OBJECTIVE: To evaluate the effects of piroxicam patch(Trast) in rheumatoid arthritis patients with knee joint pain and swelling and to determine the concentration of plasma and synovial fluid following patch application. METHODS: Twenty-two patients with rheumatoid arthritis participated in a double-blind, placebo-controlled study. The patients were instructed to apply piroxicam or placebo patch at one knee and re-apply it every other day for 2 weeks. They had washout period for 2 weeks and then applied the other patch for 2 weeks at the same joint. The patients recorded knee joint pain using visual analog scale. Knee joint swelling and tenderness were assessed before and after application of piroxicam and placebo patch. Complete blood count, AST, ALT, BUN, creatinine, joint fluid analysis were also done. Piroxicam concentration in plasma and synovial fluid were measured by high performance liquid chromatography(HPLC) after 2 weeks of piroxicam patch application. RESULTS: Knee joint pain improved significantly after the application of piroxicam patch for 2 weeks(visual analog scale, 56. 2+5. 9m vs 48. 2+5. 7mm, p=0. 03 by Wilcoxon signed rank test). There was no significant change in white cell count of synovial fluid, peripheral blood cell count, chemistry, C-reactive protein and erythrocyte sedimentation rate. In terms of adverse effects, mild gastrointesti nal disturbance(8/21 cases, 38%) and local side effects such as pruritus and ery thema(3/21 cases, 14%) were developed, which were insignificant compared with control groups(30%, 15% respectively). Piroxicam concentrations in plasma and synovial fluid after the application of piroxicam patch were 0. 129+0. 04ug/ ml (mean+SE) and 0. 644+0. 202ug/ml respectively. CONCLUSIONS: Piroxicam patch is a safe and effective therapeutic modality for knee joint pain in patients with rheumatoid arthritis. Mild adverse effects such as gastrointestinal disturbance and local side effects were noted. Piroxicam concentration was higher in synovial fluid than in plasma following the application of piroxicam patch.
Arthritis, Rheumatoid* ; Blood Cell Count ; Blood Sedimentation ; C-Reactive Protein ; Cell Count ; Chemistry ; Creatinine ; Humans ; Joints ; Knee ; Knee Joint ; Piroxicam ; Plasma ; Pruritus ; Synovial Fluid ; Visual Analog Scale

The practice of medicine today is beset with unprecedented challenges which include public distrust in medical profession, increasing market force and strengthened management. Recently medical professional societies in UK & USA are overcoming these challenges in the way that medical professionalism is modernized in a changing society. They set 'a physician charter' and new definition of medical professionalism as a partnership. The principles of new medical professionalism are patient welfare, patient autonomy and social justice. It describes doctors' commitment to integrity, compassion, altruism, continuous improvement, excellence, working in partnership, just distribution of finite resources, maintaining trust by managing conflicts of interest and others. New professionalism support improvement of health care system for the welfare of society and the collective human dignity. Experience of rebuilding medical professionalism in UK and USA will give a lesson to Korean medical profession when they seek for solution to restore public confidence and take the leadership in Korean healthcare system.
Altruism ; Delivery of Health Care ; Empathy ; Humans ; Leadership ; Personhood ; Social Justice

Traditionally, the Rhododendron species has been used in gastrointestinal disorder or hypertension. Grayanotoxin exists in honey, flowers, pollen, and the nectar of the Rhododendron species. We experienced 3 cases of Grayanotoxin intoxication. The symptoms of intoxication were nausea, vomiting, hypotension, bradycardia, diplopia, dizziness, and chest discomfort. Generally, the treatment for Grayanotoxin intoxication is fluid resuscitation and injection of atropine sulfate. The patients who were intoxicated with Grayanotoxin were discharged without complication after supportive care.
Atropine ; Bradycardia ; Diplopia ; Dizziness ; Flowers ; Honey ; Humans ; Hypertension ; Hypotension ; Nausea ; Plant Nectar ; Pollen ; Resuscitation ; Rhododendron ; Thorax ; Vomiting

No abstract available.
Humans ; Spondylitis, Ankylosing*

OBJECTIVE: To assess neurotoxicity of intrathecal restorative fluid leakage in the course of the intradiscal restorative fluid injection. METHOD: Twenty male Sprague-Dawley rats, body weight range of 300~350 gm, were divided randomly into four groups. Control group, group A (mixed solution of glucosamine hydrochloride 5%, chondroitin sulfate 5%, and bupivacaine hydrochloride 2%), group B (glucosamine hydrochloride 8%, chondroitin sulfate 2%, and bupivacaine hydrochloride 2%) and group C (glucosamine hydrochloride 16%, chondroitin sulfate 2%, and bupivacaine hydrochloride 2%). The behavioral test for cold allodynia (tail flick test) was conducted 1 day prior to the injection and 7 days postoperatively. Histopathologic evaluation was performed using light microscopy by a neuropathologist. The severity of nerve and cord injury were graded according to injury scoring system. RESULTS: Each group showed no significant difference in sensory function test using tail flick test before and after intrathecal restorative fluid injection. Cold allodynia was not showed statistically significant difference among the group. Histological examination showed statistically significant difference between control group and group B, group C, and between group A and group B, C in both cord and root. CONCLUSION: Intrathecal injection of restorative fluid shows neurotoxic changes in roots and spinal cord in histopathologic studies. Although same ingredients of restorative solution, the different concentration of the ingredients revealed different neurotoxicity.
Animals ; Body Weight ; Bupivacaine ; Chondroitin Sulfates ; Glucosamine ; Humans ; Hyperalgesia ; Injections, Spinal ; Male ; Microscopy ; Rats* ; Rats, Sprague-Dawley ; Sensation ; Spinal Cord

