We report a case of mixed connective tissue disease. A patient, 25-year-old woman, presented Raynaud phenomenon, proximal muscle weakness, sclerodactyly, fever, and diffuse alopeeia. In the serologic examination, antinuclear antibody and anti-RNP antibody were positiv but anti-native DNA antibody was negative. In direct immunofluorescent study of biopsy specimen of the skin, speckled epidermal nuclear staining of IgG and granular deposits of IgM at the dermoepidermal junction were seen: Electromyographic finding of the right deltoid and right gastrocinemius muscle was consistent with myopathy.
Adult ; Antibodies, Antinuclear ; Biopsy ; DNA ; Female ; Fever ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Mixed Connective Tissue Disease* ; Muscle Weakness ; Muscular Diseases ; Raynaud Disease ; Skin

BACKGROUND: Many physiologic, pharmacologic and immunologic abnormalities were reported in atopic dermatitis but the cause and pathogenesis of the disease remain obscure. OBJECTIVE: This study was done to investigate the systemic immunologic abnormalities in atopic dermatitis. METHOD: To evaluate the cell mediated immunity, me quantified pei ipheral blood T lymphocytes and their subsets, using flow cytometery, and assessed plasma neopteiin levels by means of radioimmunoassay. To evaluate the abnormal humoral immunity, we assessed the serum IgE levels by means of enzyme-immunoassay. RESULTS: Mean proportions of peripheral blood T lymphocytes and, heir subsets in atopic Dermatitis patients were within normal limits. Hut the suppvessor/cytotoxic T lyrphocytes(T8) were significantly decreased in the group of se"ere atopic dermatitis compared with the group of mild atopic dermatitis(P<0.05). Plasma neopterin lervels in the group of atopic dermatitis were found to be significantly elevated as compared vith the control group(P<0.01), but no significant cifference was found between the mild and severe group of atcpic dermatitis(P>0.05). Mean serum IgE levels in the patients with atopic dermatitis were higher than reference value. But there was no significant difference between the mild and severe atopic dermatitis group. Serum IgE levels ivere negatiiely correlated with T8(r=-0.3774, P<0.05) and positively with T4/T8 ratio(r =0.5007, P<0.05). Conclusions : These data;uggest that the atopic der matitis has abr ormalities in cell mediated immunity as well as elevated IgE level.
Dermatitis, Atopic* ; Humans ; Immunity, Cellular ; Immunity, Humoral ; Immunoglobulin E ; Neopterin* ; Plasma* ; Radioimmunoassay ; Reference Values ; T-Lymphocyte Subsets* ; T-Lymphocytes

No abstract available.
Granular Cell Tumor*

We report a case of cutaneous sarcoidosis which occurred in a 32-year-old female who had, in addition to some cutaneous nodules, recently developed an acute spontaneous erythematous area of induration in old scars on her forehead and lower lip. Histopathologic findings revealed well-demarcated islands of epitheloid cells with a few giant, cells. In addition, slight admixture of lyrnphoid cells with present. at the margins of the epitheloid cell granulomas. Complete regression of the skin lesions was obtained with systemic steroid therapy without recurrence for some 8 months.
Adult ; Cicatrix ; Female ; Forehead ; Granuloma ; Humans ; Islands ; Lip ; Recurrence ; Sarcoidosis* ; Skin

While the microbiology of cellulitis in the pediatric population and systemic diseases(DM, Cirrhosis, etc) is well known,the causative bacteria and clinical aspect of cellulitis in young adults are less descrihed. this study was undertaken to identify the causative organisms and clinical aspect of adult cellulits. We analysed 121 medical records of 115 young adult patients with cellulitis who had been admitted at the department of orthopaedic surgery, National Police hospital from Jan. 1994. to Dec. 1996. The results were as follows. 1. The age of patient was between 21 yrs and 25 yrs, and the sex of all patients was male. 2. The lower leg and foot were the most frequently involved site of cellulitis as 92 cases(74.2%). 3. The potals were suspected in 65 cases(56.5%),of them, traumas were detected in 43 cases(66.1%), non-traumatic skin lesions in 23 cases(33.9%). 4. In most cases, initial systemic symptoms (fever, chill, headache, etc.) and local symptoms (local heating, tenderness, etc.) were found. 5. The laboratory findings revealed leukocytosis in 19%, elevated ESR in 94%, positive CRP in 80%. 6. Microorganism were detected in 16 of 38 pus cultures. Gram positive microorganisms were detected in 15 of 16 cases culture positive. 7. 6.7% of patients with cellulitis experienced recurrence in same lesions. In conclusion, the retrospective analysis of 115 young adult patients with cellulitis showed that primary cause of young adult cellulit was circulatory disturbance and lymphatic obstruction of the lower extremities most often involved by trauma. therefore, supportive treatments such as rest,elevation,ice packs are considered prior to antibiotic treatment.antibiotic treatment aimed at gram-positive cocci appears to be sufficient.
Adult ; Bacteria ; Cellulitis* ; Fibrosis ; Foot ; Gram-Positive Cocci ; Headache ; Heating ; Hot Temperature ; Humans ; Leg ; Leukocytosis ; Lower Extremity ; Male ; Medical Records ; Police ; Recurrence ; Retrospective Studies ; Skin ; Suppuration ; Young Adult*

