Intravenous immunoglobulin (IVIG) infusion is an effective therapy for acute Kawasaki disease (KD). Nonetheless, approximately 10 percent to 20 percent of patients have persistent or recrudescent fever despite IVIG treatment, leading to a higher risk for coronary artery aneurysms (CAA). This unresponsiveness may pose a challenge to the clinicians. Tumor necrosis factor-alpha levels are elevated in the acute phase of the disease, especially in patients who develop CAA. We report a 10-month-old male with KD who failed to respond to multiple doses of IVIG and methylprednisolone and who then was treated with infliximab (5 mg/kg single dose). After infliximab treatment, he became afebrile with normalization of inflammatory markers and no further progression of CAA.
Aneurysm ; Coronary Vessels ; Fever ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Infant ; Male ; Methylprednisolone ; Mucocutaneous Lymph Node Syndrome* ; Tumor Necrosis Factor-alpha ; Infliximab

To investigate effects of cytokines on rheumatoid synovial cells, proliferation and expression of cytokine and metalloproteinase genes were studied with the primary culture of rheumatoid synovial cells which was treated with TNF-alpha, GM-CSF, TGF-alpha, PDGF and IL-B. By [3H] thymidine incorporation assay, TGF-beta and PDGF increased proliferation of synovial cells by 1.5 and 2.5 folds respectively. Cytokine gene expression was assessed by RT-PCR. Rheumatoid synovial cells expressed constitutively TGF-beta and IL-B at a high level and IL-1B, GM-CSF, and MIP-1a at a relatively low level. TGF-beta, GM-CSF and PDGF increased IL-B expression. Expression of pro-inflammatory cytokines and chemokines was increased by GM-CSF and PDGF. Both GM-CSF and PDGF increased the expression of IL-1B, GM-CSF MIP-la and IL-8. In addition, GM-CSF enhanced expression of TNF-alpha. Stromelysin and collagenase are the major proteinases responsible for destruction ot joints in rheumatoid arthritis (RA). These genes were expressed constitutivefy in rheumatoid synovial cells. In summary, PDGF and GM-CSF may piay an important role by inducing or increasing expression of IL-1B, TGF-beta and PDGF by increasing proliferation of rheumatoid synovial cells.
Tumor Necrosis Factor-alpha

mastication is basically regulated by central pattern regulator(CPG) of brain system target organ output from CPG is modulated by oral sensory feedback. anterior cross bite pattern infuluence the feedback mechanism and change muscle activity and jaw movement. .The purpose of this study was to investigate diffemce anterior cross bite group from normal group. the selected sample groups were 30 normal patient, 30 anterior cross bite patient. EMG and EGN of Biopak system were used for this study The following results were obtained 1. In resting state of mandible, anterior cross-bite showed the high r muscle activities in all the muscle.(exeeption:left digastric muscle) than normal group. 2. In clenching state, No significant difference in muscle activities of normal group and anterior cross bite group was noticed 3. In swallowing state Normal group showed the higher muscle activities in left and right masseter muscle, right posterior temporal muscle. 4. In maximum opening and closing velocity, normal group showed the higher value than anterior cross-bite. 5. In the mean value of the maximum operiing,the maximum anterior-posterior movement from centric-occlusion, the lateral deviation from centric-occclusion, normal group showed the higher value than anterior cross-bite group.
Adult* ; Brain ; Deglutition ; Feedback, Sensory ; Humans ; Jaw ; Malocclusion* ; Mandible ; Masseter Muscle ; Mastication ; Temporal Muscle

Pneumoconiosis is one of the most important occupational disease in Korea. In Pusan, most of pneumoconiosis is welders' pneumoconiosis developed in shipyard. With clinical (including interview with every patients) and radiological (chest radiographs) methods, author purposed to know the factors related to development of pneumoconiosis in shipyard welders and to apply the results to the concept for health care (management) of shipyard welders. The prevalence rate of welders' pneumoconiosis was calculated by the means of reading of chest radiographs of 547 shipyard welders. The prevalence rate of welders' pneumoconiosis (including suspected pneumoconiosis, category 0/1) was 7.9%. It was lower than that (8.9%) in same area studied in 1989. Prevalence rate increased as total welding duration increased and the welding work began early. It was higher in welders who did not use antidust mask. Probability of the occurance of welder's pneumoconiosis was related with the time that the welder began welding work. Sixteen cases among the 37 who were diagnosed as pneumoconiosis returned normal in the follow-up chest radiographs. There was no case aggrevated. The pertinent management for the personnels and their working environment contributed to the decrease of incidence of the welders' pneumoconiosis and the improvement of the disease. To prevent the occurance of the pneumoconiosis in shipyard welders, it seems to be necessary for the company to be supervised under the any legislation and to educate the welder to use the protective apparatus. It is suggested that considerate and continuous observation under the adequate management is preferable to the immediate conversion of the working department for the pneumoconiotic welders.
Busan ; Delivery of Health Care ; Follow-Up Studies ; Incidence ; Korea ; Masks ; Occupational Diseases ; Pneumoconiosis* ; Prevalence ; Radiography, Thoracic ; Welding

