Many complications after operative treatment of patella including redisplacement of fracture, refracture, weakness of extensor muscles, patellofemoral joint arthritis, metal failure, malunion, infection, avascular necrosis were reported. We report a case of transverse fracture of patella through the cannulated screw fixation site used to fix previous vertical patella fracture with a review of the literatures.
Arthritis ; Muscles ; Necrosis ; Patella* ; Patellofemoral Joint

Middle East respiratory syndrome (MERS) is an acute infectious disease of the respiratory system caused by the new betacoronavirus (MERS coronavirus, MERS-CoV), which shows high mortality rates. The typical symptoms of MERS are fever, cough, and shortness of breath, and it is often accompanied by pneumonia. The MERS-CoV was introduced to Republic of Korea in May 2015 by a patient returning from Saudi Arabia. The disease spread mostly through hospital infections, and by the time the epidemic ended in August, the total number of confirmed diagnoses was 186, among which 36 patients died. Reflecting the latest evidence for antiviral drugs in the treatment of MERS-CoV infection and the experiences of treating MERS patients in Republic of Korea, these guidelines focus on antiviral drugs to achieve effective treatment of MERS-CoV infections.
Antiviral Agents ; Communicable Diseases ; Coronavirus ; Cough ; Cross Infection ; Diagnosis ; Dyspnea ; Fever ; Humans ; Middle East* ; Mortality ; Pneumonia ; Republic of Korea ; Respiratory System ; Saudi Arabia

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown cause, and is characterized by appearance of various autoantibodies and multiple organ involvement. Some of the systems commonly involved in SLE include the muscle and joints, brain and peripheral nervous system, lungs, heart, kidneys, skin, serous membranes, and component of blood. The clinical manifestations of SLE is protean, overlap with other illnesses, and are often subtle. However there are few documented reports on SLE associated with Crohn's disease in other countries and no reporting case in Korea. We experienced a 30-year-old female patient who was admitted for right leg swelling and diagnosed as SLE with Crohn's disease.
Adult ; Autoantibodies ; Brain ; Crohn Disease* ; Female ; Heart ; Humans ; Joints ; Kidney ; Korea ; Leg ; Lung ; Lupus Erythematosus, Systemic* ; Lupus Vasculitis, Central Nervous System ; Peripheral Nervous System ; Serous Membrane ; Skin

Background: It is essential to determine the distribution of the causative microorganisms in the region and the status of local antibiotic resistance for the proper treatment of hospitalacquired pneumonia/ventilator-associated pneumonia (HAP/VAP). This study aimed to investigate the occurrence and causative strains of HAP/VAP, distribution of resistant bacteria, use of antibiotics, and the ensuing outcomes of patients in Korea. Methods: A multicenter prospective observational cohort study was conducted among patients with HAP/VAP admitted to the medical intensive care unit of 5 tertiary referral centers between August 2012 and June 2015. Patients' demographic and clinical data were collected. Results: A total of 381 patients were diagnosed with HAP/VAP. Their median age was 69 (59–76) years and 71% were males. A majority of the patients (88%) had late-onset (> 5 days) HAP/VAP. One-quarter of the patients (n = 99) had at least one risk factor for multidrug-resistant (MDR) pathogens, such as prior intravenous antibiotic use within the last 90 days. Microbiological specimens were mostly obtained noninvasively (87%) using sputum or endotracheal aspirates. Pathogens were identified in 235 (62%) of the 381 patients. The most common bacterial pathogen was Acinetobacter baumannii (n = 89), followed by Staphylococcus aureus (n = 52), Klebsiella pneumoniae (n = 25) and Pseudomonas aeruginosa (n = 22). Most of isolated A. baumannii (97%) and S. aureus (88%) were multidrug resistant. The most commonly used empirical antibiotic regimens were carbapenem-based antibiotics (38%), followed by extended-spectrum penicillin/ β-lactamase inhibitor (34%). Glycopeptide or linezolid were also used in combination in 54% of patients. The 28-day mortality rate of the patients with HAP/VAP was 30% and the 60-day mortality was 46%. Patients who used empirical antibiotics appropriately had significantly lower mortality rates than those who did not (28-day mortality: 25% vs. 40%, P = 0.032; 60-day mortality: 41% vs. 55%, P = 0.032, respectively). Administration of appropriate empirical antibiotics (odds ratio [OR], 0.282; confidence interval [CI], 0.092–0.859; P = 0.026), Day 7 treatment failure (OR, 4.515; CI, 1.545–13.192; P= 0.006), and APACHE II score on day 1 (OR, 1.326; CI, 0.988–1.779; P = 0.012) were the factors that determined the 28-day mortality in patients with HAP who had identified bacteria as pathogens. Conclusion In HAP/VAP patients, there was a large burden of MDR pathogens, and their associated mortality rate was high. Proper selection of empirical antibiotics was significantly associated with the patient's prognosis; however, there was a discrepancy between major pathogens and empirical antibiotic therapy.

