Two cases of epidermal nevi treated with systemic etretinate are presented. Case 1, a 21-year-old female, had been suffered from brownish verrucous papules and plaques on the left inguinal area, thigh, lower leg and dorsum of the foot since her first month of life; and case 2, a 4-year-old boy, had been suffered from brownish verrucous papular plaques on the left chest, axilla and back since birth. In both cases, there was no family history of similar disease. On histopathological examination, case 1 showed the findings of epidermolytic. hyperkeratosis but case 2 did not, with the exception of clumping of keratohyaline granules. In the treatment with systemic etretinate, we observed marked clinical improvement in case 1, but not in case 2. Any particular side effects of etretinate were not observed during treatment. We consider that etretinate therapy is useful in treating epidermal nevus with epidermolytic hyperkeratosis histopathologically.
Acitretin* ; Axilla ; Child, Preschool ; Etretinate* ; Female ; Foot ; Humans ; Hyperkeratosis, Epidermolytic ; Leg ; Male ; Nevus* ; Parturition ; Thigh ; Thorax ; Young Adult

BACKGROUND: Exercise testing is an importnat diagnostic and prognostic procedure in the assessment of patients with ischemic heart disease. But standard ST-segment depression criteria was not high enough to estimate coronary srtery disease. Recently, the heart rate adjustment of ST segment depression, ST segment/heart rate slope and index, have been proposed as a more accurate criteria for diagnosing significant coronary artery disease. The objective of this study was to compare the discriminating power of proposed ST segment/heart rate slope and index with that of a standard method of assessing exercise-induced ST segment depression for estimating coronary artery disease. METHODS: Sixty nine patients with ischemic heart disease were studied with exercise treadmill testing and coronary angiography. Computer-measured ST-segment amplitudes were obtained and analysis of the heart rate-adjusted ST segment depression(ST/HR slope and big up tri, Delta ST/HR index) was done. The sensitivity, specificity, and extent of coronary artery disease on each criteria were compared. RESULTS: 1) The sensitivity of big up tri, Delta ST/HR index partition of 1.6uV/beats/min was slightly higher(83%) and the specificity of ST/HR slope partition of 2.4uV/beats/min was higher(87%) than the standard exercise electrocardiographic criteria. 2) Early onset of ischemic ST-segment depression, profound ST-segment depression(> or =2mm), and downsloping ST-segment were associated with more extensive coronary artery disease. 3) On ST/HR slope, no CAD was 1.7+/-0.26uV/beats/min, one vessel disease was 2.6+/-0.34 uV/beats/min, two vessel disease was 2.7+/-1.36uV/beats/min, one vessel disease was 2.8+/-0.35uV/beats/min, and on big up tri, Delta ST/HR index, no CAD was 1.8+/-0.38uV/beats/min, one vessel disease was 2.8+/-1.36uV/beats/min, two vessel disease 3.4+/-1.44uV/beats/min, and three vessel disease was 3.7+/-2.95uV/beats/min. The increment of ST/HR slope and big up tri, Delta ST/HR index were associated with the coronary artery disease and its severity, but the correlations were not high enough. CONCLUSION: The heart rate adjustment of ST segment depression was not high enough for improved detection of coronary artery disease, compared with standard ST-segment depression criteria. But these indexes can be improved the clinical usefulness of the treadmill exercise test for coronary aretry disease.
Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Depression* ; Electrocardiography ; Exercise Test ; Heart Rate* ; Heart* ; Humans ; Myocardial Ischemia* ; Sensitivity and Specificity

Acute colonic pseudoobstruction was first reported in 1948 by Sir H. Ogilvie. It is characterized by an acute, abrupt right-sided colonic distention in the absence of physical reasons for obstruction. If untreated, it may progress to cecal perforation, peritonitis, and death. Although primary cases have been reported, 87 percent of cases were secondary results of medical or surgical conditions. The most common medical conditions were infections, cardiac disease, and neurologic problems. In surgical conditions, cesarean section has been reported as the most common cause of Ogilvie's syndrome. In 1995, the first case of Ogilvie's syndrome complicated after a cosmetic surgical procedure(abdominoplasty) was reported by Bradley et al. We report a case of Ogilvie's syndrome complicated after breast reconstruction with TRAM flap that developed in the postoperative third day in 35-year old woman. The complications are primarily related to decreased flap perfusion. No reference of intestinal pseudoobstruction was found in the literature conducted in regard to complications of TRAM flap breast reconstruction.
Adult ; Breast* ; Cesarean Section ; Colon ; Colonic Pseudo-Obstruction ; Female ; Heart Diseases ; Humans ; Intestinal Pseudo-Obstruction ; Mammaplasty* ; Perfusion ; Peritonitis ; Pregnancy

