We experienced a case of a primary aortoduodenal fistula, which was successfully diagnosed and repaired. This diagnosis must be considered in cases of gastrointestinal bleeding with an abdominal aortic aneurysm. If the correct diagnosis can be made promptly, surgical repair of the fistula is possible.
Aortic Aneurysm, Abdominal ; Diagnosis ; Fistula* ; Hemorrhage

No abstract available.
Empyema* ; Muscle, Skeletal*

BACKGROUND: We performed this study to evaluate the lower limit of the normal endothelial function, which can differentiate normal values from abnormal ones and to evaluate the changes of the endothelial function according to ages. MATERIALS AND METHODS: Study populations were consisted of four groups: patients (group A) with coronary artery disease (CAD) (n=2, mean age: 55 yrs), patients (group B) with one or more risk factors of atherosclerosis (n=3, mean age: 54 yrs), age- and sex-matched healthy subjects (group C, n=5, mean age: 54 yrs), and healthy young subjects (group D, n=3, mean age: 26 yrs). We measured the flow-mediated endothelium-dependent dilation (FMD) of brachial artery using a high-resolution ultrasound in all subjects. We analyzed the receiver operating characteristic (ROC) curve. RESULTS: The FMD of the A and B group were significantly lowered (8.6+/-3.7% vs 9.9+/-4/5% than C (14.3+/-3.3%, p<0.001) or D group (18.0+/-3.5%, p<0.001). The FMD level of 11.5% had 76.3% of sensitivity and 76% of specificity to differentiate normal endothelial function from abnormal one. The spearman correlation coefficient between ages and FMD in groups C and D was -0.543 (p<0.001). CONCLUSIONS: The endothelial function was decreased in patients with CAD or risk factors of atherosclerosis. We observed the age-related declining tendency of endothelial function in healthy subjects. 11.5% FMD) may be used to identify the person at risk of atherosclerosis.
Atherosclerosis* ; Brachial Artery ; Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Reference Values ; Risk Factors* ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography

No abstract available.
Appendicitis* ; Humans

The single enzyme P-450c17 hydroxylase catalyzes the 17a-hydroxylation of both pregnenolone and progesterone and the side-chain cleavage of 17a-hydroxypregnenolone and 17a-hydroxypro- gesterone to dehydroepiandrosterone and androstenedione. This enzyme is located in the endoplasmic reticulum and consists of a P-450c17 and a specific flavoprotein NADPH-cytochrome P-450 reductase. The clinical picture and hormonal pattern in 17a-hydroxylase deficiency have been consistent in both genotypic sexes with hypergonadotropic hypogonadism in whom the virtual absence of gonadal steroids results in a female phenotype with primary amenorrhea and pseudohermaphro- ditism in the male and underdeveloped secondary sex characteristics and hypermineralocorticoidism with hypertension, hypokalemia, suppressed renin-angiotensin system and extremely reduced aldo-sterone production. A 17-year-old girl visited endocrine clinic because of amenorrhea, absence of pubic and axillary hair, and hypertension. she had elevated levels of serum corticosterone, deoxycorticosterone(DOC), 18-hydroxycorticosterone(18-OHB). Stumulation with ACTH effected minimal increase in the elevated steroids and the ACTH-stimulated 18-OHB to aldosterone ratio was more than 280. These hormonal patterns appear to be homozygote in 17a-hydroxylase deficiency.
Adolescent ; Adrenocorticotropic Hormone ; Aldosterone ; Amenorrhea ; Androstenedione ; Corticosterone ; Dehydroepiandrosterone ; Endoplasmic Reticulum ; Female ; Flavoproteins ; Gonads ; Hair ; Homozygote ; Humans ; Hypertension ; Hypogonadism ; Hypokalemia ; Male ; Oxidoreductases ; Phenotype ; Pregnenolone ; Progesterone ; Renin-Angiotensin System ; Sex Characteristics ; Steroids

PURPOSE: We compared the clinical manifestations of patients with tsutsugamushi disease between children and adults. METHODS: From January 2003 to December 2012, 768 patients diagnosed with tsutsugamushi disease were retrospectively reviewed, and the clinical characteristics, laboratory findings, and complications were compared between children and adults. RESULTS: No patterns of annual increases in the number of patients were noted in both children and adults. The higher incidences occurred in October and November respectively. By gender, male outnumbered female in children, but the opposite trend was seen in adults. By residential area, the urban distribution of children was higher than that of adults. Rashes (P=0.001) and eschar (P=0.004) were more common in children, while myalgia was more common in adults. Children had a high prevalence of anemia (P=0.041), and low incidence rates of thrombocytopenia, abnormal liver and renal function. Children yielded better results in the duration of their hospital stay and the incidence of complications (P<0.001). A comparison of the therapeutic effects of doxycycline and macrolide antibiotics, which was performed only on the children, did not reveal any significant differences. CONCLUSION: Compared to adults, children had higher incidence rates of male patients and more often suffered from rashes and eschar. Children yielded better results in the laboratory findings and duration of the hospital stay and complications. Therefore, when children are suspected to have tsutsugamushi disease, especially during its peak occurrence period, detailed physical examination and serological test should be performed to ensure a prompt diagnosis, and the use of macrolide antibiotics, which have fewer side effects, is expected to yield the same therapeutic effects.
Adult* ; Anemia ; Anti-Bacterial Agents ; Child* ; Diagnosis ; Doxycycline ; Exanthema ; Female ; Humans ; Incidence ; Length of Stay ; Liver ; Male ; Myalgia ; Physical Examination ; Prevalence ; Retrospective Studies ; Scrub Typhus* ; Serologic Tests ; Thrombocytopenia

