1.Site-specific effect of testosterone on bone mineral density in male hypogonadism.
Hak Ryong CHOI ; Sung Kil LIM ; Moo Sang LEE
Journal of Korean Medical Science 1995;10(6):431-435
To assess the correlation between the remaining serum testosterone and bone mineral density(BMD), and to determine the effect of exogenous testosterone on BMD in subjects with male hypogonadism, we evaluated the serum testosterone levels and BMDs of the femur neck, Ward's triangle and the spine(L1-4) in 20 subjects with Klinefelter's syndrome and 7 with hypogonadotropic hypogonadism before and after testosterone replacement. BMDs of the femur neck, Ward's triangle and the spine were below the age-matched normal mean at 77.8%(21/20), 74.1%(20/27) and 88.9%(24/27), respectively. There were significant differences in serum testosterone levels and the spinal BMD between the two groups and the BMD of the spine closely correlated with the serum testosterone level (R = 0.63, p < 0.001). Following a mean 11.8 +/- 4.9 months of testosterone replacement, the BMD at all sites increased significantly and the pretreatment difference in spinal BMD between the two groups disappeared. We conclude that, although testosterone may increases the bone density, it has a site-specific effect of maintaining and increasing the bone mass especially at the spine in male hypogonadism.
Adult
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Bone Density/*drug effects/physiology
;
Human
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Hypogonadism/blood/*metabolism
;
Klinefelter Syndrome/blood/drug therapy/*metabolism
;
Male
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Middle Age
;
Testosterone/blood/metabolism/*pharmacology
2.Risk Factors for Cause-specific Mortality of Very-Low-Birth-Weight Infants in the Korean Neonatal Network.
Jae Woo LIM ; Sung Hoon CHUNG ; Dae Ryong KANG ; Chang Ryul KIM
Journal of Korean Medical Science 2015;30(Suppl 1):S35-S44
This study attempted to assess the risk factors for mortality of very-low-birth-weight (VLBW) infants in the neonatal intensive care unit (NICU, n=2,386). Using data from the Korean Neonatal Network, we investigated infants with birth weights <1,500 g and gestational ages (GAs) of 22-31 weeks born between January 2013 and June 2014. Cases were defined as death at NICU discharge. Controls were randomly selected from live VLBW infants and frequency matched to case subjects by GA. Relevant variables were compared between the cases (n=236) and controls (n=236) by Cox proportional hazards regression to determine their associations with cause-specific mortality (cardiorespiratory, neurologic, infection, gastrointestinal, and others). In a Cox regression analysis, cardiorespiratory death were associated with a foreign mother (hazard ratio, HR, 4.33; 95% confidence interval, CI, 2.08-9.02), multiple gestation (HR, 1.65; 95% CI, 1.07-2.54), small for gestational age (HR, 2.06; 95% CI, 1.25-3.41), male gender (HR, 1.69; 95% CI, 1.10-2.60), Apgar score < or =3 at 5 min (HR, 1.97; 95% CI, 1.18-3.31), and delivery room resuscitation (HR, 2.60; 95% CI, 1.53-4.40). An Apgar score < or =3 at 5 min was also associated with neurological death (HR, 2.95; 95% CI, 1.29-6.73). Death due to neonatal infection was associated with outborn delivery (HR, 5.09; 95% CI, 1.46-17.74). Antenatal steroid and preterm premature rupture of membranes reduced risk of cardiorespiratory death (HR, 0.43; 95% CI, 0.27-0.67) and gastrointestinal death (HR, 0.30; 95% CI, 0.13-0.70), respectively. In conclusion, foreign mother, multiple gestation, small gestation age, male gender, Apgar score < or =3 at 5 min, and resuscitation in the delivery room are associated with cardiorespiratory mortality of VLBW infants in NICU. An Apgar score < or =3 at 5 min and outborn status are associated with neurological and infection mortality, respectively.
