BACKGROUND AND PURPOSE: Upper respiratory infection (URI), including influenza, may exacerbate the symptoms of myasthenia gravis (MG), which is an autoimmune disease that causes muscle weakness. There is also concern that the influenza vaccine may trigger or worsen autoimmune diseases. The objective of this study was to determine the impacts of influenza infection and vaccination on symptom severity in MG patients. METHODS: Patients diagnosed with MG were enrolled from 10 university-affiliated hospitals between March and August 2015. Subjects completed a questionnaire at the first routine follow-up visit after enrolling in the study. The patient history was obtained to determine whether a URI had been experienced during the previous winter, if an influenza vaccination had been administered before the previous winter, and whether their MG symptoms were exacerbated during or following either a URI or vaccination. Influenza-like illness (ILI) was defined and differentiated from the common cold as a fever of ≥38℃ accompanied by a cough and/or a sore throat. RESULTS: Of the 258 enrolled patients [aged 54.1±15.2 years (mean±SD), 112 men, and 185 with generalized MG], 133 (51.6%) had received an influenza vaccination and 121 (46.9%) had experienced a common cold (96 patients) or ILI (25 patients) during the analysis period. MG symptoms were aggravated in 10 (40%) patients after ILI, whereas only 2 (1.5%) experienced aggravation following influenza vaccination. The rate of symptom aggravation was significantly higher in patients experiencing an ILI (10/25, 40%) than in those with the common cold (15/96, 15.6%, p=0.006). CONCLUSIONS: The results of this study suggest that the potential risk of aggravating autoimmune disease is higher for ILI than for influenza vaccination, which further suggests that influenza vaccination can be offered to patients with MG.
Autoimmune Diseases ; Common Cold ; Cough ; Fever ; Follow-Up Studies ; Humans ; Influenza Vaccines ; Influenza, Human* ; Male ; Muscle Weakness ; Myasthenia Gravis* ; Pharyngitis ; Vaccination*

PURPOSE: The purpose of this study was to evaluate the questions pertaining to the foot and ankle on the Korean Orthopedic In-Training Examination (KOITE) between 2012 and 2016. MATERIALS AND METHODS: Questions regarding the foot and ankle on KOITE during the five-year period (2012∼2016) were analyzed. Number of foot and ankle questions, topics, taxonomic classification, imaging modalities, and cited references related to each question were analyzed. RESULTS: The average number of foot and ankle questions was 35, accounting for 7.0% (35/500) of all KOITE questions. All questions were categorized into three topic areas: disease (51.4%, 18/35), trauma (31.4%, 11/35), and basics (17.1%, 6/35). Taxonomy 3 (decision-making type questions) was the most common (42.9%, 15/35). References that are commonly used for each question were Campbell's Operative Orthopedics (100%, 35/35) and the textbook of The Korean Orthopaedic Association (74.3%, 26/35). CONCLUSION: This analysis can be valuable to not only orthopaedic surgery residents to improve their knowledge of orthopedics, but also to instructors for optimizing their education programs.
Ankle ; Classification ; Education ; Foot* ; Orthopedics*

Insufficiency fracture of the calcaneus is a rare entity. In the absence of trauma, evaluating a painful ankle in an elderly patient can be difficult and also it might be overlook the insufficiency fracture. We experienced a case of insufficiency calcaneus fracture that occurred after ipsilateral total knee arthroplasty. Here, we report our case with a review of literatures.
Aged ; Ankle ; Arthroplasty* ; Calcaneus ; Fractures, Stress* ; Humans ; Knee*

Trigger finger commonly occurs in A1 pulley. However, there have been occasional reports of proximal or distal A2 pulley and A3 pulley at other sites. Especially, trigger finger that occurs in A2 pulley is usually due to thickening of flexor tendon. Flexor tendon plasty surgery or A2 pulley partial release are well known treatments of A2 pulley trigger finger. We conducted pulley lengthening of the A2 pulley to a 62-year-old man who has trigger finger occurring in distal portion of the A2 pulley, and we report about this with good results obtained.
Fingers* ; Humans ; Middle Aged ; Tendons

