Both idiopathic pulmonary fibrosis (IPF) and pulmonary involvement of collagen vascular disease(CVD) are well known cause of diffuse interstitial lung disease which lead to fibrosis and honeycombing. We analyzed HRCT findings of 33 patients with IPF and 14 patients with CVD in terms of predominant pattern, site of involvement, mediastinal lymph node enlargement, pleural change and pulmonary volume loss. Criteria of mediastinal lymph node enlargement and pleural thickening were 15mm in long diameter and 3mm, respectively. Volume loss of the lung was measured by using hilar height ratio (apex to hilum/hilum to diaphragmatic dome). Mean age was 61 years for IPF and 46 years for CVD and male: female ratio was 27:6, 4:10, respectively. Predominant HRCT pattern was honeycombing for IPF (63%), and ground-glass opacity for CVD (66%) (p=0.001). Predominantly, subpleural involvement was seen in 90% for IPF and 74% for CVD. Mediastinal lymph node enlargement was seen in 47% of the patient with IPF and 14% with CVD (p=0.004). pleural thickening was seen in 97% of the patients with IPF and 42% with CVD (P=0.002), Pleural effusion was seen in 10% of the patients with IPF and 36% with CVD (P=0.009). Hilar height ratio of more than 1.5 was seen in 84% of the patients with IPF and 29% with CVD. In conclusion, our study shows that patients with IPF are prone to have more progressed stage of pulmonary fibrosis than the patients with CVD on HRCT.
Collagen* ; Female ; Fibrosis ; Humans ; Idiopathic Pulmonary Fibrosis* ; Lung ; Lung Diseases, Interstitial ; Lymph Nodes ; Male ; Pleural Effusion ; Pulmonary Fibrosis

A 36 year old infertile was diagnosed endometrial adenocarcinoma by endometrial biopy due to vaginal bleeding. She was characterized by obesity, hirsutism and infertility. Diagnosis was confirmed endometrial adenocarcinoma(Geade I) associated with polycystic ovarian disease postoperatively. We experienced this case and so report this case with a brief review of literatures.
Adenocarcinoma* ; Adult ; Diagnosis ; Female ; Hirsutism ; Humans ; Infertility ; Obesity ; Ovarian Diseases* ; Uterine Hemorrhage

BACKGROUND: Most febrile neutropenic patients are treated in an aggressive manner. However, identification of low-risk patients may enable clinicians to administer risk-based treatment. The object of this study is to certify the factors associated with increased risk at the time of visiting the emergency department. METHODS: This is a retrospective study. We reviewed the medical records of 101 febrile neutropenic patients who had visited the emergency department of Seoul National University Hospital from January 1998 to August 1999. We assumed 22 risk prediction factors that could be assessed at admission to the emergency department and 5 factors that could be assessed during treatment course. To find independent risk-prediction factors, we analyzed these factors respectively by using multiple regression analysis. RESULTS: Tachycardia(aOR=136.5), altered mentality(aOR=28.8), decreased renal function(aOR=20.1), and significant comorbidity(aOR=17.2) are the independent factors associated with higher mortality. Altered mentality(aOR=31.6) and decreased renal function(CCr<75ml/min, aOR=5.4) are those associated with a higher incidence of septic shock. Independent factors associated with persistent(more than 3 days) fever are the early(within 10 days) onset of fever after last chemotherapy(aOR=8.8) and the existence of new pulmonary infiltrates on a simple chest X-ray(aOR=4.3). CONCLUSION: The stability of vital signs, the change of mentality, the renal function, the existence of significant comorbidity, the existence of new pulmonary infiltrates, and the rate of neutropenia are clinically useful risk-predication factors in febrile neutropenia at the time of visiting the emergency department.
Comorbidity ; Emergency Service, Hospital ; Febrile Neutropenia ; Fever ; Humans ; Incidence ; Medical Records ; Mortality ; Neutropenia ; Retrospective Studies ; Seoul ; Shock, Septic ; Thorax ; Vital Signs

