This treatise summarizes the medical facts about the persistent vegetative state(PVS) and the associated issues. In August 1998, the opinions of the 380 neurologists and the 1007 neurosurgeons are inquired about the diagnostic criteria of PVS, the degree and the withdrawal of treatment on PVS patients. The response rate is 18.8%. The diagnostic criteria of PVS is determined by the items approved above 5007o of responses. (1) no evidence of cerebral function and an inability to interact with visual, auditory stimuli and follow commands. (2) maintaining the respiratory function with spontaneous respiration and normal respiratory pattern. (3) spontaneous eye opening and eye ball movements without sustained tracking. (4) variably preserved brain stem reflexes. (5) presence of sleep-wake cycles. (6) (1)-(5) symptoms should be persist for 6 months after the development of vegetative state. (7) the diagnostic criteria of PVS should be applied more than 3 times during the minimum observation period. (8) this diagnostic criteria of PVS could be applied to adults over 7 ages. As to the degree of treatment, nasogastric tube feeding and air-way keeping through the tracheostomy are approved over 9007b. Also antibiotics can be used in infection. As to the withdrawal of treatment, do not resuscitate order of patient s family is accepted by 46.1% in an emergency condition like cardiac arrest. But discharge against medical advice by the patient s family is accepted by 73.107o in non-emergency condition. In the case of neonates, parents decision is more determinative than any other thing.
Adult ; Anti-Bacterial Agents ; Brain Stem ; Emergencies ; Enteral Nutrition ; Heart Arrest ; Humans ; Infant, Newborn ; Korea* ; Parents ; Persistent Vegetative State* ; Reflex ; Respiration ; Tracheostomy

A lg year-old female patient with pityriasis lichenoides et varioliforrnis acuta (PLEVA) was been treated with PUVA, At first, she was treated with tetracycline for 8 weeks with improvement somewhat. But 2 months later, her skin lesions aggravated slowly. So, we tried to treated her with PUVA and then she was cleared completely. The initial dose of UVA was 5 J/cm The UVA dosage increased by 10g of the previous exposure and increased to the maximum dose, 15 J/cm The patient exposed to UVA R times per week. 12 times after the PUVA therapy, the skin lesions begin to improve and completely improved at 21 times of Pl.JVA therapy. She was followed up every week and there was no side effect except hyperpigrnentation till 24 months. The total dose during treatment is 210 J/cm.
Female ; Humans ; Photochemotherapy* ; Pityriasis Lichenoides* ; Pityriasis* ; PUVA Therapy ; Skin ; Tetracycline

No Abstract Available.
Electrophysiology* ; Neuroendocrine Cells*

Systemic lupus erythematosus is a connective tissue disease which can affect every organ system. Neurologic abnormalities are common, occuring in approximately half of all patients at some time during the course of their illness. But symptoms of nervous system as the sole presenting symptoms occur in less than 1% of lupus patients. In patients initially presenting with neurologic symptoms and signs, differential diagnosis is difficult and sometimes it may be misdiagnosed. Therefore extensive laboratory investigations should be carried out in all patients with unusual neurological symptoms, since early diagnosis of lupus can help in providing effective treatment. We report a patient with systemic lupus erythematosus who presented with dysarthria and dysphagia resembling multiple sclerosis.
Connective Tissue Diseases ; Deglutition Disorders ; Diagnosis, Differential ; Dysarthria ; Early Diagnosis ; Humans ; Lupus Erythematosus, Systemic* ; Multiple Sclerosis* ; Nervous System ; Neurologic Manifestations

The cases of ectopic kidney have been occasionally reported and the most common type is pelvic kidney. Considering that vertebral anomalies frequently complicated anomalies, it is highly recommended to scrutinize thoses by intravenous urography and other methods. We experienced one case of pelvic kidney coexisting a vertebral anomaly, right atrophic remnant testis and ipsilateral ureteropelic junction stricture.
Constriction, Pathologic ; Kidney ; Testis ; Urography

In order to evaluate antitumor rnechanisms of interleukin (IL)-12/IL-2 that has been shown significant tumor suppressive activity on established primary and metastatic Renca tumor, we studied chemokine gene expression induced by direct action of IL- 12/IL-2 or cytokine cascade. IL-12/IL-2 induced gene expression of interferon gamma (IFN-r) and granulocyte monocyte-colony stimulating factor (GM-CSF) in splenocytes, and it induced gene expression of monokine induced by IFN-r (Mig), interferon inducible protein 10 (IP- 10), SDF-1, macrophage inflammatory protein (MIP)-1a, MIP-1B, MIP-2, monocyte chemotactic protein (MCP)-1, and Rantes in tumor mass. However IL-12/IL-2 could not induce these chemokines in tumor mass of GKO mice and Renca cell in vitro. IL- 12 also did not increased chemokine gene expression in Renca cell in vitro, but IFN-r induced gene expression of Mig, IP-10, MCP-1 in Renca cell in vitro. In the chemotaxis assay, culture supernatant of Renca cell stimulated with IFN-r increased splenocyte migration in vitro. All these data suggest IL-12/IL-2 can induce IFN-r-chemokine cascade in tumor mass, and Mig, IP-10, MCP-1 produced from tumor cell may play an important role for initial immune cell migration into tumor mass.
Animals ; Cell Movement ; Chemokine CCL5 ; Chemokine CXCL10 ; Chemokines ; Chemotaxis ; Gene Expression* ; Granulocytes ; Interferons ; Interleukins ; Macrophages ; Mice ; Monocytes

