Addison's disease is a rare disorder resulted from a chronic deficiency of the adreanl cortical hormone. The clinical manifestations are general weakness, weight loss, hyperpigmentation, hypovolemia with hyponatremia and hyperkalemia. We report a case of Addison's disease in a 60-year-old woman who has experienced slowly progressive weakness, weight loss and generalized cutaneous pigmentation, especially sun exposed area, extensor surface and nail bed for the last, 2 years. On a hormonal assay of the adrenal glands, basal plasma cortisol level was decreased and basal plasma ACTH level was markedly elevated. A chest X-ray showed streaky tuberculous infiltration in left, upper lobe field and adrenal CT scan showed calcific densities of both adrenal glands with nodular enlargement of right adrenal gland. There was a clinical improvement with steroid replacement therapy and anti-tuber- culosis chemotherapy. A nearly normal appearance was obtained after 5 months' treatment.
Addison Disease ; Adrenal Glands ; Adrenocorticotropic Hormone ; Drug Therapy ; Female ; Humans ; Hydrocortisone ; Hyperkalemia ; Hyperpigmentation ; Hyponatremia ; Hypovolemia ; Middle Aged ; Pigmentation ; Plasma ; Solar System ; Thorax ; Tomography, X-Ray Computed ; Weight Loss

Nefazodone, a newer antidepressant is a phenylpiperazine derivative that inhibits the reuptake of both norepinephrine and serotonin, and antagonizes 5-HT2A and alpha1 adrenergic receptors. Compared with SSRIs nefazodone caused the fewer activating symptoms, adverse gastrointestinal effects(nausea, diarrhea, anorexia) and adverse effects of sexual function, but is associated with the more dizziness, dry mouth, constipation, visual disturbances and confusion. We report on 4 cases of visual disturbances and hallucinations in patients taking nefazodone. 1) Nefazodone, as a 5-HT2A antagonist, might induce visual disturbances. 2) mCPP, metabolite of nefazodone might contribute to the hallucination through action on 5-HT receptor. 3) Dopaminergic enhancing activity of nefazodone might cause hallucination. The case report raises the possibility that dose-related perceptual disturbances may exist with nefazodone. The fact emphasizes the need to pay close attention to all possible drug interactions, particularly in patients treated with multiple psychoactive agents, older patients, and patients with decreased hepatic function.
Constipation ; Diarrhea ; Dizziness ; Drug Interactions ; Hallucinations ; Humans ; Mouth ; Norepinephrine ; Psychotropic Drugs ; Receptors, Adrenergic ; Serotonin ; Serotonin 5-HT2 Receptor Antagonists

OBJECTIVE: The aim of this study is to find the most helpful midsagittal reference plane for diagnosis in PA cephalometry compared with 3D CT. METHODS: The subjects consisted of 25 adults who showed no facial asymmetry by gross inspection. 3D CT and posteroanterior cephalogram of the subjects were taken. To find the most helpful midsagittal reference plane in PA cephalometry, we considered five kinds of midsagittal planes from which the distances to five landmarks were measured and compared the result with that of 3D CT. The midsagittal plane for 3D CT was determined by the landmarks Nasion, Sella and Basion. RESULTS: PA measurements using the midsagittal reference plane on a perpendicular plane lying through the midpoint of the right and left latero-orbitales was closest to those of 3D CT. CONCLUSIONS: It was considered that latero-orbitale perpendicular could be used as the helpful midsagittal reference plane to assess facial asymmetry in PA cephalometry.
Adult ; Cephalometry ; Deception ; Facial Asymmetry ; Humans

OBJECTIVE: The purpose of this study was to examine the effect of ipriflavone on periodontal reorganization and prevention of relapse following tooth movement. METHODS: Orthodontic rubber bands were inserted between the first and second maxillary molars of 27 white male rats for 3 weeks for experimental tooth movement. From one day before the removal of orthodontic rubber band, ipriflavone was administered 50 or 400 mg/kg daily in each experimental group whereas carboxymethyl cellulose solution was administered in the control group. They were sacrificed at the 5, 10, and 15th day from the day of removal of orthodontic rubber bands. The amount of relapse was evaluated by measuring the interdental space, and the extent of periodontal reorganization was compared through histological examination. RESULTS: In case of ipriflavone administration, the amount and velocity of relapse was less and slower compared to the control group. In addition, the ipriflavone group showed more rapid periodontal reorganization compared to the control group. CONCLUSIONS: The results of the present study suggest that ipriflavone administration can be used effectively in the prevention of relapse following orthodontic tooth movement through the acceleration of periodontal reorganization.
Acceleration ; Animals ; Carboxymethylcellulose Sodium ; Humans ; Isoflavones ; Male ; Molar ; Rats ; Recurrence ; Rubber ; Tooth ; Tooth Movement

