BACKGROUND: Acute abdominal pain is one of the most common problems in the family practice but the differential diagnosis of acute abdominal pain is difficult in first encounter. When family physicians are encountered with patients with acute abdominal pain in the ambulatory care settings, t,hey have to make a decision for management of acute abdominal pain such as admission, referral, discharge or follow-up without any definite diagnosis. If it is possible to predict the course or prognosis of acute abdominal pain by using certain data about patients, it will be helpful to make a decision for the management of acute abdominal pain. So we tested the hypothesis that acute abdominal pain with intermittent pain nature and normal simple abdomen X-ray finding is not serious and shows favorable outcome. METHODS: 126 patients with acute abdorninal pain were enrolled from Feb. to Aug. in 1995 at the emergency department of Kyungju hospital, Dongkuk University. 116 patients showed normal simple abdomen X ray finding and among them 94 patients were discharged and 21 patients were admitted. 92 patients were contacted in 1 week by phone call and they reported the outcome of their acute abdominal pain. RESULTS: Among 92 study populations, 44 patients were male and 48 patients were female. 72 patients complained intermittent abdominal pain and 21 patients complained continous abdominal pain. Frequencies of tentative diagnosis at emergency department were 45 acute gastroenteritis, 26 unknown, 14 functional gastointestinal disorders, 4 acute gastritis, 2 pelvic inflammatory diseases, and 1 ureter stone. Outcomes of patients with intermittent abdominal pain were more favorable than those with continous abdominal pain. CONCLUSIONS: If the patients with acute abdominal pain have intermittent pain nature and normal simple abdomen x ray finding, they will show favorable outcome and can be managed at ambulatory care settings.
Abdomen ; Abdominal Pain ; Ambulatory Care ; Diagnosis ; Diagnosis, Differential ; Emergency Service, Hospital ; Family Practice ; Female ; Follow-Up Studies ; Gastritis ; Gastroenteritis ; Gyeongsangbuk-do ; Humans ; Male ; Pelvic Inflammatory Disease ; Physicians, Family ; Prognosis ; Referral and Consultation ; Ureter

No abstract available.
Asthma* ; Asthma, Exercise-Induced ; Bronchoconstriction* ; Child* ; Humans

The t(3;21) (q26;q22) is associated with chronic myelogenous leukemia in blast crisis, leukemia evolving from therapy-related myelodysplasia, and with leukemia following other hematopoietic proliferative diseases. The t(3;21) is rare secondary aberration in blast crisis of Philadelphia(Ph)-positive chronic myeloid leukemia, which may be restricted to patients entering myeloid blast crisis. We report here in one case of chronic myeloid leukemia in blast crisis which reveals both t(9;22) (q34;q11), and t(3;21) (q26 ;q22). A 62-year-old male was diagnosed as chronic myeloid leukemia 5 years ago, received hydroxyurea therapy, and admitted because of gingival bleeding and fever. On examination, splenomegaly and leukocytosis with proliferated blasts(91%) in peripheral blood were noted. Bone marrow aspirate showed hypercellularity with severe blast proliferation(92.5%) which revealed all negative in peroxidase and PAS stain. Cytogenetic study of bone marrow cells showed the karyotype 46, XY, t(3;21) (q26;q22), t(9;22) (q34;q11), which might be suspected as myeloid blast crisis. Above finding was confirmed by the result of immunophenotyping(CD13 43.6%, CD34 68.2%, HLA-DR 91.6%). He received intensive chemotherapy, but still sustained proliferation of blasts was noted . The follow up cytogenetic study was as follows: 46, XY, 4(3;21) (q26:22), t(9;22) (q34;q11)/46, XY, t(3;21)(q26;q22), del(8) (q22), t(9:22) (q34,q11)/46, XY (16/3/1). He died soon from severe pancytopenia and sepsis.
Blast Crisis* ; Bone Marrow ; Bone Marrow Cells ; Cytogenetics ; Drug Therapy ; Fever ; Follow-Up Studies ; Hemorrhage ; HLA-DR Antigens ; Humans ; Hydroxyurea ; Karyotype ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Leukocytosis ; Male ; Middle Aged ; Pancytopenia ; Peroxidase ; Sepsis ; Splenomegaly

