PURPOSE: An accurate, objective scoring system to assess the severity of community-acquired pneumonia (CAP) could be helpful to physicians in predicting patient mortality and improving decisions regarding hospitalization. However reports on the severity scoring system for prediction of mortality in patients with CAP in Korea are rare. The aim of this study was to propose a new modified severity scoring system based on a previously validated A-DROP for CAP and to compare it with pneumonia severity index (PSI), CURB- 65 and A-DROP. METHODS: The medical records of 364 patients admitted with CAP via ED from January 2013 through August 2014 were reviewed retrospectively. The demographic data, comorbidities, laboratories, PSI class, CURB-65 score, and A-DROP score were reviewed. The authors investigated a modification factor by comparing the survivors with the nonsurvivors. RESULTS: The study subjects were composed of 264 men and 100 women, with a mean age of 66.2+/-15.2 years. The overall 30-day mortality was 9.6%. The areas under the receiver operating characteristic (ROC) curves for prediction of 30-day mortality in patients with CAP were 0.803 (95% confidence interval (CI): 0.739-0.868), 0.734 (95% CI: 0.652-0.816) and 0.747 (95% CI: 0.662-0.833) for PSI, CURB-65 and A-DROP respectively. The new DROP-70 scoring system which includes age> or =70 years is a simple modified version of the A-DROP. The area under the ROC curves of DROP-70 was 0.774 (95% CI: 0.698-0.850). CONCLUSION: A new severity scoring system, DROP-70, could be a useful index for predicting 30-day mortality in patients with community-acquired pneumonia.
Comorbidity ; Female ; Hospitalization ; Humans ; Korea ; Male ; Medical Records ; Mortality ; Pneumonia* ; Prognosis* ; Retrospective Studies ; ROC Curve ; Survivors

The tonsillolith is a white or yellow colored calcified lesion that forms in the crypts of the palatine tonsil. Small tonsilloliths are frequently found on tonsils, while giant tonsilloliths are a rare clinical entity. We had a 35-years old female patient, who presented throat discomfort due to a giant tonsillolith. The stone was removed and tonsillectomy was performed. We reviewed the literature on this rare clinical entity.
Female ; Humans ; Palatine Tonsil ; Pharynx ; Tonsillectomy

A reduced retroversion angle of humeral head may predispose to recurrent anterior shoulder dislocation and may also be a factor in persistent instability after soft tissue procedures. Rotation osteotomy of proximal humerus is one of many surgical modalities proposed for recurrent anterior shoulder dislocation. To support such an operation, fundamental knowledge of shoulder anatomy is essential. The semi-axial view by Soderlund have been regarded as simple and reliable method for measuring humeral head retroversion angle. The purpose of this study was to evaluate validity of the semi-axial view and to assess reference values for humeral head retroversion angle in Korean. Humeral head retroversion angle was determined from 80 healthy subjects, 48 men and 32 women. Radiographs which shown less than 10degrees between humeral shaft axis and epicondylar axis were defined as acceptable radiographs by Soderlund. Acceptable radiographs were selected and two orthopedic surgeons measured retroversion angle, separately. Acceptable radiographs were obtained in only 70 shoulders (43.8%). The mean angle was 35.2+/-8.24degrees for dominant hand and 32+/-6.27degrees for nondominant in Korean. The mean angle was 35.3+/- 7.78degrees for right side and 31.9+/-6.8degrees for left. The interobserver difference was 2.9degrees. The semi-axial view by Soderlund was not reproducible solely. But if correct arm position is considered, the method presented is easy to use daily.
Arm ; Axis, Cervical Vertebra ; Female ; Hand ; Humans ; Humeral Head* ; Humerus ; Male ; Orthopedics ; Osteotomy ; Reference Values ; Shoulder ; Shoulder Dislocation

BACKGROUND AND OBJECTIVES: Exophthalmos from Graves' disease can result in visual disturbance and cosmetic deformity. Surgical treatment of this disorder is possible through a transnasal endoscopic approach or transantral approach. We aimed to evaluate the efficacy of the transnasal endoscopic orbital decompression and transantral orbital decompression in the management of dysthyroid orbitopathy. MATERIALS AND METHODS: Transnasal endoscopic orbital decompression or transantral orbital decompression was performed on 25 orbits in 14 patients for treatment of progressive exophthalmos or visual loss. Transantral orbital decompression was performed on seven patients simultaneously. RESULTS: Proptosis was reduced an average of 2.8 mm (range 0.5 to 6 mm) by transnasal endoscopic decompression alone and of 3.5 mm (range 0.5 to 8 mm) by transnasal endoscopic decompression and transantral decompression. In five patients who complained of visual disturbance, visual acuity was improved in three of them, and stationary in two of them postoperatively. Four patients who had no diplopia preoperatively developed diplopia after the decompression. Among them the diplopia was only temporary in three patients and the remaining one was referred to an ophthalmologist for correction of persistent diplopia. CONCLUSION: Orbital decomprerssion can be performed successfully via the transantral and transnasal endoscopic approach without significant complications and external scar.
Cicatrix ; Congenital Abnormalities ; Decompression* ; Diplopia ; Exophthalmos ; Graves Disease ; Humans ; Orbit* ; Visual Acuity

