Optic nerve evulsion is a visually devastating and rare manifestation resulting in sudden visual loss after ocular trauma. The several hypothesis of mechanism include penetrating orbital injury causing a backward pull on the optic nerve, extreme rotation and forward displacement of the globe, and sudden increase in intraocular pressure causing rupture of the lamina cribrosa. The authors report a case of optic nerve evulsion in a 25- year old man who was struck in the right eye with a umbrella. The diagnosis was made by fundoscopic findings, fluorescein angiography, visual evoked potential, electroretinography, orbit computed tomography and magnetic resonance image.
Diagnosis ; Electroretinography ; Evoked Potentials, Visual ; Fluorescein Angiography ; Intraocular Pressure ; Optic Nerve* ; Orbit ; Rupture

Extraskeletal Ewing's sarcoma is a rare primary malignant soft tissue tumor that has the same pathological characteristics of skeletal Ewing's sarcoma. It is known that the differential diagnosis of Ewing's sarcoma from undifferentiated rhabdomyosarcoma, neuroblastoma, reticulum cell sarcoma, and malignant lymphoma by the histologic studies only are not easy because their histologic findings are nearly similar each other. Therefore, immunohistochemical method, electron microscopic examination, cytogenetic study, or molecular gene study are used together to confirm the diagnosis. It chiefly involves the lower extremity, soft tissues of the paravertebral region, and adjacent chest wall. We recently experienced a case of extraskeletal Ewing's sarcoma of duodenum in a 21-year old female. The patient underwent Whipple's operation and postoperative combined chemotherapy were done.
Cytogenetics ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Duodenum* ; Female ; Humans ; Lower Extremity ; Lymphoma ; Lymphoma, Non-Hodgkin ; Neuroblastoma ; Rhabdomyosarcoma ; Sarcoma* ; Sarcoma, Ewing ; Thoracic Wall ; Young Adult

We investigated the association between the oxidative stress and the concentration of heavy metals in blood among welders. The study subjects were male manual CO2 welders(N=127) exposed to several heavy metals. The age distribution was from 20 to 63 (GM=33.7) and the geometric mean(GM) of work duration was 4.2 years. We analyze the level of blood lead, cadmium, managese and chromium which was related with the oxidative stress in the animal studies. Blood selenuim, plasma malondialdehyde (MDA), plasma alpha-tocopheol and orythrocyte superoxide dismutase (SOD) were analyzed as biological markers of the oxidative stress. The results of univariate analysis showed that the plasma MDA was significantly correlated with D-tocopherol (r=0.327) and blood selenium (r=0.313) concentration. But we could not find out any relationship between the erythrocyte SOD activities and those metal concentrations. Neither smoking nor alcohol consumption was related to the level of heavy metals and the oxidative stress biomarkers. As the results of multiple regression analysis with stepwise selection method, 1) the change of MDA level were dependant with the level of alpha-tocopherol and blood selenium concentration (R2=19.7), 2) the plasma alpha-tocopherol level was dependant with MDA and blood chromium concentration (R2=15.6), 3) in case of erythrocyte SOD activity, only the duration of work was significantly selected.
Age Distribution ; Alcohol Drinking ; alpha-Tocopherol* ; Animals ; Biological Markers ; Cadmium ; Chromium ; Erythrocytes* ; Humans ; Male ; Malondialdehyde* ; Metals, Heavy* ; Oxidative Stress ; Plasma* ; Selenium ; Smoke ; Smoking ; Superoxide Dismutase* ; Superoxides*

