Ischiofemoral impingement (IFI) syndrome is an uncommon cause of gluteal and hip pain. We report on a case of a 20-year-old man who presented with chronic gluteal and hip pain with low back pain without a history of trauma or surgery. He was misdiagnosed with ankylosing spondylitis (AS) at another clinic. The patient was finally diagnosed with IFI syndrome according to pelvic magnetic resonance imaging findings at our hospital. After two weeks of medical and physical treatment, his pain showed gradual improvement. Because IFI syndrome is rarely reported in male patients, it might be misdiagnosed as AS. Therefore, IFI syndrome should be considered as a differential diagnosis of AS, particularly in young male patients with atypical pain characteristics.
Diagnosis, Differential* ; Hip ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Male ; Spondylitis, Ankylosing* ; Young Adult

PURPOSE: This study identifies the relation among the essentials of fundamental nursing skills performance (EFNSP), work capability and stress from work experienced by new clinical nurses. METHOD: This is a cross-sectional descriptive study with a self-reported questionnaire. The subjects were 224 new clinical nurses employed by general hospitals having more than 400 beds. The data, collected from February 10 to March 7, 2014, were analyzed using descriptive statistics, t-tests, ANCOVA, Pearson's correlation analysis and hierarchical linear regression. RESULTS: The highest frequency of EFNSP of new clinical nurses was vital sign measurement (4.74, +/-.89) and the lowest frequency of performance was Basic CPR & defibrillator application (1.81, +/-.94). There were significant positive correlations between frequency and confidence of EFNSP (r=.64, p<.001), frequency and work capability (r=.34, p<.001), and confidence of EFNSP and work capability (r=.48, p<.001), but negative correlation stress from work and work capability (r=-.17, p=.009). General characteristics, stress from work, frequency and confidence in EFNSP and stress from work explain 25.1% of work capability. CONCLUSION: This result suggests the importance of EFNSP education in nursing schools and availability of opportunities to practice EFNSP during the post-graduation waiting period until assignment to a hospital.
Cardiopulmonary Resuscitation ; Defibrillators ; Education ; Hospitals, General ; Linear Models ; Nursing* ; Surveys and Questionnaires ; Schools, Nursing ; Vital Signs

Klinefelter's syndrome which is characterized by hypogonadism with karyotype abnormality (47 XXY or 46 XY/47 XXY) in males has been reported to be associated with autoimmune diseases including rheumatoid arthritis and systemic lupus erythematosus. However, Klinefelter's syndrome accompanying with polymyositis has rarely been reported. We report a case of KFS with polymyosits in a 38-year old man for the first time in Korea.
Arthritis, Rheumatoid ; Autoimmune Diseases ; Humans ; Hypogonadism ; Karyotype ; Klinefelter Syndrome ; Korea ; Lupus Erythematosus, Systemic ; Male ; Polymyositis

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

BACKGROUND: Rifampin reduces the blood levels of cyclosporin (CsA) and steroids by increasing the activity of hepatic cytochrome P450 system and the inclusion of rifampin in the anti-tuberculosis treatment protocol increases the risk of acute allograft rejection and mortality due to its interaction with cyclosporine. We report the successful treatment outcome of post-renal transplant tuberculosis patients who were treated with quinolone substituted for rifampin in anti-tuberculosis regimen. METHODS: This was a retrospective study of 14 patients with tuberculosis diagnosed among 218 transplant recipients from Feb. 1988 through Dec. 2003 at Daejeon St. Mary's hospital of catholic university of Korea and 6 patients with tuberculosis who underwent transplantation in other hospital and followed up in our hospital. RESULTS: The incidence of post-renal transplant tuberculosis was 6.4%. The mean time to diagnosis of tuberculosis after transplantation was 58.6 months (3.3~180.7). 9 were pulmonary and 11 were extrapulmonary tuberculosis. The graft failure was not occurred in quinolone group (0/15) and 2 of 3 in rifampin group. The serum creatinine levels before tuberculosis were not different to that of post-treatment in quinolone group. (P=0.58) The CsA levels before tuberculosis were not also different to that of posttreatment in quinolone group (P=0.68). CONCLUSIONS: The treatment of post-renal transplant tuberculosis with rifampin sparing anti-tuberculosis regimen was successful. Rifampin, although a mainstay drug in the treatment of tuberculosis, can be avoided in patients receiving cyclosporine, thus avoiding the risk of precipitating allograft rejection.
Clinical Protocols ; Creatinine ; Cyclosporine ; Cytochrome P-450 Enzyme System ; Humans ; Incidence ; Korea ; Rejection (Psychology) ; Retrospective Studies ; Rifampin ; Steroids ; Transplantation, Homologous ; Transplants ; Treatment Outcome ; Tuberculosis

