Bone marrow transplantation has become an accepted treatment for malignancy(particulary leukemia and lymphoma), aplastic anemia, and certain inborn errors of metabolism. In addition to the problem of severe, prolonged myelosuppression, bone marrow transplantation is associated with several unusual complications. Among the complications such as GVHD, graft rejection, interstitial pneumonia and veno-occlusive disease, involvement of the gastrointestinal tract by GVHD is associated with high graft failure and mortality. Intestinal GVHD is usually manifest clinically as voluminous secretory diarrhea accompanied by abdominal cramping, ileus, nutritional depletion, and, at times, hemorrhage. We experienced a case of severe intestinal GVHD after allogeneic marrow transplantation for treatment of severe aplastic anemia. He received bone marrow from his elder sister, HLA-matched multiparous woman and suffered from large amount of watery diarrhea with skin rash 34 days after transplantation. 1n spite of prednisolone therapy the symptom was progressed. After sigmoidoscopic mucosal biopsy, intestinal GVHD was confirmed and we tried methylprednisolone pulse therapy. Skin lesion was improved but the amount of diarrhea was increased with intermittent abdominal cramping. We tried ALG(anti-lymphocyte globulin) and conservative management but the patient did not respond the therapy. He succumbed to pneumonia and acute respiratory insufficiency complicated with GVHD, 70days after transplantation.
Anemia, Aplastic* ; Biopsy ; Bone Marrow Transplantation* ; Bone Marrow* ; Colic ; Diarrhea ; Exanthema ; Female ; Gastrointestinal Tract ; Graft Rejection ; Hemorrhage ; Humans ; Ileus ; Leukemia ; Lung Diseases, Interstitial ; Metabolism, Inborn Errors ; Methylprednisolone ; Mortality ; Pneumonia ; Prednisolone ; Respiratory Insufficiency ; Siblings ; Skin ; Transplants

We presented a case of Ehlers-Danlos syndrome(ED syndrome) in s 21-year- old male, who had hyperextensibility of skin, skin fragility, and cigarette paperlike atrophic scars with no joint problems since infancy. There was a family history which was suggestive of autosomal dominant trait. Microscopic examination of the skin biopsy specimen from the normal appearing skin on the right forearm showed no abnormal appearance. In this case the manifestations of skin including marked hyperextensibility might be in accord with type I (gravis) ED syndrome, but the joint manifestation did not correspond to this type. It might be hard to classify this case according to the eleven types of ED syndrome. Wed rather consider this case as a. mixed form of type I and type Il ED syndrome.
Biopsy ; Cicatrix ; Ehlers-Danlos Syndrome ; Forearm ; Humans ; Joints ; Male ; Skin ; Tobacco Products

Clinical studies were performed that the patient with angina pectoris having no responses to Ca++ antagonist and beta-blocker had been taken nicorandil 5mg bid daily with, beta-blokade and Ca++ antagonists for 3 weeks. The results after the use of nicorandil were as follows; 1) The clinical symptoms after the use of nicorandil were improved in 20(80%) of 25 patients, specially marked improved in 16 of 25 patients. There was no significant changes of BP and heart rate after the use of nicorandil. 2) The results of CBC, urinalysis, serum chemistry exa. and chest P-A were within normal range before and after the use of nicorandil. 3) After the use of nicorandil, ST segments depressed in 13 of 25 patients before use of nicorandil was elevated in 8(61.6%) of 13 cases after the use of that. QT interval, P-R interval and T wave in 25 cases were within normal range before and after the use of that. The M mode echocardiography showed the decreased movement of ventricular septum in 19 of 25 patients before the use of Nicorandil, and there was no changes after the use of that. 4) The adverse effects after the use of nicorandil to 25 patients were as follows: headache in 3(12%), nausea and vomiting 2(8%), palpitation 1(4%), upper abdominal discomfort 1(4%), and facial flushing 1(4%).
Angina Pectoris* ; Chemistry ; Echocardiography ; Flushing ; Headache ; Heart Rate ; Humans ; Nausea ; Nicorandil* ; Reference Values ; Thorax ; Urinalysis ; Ventricular Septum ; Vomiting

