ABSTRACT
A 61-year-old woman was admitted to hospital because of generalized edema and proteinuria. Her renal function deteriorated rapidly. Serum immunoglobulin and complement levels were within normal ranges. An autoantibody examination showed negative for antinuclear antibody and antineutrophil cytoplasmic antibody. Histologic examination of a renal biopsy specimen revealed that all of the glomeruli had severe crescent formations with no immune deposits. The patient was treated with steroid pulse therapy with cyclophosphamide followed by oral prednisolone. Fifteen days later, she experienced massive recurrent hematochezia. Angiography revealed an active contrast extravasation in a branch of the distal ileal artery. We selectively embolized with a permanent embolic agent. On the 45th hospital day, the patient suddenly lost consciousness. Brain computed tomography showed intracerebral hemorrhage. We report a case of antineutrophil cytoplasmic antibody-negative pauci-immune glomerulonephritis with massive intestinal bleeding and cerebral hemorrhage.
Subject(s)
Female , Humans , Middle Aged , Angiography , Antibodies, Antineutrophil Cytoplasmic , Antibodies, Antinuclear , Arteries , Biopsy , Brain , Cerebral Hemorrhage , Complement System Proteins , Consciousness , Cyclophosphamide , Cytoplasm , Edema , Gastrointestinal Hemorrhage , Glomerulonephritis , Hemorrhage , Immunoglobulins , Prednisolone , Proteinuria , Reference Values , VasculitisABSTRACT
In cases of hyperkalemia with preserved renal function, the differential diagnoses that should be considered are drug-related disorders, primary tubular disease, and hormonal diseases including primary adrenal insufficiency. Addison's disease represents a rare disorder characterized by primary adrenal failure, general weakness, poor appetite, nausea, dizziness, and hyperpigmentation. It may also cause fatal adrenal crisis, involving hypotension, loss of consciousness, hyperkalemia, or hyperkalemic periodic paralysis under stressful conditions. We describe herein the case of a 54-year-old Korean male who developed Addison's disease, due to adrenal tuberculosis, in addition to painless thyroiditis, which led to hyperkalemic periodic paralysis.
Subject(s)
Humans , Male , Middle Aged , Addison Disease , Appetite , Diagnosis, Differential , Dizziness , Hyperkalemia , Hyperpigmentation , Hyperthyroidism , Hypotension , Nausea , Paralysis, Hyperkalemic Periodic , Thyroid Gland , Thyroiditis , Tuberculosis , UnconsciousnessABSTRACT
Rheumatoid arthritis (RA) mainly affects polyarticular joints and is characterized by inflammation of the synovial membrane leading to joint destruction. We report on an unusual case of RA presenting as an intra-articular mass invading bone of the wrist joint in a patient with chronic monoarthritis. A 43-year-old man presented with left wrist joint pain and swelling lasting several years. A plain radiograph showed a non-specific osteolytic lesion in the distal ulna but a magnetic resonance image demonstrated an intra-articular irregular mass-like lesion with eccentric bone erosion the distal radioulnar joint. Synovial biopsy detected hyperplasia of the synovial lining cell layer and finger-like protrusions of inflamed and edematous fibrovascular stroma containing dense inflammatory infiltrates, mainly plasma cells, B cells, and CD4+ T cells. Rheumatoid factor and anti-citrullinated protein antibody were highly positive. The patient was diagnosed with RA and treated with disease-modifying anti-rheumatic drugs, showing a good response on further follow-up.
Subject(s)
Adult , Humans , Antirheumatic Agents , Arthritis, Rheumatoid , B-Lymphocytes , Biopsy , Follow-Up Studies , Hyperplasia , Inflammation , Joints , Plasma Cells , Rheumatoid Factor , Synovial Membrane , T-Lymphocytes , Ulna , Wrist Joint , WristABSTRACT
Antihistamines (histamine receptor antagonists) are widely prescribed medicines in the treatment of allergic disorders, especially the symptoms of hypersensitivity reactions, mainly blocking the activity of vasoactive amines to their receptors. Drug adverse reactions such as sleepiness and dry mouth are frequently encountered. However, drug hypersensitivity provoking itchy hives by antihistamines were rarely reported. A 41-year-old female patient visited allergy clinic for generalized itchy hives from time to time, which had been aggravated 3 months before. Whenever she was exposed to antihistamines for treatment, she felt her hives got immediately full-blown. As a screening, she was tested with various antihistamines on her skin, then skin test-negative antihistamines were orally administered. Finally we failed to choose a safe antihistamine for the treatment of her symptoms. We report a case of drug hypersensitivity to various antihistamines with cross-reactions in a patient with chronic urticaria.
