Suppurative arthritis of the knee is a well known complication following intra-articular injection of steroids on the other hand, tuberculous arthritis following such injection is rare. From January, 1981 to April, 1986, 46 patients of tuberculous arthritis of the knee were admitted to Severance Hospital and Yong-Dong Severance Hospital of Yonsei University College of Medicine. Among them 22 patient (48%) had a history of intra-articular injection of steroids and we analyzed them. The results were as follows: 1. The average age was 48.6 years (3–71 years). And sex ratio was in 1:2.7 as female predominant. 2. Initial diagnosis before the steroid injection were osteoarthritis (13 patients), rheumatoid arthritis (6 patients), and traumatic arthritis (3 patients). The fifty percent of the patients were injected by the local practitioner and fourty five percent had a history of accupuncture and moxa cautery. The preoperative diagnosis (diagnosis on admission) were tuberculous arthritis (12 patients), pyogenic arthritis (5 patients), rheumatoid arthritis (3 patients) and osteoarthritis(2 patients). 3. The number of intra-articular injection ranged from 2 to 100 times (average 12.8) during periods ranging from 1 month to 4 years (average 19.2 months). And interval between last injection and confirmation of tuberculous arthritis ranged from 1 week to 2 years (average 7.0 months). 4. Eight patients (36%) had a active or inactive pulmonary tuberculosis. 5. The positive cultures of typical Mycobacteria tuberculosis were obtained from 11 patients 59%). 6. The modalities of treatment were synovectomy or curettage in 16 patients and arthrodesis in 6 patients. And all patients were treated by antibuberculous chemotherapy. In conclusion, we observed that tuberculous arthritis developed not infrequently after intra-articular injection of steroids. And we considered the causes of tuberculous arthritis following intra-articular injection of steroids were; 1) reactivation of dormant injection or hematogenous, spreed due to interferance of host defence mechanisms, 2) contamination by the instrument and equipment, 3) aggravation of preexisting tuberculous lesions. Whenever one try to inject the steroid into joint, bacterial culture foi the pyogenic organism including tuberculosis and fluid analysis from the joint fluid should be done before the injection. We recommend that other method for the confirmation for the tuberculosis is needle biopsy of the synovium. If the symptoms are not improved after injection or the joint shows inflammatory reaction, one must discontinue the injection and reexamine the joint fluid analysis and culture for the confirmation of the infection.
Arthritis ; Arthritis, Infectious ; Arthritis, Rheumatoid ; Arthrodesis ; Biopsy, Needle ; Cautery ; Curettage ; Diagnosis ; Drug Therapy ; Female ; Hand ; Humans ; Injections, Intra-Articular ; Joints ; Knee Joint ; Knee ; Methods ; Osteoarthritis ; Sex Ratio ; Steroids ; Synovial Membrane ; Tuberculosis ; Tuberculosis, Pulmonary

A clinical observation was made on 121 cases of urinary tract tuberculosis in the Department of Urology Hanyang University Hospital during the 8 year period from May, 1972 to April, 1980. The following results were obtained: 1. The incidence of urinary tract tuberculosis was 5.7% of total in-patients and the proportion of male to female was 1.7:1. 2. 34.4% were affected in the right kidney, 34.2% in the left and 31.4% in both. 3. Age and sex distribution showed that 33.9% were from 20 to 29 years old, 27.3% from 30 to 39 and 17.4% from 40 to 49. Regarding the sex, 76 cases (62.8%) were male and 45 cases (37.2%) were female. 4. Initial symptoms were mostly those of vesical irritable symptoms and hematuria (25.6%). 5. From past history 17.4% had pulmonary tuberculosis or pleurisy, 4.1% had tuberculous epididymitis, and 2.5% bone tuberculosis. 6. 25.6% of the cases visited the hospital within 1 month to 6 months after the onset of symptoms. 7. Other presenting active tuberculous lesions were pulmonary (14 cases), bony (3 cases) and lymphatic (1 case). 8. Ordinary urine cultures revealed mixed infection in 12 cases (15.2%), 4 cases of these 12 cases also had E. coli (5.1%). 9. A.F.B. was found in 67.5%. The total of all negative cases by the staining and culture method was 18.2%. 10. On cystoscopic findings 29 of 85 cases (34.1%) revealed a contracted bladder, but 5 cases (5.9%) showed normal finding. 11. Excretory urography showed calyceopelvic dilatation in 20.7% of cases, non-visualization in 19.3%, hydroureteronephrosis in 14.5%, contracted bladder in 12.4%, calcification in 7.6% and most cases had multiple changes in the kidneys. 12. Urographic findings based on the Lattimer classification showed far advanced tuberculous lesions in almost all cases. 13. Operative procedures were simple nephrectomy in 32 cases (69.6%), ureteroneocystostomy in 6.5% and ileocystoplasty with ureteroneocystostomy in 4.3% of 46 cases.
Adult ; Classification ; Coinfection ; Dilatation ; Epididymitis ; Female ; Hematuria ; Humans ; Incidence ; Kidney ; Male ; Nephrectomy ; Pleurisy ; Sex Distribution ; Surgical Procedures, Operative ; Tuberculosis* ; Tuberculosis, Osteoarticular ; Tuberculosis, Pulmonary ; Urinary Bladder ; Urinary Tract* ; Urography ; Urology

