The polyglandular autoimmune syndrome designates the dysfunction of endocrine and nonendocrine system involving two or more organs on the basis of an autoimmune mechanism. The autoimmune nature of these diseases has been based on the presence of lymphocytic infiltration in the affected gland, organ specific autoantibodies in the serum, cellular immune defects and an association with the HLA DR/DQ genes or immune response genes. This syndrome is usually classified into three classes and their etiology or pathogenesis is still not completely understood. A 28-year-old woman developed vitiligo and insulin dependent diabetes mellitus during the treatment of Graves' disease with antithyroid drug. She had a tendency of spontaneous ketonemia and serum c-peptide levels were low(0.21, 0.16ng/mL: fasting and glucagon stimulated). Thyrotrophin binding inhibitor immunoglobulin and pancreas iIslet cell cytoplasmic antibody were positive. We report here a case of polyglandular autoimmune syndrome, type III manifesting Graves' disease, vitiligo, and insulin dependent diabetes mellitus.
Adult ; Autoantibodies ; Bone Diseases ; C-Peptide ; Cytoplasm ; Diabetes Mellitus ; Fasting ; Female ; Genes, MHC Class II ; Giant Cells ; Glucagon ; Granuloma ; Graves Disease ; Humans ; Immunoglobulins ; Insulin ; Ketosis ; Pancreas ; Pedigree ; Thyrotropin ; Vitiligo

BACKGROUND: It is generally accepted that most colorectal cancers develop from adenomas, so the detection and removal of them can reduce the incidence of colorectal cancers. Sigmoidoscopy is the effective tool for detecting and removing adenomatous polyps in the rectosigmoid region, but its major limitation is that sigmoidoscopy alone can not detect considerable portion of colorectal adenomas. METHODS: From October, 1996 to August, 1997, we performed 2017 sigmoidoscopies and 1683 colonoscopies. We analysed the anatomical distribution of adenomas and compared the detection rate of adenomas between two groups. In 32 cases, adenomas detected by sigmoidoscopy were followed by colonoscopy in less than 2 months. RESULTS: We found 125 cases of adenomas in 2017 sigmoidoscopies and 281 cases of adenomas in 1683 colonoscopies. In 281 cases of adenomas found by colonoscopy, 151 cases had rectosigmoid adenomas only and 25 cases had rectosigmoid and proximal adenomas, 105 cases had proximal adenomas only. The detection rate of adenomas by sigmoidoscopy was significantly lower than that by colonoscopy in the rectosigmoid region(6.1% vs. 10.5%, p=0.002). In 32 cases of adenomas found by sigmoidoscopy that were followed by colonoscopy, 7 cases of proximal adenomas and 6 cases of additional rectosigmoid adenomas were detected. CONCLUSION: Sigmoidoscopy cannot detect adenomas in the proximal colon beyond the sigmoid, it also can miss a significant portion of adenomas in the rectosigmoid.
Adenoma* ; Adenomatous Polyps ; Colon ; Colon, Sigmoid ; Colonoscopy ; Colorectal Neoplasms ; Incidence ; Mass Screening* ; Sigmoidoscopy*

Pilomatricoma is a benign tumor differentiating towards the hair matrix. Perforation may rarely take place with extrusion of part of the contents. A 3-year-old girl presented with a 5×6 mm sized, erythematous, elevated and indurated mass with a tiny horny projection on its surface, on her righ,t upper arm. It had been present for one year. Histopathologically, there were several islands of epithelial cells in the upper to mid-dermis composed of basophilic, shadow and transitional cells. A few tumor islands adjacent to the epidermis were in the course of a characteristic transepithelial elimination process.
Animals ; Arm ; Basophils ; Child, Preschool ; Epidermis ; Epithelial Cells ; Female ; Hair ; Horns* ; Humans ; Islands ; Pilomatrixoma*

BACKGROUND: Although several epidemiologic studies have revealed that our dietary factors, obesity and alcohol are associated with an increased incidence of colon cancer, association of these factors with colorectal polyps is unclear. In this study, we tried to investigate the association between colorectal polyps and lifestyle factors in Korean adults. METHODS: Rectosigmoidoscopy was performed on all subjects from January 2001 to December 2001 at Ulsan University Hospital Health Promotion Center. Self-administered questionnaire for drinking and other life style factors was done. RESULTS: Among the 1,102 cases in which sigmoidoscopy examination was performed by a family physician, the prevalence of colorectal polyps was 17.6%. Smoking and drinking were significant risk factors for colon polyps. After adjusting for age and sex, using multiple logistic regression, the odds ratio of subjects with 20 pack years or more of smoking compared with the non-smoking subjects was 2.503 (95% CI: 1.277-3.299). Compared with non-drinking subjects, adjusted odds ratio in group with 3 or more times of drinking per week group was 2.833 (95% CI: 1.623-4.945). The odds ratio for the highest exercise group, compared with the lowest group was 0.539 (95% CI: 0.336-0.867). Exercise was associated inversely with colon polyps. Obesity was statistically insignificant in this study. CONCLUSION: These results showed that drinking and smoking were positively associated with colorectal polyps, but it was associated inversely with exercise.
Adult* ; Colon ; Colonic Neoplasms ; Drinking ; Health Promotion ; Humans ; Incidence ; Life Style ; Logistic Models ; Obesity ; Odds Ratio ; Physicians, Family ; Polyps* ; Prevalence ; Risk Factors* ; Sigmoidoscopy ; Smoke ; Smoking ; Ulsan ; Surveys and Questionnaires

