Herpes zoster is acute viral infection characterized by the appearance of vesicles that occur on the skin and mucous membrane along the pathway of an involved sensory nerve. The incidence is increased in those who have history of trauma, malignant tumor, radiation therapy and the immuno-suppressive drug users. Although herpes zoster is usually as benign viral infection, complications may occur especially when cranial nerves are involved. So careful treatment is necessary when cranial nerves are involved. We have treated two cases. One is involved trigeminal nerve mandibular branch, another maxillary branch. We have used conservative therapy, pain control, acyclovir on this area and obtained good result. After 17 and 8 months respectively, no complications occur in our two cases. So we present two cases with review of literature.
Acyclovir ; Cranial Nerves ; Drug Users ; Herpes Zoster* ; Humans ; Incidence ; Mucous Membrane ; Skin ; Trigeminal Nerve

PURPOSE: To evaluate the incidence, risk factors and prognosis of delirium in elderly patients with intertrochanteric fractures of femur. MATERIALS AND METHODS: 162 patients who underwent operation for intertrochanteric fracture of femur from July 2005 to January 2007 were reviewed retrospectively. Delirium was diagnosed by using Confusion Assessment Method (CAM). Medical records were reviewed for the information of the patients, Gross motor function classification of Palisano et al. was used for the evaluation of ambulatory status. Univariate analysis and multivariate analysis were done to find out the risk factors. RESULTS: 2 cases out of 162 (1.2%) met the criteria of delirium at admission, and 39 cases (24.1%) after surgery. Univariate analysis and multivariate analysis identified age, hematocrit, dementia, the duration of opiate use, and pulmonary complication as risk factors. Hospital stay was longer and postoperative ambulatory status was worse in the patients with delirium. CONCLUSION: Delirium is a frequent complication of intertrochanteric fractures of old age and associated with worse results. Cognitive function as well as physical status should be evaluated before and after surgery. Delirium needs more active prevention and treatment for better results.
Aged ; Delirium ; Dementia ; Femur ; Hematocrit ; Hip Fractures ; Humans ; Incidence ; Length of Stay ; Medical Records ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; Risk Factors

BACKGROUND: Bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT) following high dose chemotherapy has been an important therapeutic option for patients with hematologic malignancies or some solid tumors. The number of progenitor cells in the collection products has been used to determine the optimum time to stop the collections and to predict the hematopoietic engraftment after transplantation. In this study, we investigated the relationship between end-product cell counts measured by different methods and the influence of the infused cell dose on the engraftment rate. METHODS: Twenty five patients receiving autologous PBSCT and 25 patients receiving allogeneic BMT were studied. The number of total nucleated cells (TNC), of mononuclear cells (MNC), of CD34+ cells, and of CFU-GM (colony-forming unit-granulocyte monocyte) colonies were measured in each collection product. The number of days required to achieve an absolute neutrophil count (ANC) of 0.5x109/L with TNC count of 1.0x109/L and platelet count of 20x109/L without transfusions was taken as an arbitrary measure of the engraftment rate. RESLUTS: A close correlation between CD34+ cells/kg and CFU-GM/kg was observed in both collection products (p<0.05). However, MNC/kg also showed significant correlations with CD34+ cells/kg and CFU-GM/kg in allogeneic bone marrow collection products (p<0.05). The CFU-GM amount in the PBSC products was greater than that in the bone marrow collection products (p<0.05). Time to engraftment was a median of 14 (range 9-50) days in autologous PBSCT group, but 29 (range 17-57) days in allogeneic BMT group. In autologous PBSCT, infused CD34+ cells/kg and CFU-GM/kg correlated significantly with ANC recovery (p<0.05). CONCLUSIONS: The number of CD34+ cells was correlated with that of CFU-GM in the collection products, and the infused cell doses showed positive relation to the engraftment rate in autologous PBSCT. These findings suggest that measurement of CD34+ cell counts alone would be a sufficient parameter to predict the engraftment rate in autologous PBSCT.
Bone Marrow Transplantation* ; Bone Marrow* ; Cell Count ; Drug Therapy ; Granulocyte-Macrophage Progenitor Cells ; Hematologic Neoplasms ; Humans ; Neutrophils ; Peripheral Blood Stem Cell Transplantation* ; Platelet Count ; Stem Cells*

PURPOSE: We evaluated the usefulness of radiographic parameters for osteoporosis by analyzing the results of radiographic parameters determined by digital hip radiographs and bone mineral density T-scores, as assessed by Dual Energy X-ray Absorptiometry (DEXA). MATERIALS AND METHODS: The authors reviewed 100 subjects in the hip fracture group and 50 in the non-fracture control group. Digital hip radiographs were assessed to determine the values of Singh index, Canal-to-Calcar Ratio, and Cortical Thickness Index (CTI). Bone mineral density was assessed by DEXA. RESULTS: Intraclass Correlation Coefficient (ICC) results of the CTI were above 0.8 in the fracture group. Compared to the control group, the fracture group showed higher ICCs. Interobserver ICCs were especially lower in the control group. There were statistically significant correlations between CTI and DEXA (r=0.50~0.58, p<0.05). In the analysis of ROC curves, a mean threshold for CTI set a value of 0.54 (0.53~0.55), and mean sensitivity and specificity were 75.5% (69~79%) and 67.8% (65~78%), respectively. CONCLUSION: CTI showed reasonable reliability and correlation with DEXA results. CTI was a useful radiographic parameter to alert the surgeon to recommend referral for osteoporosis evaluation in elderly hip fracture patients.
Absorptiometry, Photon ; Aged ; Bone Density ; Hip ; Humans ; Osteoporosis ; Referral and Consultation ; ROC Curve ; Sensitivity and Specificity

