Osteochondritis dissecans of the knee occurs twice as often in males as in females. The peak incidence is about fifteen years of age, and most patients are first diagnosed before the age of eighteen. The etiology of osteochondritis dissecans is still unknown, but the most accepted theories are trauma, ischemia, abnormal ossification within the physes, constitutional or genetic predisposition, and a combination of these. Osteochondritis dissecans of the knee associated with gout was first reported by Carrabba in 1969. And no additional case has been reported. The purpose of this paper is to present an unusual case of osteochondritis dissecans of the knee associated with gout.
Female ; Genetic Predisposition to Disease ; Gout* ; Humans ; Incidence ; Ischemia ; Knee* ; Male ; Osteochondritis Dissecans* ; Osteochondritis*

Bone single photon emission computed tomography(SPECT) of the knees has been shown to be of diagnostic value for the investigation of intemal derangement of knees(IDK). This study compared bone SPECT and magnetic resonance image(MRI) with arthroscopic findings for the diagnosis of IDK. Fifty patients who had been performed arthroscopy in Seoul National University Hospital from January 1997 to September 1997 were studied with both the modalities preoperatively. There were 38 meniscal injuries, 26 cruciate ligament injuries and 8 cases of patellofemoral joint problems. In view of SPECT, the most remarkable results were from meniscal tears. In meniscal tears, the diagnostic values of SPECT were 89.5% of sensitivity, 66.7% of specificity, 84% of diagnostic accuracy, which were comparable to those of MRI, 97.4%, 91.7% and 96%, respectively. But SPECT showed inferior diagnostic values in cruciate ligament injuries. For anterior knee pain, SPECT was more sensitive than MRI for the detection of pathology. And for functionally related cases, such as ACL impingement to intercondylar notch, SPECT was far more valuable than MRI. Bone SPECT will not provide the anatomical detail of MRI but seems to be a useful tool for the detection of wide range of knee disorders including IDK. Further research is justified to investigate the precise role of bone SPECT in clinical practice and its value in relation to MRI.
Arthroscopy ; Diagnosis ; Humans ; Knee* ; Ligaments ; Magnetic Resonance Imaging* ; Patellofemoral Joint ; Pathology ; Sensitivity and Specificity ; Seoul ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: Psoriasis is a chronic immune-mediated inflammatory skin disease affecting 2~3% of the worldwide population. Ustekinumab, an IL-12/23p40 inhibitor, is a biologic reported to be effective and safe in treating psoriasis. However, there are limited data on the treatment outcomes of ustekinumab in patients with psoriasis in Korea. OBJECTIVE: To evaluate the treatment outcomes and response pattern of ustekinumab in patients with psoriasis in Korea. METHODS: This was a retrospective single-center study. Eighty-four patients with psoriasis treated with ustekinumab were analyzed. Each patient's medical records, psoriasis area and severity index (PASI) score, and body surface area were reviewed at baseline and up to week 52. RESULTS: A total of 84 patients were included (male:female=1.8:1). The mean age was 44.5 years. At week 16, 86.7% achieved PASI75, 59.0% achieved PASI90, and 20.5% achieved PASI100. By week 16, 84.8% of subjects had attained PASI75 for the head region, whereas 79.0% had attained it for the lower extremities, indicating a relatively slower treatment response of psoriatic lesions on the lower extremities. Four patients discontinued treatment due to lack of effect. No severe adverse events occurred during the follow-up period. CONCLUSION: Ustekinumab demonstrated highly effective and safe treatment profiles in Korean psoriatic patients, consistent with the previous reports from mainly Western countries. Psoriasis severity and treatment responsiveness may vary with body region.
Body Regions ; Body Surface Area ; Follow-Up Studies ; Head ; Humans ; Korea ; Lower Extremity ; Medical Records ; Psoriasis ; Retrospective Studies ; Skin Diseases ; Ustekinumab

