Pigmented photoallergic contact dermatitis is a disease usually resulting from recurrent cutaneous exposure to cosmetic photoallergens which produce bizarre dark brown hyperpigmentation. Histologicnl examination of this condition reveals liquefaction of the basal cells of the epidmis and melanophages in the upper dermis. A 50-year-female developed dark brownish mottled hyperpigmented patches on her face after using a soap named O.E. and taking a nap every afternoon for 4 years. The histological fmding on the lesion site was consistent with pigmented photoallergic contact dermatitis. The cosmetic photopatch test with, O.E. soap, and the Scandinavian scries resulted in a positive reaction only on one side where 5 J/cm2 lights were applied by using Waldman 800UV machine. The other side howed a negative finding. We fmally diagnosed pigmented photoallergic contact dermatitis based on the patients histoty of using the soap containing musk ambrette, a histological examination of a biopsy and the results of photopatch tests. We report rare case of pigmented photoallergic contact dermatitis.
Biopsy ; Dermatitis, Photoallergic* ; Dermis ; Humans ; Hyperpigmentation ; Soaps

Linear IgA bullous dermatoses(LABD) occurring in childhood is considered to be a childhood counterpart of LABD,rather than chronic bullous dermatosis of childhood. This disease characteristically involves the perioral area,lower trunk,pelvic region and the lower extremities. Immunopathologically,it is characterized by the linear deposits of IgA at the dermoepidermal junction of the perilesional skin. A 20-month-old female infant presented with multiple pruritic tense bullae on the face, lower trunk, both extremities and pelvic region of 2 weeks duration. She had no oral lesions or any specific signs or symptoms referable to the disease of the gastrointestinal tract. A skin biopsy revealed subepidermal blisters infiltrated with many neutrophils and a few eosinophils. Direct immunofluorescence demonstrated linear deposition of IgA at the dermoepidermal junction. An indirect immunofluorescence study using NaC1-split skin as the substrate revealed fluorescence for IgA in a linear pattern on the roof of the split at a titer of 1:40. The clinical diagnosis of LABD of childhood was confirmed and we started with a combined remedy of dapsone and corticosteroids; 10 weeks later almost all of the lesions had disappeared.
Adrenal Cortex Hormones ; Biopsy ; Blister ; Dapsone ; Diagnosis ; Eosinophils ; Extremities ; Female ; Fluorescence ; Fluorescent Antibody Technique, Direct ; Fluorescent Antibody Technique, Indirect ; Gastrointestinal Tract ; Humans ; Immunoglobulin A ; Infant ; Linear IgA Bullous Dermatosis* ; Lower Extremity ; Neutrophils ; Pelvis ; Skin ; Skin Diseases ; Transcutaneous Electric Nerve Stimulation

Dupuytren's contracture is characterized by progressive fibroplasia and contracture of palmar fascia with resultant deformity of hands and fingers. Recently it has been shown that the cellular element, called myofibroblast, contributes significantly in the process of contracture. Among the 6 patients we have seen during the last few years, there was a total of 9 hands with Dupuytren's contracture. Seven of these were treated by a partial fasciectomy or by a dermofascietomy with a full thickness skin graft and the results of these two procedures were compared. Electron microsconic studies were done in 3 of the 6 patients and myofibroblasts were found in 2 of them.
Biopsy ; Clinical Study ; Congenital Abnormalities ; Contracture ; Dupuytren Contracture ; Fascia ; Fingers ; Hand ; Humans ; Myofibroblasts ; Skin ; Transplants

No abstract available.
Catecholamines* ; Female ; Labor Stage, Second* ; Parturition* ; Plasma* ; Pregnancy ; Supine Position*

