We report a case of 17-year-old female with juvenile onset systemic lupus erythematosus Who developed symptomatic unilateral sacroiliitis. She had neither HLA-DR3 nir B27 antigens. Though sacroiliitis have been reported in mail SLE patient. it has been rarely reported in female patients. The rare coexistence of SLE and sacroiliitis. described in this case. may not be determined soley by genetic factors; sacroiliitis may be just an infrequent manifestation of SLE.
Adolescent ; Female* ; HLA-DR3 Antigen ; Humans ; Lupus Erythematosus, Systemic* ; Postal Service ; Sacroiliitis*

PURPOSE: We analyzed pediatric death patients who visited Dong-Kang Hospital emergency center, in order to minimize unexpected pediatric deaths. METHODS: The authors analyzed retrospectively the medical records of 110 pediatric patients who died before and within 24 hours after admission to the emergency center of Ulsan Dong-Kang General Hospital from January 1997 to December 2002. RESULTS: We classified three categories by the cause of death, accident group(AG) 46 cases(41.8%), disease group(DG) 37 cases(33.6%), unknown cause group(UG) 27 cases(24.6%) respectively. The most common age was between two and five years of age(50.0%) in AG, under one month (40.5%) in DG, between one month and one year(51.9%) in UG respectively. The most common season was summer(37.0%) in AG, winter(51.4%) in DG, spring(37.1%) in UG respectively. The most common time on arrival was from 13:00 to 18:00(37.0%) in AG, from 7:00 to noon(43.2%) in DG, from midnight to 6:00(29.6%) and from 7:00 to noon(29.6%) in UG respectively. The most common type of accident was traffic accident(47.8%). The most common cause of death in DG was respiratory disorder(40.5%). Sudden infant death syndrome was the most common(37.1%) in unknown cause of death. CONCLUSION: Accidental injuries and severe chronic illnesses are the major cause of unexpected pediatric death. Legislation related to accidents and a parents teaching program for emergency situations are necessary to decrease cases of unexpected pediatric death.
Cause of Death ; Chronic Disease ; Emergencies* ; Hospitals, General ; Humans ; Medical Records ; Parents ; Retrospective Studies ; Seasons ; Sudden Infant Death ; Ulsan

BACKGROUND: Haloperidol, a major tranquilizer similar to droperidol, has been found to have a potent antiemetic effect on postoperative nausea and vomiting (PONV), but the supporting evidence was incomplete, especially in Korea.Therefore we evaluated the prophylactic effect of haloperidol on opioid-based IV patient-controlled analgesia (PCA) related PONV in susceptible patients after gynecological laparoscopic surgery. METHODS: Ninety-six adult women scheduled gynecological laparoscopic surgery were enrolled in a randomized, double-blinded and placebo study.Patients received haloperidol 1 mg (Group H) or saline (Group C) 30 min before the end of surgery.Fentanyl-based IV PCA was administered after surgery.The incidences and severity of nausea, vomiting, rescue antiemetic administration, pain, and adverse effects (cardiac arrhythmias and extrapyramidal effects) were assessed for 24 h after surgery.The sedation score was recorded in the post-anesthesia care unit for 2 h. RESULTS: The incidences and severity of nausea and the number of antiemetic administration were significantly lower in Group H than Group C (P < 0.05). But the sedation and pain score were similar. There was no QTc prolongation or extrapyramidal symptom in both groups. CONCLUSIONS: Prophylactic haloperidol 1 mg is effective in preventing PONV related to fentanyl-based IV PCA, with less adverse effects, in patients undergoing gynecological laparoscopic surgery.
Adult ; Analgesia, Patient-Controlled ; Antiemetics ; Arrhythmias, Cardiac ; Droperidol ; Female ; Haloperidol ; Humans ; Incidence ; Laparoscopy ; Nausea ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Vomiting

