INTRODUCTIONWe performed this study to find clinical features and laboratory parameters that could facilitate the process of selecting patients who should receive lumbar punctures from among those who present with headache and fever.

METHODSWe selected patients aged ≥ 16 years who presented to and received lumbar puncture in the emergency department of Kangwon National University Hospital, South Korea, between 2011 and 2013. Patients who received lumbar punctures were divided into two groups - those who were diagnosed with viral meningitis and those who were not. We compared the clinical features and laboratory data between the two groups. Key indices were then used to develop a scoring system to diagnose viral meningitis in patients and identify those who should receive lumbar punctures.

RESULTSAmong the patients who were included in the study, 42 had viral meningitis and 96 did not. The variables of C-reactive protein level ≤ 1.291 mg/dL, neck stiffness and vomiting were assigned 3 points, 2 points and 1 point, respectively, in the scoring system. Overall scores ≥ 4 yielded a positive likelihood ratio of 7.79 (sensitivity 0.600, specificity 0.923), while negative likelihood ratio decreased to less than 0.1 (0.072) for overall scores < 3.

CONCLUSIONUsing the proposed scoring system, we were able to determine the likelihood of viral meningitis in patients presenting with fever and headache, and to successfully identify those who should receive lumbar punctures.

BACKGROUND: Metabolic health is an emerging concept that is highly correlated with various metabolic complications, and adipocytokines have been causally linked to a wide range of metabolic diseases. Thus, this study compared serum adipocytokine levels according to metabolic health and obesity status. METHODS: Four hundred and fifty-six nondiabetic subjects (mean age, 40.5 years) were categorized into four groups according to metabolic health and obesity status: metabolically healthy nonobese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy nonobese (MUHNO), and metabolically unhealthy obese (MUHO). Being metabolically healthy was defined as the presence of fewer than two of the following five metabolic abnormalities: high blood pressure, high fasting blood glucose, high triglyceride, low high density lipoprotein cholesterol, and being in the highest decile of the homeostatic model assessment of insulin resistance index. Obesity status was assessed using body mass index (BMI), with obesity defined as a BMI higher than 25 kg/m2. Levels of serum interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor alpha (TNF-alpha), and adipocyte fatty acid binding protein (A-FABP) were also evaluated. RESULTS: Of the 456 subjects, 247 (54.2%) were in the MHNO group, 66 (14.5%) were in the MHO group, 66 (14.5%) were in the MUHNO group, and 77 (16.9%) were in the MUHO group. There were no significant differences in IL-6 or MCP-1 levels among the groups, but levels of TNF-alpha and A-FABP were significantly higher in the MUHNO group compared to the MHNO group. CONCLUSION: High TNF-alpha and A-FABP levels are significantly associated with metabolically unhealthiness in nonobese Korean individuals.
Adipocytes ; Adipokines ; Blood Glucose ; Body Mass Index ; Carrier Proteins ; Chemokine CCL2 ; Cholesterol, HDL ; Fasting ; Hypertension ; Insulin Resistance ; Interleukin-6 ; Metabolic Diseases ; Obesity* ; Triglycerides ; Tumor Necrosis Factor-alpha

Encephalitozoon cuniculi is a microsporidian parasite commonly found in rabbits that can infect humans, causing encephalitozoonosis. The prevalence of encephalitozoonosis is not well documented, even when many clinics suspect pet rabbits as being highly infected. This study investigated the seropositivity of E. cuniculi using ELISA. The examination of 186 rabbits using ELISA showed that 22.6% (42/186) were seropositive against E. cuniculi. In analysis with healthy status, all 42 seropositive sera were collected from clinically normal rabbits. Moreover, the gender and age of pet rabbits did not have anysignificant effect on E. cuniculi infection. To the best of our knowledge, this is the first report to describe the seroprevalence of E. cuniculi in pet rabbits and suggests that pet rabbits could act as an important reservoir of encephalitozoonosis for both pet animals and humans in Korea.
Animals ; Antibodies, Fungal/*blood ; Encephalitozoon cuniculi/*immunology ; Encephalitozoonosis/epidemiology/*veterinary ; Enzyme-Linked Immunosorbent Assay ; Female ; Korea/epidemiology ; Male ; *Pets ; Rabbits ; Seroepidemiologic Studies