Surgery for pathologic hip fracture poses significant challenges regarding the fixation of fracture and management of the original tumor lesion. An extensive destruction of the femoral neck and intertrochanteric region by benign or malignant lesions complicated by a pathological fracture generally necessitates total hip arthroplasty; however, in adolescents and young adults, preservation of the hip is preferable. We present a 14-year-old female patient, who sustained a pathological intertrochanteric fracture through a pre-existing aneurysmal bone cyst. Several operative interventions with internal fixation and bone graft were unsuccessful, and combined nonunion and progression of osteolysis around the compression hip screw eventually caused femoral head collapse, mimicking osteonecrosis. Hip preservation and resolution of the original tumor were achieved by free vascularized fibular graft.
Adolescent ; Aneurysm ; Arthroplasty, Replacement, Hip ; Bone Cysts ; Female ; Femur Neck ; Fractures, Spontaneous ; Head* ; Hip ; Humans ; Osteolysis ; Osteonecrosis ; Transplants* ; Young Adult

Detailed information on additional drug resistance patterns of multidrug-resistant tuberculosis (MDR-TB) is essential to build an effective treatment regimen; however, such data are scarce in Korea. We retrospectively analyzed the results of phenotypic drug susceptibility testing (DST) of culture confirmed-TB patients from January 2010 to December 2014 in 7 university hospitals in Korea. MDR-TB was identified among 6.8% (n = 378) of 5,599 isolates. A total of 57.1% (n = 216) of the MDR-TB patients had never been treated for TB. Strains from MDR-TB patients showed additional resistance to pyrazinamide (PZA) (35.7%), any second-line injectable drug (19.3%), and any fluoroquinolone (26.2%). Extensively drug resistant TB comprised 12.4% (n = 47) of the MDR-TB patients. Of 378 MDR-TB patients, 50.3% (n = 190) were eligible for the shorter MDR-TB regimen, and 50.0% (n = 189) were fully susceptible to the 5 drugs comprising the standard conventional regimen (PZA, kanamycin, ofloxoacin, prothionamide, and cycloserine). In conclusion, the proportion of new patients and the levels of additional drug resistance were high in MDR-TB patients. Considering the high levels of drug resistance, the shorter MDR-TB treatment regimen may not be feasible; instead, an individually tailored regimen based on the results of molecular and phenotypic DST may be more appropriate in MDR-TB patients in Korea.

Vitiligo is a common skin disease, but its pathogenesis has not been fully determined, though an autoimmune etiology is considered likely. Kawasaki disease (KD) is an acute multisystem vasculitis of childhood associated with coronary arteriopathy, and is diagnosed based on clinical criteria. Furthermore, vitiligo has been associated with several other diseases, but no report has been issued about the relationship between vitiligo and Kawasaki's disease. The author's report the case of an 8-year-old male child that presented with depigmented lesions, which developed from the desquamative skin lesions of Kawasaki's disease.
Child ; Humans ; Male ; Mucocutaneous Lymph Node Syndrome ; Skin ; Skin Diseases ; Vasculitis ; Vitiligo

