• Tuberculosis and Respiratory Diseases
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• v.43 no.1
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• pp.69-74
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• 1996

Background: The diagnosis of pulmonary embolism (PE) based on clinical findings is often elusive and therefore requires confirmative diagnostic method. Pulmonary angiography, though the gold standard for the diagnosis of pulmonary embolism, is an invasive method and requires trained personnel and special equipment. Lung V/Q scan, on the other hand, is a noninvasive method but the diagnostic specificity and sensitivity arc not satisfactory in case that the results are either intermediate or low probability scan. Plasma D-dimer is generated when a thrombus is fibrinolysed by plasmin and is known to be increased in various thrombotic disorders. The aim of this study was to investigate the value of the determination of plasma D-dimer level in the diagnosis of pulmonary embolism. Methods: Pulmonary angiography was performed in 17 patients who were clinically suspected to have pulmonary embolism. 9 patients(PE, $56{\pm}13.4$ yrs, M:F=8:1) were diagnosed to have pulmonary embolism by pulmonary angiography. The control group were the 8 patients with negative pulmonary angiography and 13 orthopedic patients with no evidence of pulmonary embolism on scintigraphic and impedance plethysmographic studies(n=21) (non-PE, $54.5{\pm}11.1$ yrs, M:F=11:10). Plasma D-dimer was measured by latex agglutination method in study subjects and the results were analyzed according to the presence or absence of pulmonary embolism. Results: 1) The increased level of plasma D-dimer was more frequently observed in the patients with pulmonary embolism than in the controls(>0.5 mg/L, 8 in PE, 10 in non-PE; <0.5 mg/L, 1 in PE, 11 in non-PE, p=0.049). 2) The diagnostic value of plasma D-dimer level higher than 0.5 mg/L were as follows: sensitivity 88.9%(8/9), specificity 52.4%(11/21), positive predictive value 44.4%(8/18), and negative predictive value 91.7%(11/12). Conclusion: Plasma D-dimer determination showed high sensitivity and negative predictive value in the diagnosis of pulmonary embolism and is therefore thought to be useful in excluding the possibility of pulmonary embolism.

• Clinical and Experimental Pediatrics
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• v.46 no.9
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• pp.883-888
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• 2003

Purpose : The etiology of hemolytic anemia can be classified as either cellular or extracellular defects of red blood cells. The aim of this study was to investigate the clinical and laboratory findings of hemolytic anemia concerning its etiological classification. Methods : Clinical and laboratory findings of the patients with hemolytic anemia treated from January 1987 to May 2002 at Severance Hospital were analyzed retrospectively. They were divided into two groups based on the types of red cell defects(group I : erythrocytic defect, group II : extraerythrocytic defect). Results : Twenty one cases were included in group I, thirty four cases in group II, and three cases were unclassified. In group I, nineteen cases(90.5%) were diagnosed as hereditary spherocytosis and were proved to have red cell membrane disorders while two cases(9.5%) were shown to have red cell enzyme deficiencies. In group II, thirteen cases(38.2%) were noted as autoimmune hemolytic anemia, eleven cases(32.4%) as traumatic or microangiopathic hemolytic anemia, four cases(11.8%) as drug induced hemolytic anemia, two cases(5.9%) were related with systemic lupus erythematosus and one case(2.9%) with malignancy. Hemoglobin at the time of diagnosis(7.5 g/dL vs. 6.2 g/dL, P<0.05) and the incidence of splenomegaly(85.7% vs. 18.2%, P<0.05) were higher in group I though blood urea nitrogen(9.0/0.4 mg/dL vs. 27.8/1.6 mg/dL, P<0.05) was higher in group II. Conclusion : Comparing the clinical features of pediatric hemolytic anemia, we concluded as following : In cases associated with extraerythrocytic defect, blood tests revealed significant initial lower hematocrit with higher level of BUN and Cr while cases with erythrocytic defect, splenomegaly were more common noted.

