A 65-year-old female patient visited our clinic complaining of multiple skin lesions since one year ago. There were yellowish to brownish colored, bean to walnut-sized nodules on both lower extremities. Dylon stain with polarizing microscopy, immunohistochemical stain to amyloid P and immunoglobuhn-kappa chain showed positive reactivities but keratin stain was negative. According to histopathologic and immunohistochemical findings, she was diagnosed as nodular amyloidosis.
Aged ; Amyloid ; Amyloidosis* ; Female ; Humans ; Lower Extremity ; Microscopy ; Skin

Brugada syndrome can be unmasked by several conditions including a febrile state, marked leukocytosis, and electrolyte disturbances. Herein, we describe a 62-year-old man with cholangiocarcinoma in the first reported case of Brugada syndrome onset following photodynamic therapy.
Bile Duct Neoplasms/*drug therapy ; *Bile Ducts, Intrahepatic ; Brugada Syndrome/diagnosis/*etiology/therapy ; Cardiopulmonary Resuscitation ; Cholangiocarcinoma/*drug therapy ; Electrocardiography ; Fatal Outcome ; Fever/etiology ; Humans ; Klatskin's Tumor/*drug therapy ; Male ; Middle Aged ; Photochemotherapy/*adverse effects ; Predictive Value of Tests ; Treatment Outcome

The purpose of this study is to present a novel method of harvesting autogenous bone graft and to analyze the behavior of xenograft used for pelvic osteotomy in young children. Twenty hips of eighteen patients underwent pelvic osteotomies using xenograft (Lubhoc) from Sep. 1993 to Jun. 1996. In fitteen hips, we harvested autogenous bone avoiding damage to the chondroapophysis of iliac crest and t'illed the donor site with the xenograft. It supplemented the autogenous bone at the osteotomy site in eleven hips, and was used as a wedge without autogenous hone in five hips. During the followup, no growth disturbance of iliac crest was found. The xenograft incorporation was satisfactory at the graft donor sites and the osteotomy sites where it supplemented the autogenous bone, however, unsatistactory at the osteotomy sites where it was used alone. Our novel method of harvesting bone graft from young pelvis may help prevent growth disturbance of lilac crest, and Luhhoc is useful as space-filler of donor site and suppiementary to the autograft in pelvic osteotomy of young children.
Autografts ; Child* ; Follow-Up Studies ; Heterografts* ; Hip ; Humans ; Osteotomy* ; Pelvis ; Tissue Donors ; Transplants

Colorectal cancer consists of 8.2 percent of all malignancy in korea, and shows more increaing tendency. Despite the advances in the detection of calorectal cancer no single screening technique has achieved both high degree of diagnostic accuracy and minimal patient morbidity. We studied 24 patients, who underwent colonoscopy, with clinical suspicious colon cancer at Presbyterian Medical Center between Jan and Sep.1995, and evaluated the diagnostic feasibility of colon lavage cytology using oral cleansing solution.(continue...)
Colon* ; Colonic Neoplasms* ; Colonoscopy ; Colorectal Neoplasms ; Diagnosis* ; Humans ; Korea ; Mass Screening ; Protestantism ; Therapeutic Irrigation

Colorectal cancer consists of 8.2 percent of all malignancy in korea, and shows more increaing tendency. Despite the advances in the detection of calorectal cancer no single screening technique has achieved both high degree of diagnostic accuracy and minimal patient morbidity. We studied 24 patients, who underwent colonoscopy, with clinical suspicious colon cancer at Presbyterian Medical Center between Jan and Sep.1995, and evaluated the diagnostic feasibility of colon lavage cytology using oral cleansing solution.(continue...)
Colon* ; Colonic Neoplasms* ; Colonoscopy ; Colorectal Neoplasms ; Diagnosis* ; Humans ; Korea ; Mass Screening ; Protestantism ; Therapeutic Irrigation

