BACKGROUND: The study aimed to determine the type of capsular insertion and the extent of capsular elongation in anterior shoulder instability by quantitatively evaluating their computed tomography arthrographic (CTA) findings, and to investigate the correlation of these parameters with surgical outcomes. METHODS: We retrospectively reviewed 71 patients who underwent CTA and arthroscopic capsulolabral reconstruction for anterior shoulder instability between April 2004 and August 2008. The control group comprised 72 patients diagnosed as isolated type II superior labrum anterior to posterior (SLAP) lesion during the period. Among the 143 patients, 71 were examined with follow-up CTA at an average 13.8 months after surgery. It was measured the capsular length and cross-sectional area at two distinct capsular regions: the 4 and 5 o'clock position of the capsule. RESULTS: With regards to the incidence of the type of anterior capsular insertion, type I was more common in the control group, whereas type III more common than in the instability group. Anterior capsular length and cross-sectional area were significantly greater in the instability group than in the control group. Among patients of the instability group, the number of dislocations and the presence of anterior labroligamentous periosteal sleeve avulsion lesion were significantly associated with anterior capsular redundancy. Postoperatively, recurrence was found in 3 patients (4.2%) and their postoperative capsular length and cross-sectional area were greater than those of patients without recurrence. CONCLUSIONS: Capsular insertion type and capsular redundancy derived through CTA may serve as important parameters for the management of anterior shoulder instability.
Arthrography* ; Dislocations ; Follow-Up Studies ; Humans ; Incidence ; Joint Instability ; Recurrence ; Retrospective Studies ; Shoulder*

BACKGROUND: At the end of the‘Waste Drug Disposal Project’, collection and disposal of waste drugs remain a social issue. OBJECTIVE: This study aimed to provide suggestions to improve the drug waste management system in Korea by comparing domestic and overseas relevant programs. Methods: This is a comparative study between South Korea, Australia, Canada, France, and the US. These overseas countries were selected because they have been operating waste drug management programs continuously to date. Comparison was conducted by a pre-determined analysis frame including legal regulation, enforcement program and its performance. RESULTS: All selected countries except Australia had legal regulations on drug wastes. The US had the largest variety of drug waste disposal methods. Canada had recommended that pharmacies actively participate in drug waste withdrawal programs. France had the largest variety of methods to promote relevant programs, including window sticker, SNS, and app, as well as the highest level of awareness and participation. Australia had the lowest level of awareness and participation in pharmaceutical waste management programs. Pharmaceutical companies took responsibility of paying for these programs in the selected overseas countries. CONCLUSION Further efforts should be made to establish a clear guideline including the role of pharmaceutical companies, and to develop various methods for the public to be aware of appropriate ways of disposing drug wastes in Korea.

Apoptosis is an important host defense mechanism against mycobacterial infection. Recent reports suggest that links between apoptosis and endoplasmic reticulum (ER) stress are critical for the regulation of mycobacterial survival; however, the exact regulatory mechanisms are not well known. In this study, we isolated 20 Mycobacterium tuberculosis (Mtb) clinical strains from Korean patients and examined ER stress-mediated apoptosis in Mtb-infected macrophages. Most Mtb strains increased the rates of apoptosis and production of ER stress-sensing molecules in mouse macrophages, similar to Mtb H37Rv infection. Moreover, the intracellular survival of Mtb clinical isolates in macrophages was similar to that of H37Rv. Our data suggest that infection with Mtb downregulated MCP-1 and MCPIP. The regulation of MCPIP may decrease ROS production, leading to a reduction in ER stress-mediated apoptosis.
Animals ; Apoptosis* ; Endoplasmic Reticulum Stress* ; Endoplasmic Reticulum* ; Humans ; Korea* ; Macrophages* ; Mice ; Mycobacterium tuberculosis* ; Mycobacterium*

