Acute Disease ; Diagnosis ; Enterotoxins ; Exanthema ; Fever ; Hypotension ; Shock ; Shock, Septic ; Staphylococcus aureus

Reiters syndrome is classically described as the triad of urethritis, coijuctivitis, and arthritis along with the skin manifestation. of keratodermia blenorrhagica, circinate b lanitis and oral ulcetation. Since arthritis is now recognized as the only consistent component, iricr nplete forms consisting of characteristic arthritis associeited with one or more of these features and of dysentery are common, We reported a 48-year-old male who presented with a 3 years histor of significant arthralgia and psoriasiforrn skin involvemeni. He had neither an episode of dysentery not, history of sexual exposure before the onset of symptomes. Showed a correlation with the HLAB 7 tialotype. C-reactive protein levels were significantly elevated. He was treared with corticosteroid, pcycline, methotrexate and indomethacin for about 3 months resulting favorable improvement.
Arthralgia ; Arthritis ; C-Reactive Protein ; Dysentery ; HLA-B27 Antigen ; Humans ; Indomethacin ; Male ; Methotrexate ; Middle Aged ; Skin ; Skin Manifestations ; Urethritis

Infantile acute hemorrhagic edema of the skin(IAHE) is a benign disease which affects infants between 4 months and 2 years of age and is characterized by palpable ecchymotic purpura and edema on the limb and face. We report a typical case of IAHE, which was presenting a cockade, annular, reticulated, and iris-like purpura and edema on the face and extremities in a 19-month-old male infant. We consider it to be a new disease category because its characteristics different markedly from HenochSchoenlein purpura in several clinical and histopathologic findings.
Edema* ; Extremities ; Humans ; Infant ; Male ; Purpura ; Skin*

OBJECTIVES: This study was performed to investigate the effectiveness of the questionnaire. METHODS: Workers'health examination records, work environment record, and questionnaires of selected industries as samples were analysed using logistic regression analysis and discrimination analysis Results'Cases of bearing impairment (Dl+C) as dependent variables, and age, work duration and level of environmental noise as independent variables were selected for multiple unconditional logistic regression analysis. Odds ratio was 4.04 in hearing difficulty, 2.78 in tlnnitus and 1.08 in age. In the second analysis Noise induced hearing loss is selected as dependent variable. The OR in hearing difficulty was 3.67(95 % C.1. : 1.61 8.61), and was 1.09(95 % C.1. : 1.05-1.14) in age. Conditionnal multlple logistic regression analysis was performed. In hearing impairment as dependent variable, the OR of age was 1.02(95 % C.1. : 1.00-1.04) and other variables were not significant. However, NIHL as dependent, the OR of hearing difficulty was 4.57(95 % C.1. : 1.43-14.67). According to multiple logistic regression adopting each items of questionnaire as dependent variable, the only item of hearing difficulty showed significant difference with hearing ability. The discrimination analysis was performed with the class variable of hearing impairment, and discrimination variables of age, work duration, and environment noise level. The sensitivity of 59 %, and specificity of 88 %, and average error count of 23 % were obtained. When the numbers of items answered in questionnaire were assumed as the parameter of judgement for noise induced hearing loss (NIHL), the highest sensitivity and specificity were 33.5% and 49.0% in cases of more than two items answered. CONCLUSIONS: The development of items that is simple and discriminative mainly consisted of chronic and specific diseases related items is needed. Computerization for newly developed items might be needed to establish effective surveillance system for NIHL in the future.
Discrimination (Psychology) ; Hearing Loss* ; Hearing* ; Logistic Models ; Mass Screening* ; Noise* ; Odds Ratio ; Questionnaires* ; Sensitivity and Specificity

