Rheumatoid arthritis is considered to be a collagen disease which mainly involves articular structures, sometimes has extraarticular manifestations. It is generally accepted now that periarticular osteoporosis develops in early phase of rheumatoid arthritis and generalized osteoporosis in late period. Of several methods of non-invasive measurement of bone mass, single photon absorptiometry was introduced by Cameron and Sorenson(1963) and it has been used for measuring bone mass by many authors with its precision, reproducibility and objective quantification. We tried to observe the quantitative changes of bone mass in rheumatoid arthritis patients with single photon absorptiometry technique. Through the study of bone densitometry in 30 rheumatoid arthritic women compared with age-matched 60 healthy controls, we obtained follow results. 1. Bone mineral density of the rheumatoid arthritis group was lower than that of the control group, but had no significant statistical difference. 2. Bone mineral density of the 40–49-year-old group and 50–59-year-old group was considerablely different in the rheumatoid arthritis group and control group. 3. Bone mineral density of the group whose rheumatoid arthritis history was over 2 year was lower than that of the group below 2 year.
Absorptiometry, Photon ; Arthritis, Rheumatoid ; Bone Density ; Collagen Diseases ; Densitometry ; Female ; Humans ; Osteoporosis

The authors studied the effect of insufflation of oxygen at 5 cmH2O into the nonventilated lung on the arterial oxygenation in the thoracotomy patients(n=14) who showed PaO2 below 100 mmHg or oxygen saturation below 95% during one-lung ventilation. When applying CPAP 5 cmH2O to the collapsed lung, we inflated the collapsed lung with reservoir bag that is one of the equipment of self made CPAP device. Hemodynamic parameter(mean arterial pressure and heart rate), arterial blood gas analysis and calculated shunt fraction was collected 10, 20, 30min after applying CPAP. PaO2 was significantly increased from 76+/-20mmHg to 180+/-66 (mean+/-SD) and shunt fraction was significantly decreased from 43.5+/-5.6% to 31.5+/-4.9% at CPAP 10 min. There was no significant difference in the PaO2 and shunt fraction between CPAP 10, 20 and 30 min. Heart rate was also significantly decreased with CPAP compared to pre-CPAP value. Other parameter(mean arterial pressure, PaCO2) was not changed with CPAP. The authors conclude that CPAP 5 cmH2O to the nonventilated lung is effective to improve oxygenation when hypoxemia occurs during one-lung ventilation.
Anoxia ; Arterial Pressure ; Blood Gas Analysis ; Continuous Positive Airway Pressure* ; Heart ; Heart Rate ; Hemodynamics ; Insufflation ; Lung* ; One-Lung Ventilation* ; Oxygen* ; Thoracotomy

OBJECTIVE: To compare the clinical outcomes of intrauterine insemination (IUI) according to the catheter used. MATERIALS AND METHOD: From March 1998 to September 1998, total 95 infertile patients were included in this study. Patients were randomly allocated to TomCat group (n = 39) and Mackler group (n = 56) according to the catheter for insemination. The controlled ovarian hyperstimulation (COH) using luteal long protocol of gonadotropin releasing hormone agonist (GnRH-a) was used in all patients. Statistical analysis was performed using Student's t-test, Fisher's exact test, and x2 test as appropriate. Statistical significance was defined as p < 0.05. RESULTS: The total dose and duration of exogeneous gonadotropin required were similar between the two groups. There were also no significant differences in serum estradiol (E2) level, endometrial thickness and texture on the day of hCG administration between the two groups. However, the percentage of uterine souding due to failure of initial approach was significantly higher in TomCat group compared to Mackler group (23.1% vs. 0%, p < 0.01). The percentage of bleeding after IUI in TomCat group seemed to be higher than that in Mackler group (15.4% vs. 3.6%, p = 0.06), although there was no statistically significant difference between the two groups. There was also no significant difference in the clinical pregnancy rate per patient between the two groups. CONCLUSION: These results suggested that using Mackler catheter might be effective for IUI, especially for the patients with cervical factor infertility.
Catheters* ; Estradiol ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Hemorrhage ; Humans ; Infertility ; Insemination* ; Pregnancy Rate

