Intracranial vasculitis is a rare and disastrous complication of tuberculous meningitis if not treated properly. Focal neurologic deficits according to the vessels involved are common manifestation. Here, we report a 29-year-old man who suffered abrupt, bizarre behavioral changes caused by vasculitis complicating tuberculous meningoencephalitis. The diagnosis of tuberculous meningitis is based upon both the CSF findings and a chest X-ray. His systemic symptoms disappeared by after being administered antituberculous medication but various psychotic features such as hypersomnia, hyperphagia and aggressivebehavior continued. A brain MRI showed multiple small parenchymal tuberculous nodules, and the brain MR angiography revealed a narrowing of the proimal middle cerebral arteries and a reduced visualization of the cerebral vessels, suggesting widespread vasculitis. Intravenous dexamethasone successfully ameliorated his behavioral changes. In addition both the follow up brain MRI and angiography showed a normalization of the previous findings.
Adult ; Angiography ; Brain ; Dexamethasone ; Diagnosis ; Disorders of Excessive Somnolence ; Follow-Up Studies ; Humans ; Hyperphagia ; Magnetic Resonance Imaging ; Meningoencephalitis* ; Middle Cerebral Artery ; Neurologic Manifestations ; Thorax ; Tuberculosis ; Tuberculosis, Meningeal ; Vasculitis

Skin atrophy is one of the most common side effects of topical steroid use and results from decreased skin proalphaI collagen mRNA production due to specific alterations in collagen gene transcription or from reduced collagen mRNA stability. This report describes a case of a 8 year-old-girl who visited our hospital with a complaint of ambiguous genitalia. She was observed to have atrophic labia majora and atrophic striae resembling scrotal rugae. However, her serum levels of FSH, LH, 17-KS, 17-OHCS, 5-DHT, DHT and DHEA-S were all in normal range and her karyotype was 46,XX. Abdominal and pelvic ultrasonogram showed a normal uterus and ovaries. Careful history taking revealed frequent use of steroid ointment due to vulvar pruritus for 2 years and she was finally diagnosed to have atrophy of external genitalia induced by long-term use of topical steroid.
Atrophy* ; Collagen ; Disorders of Sex Development ; Female ; Genitalia* ; Karyotype ; Ovary ; Pruritus ; Reference Values ; RNA Stability ; RNA, Messenger ; Skin ; Ultrasonography ; Uterus

PURPOSE: To evaluate the role of CT in early detection, location, and extent of osteochondritis dissecans (OCD) of the elbow joint. MATERIALS AND METHODS: We reviewed surgically proved 27 cases of 22 patients with osteochondritis dissecans in elbow joint retrospectively. We compared simple x-ray(elbow AP & lateral) with CT on the basis of staging of OCD of talus by simple x-ray. RESULTS: The frequency of location was as follows:fourteen cases of capitellum, 5 cases of olecranon tip, 5 cases of medial epicondyle, 2 cases of trochlea, and 1 case of olecranon base. Among the 4 cases of normal finding on simple x-ray, CT showed 1 case each of stage I, II, III, and IV OCD and among the 8 cases of stage I on simple x-ray, CT showed 2 cases of stage I, 1 case of stage II, and 5 cases of stage III. Among the 3 cases of stage II on simple x-ray, CT showed 1 case of stage II and 2 cases of stage III. Among the 5 cases of stage III on simple x-ray, CT showed 1 case of stage II, 2 cases of stage III, and 2 cases of stage IV, but it was difficult to detect the presence or absence of attachment between the articular cartilage of mother bone and osteochondral fragment. CT was more accurate than simple x-ray in detection of loose body. CONCLUSION: CT might be an useful imaging modality in early diagnosis of OCD and evaluation of its anatomic location and extent in elbow joint.
Cartilage, Articular ; Early Diagnosis ; Elbow Joint* ; Elbow* ; Humans ; Mothers ; Olecranon Process ; Osteochondritis Dissecans* ; Osteochondritis* ; Retrospective Studies ; Talus