No abstract available.
Guillain-Barre Syndrome* ; Recurrence*

Henoch-Sch nlein purpura(HSP) occurs frequently in childhood and is a few occurrence in adults. The occurrence of nephrotic syndrome is rare in HSP patients and the association of renal disease with HSP is very important to prospect longterm clinical outcome. The causes of HSP have been diversely reported such as foods, drugs, sensitivity to infections, vaccination, insect bite, cold exposure etc and recently immune complex is studing as representative cause of HSP, but nothing is verified of definite mechanism of HSP until now. The occurrence of HSP associated with cancer has been rarely reported in the literature but there is no report in Korea. The patient was 31 year-old woman with stomach cancer who was operated in our hospital. 5 months after operation of stomach cancer, the massive proteinuria, generalized edema were developed and thereafter abdominal pain, generalized purpuric lesion on extremities were also occurred. We have done kidney biopsy and biopsy findings were compatible with HSP pathologically. After administration of prednisolone, spontaneous bacterial peritonitis was occurred suddenly, patient was recovered after ceasation of administration of prednisolone and proper antibiotic therapy but patient died of cachexia 3 months after diagnosis of HSP. We report a case of HSP presenting as nephrotic syndrome in patient with stomach cancer and complicated with spontaneous bacterial peritonitis.
Abdominal Pain ; Adult ; Antigen-Antibody Complex ; Biopsy ; Cachexia ; Diagnosis ; Edema ; Extremities ; Female ; Humans ; Insect Bites and Stings ; Kidney ; Korea ; Nephrotic Syndrome* ; Peritonitis* ; Prednisolone ; Proteinuria ; Purpura* ; Stomach Neoplasms* ; Stomach* ; Vaccination

We have experienced two cases of renal vessel malformation caused by congenitally, one is extrarenal artery aneurysm with hypertension and the other is intrarenal arteriovenous fistula. We report two cases of renal vessel malformation and the literature has been reviewed.
Aneurysm ; Arteries ; Arteriovenous Fistula ; Hypertension

We present a case of extensive thrombosis in the jugular vein and sigmoid, transverse, superior sagittal sinuses with partial deep venous thrombosis. The patient had acute severe headache but had neither focal neurological deficit nor consciousness change. Emergency endovascular thrombolysis through transfemoral approach was performed with successful restoration of venous drainage. There was no hemorrhagic complication. Several days later, the patient had a focal seizure attack due to focal venous infarction despite of continuous systemic anticoagulation therapy.
Colon, Sigmoid ; Consciousness ; Drainage ; Emergencies ; Headache ; Humans ; Infarction ; Jugular Veins ; Seizures ; Sinus Thrombosis, Intracranial* ; Superior Sagittal Sinus ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Venous Thrombosis

Endosulfan is an agricultural chemical of organic chlorine, is toxic in both the central nervous system and the cardiovascular system, and causes respiratory system disorder and deaths by status epilepticus, respiratory distress, and so on. The use of this agricultural chemical of organic chlorine is limited by its toxicity. However, it is still used as a common insecticide, so it is readily to available. Four elderly people were admitted with depression of consciousness and convulsions after eating pan-fried food. During their treatment, the patients were diagnosed with endosulfan intoxication, completely by accident. We are reporting these cases of endosulfan intoxication that showed variable clinical findings from mild sequelae to death.
Aged ; Cardiovascular System ; Central Nervous System ; Chlorine ; Consciousness ; Depression ; Eating ; Endosulfan* ; Humans ; Respiratory System ; Seizures ; Status Epilepticus

