The developement of squamous cell carcinoma from the draining sinus of chronic osteomyelitis has long been recognized as a rare and late complication. The mode of developement of carcinoma at the site of chronic osteomyelitis is not well understood. This, however, is chiefly a disease of middle aged men, and tibia is the most common site. There are two types in this carcinoma; superficial and deep types. In the superficial type obvious presence of fungaiing growth makes diagnosis simple and easily confirmed by biopsy. In the deep type the diagnosis is difficult clinically, but the features most frequently described are an increase in pain and discharge with swelling and hemorrhage. Amputation at the adequate level is the treatment of choice. Three cases of the disease involving one left femur, and two left tibiae are reported with review of literature.
Amputation ; Biopsy ; Carcinoma, Squamous Cell ; Diagnosis ; Epithelial Cells ; Femur ; Hemorrhage ; Humans ; Male ; Middle Aged ; Osteomyelitis ; Tibia

Hypertensive encephalopathy is an acute clinical syndrome that shows central nerve dysfunction with sudden and marked elevation in blood pressure. But its pathophysiologic mechanisms, clinical courses and prognosis are still not clear. In order to study clinical manifestations and response to treatment in patients with hypertensive encephalopathy, we reviewed 45 patients with hypertensive encephalopathy who were admitted in Dept. of Internal Medicine, National Medical Center, from January 1975 to December 1984. The following results were obtained: 1) The ratio of male to female was 1.1:1. The peak age of incidence was in the 6th and 7th decade with mean age of 57.5 years. 2) Among 45 patients, only 29 had known history of hypertension and the average duration of hypertension was 8.1+/-3.6 years. 3) The most common sympotm was severe headache (68.9%). And altered consciousness, nausea and/or vomiting, focal neurologic signs and visual disturbance were also common symptoms in decreasing order of frequency. 4) Funduscopic examination showed hypertensive retinopathy in 20 of 24 (91.7%) patients and lumbar puncture revealed increased CSF pressure in 12 of 20 (60%) patients. 5) In most patients, the mean interval to symptomatic improvement was 2.1 days after administration of anti hypertensive agents, but in 6 patients with initial mean arterial blood pressure above 170mmHg, 4 patients showed delayed response and 2 patients were expired.
Antihypertensive Agents ; Arterial Pressure ; Blood Pressure ; Consciousness ; Female ; Headache ; Humans ; Hypertension ; Hypertensive Encephalopathy* ; Hypertensive Retinopathy ; Incidence ; Internal Medicine ; Male ; Nausea ; Neurologic Manifestations ; Prognosis ; Spinal Puncture ; Vomiting

The importance of vegetables as a allergen for the development of hand eczema has been a matter of debate. The aim of this study was to evaluate the clinical manifestations of hand eczema and to investigate the role of vegetables in the hand eczema of Korean housewives. In this study, clinical evaluatons and patch tests with Hollister-Stier standard allergens and 22 vegetable allergens wer performed in 32 patients with housewife's hand eczema. The results are summarized as follows : 1. The prevalence was highest in fourth(59.4%) and third(25.0%) decades of life and the peak age of onset was third(53.1%) and fourth(31.3%) decades. 2. Only 3 of 32 patients(9.4%) had past histories of atopic dermatitis ; however, childrens of 12 patients(37.5%) had atopic dermatitis. 3. The common skin signs were fissuring(90.6%), scaling(78.1%), erythema(75.0%), hyperkeratosis(71.9%), lichenification(62.5%), and vesicle(43.8%) in descending order. 4. The common aggravating factors were soap or detergent(93.8%), water(90.6%) and rubber glove(25.0%). 5. The most common involved areas of hand eczema were fingers including fingertips and fingertips only. 6. The results of patch test using vegetable allergens with 10 normal controls were all negative. Of the 32 patients with hand eczema, 13(37.5%) showed positive patch test with standard allergens and 5(15.6%) showed positive with vegetable allergens. 7. Among 30 standard allergens, cinnamic alcohol(9.4%). potassium dichromate(9.4%), nickel sulfate(6.3%), and wool wax alcohol(6.3%) were the common allergens which showed positive reactions. Of the 22 vegetable allergens, garlic, Chinese cabbage juice, Chinese cabbage extract, cucumber juice, spinach extract, potato juice showed weak positive reactions in only one patient(3.1%) respectively. From the above results contact sensitivity to vegetables is not significant in Korean housewives with hand eczema.
Age of Onset ; Allergens ; Asian Continental Ancestry Group ; Brassica ; Child ; Dermatitis, Atopic ; Dermatitis, Contact ; Eczema* ; Fingers ; Garlic ; Hand ; Humans ; Nickel ; Patch Tests* ; Potassium ; Prevalence ; Rubber ; Skin ; Soaps ; Solanum tuberosum ; Spinacia oleracea ; Vegetables* ; Wool

