We compared the efficacy of each modality of treatment group in reducing the frequency of coronary artery abnormalities and change of clinical courses in children with Kawasaki disease in the children of 81 cases who were admitted in pediatric department of Yeungnam University Hospital from September 1985 to August 1990. Group A (37 cases)-aspirin alone, Group B (44 cases)-intravenous gammaglobulin (400 mmg/kg/day) for 5 consecutive days, plus aspirin. We studied the frequency of echocardiographic abnormalities, the duration of fever, and changes in the total white blood cell counts, platelet counts, ESR and CRP value at 1, 2 and 3 weeks of the illness and compared the results between the two groups. The results were as follows. 1) There was no significant intergroup difference in age and sex ratio. 2)The duration of the febrile period after the initiation of the therapy was significant shorter in group B (2.5±1.2days) than in group A: (5.2±3.5 days) (p<0.01). 3) No significant difference was noticed in the WBC and platelet counts in two groups as measured at admission day, 1 and 2 weeks of the illness, however, at 3weeks of illness significant difference was noted. 4) The CRP values measured at 1,2 and 3 weeks after treatment were significantly lower in group B (2.42±1.8, 2.00±1.2, 1.16±1.0) than in group A (7.22±5.3, 5.25±3.9, 1.85±1.2) respectively (p<0.01). 5) In 2D-Echocardiogram, coronary artery dilatation was more frequent in Group A than in Group B at 6month of illness (p<0.01). In conclusion, intravenous gammaglobulin therapy was effective in the shortening of the duration of fever and in the anti-inflammatory action and somewhat effective in prevention of coronary artery aneurysm.
Aneurysm ; Aspirin* ; Child ; Coronary Vessels ; Dilatation ; Echocardiography ; Fever ; Humans ; Leukocyte Count ; Mucocutaneous Lymph Node Syndrome* ; Platelet Count ; Sex Ratio

Richer's syndrome is a development of a high grade malignant lymphoma in a patient with preexisting chronic 1ymphocytic leukemia, small lymphocytic lymphoma or Waldenstrom's macroglobulinemia. A rare case of Richer's syndrome arising in the spleen of a 35-year-old-man was studied by morphology, immunohistochemistry and gene rearrangement study. He has had weight loss and night sweat for last 6 months. Hepatosplenomegaly and abdominal lymphadenopathy were noted on CT scanning. Especially an ovoid radiolucent mass was found within the image of splenomegaly. Lymph nodes and liver biopsy, bone marrow aspiration and splenectomy were done. In the lymph nodes, liver and bone marrow, well differentiated small lymphocytic infiltrations were found but, in the spleen, pleomorphic, large cells with occasional multinucleated giant cells formed a nodular mass surrounded by diffuse, extensive infiltration of small well differentiated lymphocytes. The two distinctive areas in the spleen had positive staining for B-cell marker (HLA-DR and L26), negative staining for T-cell marker (UCLH1), and positive staining for IgM heavy chain and kappa light chain by immuohistochemical study. so this case was diagnosed as a diffuse large cell 1ymphoma transformed from small lymphocytic lymphoma. We made an another effort to clarify their clonality. Gene rearrangement method usingcomplementarity.determining region 3(CDR3) of immunoglobulin heavy chain (IgH) gene and T-cell receptor gamma (TCRgamma) gene by polymerase chain reaction (PCR) technique was done. The two lymphomas in the spleen demonstrated the same rearrangement pattern in both IgH and TCRgamma gene. We think these findings strongly suggest that the large cell lymphoma has the same clonality with that of the small lymphocytic lymphoma.
Male ; Humans

