No abstract available.
Addison Disease*

Myasthenia gravis(MG) is an autoimmune disorder characterized by the presence of anti-acetylcholine receptor antibody and weakness of voluntary muscles. The pathogenesis of MG is decreased numbers of acetylcholine receptors at postsynaptic membranes of neuromuscular junctions. It has been reported that MG often coexists with other autoimmune disorders. This is a case report of systemic lupus erythematosus coexisting with MG in a 23 year old female patient presenting with dysarthria, dysphagia, and limb weakness. We report the case with relevant literature review.
Deglutition Disorders ; Dysarthria ; Extremities ; Female ; Humans ; Lupus Erythematosus, Systemic* ; Membranes ; Muscle, Skeletal ; Myasthenia Gravis* ; Neuromuscular Junction ; Receptors, Cholinergic ; Young Adult

Surgical management of oral cancer results in compromised masticatory and swallowing function which affects patient in social and psychological aspects due to reduced phonetic ability and facial deformity, thus, it is imperative to provide applicable prosthetic treatment to overcome such complications. This clinical study describes rehabilitation of a patient with squamous cell carcinoma treated with marginal mandibulectomy and implantation on preserved posterior portion of mandible to provide stability and support for subsequent denture treatment. Kennedy class IV removable partial denture has provided satisfactory results in esthetics and function. Bone level stability around implants was reported to be maintained during eight months of clinical observation.
Carcinoma, Squamous Cell ; Congenital Abnormalities ; Deglutition ; Denture, Partial, Removable* ; Dentures ; Esthetics ; Humans ; Mandible ; Mouth Neoplasms ; Rehabilitation*

PURPOSE: Clostridium difficile (C. difficile)-associated colitis, a known complication of colon and rectal surgery, can increase perioperative morbidity and mortality, leading to increased hospital stay and costs. Several contributing factors, including advanced age, mechanical bowel preparation, and antibiotics, have been implicated in this condition. The purpose of this study was to determine the clinical features of and factors responsible for C. difficile-associated colitis after colorectal cancer surgery. METHODS: The medical records of patients who had undergone elective resection for colorectal cancer from January 2008 to April 2010 were reviewed. Cases that involved procedures such as transanal excision, stoma creation, or emergency operation were excluded from the analysis. RESULTS: Resection with primary anastomosis was performed in 219 patients with colorectal cancer. The rate of postoperative C. difficile-associated colitis was 6.8% in the entire study population. Preoperative metallic stent insertion (P = 0.017) and aged sixty and older (> or = 60, P = 0.025) were identified as risk factors for postoperative C. difficile-associated colitis. There were no significant differences in variables such as preoperative oral non-absorbable antibiotics, site of operation, operation procedure, and duration of prophylactic antibiotics. CONCLUSION: Among the potential causative factors of postoperative C. difficile-associated colitis, preoperative metallic stent insertion and aged sixty and older were identified as risk factors on the basis of our data. Strategies to prevent C. difficile infection should be carried out in patients who have undergone preoperative insertion of a metallic stent and are aged sixty and older years.
Aged ; Anti-Bacterial Agents ; Clostridium ; Clostridium difficile ; Colitis ; Colon ; Colorectal Neoplasms ; Emergencies ; Humans ; Length of Stay ; Medical Records ; Risk Factors ; Stents

