Scurvy is a manifestation of deficiency of vitamin C, which was characterized by follicular hyperkeratosis, hemorrhagic manifestation, fatigue, muscular ache and pains, swollen jonts, swollen bleeding gums, and peripheral edema. Rescently we experienced a cases of scurvy in 13 month old boy who had been nourished by artificial feedings with ricegruel without additional vitamin C. Rentgenographic findings of bone revealed rosaries in all costochondral junctions and typical scorvutic changes in both femur. Scury is very rare disease in korea now. A brief review of literature was done.
Ascorbic Acid ; Edema ; Femur ; Gingiva ; Hemorrhage ; Humans ; Infant ; Korea ; Male ; Muscle Fatigue ; Rare Diseases ; Scurvy*

PURPOSE: To evaluate the activated zone of the supplementary motor area through motor and sensorystimula-tion of both hands by fMRI. MATERIALS AND METHODS: Twenty-four healthy volunteers, ranging in age from 20to 30 years, served as sub-jects. They were divided into four groups and performed one of the four activationtasks : complex movement, fine movement, touch sensation, heat sensation. Complex movement consisted of a fingertask in which sub-jects flexed and extended all fingers repeatedly in union, without the fingers touching eachother(group I). Fine movement involved a thumb task in which subjects flexed and extended the thumb repeatedlywithout touch-ing the other fingers(group II). Touch sensation consisted of a palm task in which another personrepeatedly drew a circle on the subject 's palm (group III), and heat sensation involved of a palm task in whichsubject 's palm was touched by another person with a 40 degreeC water-bag (group IV). F-MRI was conducted on acommer-cial 1.5-T scanner equipped with echo-planar imaging. After overlapping images were obtained using aZ-s-core, and the mean/curve in the MR devices was evaluated, the activated zone of the supplementary motor RESULTS: Thirty-two of 48 images(20 of the 24 men) revealed activated zones in the supplementary motor area. Ingroup I, activation was observed in five subjects, in three of whom it was bilateral (contralateral activation).In group II, activation was observed in five subjects, in one of whom it was bilateral. In group III, activationoccurred in five subjects(bilateral in four, and contralateral in three), and In group IV, activation was alsoob-served in five ; in three of these it was bilateral. CONCLUSION: Using fMRI, and in association with motor andsensory tasks, the supplementary motor area was activated in 66.7% of healthy volunteers (32/48).
Brain* ; Echo-Planar Imaging ; Fingers ; Hand ; Healthy Volunteers ; Hot Temperature ; Humans ; Magnetic Resonance Imaging* ; Sensation ; Thumb

PURPOSE: To determine the diagnostic accuracy and frequency of complications of fluoroscopy-guidedtransthoracic needle biopsy, using an automated gun biopsy system. MATERIALS AND METHODS: We retrospectively reviewed 86 patients who underwent automated gun biopsy between October 1995 and October 1996. An 18-gauge cutting needle was used in all cases. All biopsies were performed under fluoroscopic guidance by one interventional radiologist. RESULTS: Tissue sufficient for histologic diagnosis was obtained in 73 of 86 biopsies(84.9%). Fifty-six lesions were malignent and 30 were benign. Sensitivity and diagnostic accuracy for malignant lesions were 87.5% and 87.5%, respectively while cell type specificity in malignant diagnosis was 91.7%(11/12). Sensitivity and diagnostic accuracy for benign lesions were 80.0% and 73.3%, respectively. Postbioptic pneumothorax occurred in three of 86 biopsies(3.5%), one of which required placement of a chest tube. CONCLUSION: Automated gun biopsy is a simple, safe method for the diagnosis of focal chest lesions. An automated biopsy device offers high diagnostic accuracy in cases involving malignant and benign lesions of the chest, and is particularly useful for determining malignant cell type and specific diagnosis of benign lesions.
Biopsy* ; Biopsy, Needle ; Chest Tubes ; Diagnosis ; Fluoroscopy ; Humans ; Needles ; Pneumothorax ; Retrospective Studies ; Sensitivity and Specificity ; Thorax*