BACKGROUND: Medical skin care is essential for the treatment of skin diseases all over the world. Medical skin care is also part of medical practice and this must be differentiated from the simple skin care that is given for normal healthy skin. OBJECTIVE: We wanted to discuss medical skin care and the related medical devices and legal issues. METHODS: We reviewed the related laws and regulations, we consulted experts and associations and we analyzed the result of the survey. RESULTS: Legally, medical skin care and simple skin care are well classified. However, many illegal procedures are still performed by non-medical personnel and many adverse effects have been reported as a result. Furthermore, there are no legal restrictions for the performer based on the grade of each medical skin care procedure. CONCLUSION: For the best results and safe procedures, medical skin care must be performed by approved medical equipment under the supervision of a physician or medical personnel. Continuous control and guidance by the government is strongly needed.
Jurisprudence ; Organization and Administration ; Skin ; Skin Care ; Skin Diseases ; Social Control, Formal

Adenosquamous carcinoma of the papilla of Vater is a rare tumor and only a few cases have been reported so far. Here, we report a case of adenosquamous carcinoma in a 76-year-old male who presented with jaundice and right upper quadrant abdominal pain. Ultrasonography and enhanced abdominal CT scans showed dilated common bile duct (CBD) and intrahepatic bile duct (IHD) with a suspicious obstructing mass in distal CBD. On endoscopy, obstructing and ulcerated mass was noted on the papilla of Vater. Histopathological inspection of the biopsied specimens from mass showed adenosquamous cell carcinoma of the papilla of Vater. Since the patient refused operation, we inserted a self-expandable metallic stent in distal CBD. This is the first case report on adenosquamous carcinoma of the papilla of Vater in Korea.
Aged ; Ampulla of Vater/*pathology ; Carcinoma, Adenosquamous/*diagnosis/pathology/surgery ; Cell Differentiation ; Humans ; Immunohistochemistry ; Male ; Tomography, X-Ray Computed

Endoscopic treatment of chronic pancreatitis by stent insertion is an accepted procedure, but various complications can be induced, including proximal migration of the stent. Many techniques are used to retrieve proximally migrated, pancreatic stents. We here report a case of a proximally migrated stent into the dorsal duct of a pancreas divisum, which was retrieved endoscopically by using a mini-snare. A 39-year-old female patient had chronic pancreatitis with divisum. A stent was inserted into the dorsal duct to relieve the chronic pain. After two months, sudden epigastric pain developed due to proximal migration of the stent. The pancreatic stent was retrieved successfully with one endoscopic attempt using a mini-snare. The epigastric pain resolved after retrieval of the stent. Our observation is that pancreatic stent migration may cause severe abdominal pain and that endoscopic retrieval is possible.
Abdominal Pain ; Adult ; Chronic Pain ; Female ; Humans ; Pancreas* ; Pancreatitis, Chronic ; Stents*

Lamivudine, a nucleoside analogue, has been used widely as an effective antiviral agent for the treatment of patients with chronic hepatitis B virus (HBV) infection. However, the YMDD motif mutation of HBV polymerase resistant to lamivudine occurs very frequently after long term therapy. We developed an oligonucleotide chip for the detection of YMDD motif mutants resistant to lamivudine and investigated the prevalence of the mutants in patients with chronic HBV infection who had not been treated by lamivudine before. Forty patients who had not been treated with lamivudine were included in this study. Serum samples were tested by the oligonucleotide chips designed for detection of wild-type YMDD motif, M552V and M552I. Samples were confirmed by restriction fragment length polymorphism (RFLP) and direct sequencing. M552I mutants were detected by the oligonucleotide chips in 7.5% (3/40) of chronic HBV infected patients (2 chronic hepatitis and 1 cirrhosis). The results were in accordance with those of RFLP. YMDD motif mutants occur as natural genome variabilities in patients with chronic HBV infection who had not been treated with lamivudine before. Oligonucleotide chip technology is a reliable and useful diagnostic tool for the detection of mutants resistant to antiviral therapy in chronic HBV infection.
Adolescent ; Adult ; *Amino Acid Motifs ; Chronic Disease ; Female ; Hepatitis B/*drug therapy ; Hepatitis B virus/*genetics ; Humans ; Lamivudine/*therapeutic use ; Male ; Middle Aged ; Mutation ; *Oligonucleotide Array Sequence Analysis ; Polymorphism, Restriction Fragment Length ; Reverse Transcriptase Inhibitors/*therapeutic use ; Sensitivity and Specificity ; Sequence Analysis, DNA ; Variation (Genetics)

