Strongylodiasis is universal in distribution but is most abundant in countries with a tropical climate. Although infestation by Strongyloides stercoralis is usually limited to the intestines, dessemination of this helminth in debilitated host can be lead to death with various clinical disorders. characterized by profound malabsorption, diarrhea, electrolyte imbalance, gram negative or opportunistic fungal sepsis, coma and death. Cell-mediated immunity contributing significantly to the control of helminthic infections, may be suppressed by carcinoma, immunosuppressive chemotherapy and use of corticosteroids. Diagnosis of Strongyloidiasis is achieved by an examination of samples of feces, duodenal aspirates and sputum of patients for Strongyloides stercoralis. Treatment of strongyloidiasis is twofold : correction of the immunosuppressive state by withdrawal of immunosuppressive drug, if possible, and vigorous treatment with thiabendazole. Testing for strongyloidiasis is especially recommanded before treating a patients should be monitored for infection by Strongyloides stercoralis and other opportunistic infection. We are reporting a case patient with Strongyloides stercoralis hyperinfection and pulmonary tuberculosis who had been. used corticosteroid for persisting polyarthritis.
Adrenal Cortex Hormones ; Arthritis ; Coma ; Diagnosis ; Diarrhea ; Drug Therapy ; Feces ; Helminths ; Humans ; Immunity, Cellular ; Intestines ; Opportunistic Infections ; Sepsis ; Sputum ; Strongyloides stercoralis* ; Strongyloides* ; Strongyloidiasis ; Thiabendazole ; Tropical Climate ; Tuberculosis, Pulmonary

Plummer-Vinson syndrome is a clinical entity characterized by dysphagia, iron deficiency anemia, cheilosis, glossitis, and cervical esophageal web, especially in middle aged women. Recently, the authors experienced a case of Plummer-Vinson syndrome. A 53-year-old female was admitted due to intermittent solid food dysphagia for 18 months. She had a 2 years history of iron deficiency anemia. On admission glossitis, fissures at the angle of the mouth, spoon nails, and iron deficiency anemia were noted. Esophagogram and esophagoscopic examination revealed thin walled concentric web at upper esophagus. Esophageal web was succefully teared by endoscopic balloon dilatation with subseguant improvement of dysphagia. Skin manifestations as well as anemia were markedly improved after oral iron replacement therapy.
Anemia ; Anemia, Iron-Deficiency ; Deglutition Disorders ; Dilatation ; Esophagus ; Female ; Glossitis ; Humans ; Iron ; Middle Aged ; Mouth ; Plummer-Vinson Syndrome* ; Skin Manifestations ; Tears

From December 1987 to September 1988, clinical evaluation were performed at the Yeungnam University Hospital on 138 patients with exudative pleural effusion comparing with biochemical, bacteriologic, cytologic and pathologic studies. The results were as follows 1. Among these 138 cases, Incidence of tuberculosis was 57.3%, neoplasm 26.8%. High tendency in malignant pleural effusion occurred in elder age. 2. In tuberculosis pleural effusion, the rate of positive smear and culture for acid-fast bacilli in the pleural fluid was 3.7% and positive biopsy for granuloma 75%. 3. In malignant pleural effusion, the rate of positive cytology for cancer cell in the fluid was 42% and positive biopsy 60%. 4. Analysis in tuberculosis and malignancy showed the tendency of high pH, WBC, protein and of low glucose, but there were clinically not significant in differentiating malignant pleural effusion from tuberculous pleural effusion. 5. Among 23 cases in which the pleural tissue findings were chronic nonspecific reaction pathologically, tuberculosis (52.2%), malignancy (26%), and idiopathic (21.8%) eventually in follow up studies.
Biopsy ; Follow-Up Studies ; Glucose ; Granuloma ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Pleural Effusion* ; Pleural Effusion, Malignant ; Tuberculosis