The presence and distribution of pan-neuroendocrine markers such as neuron-specific enolase (NSE), chromogranin (CG), and synaptophysin (SYP) were investigated by immunohistochemistry in 15 cases of neuroblastic tumors, including four cases of neuroblastomas, six cases of ganglioneuroblastomas, and five cases of ganglioneuromas. Three cases of normal sympathetic ganglion were used for the normal control group. NSE was observed in all cases and both in ganglion cells and in neuropils. NSE was detected not only in the majority of the neuroblasts showing signs of differentiation, but also in some poorly differentiated neuroblasts. All cases of neuroblastic tumors were positive for CG, however, some variability of staining intensity and distribution patterns were noted. CG was found mainly in differentiated neuroblasts with enlarged cytoplasm and nuclei along the periphery of the perikaria, and was also found in the perinuclear regions of some undifferentiated cells. SYP was positive in 9 of 11 cases. In all of the 9 cases, SYP was detected in some differentiating neuroblasts and differentiated neuroblasts, as well as the mature ganglion cells. However, it has scarcely stained in dot or granular pattern. Two CG-negative tumors were also negative for SYP. Our data indicate that antibodies against NSE and CG are helpful as a diagnostic aid for neuroblastic tumors.
Antibodies ; Cytoplasm ; Ganglia, Sympathetic ; Ganglion Cysts ; Ganglioneuroblastoma ; Ganglioneuroma ; Immunohistochemistry ; Neuroblastoma ; Neurons* ; Neuropil ; Phosphopyruvate Hydratase* ; Synaptophysin*

Purpose: To analyze the causes and to prevent dislocations of the hip joint that occur in patients who underwent revisions of total hip arthroplasties by changing only the polyethylene liners and femoral heads, subsequent to primary total hip arthroplasties. Materials and Methods: We evaluated 28 patients who underwent acetabular component revisions of total hip arthroplasties subsequent to primary total hip arthroplasties. The average age of the patients was 55 years old and all 28 patients had operations through the posterolateral approach. In 17 of the cases, the acetabular cups, polyethylene liners, and femoral heads were changed; in 10 cases, just the polyethylene liners and femoral heads were changed; and in 1 case, only the polyethylene liner was changed. Results: We observed 7 cases of hip dislocations that occurred among a total of 28 cases after revisions of total hip arthroplasties. In all 7 cases, the polyethylene liners and femoral heads were changed, but not the acetabular cups. In additional, in all 7 cases of dislocation, the patients were non-compliant and started weight-bearing prematurely after revisions of the total hip arthroplasties Conclusion: We observed new dislocations in the 7 cases in which the polyethylene liners and femoral heads were changed. The main reasons were inadequate soft tissue tension and hip joint laxity. Therefore, it is necessary to increase the neck length, use elevated rim polyethylene liners, readjust the acetabular cups to their optimal positions, and apply hip abduction braces to patients early after revision of total hip arthroplasties in order to lessen the danger of dislocations.
Acetabulum* ; Arthroplasty ; Braces ; Dislocations* ; Head ; Hip ; Hip Dislocation ; Hip Joint ; Humans ; Neck ; Polyethylene ; Risk Factors* ; Weight-Bearing

OBJECTIVE: To evaluate the accuracy of combined transvaginal ultrasound and beta-hCG discriminatory zone for diagnosing intrauterine pregnancy, abortion, and ectopic pregnancy in early abnormal pregnancy. METHODS: Initial ultrasound findings and beta-hCG level were compared with final pregnancy outcome in 164 early pregnant women who visit our hospital with vaginal bleeding or abdominal pain. The sensitivity, specificity, and predictive value by the combination of two diagnostic tools were calculated. Statistic analysis of collected data used x2 of SPSS(9.0). RESULTS: Of 90 women with normal outcome, 64(71.1%) had a gestational sac 5mm, and in 47 cases, the hCG level was above 1,800 mIU/ml. Transvaginal ultrasound was non-diagnostic in 47(28.6%) of 164 women, and especially, 43(53.1%) of 81 cases with beta-hCG levels below 1,800 mIU/ml. The portion of accurate ultrasound diagnosis was significantly higher in women above 1,800 mIU/ml (85.5%, 71 of 83 cases) compard with levels below 1,800 mIU/ml (37.0%, 30 of 81 cases) : P < 0.001; Relative Risk(RR) 2.31; CI 95%. Sensitivity of transvaginal ultrasound diagnosis of intrauterine pregnancy, abortion, and ectopic pregnancy was 90.2%, 79.3%, and 66.7% in women who presented with beta-hCG levels above 1,800 mIU/ml, and 41.0%, 23.5%, and 75% below 1,800 mIU/ml, respectively. And, negative predictive value was 83.9%, 89.7%, and 98.8% in each of intrauterine pregnancy, abortion, and ectopic pregnancy above 1,800 mIU/ml, and 64.6%, 60%, and 97.3% below 1,800 mIU/ml, respectively. CONCLUSIONS: The sensitivity, specificity, and predictive value of transvaginal ultrasound for diagnosing abnormal early pregnancy were poor except cases of ectopic pregnancy when beta-hCG levels were low than discriminatory zone. Ultrasound impressions were well related with beta-hCG levels.
Abdominal Pain ; Diagnosis ; Female ; Gestational Sac ; Humans ; Pregnancy Outcome ; Pregnancy* ; Pregnancy, Ectopic ; Pregnant Women ; Sensitivity and Specificity ; Ultrasonography* ; Uterine Hemorrhage

