No abstract available.

Cardiovascular manifestations in hyperthyroidism occur frequently with various phenotypes. An association between hyperthyroidism and pulmonary arterial hypertension has been reported. In previously reported cases, the hemodynamic and symptomatic recovery of pulmonary arterial hypertension is usually concomitant with achievement of euthyroidism. We report a patient who had pulmonary arterial hypertension associated with Graves' disease, which persisted after euthyroidism was obtained.
Achievement ; Graves Disease ; Hemodynamics ; Humans ; Hypertension ; Hypertension, Pulmonary ; Hyperthyroidism ; Phenotype

PURPOSE: Fingertip injuries are the most common hand injuries and may lead to significant disability. Knowledge of fingertip anatomy is mandatory to treat these injuries effectively. All surgical techniques used for coverage of fingertip injuries must be based on the nature of the injury and the patient's age. Many authors have studied the method of fingertip reconstruction because goals of these treatments should include maintaining length, sensibility, motions, and appearance. The purpose of this study is to evaluate the effect of digital artery perforator flap for fingertip reconstruction without aesthetic and functional problems. METHODS: From November 2006 to March 2007, the authors performed fingertip reconstruction on 3 fingers of 3 patients, aged between 41 to 54 years (average age, 47 years) using digital artery perforator flap. RESULTS: All fingers recovered successfully and there were no necrosis of the flap. We followed up 3 cases more than 5 months. Light touch and temperature sensation could be detected in all flaps and the static two-point discrimination test was 8 mm. CONCLUSION: This flap is an alternative choice for coverage of fingertip defects. This method also takes short time to procedure and to recovery. The digital artery perforator flap has never been reported in Korea, however it is considered as a useful method for treatment of fingertip injury.
Aged ; Amputation ; Arteries ; Discrimination (Psychology) ; Fingers ; Hand Injuries ; Humans ; Korea ; Light ; Necrosis ; Perforator Flap ; Sensation

Mesenchymal stem cells (MSCs) have recently been identified and characterized in humans. Moreover, MSC secrete cytokines that can support hematopoietic progenitor growth. In the present study, we evaluated whether the efficacy of hematopoietic stem cell transplantation is improved by their co-transplantation with MSC, and whether this is positively correlated with the dose of infused MSCs. Accordingly, irradiated NOD/SCID mice were transplanted with 1x10(5) human CD34+ cells in the presence or absence of culture expanded MSCs (1x10(6) or 5x10(6)). We evaluated human hematopoietic cell engraftment by flow cytometry and assessed MSC tissue distributions by fluorescence in situ hybridization. We found that CD45+ and CD34+ cell levels were significantly elevated in a dose-dependent manner in cotransplanted mice 4 weeks after transplantation. The engraftments of CD33+ and CD19+ cells also increased dose-dependently. However, the engraftment of CD3+ cells did not increase after co-transplantation with MSCs. Human Y chromosome+ cells were observed in multiple tissues and were more frequently observed in mice co-transplanted with 5x10(6) rather than 1x10(6) MSCs. These results suggest that MSCs are capable of enhancing hematopoietic cell engraftment and distribution in multiple organs in a dose-dependent fashion.
Animals ; Antigens, CD34/*biosynthesis ; Cell Differentiation ; Cells, Cultured ; Dose-Response Relationship, Drug ; Female ; Fetal Blood/*metabolism ; Humans ; In Situ Hybridization, Fluorescence ; Mesenchymal Stem Cells/*cytology ; Mice ; Mice, Inbred NOD ; Mice, SCID ; Microscopy, Fluorescence/methods ; Stem Cell Transplantation/*methods

BACKGROUND AND OBJECTIVES: The clinical association between migraine and vestibular symptoms has been indicated in many studies and it is believed that migraine-associated vertigo is one of the most common causes of spontaneous recurrent vertigo. SUBJECTS AND METHOD: We investigated the nature of vestibular and migrainous symptoms of 26 patients suffering vertigo associated with migraine and their responses to antimigrainous medications. Neurotologic tests such as oculomotor tests, calorictest, and audiometry were performed between attacks. RESULTS: A marked female predominance was found. The duration of rotational (77%) and/or to-and-fro vertigo (23%) lasted from a few seconds to several hours or, less frequently, even days. We found that patients showed vestibular abnormalities in central and peripheral types. In the symptom-free interval, 31% of the patients showed central oculomotor signs such as delayed saccadic latency and horizontal saccadic pursuit. On the other hand, 15% showed unilateral weakness in the caloric test and 15% showed positive results in the head thrust tests. Overall, 85% of patients experienced resolution or significant reduction of their attacks of vertigo with medication. CONCLUSION: Most patients with migraine-associated vertigo showed normal results on the vestibular tests and responded well to preventive medication. Migraine-associated vertigo caused various clinical manifestations and there should be relevant differential diagnosis for epiodic vertigo.
Audiometry ; Caloric Tests ; Diagnosis, Differential ; Dizziness ; Female ; Hand ; Head Impulse Test ; Humans ; Migraine Disorders ; Saccades ; Vertigo* ; Vestibular Diseases

