OBJECTIVES: Anticardiolipin antibody (ACA) and lupus anticoagulant (LA) are acquired antiphospholipid antibodies (APAs), which are regarded as important risk factors far vascular thrombosis and recurrent fetal loss. Although the clinical relevance of APAs in dialysis patients is uncertain, recent studies have suggested that APAs are involved in bioincompatibility and thrombogenic complications in hemadialysis (HD) patients. METHOD: We performed a cross sectional study of ACA and LA in 50 stable HD patients and their 68 vascular accesses (52 native arteriovenous fistulae and 16 synthetic arterovenous grafts), with the analysis of factors associated with the presence of APAs and the retrospective evaluation of vascular access occlusion (VAO). LA was assessed by platelet neutralization method whereas IgG-ACA was measured by a solid phase ELISA. Values higher than 23GPLU/ml (IgG phospholipid units) were considered to be positive for IgG-ACA and positive values for LA was more than 8 seconds in prolongation of the clotting time with human platelet lysate. Vascular access survival was assessed by Kaplan- Meier method, RESULTS: The mean age of the subject (M:F 21:29) was 46 years and the mean duration of hemodialysis was 49 months. The frequency of VAO in entire subjects was 0.45+/-0.98 episodes/patient year. The median value of IgG-ACA was 16.0 GPLU/ml with a distribution from 2.7 to 46.1GPLU/ ml. The median titer of I.A was 4.5 (3.1-45.6) seconds. Fourteen patients (28%) were found to have at least one episode of VAO. In spite of comparable clinical and biochemical data according to the presence of VAO, the titers of IgG-ACA (13.6+/-7.7 vs, 20.3+/-8.7GPLIJ/ml, P<0.05) and LA (4.5+/-2.9 vs. 11.7 +/-12.6sec, P<0.05) were significantly higher in VAO group. Six out of 50 patients(12%) had an increased titer of IgG-ACA and LA was found in 11 patients(22%). No patients were positive for ACA and LA simultaneously. There was no significant difference in sex, etiology of ESRD, diabetic status, the dosage of heparin during HD or the amount of erythropoietin administered according to the presence of APAs. We could not find any significant correlation between the titer of APAs and age, duration of dialysis, blood pressure, platelet count and biochemical parameters. In the patients with positive ACA, the frequency of VAO was 1.05+/-0.12 episodes/patient year, which was significantly higher than patients without ACA (0.33+/-0.17 episodes/ patient year, P<0.05). In the patients with the presence of LA(1.06+/-0.43 vs. 0.12+/-0.06 episodes/ patients year, P<0.01). The median vascular access survival time in IgG-ACA positive patients (32.7 months) was significantly decreased compared to 66.8 months in IgG-ACA negative group. CONCLUSION: Our data suggest that the presence of APAs (ACA and/or LA) affects the event-free vascular access survival in HD patients. Therefore the evaluation of APAs status have to be included in the diagnostic strategies for the patients with recurrent VAO. Further studies are necessary to explore the pharmacologic intervention method to decrease APAs and prevent VAO in HD patients.
Antibodies, Anticardiolipin* ; Antibodies, Antiphospholipid ; Arteriovenous Fistula ; Blood Platelets ; Blood Pressure ; Dialysis ; Enzyme-Linked Immunosorbent Assay ; Erythropoietin ; Heparin ; Humans ; Kidney Failure, Chronic ; Lupus Coagulation Inhibitor* ; Platelet Count ; Renal Dialysis* ; Retrospective Studies ; Risk Factors ; Thrombosis

High dose intravenous methyl prednisolone was administered to patients with multiple sclerosis (4), transverse myelitis (6), and arachnoiditis (I). Almost complete remission was noted in 5 cases (4 with transverse myelitis and one with multiple sclerosis) and partial improvement in 3 patients (2 with multiple sclerosis and I with arachnoiditis ) within 3 days after therapy. The benefits of this therapy, however, was not that dramatic when started late after the onset of neurologic deficits.
Arachnoid ; Arachnoiditis ; Humans ; Multiple Sclerosis ; Myelitis, Transverse ; Neurologic Manifestations ; Prednisolone

