PURPOSE: The usual technique of temporomandibular joint (TMJ) reduction, recommended by most emergency medicine textbooks, consists of downward forces applied to the mandible. However, it has been the authors' experience that conscious sedation and significant force is required to achieve reduction. For that reason, we designed a new method of TMJ reduction. The purpose of our study is to introduce the new method of TMJ reduction and to compare the traditional method with the new method. METHODS: We performed a prospective, randomized trial with 52 patients who were diagnosed as having a TMJ dislocation. The patients were divided into two groups: the group treated with the traditional method (25 cases) and treated with the new method (27cases). Patients with histories of trauma or inflammatory signs were excluded from this study. The new method is an extraoral approach in which the operator applies the coronoid process on the face in the posteroinferior direction. RESULTS: Age, sex, and history of TMJ dislocation showed no statistical differences between the two groups. Reduction of the TMJ dislocation was achieved in 15 (60.0%) of the traditional method group and in 25 (92.6%) of the new method group (p=0.005). The means of the reduction time were 11.8+/-6.2 sec in the traditional method group and 6.6 +/- 3.3 sec in the new method group (p=0.007). CONCLUSION: The new method was an effective treatment for TMJ dislocation without any sedations. I had a higher success rate and a shorter reduction time than traditional method.
Conscious Sedation ; Dislocations ; Emergency Medicine ; Humans ; Mandible ; Prospective Studies* ; Temporomandibular Joint*

For many years, the histogenesis of the granular cell tumor was controversial and this resulted in the tumor being given more than 20 synonyms. Abrikossoff, reporting on the fiist granular cell tomor, favored a muscle origin, but other authora have postulated a fibroblastic or a histiocytic origin. Recently, the concept of Schwann cell origin, supported by electron microscopic studies and immunohistochemistry of S-100 protein, has gained wider recognition. Approximately 90 cases of esophageal granular cell tumor have been reported in the literature, representing about 2% incidence of all reported granular cell tumor, In Korea, only four cases of granular cell tumors were reported in the literatures including the cases occuring in the cecum, colon, and anus until now. Recently we experienced 46-years old women with granular cell tumor of the esophagus, which might be the second case in Korean literature.
Anal Canal ; Cecum ; Colon ; Esophagus* ; Female ; Fibroblasts ; Granular Cell Tumor* ; Humans ; Immunohistochemistry ; Incidence ; Korea ; Middle Aged ; S100 Proteins

All of the methicillin-resistant Staphylococcus aureus (MRSA) strains exhibit resistance to oxacillin by producing PBP2a encoded by mecA, whereas methicllin-susceptible Staphylococcus aureus (MSSA) strains do not. To investigate phenotypic differences other than oxacillin resistance level in responses to oxacillin between MSSA and MRSA, we compared alterations of viability and ultrastructure of MSSA by oxacillin treatment with those of MRSA. When MSSA and MRSA strains were exposed to oxacillin of their respective MICs, and then were assayed for viability and observed by transmission electron microscope, increase in thickness of cell wall was more prominent in MRSA strains than in MSSA strains, while decrease in number of surviving cells was more evident and change in morphology of growing cross wall was greater in MSSA strains than in MRSA strains. It is assumed that these different responses to oxacillin between MSSA and MRSA strains may be due to activation of some PBP2a unbound to oxacillin. In conclusion, MSSA and MRSA showed different functional and morphological responses to oxacillin, although they were treated with oxacillin of concentrations that respectively inhibit their proliferation.
Adenosine ; Cell Wall ; Electrons ; Methicillin-Resistant Staphylococcus aureus ; Oxacillin ; Staphylococcus aureus

For over a half centry, physicians have suspected that patients with duodenal ulcer are offered an insurance policy against gastric carcinoma. This may be used clinically so that gastric lesion in the presence of duodenal ulcer, are considered benign. However, the duodenal ulcer may coexit with gastric cancer, Although rare in incidence of coexistence of duodenal ulcer and gastric cancer, physician always should be alert in diagnosing of gastric lesion in the presence of the duodenal ulcer. Here, we present 60 years old woman with coexitence of duodenal ulcer and gastric cancer, diagnosed by endoscopy and treated surgically.
Duodenal Ulcer* ; Endoscopy ; Female ; Humans ; Incidence ; Insurance ; Middle Aged ; Stomach Neoplasms*

Coincidental occurrence of the renal cell carcinoma and renal angiomyolipoma in the same kidney is exceedingly rare, and it is usually presented as separated masses or nodules in cage of its occurrence. However, our case which has occurred in a 37-year-old-man without any stigmata of tuberous sclerosis is different because the angiomyolipoma and renal cell carcinoma are admixed in the same mass. To our knowledge, only 2 cases or combination of this tumors have been reported previously.
Angiomyolipoma* ; Carcinoma, Renal Cell* ; Christianity ; Kidney* ; Tuberous Sclerosis

