OBJECTIVES: The objective of this study was to assess the efficacy of the Korean fracture-risk assessment tool (FRAX) model for routine application in women who had a general check-up for bone mineral density (BMD). METHODS: This retrospective study was conducted at a university hospital and comprised 343 patients, whose BMD and clinical risk factors were assessed for FRAX calculation. The 10-year probabilities of hip and major osteoporotic fractures were compared with the result of the FRAX(R) tool (http://www.shef.ac.uk/FRAX, web version 3.5) applied to Korean models developed at the World Health Organization Collaborating Center with or without femoral neck bone mineral density. RESULTS: The T-score gradually decreased with increasing age. Additionally, the 10-year probability of a major osteoporotic fracture increased with age. However, the probability of hip fracture showed no correlation with age if BMD was not included in the estimation. CONCLUSION: Previous report on patients whose probability of a proximal femoral fracture were calculated using Korean FRAX models produced a higher score than our data because our data involved a general population. A larger general population is needed to confirm the Korean FRAX model. However, our data provide information for physicians to assess the Korean FRAX model in the general female population.
Bone Density ; Female ; Femoral Fractures ; Femur Neck ; Hip ; Humans ; Osteoporotic Fractures ; Retrospective Studies ; Risk Factors ; World Health Organization

OBJECTIVES: The objective of this study was to assess the efficacy of the Korean fracture-risk assessment tool (FRAX) model for routine application in women who had a general check-up for bone mineral density (BMD). METHODS: This retrospective study was conducted at a university hospital and comprised 343 patients, whose BMD and clinical risk factors were assessed for FRAX calculation. The 10-year probabilities of hip and major osteoporotic fractures were compared with the result of the FRAX(R) tool (http://www.shef.ac.uk/FRAX, web version 3.5) applied to Korean models developed at the World Health Organization Collaborating Center with or without femoral neck bone mineral density. RESULTS: The T-score gradually decreased with increasing age. Additionally, the 10-year probability of a major osteoporotic fracture increased with age. However, the probability of hip fracture showed no correlation with age if BMD was not included in the estimation. CONCLUSION: Previous report on patients whose probability of a proximal femoral fracture were calculated using Korean FRAX models produced a higher score than our data because our data involved a general population. A larger general population is needed to confirm the Korean FRAX model. However, our data provide information for physicians to assess the Korean FRAX model in the general female population.
Bone Density ; Female ; Femoral Fractures ; Femur Neck ; Hip ; Humans ; Osteoporotic Fractures ; Retrospective Studies ; Risk Factors ; World Health Organization

To identify a prognostic marker that is less sensitive to variations in the elapsed time since paraquat ingestion, we assessed the time between paraquat ingestion and a negative dithionite urine test as a prognostic parameter in patients with acute paraquat intoxication. Forty-one patients with acute paraquat intoxication were enrolled in this study and analyzed to verify significant determinants of mortality and organ dysfunction. The amount of paraquat ingested, paraquat plasma levels, and the time to a negative urine dithionite test were significant independent risk factors predicting mortality. The amount of paraquat ingestion, and the time to a negative urine dithionite test were independent risk factors predicting organ dysfunction. With a cut-off value of 34.5 hr for the time to negative conversion of the urine dithionite test, the sensitivity and specificity for mortality were 71.4% and 75.0%, respectively. The incidence of acute kidney injury and respiratory failure above 34.5 hr were 100% and 85.0%, respectively. In conclusion, the time to a negative urine dithionite test is the reliable marker for predicting mortality and/or essential organ failure in patients with acute paraquat intoxication, who survive 72 hr.
Acute Kidney Injury/etiology/mortality ; Adult ; Aged ; Dithionite/*urine ; Female ; Herbicides/blood/*toxicity ; Humans ; Liver Diseases/etiology/mortality ; Male ; Middle Aged ; Paraquat/blood/*toxicity ; Respiratory Insufficiency/etiology/mortality ; Risk Factors ; Time Factors