Insulin autoimmune syndrome (IAS) includes fasting or reactive hypoglycemia, hyperinsulinemia and the presence of insulin-binding antibodies in patients who have never been exposed to exogenous insulin. This report concems a 29-year-old male patient with Graves disease who had history of having taken methimazole for two months, without any consequence, 6 months previously. However, when methimazole was administered again for three weeks, the patient suffered hypoglycemia during the next fourth week. He denied history of diabetes mellitus (DM), of taking any oral hypoglycemic agent or of having received insulin injection. Laboratory data showed total serum insulin level > 300 pu/mL, C-peptide reactivity (CPR) 8.0ng/mL and insulin antibody 89%. After stopping methimazole, he was treated with radioiodine (131I). There was no episode of hypoglycemic attack during 8 months of follow-up.
Adult ; Antibodies ; C-Peptide ; Diabetes Mellitus ; Fasting ; Follow-Up Studies ; Graves Disease* ; Humans ; Hyperinsulinism ; Hypoglycemia ; Insulin ; Male ; Methimazole

No abstract available.
Hypopigmentation*

BACKGROUND: Malassezia yeast are lipophilic fungi that are found in 75~80% of healthy adults. The yeast are known to be associated with pityriasis versicolor, seborrheic dermatitis, Malassezia folliculitis, and recently its pathogenicity is being expanded to other various skin disorders, such as atopic dermatitis and acne vulgaris. Up to present, mycological studies on Malassezia yeast have been carried out mostly through morphological analysis and biochemical analysis. Recently however, various molecular biological techniques are being preferred over morphological analysis, which is not a suitable method for establishing taxonomic relationship between species, and more or less time-consuming. OBJECTIVE: We sought to implement novel molecular biology technique, namely 26S rDNA PCRRFLP method in identifying and classifying Malassezia yeast, and assess its clinical applicability. METHODS: Eleven standard strains and eight clinical isolates were thoroughly examined with special attention to the shape of the colonies, size and change in media. Subsequently, the colonies were classified according to Gueho classification. For molecular analysis, RFLP analysis was carried out after DNA was isolated from each organism and 26S rDNA was amplified through PCR. The results of identification were confirmed by 26S rDNA sequencing. RESULTS: In PCR analysis to amplify the 26S rDNA, a 580bp PCR band was seen in all of eleven standard colonies. On analysis of PCR-RFLP of 26S rDNA using restriction enzymes Hha1 and BstF51, all of the database in the restriction pattern of each species was attained. On analyzing eight clinical isolates, a restriction pattern which was interspecifically distinguishable, was identified, and the result was in accord with the pattern obtained from 26S rDNA PCR-RFLP of standard colonies. Out of eight, seven clinical isolates colonies was in accord with the result of 26S rDNA PCR-RFLP. In order to assess the precision of 26S rDNA PCR-RFLP, 26S rDNA sequencing was performed, whose result was in accord with 26S rDNA PCR-RFLP analysis. CONCLUSION: As evidenced above, 26S rDNA PCR-RFLP analysis could provide a sensitive and rapid identification system for Malassezia species, which may be applied to epidemiological surveys and clinical practice
Acne Vulgaris ; Adult ; Classification* ; Dermatitis, Atopic ; Dermatitis, Seborrheic ; DNA ; DNA, Ribosomal* ; Folliculitis ; Fungi ; Humans ; Malassezia* ; Molecular Biology ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Skin ; Tinea Versicolor ; Virulence ; Yeasts*

