Pulmonary paragonimiasis and tuberculosis are endemic in Asia, South America, and Africa. However, differential diagnosis among the diseases is difficult because they present with similar clinical symptoms and diagnostic features. Here, we report a case of pulmonary paragonimiasis that was identified using Ziehl-Neelsen stain after initially being assessed for pulmonary tuberculosis. Following anti-Paragonimus chemotherapy, the patient's symptoms, laboratory test results, and lung lesions improved. Thus, the identification of Paragonimus westermani using Ziehl-Neelsen stain can be considered in the diagnosis.
Africa ; Asia ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Lung ; Paragonimiasis ; Paragonimus westermani ; South America ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: The purpose of this study was to evaluate factors associated with the risk of articular surface perforation during anchor placement for arthroscopic acetabular labral repair using follow-up computed tomographic arthrography (CTA). METHODS: Forty-six patients (29 males and 17 females) underwent arthroscopic labral repair using 142 suture anchors (55 large anchors and 87 small anchors). The patients were followed with CTA 1 year postoperatively. Anchor position was assessed by the insertion angle and the distance of the suture anchor tip from the articular cartilage. The incidence of malposition of suture anchors was assessed in follow-up CTA. The location and incidence of malposition were compared between two groups divided according to the diameter of suture anchor. RESULTS: The mean insertion angle and distance were significantly different between the groups. Of the 142 anchors, 15 (11%) were placed in the cartilage-bone transitional zone. Articular involvement was most common at the 3 o'clock position of the suture anchor (six out of 33 anchors, 18.2%). Both the insertion angle and distance showed small values in the articular involvement group. CONCLUSIONS: The radiographic analysis of the placement of suture anchors after arthroscopic labral refixation based on follow-up CTA demonstrates that articular involvement of anchors is related to the location on the acetabular rim (clock position) and anchor diameter.
Acetabulum* ; Arthrography ; Cartilage, Articular ; Follow-Up Studies ; Humans ; Incidence ; Male ; Risk Factors ; Suture Anchors

PURPOSE: The purpose of this study was to develop a prediction model for the characteristics of older adults with depression using the decision tree method. METHODS: A large dataset from the 2008 Korean Elderly Survey was used and data of 14,970 elderly people were analyzed. Target variable was depression and 53 input variables were general characteristics, family & social relationship, economic status, health status, health behavior, functional status, leisure & social activity, quality of life, and living environment. Data were analyzed by decision tree analysis, a data mining technique using SPSS Window 19.0 and Clementine 12.0 programs. RESULTS: The decision trees were classified into five different rules to define the characteristics of older adults with depression. Classification & Regression Tree (C&RT) showed the best prediction with an accuracy of 80.81% among data mining models. Factors in the rules were life satisfaction, nutritional status, daily activity difficulty due to pain, functional limitation for basic or instrumental daily activities, number of chronic diseases and daily activity difficulty due to disease. CONCLUSION: The different rules classified by the decision tree model in this study should contribute as baseline data for discovering informative knowledge and developing interventions tailored to these individual characteristics.
Activities of Daily Living ; Aged ; Aged, 80 and over ; Chronic Disease ; Data Mining ; Decision Trees ; Depression/*psychology ; Female ; Health Behavior ; Health Status ; Humans ; Leisure Activities ; Male ; Middle Aged ; Quality of Life ; Socioeconomic Factors

