Neuropathic joint, which was originally described by Charcot in 1868, has been reported by many authors since that time. Charcot's joint is a feature of various conditions, such as syringmyelia, diabetes mellitus, congenital indifference to pain and leprosy, but it is mostly depended upon tertiary syphilis. In the past few decades. the occurance of this arthropathy however, seemed to decrease with the discovery of antibiotics and efficient control of syphilis in many countries. But syphilis has become popularized in recent years because of the rapid development of transportation and an offence against public deoency throughout the world. Authors experienced 3 cases of Charcots joint in Our Lady of Mercy Hospital, Catholic Medical College, two of them were tabetic, one diabetic in origin, which affected four knee joints, two ankle joints and one tarsometatarsal joint. The patients were treated conservatively without surgical intervention on the affected joints. One was lost for foIlow up after being discharged from the hospital against medical advice and the res two cases have been on follow up. This paper is auned to illustrate the importance of clinical aspects of neuropathic joints which seemed to be in the tendency of increase in recent years. in spite of development of efficient managements of the causative diseases.
Ankle Joint ; Anti-Bacterial Agents ; Arthropathy, Neurogenic ; Diabetes Mellitus ; Follow-Up Studies ; Humans ; Joints ; Knee Joint ; Leprosy ; Pain Insensitivity, Congenital ; Syphilis ; Transportation

No abstract available.
Incontinentia Pigmenti*

A case of cystic lymphangioma of the mesentery with severe and persistent abdominal pain in a 22-year-old man is presented. The cyst was filled with chylous fluid. Microscopically, numerous nerve bundles were incorporated within the lymphangiomatous walls, and some protruded into the lumen. The above findings lead to a suggestion that mesenteric lymphangioma may differ from those in the other sites by its abundance of incorporation of nerve bundles into the lymphangiomatous walls, and that increase of tumor size by intracystic accumulation of chylous fluid may subsequently result in increase of intraluminal pressure to compress the nerve bundles with which abdominal pain is much enhanced.
Male ; Humans ; Cysts

No abstract available.
Progeria*

The cavus foot is a deformity characterized by an elevated medial longitudinal arch and a hindfoot varus with plantarflexed 1st ray. The etiology of cavus foot is usually related to neuromuscular disease or idiopathic cause. Thorough clinical and radiographic evaluation is required for differentiating etiology of the cavus. Most cases of cavus foot are stable and slowly progressive deformities which can initially be managed with conservative treatment including orthoses and physical therapies. Determining whether the deformity is flexible or rigid, the apex of the deformity and any muscle imbalances in foot and ankle is important for achievement of an adequately balanced plantigrade foot. Treatment should include systematic preoperative planning for selection of appropriate procedures for maintaining a functional and flexible foot with combinations of soft-tissue release, osteotomy, tendon transfer, and arthrodesis.
Ankle ; Arthrodesis ; Congenital Abnormalities ; Diagnosis* ; Foot Deformities ; Foot* ; Neuromuscular Diseases ; Orthotic Devices ; Osteotomy ; Tendon Transfer

PURPOSE: This study was performed to suggest a realistic measure of charging for 119 emergency medical services (EMS) in Korea using Delphi study targeting emergency medical specialists. METHODS: The Delphi study was conducted four times targeting 24 emergency medical specialists. The first Delphi survey contained five categories as follows: Subjects of charging for 119 EMS, method of charging, strategy of implementation, utilization of fund, measure of quality improvement. In the second and third Delphi surveys, respondents were asked to indicate the level of importance with the questionnaire statements on a Likert scale, ranging from 0 to 5. The final consultation survey collected opinions on the system of charging for 119 EMS. RESULTS: The results from the first three Delphi surveys showed subjects of charging, method of charging, strategy of implementation, utilization of fund, and measure of quality improvement for 119 EMS. The fourth Delphi survey resulted in step 1 (classification of severity), step 2 (scene of accident), and step 3 (classification of severity at hospital). The classification of severity in steps 1 and 2 should be evaluated by first grade emergency medical technicians, and the classification of severity in step 3 should be evaluated by a person notified by the Ministry of Health and Welfare. Non-emergent patients should pay for the charge of 119 EMS to the hospital. CONCLUSION: Delphi study proposed charging for 119 EMS based on three levels of severity. This study suggests that charging for EMS can reduce unnecessary emergency calls and offer proper medical services to emergency patients.
Classification ; Delphi Technique* ; Emergencies* ; Emergency Medical Services* ; Emergency Medical Technicians ; Fees and Charges ; Financial Management ; Humans ; Korea ; Methods ; Quality Improvement ; Specialization ; Surveys and Questionnaires