Acromelanosis progressiva is a peculiar progressive pigmentary disorder characterized by intensely dark and sharply demarcated hyperpigmentation over the dorsa of fingers and toes, and the pigmentation rapidly spread proximally. A 19-year-old female had sharply demarcated symmetric dark aroarn macules on the dorsa of her hands and feet, forearms, lower legs, face and neck. These pigmentations at first appeared at the age of 5 on the dorsa of her fingers and toes, thereafter these pigmertatons spread progressively to the proximal portion of her body. Histologically, a proliferation of mela biocyte at the epidermal-dermal junction was seen, associated with mild hyperkeratosis. She was othervise normal on physical examination and had no family historv of consanguinity.
Consanguinity ; Female ; Fingers ; Foot ; Forearm ; Hand ; Humans ; Hyperpigmentation ; Leg ; Neck ; Physical Examination ; Pigmentation ; Toes ; Young Adult

The Diltiazem hydrochloride is a new calcium antagonist of which effect on angina pectoris has been reported. Authors studied the clinical effect of Diltiazem in 18 cases of angina pectoris including stable and unstable angina. The 14 cases were male and 4 cases were female with ages ranging 46 to 72 years. All cases had typical anginal attack on 1-6 times in everyday with transient improvement by sublingual nitroglycerin. After coutine physical and laboratory work-up, Diltiazem 30mg tablet was given 3 times a day for 3 consecutive weeks and checked the response of angical pain for first 3 times visit with 3 days interval and thereafter with one week interval. In 13 cases of 15 cases, the Diltiazem alone was medicated. There was considerable improvement of anginal attack in 13 cases of 15 cases with Diltiazem alone, namely complete subsidence of anginal attack throughout 3 weeks in 2 cases, only minimal substernal discomfort on effort once a week in 4 cases and in 7 cases the frequency and severity of anginal pain reduced to about 50% of control state. In 2 of 15 cases there were no effect on anginal pain until one week, subsequently a beta-blocker was added and the anginal attack improved considerably in both cases. In 3 cases of 18 cases, the anginal attacks were so severe and frequent that the Diltiazem with beta-blocker were given from the beginning. In one case the anginal pain disappeared completely and in two cases there were good effect. The effect of Diltiazem usually started to occurs in 3 days to one week after medication. The overall effectiveness of Diltiazem in angina pectoris was 87% with excellent effect in 40%, good effect in 27% and fair effect in 20%. In 5 cases of good response to Diltiazem, the stress exercise test by bicycle ergometer was carried out before and after one week medication with programs of 30 wt, 50 wt, 75 wt, and 100 wt loading for 4 minutes in each stage. The exercise tolerance improved about 25-50 wt, the ST depression by exercise became less by 1-2mm and the maximal heart rate increased by 4-9/min. These data showed marked improvement of exercise tolerance in angina pectoris by Dltiazem objectively. There were macular skin rash, diarrhea and mild dizziness in one case respectively which were improved without treatment. These data showed that Diltiazem was highly effective in angina pectoris except few very severe cases. In severe cases, the combined therapy of Diltiazem and beta-blocker was more effective.
Angina Pectoris* ; Angina, Unstable ; Calcium ; Depression ; Diarrhea ; Diltiazem* ; Dizziness ; Exanthema ; Exercise Test ; Exercise Tolerance ; Female ; Heart Rate ; Humans ; Male ; Nitroglycerin

A case of circular eczematous dermatitis around seborrheic keratosis was presented. A 54-year-old man presented with two weeks history of a round pruritic eruption around a preexisting lesion of seborrheic keratosis. Microscopic findings showed central tumor nest composed mainly of basaloid cells with occasional spongtosis and exocytosis. A diffuse, dense, mononuclear cell infiltrate with increased contents of melanophages was seen beneath the tumor. The surrounding lesion of halo dermatitis showed mild dilatation of the capillaries and perivascular infiltration of mononuclear cells in the upper and mid-dermis. The lesion of halo dermatitis disappeared gradually over a three week period following excision of the central lesion. This peculiar phenomenon seemed to be different from that of Suttons halo nevus, and might be a manifestation of an eczematous condition which might have a dermatitis provoking factor.
Capillaries ; Dermatitis* ; Dilatation ; Eczema ; Exocytosis ; Humans ; Keratosis, Seborrheic* ; Middle Aged ; Nevus, Halo

To evaluate intraindividual, interocular differences in blood flow of the optic nerve head in normal-tension glaucoma(NTG)patients with interocular asymmetric visual field loss, thirty-eight eyes of 19 NTG patients(mean age+/-SD, 56.1+/-15.0 years)with interocular asymmetric visual field loss of >3dB in the mean deviation or corrected pattern standard deviation were measured for the blood flow parameters(Volume, Velocity, Flow)at the temporal rim of the optic nerve head using scanning laser Doppler flowmetry(Heidelberg Retina Flowmeter or HRF). Measurements for peripapillary atrophy(area of zone beta)were performed using scanning laser tomography (Heidelberg Retina Tomograph). Visual field defects were evaluated by automated static threshold perimetry. The mean+/-standard deviation of the mean defect of the visual field indices was -1.38+/-3.02dB for the less affected eyes, and -6.23+/-3.84dB for the more affected eyes. All blood flow parameters were significantly smaller in the less affected eyes(0.004 Atrophy ; Flowmeters ; Glaucoma* ; Head* ; Humans ; Optic Disk ; Retina ; Visual Field Tests ; Visual Fields*