Nitroblue tetrazolium dye reduction test is now widely used for early detection of bacterial infection. Practically nitroblue tetrazolium dye reduction test (N.B.T. test) gives certain clue to rule out any possibility of aseptic inflammation. Authors performed N.B.T. test for 80 orthopaedic diseases and 40 controls, and the results were as followings: 1. Forty-one of 60 subjects with bacterial infection had more than 10% formazan positive neutrophils, and 18 of 20 subjects without bacterial infection showed less than 10%. formazan positive neutrophils, The groups of the elevated N.B.T. responses were mainly the subjects who had osteomyelitis, soft tissue inflammation, pyogenic arthritis, and bone and joint tuberculosis. 2. The mean proportion of N.B.T. positive neutrophils was 3.8±2.78% in 40 controls, 4.7±4.23% in 20 nonifectious group 12.7±10.3% in 12 chronic osteomyelitis, 12.5±10.7% in 15 treated bone and joint tuberculosis, 20.9±15.65% in 15 untreated bone and joint tuberculosis and 20±10.70% in 11 pyogenic arthritis and 7 other soft inflammatory group. 3. In noninfectious group, 7 of 8 subjects with elevated ESR and 3 of 4 subjects with elevated body temperature revealed N.B.T. responses less than 10%. 4. In 23 subjects with the elevated N.B.T. responses as well as leukecytosis, 22 subjects were the groups of bacterial infection and rest 1 was noninfectious in nature. 5. Therefore, the N.B.T. test is found to be useful for the purposes of the early diagnostic aid of the bacterial infection and differential diagnosis between bacterial infections and other diseases.
Arthritis ; Bacterial Infections ; Body Temperature ; Diagnosis, Differential ; Inflammation ; Neutrophils ; Nitroblue Tetrazolium ; Osteomyelitis ; Tuberculosis, Osteoarticular

Myasthenia gravis (MG) and inflammatory myopathy are both rare autoimmune disorders that present with signs of muscle weakness and can sometimes be accompanied by other connective-tissue diseases such as Sjogren's syndrome. However, the simultaneous occurrence of MG and inflammatory myopathy is very rare. We describe the case of a 68-year-old woman with MG occurring simultaneously with inflammatory myopathy in Sjogren's syndrome.
Aged ; Female ; Humans ; Muscle Weakness ; Myasthenia Gravis* ; Myositis* ; Sjogren's Syndrome*

A 41-year-old female complaining of easy fatigue, headache, thickened extremities and deepened facial folds was admitted to the hospital. As early as 6 years ago, she had been told by family members that her voice was changed and both hands was thickened. Cranial plain radiography indicated ballooning of sella turcica. Sella MRI disclosed 2.2cm sized pituitary tumor with suprasellar extension. The pituitary tumor with hypothalamic extension was removed via a transsphenoidal approach. The postoperative course was uneventful until hyponatremia with sudden headache and respiratory arrest was developed. The case was due to hyponatremic encephalopathy on the basis of the clinical course and symptoms, and 3% hypertonic saline was infused for 12 hours until the hyponatremia was corrected. We have experienced a mortality case of hyponatremic encephalopathy in which surgieal removal of a pituitary tumor from a female acromegalic patient in menstruant period was followed by the sudden occurrence of hyponatremia, which in turn was later associated with marked brain edema.
Adult ; Brain Edema ; Extremities ; Fatigue ; Female ; Hand ; Headache ; Humans ; Hyponatremia ; Magnetic Resonance Imaging ; Mortality ; Pituitary Neoplasms ; Radiography ; Sella Turcica ; Voice

Extensive dental erosion and wear will cause serious loss of function and aesthetics in the mouth. In order to recover this condition, careful analysis of the patient's bite relationship is required. In particular, a treatment plan should be established considering the possibility of reproduction of the vertical dimension and centric relation, and appropriateness of the occlusal plane and anterior guidance. Also, the choice of prosthetic materials is an important consideration in patients with severe wear. In this case, patients with overall wear and erosion on tooth was established anterior guidance by orthodontic treatment and fully restored with monolithic zirconia, without increasing vertical dimension.
Centric Relation ; Dental Occlusion ; Esthetics ; Humans ; Mouth Rehabilitation* ; Mouth* ; Prostheses and Implants* ; Reproduction ; Tooth Erosion* ; Tooth Wear ; Tooth* ; Vertical Dimension

