We report a case of epidermolysis bullosa acquisita in a 53 year-old woman who had. extreme skin fragility, trauma induced blisters and erosions usually localized to extensor site of the skin surface, and healing with scars and milia for several years. Histologic findings of perilesional skin showed normal epidermis, subepid malblister and spirsely infiltration of inflammatory cells. Direct immuncofluorescence showed depositiori of IgCi and C3 in a linear pattern along the epidermal basement, membrane in the per ilesional skin. In indirect immuriofluorescence, using 1.0M sodium chloride separated nor mal human skin as the sntbstrate, antitodies(IgG at a titer of 1:40) were bound to dermal site of the separation, indicating that the patient serum yields the reaction in or below the lamiria densa. Electronmicroscopic findings showed the roof of the blister was located. below the basal lamiria.
Blister ; Cicatrix ; Epidermis ; Epidermolysis Bullosa Acquisita* ; Epidermolysis Bullosa* ; Female ; Humans ; Membranes ; Middle Aged ; Skin ; Sodium Chloride

Poor R-Wave Progression(PRWP) of precordial leads is frequently encountered electrocardiographic findings of uncertain significance and has simply been deemed as suggestion of anterior myocardial infarction without concrete ground. 217 cases with poor R-Wave Progression have been analyzed on clinical records and results are as follows. 1) PRWP was most frequently found in fifties and sixities, comprising 63.9% of the subjects. 2) Co-existent disease entities with PRWP were classified into three categories, cardiovascular diseases, chronic lung diseases and normal variants. 3) The cardiovascular diseases related with PRWP were mainly hypertensive diseases, comprising 59.8% of cardiovascular diseases, followed by ischemic heart disease, valvular heart disease and cardiomyopathies. 4) PRWP may be an early sign of acute myocardial infarction in a certain part of cases, which was endorsed by typical clinical symptoms and enzyme studies. 5) As the criterion of PRWP, V3R equal to or less than 3 mm was thought more adequate for higher specificity rather than 4 mm.
Cardiomyopathies ; Cardiovascular Diseases ; Electrocardiography ; Heart Valve Diseases ; Lung Diseases ; Myocardial Infarction ; Myocardial Ischemia ; Sensitivity and Specificity

Drug-induced thrombocytopenia and purpura have boon developed by many various agents. Rifampin and Pyrazinamide have been known as bactericidal antituberculous drugs, but, the above side effects have been a problem. Especially, hematologic side effects art fatal to patients occasionally. Rifampin-induced thrombocytopenia and purpura have been well known, also, pyrazinamide-induced thrombocytopenia have been reported. A new quilonone agent Ciprofloxacin, has been commonly used in clinics now, but it's side effects are not known well. So, we report a case of a 23-year-old female with thrombocytopenia and purpura after taking Rifampin, Pyrazinamide, and Ciprofloxacin as antituberculous agents.
Ciprofloxacin* ; Female ; Humans ; Purpura* ; Pyrazinamide* ; Rifampin ; Thrombocytopenia* ; Young Adult