Objective: To identify the clinical characteristics of patients with myasthenia gravis (MG) according to age at onset. Methods: We retrospectively recruited 227 non-thymomatous MG patients with adult onset who had been followed up for more than one year. The patients were classified based on the age of symptom onset as “early-onset MG” (EOMG,18–50 years; N=135), “late-onset MG” (LOMG, 50–64 years; N=53), and “very late-onset MG” (VLOMG, 65 years; N=39). Clinical features and serological findings were compared between these groups. Results: LOMG patients showed more frequent ocular MG (55%) and less frequent thymic hyperplasia (9%) compared to EOMG patients (31% and 38%; p=0.006 and p<0.001, respectively), and no female preponderance compared to VLOMG patients (female, 49% vs.77%; p=0.014). However, there were no significant differences between VLOMG and EOMG patients, except for more frequent thymic hyperplasia (p<0.001) in EOMG patients. When analyzing female patients only, less frequent secondary generalization (10%) were additionally found in LOMG patients, compared to EOMG (47%, p= 0.008) and VLOMG (59%, p=0.004) patients. Anti-acetylcholine receptor antibody (HR, 5.48; 95% CI, 1.73–17.37; p=0.004) was independently associated with secondary generalization in female EOMG patients. Conclusion: Our study suggests that LOMG patients, especially female, were characterized by frequent ocular MG and less frequent secondary generalization, distinguished from EOMG and VLOMG patients. Further large epidemiologic studies in Korea are needed to determine the characteristics of MG patients according to the age at onset and gender.

Background: Vitiligo is an acquired depigmentary disorder characterized by the destruction of melanocytes via an autoimmune-mediated process. Treatments can be categorized into nonsurgical and surgical methods. Prognostic factors of surgical management in vitiligo have not been widely studied in the Korean population. Objective: To investigate the prognostic factors of tissue grafts in vitiligo. Methods: We retrospectively analyzed patients who underwent tissue grafting for vitiligo between January 2010 and December 2020. Medical records and clinical photographs were reviewed, and demographics, disease characteristics, and treatment outcomes were collected. Results: A total of 195 cases were evaluated, and among them, 86 (44.1%) showed 75% improvement, and 49 (25.1%) showed 50% to 74% improvements 3 months after surgery. Statistical analyses showed that the prognosis of tissue grafting was significantly different according to vitiligo subtype, recipient site, and grafting method. The focal and segmental type, head and neck sites, and suction blister grafting showed favorable results compared with the non-segmental type, sites other than the head and neck, and punch grafting. Age and adjuvant phototherapy did not affect the clinical outcomes. Conclusion This study proposes several clinical factors that affect the outcomes of skin grafting in vitiligo.

Anti-myelin oligodendrocyte glycoprotein (anti-MOG) syndrome is an immunemediated inflammatory condition of the central nervous system, which usually involves spinal cord and optic nerves. Herein, we studied the case of a 57-yearold female patient who presented with acute/subacute symptoms of sphincter dysfunction, paraparesis, and ocular pain. The patient was diagnosed with anti-MOG syndrome with findings resembling snake-eye appearance (SEA), characterized by nearly symmetrical round high signal intensity lesions located at anterior horns (gray matter) on T2-weighted image.

Anti-myelin oligodendrocyte glycoprotein (anti-MOG) syndrome is an immunemediated inflammatory condition of the central nervous system, which usually involves spinal cord and optic nerves. Herein, we studied the case of a 57-yearold female patient who presented with acute/subacute symptoms of sphincter dysfunction, paraparesis, and ocular pain. The patient was diagnosed with anti-MOG syndrome with findings resembling snake-eye appearance (SEA), characterized by nearly symmetrical round high signal intensity lesions located at anterior horns (gray matter) on T2-weighted image.

