Creutzfeldt-Jakob disease(CJD) is characterized clinically by rapidly progressive dementia with pyramidal, extrapyramidal, and cerebellar symptoms and signs, and histologically by spongiform change, neuronal loss and reactive gliosis. We have experienced 2 cases of CJD. Case 1 was a 36-year-old male who had suffered from myoclonus and cerebellar symptoms including sluggish speech, gait and balance disturbance. Case 2 was a 70-year-old female who had showed cognitive dysfunction, ataxic gait and disturbance of extraocular movement. Both patients, underwent brain biopsy. Case 1 revealed marked cortical atrophy, 2mm in thickness, with neuronal loss and astrocytic proliferation extending into white matter. The spongiform change, made up of many small, usually rounded or oval, vacuoles was noted mainly in the neuropil. Case 2 revealed remarkable spongiform change throughout the cortex and cytoplasmic vacuoles compressing the nuclei of neuronal cells were numerous. Neuronal loss and gliosis were also found without considerable change in the white matter. On double immunostaining against GFAP and PrP(Prion Protein), there was a weak positive reaction for PrP in the perinuclear cytoplasm in case 1, and a strongly positive reaction in case 2. The electron microscopic examination showed numerous membrane-bound vacuoles in neuropil and perikarya of neurons. The majority of the vacuoles were multiseptated by thin membranous structures. They demonstrated curled, or disrupted membrane, that had foldings and protrusions into the vacuolar clear spaces. There were neither identifiable virus-like particles nor amyloid deposition.
Female ; Male ; Humans

Fractures of the phalanges of the hand are very common. Many are minor and likely to have a good result. However many other phalangeal fractures cause significant and prolonged disability. Non-union of the tubular bones of the hand are uncommon occurrence, but are often associated with functional deficits. The authors have reviewed 7 cases of non-union of the phalanges which were treated in the department of orthopaedic surgery, National Medical Center from 1978 to 1985. The results were summarized as follows: 1. The non-union of phalangeal bone was defined by clinical symptoms and signs and roentgenological examination. 2. The incidence of non-union of phalangeal bone fractures was 0.9% (7/771 cases.) 3. of 7 patients, there were 6 in male and 1 in female. 4. Non-union occurred more commonly in the second decade and the group between 10 and 30 years of age. 5. Seven cases, all were the right handed, but injury was developed in the left hands except two cases. 6. The causes of non-union were thought as open wound (7 cases), type of fracture (simple or comminution:3 cases), inadequate immobilization (4 cases) and overtraction (1 case). 7. of 7 cases, 4 cases were treated with bone peg graft and K-wire fixation and 2 cases with excision of distal fragment. 8. The clinical union was 9 weeks in average.
Clinical Study ; Female ; Fractures, Bone ; Hand ; Humans ; Immobilization ; Incidence ; Male ; Transplants ; Wounds and Injuries

The importance of vegetables as a allergen for the development of hand eczema has been a matter of debate. The aim of this study was to evaluate the clinical manifestations of hand eczema and to investigate the role of vegetables in the hand eczema of Korean housewives. In this study, clinical evaluatons and patch tests with Hollister-Stier standard allergens and 22 vegetable allergens wer performed in 32 patients with housewife's hand eczema. The results are summarized as follows : 1. The prevalence was highest in fourth(59.4%) and third(25.0%) decades of life and the peak age of onset was third(53.1%) and fourth(31.3%) decades. 2. Only 3 of 32 patients(9.4%) had past histories of atopic dermatitis ; however, childrens of 12 patients(37.5%) had atopic dermatitis. 3. The common skin signs were fissuring(90.6%), scaling(78.1%), erythema(75.0%), hyperkeratosis(71.9%), lichenification(62.5%), and vesicle(43.8%) in descending order. 4. The common aggravating factors were soap or detergent(93.8%), water(90.6%) and rubber glove(25.0%). 5. The most common involved areas of hand eczema were fingers including fingertips and fingertips only. 6. The results of patch test using vegetable allergens with 10 normal controls were all negative. Of the 32 patients with hand eczema, 13(37.5%) showed positive patch test with standard allergens and 5(15.6%) showed positive with vegetable allergens. 7. Among 30 standard allergens, cinnamic alcohol(9.4%). potassium dichromate(9.4%), nickel sulfate(6.3%), and wool wax alcohol(6.3%) were the common allergens which showed positive reactions. Of the 22 vegetable allergens, garlic, Chinese cabbage juice, Chinese cabbage extract, cucumber juice, spinach extract, potato juice showed weak positive reactions in only one patient(3.1%) respectively. From the above results contact sensitivity to vegetables is not significant in Korean housewives with hand eczema.
Age of Onset ; Allergens ; Asian Continental Ancestry Group ; Brassica ; Child ; Dermatitis, Atopic ; Dermatitis, Contact ; Eczema* ; Fingers ; Garlic ; Hand ; Humans ; Nickel ; Patch Tests* ; Potassium ; Prevalence ; Rubber ; Skin ; Soaps ; Solanum tuberosum ; Spinacia oleracea ; Vegetables* ; Wool

