No abstract available.
Anemia, Hemolytic* ; Cholelithiasis* ; Hepatolenticular Degeneration*

BACKGROUND: Obesity is present in the majority of adult patients with obstructive sleep apnea(OSA) and is considered to be a major risk factor for its development. A reduction in body weight has been associated with substantial improvement in the severity of apnea. However, a variety of treatment strategies for obesity have yielded limited sucess. This study was done to determine resting energy expenditure(REE) in patients with obstructive sleep apnea and the correlation between the severity of sleep apnea and REE, and to investigate whether leptin influences REE and correlated with the severity of sleep apnea in 39 patients with OSA and 45 controls matched for obesity. METHOD: Overnight polysomnography was performed on all subjects using standard techniques. Measurements of REE were made using a Sensormedic Vmax 229 and a canopy system. Serum leptin concentration was measured by human leptin RIA kit of LINCO Reasearch INC. RESULTS: REE was greater in patients with OSA compared with controls, but there was no differences between the two groups on REE%. And also there was no significant correlation between anthropometric data, polysomnographic data and REE%. Serum leptin was linearly related to body mass index(BMI), apnea index, apnea hypopnea index and lowest arterial oxygen saturation(SaO2) but not related to REE%. CONCLUSION: This study suggests the following firstly patients with sleep apnea have a pattern of obesity characterized by energy homeostasis at an elevated body weight set-point. In order to achieve a lower body weight in these patients, it may be necessary to increase energy expenditure by increasing physical activity. Secondly leptin levels was not correlated with REE, suggesting that leptin may predominantly regulate body fat by altering eating behavior rather than calorigenesis. Lastly leptin level was significantly correlated with the severity of sleep apnea. These elevated levels of leptin in patients of sleep apnea may be related to the obesity, however it needs further studies to determine the relationship between the severity of sleep apnea and serum leptin.
Adipose Tissue ; Adult ; Apnea ; Body Weight ; Energy Metabolism* ; Feeding Behavior ; Homeostasis ; Humans ; Leptin* ; Motor Activity ; Obesity ; Oxygen ; Polysomnography ; Risk Factors ; Sleep Apnea Syndromes* ; Sleep Apnea, Obstructive

We report a case of erythema nodosurn associated with ulcerative colitis which occurred in a 13-year-old girl who showed well demarcated, painful, erythematous nodules and plaques on both upper and lower extremities. The patient also experienced frequent intermittent abdominal pain and bloody stools for about 1 year. Laboratory findings revealed polymorphonuclear leukocytosis and occult blood in the stool. Findings of sigmoidoscopy, barium enema, and rectal biopsy were consistent. with ulcerative colitis. A skin biopsy from the lesion on the right shin revealed a moderate inflammatory cell infiltrate in the septa of the subcutaneous fat layer, composed chiefly of lymphohistiocytes and a few epitheloid cells. The symptoms and signs responded well to orally administered prednisolone and sulfasalazine.
Abdominal Pain ; Adolescent ; Barium ; Biopsy ; Colitis, Ulcerative* ; Enema ; Erythema Nodosum* ; Erythema* ; Female ; Humans ; Leukocytosis ; Lower Extremity ; Occult Blood ; Prednisolone ; Sigmoidoscopy ; Skin ; Subcutaneous Fat ; Sulfasalazine ; Ulcer*

No abstract available.
Empyema, Tuberculous* ; Lymphoma, Non-Hodgkin* ; T-Lymphocytes*

