The proliferating trichilemmal cyst is a rare, usually benign tumor of external root sheath origin. About 90% of the cases gccur on the scalp, with the residual 10% occurring mainly on the back. More than 80% of the patients are women, most of whom are elderly. The cysts are commonly large, measuring up to 6 cm or more in diameter. A 33-year-old woman visited our department with a history of a matchhead- sized erythematous tender papule on her left knee that had been present for two years. A histopathological examination revealed a well-circumscribed, multilobulated cystic tumor with trichilemmal keratinization in the dermis. There were individual cell keratinization and focal calcification in some areas. This case was diagnosed as a proliferating trichilemmal cyst. This case was very unusual not only because the tumor occurred on the knee as a matchhead-sized papule but also because of her young age at presentation.
Adult ; Aged ; Dermis ; Female ; Humans ; Knee ; Scalp

Cytomegalovirus (CMV)-associated esophageal ulcer is rare in immunocompetent infants. The presence of inclusion bodies and immunohistochemical staining for CMV in biopsy specimens obtained during esophagogastroduodenoscopy (EGD) indicate that such ulcers occur because of CMV infection. A 7-week-old female infant who experienced frequent vomiting and feeding intolerance was diagnosed with a massive CMV-associated ulcer in the distal esophagus. The ulcer improved after conservative treatment using proton-pump inhibitors; however, ganciclovir was not administered. In a follow-up EGD biopsy specimen, no CMV inclusion bodies were present, and immunohistochemical staining results for this virus were negative. The presence of CMV inclusion bodies indicates active viral replication. If persistent inclusion bodies or positive immunohistochemical staining for CMV is observed in follow-up biopsy specimens, ganciclovir may be used to treat CMV-associated esophageal ulcers.
Biopsy ; Cytomegalovirus ; Endoscopy, Digestive System ; Esophagus ; Female ; Follow-Up Studies ; Ganciclovir ; Humans ; Inclusion Bodies ; Infant ; Ulcer ; Viruses ; Vomiting

PURPOSE: Liquid beta emitter filled in angioplasty balloon could be used to perform endovascular balloon brachytherapy to prevent coronary artery restenosis. We investigated the dosimetry for Re-188-DTPA liquid-filled balloon and medical internal radiation dosimetry in case of balloon leakage. MATERIALS AND METHODS: We estimated radiation dose from an angioplasty balloon (20 mm lengfh, 3 mm diameter cylinder) to the adjacent vessel wall using Monte Carlo EGS4 code. We obtained time-activity curves of kidneys in normal dog and calculated Tmax, T1/2. Using MIRDOSE3 program, we estimated absorbed doses to the major organs (kidneys, bladder) and the whole body when we assumed that balloon leaked all the isotope contained. RESULTS: The radiation dose was 17.5 Gy at the balloon surface when we applied 3,700 MBq/ml of Re-188 for 100 seconds. Fifty percent of the energy deposited within 1 mm from the balloon surface. The estimated internal dose to the whole body was 0.005 mGy/MBq and 18.5 mGy for the spillage of 3,700 MBq of Re-188. CONCLUSION: We suggest that Re-188-DTPA can be used for endovascular balloon brachytherapy to inhibit coronary artery restenosis after angioplasty with tolerable whole body radiation dose in case of balloon rupture.
Angioplasty* ; Animals ; Brachytherapy* ; Coronary Vessels ; Dogs ; Kidney ; Radiometry ; Rupture ; Whole-Body Irradiation

PURPOSE: Serum prealbumin concentration has been proposed as a useful nutritional marker that responds rapidly and sensitively to calory and protein intake. But the reports of prealbumin in premature infants are not sufficient and variable. The purpose of this study was to evaluate the usefulness of serum prealbumin concentration as a marker for nutritional adequacy in premature infants. METHODS: From March to September, 2000, 42 premature infants in NICU were studied. All infants were appropriate for gestational age and had neither evidence of congenital anomalies nor surgeries. The change of serum prealbumin levels according to postnatal age and the correlation between gestational age, anthropometric measurements, nutritional intake(calory-protein), and serum prealbumin and albumin concentration were evaluated. RESULTS: Serum prealbumin concentration was significantly increased with gestatinoal age and birth weight(P<0.05). Serum prealbumin concentration on day 3 of life was lower than that at birth, it rose by day 14 of life and then it became steady. Serum prealbumin concentration was significantly increased with calory intake and protein intake, but more with protein intake than calory intake(P<0.05). Only serum prealbumin concentration was significantly increased with protein intake. Serum albumin concentration and anthropometric measurements were not. CONCLUSION: The serum prealbumin concentration was significantly correlated with gestatinoal age, birth weight, calory intake, and protein intake and could be used as a rapid and sensitive biochemical marker for nutritional adequacy in premature infants.
Biomarkers ; Birth Weight ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Parturition ; Prealbumin* ; Serum Albumin

