BACKGROUND: Despite its unsatisfactory specificity, rheumatoid factor (RF) is the only serologic marker included in the diagnostic criteria of the American College of Rheumatology (ACR) for rheumatoid arthritis. Recently, the diagnostic value of anti-cyclic citrullinated peptide (CCP) antibodies has been emphasized in rheumatoid arthritis (RA) due to its high specificity. To evaluate the second generation of anti-CCP antibodies as a diagnostic marker, we evaluated anti-CCP test in 163 individuals. METHODS: The study population was divided into the following four groups: RA group (n=18), other disease group with arthritic symptoms (n=44), other disease group without arthritic symptoms (n=45), and healthy group (n=56). Anti-CCP was measured by an ELISA analyzer (Coda, Bio-Rad, USA) with Immunoscan RA (Euro-Diagnostica, Malmo, Sweden) and RF was measured by an automated chemistry analyzer (Toshiba, Japan) with RF-LATEX X1 (Denka Seiken, Japan). RESULTS: The sensitivity of anti-CCP and RF was 72.2% and 100%, respectively, and the respective figures for the specificity were 96.6% and 73%. On each ROC curve, the area under the curve was 0.867 for anti-CCP and 0.959 for RF. In other disease groups, most of the false positive cases of RF were found in the patients with hyperlipidemia or HBV carriage. However, anti-CCP was not detected in any of the patients with these two conditions. False positive rates of RF in the three control groups were 34.1% in other disease group with arthritic symptoms, 48.9% in the other disease group without arthritic symptoms, and 3.6% in healthy group. The respective figures for anti-CCP were 6.8%, 2.2%, and 1.8%. CONCLUSIONS: The specificity of anti-CCP antibodies was higher than that of RF for discriminating RA from other diseases, especially in the patients with hyperlipidemia or HBV carriage. With its high specificity, anti-CCP antibodies can play an additive role in establishing the diagnosis of RA in patients with RF positivity.
Adult ; Arthritis, Rheumatoid/*diagnosis ; Autoantibodies/*blood ; Biological Markers/blood ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Male ; Middle Aged ; Peptides, Cyclic/*immunology ; ROC Curve ; Reagent Kits, Diagnostic ; Rheumatoid Factor/blood ; Sensitivity and Specificity

PURPOSE: Critical pathway (CP) refers to the standardized care process that predefines the treatment sequence and timing for a specific group of diseases and patients. The recent interest in CPs has increased as a quality improvement tool and a cost-effective delivery system for medical services. The authors applied a CP for pediatric inguinal hernias, and we investigated the cost effectiveness and also the satisfaction of the patients and the medical staff. METHODS: The CP was applied to 24 patients (the CP group) and the characteristics of the patients, the length of the hospital stay, the postoperative course, the medical costs and the results of the survey were compared with 26 other patients (the non-CP group). RESULTS: There was no difference in the patients' characteristics, the length of the hospital stay, the postoperative complications and the course of between the two groups. The cost for the medications, injections, treatments and examinations for the CP group were significantly lower than those for the non-CP group (P<0.05). The satisfaction of patients was significantly improved after the application of the CP (P<0.05), and the satisfaction of the medical staff was high. CONCLUSION: The application of a CP for pediatric inguinal hernia can save treatment-related medical costs. Moreover, the CP is an effective, excellent care process that improves the satisfaction of both the patients and the medical staff.
Cost-Benefit Analysis ; Critical Pathways ; Hernia, Inguinal ; Humans ; Length of Stay ; Medical Staff ; Postoperative Complications ; Quality Improvement