No abstract available.
Osteolysis*

Recent studies have demonstrated that the patients with psoriasis have various immune alternation in both humoral and cellular immunities. However the results of these are still controversial. These facts promoted us to analyze the immune cells (T cell, T subsets and B cell) by rosette method for these cells in peripheral blood of 15 patients with psoriasis. And we also analyzed the effects of photo- chemotherapy(PUVA) on these cells. The results were summerized as follows; 1. The mean values of T cell, T, T, cell and B cell in peripheral blood of the- patients with psoriasis before PUVA therapy were 56. 2+-5.7%, 35.1+-6.9%, 5. 5+l.4%, 11.6+4. 0% respectively, These results of immune cells showed signi- ficantly lower mean values when these were compaired with the mean values. of nomnal control group(T cell; 65. 2+-2.9%, TM cell; 45.8+-3.2%, T cell; 7.3+ 1.3% B cell; 16.2+2.4%), respectively (T cell, Tm Tg, p<0.01, B cell; p<0.05). 2. The mean values of T cell, T, T, cell and B cell in peripheral blood (countinue..)
Humans ; Immunity, Cellular ; Photochemotherapy* ; Psoriasis* ; PUVA Therapy

We have experienced a case of tuberculous abscess of the liver with empyema in a 12 years old boy. He was admitted with the chief complaints of pain and mass in the right upper abdomen of about 1 month duration and intermittent mild fever for 15 days. On examination, liver was palpable 5 cm below the right costal margin, and was tender and firm. Liver scan showed a cold area in the right posterior upper part of the liver. With the needle aspiration of the liver, 240 ml of yellowish-green pus was aspirated. The stained smears of the pus showed a large number of acid-fast bacilli, and the culture revealed a growth of Mycobacterium tuberculosis. Our patient was cured successfully by the drainage of pus with the needle aspiration of the liver and antituberculous medication. We have presented here a rare case whose the diagnosis was made without the help of any operative procedure, and reviewed the literatures.
Abdomen ; Abscess* ; Child ; Diagnosis ; Drainage ; Empyema* ; Fever ; Humans ; Liver* ; Male ; Mycobacterium tuberculosis ; Needles ; Suppuration ; Surgical Procedures, Operative

Systemrc lupus erythematosus (SLE) is an autoimmune, inflammatory, chronic disorder characterized by multiorgan involvement including the nervous system. The neurologic manifestations of SLE vary in clinical signs and clinical course. We recently reviewed medical records of 198 patients with SLE who had been admitted to Severance hospital between 1980 and 1990 to see neurological features with the relationship of non-neurological features of SLE and prognosis. Among 198 cases with SLE sixty-seven patients (33.8%) had significant neurologic and/or psychiatric manifestations dunng the course of their disease. CNS lupus was found in 48 cases and symptoms were seizure, mental deterioration, psychiatric manifestations and focal neurologic deficit in decreasing order of frequency. Myelopathy was noted in 4, peripheral neuropathy in 5, and rline patients developed myopathy. Eight had typical meningitis ;four of these patients had aseptic meningitis, three had tuberculous meningitis, and one had bacterial meningitis. In half of the patients with CNS lupus, the neurologic symptoms occurred during the first one year of their illness. Other major organs such as the kidney, heart, lung, skin and joints were more commonly affected in CNS lupus. The prognosis of CNS lupus is relatively poor, especially in patients with seizure which is followed by altered mentality.
Heart ; Humans ; Joints ; Kidney ; Lung ; Lupus Erythematosus, Systemic* ; Medical Records ; Meningitis ; Meningitis, Aseptic ; Meningitis, Bacterial ; Muscular Diseases ; Nervous System ; Neurologic Manifestations* ; Peripheral Nervous System Diseases ; Prognosis ; Seizures ; Skin ; Spinal Cord Diseases ; Tuberculosis, Meningeal

