Neurofibromat osis is a familial discase with widespread manifestations such as lesions of the skin, tumors of the central and peripheral nervous system and abnormalities of bone. The presence of at least two of the following features was considered for diagnostic criteria; positive family history, positive blopsy, a minimum of six cafe-au-lait spots each with a diameter of at least 1.5 cm and multiple subcutaneous nodules. From January 1971 to December 1979, 17 patients of neurofibromatosis and 30 patients of neuro- fibroma treated at Yonsei Medical Center were clinically analized for the study and the results obtained from this study were as follows; 1. Positive family history was obtained In 2 per cent of cases with neurofibromatosis. 2. Cafe-au-lait spots or tumors were the most common findings in neurofibromatosis. The bone changes were presented in 8 patients(45 per cent) and scoliosis has been In 62.5 per cent of them. 3. The location of the neurofibroma was variable. Central nervous sustem was involved in 40.4 per cent and peripheral nervous system in 59.4 per cent. 4. Myelography and determinations of the cerebro-spinal fluid protein concentration led us to a correct diagnosis of the neurofibroma which involved the spinal cord. For the treatment of the neurofibroma, 9 out of 30 patients were performed laminectomies and excision of the intradural masses, and one of them was flxed the spinous processes with a plate and wires after laminectomy for prevent spinal instability. 5. in 3 patients with progressive scoliosis, the best results were obtained with early Harrington instrumentation and posterior fusion.
Cafe-au-Lait Spots ; Chymopapain ; Clinical Study ; Diagnosis ; Fibroma ; Humans ; Laminectomy ; Myelography ; Neurofibroma ; Neurofibromatoses ; Peripheral Nervous System ; Scoliosis ; Skin ; Spinal Cord

Transient synovitis is characterized by the development of pain arising from the hip and often felt in the thigh or knee in children between the ages of 2 and 12 years. The benign self-limiting nature of this condition has made it difficult to establish the caus'e. However, the condition is generally conceded to be the commonest cause of a painful hip in childhood. The disease is of interest, not because of its disabling condition, but because of the difficulty in differentiating it from more serious diseases of the hip, such as tuberculosis, osteomyelistis, or Legg-Perthes disease. The author had studied the clinical symptoms and signs, roentgenologic findings, and treatment of the 34 patients who had admitted to Severance Hospital Yonsei Medical Center in Seoul, Korea from January 1970 to December 1979, under the diagnosis of the transient synovitis of the hip and summerized the results as follows; 1. There was probably associated with predisposing factors such as infection and allergy. 2. Among the 34 patients, 28 cases(82.4%) were male and 6 cases(17.6%) were female. The most prevalent age were between 6 and 10 years old. 3. Pain and limitation of motion of the hip joint were the most common symptoms. In 56.5% of the patients, roentgenographic findings were positive. In 50% of the patients, the erythrocyte sedimentation rates were increased. 4. The treatment was conservative including bed rest, skin traction on the affected leg, non-weight bearing, antibiotics, and sedatives. Most of all patients had improved symtoms and signs within two weeks of treatment. 5. The course of this condition was short and benign with complete resolution. The occasional hip with chronic or recurrent symptoms could be distinguished from Legg-Perthes disease by the short history, normal radiographs, and the complete resolution.
Anti-Bacterial Agents ; Bed Rest ; Blood Sedimentation ; Causality ; Child ; Clinical Study ; Diagnosis ; Female ; Hip Joint ; Hip ; Humans ; Hypersensitivity ; Hypnotics and Sedatives ; Knee ; Korea ; Leg ; Legg-Calve-Perthes Disease ; Male ; Seoul ; Skin ; Synovitis ; Thigh ; Traction ; Tuberculosis

BACKGROUND: The facilitatory effect of spinal prostaglandins (PGs) on nociceptive transmission suggests that early PG synthesis after nerve injury could be important in the development of allodynia. METHODS: The aim of this study is to examine the effects of diclofenac (nonselective COX inhibitor), SC-560 (selective COX-1 inhibitor), and NS-398 (selective COX-2 inhibitor) on mechanical allodynia and thermal hyperalgesia in the neuropathic pain model. The rats underwent right L5 spinal nerve ligation (SNL) and were assigned to three COX inhibitor groups to be injected intraperitoneally with different administration dosages (0.2 mg, 1 mg, 5 mg) 30 minutes before, and at 1, 2, and 3 days after SNL. The withdrawal threshold of both hindpaws in response to mechanical stimulation was measured by dynamic plantar anesthesiometer and the withdrawal ratio of right to left hindpaw was calculated. The thermal stimulation applied to both hindpaws by the plantar test was calculated different administration dosages were compared with the vehicle group. RESULTS: There were no differences in mechanical allodynia among the lower dosage groups (0.2 mg) until 14 days after SNL. However, 1 mg of NS-398 decreased mechanical allodynia compared with the vehicle group at 14 days after SNL, and 5 mg of NS-398 decreased mechanical allodynia at 3 days after SNL. However, there was no difference in thermal hyperalgesia between the groups. CONCLUSIONS: These results suggest that intraperitoneal administration of COX inhibitor (especially selective COX-2 inhibitor) after nerve ligation injury can attenuate the development of mechanical allodynia.
Animals ; Cyclooxygenase Inhibitors* ; Diclofenac ; Hyperalgesia ; Ligation* ; Neuralgia* ; Prostaglandin-Endoperoxide Synthases* ; Prostaglandins ; Rats* ; Spinal Nerves*

