We report a case of linear scleroderrna associated with severe musculoskeletal atrophy of Ieft arm or disabling pansclerotic morphea of children. The patient was 11 year-old girl who has 8 years history of linear violaceoushued atrophic plaques on left arm and anterior chest, left sboulder region in a circumscribed sclerotic lesion. She had a history of injury on left forearrn at 3 years of age. One, month later, erythematous swelling and hardening of skin on left hand were developed and then progressed rapidlyfto other area for one year. However there was no signs of dyspnea, dysphagia, Raynauds phenomenon, myalgia, weakness and photcsensitivity. Diagnosis was confirmed by the characteristics of clinical features and histologic findings of skin and muscle and laboratory findings. As a therapeutic trial, low dose D-penicillamine was attempted.
Arm ; Atrophy* ; Child ; Deglutition Disorders ; Diagnosis ; Dyspnea ; Female ; Hand ; Humans ; Myalgia ; Penicillamine ; Scleroderma, Localized* ; Skin ; Thorax ; Upper Extremity*

PURPOSE: This study was aimed to identify gender-based health inequality and explore impacting factors on health inequality in one province in Korea. METHODS: This was an explanatory study using the secondary data on Chungnam province from the Fifth Community Health Survey from August 16 to Oct 31, 2012. Variables included in this analysis were education level, poverty, marital status, and residential community for socio-cultural characteristics and subjective health status as an indicator of health inequality. Data were analyzed by chi2-test, t-test, ANOVA, and multiple linear regression. RESULTS: There were gender inequalities and disparities in health, and these inequalities were greater in woman than in man (chi2=161.8, p<.001). The impacting factors were education level, poverty, marital status, and residential community, which was accounted for 22.6% of variances of health inequality. Among these variables, gender showed the largest influence in health inequalities. CONCLUSION: To solve health inequalities, it should be considered gender differences based on social determinants of health. It is necessary to develop long term project based on these results and the social determinants model of World Health Organization.
Chungcheongnam-do ; Education ; Female ; Health Surveys ; Humans ; Korea ; Linear Models ; Marital Status ; Poverty ; Social Determinants of Health ; Socioeconomic Factors* ; World Health Organization

PURPOSE:We assessed the relationship of indoor aeroallergen specific IgE levels with total IgE level, airway hyperresponsiveness (AHR) and lung function in children with atopic asthma. METHODS:Two hundred twenty-eight children with atopic asthma in Cheongju area were studied. Sera were assayed for total IgE and specific IgE antibodies to important indoor allergens including Dermatophagoides pteronyssinus (Der p), Dermatophagoides farinae (Der f), Alternaria, cats, dogs, and cockroaches. One hundred eighty children sensitized to house dust mites (HDMs) were evaluated for %FEV1 and methacholine PC20. RESULTS:Serum specific IgE to HDMs presented the highest prevalence (90.0% for Der p and 92.7% for Der f), followed by specific IgE to Alternaria (21.6%). A contribution of > 10% of the total was only common for IgE antibody to Der p or Der f. The level of specific IgE to Der p (r=0.677, P<00.001) or Der f (r=0.657, P<00.001) was significantly correlated with total IgE level. Higher level of Der f-specific IgE was associated with higher incidence of AHR and FEV1 decline. CONCLUSION:Concentration of specific IgE antibody produced to HDMs provides an explanation for the higher total IgE levels found in a major portion of children with atopic asthma and has a close relationship with AHR and lung function.
Allergens ; Alternaria ; Animals ; Antibodies ; Asthma ; Cats ; Child ; Cockroaches ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Dogs ; Humans ; Immunoglobulin E ; Incidence ; Lung ; Methacholine Chloride ; Prevalence ; Pyroglyphidae

The functional derangement of skeletal muscles which may be attributed to chronic hypoxia has been accepted as a possible mechanism of exercise impairment in patients with chronic obstructive pulmonary disease (COPD). The metabolc changes in skeletal muscle in patients with COPD are characterized by impaired oxidative phosphorylation early activation of anaerobic glycolysis and excessive lactate and hydrogen ion production with exercise. But the cause of exercise limitation in patients with chronic lung disease without hypoxia has not been known. In order to evaluate the change in the skeletal muscle metabolism as a possible cause of the exercise limitation in chronic lung disease patients without hypoxia, we compared the muscular metabolic data of seven male patients which had been derived from noninvasive 31P magnetic resonance spectroscopy(MRS) with those of five age-matched normal male control persons. 31P MRS was studied during the sustained isometric contraction of the dominant forearm flexor muscles up to the exhaustion state and the recovery period. Maximal voluntatry contraction(MVC) force of the muscle was measured before the isometric exercise, and the 30% of MVC force was constantly loaded to each patient during the isometric exercise. There were no differences of intracellular pH (pHi) and inorganic phosphate/phosphocreatine (Pi/PCr) at baseline, exhaustion state and recovery period between two groups. But pHi during the exercise was lower in patients group than the control group (p<0.05). Pi/PCr during the exercise did not show significant difference between two groups. These results suggest that the exercise limitation in chronic lung disease patients without hypoxia also could be attributed to the abnormalities in the skeletal muscle metabolism.
Anoxia ; Exercise ; Forearm ; Glycolysis ; Humans ; Hydrogen-Ion Concentration ; Isometric Contraction ; Lactic Acid ; Lung Diseases ; Lung* ; Magnetic Resonance Spectroscopy* ; Male ; Metabolism* ; Muscle, Skeletal* ; Muscles ; Oxidative Phosphorylation ; Protons ; Pulmonary Disease, Chronic Obstructive

