High dose intravenous gammaglobuline (IVLG) therapy is effective in some of the autoimmune diseases. Although the exact mechanism of action of IVIG is uncertain, the action as a neutralizing antibody against unknown etiologic agents, the action of blocking of Fc receptors of effector cells, or the action as a antiidiotypic antibody are suggested. We report a case of 12 year old girl with systemic juvenile rheumatoid arthritis who was treated with high dose IVIG and got a remission. In August 1990 she was admitted to our hospital. because of intermittent fever, transient rash and multiple arthralgia. Under the diagnosis of systemic juvenile rheumatoid arthritis, aspirin (4.0g/day) had been given with symptom improvement. She was readmitted in October 1990 because of aspirin intoxication and acute fulminant hepatitis. She was discharged after recovery and any medicine was not prescribed. In November 1990 she was admitted because of epigastric pain, vomiting, intermittent fever, multiple arthritis, and mild hepatomegaly. Total parenteral alimentation had been given under the diagnosis of superior mesenteric artery syndrome and gold sodium thiomalate (Myochrysine, 5 and 10 mg, two weekly IM injection) was given in conjunction with prednisolone (30 mg/day) and naproxen (375 mg/day). She was admitted again in February 1991 due to the fever, coughing, rash, and hepatosplenomegaly. Pneumonia and leukopenia (2100/mm(3)) were found and gold sodium thiomalate injection was discontinued. Gammaglobulin 1 g/kg/day was given intravenously for 2 consecutive days with dramatic symptom improvement. Five more monthly IV gammaglobulin had been given and the side reaction of injection were nausia, fever, and headache which were controlled by the decrease of infusion rate. Four months after the last IVIG injection she had no symtom of arthritis and the hepatosplenomegaly was decreased. Hemoglobin level was increase to 12.2 mg/dL form 6.2mg/dL and ESR was decrease to 15mm/h. The oral prednisolne and ibuprofen were stopped one year after th last IVIG injection. All the laboratory parameters of arthritis and physical examinations had been normal for more than two year after the stop of all the medications until March of 1994. We suggest that high dose intravenous gammaglobulin can be one of treatments for severe systemic juvenile rheumatoid arthritis.
Antibodies, Neutralizing ; Arthralgia ; Arthritis ; Arthritis, Juvenile ; Aspirin ; Autoimmune Diseases ; Child ; Cough ; Diagnosis ; Exanthema ; Female ; Fever ; Gold Sodium Thiomalate ; Headache ; Hepatitis ; Hepatomegaly ; Humans ; Ibuprofen ; Immunoglobulins, Intravenous ; Leukopenia ; Naproxen ; Physical Examination ; Pneumonia ; Prednisolone ; Receptors, Fc ; Superior Mesenteric Artery Syndrome ; Vomiting

A 55-year-old female experienced acute left shoulder pain without specific trauma. Radiography showed calcific deposits in the inferior part of the glenoid fossa. Magnetic resonance arthrography showed calcific deposits in the origin of the long head of triceps brachii muscle. Conservative treatment failed to resolve the symptoms; therefore, arthroscopic surgery was performed. The patient experienced immediate and dramatic pain relief, and normal shoulder motion was demonstrated 1 year after surgery. In conclusion, although rare, calcific tendinitis of the triceps brachii muscle, which causes shoulder pain, should be included in the differential diagnosis of acute shoulder pain. Arthroscopic surgery is a treatment option for chronic cases and those resistant to conservative treatment.
Arthrography ; Arthroscopy ; Diagnosis, Differential ; Female ; Head* ; Humans ; Middle Aged ; Radiography ; Shoulder ; Shoulder Joint ; Shoulder Pain ; Tendinopathy*

A retrospective study was conducted to investigate the effects of CNS prophylaxis with 1,800 cGy cranial irradiation on standing height growth of children with acute lymphoblastic leukemia (ALL). Seventeen longterm survivors (DFS over 5 years ) of ALL and Non-Hodgkins Lymphoma who had been admitted at pediatric department of Inje University Seoul Paik Hospital from January 1982 to September 1988 were studied. The long term survivors were divided into two groups by prophylactic treatment modality; intrathecal chemotherapy alone (Group I, 7 cases), intrathecal chemotherapy with cranial irradiation (Group II, 10 cases). The heights of each groups were compared normal standard growth of the sane aged children by mean SD score (The SD score was calculated with the use of the following formula). SD score=(x-x)/SD (x; height measurement, x; mean height for age of the normal population SD; standard deviation). The results were as follows; 1) The mean SD scores of Group I and Group II at diagnosis were -0.30 and -0.17, which were smaller than height of normal child. 2) In Group 1, the mean SD scores after the end of treatment were -0.14 of 1 year, 0.03 at 2 years and 0.01 at 5 years, which suggests that were normal height velocity and catch-up growth in these patients (P<0.05). The height of 1 year after the beginning of treatment were particularly smaller than that of the normal children (P<0.05). 3) The mean SD scores 5 years after the end of treatment were 0.10 in Group I and -0.17 in Group II, which shows strong tendency to statistical difference among these two groups. If larger numbers of patients are evaluated, it, however, may turn significant. In conclusion, 1,800 cGy cranial irradiation in ALL children significantly affects on height growth. We recommend to evaluate growth hormone for patient with 1,800 cGy cranial irradiation and to treat them with growth hormone.
Child* ; Cranial Irradiation* ; Diagnosis ; Drug Therapy ; Growth Hormone ; Humans ; Lymphoma, Non-Hodgkin ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Retrospective Studies ; Seoul ; Survivors