STATEMENT OF PROBLEM: The importance of fixture design and surface treatment. PURPOSE: The clinical success of dental implants is affected by many factors such like as degree of osseointegration, the effective load dispersion for the prostheses, and a lot of attempts have been made to overcome the difficulties. In this study, efforts were made to find the possibility of clinical acceptance of the dental implants of newly designed surface and resorbable blast media surcace. MATERIALS AND METHODS: In this study, two groups of custom-made, screw-shaped implants were prepared. Tthe first with the consisting of Branemark clone design and the other with the new design. These implants were divided into four groups according to the kinds of surface treatment. Four implants(AVANA., Osstem, Busan, Korea) of each group were installed in twenty rabbits. Group A was consisted of Branemark clone implant left as machined, Group B with Branemark clone implants with RBM(Resorbable blast media) surface, Group C with newly designed implants left as machined and Group D with newly designed implants with RBM surface. One of the twenty rabbits died from inflammation and the observation was made for six weeks. Specimens from four groups were observed using scanning electron microscopy with 40, 100, 1000 magnification power and microsurface structures were measured by white-light scanning interferometry for three dimensional surface roughness measurements(Accura 2000., Intek-Plus, Korea.). Removal torque was measured in 17 rabbits using digital torque gauge(MGT 12R, Mark-10 corp., NY, U.S.A.) immediately after the sacrifice and two rabbits were used for the histologic preparation(EXAKT 310., Heraeus Kulzer, Wehrheim, Germany) of specimens and observed under light microscope. Resonance frequency measurement(Osstell(R)) was taken with the 19 rabbits at the beginning of the implant fixation and immediately after the sacrifice. RESULTS: Following results were taken from the experiment. 1. The surface of the RBM implants as seen with SEM had rough and irregular pattern with reticular formation compared to that of turned specimens showing different surface topographies. 2. The newly designed implant with RBM surface had high removal torque value among four groups with no statistical significance. The average removal torque was 49.95+/-6.70Ncm in Group A, 51.15+/-4.40Ncm in Group B, 50.78+/-9.37Ncm in Group C, 51.09+/-4.69Ncm in Group D. 3. The RFA values were 70.8+/-4.3Hz in Group A, 71.8+/-3.1Hz in Group B, 70.9+/-2.5Hz, 72.7+/-2.5Hz in Group D. Higher values were noted in the groups which had surface treatment compared to the untreated groups with no statistical significance. 4. The results from the histomorphometric evaluation showed a mean percentage of bone-toimplant contact of 45+/-0.5% in Group A, 55+/-3% in Group B, 49.5+/-0.5% in Group C, and 55+/-3% in Group D. Quite amount of newly formed bone were observed at the surface RBM-treated implants in bone marrow space.
Bone Marrow ; Busan ; Clone Cells ; Dental Implants ; Inflammation ; Interferometry ; Microscopy, Electron, Scanning ; Osseointegration ; Prostheses and Implants ; Rabbits ; Reticular Formation ; Tibia* ; Torque*

OBJECTIVE: To establish the biweekly standard values of pregnancy weight gains for primiparas and multiparas, and to investigate the influence of prepregnancy body mass index on biweekly weight gain during pregnancy. METHODS: We analyzed the biweekly weight gain data from 536 primiparas and 114 multiparas who had noncomplicated singleton term pregnancy. Data was categorized according to parity and body mass index (BMI). RESULTS: Biweekly weight gain was significantly different among prepregnancy BMI groups from the 15th week but was not different between primiparas and multiparas. CONCLUSION: To prevent a lot of complications which may be associated with abnormal weight gain during pregnancy, more careful prenatal care according to the prepregnancy BMI groups is needed. To establish the Korean standard value for antenatal weight gain, a nationwide multicenter study is needed.
Body Mass Index ; Female ; Parity ; Pregnancy* ; Prenatal Care ; Weight Gain*

Dilated cardiomyopathy secondary to pheochromocytoma is rare but has been reported to be partially or completely reversible in some cases. A woman with hypertension and cardiac failure due to pheochromocytoma was found to have a dilated, hypokeinetic left ventricle and a restrictive left ventricular filling pattern on two-Dimensional and Doppler echocardiograms. Left ventricular cavity was normalized after aggressive drug treatment, and after sugery of pheochromocytoma,left ventricular filling pattern and blood pressure as well as left ventricular function in echocardiogram were also completely normalized on follow-up without any drug.
Blood Pressure ; Cardiomyopathy, Dilated* ; Female ; Follow-Up Studies ; Heart Failure ; Heart Ventricles ; Humans ; Hypertension ; Pheochromocytoma* ; Ventricular Function, Left

Dilated cardiomyopathy secondary to pheochromocytoma is rare but has been reported to be partially or completely reversible in some cases. A woman with hypertension and cardiac failure due to pheochromocytoma was found to have a dilated, hypokeinetic left ventricle and a restrictive left ventricular filling pattern on two-Dimensional and Doppler echocardiograms. Left ventricular cavity was normalized after aggressive drug treatment, and after sugery of pheochromocytoma,left ventricular filling pattern and blood pressure as well as left ventricular function in echocardiogram were also completely normalized on follow-up without any drug.
Blood Pressure ; Cardiomyopathy, Dilated* ; Female ; Follow-Up Studies ; Heart Failure ; Heart Ventricles ; Humans ; Hypertension ; Pheochromocytoma* ; Ventricular Function, Left