OBJECTIVES: In recent years, serious concerns have been raised regarding the impacts of rising temperatures on health. The present study was conducted to investigate the relationship between elevated temperatures and kidney disease through a systematic review and meta-analysis. METHODS: In October 2017, 2 researchers independently searched related studies in PubMed and Embase. A meta-analysis was conducted using a random-effects model, including only studies that presented odds ratios, relative risks, or percentage changes, along with 95% confidence intervals (CIs). The characteristics of each study were summarized, and the Egger test and funnel plots were used to evaluate publication bias. RESULTS: Eleven studies that met the criteria were included in the final analysis. The pooled results suggest an increase of 30% (95% CI, 20 to 40) in kidney disease morbidity with high temperatures. In a disease-specific subgroup analysis, statistically significant results were observed for both renal colic or kidney stones and other renal diseases. In a study design–specific subgroup analysis, statistically significant results were observed in both time-series analyses and studies with other designs. In a temperature measure–specific subgroup analysis, significant results were likewise found for both studies using mean temperature measurements and studies measuring heat waves or heat stress. CONCLUSIONS: Our results indicate that morbidity due to kidney disease increases at high temperatures. We also found significant results in subgroup analyses. However, further time-series analyses are needed to obtain more generalizable evidence.
Hot Temperature ; Infrared Rays ; Kidney Calculi ; Kidney Diseases ; Kidney ; Odds Ratio ; Publication Bias ; Renal Colic

Periprosthetic acetabular fracture (PAF) is an uncommon complication following hip arthroplasty. However, as the number of people needing hip prostheses continues to rise, the absolute number of PAF is expected to increase as well. These fractures may occur either intraoperatively or postoperatively. Postoperative fractures can be caused by traumatic events or by pathologic conditions related to periacetabular osteolysis. The management of PAF usually depends on the degree of displacement and the stability of the acetabular component. While most of non-displaced fractures can be managed nonoperatively by protected weight bearing, displaced fractures with unstable implants require surgical intervention, which is often technically challenging. This review summarized the latest findings on the epidemiology, the diagnosis, the classification, and the treatment of PAF.
Acetabulum ; Arthroplasty ; Classification ; Diagnosis ; Epidemiology ; Hip Prosthesis ; Hip ; Osteolysis ; Periprosthetic Fractures ; Weight-Bearing

OBJECTIVES: In recent years, serious concerns have been raised regarding the impacts of rising temperatures on health. The present study was conducted to investigate the relationship between elevated temperatures and kidney disease through a systematic review and meta-analysis. METHODS: In October 2017, 2 researchers independently searched related studies in PubMed and Embase. A meta-analysis was conducted using a random-effects model, including only studies that presented odds ratios, relative risks, or percentage changes, along with 95% confidence intervals (CIs). The characteristics of each study were summarized, and the Egger test and funnel plots were used to evaluate publication bias. RESULTS: Eleven studies that met the criteria were included in the final analysis. The pooled results suggest an increase of 30% (95% CI, 20 to 40) in kidney disease morbidity with high temperatures. In a disease-specific subgroup analysis, statistically significant results were observed for both renal colic or kidney stones and other renal diseases. In a study design–specific subgroup analysis, statistically significant results were observed in both time-series analyses and studies with other designs. In a temperature measure–specific subgroup analysis, significant results were likewise found for both studies using mean temperature measurements and studies measuring heat waves or heat stress. CONCLUSIONS Our results indicate that morbidity due to kidney disease increases at high temperatures. We also found significant results in subgroup analyses. However, further time-series analyses are needed to obtain more generalizable evidence.