Left ventricular assist device (LVAD) is a good treatment option for the patients ineligible for cardiac transplantation. Several studies have demonstrated that a ventricular assist device improves the quality of life and prognosis of the patients with end-stage heart failure. A 75-yr-old man debilitated with New York Heart Association (NYHA) functional class III-IV due to severe left ventricular systolic dysfunction received LVAD implantation as a destination therapy. The patient was discharged with improved functional status (NYHA functional class II) after appropriate cardiac rehabilitation and education about how to manage the device and potential emergency situations. This is the first case of successful continuous-flow LVAD implantation as a destination therapy in Korea.
Aged ; Dyspnea ; Echocardiography ; Heart Failure/*surgery ; *Heart-Assist Devices ; Humans ; Male ; Prosthesis Implantation ; Quality of Life ; Republic of Korea ; Treatment Outcome ; Ventricular Dysfunction, Left/*surgery

Purpose: The aims of this study were to evaluate the cumulative recurrence, reoperation, and pregnancy rates after ovarian endometrioma surgery at a single institution for more than a 5-year follow-up period. Materials and Methods: This study was conducted as a retrospective chart review of patients with ovarian endometrioma who underwent surgery between January 2008 and March 2016. Study subjects included premenopausal women with at least 5 years of follow-up. Exclusion criteria were patients with stage I or II ovarian endometrioma, those who underwent hysterectomy or bilateral oophorectomy, and presence of residual ovarian lesions on the first postoperative ultrasonography at 3–6 months. Recurrence was defined as a cystic mass by ultrasonography. Results: A total of 756 patients were recruited. The median follow-up duration was 85.5 months (interquartile range, 71–107 months). Recurrent endometrioma was detected in 27.9% patients, and reoperation was performed in 8.3% patients. Cumulative rates at 24, 36, 60, and 120 months were 5.8%, 8.7%, 15.5% and 37.6%, respectively, for recurrence and 0.1%, 0.5%, 2.9%, and 15.1%, respectively, for reoperation. After multivariable analysis, age ≤31 years [hazard ratio (HR)=2.108; 95% confidence interval (CI)=1.522–2.921; p<0.001], no subsequent pregnancy (HR=1.851; 95% CI=1.309–2.617; p<0.001), and postoperative hormonal treatment ≤15 months (HR=2.869; 95% CI=2.088–3.941; p<0.001) were significant risk factors for recurrent endometrioma. Among 315 patients who desired pregnancy, 54.0% were able to have a successful pregnancy and delivery. Conclusion Considering that longer postoperative hormonal treatment is the sole modifiable factor for recurrent endometrioma, we recommend long-term hormonal treatment until subsequent pregnancy, especially in younger women.

Purpose: There are many studies regarding the increased relationship between pregnancy outcomes of singleton with endometriosis. However, there was limited evidence of twin pregnancies with endometriosis. This study aimed to compare the pregnancy outcomes and complications in twin pregnancies with or without endometriosis in a single institution. Materials and Methods: From January 2011 to July 2022, a retrospective analysis of twin pregnancies was conducted. The endometriosis group included patient with histological or visual confirmation before pregnancy or during cesarean section. Pregnancy outcomes and complications were compared between the two groups. Results: Out of 1714 patients examined, 127 (7.4%) were included in the endometriosis group. Maternal body mass index (BMI) was lower in the endometriosis group (p<0.001). There were no significant differences in maternal age, mode of conception, chorionicity, and pregnancy outcomes, such as gestational age at delivery (p=0.835) and the preterm birth rate (p=0.579). The endometriosis group had a significantly higher rate of obstetrical complication: small for gestational age (SGA) <10% (p=0.029). However, after adjustment for BMI, the endometriosis group showed no statistical significance in obstetrical complications, including SGA (adjusted odds ratio, 1.568; 95% confidence interval, 0.984–2.499; p=0.059). Conclusion Twin pregnancies with endometriosis were not related to adverse effects on pregnancy outcomes and obstetrical complications. To confirm these outcomes, further large prospective studies are required.