Pathologic fracture is a bresk of bony continuity within an abnormal bone. The abnormslity ma be due to systemic skeletal disease, infection, primary benign and malignant tumor, or metastati carcinoms. Among these, metastatic carcinoma to bone is most common cause of pathologic fractur excluding those due to osteoporosis. When considering the msnagement, pathologic fractures due to systemic skeletal disease usually heal with conservative treatment, while others often require operative treatment. We have experienced 20 cases of pathologic fracture in long bones for 8 years from 19 to 1987. The results were as follows ; 1. The average sge was somewhat different according to underlying diseases Malignant tumorous lesion; 53 years Benign tumorous lesion ; 17 years Chronic osteomyelitis, 42 years 2. The most common cause was malignant tumorous lesion, 8 cases(40%). 3. The most frequent site was femur, 17 cases(85%). 4. Surgical treatment was done in 17 cases(85%), and conservative treatment was done in 3 cas(1sw). 5. In 3 cases of pathologic fractures due to metaststic tumor, the pain was markedly relieved and essy nursing care was possible immediately after operation.
Clinical Study ; Femur ; Fractures, Spontaneous ; Nursing Care ; Osteomyelitis ; Osteoporosis

We found a mistake in our recently published article.

PURPOSE: To evaluate the activated zone of the supplementary motor area through motor and sensorystimula-tion of both hands by fMRI. MATERIALS AND METHODS: Twenty-four healthy volunteers, ranging in age from 20to 30 years, served as sub-jects. They were divided into four groups and performed one of the four activationtasks : complex movement, fine movement, touch sensation, heat sensation. Complex movement consisted of a fingertask in which sub-jects flexed and extended all fingers repeatedly in union, without the fingers touching eachother(group I). Fine movement involved a thumb task in which subjects flexed and extended the thumb repeatedlywithout touch-ing the other fingers(group II). Touch sensation consisted of a palm task in which another personrepeatedly drew a circle on the subject 's palm (group III), and heat sensation involved of a palm task in whichsubject 's palm was touched by another person with a 40 degreeC water-bag (group IV). F-MRI was conducted on acommer-cial 1.5-T scanner equipped with echo-planar imaging. After overlapping images were obtained using aZ-s-core, and the mean/curve in the MR devices was evaluated, the activated zone of the supplementary motor RESULTS: Thirty-two of 48 images(20 of the 24 men) revealed activated zones in the supplementary motor area. Ingroup I, activation was observed in five subjects, in three of whom it was bilateral (contralateral activation).In group II, activation was observed in five subjects, in one of whom it was bilateral. In group III, activationoccurred in five subjects(bilateral in four, and contralateral in three), and In group IV, activation was alsoob-served in five ; in three of these it was bilateral. CONCLUSION: Using fMRI, and in association with motor andsensory tasks, the supplementary motor area was activated in 66.7% of healthy volunteers (32/48).
Brain* ; Echo-Planar Imaging ; Fingers ; Hand ; Healthy Volunteers ; Hot Temperature ; Humans ; Magnetic Resonance Imaging* ; Sensation ; Thumb

