Neonatal Gaves disease is a relatively rare condition due to transplacental passage of Thyroid-stimulating antibody(TSAb) from a mother with active or inactive Graveses disease or autoimmune thyroiditis. A 11-day-old female newborn was referred to our department of pediatrics from a local clinic because of low level T4(3.55microg/dl) concurrent with high level TSH (501.74uIU/ml) on the 5th day neonatal metabolic screening. But, our repeated laboratory data showed very high serum T4(59.6microg/dl), T3(1,600ng/dl), suppressed TSH(0.43uIU/ml), and the presence of TSH receptor antibody. Her mother was treated with propylthiouracil(PTU) for Graves disease during pregnancy. Therefore, we thought it was a delayed-onset neonatal hyperthyroidism, because the fetal thyroid gland was initially suppressed by antithyroid drug taken during pregnancy. After initiating antithyroid drug therapy for the hyperthyroid nature, TSH levels became elevated again, while thyroid hormone levels decreased. Maternal and infant blood samples at the 23th day after birth were examined for serum autoantibodies directed towards the TSH receptor(Thyrotropin-binding inhibitory immunoglobulin:TBII, Thyroid-stimulating antibody:TSAb, Thyroid-stimulating blocking antibody:TSBAb) and high levels of TBII and TSAb were detected. About 2 months after birth, TBII and TSAb decreased within normal limit, and then we could stop antithyroid medication in safety. We report here a case of neonatal Graveses disease with very high level of T4 and T3, but firstly presented as hypothyroid nature on neonatal screening because of the maternally transferred antithyroid drug, PTU.
Autoantibodies ; Drug Therapy ; Female ; Graves Disease ; Humans ; Hyperthyroidism ; Infant ; Infant, Newborn ; Mass Screening ; Mothers ; Neonatal Screening ; Parturition ; Pediatrics ; Pregnancy ; Receptors, Thyrotropin ; Thyroid Gland ; Thyroiditis, Autoimmune

BACKGROUND AND OBJECTIVES: Early glottic cancer can be effectively treated with radiation therapy or laser surgery. The aim of this study was to compare the result of treatment between laser cordectomy and radiation therapy for T1 glottic cancer. SUBJECTS AND METHOD: A retrospective review of 42 patients addresses the result of the treatment for T1 lesion of glottic carcinoma managed by radiation therapy or laser cordectomy from 1994 to 2002. The results of treatment, local control rate, expenses, complication were compared between radiation therapy group and laser surgery group. RESULTS: The local control rates of laser cordectomy group and radiation therapy group were 89.9% and 83.8%, respectively, but showed no statistical significance. The involvement of anterior commissure was the most important prognostic value in both groups. Laser cordectomy group had less complications and more cost-effectiveness than the radiation therapy group. CONCLUSION: Laser cordectomy was an effective treatment for T1 laryngeal cancer with high local control rate, less morbidity and more cost-effectiveness.
Humans ; Laryngeal Neoplasms ; Laser Therapy ; Radiotherapy* ; Retrospective Studies

Condyloma lata is a common manifestation of secondary syphilis, but involvement of the lip mucosa is rare. Nodular lesions, especially solitary nodules, are uncommon manifestations of secondary syphilis, and only a few cases have been described. Failure to recognize condyloma lata of the lip mucosa may delay diagnosis and treatment. A 20-year-old man presented with a 4-month history of a solitary nodule on his upper lip mucosa. A diagnosis of condyloma lata was made on the basis of serologic tests for syphilis and pathological findings. We report an interesting case of condyloma lata on the upper lip mucosa that showed an unusual clinical manifestation of secondary syphilis.
Humans ; Lip ; Mucous Membrane ; Serologic Tests ; Syphilis ; Young Adult

