Primary biliary cirrhosis, a chronic, progressive, and often fatal cholestatic liver disease, is characterized by destruction of intrahepatic bile ducts, portal inflammation and scarring, and the eventual development of cirrhosis and liver failure. We reviewed four cases of primary biliary cirrhosis primarily suspected with peritoneoscopic liver biopsy specimens. All patients were female and their age ranged from 29 to 50 years(median age: 43.8 years). Presenting symptoms were typically pruritus and/or upper abdominal discomfort. On physical examination, interus was presented in 3; hepatomegaly in 3; chronic liver disease stigmata in one. Co-existing autoimmune diseases such as Hashimoto' thyroiditis and Sjoegren' syndrome were found in 2 cases. Biochemical tests of liver function revealed a cholestatic pattern. An antimitochondrial-antibody test was positive in 2 out of 3 patients(75%). Increase levels of serum immunoglobulins, especially of IgM, were evident in 3 cases. Histologic staging(Ludwig et al.) disclosed stage I lesion in one, stage III in two, and stage IV in the remaining one.
Female ; Humans ; Biopsy

The Duodenal diverticulum is the rare cause of the common bile duct obstruction. We experienced a case of the diverticulum of the second portion of duodenum in a 59-year-old male, who complained recurrent attacks of right upper abdominal pain and fever since 16 months prior to admission. Duodenoscopic finding and UGI study revealed a typical duodenal diverticulum just side to the papilla of Vater. Diverticulectomy and cholecystectomy was performed and after than, he has been free front above mentioned symptoms. We reported a case of duodenal diverticulum which caused recurrent common bile duct obstruction.
Abdominal Pain ; Cholecystectomy ; Common Bile Duct* ; Diverticulum* ; Duodenum ; Fever ; Humans ; Male ; Middle Aged

OBJECTIVES: After introduction of anti-HCV assay as screening test of blood donors, the proportion of trasfusion-associated hepatitis C declined, but the proportion of hepatitis C patients with a history of parenteral drug use increased, HCV, HRV, and H1V share similiar modes of transmission and prevalent among intravenous drug users in America. Recently the number of drug users in Korea has been increasing. Therefore we investigated the prevalence of HCV, HBV, and HIV among drug users in our country. In addition several recent reports showed that anti-HCV were freguently positive in the chronic alcoholics and HCV might play a role in the development of severe liver disease in these patients. We assessed the prevalence of anti-HCV and its re1ationship to the severity of liver disease in chronic alcoholic patients. METHODS: The prevalence of anti-HCV, HHsAg, and anti-HIV among 185 drug users who were admitted at Taegu Medical Center from January 1994 to December 1995 has been studied using ELISA and the history of drug use including sort, route, and duration investigated. In addition, We studied the prevalence of anti-HCV and its relationship to the severity of liver disease in 73 chronic alcoholics. RESULTS: 1) Among 176 methamphetamine intravenous users, the prevalence of anti-HCV was 80%, that of HBsAg was 4%, and there was none with anti-HIV positive in 131 cases tested. Of the 9 marihuana smokers, all of them were negative in anti-HCV or anti-HIV, and only 1 caese(11%) was HBsAg positive. 2) Longer duration of intravenous drug use was significantly associated with anti-HCV seropositivity, Elevated ALT level was found in 80 cases(57%) of the anti-HCV seropositive 140 cases and their mean was 971U/L. 3) The group with higher optical density of anti-HCV showed inclination of elevated ALT level; however there was no significant correlation between anti-HCV optical density and ALT level. 4) The prevalence of anti-HCV was 11% in 73 chronic alcoholic patients, and that of HBsAg was 4%. The seropositivity of anti-HCV correlated with the severity of liver disease: none in patients with no liver problem or fatty liver, 12.5% in patients with chronic liver disease, 1996 in patients with cirrhosis classified by clinical, biochemical, and ultrasonographic findings, However the presence of anti-HCV was not associated with impaired liver function tests in chronic liver disease and cirrhosis groups. CONCLUSION: The prevalence of anti-HCV among intravenous drug users in Korea was 80%, similiar to that in America, By contrast the prevalence of HBsAg was only 4%, lower than that of general population. And there was no HIV-infected cases among intravenous drug users in our study. The seropositivity of anti-HCV among chronic alcoholic patients was 11%. And increased prevalence of anti-HCV in alcoholic patients with severe liver disease might suggest that hepatitis C virus is involved in liver damage in these patients.
Alcoholics* ; Americas ; Blood Donors ; Cannabis ; Daegu ; Drug Users* ; Enzyme-Linked Immunosorbent Assay ; Fatty Liver ; Fibrosis ; Hepacivirus ; Hepatitis B Surface Antigens ; Hepatitis C* ; Hepatitis* ; Herpesvirus 1, Cercopithecine ; HIV* ; Humans* ; Korea* ; Liver ; Liver Diseases ; Liver Function Tests ; Mass Screening ; Methamphetamine ; Prevalence*