Syringomyelia was described by Etienne, Morgagni and Santorini in 1594 for the first time and was named by Olliver in 1824. In spite of hundreds of years study, it's cause is still not distinctly known and symptoms are very much variable because of its wide, irregular lesion in the spinal cord. The patient of 34 years old male had been suffered from sensory and temperature dissociation and muscle weakness of lower extremity including lower trunk for two years. In case of classical syringomyelia, sense of pain and temperature were diminished on the same area but this patient had complained disturbance of pain and light touch on the same area, but temperature loss does not coincides with, as figure shows. This report will review syringomyelia of lumbosacral type with a case history and references which is relatively rare in incidences.
Humans ; Incidence ; Lower Extremity ; Male ; Muscle Weakness ; Spinal Cord ; Syringomyelia

The cataract extraction in vitrectomized proliferative diabetic retinopathy(PDR) may be different from the ordinary non-vitrectomized patients in several points. We tried to know what`s the problems during the operation, how`s the visual outcomes and the postoperative complications in these eyes. In 18 previously vitrectomized PDR patients(25 eyes), we performed the extracapsular cataract extraction(ECCE) in 7 eyes and the phacoemulsification in 18 eyes. The intraoperative problems were insufficient dilation of pupil, unstability of (anterior and posterior) chamber depth, and difficulty in removal of cortex, which is firmly adherent to the posterior lens capsule. Opacity of posterior lens capsule, elevation of intraocular pressure, exudative pupillary membrane, posterior synechia and corneal edema were the major postoperative complications. In 22 eyes(88%), the visual acuity was increased more than 2 lines, Cataract extraction was easier and less postoperative complications these cases.
Cataract Extraction* ; Cataract* ; Corneal Edema ; Diabetic Retinopathy* ; Humans ; Intraocular Pressure ; Membranes ; Phacoemulsification ; Postoperative Complications ; Pupil ; Visual Acuity

STUDY DESIGN: Surgically treated thirty-five Denis type B thoracolumbar and lumbar burst fractures were assessed to compare the differences of fracture patterns by the level of fracture. OBJECTIVE: To know the major surgical indications according to the level of fracture. SUMMARY OF BACKGROUND DATA: General operative indications of thoracolumbar and lumbar burst fractures were collapse of anterior body height more than 40-50%, kyphotic deformity more than 30 degrees, canal encroachment more than 50% and neurologic deficit. But we could not apply the same surgical indications to the whole thoraco]embar and lumbar burst fractures because their fracture patterns are different. METHODS: We compared the collapse of anterior body height, collapse of posterior body height, Cobb angle, wedge angle, canal encroachment and incidence of posterior injury according to the level of fracture. RESULTS: The higher the level of fracture, the more the collapse of anterior body height, Cobb angle, wedge angle and incidence of posterior injury But the lower the level of fracture, the more the canal encroachment. CONCLUSIONS: These results mean that the primary surgical indications for thoracolumbar junction are collapse of anterior body height, possibility of posterior injury and increased kyphosis, while for the lower lumbar fractures, amount of canal encroachment is an important factor to make decision for surgery.
Body Height ; Congenital Abnormalities ; Incidence ; Kyphosis ; Neurologic Manifestations

No abstract available.
Korea* ; Lung Neoplasms* ; Lung*

A case of low-grade endometrial stromal sarcoma resembling ovarian sex-cord tumor in the uterus of a 43-year-old woman is described. This tumor belongs to the group II category of uterine tumors resembling ovarian sex-cord tumor described by Clement and Scully, and the epithelial-like elements show prominent smooth muscle differentiation, proved by immunoreactivity for desmin and actin. The patient did not receive any adjuvant therapy; she is alive and well without recurrence 8 months postoperatively.
Female ; Humans

No abstract available.
Diagnosis, Differential*

Small cell osteosarcoma is a rare form of osteosarcoma and the histological differential diagnosis from other small round cell tumors (SRCTs) is difficult. The immunohistochemical stain for MIC2 has been considered an useful diagnostic marker for Ewing's sarcoma and primitive neuroectodermal tumors but recently, other SRCTs such as malignant lymphoma and embryonal rhabdomyosarcoma also showed positive reaction. Therefore, the usefulness of MIC2 must still be proven. We experienced a case of small cell osteosarcoma of the mandible in a 25-year-old man. Histologically, the tumor consisted of small round cells that resembled those of Ewing's sarcoma. Immunohistochemically, the tumor cells expressed diffuse strong positive reaction for MIC2 gene products. However, the scanty foci of lacy osteoid material between the tumor cells seemed to be diagnostic of osteosarcoma. The histologic and immunohistochemical findings of this case suggest close relationship between small cell osteosarcoma and Ewing's sarcoma.
Adult ; Diagnosis, Differential ; Humans ; Lymphoma ; Mandible ; Neuroectodermal Tumors, Primitive ; Osteosarcoma* ; Rhabdomyosarcoma, Embryonal ; Sarcoma, Ewing*