No abstract available.
Adult* ; Aged* ; Constipation* ; Humans

Various dermatological complications have been reported following the BCG vaccination although this vaccination has been recommended to all healthy infants in our country. A 4-months-old boy, who had a BCG vaccination three weeks after birth, developed erythematous papules and pustules on the whole body, especially on the face and upper extremities. Two erythematous subcutaneous soft nodules were also noted on the left side of the neck. A biopsy specimen from the right forearm revealed caseous necrosis surrounded by a granulomatous inflammation consisting of epithelioid cells and lymphocytes. It was centered along the axis of the damaged pilosebaceous follicle. No acid-fast bacilli could be demonstrated by AFB stain. A marked improvement of his skin eruptions was observed after anti-tuberculosis medication. However, nod-ules in the cervical area perforated spontaneously and healed leaving scars several months after the cutaneous eruptions subsided. The clinical and histologic findings and a good response to anti-tuberculous therapy support the diagnosis of papular tuberculid and suppurative lymphadenitis after BCG vaccination.
Axis, Cervical Vertebra ; Biopsy ; Cicatrix ; Diagnosis ; Epithelioid Cells ; Forearm ; Humans ; Infant ; Inflammation ; Lymphadenitis* ; Lymphocytes ; Male ; Mycobacterium bovis ; Neck ; Necrosis ; Parturition ; Skin ; Tuberculosis, Cutaneous* ; Upper Extremity ; Vaccination*

The chronic osteomyeltis of the adult long bones has different problems from the acute osteomyelitis and osteomyelitis of the children. The ischemic scar tissues and infected bones of the chronic csteomyelitis in the adult are resistant to the antibiotic therapy and their healing mechanisms are delayed. The chronic osteomyelitis has no single effective method of treatment since every case reveals different conditions and the treatment should be individualized case by case. 87 cases of chronic osteomyelitis of the adult long bones were studied in the department of orthcpaedic surgery, Fatima Hospital for 7 years during the years between 1973 to 1979. The cases were 65 male and 22 female having ages 35 years in average and the duration of the osteomyelitis was 14 years and 4 months in average ranging from 3 months to 50 years. The cau ative organisms were mostly staphylococcus but Gram (−) bacilli were found in 28% and the adjacent joint problems were found in 38% The cases were analysed in 5 different groups according to x-ray findings as follows; I. Group with sequestrum: 23 cases having sequestra with varying degree of bone sclerosis and destruction. Most cases had draining sinus but the soft tissue involvement was not severe. II. Sclerotic group: 32 cases having significant bone sclerosis with minimal destructicn if any. The soft tissue involvement and scarring were severe but involvement of the bone marrow was not significant. The duration of osteomyelitis was longest having recurrent episodes of the painful swelling in most cases. III. Destructive group: 17 cases with significant bone destruction with varying degree cf sclerosis. The involvement of the bone marrow was significant and soft tissue involvement was not marked The duration of osteomyelitis was short mostly. IV. Group with skin problem: 9 cases having scar problems overlying tibia. V. Group with complication: There were 2 pathologic fractures of the femurs, 3 quamous cell carcinomas on the lower legs and a severe deformity of a leg. Treatment was mostly surgical including 4 amputations. The surgical method was focused on saucerization of the bone and extensive excision of the infected soft tissues and the scar tissues. 23 cases having small or no dead cavity after mobilization and suture of the adjacent healthy soft tissue closed primarily. Otherwise the cavity was packed open for econdary healing in other 23 cases including several cases having big cavity which was unable to close the skin. The cases having big cavity were prepared for continueus irrigation in 14 caes which were able to closed skin. The transposition of muscles to fill the dead cavity was performed in 4 cases that had big cavity and was unable to close skin. The results were healing in 10 weeks in 54% and after 10 weeks in 38% and 8% failed to heal with the first trials. The recurrence of the ostecmyelitis was found in 9 cases among the 42 cases followed for I year and 3 months in average mostly in group II and in cases of primary closure and open packing.
Adult ; Amputation ; Bone Marrow ; Child ; Cicatrix ; Clinical Study ; Congenital Abnormalities ; Female ; Femur ; Fractures, Spontaneous ; Humans ; Joints ; Leg ; Male ; Methods ; Muscles ; Osteomyelitis ; Recurrence ; Sclerosis ; Skin ; Staphylococcus ; Sutures ; Tibia