Spinal fixation using pedicle screws has recently been the focus of increased attention, but the adequate size of pedicle screw and maximum percentage fill as related to the pedicle diameter and are not well known. The objects of this study were to determine the ideal ratio among pedicle, drill and screw diameter, and to determine the maximum percentage fill of the screw without significant decrease of pull-out strength. The materials used for the experiments were 376 thoracic pedicles obtained from the 38 young pigs, and the diameters of pedicles ranged from 3.0 to 8.5mm. After 40% to 100% drilling as compared to pedicle diameter, screws were inserted carefully, and measurements were taken of the outer pedicle changes and pull-out strengths, and adequate drill and screw sizes as related to the diameters of given pedicles were determined. It was found that pull-out strength was the strongest after 60% drill, and the larger the drill diameter, the smaller the holding power, and the larger the screw diameter, the greater the holding power. Maximum pull-out strength was seen at 80-90% fill with 60% drill. After sequentially drilling each pedicle with increasingly larger drill bits, larger screws could be inserted with pedicle changes such as expansion, cutout, split fracture, and comminuted fracture. after larger drilling up to 100%, pedicle screws with diameters smaller than 115% of measured pedicle diameters could be safly inserted without fracture and significant decrease of pull-out strength. It is concluded that effective percentages of drill and screw diameters to the pedicle diameter are 60% and 80-90% respectively, and pedicle screw up to 115% of measured pedicle diameter can be safely inserted into pedicle without significant decrease of pull-out strength. It is thought that fresh pedicle has elasticity and larger screw can be inserted to the pedicle with strong holding after larger drilling.
Elasticity ; Fractures, Comminuted ; Pedicle Screws ; Swine

BACKGROUND: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates. METHODS: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. RESULTS: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital, 101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). CONCLUSION: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.
Death Certificates* ; Education ; Emergencies ; Mortality ; Retrospective Studies ; Seoul

Actinic granuloma develops in the chronically sun-damaged skin of the neck, face, upper chest or arms. Lesions present as skin colored to erythematous papules and plaques that coalesce to form centrifugally enlarging annular patterns. Histologically, elastolytic granuloma is formed by a dense infiltrate of giant cells and histiocytes with active phagocytosis of elastoclastic fibers on the background of solar elastosis in the upper dermis. We report a clinically rare presentation of actinic granuloma, limited to both hands of a 75-year-old female with colon cancer.
Actins ; Aged ; Arm ; Colon ; Colonic Neoplasms ; Dermis ; Female ; Giant Cells ; Granuloma ; Hand ; Histiocytes ; Humans ; Neck ; Phagocytosis ; Skin ; Thorax

The antiphospholipid antibody syndrome is cha- racterized by antibodies directed against either phos-pholipids or plasma proteins bound to anionic phos- pholipids. These antibodies have been characterized by lupus anticoagulants and anticardiolipin antibodies. Patients with the antiphospholipid antibody syndrome may display a constellation of clinical features including venous and arterial thrombosis, recurrent fetal losses, and thrombocytopenia. Although the majority of patients reported have a thrombotic microangiopathy, some have also seen membranous nephopathy as well as IgA nephropathy in a patient with anti-phospholipid antibody syndrome accompanying glo-merulonephritis. Authors experienced a 37-year-old male patient who presented with generalized edema at the moment of follow-up for primary antiphos-pholipid syndrome accampanying systemic thrombotic events. Anticardiolipin antibody-IgM positivity was detected by seroligic test but no evidence for systemic lupus erythematosus was found. Kidney biopsy showed mesangial IgA deposition without th throm-botic microangiopathy of gomerular capillaries and was diagnosed finally as primary antiphospholipid syndrome with IgA nephropathy. Patient's symptom was relieved with steroids and anti platelete agents and now he is being follow-up to out patient department. This case suggests some possibility that anticardiolipin antibody may induce the IgA nephropathy. Therefore clinician should have concern about the relationship between antiphospholipid antibody and immune mediate glomerulonephritis.
Adult ; Antibodies ; Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid* ; Anticoagulants ; Antiphospholipid Syndrome* ; Biopsy ; Blood Platelets ; Blood Proteins ; Capillaries ; Edema ; Follow-Up Studies ; Glomerulonephritis ; Glomerulonephritis, IGA ; Humans ; Immunoglobulin A ; Kidney ; Lupus Erythematosus, Systemic ; Male ; Steroids ; Thrombocytopenia ; Thrombosis ; Thrombotic Microangiopathies