OBJECTIVE: To understand the clinical manifestations and disease course of adult onset Still' s disease (AOSD). METHODS: 15 patients of AOSD diagnosed at Severance hospital, Yonsei University College of Medicine were retrospectively analysed in the period of September 1988 to September 1995. RESULTS: There were 3 men and 12 women (male to female ratio of 1:4). Age of disease onset ranged from 17-55 years, and over 86% of the patients were younger than age 40 at disease onset. The prevalence of clinical features were as follows fever (100%), arthritis (93%), skin rash (93%), sore throat (60%), abnormal liver function (73%), lymphadenopathy (47%), splenomegaly (47%), hepatomegaly (20%), serositis (13%). Fever was the most common initial symptom. Common labaratory features were leukocytosis with neutrophilia (87%), anemia' Hgb <10 g/dL (67%), increased serum ferritin (83%), ESR (87%) and CRP (93%). Serum ferritin was markedly raised at disease onset and correlated with disease activity. In 2 patients, the disease was controlled with NSAID alone, but most of the patients required steroid to control the disease activity. In 6 patients, MTX was added for steroid sparing effect and for steroid resistant arthritis. Most of AOSD patients had intermittent and chronic disease course. Root joint arthritis and polyarthritis were factors associated with chronicity. CONCLUSION: The clinical features of AOSD in our study generally resemble previous reports. Serum ferritin was a useful marker of disease activity. Most patients of AOSD had intermittent and chronic disease course. Root joint athritis and polyarticular pattern at disease onset were factors associated with chronicity.
Adult* ; Arthritis ; Chronic Disease ; Exanthema ; Female ; Ferritins ; Fever ; Hepatomegaly ; Humans ; Joints ; Leukocytosis ; Liver ; Lymphatic Diseases ; Male ; Pharyngitis ; Prevalence ; Retrospective Studies ; Serositis ; Splenomegaly ; Still's Disease, Adult-Onset*

PURPOSE: Neonatal hepatitis is the major cause of neonatal cholestasis and may be divided into infectious, metabolic, genetic, and idiopathic neonatal hepatitis. Non-familial, non-metabolic, and non-A, B, C viral neonatal hepatitis is known to have made satisfactory progress, but little is known about its chronic clinical features. METHODS: Clinical and histological assessments were carried out in 34 cases with chronic neonatal hepatitis [elevated serum alanine aminotrasferase (ALT) level for more than 6 months] except for A, B, C viral hepatitis, metabolic, or genetic neonatal hepatitis, who were admitted to the Department of Pediatrics, Pusan National University Hospital, from January 1998 to January 2004. RESULTS: Males were more common (70%). Jaundice (100%) and hepatomegaly (44%) were frequent manifestations. Peak serum ALT levels were most commonly below 300 IU/L in 41.2% of patients and peak serum direct bilirubin levels were most commonly between 1.0~5.0 mg/dL in 50% of patients. Ten cases (34%) of 29 patients had positive serum cytomegalovirus (CMV) IgM or urine CMV polymerase chain reaction. Serum ALT level was normalized within 1 year in 11 (37.9%) of 29 cases, and within 2 years in 9 (69.2%) of 13 cases. Serum ALT level was elevated persistently over 2 years in four (30.7%) of 13 cases. Histologic findings such as portal or periportal activity, lobular necrosis, portal or periportal fibrosis were more severe in patients with persistent ALT elevation over 2 years than in those showing normalization of ALT within 2 years (p>0.05). CONCLUSION: When the elevation of ALT level sustains over 1 year in non-familiar, non-metabolic, non-A, B, C viral neonatal hepatitis, an assessment of the severity of liver injury and a careful monitoring about chronic liver disease may be required.
Alanine ; Bilirubin ; Busan ; Cholestasis ; Cytomegalovirus ; Fibrosis ; Hepatitis* ; Hepatomegaly ; Humans ; Immunoglobulin M ; Jaundice ; Liver ; Liver Diseases ; Male ; Necrosis ; Pediatrics ; Polymerase Chain Reaction

