diabetic old woman who developed generalized chorea-ballismus as a very rare complication of nonketotic hyperglycemia. Her brain MRI showed high signal intensity in left lentiform nucleus and right pallidum on T1 weighted images and low signal intensity in bilateral putamen on T2 weighted images with highly enhanced corresponding lesions on T1 weighted enhancement images.
Brain ; Corpus Striatum ; Diabetes Mellitus* ; Female ; gamma-Aminobutyric Acid ; Gliosis ; Hemorrhage ; Humans ; Hyperglycemia* ; Ischemia ; Magnetic Resonance Imaging ; Putamen ; Subthalamic Nucleus

PURPOSE: This methodological study was done to develop a Nursing Competency Measurement Scale based on the clinical ladders of nurses working in wards. METHODS: Thirty clinical experts and 501 ward nurses evaluated the content validity of the scale. A survey using the Nursing Competency Measurement Scale was conducted with 114 nurses to evaluate reliability and applicability of the instrument. Data were analyzed using SPSS/WIN 21.0. RESULTS: A review of the literature identified 13 components of nursing competencies and 30 core nursing competencies based on each of the 4 grade clinical ladders. Cronbach's alpha coefficient for the total was .92. Cronbach's alpha reliabilities of each clinical ladder grade were .83 for Grade I, .84 for Grade II, .81 for Grade III, and .84 for Grade IV. The Content Validity Index (CVI) of the scale with 120 individual items was 0.976~1.000 for Grade I scale, 0.986~1.000 for Grade II scale, 0.984~1.000 for Grade III scale, and 0.992~1.000 for Grade IV scale. The expert group nurses' average degree of nursing competence measured using the scale was 3.38~3.75 out of 4.0. CONCLUSION: Through this process, 120 final questions were confirmed to represent items of the Nursing Competency Measurement Scale based on clinical grade.
Career Mobility* ; Mental Competency* ; Methods ; Nursing* ; Patients' Rooms*

Primary cutaneous aspergillosis is rare. In this report we describe primary skin infection by Aspergillus in 9 children with leukemia. The skin lesion was characterized clinically by erythematous macule and papule associated with pain and itching, followed by a rapid progression to ulcer and central black eschars with raised erythematous border at the site of venipuncture, insertion of intravenous cannula, or where arm boards had been taped to extremities. Diagnosis was confirmed by skin biopsy and wound culture. Positive revealed in 6 patients, including A. glaucus in 2 cases, A. flavus in 1 case. Treatment consisted of temporary withdrawl of anticancer chemotherapy, intravenous amphotericin B, oral flucytosine, itraconazole and/or rifampin. One patient recovered completely without antifungal medication with resolution of leukopenia. Six of eight treated patients recovered. One patient discharged against medical advice, while cutaneous aspergillosis was improving. One patient died with persistent skin lesion and neutropenia. We conclude that primary cutaneous aspergillosis is increasingly recognized in association with intravenous cannula, intravenous puncture or prolonged contact with arm boards in immunocompromised patients, and that this serious disease can be treated successfully with appropriate management.
Amphotericin B ; Arm ; Aspergillosis* ; Aspergillus ; Biopsy ; Catheters ; Child* ; Diagnosis ; Drug Therapy ; Extremities ; Flucytosine ; Humans ; Immunocompromised Host ; Itraconazole ; Leukemia ; Leukopenia ; Neutropenia ; Phlebotomy ; Pruritus ; Punctures ; Rifampin ; Skin ; Ulcer ; Wounds and Injuries

PURPOSE: Hepatic atrophy has been recognized as a complication of hepatic and biliary disease but we have often found it in follow up CT after transcatheter arterial embolization {TACE). The purpose of this study is to evaluate the characteristics of hepatic atrophy after TACE. MATERIAL AND METHODS: Of 53 patients who had TACE, We evaluated the relationship between the incidence of hepatic atrophy and the number of TACE, and also evaluated the average number of TACE in patients with hepatic atrophy. Of 20 patients who had received more than average number of TACE for development of hepatic atrophy (2 times with portal vein obstruction, 2.7 times without portal vein obstruction in this study), we evaluated the relationship between the tipiodol uptake pattern of tumor and the incidence of hepatic atrophy. RESULTS: There were 8 cases of hepatic atrophy (3 with portal vein obstruction, 5 without portal vein obstruction), average number for development of hepatic atrophy were 2.5 times. As the number of TACE were increased, the incidence of hepatic atrophy were also increased. Of 20 patients who received more than average number of TACE for development of hepatic atrophy, we noted 6 cases of hepatic atrophy in 11 patients with dense homogenous lipiodol uptake pattern of tumor and noted only 1 case of hepatic atrophy in 9 patient with inhomogenous lipiodol uptake pattern. CONCLUSION: Hepatic atrophy was one of the CT findings after TACE even without portal vein obstruction. Average number of TACE was 2.5 times and risk factors for development of hepatic atrophy were portal vein obstruction, increased number of TACE, and dense homogenous lipiodol uptake pattern of tumor.
Atrophy* ; Ethiodized Oil ; Follow-Up Studies ; Humans ; Incidence ; Portal Vein ; Risk Factors

