Though the 2009 worldwide influenza A (H1N1) pandemic has been declared to have ended, the influenza virus is expected to continue to circulate from some years as a seasonal influenza. A rapid antigen test (RAT) can aid in rapid diagnosis and allow for early antiviral treatment. We evaluated the clinical usefulness of RAT using SD Bioline Influenza Antigen Test(R) kit to detect the influenza virus, considering various factors. From August 1, 2009 to October 10, 2009, a total of 938 patients who visited the outpatient clinic at Korea University Guro Hospital with influenza-like illnesses were enrolled in the study. Throat or nasopharyngeal swab specimens were obtained from each of the patients. Using these specimens, we evaluated the influenza detection rate by rapid antigen test based on the real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) method. In comparison with rRT-PCR, the sensitivity and specificity of the RAT were 44.0% and 99.9%, respectively. The cyclic threshold values of RAT negative specimens were higher than RAT positive specimens (30.1+/-3.1 vs. 28.3+/-3.9, p=0.031). The sensitivity of the RAT kit was higher in patients who visited clinics within two days of symptom onset (60.4% vs. 11.1%, p=0.026). The results of this study show that the RAT cannot be recommended for general use in all patients with influenza-like illness because of its low sensitivity. The RAT may be used, only in the settings with limited diagnostic resources, for patients who visit a clinic within two days of symptom onset.
Antigens, Viral/genetics ; Humans ; Influenza A Virus, H1N1 Subtype/genetics/immunology/*isolation & purification ; Influenza, Human/*diagnosis/virology ; Reagent Kits, Diagnostic ; Reverse Transcriptase Polymerase Chain Reaction ; Sensitivity and Specificity ; Time Factors

The purpose of this was to investigate the measurement of fluence dose map for the specific patient quality assurance. The measurement of fluence map was performed using 2D matrixx detector. The absorbed dose was measured by a glass detector, Gafchromic film and ion chamber in Hybrid Optimized VMAT Phantom (HOVP). For 2D Matrixx, the results of comparison were average passing rate 85.22%+/-1.7 (RT_Target), 89.96%+/-2.15 (LT_Target) and 95.14%+/-1.18 (G4). The dose difference was 11.72%+/-0.531, -11.47%+/-0.991, 7.81%+/-0.857, -4.14%+/-0.761 at the G1, G2, G3, G4. In HOVP, the results of comparison for film were average passing rate (3%, 3 mm) 93.64%+/-3.87, 90.82%+/-0.99. We were measured an absolute dose in steep gradient area G1, G2, G3, G4 using the glass detector. The difference between the measurement and calculation are 8.3% (G1), -5.4% (G2), 6.1% (G3), 7.2% (G4). The using an Ion-chamber were an average relative dose error -1.02%+/-0.222 (Rt_target), 0.96%+/-0.294 (Lt_target). Though we need a more study using a transmission detector. However, a measurement of real-time fluence map will be predicting a dose for real-time specific patient quality assurance in volume modulated arc therapy.
Chimera ; Glass ; Humans

PURPOSE: To establish a simple grading method for the severity of an incompetent sapheno-femoral junction (SFJ) using color Doppler ultrasound in patients with lower extremity varicose veins. MATERIALS AND METHODS: 346 legs of 241 consecutive patients with varicose veins were examined (M:F = 96:145, 11-74 years, mean 50 years). The severity of SFJ and sapheno-popliteal (SPJ) incompetence was graded from I to IV according to the patient's position (standing versus supine or prone) and whether the Valsalva's maneuver had been induced. The extent of varicose veins was graded as I to III by the US findings in the SFJ incompetence group. The grading of SFJ incompetence was compared to the extent of varicose vein. RESULTS: SFJ, SPJ, both SFJ and SPJ, and perforator incompetence was observed in 198 (57.2%), 81 (23.4%), 21 (6.1%) and 54 (15.6%), respectively. Among the SFJ incompetence group, severity grade I - IV were observed in 14 (7.1%), 75 (37.9%), 73 (36.9%), and 36 (18.2%), respectively, and the extent grade I - III were noted in 47 (23.7%), 95 (48.0%), and 56 (28.3%), respectively. The SFJ incompetence grade and varicose extent grade showed a positive correlation (p < 0.0001). CONCLUSION: Simple sonographic grading of the severity of SFJ incompetence is possible. The extent of varicose veins in the SFJ incompetence group can be determined using this new grading system.
Humans ; Leg ; Lower Extremity ; Ultrasonography, Doppler, Color ; Valsalva Maneuver ; Varicose Veins