OBJECTIVE: The goal of this study is to assess the prognostic factors of patients with chronic subdural hematoma. METHODS: A series of 150 patients with chronic subdural hematoma was reviewed. The hematoma was surgically removed in all patients. We analysed possible prognostic factors such as, age, sex, causes, preoperative radiologic findings, and preoperative neurological condition(Bender grade). RESULTS: The most important prognostic factor of chronic subdural hematoma was preoperative neurological condition. Patient's age and sex, causes and preoperative radiologic findings(hematoma thickness) do not have significant influences on the outcome. CONCLUSION: The neurological condition of the patients at the time of diagnosis and treatment are the only significant prognostic factor. Early diagnosis of chronic subdural hematoma before neurological deterioration is important.
Craniocerebral Trauma ; Diagnosis ; Early Diagnosis ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans

Herpes simplex esophagitis can occur in those with normal immune function, but is more often seen in those who are immunocompromised. In one series, 5 percent of post-kidney transplant recipients had herpes esophagitis. We experienced a case of herpes simplex esophagitis, following renal transplantation in a 9 year old male. He complained of epigastric pain, nausea and blood-tinged vomiting. Endoscopic examination showed volcano ulcer, mucosal friability and multiple confluent ulcers covered by whitish exudates on elevated margin in the middle and lower esophagus. Microscopic findings revealed multinucleated giant cells, margination of chromatin, intense nonspecific inflammation and strong positive for herpes simplex virus immunohistochemical staining. Esophageal lesions and symptoms improved after acyclovir therapy.
Acyclovir ; Child* ; Chromatin ; Esophagitis ; Esophagus ; Exudates and Transudates ; Giant Cells ; Herpes Simplex* ; Humans ; Inflammation ; Kidney Transplantation ; Male ; Nausea ; Simplexvirus* ; Transplantation ; Ulcer ; Vomiting

Malignant growth of the small bowel accounts for approximately 1 to 3 percent of malignant tumors of the gastrointestinal tract. Leiomyosarcomas are the second most common primary tumor of the small bowel, their frequency being one-third to one-half of adenocarcinoma. The common clinical symptoms of leiomyosarcoma of the small intestine are hemorrhage and abdominal pain. Accurate diagnosis cannot be based on solely on the roentgenographic finding, although in certain situations the dignosis of leiomyosarcoma may be suggested strongly. We report a case of bleeding leiomyosarcoma located in the second portion of the duodenum which was first recognized by endoscopic examination and confirmed by explolaparotomy.
Abdominal Pain ; Adenocarcinoma ; Diagnosis ; Duodenum* ; Gastrointestinal Tract ; Hemorrhage ; Intestine, Small ; Leiomyosarcoma*

Purpose: We assessed the association between the results of tear film-based matrix metalloproteinases 9 (MMP-9) immunoassay and the diagnosis of patients who visited an oculoplastic outpatient clinic. Methods: We conducted a retrospective analysis of the MMP-9 immunoassay results in 1,703 eyes from 1,703 patients who presented with ocular discomfort at an oculoplastic outpatient clinic. The MMP-9 immunoassay results were analyzed in correlation with the final oculoplastic diagnosis of the patients. Results: In total, 1,126 of 1,533 eyes demonstrated positive expression of MMP-9. No statistically significant differences were observed in MMP-9 expression based on sex (p = 0.107) and age (p = 0.510). Furthermore, 120 of 169 eyes with thyroid eye disease (71.0%, p < 0.001), 145 of 161 eyes with nasolacrimal duct obstruction (90.1%, p < 0.001), 282 of 375 eyes with nasolacrimal duct stenosis (75.2%, p < 0.001), 190 of 238 eyes with entropion (79.8%, p < 0.001), 19 of 23 eyes with ectropion (82.6%, p < 0.001), and 370 of 567 eyes with dry eye syndrome (65.3%, p < 0.001) exhibited positive MMP-9 expression. Conclusions The MMP-9 immunoassay is a noninvasive, convenient, and rapid test that evaluates ocular surface inflammation. Most patients with oculoplastic diseases exhibit positive MMP-9 expression. These findings provide valuable information for guiding diagnostic and management decisions in patients with oculoplastic conditions.