PURPOSE: This study was done to evaluate the operating status of community-based home health center for revitalization of the centers. METHOD: In this study performance data including organization plan and service utilization plan were evaluated according process theory. Target of evaluation was the community-based home health care center. RESULTS: The vulnerable part of the organization was the information system and financial resources. The home health center introduced PDA (Personal Digital Assistants) in 2005, however home health care nurses did not make full use of it. This service received full support from Seoul city and local government and there were no other sources of income. The vulnerable part of service utilization was service expansion and standardization due to vulnerability of organizational aspects. CONCLUSIONS: The home health care center provides high quality services to underprivileged people. In the future, these services should be provided with equity for continuous health care for this population.
Delivery of Health Care ; Information Systems ; Local Government

Purpose: This study assessed the results of surgical treatment for Neer type-II and type-V unstable distal clavicle fractures via hybrid fixation with a locking compression plate and finger trap wire. Materials and Methods: From September 2016 to April 2018, 15 patients treated for Neer type-II and type-V unstable distal clavicle fractures using hybrid fixation were analyzed retrospectively. The clinical results were analyzed based on the radiological healing time, range of motion of the shoulder joint, American Shoulder and Elbow Society (ASES) score, and the University of California at Los Angeles (UCLA) shoulder score. Results: The range of motion of the shoulder joint completely recovered to the normal range within 9.2 weeks on average (6−24 weeks). Furthermore, the follow-up of the clinical trial showed excellent results, including an ASES score of 98.5±2.3 and an UCLA score of 34.2±1.3. In addition, fracture union was successfully achieved in all cases, and was identified during week 15 on average. Conclusion For the treatment of unstable distal clavicle fractures, hybrid fixation is a useful surgical method with excellent clinical outcomes through rapid recovery of the range of motion of the shoulder joint after surgery.

OBJECTIVE: The aim of this study was to determine the role of survivin, caspase 3, p53 and Ki-67 expression in the carcinogenesis of cervical carcinoma and aggressiveness of cervical intraepithelial neoplasia (CIN). METHODS: The pathology specimens of 94 patients with a diagnosis of Low grade CIN (31 cases), High grade CINL (32 cases) and squamous cell carcinoma (31 cases) were evaluated immunohistochemically for the expression of survivin, caspase 3, p53 and Ki-67 in paraffin sections. RESULTS: Survivin, p53 and Ki-67 expressions were progressively increased in accordance with the increasing degree of malignancy, but caspase 3 immunoreactivity was higher in high grade CIN than in low grade CIN and invasive cervical cancers. There was no significant difference between Ki-67 index and survivin, caspase 3 and p53 expression with the increasing degree of malignancy. The Ki-67 index was closely related to p53 overexpression in invasive cervical carcinoma group. CONCLUSION: A sequential increase of survivin, p53, and Ki-67 was observed in paralleling the progression of grade of CIN and cervical cancer. In addition, caspase 3 expression increased proportionally to the low-grade CIN to high grade CIN.
Carcinoma, Squamous Cell ; Caspase 3 ; Cervical Intraepithelial Neoplasia ; Humans ; Paraffin ; Uterine Cervical Neoplasms

BACKGROUND: Diagnosis of tuberculous pleurisy is sometimes difficult using conventional diagnostic methods. We have investigated the utility of pleural fluid cell IFN-gamma production assay in the diagnosis of tuberculous pleurisy. METHODS: We prospectively performed pleural fluid cell IFN-gamma production assay in 39 patients with tuberculous pleural effusions (TPE) and in 26 patients with nontuberculous pleural effusions (NTPE) (13 malignant pleural effusions and 13 parapneumonic effusions). Pleural fluid cells were cultured in DMEM media and stimulated with purified protein derivatives (PPD), and phytohemagglutinin (PHA) for 24 hr. The amount of IFN-gamma released in the culture supernatant was quantitated by IFN-gamma ELISA assay. We have also measured adenosine deaminase (ADA) activities and IFN-gamma concentrations in the pleural fluid. RESULTS: 1) The pleural fluid levels of ADA activity and IFN-gamma concentrations were significantly higher in TPE than NTPE (p<0.01). 2) IFN-gamma production in TPE cells stimulated by PPD (755,266+/-886,636 pg/ml) was significantly higher than NTPE cells (3,509+/-6,980 pg/ml) (p<0.01). By considering the fact that IFN-gamma concentrations over 10,000 pg/ml is a criteria for the diagnosis of TBE, sensitivity and specificity of the test were 97.4 and 92.3%, respectively. 3) The ratios of IFN-gamma production by the stimulation with PPD and PHA (PPD/PHA) were significantly higher in TPE cells (59+/-85) than NTPE cells (5+/-18)(p<0.01). Considering the criteria for the diagnosis of TBE as PPD/PHA ratio over 5, sensitivity and specificity of the test were 76.9 and 92.3%, respectively. CONCLUSION: Pleural fluid cell IFN-gamma production assay may be useful for the diagnosis of tuberculous pleurisy.
Adenosine Deaminase ; Diagnosis* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleurisy ; Prospective Studies ; Tuberculosis ; Tuberculosis, Pleural*