BACKGROUND: CD4(+)CD25(high+)regulatory T cells (Tregs) are considered to be of vital importance for maintaining immunologic self-tolerance and preventing autoimmune diseases. These cells have been found to be deficient in skin lesions and in the peripheral blood of patients with psoriasis. OBJECTIVE: To investigate the role of Tregs in the pathogenesis of psoriasis and to evaluate the changes in Tregs in relation to the severity and the clinical course of psoriasis. METHODS: Immunohistochemistry (CD3, 4, 8, 79 and FOXP3) was performed in 22 psoriatic patients compared to 5 normal controls. Flow cytometry (CD3, 4, 8, 25 and FOXP3) was performed in 18 psoriatic patients and 8 normal volunteers and reverse transcriptase polymerase chain reaction (foxp3 mRNA) was performed in 8 psoriasis patients. RESULTS: An increase in the FOXP3(+) cell fraction was detected in the lesional psoriatic skin irrespective of the severity of psoriasis as compared with the normal skin. However, a decrease in FOXP3(+) cells was observed in the samples obtained from psoriasis of 'acute course'. FOXP3(+) Treg populations in the blood of the 'acute course' psoriasis was not different compared to that of 'chronic course' psoriasis and normal controls. CONCLUSION: The deficiency of FOXP3(+) Tregs in the lesional psoriatic skin might be responsible for the exacerbation of psoriasis.
Autoimmune Diseases ; Flow Cytometry ; Humans ; Immunohistochemistry ; Psoriasis ; Reverse Transcriptase Polymerase Chain Reaction ; Skin ; T-Lymphocytes ; T-Lymphocytes, Regulatory

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

The CT number corresponds to electron density and its influence on dose calculation was studied. Five kinds of CT scanners were used to obtain images of electron density calibration phantom (Gammex RMI 467). Then the differences between CT numbers for each scanners were +/-2% in homogeneous medium and 9.5% in high density medium. In order to investigate the influence of CT number to dose calculation, patients' thoracic CT images were analyzed. The maximum dose difference was 0.48% for each organ. It acquired the phantom images inserted high density material in the water phantom. Comparing the doses calculated with CT images from each CT scanner, the maximum dose difference was 2.1% in 20 cm in depth. The exact density to CT number conversion according to CT scanner is required to minimize the uncertainty of dose depends on CT number. Especially the each hospital with various CT scanners has to discriminate CT numbers for each CT scanner. Moreover a periodic quality assurance is required for reproducibility of CT number.
Calibration ; Uncertainty ; Water

While some fluoroquinolone antibiotics can cause QT prolongation and Torsades de Pointes (TdP), serious proarrhythmic effects from ofloxacin have not been reported. Here, we report a case of ofloxacin-induced Torsades de Pointes with abnormal ECG changes, mimicking acute myocardial infarction. A 68-year-old man developed syncope following hospital admission for the treatment of pulmonary tuberculosis. TdP and marked QT prolongation (QT=0.44 sec, QTc=0.62 sec) were noted, with no remarkable serum electrolyte abnormality. The QT prolongation was followed by ST segment elevation, mimicking acute myocardial infarction. After discontinuation of ofloxacin, the QT interval shortened to 0.336 sec (QTc=0.481 sec), with no recurrence of TdP, although the QT interval remained mildly elevated during the hospital course. From this case, we propose that care should be taken in the use of ofloxacin, especially in patients susceptible to TdP.
Aged ; Anti-Bacterial Agents ; Electrocardiography* ; Humans ; Myocardial Infarction* ; Ofloxacin ; Recurrence ; Syncope ; Torsades de Pointes* ; Tuberculosis, Pulmonary

