Exfoliative cytology of synovial fluid is less stressed in medical practice, but it can be a very useful tool for the differential diagnosis of various joint diseases. This report describes a case of juvenile rheumatoid arthritls in a 7 year old girl, who showed characteristic ragocytes in joint fluid. Synovial biopsy specimen confirmed the diagnosis of rheumatoid arthritis.
Diagnosis, Differential ; Biopsy

The authors reviewed 17 patients with radial nerve palsy complicating fracture of humerus who were treated at the Department of Orthopedlc Surgery, St. Mary's Hospital Catholic Medical College, for past 3 years from Jan. 1974 to Dec. 1976, and the following results were obtalned. 1. The ratio of male to female in 17 cases with radial nerve palsy was 4 to 1, and In patients within the first decade the ratio was same (1:1). But those in the 3rd and 4th decade showed high incidence of palsy. 2. Among 113 humerus shaft fractures, 17 cases (15.0%) complicated the radial nerve palsy; among 17 cases the middle shaft fractures were 15, lower 2, none in the upper third. 3. The radial nerve was the most vulnerable to injury at the middle third of the humerus, especially when there was comminution of fracture. 4. The incidence of radial nerve palsy in closed fracture (102 cases) was 13.7% (14 cases), and 27.2% (3cases) in open fracture (11 cases). 5. By early surgical exploration the practlcal cause of radial nerve palsy in 9 cases were found; 2 cases by bruise, 2 by interposition, 2 severance of nerve, one stretching, one impaled, and one unknown. 6. There were no signiflcant correlation between the type of nerve damage and the degree of its recovery, and between duration of paralysis since onset and its prognosis. 7. Of the 17 cases with palsy, complete recoveries were obtained 11 cases, 5 incomplete, and no recovery in one.
Contusions ; Female ; Fractures, Closed ; Fractures, Open ; Humans ; Humerus ; Incidence ; Male ; Paralysis ; Prognosis ; Radial Nerve

PURPOSE: Newborn infants with diarrhea, metabolic acidosis and dehydration may develop methemoglobinemia without exposure to oxidizing agents. This study was undertaken to investigate clinical features in the development of methemoglobinemia in newborn infants with diarrhea. METHOD: This study involved 16 newborn infants with diarrhea who were admitted to NICU at Dong San Medical Center between January 1995 and June 1996. We investigated the age of onset of methemoglobinemia, sex ratio, level of methemoglobin in the blood, feeding methods, clinical manifestations, arterial blood gas findings, the results of culture findings and the response to therapy. RESULT: 1) The age of onset was beyond the second week of life in most cases, no sex predilection was noted and formula feeding was used in all cases. 2) Methemoglobin level in the blood was 10.1-20.0% in 7 cases, 20.1-30.0% in 6 cases, 30.1-40.0% in 2 cases and above 40.1% in one case. 3) Clinical rnanifestations on admission: moderate to severe dehydration developed in all patients with diarrhea along with respiratory distress in 13 cases, cyanosis in 6 cases, fever was noted in 5 cases, vomiting in 5 cases, while 2 cases presented with abdominal distention. Combined diseases included metabolic acidosis in most cases (93.8%), hypokalemia in 6, failure to thrive in 3, chronic diarrhea in 2, hyponatremia in 2, necrotizing enterocolitis in 1 and hepatitis was found in one case. 4) In all cases, there were no pathogenic organisms found in either blood or urine cultures along with similar negative findings in stool cultures, and Rotazyme test results using ELISA method were negative. 5) Rehydration and correction of acidosis with sodium bicarbonate was accomplished in all patients and 11 cases with greater than 15% methemoglobin were treated with methylene blue, 2mg/kg as a 1% solution in normal saline. Response to methylene blue was indicated in 1 to 2 hours in all cases although there was a reoccurrence of methemoglobinemia after an initial response in 2 cases, they both responded favorably with retreatment with methylene blue. CONCLUSION: In all newborn infant with diarrhea, dehydration and metabolic acidosis, screening tests for early diagnosis of methemoglobinemia should be considered with prompt fluid replacement therapy.
Acidosis ; Age of Onset ; Cyanosis ; Dehydration ; Diarrhea* ; Early Diagnosis ; Enterocolitis, Necrotizing ; Enzyme-Linked Immunosorbent Assay ; Failure to Thrive ; Feeding Methods ; Fever ; Fluid Therapy ; Hepatitis ; Humans ; Hypokalemia ; Hyponatremia ; Infant* ; Infant, Newborn* ; Mass Screening ; Methemoglobin ; Methemoglobinemia* ; Methylene Blue ; Oxidants ; Retreatment ; Sex Ratio ; Sodium Bicarbonate ; Vomiting

