The clinical evaluation was done in eight eyes of four patients with bilateral branch retinal vein occlusion. The onset of age was from 36 to 65 years, and three pa dents were women. Hypertension was the most common associated systemic disease. Retinal neovascularization was complicated in six eyes, and five eyes had vitreous hemorrhage. The vitrectomy was performed in three eyes. We believe that branch retinal vein occlusion associated with hypertension should be followed carefully in the fellow eyes.
Female ; Humans ; Hypertension ; Retinal Neovascularization ; Retinal Vein Occlusion ; Veins* ; Vitrectomy ; Vitreous Hemorrhage

Leptomeningeal metastasis(LM) usually occurs in patients with previous cancer. But rarely it can be the first manifestation of cancer. We analyzed primary tumors and early clinical findings in 12 patients in whom LM was the presenting sign of cancer. Primary tumors were lung cancer in 5 cases, stomach cancer 1, lymphoma 1 and unknown 5. Most patients, previously healthy, developed progressive headache which was followed by symptoms and signs involving multiple neuraxis. Major symptoms on admission were headache, nausea, vomitting, visual dimmness, diplopia, hearing disturbance and the major neurologic deficits were papilledema, ocular motor palsy, decreased DTR and neck stiffness. From these clinical findings and CSF test, initially LM was suspected in only 6 patients. In the remaining 6 patients, initial diagnosis were tuberculosis meningitis(3), benigh intracranial hypertension(2) and adjustment disorder(1). In addition to cytology, which was positive in 9 cases, CSF carcinoembryonic antigen(CEA) and neuroimaging played an important role in the early diagnosis of LM. Despite whole brain radiation therapy, all patients worsened and expired 2 weeks-10weeks(median survival, 3 weeks) after the diagnosis.
Brain ; Diagnosis ; Diplopia ; Early Diagnosis ; Headache ; Hearing ; Humans ; Lung Neoplasms ; Lymphoma ; Nausea ; Neck ; Neoplasm Metastasis* ; Neuroimaging ; Neurologic Manifestations ; Papilledema ; Paralysis ; Stomach Neoplasms ; Tuberculosis

We reviewed 40 cases of primary mediastinal tumors which were operated on at Seoul Paik Hospital from September, 1987 to December, 1995. Of these, 18 were male and 22 were female. The patient ranged in age from 4 years to 68 years with a mean age of 34.1 years. The most common symptoms included chest pain(12.5%), cough(12.5%), dyspnea(7.5%), and palpable neck mass(7.5%), and symptoms were absent at the time of diagnosis in 37.5% of cases. Chest roentgenography and computed tomography(CT) were performed in all patients, and magnetic resonance imaging(MRI) in 5 patients, and transthoracic needle aspiration (TTNA) performed in 22 patients. The sensitivity of TTNA was 72.7%(16 of 22 patients). The lesion was located 60% in the anterosuperior mediastinum, 35% in the posterior mediastinum, and 5% in the middle mediastinum. The primary tumors included thymic neoplasms(11 cases), germ cell tumors(7 cases), neurogenic tumors(10 cases) and a miscellaneous group. The malignant tumors(12.5%) were invasive thymoma(3 cases), spindle cell sarcoma(1 case), and non-Hodgkin's lymphoma(1 case). A complete excision was done in all 35 benign tumors and 3 malignant tumors. There was no operative mortality, and postoperative complications occurred in 3 cases.
Diagnosis ; Female ; Germ Cells ; Humans ; Male ; Mediastinal Neoplasms ; Mediastinum ; Mortality ; Neck ; Needles ; Postoperative Complications ; Radiography ; Seoul ; Thorax