PURPOSE: The objectives of this study are to compare the hospital employees' and patients' recognition and attitudes toward the opening of the medical services market, to analyze the differences between hospital employees and patients on the factors in selecting a foreign hospital. MATERIALS AND METHODS: This study collected and analyzed data using systematic questionnaires that were self-administered by employees and outpatients to compare their recognition of the opening of the medical services market and the factors involved in selecting a foreign hospital. RESUTLS: Employees exhibited a higher level of recognition than the patients. Reasons for agreement were to ensure the right of selection for both the employees and patients. Reasons for disagreement, however, were split between the two groups: degraded public characteristics of medical services, for employees; and expensive medical fees, for patients. The most urgent task to prepare for the opening of the medical services market is the improvement of the diagnosis and treatment technologies for employees, and improvement of the services provided by hospital staff for patients. CONCLUSION: Korean hospitals shall need to improve their diagnosis and treatment technologies and provide medical services of high quality in order to compete with foreign hospitals.

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the feasibility and safety of a retroauricular hairline incision in partial superficial parotidectomy. SUBJECTS AND METHOD: Twenty-three patients who underwent partial superficial parotidectomy via retroauricular hairline incision from 2014 to 2016 were enrolled in the study. Patient's characteristics, surgical outcomes and postoperative complications were assessed. Subjective cosmetic satisfaction was assessed using a visual analog scale 3 months after surgery. RESULTS: In all 23 cases, parotid tumors were removed successfully via retroauricular hairline incision alone without any exposure failure. The mean operating time and the amount of postoperative drainage was 117.6 min (range, 75–163 min) and 51.5 mL (range, 25–91), respectively. Major complications such as permanent facial nerve paralysis and hematoma were not reported. The mean visual analogue scale score for subjective satisfaction with the incision scar was 9.0 (range, 6–10). CONCLUSION: We conclude that partial superficial parotidectomy via retroauricular hairline incision for the treatment of benign parotid tumor is technically feasible and it provides excellent cosmetic outcomes without an increase in complications.
Cicatrix ; Drainage ; Facial Nerve ; Hematoma ; Humans ; Methods ; Paralysis ; Parotid Gland ; Postoperative Complications ; Visual Analog Scale

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the feasibility and safety of a retroauricular hairline incision in partial superficial parotidectomy.SUBJECTS AND METHOD: Twenty-three patients who underwent partial superficial parotidectomy via retroauricular hairline incision from 2014 to 2016 were enrolled in the study. Patient's characteristics, surgical outcomes and postoperative complications were assessed. Subjective cosmetic satisfaction was assessed using a visual analog scale 3 months after surgery. RESULTS: In all 23 cases, parotid tumors were removed successfully via retroauricular hairline incision alone without any exposure failure. The mean operating time and the amount of postoperative drainage was 117.6 min (range, 75–163 min) and 51.5 mL (range, 25–91), respectively. Major complications such as permanent facial nerve paralysis and hematoma were not reported. The mean visual analogue scale score for subjective satisfaction with the incision scar was 9.0 (range, 6–10). CONCLUSION We conclude that partial superficial parotidectomy via retroauricular hairline incision for the treatment of benign parotid tumor is technically feasible and it provides excellent cosmetic outcomes without an increase in complications.