To assess the value of routine chest roentgenographic examinations at the time of admission, we analysed chest roentgenogram of 1,283 patients under the age of 15 who were admitted to St. Paul's Hospital from 1975 to 1977. A bonormal radiographic findings were detected in 111out of 1,283 Patients(8.7%). In 108 patients with abnormal findings, no medical or surgical therapy was required except three nowborn infants who had medical therapy as a result of pneumonic infiltration. In view of clinical analysis of 1,283 patients, it is considered that routine chest roentgenographic examinations were not warranted in patients under the age of 15 but justifiable in newborn infants.
Child* ; Humans ; Infant ; Infant, Newborn ; Radiography* ; Thorax*

The authors have had contact with 508 cases of perineal surgery receiving various kinds of anesthetic methods and these cases who were analazed at the Department of Anesthesiology, Ewha Womans University Hospital during the 5 year period from January 1976 to December 1980. The results are as follows: 1) There is the trend towards increasing numbers of perineal operations annually. 2) Ratio of males to females was 1.1:1.0. 3) Spinal anesthesia was the most commonly used technique(56.9%). 4) For geriatric patients, selection of anesthesia was regional aensthesia rather than general anesthesia. 5) The most common diagnosis and performed operation was hemorryhoidectomy and other perianal procedures(61.2%). 6) For premedication, demerol and atropine were commonly used(50.2%). 7) Most cases ended within 30minutes(62.8%). 8) Saddle block was satisfactory for perineal operation. And for this level, 6~8 mg of tetracaine was sufficient in spinal anesthesia.
Anesthesia* ; Anesthesia, General ; Anesthesia, Spinal ; Anesthesiology ; Atropine ; Diagnosis ; Female ; Humans ; Male ; Meperidine ; Premedication ; Tetracaine

A new hypolipidemic agent, lovastatin, hydroxy-methyl-gultaryl coenzyme A reductase inhibitor was administred to 25 patients with primary hyperlipidemia 20 to 40 mg daily for 12 weeks and sequential changes of serum lipid profile were analysed as follow. 1) Mean average at baseline period of serum total cholesterol, triglyceride, HDL and low desity lipoprotein cholesterol were 271, 179, 51 and 185 mg/dl respectively. 2) Total cholesterol showed 20% decrease at 4th week and 23% decrease at the end of 12th week while low density lipoprotein cholesterol decreased 31% and 33% respectively. 3) Triglyceride dropped 7% at 8th week and 3% at 12th week. High density lipoprotein cholesterol increased 4% at 4th week and showed 2% decrease at the end of study. 4) Only one patient complained of moderate abdominal pain, which subsided after 2 weeks drug withdrawal. In conclusion, lovastatin was well tolerated and effective, in the treatment of primary hyperlipidemia.
Abdominal Pain ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Coenzyme A ; Humans ; Hyperlipidemias* ; Lipoproteins ; Lovastatin ; Oxidoreductases ; Triglycerides

