Acute fatty liver is rare but life threatening complication and usually manifests late in pregnancy. The mean gestational age onset of symptoms has been reported 35-37 weeks of gestation. Recently, several reports revealed acute fatty liver can develops in the second trimester of pregnancy. Recent reports suggest that early diagnosis and delivery decreased the mortality of fetus and mother. We have experienced a case of the second trimester onset acute fatty liver, in pregnancy so we report the case with brief review.
Early Diagnosis ; Fatty Liver* ; Female ; Fetus ; Gestational Age ; Humans ; Mortality ; Mothers ; Pregnancy ; Pregnancy Trimester, Second*

OBJECTIVES: Several studies suggest that psychotropic drugs may affect on lipid metabolism and body weight. And the differences of levels of seam lipids were observed in patients with several psychiatric disorders. Hence, in order to elucidate the effects of psychotropic drugs on serum lipid, lipoprotein and apolipoprotein, the authors estimated the serum lipid profile in the psych op harmacological treatment. METHODS: Thirty six patients with schizophrenia and 42 patients with depressive disorder or anxiety disorder were recruited from the inpatient psychiatric units and withdrawn from all psychotropic drugs at least far 3 months. The levels of seam total cholesterol, high-density lipoprotein cholesterol(HDL-C), trighlyceride, apolipoprotein A, apolipoprotein B, and lipoprotein(a) were measured before the treatment and after 2, 4, 8 and 12 weeks of the treatment. RESULTS: No statistically significant change was found on all serum lipid profiles in the antipsychotics group. However, the changes on serum total cholesterol, low-density lipoprotein (LDL-C), apolipoprotein A, and apolipoprotein B from the baseline to the following weeks have been observed in tricyclic antidepressants group. And the serum total cholesterol and apolipoprotein B have been observed to be changed from the baseline to the following weeks in the selective serotonin reuptake inhibitors poop. The changes on seam lipoprotein(a) were proved not to be statistically significant during all the psychotropic drugs treatment. CONCLUSION: These results implicate that all psychotropic drugs might affect on the lipid metabolism, especially for tricyclic antidepressants. Therefore, this implication could be important in clinical situation because the changes on serum lipid profiles may be related to the cardiovascular disease especially in psychiatric patients with the cardiovascular risk factor.
Antidepressive Agents, Tricyclic ; Antipsychotic Agents ; Anxiety Disorders ; Apolipoproteins* ; Body Weight ; Cardiovascular Diseases ; Cholesterol ; Depressive Disorder ; Humans ; Inpatients ; Lipid Metabolism ; Lipoprotein(a) ; Lipoproteins* ; Psychotropic Drugs ; Risk Factors ; Schizophrenia ; Serotonin Uptake Inhibitors

Diabetic complications such as cystopathy and retrograde ejaculation are slowly progressive disease without any specific signs and symptoms so it is difficult to diagnose its complication and prevent it. Diabetic autonomic neuropathy is known as a neurologic lesion with combined involvement in cardiovascular and genitourinary systems. The purpose of this study is to assess correlation between diabetic cystopathy and heart rate variation on consecutive EKG waves and to detect early cystopathy in patients with decreased heart rate variation. We have studied 12 cases of diabetic cystopathy and 9 cases of retrograde ejaculation who were managed in Seoul Eulji Hospital from Mar. 1992 to Aug. 1993 and concluded as follows. Diabetic patients with autonomic neuropathy shows decreased heart rate variability(HRV) (CV%: 2.16+/-0.97) than diabetic patients without autonomic neuropathy (CV%: 3.29+/-0.58, P <0.0001 ), it means that decreased HRV on consecutive EKG waves well correlates to diabetic autonomic neuropathy such as cystopathy and retrograde ejaculation so we think that the measurement of HRV provides a simple test to be concerned urologic complications such as cystopathy or retrograde ejaculation.
Diabetes Complications ; Diabetes Mellitus ; Diabetic Neuropathies ; Ejaculation ; Electrocardiography* ; Heart Rate ; Humans ; Male ; Seoul ; Urogenital System

Endoscopic dacryocystorhinostomy appears to have a lower success rate than of conventional external dacryocystorhinostomy. However, recently this procedure has been widely performed due to its several advantages. The most frequent cause of failure in endoscopic dacryocystorhinostomy is the obstruction of mucosal or bony openings; thus various techniques were introduced to minimize this obstruction of the opening site. Between November 1995 and February 1997, we performed 60 endoscopic dacryocystorhinostomy procedures on 46 patients diagnosed with mitomycin-C, an antimetabolic agent, was performed on the osteotomy site, intraoperatively. The postoperative follow-up interval ranged from 4 to 20 months(mean, 10.3 months). The success rate of the primary operation ws 66.7%(40 of 60 eyes), and with revision of failed cased the final success rate reached 90.0%(54 do 60 eyes). No complication associated with use of mitomycin-C was observed. Thus it suggests that the endoscopic dacryocystorhinostomy with the application of mitomycin-C is a useful technique in the management of obstruction of the nasolacrimal duct.
Dacryocystorhinostomy* ; Follow-Up Studies ; Humans ; Mitomycin* ; Nasolacrimal Duct ; Osteotomy