BACKGROUND: There were several studies for the incidence of gastroesophageal reflux associated with the laryngeal mask airway(LMA), but the results of those studies were much different much different from one another. The aim of this study was to compare the incidence of gastroesophageal reflux and regurgitation of gastric contents between the LMA and the endotracheal tube(ETT). METHOD: Ninety patients scheduled for elective orthopedic surgery with a standardized general anesthetic technique were randomly allocated to receive either a LMA(n-49) or a ETT(n=41) for airway management. The esophageal manometry was carried out for the exclusion of esophageal motility disorders and the 24-hour ambulatory pH metry was done from one day before the operation. A methylene blue(50mg) capsule was swallowed just before the induction and the simultaneous recordings of pH were maintained during anesthesia. At the end of anesthesia, the episodes of regurgitation of gastric contents above hypopharynx were analyzed by the pharyngeal blue staining and the pH metric data were analyzed for the detection of gastroesophageal relux episodes during anesthesia. RESULTS: There was no significant difference in the incidence of gastroesophageal relux(pH< or =4) between two groups; only two patients in LMA and three patients in ETT had reflux episodes during the removal or arousal phase. There was no episode of the pharyngeal blue staining in both group. All of the gastroesophageal reflux patients in both group developed a cough or straining during those phases. There was no clinical evidence of aspiration of gastric contents in both group. CONCLUSION: In comparison with ETT, use of LMA does not appear to increase the incidence of gastroesophageal reflux and regurgitation above hypophryngeal level in positive pressure ventilating patients during long surgical procedures. Therefore, the risk of aspiration in LMA will not be much more than ETT.
Airway Management ; Anesthesia ; Arousal ; Cough ; Esophageal Motility Disorders ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Hypopharynx ; Incidence ; Laryngeal Masks* ; Manometry ; Masks* ; Orthopedics

BACKGROUND: The early diagnosis of invasive candidiasis is the most important for reducing of morbidity and mortality rates in the immunocompromised patients. The study of antigen detection was performed by Cand-Tec kit, but antibody detection by Western blot, had not been reported. OBJECTIVE: We reviewed 62 cases of suspected invasive candidiasis(10), immunocompromised patients with leukemia, leukopenia, pneumonia, et al(44) and normal colonization control(8) in the urine and sputum for the immunological diagnosis of invasive candidiasis by Cand-Tec and Western blot assays. METHODS: The antigen and antibody detection were done by both Cand-Tec kit and Western blot assay, in the sera of the patients collected from several hospitals. RESULTS: The sera from 4(40%) and 8(80%) of 10 suspected invasive candidiasis had a threshold positive titers of > or = 1:4 by latex agglutination (Cand-Tec) and the results of positive antibody to the immunodominant antigen (47KDa) of Candida spp. by Western blot assay, each other. Both antigen and antibody we.e detected from 21(47%) of 44 patients in the immunocompromised group and 1(12%) of 8 cases with normal flora, separately, but the antibodies from 3(18%) of 16 healthy controls were detected by Western blot analysis, only. CONCLUSION: This study confirm that the Western blot method of detecting antibody against immunodominant antigen(47KDa) of Candida spp. was more effective than antigen detection by Cand-Tec method for immunodiagnosis of invasive candidiasis.
Agglutination ; Antibodies ; Blotting, Western ; Candida ; Candidiasis, Invasive* ; Colon ; Diagnosis* ; Early Diagnosis ; Humans ; Immunocompromised Host ; Immunologic Tests ; Latex ; Leukemia ; Leukopenia ; Mortality ; Pneumonia ; Sputum

OBJECTIVE: The aim of this study was to monitor changes of prescription patterns for bipolar disorder in clinical settings during the last five years in four psychiatric treatment centers. METHODS: A retrospective chart review of data of 601 patients with bipolar disorder was performed between January 2001 and December 2005 from four psychiatric centers in Seoul and GyeongGi-Do. Data on demograpnic variables, clinical characteristics, and the types and dosages of mood stabilizers and antipsychotics, and the patterns of prescriptions over the five-year period were analyzed. RESULTS: The use of valproate has increased, whereas the percentage of lithium use has decreased. The combined prescription of valproate and lithium remained constant at 12% over the five-year period. The prescription of newer-class of mood stabilizers such as lamotrigine and topiramate was few. Most of the patients in our study were on more than two psychotropic agents, with the most common discharge medication being a combination of a mood stabilizer and an antipsychotic (81.9%). The use of atypical antipsychotics has increased its share from 71.4% in 2001 to 92.3% in 2005. Among the atypical antipsychotics, Quetiapine use showed the most rapid increase since year 2001 and ranked as the most frequenctly used antipsychotics for bipolar disorder in 2005 (38.5% of antipsychotics). Especially, in those without psychotic features, quetiapine was the most frequently used antipsychotics (51.2% in 2005). In those with psychotic features, risperidone (39.1%) was more frequently used than quetiapine (28.3%). CONCLUSION: The present study showed that significant changes have occurred in the prescription patterns of mood stabilizers and antipsychotics and the rate of combination therapy for patients with bipolar disorder in the last five years. These results seem to reflect the introduction of new agents and the accumulating evidencebased data for the treatment of bipolar disorder, and will provide the useful information to clinicians for the establishment of better treatment guidelines for patients with bipolar disorder.
Antipsychotic Agents ; Bipolar Disorder* ; Gyeonggi-do ; Humans ; Inpatients* ; Lithium ; Prescriptions* ; Retrospective Studies ; Risperidone ; Seoul ; Valproic Acid ; Quetiapine Fumarate

