Aurthors have treated 77 cases of acute supp rative osteomyelitis since January 1972 until December 1979. Among them 69 patients had surgical treatment while 8 cases had antibiotic therapy only. 42 patients out of 69 surgically treated cases had fenestration operation, while 27 cases had multiple drilling operation to evacuate the bony abscess. In 15 cases Turkels bone biopsy needle was used to decompress the infected bones, and by It the abscess could be very effectively evacuated. After decompression with a Turkel needle by placing a small calibered polyethylene tube Into the lesion, the lesion was continuously irrigated with antibiotics solution. This procedure has proved to be very effective and a successful one which can easily be practised as an office procedure in the very poor and needy cases. Also when patients are seriously ill and/or other extensive surgery is not feasible, this simple procedure can easily be practised without hazard, Good end results without sequellae were abtained when early decompression with massive antiblotic therapy was instituted even by Turkel needle drainage.
Abscess ; Anti-Bacterial Agents ; Biopsy ; Decompression ; Drainage ; Humans ; Needles ; Osteomyelitis ; Polyethylene

BACKGROUND: Recently the Korean society has been challenged with the rapid growth of obese population due to the improved socioeconomic status and lifestyle changes over the past decades. Not only has obesity been known as one of major risk factors for various diseases including cardiovascular diseases(e.g. hypertension, coronary heart disease and stroke) and diabetes mellitus, but it has also increased the death from obesity-related diseases. It has been required, however, to establish our own obesity criteria adjusted for Korean since much difference is expected to exist in the degree of obesity between white and Asian people. Therefore, this study was designed to provide with primary data to help establish new criteria through identifying the distribution of Body Mass Index(BMI), and then analysing its relatian with some obesity-related diseases. METHODS: This study calculated BMI and related it to some obesity-related diseases by analysing data from 1995 National Health Interview Surveys, in which a random sample of 5,750 Korean at the age of 15-69 had self-reported their heights, body weights and diagnoses with obesity-related diseases by physicians. Variables under consideration include potential risk factors(e.g. alcohol intakes, smoking, exercise, etc.) as well as demographics of the sample population. RESULTS: Average BMI(kg/m(2)) were 21.6+/- 2.6 for male and 21.7+/-4.8 for female(mean+/-SD), which increased in direct proportion to the increase of age until the age reached the group of 40-59, and then followed by the inverse in its relation with the age at 60 and over. It was revealed, however, that prevalences of obesity-related diseases such as hypertension, diabetes mellitus etc. were the highest among the population group with their BMI of 23.8~35.6. In short, this study identified the proportional relation of BMI with the prevalence of obesity-related diseases. CONCLUSIONS: In this study, the prevalence for hypertension and diabetes mellitus was shown to be higher than the average among population with their BMI of 21.9~238, whose figure is much lower than both 26.4, the value of the 90th percentile proposed in MONICA prot and 25, the current WHO criteria of obesity. However, a Japanese study reported that the health risk began to increase at the BMI of 23 with risks for obesity-related diseases dramatically increased at the BMI of 26-27 and over, and concluded that because Asian has more body fats accumulated within the upper body part compared with the white, the Asian persons are more obese, though less in terms of BMI, than the white. Therefore, future works should be focused on establishing our own criteria for obesity with health risks through determining the association of BMI with prevalence of various diseases in Korea.
Adipose Tissue ; Asian Continental Ancestry Group ; Body Height ; Coronary Disease ; Demography ; Diabetes Mellitus* ; Diagnosis ; Humans ; Hypertension* ; Korea ; Life Style ; Male ; Obesity ; Population Groups ; Prevalence* ; Risk Factors ; Smoke ; Smoking ; Social Class ; Weights and Measures