Appendiceal diverticula are uncommon lesions. A retrospective study of appendiceal diverticula was done for 1379 appendectomies is performed from June 1991 to May 1996. Thirty-six cases (2.6%) of appendiceal diverticula were found. Only one case was detected operatively; the rest of them were diagnosed pathologically. These thirty-six cases have been classified into three groups: 23 cases of primary appendiceal diverticulitis, 8 of secondary appendiceal diverticulitis, and 5 of simple diverticulosis. The clinical manifestations of primary appendiceal diverticulitis were different from those of typical acute appendicitis. Primary appendiceal diverticulitis was seen mainly after the fourth decade of life. The pain came on rather insidiously and seemed to extend over a longer period. A history of previous attack was frequent. The rate of perforation in primary appendiceal diverticulitis was 78.2%.The false form of appendiceal diverticula was more common in most series. Also, no case was detected in appendectomies performed on many patients under 10 years of age with a diagnosis of appendicitis. They seemed to develop after birth and were seen frequently along the mesenteric border. The rate of mucosal hyperplasia in appendiceal diverticula was 61.1%, higher than that for appendicitis. Vascular hiatus between muscular bundles along the mesenteric side, and the mesenteric covering over the diverticula, as well as the inability of false diverticula to endure high intraluminal pressures, seem to be pathophysiologically associated with the cause and the high perforation rate in appendiceal diverticula. The clinical picture and the pathologic findings of primary appendiceal diverticulitis are definitely different from those of acute appendicitis. We suggest primary appendiceal diverticulitis be regarded as a clinical entity, not a variant of acute appendicitis. The patient with atypical right lower quadrant pain should be examined with this diagnosis in mind.
Appendectomy ; Appendicitis ; Diagnosis ; Diverticulitis* ; Diverticulum ; Humans ; Hyperplasia ; Parturition ; Retrospective Studies

OBJECTIVE: To analyze the efficacy of intracytoplasmic sperm injection (ICSI) for totally unfertilized oocytes by the conventional insemination during in vitro fertilization and embryo transfer (IVF-ET) METHODS: From March 1996 to April 1998, 15 couples who experienced total fertilization failure after conventional IVF without severe male factor infertility in semen analysis were evaluated. Fertilization were assessed by the presence of 2 pronucleus (PN) after 14-16 hours of conventional insemination. All unfertilized oocytes were reinseminated by ICSI and checked for signs of fertilization between 6-10 hours after ICSI. The embryos with fertilization and development were transferred to the uterine cavity and the outcome was analyzed. RESULTS: Total numbers of unfertilized oocytes were 120, and total numbers of oocytes injected on day 1 using ICSI were 102. Total numbers of oocytes with normal fertilization after ICSI were 74 and mean fertilization rate of 71.1 +/- 24.0% was obtained. The numbers of embryos transferred was 3.6 +/- 1.7. The biochemical pregnancy rate was 13.3% (2/15) and the clinical pregnancy rate was 6.7% (1/15) per cycle. CONCLUSION: ICSI to totally unfertilized oocytes by conventional insemination technique during IVF-ET on the next day of oocyte retrieval seems to be a relatively successful mean and afford a chance of pregnancy to the infertile couples whom the ET could not perfomed to because of total fertilization failure."
Embryo Transfer ; Embryonic Structures ; Family Characteristics ; Fertilization ; Fertilization in Vitro ; Humans ; Infertility ; Insemination ; Male ; Oocyte Retrieval ; Oocytes* ; Pregnancy ; Pregnancy Rate ; Semen Analysis ; Sperm Injections, Intracytoplasmic*

We presented two cases of entrapment neuropathy which were confused with herniated lumbar disc syndrome. One was "meralgia paresthetica in association with lumbar disc herniation", and "the other inguinal neuritis along with obturator neuritis". Syndromes of these entrapment neuropathies were confirmed by subcidence of pain and creation of progressively longer pain-free intervals after analgesic blocks of the corresponding nerves by infiltration of Xylocaine and prednisolone.
Lidocaine ; Nerve Compression Syndromes ; Neuritis ; Prednisolone

