OBJECTIVE: To investigate the role of tendon reflex test in the diagnosis of diabetic peripheral neuropathy. METHOD: Patellar tendon reflex (PTR) and achilles tendon reflex (ATR) were recorded in forty six diabetic patients and thirty seven normal adults by delivering tendon taps with an electric reflex hammer. Forty six diabetic patients were divided into two groups based on nerve conduction study and diabetic neuropathy score: group 1 consisted of nineteen patients with peripheral neuropathy, group 2 consisted of twenty seven patients without peripheral neuropathy. Multiple regression equations using latency as a variable dependent on age and height were used and upper crossing of the 3 standard deviation level with regression on height and age was considered abnormal. RESULTS: Mean latencies of PTR and ATR were prolonged in the diabetic patients in comparison with the controls (p<0.01) and were prolonged in group 1 compared to group 2. In group 1, PTR was abnormal in 14 cases (sensitivity: 73.6%, specifity: 88%) and ATR was abnormal in 13 cases (sensitivity: 68.4%, specifity: 85.1%). In group 2, PTR was abnormal in 3 cases and ATR was abnormal in 4 cases. CONCLUSION: Tendon reflex test would be a valuable supplement to conventional nerve conduction studies for detection of diabetic peripheral neuropathy, especially in the proximal segment.
Achilles Tendon ; Adult ; Diabetic Neuropathies ; Diagnosis ; Humans ; Neural Conduction ; Patellar Ligament ; Peripheral Nervous System Diseases* ; Reflex ; Reflex, Stretch* ; Tendons*

BACKGROUND: Legionella pneumophila has been recognized as an important cause of community-acquired pneumonia(CAP) requiring hospitalization. However, epidemiological data on the occurrence of legionella-related pneumonia is unavailable in Korea. The purpose of this study was to evaluated the etiological imprtance of legionella pneumophila serogroup 1 in patients hospitalized with CAP. METHOD: The CAP patient over 16 year-old were recruited from July 1999 to June 2000 at the Chunchon Sacred Heart Hospital. Fifty four patients (male 29, female 25, average age 63.8±15.3) were included in this study. A diagnosis of a legionella pneumophila infection was based on a urinary antigen test using the Binax Company enzyme immunoassay. The severity of pneumonia was assessed using the Fine's PORT scoring system. RESULT: The average Fine's PORT score was 99.7(±44.9). According to the risk classification proposed by the Infectious Disease Society of America, the number of patients in each class(from class I to class V) were 6(11.1%), 13(24.1%), 9(16.7%), 14(25.8%), and 12(22.2%), respectively. Thirty two patients(59.3%) were initially admitted to the intensive care unit. The mortality rate was 16.7%(9 in 54). In all patients, urinary antigens to Legionella pneumophila serogroup 1 were not detected. CONCLUSION: Legionella pneumophila may play little role in causing adult CAP in Korea. Therefore, the routine use of macrolide in the empirical treatment of the CAP patients based upon the ATS guidelines(1993) in Korea should be reevaluated.
Adult ; Americas ; Classification ; Communicable Diseases ; Diagnosis ; Female ; Gangwon-do ; Heart ; Hospitalization ; Humans ; Immunoenzyme Techniques ; Intensive Care Units ; Korea* ; Legionella pneumophila* ; Legionella* ; Legionnaires' Disease ; Mortality ; Pneumonia*

