OBJECTIVE: Acute appendicitis is one of the most urgent surgical problems. Several factors have been considered as predictors of perforation, but this study focused on the change in pain pattern. The degree of pain and progression of appendicitis were analyzed assuming that the pain intensity would increase until the perforation and the degree of pain would decrease immediately after the perforation occurred. METHODS: In this study, 385 out of 467 patients, who were diagnosed with appendicitis in a single institution and aged between 15 and 65 years, were reviewed retrospectively. The patients' pain scores and the diameters of appendices were analyzed along with the accompanying complications. Correlation analysis and a Student's t-test were performed. RESULTS: In patients with complicated appendicitis, the mean numerical rating scale (NRS) was slightly higher than that of simple appendicitis, but there was no significant difference in the absolute value. Only the size of the appendix showed meaningful differences according to the combined computed tomography findings. The NRS distribution or appendiceal size did not correlate with the time duration from symptom onset. CONCLUSION: The appendiceal size tended to increase with progressing appendicitis. No significant correlation was observed between the patient's pain level and complications. The time duration from symptom onset did not show a relationship with the progression of appendicitis.
Abdominal Pain ; Appendicitis* ; Appendix ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Pain Measurement ; Retrospective Studies

PURPOSE: This study investigated bone mineral density and nutritional state according to consumption of milk in Korean postmenopausal women who drink coffee. METHODS: Using the 2008~2009 Korean National Health & Nutrition Examination Survey data, a total of 1,373 postmenopausal females aged 50 yrs and over were analyzed after excluding those with diseases related to bone health. According to coffee and/or milk consumption, subjects were divided into four groups: coffee only, both coffee & milk, milk only, and none of the above. All data were processed after application of weighted values and adjustment of age, body mass index, physical activity, drinking, and smoking using a general linear model. For analysis of nutrient intake and bone density, data were additionally adjusted by total energy and calcium intake. RESULTS: The coffee & milk group had more subjects younger than 65 yrs and higher education, urban residents, and higher income than any other group. The coffee only group showed somewhat similar characteristics as the none of the above group, which showed the highest percentage of subjects older than 65 and in a lower education and socio-economic state. Body weight, height, body mass index, and lean mass were the highest in coffee & milk group and lowest in the none of the above group. On the other hand, the milk only group showed the lowest values for body mass index and waist circumference, whereas percent body fat did not show any difference among the groups. The coffee and milk group showed the highest bone mineral density in the total femur and lumbar spine as well as the highest nutritional state and most food group intakes, followed by the milk only group, coffee only group, and none of the above group. In the assessment of osteoporosis based on T-score of bone mineral density, although not significant, the coffee and milk group and milk only group, which showed a better nutritional state, included more subjects with a normal bone density, whereas the none of the above group included more subjects with osteoporosis than any other group. CONCLUSION: Bone mineral density in postmenopausal women might not be affected by coffee drinking if their diets are accompanied by balanced food and nutrient intake including milk.
Adipose Tissue ; Body Height ; Body Mass Index ; Body Weight ; Bone Density* ; Calcium ; Coffee* ; Diet ; Drinking ; Education ; Female ; Femur ; Hand ; Humans ; Korea* ; Linear Models ; Milk* ; Motor Activity ; Nutrition Surveys* ; Osteoporosis ; Smoke ; Smoking ; Spine ; Waist Circumference

Myelofibrosis results from stimulation of bone marrow stromal fibroblasts by fibrogenic cytokines elaborated by neoplastic or reactive cells in the marrow. Chronic idiopathic myelofibrosis should be differentiated from secondary myelofibrosis resulting from bone marrow involvement of malignant lymphoma because these diseases have different therapeutic strategies. Myelofibrosis in systemic lupus erythematosus is an uncommon but well-recognized complication, and identifying an autoimmune myelofibrosis is important in diagnosing this benign cause of myelofibrosis. We report two cases of myelofibrosis presenting the clinical and radiologic findings that mimicked malignant lymphoma -a case of autoimmune myelofibrosis associated with systemic lupus erythematosus showing extensive lymphadenopathy and a case of chronic idiopathic myelofibrosis with focal intrasplenic extramedullary hematopoiesis- and discuss the importance of the clinical information and radiologic findings for the pathologic diagnosis of myelofibrosis.
Abdomen* ; Bone Marrow ; Cytokines ; Diagnosis ; Fibroblasts ; Hematopoiesis, Extramedullary* ; Lupus Erythematosus, Systemic* ; Lymphatic Diseases* ; Lymphoma* ; Primary Myelofibrosis*