Apgar Score
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Cohort Studies
;
Databases, Factual
;
Female
;
Gestational Age
;
Humans
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Infant
;
*Infant Death
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*Infant Mortality/trends
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Infant, Newborn
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Infant, Premature
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Infant, Very Low Birth Weight
;
Intensive Care Units, Neonatal
;
Kaplan-Meier Estimate
;
Male
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Pregnancy
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Pregnancy, Multiple
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Proportional Hazards Models
;
Republic of Korea
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Resuscitation
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Risk Factors
;
Sex Factors
3.Syndromic Diagnosis at the Epilepsy Clinic: Role of MRI .
Byung In LEE ; Kyung HEO ; Jang Sung KIM ; Ok Joon KIM ; Sun Ah PARK ; Sung Ryong LIM ; Dong Ik KIM ; Pyung Ho YOON
Journal of Korean Epilepsy Society 2001;5(1):22-32
PURPOSE: To evaluate the application of MRI to the ILAE classification of epilepsies and epileptic syndromes in the setting of epilepsy clinic. METHODS: We reviewed epilepsy registry forms, EEG, and MRI of 300 patients who were consecutively registered to the Yonsei Epilepsy Clinic. The algorhithm of syndromic classification consisted of 3 steps ; 1) clinical diagnosis based on the clinical informations described in the registry form, 2) clinical-EEG correlations, and 3) clinical-EEG-MRI correlations. The interictal epileptiform discharges (IEDs) in EEG were divided into focal, multilobar/multifocal, and generalized. MRI-lesions were divided into focal and non-focal (multilobar/multifocal, and diffuse) lesions. The clinical-EEG, EEG-MRI, and MRI-clinical correlations were categorized as concordant, not discordant, and discordant. RESULTS: Among 300 patients evaluated, 249 patients were found to have epilepsies and both EEG and MRI. By clinical analysis, 190 of 249 patients were diagnosed as localization-related epilepsies (LRE), 24 patients were generalized epilepsies (GE), 34 patients were undetermined epilepsies (UDE), and one patient had alcohol related epilepsy. EEG revealed IEDs in 124 patients and altered the clinical diagnosis in 79 patients. MRI lesions were found in 106 patients with focal lesions in 65 patients and non-focal lesions in 41 patients. MRI lesions were found in 47 of 125 patients with negative EEG. Concordance rates of clinical-EEG, EEG-MRI, and MRI-clinical correlations in 54 patients with lobar epilepsies, who had positive EEG and MRI, were 39%, 54%, and 52%, respectively, and discordant rates were 17%, 11% and 7%, respectively. The complete concordance of all 3 correlations was found in only 33% of them. In 20 patients diagnosed as GE by clinical-EEG correlations, MRI lesions were found in only 3 patients and none of them changed the diagnostic categories due to MRI lesions. CONCLUSION: In lobar epilepsies, the sensitivity of MRI was quite comparable with EEG and the clinical-MRI correlation was superior to the clinical-EEG correlations. MRI provided additional and complimentary informations and should be incorporated to the ILAE-classification system as the category of 'lesional epilepsy'.
Classification
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Diagnosis*
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Electroencephalography
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Epilepsies, Partial
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Epilepsy*
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Epilepsy, Generalized
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Humans
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Magnetic Resonance Imaging*
4.Comparison of BTA TRAK Assay with Voided Urine Cytology in the Detection of Primary and Recurrent Bladder Cancer.
