No abstract available.
Fetal Death*

Hemorrhagic fever with renal syndrome (HFRS) is a symptom complex of fever, chill, myalgia, hemorrhagic diathesis and acute renal failure. We experienced a case of non-oliguric HFRS associated severe thrombocytopenia. Peripheral blood smear showed large atypical lymphocytosis and hemophagocytic histiocytes on bone marrow aspiration. Hantaan virus antibody titer was 1:5,120. Congo-red stain after potassium permanganate treatment of bone marrow biopsy revealed yellow-green birefringence and immunohistochemistry for AA amyloid antibody showed weak positive staining in the stroma of the bone marrow. Herein, we report a case of unusual HFRS associated with secondary amyloidosis and review the literature.
Acute Kidney Injury ; Amyloid ; Amyloidosis* ; Biopsy ; Birefringence ; Bone Marrow ; Fever ; Hantaan virus ; Hemorrhagic Disorders ; Hemorrhagic Fever with Renal Syndrome* ; Histiocytes ; Humans ; Immunohistochemistry ; Lymphocytosis ; Myalgia ; Potassium Permanganate ; Thrombocytopenia

Diaphragm injuries are very important because, if both thoracic and abdominal viscera are damaged, a combination of shock and acute respiratory distress may develop. It can be highly lethal. This evaluation was based on the reviews of 17 cases of traumatic diaphragm injuries treated at the Department of Cardiovascular Surgery, Seoul Adventist Hospital during 5 years from March 1993 to February 1997. The mean age of the patients was 37.2 years and sex ratio was 3.2:1 with male dominance. Blunt trauma(N=5, Rt.=4, Lt.=1) was 29.5%, penetrating trauma(N=12, Rt.=5, Lt.=7) was 70.5%. Dyspnea(76%) was the most common symptom. Blunt trauma(9.8 3.7 Cm) was larger than the penetrating trauma(3.2 1.3 Cm)(P<0.05) in the size(mean SD) of the injury. All of the patients had associated injuries and repaired immediatley with thoracic approach 11 cases(64%), abdominal approach 3 cases(18%) and thoracoabdominal approach 3 cases(18%). 5 cases of penetrating diaphragmatic trauma was diagnosed on the operation of other organ injury. Now we suggest that diaphragmatic injury should be suspected in all patients with penetrating as well as blunt injury of the chest and abdomen to protect the patient from its late complications.
Abdomen ; Diaphragm ; Humans ; Male ; Seoul ; Sex Ratio ; Shock ; Thorax ; Viscera ; Wounds, Nonpenetrating

PURPOSE: To compare the ratio of renal cortical thickness to renal parenchymal thickness in early diabetic nephropathy and in normal control group. MATERIALS AND METHODS: We performed spiral CT in 17 patients suffering from diabetic nephropathy without renal failure or renal atrophy. The normal control group consisted of 19 persons who were normal on renal function test and did not show any abnormality of the kidney. Renal cortical and parenchymal thicknesses were measured at renal hilum level perpendicular to the renal surface by electronic caliper on contrast-enhanced transverse scan demonstrating the cortical nephrogram phase. Using student's test, the difference in renal parenchymal and cortical thickness between the two groups was tested for statistical significance. RESULTS: There was no significant difference in renal parenchymal thickness between the two groups(P>0.05) ; the patient group had a thicker renal cortex than the normal control group however (P<0.05). The ratio of renal cortical thickness to parenchymal thickness in early diabetic nephropathy patients(Rt.:0.041+/-0.051, Lt.:0.382+/-0.053) was significantly higher than in the normal control group (Rt.:0.331+/-0.067, Lt.:0.323+/-0.064). CONCLUSION: The kidney of early diabetic nephropathy patients had a thicker renal cortex than normal kidney.
Atrophy ; Diabetic Nephropathies* ; Humans ; Kidney ; Renal Insufficiency ; Tomography, Spiral Computed*