Choledochal cyst is an uncommon premalignant anomaly. The morphology and pathogenesis of the premalignant lesion of cholangiocarcinoma arising from the choledochal cyst has not been well described. Herein, we report a rare case of bile duct adenoma arising from choledochal cyst with anomalous union of pancreaticobiliary duct (AUPBD). 50-year-old woman was admitted to our hospital with the complaint of epigastric pain. She had received common bile duct (CBD) exploration and choledocholithotomy and cholecystectomy 3 months earlier under the diagnosis of multiple CBD stones. Intraoperalive cholangiogram was not remarkable except CBD dilatation at that time. Endoscopic retrograde cholangiopancreatography revealed choledochal cyst with AUPBD and round filling defect which disappeared easily on the balloon cholaniogram. On magnetic resonance cholangiopancreatography, the filling defect was confirmed as 2 cm polypoid mass attached to the distal bile duct wall. At laparotomy, a soft whitish mass was palpable on the lower CBD. On histological examination, adenoma with focal carcinoma change arising from choledochal cyst was diagnosed.
Adenoma, Villous/*diagnosis/pathology/radiography ; Bile Duct Neoplasms/*diagnosis/pathology/radiography ; Cholangiopancreatography, Magnetic Resonance ; Choledochal Cyst/*radiography/secretion/surgery ; Female ; Humans ; Middle Aged ; Tomography, X-Ray Computed

PURPOSE: To evaluate the clinical and radiological results of total hip replacement arthroplasty using a cementless, sandwich (alumina-polyethylene-titanium) acetabular component and the cause of three ceramic liner fracture. MATERIALS AND METHODS: From June 1999 to December 2001, one hundred and twenty eight (110 patients) among 146 cases (129 patients) who were underwent total hip replacement arthroplasty using a sandwich type acetabular component, were followed up for minimum 24 months (range, 54-24 months). Among 110 patients, 85 patients (101 cases) were men and 25 patients (27 cases) were women. Their mean age was 48.8 years (range, 17-78 years) old. The patients were examined clinically and radiologically at postoperative 1 month, 3 months, 6 months, 1 year and every year, thereafter. RESULTS: At the median followup of 32 months, the average Merle d'Aubigne and Postel score had improved from 8.4 to 16.7. Results were graded as excellent in 110 hips (86%), and very good in 18 hips (14%). At the last followup, all component including acetabular cup and femoral stem acquired firm bony union. Neither component migration nor acetabular osteolysis was detected. Finally three fracture and dislocation of ceramic liner developed and the fractured liners were changed other sandwich type or polyethylene liner. CONCLUSION: Even though short-term clinical result of total hip replacement arthroplasty using sandwich type acetabular component is excellent, two percent of the ceramic liner fracture incidence is unexpected high. So we have to caution with using sandwich acetabular cup. In addition, ceramic acetabular cup need more precising surgical technique.
Acetabulum ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Ceramics ; Dislocations ; Female ; Follow-Up Studies* ; Hip ; Humans ; Incidence ; Male ; Osteolysis ; Polyethylene

PURPOSE: This prospective study conducted to estimate incidence of hip fracture among persons over 50 years of age, in Jeju island, Korea during the year 2002. MATERIALS AND METHODS: Patients over 50 years of age who lived in Jeju island and sustained a femoral neck or intertrochanteric fracture during the year 2002 (from January 1st 2002 to December 31th 2002) were investigated. The information collected from the hospital records for each patient included age, sex, the nature of injury, the day of injury, location, the method of treatment, and the degree of osteoporosis. The population figures were derived from the National Statistical Office. RESULTS: There were 151 fractures of the neck or intertrochanteric region of the femur (36 in men, 115 in women) in population over 50 years of age. The incidence was 12.8/10, 000 for total patients (7.3/10, 000 for men, 16.8/10, 000 for women). The standardized incidence rate against the 1985 U.S. population was 119/100, 000 for men and 187/100, 000 population for women. The incidence rate showed seasonal variations, being highest in fall. The mean age of patients was 77.1 years (range 50 -98 years). The most common cause of injury was a simple fall (131/151, 86.8%). There were 92 (60.9%) fractures of the neck and 59 (39.1%) of the intertrochanteric fracture. One hundred twenty six patients (83.4%) showed definite osteoporosis (Singh index, Grade I-III). CONCLUSION: The incidence rate of hip fracture increased 3.8 times in 2002 data (12.8/10, 000) in Jeju island when compared with 1991 data (3.4/10, 000) in Honam area. To have more accurate trend and estimate of incidence rate of osteoporotic fractures in the elderly, further longitudinal study need to be conducted.
Aged ; Epidemiologic Studies* ; Female ; Femur ; Femur Neck ; Hip* ; Hospital Records ; Humans ; Incidence ; Korea* ; Male ; Neck ; Osteoporosis ; Osteoporotic Fractures ; Prospective Studies ; Seasons

