The central venous catheter(Quinton) was replaced in the right atrium for chemotherapy and blood sampling to a eight-year old girl with acute lymphoblastic leukemia. The catheter was flushed with heparin two times daily and the chemotherapeutic drug regimens by CCSG-105 protocol were vincristine, prednisone, L-asparaginase, daunomycin, methotrexate, cyclophosphamide, cytosine arabinoside, 6-mercaptopurine and adriamycin. On day 31 of catheterization, the lumen for blood sampling was blocked. From day 60 of catheterization, anorexia, nausea, vomiting, abdominal distension and tachypnea were developed. Echocardiogram, lung scan, pulmonary function test(PFT), arterial blood gas analysis (ABGA) were done. Two cemtimeters in diameter of thrombosis was found in the right atrium on echocardiogram. The lung scan showed slight decrease in uptake of Tc-99m on the whole lung fields. Restrictive ventratory impairment on PFT and decreased PaO2(48 mmHg) on ABGA were found. To lysis of thromboembolism, urokinase(4,400 IU/kg for initial 10 minutes and the 4,400 IU/kg for 12 hours) was injected intravenously and aspirin(30 mg/kg/d, po) was given. The thrombosis was disappeared from the atrium on echocardiogram and PaO2 was increased up to 97 mmHg temporary. The catheter was removed but total haziness on the right middle and lower lobes were developed after 5 days. The same dose of urokinase was injected just infront of the embolism through Pitfall catheter for 8 days intermittently as results of pulmonary angiography. Symptoms and PaO2 were alleviated and the lung was expanded with mild atelectasis on day 55 of the first fibrinolytic enzyme therapy. Although the frequent complications of central venous catheter are catheter occlusion and infection, we have to check the development of thromboembolism with echocardiogram periodically or in case of unexplained respiratory symptoms.
6-Mercaptopurine ; Angiography ; Anorexia ; Blood Gas Analysis ; Catheterization ; Catheters ; Central Venous Catheters* ; Cyclophosphamide ; Cytarabine ; Daunorubicin ; Doxorubicin ; Drug Therapy ; Embolism ; Enzyme Therapy ; Female ; Heart Atria ; Heparin ; Humans ; Lung ; Methotrexate ; Nausea ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prednisone ; Pulmonary Atelectasis ; Tachypnea ; Thromboembolism* ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Vincristine ; Vomiting

No abstract available.
Orchiopexy* ; Testis*

No abstract available.
Fibrosis* ; Recurrence*

Combined injury of peroneus brevis rupture and bimalleolar fracture is very rare. The avulsion of peroneus brevis tendon from insertion maybe neglected and may prevent anatomic reduction of lateral malleolar fracture. We have treated open bimalleolar fracture with avulsion of peroneus brevis tendon from its insertion.
Ankle Fractures ; Rupture ; Tendons

A case of eavernous hemangiomatosis involving alI tendon sheath of flexors and median nerve of the right forearm is reported. This case was a 22 year old Korean male who complained of painful swelling of the flexor side of right wrist region, limited motion of wrist joint, loss of pinching and opposition with tingling sensation on the admission. Roentgenographic examination revealed fusiform swelling of the soft tissues in flexor aspect of the right wrist region, with phlebolith, 3mm. in diameter. The tumor mass looked like strawberry in shape, and was scattered into all tendon sheath of flexors of the forearm, median nerve, the distal half of pronator quadrtus and other surrounding soft tissues. The specimen was confirmed as cavernous hemangioma in microscopic examination. The right long arm splint was applied for 3 weeks, and then the patient was treated with physical therapy for 4 months. Pinching, opposition, and motion of the right wrist joint recovered almost completly, and no evidence of the recurrence of hemangiomatosis was seen until 8 months after surgery.
Arm ; Forearm ; Fragaria ; Hemangioma, Cavernous ; Humans ; Male ; Median Nerve ; Recurrence ; Sensation ; Splints ; Tendons ; Wrist ; Wrist Joint

