PURPOSE: The objective of this study was to find the predictors and generate a prediction scoring model of nonresponse to intravenous immunoglobulin in patients with Kawasaki disease. METHODS: We examined 573 children diagnosed with KD at the Severance Children's Hospital between January 2009 and december 2012. We retrospectively reviewed their medical records. These patients were divided into 2 groups; the experimental group (N=433) and the validation group (N=140). Each group were divided into 2 groups the intravenous immunoglobulin nonresponders and the responders. Multivariate logistic regression analysis identified predictive factors of intravenous immunoglobulin nonresponders which make predictive scoring model. We practice internal validation and external validation. RESULTS: Multivariate logistic regression analysis identified male, cervical lymphadenopathy, changes of the extremities, platelet, total bilirubin, alkaline phophatase, lactate dehydrogenase, C-reactive protein as significant predictors for nonresponse to intravenous immunoglobulin. We generated prediction score assigning 1 point for (1) male, (2) cervical lymphadenopathy, (3) changes of the extremities, (4) platelet (< or =368,000/mm3), (5) total bilirubin (> or =0.4 mg/dL), (6) alkaline phophatase (> or =227 IU/L), (7) lactate dehydrogenase (> or =268 IU/L), (8) C-reactive protein (>77.1 mg/dL). Using a cut-off point of 4 and more with this prediction score, we could identify the intravenous immunoglobulin nonresponder group. Sensitivity and specificity were 52.5% and 82.4% in experimental group and 37.8% and 81.8% in validation group, respectively. CONCLUSION: Our predictive scoring models had high specificity and low sensitivity in Korean patients. Therefore it is useful in predicting nonresponse to intravenous immunoglobulin with Kawasaki disease.
Bilirubin ; Blood Platelets ; C-Reactive Protein ; Child ; Extremities ; Humans ; Immunoglobulins* ; Korea ; L-Lactate Dehydrogenase ; Logistic Models ; Lymphatic Diseases ; Male ; Medical Records ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity

Bicuspid ; Crowding ; Humans ; Incisor ; Malocclusion ; Orthognathic Surgery ; Orthopedics ; Osteotomy ; Palatal Expansion Technique ; Recurrence ; Temporomandibular Joint ; Temporomandibular Joint Disorders

A rare case of traumatic bilateral anterior and posterior dislocstions of the hip wss occured by autamobile accident as a passenger injury. The right hip was dislocated anteroinferior to the righ scetabulum(neer the right obturator froamen), and the left hip was dislocated posterosuperior to the left acetsbulum with a ipsilateral femur head fracture caudsd to the fovea centralis(Fig. 1).
Dislocations ; Femur Head ; Femur ; Hip

The femoral fracture, occurred associated with the cemented hip arthroplasty, is well-known cornplication but the proximal femoral fractures of the noncemented hip arthroplasty, were occurred more than those. Among the 290 patients, who were treated by the noncemented hip arthroplasty from Dec. 1987 to April 1992, the 24 cases of the femoral fracture were experienced and the results were as follows: 1) of the 24 cases, the male was nine and the female was fifteen. The age distribution was mostly occurred between 41 and 60 years old and most fracture were developed in 1 1mm stem size. In revision cases, 225mm stem length (Wagner) was common. The locations of fracture were proximal 1/3 (type I: 19 cases), tip (type II; 1 case), distal 1/3 (type III; 1 case) and comminuted (type IV; 3 cases) by Johansson; siclassification. 2) The femoral fracture was mostly developed during the stem insertion and the fracture site in anatomical stem was only proximal femur. 3) 1n cases of revision, most of the fractures were occured on the anterior or lateral side of the femur. It was difficult to manage the fracture because of the severe osteoporosis and comminution. 4) As the problem of the operative technique, the fracture incidence can be decreased by accurate preoperative measurement and it must be cautious in the stem more than 225 mm length, which were used in revision case. 5) The circumferential wiring for proximal and plate & screws in middle and distal were done as the treatment of fracture and the results were all good, but stem tip fracture in osteoporotic patients was troublesome. We think that long plate(>8 holes) & both cortex purchase and bone graft are best methods so far.
Age Distribution ; Arthroplasty ; Female ; Femoral Fractures ; Femur ; Hip ; Humans ; Incidence ; Male ; Osteoporosis ; Transplants