Abdominal wall hernias are a common problem in patients treated with continuous peritoneal dialysis. Although most patients with abdominal wall hernia are asymptomatic, some patients may present with abdominal pain or, if the hernia is incarcerated or strangulated, with signs and symptoms of peritonitis. It is often difficult to differentiate abdominal catastrophe such as peritonitis secondary to strangulated hernia from CAPD peritonitis. Because their clinical manifestations are similar, several biochemical markers including amylase and lactic acid have been recently used as an indicator of abdominal catastrophe. We report a case of strangulated umbilical hernia with perforation misdiagnosed as CAPD peritonitis. The patient was operated 36 hours after the first inspection but expired due to overwhelming sepsis, 257 days after the admission to hospital.
Abdominal Pain ; Abdominal Wall ; Amylases ; Biomarkers ; Hernia ; Hernia, Umbilical* ; Humans ; Intestinal Perforation ; Lactic Acid ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Sepsis

We experienced a case of diffuse idiopathic skeletal hyperostosis(DISH) associated with ossification of the posterior longitudinal ligament. A 58-year old man presented with clumsiness and hypesthesia of both hands. He showed weakness of sensory defit and weakness of motor function of hands. The lateral radiograph of cervical spine showed anterior hyperostosis and ossification of the posterior longitudinal ligament. A magnetic resonance image of cervical spine revealed a low-density defect posterior to cervical spine with evidence of spinal stenosis. Ossification of the posterior longitudinal ligament is a rare manifestation associated with DISH, and we report this case with a review of the literature.
Hand ; Humans ; Hyperostosis ; Hyperostosis, Diffuse Idiopathic Skeletal* ; Hypesthesia ; Ligaments* ; Longitudinal Ligaments ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; Spinal Stenosis ; Spine

BACKGROUND: The natural course of sarcoidosis is variable from spontaneous remission to significant morbidity or death. So the assessment of disease activity is important but no single parameter was generally accepted as a good marker. Recently several studies suggested that adhesion molecules, especially ICAM-1 can be a marker, but there are some controversies. And only few data are available about the relationship of ICAM-1 with clinical follow-up course. METHOD: We measured the expression of adhesion molecules on BAL cells by flow cytometry and the level of soluble ICAM-1 (sICAM-1) in serum and BALF at the time of diagnosis in 12 patients with active disease and 7 inactive sarcoidosis(5 male, 14 female, mean age : 39.4+/-10.7 years, mean follpw-up 20+/-15 months). Follow-up clinical course were compared with the changes in serum sICAMA-1 level and the adhesion molecule on BAL cells. RESULTS: In the patients with active disease, the ICAM-1 on AM(RMFI 3.68+/-1.71) and sICAM-1 level in serum(582+/-193 ng/ml) and BAL fluid(47.8+/-16.5 ng/ml) were all higher than those of 7 inactive disease(RMFI :1.89+/-0.75, p=0.0298, serum : 294+/-117 ng/ml, p=0.0049, BALF : 20.9+/-8.3ng/ml). In the active sarcoidosis, ICAM-1 on AM(RMFI:1.51+/-0.84) and serum sICAM-1 were decreased after the therapy(250+/-147 ng/ml) but no significant change was noted in inactive disease. Also we found the initial ICAM-1 on AM and serum sICAM-1 had a significant correlation with the degree of improvement in PFT after the therapy. During the follow-up, the disease relapsed in 4 patients after the discontinuation of steroid and the serum sICAM-1 level went-up again at the time of relapse. CONCLUSION: Our data suggest that the serum sICAM-1 level and the JCAM-1 expression on AM can be a good marker of disease activity and also a predictor of outcome in sarcoidosis.
Diagnosis ; Female ; Flow Cytometry ; Follow-Up Studies ; Humans ; Intercellular Adhesion Molecule-1* ; Male ; Recurrence ; Remission, Spontaneous ; Sarcoidosis*

