Trichilemmal carcinoma is a rare tumor that is located predominantly on sun-exposed skin of the elderly. It is thought to be related to the external root sheath of the hair follicle and the malignant counterpart of a trichilemmoma. We report a case of trichilemmal carcinoma in a 88-year-old woman who had a 10 year history of a single, dark brown tumor on the right preauricular region. In her past medical history, it had been excised twice at a private clinic without a histopathological evaluation and recurred 2 years later. Histopathological findings showed atypical clear cells resembling those of the outer root sheath. Tumor cells showed PAS-positive cytoplasm. Immunohistochemistry revealed positive high molecular weight cytokeratin expression. To our knowledge, this is the second case of trichilemmal carcinoma in the Korean literature. (Ann Dermatol 100) 175178, 1998).
Aged ; Aged, 80 and over ; Cytoplasm ; Female ; Hair Follicle ; Humans ; Immunohistochemistry ; Keratins ; Molecular Weight ; Skin

We report two cases of linear focal elastosis. They are a 16-year-old girl and a 14-year-old boy who had had asymptomatic, several, yellow-red, slightly elevated, palpable, striae-like lesions on their middle and lower back since their early childhood. Light microscopic examinations of skin biopsy specimens demonstrated dermal thickening and focal increases of thin wavy fibers in the upper and mid-dermis but no changes in the epidermis. Verhoeff-van Gieson stains for elastic fiber revealed aggregated, clumped, curled, or fragmented elastic fibers.
Adolescent ; Biopsy ; Coloring Agents ; Elastic Tissue ; Epidermis ; Female ; Humans ; Male ; Skin

No abstract available.
Aneurysm*

STUDY DESIGN: This was a retrospective study to evaluate anterior cervical interbody fusion with plates. OBJECTIVE: To examine the degree of angulation and translation after an anterior interbody fusion, using anterior plate fixation, upon the fusion rate and clinical outcome. SUMMARY OF LITERATURE REVIEW: Anterior cervical interbody fusion with plate allows immediate rigid internal fixation after decompression and bone grafting. MATERIALS AND METHODS: 65 cases had an anterior interbody fusion on the cervical spine, using an anterior approach and Smith-Robinson's method, between January 1998 and August 2003. Of these, 41 cases, which could be followed up for at least one year, were selected. There were 26 and 15 males and females, respectively, with an average age of 43.5 and mean follow up period of 2.1 years. 15 cases underwent an operation due to dislocation or fracture of the cervical spine due to trauma, and 26 due to cervical diseases. The angulation and translation of the plate was measured by postoperative X-rays. The fusion rate was also determined by the follow up X-rays. The Chi-squared test was used to analyze the data. RESULTS: Bony fusion was obtained in all cases. Two patients developed hoarseness and one showed torticollis, but all had recovered by the follow up. The average angulation of the plate and translation were 6.2 degrees and 3.21mm, respectively, but there was no significant difference of the interbody fusion period due to angulation and translation of the plate or in the improvement of the clinical outcomes. CONCLUSION: In the cases of anterior interbody fusion of the cervical spine, the angulation and translation of the plate had no influence on the fusion time and clinical outcomes. Long term studies and research will be needed to bring about clinically more valuable data.
Bone Transplantation ; Decompression ; Dislocations ; Female ; Follow-Up Studies ; Hoarseness ; Humans ; Male ; Retrospective Studies ; Spine ; Torticollis

Bronchopleural fistula is an uncommon but serious complication of lung resection, with a high mortality and morbidity. Problems associated with bronchopleural fistula and empyema are related to positive-pressure ventilation, which may result in infectious contamination of healthy lung tissue, loss of air, decreased alveolar ventilation leading to carbon dioxide retention, and the development of a tension pneumothorax. We experienced difficult intubation in patient who has large bronchopleural fistula and anatomic deviations of intact bronchus of the left lung, so we used a long single lumen tube made by attaching an another cuffed endotracheal tube under direct vision. The arterial oxygenation was effective, but carbon dioxide elimination was inadequate. After the operation, the ordinary cuffed endotracheal tube was intubated orally and the patient was transferred to the ward without problems 6 days after the operation.
Anesthesia* ; Bronchi ; Carbon Dioxide ; Empyema ; Fistula* ; Humans ; Intubation ; Lung ; Mortality ; Oxygen ; Pneumothorax ; Positive-Pressure Respiration ; Ventilation

