OBJECTIVE: Although the prevalence of pulmonary tuberculosis has decreased progressively after the national control program for tuberculosis began, nowadays the number of MDRTB is increasing seriously. MDRTB tends to be poor responsive to current antituberculosis regimens. It is mainly due to poor compliance, high rate of side reaction of secondary drugs, and limitation in number of available drugs. The purpose of present study is to evaluate the clinical features of pulmonary tuberculosis patients admitted in one national tuberculosis hospital and to expose the problems pertaining to current remedies, to increase the treatment efficacy for pulmonary tuberculosis including MDRTB in the end. METHOD: Retrospective analysis of 336 pulmonary tuberculosis patients admitted in National Masan Tuberculosis Hospital was done. Contents of analysis were patients profile, the first diagnosed time and medical institutes, family history, residence, previous treatment history, chief complaints at the time of admission, lesion site on chest X-ray film, combined deseases, side reaction to antibuberculosis drugs, used drugs before admission and the results of drug sensitivity test. RESULTS: The ratio between male and female was 4:1. Age showed relatively even distribution from 3rd to 6 th decades. 64.6% of the patients was diagnosed at public health center. Weight loss was the most common complaint at admission. Bilateral lesions on chest X-ray films were 59.8%. 1 30patients had combined desease, of which DM was the most common(37.7%). 95patients had family history, of which parents were the most common(41.7%). According to the time of first diagnosis, 31 patients were diagnosed before 1980, and after then the number of patients was increased by degrees Residence overwhelmed in pusan and gyung-nam province. 258 patients got previous treatment history, of which 112 patients(43.4%) had more than 3 times and only 133 patients(51.6%) got regular medication. 97 patients used more than other 3 drugs in addition to INH, EMB, RFP and PZA before admission. 154 patients were informed with the results of drug sensitivity test. of which 77 patients had resistance to more than 5 drugs. Gastrointestinal problem was the most common in side reaction to drugs. CONCLUSION: In the case of weigt loss of unknown cause, tuberculosis should be suspected. In first treatment, sufficient and satisfactory explanation for tuberculosis is necessary and treatment period should not be stict to 6 month-short term therapy. In retreatment, new drugs should not be added to used drugs enen though drug sensitivity restlts show sensitivity to some of them. Proper time for surgical intervention should not be delayed.
Academies and Institutes ; Busan ; Compliance ; Diagnosis ; Drug Resistance ; Female ; Hospitals, Chronic Disease* ; Humans ; Male ; Parents ; Prevalence ; Public Health ; Retreatment ; Retrospective Studies ; Thorax ; Treatment Outcome ; Tuberculosis* ; Tuberculosis, Pulmonary* ; Weight Loss ; X-Ray Film

Conjunctivochalasis is an isolated bilateral condition in which redundant conjunctival tissue overlies the lower eyelid margin or covers the lower pmctum. It produces tearing by mechanical obstruction of the lower punctum and/or mechanical disruption of normal outflow of the lacrimal film. A modified surgical technique, simple local excision of redundant conjuctiva in the crescent shape along the plica semilunaris and the lower bulbar conjunctiva between limbus and lower fornix, relieved epiphora in two male patients with redundant conjunctiva near the lower punctum. Surgery was done under the local anesthesia without postoperattve complications. Authers emphasize the importance of careful examination of conjunctivochalasis during ocular examination of patient complaining tearing.
Anesthesia, Local ; Conjunctiva ; Eyelids ; Humans ; Lacrimal Apparatus Diseases ; Male