The clinical study was performed to 28 patients with the pericardiac effusion who were admitted in Busan university Hospital and Paik Hospital, In-Je Medical College, Busan, korea during March 1976 and July 1981. The results were as following; 1) 12 cases(42.9%) of total 28 pericardiac effusion occured in 3rd decade, 8(28.5%) in 2nd decade and 5 cases(17.9%) in 4th decade. Sex distribution showed male to female 2.5:1. 2) With etiological distribution there were 15 cases(53.6%) tuberculous, 5(17.9%) nonspecific, 3(10.7%) malignant, 2(7.1%) pyogenic, 2 traumatic and 1(3.6%) rheumatic. 3) On admission 28 cases(100%) complained of dyspnea, 24(85.7%) distant heart sound, 20(71.4%) each engorged jugular vein and edema, 18(64.3%) each cough and abdominal fullness, 17(60.7%) each sputum and chest discomfort and pain, 12(42.9%) fever, 11(39.1%) orthopnea, 10(35.7%) chilling, 7(25%) oliguria, 4(14.6%) palpitation and 3(17.2%) headache. Increased cardiac dullness was observed in 26 cases(71.4%), hepatomegaly 18(64.3%), pulmonary rales 17(60.7%), ascites 13(46.1%), fever 12(42.9%), pericardiac friction rub 10(35.7%), splenomegaly 7(25%), paradoxical pulse 6(21.4%) and jaundice 2(7.1%). 4) On amission SGOT and SGPT level was increased each in 15(53.6%) and 13(46.7%), TTT and CCF abnormal in 10(35.7%), and 8(28.5%), serum NPN, BUN, creatinine increased in each 10(35.7%), 11(39.1%), 8(28.5%), WBC increased in 6(21.4%), RBC decreased in 8(28.5%) and ESR increased in 16(57.1%). 5) Characteristics of pericardiac effusion showed hemorrhagic 17(60.7%), serosangeous 6(21.4%), sangeous 3(17.2%) and pyogenic 2 cases(7.1%). 6) The ECG on admission revealed low voltage in 25(89.1%), depressed ST segment in 13(46.1%) and inverted T wave in 12(42.9%). 7) Chest X-ray showing cardiomegaly 28(100%), pleural effusion in 20(71.4%), and pulmonary congestion in 16(57.1%). 8) The m mode and 2-D Echocardiogram showed echo free space in 28 cases and after pericardiocentesis the space was reduced or disappeared. 9) 19 cases of 28(67.5%) were improved clinically, while 5 cases(17.9%) were not improved and 4 cases(14.6%) died.
Alanine Transaminase ; Ascites ; Aspartate Aminotransferases ; Busan ; Cardiomegaly ; Cough ; Creatinine ; Dyspnea ; Edema ; Electrocardiography ; Estrogens, Conjugated (USP) ; Female ; Fever ; Friction ; Headache ; Heart Sounds ; Hepatomegaly ; Humans ; Jaundice ; Jugular Veins ; Korea ; Male ; Oliguria ; Pericardiocentesis ; Pleural Effusion ; Respiratory Sounds ; Sex Distribution ; Splenomegaly ; Sputum ; Thorax

The purpose of this paper is to overview the life of John W. Heron, M. D. who was the first appointed medical missionary to Korea by the Presbyterian Church USA. Although he was a competent doctor as well as a devoted missionary, he is not well-known yet, because he died early after 5 years' service in Korea. Dr. Heron was born in Derbyshire, England on June 15, 1856. His father, Rev. E. S. Heron, was a Scotch Minister of Congregational Church. His family emigrated to America in 1870 when he was fourteen years old and settled in Knoxville, Tennessee. In 1881, he was admitted to the University of Tennessee Medical School and graduated with highest honors in 1883. After training in New York University Hospital, he refused the offer of professorship from the University of Tennessee to become a medical missionary to Korea. He arrived in Seoul on June 21, 1885 and began to work in Royal Government Hospital, Chejungwon, the predecessor of Severance Hospital. In 1887, he became the superintendent of the Hospital following Dr. Horace N. Allen. He also worked for the Royal family and sometimes traveled to the rural areas to care for the patients. He started Chejungwon Church which later became Namdaemoon Presbyterian Church. In 1887, Dr. Heron worked as a member of the Bible translation committee and in 1889, he was elected as the chairman of the Public Committee of the Presbyterian Churches. In 1890, he established 'The Korean Religious Tract Society (Chosunsyungkyoseohoi) with Underwood and Ohlinger. The society published and replenished Christian books, periodical magazines and booklets. In the Summer of 1890, Dr. Heron did his best to take care of the sick suffering from an epidemic dysentery and himself got infected because of the terrible overwork. He passed away on July 26th, 1890. On his deathbed, he told his soldier and native friends around him as follow: "Jesus loves you. He gave His life for you. Stand by Him!" The martyrdom of Dr. Heron should be remembered in the Korean history of mission, because he was the first victim among the foreign missionaries who had lived and worked in Seoul for Korean mission. Dr. Heron's mind of love, service and devotion should be remembered by the medical doctors working today in caring for the patients suffering from physical and spiritual illnesses.
English Abstract ; History of Medicine, 19th Cent. ; Hospitals, Religious/*history ; Korea ; Missions and Missionaries/*history ; *Religion and Medicine ; United States

