Primary subacute pyogenic osteomyelitis is defined as a bone infection of insidious onset lasting for more than several weeks without any acute systemic toxic reactions and is known to have the problem of diagnosis because there is no inflammatory symptoms or signs and X-ray findings are similar to various bone tumors. Authors reviewed 29 cases of primary subacute pyogenic osteomyelitis of long bones admitted at Fatima hospital during the years between 1976 and 1984. The osteomyelitis of infants and the osteomyelitis modified by antibiotics were excluded. The diagnosis of the cases was confirmed by bacteriological examination and/or tissue examination. The results were as follows. 1. The cases were 18 males and 11 females and 19 adults and 10 children. Male predominence was noted in children. 2. The involved bones were 11 tibias, 10 femurs and all other long bones. The involved sites were 18 metaphysis and 11 shafts. 3. All of the cases has insidious onset of local pain without any acute systemic symptoms and most of the cases has local tenderness but local deep swelling noted in about half of the cases. 4. There were many cases with elevated ESR and a few cases of slight leukocytosis. 5. The confirmed infecting organism was all staphylococcus in 16 cases of the cultures from the 25 lesions. 6. The X-ray findings were Brodies abscess in 10, illdefined cavity in 3, diffuse bones absorption in 5, diaphyseal lesion of adult with localized cortical sclerosis in 5 and with localized medullary abscess in 3 and diaphyseal lesion of children with localized medullary abscess and periosteal reaction in 3 cases. 7. All of the cases cured rapidly with rare recurrence after treatment by simple local excision in 4 and curettage in 22 cases combined with antibiotic therapy and local immobilization.
Abscess ; Absorption ; Adult ; Anti-Bacterial Agents ; Child ; Curettage ; Diagnosis ; Female ; Femur ; Humans ; Immobilization ; Infant ; Leukocytosis ; Male ; Osteomyelitis ; Recurrence ; Sclerosis ; Staphylococcus ; Tibia

No abstract available.
Anemia, Dyserythropoietic, Congenital*

In order to produce solar retinopathy, the right eyes of Strauge-Dawley albino rats were exposed to sun light(13,1500 lux) for 15 and 30 minutes respechrel(experimental groups), while the left eyes were taped to protect them from solar damages(control groups). In both experimental and control groups. We studies the lnjuries of the retina due to sun llght. The enucleated eyes ln both groups, were examined by light and electron microscopes for histopathologic changes of the retina preceded by the indirect ophthalmoscopic examination under low Illumination. Although there was no definite pathologic change in indirect ophthalmoscopic and light microscopic examinations, rather severe damage was seen at the electron microscopic level. At one day after the experiment, the inner segment of visual cells was relatively well preserved, but the other layers of the retina were markedly damaged. More severe retinal damage was seen in the 30 minute group than in the l5 minute group. At 2 weeks after the experiment, partial recovery of the whole retinal layers was observed, especially in the visual cells. At 4 weeks after experiment, the outer and inner segments of the visual cells were nearly normalized. Considering the results of the experiment, it is evedent that frequent clinical usage of indirect ophthalmoscope, surgical microscope and slit lamp biomicroscope could affect the retina and produce damage ultrastructually, even though no significant abnomalities are found by any other means.
Animals ; Lighting ; Models, Theoretical* ; Ophthalmoscopes ; Rats ; Retina ; Retinaldehyde ; Solar System

Background/Aims: Although anti-tumor necrosis factor (TNF) agents have been widely used to treat ulcerative colitis (UC), the real-world incidence of suboptimal response to anti-TNF agents has not been thoroughly investigated, especially among Asians. Methods: Using the Korean National Health Insurance database, we collected data on UC patients who initiated anti-TNF agents between July 1, 2014, and June 30, 2017. We assessed suboptimal responses, including anti-TNF discontinuation or dose escalation, switching to other biologics, augmentation with a non-biologic therapy, and the requirement for colectomy. Results: A total of 1,268 patients were included as new anti-TNF users (infliximab 713, adalimumab 433, golimumab 122). The proportion of patients who experienced at least one suboptimal response within 1 year among all patients was 63.5%, including 59.1%, 69.5%, and 68.0% of patients treated with infliximab, adalimumab, and golimumab, respectively. The cumulative incidences of at least one suboptimal response over time were 41.5%, 63.7%, 80.5%, and 87.1% at 6, 12, 24, and 36 months, respectively. Cox proportional hazards modeling revealed that adalimumab was associated with a higher risk of at least one suboptimal response (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.13 to 1.48), dose escalation (HR, 4.35; 95% CI, 2.97 to 6.38) and discontinuation (HR, 1.25; 95% CI, 1.03 to 1.52) than infliximab. Golimumab was associated with a higher risk of switching to other biologics than infliximab (HR, 1.78; 95% CI, 1.21 to 2.60). Conclusions More than half of Korean UC patients had suboptimal responses to anti-TNF agents within 1 year. UC patients treated with infliximab might be less prone to suboptimal responses than those treated with adalimumab or golimumab