BACKGROUND: Many studies have shown that pulmonary function differs widely among race, age and geographical residency. By virtue of the improvement of nutrition and environment, the elderly population in Korea is markedly increasing and so are the ages of patients complaining respiratory symptoms. However, we do not have our own data on the pulmonary functional reserve of elderly persons in Korea. We evaluate the deterioration of pulmonary functional reserve and standardize the predictive values of pulmonary function in the elderly population. METHOD: Pulmonary function tests were conducted in 100 men and 100 women over the age of 65. We analyzed changes of FVC and FEV1 according to age and height by linear regression. We compared our new multiple linear regression equation with other equations currently used in Korea. RESULTS: In men, the mean age was 71.5±5.2(mean±SD) years and the mean height was 163.6±6.2cm. The mean FVC was 3.42±0.49ℓ and the mean FEV1, 2.72±0.40ℓ. In women, the mean age was 72.0±5.1 years and the mean height was 149.1±5.9cm. The mean FVC was 2.22±0.42ℓ and the mean FEV1, 1.83±0.34ℓ. Multiple linear regression equation using age and height as an independent factors was as follows : FVC(ℓ)=1.857-0.0356×age(year)+0.02157×height(cm) (p<0.01, R2=0.279), FEV1(ℓ)=1.340-0.02698×age(year)+0.02021×height(cm) (p<0.01, R20.255) in men, FVC(ℓ)=-0.09765-0.03332×age(year)+0.03164×height(cm) (p<0.01, R2=0.435), FEV1(ℓ)=-0.169-0.02469×age(year)+0.02539×height(cm) (p<0.01, R2=0.41) in women. CONCLUSION: We established prediction regressions for pulmonary functional tests in the elderly Korean population. We also confirmed that currently adopted equations do not exactly anticipate the expected pulmonary functional reserve in the aged person over 65 years old. We suggest that our new equations from this study should be applied to interpret the pulmonary function tests in the elderly population in Korea.
Aged* ; Aging* ; Continental Population Groups ; Female ; Humans ; Internship and Residency ; Korea ; Linear Models ; Male ; Respiratory Function Tests* ; Virtues

GTP-Binding Proteins ; Receptors, Thyrotropin-Releasing Hormone ; Thyrotropin-Releasing Hormone*

An extratesticular scrotal epidermoid cyst is a relatively very rare condition, and an epidermoid cyst arising from the spermatic cord area is extremely rare. We report a case of multiple epidermoid cysts arising from the extratesticular scrotum, spermatic cord, and lower extremities. To our best knowledge, concomitant occurrence of these lesions has not been reported previously in the literature.
Epidermal Cyst* ; Lower Extremity ; Scrotum ; Spermatic Cord*

Background/Aims: Endoscopic resection (ER) has recently been accepted as the standard treatment modality for superficial nonampullary duodenal tumors (SNADTs). However, the procedure can cause adverse events such as perforation and bleeding. This study aimed to investigate the efficacy of prophylactic clipping in the prevention of delayed complications. Methods: A retrospective review of the medical records of patients who underwent ER for SNADT from 3 centers was performed. Patients were divided into 2 groups: the immediate clipping group (ICG) and the no clipping group (NCG). Various baseline characteristics and factors associated with the appearance of delayed complications, such as size of the lesion, tumor location, histologic type, and co-morbidities, were compared between the two groups. Results: A total of 99 lesions from 99 patients were included in this study. Fifty-two patients were allocated into ICG and 47 patients were allocated into NCG. Delayed bleeding occurred in 1 patient from ICG and in 8 patients from NCG. Delayed perforation occurred in 1 patient from ICG and in 3 patients from NCG. There were no procedure-related deaths in both groups. Conclusions Although the use of endoscopic clipping seemed to reduce the risk of developing delayed complications, further studies using a prospective design is required.

Digital infrared thermal imaging(DITI) has been proposed as a diagnostic aid in patient with many disease entities, such as the cardiovascular, the neurologic, the musculoskeletal diseases and so on. Supporters of thermography state that normal patients have the normal thermograms and abnormal patients have the abnormal thermograms. The purpose of this study was to determine how much a cigarette will affect skin temperature change in the course of normal day's smoking. Twenty one healthy smokers(mean age, 27.4+/-5.1 years old) and fourteen nonsmokers(mean age, 24.4+/-1.6 years old) took parts in the study. All were male. The cigarette consumption averaged 14.0 per day. Smokers maintained their smoking habit in the ambient temperature before on initial measurement and smoked a cigarette in the controlled laboratory room. Measurements were taken for 5 minutes, 1 hour and 2 hours afterward. The skin temperature of the face, the both palms and the both soles was measured using Dorex digital infrared thermal imaging system. In all sessions, the skin temperature was higher on the face and lower on the sole. There were no significant differences of skin temperature on both sides of body in all subjects(p>0.05). The skin temperature of all measured parts was significantly lower in the smoking group before and 5 minutes after smoking(p<0.01). There were no significant differences of skin temperature between smoker and nonsmoker after 1 hour of smoking(p>0.01).
Humans ; Male ; Musculoskeletal Diseases ; Skin Temperature* ; Skin* ; Smoke* ; Smoking* ; Thermography ; Tobacco Products

