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

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*

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

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

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

OBJECTIVES: The aim of this study was to compare the efficacy and safety of magnesium sulfate, ritodrine hydrochloride and nifedipine in the management of preterm labor. MATERIALS AND METHODS: 180 women with documented preterm labor were randomly assigned to receive magnesium sulfate (n=60), ritodrine hydrochloride (n=60) and nifedipine (n=60) as initial tocolytic therapy. 30 women with documented preterm labor were allocated to administer fluid only and bed rest as control group. Patient could be switched to another tocolytic regimen if they continued to have contractions or side effects. The main outcome variables examined were days gain in utero, success rate, side effects and neonatal outcome. RESULTS: There were no significant differences in maternal characteristics between the groups. The days gain in utero was no statistically different in the three groups(magnesium sulfate, ritodrine hydrochloride and nifedipine) but markedly longer in the three groups than the control group (p<.01). The total success rate was similar in the three groups, but side effects were much more in the magnesium sulfate and ritodrine group than the nifedipine group (p<.05). The respiratory distress syndrome in neonate was decreased in the three groups than the control group without statistical significance. CONCLUSION: Nifedipine is an effective, safe, and well-tolerated tocolytic agent. In this retrospective study, total success rate of controlling preterm labor was similar in the three groups, but patients who received nifedipine were less side effects than magnesium sulfate or ritodrine group.
Bed Rest ; Female ; Humans ; Infant, Newborn ; Magnesium Sulfate ; Magnesium* ; Nifedipine ; Obstetric Labor, Premature* ; Pregnancy ; Retrospective Studies ; Ritodrine* ; Tocolysis

PURPOSE: There are various methods proposed for the evaluation of the hindfoot alignment. However, due to structural calcaneus variances between patients, it is hard to assess this alignment definitively. Thus, this study proposes a new method for evaluating of the hindfoot alignment and its comparisons to the existing current methods. MATERIALS AND METHODS: This study includes simple weight bearing hindfoot coronal view radiographs of 120 patients, taken between the time period of March 2008 to November 2009. Among the 120 patients, there was a 1:1 ratio of male to female with an average age of 40. The newly proposed method for evaluating this alignment is to draw a moment arm from the point where the sustentaculum tali meets the medial calcaneus border to the most prominent aspect of the lateral process of the calcaneal tuberosity. The angle produced via the intersection of this moment arm to the mid-longitudinal axis of the tibia is found and used to evaluate the hindfoot alignment. The inter and intra-observer reliability was evaluated using the coefficient of intraclass correlation. This study also investigates the comparisons between the newly proposed method to the traditionally used Saltzman et al hindfoot alignment evaluating technique. RESULTS: The newly proposed method has higher inter and intra-observer reliability than the existing traditional Saltzman et al technique. CONCLUSION: This new method is recommended over the traditionally used Saltzman et al technique as it has a stronger confidence level and is appropriate for assessing hindfoot alignment in simple radiographs.
Arm ; Axis, Cervical Vertebra ; Calcaneus ; Female ; Humans ; Male ; Tibia ; Weight-Bearing

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*