A Case of Juvenile Ankylosing Spondylitis with Atlantoaxial Bony Ankylosis and Rheumatoid-like Hands / 대한류마티스학회지

Ankylosing spondylitis (AS) is a heterogeneous and systemic rheumatic disorder of unknown cause that is characterized by inflammation of the spine and sacroiliac joints. It is more common in young men. The disease is frequently associated with peripheral arthritis, enthesitis, anterior uveitis and high prevalence of HLA-B27. In some patients with AS, peripheral arthritis can occurs earlier than spinal symptom and more commonly affects the lower extremities than the upper extremities. Unlike men, women appear to have milder or atypical AS, especially at juvenile onset. However, involvement of the hands is extremely rare. Juvenile AS, defined as onset of disease prior to the age of 16 years, is considered a pediatric form of AS. On the other hand, although the atlantoaxial subluxation has been infrequently observed in patients with ankylosing spondylitis, atlantoaxial bony ankylosis has not been described in the literature. We describe a 23-year-old woman with juvenile AS who developed the atlantoaxial bony ankylosis and the hand involvement mimicking rheumatoid arthritis. Besides the rheumatoid-like hands and atlantoaxial bony ankylosis, she has shown the typical features of spondyloarthrpathy such as bilateral sacroiliitis, inflammatory spinal pain, enthesitis, severe arthritis of both hip joints, and positive HLA-B27 test.

A Case of Light Chain Deposition Disease without Significant Proteinuria / 대한신장학회잡지

A 67-year-old male was admitted to the hospital for evaluation of incidentally detected anemia and mild azotemia. Urinalysis showed no abnormal finding and 24 hr urine protein amount was clinically insignificant (270 mg/day). Urine and serum protein electrophoresis were negative for a monoclonal spike. However, urine and serum immunoelectrophoresis demonstrated the presence of monoclonal free kappa light chains. Renal biopsy showed the features of chronic tubulointerstitial disease and on the immunofluorescence studies, kappa light chain was in a linear pattern in basement membranes of glomeruli and tubules. Work-up for multiple myeloma including bone marrow biopsy showed results compatible with multiple myeloma. Treatment was started with vincristine, adriamycin and doxorubicin at monthly interval for three months followed by autologus peripheral blood stem cell transplantation. At follow-up 5 months after autologus peripheral blood stem cell transplantation, the patient is well with a serum creatinine of 2.3-2.6 mg/dL and 24 hr urine protein of 200-350 mg.

A clinical study of torsion of ovarian tumors in pregnancy / 대한산부인과학회잡지

OBJECTIVE: To evaluate optimal management of an ovarian tumor in pregnancy METHODS: This study includes 89 cases of an ovarian tumor in pregnancy that required surgery at Catholic Medical Center, Kangnam St. Mary's hospital, Holy Family hospital of the Catholic University Medical College from January, 1990 to December, 2001. We collected 36 cases from 48 pregnant women who underwent emergency operation. And 53 cases were pregnant women who underwent elective operation. The student t-test and x2 test were used for statistical analysis. A P value of <0.05 was considered significant. RESULTS: The most common size of torsion of an ovarian tumor during pregnancy was 6-10 cm and the incidence was the most frequent during the first trimester of pregnancy. Pregnant women with torsion of an ovarian tumor who underwent emergency operation compared with those who underwent elective operation, the risk of preterm delivery were significant. But there were no fetal deaths reported, also there were no difference in the birth weight or the method of delivery. CONCLUSION: The torsion of an ovarian tumor dose not have a serious affect on the overall pregnancy. If the early diagnosis of the ovarian tumor is made and the malignancy is ruled out, it seems likely that the conservative care is better than the invasive method of operation during the second trimester of pregnancy just to prevent from preterm labor due to emergency operation of ovarian tumor.