BACKGOUND: Brain natriuretic peptide (BNP, b-type natriuretic peptide) is released into circulation in response to ventricular dilatation and pressure overload. In the general population, the plasma concentration of BNP are useful to predict left ventricular hypertrophy (LVH) and LV systolic dysfunction. Whether these cardiac hormone have correlation with hydration state in hemodialysis (HD) patients is unclear. METHODS: We measured the pre-HD and post-HD plasma BNP level in 36 HD patients and evaluated their cardiac state with echocardiography and their fluid overload state with chest X-ray. We checked intradialytic HD weight gain and ultrafiltration volume, as a marker of hydration status. RESULTS: Mean pre-HD BNP level of 36 HD patients was 545.79 pg/mL and mean post-HD BNP level was 503.64 pg/mL. And mean BNP level of 10 healthy adults was 13.46 pg/mL. In 29 patients, BNP level was decreased after HD. But BNP levels of 7 patients were paradoxically increased after HD. Ultrafiltration volume was smaller in these patients (p=0.03) and post-HD blood pressure was higher (p=0.048). Plasma BNP level was significantly increased in 17 patients with pulmonary congestion or cadiomegaly (p=0.005). But pre-HD BNP level did not correlated with pre-HD blood pressure. BNP reduction ratio was higher in larger ultrafiltration (UF) volume (>3 L) group than in smaller UF volume group (p=0.02). There were no difference in BNP levels between DM and non-DM group. CONCLUSION: Plasma BNP level seems to be a limited but useful, marker of volume status in HD patients.
Adult ; Blood Pressure ; Brain* ; Dilatation ; Echocardiography ; Estrogens, Conjugated (USP) ; Humans ; Hypertrophy, Left Ventricular ; Natriuretic Peptide, Brain* ; Plasma* ; Renal Dialysis* ; Thorax ; Ultrafiltration ; Weight Gain

Lemierre syndrome is characterized by an acute oropharyngeal infection with septic thrombophlebitis of the internal jugular vein, anaerobic bacteremia, and multiple metastatic abscess, frequently involving lung. The most common etiologic organism is Fusobacterium necrophorum. In this case, otomastoiditis causes internal jugular vein thrombophlebitis, which complicates pulmonary septic embolism and tricuspid valve endocarditis. The patient had no underlying heart disease and wasn't injection drug user. Blood culture revealed Bacteroides fragilis group and group G beta-hemolytic Streptococcus. Pulmonary septic embolism is common complication in patient with Lemierre syndrome, but endocarditis is very rare, moreover tricuspid valve involvement. As widespread use of antibiotics, this syndrome becomes rare and typical course of the disease has changed. It leads to decrease recognition of this syndrome. But, Lemierre syndrome is potentially fatal if early diagnosis and appropriate antibiotic treatment is not followed.
Abscess ; Anti-Bacterial Agents ; Bacteremia ; Bacteroides fragilis ; Drug Users ; Early Diagnosis ; Embolism ; Endocarditis* ; Fusobacterium necrophorum ; Heart Diseases ; Humans ; Jugular Veins ; Lemierre Syndrome* ; Lung ; Mastoiditis ; Streptococcus ; Thrombophlebitis ; Tricuspid Valve*

BACKGROUND: Nation-wide measles outbreaks occurred from 2000 to 2001 in Korea. Since, mass vaccination campaign for measles eradication among children and adolescents was implemented in May-August of 2001. Even in a highly vaccinated community, measles cases occur among vaccinees and there might be different serological responses among unvaccinees. In addition, the primary and secondary vaccine failures are not rare in the mass-vaccination era. Therefore, this study was undertaken to evaluate the effectiveness of serologic method for diagnosis of measles among the vaccinees and to estimate the vaccine failure rate among students with relatively high vaccination rate during the measles outbreak in a primary school. METHODS: In March 2000, the measles outbreak occurred in a primary school in Youngduk county, Kyung-sang-buk Do. Questionnaires about clinical manifestations of measles and history of measles vaccination were given out to in 209 3rd and 5th grade students among whom many measles cases occurred. The paired sera, which were taken from all students during March and May 2000, were tested for IgM and IgG measles antibody by using Enzygnost Anti-Measles IgG and IgM (Dade Behring, Germany). RESULTS: The questionnaires and serum samples were obtained from 145(69.4%) out of 209 cases. The immunization rate of measles vaccine was 80.7% (117/145). During the measles outbreak, 25 (17.2%) out of 145 cases with previous history of measles vaccination were diagnosed as measles, based on clinical definition. Among 17 cases (17/25, 68.0%) with paired samples out of 25 measles cases, 4 cases (4/17, 23.5%) were diagnosed by seroconversion of IgG, but negative IgM antibody, and they all had received measles vaccination previously. Among 117 cases with previous history of measles vaccination, 47 (40.2%) cases without measles symptoms showed four-fold increment of IgG titer. The primary and secondary failure rates of measles vaccine were 6.0% (7/117) and 1.7% (2/117), respectively. CONCLUSION: Among symptomatic measles cases with previous history of measles vaccination, 23.5% were diagnosed only by seroconversion of IgG measles antibody. In a highly vaccinated country, the accuracy of measles serodiagnosis can be increased with the IgG test of convalescent serum sample in addition to IgM antibody test. Among vaccinees, secondary immune response was 40.2%, suggesting that non-specific measles symptoms might occur among them. Therefore, further studies on the clinical definition of measles cases, vaccine failure rate and protective antibody titers should be continued in order to effectively conduct measles eradication campaign.
Adolescent ; Child ; Diagnosis ; Disease Outbreaks ; Humans ; Immunization ; Immunoglobulin G ; Immunoglobulin M ; Korea ; Mass Vaccination ; Measles Vaccine ; Measles* ; Seroepidemiologic Studies* ; Serologic Tests ; Vaccination ; Surveys and Questionnaires