An open clinical trial was performed to test the efficacy and side effects of Pravastatin(Mevlotin(R)), HMG-CoA reductase inhibitor, administering 5mg twice daily for 12weeks in 30 patients of hypercholesterolemia in out patient clinics, Pusan National University Hospital. The total cholesterol, triglyceride and HDL-cholesterol were measured with enzyme methods and LDL-cholesterol was calculated indirectly by Friedewald formula. The result obtained were as follows: 1) The degree of change at the end points compared with baseline pretreatment levels were 26.1% fall in serum total cholesterol.36.6% fall in LDL-cholesterol, 20.8% fall in triglyceride and 14, 6% rise in HDL-cholesterol. And the rate of improvement more than moderate degree were 90.0% in total cholesterol(the fall of 10% or more), 53.3% in triglyceride (the fall 20% or more) and 33.3% in HDL-cholesterol(the rise of 7mg% or more). 2) The total cholesterol/HDL-cholesterol and LDL-cholesterol/HDL cholesterol ratios were decreased significantly from 6, 4+/-0.7 to 4.2+/-0.5(34.4%) and from 4.5+/-0.7 to 2.5 +/-0.4(44.4%) respectively. 3) The greatest fall in serum total cholesterol and LDL-cholesterol were observed in 2 weeks after administrating drug and thereafter fell gradually and maintained until 12 weeks of endpoint, but HDL-cholesterol showed significant rise from the 4 weeks of administration. On the other hand triglyceride showed remarkable fall in the measured values from the 4 weeks but statistical significance was observed only in 10 and 12 weeks after administration owing to wide individual variation of values. 4) There observed the tendency that the higher the initial pretreatment levels the greater the degree of fall in total cholesterol and triglyceride. 5) Neither side effects nor abnormal laboratory findings were shown during the period of observation. The results suggest that Pravastatin will be a useful and safe drug in the treatment of hyperlipidemia.
Busan ; Cholesterol ; Hand ; Humans ; Hypercholesterolemia* ; Hyperlipidemias ; Oxidoreductases ; Pravastatin ; Triglycerides

OBJECTIVES: Maternal depression has a detrimental effect on baby growth. Recent reports suggest that depressive symptoms are more likely to occur during pregnancy than in the postpartum period. In Korea, there are relatively few studies of depression during pregnancy compared to those related to postpartum depression. The purpose of this study is to identify factors associated with antenatal depression. METHODS: The study included 143 pregnant women who had completed the Korean version of the Edinburgh Postnatal Depression Scale (K-EPDS), the Korea-Marital Satisfaction Inventory's global distress scale, the Rosenberg Self-Esteem Scale, and the Connor-Davidson Resilience Scale-2. Based on the K-EPDS scores, we divided the participants into two groups. Logistic regression was performed to identify factors associated with antenatal depression. RESULTS: Thirty (21%) of the subjects were evaluated as being depressed, pregnant women. Pregnant women with high self-esteem and marital satisfaction were less likely to have depression. Similarly, those who are younger and those with an abortion history were more likely to have depression. Past psychiatric history and family history were not significantly different between the two groups. CONCLUSION Dissatisfaction with marriage, low self-esteem, younger age, and abortion history were closely related to the presence of antenatal depression. The results of this study can be used as baseline data for the development of family-based education programs and early antenatal depression policies.

Intractable diarrhea associated with secondary amyloidosis in rheumatoid arthritis (RA) is a serious clinical entity with poor prognosis. We describe a 39-year-old male RA patient who presented with intractable diarrhea. Biopsy findings of terminal ileum and colon revealed amyloidosis secondary to RA. Effective treatment of rheumatoid arthritis resulted in remission of intractable diarrhea caused by amyloid protein deposition.
Adult ; Amyloid ; Amyloidosis* ; Arthritis, Rheumatoid* ; Biopsy ; Colon ; Diarrhea* ; Humans ; Ileum ; Male ; Prognosis