Primary pulmonary neoplasms are uncommon in children. One such tumor, pleuropulmonary blastoma (PPB), is very rare, highly aggressive and malignant, and originates from either the lungs or pleura. It contains both mesenchymal and benign epithelial elements that resemble fetal lung, and occurs mainly in children aged less than five. The clinal symptoms often suggest upper respiratory tract infection or pneumothorax, but ultrasonography and chest CT scans depict both a large mass occupying an almost entire hemithorax, and a simple lung cyst. Contrast-enhanced CT demonstrates hetergeneous attenuation and a whorled appearance.
Child ; Humans ; Lung ; Lung Neoplasms ; Pleura ; Pneumothorax ; Respiratory Tract Infections ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVES: The goal of this study was to identify association between the continuity of ambulatory care of diabetes patients in South Korea (hereafter Korea) and the incidence of macrovascular complications of diabetes, using claims data compiled by the National Health Insurance Services of Korea. METHODS: This study was conducted retrospectively. The subjects of the study were 43 002 patients diagnosed with diabetes in 2007, who were over 30 years of age, and had insurance claim data from 2008. The macrovascular complications of diabetes mellitus were limited to ischemic heart disease and ischemic stroke. We compared the characteristics of the patients in whom macrovascular complications occurred from 2009 to 2012 to the characteristics of the patients who had no such complications. Multiple logistic regression was used to assess the effects of continuity of ambulatory care on diabetic macrovascular complications. The continuity of ambulatory diabetes care was estimated by metrics such as the medication possession ratio, the quarterly continuity of care and the number of clinics that were visited. RESULTS: Patients with macrovascular complications showed statistically significant differences regarding sex, age, comorbidities, hypertension, dyslipidemia and continuity of ambulatory diabetes care. Visiting a lower number of clinics reduced the odds ratio for macrovascular complications of diabetes. A medication possession ratio below 80% was associated with an increased odds ratio for macrovascular complications, but this result was of borderline statistical significance. CONCLUSIONS: Diabetes care by regular health care providers was found to be associated with a lower occurrence of diabetic macrovascular complications. This result has policy implications for the Korean health care system, in which the delivery system does not work properly.
Adult ; Aged ; Aged, 80 and over ; *Ambulatory Care ; Diabetes Complications ; Diabetes Mellitus/*diagnosis ; Dyslipidemias/complications ; Female ; Heart Diseases/*epidemiology/etiology ; Humans ; Hypertension/complications ; Incidence ; Insurance Claim Reporting ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Stroke/*epidemiology/etiology

Vitamin B12 deficiency anemia is a disorder caused by impaired DNA synthesis. Vitamin B12 binds to the intrinsic factor produced by the parietal cells and is absorbed in the distal ileum. After total gastrectomy, megaloblastic anemia is developed due to the absence or deficiency of the intrinsic factor. Concomitant iron deficiency states such as various malabsorption syndromes and alcoholism induce that the bone marrow erythroid megaloblastosis and peripheral blood macroovalocytosis are masked because of countervailing the tendency of iron deficiency to produce microblasts and hypochromic microcytic erythrocytes. We experienced a case of Vitamin B12 deficiency anemia with low RBC mean corpuscular volume (MCV) due to combined with iron deficiency anemia in 42 year-old female patient and report the case with literature review.
Adult ; Alcoholism ; Anemia ; Anemia, Iron-Deficiency* ; Anemia, Megaloblastic ; Bone Marrow ; DNA ; Erythrocyte Indices ; Erythrocytes ; Female ; Gastrectomy ; Humans ; Ileum ; Intrinsic Factor ; Iron* ; Malabsorption Syndromes ; Masks ; Rabeprazole ; Vitamin B 12 Deficiency* ; Vitamin B 12* ; Vitamins*

OBJECTIVES: Metabolic syndrome is an important etiologic factor in the development of certain types of cancers. The economic cost of the treatment of cancer has been steadily increasing. We therefore estimated the economic burden of cancers attributable to metabolic syndrome in Korea. METHODS: We reviewed metabolic syndrome-related cancers and relative risk and then calculated population attributable fractions. We analyzed insurance claims data for metabolic syndrome-related cancers in 2012 in order to estimate the direct costs associated with these cancers, including hospitalization, outpatient visits, transportation costs, and caregivers' costs as well as indirect costs such as loss of productivity due to cancer treatment and premature death. RESULTS: In 2012, 18 070 patients in Korea had cancers attributable to metabolic syndrome. The economic burden was USD 199.8 million and the direct and indirect costs were USD 124.5 million and USD 75.3 million, respectively. CONCLUSIONS: We estimated the economic burden of cancers attributable to metabolic syndrome in Korea and the efforts are necessary to reduce this burden.
Adult ; Aged ; Aged, 80 and over ; Cost of Illness ; Female ; Humans ; Insurance Claim Reporting ; Male ; Metabolic Syndrome X/complications/*economics/epidemiology ; Middle Aged ; Neoplasms/*economics/etiology ; Republic of Korea/epidemiology ; Risk

