Injury of the ankle ligaments is one of the most common sports-related injuries. Although there are some debates as to the best initial treatment for an acute tear of a lateral ligament, persistent functional instability of the ankle develops in approximately 20% of patients regardless of the type of initial treatment. In these patients, late reconstruction of the lateral ankle ligaments may become necessary. Among 13 cases which have been operated with Larsen procedure using peroneus brevis tendon from March 1991 to February 1993, the 11 cases followed up over 1 year were examined clinically and radiologically. We introduced the clinical analysis and results with the brief review of the literatures. 1. The indication of surgical treatment was the ankle instability which had differences over 10° in talar tilting angle or over 3mm in anterior displacement compared wit the uninjured site. 2. The postoperative results were 5 cases in excellent and 4 in good. 3. The Larsen procedure was considered a good method to anatomically and simply stabilize both the ankle and subtalar joint and to fix tendon depending on the type of instability.
Ankle ; Collateral Ligaments ; Humans ; Ligaments ; Methods ; Subtalar Joint ; Tears ; Tendons

BACKGROUND/AIMS: The aim of the study was to investigate the gastric involvement of Orientia tsutsugamushi and the relationship between the clinical features and gastritis in patients with scrub typhus. METHODS: The study included 98 patients who had been diagnosed with scrub typhus between January 2003 and December 2006. Sixteen patients were selected to undergo gastroduodenoscopy with endoscopic biopsy for molecular study. The clinical severity index score (CSIS) was evaluated. Rickettsial DNA was amplified using the paraffin- embedded biopsy tissue by performing nested PCR. The expressions of ICAM-1 and VCAM-1 were investigated by immunohistochemistry to evaluate their roles in the pathogenesis of scrub typhus. RESULTS: The endoscopic findings were gastritis (n=1), erosion (n=4) and ulcer (n=11). The average CSIS was 3.65+/-1.09. Four cases of nested PCR of the 16 gastric mucosal biopsies were positive. The gastric samples that were taken earlier after therapy tended to be PCR-positive (2.00+/-00 days vs. 3.83+/-1.27 days, p<0.001). There was no difference of the clinical features and the CSISs between the PCR-positive and PCR-negative patients. The biopsied tissue revealed no vasculitis findings. Staining for ICAM-1 was more expressed in the scrub typhus group as compared with the normal control group. Staining for VCAM-1 was sporadically expressed in the scrub typhus group and normal control group. In comparison with the patients with Helicobacter pylori-associated gastritis, the immunohistochemical staining showed no difference of expression in the patients with O. tsutsugamushi-infected gastritis. CONCLUSIONS: The gastritis seen in scrub typhus patients could be typhus that is related to the direct involvement of O. tsutsugamushi. The increased expression of ICAM-1 may be related with gastric mucosal endothelial injury due to direct infection.
Biopsy ; DNA ; Gastritis ; Helicobacter ; Humans ; Immunohistochemistry ; Intercellular Adhesion Molecule-1 ; Orientia tsutsugamushi ; Polymerase Chain Reaction ; Scrub Typhus ; Typhus, Epidemic Louse-Borne ; Ulcer ; Vascular Cell Adhesion Molecule-1 ; Vasculitis

Korea has a relatively short history in the development and use of clinical practice guidelines (CPGs). Additionally, it has been difficult to employ the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument due to the lack of consensus and the presence of differences in Korean medical settings and in the Korean socio-cultural environment. An AGREE II scoring guide was therefore developed to reduce differences among evaluators using the same tool. In consideration of the importance of using a quantitative measure of satisfaction with the elements described in the AGREE II manual, a final draft was developed through a Delphi consensus process. Ninety-two draft scoring guides for anchor points 1, 3, 5, and 7 (full score) in 23 items were developed. Consensus was defined as agreement among at least 70% of the raters. Agreement on 88 draft scoring guidelines was reached in the first Delphi round, and agreement for the remaining four was achieved in the second round. The development of an AGREE II scoring guide in this study is expected to contribute to improving the CPG environment.
Consensus ; Humans ; Peer Review ; *Practice Guidelines as Topic ; Republic of Korea

