Acute generalized exanthematous pustulosis(AGEP) is a disease entity caused mostly by drugs or viral infections. Clinically it manifests as generalized erythema, erythema multiforme and amicrobial pustules with fever. Histologically, AGEP is composed of neutrophilic subcorneal and spongiform pustules. A 70-year-old female, with no personal or family history of psoriasis, was given medication including diltiazem for hypertension. Fourteen days after taking the medications, pustular eruptions appeared on the face and rapidly spread to the trunk and limbs. A Laboratory examination revealed neutrophilic leukocytosis and an elevated erythrocyte sedimentation rate. The skin biopsy showed subcorneal and spongiform pustules. We report here a case of AGEP probably due to diltiazem.
Acute Generalized Exanthematous Pustulosis* ; Aged ; Biopsy ; Blood Sedimentation ; Diltiazem ; Erythema ; Erythema Multiforme ; Extremities ; Female ; Fever ; Humans ; Hypertension ; Leukocytosis ; Neutrophils ; Psoriasis ; Skin

BACKGROUND AND OBJECTIVES: In acute myocardial ischemia, the conduction velocity of action potential is decreased by several electrophysiological and physical factors. The ventricular activation time(VAT) is a time duration of electrical impulse propagating from endocardium to epicardium. The goal of this study is to determine whether the reduction in conduction velocity in acute myocardial ischemia can lead a change in VAT. MATERIALS AND METHOD: Thirty patient, 18 males and 12 females, who had received percutaneous balloon coronary angioplasty(PTCA) were enrolled. The mean age was 59 years old. A twelve lead surface electrocardiogram(ECG) were obtained before, during, 1 minute, 5 minutes, and 10 minutes after the PTCA as digitized data by using Cardiolab EP 4.1 program. The magnitude of the QRS wave was amplified 3 to 4 folds and the speed was increased to 200mm/sec in order to get the VAT easily and accurately. The data was the mean of three consecutive VATs. The number of vessel treated with PTCA included left anterior descending artery(12), left circumflex artery(9), and right coronary artery(9). Among twelve chronic stable angina, sixteen unstable angina, and two acute myocardial infarction patients, twenty six had single and four had two vessel diseases. RESULTS: The significant increase in VAT during PTCA compared to that before PTCA was observed in eight of 12 leads. In addition, the significant decrease in VAT of 1, 5, and 10 minutes after PTCA compared to that during PTCA were noted. Furthermore, 10 minutes after PTCA, VAT decreased significantly compared to that before PTCA. The leads did not show a significant change of VAT depending on target vessels. The ECG of 16 patients showed changes of the ST segment during PTCA. The changes of VAT were not related to the ST segment change. CONCLUSION: The conduction delay from endocardium to epicardium in acute myocardial ischemia was presented as a prolongation of VAT in surface ECG. In addition, the conduction delay was recovered within 5 minutes after relief of ischemia. Therefore, the changes of VAT can possibly be used as one of the noninvasive parameters of myocardial ischemia.
Action Potentials ; Angina, Stable ; Angina, Unstable ; Electrocardiography ; Endocardium ; Female ; Humans ; Ischemia ; Male ; Middle Aged ; Myocardial Infarction ; Myocardial Ischemia* ; Pericardium ; Thoracic Surgery, Video-Assisted

No abstract available.
Cystadenoma, Mucinous* ; Mucins* ; Pancreas*

BACKGROUND: Tufted angioma is an uncommon slowly progressive vascular tumor found typically in infants and young children with characteristic histologic findings, so called "cannonball" appearance. OBJECTIVE: The purpose of this study was aimed to investigate the clinical and histopathological characteristics of tufted angioma and the response to intralesional steroid. METHODS: Clinical information of 10 patients with tufted angioma diagnosed in Severance hospital and Pundang CHA hospital from 1983 to 1999 was obtained from the medical records and clinical follow-ups. We re-evaluated 10 biopsy specimens obtained from them with routine H&E staining. RESULTS: Five male and five female patients were included. In 9 patients the lesion appeared before 2 months of age. Four had a lesion at birth. The thigh was the most common site. The clinical symptoms were diverse, but characteristically tenderness was present in most cases. In all the patients the lesions had a tendency to spread progressively. Microscopically, numerous, distinct, variably sized, tightly packed capillary and endothelial cellular lobules were scattered in the dermis. There were characteristic semilunar spaces adjacent to the capillary tufts. Six patients received intralesional triamcinolone. This treatment was found to be effective in 5 patients who experienced remarkable improvement. The improved cases had similar histologic findings which were composed of cellular mass more than lumen formation. We classified our specimens into two categories, one with more cellular mass and the other with more lumen formation in relative proportion. The former was different from the latter in that it had more solid appearance and more definite margin. And we realized that it was useful to divide into these two categories since its response to treatment could be different. CONCLUSIONS: Tufted angioma is a relatively uncommon disease with characteristic histopathologic findings. It seems not to regress spontaneously. So early treatment is required to pre-vent further spreading up to the extent. We treated 6 patients with intralesional injection of triamcinolone and 5 patients experienced marked improvement which had more cellular mass more than lumen formation histopathologically.
Biopsy ; Capillaries ; Child ; Dermis ; Female ; Follow-Up Studies ; Hemangioma ; Humans ; Infant ; Injections, Intralesional ; Male ; Medical Records ; Parturition ; Thigh ; Triamcinolone