BACKGROUND/AIMS: Testing for hepatitis B virus (HBV) serologic markers and appropriate vaccination are required in the management of inflammatory bowel disease (IBD) patients. We evaluated immunogenicity for HBV in IBD patients and the response to the HBV vaccination. METHODS: From May 2014 to August 2016, patients diagnosed with IBD were prospectively included and evaluated for antibody to hepatitis B surface antigen, antibody to hepatitis B core antigen, and antibody to hepatitis B surface antigen. Among the 73 patients who were confirmed with nonimmunity to HBV, 44 patients who had completed the 3-dose HBV vaccination series received a single booster vaccination, while 29 patients who had not completed the vaccinations series or were unsure of receiving the vaccination received a full vaccination series. RESULTS: An optimal response was obtained in 70.5% of the patients in the booster group, and 89.7% of the patients in the full vaccination group. Age younger than 26 years (odds ratio [OR], 6.01; 95% confidence interval [CI], 1.15–31.32; P=0.033) and a complete previous vaccination series (OR, 0.15; 95% CI, 0.03–0.80; P=0.026) were associated with optimal vaccine response. Previous complete vaccination series (OR, 0.11; 95% CI, 0.02–0.73; P=0.022) was the only predictive factor for lower compliance. CONCLUSIONS: The response to the HBV vaccination was lower in patients older than 26 years and for those patients with a complete vaccination history. Since patients with a complete vaccination history also had poor compliance, serum HBV-titers should be checked more thoroughly, and a full vaccination series should be administered in cases when there is a negative response to the booster vaccination.
Compliance ; Hepatitis B Core Antigens ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B* ; Hepatitis* ; Humans ; Inflammatory Bowel Diseases* ; Korea* ; Observational Study* ; Prospective Studies* ; Vaccination*

For estimation of regional myocardial blood flow with O-15 water PET, a few modifications considering partial volume effect based on single compartment model have been proposed. In this study, we attempted to quantify the degree of heterogeneity and to show the effect of tissue flow heterogeneity on partition coefficient(lamda) and to find the relation between perfusable tissue index(PTI) and (lamda) by computer simulation using two modified models. We simulated tissue curves for the regions with homogeous and heterogenous blood flow over a various flow range(0.2-4.0ml/g/min).Simulated heterogeneous tissue composed of 4 subregions of the same or different size of block which have different homogeneous flow and different degree of slope of distribution of blood flow. We measured the index representing heterogeneity of distribution of blood flow for each heterogeneous tissue by the constitution heterogeneity(CH). For model I, we assumed that tissue recovery coefficient (FMME) was the product of partial volume effect(FMMF) and PTI. Using model I, PTI, flow, and FMM were estimated. For model II, we assumed that partition coefficient was another variable which could represent tissue characteristics of heterogeneity of flow distribution. Using model II PTI, flow and (lamda) were estimated. For the simulated tissue with homogeneous flow, both models gave exactly the same estimates of three parameters. For the simulated tissue with heterogeneous flow distribution, in model I, flow and FMM were correctly estimated as CH was increased moderately. In model II, flow and (lamda) were decreased curvi-linearly as CH was increased. The degree of underestimation of (lamda) obtained using model II, was correlated with CH. The degree of underestimation of flow was dependent on the degree of underestimation of (lamda). PTI was somewhat overestimated and did not change according to CH. We conclude that estimated (lamda) reflect the degree of tissue heterogeneity of flow distribution. We could use the degree of underestimation of (lamda) to find the characteristic heterogeneity of tissue flow and use (lamda) to recover the underestimated flow.
Computer Simulation ; Constitution and Bylaws ; Electrons* ; Myocardium* ; Population Characteristics* ; Positron-Emission Tomography*

PURPOSE: Blind individuals who have photoreceptor loss are known to perceive phosphenes with electrical stimulation of their remaining retinal ganglion cells. We proposed that implantable lateral geniculate body (LGB) stimulus electrode arrays could be used to generate phosphene vision. We attempted to refine the basic reference of the electrical evoked potentials (EEPs) elicited by microelectrical stimulations of the optic nerve, optic tract and LGB of a domestic pig, and then compared it to visual evoked potentials (VEPs) elicited by short-flash stimuli. METHODS: For visual function measurement, VEPs in response to short-flash stimuli on the left eye of the domestic pig were assessed over the visual cortex at position Oz with the reference electrode at Fz. After anesthesia, linearly configured platinum wire electrodes were inserted into the optic nerve, optic track and LGB. To determine the optimal stimulus current, EEPs were recorded repeatedly with controlling the pulse and power. The threshold of current and charge density to elicit EEPs at 0.3 ms pulse duration was about ±10 microA. RESULTS: Our experimental results showed that visual cortex activity can be effectively evoked by stimulation of the optic nerve, optic tract and LGB using penetrating electrodes. The latency of P1 was more shortened as the electrical stimulation was closer to LGB. The EEPs of two-channel in the visual cortex demonstrated a similar pattern with stimulation of different spots of the stimulating electrodes. We found that the LGB-stimulated EEP pattern was very similar to the simultaneously generated VEP on the control side, although implicit time deferred. CONCLUSIONS: EEPs and VEPs derived from visual-system stimulation were compared. The LGB-stimulated EEP wave demonstrated a similar pattern to the VEP waveform except implicit time, indicating prosthetic-based electrical stimulation of the LGB could be utilized for the blind to perceive vision of phosphenes.
Animals ; Electric Stimulation ; Electrodes, Implanted ; Evoked Potentials, Visual/*physiology ; Geniculate Bodies/*physiology ; Male ; Optic Nerve/physiology ; Optic Tract/physiology ; Photic Stimulation ; Sus scrofa ; Visual Cortex/*physiology

