The development of tophi in th absence of prior episodes of gauty arthritis is unusual. We report a case of extensive tophi in a 31 year-old man, whose initial skin lesion had started without arthritis.
Adult ; Arthritis ; Gout* ; Humans ; Skin

We Reviewed 10 hypertensive children with pheochromocytoma retrospectively and the following results were obtained. 1) Out of 10 patients, 7 were male and 3 female. Age ranged from 5.5 years to 13.8 years and their median age was 9.9 years. 2) They complained of sweating, lethargy, headache. or chest pain and so on. Hypertension were noticed in all patients. Heart murmurs were detected in 7 patients and hypertensive retinopathy in 70%. 3) The three cases arised at extraadrenal gland and bilaterality was seen in 3 patients. In the view of diagnosis, abdominal sonography, computerized tomography and urine VMA test revealed the sensitivity of 100%. But MIBG scan showed 60% in sensitivity. 4) Waiting for operation, their hypertension were controlled by adrenergic blockers or calcium channel blockers. They received tumorectomy successfully except one who was in hypertensive state after operation and followed up through OPD. In conclusion high suspicion for the existence of pheochromocytoma from the clinical manifestations should be entertained in any pediatric patients and biochemical and imaging studies were mandatory. Furthermore, for the accurate localization of tumors, several imaging studies should be collaborated.
3-Iodobenzylguanidine ; Adrenergic Antagonists ; Calcium Channel Blockers ; Chest Pain ; Child* ; Diagnosis ; Female ; Headache ; Heart Murmurs ; Humans ; Hypertension ; Hypertensive Retinopathy ; Lethargy ; Male ; Pheochromocytoma* ; Retrospective Studies ; Sweat ; Sweating

No abstract available.
Child* ; Humans ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux*

Evaluations of residual renal function and the therapeutic effectiveness in renal tuberculosis have largely been dependent on intravenous pyelogram or Contrast-CT scan, even though, exact renal function are not evaluated with there methads. 99mTc-DMSA is a radiopharmaceutical that is trapped in the functioning tubular cells of the kidney and therefore, quantitative renal function could be evaluoted by ineasuring the counts of renal radioactivity and concomittant evaluation of renal morphology could be passible with the analog imapes of the radioactivity. The authors retrospectively analyzed 99mTc-DMSA scans of 75 kidndys of 67 patients with confirmed renal tuberculosis. We classified the morphologies of tuberculous kidneys as 6 types. We classified the morphologies of tuberculous kidneys as 6 types such as the type with small cortical defect, with parenchymal ulcerocavernous lesions, ulcerocavernous fistula to pelvis, mass-like defects, contracted kidney with ureter visualization, and the type with nonvisualization of kidney, corresponding to the characters of renal tuberculous pathogenesis with abscess formation, ulcerocavernous fistula, and fibrosis, and correspondings to the renal anatomy with parenchyma, and pelvocalyceal collecting system. Their mean residual renal functions measured with 99mTc-DMSA uptake rates were 19.0%, 18.4%, 7.9%, 12%, 4.1%, 3.4% respectively.
Abscess ; Fibrosis ; Fistula ; Fluspirilene ; Humans ; Kidney ; Pelvis ; Radioactivity ; Retrospective Studies ; Succimer* ; Technetium Tc 99m Dimercaptosuccinic Acid ; Tuberculosis, Renal* ; Ureter

This study was carried out to analyse the economic feasibility of EPR. A hospital with 500 beds under the construction was selected for this study. The economic effect was performed with cost-benefit analysis for 5 years from the year 1998 to 2002. The results of this study were as follows; The economic effect of EPR was classified into direct benefit, value acceleration, and value linking. Each factor was applied and analyzed step by step. In the analysis including only direct benefit, the net present value and the ratio of benefit to cost were minus 82,920,000 won and 0.8. With this traditional cost-benefit analysis alone, the EPR in hospital can be regarded as very unprofitable. However, when value acceleration was added, the net present value and the ratio of benefit to cost rose to 748,637,000 won and 2.7 respectively. Moreover, when value linking was added, the net present value and the ratio of benefit to cost were 1,473,162,000 won and 4.3, respectively. In the results of this study, as EPR has only direct benefit, EPR can be regarded as unprofitable project. However, when value acceleration and value linking were added, EPR can be profitable project.
Acceleration ; Cost-Benefit Analysis ; Humans

