OBJECTIVE: Inflammation has long been recongnized as notoriously difficult to measure both in clinical practice and in the laboratory methods. The methods used to clinical assess rheumatoid arthritis should share the following four parameters : validity, sensitivity, reliability and simplicity. Our purposes were evaluate mehtods of accurately reflecting disease activity in rheumatoid arthritis. METHODS: We examed 32 cases(male : 4, famale:28 and mean age : 51 years) of rheumatoid arthritis. The clinical assessment included the following : (1) performance scales including grip strength, button test, and 7.5 M walking time. (2) activity of daily living(ADL) questionnaires. (3) articular indices including Ritchie, ARA and restricted joint index. (4) Laboratory assessment, Made on at the same time with the clinical assessment, included fellwing: erythrocyte sedimentation rate and CRP. RESULTS: 1. Performance scale scores were well correlated with articular indeces but ARA index showed the most frequent and strongest correlations with performance scale. 2. Performance scale score were well correlated with ADL score but ADL pain score showed the most frequent and the strongest correlation. 3. Performance scale score were more strongly correlated with CRP than with ESR. CONCLUSION: The performance scale score appear to provide useful data for quantitatire assessment of inflammatory activity of joints in the routine care of RA.
Activities of Daily Living ; Arthritis, Rheumatoid* ; Blood Sedimentation ; Hand Strength ; Inflammation ; Joints ; Surveys and Questionnaires ; Walking ; Weights and Measures

Aim. A neurobehavioral test for workers exposed to organic solvents in the workplace can be affected by many factors : age, education, motivation, ethnicity, etc. To apply more suitable neurobehavioral test for Korean workers, we evaluated the validity of several items of computerized and traditional neurobehavioral tests. Methods. We have applied eleven tests : four items of computerized neurobehavioral test(Swedish Performance Evaluation System) including Addition, Symbol-Digit, Digit Span, and Finger tapping speed, and seven items of traditional neurobehavioral test consisting of Addition, Digit-Symbol , Digit Span, Benton visual retention test, Pursuit aiming, Pegboard, and Tapping. These tests were performed on 96 workers exposed to solvents, and 100 reference workers. The concurrent and construct validities were evaluated by group difference, correlation with age, educational level, hippuric acid level, neurotoxic symptom, current exposure level, multitrait-multimethod matrix, factor analysis, and discriminant analysis. Results. Statistically significant differences were observed between the workers exposed to solvents and referents in computerized Symbol-Digit, Finger tapping speed, traditional Digit-Symbol and Pegboard. The computerized Symbol-Digit, traditional Digit-Symbol, Addition, Benton visual retention test, and Pegboard were found to be related to the age. The performance of computerized Symbol-Digit, Addition, and traditional Digit-Symbol were found to be related to the educational level significantly. The computerized Symbol-Digit, Finger tapping speed, and traditional Digit-Symbol were found to be related to hippuric acid, and neurotoxic symptom. The discriminability of Finger tapping speed, and Pegboard was better than the other tests. In discriminant analysis, the model with two variables, the computerized Symbol-Digit and Pegboard, classified almost 70 percent of the workers correctly. Conclusions. These results suggest that the computerized Symbol-Digit, Finger tapping speed, and Pegboard are more satisfactory for our purpose, and the Addition, Tapping, Benton visual retention test, and Pursuit aiming are less valid than other items. These may allow the reasonable selection of core neurobehavioral tests for workers exposed to solvents in Korea.
Education ; Fingers ; Korea ; Motivation ; Solvents

