Proposal for improving the system of physical therapy education and the Korean physical therapist licensing examination based on a comparison of the systems in World Confederation for Physical Therapy member countries / 보건의료교육평가

No abstract available.

A Case of Huge Pulmonary Blastoma With Multiorgan Invasion / 결핵및호흡기질환

A pulmonary blastoma is a rare malignant tumor of the lung that is composed of epithelial and mesenchymal elements and resembles the structure of an embryonic lung. Pulmonary blastomas have a very poor prognosis and make up 0.25 to 0.5 percent of all primary malignant lung tumors. A pulmonary blastoma usually manifests as a solitary parenchymal mass or nodule and multiple subpleural mass with effusion on chest X-ray and computed tomography. We encountered a very rare case of pulmonary blastoma in a 52 years old male. He complained of abdominal pain, fullness, and dyspnea. The radiology examination revealed a huge lung mass invading the mediastinum, heart, diaphragm, and liver. The percutaneous needle biopsies were performed, and this tumor was diagnosed as a pulmonary blastoma. We report a biopsy confirmed case of a huge pulmonary blastoma invading multiple organs.

A case of recurred malignant melanoma of the stomach and peritoneum / 대한내과학회지

Malignant melanoma may spread through the lymphatic channels or via the bloodstream. The lung, liver, bone and brain are common sites of hematogenous metastases. Malignant melanoma that has recurred to the stomach or peritoneum is not common. An 83-year old male patient was admitted to the Department of Oncology due to abdominal distension; 13 years ago, the patient had previously received a complete surgical resection for malignant melanoma of the right heel. According to a computed tomography (CT) scan of the abdomen, peritoneal carcinomatosis was suggested. Under a gastrofiberoscopic examination, two small sized polyps with central umbilication were found on the midbody of the stomach. The gastric polyps were histopathologically confirmed as metastatic melanoma. We report a rare case of metastatic malignant melanoma that has recurred to the stomach and peritoneum 13years after its initial diagnosis.

Intravascular Large B-cell Lymphoma with Bone Marrow Involvement: A Case Successfully Treated with a Rituximab-CHOP Combination Regimen

Intravascular large B-cell lymphoma is rare and generally fatal. It is defined pathologically by neoplastic proliferation of lymphoid cells within the lumens of capillaries, small veins, and arteries with little or no other parenchymal involvement. The diagnosis can be delayed because of the rarity of the disease and the difficulty of detection in imaging studies, and a suspicious clinical observation is warranted to make the correct diagnosis. Early diagnosis is important because delayed treatment could result in a fatal outcome. We have encountered a case of intravascular large B-cell lymphoma involving only the bone marrow. An early diagnosis was made and the patient was treated with combination chemotherapy and rituximab targeting CD20. The patient went into complete remission after the third cycle of chemotherapy and maintained a disease free state up to 6 months.

Recurrent Pneumomediastinum and Subcutaneous Emphysema Complicating Chronic Graft versus Host Disease after Allogeneic Bone Marrow Transplantation

Several noninfectious pulmonary complications can be associated with chronic graft versus host disease (GVHD). Obstructive airway disease can be a clinical feature of chronic GVHD and the histopathology reveals characteristic lesions of bronchiolitis obliterans. Bronchiolitis obliterans is an obstructive pulmonary disorder affecting the small airways, and it was first described as a late complication of allogeneic bone marrow transplantation (BMT). Spontaneous pneumomediastinum and subcutaneous emphysema can occur in the setting of severe bronchiolitis obliterans and only rarely are they the first sign of such disease. We describe here a case of a 27-year old woman who developed recurrent pneumomediastinum and subcutaneous emphysema that were secondary to the bronchiolitis obliterans that complicated chronic GVHD after allogeneic BMT.

