Psoriatic arthritis is an uncommon disease in the community and probably occurs in no more than 5 percent of the general psoriatic population. The authors experienced a patient who had the findings of mutilating type of psoriatic arthritis with severe joint deformities. A 30 year-old man was admitted to our hospital due to multiple joint pain and deformities with wheel chair bound state. We report a case of mutilating type in the psoriatic arthritis with brief review of literatures.
Adult ; Arthralgia ; Arthritis, Psoriatic* ; Congenital Abnormalities ; Humans ; Joints ; Wheelchairs

Cardiovascular changes induced by a variety of physiological, surgical or emotional stresses are associated with increased sympathetic nervous system activtity. Sympathetic stimulation lowers the ventricular resistance in patients with ischemic heart disease. Thus sympathoadrenal aetivation may play role in sudden cardiac death. We measured the catecholamine levels just before and after fiberoptic gastroscopy, The results were as follows: 1) Though there was no statistical significance, plama catecholamine levels tends to increase during and after fiberoptic gastroscopy. 2) Significant changes in mean blood pressure did not occur during and after fiberoptic gastroscopy. 3) Before fiberoptic gastroscopy, norepinephrine level of three hypertensive patients were lower than the levels of studied patients, But during and after fiberoptic gastroacopy, norepinephrine level increased by 3 times. 4) The highest norepinephrine level was 847 pg/ml and epinephrine level was 110 pg/ml. Though sympathetic response was enhanced by fiberoptic gastroscopy, norepinephrine level did not increase up to the level shown in myocardial infarction or severe exercise.
Blood Pressure ; Death, Sudden, Cardiac ; Epinephrine ; Gastroscopy* ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Norepinephrine ; Stress, Psychological ; Sympathetic Nervous System

PURPOSE: To investigate the prevalence rate and risk factors for anterior polar cataract. METHODS: We examined the frequency of anterior polar cataract in 603 patients who had undergone cataract operation in the Department of Ophthalmology from July 1999 to July 2000. Moreover, we evaluated retrospectively the risk factor of 628 anterior polar cataracts and compared with that of 302 non-anterior polar cataract as well as with that of 552 non-cataract persons as a control from March 1995 to December 2000. This study defined risk factors related to the cataract formation as birth place, residence, occupation, sun-light exposure, drinking, smoking, systemic disease, long-term used drugs, family history, ocular trauma, glasses, and feminine parity. RESULTS: The prevalence rate of anterior polar cataract was 16.1% in total cataract patients, it had male of 81.4% and female of 18.6%. Average age of anterior polar cataract patients was 51.9 years; below fifty years was 44 patients (45.4%), 50~59 years 28 patients (28.9%), 60~69 years 16 patients (16.5%), over 70 years 9 patients (9.3%). Our findings for multivariate analysis that ocular trauma, intraocular disease in male and diabetes in female were significantly associated with anterior polar cataract. CONCLUSIONS: In conclusion, 16.1% of total cataract patients had anterior polar cataract; 81.4% was male and 45.5% was below fifty years of age.
Cataract* ; Drinking ; Epidemiologic Studies* ; Eyeglasses ; Female ; Glass ; Humans ; Male ; Multivariate Analysis ; Occupations ; Ophthalmology ; Parity ; Prevalence ; Residence Characteristics ; Retrospective Studies ; Risk Factors* ; Smoke ; Smoking

