BACKGROUND: Multidrug-resistant tuberculosis(MDR-TB) in patients is mainly caused by acquired drug resistance, However, a small proportion of MDR-TB is caused by initial drug resistance(IDR), which may be somewhat different from acquired drug resistance. This study analyzed the clinical characteristics of IDR in MDR-TB patients to use the results as basic data in managing the disease. METHODS: A retrospective study of 30 IDR cases in MDR-TB patients from Jan. 1995 to Dec. 1998 was perormed. In order to analyzed the clinical charcteristics, the age, sex, family history, duration of negative conversion, number of resistant drugs, treatment regimens, duration of treatment, extent of disease and cavitary lesion on the chest X-ray was examined. In order too analyzed the level of improvement, the extent of the disease and cavitary lesion on the chest X-ray, tested by Wilcoxon signed rank sum test, and the disease free interval rate of 1-year and 4-year was examined using the Kaplan-Meier method. RESULTS: The mean age of the patients was 46.6 years and the sex ratio 1:1. Six(20%) patients had a family history. The mean negative conversin of the sputum AFB stain was 2.6 months. The number of resistant drugs was 7.6 and the number of used drugs 3.6. Twenty-three(67%) patients were treated for less than 12months and 28(93%) patients were treated with first-line drugs. The extent of the disease and the cavitary lesion on the chest X-ray improved after treatment(p<0.05). Among 13 patients who were followed up for 22.6 months, 2(15%) patients relapsed and the disease free interval rate of 1-year and 4-year was 85%. CONCLUSION: It is recommended that the duration of treatment of IDR in MDR-TB with first-line drugs be 9-12 months even if the extent of disease and cavitary lesion on the chest X-ray improves.
Drug Resistance* ; Humans ; Retrospective Studies ; Sex Ratio ; Sputum ; Thorax ; Tuberculosis, Multidrug-Resistant

Complex regional pain syndrome (CRPS) type II is a syndrome that develops after nerve injury. Symptoms may be severe, and vary depending on the degree of sympathetic nerve involvement. As yet, there is no satisfactory treatment. We report the case of a female patient who had an L5 left transverse process fracture and an S2 body fracture, who developed symptoms of CRPS type II in her left lower leg that were aggravated during ambulation in spite of absolute bed rest for one month after the trauma. Several treatments, including bed rest, medication, and numerous nerve blocks were attempted, but the pain persisted. We finally tried injection of polydeoxyribonucleotide (PDRN) solution at the left L5 transverse process fracture site because we knew of the anti-inflammatory effect of PDRN. One day after this treatment, her symptoms had almost disappeared and three days later, she was discharged. We will also further discuss the possibility of using PDRN solution for the treatment of CRPS.
Bed Rest ; Causalgia* ; Female ; Humans ; Leg ; Nerve Block ; Polydeoxyribonucleotides ; Walking

Postdural puncture headache (PDPH) is probably the most common complication of spinal anesthesia. The incidence of spinal headache is believed to be related to age, sex, pregnancy, size of the dural puncture needle, direction of the needle bevel, and the angle at which the needle penetrates the dura. This study were done to see the relation of sex, age, needle size (23 gauge, 25 gauge & 27 gauge needle) & bevel direction (parallel, perpendicular insertion to the longutudinal dural fiber) on the incidence, duration, severity, and location. The following results were observed: 1) The overall incidence of headache was 7.9% (49 cases). 2) The size of the needle was statistically significant assouation of PDPH. 3) Headache occured in highest frequency in patients in the second and third decades. 4) The frequency of PDPH was inversely associated with age. 5) The onset of headache was 1-2 days (68%) and duration of headache was 4-5 days (82%) in postanesthetic day. 6) The severity of headache was mild and moderate in 90% cases.
Anesthesia, Spinal ; Headache ; Humans ; Incidence ; Needles* ; Post-Dural Puncture Headache* ; Pregnancy ; Punctures

