BACKGROUND: Some diabetic feet heal without complication, but others undergo amputation due to progressive wounds. This study investigates the risk factors for amputation of diabetic feet. METHODS: A total of 55 patients who visited our institution from 2008 to 2012 were included in the study. The patients with abnormal fasting blood sugar levels, lower leg vascularity, and poor nutrition were excluded from the study group, and the wound states were unified. The patients were categorized into a treatment success group (n=47) and a treatment failure group (n=8), and their hemoglobin A1C (HgA1C), C-reactive protein (CRP), white blood cell count (WBC), and serum creatinine levels were analyzed. RESULTS: The initial CRP, WBC, and serum creatinine levels in the treatment failure group were significantly higher than that of the treatment success group, and the initial HgA1C level was significantly higher in the treatment success group. The CRP and WBC levels of both groups changed significantly as time passed, but their serum creatinine levels did not. CONCLUSIONS: The initial CRP, WBC, and serum creatinine levels were considered to be risk factors for amputation. Among them, the serum creatinine level was found to be the most important predictive risk factor. Because serum creatinine represents the renal function, thorough care is needed for the feet of diabetic patients with renal impairment.
Amputation ; Blood Glucose ; C-Reactive Protein ; Creatinine ; Diabetes Complications ; Diabetic Foot ; Fasting ; Foot ; Foot Ulcer ; Hemoglobins ; Humans ; Leg ; Leukocyte Count ; Risk Factors ; Treatment Failure ; Ulcer

Coinfection with herpes simplex virus and cytomegalovirus is a very rare cause of esophageal ulcer and upper gastrointestinal hemorrhage. A 26 year-old male kidney transplant recipient was referred with a complaint of melena. Upper gastrointestinal endoscopy showed a huge esophageal ulcer in the anastomosis site of the esophagogastrostomy. The ulcer occupied about two-thirds of the circumference of the esophageal lumen and an exposed vessel in the ulcer base was noted. Pathologic findings with immunohistochemical stain showed co-infection of herpes simplex virus and cytomegalovirus. He was treated successfully with endoscopic hemostasis and antiviral therapy. We report a case of upper gastrointestinal hemorrhage from esophageal ulcer caused by coinfection of herpes simplex virus and cytomegalovirus.
Coinfection ; Cytomegalovirus ; Endoscopy, Gastrointestinal ; Gastrointestinal Hemorrhage ; Glycosaminoglycans ; Hemostasis, Endoscopic ; Herpes Simplex ; Humans ; Immunocompromised Host ; Kidney ; Male ; Melena ; Methylmethacrylates ; Polystyrenes ; Simplexvirus ; Ulcer

Coinfection with herpes simplex virus and cytomegalovirus is a very rare cause of esophageal ulcer and upper gastrointestinal hemorrhage. A 26 year-old male kidney transplant recipient was referred with a complaint of melena. Upper gastrointestinal endoscopy showed a huge esophageal ulcer in the anastomosis site of the esophagogastrostomy. The ulcer occupied about two-thirds of the circumference of the esophageal lumen and an exposed vessel in the ulcer base was noted. Pathologic findings with immunohistochemical stain showed co-infection of herpes simplex virus and cytomegalovirus. He was treated successfully with endoscopic hemostasis and antiviral therapy. We report a case of upper gastrointestinal hemorrhage from esophageal ulcer caused by coinfection of herpes simplex virus and cytomegalovirus.
Coinfection ; Cytomegalovirus ; Endoscopy, Gastrointestinal ; Gastrointestinal Hemorrhage ; Glycosaminoglycans ; Hemostasis, Endoscopic ; Herpes Simplex ; Humans ; Immunocompromised Host ; Kidney ; Male ; Melena ; Methylmethacrylates ; Polystyrenes ; Simplexvirus ; Ulcer

The most common cause of acute pancreatitis is gallstones. However, idiopathic causes comprise about 10 to 15% of all cases of acute pancreatitis. Biliary sludge is thought to be a cause of idiopathic acute pancreatitis and mainly via obstruction of the common bile duct. Cholesterol polyps of the gallbladder, cholesterolosis and hemobilia can be associated with biliary pain. Fragments of the gallbladder polyps and blood clots can lead to acute pancreatitis in a way similar to that of biliary sludge. Yet it has never been reported that the necrotic tissue of gallbladder cancer can lead to acute pancreatitis. Herein, we report on the case of a 52-year-old man with acute pancreatitis that was caused by the necrotic tissue of gallbladder cancer. The necrotic tissue in the bile duct was revealed on endoscopic retrograde cholangiopancreatography (ERCP). The patient was successfully treated by laparoscopic cholecystectomy along with liver segmentectomy.
Bile ; Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Cholesterol ; Common Bile Duct ; Gallbladder ; Gallbladder Neoplasms ; Gallstones ; Hemobilia ; Humans ; Liver ; Mastectomy, Segmental ; Middle Aged ; Pancreatitis ; Polyps