Ansan Citizen's Knowledge of Stroke

BACKGROUND: The awareness and knowledge of stroke among general population has been poorly estimated in our country. METHODS: Well-trained personnel asked to randomly selected 985 residents in Ansan City with questionnaire concerning stroke. The results of questionnaire were analyzed in terms of demographic factors. RESULTS: Only 55.4% of the subjects answered that stroke is cerebrovascular disease. As risk factors of stroke, hypertension (70.4%) and mental stress (59.7%) were considered to be important. But the risk of cigarette smoking(18.7%), diabetes mellitus(14.5%), and heart disease(14.5%) were underappreciated. This awareness pattern did not show no statistical significance between those with and without risk factors(p>0.05). The more than half of subjects(65.2%) chose western medicine and 26.8% of subjects chose oriental medicine for the treatment of stroke. Forty four percent of the subjects perceived motor paralysis as a primary symptom of stroke. Broadcasting was the most important source of information about stroke. CONCLUSIONS: The misinformation about stroke is common among general population in Ansan City. To provide proper management for stroke by neurologists, public health education should be focused especially on those who have risk factors and are the elderly and less educated. Because primary physician play a crucial role in spreading information about stroke, special education program for them is needed.

A Case of Theophylline-Induced Hepatitis / 대한간학회지

Theophylline has been widely used in the treatment of asthma and chronic obstructive lung disease. To date, there have been very few reports on hepatotoxicity due to theophylline. We diagnosed, through biochemical testing and a liver biopsy, a case of acute cholestatic hepatitis developed after oral consumption of theophylline. A 43 year-old man was admitted to the department of internal medicine due to jaundice and pruritus which developed after ten days administration of oral theophylline (Etheophyl ). Liver function tests showed elevated serum bilirubin at 13.2 mg/dL with AST and ALT of 71 U/L and 194 U/L. Alkaline phosphatase and gamma-GTP were also elevated at 175 U/L and 301 U/L. There was no evidence of viral or autoimmune hepatitis in laboratory tests. The patient's symptoms and liver function tests were improved after conservative treatment. After 9 months oral theophylline was readministered for the control of relapsed asthma. Then, jaundice and pruritus again developed again. A liver biopsy showed a few lymphocytes and eosinophilic inflammatory cell infiltration in portal tract and cholestasis in the lobule. Drug-induced hepatitis was diagnosed with a typical clinical course; the exclusion of all possible causes of acute hepatic dysfunction; and a positive response to accidental readministration of drug. We report this case with a review of the literature.

Influence of Prosthesis Size on Change in Left Ventricular Hypertrophy Following Aortic Valve Replacement / 대한흉부외과학회지

BACKGROUND: Aortic valve stenosis induces left ventricular hypertrophy as an adaptive response to the chronic overload caused by the valve disease. Despite the fact that aortic valve replacement may lead to regression of the left ventricular hypertrophy, there is a controversy on the change of the left ventricular muscle after use of small prostheses. MATERIAL AND METHOD: We reviewed 20 patients who had undergone aortic valve replacement for aortic stenosis. There were 13 males and 7 females with a mean age of 61+/-13.8 years. A retrospective analysis of Doppler echocardiography was undertaken in preoperatively, early postoperatively(mean 10.4days), and late postoperatively(mean 29.9 months). They were divided into two groups according to the size of prosthesis used(group 1; 21 mm or smaller, group 2; 23 mm or larger). RESULT: Significant improvement of NYHA Functional class was detected in all groups. Ejection fraction was not significantly different in the group 1 between preoperative and postoperative period, however it increased significantly in the group 2 over time. But preoperative ejection fraction of the group 2 was significantly lower than that in the group 1(p=0.044). Left ventricular muscle mass index(g/m2) was not reduced significantly in the group 1 at the early postoperative period, but it was reduced significantly at the late postoperative period. In the group 2 it was reduced significantly over time. CONCLUSION: Both groups showed clinical improvement. However, the number of patients in whom 19 mm size prosthesis was used was only two. Thus, we suggest that more attention to age, BSA, and exercise should be paid in patients who will undergo aortic valve.