Clostridium difficile is the most common nosocomial pathogen of the gastrointestinal tract. Pseudomembranous colitis occurs as a result of a severe inflammatory response to Clostridium difficile toxins. Pseudomembranous colitis is an increasingly frequent cause of morbidity and mortality among elderly hospitalized patients. Diarrhea is the most common manifestation. According to the literature, stools are almost never grossly bloody, and range from soft and unformed to watery or mucoid in consistency. We now report the cases of three patients with pseudomembranous colitis whose main clinical manifestation was hematochezia.
Aged ; Clostridium difficile ; Diarrhea ; Enterocolitis, Pseudomembranous ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Humans

Human sparganosis is caused by the larval tapeworm of genus Spirometra. This parasite commonly invades subcutaneous tissues and muscles. However, infection in the pleural cavity is rare. A 65-year-old male patient, who had undergone surgical excision of subcutaneous masses due to a parasite infection (presumed to have been sparganosis) approximately 10 years ago, showed pleural effusion and peripheral eosinophilia. The anti-sparganum specific IgG antibody levels in the serum and pleural fluid were significantly higher than the normal control levels. Three consecutive doses of praziquantel (75 mg/kg/day) were administered for control of pleural effusion and peripheral eosinophilia. In this patient, sparganosis was suspected, and the probable cause of the infection was ingestion of raw snakes and frogs. Immunoserologic tests using ELISA can be helpful in diagnosis of pleural sparganosis and praziquantel is suggested as an alternative treatment for surgically unresectable cases.
Cestoda ; Eating ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia ; Eosinophils ; Humans ; Immunoglobulin G ; Male ; Muscles ; Parasites ; Pleural Cavity ; Pleural Effusion ; Pleurisy ; Praziquantel ; Snakes ; Sparganosis ; Sparganum ; Spirometra ; Subcutaneous Tissue

A case of pulmonary alveolar proteinosis is reported. Most of the alveolar spaces were filled with amorphous deep eosinohilic material which revealed strong positive reaction to periodic acid-Schiff staining. Electron microscopic observation of this material showed numerous lamellar bodies in the alveolar spaces and cytoplasms of alveolar macrophages. A part of them were concentric multilamellated type A lamellar bodies and the other were finger printlike type B bodies. Combined type A and type B lamellar bodies were rarely present. From the above features it is suggested that both type A and B lamellar bodies could be transformed one another and those lamellar bodies may be originated from pulmonary surfactant.

Hyperplastic gastric polyps (HPPs) are the most common type of gastric polyps. They are assumed to be caused by chronic inflammation and regenerative proliferation, although this has not been clearly investigated yet. Many studies suggested the development of fundic gland polyps and carcinoid during long-term proton pump inhibitor (PPI) therapy, but the relationship between PPIs and HPPs is still unclear. We encountered a patient who showed aggravation of HPPs after long-term use of PPIs. A 58-year-old male patient with liver cirrhosis visited our hospital because of hematemesis. We started PPI medication after confirming esophageal variceal bleeding and duodenal ulcer with blood clot in its base via emergency endoscopy. He took PPIs for three years because of an intractable duodenal ulcer. There was a marked increase in the size of the pre-existing polyps and in the development of new polyps. We presumed that the PPIs caused the aggravation of the HPPs, so we stopped their administration. After five months, the HPPs shrank and the polyps were partially degraded. More prospective studies are needed to investigate the relationship between HPPs and PPIs.
Carcinoid Tumor ; Duodenal Ulcer ; Emergencies ; Endoscopy ; Esophageal and Gastric Varices ; Hematemesis ; Humans ; Inflammation ; Liver Cirrhosis ; Male ; Middle Aged ; Polyps* ; Proton Pump Inhibitors* ; Proton Pumps* ; Protons*

Pelvic lipomatosis is a condition characterized by a nonmalignant overgrowth of normal fat in the perirectal and perivesical spaces in the pelvis which may be to occur obstructive uropathy. On cystography the full bladder has an abnormal shape as a gourd, banana, pear or inverted tear-drop. Compulerized tomography shows the bladder and rectosigmoid surrounded and displaced by homogeneous tissue with a low attenuation coefficient and the CT features provide diagnostic proof or pelvic lipomatosis. We present a case of pelvic Lipomatosis.
Lipomatosis* ; Musa ; Pelvis ; Pyrus ; Urinary Bladder

Nail bed malignancies are rare entities. Most nail bed malignancies are squamous cell carcinoma (SCC)s. Less than 10% of subungual SCCs occur in the foot. Fifty percent occurred on the hallux and approximately 25% on both the fourth and fifth digits. The correct diagnosis is often delayed because nail bed malignancies are frequently mistaken for benign or infectious processes. SCC on extremities is hard to distinguish from the benign lesion like chronic ulcer, fistula caused by chronic osteomyelitis, and abscess fistula. Attention should especially be paid in diagnosing the subungual lesion because paronychia is a common disease. SCC is the most common carcinoma second to malignant melanoma as a soft tissue malignant tumor in the West, and it involves mainly the head, neck and upper extremities but rarely involves lower extremities, particularly the toes. The authors emphasize the importance of a biopsy for chronic nonhealing lesions by presenting this case.
Abscess ; Biopsy ; Carcinoma, Squamous Cell* ; Diagnosis ; Extremities ; Fistula ; Foot ; Hallux ; Head ; Lower Extremity ; Melanoma ; Neck ; Osteomyelitis ; Paronychia ; Toes* ; Ulcer ; Upper Extremity