BACKGROUND/AIMS: Therapies involving bone-marrow-derived mesenchymal stem cells (BM-MSCs) have considerable potential in the management of hepatic disease. BM-MSCs have been investigated in regenerative medicine due to their ability to secrete various growth factors and cytokines that regress hepatic fibrosis and enhance hepatocyte functionality. The aim of this study was to determine the antifibrosis effect of BM-MSCs on activated hepatic stellate cells (HSCs) and the mechanism underlying how BM-MSCs modulate the function of activated HSCs. METHODS: We used HSCs in both direct and indirect co-culture systems with BM-MSCs to evaluate the antifibrosis effect of BM-MSCs. The cell viability and apoptosis were evaluated by a direct co-culture system of activated HSCs with BM-MSCs. The activations of both HSCs alone and HSCs with BM-MSCs in the direct co-culture system were observed by immunocytochemistry for alpha-smooth muscle actin (alpha-SMA). The levels of growth factors and cytokines were evaluated by an indirect co-culture system of activated HSCs with BM-MSCs. RESULTS: The BM-MSCs in the direct co-culture system significantly decreased the production of alpha-SMA and the viability of activated HSCs, whereas they induced the apoptosis of activated HSCs. The BM-MSCs in the indirect co-culture system decreased the production of transforming growth factor-beta1 and interleukin (IL)-6, whereas they increased the production of hepatocyte growth factor and IL-10. These results confirmed that the juxtacrine and paracrine effects of BM-MSCs can inhibit the proliferative, fibrogenic function of activated HSCs and have the potential to reverse the fibrotic process by inhibiting the production of alpha-SMA and inducing the apoptosis of HSCs. CONCLUSIONS: These results have demonstrated that BM-MSCs may exert an antifibrosis effect by modulating the function of activated HSCs.
Apoptosis ; Bone Marrow Cells/*cytology ; Cell Differentiation ; Coculture Techniques ; Hepatic Stellate Cells/*cytology/metabolism ; Hepatocyte Growth Factor/metabolism ; Humans ; Immunophenotyping ; Interleukin-10/metabolism ; Interleukin-6/metabolism ; Liver Cirrhosis ; Mesenchymal Stromal Cells/*cytology/metabolism ; Transforming Growth Factor beta1/metabolism

Protothecosis is a rare cutaneous soft tissue infection caused by the genus prototheca, most commonly Prototheca wickerhatmii. An 80-year-old woman has had a painful or tender, non-healing, eczematous plaque on the extensor surface of the left forearm for 4 years. A biopsy specimen revealed the characteristic thick-walled morulalike sporangia in the dermis. P. wickerha mili was isolated in the culture and the biochemical studies. Electron microscopic examination showed the thick-walled spores containing dark dense bodies and amyloplasts. Oral itraconazole therapy for 4 weeks resulted-in a marked improvement of the skin lesion.
Aged, 80 and over ; Biopsy ; Dermis ; Female ; Forearm ; Humans ; Itraconazole ; Plastids ; Prototheca ; Skin ; Soft Tissue Infections ; Sporangia ; Spores

Pulmonary vein stenosis is a rare condition which is usually congenital in origin and is almost invariably fatal in its bilateral and severe forms. It is often overlooked, however, during clinical examination, routine echocardiography, and even at cardiac catheterization. This report describes pulsed Doppler, color flow echocardiography, and hemodynamic findings of bilateral pulmonary vein stenosis accompanying ventricular septal and atrial septal defects successfully corrected by surgery.
Cardiac Catheterization* ; Cardiac Catheters* ; Catheterization ; Constriction, Pathologic* ; Echocardiography ; Echocardiography, Doppler, Color* ; Heart Septal Defects, Atrial ; Hemodynamics ; Pulmonary Veins*

Isolated ACTH deficiency is a uncommon disorder causing secondary adrenocortical insufficiency. Less than 200 cases have been reported in the world. The major clinical manifestations are hypoglycemia, weight loss, hypotension, anemia, weakness, nausea, inability to excrete water load, and hyponatremia. A 56-year-old male was admitted because of weakness, fatigue, nausea and vomiting. He was pallor and not associated with hyperpigmentation. The basal plasma ACTH and cortisol levels were 8.30 pg/ml and 0.6 ug/dl. The serum cortisol did not response to rapid ACTH stimulation test. On combined pituitary stimulation test, the cortisol did not response to insulin-induced hypoglycemia. Other anterior pituitary hormones showed normal responses except elevated prolactin level. Six months after glucocorticoid replacement therapy, the elevated basal prolactin level returned to normal. Brain MRI did not show any anatomic abnormalities of the sellar and suprasella area. We report a case of isolated ACTH deficiency accompanied by hyperprolactineia, which respond to glucocorticoid replacement therapy.
Adrenal Insufficiency ; Adrenocorticotropic Hormone* ; Anemia ; Brain ; Fatigue ; Humans ; Hydrocortisone ; Hyperpigmentation ; Hyperprolactinemia* ; Hypoglycemia ; Hyponatremia ; Hypotension ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nausea ; Pallor ; Pituitary Hormones, Anterior ; Plasma ; Prolactin ; Vomiting ; Water ; Weight Loss