Three external quality assesment trials which composed of 16 control materials(12 chemical materials and four sets of microscopic photograph of urinary sediment) for interlaboratory quality control assesment in urinalysis were performed with 796, 823, and 841 participants, in each, in the year of 2009. The response rate were 97.1% (796/820), 95.5% (823/862) and 97.1% (841/866), in the first, the second and the third trials, in each. The test items include pH, glucose, protein, ketone, bilirubin, blood, urobilinogen, nitrite, leukocyte estrase, specific gravity and four microscopic photographs of urinary sediment. The survey results are summarized as follows: 1. The chemical quality control test in urinalysis revealed generally good concordance. 2. The percentage of using urinalysis analyzer was slightly decreased as 82.3% and the distribution of using reagent strip was similar to the previous year. 3. The percentage of response rate of microscopic photographs of urinary sediment was 83.5% (702/841) and the percentage of good performance of these tests ware 83.6% to 99.1%.
Bilirubin ; Equidae ; Glucose ; Hydrogen-Ion Concentration ; Korea ; Leukocytes ; Quality Control ; Reagent Strips ; Specific Gravity ; Urinalysis ; Urobilinogen

OBJECTIVE: This study was performed to assess agreements among screening tests, to estimate prevalence, and to identify related factors with postpartum depression. METHODS: For 323 women at 7 days postpartum, self-administered questionnaires were given including postpartum depression screening test such as EPDS, QIDS-SR16, BDI and questionnaires for their demographic and psycho-social information. Obstetric information were collected from medical records. Simultaneous positive cases in EPDS and BDI were defined as gold standard and used to estimate the prevalence of postpartum depression and agreements between 3 kind of screening test and gold standard. Related factors of postpartum depression were analysed by using SPSS. RESULTS: The prevalence of postpartum depression was 19.8% and the Kappa indices were 0.711 in BDI, 0.803 in EPDS, and 0.395 in QIDS-SR16. Feeding method, smoking history, antenatal anxiety/depression symptoms, residence status, marital satisfaction, relationship with husband's parents, and postpartum care method in univariate analysis and premature delivery (odds ratio: 2.9), formulated feeding (odds ratio: 3.8), marital dissatisfaction (odds ratio: 4.3), professional husband's occupation (odds ratio: 4.4), and antenatal anxiety/ depression symptoms (odds ratio: 4.4) in the logistic regression analysis were significantly related to postpartum depression (P<0.05). CONCLUSIONS: Simultaneous test of BDI and EPDS was effective to evaluate postpartum depression prevalence at 1-week postpartum and highly agree with EPDS. Significant related factors were defined and further prospective community-based studies are warranted.
Depression ; Depression, Postpartum ; Feeding Methods ; Female ; Humans ; Logistic Models ; Marital Status ; Mass Screening ; Medical Records ; Occupations ; Parents ; Postnatal Care ; Postpartum Period ; Prevalence ; Surveys and Questionnaire ; Smoke ; Smoking

Three external quality assesment trials which composed of 16 control materials (12 chemical materials and four sets of microscopic photograph of urinary sediment) for interlaboratory quality control assesment in urinalysis were performed with 699, 718, and 732 participants, in each, in the year of 2008. The response rate were 95.4% (699/733), 96.6% (718/743) and 95.3% (732/767), in the first, the second and the third trials, in each. The test items include pH, glucose, protein, ketone, bilirubin, blood, urobilinogen, nitrite, leukocyte estrase, specific gravity and four microscopic photographs of urinary sediment. The survey results are summarized as follows: 1. The chemical quality control test in urinalysis revealed generally good concordance. 2. The percentage of using urinalysis analyzer was slightly decreased as 83.0% and the distribution of using reagent strip was similar to the previous year. 3. The percentage of response rate of microscopic photographs of urinary sediment was 81.3% (571/732) and the percentage of good performance of these tests ware 32.9% to 80.5%.
Bilirubin ; Equidae ; Glucose ; Hydrogen-Ion Concentration ; Korea ; Leukocytes ; Quality Control ; Reagent Strips ; Specific Gravity ; Urinalysis ; Urobilinogen