BACKGROUND: The aim of this study was to investigate the prevalence, clinical and laboratory findings of hereditary hemolytic anemia (HHA) in Korea from 1997 to 2006 and to develop the appropriate diagnostic approach for HHA. METHODS: By the use of questionnaires, information on the clinical and laboratory findings ofHHA diagnosed from 1997 to 2006 in Korea was collected and analyzed retrospectively. A total of 431 cases were enrolled in this study from 46 departments of 35 hospitals. RESULTS: The overall frequency of HHA did not change through the 10-year period for pediatrics but did show an increasing tendency for internal medicine. The overall male to female sex ratio did not show sex predominance (1.17:1), but a significant male predominance with a ratio of 1.49:1 was seen for pediatrics while a significant female predominance with a ratio of 1:1.97 was seen forinternal medicine. Of the total cases, 74.2% (282/431) were diagnosed before the age of 15 years. The etiologies of HHA were classified as red cell membrane defects, hemoglobinopathies, red cell enzyme deficiencies and unknown causes. There were 382 cases (88.6%) of red cell membrane defects with 376 cases (87.2%) of hereditary spherocytosis and 6 cases (1.4%) of hereditary elliptocytosis, 20 cases (4.6%) of hemoglobinopathies with 18 cases (4.2%) of beta-thalassemia, a case (0.2%) of alpha-thalassemia and a case (0.2%) of Hemoglobin Madrid, 7 cases (1.6%) of red cell enzyme deficiencies with 5 cases (1.2%) of glucose-6- phosphate dehydrogenase (G-6-PD) deficiency, a case (0.2%) of pyruvate kinase (PK) deficiency and a case (0.2%) of enolase deficiency, and 22 cases (5.1%) of unknown causes. The most common chief complaint in pediatric patients was pallor and that in adult patients was jaundice. In the red cell membrane defect group of patients, the level of hemoglobin was significantly higher than in adult patients. The mean corpuscular volume, mean corpuscular hemoglobin, corrected reticulocyte count, total and indirect bilirubin level and lactate dehydrogenase levels in the hemoglobinopathy group of patients were significantly lower than the values in the red cell membrane defect group of patients. The mean concentration of G-6-PD was 0.8+/-0.7U/1012RBC in the G-6-PD deficient patients, PK was 1.7U/1010 RBC in the PK deficient patient, and the level of enolase was 0.04U/g of Hb in the enolase deficient patient. CONCLUSION: The most prevalent cause of HHA in Korea during 1997 to 2006 was hereditary spherocytosis, but HHA by other causes such as hemoglobinopathy and red cell enzyme deficiency gradually increased with the development of molecular diagnostic methods and increasing general interest. However, the etiologies of HHA need to be pursued further in 5.1% of the patients. An systematic standard diagnostic approach is needed in a nationwide prospective study for correct diagnoses and appropriate management of HHA.
Adult ; alpha-Thalassemia ; Anemia, Hemolytic, Congenital* ; beta-Thalassemia ; Bilirubin ; Cell Membrane ; Diagnosis ; Elliptocytosis, Hereditary ; Erythrocyte Indices ; Female ; Hemoglobinopathies ; Humans ; Internal Medicine ; Jaundice ; Korea* ; L-Lactate Dehydrogenase ; Male ; Oxidoreductases ; Pallor ; Pathology, Molecular ; Pediatrics ; Phosphopyruvate Hydratase ; Prevalence ; Pyruvate Kinase ; Reticulocyte Count ; Retrospective Studies* ; Sex Ratio ; Surveys and Questionnaires

