Gout and systemic lupus erythematosus(SLE)are relatively common diseases in rheumatism.But the case of coexistent gout and SLE is extremely rare.The rarity is that may be due to misdiagnosis and disparity of the epidemiology.It is suggested that immulonogic milieu in SLE and therapy for SLE may have a negative effect on the manifestations of gout.Especially,hyperuricemia that not caused by nephritis,renal failure,use of diuretics,alcohol drinking and other risk factors in premenopausal women is extremely rare.We experienced two cases of chronic tophaceous gout in female patients with SLE who did not have other hyperuricemic risk factors.
Diagnostic Errors ; Drinking ; Female ; Gout* ; Humans ; Lupus Erythematosus, Systemic* ; Risk Factors

A technique for Thallium-201 imaging after two separate injections of the tracer, which took less than I hour, was performed to evaluate if this technique could be used clinically as a noninvasive screening test of angina pectoris. 29 patients who complained of chest pain were included in this study: 18 patients were proven to have coronary artery disease by coronary angiography and 11 patients had normal coronary arteries. With the patient supine at rest, 1.0 mCi of Thallium was injected intravenously and imaging was performed in the anterior and 50degrees left anterior oblique projections for a preset time according to Okada's protocol. Immediately after acquisition of the rest images, without moving the camera head, an infusion of dipyridamole was done at the rate of 0.14 mg/Kg/min for 4 minutes. Two minutes after stopping the infusion, 1.0 mCi of Thallium was injected intravenously and 50degrees left anterior oblique and anterior projection images were acquired. Images of the same projection were realigned using computer image registration approach (PDP-11/34 computer of DEC company). The rest image was then subtracted from the realigned dipyridamole image to produce an image representing perfusion during dipyridamole induced hyperemia (subtraction image). The results were as follows; 1) All of the subtraction images were of adequate quality for interpretation. 2) 16 cases in 18 patients of angina pectoris and 1 case in 11 normal control showed perfusion defects, so the over all sensitivity and specificity of the subtraction versus rest Thallium image technique for diagnosis of angina pectoris were 89% and 91%, respectively. 3) All patients (8 cases) whose left ventriculography revealed abnormality of regional wall motion showed perfusion defects in corresponding segments. But qualitative analysis of Thallium image could not predict if the patient whose Thallium image revealed perfusion defect has abnormality of regional wall motion. 4) segmental analysis was performed to know the association between the site of coronary artery stenosis and the perfusion defects in Thallium scan, which revealed the sensitivities for detecting stenosis of LCX, LAD & RCA were 50-60% in range and the range of specificities were 89-92%. 5) Adverse effects of dipyridamole were headache (2 cases) and chest pain (4 cases) but aminophylline was not needed in any case. In conclusion, split dose Thallium dipyridamole scan can be used as a noninvasive screening test of angina pectoris reducing the total duration of imaging to less than one hour. Futher applications of this technique may include the assessment of myocardial perfusion before and immediately after coronary angioplasty and coronary artery bypass graft and the evaluation of the impact of pharmacotheraphy on regional myocardial perfusion.
Aminophylline ; Angina Pectoris* ; Angioplasty ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Diagnosis* ; Dipyridamole* ; Head ; Headache ; Humans ; Hyperemia ; Mass Screening ; Perfusion ; Sensitivity and Specificity ; Thallium ; Transplants

The human head form has always been one of the main interests of the visual art and its artistic representation has been different from era to era, place to place, and individual artist to artist. The proportion of the head and face used by artists is different from the actual proportion in that it was developed to represent the ideal form. Though anthropometry is useful method to establish standards, the data of anthropometry are too complex and detailed to be directly applied to the field of art. This study was performed to present the anthropometry -based standard Korean face which can be utilized in visual arts. Fourteen hundred Korean profiles (630 males and 770 females) were investigated. Ten anthropometrical landmarks were selected and the distance between these points was measured. Nine indexes were developed from these measurements. Actual size of the face was measured for 2 categories, and photographs of face was used for 10 categories including 2 non -metric traits were determined. All measured values were significantly greater in males. Lower face -upper lip index and middle face -ear index were greater in male, however ear index was greater in female. Though the sexual difference in those indexes were statistically significant, when visualized on the canvas, it cannot be distinguished male from female based on those indexes. In individual facial profile, the alare was situated in front of the line which connecting the glabella and the cheilion in 40% and 70% of male and female, respectively. The cheilion was situated in front of that line in two third of both male and female. A cheek covered the alare in 62% of female, much higher percentage compared to the 27% in male. Generally cheek of older individual had more tendency to cover the alare. Data of this study showed difference from those of the Caucasian in all 9 indexes. Especially total head height -length index and middle face -lower face index were strikingly different and can be characteristic features worth considering when visualizing Korean. The representation of Korean face has been subject to the image that the artist himself had perceived. The proportion of the profile of Korean face may be used as an important reference for artists.
Anthropometry ; Cheek ; Ear ; Female ; Head ; Humans ; Lip ; Male