Although there are differences in the mode of onset, symptomatology and clinical course in the various types of cerebrovascular lesions, the general picture may be quite similar and it is often difficult to determine the nature of the lesion in any individual case from the clinical data. In the vast majority of cases the symptoms of a cerebrovascular accident are of sudden onset and reach maximum intensity within few minutes or a few hours at the most. Locksley, et al. have reported autopsies on people who died from spontaneous intracerebral or subarachnoid hemorrhage, and they found that a primary or metastatic brain tumor was the cause of hemorrhage in only 2%~3% of their necropsy. We presented our experience with two such patient whose clinical pictures before the surgery were quite similar with those of cerebrovascular accident. Cases with a large chronic subdural hematoma and cerebral glioblastoma multiforme demonstrated a sudden and dramatic onset of coma and focal neurological symptoms immediately before admission to the hospital. The responsible mechanism or etiology for the mode of such sudden dramatic onset of symptoms may be derangement of intracranial pressure mechanism and sudden hemorrhage in the tumor.
Autopsy ; Brain Neoplasms ; Coma ; Glioblastoma ; Hematoma, Subdural, Chronic ; Hemorrhage ; Humans ; Intracranial Pressure ; Stroke* ; Subarachnoid Hemorrhage

Distinct from migraine with aura or hemiplegic migraine, a rare clinical entity of migraine-like headache, transient focal neurologic deficit and CSF pleocytosis (HaNDL) has been known. Although the etiology or pathogenesis is unknown, possibility of viral infection or inflammation has been suggested. We report a 25-year-old man diagnosed as HaNDL with literature review. (J Korean Neurol Assoc 19(3):302~304, 2001)
Adult ; Aphasia ; Headache* ; Humans ; Inflammation ; Leukocytosis* ; Migraine Disorders ; Migraine with Aura ; Neurologic Manifestations*

OBJECTIVE: To determine whether the somatostatin analogue, octreotide, given concunently with human menopausal gonadotropin (HMG) affects ovarian response, ovulation induction outcome, and serum levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) in infertile patients with polycystic ovarian syndrome (PCOS) resistant to clomiphene citrate (CC). METHODS: From August 1996 to June 1998, 42 infertile patients with PCOS urresponsive to CC were enrolled in the present study. Women who had other infertility factors were excluded from this study. Patients were randomly allocated either to combined HMG and octreotide treatment (treatment group) (n=21) or HMG alone (control group) (n=21). In the treatment group, 100 micrograms of octreotide were administered daily concomitantly with HMG from the 3rd day of menstrual cycle to the preceding day of human chorionic gonadotropin (HCG) injection. RESULTS: Patient's characteristics were comparable in both groups. One cycle in the control group was abandoned because of excessive follicular development. However, none of the cycles in the treatment group was abandoned. There were no differences in the number of HMG ampules required and the duration of HMG administration between the two groups. The number of follicles > 14mm diameter on the day of HCG injection was significantly less in the treatment group than that in the control group (p<0.01). The serum estradiol level on the day of HCG injection was also significantly lower in the treatment group, with 1391.0 +/- 695.5 pg/ml compared with 2217.5 +/- 811.6pg/ml in the control group (p<0.001). The incidence of severe ovarian hyperstimulation syndrome seemed to be lower in the treatment group, but the difference did not achieve significance (4.9% vs 23.8%). There were no differences in the clinical pregnancy rate, miscarriage rate and multiple pregnancy rate between the two groups. Although serum GH levels were comparable between the two groups, serum IGF-1 level on the day of HCG injection was significantly higher in the treatment gmup than that in the control group (p<0.001). CONCLUSION: This study suggests that the combined octreotide and HMG treatment could improve hormonal milieu and folliculogenesis compared to HMG alone, and therefore may be effective in ovulation induction for patients with PCOS resistant to CC.
Abortion, Spontaneous ; Chorionic Gonadotropin ; Clomiphene ; Estradiol ; Female ; Gonadotropins ; Growth Hormone ; Humans ; Incidence ; Infertility ; Insulin-Like Growth Factor I ; Menstrual Cycle ; Octreotide ; Ovarian Hyperstimulation Syndrome ; Ovulation Induction* ; Ovulation* ; Polycystic Ovary Syndrome* ; Pregnancy ; Pregnancy Rate ; Pregnancy, Multiple ; Somatostatin*