BACKGROUND AND OBJECTIVES: Angiotensin-converting enzyme inhibitors have the effect of regression of left ventricular hypertrophy which has been known as the adverse prognostic factor in the cardiovascular diseases. There are some reports that patients having low ACE activity are prone to have the ACE inhibitorinduced cough. In this study we evaluate the difference of the regression of left ventricular mass according to ACE inhibitor induced cough. MATERIALS AND METHOD: Newly detected hypertensive patients (N=08) from Jan. 1994 to Dec.1997 without cough and other contraindications to ACEI were prospectively prescribed ACEI and followed up for two years whether they have experienced ACE inhibitor induced cough. Cough and non-cough group are analyzed the amount of regression of left ventricular mass by ECG. RESULTS: Left ventricular mass index decreases significantly from 128 38 to 11936 g/m2(deltaLVMI=9+/-22g/m2, p< 0.05), after ACE inhibitors had been used for two years. There is no difference between cough and non-cough group. When subgroup analysis has been done according to sex and the presence of the baseline left ventricular hypertrophy, LVH(+ group and female have the tendency of the larger amount of decreasing of LVMI than LVH(-) group and male respectively [LVH(+:LVH(-)=15+/-26:-3+/-15, M:F=12+/-24:-7+/-19]. After the adjusting of the influence of baseline LVM and sex, the amount of degree of LVMI regresssion in case of the men without baseline LVH is significantly different in cough and non-cough group. LVMI decreases significantly in non-cough group, but not in cough group. CONCLUSION: ACE inhibitors have the effect of the regression of LVMI by ECG. The amount of change of LVMI is greater in female and the patients with baseline LVH. In case of men without LVH, non-cough group has larger amount of decreasing of LVMI than cough group.
Angiotensin-Converting Enzyme Inhibitors ; Cardiovascular Diseases ; Cough* ; Electrocardiography ; Female ; Humans ; Hypertrophy, Left Ventricular ; Male ; Prospective Studies

BACKGROUND AND OBJECTIVES: This study was performed to assess long-term clinical outcome and restenosis rate after percutaneous mitral commissurotomy(PMC) and to identify the predictable factors influencing the clinical outcome and restenosis. METHOD: Patients underwent PMC at Seoul National University Hospital between August, 1988 and January, 1999(total 394 cases, mean follow-up duration: 75+/-32months) were enrolled. Successful PMC is defined as post-PMC mitral valve area(MVA) > or =1.5cm2 or > or =25% increase and MR < or =moderate. Restenosis is defined as MVA <1.5cm2 with > 50% reduction of initial gain. Major clinical events include repeated PMC, mitral valve replacement, stroke, and death. RESULTS: After PMC mitral valve area increased from 1.01+/-0.33cm2 to 2.23+/-0.89cm2. The 9-year event-free survival rate is 78%. The independent predictors of event-free survival rate are echocardiographic score(p=.0068) and post-PMC pulmonary artery systolic pressure(p=.0255). The 9-year restenosis-free survival rate is 44%. The independent predictors of restenosis-free survival are age(p=.0000), echocardiographic score(p=.0052) and post-PMC left atrial volume(p=.0445). For 10-year follow-up, average MVA loss is 0.24cm2: 0.17cm2 in patent group and 0.34cm2 in restenosis group. CONCLUSION: Percutaneous mitral commissurotomy as a treatment for patients with mitral stenosis is safe and achieves good long-term results.
Disease-Free Survival ; Echocardiography ; Follow-Up Studies* ; Humans ; Mitral Valve ; Mitral Valve Stenosis ; Pulmonary Artery ; Seoul ; Stroke ; Survival Rate