Peptic ulcer bleeding is a frequent cause of upper G-I bleeding. Endoscopic injection therapy with hypertonic saline-epinephrine (HS-E) is a cost-effective and widely used therapy for hemostasis; however, 1~3% of patients experience bleeding or perforation. A 70 year-old male patient was admitted with melena and hematemesis. An endoscopy on admission showed the presence of a 1 cm- sized well-demarcated ulcer with pulsatile bleeding at the lesser curvature of the distal antrum. Approximately 28 mL of HS-E solution was injected around the exposed vessel. Follow-up endoscopy performed 7 days later showed the presence of a 2 cm-sized newly developed mucosa necrosis at the lesser curvature of the pyloric channel, which was caused by ischemic necrosis of the gastric mucosa after HS-E injection. Endoscopic injection therapy with HS-E solution is a relatively safe technique, but mucosa necrosis can occur with the use of a dose of HS-E that is considered safe. We report a case of gastric mucosa necrosis following endoscopic HS-E injection therapy of a bleeding peptic ulcer.
Endoscopy ; Follow-Up Studies ; Gastric Mucosa ; Glycosaminoglycans ; Hematemesis ; Hemorrhage ; Humans ; Male ; Melena ; Mucous Membrane ; Necrosis ; Peptic Ulcer ; Stomach ; Ulcer

Background: Female farmers have a high prevalence of knee osteoarthritis (KOA) in South Korea. Femoral bowing has been reported to be related to KOA by increasing load on the mechanical axis. This study aimed to investigate factors related to femoral bowing in Korean female farmers. Methods: We analyzed the legs of 264 female farmers registered with the Korea farmers' knee cohort of Jeonnam Center for Farmers' Safety and Health. A structured questionnaire was used to determine sociodemographic variables, agricultural career, cumulative squatting working time (CSWT), and cumulative heavy lifting working time. Femoral bone density was measured and Kellgren-Lawrence (KL) grades were obtained from the knee radiographs.Mechanical axis angle (MAA), femoral bowing angle (FBA), anatomical lateral distal femoral angle (aLDFA), anatomical medial proximal tibial angle (aMPTA), and condylar-plateau angle (CPA) were measured. We examined the relationship between the FBA and related factors by using multiple linear regression. Results: The proportion of individuals with radiographic KOA (≥ KL grade 2) in this study was 37.9%. As KL grades increased, MAA, FBA, and CPA increased, whereas aLDFA and aMPTA decreased. FBA increased with age. Multiple linear regression analyses using FBA as a dependent variable showed relationship with higher age, lower height, higher BMI, lower bone mineral density, longer CSWT, and longer agricultural careers. Conclusions The results of this study suggest that external factors related to agricultural work in female farmers was associated with femoral bowing, in addition to internal factors such as age, bone density, height, and obesity.

Background: Female farmers have a high prevalence of knee osteoarthritis (KOA) in South Korea. Femoral bowing has been reported to be related to KOA by increasing load on the mechanical axis. This study aimed to investigate factors related to femoral bowing in Korean female farmers. Methods: We analyzed the legs of 264 female farmers registered with the Korea farmers' knee cohort of Jeonnam Center for Farmers' Safety and Health. A structured questionnaire was used to determine sociodemographic variables, agricultural career, cumulative squatting working time (CSWT), and cumulative heavy lifting working time. Femoral bone density was measured and Kellgren-Lawrence (KL) grades were obtained from the knee radiographs.Mechanical axis angle (MAA), femoral bowing angle (FBA), anatomical lateral distal femoral angle (aLDFA), anatomical medial proximal tibial angle (aMPTA), and condylar-plateau angle (CPA) were measured. We examined the relationship between the FBA and related factors by using multiple linear regression. Results: The proportion of individuals with radiographic KOA (≥ KL grade 2) in this study was 37.9%. As KL grades increased, MAA, FBA, and CPA increased, whereas aLDFA and aMPTA decreased. FBA increased with age. Multiple linear regression analyses using FBA as a dependent variable showed relationship with higher age, lower height, higher BMI, lower bone mineral density, longer CSWT, and longer agricultural careers. Conclusions The results of this study suggest that external factors related to agricultural work in female farmers was associated with femoral bowing, in addition to internal factors such as age, bone density, height, and obesity.