Tumor suppressive effect of dehydroepiandrosterone (DHEA) on the experimentally induced hepatocellular carcinoma was investigated, especially focusing on glutatione transferase and transglutaminase with aptosis in the carcinogenesis. The chemical hepatocarcinogenic procedure of Solt-Farber method was used on Sprague-Dawley rats. Experimental groups were divided into AA group treated by the standard Solt-Farber regimen of diethylnitrosamine (DEN) and 2-acetamidofluorene (AAF) and AD group treated with DHEA simultaneously with AAF and the AAD group treated by DHEA after treatment with AAF. Each group was divided by time sequence further into four subgroups, GI (8wk), G2 (16wk), G3 (28wk), and G4 (36wk). For neoplastic lesion, the immuno histochemical study with anti GSTP antibody was carried out, while the activity and expression of TGase was compared at the same time. The results were summarized as follows; GST-P positive foci detected in AD groups were significantly more suppressed by DHEA treatment than AA groups (P<0.05). AD groups. AD group showed higher activities of TGase than AA groups (P<0.05), which was confirmed by Western and Northern blot analysis. But the number of apoptotic bodies was not correlated with activity and expression of TGase in the nodule. These results suggest that the suppressive effect of DHEA on the murine hepatocellular carcinogenesis might be operating on the promotion process of carcinogenesis rather than regression process of transformed hyperplastic nodules.
Carcinoma, Hepatocellular

BACKGROUND: As indicators of obesity, waist circumference (WC), body mass index (BMI), and adiponectin are well known risk factor for diabetes mellitus. The objectives of this study were to measure the independent association between these obesity indicators and diabetes and to examine the combined effect of these indicators on diabetes in a Korean population. METHODS: The WC, BMI, and serum adiponectin were measured in 6,505 healthy Koreans and were classified into tertile groups for men and women. The independent and combined associations of the obesity indicators with diabetes were measured using logistic regression analyses. Diabetes was defined as fasting serum glucose greater than 126 mg/dL or taking medication. RESULTS: Levels of adiponectin were inversely associated with BMI and WC and directly associated with age and high density lipoprotein cholesterol (HDL) cholesterol (P <0.001). After adjusting for age, WC, and other lifestyle factors, low levels of adiponectin were associated with an increased prevalence of diabetes. Further adjustment for HDL cholesterol and triglyceride attenuated this association in both men and women. The best cut-off value of adiponectin in terms of identifying the presence of diabetes was 5.5 /ml with a sensitivity and specificity of 46.7% and 63.9% for men and 9.5 /ml with a sensitivity and specificity of 68.2% and 55.2 for women. CONCLUSIONS: These results suggest that adiponectin was associated with diabetes. The association was independent of WC and was partly modified by HDL and triglyceride. There were no effect modifications of adiponectin with WC on diabetes.
Adiponectin* ; Blood Glucose ; Body Mass Index ; Cholesterol ; Cholesterol, HDL ; Diabetes Mellitus ; Fasting ; Female ; Humans ; Life Style ; Logistic Models ; Male ; Obesity ; Prevalence ; Risk Factors ; Sensitivity and Specificity ; Triglycerides ; Waist Circumference

BACKGROUND: The aim of the present study was to determine the correlation between the amount of pain reduction after local anesthetic injection into the subacromial space preoperatively and clinical outcome after arthroscopic rotator cuff repair. METHODS: A total of 127 patients who underwent arthroscopic rotator cuff repair and followed up at least 1 year were analyzed retrospectively. Preoperatively, a visual analogue scale (VAS) for pain was measured in all patients before and after the ultrasound guided impingement test. The participants were divied into four groups according to pain reduntion ater impingement test (Group A: >75%, Group B: 50%–75%, Group C: 25%–50%, Group D: <25%). VAS for pain, shoulder range of motion, shoulder isometric strength, ASES score were evaluated preoperatively and at 3, 6, 9, and 12 months postoperatively. RESULTS: After surgery, the amount of pain reduction shows significantly at 3, 6 months in Groups A, B as compared to Groups C, D (p<0.05). Among the range of motion of shoulder joint, forward flexion was significantly improved in Group A at 3 months (p<0.05). The ASES score significantly improved at 3, 6 months in Groups A, B as compared to Group C, D (p<0.05). CONCLUSIONS: Preoperative degree of pain reduction after impingement test correlates with the improvement of pain after arthroscopic rotator cuff repair, especially in the early phase. Therefore, the impingement test could be effectively used.
Humans ; Range of Motion, Articular ; Retrospective Studies ; Rotator Cuff* ; Shoulder ; Shoulder Joint ; Shoulder Pain ; Ultrasonography