Pseudotumor cerebri syndrome is characterized clinically by raised intracranial pressure without ventriculomegaly. Several conditions known to interfere with CSF absorption pathways at the level of the arachnoid villi can produce the pseudotumor cerebri syndrome. Systemic lupus erythematosus (SLE) is an autoimmune, inflammatory and chronic disorder characterized by multi-organ involvement including the nervous system. Clinical evidence of central nervous system involvement includes headache, seizure, psychosis and altered mental status. However, pseudotumor cerebri syndrome has been reported infrequently as a primary feature of central nervous system involvement or a complication of SLE. A 19 year-old female was admitted with seizure preceded by headache and blurred vision. Ophthalmoscopic examination showed papilledema. The diagnosis of pseudotumor cerebri syndrome was confirmed by increased intracranial pressure(>550mmH2O) in the absence of any abnormal radiological findings of the brain. We described a 19-year-old girl whose first clinical manifestation was pseudotumor cerebri syndrome, which was diagnosed as SLE later. Therefore pseudotumor cerebri syndrome may be the part of the spectrum of clinical manifestation of SLE.
Absorption ; Arachnoid ; Brain ; Central Nervous System ; Diagnosis ; Female ; Headache ; Humans ; Intracranial Pressure ; Lupus Erythematosus, Systemic* ; Nervous System ; Papilledema ; Pseudotumor Cerebri* ; Psychotic Disorders ; Seizures ; Young Adult

Pseudotumor cerebri syndrome is characterized clinically by raised intracranial pressure without ventriculomegaly. Several conditions known to interfere with CSF absorption pathways at the level of the arachnoid villi can produce the pseudotumor cerebri syndrome. Systemic lupus erythematosus (SLE) is an autoimmune, inflammatory and chronic disorder characterized by multi-organ involvement including the nervous system. Clinical evidence of central nervous system involvement includes headache, seizure, psychosis and altered mental status. However, pseudotumor cerebri syndrome has been reported infrequently as a primary feature of central nervous system involvement or a complication of SLE. A 19 year-old female was admitted with seizure preceded by headache and blurred vision. Ophthalmoscopic examination showed papilledema. The diagnosis of pseudotumor cerebri syndrome was confirmed by increased intracranial pressure(>550mmH2O) in the absence of any abnormal radiological findings of the brain. We described a 19-year-old girl whose first clinical manifestation was pseudotumor cerebri syndrome, which was diagnosed as SLE later. Therefore pseudotumor cerebri syndrome may be the part of the spectrum of clinical manifestation of SLE.
Absorption ; Arachnoid ; Brain ; Central Nervous System ; Diagnosis ; Female ; Headache ; Humans ; Intracranial Pressure ; Lupus Erythematosus, Systemic* ; Nervous System ; Papilledema ; Pseudotumor Cerebri* ; Psychotic Disorders ; Seizures ; Young Adult