PURPOSE: To determine the effective embolic material and appropriate embolic site by comparing bowel changesafter arterial embolization in dogs in which the proximal or distal level of the superior mesenteric artery hadbeen occluded with gelfoam particles or a coil. MATERIAL AND METHODS: Using the coaxial catheter system,superselective arterial embolization was performed at sixteen sites in four dogs. In groups A and B, each site wasoccluded at the proximal or distal marginal artery, respectively, with gelfoam particles and in groups C and D, atthe proximal or distal artery, respectively, with a coi. All dogs were sacrifed one day after the procedure, andgross and microscopic histologic findings were evaluated. RESULT: In all dogs, the procedure was successful. Ingroup B, significant mucosal destruction, lymphocyte proliferation in submucosa and mucosa, and diffuse swellingin all layers of the intestine were found at all sites. The vessel in the submucosal layer was completelyobstructed by red blood cells and gelfoam.At three sites, the intestine showed diffuse ischemic change, and at oneother site, focal ischemic change was observed. In group D, exudation with destruction of mucosa and submucosalhemorrhage occurred at one site, but in groups A and C, intestinal layers were found to be normal. CONCLUSION: Using a coil, superselective arterial embolization was successful, even up to the distal level of the intestinalartery, and the intestine showed no ischemic change. Embolization with gelfoam must be performed carefully at theproximal level, and since it can cause severe intestinal necrosis, must be avoided at the distal level.
Animals ; Arteries ; Catheters ; Dogs ; Erythrocytes ; Gelatin Sponge, Absorbable* ; Intestines ; Lymphocytes ; Mesenteric Arteries ; Mesenteric Artery, Superior* ; Mucous Membrane ; Necrosis

PURPOSE: To evaluate the long-term efficacy and safety of tamsulosin 0.2 mg once daily in Korean patients with lower urinary tract symptoms(LUTS) suggestive of benign prostatic obstruction(BPO) treated for up to 1 year. MATERIALS AND METHODS: Two hundred eleven patients were enrolled from 6 centers and 146 patients were included in the analysis. The primary efficacy parameters were improvements in the total, obstructive and irritative International Prostate Symptom Score(IPSS) and maximal urinary flow rate(Qmax). The secondary efficacy parameters were a decrease of >or=30% in IPSS and an increase of >or=30% in Qmax from baseline. Changes in parameters between baseline and 52 weeks were assessed using Student's paired t-test. RESULTS: Statistically significant, gradual improvements in all efficacy parameters were observed over the 1-year period. Tamsulosin 0.2 mg/day produced progressive improvements in total IPSS(41.1%) and Qmax(39.6%, 4.56 ml/sec)(p<0.001). Tamsulosin was well tolerated. The incidence of adverse events was only 6.2%. And There were no withdrawals as a result of adverse events. There were no significant changes in blood pressure or pulse rate during the study. CONCLUSION: Long-term 1-year treatment with tamsulosin 0.2 mg once daily in Korean BPO patients is safe, well tolerated and effective in improving LUTS and urinary flow. The effect on symptoms was apparent after 12 weeks of treatment, and symptom improvement was achieved for up to 1 year at every follow-up period respectively.
Blood Pressure ; Follow-Up Studies ; Heart Rate ; Humans ; Incidence ; Lower Urinary Tract Symptoms* ; Prostate ; Single-Blind Method* ; Urinary Tract

PURPOSE: To compare the feasibility of gadolinium-enhanced excretory MR urography(GEMRU) and conven-tional MR urography using the half-Fourier acquisition single-shot turbo spin-echo(HASTE) sequence in pa-tients with hydronephrosis or non-visualized kidney. MATERIALS AND METHODS: Fifteen patients with hydronephrosis or non-visualized kidney, as demonstrated by ul-trasonography or intravenous urography, were enrolled in this study. Nine were men and six were women, and their age ranged from 18 to 77 (mean, 60.6) years. For all MR examinations, a 1.5-T MR unit was employed. For breath-hold MR urography, the HASTE technique(MRU) was used, and reconstruction involved the use of a maximum intensity-projection (MIP) algorithm. For gadolinium-enhanced excretory MR urography, the fast low angle shot(FLASH) 3-D method was used and images were obtained at 5, 10, 20, and 30 minutes, and recon-struction again involved the use of an MIP algorithm. In some cases, additional GEMRU was obtained 24 hours after contrast material injection, and an MIP algorithm was used for reconstruction. MRU and GEMRU were independently interpreted by two radiologists who for quantitative analysis compared SNR with CNR, and at each anatomic level qualitatively analysed morphologic accuracy and diagnostic value of the lesions. RESULTS: In quantitative analysis, SNR and CNR differences between the two sequences at the renal pelvis and the level of the ureter were not significant (p>0.05). In qualitative analysis, GEMRU was superior to M-RU for the assessment of evaluated ureter at each level(p<0.05), anatomic anomaly and intrinsic tumor. Ureteral stones, however, were more easily diagnosed with MRU. CONCLUSION: For assessment of the ureter GEMRU is superior to MRU and has the advantage of evaluating renal function. We believe that for evaluation of the urinary tract, especially the distal ureter, GEMRU may be a valuable adjunct to routine MR urography.
Female ; Humans ; Hydronephrosis ; Kidney ; Kidney Pelvis ; Male ; Ureter ; Urinary Tract ; Urography*

