The polyglandular autoimmune syndrome designates the dysfunction of endocrine and nonendocrine system involving two or more organs on the basis of an autoimmune mechanism. The autoimmune nature of these diseases has been based on the presence of lymphocytic infiltration in the affected gland, organ specific autoantibodies in the serum, cellular immune defects and an association with the HLA DR/DQ genes or immune response genes. This syndrome is usually classified into three classes and their etiology or pathogenesis is still not completely understood. A 28-year-old woman developed vitiligo and insulin dependent diabetes mellitus during the treatment of Graves' disease with antithyroid drug. She had a tendency of spontaneous ketonemia and serum c-peptide levels were low(0.21, 0.16ng/mL: fasting and glucagon stimulated). Thyrotrophin binding inhibitor immunoglobulin and pancreas iIslet cell cytoplasmic antibody were positive. We report here a case of polyglandular autoimmune syndrome, type III manifesting Graves' disease, vitiligo, and insulin dependent diabetes mellitus.
Adult ; Autoantibodies ; Bone Diseases ; C-Peptide ; Cytoplasm ; Diabetes Mellitus ; Fasting ; Female ; Genes, MHC Class II ; Giant Cells ; Glucagon ; Granuloma ; Graves Disease ; Humans ; Immunoglobulins ; Insulin ; Ketosis ; Pancreas ; Pedigree ; Thyrotropin ; Vitiligo

To know the difference in graft rejection after corneal transplantation between moist chamber and Optisol(Chiron Co. Irvine, CA, U.S.A.) as cornea preservation methods, we compared two groups involving 50 patients(71 eyes) who had undergone partially penetrating keratoplasty (PPKP) for the treatment of keratoconus or corneal dystrophy from 1991 to 1995. The graft rejection had occurred in 10 of 40 eyes(25%) in moist chamber group and 9 of 31 eyes(29%) in Optisol group, and the cases of permanent corneal opacity after rejection were 5 of 40 eyes(12.5%), 3 of 31 eyes(9.7%) respectively. No difference in the two groups was statistically significant(P<0.05). We found the fact that the difference did not exist in the results from graft rejection after PPKP using moist chamber method for short preservation period, or Optisol method for the relatively long period allowing serological and immunological screen test.
Cornea ; Corneal Opacity ; Corneal Transplantation ; Graft Rejection* ; Keratoconus ; Keratoplasty, Penetrating ; Transplants*

Effective noninvasive modalities such as radiotherapy and pharmacologic treatments have become highly developed in the treatment of intractable cancer pain. Although epidural narcotics have been considered particularly useful, limitations still remain in their effectiveness for some patients. Surgical therapy can be a useful alternative to these treatments. Cordotomy is one of the most effective surgical treatments. The first percutaneous cordotomy was attempted by Mullan and his associates in 1963. Rosomoff and his associates modified the procedure using radiofrequency two years later. Cordotomy was widely used by the late 1960's but due to its limited effectiveness and serious complications it was abandoned until 1980 when a new electrode was developed by Levin. A thermocouple cordotomy electrode such as the Levin electrode allows monitoring of impedance and tissue temperature. A radiofrequency lesion can be made by increasing the current directly to the desired temperature rather than by gradual heating with the usual incremental increases in lesion current and time. With the use of this electrode, consistent clinical effects are assured and operating time is reduced. The chances of boiling or charring are also minimized. Since this electrode was developed, cordotomy has received renewed attention virtually everywhere except in Korea. Five terminal cancer patients in whom conservative treatments had failed were treated by cordotomy using the three types of thermocouple electrodes: the levin cordotomy electrode; the TCE thermocouple electrode, and the Kanpolat CT electrode. Due to the small number of patients, a comparison of the effectiveness of these three types could not be made. Although complete pain relief was not achieved in every case, dosages of narcotics could be reduced as a result of this procedure. There were no serious complications except a transient paralysis of the ipsilateral arm in one case and headaches in four cases.
Arm ; Cordotomy* ; Electric Impedance ; Electrodes* ; Headache ; Heating ; Hot Temperature ; Humans ; Korea ; Narcotics ; Paralysis ; Radiotherapy ; Trout