Intravenous administration of high dose of fentanyl is gaining wide popularity as the sole anesthetic agent for patients undergoing cardiac surgery because of its favorable characteristics such as, simplicity, stable hemodynamics and supression or modification of stress response to surgery. But some investigators reported the necessity of supplementary anesthetic agent in addition to fentanyl to maintain hemodynamic stability during the surgical procedure. Therefore, we measured the heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP), and rate pressure product(RPP) at induction, tracheal intubation, skin incision, and sternotomy time to evaluate the cardiovascular responses to surgical procedure under fentanyl-O2 anesthesia on 12 patients with acquired valvular heart disease. The patients were anesthetized with a loading dose (30ug/kg fentanyl for induction and 1.5ug/ kg/min until sternotomy) followed by continuous infusion of fentanyl (0.3pg/kg/min until the end of cardiopulmonary bypass.) The patients required total doses of 108+/-4.6ug/kg fentanyl for the entire operation. These measurements were compared with control data (before induction). The results were as followings: 1) During induction (infusion of fentanyl 30ug/kg), HR, SBF, DBP, MAP, and RPP revealed no significant change compared with control data. 2) During intubation and skin incision, HR, SBP, DBP, MAP, and RPP slightly increased but were not statistically significant (p>0.05) 3) During sternotomy, SBP increased from 119.8+/-16.36 torr to 136.5+/-15.22 torr, DBP increased from 79.1+/-12.76 torr to 95.4+/-10.87 torr, MAP increased from 99.4+/-13.96 torr to 115.5+/-12.70 torr, and RPP increased from 10929+/-2206 torr.beats/min to 13889+/-2865 torr. beats/min (p<0.05). HR increased from 90.7+/-8.71 beats/min to 100.2+/-13.79 beats/min, but was not statistically significant(p> 0.05). 4) One of the patients had recall of the sternotomy and spreading of the chest with the sternal retractor. These data demonstrate that anesthetic doses of fentanyl and O produce minimal change in cardiovascular dynamics during the surgical procedures except sternotomy time. Our findings suggest that fentanyl-O2 anesthesia may be an attractive anesthetic technique in patients with valvular heart disease undergoing valve replacement operations but, will be needed considerations about infusion method, dosage of fentanyl and use of supplementary anesthetic agent according to patients conditions.
Administration, Intravenous ; Anesthesia* ; Anesthetics ; Fentanyl* ; Heart ; Heart Valve Diseases ; Hemodynamics ; Humans ; Intubation ; Methods ; Research Personnel ; Skin ; Sternotomy ; Thoracic Surgery ; Thorax

Acoustic stimulation test(AST), is currently being used as an alternative tool of nonstress test (NST). However, there are no standard guideline for analysis of AST. Computerized numerical analysis of AST would be helpful for development of diagnostic criteria of AST. Fifty-one normal pre-term pregnancies entered to this study after conventional 20-minutes NST and 10-minutes AST. Acoustic stimulations were performed using Fetal Acoustic Stimulator (Model 146, Corometrics, US). We analyzed the FHR response after acoustic stimulation using our on-line computerized FHR analysis system, HYFM-I & II software. The changes of loss of signal, baseline FHR, variability, number of fetal movements, and number of FHR accelerations were analyzed numerically. The loss of signal was increased about 2 fold(122.61%). The baseline FHR was increased from 144.57bpm to 156.81bpm(8.5%) after acoustic stimulation. Number of fetal movements was increased about 2 fold(from 2.1 to 4.12/10 minutes). FHR variability was also increased from 17.81 bpm to 26.37 bpm. After AST, number of FHR accelaration was increased 55.47%(10sec 10bpm) and 68.42%(15sec 15bpm), respectively. In this study, we acrumulated elemental FHR data using computerized system after AST. These data would be helpful in the accurate analysis of AST and also enable us to develop the objective interpretation system for AST.
Acceleration ; Acoustic Stimulation* ; Acoustics* ; Female ; Fetal Heart* ; Fetal Movement ; Heart Rate, Fetal* ; Pregnancy ; Pregnancy*

To examine the expressed gene profile during encystation of Acanthamoeba castellanii Castellani, we used differentially expressed gene (DGE) screening by RT-PCR with 20 sets of random primers. From this analysis, we found that approximately 16 genes showed upregulation during encystation. We chose 6 genes, which had relatively higher expression levels, for further investigation. Based on homology search in database, DEG2 showed 55% of similarity with xylose isomerase, DEG9 showed 37% of similarity with Na P-type ATPase, and DEG14 showed 77% of similarity with subtilisin-like serine proteinase. DEG3 and DEG26 were identified as hypothetical proteins and DEG25 exhibited no significant similarity to any known protein. Encystation of Acanthamoeba has been suggested to be a process to resist adverse environmental or nutritional conditions. Further characterization studies of these genes may provide us with more information on the encystation mechanism of Acanthamoeba.
Acanthamoeba castellanii/*genetics/*growth & development ; Amino Acid Sequence ; Animals ; *Gene Expression Profiling ; Gene Expression Regulation ; *Life Cycle Stages ; Molecular Sequence Data ; Protozoan Proteins/*genetics ; Reverse Transcriptase Polymerase Chain Reaction ; Sequence Alignment ; Sequence Homology, Amino Acid ; Up-Regulation

Intraspinal tumors in children are of especially interest to orthopaedic surgeons for two reasons; First, musculoskeletal abnormalities, are often treated for long periods before the correct diagnosls is suspected; Second, important orthopaedic problems are encountered in almost everychild treated for intraspinal tumor, not only during the immediate postoperative management but all through subsequent growth. We report a case presentation of the intraspinai tumor, dermoid cyst, successfully treated with operation.
Child ; Dermoid Cyst ; Humans ; Musculoskeletal Abnormalities ; Surgeons

No abstract available.
Child* ; Fistula* ; Humans