Objectives: The aim of this study is to investigate the clinical utility of contrast-enhanced computed tomography (CECT) in patient with non-obstrcutive acute pyelonephritis (APN). Methods: From 2007 to 2013, 537 APN patients who underwent a CE-CT scan within 24 hours after hospital admission were enrolled. We divided these patients into greater (50% or greater involvment, n = 143) and lesser (less than 50% involvement, n = 394) groups based on renal parenchymal involvement in CE-CT examination. We compared clinical characteristics between two groups and analyzed the clinical value of CE-CT scan as a reliable marker for predicting clinical severity and disease course in patient with non-obstructive APN. Results: The mean estimated glomerular filtration rate was 70.6 ± 25.5 mL/min/1.73m2. Compared with patients in lesser group, the patients in greater group had lower serum albumin levels (3.5 ± 0.5 vs 3.8 ± 0.6, P < 0.01) and longer hosptal stay (10.1 ± 4.7 vs 8.8 ± 4.5, P < 0.05). In addition, acute kidney injury (AKI) (23.1% vs 11.4%, P < 0.005) and bacteremia (36.4% vs 26.8%, P = 0.02) were frequently developed in greater group, respectively. The overall incidence of AKI was 14.8% based on RIFLE criteria. In a multivariate logistic regression analysis for predciting AKI, age, presence of diabetes mellitus and the presence of renal parenchymal involvement of greater than 50% in CE-CT were significant predictors of AKI. Conclusions The CE-CT scan could be useful to predict the clinical severity and course in non-obstructive APN patients with preserved renal function.

PURPOSE: We wanted to evaluate the mechanical strength of proximal tibia as resection distance increased from the joint surface. MATERIALS AND METHODS: We obtained the CT images of twenty knee osteoarthritis patients undergoing total knee arthroplasty. The finite element models were created based on the computed tomography images. The 8-node hexahedron element was made from BIONIX(TM) (CANTIBio. Co, Suwon, Korea), which is automatic mesh generation software program. The finite element model of the proximal tibia was resected at 6 mm, 8 mm, 10 mm, 12 mm, 15 mm and 18 mm from the lateral joint surface. A 1% strain rate was applied to a model by using HyperMesh(TM) software (Altair Engineering. Inc, Seattle, USA). The ultimate stress was calculated from the finite element analysis with using ANSYS 9.0 (ANSYS. Inc, Orlando, USA). RESULTS: The mean ultimate stress was 906.84 MPa, 877.22 MPa, 895.93 Mpa, 852.70 MPa, 742.90 Mpa and 585.51 Mpa at the 6 mm, 8 mm, 10 mm, 12 mm, 15 mm and 18 mm resection levels. As compare to the 6 mm resection level, the bone strengths at 15 mm and 18 mm were decreased with statistical significance (15 mm: p=0.005, 18 mm: p=0.000). CONCLUSION: The ultimate stress was decreased as the resection distance increased from the joint surface. But within a 12 mm resection distance from the lateral condyle articular surface of the tibia, the ultimate stress was not significantly decreased (p>0.05).
Arthroplasty ; Finite Element Analysis ; Humans ; Joints ; Knee ; Osteoarthritis ; Osteoarthritis, Knee ; Sprains and Strains ; Tibia

Mild cognitive impairment (MCI) has been defined as a transitional state between normal aging and Alzheimer disease. Diffusion tensor imaging (DTI) can estimate the microstructural integrity of white matter tracts in MCI. We evaluated the microstructural changes in the white matter of MCI patients with DTI. We recruited 11 patients with MCI who met the working criteria of MCI and 11 elderly normal controls. The mean diffusivity (MD) and fractional anisotropy (FA) were measured in 26 regions of the brain with the regions of interest (ROIs) method. In the MCI patients, FA values were significantly decreased in the hippocampus, the posterior limb of the internal capsule, the splenium of corpus callosum, and in the superior and inferior longitudinal fasciculus compared to the control group. MD values were significantly increased in the hippocampus, the anterior and posterior limbs of the internal capsules, the splenium of the corpus callosum, the right frontal lobe, and in the superior and the inferior longitudinal fasciculus. Microstructural changes of several corticocortical tracts associated with cognition were identified in patients with MCI. FA and MD values of DTI may be used as novel biomarkers for the evaluation of neurodegenerative disorders.
Aged ; Aged, 80 and over ; Aging/*pathology ; Anisotropy ; Biological Markers ; Cerebral Cortex/*pathology ; Cognition Disorders/*pathology ; Diffusion Magnetic Resonance Imaging/*methods ; Female ; Humans ; Male ; Middle Aged ; Neural Pathways/*pathology ; Severity of Illness Index

