The major presenting manifestations of systemic lupus erythematosus (SLE) in Korea are known to be cutaneous manifestations, arthritis, nephritis, and fever. The ascites due to peritoneal involvement in SLE is quite common. However, it is unusual for massive ascites to be major presenting manifestations of SLE. In this report, we describe a case of SLE patient whose disease manifested as intractable ascites. This illustrates an unusual presentation and natural history of a complex autoimmune disease.
Arthritis ; Ascites* ; Autoimmune Diseases ; Fever ; Humans ; Korea ; Lupus Erythematosus, Systemic* ; Natural History ; Nephritis

Systemic lupus erythematosus (SLE) is a multisystemic disease that can involve the gastrointestinal tract, liver, and biliary system. Symptomatic pancreatic involvement, however, has rarely been reported. It may be part of the primary disease process, such as vasculitic or autoimmune etiology, or associated with drug therapy, in particular corticosteroid. We report here a lupus patient who developed severe pancreatitis within 30 hours of initiation of corticosteroid therapy; we also discuss the relation between pancreatitis and systemic lupus erythematosus.
Biliary Tract ; Drug Therapy ; Gastrointestinal Tract ; Humans ; Liver ; Lupus Erythematosus, Systemic* ; Pancreatitis*

Tracheal bronchus is an aberrant bronchus that arises most often from the right tracheal wall above the carina and is the result of an additional tracheal outgrowth early in embryonic life. It; incidence ranges between 0.1 and 5%. This anomaly is usually diagnosed incidentally during bronchoscopy, bronchography or computed tomography. Occasionally, it represents the underlying etiology for chronic pulmonary disease, especially if it involves the right upper lobe and reflects an abnorrnal pulmonary clearing mechanism. The tracheal bronchus may be associated with other bronchopulmonary anomalies, tracheal stenosis, or Down's syndrome. Asymptornatic tracheal bronchus does not require any treatment. In case of tracheal bronchus associated recurrent right upper lobe diseases, tracheal bronchus therapy should include resection of the aberrant bronchus as well as the lob it supplies. (J Korgan Pediatr Soc 2000;43:1501-1504)
Bronchi* ; Bronchography ; Bronchoscopy* ; Down Syndrome ; Equipment and Supplies ; Incidence ; Lung Diseases ; Tracheal Diseases ; Tracheal Stenosis

Traumatic hemoperitoneum can still induce high mortality and morbidity rates, despite current method of intensive management. This study was performed to identify the independent prognostic factors in patients with traumatic hemoperitoneum. Two hundred thirty-six patients who underwent emergency operations because of traumatic hemoperitoneum at the Department of Surgery, Dong Kang General Hospital, Ulsan, from January 1986 to June 1994, were entered into this retrospective study. One hundred eighty-six patients were male, and fifty were female. The median age of the patients was 34 years (2 to 77 years). The modes of trauma were 131 motor-vehicle accidents, 43 fall down injuries, 30 stab injuries, 23 assaults, and 9 others . The common sites of injury were lthe iver and the spleen, followed by the mesentery, the stomach, the small bowels, the large bowels, the pancreas, the kidney, the diaphragm, and the retroperitoneum in order of frequency. Prognostic variables were identified from the perioperative parameters by using a univariate analysis(student t- test, chi-square test), and independent prognostic factors were determined by a multivariate stepwise logistic regression analysis, using the SPSS Win. Ver.5.0 PC package program. Statistical significance was present for p < 0.05. The overall postoperative morbidity and mortality rates were 34.3% and 19%, respectively. By using univariate analysis, the amount of bleeding, transfusion, and the immediate post-operative blood pressure were identified as significant prognostic factors for morbidity. Also age over 50, accompanying brain injury, time interval (less than 3 hrs), the systolic blood pressure on arrival (less than 100 mmHg), trauma score (less than 10), grade of liver injury (greater than IV), great vascular injury, total amount of resuscitative fluid (more than 4,000cc), the total amount of transfusion (more than 10 units), and the immediate postoperative systolic blood pressure (less than 100 mmHg) were identified as significant factors for mortality. Multivariate analysis demonstrated the following important independent prognostic factors : the total amount of transfusion for morbidity and mortality, and the post-operative blood pressure and trauma score for mortality. Our results suggest that early massive resuscitation, early operation to minimize the total amount of blood loss, and intensive immediate postoperative care to maintain blood pressure, are of utmost importance in multiple trauma patients with hemoperitoneum.
Blood Pressure ; Brain Injuries ; Diaphragm ; Emergencies ; Female ; Hemoperitoneum* ; Hemorrhage ; Hospitals, General ; Humans ; Kidney ; Liver ; Logistic Models ; Male ; Mesentery ; Mortality ; Multiple Trauma ; Multivariate Analysis ; Pancreas ; Postoperative Care ; Resuscitation ; Retrospective Studies ; Spleen ; Stomach ; Ulsan ; Vascular System Injuries