OBJECTIVES: Culture of sputum is apt to be contaminated through oral cavity and proximal airway. Therefore, identification of true etiologic agents by sputum culture is not always reliable. In order to differentiate the pulmonary infection from non-infectious disease and to identify the true etiologic agent of acute pulmonary infection, we used PSB(Protected Specimen Brushing) and evaluated the efficacy of PSB. METHODS: In 168 patients with acute febrile illness with pulmonary infiltrations(male 106, female: 61, mean age: 49.5+/-17.6), we performed PSB via a bronchoscope and compared the results along with blood culture and sputum culture. Protected specimen brush was introduced through biopsy channel of bronchoscope and was rotated within the purulent secretions. Tip of the brush was severed with aseptic technique and was immersed in 1cc of Ringer's lactate solution and vigorously mixed for 1 minute. The specimen was submitted for quantitative culture within 15 minutes and was regarded positive culture if colony forming units were above 10(3)/ml. RESULTS: Using PSB for the diagnosis of pulmonary infection, sensitivity was 71.1% and specificity was 84.296. PSB was helpful in identifing true etiologic agent among several potentially pathogenic organisms. Using PSB for the diagnosis of UAP (ventilator associated pneumonia), sensitivity was 72.4% and specificity was 100%. CONCLUSION: Use of PSB can be a helpful method for the diagnosis of pulmonary infection and identification of its etiologic agents.
Biopsy ; Bronchoscopes ; Diagnosis* ; Female ; Humans ; Lactic Acid ; Mouth ; Pneumonia ; Sensitivity and Specificity ; Sputum ; Stem Cells

BACKGROUND: Eosinophilic leukocytes are prominent cellular participants in the pathogenesis of allergic disease and asthma. Chemotaxis is still a very useful method in evaluating the response of human eosinophil to novel modulators. Degranulated mast cells and activated T lymphocytes are responsible for the pathophysiology of asthma and tryptase is one of most important proteases released after activation of mast cells. The purpose of this study was to investigate the actions of trypsin and chymotrypsin on eosinophils in terms of chemotaxis and activation. METHOD: Eosinophils were isolated by negative immunoselection from the peripheral blood of atopic donors. Chemotaxis was studied by using micro-Boyden chambers and ECP release was assayed by fluoroimmunoassay. RESULTS: Eosinophil showed a chemotactic response to trypsin. Maximal chemotactic response was with 1000microg/ml trypsin (56.52 +/- 14.50/HPF) which was comparable to PAF. But chymotrypsin showed no significant chemotactic response to eosinophils. Trypsin at the concentration of 10, 100,1000microg/ml induced secretion of ECP, which at the concentration of 10microg/ml represented about 2.7 times of the spontaneous rate of release. Soybean protease inhibitor reduced trypsin induced ECP release. CONCLUSION: Trypsin can induce chemotactic response to eosinophils and activation of eosinophils that can induce secretion of ECP. On the contrary, chymotrypsin showed no direct effect on eosinophils. We propose a role of trypsin on the chemotaxis and activation of eosinophils.
Asthma ; Chemotaxis* ; Chymotrypsin ; Eosinophils* ; Fluoroimmunoassay ; Humans ; Leukocytes ; Mast Cells ; Peptide Hydrolases ; Protease Inhibitors ; Soybeans ; T-Lymphocytes ; Tissue Donors ; Trypsin* ; Tryptases