BACKGROUND/AIMS: Accurate staging of the lymph nodes (LNs) before endoscopic mucosal resection (EMR) is important. We evaluated the accuracy of CT for LN staging in patients the endoscopically resectable early gastric cancer (EGC). METHODS: The medical records of 155 EGCs patients who had undergone an operation were analyzed. The pre-operatively performed multidetector CT scans and the post-operative histopathologic findings were reviewed for comparing the LN staging with that using the Japanese classification system. Endoscopically resectable EGC was defined as EGC without LN metastasis and also the EGC that satisfied the EMR criteria according to the Japanese guideline. RESULTS: The diagnostic efficacy of CT for LN staging of all the enrolled EGC patients was as follow: accuracy 65.2%, overstaging rate 29.7%, understaging rate 5.2%. The overall accuracy and the overstaging rate of CT for LN staging of endoscopically resectable EGC were as follows: EGC without LN metastasis [69.8% (97/139), 30.2% (42/139)], EGC satisfying extended criteria [72.5% (58/80), 27.5% (22/80)] and EGC satisfying limited criteria [79.2% (19/24), 20.8% (5/24)]. The accuracy of the EMR criteria for predicting node negative EGC were as follows: the extended criteria 98.8% (79/80), the limited criteria 100% (24/24). CONCLUSIONS: Our study showed that prediction of LN metastasis before EMR according to CT staging had limited value due to the tendency of overestimation. Therefore, we should preferentially consider the treatment strategy according to the EMR criteria.
Asian Continental Ancestry Group ; Humans ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Neoplasm Staging ; Stomach Neoplasms

Ventricular perforation is a rare complication of permanent cardiac pacemaker implantation. We report here on a 68-year-old woman with a dual chamber permanent pacemaker that had been implanted one month earlier, and she suffered cardiac perforation from the pacemaker lead. Frequent follow-up via12-lead surface electrocardiography and chest radiography and the proper work-up for pacemaker implantation are needed for detecting rare complications after pacemaker implantation.
Aged ; Electrocardiography ; Female ; Follow-Up Studies ; Heart Ventricles* ; Humans ; Radiography ; Thorax

In this study, we investigated profiles of the cytokines IFN-g, IL-12, and IL-10 in active pulmonary tuberculosis (EAPTB) patients, HIV-negative patients with multidrug-resistant tuberculosis (MDR-TB) and in healthy tuberculin reactors (HTR). We studied the responses of peripheral blood mononuclear cells (PBMC) from 12 EAPTB patients and 15 MDR-TB patients to stimulation with a purified protein derivatives (PPD) antigen (Ag), and compared them with those from 14 HTR. Using ELISA, IFN-g production was found to be significantly depressed, while IL-10 was significantly elevated in both MDR-TB and EAPTB after in vitro stimulation with PPD, compared with those in HTR. Although there was no significant difference in IL-12 production among the three groups, mean IL-12 production was highest in patients with MDR-TB. In these patients, IL-12 production was significantly correlated with IL-10 expression, but not IFN-g production. In addition, neutralization of endogenous IL-10 led to enhanced IFN-g and IL-12Rb2 mRNA expression in TB patients. Our findings suggest that both groups of TB patients may have a similar disregulated pattern of IL-12, IL-10, and IFN-g production during M. tuberculosis infection. Furthermore, the results suggest a potentially pathogenic role for IL-10 in impaired Th1 immune responses in TB patients.
Cytokines ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interferon-gamma ; Interleukin-10* ; Interleukin-12* ; Mycobacterium tuberculosis ; RNA, Messenger ; Tuberculin ; Tuberculosis ; Tuberculosis, Multidrug-Resistant* ; Tuberculosis, Pulmonary

This study was conducted to investigate the association between the chronic obstructive pulmonary disease (COPD) assessment test (CAT) and depression in COPD patients. The Korean versions of the CAT and patient health questionnaire-9 (PHQ-9) were used to assess COPD symptoms and depressive disorder, respectively. In total, 803 patients with COPD were enrolled from 32 hospitals and the prevalence of depression was 23.8%. The CAT score correlated well with the PHQ-9 score (r=0.631; P<0.001) and was significantly associated with the presence of depression (beta+/-standard error, 0.452+/-0.020; P<0.001). There was a tendency toward increasing severity of depression in patients with higher CAT scores. By assessment groups based on the 2011 Global Initiative for Chronic Obstructive Lung Disease guidelines, the prevalence of depression was affected more by current symptoms than by airway limitation. The area under the receiver operating characteristic curve for the CAT was 0.849 for predicting depression, and CAT scores > or =21 had the highest accuracy rate (80.6%). Among the eight CAT items, energy score showed the best correlation and highest power of discrimination. CAT scores are significantly associated with the presence of depression and have good performance for predicting depression in COPD patients.
Aged ; Depression/*epidemiology ; Depressive Disorder/*epidemiology ; Female ; Humans ; Male ; Prevalence ; Pulmonary Disease, Chronic Obstructive/*diagnosis/*epidemiology/psychology ; Quality of Life ; Questionnaires ; Severity of Illness Index