PURPOSE: Authors investigated the associated findings and their value in the diagnosis of anterior cruciate ligament(ACL) injury in MR image. MATERIAL AND METHODS: The knee MR images of 47 patients with ACL injury(complete; 24, partial; 23) and 61 patients with normal ACL confirmed by the knee arthroscopy or operation were reviewed retrospectively. The degree of anterior translocation of tibia and the degree of posterior cruciate ligament(PCL) buckling were evaluated. The prevalence and pattern of associated adjacent bone, ligament and meniscus injuries were studied. RESULTS: The means( +/- 2standard errors) of anterior translocation were different significantly in statistical analysis(p<0.001, student t-test) between injury group(7.51 +/- 1.16mm) and normal group(-0.56 +/- 0.92mm). In the level of 5mm of anterior translocation for the criteria of ACL injury, the sensitivity, specificity, accuracy were 78.7%, 89.5%, 84.3% for each. The means of PCL buckling ratio were also different statistically b. etween injury group(0.23 +/- 0.02) and normal group(0.17 +/- 0.01)(p<0.001). In the level of 0.20 for diagnostic criteria of ACL injury, the sensitivity, specificity, accuracy were 71.4%, 83.6%, 78.4% for each. Thirty one medial meniscus tear(66%), thirteen lateral meniscus tear(28%), ten medial collateral ligament injury(28%), one PCL injury (2%) were associated with ACL injury. The twenty nine bone marrow changes were found in twenty patients {43%) which included acutely injured seven patients. In acute cases, the bone marrow changes were depicted as diffuse or focal high signal intensity lesions in lateral femoral or tibial condyles in contrast to the changes in chronic cases depicted as focal low signal intensity lesions in variable location. Lateral femoral condylar notch depression were found in nine patients(19%) and avulsion fractures of anterior tibial spine in four patients(9%). CONCLUSION: The associated findings with ACL injury (anterior translocation, buckling of PCL, associated bone, ligament and meniscus injuries) are considered to be helpful in the diagnosis of ACL injury on Knee MR images, when the findings of anterior cruciate ligament itself are not confirmative.
Anterior Cruciate Ligament* ; Arthroscopy ; Bone Marrow ; Collateral Ligaments ; Depression ; Diagnosis ; Humans ; Knee ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Prevalence ; Retrospective Studies ; Sensitivity and Specificity ; Spine ; Tibia

PURPOSE: Authors investigated the associated findings and their value in the diagnosis of anterior cruciate ligament(ACL) injury in MR image. MATERIAL AND METHODS: The knee MR images of 47 patients with ACL injury(complete; 24, partial; 23) and 61 patients with normal ACL confirmed by the knee arthroscopy or operation were reviewed retrospectively. The degree of anterior translocation of tibia and the degree of posterior cruciate ligament(PCL) buckling were evaluated. The prevalence and pattern of associated adjacent bone, ligament and meniscus injuries were studied. RESULTS: The means( +/- 2standard errors) of anterior translocation were different significantly in statistical analysis(p<0.001, student t-test) between injury group(7.51 +/- 1.16mm) and normal group(-0.56 +/- 0.92mm). In the level of 5mm of anterior translocation for the criteria of ACL injury, the sensitivity, specificity, accuracy were 78.7%, 89.5%, 84.3% for each. The means of PCL buckling ratio were also different statistically b. etween injury group(0.23 +/- 0.02) and normal group(0.17 +/- 0.01)(p<0.001). In the level of 0.20 for diagnostic criteria of ACL injury, the sensitivity, specificity, accuracy were 71.4%, 83.6%, 78.4% for each. Thirty one medial meniscus tear(66%), thirteen lateral meniscus tear(28%), ten medial collateral ligament injury(28%), one PCL injury (2%) were associated with ACL injury. The twenty nine bone marrow changes were found in twenty patients {43%) which included acutely injured seven patients. In acute cases, the bone marrow changes were depicted as diffuse or focal high signal intensity lesions in lateral femoral or tibial condyles in contrast to the changes in chronic cases depicted as focal low signal intensity lesions in variable location. Lateral femoral condylar notch depression were found in nine patients(19%) and avulsion fractures of anterior tibial spine in four patients(9%). CONCLUSION: The associated findings with ACL injury (anterior translocation, buckling of PCL, associated bone, ligament and meniscus injuries) are considered to be helpful in the diagnosis of ACL injury on Knee MR images, when the findings of anterior cruciate ligament itself are not confirmative.
Anterior Cruciate Ligament* ; Arthroscopy ; Bone Marrow ; Collateral Ligaments ; Depression ; Diagnosis ; Humans ; Knee ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Prevalence ; Retrospective Studies ; Sensitivity and Specificity ; Spine ; Tibia

A 70-year-old woman was admitted to our department with epigastric discomfort and nausea over the duration of 1 month. An esophagogastroduodenoscopy showed the presence of a 1.0x1.0 cm-sized flat lesion with central ulceration at the greater curvature side of the antrum. A biopsy demonstrated the presence of an adenocarcinoma of well differentiated, intestinal type in the stomach. Endoscopic submucosal dissection was done and the diagnosis of a composite neuroendocrine carcinoma with an adenocarcinoma of the stomach was confirmed. We report a case of a gastric composite tumor with an adenocarcinoma and neuroendocrine carcinoma confirmed by endoscopic submucosal dissection with a review of the literature.
Adenocarcinoma ; Biopsy ; Carcinoma, Neuroendocrine ; Endoscopy, Digestive System ; Female ; Humans ; Nausea ; Stomach ; Ulcer