PURPOSE: Today, the social requirement of medicine emphasizes the importance of medical professionalism. This forces medical educators to introduce new contents and methods into the curriculum. This study aims to offer ideas for developing the curriculum through clarifying priorities on the basic qualities of medical professionalism and evaluating the current curriculums in medical schools in South Korea. METHODS: In April 2005, 46 respondents majoring in basic medical sciences, clinical medicine, and medical humanities/social sciences completed a structured questionnaire. The questionnaire consisted of 3 categories related to: 1) the basic qualities of medical professionalism/general education courses, 2) the process of developing the qualities of humanities and social sciences in medical education, and 3) the appropriate allocation of credits for each subject to premedical and medical courses. The analysis consisted of frequency, chi-square, and multiple responses using Korean Ed, SPSS 14.0 for Windows. RESULTS: The most important basic quality is basic medical knowledge. The credits for the general education are sufficient but it's contribution is lacking (44.44%). The most lacking element in the general education courses is socio-cultural comprehension (45.65%). The knowledge of humanities and social sciences is very important in developing the basic qualities (56.52%). The important learning experiences related to these is the introspection into human beings (32.16%). Credits for medical humanities classes in premedical and medical course are noticeably insufficient (45.65, 54.35%, respectively). The appropriate program of informal curriculum for fostering the qualities is meeting with various medical specialists (44.44%, 47.83%, respectively). There is almost no difference among the major groups under (p<.05.) CONCLUSION: To assist medical students to be equipped with the basic qualities of medical professionalism, the realm of medical humanities should be made mandatory; and the general education courses need to be reformed, especially in the premedical curriculum. In particular, continuous cooperation between faculties in medicine, liberal arts, and/or social sciences need to exist with the conglomeration of these into fewer medical humanities majors in Korea.
Clinical Medicine ; Comprehension ; Curriculum ; Surveys and Questionnaires ; Education, Medical ; Foster Home Care ; Humanities ; Humans ; Korea ; Learning ; Republic of Korea ; Schools, Medical ; Social Sciences ; Specialization ; Students, Medical

PURPOSE: The purpose of this study was to estimate the operating status of existing medical education management units in medical colleges and to define the roles of these units to provide basic information to medical schools contemplating to establish similar management units. METHODS: A structured questionnaire survey was conducted via mail. The survey 41 medical colleges across the nation and was done during September 2003 and March 2005. The assessment instrument included six items assessing the organizational structure, composition, major activities, self-satisfaction with performance, administration and financial aspects and the need for further development in the medical education unit for medical colleges with a medical education management unit. There were only two items assessing demand for establishment of a medical education management unit, prerequisite conditions for establishment, the expected role of such a system for medical colleges without a medical education management unit. RESULTS: Of 41 medical colleges, 18 had a medical education management unit as of September 2003 and 32 as of March 2005. The major activities of these 18 management units included curriculum development(26.7%), faculty development(26.7%), support for PBL(16.0%) and OSCE(12.0%). Recently, these units have become involved in enhancing clinical clerkship as well as improving teaching skills. To have a medical education-related unit run smoothly, at least two tenured faculty members majoring in education and medical education were needed. And a compensation systems was required for those professors working in the unit as a second post but without pay. CONCLUSION: This study underscored the importance of professional faculty members, and administrative and financial supports in having a medical education management unit meet its objectives. The role of the dean of medical college seems crucial in deciding how the unit is operated.
Clinical Clerkship ; Compensation and Redress ; Curriculum ; Education ; Education, Medical* ; Financial Support ; Korea* ; Postal Service ; Schools, Medical ; Surveys and Questionnaires

OBJECTIVE: The aims of this study were to compare the efficacy and morbidity of optimal debulking operation with those of suboptimal operation for patients with advanced gynecologic malignancies and to establish the precluding factors for performing the optimal cytoreductive surgery. METHODS: From January 1998 to December 2003, debulking operation for advanced gynecologic malignancy was performed in thirty-nine patients with ovarian cancer (32), tubal cancer (4), and primary peritoneal carcinoma (3) at the department of obstetrics and gynecology, Ghil Medical Center. Of them, 38 patients had FIGO Stage IIIC disease and only one patient had FIGO Stage IV disease. Most informations were obtained by hospital records and were analyzed retrospectively. RESULTS: The mean follow-up was 23 months (range, 1-62 months). The optimal debulking operation could be performed in 25 patients (64.1%). In multivariate analysis, the largest diameter of residual tumor was the most important prognostic factor. Two-year overall survival rate of optimally debulked patients was 86.5% and that of suboptimally debulked patients was 41.3% (p=0.015). Two-year disease free survival rates were 75.9% and 7.1%, respectively (p=0.0003). Complication rates associated with surgery were 40% in optimally debulked patients and 35.7% in suboptimally debulked patients (p=0.083). Major causes of suboptimal surgery were old age (>69 yrs), poor medical condition (cardiac problem, intraoperative unstable vital sign, bronchiectasis), no submission of permission, and involvement of the base of mesentery and small bowel. CONCLUSION: Optimal debulking operation is possible if there were no significant clinical problem and involvement of base of mesentery and small bowel. It appears acceptable surgical morbidity and better prognosis. Therefore, the surgeon should use every technique aimed at removing the tumor as much as possible.
Disease-Free Survival ; Follow-Up Studies ; Gynecology ; Hospital Records ; Humans ; Mesentery ; Multivariate Analysis ; Neoplasm, Residual ; Obstetrics ; Ovarian Neoplasms ; Prognosis ; Retrospective Studies ; Survival Rate ; Vital Signs