BACKGROUND: The two most commonly used drugs as a stressor during wtress echocardiography are dipyridamole and dobutamine. The purpose of this study was to compare diagnostic accuracies of dipyridamole and dobutamine stress echocardiography for fixed coronary artery disease and evaluate complications related to the two agents in the same patients. METHODS: 30(M : 5=19 : 11, age=56+/-8.8yr) consecutive patients without history of previous myocardial infarction underwent coronary angiography, dipyridamole and dobutamine stress echocardiography in random order. Dipyridamole was infused up to 0.84mg/Kg for 10 minutes during clinical, ECG and echocardiographic montioring. Dobutamine was infused in dose increments from 5 to 40microg/Kg/min under the same condition. Positive criteria for myocardial ischemia by echocardiography was now regional wall mation abnormatity or worsening of regional wall motion after stress. Significant coronary disease was defined as more than 70% stenosis by coronary angiography. RESULTS: The sensitivity and specificity of both stress echocardiography were same, 82% and 92% respectively. In a single vessel disease the sensitivity of dipyridamole echocardiography was 75% and dobutamine echocardiography was 83% without statistical difference. The correlation of ischemic free time during both stress test was 0.375. During dipyridamole infusion no test was prematurely terminated because of side effects, but 3 patients(10%) developed severe hypertension and ventricular arrytricular arrythmia during dobutamine infusion and test was terminated. CONCLUSION: Thus, by this prospective direct comparison of both stress test, dipyridamole and dobutamine stress echocardiography have similar diagnostic accuracies for the detection of coronary artery disease. But during dobutamine infusion, careful monitoring for hemodynamic changes arrythmia is required for possible serious complications.
Arrhythmias, Cardiac ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Dipyridamole* ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Electrocardiography ; Exercise Test ; Hemodynamics ; Humans ; Hypertension ; Myocardial Infarction ; Myocardial Ischemia ; Prospective Studies ; Sensitivity and Specificity

No abstract available.
Doxorubicin* ; Membrane Potentials* ; Membranes* ; Papillary Muscles*

BACKGROUND: Hypertonic solutions are using in emergency patients including refractory shock. The effects of the hyperosmotic solutions for the cardiac contractile effect has remained unclear. To study the mechanism of increase in twitch force by hypertonic solution, memberane potential, intracellular sodium activities(aNia), and twitch force were measured simultaneously in 1 Hz-driven canine Purkinje fibers and guinea pig papillary muscles. METHODS: To increase osmolarity, 20, 40, and 80 mOsm glucose, NaCl or mannitol was added to normal Tyrode solution. We used the conventional and Na(+)-selective microelectrodes, to study the membrane potential and intracellular sodium activity. Changes in twitch force were evaluated also by tension tranducer. RESULTS: 1) Hyperosmolar glucose or NaCl added to normal Tyrode solution produced membrane pontential hyperpolarization, increase in aNia, and increase in twitch force in dog Purkinje fibers. Increase in twitch force was related to decrease in the ratio of aNia to extracellular sodium activity(aNoa). NaCl-inducedd aNia increase was not blocked by 10(-5)M tetrodotoxin, a fast sodium channel blocker. 2) Hyperosmolar glucose or mannitol added to normal Tyrode solution produced membrane potential hyperpolarization, increase in aNia, and increase in twitch force in guinea pig papillary muscles. However, the addition of hyperosmolar NaCl did not affect on membrane potential, but produced increase in aNia, and decrease in twitch force. 3) Prolonging effect of hyperosmolar glucose on duration of action potential was smaller than that of NaCl or mannitol in Purkinje fibers and papillary muscles. 4) Increase in twich force produced by ECF Na+reduction or by hyperosmotic solution was reated to decrase in the aNia ratio. 5) Relationship curve between increase in twitch force and aNoa/aNia ratio in hyperosmolr solution was less steeper than that in ECF Na(+)-reduced solution. CONCLUSION: The above results suggested that hyperosmolar solution-induced twitch force change was related to aNoa/aNia ratio change which influenced intracellular calcium activity via Na(+)-Ca(2+)exchange.
Action Potentials ; Animals ; Calcium ; Dogs ; Emergencies ; Glucose ; Guinea Pigs ; Humans ; Hypertonic Solutions ; Mannitol ; Membrane Potentials* ; Membranes* ; Microelectrodes ; Muscles* ; Osmolar Concentration ; Papillary Muscles ; Purkinje Fibers* ; Shock ; Sodium Channels ; Sodium* ; Tetrodotoxin