In an effort to characterize the trend of renal injury of recent years, we reviewed the charts and x-ray films of 50 patients with renal trauma which occurred in the last 6 years. They were 42 males and 8 females with a mean age of 26.4 years (range: 5 to 66) and most of them are younger generation. The main causes of injury were related to falling down in 21 cases (42%) and traffic accident in 17 cases (34%), followed by stab injury in 7 cases and assault in 5 cases. The severity of renal injury was classified using the renal injury scale which was published by the Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A.A.S.T.) in 1989. According to radiologic and operative findings, they were classified as follows; Grade I, 4 cases; Grade II, 7 cases; Grade III, 12 cases; Grade IV, 23 cases; and Grade V, 4 cases. Of the 50 patients, 39 had gross hematuria and remaining 11 patients had microscopic hematuria. There was no correlation between the degree of hematuria and the severity of renal injury (p=0.098). The major combined other organ injuries were hemoperitoneum in 12 cases, fracture of extremities in 8 cases, liver laceration in 5 cases, hemopneumothorax in 4 cases and intestinal perforation in 2 cases. Surgical treatment was performed in 27 cases (54%) and the remaining 23 cases (46%) which were renal laceration of various degrees without intraperitoneal injuries were managed conservatively.
Accidents, Traffic ; Extremities ; Female ; Hematuria ; Hemoperitoneum ; Hemopneumothorax ; Humans ; Intestinal Perforation ; Kidney ; Lacerations ; Liver ; Male ; X-Ray Film

Trichloroethylene is a very common chemical used principally as a solvent and a degreasing agent in industry, We have experienced a case of toxic erythema, toxic hepatitis, and subsequent exfoliative dermatitis possibly due to trichloroethylene in a 23-year-old male. He had dealed with a cleaning process with trichloroethylene in a factory of stainless steel materials. We report our case with the review of the toxicity of trichoroethylene.
Dermatitis, Exfoliative ; Drug-Induced Liver Injury* ; Erythema* ; Humans ; Male ; Stainless Steel ; Trichloroethylene* ; Young Adult

Two cases of clear cell syringoma are reported in the women who were 39 ad 54 years old, respectively. They had had asymptomatic, ricegrain-sized skin colored to yellowish pink papules on the face, particularly on he lower eyelid for several years. Interestingly, both of them had suffered from diabetes mellitus for more than a decade and been placed on irregular antidiabetic medications. Routine laboratory findings in the elder patient(case 2), unfortunately not checked in the younger patient(cases 1) due to her refusal, were within normal limits except marked glucosuria. Histologic examination revealed numerous various-sized, well-defined tumor nests composed largely of clear cells with polygonal cellular boundary and eccentric nucleus. Special stain with Periodic acid-Schiff disclosed existance of glycogen in the clear cells, but other special stains such as alcian blue showed negative findings. Electron microscopic examination of the elder patient revealed many multivesicular bodies suggestive of lysosomes, and numerous droplets of glycogen dispersed between them in villi-rich periluminal cell.
Alcian Blue ; Coloring Agents ; Diabetes Mellitus ; Disulfiram ; Eyelids ; Female ; Glycogen ; Humans ; Lysosomes ; Middle Aged ; Multivesicular Bodies ; Skin ; Syringoma*