OBJECTIVE: Insulin has been known as a potent growth factor for connective tissues including cartilage and bone.The pathogenesis of type 2 diabetes mellitus is the insulin resistance due to insulin receptor or postreceptor abnormalities.In the present study,we investigate whether radiographic features of knee osteoarthritis in patients with type 2 DM differ from those in nondiabetogenic controls with knee osteoarthritis. METHODS: Radiographs (knee)from 59 female patients with diabetes and knee osteoarthritis were compared with those from 74 female controls who were similar with respect to age,weight,and duration of OA symptoms.Based on the Kellgren and Lawrence criteria,an overall OA severity grade for the index knee was assigned and was rated for the severity of subchondral sclerosis,osteophytes, geodes and joint space narrowing.Patients with inflammatory arthritis such as RA,severe peripheral neuropathy,or diabetic nephropathy were excluded. RESULTS: Although the 2 groups were similar with respect to the severity of joint space narrowing,geode formation,and subchondral sclerosis,osteophytes formation was less common in patients with type 2 diabetes (P=0.041)than controls.In the patients with symptomatic knee OA at least for 11 years,marked osteophyte formation was noted only in 7 of the 17 with DM (41%),but in 15 of the 27 controls (55%). CONCLUSION: Our results suggest that diminished availability of insulin at the cellular level or diabetic microvascular disease may attenuate the chondro- and osteogenesis required for osteophyte formation in the joint of patients with OA.The clinical significance of osteophyte and the pathologic mechanisms of diminished osteophyte formation in patients of knee osteoarthritis with type 2 diabetes is to be determined.
Arthritis ; Cartilage ; Connective Tissue ; Diabetes Mellitus* ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Female ; Humans ; Insulin ; Insulin Resistance ; Joints ; Knee* ; Osteoarthritis ; Osteoarthritis, Knee* ; Osteogenesis ; Osteophyte* ; Receptor, Insulin

BACKGROUND/AIMS: Benign biliary strictures (BBSs) have been endoscopically managed with plastic stent placement. However, data regarding fully covered self-expandable metal stents (FCSEMSs) in BBS patients remain scarce in Korea. METHODS: Forty-one patients (21 men, 65.9%) with BBSs underwent FCSEMS placement between February 2007 and July 2010 in Asan Medical Center. Efficacy and safety were evaluated retrospectively. Patients were considered to have resolution if they showed evidence of stricture resolution on cholangiography and if an inflated retrieval balloon easily passed through the strictures at FCSEMS removal. RESULTS: The mean FCSEMS placement time was 3.2 (1.9-6.2) months. Patients were followed for a mean of 10.2 (1.0-32.0) months after FCSEMS removal. The BBS resolution rate was confirmed in 38 of 41 (92.7%) patients who underwent FCSEMS removal. After FCSEMS removal, 6 of 38 (15.8%) patients experienced symptomatic recurrent stricture and repeat stenting was performed. When a breakdown by etiology of stricture was performed, 14 of 15 (93.3%) patients with chronic pancreatitis, 17 of 19 (89.5%) with gall stone-related disease, 4 of 4 (100%) with surgical procedures, and 2 of 2 (100%) with BBSs of other etiology had resolution at FCSEMS removal. Complications related to stent therapy occurred in 12 (29%) patients, including post-ERCP pancreatitis (n=4), proximal migration (n=3), distal migration (n=3), and occlusion (n=2). CONCLUSIONS: Temporary FCSEMS placement in BBS patients offers a potential alternative to plastic stenting. However, because of the significant complications and modest resolution rates, the potential benefits and risks should be evaluated in further investigations.
Adult ; Aged ; Bile Duct Diseases/*therapy ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis, Sclerosing/etiology ; Constriction, Pathologic ; Female ; Gallstones/etiology ; Humans ; Male ; Middle Aged ; Pancreatitis/etiology ; Retrospective Studies ; *Stents/adverse effects ; Time Factors

