BACKGROUND: The aim of this study is to evaluate the influence of immunosuppressants on in-hospital mortality from sepsis. METHODS: Using data of the Health Insurance Review & Assessment Service, we collected data from patients who were admitted to the hospital due to sepsis from 2009 to 2013. Based on drugs commonly used for immunosuppression caused by various diseases, patients were divided into three groups; immunosuppressant group, steroid-only group, and control group. Patients with no history of immunosuppressants or steroids were assigned to the control group. To identify risk factors of in-hospital mortality in sepsis, we compared differences in patient characteristics, comorbidities, intensive care unit (ICU) care requirements, and immunodeficiency profiles. Subgroup analysis according to age was also performed. RESULTS: Of the 185,671 included patients, 13,935 (7.5%) were in the steroid-only group and 2,771 patients (1.5%) were in the immunosuppressant group. The overall in-hospital mortality was 38.9% and showed an increasing trend with age. The steroid-only group showed the lowest in-hospital mortality among the three groups except the patients younger than 30 years. The steroid-only group and immunosuppressant group received ICU treatment more frequently (p < 0.001), stayed longer in the hospital (p < 0.001), and showed higher medical expenditure (p < 0.001) compared to the normal group. Univariate and multivariate analyses revealed that age, male gender, comorbidities (especially malignancy), and ICU treatment had a significant effect on in-hospital mortality. CONCLUSIONS: Despite longer hospital length of stay and more frequent need for ICU care, the in-hospital mortality was lower in patients taking immunosuppressive drugs than in patients not taking immunosuppressive drugs.
Comorbidity ; Health Expenditures ; Hospital Mortality ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Insurance* ; Insurance, Health ; Intensive Care Units ; Korea* ; Length of Stay ; Male ; Mortality ; Multivariate Analysis ; Risk Factors ; Sepsis* ; Steroids

The authors analysed 340 cases of the ocular injuries among 7633 out and in-patients who visited to the clinic of P.N.U. hospital during 5 years, from Jan. 1964 to Dec. 1968. Followings were discussed. 1. We found that 4.6% of all cases attending our eyes clinic was victims of ocular injuries. 2. The sex incidence showed that 78.9% of such ocular injuries occured in male and 21.1% in female. 3. The incidence was prevalent in young adult 21-30 years of age, and their large number of cases were injured from blowing and industrial accidents, while in children under 10 years of age sharp-pointed toys were more frequent causes. 4. The subconjunctival hemorrhage was the most frequent disturbance of ocular injuries and then came traumatic cataract and corneal foreign bodies in that order. 5. The prognosis of ocular injuries was generally poor, especially, poor, especially in the perforating and penetrating wound of the whether the foreign body was retained or not.
Accidents, Occupational ; Cataract ; Child ; Female ; Foreign Bodies ; Hemorrhage ; Humans ; Incidence ; Male ; Play and Playthings ; Prognosis ; Wounds, Penetrating ; Young Adult

Several synkinetic oculopalpebral phenomena were described in the literature in relation to ophthalmoplegias, congenital as well as acquired. Several neurologic explanations have been offered to explain their occurrence, but the entity of the phenomenon is not well clarified yet. From the study of the cases, where the third cranial nerve showed a palsy, some observations appear to be significant. This was present in both cases. In each the affected eye was divergent in the primary position. When the contralateral sound eye was covered the divergent affected eye moved medially to assume fixation, the sound eye showed an exag-gerated secondary deviation behind the occluder and at the same time, the ptotic lid showed an elevation, making the palpebral aperture wider. Adduction of the affected eye was retricted and on atttmption it widtning of the palpebral aperature indicated the occurrence of Fuchs phenomenon, the sound eye being markedly abducted. On abduction the palpebral aperture of the affected eye became narrower due to an increased ptosis. The author quoted Gowers stating the possibility of the overflow of in voluntary impulses carried by one nerve from its usual channels into another giving rise to the phenomenon. On abduction, the size of pupil became wider due to an increased ptosis. It can be deduced to be over-impulses of parasympathetic nerve. Two cases of ophthalmoplegias are described in this paper and it is hoped that the conelusions drawn therefrom may throw some light on this matter.
Hope ; Oculomotor Nerve ; Ophthalmoplegia ; Paralysis ; Pupil