BACKGROUND: The aim of this study was to investigate the prevalence, clinical and laboratory findings of hereditary hemolytic anemia (HHA) in Korea from 1997 to 2006 and to develop the appropriate diagnostic approach for HHA. METHODS: By the use of questionnaires, information on the clinical and laboratory findings ofHHA diagnosed from 1997 to 2006 in Korea was collected and analyzed retrospectively. A total of 431 cases were enrolled in this study from 46 departments of 35 hospitals. RESULTS: The overall frequency of HHA did not change through the 10-year period for pediatrics but did show an increasing tendency for internal medicine. The overall male to female sex ratio did not show sex predominance (1.17:1), but a significant male predominance with a ratio of 1.49:1 was seen for pediatrics while a significant female predominance with a ratio of 1:1.97 was seen forinternal medicine. Of the total cases, 74.2% (282/431) were diagnosed before the age of 15 years. The etiologies of HHA were classified as red cell membrane defects, hemoglobinopathies, red cell enzyme deficiencies and unknown causes. There were 382 cases (88.6%) of red cell membrane defects with 376 cases (87.2%) of hereditary spherocytosis and 6 cases (1.4%) of hereditary elliptocytosis, 20 cases (4.6%) of hemoglobinopathies with 18 cases (4.2%) of beta-thalassemia, a case (0.2%) of alpha-thalassemia and a case (0.2%) of Hemoglobin Madrid, 7 cases (1.6%) of red cell enzyme deficiencies with 5 cases (1.2%) of glucose-6- phosphate dehydrogenase (G-6-PD) deficiency, a case (0.2%) of pyruvate kinase (PK) deficiency and a case (0.2%) of enolase deficiency, and 22 cases (5.1%) of unknown causes. The most common chief complaint in pediatric patients was pallor and that in adult patients was jaundice. In the red cell membrane defect group of patients, the level of hemoglobin was significantly higher than in adult patients. The mean corpuscular volume, mean corpuscular hemoglobin, corrected reticulocyte count, total and indirect bilirubin level and lactate dehydrogenase levels in the hemoglobinopathy group of patients were significantly lower than the values in the red cell membrane defect group of patients. The mean concentration of G-6-PD was 0.8+/-0.7U/1012RBC in the G-6-PD deficient patients, PK was 1.7U/1010 RBC in the PK deficient patient, and the level of enolase was 0.04U/g of Hb in the enolase deficient patient. CONCLUSION: The most prevalent cause of HHA in Korea during 1997 to 2006 was hereditary spherocytosis, but HHA by other causes such as hemoglobinopathy and red cell enzyme deficiency gradually increased with the development of molecular diagnostic methods and increasing general interest. However, the etiologies of HHA need to be pursued further in 5.1% of the patients. An systematic standard diagnostic approach is needed in a nationwide prospective study for correct diagnoses and appropriate management of HHA.
Adult ; alpha-Thalassemia ; Anemia, Hemolytic, Congenital* ; beta-Thalassemia ; Bilirubin ; Cell Membrane ; Diagnosis ; Elliptocytosis, Hereditary ; Erythrocyte Indices ; Female ; Hemoglobinopathies ; Humans ; Internal Medicine ; Jaundice ; Korea* ; L-Lactate Dehydrogenase ; Male ; Oxidoreductases ; Pallor ; Pathology, Molecular ; Pediatrics ; Phosphopyruvate Hydratase ; Prevalence ; Pyruvate Kinase ; Reticulocyte Count ; Retrospective Studies* ; Sex Ratio ; Surveys and Questionnaires

BACKGROUND: This study compared the bronchodilator efficacy and safety of tiotropium inhalation capsules (18microgram once daily) with a ipratropium metered dose inhaler (2 puffs of 20microgram q.i.d.) in patients with chronic obstructive pulmonary disease (COPD). METHOD: After the initial screening assessment and a two-week run-in period, patients received either tiotropium 18microgram once daily or ipratropium 40microgram four times daily over a period of 4 weeks in a double blind, double dummy, parallel group study. The outcome measures were the lung function, the daily records of the peak expiratory flow rate (PEFR), the patients' questionnaire, and the use of concomitant salbutamol. The forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) were measured 5 minutes before inhalation, and 0.5, 1, 2 and 3 hours after inhaling the study drug on days 0, 14 and 28. RESULT: In 16 centers, 134 patients with a mean (SD) age of 66 (7) years and a predicted FEV1 of 42 (12)% were analyzed. The trough FEV1 response was significantly higher in the tiotropium group than in the ipratropium group after a four-week treatment period. The weekly mean morning PEFR of the tiotropium group was consistently higher than that of the ipratropium group during the 4-week treatment period with differences ranging from 12.52 to 13.88 l/min, which were statistically significant. Tiotropium was well tolerated by the COPD patients during the 4-week treatment period and had a similar safety profile to ipratropium. CONCLUSION: This study shows that tiotropium administrated once daily has a superior bronchodilator effect with a similar safety profile in treating COPD patients compared with ipratropium, inhaled four times daily.
Adult* ; Albuterol ; Bronchodilator Agents ; Capsules ; Forced Expiratory Volume ; Humans ; Inhalation ; Ipratropium* ; Lung ; Mass Screening ; Metered Dose Inhalers ; Outcome Assessment (Health Care) ; Peak Expiratory Flow Rate ; Pulmonary Disease, Chronic Obstructive* ; Surveys and Questionnaires ; Vital Capacity ; Tiotropium Bromide