Sung Ryong KIM ; Mi Won AHN ; Young Bu KIM ; Young Ae LIM ; Se Joong KIM
Korean Journal of Urology 2002;43(4):296-302
PURPOSE: We prospectively evaluated the diagnostic efficacy of the BTA TRAK assay according to the stage, grade and hematuria in detecting primary and recurrent bladder cancer, and compared results with voided urine cytology. MATERIALS AND MTHODS: Urinalysis, cytology and BTA TRAK assay were performed simultaneously with the single voided fresh urine samples from 130 subjects. The sensitivity and specificity of the BTA TRAK assay were compared to those of urine cytology and analyzed according to the stage or grade. The subjects were also divided into 4 groups according to the degree of hematuria and the influence of hematuria on the result of the BTA TRAK assay was evaluated. RESULTS: The overall sensitivity and specificity of the BTA TRAK assay for detecting bladder cancer were 82.8% and 65.3%, respectively and those of urine cytology were 44.8% and 100%. The sensitivity of the BTA TRAK assay was significantly higher than that of urine cytology in bladder cancer with lower stage and grade. On univariate and multivariate analysis, gross hematuria and the presence of bladder cancer affected the results of the BTA TRAK assay significantly. In cases following after transurethral resection of bladder tumor (TURB), the sensitivity and specificity of the BTA TRAK assay for detecting recurrent bladder cancer were 100% and 79.5%, respectively. CONCLUSIONS: The BTA TRAK assay was more sensitive but less specific than voided urine cytology. Because gross hematuria affected the result of the BTA TRAK assay independently, it appears reasonable to delay the BTA TRAK assay until gross hematuria subsides in cases with gross hematuria. In cases following after TURB, the BTA TRAK assay appears to be useful for detecting recurrent bladder cancer.
Diagnosis
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Hematuria
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Multivariate Analysis
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Prospective Studies
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Sensitivity and Specificity
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Urinalysis
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Urinary Bladder Neoplasms*
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Urinary Bladder*
5.Comparison of BTA TRAK Assay with Voided Urine Cytology in the Detection of Primary and Recurrent Bladder Cancer.
Sung Ryong KIM ; Mi Won AHN ; Young Bu KIM ; Young Ae LIM ; Se Joong KIM
Korean Journal of Urology 2002;43(4):296-302
PURPOSE: We prospectively evaluated the diagnostic efficacy of the BTA TRAK assay according to the stage, grade and hematuria in detecting primary and recurrent bladder cancer, and compared results with voided urine cytology. MATERIALS AND MTHODS: Urinalysis, cytology and BTA TRAK assay were performed simultaneously with the single voided fresh urine samples from 130 subjects. The sensitivity and specificity of the BTA TRAK assay were compared to those of urine cytology and analyzed according to the stage or grade. The subjects were also divided into 4 groups according to the degree of hematuria and the influence of hematuria on the result of the BTA TRAK assay was evaluated. RESULTS: The overall sensitivity and specificity of the BTA TRAK assay for detecting bladder cancer were 82.8% and 65.3%, respectively and those of urine cytology were 44.8% and 100%. The sensitivity of the BTA TRAK assay was significantly higher than that of urine cytology in bladder cancer with lower stage and grade. On univariate and multivariate analysis, gross hematuria and the presence of bladder cancer affected the results of the BTA TRAK assay significantly. In cases following after transurethral resection of bladder tumor (TURB), the sensitivity and specificity of the BTA TRAK assay for detecting recurrent bladder cancer were 100% and 79.5%, respectively. CONCLUSIONS: The BTA TRAK assay was more sensitive but less specific than voided urine cytology. Because gross hematuria affected the result of the BTA TRAK assay independently, it appears reasonable to delay the BTA TRAK assay until gross hematuria subsides in cases with gross hematuria. In cases following after TURB, the BTA TRAK assay appears to be useful for detecting recurrent bladder cancer.
Diagnosis
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Hematuria
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Multivariate Analysis
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Prospective Studies
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Sensitivity and Specificity
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Urinalysis
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Urinary Bladder Neoplasms*
;
Urinary Bladder*
6.A Case of Esophageal Pyogenic Granuloma.
Hyun Sun CHO ; Eun Sun JUNG ; Yune Jung LEE ; Chul Hyun LIM ; Woong Ryong JUNG ; Hye Young SUNG ; Jae Myung PARK ; Myung Gyu CHOI
Korean Journal of Gastrointestinal Endoscopy 2009;38(4):210-213
Pyogenic granulomas (PGs) are rare benign lobular capillary hemangiomas that occur on the skin or mucosa. The most common sites of PG occurrence are the skin, lip, face and finger. This entity is extremely rare in the alimentary tract, with the exception of the oral cavity. We describe here a 72-year-old man who presented with dysphagia due to the presence of a pyogenic granuloma. The tumor was located in the mid-esophagus and it was treated with endoscopic submucosal dissection. PG is considered a lesion of reactive origin that may develop in response to trauma, infection, pregnancy, angiogenic factors or hormones. Gastrointestinal PG need to be treated because it is a rare cause of gastrointestinal hemorrhage, and it is hard to differentiate from tumorous conditions such as Kaposi's sarcoma.