PURPOSE: We investigated the occurrence rate of recurrent abdominal pain (RAP) in general population of elementary school children, accompanied symptoms, symptom-aggravating factors such as emotional stresses, food and personality characters, which time of day the pain develops and whether they visited hospital for RAP. METHODS: From 1995. 4.27. to 1995. 5. 12. questionnaires were given to the parents of 1,783 elementary school children in Seoul. The qestions were as follow; 1) Have your child ever experienced abdominal pain more than 3 months and more than 3 times? 2) Were there any accompanied symptoms? 3) Does emotional stress encrease or induce the abdominal pain of your child? 4) Which time of day does the abdominal pain occur? 5) Have your child visited hospital for the RAP? 6)How is your child's personality and emotional characters? 7) Which foods induce or aggravate the abdominal pain? 8) Does your child with RAP like meat foods or vegetable foods? 9) If you think an emotional stressful factor for RAP, do you have such factors in the environment of your child? RESULTS: 1) Among the 1,783 children, 296 children had RAP (16.6%), boys 143 (15.4%), girl 153 (7.9%). The distribution of school grade of the children with RAP were in the order of the 2nd. grade (23.5%), 5th. grade (19.6%), 4th grade (15.8%), 6th. grade (15.0%), 1st. grade (14.3%), and 3rd.grade (11.9). 2) Symptoms which were accompained with abdominal pain was poor appetite (35.1%), diarrhea (31.8%), headache (27.1%), constipation (21.7%) vomiting (18.4%), urinary symptoms (11.1%) and 73 children (24.4%) had no accompanied symptom. 3) In 181 children (60.5% of RAP children), abdominal pain was induced or aggravated by emotional or psychologic stress. 4) In 130 children (43.5% of RAP children) abdominal pain occurred at postprandial time, in 80 children (28.6%) before meal, and in 70 children (23.4) early morning or night time. 5) Main personality characteristics of children with RAP were poor self confidences (111, 37.1%), strong desires for sucess (104,34.8%), and compulsivenesses (55,18.4%). 6) 135 children with RAP (45.2%) visited doctor due to RAP 7) Foods which induced or aggravated the abdominal symptoms were dairy food (56 children,19.4% of RAP children), greasy food (50,17.3%), wheat (29,10%), pork (21,7.3%) and in 165 children with RAP (57.1) foods had no relation with the abdominal pain. 8) 218 children with RAP (75.4%) liked meat foods (75.4%), and 73 children (25.3%) vegetable foods. 9) Specific emotional stresses of children with RAP which were described by the parents were school problems in 41 children (14.2%), divorces of parents in 3 children (1.4%). CONCLUSIONS: RAP in school children were more frequent than previously reported. We suspected organic causes for the RAP in many children who developed abdominal pain at night time, who had some accompanied symptoms, whose symptoms had no relation with emotional stresses or foods. Further active investigations in children with RAP are needed to elucidate the role of associated disorders.
Abdominal Pain* ; Appetite ; Child* ; Constipation ; Diarrhea ; Divorce ; Female ; Headache ; Humans ; Meals ; Meat ; Parents ; Surveys and Questionnaires ; Seoul* ; Stress, Psychological ; Triticum ; Vegetables ; Vomiting

The acardiac twin, or twin reversal of arterial perfusion (TRAP) sequence is encountered in approximately 1% of monozygotic twins with an incidence of one in 35,000 births. The problem results from vascular anastomoses between the arterial and venous circulation of normal "pump" twin and that of recipient "perfused" acardiac twin. The recipient twin may display severe and lethal anomalies, including acardia and acephalus. The pump twin is structurally normal. Mortality of about 50-75% in cases without treatment is due to heart failure, prematurity or cord entanglement. We report a case of acardiac twin diagnosed by ultrasound prenatally.
Heart Failure ; Humans ; Incidence ; Mortality ; Parturition ; Perfusion ; Twins, Monozygotic ; Ultrasonography*