There are few studies on the severity and prognosis of patients infected with the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) omicron variant. From January 11, 2022 to January 25, 2022, 181 patients were infected with the SARS-CoV-2 omicron variant in a single hospital in Korea. The initial clinical characteristics were investigated through the COVID-19 basic investigation form. Outcomes were reviewed using medical records. The median age of the patients was 57 years (range 1–90), and 95 patients (52.5%) were male. None were re-infected with SARS-CoV-2, and 127 (70.2%) were fully vaccinated (boosted or within 6 months after second vaccination). Forty-two patients (23.2%) were asymptomatic. Among symptomatic patients, the frequency of symptoms was as follows: cough (37.0%), sore throat (33.7%), and fever (30.4%). In terms of disease severity, 168 (92.8%) patients did not require supplemental oxygen, 6 (3.3%) required low-flow oxygen, 5 (2.8%) required high-flow oxygen, and 2 (1.1%) died. Four of the five individuals who required high-flow oxygen and the two who died were not vaccinated. Most of the patients who contracted the SARS-CoV-2 omicron variant exhibited mild clinical features; however, severe clinical features including mortality were encountered among individuals who were not vaccinated.

PURPOSE: To evaluate malignancy risk according to ultrasound (US) features and size change on follow-up US in mixed echoic thyroid nodules and to suggest management guidelines thereof. MATERIALS AND METHODS: Among patients who underwent US-guided fine needle aspiration biopsy, 316 mixed echoic nodules in 303 patients were included after excluding the patients with pure solid or cystic nodules or without further cytopathologic evaluation. We evaluated malignancy risk according to US features and changes in size and shape on follow-up US. RESULTS: The malignancy rate was 31.6% (6 of 19) for nodules with suspicious US features and 2.7% (8 of 297) for nodules without suspicious US features (p<0.001). Among 265 nodules with no suspicious US features and initial benign cytology, 15 nodules with suspicious US change and decreased size, 25 nodules with no suspicious US change and increased size, and 225 nodules with no suspicious US change and no change in size were observed on follow-up USs. The malignancy risk thereof was 0%, 0% and 0.4%, respectively (p=1.000). CONCLUSION: Mixed echoic nodules with no suspicious US features and benign cytology can be followed up using US, as they revealed very low malignancy rates, even if they showed growth on follow-up US.
Adult ; Biopsy, Fine-Needle/methods ; Female ; Humans ; Male ; Middle Aged ; Thyroid Neoplasms/diagnosis/ultrasonography ; Thyroid Nodule/*diagnosis/*ultrasonography

PURPOSE: The purpose was to compare the frequency of metastatic and nonmetastatic lymph nodes diagnosed by fine needle aspiration biopsy cytology (FNAC) and thyroglobulin concentration from fine needle aspiration biopsy washout fluid (FNAB-Tg) in an indeterminate range (0.2-100 ng/mL), and to evaluate the most appropriate threshold value of FNAB-Tg in an indeterminate range. MATERIALS AND METHODS: We performed ultrasound-guided FNAB and FNAB-Tg in suspicious metastatic cervical lymph nodes of papillary thyroid carcinoma and performed surgery. Ninety-five lymph nodes with indeterminate values of FNAB-Tg ranging from 0.2-100 ng/mL in ninety-two patients were included in this study. The diagnostic performances in multiple Tg levels (0.7, 1.0, 5.0, 10.0, 20.0, 50.0) were evaluated to compare with FNAB cytology using sensitivity, specificity, and accuracy with area under the curve (AUC) analysis. RESULTS: Forty-two were metastatic lymph nodes and fifty three were nonmetastatic lymph nodes. FNAB-Tg ranged from 0.22 to 90.9 ng/mL in metastatic lymph nodes (mean; 34.3+/-33.3 ng/mL) and 0.20 to 56.7 ng/mL in nonmetastatic lymph nodes (mean; 4.9+/-11.1 ng/mL) (p<0.001). The most excellent diagnostic performance was displayed in 5 ng/mL of FNAB-Tg with AUC of 0.76, sensitivity, specificity, accuracy, 69.0, 83.0, and 76.8, respectively. However, there was no significant difference from 10 ng/mL FNAB. CONCLUSION: We ascertained that 5 ng/mL yielded the most excellent diagnostic performance among FNAB-Tg levels in the present setting with a large series with the indeterminate range (0.2-100 ng/mL) of FNAB-Tg values. These results need additional confirmation under different laboratory conditions.
Biopsy, Fine-Needle/*methods/standards/statistics & numerical data ; Body Fluids/metabolism ; Carcinoma, Papillary/*metabolism/*secondary/ultrasonography ; Humans ; Lymph Nodes/metabolism/pathology/ultrasonography ; Lymphatic Metastasis ; Retrospective Studies ; Sensitivity and Specificity ; Thyroglobulin/*metabolism ; Thyroid Neoplasms/*metabolism/*secondary/ultrasonography ; Ultrasonography, Interventional