Ehlers-Danlos syndrome type IV (EDS IV) is a hereditary disorder of the connective tissue, characterized by easy bruising, thin skin with visible veins, and spontaneous rupture of the large arteries, uterus, or bowel. EDS IV is caused by mutations of the gene for type III procollagen (COL3A1), resulting in insufficient collagen production or a defect in the structure of collagen. EDS IV can have fatal complications such as the rupture of great vessels or organs, which can cause hemorrhaging and sudden unexpected death. Here, we report a case of a 43-year-old female who collapsed after a struggle with a neighbor. In this patient, the bifurcation of the bilateral common iliac artery ruptured, with no evidence of trauma, inflammation, or atherosclerosis. Genetic analysis of COL3A1 showed the presence of a c.2771G>A (p.Gly924Arg) mutation, which may be associated with EDS IV. The forensic pathologist should consider the possibility that the spontaneous visceral or arterial rupture was caused by EDS IV. Genetic analysis is not currently a routine procedure during autopsy. However, in this case, we suggest that the patient possibly had an underlying EDS IV condition, and we recommended family members of the deceased to seek genetic analysis and counseling.
Adult ; Aortic Rupture* ; Arteries ; Atherosclerosis ; Autopsy ; Collagen ; Collagen Type III ; Connective Tissue ; Counseling ; Ehlers-Danlos Syndrome* ; Female ; Humans ; Iliac Artery ; Inflammation ; Rupture ; Rupture, Spontaneous ; Skin ; Uterus ; Veins

Rheumatic manifestations in non-Hodgkin's lymphoma (NHL) are common but actual arthritis as a presenting feature appears to be very rare. We experienced a case of NHL presenting as polyarthritis in a 24-year-old woman. Eight months ago she was admitted to the hospital due to polyarthritis and skin rash. She had pleural and pericardial effusion. Antinuclear antibody was positive and rheumatoid factor was negative. Joint X-ray showed periarticular osteopenia at both knees, wrists, hands and feet. Prednisolone, salsalate and anti-tuberculosis drugs were administered under the impression of either probable lupus or rheumatoid arthritis and pleural tuberculosis. After then pleuropericardial effusion and skin rash improved. But polyarthralgia persisted and she developed right cervical lymphadenopathy. On her second admission she was found to have a round mass in left lower lung field and multiple mediastinal lymph node enlargement. Cervical lymph node biopsy revealed non-Hodgkin's lymphoma. She received 8 cycles of systemic chemotherapy until 1996 July. NHL was remitted completely and polyarthralgia disappeared. We report a case of non-Hodgkin's lymphoma presenting as polyarthritis and literatures are reviewed.
Antibodies, Antinuclear ; Arthralgia ; Arthritis* ; Arthritis, Rheumatoid ; Biopsy ; Bone Diseases, Metabolic ; Drug Therapy ; Exanthema ; Female ; Foot ; Hand ; Humans ; Joints ; Knee ; Lung ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma, Non-Hodgkin* ; Pericardial Effusion ; Prednisolone ; Rheumatoid Factor ; Tuberculosis, Pleural ; Wrist ; Young Adult

Nocturnal enuresis is a heterogeneous disorder with various underlying pathophysiological mechanisms and causes a mismatch between the nocturnal bladder capacity and the amount of urine produced during sleep at night. It is associated with a simultaneous failure of conscious arousal in response to the sensation of bladder fullness. Generally, a complete history and physical examination, with a specific focus on the genitourinary, gastrointestinal, and neurologic systems, is sufficient to evaluate a patient with enuresis. The therapeutic focus is directed toward a differential approach based on the underlying mechanism and toward combination therapies such as alarm devices and desmopressin as well as anticholinergic agents and desmopressin. Children with increased nocturnal urine production usually have a good response to desmopressin therapy. Patients with a small bladder generally show a poor response to desmopressin treatment, but they would benefit more from combination therapy with enuretic alarm, urotherapy, and antimuscarinic agents in addition to desmopressin. Different types of bladder dysfunction, which result in a small nocturnal bladder capacity, probably contribute significantly to the pathogenesis of nocturnal enuresis, particularly in those with treatment failure and refractory symptoms. Because different clinical subgroups may show different responses to treatment, it is necessary to distinguish these subgroups before a decision on the specific treatment protocol can be made.
Arousal ; Child ; Cholinergic Antagonists ; Clinical Protocols ; Deamino Arginine Vasopressin ; Enuresis ; Humans ; Muscarinic Antagonists ; Nocturnal Enuresis ; Physical Examination ; Sensation ; Treatment Failure ; Urinary Bladder