OBJECTIVES: The presence of chronic low oxygen delivery to the tissues (blood flow X Hb concentration X arterovenous oxygen content difference) in patients with chronic lung disease (CLD) leads to a aggravated dyspnea. Therefore, total oxygen delivery to the tissues is a reverse correlation with severity of dyspnea. So far, the treatment of patients with CLD has been limited to only the increase of ventilation and perfusion capacity. However, this study focused on the capacity of oxygen delivery to the tissues in patients with CLD. We measured blood oxygen parameters as one of the extended approaches. METHOD: Simultaneous arterial and venous blood samples from 15 patients with CLD at rest were evaluated for 2.3-DPG, CO-Hb (Carboxy-monohe-moglobin), Met-Hb (methomoglobin), ABGA (Arterial blood gas analysis), VBGA (Venous blood gas analysis) and Hb (Hemoglobin). Smokers and patients with other disease were excluded from the study in order to avoid the factors (2.3-DPG, CO-Hb etc.) which can shift the oxygen dissociation curve. There were 12 men and 3 women, ranging in age from 40 to 75 years. The disease onset varied from 3 years to more than 30 years. RESULTS: 1) As total oxygen delivery to the tissues decreased, Ao2(Arterial oxygen partial pressure) and A-VCb (Arteriovenous oxygen content difference) decreased, while 2.3-DPG increased. Total oxygen delivary to the tissues showed a significant correlation with more A-V and 2.3-DPG than AO2. 2) AO2 had a correlation with A-VO2 but AO2 did not clearly reflect A-VO2. 3) 2.3-DPG activity depended on more A-VO2 than AO2. 4) As A-VO2 decreased, there was more significant relationship among 2.3-DPG, A-VO2 and tissue oxygen delivery. 5) A-VO2 showed a significant reverse correlation with 2.3-DPG as well as Met-Hb % + CO-Hb %. 6) ACO2 (arterial carbon dioxide partial pressure) showed a correlation with 2.3-DPG as well as A-VO2. 7) Arterial PH did not correlate with 2.3-DPG as well as A-V. CONCLUSION: 1) AO2 in patient with CLD correlated with A-VO2 but AO2 did not clearly reflect A-V. 2) Total oxygen delivery (severity of dyspnea) showed a significant correlation with more A-VO2 and 2.3-DPG than AO2. 3) 2.3-DPG activity depended on more A-VO2 than AO2. 4) 2.3-DPG activity had a reverse correlation with A-V in spite that 2.3-DPG shifts the oxygen dissociation curve to the right, because 2.3-DPG shift is secondary change associated with the low oxygen delivery to the tissues, More extensive k prospective investigations are needed to clearly define correlation among A-VO2, 2.3-DPG and prognosis of patients with CLD.
Carbon Dioxide ; Dyspnea ; Female ; Humans ; Hydrogen-Ion Concentration ; Lung Diseases* ; Lung* ; Male ; Oxygen* ; Perfusion ; Prognosis ; Ventilation

