BACKGROUND: There is pressure difference depending on the height of hand position when blood pressure is taken, applying the oscillometric electronic digital BP(blood pressure) monitor. Authors have calculated the degree of BP differences, and evaluated the accuracy and effectiveness of the digital BP monitor comparing with the conventional Mercury Sphygmomanometer. METHOD: Randomized sixty cases consisting of in-patients and hospital workers were subjected for this study. BPs were taken at three different levels-nose level, heart level and knee level-on conventional sitting position applying OMRON Digital Automatic Blood Pressure Monitor and conventional Mercury Sphygmomanometer, and statistical analysis was made. RESULTS: At the nose level, systolic BP and diastolic BP were lower with 23.5mmHg and 18.9mmHg respectively, than at the heart level, while at the knee level, they were higher with 21mmHg and 17.5mmHg respectively, than at the heart level. No actual statistical difference of systolic and diastolic values between OMRON Digital Automatic Blood Pressure Monitoring method at the heart level and conventional Mercury Sphygmomanometeric method. CONCLUSION: Present study demonstrated significant discrepancy of BP values, in systolic and diastolic values, depending on the height of measured finger, when OMRON Digital Automatic Blood Pressure Monitor is applied in taking BP on conventional sitting position. However, no actual discrepancy of BP values was noted between two methods when BP is taken at heart level by OMRON Digital Automatic Blood Pressure Monitor and on brachial artery BP by conventional Mercury Sphygmomanometer. Thus OMRON Digital Automatic Blood Pressure Monitor could take the place of Mercury Sphygmomanometer in taking peripheral BP, which subsequently enable us to estimate central artery BP, which is believed to be better clinical index, through this much more handy electrical oscillometric device in the future.
Arteries ; Blood Pressure ; Blood Pressure Monitors ; Brachial Artery ; Electric Impedance ; Fingers ; Hand* ; Heart ; Hydrostatic Pressure ; Knee ; Nose ; Sphygmomanometers*

Collapsing glomerulopathy (CG) has become an important cause of end-stage renal disease (ESRD). First delineated from other proteinuric glomerular lesions in the 1980s, CG is now recognized as a common, distinct pattern of proliferative parenchymal injury that portends a rapid loss of renal function and poor responses to empirical therapy. The first cases in the literature trace back to human-immunodeficiency-virus (HIV)-negative patients who underwent biopsy in 1979. A 45-year-old male patient complained of hematuria and proteinuria eight years ago. He showed an abrupt serum creatinine increase from 1.75 to 2.65mg/dL in the last preceding months. Afterwards, his serum creatinine progressively increased up to 6.82mg/dL. Moreover, his 24 h urine protein level was determined to have reached 6,171 mg/day, as opposed to 670 mg/day a year earlier. Consequently, renal biopsy was performed, and its result showed collapsing glomerulopathy, compatible with the diagnosis. He has undergone continuous ambulatory peritoneal dialysis as renal replacement therapy. Thus, it is reported herein that a patient clinically diagnosed with chronic kidney disease eight years ago showed a sudden renal-function decrease and was clinicopathologically diagnosed with collapsing glomerulopathy based on the results of his renal biopsy.
Biopsy ; Creatinine ; Glomerulosclerosis, Focal Segmental ; Hematuria ; Humans ; Kidney Failure, Chronic ; Male ; Peritoneal Dialysis, Continuous Ambulatory ; Proteinuria ; Renal Insufficiency, Chronic ; Renal Replacement Therapy

BACKGROUND/AIMS: The aims of our study are to assess the frequency of peripheral blood mononuclear cell (PBMC) proliferation and cytokine profiles to hepatitis C virus (HCV) core protein and NS3 protein to search the potential immunosuppressive effect of HCV core in chronically HCV-infected patients. Subjects and METHODS: Thirty two anti-HCV-positive patients with chronic liver diseases, eight HBsAg-positive patients with chronic liver diseases, and six healthy adults were the subjects of our study. Using recombinant HCV core and NS3, proliferative response of PBMC and cytokine production were determined. RESULTS: Fifty nine percent and thirteen percent of patients with HCV-related chronic liver diseases showed positive PBMC proliferation to HCV core and NS3, respectively. Thirty four percent and fifty nine percent of patients with HCV-related chronic liver diseases showed significant production of interferon-gamma to HCV core and NS3, respectively. IL-4 production was negligible. When the PBMC were treated with HCV core and NS3 concurrently, or HCV core and phytohemagglutinin concurrently, the stimulation indices were significantly decreased compared to those treated either with NS3 or PHA without core. CONCLUSIONS: Although about two thirds of chronically HCV-infected patients with liver diseases showed the PBMC proliferation and Th 1 type cytokine profile, they could not eradicate the viral infection. This ineffective immune response seems to play a role in the pathogenesis of chronic inflammatory liver disease resulting in liver cirrhosis and hepatocellular carcinoma. HCV core showed a potential immunosuppressive effect, which has important meaning for the mechanism of HCV persistence.
Adult ; Carcinoma, Hepatocellular ; Hepacivirus ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Immunosuppression ; Interferon-gamma ; Interleukin-4 ; Liver Cirrhosis ; Liver Diseases