Hallux valgus has been defined as a static subluxation of the first metatarsophalangeal joint with lateral deviation of the proximal phalanx on the first metatarsal head from the longitudinal axis of the first metatarsal with medial deviation of the first metatarsal. And first-second metatarsal angle is increased as well as bursal hypertrophy over the medial eminence of the first metatarsal head. Many procedures have been reported for the treatment of the hallux valgus ranging from resection arthroplasty to distal first metatarsal or basal first metatarsal osteotomy. Of these, Johnson and Corless have required sufficiently good results in the modifying Mitchell osteotomy into Chevron osteotomy. The Chevron procedure is an osteotomy involving the distal portion of the first metatarsal, lateral displacement of the metatarsal head with exostosectomy, and tightening of the medial capsular structures. Authors studied 17 cases in 10 patients with the hallux valgus deformity treated by Chevron osteotomy at the Department of Orthopedic Surgery, Capital Armed Forced General Hospital from September 1987 to September 1989. The results were as follows; 1. Seven patients (12 cases) were male and three patients (5 cases) were female. All patients had bilateral hallux valgus deformity. 2. The average first-second intermetatarsal angle was 11 degrees and average valgus angle was 32 degrees, preoperatively. They were corrected to 9 degrees and 14 degrees respectively. 3. The metatarsalgia of the great toe was subsided in all cases and they were satisfied with the result of their operations in respect to cosmetically and functionally. Avascular necrosis of capital fragment, nonunion, and dorsal angulation were not developed in any case. But, one case had marginal skin necrosis, presumably due to excessive compressive dressing. 4. Chevron osteotomy is a technically easy procedure and it can be obtained early bone healing with less complication.
Arm ; Arthroplasty ; Bandages ; Congenital Abnormalities ; Female ; Hallux Valgus ; Hallux ; Head ; Hospitals, General ; Humans ; Hypertrophy ; Male ; Median Eminence ; Metatarsal Bones ; Metatarsalgia ; Metatarsophalangeal Joint ; Necrosis ; Orthopedics ; Osteotomy ; Skin ; Toes

Foreign bodies in the maxillary sinus are rare and mostly of traumatic origin. These foreign bodies result in pain, bleeding and infection and are immediately removed in most cases. Sometimes the foreign body without serious symptoms can remain for several years without treatment. However, the prognosis of foreign bodies in the paranasal sinuses can be severe. Therefore, regardless of the symptoms present, it seems worthwhile to remove the foreign body from the paranasal sinuses in order to prevent any possibility of further complications. The authors report a case of foreign body occurring in maxilla and maxillary sinus without symptoms for 25 years with related literatures.
Foreign Bodies ; Hemorrhage ; Maxilla ; Maxillary Sinus ; Paranasal Sinuses ; Prognosis

Burn patients with associated limb amputations present demanding rehabilitation problems, many of which might lead them to chronic issues. The authors studied 77 male and 9 female burn patients with amputations. Most amputations occurred with high voltage electrical burns. The fingers were the most frequent target for amputations. The most frequent site of amputation was the entrance at the right side and multiple amputation in nature. The prosthetic fittings were delayed because of burn wounds and grafts and fragile skin at the stump. Also, limited range of motion, decreased strength, hypertrophic scar contracture, heterotopic ossification and bony overgrowth were additional limiting factors. We conclude that early rehabilitation intervention would be critical to prevent complications and to improve rehabilitation outcome of burn amputee patients.
Amputation ; Amputees* ; Burns* ; Cicatrix, Hypertrophic ; Contracture ; Extremities ; Female ; Fingers ; Humans ; Male ; Ossification, Heterotopic ; Prostheses and Implants ; Range of Motion, Articular ; Rehabilitation ; Skin ; Transplants ; Treatment Outcome ; Wounds and Injuries

Fall is a major threat to the stroke patients. The purpose of this study is to find out the potential risk factors for recurrent falls in the stroke patients. The subjects were sampled 20 hemiplegic fallers who experienced at least one fall at the stroke center of Hangkang Sacred Heart hospital. Balance subscale and gait scale of Tinetti was used as a screening test for referral to mobility fuction. The potential contributing factors for fall were social activity, impulsivity, congnition, motivation. These factors were correlated with falls. The authors also surveyed the places, postures of activities, and injurires from falls. The falls occurred 2.5 times average in studied subjects and is most of subjects the first fall occurred in their first month of standing and gait training. 58.3% of falls occurred indoor(33.3% in room), 29.2% at hospital, 12.5% outdoor. The activities related to fall were walking 36.8%, rising from a chair 36.8%, sitting 10.5%. Although, most(75%) of injuries were soft tissue contusions or strains, the other 25.1% of falls accompanied fractures. The femur fracture was 18.8%, and compressed spine fracture was 6.3%. The social activity was most strongly correlated with falls with high correlation coefficent of 0.72. The other factors were not significant with lower coefficient values, balance scale of 0.35, gait scale of 0.24, motivation of 0.40, congnition of 0.26, impulsivity of ?0.19. It was suggested that activity plays an important mediating risk factor for falls in the stroke patients. These data support the concept of preventive strategy for falls in the stroke patients who are at risk.
Contusions ; Femur ; Gait ; Heart ; Humans ; Impulsive Behavior ; Mass Screening ; Motivation ; Negotiating ; Posture ; Referral and Consultation ; Risk Factors ; Spine ; Stroke* ; Walking