No abstract available.
Liver*

We report a patient with a previously undiagnosed spine metastasis that developed into paraplegia following a continuous epidural block. This is an uncommon and quite rare complication. A 52-year-old male hepatoma case with upper abdominal cancer pain was indicated for a celiac plexus block. A continuous epidural block was performed prior to the celiac plexus block. A Tuohy needle was introduced at the Tll-12 interspace and an epidural catheter was inserted about 15cm in length cephalad through the needle. During the procedure, a saline solution was infused through the Tuohy needle and epidural catheter. The tip of the catheter was expected to be near the T, level. The upper abdominal pain was subsided after the injection of 3 ml of 1% lidocaine and 3 ml of 0.5% bupivacaine via the epidural catheter around noon time. When we made ward rounds that evening, the patient complained of motor weakness and sensory change below T; however, the local anesthetics were injected continuously through the epidural catheter every 4 hours. Next morning, because the patient complained of paraplegia, the epidural injection was discontinued. Under the suspicion of spinal cord compression, a computed tomogram of the thoracic spine was taken. It showed an osteolytic destruction of the right pedicle of T, due to a metastatic tumor. This suggested subclinical tumor invasion to the epidural space. The infusion of saline and local anesthetics through the Tuohy needle and the epidural catheter may increase the epidural pressure and compress the spinal cord. A laminectomy was refused by the family and the patient was discharged from the hospital after 6 treatments of radiotherapy without any improvement. It is advisable to take a spine CT or bone acan in terminal cancer patients before an epidural block, and when paraplegia develops after an epidural block.
Abdominal Pain ; Anesthetics, Local ; Bupivacaine ; Carcinoma, Hepatocellular* ; Catheters ; Celiac Plexus ; Epidural Space ; Humans ; Injections, Epidural ; Laminectomy ; Lidocaine ; Male ; Middle Aged ; Needles ; Neoplasm Metastasis* ; Paraplegia* ; Radiotherapy ; Sodium Chloride ; Spinal Cord ; Spinal Cord Compression ; Spine*

BACKGROUND: Transforming growth factor (TGF)- has a large variety of biological functions, including the modulation of inflammation and the immune system, and is presumed to play important roles in repairing wounds and reducing scarring. The objective of this study is to examine the effects of TGF-1 on healing wounds and reducing scarring. We have also analysed the ability of the hemagglutinating virus of Japan (HVJ) liposome mediated antisense oligodeoxynucleotides (ODNs) to specifically inhibit wound-induced expressions of TGF-1 proteins and mRNA in the rat skin. METHODS: Skin wounds were created on the backs of 80 anesthetized rats. The first group of wounds, as the controls, was unmanipulated. The second group of wounds, as positive controls or an excessive scarring model, was injected with TGF-1 subcutaneously. The third group of wounds was injected with anti-TGF-1 antibody subcutaneously. The fourth group of wounds was injected with HVJ liposome mediated antisense ODNs for TGF-1 subcutaneously. The wounds of all groups were bisected and analysed histologically 5, 10, 15, 30, and 50 days after the wounds were made. RESULTS: All control wounds (TGF-1 or no injection) healed with scarring, whereas the wounds treated with the antibody or antisense ODNs healed with less scar formation compared to the control group. The wounds treated with the antibody or antisense ODNs had fewer macrophages, less collagen and fibronectin contents than the other wounds. Northern blotting and in situ hybridization analysis showed that wound sites treated with HVJ liposome mediated antisense ODNs for TGF-1 exhibited decreased levels of TGF-1 mRNA after injury. CONCLUSIONS: These findings suggest an important new approach to controlling scarring in normal wound healing, complementing the practice of adding exogenous growth factors to chronic wounds in the attempt to inhibit collagen deposition.
Animals ; Blotting, Northern ; Cicatrix* ; Collagen ; Complement System Proteins ; Fibronectins ; Genetic Therapy* ; Immune System ; In Situ Hybridization ; Inflammation ; Intercellular Signaling Peptides and Proteins ; Liposomes ; Macrophages ; Oligodeoxyribonucleotides ; Oligoribonucleotides ; Rats ; RNA, Messenger ; Sendai virus ; Skin ; Transforming Growth Factor beta ; Transforming Growth Factors ; Wound Healing ; Wounds and Injuries