A 51-year-old female had disseminated, symmetrically distributed, brownish black pigmentation and papillary hypertrophy on the intertriginous and flexural areas for 6 months, and gastric adenocarcinoma was confirmed during the evaluation of internal malignancy, The cutaneous finding of acanthosis nigricans was a significant cutaneous marker of internal malignancy in this case.
Acanthosis Nigricans* ; Adenocarcinoma* ; Female ; Humans ; Hypertrophy ; Middle Aged ; Pigmentation

One patient is a 6-year old female, who has had intensely pruritic linear papuloplaque.", on the left side of the perineal and perianal areas for three years. The other patient, is a. 23-year old male, who has had iritensely pruritic linear papuloplagues on the left upper extremity. This condition started at 1 month of life. In both cases, microscopie examination of the lesions showed psoriasiform and eczematoid appearance. In the latter case, spongioform pustule and Munro's microabscess were also found. We believe that these cases probably represent instances of the entity that. Altman and Mehregan have called inflammatory linear verrueous epidermal nevus, and unusual clinical feature in our patients was the involvement of the left groin in case 1 and of the left upper extremity in case II, which are somewhat rare sites of involvement.
Child ; Female ; Groin ; Humans ; Male ; Nevus ; Nevus, Sebaceous of Jadassohn* ; Upper Extremity ; Young Adult

Zinc sulfate, which was used as zinc sulfate ophthalmic solution in herpetic keratitis, has been found to have the therapeutic effects in cutaneous and mucosal herpes simplex. We studied ta evaluate the therapeutic effect of zinc sulfate in patients with herpes simplex. Nine patients with primary herpes simplex and twenty five patient with recurrent herpes simplex were included in this study. Twenty five patients(six with primary type and nineteen with recurrent type were treated with topical applicatiion of 0.3% zinc sulfate solutiion seven to eight times a day and nine patients(three with primary type and six with recurrent type)were applied with placebo vehicle in the same way. Maintenance treatment was then given tc all these patients, first once a week for one month, and then twice a month indefinitely. The effect was assessed by the comparison of the duration of disappearance of symptoms, drying of vesicles and crust formation, and desiccation and sloughing-off of cursts, and recurrence rate between zine sulfat,e group and placebo group. The resuilts were summarized as follows : 1. In the average time of the disappearance of symptoms, drying of vesicles and crust formation, a,nd desiccation and sloughing-off of crusts, the resu1t observecl in zinc, sulfate group was shorter than that of placebo group, respectively ( p < 0.01). 2. In recurrence rate, 11.1% observed in zinc sulfate group was much lower than 80.0%i in placebo group(p . 0.01). These findings suggest that topical zinc sulfate is an effective agent for treatment and prevention of recurrence af herpes simplex infection.
Desiccation ; Herpes Simplex* ; Humans ; Keratitis, Herpetic ; Recurrence ; Zinc Sulfate* ; Zinc*