BACKGROUND:Immunosuppressive therapy after renal transplantation stimulates the replication of hepatitis B virus (HBV) and may lead to increased liver-related mortality. We investigated the effectiveness of lamivudine for the treatment of HBV reactivation in renal transplant recipients. METHODS:We reviewed the clinical course of 16 HBsAg-positive renal transplant patients (M:F=13:3) treated with lamivudine for chronic hepatitis B. The outcome of prophylactic (HBV-DNA negative, n=5) and preemptive (HBV-DNA positive, n=4) therapy without hepatic dysfunction was analyzed in compared with that of salvage (n=7) therapy for post-transplantation hepatic dysfunction. RESULTS:Chronic hepatitis developed in four (25 %) of the enrolled 16 recipients, including one fulminant hepatic failure in prophylactic group and one hepatocellular carcinoma in the salvage group. We found that three (33%) of 9 patients under prophylactic and preemptive therapy showed post-transplantation hepatic dysfunction, but that only one (14%) of 7 patients showed elevated liver enzyme after salvage therapy. During a mean follow-up, under prophylactic and preemptive therapy, of 38 months, five (56%) of 9 patients showed resistance to lamivudine. In seven patients under salvage therapy for a mean follow-up of 26 months, only one patient (14%) showed resistance. At the last follow-up, liver enzyme levels were normal in 14 patients (87.5%). CONCLUSION:It may be beneficial to use lamivudine for the prevention of liver-related mortality in renal transplant recipients with HBs-Ag positivity. Prophylactic and preemptive lamivudine therapy tend to show higher viral resistance compared with salvage therapy.
Carcinoma, Hepatocellular ; Follow-Up Studies ; Hepatitis ; Hepatitis B virus ; Hepatitis B, Chronic ; Humans ; Kidney Transplantation ; Lamivudine* ; Liver ; Liver Failure, Acute ; Mortality ; Salvage Therapy ; Transplantation*

BACKGROUND: It is well known that ischemia/reperfusion (I/R) injury enhances immunogenicity. But, its influence on innate immunity is still undetermined. This study was performed to evaluate whether I/R injury activates innate immunity in rat kidneys. METHODS: Sprague-Dawley rats were used. Ischemic injury was induced by clamping both renal arteries for 45 minutes. Sham operation was performed in a similar manner, except clamping the renal vessels. Rats were sacrificed on day 1, 3, 5, and 7 after I/R injury. Activation of innate immunity was evaluated in terms of toll-like receptor (TLR), dendritic cells and MHC class II antigen. TLR2 mRNA expression was detected by RT-PCR, and in situ hybridization. Dendritic cells and MHC class II antigens were detected with OX62 and OX6 monoclonal antibodies by immunohistochemistry. RESULTS: TLR2 mRNA was significantly increased in on day 3 and 5 after I/R injury (1 d: 120+/-2%, 3 d: 137+/-5%, 5 d: 173+/-5% 7 d: 120+/-8% vs. 100+/-11%, p<0.05 vs. sham), and in situ hybridization signal was observed on proximal, distal tubules, and interstitial cells. Compared to the sham-operated rat kidneys, number of dendritic cells significantly increased from day 1 to day 7 after I/R injury (1 d: 22.9+/-2.4, 3 d: 25.8+/-4.9, 5 d: 26.5+/-2.3, 7 d: 24.3+/-1.6 vs. 13.3+/-1.1, p<0.05 vs. sham) with peak value at day 5. Increased expression of MHC class II antigen was observed in the proximal tubules and interstitial cells in I/R injured rat kidney and there was maximal MHC class II protein level on day 3 after I/R injury. CONCLUSION: Ischemia-reperfusion injury itself can activate innate immunity on early period after injury.
Animals ; Antibodies, Monoclonal ; Constriction ; Dendritic Cells* ; Histocompatibility Antigens Class II ; Immunity, Innate ; Immunohistochemistry ; In Situ Hybridization ; Kidney* ; Rats* ; Rats, Sprague-Dawley ; Renal Artery ; Reperfusion Injury* ; RNA, Messenger ; Toll-Like Receptors