OBJECTIVES: The objective of this report is to identify the utilization of hospital school service during hospitalization among patients in their childhood and adolescence with psychiatric disorders. METHODS: We retrospectively reviewed the medical record of child and adolescent psychiatric who were hospitalized during March 2009 through October 2012. We compared the one-year successful schooling and outpatient follow up rate between users and nonusers of the inpatient hospital school service. The hospital schooling experiences of the users were investigated upon follow-up visits to the outpatient clinic. RESULTS: Sixty-three students received hospital school service during hospitalization among total 122 child and adolescent inpatients. Hospital school participants showed a significantly higher school reentry rate (61.9%) than non-participants (40.7%). However, there was no difference on follow up rate between the two groups. More than 60% of the 22 interviewed participants expressed an above-average level of satisfaction about hospital school service. CONCLUSION: Many patients with mental illness experience difficulty in receiving school education during treatment. That induces deterioration in disease, academic failure, poor social skills, low self-esteem, economic difficulties, and future job opportunities. The results of this study emphasize the importance of hospital school service and offer useful guidance for hospital school operation.
Adolescent* ; Child* ; Education ; Education, Special ; Follow-Up Studies ; Hospitalization ; Humans ; Inpatients* ; Medical Records ; Mental Health ; Morinda ; Outpatients ; Retrospective Studies

BACKGROUND: Measurement of the plasma adrenocorticotropic hormone (ACTH) level has been recommended as the first diagnostic test for differentiating between ACTH-independent Cushing syndrome (CS) and ACTH-dependent CS. When plasma ACTH values are inconclusive, a differential diagnosis of CS can be made based upon measurement of the serum dehydroepiandrosterone sulfate (DHEA-S) level and results of the high-dose dexamethasone suppression test (HDST). The aim of this study was to assess the utility of plasma ACTH to differentiate adrenal CS from Cushing' disease (CD) and compare it with that of the HDST results and serum DHEA-S level. METHODS: We performed a retrospective, multicenter study from January 2000 to May 2012 involving 92 patients with endogenous CS. The levels of plasma ACTH, serum cortisol, 24-hour urine free cortisol (UFC) after the HDST, and serum DHEA-S were measured. RESULTS: Fifty-seven patients had adrenal CS and 35 patients had CD. The area under the curve of plasma ACTH, serum DHEA-S, percentage suppression of serum cortisol, and UFC after HDST were 0.954, 0.841, 0.950, and 0.997, respectively (all P<0.001). The cut-off values for plasma ACTH, percentage suppression of serum cortisol, and UFC after HDST were 5.3 pmol/L, 33.3%, and 61.6%, respectively. The sensitivity and specificity of plasma ACTH measurement were 84.2% and 94.3%, those of serum cortisol were 95.8% and 90.6%, and those of UFC after the HDST were 97.9% and 96.7%, respectively. CONCLUSION: Significant overlap in plasma ACTH levels was seen between patients with adrenal CS and those with CD. The HDST may be useful in differentiating between these forms of the disease, especially when the plasma ACTH level alone is not conclusive.
Adrenocorticotropic Hormone* ; Cushing Syndrome* ; Dehydroepiandrosterone Sulfate ; Dexamethasone ; Diagnosis, Differential ; Diagnostic Tests, Routine ; Humans ; Hydrocortisone ; Pituitary ACTH Hypersecretion* ; Plasma* ; Retrospective Studies ; Sensitivity and Specificity

The effects of bee venom on humans are variable from local to lethal reactions. However, ischemic stroke following bee venom acupuncture has rarely been reported. We report a case of a person who developed an ischemic stroke after bee venom acupuncture. The patient, who had a small cortical infarction one year ago, experienced anaphylatic symptoms several minutes after bee venom acupuncture. Shortly thereafter, he became confused and had aggravation of the left hemiparesis. A brain MR T2-weighted image showed a high signal intensity lesion on the right anterior border zone. A cerebral angiography revealed a right proximal internal carotid artery occlusion with collateral circulation via an anterior communicating artery. The presumed mechanism in this case was a hemodynamic infarction due to the bee venom induced anaphylactic shock. We alert the possibility for another disaster caused by inadvertent bee venom acupuncture for stroke patients.
Acupuncture* ; Anaphylaxis ; Arteries ; Bee Venoms* ; Bees* ; Brain ; Carotid Artery, Internal ; Cerebral Angiography ; Collateral Circulation ; Disasters ; Hemodynamics ; Humans ; Infarction ; Paresis ; Stroke*

