Giardiasis is one of the most common causes of infectious diarrhea and it has a worldwide distribution. Although it is a relatively common disorder, histologically confirmed Giardiasis is a rare occurrence and there have been no previous reports in Korea. A 34-year-old man presented with a 2-year history of epigastric discomfort and left flank pain. On stool examination, many cystic forms of Giardia lamblia were noted. In biopsy specimens of the small intestine, there was moderate chronic inflammatory cell infiltration and several trophozoites of Giardia were observed in the intervillous space and luminal surface. The trophozoites were pear shaped symmetrical organisms with two nuclei, and measured 9~10 micrometer in length.
Male ; Humans ; Biopsy

Local anesthesia for arthroscopic procedure of the knee is an increasinglv popular technique that avoids the use of general anesthesia and the associated risks of respiratory depression, aspiration, and postoperative sedation. Many authors, for example McGinty etc., Martin, Yoshiya etc., advocated local anesthesia as safe and efficient method for arthroscopic procedures of the knee. We performed arthoroscopy of the knee under local anesthesia on 150 patients for diagnostic and operative purposes between January l993 and December l996. The technique of local anesthesia that we used was that 20cc of 0.5%; bupivacaine with I:200,000 epinephrine was injected into superolateral portal of the knee joint and additional 10-20cc ot 1% lidocaine into the arthroscopic portals. Pnevmatic tourniquet wa, not applied in all cases. We analysed the 150 cases and the results were as follows; The diagnostic arthroscopy was performed in 50 cases and the operative arthroscopy was in 100 cases. The duration ot local anethesia was from 4 hours to 12 hours, with an average of 6 hours. In 35 cases arthroscopy was performed as outpatient procedure and average hospital stay excluding other problem was 5 days. No complication related to systemic toxicity by local anesthetics was observed. Conclusively arthroscopy of the knee under local anesthesia is safe and effective procedure to avoid the risks of general anesthesia but patients selection is very important.
Anesthesia, General ; Anesthesia, Local* ; Anesthetics, Local ; Arthroscopy* ; Bupivacaine ; Epinephrine ; Humans ; Knee Joint ; Knee* ; Length of Stay ; Lidocaine ; Outpatients ; Respiratory Insufficiency ; Tourniquets

Application of electric current in peritoneal dialysis was performed to observe the change of small intestine movement through an abdominal window, and to acceleration migration of certain ions. Prominent elevation of potassium in the dialysate was seen after applying a negative charge in the peritoneal cavity. N.P.H. was not much effected by introduction of the electric current. Acceleration of small intestinal movement was also observed after the application of electric current in peritoneal dialysis. Sow intestinal movement, when large amounts of lavage fluid are present in the peritoneal cavity, will be moderatelyaccelerated as a result of the application of electric current. Electric current can be applied both to prevent distension of the abdomen and adynamic ileus in peritoneal dialysis, and to accelerate too migration of the potassium ion and certain other ions.
Abdomen ; Acceleration ; Ileus ; Intestine, Small ; Ions ; Peritoneal Cavity ; Peritoneal Dialysis* ; Potassium ; Therapeutic Irrigation

Observation of intestinal movement in rabbits were performed through use of an abdominal window in peritoneal dialysis. The causes of an adequate drainage were also observed, through the abdominal window, and better drainage was obtained as a result of clear vision and catheter adjustment. Generally it was observed that the amount of small intestinal movement diminishes after dialysis solution was introduced into the peritoneal cavity, and the larger the amount of solution, the slower the small intestinal movement. The smaller dosage is better for effecting a diminished intestinal movement; however, the effect of the dialysis is not so great, because all the surface of the peritoneum can not be used. On the other hand, the larger dosage brings on a slowing down of the intestinal movement; yet its effect on the peritoneal dialysis is greater. Our observation lead us to conclude that 200cc of solution is more popular for rabbit experiment and that dosage above this should be avoided. Less influence to the small intestinal movement was noticed when the temperature of the solution remained a little higher than body temperature. The nephrectomized rabbits and the anuric rabbits show less intestinal movement than the normal rabbits. The possible causes of ilus and abdominal distension in peritoneal dialysis were noted and discussed. After giving prostigmin in dialysate the frequency of intestinal movement increased almost to normal. Judging from the result of this experiment, it is advisable to use small doses of prostigmin in dialysate routinely in peritoneal dialysis.
Body Temperature ; Catheters ; Dialysis ; Drainage ; Hand ; Neostigmine ; Peritoneal Cavity ; Peritoneal Dialysis* ; Peritoneum ; Rabbits

