Lipomas of the heart are benign neoplasms and have rarely been described. Due to the fact that they normally cause no symptoms, diagnosis is often purely accidental. Because of the rarity of these tumors, it seems worthwhile to present an example studied at autopsy. It was associated with the sudden death of a 15-year-old boy. The tumor arose from the wall of the left ventricle and occupied the pericardial cavity, measuring 13x7x6 cm in size. The tumor was whitish-yellow, translucent, and soft. Microscopically, the tumor was composed of mature adipose tissue which extended between muscle fibers. This current case, the giant cardiac lipoma is believed to produce disturbances of the conduction system and distrubances of cardiac filling.

Missing data such as appropriateness ratings in clinical research are a common problem and this often yields a biased result. This paper aims to introduce the multiple imputation method to handle missing data in clinical research and to suggest that the multiple imputation technique can give more accurate estimates than those of a complete-case analysis. The idea of multiple imputation is that each missing value is replaced with more than one plausible value. The appropriateness method was developed as a pragmatic solution to problem of trying to assess "appropriate" surgical and medical procedures for patients. Cataract surgery was selected as one of four procedures that were evaluated as a part of the Clinical Appropriateness Initiative. We created mild to high missing rates of 10%, 30% and 50% and compared the performance of logistic regression in cataract surgery. We treated the coefficients in the original data as true parameters and compared them with the other results. In the mild missing rate (10%), the deviation from the true coefficients was quite small and ignorable. After removing the missing data, the complete-case analysis did not reveal any serious bias. However, as the missing rate increased, the bias was not ignorable and it distorted the result. This simulation study suggests that a multiple imputation technique can give more accurate estimates than those of a complete-case analysis, especially for moderate to high missing rates (30 - 50%). In addition, the multiple imputation technique yields better accuracy than a single imputation technique. Therefore, multiple imputation is useful and efficient for a situation in clinical research where there is large amounts of missing data.
Cataract Extraction/*methods ; Humans ; Logistic Models ; Research Support, Non-U.S. Gov't

Dubin-Johnson Syndrome is a form of benign, familial idiopathic jaundice presenting with chronic intermittentconjugated hyperbilirubinnmia and a melamin-like pigment has been found in the parenchymal liver cells. This disorder is rarely diagnosed in the neonatal period. We report a case of Dubin-Johnson syndrome presenting with neonatal cholestasis.
Cholestasis ; Jaundice ; Jaundice, Chronic Idiopathic* ; Liver

Dubin-Johnson Syndrome is a form of benign, familial idiopathic jaundice presenting with chronic intermittentconjugated hyperbilirubinnmia and a melamin-like pigment has been found in the parenchymal liver cells. This disorder is rarely diagnosed in the neonatal period. We report a case of Dubin-Johnson syndrome presenting with neonatal cholestasis.
Cholestasis ; Jaundice ; Jaundice, Chronic Idiopathic* ; Liver

The cytolytic activity of CD4' T cells, both human and murine, has been clearly demonstrated in the immune response to mycobacterial infection and suggested to play a significant role in the protection and immunopathology. However, Uttle is known about the differentiation of CD4' CTL. In order to address this issue, we examined the influences of some factors on the generation of CD4' CTL specific to mycobacterial antigens. After 7 days' stimulation of PBMCs from healthy tuberculin reactors with mycobacterial antigens, the cytolytic activity of purised CD4' T cells toward autologous macrophages infected with mycobacteria was measured by Cr release assay. First, we found that both of live M. tubeiculosis and soluble antigens (ST-CF) induced the cytolytic activity of CD4' T cells, although the inducibility of the former was slightly greater than the latter. Second, the cytolytic activity was maximally induced at the relatively low antigen concentration (0.2:1 bacteria:monocyte ratio or 0.5 mg/ml of ST-CF). Finally, in the presence of increasing amounts of neutralizing anti-IL-12 or anti-IFN-r MoAb, the cytolytic activity of CD4+ T cells was decreased in a dose-dependent manner. These results suggest that low dose of antigen, its particulate type give mycobacteria), IL-12, and IFN-r give some positive signals for the generation of CD4+ CTL.
Humans ; Interleukin-12 ; Macrophages ; T-Lymphocytes* ; Tuberculin

BACKGROUND: In spite of relative high risk of extrapyramidal side effect and tardive dyskinesia, it is common clinical practice to use antipyschotics in treatment of bipolar I disorder. But in Korea, there has been few study about clinical factors related with antipsychotics treatment in bipolar disorder patients. So the author studied about the clinical factors related with antipsychotics treatment in bipolar inpatients focusing on the comparison of risperidone and classical antipsychotics. METHOD: By reviewing medical record retrospectively, datas about patient-related, illness-related, and treatment-related clinical factors on antipsychotics use were collected. Association between antipsychotics dose and duration and clinical factors were analysed by statistical method. RESULTS: Aggressive behavior was only statistically significant factor associated with antipsychotics use. And in the case of aggression, maintenance dose of risperidone was not changed(p=0.84), but dose of classical antipsychotics was increased significantly(p=0.005). Total hospital days and antipsychotics treatment duration showed no difference between risperidone and classical antipsychotics treatment groups. CONCLUSION: Clinical factors associated with antipsychotics use was aggressive behavior. In the case of aggression, risperidone required lesser dose increment compared with classical antipsychotics.
Aggression ; Antipsychotic Agents* ; Bipolar Disorder ; Humans ; Inpatients* ; Korea ; Medical Records ; Movement Disorders ; Retrospective Studies ; Risperidone*