Lipid Profile Changes in Infection of Plasmodium Vivax / 감염

BACKGROUND: Alteration in plasma lipid levels during malaria attacks was studied to evaluate the diagnstic values in vivax malaria. METHODS: The plasma levels of total cholesterol, triglycerides, HDL-cholesterol (HDL-c), and LDL-cholesterol (LDL-c) were analyzed and compared in 32 patients with vivax malaria at presentation, in 10 patients after 17-days of treatment with anti-malaria drug, and in 40 control individuals. Interrelation of lipid profile with other parameters including parasitemia level, platelet count, hemoglobin and WBC counts were analysed. RESULTS: In patients with malaria, serum total cholesterol, triglycerides, HDL-c and LDL-c concentrations were significantly lower than those of control subjects. None of lipid profile showed any correlation with the parasitemia level. After treatment, HDL-c was significantly elevated. CONCLUSION: These results suggest that lipid profile, especially decreased of HDL-c, may be a valuable information in the diagnosis of the malaria.

Lipid Profile Changes in Infection of Plasmodium Vivax / 감염

BACKGROUND: Alteration in plasma lipid levels during malaria attacks was studied to evaluate the diagnstic values in vivax malaria. METHODS: The plasma levels of total cholesterol, triglycerides, HDL-cholesterol (HDL-c), and LDL-cholesterol (LDL-c) were analyzed and compared in 32 patients with vivax malaria at presentation, in 10 patients after 17-days of treatment with anti-malaria drug, and in 40 control individuals. Interrelation of lipid profile with other parameters including parasitemia level, platelet count, hemoglobin and WBC counts were analysed. RESULTS: In patients with malaria, serum total cholesterol, triglycerides, HDL-c and LDL-c concentrations were significantly lower than those of control subjects. None of lipid profile showed any correlation with the parasitemia level. After treatment, HDL-c was significantly elevated. CONCLUSION: These results suggest that lipid profile, especially decreased of HDL-c, may be a valuable information in the diagnosis of the malaria.

Results of LASIK for High Myopia

We studied 52 eyes of 41 patients who received excimer laser in situ keratomileusis with VisX 20/20 and were followed up for at least 6 months. Tweenty three patients were male and mean age was 30.7 years old (21-49 years old). Mean preoperative spherical equivalent was -11.69+/-4.02D and mean postoperative spherical equivalent was -0.49+/-1.32D at I month, -0.73+/-l.17D at 3 months and -1.11+/-l.21D at 6 months. Mean uncorrected visual acuity preoperatively was 0.06 and postoperatively was 0.62 at I month, 0.64 at 3 months, 0. 62 at 6 months. Mean corrected visual acuity preoperatively was 0.77 and postoperatively was 0.76 at I month, 0.78 at 3 months and 0.81 at 6 months. Seven eyes (13%) gained 2 lines or more of spectacle corrected visual acuity and I eye lost 2 lines of spectacle corrected visual acuity. There was no significant contrast sensitivity change between preoperation and postoperation. No eye had intraoperative complications. Postoperative complications included 9 eyes (17%) of interface foreign bodies, 7 eyes (13%) of cap microwrinkling and 15 eyes(29%) of night glare. No eye had postoperaive corneal opacity.