BACKGROUND: Nation-wide measles outbreaks occurred from 2000 to 2001 in Korea. Since, mass vaccination campaign for measles eradication among children and adolescents was implemented in May-August of 2001. Even in a highly vaccinated community, measles cases occur among vaccinees and there might be different serological responses among unvaccinees. In addition, the primary and secondary vaccine failures are not rare in the mass-vaccination era. Therefore, this study was undertaken to evaluate the effectiveness of serologic method for diagnosis of measles among the vaccinees and to estimate the vaccine failure rate among students with relatively high vaccination rate during the measles outbreak in a primary school. METHODS: In March 2000, the measles outbreak occurred in a primary school in Youngduk county, Kyung-sang-buk Do. Questionnaires about clinical manifestations of measles and history of measles vaccination were given out to in 209 3rd and 5th grade students among whom many measles cases occurred. The paired sera, which were taken from all students during March and May 2000, were tested for IgM and IgG measles antibody by using Enzygnost Anti-Measles IgG and IgM (Dade Behring, Germany). RESULTS: The questionnaires and serum samples were obtained from 145(69.4%) out of 209 cases. The immunization rate of measles vaccine was 80.7% (117/145). During the measles outbreak, 25 (17.2%) out of 145 cases with previous history of measles vaccination were diagnosed as measles, based on clinical definition. Among 17 cases (17/25, 68.0%) with paired samples out of 25 measles cases, 4 cases (4/17, 23.5%) were diagnosed by seroconversion of IgG, but negative IgM antibody, and they all had received measles vaccination previously. Among 117 cases with previous history of measles vaccination, 47 (40.2%) cases without measles symptoms showed four-fold increment of IgG titer. The primary and secondary failure rates of measles vaccine were 6.0% (7/117) and 1.7% (2/117), respectively. CONCLUSION: Among symptomatic measles cases with previous history of measles vaccination, 23.5% were diagnosed only by seroconversion of IgG measles antibody. In a highly vaccinated country, the accuracy of measles serodiagnosis can be increased with the IgG test of convalescent serum sample in addition to IgM antibody test. Among vaccinees, secondary immune response was 40.2%, suggesting that non-specific measles symptoms might occur among them. Therefore, further studies on the clinical definition of measles cases, vaccine failure rate and protective antibody titers should be continued in order to effectively conduct measles eradication campaign.
Adolescent ; Child ; Diagnosis ; Disease Outbreaks ; Humans ; Immunization ; Immunoglobulin G ; Immunoglobulin M ; Korea ; Mass Vaccination ; Measles Vaccine ; Measles* ; Seroepidemiologic Studies* ; Serologic Tests ; Vaccination ; Surveys and Questionnaires

