Objective: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is suggested as a prognostic biomarker for communityacquired pneumonia (CAP). However, its predictive value for an individual adult and elderly CAP patients has not been fully investigated. Methods: Patients with CAP aged 18 years and older, who visited the emergency department (ED) from March 1, 2016 to March 31, 2019, were included in this study. Patients were divided into the adult group and the elderly group (age ≥70 years). Data was collected from the ED-based registry, and medical charts were retrospectively reviewed. The registry data included sociodemographic and past medical characteristics, as well as laboratory findings including NT-proBNP and C-reactive protein (CRP), Pneumonia Severity Index (PSI), and CURB65 (confusion, urea, respiratory rate, blood pressure, and aged 65 or more). The independent potential of NT-proBNP to predict mortality was assessed in both groups using multivariable logistic regression, and its predictive ability was evaluated in terms of performance (using areas under the curve [AUCs]) and goodness-of-fit (using the Bayesian information criterion [BIC]). Results: Totally, 325 CAP patients were evaluated, of which 208 (64%) belonged to the elderly group. NT-proBNP was identified as an independent predictor of CAP mortality in elderly patients, but not in adult patients. Moreover, AUC of the NT-proBNP for mortality was comparable to AUC of the PSI, but was higher than that of the CURB65, in elderly CAP patients. Similarly, the NT-proBNP had a better overall fit (lower BIC value) compared to the CURB65, for mortality. Additionally, both AUC and overall fit of the NT-proBNP for mortality were significantly superior to values obtained for CRP. Conclusion For elderly CAP patients in the ED, the NT-proBNP is an independent and useful predictor of mortality.

No abstract available.

Nevus sebaceus is a congenital cutaneous hamartoma which has a potential to develop both benign and malignant neoplasm in late life. The most common benign tumor developed within the nevus is syringocystadenoma papilliferum and the most common malignant tumor basal cell epithelioma. Although two different tumors often develop simultaneously on the lesion, it is rare to see more than two different tumors developing on the lesion of nevus sebaceus. In Korean literatures only three such cases were reported. We report an additional case of nevus sebaceus developing three different tumors, syringocystadenoma papilliferum, sebaceous epithelioma, and basal cell carcinoma, in a 67-year-old female patient.
Aged ; Carcinoma* ; Carcinoma, Basal Cell* ; Female ; Hamartoma ; Humans ; Nevus*

The Nocardia species are aerobic Gram-positive filamentous bacteria found worldwide in soil and decaying organic plant matter. Primary cutaneous nocardiosis is a rare entity and most commonly caused by Nocardia brasiliensis (N. brasiliensis). However, it can rarely be caused by N. farcinica, which is recognized as a human pathogen. Here we report a case of a 54-year-old female patient who presented with erythematous nodules on her abdomen for 1 week. She had been treated with methotrexate and prednisolone due to systemic lupus erythematosus and rheumatoid arthritis. By bacterial culture and 16S ribosomal RNA gene sequencing, the patient was diagnosed with a primary cutaneous nocardiosis caused by N. farcinica, which has not previously been reported in the Korean dermatological literature.
Abdomen ; Arthritis, Rheumatoid ; Bacteria ; Female ; Humans ; Lupus Erythematosus, Systemic ; Methotrexate ; Middle Aged ; Nocardia Infections* ; Nocardia* ; Plants ; Prednisolone ; RNA, Ribosomal, 16S ; Soil

PURPOSE: Recently, a new animal model for permanent focal brain ischemia using macrospheres was developed wherein the hypothalamic area was free from ischemic injury. The purpose of this study was to evaluate spatiotemporal changes in the expressions of cFos, pERK, and pAkt proteins in the macrosphere model. METHOD: Three or four macrospheres were injected into the internal carotid artery after ligation of the external carotid artery to induce permanent focal brain ischemic injury. RESULT: Twenty-four hours after macrosphere injection, 2,3,5-Triphenyltetrazlium (TTC) staining showed a marked ischemic injury in the blood supply territory of the middle cerebral artery, for example, the cerebral cortex and striatum. Furthermore, TUNEL staining revealed apoptotic cell death in the ischemic injury region of the cerebral cortex and striatum. Expression of the cFos protein was significant in the penumbral zone, but not in the ischemic core of the cortex and striatum, two and six hours after ischemic insult. A transient prominent expression of the pERK1/2 protein was noted in the penumbral zone of the cortex and striatum two hours after injection of macrospheres. In contrast, there was a strong immunoreactivity for the pAkt protein in the ischemic core, but not in the penumbral zone of the cortex and striatum, six hours after ischemic injury. CONCLUSION: The above results suggest that early expressions of cFos, pERK1/2, and pAkt proteins take part in different signaling cascades for cell survival or death in macrosphere animal model of permanent focal brain ischemic injury.
Animals* ; Brain Ischemia ; Brain* ; Carotid Artery, External ; Carotid Artery, Internal ; Cell Death ; Cell Survival ; Cerebral Cortex ; In Situ Nick-End Labeling ; Ligation ; Middle Cerebral Artery ; Models, Animal*

No abstract available.
Classification* ; Risk Factors* ; Trophoblastic Neoplasms* ; Trophoblasts*