The levels of expressions and catalytic activities of cytochrome P450 (CYP1A1) and glutathione-S-transferase class mu (GSTM1) enzymes in lungs and their metabolic balance may be an important determinant host factor underlying lung cancer. Genetic differences in metabolism, MspI restriction sites, Ile-Val polymorphism of CYP1A1 gene, and the null genotype of GSTM1 have been reported to be associated with susceptibility to lung cancer. The present studies were undertaken to establish frequencies of the polymorphic genotypes of CYP1A1 and GSTM1 in Koreans, and to evaluate linkage disequilibrium of the genotypes associated with higher lung cancer risks among Koreans. GSTM1(-) genotype was found in 52% of control subjects, whereas it was found in 55% of lung cancer patients. The allelic variants in CYP1A1 were distributed differently in lung cancer patients and controls. The heterozygous genotype frequency of the MspI site in lung cancer patients (53%) was higher than in controls (49%). The frequency of Ile/Val genotype of CYP1A1 was low in lung cancer patients, which are mostly squamous cell carcinoma.
Adenocarcinoma/genetics ; Carcinoma, Small Cell/genetics ; Carcinoma, Squamous Cell/genetics ; Cytochrome P-450 CYP1A1/genetics* ; Gene Frequency ; Genotype ; Glutathione Transferase/genetics* ; Human ; Korea ; Linkage Disequilibrium ; Lung Neoplasms/genetics* ; Mutation ; Polymorphism (Genetics)*

BACKGROUND: Propofol, a new intravenous anesthetic agent, is now used for brief operation and day surgery for its rapid recovery and controllability. Propofol, rapid acting sedatives hypnotics, is known to no analgesic effect. This study was taken to evaluate the analgesic effect of propofol, compared to those of fentanyl. METHODS: Forty patients (ASA physical status 1, 2) scheduled for surgery of short duration (within 1 hour) were randomly allocated into two groups. Induction of anesthesia was performed by injection of thiopental (5 mg/kg) and succinylcholine (1 mg/kg) and ventilated with O2-N2O (50%) after endotracheal intubation. Maintenance of anesthesia was performed by vecuronium (1 mg/kg) and continuous infusion of propofol (group I) or fentanyl (group II). RESULTS: There was no significant differences in systolic and diastolic blood pressure in both groups. In heart rate, there was significant difference at preincision and postincision between two groups. Time to extubation (4.5 +/- 4.6 vs 6.3 +/- 4.6 min), time to eye open (7.5 +/- 7.1 vs 6.6 +/- 5.4 min), time to complain pain after stop dropping at recovery room (30.5 +/- 8.0 vs 35.5 +/- 17.9 min), the average flow rate of drugs (6.0 +/- 2.2 mg/kg/hr vs 6.7 +/- 2.4 microgram/kg/hr) has no significant difference between two groups. CONCLUSIONS: A single continuous infusion of propofol is applied as one of general anesthesia methods with O2-N2O, muscle relaxants. Propofol has a appropriate and similar analgesic effect compared with fentanyl in operation of little hemodynamic changes and short operation, and rapid recovery compared with fentanyl.
Ambulatory Surgical Procedures ; Anesthesia ; Anesthesia, General ; Blood Pressure ; Fentanyl* ; Heart Rate ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Intubation, Intratracheal ; Propofol* ; Recovery Room ; Succinylcholine ; Thiopental ; Vecuronium Bromide