Pleomorphic adenoma presenting as primary lesion of the bronchus is very rarely encountered, and in our knowledge only 6 cases have been reported in the literature of the western world, and no case report has been published in Korea. Currently, we experienced a case of bronchial pleomorphic adenoma occuring in a 38 years old woman. On X-ray examination, hazy density in the right upper lobe and emphysematous change in the right lower lobe were noted. A right pneumonectomy was done under bronchoscopic diagnosis of bronchial adeoma. The pathologic examination of the present case showed a polypoid endobronchial tumor, 1.4 x 1.1 cm (with extraluminal portion, 2.2 x 1.7 cm) in the right upper bronchus. The microscopic examination revealed a pleomorphic adenoma showing same morphology as those found in the salivary gland. This case, therefore, was believed to be a genuine example of bronchial pleomorphic adenoma of salivary gland type. We compared this case with 6 cases in the literature.
Female ; Humans ; Adenoma

PURPOSE: To report a case of massive spontaneous suprachoroidal hemorrhage in a middle-aged female with heavy alcohol consumption. CASE SUMMARY: A 48-year-old female with a history of heavy alcohol consumption developed a massive spontaneous suprachoroidal hemorrhage in the right eye. Fundus examination and B-scan ultrasonography of the right eye revealed a hemorrhagic choroidal detachment with kissing choroidal sign. On systemic evaluation, she was diagnosed with alcohol-induced hepatitis, diabetes, and diabetic nephropathy. We performed trans-scleral drainage of the suprachoroidal hemorrhage, trans pars plana vitrectomy and silicone oil injection in her right eye. CONCLUSIONS: To our knowledge, this is the first case report of massive spontaneous suprachoroidal hemorrhage in a patient with heavy alcohol intake.
Alcohol Drinking* ; Choroid ; Diabetic Nephropathies ; Drainage ; Female ; Hemorrhage* ; Hepatitis ; Humans ; Middle Aged ; Silicone Oils ; Ultrasonography ; Vitrectomy

The 49, XXXXY Klinefelter variant is distinctive; classic findings include mental retardation, hyp ogonadism and radioulnar synostosis. Its incidence is estimated to be 1/80,000 to 1/100,000 male births. We report a case of 49, XXXXY syndrome confirmed by chromosomal study in neonatal period, whose clinical features included a coarse face, short neck, micropenis, and other multiple minor anomalies including simian creases. Echocardiography showed patent ductus arteriosus (PDA), and pulmonary hypertension. A multicystic kidney was found by abdominal ultrasonography.
Ductus Arteriosus, Patent ; Echocardiography ; Humans ; Hypertension, Pulmonary ; Incidence ; Infant, Newborn* ; Intellectual Disability ; Male ; Multicystic Dysplastic Kidney* ; Neck ; Parturition ; Synostosis ; Ultrasonography

Both Mycoplasma hominis (M. hominis) and Ureaplasma urealyticum (U. urealyticum) are important genital mycoplasmas which are found in the cervix, vagina and the urogenital tracts of females. It has been associated with various disease states including non-gonococcal urethritis, spontaneous abortion, low birth weight and chorioamnionitis. Moreover they can be transmitted up to 40% of infants born to infected mothers. The culture methods which is commonly used for the determination of above mycoplasmas requires special culture media and can take up to 7 days. Recently the polymerase chain reaction (PCR) has been successfully applied for the detection of pathogenic microorganisms. In this study, M. hominis and U. urealyticum were determined using PCR in 70 vaginal swabs and 48 urine samples. In a total of seventy vaginal swabs, thirteen (18.5%) and twenty four (34.3%) samples were positive for M. hominis and U. urealyticum, respectively. In forty eight urine samples, M. hominis and U. urealyticum were found in 3 cases (6.3%), respectively. Among vaginal swab and urine samples, one case was found to be coinfectious state. Amplified DNA bands were more frequently found in vaginal swabs than urine samples. This study shows that PCR is a relatively simple, fast and practical tool for the detection of M. hominis and U. urealyticum in a clinical materials instead of culture method.
Abortion, Spontaneous ; Cervix Uteri ; Chorioamnionitis ; Culture Media ; DNA ; Female ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Mothers ; Mycoplasma ; Mycoplasma hominis ; Polymerase Chain Reaction* ; Pregnancy ; Ureaplasma urealyticum ; Urethritis ; Vagina