To analyze the infectious causes and clinical symptoms of febrile infants aged less than 3 months presenting to a Pediatric Emergency Medical Center (PEMC) and to propose more efficient, evidence-based management and treatment. We conducted a retrospective study of 462 febrile infants aged less than 3 months who visited PEMC at Keimyung University Dongsan Medical Center from January 2015 to June 2016. Infants' sex, age, fever duration, and laboratory findings, including bacterial or viral pathogens, were recorded. To evaluate clinical signs, one point per sign was given for grunting, decreased activity, and the presence of cyanosis; total scores were compared between the bacterial infection (BI) and non-bacterial infection (NBI) groups. BI was diagnosed in 118 (25.5%) infants, and no BI was diagnosed in 344 (74.5%) infants. Escherichia coli was the most frequently isolated pathogen, accounting for 80.5% (n = 95) of all infections (n = 118). Statistically significant differences in sex, the duration of fever, sign scores, white blood cell count, neutrophil count, lymphocyte count, and C-reactive protein (CRP) level were found between the BI and NBI groups. The cut-off value for CRP was 1.445 mg/dL, with sensitivity and specificity values of 76.3% and 75.9%, respectively, in BI patients, as determined by the receiver operating characteristic curve. As more PEMCs are being built in Korea, hospital accessibility is better; thus, it may be possible to perform outpatient management of young, febrile infants aged younger than 3 months without antibiotics and lumbar puncture using individual sign scores and laboratory findings.
Anti-Bacterial Agents ; Bacterial Infections ; C-Reactive Protein ; Cyanosis ; Emergencies ; Escherichia coli ; Fever ; Humans ; Infant* ; Korea ; Leukocyte Count ; Lymphocyte Count ; Neutrophils ; Outpatients ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Spinal Puncture

Diagnosis of acute pancreatitis in dogs remains a significant challenge despite the development of advanced diagnostic methodologies. Visual inspection and pancreas biopsy using laparoscopy are generally considered to be procedures free of complications when conducted on healthy animals. However, the usefulness of laparoscopy for diagnosing acute pancreatitis has not been assessed. In the present study, the efficacy of laparoscopy for diagnosing acute pancreatitis in dogs was evaluated in animals with experimentally induced acute pancreatitis. Gross appearance of the pancreatic area was examined by laparoscopy to survey for the presence of edema, adhesions, effusion, pseudocysts, hemorrhage, and fat necrosis. Laparoscopic biopsy was performed and the histopathologic results were compared to those of pancreatic samples obtained during necropsy. The correlation between laparoscopy and histopathologic findings of the pancreas was evaluated. The presence of adhesions, effusion, and hemorrhage in the pancreatic area observed by laparoscopy significantly correlated with the histopathologic results (p < 0.05). There was no significant relationship between the histopathologic and laparoscopic biopsy findings. Results of this study suggested that laparoscopic evaluation of gross lesions has clinical significance although the laparoscopic biopsy technique has some limitations. This method combined with additional diagnostic tools can be effective for diagnosing acute pancreatitis in dogs.
Acute Disease ; Animals ; Dog Diseases/*diagnosis/etiology ; Dogs ; Female ; Laparoscopy/*veterinary ; Male ; Pancreas/*pathology ; Pancreatitis/diagnosis/etiology/*veterinary

Primary hyperparathyroidism (PHPT) is imbalance of calcium, phosphate, and bone metabolism attributed to an increased secretion of parathyroid hormone (PTH). Although PHPT is mainly associated with musculoskeletal and kidney dysfunction, variable symptoms can be presented in the elderly patients. A 75-year-old man presented with rapidly progressive dementia (RPD). Through etiological work-up of hypercalcemia and increased PTH, parathyroid adenoma was found. Subtotal parathyroidectomy resulted in recovery of cognitive impairment. Primary hyperparathyroidism should be considered in a differential diagnosis of RPD.
Aged ; Calcium ; Cognition Disorders ; Dementia* ; Diagnosis, Differential ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary* ; Kidney ; Metabolism ; Parathyroid Hormone ; Parathyroid Neoplasms ; Parathyroidectomy