Four families having identical sacral agenesis were reported in the literatures and an another family is added here. This family has an eleven year old boy and a seven year old girl who have identical complete sacral agenesis without spincter disturbance but with some anomalies in the other spines, rib and progressive club feet. These cases are followed for six years and the foot deformity was corrected by surgery.
Female ; Foot ; Foot Deformities ; Humans ; Male ; Ribs ; Sacrum ; Spine

PURPOSE: Citrate is a well recognized inhibitor of the formation of calcium oxalate and calcium phosphate stones. Hypocitraturia is a common etiology of recurrent calcium nephrolithiasis, with an incidence of 19 to 63%. Potassium citrate therapy can be a useful therapeutic approach for the management of calcium nephrolithiasis. But pharmacological treatment of hypocitraturic calcium nephrolithiasis requires taking too many tablets, or numerous crystal package or liquid supplements throughout the day. This cumbersome regimen often decreases patient compliance. We administered dietary citrate via lemon juice to stone former and evaluated the change of citrate levels. MATERIALS AND METHODS: The prospective study included 7 women and 8 men with documented recurrent or multiple urinary stone disease. None of the subjects suffered from renal impairment, urinary tract infection and other metabolic disorder. Controls comprised 6 voluntary men. They had no previous stone history and no evidence of stone. Patients ingested total 1 liter of lemon juice(containing 4.0gm/L.citrate) divided at 6 hours interval without strict diet restriction. Urine specimens were obtained for urinary citrate levels after 2-3days of lemon juice therapy and compared to pre-lemon juice baseline values. RESULTS: All 15 patient showed increased urinary citrate levels during lemon juice therapy. Average urinary citrate levels increased from 146+/-109mg/day at baseline to 453+/-226mg/day during treatment(p<0.05). Urinary citrate levels during treatment increased up to those of control group(351+/-265mg/day) and did not show significant difference (p>0.05). Urinary pH increased from 5.9+/-0.4 at baseline to 6.8+/-0.6 during treatment(p<0.05). No patient complained of gastrointestinal discomforts. CONCLUSIONS: Citrate supplementation with lemon juice increased urinary citrate levels and urinary pH. Lemon juice is well tolerated dietary source of citrate and would be beneficial in the control of calcium urolithiasis.
Calcium ; Calcium Oxalate ; Citric Acid* ; Diet ; Female ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Male ; Nephrolithiasis ; Patient Compliance ; Potassium Citrate ; Prospective Studies ; Tablets ; Urinary Calculi ; Urinary Tract Infections ; Urolithiasis*

