BACKGROUND: Insulin resistance syndrome shows extreme insulin resistance and is associated with acanthosis nigricans. We can differentiate it into type A insulin resistance that has insulin receptor defect, and type B insulin resistance due to insulin receptor autoantibody. Type B insulin resistance was firstly described by Kahn in 1976. It was often found in adult female and showed autoimmune characteristics. As clinical characteristics, there are hyperglycemia, hypoglycemia, hyperinsulinemia, extreme insulin resistance and acanthosis nigricans. METHODS: We investigated 17 insulin receptor autoantibody positive cases and 8 cases of normal control who had visited Wonju Christian Hospital from October 1994 to December 1995. Among insulin receptor autoantibody positive subject, male was 4 cases and female 13 cases. Their mean age was 42.2. We compared patients who had insulin receptor antibody positive acanthosis nigricans(IRA) with normal controls. IRA patients were 6 cases(35.3%) of nomal glucose tolerance, 11 cases(64.7%) of abnormal glucose tolerance including overt diabetes mellitus. RESULTS: The 11 cases(64.7%) among IRA patrents were obese and 13 cases(76.5%) had hyperininsulinemia. In IRA patients, mean serum insulin concentration during oral glucose tolerance test was 202.1mU/mL and it was greater than 46.3 of normal controls. Insulin sensitivity in 1.79mg/L * mM * xmU * min normal controls was higher than 0.74mg/L * mM * min of IRA patients. CONCLUSION: IRA patients showed abnormal glucose tolerance including overt diabetes millitus, severe insulin resistance, hyperinsulinemia and obesity.
Acanthosis Nigricans* ; Adult ; Diabetes Mellitus ; Female ; Gangwon-do ; Glucose ; Glucose Tolerance Test ; Humans ; Hyperglycemia ; Hyperinsulinism ; Hypoglycemia ; Insulin Resistance ; Insulin* ; Male ; Obesity ; Receptor, Insulin*

OBJECTIVES: This study was carried to investigate the prevalence and odds ratio of work related musculoskeletal disorders according to the job classification in small-to-medium-sized enterprises(<300 employee). METHODS: A questionnaire survey was given to 746 workers in 8 workplaces. 501 workers (67.2%) were finally selected in this study. The workers in the 8 workplaces was divided into 7 jobs. Those were manufacturers(metal), assemblers(appliances), cashiers, packers(cosmetics), garbage collectors, and VDT workers. Multiple logistic regression was used to estimate the odds ratios of the musculoskeletal symptoms according to the job classification. RESULTS: Univariate analysis showed that the significantly related risk factors for musculoskeletal symptoms are as follows; age, marital status, gender, work load change, work duration, hours worked per day, job demand, decision latitude, type of job. According to the type of job, the prevalence of musculoskeletal symptoms were 7.7%(clerks), 24.3%(manufacturers), 30.0%(assemblers), 23.0%(cashiers), 30.4%(packers), 11.9%(garbage collectors), 29.2%(VDT workers). Multiple logistic regression showed that the following significant odds ratios (referenceclerks): 7.32(packers), 5.63(assemblers), 5.11(cashiers), 4.79(VDT workers), 3.11(manufacturers). CONCLUSION: In small-to-medium-sized enterprises, the job classification was major risk factor for work related musculoskeletal disorders. According to the job classification, the odds ratios of the work related musculoskeletal disorders were different. Considering the odds ratios, the establishment of a prevention program of work related mus-culoskeletal disorders is recommended.
Classification* ; Garbage ; Logistic Models ; Marital Status ; Odds Ratio* ; Prevalence ; Questionnaires ; Risk Factors

No abstract available.
Emphysema* ; Tuberculosis*

Primary hypothyroidism can result in reactive enlargement of the pituitary gland which is indistinguishable from primary pituitary lesions in clinical presentation and on magnetic resonance imaging. A 17-year-old girl came to the hospital due to short stature, general weakness and galac-torrhea. The magnetic resonance imaging (MRI) study showed pitutary enlargement. The hormone study showed hyperprolactinemia, decreased basal growth hormone level and primary hypothyroi-dism. By thyroid replacement therapy only, mass was successfully regressed on follow up MRI after 4 months, and growth acceleration could be achieved.
Acceleration ; Adolescent ; Female ; Follow-Up Studies ; Growth Hormone ; Humans ; Hyperplasia* ; Hyperprolactinemia ; Hypothyroidism* ; Magnetic Resonance Imaging ; Pituitary Gland ; Thyroid Gland

