Cranial fasciitis is a rare morphological variant of nodular fasciitis. It is characterized by a rapid growing fibroblastic proliferative lesion that develops chiefly in childhood. It has varying size and involves the soft tissues of the scalp and the underlying skull. Accurate diagnosis and surgical excision is the key to management. Prognosis is good with rare recurrence. We report a case of cranial fasciitis in the temporal fossa of a 20-month-old girl and present a review of the literature.
Diagnosis ; Fasciitis* ; Female ; Fibroblasts ; Humans ; Infant ; Prognosis ; Recurrence ; Scalp ; Skull

This retrospective clinical study consists of 27 patients with lacrimal canalicular injury caused by various accidents and which were reconstructed with various materials in the department of plastic surgery at Catholic University Medical College from December 1987 to July 1996. These 27 patients were followed up at least 6 months after the canalicular reconstruction and their medical records were reviewed and analysed retrospectively in order to obtain the clinical pattern and understand the therapeutic results. The statistical items were the age and sex distribution, the causes of injury, the prevalent site of injury, the reconstruction materials, the duration of intubation and the results of treatment. The following results are obtained: 1. Males were more dominant than females by 4.4 : 1. 2. The patient age was from 6 to 73 years old and the prevalent age groups were the third and fourth decades(55.5%). 3. The most common cause of canalicular injury was the violence(29.6%) and was followed by traffic accident. 4. The left canaliculi, especially inferior canaliculi, was the prevalent injury site. 5. Regardless of the materials(P.V.C. tube, nylon and silicone tube) used in canalicular reconstruction, the longer duration of intubation was obtained the better result of treatment. 6. So the silicone tube with stainless steel(C-line canaliculus intubation set) was relatively inert and less complicating, it could be maintained more longer and had better results than other materials such as P.V.C. tube and nylon.
Accidents, Traffic ; Aged ; Female ; Humans ; Intubation ; Male ; Medical Records ; Nylons ; Retrospective Studies ; Sex Distribution ; Silicones ; Surgery, Plastic

Six cases of a rare variant of endocervieal adenocarcinoma (Adenoma maligum, AM) were collected for clinicopethologic analysis. The everage age of six patients was 49.3 years, and their chief com plaints were persis(ent mucid or watery discharge and intermittent vaginal spotting, The clinical im presaion was carcioma of The uterine cervix in faur out, of six cases. All except one were pathologically confirmed by initia1 biupey. two cases by colposcopic biopsies, two by cone biopsies, one by cone biopsy after suggested AM in calposcopic hiopsy. One case was incidentally found from hysterectnmised speeimen, which waas suspected as adennmyosis. On gross examination, the cervix usualty appeared either firm or indurated with thickening af the wall excepl one which was presented es a fungnting mass. The characteristic histologic feetures were ext,ensive arborizing endeervical glands with marked variation in size and shape, and the glands lined by mucin conyaining columnar epithelial cells with basal bland looking nuclei but with occasional cytologic atypia and rare mitose. The nenplasi.ic glands were characterized by deep stronml invasion be yond normal enddcervical glands, assosiated with loose edematous periglandular desmaplastic stromal reaction in moat cases. Immunohistochemical stainnings for carcinoembryonie antigen (CEA) revealed ey- toplasmic positivity in five cases. The clinical stage for all exeept one incidental case were : four Ib and one II b. In three cases, the radical hysterectomy with unilateral salpingooophorectomy plus dissection of bilateral pelvic and paraaortic lymph nodes was performed, and in one case radiotherapy was done prior to radical hysterectomy with bilateral salpingoophorectomy plus the dissection of left pelvic lymph nodes followed by chemotherapy. Total abdominal hysterectomy with bilateral salpingooophorectomy plus Burch's operation followed by radiation therapy was performed in on case. The remaining one case was treated with radiation therapy. Metastasis to the left obturator lymph node was discovered in one case with state IIb, and the patient expired 29 months after the radiotherapy. The remaining five cases are being carefully followed up. From our experience, we conclude that the early diagnosis of AM can be made based on comprehensive analysis concerning the clinical features, histopathological and immunohistochemical findings. The early diagnosis and proper therapy can lead to the better prognosis.
Adenocarcinoma ; Adenoma* ; Biopsy ; Cervix Uteri* ; Drug Therapy ; Early Diagnosis ; Epithelial Cells ; Female ; Humans ; Hysterectomy ; Lymph Nodes ; Metrorrhagia ; Mucins ; Neoplasm Metastasis ; Prognosis ; Radiotherapy