MCTD (Mixed Connective Tissue Disease) is a rare disease characterized by clinical characteristics of patients with overlapping features of SLE (systemic lupus erythematosus), SS (systemic sclerosis), and PM (polymyositis), and serologically characterized by high titers of Anti U1 RNP Ab. At early stage, finger swelling or Raynaud's phenomenon with high titers of Anti U1 RNP Ab are only apparent. Proteinuria and membranous nephropathy are characteristic renal manifestation of MCTD. Recently we had the opportunity to observe patient with Raynaud's phenomenon, finger swelling, high titers of Anti U1 RNP Ab, and asymptomatic proteinuria who underwent a renal biopsy. The patient was diagnosed as early MCTD and renal histology revealed membranous nephropathy. Our purpose is to report this patient and to review the literature.
Biopsy ; Connective Tissue ; Fingers ; Glomerulonephritis, Membranous ; Humans ; Mixed Connective Tissue Disease* ; Proteinuria ; Rare Diseases

Anti neutrophil cytoplasmic antibody (ANCA)-positive vasculitis and crescentic glomerulonephritis has been rarely reported in patients suffering from Graves' disease and treated with Propylthiouracil. We experienced a case of ANCA-positive crescentic glomerulonephritis presenting good prognosis after discontinuing Propylthiouracil. A 40-year-old female visited due to the proteinuria and hematuria in urinalysis. She had been medicated Propylthiouracil for 3 years. Blood pressure was 100/60 mmHg. BUN and serum creatinine were 24.7 mg/dL, and 1.9 mg/dL, respectively. Urinalysis revealed protein 1481 mg/day, many RBC's/HPF (dysmorphic 80%), Serological ANCA was positive, anti-myeloperoxidase (MPO) antibody 1,922 AAU/ mL (normal <150 AAU/mL). The histologic finding showed crescentic glomerulonephritis on light microscopy, but no immuno deposit on immunofluorescence and light microscopy. So we diagnosed ANCA positive pauci-immune glomerulonephritis. Propylthiouracil was discontinued and steroid, cyclophosphamide was medicated within about 1 month, but stopped due to cytopenia. Patient's creatinine level was maintained 1.3 mg/dL and showed stable progress for about over 18 months. We report this case that showed good prognosis after discontinuation of Propylthiouracil.
Adult ; Antibodies, Antineutrophil Cytoplasmic ; Blood Pressure ; Creatinine ; Cyclophosphamide ; Female ; Fluorescent Antibody Technique ; Glomerulonephritis ; Graves Disease ; Hematuria ; Humans ; Light ; Microscopy ; Prognosis ; Propylthiouracil ; Proteinuria ; Stress, Psychological ; Urinalysis ; Vasculitis

PURPOSE: Trauma is the 5th most common leading cause of death in Korea, but there has been no appropriate management system for patients until now. We analyzed the main causes of death in trauma patients by comparing the characteristics of those patients with the characteristics of patients who survived. We feel this analysis should have a positive effect on the development of an appropriate trauma management system in Korea. METHODS: We retrospectively reviewed trauma patients who had been admitted to the Department of General Surgery from February 2002 to February 2007. We compared several expected risk factors between the mortality and the survival group. Data on the transportation, arrival time at the emergency center, amount of transfusion, initial shock index, cause of death, and initial physical condition according to RTS (Revised trauma score), ISS (Injury severity score) and TRISS (Trauma and Injury Severity Score) were collected. Patients with ISS lower than 12 were excluded. RESULTS: Three hundred sixty-six(366) patients with multiple injuries were included. There were 40 patients in the mortality group and 326 patients in the survival group. The mean arrival time (minutes) to emergency center was longer in the mortality group (137.6 vs 93.6 p 0.04). The total amount of transfusion (ml) was larger in the mortality group (7139 vs 2470 p 0.01). The initial shock index was higher in the mortality group (1.45 vs 1.17 p<0.01). The RTS, ISS, and TRISS were not statistically different between the groups. In the multivariate analysis, mean arrival time and initial shock index were important factors for survival. CONCLUSION: If the mortality rate of trauma patients is to be reduced , the arrival time at the emergency center should be minimized. Improvement of the emergency medical transfer service system is very important for achieving that.
Cause of Death ; Emergencies ; Humans ; Korea ; Mortality ; Multiple Trauma ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Shock ; Transportation

