No abstract available.
Cutaneous Fistula ; Fistula*

No abstract available.

Dystrophic epidermolysis bullosa(DEB) is a rare, chronic non-inflamrnatory bullous disease of hereditary trait, which easily produces bullae in response to even minor traurna. We report two cases which developed at birth and infancy, respectively. Bullae, atrophic scars on the knees, ankles and elbows, as well as milia of both hands and loss of nails were seen in both cases. Histologically, cleavage occurs beneath the basal lamina and anchoring fibrils are rudirnentary on electron microscopy. We present two cases of DEB that seem to be dominant types considering the presence of family history with clinical, histological and electronmicroscopic findings.
Ankle ; Basement Membrane ; Cicatrix ; Elbow ; Epidermolysis Bullosa Dystrophica* ; Hand ; Humans ; Knee ; Microscopy, Electron ; Parturition

BACKGROUND: Livedo vasculitis predominantly affects middle-aged females with relapses in summer, and fluctuating in winter. It develops spontaneously or in association with connective tissue disorders. Histopathologically, the common feature is partial or complete obstruction of vessels with deposits of fibrinoid material in the upper and mid-derrnal vessel walls. Many studies of large series have been reported in the west, but few collective studies of livedo vasculitis have been reported in Korea. OBJECTIVE: The purpose of this study was to clarify the clinical and histopathologic features of the livedo vasculitis in Korea. METHODS: 19 patients with livedo vasculitis who had visited the Department of Dermatolagy, Chung-Ang University Hospital during the last 9 years(19861 - 1994.12) were evaluated. RESULTS: 1. The age distribution was in the range of 5-73 years. The prevalence was highest in the third decade. Sex ratio was 1.7: 1.0(12 males : 7 females). 2. All patients had purpuric or telangiectatic lesions on the lower extremities. Painful ulcers developed in 11 patients(78.9%), livedo reticularis in 8(42.1%), and healed leaving whithish atrophic scars in 4 patients(21.1%). 3. In 9 patients(47.4%) the skin lesions developed or aggravated in summer, 6 patients(31.6% ) in winter, 3 patients(15.8%) in spring, and 1 patient(5.3%) in autumn. 4. Leukocytosis was observed in 3 of 17 patients, and VDRL test was positive in 2 of 12 patients. ANA test was positive(1: 40, speckled pattern) in 3 of 7 patients. 5. Histopathologically, partial to complete obstruction of dermal blood vessels with fibrinoid thrombi, endothelial swelling, and extravasation of RBCs were observed in upper and mid-dermis. 6. 16 patients were treated with aspirin, dipyridamole, pentoxifylline and corticosteroid and among them, 10(62.5%) patients were improved slowly, but, 6(37.5%) patients turned out no response or even aggravation. CONCLUSION: According to this study, seasonal variation of livedo vasculitis showed a tendency tn aggravate in summer and winter. We found that livedo reticularis, which showed slow reduction of blood flow in the subpaillary venous plexus were often followed by livedo vasculitis.
Age Distribution ; Aspirin ; Blood Vessels ; Cicatrix ; Connective Tissue ; Dipyridamole ; Female ; Humans ; Korea ; Leukocytosis ; Livedo Reticularis ; Lower Extremity ; Male ; Pentoxifylline ; Prevalence ; Recurrence ; Seasons ; Sex Ratio ; Skin ; Ulcer ; Vasculitis*

BACKGROUND: Nitric oxide (NO) plays an important role in inflammation and multiple stages of carcinogenesis. Green tea (Camellia sinensis) polyphenols are potent antiinflammatory agents and have been shown to inhibit NO production in tumor cell lines. In the present study, we examined the effect of epigallocatechin-3-gallate (EGCG), a green tea polyphenol, on the expression of inducible NO synthase (iNOS) mRNA and generation of NO in HaCaT cells. METHODS: HaCaT cells were treated with 10 M EGCG and 100 M NAC for 1 hour. 1 hour later, they were irradiated with 50mJ/cm2 UVB and treated with 200 g/ml LPS for 12 hours, respectively. The iNOS mRNA was determined by reverse transcription-polymerase chain reaction (RT-PCR) and NO production was assessed by spectrophotometric method based on Griess reaction. Nuclear factor B (NF- B) binding activity was determined by electrophoretic mobility shift assay (EMSA). RESULTS: The results were as follows 1. EGCG inhibited UVB and LPS induced expression of inducible nitric oxide synthase. 2. HaCaT cells cotreated with EGCG produced significantly less iNOS mRNA and NO compared with HaCaT cells stimulated with UVB irradiation or LPS. 3. The inhibition of iNOS mRNA and NO production correlated with the suppression of expression of NF- B dependent gene iNOS. 4. EGCG inhibited the activation and translocation of NF- B to the nucleus. CONCLUSION: Our data suggests that EGCG inhibits the UVB and LPS-induced production of NO in HaCaT cells by interfering with the activation of NF- B through a novel mechanism. Our results further suggest that EGCG may be therapeutically effective in UVB and cytokine induced cutaneous inflammation.

