OBJECTIVE: To compare the effects of raloxifene alone with a combination of raloxifene and fluoride in postmenopausal osteoporosis on bone mineral density, bone turnover and lipid profiles, at 2 year. METHOD: Fifty two women with postmenopausal osteoporosis (T-score < 2.5) were studied. Subjects were divided into two groups; Group I (n=23), treated with raloxifene and fluoride, and Group II (n=29), treated with raloxifene alone. Bone mineral density (BMD) at the lumbar spine and femur, osteocalcin, deoxypyridinoline and lipid profiles were measured at baseline and 2 years after treatment. RESULTS: BMD at the lumbar spine was increased in two groups, and BMD in Group I was increased more than that in Group II. Osteocalcin was increased in Group I, and was decreased in Group II. Deoxypyridinoline was decreased in two groups. Total cholesterol and LDL cholesterol were decreased in two groups, but HDL cholesterol and triglyceride showed no significant change in two groups. There were no significant differences between two groups in lipid profiles. CONCLUSION: The combined therapy with raloxifene and low- dose intermittent fluoride was more effective in postmenopausal women with osteoporosis than raloxifene alone, which would not influence on positive effect of raloxifene for lipid metabolism.
Bone Density ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Female ; Femur ; Fluorides* ; Humans ; Lipid Metabolism ; Osteocalcin ; Osteoporosis* ; Osteoporosis, Postmenopausal ; Raloxifene Hydrochloride* ; Spine ; Triglycerides

Two of the common causes of hypercalcemia are malignancy and primary hyperparathyroidism. These disorders are easily diagnosed by the clinical manifestations and measurement of the serum intact parathyroid hormone (PTH) level. On the other hand, hyperthyroidism is an uncommon cause of hypercalcemia. The diagnosis of hypercalcemia associated with hyperthyroidism can only be made by excluding the common causes of hypercalcemia and by observing the improvement of the hypercalcemia and its associated symptoms with normalizing the thyroid function. Herein we reported our experience with a 67 year-old woman who presented with nausea and vomiting. She showed elevated serum calcium and phosphorus levels. Serum intact PTH level was 1.1 pg/mL (normal range; 10~65). The results of the thyroid function test were compatible with hyperthyroidism. After resolution of the thyrotoxicosis with combination treatment of methimazol and Lugol's solution, the patient's serum calcium and phosphorus levels were normalized and the symptoms were improved.
Aged ; Calcium ; Diagnosis ; Female ; Graves Disease ; Hand ; Humans ; Hypercalcemia* ; Hyperparathyroidism, Primary ; Hyperphosphatemia ; Hyperthyroidism* ; Nausea ; Parathyroid Hormone ; Phosphorus ; Thyroid Function Tests ; Thyroid Gland ; Thyrotoxicosis ; Vomiting

OBJECTIVE: This is a study to evaluate relationships between the occurrence of lymphedema and clinicopathologic factors in postmastectomy patients. METHOD: We studied 448 patients who underwent breast cancer surgery during the periods from January 1998 to December 2000, of which 69 patients developed lymphedema during the follow up period. We investigated the medical records of these follow-up patients. The general characteristics were tested by a chi-square test and student t-test and the possible risk factors were comparatively analyzed on these patients by a multiple logistic regression analysis. RESULTS: The incidence of lymphedema was significantly high with higher stages (p<0.05). The incidence of lymphedema was significantly high in higher N staging, but not in higher T staging. Patients who received radiation therapy also showed higher incidence rates (p<0.05). Patients who underwent Patey procedure showed higher incidence than those who underwent Auchincloss procedure. With increasing age, more lymphedema developed (p<0.05). CONCLUSION: These results suggest that the stage of tumor, state of lymph node metastasis, methods of surgical treatment, use of irradiation, and patient's age are the possible risk factors for the development of lymphedema. These risk factors might be useful as clinical indices for the prevention of postmastectomy lymphedema. So, we have to exert our efforts to minimize the development of lymphedema.
Breast Neoplasms* ; Breast* ; Follow-Up Studies ; Humans ; Incidence ; Logistic Models ; Lymph Nodes ; Lymphedema* ; Medical Records ; Neoplasm Metastasis ; Risk Factors*