• Clinical and Experimental Pediatrics
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• v.50 no.12
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• pp.1231-1240
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• 2007

Purpose : Bartter syndrome is a renal tubular defect in electrolyte transport characterized by hypokalemia, metabolic alkalosis and other clinical signs and symptoms. The aims of this study were to analyze the clinical manifestations and the short- and long-term outcomes of Bartter syndrome. Methods : We retrospectively reviewed clinical history, laboratory finding of blood and urine, renal ultrasonography, and hearing tests of five patients who were diagnosed and managed with Bartter syndrome at Asan Medical Center from April 1992 to May 2007. We also evaluated height and body weight periodically after institution of therapy. Results : All patients had poor oral intake, failure to thrive and polyuria. Three of them had maternal history of polyhydramnios and premature delivery. The mean age at diagnosis was 11.8 months. All children presented with hypokalemia, metabolic alkalosis, hyperreninemia. Their blood pressures were normal. One patient had nephrocalcinosis on renal ultrasonography and all of them had normal result in hearing tests. After treatment with indomethacin or other prostaglandin inhibitors and potassium supplementation,their clinical features improved with catch-up growth and improvement in the development during long-term follow-up. Conclusion : We emphasize that early diagnosis and proper treatment in patient with Bartter syndrome are related to better prognosis.

• Korean Journal of Psychosomatic Medicine
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• v.28 no.1
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• pp.81-88
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• 2020

Objectives : This study aimed to compare autonomic nervous system (ANS) dysregulation and differential relationships with clinical severities between anxiety disorder, depressive disorder, and trauma·stressor related disorder using heart rate variability (HRV) parameters. Methods : We conducted a retrospective chart review of outpatients from 2017 to 2018 in Stress Clinic of National Center for Mental Health. Total 473 patients were included; 166 anxiety disorder; 184 depressive disorder ; 123 trauma·stressor related disorder. Parameters of 5-min analysis of HRV were compared in three groups. Additionally, we investigated the differential association of each parameters with Clinical Global Impression-Severity Scale (CGI-S) across each group. Results : No significant differences were found in all HRV parameters between the three groups. However, significant group interactions by CGI-S were found in standard deviation of all RR intervals (SDNN) and the square root of the mean squared differences of successive normal-to-normal intervals (RMSSD) (SDNN, p=0.017 ; RMSSD, p=0.034). A negative relationship between CGI-S and SDNN, RMSSD has been found in anxiety disorder and depressive disorder. However, a positive relationship between CGI-S and SDNN, RMSSD has been found in trauma·stressor related disorder. Conclusions : Despite of no significant differences of each HRV parameter, our findings suggested the differential associations of HRV parameters with clinical severity among anxiety disorder, depressive disorder and trauma·stressor related disorder. In trauma·stressor related disorder, the clinical severity and degree of ANS dysregulation may differ, so more aggressive treatment is suggested.

• Journal of the Korean Arthroscopy Society
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• v.3 no.2
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• pp.109-114
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• 1999

Purpose : The importance of meniscal repair is well recognized. But transeciton of the posterior horn of the medial meniscus at the posterior tibial attachment is rarely documented and known irreparable. We experienced 9 cases of transection, and present clinical features and pull out suture technique. Methods and Materials : There were 9cases of transection of the posterior horn of medial meniscus from September 1998 to July 1999 in our hospital. Age was 59.3 years in average and ranged from 38 to 70years. Clinical features and MRI made diagnosis in all cases. We confirmed the diagnosis with arthroscopy and repaired the transection with pullout suture technique. Clinical features : Transection of the posterior horn of the medial meniscus at the posterior tibia attachment occurred frequently in middle aged people. They complained posterior knee pain, but they have no history of definitive trauma. Characteristically they had difficulty in full flexion of the knee and in having a squatting position. MRI is very important in diagnosis of transection, especially in coronal view, there is separation of the posterior horn of the meniscus from the posterior tibial attachment. Surgical technique : Pullout suture technique includes debridement of fibrous or scar tissue, exposure of the subchondral bone of the posterior tibial attachment site, suture the transected end of the meniscus with PDS suture, bone tunnel formation from the anteromedial aspect of the proximal tibia, insertion of wire loop through the tibia tunnel, pull the PDS suture through the tibia tunnel out of the joint and stabilize the PDS with post-tie technique to the proximal tibia. Conclusion : Transection of the posterior horn of the medial meniscus at the posterior tibial attachment is not common clinically and rarely documented. Clinical features and MRI are very important in diagnosis of this type tear. Arthroscopic pullout sutures is useful for treatment of this type tear of the meniscus.