ERCP was performed in 38 cases of clonorchiasis of the liver, which was confirmed by stool egg test withStoll's dilution method from Apr. 1979 to Oct. 1982. The resuls were as follows 1. The sex distribution ofclonorchiasis showed marked male predominance by 97.4% and age distrigution were higher in 5th and 6th decades. 2.Multiple small filling defects in the intrahepatic bile duct was the most characteristic finding in ERCP and widespread irregular stenosis, dilatation of terminal portion, disturbance of peripheral filling, fuziness andraggedness of intrahepatic duct were also noted. 3. The severity of clonorchiasis by ERCP were classifed asfollows; Grade I-7 cases (18.4%), GradeII-9 cases(23.7%) Grade III-12 cases (31.6%) and Grade IV-10 cases(26.3%)4. Chronic cholecystitis 10 cases(26.3%), Billary tree stone 7 cases (18.4%), malignancy of distal CBD 1 case(2.6%) were found with clonorchiasis by ERCP. 5. Three cases, treated with Niclofolan, showed marked improvementof pathology on follow-up ERCP.
Bile Ducts, Intrahepatic ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystitis ; Clonorchiasis ; Constriction, Pathologic ; Dilatation ; Follow-Up Studies ; Humans ; Liver ; Male ; Methods ; Niclofolan ; Ovum ; Pathology ; Sex Distribution ; Trees

Behcet's disease is a recurrent and multisystemic disorder which usually persists over many years and is classified under vasculitic syndrome. A classic triad in this disorder is composed of a recurrent oral ulcer, genital ulceration and uveitis. While intestinal Behcet's disease most commonly affects the ileoecal region, dysphagia associated with esophageal ulceration is very uncommon. A 34-year-old-female patient visited our hospital because of dysphagia, epigastric pain and fever. The patient had ulcers on the oral mucosa, soft palate and extemal genitalia. Multiple irregularly marginated ulcers surrounded with hyperemic edematous mucosa were found on the middle and distal esophagus and lesser curvature of the stomach by an esophagogastroduodenoscopic examination. The pathologic findings were non-specific ulcers with necrotizing vasculitis in the vulva and with suspicious vasculitis in the esophagus. So she was diagnosed to have a Behcets disease and was treated with steroid and sulfasalazine. In this study we report a case of esophageal involvement of Behcet's disease with a review of the literature.
Deglutition Disorders ; Esophagus ; Fever ; Genitalia ; Humans ; Mouth Mucosa ; Mucous Membrane ; Oral Ulcer ; Palate, Soft ; Stomach ; Sulfasalazine ; Ulcer ; Uveitis ; Vasculitis ; Vulva

A study of continuous postoperative regional analgesia by nerve sheath block for limb amputation is presented. The authors reviewed 65 patients with amputation at the level proximal to the wrist or ankle. 15 patients of which were managed with continuous postoperative regional analgesia (CPRA) by nerve sheath block. At the time of exposure of nerve trunk during amputation, a catheter was introduced directy into the transected nerve sheath through a seperated stab wound, then infuse 0.5% bupivacaine 5ml prior to wound closure and postoperatively at the rate of 2 ml/4~6 hours for 3~4 days. The results were as follows : 1) Effective amputation stump analgesia was obtained, significantly reducing the need for narcotic analgesics. 2) 46 (70%) patients experienced Phantom phenomena and 30 (46%) patients experienced Phantom pain, a less frequently in CPRA group. 3) Phantom pain was more commonly observed in patients with rnore severe preamputation pain. 4) There were no significant relationships between the occurence of Phantom pain and the age of amputee or the level of amputation. We concluded that continuous postoperative regional analgesia by nerve sheath block significantly reduced the narcotic requirements in patients with ampotation surgeries.
Amputation Stumps ; Amputation* ; Amputees ; Analgesia* ; Ankle ; Bupivacaine ; Catheters ; Extremities* ; Humans ; Narcotics ; Phantom Limb ; Wounds and Injuries ; Wounds, Stab ; Wrist

Aneurysmal malformation of the portal vein is a rare entity. To our knowledge, only scattered reports ofportal vein aneurysms appear in the literature in English, and there is no previously published report in Korean.We describe a case exhibiting aneurysmal malformation of the extrahepatic portal vein at the hepatic hilum; thefindings demonstrated by ultrasound, CT and angiography are discussed, a review of previously described cases isincluded.
Aneurysm* ; Angiography ; Portal Vein* ; Ultrasonography ; Veins

