This study aimed to establish the optimal amount of thickening agent for the appropriate viscosity in soups and beverages, which are part of the dysphagia diet. The soups were bean sprout soup and soybean paste soup; the beverages were orange juice, regular milk, and low-fat milk; the thickening agent was one type of xanthan gum product. After adding the thickening agents (from 1 g to 5 g per 200 mL of the test food), syringe tests were conducted over time (5, 10 and 15 minutes) to verify the effects of the amount of thickening agent added per sample and the time between addition and achieving the resulting viscosity, and to establish the optimal addition conditions to reach IDDSI levels 1, 2, and 3 of the dysphagia diet. Water (based on 200 mL) was used as the standard control. These results provide a useful basis for customized diets based on the patient's dysphagia severity. On the other hand, this study is limited by including only liquid foods in the dysphagia diet and one type of xanthan gum-based thickening agent. Therefore, it is necessary to conduct continuous research, based on the study results, to modify the viscosity of the dysphagia diet using various thickening agents and foods and prevent nutritional deficiencies by managing the diet according to the patient's swallowing ability.

A 74-year-old woman who had paroxysmal atrial fibrillation without mitral stenosis was hospitalized for syncope and right-sided weakness. Echocardiography revealed a large free-floating thrombus in the left atrium, sometimes prolapsing partially into the left ventricle in diastole. Because of her poor neurological status, she was managed with anticoagulation. On the 12th day, the thrombus had disappeared on the follow-up echocardiography, and aortoiliac embolization was later detected on computed tomography. Unfortunately, she developed various complications of stroke and limb infarction, and died after 4 months of hospital care. In addition to this case report, we reviewed a total 70 cases of left atrial free-floating thrombus. Atrial fibrillation and mitral pathology were two major causative factors. All the cases, except 1, were confirmed on echocardiography. The most common presentation that led to echocardiography was systemic embolization, followed by heart failure. Others were acute hemodynamic decompensation from mitral obstruction, chest pain, palpitation, and bacteremia. Cardiac thrombectomy was the preferred treatment modality with favorable outcomes.
Aged ; Atrial Fibrillation ; Bacteremia ; Chest Pain ; Diastole ; Echocardiography ; Extremities ; Female ; Follow-Up Studies ; Heart Atria ; Heart Failure ; Heart Ventricles ; Hemodynamics ; Humans ; Infarction ; Mitral Valve Stenosis ; Pathology ; Stroke ; Syncope ; Thrombectomy ; Thrombosis*

Calcium channel blockers (CCBs) are very popular drugs to lower blood pressure (BP) without significant side effects. A 72-year-old man admitted for uncontrolled hypertension. He had history of hypertension, atrial fibrillation with slow ventricular response, angina, abdominal aortic aneurysm, and stage 3 chronic kidney disease. He had taken several anti-hypertensives, such as amlodipine 5 mg, perindopril 8 mg, and indepamide 1.5 mg. To control BP, nifedipine 120 mg was added. Then pulmonary edema and pleural effusion was developed. Echocardiography showed preserved left ventricular ejection fraction and mild mitral regurgitation. Fluid restriction and high dose furosemide did not cease pleural fluid accumulation. Thus a total of 4 times of thoracentesis were done and all fluid analyses revealed transudate. We thought that pleural effusion and pulmonary edema was induced by CCBs and discontinued the drugs. He recovered quickly and finally discharged in a stable condition.
Aged ; Amlodipine ; Antihypertensive Agents ; Aortic Aneurysm, Abdominal ; Atrial Fibrillation ; Blood Pressure ; Calcium Channel Blockers* ; Calcium Channels* ; Calcium* ; Echocardiography ; Exudates and Transudates ; Furosemide ; Humans ; Hypertension* ; Mitral Valve Insufficiency ; Nifedipine ; Perindopril ; Pleural Effusion* ; Pulmonary Edema* ; Renal Insufficiency, Chronic ; Stroke Volume

Mitomycin (MMC) is a naturally ocurring alkylating agent, introduced for clinical use as early as 1958. This drug is useful in the therapy of gastrointestinal carcinomas when used in combination with 5-fluorouracil. Nephrotoxicity among toxicities from MMC is unusual with cumulative doses less than 30 mg/m2. In large studies in which the incidence of MMC nephrotoxicity were assessed, 3-15% of patients developed total dose related renal dysfunction. Three patients in our clinical practice have developed thrombotic microangiopathy clearly related to MMC. We report the clinical and pathologic features of our cases. In view of the probable dose-related and delayed toxicity of MMC, it seems necessary to monitor regularly after initiation of chemotherapy. Early detection of the renal impairment and withdrawal of MMC might halt further progression of renal failure.
Drug Therapy ; Fluorouracil ; Humans ; Incidence ; Mitomycin* ; Renal Insufficiency ; Thrombotic Microangiopathies*