PURPOSE: This study aimed to identify prognostic factors of neurological outcomes, including developmental delay, cerebral palsy and epilepsy in late-preterm and term infants with perinatal asphyxia. METHODS: All late-preterm and term infants with perinatal asphyxia or hypoxic-ischemic insults who admitted the neonatal intensive care unit of Inje University Sanggye Paik Hospital between 2006 and 2014 and were followed up for at least 2 years were included in this retrospective study. Abnormal neurological outcomes were defined as cerebral palsy, developmental delay and epilepsy. RESULTS: Of the 114 infants with perinatal asphyxia, 31 were lost to follow-up. Of the remaining 83 infants, 10 died, 56 had normal outcomes, and 17 had abnormal outcomes: 14 epilepsy (82.4%), 13 cerebral palsy (76.5%), 16 developmental delay (94.1%). Abnormal outcomes were significantly more frequent in infants with later onset seizure, clinical seizure, poor electroencephalography (EEG) background activity, lower Apgar score at 1 and 5 minutes and abnormal brain imaging (P<0.05). Infants with and without epilepsy showed significant differences in EEG background activity, clinical and electrographic seizures on EEG, Apgar score at 5 minutes and brain imaging findings. CONCLUSION: We should apply with long-term video EEG or amplitude integrated EEG in order to detect and management subtle clinical or electrographic seizures in neonates with perinatal asphyxia. Also, long-term, prospective studies with large number of patients are needed to evaluate more exact prognostic factors in neonates with perinatal asphyxia.
Apgar Score ; Asphyxia* ; Brain ; Cerebral Palsy ; Electroencephalography ; Epilepsy ; Humans ; Infant* ; Infant, Newborn ; Intensive Care, Neonatal ; Lost to Follow-Up ; Neuroimaging ; Prospective Studies ; Retrospective Studies ; Seizures

Leflunomide is a disease-modifying antirheumatic drug that has been available in Korea since 2003. Leflunomide induced interstitial pneumonitis has been reported as an adverse effect in other countries but not in Korea. A 57-year-old woman was treated with leflunomide since she had been resistant to methotrexate, hydroxychloroquine and sulfasalazine. She developed high fever, dyspnea, and non-productive cough 3 months after the administration of leflunomide. She was diagnosed leflunomide-induced interstitial pneumonitis based on history, physical, laboratory, radiologic and pathologic findings. The patient was treated by prednisolone 1 mg/kg/day with cholestyramine 24 g/day, resulting in dramatic improvement. Here we report a case of leflunomide induced pneumonitis treated successfully with high dose steroid.
Arthritis, Rheumatoid ; Cholestyramine Resin ; Cough ; Dyspnea ; Female ; Fever ; Humans ; Hydroxychloroquine ; Korea ; Lung Diseases, Interstitial* ; Methotrexate ; Middle Aged ; Pneumonia ; Prednisolone ; Sulfasalazine

Sestrin2 (Sesn2), a metabolic regulator, accumulates in response to a diverse array of cellular stresses. Sesn2 regulates cellular metabolism by inhibiting the mammalian target of rapamycin complex 1 through the AMP-activated protein kinase (AMPK) signaling pathway. Recently, researchers reported that Sesn2 regulates the differentiation and function of innate immune cells and T cells; however, the role of Sesn2 in B cells is largely unknown. In this study, we investigated the role of Sesn2 in Ig class switching and Ig production in mouse B cells. We observed that mouse B cells express Sesn2 mRNA. Interestingly, the expression of germline ε transcripts (GLTε) was selectively decreased in lipopolysaccharide-stimulated Sesn2−/− splenocytes. Overexpression of Sesn2 increased GLTε promoter activity in B cells. In addition, AICAR (an activator of AMPK) selectively increased IL-4-induced GLTε expression and surface IgE (sIgE) expression in splenocytes. Furthermore, AICAR selectively enhanced IL-4-induced GLTε expression, sIgE expression, and IgE production by anti-CD40-stimulated B cells. We observed that ovalbumin (OVA)-specific IgE concentration was reduced in OVA-challenged Sesn2−/− mice. Taken together, these results indicate that Sesn2-AMPK signaling selectively enhances IL-4-induced IgE class switching and IgE production by B cells, suggesting that this could be a therapeutic strategy targeting Sesn2 in IgE-mediated allergic diseases.

No abstract available.
Animals ; Eating* ; Eosinophils* ; Pulmonary Eosinophilia* ; Rats*

