PURPOSE: The aim of this study is to develop and apply the critical pathway to the orbital wall fracture patients and to elucidate its effect. METHODS: Critical pathway(CP) sheet and questionnaire were developed by a team approach. Critical pathway was applied to 7 orbital wall fracture patients (CP group) from April 2006 to September 2006. Length of hospitalization and cost for hospitalization of CP group were compared to those of the 10 patients who had same disease entities and treated by conventional regimen(control group). RESULTS: Length of hospitalization in the CP group (7.20 day) were insignificantly shorter than that of control group(8.71 day). Mean cost for hospitalization of the CP group(776,398 won) were insignificantly lower than that of control group(1,028,531 won). The patients satisfaction for the explanation regarding operation procedure, therapeutic operation fee, length of hospitalization and medical personnel were all affirmative. CONCLUSION: Critical pathway that we developed for orbital wall fracture definitely improved the quality of treatment. Furthermore, other critical pathways should be developed for another facial trauma patients.
Critical Pathways* ; Fees and Charges ; Hospitalization ; Humans ; Orbit* ; Orbital Fractures ; Surveys and Questionnaires

BACKGROUND: Routine typing for HLA-B27 has been usually accomplished by the microcytotoxicity assay in Korea because it does not require special equipment and is easily reproducible. Recently, an immunofluorescence method and the polymerase chain reaction have also been applied for HLA-B27 testing. However, the current economic crisis in Korea have led domestic manufacturers to develop a Korean HLA-B27 typing kit. The aim of this study was to assess the advantages and disadvantages of this kit and to assess the possibility of replacing the currently used foreign-made kits with this domestic one. METHODS: HLA-B27 testing by the microcytotoxicity test was performed on 116 patients during a period of 3 months in 1998. The Biotest typing tray and the Chongkundang typing tray were tested simultaneously. Results: There was no difference in results in 116 samples (positive: 39, negative: 77). The Korean typing tray showed high false positivity of the negative control well (8 point: 1 case, 6 point: 33 cases, 4 point: 47 cases, 2 point: 17 cases, 1 point: 18 cases) and 6 of the HLA-B27 negative cases showed false positivity in one of the four HLA-B27 wells. Typing of HLA-Bw4 and Bw6 revealed an inconsistency in five and six cases, respectively. CONCLUSIONS: Despite of the false positivity of the negative control in Korean panel, we believe that Korean typing tray can replace the foreign-made tray due to its low cost and adequate performance. Because placenta of Korean multiparous women was used for the kit, Chongkundang typing tray seems to correlate better with Korean HLA-B27 subtypes.
Cytotoxicity Tests, Immunologic ; Female ; Fluorescent Antibody Technique ; HLA-B27 Antigen* ; Humans ; Korea ; Placenta ; Polymerase Chain Reaction

PURPOSE: Recently, orbital wall fracture is common injuries in the face. Facial CT is essential for the accurate diagnosis and appropriate treatment to reconstruct of the orbital wall. The objective of this study was to report the method for accurate measurement of area and shape of the bony defect in the blow-out fractures using facial CT in prior to surgery. METHODS: The authors experienced 46 cases of orbital wall fractures and examined for diplopia, sensory disturbance in the area of distribution of the infraorbital nerve, and enophthalmos in the preoperation and followed 1 months after surgery, from August 2007 to May 2008. Bony defect was predicted by measuring continuous defect size from 3mm interval facial CT. Copying from the defect model(template), we reconstructed orbital wall with resorbable sheet(Inion CPS(R), Inion Oy, Tampere, Finland). RESULTS: One months after surgery using this method, 26(100%) of the 26 patients improved in the diplopia and sensory disturbance in the area of distribution of the infraorbital nerve. Also 8(72.7%) of the 11 patients had enophthalmos took favorable turn. CONCLUSION: This accurate and time-saving method is practicable for determining the location, shape and size of the bony defect. Using this method, we can reconstruc
Coat Protein Complex I ; Diplopia ; Enophthalmos ; Humans ; Orbit ; Orbital Fractures

PURPOSE: Recently, orbital wall fracture is common injuries in the face. Facial CT is essential for the accurate diagnosis and appropriate treatment to reconstruct of the orbital wall. The objective of this study was to report the method for accurate measurement of area and shape of the bony defect in the blow-out fractures using facial CT in prior to surgery. METHODS: The authors experienced 46 cases of orbital wall fractures and examined for diplopia, sensory disturbance in the area of distribution of the infraorbital nerve, and enophthalmos in the preoperation and followed 1 months after surgery, from August 2007 to May 2008. Bony defect was predicted by measuring continuous defect size from 3mm interval facial CT. Copying from the defect model(template), we reconstructed orbital wall with resorbable sheet(Inion CPS(R), Inion Oy, Tampere, Finland). RESULTS: One months after surgery using this method, 26(100%) of the 26 patients improved in the diplopia and sensory disturbance in the area of distribution of the infraorbital nerve. Also 8(72.7%) of the 11 patients had enophthalmos took favorable turn. CONCLUSION: This accurate and time-saving method is practicable for determining the location, shape and size of the bony defect. Using this method, we can reconstruc
Coat Protein Complex I ; Diplopia ; Enophthalmos ; Humans ; Orbit ; Orbital Fractures

