Spontaneous renal rupture with diversion of blood into the subcapsular and/or perinephric spaces in a patient on chronic hemodialysis is a rare clinical entity. The underlying causes found by various authors were tumours, vascular diseases, inflammatory process and cysts. Rupture of renal cysts is another complication that can be life-threatening when it gives rise to subcapsular and/or perinephric hematomas. Screening has been recommended with ultrasound for hemodialysis patients of longer than 3years'duration. We are report a case of spontaneous renal rupture associated with right renal cyst in a patient receiving chronic hemodialysis.
Hematoma ; Humans ; Mass Screening ; Renal Dialysis* ; Rupture* ; Ultrasonography ; Vascular Diseases

Spontaneous renal rupture with diversion of blood into the subcapsular and/or perinephric spaces in a patient on chronic hemodialysis is a rare clinical entity. The underlying causes found by various authors were tumours, vascular diseases, inflammatory process and cysts. Rupture of renal cysts is another complication that can be life-threatening when it gives rise to subcapsular and/or perinephric hematomas. Screening has been recommended with ultrasound for hemodialysis patients of longer than 3years'duration. We are report a case of spontaneous renal rupture associated with right renal cyst in a patient receiving chronic hemodialysis.
Hematoma ; Humans ; Mass Screening ; Renal Dialysis* ; Rupture* ; Ultrasonography ; Vascular Diseases

OBJECTIVES: Alcohol withdrawal delirium is a serious clinical condition with high mortality rate if not treated. This study was to examine whether readily available clinical variables can predict the development of alcohol withdrawal delirium. METHODS: The authors performed a retrospective study by reviewing charts of 566 patients who had been admitted for alcohol dependence. The cases were divided into two groups: delirium group (n=40) and control group (n=40). We compared baseline characteristics and serum analysis data at admission between two groups. We used logistic regression to predict risk factors for alcohol withdrawal delirium among potential risk factors. RESULTS: The delirium group had significantly lower hemoglobin, hematocrit, platelet counts, and potassium level than countrol group. Presence of previous withdrawal delirium history, AST, GGTP, and bilirubin level of delirium group were significantly higher than those of control group. Among potential risk factors, past history of withdrawal delirium, decreased hemoglobin, elevated bilirubin level, and number of previous detoxification were predictable factors of the development of alcohol withdrawal delirium by 72.5%. CONCLUSION: Our results suggest that the infomation obtained at admission can be useful to predict the development of alcohol withdrawal delirium. Also, it makes the individualization of detoxification strategies possible.
Alcohol Withdrawal Delirium* ; Alcoholism ; Bilirubin ; Delirium ; gamma-Glutamyltransferase ; Hematocrit ; Humans ; Logistic Models ; Mortality ; Platelet Count ; Potassium ; Retrospective Studies ; Risk Factors

OBJECTIVES: Alcohol withdrawal delirium is a serious clinical condition with high mortality rate if not treated. This study was to examine whether readily available clinical variables can predict the development of alcohol withdrawal delirium. METHODS: The authors performed a retrospective study by reviewing charts of 566 patients who had been admitted for alcohol dependence. The cases were divided into two groups: delirium group (n=40) and control group (n=40). We compared baseline characteristics and serum analysis data at admission between two groups. We used logistic regression to predict risk factors for alcohol withdrawal delirium among potential risk factors. RESULTS: The delirium group had significantly lower hemoglobin, hematocrit, platelet counts, and potassium level than countrol group. Presence of previous withdrawal delirium history, AST, GGTP, and bilirubin level of delirium group were significantly higher than those of control group. Among potential risk factors, past history of withdrawal delirium, decreased hemoglobin, elevated bilirubin level, and number of previous detoxification were predictable factors of the development of alcohol withdrawal delirium by 72.5%. CONCLUSION: Our results suggest that the infomation obtained at admission can be useful to predict the development of alcohol withdrawal delirium. Also, it makes the individualization of detoxification strategies possible.
Alcohol Withdrawal Delirium* ; Alcoholism ; Bilirubin ; Delirium ; gamma-Glutamyltransferase ; Hematocrit ; Humans ; Logistic Models ; Mortality ; Platelet Count ; Potassium ; Retrospective Studies ; Risk Factors

