It has been thought the histological features of rheumatoid arthritis do not reliably indicate the degree of activity or prognosis of the disease and that they are not specific for that condition (Hemerman, 1963). Recently, however, Muirden and Mills (1971) found in rheumatoid joints submitted for synovectomy a direct correlation between the degree of lymphocytic infiltration and joind damage. Lymphocytes might play a helpful role in protection of the rheumatoid joint. Muirden (1970) has also reported a significant relationship between histological estimates of the extent of the iron deposits nd the grades of roentgenographic changes in biopsied joints. The present study directed to confirm and analyze the changes in the clinical and pathological aspects, with the cases synovectomized at Korea and Severance Hospital, Seoul, Korea. Resuits: Clinical and histological studies were made on 21 cases of “classical” and “definite” rheumatoid arthritis submitted to the Department of Orthopaedic, Korea General Horsital and the Department of Pathology, Yonsei University College of Medicine, during the period from 1966 to 1975, and results were as follows. 1 In age distribution, 16 cases (76.2%) were in the interval between 21 and 51 years old: the mean age was 33.5 years old. The sex distribution showed approximately a three fold female predominance with 16 females (76.2%) to 5 male cases (23.8%). 2. The most common chief complaint recorded were morning stiffness and multiple joint pain. Other symptoms, in descending order of occurrence were tenderness, synovial swelling, flexion deformity, joint swelling and subcutaneous nodules. The interval from initial complaint to admission varied from 7 months to 15 years, with a mean interval of 5.9 years. 3. Serological studies for rheumatoid factor were done on 15 cases and eight (53.3%) were found to be positive while seven cases (46.7%) were negative. The positive cases had longer histories and were in older age groups than the negatives. 4. Histologic findings were characterized by proliferation of suface lining cells of synovium, infiltration of lymphocytes, proliferation and thickeness of the vessels, and synovial villi, deposition of fibrins and hemosiderins and infiltration of acute inflammtory celIs. Each of the characteristics studied was ratect on a scaled score ranging from 0 to 3 from 1 to 3. For each patient the scaled scores were totaled and the totals ranged between 6 and 18 with a mean score of 10.5 5. Roentgenographic findings were characterized by swelling of the soft tissues swelling of the joints,. narrowed space of the joint cavity, and destruction of bone. Each of the characteristics studied was rated. on a scaled score ranging from 0 to 3 or from 1 to 3. For each patient the scaled scores were totaled and the totals ranged between 3 and 11 with a mean score of 7.1. 6. There was no significant correlation between histologic findings such as synovial hyperplasia or infiltration of lymphocytes, and clinical findings such as age, duration of histories, presence of rheumatoid factor, roentgenographic findings or surgicaI findings.
Age Distribution ; Arthralgia ; Arthritis, Rheumatoid ; Congenital Abnormalities ; Female ; Fibrin ; Hemosiderin ; Humans ; Hyperplasia ; Iron ; Joints ; Korea ; Lymphocytes ; Male ; Pathology ; Prognosis ; Rheumatoid Factor ; Seoul ; Sex Distribution ; Synovial Membrane

Twenty cases who had underwent extracapsular cataract extraction with pupilloplasty followed by implantation of posterior chamber intraocular lens (PCL) were followed up more than 3 months from May 1989 to April 1991. Postoperative uncorrected visual acuity was improved in all cases. Corrected visual acuity was 20/40 or better in 13 cases (65% of all cases) and refractive state was myotic (-1.1D in average) at 2 months after operation. Postoperative astigmatism was -1.3D in average at 2 months after operation, which became -0.8D in average at 1 year after operation. Postoperatively vitreous prolapse occured in 1 case and increased intraocular pressure due to posterior synechiae was observed in 1 case. After-catract developed in 1 case. We obtained good clinical results after ECCE and PCL implantation in leprosy patients for whom wearing the contact lens and glasses were impractical due to hand and finger deformities.
Astigmatism ; Cataract Extraction ; Cataract* ; Congenital Abnormalities ; Eyeglasses ; Fingers ; Glass ; Hand ; Humans ; Intraocular Pressure ; Lenses, Intraocular* ; Leprosy ; Prolapse ; Visual Acuity

The postoperative results of 77 paients:(82 eyes) who had undergone phacoemulsification with implantation of oval optic poly methylmethacrylate (PMMA) introoular intraowlar lens (IOL) (5 X 6mm) were evaluated retrospectively. Scleral pocket incision was done tangentially at the point 2mm. apart from the surgical limbus and 5mm in length. No suture in the group 1 (30 eyes), single horizontal suture in the group 2 (31 eyes) and single X suture in the group 3 (21 eyes) were used for the closure method. Average uncorrected visual acuity at postoperative one week was 0.5 or better in each group and there was no statistically significant difference among three groups (p>0.05). The change in mean keratometric astigmatism from postoperative one to eight weeks turned out to be less than 1 diopter (D) in each group and there was no statistically significant difference among three groups (p>0.05). When the diameter of continuous cirular capsulorhexis (CCC) was greater than 5mm or the position of CCC was decentered, it was found that optic was partially escaped form the bag due to adhesion between the remained anterior and posterior capsular structure. It could be suggested that oval optic PMMA IOL showes early visual recovery with less astigmatism regardless of the suture method and in order to place the optic of IOL properly in the bag postoperatively, the diameter of CCC should be less than 5mm and the position of CCC should be centered.
Astigmatism ; Capsulorhexis ; Lenses, Intraocular* ; Methylmethacrylate ; Phacoemulsification ; Polymethyl Methacrylate ; Retrospective Studies ; Sutures ; United Nations ; Visual Acuity