Double primary cancer is usually accompanied by gastrointestinal cancer. The incidence of histologically different cancers in the same organ is less than that of double cancers arising from different organs. The cancers accompanied by esophageal squamous cell carcinoma are laryngopharyngeal cancer, gastric adenocarcinoma and primary hepatocarcinoma. Esophageal cancer is supposed to be frequently accompanied by squamous cell carcinoma of the head and neck or the upper respiratory tract because of such common carcinogens as smoking and alcohol ingestion. On the other hand, it is vary rare that a synchronous double primary cancer is diagnosed at the esophagus. We present here a case of double esophageal cancer in a 77 year-old patient who visited our hospital because of progressive dysphagia that she'd experienced for 3 weeks.
Adenocarcinoma ; Carcinogens ; Carcinoma, Squamous Cell ; Deglutition Disorders ; Eating ; Esophageal Neoplasms ; Esophagus ; Gastrointestinal Neoplasms ; Hand ; Head ; Head and Neck Neoplasms ; Humans ; Incidence ; Neck ; Respiratory System ; Smoke ; Smoking ; Stomach Neoplasms

Patients treated with peritoneal dialysis have increased intra-abdominal pressure and a high prevalence of abdominal wall complications. Hernias can lead to significant morbidity in patients on peritoneal dialysis. Hernias are clinically important because of the risk of incarceration, strangulation and subsequent bowel obstruction, rupture, and peritonitis. In this paper, a case of incarcerated umbilical hernia with small bowel obstruction in a continuous ambulatory peritoneal dialysis (CAPD) patient is reported. The small bowel obstruction improved after herniorrhaphy, and the peritoneal dialysis was resumed 2 weeks after the herniorrhaphy. The patient had been undergoing CAPD without technical failure until the 2 months follow-up after the herniorrhaphy. This case shows that early detection of incarcerated umbilical hernia and herniorrhaphy can prevent resection of a strangulated small bowel so that it can remain on CAPD without post-operative technical failure. Umbilical hernias should be carefully observed and intestinal obstruction should be considered when a CAPD patient with an umbilical hernia has abdominal pain.
Abdominal Pain ; Abdominal Wall ; Follow-Up Studies ; Hernia ; Hernia, Umbilical* ; Herniorrhaphy ; Humans ; Intestinal Obstruction ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Prevalence ; Rupture

Antiphospholipid syndrome is a multi-system disorder characterized by arterial or venous thromboses and antiphospholipid antibodies, such as lupus anticoagulant or anticardiolipin antibodies. Most common clinical manifestations are recurrent pregnancy losses and deep vein thromboses. Cardiac manifestations in antiphospholipid syndrome include valve abnormalities, occlusive arterial disease, intracardiac emboli, and ventricular dysfunction. Acute myocardial infarction is a rare manifestation of the primary antiphospholipid syndrome. We have experienced a case of myocardial infarction with antiphospholipid syndrome. A 35-year-old man with no cardiovascular risk factors, other than smoking, presented with chest pain. He was diagnosed with an acute myocardial infarction. Our evaluation for coagulapathy revealed elevated lupus anticoagulant antibody. The antiphospholipid syndrome should be considered early in the differential diagnosis as an important cause of unexplained thrombosis in young patients.
Adult ; Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome ; Chest Pain ; Diagnosis, Differential ; Humans ; Lupus Coagulation Inhibitor ; Myocardial Infarction ; Pregnancy ; Risk Factors ; Smoke ; Smoking ; Thrombosis ; Venous Thrombosis ; Ventricular Dysfunction