Transesophageal echocardiogram (TEE) was performed in the 86 normal persons using a UM9 of ATL with a 3.5 MHZ transducer in the Heart Center of Dong-A University Hospital during March-September 1990. 1) The transesophageal basal short axis views in the normal were seen in the Fig. 2~6. The Fig. 2 showed 3 aortic valve cusps, Fig. 3 the left coronary artery, Fig. 4 the right pulmonary artery bifurcated from the main pulmonary artery, Fig. 5 3 major vessels of superior vena cava, aorta and pulmonary artery and Fig. 6 the Left atrial appendage. 2) The transesophageal 4-chamber views in the normal were seen in Fig. 7~10. The Fig. 7 showed the left ventricular outflow tract, Fig. 8 right and left atrium and ventricle, Fig. 9 the atrial septum containing the membrane of fossa ovalis and Fig. 10 right atrium and ventricle. 3) The transesophageal transgastric short axis view in the normal was seen in Fig. 11. Fig. 11 showed the transverse image of LV and RV. 4) The transesophageal ascending aorta image was observed in Fig. 3. descending aorta image in Fig. 12 and the transesophageal aortic arch image in Fig. 14. 5) From the transesophageal 4 chamber view the septum-lateral wall dimension of the left ventricle was 5.0cm and the dimension between the apex and the closed mitral valve 6.3cm. The medial-lateral dimension of the left atrial appendage was 3.0cm and the superior-inferior dimension 4.1cm. The dimension of the descending aorta was 2.7cm and the ascending aorta 3.0cm.
Aorta ; Aorta, Thoracic ; Aortic Valve ; Atrial Appendage ; Atrial Septum ; Axis, Cervical Vertebra ; Coronary Vessels ; Echocardiography, Transesophageal ; Heart ; Heart Atria ; Heart Ventricles ; Humans ; Membranes ; Mitral Valve ; Pulmonary Artery ; Transducers ; Vena Cava, Superior

Sheen's ground rules can help avoid many of the pitfalls in secondary rhinoplasty. There are 1) establish realistic patient expectations; 2) defer surgery until the final resolution of the tissues; 3) have a well-defined aesthetic concept; 4) make a proper diagnosis; 5) limit the dissection and 6) use only the autogenous materials. The authors tried to ascertain which rule is the most important and should be strictly obeyed, what is the effect if the rules not obeyed, and what is the important aspects of any other rules not mentioned. Eight females cases(n=8) of secondary rhinoplasty from 1992 to 2002 were analyzed according to Sheen's ground rules. After surgery, the implants or the grafted tissues were either exposed or extruded, in two out of the five cases that did not follow the second principle, in two out of the four cases that did not the sixth principle, and in one case that did not the fifth principle. The authors conclude that all the principles of the ground rules should be obeyed if possible, most of all, it is very important to obey the first principle i.e. establishing the a realistic expectation, and second principle i.e. deferring the surgery until more than a year. Though it is undoubtful that the use of the autogenous materials is the best choice, the authors believe that a limited incisions and dissections and the use of smaller implants can help reduce the risk of complication if the alloplastic implants should be used.
Diagnosis ; Female ; Humans ; Rhinoplasty* ; Transplants

A case of systemic coccidioidomycosis with cutaneous lesions has been found in Dec. 1974, for the first time in Korea, which is proved through cutaneous biopsy .and mycologic culture from skin lesion. The patient was 57-year-old Korean male. Skin lesions on left extremities showed several skin colored or ligbt brownish papules and surrounding circular erythematous scaly patches with slightly elevated borders. The patient was also found to have moderate diabetes mellitus, hypokalemia and resultant neuropathy. Histopathology revealed granulomatous lesions in the upper dermis, and numerous spherules both inside and outside of giant cells. Mycologic culture from grind skin specimen on Sabourauds glulose agar showed snow-white colony and ather typical arthrospores. Ampbotericin B intravenous injection was started and continued for 16 days. During a,dministration of the drug, side effects consisting of chills, fever, headache, chest pain and dyspnea developed. Therefore, further administration of the drug could not be done. During tbe several months following last discharge from the hospital, the patient has been, with no further specific therapy, in relatively good general condition, and developed no new lesions. The old papules have diminished in size, but did not disappear.
Agar ; Biopsy ; Chest Pain ; Chills ; Coccidioidomycosis* ; Dermis ; Diabetes Mellitus ; Dyspnea ; Extremities ; Fever ; Giant Cells ; Headache ; Humans ; Hypokalemia ; Injections, Intravenous ; Korea ; Male ; Middle Aged ; Skin

No abstract available.
Bone Marrow* ; Head* ; Neck*