Factitious fever has been a rare cause of fever of unknown origin. We herein report a case of a young soldier, who presented with persistent fever of unusual pattern and bullae on both palms. After numerous investigations had excluded organic diseases, factitious fever was diagnosed with measurement of the freshly voided urine temperatures and body temperatures while directly observed. Biopsy of skin lesions revealed friction blister. Early recognition of this cause of fever is needed to avoid the unnecessary investigation and prolonged hospitalization.
Biopsy ; Blister ; Body Temperature ; Factitious Disorders ; Fever of Unknown Origin ; Fever* ; Friction ; Hospitalization ; Humans ; Military Personnel ; Skin

OBJECTIVE: This study was designed to investigate the effects of long term clozapine treatment on changes of weight, glucose and cholesterol levels and their relation to clozapine and its metabolite blood levels in outpatients with chronic schizophrenia. METHODS: Among outpatients diagnosed with schizophrenia according to the DSM-IV criteria, 19 consented subjects receiving long-term treatment of clozapine, its dosage level had been constant for last one month, were selected for the study. The serum level of clozapine, metabolites as well as body weight, BMI, glucose level, cholesterol level, insulin, and c-peptide were gathered and analyzed before and after the use of clozapine. RESULTS: Glucose increase after clozapine treatment was statistically meaningful but it was due to two patients who got diagnosed with diabetes. Glucose levels of other patients are all below 120 mg/dl. Cholesterol level showed significant increase after the treatment. Weight and BMI changes over the treatment are not statistically meaningful overall, but 8 out of 17 showed more than 7% increase. The changes of weight and BMI were positively correlated with weight and BMI of pre-treatment. Mean serum level of clozapine, metabolites were not correlated with glucose, cholesterol level, insulin, and C-peptide. CONCLUSIONS: Results indicate that long term treatment of clozapine is correlated with increase of glucose and cholesterol level and weight gain of the patients. Clinicians should be aware of the potential risks of diabetes, hyperlipidemia, and weight gain in patients taking clozapine.
Blood Glucose* ; Body Mass Index ; Body Weight* ; C-Peptide ; Cholesterol ; Clozapine* ; Diagnostic and Statistical Manual of Mental Disorders ; Glucose ; Humans ; Hyperlipidemias ; Insulin ; Outpatients ; Schizophrenia* ; Weight Gain

Syphilitic aortitis, passing out of our mind, is the most common systemic manifestation of late syphilis and is more typically manifestated 10 to 30 years afterward. This diagnosis has been made less frequently in recent decades than in the past, because of public awareness of syphilis and screening program. Treponema pallidum lodge within vasa vasorum, especially ascending aorta cause the histologic changes, which are responsible for the three major forms of symptomatic cardiovascular syphilis, including aortic insufficiency, coronary ostial stenosis, and aortic aneurysm. We experienced a case of syphilitic aortitis with aortic insufficiency and aortic aneurysm in a 48-year-old man presented with progressive dyspnea. Echocardiography, chest CT, and later surgical correction were performed and surgical specimen revealed the histologic finding consistent with syphilitic aortitis. We report this case with a review of the literature.
Aorta ; Aortic Aneurysm* ; Aortitis ; Constriction, Pathologic ; Diagnosis ; Dyspnea ; Echocardiography ; Humans ; Mass Screening ; Middle Aged ; Syphilis ; Syphilis, Cardiovascular* ; Tomography, X-Ray Computed ; Treponema pallidum ; Vasa Vasorum

Lung volume reduction surgery, resecting the most severely affected regions of emphysema, was designed to improve quality of life for selected patients with severe emphysema. We report a case of a 72 year old severe emphysema patient who received bilateral lung volume reduction surgery and showed marked improvement of quality of life and lung function.
Aged ; Emphysema* ; Humans ; Lung* ; Pneumonectomy* ; Quality of Life