An ectopic pregnancy in the abdominal organs is very rare. Primary intestinal pregnancy is considered the rarest form of extrauterine pregnancy, and only a few well-documented cases have been reported. Herein, a case of an abdominal pregnancy in a 25-year-old woman, with massive lower gastrointestinal bleeding, is reported. The source of bleeding could not be identified, despite gastroscopy, ultrasonography and angiography investigations. A diagnostic laparotomy disclosed an abdominal pregnancy, causing an erosion of the jejunal wall at the site of the pregnancy, with massive lower gastrointestinal bleeding. An abdominal pregnancy is seldom included in the differential diagnosis of lower gastrointestinal bleeding. The possibility of intestinal erosion in an abdominal pregnancy should be borne in mind in cases of lower gastrointestinal bleeding.
Adult ; Angiography ; Diagnosis, Differential ; Female ; Gastroscopy ; Hemorrhage* ; Humans ; Laparotomy ; Pregnancy ; Pregnancy, Abdominal* ; Pregnancy, Ectopic ; Ultrasonography

OBJECTIVE: Cell to cell and cell to extracellular matrix interaction are crucial in tumor development and progression. Tight junction proteins such as claudins and zonula occludens-1 (ZO-1) play an important role in these processes. This study was performed to investigate the difference of expressions of claudin-1, claudin-4 and ZO-1 in low grade squamous intraepithelial lesion (LSIL), high grade squamous intraepithelial lesion (HSIL), and invasive squamous cell carcinoma (ISCC) of the uterine cervix. METHODS: The expressions of claudin-1, claudin-4 and ZO-1 were evaluated using immunohistochemical staining in 78 cervical tissue specimens (LSIL 22 case, HSIL 36 case, and ISCC 20 case). RESULTS: Claudin-1 expression was positive in 40.9% of LSIL, in 94.0% of HSIL and in 20.0% of ISCC. The expression of claudin-1 was significantly high in HSIL (p=0.0001). Claudin-4 expression was positive in 31.8% of LSIL, in 41.7% of HSIL and in 25.0% of ISCC. The expression of claudin-4 was high in HSIL, but it was not statistically different. ZO-1 expression was positive in 13.6% of LSIL, in 41.7% of HSIL, and in 25.5% of ISCC. The expression of ZO-1 was significantly high in HSIL (p=0.011). CONCLUSION: These results indicate increased expressions of claudin-1 and ZO-1 in the HSIL that includes cervical intraepithelial neoplasia (CIN) 2 and 3, which decrease during progression to cervical cancer.
Carcinoma, Squamous Cell* ; Cervical Intraepithelial Neoplasia* ; Cervix Uteri ; Claudin-1* ; Claudin-4* ; Claudins ; Extracellular Matrix ; Female ; Tight Junction Proteins ; Uterine Cervical Neoplasms

A 47-year-old female patient was admission for back pain after she fell down on the table. T12 compression fracture was found for spinal magnetic resonance imaging. Absolute bed rest and pain control for non-steroidal anti-inflammatory drugs and muscle relaxant were received. After 7 days, she complained febrile sense, abdominal pain, and diarrhea. Septic shock was suspected, and then use of antibiotics and proper management were performed. Computed tomography of chest and abdomen was not revealed specific finding. Blood culture showed growth of Klebsiella pneumoniae. After patients completely resolved symptoms, colonoscopy was performed that showed erosive lesions of cecum, proximal A-colon, and rectum.
Abdomen ; Abdominal Pain ; Adult* ; Anti-Bacterial Agents ; Back Pain ; Bed Rest ; Cecum ; Colitis* ; Colonoscopy ; Diarrhea ; Female ; Fractures, Compression ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Magnetic Resonance Imaging ; Middle Aged ; Rectum ; Sepsis* ; Shock, Septic ; Thorax