BACKGROUND: The revised version of the Hasegawa Dementia Scale (HDS-R) is a useful dementia screening tool with a test for frontal lobe function and is relatively less influenced by education level and linguistic ability. We developed a Korean version of HDS-R (K-HDS) by translating the HDS-R to screen dementia patients in the Korean elderly. METHODS: The basic structure of the HDS-R was preserved but some questions were modified for lingual and cultural difference. It was administrated along with the Korean version of the MMSE, Korean Dementia Screening Questionnaire, Short form Samsung Dementia Questionnaire and Clinical Dementia Rating (CDR) scales, to 151 patients (55 Alzheimer's disease, 73 vascular dementia, 23 others) with mild to moderate dementia and to 225 elderly control subjects. To screen dementia, the optimal cut-off score was estimated by receiver operating characteristic (ROC) curve analysis. By comparing the Area Under the Curve, the diagnostic efficiency of K-HDS was compared with that of K-MMSE. RESULTS: The K-HDS had good internal consistency (Crohnbach's alpha coefficient=0.66), inter-rater reliability (r=0.95), and test-retest reliability (r=0.92). K-HDS was well correlated with the K-MMSE (r=0.84) and CDR (r=-0.67), which confirms the validity of this test. The optimal cut-off score was different according to educational level. In patients with an educational level less than 10 years, the cut-off score was 20 with the sensitivity of 87.0% and the specificity of 83%. With an educational level of 10 years or more, the cut-off score was 22 with the sensitivity of 93.0% and the specificity of 89.6%. The overall diagnostic efficiency of K-HDS was superior to that of K-MMSE especially in patients with an educational level of less than 10 years. CONCLUSIONS: The K-HDS is a reliable, valid and useful tool to screen dementia in the Korean elderly.
Aged ; Alzheimer Disease ; Dementia* ; Dementia, Vascular ; Education ; Frontal Lobe ; Humans ; Linguistics ; Mass Screening ; Surveys and Questionnaires ; Reproducibility of Results* ; ROC Curve ; Sensitivity and Specificity ; Translating ; Weights and Measures

The present report discusses four cases of chronic renal failure, which developed symptoms of parkinsonism in response to levosulpiride. The temporal relationship between levosulpiride discontinuation and the disappearance of parkinsonism suggests a causal link. In addition, decreased striatal dopamine transporter bindings assessed by [I-123] IPT SPECT were observed in two patients suggesting that a dopamine blocking agent causes the dysfunction of nigrostriatal dopaminergic neurons and that such injury may be involved in the pathogenesis of drug-induced parkinsonism.
Dopamine ; Dopamine Plasma Membrane Transport Proteins ; Dopaminergic Neurons ; Humans ; Kidney Failure, Chronic ; Parkinsonian Disorders ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: EGCG(epigallocatechin gallate), a major green tea extract, is a potent free radical scavenger which has been shown to reduce free radical-induced lipid peroxidation. The purpose of this study was to examine whether EGCG reduces focal ischemia/reperfusion-induced brain injury in rats. METHODS: Male Wistar rats were anesthetized with ketamine and xylazine and subjected to 120 min of temporary middle cerebral artery occlusion by an intraluminal nylon suture coated with poly-L-lysine. The drug (EGCG, n=8) or vehicle (normal saline, n=8) was administered iv.(as a 50 mg/kg bolus) immediately after the onset of middle cerebral artery occlusion. Neurologic status was evaluated 2 hours after occlusion and 24 hours after. Twenty-four hours after ischemia, the brain was perfusion-fixated and the infarct volume was determined. RESULTS: EGCG significantly improved the neurological status at 24 hours after middle cerebral artery occlusion.(p<0.05), and reduced total infarct volumes (p<0.01). CONCLUSIONS: These results demonstrate the neuroprotective effect of EGCG in a rat model of transient focal cerebral ischemia.
Animals ; Brain ; Brain Injuries ; Brain Ischemia ; Humans ; Infarction, Middle Cerebral Artery* ; Ischemia* ; Ketamine ; Lipid Peroxidation ; Male ; Middle Cerebral Artery* ; Models, Animal ; Neuroprotective Agents ; Nylons ; Rats ; Rats, Wistar ; Reperfusion Injury* ; Sutures ; Tea* ; Xylazine

A 49-year-old woman presented with stupor and paraplegia following an induced hypotension. The temporal relationship to the induced hypotension and the absence of a clear embolic source on diagnostic tests support a causal association between the hypotensive episode and the ischemic infarct. However, despite the association, a cause-and-effect relationship could not be automatically inferred.
Brain Infarction/*chemically induced ; Cerebrovascular Accident/*chemically induced ; Female ; Human ; Infarction/*chemically induced ; Middle Aged ; Preoperative Care/*adverse effects ; Propanolamines/*adverse effects ; Spinal Cord/*blood supply ; Spinal Stenosis/surgery