Aged
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Angiogenesis Inducing Agents
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Deglutition Disorders
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Fingers
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Gastrointestinal Hemorrhage
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Granuloma
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Granuloma, Pyogenic
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Hemangioma
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Humans
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Lip
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Mouth
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Mucous Membrane
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Pregnancy
;
Skin
7.Spontaneous Non-Traumatic Stress Fractures in Bilateral Femoral Shafts in a Patient Treated with Bisphosphonates.
Dong Yeob SHIN ; Cheol Ryong KU ; Kyung Min KIM ; Han Seok CHOI ; Yumie RHEE ; Eun Jig LEE ; Sung Kil LIM
The Korean Journal of Internal Medicine 2012;27(1):98-102
Bisphosphonates are potent inhibitors of bone resorption and widely used to treat osteoporosis. Extensive studies have shown that therapy with bisphosphonates improves bone density and decreases fracture risk. However, concerns have been raised about potential over-suppression of bone turnover during long-term use of bisphosphonates, resulting in increased susceptibility to and delayed healing of non-spinal fractures. We report a patient who sustained non-traumatic stress fractures in bilateral femoral shafts with delayed healing after long-term bisphosphonate therapy. She underwent open reduction and surgical internal fixation. Although bisphosphonates effectively prevent vertebral fractures, and their safety has been tested in randomized trials, we must emphasize the need for awareness of the possibility that long-term suppression of bone turnover with bisphosphonates may eventually lead to an accumulation of fatigue-induced damage and adverse skeletal effects such as delayed fracture healing.
Bone Density/drug effects
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Diaphyses/drug effects/injuries
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Diphosphonates/*adverse effects
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Female
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Femoral Fractures/*chemically induced/diagnosis/surgery
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Fracture Fixation, Internal
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Fracture Healing/drug effects
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Fractures, Spontaneous/*chemically induced/diagnosis/surgery
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Fractures, Stress/*chemically induced/diagnosis/surgery
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Humans
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Middle Aged
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Osteoporosis/*drug therapy
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Radiopharmaceuticals/diagnostic use
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Technetium Tc 99m Medronate/analogs & derivatives/diagnostic use
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Treatment Outcome
;
Whole Body Imaging
8.Comparison of Instructional Methods for Teaching Cardiopulmonary Resuscitation to School Children: CPR Anytime(R) and Little Anne(R).
Sung Pil CHUNG ; Junho CHO ; Yoo Seok PARK ; Euichung KIM ; Chan Woong KIM ; Kyeong Ryong LEE ; Mi Jin LEE ; Hoon LIM ; Wen Joen CHANG ; Jin Hee LEE
Journal of the Korean Society of Emergency Medicine 2008;19(6):627-631
PURPOSE: We compared the effectiveness of CPR Anytime(R) and Little Anne(R) for instructing schoolchildren in CPR. METHODS: We gave CPR instructions to 774 school children (24 classes) from the fifth to the eighth grade in 12 schools. We randomly selected two classes of the same grade from each school. Each class was given two hours of CPR instruction using either the Korean version of CPR Anytime(R) or Little Anne(R). The number of CPR Anytime(R) per student was 1:1 and Little Anne(R) was 1:6. The lesson consisted of didactic lecture, skill practice, and skill test. We compared the skill performance of students according to the instruction method. RESULTS: Three hundred ninety-seven (51%) students were taught using CPR Anytime(R) and 377 (49%) with Little Anne (R). There was no difference in the compression depth, hand position, adequacy of chest recoil, volume of ventilation, self-confidence, and willingness to do CPR between the two instructional methods. The average compression depth was less than 40~50 mm. Elementary school students showed more confidence and willingness to do CPR than middle school students. CONCLUSION: There was no difference in CPR skill performance after instruction using either Anytime CPR(R) or Little Anne(R).