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in the neonatal population. The aim of this study is to evaluate surgical indication and prognostic factors of NEC. Clinical data of seventy patients, diagnosed as NEC between January 2000 & January 2007, were reviewed retrospectively. Fifty-seven patients had medical treatment and 7 of them died. Thirteen patients who presented with pneumoperitoneum on plain abdominal film or were refractory to medical treatment received surgical treatment, and 5 of them died. All the expired 12 patients weighed less than 2500g. Twenty out of seventy patients showed thrombocytopenia, and 11 patients of them died. The finding of pneumoperitoneum and thrombocytopenia could be the most important surgical indication. Prematurity, low birth weight and thrombocytopenia were related to a bad prognosis. NEC patients who presents with these findings must be considered for close observation and intensive care.
Emergencies ; Enterocolitis, Necrotizing ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Pneumoperitoneum ; Prognosis ; Retrospective Studies ; Thrombocytopenia

BACKGROUND: Intra-abdominal hypertension (IAH) is defined as the presence of either an intra-abdominal pressure (IAP) > or = 12 mmHg or an abdominal perfusion pressure (APP = mean arterial pressure - IAP) < or = 60 mmHg. Abdominal compartment syndrome (ACS) is defined as the presence of an IAP > or = 20 mmHg together with organ failure. The purpose of this study was to investigate the prevalence of IAH and ACS on the day of admission and the effects of these maladies on the prognosis of critically ill patients in the ICU. METHODS: At the day of admission to the ICU, the IAP was recorded by measuring the intravesicular pressure via a Foley catheter. The APACHE II and III scores were checked and SAPS II was also scored during the days the patients were in the ICU. The primary end point was the prevalence of IAH and ACS at the day of admission and the correlation between them with the 28-days mortality rate. The measurement of IAP continued until the 7th day or the day when the patient was transferred to the general ward before 7th day, unless the patient died or a Foley catheter was removed before 7th day. Patients were observed until death or the 28th day. RESULTS: A total of 111 patients were enrolled. At the day of admission, the prevalence of IAH and ACS were 47.7% and 15.3%, respectively and the mean IAP was 15.1+/-8.5 mmHg. The rates of IAH for the survivor and the non-survivor groups were 56.5% and 71.4%, respectively, and these were not significantly different (p=0.593). Yet the rates of ACS between these two groups were significantly different (4/62, 6.5% vs. 13/49, 26.5%; Odds Ratio = 5.24, 95% CI = 1.58-17.30, p=0.004). CONCLUSION: In the present study, the prevalence of IAH was 47.7% and the prevalence of ACS was 15.3% on the day of admission. ACS was associated with a poor outcome for the critically ill patients in the ICU.
Abdomen ; APACHE ; Arterial Pressure ; Catheters ; Compartment Syndromes ; Critical Care ; Critical Illness* ; Humans ; Hypertension ; Intensive Care Units* ; Critical Care* ; Intra-Abdominal Hypertension* ; Mortality ; Odds Ratio ; Patients' Rooms ; Perfusion ; Prevalence ; Prognosis* ; Survivors

OBJECTIVE: To investigate the ultrasonographic findings in knee OA patients and to examine the possible causes of pain in osteoarthritis by ultrasonography. METHODS: Ultrasonography was performed with 7.5 MHz linear probe in 64 knee OA patients who fulfilled the ACR criteria. All patients were graded according to the Kellgren-Lawrence grades and then classified into group 1 (K/L I and II) and Group 2 (K/L III and IV). Also WOMAC score, BMI, laboratory finding (ESR, CRP) were checked. Ultrasonographic findings was examined; effusion, thickening of synovium, vertical length of medial and lateral osteophyte (longitudinal view), length of capsular distension (medial longitudinal view), evidence of bursitis and articular cartilage. RESULTS: 50.0% of patients had effusion, among whom 68.7% patients also had synovial thickening. In all patients, the severity of pain was correlated with 4 variables; the presence of effusion, disease duration, the length of medial osteophyte, the length of capsular distension (r=0.279, r=0.415, r=0.537, r=0.608, respectively, p<0.05). The length of medial osteophyte, the degree of capsular distension and disease duration were significantly correlated with WOMAC pain score in Group 1 (p<0.05). After multiple regression analysis, the length of medial osteophyte alone had correlation with the pain severity in Group 1 (r2= 0.396 p<0.05) and the only length of capsular distension was significantly correlated with WOMAC pain score in Group 2 (r=0.609, p<0.05). CONCLUSION: The length of osteophyte may be more related with pain severity in mild cases (K/L score I and II) while capsular distension could be an important factor causing knee pain in more advanced knee OA (K/L score III and IV).
Bursitis ; Cartilage, Articular ; Humans ; Joint Capsule ; Knee Joint* ; Knee* ; Osteoarthritis ; Osteoarthritis, Knee* ; Osteophyte ; Synovial Membrane ; Ultrasonography*