The clinicopathologic features and the comparative analysis of diagnostic methods in 42 patients having intestinal tuberculosis were studied. In all the cases, clinical and colonoscopic diagnosis was confirmed by histological examination. Abdominal pain was the most common symptom (54%). Twenty nine patients had active pulmonary tuberculosis which was confirmed by a chest X-ray, or an AFB smear and a culture of sputum. A transverse ulcer with surrounding hypertrophic mucosa and multiple erosion was the usual colonoscopic findings. The granulomas were usually located in the just upper and lower portion of muscularis mucosa. The direct smear and culture of the fresh biopsy material showed AFB in 11 (32.4%) and 12 cases (36.4%) respectively. Ziehl-Neelsen staining in serially sectioned slides from formalin-fixed, paraffin- embedded tissue revealed AFB in 15 cases (35.7%). An immunohistochemical stain for Mycobacterium bovis was done in all cases and 13 cases were positive (31%). A polymerase chain reaction (PCR) was done and showed positivity in 4 out of 20 cases of fresh biospy material and 12 out of 40 cases in paraffin embedded tissue. For the conclusive diagnosis of intestinal tuberculosis, a Ziehl-Neelsen stain is the most sensitive, fast, and cost-effective method. The diagnostic accuracy will be increased when other diagnostic methods such as tissue culture and PCR are coupled with this simple staining method.
Abdominal Pain ; Biopsy ; Diagnosis* ; Granuloma ; Humans ; Intestines ; Mucous Membrane ; Mycobacterium bovis ; Paraffin ; Polymerase Chain Reaction ; Sputum ; Thorax ; Tuberculosis* ; Tuberculosis, Pulmonary ; Ulcer

Osteoporosis represents a reduced amount of bone tissue as compared with controls of same age and sex, and common feature of osteoporosis is a state of skeletal fragility leading to various fractures such as Colles' fracture, vertebral compression fracture, femur neck fracture, generally due to an inadequate amount of normally mineralized bone tissue, making the skeleton incapable of supporting normal mechanical demand. However it is difficult to quantify precisely its magnitude because of the variety of techniques used and the many bone sampling sites concerned. In 1970, Singh and associates(24.25) developed a method for grading the trabecular structure of the proximal end of the femur and reported that the femoral trabecular pattern index can clearly separate persons with osteoporosis from normal individuals. Cameron and its associstes developed an accurste method of determining bone mineral content by means of I-125 photon absorptiometry(5. 28). This method is consistently reproducible at the 98% level and has demonstrated agreement with ash measurement of cadaver bones at the 97% level. A comparative study of the usefulness of the femoral trabecular pattern index(Singh Index) and rsdial bone mineral content measurement by photon absorption was performed in 75 Kroean persons above forty years old. 25 of 75 persons were fracture patients due to osteoporosis. The results were as follows. 1. A significant difference in Singh index was noted between the fracture group snd control group. 2. A significant difference in bone mineral density was noted between the fracture group and control group. 3. A positive correlation was noted between the bone mineral denisty and Singh Index. 4. A significant difference in bone mineral density was noted between the fracture group and the control group which have same grade of Singh Index. So, we believe that bone mineral density is more objective and accurate than Singh Index. 5. We believe that both Singh Index and bone densitometer is useful in diagnosis and grading of osteoporosis.
Absorption ; Bone and Bones ; Bone Density ; Cadaver ; Colles' Fracture ; Diagnosis ; Femoral Neck Fractures ; Femur ; Fractures, Compression ; Humans ; Methods ; Miners ; Osteoporosis ; Skeleton