BACKGROUND: Recent reports suggest that Epstein-Barr virus (EBV) may play an important role in such a wide spectrum of human neoplasia. Recently, peripheral T cell lymphomas and particularly, angiocentric lymphomas (ACL), increasingly are reported to be associated with EBV.Nasal-type and nasal T/NK cell lymphoma (TNKL) have recently been reported to comprise most of ACLs. The prognosis of these tumors has been extremely poor. OBJECTIVE: The purpose of this study was to investigate EBV association in primary or secondary cutaneous T-cell lymphoproliferative disorders and to identify any prognostic association. METHODS: Thirty six patients with primary or secondary cutaneous T-cell lymphoproliferative (CTCL) disorders were examined to evaluate the presence of Epstein-Barr virus using in situ hybridization for EBV-encoded RNA (EBER). RESULTS: EBER was detected in tumor cells in one third of the total cases (13/36); 4/4 secondary skin lymphoma from nasal TNKL, 8/8 primary cutaneous nasal type TNKLs and 1/5 mycosis fungoides (MF).EBER was not detected in the following disease: 6 cases of anaplastic large cell lymphomas (ALCL) including 2 cases of probable NK-like T cell lineage, 3 lymphomatoid papulosis, 2 CD56 (-) T cell ACLs and 7 subcutaneous panniculitic T-cell lymphomas (SPTL) by Revised European-American Lymphoma (REAL) classification and recent concept of further classification into NK-cell lineage. One case of T-cell pseudolymphoma as a negative control was also negative in EBER. CONCLUSION: High incidence of EBV was observed in primary or secondary CTCLs in Koreans, with predilection for nasal and nasal type TNKL. In MFs, an erythrodermic MF with fatal outcome was associated with EBV and the EBV detection might reflect worse prognosis in MFs as seen in an aggressive course of nasal and nasal type TNKLs.
Cell Lineage ; Classification ; Fatal Outcome ; Herpesvirus 4, Human* ; Humans ; In Situ Hybridization ; Incidence ; Lymphoma ; Lymphoma, Large-Cell, Anaplastic ; Lymphoma, T-Cell ; Lymphoma, T-Cell, Peripheral ; Lymphomatoid Papulosis ; Lymphoproliferative Disorders* ; Mycosis Fungoides ; Prognosis ; Pseudolymphoma ; RNA* ; Skin ; T-Lymphocytes*

BACKGROUNDS: There are recently increasing reported cases of patients with malignant lymphoma with unique characteristics, designated nasal-type T/natural killer (NK) cell lymphoma (NKTL), which usually expresses the NK cell marker and shows frequent extra-nodal involvement including skin and poor prognosis. The CD56+ NKTL can be divided into nasal and non-nasal types. Nasal and non-nasal (nasal type) CD56+ NKTL share the same pathologic features such as angiocentricity and necrosis. OBJECTIVE: We have studied clinicopathologic features of 5 cases of nasal CD56+ NKTL with cutaneous involvement to further elucidate the behaviour of nasal CD56+ NKTL. RESULTS: Clinically, the cutaneous lesions were variable. Four of the five cases died with rapidly progressive disease within 25 months. Histologically, variable sized pleomorphic lymphoid cells with or without prominent angiodestruction were observed. Severe necrosis was consistent features. The results of immunophenotypes(both CD56+ and CD3+) and TCR gene rearrangement study showed these 5 cases are of NK cell origin(4 cases) or NK-like T-cell origin (1 case). A firm association with Epstein-Barr virus (EBV) infection was confirmed in our study. CONCLUSION: Although the prognosis of nasal CD56+ NKTL was not so bad, higher stage of nasal CD56+ NKTL with cutaneous metastasis seemed to be very fatal. The term NKTL has to be further specified according to immunophenotypes such as CD56+ or true T-cell, NK-like T cell lymphoma since biologic behaviour of each subgroup can be different.
Genes, T-Cell Receptor ; Herpesvirus 4, Human ; Humans ; Killer Cells, Natural ; Lymphocytes ; Lymphoma* ; Lymphoma, T-Cell ; Necrosis ; Neoplasm Metastasis ; Prognosis ; Skin ; T-Lymphocytes

To investigate diagnostic value of Thallium 201(T1-201) thymid scan in differentiating malignant nodule from benign, 135 patients with thyroid nodule were evaluated with Tl-201 thyroid scan, fine needle aspiration(FNA), clinical characteristics and laboratory data. Each had histological diagnosis after thyroidectomy. Tl-201 scan had a sensitivity of 67.3% and a specificity of 66.3% and FNA had sermitivity of 46.9% and specificity of 100% in predicting malignancy. As the size of thyroid nodule and age of patient incteases, diagnostic value of 11-201 thyroid scan was improved. In the thyroid nodules larger then 3cm, sensitivity, specificity and negative predictive value were 100%, 70% and 100%, reqectively. By cornbining Tl-201 throid scan and FNA, sensitivity had 91.8%. From the data we conclude that Tl-201 thyroid scan is valuable with adjuvant diagnostic method in differentiating malignant fmm benign thyroid nodule and treatment planning.
Diagnosis ; Humans ; Methods ; Needles ; Sensitivity and Specificity ; Thallium ; Thyroid Gland ; Thyroid Nodule ; Thyroidectomy