The isolated spleen involvement is a rare presentation of Langerhans cell histiocytosis (LCH) and can lead to a misdiagnosis. We report a case of LCH in an infant presentated isolated splenomegaly and prolonged fever. A 1-month-old girl admitted due to petechiae, presented with fever for a week and splenomegaly, and showed marginal improvement on empirical treatment. The fever and progressive spleen enlargement persisted over 4 weeks and the cause remained unclear, even after thorough evaluation including bone marrow aspiration and biopsy. LCH was confirmed by splenectomy, and involvement of other organs was excluded. Splenectomy is valuable in the diagnosis of LCH presented with isolated splenomegaly without other organ involvement which may show more aggressive clinical course, but it should be limited to absolutely necessary indications.
Biopsy ; Bone Marrow ; Diagnosis ; Diagnostic Errors ; Female ; Fever of Unknown Origin ; Fever ; Histiocytosis, Langerhans-Cell ; Humans ; Infant ; Infant, Newborn ; Purpura ; Spleen ; Splenectomy ; Splenomegaly

PURPOSE: To evaluate the prognostic factors for disease-free survival and long-term results of radiotherapy for pituitary adenoma. METHODS AND MATERIALS: The study involved a retrospective review of outcome in a series of 27 patients with pituitary adenoma, between 1984 and 1995 at Paik hospital. The study included 20 patients treated with surgery and postoperative radiotherapy and 7 with radiotherapy alone. The patients were followed for 12-146 months (median : 97 months). Seventeen were men and 10 were women. The numbers of functioning and non-functioning pituitary adenoma were 22 and 5 respectively and those of microadenoma and macroadenoma were 4 and 23 respectively. The radiation doses of 5040-5580cGy (median : 5040cGy) were deliverd over 5-7 weeks, using 4MV LINAC. The prognostic factors were analyzed by log-rank test. RESULTS: For radiation therapy alone, the 5YSR was 100% and progression free survival rate was 85.8%. The tumor was controlled in 6/7 (85.8%). For surgery and postoperative radiotherapy, the 5YSR, progression free survival rate and local control rate were 95%, 84.8%, and 89.5% respectively. The parameters of tumor size, hormone secretion, radiation dose, radiotherapy field size were evaluated in a uni- and multivariate analysis and all the factors were not statistically significant (P > 0.05). Eleven of 12 (92%) with visual field defect experienced normalization or improvement, and 5 for 7 evaluable patients with hyperprolactinoma achived normalization in 4 and decrement in 5 patients. Only 2 patients developed mild degree of panhypopituitarism. CONCLUSION: The radiotherapy appears to be effective in controlling clinical symptoms and signs resulting from pituitary adenoma. Local control rate with radiotherapy alone or with surgery and postoperative radiotherapy was comparable. There was a trend toward high recurrence rate in patients with nonfunctioning or prolactin secreting tumor and larger radiation field sizes.
Disease-Free Survival ; Female ; Humans ; Male ; Multivariate Analysis ; Pituitary Neoplasms* ; Prolactin ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Visual Fields

Objective: To determine the factors affecting the amount of weight-bearing during gait training in the elderly patients who underwent internal fixation after femur or pelvic fractures and how well they performed the weight-bearing restriction as directed by the physiatrist. Methods: In this retrospective chart review study, we measured the amount of weight-bearing on the affected side in 50 patients undergoing internal fixation surgery and rehabilitation after femur or pelvic fracture using a force plate. Patients receiving non-weight-bearing or partial weight-bearing education were considered to perform weight-bearing restriction well when the amount of weight-bearing was <50 lb. Furthermore, regression analysis was performed to determine the effects of postoperative complications, age, cognitive function, and pain on weightbearing restriction. Results: Variables affecting the amount of weight-bearing were age (r=0.581, p<0.001), weight-bearing education type (r=0.671, p<0.001), manual muscle strength of hip flexion on the non-affected side (r=-0.296, p=0.037), hip abduction (r=-0.326, p=0.021), knee extension (r=-0.374, p=0.007), ankle plantar flexion (r=-0.374, p=0.008), right hand grip strength (r=-0.535, p<0.001), Korean version of Mini-Mental State Examination (r=-0.496, p<0.001), Clinical Dementia Rating (r=0.308, p=0.03), and pain visual analog scale scores (r=0.318, p=0.024). The significant predictor of the amount of weight-bearing among these variables was age (β=0.448, p=0.001). The weight-bearing restriction adherence rate was significantly lower, at 22%, for patients aged ≥65 years as compared to 73% for those <65 years. Conclusion Age was a major variable affecting the amount of weight-bearing. Compliance with weight-bearing restriction was significantly lower in patients aged ≥65 years than in patients <65 years.