BACKGROUND: A 64-slice multidetector computed tomography (MDCT) is well known to be a useful noninvasive form of angiography for the general population, but not for certain patients with diabetes. The aim of this study was to investigate the diagnostic accuracy and usefulness of 64-slice MDCT coronary angiography for detecting coronary artery disease in Korean patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 240 patients were included, 74 of whom had type 2 diabetes (M:F=40:33; 41.8+/-9.5 years). We compared significant coronary stenosis (>50% luminal narrowing) in MDCT with invasive coronary angiography (ICA) by segment, artery, and patient. We also evaluated the influence of obesity and coronary calcium score on MDCT accuracy. RESULTS: Of the 4,064 coronary segments studied, 4,062 segments (T2DM=1,109) were assessed quantitatively by both MDCT and ICA, and 706 segments (T2DM=226) were detected as a significant lesion by ICA in all patients. Sensitivity, specificity, as well as positive and negative predictive values for the presence of significant stenosis in T2DM were: by segment, 89.4%, 96.4%, 85.8%, and 97.4%, respectively; by artery (n=222), 95.1%, 92.9%, 94.4%, and 93.8%, respectively; by patients (n=74), 98.4%, 100.0%, 98.4%, and 90.0%, respectively. Regardless of presence of diabetes, there was no significant difference in diagnostic accuracy. Obesity (> or =25 kg/m2) and coronary calcium score did not also affect the diagnostic accuracy of MDCT. CONCLUSION: The 64-slice MDCT coronary angiography was found to have similar diagnostic accuracy with ICA, regardless of diabetes. These results suggest MDCT may be helpful to reduce unnecessary invasive studies for patients with diabetes.
Angiography ; Arteries ; Calcium ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Diabetes Mellitus, Type 2 ; Humans ; Multidetector Computed Tomography ; Obesity ; Phenobarbital ; Sensitivity and Specificity

BACKGROUND: The prevalence of metabolic syndrome (MetS) has risen rapidly worldwide, including in South Korea. Factors related to lifestyle are closely associated with the development of MetS. The aim of this study was to investigate the association between MetS and a number of factors positively influencing health, namely non-smoking, low-risk drinking, sufficient sleep, regular exercise, and the habit of reading food labels, among Korean men. METHODS: This cross-sectional study included 3,869 men from the 2007–2009 Korean National Health and Nutrition Examination Survey. Information on five factors positively influencing their health was obtained using a self-reported questionnaire. We categorized subjects into four groups, depending on the number of positive factors reported (group I, 0–1 factor; group II, 2 factors; group III, 3 factors; group IV, 4–5 factors). RESULTS: Men who reported a greater number of positive health factors had better laboratory and anthropometric values than men who reported fewer positive health factors. The prevalence of MetS was 29.1, 27.2, 20.7, and 14.6% in groups I to IV, respectively. Compared to group I, odds ratios (95% confidence intervals) for MetS were 0.96 (0.78–1.19) in group II, 0.67 (0.52–0.87) in group III, and 0.52 (0.35–0.76) in group IV, after adjusting for confounding factors. Odds ratios for abdominal obesity, glucose intolerance, and hypertriglyceridemia were statistically significant. CONCLUSION: A greater number of positive lifestyle factors influencing health were associated with a lower risk of developing MetS, in a nationally representative sample of Korean men.
Alcohol Drinking ; Cross-Sectional Studies ; Drinking ; Glucose Intolerance ; Humans ; Hypertriglyceridemia ; Korea ; Life Style ; Male ; Metabolic Syndrome X ; Nutrition Surveys* ; Obesity, Abdominal ; Odds Ratio ; Prevalence ; Smoking

We report our experience of unexpected low expiratory concentration of sevoflurane 0.8 vol%, low inspired fraction of oxygen 31%, and high value of bispctral index (BIS) 62 with sevoflurlane vaporizer setting 2.0 vol% and the inspired fraction of oxygen 50% during general anesthesia of a 56-year-old man undergoing elective laparoscopic hemicolectomy. The anesthesia machine (Cato edition, Drager, Lubeck, Germany) with a piston-based, electronically controlled ventilator was used for anesthesia. We checked thoroughly all the possible causes of the discrepancy of anesthetic gas concentration, and then detected the partial disconnection of fresh gas outlet. But there were no alarm signs of anesthetic monitor with adequate ventilator function. This malfunction of anesthetic gas supply without alarm signs may lead to hypoxia and awareness of patients. The intraoperative monitoring of anesthetic gas analyzer and BIS may be essential to detect the malfunction of anesthesia machine.
Anesthesia ; Anesthesia, General* ; Anoxia ; Humans ; Methyl Ethers ; Middle Aged ; Monitoring, Intraoperative ; Nebulizers and Vaporizers ; Oxygen ; Ventilators, Mechanical