PURPOSE: Orthostatic proteinuria accounts for the majority of cases of proteinuria that present in childhood or adolescent. This study was conducted to see the prevalence of Nutcracker syndrome (NCS) in children with orthostatic proteinuria using venography. METHODS: Study patients consisted of 23 children with orthostatic proteinuria. The diagnosis of NCS was made by high pressure gradients (> or =4 mmHg) between left renal vein (LRV) and inferior vena cava (IVC) in left renal venography and pressure tracing. RESULTS: Of 23 study patients, the venography showed 12 cases (52%) of typical NCS. Their mean age was 11.5 years (9-14 years). Female predominance (Male:Female=2:10) was noted. In NCS group (n=12), venous pressures of IVC and LRV were 6.50+/-3.34 and 13.21+/-3.53 mmHg, respectively. This pressure gradient between two veins was 6.71+/-2.54 mmHg, which is significantly higher than that of non-NCS group (n=11), 2.17+/-0.94 mmHg (p < 0.05). No positive correlation was observed between urinary protein during 24 hour and pressure gradient (r=0.152, p=0.636). CONCLUSION: NCS may be an important cause of orthostatic proteinuria in children. The prevalence of NCS shown in this study was very similar to that in a doppler sonographic observation published previously. A larger-scale study is necessary to confirm the prevalence.
Adolescent ; Child ; Female ; Humans ; Phlebography ; Prevalence ; Proteinuria ; Renal Veins ; Veins ; Vena Cava, Inferior ; Venous Pressure

We report on a first case of bone marrow metastasis by dedifferentiated liposarcoma. A 39-year-old male diagnosed with retroperitoneal dedifferentiated liposarcoma underwent surgery and postoperative radiotherapy. In spite of radiotherapy, his whole-body positron emission tomography showed high uptake in multiple bone metastasis. With thrombocytopenia, bone scan suggested bone marrow involvement. After bone marrow biopsy, bone marrow metastasis by dedifferentiated liposarcoma was finally confirmed. He was administered with systemic chemotherapy with doxorubicin. But he died 3 months after chemotherapy due to disease progression. This case revealed that in a patient of unexplained cytopenia with dedifferentiated liposarcoma, bone marrow metastasis should be in consideration.
Adult ; Biopsy ; Bone Marrow* ; Disease Progression ; Doxorubicin ; Drug Therapy ; Humans ; Liposarcoma* ; Male ; Neoplasm Metastasis ; Positron-Emission Tomography ; Radiotherapy ; Thrombocytopenia

PURPOSE: We report the results of replantations which was intentionally delayed for a certain period of time in patients with an amputation of multiple digits, both hands or the single digit presented at night. MATERIALS AND METHODS: Two staged intentianlly delayed replantations were performed in twenty patients. Three patients had amputations of four or more fingers, two had bilateral hand amputations and fifteen had a single digit amputation. RESULTS: The mean warm ischemic time was 3 hours and 58 minutes. The mean cold ischemic time was 2 hours and 36 minutes for the first operation, and 15 hours and 13 minutes for the second operation. Twenty digits out of 28 digits (85%) survived completely. At the mean follow-up of months, functional results according to Chen's criteria were rated as excellent in six patients, good in eight, and fair in five. CONCLUSION: When the patients had multiple finger amputations, bilateral hand amputations or presented late at night, intentional delay of the replantation also provide satisfactory outcomes.
Amputation ; Cold Ischemia ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Intention ; Replantation ; Warm Ischemia

Eaton Lambert Syndrome (ELS) is a disorder of neuromuscular transmission. The defect of neuromuscular transmission is due to decrease in the release of acetylcholine quanta from nerve terminal. This syndrome is frequently associated with bronchogenic carcinoma. The diagnosis is established by electromyography, which characteristically shows 1) low amplitude of evoked compound muscle potential to a single supramaximal stimulus on nerve, 2) significant decremental response at low rates of stimulation 3) marked incremental response at high rates of stimulation. Our patient is 52year old man with dyspnea, coughing and muscle weakness of proximal lower limbs. He has small cell lung cancer and associated with ELS, Superior vena cava syndrome and has metastatic lesion on right supraclavicular lymph node confirmed by pathology. Metastatic mass and SVC syndrome are marked improved following chemotherapy and radiotherapy, however follow up EMG finding does not improved. We are here reporting one case which considered compatible for ELS, with a few elementary reviewed literatures.
Acetylcholine ; Carcinoma, Bronchogenic ; Cough ; Diagnosis ; Drug Therapy ; Dyspnea ; Electromyography ; Follow-Up Studies ; Humans ; Lambert-Eaton Myasthenic Syndrome* ; Lower Extremity ; Lymph Nodes ; Muscle Weakness ; Pathology ; Radiotherapy ; Small Cell Lung Carcinoma* ; Superior Vena Cava Syndrome