OBJECTIVE: To explore the association of p53 codon 72 polymorphism with endometriosis. METHODS: Two hundred seventy-one women with surgically or histologically diagnosed edometriosis of stage I-IV, and 219 patients with no evidence of endometriosis by laparoscopy or laparotomy served as control. Allele frequencies and genotype distribution of p53 polymorphisms (arginine homozygosity, heterozygosity, and proline homozygosity) in affected women and controls were evaluated. RESULTS: The genotype distributions of p53 codon 72 polymorphisms did not differ significantly between endometriosis group and control group (p=0.086). However, the genotype distributions of p53 codon 72 polymorphisms differ significantly between stage I-II endometriosis group and control group (p=0.043). Proline homozygotes had higher risk for stage I-II endometriosis compared to arginine homozygotes (odds ratio=2.75, p=0.013). CONCLUSION: These results suggest that proline homozygote of p53 codon 72 polymorphism is associated with the risk of minimal or mild stage of endometriosis in the Korean population.
Arginine ; Codon* ; Endometriosis* ; Female ; Gene Frequency ; Genotype ; Homozygote ; Humans ; Laparoscopy ; Laparotomy ; Proline

BACKGROUND: As part of medicine's shift in emphasis toward primary patient care, clinical curriculum is very important in the education of medical students. There are excellent opportunities for general learning of clinical skills especially in dermatological clinical clerkship course. OBJECTIVE: The purpose of this study is to evaluate the dermatological clerkship with questionnaire by students. We would like to find out and look into the way how to improve the clerkship course. METHODS: 103 students filled in well-structured questionnaires after they had finished a 2 week-clinical clerkship course of Department of Dermatology. The questionnaire consisted of overall evaluation of clinical clerkship, of subtypes of clinical clerkship course, and the way how to evaluate students. After finishing the clinical clerkship course, 10 students were interviewed with the results of the questionnaire. RESULTS: Most students were generally pleased with the didactic quality of clerkship. The course of observation of outpatient clinic among various subtypes of clinical clerkship were favored most by the students. The newly developed educational contents revealed not to be properly used. Faculty activity was also scored to be better than average. The test for clinical clerkship was regarded a little difficult to the students. CONCLUSION: The evaluation of didactic quality of clinical clerkship seems very important in the improvement of medical education. The development of the more valid and reliable questionnaire is needed. The overall evaluation of clerkship by various perspectives such as students, faculties, patients and institutions will provide more improvement of quality of clerkship at Dermatology department.
Ambulatory Care Facilities ; Clinical Clerkship ; Clinical Competence ; Curriculum ; Dermatology* ; Education ; Education, Medical ; Humans ; Learning ; Patient Care ; Surveys and Questionnaires ; Students, Medical

BACKGROUND: The associations between angiotensinogen M235T polymorphism and essential hypertension or ischemic stroke are still controversial. The aims of this study were to observe the associations of the angiotensinogen M235T polymorphism with hypertension or ischemic stroke, and to elucidate whether angiotensinogen M235T polymorphism was related to ischemic stroke itself or to hypertension. METHODS: We analyzed a particular polymorphysm in exon 2 of the angiotensinogen gene, a threonine to methionine substitution at position 235 (M235T), by a polymerase chain reaction in sixty patients with symptomatic ischemic stroke, one hundred patients with hypertension, and one hundredcontrol subjects without cardiovascular risks. Cardioembolic stroke was excluded. RESULTS: The three groups differed with respect to age and sex, but not total cholesterol, low-density lipoprotein, triglyceride, or body mass index. However, the distribution of angiotensinogen M235T genotypes was not different among the ischemic stroke group, hypertensive group, and control subjects. The TT genotype of angiotensinogen M235T was not significantly associated with ischemic stroke or hypertension (adjusted odds ratio (OR) = 1.02, 95% confidence interval (CI), 0.44 to 2.41, adjusted OR = 0.74, 95% CI=0.41 to 1.33, respectively), adjusting for age and sex. CONCLUSIONS: We found no significant associations between the angiotensinogen 235T alleles and hypertension or ischemic stroke in the Korean population. (J Korean Neurol Assoc 19(1):24~28, 2001
Alleles ; Angiotensinogen* ; Body Mass Index ; Cholesterol ; Exons ; Genes, vif ; Genotype ; Humans ; Hypertension ; Lipoproteins ; Methionine ; Odds Ratio ; Polymerase Chain Reaction ; Stroke* ; Threonine ; Triglycerides