BACKGROUND: Although massive use of live attenuated mumps virus vaccines successfully reduced the incidence of mumps virus infection worldwide, mumps outbreaks have not been completely eliminated, even in vaccinated populations. In recent years, the incidence of mumps has been remarkably increased in Korea. This study was designed to evaluate the recent seroprevalence rate of mumps IgG among children in Kyonggi province at 1996 and 1999. METHODS: Study population included students from 8 elementary schools in Kyonggi province. Serum samples were collected twice at 1996 and 1999 and tested for mumps-specific antibody by enzyme-linked immunosorbent assay (ELISA). We also conducted a questionnaire survey on the parents and collected the records including history of vaccination and mumps infection. RESULTS: The seropositive rates against mumps were 89.47% and 89.74% at 1996 and 1999, respectively, and they were not significantly different when compared to age, sex, and region. Although the first vaccination rates were 92.17% and 92.25% at 1996 and 1999, respectively, the second vaccination rates were only 37.89% and 38.03% at 1996 and 1999, respectively. Infection rate showed no significant difference between vaccinated groups and nonvaccinated groups. Seropositive rate of infected group was higher than that of noninfected group but it was not significantly different between the vaccinated and the nonvaccinated. CONCLUSIONS: This study showed the seropositive rate and vaccination against mumps in children. There were no significant relationships between vaccination and infection. Therefore, it seems likely that the vaccination is not fully protective against mumps infection. This study will be helpful for the establishment of guideline for prevention and treatment of mumps in Korea.
Child* ; Disease Outbreaks ; Enzyme-Linked Immunosorbent Assay ; Gyeonggi-do* ; Humans ; Immunoglobulin G* ; Incidence ; Korea ; Mumps virus ; Mumps* ; Parents ; Seroepidemiologic Studies ; Vaccination ; Vaccines ; Surveys and Questionnaires

Rapid and reliable diagnosis of measles is important to establish an appropriate therapy and to monitor the epidemic. However, classical ELISA methods using purified virus or virus-infected cells as antigens are not only difficult to determine optimal condition for diagnosis but also highly expensive to establish routine and appropriate diagnostic systems. Nucleoprotein of measles virus is one of the major antigens of measles virus that evoke initial IgM responses. It can be used as an attractive antigen for sero-diagnosis of measles during early infection. To develop simple and inexpensive diagnostic method for measles, we expressed a recombinant nucleoprotein (60-kDa) and a fragmented portion of the nucleoprotein (50-kDa) in E. coli and evaluated their appropriateness as diagnostic antigens. The proteins strongly reacted with sera from measles patients but not with normal control sera. Efficiency of recombinant nucleoprotein-ELISA (rN-ELISA) to detect IgM was compared that of whole measles virus-ELISA (MV-ELISA) on the basis of a clinical diagnosis. In rN-ELISA, sensitivity was 73.8% and agreement was above 76.4%. In MV-ELISA, sensitivity was 76.9% and agreement was 79.2%. Therefore, efficacy of rN-ELISA seemed to be similar to that of MV-ELISA. In addition, we compared with Edmonston rN-ELISA and Korean isolate rN-ELISA on the basis of commercial MV-ELISA. In Edmonston rN-ELISA, sensitivity was 94.0% and agreement was 98.4%. In the case of Korean isolate rN-ELISA, sensitivity was 96.0% and agreement was 96.9%. Thus, there was no significant difference in the efficacy between Edmonston rN-ELISA and Korean isolate rN-ELISA. Furthermore, the correlation coefficient (R2) between Edmonston rN-ELISA and Korean isolate rN-ELISA was 0.9925. These results suggest both Edmonston and Korean isolate rN-ELISA may be useful to diagnose measles.
Diagnosis ; Enzyme-Linked Immunosorbent Assay* ; Humans ; Immunoglobulin M* ; Immunoglobulins* ; Measles virus* ; Measles* ; Nucleoproteins*

Cortical blindness is characterized by visual sensation loss with retention of pupillary reaction to light, and a normal fundoscopic examination. The suggested causes are emboli, profound hypotension, anemia, and infarction of watershed areas in the parietal or occipital lobe. We experienced a case of cortical blindness with severely reduced visual acuity after penile cancer surgery under general anesthesia. In the acute stage, visual acuity was slightly improved, but over the course of several months, no further improvement in visual acuity occurred. In this case there was no severe hypotension or anemia during the operation. Two days after the operation, electroencephalography (EEG) was performed during the period of blindness and the recording obtained was abnormal, with no alpha rhythm. Biparieto-occipital lucency was found by magnetic resonance imaging (MRI). Therefore parieto-occipital infarction due to seizure, embolus, or thrombosis could be considered a possible etiology. We concluded that cortical blindness can unexpectedly develop perioperatively and postoperatively, and that close monitoring of the patient and adequate management are essential.
Alpha Rhythm ; Anemia ; Anesthesia, General* ; Blindness ; Blindness, Cortical* ; Electroencephalography ; Embolism ; Humans ; Hypotension ; Infarction* ; Magnetic Resonance Imaging ; Male ; Occipital Lobe ; Penile Neoplasms ; Rabeprazole ; Seizures ; Sensation ; Thrombosis ; Visual Acuity