• Korean Journal of Clinical Laboratory Science
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• v.48 no.4
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• pp.401-410
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• 2016

Since the late 19th century, scientific logic and techniques have been used extensively in the field of clinical pathology, including many laboratory tests utilizing various apparatuses and instruments. Among the techniques to measure hemoglobin, the visual color comparison method was most popular around this time; the specific gravity method and gasometric method were not widely adopted. Instruments that use the visual color comparison method include Gowers' hemoglobinometer, von Fleischl's hemoglobinometer, Dare's hemoglobinometer, Oliver's hemoglobinometer, Haden-Hausser hemoglobinometer, and Spencer Hb meter. Initially, the visual color comparison methods were used to diluate and hemolyze blood with distilled water and then to measure its color. Later, these methods were further developed to measure hemoglobin without dilution, and improved with the formation of acid or alkaline hematin ensuring the stability of color development. Hammerschlag's method as well as the Schmaltz and Peiper's methods were based on specific gravity measurement, but they were not widely used. The gasometric method used the Van Slyke gasometer, indirectly measuring the hemoglobin concentration. This method provides the most accurate results. This survey examined the characteristics and limitations of hemoglobinometers and methods used to measure hemoglobin from the late 19th century to the early-and mid-20th century. Moreover, this study aims to improve the understanding and applicability of the current methods and emerging technologies used in measuring hemoglobin. It is also expected that this investigation is the starting point to promote awareness of the need to organize historical data for a variety of historical relics of the diagnostic laboratory tests.

• Pediatric Infection and Vaccine
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• v.15 no.2
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• pp.167-173
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• 2008

Purpose : We evaluated the prevalence and clinical, microbiological features of extrapulmonary tuberculosis (EPT) in pediatric patients. Methods : We retrospectively reviewed medical records of pediatric patients diagnosed with EPT at The Catholic University of Korea, Incheon St. Mary's Hospital between 2000 and 2007. Results : Of 109 patients diagnosed with tuberculosis (TB), 12 patients (11%) were admitted with EPT. At 2006-2007, the proportion of patients with EPT among patients with TB was the highest (20%) comparing with last 6 years. The ratio of male to female patients was 1.4:1 and the mean age was 9.2 years (range, 3 months-15 years). The involved sites were pleura in 5 (41.6%), central nervous system in 3 (25%), miliary TB in 2 (16.7%), gastrointestinal tract in 1 (8.3%) and bone and joint in 1 (8.3%). The most common symptom at admission was fever (91.6%) and mean duration of fever was 15.8 days (range, 0-47 days) in spite of the proper treatment. Confirmed rate for acid fast bacillus stain, culture, and polymerase chain reaction were 33.3%, 41.6% and 41.6%. Of 5 culture proven cases, 4 (80%) were resistant to more than one antituberculosis drugs. Eleven patients recovered without complication and 1 patient died. Conclusion : Total incidence of TB decreased steadily according to the nationwide survey. However, our results suggest that the proportion of diagnosis with EPT among diagnosis with TB in children has increased. Microbiological diagnosis of EPT in children was more difficult than that of pulmonary TB. And drug resistance rate has increased.

