Vascular leak syndrome(VLS) is characterized by endothelial damage, which causes extravasation of plasma proteins and fluid from capillaries into the extravascular space. It has been suggested that the increased vascular permeability is the result of an IL-2-induced suppression of endothelin-1 secretion by endothelial cells, an IL-2-induced activation of the complement cascade or TNF-alpha release from IL-2-activated T-cells. A 13-year-old male patient visited our hospital with abdominal pain. He was diagnosed with acute lymphoblastic leukemia(T cell type) by bone marrow study on his 2 nd day in hospital. On the 3 rd day of induction chemotherapy(prednisone, L-asparaginase, vincristine, intrathecal methotrexate), pulmonary edema and pleural effusion, ascites and generalized edema developed and lasted for 53 days without responding to supportive care. The laboratoy finding was that TNF-alpha was increased without evidence of infection and hypoalbuminemia was noted. It was suggested that the patient's clinical feature was induced by VLS.
Abdominal Pain ; Adolescent ; Ascites ; Blood Proteins ; Bone Marrow ; Capillaries ; Capillary Permeability ; Complement System Proteins ; Edema ; Endothelial Cells ; Endothelin-1 ; Humans ; Hypoalbuminemia ; Induction Chemotherapy* ; Male ; Pleural Effusion ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Pulmonary Edema ; T-Lymphocytes ; Tumor Necrosis Factor-alpha ; Vincristine

No abstract available.
Cough* ; Humans ; Hydrogen-Ion Concentration*

Objective: Anorexia nervosa and eating disorder not otherwise specified (NOS), an eating disorder not fulfilling anorexia nervosa DSM-IV criteria are on a rising trend in Singapore. The aims of this paper were to study the clinical characteristics and features of patients with anorexia and eating disorder NOS in Singapore. Methods: A retrospective cohort analysis of 373 patients between 2003 and 2010 at a tertiary hospital was done. Inclusion criteria included inpatients and outpatients with the age range of 12 years old to 40 years old fulfilling the Diagnostic and Statistical Manual (DSM)-IV criteria for anorexia nervosa and patients with the diagnosis of eating disorder NOS. The subjects are analyzed based on the severity of the eating disorder and the presentation subtypes. Results: An analysis of the overall demographic data revealed the female to the male ratio to be 22.4:1. The Chinese formed the largest ethnic group in the study population with 242 (86.1%) patients, and the bulk of the patients (75.8%) patients were between 12 to 20 years old. Anorexia nervosarestricting subtype was the most common eating disorder (55.2%) and the most common body mass Index (BMI) was between BMI 14.6 – 16.5 (35.2%). Restriction technique (p = 0.01), binge/purge (p = 0.03) and exercise (p < 0.001) are statistically significant to cause transaminitis in patients. Conclusion: There were significant changes in the demographics compared to the study reviewing patients from 1994 and 2002. There was a significant increase in the Caucasian population with changes in the Singapore immigration policy. A detail history taken during first visit can reduce the morbidity and mortality of these patients.

Between January 1982 and September 1986, at the Department of Orthopaedic Surgery of Kyung Hee University Hospital, 82 total knee arthroplasties were performed in 57 patients. We studied 25 patients (50 Knees) who had been operated by bilateral total knee arthroplasties to compare one stage and two stage operations. The follow-up ranged from 10 months to 5 years and 7 months (average 1 year and 8 months). All operations were performed by one of the authors (D.K.B.), but the follow-up study and the entire medical record were independently evaluated by another authors. The clinical results of preoperative and postoperative assessments and rehabilitation processes are as follows; 1. Group I (10 patients) had both kness replaced by one stage simultaneous operation under same anesthesia, and Group II(15 patients) had replaced by two stage operation at the intervals of 2 weeks. 2. The periods required to do bilateral weight bearing were 10.3 days for Group I, 23.6 days for Group II. 3. Complications in one stage operation was no more than the in two stage operation. 4. The postoperative pain and ROM were not significantly different in both groups. 5. Using the hospital for special surgery rating system, we found the clinical results to be similar in both groups. 6. Comparing to two stage operation, the advantages of one stage operation were shorter operative and tourniquet time, lesser use of antibiotics, reduced medical cost and hospital stay. In conclusion, if patient conditions do not prevent prolonged anesthetic time and surgeons have good surgical techniques, we recommend one stage simultaneous operation in bilateral total knee replacement.
Anesthesia ; Anti-Bacterial Agents ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Humans ; Knee ; Length of Stay ; Medical Records ; Pain, Postoperative ; Rehabilitation ; Surgeons ; Tourniquets ; Weight-Bearing

The purpose of this study is to investigate the effect of the ball-cone contact interface variation on the ceramic ball stress which is the dominant factor of the design of the moldular artificial hip joint. A contact stress analysis problem is formulated using the optimization principle and finite element analysis technique on the ball-cone system of three dimensional axi-symmetrical model, Numerical procedure is employed to get the solution for varying angles of cones and angular mismatches between the ball and cone interfaces. There is a fair amount of friction in the interface and included in the analysis model.
Ceramics ; Finite Element Analysis ; Friction ; Hip Joint ; Hip

