Candidiasis is the most common fungal infection complicating the course of patients with hematologic malignant neoplasms. Although widespread organ involvement is characteristic of disseminated candidiasis, reports of skin are rare. Reports describing typical clinical and histopathological finding of cutaneous lesions are very important since it may enable a diagnosis of disseminated candidiasis to be made and thus antifungal therapy can be initiated earlier. A 50-year-old housewife was admitted with a 5-month history of fatigue and easy bruising. She was diagnosed as ha.ving acute myelocytic leukemia and treatment was begun with daunorubicin and cytosin, arabinoside. Eight days after the start of chemotherapy, she developed a fever and generalized tender well demacated erythematous to purplish papulonodular eruption. A biopsy specimen from the skin lesion showed perivascular mononuclear cell infiltration and spore and pseudohypae v,rere found within the dermis and subcutis in PAS stain. Cultures of one skin biopsy specimen and one of four blood sarnples grew Candida tropicalis. The patient was treated with intravenous amphotericin B for disseminated candidiasis. On the tenth day of antifun gal therapy, she developed cardiopulmonary arrest and died.
Amphotericin B ; Biopsy ; Candida tropicalis ; Candidiasis* ; Daunorubicin ; Dermis ; Diagnosis ; Drug Therapy ; Fatigue ; Fever ; Heart Arrest ; Humans ; Leukemia, Myeloid, Acute ; Middle Aged ; Skin Manifestations* ; Skin* ; Spores

Mucormycosis is an infectious disease caused by fungi of the order Mucorales. Almost all patients have a serious uriderlying condition such as diabetes mallitus, imrnunosuppression, starvation, burn, but a few cais have been reported in previously heilthy subjects. In order to successfully treat this infection, diagnosis must be prompt and acior. panied by aggressive debridement and parenteral administration of amphotericin B. We report a case of primary cutaneous mucormycosis in 58-year-old man. The lesion was a well-circumscribed erythematous plaque with central necrcis Histopathologically, a biopsy revealed broad, nonsptate with branches occuring at right anghles.
Amphotericin B ; Biopsy ; Burns ; Communicable Diseases ; Debridement ; Diagnosis ; Fungi ; Humans ; Middle Aged ; Mucorales ; Mucormycosis* ; Starvation

Trichorrhexis nodosa(TN) denotes small node-like swelling with a loss of cuticle of the hair shaft through which the hair readily fractures. The basic cause of TN is mechanical or chemical trauma, and a contributing factor is an inherent weakness of the hair shaft. We report a case of localized TN in a 37-year-old male. He had an ovoid hair patch with multiple small white-gray dotted and stubby hairs localized to the right occipital scalp. TN is known to be the commonest of all hair shaft anomalies (Price, 1975). However TN is rarely reported, and there have been only four reports in Korean dermatological literature, to our knowledge, which might be due to underdiagnosis of this disorder. We postulated that diagnostic difficulty lies in the discrepancy between terminology and gross morphological findings.
Adult ; Fibrinogen ; Hair ; Humans ; Male ; Scalp

Changes in the number, the immunoreactivities and the ultrastructures of sero- tonin immunoreactive mucosal mast cells[MMCs] in rat gastrointestinal tracts after vagus nerve stimulation were investigated by using light and electron microscopic immunocytochemical methods. The vagus nerves were electrically stimulated with a square wave pulse generator for a duration of 5 minutes each, a total of 8 times at 2 minute intervals. Serotonin immunoreactive cells of the connective tissues of the gastrointestinal tract were mainly located in the lamina propria, and a small number of the cells were also scattered in the submucosa. By using electron microscopic immunocytochemistry and Wright stain, the serotonin immunoreactive cells of the lamina propria and the submucosa were identified to be MMCs. A few large-sized serotonin immunoreactive connective tissue mast cells [CTMCs], showing strong metachromasia with the Wright stain, were located together with the MMCs in the submucosa of the stomach. In most of the gut regions of the control group, the majority of the MMCs did not show any serotonin immunoreactivities and only a few MMCs showed weak serotonin immunoreactivities. After stimulation of the vagus nerves, the number and the immnu- noreactivities of the serotonin immunoreactive MMCs dramatically increased in all gut regions observed, especially in the small intestines. In the samples treated with the electron microscopic immnunocytochemical methods, hardly any serotonin immunoreactivities were detected in the MMCs of the control group. However, the serotonin imrnunoreactivities of the MMCs were significantly increased after vagus nerve stimulation. The serotonin immnunoreactive products were localized, following vagal stimulation, both in the peripheral matrix of the granules and in the cytoplasm. Also, it was confirmed ultrastructurally that the Golgi complexes were expanded in the MMCs of the vagal stimulation group. The above results suggest that vagus nerve stimulation may activate serotonin biosynthesis in MMCs.
Animals ; Connective Tissue ; Cytoplasm ; Gastrointestinal Tract* ; Golgi Apparatus ; Immunohistochemistry ; Intestine, Small ; Mast Cells* ; Mucous Membrane ; Rats* ; Serotonin* ; Stomach ; Vagus Nerve Stimulation* ; Vagus Nerve*