Lipoma is a benign fatty tumor that can arise in any location of the body where fat is present. It is found most commonly in the upper half of the body, particularly the head and neck, shoulders, and back. A mass in the antero-inferior part of the neck may be initially thought to be thyroid masses and then other cervical masses should be considered. Ultrasongraphic examination of benign lipoma demonstrates solid and echogenic mass and may differentiate nonthyroid from thyroid masses. Although the location of tumors, its consistency, and its motion with deglutition, seperation from the thyroid on sonographic examination, all pointed to nonthyroidal origin, did not rule out a possible mass that isolated from the lobes of the thyroid. Fine needle aspiration and biopsy can provide clear answer.We herein report a case of anterior cervical mass in a 48-yr-old male patient presenting a non-tender, slightly hard and nodular mass slowly growing for several years and moved with swallowing, and diagnosed his case as benign lipoma using thyroid scan and ultrasonography. When we encounter patients with anterior neck mass, we should consider benign lipoma mimicking diffuse goiter.
Biopsy ; Biopsy, Fine-Needle ; Deglutition ; Goiter ; Head ; Humans ; Lipoma ; Male ; Neck ; Shoulder ; Thyroid Gland ; Ultrasonography

OBJECTIVES: Chronic inflammation is now thought to play a key pathogenetic role in the associations of obesity with insulin resistance and diabetes. Based on our recent findings on persistent organic pollutants (POPs) including the lack of an association between obesity and either insulin resistance or diabetes prevalence among subjects with very low concentrations of POPs, we hypothesized that POP concentrations may be associated with inflammation and modify the associations between inflammation and insulin resistance in non-diabetic subjects. METHODS: Cross-sectional associations among serum POPs, C-reactive protein (CRP), and homeostasis model assessment of insulin resistance (HOMA-IR) were investigated in 748 non-diabetic participants aged > or =20 years. Nineteen types of POPs in 5 subclasses were selected because the POPs were detectable in > or =60% of the participants. RESULTS: Among the five subclasses of POPs, only organochlorine (OC) pesticides showed positive associations with CRP concentrations, while polychlorinated biphenyls (PCBs) showed inverse associations with CRP concentrations. There were statistically significant interactions between CRP and OC pesticides and between CRP and PCBs, in estimating HOMA-IR (P for interaction <0.01 and <0.01, respectively). CRP was not associated with HOMA-IR among subjects with low concentrations of OC pesticides or PCBs, while CRP was strongly associated with HOMA-IR among subjects with high concentrations of these POPs. CONCLUSIONS: In the current study, OC pesticides were associated with increased levels of CRP, a marker of inflammation, and both OC pesticides and PCBs may also modify the associations between CRP and insulin resistance.
Adult ; C-Reactive Protein/analysis/*drug effects ; Environmental Pollutants/adverse effects/*blood ; Female ; Humans ; Hydrocarbons, Chlorinated/adverse effects/*blood ; Inflammation/*chemically induced ; Insulin Resistance/*physiology ; Male ; Middle Aged ; Nutrition Surveys ; Pesticides/adverse effects/blood ; Polychlorinated Biphenyls/adverse effects/*blood

The nasal septal perforation is an inadvertent complication of septal surgery which is caused by traumatic, iatrogenic, caustic or inflammatory reasons. Repair of the perforation is indicated when complications such as whistling sound, marginal crusting, frequent nasal bleeding and low-grade perichondritis develop. There is no standard surgical method for repair of a septal perforation. The size, site and the causing factor of perforation determine closure methods. A septal perforation using the concha bullosa flap of middle turbinate was successfully repaired.
Epistaxis ; Nasal Septal Perforation ; Nasal Septum ; Singing ; Turbinates*

No abstract available.
Drug Therapy, Combination ; Female ; Human ; Infant ; Male ; Serologic Tests ; Toxoplasma/immunology ; Toxoplasmosis, Congenital/complications ; Toxoplasmosis, Congenital/diagnosis ; Toxoplasmosis, Congenital/pathology*