The treatment for full thickness skin defect with the full or split-thickness autograft was often associated with aesthetically poor result, hypertrophic scar or extensive injury on donor site. Because of this donor morbidity, the use of artificial dermis was considered, which was the substrate of collagen or collagen cross-linked with polyglactin or polylactin. Unfortunately this substrate was void of advantages for the artificial dermis but was of easy biodegradability, antigenicity, or cytotoxic property. Currently chitosan is given attention by many investigators for its biochemical properties in wound healing process. Chitosan is the deacetylated derivative of chitin, which is a polymer of 2-amino-2-deoxy glucose with chemically active free amino group. Chitosan facilitates wound healing process, and then stimulates migration of polymorphonuclear cell(PMN) and macrophage, release of IL-8 and accelerates collagen synthesis surely with vascularization. Indeed chitosan supplies the resistance against bacterial infection of the wound. In this study, we have investigated the clinical applicability of the artificial dermal substrate which is cross-linked of collagen and GAG with chitosan, which we have applied on the full thickness skin defect in Fisher rat. The conclusions are as the follows: 1. There was sufficient vascularization in the grafted dermal substrate for STSG after 2 weeks of artificial dermis grafting. 2. Four 4 weeks after artificial dermis grafting, the architecture of the dermal substrate was maintained in about half amounts and the half of dermal skeleton was replaced with the newly formed dermis(neodermis). In conclusion, the dermal substrate used in this study is available enough for wound of full thickness skin defect.
Animals ; Autografts ; Bacterial Infections ; Chitin ; Chitosan ; Cicatrix, Hypertrophic ; Collagen ; Dermis ; Equipment and Supplies ; Glucose ; Humans ; Interleukin-8 ; Macrophages ; Polyglactin 910 ; Polymers ; Rats ; Research Personnel ; Skeleton ; Skin ; Tissue Donors ; Transplants ; Wound Healing ; Wounds and Injuries

Vigabatrin (VGB) is one of the most frequently prescribed new anti-epileptic drugs in the world since 1989. It has minimal side effects and fewer drug interactions with other anti-epileptic drugs. Recently, concern of the prevalence and pathophysiology of visual impairment with VGB has been increased since the reports of visual field constriction in patients treated with VGB. We report a 46-year-old man with a visual field defect who has been suffering from complex partial seizures for 29 years. Brain magnetic resonance image (MRI) and electroencephalogram (EEG) were non-specific. The frequency of seizures was about 5 times a month for the past 5 years. VGB, in a dose of 1500 mg/day, was prescribed as an add on drug in addition to carbamazepine. 19 months after VGB treatment, the patient complained of visual dimness especially in the lower half of the visual field. He expressed it as "waving". He had no metabolic derangement. Fundus examination, visual evoked potential, and electroretinogram showed normal findings. A visual field analysis showed a bilateral field defect in the lower half. A follow up visual field analysis, 6 months after the withdrawal of VGB, revealed a slight improvement of visual field defects which were noted without significant clinical improvement. This case implicates that visual field defects due to VGB may be partially reversible.
Brain ; Carbamazepine ; Constriction ; Drug Interactions ; Electroencephalography ; Evoked Potentials, Visual ; Follow-Up Studies ; Humans ; Middle Aged ; Prevalence ; Seizures ; Vigabatrin* ; Vision Disorders ; Visual Fields*

OBJECTIVE: This study was performed to compare the clinical response to controlled ovarian hyperstimulation (COH) of in vitro fertilization and embryo transfer (IVF-ET) according to the size of baseline ovarian cyst. METHOD: From February 1992 to March 1999, a retrospective analysis was done of 272 cases who underwent COH using mid-luteal phase long protocol of gonadotropin-releasing hormone agonist (GnRH-a) for IVF-ET. These cases were divided into four group; group 1 (n=63) had cysts with mean diameters between 20.2 and 29.0 mm on their baseline ultrasound on cycle day 3, group 2 (n=57, 30.0~49.0mm), group 3 (n=68, >50.0mm) and control group (n=84). Cases were excluded according to the following criteria; pure male factor infertility, the presence of only one ovary, high CA-125 level and previous endometriosis. RESULTS: There were no statistically significant differences between cases with baseline ovarian cyst <50.0 mm in diameter and control group in any of the parameters. However, cases with baseline ovarian cyst>50.0 mm in mean diameter needed more amount of human menopausal gonadotropin (hMG), showed significantly lower estradiol (E2) level, the number of follicle >15.0 mm on the day of human chorionic gonadotropin (hCG) administration, the number of oocytes retrieved, the number of mature oocytes, and pregnancy rate compared with control group. CONCLUSION: This study suggests that cases with baseline overian cyst <50.0 mm in diameter do not adversely impact on IVF-ET outcome. However, cases with baseline ovarian cyst >50.0 mm in diameter had adverse effects on various parameters. Therefore, to improve the outcome of IVF-ET in these cases, ovarian cyst aspiration prior to initiating COH may be required.
Chorionic Gonadotropin ; Embryo Transfer* ; Embryonic Structures* ; Endometriosis ; Estradiol ; Female ; Fertilization in Vitro ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Humans ; Infertility ; Male ; Oocytes ; Ovarian Cysts* ; Ovary ; Pregnancy Rate ; Retrospective Studies ; Ultrasonography