BACKGROUND: Recent clinical isolates of bacteria often produce various beta-lactamases, for example, extended spectrum beta-lactamase (ESBL) by some species of Enterobacteriaceae, TEM beta-lactamase by Haemophilus influenzae, and penicillinase by methicillin-susceptible Staphylococcus aureus (MSSA). Cefminox, a commonly used cephamycin, is stable to various beta-lactamases, but its activity against recent clinical isolates has not been evaluated. The aim of this study was to determine the activities of cefminox against recent clinical isolates of Enterobacteriaceae, H. influenzae, and MSSA. METHODS: The organisms, isolated from Severance Hospital patients during 1997 to 1998, were kept frozen until the test. Antimicrobial susceptibility was determined by the NCCLS agar dilution method. RESULTS: All 30 isolates of Escherichia coli and 90% of 30 Klebsiella pneumoniae isolates were susceptible to cefminox, cefotetan and amikacin. All of the Enterobacter cloacae and Serratia marcescens, and 86% of Citrobacter freundii isolates were susceptible to amikacin. All of the 15 isolates each of Proteus mirabilis, P. vulgaris and Morganella morganii were susceptible to cefminox, cefotetan, cefotaxime, ceftazidime, and aztreonam, while all of the Providencia spp. were susceptible to ceftazidime and aztreonam. All of the 29 H. influenzae isolates were susceptible to cefminox, cefotaxime, and levofloxacin, while all MSSA isolates were susceptible to cefoxitin and cotrimoxazole. CONCLUSION: Cefminox is more active than the other beta-lactams against Enterobacteriaceae including, ESBL- producing E. coli, and K. pneumoniae.
Agar ; Amikacin ; Aztreonam ; Bacteria ; beta-Lactamases ; beta-Lactams ; Cefotaxime ; Cefotetan ; Cefoxitin ; Ceftazidime ; Citrobacter freundii ; Enterobacter cloacae ; Enterobacteriaceae* ; Escherichia coli ; Haemophilus influenzae* ; Haemophilus* ; Humans ; Influenza, Human ; Klebsiella pneumoniae ; Levofloxacin ; Morganella morganii ; Penicillinase ; Pneumonia ; Proteus mirabilis ; Providencia ; Serratia marcescens ; Staphylococcus aureus* ; Staphylococcus* ; Trimethoprim, Sulfamethoxazole Drug Combination

BACKGROUND: The difficulty in advancing the epidural catheters to hoped-for levels after successful demonstration of loss of resistance in the epidural space has well been known. This study was undertaken to determine the optimal distance that a catheter could be threaded into the epidural space without coiling. METHODS: An epidural catheter (single orifice, end hole) was inserted at L2-3 or L3-4 interspace with bevel of the needle directed either cephalad (n=15) or caudad (n=25). After injection of 1 ml of iohexol dye through the catheter, fluoroscopy was taken to determine the position of catheter tip. The findings of 40 epidurographies were analysed. RESULTS: The lengths of catheters threaded into the epidural spaces without coiling were 3.0+/-1.3 cm (mean+/-SD) and varied from 1.0 to 8.0 cm. Only 10 per cent of the catheters threaded without coiling 5 cm beyond the intervertebral space of insertion. No statistical significance was seen between the length threaded without coiling for catheters in the cephalad direction (2.9+/-1.1 cm) and in the caudad direction (3.0+/-1.3 cm). Although the Tuohy needle was inserted using the midline approach with the intention of positioning the catheter in the midline, only in 34.8 per cent was the catheter indeed situated in the midline. Conclusion : This study shows the futility of attempting to thread a catheter more than 3 cm within the epidural space. In lumbar epidural anesthesia, it is desirable to insert a catheter at the nearest possible spinal level.
Anesthesia, Epidural ; Catheters* ; Epidural Space* ; Fluoroscopy ; Intention ; Iohexol ; Medical Futility ; Needles

Behavior, Addictive ; Humans ; Internet

The size of spinal canal is valuable ot detect the body encroachment of spinal canal and expansion due totumors by computed tomography. This study was desinged for taking accurate measurement of the normal thoracicspinal canal in korean adults. The anteroposterior diameter, interpediculate distance and cross-sectional area ofthoracic spinal canal were measured in 80 normal adults. The results were as follows. 1. In A-P diameter, middleparts of the canal were smaller values than those of upper and lower parts from T1 to T6, and upper parts of thecanal were larger than those of middle and lower parts from T7 to T10. 2. In interpediculate distance, middleparts of the canal revealed larger value than those of upper parts. 3. All measurements of male were larger thanthose of female at all levels of the spinal canals and 65 measurement(93%) were statistically significant.
Adult ; Female ; Humans ; Male ; Spinal Canal