A Case of Acupuncture-induced Infectious Sacroiliitis / 대한류마티스학회지

Infectious sacroiliitis is an uncommon disease and the diagnosis is very difficult due to unawareness of the disease. The predisposing conditions to the disease are pelvic trauma, respiratory or genitourinary infection, skin infection, pregnancy, endocarditis, intravenous drug abuser and recent dental manipulation. The clinical characteristics of the disease are fever, leukocytosis, pain and tenderness of buttock, gait disturbance and positive result of blood culture and imaging study of sacroiliac joint. To our knowledge, the acupuncture induced infectious sacroiliitis with bacteremia is one of the rarely reported cases. We have recently experienced a case of infectious sacroiliitis as a very unusual complication of the acupuncture. In this case, increased signal intensity in the SI joint was found in the MRI, and focal hot uptake in SI joint was observed in bone scan. Staphyolococcus areus were cultured in the blood sample. Under the diagnosis of infectious sacroiliitis with bacteremia, the antibiotics was administered, and the clinical symptoms and laboratory findings were completely improved. This case report emphasizes that an acupuncture is a predisposing factor of the infectious sacroiliitis with bacteremia.

Prevalence of Tardive Dyskinesia among the Hospitalized Schizophrenic Patients

OBJECT: This cross-sectional study was performed in order to evaluate the prevalence of tardive dyskinesia among the hospitalized schizophrenic patients. METHODS: Four hundred nineteen hospitalized schizophrenic patients(male=263, female=156) were recruited for this study. They were treated with antipsychotics for more than 3 months. The prevalence of tardive dyskinesia was assessed by the Abnormal Involuntary Movement Scale. RESULTS: The prevalence of tardive dyskinesia was 35.6%(Male=36.9%, Female 33.3%). There were no significant differences in the prevalence of tardive dyskinesia among male and female schizophrenic patients. The prevalence of tardive dyskinesia among the patients over 30years old was much higher than those below 30years old. There were no significant correlations between the prevalence of tardive dyskinesia and the duration of hospitalization, the total amount of antipsychotics. The frequently involved parts of the body in the schizophrenic patients who have tardive dyskinesia were tongue, upper extremity, lips and perioral area, jaw, lower extremity, muscles of facial expression trunk, respectively. CONCLUSIONS: There was significant correlation between the age and the prevalence of tardive dyskinesia in the antipsychotic-treated schizophrenic patients.

Two Cases of Membranous Glomerulopathy Associated with Psoriasis Vulgaris / 대한신장학회잡지

Membranous glumerulonephrophy was found in two men who were diagnosed as psoriasis vulgaris. In the first patient, membranous glumerulonephropathy was developed during treatment of psoriasis and deterioration of proteinuria was appeared with aggravation of skin lesion although treated with cyclophosphamide. In the second patient, psoriasis developed during treatment of membranous glomerulonephropathy and we observed the improvement of nephrotic syndrome and psoriasis with prednisolone treatment. The simultaneous deterioration and improvement of proteinuria and skin lesion of psoriasis suggests that underlying common immune abnormalities may be involved in the pathogenesis of both psoriasis and membranous glomerulopathy.

The Expression of ICAM-1, VCAM-1, & CD44 in Papillae of the Giant Papillary Conjunctivitis

Cell Adhesion Molecule(CAM) is a cell surface glycoprotein that plays an important role in many inflammatory reaction. This is responsible for the migration and accumulation of different populations of leukocyte in inflamed tissues. To investigate the relevance of CAM expression to giant papillary conjunctivitis associated with type I and/or type IV hypersensitivity, the histology of conjunctival giant papillae from patients with papillary conjunctivitis was examined with light microscopy and using indirect immunofluorescent staining method with monoclonal antibodies against the ICAM-1, VCAM-1, and CD44. The infiltrates of the inflammatory cells such as eosinophil, basophil, plasma cell and lymphocyte were noted in conjunctival stroma by light microscopy. The ICAM-1, VCAM-1, and CD44 were expressed or upregulated in stroma and vascular wall by immunofluorescent method. These findings suggest that CAM may play a key role in the pathogenesis of giant papillary conjunctivitis. Further efforts to block or modulate the expression of CAMs may provide new therapeutic modalities in the treatment of conjunctival disease.

A Case of Limbal Complex Choristoma Containing Cartilarge

Choristomas are defined as benign congenital overgrowth of normal tissues in an abnormal location, which can contain lacrimal gland, muscle, cartilarge, adipose tissue, nerve, epidermal appendage. There are many reports about choristoma but cartilarge containing choristoma is very rare. We experienced a 20-year-old healthy male patient complaining of mass on limbus. The diagnosis was limbal dermoid. After tumor removal, histopathologically it was proved as complex choristoma. It contains not only muscular tissue, adipose tissue, neural tissue but also cartilarge. We report this case because of the rarity of cartilarge containing choristoma.

