The concurrence of ankylosing spondylitis (AS) in a patient with mixed connective tissue disease (MCTD) is rarely described in the literature. Significant and sustained efficacy with tumor necrosis factor (TNF)-alpha blockers has been demonstrated in AS patients. However, evidence to date has revealed associated side effects, including antinuclear antibody induction and development of a lupus-like syndrome. Several authors have reported lupus-like manifestations in MCTD patients treated with TNF-alpha blockers used to control peripheral polyarthritis. In our case report, we demonstrate a good response to etanercept therapy for refractory sacroiliitis in a patient with coexisting AS and MCTD, without development of a lupus-like syndrome. This demonstrates that etanercept therapy may be an appropriate therapeutic agent for sacroiliitis in MCTD patients, as it is in AS alone.
Female ; Humans ; Immunoglobulin G/*therapeutic use ; Magnetic Resonance Imaging ; Middle Aged ; Mixed Connective Tissue Disease/complications/*drug therapy/*pathology ; Receptors, Tumor Necrosis Factor/*therapeutic use ; Sacroiliac Joint/*drug effects/*pathology ; Spondylitis, Ankylosing/complications/*drug therapy/*pathology ; Treatment Outcome

Behcet's disease (BD) is a systemic vasculitis involving diverse sizes of arteries and veins. We performed this study to evaluate the vascular changes by assessment of the arterial stiffness and intima-media thickness (IMT) of carotid artery in Korean patients with BD. Forty-one patients with BD and age-, and sex-matched 53 healthy subjects were recruited in this study. Carotid arterial stiffness and IMT were assessed by using high-resolution B-mode ultrasonography. Arterial stiffness parameters such as carotid arterial distensibility coefficient, stiffness index, and incremental elastic modulus (E(inc)) were significantly increased in BD patients compared with those in healthy subjects, but not in IMT. Positive relationship was noted between age and IMT, whereas age of onset was significantly associated with arterial stiffness in BD. This finding suggests impaired endothelial function before visible structural changes of arterial wall in BD. Age and age of onset may be an independent risk factor for carotid IMT and arterial stiffness, respectively. Further studies in more large populations are required to confirm our results.
Adolescent ; Adult ; Age Factors ; Arteries/pathology ; Behcet Syndrome/*diagnosis/*pathology ; Carotid Arteries/*pathology ; Carotid Artery Diseases/pathology ; Case-Control Studies ; Female ; Humans ; Korea ; Male ; Middle Aged ; Tunica Intima/pathology ; Tunica Media/pathology

To test the hypothesis that hyperinsulinemia and/or abnormalities of red cell membrane Na^+ transport are concerned in the pathogenesis of hypertension, we investigated the relationship between blood pressure, insulin level and red cell membrane Na^+ transport in patients with acromegaly which is frequently associated with hypertension, hyperinsulinemia and abnormalities of red cell membrane Na^+ transport.The results were as follows;1) BMI and both systolic and diastolic blood pressure were significantly higher in patients with acromegaly than in control subjects.2) Fasting glucose and insulin levels were higher, and both serum glucose and insulin responses after a 75g glucose load were significantly increased in patients with acromegaly as compared with control subjects.3) Vmax of Na^+-Li^+ countertransport were significantly higher in patients with acromegaly than in control subjects while red cell Na^+ concentration and Vmax of Na^+, K^+ ATPase were similar in the two groups.4) In multiple stepwise regression analysis, age was directly correlated with both systolic and diastolic blood pressure in acromegaly. On the other hand both insulin level and red cell membrane Na^+ transport showed little correlation with either systolic or diastolic pressure. 5) Prevalence of hypertension in acromegaly was 39%(9 out of 23) and only age except for blood pressure was significantly higher in hypertensive acromegalic patients than in normotensive acromegalic patients while GH level, insulin levels and red cell membrane Na^+ transport were similar in the two groupsThese results suggest that hyperinsulinemia or abnormalities of red cell membrane Na^+ transport are not causally related to hypertension in patients with acromegaly.
Acromegaly ; Adenosine Triphosphatases ; Blood Glucose ; Blood Pressure ; Cell Membrane ; Fasting ; Glucose ; Hand ; Humans ; Hyperinsulinism ; Hypertension ; Insulin ; Prevalence

The authors report two cases of recurrent transitional cell carcinoma at the anastomotic site of the ileal conduit and ureter after total cystectomy. In one patient, a recurrent tumor was also found in the distal ureter which had not been removed during previous nephrectomy. At follow up, the patients presented with gross hematuria or hydronephrosis, and the presence of mass lesions was demonstrated by intravenous urography,antegrade pyelography, and/or loopography. Transitional cell carcinoma was diagnosed by surgery and pathologic examination.
Carcinoma, Transitional Cell* ; Cystectomy ; Follow-Up Studies ; Hematuria ; Humans ; Hydronephrosis ; Nephrectomy ; Ureter* ; Urinary Bladder Neoplasms ; Urinary Diversion* ; Urography