OBJECTIVE: To investigate the changes of bone mineral density (BMD), biochemical bone markers, and lipid profiles after combination therapy of continuous hormonal replacement therapy (c-HRT) and alendronate in postmenopausal osteoporosis. METHOD: We studied 89 women with postmenopausal osteoporosis (T-score<2.5) who visited at Department of Rehabilitation Medicine, Kosin Medical Center from August 1999 to March 2001. Subjects were divided into two groups; Group I (n=40), treated with estrogen and alendronate (10 mg/day), and Group II (n=49), treated with estrogen alone. BMD at the lumbar spine and femur, osteocalcin, urine deoxypyridinoline and lipid profiles were measured at baseline and 1-year after treatment. RESULTS: 1) BMD at the lumbar spine increased significantlyin two groups, and BMD in Group I increased significantly more than that in Group II. But, change of BMD on femoral neck was not significantly different. 2) Biochemical bone markers (osteocalcin and urine deoxypyridinoline) decreased significantly in two groups. 3) Total cholesterol and LDL cholesterol decreased significantly in two groups, but HDL cholesterol and triglyceride showed no significant change in two groups. There was no significant differences between two groups in lipid profiles. CONCLUSION: We concluded that combination therapy with c- HRT and alendronate in postmenopausal osteoporosis was more effective than c-HRT, which would not influence on positive effect of estrogen for lipid metabolism.
Alendronate* ; Biomarkers* ; Bone Density* ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Estrogens* ; Female ; Femur ; Femur Neck ; Humans ; Lipid Metabolism ; Osteocalcin ; Osteoporosis, Postmenopausal* ; Rehabilitation ; Spine ; Triglycerides

We performed this study to investigate the possible association between vitamin D receptor (VDR) gene polymorphism and the focal bone erosion in rheumatoid arthritis (RA) patients in Korea. One hundred and fifty-seven RA patients were enrolled and two control groups were selected. The focal bone erosion score was assessed by modified Sharp's method. Genotyping of VDR polymorphisms was performed by polymerase chain reaction and restriction fragment length polymorphism analysis using two restriction enzyme Taq I and Bsm I. Notably, the distribution of VDR genotype in Korean population was different from Caucasians. The frequencies of "tt" and "BB" genotypes were very rare both in RA patients and in control groups. The frequency distribution of the Taq I and Bsm I genotype was not different between RA patients (TT, 93.6%; Tt, 6.4%; tt, 0%; BB, 0.6%; Bb, 5.1%; bb, 94.3%) and control groups (TT, 90.8%; Tt, 7.5%; tt, 1.7%; BB, 1.4%; Bb, 8.1%; bb, 90.5%). There was no significant difference in the focal bone erosion score (mean+/-SD) according to the VDR genotypes of RA patients (TT, 0.92+/-1.79; Tt, 0.4+/-0.79; Bb, 0.43+/-0.80; bb, 0.92+/-1.79; p>0.05). In conclusion, these results suggest that VDR gene polymorphisms are not associated with the focal bone erosion in RA patients in Korea.
Adolescence ; Adult ; Aged ; Aged, 80 and over ; Arthritis, Rheumatoid/*genetics/*pathology ; Bone and Bones/*pathology ; Female ; Genotype ; Human ; Linkage Disequilibrium ; Male ; Middle Age ; *Polymorphism (Genetics) ; Receptors, Calcitriol/*genetics

Carbamazepine is widely used to manage of seizures and symptomatic treatment of trigeminal neuralgia and central pain. We experienced two cases of exceedingly rare but potentially fatal side effects following carbamazepine administration. One traumatic brain injured patient developed pancytopenia 3 weeks after beginning to take carbamazepine for prophylactic management of seizure and the other C6 incomplete spinal cord injured patient receiving carbamazepine for the management of central pain sequentially developed syndrome of inappropriate secretion of antidiuretic hormone (SIADH) 1 week after administration. Because of more frequent indications of carbamazepine, these side effects must be borne in mind and cautious administration will be desirable.
Brain ; Carbamazepine* ; Humans ; Inappropriate ADH Syndrome* ; Pancytopenia* ; Seizures ; Spinal Cord ; Trigeminal Neuralgia

OBJECTIVE: To investigate the changes of bone mineral density (BMD), biochemical bone markers, and lipid profiles according to the duration of menopause in postmenopausal osteoporosis patient receiving continuous hormonal replacement therapy (c-HRT). METHOD: Sixty seven patients with postmenopausal osteoporosis who have been under c-HRT for more than two years were used as subjects and divided into two groups according to the time past menopause: group I (0~10 years), group II (over 10 years). The changes of BMD, biochemical bone markers, lipid profiles on one year and two years of c-HRT were comparatively analyzed in each group. RESULTS: 1) BMD of lumbar vertebra was increased and biochemical bone markers were decreased after c-HRT in both groups, but BMD of femur from both groups showed no statistical significant changes. 2) The changes in lumbar vertebra, deoxypyridinoline and osteocalcin were significantly higher after first one year than next one year of c-HRT in both groups, with no statistical differences between two groups. 3) Total cholesterol and LDL-cholesterol were decreased, but HDL-cholesterol and triglyceride showed no significant changes after c-HRT in both groups. CONCLUSION: The effects of c-HRT on BMD, biochemical bone markers, lipid profiles were not influenced by postmenopausal period. And the effects of c-HRT during first one year were more prominent than those of c-HRT during next one year.
Bone Density* ; Cholesterol ; Female ; Femur ; Humans ; Menopause* ; Osteocalcin ; Osteoporosis ; Osteoporosis, Postmenopausal ; Postmenopause ; Spine ; Triglycerides