Primary malignant melanoma of tbe esophagus is extremely rare and its incidence is below 0.1%. The tumor is polypoid and tend to be large, which is covered with false membrane, friable, hemorrhagic, and necrotic. Hematogenous and lymphogenic metastasis are common. Resection of the tumor with an anastomotic procedure seems to be the treatment of choice, and postoperative irradiation may be useful. But, despite these measures, prognosis is poor, with a 5-year survival of 4.2%. We report a case of 58-year-old man with primary malig- nant melanoma of the epophagus, and review of the literature in presented related studies.
Esophagus* ; Humans ; Incidence ; Intestines* ; Melanoma* ; Membranes ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Stomach*

PURPOSE: This study was undertaken to investigate the spectrum and the prognosis of neonate with cardiovascular malformation delivered from diabetic mothers. METHODS: From January 2004 to December 2008, 70 neonates born to diabetic mothers who were delivered at Dongsan Medical Center, Keimyung University, and received echocardiographic study between 3rd and 14th days of life to identify the presence of cardiac anomaly were included. Cases combined with chromosomal anomaly were excluded. And follow up results (rate of cardiac operation and mortality) were assessed. RESULTS: Among 67 neonates, 22 cases (32.8%) had combined cardiovascular malformation. They were interventricular septal hypertrophy (10 cases), atrial septal defect (7 cases), significant patent ductus arteriosus (5 cases), ventricular septal defect (2 cases) and tetralogy of Fallot (1 case). Among them, 20 neonates (29.9%) were preterm babies, and 21 neonates (31.3%) were large babies. On follow up echocardiograpic examination between 2 and 12 months of life, all but 2 infants (received cardiac operation due to VSD or Tetralogy of Fallot) was improved spontaneously. And combined extracardiac anomalies were tracheoesophageal fistula (2 cases), imperforated anus (1 case) and corpus callosum agenesis (1 case). Only one preterm baby was dead due to necrotizing enterocolitis, but did not have cardiac disease. CONCLUSION: Pre-existing maternal diabetes was associated with the development of neonatal cardiac anomalies, but the prognosis was good in this study.
Agenesis of Corpus Callosum ; Anal Canal ; Ductus Arteriosus, Patent ; Echocardiography ; Enterocolitis, Necrotizing ; Follow-Up Studies ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Hypertrophy ; Infant ; Infant, Newborn ; Mothers ; Prognosis ; Tetralogy of Fallot ; Tracheoesophageal Fistula

PURPOSE: To evaluate the usefulness of MR urography(MRU) using Half-Fourier acquisition single-shot turbospin-echo(HASTE) sequence compared with conventional intravenous urography(IVU). MATERIALS AND METHODS: Thirtyfive lesions of 32 patients who underwent MRU because of delayed excretion or nonvisualization of the ureter wereincluded in this study. HASTE MR urography was performed with a 1.0 MR imaging unit. Coronal images includingthose of the kidney, ureter and bladder were obtained in every patient using the multislice technique, and werepostprocessed by means of the maximal intensity projection technique. Scan time was 17-19 seconds. We analyzed theresults of MRU, focusing on level of obstruction, incidence of stone, ureter dilatation, and motion artifact, andin each case compared MRU findings with those of IVU. RESULTS: In 12 of 35 lesions(34.2%), MRU more effectivelydiagnosed causes of obstruction than did IVU, while in seven lesions(20%), MRU and IVU were similar. In eightlesions(22.9%), all of which were caused by a stone, IVU was better than MRU, and in a further eight, neithermodality was able to diagnose the cause. For diagnosis of the level of obstruction, MRU was better than IVU in 20of 35 lesions(57.1%), and similar to IVU in seven(20%). In three lesions(8.6%), neither modality was able todetect the level of obstruction. Four lesions not related to obstruction were polycystic renal disease, cysticrenal change, vesicovaginal fistula and extra-renal pelvis. Dilatation of the ureter was seen in 23lesions(65.8%) on MRU and in seven lesions on IVU. Thus, MRU revealed dilatation of for the ureter more efectivelythan IVU. CONCLUSION: MRU using HASTE was valuable for the detection of underlying causes and levels ofobstruction in the urinary tract, and of abnormalities in surrounding structures in patients with non-visualization of the kidney or delayed contrast excretion of the ureter, as seen on delayed IVU urogram.
Artifacts ; Diagnosis ; Dilatation ; Humans ; Hydronephrosis ; Incidence ; Kidney ; Magnetic Resonance Imaging ; Pelvis ; Polycystic Kidney Diseases ; Ureter ; Urinary Bladder ; Urinary Tract ; Urography* ; Vesicovaginal Fistula