Measurements of mitral flow velocity by pulsed Doppler echocardiography are very useful in evaluating left ventricular diastolic filling properties. In hypertensive patients, abnormalities of diastolic function may precede systolic abnormalities and may serve as a more sensitive marker of end organ damage. We estimated left ventricular nass by 2-D echo short axis area-length method and compared with peak mitral flow velocity in early diastole(PFVE)and during atrial systolic(PFVA). There was a significant increase of LV mass and LV mass indices in the hypertensive patients and PFVE/PFVA ratio was decreased in them. Aithough there was no relationship between blood pressure and PFVE/PFVA ratio, a significant relationship was demonstrated between LV mass index and PFVE/PFVA ratio in the hypertensive patients.
Axis, Cervical Vertebra ; Blood Pressure ; Echocardiography, Doppler, Pulsed ; Humans

Patella position in the normal knee jolnt has been discussed by many authors such as Boon-Itt 1930, Blumensaat 1938, and Insall 1971. But measure with Boon-Itt's method was so complicated and with Blumensaat's was denied by others due to inefficacy. Insall suggested more simple and clinically applicable method that was based on the fact that patellar tendon is inelastic. Now, we measured 100 healthy Korean knee accordlng to Insall's method. The following results were obtained in the study, 1. The length of the patellar tendon is 4.45 In males, 4.08 In females, and 4.26±0.40 cm. in average. (p<0.001) 2. The length of the patella is 4.51 in males, 4.09 In females, 4.36±0.40 cm. in average. (p<0.001) 3. The length of the patellar tendon (LT) and the dlagonal length of the pattella (LP) are almost same (LT: LP is 0.99 in both males and females, 98% of normal knees are contained within the difference of +20%). Difference above this limit may mean high-riding patella. 4. Blumensaats line on the distal femur doesnt pass the lower pole of the patella but the Iine passes 1 cm. below it in average. 5. The length of the patella (LP) and of the width of the femoral condyles at Blumensaat's line (WCBL) are almost same. When LP is markedly decreased in comparison with WCBL, this case may suggest hypoplasia of the patella. 6. Height of insertion of the patellar tendon (Hl) dlffers among various indlviduals. Its length is cllnically not so significant.
Female ; Femur ; Humans ; Knee Joint ; Knee ; Male ; Methods ; Patella ; Patellar Ligament

During 1 year and 9 month period, from September, 1980 to June, 1983, retrospective study was performed on 35 patients with Mitral Valve Prolapse at Kyung Hee University Medical Center. And the following results were obtained; 1) The mitral valve prolapse syndrome presents with various cardiovascular symptoms including dyspnea(63%), palpitation(49%), chest pain(34%), syncope and dizziness(11%). 2) Of 35 patients with MVP, 17 cases were isolated MVP, 13 cases were associated with cardiovascular disorders and 5 cases were associated with non-cardiovascular disorders. 3) Electrocardiographic abnormalities were found in 20 patients with MVP. The most common abnormality was ST-T change and atrial fibrillation, VPB, RBBB, first degree A-V block and W-P-W syndrome were also noted. 4) QTc interval prolongation was more common in serverely symptomatic patients with MVP. 5) 18 cases in 35 patients showed systolic click or murmur on phonocardiography. 6) Of 35 patients with MVP, 19 patients demonstrated prolapse of the anterior leaflet, 11 patients demonstrated prolapse of posterior leaflet and 5 patients demonstrated prolapse of the both leaflets. 7) There were severe derangement on echocardiography in severely symptomatic patients were MVP.
Academic Medical Centers ; Atrial Fibrillation ; Echocardiography ; Electrocardiography ; Humans ; Mitral Valve Prolapse* ; Mitral Valve* ; Phonocardiography ; Prolapse ; Retrospective Studies ; Syncope ; Thorax

No abstract available.
Epidermolysis Bullosa* ; Epidermolysis Bullosa, Junctional*