The rectal prolapse syndome is a disease entity includes rectocele and rectal prolapse, presenting prolapse(procidentia) of rectum. In rectocele, rectum is prolapsed anteriorly into the vagina, whereas in procidentia, inferiorly out of the anus. This study was aimed at analyzing pathogenesis and adequacy of surgical treatment in rectocele and rectal prolapse. Twenty-one patients with rectocele and 18 patients with rectal prolapse were assessed pre- and post-operatively in respect to symptoms and signs, pathogenesis, defecography, and manometry. In analysis of symptoms and sings, constipation was the commonest in both diseases(86% of rectocele and 67% of rectal prolapse) and incontinence was not infrequently found in both diseases as well(14% of rectocele and 33% of rectal prolapse). In analysis of the underlying causes, two patients with rectal prolapse had prolapse from childhood. Defecography showed anorectal angle of rectal prolapse in rest and push period. They were significantly wider than those of rectocele(p<0.05). The perineal descent of rectal prolapse was longer than that of rectocele. In analysis of the associated factors, average number of delivery was more than three times in both diseases(3.5 of rectocele and 5.1 of rectal prolapse). We could easily find previous operation history in both diseases. Among them, hysterectomy was the most frequent, especially in patients with rectocele. The hemorrhoids was associated more common in rectocele than in rectal prolapse(p<0.05). Preoperative maximal resting pressure of rectal prolapse was more significantly decreased than that of rectocele(p<0.05). The sensation of fullness was significantly decreased in patients with rectal prolapse postoperatively(p<0.05). Patients with rectocele underwent levator plication by transrectal or vaginal approach. Patients with rectal prolapse underwent posterior rectopexy in 11 patients, resection and rectopexy in 3 patients, Delorme's operation and Thiersch operation in 2 patients each. Constipation was significantly improved in patients with rectocele postoperatively(p<0.05). Incontinence was markedly improved in patients with rectal prolapse postoperatively(p<0.05). At the interview about subjective improvement of symptom, 95% of patients with rectocele and 89% of patients with rectal prolapse were satisfied with surgery. In conclusion, rectocele and rectal prolapse can be categorized as rectal prolapse syndrome because both diseases have anatomical derangements caused by similar pathogenesis such as altered bowel habits, anatomical factor, delivery, past history of hysterectomy, and hemorrhoids. Levator plication and posterior rectopexy seem to be useful surgical methods of anatomical repair for the respective disease.
Anal Canal ; Constipation ; Defecography ; Hemorrhoids ; Humans ; Hysterectomy ; Manometry ; Prolapse ; Rectal Prolapse* ; Rectocele ; Rectum ; Sensation ; Vagina

Lenticular bum can occur as complication after laser iridotomy or retinal photocoagulation. Some authors have, indeed, reported the cases in which focal lenticular opacity developed after laser iridotomy or retinal photocoagulation. Fortunately, it was not progressive in short-term follow up study. When argon laser beam penetrates ocular media, a portion of it is absorbed by lens. So visible lenticular opacity is not developed after argon retinal photocoagulation if lens is clear. But it is not known whether subclinical lenticular opacity can occur after argon laser retinal photocoagulation. We focused argon laser beam onto anterior lens capsule in 35 black and brown rabbit and evaluated development of subclinical lenticular opacity with densitometer 1 and 8 weeks later. We also analyzed lens protein 1 week later. Argon laser energy used was below 20 Joules. The following results were obatined. 1. Lenticular opacity was detected by densitometer in all cases, but it was not detected by slit-lamp. 2. Amount of lenticular opacity was in direct proportion to argon laser energy(p<0.001). 3. Lenticular opacity detected on the 1st week by densitomer was not detectable on the 8th week. 4. The lens protein changes of senile cataract were not found in the lenticular opacity detected on the 1st week.
Argon* ; Cataract ; Follow-Up Studies ; Light Coagulation* ; Retinaldehyde*

Patients admitted with the clinical symptomatology of a progressive myelopathy associated with radiologic findings compatible with spondylotic degeneration of the cervical spine and who manifest appropriate neurophysiological abnormalities should be considered as candidates for surgical treatment. The authors have undertaken a study of 20 patients who had received decompressive surgical procedures and possible follow up studies for CSM, which was defined as a myelopathy related to osteophytic overgrowth and ossification of posterior longitudinal ligament(OPLL) in the cervical spinal canal causing impingement upon the spinal cord from Sep.93. To Aug. 1995. It was concluded with the following results. 1) man was exclusively prevalent in most cases. 2) age at surgery: There was a signigicant negative correlation between the age at surgery and the recovery rate. 3) Original cause of compression: There was no signigicant difference between the CSM and OPLL. 4) The involved level : three level involvement was the most common(8cases), followed by two level(6 cases), four level(3 cases), and single level(2 cases). There was no correlation between the preoperative Harsh scale and the number of the involved level. 5) Recovery rate: excellent(Grade O.I). 12 cases(60%), good(Grade II, IIIA), 4 cases(20%), poor(Grade IIIc, IV, V), 4 cases(20%).
Follow-Up Studies ; Humans ; Ossification of Posterior Longitudinal Ligament ; Spinal Canal ; Spinal Cord ; Spinal Cord Diseases* ; Spine

