Tularemia is a zoonosis caused by Francisella tularensis. It is primarily a disease of wild animals. Human infection is incidental and usually results from interaction with biting or blood-sucking insects, wild or domestic animals, or the environment. An increasing number of cases have been reported in several countries. However, in Korea it has not been reported until now. A 40-year old male patient visited our department on Jan 13, 1997, complaining of multiple swollen lymph-nodes on his axillae and reddish swollen left upper arm which contained an abscess at its central portion for about ten days. On Dec 25, 1996, he found a dead wild rabbit on a nearby mountainside, ate it after cooking it by himself with his hands injured. His abscess was drained and microbiologic examination was done. However no microorganism was isolated. His lymph nodes were surgically removed from both axillae, and we investigated them microbiologically and pathologically. On microbiologic examination, small aerobic gram negative coccobacilli were grown on a chocolate agar plate in an aerobic condition with 5% CO2 at 37 degrees centigrade. On H & E staining, the lymph node showed chronic granulomatous inflammation. We sent the microorganism and lymph nodes to the Centers for Disease Control and Prevention in the United States of America for the definitive diagnosis. Finally the microorganism was identified as F. tularensis by culture morphology, biological tests and immunohistochemical staining. We report the first case of F. tularensis in Korea.
Abscess ; Adult ; Agar ; Americas ; Animals ; Animals, Domestic ; Animals, Wild ; Arm ; Axilla ; Cacao ; Centers for Disease Control and Prevention (U.S.) ; Cooking ; Diagnosis ; Francisella tularensis ; Hand ; Humans ; Inflammation ; Insects ; Korea ; Lymph Nodes ; Male ; Tularemia* ; United States

PURPOSE: This study aimed to determine whether symptoms of urinary urgency increase according to the severity of stress urinary incontinence (SUI). For this purpose, we recruited women with symptoms of mixed as well as pure SUI and compared the clinical characteristics of each subgroup. MATERIALS AND METHODS: A total of 241 female patients who were diagnosed with SUI and mixed urinary incontinence (MUI) were analyzed retrospectively. Patients with only SUI were categorized as group 1. Patients with MUI were categorized as group 2. Clinical and urodynamic differences between the 2 groups were compared. RESULTS: The proportion of Stamey grade was significantly different between the 2 groups: grade 1 SUI was higher in group 1, but grades 2 and 3 SUI were higher in group 2. The incidence of urgency was proportional to the degree of Stamey grade (23.5% in grade 1, 36.9% in grade II, and 60.0% in grade III). In the urodynamic study, the presence of detrusor overactivity was significantly higher in group 2 than in group 1 (25.9% vs. 49.4%). Other clinical parameters were also significantly different between the 2 clinical groups: Q-tip angle (group 1: 42.1degrees, group 2: 28.6degrees, p<0.05), maximal urethral closure pressure (group 1: 54.7 cmH2O, group 2: 44.1 cmH2O, p<0.05), maximal bladder capacity (group 1: 356.3 ml, group 2: 282.0 ml, p<0.05), and bladder volume at first desire (group 1: 144.6 ml, group 2: 123.2 ml, p<0.05). CONCLUSIONS: According to this analysis, the more serious the symptoms of SUI, the higher the incidence of urinary urgency.
Female ; Humans ; Incidence ; Retrospective Studies ; Urinary Bladder ; Urinary Incontinence ; Urinary Incontinence, Urge ; Urodynamics

Fifty percents of patient with achondroplasia present neurological disturbances of varying degree. Congenital narrowing of the spinal canal in achondroplastics seems to be the main cause of the cord disturbance, and there are several other causes such as prolapse of intervertebral discs, spondyloarthitic degenerative manifestations and wedging of vertebral body. Surgical treatment of the cord disturbance consist of anterior decompression with fusion and posterior decompression. We experienced L1-2 disc herniation in achondroplasia with rapid progression of neurologic symptoms and treated with posterior decompression. Two years after operation, the patient had good result.
Achondroplasia ; Decompression ; Humans ; Intervertebral Disc ; Neurologic Manifestations ; Prolapse ; Spinal Canal

PURPOSE: Totally extraperitoneal (TEP) hernia repair has gained in popularity in the past two decades. Despite the advantages TEP hernia repair, the approach is hindered by the relatively long learning curve of the surgery. We tried to estimate the necessary number of repetitions of TEP hernia repair in the learning curve using logarithmic and exponential function models. METHODS: We performed a retrospective review of all patients who underwent TEP hernia repair by a single surgeon consecutively at a single center. We calculated how many operations were needed to achieve a reduction in the expected operating time to mean operating time using logarithmic and exponential function models. RESULTS: In the 91 patients, the logarithmic function model predicted that 37 cases were needed to overcome the learning curve for TEP hernia repair while the exponential model predicted that 39 cases were needed. CONCLUSION: According to this study, at least 37 to 39 cases are needed in the overcome learning curve of TEP hernia repair. Further studies are needed to optimize surgical education and maximize quality.
Education ; Herniorrhaphy* ; Humans ; Learning Curve* ; Learning* ; Likelihood Functions ; Retrospective Studies