Evaluations of residual renal function and the therapeutic effectiveness in renal tuberculosis have largely been dependent on intravenous pyelogram or Contrast-CT scan, even though, exact renal function are not evaluated with there methads. 99mTc-DMSA is a radiopharmaceutical that is trapped in the functioning tubular cells of the kidney and therefore, quantitative renal function could be evaluoted by ineasuring the counts of renal radioactivity and concomittant evaluation of renal morphology could be passible with the analog imapes of the radioactivity. The authors retrospectively analyzed 99mTc-DMSA scans of 75 kidndys of 67 patients with confirmed renal tuberculosis. We classified the morphologies of tuberculous kidneys as 6 types. We classified the morphologies of tuberculous kidneys as 6 types such as the type with small cortical defect, with parenchymal ulcerocavernous lesions, ulcerocavernous fistula to pelvis, mass-like defects, contracted kidney with ureter visualization, and the type with nonvisualization of kidney, corresponding to the characters of renal tuberculous pathogenesis with abscess formation, ulcerocavernous fistula, and fibrosis, and correspondings to the renal anatomy with parenchyma, and pelvocalyceal collecting system. Their mean residual renal functions measured with 99mTc-DMSA uptake rates were 19.0%, 18.4%, 7.9%, 12%, 4.1%, 3.4% respectively.
Abscess ; Fibrosis ; Fistula ; Fluspirilene ; Humans ; Kidney ; Pelvis ; Radioactivity ; Retrospective Studies ; Succimer* ; Technetium Tc 99m Dimercaptosuccinic Acid ; Tuberculosis, Renal* ; Ureter

BACKGROUND: We have found abnormal expression of ICAM-1 in thyroid follicular cells from patients with Graves disease and Hashimoto disease. In this report, we present the hormonal regulation of ICAM-1 mRNA expression and the primary structure of 5-regulatory region which is important for transcriptional regulation of ICAM-1 gene. A I.S kb fragment of the 5-regulatory sequences are identified and linked to luciferase as a reporter. METHOD: Those reporter constructs were used to evaluate the expression in response to cytokines and hormones. Deletion analysis of 1.8 kb fragment of ICAM-1 promoter in FRTL-5 cells provide the evidence for the existence of several regulatory elements of enhancer and silencer in ICAM-1 gene transcription in thyroid cells. RESULTS: ICAM-1 mRNA is easily detected by Northern analysis using total RNA from FRTL-5 cells regardless of culture conditions. The transcripts of rat ICAM-1 showed single band of 2.6 kb in length. The FRT cells which was come from early FRTL cell culture did not show ICAM-1 mRNA with usual Northern analysis, We found differential regulation of ICAM-1 RNA level in different culture condition in FRTL-5 cells, The cells maintained at 3H (no hydrocortisone, no insulin, no TSH) condition showed the highest expression level compared to 4H, 5H, or 6H medium. Hydrocortisone markedly decreased the ICAM-1 RNA and insulin partially recovered the hydrocortisone induced repression. TSH which is important in growth and function of FRTL-5 cells could independently downregulate the ICAM-1 RNA levels. Forskolin (10 mM) could mimic the action of TSH on ICAM-1 mRNA. TNF-a and interferon-y increase ICAM-1 expression in FRTL-5 thyroid cells. TSH/forskolin inhibited maximal expression of ICAM-1 by TNF-a and interferon-r. Promoter activity of the ICAM-1 gene was positively regulated by cytokines, TNF-a and IFN-r and negatively regulated by thyroid stimulating hormone. The addition of TSH and FSK caused a 50% decrease in ICAM-1 promoter activity within 24 hour. The TSH and FSK action was mapped at 175 bp and 97 bp of the start of translation. The mutant construct pCAM-175 delGAS which has no GAS sequence showed no TSH mediated suppression of promoter activity. CONCLUSION: These findings suggested that hormones and cytokines differentially regulated the ICAM-1 gene expression and TSH downregulated ICAM-1 gene transcription by inhibiting the activation of IFN-r induced transcription factors which can bind the GAS of ICAM-1 promoter.
Animals ; Cell Culture Techniques ; Clone Cells* ; Cloning, Organism* ; Colforsin ; Cytokines ; Gene Expression ; Graves Disease ; Hashimoto Disease ; Humans ; Hydrocortisone ; Insulin ; Intercellular Adhesion Molecule-1* ; Luciferases ; Rats* ; Repression, Psychology ; RNA ; RNA, Messenger ; Thyroid Gland* ; Thyrotropin ; Transcription Factors

Gangweon-do is known to be highly endemic area of sparganosis more than other provinces in Korea. A seroepidmiologic examination for the detection of anti-Spirometra erinacei plerocercoid IgG in serum was carried out in normal inhabitants in Hongcheon-gun, Gangweon-do. Sere were tested by enzyme-linked immunosrobent assay (ELISA) for the anti-sparganum antibodies. Positive rate for anti-sparganum antibody in 719 adults was 3.3%. Data of the questionnaire for 24 ELISA positive inhabitants revealed that 20 had a history of eating raw meat of snakes, 24 had a history of eating frogs, and 24 had a history of drinking stream water. Two positive cases had a past history of sparganosis. Two positive cases showed current symptoms of sparganosis. The data revealed that ELISA would be useful to find infected cases among normal inhabitants at sparganosis-endemic areas.
Adult ; Aged ; Aged, 80 and over ; Animals ; Antibodies, Helminth/*blood ; Enzyme-Linked Immunosorbent Assay ; Female ; Human ; Immunoglobulin G/*blood ; Korea/epidemiology ; Male ; Middle Aged ; Seroepidemiologic Studies ; Sparganosis/*epidemiology ; Spirometra/*immunology