A 44-year-old man had Sweet's syndrome (acute febrile neutrophilic dermatosis), accompanied by erythematous tender subcutaneous nodules resembling erythema nodosum(EN). The EN-like lesions histologically showed a septal panniculitis with predominantly neutrophilic in-filtrates. The association of Sweet's syndrome with EN seems to be uncommon and only a few cases have been reported until the present. We describe a patient with Sweet's syndrome associated with acute EN.
Adult ; Erythema Nodosum* ; Erythema* ; Humans ; Neutrophils ; Panniculitis ; Sweet Syndrome*

Bleomycin, a tumoricidal antibiotic agent, may produce unusual cutaneous manifestations such as pigmentation scleroderma, and gangrene. We report a case of the development of linear streaky pigmentation and cutaneous scleroderma in a patient treated with bleomycin for choriocarcinoma of undescented testis. The patient was 45-year-old male presented with linear brown and slate gray streaking over the trunk and extremities after three cycles of chemotherapy(bleomycin, etoposide, cisplatine). After the fourth cycle of the same chemotherapy, 18 weeks after initiation of bleomycin, the development of cutaneous scleroderma-like conditions was observed involving the same sites. Histopathologic examination showed increased basal pigmentation and thick collagen bundles through the entire dermis, extending to the subcutis. Herein, we describe a case of streaky pigmentation and scleroderma in association with bleomycin anticancer chemotherapy simultaneously in a patient.
Bleomycin* ; Choriocarcinoma ; Collagen ; Dermis ; Drug Therapy ; Etoposide ; Extremities ; Female ; Gangrene ; Humans ; Hyperpigmentation ; Male ; Middle Aged ; Pigmentation* ; Pregnancy ; Testis

Congenital melanocytic nevus(CMN) constitute a well-known risk factor in the development of malignant melanoma, but melanoma developing in newborn and infants are extremely rare. We describe a case of proliferating nodules within CMN at the age of 13 months. Like our case it is difficult to manage the proliferating lesions within CMN in infants. So we carefully suggest the indications of preventive excision when proliferating lesions occur within CMN as follows; 1) preventive excision is postponed until the age of two when the proliferating lesions are slowly growing, 2) surgical excision is needed when the lesions are rapidly growing exceeding 1 cm in size even though it is before the age of two.
Humans ; Infant ; Infant, Newborn ; Melanoma ; Nevus, Pigmented* ; Risk Factors

PURPOSE: Gamma-globulin is effective in preventing coronary aneurysm, the primary complication of Kawasaki disease(KD). However, in order to predict high-risk cases which absolutely require gamma-globulin, because of its high expenses, Harada score(HS) was introduced in Japan in 1990. We attempted to compare HS scoring with the health insurance criteria currently used in Korea. METHODS: Retrospective studies were performed on 123 cases who did not receive gamma-globulin among 283 KD patients who had been treated in this hospital from 1990 to 1997. Chi-square analyses were used. RESULTS: Of the 123 subjects, 91(74%) had HS scores higher than 4, and 32(26%) had HS less than 4, whereas 56(45.5%) belonged to the high-risk group and 67(54.5%) to the low-risk group according to the insurance criteria, with both methods differing significantly(P<0.001). Of 18 cases with the coronary complications only 2 cases had an HS<4, whereas 4 patients belonged to the low-risk group. Even though both methods did not differ significantly in discriminating risky cases, twice as many patients may have been denied adequate treatment if the insurance criteria had been applied. Of various factors, the age and albumin level were found relevant to the coronary complication. CONCLUSION: No statistically significant difference was found between HS and the insurance criteria in predicting the incidence of coronary complications in 123 KD patients. But a less lenient criteria used in the current health insurance policy may result in more cases with coronary complications.
Coronary Aneurysm* ; gamma-Globulins ; Humans ; Incidence ; Insurance ; Insurance, Health ; Japan ; Korea ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies

