Although it is widely accepted that exercise is beneficial in patients with end-stage renal disease as in the general population, it is not easy to incorporate exercise programs into routine clinical practice. This review aimed to investigate the beneficial effects of exercise during hemodialysis and also to introduce various intradialytic exercise programs and their advantages as a first step in combining exercise programs into clinical practice. Aerobic and resistance exercise are beneficial not only in improving physical functioning, including maximal oxygen uptake and muscle strength, but also in improving anthropometrics, nutritional status, hematological indexes, inflammatory cytokines, depression, and health-related quality of life. However, it is not clear whether the beneficial effects of exercise are limited to only relatively healthy dialysis patients. Therefore, the effects of individualized exercise programs for elderly patients or patients with comorbid conditions need to be studied further.
Aged ; Cytokines ; Depression ; Dialysis ; Humans ; Kidney Failure, Chronic ; Muscle Strength ; Nutritional Status ; Oxygen ; Quality of Life ; Renal Dialysis ; Resin Cements

Goltz syndrome is known as a rare mesoectodermal hereditary disease, characterized by focal dermal atrophies with hernias of adipose tissue and also associated with a multitude of possible skeletal, dental, ophthalmological and other abnormalities. We experienced a case of Goltz syndrome. An one day old female newborn had focal atrophic and telangiectatic skin lesions, microphthalmia, syndactyly and urinary tract abnormality. The finding of skin biopsy was consistent with focal dermal hypoplasia. We report the case with a brief review and related literatures.
Adipose Tissue ; Atrophy ; Biopsy ; Female ; Focal Dermal Hypoplasia* ; Genetic Diseases, Inborn ; Hernia ; Humans ; Infant, Newborn ; Microphthalmos ; Skin ; Syndactyly ; Urinary Tract

Tracheal intubation for general anesthesia is usually performed using a rigid laryngoscope and reguires the mandible to be opened with forward and upward traction of the patient's jaw which may at times result in the inadvertant injury to temporomandibular joint(TMJ). The injury may include internal derangement, dislocation and hematoma of TMJ; subsequent intraarticular adhesion formation ; dislocation of the meniscus, and rarely auriculotemporal nerve damage from traumatic TMJ dislocation. We studied in 200 patients the size of mouth opening during intubation, the change of mouth opening by tracheal intubation evaluated after operation, and any TMJ disorder arising after tracheal intubation. The results were as follows; 1) The mean size of mouth opening before operation was 42.7+/-7.0 and 40.6+/-6.2mm in male and female patients, respectively. 2) The mean size of mouth opening during intubation was 24.7+/-2.6 and 23.4+/-2.7mm in male and female patients, respectively. When vecuronium was used to prevent fasciculation, the mean was 24.3+/-3.1 and 25.2+/-2.0mm in male and female patients, respectively. 3) One week following operation The mean size of mouth opening one week postoperation was 48.3+/-8.9 and 42.2+/-6.3mm in male and female patients, respectively. When vecuronium was used to prevent fasciculation, the mean size of mouth opening was 55.5+/-5.3 and 43.2+/-6.2mm in male and female patients, respectively. 4) Five patients complained of discomfort around TMJ after tracheal intubation. It seems that upward 45 mandibule lifting by laryngoscope caused trauma to TMJs.
Anesthesia, General ; Dislocations ; Fasciculation ; Female ; Hematoma ; Humans ; Intubation ; Intubation, Intratracheal* ; Jaw ; Laryngoscopes ; Lifting ; Male ; Mandible ; Mouth ; Temporomandibular Joint Disorders ; Temporomandibular Joint* ; Traction ; Vecuronium Bromide

