Lipomas of the heart are benign neoplasms and have rarely been described. Due to the fact that they normally cause no symptoms, diagnosis is often purely accidental. Because of the rarity of these tumors, it seems worthwhile to present an example studied at autopsy. It was associated with the sudden death of a 15-year-old boy. The tumor arose from the wall of the left ventricle and occupied the pericardial cavity, measuring 13x7x6 cm in size. The tumor was whitish-yellow, translucent, and soft. Microscopically, the tumor was composed of mature adipose tissue which extended between muscle fibers. This current case, the giant cardiac lipoma is believed to produce disturbances of the conduction system and distrubances of cardiac filling.

Missing data such as appropriateness ratings in clinical research are a common problem and this often yields a biased result. This paper aims to introduce the multiple imputation method to handle missing data in clinical research and to suggest that the multiple imputation technique can give more accurate estimates than those of a complete-case analysis. The idea of multiple imputation is that each missing value is replaced with more than one plausible value. The appropriateness method was developed as a pragmatic solution to problem of trying to assess "appropriate" surgical and medical procedures for patients. Cataract surgery was selected as one of four procedures that were evaluated as a part of the Clinical Appropriateness Initiative. We created mild to high missing rates of 10%, 30% and 50% and compared the performance of logistic regression in cataract surgery. We treated the coefficients in the original data as true parameters and compared them with the other results. In the mild missing rate (10%), the deviation from the true coefficients was quite small and ignorable. After removing the missing data, the complete-case analysis did not reveal any serious bias. However, as the missing rate increased, the bias was not ignorable and it distorted the result. This simulation study suggests that a multiple imputation technique can give more accurate estimates than those of a complete-case analysis, especially for moderate to high missing rates (30 - 50%). In addition, the multiple imputation technique yields better accuracy than a single imputation technique. Therefore, multiple imputation is useful and efficient for a situation in clinical research where there is large amounts of missing data.
Cataract Extraction/*methods ; Humans ; Logistic Models ; Research Support, Non-U.S. Gov't

Dubin-Johnson Syndrome is a form of benign, familial idiopathic jaundice presenting with chronic intermittentconjugated hyperbilirubinnmia and a melamin-like pigment has been found in the parenchymal liver cells. This disorder is rarely diagnosed in the neonatal period. We report a case of Dubin-Johnson syndrome presenting with neonatal cholestasis.
Cholestasis ; Jaundice ; Jaundice, Chronic Idiopathic* ; Liver

Dubin-Johnson Syndrome is a form of benign, familial idiopathic jaundice presenting with chronic intermittentconjugated hyperbilirubinnmia and a melamin-like pigment has been found in the parenchymal liver cells. This disorder is rarely diagnosed in the neonatal period. We report a case of Dubin-Johnson syndrome presenting with neonatal cholestasis.
Cholestasis ; Jaundice ; Jaundice, Chronic Idiopathic* ; Liver

The cytolytic activity of CD4' T cells, both human and murine, has been clearly demonstrated in the immune response to mycobacterial infection and suggested to play a significant role in the protection and immunopathology. However, Uttle is known about the differentiation of CD4' CTL. In order to address this issue, we examined the influences of some factors on the generation of CD4' CTL specific to mycobacterial antigens. After 7 days' stimulation of PBMCs from healthy tuberculin reactors with mycobacterial antigens, the cytolytic activity of purised CD4' T cells toward autologous macrophages infected with mycobacteria was measured by Cr release assay. First, we found that both of live M. tubeiculosis and soluble antigens (ST-CF) induced the cytolytic activity of CD4' T cells, although the inducibility of the former was slightly greater than the latter. Second, the cytolytic activity was maximally induced at the relatively low antigen concentration (0.2:1 bacteria:monocyte ratio or 0.5 mg/ml of ST-CF). Finally, in the presence of increasing amounts of neutralizing anti-IL-12 or anti-IFN-r MoAb, the cytolytic activity of CD4+ T cells was decreased in a dose-dependent manner. These results suggest that low dose of antigen, its particulate type give mycobacteria), IL-12, and IFN-r give some positive signals for the generation of CD4+ CTL.
Humans ; Interleukin-12 ; Macrophages ; T-Lymphocytes* ; Tuberculin

