The pneumonia severity index (PSI) and CURB-65 are widely used tools for the prediction of community-acquired pneumonia (CAP). This study was conducted to evaluate validation of severity scoring system including the PSI and CURB-65 scores of Korean CAP patients. In the prospective CAP cohort (participated in by 14 hospitals in Korea from January 2009 to September 2011), 883 patients aged over 18 yr were studied. The 30-day mortalities of all patients were calculated with their PSI index classes and CURB scores. The overall mortality rate was 4.5% (40/883). The mortality rates per CURB-65 score were as follows: score 0, 2.3% (6/260); score 1, 4.0% (12/300); score 2, 6.0% (13/216); score 3, 5.7% (5/88); score 4, 23.5% (4/17); and score 5, 0% (0/2). Mortality rate with PSI risk class were as follows: I, 2.3% (4/174); II, 2.7% (5/182); III, 2.3% (5/213); IV, 4.5% (11/245); and V, 21.7% (15/69). The subgroup mortality rate of Korean CAP patients varies based on the severity scores and CURB-65 is more valid for the lower scores, and PSI, for the higher scores. Thus, these variations must be considered when using PSI and CURB-65 for CAP in Korean patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Cohort Studies ; Community-Acquired Infections/*mortality ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pneumonia/*mortality ; Prospective Studies ; Republic of Korea ; *Severity of Illness Index ; Young Adult

This study was conducted to evaluate treatment outcome, mortality, and predictors of both in patients with multidrug-resistant tuberculosis (MDR-TB) at 3 TB referral hospitals in the public sector of Korea. We included MDR-TB patients treated at 3 TB referral hospitals in 2004 and reviewed retrospectively their medical records and mortality data. Of 202 MDR-TB patients, 75 (37.1%) had treatment success and 127 (62.9%) poor outcomes. Default rate was high (37.1%, 75/202), comprising 59.1% of poor outcomes. Male sex (adjusted odds ratio [aOR], 2.91; 95% confidence interval [CI], 1.13-7.49), positive smear at treatment initiation (aOR, 5.50; 95% CI, 1.22-24.90), and extensively drug-resistant TB (aOR, 10.72; 95% CI, 1.23-93.64) were independent predictors of poor outcome. The all-cause mortality rate was 31.2% (63/202) during the 3-4 yr after treatment initiation. In conclusion, the treatment outcomes of patients with MDR-TB at the 3 TB hospitals are poor, which may reflect the current status of MDR-TB in the public sector of Korea. A more comprehensive program against MDR-TB needs to be integrated into the National Tuberculosis Program of Korea.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antitubercular Agents/*therapeutic use ; Demography ; Drug Resistance, Multiple, Bacterial ; Drug Therapy, Combination ; Female ; Hospitals, Chronic Disease ; Humans ; Male ; Middle Aged ; Odds Ratio ; Predictive Value of Tests ; Retrospective Studies ; Sex Factors ; Treatment Outcome ; Tuberculosis, Multidrug-Resistant/drug therapy/*mortality

This study was conducted to evaluate treatment outcome, mortality, and predictors of both in patients with multidrug-resistant tuberculosis (MDR-TB) at 3 TB referral hospitals in the public sector of Korea. We included MDR-TB patients treated at 3 TB referral hospitals in 2004 and reviewed retrospectively their medical records and mortality data. Of 202 MDR-TB patients, 75 (37.1%) had treatment success and 127 (62.9%) poor outcomes. Default rate was high (37.1%, 75/202), comprising 59.1% of poor outcomes. Male sex (adjusted odds ratio [aOR], 2.91; 95% confidence interval [CI], 1.13-7.49), positive smear at treatment initiation (aOR, 5.50; 95% CI, 1.22-24.90), and extensively drug-resistant TB (aOR, 10.72; 95% CI, 1.23-93.64) were independent predictors of poor outcome. The all-cause mortality rate was 31.2% (63/202) during the 3-4 yr after treatment initiation. In conclusion, the treatment outcomes of patients with MDR-TB at the 3 TB hospitals are poor, which may reflect the current status of MDR-TB in the public sector of Korea. A more comprehensive program against MDR-TB needs to be integrated into the National Tuberculosis Program of Korea.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antitubercular Agents/*therapeutic use ; Demography ; Drug Resistance, Multiple, Bacterial ; Drug Therapy, Combination ; Female ; Hospitals, Chronic Disease ; Humans ; Male ; Middle Aged ; Odds Ratio ; Predictive Value of Tests ; Retrospective Studies ; Sex Factors ; Treatment Outcome ; Tuberculosis, Multidrug-Resistant/drug therapy/*mortality