Timing of Amblyopia Therapy in Pure Anisometropic Amblyopia

The aim of this study was to analyze the effect of age at beginning of treatment on the results of anisometropic amblyopia in twenty-two consecutive children. The children who had strabismus or any other ocular disease affecting visual acuity was excluded. Two age groups were defined, according to the age at which treatment was started : 7 years or less(group I. N=10), 8 years or more(group II. N=12). Mean age of group I was 5.3 years old(4.1-7.9), while group II was 10.2 years old(8.0-13.2). Six patients were treated with occlusion therapy, 11 patients with atropine penalization, 1 patient with occlusion therapy and atropine penalization alternatively and 4 patients with spectacle correction only. All children had cycloplegic refraction before treatment and at each visit the corrected visual acuity was assessed. The difference in refractive errors between two eyes before treatment was 2.58D(1-9D) in group I and 2.75D in group II. The mean initial corrected visual acuity of amblyopic eyes was 0.43 in group I and 0.46 in group II. There was no significant difference in initial visual acuity between the two groups. The range of follow up times was from 5 to 60 months, with an average of 18 months. There was no significant difference in final visual outcome of amblyopic eye between the two groups. For patients aged 7 years or less, 80%(8/10) of patients achieved a final visual acuity of 0.8 or better and 90%(9/10) achieved the same final visual acuity as in the sound eye. For patients aged 8 years or more, 83%(11/12) of patients achieved a final visual acuity of 0.8 or better and 83%(10/12) achieved the same final visual acuity as in the sound eye. The initial visual acuity, the methods of therapy did not affect the final visual outcome. In pure anisometropic amblyopia, the patients older than 8 years of age have been treated as effectively as the patients 7 years or less.

Atlantoaxial Dislocation in Down Syndrome Treated by Occipitocervical Fusion Using Threaded Steinmann Pin: A Case Report

Atlantoaxial dislocation is common in patients with Down syndrome, and an increased incidence was first noted by Tishler and Martel in 1965. Laxity of the transverse atlantal ligament is thought to be responsible for atlantoaxial dislocation, and surgical stabilization has been recommended for pateints who have instability, with or without myelopathy. Various surgical techniques and hardwares have been developed for occipitcervical fusion with varying degrees of results. The authors presents a case of Down syndrome with cervical myelopathy treated by occipitocervical fusion with an anatomically contoured threaded Steinmann-pin, which was secured to the occiput via small burr holes and to the vertebrae by sublaminar wiring, and supplemental autograft. This technique has the advantage over bone grafting, in that it affords rigid stabilization, allows early mobilization and may contribute to eventual bony fusion.

Results of LASIK According to Nomogram

To evaluate the accuracy of the nomogram for LASIK, we retrospectively studied 109 eyes of 81 patients who received LASIK and were followed up for at least 6 months, divided into 3 groups according to the nomogram: the group I include 19 eyed which performed stromal ablation with 85~95% do photorefractive keratectomy(PRK) nomogram, the group II included 60 eyes with 100% of PRK nomogram and the group III included 30 eyes with 105included 30 dyes with 105~110% of PRK nomogram. The Chiron utomated corneal shaper and the Visx 20/20 excimer laser were used in all eyes. Multizone multipass technique was used in all eyes. The mean preoperative spherical equivalent was -12.42D in group I, -11.43D in group II and -11.29D in group III. The mean postoperative spherical equivalent in group I was -0.89D at 1 month, -1.0D at 3 months, -1.64D at 6 months, in group II was -0.31D at 1 month, -0.62D at 3 months, -1.07D at 6 months and in group III was -0.22D at 1 month, -0.46D at 3 months, -0.84D at 6 months. Eleven eyes(58%) were within 1.00D if intended correction at 6 months in group I while 35 eyes(59%) in group II and 20 eyes(67%) in group III were within 1.00D of intended correction at 6 months. Our findings suggest that slight overcorrection is recommanded in LASIK and further study on LASIK nomogram may be required.