Subject(s)
Adult , Female , Humans , Amines , Cross Reactions , Drug Hypersensitivity , Histamine Antagonists , Hypersensitivity , Mass Screening , Mouth , Skin , UrticariaABSTRACT
Eperisone hydrochloride is an antispasmodic drug, decreasing spasticity of skeletal muscle and alleviating stiffness, and as a consequence, controlling pain. It is preferably prescribed with other analgesics, beneficially less decreasing alertness compared with other antispasmodics. Its fatal drug adverse reactions were rarely reported. A 70 year-old female with hives, swollen face, hoarse voice, and near fainting admitted via emergency department. She suffered from the series of the fatal symptoms after administration of the pills, prescribed for her neck pain. Two months before, she had experienced hives on similar medications. At presentation, she revealed hypoxemia and hypotension, and treated with epinephrine, glucocorticoids and antihistamines. Among the medicines she took, eperisone hydrochloride was proven as the causative medicine and others were excluded in oral provocation tests. The positive result in intradermal test with eperisone hydrochloride suggested immediate-type hypersensitivity reaction. We report a case of anaphylaxis to eperisone hydrochloride, one of the widely prescribed medicines in clinical practice, previously without awareness of drug adverse reaction.
Subject(s)
Female , Humans , Analgesics , Anaphylaxis , Hypoxia , Drug Hypersensitivity , Emergencies , Epinephrine , Glucocorticoids , Histamine Antagonists , Hypersensitivity , Hypersensitivity, Immediate , Hypotension , Intradermal Tests , Muscle Spasticity , Muscle, Skeletal , Muscles , Neck Pain , Parasympatholytics , Propiophenones , Syncope , Urticaria , VoiceABSTRACT
BACKGROUND: Several studies have reported that cholecystokinin (CCK), a short-term meal related satiety signal, and leptin, long-term signal for controlling feeding behaviour and body weight, act synergistically to inhibit food intake. However the mechanism and neuroanatomical basis for this response remain unclear. To clarify the neuronal mechanisms underlying the synergistic interaction between leptin and CCK, we examined the neuron activated by single or combined injection of leptin and CCK in fasted rats using immunohistochemistry for Fos. The expression of Fos can be used to trace neuronal activation pathways. METHODS: The rats were divided into 4 groups; Tris solution-saline, Tris solution-CCK, leptin-saline, leptin-CCK. Rats were received a single intracerebroventricular injection of either 3mul Tris solution or 3microgram leptin, and a single intraperitoneal injection of either 2mul saline or 2microgram/kg sulfated CCK-8. The changes of the Fos expression were investigated in the paraventricular nucleus (Pa), retrochiasmatic area (RCh), lateral hypothalamic nucleus (LH), central nucleus of amygdala(Ce), supraoptic nucleus (SO), arcuate nucleus (Arc), ventromedial hypothalamic nucleus(VMH),dorsomedial hypothalamic nucleus (DM), ventral premammillary nucleus (PMV), superior lateral subdivision of parabrachial nucleus (LPBS), external lateral subdivision of parabrachial nucleus (LPBE), supragenual nucleus (SGe), area postrema (AP), medial area (SolM) and commissural area (SolC) of nucleus of the solitary tract nuclei. RESULTS: CCK increased the Fos expression in the Pa, RCh, LH, Ce, SO, Arc, VMH, DM, PMV, LPBS, LPBE and SolM. Leptin increased the Fos expression in the Pa, RCh, LH, SO, Arc, VMH, DM, PMV, LPBS, LPBE, SGe, AP and SolM. Injections of leptin and CCK significantly enhanced the Fos expression in the Pa, RCh, VMH, DM, LPBS, and SolM compared with those induced by leptin or CCK alone. CONCLUSION: Our results suggest that the Pa, RCh, VMH, DM, LPBS and SolM may be essential sites mediating the synergistic effect of leptin and CCK to regulate food intake.
Subject(s)
Animals , Rats , Arcuate Nucleus of Hypothalamus , Area Postrema , Body Weight , Brain , Cholecystokinin , Eating , Hypothalamic Area, Lateral , Immunohistochemistry , Injections, Intraperitoneal , Leptin , Meals , Negotiating , Neurons , Paraventricular Hypothalamic Nucleus , Sincalide , Solitary Nucleus , Supraoptic NucleusABSTRACT
The 46, XX male syndrome is rare disease that is characterized by a phenotypic male who has a 46, XX female karyotype. Since the first report by de la Chapelle and associates in 1964, several cases have been reported, but it is still a rare entity. Recently we examined a 20-year-old XX male who had the symptoms of gynecomastia, an infantile appearance of the external genitalia, scanty pubic hair, no Adams apple, and no axillary hair. We presently describe a patient with the 46, XX male syndrome who showed a 46, XX karyotype on chromosomal study and review the literatures.