PURPOSE: This study was conducted to investigate the incidence, associated factors and clinical impact of hyperamylasemia in self-poisoning patients. METHODS: This study was based on a toxicology case registry of patients treated from 2009 to 2013 at a tertiary care university hospital. We retrospectively investigated the demographics, clinical variables, laboratory variables and intoxicants. Hyperamylasemia was defined as an elevation in serum amylase level to above the upper normal limit within 24 hours after admission. We analyzed the predisposing factors and clinical outcomes of patients in the hyperamylasemia group. RESULTS: Hyperamylasemia was identified in 49 (13.3%) of the 369 patients. Using multivariate logistic regression, the odds ratios for HA were 3.384 (95% confidence interval, 1.142-8.013, p=0.014), 3.261 (95% confidence interval, 1.163-9.143, p=0.025) and 0.351 (95% confidence interval, 0.154-0.802, p=0.013) for pesticides, multi-drug use and sedatives, respectively. In the hyperamylasemia group, the peak amylase levels during 72 hours were correlated with the peak lipase levels (r=0.469, p=0.002) and peak aspartate aminotransferase levels (r=0.352, p=0.013). Finally, none of these patients had confirmed acute pancreatitis. CONCLUSION: Hyperamylasemia occurred rarely in these self-poisoning patients, and pesticide and multi-drug use were independent predictors of hyperamylasemia. Peak amylase levels were correlated with the peak lipase and aspartate aminotransferase levels.
Amylases ; Aspartate Aminotransferases ; Causality ; Demography ; Humans ; Hyperamylasemia* ; Hypnotics and Sedatives ; Incidence* ; Lipase ; Logistic Models ; Odds Ratio ; Pancreas ; Pancreatitis ; Pesticides ; Poisoning ; Retrospective Studies ; Tertiary Healthcare ; Toxicology

Background: Although the scallop sign is considered the most important risk factor for extensor tendon ruptures (ETRs) in patients with osteoarthritis of the distal radioulnar joint (DRUJ), previous reports provide a limited understanding of the changes at DRUJ, as risk factors were examined in plain radiographs of the wrist. The aim of this study was to assess the changes of DRUJ using axial images of computed tomography (CT) in patients with DRUJ osteoarthritis and associated ETRs and to evaluate the relationship between the changes of DRUJ and ETRs. Methods: Twelve patients with ETRs due to osteoarthritis of the DRUJ were enrolled. The changes of DRUJ were examined on axial images of CT and the following 8 parameters were measured: width of radius, anteroposterior (AP) length of radius, width of sigmoid notch (SN), AP length of SN, AP length of ulnar head, subluxation length of ulnar head, dorsal inclination of SN, and distance from Lister’s tubercle to SN. Radiological parameters of the DRUJ were measured in 60 control wrists without trauma or osteoarthritis, and the patient and control groups were statistically compared. Results: Statistically significant differences were observed between the patient and control groups in all the radiological parameters except for the AP length of SN and AP length of ulnar head. The width of radius, AP length of radius, width of SN, subluxation length of ulnar head, and dorsal inclination of SN were greater and the distance from Lister’s tubercle to SN was smaller in the patient group than in the control group. The width of SN, dorsal inclination of SN, and distance from Lister’s tubercle to SN were statistically significant risk factors among the 8 parameters. Conclusions ETRs due to osteoarthritis of the DRUJ was related to the changes of DRUJ, especially the changes around SN of the distal radius. In addition to the existing risk factors, a decreased distance from Lister’s tubercle to SN and increased dorsal inclination of SN were identified as new risk factors. Axial images of CT were effective to evaluate degenerative changes at the DRUJ.