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the effect of the strength of SCM muscle contraction and the intensity of the sound stimulation on the VEMP parameters (amplitude, latency and threshold). SUBJECTS AND METHOD: Twenty normal subjects were included. Subjects pushed with their jaw against the hand-held inflated cuff to generate cuff pressures of 20, 40 and 60 mmHg and sequential stimulation intensities were applied. Variances of each parameter were analyzed. RESULTS: There was no significant difference in terms of threshold according to the side and strength of SCM contraction. P1-N1 amplitude demonstrated no significant differences according to the side ; however, the amplitude increased significantly as the cuff pressure and stimulation intensity increased. Interaural amplitude difference ratios showed an increased difference at 20 mmHg when compared to those at 60 mmHg. There was neither a cuff pressure effect, nor stimulation intensity effect when considering the P1 latencies. As for the N1 values, there was no stimulation intensity effect but there was a delayed latency at 20 mmHg when compared to those at 40 or 60 mmHg. Interaural latency difference of N1 latencies did not differ significantly according to the cuff pressure ; however, there was an increased difference at 20 mmHg when compared to those at 40 or 60 mmHg. CONCLUSION: This study shows that VEMP response is influenced by the cuff pressure and stimulation intensity, and we recommend to get each VEMP parameter using this feedback method in the clinical setting.
Evoked Potentials ; Jaw ; Muscle Contraction ; Muscles* ; Saccule and Utricle ; Vestibular Function Tests

BACKGROUND/AIMS: Detection of asymptomatic benign colon polyp is increasing because colonoscopy is widely used as a screening and diagnostic method. Fecal occult blood test is usually performed for the selection of patients requiring colonoscopy as well as mass screening for colon cancer. The aim of this study was to investigate the usefulness of fecal occult blood test performed prior to colonoscopy as a screening method of benign colon polyps. METHODS: Clinical characteristics of patients with polyps were evaluated according to the fecal occult blood test results in patients who underwent one-day fecal occult blood test and colonoscopic polypectomies from May 2003 to October 2004, retrospectively. RESULTS: A total of 942 colonoscopic polypectomies in 288 patients were evaluated. Fecal occult blood tests were positive only in 32 patients (11.1%). In univariate analysis, there was a significant difference in polyp size (p=0.02) and location (p=0.03) according to the presence of positive fecal occult blood tests. In addition, age of the patient (p=0.046), polyp size (mean, p=0.04; largest, p<0.01) and the number of polyps (p=0.045) were significantly different. However, in multivariate analysis, only polyp size larger than 20 mm was significantly related with positive fecal occult blood test with estimated odds ratio of 4.71. CONCLUSIONS: Fecal occult blood test has limitations as a screening test in asymptomatic patients with colon polyps, except for colon polyps larger than 20 mm in size.
Colonic Neoplasms/diagnosis ; Colonic Polyps/*diagnosis ; Colonoscopy ; Female ; Humans ; Male ; Mass Screening ; *Occult Blood ; Sensitivity and Specificity

BACKGROUND/AIMS: Indications for submucosal saline-epinephrine injection (SSEI) for prevention of postpolypectomy bleeding, in the colon, is variable among endoscopists. The aim of this study was to determine the proper indication for SSEI. METHODS: Clinical data of 1,745 polypectomies was evaluated. Postpolypectomy bleeding after snare polypectomy were evaluated in 1,039 polypectomies. Subgroup analysis was performed in 4 subgroups by size (< or = 8 mm or >8 mm) and gross morphology (pedunculated or sessile), also. RESULTS: Submucosal saline-epinephrine injection was used in 679 snare polypectomies. The size of polyps was 9.5+/-4.3 mm. Distribution of polyps showed left side shift in the colon. Sessile polyps (79.4%) and benign adenoma (75.3%) were predominant. Twenty seven episodes (2.6%) of bleeding occurred after snare polypectomy. Rectal polyp, malignant polyp and procedure without SSEI increased bleeding after snare polypectomy with odds ratio 4.71, 10.48 and 3.44, respectively. However, SSEI significantly reduced the bleeding only in patients who had >8 mm sized sessile polyps with odds ratio 16.41 regardless of location and histopathology. CONCLUSIONS: SSEI should be performed in colonoscopic snare polypectomy for >8 mm sized sessile polyps, and might be performed in others for prevention of bleeding at the discretion of the clinician.
Adenoma

Tsutsugamushi fever is a serious febrile disease outwardly similar to malaria and various arboviral infections. The endemic area is Asia-Pacific. This disease are generally associated with disturbed habitats favoring large populations of vector larval trombiculid mites. Therapy with tetracycline, chloramphenicol or ciprofloxacin is currently recommanded. Unfortunately these drugs is suboptimal for children and pregnant women. Recently, azithromycin has been proven to be effective in therapy of scrub typhus. There is no evidence that azithromycin causes adverse reaction to developing fetus or children. We report four cases of tsutsugamushi fever in children successfully treated with azithromycin. This is the first report describing clinical application of azithromycin to tsutsugamushi fever in Korean children.
Azithromycin* ; Child* ; Chloramphenicol ; Ciprofloxacin ; Ecosystem ; Female ; Fetus ; Humans ; Malaria ; Pregnant Women ; Scrub Typhus* ; Tetracycline ; Trombiculidae

Rheumatoid vasculitis usually occurs in patients with long standing, seropositive, erosive rheumatoid arthritis. It involves typically small to medium-sized vessels and is associated with peripheral neuropathy, digital gangrene, nail fold infarcts, livedo reticularis, and palpable purpura. Histologic examination of skin biopsy specimens usually shows leukocytoclastic vasculitis. We report a case of rheumatoid vasculitis developed on both extremities in a 63-year-old female with rheumatoid arthritis for 15 years.
Arthritis, Rheumatoid ; Biopsy ; Extremities ; Female ; Gangrene ; Humans ; Livedo Reticularis ; Middle Aged ; Peripheral Nervous System Diseases ; Purpura ; Rheumatoid Vasculitis* ; Skin ; Vasculitis