We report the first two cases of manic and hypomanic episodes respectively induced by risperidone treatment done to schizophrenics in Korea. One case was a 22-year-old woman with catatonic schizophrenia. Since 3 years ago, she had shown psychotic symptoms, but with was poor treatment compliance. She had mainly negative symptoms such as social withdrawal, decreased flood intake, mutism, and symptoms had been worsened since last 4-5 months. Prior to closed ward admission, she was prescribed 2mg/d of risperidone far a week at OPD. Two days after taking medicine totally 6-8mg, she revealed manic features. After hospitalization, risperidone was discontinued and then, lithium 900mg/d and high dosage of conventional antipsychotics(chlorpromazine 1200mg/d or haloperidol 20mg/d) were prescribed. About on the l0th day of hospitalization, there was limited improvement of her manic symptoms. The other case was a 29-year-old man with a 3-year history of paranoid schizophrenia. He was never exposed to antipsychotics before. His main symptoms were delusions of being poisoned and of persecution. His positive and also negative symptoms were alleviated by 38 days of risperidone 2mg/d trial. However, one week after dosage increment to 3mg/d, hypomanic symptoms appeared. Risperidone medication was discontinued and was replaced by chlorpromazine 300mg/d. The hypomanic episode was resolved over 5 days. In both of the two cases, manic episodes occurred by monotherapy of risperidone without mood stabilizer, and there were no history of substance abuse and other psychiatric disorders, family history of psychiatric disorders, and comorbid physical illnesses. It is hypothesized that the potent blockade effect on serotonin(5-HT2) receptor of risperidone causes antidepressant effect, as well as therapeutic effect for negative and affective symptoms in schizophrenia. Risperidone would induce manic or hypomanic features in schizophrenic patients. And there are few case reports of risperidone-induced mania or exacerbation of preexisting manic symptoms by risperidone treatment in mood disorder and schizoaffective disorder. Risperidone is being used more widely, even for obsessive-compulsive disorder and other psychiatric disorders. It is necessary for clinicians to recognize manic switch, one of psychiatric side effects by risperidon trial. It is recommended that the combination of mood stabilizer with risperidone or usage of the minimum effective dose of risperidone may bewefal especially in the patients with mood disorders or schizoaffective disorders. Clozapine which has mood-stabilizing properties is also beneficial in risk groups of risperidone-induced mania.
Adult ; Affective Symptoms ; Antipsychotic Agents ; Bipolar Disorder* ; Chlorpromazine ; Clozapine ; Compliance ; Delusions ; Female ; Haloperidol ; Hospitalization ; Humans ; Korea ; Lithium ; Mood Disorders ; Mutism ; Obsessive-Compulsive Disorder ; Psychotic Disorders ; Risperidone ; Schizophrenia ; Schizophrenia, Catatonic ; Schizophrenia, Paranoid ; Substance-Related Disorders ; Young Adult

PURPOSE: The study was aimed to investigate immunogenetic peculiarities of neuroinflammatory CNS diseases in Korean children. METHODS: A total of 16 children with neuroinflammatory CNS diseases(9 males and 7 females; mean age 7.5+/-4.2 years) were consecutively recruited. Genomic typings were performed on their HLA DRB/HLA DQB genes using PCR-SSOP/SSP techniques with Gel immunoelectrophoresis. RESULTS: The frequencies of HLA-DRB1*14(38%), HLA-DRB1*15(25%), HLA-DRB3* 02(50%), HLA-DQB1*05(56%) and DQB1*06(44%) were significantly increased compared with a control group. The frequencies of HLA-DRB1*15(50%) and HLA-DQB1*06(63%) were significantly increased in children with ADEM and HLA-DRB3*0202(100%), HLA- DRB1*1302(67%), HLA-DRB3*0301(67%), and HLA-DQB1*0301(67%) in children with multiple sclerosis. HLA-DRB1*1401, HLA-DRB3*0202, and HLA-DQB1*0502 were found in children with acute necrotizing encephalopathy. CONCLUSION:HLA-DRB1*14, HLA-DRB1*15, HLA-DRB3*02, HLA-DQB1*05 and DQB1*06 may be associated with the susceptibility to neuroinflammatory CNS diseases in Korean children. The frequencies of HLA-DRB1*1501, HLA-DRB5*0101, HLA-DRB3* 0301, and HLA-DQB1*0602 in Korean children with multiple sclerosis were not as high as those in western children. However, HLA-DRB3*0202 was seen in all the children with multiple sclerosis. Our data may provide further evidence that the immunogenetic backgrounds of neuroinflammatory CNS diseases in Korean children are distinctly different from those in Westerns. However, further studies are needed.
Central Nervous System Diseases* ; Child* ; Encephalomyelitis, Acute Disseminated ; Female ; Humans ; Immunoelectrophoresis ; Immunogenetics ; Male ; Molecular Typing* ; Multiple Sclerosis

Behcet's disease is a systemic inflammatory disorder of unknown etiology, characterized by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. Renal involvement is rare in patients with Behcet's disease particularly immunoglobulin A (IgA) nephropathy. Other autoimmune diseases have been associated with increased risk of malignancy, but not Behcet's disease. Some cases of Behcet's disease accompanied by bladder cancer, thyroid cancer, stomach cancer, or hematologic malignancies have been reported. However, to the best of our knowledge, co-occurrence of Behcet's diseases with thymic carcinoma has not yet been reported. We experienced a 49-year-old male patient who had been treated for Behcet disease and IgA nephropathy, who presented with a large mediastinal mass on chest x-ray. After thymectomy, he was diagnosed with thymic carcinoma with complete resection.
Autoimmune Diseases ; Behcet Syndrome ; Glomerulonephritis, IGA* ; Hematologic Neoplasms ; Humans ; Immunoglobulin A ; Male ; Middle Aged ; Skin ; Stomach Neoplasms ; Stomatitis, Aphthous ; Thorax ; Thymectomy ; Thymoma* ; Thyroid Neoplasms ; Ulcer ; Urinary Bladder Neoplasms ; Uveitis