BACKGROUND: The aim of this study was to identify factors associated with mild cognitive impairment (MCI) in older Korean adults with type 2 diabetes mellitus. METHODS: A total of 226 older (age > or =65 years) adults without a history of cerebrovascular disease or dementia participated in this study. Cognitive function was assessed with the Montreal Cognitive Assessment-Korean version (MoCA-K). A MoCA-K score <23 was defined as MCI. RESULTS: The prevalence of MCI was 32.7%. In a logistic regression analysis, age (> or =74 years old vs. 65-68 years old; odds ratio [OR], 3.69; 95% confidence interval [CI], 1.55 to 8.82; P=0.003), educational background (college graduation vs. no school or elementary school graduation; OR, 0.16; 95% CI, 0.05 to 0.46; P=0.001), and systolic blood pressure (> or =135 mm Hg vs. < or =120 mm Hg; OR, 3.25; 95% CI, 1.29 to 8.17; P=0.012) were associated with MCI. CONCLUSION: More concentrated efforts focused on early detection and appropriate management of MCI may be required in older Korean adults with type 2 diabetes mellitus.
Adult* ; Blood Pressure ; Dementia ; Diabetes Mellitus, Type 2* ; Humans ; Logistic Models ; Mild Cognitive Impairment* ; Odds Ratio ; Prevalence

Primary systemic amyloidosis is a progressive disease that is frequently fatal. Nephrotic syndrome is present in almost one-third, congestive heart failure in one-quarter, and peripheral neuropathy in one-sixth of patients at the time of diagnosis. If heart or renal failure are presented, survival rate is poor. We experienced a case of a 66 year-old female patient who had complained lower leg edema and paresthesia of extremities for about 5 months. The laboratory findings were consistent with nephrotic syndrome, but the lower leg edema was non-pitting and the cause of paresthesia was unknown. We performed kidney and nerve biopsy and confirmed a case of primary systemic amyloidosis. In this case, presence of postural hypotension, probable cardiac involvement and relatively long spikes along the outside of the glomerular capillary loops on methenamine silver stain is suggestive of poor prognosis. We can predict chronic renal failure and congestive heart failure in the course of this case. We report a case of primary systemic amyloidosis predominantly presenting nephrotic syndrome and peripheral neuropathy with review of related literatures.
Aged ; Amyloidosis* ; Biopsy ; Capillaries ; Diagnosis ; Edema ; Extremities ; Female ; Heart ; Heart Failure ; Humans ; Hypotension, Orthostatic ; Kidney ; Kidney Failure, Chronic ; Leg ; Methenamine ; Nephrotic Syndrome* ; Paresthesia ; Peripheral Nervous System Diseases* ; Prognosis ; Renal Insufficiency ; Survival Rate

Colonoscopic examination is a safe procedure, however, unexpected complications can sometimes occur. Bleeding and perforation of the colon have been reported as the most common complications. Hemoperitoneum after colonoscopy is an unusual complication, but it may be catastrophic. We report on a 20-year-old man who experienced left low quadrant pain after undergoing colonoscopy. Hemoperitoneum was diagnosed using abdominal CT. A laparoscopic exploration was urgently performed, revealing a lacerated mesocolon of the descending colon. Bleeding of the injured site was controlled without complication. The patient recovered fully without signs of recurrent bleeding. This report implies that if the patient has persistent abdominal pain after undergoing colonoscopy, we should consider hemoperitoneum as one of the causes. To the best of our knowledge, no case of isolated laceration of the mesocolon of the descending colon after colonoscopy has been reported.
Colonoscopy/adverse effects ; Hemorrhage/etiology ; Humans ; Lacerations/*diagnosis/radiography ; Laparoscopy ; Male ; Mesocolon/blood supply ; Pneumoperitoneum/radiography ; Tomography, X-Ray Computed ; Young Adult

Sialadenosis is a unique form of non-inflammatory, non-neoplastic bilateral salivary gland disorder characterized by recurrent painless swelling which usually occurs in parotid glands. Alcoholism is one of the main causes of sialadenosis along with diabetes, bulimia, and other idiopathic causes. The prognosis is verified according to the degree of liver function. We present a case of a 46 year-old man who had alcoholic fatty liver disease diagnosed as alcoholic sialadenosis based on clinical points of recurrent bilateral parotid swelling after heavy alcohol drinking, computed tomography, and fine-needle aspiration biopsy. After stopping alcohol drinking and treated with conservative treatment, he got improved without specific sequela.
Adult ; *Alcohol Drinking ; Fatty Liver, Alcoholic/*diagnosis/etiology/radiography ; Humans ; Male ; Parotid Gland/*radiography/secretion ; Positron-Emission Tomography ; Sialadenitis/*diagnosis/etiology ; Tomography, X-Ray Computed