Although gastrointestinal manifestations are very common in patients with Henoch-Sch nlein purpura, protein losing enteropathy is a rare complication. We here report a case of protein losing enteropathy in a patient with Henoch-Sch nlein purpura. A 52-year old woman presented with lower abdominal pain, purpura and edema on lower extremity. Serum albumin was 1.9g/dL and 24 hour urine protein was 4.7g/ day. Skin and kidney biopsy revealed leukocytoclastic vasculitis and mesangial proliferative glomerulonephritis consistent with Henoch-Sch nlein purpura, respectively. Colonoscopy showed diffuse mucosal erosion at right colon. 99mTc-human serum albumin scintigraphy and fecal alpha-1-antitrypsin clearance confirmed protein losing enteropathy. The protein losing enteropathy improved with steroid treatment.
Abdominal Pain ; Biopsy ; Colon ; Colonoscopy ; Edema ; Female ; Glomerulonephritis ; Humans ; Hypoalbuminemia ; Kidney ; Lower Extremity ; Middle Aged ; Protein-Losing Enteropathies* ; Purpura* ; Radionuclide Imaging ; Serum Albumin ; Skin ; Technetium Tc 99m Aggregated Albumin ; Vasculitis

BACKGROUND: The estimation of anterior cruciate ligament (ACL) tear is required in certain cases involving legal and financial administration, such as the worker's compensation and/or insurance. The aim of this study is to propose and evaluate a quantitative evaluation instrument to estimate the chronicity of the ACL tear, based on the four magnetic resonance imaging (MRI) findings. METHODS: One hundred and fifty one cases of complete ACL tear confirmed by arthroscopy were divided into 4 groups according to the time from ACL injury to MRI acquisition: acute (< 6 weeks), subacute (6 weeks to 3 months), intermediate (3 months to 1 year), and chronic (> 1 year). The four MRI findings including ACL morphology, joint effusion, posterior cruciate ligament angle, and bone bruise were analyzed for temporal changes among the 4 groups. Binary logistic regression equations were formulated using the MRI findings to estimate the chronicity of ACL tear in a quantitative manner, and the accuracy of the formulated regression equations was evaluated. RESULTS: The four MRI findings showed substantial temporal correlation with the time-limits of ACL injury to be included in the estimation model. Three predictive binary logistic equations estimated the probability of the ACL injury for the three cutoff time-limits of 6 weeks, 3 months, and 1 year with accuracies of 82.1%, 89.4%, and 89.4%, respectively. CONCLUSIONS: A series of predictive logistic equations were formulated to estimate the chronicity of ACL tear using 4 MRI findings with chronological significance.
Adolescent ; Adult ; Anterior Cruciate Ligament/*injuries/surgery ; Child ; Chronic Disease ; Female ; Humans ; Knee Injuries/*diagnosis ; Logistic Models ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Time Factors ; Young Adult