Depression is well-known to comorbid with several psychiatric disorders. Many schizophrenics also suffer from depression in the course of their illness. Combined therapy of SSRI and tricyclic antidepressants were reported to have benefits in some depressed patients. Paroxetine, a potent CYP2D6 inhibitor, increases the blood levels of tricyclic antidepressant markedly, Using paroxetine, we tried this combined therapy in the treatment of depressive symptoms in 10 chronic schizophrenic inpatients and evaluated its efficacy and drug interactions between paroxetine and tricyclic antidepressants. The following results were obtained: 1) The mean score of Hamilton's Depression Rating Scale(HDRS) was reduced significantly after 6 weeks-trials of this combined therapy for the mild depressive symptoms in 10 chronic schizophrenics. In four patients, 50% or more reductions in the scores of HDRS were noticed at final evaluation. 2) Two among our 10 subjects experienced severe toxic behavioral problems. Anticholinergic crisis with toxic confusion due to high blood levels of tricyclics was fecund in one patient and the other showed rapid clinical deterioration in his psychotic symptoms such as delusion and hallucination without any consciousness alternation. 3) Baseline plasma levels of tricyclics before adding paroxetine were higher or than expected in our chronic schizophrenic subjects maintained with their antipsychotic medications. Several antipsychotics were also known as a potent CYF2D6 inhibitors and to increase the blood levels of tricyclics. Because the blood levels of tricyclics had already increased significantly by the use of antipsychotics, adding paroxetine to antipsychotics and tricyclic antidepressant In our subjects could increase the blood levels of tricyclics not so much as previously reported in the literatures.
Antidepressive Agents, Tricyclic ; Antipsychotic Agents ; Consciousness ; Cytochrome P-450 CYP2D6 ; Delusions ; Depression* ; Drug Interactions ; Hallucinations ; Humans ; Inpatients ; Paroxetine* ; Plasma ; Schizophrenia

Cancer causes a significant deterioration in health and premature death and is a national socioeconomic burden. This study aimed to measure the burden of cancer using the disability-adjusted life year (DALY) metric based on the newly adopted methodology from the Global Burden of Disease Study in 2010. This study was conducted based on data from the Korean National Cancer Registry. The DALYs were calculated using a prevalence-based method instead of the incidence-based method used by previous studies. The total burden of cancer in 2012 was 3,470.79 DALYs per 100,000 persons. Lung cancer was the most prevalent cancer burden, followed by liver, stomach, colorectal, and breast cancer. The DALYs for lung, liver, stomach, colon and rectum, and pancreatic cancer were high in men, whereas the DALYs for breast, lung, stomach, colorectal, and liver cancer were high in women. Health loss from leukemia and cancer of the brain and nervous system was prevalent for those younger than age 20; from stomach, breast, and liver for those aged 30–50; and from lung, colon and rectum, and pancreas for a large proportion of individuals over the age of 60. The most important differences were that the DALYs were calculated by prevalence and that other components of the DALYs were measured by a population-based perspective. Thus, prevalence-based DALYs could provide more suitable data for decision making in the healthcare field.
Brain Neoplasms ; Breast ; Breast Neoplasms ; Colon ; Decision Making ; Delivery of Health Care ; Female ; Humans ; Korea* ; Leukemia ; Liver ; Liver Neoplasms ; Lung ; Lung Neoplasms ; Male ; Methods ; Mortality, Premature ; Nervous System ; Pancreas ; Pancreatic Neoplasms ; Prevalence ; Rectum ; Stomach