BACKGROUND: The purpose of this study was to examine the relationship of epidural anesthesia with coagulation status and surgery outcome following lower extremity revascularization. METHODS: Twenty patients with arteriosclerosis obliterance (ASO) scheduled for lower extremity vascular reconstruction were randomized to receive either general anesthesia or combined general-epidural anesthesia. An additional 20 randomly selected patients without atherosclerotic vascular disease undergoing lower abdominal or lower extremity surgery served as controls for coagulation status. In the group with general anesthesia, anesthesia was induced by administration of pentothal sodium and succinylcholine and maintained with N2O-O2, isoflurane and vecuronium. In the group with combined anesthesia, epidural anesthesia was performed at the level of L2-3 or L3-4 epidural space using 2% lidocaine, followed by general anesthesia same as general group. Postoperative pain control was followed by on-demand oral or intravenous narcotics in the general group and followed by epidural 0.125% bupivacaine and morphine in the combined group. The coagulation status was monitored using thrombelastography (TEG) and standard coagulation tests. RESULTS: The ASO patients were hypercoagulable compared to the control patients before operation and on the first postoperative day. The hypercoagulability was attenuated postoperatively in the combined group. In the ASO-general group, postoperative MA, alpha and TEG index were 69.5 +/- 6.1 mm, 53.3 +/- 7.5 degree and 1.18 1.29 respectively, but in the ASO-combined anesthesia group, they were 58.0 +/- 6.2 mm, 38.0 +/- 4.0 degree and - 0.38 +/- 1.20 respectively (P < 0.05). The rates of postoperative complications did not significantly differ between the two groups. CONCLUSIONS: In patients with arteriosclerosis obliterance undergoing arterial reconstructive surgery, thrombelastographic evidence of increased platelet-fibrinogen interaction is associated with early postoperative thrombotic events, and epidural anesthesia is associated with beneficial effects on coagulation status.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Arteriosclerosis* ; Bupivacaine ; Epidural Space ; Humans ; Isoflurane ; Lidocaine ; Lower Extremity ; Morphine ; Narcotics ; Pain, Postoperative ; Postoperative Complications ; Sodium ; Succinylcholine ; Thiopental ; Thrombelastography ; Thrombophilia ; Vascular Diseases ; Vecuronium Bromide

We report an annular type of subacute cutaneous lupus erythematosus(SCLE) which is rare in Korea, A 23-year-old female had erythematous annular rashes with a mild itching sensation on the face, trunk and both extremities. She also had painless oral mucosal ulceration, diffuse hair loss and mild arthralgia. Serologic abnormalities of the patient were positive anti-Ro Ab, ANA and Anti-ds-DNA Ab. The histopathologic findings showed vacuolar degenerations in the basal cell layer, mononuclear cell infiltrate in the upper dermis, and dermal edema. Direct IF revealed granular deposition of IgG and IgA at the dermo-epidennal junction.
Arthralgia ; Dermis ; Edema ; Exanthema ; Extremities ; Female ; Hair ; Humans ; Immunoglobulin A ; Immunoglobulin G ; Korea ; Lupus Erythematosus, Cutaneous* ; Pruritus ; Sensation ; Ulcer ; Young Adult