Candida vertebral osteomyelitis (CVO) is a rare disease that is a complication of intravenous drug use, but recently it has been recognized as mostly an opportunistic infection. Because CVO appears to mimic pyogenic spondylodiscitis in terms of the clinical and radiologic presentations, it is often neglected in a usual clinical setting. The clinical, radiological, and biological characteristics of CVO are often used to make a differential diagnosis with vertebral osteomyelitis from other etiologies. Once an initial proper diagnosis was performed, the treatment relies on the prompt initiation of appropriate pharmacotherapy and serial monitoring of the clinical progress. This paper report late-onset CVO in two young patients who underwent a heart transplant surgery and had postoperative systemic candidiasis. These two cases are a good reminder of the potential of CVO in immunosuppressive patients treated with anti-fungal agents. This paper presents these two cases with a review of the relevant literature.
Candida ; Candidiasis ; Diagnosis ; Diagnosis, Differential ; Discitis ; Drug Therapy ; Heart Transplantation ; Heart ; Humans ; Opportunistic Infections ; Osteomyelitis ; Population Characteristics ; Rare Diseases

Voice changes developing after endotracheal intubation during right hemicolectomy with endotracheal intubation have been found to be due to a right recurrent laryngeal nerve palsy in 43-years-old male patient. It was likely that the inflated cuffed tube rode up to the level of the cricoid cartilage during the course of surgery as traction was placed on the endotracheal tube because the condenser humidifier and breathing circuit weighed heavy. Cuff overexpansion, in addition to muscle relaxation and decreased tracheal elasticity were considered as contributing factors of vocal cord palsy. We believe that tube traction and cuff overexpansion were the mechanism of vocal cord palsy in our patient. So we recommend the routine use of tube stand so that weigh of the breathing circuit does not transmit traction to the endotracheal tube. Concurrently, filling the cuff with a sample of the inspired mixture of gases, saline and 4% lidocaine in special cases or regular deflation of the cuff must be considered.
Cricoid Cartilage ; Elasticity ; Gases ; Humans ; Intubation, Intratracheal* ; Lidocaine ; Male ; Muscle Relaxation ; Respiration ; Traction ; Vocal Cord Paralysis* ; Vocal Cords* ; Voice

We report a cace of 69-year-old man who developed massive pulmonary hemorrhage and subsuquent adult respiratory distress syndrome following intravenous urokinase for acute myocardial infarction. Pulmonary hemorrhage is a rare but a potentially life-threatening complication after thrombolytic therapy and should be considered in the differential diagnosis of pulmonary infiltrates of falling hemoglobin after thrombolytic therapy for acute myocardial infarction with no obvious site of bleeding.
Adult* ; Aged ; Diagnosis, Differential ; Hemorrhage* ; Humans ; Myocardial Infarction* ; Respiratory Distress Syndrome, Adult* ; Thrombolytic Therapy* ; Urokinase-Type Plasminogen Activator

We report a case of nevus sebaceus of Jadassohn in a 31-year-old female associated with various epidermal appendage tumors, such as syringocystadenoma papilliferum, sebaceus adenoma and eccrine hidrocystoma. We supposed that the multiple lesions seem to support the concept of nevus sebaceus arising from the pluripotential primary epithelial germ.
Adenoma ; Adult ; Female ; Hidrocystoma ; Humans ; Nevus* ; Nevus, Sebaceous of Jadassohn