We treated 550 ureteral calculi patients with stone basket or Candela MDL-l laser lithotripter using the rigid ureteroscope(URS) between April 1988 and November 1993. The laser lithotripsy was applied for the patients who had failed URS stone removal with stone basket. The success rates of URS stone removal with stone basket were 33.7%(120/356) in the lower ureter stones, 1.7%(2/112) in the mid, none(0/82) in the upper. The laser lithotripsy rates and success rates were 63.4%(226/356), 99.5%(225/226) in the lower ureter, 90.1%(101/112), 85.1%(86/101) in the mid, 79.2%(65/82), 80%(52/65) in the upper, respectively. The total URS stone removal success rates were 96.9%(345/356) in the lower ureter, 78.6%(88/112) in the mid, 63.4 %(52/82) in the upper. There were 65 failures due to upward migration(27 cases), approach failure to stone by URS (35 cases), no fragmentation(3 cases). Ureterolithotomy was required in 8 cases and shockwave lithotripsy in 11 cases and retry in 22 cases. The complication of URS were minimal, gross hematuria (11.2%), pain(9.5%) and infection (1.6%). Ureteral perforation occurred in only 10 patients. In conclusion, laser lithotripsy has been significantly contributed improving of success rates and expanding of applying area for URS stone removal in our series.
Hematuria ; Humans ; Lithotripsy ; Lithotripsy, Laser ; Ureter ; Ureteral Calculi

Most obviuos will be the several anatomic differences between the proximal femur of the child and the adult. Fractures of the femoral neck in the children are extremely rsre and usually are the result of severe trauma in 80% of the cases. This accounts for the high frequency of serious associated injuries. In this injury the vascular anatomy changing with age, continuing growth potential and the effect of deforming forces play critical roles in high complication rate and these make treatment difficult. But still any secure guidelines for the treatment of this injury are not established and this is a field which requires more active research and further progress in future. 26 cases treated at Paik Hospital from Jan. 1979 to June 1988 were analyzed in clinical and radiological aspect and the following results were obtained. 1. The commonest type was Cervicotrochanteric fracture in 13 cases(50%),displaced one 21 cases. 2. In Transepiphyseal, Transcervical and Cervicotrochanteric fracture by early reduction and internal fixation, and in Intertrochanteric fracture by conservative treatment we gained satisfactory results. 3. We experienced 2 cases of coxa vara in nonthreaded pin used cases, 4 cases of premature epiphseal closure and 4 cases of avascular necrosis in threaded pin used ones. 4. Complications were developed in 13 cases (50%). These were 5 cases of coxa vara(19.2%) 4 cases of premature epiphyseal closure (15.4%) and 4 cases of avascul necrosis (15.4%). 5. Avascykar necrosis was developed in displaced fracture of Transcervical or Cervico- trochanteric fracture beyond postoperative 1 year. So. we recommend periodic long follow up for evaluation of avascular necrosis.
Adult ; Child ; Clinical Study ; Coxa Vara ; Femur ; Femur Neck ; Follow-Up Studies ; Hip ; Humans ; Necrosis