Sodium glucose cotransporter 2 (SGLT2) inhibitor has been recently reported of diabetic ketoacidosis due to accumulation of ketone bodies in patients with severe dehydration caused from such like diarrhea even though the patient had normal glucose level. This is a case of ketoacidosis in normal glucose level as production of ketone bodies is stimulated in liver with increased secretion of glucagon by stimulation of α cells in pancreas due to increase of lipolysis caused from reducing insulin and by SGLT2 inhibitor among patients who are under concurrent insulin and SGLT2 inhibitor. Thus, insulin dosage reduction requires caution in order to control blood glucose level on combined treatment of SGLT2 inhibitor in a patient who is administering insulin because the patient may be caused ketoacidosis in normal blood glucose level.
Blood Glucose ; Dehydration ; Diabetic Ketoacidosis* ; Diarrhea ; Glucagon ; Glucose* ; Humans ; Insulin* ; Ketone Bodies ; Ketosis ; Lipolysis ; Liver ; Pancreas ; Sodium*

OBJECTIVE: To investigate the effects of bisphenol A (BPA) on cell death pattern in neuronal development of chick embryos. MATERIALS AND METHODS: We planned to compare the cytokinetic features in the normal chick embryo and those with BPA. Fifteen eggs were divided into three GROUPS: the control group, BPA 50 microgram/g egg group and BPA 200 microgram/g egg group. Embryos were incubated for 56 hours (Hamburger & Hamilton stage 16) and then we injected BPA into embryos. The embryos were sectioned by 3 micrometer thickness at the level of wing buds and stained at 72 hours after incubation (HH stage 18). We observed cell death in the spinal cord using terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) method. RESULTS: The TUNEL-positivity markedly increased in proportion to the doses of BPA. The number of TUNEL-positive cells per section was 15.2+/-2.14 in the control group, 34.6+/-3.44 in the BPA 50 microgram/g egg group, 87.6+/-4.32 in the BPA 200 g/g egg group. Furthermore the contour of spinal cord was deformed as the doses of BPA raised. CONCLUSION: BPA causes neuronal cell death and exerts cytotoxic effect on early chick embryos. It suggests that BPA might have an effect on cytogenesis during neural tube development.
Animals ; Apoptosis ; Benzhydryl Compounds ; Cell Death ; Chick Embryo ; Eggs ; Embryonic Structures ; Neural Tube ; Neurons ; Ovum ; Phenols ; Spinal Cord ; Wings, Animal

BACKGROUNDS/AIMS: In the treatment of complicated cholecystitis, laparoscopic cholecystectomy (LC) has limited efficacy due to its substantial post-operative complications. In addition, the clinical characteristics of complicated cholecystitis (CC) patients were suspected as advanced age with highly risky comorbidity. Percutaneous transhepatic gall bladder (PTGBD) drainage could be an alternative option for successful LC. Hence, this study evaluated the outcome of PTGBD for CC within and after 5 days. METHODS: The medical records of 109 consecutive CC patients who had undergone an LC between January 2007 and December 2011 were retrospectively reviewed and compared with the medical records of CC patients who had undergone an LC within 72 hours of (group I, n=63) or 5 days after PTGBD (group II, n=40). In addition, group I was divided into group Ia (n=46) and group Ib (n=17), according to the patients' development of open-conversion or post-operative complications. The clinical outcomes of the four groups were analyzed. RESULTS: There was a significantly higher reference to age, the ASA score grading, and predominant comorbidities in group II than in group I. The peri-operative results of group II showed lower blood loss and relatively shorter operating times than those of group I. In the cases of early LC within 72 hours (group Ia vs. group Ib), the difference was statistically insignificant. CONCLUSIONS: The delayed LC after PTGBD for complicated cholecystitis with high clinical risk had better results in this study, although it prolonged the patient's hospital stay.
Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Comorbidity ; Drainage ; Gallbladder ; Humans ; Length of Stay ; Medical Records ; Retrospective Studies ; Urinary Bladder