A case is presented in which left-sided hemiparesis was caused by a fibromuscular dysplasia of the right internal carotid artery in the neck, and it used as a basis for discussion of the angiographic features. The 24-year-old woman was admitted to our Department of Neurosurgery, Korea University hospital, with the complaints of headache and left-sided hemiparesis which developed abruptly about one month before this admission. The carotid angiography was performed by puncture of the right common carotid artery under the clinical impression of cerebral thrombosis, which showed no gross intracranial abnormalities. But the characteristic findings were observed under and widening of the arterial lumen which are so-called loose stocking appearance or 'string of beads' appearance and are the typical feature of fibromuscular dysplasia. No surgical interventions such as arterial reconstruction and grafting, or arterial dilatation with bougies were applied on the patient, and she was discharged from the hospital three days after the admission. Fibromuscular dysplasia is a rare sclerotic, noninflammatory lesion of unknown etiology involving the wall of large arteries. This disease is found most frequently in early adult life and women are afflicted more often than men, This condition has been described most often in the renal arteries, where it has been found to be a cause of hypertension. Among the involvement of carotid system, the cervical portion of the internal carotid artery is most often affected, and the involvements are often bilateral. When localized to the internal carotid arteries, it can give symptoms of intermittent or permanent cerebral ischemia, but is usually asymptomatic. The typical angiographic appearance is the main parameter for diagnosis of fibromuscular dysplasia.
Adult ; Angiography ; Arteries ; Brain Ischemia ; Carotid Artery, Common ; Carotid Artery, Internal* ; Diagnosis ; Dilatation ; Female ; Fibromuscular Dysplasia* ; Headache ; Humans ; Hypertension ; Intracranial Thrombosis ; Korea ; Male ; Neck ; Neurosurgery ; Paresis ; Punctures ; Renal Artery ; Transplants ; Young Adult

BACKGROUND: T. vaginalis is a pathogenic protozoa infecting genitourinary tract. Metronidazole is a drug of choice to treat T. vaginalis infection. However, because of appearance of metronidazole- resistant T. vaginalis, it is needed to develop an alternative drug. So, we evaluated the effects of various concentration of kalopanaxsaponin A against T. vaginalis. METHODS: The antiprotozoal effect of kalopanaxsaponin A on the growth and fine structure of T. vaginalis was examined by using trypan blue exclusion assay and electron microscopy. RESULTS: The viability test showed markedly decreased number of T. vaginalis, treated with increasing concentration of kalopanaxsaponin A. We evaluated the electron microscopic findings for antiprotozoan effects against T. vaginalis. SEM showed that in T. vaginalis treated with 4 microgram/mL for 1 hour, axostyle was shrinked and flagella began to disappear. With gradual increase of the concentration of kalopanaxsaponin A, destruction of cell membrane was getting more severe, and degenerative change was observed in T. vaginalis treated with 8 microgram/mL for 2 hours. TEM showed that in T. vaginalis treated with 4 microgram/mL for 2 hours, the vacuoles in cytoplasm were larger and hydrogenosomes were smaller than those in control group. The number of vacuole was increased, the nucleus was destroyed, the number of polyribosome and free ribosome was also decreased in trichomonads treated with kalopanaxsaponin A (8 microgram/mL), which indicated the occurrence of degenerative changes. CONCLUSION: These results indicated that kalopanaxsaponin A had the antiprotozoal effect on T. vaginalis by inhibition of cell multiplication as well as an impairment of protein synthesis.
Cell Membrane ; Cell Proliferation ; Cytoplasm ; Flagella ; Metronidazole ; Microscopy, Electron ; Polyribosomes ; Ribosomes ; Trichomonas vaginalis* ; Trichomonas* ; Trypan Blue ; Vacuoles