PURPOSE: To compare the ratio of renal cortical thickness to renal parenchymal thickness in early diabetic nephropathy and in normal control group. MATERIALS AND METHODS: We performed spiral CT in 17 patients suffering from diabetic nephropathy without renal failure or renal atrophy. The normal control group consisted of 19 persons who were normal on renal function test and did not show any abnormality of the kidney. Renal cortical and parenchymal thicknesses were measured at renal hilum level perpendicular to the renal surface by electronic caliper on contrast-enhanced transverse scan demonstrating the cortical nephrogram phase. Using student's test, the difference in renal parenchymal and cortical thickness between the two groups was tested for statistical significance. RESULTS: There was no significant difference in renal parenchymal thickness between the two groups(P>0.05) ; the patient group had a thicker renal cortex than the normal control group however (P<0.05). The ratio of renal cortical thickness to parenchymal thickness in early diabetic nephropathy patients(Rt.:0.041+/-0.051, Lt.:0.382+/-0.053) was significantly higher than in the normal control group (Rt.:0.331+/-0.067, Lt.:0.323+/-0.064). CONCLUSION: The kidney of early diabetic nephropathy patients had a thicker renal cortex than normal kidney.
Atrophy ; Diabetic Nephropathies* ; Humans ; Kidney ; Renal Insufficiency ; Tomography, Spiral Computed*

BACKGROUND: We addressed the problem of the circadian changes in neural control of the circulation in ambulant hypertensive subjects. With spectral analysis of heart rate variability the tonic sympathetic and vagal activities and their changes are respectively assessed by the power of 0.050 - 0.015Hz(low frequency, LF) and 0.150 - 0.350Hz(respiratory linked, high frequency, HF) components of the spectrum of the beat by beat variability of RR interval. METHODS: Heart rate variability(HRV) and its circadian rhythm were evaluated in 15 patients with hypertension. By using 24-h Holter monitoring, HRV and its spectral components were measured. Finding were compared with 15 age-matched normal controls. RESULTS: The 24-hour plot of the SDs revealed that heart rate variability was significantly lower in the hypertensive patients, and the differences reached statistical significance during hours 2, 3, 9, 13, 16, 18, 19, and 23(p<0.05). Spectral analysis showed that power in the high-frequency range(0.150 to 0.350Hz) was lower among the hypertensive patients than among the normal controls during 22 of 24 hours but that the difference was statistically significant only during 2 hours(p<0.05). Power in the low frequency range(0.050 to 0.150Hz) was low at night, increased in the morning, and high during the day among controls ; this circadian rhythm was absent among hypertensive patients. CONCLUSIONS: Among hypertensive patients, HRV is decreased with a partial withdrawal of parasympathetic tone, and the circadian rhythm of sympathetic/parasympathetic tone is altered.
Circadian Rhythm ; Electrocardiography, Ambulatory ; Heart Rate ; Humans ; Hypertension

Most reports on serious MTX toxicity have focused on hepatic abnormalities, while other effects, including hematologic reactions, have not been emphasized. We experienced a case of pancytopenia secondary to MTX therapy in a patient with RA and renal insufficiency. A 67-year-old woman with a 12-year history of active seropositive RA that was a response to non-steroidal anti-inflammatory drugs, hydroxychloroquinine and intra-articular steroid injections, had been followed up and was diagnosed as early chronic renal failure in October, 1993. Recently, because of significant morning stiffness and polyarthralgia, the decision was made to institute MTX treatment. This was begun as a single oral dose of 5mg/week. After 2 doses, the patient was admitted to the hospital with general weakness. Laboratory tests showed a hemoglobin level of 7.9 g/dl, WBC count 1800/mm3 and platelet count of 64000/mm3. The serum creatinine level was 6.1 mEq/dl and the BUN level was 82 mEq/dl. Liver function test results were normal, but the serum albumin level was 2.7 g/dl. The patient subsequently developed fever and blood transfusions, granulocyte colony stimulating factor (G-CSF) and intravenous prophylactic antibiotic therapy were required. Her condition was improved. In summary, Low-dose MTX-related adverse hematologic side effects, including fatal pancytopenia, are rare but are a cause of increasing concern in patients with RA and renal insufficiency. Close monitoring of associated risk factors, particularly impaired renal function, should be mandatory for all patients who are receiving MTX therapy.
Aged ; Antirheumatic Agents/adverse effects* ; Antirheumatic Agents/administration & dosage ; Arthritis, Rheumatoid/drug therapy ; Arthritis, Rheumatoid/complications ; Case Report ; Female ; Human ; Kidney Failure, Chronic/complications ; Methotrexate/adverse effects* ; Methotrexate/administration & dosage ; Pancytopenia/chemically induced* ; Risk Factors