Thirteen patients were operated for cubital tunnel syndrome and followed for an average of 26 months postoperatively. Ten patients had a history of relevant trauma and three patients had degenerative osteoarthritis of the elbow. The average duration of symptoms was 18 months (range, 2 to 96 months). Diagnosis was made by physical examination, electromyography and nerve conduction study. Among these, nerve conduction study was found to be the most valuable diagnostic method for the patients with atypical clinical findings. Most of the operations were performed by anterior transposition of the ulnar nerve. At the most recent follow-up, the result was excellent in two patients, good in eight, and fair in three; thus ten patients(77%) showed satisfactory results. The rating system for ulnar neuropathy based on sensory, motor dysfunction and pain was useful for evaluating the operative results. The postoperative gain of score for pain and sensory function were larger than that of motor function. Factors known to influence the result of the operation (age, duration of symptom, history of trauma, method of operation) did not effect the outcome in this study. For successful operation, the ulnar nerve must be thoroughly examined, all possible levels of compression must be released and new foci of compression must be created.
Cubital Tunnel Syndrome ; Diagnosis ; Elbow ; Electromyography ; Follow-Up Studies ; Humans ; Methods ; Neural Conduction ; Osteoarthritis ; Physical Examination ; Sensation ; Ulnar Nerve ; Ulnar Neuropathies

Recently anterior spinal device in the treatment of the unstable thoraco-lumbar spine has been used. We have experienced 11 patients of the unstable thoraco-lumbar spine, which were composed of 8 patients with burst fracture and 3 patients with tuberculous spondylitis. The 11 patients with neurological deficit were treated with an one stage anterior operation consisting of anterior decompression through vertebrectomy, realignment with Kanedae device. No patient showed neurologic deterioration after surgery. The anterior spinal instrumentation with Kaneda device afford enough stability to enable early ambulation with good alignment and solid fusion.
Decompression ; Early Ambulation ; Humans ; Spine ; Spondylitis

OBJECTIVE: To identify the prevalence and risk factors for lower limb lymphedema in the patients after gynecologic neoplasms treatment in Korea. METHODS: We retrospectively reviewed the medical records and interviewed 242 gynecologic neoplasms patients who have managed surgically and medically over a 4 year period between January 2003 and December 2006. We identified the patients with lower limb lymphedema as described by the medical records or reported by the interviews. We obtained demographic characteristics, other medical history, cancer type, stage of cancer, lymph node dissection, chemotherapy, radiotherapy, hormone therapy and laboratory findings. Multiple logistic regression analysis was done to evaluate the risk factors for lower limb lymphedema. RESULTS: Forty eight (19.8%) patients out of two hundred forty two had lower limb lymphedema. Those patients with lower limb lymphedema had a higher body mass index, radiotherapy history, chemotherapy history and lymph node dissection history, radical hysterectomy. Multivariate analysis revealed that body mass index, radiotherapy and lymph node dissection were independently risk factors for lower limb lymphedema after gynecologic neoplasms treatment. CONCLUSION: The patients who had radiotherapy, body mass index greater than 25 or lymph node dissection must be considered as potential candidates to have lower limb lymphedema in the patients after gynecologic neoplasms treatment. Therefore, these patients should be informed during the follow-up period about this morbidity, the preventive measures, and the treatments.
Body Mass Index ; Female ; Follow-Up Studies ; Genital Neoplasms, Female ; Humans ; Hysterectomy ; Korea ; Logistic Models ; Lower Extremity ; Lymph Node Excision ; Lymphedema ; Medical Records ; Multivariate Analysis ; Prevalence ; Retrospective Studies ; Risk Factors