OBJECTIVE: This study was conducted to elucidate the associations of HLA with systemic sclerosis (SSc) in Koreans. METHODS: HLA associations with SSc according to SSc-specific autoantibody status and clinical subsets (diffuse and limited) were investigated. HLA-A, B, and C antigens were typed by the serological method using microlymphocytotoxicity test, and HLA-DR by DNA typing method using PCR-reverse hybridization and PCR-SSCP in 56 Korean patients with SSc and 226 healthy controls. For SSc patients, anti-Scl-70 and anicentromere antibodies were tested by double immunodiffusion and indirect immunofluorescence, respectively. RESULTS: The results of HLA class I antigen typing showed that the frequencies of HLA-A24, B52 and B62 were increased, whereas those of A33, B44 and B58 were decreased in SSc patients compared to healthy controls. The frequency of HLA-DR2 was significantly increased, whereas that of HLA-DR13 was decreased in patients with SSc compared to controls. Among HLA-DR2 alleles, both HLA-DRB1*1501 and *1502 were increased in SSc patients compared to controls. According to clinical status, HLA-DRB1*1501 was increased in limited SSc patients and that of DRB1*1502 was increased both in diffuse and limited SSc patients compared to controls. According to autoantibody status, HLA- DRB1 1502 was significantly increased in anti-Scl-70-positive SSc patients and that of DRB1 1501 was increased in anti-Scl-70-negative SSc patients compared to controls. The association of HLA-DR2 alleles with SSc according to clinical subsets and anti-Scl-70 antibody status revealed that the frequency of HLA- DRB1 *1501 was significantly increased in anti-Scl-70-negative limited SSc patients compared to controls. CONCLUSIONS: These results suggest that different HLA-DR2 alleles are associated with different types of SSc in Koreans. HLA-DRB1 1502 shows strong association with anti-Scl-70-positive SSc, and DRB1 1501 with anti-Scl-70-negative limited SSc. It is concluded that the pathogenesis of SSc in Koreans is in part, based on the same genetic background.
Alleles ; Antibodies ; Asian Continental Ancestry Group ; DNA Fingerprinting ; Fluorescent Antibody Technique, Indirect ; HLA-A Antigens ; HLA-A24 Antigen ; HLA-DR Antigens ; HLA-DR2 Antigen ; HLA-DRB1 Chains ; Humans ; Immunodiffusion ; Scleroderma, Systemic*

Chondromyxoid fibroma is a rare benign cartilaginous tumor frequently involving the metaphysis of the long bones of the lower limbs of children and adolescents. We present a case of chondromyxoid fibroma involving the entire distal phalanx of a big toe causing macrodactyly, which was treated by excision and reconstruction using iliac bone graft instead of amputation. The patient was satisfied cosmetically and there was no evidence of recurrence four years after surgery.
Adolescent ; Amputation ; Child ; Fibroma* ; Humans ; Lower Extremity ; Recurrence ; Toes* ; Transplants

Subclavian artery(SCA) injuries are rare, accounting for only 1 to 2% of all acute vascular injuries. The majority of SCA injuries are occured by motor vehicle accident and by penetrating trauma, only 1 to 5% of all subclavian artery injuries occurred by blunt mechanisms. The incidence of brachial plexus injury is also rare and 60% of brachial plexus injuries induced by blunt injury is occurred by motor vehicle accident. Aggressive diagnostic work-up is recommended for the patients with high suspicious index and repair is essential for the successful management of these rare vascular injuries. We report the experience of one case of combined subclavian artery and brachial plexus injuries due to blunt trauma.
Brachial Plexus* ; Humans ; Incidence ; Motor Vehicles ; Subclavian Artery* ; Vascular System Injuries ; Wounds, Nonpenetrating

Chronic behavioral stress is a risk factor for depression. To understand chronic stress effects and the mechanism underlying stress-induced emotional changes, various animals model have been developed. We recently reported that mice treated with restraints for 2 h daily for 14 consecutive days (2h-14d or 2hx14d) show lasting depression-like behavior. Restraint provokes emotional stress in the body, but the nature of stress induced by restraints is presumably more complex than emotional stress. So a question remains unsolved whether a similar procedure with "emotional" stress is sufficient to cause depression-like behavior. To address this, we examined whether "emotional" constraints in mice treated for 2hx14d by enforcing them to individually stand on a small stepping platform placed in a water bucket with a quarter full of water, and the stress evoked by this procedure was termed "water-bucket stress". The water-bucket stress activated the hypothalamus-pituitary-adrenal gland (HPA) system in a manner similar to restraint as evidenced by elevation of serum glucocorticoids. After the 2hx14d water-bucket stress, mice showed behavioral changes that were attributed to depression-like behavior, which was stably detected >3 weeks after last water-bucket stress endorsement. Administration of the anti-depressant, imipramine, for 20 days from time after the last emotional constraint completely reversed the stress-induced depression-like behavior. These results suggest that emotional stress evokes for 2hx14d in mice stably induces depression-like behavior in mice, as does the 2hx14d restraint.
Animals ; Anxiety ; Depression ; Glucocorticoids ; Imipramine ; Mice ; Risk Factors ; Stress, Psychological ; Water