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: Hypertension and age are recognized as important risk factors for left ventricular (LV) diastolic dysfunction. Some studies have shown that diabetes itself may also be an independent risk factor for LV diastolic dysfunction, although this is controversial. The aim of this study was to determine the factors associated with LV diastolic dysfunction in patients with type 2 diabetes in the absence of hypertension or ischemic heart disease (IHD). METHODS: Participants in this study consisted of 65 type 2 diabetes patients (M : F = 45 : 20; mean age 51 [26 to 76] years; mean body mass index [BMI] 25.0 +/- 2.5 kg/m2) without hypertension, heart disease, or renal disease. Individuals with ischemic electrocardiographic changes were excluded. LV diastolic function was evaluated by Doppler echocardiographic studies. RESULTS: Fifteen patients (23.1%) showed LV diastolic dysfunction on Doppler echocardiographic studies. Patients with LV diastolic dysfunction were older than those without diastolic dysfunction (60.0 +/- 2.5 vs. 50.5 +/- 1.9 years; P < 0.01). After adjusting for age and sex, BMI was higher (26.6 +/- 0.7 vs. 24.6 +/- 0.3 kg/m2; P < 0.01) and diabetes duration was longer (9.65 +/- 1.48 vs. 4.71 +/- 0.78 years; P < 0.01) in patients with LV diastolic dysfunction than in those without diastolic dysfunction. There were no differences in sex, smoking, blood pressure, lipid profiles, hemoglobin A1C, fasting glucose, fasting insulin, or diabetic microvascular complications between the LV diastolic dysfunction group and the normal diastolic function group. After adjusting for age, sex, and BMI, diabetes duration was found to be independently associated with LV diastolic dysfunction (odds ratio 1.38; confidence interval 1.12 to 1.72; P = 0.003). CONCLUSION: These results suggest that diabetes duration may be a risk factor for LV diastolic dysfunction in type 2 diabetic patients without hypertension or IHD.
Blood Pressure ; Body Mass Index ; Diabetes Mellitus ; Electrocardiography ; Fasting ; Glucose ; Heart Diseases ; Hemoglobins ; Humans ; Hypertension ; Insulin ; Myocardial Ischemia ; Risk Factors ; Smoke ; Smoking

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

OBJECTIVE: To investigate the association between bone mineral density (BMD) and osteoporotic compression fractures in radiographic spinal osteoarthritis (OA) patients. METHODS: Subjects were 382 female patients (ages 45 to 85) from outpatient clinic for osteoporosis and rheumatic diseases. BMD was measured at lumbar spine and hip by dual X-ray absorptiometry (Hologic QDR 2000). The standard anteroposterior and lateral plain radiographs of thoracic and lumbar spine were taken to define spinal OA and vertebral compression fractures. Radiographic spinal OA was defined by grade of disc degeneration and facet joint degeneration. Frequency of vertebral fractures was compared between spinal OA and control patients in relation to their BMD, age, weight, body mass index (BMI) and years post menopause. RESULTS: Higher proportion of fracture cases were observed in spinal OA patients than non-spinal OA patients (34.1%, 44/129 vs. 18.2%, 46/253, p<0.001) despite comparable mean BMD (0.836+/-0.152 vs. 0.834+/-0.185, p=0.89) and older mean age (65.8+/-8.5 vs. 57.8+/-10.3, p<0.001). In subjects of ages from 65 to 74, spinal OA patients showed significantly higher BMD than non-spinal OA patients (0.784+/-0.125 vs. 0.719+/-0.119, p=0.007), but the frequency of fractures seems to be higher than that of non-spinal OA patients (44.9%, 22/50 patients vs. 34%,19/55 patients, p=0.58). When all study subjects were stratified according to their spine BMD (normal, osteopenia, and osteoporosis), significantly higher proportion of vertebral compression fractures was noted in spinal OA than non-spinal OA patients in osteopenia group (38.5% vs. 13.5%, p<0.001). CONCLUSION: Higher BMD does not seem to be translated directly into decreased risk of osteoporotic compression fractures in spinal OA patients. Careful assessment of risk factors for osteoporotic fractures and newer methods for assessing bone strength in this group of patients are needed.
Absorptiometry, Photon ; Ambulatory Care Facilities ; Body Weight ; Bone Density* ; Bone Diseases, Metabolic ; Female ; Fractures, Compression* ; Hip ; Humans ; Intervertebral Disc Degeneration ; Osteoarthritis, Spine* ; Osteoporosis ; Osteoporotic Fractures ; Postmenopause ; Rheumatic Diseases ; Risk Factors ; Spine ; Zygapophyseal Joint

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

PURPOSE: Hepatocyte growth factor (HGF) stimulates proliferation, migration, and morphogenesis of epithelial cells by specifically binding to its receptor c-met. Abnomalities of the c-met oncogene have been studied in cancers of many organs including thyroid, lung, pancreas, and stomach. However, little is known about the clinical significance of c-met oncogene abnormalities in colorectal carcinomas. In this study, we investigated over- expression of the c-met protein in colorectal adenomas and adenocarcinomas, and analyzed the clinicopathologic significance of this over-expression. METHODS: Expression of the c-met protein localized in colorectal adenoma and adenocarcinoma tissues was analyzed by using immunohistochemistry. The results were compared with clinicopathologic parameters to find clinical correlation. RESULTS: c-met protein was detected in 42.5% (17/40) of colorectal cancers and in 10.0% (4/40) of colorectal adenomas (P= 0.001). In colorectal cancer, the proportion of expression of c-met protein was 0% (0/40) in stage I, 47.6% (10/40) in stage II, 53.8% (7/40) in stage III and, 0% (0/40) in stage IV. c-met protein expression was 18.8% (3/40) in tumors with invasion into the muscularis propria (MP), and 58.3% (14/40) in tumors with invasion beyond the MP. The depth of tumor invasion was a statistically significant factor (P=0.022) for c-met expression. CONCLUSIONS: The c-met protein expression was related to the depth of invasion of colorectal cancer and showed a significant difference in its rate of expression between adenoma and adenocarcinomas.
Adenocarcinoma ; Adenoma* ; Colorectal Neoplasms* ; Epithelial Cells ; Hepatocyte Growth Factor ; Immunohistochemistry ; Lung ; Morphogenesis ; Oncogenes ; Pancreas ; Stomach ; Thyroid Gland