Pharmacological mydriasis can cause an acute elevation of intraocular pressure without obstruction of angle. A prospective study of 80 normal Korean subjects(149 eyes) and 20 Korean primary open angle glaucoma patients(49 eyes) was performed in order to obtain and compare effects on intraocular pressure, pupil size and aqueous floater by phenylephrine, Mydrin-P(R) and cyclopentolate and to investigate wheather intraocular pressure elevation occurs also in Korean eyes after pupil dilation. Significant pressure elevation(6mmHg or more) was rare in normal subjects while incidence of 25% with Mydrin-P(R) and 50% with cyclopentolate occurred in primary open angle glaucoma patients. Thus, stronger cyclopegics induced intraocular pressure elevation more frequently. Statistically significant correlation between intraocular pressure elevation and aqueous floater did not exist in primary open angle glaucoma patients but only existed with cyclopentolate in normal subjects. Maximum mydriasis by phenylephrine, Mydrin-P(R) and cyclopentolate occurred in 60, 90 and 90 minutes respectively. There is a potential hazard of routine dilation of eyes with cycloplegic agents in primary open angle glaucoma patients in both Korean and occidental eyes.
Cyclopentolate* ; Glaucoma, Open-Angle ; Humans ; Incidence ; Intraocular Pressure* ; Mydriasis ; Phenylephrine* ; Prospective Studies ; Pupil

BACKGROUND: Pachydermoperiostosis(PDP) is a rare genetic disease characterized by pachydermia, periostosis, arthralgia and finger clubbing. The pathogenesis of this disease is still unknown, but the concept that platelets and endothelial cells may play a major role in the developement of pachydermia is widely accepted nowadays, It is also suspected that several serum growth factors stimulate proliferation of soft tissue. OBJECTIVE: The purpose of this study was to investigate the pathogenesis of pachydermia in patients with pachydermoperiostosis through evaluating whether the fibroblasts from these patients have a higher proliferation rate than those from controls or whether the proliferation rate of those cells are affected by certain serum growth factors. METHOD: At first, we evaluated the proliferation rate of fibroblasts from patients and corntrols by the MTT colorimetric assay, and then the proliferation rate of fibroblasts from the prepuce of newborn infants under several conditions of media containing uncentrifuged patients serum, centrifuged patients serum, uncentrifuged control serum, or centrifuged control serum. RESULTS: The proliferation of fibroblasts from patients skin was slower than the control fibroblasts and fibroblasts derived from uninvolved skin of patients. The statistically significant highest proliferation rate was observed when fibroblasts were cultured in the uncentrifuged patients serum contained media and the order of proliferation was as follows: centrifuged patients serum, uncentrifuged control serum and centrifuged control serum condition at 20%, 10%, and 1% respectively. CONCLUSION: These results suggest that patients fibroblasts do not proliferate in vitro at a higher rate than control firoblasts. Fibroblasts in PDP may only play a role as target cells and certain serum factors are responsible for the pathogenesis of PDP.
Arthralgia ; Endothelial Cells ; Fibroblasts* ; Fingers ; Humans ; Infant, Newborn ; Intercellular Signaling Peptides and Proteins ; Osteoarthropathy, Primary Hypertrophic* ; Skin