The successful treatment of community-acquired pneumonia requires appropriate, empirical antimicrobial therapy. The etiology and antimicrobial susceptibility of major pneumonia pathogens can differ by country. Therefore, the ideal treatment guidelines for community-acquired pneumonia should be based on the studies performed in each country. We developed a treatment guideline for community-acquired pneumonia for immunocompetent adults in Korea. This guideline was developed by the joint committee of the Korean Society for Chemotherapy, the Korean Society of Infectious Diseases, and the Korean Academy of Tuberculosis and Respiratory diseases.
Adult ; Anti-Bacterial Agents ; Communicable Diseases ; Humans ; Joints ; Korea ; Pneumonia ; Tuberculosis

A successful therapy of community-acquired pneumonia requires appropriate empirical antimicrobial therapy. Etiology and antimicrobial susceptibility of major pathogens of pneumonia can differ by country. Therefore, an ideal treatment guideline of community-acquired pneumonia should be based on the studies performed in each country. We developed a treatment guideline for community-acquired pneumonia in immunocompetent adults in Korea. This guideline was developed by the joint committee of the Korean Society for Chemotherapy, the Korean Society of Infectious Diseases, and the Korean Academy of Tuberculosis and Respiratory diseases.
Adult ; Communicable Diseases ; Community-Acquired Infections ; Humans ; Joints ; Korea ; Pneumonia ; Tuberculosis

A successful therapy of community-acquired pneumonia requires appropriate empirical antimicrobial therapy. Etiology and antimicrobial susceptibility of major pathogens of pneumonia can differ by country. Therefore, an ideal treatment guideline of community-acquired pneumonia should be based on the studies performed in each country. We developed a treatment guideline for community-acquired pneumonia in immunocompetent adults in Korea. This guideline was developed by the joint committee of the Korean Society for Chemotherapy, the Korean Society of Infectious Diseases, and the Korean Academy of Tuberculosis and Respiratory diseases.
Adult ; Communicable Diseases ; Community-Acquired Infections ; Humans ; Joints ; Korea ; Pneumonia ; Tuberculosis

Lemierre syndrome or postanginal septicemia (necrobacillosis) is caused by an acute oropharygeal infection with secondary septic internal jugular vein thrombophlebitis and frequent metastatic infections. 17-aged girl visted emergency room with dyspnea. She had the symptoms of fever, sore throat and myalgia before 3 or 4 days. She had multiple septic emboli in both lung fields and septic thrombophlebitis of right internal jugular vein. Although Fusobacterium necrophorum is the most common pathogen isolated from the patients, The pathogen can not be confirmed. We experienced a case of Lemierre syndrome with septic embolism after fever, sore throat and myalgia. We present the case with the review of literature.
Dyspnea ; Embolism* ; Emergency Service, Hospital ; Female ; Fever* ; Fusobacterium necrophorum ; Humans ; Jugular Veins ; Lemierre Syndrome ; Lung ; Myalgia* ; Pharyngitis* ; Sepsis ; Thrombophlebitis