Purpose: Septic arthritis of the knee is an orthopedic emergency that requires early diagnosis and surgical treatment. This study examined the effectiveness of drain insertion and irrigation in the treatment of septic arthritis of the knee under local anesthesia. Materials and Methods: A retrospective study was conducted on nine cases (eight patients) diagnosed with septic arthritis of the knee from September 2017 to February 2020 and treated with drain insertion and irrigation under local anesthesia. After penetrating through the superolateral portal to the superomedial portal and inserting the drain, daily irrigation of approximately 3 L of normal saline was done. The following were investigated: age, sex, underlying disease, cause, degree of osteoarthritis, time from diagnosis to surgery, duration of hospitalization, duration of normalization of C-reactive protein, and smear and culture. Results: The initial white blood cell count of joint fluid was 71,472±51,667/mm3 (32,400–203,904/mm3 ), and polymorphic leukocytes were 91.1%±2.6% (86%–95%). The average time from diagnosis to surgery was 8.3±1.3 hours (6–10 hours), and the irrigation period was 8.2±3.2 days (4–15 days). The average length of hospitalization was 20.8±8.7 days (9–37 days). There was no reoperation or recurrence. Smear and culture tests were not identified. Conclusion In the treatment of septic arthritis of the knee, the insertion of a drain tube and irrigation under local anesthesia is a relatively fast and simple method to reduce pain by repetitive draining of purulent joint fluid and can be used as an alternative treatment for patients with a risk of general or spinal anesthesia.

OBJECTIVE: This study was performed to evaluate the possibility of prolonged culture of human embryonic stem cells (hESC; SNUhES2) on human amniotic fluid cells (hAFC), which had been storaged after karyotyping. METHOD: The hAFC was prepared for feeder layer in the presence of Chang's medium and STO medium (90% DMEM, 10% FBS) at 37degrees C in a 5% CO2 in air atmosphere. Prior to use as a feeder layer, hAFC was mitotically inactivated by mitomycin C. The hESCs on hAFC were passaged mechanically every seven days with ES culture medium (80% DMEM/F12, 20% SR, bFGF). RESULTS: The hAFC feeder layer support the growth of undifferentiated state of SNUhES2 for at least 59 passages thus far. SNUhES2 colonies on hAFC feeder appeared slightly angular and flatter shape as compared with circular and thicker colonies observed with STO feeder layer and showed higher level with complete undifferentiation in seven days. Like hESC cultured on STO feeders, SNUhES2 grown on hAFC expressed normal karyotype, positive for alkaline phosphatase activity, high telomerase activity, Oct-4, SSEA-3, SSEA-4, Tra-1-60 and Tra-1-81 and formed embryoid bodies (EBs). CONCLUSION: The hAFC supports undifferentiated growth of hESC. Therefore, these results may help to provide a clinically practicable method for expansion of hESC for cell therapies.
Alkaline Phosphatase ; Amniotic Fluid* ; Atmosphere ; Embryoid Bodies ; Embryonic Stem Cells* ; Feeder Cells ; Female ; Humans* ; Karyotype ; Karyotyping ; Mitomycin ; Telomerase

Children's food behaviors have been expressed in a various ways because of recent changes in their family environment. Thus, this study was performed to investigate in-depth qualitative research on the mother's perception on children's food behaviors by focused group interview. This study was designed in four steps of planning, collection of participants, process, and analysis. Participants for the focus group interview were recruited and sampled from households with elementary school students in the Seoul and Gyeonggido areas. Groups were divided by total income and education expense levels. 1) High income household: It is better to improve currently existing web sites for nutrition education. 2) Mid income household: Easy, practical, and inexpensive off-line cooking class/nutrition education classes for mothers are needed. Nutrition programs for children should be developed through mass media and be promoted in the broadcasting circle. 3) Low income household: Motivation is required for mothers' education and the serious nutritional problems of children should be informed through mass media and home correspondence from school. And interesting educational materials should be developed for children to read whenever they want.
Child ; Cooking ; Family Characteristics ; Focus Groups ; Humans ; Interviews as Topic ; Mass Media ; Mothers ; Motivation ; Qualitative Research

The purposes of this study were firstly to investigate the any formation of precipitate after interaction between ALX and NaOCL and secondarily to analyze the PCA formation by using time of flight secondary ion mass (TOF-SIM) spectrometry. Mass spectrometry analysis was performed for the mixture of 0.5% ALX and 5.25% NaOCl. As controls, 2.5% CHX with 5.25% NaOCl and 1% PCA solutions were used. Any formation of precipitates in 10 tested solutions was evaluated by naked eye. Results of mass spectrum showed that the typical peak of PCA was not detected in mixed solution of ALX and NaOCl, whereas CHX/NaOCl mixture showed the same peak that found in the PCA spectrum. Precipitate formation was only observed in CHX/NaOCL mixture. The present TOF-SIM spectrometry results indicated that ALX can be a useful root canal irrigant combined with NaOCl during canal instrumentation. Further study is necessary to confirm the antimicrobial effect of ALX against endodontic pathogen before its clinical application as an endodontic irrigant.
Aniline Compounds ; Biguanides ; Dental Pulp Cavity ; Eye ; Mass Spectrometry ; Passive Cutaneous Anaphylaxis ; Sodium ; Sodium Hypochlorite ; Spectrum Analysis