PURPOSE: To evaluate the risk period of osteonecrosis of the femoral head following steroid therapy. MATERIALS AND METHODS: Medical records data were reviewed and studied the duration and dosage of steroid therapy for 22 patients who were diagnosed as in the early stage osteonecrosis by MRI but were without positive findings on plain radiographs. RESULTS: The period from the onset of steroid therapy to the time of diagnosis by MRI ranged from one to 16 months (mean, 5.3 months). Twenty-one of the 22 patients were diagnosed within 12 months. The total dosage of steroid ranged from 1,800 to 15,505 mg of prednisolone or its equivalent (mean, 5,928 mg). CONCLUSION: The current study revealed that the risk period for developing femoral head osteonecrosis in patients receiving long-term steroid therapy is 12 months. Periodical follow-up and intensive screening are recommended within the first year of long-term steroid therapy to detect osteonecrosis of the femoral head at an early stage.
Diagnosis ; Follow-Up Studies ; Head* ; Humans ; Magnetic Resonance Imaging ; Mass Screening ; Medical Records ; Osteonecrosis* ; Prednisolone

BACKGROUND AND OBJECTIVES: Kikuchi's disease (histiocytic necrotizing lymphadenitis) is a rare self-limiting disorder that typically affects the cervical lymph nodes. It has been occasionally misdiagnosed as tuberculous lymphadenitis or malignant lymphoma. In this study, we analyzed the clinical and radiologic characteristics and tried to find the differential points of Kikuchi's disease. SUBJECTS AND METHOD: Fifty-two patients who underwent, from January 1998 to December 2004, a excisional biopsy or fine needle aspiration of a cervical lymph node and diagnosed histologically with Kikuchi's disease were enrolled in this study. We retrospectively reviewed the medical record and imaging of each patient. The patients were followed up for a period of 14 to 200 seven days. RESULTS: Patients were 36 women and 16 men (2.3:1) with the mean age of 23.7 years old. The affected cervical lymph nodes were most commonly located in the posterior cervical triangle (Level V, 83%). Multiple and unilateral cervical lymph nodes were affected in 23 and 16 patients, respectively. The dimensions of affected lymph nodes were in the range of 1 to 2.5 cm (mean 1.73 cm). Leukopenia was observed in 21 patients (46%) fever in 24 patients (46%). CT finding of Kikuchi's disease appeared to be similar to tuberculous lymphadenitis but it had more homogenous density. One patient was recurred after 104 days since she was diagnosed as Kikuch's disease by biopsy. CONCLUSION: The difinite diagnosis of Kikuch's disease was determined by pathology. But half of the patients show clinical and radiologic features suggestive of Kikuch's disease. Short term use of steroid with high index of suspicion will reduce the unnecessary open biopsy in patient with Kikuchi's disease.
Biopsy ; Biopsy, Fine-Needle ; Diagnosis ; Female ; Fever ; Histiocytic Necrotizing Lymphadenitis* ; Humans ; Leukopenia ; Lymph Nodes ; Lymphoma ; Male ; Medical Records ; Pathology ; Retrospective Studies ; Tuberculosis, Lymph Node

BACKGROUND/AIMS: This prospective study was conducted to assess the effect of walking-exercise on the bowel cleansing before colonoscopy and to define subgroup of patients to whom walking-exercise was beneficial. METHODS: Before taking 2.5 L of polyethylene glycol, 393 out-patients were randomized into two groups (G1; walking-exercise, G2; non-exercise) and the amount of walking-exercise was estimated by the step counter. A single colonoscopist performed the procedure with a single-blinded manner and estimated the bowel cleansing. RESULTS: A total of 366 patients were included by per protocol analysis. The number of step count was significantly different between two groups (p<0.000). However, the groups were similar in other data collected. The degree of bowel cleansing between two groups was significantly different (p<0.01). Age, history of abdominal surgery, constipation, obesity and walking- exercise were related to the degree of bowel cleansing. Interestingly, walking-exercise was especially beneficial to patients with age less than 65 years, without history of abdominal surgery, and non-obesity. Multivariate analysis demonstrated that absence of constipation (OR=4.74), walking- exercise (OR=2.04), and younger age (OR=1.97) were independent factors associated with better bowel cleansing. Most of walking patients (97.4%) answered that walking-exercise is more comfortable than taking the solution. CONCLUSIONS: The walking-exercise was of an additional benefit to improve colonoscopic bowel cleansing without significant patients discomfort.
Colonoscopy* ; Constipation ; Humans ; Multivariate Analysis ; Obesity ; Outpatients ; Polyethylene Glycols ; Prospective Studies ; Walking