This study was undertaken to investigate the ultrastructure of the neurons, neuroglial cells and capillaries in the area postrema[AP] of the Oriental discolured bat, Vespertilio superans. The AP of the bat was a single midline structure at the most caudal portion of the fourth ventricle. Most neurons in the AP were small cells, but their ultrastructure were similar to the typical neurons located elsewhere in the central nervous system. Astroglial cells and oligodendrocytes were also observed and showed their typical ultrastructure. Ultrastructural features of neurons, astroglial cells and oligodendrocytes were not changed during hibernating cycles. However, microglial cells were only found in the hibernating AP ; these cells were located in the parenchyma and near the blood vessels of the AP. Since the microglial cytoplasm was filled with phagocytotic inclusions, the nuclei of the these cells were eccentrically located. Phagocytotic cytoplasmic inclusions were shown to be composed of a dense irregular peripheral region and the pale round central region. A Large vacant space was often found in the electron lucent central region. Continuous and fenestrated capillaries surrounded by pericytes were found in the bat`s AP. Especially, Phagocytotic inclusions were found in the pericyte cytoplasm of the hibernating AP, and this result supports suggestion that pericytes might be phagocytotic cells. On the basis of the distributions of phagocytotic tells[pericytes and microglial cell], ultrastructure of these cells, morphology of their cytoplasmic inclusions, and the appearance of phagocytotic activity of the pericytes during the hibernating stage when microglial cells were observed, it can be concluded that pericytes may also participates in the formation of rrlicroglial cells. Tanycytes were also found in the bat AP.
Area Postrema* ; Blood Vessels ; Capillaries ; Central Nervous System ; Cytoplasm ; Ependymoglial Cells ; Fourth Ventricle ; Inclusion Bodies ; Microglia ; Neuroglia ; Neurons ; Oligodendroglia ; Pericytes

Heel cord advancement(HCA), which has been applied for the correction of equinus deformity in spastic cerebral palsy, has some theoretical advantages. However, HCA has also theoretical disadvantage that the procedure remove the tensile force exerting to the calcaneal apophysis. In order to evaluate the effect of HCA on the calcaneal growth, we compared the changes of calcaneal and foot lengths between the operated feet and non-operated feet after HCA. Among the 54 patients who had been treated with HCA at Seoul National University Childrens Hospital from March 1990 to August 1995, we excluded the cases who had been treated bilaterally, and also excluded hemiplegic patients in whom the ipsilateral feet were already shortened and the growth rates are different between the ipsilateral and contralateral foot. Seven patients who met the criterior of this study were included for the evaluation. There were 3 diplegics and 4 paraplegics, and average age at operation was 10 years and 6 months(range; 7 year 8 months-16 year 5 months). Average follow-up period was 3 years and 5 months(range; 2 years-4 years 9 mos). Total calcaneal lengths, anterior and posterior part of calcaneal lengths were measured on the standing lateral radiographs of the foot and ankle. Ratios of the operated limb over the non-operated limb were calculated for the three parameters. Ratios of posterior part of calcaneal lengths decreased significantly(P=0.031). Ratios of total calcaneal lengths decreased and ratios of anterior part of calcaneal lengths increased. However, the changes of two ratios were not significant. Ratios of posterior part calcaeal lengths over total calcaneal length decreases significantly(P=0.016). In conclusion, HCA can cause calcaneal growth retardation, especially posterior part of calcaneus, due to removal of physiologic tensile force of Achilles tendon.
Achilles Tendon ; Ankle ; Calcaneus ; Cerebral Palsy* ; Child ; Equinus Deformity ; Extremities ; Follow-Up Studies ; Foot ; Heel* ; Humans ; Muscle Spasticity* ; Seoul