Factors Influencing the Therapeutic Compliance of Patients with Lung Cancer / 결핵

BACKGROUND: In recent years, lung cancer has been one of most common cause of death in Korea. Despite many physician's high degree of pessimism about the gains made in treatments progressive improvement in the survival of lung cancer by treatment has occurred, particulary in the early stages of the disease. However, a lot of patients refuse treatment or give up in the fight against the disease. This study was done to evaluate factors ifluencing the compliance to therapy and to lead in the establishment of special programs to enhance compliance in patients with lung cancer. METHODS: The medical records of 903 patients, whose ECOG(Eastern Cooperative Oncology Group) performance status was 3 or less and whose medical record was relatively satisfactory, among 1141 patients diagnosed with lung cancer between January 1989 and December 1996 were reviewed retrospectively. Compliance was classified into three groups based on the degree of compliance with physicians practice guideline : (a) complaints ; (b) patients who initially complied but gave up of themselves midway during the course of treatment ; (c) noncompliants who refused the treatment. RESULTS: The overall compliance rats was 63.9%, which was progressively increased from 57.3-61.3% in 1989 and 1990 to 64.2-67.5% in 1995 and 1996. Age, education level and occupation of patients bore statistically significant relationship with the compliance but sell marital status and smoking history did not. The compliance was significantly higher in patients without symptoms than with, and was also significantly higher in patients with good performance status. The compliance was significantly high in patients with NSCLC(non-small cell lung cancer) compared to SCLC(small cell lung cancer), but after exclusion of stage l and ll, among NSCLC, which had higher compliance to surgery there was no significant difference of compliance by histology. The compliance was significantly lower in advanced stage. CONCLUSION: To enhance the compliance, special care including education programs about therapy including complicantion and prognosis are necessary, especially for educationally and economically disadvantaged patients.

Efficacy and Safety of Subconjunctivally Injected 5-fluorouracil after Mitomycin C Trabeculectomy in High Risk Patients

To determine the safety and efficacy of using subconjunctival 5- fluorouracil(5-FU) injection on high risk eyes for filtration failure who had undergone trabeculectomy with intraoperative mitomycin C(MMC), we conducted a retrospective analysis of 17 eyes of 17 consecutive patients. Intraoperative MMC exposure (0.4mg/ml) was followed by supplemental postoperative 5-FU injection as necessary to titrate bleb vascularity and intraocular pressure (IOP). Exposure time to MMC was 2 to 5 minutes based on multiple preoperative and intraoperative risk factors. Postoperative 5-FU was administered by subconjunctival injection(5mg) adjacent to or into the bleb in a weekly interval(mean 4 injections, range 2-5 injections). Mean follow-up time was 8.6 months. Overall mean preoperative IOP was 27.1+/-7.2mmHg compared with mean postoperative IOP of 12.3+/-7.4mmHg. Fifteen eyes(88%) achieved a final IOP < OR =21mmHg without medicatio and 11 eyes(64%) achieved a final IOP< OR =12mmHg. Complications developed after 5-FU injections included corneal epithelial defect in 2 eyes (12%), hypotony (IOP< OR =5, at least 2 visits) in 2 eyes(12%), and bleb leakage in 1 eye(6%). No patient had a hypotony induced maculopathy, hyphema or choroidal effusion. Our data suggest that postoperative 5-FU may be safely used adjunctively following MMC trabeculectomy in carefully selected patients, and may improve the overall success rate with high risk trabeculectomy.

Dosimetric Consideration of the Lung Block in the Mantle Field / 대한치료방사선과학회지

PURPOSE: To evaluate the dose under lung block as a function of depth and the effectiveness of a block as a function of block width. MATERIALS AND METHODS: Field size of mantle field was 22.8 x 32.4 cm2 . Dose distribution of the mantle field was measured with two dimensional water phantom system. To analyze the effectiveness of the lung block, central axis plane, 5cm off-axis plane, and 10cm off-axis plane were studied. RESULTS: The dose under the lung block was recorded with maximum at the depth between , 5cm and 10cm . In the central axis plane, dosimetric block width was 10-15% les than physical block width. In the 5cm off-axis plane. Dosimetric block width was 4-9% less than physical block width. In the 10cm off-axis plane, dosimetric block width was 2% less than physical block width. CONCLUSION: Depth dependence of the dose under the lung block was founded. Also, block width dependence of the lung block was founded. To induce the accurate relation between the physical block width and the "effective" block width, it needs more detailed understanding of the variables involved.

A clinical study of supracondylar closing wedge osteotomy for cubitus varus / 대한정형외과학회잡지

No abstract available.

Operative treatment of the lateral condyle fractures of the humerus in children / 대한정형외과학회잡지

No abstract available.