BACKGROUND: Although massive use of live attenuated mumps virus vaccines successfully reduced the incidence of mumps virus infection worldwide, mumps outbreaks have not been completely eliminated, even in vaccinated populations. In recent years, the incidence of mumps has been remarkably increased in Korea. This study was designed to evaluate the recent seroprevalence rate of mumps IgG among children in Kyonggi province at 1996 and 1999. METHODS: Study population included students from 8 elementary schools in Kyonggi province. Serum samples were collected twice at 1996 and 1999 and tested for mumps-specific antibody by enzyme-linked immunosorbent assay (ELISA). We also conducted a questionnaire survey on the parents and collected the records including history of vaccination and mumps infection. RESULTS: The seropositive rates against mumps were 89.47% and 89.74% at 1996 and 1999, respectively, and they were not significantly different when compared to age, sex, and region. Although the first vaccination rates were 92.17% and 92.25% at 1996 and 1999, respectively, the second vaccination rates were only 37.89% and 38.03% at 1996 and 1999, respectively. Infection rate showed no significant difference between vaccinated groups and nonvaccinated groups. Seropositive rate of infected group was higher than that of noninfected group but it was not significantly different between the vaccinated and the nonvaccinated. CONCLUSIONS: This study showed the seropositive rate and vaccination against mumps in children. There were no significant relationships between vaccination and infection. Therefore, it seems likely that the vaccination is not fully protective against mumps infection. This study will be helpful for the establishment of guideline for prevention and treatment of mumps in Korea.
Child* ; Disease Outbreaks ; Enzyme-Linked Immunosorbent Assay ; Gyeonggi-do* ; Humans ; Immunoglobulin G* ; Incidence ; Korea ; Mumps virus ; Mumps* ; Parents ; Seroepidemiologic Studies ; Vaccination ; Vaccines ; Surveys and Questionnaires

The pathogenetic mechanisms of minimal change disease and immunoglobulin A nephropathy remain uncertain, but recently various reports have reported the important role of the immunological aspect in the pathogenesis of glomerular injury. To assess the abnormalities of immunoregulatory system in these glomerular disease, the percentages of lymphocyte subpopulations in peripheral blood were studied in 24 cases of minimal change disease and 28 of immunoglobulin A nephropathy diagnosed by renal biopsy. The results were as follows: 1) CD4/CD8 ratio of the minimal change disease was significantly increased, compared with normal controls and immunoglobulin A nephropathy(P<0.05). 2) No significant difference in T helper cell and T suppressor cell was found between steroid response group and steroid non-response group in minimal change disease. 3) No significant difference in lymphocyte subpopulation was found between group with nephrotic range of proteinuria and group without nephrotic range of proteinuria in minimal change disease. 4) The discrepancies in lymphocyte subpopulations was not observed between group with infection and group without infection in immunoglobulin A nephropathy. 5) The pathologic grade (criteria of WHO) did not demonstrate a significant difference in lymphocyte subpopulation in immunoglobulin A nephropathy. In conclusion, these results suggest that the dysregulation of cell-mediated immunologic system is involved in the pathogenesis of minimal change disease and immunoglobulin A nephropathy, and some differences of immunoregulatory abnormalities between minimal change disease and immunoglobulin A nephropathy exist. But in this study the change in lymphocyte subpopulation does not anticipate the clinical course and prognosis of minimal change disease and immunoglobulin A nephropathy.
Biopsy ; Glomerulonephritis, IGA* ; Humans ; Immunoglobulin A* ; Lymphocyte Subsets* ; Lymphocytes* ; Nephrosis, Lipoid* ; Prognosis ; Proteinuria ; T-Lymphocytes, Helper-Inducer

No abstract available.
Korea* ; Lung*

One hundred and fifteen thoracolumbar vertebrel fractures Out. of 85 patients were avaluated in this study. In 97 cases out of 65 patients, angular deformity and loss of height of the fractured vertebral bodies were measured, and for 6. 3 months in average follow up study was made in 23 cases out of 18 patients. The angular deformity became increased from 18.4 degrees to 21. 0 degrees wheroas loss of height has also increased from 38.6 to 40.8%, showing little statical value. Incidence was higher in male than in female without seasonal differences. Age incidence ranged from 16 to 78, and most frequent in third and fourth decades. Causes of injury were industrial accident, traffic accident, home accident and fall from height. Location of injury was mainly twelfth thoracic and first lumbar vertebrae. As associated injury, fracture of the rib, ulna, malleolus and calcaneus in order. Conservative treatment was a method of choice, while operstive treatment was performed in 7%.
Accidents, Home ; Accidents, Occupational ; Accidents, Traffic ; Calcaneus ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Incidence ; Lumbar Vertebrae ; Male ; Methods ; Ribs ; Seasons ; Ulna