We report the case of a patient with primary renal amyloidosis, who was progressed to fulminant hepatic failure. A 68-year-old man visited our hospital for evaluation of anorexia, weight loss and hepatomegaly. Laboratory examination revealed proteinuria and azotemia. He was confirmed to have primary amyloidosis by renal biopsy. His renal function progressed to deteriorate rapidly with marked deterioration of liver function with cholestasis. Peritoneal dialysis and steroid therapy were started for reduction of urine output and rapid progression of azotemia, and aggravation of liver function. Azotemia was improved after peritoneal dialysis but the liver function worsened leading to hepatic failure, causing death. If jaundice has progressed in any patients with primary amyloidosis, liver transplantation and stem cell transplantation should be considered for preparation of hepatic failure.
Aged ; Amyloidosis ; Anorexia ; Azotemia ; Biopsy ; Cholestasis ; Hepatomegaly ; Humans ; Jaundice ; Liver ; Liver Failure ; Liver Failure, Acute ; Liver Transplantation ; Peritoneal Dialysis ; Proteinuria ; Stem Cell Transplantation ; Weight Loss

PURPOSE: To compare the result of endoscopic versus open bursectomy in lateral malleolar bursitis, which was not treated conservatively. MATERIALS AND METHODS: Between January 2008 and October 2009, We divided to two groups, endoscopy (group A) 11 cases, open bursectomy (group B) 11 cases. The average follow up period was 15 months (range, 12 to 18), the mean age was 66 (range, 38 to 79). We compared patients satisfaction, complete healing time, operation time, complications and recurrence. RESULTS: Group A had significant difference in terms of the clinical satisfactions, complete healing time. operation time, complications. Group A showed satisfaction (excellent 9, good 2), mean complete healing time 11.9 (8~14) days, operation time 37 (25~45) minutes, 1 case recur. Group B showed satisfaction (excellent 4, good 3, fair 1, poor 3), complete healing time 32.7 (14~98) days, operation time 22 (18~26) minutes. complication were one case of skin necrosis, one case of wound dehiscence, two cases of superficial peroneal nerve injury, no recurrence. Significant advantages of endoscopic method include lower morbidity and rapid wound healing period (p<0.05). CONCLUSION: Endoscopic resection of the lateral malleolar bursitis is a promising technique and shows favourable results compared to the open resection. Significant advantages of this method include lower morbidiy and rapid wound healing.
Animals ; Ankle ; Bursitis ; Endoscopy ; Follow-Up Studies ; Humans ; Necrosis ; Peroneal Nerve ; Recurrence ; Skin ; Wound Healing

BACKGROUND: Vancomycin resistant enterococcal (VRE) bacteremia is increasing among patients with hematologic malignancies. Our study was to determine the clinical characteristics, risk factors for mortality, and effect of adequate antimicrobial therapy on outcome in patients with hematologic malignancies who developed VRE bacteremia. MATERIALS AND METHODS: we retrospectively reviewed episodes of VRE bacteremia in 90 patients with hematologic malignancices from January 1997 to December 2006. Adequate antimicrobial therapy was defined as the use of linezolid or quinupristin/dalfopristin, initiated within 72 hours of initial positive blood culture and continuing for at least 48 hours. Outcome was evaluated at 14 and 28 days after onset of bacteremia. RESULTS: The overall 14-day and 28-day mortality rates were 44.4% (40/90) and 54.4% (49/90) respectively. Failure of neutrophil recovery (odds ratio [OR], 40.29; 95% confidence interval [CI], 6.22 to 260.72; P< or =0.001) and increased APACHE II score (OR, 1.30; 95% CI, 1.07 to 1.58; P=0.008) were independent risk factors for 14-day as well as for 28-day mortality. To specifically examine the effects of adequate antimicrobial therapy, we performed a separate analysis of the 14-day mortality, after excluding 6 patients who died within 48 hours of bacteremia onset. Multivariate analysis showed that failure of neutrophil recovery (OR, 42.10; 95% CI, 5.77 to 307.00; P< or =0.001) and increased APACHE II score (OR, 1.25; 95% CI, 1.02 to 1.53; P=0.026) were still independently associated with mortality. Adequate antimicrobial therapy, however, did not have a protective effect (OR, 1.91; 95% CI, 0.50 to 7,22; P= 0.338). Of the 65 patients with monomicrobial bacteremia, 30 (46.2%) received adequate antimicrobial therapy and 35 (53.8%) did not: their 14-day mortality rates were 40.0% (12/30) and 42.9% (15/35), respectively (P=0.816). CONCLUSION: In conclusion, severity of underlying illness was associated with mortality. Adequacy of antimicrobial therapy did not improve survival, this may be due to low virulence of enterococci and severity of underlying disease.
APACHE ; Bacteremia* ; Enterococcus ; Hematologic Neoplasms ; Hematology* ; Humans ; Linezolid ; Mortality* ; Multivariate Analysis ; Neutrophils ; Retrospective Studies ; Risk Factors* ; Vancomycin ; Virulence