OBJECTIVE: To investigate the relationship between serum creatine kinase (CK) level and pulmonary function in Duchenne muscular dystrophy (DMD). METHODS: A total of 202 patients with DMD admitted to the Department of Rehabilitation Medicine, Gangnam Severance Hospital were enrolled from January 1, 1999 to March 31, 2015. Seventeen patients were excluded. Data collected from the 185 patients included age, height, weight, body mass index, pulmonary function tests including forced vital capacity (FVC), peak cough flow, maximal expiratory pressure (MEP), and maximal inspiratory pressure (MIP), and laboratory measurements (serum level of CK, CK-MB, troponin-T, and B-type natriuretic peptide). FVC, MEP, and MIP were expressed as percentages of predicted normal values. RESULTS: Serum CK activities were elevated above normal levels, even in the oldest DMD group. Serum CK level was strongly correlated with pulmonary functions of sitting FVC (p<0.001), supine FVC (p<0.001), MIP (p=0.004), and MEP (p<0.001). CONCLUSION: Serum CK level is a reliable screening test even in patients with advanced DMD, and is a strong predictor of pulmonary functions.
Body Weight ; Cough ; Creatine Kinase* ; Creatine* ; Humans ; Mass Screening ; Muscular Dystrophy, Duchenne* ; Reference Values ; Rehabilitation ; Respiratory Function Tests ; Troponin T ; Vital Capacity

BACKGROUND: As measurement of Ki-67 proliferation index is an important part of breast cancer diagnostics, we conducted a multicenter study to examine the degree of concordance in Ki-67 counting and to find factors that lead to its variability. METHODS: Thirty observers from thirty different institutions reviewed Ki-67-stained slides of 20 different breast cancers on whole sections and tissue microarray (TMA) by online system. Ten of the 20 breast cancers had hot spots of Ki-67 expression. Each observer scored Ki-67 in two different ways: direct counting (average vs. hot spot method) and categorical estimation. Intraclass correlation coefficient (ICC) of Ki-67 index was calculated for comparative analysis. RESULTS: For direct counting, ICC of TMA was slightly higher than that of whole sections using average method (0.895 vs 0.858). The ICC of tumors with hot spots was lower than that of tumors without (0.736 vs 0.874). In tumors with hot spots, observers took an additional counting from the hot spot; the ICC of whole sections using hot spot method was still lower than that of TMA (0.737 vs 0.895). In categorical estimation, Ki-67 index showed a wide distribution in some cases. Nevertheless, in tumors with hot spots, the range of distribution in Ki-67 categories was decreased with hot spot method and in TMA platform. CONCLUSIONS: Interobserver variability of Ki-67 index for direct counting and categorical estimation was relatively high. Tumors with hot spots showed greater interobserver variability as opposed to those without, and restricting the measurement area yielded lower interobserver variability.
Breast Neoplasms* ; Breast* ; Observer Variation* ; Online Systems

OBJECTIVE: To report the latest long-term outcome of amyotrophic lateral sclerosis (ALS) and to analyze the predictors of prognosis. METHODS: Subjects who were diagnosed with ALS between January 2005 and December 2009 at a single institute were followed up until death or up to December 2014. Data regarding age, sex, date of onset, date of diagnosis, presence of bulbar symptoms on onset, date of initiation of non-invasive ventilation (NIV), and the date of tracheostomy were collected. Survival was assessed using Kaplan-Meier curves and multivariate analyses of the risk of death were performed using the Cox proportional hazards model. RESULTS: Among 212 suspicious subjects, definite ALS was diagnosed in 182 subjects. The survival rate at 3 and 5 years from onset was 61.5% and 40.1%, respectively, and the survival rate at 3 and 5 years post-diagnosis was 49.5% and 24.2%, respectively. Further, 134 patients (134/182, 73.6%) were initiated on NIV, and among them, 90 patients (90/182, 49.5%) underwent tracheostomy. Male gender and onset age of ≥65 years were independent predictors of adverse survival. CONCLUSION: The analysis of long term survival in ALS showed excellent outcomes considering the overall poor prognosis of this disease.
Age of Onset ; Amyotrophic Lateral Sclerosis* ; Diagnosis ; Humans ; Male ; Multivariate Analysis ; Noninvasive Ventilation ; Prognosis ; Proportional Hazards Models ; Survival Rate ; Tracheostomy