Background: Fine needle aspiration and biopsy(FNAB) has known the most accurate test(about 90%) in the preoperative evaluation of patients with a thyroid nodule. The false negative findings of thyroid cancer by FNAB are mainly due to the aspiration of cystic fluid in cystic degeneration of thyroid cancer and the ipossibility of differentiation between follicular adenoma and carcinoma by aspiration or FNAB because of the failure to evaluate the capsule invasion or angioinvasion of the tumor. Actually more than 80% of the nodules are found as benign nodules in aspiration or FNAB and the findings of follieular lesions are found about half of the samples tested, so limiting the cancer incidence in surgically resected samples up to 50% of the surgical resection. Sa reasonable guidelines to manage the benign nodules on aspiration or FNAB are needed which can select the maligna~nt nodules with false negative findings on aspiration or FNAB. We tried to evaluate whether the thyroxine suppression therapy can increase the malignancy rates on thyroidectomy, Methods: We treated the benign thyroid nodules in FNAB with thyroxine for 1 year and cornpared the nodule volume change before and after treatment (every 6 month) with ultrasonogram. We performed thyroidectomy on 1~7 thyroid nodules wbich showed less than 50% decrease of nodule volume after 1 year of thyroxine suppression therapy. Results: The results were as follows. 1) Of all 17 patients, surgical resection revealed malignant thyroid nodule(Group I) in 10 cases (58.82%, papillary cancer. 6 cases, follicular cancer: 4 cases) and benign thyroid nodule(Group II) in 7 cases(41.18%, follicular adenoma: 4 cases, adenomatous goiter: 3 cases). 2) Between group I and II, there was no significant differences in serum T, T and TSH levels before and after thyroxine suppression therapy. Also, there were no significant difference in TSH suppression % between group I and group II(5.60+5.39%, 14.64+11.48%, respectively). 3) Thyroid nodule volume decrease percent before and after thyroxi~ne therapy showed no significant difference between group I and group II (124.80+54.18% vs 159.42+79.82%, p>0.05). Conclusion: Our data suggested that the benign thyroid nodules on aspiration or FNAB which were not suppressed in volume after thyroixine therapy revealed more than 50% incidence of malignancy on surgical resection, so these nodules were highly reeommended to surgical exploration.
Adenoma ; Biopsy, Fine-Needle ; Goiter ; Humans ; Incidence ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Thyroxine ; Ultrasonography

The purpose of the present study is to assess the effect of aging on left ventricular filling function and the relation between Doppler parameters of LV filling and radius/thickness ratio in an normal population and in hypertensive patients with left ventricular hypertrophy. We underwent M-mode echocardiography and pulsed Doppler measurement of the LV inflow in 123 normal controls and 78 hypertensive patinets with LVH. The results were as follows; 1) In hypertensive patients with LVH, the peak early velocity(60.9+/-13.5cm/sec)was significantly decreased, and the peak atrial velocity(78.9+/-19.6cm/sec)was significantly increased than that in normal controls(78.1+/-15.7cm/sec, 60.2+/-13.1cm/sec, P<0.005, respectively). 2) In the normal controls, peak early velocity correlated well with age(r=-0.388, -0.595, P<0.005, respectively), but not with radius/thickness ratio. 3) In the hypertensive patients with LVH, peak early velocity and the ratio of early to atrial velocity correlated with redius/thickness ratio (r=0.274 P<0.05, r=0.367 P<0.005, respectively), but not with age. In conclusion early LV diastolic filling is reduced and systolic is augmented, probably reflecting alteration in myocardial siffness with normal aging, whereas in chronic LVH, changes in radius/thickness ratio is more important determinants of ventricular compliance, overriding the effects of age.
Aging ; Compliance ; Echocardiography ; Humans ; Hypertrophy, Left Ventricular*