OBJECTIVE: Bilateral C1 lateral mass and C2 pedicle screw fixation (C1LM-C2P) is an ideal technique for correcting atlantoaxial instability (AAI). However, the inevitable situation of vertebral artery injury or unfavorable bone structure may necessitate the use of unilateral C1LM-C2P. This study compares the fusion rates of the C1 lateral mass and C2 pedicle screw in the unilateral and bilateral methods. METHODS: Over five years, C1LM-C2P was performed in 25 patients with AAI in our institute. Preoperative studies including cervical X-ray, three-dimensional computed tomography (CT), CT angiogram, and magnetic resonance imaging were performed. To evaluate bony fusion, measurements of the atlanto-dental interval (ADI) and CT scans were performed in the preoperative period, immediate postoperative period, and postoperatively at 1, 3, 6, and 12 months. RESULTS: Unilateral C1LM-C2P was performed in 11 patients (44%). The need to perform unilateral C1LM-C2P was due to anomalous course of the vertebral artery in eight patients (73%) and severe degenerative arthritis in three patients (27%). The mean ADI in the bilateral group was 2.09 mm in the immediate postoperative period and 1.75 mm in 12-months postoperatively. The mean ADI in the unilateral group was 1.82 mm in the immediate postoperative period and 1.91 mm in 12-months postoperatively. Comparison of ADI measurements showed no significant differences in either group (p=0.893), and the fusion rate was 100% in both groups. CONCLUSION: Although bilateral C1LM-C2P is effective for AAI from a biomechanical perspective, unilateral screw fixation is a useful alternative in patients with anatomical variations.
Arthritis, Rheumatoid* ; Humans ; Magnetic Resonance Imaging ; Osteoarthritis ; Postoperative Period ; Preoperative Period ; Tomography, X-Ray Computed ; Vertebral Artery

OBJECTIVE: The aim of our study is to evaluate the effect of uterine artery embolization as primary treatment for symptomatic uterine fibroid METHODS: From December 1999 to December 2004, 25 patients underwent uterine artery embolization for the treatment of uterine fibroid. The patients were followed up at regular intervals (at 1st, 3rd, 6th month and annual) for 3 years. The mean duration of follow-up was about 41 month (range; 41+/-15). During follow-up period, consecutive uterine and fibroid volume, and symptoms were checked. RESULTS: The uterine volumes were significantly reduced by 27% (P=0.0238) after 3month. And the fibroid volumes were significantly reduced by 59% (P=0.0070) after 1month. The uterine volumes were significantly reduced by 27% (P=0.0082) after 3 years. And the fibroid volumes were significantly reduced by 60% (P=0.0445) after 3 years. All women reported noticeable improvement of menorrhagia after complete of follow up. But, two of nine women who had symptoms of dysmenorrhea or lower abdominal pain, showed no changes in symptoms CONCLUSION: Uterine artery embolization appears to be effective in controlling symptoms, and substantially reducing uterine and fibroid volume with few complication after 3 years. However, long term follow-up will be necessary to establish the efficacy of this procedure.
Abdominal Pain ; Dysmenorrhea ; Female ; Follow-Up Studies ; Humans ; Leiomyoma* ; Menorrhagia ; Uterine Artery Embolization* ; Uterine Artery*

PURPOSE: To compare the efficacy of intravitreal gatifloxacin with intravitreal vancomycin in the treatment of Staphylococcus epidermidis endophthalmitis in a rabbit model. METHODS: Albino rabbits (n=30), infected with an intravitreal inoculum of S. epidermidis (10(5) colony forming unit/0.1 mL), were divided into 6 groups (n=5). Groups I and IV received 200 microgram/0.1 mL of intravitreal gatifloxacin, and groups II and V were injected 1000 microgram/0.1 mL of vancomycin intravitreally. Intravitreal balanced salt solutions (untreated control) were given to Groups III and VI. Intravitreal antibiotic therapy commenced 24 hours after bacterial inoculation. The bactericidal efficacy was determined by electroretinography (ERG), clinical grading, bacterial culture of vitreous aspirates and histopathologic grading. ERGs and clinical gradings were performed only for groups I, II, and III and bacterial cultures were done only for groups IV, V, and VI. RESULTS: Eyes in the gatifloxacin groups showed similar appearance to those in the vancomycin treated groups clinically, histologically, and functionally as proved with ERG. All aspirates from the gatifloxacin and vancomycin groups were culture negative at 5 days after bacterial inoculation, whereas all eyes in the untreated control group were culture positive. CONCLUSIONS: This study demonstrated that intravitreal injection of 200 microgram /0.1mL gatifloxacin appeared to be equally effective compared to intravitreal 1000 microgram /0.1 mL vancomycin in the treatment of S. epidermidis endophthalmitis. If proven safe and efficacious after further study in humans, intravitreal injection of gatifloxacin could be considered an effective alternative to vancomycin for the treatment of S. epidermidis endophthalmitis.
Electroretinography ; Endophthalmitis ; Eye ; Fluoroquinolones ; Humans ; Intravitreal Injections ; Rabbits ; Staphylococcus epidermidis ; Vancomycin