PURPOSE: Serum aspartate aminotransferase (AST) is an enzyme widly used in the diagnosis of acute liver disease. It is also highly sensitive in cases of myocardial infarction and muscular injury. This study is designed to ascertain the utility of AST for diagnosis in emergency room. METHODS: From July 2001 to September 2002, 98 patients with AST greater than ten times (400 U/L) the normal range were identified by the biochemistry laboratory in the Emergency Medical Center of Chonnam National University Hospital. The patients 'clinical records were studied to determine the diagnosis, the clinical course, the physical finding on arrival, the past history, other serological and imaging studies, etc. RESULTS: The most common cause of elevated AST level was hepatic in origin (74 cases, 75.5%). Other causes were soft tissue injury (13 cases, 13.3%) and myocardial infarction (11 cases, 11.2%). In group with hepatic causes for raised AST, 21 (28.3%) patients had pancreaticobiliary desease, 20 (27.0%) patients were in conditions producing hepatic ischemia, 18 (24.3%) patients had hepatocellular desease, 6 (8.1%) patients had traumatic liver injury, and 4 (5.4%) patients had malignancy. The hepatic ischemia was caused by sepsis (6 cases, 30.0%), heart failure (6 cases, 30.0%), hypoxia (5 cases, 25.0%), and prolonged hypotension (3 cases, 15.0%). CONCLUSION: The main cause of a notably increased serum AST level is known to be hepatocellular disease, but this study for emergency patients revealed that other causes, such as hepatic ischemia, traumatic liver injury, and muscular disease, were also remarkable. When the level of serum AST is abnormally high, the clinician must consider not only hepatocellular disease but also prolonged hypotension, circulatory collapse, hypoxia, traumatic liver injury, etc.
Anoxia ; Aspartate Aminotransferases ; Biochemistry ; Diagnosis ; Emergencies* ; Emergency Service, Hospital ; Heart Failure ; Humans ; Hypotension ; Ischemia ; Jeollanam-do ; Liver ; Liver Diseases ; Muscular Diseases ; Myocardial Infarction ; Reference Values ; Sepsis ; Shock ; Soft Tissue Injuries

In tetraplegia patients, activities of daily living are highly dependent on the remaining upper limb functions. In other countries, upper limb reconstruction surgery to improve function has been applied to diverse cases, but few cases have been reported in Korea. The current authors experienced a case of posterior deltoid-to-triceps tendon transfer and rehabilitation in a complete spinal cord injury with a C6 neurologic level, and we introduce the case-a 36-year-old man-with a literature review. The patient's muscle strength in C5 C6 muscles were normal, but C7 muscles were trace, and the Spinal Cord Independence Measure III (SCIM III) score was 24. The tendon of the posterior deltoid was transferred to the triceps brachii muscle, and then the patient received comprehensive rehabilitative treatment. His C7 muscle strength in the right upper extremity was enhanced from trace to fair, and his SCIM III score improved to 29.
Activities of Daily Living ; Adult ; Elbow* ; Humans ; Korea ; Muscle Strength ; Muscles ; Quadriplegia* ; Rehabilitation ; Spinal Cord ; Spinal Cord Injuries ; Tendon Transfer* ; Tendons* ; Upper Extremity

PURPOSE: There was a global increase in the prevalence of oseltamivir-resistant influenza viruses during the 2007-2008 influenza season. This study was conducted to investigate the occurrence and characteristics of oseltamivir-resistant influenza viruses during the 2007-2008 and 2008-2009 influenza seasons among patients who were treated with oseltamivir (group A) and those that did not receive oseltamivir (group B). METHODS: A prospective study was conducted on 321 pediatric patients who were hospitalized because of influenza during the 2007-2008 and 2008-2009 influenza seasons. Drug resistance tests were conducted on influenza viruses isolated from 91 patients. RESULTS: There was no significant difference between the clinical characteristics of groups A and B during both seasons. Influenza A/H1N1, isolated from both groups A and B during the 2007-2008 and 2008-2009 periods, was not resistant to zanamivir. However, phenotypic analysis of the virus revealed a high oseltamivir IC50 range and that H275Y substitution of the neuraminidase (NA) gene and partial variation of the hemagglutinin (HA) gene did not affect its antigenicity to the HA vaccine even though group A had a shorter hospitalization duration and fewer lower respiratory tract complications than group B. In addition, there was no significant difference in the clinical manifestations between oseltamivir-susceptible and oseltamivir-resistant strains of influenza A/H1N1. CONCLUSION: Establishment of guidelines to efficiently treat influenza with oseltamivir, a commonly used drug for treating influenza in Korean pediatric patients, and a treatment strategy with a new therapeutic agent is required.
Child ; Drug Resistance ; Hemagglutinins ; Hospitalization ; Humans ; Influenza, Human ; Inhibitory Concentration 50 ; Neuraminidase ; Orthomyxoviridae ; Oseltamivir ; Prevalence ; Prospective Studies ; Respiratory System ; Seasons ; Viruses ; Zanamivir