BACKGROUND: Darbepoetin alfa is a new erythropoietic agent with a three fold longer terminal half-life than recombinant human erythropoietin (r- HuEPO). The aim of this randomized, open-label study is to determine whether darbepoetin alfa is as effective as r-HuEPO for the treatment of anemia in hemodialysis patients when administered at a reduced dosing frequency. METHODS: A total 74 Korean hemodialysis patients receiving r-HuEPO therapy by either the intravenous (IV) or subcutaneous (SC) route were randomized to continue r-HuEPO or to receive an equivalent dose of darbepoetin alfa at a reduced dosing frequency. Patients receiving r-HuEPO once weekly changed to once every other week darbepoetin alfa, and those receiving r-HuEPO two or three times weekly changed to once-weekly darbepoetin alfa. The initial dose of darbepoetin alfa was based on the r-HuEPO dose at the time of entry into the study, using a formula equating the peptide mass of the two molecules (200 IU r-HuEPO=1 microgram darbepoetin alfa). The doses of r-HuEPO and darbepoetin alfa were titrated to maintain hemoglobin concentrations within -1.0 to +1.5 g/dL of patients' baseline values and within a range of 8.0 to 13.0 g/ dL for up to 20 weeks (16-week dose-titration period followed by a 4-week evaluation period). The primary end point was change in hemoglobin level between baseline and the evaluation period. RESULTS: The mean change in hemoglobin from baseline to the evaluation period was similar in the darbepoetin alfa (-0.03+/-0.19 g/dL) and r-HuEPO (0.27+/-0.20 g/dL) groups, and the difference between the two treatments was -0.30 g/dL (95% CI, -0.84 to 0.23). This was not a statistically significant or clinically relevant difference, despite the reduced frequency of darbepoetin alfa administration. The safety profiles of darbepoetin alfa and r-HuEPO were similar. CONCLUSION: This study suggests that darbepoetin alfa maintains hemoglobin as effectively as r- HuEPO, but with reduced dose frequency.
Anemia* ; Erythropoietin ; Half-Life ; Hemoglobin A ; Humans ; Renal Dialysis* ; Darbepoetin alfa

BACKGROUND: On-line hemodiafiltration (HDF) is a novel extracorporeal renal replacement therapy to increase the removal of middle molecules by convection and diffusion. This study was aimed to investigate the clinical benefit of on-line HDF. METHODS: Fifteen stable chronic renal failure patients who were maintaining on low-flux hemodialysis (HD) were switched to on-line HDF for 4 months. Blood pressure, solute clearance rate, anemia, nutrition, cardiac function, inflammatory markers, brain natriuretic peptide and subjective symptoms were compared. RESULTS: In the patients treated with HDF swiching from HD, the episode of intradialytic symptomatic hypotension was significantly decreased. In addition, KT/Vurea and urea reduction ratio as well as beta2-microglobulin clearance rate and reduction ratio were significantly increased, HDF treatment also decreased the pre-dialysis phosphorus levels and daily requirement of calcium carbonate. Furthermore, HDF treatment contributed to the reduction of erythropoietin dose to maintain similar hematocrit levels. Patients' dry weight was increased during HDF treatment without any change of serum albumin and nPCR levels. HDF treatment increased brain natriuretic peptide reduction ratio and improved subjective symptoms such as itching, headache, cramp and insomnia. Inflammatory markers such as hsCRP, IL-1beta, IL-6 and TNF-alpha were not changed by HDF treatment. CONCLUSION: Compared to conventional HD, on-line HDF may offer additional benefits with improved cardiovascular stability, enhanced middle molecule clearance, improvement of anemia and good control of subjective symptoms.
Anemia ; Blood Pressure ; Calcium Carbonate ; Convection ; Diffusion ; Erythropoietin ; Headache ; Hematocrit ; Hemodiafiltration* ; Humans ; Hypotension ; Inflammation ; Interleukin-6 ; Kidney Failure, Chronic* ; Muscle Cramp ; Natriuretic Peptide, Brain ; Phosphorus ; Pruritus ; Renal Dialysis ; Renal Replacement Therapy ; Serum Albumin ; Sleep Initiation and Maintenance Disorders ; Tumor Necrosis Factor-alpha ; Urea