Objective: Osteoporosis is the most common chronic disease that occurs after menopause in women. The purpose of this study was to investigate the current status of use of osteoporosis drugs in Korea by figuring out the size of osteoporosis drugs sold in Korea in 2020. Methods: Data Based on Intercontinental Marketing Services (IMS) data for 5 years from 2016 to 2020, the sales amount of osteoporosis drugs was calculated to determine the usage status of osteoporosis drugs. Specific pharmacologic drugs were analyzed included oral and intravenous bisphosphonate, raloxifene, parathyroid hormone, RANKL inhibitors and others. In November 2019, Romosozumab was newly approved by the Ministry of Food and Drug Safety for use as a treatment for osteoporosis and was included in this analysis. Results: When looking at the market share of non-hormonal drugs in osteoporosis treatment, denosumab, a SERM drug, showed a steep rise from 2% in 2017 to 30% in 2020, and denosumab was the most used drug in 2020. Compared to 2019, the quarterly sales in 2020 also increased by 58.6% from 47.5 billion won to 75.1 billion won compared to the previous year. It was followed by Ibandronate, Alendronate, and Risedronate, and bisphosphonate showed a decreasing trend. In the case of calcitonin and raloxifene, there is a decreasing trend compared to 2016. In the case of newly added Romosozumab, the market share by component was 2%. Although the insurance benefit standard was applied on December 1, 2020 and is not widely used in 2020, considering the mechanism and effect of this drug, it is likely to emerge as the most important treatment for severe osteoporosis patients in the future. Conclusion Osteoporosis is the most common chronic disease in the elderly, and it will become more serious as we age. However, compared to the seriousness of the disease, there were not many treatments for this disease. As Romosozumab, an anabolic agent, is added as a new treatment for osteoporosis, it will be possible to save many patients from the risk of fracture by using various treatment agents well.

We analysed retrospectively pharmacokinetic parameters of gentamicin and amikacin in 44 and 58 Korean pediatric patients, respectively, with normal renal function. Pharmacokinetic parameters were calculated from two concentrations in serum by method of Sawchuck. There was wide individual variation in peak serum concentrations of gentamicin and amikacin, Administration of the usually recommended doses yielded subtherapeutic concentrations in 47% and 82%, respectevely, of patients in the peak concentrations of gentamicin and amikacin. The volumes of distribution of gentamicin and amikacin in children of over 1 year of age were 0.37+/-0.13L/kg and 0.41+/-0.13L/kg which are greater than those reported from the western countries. We conclude that the wide individual variation and high frequency of subtherapeutic levels in the peak concentrations of gentamicin and amikacin obtained by usually recommended dosage as well as the narrow safety margin of these drugs necessitate monitoring of serum concentration and adjustment of individual dosage regimen early in the course of treatment with aminoglycosides.
Amikacin* ; Aminoglycosides ; Child* ; Gentamicins* ; Humans ; Pharmacokinetics* ; Retrospective Studies

BACKGROUND: Mutations in the gene encoding transforming growth factor-beta induced (TGFBI) are associated with corneal dystrophies. We evaluated the diagnostic performance of the GENEDIA Avellino corneal dystrophy (ACD) mutation detection kit and GENEDIA corneal dystrophy screening master mix (Green Cross Medical Science Co., Korea) by comparing it with an in-house sequencing method. METHODS: The study group consisted of 40 patients with Avellino corneal dystrophy (ACD) and 40 patients suspected to suffer from ACD; 40 healthy individuals were used as the control. All samples used for this study were previously obtained. All results obtained using the kit were evaluated for sensitivity, specificity, and detection limit. RESULTS: The sensitivity of the GENEDIA ACD kit was 100.0% with a positive mean+/-2SD Ct (cycle threshold) value of 25.87+/-1.24 and an excellent coefficient of variation value of 0.02 in ACD group. All normal control samples were negative, indicating a specificity of 100% for the GENEDIA kit. The detection limit was set at a DNA concentration of >0.2 ng/microL. Direct sequencing results obtained using the GENEDIA master mix and the in-house method agreed for all 20 ACD samples. Additional R555W mutation detected in four ACD-suspected samples were suggestive of the diagnosis of granular corneal dystrophy type I. CONCLUSIONS: The GENEDIA ACD detection kit and master mix showed acceptable results, demonstrating high sensitivity and specificity, and may be considered for clinical application. Furthermore, the GENEDIA master mix was useful for the detection of mutations in exons 4 and 12 of the TGFBI gene.
Diagnosis ; DNA ; Exons ; Humans ; Limit of Detection ; Mass Screening* ; Methods ; Real-Time Polymerase Chain Reaction ; Sensitivity and Specificity