OBJECTIVE: To determine whether MRI is able to demonstrate the effect of radiation synovectomy after the intra-articular injection of holmium-166-chitosan complex for the treatment of rheumatoid arthritis of the knee. MATERIALS AND METHODS: Fourteen patients aged 36-59 years were treated with 10-20 mCi of holmium-166-chitosan complex. A criterion for inclusion in this study was the absence of observable improvement after 3- or more months of treatment of the knee with disease-modifying anti-rheumatic drugs. MR images were acquired both prior to and 4-months after treatment. Clinical evaluation included the use of visual analog scales to assess pain, and the circumference of the knee and its range of motion were also determined. MR evaluation included measurement of the volume of synovial enhancement and wall thickness, the amount of joint effusion, and quantifiable scoring of bone erosion, bone edema and lymph nodes. RESULTS: Visual analog scale readings decreased significantly after radiation synovectomy (p < 0.05). MRI showed that joint effusion decreased significantly (p < 0.05), and that the volume of synovial enhancement tended to decrease, but to an insignificant extent (p = 0.107). CONCLUSION: The decreased joint effusion noted at 4-month follow-up resulted from radiation synovectomy of the rheumatoid knee by means of intra-articular injection of holmium-166-chitosan complex.

PURPOSE: Proteinuria is the hallmark of glomerular injury and results from alterations in glomerular permeability. The permeability of diseased glomerulus has been estimated by selectivity of proteinuria. Recently, some authors showed a significant relationship between selectivity of proteinuria and tubulointerstial damage. The present study examines the role of protein selectivity as a prognostic marker in patients with IgA nephropathy and its correlation with other prognostic indices. METHODS: The selective proteiuria index of 81 cases with IgA nephropathy diagnosed between 1990 and 2000 were reviewed, and each case was subclassified using the following : highly selective(SPI0.2). The mean age of the patients was 27+/-15 years with a follow-up period of 38+/-24 months. Six patients had highly selective proteinuria, thirty three patients had moderately selective proteinuria, and forty two patients had nonselective proteinuria. RESULTS: 1) A significant relationship was found between the SPI and Haas subclasess(p=0.01). With respect to clinical presentaion, hypertension(0, 4, 11 cases, p<0.05), proteinuria(0.52+/-0.35, 1.85+/-1.55, 2.79+/-2.51 g/day, p<0.05) were significant correlation.2) Chronic renal failure was significantly higher in patients with nonselective proteinuria in comparison with patients with selective proteinuria(p<0.05).3) Markers of renal failure by the Cox proportional hazards model were Cr(Exp(B)=4.2, p<0.001), Ccr (Exp(B)=2.1, p<0.05), SPI(Exp(B)=1.7, p<0.05), hypertension(Exp(B)=1.6, p<0.05). 4) In 28 patients of IgA nephropathy with nephrotic syndrome, 9 patients were moderately selective, 19 patients were nonselective. The response to therapy, evaluated retrospectively, was 67% and 16% in moderate and nonselective proteinuria(p=0.01). CONCLUSION: There is a significant relationship between selectivity of proteinuria and clinical para meters. Moreover, the selectivity of proteinuria has a predictive value on functional outcome.
Predictive Value of Tests

Wegener's granulomatosis (WG)is a multisystemic inflammatory disease characterized by necrotizing granulomatous inflammation and vasculitis of unknown etiology which classically affects the upper airway,lung,and kidney.Subglottic stenosis (SGS)is rare and occurs independently of other features of active WG. SGS can be a life-threatening manifestation of disease,and prompt diagnosis is essential.Since the presenting symptoms of SGS can be nonspecific,SGS should be considered in the differential diagnosis of any patient with WG who has increasing dyspnea,voice change,or cough.Although both surgical and medical treatments have been utilized,the optimal therapeutic approach to SGS in patients with WG has not been determined.So far,a case of WG with SGS has not been reported in Korea.Recently,we experienced a case of 59-year-old woman with SGS in WG.She responded to prednisolone and methotrexate therapy and did not require surgical intervention.So we report this case with a review of literatures.
Constriction, Pathologic* ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Inflammation ; Methotrexate ; Middle Aged ; Prednisolone ; Vasculitis ; Wegener Granulomatosis*