BACKGROUND: Recently, there are many reports about the association of Diffusion Weighted Imaging (DWI) and the prognosis of hypoglycemic encephalopathy (HE), but those relationships have not yet been completely determined. As such, we researched for prognosis, according to a variety of clinical data, and the lesion's distribution on DWI. METHODS: We retrospectively reviewed 19 patients who were diagnosed as HE. In addition, those prognoses were analyzed by a variety of clinical data and characteristics of lesion's distribution, which were evaluated on DWI and Apparent Diffusion Coefficient (ADC) maps. Three months later, those prognoses were determined by each Modified Rankin Scale. Further, the time-dependent average Glasgow Coma Scale (GCS), among the groups according to the characteristics of lesion's distributions in the initial DWI, was estimated. RESULTS: In this study, the difference of prognosis was not shown, according to all the clinical data, such as the severity or duration of the hypoglycemic state, but the group that did not have any pathologic lesion on the initial DWI demonstrated a better prognosis, in comparison with the groups-that exhibited any positive lesion on the initial DWI (p = 0.006). The group that had a focal pathologic lesion on the initial DWI showed a better prognosis than the diffuse lesion's group (p = 0.045). The groups with no lesion or focal lesion showed a faster recovery of GCS than the other groups with a positive lesion or diffuse lesion within the initial 1 week. CONCLUSIONS: We can identify that the characteristics of the lesion's distribution of DWI can be more helpful to predict of prognosis in HE than a variety of clinical data, such as the severity or duration of the hypoglycemic state.
Diffusion ; Glasgow Coma Scale ; Humans ; Hypoglycemia ; Prognosis ; Retrospective Studies

The aim of this study was to evaluate the appropriateness of some kinds of surgery and admission, such as cesarean section (C/S), cholecystectomy, and pediatric pneumonia. For appropriateness evaluation, we ourselves developed some criteria, which were included in the category of explicit and linear criteria, with the assistance of specialists of relevant clinical field. The evaluation of appropriateness was performed by two family physicians. The major findings were as follows: 1. For ceserean section, 77.6% of deliveries were determined to be 'appropriate', but the level of appropriateness was not significantly different among hospitals between hospital groups by size. The most frequent indication of C/S was repeated operation, followed by cephalopelvic disproportion(CPD). The labor trials for vaginal delivery among repeated C/S and CPD cases were performed in 24.5% of pertinent deliveries. 2. About 73.8% of cholecystectomy cases was appropriate to one of the surgical indications, without significant differences among hospitals. Of surgical indications, 'sufficiently frequent and intense symptom recurrence' was the most frequent, and 'confirmed acute cholecystitis' was the second. 3. Of children admitted due to pneumonia, only 57.4% of cases satisfied admission criteria, and the level of appropriateness of admission was different among hospitals. The common reasons for admission were 'failure to initial treatment', 'suspected bacterial pnermonia', 'young infant', etc. We could find that there were differences of quality among hospitals in some procedures, especially in the pediatric pneumonia and labor trial before C/S, which suggested that the implementation of quality assurance activities would be necessary in this country. In this study, we used some simple and primitive research tools and the numbers of subjects and tracer procedures were limited. So advanced studies with plentiful subjects and more representative diseases or procedures should be tried.
Cesarean Section* ; Child ; Cholecystectomy* ; Female ; Humans ; Physicians, Family ; Pneumonia* ; Pregnancy ; Specialization ; Trial of Labor ; Utilization Review

Pheochromocytoma is a hazardous and dramatic cause of hypertension. This potentially lethal neoplasm originates in most cases in the adrenal medulla and less frequently in the cells of the extraadrenal paraganglion system which are disseminated along the paravertebral axis from the pelvis to the base of the skull. The organ of Zuckerkandl is paraganglia lying the abdominal aorta with highest incidence in the region of the inferior mesenteric artery and usually degenerate shortly after birth. In the literature, and additional one case of pheochromocytoma arising from the organ of Zuckerkandl associated with intracerebral hemorrhage which was treated recently in the Kyung Hee University Hospital is presented in this report.
Adrenal Medulla ; Aorta, Abdominal ; Axis, Cervical Vertebra ; Cerebral Hemorrhage* ; Deception ; Hypertension ; Incidence ; Mesenteric Artery, Inferior ; Para-Aortic Bodies* ; Parturition ; Pelvis ; Pheochromocytoma* ; Skull