Esmolol is rapid ultrashort-acting, cardioselective beta1-adrenergic blocker and that is used for attenuation of acute hypertension associated with rapid sequence induction of general anesthesia. A 35-year-old severe preeclamptic patient was scheduled for elective cesarean section. After preoxygenation, anesthesia induced with using penthotal sodium 250 mg, esmolol 25 mg, and succinylcholine 62.5 mg for endotrachial intubation. We detected to increase airway resistance during manual ventilation. Breathing sound was auscultated wheezing and ronchi. And then cyanosis was developed and oxygen saturation was decreased to below 75%. After 20 min, patient's color was returned to pink and patient's self-respiratory function was good. Bronchospasm occured because that beta-adrencergic blockade with esmolol, by leaving the parasympathetic and alpha-adrencrgic influence relatively unopposed. We report bronchospasm after esmolol 25 mg was injeected for attenuation of acute hypertensive response for cesarean section of preeclamptic patient with rapid sequence induction of general anesthesia.
Adult ; Airway Resistance ; Anesthesia ; Anesthesia, General ; Bronchial Spasm* ; Cesarean Section ; Cyanosis ; Female ; Humans ; Hypertension ; Intubation ; Oxygen ; Pregnancy ; Respiratory Sounds ; Sodium ; Succinylcholine ; Ventilation

Esmolol is rapid ultrashort-acting, cardioselective beta1-adrenergic blocker and that is used for attenuation of acute hypertension associated with rapid sequence induction of general anesthesia. A 35-year-old severe preeclamptic patient was scheduled for elective cesarean section. After preoxygenation, anesthesia induced with using penthotal sodium 250 mg, esmolol 25 mg, and succinylcholine 62.5 mg for endotrachial intubation. We detected to increase airway resistance during manual ventilation. Breathing sound was auscultated wheezing and ronchi. And then cyanosis was developed and oxygen saturation was decreased to below 75%. After 20 min, patient's color was returned to pink and patient's self-respiratory function was good. Bronchospasm occured because that beta-adrencergic blockade with esmolol, by leaving the parasympathetic and alpha-adrencrgic influence relatively unopposed. We report bronchospasm after esmolol 25 mg was injeected for attenuation of acute hypertensive response for cesarean section of preeclamptic patient with rapid sequence induction of general anesthesia.
Adult ; Airway Resistance ; Anesthesia ; Anesthesia, General ; Bronchial Spasm* ; Cesarean Section ; Cyanosis ; Female ; Humans ; Hypertension ; Intubation ; Oxygen ; Pregnancy ; Respiratory Sounds ; Sodium ; Succinylcholine ; Ventilation

The diagnosis of peripheral T cell lymphoma is difficult due to the varying size and shape of the neoplastic lymphoid cells and the frequent admixture of nonneoplastic mature lymphyocytes, histiocytes, eosinophils, and plasma cells. We report a case of peripheral T cell lymphoma, lymphoepithelioid cell type, which was difficult to differentiate from tuberculous lymphadenitis due to the aggregates of epithelioid histiocytes mimicking granuloma and the past history of pulmonary tuberculosis. Fine needle aspiration cytology of the inguinal lymph node in a 63-year-old male was characterized by hypercellular aspirates composed of a mixture of small and intermediate-size lymphoid cells and large lymphoid cells with background of confluent epithelioid histiocytes. The neoplastic lymphocytes demonstrated significant nuclear irregularity with protrusion and indentations of the nuclear membrane, prominent nucleoli, and frequent mitotic figures. The diagnosis of peripheral T cell lymphoma was confirmed by histological and immunohistochemical studies.
Biopsy, Fine-Needle ; Carcinoma, Acinar Cell ; Diagnosis ; Eosinophils ; Glomerulonephritis* ; Granuloma ; Histiocytes ; Humans ; Lymph Nodes ; Lymphocytes ; Lymphoma, T-Cell, Peripheral ; Male ; Middle Aged ; Nephrotic Syndrome* ; Nuclear Envelope ; Parotid Gland ; Plasma Cells ; Tuberculosis, Lymph Node ; Tuberculosis, Pulmonary

A 13-month-old boy had irregularly shaped, erythematous to dusky red, slightly raised patches and plaques on the left antecubital fossa and arm for 7 months. The lesions were firm and tender. Histopathologically the lesion consisted of small, circumscribed, angiomatous tufts and lobules with a cannonball appearance scattered throughout dermis, a characteristic feature of tufted angioma. For 15 weeks, interferon-a intralesional injections have been performed and the lesions showed an improvement.
Arm ; Dermis ; Hemangioma* ; Humans ; Infant ; Injections, Intralesional ; Interferon-alpha* ; Male