PURPOSE: HuR, human family embryonic-lethal abnormal vision-like protein, can bind to mRNA and stabilizes the nucleic acid in the cytoplasm, resulting in more efficient translation. HuR is predominantly present in the nucleus and shuttles between the nucleus and cytoplasm. HuR stabilizes cyclooxygenase-2 (Cox-2) mRNA in several cancers, including breast, stomach, lung and brain cancer. MATERIALS AND METHODS: We investigated the expression and cellular location of HuR, as well as evaluated Cox-2 expression in 79 colorectal cancer patients with the use of immunohistochemical methods. The biological implications of HuR localization and Cox-2 expression in colorectal carcinoma were evaluated. RESULTS: Nuclear HuR expression was observed in 59 (74.7%) tumors and cytoplasmic HuR expression was seen in 25 (31.6%) tumors. Cox-2 immunoreactivity was noted in 42 (53%) tumors. The expression of cytoplasmic HuR was significantly associated with Cox-2 expression (p=0.004). Cytoplasmic expression of HuR showed a correlation with lymphatic invasion (p=0.025) and the presence of a lymph node metastasis (p=0.027). The presence of nuclear HuR showed no correlation with Cox-2 expression or any other of the clinicopathological parameters that were examined. CONCLUSION: These results suggest that cytoplasmic translocation of HuR is associated with Cox-2 expression for some colorectal carcinomas.
Brain Neoplasms ; Breast ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Cyclooxygenase 2 ; Cytoplasm ; Humans ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; RNA, Messenger ; Stomach

Colovesical fistulae secondary to diverticulitis usually manifest themselves as non-specific lower abdominal discomfort and urologic symptoms. CT is known to be the most sensitive modality for diagnosing this entity. Ultrasonography is the initial diagnostic tool used for evaluating patients with these symptoms, but there have been no reports describing the ultrasonographic findings of colovesical fistulae in Korea. Therefore, we present a case of an ultrasonographically diagnosed colovesical fistula complicating sigmoid diverticulitis. Color Doppler ultrasonography was used in conjunction with lower abdominal compression in order to determine if the fistulous tract was open or obliterated.
Colon ; Colon, Sigmoid ; Diverticulitis ; Fistula ; Humans ; Intestinal Fistula ; Korea ; Ultrasonography, Doppler, Color ; Urinary Bladder

Clostridium perfringens is an anaerobic, gram-positive rod that inhabits the soil and the intestinal tracts of many animals, including humans. C. perfringens is a major cause of food poisoning, traumatic or nontraumatic myonecrosis, clostridial cellulitis, gangrenous cholecystitis, sepsis or bacteremia, and intravascular hemolysis. Massive intravascular hemolysis is a rare complication of C. perfringens septicemia and has a high mortality rate with an extremely rapid progression. Therefore, aggressive treatment is required as soon as the diagnosis is made. In this study, we report a case of massive intravascular hemolysis due to C. perfringens septicemia in a 34-year-old man with liver cirrhosis.
Adult ; Animals ; Bacteremia ; Cellulitis ; Cholecystitis ; Clostridium perfringens ; Diagnosis ; Foodborne Diseases ; Hemolysis* ; Humans ; Liver Cirrhosis ; Mortality ; Sepsis* ; Soil

PURPOSE: This study aims to abstract the differences of scores between the clinical instructors and standardized patients (SPs) in a clinical performance examination (CPX) using SPs and to correlate the concordance between the evaluation scores and the school records. METHODS: The CPX was administered in 2003 to a total of thirty-six fifth year medical students at Gachon Medical School. The examination consisted of four cases, and four stations were duplicated, each requiring a total of 7.5 minutes per station. Evaluation of the student' s performances was conducted by both clinical instructors and SPs using a formatted checklist. Results were analysed by t-test, agreement rates, and Pearson correlation. RESULT: The mean scores given out by the clinical instructors and the SPs for the newly developed case were significantly different, while those scores for pre-existing cases were not in the old cases. The correlation coefficients between these two evaluation groups were relatively high. And agreements between the two evaluation groups were 0.37~0.72. The mean scores among clinical instructors were not significantly different, but the correlation coefficients and agreement rates were relatively high. The correlation between the evaluation scores and school records did not correlate significantly. CONCLUSION: It is concluded that the CPX is a useful tool to measure the students' essential competences in areas of knowledge, skills and attitude during the subinternship stage. In conducting a successful CPX, it is crucial to reconsider the recycling of cases and the selection and training of SPs aside from the development of an objective checklist.
Checklist ; Clinical Competence ; Humans ; Recycling ; Schools, Medical* ; Students, Medical