BACKGROUND: An association between diabetes and tuberculosis has long ken implied. The severity of diabetes appears to correlate with the degree of tuberculous activity. METHODS: A retrospective chart review of 82 patients with active pulmonary tuberculosis in diabetics(DMTB) and 83 patients with active pulmonary tuberculosis in nondiabetios (Non-DMTB) admitted to the Kyung Hee Medical Center between January 1995 and December 1996 was undertaken. RESULTS: The sex ratio of DMTB was 58 : 24, and that of Non-DMTB was 62 : 21. Male patients predominated in both groups. The highest incidence of DMIB was 6th and 7th decades and that of Non-DMTB was 3rd and 4th decades. In case which the tuberculosis developed after diagnosis of diabetes, the prevalence of pulmonary tuberculosis was the highest in diabetes for 5 -10 years. On chest X-ray findings, the moderate advanced tuberculosis cases were the most common (60.9% in DMTB and 50.6% in Non-DMTB). There was no relation between the degree of tuberculosis activity on chest x-ray(minimal, moderata awl far advanced tuberculosis) and presence of diabetes. The incidence of lower lung field tuberculosis in DMTB was significantly higher than Non-DMTB(p<0.05). The multiple lobe involvement was the predominant chest roentgenograpflc finding in both groups. There was no significant difference of treatment response between DMTB and Non-DMTB. There was no relationship between initial HbA1c and the stverity of pulmonary tuberculosis on chest X-ray. During treatmenu of pulmonary tuberculosis in excellently and well controlled diabetes, the cure rate of pulmonary tuberculosis was sigrificantly higher than the pcorly controlled diabetes and the rate of treatment failure was significantly lower than poorly controlled diabetes. (p<0.05). CONCLUISON: Poor control of blood glucose is related with increased rate of treatment failure in pulmonary tuberculosis with diabetes mellitus. Further investigation will be needed to study the mechanisms of treatment failure in poorly controlled diabetics with pulmonaiy tuberculosis.
Blood Glucose ; Diabetes Mellitus ; Diagnosis ; Humans ; Incidence ; Lung ; Male ; Prevalence ; Retrospective Studies ; Sex Ratio ; Thorax ; Treatment Failure ; Tuberculosis ; Tuberculosis, Pulmonary*

High blood pressure is an important determinant of the incidence of coronary heart disease, stroke, congestive heart failure, renal failure, and peripheral vascular disease. Recommendations for control of high blood pressure emphasize lifestyle modification, including weight control, reduced sodium intake, increased physical activity. Subjects who were normotensive (n = 19, 47.2 +/- 9.0 y, BP 116/81 mmHg), treatment hypertensive (n = 33, 54.2 +/- 6.9 y, BP 132/85 mmHg) and non-treatment hypertensive (n = 14, 50.1 +/- 11.0 y, 149/94 mmHg) recruited. Anthropometric assessment (height, weight, waist circumference, hip circumference, fat %, fat mass, and lean body mass) and dietary assessments (using 3-days food records, daily nutrient intakes were analysed by CAN PRO 2.0 were carried out. Blood and 24-hour urine were collected). Test of recognition for salt taste threshold were performed. In non-treatment hypertensive male subjects, weight, %IBW, BMI, and waist circumference were significantly higher than those of normotensive and treatment hypertensive subjects (p < 0.05). Food habits were not significantly different among the three groups. Intakes of vitamin A, vitamin B1, and vitamin B2 were significantly higher in normotensive group (p < 0.05). Intakes of sodium and salt taste recognition threshold were the highest in normotensive group and the lowest in treatment hypertensive group (p < 0.05). Blood levels of lipids and minerals were not significantly different among the three groups. Urinary calcium level of normotensive group were significantly higher than that of treatment hypertensive and non-treatment hypertensive groups (p < 0.05). These results indicate that continuous management of hypertension by drug and non-drug treatment affects salt taste recognition threshold and reduced the consumption of sodium. However, dietary sodium intake exceed recommended sodium intake to prevent and treat hypertension. It is necessary to develop the lifestyle modification program that may have beneficial effects on hypertension treatment.
Calcium ; Coronary Disease ; Food Habits ; Heart Failure ; Hip ; Humans ; Hypertension* ; Incidence ; Life Style ; Male ; Minerals ; Motor Activity ; Peripheral Vascular Diseases ; Renal Insufficiency ; Riboflavin ; Sodium ; Sodium, Dietary ; Stroke ; Taste Threshold ; Thiamine ; Vitamin A ; Waist Circumference

SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome designates a group of articular and osseous manifestations frequently combined with skin disorders. Its fundamental component is inflammatory, pseudoinfectious, and sterile osteitis. The anterior chest wall is the most frequent localization and all the components of this structure may be involved. Palmoplantar pustulosis, psoriasis, acne conglobata, acne ulcerans, acne fulminans, pyoderma gangrenosum can be associated with the characteristic bone lesions. We report two cases of SAPHO syndrome : A 40-year-old female presented with both buttock pain with hyperostosis, costochondritis, synovitis and pustulosis palmaris and a 23-year-old male presented with migrating polyarthritis with costochondritis, synovitis, acne, pustulosis.
Acne Vulgaris ; Acquired Hyperostosis Syndrome* ; Adult ; Arthritis ; Buttocks ; Female ; Humans ; Hyperostosis ; Male ; Osteitis ; Psoriasis ; Pyoderma Gangrenosum ; Skin ; Synovitis ; Thoracic Wall ; Young Adult