Hyperamylasemia and hyperlipidemia occur when the amounts of amylase and lipase that enter the blood overweigh the kidney and liver reticuloendothelial system clearance of the enzymes. In normal homeostasis, most of these enzymes are excreted from the apical membrane of the acinar cells into the ductal system of the gland. However, in pathological conditions, this apical exocytosis is blocked, and the leakage of these enzymes at the basolateral membrane is increased. Therefore, these enzymes are released into the bloodstream. Many different pancreatic pathologies and Gullo syndrome can cause this type of leakage in the pancreas. This mechanism can also cause basolateral leakage in other organs that secrete amylase and lipase. In small bowel inflammatory conditions, amylase and lipase are absorbed through the inflamed mucosa and introduced into the bloodstream due to increased vascular permeability. Regardless of the enzymes that enter the blood circulation, several kidney and liver diseases prevent the excretion and metabolism of serum amylase and lipase. When the amylase and lipase are combined with immunoglobulins, they escape normal glomerular filtration due to the development of macroenzymes and accumulate in the blood. These situations related to the clearance of the enzymes are also crucial mechanisms of serum enzyme elevation that should not be overlooked.

OBJECTIVE: This study was conducted to investigate the effect of vitrification on the implantation the pregnancy of human blastocysts. METHOD: The transfer of the frozen-thawed blastocysts by the slow freezing or vitrification was performed between January 1998 and July 1999. The zygotes derives from IVF were cocultured with cumulus cells in YS medium containing 20% hFF for 5days. Two or three of the best balstocysts produced on day 5 were transferred into the uterus, and then supernumerary blastocysts were randomly divided into two groups. One was frozen by slow freezing and the other was frozen by vitrification method. The slow freezing procedure was performed in two steps (5% glycerol and 9% glycerol + 0.2 M sucrose for 10 min, respectively) using programmed freezer (-2degrees C/min to -7degrees C, 0.3degrees C and plunged into LN2). The blastocysts frozen by slow freezing were thawed at 36degrees C then removed glycerol in 7 steps. The vitrification procedure was performed in three steps (10% glycerol for 5 min, 10% glycerol + 20% ethylene glycol for 5 min, 25% glycerol + 25% ethylene glycol and directly LN2 within 1 min). The blastocysts frozen by vitrification were thawed at 20degrees C water then removed cryoprotectant in 3 steps. In each group, thawed blastocysts were cocultured with cumulus cells in YS medium containing 20% hFF for 18h and transferred into the uterus. The implantation rate was evaluated per transferred blastocysts and the pregnancy rate was evaluated per transfers. RESULTS: The survival rate of vitrified group (74.5%) was higher than slow freezing group (68.0%), but not significant. When 98 thawed blastocysts of vitrification were transferred in 40 cycles, 19 pregnancies (clinical pregnancy rate; 47.5%) were established. One miscarriage occurred in the eighth week of pregnancy (ongoing pregnancy rate; 45.0%). 7 pregnancies were ongoing, 11 pregnancies went to term, and 16 healthy infants were born. The Implantation rate was 31.6%. These results were higher than those obtained by the slow freezing (clinical pregnancy rate; 40.3%, ongoing pregnancy rate; 32.5% and implantation rate; 25.3%), but not significant. CONCLUSION: Vitrification is a simple, quick and economical method when compared to slow freezing. It will be chosen as a good method of human embryo freezing in IVF-ET programs.
Abortion, Spontaneous ; Blastocyst* ; Cumulus Cells ; Embryonic Structures ; Ethylene Glycol ; Female ; Freezing ; Glycerol ; Humans ; Infant ; Pregnancy Rate ; Pregnancy* ; Sucrose ; Survival Rate ; Uterus ; Vitrification* ; Water ; Zygote