OBJECTIVE: The purpose of this study was to investigate the serum and synovial IGF-I levels in 30 patients with knee osteoarthritis (OA) and the relationships among the IGF-I level, pain intensity and severity of knee OA. METHOD: Thirty patients who met criteria of knee OA of American Rheumatology Association participated in this study. Samples of serum and synovial fluid were obtained from all patients. The levels of IGF-I were determined by radioimmunoassay (RIA). The intensity of pain was assessed by Pain Rating Score (PRS) and Visual Analogue Scale (VAS). The severity of knee OA was evaluated by Kellgren's grade of knee OA. RESULTS: The mean serum and synovial IGF-I level was 231.66+/-86.15 ng/ml and 122.42+/-37.79 ng/ml, respectively. There was no correlation between pain intensity and IGF-I levels. Neither was there statistically significant correlation between Kellgren's grade and IGF-I levels. CONCLUSION: The serum and synovial IGF-I levels were not related with pain intensity and severity of knee OA.
Humans ; Insulin-Like Growth Factor I* ; Knee* ; Osteoarthritis, Knee* ; Radioimmunoassay ; Rheumatology ; Synovial Fluid

OBJECTIVE: To assess the effect of vitamin K2 in addition to risedronate on postmenopausal osteoporosis METHOD: We enrolled 21 postmenopausal osteoporosis women (age: 65.2+/-7.8 years). Ten subjects received risedronate (35 mg, weekly) and vitamin K2 (45 mg, daily) and eleven subjects only received risedronate. They all received calcium citrate 2,130 mg and vitamin D 600 IU daily. The duration of treatment was 7.7+/-1.4 months. Bone mineral density (BMD) of lumbar spine and both femurs, serum osteocalcin and urine deoxypyridinoline were examined at baseline and after treatment. RESULTS: After treatment, BMD, serum osteocalcin and urine deoxypyridinoline were improved in each group but there was no statistical difference between the groups. CONCLUSION: There was no evidence of the benefit of vitamin K2 in addition to risedronate in bone metabolism on postmenopausal osteoporosis.
Bone Density ; Calcium Citrate ; Female ; Femur ; Humans ; Metabolism ; Osteocalcin ; Osteoporosis, Postmenopausal* ; Risedronate Sodium ; Spine ; Vitamin D ; Vitamin K 2* ; Vitamins*

OBJECTIVE: To evaluate effects of short stretch bandage and electrical stimulation therapy (EST) for the complex regional pain syndrome (CRPS) in hemiplegic patients METHOD: 10 hemiplegic CRPS patients after stroke or traumatic brain injury were included in the study. We established CRPS from clinical symptoms and triphasic bone scan. Short stretch bandage was applied on affected limb and changed every 24 hours for 2 weeks. EST was tried for 10 minutes twice per day. It was applied at finger and wrist flexor muscles. We measured hand volume of pre-and posttreatment using hand volumeter. Also compared pre-and posttreatment pain-free range of motion (ROM) of metacarpophalangeal (MCP) joint and third proximal interphalangeal (PIP) joint circumference. RESULTS: Mean difference of hand volume between the affected and the unaffected prior to treatment was 20.5+/-4.9 ml (7.9+/-2.3%). After treatment, mean volume change was 15.5+/-4.9 ml (5.5+/-1.8%) (p<0.05). Mean change of pain-free ROM was 8.0+/-4.8 degree (10.9+/-7.1%), mean change of PIP joint circumference was 3.1+/-1.4 mm (5.9+/-2.4%) (p<0.05). CONCLUSION: Short stretch bandage and EST complex therapy is effective for the reduction of paralyzed hand edema and pain in hemiplegic CRPS patients. However further control study is required.
Bandages* ; Brain Injuries ; Edema ; Electric Stimulation Therapy* ; Electric Stimulation* ; Extremities ; Fingers ; Hand ; Humans ; Joints ; Muscles ; Range of Motion, Articular ; Stroke ; Wrist