OBJECTIVES: Rapidly progres s ive glomerulonephritis (RPGN) is a clinico- pathologic entity characterized by extens ive crescent formation(usually involving 50% or more of glomeruli) as the principal his tologic finding and a rapid deterioration of kidney function, which can lead to end s tage renal disease within a few weeks. T he etiology and incidence of RPGN has been well defined in Europe and North America, however, there has been no report of a large series in Korea. T he aim of the present s tudy was to analyze the etiology and clinico- pathologic features of 26 patients with RPGN, seen during 1983-1997. METHODS: T wenty-six patients with RPGN(crescents in > 50% of glomeruli) were obs erved during a period of las t 14 years. Male to female ratio was 1:1.4, and the mean age was 30(6-75) years. Mean time from the initial symptoms to the ESRD was 3.1 months . RESULTS: The incidence of RPGN in our series was 2.1% of primary glomerulonephritis. Immunecomplex mediated disease was presented in 14 cases (54%), including 6 sys temic lupus erythematos us, 3 post- streptococcal glomerulonephritis, 3 Henoch- Schonlein purpura, and 2 IgA nephropathy. Pauci- immune disease was presented in 12 cases (46%), including 3 Wegener' s granulomatos is, one necrotizing crescentic glomerulonephritis, and 8 idiopathic crescentic glomerulonephritis. However, there was none of anti-GBM- mediated disease in our s tudy. ANCA were found in 6 patients. All 3 patients with WG were C- ANCA pos itive, whereas one patient with PSGN, necrotizing cres centic GN, and idiopathic crescentic GN were P- ANCA pos itive, respectively. Initial clinical and laboratory features included edema(80%), hypertens ion(72%), oliguria(68%), a decreased renal function(serum creatinine > 5mg/dL, 35%), and gros s hematuria(36%). Renal biopsy showed large crescents more than 80% of the glomeruli in 14 cases (54%) which were predominantly fibrocellular. Fifteen patients (58%) were treated with prednis olone alone, and 12 of them received puls e doses of corticosteroids. Five patients were treated with prednisolone and cyclophos phamide IV pulse. Two cases received plasma exchange. During the mean follow-up of 31+/-37 months, 18 patients (69%) developed inexorable progression of renal failure, three(12%) showed recovery of renal function, and two(8%) showed partial improvement, which is followed by varying degrees of renal insufficiency. During follow-up, three patients died : two from res piratory failure with severe pulmonary hemorrhage and one from opportunistic pulmonary infection during immunosuppressive therapy. Poor prognos is is as sociated with hypertension, increased serum creatinine level at the time of diagnosis, large crescents more than 85% of glomeruli, and glomerular scleros is . CONCLUSION: We conclude that an earlier diagnos is including kidney biopsy and the more aggressive treatment are essential in the management of RPGN.
Adrenal Cortex Hormones ; Antibodies, Antineutrophil Cytoplasmic ; Biopsy ; Creatinine ; Diagnosis ; Europe ; Female ; Follow-Up Studies ; Glomerulonephritis* ; Glomerulonephritis, IGA ; Hemorrhage ; Humans ; Hypertension ; Immune System Diseases ; Incidence ; Kidney ; Kidney Failure, Chronic ; Korea ; Male ; North America ; Plasma Exchange ; Prednisolone ; Purpura ; Renal Insufficiency ; Systemic Vasculitis

All registered inactive leprosy patients were treated with multidrug regimen since 1985. We experienced two couples of relapsed leprosy patients among them. Three were relapsed as multibacillary type and one paucibacillary type. They were given the regimen regularly but taken irregularly. The spouse cases were relapsed 6months and 4years after index cases relapsed. Three patients were elevated PGL1 ELISA titer after relapse
Enzyme-Linked Immunosorbent Assay ; Family Characteristics* ; Humans ; Leprosy* ; Recurrence* ; Spouses

Collagen ; Head ; Maxilla ; Maxillary Fractures ; Maxillary Sinus ; Mouth ; Mucous Membrane ; Nasal Cavity ; Neck ; Orbit ; Postoperative Complications ; Zygoma

PURPOSE: Tumor suppressor gene called PTEN has been localized to 10q23 in 1997 and its mutation has been implicated in some malignancies. Loss of the PTEN gene has been clinically associated with unfavorable histology and influencing tumor staging and recurrence in the determination of a prognosis in patients suffering from other cancers, its role in colorectal cancers is inconclusive as of yet. The purpose of this study is shed light on PTEN expression in colorectal cancer and its significance associated with pathological findings and clinical findings. METHODS: A total of 217 patients who had been diagnosed with colorectal cancer, had undergone radical colectomy from October of 1993 to December of 2000, and for whom follow-up was possible were selected for this study. Their clinical records were analyzed and specimens were stained immunohistochemically RESULTS: In comparing the PTEN positive group (48 patients, 22.1%) with the negative group (171 patients, 77.9%), there was a significantly (P=0.021) higher frequency of recurrence in the negative group (29.0%) than in the positive group (12.5%), and an especially higher frequency of distant metastasis in the negative group (18.3%) than in the positive group (4.2%), with P=0.010. Although there was no meaningful difference in the overall five year survival rate, the five year disease free survival rate was significantly (P=0.029) higher in the positive group. CONCLUSIONS: The results of this study reveal the possibility of using PTEN as a prognostic indicator in colorectal cancer.
Colectomy ; Colorectal Neoplasms* ; Disease-Free Survival ; Follow-Up Studies ; Genes, Tumor Suppressor ; Humans ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Recurrence ; Survival Rate