OBJECTIVE: In rheumatoid arthritis(RA) patients, HLA-B27 has been mainly found with the same frequency as in the normal population. An increased frequency of HLA-B27 in RA has, however, repeatedly been found in northern Sweden and in Filand. The results concerning the association of HLA-B27 to the outcome of the disease have been contradictory in RA. In RA, the presence of I-ILA-B27 has shown to be a prognostic index for cervical spine subluxation. There has been no report regarding the association between RA and HLA-B27 in the Korean population. METHODS: 188 patients with RA were randomly selected from the patients who were diagnosed at Rheumatism Center of Hanyang University iHospital from October 1994 to June 1995 to establish the frequency of HLA-B27 in RA and to investigate the possible influence and prognostic significance on clinical outcome including atlantoaxial subluxations. RESULTS: The results were as follows: 1) HLA-B27 was present in 12.2% of the RA patients studied. The relative risk(RR) and etiologic fraction(EF) of HLA-B27 were 5.99 and 0. 1019 respectively. 2) The rheumatoid factor was positive in 79.8% of the total patients, 73.9% in HLA-B27 positive patients, and 80.6% in HLA-B27 negative patients. HLA-B27 was not associated with the presence of rheumatoid factor in this study. 3) HLA-B27 was not associated with the duration of morning stiffness, Ritchie index, extraarticular manifestations, the number of swollen joints, ARA functional class, ESR, C-reactive protein, or hemoglobin. HLA-B27 was not associated with the positivity of ANA and antiperinuclear factor. 4) HLA-B27 was not associated with the positive rate of erosion and Steinbrocker class in peripheral joints. 5) Atlantoaxial subluxation was present in 13% of HLA-B27 positive patients and 17% of HLA-B27 negative patients. The involvement of atlantoaxial joint including narrowing of lateral facet joints was 26.1% in HLA-B27 positive patients and 20.6% in HLA-B27 negative patients. Subaxial subluxation was presented in only 1 case in HLA-B27 negative group of total patients. HLA-B27 was not associated with the cervical changes in RA. CONCLUSIONS: An increased freuency of HLA-B27 in RA patients was significantly found in Korea(RR=5.99, EF=0.1019). However, patients with HLA-B27 had a similiar clinical profile to patients without HLA-B27 and HLA-B27 positivity did not further contribute to the severity with respect to clinical and laboratory variables or to radiological progression in peripheral joints or cervical spine.
Arthritis, Rheumatoid* ; Atlanto-Axial Joint ; C-Reactive Protein ; HLA-B27 Antigen* ; Humans ; Joints ; Rheumatic Diseases ; Rheumatoid Factor ; Spine ; Sweden ; Zygapophyseal Joint

Gastric carcinoid tumor is a rare neoplasm and it accounts for only 0.3% of all the gastric neoplasms. Gastric carcinoid tumor has high incidence in patients who are aged between 50 and 70 years, and it usually develops over a long period of time. Type I gastric carcinoid tumors are associated with autoimmune atrophic gastritis and pernicious anemia, and there are a few cases of gastric carcinoids in patients with other autoimmune diseases like Sjogren's syndrome and autoimmune thyroiditis. Here, we report on a case of recurrent type I gastric carcinoid tumors in a 42-years old woman who suffered with systemic lupus erythematosus.
Aged ; Anemia, Pernicious ; Autoimmune Diseases ; Carcinoid Tumor ; Female ; Gastritis, Atrophic ; Humans ; Incidence ; Lupus Erythematosus, Systemic ; Sjogren's Syndrome ; Stomach Neoplasms ; Thyroiditis, Autoimmune

OBJECTIVES: To investigate the clinical, laboratory and radiological features of psoriatic arthritis. METHODS: Seventeen patients with psoriatic arthritis were studied. The diagnosis of psoriatic arthritis was based on the presence of an inflammatory arthritis associated with psoriasis, usually seronegative. Other rheumatic conditions were excluded. RESULTS: 1) There were 8 men and 9 women(male to female ratio of 1:1.13) and mean age was 41 years old. 2) Thirteen patients developed arthritis an average of 7. 3 years after the onset of psoriasis ; Three had a simultaneous onset of skin and joint disease(within 6 months), while in one patient the arthritis preceded psoriasis by a 10 years. 3) Ten patients had nail lesions, and dactyliris was presented in 6 patients. 4) The frequency of positive rheumatoid factor was 18 percent of the patients, and HLA-B27 was detected in 24 percent. 5) The prevalences of clinical patterns were as follows : oligoarthritis(41.2%), polyarthritis(29.4%), spondyloarthritis(23.5%) and arthritis in distal joint (5.9%). CONCLUSIONS: In contrast to rheumatoid arthritis, psoriatic arthritis occured frequently in males as in females and oligoarthritis was the most common joint pattern.
Adult ; Arthritis ; Arthritis, Psoriatic* ; Arthritis, Rheumatoid ; Diagnosis ; Female ; HLA-B27 Antigen ; Humans ; Joints ; Male ; Prevalence ; Psoriasis ; Rheumatoid Factor ; Skin