OBJECTIVE: To investigate the clinical characteristics of Korean JRA and the possible profiles related to prognosis and to compare these data to pre-existing occidental reports. METHODS: 140 cases of JRA patients were randomly selected from 1986 through 1995. Juvenile ankylosing spondylitis was excluded with the aid of modified New York criteria for ankylosing spondylitis. We used the classification of progression of rheumatoid arthritis (radiological stage III+IV / I+II+III+IV) as a index of prognosis. The study factors were sex, age, type, affected joints, degree of destruction of joint, anti-nuclear antibody (ANA), rheumatoid factor (RF), HLA-B27 and extra-articular manifestations. Chi-square test, One-way ANOVA test, and Pearson' s correlation coefficient were used as statistical methods. RESULTS: Our study show results as follows : (1) Systemic onset type (ll%) { polyarthritis subset (66%), oligoarthritis subset (34%) }, oligoarthritis onset type (62%) { sero (-) -HLA-B27 (+) subset (66%) , RF (+) subset (20%), not otherwise classified subset (14%) ANA(+)-chronic uveitis subset(O%) }, polyarthritis onset type (27%) { RF(+) subset (66%), not otherwise classified subset (34%) }, (2) Sex ratio was M:F=1.8:l. (3) Age of onset was 11+3.6 years. (4) Affected joints were knee, ankle, hand in decreasing order of frequency. (5) Patients show seropositivity of RF in 31%, HLA-B27 in 54%, ANA in 8%. (6) Chronic uveitis was observed in 7 cases (5%) (all oligoarthritis onset type, M:F=6:1, age of onset 11+4.3 years, ANA (0%), HLA-B27 (86%) , 2 cases leading to blindness. (7) Destructive bone change was significantly more prominent in female (p<0.01) , RF(+) (p<0.01), HLA-B27(-) (p<0.01) , polyarthritis onset type (p=0.02). CONCLUSIONS: In this study, we obtained interesting results that are somewhat different from Occidental data in sex ratio (male dominance), age of onset (older age) , profiles of HLA-B27 (high positivity in spite of low HLA-B27 positivity in Korean (about 2. 3%) , low rate of destructive change) , ANA (low positivity, older age of onset) , chronic uveitis (low incidence, male dominance, older age of onset, high association with HLA-B27, not associated with ANA) . This study suggests possible racial difference in clinical features of JRA. But for prove of racial difference, further multi-center trial and large scale epidemiological study should be done.
Age of Onset ; Ankle ; Antibodies, Antinuclear ; Arthritis ; Arthritis, Juvenile* ; Arthritis, Rheumatoid ; Blindness ; Classification ; Epidemiologic Studies ; Female ; Hand ; HLA-B27 Antigen ; Humans ; Incidence ; Joints ; Knee ; Male ; Prognosis ; Rheumatoid Factor ; Sex Ratio ; Spondylitis, Ankylosing ; Uveitis

Boerhaave's syndrome, spontaneous esophageal rupture, is lethal and associated with a 70% survival rate despite emergent surgical management in recent reports. Early diagnosis and management is critical for more favorable outcome. But, it is difficult to diagnose early because of the low incidence and lack of specific symptoms and signs. We experienced 37 year-old male patient with Boerhaave's syndrome who was heavy drinker, and suffered from chronic renal failure. He visited a hospital because of hematemesis and severe back pain. He was transferred to our hospital with a nasogastric tube insertion, which was penetrating the distal esophagus. A radiologic examination revealed that the distal tip was located in the left pleural cavity. It was assumed that the tube had passed through the preexisting perforation site. Operation was not performed emergently due to delay in diagnosis and severe hyperkalemia. The patient was in a septic condition, but had recovered slowly after systemic broad spectrum antibiotic therapy, pleural drainage and intrapleural antibiotic injections. An esophagography revealed no leakage of gastro-grafin on the 14th hospital day, and he later completely recovered from sepsis.
Adult ; Back Pain ; Diagnosis ; Drainage ; Early Diagnosis ; Esophageal Perforation ; Esophagus ; Hematemesis ; Humans ; Hyperkalemia ; Incidence ; Kidney Failure, Chronic ; Male ; Pleural Cavity* ; Rupture ; Sepsis ; Survival Rate