BACKGROUND: Most current reseatch using prognostic scoring systems in critically ill patients have focused o prediction using the first intensive care unit(ICU) day data or daily updated data. Usually the mean ICU length of stay in Korea is longer than in the western world. Consequently, a more cost-effective and practical prognostic parameter is required. The principal aim of this study was to assess the prognostic value of the seventh day(7th day : the average mean ICU length of stay) APACHE III score in a medical intensive care unit. METHODS: 241 medical ICU patients from July 1997 to April 1998 were enrolled. The 1st and 7th scores were measured by using the APACHE III scoring system and compared between survivors and non-survivors. Logistic regression analysis was performed to determine the relationship between the 1st and 7th APACHE III scores and the mortality risk. RESULTS: 1) The mean length of stay in the ICU was 10.3±13.8 days. 2) The mean 1st and 7th day APACHE III scores were 59.7±30.9 and 37.9±27.7. 3) The mean 1st day APACHE III scores was significantly lower in survivors than in non- survivors(49.9±23.8 vs 86.3±32.3 P<0.0001). 4) The mean 7th day APACHE III scores was significantly lower in survivors than in non- survivors(30.1±18.5 vs 80.1±30.4, P<0.0001). 5) The odds ratios among the 1st and 7th day APACHE III scores and the mortality rate were 1.0507 and 1.0779 respectively. CONCLUSION: These results suggest that the seventh day APACHE III scores is as useful in predicting the outcome as is such like the first day APACHE III score. Therefore, in comparison to the daily APACHE III score, measuring the 1st and 7th day APACHE III scores are also useful for predicting the prognosis of critically ill patients in terms of cost-effectiveness. It is suggested that the 7th day APACHE III score is useful for predicting the clinical outcome.
APACHE* ; Critical Illness ; Humans ; Intensive Care Units* ; Critical Care* ; Korea ; Length of Stay ; Logistic Models ; Mortality ; Odds Ratio ; Prognosis ; Survivors ; Western World

Background and objective: With recent advances in technology and miniaturization of equipment, the trans-radial approach has currently been advocated as an alternative method for coronary angioplasty. We tried to evaluate the feasibility of trans-radial coronary intervention (TRCI). MATERIALS AND METHODS: 138 Allen-positive cases (159 lesions) underwent TRCI with currently available devices. Mean age was 60.8 + 9.2 years and 67% were men. Clinical diagnoses were AMI in 49, unstable angina in 48, stable angina in 28, OMI in 9 and 4 cases of restenotic lesions. RESULTS: Technical success was achieved in 124 cases (89.9%). Among the 124 successful cases, left and right radial arteries were used in 93 cases (110 lesions) and in 31 cases (35 lesions), respectively. The size of the guiding catheter used for TRCI was 6 Fr in 100 cases (80.7%), 7 Fr in 21 cases (16.9%), and 8 Fr in 3 cases (2.4%). Stent implantation and rotational atherectomy were successfully performed in 75 cases (86 lesions) and 10 cases (12 lesions), respectively. The reasons of failure were puncture failure in 2 cases, guiding failure in 6 cases, guide-wire crossing failure in 4 cases who had chronic total occlusion, and suboptimal results in 2 cases. Major cardiac complications occurred in 3 cases, one case of each cardiac death, nonfatal myocardial infarction and coronary artery perforation. No major entry site complications were seen with only non-ischemic radial artery occlusions in 3 cases (2.8%). CONCLUSION: TRCI is feasible with currently available devices and is safe with a relatively acceptable procedural success rate and low complications.
Angina, Stable ; Angina, Unstable ; Angioplasty ; Atherectomy, Coronary ; Catheters ; Coronary Vessels ; Death ; Diagnosis ; Gangwon-do* ; Humans ; Male ; Miniaturization ; Myocardial Infarction ; Punctures ; Radial Artery ; Stents

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 ; Diagnosis* ; Electroencephalography ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Generalized ; Humans ; Magnetic Resonance Imaging*

PURPOSE: Recently, bicarbonate use in cardiopulmonary resuscitation (CPR) has been reappraised in some studies. This study was performed to consider aspects of sodium bicarbonate (SB) use in CPR and to evaluate the effect of SB use in CPR. METHODS: In a tertiary university hospital, the CPR records of out-of-hospital cardiac arrest (OHCA) patients over a two-year period were reviewed. First, we examined the cardiac arrest variables, whether SB was used or not, and the time when SB was used. Second, we analyzed the effect of SB use on the CPR outcome. RESULTS: The study included 187 patients. SB was used in 78 patients (42%). The mean time when SB was used was 16 minutes after initiation of CPR, corresponding to an average 38-minute elapsed time from the patient's collapse. There was no relation between the prehospital arrest time and the SB use rate, but a positive relation was seen between the CPR duration and the SB use rate. The investigation of the effect of SB on CPR outcome included 82 patients, and we performed a logistic regression analysis. SB use seemed to be related to return of spontaneous circulation (ROSC), however, statistically, it was not significant (OR=2.499, 95% CI: 0.491, 12.718). CONCLUSION: SB use for OHCA patient resuscitation was not based on consideration of prehospital hypoxia time. SB use did not affect ROSC in this retrospective study.
Anoxia ; Cardiopulmonary Resuscitation* ; Heart Arrest ; Humans ; Logistic Models ; Out-of-Hospital Cardiac Arrest ; Resuscitation ; Retrospective Studies ; Sodium Bicarbonate* ; Sodium*