OBJECTIVES: Surgery is being offered to an increasing proportion of the over 60s and postpoerative cognitive dysfunction may occur in the elderly. We investigated that age could be a risk factor. The confounding effects, such as learning effect due to repeated testing and the effect of distress on the test performance, were controlled for by control group. METHOD: Twenty patients aged at least 60 years completed neuropsychological test 1 day before and 1 week after surgery. We measured Mini-Mental Status Examination (MMSE), digit span, 'A' test, similarity test, Digit Symbol Substitution Test (DSST), Beck Depression Inventory (BDI), Montgomery-Asberg Depression Rating Scale (MADRS) and State Anxiety Inventory (SAI). The authors compared postoperative cognitive dysfunction by neuropsychological test in the elderly patients with those in the control group. RESULTS: One week after operation, there was no cognitive impairment compared with before operation. Advanced age might not contribute to cognitive impairment except DSST. And there was an improvement in the scores for BDI and SAI in the control group only. We did not find a significant relation between early postoperative cognitive dysfunction and mood state before operation. Because the elderly patients had lower educational level and more depressive than control group before operation, we thought that the deterioration of DSST did not happened with operation, but by insufficiency of learning effect in the elderly patients. CONCLUSION: Cognition in the elderly patients was not impaired significantly after operation when attention was paid to the known perioperative influences on mental function.
Aged* ; Anxiety ; Cognition* ; Depression ; Humans ; Learning ; Neuropsychological Tests ; Risk Factors

Pick's disease is a rare neurodegenerative disorder presenting cortical type of dementia. Pick's disease shows unique clinical and pathological features, that are due to a degeneration of fronto-temporal lobes of the cerebrum. The authors experienced a case of Pick's disease in a 58-year-old male patient who had dementia symptoms for five years. The patient showed compulsive behavior since five years ago. Memory decline started from four years ago and progressed. Brain CT disclosed lobar atrophy of the cerebral gyri in frontal and temporal lobes. He died of septicemia associated with aspiration pneumonia. At autopsy, both cerebral hemispheres showed marked encephalomalacia. The gyral atrophy was moderately severe in prefrontal and anterior temporal lobes. Coronal section disclosed moderate dilatation of the lateral ventricles. Microscopically, there were marked neuronal loss in prefrontal and anterior temporal cortices. Also noted were Pick's cells and Pick's body in occasional pyramidal cells preserved.
Atrophy ; Autopsy* ; Brain ; Cerebrum ; Compulsive Behavior ; Dementia ; Dilatation ; Encephalomalacia ; Humans ; Lateral Ventricles ; Male ; Memory ; Middle Aged ; Neurodegenerative Diseases ; Neurons ; Pick Disease of the Brain* ; Pneumonia, Aspiration ; Pyramidal Cells ; Sepsis ; Temporal Lobe

PURPOSE: Recently, the incidence of refractory Mycoplasma pneumoniae (MP) pneumonia has increased in Korea. Given that its early diagnosis is helpful in selection of the treatment, this study aimed at investigating the value of the antimycoplasma antibody (IgM) for early diagnosis of MP pneumonia. METHODS: A total of 315 children admitted with MP pneumonia from September 2015 to May 2016 were investigated with the IgM and polymerase chain reaction (PCR) for the diagnosis of MP pneumonia. Specifically, patients were grouped into nonrefractory respiratory MP and refractory MP groups according to their response to macrolide therapy. RESULTS: In the 44 PCR-negative seroconversed children, seroconversed IgM was more frequent in the refractory MP group compared with the nonrefractory respiratory MP group with statistical significance (P<0.001). In the 264 IgM-positive children, the time of antibody reaction was more delayed in the refractory MP group compared to the nonrefractory respiratory MP group with statistical significance (P<0.001). CONCLUSION: This study showed that there was a higher incidence of seroconversed IgM and delayed antibody reaction in the refractory MP group. In children with suspect MP pneumonia, follow-up studies of antibody are necessary, even through initial antibody and PCR showed negative findings. In addition, this result may suggest that the diagnosis of refractory MP pneunomia will be helpful in establishing the strategy of the treatment.
Child ; Diagnosis ; Early Diagnosis ; Follow-Up Studies ; Humans ; Immunoglobulin M ; Incidence ; Korea ; Mycoplasma pneumoniae ; Mycoplasma ; Pneumonia ; Pneumonia, Mycoplasma ; Polymerase Chain Reaction