• Journal of Veterinary Clinics
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• v.19 no.4
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• pp.401-404
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• 2002

A 6-month-old, male, American cocker spaniel was presented with severe pruritus, alopecia and head shaking. In physical examination generalized erythema, papules, scales and crust were observed. Otic discharge was dark-brown colored in both ear canals. After extensive dermatologic diagnostic evaluations, the infestation of scabies, ear mites, Malassezia spp, cocci were proved. Therefore, he was treated with selamectin 6 ㎎/㎏ which was applied to the skin in a single spot twice a week for 2 weeks in order to investigate the effect of selamectin on canine scabies and ear mites by this treatment protocol. When he was rechecked at 14th day after fourth being administered, scabies and ear mites wasn't seen. The dermatological signs, pruritus, papules were remarkably decreased and only slight scales were observed. After treatment of scabies and ear mites, the clavamox and koto-conazole was administered for cocci and Malassezia spp, respectively, for 1 week and topical therapy was initiated. with sebolytic and chlorhexidine shampoo once a week for 3 weeks. Two months later skin lesions were normal dermatologically and the hair was fully recovered. Despite of the expensiveness the selamectin is very effective in the dogs that infected by scabies and ear mites as this treatment protocol.

• Childhood Kidney Diseases
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• v.11 no.2
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• pp.264-271
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• 2007

Purpose : It is important to take a precise history of patients to diagnose enuresis. However, this is difficult to perform in the outpatient department, because the consultation time is limited. So by taking the medical histories with questionnaires, we classified the enuresis patients into monosymptomatic and non-monosymptomatic groups and compared the clinical characteristics between the two groups in order to determine whether this would aid in the diagnosis and treatment of enuresis. Methods : Thirty-four enuresis patients seen in the Department of Pediatrics at Yeungnam University Hospital from 2004 January to 2005 July were enrolled in this study. Two to three weeks before starting medical treatment, questionnaires about the patients' urination habits and past medical history were taken from the Parents with consents. Results : There were 21 patients in the monosymptomatic group and 13 patients in the non-monosymptomatic group. There was no difference in the delivery mode, birth weight, birth order, sleep habit, constipation, and treatment results between the two groups. Urinary infection was more frequently observed in the non-monosymptomatic group. There was a higher incidence of daytime incontinence and a past medical history of allergy in the non-monosymptomatic group. Oriental medicine was the most common treatment of enuresis before visiting the hospital, but the treatment effect was minimal. Conclusion : Comparison between the monosymptomatic and non-monosymptomatic group with the questionnaires was helpful for detailed diagnosis and treatment of enuresis. A more effective education for enuresis patients is needed, since before visiting the hospital many of them wasted their efforts with ineffective oriental medicine treatment. (J Korean Soc Pediatr Nephrol 2007;11:264-271)

• Pediatric Infection and Vaccine
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• v.18 no.1
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• pp.48-53
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• 2011

Purpose : Early diagnosis of active tuberculosis (TB) in children is difficult. The widely used tuberculin skin test has low sensitivity and cross reactivity with non-tuberculous mycobacteria or Bacille Calmette-Gu$\acute{e}$rin vaccination. Interferon gamma release assays have been shown good diagnostic accuracy for active in adults. But studies in children were limited. The purpose of this study was to examine the performance of enzyme-linked immunospot assay (ELISpot) as an initial test in the diagnosis of active tuberculosis in children. Methods : In a hospital-based study, we prospectively examined the performance of ELISPot in 33 children suspected of active TB. TB was confirmed bacteriologically or histologically. Results : Among 33 patients, 9 had active tuberculosis. When tested, they all had a positive test result from the ELISpot. The sensitivity and specificity of the assay were 100% (95% CI, 66.4-100%) and 95.8% (95% CI, 78.9-99.9%) respectively. Conclusion : ELISpot might be an useful and improved clinical diagnostic method for the detection of active TB in children.