OBJECTIVES: The purpose of this article is to analyze the incidence, demographic distribution, type, and etiology of mandible fractures that were treated by the Department of Oral and Maxillofacial Surgery in Kyung Hee University Dental Hospital from January 2002 to December 2012. MATERIALS AND METHODS: This was a descriptive and analytic retrospective study that evaluated 735 patients that were treated for mandible fracture. RESULTS: This study included 1,172 fractures in 735 patients. The ratio of male to female patients was 5.45 : 1; the maximum value was in patients between 20 and 29 years (38.1%) and the minimum in patients over 70 years old. The monthly distribution of facial fractures peaked in the fall and was lower during winter. No specific correlation was identified based on the annual fracture distribution. Among the 735 fracture patients, 1.59 fracture lines were observed per patient. The most frequent site was the symphysis, which accounted for a total of 431 fractures, followed by the angle (348), condyle (279), and body (95). The symphysis with angle was the most common site identified in combination with fracture and accounted for 22.4%, followed by symphysis with condyle (19.8%). The angle was the most frequent site of single fractures (20.8%). The major cause of injury was accidental trauma (43.4%), which was followed by other causes such as violence (33.9%), sports-related accidents (10.5%), and traffic accidents (10.1%). Fracture incidents correlated with alcohol consumption were reported between 10.0%-26.9% annually. CONCLUSION: Although mandible fracture pattern is similar to the previous researches, there is some changes in the etiologic factors.
Accidents, Traffic ; Alcohol Drinking ; Female ; Humans ; Incidence ; Jaw Fractures ; Male ; Mandible* ; Mandibular Fractures ; Retrospective Studies* ; Surgery, Oral ; Violence

BACKGROUND: Rapid and accurate diagnosis is essential for successful management of acute aortic dissection. As transesophageal echocardiography(TEE) provides excellent imaging of thoracic aorta conveniently, TEE is widely indicated as a effective diagnostic method of aortic disease. To evaluate clinical usefulness of TEE in patients with suspected aortic dissection, we assessed diagnostic accuracy and feasibility of TEE. METHODS: Ninety-one consecutive patients with clinically suspected aortic dissection were examined by TEE, computerized tomography(CT), magnetic resonance imagion(MRI) and aortic angiography between August 1991 and September 1994. The diagnosis was confirmend by these techniques and surgery. RESULTS: 1) We diagnosed 27 proximal aortic dissection, 22 distal aortic dissection, 8 aortic intramural hematioma, 12 thoracic aortic aneurysm, 2 penetration ulcer, 1 necrotizing aortitis, 1 traumatioc aortic rupture and 18 normal findings in 91 study patients. 2) The sensitivity and specificity of TEE for aortic dissection were 98% and 97%, respecitively. The sensitivity and specificity of TEE to detect ascending aorta involvement were 94% and 100%. 3) CT was chosen in 62 cases as primary diagnostic method of aortic dissection, whereas TEE was performed in 21 cases. TEE was chosen as confirmative diagnostic method following CT in 45 cases, in one-third of whom TEE played a great role in diagnosis or decision of treatment modality. CONCLUSION: As TEE is and accurate and practical method in diagnosis of aortic dissection, TEE may be suggested as primary diagnostic method in suspected aortic dissection. TEE was also useful as confirmative diagnostic method complemention CT.
Angiography ; Aorta ; Aorta, Thoracic ; Aortic Aneurysm, Thoracic ; Aortic Diseases ; Aortic Rupture ; Aortitis ; Complement System Proteins ; Diagnosis* ; Echocardiography, Transesophageal* ; Humans ; Sensitivity and Specificity ; Ulcer

We present a case of orthotopic liver transplantation in 63 year-old female patient with liver cirrhosis, who is the record of the oldest recipient in Korea. The donor was 20 year-old male patient with subarachnoidal hemorrhage. The operation time was 12 hours. The duration of cold ischemic time and anhepatic phase were 8 hours and 85 minutes respectively. After operation the patient resumed clear consciousness. The ventilator was weaned and removed. On the third postoperative day, reoperation was required due to hemoperitoneum. Splenectomy was performed for a tearing in the hilum. After reoperation, acute renal failure and sepsis developed. Continous arteriovenous hemofiltration was continued for 3 weeks. The patient was discharged on postoperative 59th day. The patient is doing well with normal liver function. No episode of acute rejection occurred until now. More aggressive approach has been feasible in organ transplantation for older patients by advanced knowledge of perioperative management. We conclude that age over 60 years should not be a barrier to liver transplantation.
Acute Kidney Injury ; Cold Ischemia ; Consciousness ; Female ; Hemofiltration ; Hemoperitoneum ; Hemorrhage ; Humans ; Korea* ; Liver Cirrhosis ; Liver Transplantation* ; Liver* ; Male ; Middle Aged ; Organ Transplantation ; Reoperation ; Sepsis ; Splenectomy ; Tissue Donors ; Transplants ; Ventilators, Mechanical ; Young Adult