Repairing of lacrimal canalicular laceration has some controversies on the golden time of surgery, the suture method, and the materials for stent. Recently, intubation of silicone tubes has become popular for repair of lacrimal canalicular injuries. Thirty-two cases of injured lacrimal canaliculi were repaired with use of silicone tube stents. The surgery can be done with monocanalicular(10 patients) or bicanalicular(22 patient) methods. The follow-up period was from two to eighteen months(mean ten months). Seven cases using the monocanalicular method and nineteen cases using the bicanalicular method were successful. Three cases of monocanalicular method had epiphora with canalicular obstruction due to early loss of the silicone tube. In monocanalicular method, postoperative complications were punctal granuloma(1 case), punctal slits(2 cases), and early loss of the silicone tube(3 cases). In bicanalicular method, postoperative complications were persistent epiphora during the period of intubaion(4 cases), conjunctival irritation sign(3 cases) and loop retraction(1 case). In conclusion, the success rate of bicanalicular stents were higher than that of monocanalicular stents for canalicular laceration. But the bicanalicular stent had some complications including cosmetic problem, possibility of injuries to the normal canaliculus during intubation, conjuntival irritation sign, and loop retraction.
Follow-Up Studies ; Intubation* ; Lacerations ; Lacrimal Apparatus Diseases ; Postoperative Complications ; Silicones* ; Stents ; Sutures

The relationship between obesity and ketonuria is not well-established. We conducted a retrospective observational study to evaluate whether their body weight reduction response differed by the presence of ketonuria after fasting in the healthy obese. We used the data of 42 subjects, who had medical records of initial urinalysis at routine health check-up and follow-up urinalysis in the out-patient clinic, one week later. All subjects in the initial urinalysis showed no ketonuria. However, according to the follow-up urinalysis after three subsequent meals fasts, the patients were divided into a non-ketonuria group and ketonuria group. We compared the data of conventional low-calorie diet programs for 3 months for both groups. Significantly greater reduction of body weight (-8.6 +/- 3.6 kg vs -1.1 +/- 2.2 kg, P < 0.001), body mass index (-3.16 +/- 1.25 kg/m2 vs -0.43 +/- 0.86 kg/m2, P < 0.001) and waist circumference (-6.92 +/- 1.22 vs -2.32 +/- 1.01, P < 0.001) was observed in the ketonuria group compared to the non-ketonuria group. Fat mass and lean body mass were also more reduced in the ketonuria group. In addition, serum free fatty acid concentration after intervention in the ketonuria group showed significant more increment than in the non-ketonuria group. The presence of ketonuria after fasting may be a predicting factor of further body weight reduction.
Adult ; Diet, Reducing ; Fasting/*physiology ; Female ; Humans ; Ketosis/*complications/*pathology ; Male ; Middle Aged ; Obesity/*complications/diet therapy/pathology/*urine ; Retrospective Studies ; Weight Loss/*physiology