PURPOSE: To evaluate the relationships between the apoptosis induced by nitric oxide (NO), aseptic loosening and osteolysis, which are the most serious causes of failure after total hip arthroplasty. MATERIALS AND METHODS: Apoptosis of the inflammatory cells of interface tissues from 18 patients who underwent revision hip arthroplasty was identified by Terminal Deoxyribonucleotidyl Transferase-Mediated dUTP Nick End Labeling (TUNEL). The reaction to immunostaining of inducible nitric oxide synthase (iNOS), p53, Bax, Bcl2, and Ki-67 were evaluated. Six joint capsules obtained from six patients of femoral neck fracture were studied as controls. RESULTS: Sixteen (89%) of 18 interface tissues were positive for iNOS, p53, and Bax monoclonal antibody and twelve (67%) for Bcl2 and Ki-67 monoclonal antibody. All tissues were positive for TUNEL. In the control group of six joint capsules, only one (17%) was positive for iNOS and Bax, and three (50%) were positive for TUNEL. The incidences of apoptotic signals at the interfacial tissue of aseptic loosening and osteolysis were significantly greater than those of the control. CONCLUSION: The current study suggested that the apoptosis of inflammatory cells, due to oxidative stress by NO, might be involved in the development of implant loosening and osteolysis after total hip arthroplasty. This information might be crucial for the treatment and prevention of periprosthetic osteolysis and subsequent loosening.
Apoptosis* ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Femoral Neck Fractures ; Hip* ; Humans ; In Situ Nick-End Labeling ; Incidence ; Joint Capsule ; Nitric Oxide ; Nitric Oxide Synthase Type II ; Osteolysis* ; Oxidative Stress

PURPOSE: This study was performed to determine whether abnormalities of thrombosis and fibrinolysis are associated with nontraumatic osteonecrosis of the femoral head. MATERIALS AND METHODS: A case-control study was conducted in 24 patients with nontraumatic osteonecrosis of the femoral head. These patients were matched with 24 controls for gender, age (1-year range), and time of presentation (1-year range). The study included 19 men and 5 women, and the mean age of patients and controls was 46 years (range, 16-68 years). Eight patients had idiopathic osteonecrosis and the remaining 16 patients had secondary osteonecrosis. Protein C activity, protein C antigenicity, protein S activity, protein S antigenicity, antithrombin III, anticardiolipin antibody-Ig G, anticardiolipin antibody-Ig M, lupus anticoagulant, plasminogen, tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), and lipoprotein(a) were investigated. RESULTS: Protein C antigenecity and protein S antigenecity, which have been known to decrease in osteonecrosis patients, were increased in patients compared with those of controls (P<0.05). No significant differences were found in the levels of other thrombotic or fibrinolytic factors. In a subgroup of 16 patients with secondary osteonecrosis, the level of anticardiolipin antibody immunoglobulin M was greater than in the respective controls (P<0.05). CONCLUSION: The results of the current study suggest that abnormalities in the coagulation and fibrinolytic system are not associated with the pathogenesis of osteonecrosis of the femoral head.
Antibodies, Anticardiolipin ; Antithrombin III ; Case-Control Studies ; Female ; Fibrinolysis ; Head* ; Humans ; Immunoglobulin M ; Lipoprotein(a) ; Lupus Coagulation Inhibitor ; Male ; Osteonecrosis* ; Plasminogen ; Plasminogen Activators ; Protein C ; Protein S ; Thrombophilia ; Thrombosis ; Tissue Plasminogen Activator