Subject(s)
Female , Humans , Male , Young Adult , 46, XX Testicular Disorders of Sex Development , Genitalia , Gynecomastia , Hair , Karyotype , Rare DiseasesABSTRACT
By the concept that IDDM (insulin-dependent diabetes mellitus) is one of the autoimmune diseases, several immune suppressive drugs and immune modulators including BCG have been used to suppress the occurrence of IDDM. A data reported that BCG has different effects for prevention of diabetes according to the timing of drug administration. This study was performed to examine the preventive effect of diabetes development and insulitis by administering BCG at breast-fed period. NOD (non-obese diabetic) mice were divided into three groups: Group I, II, III were injected by BCG on the first day, eighth day, and twenty second day of life respectively. The later BCG was injected, the smaller occurrence of diabetes and the lower severity of insulitis were.
Subject(s)
Animals , Mice , Autoimmune Diseases , Diabetes Mellitus, Type 1 , Mice, Inbred NOD , Mycobacterium bovisABSTRACT
MEN IIa is the rare disorder consisted of thyroid medullary carcinoma, pheochromocytoma, and hyperparathyroidism. We experienced the case in which 42 year-old male patient with thyroid medullary carcinoma and pheochromocytoma complicated by acute myocardial infarction. During the process of conventional treatment of acute myocardial infarction, paroxysmal hypertension occurred for several times. We sought for the cause of paroxysmal hypertension, and found pheochromocytoma by the radiologic imaging study and the biochemical study and we found the 4X4 cm sized neck mass by palpation. After stabilizing his blood pressure by the use of phenoxybenzamine, we removed the pheochromocytoma in right adrenal gland and the medullary thyroid cancer, by right adrenalectomy and total thyroidectomy respectively. Thereafter, his subjective symptoms and objective signs were improved. We report the case with review of literatures.
Subject(s)
Adult , Humans , Male , Adrenal Glands , Adrenalectomy , Blood Pressure , Carcinoma, Medullary , Hyperparathyroidism , Hypertension , Multiple Endocrine Neoplasia Type 2a , Multiple Endocrine Neoplasia , Myocardial Infarction , Neck , Palpation , Phenoxybenzamine , Pheochromocytoma , Thyroid Gland , Thyroid Neoplasms , ThyroidectomyABSTRACT
OBJECTIVES: Peripheral benzodiazepine receptor has been suggested to be associated with the relief of anxiety response induced by stresses. This study was designed to observe the anxiolytic activity of peripheral benzodiazepine receptor. METHODS: Male Sprague-Dawley rats, weighing 200-250g were forced to suffer an immobilization stress for 2 hours. The level of anxiety by immobilization was performed by an elevated plus maze and was evaluated by the number of [3H]Ro5-4864 binding sites in the olfactory bulb. RESULTS: Saturation experiments followed by scatchard anlayses of the results showed that the density of peripheral benzodiazepine receptor increased and the affinity of the peripheral benzodiazepine receptor remained unchanged. It was found that there was no significant change in the cerebral cortex. Pretreatment with clonazepam, a central benzodiazepine receptor agonist, before an immobilization stress abolished the anxoius response on the performance of plus maze. In this group, upregulation of peripheral benzodiazepine receptor of olfactory bulb was not observed. Ro5-4864, a peripheral benzodiazepine receptor agonist, elicited an increase of anxiolytic response on the performance of plus maze. Progesterone, a precursor of neuroactive steroid, also increased anxiolytic response on the performance of plus maze. Pretreatment with PK11195, a peripheral benzodiazepine receptor antagonist, abolshed the anxiolytic effect of progesterone. CONCLUSIONS: From these results, it could be concluded that peripheral benzodiazepine receptor is closely associated with the relief of acute stress induced anxiety response via an increase of synthesis of neuroactive steroid.