Idiopathic restrictive cardiomyopathy is characterized by clinical and hemodynamic findings of restrictive cardiomyopathy in the absence of morphologic cause. The differential diagnosis between idiopathic restrictive cardiomyopathy and noncalcified constrictive pericarditis is difficult but the distinction is crucial because of the therapeutic implication. The diagnosis of idiopathic restrictive cardiomyopathy is aided by echocardiography and cardiac catheterization, cardiac magnetic resonance imaging. The patients should be approached systemically to differentiate from noncalcified constritive pericarditis.
Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathy, Restrictive* ; Diagnosis ; Diagnosis, Differential ; Echocardiography ; Hemodynamics ; Humans ; Magnetic Resonance Imaging ; Pericarditis ; Pericarditis, Constrictive

BACKGROUND: Naloxone,an opioidant agonist, has been s hown t o have a c ar di ovascular pressor effect in states of hemorrhagic and endotoxic shock.We determined the direct inotropic effect of naloxone using guinea pig right ventricular papillary muscles. METHODS: With institutional approval,isometric contractile force was measured in normal and 26mM K+ Tyrode's solution at various stimulation rates.Normal and slow action potentials (APs) were measured with conventional microelectrode technique.The effects of naloxone on sarcoplasmic recticulum function were evaluated by measuring rapid cooling contractures (RCCs)in normal Tyrode 's solution and rested-state (RS)contraction in low Na+ (25 mM)Tyrode's solution.Patch clamp study was performed to examine the direct effect on Ca2+ current in myocytes. RESULTS: Naloxone (50,100,200 micro M)caused dose-dependent depression of peak force and maximal rate of peak force (dF/dt-max)by 30,50 and 70%,respectively.Modest depression was shown in RS contraction in low Na+ Tyrode's solution.In 26 mM K+ Tyrode's solution,100 micro M naloxone markedly depressed late force development.100 micro M naloxone depressed RCCs by 20%. While 100 micro M naloxone did not alter amplitude or dV/dt-max in normal and slow APs at 0.25 Hz, AP duration was prolonged significantly.In patch clamp study,50 micro M naloxone depressed Ca2+ current by 50%. CONCLUSIONS: Naloxone depresses contractile force.Myocardial depressant effect partly seems to be caused by depressed Ca2+ influx through cardiac membrane.Rapid release of Ca2+ from the sarcoplasmic reticulum by depolarization and release by rapid cooling seems to be minimally affected.
Action Potentials ; Animals ; Contracture ; Depression ; Guinea Pigs ; Heart ; Microelectrodes ; Muscle Cells ; Myocardial Contraction ; Myocardium ; Naloxone* ; Papillary Muscles ; Sarcoplasmic Reticulum

We investigate the clinical characteristics of Sjogren's syndrome (SS). METHODS: We. retrospectively reviewed 59 patients with SS in the period from January 19: To 86 to January 1997. European Epidemiology Center criteria was used to diagnose SS. OBJECTIVES AND RESULTS: Thirty-one primary SS and 28 secondary SS patients were included in this study. There were 57 females and 2 males, the mean age was 45. 2+12.3 years (24 to 70 years). Patients with secondary SS were associated with rheumatoid arthritis(n=10), systemic lupus erythematosus(n=7), scleroderma(n=5), mixed connective tissue disease(n=3), and myositis(n=3). The common presenting symptoms were dry mouth in 92% and dry eyes in 90% of patients. Other symptom and signs included fatigue(27%), lymphadenopathy(22%) and parotid gland swelling (10%). The commonly presented autoantibodies were antinuclear antibody(83%) and rheumatoid factor(57%). Anti-Ro was positive in 49%(25/51) and anti-La in 37%(19/51). Anti-La positivity was significantly higher in primary SS(52%) compared to secondary SS(21%) (p<0.05). Schirmer test was positive in 98% (44/45), salivary radioscintigraphy in 74%(25/34), and lower lip biopsy in 47%(16/34). Extraglandular manifestations, such as Raynaud's phenomenon, vasculitis, glomerulonephritis, vaginal dryness, renal tubular acidosis, and primary biliary cirrhosis, were more frequently presented in primary SS compared to secondary SS (p<0. 05). CONCLUSION: The sex, age, and clinical manifestation of primary SS were similar with secondary SS, but extraglandular manifestations and anti-La antibody positivity were more frequent in primary SS.
Acidosis, Renal Tubular ; Autoantibodies ; Biopsy ; Connective Tissue ; Diagnostic Tests, Routine ; Epidemiology ; Female ; Glomerulonephritis ; Humans ; Lip ; Liver Cirrhosis, Biliary ; Male ; Mouth ; Parotid Gland ; Retrospective Studies ; Sjogren's Syndrome* ; Vasculitis

