We studied the incidence of deep vein thrombosis in the 110 Korean patients who had Porous Coated Anatomic (P.C.A.) cementless total hip replacement. The diagnosis of deep vein thrombosis was made by roentgenographic venography. The perfusion lung-scanning was done to make a diagnosis of pulmonary embolism. Our findings showed that there was an unusually low incidence (7 per cent) of deep vein thrombosis in our unprotected patient group. They also revealed that some factors that are believed to be relevant to thrombosis were conspicuously rare in this series. In view of this fact, we re-evaluated the so-called risk factors and came to a conclusion that some of them-such as advanced age, venous valve number; coagulation assay data, orthopedic diagnosis, preoperative limitation of mobility, hypertension and blood group-that have been claimed to be relevant in fact seem to be irrelevant to deep vein thrombosis.
Bone Cements ; Female ; Hip Prosthesis/adverse effects* ; Human ; Korea ; Male ; Middle Age ; Risk ; Thrombophlebitis/etiology*

No abstract available.
Gangwon-do* ; Humans ; Norovirus* ; Sequence Analysis*

BACKGROUND: A point mutation in the RET proto-oncogene, in medullary thyroid carcinoma (MTC) is well known, but no other genetic causes of MTC have been found. This study was performed to identify the most common DNA copy number changes in MTC by comparative genomic hybridization (CGH). METHODS: Twenty-nine surgically resected MTC specimens were retrospectively selected from patients operated on between 1996 and 2004 at the Asan Medical Center. A review of the clinical data and pathological findings was performed. Congored staining and immunohistochemical stains (calcitonin, chromogranin A and CEA) were processed by tissue microarray. CGH analysis was performed. RESULTS: The Congo-red stain was positive in only 12 cases. The immunohistochemical results were positive in 29 cases for chromogranin A, 26 cases for CEA and 25 cases for calcitonin. DNA copy number changes were found in 23 cases (79.3%). The most frequent change was a gain of 19q (65.5%); less frequent changes were gain of 22 (55.2%), 19p (51.7%), 16p (27.58%), 17q (17.24%), and loss of 4q (27.6%) and 3p (17.24%). CONCLUSIONS: DNA copy number changes of MTC were more common (79.3%) than reported in previous studies. The most frequent changes were gains in 19q, 22 and 19p.

BACKGROUND: Pneumoperitoneum and a head-down tilt during a laparoscopically-assisted vaginal hysterectomy (LAVH) decrease the cardiac index with a concurrent increase in blood pressure. This study investigated the effects of bolus nicardipine on the changes in the hemodynamics. METHODS: The patients scheduled for LAVH were randomly assigned to 1 of 3 treatment groups: control (n = 40) receiving normal saline; NIC 15 (n = 40) and NIC 30 (n = 40) groups receiving intravenous nicardipine 15 microgram/kg, 30 microgram/kg, respectively 1min before pneumoperitoneum. The hemodynamic parameters (mean blood pressure [MBP], cardiac index [CI], and heart rate [HR]) were measured before inducing anesthesia (INI, only the MBP and HR [the CI was not measured]), immediately after tracheal intubation (INT), prior to the skin incision (BF), and 2, 5, 10, 20, and 30 min after pneumoperitoneum (P2, P5, P10, P20, P30) by noninvasive cardiac output measurements. A p value < 0.05 was considered statistically significant. RESULTS: In the control group, the MBP increased significantly 5min after pneumoperitoneum compared with the INI. There was a decrease in the MBP in the NIC 30 group at P2, P5 compared with the INI, but there was no reduction of MBP at INI > 20%. In the control group, the CI had decreased at P2, P5 in comparison with BF. An increase of CI was observed at P5 in the NIC 15 group and at P2, 5, and 10 in the NIC 30 group compared with the control group. CONCLUSIONS: Intravenous bolus dosing of 30 microgram/kg nicardipine at 1 min before pneumoperitoneum during LAVH can reduce the decrease in CI after pneumoperitoneum and Trendelenburg position in LAVH but the blood pressure needs to be monitored carefully.
Anesthesia ; Blood Pressure ; Cardiac Output ; Female ; Head-Down Tilt ; Heart Rate ; Hemodynamics* ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Intubation ; Laparoscopy ; Nicardipine* ; Pneumoperitoneum* ; Skin

BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease that's influenced by many genetic and environmental factors. Various treatment modalities are being applied for AD, including phototherapy, topical applicants and systemic agents. However, there has been no mass survey in Korea concerning the compliance of patients' to use their prescribed medication, which might influence the clinical efficacy of the physicians' treatment. OBJECTIVE: The purpose of the present study is to evaluate the efficacy, safety and patient compliance with using topical pimecrolimus to treat AD. METHODS: We reviewed the medical recordings, laboratory profiles, clinical severity scoring and photographs of AD patients at 9 general hospitals in Seoul and the local area of Korea. Interviews with the patients and a telephone survey were also done. Those patients who weren't perscribed topical applicants or those who did not use topical pimecrolimus or steroid within 6 months were excluded from this study. RESULTS: Topical pimecrolimus cream effectively controlled AD with a reduction of the EASI score from baseline 13.75 to 11.39 at 2 weeks and 4.46 at 10 weeks of topical pimecrolimus application. When topical pimecrolimus cream was applied for more than 12 months it significantly suppressed the recurrence and reactivation of AD (p<0.05). Although 22.6% of the patients complained of adverse effects, these were all transient and they did not evoke significant medical problems. Using topical pimecrolimus cream did not show significant adverse effects or complications. CONCLUSION: Topical pimecrolimus might well be an effective treatment modality for treating AD when patients show good compliance for applying the cream.
Compliance ; Dermatitis, Atopic ; Hospitals, General ; Humans ; Korea ; Medical Records ; Patient Compliance ; Phototherapy ; Recurrence ; Skin Diseases ; Tacrolimus ; Telephone

BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease that's influenced by many genetic and environmental factors. Various treatment modalities are being applied for AD, including phototherapy, topical applicants and systemic agents. However, there has been no mass survey in Korea concerning the compliance of patients' to use their prescribed medication, which might influence the clinical efficacy of the physicians' treatment. OBJECTIVE: The purpose of the present study is to evaluate the efficacy, safety and patient compliance with using topical pimecrolimus to treat AD. METHODS: We reviewed the medical recordings, laboratory profiles, clinical severity scoring and photographs of AD patients at 9 general hospitals in Seoul and the local area of Korea. Interviews with the patients and a telephone survey were also done. Those patients who weren't perscribed topical applicants or those who did not use topical pimecrolimus or steroid within 6 months were excluded from this study. RESULTS: Topical pimecrolimus cream effectively controlled AD with a reduction of the EASI score from baseline 13.75 to 11.39 at 2 weeks and 4.46 at 10 weeks of topical pimecrolimus application. When topical pimecrolimus cream was applied for more than 12 months it significantly suppressed the recurrence and reactivation of AD (p<0.05). Although 22.6% of the patients complained of adverse effects, these were all transient and they did not evoke significant medical problems. Using topical pimecrolimus cream did not show significant adverse effects or complications. CONCLUSION: Topical pimecrolimus might well be an effective treatment modality for treating AD when patients show good compliance for applying the cream.
Compliance ; Dermatitis, Atopic ; Hospitals, General ; Humans ; Korea ; Medical Records ; Patient Compliance ; Phototherapy ; Recurrence ; Skin Diseases ; Tacrolimus ; Telephone

The purpose of the present study was to evaluate the correlation among the trial number of in vitro fertilization (IVF), preoperative anxiety, and propofol requirement for conscious sedation. One hundred and twenty six Korean women undergoing oocyte retrieval were enrolled. The target-controlled infusion by the anesthesiologist was conducted with initial target propofol concentration of 2.5 microgram/mL, which was manipulated until the sedation score 3 and desired clinical end point were achieved. A weak correlation was observed between visual analogue scale (VAS) anxiety and the dose of propofol required for the induction of conscious sedation (r=0.22, p=0.0192). A weak correlation was also found between VAS anxiety and the sedation time needed to reach the proper conscious sedation level for the procedure (r=0.181, p=0.0484). Multiple regression analysis showed that VAS anxiety, preoperative baseline prolactin level, and cortisol level had statistically significant effects on the propofol induction dose for target controlled conscious sedation. We concluded that the induction dose and time requirements for propofol in anesthesiologist- controlled conscious sedation be modified based on the preoperative anxiety level and the baseline blood concentration of stress hormone, cortisol and prolactin.
Adult ; Anesthetics, Intravenous ; *Anxiety ; *Conscious Sedation ; Female ; *Fertilization in Vitro ; Human ; Hydrocortisone/blood ; Korea ; *Ovum ; Preoperative Care ; Prolactin/blood ; *Propofol ; Regression Analysis ; Statistics ; *Tissue Harvesting