BACKGROUND: Aggressive treatment of sternoclavicular joint (SCJ) infection involves systemic antibiotics, surgical drainage and resection if indicated. The purpose of this paper is to describe a classification of post resectional SCJ defects and highlight our reconstructive algorithm. Defects were classified into A, where closure was possible often with the aid of topical negative pressure dressing; B, where parts of the manubrium, calvicular head, and first rib were excised; and C, where both clavicular, first ribs and most of the manubrium were resected. METHODS: Twelve patients (age range, 42 to 72 years) over the last 8 years underwent reconstruction after SCJ infection. There was 1 case of a type A defect, 10 type B defects, and 1 type C defect. Reconstruction was performed using the pectoralis major flap in 6 cases (50%), the latissimus dorsi flap in 4 cases (33%), secondary closure in 1 case and; the latissimus and the rectus flap in 1 case. RESULTS: All wounds healed uneventfully with no flap failure. Nine patients had good shoulder motion. Three patients with extensive clavicular resection had restricted shoulder abduction and were unable to abduct their arm past 90degrees. Internal and external rotation were not affected. CONCLUSIONS: We highlight our reconstructive algorithm which is summarised as follows: for an isolated type B SCJ defect we recommend the ipsilateral pectoralis major muscle for closure. For a type C bilateral defect, we suggest the latissimum dorsi flap. In cases of extensive infection where the thoracoacromial and internal mammary vessels are thrombosed, the pectoralis major and rectus abdominus cannot be used; and the latissimus dorsi flap is chosen.
Anti-Bacterial Agents ; Arm ; Arthritis, Infectious ; Drainage ; Head ; Humans ; Manubrium ; Muscles ; Ribs ; Shoulder ; Sternoclavicular Joint ; Surgical Flaps

BACKGROUND: beta-lactam antibiotics are one of the most frequently used antimicrobial agents. However, with the increase of beta-lactamase-producing bacteria, penicillins arid 1 st generation cephalosporins have become less useful. Cefatrizine and clavulanic acid combination (CTCA) was developed to restore the activity. The aim of this study was to determine the activities of CTCA against major recent clinical isolates. METHODS: Aerobic and anaerobic bacteria tested were isolated from clinical specimens in Severance Hospital during 1996 to 1999. Antimicrobial susceptibility was determined by the NCCLS agar dilution methods. RESULTS: MICs of cefatrizine (CT) and CTCA were similar for methicillin-susceptible Staphylococcus aureus, Streptococcus pyogenes and S. pneumoniae. For Moraxella (Branhamella) catarrhalis, MIC90 CTCA was 1 microgram/mL, which was 1/8-fold lower than that of cefatrizine. MIC90S of CTCA for Escherichia coli and Klebsiella pneumoniae were 4 microgram/mL and 8 microgram/mL, respectively, which were 1/4- to 1/16-fold lower than those of CT. However, it was less active against Citrobacter freundii, Enterobacter cloacae and Serratia marcescens. Against Bacteroides fragilis group organisms, it showed good activities similar to those of other beta-lactam and beta-lactamase inhibitor combinations. CONCLUSIONS: CTCA showed good antimicrobial activities against M. (B.) catarrhalis, Haemophilus influenzae, Neisseria gonorrhoeae, extended spectrum beta-lactamase-producing E. coli and K. pneumoniae, Proteus vulgaris and B. fragilis. In conclusion, it would be useful for the treatment of infections due to those organisms, and for the empirical treatment of respiratory and urinary tract infections.
Agar ; Anti-Bacterial Agents ; Anti-Infective Agents ; Bacteria* ; Bacteria, Anaerobic ; Bacteroides fragilis ; beta-Lactamases ; Cefatrizine ; Cephalosporins ; Citrobacter freundii ; Clavulanic Acid ; Enterobacter cloacae ; Escherichia coli ; Haemophilus influenzae ; Klebsiella pneumoniae ; Moraxella (Branhamella) catarrhalis ; Neisseria gonorrhoeae ; Penicillins ; Pneumonia ; Proteus vulgaris ; Serratia marcescens ; Staphylococcus aureus ; Streptococcus pyogenes ; Urinary Tract Infections

Malignant tumors of the eyelid pose a serious threat because of their proximity to the globe, brain & paranasal sinuses. Three types of carcinomas account for the vast majority of the malignant eyelid tumors: basal cell carcinoma, squamous cell carcinoma, and sebaceous gland carcinoma. In these malignancies, basal cell carcinoma is the most common. However, sebaceous gland carcinoma has a high recurrence rate and a moderately high 5-year mortality rate because of late diagnosis and incomplete surgical removal. This tumor may be clinically misdiagnosed frequently as a chronic unilateral conjunctivitis, chalazion, basal cell carcinoma, or squamous cell carcinoma in initial biopsy. Suspicious lid lesions should be managed with incisional biopsy initially. If they are positive for sebaceous gland carcinoma, wide excision and frozen section monitoring of surgical margin is the treatment of choice. The final diagnosis should be confirmed by special stain for lipid. We experienced 12 cases of malignant eyelid tumors including 3 cases of sebaceous gland carcinoma. In cases of sebaceous gland carcinoma, wide surgical excision with frozen section monitoring was performed and followed by eyelid reconstruction with intact eyelid tissue remained and adjuvant radiotheraphy. Guidelines for management are discussed.
Biopsy ; Brain ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Chalazion ; Conjunctivitis ; Delayed Diagnosis ; Diagnosis ; Eyelids* ; Frozen Sections ; Mortality ; Paranasal Sinuses ; Recurrence ; Sebaceous Glands