Clostridium difficile is the most common nosocomial pathogen of the gastrointestinal tract. Pseudomembranous colitis occurs as a result of a severe inflammatory response to Clostridium difficile toxins. Pseudomembranous colitis is an increasingly frequent cause of morbidity and mortality among elderly hospitalized patients. Diarrhea is the most common manifestation. According to the literature, stools are almost never grossly bloody, and range from soft and unformed to watery or mucoid in consistency. We now report the cases of three patients with pseudomembranous colitis whose main clinical manifestation was hematochezia.
Aged ; Clostridium difficile ; Diarrhea ; Enterocolitis, Pseudomembranous ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Humans

Human sparganosis is caused by the larval tapeworm of genus Spirometra. This parasite commonly invades subcutaneous tissues and muscles. However, infection in the pleural cavity is rare. A 65-year-old male patient, who had undergone surgical excision of subcutaneous masses due to a parasite infection (presumed to have been sparganosis) approximately 10 years ago, showed pleural effusion and peripheral eosinophilia. The anti-sparganum specific IgG antibody levels in the serum and pleural fluid were significantly higher than the normal control levels. Three consecutive doses of praziquantel (75 mg/kg/day) were administered for control of pleural effusion and peripheral eosinophilia. In this patient, sparganosis was suspected, and the probable cause of the infection was ingestion of raw snakes and frogs. Immunoserologic tests using ELISA can be helpful in diagnosis of pleural sparganosis and praziquantel is suggested as an alternative treatment for surgically unresectable cases.
Cestoda ; Eating ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia ; Eosinophils ; Humans ; Immunoglobulin G ; Male ; Muscles ; Parasites ; Pleural Cavity ; Pleural Effusion ; Pleurisy ; Praziquantel ; Snakes ; Sparganosis ; Sparganum ; Spirometra ; Subcutaneous Tissue

BACKGROUND: Apart from devaluing the basic skills of history taking and clinical examinations, the indiscriminate use of STAT tests is increasing in hospital practice. The purpose of this study is to evaluate the appropriateness of the STAT test requests in a tertiary care teaching university hospital. METHODS: We assessed the reasons for the STAT test requests on 644 patients (inpatients 338, emergency room patients 215, and outpatients 91), totaling 1,681 requests, during a 2 week period (between August 8 to 22, 1996) by discussing with the clinicians and nurses and/or reviewing the patient's records. RESULTS: Of 1,681 requests, 779 (46.3%) were considered inappropriate according to the criteria used to define categories. Inappropriate requests were detected in 45.1% (265/588) in wards, 49.0% (446/910) in the emergency room, and 37.2% (68/183) in the out patient department. The frequency of requests during the day showed two peaks: the first between 10 and 11 a.m., and the second between 3 and 4 p.m., which appears to indicate that the STAT tests are often requested for the convenience of the physician rather than true need of the patients. CONCLUSIONS: Many STAT tests are requested for reasons other than true emergencies. Inconsiderate, wasteful, and disruptive STAT test requests imposed an extra burden on the laboratory and resulted in a delay of reports on other true STAT or routine tests. Strategies to reduce the number of inappropriate STAT tests should be established in order to reserve the emergency service for situations of true need.
Emergencies ; Emergency Service, Hospital ; Humans ; Outpatients ; Tertiary Healthcare

BACKGROUND/AIMS: The aim of this study was to determine the risk factors and clinical features related to esophagitis and gastritis in the newborn. METHODS: From January 1995 to July 2002, twenty-six neonates were diagnosed as having esophagitis and/or gastritis. The clinical and demographic data of the patients and their mothers were evaluated retrospectively. RESULTS: Twelve males and 14 females were studied. All but one premature infant were full-term. All the babies had a birth weight that was appropriate for their gestational age. The risk factors related to esophagitis and gastritis were not found. The clinical symptoms leading to endoscopy were frequent regurgitation or vomiting, hematemesis and poor feeding. Esophagitis by itself was found in 4 cases, gastritis alone was found in 13 cases and esophagitis associated with gastritis was found in 9 cases. The endoscopic findings of esophagitis showed somewhat severe lesions that consisted of multiple erosions or a fibrinous exudate. The gastric lesions were petechiae and aphthous ulcers on congestive mucosa. All the infants were treated with antisecretory drugs, and transfusion was done in 4 cases and hemoclipping was done in 2 cases. The clinical symptoms resolved rapidly with treatment. All the patients fully recovered without disease recurrence. CONCLUSION: The clinical features and endoscopic findings of esophagogastritis in the neonates were quite different from those features and findings in the older children and adults. Esophagitis may be characterized by frequent association with gastritis.
Adult ; Birth Weight ; Child ; Endoscopy ; Esophagitis* ; Estrogens, Conjugated (USP) ; Exudates and Transudates ; Female ; Fibrin ; Gastritis* ; Gestational Age ; Hematemesis ; Humans ; Infant ; Infant, Newborn* ; Infant, Premature ; Male ; Mothers ; Mucous Membrane ; Purpura ; Recurrence ; Retrospective Studies ; Risk Factors ; Stomatitis, Aphthous ; Vomiting