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 discern whether the vasodilatory response of pulmonary artery pressure could be predicted by the right ventricular (RV) pressure waveforms, and therefore, from continuous wave Doppler signals of tricuspid regurgitant jet (CWTR). SUBJECTS AND METHODS: Twelve patients with pulmonary hypertension who underwent cardiac catheterization were enrolled. Nitroprusside was infused at a dose of 0.5 microgram/kg/min, with the dosage being increased by 0.5 microgram/kg/min every 5 minutes to a maximum of 4 microgram/kg/min. Cardiac output (CO), pulmonary vascular resistance (PVR), peak systolic RV pressure (Pp), RV pressure at the inflection point (Pi), deltaP (Pp-Pi) and CWTR were obtained before and at the end of the nitroprusside infusion. A positive response to the vasodilator was defined when there was > or =20% change in the mean pulmonary artery pressure at the end of the nitroprusside infusion. RESULTS: Eight patients did not show a positive response (Group 1) while four patients did (Group 2). Mean decrements in Pp following the nitroprusside test were 4.1+/-7.7 mmHg in group 1 and 27.8+/-5.6 mmHg in group 2. There were no significant differences between groups 1 and 2 in baseline CO, PVR or Pp. However group 1 had a significantly higher deltaP than group 2 (29.0+/-10.5 mmHg vs. 13.3+/-3.0 mmHg, p<0.05). In the configuration analysis of CWTR, the slope between the inflection point and peak velocity was linear in group 1, while there was an indentation in group 2. CONCLUSION: Patients with a small difference between Pp and Pi tend to be reactive to a vasodilator and this tendency can be predicted from the configuration of CWTR.
Cardiac Catheterization ; Cardiac Catheters ; Cardiac Output ; Humans ; Hypertension* ; Hypertension, Pulmonary ; Nitroprusside ; Pulmonary Artery* ; Tricuspid Valve Insufficiency ; Vascular Resistance ; Ventricular Pressure*

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

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

BACKGROUND AND OBJECTIVES: The reported incidence of angiotensin converting enzyme inhibitor-induced cough ranges widely from 1.3% to 44% in many studies, depending upon methods of data collection, analysis, symptom reporting, and race. Risk factors of ACE induced cough is not well recognized. We evaluated the incidence of ACEI-induced cough and risk factors including ACE gene polymorphism that partially determine ACE activity in hypertensive patients. MATERIALS AND METHOD: New hypertensive patients (N=56, F:M=96:160) from Jan. 1994 to Jul. 1998 at Seoul National University Hospital were prospectively prescribed ACEI and followed up for one year observing the occurrence of cough. Cough group is defined as reproduced cough after ACEI therapy without evidence of any other cause of cough and cough stops within 4 weeks after withdrawal. Non-cough group is defined as not developing cough during 12 months with ACEI. Differences between two groups are analyzed in clinical factors and ACE gene polymorphism. RESULTS: Cough developed in 144 patients (40%, 144/356) after ACEI administration. The cough incidence was not statistically different between ACEIs; 34%(19/58) for captopril, 38%(61/161) for enalapril, and 47%(64/137) for perindopril. In univariate analysis, the frequencies of female gender and non-smokers were significantly higher in the cough group than non-cough group than non-cough group(M:F =43:101 vs 116:95, p<0.001, OR 2.87 ; non-smoker : smoker =124:18 vs 166:46, p<0.05, OR 1.91, cough vs non-cough group, respectively). However, ACE gene polymorphism does not have an association with cough (I/I:I/D:D/D=6:44:31 vs 74:76:37, p=S; I:D=.59:0.41 vs 0.60:0.40, p=S, cough vs non-cough group, respectively). In multivariate analysis, female gender is the only significant risk factor for cough. Though adjusting of age, sex, and smoking status between two groups, ACE gene polymorphism was not associated with cough. (II:ID:DD=7:22:18 vs 23:30:14, p=NS). CONCLUSION: The incidence of ACEI-induced cough is higher in Koreans than that of previously reported in Caucasians. Our present study suggests The significant risk factors for ACEI-induced cough in Korean are female gender(cough incidence 50%, 93/196) and non-smoking status rather than ACE gene polymorphism.
Captopril ; Continental Population Groups ; Cough* ; Data Collection ; Enalapril ; Female ; Humans ; Hypertension* ; Incidence ; Multivariate Analysis ; Peptidyl-Dipeptidase A ; Perindopril ; Prospective Studies ; Risk Factors* ; Seoul ; Smoke ; Smoking

Hemorrhagic fever with renal syndrome frequently found in Korea is a acute infectious disease caused by Hantaan virus. Its clinical manifestations include high fever, cardiovascular collapse, hemorrhagic tendency and acute renal failure. Many patients with hemorrhagic fever with renal syndrome show hemorrhagic tendency such as subconjunctival hemorrhage and mucocutaneous petechia. In vital organs such as lung, kidney, spleen, brain, and pituitary, hemorrhage occasionally occurs spontaneously or by minor trauma. As a results, hematemesis, hemoptysis, melena and gross hematuria can be developed in some patients. Anemia and circulatory shock may result from large hematoma formed in third spaces like retroperitoneal and pleural space. But retroperitoneal hematoma and hemothorax was rarely reported. We report a case of hemorrhagic fever with renal syndrome complicated by retroperitoneal hematoma and hemothorax with review of literatures.
Acute Kidney Injury ; Anemia ; Brain ; Communicable Diseases ; Fever ; Hantaan virus ; Hematemesis ; Hematoma* ; Hematuria ; Hemoptysis ; Hemorrhage ; Hemorrhagic Fever with Renal Syndrome* ; Hemothorax* ; Humans ; Kidney ; Korea ; Lung ; Melena ; Shock ; Spleen