BACKGROUND: Despite numerous investigations, the pathogenesis of Meniere's disease is uncertain. Endolymphatic hydrops (ELH) has been the main histologic finding of Meniere's disease. Experimentally induced ELH in animal model has been developed in order to understand better the consequences of this morphopathology on inner ear structure and function. OBJECTIVES: The aim of this study is to develope the animal model of ELH. MATERIAL AND METHODS: We made an animal endolymphatic hydrops model on giunea pigs by mechanically obliterating the right endolympatic sac and duct. The left ears were used as a controls. RESULTS: After twelve weeks, the temporal bones were prepared for light and electron microscopic examination. The light microscopic study showed the distension and folding of Reissner's membrane, however other pathologic changes were uncertain in hydropic aminal. Under scanning electron microscopic examination, the cellular population of Reissner membrane remained normal but the microvilli of Reissner membrane were significantly decreased in hydrops group. The damage pattern of stereocilia were most severe in the apical turns, followed by the middle and the basal turns, in the order of severeity. The outer hair cell third row was most severely damaged in the entire cochlea, whereas the outer hair cell first row was relatively spared. On the single hair cell examination, abnormal distensions of the tip of stereocilia started from longer stereocilia. The number of microvilli on marginal cell was reduced in stria vascularis, but atrophic change was not observed.
Animals ; Cochlea ; Ear ; Ear, Inner ; Edema ; Endolymphatic Hydrops* ; Guinea Pigs* ; Guinea* ; Hair ; Membranes ; Meniere Disease ; Microvilli ; Models, Animal ; Stereocilia ; Stria Vascularis ; Swine ; Temporal Bone

Incontinentia pigmenti (IP) is an uncommon genodermatosis that occurs mostly in female infants, but is rarely found in male infants. Male patients with incontinentia pigmenti are usually more severely affected than their female counterparts. IP is characterized by ectodermal, mesodermal, neurological, ocular, and dental manifestations. Herein, we report a case of IP in a male infant who presented with a typical course of skin manifestation, dental defects, and recurrent partial seizures. However, he did not show any signs or symptoms for ocular or cardiovascular anomalies.
Ectoderm ; Female ; Humans ; Incontinentia Pigmenti* ; Infant* ; Male* ; Mesoderm ; Seizures ; Skin Manifestations

STUDY DESIGN: In vitro cell culture model. PURPOSE: To investigate the effects of RNA interference (RNAi) on p75 expression and viability of rat notochordal cells treated with serum deprivation. OVERVIEW OF LITERATURE: RNAi enables the inhibition of specific genes by sequence-specific gene silencing using a double-stranded RNA. METHODS: Notochordal cells were isolated, cultured, and placed in 10% (control) or 0% (apoptosis-promoting) fetal bovine serum (FBS) for 48 hours. The expression of p75, apoptosis, and cell proliferation were determined. To suppress p75 expression, a small interfering RNA (siRNA) was synthesized against p75 (p75 siRNA) and transfected into cells. The suppression of p75 mRNA expression was investigated using the reverse transcription-polymerase chain reaction. The degree of p75 suppression was semiquantitatively analyzed using densitometry. The effect of p75 siRNA on apoptosis and proliferation of cells was determined. Solutions of an unrelated siRNA and transfection agent alone served as controls. RESULTS: Serum deprivation significantly increased apoptosis by 40.3%, decreased proliferation of notochordal cells by 45.3% (both, p<0.001), and upregulated p75 expression. The p75 siRNA suppressed p75 expression in cells cultured in 0% FBS. The rate of suppression by p75 siRNA of p75 mRNA was 72.9% (p<0.001). Suppression of p75 expression by p75 siRNA inhibited apoptosis by 7% and increased proliferation by 14% in cells cultured in 0% FBS (both, p<0.05). CONCLUSIONS: siRNA-mediated suppression of p75 inhibited apoptosis and increased proliferation of notochordal cells under conditions of serum deprivation, suggesting that RNAi might serve as a novel therapeutic approach for disc degeneration caused by insufficient viability of disc cells through the suppression of the expression of harmful genes.
Animals ; Apoptosis ; Cell Culture Techniques ; Cell Proliferation ; Densitometry ; Gene Silencing ; In Vitro Techniques ; Intervertebral Disc Degeneration ; Notochord* ; Rats* ; RNA Interference ; RNA* ; RNA, Double-Stranded ; RNA, Messenger ; RNA, Small Interfering ; Transfection