PURPOSE: Chlamydia trachomatis (C. trachomatis) is a well known cause of non-gonococcal urethritis (NGU). No other microorganism has been shown to cause any larger proportion of the remaining NGU cases. As a possible causative organism of NGU, we wanted to evaluate the detection rate of Mycoplasma genitalium (M. genitalium) and its role in NGU using polymerase chain reaction (PCR). MATERIALS AND METHDS: From June 1998 to July 2000, we examined a total of 116 men. Of these men 70 had symptoms and signs compatible with urethritis and 46 were for normal control. In the patient group, two urethral discharge or swab specimens were collected. One was used for Gram stain to detect Gram negative intracellular diplocci. The other was subjected to PCR for C. trachomatis and M. genitalium. In the control group, urethral swab specimen was used to detect C. trachomatis and M. genitalium by PCR based assay. RESULTS: Gonococcal urethritis (GU) was diagnosed in 14 cases (20.0%). Detection rates of M. genitalium and C. trachomatis in urethritis group were 8.6% (6/70), 18.6% (13/70). M. genitalium and C. trachomatis were detected in 7.1% (1/14), 14.3% (2/14) of GU and 8.9% (5/56), 19.6% (11/56) of NGU. Detection rate of M. genitalium in chlamydia-negative NGU was 11.1% (5/45). No patient positive for M. genitalium had a simultaneous chlamydia infection. In control group with no urethral symptom or sign, M. genitalium and C. trachomatis were not detected at all. Compared with chlamydia- positive NGU, M. genitalium-positive urethritis exhibited higher recurrence rate. CONCLUSIONS: M. genitalium was detected in 8.9% of NGU and 11.1% of non-chlamydia NGU. This study suggests that M. genitalium may be one of the causative organisms in NGU. Further studies will be necessary to define its role in NGU.
Chlamydia Infections ; Chlamydia trachomatis ; Humans ; Male ; Mycoplasma genitalium* ; Mycoplasma* ; Polymerase Chain Reaction ; Recurrence ; Urethritis*

No abstract available.

Currently, phosphodiesterase type 5 (PDE5) inhibitors are the initial treatment option for erectile dysfunction. The reported efficacy of PDE5 inhibitors is about 70%, although it is significantly lower in difficult-to-treat subpopulations. Treatment failures might be due to the severity of the underlying pathophysiology, improper use of medication, unrealistic patient expectations, difficult relationship dynamics, severe performance anxiety, and other psychological problems. Physicians must address these issues to identify true treatment failures attributable to the drugs. This article discusses factors that might affect the response to PDE5 inhibitors and develops a strategy to maximize the overall efficacy of PDE5 inhibitors in initial non-responders to PDE5 inhibitors.
Carbolines ; Erectile Dysfunction ; Humans ; Imidazoles ; Male ; Performance Anxiety ; Phosphodiesterase 5 Inhibitors ; Piperazines ; Purines ; Sulfones ; Treatment Failure ; Triazines ; Sildenafil Citrate ; Tadalafil ; Vardenafil Dihydrochloride

Forty cases of infiltrating duct carcinoma of the breast were examined immunohistochemically for expression of TGF-beta and angiogenesis in order to analyze significant correlation with prognostic parameters including tumor size, axillary lymph node metastasis, clinical stage, histologic grade, estrogen receptor and progesterone receptor status. The TGF-beta expression was observed in tumors center and advancing edges of tumors. To determine microvessel density for angiogenesis, we stained endothelial cells for Factor VIII related antigen and counted microvessel within tumor. The results were as follows: 1) The strong immunohistochemical expression of TGF-beta and higher counts of microvessels were observed in advancing edges of tumors (p<0.05). 2) The TGF-beta expression in the advancing edges of tumors was closely related to clinical stage and presence of axillary lymph node metastasis (p<0.05). 3) The mean microvessel counts were significantly higher in tumors from patients with axillary lymph node metastasis and increased with increasing clinical stage (p<0.05). 4) The TGF-beta expression was not related to histologic grade, estrogen receptor and progesterone receptor status(p>0.05). Therefore, the results suggested that the TGF-beta expression and angiogenesis in infiltrating duct carcinoma of the breast may play an important part in prognostic factors, closely related to the lymph node metastasis and clinical stage.
Neoplasm Metastasis

In chronic tophaceous gouty arthritis, the treatment may be very difficult due to eroding, replacing and absorbing articular cartilage, deforming arthritis, and fibrous ankylosis by deposition of sodium urate crystals. We reported two cases of chronic tophaceous gouty arthritis which were satisfactorily treated by arthroscopic chondroplasty, debridement of the pannus of granulation tissue and urate salts in the joint, as well as excision of tophi around the joints.
Ankylosis ; Arthritis ; Arthritis, Gouty* ; Cartilage, Articular ; Cytochrome P-450 CYP1A1 ; Debridement ; Granulation Tissue ; Joints ; Salts ; Uric Acid