STUDY DESIGN: Retrospective analysis. OBJECTIVES: To determine the relationship between pelvic tilt and lumbar disc degeneration. SUMMARY OF LITERATURE REVIEW: The shape and the spatial orientation of the pelvis determine the organization of the lumbothoracic spine. The purpose of our study was to determine the relationship between pelvic tilt and lumbar disc degeneration. MATERIALS AND METHODS: Sixty patients over 50 years of age who had undergone lumbar spine magnetic resonance imaging were recruited. In individuals between 41 and 60 years of age, the normal pelvic tilt is 14°. Patients were divided into a low pelvic tilt (PT) group (<14°) and a high pelvic tilt (PT) group (≥14°). Lumbar disc degeneration was graded from I to V according to the Pfirrmann grade. We defined grades IV and V as high-grade degeneration and the others as low-grade degeneration. Radiologic parameters and lumbar disc degeneration were compared between these 2 groups. RESULTS: In the low PT group, the average degeneration grade of each lumbar segment was 2.61 in L1-L2, 2.61 in L2-L3, 3.00 in L3-L4, 3.39 in L4-L5, and 3.84 in L5-S1. The corresponding grades in the high PT group were 2.34 in L1-L2, 2.62 in L2-L3, 3.07 in L3-L4, 3.76 in L4-L5, and 3.55 in L5-S1. The grade of degeneration of the high PT group was significantly higher than that of the low PT group for L4-L5 (p=0.031). High-grade degeneration of the L4-L5 segment was significantly more common in the high PT group (odds ratio=4.65; 95% CI, 1.406-15.381; p=0.012). CONCLUSIONS: Patients with high pelvic tilt had a higher grade of lumbar disc degeneration in the L4-L5 segment regardless of age or gender.
Humans ; Intervertebral Disc Degeneration* ; Magnetic Resonance Imaging ; Pelvis ; Retrospective Studies ; Spine

PURPOSE: Hip fractures in hemodialysis patients are accompanied by high rates of complications and morbidities. Previous studies have mainly reported on nonunion and avascular necrosis of femoral neck fractures in this patient group. In this study the complication and clinical results of hemodialysis patients with intertrochanteric fractures treated with proximal femoral intramedullary nailing have been investigated through comparison with patients with normal kidney function. MATERIALS AND METHODS: Forty-seven patients were included; the hemodialysis group (n=17) and the control group with normal kidney function (n=30). The medical history and clinical findings including preoperative and postoperative blood examinations, radiological examinations and ambulatory status (measured using the Koval score). The rate of complications and morbidities were also investigated and compared. RESULTS: Preoperative hemoglobin/hematocrit was lower but a significant increase in partial thromboplastin time was observed in the hemodialysis group. The amount of bleeding/transfusions were higher and operative time was longer in the hemodialysis group. Upon radiologic examination, there was no significant difference in rate of unstable fracture and nonunion between the two groups. However the postoperative Koval score was significantly worse and the odds ratio of inability to walk after surgery was 13.5 times higher in the hemodialysis group. CONCLUSION: There was no significant difference in radiological results, but the risk of inability to walk after surgery was 13.5 times higher in the hemodialysis group. Hemodialysis patients have more morbidities and are hemodynamically unstable therefore require special attention. Accurate reduction and firm fixation is required and attentive postoperative rehabilitation is needed.
Femoral Neck Fractures ; Femur ; Fracture Fixation, Intramedullary ; Hip Fractures ; Humans ; Kidney ; Necrosis ; Odds Ratio ; Operative Time ; Partial Thromboplastin Time ; Rehabilitation ; Renal Dialysis*