Presented in this paper are the experimental results that measure rapid prototyping (RP) errors in 3D medical models. We identified various factors that can cause dimensional errors when producing RP models, specifically in maxillofacial areas. For the experiment, we used a human dry skull. A number of linear measurements based on landmarks were first obtained on the skull. This was followed by CT scanning, 3D model reconstruction, and RP model fabrication. The landmarks were measured again on both the reconstructed models and the physical RP models, and these were compared with those on dry skull. We focused on major sources of errors, such as CT scanning, conversion from CT data to STL models, and RP model fabrication. The results show that the overall error from skull to RP is 0.64+/-0.36mm(0.71+/-0.66%) in absolute value. This indicates that the RP technology can be acceptable in the real clinical applications. A clinical case that has applied RP models successfully for treatment planning and surgical rehearsal is presented. Although the use of RP models is rare in the medical area yet, we believe RP is promising in that it has a great potential in developing new tools which can aid diagnosis, treatment planning, surgical rehearsal, education, and so on.
Diagnosis ; Education ; Humans ; Skull ; Tomography, X-Ray Computed

Objective: To investigate the suitability of citrus-press cakes, by-products of the juice industry as a source for the whitening agents for cosmetic industry.
Methods:Ethylacetate extracts of citrus-press cakes (CCE) were examined for their anti-melanogenic potentials in terms of the inhibition of melanin production and mechanisim of melanogenesis by using Western Blot analysis with tyrosinese, tyrosinase-related protein-1 (TRP-1), TRP2, and microphthalmia-associated transcription factor (MITF) proteins. To apply the topical agents, citrus-press cakes was investigated the safety in human skin cell line. Finally flavonoid analysis of CCE was also determined by HPLC analysis.
Results: Results indicated that CCE were shown to down-regulate melanin content in a dose-dependent pattern. The CCE inhibited tyrosinase, TRP-2, and MITF expressions in a dose-dependent manner. To test the applicability of CCE to human skin, we used MTT assay to assess the cytotoxic effects of CCE on human keratinocyte HaCaT cells. The CCE exhibited low cytotoxicity at 50 μg/mL. Characterization of the citrus-press cakes for flavonoid contents using HPLC showed varied quantity of rutin, narirutin, and hesperidin.
Conclusions:Considering the anti-melanogenic activity and human safety, CCE is considered as a potential anti-melanogenic agent and may be effective for topical application for treating hyperpigmentation disorders.

PURPOSE: As a sedative hypnotic agent, etomidate has a little side effect like respiratory depression and has an excellent pharmacokinetics and hemodynamics. The objective of this study is comparison of etomidate effect in the two groups, only lidocaine injection group and combinational administration group, during closed thoracostomy in the emergency department. METHODS: The patients with respiratory problems, which needed a closed thoracostomy, from March 1, 2003 to February 29, 2004 were enrolled in this prospective study. Thus, we were enrolled 68 patients. etomidate were used for 34 patients and only lidocaine local injection was used for 34 patients. Patients of combinational administration were randomized to receive intravenous boluses of etomidate (0.2 mg/kg) prior to fentanyl (1.0 ug/kg) during PSA (procedural sedation anesthesia). We recorded pre-administration and interval of 5 minute, 10 minute, 15 minute and transcutaneous oxygen saturation, heart rate, respiratory rate, blood pressure, degree of sedation, satisfaction of sedation, and side effects after administration. RESULTS: Of all combinational administration group, significant hemodynamic, as hypotension or bradycardia etc. and respiratory depression, as apnea or tachypnea etc. were absent. With comparison of two groups, significant clinical problems and statistics were not different and degree of sedation was fast and impaired conscious was effective in the combinational administration group. CONCLUSION: We conclude combinational administration with etomidate and fentanyl during procedural sedation is safty and excellent effectiveness. Therefore we recommened the use of etomidate for emergency procedural sedation in emergency department.
Apnea ; Blood Pressure ; Bradycardia ; Emergencies ; Emergency Service, Hospital ; Etomidate* ; Fentanyl* ; Heart Rate ; Hemodynamics ; Humans ; Hypnotics and Sedatives* ; Hypotension ; Lidocaine ; Oxygen ; Pharmacokinetics ; Prospective Studies ; Respiratory Insufficiency ; Respiratory Rate ; Tachypnea ; Thoracostomy*