We report herein a case of acral lentiginous melanoma in a 65-year-old female. An about 2x3cm sized erythematous to brownish mass with central ulceration was located on the left heel accompanied by enlargement of the left inguinal lymph nodes. Histopathologic findings showed lentiginous proliferation of atypical melanocytes with pseudoepithliomatous hyperplasia and invasion of tumor cells from the epidermis into the dermis. Focal pigmented melanocytes were also noted. Complete surgical excision and chemotherapy with DTIC were done. Marked edematous swelling on the left lower leg was developed after 8 months and 1 month later she was expired.
Aged ; Dacarbazine ; Dermis ; Drug Therapy ; Epidermis ; Female ; Heel ; Humans ; Hyperplasia ; Leg ; Lymph Nodes ; Melanocytes ; Melanoma* ; Ulcer

Toxic epidermal necrolysis (T~EN) is a severe mucocutaneous disease characterized by epidermal necrosis possibly extended to the entire body surface and involving multiple internal organs. Digestive tract may be involved too, but there is few report about gastrointestinal lesion in patient with TEN. Recently we experienced a case of TEN with gastrointestinal bleeding in previously healthy 32-year-old woman. The condition developed three days after the initiation of treatment with NSAID and progressed caudally, involving 60 percent of the skin surfaces. During a period of admission gastrointestinal bleeding was noticed. The gastrofiberscopy showed diffuse superficial mucosal lesion with oozing from swollen friable and erythematous mucosa. The skin lesion was progressed inspite of withdrawal of causative agents. The patient was expired due to combined septic shock 10 days later. We report this case with gastrofiberscopic findings and a brief review of literature.
Adult ; Female ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Mucous Membrane ; Necrosis ; Shock, Septic ; Skin ; Stevens-Johnson Syndrome*

We recently experienced a case of an elderly patient with mediastinal abscess, which is a rare complication of esophageal perforation, in whom dyspnea, chest pain and odynophagia were main clinical symptoms after eating cooked fish. During evaluation, upper mediastinal widening, with air-fluid level, and eaophageal perforation plugged with pus were detected by chest X-ray films and endoscopic examinatien. After draining of pus(about 300 cc) through the perforation site by careful manipulation of endoscope, inner wall of abacess cavity communicating with esophagus could be observed through esophago-mediastinal fistula. For further management, drainage procedure of mediastinal abscess, esophageal diversion and feeding gastrostomy were done.
Abscess* ; Aged ; Chest Pain ; Drainage ; Dyspnea ; Eating ; Endoscopes ; Esophageal Perforation* ; Esophagus ; Fistula ; Gastrostomy ; Humans ; Suppuration ; Thorax ; X-Ray Film

BACKGROUND: A clinical trial was performed to evaluate the antihypertensive efficacy and side effects of amlodipine, a new long-action calcium antagonist, in patients with mild to moderate essential hypertension as measured by 24-h ambulatory blood pressure monitoring. METHODS AND RESULTS: 1) The study patients consisted of 4 men and 6 women, and the mean age was 51 years. Amlodipine monotherapy(5~10mg) was continued for 4 weeks, and blood pressure was measured by 24-h ambulatory blood pressure monitoring. 2) A smooth and sustained lowering of blood pressure was clearly achieved without affecting the circadian rhythm throughout dosing interval. The mean-pressure drop was 21.2/13.7mmHg after 4 weeks of amlodipine monotherapy. 3) The ambulatory pulse rate revealed virtually identical average hourly pulses during the recording period before and after amlodipine treatment. 4) All of the laboratory parameters including blood chemistry, glucose, lipid and electrolytes did not change significantly after 4 weeks of amlodipine monotherapy. 5) Amlodipine therapy resulted in minimal side effects that were well tolerated. CONCLUSIONS: Once-daily amlodipine monotherapy with 5 to 10mg in controlling blood pressure throughout each 24-h cycle is effective and well tolerated in the patients with mild to moderate essential hypertension.
Amlodipine* ; Blood Pressure Monitoring, Ambulatory ; Blood Pressure* ; Calcium ; Chemistry ; Circadian Rhythm ; Electrolytes ; Female ; Glucose ; Heart Rate ; Humans ; Hypertension ; Male

In 22 end-stage renal disease patients on regular hemodialysis, echocardiographic study including 2-D Doppler echocardiogrphy was performed to evaluate the effect of hemodialysis on cardiac performance and the degree of valvular regurgitation. After hemodialysis, there were significant improvement of ventricular contractility and reduction of circulating volume in accordance with the reduction of degree of valvular regurgitation in comparison with before hemodialysis. We postulate that the reduction of valvular regurgitation after hemodialysis is caused by relief of hypervolemic state.
Echocardiography* ; Echocardiography, Doppler ; Humans ; Kidney Failure, Chronic ; Renal Dialysis*