Subject(s)
Animals , Humans , Male , Rats , Anti-Anxiety Agents , Anxiety , Benzodiazepines , Binding Sites , Cerebral Cortex , Clonazepam , Immobilization , Olfactory Bulb , Progesterone , Rats, Sprague-Dawley , Receptors, GABA-A , Up-RegulationABSTRACT
The authors applied ADDES-HV parent evaluation scale for the purpose of screeing test to 538 2nd grade elementary school students from March 1994 to May. The results were as follows: There was no differences in scores of ADHD between schools. In comparing the male and female between three school students, male students showed signifieant high scores (p<0.05) than female students in the score of ADDES-HV subscale and total. There was no significant differences in ADDES-HV scale between male students and female students in both ADHD patients and normal controls. In reliability test for test and retest, the reliability coefficient was higher satisfatorily and that of inattention was 0.80, inpulsivity was 0.69, hyperactivity was 0.63 and the total score was 0.82. In reliability test by internal consistancy, the Cronbach a coefficient of patient group was 0.85(p<0.05) and that of normal control was 0.84(p<0.05). The Concurrent validity between ADDES-HV scale and DSM- III -R scale was 0.57(p<0.05) in ADHD patient group and 0.84(p<0.05) in normal control group. In discriminant validity test between ADHD patient group and normal control, the ADHD patient group showed higher score(p<0.05). The total disciminant capacity of the patient group in ADDES-HV scale was 94.44%. When we regard the cut off point as standard deviation 1.5, the male student was 80 score and the female student was 69 score. In this point of view, ADDES-HV scale was proved to be the useful screening test tool for ADHD research and showed higher reliability and validity in applying to Korean subjects.
Subject(s)
Child , Female , Humans , Male , Attention Deficit Disorder with Hyperactivity , Mass Screening , Parents , Reproducibility of ResultsABSTRACT
No abstract available.
ABSTRACT
No abstract available.
ABSTRACT
In order to make transcultural research for mental health centered on anxiety and depression between two countries of which psychosocial factors are different, the author studied 698 Nepalese in Dolka in January 1990 and 417 Korean of Chungdo and Kyungju in Korea from July to August 1990 by using the Combined Self-Rating Anxiety Depression Scale (CSADS). The author applied t-test and ANOVA to compare these two groups. The results were as follows: The total scored of Nepalese scored 51.27±11.10 while Korean Scored 44.29±11.79. The anxiety-depression scores relating to the items of restlessness, depressed affect, apprehension, crying spells and fatigue were significantly high in Nepalese, while fatigue, sleep disturbance, dissatisfaction, dizziness, and anxiousness were significantly high in Korean. Both groups showed an increase of score with age. The item relating to education, the scores of the CSADS was significantly high in lower education level in Nepal but Korean showed no significant difference among education level. The score of the CSADS above 50 (clinically significant level) was seen in 361 (51.7%) Nepalese and 116 (27.9%) Korean, which shows the proportion of Nepalese are significantly higher than that of Korean.
Subject(s)
Anxiety , Crying , Depression , Dizziness , Education , Fatigue , Korea , Mental Health , Nepal , Psychology , Psychomotor Agitation , Rural PopulationABSTRACT
This research is focused on the attitudes toward dying and hospice. 4subjects groups are Ca. patient, Ca. patient's family, elderly, medical personnel. A 40 questionnaire was filled out by each participant. For this study chi-square and T-test was done. The results were as follows: 1. Telling the truth 61.2% of all subject groups agreed upon telling the impending death. About 40% of elderly group and cancer patient group were disagreed which is the highest percentage in all groups. Particularly medical personnel group were remarkably high in telling the truth. 2. Attitudes of medical personnels 43.3% of all groups agreed upon medical personnels prefer to avoid dying patient. In medical personnel group. 44% of respondents disagreed comparably higher than other group, But 37.3% of medical personnel agreed. It showed that medical personnels admitted their negative feelings toward dying patient in considerable degree. 3. Attitudes toward mechanical assistance for life-expanding or hopeless patient. 44.8% of all groups disagreed upon mechanical assistance for hopeless case. Elderly (54.9%) and medical personnels (50%) disagreed, which is higher than cancer patient (33.3%) and (22.8%) of cancer patient's family. 4. Special facility and educational preparation for dying patient. 67.4% of all groups agreed upon the needs of special facility for dying, 81.3% of medical personnels agreed which is highest percentage in all group. 5. Attitudes of family members of dying patient. 82.3% of all groups agreed upon the family members feel annoyed at dying patient. 34% of cancer patient's family member and 48% of cancer patients group agreed, but elderly group showed highest percentage (84%). 6. Perception of dying patient about imminent death. 58.3% of all group thought dying patients are aware of their impending death even though they had not been told. 77.3% of medical personnel agreed which is highest percentage in all group.