BACKGROUND: Tamoxifen (TAM) inhibits the action of estrogen by binding to estrogen receptors, and also has non-estrogen receptor mediated cytostatic activities. Transforming growth factor-1 (TGF-1) inhibits the proliferation of many other cell types, such as epithelial, hematopoietic and endothelial cells. METHODS: We investigated the effects of tamoxifen on the growth of 7,12-dimethylbenz(a)anthracene (DMBA)-induced rat mammary tumors and the expression of cyclin D1, cyclin E, p21Cip1, and p27Kip1 by performing immunohistochemistry and Western blot analysis, and studied whether TGF-1 injection amplified the effects of TAM. When tumor size reached between 10-15 mm in the largest dimension, the rats were divided into 3 groups: DMBA-control group (n=12), DMBA-TAM group (n=14) and DMBA-TAM plus TGF-1 group (n=5). RESULTS: The consecutive administration of TAM markedly decreased the tumor development compared with the DMBA-control group. The DMBA-TAM and DMBA-TAM plus TGF-1 groups showed decreased expression of bromodexoyuridine, cyclin D1, cyclin E, and p21Cip1 when compared with those of the DMBA-control group. On the other hand, the labeling index of p27Kip1 was higher in the DMBA-TAM plus TGF-1 group than in the DMBA-control group. CONCLUSION: TAM suppresses tumor development, which may be associated with down-expression of cyclin D1 and cyclin E, and overexpression of p27Kip1, and addition of TGF-1 does not influence tumor development treated by TAM.
Animals ; Blotting, Western ; Breast ; Cell Cycle ; Cyclin D1* ; Cyclin E* ; Cyclins* ; Endothelial Cells ; Estrogens ; Hand ; Immunohistochemistry ; Rats* ; Receptors, Estrogen ; Robenidine ; Tamoxifen* ; Transforming Growth Factor beta

Transforming growth factor-beta1(TGF-beta1) is known to be a potent growth inhibitor for many cell types, including most epithelial cells. In skin keratinocytes, TGF-beta1 has been shown to inhibit growth and to rapidly reduce c-myc expression. However, the molecular mechanism of TGF-beta1 action on cell growth of cervical carcinoma has not yet been elucidated. We thus assessed the effect of TGF-beta1 on the growth of cervical carcinoma cell lines. Two cervical squamous carcinoma cell lines were incubated with varying concentration of TGF-beta 1, and growth inhibition was evaluated with tetrazolium-based colorimetric assay. After culturing in concentrations of 0.1~10 ng/ml in both cell lines. Northern blot analysis revealed c-myc mRNA expression was suppressed by 10 ng/ml of TGF-beta 1 following 6-hour of treatment in both cell lines. These results suggest that TGF-beta1 inhibits the growth of cervical carcinoma cells by suppressing c-myc oncogene expression.
Blotting, Northern ; Carcinoma, Squamous Cell ; Cell Line* ; Epithelial Cells ; Genes, myc* ; Keratinocytes ; Oncogenes ; RNA, Messenger ; Skin ; Transforming Growth Factor beta ; Transforming Growth Factor beta1 ; Uterine Cervical Neoplasms

Mesenteric cysts are uncommon, and they are histopathologically classified as pseudocyst, mesothelial cyst, lymphangioma and omental cyst. We report a case of a 27-year-old female with a huge cystic mass arising from greater omentum. Patient complained the symptoms of abdominal distention due to massive ascites and intermittent pelvic discomfort. The diagnostic examinations including ultrasonography and computed tomography were performed and identified a huge, intraabdominal cyst. Laparoscopic resection of cyst was done with no clinical and symptomatic evidence of adverse event till 12 months. The diagnostic role of sonography and CT in ascites with unknown etiology is emphasized. Minimal invasive surgery showed comparable result to open exploration.
Adult ; Ascites ; Female ; Humans ; Laparoscopy ; Lymphangioma ; Mesenteric Cyst ; Omentum