The Changes of Marginal Epithelial Cells in Corneal Wound Healing

The changes of marginal epithelial cells in corneal wound healing were observed in a rabbit. The randomly assigned three eyes in the rabbits were extracted at first, third, and eighteenth day after full thickness epithelial removal, then observed under the electronmicroscope. At the 1st and 3rd day ,the thickness of the epithelium at the wound margin was reduced at the leading edge. These flattened epithelial cells showed ruffling and folding of the plasma membrane near free edge to form filopodia or lamellipodia processes, extending onto wound surface. Cytoskeletons reorganized and rearranged in leading edge. Basement membrane of the wound was relatively intact, but on which cellular debris were observed, and cell migration undergone and hemidesmosomes developed incompletely. In eighteenth day, basal cell recovered original cylindric shape, cytoskeletons was originally redistributed in cytoplasm after migratory phase, and hemidesmosome developed completely.

A Case of Corneal Opacity in X-linked Ichthyosis Patient

X-linked ichthyosis is a hereditary dermatosis characterized by large dark and thick scaly skin of trunk, extremities, scalp and neck. Rare manifested ocular signs include scales on lid and lashes, corneal opacity, lens opacity, and peripheral retinal granular hyperpigmentation. The authors experienced a case of diffuse punctate corneal opacities observed in the deep stroma or pre- Descemet's layer which developed in a 12-year old male patient who visited our clinic complaining symtoms of itching and dark thick scales on trunk, extremities, and scalp since at birth a.nd diagnosed as X-linked ichthyosis by clinical and histologic features.

Ocular Findings Associated with Long-term Chlorpromazine Therapy

Chlorpromazine has been widely used as anti-psychosis drug in psychiatry and its prolonged intake can cause pathologic changes in skin and eye preferentially. We performed ocular examinations on 17 patients(34 eyes) who have received long-term chlorpromazine therapy. In slit lamp biomicroscopic examination, changes on periocular skin, conjunctiva and retina could rarely be seen. However, deep punctate or granular corneal opacities were seen in 10 eyes (29.4%), anterior subcapsular stellate cataracts were seen in 12 eyes (35.3%) and photosensitive conjunctival injections were seen in 6 eyes (17.6%). Secretory function of tear decreased in 30 eyes (88.2%). Conclusively, in treating patients who have above findings of anterior segment, careful history taking about long term drug intake and periodic follow up are recommended.

A Case of Pleomorphic Adenocarcinoma (Malignant Mixed Tumor) of the Lacrimal Gland

Pleomorphic adenocarcinoma of the lacrimal gland is a rare malignant epithelial tumor. It is commonly metastasize to regional lymph node at early stage and sometimes to the lungs and bone. A 64-year-old man visited with complaints of progressive orbital protrusion and visual disturbance on his left eye for five months. CT scans demonstrated a huge mass on the superotemporal portion of the left orbit. Histopathological diagnosis of pleomorphic adenocarcinoma of the lacrimal gland was made. Bone scintigram and chest CT scans demonstrated distant metastases to the bone and lungs. We report a case of malignant mixed tumor of the lacrimal gland with mltiple distance metastases.

Case Report: Ocular sareoidoasis

Sarcoidosis is a multisystem granulomatous disorder of unknown etiology. The authors experienced a case of sarcoidosis in 22-year-old female who had palpable mass on left eyelid. Ocular examination revealed enlargement of lacrimal gland, anterior uveitis, iris nodule and abnormal fundus findings such as hyperemic disc with blurred margin, perivasculitis, vitreous himorrhage, and choroidal nodule. Systemic investigation yielded bilateral hilar lymphadenopathy and pulmonary infiltration, enlargement of multiple supraclavicular lymphnodes. Histologic findings of lacrimal gland revealed non-caseating epitheloid granuloma. In the course of corticosteroid therpy, above signs are subsided gradually, but exacerbated when she discontinued steroid because of the development of acne on the face. And so, we confirmed the sarcoidosis.