The light and electron microscopic studies were carried out to find the morphological changes of epithelial cells covering Peyer's patch after simple observation of gerbil (Mongolian gerbil) ileum. Animals were classified as the control, 6 hour-ligation and 18 hour-ligation groups. Terminal ileum was ligated with white silk around Peyer's patch without the vascular injury. In control group, epithelia of the gerbil ileum was consisted of villous epithelium and follicle-associated epithelium (FAE) covering Peyer's patch. FAE represented typical dome structure, and was composed of the cuboid absorptive cells mainly and M cells. M cells were distributed at the periphery rather than central portion of dome-like FAE that are distinguishable from absorptive cells, owing to their typically short and thick microvilli on its free surface. In the light mictoscopy on 6 hour-ligation group, cells with vacuoles were appeared in FAE, and some lymphocytes in lymphoid follicle were condensed and then densely stained. There are many lymphocytes in FAE, infiltrated through the interrupted basement membrane. In the electron microscopic findings of 6-hour-ligated group, absorptive cells appeared to have many vesicle and vacuoles in various size, some lipid droplets and membranous structure contained inclusion bodies. Microvilli of M cell appeared to be destroyed at the central portion on its free surface. In the light microscopy of 18 hour-ligation group, FAE destructed partially and lymphoid follicle was hypertrophied and atrophied simultaneously. In the electron microscopic findings of 18 hour-ligation group, absorptive cells appeared to have the irregular and densely stained nucleus, and have many lipid droplets other than structures observed in 6 hour-ligation group. M cell appeared to have various-sized vacuoles, and have the bleb-like and irregular membrane-limited structures that protrude into the lumen and have less the cytoplasmic cell organs. These results suggested that the simple ligation of ileum gives rise to the inflammatory response on FAE of 6 hourligated group and then lead to the various response; degeneration, necrosis and atrophy of cells in FAE, and the hypertrophy and atrophy of lymphocytes in lymphoid follicle. M cell might have no special function and have the degenerative change with the adjacent absorptive cells during simple obstruction.
Animals ; Atrophy ; Basement Membrane ; Cytoplasm ; Electrons ; Epithelial Cells ; Epithelium ; Gerbillinae ; Humans ; Hypertrophy ; Ileum ; Inclusion Bodies ; Ligation ; Light ; Lymphocytes ; Microscopy ; Microvilli ; Necrosis ; Silk ; Vacuoles ; Vascular System Injuries

PURPOSE: Clotting factor X deficiency is one of the least common coagulation disorders. The authors describe a case of cleft palate in a patient with a congenital clotting factor X deficiency. METHODS: In pediatric patients with a cleft palate, the coagulation problem is more worrisome, because they are more sensitive to blood than adults, and because postoperative bleeding can cause blood ingestion with subsequent vomiting, aspiration, and airway obstruction. To prevent hemorrhagic complications in the described case, fresh frozen plasma (FFP) was administered every 24 hours from the day before surgery to the second postoperative day. RESULTS: Good hemostasis, normal healing, and no complications was shown postoperatively. CONCLUSION: The replacement of fresh frozen plasma was useful in the case of congenital clotting factor deficiency for bleeding prophylaxis in cleft palate operation.
Adult ; Airway Obstruction ; Cleft Palate ; Eating ; Factor X ; Factor X Deficiency ; Hemorrhage ; Hemostasis ; Humans ; Plasma ; Vomiting

Povidone-iodine (PVP-I, Betadine) has many advantages as a disinfectant solution for preoperative preparations, especially for oral surgery. It is widely used because of its low toxicity and excellent bactericidal effect. The authors report a case of pneumonia secondary due to the aspiration of PVP-I, which was used as an oral disinfectant. We present a case of aspiration pneumonia that resulted from the careless use of PVP-I during preoperative preparation. The patient was a 10-month-old female scheduled for elective surgery to correct a complete cleft of secondary palate. During the preparation of the oral cavity for that cleft palate patient, PVP-I was incidentally aspirated to the airway. The lung resistance was noted with positive pressure and pneumonic infiltration on chest radiograph was seen. The operation was postponed and the patient underwent respiratory care. Three months later, elective palatoplasty under general anesthesia was performed without complication. Based on the experiences of this case, the authors advise that throat-packing should be placed before oral preparation to prevent serious pulmonary complications.
Anesthesia, General ; Cleft Palate ; Female ; Humans ; Lung ; Mouth ; Palate ; Pneumonia ; Pneumonia, Aspiration ; Povidone-Iodine ; Surgery, Oral ; Thorax

Alveolar Process ; Atrophy ; Denture, Partial, Fixed ; Discrimination (Psychology) ; Follow-Up Studies ; Humans ; Mandible ; Mandibular Nerve