BACKGROUND/AIMS: The buttonhole technique, in which needle insertion during cannulation is always into the same site, confers advantages including ease of cannulation, ease of achieving hemostasis, and reduced pain compared with rope-ladder needling. We introduced the buttonhole technique in hemodialysis patients experiencing pain during needling. None of the disadvantages associated with the buttonhole technique, such as infection or access events, were observed, due to the short duration of the study. METHODS: Patients undergoing buttonhole needling were observed prospectively. Data were collected on the following parameters: infectious complications, hospitalizations and access events. We compared buttonhole and rope-ladder needling using baseline data. RESULTS: A total of 48 patients (34 males; mean age = 49.4 +/- 13.8 years) were enrolled. Seven patients were excluded: in three patients, the buttonhole technique failed to form a tract, three others underwent kidney transplantation, and one was lost to follow-up. The remaining 41 patients were followed for 15.7 +/- 4.7 months. Thirteen patients suffered infections, as follows: local infections (n = 5), pneumonia (n = 3), bacteremia (n = 2), cellulitis (n = 1), osteomyelitis (n = 1), and liver abscess (n = 1). There were no significant differences between the rope-ladder and buttonhole needling techniques in rates of infection, hospitalization or vascular access events. CONCLUSIONS: The infection rate and access event frequency associated with buttonhole needling did not differ in relation to that of rope-ladder needling.
Arteriovenous Fistula ; Bacteremia ; Catheterization ; Cellulitis ; Hemostasis ; Hospitalization ; Humans ; Kidney Transplantation ; Liver Abscess ; Lost to Follow-Up ; Male ; Needles ; Osteomyelitis ; Pneumonia ; Prospective Studies ; Renal Dialysis*

BACKGROUND/AIMS: The buttonhole technique, in which needle insertion during cannulation is always into the same site, confers advantages including ease of cannulation, ease of achieving hemostasis, and reduced pain compared with rope-ladder needling. We introduced the buttonhole technique in hemodialysis patients experiencing pain during needling. None of the disadvantages associated with the buttonhole technique, such as infection or access events, were observed, due to the short duration of the study. METHODS: Patients undergoing buttonhole needling were observed prospectively. Data were collected on the following parameters: infectious complications, hospitalizations and access events. We compared buttonhole and rope-ladder needling using baseline data. RESULTS: A total of 48 patients (34 males; mean age = 49.4 +/- 13.8 years) were enrolled. Seven patients were excluded: in three patients, the buttonhole technique failed to form a tract, three others underwent kidney transplantation, and one was lost to follow-up. The remaining 41 patients were followed for 15.7 +/- 4.7 months. Thirteen patients suffered infections, as follows: local infections (n = 5), pneumonia (n = 3), bacteremia (n = 2), cellulitis (n = 1), osteomyelitis (n = 1), and liver abscess (n = 1). There were no significant differences between the rope-ladder and buttonhole needling techniques in rates of infection, hospitalization or vascular access events. CONCLUSIONS: The infection rate and access event frequency associated with buttonhole needling did not differ in relation to that of rope-ladder needling.
Arteriovenous Fistula ; Bacteremia ; Catheterization ; Cellulitis ; Hemostasis ; Hospitalization ; Humans ; Kidney Transplantation ; Liver Abscess ; Lost to Follow-Up ; Male ; Needles ; Osteomyelitis ; Pneumonia ; Prospective Studies ; Renal Dialysis*

PURPOSE: Malignant melanoma is a fatal tumor arising in the melanocytic systems of the skin. The incidence of malignant melanoma, formerly considered a rare tumor in Korea, is observed to increase. The aim of this study is to analyze the clinical and histopathological pattern of malignant melanoma in one institute. METHODS: Thirty patients with ages ranging from 33 to 80 years, diagnosed as malignant melanoma at our skin tumor department, were enrolled in a retrospective study over a 6 year period(2000. 9-2006. 7). The analyzed data included age, sex, location, duration before diagnosis, clinical type, level of invasion, and stage. RESULTS: The cases were identified and analyzed by clinical and histopathologic study. The male to female ratio was 1:1.7. Lower extremities(especially, feet) were favored sites. The majority of cases were acral lentiginous melanoma(40%), followed by nodular melanoma (36.7%), superficial spreading melanoma(20%) in this study. Clark level IV was predominant in histopathologic study. There was merely narrow gap among each stage by AJCC. CONCLUSION: The clinicopathological characteristic of melanoma in our patients is quite different with that in the West. In this retrospective study, primary lesions of the foot were predominant with melanoma, and a high percentage of these were classified pathologically as acral lentiginous melanomas. Patients had a more advanced stage of disease at first presentation and a more deeply invasive primary lesion than Western patients. These suggest that malignant melanoma has a worse prognosis in our patients than in the West. So, further organized prospective studies are needed to approach the prudent and accurate diagnosis and management of melanoma in Korea.
Diagnosis ; Female ; Foot ; Humans ; Incidence ; Korea ; Male ; Melanoma* ; Prognosis ; Retrospective Studies ; Skin