Cardiopulmonary Resuscitation
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Child
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Hand
;
Humans
;
Thorax
;
Ventilation
9.Toll-like receptor 9 dependent activation of MAPK and NF-kB is required for the CpG ODN-induced matrix metalloproteinase-9 expression.
Eun Jung LIM ; Sun Hye LEE ; Jin Gu LEE ; Jae Ryong KIM ; Sung Su YUN ; Suk Hwan BAEK ; ChuHee LEE
Experimental & Molecular Medicine 2007;39(2):239-245
Unmethylated CpG oligodeoxynucleotides (CpG ODNs) activate immune cells to produce immune mediators. This study demonstrates that in murine macrophage RAW 264.7 cells, CpG ODN-mediated matrix metalloproteinase-9 (MMP-9) expression is regulated at transcriptional level and requires de novo protein synthesis. Inhibition of ERK and p38 MAPK, but not JNK, results in significant decrease of CpG ODN-induced MMP-9 expression. We found that endosomal maturation inhibitors, chloroquine and bafilomycin A, block CpG ODN-induced ERK and p38 MAPK activation and the subsequent MMP-9 expression. We also observed that CpG ODN induces NF-kappa B activation and NF-kappa B is a downstream target of p38 MAPK. Taken together, our data demonstrate that CpG ODN triggers MMP-9 expression via TLR-9 dependent ERK and p38 MAPK activation followed by NF-kappa B activation.
Animals
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Cell Line
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Enzyme Activation/drug effects
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Enzyme Induction/drug effects
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Matrix Metalloproteinase 9/*biosynthesis
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Mice
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Mitogen-Activated Protein Kinase 1/antagonists & inhibitors/metabolism
;
Mitogen-Activated Protein Kinase 3/antagonists & inhibitors/metabolism
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Mitogen-Activated Protein Kinases/*metabolism
;
NF-kappa B/*metabolism
;
Oligodeoxyribonucleotides/*pharmacology
;
Signal Transduction/drug effects
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Toll-Like Receptor 9/antagonists & inhibitors/*metabolism
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p38 Mitogen-Activated Protein Kinases/antagonists & inhibitors/metabolism
10.Depression as a Mediator of the Relationship Between Resilience and Posttraumatic Stress Symptoms and Dissociation in Firefighters.
Tae Hoon KWON ; So Yeon HYUN ; Young Ki CHUNG ; Ki Young LIM ; Jae Sung NOH ; Dae Ryong KANG ; Gwiyeom HA ; Nam Hee KIM
Korean Journal of Psychosomatic Medicine 2016;24(1):109-116
OBJECTIVES: This study aimed to investigate the effects of resilience on posttraumatic stress symptoms and dissociation and whether depression mediates the relationships between resilience and posttraumatic stress symptoms and dissociation. METHODS: A total of 115 firefighters participated in the study. Data were collected via the Life Events Checklist, Impact of Event Scale-Revised, Dissociative Experience Scale, Beck Depression Inventory, and Connor-Davidson Resilience Scale. Structural equation modeling and path analysis were applied to estimate the relationships between resilience, depression, posttraumatic stress symptoms, and dissociation. RESULTS: Greater resilience was associated with lower posttraumatic stress symptoms and dissociation, and the relationship between them was fully mediated by depression. CONCLUSIONS: Specific aspects of depression may help explain the relationships between resilience and posttraumatic stress symptoms and dissociation. Tailored prevention programs and treatments based on resilience and depression may prevent posttraumatic stress symptoms and dissociation in firefighters and improve treatments outcomes among firefighters with posttraumatic stress symptoms and/or dissociation.
Checklist
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Depression*
;
Firefighters*
;
Humans