Myelitis is caused by various infectious organisms or an autoimmune mechanism. We report two cases of myelitis with increased serum total IgE and mite antigen specific IgE. The patients had paresthesia and Lhermitte's signs without weakness nor bladder dysfunctions. A spine MRI revealed a T2-high signal lesion with focal enhancement in the upper cervical cord. The patients showed favorable responses to steroid treatment. Atopic myelitis should be considered as a form of myelitis.
Humans ; Immunoglobulin E ; Magnetic Resonance Imaging ; Mites ; Myelitis* ; Paresthesia ; Spine ; Urinary Bladder

Malignant duodenocolic fistula is a rare complication of colon cancer, and this usually develops as the right-side colon cancer or colonic hepatic flexure cancer infiltrates into the second portion of the duodenum. Six Korean cases of this malignancy have been previously reported on. The patients usually complain of watery diarrhea, feculant vomiting and weight loss that can be attributed to the altered normal flora. Barium enema has been the diagnostic procedure of choice to demonstrate the fistulous tract, but with the technical development of gastroendoscopy, the primary procedure is also changing. Curative resection is not possible in many cases. Palliative ileotransverse colostomy with gastrodjejunostomy is performed to relieve symptoms, but it cannot completely prevent the vomiting or diarrhea. We herein present a case of malignant duodenocolic fistula in a patient who had been suffering from indigestion, loose stool and feculant vomiting for one year. This case was diagnosed by endoscopy and the patient underwent a palliative operation.
Barium ; Colon ; Colonic Neoplasms ; Colostomy ; Diarrhea ; Duodenum ; Dyspepsia ; Endoscopy ; Enema ; Fistula ; Humans ; Stress, Psychological ; Vomiting ; Weight Loss

PURPOSE: Some report that basic life support (BLS) skills decay rapidly, mostly by three months after initial training. Retraining at specific intervals or with more effective methods is necessary to delay this decay. This study was undertaken to determine the effects of the time interval from initial training and to evaluate the impacts of a knowledge-only reinforcement on BLS skills in medical students and interns. METHODS: We tested the single-rescuer BLS performance of 92 medical students and interns with Resusci(R) Anne SkillReporter(TM) and BLS performance criteria. All trainees had been instructed by senior residents in 1~24 months before the test and were assigned into four groups by interval from initial training [group A: 1~3 months (n=21), group B: 4~7 (n=26), group C: 8~15 (n=20), group D: 16~24 (n=25)]. Groups C and D had 1-hour knowledge-only lectures. RESULTS: The performance criteria score of group B was lower than that of group A (p=0.005), but that of group C was higher than that of group B (p=0.025). The percent correct of ventilation (PCV) and compression (PCC) decreased surprisingly during the first three months after initial training. There was no difference in the PCC among the four groups. However, the PCV in group C was lower than that in group A (p=0.047). The PCV and the interval from initial training had a negative correlation (R=-0.273, p=0.009). CONCLUSION: Overall BLS performance of medical students and interns on clinical clerkship, without reinforcement, decreases more significantly after three months compared to the first three months from initial training. The accuracy of the skills decreases rapidly from the time of initial training. A knowledge-only reinforcement could temporally improve overall BLS performance. However, the accuracy of the ventilation skill decays regardless of reinforcement.
Cardiopulmonary Resuscitation ; Clinical Clerkship* ; Humans ; Lectures ; Students, Medical* ; Ventilation

A 36-year-old woman presented with erythematous confluent macules on her whole body with fever and chills associated with jaundice after 8 months of dapsone therapy. Her symptoms had developed progressively, and a physical examination revealed bilateral cervical lymphadenopathy and splenomegaly. Excisional biopsy of a cervical lymph node showed effacement of the normal architecture with atypical lymphoid hyperplasia and proliferation of high endothelial venules compatible with angioimmunoblastic T-cell lymphoma. However, it was assumed that the cervical lymphadenopathy was a clinical manifestation of a systemic hypersensitivity reaction because her clinical course was reminiscent of dapsone-induced hypersensitivity syndrome. A liver biopsy revealed drug-induced hepatitis with no evidence of lymphomatous involvement. Intravenous glucocorticoid was immediately initiated and her symptoms and clinical disease dramatically improved. The authors present an unusual case of cervical lymphadenopathy mimicking angioimmunoblastic T-cell lymphoma as an adverse reaction to dapsone.
Biopsy ; Chills ; Dapsone ; Drug-Induced Liver Injury ; Female ; Fever ; Humans ; Hyperplasia ; Hypersensitivity ; Jaundice ; Liver ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma, T-Cell ; Physical Examination ; Pseudolymphoma ; Splenomegaly ; T-Lymphocytes ; Venules