OBJECTIVE: To determine whether estradiol (E2), lipid profile, biochemical markers, and bone mineral density (BMD) are related according to postmenopausal period. METHOD: One hundred fifty four women were divided into four groups according to the time past menopause: group I (0~5 years), group II (6~10 years), group III (11~15 years), group IV (more than 16 years). Group I, II, III were subdivided into osteoporosis group (t-score< 2.5) and non-osteoporosis group (t-score> or = 2.5). E2, lipid profile, osteocalcin, alkaline phosphatase, deoxypyridinoline, and BMD by DEXA were measured in all groups. RESULTS: There were significant inverse correlation between BMD and postmenopausal period (p<0.05). Deoxypyridinoline and osteocalcin were correlated with postmenopausal period but there was no statistical significance. Deoxypyridinoline and osteocalcin were increased in osteoporosis group compared to non-osteoporosis group but there was no statistical significance. E2 had significant inverse correlations with postmenopausal period (p<0.05). E2 had no correlation with factors such as biochemical markers and lipid profile in group I, II, III but had adverse correlation with deoxypyridinoline in group IV. CONCLUSION: No specific biochemical markers regarding the duration of menopause were found. Regardless of the duration of menopause, checking both osteocalcin and deoxypyridinoline was statistically significant for the evaluation of postmenopausal osteoporosis.
Alkaline Phosphatase ; Biomarkers* ; Bone Density* ; Estradiol* ; Female ; Humans ; Menopause ; Osteocalcin ; Osteoporosis ; Osteoporosis, Postmenopausal ; Postmenopause*

A 45-year-old man with a long history of nephrotic syndrome presented with low back pain and progressive weakness of both legs for one day. Physical examination showed an acutely ill-appearing patient with a loss of both femoral artery pulses. Immediate digital subtraction angiography of abdominal aorta revealed total occlusion of the distal abdominal aorta. Transvascular embolectomy using urokinase was undertaken 6 hours later. Digital subtraction angiography after embolectomy revealed both common ilicac arteries to be patent with good distal flow. Electrodiagnostic examinations (post embolectomy 5th and 45th day) revealed peripheral polyneuropathy of both lower extremity. Anticoagulation therapy was continued and the patient was discharged several months later. During this period, there was improvement in both lower limbs from power of grade 1 to 4 except for both ankle dorsiflexors which had not recovered. We report a rare case of peripheral ischemic polyneuropathy of both lower extremities as the result of acute abdominal aortic occlusion.
Angiography, Digital Subtraction ; Ankle ; Aorta, Abdominal ; Arteries ; Embolectomy ; Femoral Artery ; Humans ; Leg ; Low Back Pain ; Lower Extremity ; Middle Aged ; Nephrotic Syndrome ; Physical Examination ; Polyneuropathies* ; Urokinase-Type Plasminogen Activator

BACKGROUND: Pulmonary infiltrate in immunocompromised hosts has many infectious and non- infectios etiologies. To evaluate the diagnostic yield and therapeutic implication of two invasive diagnostic methods, such as bronchoscopy and surgical lung biopsy, we performed retrospective analysis of these patients. METHODS: All immunocompromised patients admitted to Samsung Medical Center from October 1995 to August 1998 who underwent bronchoscopy and/or surgical lung biopsy for the diagnosis of pulmonary infiltrates were included in this study. Confirmative diagnostic yield, the rate of changed therapeutic plan and patients' survival were investigated. RESULTS: Seventy-five episodes of pulmonary infiltrates developed in 70 patients(M : F = 46 : 24, median age 51). Underlying diseases of patients were hematologic malignancy(n=30), organ transplantatio n(n=11), solid tumor(n=12), connective tissue disease(n=6) and others. Confirmative diagnosis was made in total 53 cases (70.7%), of which 70.2% had infectious etiology. Diagnostic yields of bronchoscopy, bronchoalveolar lavage(BAL), transbronchial lung biopsy(TBLB) and surgical lung biopsy were 35.0%(21/60), 31.4%(16/51), 25.0%(9/36) and 80.0%(20/25). Therapeutic plan was changed in 40%(24/60) of patients after bronchoscopy and in 36%(9/25) of patients after surgical lung biopsy. More patients survived (84.4% vs 60.5%, p=0.024) when therapeutic plan was changed after invasive diagnostic study. CONCLUSION: Bronchoscopy and surgical lung biopsy are helpful for the therapeutic implication of pulmonary infiltrates in immunocompromised hosts. Large-scale prospective case-control study may further clarify their limitation and usefulness.
Biopsy* ; Bronchoscopy* ; Case-Control Studies ; Connective Tissue ; Diagnosis* ; Humans ; Immunocompromised Host* ; Lung* ; Retrospective Studies