Interferon-gamma Release Assay among Tuberculin Skin Test Positive Students in Korean High Schools / 결핵및호흡기질환

BACKGROUND: There are several active tuberculosis (TB) cases in Korean high schools each school year. The risk of transmission in schools is extremely high due to the considerable time spent in closed classrooms. We evaluated the control of latent tuberculosis infection in Korean high schools. METHODS: When a student was identified with active TB, tuberculin skin testing was performed on their classmates and on students in their same school grade. When a student had a positive tuberculin skin tests (TST), they underwent follow-up testing with QuantiFERON-TB Gold In-Tube (QFT). The manufacturer recommended a cut-off of 0.35 IU/mL to determine QFT positivity was applied. RESULTS: A total of 131 pulmonary tuberculosis (TB) patients were included based on the criteria for screening TB contacts in the National Tuberculosis Control Program. Seventy-five (57.2%) students tested smear positive. TST were performed on 7,109 students who were classmates of, or in the same grade as, a TB patient. Of the contacts, 1,231 students (17.3%) were TST positive and they were screened with QFT. Six hundred-sixty-six (55.0%) of the tested students returned a positive QFT result and the rate of positivity was significantly associated with the increasing size of TST indurations (p<0.0001). CONCLUSION: The use of QFT resulted in approximately 45% of TST positive students not being given chemoprophylaxis.

Supernumerary Parathyroid Gland Diagnosed with Contrast-enhanced MDCT after Total Parathyroidectomy / 대한신장학회지

We report a case of a 25-year old man with chronic kidney disease with secondary hyperparathyroidism who had persistent elevation of serum parathyroid hormone level after the immediate total parathyroidectomy and autotransplantation. To localize supernumerary (ectopic) parathyroid gland, we checked Tc-99m MIBI scintigraphy, MDCT and PET-CT. Contrast-enhanced MDCT showed a small strong enhancing lesion over left bracheocephalic vein, and PET-CT showed multiple brown tumors. We removed the supernumerary parathyroid gland and got a rapid drop of parathyroid hormone level.

Immunologic Characterization of Newly Found Koreans as HIV Seropositives by the Year / 감염

BACKGROUND: Although HIV is introduced relatively late into Asia, the amount of HIV-positive population has been continuously growing in this area. UNAIDS/WHO estimate that 6.5 million people are living with HIV in the Asia/Pacific region at the end of 1999. To expect the HIV/AIDS epidemic in the 21st century in Korea, it is necessary to monitor the changes of the number of newly found HIV-infected individuals and their immune status by year including their epidemiological data. METHODS: We have selected 591 HIV-infected individuals whose first CD4 count was checked within 6 months from the time of diagnosis of HIV infection from 1990 to 1999. For the measurement of CD4+T and CD8+T cells, blood samples of HIV-1 infected individuals were collected into three potassium ethylene diamine tetra-acetic acid (K3EDTA)-treated tubes and stained within at least 24 hours after drawing and analysed by flow cytometer (FACStar or FACScount). The immune status were classified into 4 groups as follows: group I (> or =500 CD4+T cells/mm3), group II (201~499 CD4+T cells/mm3), group III (51~200 CD4+T cells/mm3), and group IV (< or =50 CD4+T cells/mm3). RESULTS: The mean of number of CD4+T cells of HIV-infected individuals at the time of HIV diagnosis was 677 cells/mm3 and the percentage of CD4+T cells was 22.5% in 1990~1991 but 350 cells/mm3 and 14.7% in 1999, respectively. The number of newly found HIV-infected individuals belong to Group III increased rapidly from 1997 to 1999. Also, the proportion of newly found HIV-infected individuals having the CD4+T cell counts of < or =50 cells/mm3 increased slowly by the time of diagnosis of HIV infection. The proportion of newly found HIV-infected individuals who were found in general hospitals increased during the second half of the 1990s. CONCLUSION: These results show that not only the number of newly found HIV-infected individuals has increased annually but also their immune status at the time of HIV diagnosis have been more depressed by the year. Therefore, we should enforce education for prevention of HIV/AIDS about general population as well as high risk groups.

A Clinical Study on the Fracture of the Proximal Humerus / 대한정형외과학회잡지

In recent years, there has been a tendency to advocate operative treatment as the method of choice for certain fractures of the proximal humerus. But the management of this fracture is still under debate, especially in the elderly patients. Seventy eight patients with displaced fractures of the proximal humerus were reviewed, and the results were as follows ; l. Among the 78 patients, the ratio of males and females was 44:34 and the highest incidence was between the ages of 40 and 49 years. 2. The most common cause of injuries was traffic accident (57.7%), and falling or slipped down was in 33.3%. 3. According to the classificatoin of Neer, the commonest type was two part fracture (60.3%). 4. Fifty-three cases were treated conservatively, and surgical treatment was done at 25 cases. At old age, or patients with severe associated injury, external fixation was done (12 cases), and one case of four-part fracture was treated by prosthetic replacement. 5. The results were analyzed according to Neer's criteria, and 38 cases (48.7%) showed good, 25 cases (32.1%) was fair, and 15 cases (19.2%) was poor. 6. Total cases with complication were 19 (24.4%), and joint stiffness was most common (10 cases). 7. At elderly patient above 50 years old, the result of surgical treatment was satisfactory in 72.7%, and 58.8% was so when treated conservatively. And the external fixation showed slightly better result than that of internal fixation.

Treatment of the Displaced Fractures of the Proximal Humerus by External fixation / 대한정형외과학회잡지

Treatment by External Fixation with External Compression Device was used for the displaced fractures of the proximal humerus. Especially in the old aged patient and patient with severe associated injury, this method was excellent for the early, painless motion of the shoulder and then good functional result. This experimental treatment was performed in 8 patients, and its merits were as follows: 1. The technique of operation was relatively easy, and was possible within a short time with minor injury. 2. The quality of reduction was good in all cases. 3. By the compression effect on the fracture site and firm maintenance of reduction during the treatment, solid healing as in internal fixation was possible. 4. Firm maintenance of reduction & minimal injury of soft tissue made possible early painless and wide ROM exercise, and then good functional result.