A bicuspid aortic valve is one of common congenital cardiac anomaly. But the septic embolism from bicuspid aortic valve into the left anterior descending artery (LAD) resulting in acute inferior myocardial infarction is very rare. A twenty eight year-old man suffered from severe chest pain and fever of four-week's duration. Acute inferior myocardial infarction was diagnosed on electrocardiogram. Transesophageal echocardiogram demonstrated vegetation on the bicuspid aortic valve directed into left coronary artery ostium, and diagnostic coronary angiogram revealed round filling defect within the distal LAD. He underwent operation for aortic valve replacement, which indicated vegetated bicuspid aortic valve directed into the ostium of left coronary artery.
Aortic Valve* ; Arteries* ; Bicuspid* ; Chest Pain ; Coronary Vessels ; Electrocardiography ; Embolism* ; Fever ; Inferior Wall Myocardial Infarction*

BACKGROUND: Coronary sinus(CS) electrode catheter has been used ad a very useful mapping and guiding tool in catheter ablation of the left-side atrioventricular pathway(AP). Recently, it was reporter that single catheter approach of catheter ablation of the manifest left-side AP was feaside with a comparable success rate but shorter fluoroscopy time, compared with the standard approach. This study was performed to evaluate the role of CS electrode catheter in catheter avlation of the lefr-side AP. SUBJECTS AND METHODS: Sixty-five consecutive patients(43 men, 22 women) with a single left-side AP were included in this study. The first 32 patients underwent catheter ablation with an eletrode catheter in CS(CS+ group: 19 men, 13 women: 42.3+/- 14.6 years) and the later 33 patients with no electrode catheter in CS(CS- group: 24 men, 9 women: 38.8+/- 14.1 years). APs were localized by mapping the CS in CS+ group or by mapping the mitral valve annulus in CS- group with a 4mm-tipped deflectable catheter(7F, Webster or EPT). Radiofrequency energy(RF) was delivered unipolarly at a fixed power of 30-50 volts or 30-60 seconds. AP location, succes rate, number of RF applications, fluoroscopy time, and complications were compared between 2 group. RESULTS: APs were located at the left posteroseptal wall in 2(6.2%), left posterior wall in 5(15.5%), left posterolateral wall in 3(9.3%), left lateral wall in 18(56.3%), left anterolateral wall in 4(12.5%) in CS+ group. In CS- group, there were 6(18.2%) left posteroseptal, 2(6.1%) left posterior, 5(15.2%) left posterolateral, 12(36.4%) left lateral, 8(24.2%) left anterolateral AP with no significant difference in the distribution of the APs between 2 groups. The proportions of concealed and manifest APs wrer similar in 2 groups(17/15 vs. 19/14). Twenty-eight(87.5%) of 32 APs in CS+ group and 30(90.9%) of 33 APs in CS- group were successfully ablated showing no signigicant difference in the succes rates between 2 groups. The numbers of RF applications to ablate the APs were similar between 2 groups(3.9+/-3.4 vs. 3.5+/-2.9). Total fluoroscopy times wrer also similar between 2 groups(54.3+/-33.5 minutes vs. 47.2+/-21.4 minutes). There were no major conplications in both groups. CONCLUSIONS: Radiofrequency catheter ablation of the left-side APs may be successfully performed without using a CS electrode catheter as a guide in diagmosing and localizing left-side APs.
Catheter Ablation* ; Catheters* ; Coronary Sinus* ; Electrodes* ; Female ; Fluoroscopy ; Humans ; Male ; Mitral Valve

This article describes methods used to produce a RBRVS (resource-based relative value scales), a common scale from two specialties (internal medicine and general surgery) and explains the newly developed extrapolation process within each specialty. To produce a common scale, we selected six 'same' services as linking services common to both specialties. Then we used the bi-weighted least squares method to locate all the same services on a single, common scale. By using the same method, we tried to extrapolate all the services within each specialty, not by the method of Kelly et al, dividing all the services within the specialty into families (small homogeneous groups of services) to apply charge-based ratios. To compare both methods, we extrapolated all the services of general surgery according to each method. With the correlation analysis to compare both results to American RVUs, we found that general surgery's RVUs from our own extrapolation method turned out to be more highly correlated with American RVUs than from Kelly's extrapolation method. Consequently, extrapolation with bi-weighted least squares method gave reasonable results.
Human ; *Internal Medicine ; Least-Squares Analysis ; *Relative Value Scales