PURPOSE: To report the loss of correction of a sagittal imbalance and the clinical outcomes after a corrective osteotomy for lumbar degenerative kyphosis. MATERIALS AND METHODS: This study analyzed the radiological parameters, surgical techniques, and clinical outcomes of 23 patients, who underwent corrective osteotomy for lumbar degenerative kyphosis. The patients were divided into groups I (>5 cm loss of correction of sagittal imblance, 12 patients) and II (<5 cm, 11 patients) to compare the patients with the correction preserved with those with the correction lost. In terms of the clinical outcome, group A (high satisfaction score group >3.5 out of 5, 11 patients) was compared with group B (low satisfaction score group <3.5 out of 5, 12 patients). RESULTS: The sagittal imbalance was corrected by performing a Smith-Petersen osteotomy (SPO) in 11 cases and Pedicle subtraction osteotomy (PSO) in 12. The mean preoperative sagittal imbalance was improved from 26.4 cm to 4.05 cm, postoperatively, and 11.2 cm at the last follow up. The mean loss of correction was 11.2 cm in group I and 2.3 cm in group II. The mean satisfaction score was 4.56 in group A and 2.18 in group B. The presence of an old compression fracture was found to be related to the loss of correction, and the preoperative symptomatic spinal stenosis was related to poor clinical outcomes. CONCLUSION: After mean 45 month follow up, the mean loss of sagittal correction was 38.3%, which mainly occurred at the proximal unfused segment. The clinical success rate was 45.5%, regardless of the loss of sagittal balance correction.
Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphosis ; Osteotomy ; Spinal Stenosis

Small cell carcinoma with unknown primary (SCUP) is an uncommon cancer. Histologically, SCUP has been included with extrapulmonary small cell carcinoma (EPSCC) that is defined as a biopsy proven small cell carcinoma in a nonpulmonary primary site. SCUP is usually diagnosed in the lymph nodes, liver, brain, or bone. This tumor is a distinct clinicopathologic entity from small cell carcinoma of the lung. Generally, the clinical course is aggressive and often recurrent, and it has poor prognosis. The identification and differential diagnosis of this tumor can be made with the morphology of neuroendocrine features, immunohistochemistry with chromogranin A, neuron-specific enolase, synaptophysin and CD56, and cytogenetic findings. We treated a case of aggressive SCUP diagnosed by bone marrow biopsy in a 68-year-old man. There was no evidence of tumor in the lung. The patient died one month after without receiving any therapy.
Aged ; Biopsy ; Bone Marrow ; Brain ; Carcinoma, Small Cell* ; Chromogranin A ; Cytogenetics ; Diagnosis, Differential ; Humans ; Immunohistochemistry ; Liver ; Lung ; Lymph Nodes ; Phosphopyruvate Hydratase ; Prognosis ; Synaptophysin

No abstract available.
Calcium

PURPOSE: In Kyung Hee East-West Neo Medical Center, Seoul, Korea, efforts to raise rooming-in care success rate have been undertaken since when the hospital was established in 2006. We intended to analyze our experience over the past 3 years of period and to discuss the advantages of rooming-in. METHODS: We analyzed the rooming-in practice rate, failure rate, and the breast feeding rate. Subjects were 860 normal healthy neonates from June 2006 to June 2009. RESULTS: Among these 860 cases, 83 babies were required separation out of rooming-in in the middle of the course. Among these 83 cases, 70 cases had to stop the course due to poor condition of babies and 13 cases due to maternal condition. 70 cases of infant's causes consist of 68 cases of NICU admission and 2 cases of poor feeding support. The other 13 cases of separation include refusal by maternal condition. Therefore the success rate of rooming-in for the last 3 years was 90.3%, that is 777 cases among the total 860 cases. The percentage of exclusive breast feeding was 64%, that of mixed feeding with breast and formula feeding was 25%, and formula feeding only was 11%. CONCLUSION: We experienced successful rooming-in care for the last 3 years. Nursery facilities should educate and encourage the advantages of rooming-in, including the good formation of attachment between mother and infant, emotional stability, protection from infection, and increased breast feeding rate so that rooming-in care can be fully established.
Breast ; Breast Feeding ; Disulfiram ; Humans ; Infant ; Infant, Newborn ; Korea ; Mothers ; Nurseries ; Rooming-in Care