No abstract available.
Knee*

Since the first report by Berberich and Hirsch in 1923, conventional angiography had been playing essential roles in diagnosis and treatment in the field of Orthopedic Surgery. Angiography is still the most definitive method for evaluating arterial disease, and is also an invaluable aid in the diagnosis of certain abnormalities which characteristically alter the normal vascular pattern. But the clinical use of conventional angiography as a routine diagnostic study has been limited by the risk associated with arterial catheterization cost, and poor patient acceptance. With improvement of radionuclide angiography and development of the methods for the identification and amplification of signals from small quantities of intravascular administered iodinated contrast agent and their combination with image subtraction (so called digital subtraction angiography, DSA), we have partially substituted the DSA and Radionuclide angiography for conventional angiography in diagnosis and post-operative evaluation of orthopedic patients. We have analyzed and compared the 197 cases who had taken conventional angiography from August, 1981 to July, 1985, and 16 cases who had taken radionuclide angiography from January, 1983 to July, 1985, and 21 cases who had taken DSA from October, 1983 to July, 1985 in Department of Orthopedic Surgery, Seoul National University Hospital. The results were as follow: 1. Conventional angiography is the most reliable and most widely used method in diagnosis of peri pheral arterial disease and evaluating the distribution of peripheral circulation of patient who need arterial reconstruction. But the clinical use of the angiography has been limited by the risk of complications. 2. DSA is simple, relatively non-invasive and can be done in out-patient basis. DSA is particulary useful and can replace the conventional angiography in post-operative assessment of peripheral vascular reconstruction, in the assessment of blunt and penetrating peripheral arterial trauma, and in the evaluation of peripheral aneurysm and vascular malformation. 3. Radionuclide angiography is also simple, and has no morbidity and useful in the patients who may be allergic to the contrast medium. Radionuclide angiography is useful in the evaluation of obstruction of major artery, deep vein thrombosis, and in repeated post-operative evaluation of arterial reconstruction.
Aneurysm ; Angiography ; Angiography, Digital Subtraction ; Arteries ; Catheterization ; Catheters ; Diagnosis ; Extremities ; Humans ; Methods ; Orthopedics ; Outpatients ; Radionuclide Angiography ; Seoul ; Vascular Malformations ; Venous Thrombosis

PURPOSE: Although radionuclide cisternography (RNC) is an useful study to detect cerebrospinal fluid (CSF) leakage in the patient with spontaneous intracranial hypotension (SIH), it sometimes fails to demonstrate the site of CSF leakage. The aim of the study is to improve the detection of leakage site of CSF and to reduce time for the study in RNC using modified protocol (m-RNC). MATERIALS AND METHODS: The study consists of 8 studies of 7 patients (38+/-8 years, M:F=2:5) with SIH, who underwent m-RNC following administration of 185-222 MBq of 99mTc-DTPA into the lumbar subarachnoid space. Sequential images were obtained the whole spine with the head including urinary bladder at 10 minute, 30 minute, 1 hour, 2 hour, 4 hour and 6 hour. Radioactivity of extradural space and urinary bladder was evaluated. RESULTS: Leakage site of CSF was identified in all 8 cases by m-RNC. Leakage site was cervicothoracic junction (CTJ, n=3), CTJ with C1-2 (n=2), CTJ with thoracic spine, thoracolumbar spine and lumbar spine (each n=1). All cases presented leakage sites within 1 hour and multiple sites, where CTJ was included in 6 cases. Only one case presented additional site in 6 hour image. Early radioactivity within the urinary bladder was noted in 6 cases, but that was following after identification of the leakage site. CONCLUSION: Radionuclide cisternography is sensitive to detect the leakage site of CSF and is expected to improve the detection of CSF leakage site and reduce time for the study using modified protocol.
Cerebrospinal Fluid ; Head ; Humans ; Intracranial Hypotension* ; Radioactivity ; Spine ; Subarachnoid Space ; Urinary Bladder

Dendritic cells (DC) are highly efficient antigen-presenting cells that initiate the primary immune response. Several laboratories have developed culture systems for human DC from peripheral blood monocytes. Most of these studies have used fetal calf serum (FCS) containing culture conditions that are inappropriate for human application. GM-CSF and IL-4 were used to make immature DC. The monocyte-conditioned medium (MCM) was used to induce the final maturation of DC. Using the previously described methods, the quality of MCM has unpredictable variations. Therefore using a defined cocktail of growth factors for the generation of mature DC would be advantageous for experimental as well as clinical purposes. In this study, it is suggested that combinations of both GM-CSF/IL-4 or GM-CSF/IL-13 could be used as the first-step culture to produce immature DC, and that cytokine cocktail (GM-CSF, IL-4, IL-1beta, TNF-alpha, IL-6, PGE2) was as efficient as MCM for the second step-culture to produce fully maturated DC. Here, we have generated an easily reproducible culture system for DC that allows for the generation of large amounts of immature and mature DC, and we also now have established the method in a FCS-free system that is suitable for clinical use.
Cell Division/drug effects ; Culture Media/pharmacology ; Cytokines/pharmacology ; Cytological Techniques* ; Dendritic Cells/cytology* ; Human ; Monocytes/cytology*