Intra-articular administration of local anesthetics such as bupivacaine can produce short-term postoperative analgesia in patients who are undergoing shoulder arthroscopy. Yet bupivacaine can result in cardiovascular toxicity that can lead to cardiac arrest. We experienced a case of 63-year-old male patient with severe cardiac toxicity that led to ventricular fibrillation 15 minutes after injecting 0.5% bupivacaine into the patient's shoulder joint for shoulder arthroscopy.
Analgesia ; Anesthetics, Local ; Arthroscopy ; Bupivacaine ; Heart Arrest ; Humans ; Male ; Middle Aged ; Shoulder ; Shoulder Joint ; Ventricular Fibrillation

Epidural blood patch is an effective management for treatment of severe post-dural puncture headache. Here we describe a case of a patient with hip fracture, who was complained regarded as having suspicious post-dural puncture headache after epidural anesthesia, but it failed to be treated with 4 times of epidural blood patch, and later was diagnosed with multiple metastatic brain tumor.
Anesthesia, Epidural ; Blood Patch, Epidural ; Brain Neoplasms* ; Brain* ; Headache ; Hip ; Humans ; Post-Dural Puncture Headache*

Anaerobiospirillum succiniciproducens is a spiral-shaped, gram-negative anaerobic bacterium. A. succiniciproducens is a rare cause of bacteremia in human, especially immunocompromised patients. This organism may be mistakenly identified when using an automated bacterial identification system, and may be mistaken for Campylobacter spp. when using Gram staining. We report a case of bacteremia caused by A. succiniciproducens, which was negative for catalase, oxidase, and urease and confirmed by 16S rRNA sequencing (analysis revealed a 99% similarity), in a 69-year-old patient who was undergoing chemotherapy for treatment of a malignancy. To the best of our knowledge, this is the first report of bacteremia caused by A. succiniciproducens in Korea.
Aged ; Anaerobiospirillum ; Bacteremia ; Campylobacter ; Catalase ; Humans ; Immunocompromised Host ; Korea ; Oxidoreductases ; Urease

BACKGROUND: Postoperative nausea and vomiting (PONV) is the major cause of patient's discomfort after surgery. Dexamethasone and ondansetron have been known to have some preventive effects on PONV. The purpose of this study was to compare the effects combination therapy of these drugs in the prevention of PONV after tympanomastoidectomy which has been known to be a high risk factor of PONV. METHODS: Ninty patients scheduled tympanomastoidectomy under general anesthesia were included. Patients were randomly divided into three groups and received dexamethasone 5 mg (group D), ondansetron 4 mg (group O), or dexamethasone 5 mg plus ondansetron 4 mg (group DO) at 30 min before the end of operation. The degree of PONV was assessed at 6 h, 12 h, 24 h, and 48 h after operation. RESULTS: The degrees of nausea in group DO during 0-6 h and 6-12 h were lesser than those of other groups. The overall incidences of nausea were 73% (group D), 62% (group O), and 23% (group DO, P < 0.05). The degrees of vomiting in group O and DO during 0-6 h were lesser than those of group D. The overall incidences of vomiting were 37% (group D), 17% (group O), and 7% (group DO, P < 0.05). CONCLUSIONS: The combination of dexamethasone and ondansetron is more effective than single use of each drug for the prevention on PONV after tympanomastoidectomy.
Anesthesia, General ; Dexamethasone* ; Humans ; Incidence ; Nausea ; Ondansetron* ; Postoperative Nausea and Vomiting* ; Risk Factors ; Vomiting

Background and Objectives: The 10-item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) is a recently developed questionnaire for assessing both nasal obstruction and nasal cosmetic satisfaction. It is widely used in rhinoplasty clinics based on its high level of reliability and efficacy in Western countries. In this study we evaluated the validity of the Korean version of the SCHNOS (K-SCHNOS).Subjects and Method The SCHNOS was translated into easily-understandable Korean following the guideline of the developers. Twenty-seven patients undergoing rhinoplasty and a control group of 29 non-rhinoplasty patients completed K-SCHNOS twice at intervals of 2 weeks regardless of pre- or postoperative state. The K-SCHNOS was evaluated for internal consistency, test-retest reliability, and validity. Results: Of the 56 study participants, 39 (69.6%) were male and 17 (30.4%) were female, with the mean (standard deviation) age of 33.5 (12.9) years. Both obstructive domain and cosmetic domains showed high internal consistency with their respective Cronbach’α values being 0.92 and 0.91. The correlations in the test-retest analysis for each item were acceptable, ranging from 0.6-0.82. The association between the obstructive domain and cosmetic domain was 0.48 (95% confidence interval, 0.32-0.61), indicating a very weak correlation. Conclusion The K-SCHNOS has proven to be a reliable and valid questionnaire to be used by Korean-speaking patients undergoing functional or cosmetic rhinoplasty.