No abstract available.
Aorta* ; Endothelium-Dependent Relaxing Factors*

Ganglion cyst of the spinal facet joint is rare. It is believed that ganglion cysts on the dorsal aspect of the facet joints are asymptomatic and therefore are not clinically appreciated. But we have experienced a patient who had severe low-back and buttock pain and diagnosed as ganglion cyst located on the dorsal aspect of the right side facet joint between the fourth and fifth lumbar vertebrae. The treatment was surgical excision of the cyst and resulted in a satisfactory recovery. The differential diagnosis involving herniated lumbar intervertebral disc should not exclude ganglion cyst of the dorsal aspect of the lumbar facet joint.
Buttocks ; Diagnosis, Differential ; Ganglion Cysts* ; Humans ; Intervertebral Disc ; Lumbar Vertebrae ; Zygapophyseal Joint*

PURPOSE: Defecography is a technique of examining the rectum and anal canal by using fluoroscopy during defecation. This study was done to determine the range of normal findings of defecography in young asymptomatic Korean volunteers. MATERIALS AND METHODS: Twenty-nine asymptomatic young volunteers underwent defecography. Anorectal angle, perineal descent, length and width of anal, rectocele, rectal intussusception and incontience were evaluated. RESULTS: The range of anorectal angle was 82 degrees-149 degrees in resting state, compared to the 63 degrees -116 degrees in squeezing state, and 95 degrees -116 degrees in straining state respectively. The pelvic floor in straining state descended on average of 1.62cm from the inferior margin of ischial tuberosity that its broad range of position from --5.2cm to 0.8 cm implies a wide variation of anorectal angle and periheal descent. Mild degree of rectocele with less than 2cm of depth was found in 12 out of 29 cases. Rectal intussusception was noted in six and rectal incontinence was seen in one case. Formation of rectocele and intussusception during defecation was common in asymptomatic young volunteers. CONCLUSION: The wide range of defecographic measurements warrants the necessity of other complementary studies on anorectal function to improve the diagnostic accuracy. The interpretation of defecographic measurement should therefore be made with caution and should not be used as the sole criteria for seliction of treatment modality.
Anal Canal ; Defecation ; Defecography ; Fluoroscopy ; Intussusception ; Pelvic Floor ; Rectocele ; Rectum ; Volunteers*

In Korea, more than in most other countries, motions in hip and knee are extremely important because kneeling and squatting are conventional potures in the home and social activities. from this point of view, the preservation of mobility is a critical trial in the treatment of tubercuiosis of the knee joint. In 1974 we reported five cases of tuberculosis of the knee which were treated with preservation of the joint mobility. This is the report of another four cases of knee joint tuberculosis which were treated by synovectomy and curettage of the bony focus in an allempt to half the pathological process without sacrificing joint motion. All of the four cases have preserved their knee joint motion and have gained an average of 43.7 degrees of motion through joint exercise started five weeks post-operatively. Previously reported cases started their joint exercise eight weeks after operation and gained an average of only 26.7 degrees of motion. As chemotherapy provides more effectiveness in the treatment of joint tuberculosis, early joint motion postoperatively is important to gain more range of joint motion. In conclusion, tuberculosis of major weight bearing joints, notably the knee, may be successfully treated their joint motions preserved by surgical eradication of the lesion and chemotherapy.
Curettage ; Drug Therapy ; Hip ; Joints ; Knee Joint ; Knee ; Korea ; Tuberculosis ; Tuberculosis, Osteoarticular ; Weight-Bearing

Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infection in infants. Life-threatening RSV infection is often reported in young children and immunocompromised hosts. Since there is no report on ribavirin therapy for RSV pneumonia in pediatric cancer patients in Korea, we report one case of RSV pneumonia that developed in an infant with acute lymphoblastic leukemia (ALL). Despite administration of oral ribavirin and intravenous immunoglobulin, the patient's respiratory distress worsened and admission to an intensive care unit was necessary. Chest x-ray showed multifocal consolidation, pneumothorax, and pneumomediastinum. Treatment with aerosolized ribavirin led to significant clinical improvement. The role of aerosolized ribavirin is still controversial, but it might have a therapeutic potential for severe RSV pneumonia in children with leukemia.
Child ; Humans ; Immunocompromised Host ; Immunoglobulins ; Infant ; Intensive Care Units ; Korea ; Leukemia ; Mediastinal Emphysema ; Pneumonia ; Pneumothorax ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Ribavirin ; Thorax

BACKGROUND: The testes are one of the most common extramedullary sites of relapse in boys with acute lymphoblastic leukemia(ALL). The reported incidence of isolated testicular relapse varies from 3 to 40%. If these patients are treated exclusively with testicular irradialion, a systemic relapse occurs within a few months. Recently, the use of intensive chemotherapy and testicular irradiation improved the survival rate for boys with testicular leukemia. So, we performed this study to identify clinical manifestations, disease free survival and prognostic factors of testicular leukemia in children. METHODS: We reviewed 33 patients of testicular leukemia among total 410 boys with ALL diagnosed at the Department of Pediatrics, Seoul National University Children's Hospital from Jan. 1970 to Aug. 1996. Testicular leukemia was confirmed by testicular biopsy in all 33 patients. These patients were treated with combined local testicular irradiation(2,400~2,500 cGy/8~12fractions) and systemic chemotherapy. Two patients, in whom testicular relapse was diagnosed before 1979, unilateral orchiectomy of the involved site and testicular irradiation of the opposite site were performed. Probability estimates of disease free survival (DFS) were calculated by the method of Kaplan and Meier, and the relationship of prognostic factors to DFS was compared using the chi-square test in survival analysis. RESULTS: In 410 boys with ALL, testicular leukemia occurred in 33 patients(8%). Of 33 patients, 6 patients presented with testicular involvement at initial diagnosis, 16 patients had testicular relapse while still receiving chemotherapy and 11 patients had testicular relapse 3 to 57 months(median : 15 months) after cessation of chemotherapy. The median age of 33 patients was 7.4 yrs(9 months~18 yrs) and median WBC count 7,600/ L(2,700~270,000/L). All patients presented with painless testicular enlargement and testicular leukemia was confirmed by testicular biopsy. Among 33 patients, 2 had prior CNS relapse and 11 had concomitant bone marrow and/or CNS relapse. Twenty nine patients were treated with combined local testicular irradiation and systemic chemotherapy. Eleven had second relapse(6 bone marrow, 3 CNS, 2 opposite testis). Seventeen have been followed until now: 6 patients on chemotherapy and 11 patients(37.9%) in complete remission for 48.5+/-22.3 months(19~86 months). The 3 year DFS for 29 patients was 55.3%+/-10.1%. The following prognostic factors showed no significant association with DFS in testicular relapse : age and WBC count at initial diagnosis, age at testicular relapse, and concomitant relapse. Whether testicular relapse occurred on initial therapy or off initial therapy has prognostic value in predicting DFS. The 3 year DFS for boys with testicular relapse on and off initial therapy were 40.0%+/-12.9% and 78.8%+/-13.4%, respectively(P: 0.046). CONCLUSION: With the use of chemotherapy and testicular irradiation, prolonged second re mission can be achieved in many patients with testicular leukemia. The patients with testicular relapse off initial therapy fared significantly better than patients on therapy. So, to improve the DFS for boys with testicular leukemia, a better understanding of its biology and prognostic factors is needed.
Biology ; Biopsy ; Bone Marrow ; Child ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Humans ; Incidence ; Leukemia ; Missions and Missionaries ; Orchiectomy ; Pediatrics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Recurrence ; Seoul ; Survival Rate ; Testis

No abstract available.
Deglutition Disorders ; Facial Nerve ; Glossopharyngeal Nerve ; Herpes Zoster ; Herpes Zoster Oticus ; Paralysis