PURPOSE: The aim of this study is to compare the quality of chest compressions between cardiopulmonary resuscitation (CPR) performed by a single trained rescuer and two rescuer CPR performed by a trained rescuer and an untrained rescuer in a prolonged out-of-hospital CPR scenario. METHODS: For the phase I experiment, thirty-six emergency medical technician students (trained rescuers) were asked to perform 10 minutes of lone rescuer CPR on an instrumented manikin. For the phase II experiment, thirty-six volunteers with no previous CPR training (untrained rescuers) were recruited. Each untrained rescuer was randomly assigned to one trained rescuer. They were asked to perform 10 minutes of two rescuer CPR during the phase II experiment. RESULTS: During phase I, the percent of correct compressions diminished over time. The number of total compressions attempted for 10 minutes was increased significantly in phase II (786+/-50 versus 689+/-50 in phase I, p<0.01). However, the mean percentage of correct compressions for 10 minutes did not show a significant difference between phases (66+/-34% in phase I versus 64+/-22% in phase II). The duration of chest compression interruption was significantly reduced in phase II (3.0+/-0.4 versus 3.5+/-0.5 min in phase I, p<0.01). CONCLUSION: The quality of two rescuer CPR performed by a trained rescuer and an untrained rescuer was comparable to that of lone rescuer CPR performed by a single trained rescuer in a 10-min CPR scenario. When CPR goes on for a prolonged period, changing the person doing the chest compressions to an untrained rescuer may improve the quality of CPR.
Cardiopulmonary Resuscitation ; Emergency Medical Technicians ; Fatigue ; Humans ; Manikins ; Thorax

BACKGROUND/AIMS: Infection of pancreatic necrosis is one of the leading cause of death in patients with severe necrotizing pancreatits. Because of high mortality rate up to 50%, immediate surgical debridement including pancreatectomy is recommended. However, early surgical treatment still showed high mortality rate and better treatment strategy is required. This study was conducted to evaluate the outcomes of early intensive non-surgical treatments in patients with infected necrotizing pancreatitis. METHODS: This study was based on retrospective analysis of 71 patients with acute severe necrotizing pancreatitis (APACHE II score>or=8, or Ranson's score>or=3, and pancreatic necrosis on CT scan), who were admitted to medical center during past 16 years. Infection of pancreatic necrosis was confirmed by fine needle aspiration, and early intensive medical treatments comprised of prophylactic antibiotics coverage, fluid resuscitation, organ preserving supportive measures, and percutaneous catheter drainage were carried out. RESULTS: Among the enrolled patients, infections were suspected in 46 patients, but fine needle aspirations were done only in 32 patients. In 21 patients, infections of necrotic tissue were confirmed by bacteriology, while other 11 patients showed no evidence of bacterial growth. Of 21 patients with infected necrosis, initial surgical interventions were performed in 2 patients, while initial medical treatments were performed in 19 patients. The success rate of medical treatment group in infected necrotizing pancreatitis was 79% (15/19). The mortality rate of medical treatment group and surgical treatment group was 5% (1/19) and 50% (1/2). CONCLUSIONS: Early intensive medical treatment seems to be a good therapeutic strategy, even if the infection has developed in pancreatic necrosis. Further prospective randomized studies are required to confirm this finding.
Bacterial Infections/diagnosis/*prevention & control ; Humans ; Pancreatitis, Acute Necrotizing/complications/diagnosis/*therapy ; Retrospective Studies ; Treatment Outcome

PURPOSE: To evaluate the diagnostic ability in differentiating between ameloblastoma and odontogenic keratocyst according to the imaging modalities and observers. MATERIALS AND METHODS: We evaluated thirty-six cases of ameloblastomas and forty-seven cases of odontogenic keratocysts all histologically confirmed. Six oral and maxillofacial radiologists diagnosed the lesions by 3 methods: using panoramic radiograph, using computed tomograph (CT), and using panoramic radiograph and CT. The observers were classified by 3 groups: group 1 had experienced over 10 years in oral and maxillofacial radiologic field, group 2 had experienced for 3-4 years, and group 3 was in the process of residentship. After over 2 weeks, the observers diagnosed them by the same methods. RESULTS: The ROC curve areas except for group 3 were the highest with interpretation using panoramic radiograph and CT, followed by interpretation using CT only, and the lowest with interpretation using panoramic radiograph only. The overall difference was not found in diagnostic ability among groups in using panoramic radiograph only, but there was difference in diagnostic ability of group 1 and 2 vs 3 in using CT only, and combination panoramic radiograph and CT. CONCLUSIONS: To differentiate between ameloblastoma and odontogenic keratocyst more accurately, the experienced oral and maxillofacial radiologist should diagnose with combination of panoramic radiograph and CT.
Ameloblastoma* ; Diagnosis, Differential* ; Odontogenic Cysts* ; ROC Curve