No abstract available.
Neoplasm Metastasis*

The errors were discovered after publication: missing references and missing words.

Wernickes encephalopathy is an illness characterized by mental disturbance, paralysis of eye movements and ataxia of gait. The specific factor for most, if not all, of these symptoms is a deficiency of thiamine. Wemicke's encephalopathy mostly occurs in developing countries when the patient is in a state such as nutritionally deprived state, anorexia nervosa, stomach cancer, long duration of parenteral nutrition. Wernickes encephalopathy was recognized as a complication of hyperemesis of pregnancy in 1914. Unfortunately, cases continue to occur. We present here a case of Wernickes encephalopathy in a 36-year-old pregnant woman. We discuss the clinical picture, histopathology, radiology, therapeutic management and prognosis with review of the literature.
Adult ; Anorexia Nervosa ; Developing Countries ; Eye Movements ; Female ; Gait Ataxia ; Humans ; Hyperemesis Gravidarum* ; Hyperthyroidism* ; Paralysis ; Parenteral Nutrition ; Pregnancy ; Pregnant Women ; Prognosis ; Radiation Oncology ; Stomach Neoplasms ; Thiamine ; Wernicke Encephalopathy*

Recent development in thepolymerase chain reaction (PCR) has brought an extraordinary opportunity for the rapid detection of M. tuberculosis in clinical specimens for the diagnosis of tuberculosis. Pneumoconiosis is a sort of pulmonary fibrosis consequent to inhalation of the respirable dust. The association between pulmonary tuberculosis and pneumoconiosis is well recognized. There is a 10-fold increase in the tuberculosis risk among the workers who have pneumoconiosis demonstrated by chest roentgenogram. The physicians managing the patients with pneumoconiosis have to maintain a high index of suspicion for the development of mycobacterial infection, since the diagnosis of tuberculosis is often difficult. Mycobacterium tuberculosis is a very slow growing organism and acid-fast bacillus (AFB) staining frequently shows false negative results, and therefore PCR would be a very rapid, easy and sensitive diagnostic method for the diagnosis of Mycobacterium tuberculosis in pneumoconiotic patients. To compare the PCR method with the conventional methods in diagnosing Mycobacterium tuberculosis in sputum, we used the sputa of 115 pneumoconiosis patients in Munkyeong Cheil Hospital. Of 32 pulmonary tuberculosis in the pneumoconiosis patients, 29 were PCR positive and were higher than 28, 20 positive by culture and AFB stain. Overall sensitivity, specificity, and which were 90.6, 91.5 % respectively for the PCR assay, 87.5, 100 % for the culture method ; 62.5, 98.7 % for the AFB stain. The PCR assay is a rapid, efficient, sensitive method which can detect M. tuberculosis directly in pneumoconiosis patients, and further study should be followed for the development of the easier method.
Bacillus ; Diagnosis* ; Dust ; Humans ; Inhalation ; Mycobacterium tuberculosis ; Pneumoconiosis ; Polymerase Chain Reaction* ; Pulmonary Fibrosis ; Sensitivity and Specificity ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary*

At Orthopedic Department of Kyung Hee University Hospital, we performed 20 total knee replacements in 12 patients who had rheumatoid arthritis and 18 total knee replacements in 13 patients who had osteoarthritis during the period from August 1982 to May 1986. All patients were female. Comparative analysis was done between the two groups with a follow-up period ranging from 1 year to 4 years 8 months, average being 2 years and 3 months. The average age of rheumatoid arthritis patients was 10 years younger than osteoarthritis patients. The improvement of range of knee motion after total knee replacement was greater in rheumatoid arthritis comparing to osteoarthritis. Preoperative flexion contracture was more severe in rheumatoid arthritis than osteoarthritis, but after total knee replacement the average degree of flexion conrcacture was no significant difference between two groups. The average of preoperative Hospital Surgery Knee Rating Scale was low in rheumatoid arthritis group than in osteoarthritis group, but postoperative Knee Rating Scale was similar in both groups. It seems that the problem of wound was more frequent in rheumatoid arthritis than in osteoarthritis.
Arthritis, Rheumatoid ; Arthroplasty, Replacement, Knee ; Contracture ; Female ; Follow-Up Studies ; Humans ; Knee ; Orthopedics ; Osteoarthritis ; Wounds and Injuries