BACKGROUND: It has been suggested that chronic hepatitis C virus (HCV) infection is associated with diabetes. The aim of this study was to establish a potential relationship between chronic HCV infection and diabetes mellitus in Korean patients. METHODS: We performed a prospective analysis of 404 patients with chronic viral hepatitis or liver cirrhosis who visited our hospital and analyzed whether age, sex, body mass index, alcohol consumption, hepatitis B virus (HBV) infection, HCV infection and cirrhosis were associated with diabetes. We also enrolled 627 diabetic patients and the seroprevalence of HBV surface antigen (HBsAg) and anti-HCV was determined. RESULTS: Diabetes was observed more frequently in individuals with HCV infected chronic liver disease (24.0%) than in those with HBV infected (10.4%) (p<0.05). Univariate analyses revealed that age, alcohol consumption and HCV infection were significant independent predictors for diabetes. The mean age of the patients with HCV infected chronic liver disease was higher than that of HBV infected (56+/-16 vs 44+/-13, p<0.05). The prevalence of diabetes in HCV infected group was higher than that in HBV infected group in the age of 41~60 (p<0.05). In diabetic group, the seroprevalence of HBsAg positivity was 4.5% and that of anti-HCV was 2.1%. CONCLUSION: Our study demonstrates an association between diabetes and chronic HCV infection in Korean patients. The prevalence of diabetes in patients with HCV infected chronic liver disease is higher than that in those with HBV infected. Age and alcohol consumption are another risk factor for diabetes in patients with chronic viral liver disease.
Adult ; Age Distribution ; Aged ; Analysis of Variance ; Comorbidity ; Comparative Study ; Cross-Sectional Studies ; Diabetes Mellitus/epidemiology* ; Diabetes Mellitus/diagnosis ; Female ; Hepatitis C, Chronic/epidemiology* ; Hepatitis C, Chronic/diagnosis ; Human ; Korea/epidemiology ; Male ; Middle Age ; Prevalence ; Probability ; Prospective Studies ; Risk Assessment ; Risk Factors ; Sex Distribution

Histiocytosis-X is a term used to define three diseases with similar morphologic characteristics : Letterer-Siwe diseae, Hand-Schuller-Christian disease and Eosinophilic granuloma. In general, they differ in terms of their age of onset, severity of clinical course and site of involvement. Eosinophilic granuloma typically is seen in young adults. Eosinophilic granuloma is diagnosed in the presense of diffuse pulmonary infiltrate, bony involvement. However, the Pulmonary radiologic findings of eosinophilic granuloma are variable accordinary to stage of disease. therefore pathologic diagnosis of involving site is essential for confirmative diagnosis of eosinophilic grananuloma. Pathologically. the three disease are characterized by granulomatous infiltration of alveolar septa and bronchial walls and often involvement of bone. The hallmark of this disease is proliferation of the Langerhans' cell. The identifying feature is the X-body or Birbeck granule that is present in Langerhans' cells and histiocytic cells found in the lung of EG patient. We report a case of bilateral, recurrent and spontaneous pneumothoraces in a 21 year old man with pulmonary histiocytosis-X which is confined by eosinophilc granuloma in bone marrow biopsy and ultrastructural examination in cells obtained from BAL.
Age of Onset ; Biopsy ; Bone Marrow ; Diagnosis ; Eosinophilic Granuloma ; Eosinophils ; Granuloma ; Histiocytosis, Langerhans-Cell* ; Humans ; Lung ; Pneumothorax* ; Young Adult

Isoenzymes of alkaline phosphatase from purified extracts of liver, intestine, pancreas and bone of rats were determined by their isoelectric points and compared with those from serum. 1) The extracts obtained from homogenized tissues were centrifuged at 65,000xg and filtered through an Ultrogel AcA 34 column. Among the three major peaks obtained by gel filtration, the second peak fractions were further separated by isoelectric focusing. Isoenzymes of alkaline phosphatase were found only in the second peak. 2) Isoenzymes of alkaline phosphatase were distinguishable with pH 3.5-10 ampholytes. When pH 3-6 ampholytes were used, isoenzymes were more clearly separated, e.g., 4in serum, 5 in intestine and 2 each in the liver, pancreas, and bone. 3) Comparing the bands of the isoenzymes of alkaline phosphatase to those of serum, only the band with 5.04 pI was the same between serum and intestine. These results indicate that several forms of alkaline phosphatase, even though all are from the rat, may exist; and some of the isoenzymes of alkaline phosphatase found in the serum originated from the intestine.
Alkaline Phosphatase/analysis* ; Alkaline Phosphatase/blood ; Animal ; Isoenzymes/analysis* ; Isoenzymes/blood ; Rats