The cell surface glycoprotein CD44 is a kind of adhesion molecule, which binds hyaluronic acid, type I collagen and fibronectin. Although there have been numerous reports on the expression and the function of CD44 in lymphocytes and macrophages, very little is known about its distribution and definite role in epithelial tissue, especially in oral epithelial one. The present study was performed to investigate the distribution and expression of the CD44 in human gingiva and squamous cell carcinoma(SCC) arising in human gingiva. And the authors compared CD44 expression with histopathologic grade of SCC. The results were as follows: 1. The CD44 was strongly expressed in granular, spinous and basal layers of normal marginal and attached gingiva, in spinous and basal layers of normal sulcular gingiva, and in all epithelial layers of normal junctional gingiva. 2. In SCC of gingiva, the CD44 was expressed in all but one case. In most of the cases the CD44 was expressed at cell membrane and the degree of expression was relatively strong. 3. In low-grade SCC of gingiva, the CD44 was strongly expressed, especially at the basal and spinous layers of abundantly keratinized cancer nests. In high-grade SCC of gingiva, the CD44 expression tended to be weak but was strong at cells showing individual keratinization. This study suggest that the CD44 expression of normal and cancerous gingival epithelium is associated with the degree of proliferation and differentiation of epithelial cells.
Carcinoma, Squamous Cell* ; Cell Membrane ; Collagen Type I ; Epithelial Cells ; Epithelium ; Fibronectins ; Gingiva ; Humans ; Hyaluronic Acid ; Lymphocytes ; Macrophages ; Membrane Glycoproteins

Cyanosis in children is most often caused by pulmonary disease, or cyanotic heart disease but is rarely caused by hematological problems such as methemoglobinemia and sulfhemoglobinemia. Abnormal hemoglobins with a reduced oxygen affinity are an exceptionally uncommon cause of cyanosis in children. Hemoglobin-M (Hb-M) is rapidly auto-oxidized into the met-form resulting in the loss of its O2-binding ability. This hemoglobinopathy is inherited in an autosomal dominant pattern and is characterized by marked cyanosis. Hb-M affects the anesthetic management because of the anomalous absorption spectrum of Hb-M in standard pulse oximetry. Sufficient O2 delivery should be maintained by keeping a high FiO2 and intermittently checking the O2 delivery state using arterial blood gas analysis. We reported our experience of the anesthetic management of a patient with hemoglobin M.
Absorption ; Blood Gas Analysis ; Child ; Cyanosis ; Heart Diseases ; Hemoglobin M ; Hemoglobinopathies ; Hemoglobins, Abnormal ; Humans ; Lung Diseases ; Methemoglobin ; Methemoglobinemia ; Oximetry ; Oxygen ; Sulfhemoglobinemia

Solitary choroidal tubercle is rare disease nowadays although it was frequently reported in the old literatures. It is characterized by indefinite yellowish-white round nodule in the posterior pole of the eyeball in young adults with inactive disease. It is sometimes protruded toward vitreous cavity with retinal necrosis, vitreous opacity and cyclitis. Authors experienced a case of solitary choroidal tubercle which had been misdiagnosed as a malignant melanoma. We confirmed it by pathologic findings.
Choroid* ; Humans ; Melanoma ; Necrosis ; Rare Diseases ; Retinaldehyde ; Tuberculoma* ; Young Adult

No abstract available.
Vasodilation*

BACKGROUND: Nowadays drug resistant tuberculosis is making problems in the treatment of pulmonary tuberculosis and its number is increasing. Several reasons for this are considered including irregular medication, poor drug compliance and wrong regimens. But there are treatment failure cases in spite of regular medication with short-term standard regimens. We reviewed clinical data of 50 patients to find out possible causes of this. METHODS: Subject of this study was 50 patients who failed in the primary treatment of pulmonary tuberculosis in spite of regular medication with short-term standard regimens. All of them were under treatment with secondary regimens in National Masan Tuberculosis Hospital on Oct. 1996. The patient's records were analyzed retrospectively and direct interviews with patients were done. RESULTS: There were relatively more patients in the age of 20th. Male overwhelmed in number. There were smoking in 22 patients and drinking in 24 patients during medication. 17(34%) patients had family history of tuberculosis. Public health center was the most common site for the initial diagnosis among medical institutes. 42 patients had subjective symptoms for pulmonary tuberculosis. 38 patients got sufficient explanation from medical institute about tuberculosis and medication courses. 24 patients had bilateral lesions on chest X-ray film and 43 patients had cavitary lesions. 29 patients had past history for pulmonary tuberculosis with regular medication. The results of drug sensitivity test showed resistance in 41 patients of whom we could get the results CONCLUISON: Main cause of treatment failure of pulmonary tuberculosis in spite of regular medication with short-term standard regimens was drug resistance. Several factors were considered to be related to high prevalence of drug resistance, including age of 20th, male, family history for tuberculosis, bilateral lesions or remaining cavitary lesion on chest X-ray film.
Academies and Institutes ; Compliance ; Diagnosis ; Drinking ; Drug Resistance ; Hospitals, Chronic Disease ; Humans ; Male ; Prevalence ; Public Health ; Retrospective Studies ; Smoke ; Smoking ; Thorax ; Treatment Failure* ; Tuberculosis ; Tuberculosis, Pulmonary* ; X-Ray Film