At Orthopaedic Department of Kyung Hee University Hospital, we performed 50 total knee replacement in 32 patients who had suffered from rheumatoid arthritis during the period from Aug. 1982 to Dec. 1987. We studied these cases and compared the results of total knee replacement surgery in preoperative ambulatory patients(group I ) with those in preoperative non-ambulatory patients(group II ). 1. Preoperatively, 19 patients were able to walk, and 13 patients were unable to walk. 2. 7 patients of bilateral TKR(36.8%) were included in group I, and 11 patients (86.9%) in group II. 3. The improvement of range of motion after TKR was greater in group II (34 degrees) and in group I, average postoperative range of motion was similar to the average preoperative ROM. 4. Flexion contracture was more markedly improved in group II. 5. In group I, the average preoperative knee rating score by Hospital for Special Surgery rating system was 38.8 and improved to 93.4 postoperatively. In group II, the average preoperative knee rating score was 27.4 and improved to 85.7 postoperatively. 6. Postoperatively most of the patients were able to walk without support except one cases of infection(group I ) and the other who had severe rheumatoid involvements in other joints (group II ). 7. Preoperative evaluation for involvements of cervical spine and surrounding soft tissue structure was necessary endotracheal anesthesia. 8. There was 2 cases of complications in group I, and 4 cases in group II.
Anesthesia, Endotracheal ; Arthritis ; Arthritis, Rheumatoid ; Arthroplasty, Replacement, Knee ; Contracture ; Humans ; Joints ; Knee ; Range of Motion, Articular ; Spine

No abstract available.
Alcoholics* ; Humans ; Skin*

Todays, remnant split-thickness skin graft is stored for graft failure or for delayed grafting. Refrigerated skin is usually stored for 3 weeks, after which, cellular respiration ceaces. Even though the refrigerated skin can be used before 3 weeks after harvest, the success rate of the skin graft is usually lower than in case of fresh skin. One of the most reliable explanations is multiplication of microorganisms on the stored skin, that is, the more microorganisms on the refrigerated skin, the less the success rate of grafts. For this reasons, some kind of antibiotics have been used for storage of the split-thickness skin piece. But there is no report about the effect of antibiotics on stored skin. We want to know the effect of the antibiotics on stored skin. For this purpose, we did three experiments for qualititative bacteriology of refrigerated skin. Experiment 1 was qualititative identification of microorganisms colonizing split-thickness skin after 2 weeks storage in low temperature, and sensitivity tests for identified microorganisms. On the basis of experiment 1, the proper antibiotics were selected and samples of split-thickness skin were stored using this antibiotics. At 2 weeks after storage in low temperature, samples of split-thickness skin were cultured for identification of bacterial growth. This is experiment 2. Experiment 3 is histologic examination of the split-thickness skin involved in experiment 1 and 2.In the experiment 1, we found five kinds of microorganisms in 9 out of 30 split-thickness skin samples. The most common microorganism was coagulase negative Staphylococcus which was found in 4 samples. Through the antibiotics sensitivity test, teicoplanin was selected as the most proper antibiotics. In experiment 2, we could not find any microorganisms in 30 split-thickness skin samples. In experiment 3, there were no histologic differences in the split-thickness skin samples whether antibiotics were used or not. Through these results, we have confirms that split-thickness skin pieces are more safely stored using proper antibiotics.
Anti-Bacterial Agents* ; Bacteriology ; Cell Respiration ; Coagulase ; Colon ; Skin* ; Staphylococcus ; Teicoplanin ; Transplants