BACKGROUND/AIMS: Alcoholic liver disease with metabolic acidosis may have possible causes such as alcoholic ketoacidosis, diabetic ketoacidosis, lactic acidosis. Salicylate, methanol, and ethylene glycol intoxication should also be considered. The aim of this study was to investigate the short-term prognostic factors in patients with alcoholic liver disease with metabolic acidosis. METHODS: Clinical data related to twenty-nine patients with alcoholic liver disease and metabolic acidosis was analysed retrospectively. Patients were divided into two groups according to the outcome (survival or death). Past medical history, and physical, laboratory and radiologic data at admission were compared. RESULTS: The amount of daily alcohol intake differed significantly between the two groups (P=0.034), but duration and total amount of alcohol intake did not differ significantly between the two groups (P=0.128; P=0.360). The presence of ascites differed significantly between two the groups (P=0.019). On laboratory testing, the following differed significantly: base excess (P=0.038), hemoglobin (P=0.019), platelet (P=0.040), total bilirubin (P=0.007), albumin (P=0.012), creatinine (P=0.014), phosphorus (P=0.021), chloride (P=0.010), ammonia (P=0.003), prothrombin time (P=0.033), fibrinogen (P=0.011) and D-dimer (P=0.024). Review of the medical history of the patients showed diabetes (10/29), cirrhosis (10/29), and hepatocellular carcinoma (1/29). Combined conditions at admission were sepsis (8/29), pneumonia (7/29), acute renal failure (6/29), rhabdomyolysis (5/29), gastrointestinal hemorrhage (4/29), acute pancreatitis (3/29), acute respiratory distress syndrome (2/29), and acute myocardial infarction (1/29). CONCLUSIONS: The amount of daily alcohol intake, base excess, hemoglobin, platelet, total bilirubin, albumin, creatinine, phosphorus, chloride, ammonia, prothrombin time, fibrinogen and D-dimer seemed to be useful parameters in predicting short-term prognosis of patients with alcoholic liver disease with metabolic acidosis. Further study is needed to define the significance of these factors.
Acidosis/*etiology ; Adult ; Aged ; English Abstract ; Female ; Humans ; Liver Diseases, Alcoholic/*complications ; Male ; Middle Aged ; Prognosis

BACKGROUND: Self-assessed health is a crude and simple measure which was used as a summary of an individual's general state of health. In this study, we examined the relationship between comprehensive variables and self-assessed health and identified the major determinants of self-assessed health among community dwelling elderly. METHODS: We performed a study on variables using comprehensive geriatric assessment in 308 elderly people who visited the department of family medicine or the department physical medicine and rehabilitation of 11 university hospitals or general hospitals in Korea from July 1, 1999 through October 31, 1999. The association of self-assessed health and variables was examined by X2-test and multiple linear regression analysis. For dependent variable a question "How would you describe your health now?" was used and the subjects responded from these categories: very good, good, fair, poor, and very poor. The independent variables were sociodemographic characters, health behavior, diseases, physical and social function, family and social support. RESULTS: In the X2-test, self-assessed health was significantly associated with income, exercise, nutrition, number of disease, cardiac disease, cerebrovascular disease, fall, ADLs, IADLs, depression and social support. In the multiple linear regression analysis, majority of the explained variance in self-assessed health was nutrition, cardiac disease and depression. CONCLUSION: Self-assessed health among older adults was influenced by various factors. Based on the results, multidimensional approach needs to be developed to improve health.
Activities of Daily Living ; Adult* ; Aged* ; Depression ; Geriatric Assessment ; Health Behavior ; Heart Diseases ; Hospitals, General ; Hospitals, University ; Humans ; Korea ; Linear Models ; Physical and Rehabilitation Medicine

INTRODUCTION: Although myocardial ischemia tends to occur more frequently than can be documented in ventilated patients, it has not been well studied on the factors related to the occurrence of the ischemia. METHODS: To investigate the related factors to ischemia development,a prospective study was done in 95 cases with consecutive 73 patients who had received mechanical ventilation(MV) in MICU. In addition to 24 h holter monitoring, echocardiogram, electrolytes, cardiac enzymes, hemodynamic, and gas exchange measurements were done within 24 h after initiation of MV in 69 cases. The measurements were repeated at weaning period in 26 cases. The ischemia was defined by the ST segment changes; up-sloping depression more than 1.5 mm or down-sloping or horizontal depression more that 1.0 mm from isoelectric baseline for 80 ms following J point. RESULTS: Twelve patients (12.6% in 95 cases) developed ischemia in total. The incidence of ischemia development showed an increased tendency in the initial 24 hr after MV (15.9%) and in patients with left-sided heart failure found by echocardiogram (18.2%) compared with that of the weaning period (3.8%) and patients without heart failure (10.9%) (P=0.12, P=0.09, in each). There were no differences in APACHE III score, baseline ECG findings, electrolytes abnormalities, use of inotropics or bronchodilators, presence of sepsis or shock, mode of ventilation, and survival rate according to the development of ischemia. Maximal heart rates and mean arterial pressure also were not different between patients with (137.2+/-30.9 /min, 82.5+/-15.9 mm Hg) and without ischemia (129.5+/-29.7 /min, 83.8+/-17.6 mm Hg). CONCLUSION: Although the incidence of myocardial ischemia was 12.6% in total, there were no clinically predictable factors to the development of ischemia during mechanical ventilation.
APACHE ; Arterial Pressure ; Bronchodilator Agents ; Depression ; Electrocardiography ; Electrocardiography, Ambulatory ; Electrolytes ; Heart Failure ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Ischemia ; Myocardial Ischemia* ; Prospective Studies ; Respiration, Artificial* ; Respiratory Insufficiency ; Sepsis ; Shock ; Survival Rate ; Ventilation ; Weaning