STUDY DESIGN: Retrospective study. OBJECTIVES: The goal of this study was to evaluate the risk factors of osteoporotic vertebral fractures (OVFs) in patients with Cushing syndrome. SUMMARY OF LITERATURE REVIEW: In most reports, vertebral fractures in Cushing syndrome have been found to be related to osteoporosis. However, few studies have analyzed the clinical risk factors for OVFs. MATERIALS AND METHODS: Thirty-two patients with Cushing syndrome who visited the orthopaedic department complaining of back pain were included in this study. Standing lateral X-rays were performed to evaluate the presence of vertebral fractures, and bone mineral density (BMD) was measured. RESULTS: Of the 32 patients with Cushing syndrome with back pain, 8 (25%) were diagnosed with OVFs using morphometric criteria. The average weight and body mass index of the vertebral fracture group (VF group) were significantly higher than the values observed in the non-vertebral fracture group (non-VF group) (p=0.004, p=0.018). Lumbar BMD was significantly lower in the VF group (p=0.006). A risk factor for OVFs in Cushing syndrome was osteoporosis (odds ratio=18.56, 95% confidence interval=1.72-200.21, p=0.016) regardless of gender, obesity, menopause, or urine free cortisol levels. CONCLUSIONS: OVFs in Cushing syndrome have been associated with overweight, and overweight is an indicator of compliance in the treatment of Cushing syndrome. Therefore, weight reduction and the prevention of osteoporosis should be emphasized in patients with Cushing syndrome to prevent OVFs.
Back Pain ; Body Mass Index ; Bone Density ; Compliance ; Cushing Syndrome* ; Female ; Humans ; Hydrocortisone ; Menopause ; Obesity ; Osteoporosis ; Overweight ; Retrospective Studies ; Risk Factors* ; Weight Loss

The Cre/LoxP system is a well-established approach to spatially and temporally control genetic inactivation. The calcium/calmodulin-dependent protein kinase II alpha subunit (CaMKIIalpha) promoter limits expression to specific regions of the forebrain and thus has been utilized for the brain-specific inactivation of the genes. Here, we show that CaMKIIalpha-Cre can be utilized for simultaneous inactivation of genes in the adult brain and in male germ cells. Double transgenic Rosa26(+/stop-lacZ)::CaMKIIalpha-Cre(+/Cre) mice generated by crossing CaMKIIalpha-Cre(+/Cre) mice with floxed ROSA26 lacZ reporter (Rosa26(+/stop-lacZ)) mice exhibited lacZ expression in the brain and testis. When these mice were mated to wild-type females, about 27% of the offspring were whole body blue by X-gal staining without inheriting the Cre transgene. These results indicate that recombination can occur in the germ cells of male Rosa26(+/stop-lacZ)::CaMKIIalpha-Cre(+/Cre) mice. Similarly, when double transgenic Gnao(+/f)::CaMKIIalpha-Cre(+/Cre) mice carrying a floxed Go-alpha gene (Gnao(f/f)) were backcrossed to wild-type females, approximately 22% of the offspring carried the disrupted allele (Gnao(Delta)) without inheriting the Cre transgene. The Gnao(Delta/Delta) mice closely resembled conventional Go-alpha knockout mice (Gnao(-/-)) with respect to impairment of their behavior. Thus, we conclude that CaMKIIalpha-Cre mice afford recombination for both tissue- and time-controlled inactivation of floxed target genes in the brain and for their permanent disruption. This work also emphasizes that extra caution should be exercised in utilizing CaMKIIalpha-Cre mice as breeding pairs.
Animals ; Brain/*metabolism ; Calcium-Calmodulin-Dependent Protein Kinase Type 2/genetics ; Female ; GTP-Binding Protein alpha Subunits, Gi-Go/*genetics ; *Gene Deletion ; Gene Knockout Techniques/*methods ; Male ; Mice ; RNA, Untranslated/genetics ; Recombination, Genetic ; Spermatozoa/*metabolism