PURPOSE: Measurement of colon transit time is well-known physiologic study for patients with chronic constipation. But information we get from it is frequently inconsistent with patient's complaint. This study was designed to ascertain the actual significance of that measurement. METHODS: The subjects included two groups of patients with chronic constipation. One group consists of 32 patients(group A), The other group 36 patients(group B). Colon transit time study and defecographic examinations were done using previously described methods. But the former study was a little modified in group A, in which sodium phosphate enema was given at the previous day of oral intake of radio-opaque markers. Findings of colon transit time study and their relations to the defecographic results were compared with each other. RESULTS: As for the 5th day-findings of colon transit time, 6 cases(18.7%) were abnormal in group A and 3 cases(8.4%) in group B(statistically not different). As for the 3rd day-findings, 15 cases(46.9%) were abnormal in group A and 7 cases(19.5%) in group B( statistically different, p=0.0163). Defecographic findings showed 7 cases(21.9%) of outlet obstruction pattern in group A and 9 cases(25%) in group B. Correlations between these findings and those of colonic transit time studies were not proven statistically. CONCLUSION: Colon transit time study with single marker bolus and the 5th day photography technique was considered not to reflect the actual conditions of patients with chronic constipation. But sodium phophate enema, given to patients before starting the study, seemed to enhance the accuracy of study.
Colon* ; Constipation* ; Enema ; Humans ; Photography ; Sodium ; Time and Motion Studies*

Narcolepsy is a sleep disorder, which is characterized by excessive daytime sleepiness (EDS) that is typically associated with cataplexy, sleep fragmentation and other REM sleep-related phenomenon such as sleep paralysis and hypnagogic hallucination. Narcoleptic symptoms can be developed from various medical or neurological disorders. A 17-year-old male patient admitted for the evaluation of EDS which started three-month ago. He slept more than 18 hours a day with cataplexy and hypnagogic hallucination. He was obese with body mass index (BMI) of 30.4 kg/m2. After admission he was newly diagnosed to the thyrotoxicosis. T3 391.2 ng/dL (60-181), free T4 4.38 ng/dL (0.89-1.76), TSH <0.01 microIU/mL (0.35-5.5) were measured. His pulse rate ranged 70-90 beats per minute and blood pressure ranged 150/100-120/70 mmHg. Polysomnography revealed many fragmentations in sleep with many positional changes (81 times/h). Sleep onset latency was 33.5 min, sleep efficiency was 47.9%, and REM latency from sleep onset was delayed to 153.6 min. REM sleep percent was increased to 27.1%. Periodic limb movement index was 13.4/h. In the multiple sleep latency test (MSLT), average sleep latency was 0.4 min and there were noted 3 SOREMPs (Sleep Onset REM sleep period) on 5 trials. We couldn't discriminate the obvious sleep-wake pattern in the actigraph and his HLA DQB1 *0602 type was negative. His thyroid function improved following treatment with methimazole and propranolol. Vital sign maintained within normal range. Cataplexy was controlled with venlafaxine 75 mg. Subjective night sleep continuity and PLMS were improved with clonazepam 0.5 mg, but the EDS were partially improved with modafinil 200-400 mg. Thyrotoxicosis might give confounding role when we were evaluating the EDS, though sleep fragmentation was one of the major symptoms of narcolepsy, but enormous amount of it made us think of the influence of thyroid hormone. The loss of sleep-wake cycle, limited improvement of EDS to the stimulant treatment, and the cataplexy not supported by HLA DQB1 *0602 should be answered further. We still should rule out idiopathic hypersomnia and measuring CSF hypocretin level would be helpful.
Adolescent ; Benzhydryl Compounds ; Blood Pressure ; Body Mass Index ; Cataplexy ; Clonazepam ; Cyclohexanols ; Extremities ; Hallucinations ; Heart Rate ; HLA-DQ beta-Chains ; Humans ; Hypersomnolence, Idiopathic ; Intracellular Signaling Peptides and Proteins ; Male ; Methimazole ; Narcolepsy ; Nervous System Diseases ; Neuropeptides ; Polysomnography ; Propranolol ; Reference Values ; Sleep Deprivation ; Sleep Paralysis ; Sleep, REM ; Thyroid Gland ; Thyrotoxicosis ; Vital Signs ; Orexins ; Venlafaxine Hydrochloride