BACKGROUND: Preemptive treatment with ketamine, a noncompetitive NMDA antagonist, may prevent establishment of postoperative hypersensitivity by blocking the sensory input that induces the central sensitization. The aim of this study was to determine if continuous preemptive administration of intravenous (IV) ketamine decreases postoperative pain. METHODS: Sixty healthy informed patients scheduled for elective abdominal hysterectomy were randomly divided into two groups of equal size and studied in a double-blind manner. Before surgical incision, patients were given 1 mg/kg of ketamine or equal volume of saline followed by IV infusion of 0.01 mg/kg/min, which was discontinued at peritoneal closure. IV morphine patient-controlled analgesia (PCA) was started in all patients at peritoneal closure. Visual analogue scale (VAS) pain scores and total morphine consumption were recorded at 1, 3, 6, 9, 12, 24, 36, and 48 hours postoperatively. RESULTS: VAS pain scores at rest were significantly less in the ketamine group than in the saline group at 1, 3, 24, 36, and 48 hr postoperatively. VAS at moving status were less in the ketamine group at 1, 3, 12, 24, 36, 48 hr postoperatively. Patients in the ketamine group had significantly lower morphine consumption throughout the study period, about 20-50% reduction in postoperative total morphine was observed. Only ketamine group experienced severe headache (10 cases), while there were no intergroup differences in other side effects such as pruritus, bad dream, and backache. CONCLUSION: These results suggest that preemptive continuous IV ketamine decreases postoperative pain intensity and IV morphine requirement, and its action lasts longer than the normal expected duration of action of ketamine.
Analgesia, Patient-Controlled ; Back Pain ; Central Nervous System Sensitization ; Dreams ; Headache ; Humans ; Hypersensitivity ; Hysterectomy ; Ketamine* ; Morphine ; N-Methylaspartate ; Pain, Postoperative ; Pruritus

Superior vents lava(SVC) syndrome is mostly related to a malignant process, but many different benign causes haute also been described. We report a case of SVC syndrome caused by Klebsiella pneumonia diagnosed by sputum culture and serial chest X-ray changes. A 27-year-old man had been in stable health until three days before admission, when he complained of pleuritic chest pain, facial flushing, and shortness of breath. Examination of the head and neck disclosed edema of face and both arms, and jugular venous distention to the angle of the jaw. The chest auscultation resealed decreased breath sound without crackle on right upper lung field. The chest roentgenogram showed homogenous air space consolidation on right upper lobe, asociated with downward displacement of minor fissure and contralateral displacement of trachea, but air bronchogram was not seen. We began antibiotic therapy under impression of pneumonia after assailable culture was taken from blood and sputum. SVC scintigraphy showed stasis of drain of right brachiocephalic vein at the proximal portion with reflux into the right internal jugular vein and faintly visible SVC via the collaterals. Sputum culture resealed Klebsiella pneumoniae. Antibiotic therapy resulted in a cure of infection and disappearance of facial swelling. Follow-up SVC scintigraphy after 20 days showed normal finding. We first report a case of SVC syndrome caused by klebsiella pneumonia
Adult ; Arm ; Auscultation ; Brachiocephalic Veins ; Chest Pain ; Dyspnea ; Edema ; Flushing ; Follow-Up Studies ; Head ; Humans ; Jaw ; Jugular Veins ; Klebsiella pneumoniae ; Klebsiella* ; Lung ; Neck ; Pneumonia* ; Radionuclide Imaging ; Respiratory Sounds ; Sputum ; Superior Vena Cava Syndrome* ; Thorax ; Trachea ; Vena Cava, Superior*

PURPOSE: The purpose of this article is to analysis undiagnosed HIV-positive patients in the Emergency Room (ER). We expect these analysis to be of help in preventing exposure to HIV and in making a diagnosis effectively. METHODS: A retrospective analysis by chart review was carried out on 8 unrecognized HIV patients who had been admitted to the ward via the ER from December 2000 to August 2002. RESULTS: The results were as follows: 1) The chief complaints were fever with mental change, dyspnea, hemiparesis, dyspnea with fever, chronic diarrhea with fever, abdominal discomfort, and dyspnea with fever and vertigo. 2) The 8 patients all had AIDS as well as other diseases. 3) The reasons for the anti-HIV test were continuous fever of unknown origin (FUO) 33.3%, chest X-ray abnormality 20.0%, VDRL (Venereal Disease Research Laboratory) test positive 13.3%, pre-operation screening blood test 13.3%. The rest were due to MRI (magnetic resonance image) abnormality, intraabdominal tuberculosis, and Cryptococcus in cerebrospinal fluid and comprised 6.7% of the total. CONCLUSION: We recommend that an anti-HIV test be given in the ER for patients who have FUO, infiltration of both lungs in the chest X-ray and a VDRL positive in serum. We also recommend that an anti-HIV test be given in the ER for patients with suspected HIV-related encephalopathy, tuberculosis, Pneumocystis carinii pneumonia, recurrent pneumonia, and progressive multi-focal leukoencephalopathy.
Cerebrospinal Fluid ; Cryptococcus ; Diagnosis ; Diarrhea ; Dyspnea ; Emergencies* ; Emergency Service, Hospital* ; Fever ; Fever of Unknown Origin ; Hematologic Tests ; HIV ; Humans ; Leukoencephalopathies ; Lung ; Magnetic Resonance Imaging ; Mass Screening ; Paresis ; Pneumonia ; Pneumonia, Pneumocystis ; Retrospective Studies ; Thorax ; Tuberculosis ; Vertigo