The facial flatness was studied by the metric method which involves six measurements of breadth and projection of the midfacial skeleton, the calculation of three indices from the measurements. The indices of the modern Korean adult crania, Korea & Chosun Dynasty crania, the Iron Age Korean crania, and the late Neolithic Korean crania were investigated. The indices were compared to those of other published data on the Korean crania and those of neighboring asian races as well. All indices for facial flatness of Korea & Chosun Dynasty were similar to modern Korean. However, zygomaxillary index was different between modern and late Neolithic crania. The difference of zygomaxillary index was prominent in males than females. The difference of facial flatness between modern and ancient seems to be mainly due to zygomatic breadth. The frontal indices of modern Korean and Korea & Chosun Dynasty crania were relatively low and the simotic indices were relatively high among neighboring asian races. The zygomaxillary index is intermediate. Clustering analysis represented that the flatnesses of the modern Korean crania and Korea & Chosun Dynasty crania were closely related to those of the northern Chinese, modern Japanese, however, somewhat different from that of ancient Korean, Mongol, Siberian etc.
Adult ; Asian Continental Ancestry Group ; Continental Population Groups ; Female ; Humans ; Iron ; Korea ; Male ; Skeleton

No abstract available.
Aneurysm, False ; Catheterization ; Catheters ; Humans ; Takayasu Arteritis

In this research, the author investigated antitumor effects of green tea catechin on cancer cell lines in various concentrations and durations. Additionally, antitumor mechanism of catechin associated with apoptosis and necrosis, especially their onset and duration were invesigated. Cancer cell lines, L1210 (lymphocytic leukemia), L929 (fibrosarcoma), HepG2 (hepatoblastoma) were used. In each group, intensity of morphological changes and cell damage was observed under inverted, light, confocal and electron microscopes, and MTT and flowcytometric analysis, gel electrophoresis were used to elucidate the effects of catechin after exposure to 1, 10, 100 and 500 microgram/ml catechin until 72 hours. In all cancer cell lines, catechin induced cellular injury and inhibition of proliferation in concentration- and duration-dependent manner. The effects of catechin were the strongestt in L1210 cells and L929 and HepG2 cells in order. Dual phenomena, of apoptosis and necrosis, were shown after catechin treatment. In necrotic cells, cellular swelling, cell organelles destruction, nuclear disintegration and random DNA fragmentation were observed. In apoptotic cells, apoptotic bodies, nuclear and cytoplasmic condensations, periodic DNA fragmentation were seen. In L1210 cells, necrotic and apoptotic cells were co-existed earlier, after exposure to catechin 100 microgram/ml and then apoptosis predom-inated later. In the same concentration, catechin induced apoptosis of L929 cells. but after exposure to 500 microgram/ml catechin, They were involved with apoptosis and necrosis simultaneously. On the other hand, HepG2 cells were damaged less than other cell lines but were involved with necrosis and inhibition of G2/M phase after treatment with 500 microgram/ml catechin. These results suggested that anti-tumor mechanism of catechin, associated with apoptosis, necrosis and cell cycle arrest, were quite different according to cancer type, concentration and duration of catechin treatment. Therefore, much more research would be essential for clinical application of catechin and this study would be the basic source for further study of green tea.
Apoptosis ; Catechin* ; Cell Cycle Checkpoints ; Cell Line* ; Cytoplasm ; DNA Fragmentation ; Electrophoresis ; Hand ; Hep G2 Cells ; Necrosis ; Organelles ; Tea*