BACKGROUND: In the United States, the Centers for Disease Control and Prevention recorded a 20-fold increase in the incidence of vancomycin-resistant enterococci (VRE) associated with nosocomial infections between 1989 and 1991. Although VRE has been reported in Korea since 1992, infections caused by these organisms are still extremely rare in Pusan, Korea. Therefore, a point prevalence culture survey was carried out to investigate the prevalence of intestinal colonization with VRE among patients admitted to Kosin Medical Center, which can predict the appearance of clinical infections with VRE. METHODS: Between July 1997 and August 1997, stool specimens were obtained from 303 patients. Specimens were placed in bile esculin azide broth containing vancomycin (64 microgram/mL) and aatreonam (60 microgram/mL). Cultures were done for 48 hours at 37degrees C, and turbid solutions were subcultured on blood agar. Minimal inhibitory concentrations (MIC) of vancomycin and teicoplanin to Enterococcus isolates were determined by Etest on Mueller-Hinton agar. For amplification of the vanA, vanB, and vanC genes, polymerase chain reactions were performed. RESULTS: VRE isolates were isolated from 6 of the patients (2%). Four of them were identified as E. faecium, and 1 was identified as E. avium, and 1 was identified as Enterococcus spp. All of them were highly resistant to vancomycin (MICs >256 microgram/mL), and they were also resistant to teicoplanin (MICs 32-->256 microgram/mL). All of 6 VRE strains carried vanA gene. CONCLUSION: The colonization of VRE was not infrequent among the patients of a university hospital in Pusan, Korea. Moreover, a large proportion of the colonizing VRE was revealed Enterococcus faecium with vanA gene, which implies quite a possibility of a sudden rising of infections by this organism in the near future. So we propose that the vancomycin susceptibility test should be done for every enterococcal isolate from clinical specimens and the intestinal colonization rate of VRE should be closely monitored at regular intervals for the purpose of surveillance 50 that proper establishment of plans for the prevention of this troublesome pathogen's spread can be promptly made.
Agar ; Bile ; Busan ; Centers for Disease Control and Prevention (U.S.) ; Colon* ; Cross Infection ; Enterococcus ; Enterococcus faecium ; Esculin ; Humans ; Incidence ; Korea ; Polymerase Chain Reaction ; Prevalence ; Teicoplanin ; United States ; Vancomycin

STATEMENT OF PROBLEM: Dental ceramics exhibit excellent esthetic property, compressive strength, chemical durability, biocompatibility and translucency. However, it suffers from inherent brittle fractures. Various techniques and materials for intraoral porcelain repair has been suggested. PURPOSE: This study is to compare the tensile bond strength of four commonly used porcelain repair systems (Vivadent, Bisco, Ultradent, Voco) and to insure the best system for the clinical application to the fractured porcelain. MATERIALS AND METHODS: A total of fifty specimens were fabricated. Specimens were stored in 37degrees C distilled water for 7 days and thermocycling was performed(1000 cycles), and subjected to a tensile force parallel to the repair resin and porcelain interface by use of an Universal Testing Machine. RESULT: 1. Voco showed the highest tensile bond strength. In decreasing order, the tensile bond strength of the other materials was as follows : Ultradent, Bisco, Vivadent. 2. There was a statistically significant difference between the porcelain repair systems(Voco, Ultradent > Bisco, Vivadent) (p<0.05). 3. SEM examination of prepared porcelain surfaces revealed that the surface treated with Voco showed brittle fracture. However, Ultradent, Bisco and Vivadent showed ductile fracture. 4. All specimens treated with four porcelain repair systems showed adhesive failure between porcelain and composite resin.
Adhesives ; Ceramics ; Compressive Strength ; Dental Porcelain* ; Water

Bone scan is one of the most frequently performed studies in nuclear medicine with few adverse reactions for the examination of pathologic conditions of bone. Diffuse liver uptake of Technetium-99m methylene diphosphonate (Tc-99m MDP) is a rare occurrence with only a few reports in the literature. Furthermore, there is no report of Tc-99m MDP-induced liver injury. Here we report a case of acute hepatitis with diffusely increased uptake of Tc-99m MDP in a hemodialysis patient.
Diphosphonates ; Hepatitis ; Humans ; Liver ; Nuclear Medicine ; Renal Dialysis ; Technetium Tc 99m Medronate