Menetrier's disease is characterized by enlarged gastric folds with foveolar hyperplasia and cystic dilatation of gastric glands. The additional biochemical features of hypoproteinemia, hypochlorhydria, and increased gastric mucus are often encountered. The pathogenesis and etiologic factors have not been clearly defined. In this report, we present two cases of Menetrier's disease in the stomach, one occurring in a 38-year-old male, associated with massive hematemesis, and the other in a 39-year-old male. Grossly, both cases showed marked giant gastric rugal folds resembling cerebral convolutions, sparing the antral portion. Microscopically, the giant gastric rugal folds consisted of the striking foveolar hyperplasia accompanied by an occasional presence of the smooth muscle fibers from the muscularis mucosa. The immunohistochemical stain revealed an intense positive reaction for transforming growth factor-alpha (TGF-alpha) and epidermal growth factor receptor (EGF-R) in the majority of mucous cells throughout the gastric mucosa and parietal cells, but did not reveal for epidermal growth factor (EGF). We suggested that TGF-alpha and EGF-R might be involved in the pathogenesis of Menetrier's disese.
Achlorhydria ; Adult ; Dilatation ; Epidermal Growth Factor ; Gastric Mucosa ; Gastritis, Hypertrophic* ; Hematemesis ; Humans ; Hyperplasia ; Hypoproteinemia ; Immunohistochemistry ; Male ; Mucous Membrane ; Mucus ; Muscle, Smooth ; Rabeprazole ; Receptor, Epidermal Growth Factor ; Stomach ; Strikes, Employee ; Transforming Growth Factor alpha

PURPOSE: To evaluate risk factors associated with the development of strabismus in children with organic ocular diseases. METHODS: The authors reviewed the medical records of 143 patients diagnosed with organic ocular disease between the ages of six months and 19 years from March 2000 through September 2009. The distributions of etiology, age, visual acuity and visual acuity difference between both eyes at onset of visual loss, spherical equivalent difference between both eyes, duration of visual loss, and nystagmus were analyzed to determine relationships with the development of strabismus. RESULTS: Of 143 patients, strabismus developed in 41 children (28.7%). The causative diseases were congenital cataract (73.2%), developmental cataract (7.3%), uncorrected aphakia (7.3%), retinal detachment (4.9%), lens subluxation (2.4%), optic nerve disorder (2.4%), and corneal opacity (2.4%). The incidence of strabismus increased significantly in the cases of congenital disease, those < or = five years of the age at onset of visual loss, those with < or = 20/200 visual acuity, and those with large interocular spherical equivalent difference. There was no relationship between incidence of strabismus and visual acuity difference between both eyes. However, the incidence of strabismus increased significantly when the visual acuity difference was more than three Snellen lines in congenital ocular disease. CONCLUSIONS: When ocular disease is congenital, an increased risk of onset of strabismus should be considered when the age at onset of visual loss is less than five years, when visual acuity is below 20/200, and when there is a large spherical equivalent difference between both eyes.
Adolescent ; Aphakia ; Cataract ; Child ; Corneal Opacity ; Eye ; Humans ; Incidence ; Lens Subluxation ; Medical Records ; Optic Nerve ; Retinal Detachment ; Risk Factors ; Strabismus ; Visual Acuity

PURPOSE: Headache is a frequent symptom in pediatric practice, but the prevalence of chronic recurrent headache was estimated in several studies with wide variations, because of inadequate expression and differences in case definition in children. Headache classification of International Headache Society is usually used in adults, but the application of it to children is uncommon, so we tried to diagnosis children with headache by using International Headache Society Classification. METHODS: We analyzed the clinical pictures, physical examinations including neurologic examination, PNS series, EEG and CT or MRI in 53 children with nonprogressing recurrent headache over than one month, who visited to pediatric department of Dong-A University hospital from January, 1995 to Feburary, 1996 and diagnosed them by using International Headache Society Classification. RESULTS: 1) The sex ratio between male and female was 1:1.2. 2) Diagnosed groups consisted of children with migraines in 22 cases(41.5%), tension-type headache in 19 cases(35.9%), coexisting migraine and tension-type headaches in 5 cases(9.4%), miscellaneous headaches not associated with structual lesion in 1 case(1.9%), headache associated with vascular disorders in 2 cases(3.8%), headache associated with nonvascular intracranial disorder in 1 case(1.9%), headache due to facial pain in 3 cases(5.6%). 3) Of 22 migraine cases, 13 cases(59.1%) had migraine with aura, 8 cases(40.9%) have migraine without aura and of 19 tension-type headache cases, 8 cases(42.1%) have episodic type, 11(57.9%) cases have chronic type. 4) Of 53 cases with recurrent headache, 3 cases(6%) had abnormal findings in CT or MRI. 5) Of 53 cases with recurrent headache, 9 cases(17%) had abnormal findings in EEG. CONCLUSIONS: International Headache Society Classifications are useful, but the diagnostic criteria are too strict for children, especially in migraine and tension type headache.
Adult ; Child* ; Classification* ; Diagnosis ; Electroencephalography ; Facial Pain ; Female ; Headache* ; Humans ; Magnetic Resonance Imaging ; Male ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Neurologic Examination ; Physical Examination ; Prevalence ; Sex Ratio ; Tension-Type Headache