Mauriac syndrome consists of a triad of poorly controlled diabetes, profound growth retardation and hepatomegaly. We experienced a case of Mauriac syndrome in an 18-year-old girl who had poorly controlled diabetes mellitus, short stature, hepatomegaly and central obesity. Also at the time of examination, she had complications of diabetic cataract and nephropathy. Fourteen years prior to admission, she was diagnosed as diabetes mellitus at a hospital. Thereafter, she had been managed with irregular insulin injection. On physical examination at admission, her height was 135cm(<3 percentile) and her weight was 39kg(<3 percetile). She was short and obese. The liver was 5 cm palpable below the right subcostal margin. Her sexual maturation was Tanner stage I. On ophthalmologic examination, the cataracts were observed on both eyes and diabetic retinopathy was absent. Diabetic nephropathy could not be confirrned by kidney biopsy due to her mother's refusal. We studied the hormonal, radiographic and histological abnormalities. The hormonal study was normal and the bone age was by delayed as much as 10 years. The liver biopsy revealed glycogen accumulation in hepatocyte. She was consistent with Mauriac syndrome. She was managed by strict diabetic control with insulin therapy, diabetic diet and intensive education. She was discharged with well controlled blood glucose. Five months later, growth acceleration and sexual maturation have not been observed, but hepatomegaly subsided. (J Korean Pediatr Soc 2000;43-837-841)
Acceleration ; Adolescent ; Biopsy ; Blood Glucose ; Cataract ; Diabetes Mellitus* ; Diet, Diabetic ; Diabetic Nephropathies ; Diabetic Retinopathy ; Disulfiram ; Education ; Female ; Glycogen ; Hepatocytes ; Hepatomegaly ; Humans ; Insulin ; Kidney ; Liver ; Obesity, Abdominal ; Physical Examination ; Sexual Maturation

The neurotoxic effects of inorganic lead, a common environmental toxic substance, include peripheral neuropathy in adults and encephalopathy in children. Behavioral changes including hyperactivity, short attention span, easy distractibility and impulsiveness have also been noted in patients with chronic lead exposure in childhood. The level of norepinephrine in brain may relate to hyperactivity and chronic lead exposure. The purpose of this study was to determine the effect of inorganic lead (PbCl(2)) administration in neonatal rats using immunocytochemical and electron microscopical analysis of norepinephrinergic neurons of the locus ceruleus. Lead chloride were dissolved in distilled water at the concentration of 0.05%, 0.1% and 0.2% and the solution was administered orally via drinking water. After 4, 8 or 12 weeks of continuous administration, all rats were sacrificed and the brain was processed and immunostained with antibody against tyrosine hydroxylase, a rate limiting enzyme of norepinephrine synthesis antibody. The number of tyrosine hydroxylase immunostained cell bodies in locus ceruleus was estimated. Densitometric analysis of tyrosine hydroxylase immunoreactive profiles in electron microscopic photographs were done by using image analyzer. The number of tyrosine hydroxylase immunoreactive neurons in the locus ceruleus had increased statistically after lead administration. Density of tyrosine hydroxylase immunoreactive profiles in the electron microscopy had also increased. Degenerative changes, such as intra-axonal vacuolar space formation, were found within tyrosine hydroxylase immunoreactive axons. Somewhat widened intercellular spaces and retracted processes were also found in the region of the locus ceruleus. Increased tyrosine hydroxylase immunoreactivity may correlate with hyperreactivity of lead intoxicated children. Degenerative changes may be responsible for the short attention span, easy distractibility and impulsiveness observed in case of mild lead poisoning.
Adult ; Animals ; Axons ; Brain ; Child ; Drinking Water ; Extracellular Space ; Humans ; Immunohistochemistry ; Lead Poisoning ; Locus Coeruleus* ; Microscopy, Electron ; Neurons* ; Norepinephrine ; Peripheral Nervous System Diseases ; Rats* ; Tyrosine 3-Monooxygenase ; Water