Myoma is the most common tumor in gynecologic field. As ultrasonography because popular in antenatal care, the more cases of myoma and those adverse effects during pregnancy are more frequently detected. The management of myoma during pregnancy is conservative, but in rare circumstances, surgical intervention including myomectomy may be required. We have experienced a case of protruded subserosal myoma with the uterine cervix in midtrimester of pregnancy. The patient was managed surgically by transvaginal myomectomy and had successfully maintained pregnancy. We report a case of protruded subserosal myoma through pelvic floor in pregnancy with brief review of literatures.
Cervix Uteri ; Female ; Humans ; Myoma* ; Pelvic Floor* ; Pregnancy Trimester, Second ; Pregnancy* ; Ultrasonography

Antiphospholipid antibody syndrome (APS) is characterized by raised levels of antiphospholipid antibodies (aPL), in association with thrombosis, recurrent fetal loss, and thrombocytopenia. Development of APS is related with idiopathic origin, autoimmune disease, malignancy and, on rare occasions, infection. However, in secondary APS combined with bacterial infections, aPL is usually shown with low titer and rarely associated with thrombotic events. A 52-year-old male was admitted due to pneumonia and multiple hepatosplenic abscesses. He had been treated with proper antibiotics, but he presented ascites and sudden variceal bleeding because of portal vein thrombosis. The bleeding was controlled by endoscopic variceal ligation. Acute portal vein thrombosis was successfully managed by low molecular weight heparin and hepatosplenic abscesses were completely resolved by antibiotics. This case suggests that systemic bacterial infection in immunocompetent patients possibly develops into secondary APS.
Abscess ; Anti-Bacterial Agents ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Ascites ; Bacterial Infections* ; Esophageal and Gastric Varices* ; Gastrointestinal Hemorrhage* ; Heparin, Low-Molecular-Weight ; Humans ; Ligation ; Male ; Middle Aged ; Pneumonia ; Portal Vein ; Thrombocytopenia ; Venous Thrombosis

Multiple gestation accounts for 1 percent of all pregnancies. But, the morbidity of congenital anomaly is more than 2 times in contrast to singleton gestation. The major congenital anomaly was developed about 2 percent in the multiple gestation. Hydrocephalus and anencephaly, known central nervous system anomaly, were seen about 0.1% each other in singleton gestation. We have experienced a case of prenatally detected concomitant hydrocephalus and anencephaly in twin pregnancy which was diagnosed by ultrasonography at 16 weeks gestation. Thus, we report a case with brief review of the literature.
Anencephaly* ; Central Nervous System ; Humans ; Hydrocephalus* ; Pregnancy ; Pregnancy, Twin* ; Ultrasonography

This prospective study was performed to determine the effective antibiotics for use in treating acute appendicitis patients during the perioperative period. To identify the sensitive antibiotics, the peritoneal fluid was cultured during operation. Also, wound infection was defined as pus or serous discharge in the wound or when we opened the wound under suspicious of a wound problem. The results were obtained as follows: 1) A total of 138 cases treated during the two years from January 1995 to December 1996 were examined; 84 of them (60.87%) were found to have positive peritoneal fluid cultures, of which 29 (34.52%) were monomicrobial and 55 (65.48%) were polymicrobial. 2) The most common species were Escherichia coli (73.81%), Bacteroides (32.14%), Klebsiella (16.67%), Pseudomonas (9.52%), and Streptococcus (9.52%). 3) In the sensitivity test, the most sensitive drugs were aminoglycosides and cefotaxime. 4) Infectious complications, which developed in 27 (19.6%) patients, were wound infection and intraabdominal abscess. 5) The average length of stay for all patients 9.9 days (range: 3 to 32 days). 6) The common organisms curtured from the complication cases were E. coli and Bacteroides.
Abscess ; Aminoglycosides ; Anti-Bacterial Agents* ; Appendicitis* ; Ascitic Fluid ; Bacteroides ; Cefotaxime ; Escherichia coli ; Humans ; Klebsiella ; Length of Stay ; Perioperative Period ; Prospective Studies ; Pseudomonas ; Streptococcus ; Suppuration ; Wound Infection ; Wounds and Injuries