PURPOSE: In Korea, emergency department overcrowding in large hospitals have caused social concern. Moreover, patients with low socioeconomic status visit the emergency department more frequently. This kind of visitation also causes a burden on the national budget, but emergent patient should be treated in emergency department regardless of economic state. So, on establishment of policy about the patient with low socioeconomic status, the frequency of emergency visitation alone is difficult to obtain a sufficient basis for policy-making. METHODS: We retrospectively analyzed adult patients with a disease who visited the Pusan Wide-regional Emergency Center in 2015. Korean Triage and Acuity Scale level I, II or III were defined as emergency, and level IV or V was defined as non-emergency. The ratio of emergency and non-emergency was compared in the National Health Insurance and Medicaid database. RESULTS: The number of patients with National Health Insurance was 16,208 (90.3%) and with Medicaid was 1,737 (9.7%). Among those with National Health Insurance, there were 12,720 (78.5%) emergency cases and 3,488 (21.5%) non-emergency cases. Among those with Medicaid, 1,379 (79.4%) emergency cases and 358 (20.6%) non-emergency cases. Between National Health Insurance and Medicaid, there was no statistically significant difference in the ratio of emergency and non-emergency (p=0.380) CONCLUSION: Accessibility of emergency and non-emergency patients with National Health Insurance and Medicaid to Pusan Wide-regional Emergency Center was not different.
Adult ; Budgets ; Busan ; Emergencies* ; Emergency Service, Hospital ; Humans ; Insurance Coverage* ; Insurance* ; Korea ; Medicaid ; National Health Programs ; Retrospective Studies ; Social Class ; Triage

Leiomyoma and adenomyosis of the uterus are the most common gynecologic disorders in an enlarged uterus. The characteristic US and MR findings in differentiation between both lesions were prospectively evaluated in 30 patients. Of 30 patients, 15 were leiomyomas, 6 were adenomyosises, 8 were leiomyomas and adenomyosises, and 1 was a normal pregnancy, histologically. The total number of leiomyom nodules were 49 while adenomyosises were 14 (9 diffuse and 5 focal). Among 49 myomas nodules, 36 were correctly diagnosed by sonography. The characteristic US findings of uterine leiomyoma were well defined nodules (36), hypoechoic peripheral rim (16), and whorl-like internal echoes (13). Forty four of the 49 myoma nodules were correctly diagnosed by MRI. The characteristic MR findings of myoma were well defined nodules (43), peripheral low signal intensity rim on T1WI (13) and T2WI (9), and peripheral high signal intensity rim on T2WI (5). Among 14 adenomyosises, 9 were correctly diagnosed by sonography. The characteristic US findings of adenomyosis were diffuse uterine hypertrophy more than 5.5cm in AP diameter with endometrial displacement and no significant echo change in myometrium All 14 adenomyosis as were correctly diagnosed from MRI. On T2WI, adenomyosis appeared as ill defined localized or diffuse thickening of the junctional zone more than 1cm in thickness. It was our conclusion that to differentiate between leiomyoma and adenomyosis focused on should be the detection of existence of nodule in leiomyoma, the primary sign, not on the secondary indirect sign.
Adenomyosis* ; Animals ; Female ; Humans ; Hypertrophy ; Leiomyoma* ; Magnetic Resonance Imaging ; Mice ; Myoma ; Myometrium ; Pregnancy ; Prospective Studies ; Uterus

Obstetrical hemorrhage is one of the deadly triad, along with hypertensive disorder in pregnancy and infection. Postpartum hemorrhage is the major cause of obstetrical hemorrhage. Uterine atony is the most common cause of postpartum hemorrhage, and resulted from poor uterine contraction after delivery of the fetus and placenta. Initial management to control postpartum uterine atonic bleeding is based on the use of uterotonics such as well known oxytocin and ergot preparations together with uterine massage. Prostaglandin E2 analogue, sulprostone can be used next when these agents are failed to produce uterine contraction. The woman unresponsive to non-surgical managements requires surgical interventions including emergency hysterectomy. Recently prostaglandin E1 analogue, misoprostol, has been known to elicit potent uterine contraction and cervical ripening after oral, vaginal or rectal administration. We have experienced two cases of postpartum uterine atonic bleedings which were unresponsive to oxytocin, ergot, or prostaglandin E2, but were successfully controlled by rectal administration of misoprostols.
Administration, Rectal ; Alprostadil ; Cervical Ripening ; Dinoprostone ; Emergencies ; Female ; Fetus ; Hemorrhage* ; Humans ; Hysterectomy ; Massage ; Misoprostol* ; Oxytocin ; Placenta ; Postpartum Hemorrhage ; Postpartum Period* ; Pregnancy ; Uterine Contraction ; Uterine Inertia

A gastric intramural hematoma is very rare and commonly associated with trauma, anticoagulation therapy, coagulopathy, pancreatic disease, aneurysm and peptic ulcer disease. This is a case of gastric intramural hematoma which occurred in a patient taking aspirin after hypertonic saline-epinephrine injection for bleeding from a biopsy site. We describe a case of gastric intramural hematoma that was successfully managed with conservative therapy.
Aneurysm ; Aspirin ; Biopsy ; Epinephrine ; Hematoma* ; Hemorrhage ; Hemostasis* ; Humans ; Pancreatic Diseases ; Peptic Ulcer ; Saline Solution, Hypertonic