The effects of cholic acid and eight related cholanic acid analogs on bile flow and biliary excretion of bile salts and cholesterol were studied in rabbits. Bile acids were infused intravenously in anesthetized rabbits. In all except hyodeoxycholic or lithocholic acid treated animals increases in bile flow were recorded within 10 minutes during infusion of bile acid-The increase in bile f1ow associated with an increase in bile salt level in bile after cholic acid infusion was observed, however, there were little changes in biliary, cholesterol levels. Bile salt level in bile was not associated with bile flow after chenodeoxycholic acid infusion but the cholesterol level in bile was significantly increased. Ursodeoxycholic acid similarly increased cholesterol but to a lesser extent. Keto-forms of chenodeoxycholic acid were without action. These results indicate that both cholic and chenodeoxycholic acids have the capacity to alter specific biliary excretion of bile components, the former on bile salts and the latter on cholesterol-a precursor of bile acids in bile.
Animal ; Bile/analysis ; Bile/secretion* ; Bile Acids and Salts/administration & dosage ; Bile Acids and Salts/metabolism ; Bile Acids and Salts/pharmacology* ; Bilirubin/analysis ; Cholesterol/analysis ; Cholesterol/metabolism* ; Cholic Acids/analogs & derivatives ; Cholic Acids/analysis ; Female ; Liver/metabolism ; Male ; Rabbits

Fractionation of protein components of the human synovial fluid was carried out with paper and disc electrophoresis, and isoelectric focusing. The mean ranges of total protein content of synovial fluid obtained in the thirty patients suffering from nonspecific and traumatic synovitis, degenerative osteoarthritis or rheumatoid arthritis were 3.8 to 4.6g/dl. There was no significant difference between each from of arthritis. The pattern of protein fractionation of synovial fluid by paper electrophoresis was similar to that of serum protein. On disc electrophoresis, 20 fractions were identified in synovial fluid and the main fraction was albumin. Isoelectric focusing of the human serum with Ampholine carrier ampholyte in thin layer polyacrylamide gel revealed 27 protein fractions and five isoenzymes of amylase and two of them were the main fractions. In the synovial fluid 22 protein fractions and two isoenzymes of amylase, which had the same isoelectric points as the main fractions of serum, were noted. It is suggested that the isoamylases in the synovial fluid are a dialysate of plasma enzymes.
Arthritis, Rheumatoid/metabolism ; Human ; Osteoarthritis/metabolism ; Proteins/metabolism* ; Synovial Fluid/metabolism* ; Synovitis/metabolism

BACKGROUND/AIMS: The aim of this study was to evaluate the usefulness of intraductal endoscopy in pancreaticobiliary tract disease by means of percutaneous cholangioscopy(PCS), peroral cholangioscopy(POCS) and peroral pancteatoscopy(POPS). METHODS: PCS was performed in 33 patients, including 24 patients with biliary tract stones, and 8 patients with malignant biliary tract disease, and one with villous adenoma of common bile duct(CBD), POCS was performed in 5 patients, including two with cholangiocarcinoma, two with icteric hepatoma and one with benign stenosis of bile duct. POPS performed in 6 patients, ineluding 3 patients with chronic pancreatitis, two with pancreatic cancer and one with mucinous ductal ectasia. RESULTS: 1. Complete removal of the stones was achieved in 22 of 24 patie~nts(91.7%). 2. Accuracy rate of forceps biopsy in PCS was achieved 13 fo 14 patients(92.9%). 3. Success rate of therapeutic PCS was 100%. 4. Accuracy rate of forceps biopsy in POCS was achieved 3 of 5 patients(60%). 5. Diagnostic gain of POPS was achieved 5 of 6 patients(83.3%). 6. There was no serious complications with only mild complications in 3 patients, including mild bleeding in 2 patients and cholangitis in only one. CONCLUSIONS: Intraductal endoscopy of biliary tract, including PCS and POCS were useful diagnostic and therapeutic methods with advantages of direct visualization of intraductal disease and POPS using ultrathin pancreatoscope could provide direct assessment of the pancreatic duct.
Adenoma, Villous ; Bile ; Bile Ducts ; Biliary Tract Diseases ; Biliary Tract* ; Biopsy ; Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Cholangitis ; Constriction, Pathologic ; Dilatation, Pathologic ; Endoscopy* ; Hemorrhage ; Humans ; Mucins ; Pancreas* ; Pancreatic Ducts ; Pancreatic Neoplasms ; Pancreatitis, Chronic ; Surgical Instruments