This review-article is aimed at shedding a light upon the nature of age-associated changes in the human skeletal system. When the anatomical, physiological and biochemical consequences of bone aging are considered together with the hardening, drying and the diminished repair capabilities of the elderly, it can be seen that fractures assume greater importance as a clinical problem in the geriatric population. Older people start out with a deficit of cortical bone, making them more fracture prone and once fractures occur, the necessary treatments (immobilization, use of casts, etc.) accelerate the rate of bone loss. In addition, aged individuals stand a higher risk for complications of the hospital and enforced bed rest that may ensue. The problems resulting from bone loss in the elderly may be partially alleviated by providing adequate health service support which should include consideration of the following points : 1. Age, sex and general health status ; 2. Habits and inclinations towards physical activities ; 3. Nutritional and endocrine background ; 4. Presence of any specific bone diseases, including osteoporosis, osteoarthritis, osteomalacia and ankylosis ; 5. Psychosocial adaptability and other behavioral elements.
Aged ; Aging ; Ankylosis ; Bed Rest ; Biology* ; Bone Diseases ; Health Services ; Humans* ; Motor Activity ; Osteoarthritis ; Osteomalacia ; Osteoporosis

Accelerated acute rejection(AAR) is a rare condition and has a poor prognosis in graft survival following renal transplantation. To elucidate its characteristics, we analysed 14 cases(5.0%) of AAR among 279 renal transplantation. AAR is defined as a condition in which immediate postoperative urine output is good followed by decreased urine output and increase of serum creatinine level within 7 days after transplantation. The incidence of AAR was more prevalent in cadaveric donors than living donors. One year graft survival was inferior in AAR, namely 8 out 14 cases(57%), than that of the patients without AAR(95.1%). Among the factors affecting graft survival in AAR, age and sex of both donor and recipient, donor condition such as living or cadaveric donor, and preoperative HLA matching had no relevance to a graft survival. Time of onset of AAR has no effect on graft survival either. Postoperative donor lymphocytotoxic test showed positive result in one out of 3 patient despite of all negative findings in the preoperative crossmatching test. Histologic finding such as vasculitis on renal biopsy was related to graft survival. Response of treatment was 55% in initial solumedrol pulse therapy and 20% in secondary OKT3 treatment, with an overall effect of 57%. Rerejection developed in 4 out of 8 cases of graft survival group while all cases showed a good function at post operative two years. Graft survival following AAR remains low and AAR is one of the main cause of graft loss following renal transplantation. To illustrate its characteristics, more clinical analysis are required.
Allografts* ; Biopsy ; Cadaver ; Creatinine ; Graft Survival ; Humans ; Incidence ; Kidney Transplantation ; Living Donors ; Methylprednisolone Hemisuccinate ; Muromonab-CD3 ; Prognosis ; Tissue Donors ; Transplants ; Vasculitis

No abstract available.
Lupus Erythematosus, Systemic* ; Polyarteritis Nodosa*

OBJECTIVES: Radiofrequency(RF) ablation is an effective and low risk curative treatment for supraventricular arrhythmias. Catheter ablation produced cardiac lesions primarily through formation of coagulation necrosis. We evaluated the degree of myocardial injury after RF catheter ablation by means of serial measurement of myocardial enzyme. METHODS: Fifty-one patients with symptomatic supraventricular tachycardia were included. There were 32 men and 19 women(mean age. 39.5+/-15.4 years)All patients underwent electrophysiologic study to detect accessary pathway and ablation with radiofreguency current. A mean of 18.3+/-14.2 radiofrequency pulses were delivered. The pulses were at a power of 50 to 60 Volts for a duration of 20 to 30 seconds. Unipolar method and a 6F or 7F catheter with a 4 mm tip electrode was used. LDH, CPK and Ck-MB as a kind of cardiac enzyme were measured before and after ablation. RESULTS: 1) The concentration of LDH and CPK were elecated at 8 hours and 16 hours after ablation (p<0.05). 2) The concentration of CK-MB was elevated at 8 hours, 16 hours, 24 hours and 72 hours after ablation(p<0.05). 3) There was no correlation between the number of applications and amounts of radiofrequency current and rise in LDH, CPK, CK-MB concentration. CONCLUSION: The concentration of LDH, CPK and CK-MB were elevated after ablation but they were within normal limits. RF catheter ablation produced myocardial damage inevitably but were within normal limits. RF catheter ablation produced myocardial damage inevitably but minimally, then RF ablation is an effective and safe therapeutic modality for patients with symptomatic tachyarrhythmias.
Arrhythmias, Cardiac ; Catheter Ablation* ; Catheters ; Electrodes ; Humans ; Male ; Necrosis ; Tachycardia ; Tachycardia, Supraventricular*