A 63-year old man developed acute monoarthritis in the dorsum of the left foot. Polarized light microscopy of the synovial fluid from his third metatarsophalangeal joint revealed numerous positively birefringent lipid spherules with a maltese cross appearance. Positively birefringent lipid spherules can be found in association with acute, otherwise unexplained arthritis, and may induce synovial inflammation similar to that seen in other types of crystal-induced arthritis. We report a case of acute monoarthritis in which large numbers of positively birefringent lipid spherules were present in a hyperlipidemic diabetic patient.
Acute Disease ; Arthritis/metabolism* ; Arthritis/complications* ; Birefringence ; Case Report ; Crystallization ; Diabetes Mellitus/blood* ; Human ; Hyperlipidemia/complications* ; Lipids/metabolism* ; Male ; Middle Age ; Synovial Fluid/metabolism*

PURPOSE: The pathogenesis of lower urinary tract symptoms (LUTS) is uncertain. We investigated the potential role of inflammation in the development of LUTS, with the use of high-sensitivity C-reactive protein (hsCRP) as an inflammatory marker, in a population-based study of aging men in Korea. MATERIALS AND METHODS: Our study used a multistage stratified design to recruit a random sample of 1,510 men aged 45 years or older in Chuncheon, Korea, in 2003. Men with urologic or neurologic diseases that could cause voiding dysfunction were excluded. Also, men with medical conditions that could affect inflammation, such as infection or the use of nonsteroidal anti-inflammatory drugs, were excluded. LUTS were defined according to the International Prostate Symptom Score (IPSS). Various potential confounding factors were included in the analyses. RESULTS: A total of 330 subjects were included in the final analyses. There were 155 (47.0%) with an IPSS<8 and 175 (53%) with an IPSS> or =8. The mean age of all subjects was 69.2+/-8.4 years. The mean hsCRP level of all subjects was 2.30+/-3.27 (median, 1.19) mg/l. The hsCRP levels in subjects with an IPSS> or =8 differed significantly from those in subjects with an IPSS<8. Also, IPSS, storage symptom, voiding symptom, and quality of life (QoL) scores increased as hsCRP levels increased, respectively. The hsCRP level remained an independent risk factor of LUTS (IPSS> or =8, storage symptom score> or =4, incomplete voiding, intermittency, and QoL) after adjustment for variable possible confounding factors. CONCLUSIONS: Our results suggest that inflammatory processes may play an important role in the pathogenesis of LUTS and that hsCRP levels may indicate the severity of LUTS in aging men.
Aged ; Aging ; C-Reactive Protein ; Humans ; Inflammation ; Korea ; Lower Urinary Tract Symptoms ; Male ; Prostate ; Quality of Life ; Risk Factors

To provide the information about overall test reliability and test improvement, we analyzed the first fundamental medical sciences examination at the Kon-Kuk University College of Medicine on August 23, 1997. The results are as follows: 1. The number of the items in the test is 230. The range of the scores is from 32.5 to 61.3(average percentage score: 50.0+/-6.1). Among the 39 students, three(7.7%) passed the examination with percentage scores of higher than 60. 2. The correlation coefficients between the fundamental medical sciences examination and academic records are 0.4682(the first semester in 1st grade), 0.5933(the second semester in 1st grade), and 0.6538(the first semester of 2nd grade), respectively. 3. Among the 230 items, 47(20.4%) are too difficult or too easy. Therefore these items are recommended to be discarded. 4. Among the 230 items, 115(50%) have lower discriminative indices(lower than 0.14) and 55(23.9%) have higher discriminative indices(higher than 0.23). 5. Among the 230 items, overall acceptable items are 101; the range of difficulty is 0.15~0.84 and discriminative indices are higher than 0.15. Good acceptance is shows in pharmacology and microbiology.
Humans ; Pharmacology