BACKGROUND: To decide the optimal antibiotics and application of chest tube, examination of pleural fluid is fundamental in the management of empyema. Some criteria for drainage of pleural fluid have been recommended but some controversies have been suggested. Recently, newer radiologic methods including ultrasound and computed tomography scanning, have been applied to the diagnosis and management of pleural effusions. We undertook a retrospective analysis of 30 patients with pleural effusion who had CT scans of the chest in order to apply the criteria of Light et at retrospectively to patients with loculation and to correlate the radiologic appearance of pleural effusions with pleural fluid chemistry. METHOD: We analyzed the records of 30 out of 147 patients with pleural effusion undergoing chest CT scans. RESULTS: 1) Six of the pleural fluid cultures yielded gram negative organisms and three anaerobic bacterias and one Staphylococcus aureus and one non-hemolytic Streptococci. No organism was cultured in nineteen cases(63.0%). 2) The reasons for taking chest CT scans were to rule out malignancy or parenchymal lung disease(46.7%), Poor response to antibiotics(40.0%), hard to aspirate pleural fluid(10.0%) and to decide the site for chest tube insertion(3.3%). 3) There was no significant correlations between ATS stages and loculation but there was a tendency to Inoculate in stage III. 4) There was a significant inverse relationship between the level of pH and loculation(P<0.05) but there appeared to be no relationship between pleural fluid, LDH, glucose, protein, loculation and pleural thickening. 5) In 12 out of 30, therapeutic measures were changed according to the chest CT scan findings. CONCLUSION: We were unable to identify any correlations between the plerual fluid chemistry, ATS stages and loculations except pH, and we suggest that tube thoracotomy should be individualized according to the clinical judgement arid serial observation. All patients with empyema do not need a chest CT scan but a CT scan can provide determination of loculation, guiding and assessing therapy which should decrease morbidity and hospital stay.
Anti-Bacterial Agents ; Bacteria, Anaerobic ; Chemistry ; Chest Tubes ; Diagnosis ; Drainage ; Empyema* ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Length of Stay ; Lung ; Pleural Effusion ; Retrospective Studies ; Staphylococcus aureus ; Thoracotomy ; Thorax* ; Tomography, X-Ray Computed* ; Ultrasonography

OBJECTIVES: The purpose of this study was to evaluate the performance of half-dose chest CT using an iterative reconstruction technique in patients with lung malignancies. METHODS: The Dual-source CT scans were obtained and half-dose datasets were reconstructed with 5 different strengths in 38 adults with lung malignancies. Two radiologists graded subjective image quality; noise, contrast and sharpness at the central/peripheral lung, mediastinum and chest wall of the reconstructed half-dose images, compared with those of standard-dose images, using a three-point scale. A lesion assessment; lesion conspicuity and diagnostic confidence, was also performed. The quantitative image noises; contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were measured and compared with those of standard-dose images. RESULTS: The subjective image noise in the half-dose images was less than that of the standard-dose images. The contrast in strengths 2 to 5 was superior, the sharpness of the lung parenchyma in strengths 3 to 5 was inferior, and the CNR/SNR in all strengths were higher than those of standard-dose images (P < 0.05). The improvement of subjective image noise and contrast, the decrease in sharpness, were correlated with strength level (P < 0.05). The lesion conspicuity in half-dose images of strengths 4 and 5 was decreased. The diagnostic confidence of the half-dose images of all strengths was comparable to that of the standard-dose images (P < 0.05). CONCLUSIONS: Half-dose chest CT images using an iterative reconstruction technique show decreased image noise, increased contrast, and diagnostic confidence comparable to standard-dose images. Images reconstructed with strength 2 and 3 appear to be the optimal choice in clinical practice.
Adult ; Dataset ; Humans ; Lung* ; Mediastinum ; Noise ; Signal-To-Noise Ratio ; Thoracic Wall ; Thorax* ; Tomography, X-Ray Computed

Except for special situations, it is generally agreed that best results in the treatment of facial fractures is expected if reduction is done within the first 2 or 3 weeks after injury. We reduced facial bone fractures at 4 to 7 weeks after trauma. A 44-year-old female patient underwent open reduction for her right zygomaticomaxillary complex fracture at 7 weeks after injury. A 59-year-old female patient underwent surgery for the right mandible body and left parasymphysis fractures at 4 weeks after injury. Using traditional approaches, granulation tissue and callus were removed from the fracture sites, and malunited fracture lines were separated by a small osteotome. We reduced the displaced fractured zygoma and mandible to their normal anatomical positions and fixed them using titanium plates. No complications such as asymmetry, malunion, malocclusion, or trismus were seen. Unfavorable asymmetric facial contours were corrected, and we obtained good occlusion with favorable bony alignment. The functional and aesthetic outcomes were satisfactory. Through removal the callus and limited osteotomy, a successful approach to the previously fractured line was possible, and an exact correction with symmetry was obtained. This method can be a good option for obtaining good mobility and clinical results in treating delayed facial bone fractures.
Adult ; Bony Callus ; Facial Bones* ; Female ; Fractures, Malunited ; Granulation Tissue ; Humans ; Malocclusion ; Mandible ; Mandibular Fractures ; Middle Aged ; Osteotomy ; Titanium ; Trismus ; Zygoma ; Zygomatic Fractures