Primary meningeal melanocytoma of the central nervous system is extremely rare. We report a case of meningeal melanocytoma associated with Ota's nevus as a recurrent form in a 53-year old male. The meningeal melanocytoma was removed from right parietooccipital lobe 4 years ago and recurred in right parietal, occipital and left frontal lobes. Ultrastructurally, the tumor cells were characterized by the presence of numerous melanosomes and premelanosomes in their cytoplasm. Moreover, the tumor was lacking in histologic and ultrastructural features of pigmented meningioma, melanotic schwannoma and prolonged clinical course was different from primary meningeal melanoma or metastatic malignant melanoma.
Neoplasm Metastasis

PURPOSE: To assess the surgical results of a punctoplasty with insertion of a silicone tube using a pigtail probe for the management of acquired punctal obstruction. METHODS: The medical records of 61 patients who underwent an operation for the management of punctual obstruction were reviewed. After punctal dilation, fluorescein dye disappearance test was performed to evaluate its efficacy. In the case of no functional delay after punctal dilation, three-snip punctoplasty with a silicone tube using a pigtail probe was performed. In the case of a functional delay, three-snip punctoplasty with a silicone tube into the nasolacrimal duct was performed. RESULTS: The surgical success over 1 year was 39.1% in patients who underwent only three-snip punctoplasty, 79.2% in patients who underwent a three-snip punctoplasty with a silicone tube insertion into the nasolacrimal duct, and 85.7% in patients who underwent a three-snip punctoplasty with canalicular intubation using a pigtail probe. CONCLUSIONS: The use of a pigtail probe for canalicular intubation together with a three-snip punctoplasty is useful to prevent the recurrence of punctal obstruction.
Fluorescein ; Humans ; Intubation ; Lacrimal Apparatus Diseases ; Medical Records ; Nasolacrimal Duct ; Recurrence ; Silicones

The epidermoid cyst of the testis is a rare benign lesion with a characteristic gross and microscopic appearances. This 25 year old male who had been previously diagnosed as Klinefelter's snydrome (47/XXY) had right orchiectomy due to hard testicular nodule for a presented malignant testicular tumor. Sectioning of the testis revealed a intraparenchy matous cystic lesion, 1.5 cm in diameter, filled with cheesy white material. Histologically, stratified squamous epithelium lined the cyst. The remaining testis showed advanced tubular sclerosis and Leydig cell hyperplasia. It is necessary to submit multiple sections to rule out other histologic elements in the cyst wall or the presence of a scar. Although epidermoid cyst occurring as a solitary testicullar nodule could be regarded as a stage in the development of a teratoma, they need to be distinguished from the complex differentiated teratomas because of a distinct difference in prognosis.
Male ; Humans ; Cysts

In the present study, immunohistochemical detection of p53 oncoprotein was performed to determine whether the grade of differentiation and the histologic type of gastric adenocarcinoma, and the degree of atypia accompanied with adenoma can be related to p53 mutation. Paraffin sections of 22 gastric adenomas and 56 gastric adenocarcinomas were examined for the overexpression of p53 oncoprotein with the avidin-biotin peroxidase complex staining procedure. The obtained results were as follows; 1. All the 22 cases of adenomas and 16 cases of well differentated adenocarcinomas showed uniformly negative staining. 2.Seven of 18 cases of moderately differentiated adenocarcinomas(39%), and five of 30 cases of poorly differentiated adenocarcinomas(17%) exhibited p53 protein expression. 3. Three of 29 cases of diffuse type (10%) and 9 of 19 cases of intestinal type(47%) exhibited p53 protein expression. These results suggest that p53 mutation is important in carcinogenesis of the intestinal type of gastric adenocarcinoma, and there is no correlation between the differentiation of gastric adenocarcinoma and the degree of p53 oncoprotein overexpression.
Adenocarcinoma ; Adenoma