PURPOSE: We evaluated the efficacy, safety and psychological aspect of monthly administrations of the gonadotropin-releasing hormone agonists (GnRHa), leuprolide acetate depot (Luphere depot 3.75 mg), in patients with precocious puberty. METHODS: A total of 54 girls with central precocious puberty were administered with leuprolide acetate (Luphere depot 3.75 mg) every four weeks over 24 weeks. We evaluated the percentage of children exhibiting a suppressed luteinizing hormone (LH) response to GnRH (LH peak< or =3 IU/L), peak LH/follicle stimulating hormone (FSH) ratio of GnRH stimulation test less than 1, change in bone age/chronologic age ratio, change in the Tanner stage and change in eating habit and psychological aspect. RESULTS: (1) The percentage of children exhibiting a suppressed LH response to GnRH, defined as an LH peak< or =3 IU/L at 24 weeks was 96.3 % (52/54). (2) The percentage of children exhibiting peak LH/FSH ratio<1 at 24 weeks of the study was 94.4 % (51/54). (3) The ratio of bone age and chronological age significantly declined from 1.27+/-0.07 to 1.24+/-0.01 after the 6 months of the study. (4) The mean Tanner stage manifested a significant change 2.3+/-0.48 at baseline, down to 1.70+/-0.61 at 24 weeks. (5) Based on the questionnaires, the score for eating habits showed a significant change from the baseline 34.0+/-6.8 to 31.3+/-6.8. (6) The psychological assessment did not exhibit a significant difference except with scores for sociability, problem behavior total score and other problems. CONCLUSION: The leuprolide 3.75 mg (Luphere depot) is useful and safety for treating children with central precocious puberty.
Child ; Eating ; Female* ; Gonadotropin-Releasing Hormone ; Humans ; Leuprolide* ; Luteinizing Hormone ; Puberty, Precocious* ; Treatment Outcome ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: Collectins (surfactant protein A and D) are proteins with collagen tails and globular lectin domains that appear to play an important role in the first line of host defense in mammalians. However, it is not known if collectins are also present in human nasal mucosa. The purpose of this study was to investigate the expression of collectin proteins in human nasal mucosa and to compare the expressions of SP-A and D mRNA in the normal nasal mucosa and in chronic inflammatory nasal diseases. MATERIALS AND METHOD: Ten chronic rhinosinusitis patients were recruited and ten normal nasal mucosae were used as normal controls. Reverse transcriptase-polymerase chain reaction was performed to detect SP-A and SP-D mRNA. The level of collectin and GAPDH (glyceraldehyde-3-phosphate dehydrogenase) transcripts were semi-quantified with the desitometry. We have characterized the cellular localization of SP-A and SP-D protein using immunohistochemistry. RESULTS: SP-A2/GAPDH mRNA ratio in chronic rhinitis nasal mucosa is greater compared with that in normal nasal mucosa (p<0.05). SP-A protein was expressed in the nasal epithelium and in the epithelial cells of the submucosal glands. SP-D mRNA and protein were not expressed in the nasal mucosa. CONCLUSION: These data provide the first evidence of the presence of collectins in the human nasal mucosa. These results suggested that up-regulation of collectin in chronic rhinosinusitis may be a protective response for the nasal mucosa.
Collagen ; Collectins* ; Epithelial Cells ; Humans* ; Immunohistochemistry ; Nasal Mucosa* ; Nose Diseases ; Pulmonary Surfactant-Associated Protein A ; Pulmonary Surfactant-Associated Protein D ; Pulmonary Surfactants ; Rhinitis ; RNA, Messenger ; Sinusitis ; Staphylococcal Protein A ; Up-Regulation

BACKGROUND: Depression and suicide are common in neurological disorders. However, their reported frequencies have varied widely due to heterogeneities in methodology and assessment timing. We evaluated the frequencies of current depression and suicidality in patients with epilepsy, Parkinson's disease (PD), and ischemic stroke (IS). METHODS: We enrolled patients who visited a tertiary care hospital in Seoul between January and December 2013. All of the patients completed the Beck Depression Inventory (BDI) and the Hospital Anxiety and Depression Scale-Depression subscale (HADS-D). Any patient with depressive symptoms (defined as a total HADS-D or BDI score of ≥9 or ≥17, respectively) was reassessed with a structured psychiatric interview based on the Mini International Neuropsychiatric Interview Plus 5.0.0 (MINI). RESULTS: In total, 305 patients were recruited, comprising epilepsy (n=92, 30.2%), PD (n=99, 32.4%), and IS (n=114, 37.4%). Depressive symptoms were exhibited by 52 epilepsy patients (56.5%), 56 PD patients (56.6%), and 54 IS patients (47.4%), and these were further evaluated with the aid of the MINI. Seven epilepsy patients were diagnosed as major depressive disorder (MDD), five as dysthymic disorder (DD), and nine as depressive disorder not otherwise specified (DDNOS). Twelve PD patients were diagnosed as MDD, 7 as DD, and 10 as DDNOS. Ten stroke patients were diagnosed as MDD, 7 as DD, and 11 as DDNOS. Most patients with depressive symptoms (91.4%) exhibited suicidality. CONCLUSIONS: Patients with epilepsy, PD, and IS frequently exhibit depression and suicidality. Neurologists should always be concerned about comorbid psychiatric problems when they see patients with neurological disorders.
Anxiety ; Depression* ; Depressive Disorder ; Depressive Disorder, Major ; Dysthymic Disorder ; Epilepsy* ; Humans ; Nervous System Diseases* ; Parkinson Disease* ; Seoul ; Stroke* ; Suicide ; Tertiary Healthcare