No abstract available.
Glomerulonephritis, IGA* ; Immunoglobulin A*

BACKGROUND: Superficial fungal infections are common diseases acid the prevalence of superficial fungal diseases are not static but change under the influence of various forces such as climate, migration of peoples and development in prophylaxis and therapy. OBJECTIVE: To investigate the present status of superficial dermatiphytoses and some changes on the frequency of the diseases, sex distributions and varieties of the casiative organisms. MEHTODS: The clinical and rnycological aspects of superficial fungal diseases of 3,222 patients from July 1989 to June 1992 were analyzed. Results : 1) The incidence of superficial fungal diseases was 25.4% of total out-patients. 2) The superficial fungal diseases showed a higt incidence in the third(26.4%) and the fourth decade(24.3%). 3) The ratio of male to female was 2.11:1(2,188:1,034). 4) The monthly prevalence of super ficial fungal diseases was high inhuly(17.8%), August(15.2%) and June(1.7%). 5) The incidence of superficial fungal diseases in order of frequency were tinea pedis ,28.1%, tinea cruris(19.5%), onychomycosis(15.6%), tinen orporis(11.5%), tinea manus(7.8%), tinea versicolar(7.8%), candidiasis(7.4%) and tinea capitis(2.3%), 6) Coexisting fungal infections were found in 644 patients(19.9%) and the case of tinea pedis with onychomycosis was the most common. 7) The positive rate of KOH scraping was 54.0% and the positive rate of culture on ordinary Salourauds dextrose agar media was 42.7%. 8) Trichophyton rubr,im was the most common causative orantism of superficial dermatophytes(38.4%), and other in decreasing frequency were Candida albicans(36.9%), Trichophyton mentagrophytes(23.6%) Microsporum canis(0.7%), Trichophyton ferrvgiteum(0.3%) and Epidermophyton floccosum(0.1%). CONCLUSION: These results are not significantly different from those iif previous studies. But the incidence rate of the superficial pungal diseases(25.4%) were higher thar, previous studies and showed a high incidence in young male patients and in the summer. The positiv rate of KOH scraping(54.0%) was lower than previous studies. The most common causative organism was Trichophyton rubrum(38.4 %).
Agar ; Candida ; Climate ; Epidermophyton ; Female ; Glucose ; Humans ; Incidence ; Male ; Microsporum ; Onychomycosis ; Outpatients ; Prevalence ; Sex Distribution ; Tinea ; Tinea Pedis ; Trichophyton

We performed erotic stimulation that in 63 patients with erectile dysfunction in order to investigate erectile responses to visual sexual stimulation in patients with psychogenic and organic impotence and to elucidate valuable parameters for differential diagnosis between psychogenic and organic impotence. After the test using polygraph system and erotic film, subjective sexual drive in each patient was evaluated as grade I (poor), grade II (moderate), grade III (good). Following parameters were statistically analyzed : degree of maximal rigidity, degree of maximal tumescence, T -up phase (time taking place from the beginning of the erection to maximal level). The T-max phase (time taking place for the plateau phase of maximal erection). The results obtained were summarized as follows. Regardless of sexual drive of each patient, psychogenic impotence group showed better maximal rigidity and shorter T-up phase of rigidity than organic impotence group (p<0.05}. Of patients with psychogenic impotence, good sexual drive group showed better maximal rigidity and maximal tumescence than poor sexual drive group (p<0.06). Psychogenic impotence group showing good sexual drive revealed much better maximal rigidity and shorter T-up phase of rigidity than organic impotence group with same degree of sexual drive (p<0.05). These results indicate erotic stimulation test is highly valuable method for differential diagnosis between psychogenic and organic impotence, especially when the patient shows sexual drive in moderate or good degree. And it is suggested that maximal rigidigity and T-up phase of erection parameters in erotic stimulation test provide high validity for the differention.
Diagnosis, Differential ; Erectile Dysfunction* ; Humans ; Male

No abstract available.
Coronary Sinus*

Neurenteric cyst is an extremely rare developmental cyst of the central nervous system. It is lined withintestinal epithelium and is usually found in the subarachnoid space of the cervical and thoracic spine. We reporta case of intracranial neurenteric cyst in a 40-year-old man, and describe the MRI findings. This modality showeda large cyst, ventral to the pons and extending bilaterally to the cerebellopontine angles and craniovertebraljunction;its signal was hyperintense on both T-1and T2-weighted images and there is no enhancement on postcontrastT1-weighted images.
Adult ; Central Nervous System ; Cerebellopontine Angle ; Epithelium ; Humans ; Magnetic Resonance Imaging ; Neural Tube Defects* ; Pons ; Spine ; Subarachnoid Space

Self emasculation, defined as autocastration, penile amputation, dr both, is the end result of an unusual psychiatric disorder that falls into the category of self-mutilation, A case of penile and bilateral testicular replantation is reported in which a 25-year-old man suffered a self-inflicted complete penile and bilateral testicular amputation. Replantation of the penis was successful; 2 months after surgery, a urethrogram demonstrated no evidence of urethral stricture, and color duplex ultrasonography showed good blood flow intoboth dorsal arteries and deep dorsal to the amputation site. Although complete erection has not been obtained, no other functional impairments have been encountered in the 4 months since replantation. It was hoped that the testicles would function as a true endocrine organ. Unfortunately, the tissue did not remain viable and was replaced by fibrous tissue. Therefore, he has been given supplementary testosterone.
Adult ; Amputation* ; Arteries ; Hope ; Humans ; Male ; Microsurgery ; Penis ; Replantation* ; Testis ; Testosterone ; Ultrasonography ; Urethral Stricture