To assess prophylatic antibiotic usage and the value of an intraoperative bile culture in biliary tract surgery, intraoperative bile cultures were taken in 276 biliary surgical patients during the period from Jan. 1991 to Dec. 1995. The results of bile culture, the isolation of organisms, susceptibility of the microorganisms to antibiotics, and the relationship between a positive culture and postoperative complications were analyzed. The positive culture rate was 56.5%, and the highest culture rate(100%) was seen in patients with combined stones in the gallbladder, the common bile duct and the intrahepatic duct. The most common gram negative microorganism was E. coli(44%), and Enterococcus was the most common among the gram positive microorganisms. The effective antibiotics for gram negative organisms were Amikacin, Gentamicin, Tobramycin, and Chloramphenicol; for gram positive organisms, they were Amikacin, Tetracycline, Gentamicin, and Tobramycin in order of effectiveness. The frequency of wound infection was larger in positive cultures(11.5%) than in negative cultures (2.5%), and the risk factors for positive cultures were old age, obstructive jaundice, a high serum SGOT/SGPT level, and previous biliary tract surgery. In conclusion, we recommend that prophylactic antibiotic treatment be done during the perioperative period for old patients with leukocytosis, obstructive jaundice, cholangitis, or a history previous biliary tract surgery. Antibiotic prophylaxis in biliary tract surgery reduces postoperative infectious complications.
Amikacin ; Anti-Bacterial Agents ; Antibiotic Prophylaxis* ; Bile* ; Biliary Tract* ; Chloramphenicol ; Cholangitis ; Common Bile Duct ; Enterococcus ; Gallbladder ; Gentamicins ; Humans ; Jaundice, Obstructive ; Leukocytosis ; Perioperative Period ; Postoperative Complications ; Risk Factors ; Tetracycline ; Tobramycin ; Wound Infection

Two cases of an anomalous systemic arterial supply to the basal segments of the left lower lobe without pulmonary wequestration are presented. In the first case, a preoperative diagnosis was made by chest CT, and confirmed by angiograpy, in a 22-year old man who had a recurrent hemoptysis. There was systemic arterial supply that originated from the thoracic descending aorta and no pulmonary arterial supply to the basilar segment of the left lower lobe. However, the pulmonary parenchyma was normal without sequestration. Ligation of the abnormal artery and a left lower lobectomy were performed without complication. In the second case, there were characteristic features of this anomaly on chest CT and the angiogram in a 31-year-old man with symptoms of hemoptysis. The patient refused surgery.
Adult ; Aorta, Thoracic ; Arteries ; Bronchopulmonary Sequestration ; Diagnosis ; Hemoptysis ; Humans ; Ligation ; Tomography, X-Ray Computed

Colonoscopy is a frequently performed procedure used for colorectal cancer screening. Most frequent complication is colonic perforation and bleeding. Other visceral injuries are very rare, but injuries to the spleen and liver have been described. We report on 66-yr-old female who presented with abdominal pain after uneventful colonoscopy. Abdominal CT scan revealed a band at previous hysterectomy site and dilated small bowel suggesting strangulated loop. A broad based knowledge of the different complication is necessary to decrease the risk of associated morbidity and mortality.
Abdominal Pain ; Colon ; Colonoscopy ; Colorectal Neoplasms ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Intestinal Obstruction ; Liver ; Mass Screening ; Spleen

Juvenile polyps are relatively common polyps that affect predominantly young patients and may occur in isolated, multiple, and/or familial forms. They have been considered to be benign lesions without neoplastic potential, but for patients with multiple juvenile polyposis, the cumulative malignant risk is greater than fifty percents. In patients with a solitary polyp, the risks are minimal, and only a few cases of malignant change from a solitary juvenile polyp have been reported. We describe the case of a twenty one year old female with one solitary juvenile polyp, which contained a signet ring cell carcinoma in the mucosal layer.
Carcinoma, Signet Ring Cell ; Colon ; Colonic Polyps ; Female ; Humans ; Polyps