BACKGROUND: In spite of relative high risk of extrapyramidal side effect and tardive dyskinesia, it is common clinical practice to use antipyschotics in treatment of bipolar I disorder. But in Korea, there has been few study about clinical factors related with antipsychotics treatment in bipolar disorder patients. So the author studied about the clinical factors related with antipsychotics treatment in bipolar inpatients focusing on the comparison of risperidone and classical antipsychotics. METHOD: By reviewing medical record retrospectively, datas about patient-related, illness-related, and treatment-related clinical factors on antipsychotics use were collected. Association between antipsychotics dose and duration and clinical factors were analysed by statistical method. RESULTS: Aggressive behavior was only statistically significant factor associated with antipsychotics use. And in the case of aggression, maintenance dose of risperidone was not changed(p=0.84), but dose of classical antipsychotics was increased significantly(p=0.005). Total hospital days and antipsychotics treatment duration showed no difference between risperidone and classical antipsychotics treatment groups. CONCLUSION: Clinical factors associated with antipsychotics use was aggressive behavior. In the case of aggression, risperidone required lesser dose increment compared with classical antipsychotics.
Aggression ; Antipsychotic Agents* ; Bipolar Disorder ; Humans ; Inpatients* ; Korea ; Medical Records ; Movement Disorders ; Retrospective Studies ; Risperidone*

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

OBJECTIVE: Dementia is major neuropsychiatic disorder in the elderly. This study was aimed to investigate the prevalence of dementia and provide fundamental data for community mental health programs. METHOD: 500 elderly people aged 65 years and over in Kwachon were interviewed according to DSM-IV and examined MMSE-K, Korea-Dementia Rating Scale (K-DRS), Clinical Dementia Rating (CDR), Modified Hatchinski Ischemic Scale (MHIS) by trained research assistants. RESULTS: Prevalence of dementia is 10.6% (Alzheimer type 8.0%;vascular type 2.6%). Old age, lower education, cardiovascular disease, head trauma and heavy smoking seem to be risk factors for developing dementia but sex difference is non significant. CONCLUSION: The results showed similar prevalence rates compared to other epidemiological studies. Demented group showed more cognitive disturbances than non-demented one. For patients of dementia, appropriate treatment and management by family members, other caregivers and mental health professionals are needed.
Aged ; Cardiovascular Diseases ; Caregivers ; Craniocerebral Trauma ; Dementia* ; Diagnostic and Statistical Manual of Mental Disorders ; Education ; Epidemiologic Studies* ; Epidemiology ; Gyeonggi-do ; Humans ; Korea* ; Mental Health ; Prevalence ; Risk Factors ; Sex Characteristics ; Smoke ; Smoking

PURPOSE: Septic arthritis is uncommon in neonates, and the diagnosis of septic arthritis in newborns is difficult because of non-specific laboratory findings and paucity of signs and symptoms. When appropriate treatment is delayed, permanant sequelae are inevitable. We report a retrospective study of 22 neonates who were diagnosed with septic arthritis. METHODS: We reviewed 22 patients, who were diagnosed with septic arthritis in the nursery room of Pusan National University Hospital, between July 1, 1995 and December 31, 2003. We investigated demographic features, predisposing factors, symptoms and signs, involving sites, diagnostic methods, laboratory findings, causative organisms, treatments and outcomes in these neonates. RESULTS: The mean age was 16.6 days(range 7-40 days). The male to female ratio was 1.44 : 1 with male predominance. Five of 22 neonates were prematurity. Eleven neonates were diagnosed with septic arthritis in hospitalization. Septic arthritis was multifocal in 22.7% and involved the hip joint most frequently(12 cases, 14 joints). Of diagnostic imaging studies, MRI was most sensitive, with four positivity in five cases. An etiologic organism was isolated from 11(50%) : Staphylococcus aure us, 7; GBS, 2; coagulase (-) staphylococcus, 1; Klebsiella pneumoniae 1. Of 13 surgical specimens from joint fluid, two were positive. Four neonates had sequelae over 1 year follow-up, three were in knee joints and one in the hip joint. CONCLUSION: Four of 22 neonates who suffered from septic arthritis had sequelae, two were premature and three were diagnosed in hospitalization. To decrease hospital-acquired infections would decrease the incidence of septic arthritis and the frequency of permanant sequelae in neonates.
Arthritis, Infectious* ; Busan ; Causality ; Coagulase ; Diagnosis ; Diagnostic Imaging ; Female ; Follow-Up Studies ; Hip Joint ; Hospitalization ; Humans ; Incidence ; Infant, Newborn* ; Joints ; Klebsiella pneumoniae ; Knee Joint ; Magnetic Resonance Imaging ; Male ; Nurseries ; Retrospective Studies ; Staphylococcus