The bone marrow biopsy is an integral part of the staging process in patients with malignant lymphomas. Bone marrow(BM) involvement indicates stage IV disease, but there are always a lot of cases in which clear separation is not possible when based on morphology alone. Additional difficulties are caused by morphologic discordance between the BM and the primary lymphoma. Immunohistochemical stain, mRNA in situ hybridization (ISH) for light chain restriction and polymerase chain reaction (PCR) for IgH CDR3 and TCRgamma were performed to find a minimal lesion and the clonality in formalin fixed paraffin embedded tissues of 39 primary lymphomas and corresponding BM biopsy specimens. As a result, nine morphologically negative bone marrows of 18 lymphomas were positive by PCR (Group I). Among the 6 lymphoma cases with morphologically suspicious BM involvement (Group II), one was confirmed to be positive for marrow involvement by both mRNA ISH and PCR and the other four by PCR alone. The positive bone marrows of Group I and II revealed gene rearrangement at the same site as the primary lesion, suggesting the same clonality. Thirteen of 15 lymphomas with morphologically positive BM (Group III) had the same clonality in the primary lymphomas and the BM lesion. Three cases among the Group III with morphologic discordance also revealed the same clonality by PCR. This study shows that a combination of mRNA ISH and PCR in addition to an immunohistochemical stain improves the diagnostic sensitivity in the detection of BM involvement and identification of clonality. Among the three different methods used, PCR is the most sensitive in detecting a minimal lesion.
Biopsy ; Bone Marrow ; Formaldehyde ; Gene Rearrangement ; Humans ; In Situ Hybridization ; Lymphoma* ; Paraffin ; Polymerase Chain Reaction ; RNA, Messenger

The coronary artery fistula from right coronary artery to left ventricle is a rare disease among coronary artery anomaly. We experienced three cases of rare coronary fistula and report with literature review. Although symptoms of coronary artery fistula are associated with arteriovenous shunt and coronary steal phenomenon, many cases are asymptomatic. In this report, all patients had no symptom. but incidental murmur was noted (two are continuous, one is diastolic rumbling). The diagnosis was made by transthoracic or transesophageal echocardiogram and selective coronary angiography. Because patients were relatively young and the diameter of dilated coronary artery were huge, we perfomed operation on three patients.
Coronary Angiography ; Coronary Vessels* ; Diagnosis ; Fistula* ; Heart Ventricles* ; Humans ; Rare Diseases

Since 1949, lithium has been widely used for treatment of manic depressive disorder. It has also been used for agranulocytosis after anticaneer chemotherapy and partially for hyperthyroidism. But it is well known that the long term administration of this drug is associated wih various antithyroid effects such as hypothyroidism, simple goiter, nodules and even thyrotoxicosis. Although the exact mechanism for leading hypothyroidism or goiter is still unknown, the incidence of lithium-induced hypothyroidism is 1-37% during lithium atment. We had an experience of newly developing goiter with or without hypothyroidism during lithium treatment in 4 MDP patients. Among our patients, the duration of lithium administration was from 0.7 months to 11 years, and the development of thyroid abnormality was impossible to predict. They were treated with thyroxine while lithium was discontinued causing favorable outcome. We suggest that routine thyroid function test include thyroid autoimmune antibody screening in patients planning to undergo lithium treatment.
Agranulocytosis ; Antithyroid Agents ; Depressive Disorder ; Drug Therapy ; Goiter* ; Humans ; Hyperthyroidism ; Hypothyroidism ; Incidence ; Lithium Carbonate* ; Lithium* ; Mass Screening ; Thyroid Function Tests ; Thyroid Gland ; Thyrotoxicosis ; Thyroxine

Down syndrome is perhaps the most common genetic condition associated with mental retardation. In cytogenetic examination, trisomy 21 is in 95% of Down syndrome, and the others are mosaicism, translocation or deletion. There are many associated diseases with Down syndrome such as, thyroid function abnormality, congenital heart disease, intestinal blockage, and so on. Hypothyroidism appeared in 15% before adolescent in Down syndrome patients. In Korea, there were several reports of Down syndrome with hypothyroidism in childhood but not in adulthood. And we had three cases of hypothyroidism with Down syndrome in adulthood. Cytogenetic examination revealed trisomy 21 in the 2 cases and 1 case of mosaicism. Antithyroid antibody was positive in one case. None of these cases was admitted due to symptoms of hypothyroidism. It is very difficult to make the diagnosis of hypothyroidism in Down syndrome because of similarity in symptoms between Down syndrome and hypothyroidism. Thus, periodic thyroid function test should be made in Down syndrome, and this could be a part of improving quality of life in Down syndrome.
Adolescent ; Adult* ; Congenital Abnormalities ; Cytogenetics ; Diagnosis ; Down Syndrome* ; Heart Diseases ; Humans ; Hypothyroidism* ; Intellectual Disability ; Korea ; Mosaicism ; Quality of Life ; Thyroid Function Tests ; Thyroid Gland