Objective: During the coronavirus disease 2019 (COVID-19) pandemic, the use of mechanical chest compression (meCC) devices for cardiopulmonary resuscitation (CPR) in emergency departments might have increased. However, there are few reports yet of such an increase in use. This study aimed to assess the current status of meCC device utilization in emergency medical institutions nationwide through a survey. Methods: This cross-sectional study conducted a survey from August 20, 2022 to September 29, 2022, using emails and text messages to target 287 out of a total of 409 emergency medical institutions nationwide for which contact information was obtained. Results: Of the 287 emergency medical institutions, 127 responded (44.2% response rate). Of these, 74 (58.3%) reported using meCC devices. The utilization rates were highest in the regional emergency medical center, followed by local emergency medical centers and local emergency medical agencies (93.3% vs. 67.3% vs. 27.1%, respectively; P<0.001). The most common reason for device purchases was to reduce rescuer fatigue and ensure high-quality CPR. The second reason was personnel shortages, while the regional emergency medical center gave a higher priority to the protection of medical staff from COVID-19. The meCC device group reported significantly higher cases of CPR (100 or more cases per year) compared to the non-meCC device group (64.9% vs. 24.6%; P<0.001) although no difference was shown in the total number of medical staff participated in CPR between the groups. Also, 90.5% of the meCC group expressed satisfaction with using the device. Conclusion More than 50% of emergency medical institutions used meCC devices in CPR, citing reasons such as reducing rescuer fatigue and ensuring high-quality CPR.

We report a 45-year-old woman presenting with a painful subungual epidermal cyst on the 4th finger nail bed. Based on clinical features only, the lesion was initially suspected to be a glomus tumor. However, histopathological examination revealed an epidermal cyst on the nail bed. Subungual epidermal cysts are rare disorders that may cause pain and tenderness that increase according to tumor growth. They can mimic glomus tumors owing to their similar clinical manifestations. To differentiate subungual epidermal cysts from glomus tumors, imaging tools such as ultrasonography and magnetic resonance imaging can be used. Dermatologists should be aware that several kinds of tumors including epidermal cysts with clinical similarities may occur in the subungual area.
Epidermal Cyst ; Female ; Fingers ; Glomus Tumor ; Humans ; Hydrazines ; Magnetic Resonance Imaging ; Middle Aged ; Nails

BACKGROUND: AVP (arginine vasopressin) shows unique hemodynamic characteristics, as a vasopressor. AVP has been tried in many cathecholamine refractory vasodilatory situations, and sometimes resulted in effective hemodynamic improvement. In this study, we hypothesized that low dose AVP infusion could recover the decreased SVR (systemic vascular resistance) induced by milrinone infusion with minimal effect on PVR (pulmonary vascular resistance). METHODS: Sixteen patients undergoing OPCAB participated in this study. After a loading dose milrinone was infused, low dose vasopressin infusion was started and titrated until the systemic blood pressure increased by 20%. During the study, hemodynamic factors including pulmonary capillary wedge pressure and cardiac output were measured using a continuous thermodilution technique with a Swan-Ganz catheter. RESULTS: Milrinone infusion reduced both SVR and PVR. And vasopression infusion increased SVR, but show relatively less effect on PVR. CONCLUSIONS: Low-dose vasopressin infusion could be used to recover the SVR decrease caused by milirinone infusion with little effect on PVR.
Blood Pressure ; Cardiac Output ; Catheters ; Hemodynamics* ; Humans ; Milrinone* ; Pulmonary Wedge Pressure ; Thermodilution ; Vasopressins*

We report a case of Kasabach-Merritt syndrome arising from a tufted angioma successfully treated with systemic corticosteroid. A 2-month-old male infant presented with a palm-sized, erythematous induration on his left pubis. The lesion was diagnosed as tufted angioma histopathologically. After 1 month, the lesion suddenly expanded to the abdomen and scrotum. Initial laboratory tests were consistent with consumptive coagulopathy. He was diagnosed with Kasabach-Merritt syndrome and treated with intravenous dexamethasone at 0.32 mg/kg/day (equivalent to prednisolone 2.0 mg/kg/day). Two days after initiating the treatment, his platelet counts recovered and the lesion ceased to expand. Steroid therapy was converted to oral prednisolone and the dosage was subsequently tapered, and the lesion gradually involuted with no signs of recurrence for a year.
Abdomen ; Dexamethasone ; Hemangioma ; Humans ; Infant ; Kasabach-Merritt Syndrome ; Male ; Platelet Count ; Prednisolone ; Recurrence ; Scrotum ; Skin Neoplasms

Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance and β-cell dysfunction. Among available oral antidiabetic agents, only the thiazolidinediones (TZDs) primarily target insulin resistance. TZDs improve insulin sensitivity by activating peroxisome proliferator-activated receptor γ. Rosiglitazone and pioglitazone have been used widely for T2DM treatment due to their potent glycemic efficacy and low risk of hypoglycemia. However, their use has decreased because of side effects and safety issues, such as cardiovascular concerns and bladder cancer. Lobeglitazone (Chong Kun Dang Pharmaceutical Corporation), a novel TZD, was developed to meet the demands for an effective and safe TZD. Lobeglitazone shows similar glycemic efficacy to pioglitazone, with a lower effective dose, and favorable safety results. It also showed pleiotropic effects in preclinical and clinical studies. In this article, we summarize the pharmacologic, pharmacokinetic, and clinical characteristics of lobeglitazone.

Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance and β-cell dysfunction. Among available oral antidiabetic agents, only the thiazolidinediones (TZDs) primarily target insulin resistance. TZDs improve insulin sensitivity by activating peroxisome proliferator-activated receptor γ. Rosiglitazone and pioglitazone have been used widely for T2DM treatment due to their potent glycemic efficacy and low risk of hypoglycemia. However, their use has decreased because of side effects and safety issues, such as cardiovascular concerns and bladder cancer. Lobeglitazone (Chong Kun Dang Pharmaceutical Corporation), a novel TZD, was developed to meet the demands for an effective and safe TZD. Lobeglitazone shows similar glycemic efficacy to pioglitazone, with a lower effective dose, and favorable safety results. It also showed pleiotropic effects in preclinical and clinical studies. In this article, we summarize the pharmacologic, pharmacokinetic, and clinical characteristics of lobeglitazone.

Background: We performed this study to establish a prediction model for 1-year neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients who achieved return of spontaneous circulation (ROSC) immediately after ROSC using machine learning methods. Methods: We performed a retrospective analysis of an OHCA survivor registry. Patients aged ≥ 18 years were included. Study participants who had registered between March 31, 2013 and December 31, 2018 were divided into a develop dataset (80% of total) and an internal validation dataset (20% of total), and those who had registered between January 1, 2019 and December 31, 2019 were assigned to an external validation dataset. Four machine learning methods, including random forest, support vector machine, ElasticNet and extreme gradient boost, were implemented to establish prediction models with the develop dataset, and the ensemble technique was used to build the final prediction model. The prediction performance of the model in the internal validation and the external validation dataset was described with accuracy, area under the receiver-operating characteristic curve, area under the precision-recall curve, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Futhermore, we established multivariable logistic regression models with the develop set and compared prediction performance with the ensemble models. The primary outcome was an unfavorable 1-year neurological outcome. Results: A total of 1,207 patients were included in the study. Among them, 631, 139, and 153were assigned to the develop, the internal validation and the external validation datasets, respectively. Prediction performance metrics for the ensemble prediction model in the internal validation dataset were as follows: accuracy, 0.9620 (95% confidence interval [CI],0.9352–0.9889); area under receiver-operator characteristics curve, 0.9800 (95% CI, 0.9612– 0.9988); area under precision-recall curve, 0.9950 (95% CI, 0.9860–1.0000); sensitivity, 0.9594 (95% CI, 0.9245–0.9943); specificity, 0.9714 (95% CI, 0.9162–1.0000); PPV, 0.9916 (95% CI, 0.9752–1.0000); NPV, 0.8718 (95% CI, 0.7669–0.9767). Prediction performance metrics for the model in the external validation dataset were as follows: accuracy, 0.8509 (95% CI, 0.7825–0.9192); area under receiver-operator characteristics curve, 0.9301 (95% CI, 0.8845–0.9756); area under precision-recall curve, 0.9476 (95% CI, 0.9087–0.9867); sensitivity, 0.9595 (95% CI, 0.9145–1.0000); specificity, 0.6500 (95% CI, 0.5022–0.7978); PPV, 0.8353 (95% CI, 0.7564–0.9142); NPV, 0.8966 (95% CI, 0.7857–1.0000). All the prediction metrics were higher in the ensemble models, except NPVs in both the internal and the external validation datasets. Conclusion We established an ensemble prediction model for prediction of unfavorable 1-year neurological outcomes in OHCA survivors using four machine learning methods. The prediction performance of the ensemble model was higher than the multivariable logistic regression model, while its performance was slightly decreased in the external validation dataset.