BACKGROUND: The role of antidepressants (ADs) in bipolar disorder is long-standing controversial issue in psychiatry. Many clinicians have used ADs as a treatment for bipolar depression, and the selection of therapeutic agents is very diverse and inconsistent. This study aimed to examine recent AD prescription patterns for patients with bipolar disorder in Korea, using the nationwide, population-based data. METHODS: This study utilized the Korean nationwide, whole population-based registry data of the year 2010, 2011, and 2013. All prescription data of the ADs, antipsychotics, and mood stabilizers of the sampled patients diagnosed with bipolar disorder (n = 2,022 [in 2010]; 2,038 [in 2011]; 2,626 [in 2013]) were analyzed for each year. RESULTS: Annual prescription rate of ADs was 27.3%–33.6% in bipolar disorder, which was gradually increasing over the 3-year period. The combination pattern of ADs and antipsychotic drugs tended to increase over 3 years. The proportion of females and the prevalence of comorbid anxiety disorder were significantly higher in AD user group in all three years. Among individual ADs, escitalopram was prescribed most frequently, and fluoxetine and bupropion were prescribed to the next many patients. The mean duration of bipolar depressive episodes was 135.90–152.53 days, of which ADs were prescribed for 115.60–121.98 days. CONCLUSION: Our results show prescription rate of ADs in bipolar disorder was maintained at substantial level and increased in recent 3 years. More empirical data and evidence are needed to establish practical treatment consensuses.
Antidepressive Agents ; Antipsychotic Agents ; Anxiety Disorders ; Bipolar Disorder* ; Bupropion ; Citalopram ; Consensus ; Female ; Fluoxetine ; Humans ; Korea* ; Prescriptions* ; Prevalence

Pnuemocystis jirovecii pneumonia (PJP) is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV), and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO) treatment for respiratory failure associated with severe PJP in HIV-infected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART) initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.
Antiretroviral Therapy, Highly Active* ; Extracorporeal Membrane Oxygenation* ; HIV ; Humans ; Mortality ; Pneumocystis jirovecii* ; Pneumocystis* ; Pneumonia* ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Respiratory Insufficiency ; Salvage Therapy

Levetiracetam has not been reported to cause purpura. We report a case of purpura associated with levetiracetam. A 81-year-old man suffered from post-stroke seizure. Seizure was well controlled with valproate. Valproate was discontinued due to pancytopenia and levetiracetam was prescribed when he was admitted with pneumonia. A few days later, he recovered from pancytopenia and pneumonia. However, he was rehospitalized due to multiple variable sized-purpura on the whole body surface without thrombocytopenia. After discontinuing levetiracetam, purpura disappeared.
Aged, 80 and over ; Humans ; Pancytopenia ; Piracetam ; Pneumonia ; Purpura ; Seizures ; Thrombocytopenia ; Valproic Acid

McCune-Albright syndrome (MAS) is a rare disorder that develops from an activating mutation in the Gs gene. It is characterized by an association with Polyostotic fibrous dysplasia, and precocious puberty, Caf-au-lait pigmentation, and other endocrinopathies that result from the hyperactivity of a variety of endocrine glands. Recently we encountered a patient with MAS with fibrous dysplasia, skin pigmentation, acromegaly, hyperprolactinemia and a thyroid nodule. A 23-year-old male presented for an evaluation of a change in his facial structures. Fibrous dysplasia was diagnosed by a bone biopsy and radiographic studies. The GH level increased paradoxically after an oral glucose load. The plasma prolactin, IGF-1 and alkaline phosphatase were high. Thyroid ultrasonography revealed multiple nodules. The brain MRI demonstrated a mass in the left pituitary gland. Genetic analysis identified a change from Arg (CGT) at codon 201 to Cys (TGT).
Thyroid Diseases/etiology/genetics ; Puberty, Precocious/etiology/genetics ; Mutation ; Male ; Hyperprolactinemia/etiology/genetics ; Humans ; GTP-Binding Protein alpha Subunits, Gs/*genetics ; Fibrous Dysplasia, Polyostotic/*diagnosis/genetics/pathology ; Cafe-au-Lait Spots/etiology/genetics ; Adult ; Acromegaly/*diagnosis/etiology