BACKGROUND: Differentiation of atypical pathogens is important for community-acquired pneumonia (CAP). In this study, we compared sputum and nasopharyngeal swabs (NPS) for use in detection of Mycoplasma pneumoniae (MP), Chlamydophila pneumoniae (CP), and Legionella pneumophila (LP), using Seeplex PneumoBacter ACE Detection Assay (PneumoBacter; Seegene). METHODS: Sputum and NPS specimens were collected from patients in 15 hospitals. DNA was extracted from sputum using QIAamp DNA Stool Mini Kit (Qiagen) and from NPS using easyMAG (bioMerieux). Both types of specimens were evaluated by multiplex PCR using PneumoBacter. To determine the diagnostic performance of this assay, sputum samples were also tested using BD ProbeTec ET Atypical Pneumonia Assay (APA; Becton Dickinson). RESULTS: Among 217 sputum and NPS, 20 (9.2%), 2 (0.9%), and 0 sputum were positive for MP, LP, and CP, respectively, whereas 8 (3.7%) NPS were positive for MP. The sputum APA test yielded 186, 206, and 204 interpretable results for MP, LP, and CP, respectively. Of these, 21 (11.3%) were positive for MP, 2 (1.0%) were positive for LP, and 0 samples were positive for CP. Compared to APA, the sensitivity and specificity of the sputum assay for MP were 95.2% and 100.0%, respectively, whereas for the NPS assay, these were 38.1% and 93.9%. Sputum testing was more sensitive than NPS testing (P=0.002). For LP and CP diagnosis, PneumoBacter and APA tests agreed 100%. CONCLUSIONS: Specimen type is crucial and sputum is preferred over NPS for simultaneous detection of MP, LP, and CP using multiplex PCR in CAP.
Chlamydophila Infections/diagnosis ; Chlamydophila pneumoniae/*genetics/isolation & purification ; Community-Acquired Infections/*diagnosis ; DNA, Bacterial/analysis/isolation & purification ; Humans ; Legionella pneumophila/*genetics/isolation & purification ; Legionnaires' Disease/diagnosis ; Multiplex Polymerase Chain Reaction ; Mycoplasma pneumoniae/*genetics/isolation & purification ; Nasopharynx/*microbiology ; Pneumonia, Mycoplasma/diagnosis ; Reagent Kits, Diagnostic ; Sputum/*microbiology

PURPOSE: The purpose of this study is to compare the result between closed reduction and minimal open reduction in case of difficult reduction for subtrochanteric fractures fixed with intramedullary nail. MATERIALS AND METHODS: From Jan. 2001 to May 2005, 35 cases of subtrochanteric femur fracture treated by intramedullary nail and followed up for more than a year were selected out of 42 subtrochanteric femur fractures. Fielding classification and Russel-Taylor classification were used, and according to the fracture classification and method of reduction, the patients were grouped into closed or open reduction group. Fracture with minimal displacement or anatomical reduction was fixed by closed reduction, but in case of failed closed reduction or loss of reduction, minimal incision was made for open reduction and internal fixation, and the result between two groups were compared. RESULTS: In total of 35 cases, 15 cases were fixed by closed reduction and the rest 20 cases required open reduction. Operation time, amount of transfusion, total hospital days, partial weight bearing ambulation, and union time did not show significant differences between two groups. Ambulation and range of motion after the operation were satisfying in both groups. CONCLUSION: In treatment of subtrochanteric femur fracture with intramedullary nail, both closed and open reduction shows satisfying result, therefore when anatomical reduction is difficult to achiev by closed reduction, minimal incision open reduction and additional fixation is strongly recommended to obtain anatomical reduction and firm fixation.
Displacement (Psychology) ; Femur ; Hip Fractures ; Humans ; Nails ; Range of Motion, Articular ; Walking ; Weight-Bearing