BACKGROUND: To evaluate how efficaciously and safely we can make transthoracic lung biopsy with an 18-gauge automated biopsy device. METHODS: We performed 130 transthoracic needle biopsies including 16 repeat biopsies in 114 patients with a pulmonary mass using an 18-gauge biopsy device (ASAP 18, Microvasive-. Eighty-three biopsies were performed by an experienced radiologist and 47 by several less experienced radiologists. All biopsies were guided by biplane fluoroscopy. RESULTS: We successfully obtained sufficient tissue(>2-mm in the length) in 128(985) of 130 biopsies. Biopsy provided the specific diagnosis in 97 (85%) of 114 patients including 78 (88%) of 89 patients with a malignant tumor and 19 (90%) of 21 patients with a benign condition. The diagnosis could not be made in the remaining four patients. Of interest to note was the superb capability (74/74) of biopsy to make a distinction between small cell carcinoma and non-small cell carcinoma. There was no significant difference in the diagnostic yields between the experienced and less experienced radiologists, Of the total 130 biopsies, pneumothorax appeared in 13 (10%), among which treatment was required in 2 (2%), Mild, self-limiting hemoptysis was noted in seven (5%), but in no case was the treatment required. CONCLUSION: We conclude transthoracic lung biopsy with an 18-gauge automated device is an effective procedure for the specific diagnosis of benign and malignant lung disease. It is safe with the complication rate cornparable to that of fine-needle aspiration biopsy as well.
Biopsy* ; Biopsy, Fine-Needle ; Biopsy, Needle ; Carcinoma, Small Cell ; Diagnosis ; Fluoroscopy ; Hemoptysis ; Humans ; Lung Diseases ; Lung Neoplasms ; Lung* ; Pneumothorax

We report a case of a 58 year-old male with polysplenia and left inferior vena cava draining into the right atrium via hemiazygous vein; the left superior vena cava and the coronary sinus in order. He presented dyspnea on exertion and atrial fibrillation. Originally, through findings of mediastinal widening in chest X-ray and the double lumen of the descending aorta in transesophageal echocardiography, he was erroneously diagnosed with aortic dissection. The anomalous venous connection was discovered via spiral CT and venography. We also found three to five small spleens via CT. We emphasize that normal left superior vena cava mimic aortic dissection on chest X-rays and transesophageal echocardiographys.
Aorta, Thoracic ; Atrial Fibrillation ; Coronary Sinus ; Dyspnea ; Echocardiography, Transesophageal ; Heart Atria* ; Heterotaxy Syndrome* ; Humans ; Male ; Middle Aged ; Phlebography ; Spleen ; Thorax ; Tomography, Spiral Computed ; Veins ; Vena Cava, Inferior* ; Vena Cava, Superior*

BACKGROUND AND OBJECTIVES: Genetic factors play a role in the etiology of allergic rhinitis. The glutathione S-transferase (GSTP1) is one of the detoxifying enzymes for oxidative stress. The purpose of this study is to examine Polymorphisms of whether there is an association between some alleles of GSTP1 genes and allergic rhinitis. SUBJECTS AND METHOD: Patients with allergic rhinitis were selected on the basis of the following criteria: 1) watery rhinorrhea, sneezing, nasal obstruction and/or itching for longer 3months and 2) positive reaction at the allergic skin prick test for DP, DF allergen and 3) positive reaction at specific IgE RAST for DP, DF allergen. GSTP1 gene polymorphisms in exon5 (Ile105Val) were analyzed by polymerase chain reaction (PCR) with restriction fragment length polymorphisms (RFLP) in 149 patients with allergic rhinitis and 156 healthy control subjects. RESULTS: In allergic rhinitis, Ile105/Ile105 were 106 cases (71.1%), Ile105/Val105 were 42 cases (28.2%), Val105/Val105 were 1 case (0.7%) and in normal controls, Ile105/Ile105 were 100 cases (64.1%), Ile105/Val105 were 45 cases (28.8%), Val105/Val105 were 11 cases (7.1%)(p=0.004). CONCLUSION: Genetic polymorphism of Val105/Val105 in GSTP1 may be protective genotypes in allergic rhinitis.
Alleles ; Genotype ; Glutathione Transferase* ; Glutathione* ; Humans ; Immunoglobulin E ; Nasal Obstruction ; Oxidative Stress ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Polymorphism, Restriction Fragment Length ; Pruritus ; Rhinitis* ; Skin ; Sneezing