OBJECTIVE: To investigate the relationship between serum trace element levels with disease activity in Korean patients with rheumatoid arthritis (RA). METHODS: The serum levels of zinc, copper and ceruloplasmin were measured by inductively coupled plasma atomic emission spectrometers in 80 patients th , 26 osteoarthritis (OA), and 30 healthy controls (HC). We also measured the levels of zinc and copper in the synovial fluid (SF) of patients with RA. We nvestigated the clinical parameters simultaneously obtained at sampling of serum and analyzed correlation between serum levels of trace elements and disease activity in RA. RESULTS: In RA, the levels of serum zinc were significantly lower than that of HC, and thelevels of serum copper and ceruloplasmin were significantly higher than those of HC. In active RA, the levels of serum zinc were more decreased , and the levels of serum copper and ceruloplasmin were more increased than those of inactive group of RA. The levels of both copper and ceruloplasmin showed positive correlation with the levels of serum ESR and CRP. On the other hand, the levels of serum zinc showed negative correlation with the levels of serum ESR and CRP. CONCLUSION: Serum zinc levels are significantly lower and serum copper levels significantly higher in patients with active RA and these trace elements were useful parameter of disease activity in RA.
Arthritis, Rheumatoid* ; Ceruloplasmin ; Copper* ; Hand ; Humans ; Osteoarthritis ; Plasma ; Synovial Fluid ; Trace Elements ; Zinc*

Background: There is increasing interest in the quality of health care and considerable efforts are being made to improve it. Rheumatoid arthritis (RA) is a disease that can result in favorable outcomes when appropriate diagnosis and treatment are provided. However, several studies have shown that RA is often managed inappropriately. Therefore, the Korean College of Rheumatology aimed to develop quality indicators (QIs) to evaluate and improve the health care of patients with RA. Methods: Preliminary QIs were derived based on the existing guidelines and QIs for RA. The final QIs were determined through two separate consensus meetings of experts. The consensus was achieved through a panel of experts who voted using the modified Delphi method. Results: Fourteen final QIs were selected among 70 preliminary QIs. These included early referral to and regular follow-up with a rheumatologist, radiographs of the hands and feet, early initiation and maintenance of disease-modifying anti-rheumatic drug (DMARD) therapy, periodic assessment of disease activity, screening for drug safety and comorbidities,including viral hepatitis and tuberculosis before biologic DMARD therapy, periodic laboratory testing, supplementation with folic acid, assessment of the risk for cervical spine instability before general anesthesia, patient education, and specialized nurse. Conclusion These QIs can be used to assess and improve the quality of health care for patients with RA.

OBJECTIVE: To evaluate the fate of abstracts presented at scientific meetings of the Korean College of Rheumatology (KCR). METHODS: This study examined the abstracts presented at annual meetings of the KCR from 2005 to 2014. Only original studies were selected, excluding case reports. A manual search was conducted using PubMed, KoreaMed, Cochrane Library, and Embase to track the published articles. The abstracts were considered to have been published if the authors, title, study design, and results were the same for a published article. In addition, they were considered published if the author and the study design matched, even if the results of the abstract and the results of the published articles were not identical. RESULTS: A total of 928 abstracts from 2005 to 2014 were analyzed. Of the 928 abstracts, 468 (50.43%) abstracts were published in a peer-reviewed journal and the mean time to publication was 19 months. Of the 468 abstracts, 414 were published in a science citation index extended (SCI[E]) journal, and 54 were published in non-SCI(E) journals. The proportion of SCI(E) articles increased annually. The average impact factor for the SCI(E) journals was 2.93. In subgroup analysis, the abstracts that were awarded the best oral or best poster presentation were more likely to be published as full-length articles with a higher impact factor than the abstracts not awarded. CONCLUSION: Half of the abstracts presented in the KCR annual meetings were published in a peer-reviewed journal. Approximately 90% of the articles were published in a SCI(E) journal.
Awards and Prizes ; Korea ; Publications ; Rheumatology*