Mucinous ductal ectasia(MDE) is a newly described entity of mucinous neoplasm of pancreas with characteristic endoscopic and pancreatographic findings. It is charaeterized by a patulous duodenal papilla extruding mucus and a pancreatogram showing dilatation with amorphous filling defects, communication of the mass with the pancreatic duct. MDE is intraductal lesion consisting of dilated "cystified" ducts lined by mucin-producing columnar cells. The lesion is usually located in the head or uncinate process. When the radiographic appearance of the ERCP cannot provide sufficient information for definite diagnosis, additional endoscopic visualization is desirable. With the advent of pancreatoscopy, an endoscopic procedure is now available that has proven to enhance diagnostic accuracy. The 0.8-mm ultrathin pancreatoscope allows macroscopic diagnosis under direct vision. Endoscopic sphincterotomy is not required, and insertion into the pancreatic duct is feasible in most cases with the aid of guidewires. Major indications are unclear filling defects on ERCP, strictures of uncertain origin, and duct cut-offs. A limitation of this procedure are the lack of angulation, insufficient illumination, fragility of endoscopic equipment, and nonspecific findings. In addition, biopsy while directly viewing the lesion is impossible at present. We experienced one case of MDE who presented with the symptom of weight loss. Ultrathin pancreatoscopy was useful for the direct visualization af pancreatic duct in the differential diagnosis of filling defects of main pancreatic duct.
Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic ; Diagnosis ; Diagnosis, Differential ; Dilatation ; Dilatation, Pathologic* ; Head ; Lighting ; Mucins* ; Mucus ; Pancreas ; Pancreatic Ducts ; Sphincterotomy, Endoscopic ; Weight Loss

The main objective of palliative treatment of malignant esophageal stenosis is rapid restoration of passage of fluid and solids. Endoscopic intubation with plastic endoprosthesis may lead to prompt relief of dysphagia and is a effective procedure for the palliative treatment of malignant esophageal stenosis. However, the insertion procedure, which necessitates prior dilatation, is traumatic and associated with considerable risk for perforation and bleeding. Tumor overgrowth, stent migration and stent blockage are frequent complications. Recently, self expanding metal stents woven in the form of tubular mesh made from surgical grade stainless steel alloy filaments(Wallstent), have been developed to offer possible advatage over conventional plastic tubes. The small diameter of introducer system carrying the compressed stent(18Fr) allows a relatively easy insertion procedure that dose not require prior dilatation. This stent is pliable. self-expanding and flexible in the longitudinal axis. We experienced a case of a 74-year-old male with malignant esophageal stenosis in whom self-expanding Wallstent was implanted with successful oral nutrition and much improvement of dysphagia.
Aged ; Alloys ; Axis, Cervical Vertebra ; Deglutition Disorders ; Dilatation ; Esophageal Stenosis* ; Hemorrhage ; Humans ; Intubation ; Male ; Palliative Care* ; Plastics ; Stainless Steel ; Stents