BACKGROUND: Cellulitis is a suppurative inflammation involving particularly the subcutaneous tissue. There has been no data about its clinicopathologic features in Korea. OBJECTIVES: The purpose of this study was to investigate the clinicopathologic characteristics of cellulitis and to assess the yield rate of special stainings (Brown-Brenn, Gram) for organisms. METHODS: We reviewed the medical records and histologic sections of 45 patients who had been diagnosed as cellulitis in the Department of Dermatology, Chungbuk National University Hospital from January 1992 to August 1998. RESULTS: The results were as follows. 1. The sex ratio of male to female was 1.5:1 and average age was 43 years old. 2. The lower extremity was the most frequently involved site of cellulitis with a frequency of 53.4%. 3. Erythema, tenderness, local heating, swelling, and pain were almost always presenting clinical manifestations. 4. Diabetes mellitus was the most frequent underlying systemic disease. 5. The route of infection was suspected in 25 cases(55.6%). Tinea pedis was strongly suspected in 7 cases(28.0%), and followed by insect bite in 5 cases(20.0%), herpes zoster in 4 cases(16.0%), and trauma in 2 cases(8.0%). 6. The main complications were orthopedic problems including bursitis, osteomyelitis, and septic arthritis. 7. Microorganisms were isolated in 20 of 43 tissue cultures(46.5%). 8. It is important to suspect Escherichia coli as a causative organism if blistering cellulitis occurs, especially in patients with underlying systemic disease. 9. The most frequent histopathologic findings were perivascular lymphohistiocytic infiltrations in both dermis and subcutaneous fat simultaneously without vasculitis. 10. Special stainings(Brown-Brenn or Gram) were worthy to try, especially in the neutrophilic dominant cellulitis. 11. First-generation cephalosporin was chosen as primary antibiotics in 31 cases, and there was no difference in clinical course between its monotherapy and combined therapy. 12. Twenty percent of cases experienced recurrences. Lower extremity was most common site of recurrence(63.6%). CONCLUSION: Diabetes mellitus and tinea pedis were so closely bound up with cellulitis that control of those diseases is important in view of the clinical course of cellulitis. Special stainings(Brown-Brenn or Gram) were worthy to try, especially in the neutrophilic dominant cellulitis.
Adult ; Anti-Bacterial Agents ; Arthritis, Infectious ; Blister ; Bursitis ; Cellulitis* ; Chungcheongbuk-do ; Dermatology ; Dermis ; Diabetes Mellitus ; Erythema ; Escherichia coli ; Female ; Heating ; Herpes Zoster ; Hot Temperature ; Humans ; Inflammation ; Insect Bites and Stings ; Korea ; Lower Extremity ; Male ; Medical Records ; Neutrophils ; Orthopedics ; Osteomyelitis ; Recurrence ; Sex Ratio ; Subcutaneous Fat ; Subcutaneous Tissue ; Tinea Pedis ; Vasculitis

No abstract available.
Angiography ; Arterial Occlusive Diseases ; Lower Extremity

Traditionally, total parenteral nutrition(TPN) has been used when patients with hypaemesis gravidarum failed to respond to conservative management, but now many physicians attempt to enteral feeding via nasogastric tube because TPN is expensive and has many complications. Recently, we experienced 2 cases of hyperemesis gravidarum successfully managed by enteral feeding via nasogastric tube, therefore we think that this method may be carefully considered to the patients with hyperemesis gravidarum failed to respond to conservative management. So we report them with brief review of the literatures.
Enteral Nutrition* ; Female ; Humans ; Hyperemesis Gravidarum* ; Pregnancy

OBJECTIVE: Brachial plexus injury can produce a intractable chronic neuropathic pain. This study was undertaken to assess the long term outcome of microsurgical dorsal root entry zonotomy(MDT). METHODS: Between October 1997 and December 2002, 21 patients received MDT because of a intractable pain resulting from brachial plexus injury. Of these, 19 patients were followed for more than 2 years. Fourteen of 19 patients were male and patient ages ranged from 22 to 69 years. Mean pain duration was 36.8 months and all patients had severe pain of 9~10 visual analogue scale. To achieve complete destruction of abnormal dorsal horns, thermocoagulation of the posterolateral sulcus were performed and careful gluing was done to prevent postoperative adhesion and pain recurrence. RESULTS: Of the 19 patients, 15 patients had excellent (>75% reduction in pain) and good (51~75% pain relief) results in a average postoperative period of 4.1 years. One patient had a poor (less than 25% pain relief) result. Three patients were considered to have a fair result (26~50% pain relief). Postoperative complications were 2 transient ipsilateral ataxia and 1 CSF fistula that resolved without surgical revision. CONCLUSION: These results indicate that MDT provides excellent long-term pain relief in medically intractable chronic neuropathic pain following brachial plexus injury without significant complications.
Animals ; Ataxia ; Brachial Plexus* ; Electrocoagulation ; Fistula ; Horns ; Humans ; Male ; Neuralgia ; Pain, Intractable* ; Postoperative Complications ; Postoperative Period ; Recurrence ; Reoperation ; Spinal Nerve Roots*

BACKGROUND: pH measurement is an important test in assessing the etiology of pleurisy and in identifying complicated parapneumonic effusion. Although the blood gas analyzer is the' gold standard method' for pleural pH measurement, pH meter & pH strip methods are also used for this purpose interchangably. However, the correlation among the pH data measured by the three different methods needs to be evaluated. In this study, we measured the pH of pleural fluid with the three different methods respectively and evaluated the correlation among the measured data. METHODS: From August 1999 to March 2000, were measured the pleural fluid pH in 34 clinical samples with three methods-blood gas analyzer, pH meter, and pH strip. In the blood gas analyzer and pH meter methods, the temperature of plerual fluid was maintained around 0℃ in air-tight condition before analysis and measurement was performed within 30 minutes after collection. As for the pH strip method, the pleural fluid pH was checked in the ward immediately after tapping and in the clinical laboratory of our hospital. This part is unclear. RESULTS: The causes of pleural effusion were tuberculosis pleurisy in 16 cases, malignant pleural effusion 5 cases, parapneumonic effusion 9 cases, empyema 3 cases, and congestive heart failure 1 case. The pH of pleural fluid (mean±SD) was 7.34±0.12 with blood gas analyser, 7.52±0.25 with pH meter, 7.37±0.16 with pH strip of immediate measurement and 6.93±0.201 with pH strip of delayed measurement. The pH measured by delayed pH strip measurement was lower than those of other methods(p<0.05). The correlation of the results between the blood gas analyzer and pH meter(p=0.002, r=0.518) and the blood gas analyzer and pH strip of immediate measurement(p<0.001, r=0.607). CONCLUSION: In the determination of pH of pleural fluid, pH strip method could be a simple and reliable method under immediate measurement conditions after fluid tapping.
Empyema ; Heart Failure ; Hydrogen-Ion Concentration* ; Methods* ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleurisy ; Tuberculosis