BACKGROUND: The in vivo skin prick test (SPT) or in vitro detection of allergen specific IgE in serum is commonly used for the diagnosis of allergic disease. In this study, we evaluated the usefulness of a new multiple allergen simultaneous test (MAST) immunoblot assay, Polycheck Allergy (Biocheck GmbH, Germany). METHODS: A total of 100 patients with clinical findings of allergic diseases were tested by SPT and three different MAST assays: Polycheck Allergy (Biocheck GmbH, Germany), MAST CLA allergy system (Hitachi Chemical Diagnostics, USA) and Allergy Screen (R-biopharm, Germany). The results of MAST assays were compared with those of SPT. RESULTS: Concordance rates of MAST assays with SPT were 79-100% for Polycheck Allergy, 88.9-100% for MAST CLA and 72.7-98.3% for Allergy Screen. In ROC curve analysis, significant differences were observed in four of 25 allergens analysed: Alternaria, Birch, Hazelnut and D. farinae. For Alternaria and Birch, Polycheck Allergy (P<0.001) and Allergy Screen (P=0.0075) showed significantly larger AUC (area under the curve) than MAST CLA. For Hazelnut, Polycheck Allergy (P=0.0021), and for D. farinae, MAST CLA (P=0.015) showed significantly larger AUCs than the other two tests. The ROC analysis for overall 16 food allergens showed better results in Polycheck Allergy (P<0.001), and that for overall 21 inhalants did not show significant differences among three MAST assays (P>0.05). CONCLUSIONS: Since Polycheck Allergy showed similar or superior result to the others, it can be used for the detection of allergen specific IgE antibodies.
Adolescent ; Adult ; Allergens/*immunology ; Area Under Curve ; Child ; Child, Preschool ; Female ; Humans ; Hypersensitivity, Immediate/*diagnosis ; Immunoblotting/*methods ; Immunoglobulin E/*blood ; Male ; Middle Aged ; ROC Curve ; Reagent Kits, Diagnostic ; Sensitivity and Specificity ; Skin Tests/methods

In myopathy patients, fat mass increases as the disease progresses, while lean body mass decreases. The present study aimed to investigate the overall nutritional status of Korean myopathy patients through surveys of diet and dietary habits, bioelectrical impedance analysis (BIA), and biochemistry tests, as well as the examination of related factors, for the purpose of using such findings as a basis for improving the nutritional status in myopathy patients. The energy intake of all participants was found to be insufficient at only 44.5% of Dietary Reference Intakes for Koreans 2010 (KDRIs 2010), whereas protein intake was sufficient at 89.8% of KDRIs 2010. Dietary fiber intake was found to be 58.4% of sufficient dietary fiber intake for adults according to KDRIs 2010. Calcium intake was found to be 55.0% and magnesium was 14.9% of the recommended calcium and magnesium intake for adults according to KDRIs 2010. With respect to quality of life (QOL), overall increase in QOL domain score showed significant positive correlations with vegetable fat intake (p < 0.05), vegetable protein intake (p< 0.05), and dietary fiber intake (p < 0.05). With respect to BIA, the mean phage angle of all participants was found to be 2.49 +/- 0.93degrees, which was below the cutoff value. As a study that examined nutrient analysis and dietary habits of myopathy patients in Korea, the present study is meaningful in providing the basic data for future studies that aim to present dietary guidelines for patients suffering from myopathy.
Adult ; Bacteriophages ; Biochemistry ; Body Composition* ; Calcium ; Diet ; Dietary Fiber ; Electric Impedance ; Energy Intake ; Food Habits ; Humans ; Korea ; Magnesium ; Muscular Diseases* ; Nutrition Policy ; Nutritional Status* ; Quality of Life ; Recommended Dietary Allowances ; Vegetable Proteins ; Vegetables