PURPOSE: To perform a medical audit of screening mammography for breast cancer and to determine the benefit of this procedure for the early detection of this condition. MATERIALS AND METHODS:We reviewed the results of 43,329 instances of mammography in 36,802 women [18-86 (mean, 46) years old] who underwent the procedure at our health promotion center between January 1995 and December 1998. After reviewing the mammographic reports, we selected ACR BI-RADS assessment cate-gories 0, 4, 5, and then reviewed the follow-up studies and the pathologic results thus obtained. By comparison with the total number of patients diagnosed with breast cancer during the same period, false negative cases were confirmed, and from these data a medical audit was performed. RESULTS: The percentage of women undergoing mammographic examination has increased in recent years (from 64.5% in 1995 to 97.4% in 1998), and cases of breast cancer among those aged 30 to 69 has tended to increase. A total of 1,879 cases were assessed as BI-RADS categories 0, 4, 5, and of these, 155 were recommended for biopsy or surgery. A confirmatory pathologic diagnosis was obtained in 106 cases, and in 43 of these, breast cancer was pathologically proven. The recall rate was 5.1%, and the cancer detection rate was 1.2/1000 population. Positive predictive value 1(PPV1) was found in 2.3% of cases, PPV2 in 27.7%, and PPV3 in 40.6%. The most common mammographic finding was microcalcification (40.5%), and a pathological finding of invasive ductal carcinoma was found in 66.7% of cases. Patients diagnosed with breast cancer totalled 47 (four cases were false negative); the estimated sensitivity was 91.5%, with a specificity of 95.0%. The percentage of minimal cancers found was 48.8, while that of axillary node-positive invasive cancers was 33.3. The total rate of axillary nodal metastasis was 22.0%, and the rate of stages 0 and I was 73.2%. CONCLUSION: When appropriate interpretation and follow-up monitoring of screening mammography is per-formed, the procedure is effective for the early detection of breast cancer.
Biopsy ; Breast Neoplasms ; Carcinoma, Ductal ; Diagnosis ; Early Detection of Cancer ; Female ; Follow-Up Studies ; Health Promotion ; Humans ; Mammography* ; Mass Screening* ; Medical Audit ; Neoplasm Metastasis ; Sensitivity and Specificity

We investigate the effect of a new photoscreening camera designed to detect amblyogenic factors including strabismus, asymmetric and abnormal refractive errors and media opacities. The photoscreener uses eccentric photorefraction principles and provides two meridian photographs of the retinal reflex. Pass/fail screening data from photograph of 58 nondilated children, determined by two masked observers, were compared with data from complete ophthalmologic examinations. Photoscreener had a sensitivity rate of 92.0%, a specificity rate of 72.2%, a positive predictive value of 94.8%, a negative predictive value of 61.9% and overall agreement rate of 90.5%. The new two-flash photoscreenig camera, which uses high-speed polaroid film, is an accurate and reliable method of detecting amblyogenic factors in undilated children, and the camera promise as a useful mass screening tool.
Child ; Humans ; Masks ; Mass Screening ; Reflex ; Refractive Errors ; Retinaldehyde ; Sensitivity and Specificity ; Strabismus

PURPOSE: We report the results of replantations which was intentionally delayed for a certain period of time in patients with an amputation of multiple digits, both hands or the single digit presented at night. MATERIALS AND METHODS: Two staged intentianlly delayed replantations were performed in twenty patients. Three patients had amputations of four or more fingers, two had bilateral hand amputations and fifteen had a single digit amputation. RESULTS: The mean warm ischemic time was 3 hours and 58 minutes. The mean cold ischemic time was 2 hours and 36 minutes for the first operation, and 15 hours and 13 minutes for the second operation. Twenty digits out of 28 digits (85%) survived completely. At the mean follow-up of months, functional results according to Chen's criteria were rated as excellent in six patients, good in eight, and fair in five. CONCLUSION: When the patients had multiple finger amputations, bilateral hand amputations or presented late at night, intentional delay of the replantation also provide satisfactory outcomes.
Amputation ; Cold Ischemia ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Intention ; Replantation ; Warm Ischemia