BACKGROUND: Although oxycodone has been known to be superior to other opioids in postoperative care, few studies have compared its analgesic potency with that of fentanyl. We therefore examined these two drugs in terms of their dose requirements, effects on pain intensity, time needed for relief of pain, and side effects after surgery. METHODS: We enrolled 56 healthy women scheduled for total abdominal hysterectomy and randomly allocated them to either oxycodone or fentanyl. The opioids were administered to the two groups 10 minutes before the end of the operation. In the post-anesthesia care unit (PACU) after surgery, a visual analog scale (VAS) was used to assess the patients' pain every 10 minutes Whenever pain control was required, a bolus of the same dose of the respective drugs was repeated at 10-minute intervals. Patient-controlled analgesia (PCA) was used to manage postoperative pain. After the patient arrived on the ward, pain scores were recorded at once and then 1, 2, 3, and 24 hours thereafter. RESULTS: During the hour spent in the PACU, fewer patients in the oxycodone group required the opioid, and the time needed to achieve pain relief was shorter with oxycodone than with fentanyl. Moreover, postoperative VAS levels were significantly lower in the oxycodone group both in the PACU and on the ward (over a 24-hours period). There were no significant differences in side effects between the patients given oxycodone and those given fentanyl. CONCLUSIONS: Oxycodone was more effective than fentanyl when administered on the basis of the recommended dose ratio (1 : 100). Although further evaluation is needed to investigate the optimal dose ratio, we would recommend a higher conversion factor (1 : 62).
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics, Opioid ; Female ; Fentanyl* ; Humans ; Hysterectomy* ; Oxycodone* ; Pain, Postoperative* ; Postoperative Care ; Visual Analog Scale

Acute thrombosis of the portal and superior mesenteric vein (SMV) due to inflammation of abdominal organs is a rare condition, but delayed diagnosis causes severe problems and serious long term complications. Therefore the early diagnosis and adequate management of the underlying disease and thrombus is very important. Here a case of an 84-year-old man with portal vein and SMV thrombosis on Doppler ultrasonography and computed tomography (CT) after cholecystectomy and choledochostomy by the 10th day is reported. The patient's condition improved without complication after the treatments with an anticoagulant regimen and antimicrobials. In the follow up, there was no thrombus on the CT or sign of a recurrent disease.
Aged, 80 and over ; Cholangitis ; Cholecystectomy* ; Choledochostomy* ; Delayed Diagnosis ; Early Diagnosis ; Follow-Up Studies ; Humans ; Inflammation ; Mesenteric Veins* ; Portal Vein* ; Thrombosis* ; Ultrasonography, Doppler ; Venous Thrombosis

PURPOSE: To evaluate the usefulness of T2-weighted oblique coronal imaging in the diagnosis of anteriorcruciate ligament (ACL) injury. MATERIALS AND METHODS: The MRI findings of 12 patients with ACL injury and a groupof 12 with normal ACL were respectively reviewed in terms of nonvisualization or focal defect, morphologic changeand increased signal intensity of ACL. Diagnostic accuracy in the conventional sagittal or coronal plane and inthe T2-weighted oblique coronal plane was also compared. T2-weighted oblique coronal scanning was performed, withthe imaging plane parallel to the direction of the intercondylar roof. RESULTS: In the ACL injury group,conventional MR imaging showed nonvisualization or focal defect (10/12), morphologic change (7/12), displacement(4/12), and increased signal intensity (9/12). T2-weighted oblique coronal imaging showed nonvisualization orfocal defect (11/12), morphologic change (5/12), and increased signal intensity(9/12). In the normal ACL group,conventional MR imaging demonstrated false-positive findings, i.e. these mimicked ACL injuries. Nonvisualizationor focal defect (2/12), and morphologic change (1/12), and increased signal intensity (5/12) were seen.T2-weighted oblique coronal imaging demonstrated normal ACL as an anteromedial and posterolateral band ; therewere no false-positive cases. On T2-weighted oblique coronal scan, no normal ACL showed increased signal intersity; compared with conventional MR imaging, this difference was statistically significant(P < 0.005). Overall, thesensitivity, specificity, and accuracy of conventional sagittal or coronal plane and T2-weighted oblique coronalplane imaging were, respectively 92% and 92%, 58% and 100%, and 75% and 96%. CONCLUSION: On T2-weighted obliquecoronal scans, the visualization of all normal anterior cruciate ligaments was better than on conventional MRimages. When ACL injury is vague on conventional MR imaging, T2-weighted oblique coronal imaging is considered tobe useful for the differentiation of ACL injury and normal ACL.
Anterior Cruciate Ligament* ; Diagnosis ; Humans ; Ligaments ; Magnetic Resonance Imaging* ; Sensitivity and Specificity

No abstract available.
Lipoma*

When anesthesiologists encounter conditions in which intubation is not possible using a conventional direct laryngoscope, they can consider using other available techniques and devices such as fiber optic bronchoscope (FOB)-guided intubation, a laryngeal mask airway (LMA), intubating LMA (ILMA), a light wand, and the Combitube. FOB-guided intubation is frequently utilized in predicted difficult airway cases and is generally performed when the patient is awake to enable easier access to the trachea. An LMA can be introduced to ventilate the patient with relative ease, while an ILMA can be used for definite endotracheal intubation. However, occasionally, an endotracheal tube (ETT) cannot pass through the larynx, despite successful introduction of a FOB into the trachea and placement of an ILMA by the anesthesiologist. Therefore, we initially introduced an ILMA for emergent ventilation, followed by successful insertion of an ETT under FOB guidance. In this report, we describe three cases of difficult intubation using a FOB and ILMA combination approach.
Bronchoscopes* ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngeal Masks* ; Laryngoscopes ; Larynx ; Nerve Fibers, Myelinated* ; Trachea ; Ventilation