OBJECTIVE: To investigate the diagnostic value of ultrasonography for limited finger joint mobility in diabetes and association between limited finger joint mobility and the presence of diabetic chronic complications. METHODS: Ultrasonography were performed in 13 non insulin-dependent diabetes with limited finger joint mobility and 15 non insulin-dependent diabetes without limited finger joint mobility matched for similar ages, sexes and durations of diabetes. Controls consisted of 12 healthy volunteers with no evidence of diabetes mellitus. Ultrasonography was used to measure flexor tendon and tendon sheath thickness of the third and fourth fingers in the volar aspect of both hands. We evaluated neuropathy, nephropathy and retinopathy in all diabetic patients and investigated association between limited finger joint mobility and the presence of diabetic chronic complications. RESULTS: Thickness of flexor tendon sheath of the third and fourth fingers were significantly increased in the diabetes with limited finger joint mobility compared to the diabetes without limited finger joint mobility (p<0.01). Also, flexor tendon thickness of the third finger was significantly increased in the diabetes with limited finger joint mobility compared to the diabetes without limited finger joint mobility (p<0.05). The diabetes with limited finger joint mobility had a significantly increased frequency of the diabetic chronic complications (p<0.05). CONCLUSION: In the diabetes with limited finger joint mobility, thickening of flexor tendon sheath and tendon were shown by ultrasonography. This finding suggests that ultrasonography can be used to diagnose limited finger joint mobility in the diabetes. Limited finger joint mobility is closely associated with diabetic chronic complications.
Diabetes Mellitus ; Finger Joint* ; Fingers* ; Hand ; Healthy Volunteers ; Humans ; Tendons ; Ultrasonography*

Background/Aims: Endoscopic resection (ER) has recently been accepted as the standard treatment modality for superficial nonampullary duodenal tumors (SNADTs). However, the procedure can cause adverse events such as perforation and bleeding. This study aimed to investigate the efficacy of prophylactic clipping in the prevention of delayed complications. Methods: A retrospective review of the medical records of patients who underwent ER for SNADT from 3 centers was performed. Patients were divided into 2 groups: the immediate clipping group (ICG) and the no clipping group (NCG). Various baseline characteristics and factors associated with the appearance of delayed complications, such as size of the lesion, tumor location, histologic type, and co-morbidities, were compared between the two groups. Results: A total of 99 lesions from 99 patients were included in this study. Fifty-two patients were allocated into ICG and 47 patients were allocated into NCG. Delayed bleeding occurred in 1 patient from ICG and in 8 patients from NCG. Delayed perforation occurred in 1 patient from ICG and in 3 patients from NCG. There were no procedure-related deaths in both groups. Conclusions Although the use of endoscopic clipping seemed to reduce the risk of developing delayed complications, further studies using a prospective design is required.

BACKGROUND: Recent technological developments have introduced a new method to identifying M. tuberculosis complex DNA in clinical samples directly. The direct amplification test (DAT) is approved for identifying M. tuberculosis complex in respiratory specimens that are smear-positive for acid-fast bacilli (AFB). When there is a discrepancy between the AFB smear and DAT, no information on their clinical utility is currently available. In this study, the diagnostic reliability of DAT was investigated in suspected pulmonary tuberculosis patients whose sputum AFB smear was negative. METHODS: From June 1, 1998 through May 30, 1999, 909 patients with presumed active pulmonary tuberculosis were enrolled. A sputum AFB stain, culture, DAT and /or biopsy were performed. using the criteria of clinical tuberculosis or confirmed tuberculosis, the positive predictive value of DAT in diagnosing pulmonary tuberculosis was investigated. RESULTS: The positive predictive value of DAT was 82.1% by the clinically active tuberculosis criteria. However, it decreased to 61.5% when diagnosis was restricted to only to culture positive or biopsy proven cases. The false positive rate of DAT was 18.0%. CONCLUSION: The DAT is a valuable diagnostic method in suspected patients whose sputum AFB is was negative.
Biopsy ; Diagnosis* ; DNA ; Humans ; Polymerase Chain Reaction* ; Sputum* ; Tuberculosis ; Tuberculosis, Pulmonary*