PURPOSE: Delayed massive hemorrhages from pseudoaneurysm rupture of the peripancreatic large arteries, after pancreaticoduodenectomy, are fatal. We reviewed the clinical course and outcome of bleeding pseudoaneurysms after pancreaticoduodenectomy. METHOD: The medical records of 905 consecutive patients who underwent pancreaticoduodenectomies between October 1994 and February 2007 were reviewed retrospectively. In 27 cases with hemorrhagic complications, pseudoaneurysms were diagnosed as the main cause of bleeding. The clinical characteristics, course, management, and outcomes were reviewed. RESULT: In 27 cases (3.0%) of the 905, the bleeding pseudoaneurysms were diagnosed by angiography, during surgery or clinically. In 11 cases, the hemorrhage was from the pseudoaneurysm on the ligated gastroduodenal artery-stump, in five it was from the right hepatic artery, in four from the proper hepatic artery or common hepatic artery, and two from the right gastric artery. Twelve cases had pancreatic leakage. Sentinel bleedings were observed in 21 cases, there were 11 cases of bleeding from the surgical drains, eight cases from the GI tract, and in two cases from both. In 23 cases, arterial embolization was attempted and 18 cases were successful. Four cases had secondary pseudoaneurysmal bleeding. After embolization at the common or proper hepatic artery, six cases had liver abscess or infarction and there was one case of hepatic failure. CONCLUSION: Delayed massive hemorrhage after pancreaticoduodenectomy should be ruled out to determine whether it is associated with an arterial pseudoaneurysm rupture. Transcatheter arterial embolization is an effective modality for control of the bleeding from an arterial pseudoaneurysm.
Aneurysm, False* ; Angiography ; Arteries ; Gastrointestinal Tract ; Hemorrhage* ; Hepatic Artery ; Humans ; Infarction ; Liver Abscess ; Liver Failure ; Medical Records ; Pancreaticoduodenectomy* ; Retrospective Studies ; Rupture

OBJECTIVE: The association between the connective tissue diseases and lung diseases is well established. DLCO and 99mTc-DTPA aerosol scintigraphy are used for evaluation of the alvelolar-capillary permeability. This study evaluated the changes in permeability of alveolar-capillary membrane and the utility of the 99mTc-DTPA aerosol clearance to detect lung involvement in patients with connective tissue diseases. METHODS: The patient group consisted of the patients with any proven connective tissue diseases (27 rheumatoid arthritis, 17 systemic lupus erythematosus, 7 other connective tissue diseases) and the control group consisted of healthy 12 persons. The patients and controls were non-smokers and had no concomitant diseases that could affect the result (diabetes, any lung diseases etc). Chest X-ray, spirometric measurements of lung volumes, flow idices, diffusing capacities and 99mTc-DTPA aerosol scintigraphy were performed in the patient group and control group. 99mTc-DTPA aerosol (1110 MBq) was used with the aero-vent jet nebulizer as a lung delivery system. Patients in sitting position inhaled for 5 minutes at normal tidal oral breathing, Scintigraphic data were recorded using the Picker Prism 2000 gamma cammera, 15 frames of the lung were obtained as the area of interest anteriorly and posteriorly (120 msec at each frame, for 30 minutes). 99mTc-DTPA clearance rate was calculated as the time to half clearance (T1/2). RESULTS: The mean clearance rates of 99mTc-DTPA were 64.0+/-24.1 min (RA 70.7+/-26.2 min, SLE 61.6+/-14.0 min, Others 43.9+/-24.7 min), and 47.0+/-10.3 min in the patient group and the control group respectively. Significant correlation was not found between the pulmonary clearance rate of 99mTc-DTPA and other parameters (disease duration, ESR, CRP, DLCO and FEV1/FVC). CONCLUSION: 99mTc-DTPA clearance in the patient group (RA, SLE, others) was significantly decreased than that in control group (p<0.05). In the patient group with normal chest X-ray, 99mTc-DTPA clearance in the connective tissue disorders was significantly decreased than control group (p<0.05). We suggest that 99mTc-DTPA aerosol scintigraphy may be one of useful technique for early detection of the lung involvement in the connective tissue disorders.
Arthritis, Rheumatoid ; Connective Tissue Diseases* ; Connective Tissue* ; Humans ; Lung Diseases ; Lung* ; Lupus Erythematosus, Systemic ; Membranes ; Nebulizers and Vaporizers ; Permeability* ; Radionuclide Imaging* ; Respiration ; Thorax