No abstract available.
POEMS Syndrome*

No abstract available.
Appendicitis* ; Purpura, Schoenlein-Henoch*

BACKGROUND: Rapid adrenocorticotropin (ACTH) stimulation test using 250ug of ACTH (1-24) has been used as a standard test in the initial assessment of adrenal function. However, it has recently been suggested that a rnaximal cortisol response can be achieved with a much lower ACTH dose, and reducing the dose might further enhance the sensitivity of the test in the detection of mild adrenal insufficiency. This study was performed to evaluate the role of low-dose (lug) ACTH stimulation test in the assessment of adrenal function and the diagnosis of subtle adrenal insufficiency. METHODS: Twenty-two subjects with suspected adrenal insufficiency due to long-term corticosteroid use were included in this study. The correlations between clinical features and the serum cortisol responses to low dose (lug) and high dose (250 ug) ACTH stimulation were evaluated. RESULTS: In high dose test, 10 (67%) out of 15 subjects with clinical features of adrenal insufficiency showed decreased serum cortisol response (peak cortisol level <18 ug/dL), but 5 (33%) subjects showed normal response (peak cortisol level > 18ug/dL). On the other hand, 14 (93%) subjects with clinical features of adrenal insufficiency showed decreased serum cortisol response in low dose test, while only one showed normal response. In 7 subjects without clinical features of adrenal insufficiency, 5 subject (71%) showed normal response, and 2 subjects (29%) showed decreased response in both low and high dose tests. CONCLUSION: These results suggest that the 1-ug low dose ACTH stimulation test might be more sensitive than conventional 250-ug test in the detection of mild adrenal insufficiency. Further studies are needed to determine the optimal dose of ACTH and the criteria for normal response to ACTH stimulation.
Adrenal Insufficiency* ; Adrenocorticotropic Hormone* ; Cosyntropin ; Diagnosis* ; Hand ; Hydrocortisone

Mesenteric and omental cysts are rare intra-abdominal lesions in childhood, and may present various clinical features such as an asymptomatic mass or an acute abdomen. Therefore, these entities are frequently misdiagnosed preoperatively or are found only incidentally at operation for other conditions. We analyzed our experiences of 19 cases in a 19 year period from 1981 to 1999, at College of Medicine, Catholic University of Korea. There were 12 boys and 7 girls with a mean age of 4.8 years (range, 3 days to 15 years). Common presenting symptoms were abdominal pain (47%), abdominal distension (31%), abdominal mass (24%), vomiting (15%) and fever (10%). Ultrasonography was the most preferred method of diagnosis. Other diagnostic modalities include CT, MRI, and abdominal ascites tapping in selected patients. Location of the mesenteric cysts was small bowel mesentery in nine, the right mesocolon and retroperitoneum in one, the left mesocolon in one, and the jejunum, sigmoid-colon mesentery in one. Most of the patients underwent cyst excision, but six patients required concomitant bowel resection for complete removal of the lesions, and two patients underwent unroofing and simple aspiration respectively. There was one mortality case due to sepsis.
Abdomen, Acute ; Abdominal Pain ; Ascites ; Child* ; Diagnosis ; Female ; Fever ; Humans ; Jejunum ; Korea ; Magnetic Resonance Imaging ; Mesenteric Cyst ; Mesentery ; Mesocolon ; Mortality ; Sepsis ; Ultrasonography ; Vomiting

No abstract available.
Helicobacter pylori* ; Helicobacter* ; Stomach Neoplasms*

We compared the efficacy and toxicity of mitomycin C and Bacillus Calmette-Guerin (BCG) intravesical instillation in 86 patients with stage T1 of the superficial bladder tumor. Of them, 34 patients were received mitomycin C (40 mg/40 ml sodium chloride, once a week for 8 weeks) and 26 patients were received BCG (120 mg/50 ml sodium chlorids, once a week for 6 weeks) after transurethrat resection of bladder tumor and 24 patients (control) underwent transurethral resection alone. The mean follow up period was 24.8 months in control group, 26.8 months in mitomycin C group and 25.7 months in BCG group. The mean time to recur was 11.3 months in control group, 11.5 months in mitomcyin C group and 15.9 in BCG group but there was no significant difference among each groups (p>0.05). The overall recurrence rate was 34.6% in BCG group compared with 70.5% in mitomycin C group and 75.0% in control group, showing significant difference (p<0.05). Side effects were more common after BCG instillation than mitomycin C instillation. The most common side effect after BCG instillation was hematuria in 14 patients (53.8%). That of mitomycin C was cystitis in 10 patients (29.4%). Our study suggests that the prophylactic efficacy of BCG was significantly superior to that of mitomycin C, but there was no significant superiority regarding prophylactic effect of reduced mean time to recur in stage T1 bladder cancer patients. Additionally, further follow up studies were needed in mitomycln C.
Administration, Intravesical ; Bacillus* ; Cystitis ; Follow-Up Studies ; Hematuria ; Humans ; Mitomycin* ; Mycobacterium bovis ; Recurrence ; Sodium ; Sodium Chloride ; Urinary Bladder Neoplasms* ; Urinary Bladder*