Between 1987 and 1995, eleven patients with severe chronic corrosive stenosis of the hypopharynx and esophagus underwent surgical restoration of digestive continuity at Inje University Seoul Paik Hospital. There were 7 male and 4 female patients aged from 21 to 47 years (mean, 34 years). The caustic material was acid in 6 patients and alkali in 5 patients. The esophagus was reconstructed using the right colon in 9 and left colon in 2. The cervical approach and the side of proximal anastomosis depended on the status of the pyriform sinus of the hypopharynx. In the neck, J-formed incision was made along the sternocleidomastoid muscle. The sternohyoid and thyrohyoid muscles were divided transversely to expose the thyroid cartilage. Hypopharyngeal opening for proximal anastomosis was made by reverse triangular formed resection of the thyroid cartilage after elevation of perichondrium. Immediately after operation, dysphagia and aspiration into trachea were common, so training of swallowing was required. Feeding gastrostomy was usually maintained for 3 months until restoration of swallowing function was confirmed. There was graft necrosis in 3 patients, who were treated with jejunal free graft. Revisional procedures for stenosis of cervical anastomosis in 3 patients consisted of widening of pharyngocecostomy site in 2 and resection of adhesive band in one. Return of normal swallowing assuring normal nutrition was obtained in 10 of 11 cases.
Adhesives ; Alkalies ; Colon ; Constriction, Pathologic* ; Deglutition ; Deglutition Disorders ; Esophageal Stenosis ; Esophagus ; Female ; Gastrostomy ; Humans ; Hypopharynx ; Male ; Muscles ; Neck ; Necrosis ; Pyriform Sinus ; Seoul ; Thyroid Cartilage ; Trachea ; Transplants

Huntington's disease(HD) is clinically diagnosed by the triad of autosomal dominant inheritance, involuntary movements mainly chorea, and dementia. The phenotype of HD is variable and other diseases can have the same phenocopy. A definite diagnosis of Huntington's disease cannot be made by clinical informations alone Pathologic or genetic studies was necessary to exclude other neurodegenerative diseases which may present with familial dementia or chorea. Therefore, genetic studies of HD become essential for confirmatory diagnosis. Recent discovery of an expanded CAG trinucleotide repeat at the telomeric position of chromosome 4p made the diagnosis possible even in sporadic and presymptomatic cases. We previously demonstrated expantion of CAG repeats in clinically diagnosed HD, and were able to find presymptomatic. We herein present the clinical and genetic information in all the cases of genetically confirmed HD. 1) There was a clear gap between the number of CAG repeats in HD and normal and disease control. 2) Two out of three patients who had chorea without family history were confirmed as HD by genetic study. 3) One who had psychosis and a family history of HD was shown not to be HD. 4) We found 12 asymptomatic cases with HD mutation during family screening. 5) Caudate atrophy in MRI was not seen in the early stage of HD. Our data confirms that gene analysis is a powerful tool to make a diagnosis of HD even in sporadic and presymptomatic cases. Proper genetic counselling after judicious preparation of the family and society is sorely needed.
Atrophy ; Chorea ; Dementia ; Diagnosis ; Dyskinesias ; Humans ; Huntington Disease* ; Korea* ; Magnetic Resonance Imaging ; Mass Screening ; Neurodegenerative Diseases ; Phenotype ; Psychotic Disorders ; Trinucleotide Repeats ; Wills

Huntington's disease(HD) is clinically diagnosed by the triad of autosomal dominant inheritance, involuntary movements mainly chorea, and dementia. The phenotype of HD is variable and other diseases can have the same phenocopy. A definite diagnosis of Huntington's disease cannot be made by clinical informations alone Pathologic or genetic studies was necessary to exclude other neurodegenerative diseases which may present with familial dementia or chorea. Therefore, genetic studies of HD become essential for confirmatory diagnosis. Recent discovery of an expanded CAG trinucleotide repeat at the telomeric position of chromosome 4p made the diagnosis possible even in sporadic and presymptomatic cases. We previously demonstrated expantion of CAG repeats in clinically diagnosed HD, and were able to find presymptomatic. We herein present the clinical and genetic information in all the cases of genetically confirmed HD. 1) There was a clear gap between the number of CAG repeats in HD and normal and disease control. 2) Two out of three patients who had chorea without family history were confirmed as HD by genetic study. 3) One who had psychosis and a family history of HD was shown not to be HD. 4) We found 12 asymptomatic cases with HD mutation during family screening. 5) Caudate atrophy in MRI was not seen in the early stage of HD. Our data confirms that gene analysis is a powerful tool to make a diagnosis of HD even in sporadic and presymptomatic cases. Proper genetic counselling after judicious preparation of the family and society is sorely needed.
Atrophy ; Chorea ; Dementia ; Diagnosis ; Dyskinesias ; Humans ; Huntington Disease* ; Korea* ; Magnetic Resonance Imaging ; Mass Screening ; Neurodegenerative Diseases ; Phenotype ; Psychotic Disorders ; Trinucleotide Repeats ; Wills