PURPOSE: To evaluate the clinical findings, prognosis and treatment strategy of patients with neuroendocrine carcinoma of cervix. MATERIALS AND MEHTODS: Thirteen patients with neuroendocrine carcinoma of cervix were included in this study, as confirmed histologically and immunohistochemically at the Dongsan Medical Center, Keimyung University, between May 1944 and October 2001. The mean age of patients was 56 years with a range of 32 to 78 years of age. According to the FIGO staging system, there were 5 patients with stage IB carcinoma, 5 patients with IIA, and 3 patients with stage IIB. Four patients underwent radical hysterectomy with pelvic lymphadenectomy, 3 of these patients also received postoperative radiotherapy, and one patient underwent extrafascial hysterectomy after radiotherapy. Primary radiotherapy was done in 9 patients, and 3 were irradiated postoperatively. Nine patients received chemotherapy, 7 received neoadjuvant and 2 received concurrent chemoradiotherapy. The radical purpose of radiotherapy consisted of external irradiation to the whole pelvis (4,500~5,400 cGy) and intracavitary irradiation (3,000~3,500 cGy). RESULTS: The mean follow up duration was 36 months with a range of 3 to 104 months. The overall 5-year survival rate was 61.5% and the 5-year survival rates for stage IB, IIA, IIB were 60.0%, 60.0%, and 66.7% respectively (p=0.99). Eight patients are still alive without disease, and all of the 5 patients with recurrence are dead due to distant metastasis. CONCLUSION: Neuroendocrine carcinoma of cervix is highly aggressive, with early lymphatic dissemination and a high rate of distant recurrence. Therefore, an aggressive therapeutic strategy is required to obtain pelvic and distant disease control. Multimodal therapy should be considered at the time of initial diagnosis.
Carcinoma, Neuroendocrine* ; Cervix Uteri* ; Chemoradiotherapy ; Diagnosis ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Lymph Node Excision ; Neoplasm Metastasis ; Pelvis ; Prognosis ; Radiotherapy ; Recurrence ; Survival Rate

OBJECTIVE: Strong genetic evidence has shown an association between cytotoxic T lymphocyte associated antigen-4 (CTLA-4) and autoimmune diseases. This study was set out to determine whether the polymorphisms of the CTLA-4 exon 1 and promoter are associated with susceptibility to systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and their clinical features. METHODS: Polymerase chain reaction of genomic DNA-restriction fragment length polymorphism using Bst E II and Tru9 I was used to determine genotypes of the CTLA-4 exon 1 and promoter in 80 SLE, 86 RA patients and 86 healthy control subjects. Clinical manifestations were analyzed in each patient and correlated with the genotypes. RESULTS: The genotype frequency of the CTLA-4 exon 1 differed between SLE patients and controls (chi-squared=.74, 2 degrees of freedom (df), p=.03). The CTLA-4 AG genotype occurred more frequently in patients with SLE (46.3% vs. 33.7% controls). On the other hand, the CTLA-4 AA genotype as well as the CTLA-4 GG genotype was less frequent among SLE patients than among control subjects (1.3% vs. 9.3% and 52.5% vs. 57.0% respectively). The genotype distribution of the CTLA-4 promoter differed between SLE patients and control subjects (CT, TT, CC genotypes 27.5%, 0%, 72.5% vs. 16.3%, 4.7%, 79.1% controls respectively, chi-squared=.36, 2 df, p=0.04). When the association was analyzed with respect to sex, the distribution of the CTLA-4 exon 1- promotor genotypes was significantly different between female SLE patients and females in the control group (chi-squared=8.16, 3 df, p=0.04). The frequencies of the CTLA-4 exon 1 and promoter genotypes, allele and phenotypes and exon 1-promotor genotypes were not significantly different between RA patients and control subjects. Clinically, there were no significant differences in patients with SLE and RA according to the CTLA-4 polymorphisms. CONCLUSION: The polymorphisms within the CTLA-4 exon 1 and promoter appear to play a role in susceptibility to SLE, but not to be associated with clinical features of SLE, susceptibility to RA and its clinical features.
Alleles ; Arthritis, Rheumatoid* ; Autoimmune Diseases ; Exons* ; Female ; Freedom ; Genotype ; Hand ; Humans ; Lupus Erythematosus, Systemic* ; Lymphocytes ; Phenotype ; Polymerase Chain Reaction