Intracranial subdural hematoma is an exceptionally rare complication of spinal anesthesia. An 88-year-old female patient diagnosed with grade V uterine prolapse with rectocystocele received a vaginal hysterectomy and anteroposterior repair under spinal anesthesia. At 4 days postoperatively, she appeared to have decreased orientation, inappropriate behavior, and right side weakness grade III. Brain MR diffusion and CT revealed a bilateral subdural hematoma. She was improved after burr hole drainage. We report a case of intracranial subdural hematoma developing after spinal anesthesia, a rare complication.
Aged, 80 and over ; Anesthesia, Spinal ; Brain ; Diffusion ; Drainage ; Female ; Hematoma, Subdural ; Hematoma, Subdural, Intracranial ; Humans ; Hysterectomy, Vaginal ; Orientation ; Uterine Prolapse

A 62 year old female patient was transferred to the operating room for open reduction and internal fixation of the left femur fracture under general anesthesia. At 15min. after femur tourniquet application, there were suddenly decreased oxygen saturation, end-tidal CO2 concentration and blood pressure. We suspected a pulmonary embolism, and attempted vigorous emergency treatment and intensive care including ventilator care, vasopressor drug use, pulmonary artery pressure monitoring. At the 5th day after intensive care unit, she was transferred to general ward and she discharged without any sequelae after 17th day postoperatively.
Anesthesia, General ; Blood Pressure ; Embolism ; Emergency Treatment ; Female ; Femur ; Humans ; Critical Care ; Intensive Care Units ; Middle Aged ; Operating Rooms ; Oxygen ; Patients' Rooms ; Pulmonary Artery ; Pulmonary Embolism* ; Tourniquets ; Ventilators, Mechanical

BACKGROUND: Benign pathologic findings are shown in 800% of thyroid nodules by fine needle aspiration cytology (FNAC) or needle biopsy. About half of these benign nodules are follicular lesions which are presented only as thyroid follicles or thyroid cell clumps. Differential diagnosis of follicular adenoma, follicular carcinoma and adenomatous goiter is impossible by FNAC or needle biopsy. Thyroxine suppression therapy has been performed traditionally in order to discriminate malignant nodules, but few studies are available which confirmed the efficacy of thyroxine suppression therapy in thyroid nodules of those the initial pathologic findings were follicular lesions. So we tried to evaluate the efficacy of thyroxine suppression therapy in benign thyroid nodules and also the incidence of thyroid cancer of the thyroid nosules which were not decreased on thyroxine suppression therapy after surgical resection. METHODS: Total 1027 patients with thyroid nodules were evaluated by FNAC or needle biopsy at Soonchunhyang university hospital from 1990 to 1996. Among 1027 patients, 507 patients showed follicular lesions in FNAC or needle biopsy and they received thyroxine suppression therapy. Thyroid nodule volume was measured before and after thyroxine suppression therapy using ultrasonography. We studied 184 patients who were followed up for more than 1 year. Serial changes of thyroid function tests, thyroid nodule volume, serum thyroglubulin (Tg) level before and after therapy were analyzed. RESULTS: l. In 80 (43.5%) of the 184 patients, nodule volumes decreased more than 50 percent after thyroxine suppression therapy. 2. There was no significant difference in serum T3, T4, TSH levels before and after thyroxine suppression therapy between group I (nodule volume decreased less than 50%) and group II (nodule volume decreased more than 50%). 3. In group II patients, thyroid nodule volumes were decreased continuously at 12 month, 18 month and 30 month after thyroxine suppression (p<0.05). 4. There was no significant difference between the group I and group II in the frequency of multiple thyroid nodules on ultrasonography. 5. Among 37 patients who underwent thyroidectomy, 19 cases (51.4%) were revealed as malignant thyroid nodules (papillary cancer 4 cases, follicular cancer 15 cases). Eighteen cases (48.6%) were revealed as benign thyroid nodules (follicular adenoma 10 cases, adenomatous goiter 8 cases). 6. There was no significant difference in the frequency of multiple nodules on ultrasonography between benign and malignant nodules. CONCLUSION: Our data suggested thyroxine suppression therapy was effective in discriminating malignant thyroid nodules from benign nodules, especially in selecting follicular carcinoma from follicular lesion by FNAC or biopsy.
Adenoma ; Biopsy ; Biopsy, Fine-Needle ; Biopsy, Needle ; Diagnosis, Differential ; Goiter ; Humans ; Incidence ; Thyroid Function Tests ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Thyroidectomy ; Thyroxine* ; Ultrasonography