No abstract available.
Creatinine* ; Humans ; Infant, Newborn*

Papillary carcinoma of the thyroid is a well differentiated neoplasm and usually has a good prognosis. However, a subset of morphologically distinct papillary carcinoma has bad prognoses. The tall cell variant of papillary carcinoma (TCPC), characterized by tall columnar cells with a height at least twice the width, is the one of these. In order to differentiate TCPC from usual papillary carcinoma (UPC) in terms of prognosis, we performed immunohistochemical studies for the expression of p53, bcl-2 and Leu-M1 proteins in 25 cases of TCPC, 26 cases of UPC and 14 cases of poorly differentiated, solid type papillary carcinoma (SPC) with an analysis of clinical parameters. The nuclear expression of p53 was noted in one case each of UPC and TCPC. The cytoplasmic p53 expression of TCPC, UPC, and SPC was observed in 17/25 cases (68%), 14/26 cases (54%), 3/14 cases (21%), respectively. bcl-2 expression was 19/25 cases (76%), 18/26 cases (69%), 5/14 cases (36%), and that of Leu-M1 was 21/25 cases (84%), 18/26 cases (69%), 4/14 cases(29%), respectively. There were no statistical significance in the expression of those immunoproteins among these three groups (p>0.05). The p53 protein was consistently expressed in the cytoplasm rather than nucleus in this study and was very well correlated to bcl-2 positivity (p<0.01). There were no statistical significance in any clinical parameters examined among these three groups (p>0.05). In conclusion, TCPC can not be separated from UPC as a distinct entity in this study and the cytoplasmic expression of p53 protein provides another mechanism of p53 inactivation in tumorigenesis of the thyroid papillary carcinoma, possibly by bcl-2 related mechanism.
Carcinogenesis ; Carcinoma, Papillary ; Cytoplasm ; Immunoproteins ; Prognosis ; Thyroid Gland* ; Thyroid Neoplasms*

Endoscopic injection sclerotherapy(EIS) is currently the most widely practiced method for treating and eradicating acutely bleeding esophageal varices in repeated sessions, but may be associated with some uadesirable local and systemic complications. Endoscopic variceal ligation(EVL), which consists of mechanical ligation and thrombosis of varices using elastic "0"- rings, has been recently developed as a non-operative alternative to EIS. We performed EVL in 16 patients who had recently bled from esophageal varices. Total 249 variceal ligations were performed during 71 separate EVL sessions. Three patients were actively bleeding at initial EVL; all of them were successfully controlled by emergency EVL. During the study period two patients died after initial EVL; one who refused te return for repeated EVL died from rebleeding, the other died from hepatic failure without any rebleeding. Rebleeding, following initiation of EVL, occured in 3 patients(l8.8%); two patients had bled from varices except previousiy ligated site and were successfully controlled by emergency EVL, remained one who refused any repeat endoscopy could not be confirmed the bleeding site. Varices were eradicated or reduced to grade I in 10(71.4%) of the 14 survivors by 14-28 ligations(mean, 19.5 ligations) in 3 -7 EVL sessions(mean, 5.4 sessions), During or after EVL, there were no complications, except transient mild dysphagia in 3 patients of 16 patients. These results indicated that EVL is a safe and effective method for treatmet of bleeding esophageal varices.
Deglutition Disorders ; Emergencies ; Endoscopy ; Esophageal and Gastric Varices* ; Hemorrhage* ; Humans ; Ligation* ; Liver Failure ; Survivors ; Thrombosis ; Varicose Veins