PURPOSE: The object of this study was to evaluate entrance angle effects on femoral tunnel length and cartilage damage during anteromedial portal drilling using three-dimensional computer simulation. MATERIALS AND METHODS: Data was obtained from an anatomic study performed using 16 cadaveric knees. The anterior cruciate ligament femoral insertion was dissected and the knees were scanned by computer tomography. Tunnels with different of three-dimensional entrance angles were identified using a computer simulation. The effects of different entrance angles on the femoral tunnel length and medial femoral cartilage damage were evaluated. Specifically, tunnel length and distance from the medial femoral condyle to a virtual cylinder of the femoral tunnel were measured. RESULTS: In tunnels drilled at a coronal angle of 45degrees, an axial angle of 45degrees, and a sagittal angle of 45degrees, the mean femoral tunnel length was 39.5+/-3.7 mm and the distance between the virtual cylinder of the femoral tunnel and the medial femoral condyle was 9.4+/-2.6 mm. The tunnel length at a coronal angle of 30degrees, an axial angle of 60degrees, and a sagittal angle of 45degrees, was 34.0+/-2.9 mm and the distance between the virtual cylinder of the tunnel and the medial femoral condyle was 0.7+/-1.3 mm, which was significantly shorter than the standard angle (p<0.001). CONCLUSION: Extremely low and high entrance angles in both of axial plane and coronal plane produced inappropriate tunnel angles, lengths and higher incidence of cartilage damage. We recommend that angles in proximity to standard angles be chosen during femoral tunnel drilling through the anteromedial portal.
Aged ; Anterior Cruciate Ligament/*surgery ; Anterior Cruciate Ligament Reconstruction/instrumentation/*methods ; Cadaver ; Computer Simulation ; Female ; Femur/anatomy & histology/*surgery ; Humans ; Imaging, Three-Dimensional ; Knee Joint/radiography/*surgery ; Male ; Middle Aged ; Osteotomy/*methods ; Outcome and Process Assessment (Health Care) ; Patient Positioning ; Surgical Instruments ; Tomography, X-Ray Computed

It is very important for the anesthesiologists to manage this kind of patient during anesthesia because of severe hemodynamic change that is induced by aortic clamping and declamping, and its secondary effect on visce, heart and spinal cord, etc. To minimize the sudden severe hemodynamic change, we used the following agents and techniques in this clinical report. 1) Ethrane anesthesia with intermittent Innovar administration to minimize cardiac irritability. 2) To prevent secondary damage by distal hypotension during aortic clamping and declamping. 1. slight overhydration. 2. mannitol. 3. diuretics. 3) To prevent secondary damage by proximal hypertension during aortic clamping. 1. d-tubocurarine for muscle relaxation. 2. Morphine. 3. Chlorpromazine. 4. phentolamine. More over, we recommend this kind of anesthetic method in some other surgeries such as coarctation of aorta, aortic aneuryam and pheochromocytoma, etc. which may exhibit severe hemodynamic change during anesthesia.
Anesthesia ; Aortic Coarctation ; Chlorpromazine ; Constriction ; Diuretics ; Enflurane ; Heart ; Hemodynamics ; Humans ; Hypertension ; Hypertension, Renovascular* ; Hypotension ; Mannitol ; Morphine ; Muscle Relaxation ; Phentolamine ; Pheochromocytoma ; Spinal Cord ; Tubocurarine

BACKGROUND: Activated coagulation time (ACT) is commonly used to guide heparin and protamine dosing during cardiovascular surgery. There are many factors that influence the ACT such as time of test, hemodilution, temperature, aprotinin and etc. We considered the other factor that influence the ACT, the route of blood sample. METHODS: This study included 40 patients who were scheduled for cardiac surgery. Whole blood was sampled through arterial and central venous line at 10 minutes after surgical incision and heparin administration. The ACT was measured with Hemochron 801 blood coagulation timer with 12 mg of celite surface activator. RESULTS: At 10 minutes after surgical incision and heparin administration, arterial blood and venous blood ACTs were 127 20, 537 214 seconds and 118 18, 496 145 seconds respectively (p<0.05). CONCLUSIONS: We conclude that the venous blood ACT is more less than arterial blood ACT during cardiovascular surgery.
Aprotinin ; Blood Coagulation ; Diatomaceous Earth ; Heart* ; Hemodilution ; Heparin ; Humans ; Thoracic Surgery*

No abstract available.
Membranes* ; Pregnancy* ; Rupture*