A posterior reversible encephalopathy syndrome (PRES) is characterized as headache, altered mental function, seizure, and visual disturbances resulted from vasogenic edema in the brain. A 29-year-old normotensive parturient developed a postural headache two days after the cesarean section under spinal anesthesia. The headache was initially misdiagnosed as a postdural puncture headache (PDPH). The patient experienced generalized seizures four days after delivery. Her blood pressure increased to 170/100 mmHg with mild proteinuria. She developed homonymous hemianopsia two days after the seizures. MRI revealed high signal intensity areas in the posterior temporal, frontal, occipital and parietal white matter. Presuming a diagnosis of PRES, the patient was treated with magnesium sulfate, sodium valproate, and carbohydrate solutions. She was discharged without headache or neurologic deficit on postoperative day 13. When patients present a headache with focal neurological deficits or visual disturbances, the anesthesiologist must consider the possibility of PRES and aggressively treat based on the clinical presentation.
Adult ; Anesthesia, Spinal* ; Blood Pressure ; Brain ; Cesarean Section* ; Diagnosis ; Edema ; Female ; Headache ; Hemianopsia ; Humans ; Magnesium Sulfate ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Post-Dural Puncture Headache ; Posterior Leukoencephalopathy Syndrome* ; Postpartum Period ; Pregnancy ; Proteinuria ; Rabeprazole ; Seizures ; Valproic Acid

BACKGROUND: Since the advent of AIDS, tuberculosis has become a major public health problem in the western society. Therefore, it is essential that pulmonary tuberculosis be rapidly diagnosed. Light microscopic detection of acid-fast organisms in sputum has traditionally been used for rapidly diagnosing tuberculosis. However positive smears are only observed in about one-half to three-quarters of cases. Studies using PCR for diagnosing pulmonary tuberculosis disclosed several shortcomings suggesting an inability to distinguish between active and treated or in active tuberculosis. In this study, the clinkcal significance of a PCR-bases rapid technique for detecting Mycobacterium tuberculosis DNA in peripheral blood investigated. MATERIALS AND METHODS: From July 1, 1998 through to August 30, 1999, 59 patients with presumed tuberculosis, who had no previous history of anti-tuberculosis medication use whithin one year prior to this study were recruite and followed up for more than 3 months. AFB stain and culture in the sputum and/or pleural fluids and biopsies when needed were performed. Blood samples from each of the 59 patients were obtained in order to identify Mycobacterium Tuberculosis DNA by a PCR test. RESULTS: 1) Forty five out of 59 patients had a final diagnosis of tugerculosis; Twenty eight were confirmed as having active pulmonary tuberculosis by culture or biopsy. Four were clinkcally diagnosed with pulmonary tuberculosis. The othe 13 patients were diagnosed as having tuberculous pleurisy (9) and extrapulmonary tuberculosis (4). 2) Fourteen patients showed a positive blood PCR test. The PCR assay correctly identified active tuberculosis in 13 out of 14 patients. The overall sensitivity and specificity of this blood PCR assay for diagnosing tuberculosis were 29% and 93%, respectively. The positive predictive value was 93%, the negative predictive value was 29% and diagnostic accuracy was 44%. 3) Six out of 14(43%) patients with blood PCR positive tuberculosis were immunologically compromised hosts. 4) A simple chest radiograph in blood PCR positive tuberculosis patients showed variable and inconsistent findings. CONCLUSION: A peripheral blood PCR assay for Mycobacterium tuberculosis is not recommended as screening method for diagnosing active tuberculosis. However, it was suggested that the blood PCR assay could contribute to an early diagnostic rate due to its high positive predictive value.
Biopsy ; Diagnosis ; DNA* ; Humans ; Mass Screening ; Mycobacterium tuberculosis* ; Mycobacterium* ; Polymerase Chain Reaction ; Public Health ; Radiography, Thoracic ; Sensitivity and Specificity ; Sputum ; Tuberculosis ; Tuberculosis, Pleural ; Tuberculosis, Pulmonary

Fabry disease is a X-linked lysosomal storage disorder caused by deficiency of alpha-galactosidase A. This abnormality in enzyme results intracellular accumulation of globotriaosylceramide and leads to severe painful neuropathy with progressive renal, cardiovascular, and cerebrovascular dysfunction and early death. We report a 35 year-old man who had been suffered from acroparesthesia aggravated by body temperature elevation and with asymptomatic renal function impairment, which were proven to be due to Fabry disease. We performed gene analysis by PCR direct sequencing and confirmed missense mutation of GLA gene. Recently enzyme replacement of alpha-galactosidase was introduced and we think that the importance of early diagnosis and treatment should be emphasized.
Adult ; alpha-Galactosidase* ; Body Temperature ; DNA Mutational Analysis ; Early Diagnosis ; Fabry Disease* ; Humans ; Mutation, Missense ; Polymerase Chain Reaction ; Proteinuria