Mechanical obstruction of the common hepatic duct includes the following causes; choledocholithiasis, sclerosis, cholangitis, pancreatic carcinoma, cholangiocarcinoma, postoperative stricture, primary hepatic duct carcinoma, enlarged cystic duct lymph nodes, and metastatic nodal involvement of the porta hepatis. Partial mechanical obstruction of the common hepatic duct caused by impaction of stones and inflammation surrounding the vicinity of the neck of the gallbladder had been reported on the “syndrome del conducto hepatico” in 1948 by Mirizzi. Nowadays, this disease was named by Mirizzi syndrome. Mrizzi syndrome is a rare entity of common hepatic duct obstruction that results from an inflammatory response secondary to a gallstone impacted in the cystic duct or neck of the gallbladder. It results from an almost parallel course and low insertion of the cystic duct into the common hepatic duct. In a variant of Mirizzi's syndrome, the cause of the common hepatic duct obstruction was a primary cystic duct carcinoma rather than gallstone disease. A 71-year-old man was admitted with a four-day history of right upper quadrant abdominal pain. Past medical history was unremarkable. On physical examination, the patient had a temperature of 38℃, icteric sclera and right upper quadrant tenderness. Pertinent laboratory findings included WBC 18,000/cm3; albumin 2.6 g/dl (normal 0-1) with the direct bilirubin, 4.4 mg/dl (normal 0-0.4). Ultrasonography revealed a dilated extrahepatic biliary tree. ERCP showed that the superior margin was angular and more consistent with a calculus causing partial CHD obstruction (Mirizzi syndrome). At surgery a diseased gallbladder containing calculi was found. In addition, there was two calculi partially eroding through the proximal portion of the cystic duct and compressing the common hepatic duct. A cholecystectomy and excision of common bile duct was performed, with Roux-en-Y hepaticojejunostomy. The postoperative course was uneventful.
Abdominal Pain ; Aged ; Biliary Tract ; Bilirubin ; Calculi ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystectomy ; Choledocholithiasis ; Common Bile Duct ; Constriction, Pathologic ; Cystic Duct ; Cytochrome P-450 CYP1A1 ; Gallbladder ; Gallstones ; Hepatic Duct, Common ; Humans ; Inflammation ; Jaundice, Obstructive ; Lymph Nodes ; Mirizzi Syndrome* ; Neck ; Physical Examination ; Sclera ; Sclerosis ; Ultrasonography

BACKGROUND: Today, the eradication of H. pylori represents a generally accepted and beneficial therapeutic strategy for treatment and prevention of peptic ulcer relapse. Major factors that have affected H. pylori eradication are eradication rate of regimen, compliance of patients and complications of drugs. Recently, the combination of omeprazole, amoxicillin and clarithromycin has been accepted as one of the most effective treatment for the eradication of H. pylori. The primary aim of this study was to evaluate the efficacy of this therapeutic modality in Korean patients. METHODS: Two hundred twenty three patients with peptic ulcer and H. pylori infection were taken two types of triple therapy. Group A were treated with omeprazole 20 mg bid, amoxicillin 500 mg tid, clarithromycin 500 mg tid daily for 14 days. Group B were treated with omeprazole 20 mg bid, amoxicillin 1g bid, clarithromycin 500 mg bid daily for 7 days. Endoscopy with H. pylori tests was repeated 4 weeks after the end of treatment and then biopsy specimens were taken in antrum and body. CLO test and Warthin Starry silver stain were conducted concordantly. RESULTS: The H. pylori eradication rate was 92.5% in group A, 90.4% in group B. There was no significant difference in eradication rate. More than 50% of ulcer size reduction was observed 90.5% in group A, 86.3% in group B. There was no significant difference in ulcer healing(p > 0.05). The incidence of all side effects in both group were as follows; 22.6% in group A, 19.1% in group B. But major side effect was found only group A, of whom the symptom was too serious for the treatment to continue. CONCLUSION: We concluded that the seven days regimen was more favorable, because the eradication rate was almost the same as the 14 days regimen. And drug compliance and cost effectiveness were better than 14 days treatment regimen.
Amoxicillin* ; Biopsy ; Clarithromycin* ; Compliance ; Cost-Benefit Analysis ; Endoscopy ; Helicobacter pylori* ; Helicobacter* ; Humans ; Incidence ; Omeprazole* ; Peptic Ulcer ; Recurrence ; Silver ; Ulcer