BACKGROUND/AIMS: Lamivudine, a nucleoside analogue has been widely used as an effective antiviral agent for the treatment of patients with chronic hepatitis B infection. However, the YMDD motif mutation of HBV polymerase resistant to lamivudine very frequently occurs after long-term use of lamivudine. It is well known that the mutation is selected by the lamivudine. We hypothesized that a few mutant strains of YMDD motif are present as quasispacies before the lamivudine treatment, are selected by the treatment, and breakthrough during treatment. We investigated the prevalence of the YMDD motif mutants in patients with chronic hepatitis B infection who had not been treated by antiviral agents before. METHODS: The study included the serums of 40 patients with chronic heptitis B infection, which stored at -70 degrees C. Thirty-four patients had chronic hepatitis and 6 patients had cirrhosis. Thirty-one patients were diagnosed by liver biopsy. The average age and range were 29 years and 13-57 years respectively. None had taken any antiviral agents before. To detect YMDD mutants, YVDD (M552V), and YIDD (M552I), we used direct sequencing and the restriction fragment length polymorphism (RFLP) method. RESULTS: The YMDD mutant was detected by RFLP method in 7.5% (3/40) of the patients with chronic hepatitis B infection, in two patients with chronic hepatitis and one with cirrhosis. All were YMDD+ YIDD mutants. CONCLUSIONS: The YMDD motif mutation occurs spontaneously without antiviral therapy in patients with chronic hepatitis B infection.
Adolescent ; Adult ; Drug Resistance, Viral/genetics ; Female ; Gene Products, pol/*genetics ; Hepatitis B virus/*genetics ; Hepatitis B, Chronic/*virology ; Humans ; Male ; Middle Aged ; *Mutation ; Polymorphism, Restriction Fragment Length

BACKGROUND AND OBJECTIVES: A left ventricular mass (LVM) can be used as a prognostic factor in patients with cardiovascular disease, and echocardiographic LVM measurements are most commonly used. We have measured LVM using quantitativel gated myocardial perfusion SPECT (QGS), and compared these results with LVM measured by echocardiography. SUBJECTS AND METHODS: One hundred and sixteen subjects (M/F=66/50, mean age: 58 yrs) underwent both rest QGS with Tc-99m MIBI and echocardiography. On visual interpretation, thirty-six subjects (31%) showed perfusion defects. The myocardial volume was obtained using the AutoQUANT program, and the LVM (LVMSPECT) was calculated by multiplying the volume by the specific gravity of the myocardium. We also measured the echocardiographic LVM (LVMEcho) by the Devereux formula, within one month of the LVMSPECT. RESULTS: The LVMSPECT and LVMEcho were well correlated (r=0.717, p<0.001), but a significant difference was noted between the two values. The mean difference between the LVMSPECT and LVMEcho was 24 g. The LVMEcho was smaller than the LVMSPECT in those subjects with a small LVMEcho, and greater than the LVMSPECT in the subjects with a large LVMEcho. The difference between the LVMEcho and LVMSPECT (LVMEcho-LVMSPECT) was positively correlated with the LVMEcho (r=0.893, p<0.001). CONCLUSION: The LVMs measured by gated myocardial perfusion SPECT and echocardiography were well correlated. But they were significantly different, especially in subjects with large LVMs.
Cardiovascular Diseases ; Echocardiography* ; Humans ; Hypertrophy, Left Ventricular ; Myocardium ; Perfusion* ; Specific Gravity ; Tomography, Emission-Computed, Single-Photon*

Eosinophilic colitis is a relatively rare complication of hypereosinophilic syndrome which is characterized by abdominal pain and bloody diarrhea and is usually treated with steroids and hydroxyurea. However, no standard regimen exists in cases of intractable disease despite several treatment attempts with Interferon- alpha, cyclosporin, etoposide, and vincristine, etc. We here report a case of a 43-year-old woman with recurrent eosinophilic colitis as a complication of hypereosinophilic syndrome who was successfully treated with cyclophosphamide.
Adult ; Case Report ; Colitis/*complications/*drug therapy/pathology ; Cyclophosphamide/*therapeutic use ; Eosinophilia/*complications/*drug therapy/pathology ; Female ; Human ; Hypereosinophilic Syndrome/*complications ; Recurrence