PURPOSE: Children under 3 years old with medulloblastoma (MB) or supratentorial primitive neuroectodermal tumor (SPNET) have a poor prognosis. They are more susceptible to the deleterious effects of craniospinal radiation (CSR). This study was undertaken to determine the survival rates and prognostic factors of currently used treatment. METHPDS: Retrospective review of 19 children (MB 16, SPNET 3) who were newly diagnosed as MB or SPNET at Seoul National University Children's Hospital from April 1996 to August 2000 was done. Eligible Patients were treated with postoperative induction chemotherapy using Children's Cancer Group (CCG) 9921A or 9931. Patients over 3 year of age received CSR as well. RESULTS: Three Patients with SPNET are all alive without disease. However, 6 patients under 3 years old at diagnosis with MB were all dead whereas only one patient had an event among 10 patients over 3 years old at diagnosis. Among patients with MB, age under 3 years at diagnosis or residual tumors after induction chemotherapy correlated with poor outcome. Metastasis at diagnosis, postoperative residual disease or extent of excision did not have a significant effect on survival statistically. Three-year event-free survival (EFS) of patients with MB was 53%. Three-year EFS of patients over 3 years old at diagnosis with MB was 85.7% and 1-year EFS of under 3 years old at diagnosis with MB was 16.7%. CONCLUSION: The combined use of chemotherapy and CSR in the treatment of MB and SPNET improved survival in children over 3 years old, whereas any treatment failed to improve survival in children under 3 years old. So, there's a need for a new treatment modality to improve survival of children under 3 year of age.
Child ; Child, Preschool ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Humans ; Induction Chemotherapy ; Medulloblastoma* ; Neoplasm Metastasis ; Neoplasm, Residual ; Neuroectodermal Tumors, Primitive* ; Prognosis ; Retrospective Studies ; Seoul ; Survival Rate*

This study was conducted to determine the nutritional characteristics of horsemeat and bone meal in comparison with those of beef and pork presented by Dietary Reference Intakes For Koreans. Longissimus muscle and large metacarpal bone samples were collected from 20 fattened Jeju horses. Muscle samples were subjected to proximate analysis, assays for fatty acid profile and minerals, and bone samples to mineral assays. Horsemeat had similar levels of protein (21.1 vs 21.0 or 21.1%) and lower levels of fat (6.0 vs 14.1 or 16.1%) compared with beef or pork, respectively. Horsemeat had much higher levels of palmitoleic (8.2 vs 4.4 or 3.3%) and alpha-linolenic (1.4 vs 0.1 or 0.6%) acids than beef or pork, respectively. Linoleic acid was much higher in horsemeat (11.1%) and pork (10.1%) than in beef (1.6%). PUFA:SFA and n-6:n-3 ratios in horsemeat were 0.29 and 10.2, respectively. There were no big differences in mineral contents between horsemeat, beef and pork. For daily recommended mineral intakes of male adults (Dietary Reference Intakes For Koreans), phosphorus, sodium, potassium, iron, zinc and copper can be provided up to 24, 2.5, 6.7, 21, 26 and 40%, respectively, by 100 g raw horsemeat, but calcium and manganese levels are negligible. Horse cannon bone had much higher mineral contents especially in calcium (10,193 mg/100 g), phosphorus (5,874 mg/100 g) and copper (0.79 mg/100 g). Thiamin, riboflavin, niacin and retinol contents were 0.20, 0.21, 1.65 mg/100 g and 30 microgram/100 g, respectively. But ascorbic acid and beta-carotene were not detected. Our data demonstrated that higher levels of palmitoleic and alpha-linolenic acid in horsemeat than in beef and pork may be beneficial for human health. Horsemeat and bone meal are a good source of some minerals and vitamins.
Adult ; alpha-Linolenic Acid ; Ascorbic Acid ; beta Carotene ; Calcium ; Copper ; Horses ; Humans ; Iron ; Linoleic Acid ; Male ; Manganese ; Meals ; Minerals ; Niacin ; Phosphorus ; Potassium ; Recommended Dietary Allowances ; Riboflavin ; Sodium ; Vitamin A ; Vitamins ; Zinc