Isoniazid(Isonicotinic acid hydrazide) is an antimicrobial drug used since 1952 as a fast line agent for the prophylaxis and treatment of tuberculosis. Isoniazid is well known for problems in population having a high prevalence of isoniazid use for prophylaxis or treatment of tuberculosis. But intentional or accidental isoniazid overdose is uncommon. The ingestion of toxic amounts of isoniazid causes recurrent seizures, profound metabolic acidosis, coma and even death. In adults, toxicity can occur with the acute ingestion of as little as 1.5g of isoniazid. Doses larder than 30mg per kg often produce seizures. When ingested in amounts of 80-150mg per kg or more, isoniazid can be rapid fatal. 40-year-old woman having previous pulmonary tuberculosis ingested 7 gram of isoniazid(140mg/kg) to attempt suicide approximately 30 minutes prior to visit to our emergency medical center. She had recurrent generalized tonicclonic seizures and metabolic acidosis. We report one patient treated with pyridoxine, which was equivalent to the amount of isoniazid ingested and administered as a intravenous dose and oral dose.
Acidosis ; Adult ; Coma ; Eating ; Emergencies ; Female ; Humans ; Isoniazid* ; Prevalence ; Pyridoxine ; Seizures* ; Suicide ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: The association of Kaposi's sarcoma-associated human herpesvirus, or human herpesvirus 8 (HHV8) with various skin diseases has been described in many reports. However, only 3 human diseases: Kaposi's sarcoma, primary effusion lymphoma, and multicentric Castleman disease were proved to be associated with HHV8. In addition to Karposi's sarcoma, sarcoidosis and Kikuchi's disease were also described to be associated with HHV8. OBJECTIVE: The purpose of this study was aimed at the association of HHV8 with various skin diseases, such as Kaposi's sarcoma, sarcoidosis, and Kikuchi's disease. METHODS: We performed PCR to examine whether the 233-bp segment of the viral DNA of HHV8 was detected in Korean patients with Kaposi's sarcoma, sarcoidosis, Kikuchi's disease, angiosarcoma, and angiolymphoid hyperplasia with eosinophilia. The medical records and histopathological specimens of patients diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. RESULTS: HHV8 DNA sequences were identified in 9 (69%) of sarcoid tissues from 12 patients with sarcoidosis and in all (100%) of from 8 patients with Kaposi's sarcoma but not in 2 tissues from 2 patients with Kikuchi's disease, in 3 tissues from 2 patients with angiosarcoma and 2 tissues from 2 patients with angiolymphoid hyperplasia with eosinophilia. CONCLUSION: HHV8 may be strongly associated with the pathogenesis of Kaposi's sarcoma and sarcoidosis. However, the association with Kikuchi's disease, angiosarcoma, and angiolymphoid hyperplasia with eosinophilia was denied in this study. Further extensive study will be needed.
Angiolymphoid Hyperplasia with Eosinophilia ; Base Sequence ; Chungcheongnam-do ; DNA, Viral ; Giant Lymph Node Hyperplasia ; Hemangiosarcoma ; Herpesvirus 8, Human* ; Histiocytic Necrotizing Lymphadenitis ; Humans* ; Lymphoma, Primary Effusion ; Medical Records ; Polymerase Chain Reaction* ; Sarcoidosis ; Sarcoma ; Sarcoma, Kaposi ; Skin Diseases

Phenobarbital is a long-acting barbiturate causing generalized depression of neuronal activity in the brain. Its effect is primarily achieved through enhanced GABA-mediated synaptic inhibition. Its use as an antiepileptic agent was first described in 1912. Before the introduction of phenytoin, phenobarbital is used as sedative-hypnotics. It is used for the treatment of epilepsy and status epilepticus. All barbiturates, including phenobarbital, have a high potential far abuse. They were frequently used for suicide attempts in the past, but they have in large part been replaced by benzodiazepines. the onset of symptoms depends on the drug and the route of administration. Mild to moderate barbiturate intoxication resembles ethanol inebriation with slurred speech, ataxia, and lethargy. Severe acute barbiturate intoxication is life threatening. Early deaths are generally cardiovascular-related. Hypotension, shock, pulmonary edema, and cardiac arrest that occurs with large doses are caused by depression of central sympathetic tone and as well as by direct depression of cardiac contractility. The potentially fatal oral dose of phenobarbital is 6-l0g. We describe an 23-year-old woman with pulmonary edema and cardiac arrest after ingestion of 18 grams of phenobarbital. She was completely recovered by successful cardiopulmonary resuscitation and hemoperfusion. We report a case with literature review.
Ataxia ; Barbiturates ; Benzodiazepines ; Brain ; Cardiopulmonary Resuscitation ; Depression ; Eating ; Epilepsy ; Ethanol ; Female ; Heart Arrest* ; Hemoperfusion ; Humans ; Hypotension ; Lethargy ; Neurons ; Phenobarbital* ; Phenytoin ; Pulmonary Edema* ; Shock ; Status Epilepticus ; Suicide ; Young Adult

No abstract available.
Addison Disease*