OBJECTIVE: To investigate whether the findings of wrist magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA) is representative of their disease activity. METHODS: MRI and plain radiographs were performed on the wrists of 15 patients with RA. Four MRI techniques were used; T1 weighted spin echo image (T2WI), chemical fat suppression T2 weighted image (FS-T2WI) and Gadolinium-DTPA contrast enhanced T1 weighted image (CE-TIWI). Erosion scores used as radiologic index were calculated from total counts of bone erosion in all coronal planes of wrist MRI and .plain radiographs. This erosion score was compared with the clinical indices (Ritchie index, grip strength, visual analogue pain scale) and laboratory indices (ESR, CRP, hemoglobin, immunoglobulins). RESULTS: MRI erosion score of the wrist in patients with RA significantly correlated with ESR and serum IgG level, but did not correlate with global clinical indices such as grip strength and Ritchie index. MRI was especially useful in early detection of erosive bone change. Special MR images such as fat suppres-sion and Gd-DTPA enhanced images were superior to plain radiographs and conventional MR images in detecting the erosive lesion of carpal bones. CONCLUSIONS: Wrist MRI is useful in early detection of erosive bone change and may be an important tool for the measurement of disease activity in RA. We prospect that it could be used to assess the progression of the disease and the response of drug therapy.
Arthritis, Rheumatoid ; Carpal Bones ; Drug Therapy ; Gadolinium DTPA ; Hand Strength ; Humans ; Immunoglobulin G ; Magnetic Resonance Imaging* ; Wrist*

Mucormycosis is a rare, fulminating, opportunistic fungal infection that occurs almost exclusively in immunocompromised hosts such as patients with diabetes, leukemia, lymphoma. These fungi are ubiquitous in nature, and can be found on decaying vegetation and in the soil. So they are relatively frequent contaminants in the clinical microbiology laboratory. Recently the incidence of mucormycosis is rising associated with the increasing use of immunosuppressive agents, antibiotics. Though mucormycosis is frequently fatal, there has been a significant improvement in the outcome by early diagnosis and aggressive treatment. Mucormycosis can be categorized as rhinocerebral, pulmonary, gastrointestinal, cutaneous, widely disseminated and miscellaneous; gastro-intestinal involvement is extremely rare. We report a patient with gastric mucormycosis who had diabetes mellitus and alcoholic hepatitis. His chief complaint was an epigastric pain, and the gastroscopy showed huge multiple ulcers, coated with exudates. The histologic examination revealed multiple broad, nonseptate hyphae with right angle branchings, diagnosed as mucormycosis.
Alcoholics* ; Anti-Bacterial Agents ; Diabetes Mellitus* ; Early Diagnosis ; Exudates and Transudates ; Fungi ; Gastroscopy ; Hepatitis, Alcoholic* ; Humans ; Hyphae ; Immunocompromised Host ; Immunosuppressive Agents ; Incidence ; Leukemia ; Lymphoma ; Mucormycosis* ; Soil ; Ulcer

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Intrasellar or pituitary abscess was first reported about a century ago, after then once relatively common but now is rare. Since 1925, about 50 cases have been reported in the literatures, of which characters were variable, but clinical very similar to one of pituitary tumor. So they were often diagnosed preoperatively as pituitary tumor. Several pathogenic factors were postulated in relation to clinical aspects. We had recently experienced a case of pituitary abscess combined with chromophobe adenoma. A 28 years old clerkman was admitted to our hospital with complaints of impared ejaculation and visual disturbance. Clinical aspects and diagnostic studies gave us a strong impression of pituitary tumor. Upon surgery we found a cystic mass in pituitary region, of which aspiration showed whitish-gray, tenacious and liquid material. Many polymorphous leukocytes were noted by direct smear, but no microorganisms were detected in culture. He had postoperatively suffered from transient polyuria and polydipsia, which soon disappeared under the medication of Esidrex. He was discharged from this hospital with recommendation of radiation therapy. Clinical features and treatment were also discussed with review of ever reported cases.
Abscess* ; Adenoma, Chromophobe ; Adult ; Ejaculation ; Humans ; Hydrochlorothiazide ; Leukocytes ; Male ; Pituitary Neoplasms ; Polydipsia ; Polyuria