PURPOSE: This study was intended to evaluate the positional relationship between the hyoid bone and the mandible in patients with mandibular protrusion after mandibular set-back surgery by means of 3D-CT. MATERIALS AND METHODS: Preoperative(3 weeks before) and postoperative (6 weeks after) 3D-CT and cephalogram were taken on 32 patients(12 male, 20 female, mean age of 23.2) treated by bilateral sagittal split osteotomy with rigid fixation. The angular measurement on 3D-CT basilar view were deviation of Me and H, long axis angle of left and right cornu majus. The lineal measurement on 3D-CT basilar view were composed of intercondylar line and coordinates(x,y) of Me and H. The angular and lineal measurement of lateral cephalogram were composed of mandibular plane angle, SNA, SNB, ANB, FH-NA and FH-NB, and coordinates(x,y) of B, Pog, Me and H, PAS, Lpw, MPH and IAS. On the frontal cephalogram, deviation of Me were evaluated. RESULTS: The mean mandibular set-back was 8.0mm horizontally and mandibular plane angle was slightly increased. The hyoid bone was displaced postero-inferiorly, the distance between MP(mandibular plane) and H(hyoid bone) was increased and the posterior airway space values (PAS, Lpw, IAS) were decreased. The coordinates Me(x,y), H(x,y) and deviation angle Me' and H'were revealed the strong positive correlation. CONCLUSION: The results revealed that the horizontal, vertical and transverse relationship of the mandibular and the hyoid bone movements were significantly correlated in patients performed mandibular set-back surgery.
Axis, Cervical Vertebra ; Female ; Humans ; Hyoid Bone* ; Male ; Mandible* ; Orthognathic Surgery* ; Osteotomy

BACKGROUND: Pyoderma gangrenosum is a rare disease in which a painful nodule or pustule breaks down to form a progressive enlarging ulcer. Until now, only 8 cases of pyoderma gangrenosum have been reported in Korea. Therefore, we thought it necessary to perform a clinical analysis of pyoderma gangrenosum in Korea with a review of literature. OBJECTIVE: Our purpose was to find the clinical features of pyoderma gangrenosum in Korea. METHODS: Fourteen cases with pyoderma gangrenosum were investigated by reviewing medical records. Results There were 6 males and 8 females. The onset age was between 4 years and 65 years, and most(9 cases) had developed the condition between the ages of 20 and 60. Thirteen cases involved the extremities and 3 cases had whale body involvement, Seven cases(50%) had multiple lesions. All cases had pain at the lesional sites. Two cases were classified as the bullous type and the others were ulcerative in nature. The histological fmdings were non-specific. Dense inflarnmatory infiltrates composed of lymphocytes and predominant neutrophils were found in the epidermis and dermis associated with ulceration. Two cases were treated only with systemic steroids, and 2 cases with dapsone and steroids, 2 cases with colchicine and steroids, and 1 case with steroids, dapsone and colchicine. One case was treated with colchicine and anti-Tbc drug, 1 case with dapsone, 3 cases with antibotics, 1 case with the anti-Tbc drug and 1 case with anti-cancer drugs. Systemic disease was present in 5D% of the cases. The associated diseases were Behcets disease(3 cases), tuberculosis(2 cases), systemic lupus erythematosus(1 case), pancytopenia(1 case), iron deficiency anemia(1 case), acute leukemia(1 case), and colon adenoma(1 case). Recurrence developed in 2 cases and positive pathergy reactions were observed in 3 cases. CONCLUSION: Pyoderma gangrenosum was eccompanied with systemic disease in 50% of the cases and the most common therapeutic drugs were steroids. It is therefore impartant to detect the presence of any underlying disease and to treat this alongside pyoderma gangrenosum.
Age of Onset ; Colchicine ; Colon ; Dapsone ; Dermis ; Epidermis ; Extremities ; Female ; Humans ; Iron ; Korea ; Lymphocytes ; Male ; Medical Records ; Neutrophils ; Pyoderma Gangrenosum* ; Pyoderma* ; Rare Diseases ; Recurrence ; Steroids ; Ulcer ; Whales