PURPOSE: This paper examined the results of a tibiofibular osteotomy and external fixation in idiopathic genu varum. MATERIALS AND METHODS: Ten patients (20 cases) with idiopathic genu varum were treated with a tibiofibular osteotomy and external fixation. The average follow-up period was 13 months (range, 6-27). The average age of the patients was 23.1 (range, 16-39). A tibial osteotomy was performed an average 9.1 cm (range, 5-13.5) distal to the tibial spine, which was 2 cm distal to the center of the rotation axis (CORA). RESULTS: The preoperative anatomical tibio-femoral angle of varus, 7.0o (range, 4-10), was corrected to valgus 0.8o (range, varus 5-valgus 6). After surgery, the femur intercondylar distance of 5.3 cm (range, 4-7) was improved to 0.4 cm (range, 0.5-4), and the preoperative average maximal intercalf distance of 11.2 cm (range, 8.5-13) was improved to 6.5 cm (range, 4-9). A preoperative mechanical axis deviation of 2.0 cm (range, 0-3.5) improved to 0.3 cm (range, 0-2.3). The complications encountered were 4 cases of a pin site infection, 1 case of a superficial peroneal sensory nerve injury, 1 case of a deep peroneal nerve partial injury and 2 cases of a popliteal artery partial occlusion. CONCLUSION: The tibiofibular osteotomy and external fixation is considered to be an effective method for treating an idiopathic genu varum with early ROM and weight bearing. However, surgeons need to pay careful attention in order to prevent a neurovascular complications.
Axis, Cervical Vertebra ; Femur ; Follow-Up Studies ; Genu Varum* ; Humans ; Osteotomy* ; Peroneal Nerve ; Popliteal Artery ; Spine ; Weight-Bearing

PURPOSE: To analyze the results between PFN (Proximal Femoral Nail) and DHS (Dynamic Hip Screw) on the operative treatment of unstable intertrochanteric fractures retrospectively. MATERIALS AND METHODS: 35 cases of unstable intertrochanteric fractures (grouped 24 patients with DHS and 11 patients with PFN) who were taken the operations from Jan. 2001 to Mar. 2002 were analysed regarding to union state, union time, operation time, sliding length of lag screws, blood loss, postoperative complications and functional recovery scores by Sk?vron with ANOVA and multivariate linear regression. RESULTS: The means of union time were 17.9 weeks (DHS) and 17.0 weeks (PFN), sliding length of lag screws were 3.9 mm (DHS) and 2.1 mm (PFN), perioperative blood losses were 743 cc (DHS) and 736 cc (PFN), operation time were 93.4 minutes (DHS) and 102 minutes (PFN), and the functional recovery scores by Sk?vron were 71.8% (DHS) and 76.8% (PFN), respectively. The results of our study indicate that there were not statistically significant differences between PFN and DHS groups in treatment of unstable intertrochanteric fractures (p>0.05). But, there was less sliding of lag screws in PFN group in statistical significance (p<0.05). CONCLUSION: Authors think that PFN is one of the useful implants in treating unstable intertrochanteric fractures of the femur in regarding to sliding.
Femur* ; Hip Fractures ; Hip* ; Humans ; Linear Models ; Postoperative Hemorrhage ; Retrospective Studies

OBJECTIVE: To define arthrographic findings in patients with frozen shoulder and to evaluate the therapeutic effect of arthrographic capsular distension and rupture. METHOD: Thirty patients who were clinically diagnosed as frozen shoulder were enrolled. During a trial of intra-articular injection of 35 mL of fluid which contained 8 mL of 1% lidocaine, 2 mL of prednisolone (80 mg) and 25 mL of radiocontrast material, arthrographic findings and the occurrence of iatrogenic capsular tear were observed. Passive range of shoulder motion (percent of normal, %) at flexion, abduction, internal rotation, and external rotation was measured at pre- and 1 week post-injection. The therapeutic effect of the procedure was statistically analyzed by paired Student's t-test. RESULTS: Mean age of the subjects was 57-years-old (range: 40~76 years) and mean duration of the symptom was 6 months (2~42 months). A decreased joint volume of less than 10 mL (100%), poor or absent filling of the axillary recess or subscapular bursa (75.9%), nonfill of the biceps tendon sheath (37.9%), and irregularity of capsular insertion (31.0%) were typical abnormal arthrographic findings. In one week after arthrographic distension and rupture, the passive range of shoulder motion was significantly (p<0.05) increased at flexion, abduction and external rotation, of which the range of external rotation was the most remarkably increased (mean, 23.9%). CONCLUSION: Distension arthrography was useful for increasing shoulder motion in frozen shoulder, especially at flexion, abduction and external rotation.
Arthrography* ; Bursitis* ; Humans ; Injections, Intra-Articular ; Joints ; Lidocaine ; Prednisolone ; Rupture ; Shoulder ; Tendons

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin lesion) is rare multisystem disease of unknown cause with varying clinical manifestations. Although there is no established definition for this syndrome, the common classical features are considered to be secondary to the plasma cell dyscrasia with the production of a monoclonal component. Anasarca, including ascites, peripheral edema, and pleural effusion, occurs frequently in POEMS syndrome, but cases with idiopathic liver cirrhosis are rarely reported. We experienced a 73-year-old female with POEMS syndrome whose main problem was massive ascites. It is the first report of idiopathic liver cirrhosis in a patient with POEMS syndrome in Korea.
Aged ; Ascites ; Edema ; Female ; Humans ; Korea ; Liver ; Liver Cirrhosis ; Paraproteinemias ; Pleural Effusion ; POEMS Syndrome ; Skin