Gerstmann syndrome that was caused by a traumatic origin was very rare. We have reported a case of typical Gerstmann syndrome which was caused by a localized head injury. The case showed finger agnosia, right-left disorientation, acalculia and dysgraphia. And also the case revealed amnesic dysphasia and autotopagnosia. The lesion was an egg-shell typed depressed fracture(4 cm in diameter) of the left inferior parietal bone associated with the intracerebral hematoma in the lower parietal lobe which seemed to be the transitional area of the angular gyrus and the second occipital convolution.
Agnosia ; Agraphia ; Aphasia ; Craniocerebral Trauma ; Dyscalculia ; Gerstmann Syndrome* ; Hematoma ; Parietal Bone ; Parietal Lobe

We have reported a case of dumbbell shaped maligfnant melanoma which developed and formed a large mass(2x7x5 cm) in the frontal scalp at the midline, eroded the bone, and invaded directly into the epidural region through the bony defect and formed another large tumor(3x7x8 cm) in the frontal fossa. Several small nodules of malignant melanoma were found in the anterior chest wall, too. In spite of the huge mass in the frontal fossa the case developed only dull headache without any neurological deficits. The frontal mass was successfully excised, of which pathological finding showed malignant melanoma.
Cytochrome P-450 CYP1A1 ; Headache ; Melanoma* ; Scalp ; Thoracic Wall

BACKGROUND: Bupivacaine is a potent, and commonly used, long acting local anesthetic. If accidentally injected into the systemic circulation, bupivacaine can cause lethal dysrhythmias and circulatory collapse. Attempts to treat bupivacaine induced cardiac toxicity have been varied and controversial, and they have not been very successful. The aim of this study was to investigate the electrophysiologic effects of bupivacaine in Purkinje fibers. METHODS: Effects of bupivacaine on the membrane potential were studied in 12 isolated canine Purkinje fibers. Purkinje fibers from ventricle were dissected and mounted in a tissue chamber perfused with Tyrode's solution. Transmembrane potentials recorded through glass microelectrodes filled with 3M KCI in the beating or quiescent Purkinje fibers during infusions of bupivacaine at concentratons of 3*10/-7M,10/-6M, 3*10/-6M,10/-5M, and 3*10/-5M. RESULTS: Bupivacaine reduced action potential druation in a dose-dependent manner. Bupivacaine produced a decrease in intracelullar sodium ion activity in driven(1Hz) and quiescent canine Purkinje fibers. Bupivacaine-induced hyperpolarizaton of diastolic membrane potential in quiescent Purkinje fibers was dose dependent, and the hyperpolarization by bupivacaine was attenuated by depolarization induced by high potassium extracellular concentration in part. CONCLUSIONS: These results suggest that bupivacaine decreases the fast inward sodium current, and inhibits pacemaker current in canine Purkinje fibers.
Action Potentials ; Bupivacaine* ; Glass ; Membrane Potentials* ; Membranes* ; Microelectrodes ; Potassium ; Purkinje Fibers ; Shock ; Sodium ; Sodium Channels

We describe a case of fine needle aspiration cytology of metastatic nasopharyngeal carcinoma in the lymph node of the neck presenting a predominantly spindle cell pattern. A 36 year-old male patient complained of dysesthesia on the right face and a palpable neck mass. Fine needle aspiration was done on the neck mass. Tumor cells were present in syncytial groups or singly with mainly spindle shaped nuclei, vesicular chromatin, thin and regular nuclear membrane, occasional prominent nucleoli and a few foci of cellular cohesiveness. The cytoplasm was scant and pale with ill-defined borders. Mature lymphocytes were present in the background of aspirates and within the tumor cell clusters. Histologically, the tumor of nasopharynx showed several areas of spindle cell pattern. Because the tumor cells showed a predominantly spindle shape with vesicular nuclear chromatin, the differential diagnosis of spindle cell sarcoma or granuloma of epithelioid cells were considered, but the characteristic morphology of the nuclei with vesicular chromatin and prominent nucleoli, and cellular cohesiveness were important in making the diagnosis of nasopharyngeal carcinoma. The possibility of metastatic carcinoma should always be considered in fine needle aspiration cytology of the lymph node in the neck because the incidence of metastatic carcinoma, particularly of the nasopharyngeal carcinoma in the lymph nodes of the neck is relatively high.
Child ; Male ; Female ; Humans ; Diagnosis, Differential ; Incidence ; Neoplasm Metastasis