We report a case of spontaneous bilateral intracranial vertebral artery dissecting aneurysms with subarachnoid hemorrhage. One dissecting lesion was treated with a coronary balloon-mounted stent (BMS) technique; however, due to differences in access route tortuosity, the other lesion was treated with a self-expandable stent (SES) technique. After 2 months, the angiographic outcome showed complete healing of the dissected segment on the side that was treated with BMS; in contrast, the dissection lesion appeared to be re-growing on the side that was treated with SES. Complete treatment of the aggravated lesion was achieved by additional deployment of BMSs. Therefore, we have provided a discussion of the possible reasons for this difference in outcome according to the stent type.
Aneurysm ; Aneurysm, Dissecting ; Stents ; Subarachnoid Hemorrhage ; Vertebral Artery ; Vertebral Artery Dissection

We report a case of spontaneous bilateral intracranial vertebral artery dissecting aneurysms with subarachnoid hemorrhage. One dissecting lesion was treated with a coronary balloon-mounted stent (BMS) technique; however, due to differences in access route tortuosity, the other lesion was treated with a self-expandable stent (SES) technique. After 2 months, the angiographic outcome showed complete healing of the dissected segment on the side that was treated with BMS; in contrast, the dissection lesion appeared to be re-growing on the side that was treated with SES. Complete treatment of the aggravated lesion was achieved by additional deployment of BMSs. Therefore, we have provided a discussion of the possible reasons for this difference in outcome according to the stent type.
Aneurysm ; Aneurysm, Dissecting ; Stents ; Subarachnoid Hemorrhage ; Vertebral Artery ; Vertebral Artery Dissection

Wilson's disease typically presents symptoms associated with liver damage or neuropsychiatric disturbances, while endocrinologic abnormalities are rare. We report an unprecedented case of hypopituitarism in a patient with Wilson's disease. A 40-year-old woman presented with depression, general weakness and anorexia. Laboratory tests and imaging studies were compatible with liver cirrhosis due to Wilson's disease. Basal hormone levels and pituitary function tests indicated secondary hypothyroidism and adrenal insufficiency due to hypopituitarism. Brain MRI showed T2 hyperintense signals in both basal ganglia and midbrain but the pituitary imaging was normal. She is currently receiving chelation therapy along with thyroid hormone and steroid replacement. There may be a relationship between Wilson's disease and hypopituitarism. Copper deposition or secondary neuronal damage in the pituitary may be a possible explanation for this theory.
Adrenal Insufficiency/diagnosis/etiology ; Adult ; Brain/diagnostic imaging ; Depression/etiology ; Female ; Hepatolenticular Degeneration/*complications ; Humans ; Hypopituitarism/complications/*diagnosis/drug therapy ; Hypothyroidism/diagnosis/etiology ; Liver Cirrhosis/complications/diagnostic imaging ; Magnetic Resonance Imaging ; Steroids/therapeutic use ; Thyrotropin-Releasing Hormone/therapeutic use

Wilson's disease typically presents symptoms associated with liver damage or neuropsychiatric disturbances, while endocrinologic abnormalities are rare. We report an unprecedented case of hypopituitarism in a patient with Wilson's disease. A 40-year-old woman presented with depression, general weakness and anorexia. Laboratory tests and imaging studies were compatible with liver cirrhosis due to Wilson's disease. Basal hormone levels and pituitary function tests indicated secondary hypothyroidism and adrenal insufficiency due to hypopituitarism. Brain MRI showed T2 hyperintense signals in both basal ganglia and midbrain but the pituitary imaging was normal. She is currently receiving chelation therapy along with thyroid hormone and steroid replacement. There may be a relationship between Wilson's disease and hypopituitarism. Copper deposition or secondary neuronal damage in the pituitary may be a possible explanation for this theory.
Adrenal Insufficiency/diagnosis/etiology ; Adult ; Brain/diagnostic imaging ; Depression/etiology ; Female ; Hepatolenticular Degeneration/*complications ; Humans ; Hypopituitarism/complications/*diagnosis/drug therapy ; Hypothyroidism/diagnosis/etiology ; Liver Cirrhosis/complications/diagnostic imaging ; Magnetic Resonance Imaging ; Steroids/therapeutic use ; Thyrotropin-Releasing Hormone/therapeutic use

BACKGROUND: There is a wide spread increase in the use of CAM by patients with rheumatic disease. This study was performed to identify the prevalence of CAM use and determining factors affecting CAM use by patients with rheumatic disease. METHODS: From October 23 to November 31 in 2003, face-to-face structured interviews were conducted in a rheumatology hospital in Seoul. A total of 182 patients with rheumatic disease, who visited the hospital, participated. RESULTS: CAM was used by 59.3% (95% CI=52.1~66.2%) of the patients with rheumatic disease. The most common use of CAM was traditional Chinese medicine such as acupuncture and herbs. Demographic variables were not predictive for the use of CAM. As the duration of disease was longer, probability on CAM use was lower (odd ratio: 0.922, 95% CI=0.855~0.994). CAM use on disabled people who registered were 4.623 (95% CI=1.105~19.348) times higher than non-disabled. CONCLUSION: CAM use is common in patients with rheumatic disease. The duration of disease and physical disability were the influencing factors for using CAM. These findings support a need for outcome studies on the effectiveness of CAM in rheumatic disease, as well as the improvement of providing patients with information on CAM usage.
Acupuncture ; Complementary Therapies* ; Humans ; Korea* ; Medicine, Chinese Traditional ; Outcome Assessment (Health Care) ; Prevalence ; Rheumatic Diseases ; Rheumatology ; Seoul