To compare the effect of intermittent parathyroid hormone (PTH) treatment with that of estrogen treatment on epiphyseal growth in ovariectomized rats, 46 Sprague-Dawley female rats aged 9-10 weeks (about 200-220 g) were either ovariectomized or sham operated. From 6 weeks after ovariectomy (ovx), rats were daily injected with subcutaneous human recombinant PTH (1-84)-dosed 30 micrograms/kg (the low dose PTH-treated group) or 300 micrograms/kg (the high dose PTH-treated group), 17 beta-estradiol (the 17 beta-estradiol-treated group, 30 micrograms/kg) or vehicle (the ovx-alone group), 5 times a week for 4 weeks. The decalcified sections of the distal femoral epiphyseal plate were analyzed on light microscopy after H&E stain, and the lengths of the zones of proliferation, maturing and hypertrophic chondrocytes were measured. The length of the growth plate, the zone of proliferation and the zone of hypertrophic chondrocyte in the ovx-alone group were significantly shorter than those of the sham-operated group. The treatment of 17 beta-estradiol speeded up the differentiation of cells from proliferating chondrocytes to maturing and hypertrophic chondrocytes even though the length of the growth plate was comparable to that of the sham-operated group. Both low and high dose PTH treatments increased the length of the growth plate, and those lengths were comparable to that of the sham-operated group. The fractions of proliferating, maturing and hypertrophic zone in the low dose PTH-treated group were also comparable to those of the sham-operated group. However, high dose PTH treatment slowed down the differentiation of cells from proliferating chondrocytes to maturing and hypertrophic chondrocytes to a greater extent, and therefore the fraction of proliferating chondrocytes of the high dose PTH-treated group was larger than that of the low dose PTH-treated group (73.8 +/- 1.8 Vs 63.3 +/- 1.3%, p < 0.005). From these results, we showed that intermittent PTH treatment could promote linear growth in the ovariectomized growing rat. We propose that PTH may be an alternative drug candidate for promoting linear growth of long bones without the risk for early closure of the growth plate.
Animal ; Bone Development/drug effects* ; Female ; Human ; Ovariectomy* ; Parathyroid Hormones/pharmacology ; Parathyroid Hormones/administration & dosage* ; Rats ; Rats, Sprague-Dawley ; Recombinant Proteins

OBJECTIVE: We compared the rehospitalization rate of first-episode schizophrenic inpatients who were discharged from a university hospital while being treated with risperidone, olanzapine, quetiapine, or the conventional antipsychotic haloperidol. We also assessed other possible predictors of rehospitalization. METHODS: We monitored the rehospitalization status of all first-episode schizophrenic inpatients who were discharged from a university hospital between 1 January 2001 and 30 June 2003 while they were taking risperidone (n=16), olanzapine (n=26), quetiapine (n=9), or haloperidol (n=10). Rehospitalizations were tracked over a 2-year period using the Kaplan-Meier method. Risk factors associated with rehospitalization were examined using the Cox proportional hazards regression model. RESULTS: The rehospitalization rates estimated using the Kaplan-Meier formula for patients taking haloperidol (60.0%) did not differ significantly from the rates for patients treated with risperidone (37.5%), olanzapine (34.6%), or quetiapine (33.3%) during the 24-month follow-up period. The length of untreated illness before drug treatment predicted rehospitalization. CONCLUSION: The rehospitalization rates of first-episode schizophrenic inpatients taking risperidone, olanzapine, quetiapine, or haloperidol do not differ. However, the small number of patients who participated in this study made it difficult to establish significance.
Antipsychotic Agents ; Follow-Up Studies ; Haloperidol ; Humans ; Inpatients* ; Risk Factors ; Risperidone ; Schizophrenia

Herniation of the synovium from the joint space into perioarticular soft tissues is a relatively common complication of adult rheumatoid arthritis, but rare in juvenile rheumatoid arthritis. The most completely described is the popliteal cysts. However, cysts have rarely been reported in the arm. Authors experienced a case of a boy with systemic form of juvenile rheumatoid arthritis who have bicipital synovial cysts in both arm and report this with a review of literature.
Adult ; Arm ; Arthritis, Juvenile* ; Arthritis, Rheumatoid ; Humans ; Joints ; Male ; Popliteal Cyst ; Synovial Cyst ; Synovial Membrane