BACKGROUND: Airwayscope (AWS), which has been used successfully for difficult airway in general anesthesia, has been anticipated that hemodynamic response to tracheal intubation in the difficult airway may be attenuated. Also, there is a series of reports demonstrating the successful use of lightwand to open the difficult airway. Thus, we decided to conduct a survey to compare AWS to lightwand and to direct laryngoscopy of cardiovascular response to tracheal intubation. METHODS: Of 64 healthy patients without cardiovascular disease, 22, 21, 21 patients were randomly assigned to AWS group, lightwand group and direct laryngoscope group. After induction of general anesthesia, intubation was performed with manual in-line neck stabilization. During laryngoscopy, a modified Cormack-Lehane grade was assessed and time to intubation was measured. Systolic arterial pressure (SAP) and heart rate (HR) were recorded at the following timepoints: baseline, just before intubation, 1 min, 2 min, 3 min, 4 min and 5 min after intubation. RESULTS: There were no significant differences between the 3 groups in SAP, HR (P > 0.05). However modified Cormack-Lehane grade of all patients in the AWS group was I, while that in direct laryngoscope group was IIB or III. In addition, the mean time to intubation of the direct laryngoscope group was significantly longer than that of the AWS and lightwand (P < 0.05). CONCLUSIONS: In the difficult airway, AWS was very effective in improving laryngeal view and decreasing time to intubation compared to direct laryngoscopey. In addition, lightwand reduced the time to intubation. However we could not find any significant difference in hemodynamic response to tracheal intubation among the 3 groups.
Anesthesia, General ; Arterial Pressure ; Cardiovascular Diseases ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Laryngoscopes ; Laryngoscopy ; Neck

PURPOSE: To evaluate the usefulness of whole body bone mineral densitometry in the diagnosis of frequent osteopenia of preterm infants by comparison with the wrist radiographs and biochemical parameters. MATERIALS AND METHODS: From January 1995 to January 1996, we obtained whole body bone mineral density(BMD) studies using dual energy X-ray absorptiometry(DXA) and wrist radiographs of 39 preterm infants. They were divided into three groups according to birth weight, under 1500g, 1501g to 2000g and above 2000g, and four grades of skeletal change, as seen on wrist radiography, according to the scoring method of Koo et al. Groups of birth weight and grades of skeletal change were then correlated with whole body BMD and biochemical parameters. For comparison, normal data were obtained from 13 infants born at full term. Data were analyzed by one way analysis of variation(ANOVA) and correlation and regression analysis. A p-value of less than 0.05 was considered significant. RESUTLS: Whole body BMDs were significantly lower in the more premature and smaller birth weight infants(r=0.77, p=0.0000), and in the higher grade of skeletal change (r=-0.5276, p=0.0000). Aggravated skeletal changes were found in infants with lower birth weight(r=-0.3822, p=0.01). Interobserver variation in grading skeletal change was 42.9%, and intraobserver variation was 18.4%. Biochemical parameters such as serum calcium, phosphate, alkaline phosphatase, parathromone, calcitonin and 25-hydroxy-vitamine D did not vary significantly according to either birth weight or skeletal change (p>0.05). CONCLUSION: Premature osteopenia is more effectively diagnosed by measuring whole body BMD using DXA than by grading radiographical skeletal change or by biochemical parameters.
Alkaline Phosphatase ; Birth Weight ; Bone Diseases, Metabolic* ; Calcitonin ; Calcium ; Densitometry* ; Diagnosis ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Observer Variation ; Parturition ; Radiography* ; Research Design ; Rickets ; Wrist*

After the introduction of antibiotics, empyema is a rare complication of retropharyngeal abscess caused by acute epiglottitis. But once it occurs, it may be a fatal outcome. Retropharyngeal abscess may spread to mediastinum and pleural cavity along the deep cervical fascia, then it can induce pneumonia, mediastinitis, empyema, and sepsis. Because of its fatal complication, early diagnosis and intensive surgical treatment, such as incision and drainage, is necessary. Now we have a experience of empyema caused by retropharyngeal abscess in a 56-year old diabetic patient with nephropathy. He was admitted to our hospital because of hoarseness and sore throat due to acute epiglottitis. Several days after his admission, he complained of swelling of neck, which was diagnosed as retropharyngeal abscess by the computerized tomography. Retropharyngeal abscess was managed with antibiotics, incision and drainage and culture revealed Peptostreptococcus prevotii. Subsequently empyema developed in his right chest, which was managed with closed thoracotomy, though, he expired due to progression of sepsis.
Anti-Bacterial Agents ; Drainage ; Early Diagnosis ; Empyema* ; Epiglottitis* ; Fascia ; Fatal Outcome ; Hoarseness ; Humans ; Mediastinitis ; Mediastinum ; Middle Aged ; Neck ; Peptostreptococcus ; Pharyngitis ; Pleural Cavity ; Pneumonia ; Retropharyngeal Abscess* ; Sepsis ; Thoracotomy ; Thorax