Glucagon-like peptide 1 (GLP-1) is an incretin hormone that is released from enteroendocrine L-cells upon nutrient absorption; it stimulates glucose-dependent insulin secretion from pancreatic betacells. GLP-1 has pleiotropic effects including deceleration of gastric emptying, decreased appetite, and increased satiety. Treatment with GLP-1 receptor agonists (GLP-1RAs) improves glycemic control in patients with type 2 diabetes without increasing the risk of hypoglycemia or weight gain. Current GLP-1RAs can be classified by their structure (exendin-4-based or human GLP-1-based), duration of action, and molecular size. Different GLP-1RAs exhibit different pharmacokinetics and pharmacodynamics. Herein we review the characteristics of available GLP-1RAs and discuss current issues such as insulin combination therapy and anti-obesity effects.
Absorption ; Appetite ; Deceleration ; Diabetes Mellitus, Type 2 ; Gastric Emptying ; Glucagon-Like Peptide 1* ; Humans ; Hypoglycemia ; Incretins ; Insulin ; Obesity ; Pharmacokinetics ; Weight Gain ; Glucagon-Like Peptide-1 Receptor

A Meige's syndrome is a rare neurological syndrome characterized by blepharospam and oromandibular dystonia. Its pathophysiology is not clearly determined yet, but the hypothesis of dopaminergic and cholinergic hyperactivity is most widely accepted. Anticholinergic drugs, antidopaminergic drugs and botulism toxin injection are currently used for the treatment of Meige's syndrome. The Meige's syndrome could be misdiagnosed as a psychaitric disorder such as conversion disorder or anxiety disorder, because clinical features of the Meige's syndrome are very variable and affected by psychological factors. The authors experienced one case of a 49-year-old female patient who was initally misdiagnosed as conversion disorder but confirmed later as Meige's syndrome, and then successfully treated.
Anxiety Disorders ; Botulism ; Conversion Disorder* ; Diagnosis, Differential* ; Dystonia ; Female ; Humans ; Middle Aged ; Psychology

OBJECTIVE: Our aim was to compare the compression quality, exercise intensity, and energy expenditure in 5-minute single-rescuer cardiopulmonary resuscitation (CPR) using 15:1 or 30:2 compression-to-ventilation (C:V) ratios or chest compression only (CCO). METHODS: This was a randomized, crossover manikin study. Medical students were randomized to perform either type of CPR and do the others with intervals of at least 1 day. We measured compression quality, ratings of perceived exertion (RPE) score, heart rate, maximal oxygen uptake, and energy expenditure during CPR. RESULTS: Forty-seven students were recruited. Mean compression rates did not differ between the 3 groups. However, the mean percentage of adequate compressions in the CCO group was significantly lower than that of the 15:1 or 30:2 group (31.2±30.3% vs. 55.1±37.5% vs. 54.0±36.9%, respectively; P<0.001) and the difference occurred within the first minute. The RPE score in each minute and heart rate change in the CCO group was significantly higher than those of the C:V ratio groups. There was no significant difference in maximal oxygen uptake between the 3 groups. Energy expenditure in the CCO group was relatively lower than that of the 2 C:V ratio groups. CONCLUSION: CPR using a 15:1 C:V ratio may provide a compression quality and exercise intensity comparable to those obtained using a 30:2 C:V ratio. An earlier decrease in compression quality and increase in RPE and heart rate could be produced by CCO CPR compared with 15:1 or 30:2 C:V ratios with relatively lower oxygen uptake and energy expenditure.
Cardiopulmonary Resuscitation* ; Energy Metabolism* ; Heart Rate ; Humans ; Manikins* ; Oxygen ; Students, Medical ; Thorax* ; Ventilation

No abstract available.
Multiple Myeloma* ; Plasmacytoma*

Malignant melanoma of the vulva is a rare neoplasm and accounts for approximately 10% of all vulvar malignancies. Five-year survival rates range from 8% to 54%, with occuring predominantly in postmenopausal white women. As compared with malignant melanoma of the skin, vulvar melanoma infiltrates early deep into the tissues with abundant lymphatic channels and blood vascularization, so its prognosis is mostly poor. Depth of invasion has been reported as the single most important indicator of prognosis. Historically the treatment of choice for vulvar melanoma has been en bloc radical vulvectomy with bilateral inguinofemoral lymphadenectomy. But recently there have been reports suggesting that acceptable survival may be achieved by less radical operation. The authors report a 84-year old woman with malignant melanoma of the vulva. She underwent wide local excision of the lesion. Now we are following her up with no clinical evidence of cancer recurrence and remnant.
Aged, 80 and over ; Female ; Humans ; Lymph Node Excision ; Melanoma* ; Prognosis ; Recurrence ; Skin ; Survival Rate ; Vulva*