Central venous catheterization is used to provide a large amount of fluid, total parenteral nutrition and to administer antitumor agents with few complications reported. We report an uncommon case of pleural effusion that occurred after central venous catheterization. In many cases, the mechanism for the pleural effusion after central venous catheterization occurs through an injury to the superior vena cava by the continuous mechanical force of the catheter tip, the flow of large amount of fluid and an osmotic injury to the wall of the vein. This case is somewhat different in that the central catheter was placed in an aberrant vessel resulting in the pleural effusion. A post-placement chest roentgenogram and the correct approach of catheterization are important for preventing this complication.
Antineoplastic Agents ; Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters* ; Parenteral Nutrition, Total ; Pleural Effusion* ; Thorax ; Veins ; Vena Cava, Superior

BACKGROUND: Several studies suggest that serum ferritin concentrations reflect systemic inflammation, and high ferritin levels can increase the risk of hypertension in adult men. Shift work is also known to increase the risk of hypertension; however, there has been no study about the relationship between serum ferritin levels and the prevalence of hypertension according to the working type. METHODS: This cross-sectional study included 4,442 male participants (3,651 daytime workers and 791 shift workers) who participated in the fifth Korean National Health and Nutrition Examination Survey. Hypertension was defined as a systolic blood pressure greater than or equal to 140 mmHg, a diastolic blood pressure greater than or equal to 90 mmHg or the current use of antihypertensive medications regardless of blood pressure values. For the statistical analyses, serum ferritin levels were reclassified into quartiles, and complex sample analyses were used to evaluate the relationship between serum ferritin levels and the prevalence of hypertension according to the working type in this study. RESULTS: Serum ferritin and shift work were positively associated with the prevalence of hypertension. The effect of interaction was above multiplicative. When compared to participants in the lowest serum ferritin quartile, the odds ratio for hypertension for participants in the highest serum ferritin quartile was 1.372 (1.027–1.833) in daytime workers and 2.009 (1.042–3.873) in shift workers after adjustment. CONCLUSIONS: The prevalence of hypertension increased as ferritin levels increased in individuals, especially in shift workers.
Adult ; Blood Pressure ; Cross-Sectional Studies ; Ferritins ; Humans ; Hypertension ; Inflammation ; Male ; Nutrition Surveys ; Odds Ratio ; Prevalence

BACKGROUND: Studies on the hematologic toxicity of ethylene glycol ethers in humans are limited. Therefore, the aim of this study was to examine the association between exposure to solvents (containing 2-butoxyethanol and 2-ethoxyethanol) and hematological effects. METHODS: Thirty-four screen-printing workers who were exposed to 2-butoxyethanol and 2-ethoxyethanol and 37 non-exposed clerical workers were selected using data from the health care facilities that provided regular health screening services. Student's t-tests and Pearson's chi-square tests were used to compare differences in hematological parameters between the exposed and the control groups. A multivariate analysis was performed using the multiple logistic regression models to adjust for other variables. RESULTS: The chi-square test showed the reticulocyte percentages and corrected reticulocyte counts to be significantly higher in the exposed group. The t-tests showed a significant increase in white blood cell counts, reticulocyte percentages, and corrected reticulocyte count (i.e., reticulocyte index) in the exposed group, with p-values of 0.002, 0.004, and 0.002, respectively. Multivariate analysis showed the odds ratio for the corrected reticulocyte counts to be 16.30 for the exposed group, when compared with that of the control group. CONCLUSIONS: Exposure to 2-butoxyethanol and 2-ethoxyethanol was significantly associated with reticulocytosis, necessitating the implementation of preventive measures for workers prone to occupational exposure to ethylene glycol ethers.
Clergy ; Delivery of Health Care ; Ether ; Ethers ; Ethylene Glycol ; Humans ; Leukocyte Count ; Logistic Models ; Mass Screening ; Multivariate Analysis ; Occupational Exposure ; Odds Ratio ; Reticulocyte Count ; Reticulocytes ; Reticulocytosis* ; Solvents