BACKGROUND: Granuloma annulare is a chronic skin disease of unknown origin, that can present itself with diverse clinical and histopathologic findings. But no clinicopathological studies has been reported yet in Korea. OBJECTIVE: Our purpose was to investigate the clinicopathological findings of each type of granuloma annulare. METHODS: We observed twenty two cases of granuloma annulare and examined their clinical manifestations and histopathological findings. RESULTS: The incidence showed a bimodal peak between 3 to 4 years and 49 to 51 years in age and females were affected twice as much as males. The lesions are commonly located on the distal portion of the extremities. In histopathologic findings, perforating type was observed in 13.6% and subcutaneous type in 18.2%. In collagen alteration, fragmentation and hyalinization were observed in 72.7% and 81.8% respectively. Most infiltrated cells were epithelioid cells. In vascular changes, endothelial swelling and occlusion of vessels were common findings and vasculitis was shown in 36.4%. CONCLUSION: There were not epidemiologic differences from the reported studies in western patients. But the clinical manifestation and the histopathologic findings were so varied that differential diagnosis is important in diagnosis of granuloma annulare. Immunological and immunohistochemical studies may be necessary for differential diagnosis and elucidating pathogenesis of granuloma annulare.
Collagen ; Diagnosis ; Diagnosis, Differential ; Epithelioid Cells ; Extremities ; Female ; Granuloma Annulare* ; Granuloma* ; Humans ; Hyalin ; Incidence ; Korea ; Male ; Skin Diseases ; Vasculitis

BACKGROUND: There are several ways to treat for recurrent pericardial effussion and cardiac tamponade due to malignancy. They are repeated pericardiocentesis, pericardial instillation of sclerosing and chemotherapeutic agents, surgical creation of a pericardial window and transthoracic pericardiectomy. Surgical techniques are usually effective but bear a significant morbidity and mortality especially in chronic debilitating cancer patients. So percutaneous balloon pericardial window as an alternative to surgery in these patients. METHODS: After pericardiocentesis was performed, a 0.035 inch J-tip guidewire was advanced into the pericardial space. And a pigtail catheter was advanced over the wire. A moderate amount of pericardial fluid were removed. A nd then the pigtail catheter was withdrawn and 8F sheath was inserted. A20mm diameter, 4cm long(Single balloon method) or two 10mm diameter, 4cm long balloon dilating catheter(Double balloon medium) was advanced over the wire to straddle the parietal pericardial border though the sheath. Several inflations of the balloon with a solution containing 50% radiographic contrast medium were performed until disappearance of the balloon waist. After balloon dilation, contrast medium from the pericardial space to subcutaneous tisse suggesting successful PBPWF. Single ballon method was employed in 4 patients and Dould balloon method in 2 patients. RESULT: We performed percutaneous balloon pericardial window formation in 6 patiemts with malignant pericardial effusion. We did percutaneous balloon pericardial window formation successfully in 5 patients and failed due to adhesion of parietal pericardium in 1 patient. One patient developed recurrent pericardial effusion with tamponade at a mean follow-up of 11.49.6 months(1.5-26 months). Conclusion: These results suggest that PBPWF is an alternative method less invasive than subxiphoid surgical windowing, espesially in critically ill patients with recurrent malignant pericardial effussion. It carries less risks and has more constant effect than repeated pericardiocentesis.
Cardiac Tamponade ; Catheters ; Critical Illness ; Follow-Up Studies ; Humans ; Mortality ; Pericardial Effusion* ; Pericardiectomy ; Pericardiocentesis ; Pericardium ; Rabeprazole

Descending necrotizing mediastinitis (DNM) is one of the most lethal form of mediastinitis originating from an oropharyngeal infection. It requires an early and aggressive sugical treatment, but the operative approach and optimal form of mediastinal drainage remains controversial. We report a case of DNM in a 45-year-old male who underwent right cervicomediastinotomy to drain the deep neck space, upper mediastinum and anterior mediastinal drainage was accomplished through a subxiphoid approach. After this procedure, he steadily improved and was dischrged on hospital day 36. We report this case with a brief review of the literature.
Drainage ; Humans ; Male ; Mediastinitis* ; Mediastinum ; Middle Aged ; Neck