PURPOSE: To evaluate the effect of gadoxetic acid on the measurement of the stiffness value of MR elastography (MRE) used to evaluate hepatic fibrosis (HF). MATERIALS AND METHODS: MRE was obtained in 32 patients with clinically suspected chronic liver disease, both before and after injection of gadoxetic acid. Two independent reviewers measured the stiffness values of the liver parenchyma on elastograms. The mean liver stiffness values were compared in the pre- and post-contrast MREs using the paired t-test. Intra-rater and inter-rater correlation was assessed using the intraclass correlation coefficient (ICC). The accuracy, sensitivity, and specificity of both pre- and post-contrast MREs was evaluated for the diagnosis of significant HF (> or = F2) using cut off value of 3.1 kPa. RESULTS: There were no significant differences in the stiffness values of the liver parenchyma on pre- and post-contrast MREs (p = 0.15 and 0.38 for each reader, respectively). Regarding intra-rater correlation, excellent agreement was noted on rater 1(ICC = 0.998) and rater 2 (ICC = 0.996). Excellent correlation regarding the measured stiffness values was noted on both pre- and post-contrast MREs (ICC = 0.988 for pre-contrast, ICC = 0.993 for post-contrast). The accuracy, sensitivity, and specificity of the pre- and post-contrast MREs for differentiating significant HF (> or = F2) from < or = F1 were same as 71%, 60%, and 100%, respectively. CONCLUSION: As there was no significant difference in the stiffness measurements seen on MREs before and after administration of gadoxetic acids, it is therefore acceptable to perform MRE after contrast injection in order to evaluate HF.
Elasticity Imaging Techniques ; Fibrosis ; Gadolinium DTPA ; Humans ; Liver ; Liver Diseases ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Sensitivity and Specificity

OBJECTIVE: To investigate whether the polymorphism of Fas promoter gene is associated with susceptibility to systemic lupus erythematosus (SLE) and its clinical features. METHODS: Polymerase chain reaction of genomic DNA-restriction fragment length polymorphism using MvaI was used to determine genotypes of the Fas promoter in 87 SLE patients and 87 healthy control subjects. Clinical manifestations were analyzed in each patient and correlated with the genotypes. RESULTS: The genotype distribution of the Fas promoter did not differ between SLE patients and control subjects (AA, GA, GG genotypes 31.0%, 54.0%, 14.9% in SLE patients vs. 29.9%, 55.2%, 14.9% in controls respectively, chi2=0.03, 2 degrees of freedom, p=0.99). No significant differences were also found in allele frequencies between the groups. Clinically in the lupus patients according to the Fas promoter polymorphism, there were no significant differences in age at onset, anti-ds DNA titer, C3, C4 level, renal involvement, number of ACR (American College of Rheumatology) criteria presented, SLE Disease Activity Index, SLICC/ACR (The Systemic Lupus international Collaborating Clinics/American College of Rheumatology) damage index, and autoantibody profiles except for anti-RNP antibody. The frequency of anti-RNP antibody in the lupus patients was increased in AA group (71.4%) compared to GA and GG groups (26.2% and 30.0%, p=0.007). CONCLUSION: The Fas promoter polymorphism does not seem to confer susceptibility to SLE, but seems to have some influence on the development of certain autoantibody like anti-RNP antibody, suggesting that the Fas promoter polymorphism is functional.
DNA ; Freedom ; Gene Frequency ; Genotype ; Humans ; Lupus Erythematosus, Systemic* ; Polymerase Chain Reaction