PURPOSE: We investigated how serum low-density lipoprotein (LDL) level is related to various isoforms of apolipoprotein (ApoE) polymorphism in association with obesity and metabolic syndrome. MATERIALS AND METHODS: We gathered total 332 sample of postmenopausal Korean women and analyzed ApoE isoforms, serum lipid level including LDL, blood pressure, fasting glucose, and anthropometry. The relationship between ApoE isoforms and serum lipid level, metabolic syndrome, and obesity was investigated. RESULTS: Six ApoE isoforms were found, ApoE2 [E2/2 (n=1), E2/3 (n=54), E2/4 (n=14)], ApoE3 (E3/3, n=200), ApoE4 [E3/4 (n=55), and E4/4 (n=8)]. The prevalence of metabolic syndrome and obesity showed higher ApoE3 isoform than that of other isoforms. In additon, ApoE3 isoform was related to higher serum LDL and total cholesterol level than to ApoE2 isoform. The odds ratio of having the highest LDL cholesterol quartile in ApoE3 with obesity, compared to ApoE2 without obesity, was 3.46 [95% confidence interval (CI); 1.07-11.14, p=0.037], and odds ratio of ApoE3 with metabolic syndrome compared to ApoE2 without metabolic syndrome was 5.06 (95% CI; 1.14-22.29, p=0.037). Serum LDL cholesterol was positively associated with obesity or metabolic syndrome in ApoE3 isoform. CONCLUSION: This study suggests that obesity or metabolic syndrome risk should be effectively managed in ApoE3 isomform groups to reduce serum LDL in postmenopausal Korean women.
Aged ; Apolipoproteins E/*genetics ; Cholesterol, LDL/*blood ; Female ; Humans ; Middle Aged ; Obesity/*blood ; *Polymorphism, Genetic ; Postmenopause/*blood ; Republic of Korea ; Syndrome

If in the aneurysmal rupture patients the brain metabolic parameters obtained from blood chemistry were significant and useful in clinical practice, it cannot be overstimated. Hansdorfer er al.(1973) reported that lactate, pyruvate, uric acid and alpha-HBDH of central venous blood obtained form the patients with brain contusion in basal metabolic state were significantly increased and they were useful in evaluating the prognosis of the patients. Zooping(1970) and Broderson(1974) also had tried to evaluate the prognosis and brain metabolic status of the comatous patients with blood gas analysis and CSF biochemistry. They encouraged us to estimate lactate and lactate/pyruvate ratios of canine jugular venous blood combined with gas analysis. Complete cerebral bloody-ischemia similar with initial stage of aneurysmal rupture was induced by the instanteneous elevation of intracranial pressure 30 mmHg above systemic arterial pressure by infusion of blood and mock CSF mixture into the cisterna arrest or pulmonary hypertension were discarded. At the end of the 5 minutes ischemic period, the needle tip which was inserted in to cisterna magna was removed without decreasing intracranial pressure. At 3 hours, 24 hours, 48 hours and 72 hours after ischemic period jugular venous and arterial blood were sampled for determination of lactate and pyruvate, and blood gas analysis. The following results were obtained. ie ; 1. Both lactate and pyruvate of canine jugular venous blood were increased from 3 hours and reached peak level at 24 hours after insult. Standard value of lactate and pyruvate were 1.416mM and 0.075mM and peak values were 2.429 and 0.165mM(P<0.05). 2. The more severe the neurological deficits of the animals, the highest levels of lactate and pyruvate were observed. 3. The lactate concentrations in 48 hours and 72 hours sample slopped down from 24 hours peak level but were significantly higher than those of standard. 4. Pyruvate returned to the normal range within 48 hours after insult. 5. L/P ratios were not changed significantly until 48 hours after insult but steeply elevated in 72 hours sample. 6. In gas analysis all the animals show respiratory alkalosis after insult. 7. In arterial boundary zones multiple focal ischemia were found in necropsy which was thought as reflecting no-reflow phenomenon. We concluded that elevation of lactate and pyruvate in early stage must be due to the hyperventilation after insult and lactate of late stage reflected CSF lactic acidosis.
Acidosis, Lactic ; Alkalosis, Respiratory ; Aneurysm ; Animals ; Arterial Pressure ; Biochemistry ; Blood Gas Analysis ; Brain ; Brain Injuries ; Chemistry ; Cisterna Magna ; Humans ; Hypertension, Pulmonary ; Hyperventilation ; Intracranial Pressure ; Ischemia ; Lactic Acid* ; Needles ; No-Reflow Phenomenon ; Prognosis ; Pyruvic Acid ; Reference Values ; Rupture ; Uric Acid