No abstract available.
Hemangioma, Cavernous* ; Occipital Lobe* ; Status Epilepticus*

The clinical manifestations, radiological and endoscopic findings of colonic tuberculosis are non-specific. A diagnosis of colonic tuberculosis is usually difficult because the condition can mimic tumors. Fever occurs in 60~85% of patients with tuberculosis, which is one of the important signs of disease activity, and usually resolves by the second week after beginning treatment. However, there are some patients who remain febrile beyond a reasonable treatment period or develop fever during treatment. Such cases raise issues, such as cytokine release from tuberculous granuloma, drug induced fever, drug resistance, and drug malabsorption. We encountered a patient with polypoid colonic tuberculosis who presented with prolonged fever after commencing treatment and became defervescence after a colonoscopic polypectomy. We report this case with a review of the relevant literature.
Colon ; Drug Resistance ; Fever ; Granuloma ; Humans ; Hydrazines ; Tuberculosis

OBJECTIVES: The aim of this study is to enhance understanding the clinical features, pathogenesis, diagnosis and treatment of gouty arthritis in Korea by analyzing the clinical manifestations of the patients with urate crystal-proven gouty arthritis. METHODS: 78 cases who had been diagnosed as gouty arthritis by confirming the urate crystals in synovial fluids or tophi in Seoul National University Hospital between January 1, 1989 and July 31, 1995 were analysed for their histories, symptoms, signs, laboratory data, and X-ray findings. RESULTS: 1) Male to female ratio was 18.5:1. The mean age of onset is 49.3 +/- 14.5 years(range 11-83 years); the mean duration of disease 6.5 +/- 7.0 years(range 0-30 years); the mean duration of gouty attack 7.2 +/- 5.5 days(range 1-30 days). 2) The frequent precipitating factors of gouty arthritis were hospitalization(37%) and alcohol drinking(15%). The most frequent accompanying disease was hypertension(24%). Obesity, diabetes, chronic renal failure, hyperlipidemia, ischemic heart diseases, or cerebrovascular diseases were also accompanied by gouty arthritis. 3) The patterns of joint involvement were devided into 3 groups: monoarthritis; 42%, oligoarthritis; 35%, polyarthritis; 23%, The most frequent site of the first gouty attack was the 1st toe(65%). The most frequently involved joint at gouty attack was also the 1st toe(68%). While only lower extremities were involved in most cases with monoarthritis and oligoarthritis(91% and 78%, respectively), both lower and upper extremities were involved in most cases with polyarthritis(78%). 4) Hyperuricemia was found in 74% of the cases at gouty attack. But serum uric acid level was normal in 26%. With respect to pathogenesis of hyperuricemia, 14% of the cases had uric acid overproduction and 86% had uric acid underexcretion. 5) Bony changes in radiologic findings were found in 47% of the cases and tophi in 33%. Bony changes and tophi was significantly related to the younger age of gouty onset and higher serum uric acid level at gouty attack. 6) Acute gouty arthritis responded well to colchicine and NSAIDs. There was no difference in efficacy and the frequency of side effects between them. CONCLUSION: The clinical features of the gouty arthritis in Korea showed no difference from those in foreign studies except higher prevalence of oligo-/polyarthritis and tophi. To be remarkable, 26% of the patients with gouty arthritis did not have hyperuricemia at gouty attack. This finding indicates that urate crystals should be confirmed by synovial fluid examination for diagnosis of gouty arthritis.
Age of Onset ; Anti-Inflammatory Agents, Non-Steroidal ; Arthritis ; Arthritis, Gouty* ; Colchicine ; Diagnosis ; Female ; Gout ; Humans ; Hyperlipidemias ; Hyperuricemia ; Joints ; Kidney Failure, Chronic ; Korea ; Lower Extremity ; Male ; Myocardial Ischemia ; Obesity ; Precipitating Factors ; Prevalence ; Seoul ; Synovial Fluid ; Upper Extremity ; Uric Acid